不同方法留取系统性红斑狼疮病人 尿标本中微量蛋白含量观察

为了正确选择系统性红斑狼疮（ＳＬＥ）病人尿微量转铁蛋白（Ｔｆ）、白蛋白（ＵＭＡ０和免疫球蛋白Ｇ标本留取方法,收集２２例尿常规检查尿蛋白阴性的ＳＬＥ病人晨尿、随机尿和２４ｈ尿标本,采用速率散射比浊法测定Ｔｆ、ＵＭＡ和ＩｇＧ。结果：晨尿与２４ｈ尿标本中Ｔｆ、ＵＭＡ和ＩｇＧ检出率无显著性差异（Ｐ〉０．０５）,随机尿与２４ｈ尿标本中Ｔｆ、ＵＭＡ和ＩｇＧ检出率有统计学差异（Ｐ〈０．０５）。提示：晨尿与２４ｈ     

骨化三醇治疗维生素D不足高血压伴肾损害患者的临床观察

目的探讨骨化三醇对维生素D不足的高血压伴肾损害患者的临床疗效。方法.将25-羟维生素D_3[25-hydroxyvitamin D_3,25(OH)D_3]不足的高血压伴肾损害患者65例,采用随机数字表法分为2组,对照组32例,给予常规规范化治疗控制血压;观察组33例,在对照组控制血压治疗基础上给予骨化三醇胶囊0.25μg/次,每晚口服1次,连续应用12周。观察2组患者治疗前后血压、血25(OH)D_3、血钙、血磷、血全段甲状旁腺素(intact parathyroid hormone,iPTH)、血清胱抑素C(cystatin C,Cys C)、晨尿微量白蛋白(urine microalbumin,mAlb)及尿β2微球蛋白(urine beta 2 microdobulin,β2-MG)水平。结果对照组治疗前后,其收缩压、舒张压、血钙、血磷、25(OH)D_3及血iPTH均无明显改变(P0.05)。观察组治疗前与对照组治疗前相比,2组相关指标均无统计学差异(P0.05);观察组给予骨化三醇治疗后第12周,血25(OH)D_3水平较治疗前明显升高(P0.05),血钙水平升高(P0.05),血iPTH水平下降(P0.05),但均在正常范围内;2组治疗前后收缩压、舒张压及血磷水平无明显变化(.P0.05)。对照组治疗前后,血清CysC、尿mAlb及β2-MG均呈下降趋势,但差异无统计学意义(P0.05)。观察组治疗前与对照组治疗前相比,2组相关指标均无统计学差异(P0.05),但观察组给予骨化三醇治疗后第12周时,血清CysC、尿mAlb及β2-MG明显下降,差异有统计学意义(P0.01),其下降水平分别为9.4%、18.8%、38.0%。结论骨化三醇能减轻维生素D不足的高血压伴肾损害患者的尿mAlb、β2-MG及血清Cys C水平。     

临床实践中慢性肾功能损伤早期的实验室预警指标分析

目的应用简化肾脏病膳食改善(MDRD)方程[即四变量公式(改良4v-MDRD公式)]估算肾小球滤过率(eGFR),以eGFR<60 mL/(min.1.73 m2)或出现微量白蛋白(mAlb)尿为肾功能损伤的判断界限,观察相关实验室指标的异常表现。方法选择内科正常饮食的住院非移植患者425例。酶法测定血清肌酐(SCr),先溯源至罗氏苦味酸法得到校正后的肌酐(Cr)浓度,用改良4v-MDRD公式计算eGFR。将425例患者按eGFR结果分为正常对照组及肾功能轻度、中度、重度损伤组。同时测定高敏C反应蛋白(hs-CRP)、半胱氨酸蛋白酶抑制剂C(Cys C)及尿mAlb、尿常规。以受试者工作特征(ROC)曲线确定Cys C的临床Cut-off值。根据尿mAlb/尿Cr(UCr)比值,比较正常尿液组、mAlb尿组和显性白蛋白(Alb)尿组实验室各指标的检测差异。结果现用的酶法检测SCr与罗氏苦味酸法测定相关性良好(r=0.999 8)。正常对照组及肾功能轻度、中度、重度损伤组的Cys C浓度分别为(0.82±0.28)、(1.00±0.38)、(1.17±0.31)、(2.94±1.24)mg/L;SCr浓度分别为...     

高血压病患者微量蛋白尿的临床研究

目的探讨高血压病患者肾脏早期损害指标。方法选择高血压病患者138例为观察组,健康体检者92例为正常对照组,采用散射比浊法检测2组的微量白蛋白(ALB)、转铁蛋白(TRF)、α-微球蛋白(α1-MG),并进行分析比较,同时从观察组中抽取56例依从性较好的患者,观察药物治疗前后各项指标的变化。结果正常对照组ALB为(4.04±2.02)mg/L,TRF为(1.07±0.20)mg/L,α1-MG为(5.64±2.06)mg/L,观察组分别为(10.85±5.15)mg/L、(1.72±0.81)mg/L和(13.58±6.07)mg/L,与正常对照组比较,观察组患者ALB显著增高(P<0.05),α1-MG为非常显著增高(P<0.01);观察组中高血压病2~3级与高血压病1级比较,ALB、α1-MG均有非常显著增高(P<0.01);观察组56例患者治疗3~6个月后ALB(9.08mg/L±5.15mg/L)、α1-MG(8.56mg/L±4.87mg/L)与治疗前ALB(12.48mg/L±5.25mg/L)、α1-MG(13.74mg/L±6.38mg/L)比较均有显著降低(P<0.05或P<0.01)。结论α-MG及ALB为高血压病早期肾损害的敏感指标,与高血压分级呈正相关,且能反映高血压的控制状况。     

滋肾固精凉血法对早期糖尿病肾病尿微量白蛋白的影响

目的 观察滋肾固精凉血法对早期精尿病肾病尿微量白蛋白漏出的影响.方法 110例早期糖尿病肾病患者按随机数字表分为两组,对照组采用基础治疗加洛丁新口服治疗,治疗组在对照组基础上,加用滋肾因精胶囊(自拟方)口服.所有患者治疗前、后检测24 h尿微量白蛋白.结果 治疗后24 h尿微量白蛋白均有不同程度下降,对照组总有效率为86.8%,治疗组总有效率为94.7%(t=9.31,P<0.01).结论 滋肾固精凉血法可显著改善早期糖尿病肾病尿微量白蛋白的漏出.     

PCX、mALB、NAG联合检测对糖尿病肾病早期诊断的临床意义

目的探讨尿足细胞标志蛋白（Podocalyxin,PCX）、微量白蛋白（Microalbumin,mALB）和N一乙酰一B—D氨基葡萄糖苷酶（N—acetyl—B．D—glucosaminidase,NAG）联合检测对糖尿病肾病早期诊断的意义。方法检测85例糖尿病肾病早期患者及50例健康者尿液中足细胞标志蛋白、微量白蛋白与肌酐的测值。结果糖尿病组PCX、mALB、NAG测值明显低于对照组,差异有统计学意义（P〈0．01）;糖尿病患者尿液PCX、mALB、NAG阳性率分别为31．8％、24．7％、22．4％,三者联合检测阳性率45．9％,与各单项检测阳性率比较差异有统计学意义（P〈0．05）。结论尿PCX、mALB、NAG联合检测对糖尿病肾病早期诊断有重要价值。     

血清β2微球蛋白和尿微量白蛋白在糖尿病肾病早期诊断中的价值

目的探讨血清β2微球蛋白(β2MG)和尿微量白蛋白(MAlb)在糖尿病肾病(DN)早期诊断中的意义。方法采用免疫比浊法检测85例糖尿病(DM)患者血清β2MG和尿MAlb,并与35例健康体检人员作对照。结果DM患者血清β2MG和尿MAlb明显高于对照组,相比较差异有显著性(P<0.01)。结论检测血清β2MG和尿MAlb与DM有着密切的关系,二者联检有助于全面评估DM患者的肾脏损害,对早期发现、诊断和治疗DM具有重要意义。     

MicroRNAs from urinary extracellular vesicles are non-invasive early biomarkers of diabetic nephropathy in type 2 diabetes patients with the ‘Asian Indian phenotype’

AimsMicroRNAs (miRNAs) from extracellular vesicles (EVs) have been proposed as promising biomarkers for a number of diseases. In this study, their potential as urine-based biomarkers of diabetic nephropathy (DN) was assessed.MethodsMiRNAs were profiled in urinary EVs from 160 fasting subjects with normal glucose tolerance (NGT) and in T2DM patients with either microalbumininuria (MIC) or macroalbuminuria (MAC).ResultsA total of 73 miRNAs detected in urinary EVs (NGT) were predicted to target important functions for kidney homoeostasis, thereby validating their use as indicators of kidney dysfunction. Indeed, a urinary EV miRNA signature was found to comprise increased levels of let-7i-3p, miR-24-3p and miR-27b-3p, and decreased levels of miR-15b-5p, to identify patients with MIC. ROC curve analysis confirmed this ability to identify MIC in normo-albuminuria T2DM (T2DM-NA) patients and to differentiate between MAC and T2DM patients. These miRNAs were also predicted to target protein networks involved in the Wnt/β-catenin signalling cascade, activin receptor signalling and cell differentiation/proliferation, and correlated with eGRF, HbA_1c, serum creatinine, urea, albumin and blood pressure. Concentrations of miR-30a-5p were specifically modified in urinary EVs from patients with MAC, but not MIC, suggesting that miR-30a-5p could be related to severe kidney damage.ConclusionUrinary EV miRNAs correlate with the degree of MIC. As they are also thought to regulate pathways that are targets of pharmacological agents to prevent DN (reticulum stress, activin receptors), they may also serve as non-invasive ‘liquid biopsies’ to stratify patients at risk of developing MAC and to monitor treatment efficacy.     

支原体肺炎患儿血、尿胱抑素C检测的临床研究

目的探讨支原体肺炎患儿急性期、恢复期血、尿胱抑素c（CysC）水平及其临床价值。方法支原体肺炎患儿36例,正常对照组120例,分别检测支原体肺炎患儿急性期、恢复期的血、尿胱抑素c、α1-微球蛋白、微量白蛋白、肌酐等指标,并对结果进行统计分析。结果与对照组相比,支原体肺炎患儿急性期血、尿Cysc含量差异均有统计学意义（P〈0．01）,而恢复期差异无统计学意义（P〉0．05）;支原体肺炎患儿急性期与恢复期比较,差异有统计学意义（P〈0．05）。结论支原体肺炎患儿急性期肾功能有程度不等的损害,但肾功能损伤是可恢复的;血、尿CysC测定对支原体肺炎患儿早期肾功能损害的诊断具有重要的临床价值。     

Evaluation of the Bayer microalbumin/creatinine urinalysis dipstick

BACKGROUND: The objective of this study was to evaluate the utility of the Bayer(R) microalbumin/creatinine urine reagent strip compared to established laboratory methods. METHODS: Random urine specimens from low and high risk pregnancy clinics as well as a random cohort from the community were analyzed for microalbumin and creatinine using both the reagent strip and the Roche Integra(R) 700, according to manufacturers' specifications. Sensitivity and specificity were then calculated. RESULTS: For the pregnant cohorts the sensitivities ranged from 19% to 59%, and the range of specificities was 45.4% to 84.2%. Using the microalbumin/creatinine data from the community, the sensitivity and specificity of the strip were 52.4% and 97.6%, respectively. CONCLUSION: The poor sensitivity of the microalbumin/creatinine urine reagent strip to detect significant microalbuminuria will likely limit its usefulness as a screening tool.