尿N-乙酰-β-D-氨基葡萄糖苷酶对监测早期肾功能损害的价值

目的探讨尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）监测早期肾功能损坏的价值。方法根据内生肌酐清除率（Ccr）将120例肾病患者分为A、B两组,A组58例,其Ccr≥80mL／min。B组62例,其Ccr〈80mL／min。分别检查A、B．两组和50例健康人的尿NAG（U／mmol Cr）,并与其尿微量清蛋白[mAlb（mg／mmol Cr）]和血肌酐（Cr）含量进行比较。结果A、B两组肾病患者尿NAG、rnAlb检测结果显著高于健康对照组,差异有统计学意义（P〈0．05）,B组患者尿NAG、mAlb检测结果显著高于A组,差异有统计学意义（P〈0．05）;在A、B两组中,尿NAG的阳性率显著高于尿mAlb和血Cr,差异也有统计学意义（P〈0．05）;肾病患者尿NAG活性与Ccr具有良好的相关性,差异有统计学意义（r=0．876,P〈0．05）。结论尿NAG在肾病早期有较高的检出率,可作为监测早期肾功能损害的敏感指标。     

Effect of imidapril versus ramipril on urinary albumin excretion in hypertensive patients with type 2 diabetes and microalbuminuria

Objective: Aim of this study was to compare the antiproteinuric effect of imidapril (I) and ramipril (R) in diabetic hypertensive patients with microalbuminuria.

Research design and methods: One hundred and seventy-six patients were randomised to I 10 – 20 mg once daily (od) (n = 88) or R 5 – 10 mg od (n = 88) for 24 weeks. Clinic, ambulatory, central blood pressure (BP), urinary albumin excretion (UAE), plasma Angiotensin II (Ang II), bradykinin and brain natriuretic peptide (BNP) were assessed at baseline and after 6, 12 and 24 weeks.

Results: Both I and R produced a similar decrease in clinic, ambulatory and central BP (p < 0.001 vs baseline). Both treatments significantly reduced UAE throughout the study, but the decrease in UAE associated with I was more pronounced, being evident at week 6 (p = 0.05) and maximal at week 24 end-point (?42 vs –29%, p < 0.01). BNP and Ang II levels were similarly reduced by I and R, while bradykinin increased more with R (+132 vs +86%, p < 0.05).

Conclusions: These findings showed that in diabetic hypertensive patients with microalbuminuria, despite equivalent BP-lowering effect, I produced a greater antiproteinuric effect than R, which might be due to different intrinsic molecular properties of the two drugs.     

Drug Treatment for Hypertensive Patients in Special Situations: Diabetes and Hypertension

Diabetes mellitus and hypertension is often associated, but with a different type of development in type 1 and type 2 diabetes. Type 1 diabetes, renal disease, starting with microalbuminuria, is associated with increasing blood pressure or hypertension, whereas the patient without renal disease is most often normotensive. Poor metabolic control is a predictor of microalbuminuria or incipient nephropathy, but with microalbuminuria hypertension is an important risk factor for progression along with poor glycemic control. The same is the case for overt renal disease, and metabolic control is important in all stages of renal disease in type 1 diabetes. It has also been shown that good metabolic control as well as antihypertensive treatment, especially with ACE-inhibitors, often combined with other agents is quite effective in preventing progression in renal disease in all its stages.

In type 2 diabetes, blood pressure elevation is often found as early as at the actual diagnosis, and blood pressure significantly increases according to the degree of albuminuria, normo-microalbuminuria and clinical proteinuria (macroalbuminuria). Elevated blood pressure is an important risk for renal disease but more importantly so also for cardiovascular disease. Several studies document that antihypertensive treatment in particular with ACE-inhibitors is important in preventing microalbuminuria, in treating microalbuminuria and thus preventing progression, also in overt renal disease. Near-normalization of blood pressure is vital. Regarding cardiovascular disease, a series of studies now document that antihypertensive treatment with various antihypertensive agents is able to significantly reduce a number of major cardiovascular complications in diabetes, such as cardiac disease, stroke, and also microvacular disease, including retinopathy. Several studies show that antihypertensive treatment should be started at a level higher than 140–150/90. The blood pressure to be achieved during treatment is probably around 140/85 mmHg or even 130180 mmHg as a pragmatic goal. However, there is no sign of a J-shaped curve in any of the studies, and therefore even lower blood pressure could be advantageous. Even mortality, at least fiom diabetes-related causes can be effected by antihypertensive treatment. With more advanced renal disease, normalization of blood pressure is increasingly difficult, especially systolic blood pressure, and therefore it is recommendable to screen patients much earlier on with focus on blood pressure recordings and measurements of albuminuria, including microalbuminuria, and to treat early.     

Association between triglyceride-glucose index and chronic kidney disease: A cohort study and meta-analysis

Background and aimsNowadays, the relationship between triglyceride-glucose (TyG) index and chronic kidney disease (CKD) is still controversial. We aimed to prospectively investigate the relationship between TyG index and CKD in a cohort and meta-analysis.Methods and resultsA total of 10498 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. Participants were divided into four groups based on the quartiles of the TyG index. CKD was based on self-reported physicians’ diagnosis or personal eGFR level. A cox regression model was established to analyze the correlation between TyG index and CKD. A meta-analysis was conducted to incorporate the results of the current study and previous studies on the association of TyG index with CKD. In multivariable-adjusted analyses, the adjusted hazard ratio (95% confidence interval) for the highest versus lowest quartile of TyG index was 1.30 (1.08–1.57). Each 1-SD higher TyG index was associated with an increased risk of 11% (HR 1.11, 95% CI 1.03–1.19). The meta-analysis further confirmed the significant associations between TyG and CKD and pooled relative risk for highest vs lowest TyG index quartile was 1.47 (1.32–1.63).ConclusionsHigher TyG index was associated with increased risk of CKD, independently of established risk factors. The TyG index may be a predictor of incident CKD.     

炎症相关生物标志物对糖尿病肾病的诊断价值

糖尿病的主要微血管并发症之一是糖尿病肾脏疾病(diabetic kidney disease,DKD),据估计,10％～40％的糖尿病患者中约有10％～40％会发展为DKD[1].发达国家DKD是导致终末期肾脏疾病(end-stage kidney disease,ESKD)的主要原因,约占所有ESKD病例的50％[2...