蹲踞试验对糖尿病心血管自主神经病变的诊断价值——附66例分析

目的：评价蹲踞试验对糖尿病心血管自主神经病变的诊断价值。方法：对６６例２型糖尿病患者和４４名正常对照组同期进行蹲踞经典心电图心血管自主神经功能测定。结果 与对照组同年龄比较，糖尿病踞副交感神经功能比值（ＳｑＴｖ）明显升高，蹲踞交感神经功能比值（ＳｑＴａ）显著降低；与对照组和正常清蛋白尿患者比较，伴清蛋水者，尤其是大量清蛋白尿者。ＳｑＴｖ明显升高，ＳｑＴｓ明显降ｑＴｖ和ＳｑＴｓ和经典心血管自主神经功     

苯那普利对糖尿病肾病的预防作用

目的验证苯那普利(洛丁新)预防2型糖尿病患者肾脏并发症的作用。方法159例2型糖尿病患者,无糖尿病肾病,无高血压,随机分为苯那普利治疗组82例,对照组77例,治疗组在常规治疗的基础上加苯那普利10mg/d,观察19个月。结果治疗组患者尿白蛋白治疗前后无明显变化,而对照组患者试验结束时尿白蛋白明显升高,与治疗前相比,P<0.01。结论早期应用苯那普利对2型糖尿病患者肾脏有保护作用。     

Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo-Asian population.

BACKGROUND: Albuminuria (>30 mg/day) based on 24 h urine albumin excretion is one of the criteria for chronic kidney disease (CKD) and a predictor of cardiovascular disease (CVD). Differences in urine albumin concentration and creatinine excretion rates between Indo-Asians and other populations may require different threshold values for detection of albuminuria. We compared the use of spot urine albumin concentration and urine albumin to creatinine excretion ratio for detection of albuminuria in this population. METHODS: A total of 577 subjects aged >or=40 years, 54% of whom were women, were recruited from the general population in Karachi, Pakistan. Albumin concentration (mg/l) and albumin to creatinine ratio (mg/g of creatinine) were determined in a spot morning urine sample, and albuminuria (30 mg/day or greater) measured in a 24 h urine collected on the subsequent day. RESULTS: The median (25-75 percentile) of urine albumin excretion was 4.8 (3.6-10.3) mg/day: 5.4 (3.7-12.5) mg/day in men and 4.5 (3.8-8.9) mg/day in women. The overall prevalence (95% CI) of albuminuria was 11.8% (7.2-12.0%): 14.8% in men and 9.2% in women (P = 0.04). The areas under the receiver operator characteristic (ROC) curves for urine albumin concentration were 0.86 (0.82-0.90) and 0.88 (0.84-0.92), respectively, in women and men. The areas under the ROC curves for albumin to creatinine ratio were 0.86 (0.82-0.89) and 0.90 (0.86-0.93), respectively, in women and men. For urine albumin concentration, the sensitivity and specificity were 37 and 97%, respectively, in women and 69 and 94%, respectively, in men at the conventionally recommended value of 2 mg/dl. The discriminator value of urine albumin concentration identified in the analysis was 0.5 mg/dl in women (sensitivity of 87% and specificity of 75%) and 1.7 mg/dl in men (sensitivity of 74% and specificity of 93%). For the albumin to creatinine ratio, the sensitivity and specificity were 46 and 95%, respectively, in women and 60 and 97%, respectively, in men at cut-off value of 30 mg/g. CONCLUSION: Both urine albumin concentration and albumin to creatinine ratio are acceptable tests for population screening for albuminuria in Indo-Asians. While sensitivities may be suboptimal, particularly in women, lowering the existing thresholds would compromise specificity. Those who screen positive need evaluation and management of CKD and prevention of CVD.     

Ⅱ型糖尿病患者糖尿病肾病危险因素的多元逐步回归分析

目的为筛选与糖尿病肾病（ＤＮ）有关的危险因素，并了解各因素在ＤＮ发病中各自独立的作用及相对影响大小。方法采用多元逐步回归的统计方法对１０６例Ⅱ型糖尿病（ＤＭ）患者的临床及生化指标进行分析。结果①存在微量白蛋白尿的患者占总病例数的３０．１％；②Ⅱ型ＤＭ合并异常白蛋白尿组和正常白蛋白尿组相比，前组年龄、病程、体重指数、空腹Ｃ－肽、ａｐｏＢ１００和Ｌｐ（ａ）均高于后组；③与ＤＮ相关的危险因素依次为ａｐｏＢ１００、舒张压、空腹血糖、餐后２ｈＣ－肽、病程、年龄、Ｌｐ（ａ）和餐后２ｈ胰岛素。结论血脂异常、高血压、高血糖及高胰岛素血症是ＤＮ发病的主要危险因素。积极纠正血脂异常，控制血压、血糖以及改善胰岛素抵抗状态是预防和延缓ＤＮ发生发展的有效手段。     

Lipoprotein(a) in Type 1 Diabetic Patients with Renal Disease

Lp(a) was measured in 64 normoalbuminuric, 52 microalbuminuric, and 37 proteinuric Type 1 diabetic patients and 54 healthy subjects. Microalbuminuric and proteinuric Type 1 diabetic patients had higher median Lp(a) values (133 (16–1932) and 169 (17–1149) mg I^?1) than patients with normal AER (73 (15–1078) mg I^?1; p=0.048 and p=0.027). Lp(a) in healthy subjects (110 (15–1630)mg I^?1) did not differ from the diabetic subgroups. The frequency of Lp(a) values in the upper quarter of the normal distribution was similar in the diabetic groups and did not differ between diabetic and control subjects. The cumulative distribution of Lp(a) was similar in all groups. Lp(a) concentrations were not related to AER, age, gender, duration of diabetes, body mass index, glycaemic control, serum creatinine, free insulin or systolic blood pressure. Cholesterol, LDL-cholesterol, triglycerides, and apo B were higher in microalbuminuric and proteinuric than in normoalbuminuric Type 1 diabetic patients. Lp(a) was independently related to diastolic blood pressure, fibrinogen, and macroangiopathy. In conclusion, median Lp(a) concentrations tend to be higher in Type 1 diabetic patients with early and established renal disease, although the differences are small and the overlap between groups large. Lp(a) is related to diastolic blood pressure and fibrinogen, and this association of powerful risk factors suggests that Lp(a) may play a role in the pathogenesis of cardiovascular disease in Type 1 diabetic patients with proteinuria. Whether Lp(a) is an independent determinant of increased cardiovascular risk in these patients needs to be elucidated by prospective studies.     

2型糖尿病肾病患者血清色素上皮源因子水平的变化及意义

目的探讨2型糖尿病（T2DM）肾病患者血清色素上皮源因子（PEDF）水平变化及其在糖尿病肾病发生发展中的意义。方法选取49例健康对照,132例T2DM患者,并根据24h尿微量白蛋白排泄率（UAER）将患者分为正常白蛋白尿组（NA）48例、微量白蛋白尿组（MA）50例、临床蛋白尿组（PR）34例。采用酶联免疫（ELISA）法检测血清PEDF水平,免疫比浊法检测尿微量白蛋白,同时检测糖化血红蛋白（HbAllc）、空腹血糖（FPG）、血脂和高敏C反应蛋白（hs-CRP）。结果T2DM患者血清PEDF水平显著高于健康对照组（2．7±1．3）mg／L,MA组患者血清PEDF（4．7±2．9）mg／L显著高于NA组（3．7±2．2）mg／L,（P〈0．01）;PR组（5．7±2．8）mg／L显著高于MA组（P〈0．05）。血清PEDF水平与HbAlc（r=0．198,P〈0．01）、FPG（r=0．231,P〈0．01）、甘油三酯（TG）（r=0．302,P〈0．01）、hs．CRP（r=0．214,P〈0．01）和UAER（r=0．169,P〈0．05）呈显著正相关,而与高密度脂蛋白胆固醇（r=-0．237,P〈0．01）呈显著负相关。多元回归分析发现TG（B=0．314,P〈0．01）、hs．CRP（B=0．260,P〈0．01）、UAER（B=0．148,P〈0．05）是血清PEDF的独立决定因子。结论PEDF在T2DM患者中显著升高,并随白蛋白尿严重程度而逐渐升高;TG、hs-CRP和UAER是血清PEDF的独立影响因子。血清PEDF水平的升高可能参于了糖尿病肾病的发生和发展。     

The inter-relationships between albuminuria, plasma albumin concentration and indices of glycaemic control in non-insulin-dependent diabetes mellitus

We studied the relationship between albuminuria (measured as albumin/creatinine ratio (alb/Cr) in a random urine sample) and measures of glycaemic control (fructosamine, HbA₁ and glucose) in 470 patients with non-insulin-dependent diabetes mellitus (NIDDM). Albumin excretion was in the microalbuminuric range (alb/Cr ratio > 5.4–40.3) in 112 (23.8%) and in the macroalbuminuric range (alb/Cr ratio > 40.3 mg/mmol) in 89 patients (18.9%). Fourteen percent (n = 67) of patients had a normal plasma HbA₁ (≤8.5%) while 27% (n = 127) had a normal plasma fructosamine concentration (≤ 2.2 mmol/l). Using stepwise multiple regression analysis, plasma fructosamine concentration was found to be independently and negatively associated with urine albumin/creatinine ratio (B = 0.24, P < 0.006) in the macroalbuminuric group. Further analysis of the relationship between plasma albumin concentration and indices of glycaemic control showed that plasma albumin concentration correlated negatively with random plasma glucose concentration in the normoalbuminuric patients (r = −0.16, P = 0.008) but not in microalbuminuric or macroalbuminuric groups. HbA₁ was not correlated with plasma albumin concentration. Our results indicate that albuminuria has an effect on the plasma fructosamine concentration which is independent of plasma albumin concentration.     

溃疡性结肠炎患者血C反应蛋白活性与尿白蛋白含量的变化及其临床意义

目的　探讨血C反应蛋白 (CRP)活性与尿白蛋白 (AU )含量在溃疡性结肠炎 (UC)患者病情活动性与严重性评价中的意义。方法　采用试剂盒与免疫散射比浊法检测 2 5例缓解期UC患者、3 2例活动期UC患者及 3 0例对照组的血浆CRP活性及AU含量 ,并对活动期患者行肠镜及病理组织学检查 ,评价病情轻重程度。结果　活动期患者组血CRP活性和AU含量显著高于缓解期组和对照组 (P <0 .0 1) ,且二者与UC病情活动性、病情分型均呈显著正相关 ,与内镜表现分级呈中度正相关 ,与病理组织学分级无相关性。结论　血CRP活性和AU含量可作为评价UC患者病情活动性及严重程度的良好指标     

子痫前期患者脉压与蛋白尿相关性分析

目的：探讨子痫前期患者脉压与蛋白尿的相关性。方法：按脉压高低将子痫前期患者分为脉压≤40mmHg、41～80mmHg、〉80mmHg三组,比较各组蛋白尿的发生率。结果：三组间的收缩压、舒张压、蛋白尿发生率,24h尿蛋白浓度差异有统计学意义（P〈0.05）;SBP、DBP、平均动脉压和脉压与24h尿蛋白量的β值分别为0.425、0.331、0.357和0.486（P〈0.05）。结论：脉压对尿蛋白的发生率有明显影响,临床上在治疗子痫前期患者时,不但要降低收缩压和舒张压,还要降低脉压,只有这样才能使肾脏的损伤程度减轻。     

2型糖尿病尿白蛋白排泄率与心脏结构和功能的相关性

目的 探讨2型糖尿病患者合并白蛋白尿时对心脏结构和功能的影响.方法 选取2型糖尿病患者520例,依据8h尿白蛋白排泄率水平分为三组,正常白蛋白尿组424例,微量白蛋白尿组75例,大量白蛋白尿组21例,同时选取健康体检者50例作为健康对照组.根据超声心动图结果评价各组心脏结构和功能.结果 2型糖尿病患者出现白蛋白尿后,特别是大量白蛋白尿组,收缩末期左心房前后径[(34.39±3.46)mm]、舒张末期左心室后壁厚度[(10.34±1.05)mm]、相对室壁厚度(0.46±0.05)、室间隔厚度[(10.49±1.07)mm]、左心室质量[(167.37±32.12)g]、左心室质量指数[(87.62±12.16)g/m2]明显升高,左心室舒张早期及舒张晚期二尖瓣最大血流速度比值(0.82±0.19)明显降低,与健康对照组的(32.59±2.71)mm、(9.30±0.77)mm、0.42±0.04、(9.75±0.81)mm、(147.33±27.23)g、(80.14±13.81)g/m2、1.21±0.16比较差异有统计学意义(P＜0.05).结论 2型糖尿病患者合并白蛋白尿时,其心脏结构和功能会出现不同程度的异常,其异常程度随着尿白蛋白排泄率的增加而加重,提示发生糖尿病心肌病的可能性增加.