胃旁路术对糖尿病肾病蛋白尿影响的随访研究

目的 :探讨胃旁路术对糖尿病肾病(diabetic nephropathy,DN)的疗效。方法 :回顾性分析58例接受胃旁路术的肥胖合并DNⅢ/Ⅳ期病人,随访1年分析手术对2型糖尿病、血压、肾功能以及蛋白尿的影响。结果:术后1年降糖及降压药物用量显著减少,体重、血糖、糖化血红蛋白以及胰岛素抵抗指标均显著下降,DNⅢ期和Ⅳ期糖尿病缓解率分别为83.9%和77.8%。手术前、后肾功能无显著变化,24 h尿蛋白(正常值为0.05]。结论:胃旁路术对2型糖尿病合并肥胖有显著减重、降糖的疗效,且有缓解DN进展的可能。     

尿微量清蛋白干化学法测定的可靠性探讨

目的用微量清蛋白尿的定量检验方法验证干化学法测试尿液中微量清蛋白以及微量清蛋白／肌酐比值（M／C）的可靠性。方法80例临床确诊的糖尿病患者尿液分别用生化定量和干化学定性作双份平行微量清蛋白测定。干化学法定性采用桂林华通公司所生产的HT2000尿液分析仪及其配套测试带。尿微量清蛋白定量测定方法为免疫透射比浊法。肌酐定量测定使用肌氨酸氧化酶法。去除10例离群检测样本后,以定量测定M／C的结果为参考标准,与微量清蛋白定量法和干化学法以及干化学法M／C检测微量清蛋白尿的结果进行比较分析。结果以定量测定M／C为参考标准,微量清蛋白定量法、微量清蛋白干化学法、干化学法M／C的灵敏度、准确度、约登指数依次降低。干化学法M／C与定量测定M／C的结果之间差异具有统计学意义（P〈0．01）。干化学法M／C的误诊率、漏诊率显著高于定量测定M／C的结果。结论干化学法微量清蛋白半定量测定的灵敏度较高,建议作为微量清蛋白的筛查方法。干化学法M／C不宜作为即刻尿中微量清蛋白的过筛指标。     

微量白蛋白尿及假性血友病因子与高血压代谢综合征的关系

目的:比较伴代谢综合征的高血压患者与单纯高血压患者的微量白蛋白尿(microalbuminuria, MAU)及假性血友病因子(von Willebrand factor, vWF)水平的差异,探讨二者与代谢综合征的关系.方法:连续收治的133例患者,根据2005年国际糖尿病联盟(International Diabetes Federation, IDF)代谢综合征全球定义分为伴代谢综合征(metabolic syndrome, MS)的高血压组(97例)与单纯高血压组(36例).测定血生化、血浆vWF、24 h尿白蛋白排泄率(urine albumin excretion, UAE)及晨尿白蛋白/肌苷比(albumin/creatinine ratio, ACR).应用统计学方法分析MAU、vWF与代谢综合征的关系.结果:同单纯的高血压患者相比,伴MS的高血压患者腰围、体重指数、甘油三酯(triglyceride,TG)及低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C) 升高(P<0.05或<0.01),而高密度脂蛋白胆固醇(high density lipoprotein cholesterol, HDL-C) 降低(P<0.01);血浆vWF含量及UAE增加[ (P均<0.05).]高血压患者UAE与ACR之间存在显著相关性(r=0.707, P<0.01).而vWF与UAE及ACR则未见显著的相关性(r分别为0.079及0.052,P均>0.05).Logistic回归分析显示HDL-C, TG, LDL-C, vWF及UAE与高血压患者MS的发生具有关联性 (相应的标准化回归系数分别为-0.825, 0.63, 0.339, 0.331, 0.371,[P<0.05] 或<0.01).结论:相比单纯高血压,伴MS的高血压患者MAU增加,内皮损伤程度更重.UAE与ACR显著相关.vWF、UAE均与高血压患者MS的发生有关.     

替米沙坦与螺内酯配伍对早期糖尿病肾病76例微量白蛋白尿及脑钠肽的影响

目的:探讨替米沙坦与螺内酯配伍对早期糖尿病肾病患者微量白蛋白尿及脑钠肽的影响,以观察血管紧张素Ⅱ受体拮抗剂与醛固酮受体拮抗剂联用对早期糖尿病肾病的治疗作用。方法:将76例早期糖尿病肾病患者随机分为替米沙坦与螺内酯配伍治疗(治疗组)和单用替米沙坦治疗(对照组)两组,每组38例。治疗前及治疗3月后分别检测两组尿微量白蛋白排泄率(UAER)、脑钠肽(BNP)、血肌酐(Scr)、血糖、糖化血红蛋白(HbA1c)、血钾等的变化并进行分析。结果:治疗前后,两组患者血糖、糖化血红蛋白、血钾、肌酐等指标变化均无显著性差异(P>0.05),但治疗后两组UAER、BNP水平均较治疗前显著降低(P<0.05);而治疗组UAER、BNP水平下降较对照组更为明显(P<0.05)。结论:替米沙坦与螺内酯配伍治疗早期糖尿病肾病,尿微量白蛋白及脑钠肽水平下降更为明显,且无严重不良反应。     

人体测量学肥胖指标与微量白蛋白尿的相关性研究

目的 探讨人体测量学肥胖指标与微量白蛋白尿(microalbuminuria,MAU)的相关性.方法 在青岛市城阳区人民医院2012年流行病学调查数据库中收集调查人群1170例,留取清晨随机尿测定尿微量白蛋白(urinary albumin,UAlb)和尿肌酐(urinary creatine,UCr),计算比值(urinary albumin creatine rate,UACR)并根据UACR水平分为:正常白蛋白尿组(nornal albumin urine,NAU)(807例)和MAU组(363例),收集人体测量学指标和测定生化指标,作统计学处理.结果 ①与NAU组相比,MAU组年龄、空腹血糖(fasting blood glucose,FBG)、舒张压(diastolic blood pressure,DBP)、收缩压(systolic blood pressure,SBP)、血清尿酸(serun urinary acid,SUA)、腰围(waist circumference,WC)、腰身比(Waist to height ratio,WTHR)、腰臀比(Waist to hip ratio,WHR)均高于前者,差异有统计学意义(P＜0.05或P＜0.01);与NAU组相比,MAU 组高血糖(hyperglycemia,HG)、原发性高血压(primary hypertension,PHT)、血脂异常(dyslipidemia,DLP)及OB,尤其腹型肥胖(abdominal obesity,AOB)患病率升高,差异有统计学意义(P＜0.05或P＜0.01);②多元线性回归分析显示,对MAU贡献大小依次WTHR＞ WC＞ WHR;③采用受试者工作特征曲线(ROC)分析男性人群WTHR、WHR、WC等预测MAU的曲线下面积依次为0.68(95％CI:0.67 ～ 0.70)、0.64(95％ CI:0.62 ～0.65)、0.57 (95％ CI:0.55～0.59),预测切点0.52、0.90、91.8 cm.在女性人群中,WSR、WC、WHR等预测MAU的曲线下面积依次为0.71(95％CI:0.70～0.72)、0.69 (95％ CI:0.68～0.70)和0.64(95％ CI:O.62 ～0.65),预测切点0.52、0.84、82.5 cm.结论 ①AOB为MAU的高危人群;②WTHR为最佳预测指标,切点为0.52,其次为WC和WHR,男性切点分别为89.6 cm和0.88 cm,女性为84.5 cm和0.84 cm.     

Empagliflozin alleviates podocytopathy and enhances glomerular nephrin expression in db/db diabetic mice

BACKGROUNDModern guidelines recommend sodium-glucose cotransporter-2 (SGLT2) inhibitors as the preferred antihyperglycemic agents for patients with type 2 diabetes and chronic kidney disease. However, the mechanisms underlying the renal protective effect of SGLT2 inhibitors are not fully understood.AIMTo estimate the effect of the SGLT2 inhibitor, empagliflozin (EMPA), on the structure of podocytes and nephrin expression in glomeruli in db/db diabetic mice.METHODSWe treated 8-wk-old male db/db mice with EMPA (10 mg/kg/d) or vehicle for 8 wk. Age-matched male db/+ mice were included as non-diabetic controls. Parameters of body composition, glycemic and lipid control, and plasma concentrations of leptin, insulin and glucagon were assessed. We evaluated renal hypertrophy as kidney weight adjusted to lean mass, renal function as plasma levels of creatinine, and albuminuria as the urinary albumin-to-creatinine ratio (UACR). Renal structures were studied by light and transmission electron microscopy with a focus on mesangial volume and podocyte structure, respectively. Glomerular nephrin and transforming growth factor beta (TGF-β) were assessed by immunohistochemistry.RESULTSSevere obesity and hyperglycemia developed in db/db mice prior to the start of the experiment; increased plasma concentrations of fructosamine, glycated albumin, cholesterol, leptin, and insulin, and elevated UACR were detected. Mesangial expansion, glomerular basement membrane thickening, and increased area of TGF-β staining in glomeruli were revealed in vehicle-treated mice. Podocytopathy was manifested by effacement of foot processes; nephrin-positive areas in glomeruli were reduced. EMPA decreased the levels of glucose, fructosamine and glycated albumin, UACR, kidney hypertrophy, mesangial expansion, glomerular basement membrane thickening, and glomerular TGF-β staining, alleviated podocytopathy and restored glomerular staining of nephrin.CONCLUSIONThese data indicate that EMPA attenuates podocytopathy in experimental diabetic kidney disease. The anti-albuminuric effect of EMPA could be attributed to mitigation of podocyte injury and enhancement of nephrin expression.     

Profiling proteinuria in pediatric patients

This study was designed to characterize proteinuria in children with kidney disease. Random urine samples from 250 pediatric patients were examined by quantitative measures of total protein (pr), albumin (Alb), and creatinine (cr). Patient diagnoses were subjectively categorized as “Glomerular” (GD) or “Tubulo-interstitial” disease (TD) in origin. Proteinuria was quantitated by the random urine protein-to-creatinine (Upr/cr) ratio, and glomerular proteinuria was assessed as the albumin-to-creatinine ratio (Ualb/cr) and percentage albuminuria (%Alb=Alb/pr*100). The non-albumin fraction (1−Alb/pr) includes low-molecular-weight proteins and micro- and macroglobulins. Of the 250 patients, 112 (45%) had GD and 138 (55%) had TD. Both proteinuria and albuminuria correlated with a decline in glomerular filtration rate (GFR) (r=−0.4; p<0.0001). Those with GD averaged significantly greater %Alb than those with TD at all levels of proteinuria (p<0.0001). With loss in GFR, %Alb increased significantly in patients with TD (18±13 to 47±30%; p<0.001) and GD (56±26 to 74±15%; p<0.01), respectively. The %Alb at all levels of GFR averaged <50% in those with TD and >50% in those with GD. In conclusion, random Ualb/cr, Upr/cr, and %Alb provide a simple and inexpensive assessment of proteinuria and may profile renal disease activity and response to therapy in pediatric patients.     

Is glycogen storage disease 1a associated with atherosclerosis?

Deficiency of microsomal glucose-6-phosphatase in liver and kidney leads to glycogen storage disease type la (GSD 1a). Notwithstanding intensive dietary therapy, moderate to severe dyslipidaemia and microal-buminuria, both known atherosclerotic risk factors, remain present. Although more patients reach adult age, no information is still available about accelerated athero-sclerosis. the aim of our study was to investigate whether GSD 1a was associated with premature atherosclerosis. In nine adolescent patients (mean age 22.7±3.4 years) and nine matched healthy control subjects, lipid profile, blood pressure, ankle-brachial indices, aortic distensibility and intima-media thickness (IMT) of the carotid and femoral arteries were determined. As expected, lipid profiles were significantly unfavourable in the patient group compared with the control group. No differences were found in blood pressure, ankle-brachial indices and aortic distensibility between both groups. IMT segments were comparable in both groups, with even thinner segments in the patient group. In different multivariate models, GSD la remained an independent predictor for a thinner IMT (R²=0.90; \=−0.69;P=0.018).Conclusion: glycogen storage disease type 1a is not associated with premature atherosclerosis, despite the existence of longstanding dyslipidaemia and microalbuminuria. Published online: 2 July 2002     

老年2型糖尿病患者尿白蛋白与心脏结构和功能的关系

84例老年2型糖尿病患者资料显示，尿白蛋白排泄率与左心室内径和左心室厚度正相关，与左心室射血分数负相关。