活血化瘀方辅助血液透析治疗糖尿病肾病临床研究

目的:观察糖肾汤治疗Ⅲ、Ⅳ期糖尿病肾病(DN)的临床疗效。方法:将94例Ⅲ、Ⅳ期DN患者随机均分为对照组和联合组各47例。对照组给予常规治疗,联合组在对照组基础上给予糖肾汤治疗。比较2组患者临床疗效和治疗前、治疗后3个月血糖、血肌酐(SCr)、血尿素氮(BUN)、肾小球滤过率(GFR)等指标的差异。结果:联合组治疗总有效率为91.49%高于对照组的74.47%(P<0.05)。经治疗,2组的血糖水平均改善(P<0.05)。但2组治疗后血糖水平比较,差异无统计学意义(P>0.05)。经治疗,联合组SCr、BUN及GFR水平均较治疗前改善(P<0.05),且优于对照组治疗后(P<0.05)。结论:在常规治疗的基础上,采取糖肾汤治疗Ⅲ、Ⅳ期DN可有效改善患者肾功能,减缓病情进展,可取得理想的临床疗效。     

肾损伤分子-1、丛生蛋白和胱抑素C对庆大霉素诱导的大鼠肾损伤早期预测的研究

目的 应用庆大霉素（GM）诱导的大鼠亚急性肾损伤模型,研究一组新的生物标志物肾损伤分子-1（kidney injury molecule-1,Kim-1）、丛生蛋白（clusterin）和胱抑素C（cystatin C）在尿液中的变化,并与传统生物标志物血肌酐（SCr）和尿素氮（BUN）进行比较,评价其对肾损伤的早期预测性。方法 建立GM诱导的大鼠亚急性肾损伤动物模型,检测不同给药时间点模型组和对照组大鼠的SCr、BUN和尿Kim-1、clusterin与cystatin C水平,并进行肾组织病理学检查。结果 在SCr、BUN和肾组织病理学未出现异常变化时,大鼠尿Kim-1、clusterin、cystatin C就表现出明显的升高,并随给药时间延长呈线性升高。在SCr、BUN和尿Kim-1、clusterin和cystatin C测定结果的ROC曲线中,尿Kim-1、clusterin和cystatin C的曲线下面积均大于0.9。结论 尿Kim-1、clusterin和cystatin C在肾损伤中具有良好的敏感性和特异性,能够提高对药物诱导的肾损伤的早期预测能力。     

Elevated fasting serum insulin level predicts future development of hypertension

Background

Studies have investigated clinical association between fasting insulin level and hypertension. However, it is still debatable whether elevated fasting insulin actually increases the risk of hypertension with the passage of time. Thus, this study was aimed at investigating the association between baseline fasting insulin level and the development of hypertension.

Methods

25,062 normotensive, non-diabetic Korean men participating in a medical health check-up program were followed up from 2005 until 2010. They were divided into 4 groups according to baseline fasting insulin levels (first quartile–fourth quartile). The incidence of hypertension was compared among 4 groups, and Cox proportional hazards model was used to determine if hypertension was associated with higher baseline fasting insulin level.

Results

The incidence of hypertension increased according to the baseline fasting insulin level (first quartile: 13.3%, second quartile: 15.4%, third quartile: 17.5%, fourth quartile: 23.2%, P < 0.001). Even after adjusting for multiple covariates, the HRs (95% CI) for hypertension were higher for the second (1.12; 0.96–1.31), third (1.39; 1.20–1.62) and fourth quartile group (1.75; 1.51–2.03), compared to the first quartile group, respectively (P for trend < 0.001).

Conclusion

The risk of hypertension was in proportion to the baseline fasting insulin level. In addition, hyperinsulinemia was an independent risk factor for the future development of hypertension. These findings suggest the value of fasting insulin level as an early predictor of hypertension.     

Fc-gamma receptor 3A polymorphism predicts the incidence of urinary tract infection in kidney-transplant recipients

We investigated the impact of polymorphisms in host innate immunoregulatory genes on the development of infectious complications after kidney transplantation (KT). The single-nucleotide polymorphisms (SNPs) of C1QA [276 A/G], FCGR2A [131 H/R], and FCGR3A [158 F/V], genes encoding the Fc gamma receptor (FcγR), were analyzed in 81 KT recipients in relation to the occurrences of postoperative infectious complications within 30 days after KT. Consistent with a lower affinity of the isoform encoded by the FCGR3A [158 F] to both IgG1 and IgG3, a significantly higher incidence of urinary tract infections (UTIs) was observed in the FCGR3A [158 F/V or F/F] individuals (65.5%) than in the FCGR3A [158 V/V] individuals (34.5%) following KT. The combination of FCGR2A and FCGR3A SNPs further stratified the incidence of UTIs, regardless of C1QA SNP following KT. No differences were observed in the incidence of fungal or cytomegalovirus infections with respect to the 3 gene polymorphisms.In conclusion, our findings indicate that FcγR SNPs are predisposing factors for UTIs after KT. This study provides a foundation for further prospective studies on a larger scale.