慢性肾小球肾炎患者血浆纤溶酶原激活物及其受体和纤溶酶原激活物抑制剂的变化与干预研究

目的探讨慢性肾小球肾炎血浆纤溶酶原激活物及其受体和纤溶酶原激活物抑制剂(PAI-1)的变化意义,血管紧张素转换酶抑制剂(ACEI)治疗的干预影响。方法测定78例慢性肾小球肾炎患者的血浆组织型纤溶酶原激活物(tPA)、尿激酶型纤溶酶原激活物(uPA)及其受体(uPAR)和PAI-1的水平,与健康成年人43人作对照;并观察经ACEI治疗8周后各项指标的改变。结果78例患者血浆uPAR水平明显高于对照组(P<0.05),PAI-1水平显著高于对照组(P<0.01)。予以ACEI(福辛普利)10～20mg/d治疗8周后,ACEI治疗组患者PAI-1水平较常规治疗组患者明显下降(P<0.05)。结论慢性肾小球肾炎患者血浆PAI-1水平明显升高,细胞外基质(ECM)的转化受到抑制;ACEI治疗可降低PAI-1水平,促进ECM的转归,延缓肾脏纤维化。     

Cardiorenal Disease: A Clinical Intersection

This review focuses on the association between renal insufficiency and cardiovascular disease and discusses therapeutic options. Although the association of chronic renal insufficiency and cardiovascular risk was first shown in patients with end-stage renal disease, even minor renal dysfunction has now been established as an independent risk for atherosclerotic cardiovascular disease. Treatment with angiotensin-converting enzyme inhibitors and statins can reduce cardiovascular morbidity and mortality in patients with renal insufficiency. Coronary revascularization improves the prognosis in patients with renal dysfunction, but there is still an underutilization of coronary revascularization procedures in patients with renal insufficiency. There is enough data that shows high mortality after percutaneous transluminal coronary angioplasty in patients with reduced renal function and that slight renal dysfunction exposes the patient with a cardiac event to an excessive cardiac mortality. Further investigation should focus on the cause of and possible preventive interventions, for the staggering cardiovascular risk in the ever-increasing number of people with renal dysfunction.     

双重阻断肾素-血管紧张素系统对慢性肾脏疾病血压、蛋白尿和肾功能的影响

目的 观察长程应用ACEI联合ARB治疗慢性肾脏疾病的疗效和安全性。 方法 60例慢性肾脏疾病患者随机分为3组：ACEI组、ARB组和联合组，ACEI组接受贝那普利治疗，ARB组接受缬沙坦治疗，联合组接受贝那普利联合缬沙坦治疗。观察治疗后1、3、6、9和12个月的相关临床指标变化，并进行评价。 结果 3 组患者经过12个月治疗后，24 h尿蛋白从(1.08±0.68) g降至(0.27±0.29) g，P < 0.05；收缩压从(129±24) mm Hg降至(116±18) mm Hg(P < 0.05)；肾小球滤过率从(67.5±30.2)ml/min升至(69.3±34.6)ml/min(P > 0.05)；血钾变化不大(P > 0.05)；不良反应轻微。3 组相比，联合组有最强的减少尿蛋白和降低舒张压作用(P < 0.05)，而在肾功能改善、血钾变化及不良反应方面，3 组间差异无统计学意义(P > 0.05)。结论 长期联合治疗双重阻断RAS系统有更强地降低蛋白尿和舒张压作用，而不良反应轻微。     

ACEI对2型糖尿病患者微量白蛋白尿与胰岛素抵抗的影响

目的：探讨ACE抑制剂对2型糖尿病患者微量白蛋白尿与胰岛素抵抗的影响。方法：120例2型糖尿病合并微量白蛋白与胰岛素抵抗的患者，承机分为治疗组和对照组。治疗组口服ACE抑制剂（苯那普利片）和降糖药，对照组只口服降糖药。疗程6个月。结果：ACE抑制制剂减少2型糖尿病患者尿微量白蛋白排泄（P＜0．05），显著增加患者胰岛素的敏感性（P＜0．05）。两组相比有显著差异（P＜0．05）。结论ACE抑制剂是安全有效治疗2型糖尿病微量白蛋白与胰岛素抵抗的有效药物。     

Association between COVID-19 and angiotensin-converting enzyme inhibitors with the spotlight on zinc: an opinion

In the setting of the raging COVID-19 pandemic, the search for innovative therapeutics is desperately sought after. As we learn more about the characteristics and metabolic health of patients and as our understanding of COVID-19 pathophysiology and treatment progresses, so is our understanding of medication effects that might increase disease severity. As of late, ACE inhibitors have been under investigation for a potential increase in illness severity due to ACE2 upregulation. Given our knowledge of other nutrient-pharmaceutical interactions, could the ACE inhibitor impact on COVID be due to something else? In this paper, we discuss the possibility that ACE inhibitors might be affecting COVID-19 patients by causing zinc insufficiency.

KEY MESSAGES

1. Zinc deficiency caused by chronic ACE inhibitor usage may exacerbate the pathogenicity of COVID-19 in susceptible patients.
2. A multi-center study is needed to assess the zinc levels of patients with COVID-19 who are taking ACE inhibitors and other medications that may result in low zinc levels.

     

Quality of care and education provided by Greek day-care centres: an approach from researcher's and early childhood educators' perspective

The present study is aimed at examining the level of quality and care provided by Greek preschool programmes, from the researcher's and early childhood educators' perspectives and verify whether they evaluate with the same way. Research results indicate that according to the researcher's assessment both preschool and infant/toddler classrooms provide care and education of adequate quality, whereas according to early childhood educators their classrooms (both preschool and infant/toddler) provide care and education of good quality. Correlation analysis indicated that early childhood educators rated higher the quality of care and education provided by them compared with researcher. Years of experience and level of education have been found to correlate with early childhood educators' ratings. Thus, the type of setting has been found to correlate both with the researcher's and the early childhood educators' ratings. Research results suggest that the quality of care and education is a relative concept and substantiating previous research results highlight the need to take into account the perspectives of all those involved (parents, children and educators) when we attempt to define and evaluate the quality.     

Meta-analysis: the efficacy and safety of combined treatment with ARB and ACEI on diabetic nephropathy

Abstract

Objective: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce proteinuria in diabetic nephropathy (DN). Some studies have suggested that dual blockade of the renin–angiotensin system provides additive benefits in DN but others showed increased adverse events. We performed a meta-analysis to evaluate the efficacy and safety of combination therapy for DN. Methods: Studies were identified by searching MEDLINE, EMBASE, PubMed, and CNKI. All trials involved ACEI?+?ARB (combination therapy), and ACEI or ARB alone (monotherapy) for DN. The outcomes measured were urinary total proteinuria (UTP), urinary albumin excretion rate (UAER), serum creatinine, glomerular filtration rate (GFR), end-stage renal disease (ESRD), hyperkalemia, hypotension, and acute kidney injury (AKI). Results: In the 32 included trials, 2596 patients received combination therapy and 3947 received monotherapy. UTP and UAER were significantly reduced by combined treatment compared with monotherapy. It was notable that low doses of combination therapy reduced UTP more than high doses. Serum creatinine, GFR, and ESRD were not significantly different between the two groups. In severe DN, the occurrence of hyperkalemia and AKI were higher with combination therapy. However, in mild DN, the prevalence of hyperkalemia and AKI were the same in both the groups. In mild DN, the occurrence of hypotension was higher with combination therapy; however, in severe DN, it was not different between the two groups. Conclusion: Our meta-analysis suggests that combination therapy can be used on DN with proteinuria, but should be used with caution in those with decreased renal function, especially with severe renal failure.     

Determinants of late-onset heart failure in myocardial infarction survivors: GISSI Prevenzione trial results

INTRODUCTION AND OBJECTIVES: Improvement in the early phase of myocardial infarction (MI) is associated with a higher rate of late complications, including late-onset heart failure (LHF). The factors predicting LHF are not well understood. Our aims were to identify the factors predicting LHF and to determine the survival rate in these patients. PATIENTS AND METHOD: The GISSI-Prevenzione trial involved 11,323 low-risk patients (NYHA class < or = II) who had had a recent MI (< 3 months). It was a multicenter, open-label, clinical trial of the efficacy of treatment with polyunsaturated fatty acids, vitamin E, both, or neither. Patients with heart failure at baseline and those whose ejection fraction was unknown (n = 2908) were excluded from the present analysis. Late-onset heart failure was defined prospectively as hospital admission due to heart failure. A Cox regression model adjusted for major covariates was used for risk analysis. RESULTS: The study included 8415 patients. During 3.5 years of follow-up, 192 (2.3%) developed LHF. The risk of LHF could be predicted from readily available parameters: age (per year; RR=1.07; 95% CI, 1.05-1.09), ejection fraction (per 1% increment; RR=0.96; 95% CI, 0.94-0.97), heart rate (> or = 74 beats/min; RR=1.62; 95% CI, 1.21-2.16), white blood cell count (> or = 8900 per ml; RR=1.42; 95% CI, 1.05-1.94), diabetes (RR=1.62; 95% CI, 1.17-2.24), hypertension (RR=1.76; 95% CI, 1.33-2.34), peripheral artery disease (RR=2.11; 95% CI, 1.32-3.37), and reinfarction (RR=2.09; 95% CI, 1.28-3.39). LHF was associated with poor survival: (RR=2.34; 95% CI, 1.63-3.36). CONCLUSIONS: The risk of LHF in post-MI patients can be predicted from readily available parameters. LHF was associated with a poor prognosis.