黄葵胶囊联合 ACEI 及 ARB 治疗早期糖尿病肾病的临床研究

目的：探讨黄葵胶囊联合血管紧张素转换酶抑制剂（ ACEI）及血管紧张素Ⅱ受体拮抗剂（ ARB）治疗早期糖尿病肾病（ DN）的临床效果。方法将60例早期DN患者随机分为两组,各30例。对照组给予依那普利片和厄贝沙坦片治疗,观察组在对照组治疗基础上给予黄葵胶囊。对比两组治疗前后尿白蛋白排泄率（ UAER ）、醛固酮（ ALD ）、血管紧张素II （AII）、糖化血红蛋白（HbA1c）、血肌酐、尿素氮、血糖及平均动脉压（MAP）的变化,并观察药物不良反应发生情况。结果两组治疗前UAER、ALD、AII、HbA1c、血肌酐、尿素氮、血糖及MAP比较,差异均无统计学意义（ P ＞0．05）;两组治疗后血糖均无明显变化（ P ＞0．05）;观察组治疗后UAER、ALD、AII、HbA1c、血肌酐、尿素氮和MAP均低于治疗前（ P ＜0．05）;对照组治疗后UAER、ALD、AII、尿素氮和MAP均低于治疗前（ P ＜0．05）;两组治疗后比较,观察组UAER、ALD、AII、HbA1c、血肌酐和尿素氮均低于对照组（ P ＜0．05或P ＜0．01）。两组患者治疗期间不良反应发生率比较,差异无统计学意义（ P ＞0．05）。结论黄葵胶囊联合ACEI及ARB治疗早期DN效果显著,且使用安全。     

Dissociation between urinary pyrraline and pentosidine concentrations in diabetic patients with advanced nephropathy

It has been reported that the concentrations of both pyrraline and pentosidine, well-characterized advanced glycation end products, are increased in the urine of diabetic patients. To determine factors that influence the urinary excretion of pyrraline or pentosidine, we compared pyrraline or pentosidine concentrations with glycemic-control indexes, urinary albumin excretion, and urinary β2-microglobulin in patients with type 2 diabetes. The study was conducted in 39 age-matched healthy control subjects and 50 diabetic patients, including 22 patients with normoalbuminuria, 15 with microalbuminuria, and 13 with macroalbuminuria. Both urinary pyrraline and pentosidine were measured in early-morning urine specimens with the use of high-pressure liquid chromatography. The urinary pentosidine concentration was significantly higher in diabetic patients than in control subjects (P < .01). In contrast, the urinary pyrraline concentration was significantly lower in diabetic patients than in control subjects (P < .001). Urinary pentosidine concentrations were greater in diabetic patients with macroalbuminuria and microalbuminuria than in those with normoalbuminuria. However, urinary pyrraline concentrations were significantly lower in diabetic patients with advanced nephropathy. Both the hemoglobin A_1c (HbA_1c) and the preceding year's mean HbA_1c were lower in patients with macroalbuminuria than in those with normoalbuminuria or microalbuminuria. Urinary pyrraline, but not pentosidine, showed a significantly positive correlation with the preceding year's mean HbA_1c (P<0.01). Multivariate analysis disclosed that urinary β-2-microglobulin was independently correlated with the urinary concentrations of pentosidine and pyrraline (P < .05 for both). We conclude that the urinary concentration of pentosidine is greater in diabetic patients with overt nephropathy, whereas the urinary pyrraline concentration is significantly lower in diabetic patients with overt nephropathy. Because urinary pyrraline is more directly influenced by glycemia than by pentosidine, the difference in glycemic control among diabetic patients with various grades of nephropathy may be responsible for a dissociation between urinary pyrraline and pentosidine concentrations in patients with overt diabetic nephropathy.     

尿毒清颗粒联合血管紧张素系统阻滞剂治疗糖尿病肾病的Meta分析

目的:系统评价尿毒清颗粒联合RAAS系统阻滞剂治疗糖尿病肾病的疗效.方法:运用计算机检索CNKI、万方、VIP、Pubmed、Embase及Cochrane Library中关于尿毒清颗粒联合RAAS系统阻滞剂治疗糖尿病肾病随机对照试验(RCT)的研究文献.采用RevMan5.3软件对符合本次研究的文献中所需要的数据进...     

ACEI和ARB治疗改善糖尿病大鼠胰岛素分泌功能的研究

目的：研究血管紧张素转换酶抑制剂ACEI和血管紧张素II受体拮抗剂ARB对高脂喂养链脲佐菌素（STZ）诱导的糖尿病大鼠胰岛素和胰高糖素分泌及氧化应激功能的影响。方法：应用Enalaprial和Losartan对高脂喂养STZ诱导的糖尿病大鼠进行干预,放免法测定胰岛素和胰高糖素,ELISA检查氧化应激指标8-isoPGF-2α水平。并通过静脉葡萄糖耐量实验了解ACEI和ARB治疗对一相胰岛素分泌的影响。结果：ACEI或ARB治疗可以减少氧化应激,保护一相胰岛素分泌。结论：ACEI或ARB治疗对维持正常的胰岛素分泌可能起到了重要保护作用,从而降低血糖和减少糖尿病的发生。这可能是大规模临床研究中ACEI和ARB使血糖回归至正常水平或减少新发的糖尿病的发生率的深层机制之一。     

Impact of left atrial volume in prediction of outcome after cardiac resynchronization therapy

Left atrial volume index (LAVI) as a predictor of mortality has not been well investigated in patients with cardiac resynchronization therapy (CRT). The purpose of this study is to evaluate the impact of LAVI in predicting mortality in CRT patients.

Methods

We studied 100 consecutive patients who received CRT (male 73, age 69.9 ± 9.6 years). The follow-up duration of all echocardiographic measurements was 14.4 ± 10.5 months after CRT. LAVI was measured from apical views on two-dimensional echocardiography by bi-plane rule. A decrease of left ventricular end systolic volume ≥ 15% after CRT was defined as a positive response to CRT.

Results

The mean LAVI at baseline was 59.9 ± 22.7 ml/m². LAVI in patients who died (78.2 ± 27.5 ml/m²) was significantly greater than those who survived (55.9 ± 19.5 ml/m², p < 0.0001) during follow-up of 17 ± 10.6 months. The area under ROC curve (AUC) for LAVI predicting death was 0.77 (p = 0.0001). The cutoff point for LAVI predicting death was LAVI > 59.4 ml/m². LAVI > 59.4 ml/m² was related to mortality by Cox proportional univariate regression [hazard ratio (HR) = 5.15, 95% CI = 1.48-17.93, p = 0.01]. After adjustment for the variables with significant difference by univariate regression, LAVI > 59.4 ml/m² was continuously related to mortality by multivariate regression (HR = 4.56, 95% CI, 1.30-15.97, p = 0.02). LAVI > 59.4 ml/m² was associated with a near 5-fold increase in mortality during follow-up of 17 ± 10.6 months.

Conclusion

Patients who have LAVI > 59.4 ml/m² continue to have increased mortality despite CRT.     

Risk of progression of nephropathy in a population-based sample with type 2 diabetes

Aims

Progression through stages of nephropathy has not been well described in a large, well-characterized, population-based study. Our aims were to describe the progression of nephropathy and identify characteristics associated with progression in a U.S. population-based sample.

Methods

We identified 10,290 members of a managed care organization who had hypertension and type 2 diabetes, a urine albumin-to-creatinine ratio (UACR) measurement in 2001-2003, and at least 2 follow-up UACRs. Progression of nephropathy was defined as progression to a higher stage of nephropathy than was present at baseline.

Results

At baseline, 57% had normoalbuminuria, 31% had microalbuminuria, and 12% had macroalbuminuria. The incidence of nephropathy progression (per 1000 person-years) was 94.7, 35.1, and 6.5 for normo-, micro-, and macro-albuminuria, respectively. ACEi/ARB use ranged from 61-67%, except among patients with macroalbuminuria at follow-up. Age, diabetes duration, and A1C were significant predictors of progression.

Conclusions

Our study, one of the first to examine the progression of nephropathy in a U.S. population-based sample, showed that among adults with diabetes and hypertension, the burden of nephropathy and its progression may be greater than previously reported. Further, the use of ACEi/ARBs was not optimal.     

ACEI类药物治疗糖尿病肾病的临床疗效观察

目的：探讨ACEI类药物治疗糖尿病肾病的临床疗效。方法：将本院糖尿病专科2009年4月～2010年10月收治的120例患者按照随机数字表随机分成3组,①血管紧张素转换酶抑制剂（ACEI）组,给予贝那普利治疗;②血管紧张素受体拮抗剂（ARB）组,给予缬沙坦治疗;③ACEI＋ARB联合用药组,给予缬沙坦与贝那普利。统计分析患者治疗前后24h内的尿蛋白以及血肌酶变化情况,并观察比较各组的耐受性、临床效果与不良反应。结果：ACEI组、ARB组、联合用药组治疗3个月后尿蛋白分别为0.729、1.000、0.825g/L,治疗6个月后分别为0.500、0.375、0.305g/L,A-CEI组、ARB组患者的治疗3、6个月后的尿蛋白及血肌酶变化对比联合用药有一定差异（P〈0.05）。结论：ACEI类药物进行联合用药对糖尿病患者的肾功能保护作用会更加明显。     

强心宁治疗阳虚水泛型心衰26例

[目的]观察强心宁治疗阳虚水泛型心衰疗效。[方法]将50例随机分为两组,对照组24例应用洋地黄制剂、利尿剂、ACEI、ARB、硝酸酯类等常规治疗;治疗组26例在控制并发症的基础上予强心宁50mL日3次口服,疗程均为4周。[结果]治疗组显效5例,好转18例,无效3例,总有效率88.45%,无不良反应。对照组显效6例,好转16例,无效2例,总有效率91.67%,有10例次出现不良反应。[结论]强心宁既具有强心、利尿、扩血管及逆转心室重构作用,又具有利尿而不失离子、无毒副反应、安全有效、价格低廉、患者依从性好等优点,成为中医药治疗心衰的重要手段,值得推广应用。