血Cystatin C在糖尿病肾病诊断中的应用

[目的]探讨血半胱氨酸蛋白酶抑制剂C(Cystatin C)测定在糖尿病肾病早期诊断中的应用价值.[方法]49例2型糖尿病患者按白蛋白排泄率(UAE)分为无DN组19例UAE＜15μg/min;DN早期组17例UAE＞15 μg/min但＜200μg/min;DN组13例UAE＞200μg/min.同时选取健康对照组20例,各组均测定血清中的肌酐(Cr)、尿素及Cystatin C和晨尿中的白蛋白(Alb)/尿Cr.进而对各指标的敏感性和特异性进行比较,同时对各指标和UAE的相关性进行分析.[结果]以UAE为标准,DM患者中DN的诊断敏感性和特异性,血Cr(以120 μmol/L为界值)分别是53.3%、94.7%;尿素(以6.76 mmol/L为界值)70.0%、73.7%;Cystatin C(以0.95 mg/L为界值)70.0%、84.2%;尿Alb/尿Cr(以1.39 mg/mmol为界值)83.3%、100.0%.四种指标与UAE的相关系数分别为血Cr 0.565、尿素0.480、CvstatinC0.536、尿Alb/尿Cr 0.910.P值均＜0.01.[结论]血Cystatin C浓度的检测为临床提供了一种新的快速、简便的诊断DN早期肾损伤的指标.     

不同劳动强度下战士某些生化指标的变化特点及其与疲劳的关系

本项研究观察了36名战士在不同的劳动强度下,某些生化指标的变化。结果表明:劳动后,血乳酸与劳动强度呈双曲线型相关;尿蛋白与尿Na~+的变化幅度随劳动强度呈线性增加;尿K~+的增加幅度则渐小;尿肌酐、唾液K~+、Na~+的增加量随劳动强度是二次抛物线型变化。提示不同劳动强度下,机体各系统生物化学变化规律不一,疲劳的致因亦不尽相同。血乳酸、尿蛋白、尿Na~+可考虑作为评价疲劳的较好指标。     

PROTEIN LOADING TEST BEFORE AND AFTER KIDNEY DONATION

Abstract Renal response to a 60 g protein load was investigated in 33 normal subjects in terms of creatinine clearance and urinary protein excretion. The test was repeated in 10 of these subjects six months after donor nephrectomy. Creatinine clearance and urinary protein excretion increased significantly one and two hours after ingestion of the protein load (in the form of casein mixture); the change in urinary protein excretion correlated significantly with the change in creatinine clearance (p <0.0001). Plasma urea, calcium, and phosphate concentrations increased after protein ingestion, while plasma creatinine and uric acid decreased. Six months after donor nephrectomy the creatinine clearance had decreased but baseline protein excretion had increased. The pre-nephrectomy renal response to protein ingestion (i.e. increase in creatinine clearance and urinary protein excretion) did not predict creatinine clearance of the kidney after donor nephrectomy. After donor nephrectomy, the single kidney was able to increase creatinine clearance after a protein load, although qualitativel the response was different from that obtained with two kidneys in situ. (Aust NZ J Kned 1986; 16: 691–694.)     

用与不用体表面积校正肌酐清除率的差异性研究

对２６６例正常人及２３９例肾综合征出血热（ＲＳＨＦ）１４４８例次的肌酐清除率（ＣＣｒ）进行了测定。按不同身高、体重各分７组，并分别比较各组中用与不用体表面积校正ＣＣｒ值之间的配对差异程度。结果显示：在正常人及ＲＳＨＦ患者随身高、体重增加，二值差异逐渐缩小，仍存在差异（Ｐ＜０．０５～０．００１）。表明根据目前我国成人的平均身高、体重，对实测ＣＣｒ值须进行体表面积校正。使不同大小个体的ＣＣｒ资料准确，并具有相当恒定及可比性。     

Predicted reciprocal serum creatinine at age 10 years as a measure of renal function in children with nephropathic cystinosis treated with oral cysteamine

The predicted reciprocal creatinine at age 10 years (PRC₁₀), a parameter of renal function based upon the linear relationship between reciprocal serum creatinine and age, incorporates age, serum creatinine, and rate of renal deterioration into a single term. PRC₁₀ measurements were employed to assess renal function in children with nephropathic cystinosis treated with oral cysteamine, a cystine-depleting agent. In 71 children receiving oral cysteamine for at least 1 year, PRC₁₀ decreased linearly with initial serum creatinine concentration. This indicated that, although established renal damage in cystinosis was irreversible, early intervention with cysteamine therapy could favorably alter the rate of glomerular deterioration. In other analyses, mean PRC₁₀ was shown to increase with duration of cysteamine therapy and extent of leukocyte cystine depletion. The predicted reciprocal creatinine value at a certain age can be useful in analyzing the effects of therapeutic intervention in a disease with a relatively uniform rate of renal deterioration.     

Mycological-diagnostic assessment of the efficacy of amphotericin B + flucytosine to control Cryptococcus neoformans in AIDS patients

Abstract: Optimal diagnostic data (microscopy, culture and serology) on 15 cases of Cr. neoformans infection in AIDS patients served as a basis for the preliminary subdivision of the stages of cryptococcosis: Primary (minor involvement of the lungs only) and secondary (hematogenous dissemination with involvement of various organs) stages. Cr. neoformans counts in body fluids and antigen titres in serum and CSF proved to be useful criteria to assess the stage of infection. The efficacy of the combination therapy with amphotericin B + flucytosine seems to be related to the stage of infection. From the mycological point of view, the standard combination of 0.3–0.5 mg/kg BW/d amphotericin B and 150 mg/kg BW/d flucytosine proved to be effective. Data on sensitivity of the agent to amphotericin B and flucytosine are presented in a summarized form. The subjects of duration of therapy, relapse and resistance to flucytosine are commented by means of examples. It should be the aim of an optimal therapy of cryptococcosis to diagnose this mycotic disease in its primary stage. Zusammenfassung: Anhand von 15 Fällen wird versucht, die Cr. neoformans-Infektion AIDS-Kranker in das Primärstadium (alleiniger und geringer Befall der Lunge) und das Sekundärstadium (hämatogene Dissemination mit Befall verschiedener Organe) einzuteilen. Die Keimzahl von Cr. neoformans in Körperflüssigkeiten und der Cr. neoformans-Antigentiter in Serum und Liquor dienten hierbei als die beiden wesentlichen Kriterien zur Einschätzung des Stadiums der Infektion und seiner Therapierbarkeit. Aus mykologischer Sicht erwies sich die Standardkombination von Amphotericin B (0,3–0,5 mg/kg KG täglich) + Flucytosin (150 mg/kg KG täglich) als wirksam. Anhand von Beispielen wird zu den Themen: Dauer der Therapie, Rezidiv und Flucytosin-Resistenz Stellung genommen. über die Empfindlichkeit der Cr. neoformans-Stämme gegen Amphotericin B und Flucytosin (Ancotil ) wird zusammenfassend berichtet. Voraussetzung für eine optimale Therapierbarkeit der Kryptokokkose scheint die Diagnostik dieser Mykose in ihrem Primärstadium zu sein.     

Cyclical Changes in Endogenous Overnight Creatinine Clearance during the Third Trimester of Pregnancy

To investigate the pattern of change in endogenous overnight creatinine clearance during the third trimester, 12 healthy women with uncomplicated pregnancies were examined three times a week. Urine was collected overnight from 22.00 to 08.00 hours and analysed for creatinine. Serum was sampled in the morning and analysed for creatinine, β₂-microglobulin, progesterone and estradiol. The general trend of creatinine clearance was parabolic with a declining level during the last month before term. A sinusoid pattern with minimum values around the time when the women would have had menstruation had they not become pregnant was superimposed on the parabolic trend. A mathematical model (parabolas overlaid with a cosine curve) was constructed and fitted to the data. The cyclical pattern was significant. Serum creatinine showed a pattern with increasing values during the last 4–6 weeks before term and cyclical changes which were also significant. In the individual case the monthly and preterm clearance decrement sometimes was over 50%. Monthly and preterm decreases in creatinine clearance may be quite normal and serial measurements of creatinine clearance are therefore necessary to determine if declining values indicate pathological falls in the glomerular filtration rate.     

不同时限尿标本白蛋白微量检测对早期糖尿病肾病的诊断意义

糖尿病患者任意时，空腹２ｈ尿白蚤白（ＵＡｌｂ）含量均与２４ｈＵＡｌｂ呈正相关；任意时ＵＡｌｂ／Ｕｃｒ分别与２４ｈＵＡｌｂ及２４ｈＵＡｌｂ／Ｕｃｒ呈正相关。     

吲达帕胺对肾脏的保护作用

为了观察吲达帕胺降低血压的同时，是否对肾脏有保护作用，本文对26例高血压病患者于服用吲达帕胺前及服用8周后，分别采血及收集尿标本测定Ser、BUN、Ucr、UAlb、Uα1M、UNAG，并与30例正常人对照．结果发现，高血压病患者服药前UAlb、Uα1M、UANG较对照组明显升高；服药后在血压下降的同时UAlb、Uα1M较用药前显著降低，而Scr、BUN变化不大．作者还观察了该药的不良反应．探讨了作用原理，并认为应用吲达帕胺降压后UAlb、Uα1M降低，受损的肾功能得到了改善，提示该药对肾脏具有保护作用。     

A cross-sectional study of glomerular function in 740 unselected lithium patients

Creatinine clearance was estimated using a formulaic method from serum creatinine, age and sex in 740 unselected lithium-treated patients in southeastern Scotland. Psychiatric history and details of prescribing and monitoring of lithium treatment were obtained from existing case registers. Lithium treatment duration and glomerular filtration, controlling for the effects of age, were weakly related, but only in males. Cases who had been exposed to higher serum lithium concentrations had lower creatinine clearance than those maintained within therapeutic range. Of cases within the lowest quartile of renal function, proportionally more were supervised in general practice rather than at hospital clinics. Suggestions are made for the clinical practice of monitoring serum lithium concentrations and serum creatinine.