A screening programme for microalbuminuria at a diabetes clinic in Apulia,southern Italy

Microalbuminuria is a predictor of renal and cardiovascular disease in both type 1 (insulin-dependent) and type 2 (insulin-independent) diabetes. We report on a screening programme for microalbuminuria at a diabetes clinic in Italy. All diabetic patients without Albustix-positive proteinuria attending the clinic between April and September 1991 were screened. Microalbuminuria was defined as a urinary albumin/creatinine ratio, on an early morning sterile urine sample, >3 in at least two consecutive urine collections. Three hundred and fifty patients, 45 (20 female, 25 female) type 1 and 305 (145 male, 160 female) type 2 diabetics, were examined. The age range was 18–42 years and 36–73 years and duration of diabetes 1–24 and 1–35 years for type 1 and type 2 diabetic patients respectively. Blood pressure, lipids, glycosylated haemoglobin, body mass index and insulin dose, where appropriate, were measured in all patients. Microalbuminuria was found in 8 (22%) of the type 1 diabetics. These patients had a longer duration of diabetes (17.5 vs 7.4 years,P<0.001), higher diastolic blood pressure (86±2.1 vs 76±2.6 mmHg,P<0.05) and an increased total serum cholesterol level (203±23 vs 180±25 mg/dl,P<0.05) compared with diabetic patients with microalbuminuria. Of the type 2 diabetic patients 95 (33%) were found to have microalbuminuria and 210 (69%) nor-moalbumiuria. The prevalence of hypertension (defined blood pressure >140/90 mmHg or antihypertensive treatment) and of dyslipidaemia (defined as total cholesterol >200 and triglycerides >170 or hypolipidaemic treatment) were significantly higher (P<0.001 and 0.01 respectively) in patients with microalbuminuria. This study shows a prevalence of microalbuminuria in type 1 and type 2 diabetic patients similar to that reported in surveys of diabetes clinic outpatients in northern Europe. The association between microalbuminuria and recognized risk factors for cardiovascular and renal disease justifies screening programmes for microalbuminuria for early detection of at-risk diabetic patients and for the implementation of preventive therapeutic measures.     

Dietary factors and progression of diabetic nephropathy

The role of dietary factors in patients with type 1 (insulin-dependent) diabetes is reviewed by examining three different aspects: the effect of an acute protein load, the effect of dietary protein restriction on the progression of nephropathy and the metabolic effects of low-protein diets. After an acute protein load some impairment of the renal functional reserve may be observed only in patients with type 1 diabetes and overt nephropathy. However, the renal functional reserve is not able to give useful indications of the extent of renal damage and the prognosis of the disease. Both short-term and long-term dietary protein restriction are followed by a significant decrease in glomerular filtration rate (GFR) and albuminuria in type 1 diabetics with incipient nephropathy. In patients with overt nephropathy the long-term administration of a low-protein diet is followed by significant reductions in the rate of decline of GFR and in urinary protein excretion only when started at GFR values higher than 45 ml/min. The rate of functional deterioration when dietary treatment is prescribed seems critical in modulating the effects of a low-protein diet. In addition, low-protein diets may exert important metabolic and clinical effects beyond their supposed effect on progression. Clearly, an adequate dietary regimen is only part of the medical treatment in patients with diabetic nephropathy.     

2型糖尿病患者血IL-6与循环内皮细胞的关系及意义

目的探讨2型糖尿病(DM)患者血管内皮细胞损伤与血白介素6(IL-6)的关系及其意义。方法检测45例2型DM患者及20例正常人外周血IL-6和循环内皮细胞(CEC)水平并进行比较。结果①2型DM患者血IL-6和CEC水平高于正常人(P<0.05);②早期糖尿病肾病患者血CEC水平明显高于单纯糖尿病患者(P<0.01);③多元逐步回归分析显示CEC与血IL-6水平和尿蛋白排泄率(UAER)显著相关,标准偏回归系数β分别为0.264(P=0.033)和0.545(P=0.000)。结论2型糖尿病血管内皮细胞损伤与体内IL-6升高有密切关系,并在糖尿病肾病的发病过程中起一定作用。     

2型糖尿病血管病变时血浆ANP、BNP及CNP的变化及临床意义

目的：探讨血浆心钠素(ANP)、脑利钠肽(BNP)、C型利钠肽(CNP)在2型糖尿病血管病变时的变化及其临床意义。方法:应用酶联免疫吸附法(ELISA)测定正常对照组(9例)、2型糖尿病无血管病变组(34例)及2型糖尿病血管病变组(23例)血浆proANP、BNP fragment及NT-proCNP浓度，分析各组间血浆利钠肽水平的变化及相关因素。结果:2型糖尿病血管病变组血浆ANP、BNP明显高于另外2组（P<0.01），而血浆CNP明显降低（P<0.01），2型糖尿病血管病变组各亚组(微血管病变组、大血管病变组及微血管合并大血管病变组)间血浆利钠肽水平无明显差异（P>0.05）。2型糖尿病血管病变组血浆ANP与BNP间存在显著正相关（r=0.309, P<0.05），ANP与CNP（r=-0.374, P<0.05）以及BNP与CNP（r=-0.653, P<0.01）间存在显著负相关。结论:血浆ANP、BNP及CNP的联合检测可以作为简便、价廉、可靠的糖尿病血管病变的筛选指标。     

负压封闭吸引对糖尿病溃疡愈合的促进作用

目的 在"创而床准备(WBP)"理论指导下,观察负压封闭吸引局部处理糖尿病溃疡的疗效.方法 收集2000年1月至2005年1月间收治的27例糖尿病溃疡患者作对照组,2005年1月至2007年6月的8例糖尿病溃疡患者为试验组.两组患者均经常规系统的治疗,试验组在创面的黑、黄期采用清创后负压吸引治疗.观察两组创而各分期间的演进情况.比较两组手术Ⅰ期修复率、入院首次及实施负压治疗后1、2、3周创面细菌学检查结果 .观察各期创面组织标本的HE染色和黄、红两期Ⅰ、Ⅲ型胶原纤维苦味酸-天狼猩红染色结果 及对其含量进行图像分析.结果 试验组患者创面各分期的演进速度、于术Ⅰ期修复率均优于以照组(100%比46%,P<0.05).治疗2周后试验组创面末检出致病菌,对照组检出率为66.7%(P<0.05).HE染色显示试验组各期间的演进类似于急性创面愈合过程,且试验组黄期Ⅰ、m型胶原总含量为12.28%,对照组为24.77%(P<0.01).结论 基于WBP方案的负压吸引治疗能促进糖尿病溃疡的创面愈合过程.     

Hemodynamic factors in the pathogenesis of diabetic nephropathy

Summary The pathogenesis of the diabetic glomerular lesion is unknown. However, cumulative indirect evidence favors hemodynamic factors associated with the abnormal endocrine environment as the cause of diabetic angiopathy. Experimental evidence suggests that the increased hydrostatic pressures in capillary beds, a hallmark of the early stages of insulin-dependent diabetes, are associated with macromolecular leakage leading to the typical thickening of glomerular capillary basement membrane and increased glomerular mesangial matrix even prior to the occurrence of systemic hypertension. Patients with renal or carotid artery stenosis seem to be protected against diabetic nephropathy and retinopathy on the stenosed side. The first signal of diabetic nephropathy even before deterioration of the renal function is microalbuminuria detected by sensitive methods such as radioimmunoassay. Not only in hypertensive, but even in normotensive diabetic patients with microalbuminuria antihypertensive therapy has been shown to reduce albumin excretion rate and to slow the progression of diabetic nephropathy. Once overt diabetic nephropathy has been established, hypertension is a constant accompaniment of the disease. Thus, hypertension may be a cause as well as a result of diabetic nephropathy. Tight control of blood sugar in close association with antihypertensive treatment reducing blood pressure to a lower normal limit, possibly with agents that specifically decrease glomerular capillary hydraulic pressure are the corner stone in protection against progression of the diabetic angiopathy.Abbreviations ECF extracellular fluid - ESRD end-stage renal disease     

Understanding the microbiome of diabetic foot osteomyelitis: insights from molecular and microscopic approaches

Objectives

Rigorous visual evidence on whether or not biofilms are involved in diabetic foot osteomyelitis (DFO) is lacking. We employed a suite of molecular and microscopic approaches to investigate the microbiome, and phenotypic state of microorganisms involved in DFO.

阿魏酸钠对糖尿病大鼠肾脏非酶糖基化和氧化的影响

目的:探讨阿魏酸钠(SF)对糖尿病(DM)大鼠肾脏非酶糖基化和氧化的影响。方法:对链脲佐菌素(STZ)诱导的DM大鼠灌胃给予SF 110 mg·kg^-1·d^-1,治疗8周,测定各组大鼠肾重／体重、肌酐清除率(Ccr)、24 h尿蛋白定量、血清和肾皮质果糖胺(FMN)、血清和肾皮质丙二醛(MDA)含量及抗氧化酶活性,并分别测定肾皮质糖基化终产物(AGEs)含量,观察肾脏病理改变。结果:糖尿病对照组(DM组)大鼠肾重／体重、Ccr、24 h尿蛋白定量、血清FMN、肾皮质FMN和AGEs显著高于正常对照组(N组);SF治疗组(SF组)肾重／体重、Ccr、24 h尿蛋白定量、血清FMN和肾皮质AGEs显著低于DM组;DM组大鼠肾皮质和血清超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活性显著低于N组,MDA含量显著高于N组,SF治疗组大鼠肾皮质和血清SOD、CAT活性显著高于DM组,MDA含量显著低于DM组:DM组大鼠肾脏病理改变异常显著,SF组的肾脏病理学改变轻于DM组大鼠。结论: SF通过保护肾脏抗氧化酶,减轻氧化应激,抑制AGEs在肾脏的沉积对DM大鼠肾脏产生保护作用。