糖尿病患者手部深度烧伤创面修复临床疗效分析

目的讨论糖尿病患者手部深度烧伤创面修复临床疗效。方法选取2019年4月—2020年4月期间该院收治的118例手部深度烧伤患者作为该次研究对象,根据是否患有糖尿病分为糖尿病组和非糖尿病组,每组59例。两组患者均采用皮瓣、全厚皮和中厚皮进行创面修复治疗,观察两组患者的治疗效果。结果①干预前,糖尿病组和非糖尿病组患者的空腹血糖以及餐后2 h血糖水平差异有统计学意义(t=14.147、4.998,P<0.001);治疗后,糖尿病组空腹血糖为(5.9±1.2)mmol/L,非糖尿病组空腹血糖为(5.5±1.4)mmol/L,差异无统计学意义(t=1.666,P=0.098>0.05),说明糖尿病患者治疗后血糖水平接近正常值;糖尿病组餐后2 h血糖为(7.4±0.4)mmol/L,非糖尿病组餐后2 h血糖为(7.3±0.3)mmol/L,差异无统计学意义(t=1.563,P=0.127>0.05),说明糖尿病患者治疗后血糖水平接近正常值。②糖尿病组患者的手功能恢复优良率为86.4%,与非糖尿病组的98.3%,组间数据差异有统计学意义(χ²=4.330,P=0.037)。结论对于手部深度烧伤患者来讲,在采用相同的床修复方法时非糖尿病患者的治疗效果相对较好,糖尿病患者恢复效果则相对较差,临床对于糖尿病手部深度烧伤患者应给与高度关注,并积极进行进一步治疗。     

¿Cuándo realizar biopsia renal en pacientes con diabetes mellitus tipo 2? Modelo predictivo de enfermedad renal no diabética

IntroductionDiabetic nephropathy (DN) is one of the most frequent complications in patients with diabetes mellitus (DM) and its diagnosis is usually established on clinical grounds. However, kidney involvement in some diabetic patients can be due to other causes, and renal biopsy might be needed to exclude them. The aim of our study was to establish the clinical and analytical data that predict DN and no-diabetic renal disease (NDRD), and to develop a predictive model (score) to confirm or dismiss DN.Material and methodsWe conducted a transversal, observational and retrospective study, including renal biopsies performed in type 2 DM patients, between 2000 and 2018.ResultsTwo hundred seven DM patients were included in our study. The mean age was 64.5 ± 10.6 years and 74% were male. DN was found in 126 (61%) of the biopsies and NDRD in 81 (39%). Diabetic retinopathy was presented in 58% of DN patients, but only in 6% of NDRD patients (P < .001). Patients with NDRD were diagnosed of primary glomerulopathies (52%), nephroangiosclerosis (16%), inmunoallergic interstitial nephritis (15%) and vasculitis (8.5%). In the multivariate analysis, retinopathy (OR 26.7; 95% CI: 6.8-104.5), chronic ischaemia of lower limbs (OR 4,37; 95% CI: 1.33-14.3), insulin therapy (OR 3.05; 95% CI: 1.13-8.25), time course of DM ≥ 10 years (OR 2.71; 95% CI: 1.1-6.62) and nephrotic range proteinuria (OR 2.91; 95% CI: 1.2-7.1) were independent predictors for DN. Microhaematuria defined as ≥ 10 red blood cells per high-power field (OR 0.032; 95% CI: 0.01-0.11) and overweight (OR 0.21; 95% CI: 0.08-0.5) were independent predictors of NDRD. According to the predictive model based on the multivariate analysis, all patients with a score > 3 had DN and 94% of cases with a score ≤ 1 had NDRD (score ranked from −6 to 8 points).ConclusionsNDRD is common in DM patients (39%), being primary glomerulonephritis the most frequent ethology. The absence of retinopathy and the presence of microhematuria are highly suggestive of NDRD. The use of our predictive model could facilitate the indication of performing a renal biopsy in DM patients.     

非糖尿病冠心病患者糖化血红蛋白与颈动脉病变相关性分析

目的探讨非糖尿病冠心病患者糖化血红蛋白（HbA1c）水平与颈动脉病变的相关性。方法选择经冠脉造影明确诊断冠心病的非糖尿病患者275例,按照HbA1c水平以三分位法分为低水平组（HbA1c≤5.6%,n=103例）,中水平组（HbA1c：5.6%-5.9%,n=93例）,高水平组（HbA1c〉5.9%,n=79例）。颈动脉超声测定颈总动脉内膜中膜厚度（IMT）,分为正常对照组（IMT≤0.9mm）,轻度增厚组（IMT0.9mm-1.2mm）,明显增厚组或斑块形成组（IMT〉1.2mm）。分析HbA1c水平与颈动脉病变的相关性。结果 HbA1c高水平组中IMT〉1.2mm者共56例,占70.9%,比例大于中水平组（64例,占68.8%）,大于低水平组（67例,占65%）,但无统计学意义。经Pearson相关分析及偏相关分析,校正年龄、性别、吸烟状况、饮酒状况、心梗史、病变支数、空腹血糖、尿酸、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、BMI（体重指数）等因素后,HbA1c水平与颈动脉内中膜及斑块厚度无显著关系。结论在非糖尿病的冠心病人群中,HbA1c水平与颈动脉内中膜及斑块厚度无明显相关性。     

SELF-MEASURED SYSTOLIC BLOOD PRESSURE IN THE MORNING IS A STRONG INDICATOR OF DECLINE OF RENAL FUNCTION IN HYPERTENSIVE PATIENTS WITH NON-DIABETIC CHRONIC RENAL INSUFFICIENCY

While blood pressure is a recognized major determinant of renal function deterioration, the role of self blood pressure measurement (BPM) in predicting the loss of renal function in hypertensive patients with chronic renal insufficiency (CRI) has not been adequately addressed. One hundred and thirteen patients (F/M: 46/67; 56±1 years) with CRI (mean serum creatinine: 1.87±0.08; range: 1.4 to 3.5?mg/dl; average urinary protein excretion: 1.2±0.2?g/24?hrs.) were followed for 3 years. The record of renal biopsy revealed that 74 patients had IgA nephropathy, 16 had chronic glomerulonephritis, and 6 had membranous nephropathy, while 17, unbiopsied patients had underlying renal disease of unknown origin. Self BPM were made at regular intervals throughout the course of the study. All recorded blood pressures were included in a stepwise multiple regression analysis in which the decline in GFR per year was the dependent variable. Patients were primarily treated with a combination of amlodipine (5 to 20?mg daily), a calcium antagonist, and benazepril(2.5 to 5?mg daily), an ACE inhibitor in an effort to reduce their blood pressure at the office to <130/85?mmHg. The simple correlation between blood pressures (i.e., office, home morning and home evening) and the decline in GFR were all statistically significant. The correlation coefficients of determination for this model were as follows: r=0.64 for home morning SBP; 0.43 for office SBP; 0.39 for office DBP; and 0.38 for home morning DBP. The level of urinary protein excretion did not correlate with the decline in GFR. These data suggest that self BPM improves prognostic ability in hypertensive patients with CRI.     

Development and validation of a predictive model for the differential diagnosis of diabetic nephropathy and non-diabetic renal disease in patients with type 2 diabetes mellitus

Objective To develop and validate a predictive model for the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus. Methods A retrospective study with patients with type 2 diabetes who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from February 2012 to January 2015 was conducted. The dataset was randomly split into development (70.0%) and validation (30.0%) cohorts. Baseline predictors for model development was selected by using univariable and multivariable logistic regression. The model's performance in the two cohorts, including discrimination and calibration, was evaluated by the C-statistic, calibration curve and the P value of the Hosmer-Lemeshow test. Results Among the 931 patients with type 2 diabetes, 478 cases (51.3%) diagnosed as DN alone, 214 cases (23.0%) as NDRD alone and 239 cases (25.7%) as DN plus superimposed NDRD (MIX). Among NDRD and MIX patients, membranous nephropathy was the most common pathological type, followed by IgA nephropathy. The variables selected in the final predictive model were age, duration of diabetes, diabetic retinopathy, systolic blood pressure, hemoglobin, fasting blood glucose, glycosylated hemoglobin, cystatin C. The model performed well with good discrimination and calibration. The C-statistics were 0.913(95%CI 0.892-0.935) in the derivation cohort and 0.897(95%CI 0.876-0.919) in the validation cohort. The model had the best P value of 0.934 of the Hosmer-Lemeshow test. Conclusions A simple predictive model with high accuracy is constructed for predicting the presence of NDRD and MIX for type 2 diabetic patients. The nomogram can be used as a decision support tool to provide a non-invasive method for differential diagnosis of DN and NDRD, which may help clinicians assess the risk-benefit ratio of kidney biopsy for type 2 diabetic patients with renal impairment.     

Prevalence of diabetes among glycosuric individuals in an urban area of greece

Summary Epidemiologic data on the frequency of diabetes in the urban Greek population were lacking in Greece. Postprandial urine samples of 21,410 inhabitants of a suburb of Athens were examined for glycosuria by two different enzymatic methods. It was found that 569 persons,i.e. 3.20% of the whole population aged 10 or more, presented postprandial glycosuria (cases of previously known diabetes were excluded); 417 persons out of these were submitted to an OGTT (50 g) and 135 new cases of diabetes were discovered. Glycosuria was associated with diabetes mostly in the age-groups above 40. Obesity was frequent among the newly discovered diabetics. Two thirds had abnormal blood sugar levels already in the fasting condition. The prevalence of non-diabetic glycosuria was 2.70% in males and 1.60% in females. The frequency of a family history positive for diabetes was found to be approximately twice as high in diabetics compared to subjects without glycosuria.     

Prevalence of diabetic nephropathy complicating non-diabetic renal disease among Chinese patients with type 2 diabetes mellitus

Background

The incidence of diabetes mellitus (DM) and diabetic nephropathy (DN) have risen rapidly in the past few decades and have become an economic burden to the healthcare system in China. DN is a major complication of DM and is a leading cause of end-stage renal disease (ESRD). The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. It is generally believed that it is difficult to reverse DN, whereas some cases of NDRD are readily treatable and remittable. However, DN is known to co-exist with NDRD in a poorly defined population of patients with type 2 diabetes mellitus (T2DM). This study estimated the prevalence of co-existing DN and NDRD in Chinese patients.

Methods

Data were retrospectively analyzed from 244 patients with T2DM who had undergone a renal biopsy between January 2003 and December 2011 at the Nephrology Department, China-Japan Friendship Hospital, China. Male patients numbered 151 (61.9%) of the study population. The biopsies were performed because urinary abnormalities or renal function were atypical of a diagnosis of DN. Biopsy samples were examined using light, immunofluorescence (IF) and electron microscopy (EM). Clinical parameters were recorded for each patient at the time of biopsy.

Results

Nineteen of 244 diabetic patients (7.8%) had co-existing DN and NDRD. These patients showed clinical features and pathologic characteristics of DN, including a high prevalence of diabetic retinopathy (89.5%), a long duration of diabetes, increased thickness of the glomerular basement membrane (GBM) and mesangial expansion. However, they also presented with clinical findings which were inconsistent with DN, such as hematuria, rapidly progressive renal failure and marked proteinuria. Immunoglobulin A (IgA) nephropathy was apparent in 10 out of the 19 patients (52.6%), tubulointerstitial lesions were found in four patients (21.1%), membrano-proliferative glomerulonephritis (MPGN) in three patients (15.8%) and membranous nephropathy (MN) in two patients (10.5%).

Conclusion

Retrospective analysis of biopsy data suggests that approximately 8% of Chinese patients with T2DM may have co-existing DN and NDRD. The most common histological diagnosis in our small series was IgA nephropathy.     

血红蛋白在鉴别糖尿病肾病与非糖尿病肾脏疾病中的作用

目的探讨血红蛋白在鉴别糖尿病肾病(DN)与非糖尿病肾脏疾病(NDRD)中的临床意义。 方法对2004年1月至2012年4月在解放军总医院肾脏病科行肾活检、病理诊断明确且病史资料完整的66例DN、78例NDRD患者进行回顾性分析,比较两组临床指标及合并症的差异,采用多因素Logistic回归分析方法明确DN的独立危险因素;比较DN及NDRD组不同CKD分期的血红蛋白水平差异,明确其贫血性质及贫血相关的独立危险因素。 结果DN组糖尿病罹病时间、肾病罹病时间、平均动脉压、血清肌酐、尿素氮、24 h尿蛋白定量水平及合并糖尿病视网膜病变、心血管病、贫血的比例均高于NDRD组,差异具有统计学意义(P<0.05);多因素分析显示糖尿病罹病时间长(OR＝1.012,95%CI 1.005～1.019)、合并糖尿病视网膜病变(OR＝ 4.265,95%CI 1.616～11.255)、血红蛋白水平低(OR＝ 0.952,95%CI 0.929～0.976)及合并心血管病(OR＝2.875,95%CI 1.089～7.593)是DN的独立危险因素;CKD1～3期DN组及NDRD组的血红蛋白水平均存在显著性差异(P<0.05),该差异在CKD 4～5期消失;DN及NDRD组共有60例诊断为贫血,均为正细胞正色素性贫血;多因素Logistic回归分析显示白蛋白降低(OR＝0.928,95%CI 0.879～0.980)、血清肌酐升高(OR＝1.011,95%CI 1.004～1.019)、病理诊断为DN(OR＝6.213,95%CI 2.690～14.347)是贫血的独立危险因素。 结论血红蛋白与DN显著独立相关,早期对血红蛋白水平的监测可能为临床鉴别DN与NDRD提供新线索。     

糖尿病合并肾脏损害患者肾活检的临床意义

糖尿病肾脏疾病(DKD)是导致慢性肾衰竭的主要原因,其中2型糖尿病所致的肾脏病变占绝大多数。肾活检病理检查是诊断的"金标准",对患者治疗方案的选择及预后判断具有重要价值,对新药的开发具有重要意义,也是DKD流行病学调查、确定临床病理联系和开发无创诊断方法的重要依据。因此,对糖尿病尤其是2型糖尿病合并肾脏损害的患者积极开展肾活检病理检查具有重要的临床意义。