糖化血红蛋白、尿微量清蛋白与β2微球蛋白检测在糖尿病早期肾损害中临床意义

目的研究糖化血红蛋白(HbA1c)、随机尿微量清蛋白(mALB)与尿β2微球蛋白(β2MG)这3种指标监测在糖尿病(DM)早期肾损害中的作用。方法对糖尿病肾病组(DN)、单纯糖尿病组(DM)、对照组均采用高效液相色谱法测定糖化血红蛋白,采用透射比浊法检测β2MG及尿微量清蛋白。结果 DM组与对照组相比,前述3种指标的差异具有统计学意义(P<0.05),在DN组中,HbA1c、mALB及β2MG水平均显著高于对照组和DM组,其差异有高度统计学意义(P<0.01)。结论 HbA1c、mALB、β2MG 3个指标用来判断DM早期肾损害敏感而且可靠,灵敏度高,费用低廉,能够准确评估患者的病情发展程度。     

昼夜血压波动与2型糖尿病患者尿蛋白关系研究

目的 :探讨动态血压昼夜节律变化与2型糖尿病肾损害之间关联。方法 :选取我院2009年6月~2011年6月住院部102例2型糖尿病患者为研究对象,根据血压昼夜变化节律分为勺型组、非勺型组和深勺型组,对各组患者进行24小时动态血压监测及尿蛋白四项测定。结果:非勺型组患者,尿微量白蛋白、尿转铁蛋白、尿免疫球蛋白、尿微球蛋白均有不同程度增高,与其他两组对比有显著差异,其中尿微量白蛋白最为明显。结论 :无明确高血压2型糖尿病患者血压昼夜节律改变与肾损害相关,糖尿病患者应关注血压变化,及早进行针对性治疗,延缓糖尿病肾病发生发展。     

2型糖尿病患者血糖水平对肿瘤标志物CEA、CA199、CA125表达的影响

目的:分析2型糖尿病患者血糖水平对肿瘤标志物癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)表达的影响。方法:抽取150例2型糖尿病患者(DM组)和150名健康体检者(对照组),检测两组受试者空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平,使用化学发光法测定其血清CEA、CA199、CA125水平,运用Pearson法计算FPG、HbA1c与CEA、CA199、CA125的相关性。结果:DM组FPG、HbA1c均高于对照组,血清CA199、CA125浓度高于对照组差异有统计学意义(P<0.05)。两组血清CEA浓度比较,差异无统计学意义(P>0.05)。相关性分析结果 FPG、HbA1c与CA199呈显著正相关(P<0.05);FPG、HbA1c与CEA、CA125无明显相关性(P>0.05)。结论:2型糖尿病患者FPG、HbA1c的升高可导致CA199表达上升,但对CEA、CA125表达水平无明显影响,这可能是2型糖尿病患者胰腺癌患病率较高的原因之一。     

缬沙坦联合胰激肽原酶降低早期老年DN患者微量蛋白200例疗效及安全性分析

目的:评价缬沙坦联合胰激肽原酶降低早期老年糖尿病肾病患者微量蛋白的临床疗效与安全性,为该类疾病的临床治疗提供参考。方法:以徐州市第一人民医院老年科于2011年2月至2014年3月间收治的200例老年糖尿病肾病(Diabetic nephropathy,DN)患者为研究对象,随机分为对照组和研究组,对照组给予缬沙坦治疗、研究组给予缬沙坦联合胰激肽原酶,评价两组的临床疗效。结果:治疗结束后,研究组与对照组患者的微量蛋白清除率、微量蛋白等肾功能相关指标及血液黏度均有明显下降,与治疗前相比差异具有统计学意义(P<005),且以研究组的下降程度较为显著。在不良方面,两组均未见与药物相关的严重不良反应。结论:缬沙坦单药或与胰激肽原酶联用均能有效降低早期老年DN患者尿微量蛋白,以两药联用时的效果较佳。     

辛伐他汀对糖尿病肾病患者非降脂保护作用的临床研究

目的:探讨辛伐他汀对糖尿病肾病的肾保护作用,为该类疾病的临床治疗提供参考。方法:以我院2012年2月至2014年1月间收治的160例DN患者为研究对象,随机分为两组,对照组给予常规的降糖、降压治疗,研究组在原治疗方案的基础上增加辛伐他汀。结果 :治疗3个月后,研究组和对照组患者的FBG、HDL-C、UA、LDL-C、U-MA较治疗前均有明显改善,差异具有统计学意义(P<0.01)。研究组的U-MA、TG、LDL-C和HDL-C改变较对照组更加显著,且差异具有统计学意义(P<0.05)。结论:辛伐他汀对于糖尿病肾病患者而言,除可降低血脂,在降低微量蛋白水平方面也具有较为明确的临床疗效。     

血清Betatrophin水平与2型糖尿病合并非酒精性脂肪肝病的相关性

目的 :分析2型糖尿病患者血清促代谢因子(Betatrophin)水平与合并非酒精性脂肪肝病的相关性。方法 :选取我院2017年9月至2019年3月收治的93例2型糖尿病患者作为病例组,按照是否合并非酒精性脂肪肝病分为合并NAFLD组与未合并NAFLD组,另选取50例健康体检者作为对照组,比较各组间一般资料、糖脂代谢指标及Betatrophin等指标,分析Betatrophin表达水平与2型糖尿病患者合并非酒精性脂肪肝病的相关性。结果 :病例组与对照组FPG、FINS、HbA1c、TC、TG、HDL-C、LDL-C、Betatrophin等指标比较差异均有统计学意义(P<0.05)。合并NAFLD组与未合并NAFLD组年龄、BMI、TC、TG、HDL-C、LDL-C、Betatrophin等指标比较差异均有统计学意义(P<0.05)。多因素分析发现Betatrophin与TG是2型糖尿病患者合并非酒精性脂肪肝的独立危险因素(P<0.05)。相关性分析发现,Betatrophin与TG呈正相关(r=0.504,P<0.05)。Betatrophin预测非酒精性脂肪肝病的ROC曲线下面积为0.658,具有一定预测价值(P=0.003)。结论 :Betatrophin可能通过影响脂质代谢促进2型糖尿病患者合并非酒精性脂肪肝病的发生。     

2型糖尿病患者肾动脉血流变化及彩色多普勒超声对糖尿病肾病早期诊断价值

目的 :分析彩色多普勒超声对糖尿病肾病(DN)的早期诊断价值。方法 :自2014年2月至2016年2月两院门诊及住院成人患者中选取196例2型糖尿病患者,按照其24 h尿蛋白排泄率(UAER),将患者分别纳入糖尿病肾功能正常组(UAER<30 mg)、早期DN组(UAER 30~300 mg)及DN组(UAER>300 mg);同时选取60名健康体检者作为健康对照组。使用彩色多普勒超声观察并比较各组受试者肾脏体积、肾动脉血流差异,并运用Pearson法计算肾内各级动脉阻力指数(RI)与UAER的相关性。结果 :健康对照组肾体积低于3组糖尿病患者,肾功能正常组、早期DN组、DN组肾体积依次增大,各组间差异有统计学意义(P<0.05)。DN组、早期DN组肾内各级动脉EDV、RI均高于健康对照组、糖尿病肾功能正常组,DN组肾内各级动脉EDV、RI均高于早期DN组,差异有统计学意义(P<0.05)。肾内各级动脉RI与UAER呈正相关。结论 :DN患者在肾功能出现明显改变之前已存在肾脏体积增大以及肾动脉血流变化,彩色多普勒超声图像能够准确显示上述变化,为DN的早期诊断提供可靠参考。     

胰岛素泵强化治疗对初治2型糖尿病患者β细胞功能和预后的影响

目的:探讨胰岛素泵强化治疗对新诊断2型糖尿病患者β细胞功能和预后的影响。方法:60例2型糖尿病初治患者随机分为两组,A组(胰岛素泵组,n=28例)、B组(间断胰岛素皮下注射组,n=32例)。A、B两组患者予胰岛素泵及间断胰岛素皮下注射2周,之后根据患者血糖变化情况调整治疗方法。分别于治疗前、治疗后2周、治疗后3个月监测患者体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、C反应蛋白(CRP)、糖化血红蛋白(GhbA1c)、空腹血糖(FPG)、餐后2h血糖(2hPBG),计算治疗前后胰岛素抵抗指数(HOMAIR)、胰岛β细胞指数(HOMA-β)的变化,并统计两组患者治疗期间胰岛素平均用量、血糖达标时间及低血糖的发生情况。结果:治疗3个月后BMI、TC、TG、CRP与治疗前相比明显降低,差异有统计学意义;两组患者治疗3个月的血糖指标及胰岛素功能指标与治疗前相比差异有统计学意义,且A组治疗3个月的FPG及2hPBG明显低于B组,差异有统计学意义;A组患者平均胰岛素用量、血糖达标时间及低血糖的发生明显低于B组患者,差异有统计学意义。结论:新诊断的2型糖尿病患者采用胰岛素泵强化治疗不仅有助于胰岛β细胞功能恢复、减低患者体重、血糖、血脂和炎症反应,而且与间断胰岛素皮下注射相比可降低平均胰岛素用量、血糖达标时间和低血糖的发生。     

利拉鲁肽联合二甲双胍对糖尿病合并非酒精性脂肪性肝病患者疗效、肝脏脂肪含量及 ANGPTL4和CTRP12表达的影响

目的 探究利拉鲁肽与二甲双胍联合治疗对糖尿病合并非酒精性脂肪性肝病患者疗效、肝脏脂肪含量及ANGPTL4和CTRP12表达的影响。方法 选取96例我院于2021年2月～2023年8月期间收治的2型糖尿病合并非酒精性脂肪肝患者,随机分为两组,即对照组(48例)和治疗组(48例)。比较两组患者临床疗效;检测血糖指标、脂代谢指标及肝脏功能指标;比较两组患者血清中ANGPTL4和CTRP12水平及肝脏脂肪含量;评价两组患者不良反应发生情况。结果 治疗组较对照组患者临床疗效升高(P<0.05)。和治疗前相比,治疗后两组患者FBG、HbA1c、HOMA-IR指标、血清中ALT、AST、TC、TG、LDL-C、HDL-C指标、ANGPTL4、CTRP12水平及肝脏脂肪含量均降低,FINS增加(P<0.05);和治疗后对照组相比,治疗组患者FBG、HbA1c、HOMA-IR指标、血清中ALT、AST、TC、TG、LDL-C、HDL-C指标、ANGPTL4、CTRP12水平及肝脏脂肪含量均降低,FINS增加(P<0.05)。对照组不良反应(恶心呕吐、头晕、腹泻、低血糖)发生情况和治疗组...     

终末期糖尿病肾病腹膜透析治疗疗效

目的 :比较终末期糖尿病肾病(end-stagerenaldiease,ESRD)患者采用不同透析治疗疗效。方法 :60例ESRD患者,分为观察组对照组各30例;观察组采用腹膜透析(CAPD),对照组给予血液透析(HD)治疗。比较生存率、并发症、血压等指标。结果 :两组的6个月、1年、2年、3年存活率差异无统计学意义(P>0.05);观察组收缩压、舒张压水平均显著低于对照组,观察组TG、TC、每日尿量水平明显高于对照组;观察组的心脑血管疾病、眼底出血、内瘘发生率均明显低于对照组,但观察组营养不良、血糖控制不佳发生率显著高于对照组,有统计学意义(P<0.05)。结论 :两种方式近期、远期疗效差异不大,CAPD治疗能有效改善患者血压状态,有效减少脑血管疾病等并发症的发生;而HD的感染、营养不良、血糖控制不佳等并发症发生率低,临床要根据患者病情特点采取个体化治疗方案。     

智能监护与健康管理系统在妊娠期糖尿病中的居家应用

目的:探讨智能监护与健康管理系统对妊娠期糖尿病患者居家期间的干预作用.方法:选取100例在医院就诊的妊娠期糖尿病患者用随机数字表法分为2组,对照组50例居家期间采取常规管理模式,研究组50例居家期间通过智能监护与健康管理系统进行干预,2组均干预至分娩.对比2组干预前后患者的健康认知评分、糖化血红蛋白(Glycated ...     

Astaxanthin delayed the pathogenesis of diabetic nephropathy in type 1 diabetic rats

This study was designed to investigate the protective effects of Astaxanthin (AST) in rats with diabetes mellitus (DM) induced by streptozotocin. SD rats were divided into control group (n = 5, only received normal saline), DM group (n = 8) and AST + DM group (n = 8; AST: 50 mg/kg/day). DM rats were induced by intraperitoneal injection of streptozocin (STZ, 65 mg/kg). Blood glucose level and body weight were determined at weeks 0, 2, 4, 6 and 8, respectively. At week 8, kidney function was determined, together with expression of P53 and dynamin-related protein-1 (Drp1) by Western blot analysis and immunofluorescence. AST led to increase of body weight in rats with DM. AST + DM group showed a significant decrease in blood glucose level at week 4 compared with DM group (P < 0.05). AST improved renal function and significantly reduced expression of P53 and Drp1 in DM rats. In addition, AST can effectively reduce the blood glucose in DM rats, and delayed the pathogenesis of diabetic nephropathy. Such delay mediated by AST may be associated with the downregulation of Drp1 and P53.     

Zinc alpha 2 glycoprotein (ZAG): A potential novel pharmacological target in diabetic retinopathy

Zinc alpha 2 glycoprotein (ZAG) is a 41 KDa secretory soluble glycoprotein found in different body fluids like the serum, saliva, sweat, breast milk, and urine. It is also found in tissues like the testis, epididymis, kidney, spleen, liver, lungs, heart, and brain. ZAG is an adipokine with multiple roles, including lipid mobilization, modulating glucose metabolisms, improving insulin sensitivity, inhibiting tumor proliferation through RNAse activity, and suppressing inflammation. Low levels of zinc and ZAG are linked to metabolic syndrome and are also reported as potential biomarkers for diabetic nephropathy. Interestingly zinc has been found to regulate the binding of ZAG to fatty acids. Based on very few reports on the vitreous ZAG and based on its known functions, we speculate that ZAG has a potential role in diabetic retinopathy. In this article, we discuss the structural component of the protein, its secretion from various tissues, and its distribution in multiple tissues in normal and disease conditions, especially in diabetes and its complications.     

两种方法学检测锌钙镁铁与糖尿病性肾病分级的相关性

目的探讨化学法和原子吸收法检测锌(Zn)、钙(Ca)、镁(Mg)、铁(Fe)与糖尿病性肾病的分级相关性。方法选取201例糖尿病肾病(DN)病人,男124例占61.69%;女77例占38.31%,年龄23-93岁,并根据MDRD方程结果进行分级(CKD1期:135例,CKD2期:39例,CKD3期:8例,CKD4期:4例,CKD5期:5例)。检测所研究对象的Zn、Ca、Mg、Fe、肌酐(CREA)、尿素(UREA)、尿酸(UA)、糖化血红蛋白(HbA1c)、糖化白蛋白(GA%)、尿白蛋白/尿肌酐(UALB/UCREA)、24小时尿蛋白定量(24hUTP)。结果原子吸收法全血Zn CKD2期和CKD3期水平分别为(73.15±5.24,73.34±3.82)umol/L低于CKD1期(76.40±5.31)umol/L(P<0.05),原子吸收法全血Ca在CKD2(1.45±0.04)mmol/L期低于CKD1期(1.48±0.04)mmol/L(P<0.05)。与化学法检测得其它项目Zn、Ca、Mg、Fe在CKD1至5期间无显著差异。化学法和原子吸收法两方法间有统计学意义(P<0.05)。化学法Zn和Mg极强相关,在Zn和Fe、Mg和Fe中等相关,Ca和UALB/UCREA负相关。原子吸收法Zn和Ca中等相关;Ca和Fe、Mg和UALB/UCREA正相关;Zn、Ca和CKD分级负相关。原子吸收法与化学法检测四元素Zn、Ca、Mg、Fe有统计学差异(P<0.05)。结论原子吸收法锌在CKD2、3期低于CKD1期,原子吸收法钙CKD2期低于CKD1期。原子吸收法较化学法有更好的提示糖尿病肾病CKD1期转为CKD2~5期。     

地参多糖对正常及实验性糖尿病小鼠血糖的影响实验研究

目的：研究地参多糖对正常及实验性糖尿病小鼠血糖的影响。方法：。用地参多糖分别灌胃给予正常小鼠、四氧嘧啶（ALX）性糖尿病小鼠、肾上腺素（Adr）性及葡萄糖性高血糖小鼠模型,连续14d后,分别测定各组小鼠空腹血糖。结果：地参多糖对正常小鼠的血糖没有显著的降低作用,150mg/kg、300mg/kg地参多糖能显著降低四氧嘧啶性糖尿病小鼠高血糖,同时还能拮抗肾上腺素与外源性葡萄糖所致小鼠血糖升高,但150mg/kg地参多糖对肾上腺素性糖尿病小鼠高血糖无明显影响。结论：地参多糖能降低不同类型实验性糖尿病小鼠血糖。     

盐酸沙格雷酯联合前列地尔对早期糖尿病肾病尿白蛋白排泄率的影响

目的观察盐酸沙格雷酯联合注射用前列地尔对糖尿病肾病尿白蛋白治疗效果。方法将58例糖尿病肾病患者同标准分成治疗组和对照组各29例,治疗组每日给予前列地尔10μg入液静点。同时联合盐酸沙格雷酯100mg口服,3次/日。对照组仅给予前列地尔静点。2组疗程均为4周;分别观察2组治疗前后尿白蛋白排泄率（UAER）、空腹血糖（FBS）、血肌酐（Scr）、尿素氮（BUN）变化。结果 2组治疗后UAER和FBS均有明显下降,与治疗前比较,差异有显著的意义（P〈0.01）;2组治疗后比较,联合用药治疗组对较对照组UAER下降更加明显,2组差异有显著意义（P〈0.01）;2组治疗后Scr和BUN无显著差异（P〉0.05）。结论盐酸沙格雷酯联合前列地尔治疗糖尿病肾病疗效明显。     

An integrated bioinformatics analysis and experimental study identified key biomarkers CD300A or CXCL1, pathways and immune infiltration in diabetic nephropathy mice

Diabetic nephropathy (DN) is a common microvascular complication that easily leads to end-stage renal disease. It is important to explore the key biomarkers and molecular mechanisms relevant to diabetic nephropathy (DN). We used highthroughput RNA sequencing to obtain the genes related to DN glomerular tissues and healthy glomerular tissues of mice. Then we used LIMMA to analyze differentially expressed genes (DEGs) between DN and non-diabetic glomerular samples. And we performed KEGG, gene ontology functional (GO) enrichment, and gene set enrichment analysis to reveal the signaling pathway of the disease. The CIBERSORT algorithm based on support vector machine was used to determine the immune infiltration score. Random forest algorithm and Cytoscape obtained hub genes. Finally, we applied co-staining, immunohistochemical staining, RT-qPCR and western blotting to validate the protein and mRNA expression of both hub genes. We obtained 913 DEGs mainly related to inflammatory factors and immunity. GSEA results showed that differential genes were mainly enriched in IL-17 signaling pathway, lipid and atherosclerosis, rheumatoid arthritis, TNF signaling pathway, neutrophil extracellular trap formation, Staphylococcus aureus infection and other pathways. The intersection of the random forest algorithm and Cytoscape revealed both hub genes of CD300A and CXCL1. Experiments have shown that the both key genes of CD300A and CXCL1 shown increased expression in glomerular podocytes, and are related to the inflammation of diabetic nephropathy. And immunohistochemical staining and RT-qPCR further confirmed that the protein and mRNA expression level of CD300A or CXCL1 in glomeruli tissue in DN mice were increased. The expression levels of CD300A and CXCL1 increased significantly under HG (high glucose) stimulation, further confirming that diabetes can lead to increased levels of CD300A and CXCL1 at the cellular level. Through bioinformatics analysis, machine learning algorithms, and experimental research, CD300A and CXCL1 are confirmed as both potential biomarkers in diabetic nephropathy. And we further revealed the main pathways of differential genes and the differentially distributed immune infiltrating cells in diabetic nephropathy.     

Kidney injury and cell therapy: Preclinical study

The aim of this study is to show histological and immunofluorescence analysis of renal parenchyma of agoutis affected by gentamicin‐induced renal disease after the infusion of bone marrow mononuclear cells (BMMC) stained with Hoechst®. Nine agouti's males were divided into three groups: Test group (TG): renal disease by gentamicin induced (n = 3), cell therapy group (CTG): renal disease by gentamicin induced and BMMC infusion (n = 3), and control group (CG): nonrenal disease and BMMC infusion (n = 3). TG and CTG were submitted to the protocol of renal disease induction using weekly application of gentamicin sulfate for 4 months. CG and CTG received a 1 × 108 BMMC stained with Hoechst and were euthanized for kidney examination 21 days after BMMC injection and samples were collected for histology and immunofluorescence analysis. Histological analysis demonstrated typical interstitial lesions in kidney similarly to human disease, as tubular necrosis, glomerular destruction, atrophy tubular, fibrotic areas, and collagen deposition. We conclude that histological analysis suggest a positive application of agouti's as a model for a gentamicin inducing of kidney disease, beyond the immunofluorescence analysis suggest a significant migration of BMMC to sites of renal injury in CTG. Microsc. Res. Tech., 2012. © 2011 Wiley Periodicals, Inc.     

Diabetes screening by telecentric digital holographic microscopy

Diabetes is currently the world's fastest growing chronic disease and it is caused by deficient production of insulin by the endocrine pancreas or by abnormal insulin action in peripheral tissues. This results in persistent hyperglycaemia that over time may produce chronic diabetic complications. Determination of glycated haemoglobin level is currently the gold standard method to evaluate and control sustained hyperglycaemia in diabetic people. This measurement is currently made by high‐performance liquid chromatography, which is a complex chemical process that requires the extraction of blood from the antecubital vein. To reduce the complexity of that measurement, we propose a fully‐optical technique that is based in the fact that there are changes in the optical properties of erythrocytes due to the presence of glucose‐derived adducts in the haemoglobin molecule. To evaluate these changes, we propose to perform quantitative phase maps of erythrocytes by using telecentric digital holographic microscopy. Our experiments show that telecentric digital holographic microscopy allows detecting, almost in real time and from a single drop of blood, significant differences between erythrocytes of diabetic patients and healthy patients. Besides, our phase measurements are well correlated with the values of glycated haemoglobin and the blood glucose values.     

探讨高血压合并冠心病患者动态血压与心电图的相关性

目的探讨高血压合并冠心病患者的血压波动与ST-T改变及心律失常发生的相关性。方法对88例高血压和/或冠心病患者进行分组研究,其中高血压合并冠心痛组25例,高血压无并发症组28例.冠心病组35例,所有患者均同步监测24h动态血压(ABPM)和动态心电图(DCG),观察不同组血压波动与ST-T改变和心律失常发生的相关性并进行对照分析。结果 ABPM与DCG同步检出高血压合并冠心痛组血压变化与ST-T改变和心律失常发生率为88%,明显高于高血压无并发症组42.9%和冠心病组65.7%,表明高血压合并冠心痛患者血压变化与ST-T改变及心律失常有关联。结论 ABPM与DCG同步检测有助于鉴别血压变化与心脏的关系,对预防心血管事件的发生具有积极的临床意义。