川芎嗪联合贝那普利治疗糖尿病肾病的疗效分析

目的观察川芎嗪联合贝那普利治疗糖尿病肾病(DN)的疗效及安全性。方法按数字表法将144例DN患者随机分为A组、B组和C组各48例,三组患者均给予常规治疗。A组在常规治疗基础上,给予川芎嗪注射液150 mg加入0.9%氯化钠注射液250 mL静滴,1次/d;口服贝那普利10 mg,1次/d;B组在常规治疗基础上,静滴川芎嗪注射液,用量用法同A组;C组在常规治疗基础上,口服贝那普利,用量用法同A组。三组疗程均为4周。结果 (1)A组患者临床疗效明显优于B组和C组(P均<0.01);(2)A组患者24 h尿蛋白排泄率(UAER)、血清肌酐(Scr)、尿素氮(BUN)等肾功能指标改善程度明显优于B组和C组(P均<0.01);(3)A组患者收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)水平显著低于B组和C组(P均<0.01)。三组患者在治疗期间均未出现药物不良反应。结论在常规治疗基础上,川芎嗪联合贝那普利治疗DN,能显著减少DN患者的尿蛋白,有效改善患者的症状,延缓和减轻肾功能恶化的程度和速度,且安全性好,值得基层医院推广应用。     

丹红注射液治疗糖尿病肾病疗效观察

将58例糖尿病肾病(DN)患者随机分为两组,对照组行常规治疗,治疗组在常规治疗基础上加用丹红注射液;治疗前后检测24h尿蛋白定量、血浆白蛋白、血脂、血肌酐、尿素氮,评定临床疗效.结果与对照组比较,治疗组临床疗效明显(P<0.05);用药后24h尿蛋白定量明显降低(P<0.01),血白蛋白升高,血脂下降(P均<0.05),血肌酐、尿素氮控制优于对照组.提示丹红注射液对DN患者有明显的降低尿蛋白、改善肾功能作用.     

雷公藤多苷治疗糖尿病肾病的前瞻性随机对照临床试验

目的:糖尿病肾病(DN)的发病率逐年升高,随着病情进展,出现大量蛋白尿、肾功能恶化,最终导致肾功能衰竭。但目前除血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体阻断剂(ARB)外,尚无治疗DN大量蛋白尿的有效手段,本文前瞻性的观察了雷公藤多苷(TW)治疗DN的疗效及其安全性。方法:符合2型糖尿病(T2DM),DN,且尿蛋白≥2.5g/24h的患者65例,随机分为TW治疗组(n=34)和ARB对照组(n=31),治疗组予TW120mg/d治疗3月后减量至60mg/d维持治疗3月,对照组予缬沙坦胶囊160mg/d治疗,观察6月。观察尿蛋白下降程度及肾功能进展情况。结果:到达治疗终点6月时,TW组尿蛋白较基线明显下降[(4.99±2.25)vs(2.99±1.81)g/24h,P0.01],且起效迅速,第1、3、6月平均下降幅度分别为32.9%、38.8%和34.3%;而ARB组尿蛋白下降幅度分别为1.05%、10.1%和-11.7%。两组患者随访过程中平均SCr水平较基线均有升高,但至随访终点,ARB组SCr升高幅度明显高于TW组(36.9%vs20.3%,P0.05),eGFR下降幅度高于TW组(24.6%vs13.7%,P0.05)。然而,TW组至随访终点血浆白蛋白水平升高不明显[(33.0±5.66)vs(34.8±5.49)g/L,P0.05),而ARB组尿蛋白虽无明显改善,但血浆白蛋白较基线升高[(33.07±4.74)vs(36.3±5.47)g/L,P0.01)。不良反应的发生率两组间无明显差异。结论:TW能够有效减少DN患者尿蛋白,延缓肾功能进展,疗效优于ARB,且不良反应少,耐受良好,是治疗DN的有效药物。     

糖尿病肾病尿毒症者应用血透治疗的临床效果分析

目的探究血液透析治疗糖尿病肾病(DN)尿毒症的临床效果。方法资料随机选取2013年3月—2014年3月该院收治的73例糖尿病肾病尿毒症患者作为DN组,并随机选取75例同期非糖尿病肾病尿毒症患者作为非DN组,均行血液透析治疗,分析两组各项临床检验指标改善、生活质量改善和并发症情况。结果治疗后DN组白蛋白水平低于非DN组,血糖值高于非DN组(P0.05),两组其他临床检验指标比较均无明显差异(P0.05);治疗后DN组GQLI评分高于非DN组(P0.05);DN组并发症发生率高于非DN组(P0.05)。结论糖尿病肾病尿毒症患者应尽早进行血液透析治疗,并积极防控并发症的发生,以延长生存期并提高生活质量。     

尿蛋白阴性糖尿病肾病患者肾功能异常的影响因素

目的探讨尿蛋白阴性糖尿病肾病(DN)患者肾功能异常可能的影响因素。方法选择尿蛋白阴性的DN患者205例,其中尿蛋白阴性的糖尿病肾脏疾病患者108例(DN组),无白蛋白尿2型糖尿病患者肾功正常患者97例(对照组)。比较两组的临床资料和实验室检查,Logistic回归分析肾功能下降的影响因素。结果在尿蛋白阴性的DN患者中踝肱指数(ABI)、趾肱指数(TBI)显著低于对照组,颈动脉内中膜厚度(CIMT)显著高于对照组(P0.05)。尿蛋白阴性的DN患者肾小球滤过率(GFR)与ABI、TBI呈显著正相关;ABI、TBI为尿蛋白阴性的DN患者的独立危险因素。结论尿蛋白阴性的DN疾病的发生可能与动脉硬化有关。     

糖尿病肾病尿毒症者应用血透治疗的临床效果分析

目的探究血液透析治疗糖尿病肾病(DN)尿毒症的临床效果。方法资料随机选取2013年3月—2014年3月该院收治的73例糖尿病肾病尿毒症患者作为DN组,并随机选取75例同期非糖尿病肾病尿毒症患者作为非DN组,均行血液透析治疗,分析两组各项临床检验指标改善、生活质量改善和并发症情况。结果治疗后DN组白蛋白水平低于非DN组,血糖值高于非DN组(P<0.05),两组其他临床检验指标比较均无明显差异(P>0.05);治疗后DN组GQLI评分高于非DN组(P<0.05);DN组并发症发生率高于非DN组(P<0.05)。结论糖尿病肾病尿毒症患者应尽早进行血液透析治疗,并积极防控并发症的发生,以延长生存期并提高生活质量。     

西格列汀对老年糖尿病肾病患者临床指标的影响

目的探讨西格列汀治疗对老年糖尿病肾病(DN)患者肾功能等临床指标的影响。方法选择80例老年DN患者,按照自愿原则分为观察组与对照组,各40例。在糖尿病常规治疗基础上,对照组实施胰岛素治疗,观察组使用西格列汀治疗。连续治疗6个月后,对比观察两组患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血压、体重指数(BMI)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、炎性指标及肾功能的变化。结果观察组与对照组纤维蛋白原(FIB)、FPG、HbA1c治疗后均降低(P0.05),治疗后两组无差异(P0.05),两组血清TG、LDL-C治疗后均降低(P0.05),观察组降低优于对照组(P0.05);治疗后对照组及观察组尿蛋白/肌酐、24 h尿蛋白定量下降,内生肌酐清降率(Ccr)上升(P0.05),观察组较对照组改善明显(P0.05);观察组与对照组C反应蛋白(CRP)、白细胞介素(IL)-6、IL~(-1)0、纤溶酶原激活物抑制剂(PAI)~(-1)治疗后相比治疗前均有显著改善(P0.05),观察组较对照组改善明显(P0.05)。结论西格列汀治疗老年DN临床效果好,利于降糖、减轻炎症反应,控制尿蛋白,保护肾功能。     

安体舒通在糖尿病肾病治疗中的应用效果观察

目的 研究对在已应用血管紧张素转化酶抑制剂(ACEI)和(或)血管紧张素Ⅱ受体拮抗剂(ARB)治疗且尿蛋白仍在0.5 g/24 h以上的糖尿病肾病(DN)患者加用小剂量安体舒通,观察其对尿蛋白及肾功能的影响.方法 按开放、随机、对照的方法将临床确诊为DN患者38例分为安体舒通组和对照组.安体舒通组在原应用ACEI和(或)ARB基础上加用安体舒通20 mg/d,对照组继续按原量服用ACEI和(或)ARB药物.于治疗第0、4、8、12、16周检测24h尿蛋白、血清肌酐、血清钾、血浆醛固酮、血压,并根据血清肌酐计算肾小球滤过率(eGFR).结果 治疗后安体舒通组尿蛋白较前明显下降(P＜0.05),而对照组蛋白尿无明显下降.两组肾功能、eGFR、血钾、血浆醛固酮水平、血压治疗前后变化水平无统计学差异.结论 在应用ACEI和(或)ARB基础上加用安体舒通可明显降低DN患者尿蛋白水平.     

疏血通联合替米沙坦对早期糖尿病肾病的疗效观察

目的 评价疏血通注射液联合替米沙坦对早期糖尿病肾病(DN)的临床疗效.方法 选取2011年1月-2011年11月住院糖尿病肾病患者84例,随机分为两组.对照组(38例)给予常规降糖,降压及调脂,优质蛋白饮食治疗;治疗组(46例)在对照组治疗基础上给予疏血通注射液、替米沙坦治疗.结果 治疗14 d后两组血肌酐、尿素氮,24 h尿蛋白,24 h尿微量白蛋白排泄率比较有统计学意义(P＜0.05),治疗组优于对照组.结论 疏血通注射液联合替米沙坦治疗有效减少DN患者的蛋白尿,改善肾功能.     

氯沙坦钾治疗糖尿病早期肾病的临床观察

选择40例DN患者,随机分为2组,均予降血糖、降血压基础治疗,A组加用氯沙坦钾,B组予安慰剂。结果观察12周,A组患者24h尿总蛋白与B组比较均明显降低（P〈0.05）。结论氯沙坦钾可以减少尿蛋白的排出,改善肾功能。     

糖尿病肾病患者血脂异常及血清脂蛋白(a)与糖尿病肾病的关系

目的研究糖尿病肾病患者血脂变化及血清脂蛋白(a)[Lp(a)]与糖尿病肾病(DN)的关系。方法将110例2型糖尿病患者分为正常蛋白尿组(A组,43例)、微量蛋白尿组(B1组,37例)和大量蛋白尿组(B2组,30例)3组,分别检测其血脂及脂蛋白(a)水平,并与对照组(50例)比较。结果与对照组比较,2型糖尿病患者各组甘油三脂(TG)、低密度脂蛋白胆固醇(LDLC)和Lp(a)水平均升高,B1组、B2组与A组比较及B2组与B1组比较,Lp(a)均升高,差异有显著性(P<0.01);B1组、B2组胆固醇(TC)水平升高及高密度脂蛋白胆固醇(HDLC)、载脂蛋白A1(ApoA1)水平降低,B2组载脂蛋白B(ApoB)水平升高,差异有显著性(P<0.01);TG、LDLC、ApoB的升高与尿白蛋白排泄率(UAER)呈正相关,TG、LDLC升高与空腹血糖(FBG)呈正相关。Lp(a)与尿白蛋白排泄率呈正相关,与其它血脂变化无相关性。结论脂蛋白(a)水平升高可能继发于糖尿病肾病的肾脏损害,随肾脏损害的加重而逐步升高;高脂血症促进糖尿病肾病的发生和发展,糖尿病则加重血脂紊乱,形成恶性循环。     

肾上腺髓质素与糖尿病肾病肾小管间质病变的关系研究

目的研究肾上腺髓质素(ADM)水平的变化对糖尿病肾病(DN)肾小管间质病变的关系。方法将42例糖尿病患者分为单纯糖尿病组(A组)、早期糖尿病肾病(DN)组(B组)、临床期DN组(C组),另选11例健康志愿者为D组。检测其ADM、内皮素-1(ET-1)水平,分析其与肾小管间质损伤标志物尿α1-MG、β1-MG水平的相关性。结果 4组研究对象血浆ADM及ET-1水平比较,差异均有统计学意义(P<0.05);血浆ADM与肾小管间质损伤标志物血、尿α1-MG,尿β1-MG水平呈正相关(均P<0.05)。结论 DN早期的肾脏血流动力学紊乱,ADM在肾小管间质病变的发展中可能起着重要的作用。     

分析糖尿病肾病和非糖尿病肾病腹膜透析患者容量负荷及营养状态

目的观察对比糖尿病肾病和非糖尿病肾病腹膜透析患者容量负荷及营养状态。方法该院2019年2月—2020年2月收治的108例行腹膜透析治疗患者为该次研究对象,按照患者疾病类型是否为糖尿病肾病分为A组(54例糖尿病肾病)与B组(54例非糖尿病肾病),比较两组患者容量负荷及营养状态。结果A组患者治疗6个月后血压、尿量以及超滤量等容量负荷相关参数均高于B组,数据差异有统计学意义(P<0.05)。A组患者治疗6个月后水肿个体所占比例62.96%显著高于B组48.15%,数据差异有统计学意义(χ²=5.523,P<0.05)。A组患者治疗6个月后白蛋白、总蛋白等营养指标均低于B组,数据差异有统计学意义(P<0.05)。A组患者治疗6个月后营养不良率74.07%显著高于B组营养不良率38.89%,数据差异有统计学意义(χ²=13.599,P<0.05)。结论糖尿病肾病患者与非糖尿病肾病患者经血液透析治疗6个月后处于较高的容量负荷状态,营养状态较差。     

Conformational mediated renal selectivity towards albumin in diabetes mellitus

In an attempt to define the nature of renal selectivity in diabetes mellitus, we have determined the free sulfhydryl (SH) groups of serum and urinary albumin in 9 normal subjects and 24 diabetic patients with various grades of renal involvement, as defined by their urinary excretion rates of albumin (alb. UER): 8 with alb. UER less than 10 micrograms/min (Group A), 6 with alb. UER between 10 and 30 micrograms/min (Group B), 5 with alb. UER between 30 and 200 micrograms/min (Group C) and 5 with alb. UER greater than 200 micrograms/min (Group D). The free SH group content of urinary albumin was three to four fold increased in comparison with its serum homologue in normal subjects and in diabetics with normal or slightly increased alb. UERs (Groups A and B). Diabetics in Group C showed a two-fold increase in free SH groups of urinary albumin compared to serum albumin and diabetics with clinical nephropathy (Group D) showed no increase at all. The SH group content of urinary albumin correlated in all diabetics with the concentration of glycosyl albumin and the of urinary/serum albumin SH groups ratio was inversely correlated with alb. UER. From these observations concerning the selectivity properties of the renal filter in normal and diabetic subjects, it is concluded that the mechanism for progression of diabetic nephropathy may be the hyperfiltration of albumin with an altered conformational state.     

肝硬化亚临床肾病的诊断方法及肾病形成机制的探讨

我们用放射免疫分析方法检测了肝硬化患者尿中3种微量蛋白,同时测定了血清部分免疫球蛋白和补体。结果,43例肝硬化一般肾功能正常患者尿白蛋白明显增高者29例(67％),尿IgG增高者24例(55％),THP增高者18例(42％),与正常对照组比差异具显著性。血清IgA显著升高,且与尿白蛋白增高相平行,但不同肝功能分级间无明显变化。因此,我们认为血清IgA升高与肝硬化肾病形成有关,尿微量蛋白测定可作为肝硬化亚临床肾病的诊断方法。     

Reversible acute renal failure and nephrotic syndrome in a Type 1 diabetic patient

Nephrotic syndrome is a condition commonly associated with end-stage renal disease secondary to diabetic nephropathy. It is usually associated with long-standing renal insufficiency, microalbuminuria, and overt proteinuria. We present a diabetic patient with acute oliguric renal failure and nephrotic syndrome. At presentation, he had a serum creatinine of 2.3 mg/dl, blood urea nitrogen (BUN) of 69 mg/dl, urinary protein excretion of 10.5 g/24 h, serum albumin of 1.3 g/dl, and a urine output < 400 cc/24 h. A renal biopsy was done and the renal pathology was compatible with early diabetic nephropathy. Despite intense diuretic therapy, the patient's renal condition did not improve, and peritoneal dialysis was started several months after diagnosis. After 8 months of dialysis therapy, the patient's renal parameters and urinary output spontaneously restored to normal limits (serum creatinine was 1.1 mg/dl, urinary albumin excretion was 411 mg/24 h, serum albumin was 4.3 g/dl, and normal urine output) and dialysis was discontinued. His renal function did not deteriorate after discontinuation of dialysis. We conclude that this patient's reversible acute renal failure and nephrotic syndrome were associated with minimal change disease and not due to diabetic nephropathy.     

Risk factors for diffuse and focal macular edema

OBJECTIVE: The epidemiological risk factors for the different forms of diabetic macular edema (focal or diffuse) are not differentiated in the literature. In the present study, the objective was to determine which risk factors influence the appearance of focal or diffuse macular edema. RESEARCH, DESIGN, AND METHODS: A 4-year prospective study in a population of Type II diabetic patients (NIDDM) in three groups, the first with 29 patients with diffuse diabetic macular edema (Group A), the second with 32 patients with focal macular edema (Group B), and the third with 32 patients with diabetic retinopathy but without diabetic macular edema (Group C); the three groups were selected on the basis of sex, age, and duration of diabetes with similar patterns. We studied the following risk factors: treatment of diabetes mellitus by insulin, presence of diastolic blood hypertension, presence of microalbuminuria or diabetic nephropathy, levels of HbA1c, type of diabetic retinopathy, presence of previous panretinal photocoagulation, and levels of triglycerides and fractions of cholesterol. RESULTS: In discriminant analysis and in order of importance, the epidemiological risk factors for Group A were the following: presence of panretinal laser, diastolic blood hypertension, diabetic nephropathy, and insulin treatment; for group B, the risk factors were the following: insulin treatment, presence of diastolic blood hypertension, and high levels of glycated haemoglobin (HbA1c); and for group, C the risk factors were the following: diastolic blood hypertension, insulin treatment of diabetes, and high levels of HbA1c. CONCLUSIONS: In the present study, the group of patients with focal macular edema were epidemiologically similar to the group of patients with diabetic retinopathy without macular edema, the group of patients with diffuse macular edema were epidemiologically different.     

低分子质量肝素治疗糖尿病肾病30例临床分析

目的　观察低分子质量肝素对糖尿病肾病的治疗效果。方法　 6 0例糖尿病肾病患者随机分为A、B两组。A组常规治疗基础上加低分子质量肝素 (法安明 ) 5 0 0 0U每日 2次 ,皮下注射 ,10天 1个疗程。B组予以常规治疗 ,不加法安明。结果　A组治疗后尿蛋白明显减少 ,差异显著 (P <0 .0 1)。而B组治疗前后尿蛋白变化无差异 (P >0 .0 5 )。A、B两组疗效比较差异有显著性 (P <0 .0 5 )。结论　糖尿病肾病临床蛋白尿期 ,低分子质量肝素治疗对减少尿蛋白有一定疗效。     

Non-enzymatic glycosylation of urinary proteins in Type 1 (insulin-dependent) diabetes: correlation with metabolic control and the degree of proteinuria

Summary In 18 control subjects and in 41 Type 1 (insulin-dependent) diabetic patients (13 with normal proteinuria, group A; 15 with microproteinuria, group B; and 13 with clinical proteinuria, group C), mean blood glucose, glycosylated haemoglobin and non-enzymatic glycosylated serum and urinary proteins, expressed as 5-hydroxymethylfurfural (5-HMF), were measured. In each group of diabetic patients, the levels of mean daily blood glucose, glycosylated haemoglobin and serum 5-HMF/mg protein were higher than in the control subjects. The urinary 5-HMF/mg proteinuria and the urinary/serum 5-HMF concentration ratio values were raised in group A and reduced in groups B and C. Moreover, they showed a negative correlation with 24-h urinary protein excretion in the control subjects and in each group of diabetic patients. The urinary 5-HMF/day in groups A, B and C was greater than in the control subjects. The urinary 5-HMF/day did not correlate with the mean daily blood glucose levels and, only in group A, did it correlate with serum 5-HMF and glycosylated haemoglobin. This suggests that, in this group, functional factors result in the increased renal elimination of 5-HMF and, therefore, of non-enzymatically glycosylated proteins. However, in the other groups of patients, this elimination depends on the degree of proteinuria.     

FDP/尿蛋白比值检测在90例糖尿病肾病诊断中临床应用

目的研究FDP/尿蛋白比值检测在糖尿病肾病诊断中的临床意义。方法选取该院接受治疗的糖尿病肾病患者90例作为研究对象,其中FDP/尿蛋白比值大于0.1的20例患者作为观察组,FDP/尿蛋白比值小于0.5的26例患者作为对照组,对所有患者每个月进行1次随访,并使用酶联免疫吸附法检测患者的凝血、纤溶指标,观察患者尿蛋白与肾功能的变化。结果糖尿病肾病患者的FDP/尿蛋白比值与凝血、纤溶活性以及HbA1C、尿蛋白呈现出明显的正相关的关系,糖尿病肾病患者的FDP/尿蛋白比值与肾功能呈现出负相关的关系,观察组患者与对照组患者相比,观察组患者存在着明显的凝血与纤溶活性增强的状况,并且肾功能恶化速度也比较快。结论糖尿病肾病患者的FDP/尿蛋白比值不仅能够反映患者的凝血和纤溶状态,而且能够反映糖尿病肾病患者的病情状况,预测出患者肾功能的恶化速度,对于糖尿病肾病的诊断与治疗具有重要意义。