Nutrient intake of patients with cystic fibrosis

Nutrient intake, anthropometric measurements, and pulmonary function were assessed in 26 young adult patients with cystic fibrosis (CF). Mean nutrient intakes, excluding those from vitamins and nutrient supplements, were less than the Recommended Dietary Allowances for folate for men and women and for iron and vitamin B-6 for women. Male cystic fibrosis patients consumed significantly more of 11 of 16 nutrients in comparison with men with Crohn's disease and men with functional gastrointestinal complaints. Female cystic fibrosis patients consumed significantly more of 9 of 16 nutrients than did women with gastrointestinal complaints. The relative body weight was less than 85% of standard in 65% of men and 50% of women with CF. Relative body weight was correlated with variables indicative of airflow obstruction, reduced vital capacity, and hyperinflation of lung volumes.     

Probabilistic approach to developing nephropathy in diabetic patients with retinopathy

It is well known that diabetes is a risk factor for many complications including diabetic retinopathy and nephropathy. An interesting question is whether a diabetic patient who has developed a retinopathy develops a nephropathy sooner. We approached this problem by calculating the conditional probability that a diabetic patient will develop a second complication, given that they had already developed the first complication. We also propose the application of Bayes' formula to estimate the probability of developing the second complication, given that the first complication had developed previously. We compared these two methods by applying them to analyse 5473 patients with type 2 diabetes. The results of our experience are described.     

糖尿病肾病患者西格列汀联合贝那普利治疗临床观察

目的糖尿病肾病(diabetic nephropathy,DN)患者若治疗不及时,易导致病情加重,造成肾功能不可逆损伤。本研究探讨西格列汀联合贝那普利对DN患者肾功能及血清白细胞介素-18(interleukin,IL-18)和胱抑素C(cystatin C,CysC)的影响。方法选择2018-01-01-2018-12-31黄河中心医院收治的86例DN患者作为研究对象,按照年龄、性别和病程等因素组间具有可比性的原则选择对照组和观察组,各43例。对照组采用西格列汀(100mg/片)口服治疗,1片/次,1次/d;观察组在对照组基础上使用贝那普利(10mg/片)口服治疗,1片/次,1次/d。比较两组治疗效果、24h尿蛋白排泄率(urinary protein excretion rate,UAER)、IL-18、CysC水平及不良反应。结果治疗后,观察组显效21例,有效19例,无效3例,治疗总有效率为93.02%(40/43);对照组显效13例,有效20例,无效10例,治疗总有效率为76.74%(33/43);组间相比差异有统计学意义,χ~2=4.441,P=0.035。治疗后,与对照组相比,观察组UAER(t=13.847,P0.001)、CysC(t=3.490,P=0.001)和IL-18(t=12.804,P0.001)水平均降低,差异有统计学意义。观察组不良反应发生率为4.65%,对照组不良反应发生率为9.30%,差异无统计学意义,χ~2=0.179,P=0.397。结论西格列汀联合贝那普利治疗DN效果显著,可有效改善机体肾功能及炎症状态,降低CysC和IL-18水平,且安全性较高。     

胰岛素治疗105例糖尿病肾病患者治疗回顾性分析

糖尿病肾病(diabetic nephropathy,DN)是糖尿病的主要并发症,也是导致终末期肾病的首位原因,严重影响了人类健康和生活质量。它的早期表现为间歇性无症状性微量蛋白尿[1]。我国近年来糖尿病发病率不断上升,患病人数仅次于印度,居世界第二位[2],据我院近8年来收集住院糖尿病患者308例,在除外其他肾脏病后的105例尿蛋白阳性者(或伴少许管型),临床诊断符合糖尿病肾病,使用胰岛素治疗,并发肾功能衰竭的患者作腹膜透析和血液透析     

Changes in food choices of recently diagnosed insulin-dependent diabetic patients

Current food use and habitual food use prior to the diagnosis of diabetes were measured using a food frequency questionnaire in a group of recently diagnosed insulin-dependent diabetic patients. Patients (51 m, 29 f) were between the ages of 20 and 40 years and had been diagnosed as insulin-dependent diabetics less than 6 months prior to the study. The results show that patients after the diagnosis of diabetes reduce their consumption of foods and beverages with high sugar content, of snacks and of foods from the dairy and meat group with high fat content, and incorporate foods with low fat content into their pattern of food consumption. Some of the changes have been less favourable from a nutritional perspective such as the increased consumption of diabetic specialty foods, the reduced consumption of pulses, and the lower overall food variety. In conclusion, patients are able to change their food use after the diagnosis of the insulin-dependent diabetes; however the extent to which patients will change their food choices on a long-term basis remains to be determined.     

Glycemic responses in insulin-dependent diabetic patients: effect of food composition

This study examined the hypothesis that the glucose component of food and not the total carbohydrate is the major determinant of the glycemic response in patients with insulin-dependent diabetes mellitus. Patients were given glucose alone, fructose alone, glucose + fructose, lactose, and glucose + fat + protein. Fructose given alone increased the blood glucose almost as much as a similar amount of glucose (78% of the glucose-alone area, p less than 0.05). However, the same amount of fructose given with glucose produced no greater glycemic response than did glucose alone (108%). Similarly, galactose contributed only slightly to the glycemic response when given as lactose (122%, p less than 0.01) whereas protein and fat had no additional glycemic effect (101%). To test the above hypothesis in natural foods, patients were fed an amount of bread (high glycemic index) or apple (low glycemic index) that contained 25 g glucose. Both challenges produced glycemic responses very similar to 25 g purified glucose.     

Usual dietary intake and hemoglobin A1 level in patients with insulin-dependent diabetes

Objective To explore epidemiologic evidence for the relationship between dietary intake and glycemic control.

Design/subjects We examined usual dietary intake, assessed by a food frequency questionnaire, from a random sample (n = 136) of patients who had had insulin-dependent diabetes mellitus for 15 to 21 years.

Results In men, absolute intakes of energy, carbohydrate, protein, fat, and dietary fiber were positively correlated with hemoglobin A₁ (HbA₁) (P<.05); Spearman correlation coefficients (r_s) were .28, .22, .28, 34, and .25, respectively. In women, the correlations were weaker and not significant; r_s values were .18, .13, .17, .19, and .16, respectively. When these nutrients were expressed as a percentage of energy or as an amount per 1,000 kcal, only percentage of energy from fat showed a significant association with HbA₁—but only in men (r_s=.23 for men and .02 for women). Adjustment for body weight, insulin dose, and physical activity using multiple regression analysis did not change the relationship between HbA₁ and intakes of energy and fat. Sucrose and alcohol intakes did not show any association with HbA₁.

Conclusions Among men with insulin-dependent diabetes mellitus, the major dietary correlates of poor glycemic control were high intake of energy and percentage of energy from fat. Further investigation is needed to confirm this relationship of energy, fat, and glycemic control.     

微量元素的检测在糖尿病及糖尿病肾病中临床意义

目的:探讨四种微量元素铜(Cu)、锌(Zn)、铁(Fe)、铬(Cr)与糖尿病(DM)及糖尿病肾病(DN)之间的关系,研究微量元素在DM发生、发展中的作用。方法:同时测定98例DM患者,DM、DN肾功能正常组53例,DM、DN肾功能不全组33例,正常对照组60例的微量元素铜(Cu)、锌(Zn)、铁(Fe)、铬(Cr)的值及肌酐(Cr)、尿素(BUN)、胱抑素C(Cy-sC)及内生肌酐清除率(CCr)的值。结果:DM组与对照组比较,铜高于正常对照组,锌、铁、铬低于正常对照组(P<0.05)。微量元素与血糖的相关性,除铜是正相关,锌、铁、铬均为负相关。DN肾功能不全组和DN肾功能正常组锌、铁、铬均低于正常对照组,铜高于正常对照组(P<0.05);DN肾功能不全组锌、铁均低于DN肾功能正常组(P<0.05)。结论:微量元素的检测,对DM的发生、发展,有效的预防并发症DN的发生,有一定的临床意义。     

足细胞标志蛋白检测在糖尿病肾病中的临床应用价值

目的 检测糖尿病肾病(DN)患者足细胞标志蛋白(PCX)表达的变化,并探讨其相关的临床意义. 方法 选择DN患者68例(DN组),按尿白蛋白与肌酐比值分为三个亚组:正常蛋白尿组(＜ 30mg/g,A组)、微量白蛋白尿组(≥30 mg/g而＜300 mg/g,B组)、大量白蛋白尿组(≥300 mg/g,C组).另选择健康体检者20例作为对照组,酶联免疫吸附试验法检测尿沉渣中PCX表达水平. 结果 DN组患者尿沉渣中PCX、血肌酐、血尿素氮的表达水平显著高于对照组[(27.44±6.87) μg/L比(3.52±1.13) μg,/L、(154.82±11.54) μmol/L比(82.56±5.71)μmol/L、(8.79±0.58) mmol/L比(4.23±0.34) mmol/L,P＜0.01];A、B、C组PCX的表达水平分别为(18.04±4.12)、(23.58±5.43)、(32.18±6.05)μg/L,差异均有统计学意义(P＜0.05);A、B、C组血肌酐、血尿素氮分另为 (138.54±8.66)、(142.16±11.74)、(165.13±12.85) μmol/L,(8.48±0.43)、(8.56±0.61)、(10.04±1.17) mmol/L,血肌酐、血尿素氮在A组和B组比较差异无统计学意义(P＞0.05),但在A组和C组、B组和C组比较差异有统计学意义(P＜0.05).结论 DN患者尿沉渣中存在PCX的高表达,检测PCX有利于DN患者肾损害的早期诊断和病变程度的评估.     

厄贝沙坦辅助治疗糖尿病肾病的疗效及对患者肾功能、血清炎症细胞因子水平的影响

目的探讨厄贝沙坦辅助治疗糖尿病肾病的疗效及对患者肾功能和胰岛素样生长因子1 (insulin-like growth factor-1,IGF-1)、高迁移率族蛋白B1(high-mobility group box-1,HMGB1)、血管内皮生长因子165(vascular endothelial growth factor,VEGF165)水平的影响。方法前瞻性选取2016年5月~2018年5月马鞍山十七冶医院收治的糖尿病肾病患者86例,按照随机数表法分为对照组和观察组各43例。对照组于每餐前皮下注射门冬胰岛素30注射液,0.5~1.0 U/(kg·d),3次/d,并根据患者情况调整剂量;观察组在对照组的治疗基础上,予以厄贝沙坦150 mg,1次/d,口服。两组患者均连续治疗3个月,观察临床疗效,比较治疗前后两组患者空腹血糖(fasting plasmaglucose,FPG)、餐后2 h血糖(2 hours plasmaglucose,2hPG)和糖化血红蛋白(HbA1c)、血压、肾功能[血包括血清肌酐(serum creatinine,Scr)、尿素氮(BUN)、同型半胱氨酸(Homocysteine,Hcy)、胱抑素C(cystain C,Cys C)]及IGF-1、HMGB1、VEGF165水平。结果两组治疗后总有效率对比,观察组高于对照组(93.02%vs.74.42%),差异有统计学意义(P <0.05)。治疗后,观察组FPG、2hPG、HbA1C、收缩压、舒张压、Scr、BUN、Hcy及Cys C水平明显低于对照组,观察组血清IGF-1、HMGB1、VEGF165水平明显低于对照组,差异有统计学意义(P <0.05)。结论厄贝沙坦联合门冬胰岛素30注射液治疗糖尿病肾病可提高临床疗效,降低血糖和血压水平,改善肾功能及血清炎性细胞因子水平。     

Nutrient intake and nitrogen metabolism in cancer patients during oncological chemotherapy

Aggressive oncological chemotherapy often impairs the nutritional status of tumor patients. To evaluate the pathogenetic mechanisms, food intake in 13 cancer patients was investigated in correlation with nitrogen losses, N balances, muscle wasting, and weight course, during cytostatic therapy. Median daily N and energy intakes were reduced only in patients with weight loss [0.55 g protein, 16.5 kcal/kg ideal body wt (IBW)]. Patients with constant weight had the same intake as control subjects (1.27 g protein, 37.2 kcal IBW). N balances and creatinine height index (CHI) correlated with daily nutrient intake. Fecal N excretions did not correlate with urinary losses; there was no excess of fecal N loss because of cytostatic treatment. The impairment of cancer patients' nutritional status seems to depend primarily on the decrease of spontaneous oral intake as a consequence of the side effects of tumor therapy. Changes in CHI, compared before and after chemotherapy, indicated muscle wasting of weight-losing patients.     

吡格列酮对2型糖尿病肾病血清脂联素水平的影响

目的观察噻唑烷二酮衍生物吡格列酮对2型糖尿病肾病患者血清脂联素水平的影响,并探讨其临床意义。方法临床选择研究2型糖尿病肾病52例,分为糖尿病肾病对照组(29例)和吡格列酮治疗组(23例)。所有患者均给予口服降糖药或胰岛素控制血糖常规治疗,待血糖稳定1周后,对照组继续维持原治疗,吡格列酮治疗组加用吡格列酮片口服8周(30mg/日)。各组治疗前后均测定空腹血糖(FPG)、糖化血红蛋白(HbA1c)、24h尿白蛋白定量(24hUA)、高敏C-反应蛋白(hs-CRP)和脂联素水平。结果①糖尿病肾病对照组与吡格列酮治疗组对比,治疗前FPG、HbA1c、24hUA、hs-CRP和脂联素水平均无明显差别,差异无统计学意义(P﹥0.05)。②治疗8周后,糖尿病肾病对照组的24hUA、hs-CRP和脂联素水平与治疗前对比无明显改变,差异无统计学意义(P﹥0.05),但是吡格列酮治疗组的24hUA、hs-CRP和脂联素水平却明显下降,差异有统计学意义(P﹤0.05)。结论噻唑烷二酮衍生物能够降低2型糖尿病肾病患者的脂联素水平,改善糖尿病的肾脏损害,减少尿白蛋白滤过。     

胱抑素C在2型糖尿病肾病患者早期的检测及意义

目的:血清和尿液探索胱抑素C在预测2型糖尿病肾病患者蛋白正常时肾功能损害的临床意义,评价其与蛋白尿的关系。方法:将232例患者分成3组:正常蛋白尿组、微量白蛋白尿组和大量白蛋白尿组,检测肌酐、尿白蛋白、血清/尿胱抑素C、肾小球滤过率(eGFR、MDRD计算的eGFR和CKD-EPI计算的eGFR)。结果:胱抑素C随尿蛋白的增加而增加。血清胱抑素C受CRP、性别、尿白蛋白/肌酐比值和eGFR影响,而尿胱抑素C受甘油三酯、年龄、eGFR和ACR影响。胱抑素C在正常蛋白尿组MDRD计算的eGFR<60 ml/min/1.73 m2中是独立因子。结论:胱抑素C在诊断2型糖尿病肾病尿蛋白正常时为有用的指标。     

血管紧张素Ⅱ受体拮抗剂对糖尿病肾病蛋白尿影响的临床观察

目的观察血管紧张素Ⅱ1型受体拮抗剂缬沙坦时伴有高血压的糖尿病肾病减少蛋白尿的有效性和安全性。方法121例糖尿病肾病患者分为治疗组91例，对照组30例，两组均给予阿斯匹林100mg／d，尼群地平10mg，3次／d，治疗组在上述治疗基础上加缬沙坦160～240mg／d，疗程60mo，治疗前后行尿微量白蛋白测定。结果缬沙坦治疗组尿蛋白明显减少，自身比较及与对照组比较差异有统计学意义（P〈0．01）；缬沙坦240mg剂量优于160mg，临床转归观察治疗组完全缓解和部分缓解率为83.6％，明显高于对照组（6．7％）。结论缬沙坦可明显减少DN蛋白尿，对肾脏有明显的保护作用，并且耐受性较好。     

Biphasic intrauterine growth in insulin-dependent diabetic pregnancies

Early fetal growth delay (7-14 weeks of gestation) has been reported in insulin-dependent diabetic (IDD) pregnancies and in several animal models. Macrosomia is a classic feature of the infant of the IDD mother. We hypothesized therefore that a biphasic pattern of fetal growth exists in IDD pregnancies. We compared fetal growth measurements [biparietal diameter (BPD) and abdominal circumference (AC)] obtained sonographically from 106 IDD pregnancies (Class B-RT) to similar data obtained from 117 normal, nondiabetic patients. The goals for diabetic glycemic control were: fasting blood sugar less than or equal to 100 mg/dl and postprandial blood sugar less than 140 mg/dl. From one to five ultrasonographic measurements were performed at varying gestational ages in all study patients. For data analysis, one examination from each pregnancy was randomly selected by computer. Gestational age (GA) was calculated from last menstrual period and corroborated by infant physical examination (Ballard score) at birth. BPD growth pattern was biphasic in the diabetic group, described by a cubic equation: BPD = 4.99 - 0.567GA + 0.037(GA)2 - 0.0005(GA)3, R2 = 0.935. Such a biphasic pattern did not exist in the control population [BPD = -3.0323 + 0.473(gestation) - (-0.0040)(gestation)2, R2 = 0.9173]. Early growth delay was greater in fetuses that subsequently developed macrosomia (p less than 0.01). Similar results were found for AC measurements. We conclude that fetal growth delay occurs in the first half of the IDD pregnancy, followed by a phase of increased growth. The mechanism of the early growth delay is unclear. We speculate that early growth delay may be due to a "toxic" effect of glucose or other metabolite; and subsequent increased growth relates to fetal hyperinsulinism which develops from weeks 15 to 20 of gestation.     

不同白蛋白尿水平的2型糖尿病肾病患者血清不对称性二甲基精氨酸与血管内皮损伤的相关性研究

目的 探讨不同白蛋白尿水平的2型糖尿病肾病患者血清不对称性二甲基精氨酸(ADMA)与血管内皮损伤的相关性.方法 将81例2型糖尿病肾病患者按尿白蛋白排泄率(UAER)分为微量白蛋白尿组(UAER 21～199 mg/24h,38例)和大量白蛋白尿组(UAER≥200 mg/24h,43例),另选择20例健康体检者作为对照组,均应用彩色多普勒超声诊断仪检测右前臂桡动脉内膜-中层厚度和内皮舒张功能,并采用酶联免疫吸附法测定血清ADMA.结果 三组桡动脉腔内径及内膜-中层厚度比较差异无统计学意义(P＞0.05);微量白蛋白尿组、大量白蛋白尿组内皮依赖性舒张功能(EDD)和非内皮依赖性舒张功能(EID)均明显低于对照组[(10.45±2.58)％、(7.56±2.17)％比(15.72±3.05)％、(15.42±2.71)％、(15.37±2.92)％比(19.31±3.76)％],大量白蛋白尿组EDD明显低于微量白蛋白尿组,差异均有统计学意义(P＜0.05).微量白蛋白尿组、大量白蛋白尿组血清ADMA均明显高于对照组[(0.63±0.08)、(0.92±0.12)μmol/L比(0.39±0.05)μmol/L],大量白蛋白尿组明显高于微量白蛋白尿组,差异均有统计学意义(P＜0.05).2型糖尿病肾病患者血清ADMA与EDD呈负相关(r=-0.81,P=0.020),与C反应蛋白呈正相关(r=0.75,P=0.034).结论 2型糖尿病肾病患者血清ADMA显著升高,其升高与动脉内皮功能损伤密切相关.