阿魏酸钠对糖尿病早期肾损害患者血浆内皮素-1、肾功能的影响

目的探讨阿魏酸钠对糖尿病患者早期肾损害的治疗价值。方法将80例伴有微量白蛋白尿的2型糖尿病患者随机分为常规治疗组（RTG组）和阿魏酸钠治疗组（SFG组）。比较治疗前后血脂、内皮素-1（ET-1）、血尿β2-微球蛋白（β2-MG）及尿微量白蛋白（Alb）的变化。结果与治疗前比较,SFG组血尿β2-MG、尿Alb及血ET-1均显著降低（P〈0.01）,并且脂质代谢紊乱亦有改善;而RTG组血尿β2-MG、尿Alb及血ET-1治疗前后比较,差异无统计学意义（P〉0.05）。结论阿魏酸钠治疗能改善血管内皮功能,逆转糖尿病患者的早期肾损害。     

血浆内皮素和同型半胱氨酸与糖尿病性肾脏疾病的相关性研究

目的探讨血浆内皮素（ET）和同型半胱氨酸（Hey）与糖尿病性肾脏疾病（DKD）的关系。方法测定116例糖尿病（DM）患者和100名正常对照者（NC组）血浆ET、Hcy及尿白蛋白排泄率（UAER）。结果DM无肾病组血浆ET和Hcy含量均高于NC组（P〈0．05）;微量白蛋白尿组与临床白蛋白尿组血浆ET和Hcy均与NC组比较有统计学差异（P〈0．05）。相关性分析显示,临床白蛋白尿组血浆ET和Hcy与UAER呈正相关。结论血浆ET和Hcy的上升,可能反映DKD的进展。     

消渴保肾汤治疗早期糖尿病肾病的临床研究

摘要收集2型糖尿病DN患者共120例,随机分为中西结合治疗组（60例）,西药对照组（60例）,两组均采用严格血糖控制及口服洛汀新治疗,治疗组加服中药。结果：治疗组在降低尿微量白蛋白（UAER）、ET、hs—CRP及提高血清NO水平方面取得较好的疗效,（P〈0．05）;两组治疗前后空腹血糖（FPG）、糖化血红蛋白（HbA．c）和血压无统计学意义（P〉0．05）。结论：加用中药消渴保肾汤治疗,能进一步降低尿VAER。     

糖尿病肾病患者TNF-α,hsCRP的变化及意义

目的分析糖尿病肾病（DN）患者肿瘤坏死因子-α（TNF—α）、超敏C反应蛋白（hsCRP）水平的变化及意义。方法将302例2型糖尿病（T2DM）患者根据24h尿白蛋白排泄率（UAER）分为正常白蛋白尿组、微量白蛋白尿组和临床白蛋白尿组,测定各组TNF-α、hsCRP水平。结果三组间比较,随着UAER的增加,TNF-α、hsCRP水平逐渐升高;TNF-α和hsCRP与UAER呈显著正相关（r分别为0．420、0．468,P均〈0．01）。结论T2DM患者TNF-α、hsCRP水平与DN关系密切。     

缬沙坦联合胰激肽原酶治疗早期糖尿病肾病的疗效观察

目的观察缬沙坦联合胰激肽原酶治疗早期糖尿病肾病（DN）的临床疗效。方法90例早期DN患者随机分成3组,缬沙坦联合胰激肽原酶组、缬沙坦组及对照组各30例,观察6个月,比较治疗前后患者尿白蛋白排泄率（UAER）、尿β2-微球蛋白（β2-GM）、平均动脉压（MAP）、血清肌肝（Scr）及糖化血红蛋白（HbA1c）变化。结果治疗后缬沙坦联合胰激肽原酶组及缬沙坦组UAER及尿β2-MG较治疗前显著下降（P〈0．01）,且较对照组显著下降（P〈0．01）,缬沙坦联合胰激肽原酶组较缬沙坦组下降更为显著（P〈0．01）,3组治疗后MAP较治疗前均有明显下降（P〈0．01）,3组之间无统计学差异（P〉0．05）。结论缬沙坦联合胰激肽原酶治疗早期DN疗效确切,可有效减轻糖尿病肾病患者白蛋白尿。     

阿魏酸钠对早期糖尿病肾病的治疗观察

将同期住院病人随机分为对照组和治疗组进行观察≈结果：两组治疗前后对微量白蛋白尿定量对比观察有显著差异（P〈0．05）；结论：阿魏酸钠具有降低尿白蛋白排泄和改善肾功能作用，其机制可能与拮抗内皮素有关。     

尿微量白蛋白与老年糖尿病并发脑梗死的关系

目的观察老年糖尿病患者尿微量白蛋白排泄率（UAER）与脑梗死的关系,并对其他相关危险因素进行分析。方法对收治的105例老年糖尿病患者,按是否合并脑梗死分两组,测定各组患者的空腹血糖（FBG）、糖化血红蛋白（HbAlC）、血脂、UAER等指标并进行相关影响因素的Logistic回归分析。结果糖尿病并发脑梗死组UAER、FBG水平均高于糖尿病非脑梗死组（P〈0．01）,多因素回归分析显示老年糖尿病并发脑梗死与UAER（r=0．533P〈0．01）、FBG（r=0．457,P〈0．05）均呈正相关。结论尿微量白蛋白和空腹血糖是老年糖尿病患者并发脑梗死的两个独立危险因素,积极控制患者空腹血糖和降低UAER,可减少老年糖尿病患者并发脑梗死。     

阿魏酸钠治疗糖尿病肾病疗效观察

临床糖尿病肾病患者59例，随机分为阿魏酸钠治疗组30例和常规治疗组29例。两组患者再根据尿蛋白和肾功能的不同分别分为早期肾病组，临床期肾功能正常组2个亚组，进行治疗观察。结果与治疗前相比，阿魏酸钠治疗组尿总蛋白和尿白蛋白明显降低（P〈0．01），疗效明显优于常规治疗组，差异有显著性意义（P〈0．01）。结论阿魏酸钠具有降低早期和肾功能正常临床期糖尿病肾病患者尿蛋白和尿白蛋白的作用。     

阿魏酸钠治疗糖尿病肾病疗效观察

临床糖尿病肾病患者59例，随机分为阿魏酸钠治疗组30例和常规治疗组29例。两组患者再根据尿蛋白和肾功能的不同分别分为早期肾病组，临床期肾功能正常组2个亚组，进行治疗观察。结果与治疗前相比，阿魏酸钠治疗组尿总蛋白和尿白蛋白明显降低（P〈0．01），疗效明显优于常规治疗组，差异有显著性意义（P〈0．01）。结论阿魏酸钠具有降低早期和肾功能正常临床期糖尿病肾病患者尿蛋白和尿白蛋白的作用。     

阿托伐他汀对血脂正常的老年早期糖尿病肾病尿蛋白及相关因素的影响

目的 探讨阿托伐他汀对血脂正常老年患者早期糖尿病肾病(DN)尿蛋白、内皮素(ET)、一氧化氮(NO)、C反应蛋白(CRP)的影响.方法 血脂正常的50例2型糖尿病老年患者,随机分为常规用药组(常规组)25例;在常规组基础上加用阿托伐他汀组(联合组)25例,另设健康老年人为对照组25例.测定治疗前后血脂(CH、TG、LDL、HDL)、ET、NO、CRP、尿白蛋白排泄率(UAER).结果 DN患者血ET、CRP显著高于对照组,NO明显低于对照组.常规组治疗12周后与治疗前比较血脂、ET、NO、CRP 、UAER差异无显著性,联合组治疗后CH、TG、LDL 、ET、CRP、尿UAER显著降低,NO、HDL明显升高.结论 阿托伐他汀可改善ET、NO失衡,改善血脂水平,减轻炎症反应,减少早期糖尿病肾病患者的尿微量白蛋白,有保护肾脏的作用.     

Significantly higher incidence of carotid atherosclerosis found in Japanese type 2 diabetic patients with early nephropathy

We have tried to evaluate the clinical incidence of carotid atherosclerosis found in Japanese type 2 diabetic patients with early diabetic nephropathy. 123 diabetic patients with micro-albuminuria (group A) were investigated during 2-week hospitalization. As a control group, 50 diabetic patients without nephropathy (group B) were investigated. Carotid arteries were examined by B-mode ultrasonography (7.5 MHz), and peripheral arterial blood flow and pressure was examined at the same time with Doppler ultrasonography by a single examiner. Fasting blood samples and 24-h urine samples were taken to analyze biochemical data and urinary albumin excretion rate. In group A, 77 patients were found to have either carotid plaque lesions or increased thickness of carotid wall. And this was found significantly higher than in the control group B (18 cases, P < 0.01). To clarify the clinical risk factors for carotid atherosclerosis in diabetic patients with early nephropathy, 123 group A patients were divided into two groups with (group C, n = 76) or without carotid atherosclerosis (group D, n = 47) and comparative analysis was carried out. From this study, significantly higher incidence of carotid atherosclerosis was confirmed in the diabetic patients with early nephropathy. And it was suggested that the age, lipid levels, presence of hypertension would be important clinical risk factors for carotid atherosclerosis found in diabetic patients with early nephropathy.     

巯甲丙脯酸对糖尿病肾病蛋白尿、肾血浆流量和血浆过氧化脂质的影响

观察了30例伴微白蛋白尿或临床蛋白尿的NIDDM患者用Captopril或常规治疗4周后尿白蛋白及血浆过氧化脂质(LPO)水平的变化,结果表明,常规治疗后尿白蛋白无改变,而Captopril治疗后尿白蛋白减少,肾血浆流量增加,但尿白蛋白的减少与平均动脉压的降低无相关性。Captopril对肌酐清除率、血脂,血尿钾钠亦无明显影响。糖尿病患者血浆LPO水平高于健康对照者,Capropril治疗后降低,而常规治疗后无明显变化。以上结果提示,Captopril具有减少尿蛋白排泄及抗脂质过氧化作用。     

Prostaglandins and diabetic nephropathy

Abnormalities of renal prostaglandins (PGs) contribute to the pathogenesis of diabetic nephropathy through changes in renal hemodynamics. Our recent studies have demonstrated that urinary excretion ratio of 6-keto-PGF₁ (6KF) to TXB₂ is decreased in patients with non-insulin-dependent diabetes mellitus (NIDDM). In the present study, we evaluated the clinical effects of some drugs on renal PG metabolism and diabetic nephropathy. Ozagrel, a specific thromboxane synthetase inhibitor, reduced urinary TXB₂ excretion, resulting in the improvement of the decreased urinary 6KF/TXB₂ ratio in NIDDM patients. Urinary albumin excretion was decreased and creatinine clearance (Ccr) was increased during ozagrel administration. The similar beneficial effect was also found in the administration of cilostazol, a phosphodiesterase inhibitor, whereas a stable analogue of PGI₂, beraprost sodium, reduced urinary albumin excretion in relation to the reduction of platelet aggregation rate. In conclusion, the drugs modulating renal and platelet PG_S metabolism with direction to an increase in 6KF/TXB₂ ratio and an inhibition against platelet function might be beneficial for the treatment of diabetic nephropathy.     

贝前列腺素钠对早期糖尿病肾病患者尿白蛋白排泄率血清胱抑素C及血管内皮功能的影响

目的：探讨贝前列腺素钠对早期糖尿病肾病患者尿白蛋白排泄率、血清胱抑素C及血管内皮功能的影响。方法选择早期糖尿病肾病患者58例,按随机数字表法分为对照组30例和治疗组28例。对照组予低蛋白饮食、人胰岛素控制血糖、控制血压等常规治疗;治疗组在常规治疗的基础上使用贝前列腺素钠40μg,口服3次/d,共使用12周。检测早期糖尿病肾病患者治疗前后糖化血红蛋白（ HbA1c）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、24 h尿白蛋白排泄率（24h UAER）、血清胱抑素C（Cys-C）、内生肌酐清除率（Ccr）、血内皮素-1（ET-1）水平,同时利用超声检测肱动脉血流介导的内皮依赖性血管舒张功能（ FMD）。结果两组患者治疗前后血糖、血压、血脂等指标比较差异无统计学意义（ P＞0.05）,治疗组患者治疗后24 h UAER、血清Cys-C、ET-1较对照组显著降低,Ccr、内皮依赖性血管舒张功能（ FMD）较对照组显著升高,差异均有统计学意义（ P均＜0.05）。结论贝前列腺素钠有效地降低早期糖尿病肾病患者的血清Cys-C及24h UAER水平,并改善血管内皮功能。     

血栓调节蛋白在糖尿病微血管病变中的变化

目的探讨血浆血栓调节蛋白（ＴＭ）在糖尿病性肾病患者中的变化以了解其在微血管病变发病中的意义。方法检测５８例２型糖尿病患者血浆ＴＭ与内皮素（ＥＴ）的水平,并与３０例正常人进行比较。结果（１）糖尿病组血浆ＴＭ水平明显高于正常对照组（Ｐ＜０．００１）,其中临床糖尿病肾病组血浆ＴＭ水平明显高于早期糖尿病肾病组（Ｐ＜０．００１）及尿白蛋白正常的糖尿病组（Ｐ＜０．０１）;（２）血浆ＴＭ水平与尿白蛋白排泄率、ＥＴ水平呈显著正相关（ｒ＝０．５３９０和０．５６５０,Ｐ均＜０．００５）。结论血浆ＴＭ水平测定对２型糖尿病性肾病的早期诊断和病情分析有重要的临床价值。     

糖尿病肾病与脂代谢异常之间的关系分析

目的研究糖尿病肾病与脂代谢异常之间的关系。方法研究时段是在2018年1月-2019年11月选择该院接收的100例单纯糖尿病患者为甲组,选择该院接收的80例糖尿病肾病患者为乙组,另择取70例同期健康体检者为对照组,均检测研究对象的临床生化指标,比较3组的检查结果。结果乙组患者总胆固醇(5.69±1.42)mmol/L、甘油三酯(2.70±1.18)mmol/L、低密度脂蛋白(3.59±1.12)mmol/L及载脂蛋白A(320.87±99.12)mmol/L指标明显高于甲组、对照组;乙组患者高密度脂蛋白(0.95±0.22)mmol/L、对氧磷脂酶-1指标(103.45±36.87)ku/L低于甲组、对照组,差异有统计学意义(P<0.05)。结论脂代谢异常对糖尿病肾病造成不同程度的加重,因此治疗疾病时高度重视脂代谢很重要,便于控制疾病进展且获得良好的效果。     

Blockade of cannabinoid receptor 1 improves insulin resistance, lipid metabolism, and diabetic nephropathy in db/db mice

The endocannabinoid system is important in the pathogenesis of obesity-related metabolic disorders. However, the effect of inhibiting the endocannabinoid system in type 2 diabetic nephropathy is unclear. Therefore, we examined the effect of the cannabinoid (CB)1 receptor antagonist, SR141716, on insulin resistance and diabetic nephropathy in db/db mice. Six-week-old db/db mice were treated with the CB1-specific antagonist SR141716 (10 mg/kg · d) for 3 months. Treatment with SR141716 significantly improved insulin resistance and lipid abnormalities. Concomitantly, CB1 antagonism improved cardiac functional and morphological abnormality, hepatic steatosis, and phenotypic changes of adipocytes into small differentiated forms, associated with increased adiponectin expression and decreased lipid hydroperoxide levels. CB1 receptor was overexpressed in diabetic kidneys, especially in podocytes. Treatment with the SR141716 markedly decreased urinary albumin excretion and mesangial expansion and suppressed profibrotic and proinflammatory cytokine synthesis. Furthermore, SR141716 improved renal lipid metabolism and decreased urinary 8-isoprostane levels, renal lipid hydroperoxide content, and renal lipid content. In cultured podocytes, high-glucose stimulation increased CB1 receptor expression, and SR141716 treatment abolished high-glucose-induced up-regulation of collagen and plasminogen activator inhibitor-1 synthesis. Additionally, knockdown of CB1 receptor expression by stealth small interfering RNA abolished high-glucose-induced sterol-regulatory element-binding protein-1 expression in podocytes. These findings suggest that CB1 blockade improves insulin resistance and protect against renal injury through both metabolic and antifibrotic effects in type 2 diabetic nephropathy. Targeting CB1 blockade could therefore provide a new therapeutic target to prevent type 2 diabetic nephropathy.     

糖尿病肾病患者肱动脉内皮依赖性舒张功能测定及意义

2型糖尿病患者按尿白蛋白排泄率分为单纯糖尿病组(30例)，早期糖尿病肾病组(24例)和临床糖尿病。肾病组(20例)，用高分辨彩色多普勒仪测定肱动脉血流介导的内皮依赖性舒张功能，同时测定血循环内皮细胞数。结果显示3组糖尿病患者的肱动脉内皮依赖性舒张功能依次降低，提示此测定可作为反映2型糖尿病患者血管内皮功能状况和血管病变程度的一项指标。