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。     

如何选择终末期糖尿病肾病的替代治疗

糖尿病 (DM)是终末期肾病 (ESRD)主要原因之一 ,美国DM是ESRD各种病因之首 ,而欧洲和日本占第二位。我国DM发生率也明显增加 ,糖尿病肾病 (DN)而行替代治疗者也逐年增加 ,新进入透析治疗患者中 ,DN约占 30 %。DN尿毒症又有其特点 :①并发症多 :除一般尿毒症有多种并发症外 ,尚有DM的并发症 ,尤其心、脑血管病变 ,视网膜病变 ,感染和营养不良等。②生存期短 ,死亡率高 ,生活质量差 ,病残率高。③透析的退出率高 ,对医护的要求也高。因此如何更好地选择DN尿毒症的替代疗法具其特殊性和实用价值。可供选择的主要方式有 :腹透 (PD)、…     

科素亚联合益肾胶囊治疗老年糖尿病肾病78例疗效观察

糖尿病肾病 (DN)是糖尿病 (DM )的严重并发症之一 ,我国目前DM的发生率为 3 .2 1% ,DM约有 40 %发展为DN ,在我国DN致终末期肾病病人约占透析病人的 5 % ,且呈增加趋势 ,因此DN的早期透析治疗显得尤为重要 ,现应用科素亚加益肾胶囊治疗糖尿病肾病取得良好效果 ,现报道如下。1　资料与方法1.1　一般资料　 78例DN病人符合DN诊断标准[1] ,选取病例均为DNⅣ期～Ⅴ期 ,随机分为两组 ,治疗组 42例 ,年龄 68岁± 5 .2岁 ,最小 60岁 ,最大 82岁 ;病程 6年～ 2 1年 ,平均 11.8年 ;对照组 3 6例 ,年龄 67岁± 6.1岁 ,最小 60岁 ,最大 70岁 ;…     

2型糖尿病肾病患者血清脂联素水平的变化

目的:观察2型糖尿病肾病(DN)患者血清脂联素(adiponectin, ADPN)水平变化及其临床意义. 方法:正常对照组(NC)10例;2型糖尿病患者53例,根据尿白蛋白排泄率(UAER)及血清肌酐(SCr)水平分成糖尿病组(DM,UAER<30 mg/g,SCr<132.6 μmol/L)、糖尿病肾病组(DN1,≥30 mg/g,SCr<132.6 μmol/L)和晚期糖尿病肾病组(DN2,UAER≥300 mg/g,SCr>132.6 μmol/L);应用酶联免疫吸附法(ELISA)测定各组血清中的ADPN、可溶性血管细胞粘附分子1(sVCAM-1)水平. 结果:DN2组的血清ADPN水平高于NC组、DM组和DN1组(P<0.05);DN1组的ADPN高于NC组和DM组,但无统计学差异;DM组的ADPN水平低于NC组,但无统计学差异.sVCAM-1在NC组、DM组、DN1组和DN2组依次逐渐增高.相关分析显示ADPN与尿酸(UA)、SCr、肾小球滤过率(eGFR)呈显著相关关系(P<0.05),多元逐步回归分析显示SCr是ADPN的独立相关因素(决定系数为r2＝0.265,β＝3.130,P<0.01).无论在研究对象总体还是糖尿病患者中,ADPN与sVCAM-1均呈正相关性(相关系数分别为0.331,P<0.01;0.316,P<0.05) 结论:2型糖尿病肾病患者血清ADPN水平升高可能与肾功能减退有关,血清ADPN升高可能参与了糖尿病肾病患者的内皮功能损害机制.     

糖尿病肾病相关因素分析

目的 探讨糖尿病肾病(DN)的相关因素,为DN的一级预防提供理论依据.方法 选择2型糖尿病(T2DM)患者267例,其中DN患者102例(DN组),单纯糖尿病无肾病165例(NDN组),采集血糖等临床资料,进行t检验、X2检验和Logistic回归分析.结果 组间比较显示,DN组与NDN组的年龄、糖尿病(DM)病程、B...     

生长激素与糖尿病肾病关系的探讨

目的　探讨血清生长激素 (GH )与糖尿病肾病的关系。方法　 6 7例 2型糖尿病(DM )患者根据尿白蛋白排泄率 (UAER)分为正常蛋白尿组 (NA)、微量蛋白尿组 (MA)和临床蛋白尿 (CDN )组 ,分别检测各组的血清GH、血糖 (PG)、HbA1c、胰岛素 (Ins)及TG、LDL、HDL、Lp(a)的水平 ,并与 18名正常人 (对照组 )进行比较。结果　CDN组的FGH明显高于对照组、NA组及MA组 (P <0 .0 1) ;MA组的空腹生长激素 (FGH)明显高于对照组和NA组 (P <0 .0 1) ;CDN组PGH明显高于NC组和对照组 (P <0 .0 1)。FGH与HbA1c、FPG、UAER、LDL、Lp(a)呈正相关 ;FGH与病程、FIns无相关。结论　GH水平的增高 ,加重糖代谢和脂代谢紊乱 ,参与糖尿病肾病的发生。     

同型半胱氨酸与2型糖尿病肾病的相关性研究

目的研究血清同型半胱氨酸(Hcy)与2型糖尿病(T2DM)伴发糖尿病肾病(DN)的关系。方法对60名T2DM患者进行24h尿蛋白,肾小球滤过率测定,并根据其结果分为单纯糖尿病组(DM)和DN组,另选择健康对照组20名。取空腹静脉血测定血糖(BG)、甘油三酯(TG)、糖化血红蛋白(HbAlc)、Hcy。结果DM患者血浆Hcy水平〔(15.01±5.99)μmol/L〕较健康对照组〔(12.00±1.96)μmol/L〕有明显升高(P<0.001)。将Hcy≥15.80μmol/L作为高Hcy血症的诊断标准,将T2DM分为高Hcy组和无高Hcy组,高Hcy组DN发生率比无高Hcy组明显升高(50%vs26.8%)(P<0.05)。各危险因素与DN多元回归分析表明,Hcy与DN的发生有关。结论Hcy血症是T2DM、DN的一个独立危险因素,Hcy为DN早期发现和临床诊断提供了有力的指标。     

糖尿病肾病分期与血压血糖胰岛素胰岛素样生长因子-1的相关性探讨

目的　研究胰岛素样生长因子 1(IGF 1)、胰岛素 (INS)、血糖、血压等与各期糖尿病肾病 (DN)的关系。方法　 2型糖尿病 (T2DM ) 16 8例分非DN组 79例、早期DN组 46例、临床期DN组 2 0例和终末期DN组 2 3例 ,健康对照组 (对照组 ) 5 0例 ,应用免放法检测IGF 1。结果　 (1)DM各组收缩压 (SBP)高于对照组、DN各组高于非DN组 ,终末期DN组SBP和舒张压 (DBP)均高于其余各组 (P <0 0 1) ;DM各组FINS高于对照组 ,临床期DN组和终末期DN组高于其他组 (P <0 0 1) ;终末期DN组IGF 1质量浓度高于临床期DN组 ,终末期DN组和临床期DN组高于其他组 (P <0 0 1)。 (2 )多元回归显示 ,SBP、FINS和IGF 1与UAE正相关。结论　血压、INS、IGF 1升高与DN及其程度密切相关。     

糖尿病肾病尿毒症患者血透治疗的临床分析

目的研究采用血液透析治疗糖尿病肾病尿毒症患者的临床效果,以期为延长该类患者生存时间及改善患者生存质量提供对策。方法以在该院进行血液透析治疗的46例糖尿病肾病尿毒症患者(DN组)及46例非糖尿病肾病尿毒症患者(非DN组)为研究对象,观察比较两组患者各项生化指标的变化情况、并发症发生率及他们的生存与预后情况。结果在血液透析患者的各项生化指标中,与非DN组患者相比,DN组患者的白蛋白和肌酐水平明显降低,而血糖水平却显著提高;DN组患者发生并发症的概率显著高于非DN组;而且DN组患者的生存率远不及非DN组患者。结论糖尿病肾病尿毒症患者进行血液透析治疗时,应控制白蛋白、肌酐及血糖水平,预防感染、心脑血管疾病、低血压等并发症的发生,改善患者的预后,提高生存率。     

肥胖2型糖尿病肾病患者动态血糖分析

目的探讨肥胖2型糖尿病（T2DM）肾病患者的动态血糖特点。方法80例肥胖T2DM患者根据24h尿白蛋白排泄率（24hUAER）分为糖尿病肾病（DN）组和单纯2型糖尿病（T2DM）组,每组40例;另选健康体检者15名组成正常对照（NC）组。动态血糖监测系统（CGMS）监测三组72h血糖变化,并进行对比分析。结果DN组血糖波动系数（BGFC）、日内血糖波动最大幅度、2hPG均明显大于T2DM组及NC组（P均〈0．05）,DN组BGFC与24hUAER正相关（r=0．356、P〈0．05）。结论血糖波动与肥胖2型糖尿病肾病相关。     

Serum levels of non-carboxymethyllysine advanced glycation endproducts are correlated to severity of microvascular complications in patients with Type 1 diabetes

We investigated whether serum levels of N-(carboxymethyl)lysine (CML), non-CML advanced glycation endproducts (AGEs), or pentosidine are associated with severity of diabetic microvascular complications in patients with Type 1 diabetes. Serum levels of CML, non-CML AGE, and pentosidine were measured by an enzyme-linked immunosorbent assay in 38 males and 47 females aged 31+/-8 years (mean+/-S.D.) with Type 1 diabetes for 18.7+/-7.0 years. There was a significant correlation between serum levels of CML or non-CML AGE and current HbA(1c) level (P<.01 and P<.05, respectively). The serum levels of non-CML AGE, but not CML or pentosidine, were significantly increased as normal renal status advanced to microalbuminuria, clinical nephropathy, and hemodialysis (P<.0001) and were positively correlated with urinary albumin excretion (UAE) in patients with Type 1 diabetes (P<.0001). A significant elevation of serum non-CML AGE was found in association with the severity of diabetic retinopathy (P<.0001). We found in the present study that CML levels were also increased in the stage of simple retinopathy, the early stage of clinically evident retinopathy (P<.05). Serum levels of non-CML AGE were significantly associated with the severity of diabetic nephropathy and retinopathy, suggesting a role of non-CML AGE in the progression of microvascular complications in patients with Type 1 diabetes. Since serum levels of CML were significantly increased in patients with simple retinopathy, CML may participate in the initiation of diabetic retinopathy.     

住院老年2型糖尿病患者微血管病变的相关因素分析

目的探讨老年2型糖尿病患者微血管病变的构成比及相关因素。方法用回顾性分析的方法研究2003年～2010年于卫生部北京医院住院治疗的年龄≥60岁的2型糖尿病患者876例,分为糖尿病肾病(DN)组和非糖尿病肾病(非DN)组,糖尿病视网膜病变(DR)组和非糖尿病视网膜病变(非DR)组,糖尿病周围神经病变(DPN)组和非糖尿病周围神经病变(非DPN)组,计算DN、DR、DPN构成比,比较患者的临床特点,并探寻老年2型糖尿病患者DR、DN、DPN的相关因素。结果 (1)DN构成比为34.5%,DR构成比为42.4%,DPN构成比为82.3%。(2)DN与非DN两组间体质量指数(BMI)、糖尿病病程、高血压病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBS)、糖化血红蛋白(HbA1c)、空腹胰岛素(Fins)、高密度脂蛋白胆固醇(HDL)、甘油三酯(TG)、尿酸(UA)均有显著性差异(P<0.05或P<0.01);DR与非DR两组间仅糖尿病病程、SBP、空腹C肽(FCP)有显著性差异(均P<0.01);DPN与非DPN两组间年龄、糖尿病病程、HbA1c、TC、LDL有显著性差异(P<0.05或P<0.01)。(3)Logistic回归结果显示,DN与SBP、HbA1c、FBS、HDL、UA、糖尿病病程有关(OR值分别为1.022、1.098、1.075、0.501、1.004,1.048,P<0.05或P<0.01);DR与SBP、HbA1c、糖尿病病程有关(OR值分别为1.017、1.102、1.097,P<0.05或P<0.01);DPN与HbA1c、LDL、糖尿病病程、年龄有关(OR值分别为1.226、1.370、1.041、1.058,P<0.05或P<0.01)。结论对于老年2型糖尿病患者,DN、DR、DPN均与糖尿病病程和HbA1c有关,控制血糖对防治微血管病变意义重大,综合控制血糖、血压、血脂、尿酸可以更好的防治糖尿病微血管并发症。     

Serum concentrations of advanced glycation endproducts are associated with the development of atherosclerosis as well as diabetic microangiopathy in patients with type 2 diabetes

We measured serum concentrations of advanced glycation endproducts (AGEs) in patients with type 2 diabetes, to elucidate the mechanisms underlying the elevated serum concentrations of AGEs and to clarify the relationship between serum AGE concentrations and the development of microangiography and macroangiopathy. Serum AGEs were significantly higher in diabetic patients than in age-matched control subjects (p < 0.0001). In diabetic patients, serum AGEs were positively correlated with HbA1c (r = 0.47, p < 0.0001), urinary albumin excretion (UAE) (r = 0.42, p < 0.0001), diabetes duration (r = 0.31, p = 0.0030), and fasting plasma glucose (r = 0.34, p = 0.0010). Multiple regression analysis disclosed that only the HbA1c and UAE levels independently correlated with serum AGE levels. Serum AGEs in diabetic patients with progressive retinopathy and overt nephropathy were significantly higher than in those with less severe retinopathy and nephropathy. Serum AGEs were significantly higher in the diabetic patients with coronary heart disease (CHD) than in those without CHD. These results suggest that the HbA1c and UAE levels are independent risk factors for increased serum AGE concentrations in type 2 diabetic patients, and that higher serum AGE concentrations are associated with increased severity of diabetic retinopathy and nephropathy. Serum AGE concentrations may be a useful marker not only for the severity of diabetic microangiopathy but also for the development of CHD in patients with type 2 diabetes mellitus. Received: 8 May 2000 / Accepted in revised form: 5 September 2000     

The meaning of serum levels of advanced glycosylation end products in diabetic nephropathy

It has been reported that advanced glycosylation end products (AGEs) play an important role in the development of diabetic complications. To evaluate the relationship between serum AGEs and diabetic nephropathy, we measured serum AGE levels in diabetic patients with normoalbuminuria (N), microalbuminuria (M), overt proteinuria (O), and hemodialysis (HD), non diabetic patients with nephropathy, and age-matched control subjects using the enzyme-linked immunosorbent assay (ELISA). Urine AGE levels were also measured in these subjects except group HD. Serum AGE levels in diabetic patients were not significantly higher than those in the normal subjects. When we compared serum AGE levels among various stages of diabetic nephropathy, groups O and HD had significantly higher serum AGE levels than the other groups. Serum AGE levels in group HD were almost 6-fold higher than those in groups N and M. In contrast, there were no significant differences in urinary AGE levels among any diabetic groups. As for the variables that determine serum AGE levels in diabetic patients, there was no significant correlation between serum AGEs and fasting blood glucose, hemoglobin A1c (HbA1c), or duration of diabetes. In contrast, serum AGEs showed a strong correlation with serum creatinine and an inverse correlation with creatinine clearance. To evaluate the relationship between serum AGEs and oxidative stress in diabetic nephropathy, urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and serum malondialdehyde (MDA), which are biological markers of total oxidative stress in vivo, were also examined. Both urinary 8-OHdG and serum MDA levels were significantly higher in diabetic patients with proteinuria versus those without proteinuria. However, there was no significant correlation between serum AGEs and urinary 8-OHdG or serum MDA levels in diabetic patients. These results suggest that the accumulation of serum AGEs in diabetic nephropathy may be mainly due to decreased removal in the kidney rather than increased production by high glucose levels or oxidative stress.     

PAI-1基因启动子区4G/5G基因多态和Enos第4内含子a/b基因多态与糖尿病肾病的相关性研究

为探讨 PAI- 1基因启动子区 4 G/ 5 G基因多态性、一氧化氮合酶 (e NOS)第 4内含子 2 7bp插入 /缺失 (a/b)多态性与糖尿病肾病 (DN)的相关性 ,采用发色底物法测定 PAI- 1活性 ;等位基因特异性引物 PCR扩增技术测定 PAI- 1基因 4 G/ 5 G多态性 ;聚合酶链反应测定 e NOS基因第 4内含子 2 7bp的 a/ b多态性。结果显示 ,Hb A1c、SBP、TC、e NOS基因第 4内含子 a/ b多态均属 DN的独立危险因素。早期糖尿病肾病组 (DN+组 ) a等位基因及 ab基因型频率显著高于糖尿病非肾病组 (DN-组 ) (P<0 .0 5 )。DN+组血浆 PAI- 1活性明显高于 DN-组 (P<0 .0 5 ) ;4 G纯合子组 PAI- 1活性明显高于 4 G/ 5 G杂合子及 5 G纯合子组 (P<0 .0 0 5 )。2型糖尿病患者中 ,4 G纯合子和a/ b杂合子携带者 DN的相对风险明显增加 (P<0 .0 5 ) ,4 G杂合子携带者 DN的相对风险增加不明显 (P>0 .0 5 )。当 a/ b杂合子和 4 G纯合子基因多态并存时 DN的发病风险明显增加。认为 PAI- 1基因启动子区 4 G/ 5 G基因多态、e NOS基因第 4内含子 a/ b多态与 DN的发生、发展有关。两种基因多态同时存在时 ,DN的发病风险明显增加     

检测2型糖尿病患者血浆同型半胱氨酸水平的临床意义探讨

目的 探讨2型糖尿病(DM)患者血浆同型半胱氨酸(HCY)水平及意义。方法 用化学发光法对55例肾功正常的2型DM患者[DM组,其中无肾病38例、早期糖尿病肾病17例(DN)例]及51例健康人(对照组)的血浆HCY水平进行测定比较,同时分析血浆HCY与DM患者年龄、病程、血压、血浆叶酸(Fol)、维生素B12、总胆固醇(CH)、肌酐(SCr)及尿白蛋白排泄率(UAER)之间的相关性。结果 DM组血浆HCY水平均较对照组明显升高(P<0.01),合并早期肾病者血浆HCY水平较无肾病者明显升高(P<0.05);DM患者血浆HCY水平与UAER及SCr呈显著正相关(P<0.05),与其他因素间无明显相关性。结论 糖尿病患者尤其是合并肾脏损害者血浆HCY明显升高,高HCY血症可能是DN发生发展的危险因素之一。     

Serum and urinary concentrations of type IV collagen and laminin as a marker of microangiopathy in diabetes.

Serum and urinary concentrations of type IV collagen and laminin were measured by enzyme-linked immunosorbent assay (ELISA) in diabetic patients and compared with normal control subjects. In diabetic patients with proteinuria or with renal insufficiency, serum and urinary concentrations of type IV collagen were higher than those of control subjects (p less than 0.005). Furthermore urinary concentrations of type IV collagen and laminin were significantly higher in diabetes, even in the absence of nephropathy, than in normal controls (p less than 0.05). Urinary concentrations of type IV collagen in patients with diabetes and microalbuminuria (0.73 +/- 0.11 mg mmol-1) were significantly higher than in diabetic patients without nephropathy (0.40 +/- 0.060 mg mmol-1) (p less than 0.025). Urinary concentrations of type IV collagen may have a role as an indicator of early diabetic nephropathy. Serum concentrations of type IV collagen in diabetic patients with retinopathy were significantly higher than in normal controls (p less than 0.025). However, urinary concentrations of type IV collagen (p less than 0.05) and serum concentrations of laminin (p less than 0.025) were significantly higher in diabetic patients than normal controls and the difference between patients with and without retinopathy was not significant.     

血清基质金属蛋白酶9、糖基化终产物与糖尿病足的相关研究

比较糖尿病足患者(糖尿病足组)、2型糖尿病但非糖尿病足患者(非糖尿病足组)及健康体检者血清基质金属蛋白酶9(MMP-9)、晚期糖基化终产物(AGE)水平.糖尿病患者MMP-9、AGE水平高于健康者,糖尿病足组MMP-9高于非糖尿病足组.血清MMP-9升高似可预测糖尿病足发生及足溃疡的预后.     

Serum levels of carboxy-terminal propeptide of human type I procollagen are an indicator for the progression of diabetic nephropathy in patients with type 2 diabetes mellitus

The finding that glomerular mesangial cells produce human type I collagen suggests that the serum levels of carboxy-terminal propeptide of human type I procollagen (P1CP) may reflect the severity of diabetic nephropathy. We therefore investigated the relationship between serum P1CP levels and the extent of diabetic complications in 100 patients (46 males and 54 females) with Type 2 diabetes and in 64 healthy subjects. Serum P1CP was determined by radioimmunoassay. In diabetes, we defined P1CP levels less than 142 ng/ml as a normal P1CP group (group A), whereas we defined them as equal to or greater than 142 ng/ml as a high P1CP group (group B). The diabetic patients had significantly elevated serum P1CP levels compared with the controls. The prevalence of hypertension, proliferative diabetic retinopathy or macroalbuminuria was significantly higher in group B than in group A. Serum P1CP levels showed a significant positive correlation with urinary albumin excretion, but not with fasting blood glucose, glycosylated hemoglobin A(1c) or serum osteocalcin. Macroalbuminuric patients showed significantly higher P1CP levels than the normoalbuminuric patients. In patients in the absence of diabetic nephropathy, no significant differences of P1CP levels were found among the severity of diabetic retinopathy. The present results suggest that serum P1CP levels reflect the progression of diabetic nephropathy in patients with Type 2 diabetes.     

糖尿病肾病患者抵抗素与胰岛素抵抗的关系及临床意义

目的探讨糖尿病肾病（DN）患者血清抵抗素与胰岛素抵抗（IR）的关系及临床意义。方法检测61例2型糖尿病（T2DM）患者（DN组31例、无DN组30例）及30例健康对照者的血清抵抗素、空腹血糖（FPG）、空腹胰岛素（Fins）及胰岛素抵抗指数（Homa—IR）,分析血清抵抗素水平与各检测指标的相关性。结果与对照组比较。DN组、无DN组的血清抵抗素、FPG、Fins、Homa-IR均明显升高（P均〈0．05）;与无DN组比较,DN组上述指标虽有升高趋势,但均无统计学差异（P均〉0．05）。相关分析显示,DN组血清抵抗素水平与FPG、Fins、Homa-IR均呈显著正相关（P〈0．05）。结论抵抗素与DN患者的IR密切相关,检测T2DM患者的血清抵抗素变化,在一定程度上可反映其肾脏病变。