Association between diabetic retinopathy with atherosclerosis cardiovascular disease / 中华全科医师杂志

Objective To investigate the association between diabetic retinopathy ( DR) and atherosclerosis cardiovascular disease ( ASCVD) .Methods Clinical data of 654 patients with type 2 diabetic mellitus (T2DM) were collected from a cross sectional , population based survey on chronic diseases and risk factors which was conducted in Beijing Changping district from July 2010 to March 2011.Among 654 T2DM patients, there were 73 patients with ASCVD (ASCVD group) and 581 patients without ASCVD ( non-ASCVD group ) .The association between DR and ASCVD was analyzed .Results Patients with ASCVD had significantly older age [58.5(53.9,65.9) years], more female sex[52(71.2%)], higher proportion of ASCVD history [45(61.6%)], higher levels of PG 2 h[16.26(11.08,19.20) mmol/L], HbA1c[7.20(6.55,8.85)%], systolic pressure [151(133,165) mmHg(1 mmHg＝0.133 kPa)] and lower eGFR[87.2(75.0,103.0) ml· min-1· 1.73 m-2] than non-ASCVD patients[52.4(46.5,58.3) years, Z＝-5.86, P＝0.00; 307(52.8%),χ2＝-8.86, P＝0.00; 256(44.1%),χ2＝8.07, P＝0.01; 13.10(8.99,17.93) mmol/L, Z＝-2.35, P＝0.02; 6.70(6.00, 7.90)%, Z＝-3.33, P＝0.00; 143(131,158) mmHg, χ2＝-2.28, P＝0.02; 94.6(84.8,106.3) ml· min-1· 1.73 m-2, Z＝-3.47, P＝0.00].The trend to develop DR in ASCVD group was significantly higher than that in non-ASCVD group [19.2%(14/74) vs.8.3%(48/581), χ2＝9.01, P ＝0.00] .DR was an independent statistical indicator of the presence of ASCVD [ OR ( 95%CI ): 2.64 ( 1.37 -5.06 ), P ＝0.00 ] . Furthermore, when DR was divided into NPDR and PDR according to its severity , only PDR was significantly associated with incident ASCVD [OR(95%CI): 12.05 (2.63-55.12), P＝0.00].After adjusting for traditional ASCVD risk factors , such an association still existed , with the risk of having ASCVD increasing by 718%[ OR (95% CI): 8.18 ( 1.56 -42.81 ), P ＝0.01] .DR associates strongly with ASCVD in the Chinese population with T 2DM.Conclussion With the severity of DR increasing , the risk of ASCVD also grows.After adjustment for traditional risk factors , PDR is still associated with the risk of prevalent ASCVD.

Investigation and analysis of macular thickness in natural population and diabetes patients in Changping district of Beijing / 国际生物医学工程杂志

Objective To measure the macular thickness of natural population in Changping district of Beijing by optical coherence tomography (OCT), and to analyze whether there is an increased thickness in diabetic patients.Methods In a cross-sectional population-based study, OCT was performed on 521 subjects (233 with normal glucose homeostasis, 174 with pre-diabetes and 114 with type 2 diabetes (T2D) according to 2011 Health Examination Survey of Changping.The subjects also received physical examination and laboratory measurements including fasting plasma glucose (FPG), oral glucose tolerance test (OGTT)-2 h plasma glucose and hemoglobin A1c (HbA1c).Results The results showed that central subfield thickness (CST) of the retina of men ((246±22) μm) was significantly greater than that of women ((235±26) μm) (P＜0.001).Meanwhile, no significant difference was found in the CST in subjects of different age, HbAlc and body mass index (BMI) (P＞0.05).Difference in thickness of different glucose groups was not seen in central subfield, inner subfields and outer subfields(P＞0.05).Conclusions Retina CST of men was significantly greater than that of women.No significant difference was found in the CST in subjects of different age, HbA1c and BMI.

Effect ofTangshen-Huazhuorecipe on the levels of serum transforming growth factorβ1 and platelet derived growth factor in patients with IV stage of diabetic nephropathy / 国际中医中药杂志

Objective To investigate the effect of extract ofTangshen-HuazhuoRecipe(TSHZR) on the serum concentrations of transforming growth factorβ1(TGF-β1) and platelet derived growth factor(PDGF) in patients withⅣ stage of diabetic nephropathy(DN).Methods From June 2012 to December 2012, 98 patients ofⅣstage DN in our hospital outpatient were enrolled and randomly divided into treatment group(n=48) and control group(n=50) using random number table. All patients received conventional therapies of controlling blood sugar, lipid, blood pressure and anticoagulant therapy. On such basis, the control group was treated by irbesartan, 150 mg/d, and the treated group treated by TSHZR combined with irbesartan,150 mg/d, for 6 months. Serum TGF-β1 and PDGF were determined with ELISA before and after treatment,and urinary albumin excretion rate,HbA1c,serum creatinine,blood urea nitrogen and lipid profiles were examined as well. ResultsIn the treated group, the TGF-β1 was(172.5±31.3), (123.6±21.2)pg/ml, the PDGF was(860.9± 131.2), (500.6±130.2)pg/ml before the treatment and after the treatment, respectively. The TGF-β1 and PDGF after the treatment were significantly decreased than those before the treatment(P<0.01). After the treatment, TGF-β1 and PDGF in the treated group were statistically significant compared to the control group[TGF-β1 is(157.4±39.6)pg/ml, PDGF is(765.7±161.8)]pg/ml,P<0.01). After the treatment, the treatment group was superior to the control group in TG(1.72±0.25)mmol/L,(2.09±0.27)mmol/L,(P<0.01), TC(4.56± 0.64)mmol/L,(6.11±0.93)mmol/L, (P<0.01), HDL-C(1.56±0.50)mmol/L,(1.36±0.44)mmol/L, (P<0.01), LDL-C(2.46±1.08)mmol/L(3.32±0.87)mmol/L,(P<0.05)and UAER(100.73±204.24)μg/min, (226.24±396.38)μg/min, (P<0.01).Conclusion TSHZR can inhibit the progressive of IV stage of diabetic nephropathy by suppressing TGF-β1 and PDGF expression level.

Effect of Cordyceps sinensis on expressions of HIF-1α and VEGF in the kidney of rats with diabetic nephropathy / 中南大学学报(医学版)

OBJECTIVE@#To examine the expressions of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in the kidney of rats with diabetic nephropathy before and after the treatment of Cordyceps sinensis, and to explore the mechanism of Cordyceps sinensis against hypoxia.@*METHODS@#The diabetes model was produced by intraperitoneal injection of 60 mg/kg streptozotocin, then the rats whose 24 h urine protein level was above 30 mg/d were thought to have suffered diabetic nephropathy. Thirty rats were randomly divided into a diabetic nephropathy group (DN group, n=15) and a Cordyceps sinensis group (CS group, n=15), and another 15 normal rats served as a normal control group (NC group, n=15). The CS group were intragastrically administered Cordyceps sinensis extract liquid [5.0 g/(kg.d)], the other groups were intragastrically administered drinking water of equal volume. Five rats in each group were killed after 2, 4, and 6 weeks. The 24 h urine protein excretion, urine β-N-acetyl glucosaminidase (NAGase) and serum creatinine were measured; the renal pathological changes were evaluated by HE and Masson staining; the mRNA and protein expressions of HIF-1α and VEGF were dectected by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry.@*RESULTS@#Compared with the normal control group, the renal tubular vacuolar degeneration was obvious, and the glomerular mesangial matrix increased in the DN group. The 24 h urinary protein excretion, urine NAGase and serum creatinine also increased significantly (all P0.05).@*CONCLUSION@#The expressions of HIF-1α and VEGF increase in the kidney of rats with diabetic nephropathy, and the positive correlation suggests that there is chronic hypoxia in the renal tissue of diabetic nephropathy. Cordyceps sinensis may protect against chronic hypoxia injury in diabetic nephropathy by lowering the expressions of HIF-1α and VEGF.

Effect of Cordyceps sinensis on the expression of HIF-1α and NGAL in rats with renal ischemia-reperfusion injury / 中南大学学报(医学版)

OBJECTIVE@#To observe the level of urinary neutrophil gelatinase-associated lipocalin (NGAL), the expression of hypoxia inducible factor-1α (HIF-1α) and NGAL in rat kidney after renal ischemia and reperfusion (I/R), before and after the treatment with Cordyceps Sinensis (C. sinensis), and to explore the mechanism of C. sinensis against I/R injury.@*METHODS@#A total of 45 healthy male Sprague-Dawley rats were randomly divided into a sham group, a renal I/R model group, and a C. sinensis group (15 in each group).The rats in the sham group and the renal I/R model group were intragastrically administered saline (2 mL/d), and rats in the treatment group were intragastricabby administered of C. sinensis [5.0 g/(kg.d)]. The rats were sacrificed at 24, 48, and 72 h, respectively after the reperfusion and urinary N-acetyl-β-D-glucosaminidase (NAG) level was measured, renal function in rats was detected, and the pathological changes were observed with HE staining. We determined the urinary NGAL levels in the rats by ELISA, the expression of HIF-1α mRNA by RT-PCR, and the expressions of HIF-1α and NGAL proteins by confocal immunofluorescence.@*RESULTS@#Compared with the sham group, the levels of BUN, SCr, levels of NAG and NGAL in urine were increased in the I/R group and the C. sinensis group, reached a peak at 24 h after the reperfusion and slowly declined at 48 and 72 h. Glomerular and tubulointerstitial areas in the sham group did not show any pathological change. Induced pathological changes included tubular cell necrosis, focal areas of proximal tubular dilation, distal tubular casts, effacement and loss of proximal tubule brush border, etc. Compared with the sham group, the expression of HIF-1α and NGAL in the kidney tissues of the I/R group and the C. sinensis group increased. C. sinensis can lower the level of NAG and NGAL in the urine and the expression of NGAL protein in the kidney tissues. It up-regulated the expression of HIF-1α mRNA and protein in the kidney tissues whilst attenuated the pathological changes.@*CONCLUSION@#Renal I/R injury in rats can lead to pathological changes in renal tubular epithelial cells and renal interstitial damage, which are consistent with the pathological features of acute kidney injury (AKI).The level of urinary NAGL increases after the I/R, and positively correlates with the level of urinary NAG and pathological changes, suggesting that urinary NGAL may serve as a urinary biomarker for specific detection of tubular injury in AKI. C. sinensis can attenuate the renal I/ R-induced AKI. Its mechanism may be associated with up-regulating the expression of HIF-1α and down-regulating the expression of NGAL in the kidney tissues.

Prevalence of dyslipidemia in subjects with type 2 diabetes mellitus in Beijing urban communities:Beijing community diabetes study 8 / 中华全科医师杂志

Objective To investigate the prevalence of dyslipidemia in subjects with type 2 diabetes mellitus in Beijing urban communities.Methods Total 3316 subjects with type 2 diabetes (age 20-80 years) were recruited from 15 urban community health centers in Beijing using a multi-stage random sampling approach.Dyslipidemia was diagnosed according to Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults:2007 version.Results Among 3316 diabetic subjects (1329 malesand 1987 females),75.6％ (2506/3316) had dyslipidemia,the prevalence was 72.5％ (964/1329)in men and 77.6％ (1542/1987) in women.The prevalence of hypertriglyceridemia and hypercholesterolemia was 41.9％ (1388/3316) and 48.1％ (1595/3316),respectively.31.5％ (1043/3316) subjects had high levels of low-density lipoprotein cholesterol (LDL-C) and 21.2％ (703/3316) had low high-density lipoprotein cholesterol (HDL-C).Among all subjects with dyslipidemia only 22.9％ (575/2506) took hypolipid agents.The overall blood lipid control rates of triglyceride (TG),total cholesterol (TC),LDL-C and HDL-C in 1393 subjects with dyslipidemia history were 48.0％ (669/1393),17.4％ (242/1393),30.9％ (430/1393) and 75.8％ (1056/1393),respectively.Diabetics with dyslipidemia had higher body mass index,waist circumference,blood pressure,plasma glucose and hemoglobin A1c.The prevalence of dyslipidemia in the overweight and uncontrolled-glucose group were 79.0％ (1678/2125),78.9％ (1756/2227),respectively.Logistic regression analysis showed that gender,age,body mass index and hemoglobin A1c were associated with dyslipidemia.Conclusions The prevalence of dyslipidemia in diabetic subjects in Beijing urban communities is high and less than one quarter patients take hypolipid agents.Age,body mass index and hemoglobin A1c are the risk factors of dyslipidemia in type 2 diabetic patients.

Clinical characteristics of diabetic patients with metabolic syndrome and its components at 15 urban communities in Beijing / 中华全科医师杂志

Objective To study clinical characteristics of type 2 diabetic(T2D)patients with metabolic syndrome(MS)and its components in Beijing urban communities.Methods Totally,3295 T2D patients involved in a combined prospective diabetic management study from 15 urban communities in Beijing were classified as four groups, according to 2004 Chinese Diabetes Society's definition of MS, i. e, isolated T2D, T2D with one component of MS, T2D with two components of MS and T2D with three components of MS. Their clinical characteristics were analyzed. Results ( 1 ) Among 3295 T2D patients, 155 (4. 7% )were isolated T2D, 107 (32.6%) T2D with one component of MS, 1386 (42.1%) T2D with two components of MS and 679 (20.6%) T2D with three components of MS, with an overall 62.7% (2065/3295) of T2D patients complicated with MS. (2) In these T2D patients, the more components of MS they had, the higher body mass index (BMI), waist circumference, waist to hip circumference ratio (WHR),systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum levels of insulin and triglyceride (TG) and the lower level of high-density lipoprotein-cholesterol (HDL) were presented (P <0. 01 ). (3) Percentage of isolated T2D in women increased from 49. 0% (76/155) to 61.9% (420/679)of those with three components of MS ( P < 0 01 ), with increasing of components of MS. (4) Multiple logistic regression analysis showed that BMI, history of hypertension, decreased HDL, increased TG,increased blood pressure, all were risk factors for T2D patients complicated with MS. Conclusions Among T2D patients in urban communities of Beijing, 95.3% (3140/3295) of them complicated with one or more components of MS, and 61.9% (420/679) of them complicated with MS. So, community diabetic management must be implemented in an all-round way, including control of blood pressure, blood lipids,body weight and so on, in addition to control of blood sugar.

Effect of aldosterone and its antagonist spironolactone on epithelial-mesenchymal transition of mormal rat kidney epithelial cells in high glucose / 中南大学学报(医学版)

Objective To determine the effect of aldosterone and its antagonist, spironolactone on epithelial-mesenchymal transition (EMT) of normal rat kidney epithelial cells (NRK-52E) in a high glucose milieu,and to explore the mechanism of renoprotection in diabetic nephropathy (DN ) in rats involving aldosterone and spironolacton. Methods NRK-52E cells were simultaneously cultured in the serum-free Dulbecco's modification of Eagle's medium Dulbecco (DMEM) for 12 hours. Then the low glucose (LG) group was cultured in LG (1000 mg/L) DMEM:The high glucose (HG) group was cultured in high glucose (4 500 mg/L) DMEM. The aldosterone (Aldo) groups were cultured in high glucose DMEM with the addition of 10,50 and 100 nmol/L aldosterone respectively. The SP group was cultured in high glucose (4 500 mg/L) DMEM plus 10~(-7)mol/L spironolactone. Immunohistochemistry, RT-PCR and Western blot were used to detect E-cadherin and α smooth muscle actin(α-SMA) mRNA expression. Results RT-PCR showed that compared with the LG Group, E-cadherin mRNA expression in the HG group was significantly lower, and α-SMA mRNA expression was significantly increased(P＜0.05). E-cadherin mRNA expression in the 50 nmol/L Aldo group and 100 nmol/L Aldo group was significantly lower than that in the HG group, while the expression of α-SMA mRNA was significantly increased in the HG group(P＜0.05), with a dose-dependent relationship with aldosterone(r=-0.70,P＜0.05;r=0.67, P＜0.05). E-cadherin mRNA in the SP group was significantly higher,while α-SMA mRNA expression was lower than that in the HG group(P＜0.01). Immunohistochemistry and Western blot showed that compared with the LG group, E-cadherin protein expression was significantly reduced, and α-SMA expression was significantly increased in the HG group(P＜0.01). In the 10 nmol/L Aldo, 50 nmol/L Aldo, and the 100 nmol/L Aldo groups, E-cadherin protein expression was significantly lower, and α-SMA protein expression was significantly higher than that in the HG group(P＜0.05), with a dose-dependent relationship with aldosterone(r=-0.83,P＜0.05;r=0.81, P＜0.05). In the SP group, E-cadherin protein expression was higher, and α-SMA protein level was lower than that in the HG group(P＜0.05). Conclusion Aldosterone can promote EMT of tubular epithelial cells in a high sugar milieu, leading to renal interstitial fibrosis in Diabetic nephropathy. Spironolactone can inhibit high glucose-induced renal tubular epithelial cells EMT, which may be an important mechanism for the inhibition of renal interstitial fibrosis.

Effect of local aldosterone on renal epithelial-mesenchymal transition in diabetic nephropathy rats / 中华肾脏病杂志

Objective To explore the effect of aldosterone on renal epithelialmesenchymal transition in streptozocin(STZ)-induced diabetic nephropathy rats. Methods Wistar rats were intraperitoneally injected with STZ(60 mg/kg)for the preparation of diabetic model.After 4 weeks,the rats with urinary protein＞30 mg/d were regarded as successful diabetic nephropathy(n=16),and were randomly divided into diabetic nephropathy(DN group,n=8)and spironolactone group(SP group,n=8).Then eight healthy rats were selected randomly as control group(N group,n=8).SP group rats were treated with spironolactone 40 mg·kg-1·d-1,and N group and DN group rats were given equal water.After 8 weeks,rats were sacrificed to collect urine,blood plasma,kidney tissue for detection of 24 h urinary protein,creatinine and renal pathological changes.Aldosterone concentration in plasma and kidney tissue was detected by mdioimmunoassay;E-cadherin,α-SMA protein expression by immunohistochemistry,Western blotting; E-cadherin,α-SMA mRNA expression by RT-PCR. Results Compared with N group,serum creatinine, urinary protein excretion in the DN rats were significantly higher (P＜0.01,respectively), E-cadhefin protein and mRNA were significantly reduced (P＜0.01, respectively),α-SMA protein and mRNA expression was up-regulated (P＜0.01, respectively). Aldosterone level of kidney tissue in DN rats was increased obviously [(24.71±5.30) ng/g vs (16.38±2.85) ng/g, P＜0.01], which was positively correlated with urinary protein excretion, serum creatinine and α-SMA protein (r=0.737, 0.574, 0.688, P＜0.01, respectively), and negatively correlated with E-cadherin protein (r=-0.659, P＜0.O1). While no significant difference was found in serum aldosterone among three groups. Compared with DN rats, urinary protein excretion, serum creatinine were reduced (P＜0.01, respectively), E-cadherin protein and mRNA were increased (P＜0.01, respectively), α-SMA protein and mRNA expression were decreased (P ＜0.01, respectively) in SP group rats.Conclusions Local aldosterone involves in renal epithelial-mesenchymal transition in diabetic nephropathy rat. Spironolactone can block the effect of aldosterone and play a role in renal protection.

Nerve function and nerve sorbitol content changes in diabetic rats and the effect of sodium fulvate / 中华内分泌代谢杂志

Objective To observe the changes of nerve function and nerve sorbitol in diabetic rats and to explore the effect of sodium fulvate (SF). Methods Diabetic rats were induced by intraperitoneal injection of streptozotocin. One group of diabetic rats were given SF for six months. Plasma glucose, HbA 1c and nerve sorbitol were measured, and pain threshold was detected by thermalpain apparatus and hotplate test. Results (1)There was no effect of SF on hyperglycemia in diabetic rats. (2)The withdrawal latency was significantly decreased and nerve sorbitol content was significantly increased in untreated diabetic rats. (3)Untreated diabetic rats showed pain reaction at non noxious temperature (40℃) and the times of hind paw withdrawal reflex per minute at 44℃ were increased in hotplate test 〔(3.42?0.59)/min〕 as compared with non diabetic control group 〔(0.88?0.36)/min〕 (P