ABSTRACT
Objective To determine the changes in serum and urine vitamin D binding protein ( VDBP) concentrations in type 2 diabetes, and to explore the clinical significance. Methods The serum and urine VDBP concentrations in 102 healthy individuals and 106 type 2 diabetic patients were determined by ELISA. For analysis and comparison, 106 type 2 diabetic patients were divided into imperfect glycemic control subgroup and perfect glycemic control subgroup, microalbuminuria subgroup and normal albuminuria subgroup. Results The cut-off point of serum VDBP concentrations was 60. 6 μg/ ml and the cut-off point of the urine ratio of VDBP and creatinine was 7. 76 mg/ g, and both were determined according to the upper limit of 97. 5 % credit intervals in 110 healthy individuals. Serum VDBP concentration and the urine ratio of VDBP to creatinine in type 2 diabetic patients were significantly higher than those in the healthy individuals ( P < 0. 01 ), the imperfect glycemic control subgroup had higher serum VDBP concentrations and the urine ratio of VDBP to creatinine than those in the perfect glycemic control subgroup ( P <0. 05). The microalbuminuria subgroup had higher urine ratio of VDBP to creatinine than that in the normal albuminuria subgroup ( P<0. 01). Urine ratio of VDBP to creatinine in diagnosing early diabetic nephropathy had sensitivity of 96. 4 % , specificity of 68 % , and concordance of 83% . Conclusion Detection of serum VDBP levels has some reference value in understanding the state of diabetes. Combined determinations of urine ratio of VDBP to creatinine and ratio of albumin to creatinine have significant clinical value in the early diagnosis of diabetic nephropathy.
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Objective To explore the reasons of the failure of primary arteriovenous fistula (AVF)surgery and the preventive measures in patients with end-stage renal disease.Methods A total of 819patients with end-stage renal disease who accepted primary AVF surgery were selected.The data of hemoglobin (Hb),albumin (ALB),cholesterol (CHOL),parathyroid hormone (PTH),fasting blood glucose and blood pressure were collected before surgery,while the diameters of radial artery and cephalic vein were measured by upper extremity vascular ultrasound.Results Seven hundred and forty-two patients with AVF surgery were successful,and 77 patients were failed.The age,the ratio of diabetes,hypertension and blood pressure ＜ 120/70 mm Hg (1 mm Hg =0.133 kPa) in AVF failed patients was higher than that in AVF successful patients[(61.3 ± 13.4) years vs.(45.6 ± 11.2) years,46.8％(36/77) vs.31.7％ (235/742),26.0％ (20/77) vs.19.5％ (145/742),36.4％ (28/77) vs.9.2％ (68/742)],and there was significant difference (P＜0.05 or ＜0.01).The diameters of radial artery and cephalic vein in AVF failed patients was lower than that in AVF successful patients [(1.35 ± 0.64) mm vs.(1.98 ± 0.47) mm,(2.13 ± 0.81)mm vs.(2.47 ± 0.74) mm],and there was significant difference (P＜ 0.01).The level of PTH in AVF failed patients was higher than that in AVF successful patients [(782.39 ± 423.85) ng/L vs.(378.83 ± 352.21) ng/L],and there was significant difference (P ＜ 0.05).Logistic regression analysis showed that blood pressure,diabetes,PTH,the diameters of radial artery and cephalic vein was the risk factor of AVF failed.Conclusion AVF surgery failed is highly correlated with the patient s blood pressure,th primary disease,the vessel diameter,
ABSTRACT
Objective To investigate the anti-erythropoietin antibody level and its clinical significance in maintenance dialysis patients. Methods Eighty maintenance hemodialysis (HD) and 30 peritoneal dialysis (PD) patients were enrolled in the study. Serum anti-erythropoietin antibody levels of above 110 dialysis patients were measured by ELISA. Immunoreactive parathyroid hormone (iPTH), Scr, BUN, Hb, and CRP were determined by conventional methods at the same time. Correlations among these indexes were examined. Results The anti-erythropoietin antibody levels of the dialysis patients were significantly higher than those of healthy people (P＜0.05), but no significant difference was found between HD patients and PD patients. There were no significant differences of anti-erythropoietin antibody, Hb, BUN, Scr, iPTH and CRP among different primary diseases. Hb was negatively correlated with anti-erythropoietin antibody and CRP (r=-0.56, -0.20,P ＜0.05), but was not correlated with BUN, Scr, iPTH. There was no correlation of antierythropoietin antibody with BUN, Scr, CRP and iPTH. One patient receiving recombinant human erythropoietin (rHuEPO) treatment with anti-erythropoietin antibody 43.63 U/L developed pure red cell aplasia diagnosed by marrow biopsy. Conclusions The anti-erythropoietin antibody levels of the dialysis patients are significantly higher as compared to healthy people, but are not significantly different between HD and PD patients. Anti-erythropoietin antibody is not correlated with BUN, Scr,iPTH and CRP. Hb is negatively correlated with anti-erythropoietin antibody and CRP. The rHuEPO can induce the anti-erythropoietin antibody leading to pure red cell aplasia in dialysis patients.