Clinical study of Yiqi Dihuang Decoction combined with conventional therapy for the patients with early stage diabetic nephropathy and deficiency of qi and yin / 国际中医中药杂志

Objective:To investigate the effect of Yiqi Dihuang Decoction assisting conventional western medicine therapy in the treatment of early diabetic nephropathy (DN) with deficiency of qi and yin.Methods:A total of 117 patients with early DN who met the inclusion criteria from June 2018 to December 2020 in Beijing Hospital of Traditional Chinese Medicine Shunyi Branch were divided into a control group of 58 patients and a treatment group of 59 patients according to the random number table method. The control group was treated with conventional western medicine therapy, and the treatment group was additionally treated with Yiqi Dihuang Decoction on the basis of the control group. Both groups were treated for 1 month. Serum levels of IL-1, macrophage scavenger receptor A (SR-A), TNF-α, C-C motif chemokine 2 (CCL2), GSH-Px and SOD were detected by ELISA before and after treatment. Cystatin C (Cys C) and SCr levels were detected by automatic biochemical analyzer. The urinary albumin was determined by radioimmunoassay, urinary creatinine determined by rate method, and urinary albumin/creatinine ratio (UACR) and glomerular filtration rate (eGFR) were calculated. The adverse events during treatment and clinical efficacy were evaluated.Results:The total effective rate was 94.92% (56/59) in the treatment group and 81.03% (47/58) in the control group, and the difference between the two groups was statistically significant ( χ2=5.35, P=0.021). After treatment, UACR [(92.28±15.42) mg/g vs. (108.42±20.76)mg/g, t=4.78], eGFR [(91.42±13.18) m·min -1·1.73m -2vs. (95.30±15.94) m·min -1·1.73m -2, t=2.02], SCr [(65.30±9.54) μmol/L vs. (70.18±12.53) μmol/L, t=5.42], Cys C [(0.65±0.12)mg/L vs. (1.07±0.26)mg/L, t=11.25] in the treatment group were significantly lower than those in the control group ( P<0.05). Serum SR-A [(37.18±6.10) μg/L vs. (51.51±7.12) μg/L, t=11.70], CCL2 [(13.12±1.63) μg/L vs. (19.68±2.90) μg/L, t=15.12], TNF-α [(20.57±3.50) ng/L vs. (29.68±4.17) ng/L, t=12.81], IL-1 [(8.47±0.97) ng/L vs. (13.12±1.57) ng/L, t=19.31] levels in the treatment group were significantly lower than those in the control group ( P<0.01); serum SOD [(24.09±3.12) mg/L vs. (18.72±2.76) mg/L, t=9.85] activity and GSH-Px [(231.57±25.38) mg/L vs. (174.58±22.96) mg/L, t=12.73] in the treatment group were significantly higher than those in the control group ( P<0.01). During the treatment period, the incidence of adverse events was 10.34% (6/58) in the control group and 6.78% (4/59) in the treatment group, and there was no significant difference between the two groups ( χ2=0.48, P=0.490). Conclusion:Yiqi Dihuang Decoction assisted with conventional western medicine can effectively improve the renal function of patients with early DN syndrome of qi and yin deficiency, inhibit the body's inflammatory response and oxidative stress response, and improve clinical efficacy.

Evolución del paciente quirúrgico grave con ventilación mecánica en cuidados intensivos, según valor de creatininuria / Evolution of critically ill surgical patient with mechanical ventilation in intensive care, according the urine creatinine value

Introducción: El estado nutricional al ingreso influye en la evolución del paciente quirúrgico grave. La creatininuria, indicador de este estado, podría mostrar su posible asociación con la evolución de estos pacientes. Objetivos: Identificar la evolución de los pacientes quirúrgicos graves, con ventilación mecánica invasiva y su posible asociación con la creatininuria al ingreso. Métodos: Se realizó un estudio observacional descriptivo y longitudinal, en 85 pacientes quirúrgicos con ventilación mecánica invasiva, ingresados en la sala de cuidados intensivos, desde enero del 2000 a agosto del 2007. Se evaluó el índice APACHE II al ingreso y la creatininuria en la orina de 24 horas durante 3 días seguidos, con un equipo microprocesador Hitachi 902. El valor medio se contrastó con la mortalidad, morbilidad, estadía en cuidados intensivos y tiempo de ventilación mecánica. Las variables cuantitativas se expresaron como media, con desviación estándar y las cualitativas, como frecuencias absolutas o porcentajes. La comparación de medias se realizó con la t de Student. La asociación entre variables cualitativas se evaluó con ji cuadrado. Resultados: La edad media fue de 52,3 ± 15,8 años; el 54,1 por ciento correspondió al sexo masculino y el índice de APACHE II fue 20,4 ± 6 puntos. El diagnóstico más frecuente fue la peritonitis secundaria (49,4 por ciento). Los valores inferiores de creatininuria se asociaron a la mortalidad, presencia de complicaciones, mayor estadía en cuidados intensivos y del tiempo de ventilación mecánica. Conclusiones: La creatininuria al ingreso está asociada a la evolución de los pacientes quirúrgicos con ventilación mecánica invasiva(AU)

Introduction: The nutritional status at admission influences the evolution of the severely ill surgical patient. Urine creatinine, an indicator of this state, could show its possible association with the evolution of these patients. Objectives: To identify the evolution of critically ill surgical patients with invasive mechanical ventilation and its possible association with urine creatinine on admission. Methods: A descriptive and longitudinal observational study was carried out in 85 surgical patients with invasive mechanical ventilation, admitted to the Intensive Care Unit, from January 2000 to August 2007. The APACHE II index on admission and urine creatinine in the 24-hour urine for 3 consecutive days, with a Hitachi 902 microprocessor equipment. The mean value was contrasted with mortality, morbidity, stay in intensive care and time on mechanical ventilation. Quantitative variables were expressed as mean, with standard deviation, and qualitative variables, as absolute frequencies or percentages. The comparison of means was carried out with Student's t test. The association between qualitative variables was evaluated with chi square. Results: The mean age was 52,3 ± 15,8 years; 54,1 percent corresponded to the male sex and the APACHE II index was 20,4 ± 6 points. The most frequent diagnosis was secondary peritonitis (49,4 percent). Lower urine creatinine values ​​were associated with mortality, the presence of complications, a longer stay in intensive care and the time on mechanical ventilation. Conclusions: Urine creatinine on admission is associated with the evolution of surgical patients with invasive mechanical ventilation(AU)

Can urine albumin/creatinine ratio replace 24 hours urinary albumin? / 中华内科杂志

Objective To analyze the correlation between urinary albumin/creatinine ratio (ACR) and 24-hour urinary microalbumin (UMA) and evaluate the predictive value of ARC for early diabetic nephropathy.Methods A total of 368 patients with type 2 diabetes mellitus were retrospectively collected.Early diabetic nephropathy was defined as 24h UMA 30～＜300 mg/24h.The correlation between ACR and 24hUMA,and the area under the receiver operating characteristic (ROC) curve of ACR in diagnosis of early diabetic nephropathy were calculated.Gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol were used as adjusting variables to establish univariate and multivariate logistic models of ACR for early diabetic nephropathy,respectively.A regression model was used to evaluate the diagnostic value of ACR for early diabetic nephropathy.Results The correlation between ACR and 24h UMA was 0.658.The area under ROC curve of ACR for early diabetic nephropathy was 0.907 before and 0.933 after adjustments of gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol,respectively.The OR value of ACR of diabetic nephropathy was 2.016 before and 2.762 after same adjustments.The calibration of Hosmer-Lemeshow chi-square test evaluation model was 19.362 before (P=0.13) and 14.928 after adjustments (P=0.061).Conclusion ACR is a better predictor for early diabetic nephropathy although its value is influenced by gender,age,course of disease,blood sugar,lipid,and blood pressure.

Estimating 24-Hour Urine Sodium Level with Spot Urine Sodium and Creatinine

The 24-hr urine sodium excretion level was estimated based on the spot urine sodium, and the efficacy of the formula was validated to determine the status of low salt intake or =100 mEq/day using the estimated amount> or =100 mEq/day was 84.3%, 87.6%, and 84.8%, respectively. In conclusion, the three equations used to estimate the 24-hr urine sodium content were useful to determine the status of low salt intake.

A clinical study on treatment of stageⅢdiabetic nephropathy by Qizhi Jiangtang capsule / 中国中西医结合急救杂志

Objective To observe the effect of stageⅢdiabetic nephropathy(DN)treated by Qizhi Jiangtang capsule and explore its potential mechanism. Methods According to digital table method,the patients who conformed to the diagnostic criteria of stageⅢDN were randomly divided into two groups:an experiment group and a control group. All the patients in the two groups took elution treatment for 2 weeks,and then were treated with western basic therapy. The patients in the experiment group were administered orally with Qizhi Jiangtang capsule(2.5 g once, 3 times a day),while those in the control group treated with valsartan 80 mg,once a day. Urine microalbumin(mALB), mALB/urine creatinine(UCr),β2-microglobulin(β2-MG),α1-microglobulin(α1-MG)were observed in the two groups,endothelin-1(ET-1),nitric oxide(NO),thromboxane B2(TXB2),6-keto prostaglandin F1α(6-keto-PGF1α) were also determined. Serum creatinine(SCr),blood urea nitrogen(BUN),serum cystatin-C(Cys-C),retinol-binding protein(RBP),β2-MG were detected in the blood biochemistry automatic analyzer. These laboratory markers were inspected before treatment and at the 4th,8th and 12th week after treatment. Results Ninety-six patients in the experiment group and 95 patients in the control group were effectively included in the end. Before treatment,there were no statistic significant differences in urine mALB,mALB/UCr,β2-MG,α1-MG and blood ET-1,NO,TXB2, 6-keto-PGF1α between two groups(all P>0.05). Along with the prolongation of treatment,urine mALB,mALB/UCr,β2-MG,α1-MG and ET-1,TXB2 were significantly reduced,while NO,6-keto-PGF1α were significantly raised in the two groups after treatment,and the above changes in the experimental group were more obvious. There were statistic significant differences of mALB,mALB/UCr,β2-MG,α1-MG and TXB2,6-keto-PGF1αbetween two groups at the 12th week after treatment〔mALB(mg/L):36.6±9.2 vs. 78.6±16.5,mALB/UCr(mg/mmol):3.90±1.97 vs. 9.70±2.90,β2-MG(mg/L):0.25±0.10 vs. 0.40±0.12,α1-MG(mg/L):8.40±2.26 vs. 12.50±3.21,TXB2 (ng/L):75.8±18.7 vs. 94.7±21.7,6-keto-PGF1α(ng/L):73.4±15.2 vs. 65.2±11.5,P0.05〕. In each of the two groups,the comparisons of the levels of SCr,BUN before and after treatment,there was no statistical significant difference at any time point;the same comparisons between the two groups,there was also no statistic significant difference before treatment and at each of the same time-point after treatment(all P>0.05). The levels of Cys-C,RBP andβ2-MG of the control group after treatment had the tendency of decreasing,but no statistic significant differences were found(all P>0.05). The levels of Cys-C,RBP,β2-MG of the experimental group at the 12th week after treatment were significantly lower than those before treatment〔Cys-C(mg/L):0.72±0.07 vs. 0.89±0.12,RBP (mg/L):53.0±14.2 vs. 66.1±16.5,β2-MG(mg/L):1.86±0.71 vs. 2.79±0.82,all P<0.05〕. Conclusions Qizhi Jiangtang capsule can significantly reduce the levels of urine mALB and mALB/UCr of patients with stageⅢDN and stabilize their renal functions;its therapeutic effect is better then that of valsartan. Its mechanisms are related to the reduction of ET-1,elevation of NO,maintenance of dynamic equilibrium of thromboxane A2/prostacycline(TXA2/PGI2) and protection of vascular endothelial cells.

Correlación entre la proteinuria de 24 horas y el índice proteinuria/creatinina en alícuotas de orina: valor y limitaciones / Correlation between 24-hours proteinuria and proteinuria/creatinine rate in urine aliquots: value and limitations

Objetivo: Estudiar la correlación existente entre la recolección de proteinuria de veinticuatro horas y el índice proteinuria/creatinina tomada de una alícuota de la misma muestra y analizar las variables que afectan la correlación. Material y Métodos: Se seleccionaron 100 personas adultas de diversos servicios hospitalarios y ambulatorios del Hospital Nacional Cayetano Heredia a quienes se les solicitó proteinuria en 24 horas por diversas circunstancias. La proteinuria y la creatinina en orina se midieron utilizando auto-analizadores con técnicas de química seca. Resultados: Un paciente fue excluido por dudosa recolección de la muestra. Hubo 18% varones y 82% mujeres. En la muestra hubo 38% de pacientes gestantes La correlación obtenida en toda la muestra tuvo un r= 0,74 (p < 0,001), evidenciándose que la dispersión de los datos ocurrió en presencia de pacientes con proteinuria superior a 7 g/día; con volumen urinario menor a 600 ml/día y pacientes gestantes. Al excluir estos datos la correlación tuvo un r= 0,95, p < 0,001 (r2= 0,88, IC 95% 0,79-0,93, p < 0,001). Conclusión: Existe una alta correlación entre proteinuria en 24 horas y el índice proteinuria/creatinina tomada en una alícuota. Existen variables críticas que afectan la correlación entre estos dos parámetros: diuresis dudosas, gran proteinuria y pacientes gestantes.

Objective: To study the correlation between twenty-four hours proteinuria and proteinuria/creatinine index taken from an aliquot of the same sample and analyze the variables that affect the correlation. Methods: 100 people were selected from various adult inpatient and outpatient services from Hospital Nacional Cayetano Heredia who required the measurement of proteinuria in 24 hours for various reasons. Proteinuria and creatinine were measured using auto-analyzers with dry chemistry techniques. Results: One patient was excluded for doubtful collection of the sample. There were 18% male and 82% women. 38% of the sample was pregnant patients. The correlation in the entire sample had an r= 0.74 (p < 0.001), demonstrating that the scattering of data occurred in the presence of proteinuria more than 7 g/day; urine volume less than 600 ml/day and pregnant patients. By excluding these data, the correlation had an r= 0.95, p < 0.001 (r2 = 0.88, 95% CI 0.79-0.93, p < 0.001). Conclusion: There is a high correlation between 24-hours proteinuria and the proteinuria/creatinine index taken from an aliquot. There are critical variables that affect the correlation between these two parameters: doubtful diuresis, great proteinuria and pregnant patients.

Analysis of Urine Iodine Excretion Decrease by Two-Week Stringent Low Iodine Diet for Remnant Thyroid Ablation with Radioactive Iodine in Korean Patients with Thyroid Cancer; Prospective Study / 핵의학분자영상

A low iodine diet (LID) is the recommended preparation for radioactive iodine treatment. However, the recommended duration and stringency of LID are different among each recommendation. More stringent LID is expected in Korea because Korea is a iodine-rich region. We investigated the decrement of urine iodine excretion by two-week stringent LID for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer, prospectively. MATERIAL AND METHOD: From November 2006, patients who referred to our hospital for remnant ablation after total thyroidectomy were included in this study. To decrease total body iodine, our protocol included three strategies. First, we checked medication which could inhibit the radioactive iodine uptake. Second, the date of I-131 treatment was scheduled at least 3 months later if contrast agent had been used. The last strategy was two-week stringent LID education by specialized nutritionist. Before and after two-week stringent LID, 24hr-urine iodine was analyzed respectively. 24hr-urine creatinine was also analyzed for determining more valid 24hr urine sampling subgroup. RESULTS: Total 51 patients were finally enrolled. Average of 24hr-urine iodine excretion was significantly lowered (787+/-2242 -> 85+/-85 microgram/d, p=0.03) after LID and 74.4% of patients reached below the recommended urine iodine excretion level ( 99+/-116 microgram/d, p=0.05) and 78.6% of patients met the criteria. CONCLUSION: Most patients could reach below the recommended urine iodine level after two-week stringent LID. Therefore, in our opinion, at least two-week stringent LID should be recommended in Korea.