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To observe the multi-targeted therapeutic effects of Huangkui Capsules(HKC)on insulin resistance(IR)and urine microalbumin in the early diabetic kidney disease(DKD)patients. The case data from the 83 DKD patients at G2 and A2 stage were collected respectively and analyzed retrospectively. According to the different treatment,all patients were divided into the control(A)group(40 cases)and the treated(B)group(43 cases). Among them,the A group patients were received "routine basic treatment";the B group patients were received "routine basic treatment+HKC". For the 2 group patients,firstly,the baseline parameters before receiving the treatment were compared respectively,and then,the changes of the total scores of traditional Chinese medicine(TCM) syndromes and the indicators of IR,urine protein,renal function,blood lipids and safety after receiving the treatment for 8 weeks were compared,respectively. Furthermore,for the all patients,the correlation analysis between IR and urine protein or IR and the total scores of TCM syndromes was carried out,respectively. The results showed that,for the B group patients received "routine basic treatment",their total scores of TCM syndromes,urine protein indicators including urine microalbumin(micro-UAlb) and urine microalbumin/urinary creatinine(UACR),IR indicators including fasting serum insulin(FIN)and homeostasis model assessment of insulin resistance(HOMA-IR)were significantly improved,respectively. For the all DKD patients,before and after the treatment,the main IR indicators(FIN and HOMA-IR)were positively correlated with urine protein indicators(micro-UAlb and UACR). The main IR indicators(FIN and HOMA-IR) were also positively correlated with the total scores of TCM syndromes. In addition,2 treatments had no significant effects on renal function,blood lipids and safety indicators in the all DKD patients. Overall, "routine basic treatment+HKC" can ameliorate IR and reduce urine microalbumin in the early DKD patients. Its therapeutic targets may be not only proteinuria,but also IR,which is the upstream risk factor of proteinuria.
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Humans , Albuminuria , Capsules , Diabetes Mellitus , Diabetic Nephropathies , Drugs, Chinese Herbal , Insulin , Insulin Resistance , Kidney , Retrospective StudiesABSTRACT
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.
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Objective To investigate the significance of plasma retinol binding protein (RBP),Cystatin C (CysC),soluble intercellular adhesion factor 1 (sICAM 1) and urinary microalbumin (u-MALB) in the detec-tion of early diabetic nephropathy.Methods 40 patients with diabetic nephropathy received from May 2015 to May 2016 at the Capital Medical University Desheng Teaching and Research Center were selected as the ob-servation group and 40 healthy subjects were selected as the control group.Both groups were tested by using immunoassay and biochemical analyzer.Then RBP,CysC,sICAM-1 and u-MALB results in two groups were compared.The sensitivity and specificity of individual and combined detection of related indexes were analyzed by ROC curve.Results The levels of RBP,CysC,sICAM-1 and u-MALB in the observation group [(1.36 ± 0.03)mg/mL,(1.43 ± 0.10)mg/L,(208.72 ± 30.34)ng/mL,(42.39 ± 3.32)mg/L] were higher than those in the control group [(0.33 ± 0.01)mg/mL,(0.14 ± 0.01)mg/L,(85.39 ± 16.85)ng/mL,(10.31 ± 2.20)mg/L],and the difference was statistically significant (P< 0.05).The positive rate of combined detection was higher than single detection of RBP,CysC,sICAM-1 and u-MALB.Conclusion RBP,CysC,sICAM-1 and u-MALB are effective indicators to reflect the patient′s renal injury.The combined detection could effectively improve the positive rate of diagnosis of diabetic nephropathy and monitoring the levels of RBP,CysC,sICAM-1 and u-M ALB level in diabetic nephropathy patients is important for the diagnosis of the onset and the devel-opment of early kidney injury,and the treatment and the progression of the disease.
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Objective To explore the relationship between blood pressure level and urinary micro-albumin, kidney damage and metabolic indicators, so as to provide scientific evidence for the prevention and treatment of hypertension. Methods Using stratified multi-stage random sampling method, we selected local residents (15 years old) in Tongnan area of Chongqing for questionnaire survey, physical examination, and the detection of blood and urine samples to obtain blood glucose, blood lipids, urinary micro-albumin, and other clinical data. The data were statistically analyzed by SPSS 20.0 software. Results The proportions of patients with microalbuminuria (urinary micro-albumin level≥20 mg/L) in the normal blood pressure group, the prehypertension group, and the hypertension group were 21.40% (61/285), 27.36% (110/402) and 48.06% (149/310), respectively, and there were significant differences between the three groups (P0.05). The proportion of patients with microalbuminuria in the hypertension patients was significantly increased with the increase of blood pressure (P0.05). Multiple linear regression analysis showed that systolic blood pressure was significantly increased with the increase of triglyceride and low-density lipoprotein cholesterol levels (P0.05), and diastolic blood pressure was significantly increased with the increase of triglyceride level (P0.05). Binary logistic regression analysis showed that urinary micro-albumin, high-density lipoprotein cholesterol, age and waist circumference were the influencing factors of hypertension (P0.05). Conclusion Urinary micro-albumin level is closely related to blood pressure level, and can be used as an important indicator for the diagnosis of early renal damage diagnosis. Urinary micro-albumin, high-density lipoprotein cholesterol, age and waist circumference are independently associated with hypertension.
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Dipeptidyl Peptidase-4 inhibitor (DPP-4 inhibitor),a new kind of oral anti-diabetic medicine,has been widely used for the treatment of type 2 diabetes (T2DM) during the last decades.Recent evidence showed that DPP-4 inhibitor may have renal protective effects beyond glycemic control.Some clinical studies revealed that the reduction of HbA1c by DPP-4 inhibitor was paralleled by an improvement of albuminuria and renal function.Experimental studies indicated that the renal protection mechanism of DPP-4 inhibitor may be involved in its multiple effects including anti-inflammatory,anti-oxidation and improvement of endothelial function.However,the evidence of decreasing albuminuria for DPP-4 inhibitor mainly comes from animal models and some clinical trials with small sample size.More large randomized controlled trials (RCT) will be needed to certify the renal protection effect of DPP-4 inhibitor.In this review,the role of DPP-4 inhibitor on albuminuria will be considered and discussed from both experimental and clinical perspectives.
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Objective To investigate the application value of urine microalbumin (mALB) ,retinol binding protein(RBP) and cys-tatin C(CysC) and their combined detection in early diagnosis of type 2 diabetic nephropathy(DN) .Methods Ninety-two inpatients with DN (DN group) and 90 people undergoing the physical examination(control group) in our hospital from June 2014 to Decem-ber 2015 were collected .Urine mALB ,RBP and CysC were detected in all subjects and detection results were analyzed statistically . Results The levels of urine mALB ,RBP and CysC in the DN group were significantly higher than those in the control group ,the differences all had statistical significance (P< 0 .05) .Among 3 indicators ,the positive rate of urine mALB for detecting DN was highest (94 .57% ) ,while which of 3-index combined detection was 97 .83% ,and significantly higher than that of single detection , the difference was statistically significant(P<0 .05) .The sensitivity ,specificity ,positive predictive value ,negative predictive value and Youden index of 3-index combined detection were all higher than those of single index .The ROC curve showed that AUC of u-rine mALB for diagnosing DN was 0 .732 ,the diagnostic cut-off value was 43 .58 mg/L ,AUC of urine RBP was 0 .685 ,the diagnos-tic cut-off value was 1 .47 mg/mL ,AUC of urine CysC was 0 .701 ,the diagnostic cut-off value was 1 .42 mg/L ,while AUC of com-bined detection was 0 .928 .Conclusion Urine mALB ,RBP and CysC are better indexes reflecting renal injury .Their combined de-tection will increase the positive rate ,sensitivity and specificity for diagnosing DN .So monitoring the levels of urine mALB ,RBP and CysC has an important significance to diagnosing the occurrence and development of DN early renal injury and prevention ,treat-ment and delaying progress of DN .
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? Diabetic retinopathy is one of those significant complications of diabetes.With the increasing number of diabetic patients, blind caused by diabetic retinopathy is a serious threat to human health which cannot be neglected, but there is no highly effective treatment for it. Consequently, early detection and preventive treatment for it are important.Currently, studies have found that urine microalbumin had a close relation with diabetic retinopathy and that urine microalbumin might play an important role in early predicting of diabetic retinopathy. The review is about the diagnostic significance of urine microalbumin test for early diabetic retinopathy.
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Objective To evaluate the effect of telmisartan on serum adiponectin and urine microalbumin(mAlb) level by administrating it to mice with simple obesity, so as to explore new therapies for obesity-related kidney diseases.Method A total of 24 8-week-old male OB mice and 8 8-week-old male C57 mice were selected for this study.The genetic background of OB mouse was C57 mouse, but the lepin gene was deleted in OB mouse.OB mice were randomly divided into 3 groups by body weight and fed with high-fat diet for 12 weeks: model group (M group), telmisartan group (T1 group) and losartan group (T2 group).C57 mice acted as control and were fed with general diet for 12 weeks.Serum adiponectin and blood glucose levels were measured before and after treatment.24 h urine was collected to measure urine mAlb.Quantitative real-time PCR (qRT-PCR) was used to measure the expression level of peroxisome proliferators-activated receptors gamma mRNA(PPARγ mRNA).HE stain was used to observe the morphological changes of kidney and measure the glomerular diameter.Body weight, serum adiponectin level, blood glucose level, urine mAlb level, expression level of kidney PPARγ mRNA, kidney wet weight and glomerular diameter of 4 groups were compared and a correlation analysis was carried out by Person correlation coefficient.Results Compared with C group, the urine mAlb level in M group increased (P＜0.01), serum adiponectin level and the expression level of kidney PPARγ mRNA in M group decreased (P ＜ 0.01);The urine mAlb level was negatively correlated with serum adiponectin level and expression of kidney PPARγmRNA (r=-0.773,P ＜ 0.01;r=-0.469, P ＜ 0.01).The urine mAlb level in T1 group was lower than M group (P ＜ 0.05),serum adiponectin level and expression of kidney PPARγmRNA in T1 group were higher than M group (P ＜ 0.05).Compared with T2 group, the urine mAlb level in T1 group decreased, serum adiponectin level and expression of kidney PPARγ mRNA in T1 group increased (P ＜ 0.05);Compared with M group, the urine mAlb level in T2 group decreased (P=0.01).The morphological changes of kidney:glomerular volume increase and focal segmental sclerosis were found in some mice in M group and T2 group.No glomerular volume increase and focal segmental sclerosis were observed in T1 group.Conclusions Telmisartan can reduce urine microalbumin, whose mechanism might be that telmisartan can active the PPARγand promote the level of serum adiponectin.
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Objective To investigate the serum concentration of cystatin C in puerperae and the relationship of cystatin C with e-rythrocyte count,leukocyte count,urine microalbumin and specific gravity.Methods The serum cystatin C,Cr,BUN and urine e-rythrocyte count,leukocyte count,urine microalbumin and specific gravity were detected in 232 puerperae and 200 healthy women. Multiple linear regression analysis was performed to analyze the relationship of cystatin C with urine erythrocyte count,leukocyte count,urine microalbumin and specific gravity.Results The concentration of cystatin C in the puerperal group was significantly higher than that in the normal control group(P <0.05).The concentrations of Cr,BUN in the puerperal group were significantly lower than that in the normal control group (P <0.05).The erythrocyte count and the leukocyte count,in the puerperal group were higher than those in the control group(P <0.05).The urine microalbumin was higher in the puerperal group than that in the con-trol group(P <0.05).There was no significant difference of specific gravity between them.In multiple linear regression analysis,a regression relationship was found between cystatin C(Y)and urine microalbumin(X1 )and specific gravity(X2 ).Regression relation-ship was not found between cystatin C and other indices.Conclusion Elevated serum cystatin C,together with urine microalbumin suggests early renal function change.They can be used to monitor renal function for the puerperae.
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Objective To investigate the diagnostic value of serum Cystatin C and 24 h urine microalbumin quantitative exami-nation in the early gestational diabetes kidney.Methods Chose 110 cases of patients from 37 to 40 weeks during pregnancy with gestational diabetes.According to the GFR,patients were divided into GFR moderate decline group A (30 ml/min/1.73m2 ≤GFR0.05).There was positive correlation between levels serum Cys C and urine microalbumin in group A and B (r=0.756,0.725,t=5.209,4.835,P <0.01,respectively).The sensitivity of Cys C and urine microalbumin were 95.2% and 90.5%,sensitivity of the combination of Cys C and urine microalbumin was 100% (χ2 =8.24,7.08,P <0.05,respectively).Conclusion As sensitive indicators of gestational diabetes in the early renal damage stage,joint detection of Cys C and urine microalbumin is of great significance for diagnosis and monitoring of diabe-tes in the early renal damage stage.
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Objective To observe the influence of pulse pressure on renal injury in patients with essential hypertension (EH).Methods Two hundred and twenty-nine patients with mild-to-moderate EH completed 24 h ambulatory blood pressure monitoring.The patients were divided into 2 groups according to 24 h mean pulse pressure (MPP):EH 1 (24 h MPP ≥ 60 mmHg,1 mmHg =0.133 kPa) group (128 cases) and EH2 (24 h MPP ＜ 60 mmHg) group (101 cases).According to 24 h urine microalbumin and biochemical determination of renal function,the influence of pulse pressure on kidney function was observed and compared.Results The 24 h mean systolic blood pressure (MSBP) and 24 h MPP in EH1 group were significantly higher than those in EH2 group [(156.20 ±6.11) mmHg vs.(143.67 ±5.46) mmHg,(69.09 ±5.87) mmHg vs.(51.15 ±7.15) mmHg] (P ＜0.01),the 24 h mean diastolic blood pressure (MDBP) in EH2 group was significantly higher than that in EH1 group [(92.52 ±5.93) mmHg vs.(87.11 ± 5.52) mmHg](P＜ 0.01).The 24 h urine microalbumin in EH1 group was significantly higher than that in EH2 group [(104.80 ± 24.25) mg vs.(91.29 ± 24.03) mg] (P ＜ 0.01).There was positive correlation between 24 h MPP,24 h MSBP and 24 h urine microalbumin (r =0.259,0.201,P ＜ 0.01),and there was negative correlation between 24 h MDBP and 24 h urine microalbumin (r =-0.180,P＜ 0.01).Conclusion The 24 h MPP is closely related with the renal injury which is caused by high blood pressure in patients with EH.
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Objective To evaluate the clinical application value of the HC-900 fully automated urine dry chemistry analyzer and its matched test strip (HC-900 analysis system) for detecting urine microalbumin (U-mAlb) .Methods 660 urine samples were collected with the negative urine protein detected by the HC-900 analysis system as the standard ,among them ,159 samples with positive U-mAlb screened by the test strip and 106 samples with the partial negative were performed the quantitative analysis by the Immage 800 fully automatic specific protein analyzer for verifying the results screened by the HC-900 analysis system .The compari-son of the U-mAlb quantitative detection results between the screening positive group and the screening negative group adopted the two samples rank sum test .The comparison between the enumeration data was carried out by Kappa test for consistency .Results Among 660 samples ,159 samples with positive U-mAlb were quantitatively detected by the Immage 800 analyzer and 101 samples were confirmed positive U-mAlb with the real positive rate of 63 .5% .Among 106 samples of negative U-mAlb randomly extracted by the HC-900 analysis system ,9 samples were confirmed to be positive U-mAlb quantitatively detected by the Immage 800 analy-zer .By the consistency test ,the difference between the two methods had statistical significance (Kappa=0 .495 ,P<0 .01) .The U-mAlb level was 18 .02(8 .23-34 .89)mg/L in the screening positive group ,which was significantly higher than 4 .78(2 .51-8 .46) mg/L in the screening negative group ,the difference had statistical significance (Z= -8 .689 ,P<0 .01) .Relative to the detection by the Immage 800 quantitative analyzer ,the sensitivity and specificity of the U-mAlb for the rapid screening by the dry chemistry method was 91 .8% (101/110) and 62 .5% (97/155) respectively .Conclusion The HC-900 analysis system for screening U-mAlb has a certain clinical application value .
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Objective To investigate the clinical diagnostic value of serum homocysteine (Hcy) ,serum beta 2-microglobulin(Sβ2-MG),urine beta 2-microglobulin(Uβ2-MG),urine microalbumin(UmAlb) combined detection for diabetic nephropathy (DN). Methods 230 cases of type 2 diabetes in which 100 patients without complications (diabetic group) ,130 patients with DN (DN group) were enrolled ,and another 50 healthy people served as control group .Automatic biochemical analyzer was employed to de-tect serum Hcy and creatinine ,automated chemiluminescence analyzer was used to detect Sβ2-MG and Uβ2-MG ,Glycated hemoglo-bin cytometry was adopted to measure glycosylated hemoglobin A 1c(GHbA1c) .Positive rates were compared among serum Hcy , Sβ2-MG ,Uβ2-MG ,UmAlb detection and sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive value were compared between individual and joint detection .Results Serum Hcy ,GHbA1c ,creatinine ,Sβ2-MG ,Uβ2-MG and UmAlb concen-trations of patients in DN group were significantly higher than those in the diabetic group and the control group (P0 .05) ,and differences of remaining indicators′concentration in the diabetic group were significantly higher than those in the control group(P<0 .05) .The positive rate of Hcy ,Sβ2-MG ,Uβ2-MG and UmAlb combined detection in the diabetic group was 23 .00% .In DN group ,the positive rate of the four indicators combined detection was 95 .38% ,with 84 .67% ,84 .35% for specificity and posi-tive predictive value ,respectively ,and 95 .38% ,89 .64% ,95 .49% for sensitivity ,accuracy and negative predictive values ,respective-ly .Conclusion Serum Hcy ,Sβ2-MG ,Uβ2-MG and UmAlb combined detection has important value for early diagnosis of DN .
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Objective The purpose of this study was to observe the effects of bumetanide on elderly type 2 diabetic patients with middle and advanced stages nephropathy. Methods Forty cases with diabetic nephropathy (DN) were divided into two groups:control group (20 cases) and treatment group (20 cases) . The control group accepted furosemide (20 mg, once a day) and the bumetanide was orally administrated at the dose of 1.0 mg, twice a day to the treatment group for 3 months. The assessment of transferrin (TRF) and urine microalbumin (UALB) was performed at the time points at the end of 1, 4, 8, 12 weeks after treatment. Results (1) The levels of BUN, SCr and UA after treatment were lower than before treatment, but there were no significant differences. (2) In the treatment group, the levels of TRF and UALB have decreased after treatment for 1 week, with no statistically significant. But at the end of 4, 8 and 12 weeks,the differences were statistically significant ( <0.05) . Especially, during the three months follow-up,the levels of TRF and UALB at 12 weeks have decreased obviously. Conclusion The therapeutic effect of bumetanide on DN might be better than that of furosemide.
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From August 2011 to March 2012,5 241 type 2 diabetic patients with body mass index ≥ 24kg/m2 were enrolled from 60 hospitals in Guangdong Province.According to estimated glomerular filtration rate (eGFR),a total of 2 631 subjects with norml urine microalbumin level (＜30 ng/L) were divided into normal eGRF group and decreased eGRF group.Binary logistic regression was used to analyze the associations between eGFR and its related risk factors.The results showed that age,blood uric acid,blood urea nitrogen,history of hypertension and coronary heart disease,family history of diabetes,and hyperuricemia were positively related to lowering of eGFR (P＜ 0.05 or P＜0.01).HbA1C＜7％,regular glucose monitoring,and regular physical activity were negatively related to eGFR decrease (all P＜ 0.01).These results suggest that urine microalbumin and eGFR should be applied to overweight or obese patients with type 2 diabetes in order to screen diabetic nephropathy.Furthermore,intensive control of blood glucose,uric acid,and blood pressure is beneficial to lowering the risk of diabetic nephropathy.
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Objective Toinvestigatethecorrelationofsmallvesseldisease(CSVD)causedacute lacunarinfarctionandurinemicroalbumin.Methods Theclinicaldataof136patientswithacutelacunar infarction admitted to the Department of Neurology,Shengjing Hospital of China Medical University from November 2012 to April 2014 were analyzed retrospectively. They were divided into either a CSVD group (n=72)or a cerebral large vessel disease (CLVD)group (n=64)according to their carotid artery color Doppler ultrasound and head magnetic resonance angiography findings. The levels of urinary microalbumin in both groups were observed and compared. SAS 9. 1 software was used to conduct statistic analysis. A Logistic regression analysis was used to determine the independent risk factors for CSVD caused acute lacunarinfarction.Results TheconcentrationofurinemicroalbuminoftheCSVDgroup(22±13mg/L) was significantly lower than (29 ± 14 mg/L)that of the CLVD group. There was significant difference (P<0.05). There was significant difference in the increased urine microalbumin levels between the CSVD group and the CLVD group (P<0. 01). There was an increasing trend for the proportion of patients with urine microalbumin concentration 10- <30 mg/L (56. 9%[41/72])in the CSVD group compared with the CLVD group (26. 6%[17/64]). Logistic regression analysis showed that the slightly increased microalbuminuria was associated with CSVD caused acute lacunar infarction (OR,3. 130,95%CI 1. 481-6.618;P<0.01).Conclusion Theslightlyincreasedmicroalbuminuriaisanindependentriskfactorfor CSVD caused acute lacunar infarction.
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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.
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Objective To observe the changes of urine microalbumin (mAlb), renal function and intima-media thickness(IMT) of the carotid artery in prehypertensive patients and investigate whether there are related target organ damage. Methods From August 2009 to May 2010,one hundred and eighty patients were recruited into the study and divided into 3 groups according to the 2005 revised edition of guideline for prevention and treatment of hypertension in China: Sixty normotensive subjects ( NT group,41 males, 19 females,mean age [54. 6 ± 12. 3] years old) ;Sixty prehypertensive patients( PH group,32 males,28 females,mean age [57.0 ± 12.7] years old) and 60 hypertensive patients ( EH group, 28 males, 32 females, mean age [65.0 ±12. 1] years old). Urine mAlb, serum creatinine(Cr) and IMT of the carotid artery were measured and compared among the three groups. The relationships between prehypertension and urine mAlb,serum Cr, IMT of the carotid artery were analyzed. Results In the NT group, PH group and EH group, the urine mAlb concentrations were ( 15.3 ± 7.5 ) mg/L, ( 24. 6 ± 10. 7 ) mg/L and ( 37.3 ± 20. 4) mg/L respectively ;serum Cr were ( 68.0 ± 16. 5 )μmol/L, (81.9 ± 14.9)μmol/L and (95.8 ± 22.5)μmol/L respectively; IMT of the carotid artery were ( 1.46 ± 0. 67 ) mm, ( 1.79 ± 0. 74 ) mm and( 2. 34 ± 0. 78 ) mm respectively. Urine mAlb, serum Cr and IMT of the carotid artery were significantly higher in the PH group and EH group when compared to NT group ( P ＜0. 05 or 0. 01 ); and in the EH group these indices were also significantly higher than those in the PH group( P ＜0. 01 ). Multiple linear regression analysis showed that after adjusted age, body mass index (BMI), blood pressure( BP), serum lipid and serum glucose, in the PH group,the standard partial regression coefficients of correlation between urine mAlb and systolic blood pressure (SBP), diastolic blood pressure(DBP) and serum glucose were 0. 279,0. 259 and 0. 360 respectively ( P = 0. 012, 0. 043 and ＜ 0. 001 ); the standard partial regression coefficients of correlation between serum Cr and SBP, DBP and serum glucose were 0. 317,0. 257 and 0. 377 respectively ( P = 0. 006,0. 049 and ＜ 0. 001 ). The standard partial regression coefficients of correlation between IMT of the carotid artery and age, SBP, DBP, total cholesterol and serum glucose were 0. 381,0. 375,0. 263,0. 265 and 0. 372 respectively( P ＜ 0. 001, ＜ 0. 001, = 0. 033,0. 021 and ＜ 0. 001 ). In the EH group, the standard partial regression coefficients of correlation between urine mAlb and SBP, DBP and serum glucose were 0. 378,0. 258 and 0. 283 respectively( P ＜ 0. 001, = 0. 046, and 0. 009); the standard partial regression coefficients of correlation between serum Cr and SBP, DBP and serum glucose were 0. 294,0. 261 and 0. 464respectively (P =0. 008,0. 042 and ＜0. 001 ) ;the standard partial regression coefficients of correlation between IMT of the carotid artery and age, SBP, high density lipoprotein cholesterol and serum glucose were 0. 262,0. 264, -0. 374 and 0. 306 respectively ( P = 0. 035,0. 023, ＜ 0. 001 and 0. 007 ). We found that both urine mAlb and serum Cr were significantly associated with BP and serum glucose; IMT of the carotid artery was significantly associated with age, BP, serum lipid and serum glucose. Conclusion Urine mAlb, serum Cr andIMT of the carotid artery increased in prehypertensive patients, and these indices were significantly associatedwith the level of the BP. These data indicated there were related target organ damage occurred in prehypertensive patients,the BP level was the risk factor that increased urine mAlb,serum Cr and IMT of the carotid artery.
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Type IV collagen is the principal component of glomerular basement membrane and messangial matrix. Studies have shown increased levels of urinary type IV collagen (uIV) in diabetic patients compared to healthy controls. The concentration of uIV increases gradually as diabetic nephropathy progresses. Aim and method: This study was carried out to determine whether urinary type IV collagen (uIV) can serve as an indicator of diabetic nephropathy. Using a sandwich enzyme immunoassay technique, uIV excretion was determined in 30 type 2 diabetic patients with normoalbuminuria and 20 patients with microalbuminuria. Results: uIV excretion was signifi cantly increased in type 2 diabetics, in both normoalbuminuric and microalbuminuric patients, compared with healthy controls. The increase in urinary type IV collagen was well correlated with the amount of urinary albumin but not with HbA1C. Conclusion: Our fi ndings that uIV is higher in those with microalbuminuria and correlates with albuminuria, support uIV as an indicator of diabetic nephropathy. Whether the increased uIV excretion would predict the impending renal failure needs further confi rmation.
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BACKGROUND: Preeclampsia is a frequent cause of maternal or fetal morbidity and mortality. There have been many trials to use microalbuminuria as a predictor for preeclampsia, but the usefulness is controversial. Authors have studied the changes in urinary microalbumin excretion during normal pregnancy to help establish a reference interval in which physiologic alteration during pregnancy is reflected. METHODS: During the period from January to April 1999 and from December 1999 to January 2000, urinary albumin and creatinine levels were measured in the 151 spot urine samples from pregnant women visiting Hanyang University Kuri Hospital for prenatal care. They were free of hypertension, proteinuria, and renal diseases at the time of sampling for the medical records. A homemade ELISA and the Cobas Integra 700 were used to measure the urinary albumin and urinary creatinine levels. The analysis of the data was performed as urinary microalbumin/creatinine ratio (ACR). RESULTS: In the 146 urine samples from normotensive pregnant women, urine ACR was 1.36+/-1.72 g/mol (mean+/-standard deviation). The urine ACR was 0.83+/-1.12 g/mol in the first trimester, 1.06+/-1.38 g/mol in the second trimester, and 1.82+/-1.06 g/mol in the third trimester. The urine ACR of the third trimester was significantly different from that of the first or second trimester (3rd vs 1st, P=0.026 and 3rd vs 2nd, P=0.011). CONCLUSIONS: During the course of normal pregnancy, urinary microalbumin excretions increased significantly in the third trimester. It is necessary that the reference interval for urinary microalbumin excretions be established based on gestational weeks.