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ObjectiveTo investigate the value of combined determination of Model for End-Stage Liver Disease （MELD） score， albumin-bilirubin （ALBI） score， and β2-microglobulin in the diagnosis of liver cirrhosis with acute kidney injury （AKI）. MethodsClinical data were collected from 258 patients with liver cirrhosis who attended The First Affiliated Hospital of Zhengzhou University from October 2019 to October 2022， and according to the presence or absence of AKI， they were divided into AKI group with 117 patients and non-AKI group with 141 patients. The changes in each index were compared between the two groups and between the patients with different stages of kidney injury. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and a one-way analysis of variance was used for comparison between multiple groups； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic （ROC） curve was plotted to evaluate the efficacy of each index in the diagnosis of liver cirrhosis with AKI. ResultsCompared with the non-AKI group， the AKI group had significantly higher age （t=2.307， P=0.022）， proportion of patients with hepatic encephalopathy （χ2=18.064， P<0.001） or with spontaneous peritonitis （χ2=16.397， P<0.001）， mortality rate （χ2=45.251， P<0.001）， levels of creatinine （Z=-8.737， P<0.001） and β2-microglobulin （Z=-8.829， P<0.001）， and scores of CTP （Z=-4.058， P<0.001）， ALBI （t=2.563， P=0.011）， and MELD （Z=-5.628， P<0.001）， as well as a significantly shorter length of hospital stay （Z=-3.391， P=0.001）. There were significant differences in creatinine， β2-microglobulin， MELD score， and ALBI score between the patients with stage 1， 2 or 3 AKI （P<0.05）， while there was no significant difference in CTP score between these three groups （P>0.05）. The combined determination of ALBI score， MELD score， and β2-microglobulin had an area under the ROC curve （AUC） of 0.837 （95% confidence interval ［CI］： 0.782 — 0.892）， with a sensitivity of 75.2% and a specificity of 90.8%； ALBI score combined with MELD score had an AUC of 0.700 （95%CI： 0.636 — 0.764）， ALBI score combined with β2 microglobulin had an AUC of 0.823 （95%CI： 0.765 — 0.881）， and MELD combined with and β2 microglobulin had an AUC of 0.835 （95%CI： 0.779 — 0.890）， suggesting that combined determination of ALBI score， MELD score， and β2-microglobulin had a better diagnostic efficacy than ALBI score， MELD score， or β2-microglobulin used alone or in pairs， as well as a better diagnostic efficacy than creatinine. ConclusionCombined determination of ALBI score， MELD score， and β2-microglobulin has a relatively high value in the diagnosis of liver cirrhosis with AKI.
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Cancer immunotherapy has become a new generation of anti-tumor treatment, but its indications still focus on several types of tumors that are sensitive to the immune system. Therefore, effective strategies that can expand its indications and enhance its efficiency become the key element for the further development of cancer immunotherapy. Natural products are reported to have this effect on cancer immunotherapy, including cancer vaccines, immune-check points inhibitors, and adoptive immune-cells therapy. And the mechanism of that is mainly attributed to the remodeling of the tumor-immunosuppressive microenvironment, which is the key factor that assists tumor to avoid the recognition and attack from immune system and cancer immunotherapy. Therefore, this review summarizes and concludes the natural products that reportedly improve cancer immunotherapy and investigates the mechanism. And we found that saponins, polysaccharides, and flavonoids are mainly three categories of natural products, which reflected significant effects combined with cancer immunotherapy through reversing the tumor-immunosuppressive microenvironment. Besides, this review also collected the studies about nano-technology used to improve the disadvantages of natural products. All of these studies showed the great potential of natural products in cancer immunotherapy.
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Objective:To investigate the relationship between plasma beta-2 microglobulin(β2M)levels and the total magnetic resonance imaging(MRI)burden of cerebral small-vessel disease(CSVD)in elderly patients with lacunar stroke.Methods:A total of 93 elderly patients with lacunar stroke admitted to the Department of Neurology, Changzhou Second People's Hospital form August 2018 to August 2019 were enrolled retrospectively, all with complete records of cranial magnetic resonance imaging and plasma β2M measurement.According to the total MRI CSVD burden, which ranges from an ordinal score of 0 to 4, patients were divided into 5 groups.Single-factor analysis was used to compare clinical data between the 5 groups.The association between the plasma β2M level and total MRI CSVD burden was analyzed by ordered multiple Logistic regression models.Results:Among elderly patients with lacunar infarction, 19 had a CSVD score of 0, 19 had a score of 1, 23 had a score of 2, 21 had a score of 3, and 11 had a score of 4, with statistically significant differences in age, percentage with diabetes, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, plasma β2M, and eGFR between the 5 groups( P<0.05). Spearman correlation analysis showed that plasma β2M level was significantly positively correlated with total MRI CSVD burden( r=0.687, P<0.001). In ordered multivariate logistic regression models, after adjustment for possible confounding factors such as age, sex and hypertension, the results demonstrated that plasma β2M level( OR=5.253, 95% CI: 2.350-11.740, P<0.001)was an independent risk factor for total MRI CSVD burden. Conclusions:In elderly lacunar stroke patients, the plasma β2M level is closely related to the total MRI CSVD burden and can be used as a marker for predicting the severity of lesions.
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Objective@#To investigate the changes of serum carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), β2-microglobulin (β2-MG) levels in non-Hodgkin's lymphoma (NHL) patients and their clinical significance.@*Methods@#From February 2015 to February 2018, 54 patients with NHL who were hospitalized in Shiyan People's Hospital were selected as the observation group. All patients underwent two cycles of chemotherapy combined with radiation therapy. Another 54 healthy subjects were selected as the control group. To observe the changes of serum LDH, β2-MG, CEA levels in the control group, and compare the changes of serum LDH, β2-MG, CEA levels before and after treatment with different clinical stages, different conditions, and different effects in NHL.@*Results@#The levels of serum LDH, β2-MG, and CEA in the observation group were higher than those in the control group (P<0.05); the levels of serum LDH, β2-MG, and CEA in patients with NHL in stage Ⅲ to Ⅳ were higher than those in stage Ⅰ to Ⅱ (P<0.05); the levels of serum LDH, β2-MG, and CEA in patients with NHL in the middle-high-risk and high-risk groups were higher than those in the middle-risk and low-risk groups (P<0.05); after treatment, the levels of serum LDH, β2-MG, and CEA in stable disease (SD) and progression disease (PD) patients were not significantly different from those before treatment (P>0.05). While after treatment, the levels of serum LDH, β2-MG and CEA in complete relief (CR) and partial remission (PR) patients were lower than those before treatment (P<0.05), and were lower than those in SD and PD patients.@*Conclusions@#The level of serum LDH, β2-MG and CEA in patients with NHL increased, and the combined detection of the level changes is of great clinical value in the determination of clinical stage, malignant degree, clinical efficacy and prognosis of NHL patients.
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Objective To investigate the changes of serum carcinoembryonic antigen (CEA),lactate dehydrogenase (LDH),β2-microglobulin (β2-MG) levels in non-Hodgkin's lymphoma (NHL) patients and their clinical significance.Methods From February 2015 to February 2018,54 patients with NHL who were hospitalized in Shiyan People's Hospital were selected as the observation group.All patients underwent two cycles of chemotherapy combined with radiation therapy.Another 54 healthy subjects were selected as the control group.To observe the changes of serum LDH,β2-MG,CEA levels in the control group,and compare the changes of serum LDH,β2-MG,CEA levels before and after treatment with different clinical stages,different conditions,and different effects in NHL.Results The levels of serum LDH,β2-MG,and CEA in the observation group were higher than those in the control group (P ＜ 0.05);the levels of serum LDH,β2-MG,and CEA in patients with NHL in stage Ⅲ to Ⅳ were higher than those in stage Ⅰ to Ⅱ (P ＜0.05);the levels of serum LDH,β2-MG,and CEA in patients with NHL in the middle-high-risk and high-risk groups were higher than those in the middle-risk and low-risk groups (P ＜ 0.05);after treatment,the levels of serum LDH,β2-MG,and CEA in stable disease (SD) and progression disease (PD) patients were not significantly different from those before treatment (P ＞ 0.05).While after treatment,the levels of serum LDH,β2-MG and CEA in complete relief (CR) and partial remission (PR) patients were lower than those before treatment (P ＜ 0.05),and were lower than those in SD and PD patients.Conclusions The level of serum LDH,β2-MG and CEA in patients with NHL increased,and the combined detection of the level changes is of great clinical value in the determination of clinical stage,malignant degree,clinical efficacy and prognosis of NHL patients.
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Objective@#To explore the value of combined detection of serum cystatin C (CysC), urinary β2-microglobulin (β2-MG), and liver type fatty acid binding protein (L-FABP) in early diagnosis of acute renal injury after cardiac surgery.@*Methods@#126 patients undergoing cardiac surgery in our hospital from April 2015 to August 2016 were selected as the subjects, according to the occurrence of acute renal injury after operation, 48 cases were divided into acute renal injury (AKI) group and 78 cases into non-acute renal injury (non AKI) group, the levels of serum CysC, urine β2-MG, and L-FABP were detected in the two groups. Receiver operating characteristic (ROC) curve was used to analyze the effects of serum CysC, urine β2-MG, L-FABP in the early diagnosis of acute renal injury after cardiac surgery.@*Results@#The incidence of AKI after cardiac surgery was 38.10% (48/126); the serum CysC level in group AKI was significantly higher than that in non AKI group (P<0.05); the levels of urine β2-MG and L-FABP were significantly higher than those in non AKI group (P<0.05); the area under curve (AUC) of serum CysC for AKI diagnosis after cardiac surgery was 0.874 (P<0.05), with diagnostic sensitivity 85.7%, and specificity 76.5%; the AUC area of urinary β2-MG for AKI diagnosis after cardiac surgery was 0.754 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 73.5%, respectively; the AUC area of urinary L-FABP for AKI diagnosis after cardiac surgery was 0.834 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 74.1%. The AUC area of combined diagnosis of the three was 0.914 (P<0.05), with the diagnostic sensitivity 92.1%, and specificity 82.4%.@*Conclusions@#Serum Cys C, urine β 2-MG and L-FABP levels were significantly increased in patients with AKI. The diagnosis of the three alone has a certain reference value, which is lower than the combined diagnosis. The combined diagnosis of the three can provide an important reference for screening acute renal injury after heart surgery.
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Objective To explore the value of combined detection of serum cystatin C (CysC),urinary β2-microglobulin (β2-MG),and liver type fatty acid binding protein (L-FABP) in early diagnosis of acute renal injury after cardiac surgery.Methods 126 patients undergoing cardiac surgery in our hospital from April 2015 to August 2016 were selected as the subjects,according to the occurrence of acute renal injury after operation,48 cases were divided into acute renal injury (AKI) group and 78 cases into non-acute renal injury (non AKI) group,the levels of serum CysC,urine β2-MG,and L-FABP were detected in the two groups.Receiver operating characteristic (ROC) curve was used to analyze the effects of serum CysC,urine β2-MG,L-FABP in the early diagnosis of acute renal injury after cardiac surgery.Results The incidence of AKI after cardiac surgery was 38.10％ (48/126);the serum CysC level in group AKI was significantly higher than that in non AKI group (P ＜ 0.05);the levels of urine β2-MG and L-FABP were significantly higher than those in non AKI group (P ＜ 0.05);the area under curve (AUC) of serum CysC for AKI diagnosis after cardiac surgery was 0.874 (P ＜ 0.05),with diagnostic sensitivity 85.7％,and specificity 76.5％;the AUC area of urinary β2-MG for AKI diagnosis after cardiac surgery was 0.754 (P ＜0.05),with diagnostic sensitivity 92.9％,and specificity 73.5％,respectively;the AUC area of urinary L-FABP for AKI diagnosis after cardiac surgery was 0.834 (P ＜ 0.05),with diagnostic sensitivity 92.9％,and specificity 74.1％.The AUC area of combined diagnosis of the three was 0.914 (P ＜0.05),with the diagnostic sensitivity 92.1％,and specificity 82.4％.Conclusions Serum Cys C,urine β 2-MG and LFABP levels were significantly increased in patients with AKI.The diagnosis of the three alone has a certain reference value,which is lower than the combined diagnosis.The combined diagnosis of the three can provide an important reference for screening acute renal injury after heart surgery.
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ABSTRACT Tubulointerstitial nephritis and uveitis syndrome is a rare and probably underdiagnosed condition. Renal and ocular manifestations may not occur simultaneously, making the diagnosis more difficult. Nephritis may be asymptomatic; therefore, renal function evaluation is essential for diagnosis. Urinary β2-microglobulin levels may be particularly useful. Uveitis, mostly anterior, nongranulomatous and bilateral, occurs usually after the onset of nephritis. Treatment includes corticosteroids and, eventually, other immunosuppressant agents. Renal disease is usually benign and resolves spontaneously or after treatment with systemic corticosteroids. Uveitis, however, may be chronic or recurrent. The authors described the cases of three pediatric patients diagnosed with tubulointerstitial nephritis and uveitis syndrome. The goal of this paper was to warn the medical community over the need to screen patients with uveitis for renal disease.
RESUMO A síndrome nefrite tubulointersticial e uveíte é uma doença rara, provavelmente subdiagnosticada. As manifestações renais e oculares podem não ocorrer simultaneamente, tornando o diagnóstico mais difícil. A nefrite é geralmente assintomática, tornando fundamental a avaliação da função renal em doentes com uveíte. O doseamento da excreção urinária de β2-microglobulina é particularmente útil para o diagnóstico. A uveíte, tipicamente anterior, não granulomatosa e bilateral, manifesta-se após a nefrite na maioria dos casos. O tratamento inclui corticoides e, por vezes, outros imunossupressores. A doença renal tem evolução benigna, resolvendo-se espontaneamente ou com terapêutica com corticoides sistêmicos na maioria dos casos, no entanto, a uveíte pode ser crônica ou recorrente. Os autores descrevem três casos de síndrome nefrite tubulointersticial e uveíte, diagnosticados em idade pediátrica, e pretendem alertar para a necessidade de pesquisar sempre alterações renais nos doentes com uveíte.
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Humans , Female , Child , Adolescent , Uveitis/diagnosis , Uveitis/drug therapy , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/drug therapyABSTRACT
Objective To observe and analyze the difference of serum immunoglobulin IgA, IgG, IgM, β2-microglobulin and transferrin in pre-eclampsia (PE) and pregnancies complicated with chronic kidney disease.Methods Totally 46(40.0%)pregnancies with PE(PE group),36(31.3%)pregnancies with chronic kidney disease(chronic kidney disease group)and 33(28.7%)normal pregnancies with normal blood pressure and proteinuria without any complication(control group)delivered in Renji Hospital were recruicted in this study from February 2017 to July 2017.Serum IgA,IgG,IgM,β2-microglobulin and transferrin levels were detected. Correlation tests were conducted between these indicators and blood pressure, 24 hours proteinuria value and delivery weeks. Results (1) Comparison of general situation of pregnancies in the 3 groups:there were no significant difference in the age and child bearing history between the 3 groups(all P>0.05),while there was a significant difference in the blood pressure and deliver week(all P<0.01).There was no significant difference in 24 hours proteinuria values between PE group and chronic kidney disease group (Z=-0.187, P=0.852). (2) Comparison of serum immunoglobulin, β2-microglobulin and transferrin levels in pregnant women with three groups: serum IgA level in chronic kidney disease group was significantly higher than those in PE and control groups[(2.4±0.9)vs(1.8±0.9)vs(1.6±0.6)g/L;F=9.959,P<0.01].The serum IgG and IgM values had no significant difference between the 3 groups(all P>0.05).Serum β2-microglobulin in chronic kidney disease group was significantly higher than those in PE and control groups[(4.0±2.6)vs(2.7±0.7)vs(2.0±0.5)mg/L;F=15.892,P<0.01].Serum transferrin in chronic kidney disease group was significantly lower than those in PE and control groups[(3.0±0.8)vs(3.7±1.1)vs(3.6±0.6) g/L; F=6.284, P<0.01]. (3) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in PE group: the blood pressure level was not correlated with serum IgA,β2-microglobulin and transferrin values in PE group(all P>0.05).So,24 hours proteinuria value was positively correlated with β2-microglobulin (r=0.557, P<0.01), which was negatively correlated with transferrin (r=-0.442, P<0.01) and was not correlated with IgA(r=0.089, P=0.556). There was a negative correlation between delivery weeks and β2-microglobulin(r=-0.328,P=0.026),and positive correlation with transferrin (r=0.315, P=0.035) and no correlation with IgA (r=-0.169, P=0.260). (4) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in chronic kidney disease group:the blood pressure level was positively correlated with β2-microglobulin(systolic pressure: r=0.598,P<0.01;diastolic pressure:r=0.557,P<0.01),which was not correlated with IgA and transferrin in chronic kidney disease group (all P>0.05). So,24 hours proteinuria value was positively correlated with β2-microglobulin and IgA(r=0.568,r=0.330,both P<0.05), and not correlated with transferrin (r=0.255, P=0.133). Delivery weeks had a negative correlation with β2-microglobulin(r=-0.574,P<0.01),while it had a positive correlation with transferrin(r=0.369,P=0.027). No correlation was found between delivery weeks and IgA values (r=-0.257, P=0.131). Conclusion The serum levels of IgA,β2-microglobulin and transferrin in PE and pregnancies with chronic kidney disease are significantly different,which may provide clinical value for the diagnosis of PE and pregnancies with chronic kidney disease in future.
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Beta 2-microglobulin (β2-MG) has low expression levels in tissues and cells of normal organisms,but its expression levels is increasing in tumor.The main function of β2-MG is to regulate signal transduction in tumor cells and promote tumor cell growth and angiogenesis.High level expression of β2-MG is associated with the occurrence,progression,metastasis and prognosis of human tumors and can serve as an independent indicator of tumor prognosis.It has been confirmed in a variety of tumor cells that agent targeting β2-MG is expected to become a new generation of targeted drugs.
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Objective To investigate the relationship between the indexes change of lactate dehydrogenase(LDH),serum tumor associated material(BXTM),β2-microglobulin(β2-MG),C-reactive protein(CRP) and D-dimer(DD) with lymphoma cell bone marrow infiltration(BMI) degree in the patients with non-Hodgkin's lymphoma(NHL).Methods Seventy-four cases of initially treated NHL were retrospectively analyzed and divided into the bone marrow invasion group(BMI,26 cases),lymphoma cell leukemia group(LMCL,31 cases) and non-BMI group(N-BMI,17 cases).The related indexes levels in each group were detected.ROC curve was drawn and analyzed.Results The levels of LDH,β2-MG,CRP and DD levels in the BMI group and LMCL group were higher than those in the N-BMI group(P＜0.05).Based on the ROC curve analysis,the optimal diagnostic cut-off points of each index in BMI were determined.The CRP and LDH had good sensitivity(100.00 ％),specificity(80.00 ％-100.00 ％) and diagnostic accuracy(80.00 ％ 100.00％).In the LMCL group,the diagnostic accuracy of DD,BXTM and β2-MG was 63.30 ％-100.00％.Conclusion The changes of LDH,CRP,β2-MG and DD in the patients with NHL are consistent with the BMI severity of lymphoma cells,which has a good clinical value in staging,curative effect judgment and prognosis.
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Objective To investigate the clinical value of GFR, microalbuminuria (mAlb), serum β2-microglobulin (MG) and cystatin C (CysC) for the evaluation of renal function in patients with DN.Methods A total of 150 patients with type 2 DM diagnosed by WHO standard (1999) from December 2012 to December 2015 were retrospectively analyzed.Thirty-three kidney transplantation donors during the same time were chosen as the control group.The urine mAlb, Cr, albumin/Cr ratio(ACR) and SCr, serum β2-MG, CysC, urea, uric acid(UA), fasting blood glucose (FBG), hemoglobin A lc (HbA1c) and C-reactive protein (CRP) were measured.99Tcm-DTPA renal dynamic imaging was performed.The Gates method was used to calculate GFR, and the modification of diet in renal disease (MDRD) method was used to calculate the estimated GFR (eGFR).The relative equation between GFR and eGFR was studied.The clinical stages of renal function in type 2 DM patients were evaluated by Mogenesen standard method.Two-sample t test was used for data analysis.ROC curve analysis was performed to study the diagnostic value of GFR in DN.Results The patients were divided into merely type 2 DM group, early stage DN (Ⅰ, Ⅱ, Ⅲ), and clinical DN(Ⅳ) groups by Mogenesen standard method.GFR and eGFR in the DNⅠstage were higher than those of the merely type 2 DM group (t values:-7.502,-3.629, both P0.05), but the renal function indicators were different (t values:-5.090-2.209, all P<0.01).Compared with the normal CRP group, the FBG, HbA1c and renal function indicators were statistically different in high CRP group (t values:-6.114-7.386, all P<0.01).Conclusions GFR and eGFR show a linear relationship in type 2 DM.GFR is a sensitive, specific diagnostic index in DN Ⅰ period.β2-MG, CysC, mAlb and ACR are conducive to the early diagnosis of DN.High UA is an independent risk factor for the onset of DN, and high CRP is an inflammatory damage factor in DN.
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Objective: To investigate the correlation of serum β2-microglobulin (β2-MG) with overall survival and mantle-cell lymphoma international prognostic index (MIPI) of patients with mantle-cell lymphoma (MCL). Methods: The clinical data of 61 MCL patients admitted in Tianjin Medical University Cancer Institute and Hospital were retrospectively analyzed. Fisher's exact test was used to analyze the relationship between serum β2-MG level and the clinical features of MCL patients. COX proportional hazards model was used to analyze the influencing factors of prognosis in MCL patients. Results: In total of 61 MCL patients, 35 (57.4%) had abnormal elevation of serum β2-MG. The level of serum β2-MG was significantly associated with clinical stage (P = 0.011), B symptom (P = 0.032), bone marrow (P 2.5 mg/L have a poor overall survival as compared with the pateints with serum β2-MG ≤2.5 mg/L.
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Objective To explore the effects of heterozygous blood purification on clearance of β2-microglohulin (β2-MG) and alleviation of microinflammatory state in patients on maintenance hemodialysis.Methods A total of 128 patients on maintenance hemodialysis for more than 6 months in the First Affiliated Hospital of Chongqing Medical University and the First Branch of the First Affiliated Hospital of Chongqing Medical University were enrolled and divided into the routine hemodialysis group and heterozygous blood purification group,64,cases in each group.The serum levels of β2-MG,high-sensitive C reactive protein (hs-CRP) and interleukin-6 (IL-6) of patients in the two groups were measured before and 6 months after the initiation of hemodialysis.Results After 6 months of treatment,the serum levels of β2-MG,hs-CRP and IL-6 were decreased in heterozygous blood purification group,compared with those before treatment,the differences were statistically significant (P＜0.05).In routine hemodialysis group,the serum level of β2-MG was decreased,and serum levels of hs-CRP and IL-6 were increased,,compared with those before treatment,no statistically significant difference was found (P＞0.05).Moreover,after 6 months of treatment,the serum levels of β2-MG,hsCRP and IL-6 in heterozygous blood purification group were significantly lower than those in the routine hemodialysis group (P＜ 0.05).Conclusion Heterozygous blood purification couldefficiently remove middle molecule toxins from blood,and alleviate microinflammatory status in patients on maintenance hemodialysis.
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Objective To explore the effects of heterozygous blood purification on clearance of β2-microglohulin (β2-MG) and alleviation of microinflammatory state in patients on maintenance hemodialysis.Methods A total of 128 patients on maintenance hemodialysis for more than 6 months in the First Affiliated Hospital of Chongqing Medical University and the First Branch of the First Affiliated Hospital of Chongqing Medical University were enrolled and divided into the routine hemodialysis group and heterozygous blood purification group,64,cases in each group.The serum levels of β2-MG,high-sensitive C reactive protein (hs-CRP) and interleukin-6 (IL-6) of patients in the two groups were measured before and 6 months after the initiation of hemodialysis.Results After 6 months of treatment,the serum levels of β2-MG,hs-CRP and IL-6 were decreased in heterozygous blood purification group,compared with those before treatment,the differences were statistically significant (P＜0.05).In routine hemodialysis group,the serum level of β2-MG was decreased,and serum levels of hs-CRP and IL-6 were increased,,compared with those before treatment,no statistically significant difference was found (P＞0.05).Moreover,after 6 months of treatment,the serum levels of β2-MG,hsCRP and IL-6 in heterozygous blood purification group were significantly lower than those in the routine hemodialysis group (P＜ 0.05).Conclusion Heterozygous blood purification couldefficiently remove middle molecule toxins from blood,and alleviate microinflammatory status in patients on maintenance hemodialysis.
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Objective To analyze the differences of biochemical and immunological indicators in gender or Lee′s classification of IgA nephropathy ( IgAN) to provide laboratory evidence for clinical diagnosis and treatment of IgAN.Methods Retrospective cohort study.The information of biochemical and immunological indicators of 213 in-hospital patients which were admitted in Chinese PLA General Hospital in June to December, 2012.The data were collected and analyzed with t-test, non-parameter analysis, Pearson correlation analysis, ROC curves analysis and Logistic regression analysis according to gender or Lee′s classification ( Lee′s≤3 group and Lee′s>3 group).Results In this study, the average age and sex ratio of patients with IgAN was ( 35.0 ±10.6 ) years old and 2.04∶1.00.T-test and non-parameter analysis indicated homocysteine(HCY), immunoglobulin E (IgE), immunoglobulin M (IgM), prealbumin (PA), ceruloplasmin ( CP) ,α1-acidoglycoprotein(α1-AGP) , albumin ( Alb) ,α2-globulin(α2-G) andγ-globulin (γ-G) had significant difference in gender (P<0.05).And cystantin-C (CYS-C), HCY, complement 4 (C4),β2-microglobulin(β2-MG), PA, α1-AGP, α1-globulin(α1-G), immunoglobulin G (IgG), IgM and transferrin ( TF ) had significantly different in Lee′s classification ( P<0.05 ).ROC curves analysis showed that the areas under curves of CYS-C andβ2-MG were 0.891 and 0.839 respectively;the sensitivity was 90.2%and specificity was 75.3% when cutoff value of CYS-C was 1.56 mg/L; the sensitivity was 80.3%and specificity was 78.8% when cutoff value of β2-MG was 0.275 mg/dl.Logistic regression analysis showed that CYS-C ( OR: 31.380, 95% CI: 10.808 -91.113, P=0.000 ) and HCY ( OR:1.035, 95%CI:1.002-1.069, P=0.040) were introduced into the model after twice variable selections.ROC curve of CYS-C combined with HCY for classifying Lee′s classification showed that the sensitivity, specificity, Jorden index and AUC were 0.843, 0.862, 0.705 and 0.894 ( P=0.000 ) , respectively.Conclusions CYS-C,β2-MG, PA and HCY were valuable indicators for Lee′s classification.CYS-C andβ2-MG had high correlation with Lee′s classification, which indicated that these two tests were related to the severity of IgAN.CYS-C combined with HCY could improve the diagnostic efficiency of IgAN Lee′s classification.Combination of biochemical and immunological indicators could improve the accuracy of Lee′s classification and provide effective laboratory evidence for clinical treatment of IgAN.
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Objectives: Men who have sex with men are at risk of tenofovir nephrotoxicity due to its wide use in both treatment and prophylaxis for human immunodeficiency virus infection, but little is known about the urinary biomarkers of early renal dysfunction in this population. This study aims to identify useful biomarkers of early renal dysfunction among human immunodeficiency virus-infected men who have sex with men exposed to tenofovir.Methods: In a cross-sectional study urinary alpha1-microglobulin, beta2-microglobulin, N-acetyl-B-n-glucosaminidase and albumin were measured and expressed as the ratio-to-creatinine in 239 human immunodeficiency virus-infected men who have sex with men who were treatment naïve or receiving antiretroviral therapy with tenofovir-containing or non-tenofovir-containing regimens. Additionally, 56 patients in the non-antiretroviral therapy group started a tenofovir-containing regimen and were assessed after 3 and 6 months on antiretroviral therapy.Results: Both the frequency of alpha1-microglobulin proteinuria (alpha1-microglobulin-creatinine ratio >25.8 mg/g) and the median urinary alpha1-microglobulin-creatinine ratio were higher in the tenofovir disoproxil fumarate group than the other two groups (all p< 0.05). A higher frequency of beta2-microglobulin proteinuria (beta2-microglobulin-creatinine ratio >0.68 mg/g) was also observed in the tenofovir group (28.9%) compared to the non-tenofovir group (13.6%, p= 0.024). There were no significant differences between groups for N-acetyl-β-n-glucosaminidase and albumin. In the longitudinal study, the median urinary alphat-microglobulin-creatinine ratio after 3 and 6 months on tenofovir-containing therapy (16.8 and 17.3 mg/g) was higher than baseline (12.3 mg/g, p= 0.023 and 0.011, respectively), while no statistically important changes were observed in urinary beta2-microglobulin-creatinine ratio or in the other biomarkers after 3 and 6 months on antiretroviral therapy (all p> 0.05).Conclusion: Urinary alphat-microglobulin seems to be a more sensitive and stable indicator of tubular dysfunction than urinary beta2-microglobulin for assessing tenofovir-related nephrotoxicity and can be significantly altered after tenofovir exposure.
Subject(s)
Adult , Humans , Male , AIDS-Associated Nephropathy/chemically induced , Alpha-Globulins/urine , Homosexuality, Male , Kidney Tubules, Proximal , Tenofovir/adverse effects , /urine , AIDS-Associated Nephropathy/diagnosis , AIDS-Associated Nephropathy/urine , Acetylglucosaminidase/urine , Albuminuria/chemically induced , Biomarkers/urine , Cross-Sectional Studies , Longitudinal Studies , Tenofovir/therapeutic useABSTRACT
Objective To investigate the expressions of serum cystatin C CysC),retinolbinding protein (RBP),serum and urinary β2-microglobulin (β2-MG) and their effects on predicting renal damage in primary hypertension in elderly patients.Methods A total of 149 patients were divided into 3 groups of hypertension grade 1 (n =50),hypertension grade 2 (n =50) and hypertension grade 3 group (n=49).92 healthy controls who took physical examination were selected as control group.The levels of serum CysC,RBP,serum and uric β2-MG,blood urea nitrogen,creatinine and other biochemical indexes were detected.The complications of hypertension were observed.The differences in renal function indexes between groups and their correlations were analyzed.Results There were 86 cases with hyperlipidemia (57.7％),71 cases with atherosclerosis (47.7％),59 cases with type 2 diabetes mellitus (39.6％),56 cases with coronary heart disease (37.6％),and 49 cases with cerebral vascular disease (32.9％) in 149 hypertensive patients.The levels of serum CysC,RBP,serum and uric β2-microglobulin were increased in hypertensive patients as compared with healthy controls (P＜0.05 or 0.01),and the extents of increments in the above indexes were positively correlated with blood pressure level [CysC:(1.2± 0.5) mg/L,(1.7±0.6) mg/L,(2.2±0.9) mg/L;RBP:(53.1±10.2) mg/L,(65.2±16.3)mg/L,(75.8±17.5) mg/L;serum β2-MG:(2.7±1.5) mg/L,(4.0±2.1) mg/L,(4.9±2.0) mg/L;uric β2-MG:(178.3±73.9) ng/L,(237.9±78.6) ng/L,(277.5±87.5) ng/L;respectively,P＜0.05or 0.01].Conclusions Elderly hypertensive patients are complicated with a variety of diseases.The levels of serum CysC,retinol-binding protein,serum and uric β2 microglobulin have significant diagnostic values on renal impairment caused by hypertension,and can be considered as sensitive factors for early renal impairment in essential hypertension.
ABSTRACT
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a relapsing-remitting disorder for which steroid administration is a key to control the progression. CLIPPERS can exhibit radiological features similar to malignant lymphoma, whose diagnosis is confounded by prior steroid administration. We report a case of CLIPPERS accompanied by abnormal elevation of beta-2 microglobulin in the cerebrospinal fluid (CSF). A 62-year-old man started to experience numbness in all fingers of his left hand one year ago, which gradually extended to his body trunk and legs on both sides. Magnetic resonance imaging demonstrated numerous small enhancing spots scattered in his brain and spinal cord. CSF levels of beta-2 microglobulin were elevated; although this often indicates central nervous system involvement in leukemia and lymphoma, the lesions were diagnosed as CLIPPERS based on the pathological findings from a biopsy specimen. We emphasize the importance of biopsy to differentiate between CLIPPERS and malignant lymphoma because the temporary radiological response to steroid might be the same in both diseases but the treatment strategies regarding the use of steroid are quite different.
Subject(s)
Humans , Middle Aged , Biopsy , Brain , Central Nervous System , Cerebrospinal Fluid , Diagnosis , Fingers , Hand , Hypesthesia , Inflammation , Leg , Leukemia , Lymphoma , Magnetic Resonance Imaging , Spinal Cord , SteroidsABSTRACT
OBJECTIVES: To investigate the clinical findings upon initial diagnosis and extraglandular manifestations in Korean patients with primary Sjogren's syndrome (pSS). METHODS: We collected clinical and laboratory data from 238 pSS patients enrolled at Seoul National University Hospital, Seoul National University Bundang Hospital and Seoul Medical Center from March 2011 to December 2014. All patients met the American-European Consensus Group criteria for pSS. RESULTS: Upon initial diagnosis, sicca symptoms (xerophthalmia or xerostomia) as the chief complaint were only observed in 129 (54.2%) pSS patients, while extraglandular manifestation was more common as the chief complaint in male patients or those with younger age (<40 years) than female or older patients (both p<0.05). Extraglandular manifestations were found in 178 (74.8%) patients, with musculoskeletal manifestations being most common (53.8%). Peripheral neuropathy in pSS patients was associated with Raynaud phenomenon and elevated serum total immunoglobulin G (IgG) levels (both p<0.05). Serum beta2-microglobulin (beta2-M) levels were significantly correlated with European League against Rheumatism (EULAR) Sjogren's syndrome disease activity index, erythrocyte sedimentation rate and serum total IgG (all p<0.001), and were higher in patients with extraglandular manifestations than those without (p<0.05). Serum C3 levels were decreased in patients with extraglandular manifestation, compared to those without (p<0.05). Malignant lymphoma was found in Korean pSS patients (1.7%) and associated with elevated serum beta2-M levels (p<0.0001). CONCLUSION: Extraglandular manifestations were common in pSS patients and may be a diagnostic tool for male or younger pSS patients. Serum beta2-M levels can be useful markers for monitoring pSS patients.