Relationship between chronic renal injury and white matter hypertensity, enlarged perivascular spaces in elderly patients / 临床神经病学杂志

Objective To study the relationship between chronic renal injury and white matter hypertensity (WMH), enlarged perivascular spaces (EPVS) in elderly patients.Methods A total of 133 inpatients from 2015 to 2016 without clinical histories of stroke underwent brain MRI scan were enrolled.The degree of WMH and EPVS were evaluated according to Flair and T 2 MRI, respectively.Clinical characteristics including disease history , glomerular filtration rate ( eGFR), urine albumine／creatine ratio ( UACR ) and so on were compared between different degrees of WMH or EPVS.A logistic regression analysis was applied for further analysis.Results Compared with WMH scoring 0 -1 group, eGFR of WMH scoring 2 -3 group was significantly decreased , while UACR was significantly increased ( all P＜0.001).Compared with EPVS scoring 0 -1 group, eGFR of EPVS scoring 2-3 group was significantly decreased , while UACR was significantly increased (all P＜0.001).Logistic regression analysis showed that low eGFR and high UACR were independent risk factors for WMH and EPVS (all P＜0.05).Conclusion Chronic renal injury could be the independent risk factor of higher degree of WMH and EPVS , which would be potential for clinical use.

Lipotoxicidade na leptospirose humana: aspectos prognósticos e potencial efeito benéfico da administração de albumina / Lipotoxicity in human leptospirosis: prognostics aspects and potential beneficial effect of albumin administration

A leptospirose humana é uma doença infecciosa aguda de amplo espectro clínico e que cursa com alterações metabólicas e dislipidêmicas envolvendo colesterol total e frações, triglicerídeos e ácidos graxos não esterificados (AGNEs). Dentre os mecanismos celulares envolvidos na sua fisiopatologia encontram-se a inibição da enzima Na, K ATPase pela endotoxina GLP e a lipotoxicidade, ambos agravados pela redução dos níveis circulantes da albumina, molécula que exerce um papel fundamental na adsorção de moléculas lipídicas. Neste estudo observacional, determinamos as concentrações séricas de bilirrubina, creatinina e albumina e, pela técnica de cromatografia líquida de alta performance, a concentração sérica dos AGNEs de cadeia longa (C16: C18) de 27 pacientes com síndrome de Weil durante o período de internação hospitalar, dos quais cinco vieram a falecer. Verificamos correlações significantes (p<0,05) ao longo da internação hospitalar, nas concentrações séricas de marcadores bioquímicos de gravidade da doença (bilirrubina, creatinina e albumina), AGNEs, ácido oléico e ácido linoléico, e relação molar ácido oléico/albumina, com r (Pearson) de -0,7981, -0,7699, 0,9014, -0,8795 -0,9816, -0,9694, -0,9821, respectivamente. A relação molar ácido oléico/albumina e ácido oléico+linoléico/albumina foi significantemente mais elevada nos pacientes que faleceram (p<0,001), retornando aos valores semelhantes aos do grupo controle nos pacientes que evoluíram para a cura. Na análise por Curva Roc, a relação molar ácido oléico/albumina se mostrou um bom teste preditivo, com valor de corte 0,705 associado com maior especificidade e sensibilidade prognóstica. Nossos resultados sugerem que a utilização parenteral da albumina humana em pacientes com leptospirose pode ser uma potente ferramenta terapêutica nos casos mais graves ao interferir positivamente no resgate do equilíbrio bioquímico das relações molares ácido oléico/algumina e ácido oléico+linoléico/algumina.

Human leptospirosis is an acute infectious disease with a broad clinical spectrum. It courses with metabolic and dyslipidemic alterations, involving total cholesterol and fractions, triglycerides and nonesterified fatty acids (NEFAs). The cellular mechanisms involved in its pathogenesis include the inhibition of the enzyme sodium-potassium adenosine triphosphatase and lipotoxicity. Both mechanisms are aggravated by the reduction of serum levels of albumin, a molecule that plays a fundamental role in the absorption of lipid molecules. In this observational study, we determined the serum concentrations of bilirubin, creatinine and albumin, and, by High Performance Liquid Chromatography, the serum concentrations of long chain NEFAs (C16: C18) during the period of hospitalization of 27 patients with Weil's syndrome, five of whom progressed to death. Significant correlations were found between the length of hospitalization and serum concentrations of biochemical markers of severity (bilirubin, creatinine, albumin), NEFAs, oleic acid and linoleic acid, and the oleic acid: albumin molar ratio, with r (Pearson) of de -0,7981, -0,7699, 0,09014, -0,8795 -0,9816, -0,9694, -09821 respectively. The oleic acid: albumin molar ratio and oleic-plus-linoleic acid: albumin molar ratio were significantly higher in the patients who progressed to death, whereas in the cured patients this ratio decreased to levels that were similar to those found in the control group. Roc Curve analysis for the acid oleic: albumin molar ratio proved a good predictive test, with value of cutting 0.705 associated with greater specificity and prognostic sensitivity. Our results suggest that parenteral administration of human albumine may interfere positively in the rescue of biochemical balance of oleic acid: albumin molar ratio and oleic-plus-linoleic acid: albumin molar ratio and be a therapeutic tool for severe cases of leptospirosis.

The clinical effect of benazepril combined with amoldipin on cardiac function and urine microalbuminuria in patients with moderate and severe primary hypertensive left ventricular hypertrophy / 中国综合临床

Objective To explore the effect of benazepril combined with amoldipin on cardiac function and urine microalbuminuria in patients with moderate and severe primary hypertensive left ventricular hypertrophy.Methods 90 patients with mild to moderate essential hypertension and left ventficular hypertrophy were randomly divided into three groups(n=30 in each group),who were treated with benazepril,amoldinpin and benazepril com-bined with amoldipin,respectively.Blood pressure was monitored and left ventricular diameter(LVDd),interven-tricular septal thick(IVS),left ventricular posterior wall(LVPW),left ventricular masses index(LVMI)were measured by echocardiography before and after treatment in three groups.Microalbuminuria,serum nitrogen and creatinine were examined at the same time.Results Both SBP and DSP were significantly decreased in three groups after two weeks treatment.E/A ratio and EF were increased at the same time(P<0.01).After treatment,these changes were more significant in Benazepril with Amlodipine group(P<0.05).After 24 week treatment IVS,LVPW and LVMI were significantly dereased(P<0.01),while LVEF and E/A increased(P<0.01).After 4-week treatment,microalbuminuria was decreased in three groups,especially in combined treatment group(P<0.01).With the time of medication in combined treatment group,microalbuminuria was increasingly decreased which was significant in benazepril and amoldipin group after 24 weeks(P<0.01).Conclusion The Benzazepril with am-lodipine are more effective in lowering blood pressure,left ventricular hypertrophy and decrease microalbuminuria.

The clinical effect of benazepril combined with amoldipin on cardiac function and urine microalbuminuria in patients with moderate and severe primary hypertensive left ventricular hypertrophy / 中国综合临床

Objective To explore the effect of benazepril combined with amoldipin on cardiac function and urine microalbuminuria in patients with moderate and severe primary hypertensive left ventricular hypertrophy.Methods 90 patients with mild to moderate essential hypertension and left ventficular hypertrophy were randomly divided into three groups(n=30 in each group),who were treated with benazepril,amoldinpin and benazepril com-bined with amoldipin,respectively.Blood pressure was monitored and left ventricular diameter(LVDd),interven-tricular septal thick(IVS),left ventricular posterior wall(LVPW),left ventricular masses index(LVMI)were measured by echocardiography before and after treatment in three groups.Microalbuminuria,serum nitrogen and creatinine were examined at the same time.Results Both SBP and DSP were significantly decreased in three groups after two weeks treatment.E/A ratio and EF were increased at the same time(P<0.01).After treatment,these changes were more significant in Benazepril with Amlodipine group(P<0.05).After 24 week treatment IVS,LVPW and LVMI were significantly dereased(P<0.01),while LVEF and E/A increased(P<0.01).After 4-week treatment,microalbuminuria was decreased in three groups,especially in combined treatment group(P<0.01).With the time of medication in combined treatment group,microalbuminuria was increasingly decreased which was significant in benazepril and amoldipin group after 24 weeks(P<0.01).Conclusion The Benzazepril with am-lodipine are more effective in lowering blood pressure,left ventricular hypertrophy and decrease microalbuminuria.