RESUMO
Objective To investigate the application value of chronic kidney disease epidemiology collaboration (CKD-EPI) equations and amendatory equations for calculating glomerular filtration rate (GFR) in Chinese patients with diabetes,including CKD-EPI serum creatinine (Scr) equation (CKD-EPLcr),CKD-EPI serum cystatin C (ScysC) equation (CKD-EPLcysc),combination of CKD-EPLcr and CKD-EPIScrSCysC (CKD-EPISr SCysC),Asian modified CKD-EPI equation (CKD-EPIAsian),Chinese diabetes CKD-EPI equation (CKD-EPIDiabctes),refitted modification of diet in renal disease (MDRD) equation (rMDRD),Cockcroft-Gault equation (CG) and Simplified MDRD equation.Methods Serum creatinine (Scr) was detected using basic picric acid method,serum cystatin C (CysC) was measured by Latex enhanced turbidimetric,and the reference value of GFR was worked out by 99Tcm-DTPA renal dynamic imaging and standardization of body surface area.Relation of Scr,Scysc,GFR measured by every equations and rGFR were analyzed.The accuracy of 30％ of each equation,the consistency and deviation of the evaluation of renal function by each equation were compared.The diagnostic efficacy in GFR＜60 ml/(min · 1.73 m2) was compared using the receiver operating characteristic (ROC) curve.Results The rGFR had negative correlation with Scr、ScysC (both P＜0.001).The rGFR had positive correlation with GFR measured by CKD-EPIScr,CKD-EPIScysC,CKD-EPIS-SCysC,CKD-EPIAsian,CKD-EPIDiabetes rMDRD,CG and Simplified MDRD (all P＜0.001).The coincidence rate between 30％ of rGFR and GFR measured byCKD-EPIDiabetes and simplified MDRD were higher.There was no significant difference of rGFR and GFR measured by CKD-EPIscr,CKD-EPIScysC,CKD-EPIScr-SCysC,CKD-EPIAsian,CKD-EPIDiabetes,rMDRD,CG and Simplified MDRD.GFR measured by CKD-EPIDiabetes has the best consistent degree with rGFR.ROC curve showed that the area under curve of GFR measured by CKD-EPIDiabctes was largest and the Youden index was the highest.Conclusion There are different degrees of deviation in eGFR predicted by the eight kinds of equations.The accuracy and consistency of CKD-EPIDiabetes in Chinese 2-type diabetes is the best.
RESUMO
Objective To investigate the effects of early physiotherapy in combination with atorvastatin on the levels of serum brain-derived neurotrophic factor (BDNF) and neurological function in patients with acute ischemic stroke.Methods Fifty patients with acute ischemic stroke were randomly divided into either an atorvastatin group (monotherapy group,n =25) or a early physiotherapy + atorvastatin group (combination treatment group,n =25).All patients received the prescribed drugs according to the diagnosis and treatment guidelines for ischemic stroke.The monotherapy group added atorvastatin calcium (20 mg,1 tablet every night orally).On the basis of the monotherapy group,the combination treatment group also conducted early physical therapy.At 2 and 6 weeks before and after treatment,a double-antboody sandwich enzyme-linked immunosorbent assay was used to detect the serum BDNF levels.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit.Barthel index (BI) was used to evaluate the activities of daily living.The modified Rankin scale (mRS) was used to assess the degree of disability.Results There was no significant difference in demographics and baseline data between the monotherapy group and the combination treatment group.The scores of NIHSS,BI,and mRS in both groups after treatment were significantly better than those before treatment (all P ＜ 0.001).There were no difference in the scores of NIHSS,BI and mRS at 2 weeks before and after treatment,but at 6 weeks after treatment,the scores of NIHSS (2.40 ± 1.38 vs.3.36 ± 1.73; P =0.035) and mRS (1.40 ± 0.87 vs.1.96 ±0.94; P =0.047) of the combination treatment group were significantly lower than those of the monotherapy group,and the BI scores (92.60 ±7.50 vs.85.20 ± 11.68; P=0.011) were significantly higher than those of the monotherapy group.After treatment,the serum BDNF levels were increased significantly in both groups.There were significant differences among all the time points (all P＜0.001).At 2 weeks after treatment,the serum BDNF levels (3.07 ±0.93 ng/ml vs.2.45 ±0.76 ng/ml; t =2.559,P =0.014) and at 6 weeks after treatment,those (2.90 ± 0.93 ng/ml vs.2.31 ± 0.77 ng/ml; t =2.433,P =0.019) in the combination treatment group were significantly higher than those in the monotherapy group.Spearman correlation analysis showed that the serum BDNF levels were significantly negatively correlated with the scores of NIHSS (r =-0.738,P ＜ 0.001) and mRS (r =-0.654,P ＜ 0.001),but they were significantly positively correlated with the BI scores (r =0.716,P ＜ 0.001).No serious adverse reaction occurred in both groups.Conclusions Early physiotherapy in combination with atorvastatin for the treatment of acute ischemic stroke can more effectively promote the recovery of neurological function,and its mechanism may be associated with the increased serum BDNF levels.