Clinical analysis of early damage in multiple extra-pulmonary organs in COVID-19 / 南方医科大学学报

OBJECTIVE@#To analyze the clinical manifestations of heart, liver and kidney damages in the early stage of COVID-19 to identify the indicators for these damages.@*METHODS@#We analyzed the clinical features, underlying diseases, and indicators of infection in 12 patients with COVID-19 on the second day after their admission to our hospital between January 20 and February 20, 2020.The data including CK-MB, aTnI, BNP, heart rate, changes in ECG, LVEF (%), left ventricular general longitudinal strain (GLS, measured by color Doppler ultrasound) were collected.The changes of liver function biochemical indicators were dynamically reviewed.BUN, UCR, eGFR, Ccr, and UACR and the levels of MA, A1M, IGU, and TRU were recorded.@*RESULTS@#The 12 patients included 2 severe cases, 8 common type cases, and 2 mild cases.Four of the patients presented with sinus tachycardia, ECG changes and abnormal GLS in spite of normal aTNI and LVEF; 1 patient had abnormal CKMB and BNP.On the first and third days following admission, the patients had normal ALT, AST and GGT levels.On day 7, hepatic function damage occurred in the severe cases, manifested by elevated ALT and AST levels.Abnormalities of eGFR, Ccr and UACR occurred in 8, 5 and 5 of the patients, respectively.Abnormal elevations of MA, A1M, IGU and TRU in urine protein were observed in 4, 4, 5, and 2 of the patients, respectively.@*CONCLUSIONS@#In patients with COVID-19, heart damage can be identified early by observing the GLS and new abnormalities on ECG in spite of normal aTNI and LVEF.Early liver injury is not obvious in these patients, but dynamic monitoring of the indicators of should be emplemented, especially in severe cases. In cases with normal CR and BUN, kidney damage can be detected early by calculating eGFR, Ccr and UACR and urine protein tests.

Relationship between OGTT blood glucose levels and early kidney damage in patients with essential hypertension / 医学研究生学报

Objective More and more research shows microangiopathy may occur in the early stage of diabetes. The purpose of this study was to observe the relationship between OGTT 1-hour hyperglycemia (1hPG) and 2-hour hyperglycemia (2hPG) levels and urinary albumin creatinine ratio (UACR).Methods We retrospectively analyzed 408 patients with primary hypertension of grade 2 or above who were eligible for 2015 World Health Organization (WHO) outpatient and inpatient visits from September 2015 to April 2018 in our hospital for a course of up to 10 years. All selected participants underwent an OGTT test (1 and 2 hour post-sugar glucose) and records were made on fasting plasma glucose (FPG), OGTT1-hour blood glucose (1 hPG), OGTT 2-hour blood glucose (2 hPG). All the patients were divided into 4 groups according to blood glucose levels: NGT group (n=100), 1 h PG group(n=102), 2h PG group(n=104), 1h PG/2h PG group (n=102). Records were made on the clinical data of 408 patients, including height, weight, BMI, gender, age, history of hypertension, smoking history, blood pressure, blood lipids, creatinine and other general clinical data, and the calculation of glomerular filtration rate (eGFR) values was based on creatinine values and age values to analyze the relationship between 1 hHPG and 2 hHPG levels with ACR.Results No significant difference was found among the four groups in the aspects of hypertension course, age, gender, body mass index (BMI), diastolic blood pressure, lipid metabolism index and fasting blood glucose(P>0.05). There were significant difference in systolic blood pressure, serumcreatinine, eGFR, and ACR among different levels of increased blood glucose(P<0.05). ACR in 1h PG group, 2h PG group and 1h PG/2h PG group were significantly higher than NGT group(P<0.01), ACR in 1h HPG/2hHPG was significantly higher than 1h PG group(P<0.05) and ACR in 1h PG group was significantly higher than 2h HPG group(P<0.05). The logistic regression analysis showed that 1h PG(OR=2.461, 95%CI:1.947-3.112), creatinine (OR=1.071, 95%CI:1.027-1.117) and 2h PG(OR=2.016, 95%CI:1.500-2.710) were risk factors for microalbuminuria(P<0.01).Conclusion The abnormalities of 1h PG and 2h PG are associated with ACR, which may become the key index for predicting early kidney damage.

Significance of combined detection of serum Cys-C and Hcy in the diagnosis of early renal injury in children ;with diabetes / 中国糖尿病杂志

Objective To investigate the combined detection of serum cystatin C (Cys‐C ) and homocysteine (Hcy) for the diagnosis of early renal damage in diabetic children. Methods Data of 97 cases of diabetic children were collected in our hospital. According to the levels of 24 hUAER ,diabetic children were divided into <30 mg group (n=34) ,30~299 mg group (n=42) ,and ≥300 mg group (n=21). 40 cases of healthy children were selected as control group (NC). Laboratory indexes were compared among different groups. The critical values of Cys‐C and Hcy in early diagnosis of renal damage were calculated by receiver operating curve (ROC). Results The levels of Cys‐C and Hcy in <30 mg group were significantly higher than in NC group [Cys‐C (1.04 ± 0.26 ) vs(0.79 ± 0.21 ) mg/L ,Hcy (13.09 ± 2.15) vs(8.57 ± 1.24)μmol/L ,respectively ,P< 0.05]. When Cys‐C cutoff point took 1.02 mg/L ,the diagnosis sensitivity for diabetic nephropathy diagnosis was 86.09% and the specificity was 83.28% ,the maximum diagnostic index reached 1.6937 ,ROC area under the curve was 0.841.When Hcy threshold took 13.00 μmol/L ,the sensitivity was 83.98% and the specificity was 79.24% ,with the maximum diagnostic index 1.6322 and ROC area 0.795.Cys‐C combined with Hcy had a sensitivity of 92.38% and a specificity of 89.17% ,with the maximum diagnostic index 1.764 and ROC area 0.928. Conclusion Cys‐C combined with Hcy detection for early diagnosis of renal injury in diabetic children has important clinical value.