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Objective:To observe the efficacy of modified Fangji Huangqitang on early renal damage in hypertension (Qi deficiency and dampness obstruction syndrome) and its effect in resisting inflammation and protecting vascular endothelium. Method:One hundred and forty-four patients were randomly divided into control group and observation group by random number table. Patients in control group got losartan potassium tablets, 50 mg/time, 1 time/day, and nifedipine controlled-release tablets, 30 mg/time, 1 time/day. In addition to the therapy of control group, patients in observation group were alsog given modified Fangji Huangqitang, 1 dose/day. The qualification rate of blood pressure was recorded for every week, and ambulatory blood pressure was detected before and after treatment. Standard deviation of systolic blood pressure for 24 h (24 hSSD), standard deviation of diastolic pressure for 24 h (24 hDSD), mean systolic blood pressure for 24 h (24 hSBP), average diastolic pressure for 24 h (24 hDBP) were recorded, and dynamic pulse pressure index (PPI), dynamic arteriosclerosis index (AASI), and ratio of UmALB and creatinine (CR) were calculated, levels of beta 2 microglobulin (β2-MG), urinary N-acetyl-beta-glucosaminidase (NAG), serum cystatin C (CysC), urinary microalbumin (UmALB), interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), nitric oxide (NO), endothelin-1 (ET-1) were detected, and symptoms and signs were scored. Result:During the 12-week observation period, the qualification rate of blood pressure in observation group was 89.09%, which was higher than 81.52%in control group (χ2=18.776, Pβ2-MG, CysC, NAG, UmALB, UACR, IL-6, IL-1β, TNF-α and ET-1 were lower than those in control group (PPZ=2.146, PConclusion:In addition of the western medicine therapy, modified Fangji Huangqitang can be added to control blood pressure level, improve blood pressure compliance rate, reduce blood pressure variability, protect renal function, prevent and relieve clinical symptoms, improve the clinical efficacy, inhibit inflammatory reaction and improve endothelial function.
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Objective@#To explore urinary NAG, Cr, MA, α1-MG andβ2-MG as the early renal damage index in children hydronephrosis.@*Methods@#The clinical data of 206 patients in the Bayi Children′s Hospital Affiliated to the Seventh Medical Center of Chinese PLA General Hospital from May 2018 to January 2019 were analyzed retrospectively. Among them, 152 children with hydronephrosis were set as observation group, 54 children without hydronephrosis were set as control group. In the observation group, the age ranged from 1 month to 18 years old, and the median age was 2 years old. There were 123 cases of hydronephrosis caused by ureteropelvic junction obstruction (UPJO) and 29 cases of posterior urethral valve complicated with hydronephrosis. In the control group, the age ranged from 1 month to 15 years old, with a median age of 5 years. There were 18 hypospadias cases, 15 occult penis cases and 21 phimosis. All children with hydronephrosis underwent nuclear medicine renal dynamic imaging. Urine specimens were tested for urinary NAG, Cr, MA, α1-MG, and β2-MG. According to renal dynamic results, the observed components were the renal function injury group and the normal renal function group. The above indicators analyzed to judge the clinical value to find the early renal damage.@*Results@#The expression levels of urinary NAG, MA, α1-MG and β2-MG in the observation group were higher than those in the control group, and the difference was statistically significant. The expression of urinary Cr and the abnormal rate were no significant difference between any two groups(P=0.647, P=0.572). The expression levels of urinary NAG, MA, α1-MG and β2-MG were not significantly different between the normal renal hydronephrosis group and the renal function impairment group (P=0.365, P=0.448, P=0.379, P=0.338). The abnormal expression rate of Urine MA and β2-MG was not statistically significant in the patients with normal renal hydronephrosis and the renal function impairment group (P=0.436, P=0.478). MA got the highest sensitivity of (58.8%), and NAG had the highest specificity of 89.3% to detect early renal demage. Four indexes combined analysis, sensitivity, negative predictive rate, diagnostic coincidence rate improved obviously. Joint analysis of posterior urethral valves combined with hydronephrosis, the abnormal rate was 89.7%(26/29). The renal dysfunction of the posterior urethral valve showed that the renal dynamics dysfunction rate was only 37.9%(11/29).@*Conclusions@#The combined analysis of urinary NAG, MA, α1-MG and β2-MG can accurately predict early renal injury. The index of early renal loss may be the early evidence to judge whether the posterior urethral valve is complicated with upper urinary tract function injury.
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Objective To explore urinary NAG,Cr,MA,α1-MG andβ2-MG as the early renal damage index in children hydronephrosis.Methods The clinical data of 206 patients in the Bayi Children's Hospital Affiliated to the Seventh Medical Center of Chinese PLA General Hospital from May 2018 to January 2019 were analyzed retrospectively.Among them,152 children with hydronephrosis were set as observation group,54 children without hydronephrosis were set as control group.In the observation group,the age ranged from 1 month to 18 years old,and the median age was 2 years old.There were 123 cases of hydronephrosis caused by ureteropelvic junction obstruction (UPJO) and 29 cases of posterior urethral valve complicated with hydronephrosis.In the control group,the age ranged from 1 month to 15 years old,with a median age of 5 years.There were 18 hypospadias cases,15 occult penis cases and 21 phimosis.All children with hydronephrosis underwent nuclear medicine renal dynamic imaging.Urine specimens were tested for urinary NAG,Cr,MA,α1-MG,and β2-MG.According to renal dynamic results,the observed components were the renal function injury group and the normal renal function group.The above indicators analyzed to judge the clinical value to find the early renal damage.Results The expression levels of urinary NAG,MA,α1-MG and β2-MG in the observation group were higher than those in the control group,and the difference was statistically significant.The expression of urinary Cr and the abnormal rate were no significant difference between any two groups(P =0.647,P =0.572).The expression levels of urinary NAG,MA,α1-MG and β2-MG were not significantly different between the normal renal hydronephrosis group and the renal function impairment group (P =0.365,P =0.448,P =0.379,P =0.338).The abnormal expression rate of Urine MA and β2-MG was not statistically significant in the patients with normal renal hydronephrosis and the renal function impairment group (P =0.436,P =0.478).MA got the highest sensitivity of (58.8％),and NAG had the highest specificity of 89.3％ to detect early renal demage.Four indexes combined analysis,sensitivity,negative predictive rate,diagnostic coincidence rate improved obviously.Joint analysis of posterior urethral valves combined with hydronephrosis,the abnormal rate was 89.7％ (26/29).The renal dysfunction of the posterior urethral valve showed that the renal dynamics dysfunction rate was only 37.9％ (11/29).Conclusions The combined analysis of urinary NAG,MA,α1-MG and β2-MG can accurately predict early renal injury.The index of early renal loss may be the early evidence to judge whether the posterior urethral valve is complicated with upper urinary tract function injury.
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Objective To investigate the diagnostic value of 99mTc-DTPA nuclide renal dynamic imaging in early renal damage in elderly essential hypertension(EH). Methods Among the elderly patients with essential hypertension who were enrolled in our hospital. 86 patients were enrolled as the study subjects. They were divided into two groups according to the results of 24-hour urinary microalbuminuria(MA):MA negative(A) group and MA posistive(B) group.Meanwhile,20 elderly healthy persons were selected as the control group. 99mTc-DTPA re-nal dynamic imaging was performed in all subjects to detect couple glomerular filtration rate(GFR),the peak time(TP),half emptying time(T1/2) and ration of 20 min and peak phase kidney radioactivity count(T20/P%).At the same time,MA,serum cystatin C(Cys-C),surem creatinine(SCr) and blood urea nitrogen(BUN) were de-tected and compared with three groups. Rusults(1)The positive rate of early renal damage with 99mTc-DTPA nu-clide renal dynamic imaging method was significantly higher than those of two later methods(P < 0.01).(2)The levels of GFR,TP,T1/2,and T20/P% in group A were significantly higher than those in the control group and those in group B significantly higher than those in group A(P<0.05).(3)The levels of MA and Cys-C in group A was sig-nificantly higher than that of the control group,and those in group B significantly higher than that of group A(P<0.05).In comparisons of SCr and BUN among the three groups,the results had no significant difference. Conclu-sion 99mTc-DTPA nuclide renal dynamic imaging can early detect the renal damage in elderly EH patients,and it has better clinical value.
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Objective To study the clinical value of combined detection of homocysteine (Hcy) ,glycosy-lated hemoglobin (HbA1c) and nephrotic index in screening early renal injury in type 2 diabetes mellitus . Methods From January 2016 to January 2017 ,164 patients with diabetes were selected as the subjects .Ac-cording to the glomerular filtration rate ,they were divided into normal renal function group (n=49) ,renal insufficiency compensatory group (n=56) ,renal insufficiency decompensation group (n=59) ,and 60 healthy physical examination personnel were taken as the health control group .We also evaluated the diagnostic value of Hcy ,HbA1c and nephrotic index alone and combined detection in early diabetic nephropathy .Results The average level of Hcy ,HbA1c and nephropathy index in healthy control group ,normal renal function group , renal insufficiency compensation group ,and renal insufficiency decompensation group increased in turn .In the early diagnosis of renal injury in diabetic patients ,the sensitivity was HbA1c (97 .39％ ) ,the specificity was Hcy (81 .16％ ) ,the Jordan index (0 .76) ,and the rate of coincidence (92 .76％ ) were all high in the index of kidney disease .The sensitivity (99 .13％ ) and negative predictive value (98 .43％ ) of the 3 indexes were im-proved .Conclusion Combined detection of Hcy ,HbA1c and nephrotic index is of high clinical value in early detection of early diabetic nephropathy .
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[Summary] The aim of this study was to examine the association between obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and microalbuminuria in type 2 diabetes mellitus patients. We found that severe OSAHS significantly increases the risk of early renal damage in type 2 diabetes mellitus patients with HbA1C<7% ( lowest oxygen saturation:OR=2. 41, 95% CI 1. 19-8. 08; apnea hyponea index: OR=2. 91, 95% CI 1. 50-9. 11), suggesting that OSAHS may increase the risk for early renal damage in type 2 diabetes mellitus, especially in those with successful control of glucose.
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Objective To investigate early renal damage of chronic hepatitis B (CHB) patients and the risk factors related to their renal function. Methods CHB patients who visited the second people’s hospital but did not receive systemic treatment were enrolled in our study. Those who visited for general check-up with no hepatic findings during the same period were selected as control group. Glomerular filtration rate (GFR) of all the participants were estimated by simplified MDRD equation and CKD-EPI equation (designated as M-eGFR and C-eGFR respectively). Influence factors of eGFR were statistically analyzed. Results In the total 528 cases in CHB group, 88 (16.67%) and 62 (11.74%) suffered declined M-eGFR and C-eGFR respectively. By contrast, 10 (8.77%) and 6 (5.26%) cases in the total 114 cases in control group present declined M-eGFR and C-eGFR ac?cordingly. Percentages of renal function impairment, estimated by both M-eGFR and C-eGFR, were higher in the CHB group than those in control group. The difference was statistically significant (χ2=4.518, P<0.05;χ2=4.156, P<0.05). Multiple linear regression analysis indicated that age, HBsAg and body mass index (BMI) were risk factors of M-eGFR while age, HBsAg, gender and serum albumin were risk factors of C-eGFR. On the other hand, HBV-DNA and HBeAg were not risk factors for M-eGFR or C-eGFR. Conclusion HBV infection can lead to early renal damage. Age and HBsAg are main risk factors of renal function impairment. Therefore, renal function should be scrutinized in CHB patients.
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Objective To explore the applied value of combined measurement of cystatin c (Cys-C) ,fibrinogen(Fbg) and U-mALB in early renal damage due to diabetes .Methods 97 cases of type Ⅱ diabetes mellitus (T2DM ) patients were divided into 2 groups according to the measured glycated hemoglobin HbA 1c ,serum glucose well control group (46 cases ,HbA1c≤8% ) ,and ser-um glucose poor control group (51 cases ,HbA1c>8% ) .39 healthy people were randomly selected as control group .The concentra-tion of Cys-C ,Fbg and U-mALB were detected .Results Cys-C ,Fbg and U-mALB of serum glucose poor control group were higher than that of glucose well control group and control group (P<0 .01) .Cys-C and U-mALB of glucose well control group were high-er than the control group (P<0 .01) .As a single positive marker of diagnosis ,the sensitivity for serum Cys-C ,serum Fbg ,and U-mALB were 73 .6% ,71 .4% and 61 .5 % respectively .The positive rate of combined detection was 97 .0% ,which was significantly higher than that of the individual testing (P<0 .05) .Conclusion Combined measurement of Cys-C ,Fbg and U-mALB has impor-tant clinical value for diagnosis and condition monitoring in early renal damage .
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Objective To observe the effects of Yishen-Pinggan dcoction on the urine microalbumin and the expression of ACE2, AngⅡin the spontaneously hypertensive rat kidney(SHR);to observe the kidney level hepatic side of the protective effect of early renal in SHR hypertension. Methods The same old male SHR and normal rats(Wistar-Kyoto rats, WKY) for the study, at 10 weeks of age, SHR rats were randomly divided into a model group, a Chinese medicine group, and a lotensin group;while WKY rats were served as a normal control group(n=8). They were continuously treated for 12 weeks. Urine mAlb and β2-MG of rats were quantified at pre-experiment and after experiment, immuno-histochemical detection of renal ACE2 and AngⅡwere performed, the obtained results were statistically analyzed by computer image analysis. Result At the 12th week, compared with urinary mAlb(509.3±160.3)ng/ml,β2-MG(0.150±0.037)μg/ml, Ang kidneyⅡ(7 174.24±1 068.99)μm2,kidney ACE2(2 158.90±376.60)μm2 in the WKY group, the urinary mAlb(908.3 ±13.2)ng/ml, β2-MG(0.378±0.099)μg/ml, kidney AngⅡ(11 085.37±1 398.03)μm2 in the hypertension model group were significantly higher(P<0.01), and kidney ACE2(1 375.77±466.21)μm2 was decreased significantly(P<0.01); compared with hypertensive model group, rat urinary mAlb(574.9±197.8)ng/ml,β2-MG(0.198±0.040)μg/ml, kidney AngⅡ(8 462.91±781.23)μm2 in Chinese medicine group, rat urinary mAlb(644.4±147.5)ng/ml, β2-MG(0.206±0.044)μg/ml, kidney AngⅡ(8 696.88±679.70)μm2 in lotensin group were significantly decreased(P<0.01); while kidney ACE2(1 904.02 ± 454.08)μm2 in Chinese medicine group, kidney ACE2(1896.11±445.43)μm2 in lotensin group was significantly increased(P<0.01). Conclusion Yishen-Pinggan decoction can reduce the SHR urinary microalbumin excretion so as to reduce high blood pressure early kidney damage; its role may be associated with its increasing local renal ACE2 expression and reducing the kidney Ang Ⅱ expression.
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Objective To explore the differences of biological markers level between upper urinary tract infection(UUTI) and lower urinary tract infection(LUTI) in children for providing help for localization diagnosis of urinary tract infection(UTI).Methods One hundred and nine children with UTI hospitalized in Children's Hospital of Tianjin from May 2010 to Jan.2012 were divided into UUTI group (18 cases) and LUTI group (91 cases).The clinical information (sex,age,onset symptoms),laboratory test including blood urea nitrogen and creatinine,biological markers including serum cystatin C(CysC),procalcitonin(PCT),β2-microglobulin (β2-MG),urine microalbumin(mAlb),transferrin (TF),α1-microglobulin (α1-MG),β2-MG and N-acetyl-β-D-glucosaminidase (NAG) were recorded.Then SPSS 17.0 software was used to analyze the data.Results UUTI children showed higher level of serum CysC,PCT,urine mAlb,TF,α1-MG,β2-MG and NAG than LUTI children did.The area under ROC curve of the 7 biological markers were all between 0.71 and 0.87.Logistic regression test was used to do multiple regression analysis and establish the multiple regression model.The standard of eliminating or screening variables was 0.05.CysC,PCT,NAG were identified as influence factors.Combining test result of CysC,PCT,NAG could improve diagnostic value so that the sensitivity could reach 90％ and the specificity could reach 88.9％.Conclusions Both of serum CysC,PCT and urine mAlb,TF,α1-MG,β2-MG,NAG can be used for the positioning diagnosis of UTI,and the diagnostic value of joint test of serum change of CysC,PCT,urine NAG is higher than any single biological marker.
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Objective To discuss the value of essential hypertension arteriosclerosis as a predictor of early renal damage.Methods 90 cases of essential hypertension with early renal damage were selected and statistical analysis to result of AASI,Scr,ACR and eGFR with SPSS17.0、Excel statistical analysis software were carried out.Group A was defined as AASI≥0.55 and group B was defined as AASI＜0.55.Compared the two groups with relevant analysis,and then built multivariate linear regression equation.Results ① The group A showed higher age(P＜0.01),24 h DBP(P＜0.05),ACR(P＜0.01),ACR(+) rate(P＜0.01)and lower eGFR (P＜ 0.01),compared with the group B.②AASI showed a positive correlation with age (r＝ 0.483,P＝ 0.000),24 h SBP (r＝ 0.350,P ＝0.001),ACR (r＝0.474,P＝ 0.000),and a negative correlation with eGFR (r＝-0.383,P＝ 0.000).Two multiple linear regressions showed that AASI was associate with eGFR (B ＝-0.001,P＝ 0.038) and ACR(B ＝ 0.025,P ＝ 0.000) independent of other factors.Conclusion ①Arteriosclerosis is closely related with age and blood pressure mutation rate day and night.②Arteriosclerosis has a closely relationship with essential hypertension early renal damage,and can predict early renal damage in hypertension patients.
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Objective To observe the indicative function of pulse pressure(PP)and PP index(PPI)on early renal damage in patients with hypertension.Methods Eighty old aged patients with hypertension and renal damage were selected as group A,60 old aged patients with hypertension as group B,and 30 old aged healthy people as group C.PP and PPI were examined in all groups,and early renal damage index was examined in group A.Results The rates of PP ≥ 60 mm Hg(1 mm Hg=0.133 kPa)and PPI ≥0.5 in group A were significantly higher than those in group B and group C[70.0％(56/80)vs.41.7％(25/60)and 26.7％(8/30),75.0％(60/80)vs.43.3％(26/60)and 23.3％(7/30),P＜0.05].In group A,there were significant differences between PP ≥ 60 mm Hg patients and PP＜60 mm Hg patients in beta 2 microglobulin(β 2-MG),microalbuminuria(MAU),high-density lipoprotein(HDL),low-density lipoprotein(LDL)and homocysteine protease inhibitors C(Cys-C)[(13.23±3.22)mg/L vs.(12.03±2.32)mg/L,(56.6±13.2)mg/24 h vs.(42.7±12.3)mg/24 h,(1.9±1.2)mmol/L vs.(2.2±1.3)mmol/L,(2.6±1.2)mmol/L vs.(2.9±1.3)mmol/L,(2.01±0.80)mg/L vs.(1.21±0.90)mg/L,P＜0.05],but there was no significant difference in serum uric acid(SUA)and serum creatinine(SCr)(P＞0.05).There were significant differences between PPI ≥0.5 patients and PPI＜0.5 patients in β 2-MG,SCr,MAU,LDL and Cys-C[(10.53±2.43)mg/L vs.(14.00±2.15)mg/L,(97±22)μmol/L vs.(82±16)μmol/L,(52.5±12.4)mg/24 h vs.(40.7±11.3)mg/24 h,(2.2±1.2)mmol/L vs.(2.7±1.3)mmol/L,(1.91±0.90)mg/L vs.(1.23±1.10)mg/L,P＜0.05],but there was no significant difference in SUA and HDL(P＞0.05).Conclusions The rates of PP ≥ 60 mm Hg and PPI ≥ 0.5 in hypertension with renal damage are significantly higher than those in simple hypertension and healthy people.PP and PPI can be served as the indexes of early renal damage,and it should be cautious on this kind of patients.
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Objective To investigate the effects of Buyang-Huanwu decoction combined with western medicine on early diabetic renal injury.Methods 200 cases of early diabetic renal injury were randomly recruited into study group and control group,with 100 cases in each group.The control group was treated with insulin injection and oral benazepril hydrochloride,and the blood pressure,blood lipid changes were closely monitored; while the study group was additionally treated with Buyang-Huanwu decoction on the basis of the control group.Results The total therapeutic effects in the study group was significantly higher than the control group (x2=15.62,P＜0.01).The values of FBG,2 h PG,DBP,SBP,HbAlc in both groups were significantly reduced after the treatment (P＜0.05,t=4.23,4.47,3.59,3.87,3.99 in the study group,t=4.34,4.76,4.05,3.78,3.69 in the control group) ; but the difference between the two groups had no significance (P＞0.05).Before treatment rnALB,Urea,Cr,TG and TC were not significantly different (P＞0.05) ; the values of mALB,Ureaand Cr were significantly reduced in the study group after the treatment (P＜0.05,t=4.56,3.73,3.28);especially mALB in the study group was obviously lower than the control group (P＜0.05,t=5.01).Conclusion Buyang-Huanwu decoction combined with western medicine was effective to treat early renal damage of type 2 diabetes,with the functions of reducing urinary protein,improving microcirculation and protecting renal function.
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Objective To study the clinical effects of YangGanYiShui granule(YGYSG) on treating early renal damage induced by essential hypertension(EH)and observe the corresponding changes of total cholesterol(TC)、low-density lipoprotein cholesterol(LDL-C)、 C-reactive protein(CRP) and serum uric acid(UA).Methods Eighty EH patients with early renal damage were randomly divided into 2 groups: treatment group(n=40) and control group(n=40).Both two groups were treated with conventionally therapeutic methods of antihypertensive for four weeks.Besides,the YGYSG was added Simultaneously into the treatment group.The levels of TC、LDL-C、UA、CRP in 80 cases were measured and compared.Results After the therapy with YGYSG,the levels of TC、LDL-C、UA、CRP were significantly decreased.The difference between two groups was prominent(P