BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCT...BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and ur展开更多
Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and...Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In 展开更多
BACKGROUND Proteinuria is an important and well-known biomarker of many forms of kidney injury.Its quantitation is of particular importance in the diagnosis and management of glomerular diseases.Its quantification can...BACKGROUND Proteinuria is an important and well-known biomarker of many forms of kidney injury.Its quantitation is of particular importance in the diagnosis and management of glomerular diseases.Its quantification can be done by several methods.Among these,the measurement of 24-h urinary protein excretion is the gold standard method.However,it is cumbersome,time-consuming,and inconvenient for patients and is not completely foolproof.Many alternative methods have been tested over time albeit with conflicting results.Among the latter,the measurement of urine protein-to-creatinine ratio(uPCR)in singlevoided urinary samples is widely used.The majority of studies found a good correlation between uPCR in single urine samples with 24-h urinary protein estimation,whereas others did not.AIM To investigate the correlation of spot uPCR with 24-h urinary protein estimation in patients suffering from different forms of glomerulopathies at a single largevolume nephrological center in Pakistan.METHODS This cross-sectional,observational study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan from September 2017 to March 2018.All newly presenting adult patients with proteinuria who were being investigated for suspected glomerulonephritis and persistent proteinuria with ages between 18 to 60 years were enrolled.All patients were given detailed advice regarding 24-h urine collection starting at 7:00 AM for total protein and creatinine excretion estimations.A spot urine sample was collected the next day at the time of submission of a 24-h urine sample for measuring uPCR along with a blood sample.The data of patients were collected in a proforma.SPSS version 20.0 was used for statistical analysis.RESULTS A total of 157 patients were included.Their mean age was 30.45±12.11 years.There were 94(59.8%)males and 63(40.2%)females.The mean 24-h urinary protein excretion was 3192.78±1959.79 mg and the mean spot uPCR was 3.16±1.52 in all patients.A weak but significant correlation展开更多
目的以尿蛋白与肌酐比值（UACR）为观察指标,比较不同程度的慢性心衰患者UACR的水平,以及与血浆脑利钠肽（BNP）的相关性。方法选择103例住院患者,按照纽约心功能分级（New York Heart Association class,NYHA）,分为Ⅰ～Ⅳ级,心功能Ⅰ...目的以尿蛋白与肌酐比值（UACR）为观察指标,比较不同程度的慢性心衰患者UACR的水平,以及与血浆脑利钠肽（BNP）的相关性。方法选择103例住院患者,按照纽约心功能分级（New York Heart Association class,NYHA）,分为Ⅰ～Ⅳ级,心功能Ⅰ级患者为对照组,共20例,心功能Ⅱ～Ⅳ级的患者为心衰组,共83例,其中心功能Ⅱ级32例,心功能Ⅲ级28例,心功能Ⅳ级23例。入院后留取晨尿,用免疫比浊法检测尿白蛋白,酶法测量尿肌酐,计算UACR。结果心衰组患者UACR水平LnUACR（3.97±1.68）明显高于对照组（1.09±0.53）,P〈0.05;UACR水平随着心衰程度的加重而逐渐升高,心功能Ⅳ级组UACR水平LnUACR（4.28±1.00）明显高于心功能Ⅱ级组（3.61±0.26）、Ⅲ级组（4.07±1.02）,三组之间比较差异有显著性意义（P均〈0.05）;UACR水平与心功能级别及NT-proBNP呈正相关（r=0.328,P〈0.05;r=0.375,P〈0.05）,UACR水平与eGFR呈负相关（r=-0.236,P〈0.05）。结论慢性心衰患者的UACR水平明显升高,并且随着心衰的加重,呈上升趋势。展开更多
AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHOD...AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHODS In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor(ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio(ACR) in urine. Genotyping of ACE I/D and AGT M235 T polymorphisms were performed by using primer specific polymerase chain reaction(PCR) and PCR-RFLP techniques, respectively. RESULTS Forty-eight percent of DN patients(responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric(≥ 30 and < 300 mg/g creatinine) or macro-albuminuric(≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients(55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235 T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response(72%). CONCLUSION ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235 T polymorphisms.展开更多
Background Cystatin C(Cys-C)is an emerging biomarker of renal diseases and its clinical use,particularly for screening the communities affected by chronic kidney disease of unknown etiology(CKDu),is hindered due to th...Background Cystatin C(Cys-C)is an emerging biomarker of renal diseases and its clinical use,particularly for screening the communities affected by chronic kidney disease of unknown etiology(CKDu),is hindered due to the lack of reference intervals(RIs)for diverse ethnic and age groups.The present study aimed to define RIs for urinary Cys-C(uCys-C)for a healthy pediatric population in Sri Lanka and in turn compare the renal function of the residential children in CKDu endemic and non-endemic regions in Sri Lanka.Methods A cross-sectional study was conducted with 850 healthy children(10-17 years)from selected locations for reference interval establishment,while a total of 892 children were recruited for the comparative study.Urine samples were collected and analyzed for Cys-C,creatinine(Cr)and albumin.Cr-adjusted uCys-C levels were partitioned by age,and RIs were determined with quantile regression(2.5th,50th and 97.5th quantiles)at 90%confidence interval.Results The range of median RIs for uCys-C in healthy children was 45.94-64.44 ng/mg Cr for boys and 53.58-69.97 ng/mg Cr for girls.The median(interquartile range)uCys-C levels of children in the CKDu endemic and non-endemic regions were 58.18(21.8-141.9)and 58.31(23.9-155.3)ng/mg Cr with no significant difference(P=0.781).A significant variation of uCys-C was noted in the children across age.Conclusions Notably high uCys-C levels were observed in children with elevated proteinuria.Thus,uCys-C could be a potential biomarker in identifying communities at high risk of CKDu susceptibility.展开更多
This study aimed to investigate the correlation between serum miR-154-5p and urinary albumin to creatinine ratio(UACR)in patients with type 2 diabetes mellitus(T2DM)and the association with biomarkers of inflammation ...This study aimed to investigate the correlation between serum miR-154-5p and urinary albumin to creatinine ratio(UACR)in patients with type 2 diabetes mellitus(T2DM)and the association with biomarkers of inflammation and fibrosis in diabetic kidney disease(DKD).A total of 390 patients with T2DM were divided into three groups:normal albuminuria(UACR<30 mg/g,n=136,NA),microalbuminuria(UACR at 30-300 mg/g,n=132,MA),and clinical albuminuria(UACR>300 mg/g,n=122,CA).Circulating miR-154-5p,inflammatory(C-reactive protein(CRP);erythrocyte sedimentation rate(ESR);and tumor necrosis factor-a(TNF-α)and fibrotic markers(vascular endothelial growth factor(VEGF);transforming growth factor-β1(TGF-β1);and fibronectin(FN),and other biochemical indicators were assessed via real-time PCR,enzyme-linked immunosorbent assay,and chemiluminescence assay in patients with T2DM and 138 control subjects(NC).UACR,miR-154-5p,glycated hemoglobin(HbA1c),serum creatinine(sCr),blood urea nitrogen(BUN),ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were significantly higher and the estimated glomerular filtration rate(eGFR)was significantly lower in NA,MA,and CA groups than in NC subjects(P<0.05).Elevated levels of UACR and miR-154-5p were directly correlated with HbA1c,sCr,BUN,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN and negatively correlated with eGFR(P<0.05).miR-154-5p,HbA1c,sCr,BUN,eGFR,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were important factors affecting UACR.These findings indicated that elevated serum miR-154-5p is significantly correlated with high UACR in patients with T2DM and may offer a novel reference for the early diagnosis of DKD.展开更多
Objective To establish albumin-creatinine ratio （ACR） reference value of the rural population in Hebei province. Methods This study enrolled 5154 participants. By excluding subjects with hypertension, diabetes, dys...Objective To establish albumin-creatinine ratio （ACR） reference value of the rural population in Hebei province. Methods This study enrolled 5154 participants. By excluding subjects with hypertension, diabetes, dyslipidemia, cardiovascular and cerebrovascular diseases, kidney diseases, and overweight condition, as well as those with an estimated glomerular filtration rate （eGFR）（60 ml/（min· 1.73 m^2）, apparently healthy subjects （1168） were selected. Urine albumin was measured by using the immunoturbidimetic method, serum creatinine was measured by using Jaffe＇s kinetic method on a morning spot-urine sample, and ACR was calculated. The 95th percentile of ACR in the healthy subjects was used as the normal upper limit. Results The normal upper limit of ACR was 28.71 mg/g （3.25 mg/retool） for males and 31.85 mg/g （3.60 rag/retool） for females. Based on this ACR reference value, the age-gender standardized prevalence of albuminuria in the rural areas of Hebei province was 12.9%. Conclusion The ACR reference value in the rural of Hebei province is higher than that of the Western population.展开更多
Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-termina...Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,and creatinine(Cr),as well as combinations of these,for the prediction of AKI in patients with AHF.Methods:A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study.Their NLR,NT-proBNP,urea,and Cr concentrations were measured on admission.AKI was defined using the Acute Kidney Injury Network criteria.Receiver operating characteristic(ROC)curves,the areas under the curves(AUCs),sensitivity,and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI.This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital,Sun Yat-sen University(approval No.SYSEC-KY-KS-2021-126)on June 22,2021.Results:Forty-six(30.1%)participants developed AKI during hospitalization.The NLR and NT-proBNP of the participants with AKI were higher than those without(NLR:median 7.886 vs 4.717,P<0.0001;NT-proBNP,median 6774 vs 2786pg/mL,P<0.0001).ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI(NLR:cut-off 5.681,AUC 0.716,sensitivity 58.9%,specificity 80.4%;NT-proBNP:cut-off 5320pg/mL,AUC 0.700,sensitivity 72.9%,specificity 65.2%).Moreover,a combination of NLR,NT-proBNP,urea,and Cr yielded an AUC of 0.815,sensitivity 80.4%,and specificity of 74.8%.In addition,the AUCs for the prediction of AKI in the participants with New York Heart Association(NYHA)classes II,III,and IV were 0.936,0.860,and 0.772,respectively,using this combination.Conclusion:A combination of NLR,NT-proBNP,urea,and Cr,measured at admission,may represent a promising tool for the prediction of AKI in patients with AHF.This method performs best for AKI risk asses展开更多
Objective: To provide scientific basis for the pathogenesis and prevention and control of diabetic retinopathy through studying on relationship between different stages of diabetic retinopathy and blood glucose, blood...Objective: To provide scientific basis for the pathogenesis and prevention and control of diabetic retinopathy through studying on relationship between different stages of diabetic retinopathy and blood glucose, blood lipid andother related factors. Mehods: Collected 196 type 2 diabetes patients in a hospital branch ,it could be divided into NDR (n=180), NPDR (n=11) and PDR (n=5) and collected 40 control cases. Each object were surveyed fundus colorized photographyorfundus fluorescence angiography examination, physical and blood tests, and the results were statistically analyzed. Results: BMI, SBP, HbAlc, FPG, P2hPG, TG, HDL, DN and urinary albumin/creatinine ratio (UACR) between the four groups were statistically difference;SBP, HbAlc, P2hPG, TG and UACR were positively correlated relationship with different stage of DR;HDL was negatively related with different stage of DR. Conclusion: SBP, HbAlc, P2hPG, HDL and UACR were factors of different stages of DR, the SBP, HbAlc, P2hPG and TG were more higher and the HDL was more lower, the DR was more serious.展开更多
文摘BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and ur
基金supported by the Guangxi Medical and Health Appropriate Technology Development and Application Project(No.S2021095)Undergraduate Enrollment Project of Guangxi Medical University(No.S202410598186).
文摘Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In
文摘BACKGROUND Proteinuria is an important and well-known biomarker of many forms of kidney injury.Its quantitation is of particular importance in the diagnosis and management of glomerular diseases.Its quantification can be done by several methods.Among these,the measurement of 24-h urinary protein excretion is the gold standard method.However,it is cumbersome,time-consuming,and inconvenient for patients and is not completely foolproof.Many alternative methods have been tested over time albeit with conflicting results.Among the latter,the measurement of urine protein-to-creatinine ratio(uPCR)in singlevoided urinary samples is widely used.The majority of studies found a good correlation between uPCR in single urine samples with 24-h urinary protein estimation,whereas others did not.AIM To investigate the correlation of spot uPCR with 24-h urinary protein estimation in patients suffering from different forms of glomerulopathies at a single largevolume nephrological center in Pakistan.METHODS This cross-sectional,observational study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan from September 2017 to March 2018.All newly presenting adult patients with proteinuria who were being investigated for suspected glomerulonephritis and persistent proteinuria with ages between 18 to 60 years were enrolled.All patients were given detailed advice regarding 24-h urine collection starting at 7:00 AM for total protein and creatinine excretion estimations.A spot urine sample was collected the next day at the time of submission of a 24-h urine sample for measuring uPCR along with a blood sample.The data of patients were collected in a proforma.SPSS version 20.0 was used for statistical analysis.RESULTS A total of 157 patients were included.Their mean age was 30.45±12.11 years.There were 94(59.8%)males and 63(40.2%)females.The mean 24-h urinary protein excretion was 3192.78±1959.79 mg and the mean spot uPCR was 3.16±1.52 in all patients.A weak but significant correlation
文摘目的以尿蛋白与肌酐比值（UACR）为观察指标,比较不同程度的慢性心衰患者UACR的水平,以及与血浆脑利钠肽（BNP）的相关性。方法选择103例住院患者,按照纽约心功能分级（New York Heart Association class,NYHA）,分为Ⅰ～Ⅳ级,心功能Ⅰ级患者为对照组,共20例,心功能Ⅱ～Ⅳ级的患者为心衰组,共83例,其中心功能Ⅱ级32例,心功能Ⅲ级28例,心功能Ⅳ级23例。入院后留取晨尿,用免疫比浊法检测尿白蛋白,酶法测量尿肌酐,计算UACR。结果心衰组患者UACR水平LnUACR（3.97±1.68）明显高于对照组（1.09±0.53）,P〈0.05;UACR水平随着心衰程度的加重而逐渐升高,心功能Ⅳ级组UACR水平LnUACR（4.28±1.00）明显高于心功能Ⅱ级组（3.61±0.26）、Ⅲ级组（4.07±1.02）,三组之间比较差异有显著性意义（P均〈0.05）;UACR水平与心功能级别及NT-proBNP呈正相关（r=0.328,P〈0.05;r=0.375,P〈0.05）,UACR水平与eGFR呈负相关（r=-0.236,P〈0.05）。结论慢性心衰患者的UACR水平明显升高,并且随着心衰的加重,呈上升趋势。
基金Supported by Department of Biotechnology,Government of India,New Delhi(DBT Project),No.BT/PR 4640/MED/30/716/2012
文摘AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHODS In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor(ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio(ACR) in urine. Genotyping of ACE I/D and AGT M235 T polymorphisms were performed by using primer specific polymerase chain reaction(PCR) and PCR-RFLP techniques, respectively. RESULTS Forty-eight percent of DN patients(responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric(≥ 30 and < 300 mg/g creatinine) or macro-albuminuric(≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients(55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235 T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response(72%). CONCLUSION ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235 T polymorphisms.
基金This research was funded by the Accelerating Higher Education Expansion and Development(AHEAD)Operation of the Ministry of Higher Education funded by the World Bank(No.AHEAD DOR 02/40).
文摘Background Cystatin C(Cys-C)is an emerging biomarker of renal diseases and its clinical use,particularly for screening the communities affected by chronic kidney disease of unknown etiology(CKDu),is hindered due to the lack of reference intervals(RIs)for diverse ethnic and age groups.The present study aimed to define RIs for urinary Cys-C(uCys-C)for a healthy pediatric population in Sri Lanka and in turn compare the renal function of the residential children in CKDu endemic and non-endemic regions in Sri Lanka.Methods A cross-sectional study was conducted with 850 healthy children(10-17 years)from selected locations for reference interval establishment,while a total of 892 children were recruited for the comparative study.Urine samples were collected and analyzed for Cys-C,creatinine(Cr)and albumin.Cr-adjusted uCys-C levels were partitioned by age,and RIs were determined with quantile regression(2.5th,50th and 97.5th quantiles)at 90%confidence interval.Results The range of median RIs for uCys-C in healthy children was 45.94-64.44 ng/mg Cr for boys and 53.58-69.97 ng/mg Cr for girls.The median(interquartile range)uCys-C levels of children in the CKDu endemic and non-endemic regions were 58.18(21.8-141.9)and 58.31(23.9-155.3)ng/mg Cr with no significant difference(P=0.781).A significant variation of uCys-C was noted in the children across age.Conclusions Notably high uCys-C levels were observed in children with elevated proteinuria.Thus,uCys-C could be a potential biomarker in identifying communities at high risk of CKDu susceptibility.
基金This study was supported by the Higher School“High-end Talent Team Construction”of Liaoning Province(No.[2014]187)the Natural Science Foundation of Liaoning Province(No.201602862),Liaoning Province,China.
文摘This study aimed to investigate the correlation between serum miR-154-5p and urinary albumin to creatinine ratio(UACR)in patients with type 2 diabetes mellitus(T2DM)and the association with biomarkers of inflammation and fibrosis in diabetic kidney disease(DKD).A total of 390 patients with T2DM were divided into three groups:normal albuminuria(UACR<30 mg/g,n=136,NA),microalbuminuria(UACR at 30-300 mg/g,n=132,MA),and clinical albuminuria(UACR>300 mg/g,n=122,CA).Circulating miR-154-5p,inflammatory(C-reactive protein(CRP);erythrocyte sedimentation rate(ESR);and tumor necrosis factor-a(TNF-α)and fibrotic markers(vascular endothelial growth factor(VEGF);transforming growth factor-β1(TGF-β1);and fibronectin(FN),and other biochemical indicators were assessed via real-time PCR,enzyme-linked immunosorbent assay,and chemiluminescence assay in patients with T2DM and 138 control subjects(NC).UACR,miR-154-5p,glycated hemoglobin(HbA1c),serum creatinine(sCr),blood urea nitrogen(BUN),ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were significantly higher and the estimated glomerular filtration rate(eGFR)was significantly lower in NA,MA,and CA groups than in NC subjects(P<0.05).Elevated levels of UACR and miR-154-5p were directly correlated with HbA1c,sCr,BUN,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN and negatively correlated with eGFR(P<0.05).miR-154-5p,HbA1c,sCr,BUN,eGFR,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were important factors affecting UACR.These findings indicated that elevated serum miR-154-5p is significantly correlated with high UACR in patients with T2DM and may offer a novel reference for the early diagnosis of DKD.
基金Supported by the National Basic Research Program of China(973 Program)(2007CB512201)the Program of Health Policy for blindness prevention from China+2 种基金the Key Technologies R&D Program(2006-10903)from the Science and Technology Bureau of Handan City,Hebei Province,Chinaa program from Beijing Tongren Hospitalkey discipline fund of Health Bureau,Handan City,Hebei Province,China
文摘Objective To establish albumin-creatinine ratio （ACR） reference value of the rural population in Hebei province. Methods This study enrolled 5154 participants. By excluding subjects with hypertension, diabetes, dyslipidemia, cardiovascular and cerebrovascular diseases, kidney diseases, and overweight condition, as well as those with an estimated glomerular filtration rate （eGFR）（60 ml/（min· 1.73 m^2）, apparently healthy subjects （1168） were selected. Urine albumin was measured by using the immunoturbidimetic method, serum creatinine was measured by using Jaffe＇s kinetic method on a morning spot-urine sample, and ACR was calculated. The 95th percentile of ACR in the healthy subjects was used as the normal upper limit. Results The normal upper limit of ACR was 28.71 mg/g （3.25 mg/retool） for males and 31.85 mg/g （3.60 rag/retool） for females. Based on this ACR reference value, the age-gender standardized prevalence of albuminuria in the rural areas of Hebei province was 12.9%. Conclusion The ACR reference value in the rural of Hebei province is higher than that of the Western population.
基金supported by grants from Guangdong Science and Technology Department(No.2020B1212060018)National Key Program of the Ministry of Science and Technology Foundation of China(No.2020YFC2004505)+2 种基金Guangdong Provincial Natural Science Foundation(No.2020A1515011467)Guangzhou City Science and Technology Project Plan Foundation(No.202002030149)National Natural Science Foundation of China(No.82002203).
文摘Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,and creatinine(Cr),as well as combinations of these,for the prediction of AKI in patients with AHF.Methods:A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study.Their NLR,NT-proBNP,urea,and Cr concentrations were measured on admission.AKI was defined using the Acute Kidney Injury Network criteria.Receiver operating characteristic(ROC)curves,the areas under the curves(AUCs),sensitivity,and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI.This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital,Sun Yat-sen University(approval No.SYSEC-KY-KS-2021-126)on June 22,2021.Results:Forty-six(30.1%)participants developed AKI during hospitalization.The NLR and NT-proBNP of the participants with AKI were higher than those without(NLR:median 7.886 vs 4.717,P<0.0001;NT-proBNP,median 6774 vs 2786pg/mL,P<0.0001).ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI(NLR:cut-off 5.681,AUC 0.716,sensitivity 58.9%,specificity 80.4%;NT-proBNP:cut-off 5320pg/mL,AUC 0.700,sensitivity 72.9%,specificity 65.2%).Moreover,a combination of NLR,NT-proBNP,urea,and Cr yielded an AUC of 0.815,sensitivity 80.4%,and specificity of 74.8%.In addition,the AUCs for the prediction of AKI in the participants with New York Heart Association(NYHA)classes II,III,and IV were 0.936,0.860,and 0.772,respectively,using this combination.Conclusion:A combination of NLR,NT-proBNP,urea,and Cr,measured at admission,may represent a promising tool for the prediction of AKI in patients with AHF.This method performs best for AKI risk asses
文摘Objective: To provide scientific basis for the pathogenesis and prevention and control of diabetic retinopathy through studying on relationship between different stages of diabetic retinopathy and blood glucose, blood lipid andother related factors. Mehods: Collected 196 type 2 diabetes patients in a hospital branch ,it could be divided into NDR (n=180), NPDR (n=11) and PDR (n=5) and collected 40 control cases. Each object were surveyed fundus colorized photographyorfundus fluorescence angiography examination, physical and blood tests, and the results were statistically analyzed. Results: BMI, SBP, HbAlc, FPG, P2hPG, TG, HDL, DN and urinary albumin/creatinine ratio (UACR) between the four groups were statistically difference;SBP, HbAlc, P2hPG, TG and UACR were positively correlated relationship with different stage of DR;HDL was negatively related with different stage of DR. Conclusion: SBP, HbAlc, P2hPG, HDL and UACR were factors of different stages of DR, the SBP, HbAlc, P2hPG and TG were more higher and the HDL was more lower, the DR was more serious.
