摘要:目的: 觀察低分子肝素聯合ACEI/ARB治療糖尿病腎病(DN)的療效。 方法 :將55例2型DN患者隨機分為對照組(ACEI/ARB)和治療組(ACEI/ARB+低分子肝素),療程8周。比較兩組治療前和治療后24h尿蛋白,Scr、BUN、血漿白蛋白等指標的變化。 結果 :(1)治療后治療組和對照組24h尿蛋白、Scr均顯著下降(〖WTBX〗P lt;001,〖WTBX〗P lt;005),治療組比對照組下降更為明顯(〖WTBX〗P lt;005)。(2)治療后兩組血漿白蛋白均增加(〖WTBX〗P lt;001),治療組與對照組治療后比較無明顯差異(〖WTBX〗P gt;005)。(3)治療后兩組BUN均降低(〖WTBX〗P lt;005),治療組與對照組治療后比較無明顯差異(〖WTBX〗P gt;005)。(4)治療后兩組TC和TG均無明顯變化。 結論 :聯合應用低分子肝素能有效減少DN患者的蛋白尿,改善腎功能。Abstract: Objective: To study the clinical effects of lowmolecularweight heparin (LMWH) and ACEI/ARB on diabetic nephropathy(DN).Methods :55 patients of type 2 Diabetic nephropathy were randomly divided into treatment group(ACEI/ARB+ LMWH)and control group (ACEI/ARB).SCr,quantity of protein in 24hour urine,BUN and plasma albumin figures were compared between two groups before treatment and eight weeks after treatment.Results :(1)SCr,quantity of protein in 24hour urine had been decreased significantly in both groups(P lt;001,P lt;005),and more significantly in treated group than in control group (P lt;005).(2)Plasma albumin increased significantly in both groups(P lt;001).But no significantly increase of plasma albumin had been found in treatment group during the followup(P gt;005).(3)BUN decreased significantly in both groups(P lt;005), but no significantly decrease of BUN had been found in treatment group during the followup(P gt;005).(4)There were no significantly difference in TC and TG between two groups.Conclusion : LMWH and ACEI/ARB can ameliorate proteinuria and improve renal function of the patients with DN.
Objective To investigate the diagnostic value of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammatory body and sphingosine-1-phosphate (S1P) in early diabetic nephropathy and its progression. Methods A total of 600 diabetic patients who were treated in Shaanxi Provincial People’s Hospital between January 2018 and December 2020 were selected, and the patients were divided into simple diabetes group, early diabetic nephropathy group and clinical diabetic nephropathy group. The expression of NLRP3 messenger RNA (mRNA) in fasting venous blood mononuclear cells was detected by real-time fluorescence quantitative polymerase chain reaction, and the level of S1P was detected by enzyme-linked immunosorbent assay double-antibody sandwich method. Pearson correlation analysis was used to explore the correlation between blood NLRP3 mRNA and S1P levels. The receiver operating characteristic curve was used to evaluate the diagnostic value of blood NLRP3 mRNA and S1P levels in early diabetic nephropathy and clinical diabetic nephropathy. Results Among the 600 diabetic patients, 205 were in the simple diabetes group, 198 in the early diabetic nephropathy group and 197 in the clinical diabetic nephropathy group. There was no significant difference in age and gender among the three groups (P>0.05). The blood levels of NLRP3 mRNA and S1P in the clinical diabetic nephropathy group were higher than those in the early diabetic nephropathy group and the simple diabetes group, the blood NLRP3 mRNA and S1P levels in the early diabetic nephropathy group were higher than those in the simple diabetes group. The differences were statistically significant, and the blood NLRP3 mRNA levels of the three groups were 2.69±0.64 vs. 2.05±0.56 vs. 1.76±0.51, and the S1P levels were (1.49±0.27) vs. (1.16±0.13) vs. (0.89±0.07) μmol/L (P<0.05). There was a positive correlation between blood NLRP3 mRNA and S1P level in patients (r=0.455, P<0.001). Blood NLRP3 mRNA, S1P levels and their combined detection can be used to diagnose whether diabetic patients develop early diabetic nephropathy (area under the receiver operating characteristic curve were 0.645, 0.968, 0.971; P<0.001) and whether it progressed to clinical diabetic nephropathy (area under the receiver operating characteristic curve were 0.825, 0.918, and 0.945; P<0.001). Conclusion Blood NLRP3 mRNA and S1P levels can be used to diagnose early diabetic nephropathy and evaluate its disease progression.
Objective To compare the effectiveness of three kinds of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy combined with transit bipartition (SG+TB ) as three weight-loss surgical differences in weight loss and glucose control as well as alleviation of nephropathy in obese rats with diabetic nephropathy (DN). MethodsTwelve of 60 SD male rats were randomly selected according to their average body mass and fed with a standard diet (12% fat fever) as normal control (NC) group, and the remaining 48 were fed with high-fat diet (40% fat calories) for 1 month and combined with low-dose 1% streptozotocin method to induce the establishment of obese combined diabetic nephropathy rat model, and subsequently randomized equally into SG group, RYGB group, SG+TB group and sham-operated group. Body mass and food intake were weighed and the fasting blood glucose (FBG) level after fasting for 6 hours was detected before and every month at 1–6 months after operation. At the same time, oral glucose tolerance test (OGTT), insulin tolerance test (ITT), urinary albumin creatinine ratio (UACR), serum creatinine (Scr) and blood urea nitrogen (BUN) were tested before operation and at the 1st and 6th month after operation. Finally, rat kidney tissues were taken to observe the pathological changes. Results Body mass and food intake of the SG group, the RYGB group and the SG+TB group were lower than that of the sham-operated group at 1–6 months after operation (P<0.05). The body mass of the RYGB group and the ST+TB group were lower than that of the SG group at 1–6 months after operation (P<0.05). There was no significant difference in food intake among the SG group, the RYGB group and the SG+TB group (P>0.05). The FBG levels in the SG group, the RYGB group and the SG+TB group were lower than those in the sham-operation group at 1–6 months after operation (P<0.05). The FBG levels in the RYGB group and the SG+TB group were lower than those in the SG group at 4–6 months after operation(P<0.05). The blood glucose levels detected by OGTT and ITT in the SG group, the RYGB group and the SG+TB group after operation were all lower than those in the sham-operation group (P<0.05), and all were lower than before operation (P<0.05), and the blood glucose level detected by OGTT in the RYGB group at the 1st postoperative month was lower than those in the SG group and the SG+TB group (P<0.05). Whereas there was no significant difference in the blood glucose levels detected by OGTT at the 6-month postoperative period between the the RYGB group and the SG+TB group (P>0.05), but were lower than the SG group (P<0.05). The levels of UACR, Scr and BUN in the SG group, the RYGB group and the SG+TB group after operation were lower than those in the sham-operation group (P<0.05) and lower than those before operation (P<0.05). The UACR and Scr levels in the RYGB group and the SG+TB group were lower than those in the SG group at the 1st and 6th month after operation (P<0.05). There was no significant difference in BUN level among the SG group, the RYGB group and the SG+TB group after operation (P>0.05). Typical pathological changes of diabetic nephropathy occurred in the kidney of rats in sham operation group, such as glomerular edema, capillary cavity congestion and congestion, and mesangial matrix increase. The mesangial matrix of rats in the SG group, the RYGB group and the SG+TB group were significantly improved compared with that in the sham-operation group. Conclusion SG, RYGB and SG+TB can effectively reduce weight, reduce blood sugar and relieve diabetic nephropathy, and SG+TB and RYGB are better than SG.
Objective To study the association between the insertion(I)/deletion(D) polymorphism of the angiotensin-converting enzyme gene intron 16 (ACE/ID) and diabetic nephropathy (DN) among Chinese population by Meta-analysis. Methods Odds ratios of ACE/ID genotype distributions were analyzed in NIDDM or IDDM patients with and without DN. All the related studies on ACE/ID polymorphism and DN were identified while poor-qualified studies were excluded, and the risk of publication bias was estiMetad. The Meta-analysis software, RevMan 3.1, was applied for investigating heterogeneity among individual studies and summarizing effects across studies by proper statistical methods. Result The pooled odds ratios (with 95%CI) of DD vs ID + II and II vs ID + DD were 2.17 (1.74-2.70) and 0.49 (0.36-0.66) in NIDDM (12 studies), 3.92 (2.05-7.47) and 0.19 (0.09-0.43) in IDDM (3 studies) respectively (Plt;0.01). Conclusion In both NIDDM and IDDM, ACE/ID polymorphism is believed to be associated with diabetic nephropathy. The number of DN patients with DD genotype has been increased while that with II genotype decreased.