目的 对尿液特征组分与糖尿病早期肾损害的关系进行了初步探索。 方法 对2011年12月－2012年5月间28例2型糖尿病组、33例2型糖尿病肾病组及26例健康对照组尿液中尿蛋白含量和几种常见非蛋白氮物质，包括肌酸、尿囊素、肌酐、尿酸和假尿嘧啶核苷的浓度进行测定，采用多种归一化方法对数据进行对比分析，并通过t检验减少高效液相色谱测定的变量信息，保留P＜0.05的检出峰进行主成分分析，获得分类结果。 结果 采用体积归一化方法，发现健康对照组尿液中肌酸、尿囊素和尿酸的含量与2型糖尿病组和糖尿病肾病组相比，差异均有统计学意义（P＜0.05），2型糖尿病组尿液中尿蛋白的浓度与糖尿病肾病组相比，差异有统计学意义（P＜0.05）。 结论 通过肌酸、尿囊素、尿酸和尿蛋白的联合测定为肾脏损伤程度的监测及疗效观察提供依据，为2型糖尿病患者肾功能损坏的早期预防与诊断进行初步判断提供了新的方法。
【摘要】 目的 探讨灯盏花素注射液联合血管紧张素转换酶抑制剂（ACEI）依那普利治疗糖尿病早期肾病的临床效果。 方法 2006年10月-2009年12月，将59例临床确诊2型糖尿病早期肾病的患者随机分为治疗组（n=30）与对照组（n=29）。对照组在基本治疗的基础上应用依那普利，治疗组在基本治疗的基础上联合应用依那普利和灯盏花素注射液，疗程均为3周。观察治疗前后两组患者24 h尿微量白蛋白排泄率（UAER）、全血黏度、血浆黏度、甘油三酯（TG）、尿素氮（BUN）、血肌酐（SCr）的变化。 结果 两组患者治疗前后自身对比，24 h UAER均有明显下降（Plt;0.05）；治疗组UAER下降较对照组更为明显（Plt;0.05）。 结论 ACEI联合灯盏花素，其降低24 h UAER疗效优于单纯ACEI疗效，还可有效降低全血黏度和血浆黏度，降低纤维蛋白原含量，改善患者血液流变性。【Abstract】 Objective To investigate the therapeutic effects of breviscapine combined with angiotensin converting enzyme inhibitor (enalapril) on early diabetic nephropathy. Methods A total of 59 patients with early diabetic nephropathy diagnosed between October 2006 and December 2009 were randomly divided into treatment group (n=30) and control group (n=29). The patients in treatment group were treated by breviscapine combined with enalapril, while the patients were treated with only enalapril in the control group. All of the patients were treated for three weeks. Urinaryalbuminexcretion (UAE), whole blood viscosity, plasma viscosity, triglycercide, blood urea nitrogen and serum creatinine in the two groups were detected before and after the treatment. Results After the threatment, UAE decreased in both of the two groups compared with the value before the treatment (Plt;0.05); the decrease in treatment groups was more obvious than that in the control group (Plt;0.05). Conclusion The combination of breviscapine and enalapril is effective on early diabetic nephropathy.
【摘要】 目的 评价尿蛋白与尿肌酐比值检测在子痫患者中的诊断意义。 方法 回顾分析 35例子痫患者的临床资料。患者年龄20~34岁,平均年龄(2681±639)岁;孕周22~34周,平均孕周(2902±419)周。平均血压(15620±1235 )mm Hg(1 mm Hg=0133 kPa)。均检测24 h尿蛋白及点时尿检测尿蛋白与尿肌酐比值,采用线形回归分析尿蛋白与尿肌酐比值与24 h尿蛋白结果相关性。结果 35例患者24 h尿蛋白水平(351±116) g/24 h,〖JP〗直线回归分析显示尿蛋白与尿肌酐比值与24 h尿蛋白水平呈正相关(R=0897,Plt;001)。结论 尿蛋白与尿肌酐比值可能是一个重要的用于子痫患者尿蛋白筛查的指标。【Abstract】 Objective To investigate the diagnostic significance of urinary spot protein:creatinine ratio in Eclampsia.Method Thirtfive pregnant patients suffering from eclampsia with average age of (2681±639) years old were enrolled in this study.All patients were examined both urinary protein over 24 hours and urinary spot protein:creatinine ratio. The correlation between urinary protein over 24 hours to urinary spot protein:creatinine ratio with linear regression were analyzed. Result The rinary protein of 35 patients over 24 hours were (351±116) g/24 h,meanwhile the urinary spot protein:creatinine ratio were (0345±017) g/mmol. With linear regression, urinary spot protein:creatinine ratio had a positive correlation with the data of urinary protein over 24 hours (R=0897,Plt;001). Conclusion The spot protein:creatinine ratio is a reasonable test for detecting proteinuria in eclampsia pregnancy.
The prevalence, incidence, and medical expenses of end-stage renal disease (ESRD) is extremely high in Taiwan, China; so decreasing the incidence of ESRD is a major work for kidney disease prevention in Taiwan, China. Current chronic kidney disease (CKD) guideline suggests multidisciplinary team (MDT) care for CKD patient with estimated glomerular filtration rate (eGFR) less than 30 mL/(min·1.73 m2). MDT includes not only nephrologist but also nursing specialty, dietitian, social worker, psychologist, and other professional personnel. The aim of the MDT care is to preserve renal function, decrease complications, provide nutrient support and nephrotoxic drug consultation, establish the concept of renal replacement therapy and preparation for dialysis access, provide the renal transplantation information, and give the psychosocial support. These cares should provide to CKD patients one year before starting renal replacement therapy. The MDT care for CKD could delay the progression from CKD to ESRD, lower the mortality and hospitalization of CKD, slow the renal function decline, provide better medical care and quality of life for patients, and decrease the medical expenditures. Besides, advanced CKD patients receiving MDT care have higher arteriovenous access preparation rate that prevent the additional intervention and hospitalization while starting dialysis. MDT care also decreases the hospitalization costs and medical expenditures, and decrease 3-year mortality rate after dialysis initiation. The further developing MDT care includes: (1) providing personalized renal care and treatment model, and intergraded care by cardiology-nephrology-diabetes-neurology model; (2) new iCKD care with health management platform and care mode combined with communication technology; (3) shared decision making for choice of renal replacement therapy; (4) advance care planning clinic for palliative treatment of ESRD. All MDT care hopes to establish a person-oriented care policy, provides a better quality care model, not only for the patient’s personalized medical care, but also hopes to improve the overall kidney disease care and prevention work. In addition, we can extend the CKD prevention and treatment experience to other countries worldwide.