慢性肾脏病伴发高尿酸血症预后的回顾性研究

摘要 目的：本研究对慢性肾脏病伴发高尿酸血症的情况进行现状分析及随访,观察我院住院患者中符合该条件的人群,并对该人群是否较早进入以透析为主要方式的肾脏替代治疗阶段或是以死亡为主要表现的终点事件进行评估,以期降低肾脏病致死致残风险。方法：收集2013.1-2018.1在哈尔滨医科大学第一临床医院肾内科住院确诊为慢性肾脏病CKD1-5期患者的临床资料,进行回顾性分析。用SAS9.4软件统计数据,所得的数据以均值±标准差或者例数（百分比）的方式进行描述;方差齐时t检验应用于定量资料组间比较;方差不齐时应用Satterthwaite t''检验;完全随机设计的方差分析体现在多组间比较的应用。卡方检验是组间比较定性资料的一种选择。Pearson分析用来挖掘尿酸与本实验中其他指标的相关可能。采用单、多因素logistic回归分析汇总探讨慢性肾脏病的可能危险因素。结果：1）高尿酸血症组患者以24.93%的比例进入透析阶段,比非高尿酸组高了12.04%。死亡结果对两组之间的差异不构成影响。2）尿酸和胆固醇及血糖具有正相关关系,相关系数分别为0.12637 和0.11639。与eGFR具有负相关性,相关系数为-0.326。3) 单因素logistic回归分析CKD的危险因素结果表明年龄、尿酸、胱抑素C、尿素氮、血肌酐、尿蛋白、尿潜血、收缩压是CKD的危险因素。以CKD分期为应变量,单因素logistic 回归分析中有意义的变量为自变量,包括尿酸、尿蛋白、尿潜血、年龄、BUN、CysC、收缩压、血肌酐、吸烟、饮酒、BMI、甘油三酯、胆固醇、血红蛋白（Hemoglobin, Hb）进行多因素回归分析,变量筛选法采用向后法,结果显示,尿蛋白、尿素氮、尿酸是CKD独立危险因素。结论：1）与慢性肾脏病非高尿酸血症组相比,伴有高尿酸血症的慢性肾脏病患者进入透析阶段的比例更大。2）本研究可以得出尿蛋白、血尿素氮、尿酸是CKD的独立危险因素。     

肾病综合征患者血浆leptin、IL-4、IL-18及TNF-α水平变化及其临床意义

摘要 目的：探究肾病综合征患者血浆瘦素（leptin）、白介素-4（IL-4）、白介素-18（IL-18）及肿瘤坏死因子-α（TNF-α）水平变化及其临床意义。方法：选择2018年2月至2019年10月我院诊治的110例肾病综合征患者作为观察组,选择同期在我院体检的110名健康者作为对照组。检测并比较两组的血浆leptin、IL-4、IL-18、TNF-α水平及24 h蛋白尿、血浆白蛋白水平,采用Pearson法分析血浆leptin、IL-4、IL-18和TNF-α与24 h蛋白尿、血浆白蛋白的相关性,采用受试者工作特征曲线（ROC）分析各指标对肾病综合征的诊断价值。结果：与对照组相比,观察组的血浆leptin、IL-4、IL-18及TNF-α水平明显升高（P<0.05）。与对照组相比,观察组的24 h蛋白尿明显升高,血浆白蛋白水平明显下降（P<0.05）。血浆leptin、IL-4、IL-18和TNF-α水平与24 h蛋白尿均呈正相关性,而与血浆白蛋白均呈负相关性（P<0.05）。血浆leptin、IL-4、IL-18和TNF-α联合检测对肾病综合征的诊断价值明显高于各项指标单独检测。结论：肾病综合征患者血浆leptin及炎症因子水平明显升高,并且与患者24h蛋白尿以及血浆白蛋白具有相关性,血浆leptin和IL-4、IL-18、TNF-α联合检测对肾病综合征具有较高的诊断价值。     

三维斑点追踪技术对慢性肾功能不全患者左心室收缩功能和右心室功能的评估价值研究

摘要 目的：探讨慢性肾功能不全患者应用三维斑点追踪技术对其左心室收缩功能和右心室功能的评估价值。方法：选择我院收治的慢性肾功能不全患者82例,根据患者肾功能将其分为轻度慢性肾功能不全组[慢性肾脏病（CKD） 2期,47例],中-重度慢性肾功能不全组（CKD 3~5期,35例）,另选取同期医院体检的健康志愿者30例作为对照组,应用二维超声及三维斑点追踪技术检测各组心脏指标,比较三组二维超声指标、三维斑点追踪技术指标,应用受试者工作特征（ROC）曲线分析三维斑点追踪技术对患者左心室收缩功能和右心室功能的评估价值。结果：中-重度慢性肾功能不全组室间隔舒张末期厚度（IVSTd）、肺动脉收缩压（PASP）显著高于轻度慢性肾功能不全组、对照组,右心室面积变化分数（RVFAC）、组织运动三尖瓣环位移（TAPSE）、左心室射血分数（LVEF）显著低于轻度慢性肾功能不全组、对照组（P<0.05）。中-重度慢性肾功能不全组左室整体圆周收缩期峰值应变（LGCS）、左室整体纵向收缩期峰值应变（LGLS）、右室整体圆周收缩期峰值应变（RGCS）右室整体纵向收缩期峰值应变（RGLS）、显著高于轻度慢性肾功能不全组、对照组,左室整体径向收缩期峰值应变（LGRS）、三维左室射血分数（3D-LVEF）、右室整体径向收缩期峰值应变（RGRS）、三维右室射血分数（3D-RVEF）显著低于轻度慢性肾功能不全组、对照组（P<0.05）。ROC曲线分析显示,三维斑点追踪技术对慢性肾功能不全患者左心室收缩功能和右心室功能的评估价值较高。结论：三维斑点追踪技术可以准确检测心脏的纵向运动、圆周运动、径向运动,为临床早期发现慢性肾功能不全患者的心脏功能异常提供依据。     

血浆PLSCR1、PTX3、SALL4与肝细胞癌患者临床病理参数的关系及联合检测的辅助诊断价值研究

摘要 目的：探讨血浆磷脂爬行酶1（PLSCR1）、正五聚蛋白3（PTX3）、spalt样转录因子4（SALL4）与肝细胞癌（HCC）患者临床病理参数的关系及联合检测的辅助诊断价值。方法：纳入2020年1月～2021年12月南京医科大学附属无锡第二医院收治的94例HCC患者（HCC组）、67例肝硬化患者（肝硬化组）、78例慢性乙型肝炎患者（慢性乙型肝炎组），另取同期健康体检者58例为对照组，检测并对比四组血浆PLSCR1、PTX3、SALL4及血清甲胎蛋白（AFP）水平。分析血浆PLSCR1、PTX3、SALL4水平与HCC患者临床病理参数的关系。采用受试者工作特征（ROC）曲线分析血清AFP联合血浆PLSCR1、PTX3、SALL4对HCC的辅助诊断价值。结果：HCC组血浆PLSCR1、PTX3、SALL4、血清AFP水平高于肝硬化组、慢性乙型肝炎组以及对照组，肝硬化组上述指标水平高于慢性乙型肝炎组和对照组，慢性乙型肝炎组上述指标水平高于对照组（P＜0.05）。不同分化程度、Child-Pugh分级、巴塞罗那临床肝癌（BCLC）分期、淋巴结转移HCC患者血浆PLSCR1、PTX3、SALL4水平比较，差异有统计学意义（P＜0.05）。ROC曲线分析结果显示，血清AFP、血浆PLSCR1、PTX3、SALL4四项联合检测诊断HCC的曲线下面积（AUC）为0.923，明显高于血浆PLSCR1、PTX3、SALL4三项联合检测以及各指标单独检测（P＜0.05）。结论：HCC患者血浆PLSCR1、PTX3、SALL4水平呈高表达，与分化程度、Child-Pugh分级、BCLC分期和淋巴结转移有关，可作为HCC早期诊断的辅助指标。     

不同分期慢性肾脏病患者血清Klotho蛋白、FGF-23、RBP4、TWEAK水平与肾功能的相关性研究

摘要 目的：探究不同分期慢性肾脏病(CKD)患者血清Klotho蛋白、成纤维细胞生长因子-23(FGF-23)、视黄醇结合蛋白4(RBP4)、肿瘤坏死因子样弱凋亡诱导因子(TWEAK)水平与肾功能的相关性。方法：选择2018年2月至2020年2月我院诊治的80例CKD患者作为CKD组,选择同期在我院进行健康体检的80名健康者作为对照组。检测并比较对照组和CKD组以及不同CKD分期患者血清Klotho蛋白、FGF-23、RBP4、TWEAK水平及肾功能指标水平,采用Pearson相关性分析对血清Klotho蛋白、FGF-23、RBP4、TWEAK水平与肾功能指标的相关性进行分析。结果：与对照组相比,CKD组血清Klotho蛋白、TWEAK水平和肾小球滤过率（GFR）明显下降,而血清FGF-23、RBP4水平、血清肌酐、24尿蛋白定量和血清尿素氮水平明显升高（P<0.05）。Ⅰ～Ⅱ期患者的血清Klotho蛋白、TWEAK水平和GFR最高,其次为Ⅲ～Ⅳ期患者,Ⅴ期患者最低（P<0.05）。而Ⅰ～Ⅱ期患者血清FGF-23、RBP4水平、血清肌酐、24尿蛋白定量和血清尿素氮水平最低,其次为Ⅲ～Ⅳ期患者,Ⅴ期患者最高（P<0.05）。Klotho蛋白和TWEAK水平与血清肌酐、24尿蛋白定量和血清尿素氮水平呈负相关,与GFR呈正相关（P<0.05）。FGF-23和RBP4水平与血清肌酐、24尿蛋白定量和血清尿素氮水平呈正相关,与GFR呈负相关（P<0.05）。结论：CKD患者中血清Klotho蛋白、TWEAK水平以及肾功能下降,FGF-23、RBP4水平明显升高,且血清Klotho蛋白、TWEAK、FGF-23、RBP4水平与肾功能及CKD分期相关。     

腹部超声联合血清甲胎蛋白、高尔基体蛋白73、γ-谷氨酰转肽酶/血小板比值对慢性乙型肝炎患者肝纤维化的诊断价值研究

摘要 目的：探讨腹部超声联合血清甲胎蛋白（AFP）、高尔基体蛋白73（GP73）、γ-谷氨酰转肽酶/血小板比值（GPR）对慢性乙型肝炎患者肝纤维化的诊断价值。方法：选择新疆维吾尔自治区中医医院2020年3月～2022年2月期间收治的慢性乙型肝炎患者148例,根据肝脏活检病理诊断结果分为无肝纤维化组39例、轻度肝纤维化组33例、中度肝纤维化组51例、重度肝纤维化组25例。比较各组患者入院后腹部超声检查结果及血清AFP、GP73、GPR,应用受试者工作特征（ROC）曲线分析腹部超声联合AFP、GP73、GPR对慢性乙型肝炎患者肝纤维化的诊断价值。结果：随着肝纤维化程度地增加,患者肝脏轮廓逐渐不清晰、表面不光滑、肝脏回声逐渐增粗增强、有结节感、肝内胆管走形逐渐模糊,脂肪肝和腹水比例逐渐增加,脾脏厚度、脾脏长度、门静脉内径、脾静脉内径逐渐增加,经单因素方差分析显示各组超声指标比较差异有统计学意义（P<0.05）。腹部超声对慢性乙型肝炎患者肝纤维化诊断的灵敏度为79.82%、特异度为76.92%、准确度为79.05%。随着肝纤维化程度的增加,患者血清AFP、GP73及GPR逐渐增加,差异均有统计学意义（P<0.05）。ROC曲线分析结果显示,血清AFP、GP73、GPR对慢性乙型肝炎患者肝纤维化诊断具有较高的曲线下面积（AUC）,分别为0.701、0.664、0.779,腹部超声联合血清AFP、GP73、GPR对慢性乙型肝炎患者肝纤维化诊断的AUC最高（AUC为0.819）。结论：慢性乙型肝炎肝纤维化患者血清AFP、GP73、GPR升高,腹部超声联合血清AFP、GP73、GPR对慢性乙型肝炎患者肝纤维化具有较高的诊断价值。     

糖尿病肾病患者CD147的表达和意义

摘要 目的：研究CD147在2型糖尿病肾病不同分期的表达,分析CD147与疾病进展的关系和意义。方法：选择2017年1月至2017年12月于陕西省人民医院肾病内科和内分泌科住院的2型糖尿病患者为研究组,根据糖尿病肾病的诊断标准分为微量白蛋白尿组（A组）,大量白蛋白尿组（B组）,肾功能损害组（C组）,以及糖尿病正常白蛋白尿为对照组（D组）,收集受试者的临床资料,采用ELISA方法检测各组研究对象的血清及尿液CD147、血清转化生长因子(transforming growth factor beta,TGF-β1)并进行对比分析。结果：A组、B组、C组的血清CD147,尿CD147逐渐升高,C组与A组、B、D组相比,有统计学显著性差异（P<0.05）,B组与A组及D组相比,有统计学显著性差异（P<0.05）。C组血TGFβ1与A组、B组、D组相比,有统计学显著性差异（P<0.05）。糖尿病肾病患者血清CD147与尿CD147呈正相关关系,相关系数r为0.618（P<0.01）,糖尿病肾病患者血清CD147与UACR呈正相关关系,相关系数r为0.503(P<0.01),与eGFR呈负相关关系,相关系数r为-0.557(P<0.05)。尿CD147水平与UACR呈正相关关系,相关系数r为0.425（P<0.01）与eGFR呈负相关关系,相关系数r为-0.312(P<0.05)。血TGFβ1水平与eGFR呈负相关关系,相关系数r为-0.22(P<0.05)。结论：CD147与糖尿病肾病进展有关,并对糖尿病肾病间质纤维化诊断具有一定的早期诊断价值。     

血浆外泌体miR-1290、miR-1307表达水平与卵巢癌患者临床病理特征的关系及其诊断价值分析

摘要 目的：探讨卵巢癌患者血浆外泌体中微小RNA（miR）-1290和 miR-1307的表达,分析两者与临床病理参数的关系及诊断价值。方法：选取2019年1月至2021年1月于靖江市人民医院诊治的60例卵巢癌患者为卵巢癌组,另分别选取同期52例良性卵巢肿瘤患者和50例女性健康体检者为良性肿瘤组和健康对照组。采用实时荧光定量PCR（qRT-PCR）法检测miR-1290、miR-1307在各组血浆外泌体中的表达,分析miR-1290、miR-1307与卵巢癌患者临床病理特征的关系,采用受试者工作特征（ROC）曲线分析血浆外泌体miR-1290、miR-1307对卵巢癌的诊断效能。结果：与良性肿瘤组和健康对照组相比,卵巢癌组的血浆外泌体miR-1290、miR-1307表达水平较高（P＜0.05）。卵巢癌组的miR-1290表达水平与FIGO分期、分化程度及淋巴结转移有关,miR-1307表达水平与FIGO分期、淋巴结转移有关（P＜0.05）;卵巢癌患者血浆外泌体miR-1307表达与miR-1290表达呈显著正相关（r＝0.478,P＜0.05）。血浆外泌体miR-1290、miR-1307联合应用诊断卵巢癌的曲线下面积（AUC）（0.95CI）为0.726（0.526～0.926）,高于两指标单独应用的0.724（0.466～0.987）、0.845（0.750～0.933）。结论：卵巢癌患者血浆外泌体miR-1290、miR-1307表达水平升高,两者联合检测对卵巢癌的早期诊断具有较高的价值,有望成为新的卵巢癌的分子标志物。     

rhGM-CSF联合氨磷汀治疗放射性口腔黏膜炎的临床疗效及对外周血淋巴细胞亚群的影响

摘要 目的：研究重组人粒细胞/巨噬细胞集落刺激因子（rhGM-CSF）联合氨磷汀治疗放射性口腔黏膜炎患者的临床治疗疗效以及对外周血淋巴细胞亚群的影响。方法：选取2019年1月到2020年12月在我院接收治疗的放射性口腔黏膜炎患者60例,随机分为对照组和rhGM-CSF组两组,每组30例。对照组接受静脉滴注氨磷汀治疗,rhGM-CSF组接受rhGM-CSF漱口液漱口联合静脉滴注氨磷汀治疗。比较两组患者临床治疗疗效、治疗后口腔黏膜炎评分、疼痛评分、吞咽功能、血清炎症因子以及外周血淋巴细胞亚型。结果：（1）rhGM-CSF组患者临床治愈率和治疗总有效率分别为26.67 %和90.00 %,均高于对照组6.67 %临床治愈率和70.00 %临床治疗总有效率（P<0.05）。（2）治疗后,rhGM-CSF组口腔黏膜炎评分、疼痛评分、吞咽功能、血清干扰素-γ（IFN-γ）、肿瘤坏死因子（TNF-α）和白介素-6（IL-6）含量均显著低于对照组患者（P<0.05）。（3）rhGM-CSF组患者治疗后外周血CD3⁺T淋巴细胞与对照组比较无差异（P>0.05）,外周血CD4⁺和CD4⁺/CD8⁺T淋巴细胞亚群显著高于对照组患者,而CD8⁺T淋巴细胞亚群显著低于对照组患者（P<0.05）。结论：rhGM-CSF漱口液联合静脉滴注氨磷汀治疗治疗放射性口腔黏膜炎临床疗效更优,有助于减轻患者外周血炎症反应,增强细胞免疫功能。     

血浆置换联合血液灌流胆红素吸附对慢性重型乙型病毒性肝炎患者血清生化指标的影响

摘要 目的：探讨血浆置换联合血液灌流胆红素吸附对慢性重型乙型病毒性肝炎患者血清生化指标的影响。方法：选取研究对象为我院2018年5月~2019年5月收治的80例慢性重型乙型病毒性肝炎患者,采用随机数表法分为对照组（给予血浆置换术治疗）和研究组（给予血浆置换联合血液灌流胆红素吸附治疗）各40例,观察两组治疗前后血清生化指标包括肝功能指标[血清谷草转氨酶（serum aspartate aminotransferase,GOT）、谷丙转氨酶（alanine aminotransferase,GPT）、总胆汁酸（total bile acid,TBA）、天冬氨酸氨基转移酶（Aspartate aminotransferase,AST）、丙氨酸转氨酶（alanine aminotransferase,ALT）、血浆白蛋白（plasma albumin,Alb）、总胆红素（total bilirubin,TBiL）及球蛋白（globulin,GLO）]、血清炎性因子[肿瘤坏死因子-α（tumor necrosis factor- α,TNF-α）、白细胞介素-6（interleukin-6,IL-6）、IL-18、IL-8、IL-10]、T细胞亚群[CD4⁺、CD8⁺]及HBV-DNA载量。统计两组治疗后血浆用量及治疗时间、临床疗效及不良反应发生改善情况。结果：治疗后,研究组治疗效果明显优于对照组（92.5 % vs 72.5 %,P＜0.05）;两组TBA、AST、ALT、TBiL、GLO、TNF-α、IL-6、IL-18及IL-8水平,CD8⁺含量及HBV-DNA载量均有所下降,而Alb、IL-10水平及CD4⁺含量均上升（P＜0.05）,其中研究组上述指标的变化优于对照组（P＜0.05）。在治疗过程中,研究组血浆用量明显低于对照组（P＜0.05）;两组治疗时间比较无差异（P＞0.05）。研究组不良反应发生率显著低于对照组（7.50 % vs. 27.50 %,P＜0.05）。结论：血浆置换联合血液灌流胆红素吸附在慢性重型乙型病毒性肝炎患者效果明显优于与血浆置换,可调节血清生化指标,安全性高。     

慢性肾脏病患者血清GDF-15的水平及临床意义

目的:探讨慢性肾脏病(Chronic Kidney Disease,CKD)患者血清生长分化因子-15(Growth Differentiation Factor-15,GDF-15)的表达及与其他肾功能相关临床指标的相关性。方法:选取西南医科大学附属医院2017年3月至2017年7月健康体检中心30例健康体检者对照组及肾病内科、内分泌科、心内科住院病房各期CKD患者150例,采用ELISA法测试验检其血清GDF-15水平。结果:除去CKD1期外,各期CKD患者eGFR及血清SCr、BUN、GDF-15水平均明显高于健康对照组,差异具有统计学意义(P0.05);随着CKD分期的增加,患者血清SCr、BUN、GDF-15浓度逐渐增加,且各组之间差异具有统计学意义(P0.05)。CKD3组患者血清UA浓度明显高于健康对照组、CKD1组(P0.05),CKD4组、CKD5组血清UA浓度明显高于健康对照组、CKD1组及CKD2组(P0.05)。GDF-15水平与eGFR水平呈负相关(r=-0.768,P0.01),与SCr水平呈正相关(r=0.751,P0.01),与BUN水平呈正相关(r=0.764,P0.01),与UA水平呈正相关(r=0.470,P0.01)。结论:GDF-15与慢性肾脏病的发生与发展密切相关。     

Uncoupling Protein 2 Expression Modulates Obesity in Chronic Kidney Disease Patients

Background:Obesity is a multifactorial metabolic disease resulting from behavioral and genetic factors. Obesity is linked to diabetes mellitus and hypertension, which are considered as major risk factors for chronic kidney disease (CKD); moreover, it has a direct effect on developing CKD and end stage renal disease (ESRD). Here was aimed to examine the association between uncoupling protein 2 (UCP2) gene expression and obesity in CKD patients. Methods:UCP2 gene expression was analyzed by real time polymerase chain reaction (RT-PCR) in 93 participants divided into three groups. The groups included 31 non-obese CKD patients, 31 obese CKD patients, and 31 healthy, age-matched, unrelated volunteers as a control group. Results:UCP2 gene expression was significantly relevant when comparing the non-obese CKD and obese CKD groups to the control group (p< 0.001). No significant association was found when the groups were compared by gender; Chi-square (X2) was 2.38 and p= 0.304. A significant negative correlation was found between UCP2 gene expression and BMI in CKD (p< 0.05).Conclusion:These results indicate that UCP2 gene expression plays a significant role as a risk factor for obesity in CKD patients. Key Words: Chronic Kidney Disease (CKD), Obesity, Uncoupling Protein 2 (UCP2) Gene Expression, Real-Time Polymerase Chain Reaction (RT-PCR)     

Management of Secondary Hyperparathyroidism in Stages 3 and 4 Chronic Kidney Disease

ObjectiveTo review approved treatment options for secondary hyperparathyroidism (SHPT) in patients with stages 3 and 4 chronic kidney disease (CKD).MethodsRecently published data on the diagnosis and treatment of SHPT in patients with CKD were critically assessed.ResultsEarly detection of SHPT is critical for effective treatment. Approximately 40% of patients with stage 3 CKD and 80% of patients with stage 4 have SHPT due to low serum 1,25-dihydroxyvitamin D levels. Appropriate treatment involves suppression of parathyroid hormone (PTH) to normal levels with active vitamin D therapy and phosphate binders. Ergocalciferol or cholecalciferol should be used to correct 25-hydroxyvitamin D levels either before or during active vitamin D therapy. Active vitamin D analogues include calcitriol, doxercalciferol, and paricalcitol. Calcitriol is effective, but has a narrow therapeutic window at higher doses because of hypercalcemia and hyperphosphatemia, which require frequent monitoring. Doxercalciferol is also effective, but has been associated with significant elevations in serum phosphorus requiring greater use of oral phosphate binders. Paricalcitol effectively suppresses PTH with minimal impact on serum calcium and phosphorus. Limited data exist on the use of cinacalcet in treating SHPT in stages 3 and 4 CKD, and it is only approved for use in patients receiving dialysis.ConclusionSHPT is an early and major complication of CKD. Treatment involves suppression of PTH to prevent metabolic bone disease, bone loss, and metabolic complications that may result in marked morbidity and mortality. Early detection of elevated PTH levels with appropriate intervention using active vitamin D therapy, even in the absence of elevated serum phosphorus and reduced serum calcium, is critical. (Endocr Pract. 2008;14:18-27)     

Relation of neuropeptide Y gene expression and genotyping with hypertension in chronic kidney disease

ObjectivesThe prognosis of high-risk patients might be greatly ameliorated using genetic predisposition risk factors. Sympathetic activity and innate immunity related to neuropeptide Y function may be related to dyslipidemia and atherosclerosis. The aim of this study is to detect the correlation between Neuropeptide Y (NPY) SNP rs16147 and its gene expression in chronic kidney disease with and without hypertension.MethodsThis study carried out on 150 subjects who were divided into 3 main groups group (I) 50 CKD patients with hypertension, group (II) 50 CKD patients without hypertension and group (III) 50 healthy individuals. Carotid intima media thickness (CIMT) was measured by Ultrasound. Kidney function test and lipid profile were performed. Genotyping and gene expression of neuropeptide Y (NPY) were performed using real time PCR.ResultsThere was a significant increase in number and percentage of CC genotype and C allele of NPY SNP distribution in CKD patients with and without hypertension when compared to controls. A significant association was found between CC genotype and C allele and the risk of CKD with hypertension with odd ratio 3.26 and 1.77, respectively. There is a significant positive correlation between NPY gene expression level and CIMT among chronic kidney disease patients with highest level of TC, LDLc and CIMT among CC genotype of NPY gene.ConclusionA significant association was found between CC genotype and C allele of NPY at rs16147 with increase NPY gene expression and risk of developing hypertension in CKD.     

血清超敏C反应蛋白水平与慢性肾脏病患者心血管并发症发生风险关系的探讨

目的:探讨血清超敏C反应蛋白(hs-CRP)水平与慢性肾脏病(CKD)患者心血管并发症发生风险关系。方法:选择82例CKD患者与21例健康体检者为研究对象,根据肾小球滤过率(e GFR)将CKD患者分成CKDl~2期组、CKD3~4期组和CKD5期组。检测和比较各组hs-CRP、B型钠尿肽前体(pro-BNP)、尿素氮(BUN)、尿酸(UA)、肌酐(Cr)、前白蛋白(PA)、白蛋白(Alb)、同型半胱氨酸(Hcy)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、钙(Ca)、磷(P)、血红蛋白(Hb)的水平,同时评估患者是否有心肌缺血及心室肥厚、心脏瓣膜钙化表现。结果:随着e GFR下降,CKD患者血清hs-CRP水平呈上升趋势,不同CKD分期患者血清hs-CRP水平之间差异具有统计学意义(P0.01),CKD患者血清hs-CRP水平与BUN、Cr、UA、P、TG、Hcy、pro-BNP水平之间均存在明显的正相关(P0.05);血清hs-CRP水平与白蛋白、Hb、Ca、HDL之间均存在明显的负相关(P0.05);血清hs-CRP水平与前白蛋白、胆固醇、LDL之间无显著相关性(P0.05)。以hs-CRP为因变量,其他相关指标为自变量进行多元逐步回归分析,结果显示尿酸、Hb、Hcy进入多元逐步回归方程。以心肌缺血是否阳性和瓣膜钙化是否阳性为因变量,hs-CRP为自变量做logistic回归分析,结果显示血清hs-CRP水平为心肌缺血和瓣膜钙化的危险因素(OR1)。结论:CKD患者血清hs-CRP水平升高与其肾功能降低密切相关,且为其发生心肌缺血、心脏瓣膜钙化的危险因素。     

Pulmonary Hypertension: Epidemiology in Different CKD Stages and Its Association with Cardiovascular Morbidity

BackgroundPulmonary hypertension (PH) was recently recognized as a common complication of end-stage renal disease (ESRD) that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD) and its association with cardiovascular (CV) morbidity are scarce.MethodsWe retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1–4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model.ResultsPH was detected in 426 patients (18.1%). Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%). Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI) for mild PH: 1.79 (1.30–2.47); moderate PH: 2.75 (1.73–4.37); severe PH: 3.90 (1.46–10.42)].ConclusionsOur study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events.     

Plasma Free Metanephrine and Normetanephrine Levels are Increased in Patients with Chronic Kidney Disease

ObjectivePatients with impaired renal function, particularly those on dialysis, frequently exhibit high blood pressure and hemodynamic instability, which often lead to pheochromocytoma assessment. Our objective was to assess plasma free metanephrine (MN) and normetanephrine (NMN) in chronic kidney disease patients (CKD) with or without dialysis.MethodsIn this prospective observational study we performed enzyme-linked immunosorbent assays (ELISAs) to evaluate plasma free MN and NMN in 48 CKD patients (15 with stage 3-5 CKD without dialysis, 26 on hemodialysis [HD], and 7 continuous ambulatory peritoneal dialysis [CAPD]), 30 patients with histologically proven pheochromocytoma, and 43 hypertensive patients. Adrenal masses were ruled out by abdominal computed tomography (CT) scans in all CKD and control hypertensive patients.ResultsAll 3 CKD groups (HD, CAPD, and CKD without dialysis) had significantly higher plasma free MN and NMN levels than the control hypertensive group (P < .0055). HD and CAPD patients had significantly lower plasma free NMN (P < .0055), but free MN levels were not significantly different than those observed in pheochromocytoma patients. In patients with HD, CAPD, and CKD without dialysis, plasma free MN and NMN were higher than manufacturer’s upper limits of normal in 57.7% and 28.5%, 13.3% and 61.5%, and 85.7% and 26.6%, respectively. Regression models showed that the number of dialysis years was significantly correlated with plasma free MN (r = 0.615, P < .001) but not free NMN.ConclusionPlasma free MN and NMN levels are frequently elevated in CKD patients, particularly in those on dialysis. Plasma free MN levels significantly overlap with the range in pheochromocytoma patients and correlate with the number of years on dialysis. (Endocr Pract. 2014;20:139-144)     

血清RBP4、NGAL、Klotho蛋白在慢性肾脏病病情监测及预后评估中的价值

目的:探讨血清视黄醇结合蛋白4(retinol binding protein 4,RBP4)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、Klotho蛋白在慢性肾脏病病情监测及预后评估中的价值。方法:收集我院2017年5月～2019年2月收治的297例慢性肾脏病患者为研究对象,依据肾小球滤过率(GFR)分为1期24例、2期46例、3期128例、4期66例、5期33例,并依据临床转归情况分为肾功能稳定组104例和肾功能恶化组193例;同期选择门诊健康体检者251例作为对照组。比较各组血清RBP4、NGAL、Klotho蛋白表达情况,并分析慢性肾脏病患者血清RBP4、NGAL、Klotho蛋白和GFR的相关性。结果:慢性肾脏病组血清RBP4、NGAL水平高于对照组,Klotho蛋白低于慢性肾脏病组(P0.05)。慢性肾脏病5期者血清RBP4、NGAL水平高于4期、3期、2期及1期者,Klotho蛋白低于4期、3期、2期及1期者,差异有统计学意义(P0.05)。慢性肾脏病患者血清RBP4、NGAL和GFR呈负相关,Klotho蛋白和GFR呈正相关(P0.05)。肾功能恶化组血清RBP4、NGAL水平高于肾功能稳定组,Klotho蛋白低于肾功能稳定组,差异有统计学意义(P0.05)。结论:血清RBP4、NGAL及Klotho蛋白表达水平的变化对了解慢性肾脏病患者病情程度及预后评估中有重要的参考价值,建议临床予以重视。     

Characterization of soluble thrombomodulin levels in patients with stage 3–5 chronic kidney disease

Abstract

Objective: This study aims to test the serum levels of soluble thrombomodulin (TM) in patients with chronic kidney disease (CKD)3–5 and to assess their connection with the different stages and severity of disease.

Methods: Sixty-seven patients with CKD are included, disease severity was evaluated accordingly to CKD staging and clinical data is collected. Nineteen healthy volunteers served as healthy controls. Serum soluble TM is analyzed by ELISA.

Results: The levels of soluble TM in all patients with CKD were significantly higher than those of healthy controls (p?<?0.001). CKD5 patients showed higher serum levels of soluble TM, in comparison to CKD4 patients (p?=?0.001), CKD3 patients (p?<?0.001), and healthy controls (p?<?0.001). The correlation analysis revealed significant correlation between serum soluble TM and disease severity (r?=?0.714, p?<?0.001). Serum soluble TM was found to be correlated with eGFR (r?=??0.766; p?<?0.001) and serum creatinine (r?=?0.778, p?<?0.001).

Conclusion: Soluble TM concentrations significantly increase in the CKD patients and are associated with the severity of the disease. Soluble TM may play critical roles in the development of CKD, as a biomarker of endothelial cells damage, anticoagulation and anti-inflammation.