血清β2-MG、Cys-C及肾功能相关指标在肾病综合征中的水平及临床意义分析

摘要 目的：分析血清β2微球蛋白（β2-MG）、胱抑素C（Cys-C）及肾功能相关指标[24 h尿蛋白排泄率（UPE）、尿素（BUN）、肌酐（SCr）]在肾病综合征中的水平及临床意义。方法：选择我院自2019年3月至2022年3月收治的180例肾病综合征患者作为观察组,另选同期的180例健康体检者作为对照组。检测所有受试者血清β2-MG、Cys-C及肾功能相关指标;根据观察组患者治疗转归情况,分为转归组和未转归组,使用多因素Logistic回归分析血清β2-MG、Cys-C及肾功能相关指标与肾病综合征患者治疗未转归的关系,通过ROC下面积（AUC）评价血清β2-MG、Cys-C及肾功能相关指标对治疗未转归的预测效能。结果：观察组血清β2-MG、Cys-C、UPE、BUN、SCr水平均高于对照组（P＜0.05）;未转归组血清β2-MG、Cys-C、UPE、BUN、SCr水平均高于转归组（P＜0.05）;经多因素Logistic回归分析,血清β2-MG、Cys-C、UPE、BUN、SCr均是肾病综合征患者治疗未转归的独立预测因素（P＜0.05）;经ROC曲线分析,血清β2-MG、Cys-C、UPE、BUN联合SCr预测肾病综合征患者治疗未转归的AUC为0.910。结论：血清β2-MG、Cys-C及肾功能相关指标与肾病综合征密切相关,联合预测患者治疗未转归的效能较好,值得临床予以重视应用。     

厄贝沙坦对早期糖尿病肾病患者血清hs-CRP、TNF-α、ET及Hcy水平的影响

目的:探讨厄贝沙坦治疗对早期糖尿病肾病患者血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、内皮素(ET)及同型半胱氨酸(Hcy)水平的影响。方法:入选符合纳入标准的早期糖尿病肾病患者82例,按照随机抽签的方法分为对照组和观察组,每组各41例。对照组在指导患者饮食、合理运动的基础上给予降糖、降压治疗、改善贫血、保证酸碱平衡等,观察组在对照组基础上联合厄贝沙坦治疗。检测两组患者治疗前后血脂指标:甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C);肾功能各项指标:尿素氮(BUN)、血肌酐(SCr)、胱抑素-C(CysC)、24 h尿蛋白定量(24 h UP)以及血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、内皮素(ET)及同型半胱氨酸(Hcy)水平的变化。结果:治疗前,两组血脂指标、肾功能指标、血清hs-CRP、TNF-α、ET及Hcy水平比较差异无统计学意义(P0.05)。与治疗前相比,两组患者治疗后血清TC、TG、LDL-C、BUN、SCr、CysC、24h UP、hs-CRP、TNF-α、ET及Hcy水平均显著降低,且观察组以上指标均明显低于对照组(P0.05);而两组血清HDL-C均明显升高,且观察组显著高于对照组(P0.05)。结论:厄贝沙坦用于治疗早期糖尿病肾病可更有效改善患者血脂水平、降低血清hs-CRP、TNF-α、ET及Hcy水平,进而保护患者肾功能。     

肾康注射液联合前列地尔注射液对慢性肾炎患者肾功能及脂糖代谢的影响

目的:探讨肾康注射液联合前列地尔注射液对慢性肾炎(CN)患者肾功能及脂糖代谢的影响。方法:选取2015年1月至2017年10月海南省中医院收治的CN患者108例为研究对象,按照随机数字表法分为对照组(n=54)和研究组(n=54)。对照组给予前列地尔注射液治疗,研究组在前列地尔注射液的基础上联合肾康注射液治疗,两组均连续治疗12d。比较两组治疗前后肾功能指标、脂糖代谢指标、临床疗效及不良反应发生情况。结果:与治疗前比较,两组治疗后24h尿蛋白定量(24h-UPro)、尿白蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(SCr)水平均降低,且研究组低于对照组(P0.05)。与治疗前比较,两组治疗后甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)水平均降低,高密度脂蛋白胆固醇(HDL-C)水平升高,且研究组TG、TC、LDL-C、FBG水平较对照组降低,HDL-C水平较对照组升高(P0.05)。研究组总有效率为92.59%,高于对照组的77.78%,组间比较差异有统计学意义(P0.05)。研究组不良反应发生率为5.56%,与对照组的7.41%比较差异无统计学意义(P0.05)。结论:肾康注射液联合前列地尔注射液治疗CN具有较好的疗效,能有效改善患者肾功能和脂糖代谢,且不会增加不良反应的发生,值得临床推广应用。     

胰岛素联合六味地黄丸治疗老年早期糖尿病肾病患者的临床疗效研究

目的:探讨胰岛素联合六味地黄丸治疗老年早期糖尿病肾病患者的临床疗效。方法:收集我院收治的老年早期糖尿病肾病患者100例,随机分为对照组和实验组,每组各50例,对照组患者血糖情况给予胰岛素1次~2次/d,实验组患者在此基础上给予六味地黄丸1丸/次,2次/d,口服。连续4周。治疗结束后,对患者血清糖基化血红蛋白(Hb A1c)、同型半胱氨酸(HCY)、胱抑素C(Cys-C)水平的变化及临床疗效进行检测并比较。结果:与治疗前相比,两组患者的Hb A1c、HCY、Cys-C均下降(P0.05);与对照组相比,实验组患者Hb A1c、HCY、Cys-C水平较低(P0.05),实验组患者治疗总有效率较高(P0.05)。结论:胰岛素联合六味地黄丸能够有效改善老年早期糖尿病肾病患者的糖稳态及肾功能,临床疗效较好。     

前列地尔联合尿毒清颗粒对慢性肾衰竭患者血清甲状旁腺激素、同型半胱氨酸水平及临床疗效的影响

目的:探究前列地尔联合尿毒清颗粒对慢性肾衰竭患者血清甲状旁腺激素、同型半胱氨酸及临床疗效的影响。方法:收集我院收治的慢性肾衰竭患者74例,根据随机对照表分为对照组和试验组,每组37例。对照组予以前列地尔注射液治疗,试验组在对照组基础上予以尿毒清颗粒治疗。观察并比较两组患者临床疗效,治疗前后血清肌酐(SCr)、尿素氮(BUN)、血尿酸(UA)、内生肌酐清除率(Ccr)、超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、甲状旁腺素(PTH)、β2微球蛋白(β2-MG)水平以及不良反应的发生情况。结果:与对照组相比,试验组治疗后临床总有效率较高(P0.05)。两组治疗后血清肌酐、尿素氮、血尿酸水平下降(P0.05),内生肌酐清除率水平升高(P0.05);与对照组相比,试验组血清肌酐、尿素氮、血尿酸水平较低(P0.05),内生肌酐清除率水平较高(P0.05)。两组治疗后超敏C反应蛋白、同型半胱氨酸、甲状旁腺素以及β2微球蛋白水平降低(P0.05);与对照组相比,试验组超敏C反应蛋白、同型半胱氨酸、甲状旁腺素以及β2微球蛋白水平较低(P0.05)。两组不良反应发生情况相比差异无统计学意义(P0.05)。结论:前列地尔联合尿毒清颗粒对慢性肾衰竭患者的临床疗效显著,安全性较高,可能与其下调血清甲状旁腺激素以、同型半胱氨酸及β2微球蛋白水平有关。     

急性心肌梗死患者血清Hcy、hs-CRP、Cys-C水平变化及临床意义

目的:评价心肌梗死患者血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)及胱抑素C(Cys-C)水平变化及临床意义。方法:对急性心肌梗死(AMI)组66例患者血清Hcy、hs-CRP、Cys-C水平进行测定,并与正常对照组的40例健康受试者进行比较分析。结果:AMI组血清Hcy、hs-CRP、Cys-C水平均显著高于正常对照组,差异均有统计学意义(P<0.05);且AMI组血清Hcy、hs-CRP、Cys-C两两之间均呈正性显著相关。结论:检测AMI患者血清Hcy、hs-CRP、Cys-C水平对患者病情评估及治疗措施的选择具有重要的临床意义。     

介入治疗联合降血清同型半胱氨酸治疗对冠心病患者血清微炎症介质水平的影响

目的:探讨介入治疗联合降同型半胱氨酸治疗对冠心病患者血清微炎症介质水平的影响。方法:选择2014年1月至2017年1月我院收治的冠心病患者82例,随机分成研究组和对照组,各41例。对照组患者同时使用氯吡格雷、阿司匹林、他汀类药物和β-阻滞剂等常规用药进行治疗,研究组患者在常规治疗的基础上联合使用叶酸、B组维生素进行降同型半胱氨酸治疗。连续治疗半年后,观察和比较两组患者治疗前后的血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)、可溶性细胞间粘附因子-1(ICAM-1)、N末端脑钠肽前体水平(NTpro-BNP)和血清同型半胱氨酸(Hcy)水平的变化情况。结果:治疗前,两组患者血清Hcy、L-6、CRP、PCT、ICAM-1和NTpro-BNP水平比较差异均无统计学意义(P0.05)。治疗后,两组患者血清Hcy、L-6、CRP、PCT、ICAM-1和NTpro-BNP水平均较治疗前显著降低,且研究组以上指标明显低于对照组(P0.05)。结论:介入治疗联合降同型半胱氨酸治疗冠心病患者可有效其血清Hcy水平,减轻机体的炎症反应,有效发挥保护心肌功能的作用。     

脑利尿钠肽、同型半胱氨酸与2型糖尿病早期肾病的关系及血糖变化的影响

目的:观察脑利尿钠肽、同型半胱氨酸与2型糖尿病早期肾病的关系及强化治疗后三者的变化.方法:实验组:116例,根据尿白蛋白排泄量(UAER)和血肌酐水平分为4个亚组:正常蛋白尿组(NA组)32例;蛋白尿组40例(MA组);临床蛋白尿组32例(ODN);肾功减退组12例.正常对照组(NC)47例.将所有的糖尿病患者行降糖、护肾等综合治疗后重新测定血清血清脂联素、脑利尿钠肤、同型半胱氨酸水平.结果:1、脑利尿钠肽、同型半胱氨酸在糖尿病早期肾病中明显增高;2、糖尿病肾病(DN)各组脑利尿钠肽、同型半胱氨酸水平与正常对照组相比有极显著差异(P<0.05,P<0.01),且经方差分析结果显示:糖尿病肾病(DN)各组间的血清脑利尿钠肽、同型半胱氨酸水平逐渐递增,三组间有显著性差异(P<0.05,P<0.01);3、二者与尿微量白蛋白有很好的相关性;4、强化控制后脑利尿钠肤、同型半胱氨酸水平的变化具有统计学意义.结论:脑利尿钠肽、同型半胱氨酸水平与糖尿病肾病的发生、发展及血糖的变化密切相关,可作为诊断早期糖尿病肾病的血清标志物.     

联合检测血清NGAL、KIM-1和SCr可有效提高慢性肾病分期诊断

为了探讨中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin, NGAL)和肾损伤分子-1 (kidney injury molecule-1, KIM-1)以及血肌酐(serum creatinine, SCr)联合检测对慢性肾病(chronic kidney disease, CKD)的早期诊断价值,本研究收集260例肾病患者和85例健康体检者,检测其血清NGAL、KIM-1和SCr水平。依据肾功能分级标准,CKD患者分为CKD 1期(53例),CKD 2期(68例),CKD 3期(71例),CKD 4期(46例)和CKD 5期(22例),并分析以上指标在各组间的含量差异,及其联合测定对CKD早期的敏感性。与健康对照组相比较,CKD 1期、CKD 2期、3期、4期和5期患者的NGAL、KIM-1水平均明显升高(p<0.001)。血清SCr含量在CKD 3期、4期和5期组较健康对照组显著增加(p<0.001)。以上3项指标均随着CKD严重程度增加而升高。各组指标阳性率分析显示,3项联合检测阳性率高于单项检测阳性率。ROC曲线分析NGAL、KIM-1、SCr对CKD诊断的AUC值F分别是为0.824、0.805、0.856。相关性分析结果显示,GFR和NGAL、KIM-1、SCr相关系数分别是r=-0.784、-0.756、-0.728 (p<0.05)。NGAL与KIM-1、SCr的相关系数分别是r=0.932、0.764 (p<0.05);KIM-1与SCr的相关系数r分别是0.791 (p<0.05)。本研究初步得出结论:血清NGAL、Kim-1可作为CKD早期诊断的重要指标,联合检测血清NGAL、Kim-1、SCr可有效提高CKD早期肾损伤诊断的敏感度,对CKD的分期诊断和治疗具有极其重要的临床价值。     

肾康注射液联合血液透析治疗慢性肾功能衰竭的临床效果及对肾功能、营养指标的影响

目的探讨肾康注射液联合血液透析治疗对慢性肾功能衰竭患者的肾功能、营养指标及临床疗效的影响。方法选取2018年3月~2019年2月我院肾内科收治的116例慢性肾功能衰竭患者作为研究对象,随机分为对照组和观察组各58例。对照组给予单纯血液透析治疗,观察组给予肾康注射液联合血液透析治疗,治疗16周后观察两组患者的肾功能及肾纤维化指标、营养及贫血指标改善情况,并比较两组患者的临床疗效、不良反应发生情况。结果治疗16周后,两组患者的血肌酐(Scr)、尿素氮(BUN)、Ⅳ型胶原(C-Ⅳ)、透明质酸(HA)、Ⅲ型前胶原(PC-Ⅲ)均较治疗前降低(均P<0.05),纤维连接蛋白(FN)较治疗前升高(均P<0.05),而两组患者各指标比较,观察组的改善效果优于对照组(均P<0.05)。两组患者的红细胞总数(RBC)、血红蛋白(HGB)、血清总蛋白(TP)、血清白蛋白(ALB)水平均较治疗前改善(均P<0.05),观察组的改善效果明显优于对照组(均P<0.05)。两组患者治疗前后的血铁(Fe)、转铁蛋白(TRF)、铁蛋白(FER)、促红细胞生成素(EPO)水平比较,对照组各指标水平均较治疗前降低(均P<0.05),观察组治疗前后各指标水平比较无差异性(均P>0.05)。两组患者的临床疗效比较,观察组总有效率(86.21%)明显高于对照组(60.34%),差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论肾康注射液联合血液透析治疗慢性肾功能衰竭能明显改善患者肾功能及营养状况,提高临床疗效,且安全性高,值得临床推广。     

枇杷花茶水提物的镇咳、抗炎与抗氧化作用研究

采用小鼠氨水致咳法研究枇杷花茶水提物镇咳效果,以二甲苯致小鼠耳肿胀法研究其抗炎效果,并从枇杷花茶的还原能力及对超氧阴离子和羟自由基的清除作用分析枇杷花茶水提物的抗氧化效果。结果表明,枇杷花茶的水提物高剂量组(3000 mg·kg-1)、低剂量组(700 mg·kg-1)均有镇咳抗炎效果,水提物的浓度越高,效果越好。各浓度枇杷花茶水提物均表现出一定的还原能力,对于羟基自由基和超氧阴离子都有一定的清除效果。其中,20 mg·mL-1水提物还原效果最好(吸光值0.903),超过0.2 mg·mL-1抗坏血酸(吸光值0.814);10 mg·mL-1的水提物对超氧阴离子的清除率为47.32%;20 mg·mL-1水提物对于羟基自由基的清除效果非常明显,清除率为91.62%。枇杷花茶水提物镇咳、抗炎、抗氧化效果明显。     

Systematic analysis of residual density suggests that a major limitation in well‐refined X‐ray structures of proteins is the omission of ordered solvent

In the residual electron density map of a fully refined X‐ray protein model, there should be no peaks arising from modeling errors or missing atoms. Any residual peaks that do occur should be contributed by random residual intensity differences between the model and the data. If the model is incomplete (i.e., some atoms are missing), there will be more positive peaks than negative ones. On the other hand, if the model includes inappropriately located atoms, there will be an excess of negative peaks. In this study, random residual peaks are quantified using the probability density function P(x), which is defined as the probability for a peak having peak height between x and x + dx. It is found that P(x) is single‐exponential and symmetric for both positive and negative peaks. Thus, P(x) can be used to discriminate residual peaks contributed by random noise in complete models from residual peaks being attributable to modeling errors in incomplete models. For a number of representative structures in the PDB it is found that P(x) has far more large (greater than 5 sigma) positive peaks than large negative peaks. This excess of large positive peaks suggests that the main defect in these refined structures is the omission of ordered water molecules.     

Flavonoids and cognitive function: a review of human randomized controlled trial studies and recommendations for future studies

Evidence in support of the neuroprotective effects of flavonoids has increased significantly in recent years, although to date much of this evidence has emerged from animal rather than human studies. Nonetheless, with a view to making recommendations for future good practice, we review 15 existing human dietary intervention studies that have examined the effects of particular types of flavonoid on cognitive performance. The studies employed a total of 55 different cognitive tests covering a broad range of cognitive domains. Most studies incorporated at least one measure of executive function/working memory, with nine reporting significant improvements in performance as a function of flavonoid supplementation compared to a control group. However, some domains were overlooked completely (e.g. implicit memory, prospective memory), and for the most part there was little consistency in terms of the particular cognitive tests used making across study comparisons difficult. Furthermore, there was some confusion concerning what aspects of cognitive function particular tests were actually measuring. Overall, while initial results are encouraging, future studies need to pay careful attention when selecting cognitive measures, especially in terms of ensuring that tasks are actually sensitive enough to detect treatment effects.     

A sequence-coupled vector-projection model for predicting the specificity of GalNAc-transferase.

The specificity of GalNAc-transferase is consistent with the existence of an extended site composed of nine subsites, denoted by R4, R3, R2, R1, R0, R1', R2', R3', and R4', where the acceptor at R0 is either Ser or Thr to which the reducing monosaccharide is being anchored. To predict whether a peptide will react with the enzyme to form a Ser- or Thr-conjugated glycopeptide, a new method has been proposed based on the vector-projection approach as well as the sequence-coupled principle. By incorporating the sequence-coupled effect among the subsites, the interaction mechanism among subsites during glycosylation can be reflected and, by using the vector projection approach, arbitrary assignment for insufficient experimental data can be avoided. The very high ratio of correct predictions versus total predictions for the data in both the training and the testing sets indicates that the method is self-consistent and efficient. It provides a rapid means for predicting O-glycosylation and designing effective inhibitors of GalNAc-transferase, which might be useful for targeting drugs to specific sites in the body and for enzyme replacement therapy for the treatment of genetic disorders.     

北京市老年人肝肾功能参数的参考值范围调查

目的：观察北京市60岁以上不同年龄段健康老年人肝肾功能检验项目水平的差异,建立各自的参考值范围。方法：随机挑选600例60岁以上的北京市健康老人,按照不同年龄段分为三组,空腹采血,采用Modular仪器及原装试剂测定血清ALT（丙氨酸氨基转移酶）、AST（天冬氨酸氨基转移酶）、TP（总蛋白）、ALB（白蛋白）、Bun（尿素氮）、Crea（肌酐）、UA（尿酸）水平,结果利用SPSS11.0进行统计分析,根据统计学结果,判断参考值范围,并比较不同组间水平的差异。同时随机选择371例健康青年,与老年组进行这些项目水平的比较。结果：统计学结果显示,AST、TP、UA组间无显著差异;ALT、ALB随年龄增加而下降;Bun、Crea随年龄增加而升高。结论：通过上述实验,对老年人群的ALT、AST、TP、ALB、Bun、Crea、UA等项目的参考区间进行初步分析,对现行参考区间的设定提供建议与参考。各实验室应建立自己的参考值范围。     

A method for assessing recovery of fine motor function of the hand in a rhesus monkey model of cortical injury: an adaptation of the Fugl–Meyer Scale and Eshkol–Wachman Movement Notation

Motor dysfunction of the upper extremity can result from stroke, cortical injury and neurological diseases and causes significant disruption of activities of daily living. While some spontaneous recovery in terms of compensatory movements does occur after injury to cortical motor areas, full recovery is rare. The distinction between complete recovery and compensatory recovery is important as the development of compensatory movements in the upper extremity may not translate into full functional use in human patients. However, current animal models of stroke do not distinguish full recovery from compensatory recovery. We have developed a Non-Human Primate Grasp Assessment Scale (GRAS) to quantify the precise recovery of composite movement, individual digit action, and finger-thumb pinch in our rhesus monkey model of cortical injury. To date, we have applied this GRAS scale to assess the recovery of fine motor function of the hand in young control and cell-therapy treated monkeys with cortical injury confined to the hand representation in the dominant primary motor cortex. We have demonstrated that with this scale we can detect and quantify significant impairments in fine motor function of the hand, the development of compensatory function during recovery and finally a return to full fine motor function of the hand in monkeys treated with a cell therapy.     

北京市老年人肝肾功能参数的参考值范围调查

目的:观察北京市60岁以上不同年龄段健康老年人肝肾功能检验项目水平的差异,建立各自的参考值范围。方法:随机挑选600例60岁以上的北京市健康老人,按照不同年龄段分为三组,空腹采血,采用Modular仪器及原装试剂测定血清ALT(丙氨酸氨基转移酶)、AST(天冬氨酸氨基转移酶)、TP(总蛋白)、ALB(白蛋白)、Bun(尿素氮)、Crea(肌酐)、UA(尿酸)水平,结果利用SPSS11.0进行统计分析,根据统计学结果,判断参考值范围,并比较不同组间水平的差异。同时随机选择371例健康青年,与老年组进行这些项目水平的比较。结果:统计学结果显示,AST、TP、UA组间无显著差异;ALT、ALB随年龄增加而下降;Bun、Crea随年龄增加而升高。结论:通过上述实验,对老年人群的ALT、AST、TP、ALB、Bun、Crea、UA等项目的参考区间进行初步分析,对现行参考区间的设定提供建议与参考。各实验室应建立自己的参考值范围。     

Etiological Theories of Function: A Geographical Survey

Formulations of the essential commitment of the etiological theory of functions have varied significantly, with some individual authors' formulations even varying from one place to another. The logical geography of these various formulations is different from what is standardly assumed; for they are not stylistic variants of the same essential commitment, but stylistic variants of two non-equivalent versions of the etiological theory. I distinguish these strong and weak versions of the etiological theory (which differ with respect to the role of selection in their definitions of function), draw out their respective implications, and argue that the weak version is to be preferred to the strong.     

甲亢性肝损害116例临床分析

目的探讨甲状腺功能亢进症（甲亢）肝损害的临床特点。方法收集228例甲亢患者的临床资料,分为肝损害组及无肝损害组,对两组患者的年龄、性别、甲亢病程、肝功能及甲状腺功能等指标进行分析比较。结果 228例甲亢患者中发生肝损害116例,发生率为50.72%。甲亢患者的性别与甲亢性肝损害的发生率无相关性;而年龄越大甲亢性肝损害发生率越高,病程越长甲亢性肝损害发生率也越高。甲亢性肝损害患者甲状腺功能指标TT4、FT3明显高于甲亢肝功能正常的患者,差异有统计学意义（P〈0.05）;肝功能测定以ALT、ALP升高多见。结论甲亢性肝损害的发病率较高,病情的严重程度与年龄、病程、甲状腺激素水平有密切关系;建议临床医生对初诊及复诊甲亢患者进行肝功能常规测定,以便合理选用治疗方案,使甲亢性肝损害得以及早治疗。