血清RBP,Hcy,CysC及尿m ALB水平在糖尿病肾病早期诊断中的临床应用

目的:研究血清视黄醇结合蛋白(RBP)、同型半胱氨酸(Hcy)、胱抑素C(Cys C)及尿微量白蛋白(m ALB)水平在糖尿病肾病早期诊断中的临床价值,为临床诊疗提供依据。方法:选取2014年6月到2016年2月我院收治的2型糖尿病患者138例,根据24小时尿蛋白排泄率将患者分为单纯糖尿病(A组65例),早期糖尿病肾病(B组73例),另选取同期健康体检者65例为对照组,检测各组血清中RBP、Hcy、Cys C及尿m ALB水平。结果:B组RBP、Hcy、Cys C及尿m ALB水平均显著高于A组和对照组,比较差异具有统计学意义(P0.05),A组RBP、Hcy、Cys C显著高于对照组,比较差异具有统计学意义(P0.05);RBP、Hcy、Cys C及尿m ALB联合检测阳性率显著高于单独检测(P0.05)。结论:早期糖尿病肾病患者血清RBP、Hcy、Cys C及尿m ALB水平显著上升,联合检测能提高检测阳性率。     

视黄醇结合蛋白4与2型糖尿病微血管病变的研究进展

视黄醇结合蛋白4（Retinolbindingprotein4,RBP4）是一种分泌型视黄醇结合蛋白,主要由肝脏合成,在协助视黄醇发挥生理功能中起着重要的作用。近年研究发现,RBP4是一种新的循环性脂肪因子,亦能由脂肪组织特异性分泌,它不仅能够抑制肌肉组织中的胰岛素信号通路,而且能够促进糖异生,增加肝糖输出,从而导致胰岛素抵抗的发生,增加糖尿病的发病风险。目前RBP4与2型糖尿病（Type2diabetes mellitus,T2DM）关系逐渐受到人们的重视,本文就RBP4的生理功能、RBP4与T2DM微血管病变的研究进展作一综述。     

2型糖尿病患者肾小管功能测定及其相关因素分析

目的：探讨2型糖尿病（DM）患者的肾小管功能改变,分析其相关因素。方法：将64例2型DM患者根据尿微量白蛋白量分为3组：正常蛋白尿组（〈30mg/24h）21例、微量白蛋白尿组（30~300mg/24h）20例和临床蛋白尿组（〉300mg/24h）23例,测定各组尿β2微球蛋白（U-β2MG）和尿渗透压（U-OSM）。探讨年龄、DM病程、24h尿白蛋白量、糖化血红蛋白、血压、血脂水平与肾小管功能损害的关系。结果：2型DM患者均有不同程度的尿β2MG增高及尿渗透压减低,在正常蛋白尿组即有4例尿β2-MG和7例尿OSM存在异常;方差分析显示,随尿白蛋白量的增高,尿β2MG逐步增高,尿渗透压逐步减低,三组间差异有统计学意义（F=26.123和13.889,P均〈0.01）,任两组比较差异均有统计学意义（P均〈0.05）。线性回归显示,尿β2MG及尿OSM改变与DM病程、尿白蛋白（U-ALB）、收缩压（SBP）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、低密度脂蛋白（LDL-C）独立有关。结论：2型DM肾脏损害并非仅累及肾小球,在尿微量白蛋白出现之前即可出现肾小管功能异常。联合检测24h尿白蛋白量、尿β2-MG、尿OSM有助于全面评估2型糖尿病患者的肾脏损害情况。严格控制血糖,尽早纠正代谢紊乱对肾小管功能有保护作用。     

α-硫辛酸对2型糖尿病早期肾病的保护作用研究

目的：探讨注射用α-硫辛酸对2型糖尿病早期肾病（DN）的保护作用。方法：将56例2型糖尿病早期肾病患者随机分为治疗组28例,采用注射α-硫辛酸加常规治疗;对照组28例,仅给予常规治疗。治疗前后测定尿微量白蛋白排泄率（UAER）、超氧化物歧化酶（SOD）、／丙二醛（MDA）、一氧化氮（NO）水平。结果：与治疗前比较,治疗组UAER及MDA均显著降低（P〈0．05）,SCr、SOD及NO显著升高（P〈0．05）。对照组SCr、UAER、SOD、MDA及NO与治疗前比较差异无统计学意义（P〉0．05）。结论：注射用α-硫辛酸能减少2型糖尿病肾病患者尿微量白蛋白的排泄,对早期肾病具有保护作用。     

alpha-硫辛酸对2 型糖尿病早期肾病的保护作用研究

目的：探讨注射用alpha-硫辛酸对2 型糖尿病早期肾病（DN）的保护作用。方法：将56 例2 型糖尿病早期肾病患者随机分为治 疗组28 例,采用注射alpha-硫辛酸加常规治疗;对照组28 例,仅给予常规治疗。治疗前后测定尿微量白蛋白排泄率（UAER）、超氧化 物歧化酶（SOD）、丙二醛（MDA）、一氧化氮（NO）水平。结果：与治疗前比较,治疗组UAER及MDA均显著降低（P＜0.05）,SCr、 SOD及NO 显著升高（P＜0.05）。对照组SCr、UAER、SOD、MDA 及NO与治疗前比较差异无统计学意义（P＞0.05）。结论：注射用 alpha-硫辛酸能减少2型糖尿病肾病患者尿微量白蛋白的排泄,对早期肾病具有保护作用。     

视黄醇结合蛋白4与2型糖尿病微血管病变的研究进展

视黄醇结合蛋白4(Retinolbindingprotein4,RBP4)是一种分泌型视黄醇结合蛋白,主要由肝脏合成,在协助视黄醇发挥生理功能中起着重要的作用。近年研究发现,RBP4是一种新的循环性脂肪因子,亦能由脂肪组织特异性分泌,它不仅能够抑制肌肉组织中的胰岛素信号通路,而且能够促进糖异生,增加肝糖输出,从而导致胰岛素抵抗的发生,增加糖尿病的发病风险。目前RBP4与2型糖尿病(Type2diabetes mellitus,T2DM)关系逐渐受到人们的重视,本文就RBP4的生理功能、RBP4与T2DM微血管病变的研究进展作一综述。     

2型糖尿病性视网膜病变非增殖期与脂联素、肝细胞生长因子等相关性研究

【摘 要】目的 探讨影响2型糖尿病无视网膜病变（DM）进展为糖尿病性视网膜病变非增殖期（DR）过程中的相关因素。方法 选择浙江中医药大学附属第一医院2012年11月至2013年5月收治的64例糖尿病患者,其中无视网膜病变2型糖尿病（DM）32例,非增殖期视网膜病变糖尿病32例。检测空腹血糖（FPG）、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇（HDL-C）、脂联素（ADPN）、肝细胞生长因子（HGF）和尿微量白蛋白（mALB）的浓度变化,根据所得的结果进行组间比较。结果 DM组与DR组FPG浓度分别为（7.15±0.65）mmol/L、（7.0±0.45）mmol/L,二者差异无统计学意义。HBA1c（8.15±0.23）% vs（9.24±0.29）%、HDL-C（1.59±0.06）mmol/L vs（1.40±0.41）mmol/L、脂联素（1002.14±132.04）mg/L vs（941.44±118.51）mg/L和尿微量白蛋白（21.61±3.93）mg/L vs（209.15±98.15）mg/L的结果提示两组间差异有统计学意义(P<0.05)。肝细胞生长因子（21.61±3.93）ng/L vs（16.74±1.65）ng/L,在DM组与DR组间差异无XYYFIP UJYQ(P>0.05)。结论 与DM患者相比,DR患者的高糖状态,HDL-C降低,ADPN下降以及早期肾脏损害程度较重,密切监测以上指标有利于判断早期DR发生。     

萨丽-嘎日迪+协日嘎-4味汤与肾复康对糖尿病肾病患者降尿蛋白的对比性研究

为了探讨萨丽-嘎日迪+协日嘎-4味汤与肾复康对糖尿病肾病患者的治疗效果,本研究选择我院确诊的糖尿病肾病患者100例作为研究对象,按照随机字母表法分为两组,每组50例。观察组患者采用萨丽-嘎日迪+协日嘎-4味汤治疗,对照组患者采用肾复康治疗。比较两组患者的治疗效果、24 h尿蛋白水平、尿白蛋白排泄率,并检测两组患者的肝功能、肾功能和血常规变化。研究结果表明,观察组的有效率(88.00%)显著高于对照组(74.00%)(p=0.037)。治疗2周后两组患者的24 h尿蛋白和尿白蛋白排泄率均显著下降(p0.05),然而,观察组的24 h尿蛋白和尿白蛋白排泄率均显著低于对照组(p0.05)。治疗前后观察组和对照组糖尿病肾病患者的肝功能、肾功能和血常规均无显著差异(p0.05)。研究的初步结论表明,萨丽-嘎日迪+协日嘎-4味汤在治疗糖尿病肾病方面疗效显著高于肾复康,可显著降低患者尿蛋白水平,并且安全性高。     

HbA1c和FPG水平与2型糖尿病患者视网膜病变的相关性分析

目的：探讨糖化血红蛋（HbA1c）、空腹血糖（FPG）与2型糖尿病患者视网膜病变（DR）的相关性。方法：对我院2010年1月-2012年12月住院或门诊的336例2型糖尿病（T2DM）患者进行眼底检查或眼底血管荧光素造影检测,按有无视网膜病变分为视网膜病变（DR）组和无视网膜病变（NDR）组,并对HbA1c、FBG水平进行检测。结果：DR组较NDR组HbA1c水平高,差异有统计学意义（P〈0．05）,HbA1c水平和DR分期呈正相关（I=0．526,P〈0．001）,而DR组和NDR组FPG水平差异无无统计学意义（P〉0．05）。结论：可将HbA1c作为2型糖尿病患者视网膜病变发生和发展的监测指标之一。     

免疫学方法作为早期诊断高血压患者肾损害的探讨

为了探讨高血压患者血压与肾脏损害的关系 ,分别以RIA和ELISA共同检测尿视黄醇结合蛋白、尿微量白蛋白、尿 β2 微球蛋白和血中半胱氨酸蛋白酶抑制物C。结果显示高血压组血CystatinC、尿RBP、mALB、β2 MG均显著高于对照组 (p <0 .0 1) ,且随病程的延长而有逐渐升高的趋势。血压昼夜节律异常组的血CystatinC、尿RBP、mALB和 β2 MG也明显高于血压昼夜节律正常组 (p <0 .0 1) ,提示高血压所致的肾损害不仅与血压增高程度有关 ,而且与血压在较高水平持续时间有关。结论 :高血压病引起的肾小球、肾小管损害 ,以检测CystatinC、RBP、mALB、β2 MG可作为早期诊断肾脏损害的敏感指标     

高龄老年尿钠排泄的特点分析

目的:探讨高龄老年人24 h尿钠排泄特点,为防治老年钠代谢紊乱提供依据.方法:我院老年病房80岁以上老年42例,根据肌酐清除率分为肌酐清除率正常组及异常组.另选中年组24人及老年组31人作为对照.所有患者均检测24 h尿钠、钾、磷、肌酐及肌酐清除率.结果:①高龄组肌酐清除率低于中年组及老年组,24 h尿钠排泄量亦较中年组及老年组减少;高龄组中肌酐清除率异常组的24 h尿钠排泄量较肌酐清除率正常组显著减少.②中年组与老年组尿钠排泄和肌酐清除率无相关关系,高龄组尿钠排泄与肌酐清除有直线相关关系;高龄组肌酐清除率正常组肾脏排钾保钠能力减退、尿钠排泄增加,肌酐清除率异常组钾、钠排泄均减少;③三组的钠摄入量均在6g以上.结论:高龄老年24 h尿钠排泄与肌酐清除率呈直线相关关系.当肾功能处于代偿阶段时,钠排泄增多,但严重肾功能不全时尿钠排泄减少.     

Excretion of estrone,estradiol, and progesterone in the urine and feces of the female cotton-top tamarin (Saguinus oedipus oedipus)

The excretion of three gonadal steroids was studied in the urine and feces of female cotton-top tamarins (Saguinus oedipus oedipus). Each steroid, ¹⁴C-estrone, ¹⁴C-estradiol, and ¹⁴C-progesterone, was injected into a separate female cotton-top tamarin. Urine and feces were collected at 8 hr intervals for 5 days on the three tamarins. Samples were analyzed to determine the proportion of free and conjugated steroids. Steroid excretion patterns were determined by sequential ether extraction, enzyme hydrolysis, and chromatography. Labeled estrone was excreted in a slow and continuous manner into the urine (57%) and feces (43%) with 90% of the steroid conjugated. The nonconjugated form had an elution profile identical to ³H estrone, but the conjugated portion was not completely hydrolyzed by enzyme. Labeled estradiol was excreted primarily in the urine (87%) and was released rapidly. Over 90% of the injected ¹⁴C-estradiol was excreted in urine as a conjugate, of which 41% was converted to an estrone conjugate and the remaining 59% was excreted as a polar estradiol conjugate. Labeled progesterone was excreted primarily in the feces (95%), 61% of which was free steroid. Four to six individual peaks of radioactivity were found when using celite chromatography and high performance liquid chromatography (HPLC), indicating that progesterone is metabolized into several urinary and fecal metabolites. One of these peaks matched ³H-progesterone and others may be pregnanediols, pregnanetriols, and 17-hydroxyprogesterone. These steroidal excretion patterns help explain the atypical hormonal patterns seen during the tamarin ovarian cycle.     

Urinary selenium and iodine during pregnancy and lactation

The New Zealand environment is low in selenium and iodine, and is therefore ideally suited for the study of these anionic trace elements. The aim of this study was to determine urinary excretion of selenium and iodine during pregnancy and postpartum as part of an investigation of the influence of pregnancy and lactation on selenium metabolism in women of low selenium status. In a double-blind placebo-controlled study, 35 women in the earliest stages of pregnancy and 17 non-pregnant women were recruited in Dunedin, New Zealand. Eighteen pregnant women received 50 μg selenium as L-selenomethionine, while the others received a placebo daily during pregnancy and 12 months postpartum. The non-pregnant women received the supplement, serving as a positive control. Blood samples and twenty-four hour urine samples were collected monthly during pregnancy and at 3, 6, and 12 months postpartum for analysis of selenium and iodine. Selenium content in plasma and urinary excretion of selenium fell during pregnancy; however, total excretion of selenium was greater during pregnancy than postpartum. Urinary iodine excretion was much lower than reported previously in New Zealand. Due to large intra- and inter-subject variability, no trends in iodide excretion were observed. Factors which influence urinary excretion of selenium include dietary intake, but more closely, plasma concentrations of selenium (which is probably related to total selenium pool), creatinine excretion and therefore lean body mass, and glomerular filtration rate. The exact mechanism and sequence of events remains unclear and future studies incorporating new speciation techniques are necessary.     

Molybdenum in infancy: Methodical investigation of urinary excretion

PROJECT: The clinical evaluation of trace element metabolism in infancy is based on optimal pre-analytical procedures. Urinary molybdenum excretion, the major determinant of its retention, was investigated to deduce criteria for representative specimen collection. PROCEDURES: 1.) Molybdenum concentration was analyzed in 24-hour urinary specimens (n = 193) to evaluate the range in pediatric patients. 2.) In 20 children aged 0.4 to 9.3 (mean 2.3) years admitted for a micturition cystourethrogram, three urinary collection methods (catheter, spontaneous midstream samples, urinary collection bags) were compared. 3.) Diurnal variations of molybdenum concentration were assessed by fractional urinary colLection in preterm infants fed infant formula or human milk (n = 10). Analysis was performed using atomic absorption spectroscopy. RESULTS: 1.) The molybdenum concentration in 24hour specimens was 4.0 (0-123) microg Mo/l. 2.) Urine gained by catheter collection (n = 20) rendered 7.0 (0.5-60.1) microg Mo/l, midstream samples and the use of urinary collection bags showed a concentration of 21.25 (0-91) microg Mo/l (p > 0.05). 3.) Fractional collection over 72 hours rendered a significant increase in only one participant. Diurnal differences of the urinary molybdenum concentration were significant between 3-6 p.m. and 6-9 p.m.. The molybdenum/creatinine quotient differed between the time intervals 3-6 p.m. and 9-12 p.m., as well as 9-12 a.m. and 6-9 a.m. (p < 0.05). CONCLUSION: Pediatric routine procedures are suitable for the assessment of urinary molybdenum excretion. The diurnal variations assessed are of minor clinical relevance, but should be considered by respective definition of collecting times and reference values.     

Association between urinary calcium excretion level and mortality in inhabitants of the Jinzu River basin area of Japan

A follow-up study on 5442 inhabitants (2699 men, 2743 women) was conducted to determine the association between urinary Ca excretion level and mortality of the general population of three different areas of the Jinzu River basin area, namely, non-Jinzu River, mixed, and the Jinzu River water systems, over a period of 6127 d. More than 98% of the subjects were followed completely in each area. In comparison with the low- and high-Ca-excretion groups (cutoff values; 25.1 mg/dL in men, 20.4 mg/dL in women), the mortality rates per 1000 person-years and standardized mortality ratios (SMRs) tended to be greater in the low-Ca-excretion groups than in the high-Ca-excretion groups in both sexes for each of the three areas. Moreover, Cox’s hazard ratios in men and women of the three areas exhibited negative values, 0.99 except for men of the mixed water system. These values were statistically significant in both sexes for the Jinzu River water system and in women for the non-Jinzu River water system. We conclude that the life-span becomes shorter as urinary Ca excretion levels become lower.     

Monitoring urinary excretion of 5-hydroxymethyluracil for assessment of oxidative DNA damage and repair

Urinary excretion of oxidized nucleobases and nucleosides has been used as a biomarker of oxidative DNA damage and repair. Most studies have focused on the measurements of 8-oxo-7,8-dihydro-2'-deoxyguanosine; however, the urinary levels of other DNA modifications may represent useful indicators of oxidative stress. We developed a method for the determination of 5-hydroxymethyluraciI (5-HMUra), consisting of the separation of the modified base in urine by HPLC and quantification by GC/MS in the selective ion monitoring mode. This experimental approach was subsequently validated in human samples, with the effect of storage and the inter- and intra-individual variations in 5-HMUra excretion being evaluated. Results showed that 5-HMUra is stable in samples frozen at-80 °C for at least 4 months. Inter-individual variations in 5-HMUra excretion were observed when the results were expressed either as nmoles excreted per kg per day (1.2-2.4) or corrected by creatinine values (7.2-12.2 nmoles 5-HMUra per mmoles creatinine). Intra-individual variability was low, varying slightly at different time collections for several individuals. Differences in the excretion of 5-HMUra in urine collected at three different 8-h intervals during the day were not significant and, in particular, the levels of 5-HMUra calculated from the overnight or the 24-h samples were highly correlated. These results indicate that monitoring urinary levels of 5-HMUra could be a suitable indicator of oxidative damage in human studies.     

Monitoring urinary excretion of 5-hydroxymethyluracil for assessment of oxidative DNA damage and repair

Abstract

Urinary excretion of oxidized nucleobases and nucleosides has been used as a biomarker of oxidative DNA damage and repair. Most studies have focused on the measurements of 8-oxo-7,8-dihydro-2′-deoxyguanosine; however, the urinary levels of other DNA modifications may represent useful indicators of oxidative stress. We developed a method for the determination of 5-hydroxymethyluraciI (5-HMUra), consisting of the separation of the modified base in urine by HPLC and quantification by GC/MS in the selective ion monitoring mode. This experimental approach was subsequently validated in human samples, with the effect of storage and the inter- and intra-individual variations in 5-HMUra excretion being evaluated. Results showed that 5-HMUra is stable in samples frozen at-80 °C for at least 4 months. Inter-individual variations in 5-HMUra excretion were observed when the results were expressed either as nmoles excreted per kg per day (1.2–2.4) or corrected by creatinine values (7.2–12.2 nmoles 5-HMUra per mmoles creatinine). Intra-individual variability was low, varying slightly at different time collections for several individuals. Differences in the excretion of 5-HMUra in urine collected at three different 8-h intervals during the day were not significant and, in particular, the levels of 5-HMUra calculated from the overnight or the 24-h samples were highly correlated. These results indicate that monitoring urinary levels of 5-HMUra could be a suitable indicator of oxidative damage in human studies.     

Urinary excretion of bioactive amines and their metabolites in psychiatric patients receiving phenelzine

Phenelzine [2-phenylethylhydrazine] (PLZ), a potent inhibitor of monoamine oxidase (MAO)-A and-B, is used widely in psychiatry. We have studied the effects of PLZ administration on urinary excretion of several bioactive amines and their metabolites in psychiatric patients. Urine samples (24-hour) were collected prior to treatment and again at 2 and 4 weeks of treatment with PLZ (30–90 mg daily in divided doses). Amines and metabolites analyzed included 2-phenylethylamine (PEA), m-and p-tyramine (m-and p-TA), phenylacetic acid (PAA), m-and p-hydroxyphenylacetic acid (m-and p-OH-PAA), tryptamine (T), 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), normetanephrine (NME), 3-methoxy-4-hydroxyphenylglycol (MHPG), 3-methoxytyramine (3-MT), and homovanillic acid (HVA). Levels of PEA, p-TA, 5-HT, and T were elevated during treatment with PLZ, but no significant changes in urinary excretion of the acid metabolites PAA, p-OH-PAA, and 5-HIAA were observed. Urinary levels of the noradrenaline metabolites NME and MHPG were increased and decreased, respectively; a similar pattern was observed with the dopamine metabolites 3-MT and HVA. There was an elevation in levels of m-TA and a decrease in its acid metabolite m-OH-PAA during the treatment with PLZ.     

Serum lipids and urinary albumin excretion in non insulin-dependent diabetics

The increase of urinary albumin excretion has a predictive value for cardiovascular disease in insulin-dependent and non insulin-dependent diabetics. To study the relationship between urinary albumin excretion and serum lipids, 380 non insulin-dependent diabetics, 40 to 75 yr old, with urinary albumin excretion from 0 to 200 mg/l, and normal serum creatinine (less than 150 µmol/1), were surveyed. Urinary albumin excretion, was related positively to age (r² = 0.014; p = 0.02), to systolic blood pressure (r² = 0.073, p = 0.0001) and diastolic blood pressure (r² = 0.052, p = 0.0001); a negative correlation existed with HDL-cholesterol (r² = 0.043, p = 0.0001) and Apoprotein A1 (r² = 0.044, p = 0.0001). A stepwise regression analysis was performed and resulted in three independently contributing variables related to urinary albumin excretion: First systolic blood pressure (F = 36), second Apoprotein A1 (F 24), third hemoglobin AlC (F = 6). The presence of hypertension or insulin therapy did not modify these findings. In conclusion, serum lipid seems an important determinant of urinary albumin excretion in non insulin-dependent diabetics.Abbreviations UAE Urinary Albumin Excretion - IDDs Insulin-Dependent Diabetics - NIDDs Non Insulin-Dependent Diabetics - ACE Angiotensin-converting-enzyme - HDL High Density Lipoproteins - VLDL Very Low Density Lipoproteins - LDL Low Density Lipoproteins     

Modelling purine derivative excretion in dairy goats: endogenous excretion and the relationship between duodenal input and urinary output

To determine the endogenous contribution of purine derivatives (PD) to renal excretion and the urinary recovery of duodenal purine bases (PB), five dairy Granadina goats (initial weight ± s.e.: 38.6 ± 2.78 kg) were each fitted with a duodenal infusion catheter. Animals were offered ad libitum a mixed diet (75 : 25; alfalfa hay : concentrate), which was supplied in equal portions every 3 h. To label microbial PB, (15NH4)2SO4 was added to the concentrate. The lower enrichment of urinary PD (15N-allantoin) compared with duodenal PB enrichment confirmed the presence of an endogenous PD fraction (268.5 ± 21.98 μmol/kg weight0.75 or 0.386 of the total PD excretion). The recovery of PD in urine and milk increased linearly in response to increasing amounts of duodenally infused RNA (starting on day 21 after parturition). On average, 0.74 of infused PB from RNA was recovered in urine. Milk PD constituted a minor (<0.01) fraction of the total PD excretion and this fraction decreased as the amount of infused PB increased. Our findings indicate that lactation in goats did not affect the urinary recovery of duodenal PB but increased the endogenous contribution to urinary excretion of PD.