超声对早期糖尿病肾病的诊断价值及肾动脉血流阻力指数与血清hs-CRP、VEGF的关系分析

目的:研究彩色多普勒超声对早期糖尿病肾病的诊断价值及肾动脉血流阻力指数与血清超敏C反应蛋白(hs-CRP)、血管内皮生长因子(VEGF)的关系。方法:选取从2017年2月～2018年2月兰州大学第二医院收治的早期糖尿病肾病患者50例记为病变组,另取同期于该院进行体检的健康人员50例记为对照组。分别对两组人员进行彩色多普勒超声检查,比较肾血流参数。采用酶联免疫吸附法检测两组人员血清hs-CRP、VEGF水平,并作指标间的相关性分析。结果:病变组肾主动脉、肾锥体两侧叶间动脉、肾段动脉的收缩期峰值速度、舒张期最低速度较对照组降低,病变组肾主动脉、肾锥体两侧叶间动脉、肾段动脉的阻力指数较对照组升高(均P0.05)。病变组血清hs-CRP、VEGF水平较对照组升高(均P0.05)。经Pearson相关性分析显示:早期糖尿病肾病患者肾主动脉、肾锥体两侧叶间动脉、肾段动脉的血流阻力指数与血清hs-CRP、VEGF均呈正相关关系(均P0.05)。结论:彩色多普勒超声应用于早期糖尿病肾病的诊断价值较高,且肾动脉血流阻力指数与血清hs-CRP、VEGF密切相关,临床工作中通过联合检测血清hs-CRP、VEGF,从而有助于早期糖尿病肾病的诊断。     

IgA肾病与膜性肾病患者肠道微生物菌群结构分析

【背景】越来越多的证据表明肠道失衡与免疫介导的疾病相关,但肠道菌群和免疫介导的肾脏疾病之间的关系仍不清楚。【目的】通过Illumina高通量测序方法对IgA肾病(immunoglobulin A nephropathy, IgAN)、膜性肾病(membranous nephropathy, MN)患者和健康人群的肠道菌群进行比较。【方法】回顾性选择2020年9月–2021年12月期间,在甘肃省人民医院肾内科行肾穿刺活检并诊断为IgAN及MN患者的新鲜粪便标本,分别编号为IgAN组和MN组,收集体检中心健康人群粪便标本作为健康对照组,每组样本为10例。采用高通量测序技术对粪便样本中所有细菌的16S rRNA基因V3-V4区进行DNA测序,然后进行分类操作单元(operational taxonomic units, OTU)、物种分类、α多样性、β多样性等分析,比较3组之间的肠道菌群差异。【结果】与健康对照组相比,门水平上IgAN组的变形菌门(Proteobacteria)和放线菌门(Actinobacteria)比例明显增高,分别为18%vs. 4%和18.3%vs. 5%;属水平上I...     

肾衰宁颗粒联合甘精胰岛素对糖尿病肾病患者肾功能、血糖及氧化应激的影响

摘要 目的：探究糖尿病肾病患者采用肾衰宁颗粒联合甘精胰岛素治疗对氧化应激、血糖水平以及肾功能产生的影响。方法：将我院95例糖尿病肾病患者视为研究对象,分为对照组（47例,甘精胰岛素治疗）、观察组（48例,肾衰宁颗粒联合甘精胰岛素治疗）,对照组仅采用甘精胰岛素治疗,观察组采用肾衰宁颗粒联合甘精胰岛素治疗,对比两组临床疗效、治疗前后肌酐清除率（CCr）、肌酐（Scr）、尿素氮（BUN）、24h尿蛋白（24 hUP）、糖化血红蛋白（HbA1c）、空腹血糖（FBG）、餐后2h血糖（2 hPG）、谷胱甘肽过氧化物酶（GSH -Px）、超氧化物歧化酶（SOD）、丙二醛（MDA）水平与不良反应发生情况。结果：观察组治疗总有效率较对照组高（P＜0.05）;两组不良反应发生率对比无差异（P＞0.05）;与治疗前比较,两组治疗后CCr水平提高,24 hUP、SCr、BUN水平均降低（P＜0.05）;与对照组比较,观察组治疗后24 hUP、SCr、BUN水平更低,CCr水平更高（P＜0.05）;与治疗前比较,两组治疗后MDA水平均降低,SOD、GSH -Px水平均提高（P＜0.05）;与对照组比较,观察组治疗后MDA水平更低,SOD、GSH -Px水平更高（P＜0.05）。结论：糖尿病肾病患者采用肾衰宁颗粒联合甘精胰岛素治疗疗效明确,可减轻机体氧化应激状态,改善肾功能与血糖,且用药安全性较好。     

卡托普利联合坎地沙坦对糖尿病肾病患者的疗效及对血浆ET、D-D、Hcy、ADM、FIB水平的影响

目的:研究卡托普利联合坎地沙坦治疗糖尿病肾病患者的临床疗效及对血浆内皮素(Endothelin,ET)、D-二聚体(D-Dimer,D-D)、同型半胱氨酸(Homocysteine,Hcy)、肾上腺髓质素(Adrenal medulla,ADM)、纤维蛋白原(Fibrinogen,FIB)的影响。方法:选择2016年1月至2017年8月在我院治疗的糖尿病肾病患者72例,根据不同的治疗方法分为观察组和对照组。对照组采用卡托普利治疗,观察组在对照组的基础上联用坎地沙坦治疗,观察和比较两组患者的临床治疗效果,治疗前后ET、D-D、Hcy、ADM、FIB水平、肾功能及空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖浓度(2 hours Plas ma Glucose,2hPG)、糖化血红蛋白(Hemoglobin A1c,HbA1C)水平的变化。结果:治疗后,观察组总有效率为88.89%,明显高于对照组69.44%(P0.05);观察组血浆ET、D-D、Hcy、ADM、FIB、FPG、2hPG、HbA1C水平、24 h尿总蛋白及尿白蛋白排泄率均显著低于对照组(P0.05)。结论:卡托普利联合坎地沙坦治疗糖尿病肾病患者的临床疗效明显优于单用卡托普利治疗,可助于降糖、降压并有效保护患者肾脏功能。     

Co-inheritance of specific genotypes of HSPG and ApoE gene increases risk of type 2 diabetic nephropathy

The objective of this paper is to investigate co-inheritance of specific HSPG and ApoE genotypes in the development of Chinese type 2 diabetic nephropathy. PCR-RFLP was used to detect HSPG and ApoE genotypes in 385 Chinese subjects including 298 patients with type 2 diabetes mellitus (T2DM) and 87 non-diabetic controls (Non-DM). The T2DM group was subdivided into patients with (TDN; n = 218) and without diabetic nephropathy (Non-DN; n = 80). The latter group was further subdivided into groups of patients with microalbuminuria nephropathy (DN-1; n = 129) and severe diabetic nephropathy (DN-2; n = 89). We then compared the relative frequencies of various HSPG and ApoE genotypes and alleles among the groups, searching for predictive trends. The T allele of the HSPG gene occurred more frequently in the DN-2 group than in the Non-DN or DN-1 or groups, their (Fisher's exact p was 1.05 × 10^–3 and 6.58 × 10^–6; odds ratios were 2.09 (95% CI 1.32–3.30) and 2.48 (95% CI 1.64–3.74), respectively. The E2 allele of the ApoE gene occurred more frequently in the T2DM than in the Non-DM group, the Fisher's exact p was 0.0087; odds ratio was 3.45 (95% CI 1.30–9.81). Genotype analysis showed that the TT or TG of HSPG gene were paired with the E2/2 or E2/3 of ApoE gene significantly more frequently in the TDN group than in the Non-DN group, with an odds ratio of 3.03 (95% CI 1.03–8.90). There was no significant differences in other combinations of genotypes in HSPG and ApoE genes between TDN and Non-DN group. These results suggest that the HSPG T allele is a risk factor for the development of severe diabetic nephropathy in type 2 diabetic patients, and that the ApoE E2 allele is a risk factor for the occurrence of type 2 diabetes mellitus in Chinese general population. In addition, we find that co-inheritance of T/E2 confers a higher risk of type 2 diabetes mellitus progression to diabetic nephropathy in Chinese.     

中西医结合治疗膜性肾病的疗效及机制研究

摘要 目的：探究中西医结合对膜性肾病的治疗效果,并就其机制进行研究。方法：选择2015年12月至2019年12月于我院接受治疗的98例肾病综合征患者,按照随机数字表法将其均分为研究组与对照组（每组各49例）,对照组接受常规西医治疗,研究组在对照组基础上加用中医疗法,对比两组治疗有效率,分别检测并对比治疗前后两组免疫球蛋白A（immunoglobulin A,IgA）、免疫球蛋白G（immunoglobulin G,IgG）、免疫球蛋白M（immunoglobulin M,IgM）、蛋白排泄率（urinary albumin excretion rates,UAER）、血浆白蛋白（albumin,Alb）、尿素氮（blood urea nitrogen,BUN）、血肌酐（serum creatinine,Scr）等指标,并就治疗安全性进行对比。结果：（1）研究组治疗有效率显著高于对照组（95.92 % vs. 81.63 %,P<0.05）;（2）治疗前两组IgA、IgG、IgM水平对比无统计学意义（P>0.05）,干预后研究组上述指标均优于对照组（P<0.05）;（3）治疗前两组UAER、Alb、BUN及Scr水平对比无统计学意义（P>0.05）,治疗后研究组上述指标均优于对照组（P<0.05）;（4）研究组治疗中不良反应发生率低于对照组（P<0.05）。结论：中西医结合疗法对膜性肾病具有较好的治疗效果,能够显著改善患者免疫功能及肝肾功能,同时还能够降低治疗中不良反应发生率。     

氯沙坦钾治疗特发性膜性肾病对血清抗PLA2R抗体的影响

目的:探讨氯沙坦钾治疗特发性膜性肾病对血清抗磷脂酶A2受体(Phospho lipase A2 receptor,PLA2R)抗体的影响。方法:2014年8月到2018年8月选择在西安交通大学医学院附属汉中3201医院(本院)肾内科诊治的特发性膜性肾病患者78例,根据随机数字表法分为两组,各39例,对照组给予常规腹膜透析治疗,观察组在对照组治疗的基础上给予氯沙坦钾治疗,两组都治疗观察3个月,记录血清抗PLA2R抗体表达变化。结果:观察组治疗的总有效率为100.0%,显著高于对照组的87.2%(P0.05)。两组治疗后的血尿素氮(Blood urea nitrogen, BUN)、肌酐(Creatine, CREA)、尿酸(Uric acid, UA)值都低于治疗前,且观察组也显著低于对照组(P0.05)。两组治疗后的血清超氧化物歧化酶(Superoxide Dismutase, SOD)、谷胱甘肽过氧化酶(Glutathione Peroxidase, GSH-Px)值都高于治疗前,丙二醛(Malonic dialodehyde, MDA)值低于治疗前,且观察组变化更加显著(P0.05)。两组治疗后的血清抗PLA2R抗体表达水平显著低于治疗前(P0.05),观察组也显著低于对照组(P0.05)。结论:氯沙坦钾治疗特发性膜性肾病能抑制血清抗PLA2R抗体表达,调节氧化应激功能,从而促进肾功能的改善,提高患者的治疗效果。     

糖尿病肾病患者血清亲环素水平及其临床意义

目的:探讨糖尿病肾病(DN)患者血清亲环素A(Cy PA)水平及其临床意义。方法:将我院2014年10月-2015年10月收治的86例2型糖尿病肾病(T2DN)患者依据24 h尿白蛋白排泄率(UAER)水平分为3组,即糖尿病无肾病组(SDM组) 30例、早期糖尿病肾病组(EDN组)28例、糖尿病肾病组(CDN组)28例。另选取同期本院健康体检者26例为对照组(NC组)。比较4组的血清Cy PA水平、收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)、血肌酐(Cr)、尿素氮(BUN)水平。以EDN组为实验组,在常规控制血压、血糖、血脂等基础上,给予小剂量雷公藤多甙片治疗4周,分析Cy PA水平与24 h UAER的相关性。结果:SDM组、EDN组、CDN组的HbAlc水平显著高于CN组(P0.05)。EDN组、CDN组的24 h UAER水平显著高于SDM组和CN组(P0.05),CDN组的24 h UAER水平显著高于EDN组(P0.05),而EDN组和CN组的24 h UAER水平比较差异无统计学意义(P0.05)。SDM组、EDN组、CDN组、CN组血清Cy PA水平依次升高,两两比较差异均有统计学意义(P0.05)。糖尿病肾病患者血清Cy PA水平与24 h UAER呈正相关(r=0.697,P0.05)。结论:血清Cy PA水平在一定程度上能反映糖尿病肾病患者的肾损伤严重程度。     

Evidence of O-linked N-acetylglucosamine in diabetic nephropathy

AimsThere is increasing evidence that O-linked N-acetylglucosamine (O-GlcNAc) plays an important role in cell signaling pathways. It has also been reported that increases in O-GlcNAc contribute to the development of diabetes and diabetic complications; however, little is known about O-GlcNAc levels in diabetic nephropathy (DNP). Therefore the goal of this study was to determine whether O-GlcNAc could be detected in human kidney biopsy specimens, and if so to examine whether O-GlcNAc levels were increased in the kidneys of patients with DNP compared to the non-diabetic individuals.Main methodsKidney biopsy specimens were obtained from type-2 diabetic patients (n = 6) and patients diagnosed with thin basement membrane nephropathy (n = 7) were used as non-diabetic controls. O-GlcNAc levels were assessed by immunohistochemistry using the anti-O-GlcNAc antibody CTD110.6.Key findingsWe show that O-GlcNAc modification of proteins can be detected in the human kidney biopsy specimens. Furthermore, in diabetic patients, we found significantly increased numbers of O-GlcNAc positive cells in the glomeruli and significantly elevated staining in the tubuli (both in the nucleus and in the cytosol). In addition we also observed an intense, granular O-GlcNAc staining specifically in diabetic tubuli.SignificanceIn light of the increase in O-GlcNAc staining in the diabetic patients, we propose that increased O-GlcNAc levels might contribute to the development of diabetic nephropathy.     

泼尼松联合来氟米特治疗IgA肾病的临床疗效及对患者血清VEGF及MMP-9水平的影响

目的:探讨泼尼松联合来氟米特治疗Ig A肾病的临床疗效及对患者血清内皮生长因子(vascula endothelial growth factor,VEGF)及基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)水平的影响。方法:选择我院肾病内科收治的Ig A肾病患者60例,随机分为对照组与观察组,每组各30例。对照组患者给予尼泼松治疗,观察组在对照组基础上给予来氟米特治疗。比较两组患者治疗后的临床疗效及不良反应发生情况;分别于治疗前后检测和比较两组患者的肾功能、血清VEGF及MMP-9水平。结果:治疗后,对照组患者临床总有效率为73.33%,总不良反应率为10.00%;观察组患者临床总有效率为86.67%,明显高于对照组,而总不良反应率为3.33%,显著低于对照组(P0.05)。治疗后,两组患者血清血尿氮(blood urine nitrogen,BUN)、血肌酐(creatinine,Cr)、VEGF及MMP-9水平均明显低于本组治疗前,肾小球滤过率(glomerular filtration rate,GFR)水平明显高于本组治疗前;且观察组患者治疗后血清BUN、Cr、VEGF及MMP-9水平明显低于对照组,GFR水平明显高于对照组(P0.05)。结论:泼尼松联合来氟米特治疗Ig A肾病的临床疗效明显优于单用泼尼松治疗,可更显著改善患者肾脏功能,可能与其降低患者血清VEGF及MMP-9水平有关。     

Association between testosterone, estradiol and sex hormone binding globulin levels in men with type 1 diabetes with nephropathy

Male sex is a risk factor for development and progression of diabetic nephropathy; however, the relationship between sex hormone levels and diabetic nephropathy in type 1 diabetic men is unknown. This was a prospective follow-up study as part of the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study; 297 patients were followed for 5.9 ± 1.5 years. Serum total testosterone (Tt) and estradiol (Te), calculated free testosterone (cFt) and estradiol (cFe) and sex hormone binding globulin were measured at baseline and correlated with urinary albumin excretion rate, estimated glomerular filtration rate and markers of metabolic syndrome. Diabetes without renal disease was associated with decreased Tt (p < 0.001), Te (p < 0.001) and cFt (p = 0.001) levels compared with healthy non-diabetic men. With progression of renal disease from micro- to macroalbuminuria, this decrease in serum Tt was even more pronounced. Cox regression showed that cFt and cFe were independent predictors of the progression from macroalbuminuria to end-stage renal disease. Our study shows that men with type 1 diabetes exhibit dysregulated sex hormone levels, which is most pronounced in men with progressive renal disease, suggesting that sex hormones may play a role in the pathogenesis of diabetic nephropathy associated with type 1 diabetes.     

糖尿病肾病患者血浆基质金属蛋白酶-2和同型半胱氨酸水平及其临床意义

目的:探讨糖尿病肾病患者血浆基质金属蛋白酶-2和同型半胱氨酸水平及其临床意义。方法:选取糖尿病患者71例,其中并发糖尿病肾病组(n=35)和未并发肾病组(n=36),同时选取健康人群40例为对照组。检测患者MMP-2、Hcy、MAU及Scr水平。结果:糖尿病肾病组、糖尿病无肾病组血浆MMP-2、Hcy及MAU水平均显著高于健康对照组(P0.01);与糖尿病无肾病组比较,糖尿病肾病组患者MMP-2、Hcy及MAU水平较高(P0.05);糖尿病肾病组患者的血浆SCr水平明显高于其他两组(P0.05)。糖尿病肾病患者血浆MMP-2与MAU呈显著正相关(r=0.522,P0.05),与Hcy呈显著负相关(r=-0.007,P0.05),与Scr不相关(P0.05);Hcy与MAU(r=0.012,P0.05)、Scr均(r=0.031,P0.05)呈正相关。结论:糖尿病肾病患者MMP-2水平降低,Hcy水平升高,有望作为糖尿病肾病患者的诊断和预后预测参考指标。     

Small ubiquitin-like modifier 4 M55V polymorphism is not associated with diabetic nephropathy in Iranian type 2 diabetes patients

INTRODUCTION:

We studied the impact of small ubiquitin-like modifier 4 (SUMO4) M55V polymorphism on susceptibility to diabetic nephropathy in Iranian type 2 diabetes patients.

MATERIALS AND METHODS:

The patient group consisted of 50 Iranian type 2 diabetes patients with nephropathy, and the control group consisted of 50 Iranian type 2 diabetes patients without nephropathy. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism method for the M55V.

RESULTS:

The frequency of SUMO4 AA, AG, and GG genotypes were 23%, 18%, and 9% in the patient group and 10%, 22%, and 18% in the control group. There was no significant difference in frequency of SUMO4 genotypes in patients compared to controls.

CONCLUSION:

These findings indicate that SUMO4 M55V polymorphism is not associated with diabetic nephropathy in Iranian type 2 diabetes patients.     

Satureja khozestanica essential oil ameliorates progression of diabetic nephropathy in uninephrectomized diabetic rats

Diabetic nephropathy is the common cause of leading to end stage of renal disease (ESRD). Satureja khozestanica essential oil (SKEO) was used as an antioxidant and antidiabetic for the inhibition of diabetic nephropathy. Forty male rats were uninephrectomized and divided in four groups randomly; group one as control, group two diabetic untreatment, groups three and four treatment with SKEO by 250 or 500 ppm in drinking water, respectively. Diabetes was induced in the second, third and fourth groups by alloxan injection subcutaneously. After eight weeks treatment, serum malondialdehyde, serum creatinine and serum urea were measured. The kidney paraffin sections were stained by periodic acid Schiff method. Glomerular volume and glomerular number were estimated by stereological rules. Glomerular sclerosis was studied semi-quantitatively. The means were compared by SPSS 13 software and Mann-Whitney test at p < 0.05. Satureja khozestanica essential oil (250 or 500 ppm) significantly inhibited the progression of glomerular hypertrophy, glomerular number loss, glomerulosclerosis, lipid peroxidation, serum urea and creatinine compared with the diabetic untreated group. The level of glomerular number, serum malondialdehyde, serum creatinine and urea in the treated groups was significantly maintained at the same level as that of the control group. In conclusion, satureja essential oil significantly can ameliorate glomerular hypertrophy, loss of glomerular number, glomerulosclerosis and attenuated serum urea and serum creatinine in diabetic rats.     

卡托普利与坎地沙坦对老年糖尿病肾病患者肾功能的影响

目的:研究卡托普利联合坎地沙坦对糖尿病肾病患者肾功能的影响及临床疗效。方法:选择2014年5月-2015年5月我院收治的糖尿病肾病患者90例,根据治疗方法不同分为观察组和对照组。对照组给予卡托普利治疗,观察组在对照组基础上加用坎地沙坦治疗。观察并比较两组患者的临床疗效以及治疗前后空腹血糖、血尿素氮、血肌酐、24 h尿蛋白等水平的变化情况。结果:观察组的治疗总有效率为93.3%,对照组的治疗总有效率为84.4%;观察组患者的临床疗效显著高于对照组,但差异并不具有统计学意义(P0.05)。与治疗前比较,两组患者治疗后的空腹血糖、血尿素氮、血肌酐及24 h尿蛋白水平均显著降低,差异具有统计学意义(P0.05);治疗后,观察组患者的空腹血糖、血尿素氮、血肌酐和24 h尿蛋白值均显著均明显低于对照组,差异均具有统计学意义(P0.05)。结论:卡托普利联合坎地沙坦治疗糖尿病肾病较单独采用卡托普利治疗能够更加有效的改善患者的临床症状,保护患者的肾功能,具有较好的临床疗效。     

Gene polymorphisms in patients with type 2 diabetes and diabetic nephropathy

A considerable variability in the incidence and prevalence of diabetic nephropathy (DN) coheres with an important contribution of multigenetic predisposition in the development of DN. Some genes, which probably participate in the pathogenesis of diabetic nephropathy, also play a role in the regulation of blood pressure, familial hyperlipidemia, familial hypertension and other diseases of the cardiovascular system. We have examined the association of diabetic nephropathy, nephropathy of non-diabetic origin, hypertension and of type 2 diabetes itself with several genetic polymorphisms (the insertion/deletion polymorphism in the gene for angiotensin-converting enzyme, the G/T polymorphism in the glucose transporter 1 gene, the G/T (894) polymorphism and the T/C (−786) polymorphism in the eNOS gene in three groups of patients with diabetes mellitus: 1) patients without diabetic nephropathy (DM); 2) patients with DN; 3) patients with nephropathy of non-diabetic origin (NDRD). Angiotensin-converting enzyme is an important factor in a development of arterial hypertension, but in our groups of Central European diabetic patients the I/D polymorphism was not associated with diabetic nephropathy. Furthermore, we have confirmed that the T/C (T786C) polymorphism in the eNOS gene is associated with metabolic syndrome including type 2 diabetes.     

血清微小RNA-21水平与糖尿病肾病患者氧化应激的相关性研究

目的:探讨血清微小RNA-21(mi R-21)水平与糖尿病肾病(DN)患者氧化应激的相关性。方法:选择2015年1月到2017年5月我院就诊的169例DN患者作为研究对象,其中DN分期早期组95例,中晚期组74例。另选同期在我院接受健康体检者90例作为对照组,对比各组血清mi R-21水平和氧化应激指标,分析患者血清mi R-21水平与氧化应激指标的相关性。结果:各组血清mi R-21水平相比差异有统计学意义(P0.05),中晚期DN组及早期DN组血清mi R-21水平均明显低于对照组,且中晚期DN组又明显低于早期DN组,差异均有统计学意义(P0.05)。各组氧化应激指标相比差异有统计学意义(P0.05),中晚期DN组及早期DN组丙二醛(MDA)、超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPP)及NADPH氧化酶4(NOX4)均明显高于对照组,且中晚期DN组又明显高于早期DN组;而血红素氧合酶1(HO-1)明显低于对照组,且中晚期DN组又明显低于早期DN组,差异均有统计学意义(P0.05)。依据Spearman法分析相关性发现,血清miR-21水平与MDA、SOD、AOPP及NOX4均呈负相关(P0.05),与HO-1呈正相关(P0.05)。结论:血清mi R-21水平与DN患者氧化应激指标均具有明显的相关性,临床上可尝试将miR-21纳入到DN患者病情监测的指标体系中,从而有助于疾病的诊治及患者的预后。     

Schisandrin B alleviates diabetic nephropathy through suppressing excessive inflammation and oxidative stress

Diabetic nephropathy (DN) is a progressive kidney disease due to glomerular capillary damage in diabetic patients, with inflammation and oxidative stress implicated as crucial pathogenic factors. There is an urgent need to develop effective therapeutic drug. Natural medicines are rich resources for active lead compounds. They would provide new opportunities for the treatment of DN. The present study was designed to investigate the protective effects of Schisandrin B (SchB) on DN and to delineate the underlying mechanism. Oral administration of SchB in the diabetic mouse model significantly alleviated hyperglycemia-induced renal injury, which was accompanied by maintenance of urine creatinine and albumin levels at similar to those of control non-diabetic mice. Histological examination of renal tissue indicated that both development of fibrosis and renal cell apoptosis were dramatically inhibited by SchB. The protective effect of SchB on DN associated with suppression of inflammatory response and oxidative stress. These results strongly suggested that SchB could be a potential therapeutic agent for treatment of DN. Moreover, our findings provided a fuller understanding of the regulatory role of NF-κB and Nrf2 in DN, indicating that they could be important therapeutic targets.     

胰岛素联合百令胶囊治疗早期糖尿病肾病患者的临床疗效

目的:观察胰岛素联合百令胶囊治疗早期糖尿病肾病患者的临床疗效,并探讨其可能机制。方法:收集在我院就诊或住院治疗的62例糖尿名肾病患者,随机分为实验组和对照组,每组31例。对照组患者给予诺和灵30R胰岛素,实验组患者在对照组基础上给予百令胶囊治疗。治疗后,对患者的血肌酐、尿蛋白、CD68以及临床疗效进行检测并比较。结果:与治疗前相比,两组患者治疗后的血肌酐、尿蛋白、CD68均下降(P0.05);与对照组相比,实验组患者的血肌酐、尿蛋白、CD68水平较低(P0.05),临床治疗有效率较高(P0.05)。结论:胰岛素联合百令胶囊能够有效提高早期糖尿病肾病患者的临床疗效,可能与其降低血清CD68水平,减轻炎症反应有关。     

BsmI polymorphisms in vitamin D receptor gene are associated with diabetic nephropathy in type 2 diabetes in the Han Chinese population

We investigated the relationship between BsmI/ApaI polymorphisms in vitamin D receptor gene and diabetic nephropathy in a Han Chinese population. PCR-restriction fragment length polymorphism was used to test the genotype and allele frequency of BsmI and ApaI polymorphisms in 304 patients with type 2 diabetes mellitus (DM group) and 100 control individuals (ND group). The DM group was further divided into DN0 (no diabetic nephropathy), DN1 (diabetes with small amount of albuminuria), DN2 (diabetes with large amount of albuminuria), L/NDN (late-onset DN after 5 years/no DN over the whole follow-up period of 5 years) and EDN (early-onset diabetic nephropathy occurring within first year) subgroup. We found that (1) genotype and allele frequency of BsmI polymorphism had significant difference between DM and ND group; BB+Bb genotype and B allele frequency were significantly higher in DN2 group than in ND and DN0 group; the ApaI polymorphism and allele frequency did not show any difference between DM and ND group; (2) BsmI BB+Bb genotype and B allele frequency were significantly higher in EDN group than in L/NDN group; (3) among patients with nephropathy, albumin excretion rate (AER) in 24-hour urine was significantly higher in those with BB+Bb phenotype than in those with bb phenotype (P<0.01), (4) unconditional logistic regression analysis showed that BsmI BB+Bb genotype was not only correlated with type 2 diabetic nephropathy, but also correlated with early-onset type 2 diabetic nephropathy. We conclude that the allele B (BB or Bb genotype) in vitamin D receptor gene is correlated with large amount albuminuria in the Han Chinese population with type 2 diabetes, and is probably a risk factor for early-onset diabetic nephropathy.