Correlation between visceral adipose index and glomerular filtration rate in patients with type 2 diabetes mellitus / 中国基层医药

Objectives:To investigate the relationship between visceral adipose index and glomerular filtration rate in patients with type 2 diabetes mellitus.Methods:A total of 1 036 patients with type 2 diabetes mellitus who received treatment in The Second Affiliated Hospital of Xi'an Jiaotong University from May 2017 to May 2018 were included in this study. The visceral adipose index was detected using a bioresistance assay. These patients were divided into four groups using the quartile method: Visceral adipose index < 8.10 (q1 group, n = 246), 9.60 > visceral adipose index ≥ 8.10 (q2 group, n = 64), 11.10 > visceral adipose index ≥ 9.60 (q3 group, n = 423), visceral adipose index ≥ 11.10 (q4 group, n = 233). One-way analysis of variance was performed to compare the differences among groups. Partial correlation and multiple regression were used to analyze the correlation between body mass index, waist circumference, waist-to-height ratio, waist-to-hip ratio, body fat content, visceral adipose index, and urinary microalbumin and glomerular filtration rate. Results:With the increase in the visceral adipose index, the glomerular filtration rate gradually decreased. The glomerular filtration rate in the q1, q2, q3, q4 groups was (112.19 ± 31.74) mL·min -1·1.73 m -2, (106.14 ± 28.26) mL·min -1·1.73 m -2, (104.73 ± 23.63) mL·min -1·1.73 m -2, (103.40 ± 27.51) mL·min -1·1.73 m -2, respectively. In the female group, with the increase in visceral adipose index, the glomerular filtration rate decreased gradually. After controlling for age, sex, diabetes, and hypertension, the visceral adipose index was significantly correlated with the glomerular filtration rate ( r = -0.10, P < 0.001). Multiple regression analysis showed that visceral adipose index and waist-to-height ratio were closely related to glomerular filtration rate ( F = 6.00, P < 0.001). Conclusion:With the increase of visceral adipose index, body mass index, waist circumference, waist-to-height ratio, waist-to-hip ratio, body fat content, and urinary microalbumin increased gradually. When the visceral adipose index is greater than 9.60, the glomerular filtration rate is significantly decreased. Therefore, it is suggested to adopt various methods to evaluate obesity in clinical work, and visceral fat index should be paid more attention, especially when the visceral fat index is greater than 9.60.

Diagnostic value of combined detection of urine and plasma kidney injury markers in children with Henoch-Sch?nlein purpura nephritis / 中华检验医学杂志

Objective:To investigate the clinical significance and the diagnostic value of detecting kidney injury biomarkers in urine and serum of children with Henoch-Sch?nlein purpura nephritis (HSPN).Methods:A total of 216 children with untreated HSPN, who were admitted in Beijing Children′s Hospital of Capital Medical University from January 2018 to December 2019, were recruited in this retrospective study. Two hundred and sixteen healthy children were selected as the healthy control group. We determined the levels of six biomarkers of kidney injury, including transferrin (TRF), immunoglobulin (IgG), microalbumin (mAlb), alpha-1 microglobulin (α1-MG), N-acetyl-β-D-glucosaminidase (NAG) in urine and cystatin C (CysC) in serum. The data from the two groups were analyzed, the diagnostic value of each biomarker was evaluated and a logistic regression model for the diagnosis of HSPN was established. In addition, 60 children with HSPN, who were admitted to our hospital from November 2021 to February 2022 and 60 healthy children, who underwent healthy check up in the same period were included to validate the diagnostic performance of the established logistic model. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of each biomarker.Results:The urine levels of TRF, IgG, mAlb, α1-MG and NAG and the serum level of CysC were significantly higher in the HSPN group than those in healthy control group (all P<0.05). The area under the ROC curve (AUC) of TRF, IgG, mAlb, α1-MG, NAG and the serum levels of CysC was 0.749, 0.719, 0.810, 0.648, 0.828 and 0.790 (all P<0.05). Logistics regression analysis showed that IgG, mAlb and TRF were the three diagnostic determinants of HSPN ( OR=1.083, 1.105, 1.704,all P<0.001), and the AUC was 0.916 of the established logistic model based on these three biomarkers. The sensitivity was 87.4% and the specificity reached 96.2%. The logistic model was validated by independent cohorts, and the AUC was 0.973, the sensitivity was 95.0% and the specificity was 98.3%. Conclusions:The levels of urine TRF, IgG, mAlb, α1-MG, NAG and serum CysC were higher in children with HSPN. The established logistic regression model based on three biomarkers including IgG, mAlb and TRF in this study has satisfactory clinical value in diagnosing HSPN in children.

Correlation between markers of early renal injury in urine and serum homocysteine elevation / 中华健康管理学杂志

Objective:To investigate the correlation between early renal impairment markers in urine and elevated serum homocysteine.Methods:Clinical data of serum homocysteine (Hcy) and early renal injury markers in urine of the health examination population from the Physical Examination Center of Peking University Third Hospital from January 2019 to May 2020 were retrospectively analyzed (1133 cases). The previous medical history, age, sex, blood pressure, body mass index (BMI) of the subjects were collected. Early urine kidney injury markers, including urine microalbumin (U-mALB), urinary N-acetyl-β-D-glucosaminidase (NAG), urinary albumin to creatinine ratio (UACR), and serum renal function, liver function, blood lipid, myocardial enzyme and glycosylated hemoglobin (HbA 1C), etc. were also collected. Those with incomplete previous history, general information, biochemical indexes and decreased estimated glomerular filtration rate (eGFR) were excluded, and 969 cases were included. The included subjects were divided into the normal group (?15 μmol/L) and the elevated group (≥15 μmol/L) according to Hcy levels, the indexes with significant difference between the two groups were included as independent variables, and the multivariate logistic regression was used to explore the influence factors of Hcy elevation. Results:The male ratio, the incidence of increased U-mALB, NAG and UACR were significantly higher in the elevated group than those in the normal Hcy group (93.4% vs 50.6%, 16.4% vs 8.0%, 23.0% vs 14.0%, 13.9% vs 7.9%) (all P<0.05). Systolic blood pressure, diastolic blood pressure, serum uric acid, calcium, alanine aminotransferase (ALT) and lactate dehydrogenase in the elevated group were higher than those in the normal group [(127.5±15.4) vs (121.9±16.2) mmHg (1 mmHg=0.133 kPa), (78.6±9.3) vs (76.0±11.0) mmHg, (385.9±86.0) vs (335.7±88.2) μmol/L, (2.392±0.086) vs (2.366±0.092) mmol/L, (27.8±21.0) vs (23.8±20.2) U/L, (198.3±28.4) vs (192.2±31.2) U/L] (all P<0.05), while high density lipoprotein cholesterol (HDL-C), serum phosphorus were lower than those in the normal group [(1.21±0.25) vs (1.31±0.30) mmol/L, (1.107±0.154) vs (1.158±0.159) mmol/L] (all P<0.05). The increased systolic blood pressure, male, uric acid, U-mALB, NAG were independent correlative factors of Hcy elevation. Conclusion:The increase of Hcy is independently correlated with urine U-mALB and NAG, which suggests that the level of Hcy should be detected as soon as possible in patients with elevated early renal injury markers.

Multi-targeted therapeutic effects of Huangkui Capsules on insulin resistance and urine microalbumin in early diabetic kidney disease patients / 中国中药杂志

To observe the multi-targeted therapeutic effects of Huangkui Capsules(HKC)on insulin resistance(IR)and urine microalbumin in the early diabetic kidney disease(DKD)patients. The case data from the 83 DKD patients at G2 and A2 stage were collected respectively and analyzed retrospectively. According to the different treatment,all patients were divided into the control(A)group(40 cases)and the treated(B)group(43 cases). Among them,the A group patients were received "routine basic treatment";the B group patients were received "routine basic treatment+HKC". For the 2 group patients,firstly,the baseline parameters before receiving the treatment were compared respectively,and then,the changes of the total scores of traditional Chinese medicine(TCM) syndromes and the indicators of IR,urine protein,renal function,blood lipids and safety after receiving the treatment for 8 weeks were compared,respectively. Furthermore,for the all patients,the correlation analysis between IR and urine protein or IR and the total scores of TCM syndromes was carried out,respectively. The results showed that,for the B group patients received "routine basic treatment",their total scores of TCM syndromes,urine protein indicators including urine microalbumin(micro-UAlb) and urine microalbumin/urinary creatinine(UACR),IR indicators including fasting serum insulin(FIN)and homeostasis model assessment of insulin resistance(HOMA-IR)were significantly improved,respectively. For the all DKD patients,before and after the treatment,the main IR indicators(FIN and HOMA-IR)were positively correlated with urine protein indicators(micro-UAlb and UACR). The main IR indicators(FIN and HOMA-IR) were also positively correlated with the total scores of TCM syndromes. In addition,2 treatments had no significant effects on renal function,blood lipids and safety indicators in the all DKD patients. Overall, "routine basic treatment+HKC" can ameliorate IR and reduce urine microalbumin in the early DKD patients. Its therapeutic targets may be not only proteinuria,but also IR,which is the upstream risk factor of proteinuria.

The application value of Multi-Latex polygranular technique joint detection of urinary microproteins in noninvasive diagnosis after renal transplantation / 器官移植

Objective To investigate the application value of Multi-Latex polygranular technique joint detection of kidney injury-related urinary microproteins in noninvasive diagnosis after renal transplantation. Methods Clinical data of 72 recipients undergoing renal transplantation were retrospectively analyzed. According to the level of serum creatinine (Scr), the recipients were divided into normal renal function group (group A, n=14), mild kidney injury (group B, n=37), and severe kidney injury group (group C, n=21). 20 healthy volunteers were selected as the healthy control group (HC group). The contents of urinary retinol binding protein (RBP), microalbumin (mAlb), IgG, transferrin (TRF), α1-microglobulin (MG), and β2-MG of subjects in each group were detected using the Multi-Latex polygranular technique. The correlation between urinary microproteins and Scr, blood urea nitrogen (BUN) was analyzed. The differences of urinary microproteins in each group were compared. And the diagnostic value of single and joint detection of urinary microproteins was evaluated. Results Six kinds of urinary microproteins in HC group and group A were significantly lower than those in group B and group C, and six kinds of urinary microproteins in group B were significantly lower than those in group C (all P < 0.01). Six kinds of urinary microproteins in renal transplant recipients were positively correlated with BUN. RBP, mAlb, α1-MG, and β2-MG were positively correlated with Scr. The correlations were statistically significant (P < 0.001-0.05). The diagnostic value of joint detection of urinary microproteins is better than the detection of single index, among which TRF+mAlb+RBP+α1-MG quadruple detection had the highest diagnostic value. Conclusions Six kinds of urinary microproteins can be used as specific indicators to reflect graft renal function. The polygranular technique can simultaneously detect its contents and achieve noninvasive diagnosis. The diagnosis based on TRF+mAlb+RBP+α1-MG quadruple detection is expected to further improve the noninvasive diagnosis system after renal transplantation.

Relationship between urinary microalbumin creatinine ratio and diabetic retinopathy in type 2 diabetic patients in Hefei area / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the correlation between urinary microalbumin creatinine ratio and diabetic retinopathy(DR)in type 2 diabetic patients in Hefei area. <p>METHODS: A retrospective case analysis. 281 patients with type 2 diabetes mellitus(T2DM)hospitalized in Hefei Second People's Hospital from November 2018 to September 2019 were conducted in this study. According to the digital fundus photography, the patients were divided into diabetic retinopathy group(DR group)and non-diabetic retinopathy group(NDR group). The patients' gender, age, course of diabetes, history of hypertension, body mass index(BMI), blood urea nitrogen(BNU), urinary microalbumin creatinine ratio(UACR),fasting blood glucose, HbA1c, total bilirubin(TB), total cholesterol(TC), triglyceride(TG)were collected and risk factors of DR were analyzed.<p>RESULTS: A total of 281 cases, 169(60.1%)were in the NDR group and 112(39.9%)in the DR group. Logistic regression analysis and ROC curve analysis showed that the risk factors related to DR were UACR(β=0.036,<i> OR</i>=1.037, 95% <i>CI</i>:<i> </i>1.019-1.056, <i>P</i><0.001), the best critical value was 10.15mg/g·Cr(AUC=0.717, <i>P</i><0.001); the course of diabetes(β=0.061, <i>OR</i>=1.063, 95% <i>CI</i>: 1.008-1.120, <i>P</i>=0.023), the best critical value was 10.5a(AUC=0.666, <i>P</i><0.001).<p>CONCLUSION: UACR and the course of diabetes are independent risk factors for DR in some of the patients with type 2 diabetes in Hefei.

Can urine albumin/creatinine ratio replace 24 hours urinary albumin? / 中华内科杂志

Objective To analyze the correlation between urinary albumin/creatinine ratio (ACR) and 24-hour urinary microalbumin (UMA) and evaluate the predictive value of ARC for early diabetic nephropathy.Methods A total of 368 patients with type 2 diabetes mellitus were retrospectively collected.Early diabetic nephropathy was defined as 24h UMA 30～＜300 mg/24h.The correlation between ACR and 24hUMA,and the area under the receiver operating characteristic (ROC) curve of ACR in diagnosis of early diabetic nephropathy were calculated.Gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol were used as adjusting variables to establish univariate and multivariate logistic models of ACR for early diabetic nephropathy,respectively.A regression model was used to evaluate the diagnostic value of ACR for early diabetic nephropathy.Results The correlation between ACR and 24h UMA was 0.658.The area under ROC curve of ACR for early diabetic nephropathy was 0.907 before and 0.933 after adjustments of gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol,respectively.The OR value of ACR of diabetic nephropathy was 2.016 before and 2.762 after same adjustments.The calibration of Hosmer-Lemeshow chi-square test evaluation model was 19.362 before (P=0.13) and 14.928 after adjustments (P=0.061).Conclusion ACR is a better predictor for early diabetic nephropathy although its value is influenced by gender,age,course of disease,blood sugar,lipid,and blood pressure.

Diagnostic value of serum amyloid A and retinol binding protein in patients with early type 2 diabetic kidney disease / 中国综合临床

Objective To investigate the value of serum amyloid A (SAA) and retinol binding protein (RBP) in diagnosis of early type 2 diabetic kidney disease (DKD).Methods A total of 182 type 2 diabetic patients hospitalized in department of Endocrinology and Nephrology of Lianyungang Second People's Hospital from January to December 2017 were randomly collected as subjects.According to urinary albumincreatinine ratio (UACR),all subjects were divided into three groups of normal albuminuria group (NA,60 cases),microalbuminuria group (MA,63 cases) and clinical proteinuria (CP,59 cases).In the same period,60 healthy persons were selected as normal control (NC).The levels of serum SAA and RBP were detected by automatic biochemical analyzer.Receiver operating curve (ROC) was used to analysis the diagnostic efficiency of DKD and the risk factors of DKD were further estimated.Results The levels of SAA were (6.88±2.82) and (37.21±20.58) mg/L in control group and case group.And levels of serum SAA in the NA group,MA group and CP group were (16.33±5.98),(40.97± 15.62),(54.43±22.91) mg/L respectively.The levels of RBP were (37.56± 10.51) and (69.26±21.23) mg/L in control group and case group.And levels of RBP in the NA group,MA group and CP group were (52.66 ± 14.31),(69.66 ± ± 15.52),(85.70± 19.51) mg/L respectively.The concentrations of serum SAA and RBP in type 2 diabetic patients were significantly higher than those normal controls (t =10.36,P＜0.05;t =11.11,P＜0.05) and increased with DKD progression (F =83.6,P＜ 0.05;F =59.2,P＜ 0.05).Diagnostic sensitivity of serumSAA,RBP in DKD was 81.8％ and 84.1％ respectively.Diagnostic sensitivity of combined detection was 90.9％.Regression analysis showed that SAA,RBP and UACR were independent risk factors for DKD (OR (95％ CI) =1.391 (1.068-1.812),1.212 (1.085-1.353),1.148 (1.038-1.270);all P ＜0.05).Conclusion Both of serum SAA and RBP were significantly elevated in diabetic patients with renal injury so that they had great value in early diagnosis of DKD.

Assessment of Potential Renal Dysfunction in Patients with Congenital Heart Disease after Biventricular Repair

BACKGROUND AND OBJECTIVES: There are few reports on renal dysfunction in the remote period after biventricular repair, and biomarkers for early detection of renal dysfunction are not well understood. We examined whether early fluctuation of biomarkers of renal function occurs in the remote period after biventricular repair in patients with congenital heart disease (CHD). METHODS: Fourteen patients with CHD after biventricular repair were included. The examination values obtained by cardiac catheterization test and renal function indices based on blood and urine sampling were compared. RESULTS: The median estimated glomerular filtration rate (eGFR) of creatinine was 113 mL/min/1.73 m2, and the median eGFR of cystatin C was 117 mL/min/1.73 m2. A urine albumin-to-creatinine ratio (UACR) ≥10 mg/gCr was considered a risk factor for cardiovascular disease in 6 (43%) patients. There was a significant difference in right ventricular ejection fraction and deviation in right ventricular end-diastolic volume from the normal value between the 2 groups divided by UACR. Cyanosis before biventricular repair was noted in 2 (25%) patients with UACR < 10 mg/gCr and in 4 (67%) patients with UACR ≥10 mg/gCr. CONCLUSIONS: Increased UACR was noted in 43% of patients. In patients with UACR ≥10 mg/gCr, right heart system abnormality was observed, and several patients had cyanosis before radical treatment. Measurement for UACR may be able to detect renal dysfunction early in the postoperative remote period.

Clinical significance of four plasma levels in patients with early diabetic nephropathy / 国际检验医学杂志

Objective To investigate the significance of plasma retinol binding protein (RBP),Cystatin C (CysC),soluble intercellular adhesion factor 1 (sICAM 1) and urinary microalbumin (u-MALB) in the detec-tion of early diabetic nephropathy.Methods 40 patients with diabetic nephropathy received from May 2015 to May 2016 at the Capital Medical University Desheng Teaching and Research Center were selected as the ob-servation group and 40 healthy subjects were selected as the control group.Both groups were tested by using immunoassay and biochemical analyzer.Then RBP,CysC,sICAM-1 and u-MALB results in two groups were compared.The sensitivity and specificity of individual and combined detection of related indexes were analyzed by ROC curve.Results The levels of RBP,CysC,sICAM-1 and u-MALB in the observation group [(1.36 ± 0.03)mg/mL,(1.43 ± 0.10)mg/L,(208.72 ± 30.34)ng/mL,(42.39 ± 3.32)mg/L] were higher than those in the control group [(0.33 ± 0.01)mg/mL,(0.14 ± 0.01)mg/L,(85.39 ± 16.85)ng/mL,(10.31 ± 2.20)mg/L],and the difference was statistically significant (P< 0.05).The positive rate of combined detection was higher than single detection of RBP,CysC,sICAM-1 and u-MALB.Conclusion RBP,CysC,sICAM-1 and u-MALB are effective indicators to reflect the patient′s renal injury.The combined detection could effectively improve the positive rate of diagnosis of diabetic nephropathy and monitoring the levels of RBP,CysC,sICAM-1 and u-M ALB level in diabetic nephropathy patients is important for the diagnosis of the onset and the devel-opment of early kidney injury,and the treatment and the progression of the disease.

Changes of urinary microalbumin and BNP levels in patients with diabetic nephropathy complicating heart failure and their influence on recent prognosis / 国际检验医学杂志

Objective To investigate the changes of urinary microalbumin(mALB)and type B urinary na-triuretic peptide(BNP)in the patients with diabetic nephropathy(DN)complicating heart failure and their in-fluence on recent prognosis.Methods A total of 73 patients with diabetes mellitus(DN)complicating heart failure from January 2014 to December 2016 were selected as the observation group and 73 persons undergoing healthy physical examination were selected as the control group.The urinary mALB and BNP levels in the two groups and the patients with different heart function grades were analyzed.The receiver operating characteris-tic(ROC)curve and survival curve were drawn for analyzing their diagnostic value and influence on progno-sis.Results The levels of urinary mALB and BNP levels in the observation group were significantly higher than those in the control group,the difference was statistically significant(P< 0.05).In the observation group,the poorer the heart function,the more obvious the urinary mALB and BNP abnormality,the difference was statistically significant(P<0.05).When the critical value of urinary mALB for diagnosing DN complica-ting heart failure was 18.56 ng/L,the area under the curve(AUC),95% CI,sensitivity and specificity were 0.983,0.964 -0.999,0.986 and 0.900 respectively,the difference was statistically significant(P< 0.05);

Relationship between blood pressure level and urinary micro-albumin and other influencing factors / 第二军医大学学报

Objective To explore the relationship between blood pressure level and urinary micro-albumin, kidney damage and metabolic indicators, so as to provide scientific evidence for the prevention and treatment of hypertension. Methods Using stratified multi-stage random sampling method, we selected local residents (15 years old) in Tongnan area of Chongqing for questionnaire survey, physical examination, and the detection of blood and urine samples to obtain blood glucose, blood lipids, urinary micro-albumin, and other clinical data. The data were statistically analyzed by SPSS 20.0 software. Results The proportions of patients with microalbuminuria (urinary micro-albumin level≥20 mg/L) in the normal blood pressure group, the prehypertension group, and the hypertension group were 21.40% (61/285), 27.36% (110/402) and 48.06% (149/310), respectively, and there were significant differences between the three groups (P0.05). The proportion of patients with microalbuminuria in the hypertension patients was significantly increased with the increase of blood pressure (P0.05). Multiple linear regression analysis showed that systolic blood pressure was significantly increased with the increase of triglyceride and low-density lipoprotein cholesterol levels (P0.05), and diastolic blood pressure was significantly increased with the increase of triglyceride level (P0.05). Binary logistic regression analysis showed that urinary micro-albumin, high-density lipoprotein cholesterol, age and waist circumference were the influencing factors of hypertension (P0.05). Conclusion Urinary micro-albumin level is closely related to blood pressure level, and can be used as an important indicator for the diagnosis of early renal damage diagnosis. Urinary micro-albumin, high-density lipoprotein cholesterol, age and waist circumference are independently associated with hypertension.

Study on Combined Determination Plasma NGAL,Cys C and Urinary NAG/Crea for the Diagnosis of Early Diabetic Nephropathy / 现代检验医学杂志

Objective To investigate the value of plasma neutrophil gelatinase-associated lipocalin (NGAL),cystatin C (Cys C) and the ratio of urinary N-acetyl-beta-D-glucosaminidase to creatinine (NAG/Crea) combined determination in the diagnosis of early diabetic nephropathy.Methods Collected 67 cases of patients with type 2 diabetes hospitalized in the First Affiliated Hospital of Kunming Medical University from December 2016 to February 2017.According to the value of UALB/Crea was divided into two groups:Diabetic urinary microalbumin normal group (UALB/Crea＜30 mg/gCrea) had 35 patients and early diabetic nephropathy group (namely the trace albuminuria group,UALB/Crea 30 ～ 300 mg/gCrea) had 32 patients.Other selected 20 normal volunteers as control group,compared with a medical group to gather all the staff of the clinical data,using automatic biochemical analyzer detected the plasma NGAL,Cys C and urine NAG/Crea,and adopted the receiver-operating characteristic (ROC) curve of the detection index was analyzed.Results ①Plasma NGAL,Cys C and urinary NAG/Crea of diabetic nephropathy patients was significantly higher than those of healthy control group (Z=-5.740 ～-5.386,P＜0.05).②The areaunder receiver operating characteristic (ROC) curve of plasma NGAL,Cys C and urine NAG/Crea were 0.858,0.911 and 0.714.Conclusion Plasma NGAL,Cys C and urinary NAG/Crea combined determination have a higher value for early diagnosis of diabetic nephropathy.

Clinical significance of joint detection of urine light chains ,urine microalbumin and urine α1-microglobulin in early diabetic kidney injury / 国际检验医学杂志

Objective To explore the clinical value of joint detection of urine light chains ,urine microalbumin and urine α1-mi-croglobulin in early diabetic kidney injury .Methods 218 cases type 2 diabetes mellitus(T2DM ) were selected as the observational group and 62 cases undergoing healthy physical examination as the control group .The rate scattering turbidimetry method was a-dopted to detect urinary κlight chains ,urinary λlight chains ,urinary micro-albumin(mALB) ,α1-microglobulin(α1-MG) in the two groups .Then the test results were performed the comparative analysis .Results The positive rate of urine κ light chains ,urine λlight chains ,mALB and α1-MG in the observational group were significantly higher than those in the control group ,the difference was statistically significant(P<0 .01);theκ/λvalue had no statistical difference between the observation group and control group (P>0 .05) .The receiver-operating characteristic curve analysis showed that the area under curve (AUC) of urineκlight chains ,u-rineλlight chains ,mALB and α1-MG ,and 95% CI were 0 .763 ,0 .541 ,0 .854 ,0 .807 and 0 .708 -0 .817 ,0 .464-0 .691 ,0 .811-0 .897 and 0 .758-0 .856 respectively ,AUC and 95% CI of joint detection of 4 urine indicators were 0 .919 and 0 .886-0 .951 ,the difference was statistically significant(P<0 .01) .Conclusion The combined detection of urine κ light chains ,urineλ light chains , mALB and α1-MG has an important clinical value for predicting early diabetic kidney injury .

Association between the serum CysC,lipoprotein(a) and urinary microalbumin/creatinine ratio among elderly type 2 dibetic patients / 国际检验医学杂志

Objective To analyze the relationship between the serum CysC,lipoprotein(a) [Lp(a)] and the urinary microalbumin/creatinine ratio in elderly type 2 dibetic (T2CM) patients.Methods A total of 102 elderly patients with T2CM who were treated in our hospital from December 2014 to December 2015 were selected.The patients were divided into diabetic nephropathy(DN) group(mALB≥20 μg/min,48 cases)and non-diabetic nephropathy(NDN) group (mALB<20 μg/min,54 cases) according the levels of urinary mALB,while 30 cases of healthy controls were selected from physical examination center.The biochemical indexes,CysC,Lp(a) and UACR were detected among all cases.The correlation between indexes and UACR was analyzed by Pearson correlation analysis,risk factors for UACR among DN patients were analyzed by Logistic regression analysis.Results There were significant differences in levels of low density lipoprotein cholesterol(LDL-C),Lp(a),urea,creatinine,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),Cysc,and UACR among these groups (P<0.05).No correlation between CysC、Lp(a) and UACR was found in normal-control group and non-diabetic nephropathy group.In diabetic nephropathy group,there was a positive correlation between CysC,Lp(a) and UACR(r=0.658,P<0.01;r=0.525,P<0.05).The Logistic regression analysis showed that diabetes duration,CysC,Lp(a) were independent risk factors for UACR(P<0.05).Conclusion In patients with diabetic nephropathy,CysC,Lp(a) are positively correlated with UACR,and CysC is a sensitive index that reflect early renal damage in T2DM patients.Lp(a) level is one of the independent risk factors for UACR,which can reveal the kidney damage in DN patients.

Expression of miR-155 ,NF-κB and sICAM-1 in peripheral blood in patients with type 2 diabetes mellitus and its relationship with vascular complications / 中国糖尿病杂志

Objective To investigate the expression of miR-155 ,nuclear factor kappa B (NF-κB) and soluble intercellular adhesion molecule -1 (sICAM-1 ) in peripheral blood in patients with type 2 diabetes mellitus (T2DM ) ,and to explore the role of miR-155 in vascular lesions of T2DM. Methods A total of 165 T2DM patients and 60 health subjects from health examinations were enrolled in this study. All the subjects were divided into two groups :subjects without vascular lesions group and vascular disease group. Vascular disease group was further divided into microangiopathy group ,macroangiopathy group , microangiopathy+ macroangiopathy group ;based on 24 hUAlb level normal urinary albumin (NAU ) group ,microalbuminuria (MAU) group ,macroalbuminuria (MAAU) group. MiR-155 ,NF-κB and sICAM-1 in peripheral blood were tested by RT-PCR. Single factor analysis of variance was used for comparison among groups. Stepwise regression analysis was used for correlation factors analysis. Results The expression of miR-155 ,NF-κB and sICAM-1 were significantly higher in T2DM group than in NC group [(1.82 ± 0.71) vs (1.00 ± 0.12) ,(2.28 ± 0.66) vs (1.04 ± 0.33) ,(1.88 ± 0.80) vs (1.03 ± 0.30) ,P<0.05]. The level of miR-155 ,NF-κB ,sICAM-1 were significantly higher in T2DM vascular lesions group than in subjects without vascular lesions group [(1.95 ± 0.73) vs (1.34 ± 0.29) ,(2.40 ± 0.65) vs (1.65 ± 0.16 ) ,(2.01 ± 0.77 ) vs (1.07 ± 0.41 ) ,P < 0.05 ]. The expression of miR-155 was higher in microangiopathy+ macroangiopathy group than in macroangiopathy group [(2.36 ± 0.61 ) vs (1.77 ± 0.59) ,P < 0.05 ].The expression of NF-κB was also significantly higher in microangiopathy +macroangiopathy group than in microvascular disease group and macroangiopathy group (P<0.05). The level of miR-155 was significantly higher in group MAU group and MAAU group than in NAU group [(1.41 ± 0.49) ,(2.64 ± 0.52) vs (1.04 ± 0.20) ,P<0.05] ,and NF-κB and sICAM-1 were also higher than NAU group (P<0.05). Multiple stepwise regression analysis showed that miR-155 was positively correlated with NF-κB and sICAM-1(t=4.235 ,9.728 ,P<0.01). Conclusion The expression of miR-155 increases in T2DM patients with vascular complications ,and this trend is the same as NF-κB and sICAM-1. It suggests that miR-155 maybe involves in the pathogenesis of diabetic chronic vascular disease.

Clinical value of urine and serum tumor markers combined detection in early renal damage in patients with primary hypertension / 中国综合临床

Objective To investigate the value of combined detection of serum cystatin C(Cys-C),alpha 1- microspheres(α1-MG)and urinary microalbumin(mAlb)in the early stage of renal damage in patients with primary hypertension(PH).Methods One hundred and twenty-eight patients with PH were divided into 3 groups according to urinary albumin excretion rate(UAER),group I,normal proteinuria,47 cases,group II microalbuminuria,43 cases,group III,massive proteinuria,38 cases and 50 healthy subjects(the control group)served as research object.Hitachi 7180 automatic biochemical analyzer was applied with latex turbidimetric immunoassay to detect serum Cys-C,α1-MG and mAlb,serum creatinine(Crea)and serum urea (Urea)were determined by enzyme method.Comparative analysis on the early diagnosis efficiency of renal damage was made o based on the combined detection results.Results PH patients were tested by Cys-C( (0.98±0.13)mg/L vs.(1.62±0.55)mg/L vs.(3.17±1.04)mg/L),α1-MG((29.32±6.46)mg/L vs. (38.58±11.79)mg/L vs.(61.42±22.71)mg/L),mAlb((26.35±6.53)mg/24 h vs.(54.24±12.78)mg/24 h vs.(373.6±98.40)mg/24 h),Crea((5.06±0.67)μmol/L vs.(89.64±28.84)μmol/L vs.(164.16 ±58.77)μmol/L),Urea((5.06 ± 0.67)mmol/L vs.(7.87 ± 2.95)mmol/L vs.(15.10 ± 7.41)mmol/L, compared with those in the control group((0.69±0.08)mg/L,(17.15±4.30)mg/L,(19.55±4.28)mg/24 h,(68.39±20.11)μmol/L,(5.05±0.78)mmol/L,there were significant differences among the four groups(F=164.74,93.01,553.27,61.38,65.24,P=0).The results of Cys-C,α1-MG and mAlb in patients with PH were higher than those in the control group(P<0.05,P<0.01).The results of Cys-C,α1-MG and mAlb in group II were higher than those in group I,but lower than those in group III(P<0.01).The detection results of Crea in group I and group II were higher than those in the control group(P>0.05),but lower than that in group III(P<0.05).The result of Urea in group I was higher than that in the control group(P>0.05),but lower than those in group II and group III(P<0.05).Crea Cys-C and Urea were positively correlated(r=0.385,r=0.310,P=0.006,P=0.025),α1-MG was positively correlated with Crea,Urea(r=0.310,r=0.228,P=0.028,P=0.043); mAlb was positively correlated with Crea and Urea(r=0.382,r=0.302,P=0.006,P=0.033). The specificity of combined detection of three markers(55.3%)was lower than the individual detection(74.5%,68.1%,80.9%)and also lower than the two-unit(70.2%,63.8%,index 78.7%); its sensitivity(90.7%)was significantly higher than that of the individual detection(65.1%,58.1%,67.4%)and the two-unit(79.1%,74.4%,69.8%).Conclusion Cys-C,α1-MG and mAlb can be used as important indicators in the diagnosis in the patients with PH renal damage,which can increase the effectiveness PH early renal damage diagnosis,can be used for early detection of renal damage in PH patients,with the disease monitoring.

Effects of Dipeptidyl Peptidase-4 inhibitor on albuminuria in patients with type 2 diabetes mellitus / 中国糖尿病杂志

Dipeptidyl Peptidase-4 inhibitor (DPP-4 inhibitor),a new kind of oral anti-diabetic medicine,has been widely used for the treatment of type 2 diabetes (T2DM) during the last decades.Recent evidence showed that DPP-4 inhibitor may have renal protective effects beyond glycemic control.Some clinical studies revealed that the reduction of HbA1c by DPP-4 inhibitor was paralleled by an improvement of albuminuria and renal function.Experimental studies indicated that the renal protection mechanism of DPP-4 inhibitor may be involved in its multiple effects including anti-inflammatory,anti-oxidation and improvement of endothelial function.However,the evidence of decreasing albuminuria for DPP-4 inhibitor mainly comes from animal models and some clinical trials with small sample size.More large randomized controlled trials (RCT) will be needed to certify the renal protection effect of DPP-4 inhibitor.In this review,the role of DPP-4 inhibitor on albuminuria will be considered and discussed from both experimental and clinical perspectives.

Risk factors of early renal damage in children with Henoch Schonlein purpura / 国际检验医学杂志

Objective To analyze the risk factors of early renal damage in children with Henoch Schonlein purpura(HSP).Methods The clinical data of 196 children with HSP admitted to our hospital from April 2012 to January 2016 were analyzed retrospectively.They were divided into the renal damage group and non-renal damage group within 90 d after confirmed diagnosis.The related clinical data such as serum immunoglobulin and urinary microalbumin were compared between the two groups,and the risk factors of early renal damage in children with HSP were screened.Results There were significant differences between the two groups on age,joint symptoms,recurrent purpura,persistent rash,gastrointestinal bleeding and abdominal pain(with χ2 or t of 11.345,16.223,11.275,43.211,12.592,17.771,P<0.05).The white blood cell count,platelet count,immunoglobulin A(IgA) level and urinary albumin level also showed significant differences between the two groups(t=33.750,60.442,9.451,8.458,P<0.05).The multivariate regression analysis showed that the independent risk factors for early renal damage in children with HSP included age(OR=2.703),recurrent purpura(OR=2.721),persistent skin rash(OR=1.782),gastrointestinal bleeding(OR=11.472),abdominal pain(OR=2.046),IgA level(OR=1.221) and urine microalbumin(OR=3.214).Conclusion Age,recurrent purpura,persistent skin rash,gastrointestinal bleeding,abdominal pain,IgA level and urine microalbumin are closely related to early renal damage in children with HSP.

Clinical significance of urinary mALB ,RBP and CysC and their combined detection in early diagnosis of type 2 diabetic nephropathy* / 国际检验医学杂志

Objective To investigate the application value of urine microalbumin (mALB) ,retinol binding protein(RBP) and cys-tatin C(CysC) and their combined detection in early diagnosis of type 2 diabetic nephropathy(DN) .Methods Ninety-two inpatients with DN (DN group) and 90 people undergoing the physical examination(control group) in our hospital from June 2014 to Decem-ber 2015 were collected .Urine mALB ,RBP and CysC were detected in all subjects and detection results were analyzed statistically . Results The levels of urine mALB ,RBP and CysC in the DN group were significantly higher than those in the control group ,the differences all had statistical significance (P< 0 .05) .Among 3 indicators ,the positive rate of urine mALB for detecting DN was highest (94 .57% ) ,while which of 3-index combined detection was 97 .83% ,and significantly higher than that of single detection , the difference was statistically significant(P<0 .05) .The sensitivity ,specificity ,positive predictive value ,negative predictive value and Youden index of 3-index combined detection were all higher than those of single index .The ROC curve showed that AUC of u-rine mALB for diagnosing DN was 0 .732 ,the diagnostic cut-off value was 43 .58 mg/L ,AUC of urine RBP was 0 .685 ,the diagnos-tic cut-off value was 1 .47 mg/mL ,AUC of urine CysC was 0 .701 ,the diagnostic cut-off value was 1 .42 mg/L ,while AUC of com-bined detection was 0 .928 .Conclusion Urine mALB ,RBP and CysC are better indexes reflecting renal injury .Their combined de-tection will increase the positive rate ,sensitivity and specificity for diagnosing DN .So monitoring the levels of urine mALB ,RBP and CysC has an important significance to diagnosing the occurrence and development of DN early renal injury and prevention ,treat-ment and delaying progress of DN .