BACKGROUND Retinopathy is the most common microvascular disease of type 2 diabetes,and seriously threatens the life,health and quality of life of patients.It is worth noting that the development of diabetic retinopath...BACKGROUND Retinopathy is the most common microvascular disease of type 2 diabetes,and seriously threatens the life,health and quality of life of patients.It is worth noting that the development of diabetic retinopathy(DR)can be hidden,with few symptoms.Therefore,the preliminary screening of diabetic patients should identify DR as soon as possible,delay disease progression,and play a vital role in its diagnosis and treatment.AIM To investigate the correlation between glycated hemoglobin A1c(HbA1c),urinary microalbumin(U-mALB),urinary creatinine(U-CR),mALB/U-CR ratio,β2 microglobulin(β2MG),retinol binding protein(RBP)and DR.METHODS A total of 180 patients with type 2 diabetes mellitus attending the Second People’s Hospital of Hefei from January 2022 to August 2022 were retrospectively enrolled by ophthalmologists.Based on whether they had combined retinopathy and its degree,68 patients with diabetes mellitus without retinopathy(NDR)were assigned to the NDR group,54 patients with non-proliferative DR(NPDR)to the NPDR group,and 58 patients with proliferative DR to the PDR group.General data,and HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR results were collected from the patients and compared among the groups.Pearson's correlation method was used to analyze the correlation between HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR indices,and multiple linear regression was applied to identify the risk factors for DR.Receiver operator characteristic(ROC)curves were also drawn.RESULTS The differences in age,gender,systolic and diastolic blood pressure between the groups were not statistically significantly(P>0.05),but the difference in disease duration was statistically significant(P<0.05).The differences in fasting blood glucose,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,total cholesterol,and triglyceride between the groups were not statistically significant(P>0.05).HbA1c in the PDR group was higher than that in the NPDR and NDR groups(P<0.05).The levels of mALB,β2MG,RBP,mALB/U-CR and UCR in the PDR group were higher than those in the NPDR and NDR groups(P<0.05).Multiple linear regression analysis showed that disease duration,HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR were risk factors for the development of DR.The ROC curve showed that the area under the curve(AUC)for the combination of indices(HbA1c+mALB+mALB/U-CR+U-CR+β2MG+RBP)was 0.958,with a sensitivity of 94.83%and specificity of 96.72%,which was higher than the AUC for single index prediction(P<0.05).CONCLUSION HbA1c,mALB,mALB/U-CR,U-CR,β2MG and RBP can reflect the development of DR and are risk factors affecting PDR,and the combination of these six indices has predictive value for PDR.展开更多
Objective:To explore the predictive value of the combined test of urinary sodium,urinary potassium excretion fraction(FEK),and urinary potassium concentration/urine creatinine concentration(UK/UCr)in sepsis-induced ea...Objective:To explore the predictive value of the combined test of urinary sodium,urinary potassium excretion fraction(FEK),and urinary potassium concentration/urine creatinine concentration(UK/UCr)in sepsis-induced early acute kidney injury(AKI).Methods:Sixty sepsis patients admitted to the Northern Hospital of National Pharmaceuticals from 2022.4 to 2024.4 were selected and divided into the AKI group(n=21)and the non-AKI group(n=39)according to whether AKI occurred or not,and another 20 health check-up subjects from our hospital were selected to be included in the control group during the same period of time,and we compared the urinary sodium,urinary FEK,and urinary UK/UCr tests of the three groups,and analysed the urinary potassium concentration/urine creatinine concentration(UK/UCr)in the early stage of sepsis-induced acute kidney injury(AKI)by plotting the working characteristics of the subjects(ROC)curve graph to analyse the predictive value of the combined detection of urinary sodium,urinary FEK and urinary UK/UCr in sepsis-induced early AKI.Results:The levels of urinary FEK and urinary UK/UCr in the non-AKI group were higher than those in the control group,and the levels of urinary sodium were lower than those in the control group(P<0.05),while the levels of urinary FEK and urinary UK/UCr in the AKI group were higher than those in the non-AKI group,and the levels of urinary sodium were lower than those in the non-AKI group(P<0.05);the ROC was plotted and found that the combined test of urinary sodium,urinary FEK,and urinary UK/UCr was useful for the prediction of early AKI caused by sepsis.The area under the curve(AUC)values ranged from 0.694-0.940,with high sensitivity and specificity,and the value of predicting sepsis-induced early AKI was high.Conclusion:Urinary sodium,urinary FEK and urinary UK/UCr can be used as effective biomarkers for the early prediction of AKI,and the combined test has high value in predicting early AKI caused by sepsis.展开更多
Most studies assessing urine biochemistry for acute kidney injury(AKI)monitoring rely on paradigms from the 1970s.It was proposed that a single measurement of urinary parameters in the presence of increased serum crea...Most studies assessing urine biochemistry for acute kidney injury(AKI)monitoring rely on paradigms from the 1970s.It was proposed that a single measurement of urinary parameters in the presence of increased serum creatinine(sCr)could help understand AKI pathophysiology and predict its duration.However,those studies produced variable and controversial results.Recently,an alternative“urine biochemical approach”has been proposed.In contrast with the traditional approach,it includes sequential urine electrolyte assessment,evaluation before AKI diagnosis,and interpretation of avid sodium retention as a marker of renal microcirculatory stress instead of low renal perfusion.This review highlights the rationale of this alternative approach,which is focused on early urinary biochemical changes that precede increases in sCr as well as signs of renal recovery before decreases in sCr.The relevance of urine composition in conjunction with urine volume for a proper evaluation of renal function is emphasized.This new approach aims to enhance the utility of urinary biochemical parameters in AKI monitoring,particularly in patients who are critically ill.展开更多
BACKGROUND Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease.The disease characteristics,morbidity,and renal function progression rate of patients with DKD are all related to sex.This...BACKGROUND Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease.The disease characteristics,morbidity,and renal function progression rate of patients with DKD are all related to sex.This suggests that sex hormones may play an important role in changing renal function in patients with diabetes.There have been only a few studies on the correlation between sex hormones and DKD,which have contradictory conclusions.AIM To investigate the relationship between circulating sex hormone levels and DKD in men and postmenopausal women with type 2 diabetes mellitus(T2DM).METHODS This retrospective cross-sectional study included 356 patients with T2DM.Pearson or Spearman rank correlation analyses assessed the relationships between sex hormone levels and renal function indices.By adjusting for age,body mass index,systolic blood pressure,diastolic blood pressure,duration of diabetes,use of sodium-glucose cotrasporter-2 inhibitor,use of glucagon-like peptide-1 receptor agonist,hypertension,use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor,diabetic retinopathy,diabetic peripheral vascular disease,triglyceride,uric acid,and hemoglobin A1c,multiple linear regression and logistic regression analyses were conducted to identify factors influencing the urinary albumin/creatinine ratio(UACR)and DKD.RESULTS In men,dehydroepiandrosterone sulfate levels were inversely associated with log-transformed UACR after adjustment for covariate factors[regression coefficient(β)=-0.691,95%confidence interval(CI):-1.241 to-0.141 for quartile 4 vs quartile 1;P=0.006 for trend].Elevated levels of estradiol were positively associated with DKD[odds ratio(OR)=3.097,95%CI:1.083-8.856 for quartile 4 vs quartile 1;P=0.041 for trend],and higher luteinizing hormone(LH)levels were similarly associated with DKD(OR=4.164,95%CI:1.30-13.330 for quartile 4 vs quartile 1;P=0.048 for trend).In postmenopausal women,LH levels were positively correlated with log-transformed UACR and DKD(β=1.039,95%CI:0.284-1.794 for quartile 4 vs quartile 1;P=0.006 for trend and OR=15.117,95%CI:2.191-104.326 for quartile 4 vs quartile 1;P=0.004 for trend).Follicle-stimulating hormone(FSH)levels were also positively associated with DKD(OR=9.588,95%CI:1.680-54.709 for quartile 4 vs quartile 1;P=0.014 for trend).CONCLUSION In men with T2DM,elevated levels of estradiol and LH levels were positively associated with increased risk of DKD.In postmenopausal women with T2DM,high FSH and LH levels were positively associated with increased risk of DKD.展开更多
Objective:To evaluate the efficacy and safety of QL1206(a denosumab biosimilar to Xgeva■)in breast cancer patients with bone metastasis(BM)through subgroup analysis of a randomized,double-blind phaseⅢtrial(No.NCT045...Objective:To evaluate the efficacy and safety of QL1206(a denosumab biosimilar to Xgeva■)in breast cancer patients with bone metastasis(BM)through subgroup analysis of a randomized,double-blind phaseⅢtrial(No.NCT04550949).Methods:This subgroup analysis included patients with BM from breast cancer enrolled in a phaseⅢtrial.Patients were randomized(1:1)to receive either three cycles of QL1206 or denosumab(120 mg subcutaneously every 4 weeks).Subsequently,they received 10 cycles of QL1206(120 mg)over 40 weeks,followed by a 20-week safety follow-up.The primary endpoint was the percentage changes from baseline to week 13 in urinary Ntelopeptide corrected for creatinine(u NTx/Cr).Results:The breast cancer cohort consisted of 311 patients.Vertebral involvement(66.4%)was the most prevalent BM site at enrollment,while 27.7%of patients presented with≥3 metastatic bone lesions.At week 13,QL1206 demonstrated a median u NTx/Cr reduction of-69.9%(range:-98.1%-568.0%)vs.-74.3%(range:-97.7%-386.3%)for denosumab.The analysis of covariance revealed comparable least-square means for log-transformed changes:-1.416[95%confidence interval(95%CI):-1.736 to-1.096]vs.-1.501(95%CI:-1.824 to-1.178),yielding an between-group difference of 0.085(90%CI:-0.062-0.232;P=0.343).After a 53-week treatment period,83.6%achieved bone density improvement/disease stabilization.Safety profiles were comparable between groups.Conclusions:QL1206 demonstrated similar efficacy and safety to the reference denosumab in patients with BM from breast cancer,supporting QL1206 as a new option for management of BM from breast cancer.展开更多
Objective: to explore the combination of blood Cys-C (Cys-C) and UmAlb / UCr (creatinine ratio in urinary microalbuminuria) for the early screening of diabetic kidney disease. Methods: 60 patients were selected and co...Objective: to explore the combination of blood Cys-C (Cys-C) and UmAlb / UCr (creatinine ratio in urinary microalbuminuria) for the early screening of diabetic kidney disease. Methods: 60 patients were selected and considered as clinical research subjects. Sixty patients admitted from March 2021 to March 2022 were selected as controls. The changes of plasma cystatin and urinary microalbuminuria creatinine were compared between the two groups by using the dynamic method of immune transmission ratio, scattering ratio method and picric acid. Results: 60 patients with diabetic nephropathy were selected and considered as clinical research subjects. Sixty patients admitted from March 2021 to March 2022 were selected as controls. The changes of plasma cystatin and urinary microalbuminuria creatinine were compared between the two groups by using the dynamic method of immune transmission ratio, scattering ratio method and picric acid. Conclusion: the relationship between the CH index in blood and the creatinine ratio in urine is explored, and the detection accuracy is significantly higher than that of the two indicators alone, which can effectively improve the accuracy and sensitivity of the early detection of diabetic nephropathy and improve the early diagnosis rate. It can be used as an excellent detection method. It has high clinical value and deserves further promotion and use.展开更多
AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHOD...AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHODS In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor(ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio(ACR) in urine. Genotyping of ACE I/D and AGT M235 T polymorphisms were performed by using primer specific polymerase chain reaction(PCR) and PCR-RFLP techniques, respectively. RESULTS Forty-eight percent of DN patients(responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric(≥ 30 and < 300 mg/g creatinine) or macro-albuminuric(≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients(55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235 T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response(72%). CONCLUSION ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235 T polymorphisms.展开更多
<strong>Aims: </strong>To evaluate the association of Nuclear factor kappa B1(NFkB1) gene polymorphism with inflammatory markers Urinary Monocyte Chemoattractant Protein 1 (UMCP1) and Tumor Necrosis Factor...<strong>Aims: </strong>To evaluate the association of Nuclear factor kappa B1(NFkB1) gene polymorphism with inflammatory markers Urinary Monocyte Chemoattractant Protein 1 (UMCP1) and Tumor Necrosis Factor alfa (TNF alfa) in Patients of diabetes mellitus with or without renal involvement in Eastern India. <strong>Material and Methods: </strong>Consecutive Patients of Type 2 Diabetes Mellitus (DM) with or without microalbuminuria attending SCB MEDICAL COLLEGE and HOSPITAL Medical OPDs in between September 2018 to September 2019 were recruited in this study. Patients were subjected to blood and urine investigations. DNA extraction and Restriction fragment Length Polymorphism (RFLP) was done in Department of Biochemistry. Controls were unrelated healthy attendants with no history of Diabetes Mellitus, HTN, Chronic Kidney Disease (CKD). <strong>Results:</strong> Mean Systolic BP, Fasting Blood Glucose, Post Prandial Blood Glucose, HBA1c, Total Cholesterol were significantly higher in diabetes mellitus and diabetic nephropathy groups than control group. Estimated Glomerular Filtration Rate was significantly lower in diabetic nephropathy (p value < 0.001). UMCP1, Urinary Albumin Creatinine Ratio, TNF alfa were higher in diabetes mellitus and nephropathy with p value (<0.001, 0.006 < 0.001) respectively. In between DM and Diabetic Nephropathy groups nfkb1 gene expression, umcp1 and tnf alfa levels were significantly increased in Diabetic nephropathy with p value 0.019, <0.01, 0.001 respectively. Insertion/insertion NFkB1 gene polymorphisms were more in diabetic nephropathy group and were positively correlated with inflammatory markers UMCP1 (r = 0.517, p < 0.01) and TNF alfa (r = 0.172, p = 0.19). <strong>Conclusion:</strong> insertion/insertion NFkB1 gene polymorphism increases the risk of nephropathy by 2.52 times (OR = 2.52, 95% CI: 0.04 - 0.63, p value = 0.019) in diabetes patients in eastern India.展开更多
Objective To investigate the level of urinary serine protease(Corin)in early diabetic kidney disease(DKD)and its correlation with clinical stage.Methods One hundred and seventy-three patients with type 2 diabetes mell...Objective To investigate the level of urinary serine protease(Corin)in early diabetic kidney disease(DKD)and its correlation with clinical stage.Methods One hundred and seventy-three patients with type 2 diabetes mellitus(DM)from two tertiary A hospitals in Henan,diagnosed between April 2023 and December 2023 were selected as the research group,and 120 healthy subjects were selected as the contro1lgroup.Basicclinical information and laboratory datawere collected,and urinary Corin level was detected.DM patients were classified into G1-G5 stages based on estimated glomerular filtration rate(eGFR),and those in the early DKD stages(G1-G3)were further divided into A1-A3 subgroups based on urinary albumin/creatinine ratio(ACR).Spearman correlation analysis was performed to assess relationships between urinary Corin and other indicators,linear regression analysis identified factors influencing urinary Corin in early DKD patients,logistic regression analysis evaluated the risk factors for early DKD,and receiver operating characteristic(ROC)curve analysis determined the diagnostic value of urinary Corin in early DKD.Results Urinary Corin levels were significantly higher in early DKD patients compared to healthy controls,with levels increasing as ACR rose(P<0.05).Urinary Corin was positively associated with serum creatinine(r=0.570),urea(r=0.458),cystatin C(r=0.693),ACR(r=0.616),urinary transferrin(r=0.448),urinaryαl microglobulin(r=0.507),urinary n-acetyl-β-D-glucosaminase(r=0.388)and A subgroup(r=0.692)while was negatively correlated with eGFR(r=-0.647),albumin(r=-0.312)(all P<0.05).eGFR was the only independent factor affecting urinary Corin.After adjusting for confounding factors in logistic regression analysis,urinary Corin was still an independent influencing factor for early DKD.ROC curve analysis indicated that urinary Corin had a diagnostic AUC of 0.842(95%CI 0.791-0.892,P<0.001),with a cut-off value of 2226.04 pg/mL,sensitivity of 0.712,and specificity of 0.858 for early DKD diagnosis.Conclusion Urinary Corin is elevated in early DKD patients and correlated with clinical stage.Urinary Corin is an independent factor of early DKD and a reliable predictor of early DKD diagnosis.展开更多
This study aimed to investigate the correlation between serum miR-154-5p and urinary albumin to creatinine ratio(UACR)in patients with type 2 diabetes mellitus(T2DM)and the association with biomarkers of inflammation ...This study aimed to investigate the correlation between serum miR-154-5p and urinary albumin to creatinine ratio(UACR)in patients with type 2 diabetes mellitus(T2DM)and the association with biomarkers of inflammation and fibrosis in diabetic kidney disease(DKD).A total of 390 patients with T2DM were divided into three groups:normal albuminuria(UACR<30 mg/g,n=136,NA),microalbuminuria(UACR at 30-300 mg/g,n=132,MA),and clinical albuminuria(UACR>300 mg/g,n=122,CA).Circulating miR-154-5p,inflammatory(C-reactive protein(CRP);erythrocyte sedimentation rate(ESR);and tumor necrosis factor-a(TNF-α)and fibrotic markers(vascular endothelial growth factor(VEGF);transforming growth factor-β1(TGF-β1);and fibronectin(FN),and other biochemical indicators were assessed via real-time PCR,enzyme-linked immunosorbent assay,and chemiluminescence assay in patients with T2DM and 138 control subjects(NC).UACR,miR-154-5p,glycated hemoglobin(HbA1c),serum creatinine(sCr),blood urea nitrogen(BUN),ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were significantly higher and the estimated glomerular filtration rate(eGFR)was significantly lower in NA,MA,and CA groups than in NC subjects(P<0.05).Elevated levels of UACR and miR-154-5p were directly correlated with HbA1c,sCr,BUN,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN and negatively correlated with eGFR(P<0.05).miR-154-5p,HbA1c,sCr,BUN,eGFR,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were important factors affecting UACR.These findings indicated that elevated serum miR-154-5p is significantly correlated with high UACR in patients with T2DM and may offer a novel reference for the early diagnosis of DKD.展开更多
文摘BACKGROUND Retinopathy is the most common microvascular disease of type 2 diabetes,and seriously threatens the life,health and quality of life of patients.It is worth noting that the development of diabetic retinopathy(DR)can be hidden,with few symptoms.Therefore,the preliminary screening of diabetic patients should identify DR as soon as possible,delay disease progression,and play a vital role in its diagnosis and treatment.AIM To investigate the correlation between glycated hemoglobin A1c(HbA1c),urinary microalbumin(U-mALB),urinary creatinine(U-CR),mALB/U-CR ratio,β2 microglobulin(β2MG),retinol binding protein(RBP)and DR.METHODS A total of 180 patients with type 2 diabetes mellitus attending the Second People’s Hospital of Hefei from January 2022 to August 2022 were retrospectively enrolled by ophthalmologists.Based on whether they had combined retinopathy and its degree,68 patients with diabetes mellitus without retinopathy(NDR)were assigned to the NDR group,54 patients with non-proliferative DR(NPDR)to the NPDR group,and 58 patients with proliferative DR to the PDR group.General data,and HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR results were collected from the patients and compared among the groups.Pearson's correlation method was used to analyze the correlation between HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR indices,and multiple linear regression was applied to identify the risk factors for DR.Receiver operator characteristic(ROC)curves were also drawn.RESULTS The differences in age,gender,systolic and diastolic blood pressure between the groups were not statistically significantly(P>0.05),but the difference in disease duration was statistically significant(P<0.05).The differences in fasting blood glucose,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,total cholesterol,and triglyceride between the groups were not statistically significant(P>0.05).HbA1c in the PDR group was higher than that in the NPDR and NDR groups(P<0.05).The levels of mALB,β2MG,RBP,mALB/U-CR and UCR in the PDR group were higher than those in the NPDR and NDR groups(P<0.05).Multiple linear regression analysis showed that disease duration,HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR were risk factors for the development of DR.The ROC curve showed that the area under the curve(AUC)for the combination of indices(HbA1c+mALB+mALB/U-CR+U-CR+β2MG+RBP)was 0.958,with a sensitivity of 94.83%and specificity of 96.72%,which was higher than the AUC for single index prediction(P<0.05).CONCLUSION HbA1c,mALB,mALB/U-CR,U-CR,β2MG and RBP can reflect the development of DR and are risk factors affecting PDR,and the combination of these six indices has predictive value for PDR.
文摘Objective:To explore the predictive value of the combined test of urinary sodium,urinary potassium excretion fraction(FEK),and urinary potassium concentration/urine creatinine concentration(UK/UCr)in sepsis-induced early acute kidney injury(AKI).Methods:Sixty sepsis patients admitted to the Northern Hospital of National Pharmaceuticals from 2022.4 to 2024.4 were selected and divided into the AKI group(n=21)and the non-AKI group(n=39)according to whether AKI occurred or not,and another 20 health check-up subjects from our hospital were selected to be included in the control group during the same period of time,and we compared the urinary sodium,urinary FEK,and urinary UK/UCr tests of the three groups,and analysed the urinary potassium concentration/urine creatinine concentration(UK/UCr)in the early stage of sepsis-induced acute kidney injury(AKI)by plotting the working characteristics of the subjects(ROC)curve graph to analyse the predictive value of the combined detection of urinary sodium,urinary FEK and urinary UK/UCr in sepsis-induced early AKI.Results:The levels of urinary FEK and urinary UK/UCr in the non-AKI group were higher than those in the control group,and the levels of urinary sodium were lower than those in the control group(P<0.05),while the levels of urinary FEK and urinary UK/UCr in the AKI group were higher than those in the non-AKI group,and the levels of urinary sodium were lower than those in the non-AKI group(P<0.05);the ROC was plotted and found that the combined test of urinary sodium,urinary FEK,and urinary UK/UCr was useful for the prediction of early AKI caused by sepsis.The area under the curve(AUC)values ranged from 0.694-0.940,with high sensitivity and specificity,and the value of predicting sepsis-induced early AKI was high.Conclusion:Urinary sodium,urinary FEK and urinary UK/UCr can be used as effective biomarkers for the early prediction of AKI,and the combined test has high value in predicting early AKI caused by sepsis.
文摘Most studies assessing urine biochemistry for acute kidney injury(AKI)monitoring rely on paradigms from the 1970s.It was proposed that a single measurement of urinary parameters in the presence of increased serum creatinine(sCr)could help understand AKI pathophysiology and predict its duration.However,those studies produced variable and controversial results.Recently,an alternative“urine biochemical approach”has been proposed.In contrast with the traditional approach,it includes sequential urine electrolyte assessment,evaluation before AKI diagnosis,and interpretation of avid sodium retention as a marker of renal microcirculatory stress instead of low renal perfusion.This review highlights the rationale of this alternative approach,which is focused on early urinary biochemical changes that precede increases in sCr as well as signs of renal recovery before decreases in sCr.The relevance of urine composition in conjunction with urine volume for a proper evaluation of renal function is emphasized.This new approach aims to enhance the utility of urinary biochemical parameters in AKI monitoring,particularly in patients who are critically ill.
基金Supported by the National Natural Science Foundation of China,No.82270942.
文摘BACKGROUND Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease.The disease characteristics,morbidity,and renal function progression rate of patients with DKD are all related to sex.This suggests that sex hormones may play an important role in changing renal function in patients with diabetes.There have been only a few studies on the correlation between sex hormones and DKD,which have contradictory conclusions.AIM To investigate the relationship between circulating sex hormone levels and DKD in men and postmenopausal women with type 2 diabetes mellitus(T2DM).METHODS This retrospective cross-sectional study included 356 patients with T2DM.Pearson or Spearman rank correlation analyses assessed the relationships between sex hormone levels and renal function indices.By adjusting for age,body mass index,systolic blood pressure,diastolic blood pressure,duration of diabetes,use of sodium-glucose cotrasporter-2 inhibitor,use of glucagon-like peptide-1 receptor agonist,hypertension,use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor,diabetic retinopathy,diabetic peripheral vascular disease,triglyceride,uric acid,and hemoglobin A1c,multiple linear regression and logistic regression analyses were conducted to identify factors influencing the urinary albumin/creatinine ratio(UACR)and DKD.RESULTS In men,dehydroepiandrosterone sulfate levels were inversely associated with log-transformed UACR after adjustment for covariate factors[regression coefficient(β)=-0.691,95%confidence interval(CI):-1.241 to-0.141 for quartile 4 vs quartile 1;P=0.006 for trend].Elevated levels of estradiol were positively associated with DKD[odds ratio(OR)=3.097,95%CI:1.083-8.856 for quartile 4 vs quartile 1;P=0.041 for trend],and higher luteinizing hormone(LH)levels were similarly associated with DKD(OR=4.164,95%CI:1.30-13.330 for quartile 4 vs quartile 1;P=0.048 for trend).In postmenopausal women,LH levels were positively correlated with log-transformed UACR and DKD(β=1.039,95%CI:0.284-1.794 for quartile 4 vs quartile 1;P=0.006 for trend and OR=15.117,95%CI:2.191-104.326 for quartile 4 vs quartile 1;P=0.004 for trend).Follicle-stimulating hormone(FSH)levels were also positively associated with DKD(OR=9.588,95%CI:1.680-54.709 for quartile 4 vs quartile 1;P=0.014 for trend).CONCLUSION In men with T2DM,elevated levels of estradiol and LH levels were positively associated with increased risk of DKD.In postmenopausal women with T2DM,high FSH and LH levels were positively associated with increased risk of DKD.
文摘Objective:To evaluate the efficacy and safety of QL1206(a denosumab biosimilar to Xgeva■)in breast cancer patients with bone metastasis(BM)through subgroup analysis of a randomized,double-blind phaseⅢtrial(No.NCT04550949).Methods:This subgroup analysis included patients with BM from breast cancer enrolled in a phaseⅢtrial.Patients were randomized(1:1)to receive either three cycles of QL1206 or denosumab(120 mg subcutaneously every 4 weeks).Subsequently,they received 10 cycles of QL1206(120 mg)over 40 weeks,followed by a 20-week safety follow-up.The primary endpoint was the percentage changes from baseline to week 13 in urinary Ntelopeptide corrected for creatinine(u NTx/Cr).Results:The breast cancer cohort consisted of 311 patients.Vertebral involvement(66.4%)was the most prevalent BM site at enrollment,while 27.7%of patients presented with≥3 metastatic bone lesions.At week 13,QL1206 demonstrated a median u NTx/Cr reduction of-69.9%(range:-98.1%-568.0%)vs.-74.3%(range:-97.7%-386.3%)for denosumab.The analysis of covariance revealed comparable least-square means for log-transformed changes:-1.416[95%confidence interval(95%CI):-1.736 to-1.096]vs.-1.501(95%CI:-1.824 to-1.178),yielding an between-group difference of 0.085(90%CI:-0.062-0.232;P=0.343).After a 53-week treatment period,83.6%achieved bone density improvement/disease stabilization.Safety profiles were comparable between groups.Conclusions:QL1206 demonstrated similar efficacy and safety to the reference denosumab in patients with BM from breast cancer,supporting QL1206 as a new option for management of BM from breast cancer.
文摘Objective: to explore the combination of blood Cys-C (Cys-C) and UmAlb / UCr (creatinine ratio in urinary microalbuminuria) for the early screening of diabetic kidney disease. Methods: 60 patients were selected and considered as clinical research subjects. Sixty patients admitted from March 2021 to March 2022 were selected as controls. The changes of plasma cystatin and urinary microalbuminuria creatinine were compared between the two groups by using the dynamic method of immune transmission ratio, scattering ratio method and picric acid. Results: 60 patients with diabetic nephropathy were selected and considered as clinical research subjects. Sixty patients admitted from March 2021 to March 2022 were selected as controls. The changes of plasma cystatin and urinary microalbuminuria creatinine were compared between the two groups by using the dynamic method of immune transmission ratio, scattering ratio method and picric acid. Conclusion: the relationship between the CH index in blood and the creatinine ratio in urine is explored, and the detection accuracy is significantly higher than that of the two indicators alone, which can effectively improve the accuracy and sensitivity of the early detection of diabetic nephropathy and improve the early diagnosis rate. It can be used as an excellent detection method. It has high clinical value and deserves further promotion and use.
基金Supported by Department of Biotechnology,Government of India,New Delhi(DBT Project),No.BT/PR 4640/MED/30/716/2012
文摘AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHODS In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor(ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio(ACR) in urine. Genotyping of ACE I/D and AGT M235 T polymorphisms were performed by using primer specific polymerase chain reaction(PCR) and PCR-RFLP techniques, respectively. RESULTS Forty-eight percent of DN patients(responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric(≥ 30 and < 300 mg/g creatinine) or macro-albuminuric(≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients(55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235 T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response(72%). CONCLUSION ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235 T polymorphisms.
文摘<strong>Aims: </strong>To evaluate the association of Nuclear factor kappa B1(NFkB1) gene polymorphism with inflammatory markers Urinary Monocyte Chemoattractant Protein 1 (UMCP1) and Tumor Necrosis Factor alfa (TNF alfa) in Patients of diabetes mellitus with or without renal involvement in Eastern India. <strong>Material and Methods: </strong>Consecutive Patients of Type 2 Diabetes Mellitus (DM) with or without microalbuminuria attending SCB MEDICAL COLLEGE and HOSPITAL Medical OPDs in between September 2018 to September 2019 were recruited in this study. Patients were subjected to blood and urine investigations. DNA extraction and Restriction fragment Length Polymorphism (RFLP) was done in Department of Biochemistry. Controls were unrelated healthy attendants with no history of Diabetes Mellitus, HTN, Chronic Kidney Disease (CKD). <strong>Results:</strong> Mean Systolic BP, Fasting Blood Glucose, Post Prandial Blood Glucose, HBA1c, Total Cholesterol were significantly higher in diabetes mellitus and diabetic nephropathy groups than control group. Estimated Glomerular Filtration Rate was significantly lower in diabetic nephropathy (p value < 0.001). UMCP1, Urinary Albumin Creatinine Ratio, TNF alfa were higher in diabetes mellitus and nephropathy with p value (<0.001, 0.006 < 0.001) respectively. In between DM and Diabetic Nephropathy groups nfkb1 gene expression, umcp1 and tnf alfa levels were significantly increased in Diabetic nephropathy with p value 0.019, <0.01, 0.001 respectively. Insertion/insertion NFkB1 gene polymorphisms were more in diabetic nephropathy group and were positively correlated with inflammatory markers UMCP1 (r = 0.517, p < 0.01) and TNF alfa (r = 0.172, p = 0.19). <strong>Conclusion:</strong> insertion/insertion NFkB1 gene polymorphism increases the risk of nephropathy by 2.52 times (OR = 2.52, 95% CI: 0.04 - 0.63, p value = 0.019) in diabetes patients in eastern India.
文摘Objective To investigate the level of urinary serine protease(Corin)in early diabetic kidney disease(DKD)and its correlation with clinical stage.Methods One hundred and seventy-three patients with type 2 diabetes mellitus(DM)from two tertiary A hospitals in Henan,diagnosed between April 2023 and December 2023 were selected as the research group,and 120 healthy subjects were selected as the contro1lgroup.Basicclinical information and laboratory datawere collected,and urinary Corin level was detected.DM patients were classified into G1-G5 stages based on estimated glomerular filtration rate(eGFR),and those in the early DKD stages(G1-G3)were further divided into A1-A3 subgroups based on urinary albumin/creatinine ratio(ACR).Spearman correlation analysis was performed to assess relationships between urinary Corin and other indicators,linear regression analysis identified factors influencing urinary Corin in early DKD patients,logistic regression analysis evaluated the risk factors for early DKD,and receiver operating characteristic(ROC)curve analysis determined the diagnostic value of urinary Corin in early DKD.Results Urinary Corin levels were significantly higher in early DKD patients compared to healthy controls,with levels increasing as ACR rose(P<0.05).Urinary Corin was positively associated with serum creatinine(r=0.570),urea(r=0.458),cystatin C(r=0.693),ACR(r=0.616),urinary transferrin(r=0.448),urinaryαl microglobulin(r=0.507),urinary n-acetyl-β-D-glucosaminase(r=0.388)and A subgroup(r=0.692)while was negatively correlated with eGFR(r=-0.647),albumin(r=-0.312)(all P<0.05).eGFR was the only independent factor affecting urinary Corin.After adjusting for confounding factors in logistic regression analysis,urinary Corin was still an independent influencing factor for early DKD.ROC curve analysis indicated that urinary Corin had a diagnostic AUC of 0.842(95%CI 0.791-0.892,P<0.001),with a cut-off value of 2226.04 pg/mL,sensitivity of 0.712,and specificity of 0.858 for early DKD diagnosis.Conclusion Urinary Corin is elevated in early DKD patients and correlated with clinical stage.Urinary Corin is an independent factor of early DKD and a reliable predictor of early DKD diagnosis.
基金This study was supported by the Higher School“High-end Talent Team Construction”of Liaoning Province(No.[2014]187)the Natural Science Foundation of Liaoning Province(No.201602862),Liaoning Province,China.
文摘This study aimed to investigate the correlation between serum miR-154-5p and urinary albumin to creatinine ratio(UACR)in patients with type 2 diabetes mellitus(T2DM)and the association with biomarkers of inflammation and fibrosis in diabetic kidney disease(DKD).A total of 390 patients with T2DM were divided into three groups:normal albuminuria(UACR<30 mg/g,n=136,NA),microalbuminuria(UACR at 30-300 mg/g,n=132,MA),and clinical albuminuria(UACR>300 mg/g,n=122,CA).Circulating miR-154-5p,inflammatory(C-reactive protein(CRP);erythrocyte sedimentation rate(ESR);and tumor necrosis factor-a(TNF-α)and fibrotic markers(vascular endothelial growth factor(VEGF);transforming growth factor-β1(TGF-β1);and fibronectin(FN),and other biochemical indicators were assessed via real-time PCR,enzyme-linked immunosorbent assay,and chemiluminescence assay in patients with T2DM and 138 control subjects(NC).UACR,miR-154-5p,glycated hemoglobin(HbA1c),serum creatinine(sCr),blood urea nitrogen(BUN),ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were significantly higher and the estimated glomerular filtration rate(eGFR)was significantly lower in NA,MA,and CA groups than in NC subjects(P<0.05).Elevated levels of UACR and miR-154-5p were directly correlated with HbA1c,sCr,BUN,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN and negatively correlated with eGFR(P<0.05).miR-154-5p,HbA1c,sCr,BUN,eGFR,ESR,CRP,VEGF,TNF-α,TGF-β1,and FN were important factors affecting UACR.These findings indicated that elevated serum miR-154-5p is significantly correlated with high UACR in patients with T2DM and may offer a novel reference for the early diagnosis of DKD.
