Objective To search evidence of angiotensin-converting-enzyme inhibitors for microalbumin-uria in type 2 diabetes for guiding clinical practice. Methods We searched MEDLINE （ 1970 -Jun. 2005 ） to identify randomized controlled trials （RCT）of the effect on angiotensin-converting-enzyme inhibitors to prevent microalbuminuria in type 2 diabetes. Results One RCT （n =1 204）was identified. The result showed that angiotensin-converting-enzyme inhibitors were significantly more effective in prevention of microalbuminuria than other medicines in type 2 diabetes. However, angiotensin-converting-enzyme inhibitors may increase the risk of cardiac mortality. We explained the evidence to patients and they were satisfied with our explanation. Conclusions Angiotensin-converting-enzyme inhibitors can decrease the incidence of microalbuminuria in patients with type 2 diabetes and hypertension.
Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
Objective To make individualized evidence-based treatment for patients with diabetic nephropathy with albuminuria. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ willingness was also taken into consideration in the decision-making treatment Results Seventy studies were retrieved and finally 14 randomized controlled trials, 2 systematic reviews, 2 meta-analyses and 41 clinical guidelines were considered eligible. The evidence indicated that albuminuria was an independent cardiovascular risk factor of diabetic patients; angiotensin receptor antagonists might decrease the level of urinary albumin excretion in patients with type 2 diabetic nephropathy; and such patients might benefit from blood glucose and blood pressure control. The individualized treatment plans were developed based on the available evidence. After 1 month of treatment, the serum creatinine returned to normal and albuminuria became negative. Conclusion The individualized treatment plans based on the high quality evidence were optimal in reducing cardiovascular complications and urinary albumin excretion. However, long-term prognostic benefits need to be confirmed by further follow-up.
目的：探討銀屑病合并蛋白尿患者的臨床特點。方法：回顧性分析1996年1月～2005年8月收治的銀屑病合并蛋白尿者臨床資料，并與銀屑病非蛋白尿者的臨床特點比較。結果：銀屑病合并不明原因蛋白尿48例，皮膚受累面積與蛋白尿程度無相關關系（P＞0.05），但銀屑病合并蛋白尿組的銀屑病病程更短,腎臟病理熒光表現為IgA沉積為主。蛋白尿組皮膚受累面積與非蛋白尿組皮膚受累面積比較，無統計學意義（P＞0.05），蛋白尿組和非蛋白尿組的病程也無統計學差異（P＞0.05）。結論：銀屑病合并不明原因蛋白尿值得重視，有必要對其發病機制、臨床特點、病理特征進行深入的研究。
ObjectiveTo discuss the relationship between microalbuminuria (MAU) and antioxidant activity of plasma hyper density lipoprotein (HDL) in hypertensive patients, and investigate whether MAU could be a predictor of HDL antioxidant activity. MethodFrom December 2007 to March 2009, sixty consecutive primary hypertensive patients from the inpatient and outpatient departments of West China Hospital and Sichuan Electric Power Central Hospital were included in the study, and 30 healthy volunteers served as controls. MAU, plasma HDL and paraoxonase (PON1) activity were tested. ResultsPON1 activity was lower in hypertensive patients than the controls (P<0.05), and this degree of decline was positively related to MAU (P<0.05). ConclusionMAU reflects PON1 activity in hypertensive patients and can be a predictor to judge plasma HDL function in patients with hypertension.
目的:探討老年原發性高血壓(EH)患者早期腎損害指標微量白蛋白尿(MAU)和動脈粥樣硬化的早期征象頸動脈內中膜厚度(C-IMT)之間的關系。方法:99名老年EH患者按尿白蛋白/肌酐比值(ACR)分為異常ACR組和正常ACR組,對兩組的C-IMT、斑塊發生率、ACR水平及血中尿素氮(Bun)、肌酐(Cr)、總膽固醇(TC)、甘油三酯(TG)、血糖(Glu)、體重指數(BMI)等進行分析和比較。結果:異常ACR組的年齡、尿酸、ACR、C-IMT、24小時平均收縮壓,平均動脈壓及脈壓均高于正常ACR組(Plt;0.05);且C-IMT與ACR水平呈正相關(Plt;0.05)。結論:微量白蛋白尿和頸動脈IMT密切相關,提示微量白蛋白尿不僅和老年高血壓腎臟病變有關,也是亞臨床期動脈粥樣硬化的早期標志.
目的 檢測血細胞減少患者外周血紅細胞和中性粒細胞細胞膜糖基磷脂酰肌醇（GPI）連接的補體調節蛋白衰變加速因子（CD55)和膜反應性溶血抑制物（CD59）表達情況，并探討其臨床意義。 方法 2006年7月－2011年3月，采用直接免疫熒光標記法流式細胞儀檢測182例血細胞減少患者外周血CD55及CD59表達情況，其中陣發性睡眠性血紅蛋白尿（PNH）9例，再生障礙性貧血（AA）-PNH綜合征8例，AA 83例，骨髓增生異常綜合征51例，自身免疫性溶血性貧血11例，造血功能停滯6例，缺鐵性貧血7例，巨幼細胞性貧血4例，脾功能亢進3例。 結果 PNH及AA-PNH患者CD55、CD59抗原缺失率均較其他血細胞減少者明顯增高。 結論 流式細胞儀檢測外周血中紅細胞和中性粒細胞膜CD55和CD59抗原表達缺失率是目前診斷PNH可靠和敏感的方法，也是對PNH、AA-PNH早期診斷敏感指標，并且PNH克隆檢測還能為診斷疾病提供鑒別診斷依據。