Objective To assess the effectiveness and safety of breviscapine on diabetic nephropathy. Methods All randomized or quasi-randomized controlled trials of breviscapine on diabetic nephropathy were performed. All of the clinical trials were searched from the Cochrane Controlled Trials Registered, Medline, Embase, National Knowledge Infrastructure Database, the Chinese Biological Medicine Database, the Chinese Science and Technology Journal Full-text and the references of all included trials. The selection of studies, assessment of methodological quality and data extraction were performed independently by two reviewers according to predefined inclusion and exclusion criteria. Results Thirty-three clinical trials including 2 322 patients of diabetic nephropathy met the inclusion criteria. But most included trials were of low quality and small sample. Until now, there were no clinical trials with multicentre, large sample and high quality. A “Funnel plot” showed asymmetry, which indicated possible publication bias and low quality in methodology. And publication bias showed that the trials with negative results might not be published. The results of meta-analysis indicated that: 1. Breviscapine showed more effects on the decrease of the 24-hour urinary albumin excretion rate (UAER), 24-hour urinary protein, serum creatinine (Scr), total cholesterol, triglyceride, plasma viscosity and fibrinogen. 2. Breviscapine showed less effect on the decrease of the 24-hour urinary protein when compared to angiotensin-converting enzyme inhibitor, it seemed as same effective as ACEI on decrease of 24-hour urinary albumin excretion rate (UAER), serum creatinine (Scr) and blood urea nitrogen (BUN); 3. Breviscapine showed more effect on the decrease of 24-hour urinary protein and fibrinogen when compared to other Chinese herbal medicine (Salvia miltiorrhiza); 4. Breviscapine showed less effect on decrease of the 24-hour urinary albumin excretion rate (UAER) when compeard to Prostaglandin E1. No significant adverse effects were reported. Conclusion Breviscapine shows some effects and relatively safe on diabetic nephropathy. However, the evidence is not b enough because of some of the low-quality trials and publications bias. Rigorous designs, randomized, double-blind, placebo-controlled trials of Breviscapine for diabetic nephropathy are needed to further assess the effect.
Diabetic kidney disease (DKD) is a major complication of diabetes mellitus. One third of patients with advanced diabetes mellitus can develop to uremia, which seriously endangers people’s health. In recent years, with the improvement of people’s living standards and the increasing incidence of diabetes, it has become the main cause of end stage renal disease in China. Over the past two decades, the understanding of diagnosis and treatment of DKD has been improved, such as putting forward the new concept of normoalbuminuric DKD and developing a variety of new anti-diabetic drugs. However, at present, the basic strategies of DKD treatment are still lifestyle modification, glucose control, blood pressure control and lipid control.
【摘要】 目的 探讨男性和女性糖尿病肾病患者危险因素之间的差异。方法 收集2004年1月—2008年12月以糖尿病肾病为诊断的住院患者1 300例,根据入院日期以系统的方法随机纳入650例患者,排除20例尿常规正常和血肌酐值正常的患者,共630例,其中男342例,女288例,平均年龄65岁。288例女性患者中有271例为绝经后妇女,平均年龄48岁。比较女性和男性糖尿病肾病患者危险因素的差别。结果 ①绝经后糖尿病肾病患者占女性患者的94.1%；②女性糖尿病肾病患者组收缩压、脉压及糖化血红蛋白水平高于男性糖尿病肾病患者组,两者有统计学意义(Plt;0.05)；③两组患者在发病年龄,病程,糖尿病家族史,空腹血糖水平,低密度脂蛋白,高密度脂蛋白,血肌酐,24 h尿蛋白定量、是否使用血管紧张素转换酶抑制剂,血管紧张素受体拮抗剂,胰岛素,是否透析,死亡率均无统计学意义(Pgt;0.05)。结论 在女性糖尿病肾病患者中绝经后妇女所占比例较高,女性糖尿病肾病患者收缩压、脉压及糖化血红蛋白水平均高于男性糖尿病肾病患者,雌激素的水平可能导致差异的产生。
In the management of diabetic nephropathy patients with hemodialysis, diabetes link nurse (DLN) can realize the continuity of nursing management, simplify the communication between multiple disciplines, and play multiple roles such as relieving patients’ psychology, participating in scientific research and clinical management. In this paper, by introducing the origin and development status of DLN in foreign countries, and summarizing the function and clinical contribution of DLN in the management of diabetic nephropathy hemodialysis patients. This article combines the current development status of DLN in China, to arouse the attention of clinical nursing colleagues, and provide some reference for the management of diabetic nephropathy patients with hemodialysis and the training of DLN in China.
ObjectiveThis study applied Mendelian randomization to explore the potential causal relationship between inflammatory factors and diabetic nephropathy. MethodsSummary-level data from genome-wide association studies of inflammatory factors and diabetic nephropathy were used, and inverse variance weighted analysis was used as the primary analytical method, complemented by results from weighted median, MR-Egger regression, simple model, and median model approaches. Sensitivity analysis was used to test the reliability of the MR analysis results. ResultsIn the inverse variance weighted method, stem cell factor (OR=1.28, 95%CI 1.04 to 1.58, P=0.020) and interferon-γ (OR=1.36, 95%CI 1.10 to 1.70, P=0.005) were positively correlated with diabetic nephropathy, and diabetic nephropathy was positively correlated with interferon-inducible protein 10 (OR=0.90, 95%CI 0.83 to 0.98, P=0.012) were negatively correlated with diabetic nephropathy. Sensitivity analysis showed that MR analysis was reliable. ConclusionStem cell factors and interferon-γ are associated with an increased risk of developing diabetic nephropathy, and diabetic nephropathy decreases the expression of interferon-inducible protein 10 in vivo. Our results demonstrate a potential causal relationship between inflammatory factors and the development of diabetic nephropathy. This finding is of clinical significance for the pre-diagnosis and treatment of diabetic nephropathy.
目的:观察采用疏血通注射液联合ACEI/ARB治疗早期糖尿病肾病(DN)的疗效。方法:将78例2型DN患者随机分为对照组(ACEI/ARB)和治疗组(ACEI/ARB+疏血通注射液),疗程4周。比较两组治疗前和治疗后尿微量白蛋白(mAlb),Scr、BUN等指标的变化。结果:(1)治疗后治疗组和对照组尿白蛋白均显著下降(Plt;0.01,Plt;0.05),治疗组比对照组下降更为明显(Plt;0.05)。(2)治疗后两组血浆白蛋白均增加(Plt;0.01),治疗组与对照组治疗后比较无明显差异(Pgt;0.05)。(3)治疗后两组Scr、BUN、TC、TG和血钾均无明显变化。结论:联合应用疏血通注射液能有效减少早期DN患者的蛋白尿,改善肾功能。
ObjectiveTo investigate the protective effect of Roux-en-Y gastric bypass surgery on early damage of renal tissue in type 2 diabetes mellitus rats, and explore the mechanism of the protective effects. MethodsDiabetes mellitus animal models were induced by intraperitoneal injection of streptozotocin (STZ, 35 mg /kg) and a high-fat diet.Diabetic rats were divided into three groups randomly (digital table method): diabetes control group (n=8), sham operation group (n=8), and Roux-en-Y gastric bypass group (n=14).Another 8 normal SD rats as the normal control group.The fasting blood glucose, serum total cholesterol (TC), triglyceride (TG), and free fatty acid (FFA) were measured before operation and in 8 weeks after operation; plasma BUN and Cr were measured respectively before operation and in 4 and 8 weeks after operation in each group rats, 24 h urine microalbumin and urine 8-hydroxydeoxyguanosine were measured respectively before operation and in 8 weeks after operation in each group rats.Renal pathological changes were observed and the indexes of kidney hypertrophy, the mean glomerular area (MGA), and the mean glomerular volume (MGV) were analyzed in 8 weeks after operation.The expressions of fibronectin, typeⅣcollagen (CoⅣ), transforming growth factor-β1 (TGF-β1), intercellular adhesion molecule-1(ICAM-1), nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4), and Bcl-2 protein in renal tissues were investigated by immunohistochemical staining. ResultsRoux-en-Y gastric bypass surgery could reduce the blood glucose, blood lipid, MGA, MGV, and the index of kidney hypertrophy of diabetic rats significantly (P < 0.05), improved renal pathological morphology and kidney function (P < 0.05), reduced the protein expressions of fibronectin and CoⅣ, decreased the protein expressions of TGF-β1, ICAM-1, and NOX4, and increased the protein expression of Bcl-2. ConclusionRoux-en-Y gastric bypass surgery can improve kidney function and the pathological damage of diabetes rats, its mechanism may be related to inhibition the protein expressions of TGF-β1, ICAM-1, and NOX4, and increase the protein expression of Bcl-2.