Abstract:Vascular complications of type 1 diabetes mellitus (T1DM), clinically manifested as microvascular and macrovascular complications, are the most important causes of patients death and disability. Poor glycemic control and elevated glycosylated hemoglobin (HbA1c) levels are the main risk factors for the development of vascular complications.Intensive hypoglycemic therapy can be used as a tertiary prevention method for T1DM patients to prevent vascular complications. Studies including new oral hypoglycemic agents and stem cell therapy for T1DM vascular complications have been started. It is expected to provide more methods and evidence-based medical evidence for the prevention and treatment of T1DM vascular complications. Deep understanding of the mechanism of occurrence and development of T1DM vascular complications is of great significance for the prevention and treatment of cardiovascular events in T1DM patients.

Abstract:Diabetes is a group of metabolic diseases characterized by disorders of glucose metabolism, which are caused by a variety of environmental and genetic causes. Diabetic nephropathy (DN) is the most common and severe chronic comorbidity in patients with diabetes. At present, diabetic nephropathy accounts for about 40% of diabetic patients, and is the main cause of chronic kidney disease (CKD) worldwide. At present, China is already the worlds largest country with diabetes and a country with diabetic nephropathy. This article reviews the new research progress in the diagnosis and treatment of diabetic nephropathy. Designed to provide the latest information on DN diagnosis and treatment.

Abstract:IgAN is the most common primary glomerular disease in China. It can occur at any age and progress chronically. Current data show that about 20%~40% of patients develop to end-stage kidney in 10~20 years. There are many factors contributing to the progress of IgAN. In addition to the recognized immune factors, many metabolic factors such as body mass index, insulin resistance and hyperuricemia have been reported in recent years, which are also related to the progress of IgAN. IgAN is not uncommon in patients with high BMI and kidney diseases, which are not all obesity-related nephropathy. This paper reviews the correlation between high BMI index and IgAN.

Abstract:Aim To investigate the effects of acupuncture combined with Tangke apozem on transforming growth factor-β1 (TGF-β1), matrix metalloproteinase-9 (MMP-9) and connective tissue growth factor (CTGF) in diabetic nephropathy rats. Methods 54 SPF SD male rats were selected, and 8 of them were randomly selected as control group. The remaining rats were subjected to diabetic nephropathy (DN) model replication, one-time rat tail vein injection of streptozotocin. Rats were randomly divided into model group, irbesartan group, acupuncture combined with Tangke apozem group (acupuncture combined with traditional Chinese medicine group), Tangke apozem treatment group (Chinese medicine group) and acupuncture group. Observe the general condition of the rats, and measure body weight, blood sugar, kidney weight/body weight, 24-hour urine protein, blood urea nitrogen (BUN), serum creatinine (SCr), triglyceride (TG) and total cholesterol (TC); HE staining, Masson staining and glycogen staining (PAS) were used to observe changes in renal tissue morphology; The protein expression levels of TGF-β1, MMP-9, collagen Ⅰ, CTGF, and TIMP-1 in kidney tissues were detected by Western blot method. Results Compared with the model group, the weight, kidney weight/body weight ratio, 24 h urine protein, BUN, SCr, TG, TC of the acupuncture combined with traditional Chinese medicine group, Chinese medicine group and irbesartan group were significantly improved, and the combination of needle and medicine was more remarkable. The acupuncture group slightly improved. The expression levels of TGF-β1 and CTGF protein were significantly decreased. The expression of TIMP-1 was down-regulated by adjusting the protein expression of MMP-9, and the hydrolysis of Collafen Ⅰ was accelerated. The expression of TGF-β1, CTGF and TIMP-1 in the acupuncture combined with traditional Chinese medicine group was significantly lower than that in the traditional Chinese medicine or irbesartan group, and the expression of MMP-9 was increased. The acupuncture combined with traditional Chinese medicine group was more effective than the Chinese medicine group and the Western medicine group. Conclusions Acupuncture combined with Tangke apozem has obvious therapeutic effect compared with traditional Chinese medicine group. It can effectively regulate the expression of TGF-β1, MMP-9 and CTGF, reduce glomerular sclerosis, reduce proteinuria and prevent renal function, and protect DN lesions. The progress has been delayed.

Abstract:Aim To evaluate the association between left ventricular end-diastolic pressure (LVEDP) and contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). Methods Single center clinical data of patients who underwent PCI were retrospectively analysed to explore the predictive value of LVEDP for the occurrence of CIN. Results Among 1 301 patients who underwent PCI during the study period, 125 patients (9.61%) developed CIN. Risk factors for CIN included age, female, chronic kidney disease, history of diabetes mellitus, anemia, heart failure and emergencies in our study cohort. Compared with non-CIN group, the average LVEDP was higher in patients with CIN after PCI ((18.4±8.7) mmHg vs (14.4±6.6) mmHg, P<0.001). Multiple regression analysis showed that LVEDP (≥20 mmHg) could independently predict the occurrence of CIN (OR 1.6,5%CI 1.08～1.47). The predictive value of LVEDP for CIN was enhanced in patients with low ejection fraction. Contrast dosage in high-risk patients determined by elevated LVEDP was comparable to that in patients not found. Conclusions LVEDP is an independent predictor for CIN. Patients with elevated LVEDP (≥20 mmHg) are at higher risk of CIN after PCI. In CIN prevention, high-risk patients defined by elevated LVEDP need to be noticed by clinicians.

Abstract:Aim To find risk factors of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in elderly diabetic patients with acute coronary syndrome (ACS). Methods 134 cases of elderly diabetic patients with ACS (≥65 years old) was involved in this study. In the same period, 145 cases of PCI patients without diabetes were used as controls. The age, preoperation brain natriuretic peptide (BNP), ejection fraction, 25 hydroxyvitamin D, estimated glomerular filtration rate (eGFR), blood albumin and so on were compared between the two groups. Multifactor logistic regression analysis was used to find risk factors of CIN. Results 17 cases of CIN were found in 134 cases of patients with diabetes after PCI, the incidence was 12.6%. In 145 elderly patients without diabetes, there were 13 cases of CIN, with an incidence of 8.9%, there was no statistically significant difference between the two groups (P＞0.05). Statistically difference was found in gender and perioperative use of ACEI/ARB between two groups (P<0.05). Preoperation BNP, fibrinogen, platelet volume distribution of the diabetes group was higher than non-diabetic, 25 hydroxyvitamin D was lower than non-diabetic group (P<0.05). Loistic regression analysis showed that fibrinogen and 25 hydroxyvitamin D were the risk factors of CIN for elderly diabetic patients with acute coronary syndrome after PCI. Preoperative fibrinogen elevation increased the risk of CIN (OR=3.3,5%CI 1.353～6.845, P=0.007), 25 hydroxyvitamin D reduction increased the risk of CIN (OR=0.5,5%CI 0.282～0.833, P=0.009). Conclusion The risk of CIN was increased when preoperative fibrin was elevated and 25 hydroxyvitamin D was decreased in elderly diabetes mellitus patients with acute coronary syndrome after PCI.

Abstract:Aim To investigate the relationship between serum uric acid on admission and incidence of contrast-induced nephropathy (CIN) in patients with coronary heart disease complicated with diabetes mellitus. Methods A total of 150 patients with coronary heart disease complicated with diabetes mellitus were divided into two groups:control group (n=95) and increased serum uric acid group (n=55). The incidence of CIN was compared between the two groups and the risk factors of CIN were analyzed by Logistic regression. Results The incidence of CIN in 55 patients with increased serum uric acid was 27.27% (15/55),and it was significantly higher than that in patients with normal serum uric acid [10.53%(10/95), P=0.008]. Multivariate Logistic regression analysis revealed that the independent risk factors of CIN were serum uric acid (OR 1.7,5% confidence interval:1.001～1.013, P=0.014) and contrast dosage (OR 1.5,5% confidence interval:1.017～1.054, P=0.000). Conclusion Increased serum uric acid on admission is independently associated with higher risk of CIN among patients with coronary heart disease complicated with diabetes mellitus.

Abstract:Aim To investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods A total of 261 consecutive patients with acute myocardial infarction undergoing PCI in our hospital from March 2014 to May 2016 were enrolled in this study. Patients were divided into NAFLD group (n＝117) and non-NAFLD group (n＝144) based on the diagnosis of B-mode ultrasound. CIN was defined as≥44.2 μmol/L or ≥25％ increase from baseline serum creatinine within 48～72 hours after contrast medium exposure, and that was not attributable to other causes. The following data were recorded:the baseline measurements, blood urea nitrogen, serum creatinine levels before PCI and 1,2 and 3 days after PCI, estimated glomerular filtration rate (eGFR), the contrast volume and coronary pathological features after PCI. Risk factors for CIN were determined by multivariate Logistic regression analysis. Results CIN occurred in 16.5% (43/261) of patients, and incidence of CIN was significantly higher in the NAFLD group than that in the non-NAFLD group [23.93%(28/117) vs. 10.42% (15/144), P＝0.003]. Compared with adverse events in the hospital, the incidence of acute heart failure in NAFLD group was higher (P＜0.05). Multivariate Logistic regressive analysis showed that NAFLD (OR＝2.18), diabetes (OR＝2.42), contrast volume (OR＝2.44) were risk factors for the incidence of CIN. Conclusion NAFLD is the independent risk predictor of CIN in patients with AMI undergoing PCI.

Abstract:Aim To investigate the clinical value of neutrophil gelatinase-associated lipocalin (NGAL) for the early diabetic nephropathy(DN), and further explore the relationship of NGAL and atherogenic index of plasma. Methods 120 cases of patients with diabetes mellitus were divided into 2 groups according to the urinary albumin creatinine ratio(UA/Cr). In addition, there is a control group including 60 cases of healthy subjects. NGAL, hypersensitive c-reactive protein (hs-CRP) and lipid related indicators of all cases were measured and the atherogenic index of plasma (AIP) was calculated. The changes of NGAL, hs-CRP, AIP were compared and analyzed. All cases were divided into three groups according to the three digits of AIP. The changes of NGAL and hs-CRP were analyzed. Simple linear correlation and multiple linear regression analysis were performed for all variables. Results The level of NGAL, AIP and hs-CRP in normal albuminuria group and DN group was significantly increased compared with control group(P<0.001). The level of NGAL, AIP and hs-CRP in DN group was significantly increased compared with normal albuminuria group(P<0.001).Serum NGAL level increased obviously as the rise of the AIP three digits. AIP were positively correlated with hs-CRP and NGAL(r=0.296, 0.313, P<0.05). Independent influencing factors for AIP were NGAL and hs-CRP. Conclusion NGAL is an index for early DN. NGAL is an acute phase reaction protein which is involved in the development of atherosclerosis in diabetic nephropathy.

Abstract:Aim To study the beneficial effects of high dose atorvastatin sequential treatment in preventing contrast-induced nephropathy (CIN) in acute non-ST-segment elevation acute myocardial infarction (NSTEMI) patients underwent elective percutaneous coronary intervention (PCI). Methods One hundred patients with NSTEMI undergone elective PCI were randomly divided into two groups:high dose atorvastatin sequential treatment group (sequential treatment group for short) and control group. All patients were given 80 mg atorvastatin instantly and then 40 mg once a day. On the basis of hydration therapy, sequential treatment group received additional 40 mg atorvastatin at 6 hours before PCI. Serum creatinine (Scr), endogenous creatinine clearance rate (Ccr) and the incidence rate of CIN were measured and compared 24 hours and 48 hours post-PCI. Results The levels of Scr, Ccr had no significant difference in the two groups at all time points. Compared with the preoperative, Scr and Ccr had no significant changes postoperatively in sequential treatment group. In control group, Scr and Ccr had no significant change 24 hours postoperatively, Scr had significantly increased, Ccr had significantly decreased after 48 hours (P＜0.05). Compared with 24 h postoperatively, Scr had significantly increased, Ccr had significantly decreased (P＝0.00). Scr decreased to the normal range after 7~10 days in all patients with CIN. The CIN incidence rate had no significant difference in the two groups (16% vs. 15%, P＝0.585). Conclusion For patient who had used lipid-lowering program before PCI:40 mg/d atorvatatin, the strategy of re-load atorvastatin 40 mg can not reduce the CIN incidence rate.