糖尿病肾病慢性炎症机制研究进展

侯显玥，杜柯锐，杨小娟*

延安大学附属医院肾内科，陕西 延安

收稿日期：2022年6月1日；录用日期：2022年6月24日；发布日期：2022年7月4日

摘 要

随着对糖尿病肾病(DKD)研究的不断深入，慢性炎症状态的地位越来越凸显。近年来，一种与天冬氨酸半胱氨酸蛋白水解酶(Caspase)-1相关的程序性细胞死亡机制，通过足细胞与肾小管上皮细胞的焦亡引起一系列炎症反应，最终导致肾功能恶化。肠道菌群异常在慢性肾脏病患者中致病证据越来越充分，其机制表现为菌群比例的失调(有害细菌增多、有益菌减少甚至缺如)，产生炎症因子及氧化应激产物。另外，内脂素(Visfatin)在DKD发生发展中均发挥作用，参与胰岛素抵抗、调控糖脂代谢、增强炎症反应等过程。同样，适应性免疫系统及相关细胞因子同样有重要作用，通过T细胞、B细胞及白细胞介素(interleukin,IL)-17A、白细胞介素(interleukin, IL)-2、肿瘤坏死因子(TNF)和肿瘤坏死因子(TNF)受体等细胞因子共同导致蛋白尿的产生、肾功能的恶化。因此，了解诱导慢性炎症的各类分子机制在糖尿病肾病发生以及发展中的作用，对糖尿病肾病的早期识别及治疗有重要意义。

关键词

糖尿病肾病，炎症，细胞焦亡，肠道菌群，内脂素，适应性免疫

Progress in the Study of Chronic Inflammatory Mechanism of Diabetic Nephropathy Xianyue Hou, Kerui Du, Xiaojuan Yang*

Department of Nephrology, Affiliated Hospital of Yan’an University, Yan’an Shaanxi Received: Jun. 1st, 2022; accepted: Jun. 24th, 2022; published: Jul. 4th, 2022

Abstract

With the continuous deepening of the study of Diabetic Kidney Disease (DKD), the status of chron-ic inflammation is becoming more and more prominent. In recent years, a programming cell death mechanism related to cyspase-1 is caused by the scorching of foot cells and renal tubular epithelial cells, which causes a series of inflammatory reactions and eventually leads to kidney function worsen. The inferior of the intestinal flora is increasingly sufficient in patients with chronic kidney disease, and its mechanism is manifested as the disorders of the flora ratio (increasing harmful bacteria, reduced beneficial bacteria, or even lack of), producing inflammatory factor and oxidation stimulating products. In addition, Visfatin played a role in the development of DKD to participate in the process of participating in insulin resistance, regulating sugar fat metabolism, and enhancing inflammatory response. Similarly, the adaptive immune system and related cytokine also have an important role, T cells, B cells and cytokines such as interleukin (IL)-17A, interleukin (IL)-2, tumor necrosis factor (TNF) and tumor necrosis factor (TNF) receptor jointly lead to the production of proteinuria and the deterioration of renal function. Therefore, understanding the role of various types of molecular mechanisms that induce chronic inflammation in the occurrence and development of diabetic nephropathy is of great significance for the early identification and treatment of diabetic nephropathy.

Keywords

Diabetic Kidney Disease, Inflammation, Pyroptosis, Gut Microbiota, Visfatin, Adaptive Immunity

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This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

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VSD负压引流联合纳米银敷料治疗3、4期 压力性损伤中的应用对比研究

许洋洋* ，陈树荣，田章萍，蔡晓燕，李 慧

盐城市亭湖区人民医院，江苏 盐城

收稿日期：2022年3月26日；录用日期：2022年4月21日；发布日期：2022年4月28日

摘 要

目的：研究VSD负压引流联合纳米银敷料在3、4期压力性损伤感染创面中的应用效果，为3、4期压力性损伤感染创面的患者制定合理的护理方案、评价护理效果提供依据。方法：选取2019年3月~2021年3月一年时间中，在我院就诊的3、4期压力性损伤患者320例，并将其平均分为两组，即观察组与对照组。前者采用的治疗方式为VSD负压引流技术联合纳米银离子敷料；后者使用VSD负压引流技术进行治疗。两组进行数据对比，对比的因素有临床治疗效果、换药次数与费用、创面愈合与肉芽组织生长时间。结果：观察组上述因素都明显低于对照组(P < 0.05)，其临床治疗有效率(86.88%)显著高于对照组(59.38%,P < 0.05)。结论：采用VSD负压引流技术联合银离子技术对3、4期压力性损伤患者进行治疗，可以减少换药次数以此来节省费用，同时患者所承受的疼痛也有很大程度降低，并且创面愈合速度更快，综上所述，其临床应用价值较高，值得进行推广。

关键词：VSD负压引流，纳米银敷料治疗，压力性损伤，促进创面愈合，临床治疗效果，应用对比研究

Comparative Application Study of VSD Negative Pressure Drainage Combined with Nano-Silver Dressing in the Treatment of Stage 3 and 4 Pressure Injuries

Yangyang Xu*, Shurong Chen, Zhangping Tian, Xiaoyan Cai, Hui Li

People’s Hospital of Tinghu District, Yancheng City, Yancheng Jiangsu

Received: Mar. 26th, 2022; accepted: Apr. 21st, 2022; published: Apr. 28th, 2022

文章引用: 许洋洋, 陈树荣, 田章萍, 蔡晓燕, 李慧. VSD 负压引流联合纳米银敷料治疗 3、4 期压力性损伤中的应用对比研究[J]. 临床医学进展, 2022, 12(4): 3529-3534. DOI: 10.12677/acm.2022.124512

Abstract

Objective: To study the application effect of VSD negative pressure drainage combined with nano-silver dressing in stage 3 and 4 pressure injury infected wounds, so as to provide basis for formulating reasonable nursing plan and evaluating nursing effect for patients with stage 3 and 4 pressure injury infected wounds. Methods: A total of 320 patients with stage 3 and 4 stress injury admitted to our hospital from March 2019 to March 2021 were randomly divided into observation group and control group, with 160 cases in each group. The control group was treated with VSD negative pressure drainage, and the observation group was treated with VSD negative pressure drainage combined with nano-silver ion dressing. Pain degree, dressing change times, dressing change cost, wound healing time, granulation tissue growth time and clinical treatment effect were compared between the two groups. Results: The number of dressing change, cost of dressing change, wound healing time, pain degree and granulation tissue growth time in the observation group were significantly lower than those in the control group (P < 0.05). The clinical effective rate in the observation group (86.88%) was significantly higher than that in the control group (59.38%, P < 0.05). Conclusion: We use VSD negative pressure drainage technology to combine silver ion technology to treat patients with stress injuries 3 and 4, which can reduce the number of changes to save costs large extent, and the wound healing is faster, at the same time, the pain of the patient has been greatly reduced, and the wound healing is faster. In summary, its clinical application is worth promoting.

Keywords：VSD Negative Pressure Drainage, Nano-Silver Dressing Treatment, Pressure Injury, Promote Wound Healing, Clinical Treatment Effect, Comparative Application Study

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糖尿病足合并类风湿性关节炎一例报道

周 甜1,2，邵小娟1 ，杜小东1,2，马卫国1 ，李 亚1*

1 西安医学院第一附属医院内分泌科，陕西 西安

2 西安医学院研究生院，陕西 西安

收稿日期：2022年4月27日；录用日期：2022年5月21日；发布日期：2022年5月30日

摘 要

本文报道2021年09月29日西安医学院第一附属医院内分泌科收治的1例62岁男性2型糖尿病足合并反复发热患者的诊疗过程。经过积极检查及诊疗临床诊断为糖尿病足合并类风湿性关节炎，且给予降温、抗感染、局部清创换药等治疗后，患足创面愈合良好。启示：临床上糖尿病足伴发热的原因主要为感染性疾病，但不局限于感染性疾病，自身免疫性疾病不易忽略，尤其在使用糖皮质激素治疗时。

关键词：糖尿病足，类风湿性关节炎，发热

A Case Report of Diabetic Foot Complicated with Rheumatoid Arthritis Tian Zhou1,2, Xiaojuan Shao1, Xiaodong Du1,2, Weiguo Ma1, Ya Li1*

1 Department of Endocrinology, The First Affiliated Hospital of Xi’an Medical College, Xi’an Shaanxi

2 Graduate School of Xi’an Medical College, Xi’an Shaanxi

Received: Apr. 27th, 2022; accepted: May 21st , 2022; published: May 30th, 2022

Abstract

This article reported on the diagnosis and treatment of a 62-year-old male patient with type 2 diabetic foot complicated with recurrent fever admitted to the Department of Endocrinology of the First Affiliated Hospital of Xi’an Medical University on September 29, 2021. After positive examination and diagnosis and treatment, the patient was clinically diagnosed as diabetic foot compli-cated with rheumatoid arthritis. After cooling, anti-infection, local debridement and dressing change, the wound healed well. Revelation: Clinically, diabetic foot with fever is mainly caused by infectious diseases, but not limited to infectious diseases. Autoimmune diseases are not easy to be ignored, especially when glucocorticoids are used for treatment.

Keywords：Diabetic Foot, Rheumatoid Arthritis, Fever

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内脏脂肪面积与2型糖尿病患者血管病变的相 关性研究进展

栾敬红* ，李社莉#

延安大学附属医院，陕西 延安

收稿日期：2022年1月16日；录用日期：2022年2月9日；发布日期：2022年2月18日

摘 要

在全球范围内2型糖尿病的患病率呈逐年上升趋势，目前我国糖尿病患病率达11.2% (WHO标准)或12.8% (ADA标准)。造成糖尿病大流行的原因是多方面的，包括人口老龄化、不健康饮食以及不良生活方式等。糖尿病及其慢性并发症带给患者及其家庭巨大的经济及心理负担，其中血管病变是最常见的糖尿病慢性并发症。有研究表示内脏脂肪与2型糖尿病的发生发展有关。内脏脂肪面积可能在糖尿病血管病变中起重要作用，通过研究两者关系，可以为临床早期防治糖尿病血管病变提供新思路。基于此，本文就内脏脂肪面积与2型糖尿病患者血管病变的相关性研究展开综述。

关键词：内脏脂肪面积，内脏脂肪组织，2型糖尿病，糖尿病血管病变

Progress in the Correlation between Visceral Fat Area and Vascular Lesions in Patients with Type 2 Diabetes

Jinghong Luan*, Sheli Li#

Yan’an University Affiliated Hospital, Yan’an Shaanxi

Received: Jan. 16th, 2022; accepted: Feb. 9th, 2022; published: Feb. 18th, 2022

Abstract

The prevalence of type 2 diabetes worldwide is increasing year by year. At present, the prevalence of diabetes in China is 11.2% (WHO standard) or 12.8% (ADA standard). The diabetes epidemic is driven by many factors, including ageing populations, unhealthy diets and poor lifestyles. Diabetes and its chronic complications bring enormous economic and psychological burden to patients and their families, among which vascular disease is the most common chronic complication of dietes. Studies have shown that visceral fat is related to the occurrence and development of type 2 diabetes. Visceral fat area may play an important role in diabetic vascular disease. The study of the relationship between the two can provide new ideas for early clinical prevention and treatment of diabetic vascular diseases. Based on this, this paper reviews the correlation between visceral fat area and vascular lesions in type 2 diabetes patients.

Keywords: Visceral Fat Area, Visceral Adipose Tissue, Type 2 Diabetes, Diabetic Vasculopathy

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糖尿病患者如何预防骨质疏松的研究进展

牛婷玉1* ，李小凤2#

1 西安医学院，陕西 西安

2 西安医学院附属陕西省人民医院，陕西 西安

收稿日期：2022年1月16日；录用日期：2022年2月9日；发布日期：2022年2月21日

摘 要

糖尿病(Diabetes)是一类以高血糖为特征可影响全身多个脏器和系统的慢性疾病，不仅使患者心血管、肾脏病等发病风险升高，也与骨质疏松的发生发展密切相关。骨质疏松一旦发生不可逆转，最终甚至演变为骨折的结局，给患者治疗和康复造成很大困难，因此早期预防至关重要。若能采取有效预防方法，就能降低糖尿病骨质疏松的患病率，减少患者痛苦、提高生活质量。本文主要就现阶段糖尿病患者如何预防骨质疏松的研究进展予以总结。

关键词：糖尿病，骨质疏松，预防方法

文章引用: 牛婷玉, 李小凤. 糖尿病患者如何预防骨质疏松的研究进展[J]. 临床医学进展, 2022, 12(2): 1178-1185.

DOI: 10.12677/acm.2022.122171

Research Progress on How to Prevent Osteoporosis in Diabetic Patients Tingyu Niu1*, Xiaofeng Li2#

1 Xi’an Medical University, Xi’an Shaanxi

2 Shaanxi Provincial People’s Hospital Affiliated to Xi’an Medical University, Xi’an Shaanxi

Received: Jan. 16th, 2022; accepted: Feb. 9th, 2022; published: Feb. 21st, 2022

Abstract

Diabetes is a chronic disease characterized by hyperglycemia that affects multiple organs and systems throughout the body. It not only increases the risk of cardiovascular and renal diseases, but also is closely related to the occurrence and development of osteoporosis. Once osteoporosis occurs irreversibly, it may even evolve into fracture, which causes great difficulties for the treatment and rehabilitation of patients. Therefore, early prevention is crucial. If effective prevention methods can be adopted, the prevalence of diabetic osteoporosis can be reduced, the pain of patients can be reduced, and the quality of life can be improved. This article mainly summarizes the research progress of how to prevent osteoporosis in diabetic patients at present.

Keywords：Diabetes Mellitus, Osteoporosis, The Prevention Methods

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Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Study of 82 Patients and Review of the Literatures

Ehab Mohammed1, Issa Al Salmi1,2* , Dawood Al Riyami3, Saif Khan3, Marwa Al Riyami4, Fatma Al Rahbi1, Suad Hannawi5

1 The Renal Medicine Department, The Royal Hospital, Muscat, Oman

2 The Medicine Department, Oman Medical Specialty Board, Muscat, Oman

3 The Renal Medicine Department, SQUH, Muscat, Oman

4 The Pathology Department, SQUH, Muscat, Oman

5 The Medicine Department, MOHAP, Dubai, UAE

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How to cite this paper: Mohammed, E., Al Salmi, I., Al Riyami, D., Khan, S., Al Riyami, M., Al Rahbi, F. and Hannawi, S. (2022) Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Study of 82 Patients and Review of the Literatures. Open Journal of Nephrology, 12, 169-186. https://doi.org/10.4236/ojneph.2022.121017

Received: February 25, 2022

Accepted: March 25, 2022

Published: March 28, 2022

Copyright © 2022 by author(s) and Scientific Research Publishing Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/

Abstract

Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patients, however there is a great discrepancy between countries. The aim of the present study is to evaluate the findings of kidney biopsies performed on diabetic patients.

Materials and Methods: We studied native kidney histopathological findings in the period from January 2016 till end of December 2018 done for patients with T2DM with chronic kidney diseases-CKD.

Results: A total of 82 DM-patients, 50 males (61%) and 32 females (39%) with age mean (95% CI) of 50.8 (47.1 - 55.2) years for all patients, ranged between 15 to 65 years. Histological findings showed that 57.3% of patients had DN. While focal-segmental-glomerulosclerosis-FSGS was present in 20.7%—primary in 8.6% and secondary in 12.1%. IgA represented 4.9%, while Lupus nephritis, Membranous and drug induced interstitial nephritis were each present in 3.7%. MCD was present in 2.4%. Lastly diffuse proliferative GN, ANCA associated glomerulonephritis, and hypertensive nephrosclerosis accounted for 1.2%.

Conclusion: The prevalence of NDKD is remarkably frequent in DM patients who underwent kidney biopsy and FSGS was the most frequent diagnosis. To get a proper histopathological diagnosis, an adequate tissue biopsy is needed with an adequate number of glomeruli. There is a great need for more consideration to biopsy diabetic patients, as the finding of NDKD requires a different therapeutic approach. This, hopefully, will help to manage these patients better and therefore, ameliorate the progression to ESKD over time and therefore delay the need for RRT.

Keywords

Diabetic Nephropathy, Diabetic Kidney Disease, Histopathology, Light Microscopy, Electron Microscopy, Immunofluorescence, Non-Diabetic Kidney Diseases, Renal Replacement Therapy (RRT)