OBJECTIVETo investigate the relationship of Chinese medicine syndrome pattern with urinary albumin excretion rate (UAER) and its related factors in patients with diabetic nephropathy (DN).

METHODSSixty-three early stage DN patients were subjected to the study, the Chinese medicine syndrome patterns were differentiated, and their condition of methylene tetrahydrofolate reductase (MTHFR) C677T mutation was detected (shown by gene polymorphism of 677 base pairs). Meantime, plasma levels of homocysteine (Hcy), folic acid, fasting and postprandial glucose (FG and PG), glycohemoglobin (HbA1c), blood lipids as well as UAER were measured.

RESULTSSyndrome pattern was differentiated as yin-deficiency with heat-flourishing in 17 patients, qi-yin deficiency in 24, and yin-yang deficiency in 22; while accompanied blood stasis syndrome (BSS) was found in 35. Gene polymorphism detection indicated that 19 patients were of CC-type, 17 of TT-type, and 27 of CT-type. Analysis showed that higher UAER level often revealed in patients with BSS, as compared with that in patients of non-BS pattern, the difference was statistically significant (P < 0.05). UAER levels in patients of different genotypes were insignificantly different (P > 0.05), but showed a linear regressive relation, namely positively correlated with Hcy level in patients of isogeneic type (r = 0.674, P < 0.05). No statistical significance was found between levels of UAER and other related factors (P > 0.05).

CONCLUSIONUAER level in early stage DN patients of BSS pattern is rather higher, and it shows a linear regression relationship (positive correlation) with Hcy level in patients of isogeneic type.

Adult ; Aged ; Albuminuria ; physiopathology ; Diabetic Nephropathies ; genetics ; physiopathology ; urine ; Diagnosis, Differential ; Female ; Homocysteine ; blood ; Humans ; Male ; Medicine, Chinese Traditional ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Middle Aged ; Polymorphism, Genetic

OBJECTIVETo explore the relationship between Chinese medicine syndrome patterns (CMSP) and their associated factors in patients with type 2 diabetic nephropathy stage III (DN2-3).

METHODSRetrospective analysis was conducted on 209 patients with type 2 diabetes mellitus (T2DM). The patients were allocated into two groups, the DN2-3 group and the control group. Some related clinical materials and laboratory indexes, including age, course of disease, body mass index (BMI), glycosylated hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood levels of total cholesterol (TC), triglyceride (TG), high and low density lipoprotein (HDL and LDL), serum creatinine (Scr) and microalbuminuria (MALB) as well as their CMSP (both the essential syndrome and the superficial syndrome) in the DN2-3 group were collected and compared.

RESULTSSignificant differences were found between the DN2-3 group and the control group in aspects of course of disease (months, 107.74 +/- 96.19 vs. 82.03 +/- 79.10), BMI (kg/m2, 26.25 +/- 4.02 vs. 24.95 +/- 3.56) and Scr level (mmoL/L, 71.93 +/- 24.24 vs. 65.91 +/- 13.70, P < 0.05). The qi-yin deficiency SP (38 cases, 36.19%), and the blood stasis (51 cases, 48.58%) presented as the dominant essential and superficial CM-SP respectively in DN2-3 patients, holding the highest proportion. Analysis on the relationship of associated indices among patients with different CMSP showed statistical differences presented in level of MALB, i.e. which in pi-shen qi-deficiency SP (128.77 +/- 103.59 mg/24 h) was higher than in yin-deficiency dryness-fire SP and qi-yin deficiency SP (88.43 +/- 68.93 mg/24h and 82.60 +/- 55.22 mg/24 h, P < 0.05); it also presented in HbA1c (%) and TG levels(mmol/L), those in stasis SP were 10.73 +/- 2.71 and 2.29 +/- 1.58 ), in dampness SP were 8.80 +/- 2.19% and 4.37 +/- 5.92, and in stasis-phlegm SP were 8.83 +/- 2.09 and 2.40 +/- 2.18 (all P < 0.05).

CONCLUSIONSThe risk factors for occurrence of DN2-3 may be the course of disease, BMI and Scr. Qi-yin deficiency with blood-stasis is the most commonly encountered syndrome in patients with DN2-3. Relations of MALB with Pi-Shen qi-deficiency pattern; HbA1c with blood-stasis pattern, and TG with dampness syndrome are distinctly exhibited in them.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Albuminuria ; physiopathology ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Nephropathies ; physiopathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Retrospective Studies ; Young Adult

BACKGROUND/AIMS: Diabetic cystopathy is a frequent complication of diabetes mellitus. This study assessed the association between the post-voiding residual (PVR) urine volume and diabetic nephropathy in type 2 diabetics with no voiding symptoms. METHODS: This study investigated 42 patients with type 2 diabetes who were followed regularly at our outpatient clinic between July 1, 2008 and June 30, 2009. No patient had voiding problems or International Prostate Symptom Scores (IPSSs) > or = 12. An urologist performed the urological evaluations and the PVR was measured using a bladder scan. A PVR > 50 mL on two consecutive voids was considered abnormal, which was the primary study outcome. RESULTS: The mean patient age was 60 +/- 10 years; the IPSS score was 3.7 +/- 3.3; and the diabetes duration was 11.9 +/- 7.8 years. Seven of the 42 patients (16.7%) had a PVR > 50 mL. The presence of overt proteinuria or microalbuminuria was associated with an increased risk of a PVR > 50 mL (p < 0.01). Patients with a PVR > 50 mL had a significantly lower estimated glomerular filtration rate (eGFR) compared with those with a PVR < or = 50 mL (59.2 +/- 27.1 mL/min/1.73 m2 vs. 28.7 +/- 23.3 mL/min/1.73 m2; p < 0.001). Multivariate logistic analysis revealed that a lower eGFR (odds ratio, 0.94; 95% confidence interval, 0.88 to 0.99; p = 0.04) was a significant risk factor for a PVR > 50 mL. CONCLUSIONS: Patients with diabetic nephropathy had a significantly higher PVR and a lower eGFR was associated with an abnormal PVR.
Adult ; Aged ; Aged, 80 and over ; Diabetes Mellitus, Type 2/*complications/diagnosis ; Diabetic Nephropathies/diagnosis/*etiology/physiopathology ; Female ; *Glomerular Filtration Rate ; Humans ; Kidney/*physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Outpatient Clinics, Hospital ; Republic of Korea ; Risk Factors ; Time Factors ; *Urodynamics

PURPOSE: To screen for diabetic autonomic neuropathy of the pupil using 0.5% apraclonidine and 0.1% pilocarpine and to evaluate the early diagnostic value of this pharmacologic pupillary test by assessing the relationship between pupillary and cardiovascular autonomic neuropathies. METHODS: A total of 22 diabetic patients were recruited. Baseline pupillary diameter (PD) and the difference in PD between the test eye and the control eye before and after instillation of apraclonidine and pilocarpine were measured. All patients also underwent cardiovascular autonomic function (CAF) testing. RESULTS: Baseline PD in room light correlated with duration of diabetes mellitus (DM, p=0.049) and the presence of DM retinopathy (DMR, p=0.022). Eleven patients (50%) had positive apraclonidine tests, and two patients had positive pilocarpine tests. The patients who had positive pilocarpine tests also had positive apraclonidine tests. Patients who had a positive pupillary test had a significantly higher rate of positive CAF tests (p=0.032). CONCLUSIONS: Pupillary autonomic neuropathy was related to the duration of diabetes and the degree of DMR. There was also a significant correlation between pupillary autonomic neuropathy and cardiovascular autonomic neuropathy (CAN). Also, sympathetic nerve dysfunction occurred prior to parasympathetic dysfunction in this study. A simple pharmacologic pupillary test can help manage complications in diabetic patients because patients with pupillary autonomic dysfunction have an increased risk of CAN.
Adrenergic alpha-Agonists/administration & dosage/diagnostic use ; Adult ; Aged ; Clonidine/administration & dosage/*analogs & derivatives/diagnostic use ; Diabetic Nephropathies/*diagnosis/physiopathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Miosis/*chemically induced/physiopathology ; Miotics/administration & dosage/diagnostic use ; Ophthalmic Solutions ; Pilocarpine/administration & dosage/*diagnostic use ; Pupil/drug effects/*physiology ; Reproducibility of Results