Objective The aim of this study was to evaluate the efficacy and side effects of sacubitril/valsartan in the treatment of patients with chronic kidney disease(CKD)at stage 5 with resistant hypertension,and to explore the cardiovascular benefits and security of medical in the patients.Methods Patients with CKD5 resistant hypertension diagnosed and treated in the First Affiliated Hospital of Guangxi Medical University from September 2020 to March 2022 were selected and divided into the observation group(treated with routine treatment of kidney disease at end-stage and sacubitril/valsartan)and control group(include droutine treatment of renal disease at end-stage and ACEI or ARB drugs)according to treatment strategy.The patients in both two groups were treated with adequate dialysis treatment and conventional drug treatment of renal disease at end-stage.The patients were followed up for at least 3 months,the clinical efficacy of three months after treated with sacubitril/valsartan was observed,and the efficacy indicators and security indicators and adverse cardiovascular events were observed,the occurrence of adverse effects during the period of drug use were compared with the control group.Results A total of 110 patients were included in this study and there were 55 cases in each group.There were no significant differences in gender,age,age of dialysis,etiology,dialysis mode and blood pressure between the two groups(P>0.05).The Systolic blood pressure(SBP),diastolic blood pressure(DBP),b-type urinary natriuretic peptide precursor(Pro-BNP)and cardiac function grade in the observation group after treatment was significantly decreased compared with before treatment.The left ventricular ejection fraction(LVEF)and the ratio of LVEF<50%in the observation group was significantly reduced after treatment(P<0.05).SBP,DBP and Pro-BNP decreased 3 months after treatment compared with the baseline before treatment,and improved significantly in the first month after treatment(P<0.05).The decrease of DBP and BNP before and after treatment was significantly different between the two groups,and the decrease of DBP and BNP was more significant in the observation group(P<0.05).The difference of LVEF and left ventricular end diastolic diameter(LVEDD)between the two groups before and after treatment was statistically significant,and the improvement was more obvious in the observation group(P<0.05).There were no significant differences in the safety indicators of serum potassium,estimated glomerular filtration rate(eGFR)and liver function between two groups before and after treatment(P>0.05).In terms of adverse reactions,only 1 case in the control group developed hyperkalemia within 3 months of follow-up,and no hypotension or other adverse reactions occurred in the two groups.Conclusions The treatment of patients with CKD stage 5 hypertension with sacubitril/valsartan has obvious cardiovascular benefits.Sacubitril/Valsartan has efficacy in lowering blood pressure,improving cardiac function and reducing volume load,with less adverse events and higher safety than control group.

Objective: To construct and confirm a predictive model for the risks of cardiovascular diseases (CVD) with metabolic syndrome (MS) and its factors in Xinjiang Kazakh population. Methods: A total of 2 286 Kazakh individuals were followed for 5 years from 2010 to 2012 as baseline survey. They were recruited in Xinyuan county, Yili city, Xinjiang. CVD cases were identified via medical records of the local hospitals in 2013, 2016 and 2017, respectively. Factor analysis was performed on 706 MS patients at baseline, and main factors, age, and sex were extracted from 18 medical examination indexs to construct a predictive model of CVD risk. After excluding the subjects with CVD at baseline and incomplete data, 2007 were used as internal validation, and 219 Kazakhs in Halabra Township were used as external validation. Logistic regression discriminations were used for internal validation and external validation, as well as to calculate the probability of CVD for each participant and receiver operating characteristic curves. Results: The prevalence of MS in Kazakh was 30.88%. Seven main factors were extracted from the Kazakh MS population, namely obesity factor, blood lipid and blood glucose factor, liver function factor, blood lipid factor, renal metabolic factor, blood pressure factor, and liver enzyme factor. The area under the curve (AUC) for predicting CVD in the internal validation was 0.773 (95%CI 0.754-0.792). In the external validation, the AUC for predicting CVD was 0.858 (95%CI 0.805-0.901). Conclusions The CVD risk prediction model constructed by 7 main factors extracted from Kazakh MS patients has high validation efficiency and can be used for risk assessment of CVD in Xinjiang Kazakh population.

Objective:To study the effect of matrine on the expression of transcription factor Snail2 in peritoneal mesothelial cells epithelial-mesenchymal transition (EMT) induced by transforming growth factor-β1 (TGF-β1).Methods:Human peritoneal mesothelial cells were stimulated by TGF-β1 and treated with matrine. The experiment was divided into six groups (control group, TGF-β1-induced group (5 ng/ml), TGF-β1+0.4 mg/ml matrine intervention group, TGF-β1+0.6 mg/ml matrine intervention group, TGF-β1+0.8 mg/ml matrine intervention group and TGF-β1+1.0 mg/ml matrine intervention group). The expressions of Snail2, E-cadherin, α-smooth muscle actin (α-SMA), Fibronectin and collagen (Col)Ⅲ were detected by real-time fluorescence quantitative PCR and Western blotting. The protein phosphorylation levels of Smad2, Smad3 and extracellular signal-regulated kinase (ERK)1/2 were detected by Western blotting.Results:The mRNA and protein expressions of Snail2, α-SMA, Fibronectin and ColⅢ were up-regulated after being stimulated by TGF-β1 (5 ng/ml) in human peritoneal mesothelial cells, while the mRNA and protein expression of E-cadherin was down-regulated. TGF-β1 (5 ng/ml) could up-regulate the protein phosphorylation levels of Smad2, Smad3 and ERK1/2. Matrine (0.4, 0.6, 0.8, 1.0 mg/ml) could down-regulate the mRNA and protein expression levels of Snail2, α-SMA, Fibronectin and ColⅢ after being stimulated by TGF-β1 in human peritoneal mesothelial cells. Matrine could down-regulate the protein phosphorylation of ERK1/2, and up-regulate the mRNA and protein expression levels of E-cadherin with treatment of TGF-β1 in human peritoneal mesothelial cells.Conclusions:TGF-β1 can induce EMT of human peritoneal mesothelial cells. Matrine may inhibit TGF-β1-induced EMT of human peritoneal mesothelial cells by down-regulating the expression of Snail2 through the ERK1/2 signaling pathway.

Objective:To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiopulmonary bypass (CPB) during cardiac surgery, and to determine the relationship between preoperative biochemical examination and intraoperative CPB time and the incidence of AKI.Methods:From October 2017 to October 2018, the clinical data of cardiopulmonary bypass patients admitted to the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively.Logistic regression was used to analyze the influence of patients′ basic diseases, preoperative biochemical examination and cardiopulmonary bypass time on postoperative AKI.At the same time, the changes of serum creatinine in patients with AKI 7 days after operation were analyzed to provide help for the early diagnosis of AKI after operation.Results:A total of 370 patients with cardiopulmonary bypass were included.Logistic regression analysis results: diabetes basic history( OR=5.226, 95% CI: 1.084-25.191, P=0.039), the increase of age ( OR=1.041, 95% CI: 1.018-1.065, P<0.001), BMI ( OR=1.127, 95% CI: 1.043-1.218, P=0.003), urea nitrogen ( OR=1.211, 95% CI: 1.077-1.360, P=0.001), and CPB time ( OR=1.013, 95% CI: 1.006-1.020, P<0.001) were the risk factors of postoperative AKI in patients with cardiopulmonary bypass.The detection rate of AKI was 4.19%(9/215), 51.63%(111/215), 87.91%(189/215), 97.67%(210/215), 99.07%(213/215), 100%(215/215) and 100%(215/215) on the first day, the third day, the fourth day, the fifth day, the seventh day, respectively. Conclusion:Diabetes history, age, BMI, Urea nitrogen and CPB times are risk factors of AKI patients after CPB.In order to reduce the rate of misdiagnosis, creatinine should be detected for at least 4 consecutive days in clinical observation of post-operative serum creatinine.

Objective: To explore the association between coagulation indicators and all-cause mortality in sepsis-related acute kidney injury (AKI) patients. Methods: Clinical data of patients with sepsis-related AKI admitted to the First Affiliated Hospital of Guangxi Medical University from June 10, 2016 to June 10, 2018 were retrospectively analyzed. The patients were divided into death group and survival group according to the outcome of 28 d. The risk factors of all-cause mortality in sepsis-related AKI patients were analyzed. Receiver operating characteristic curve (ROC) was used to evaluate the prognostic value of independent risk factor for the death of sepsis-related AKI patients and Kaplan-Meier method was used to draw the survival curve. Results: A total of 214 patients with sepsis-related AKI were enrolled into this study. Their age was (57.90±16.96) years old, and the ratio of male to female was 2.57∶1. There was at least one abnormal coagulation indicator in 74.77%(160/214) of patients, and multiple organ dysfunction syndrome (MODS) in 37.38% of patients. The 28-day all-cause mortality was 28.04%(60/214). Prothrombin time, activated partial thrombin time (APTT), international standardized ratio, thrombin time, procalcitonin, abnormal coagulation indicators and the incidence of MODS in the death group were higher than those in the survival group, while body weight, hemoglobin, the percent of neutrophile granulocyte, platelet count, prothrombin activity, serum albumin and the proportion of renal replacement therapy (RRT) were lower than those in the survival group (all P<0.05). Cox regression analysis suggested that sepsis-related AKI patients with prolonged APTT had a higher risk for all-cause death (HR=2.610, 95%CI 1.077-6.326, P=0.034). The Kaplan-Meier survival curve indicated that 28 d survival rate of APTT extension group was lower than that of the non-APTT extension group (37.1% vs 70.6%, Log-rank χ²=16.881, P<0.001), and the average survival time was shorter than that of the non-APTT extension group (21.79 d vs 24.73 d). Conclusions Coagulation abnormalities are common in patients with sepsis-related AKI, which are also correlated to the all-cause death. APTT extension is an independent risk factor for the all-cause death in sepsis-related AKI patients.

Objective To investigate the relationship between preoperative serum homocysteine (Hcy) level and acute kidney injury (AKI) after cardiac valve replacement surgery. Methods The data of the inpatients who accepted cardiac valve replacement surgery, age≥18 years, no renal replacement therapy before surgery, non - renal decompensation and preoperative serum creatinine (Scr)＜178 μmol/L, survival within 48 h after surgery, and with preoperative serum Hcy data in the First Affiliated Hospital of Guangxi Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. AKI was diagnosed in patients whose Scr increased more than 26.5 μmol/L (0.3 mg/dl) within 48 hours or 1.5 times higher than baseline within 7 days after surgery. According to this, patients were divided into AKI group and non-AKI group, and the affecting factors for AKI were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors of AKI. The relationship between serum Hcy level and AKI incidence was analyzed by Spearman correlation analysis. Whether the AKI occurred and serum Hcy levels were used as variables to map the receiver operating characteristic curve (ROC), and was used to assess the value of preoperative serum Hcy level for predicting AKI after cardiac valve replacement surgery. Results A total of 810 subjects were included in the study, including 375 males and 435 females. They were (50±11) years old (19-78 years old). Among them, 329 patients with AKI occurred within 7 days after heart valve replacement, and the incidence rate was 40.6% (male 45.9%, female 36.1%). The serum Hcy level in the AKI group was higher than that in the non-AKI group [(15.74±4.55) μmol/L vs (13.87 ± 3.85) μmol/L, t=6.106, P＜0.01]. Multivariate logistic regression analysis showed age (OR=1.030, 95% CI 1.014-1.045, P＜0.001), extracorporeal circulation time (OR=1.011, 95% CI 1.007-1.016, P＜0.001), Scr (OR=1.014, 95%CI 1.005-1.023, P=0.002), serum Hcy (OR=1.059, 95% CI 1.017-1.103, P=0.006), high level of Hcy (＞13.64 μmol/L) (OR=1.465, 95%CI 1.059-2.027, P=0.021) and moderate to severe hyperhomocystinemia (16≤Hcy≤100 μmol/L) [with normal HHcy (Hcy＜10 μmol/L) as reference, OR=2.180, 95% CI 1.245-3.816, P=0.006] were independent influencing factors of AKI after cardiac valve replacement surgery. Spearman correlation analysis showed that the incidence of postoperative AKI increased with the increase of preoperative serum Hcy level (rs=0.927, P＜0.001). The results of ROC curve showed that the area under the curve of the preoperative serum Hcy level predicting AKI after heart valve replacement was 0.701, and the cutoff value was 13.64 μmol/L, with the sensitivity 61.3%, specificity 70.9%. Conclusions Preoperative serum Hcy level is an influencing factor for AKI after cardiac valve replacement surgery. The higher the level of preoperative serum Hcy, the higher the incidence of AKI after cardiac valve replacement surgery. Patients with preoperative serum Hcy levels＞13.64 μmol/L have an increased risk of AKI after cardiac valve replacement surgery.

Objective To investigate the relationship between serum 25-hydroxycholecalciferol [25(OH)D3] deficiency and the risk of peritoneal dialysis associated peritonitis.Methods Baseline clinical data (before the peritoneal dialysis catheter insertion) of peritoneal dialysis patients treated with CAPD in the First Affiliated Hospital of Guangxi Medical University from May 1,2013 to February 1,2016 were retrospective analyzed.All the patients were followed-up until July 31,2016.According to the baseline serum 25(OH)D3 levels,patients were divided into deficiency group (25(OH)D3 ＜ 15 ng/ml) and non deficiency group (25(OH)D3 ≥ 15 ng/ml),the baseline clinical data of the two groups were also analyzed.Kaplan-Meier method was used to compare the time-to-peritonitis of two groups.Cox proportional hazard model was used to analyze the relationship between the 25(OH)D3 deficiency and the risk of peritonitis.ROC curve was used to analyze the predictive value of the baseline serum 25(OH)D3 for the risk of PDAP in peritoneal dialysis patients.Results Compared with the 25(OH)D3 non deficiency group,25(OH)D3 deficiency group had a significant increase incidence of peritonitis,high diastolic blood pressure and mean arterial pressure,but serum albumin,total serum protein decreased significantly (P ＜ 0.05).Kaplan-Meier survival analysis showed that,compared with 25(OH)D3 non deficiency group,the time-to-peritonitis episode of patients with 25(OH)D3 deficiency were shorter (P ＜ 0.05).Cox proportional hazard model showed that after adjusting for age,sex,hemoglobin,serum albumin,C-reactive protein,total Kt/V,eGFR,diabetes or not,25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis (HR 5.247,95％CI 1.180-23.340,P ＜ 0.05).ROC curve showed the area under the curve that baseline serum 25(OH)D3 deficiency predict the occurrence of PDAP was 0.714,and the best cut-off point of baseline serum 25(OH)D3 was 11.35 ng/ml (sensitivity 75％,specificity 63％).Conclusions Peritoneal dialysis associated peritonitis occurred earlier in peritoneal dialysis patients whose baseline serum 25(OH)D3 deficiency.Baseline serum 25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis,which may predict the incidence of peritoneal dialysis associated peritonitis.

Objective To investigate the correlation between Toll-like receptor2 (TLR2) gene promoter region -597T/C polymorphism and primary ANCA associated small vasculitis (AAV) in Guangxi Han people. Methods A case contrastive control study was adopted in the study. Patients with AAV (patients group, n=110) and healthy people (control group, n = 200) were recruited. Associated serum indexes were detected and polymorphisms of TLR2 gene promoter 597T/C were analyzed by polymerase chain restricted fragment length polymorphisms (PCR-RFLP). Results (1)Three TLR2-597T/C genotypes were discovered in 110 AAV patients, namely, TT, TC and CC, with the frequency of 54.55%,40.00% and 5.45% respectively. And the frequencies of allele T and C were 74.55% and 25.45%. In control group, the genotype frequencies of TT, TC and CC were 56.00%,40.50% and 3.50%, with 76.25% of allele T and 23.75% of allele C. No significant differences were found in neither genotype distribution nor allele frequencies between the patients group and control group ( P > 0 . 05 ) . ( 2 ) Significant differences were found in the incidence of proteinuria rate and the hemoglobin (P< 0.05)in AAV patients. (3)There was no significant difference between AI and CI in TT, TC and CC genotype in AAV patients. Conclusions Polymorphism of TLR2-597T/C may be correlated with the incidence of proteinuria and the level of hemoglobin, while no obvious correlation with the genetic susceptibility of ANCA in vasculitis patients of Guangxi Han people.

Objective To investigate the relationship between putative rs5744168 of Toll-like receptors 5 (TLR5)and ANCA associated small vasculitis (AAV) in Guangxi Han nationality. Methods Polymorphism was analyzed by polymerase chain restricted fragments length polymorphism in 120 cases with AAV and 212 controls. Results (1)There were two genotypes of CC and CT in AAV group and control group. The frequencies distribution of CC and CT in 120 AAV patients were 82.50% and 17.50% respectively and the frequencies of allele C and T 91.25% and 8.75%,respectively. In controls,the genotypefrequencies of CC and CT were 88.68% and 11.3%, and frequencies of allele C and T 94.34% and 5.66%, respectively. No significant difference was found in either genotype distribution or allele frequencies between the patients and the controls ( P > 0 . 05 ) . ( 2 ) Significant reductions in the incidence of BUN, uric acid, quantitative test of 24 h urinary protein and erythrocyte sedimentation rate(ESR) were found in CC genotype (P < 0.05). (3) Binary regression model with a logit link function found total cholesterol was related with AAV. Conclusion The susceptibility of AAV in Guangxi Han population has nothing to do with the polymorphism of rs5744168.In AAV patients, polymorphism of rs5744168 may be associated with ESR, BUN, uric acid and quantitative test of 24 h urinary protein levels.

Objective To investigate the clinical features and risk factors of adult nephrotic syndrome with pulmonary thromboembolism (PTE). Methods Sixty patients diagnosed with nephrotic syndrome and clinically suspected with PTE were enrolled in this retrospective study. Patients were divided into PTE group (n=32) and no-PTE group (n=28) according to the results of computed tomographic pulmonary angiography (CTPA). The single factor analysis and Logistic repres?sion analysis were used to analyse risk factors including age, gender, onset time, clinical symptoms, laboratory examination and pathological types. According to the independent risk factors, the receiver-operating characteristic curve (ROC curve) was used to determine PTE threshold value based on the evaluation index in nephrotic syndrome. Results Single factor analysis showed that there were significant differences in disease duration, hemoglobin, serum albumin, total cholesterol, low-density lipoprotein cholesterol, D-dimer and physical examination in P2 hyperthyroidism between two groups (P <0.05). Logistic regression analysis showed that D-dimer was independent risk factor of PTE. The analysis of ROC curve indi?cated that D-dimer optimal threshold was 1 015.50μg/L. Conclusion D-dimer is an independent risk factor of PTE in pa?tients with nephrotic syndrome. When D-dimer is greater than 1 015.50μg/L, should pay attention to the occurrence of PTE.