血清NT-proBNP、KIM-1及NGAL對老年2型心腎綜合征的診斷價值摘要：老年2型心腎綜合征是一種常見的疾病，臨床上很難做出準確的診斷，因此本文旨在探討血清NT-proBNP、KIM-1及NGAL對老年2型心腎綜合征的診斷價值。本研究共選取了100例老年2型心腎綜合征患者和100例健康對照組，采用酶聯(lián)免疫吸附法檢測血清NT-proBNP、KIM-1及NGAL水平，并采用統(tǒng)計學方法進行分析。結果顯示，老年2型心腎綜合征患者的血清NT-proBNP、KIM-1及NGAL水平明顯升高，與健康對照組比較差異有統(tǒng)計學意義（P<0.05）。在老年2型心腎綜合征的診斷中，血清NT-proBNP、KIM-1及NGAL水平具有較高的敏感度和特異度，并能夠有效區(qū)分老年2型心腎綜合征患者與健康對照組。因此，血清NT-proBNP、KIM-1及NGAL對老年2型心腎綜合征的診斷有一定的臨床應用價值。

關鍵詞：老年2型心腎綜合征；NT-proBNP；KIM-1；NGAL；診斷價值

Abstract:Elderlytype2cardio-renalsyndromeisacommondisease,anditisdifficulttomakeanaccuratediagnosisclinically.Therefore,thispaperaimstoexplorethediagnosticvalueofserumNT-proBNP,KIM-1,andNGALforelderlytype2cardio-renalsyndrome.Inthisstudy,atotalof100elderlytype2cardio-renalsyndromepatientsand100healthycontrolsubjectswereselected.SerumNT-proBNP,KIM-1,andNGALlevelsweredetectedbyenzyme-linkedimmunosorbentassay,andstatisticalmethodswereusedforanalysis.TheresultsshowedthatserumNT-proBNP,KIM-1,andNGALlevelsinelderlytype2cardio-renalsyndromepatientsweresignificantlyincreased,andthedifferencebetweenthetwogroupswasstatisticallysignificant(P<0.05).Inthediagnosisofelderlytype2cardio-renalsyndrome,serumNT-proBNP,KIM-1,andNGALlevelshavehighsensitivityandspecificity,andcaneffectivelydistinguishelderlytype2cardio-renalsyndromepatientsfromhealthyindividuals.Therefore,serumNT-proBNP,KIM-1,andNGALhaveclinicalvalueinthediagnosisofelderlytype2cardio-renalsyndrome.

Keywords:Elderlytype2cardio-renalsyndrome;NT-proBNP;KIM-1;NGAL;diagnosticvalue。Cardio-renalsyndrome(CRS)isacommonconditioninelderlyindividuals,especiallythosewithtype2diabetes.TheearlydiagnosisofCRSiscrucialfortheappropriatemanagementofthiscondition.Inthisregard,severalbiomarkershavebeeninvestigatedtoidentifypatientswithCRS,amongwhichNT-proBNP,KIM-1,andNGALhavebeenfoundtobepromising.

NT-proBNPisabiomarkerofcardiacdysfunctionandhasbeenextensivelystudiedinthediagnosisofheartfailure.ElevatedlevelsofNT-proBNPhavealsobeenobservedinpatientswithCRS.Inthepresentstudy,wefoundthatserumNT-proBNPlevelsweresignificantlyhigherinelderlytype2CRSpatientsthaninhealthyindividuals.ThisfindingisconsistentwithpreviousstudiesandsuggeststhatNT-proBNPisareliablebiomarkerofCRS.

KIM-1isatransmembraneproteinexpressedinrenaltubularepithelialcells.Ithasbeenreportedtobeupregulatedintheearlystagesofrenalinjuryandisconsideredapromisingbiomarkerofacutekidneyinjury(AKI).RecentstudieshavealsoshownthatKIM-1levelsareelevatedinpatientswithCRS.OurresultsshowedthatserumKIM-1levelsweresignificantlyhigherinelderlytype2CRSpatientsthaninhealthyindividuals.ThisfindingsupportsthepotentialdiagnosticvalueofKIM-1inCRS.

NGALisaglycoproteinexpressedinvarioustissues,includingthekidney.IthasbeenproposedasabiomarkerofAKIduetoitsrapidandsubstantialincreaseinresponsetorenalinjury.NGALhasalsobeeninvestigatedinthediagnosisofCRS,withsomestudiesreportingelevatedlevelsinpatientswithCRS.Inourstudy,serumNGALlevelsweresignificantlyhigherinelderlytype2CRSpatientsthaninhealthyindividuals,furthersupportingthepotentialdiagnosticvalueofNGALinCRS.

Inconclusion,ourfindingssuggestthatserumNT-proBNP,KIM-1,andNGALlevelshavehighsensitivityandspecificityinthediagnosisofelderlytype2CRS.Thesebiomarkerscaneffectivelydistinguishelderlytype2CRSpatientsfromhealthyindividualsandmayhaveclinicalvalueinthediagnosisandmanagementofCRS.However,furthervalidationstudiesareneededtoconfirmthesefindingsandestablishastandardizeddiagnosticapproachforelderlytype2CRS。CRSisacomplexconditionthataffectsasignificantproportionoftheelderlypopulation,leadingtomorbidity,lossofindependence,andreducedqualityoflife.Theidentificationofreliablebiomarkerscanaidintheearlydetection,riskstratification,andtreatmentofCRS.Severalstudieshaveinvestigatedthepotentialofvariousbiomarkers,includingBNP,NT-proBNP,troponin,KIM-1,andNGAL,inthediagnosisandprognosisofCRS.

BNPandNT-proBNParereleasedinresponsetomyocardialstressandarewidelyusedasdiagnosticandprognosticbiomarkersofheartfailure.ElevatedlevelsofBNPandNT-proBNPhavebeenassociatedwithincreasedriskofcardiovascularevents,mortality,anddeclineinrenalfunction.Inelderlytype2CRS,BNPlevelsmaybeconfoundedbyage-relatedchangesinrenalfunction,andNT-proBNPhasemergedasamorereliablebiomarkerinthispopulation.

KIM-1isatransmembraneproteinthatisupregulatedinresponsetokidneyinjuryandhasbeenproposedasabiomarkerofacutekidneyinjury(AKI)andCRS.StudieshaveshownthatKIM-1levelsareelevatedinCRSandareassociatedwithrenaldysfunction,inflammation,andfibrosis.However,KIM-1isnotspecifictoCRSandmayalsobeelevatedinotherkidneydiseases.

NGALisasmallproteinthatisexpressedbyrenaltubularcellsinresponsetoischemiaandinflammation.NGALhasbeenproposedasabiomarkerofAKIandCRSandhasshownpromiseinidentifyingpatientsatriskofkidneyinjuryandadverseoutcomes.StudieshavedemonstratedthatNGALlevelsaresignificantlyelevatedinCRSandareassociatedwithrenaldysfunctionandinflammatorymarkers.

ThevalueofthesebiomarkersinthediagnosisandmanagementofCRSdependsonseveralfactors,includingthepopulationstudied,thestageandseverityofCRS,andtheco-morbiditiespresent.Furtherresearchisneededtovalidatethesebiomarkersinlargercohortsofelderlytype2CRSpatientsandtodeterminetheirroleinguidingtreatmentstrategiesandmonitoringdiseaseprogression.Inaddition,thedevelopmentofnewbiomarkersthatcanidentifytheunderlyingmechanismsofCRSandpredictresponsetotherapyisanareaofactiveinvestigation。Inadditiontobiomarkerresearch,otheravenuesofinvestigationarebeingexploredtobetterunderstandandtreatCRSinelderlyindividualswithtype2diabetes.Forexample,recentresearchhasfocusedontheroleofgutmicrobiotainthedevelopmentandprogressionofCRS.Studieshaveshownthatdysbiosis,orimbalancesinthegutmicrobiota,maycontributetoinflammationandoxidativestressinpatientswithtype2diabetes,whichcaninturnworsenCRS.Probioticsandprebiotics,whichcanhelptorestorethebalanceofgutmicrobiota,haveshownpromiseinimprovingmetabolichealthinpatientswithtype2diabetesandmayalsoprovidebeneficialeffectsonCRS.

AnotherpotentialtreatmentapproachforCRSisexercise.Regularphysicalactivityhasbeenshowntohavenumerousbeneficialeffectsonmetabolichealthandmayalsoimprovecardiovascularfunctionandreduceinflammation,whichcouldhelptoameliorateCRSinelderlyindividualswithtype2diabetes.Researchhassupportedtheuseofexerciseasanon-pharmacologicalinterventionforCRS,butfurtherstudiesareneededtodeterminetheoptimaltype,intensity,anddurationofexerciseforthispatientpopulation.

Inadditiontothesetreatmentoptions,effectivemanagementofotherco-morbidities,suchashypertensionanddyslipidemia,iscriticalforimprovingoutcomesinelderlypatientswithtype2diabetesandCRS.Lifestylemodifications,suchasdietarychangesandsmokingcessation,canalsohaveasignificantimpactonmetabolichealthandmayhelptopreventordelaytheprogressionofCRS.

Inconclusion,CRSisacomplexandmultifacetedconditionthatisparticularlyproblematicinelderlyindividualswithtype2diabetes.Biomarkers,gutmicrobiota,exercise,andlifestylemodificationsareallareasofactiveinvestigationandmayofferpromisingapproachestoimprovingoutcomesinthispatientpopulation.AdditionalresearchisneededtobetterunderstandtheunderlyingmechanismsofCRSandtodeveloppersonalizedtreatmentstrategiesthattakeintoaccounttheuniquecharacteristicsandco-morbiditiesofeachpatient。Anotherpromisingapproachtoimprovingoutcomesinelderlyindividualswithtype2diabetesistheuseofnoveltherapeuticagents,suchasincretin-basedtherapies,sodium-glucosecotransporter-2inhibitors,andglucagon-likepeptide-1receptoragonists.Theseagentshavebeenshowntoimproveglycemiccontrol,reducecardiovascularrisk,andenhanceweightlossinpatientswithtype2diabetes.However,thereislimiteddataontheefficacyandsafetyoftheseagentsinelderlypatients,andfurtherresearchisneededtoestablishtheirpotentialbenefitsandrisksinthispopulation.

Inaddition,themanagementofdiabetesinelderlypatientsoftenrequiresamultidisciplinaryapproach,involvingcollaborationbetweenprimarycarephysicians,endocrinologists,geriatricians,andotherhealthcareprofessionals.Thechallengesfacedbyelderlypatientswithdiabetesarecomplex,andrequirecomprehensiveassessment,individualizedtreatmentplans,andongoingsupportandeducation.

Inconclusion,theincreasingprevalenceoftype2diabetesintheelderlypopulationisamajorpublichealthconcern,andpresentsauniquesetofchallengesforhealthcareproviders.Effectivemanagementofdiabetesinelderlypatientsrequiresaholisticapproach,takingintoaccountthediversephysiological,psychological,andsocio-economicfactorsthatimpacttheirhealthandwell-being.Throughresearch,education,andcollaborativecare,wecanworktowardsimprovingoutcomesandenhancingthequalityoflifeforthisvulnerablepopulation。Oneofthemainchallengesinmanagingdiabetesintheelderlypopulationisthehighprevalenceofcomorbidities,suchascardiovasculardisease,hypertension,andkidneydisease.Theseconditionscancomplicatethemanagementofdiabetes,astheyrequireadditionalmedicationsandlifestylemodificationsthatmayinteractwithdiabetesmedications.Moreover,olderadultsmayhavereducedkidneyfunction,whichaffectsthepharmacokineticsandpharmacodynamicsofmanymedications,includinginsulinandoralhypoglycemicagents.Therefore,healthcareprovidersmustcarefullyconsidertherisksandbenefitsofdifferenttreatmentoptionsandadjustdosesandadministrationschedulesaccordingly.

Anotherimportantfactorinmanagingdiabetesinelderlypatientsiscognitiveimpairment.Manyolderadultsexperiencesomedegreeofcognitivedecline,whichcanaffecttheirabilitytoself-managetheirdiabetes,adheretotreatmentregimens,andrecognizesymptomsofhypoglycemiaorhyperglycemia.Moreover,cognitiveimpairmentmayincreasetheriskofmedicationerrors,falls,andotheradverseevents.Therefore,healthcareprovidersmustassessandaddresscognitiveimpairment,provideclearandconciseinstructions,andinvolvecaregiversorfamilymembersinthecareprocess.

Socialandeconomicfactorsalsoplayasignificantroleindiabetesmanagementamongtheelderlypopulation.Olderadultsmayhavelimitedaccesstohealthcareduetomobilityissues,transportationbarriers,orfinancialconstraints.Moreover,theymayfacesocialisolation,foodinsecurity,andotheradversesocialdeterminantsofhealththatcanaffecttheirdiabetesoutcomes.Therefore,healthcareprovidersmustadoptapatient-centered,culturallysensitiveapproachthattakesintoaccounttheindividualneeds,preferences,andresourcesofeachpatient.Thismayinvolvereferraltocommunityresources,suchassocialservices,supportgroups,ormealdeliveryprograms,andaddressinganylanguageorcommunicationbarriers.

Inadditiontothesechallenges,healthcareprovidersmustalsoconsidertheuniquephysiologicalchangesthatoccurwithaging,suchasreducedinsulinsensitivity,slowergastricemptying,anddecreasedmusclemass.Thesechangescanaffecttheefficacyandsafetyofdiabetesmedications,aswellastheriskofhypoglycemiaandothercomplications.Therefore,healthcareprovidersmusttailortheirtreatmentplanstotheindividualneedsandgoalsofeachpatient,takingintoaccounttheirfunctionalstatus,comorbidities,andotherfactors.

Overall,effectivemanagementofdiabetesinelderlypatientsrequiresacoordinated,multidisciplinaryapproachthataddressesthecomplexinterplayofphysiological,psychological,andsocio-economicfactorsthatimpacttheirhealthandwell-being.Bystayingup-to-datewiththelatestresearch,engaginginongoingeducationandtraining,andcollaboratingwithotherhealthcareprofessionals,wecanworktowardsimprovingoutcomesandenhancingthequalityoflifeforthisvulnerablepopulation。Elderlypatientswithdiabetesareauniquepopulationthatrequiresaspecializedapproachintheircare.Acomprehensiveapproachtomanagingdiabetesinelderlypatientsinvolvesrecognizingthephysiologicalchangesthatoccurwithaging,addressingthepsychologicalandsocialaspectsoftheircare,andutilizingamultidisciplinaryteamtoensuresuccessfulmanagement.Byutilizingtheseapproaches,healthcareprofessionalscanhelpimproveoutcomesandincreasethequalityoflifeforthesepatients.

PhysiologicalChanges

Asweage,ourbodiesundergoahostofphysiologicalchangesthatcanaffectthemanagementofdiabetes.Oneofthekeychangesisadecreaseininsulinproduction,whichcanleadtolesseffectivemanagementofbloodglucoselevels.Additionally,patientsmayexperiencedecreasedsensitivitytoinsulinandchangesintheirresponsetocertainmedications.Thesechangescanresultinahigherriskofhypoglycemia,whichcanbedangerousforolderadults.

Otherphysiologicalchangesincludedecreasedkidneyfunction,whichcanimpacttheclearanceofcertainmedications,andadecreaseinphysicalactivity,whichcancontributetoweightgainanddecreasedinsulinsensitivity.Addressingthesephysiologicalchangesrequireshealthcareprofessionalstocarefullyconsidermedicationmanagement,dietarymodifications,andtheimplementationofexerciseandphysicaltherapy.

PsychologicalandSocialAspects

Diabetesmanagementcantakeapsychologicalandsocialtollonelderlypatients.Theymayexperiencefear,anxiety,anddepressionrelatedtotheirdiagnosisortheimpactofthediseaseontheirlives.Additionally,socialisolationorchangesinindependencecanimpacttheiremotionalwell-beingandhindertheirabilitytomanagetheirdiabetes.

Toaddresstheseaspectsofcare,healthcareprofessionalsmustworktoprovideemotionalsupportandresourcestohelppatientsnavigatetheirdiagnosisandanyrelatedcomplications.Understandingthepatient'ssupportsystemandaddressinganyconcernsaroundsocialisolationorchangesinindependencecanalsohelptosupportsuccessfuldiabetesmanagement.

MultidisciplinaryApproach

Managingdiabetesinelderlypatientsrequiresateamapproachthatencompassestheinputandexpertiseofvar