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Wan W, Zhou J, Lu R, Wang C, Hu S, Liu M, Xiong R, Kuang J, Fan X. Clinical Efficacy of Huangkui Capsule plus Methylprednisolone in the Treatment of Nephropathy and the Effect on Urinary Protein and Serum Inflammatory Factors in Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6232264. [PMID: 35845574 PMCID: PMC9279028 DOI: 10.1155/2022/6232264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
Objective The study aimed to assess the clinical efficacy of Huangkui capsule plus methylprednisolone in the treatment of nephropathy and the effect on urinary protein and serum inflammatory factors in patients. Methods Between June 2017 and July 2020, 90 patients with nephropathy admitted to our hospital were recruited after assessment of eligibility and assigned via the random number table method (1 : 1) to receive either methylprednisolone tablets (observation group) or methylprednisolone tablets plus Huangkui capsules (experimental group). All eligible patients were also given dipyridamole and valsartan. Outcome measures included clinical efficacy, urine protein, hematuria, serum inflammatory factor levels, and adverse reactions. Results A higher clinical efficacy was observed in the experimental group versus the observation group (P < 0.05). Huangkui capsules resulted in significantly lower levels of urine protein and hematuria in the experimental group versus the observation group after treatment (P < 0.05). The serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and monocyte chemoattractant protein-1 (MCP-1) levels in the experimental group were significantly lower than those in the observation group after treatment (P < 0.05). Huangkui capsules plus methylprednisolone were associated with a lower incidence of adverse events versus methylprednisolone (P < 0.05). Conclusion The clinical efficacy of Huangkui capsule plus methylprednisolone in the treatment of patients with nephropathy is remarkable. It can effectively mitigate the inflammatory responses and enhance renal function, with reliable clinical safety, so it is worthy of clinical application.
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Affiliation(s)
- Weibo Wan
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Jingjing Zhou
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Rong Lu
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Chaoyang Wang
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Shuli Hu
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Mei Liu
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Rong Xiong
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Jing Kuang
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
| | - Xuepeng Fan
- Department of Critical Care, Wuhan First Hospital of Hubei Province, Wuhan 430000, China
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Vogg N, Kurlbaum M, Deutschbein T, Gräsl B, Fassnacht M, Kroiss M. Method-Specific Cortisol and Dexamethasone Thresholds Increase Clinical Specificity of the Dexamethasone Suppression Test for Cushing Syndrome. Clin Chem 2021; 67:998-1007. [PMID: 33997885 DOI: 10.1093/clinchem/hvab056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The dexamethasone suppression test (DST) is the recommended first-tier test for suspected Cushing syndrome (CS). Missed dexamethasone intake or insufficient dexamethasone serum exposure may yield false positive results. Quantification of serum dexamethasone in DST samples may therefore improve test performance. METHODS Simultaneous quantification of dexamethasone and cortisol by liquid chromatography-tandem mass spectrometry in 400 DST serum samples (100 overt CS, 200 excluded CS, 100 adrenal incidentalomas with (possible) autonomous cortisol secretion, AI-ACS) randomly selected within the indication groups. The 2.5th percentile of dexamethasone in patients with excluded CS was considered the lower limit of normal (LLN). RESULTS Serum dexamethasone varied from undetectable to 20.2 ng/mL with a median of 4.8 ng/mL (95% CI 4.5-5.1 ng/mL). Dexamethasone was undetectable in only 16 patients (4%), suggesting non-compliance. The dexamethasone LLN was 1.8 ng/mL (4.6 nmol/L). Decreased glomerular filtration rate and diabetes mellitus were associated with higher serum dexamethasone concentration, while body mass index, sex, age, nicotine, and oral contraceptives had no significant effect. By excluding the 27 samples with dexamethasone <LLN and applying the method-specific cortisol cutoff of 2.4 µg/dL (66 nmol/L) to samples with suspected CS, the clinical specificity for CS increased from 67.5% to 92.4% while preserving 100% clinical sensitivity. Among 100 AI-ACS samples (defined by immunoassay), 4 samples had dexamethasone <1.8 ng/mL and 14 samples had cortisol <2.4 µg/dL, which excluded autonomous cortisol secretion. CONCLUSIONS Quantification of dexamethasone and method-specific cortisol cutoffs in DST samples may reduce the false positive rate and lower the proportion of patients requiring further workup.
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Affiliation(s)
- Nora Vogg
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany.,Central Laboratory, Core Unit Clinical Mass Spectrometry, University Hospital Würzburg, Würzburg, German
| | - Max Kurlbaum
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany.,Central Laboratory, Core Unit Clinical Mass Spectrometry, University Hospital Würzburg, Würzburg, German
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany.,Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Benedict Gräsl
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany.,Central Laboratory, Core Unit Clinical Mass Spectrometry, University Hospital Würzburg, Würzburg, German
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany.,Central Laboratory, Core Unit Clinical Mass Spectrometry, University Hospital Würzburg, Würzburg, German.,Department of Internal Medicine IV, LMU University Hospital Munich, University of Munich, Munich, Germany
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