肾病综合征患儿血IgG与尿蛋白变化的分析

目的观察儿童原发性单纯性肾病综合征血免疫球蛋白G（IgG）与尿蛋白变化之间有无相关关系。方法运用医学统计学方法,分析46例初次发病且未经激素治疗的原发性单纯性肾病综合征患儿血IgG变化与尿蛋白定量的关系。结果血IgG与尿蛋白定量之间不存在线形回归关系,也无相关关系。结论部分肾病综合征患儿发病时即有血IgG水平降低,但分析显示血IgG水平与尿蛋白定量之间不存在线形回归关系,也无相关性,提示大量蛋白尿可能不是某些原发性单纯性肾病综合征患儿血IgG水平降低的主要原因。     

儿童肾病活动期氧化应激状态变化及临床意义

目的探讨儿童肾病综合征和过敏性紫癜肾炎疾病活动与氧化应激状态的关系及其临床意义。方法抽取诊断明确的肾病综合征和过敏性紫癜肾炎患儿疾病活动期清晨空腹外周血，采用化学比色法检测血中丙二醛（Malondialdehyde，MDA）含量及超氧化物歧化酶（Superoxide dismutase，SOD）和总抗氧化能力（Total antioxidative capacity，T—AOC）的活性。结果肾病综合征患儿疾病活动期血中MDA含量明显高于正常对照组（P=0．011）；血中SOD、T-AOC活性明显低于正常对照组（P=0．000）；且肾病综合征活动期MDA含量与血清白蛋白含量及241a尿蛋白排泄量分别呈负相关及正相关（r分别为-0．557，0．793，P分别为0．048，0．002），soD活性和T—AOC活性与24h尿蛋白排泄量呈负相关（r分别为-0．822，-0．851；P分别为0．001，0．000）。紫癜性肾炎患儿疾病活动期血中MDA含量明显高于正常对照组（P=0．014），血中SoD、T—AOC活性明显低于正常对照组（P〈0．05）。结论儿童肾病综合征和过敏性紫癜肾炎疾病活动期存在明显的过氧化反应增强及抗氧化能力减退，且与肾病轻重密切相关。     

高敏C-反应蛋白和纤维蛋白原与糖尿病肾病相关分析

目的：观察糖尿病肾病fDN）患者血高敏C-反应蛋白（hsCRP）和纤维蛋白原（Fib）的水平并对其浓度进行分析。方法：收集糖尿病患者106例,根据尿白蛋白排泄率（UAER）将糖尿病患者分为正常蛋白尿组32例、微量蛋白尿组36例和大量蛋白尿组38例,测定其hsCRP和Fib含量,健康对照组50例。结果：正常蛋白尿组血hsCRP和Fib水平与对照组相比无显著性差异（P〉0．05）;微量蛋白尿组和大量蛋白尿组血hsCRP和Fib水平明显高于健康对照组和正常蛋白尿组,且以大量蛋白尿组更为显著（P〈0．01）。hsCRP和Fib分别与UAER呈显著正相关（r=0．526,r=0．435,P〈0．05）。结论：hsCRP和Fib与DN的发生发展相关。     

骁悉治疗难治性肾病综合征临床分析

目的观察难治性原发性肾病综合征应用骁悉治疗后蛋白尿、血肌酐（Scr）、谷丙转氨酶（ALT）和血白细胞（WBC）的变化。方法对26例原发性肾病综合征患者应用中剂量泼尼松（0．5mg/kg^-1／d^-1）和骁悉（MMF）口服12周，以中剂量泼尼松和环磷酰胺（CTX）治疗组为对照，在治疗的第4、8、12周测定患者24h尿蛋白定量、血浆白蛋白、SCR、ALT、WBC等，并观察2组的不良反应。结果两组在观察结束时的总疗效无统计学差异（P〉0．05），但骁悉治疗组的不良反应要明显低于环磷酰胺治疗组（P〈0．05）。结论骁悉是治疗原发性肾病综合征一种安全有效的药物，且适合于对应用环磷酰胺有禁忌的患者。     

氯沙坦在改善肾病综合征患儿尿蛋白及血浆白蛋白水平中的作用

目的：探讨氯沙坦在改善肾病综合征患儿尿蛋白及血浆白蛋白水平中的作用。方法选取2012年1月至2014年1月我院收治的50例肾病综合征患儿,依据随机数字表法分为观察组和对照组两组,每组25例。给予对照组患者常规四联疗法治疗,给予观察组患儿常规四联疗法治疗基础上的氯沙坦治疗。结果治疗后观察组患儿的尿蛋白定量、尿蛋白定性均明显比对照组低（P＜0．05）,血浆白蛋白水平、CD4/CD8均明显比对照组高（P＜0．05）;观察组患儿的不良反应发生率20％（5/25）明显比对照组60％（15/25）低（P＜0．05）。结论氯沙坦能够显著改善肾病综合征患儿尿蛋白及血浆白蛋白水平。     

肾病综合征甲状腺功能的研究

目的　进一步探讨肾病综合征的甲状腺功能。方法　对 48例肾病综合征大量蛋白尿期测定甲状腺功能 (T3、T4 、TSH)、血清白蛋白、2 4小时尿蛋白 ,另 2 0例治疗获缓解后 3个月复查T3、T4 、TSH ,并与正常健康同龄儿作对照 ;结果　肾病综合征组血T3、T4 水平明显低于对照组 (P均 <0 .0 1) ,TSH差异无显著性 (P>0 .0 5 ) ,各种病理类型血清甲状腺激素和 2 4小时尿蛋白差异无显著性 (P均 >0 .0 5 ) ,单纯性肾病与肾炎性肾病血清甲状腺激素水平差异无显著性 (P均 >0 .0 5 ) ,治疗获得缓解后的患儿血清甲状腺激素水平与对照组相比差异无显著性 (P均 >0 .0 5 ) ,血清T3、T4 变化与尿蛋白呈负相关 (r =-0 .48～ -0 .74) ,与血清白蛋白呈正相关 (r =0 .7～ 0 .78) ;结论　肾病综合征大量蛋白尿期存在暂时性甲状腺功能低下 ,与甲状腺激素伴随大量蛋白尿有关 ,监测甲状腺功能对估计病情、判断预后、指导治疗有重要意义。     

激素干预对肾病综合征患儿外周血CXCLl6表达水平的影响

目的：探讨原发性肾病综合征患儿血清中人CXC型趋化因子配体16（CXCLl6）表达水平及临床意义。方法：采用EI．ISA法检测28例原发性肾病综合征患儿（实验组）和20例健康对照者（对照组）血清CXCLl6水平,比较两组的差异。分析其与24h尿蛋白水平的相关性,并分析激素干预前后肾病综合征患儿血清中cXCLl6表达的差异。结果：肾病综合征患儿血清cXCLl6水平为（581．07±38．62）pg／L,对照组血清中水平为（416．53±25．90）Pg／L,患儿血清CXCLl6水平明显高于对照组,差异有统计学意义（P〈0．05）;肾病综合征患儿血清cXCLl6水平与24h尿蛋白水平呈正相关（r=0．158,P〈0．05）。激素干预后肾病综合征患儿血清CXCLl6的水平为（456．07±42．89）pg／L,与干预前比较,差异有统计学意义（P〈0．01）。结论：趋化因子cXCLl6可能参与了肾病综合征的发病过程。     

肝细胞生长因子与糖尿病肾病的关系

目的探讨肝细胞生长因子（HGF）在糖尿病肾病发生、发展中的作用。方法检测正常对照组、单纯糖尿病组、微量白蛋白尿组和蛋白尿组受检者的空腹血糖、糖化血红蛋白（HbA1c）、尿蛋白、尿微量白蛋白和血清HGF水平，并分析HGF与HbA1c尿蛋白、尿微量白蛋白的关系。结果单纯糖尿病组、微量白蛋白尿组和蛋白尿组空腹血糖、HbA1c水平与正常对照组比较，差别均有统计学意义（P〈0．05）。蛋白尿组尿蛋白水平与其他3组比较，差别均有统计学意义（P〈0．05）。微量白蛋白尿组和蛋白尿组患者尿微量白蛋白和血清HGF水平与正常对照组、单纯糖尿病组比较，差别均有统计学意义（P〈0．05）。血清HGF水平与尿微量白蛋白及HbA1c呈正相关（P〈0．01）。结论HGF与糖尿痛肾病的发生、发展有关．检测血清HGF水平可能有助干旱期诊断和评估糖尿病肾病。     

66例原发性肾病综合征院内感染分析及防治

目的 探讨原发性肾病综合征院内感染的临床特点及防治措施。方法 对2000～2005年我院肾内科收治的原发性肾病综合征患者66例的临床资料进行回顾性分析，总结医院感染与肾脏病理类型、血浆免疫球蛋白水平、血浆白蛋白水平、激素使用时间长短及24h尿蛋白定量等临床资料。结果 发生医院感染21例，感染率31．8％。感染部位以呼吸道最常见，医院感染率与肾脏病理类型无关（P〉0．05），血浆白蛋白水平越低者，医院感染发生率明显升高（P〈0．01），激素使用时间越长，医院感染的发生率越高（P〈0.01），24h尿蛋白定量〉0．2g／（kg·d）时，医院感染的危险性大于24h尿蛋白≤0．2g／（kg·d）者（P〈0．01）。结论 医院感染率与肾脏病理类型无关，与血浆免疫球蛋白水平、血浆白蛋白水平、激素使用时间、24h尿蛋白定量相关。     

川穹嗪注射液联合低分子肝素治疗原发性肾病综合征疗效观察

目的：观察川穹嗪注射液联合低分子肝素治疗原发性肾病综合征的疗效。方法 将40例原发性肾病综合征患者随机分成两组,对照组20例常规给予强的松、转换酶抑制剂、潘生丁、利尿剂及降脂药物,治疗组20例在对照组治疗基础上加用川穹嗪与低分子肝素,观察两组患者治疗前后水肿等临床症状改善情况,并检测血浆白蛋白、24 h尿蛋白定量、血胆固醇、甘油三脂等。结果 两组患者治疗后血浆白蛋白均升高,24 h尿蛋白定量减少,总胆固醇和甘油三酯下降,与治疗前比较差异显著（ P＜0．01）;两组患者血小板、血肌酐指标均无明显治疗效果（P＞0．05）,在降血脂方面,两组间也无明显差异（P＞0．05）;治疗组在减轻蛋白尿、升高血浆白蛋白方面更优于对照组（ P＜0．05）。结论 在激素治疗的基础上,联合使用川穹嗪注射液、低分子肝素治疗原发性肾病综合征患者,可以更显著地减少尿蛋白,提升血浆白蛋白浓度,从而加快水肿消退,提高临床缓解率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.