血浆BNP水平在老年血液透析患者干体重评估中的应用价值

目的探讨血浆B型钠尿肽(BNP)水平在老年血液透析患者干体重评估中的临床意义。方法选取老年血液透析患者中实际体重超出干体重的30例患者,所有研究对象经过2周逐渐透析脱水下调体重达到临床干体重。测定患者下调体重前后的血浆BNP、心胸比值(CTR)及体重,并观察临床表现。选取老年健康体格检查者20例作为对照组。结果 (1)下调体重后血浆BNP、CTR均较下调体重前显著下降(P<0.05);与对照组相比,下调体重前BNP明显高于对照组(P<0.05),下调体重后,BNP差异无统计学意义(P>0.05);(2)体重下调前后BNP之差与体重下调前后CTR之差呈正相关(r=0.71,P<0.05),体重下调前后BNP之差与体重之差呈正相关(r=0.69,P<0.05)。结论测定血浆BNP水平可以作为评估老年血液透析患者干体重的一种方法。     

稳心汤对心力衰竭患者临床疗效和血浆NT-proBNP变化的影响研究

目的 探讨稳心汤对心力衰竭患者临床疗效和血浆NT-proBNP变化的影响观察.方法 选取本院2014年1月至2016年1月期间收治的80例心力衰竭患者作为研究对象,按随机数字表方法分为观察组和对照组,各40例.对照组患者使用常规的西药进行治疗;观察组患者在对照组的基础上加以使用稳心汤进行治疗,分别对两组患者的临床疗效、治疗前后的血浆NT-proBNP浓度和心功能进行客观比较.结果 经比较,观察组患者的临床总有效率明显高于对照组,差异有统计学意义(P＜0.05);治疗前,两组患者的血浆NT-proBNP浓度差异无统计学意义(P＞0.05),治疗后,两组患者的血浆NT-proBNP浓度明显低于治疗前,且观察组更低于对照组,差异有统计学意义(P＜0.05);同时,观察组治疗后心功能明显更优于治疗前和对照组,差异有统计学意义(P＜0.05).结论 稳心汤治疗心力衰竭的临床疗效显著,同时可以改善患者的心功能和降低血浆NT-proBNP水平,因而值得临床推广应用.     

血清N端脑钠肽水平对血液透析患者容量负荷评估的价值

目的分析维持性血液透析(maintenance hemodialysis,MHD)患者血清N端脑钠肽(N-terminal pro brain natriuretic pep-tide,NT-proBNP)水平与传统容量负荷指标之间的关系,探讨NT-proBNP评估MHD患者容量负荷的意义。方法选取该院81例MHD患者,超声检测下腔静脉直径/体表面积(VCD),并分为高容量组(VCD≥11.5 mm.m-2)及非高容量组(VCD11.5mm.m-2),予高容量组降低干体重,同时动态观察血透前后、干体重降低前后NT-proBNP水平,并对NT-proBNP水平与超滤量、VCD及干体重进行相关分析。结果 MHD患者透析前、后血清NT-proBNP水平均显著高于健康对照组(P0.01),透析后NT-proBNP水平较透析前明显下降(P0.05),透析前后NT-proBNP的差值与超滤量之间呈正相关(r=0.321,P0.01);高容量组NT-proBNP水平明显高于非高容量组(P0.05),高容量组降低干体重后,NT-proBNP明显降低(P0.05),干体重调整前后NT-proBNP的差值与干体重下降差值呈正相关(r=0.568,P0.01),NT-proBNP水平与VCD呈正相关(r=0.543,P0.01)。结论 MHD患者血清NT-proBNP水平普遍升高,且与超滤量、VCD及干体重正相关,NT-proBNP水平对血液透析患者容量负荷的评估、调整干体重具有临床应用价值。     

心脏康复对慢性心力衰竭患者心功能改善与生活质量的影响分析

目的探讨心脏康复治疗对慢性心力衰竭患者心脏功能改善与生活质量影响。方法选择2016年1月至2018年6月诊断慢性心力衰竭(NYHAⅠ～Ⅱ级)患者150例,随机分为康复组与对照组,各75例。对照组患者依据其危险因素给予常规药物治疗。康复组在对照组治疗基础上给予心脏康复治疗,治疗时间6个月。治疗前后,采用免疫化学法检测两组患者血浆氨基末端脑钠尿肽(NT-proBNP)、血清肌钙蛋白I(cTnI),测量心脏超声参数左心房内径(LAD)、左室舒张末期内径(LVEDd)、射血分数及E/A比值变化差异,比较两组患者6 min步行距离,采用SF-36心力衰竭量表评估患者生活质量差异。结果治疗后,两组患者血浆NT-proBNP、血清cTnI水平下降,LAD、LVEDd缩小,EF、E/A比值升高,治疗前后比较差异无统计学意义(P <0.05)。其中,康复组改善幅度优于对照组(P <0.05)。治疗后,康复组患者6 min步行距离与生活质量显著改善,两组比较差异有统计学意义(P <0.05)。结论心脏康复治疗可以显著提高慢性心力衰竭患者心脏功能,防治心室重构,提高患者生活质量。     

低温联合斜线式钠曲线在老年血液透析患者中的应用效果

目的探讨低温联合斜线式钠曲在老年血液透析患者中的应用效果。方法选取我院2016年3月～2017年12月收治48例老年血液透析患者作为本次研究对象,采用随机分组的方法分为对照组(24例)与研究组(24例),对照组采用常规透析方法,研究组采用低温联合斜线式钠曲透析方法,比较两组的低血压发生率、透析期间获得体质量、超滤量、钠离子浓度、血肌酐浓度、血尿素氮及血清Na+指标。结果研究组低血压发生率8.33%比对照组低血压发生率33.33%低,数据差异有统计学意义(P 0.05)。两组在透析期间获得体质量比较,差异无统计学意义(P 0.05);治疗前研究组超滤量比对照组超滤量高,差异有统计学意义(P 0.05)。两组治疗前后钠离子浓度、血肌酐浓度、血尿素氮比较,差异有统计学意义(P 0.05);对照组患者治疗后钠离子浓度比治疗前高、血肌酐浓度比治疗低、血尿素氮比治疗前低,差异有统计学意义(P 0.05);研究组患者治疗后钠离子浓度比治疗前高、血肌酐浓度比治疗前低、血尿素氮比治疗前低,差异有统计学意义(P 0.05)。结论老年血液透析患者采取低温联合斜线式钠曲血液透析方案治疗,可有效降低低血压发生率,提高老年血液透析患者治疗耐受程度,对血钠浓度影响较低,值得在临床推广使用。     

乌司他丁对急性心肌梗死患者溶栓后血浆N末端脑钠肽前体水平的影响

目的:观察乌司他丁对急性心肌梗死患者溶栓后血浆N末端脑钠肽前体(NT-proBNP)水平的影响。方法:纳入2014年6月—2016年3月收治的急性心肌梗死患者130例,根据电脑随机平均分配的原则将其分为对照组和观察组各65例。对照组患者接受常规治疗,观察组患者在常规治疗的基础上,再给予乌司他丁进行治疗。2组患者均进行为期3 d的治疗,比较2组患者溶栓当日与3 d后的左心室射血分数,观察并比较2组患者血浆NT-proBNP质量浓度的变化。结果:溶栓前,2组患者血浆NT-proBNP质量浓度的差异无统计学意义(P>0.05);溶栓后30 min、2、6、24 h,观察组患者血浆NT-proBNP质量浓度均明显低于对照组,差异有统计学意义(P<0.05)。溶栓当日和溶栓3 d后,观察组患者左心室射血分数均明显高于对照组,差异有统计学意义(P<0.05)。结论:应用乌司他丁对急性心肌梗死患者进行治疗,可显著改善患者的血浆NT-proBNP水平,提高左心室射血分数。     

高通量血液透析对维持性透析患者心胸比值的影响

目的探讨高通量血液透析方法对维持性血液透析患者心胸比值的影响。方法选取2012年6月至2013年12月在苏州相城人民医院肾内科就治的终末期肾病维持性血液透析患者,共64例,并随机分为高通量血液透析组(n=30)和常规透析组(n=34),比较治疗前后心胸比值、左心室结构和功能、炎性因子等的变化。结果与治疗前相比,高通量血液透析治疗12个月后,患者心胸比值无明显变化(P>0.05);左心室功能指标LAD、LVDd、LVPWT、LVST、LVEF、LVMI无显著统计学差异(P>0.05);血清ALB、HDL水平上升(P<0.05);血清CHOL、LDL、β2-MG、AGEs、IL-6水平显著降低(P<0.05);血磷、血钙、PTH、血清PA和TG无明显变化(P>0.05)。结论高通量血液透析可有效延缓维持性透析患者心室的进一步扩大,从而改善维持性透析患者左心室的舒张功能,延缓血管内皮功能的进一步损害。     

血浆N末端B型利钠肽原在不同心脏病患者中诊断心力衰竭的价值

目的 探讨N末端B型利钠胜原(NT-pmBNP)时不同心脏病患者心力衰竭的诊断价值.方法 检测150例患者血浆NT-proBNP浓度,分析不同病因及不同分级心力衰蝎患者血浆NT-proBNP浓度的比较结果.结果 不同病因患者的NT-proBNP含量比较,差异无统计学意义(P＞0.05);血浆NT-proBNP浓度随心力衰竭的分级增大而升高(P＜0.05).结论 血浆NT-proBNP浓度在患者发生心力衰竭时显著升高,是诊断心力衰竭的可靠指标.     

家庭跟进护理对维持性血液透析患者生存质量的影响

目的探讨家庭跟进护理对维持性血液透析患者生存质量的影响。方法选择2016年1~8月在我院行维持性血液透析的患者60例为研究对象,随机分为干预组与对照组各30例。对照组给予常规护理,干预组在常规护理的基础上给予家庭跟进护理。比较两组干预前后营养指标水平、KDQOL-SF评分结果。结果干预后,干预组Hb、血清白蛋白、转铁蛋白、前白蛋白水平均显著高于干预前,差异有统计学意义(P<0.05);干预后,干预组Hb、血清白蛋白、转铁蛋白、前白蛋白水平均显著高于对照组,差异有统计学意义(P<0.05);干预后,对照组营养指标与干预前比较差异无统计学意义(P>0.05)。干预后,干预组KDQOL-SF得分均显著高于干预前,差异有统计学意义(P<0.05);干预后,干预组KDQOL-SF得分均显著高于对照组,差异有统计学意义(P<0.05);干预后,对照组KDQOL-SF得分与干预前比较差异无统计学意义(P>0.05)。结论家庭跟进护理能够显著改善维持性血液透析患者的营养状况及生存质量。     

血浆NT-proBNP水平对心力衰竭诊断及预后的评估价值

目的观察血浆NT-proBNP水平在心力衰竭诊断及预后的评估价值。方法将2015年1月至2018年12月108例在我院接受治疗的心力衰竭患者作为观察组,另选取同期在我院常规体检的正常人群50例作为对照组,检测两组血浆氨基末端B型脑钠肽前体(N-terminal probrain natriuretic peptide,NT-proBNP)水平,予以比较,并比较不同心功能分级心力衰竭患者血浆NT-proBNP水平。结果观察组患者血浆NT-proBNP水平显著高于对照组(P<0.05),有统计学意义;且心功能Ⅳ级组患者血浆NT-proBNP水平明显高于Ⅰ级、Ⅱ级、Ⅲ级(P<0.05),差异有统计学意义;经过治疗,观察组患者血浆NT-proBNP水平明显降低,与治疗前比较差异有统计学意义(P<0.05)。结论血浆NTproBNP水平在心力衰竭中呈现出高表达,且心功能级别越高血浆NT-proBNP水平越高,能够用于心力衰竭诊断及预后评估。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.