难治性肾病的羊别及危险因素分析

目的 产生激素敏感性肾病与难治性肾病的判别函数，了解引起肾病难治的危险因素。方法 使用ＳＰＳＳ软件包，对激素敏感与难治性肾病２组患儿的临床资料进行了逐步判别分析和条件ｌｏｇｉｓｔｉｃ逐步回归。结果 筛选出血尿（ｂｌｏ）、水肿程度（ｅｄｅ）、感染（ｉｎｆ）、白蛋白输入（ｐｅｒ）４个变量对２类总体有显著贡献，其判别方程为：Ｘ１＝－６．１６１８＋５．２６２２ｂｌｏ＋２．５８６０ｅｄｅ＋０．７１０８ｉｎｆ     

盐酸氮芥联合肝素治疗难治性肾病综合征

目的 :观察盐酸氮芥联合肝素治疗难治性肾病综合征的疗效。方法 :经正规强的松治疗 8周以上或激素依赖的难治性肾病综合征 2 6例。采用盐酸氮芥间日静脉注射 ,1 0针为 1个疗程 ;联合肝素 5 0 mg静脉注射 ,1日 2次。结果 :2 6例中完全缓解 1 1例 (4 2 .3 % ) ,部分缓解 1 0例。总有效率 80 .8%。 2 4例顽固性水肿治后消肿 2 3例 ,1 2例伴肾功能不全者肾功能全部恢复正常。结论 :盐酸氮芥联合肝素对难治性肾病综合征有较好的疗效 ,特别对利尿消肿作用明显 ,毒性反应并不很严重 ,不失为治疗难治性肾病伴有顽固性水肿及合并急性肾衰的患者的有效治疗方法     

肾病综合征脂质紊乱转归与蛋白代谢改变的关系

目的　探讨肾病综合征脂质紊乱及其转归与蛋白代谢异常的关系。方法　将70例原发性肾病综合征(NS)患者按对激素的反应及复发情况分为非难治性肾病组(A组)和难治性肾病组(B组) ,35名健康者作为对照组。检测3组血脂、血尿蛋白及白蛋白指标,分析激素治疗后脂质紊乱转归与蛋白代谢的关系。结果　1 NS患者存在脂质代谢紊乱,TC、TG、L DL - C、apo B水平升高,B组比A组更明显(P<0 .0 1 )。2经激素治疗,TC、TG、L DL、apo B显著下降(P<0 .0 1 ) ,但仍高于正常对照组(P<0 .0 1 )。3TC、TG、L DL - C、apo B与血白蛋白(AL B)呈显著负相关(P<0 .0 1 ) ,与尿白蛋白排泄率(UAER)呈显著正相关(P<0 .0 1 )。激素治疗早期(治疗1个月后) UAER、Up的下降量(ΔUAER、ΔUp)与治疗后期(治疗2个月后)血脂指标的变化量(ΔTC、ΔTG、ΔL DL、Δapo B)有一定的相关性(P<0 .0 5或P<0 .0 1 ) ;与ΔUp相比,ΔUAER、ΔTC、ΔTG、ΔL DL、Δapo B有更大的相关性(P<0 .0 5 )。结论　以白蛋白为代表的中分子蛋白在尿中丢失与肾病综合征脂质紊乱密切相关,激素治疗后尿白蛋白排泄率的早期变化是脂质紊乱治疗转归相对特异的临床实验指标。     

难治性肾病综合征

1难治性肾病综合征的概念 　　目前,国内外尚无关于难治性肾病综合征一致的定义.一般认为,难治性肾病综合征包括频繁复发型、激素依赖型和激素抵抗型的肾病综合征.频繁复发型肾病综合征是指经治疗缓解后半年内复发2次或2次以上者,或1年内复发3次或3次以上者;激素依赖型系指经激素治疗获得缓解,但在激素撤减过程中或停用激素后14天内肾病综合征复发者;激素抵抗型则指规范化激素治疗无效的肾病综合征.难治性肾病综合征的病人由于病程较长,病情往往比较复杂,因此临床治疗上较为棘手.处理这样的病人之前,应该明确导致肾病综合征难治的原因到底是什么？     

激素联合环磷酰胺治疗难治性肾病综合征的护理

临床上对频繁复发、激素耐药、激素依赖 3种情况中任一种称为难治性肾病综合征 [1 ]。强的松是治疗肾病综合征的首选药物 ,但对治疗难治性肾病综合征效果不满意。临床实践证明 ,强的松与环磷酰胺联合应用对于保护肾功能、减少肾功衰竭较单用强的松效果好 ,是目前治疗难治性肾病综合征较理想的方法。我院自 1998～ 2 0 0 0年共收治 6 1例难治性肾病综合征患儿 ,均采用强的松加环磷酰胺冲击疗法 ,效果显著 ,现将护理体会报道如下。1　临床资料6 1例难治性肾病综合征患儿中 ,单纯性肾病综合征 5例 ,占 2 5 % ,发病年龄最小 1.5岁 ,最大 6岁。肾…     

肾病综合征尿白蛋白排泄率与脂质紊乱转归的关系

目的　研究肾病综合征激素治疗后脂质紊乱转归及其与尿白蛋白排泄率改变的关系。方法　检测2 7例原发性肾病综合征患者血脂、血尿蛋白及尿白蛋白指标。结果　经正规激素治疗 ,血尿蛋白得到相应的改善 ,并随血脂指标 (TC ,TG ,LDL ,apoB)缓解 (P <0 0 1)。治疗前肾病综合征患者 ,血清白蛋白 (ALB)、尿白蛋白排泄率 (UAE)与TC ,TG ,LDL ,apoB均有显著的相关关系 (P <0 0 1) ,而 2 4h尿蛋白定量 (Up)仅与TC有显著的相关 (P <0 0 5 ) ;激素治疗早期 (治疗 1个月后 )UAE ,Up的下降量 (△UAE ,△Up)与治疗后期 (治疗 2个月后随访 )血脂指标变化量 (△TC ,△TG ,△LDL ,△apoB)有一定的相关性 (P <0 0 1,P <0 0 5 ) ;与△Up相比 ,△UAE与△TC ,△TG ,△LDL ,△apoB有更大的相关性 (P <0 0 5 )。结论　肾病综合征尿白蛋白排泄率的早期变化与脂质紊乱治疗转归密切相关。     

长春新碱冲击治疗小儿难治性肾病综合征60例临床观察

采用长春新碱冲击疗法联合强的松治疗小儿难治性肾病综合征 60例 ,其中单纯性肾病 2 5例 ,肾炎性肾病 35例。激素耐药性 47例 ,频繁复发性 8例 ,激素依赖性 5例。肾活检 1 0例中 ,Ig A肾病 1例 ,Ig M肾病 2例 ,弥漫系膜增生性肾小球肾炎 4例 ,微小型病变 2例 ,局灶节段性肾小球硬化 1例。经 6～ 1 0次治疗后总有效率为 91 .7%。提示长春新碱冲击疗法对小儿难治性肾病仍是一种有效疗法     

难治性肾病综合征免疫抑制治疗的临床挑战

难治性肾病综合征目前尚无统一定义,大多数肾脏病学者主张按激素的治疗反应,一般将激素抵抗、激素依赖(或频繁复发)的肾病综合征归入难治范畴,我们认为广义的难治性肾病综合征还应包括多种免疫抑制药物抵抗或反复复发的肾病综合征、持续大量蛋白尿的特发性膜性肾病(idiopathic membranous nephropathy,IMN)、不能耐受激素或其他免疫抑制药物治疗的的肾病综合征等.     

环磷酰胺静脉冲击联合强的松治疗12例儿童难治性肾病报告

我科对强的松正规治疗无效或对强的松依赖及频繁复发的 12例难治性肾病患者加用环磷酰胺静脉冲击 (ＣＴＸ -ＰＴ)治疗 ,获得较好的效果 ,现报道如下。1　对象和方法1.1　对象　 1995年 1月～ 2 0 0 1年 12月我科共收治难治性肾病 12例 ,其中男 8例 ,女 4例 ;年龄 3～ 14岁 ,肾病病程 6个月～ 5年。均符合 1985年全国小儿肾脏疾病协作组制订的难治性肾病的诊断标准。其中激素耐药型 4例 ,激素依赖型 2例 ,频繁复发型 6例。1.2　方法　ＣＴＸ -ＰＴ每次 80 0ｍｇ～ 10 0 0ｍｇ/ｍ2 ,加入 0 .9%生理盐水 10 0ｍｌ内静脉滴注 ,1～ 2ｈ内滴毕 ,每…     

温肾I号对激素依赖性难治性肾病血、尿17一酮类固醇含量的影响

目的：探讨温肾I号对激素依赖性难治性。肾病患者血、尿17一酮类固醇含量的影响。方法：选取激素依赖性难治性肾病患者100例,随机分为治疗组及对照组,每组50例。治疗组自激素减至小剂量（20mg／d）时即加用中药治疗,以后激素每2周递减2．5mg至维持阶段,维持量服用0．5—1年;对照组单纯激素治疗。两组治疗时间均为激素减完为止。结果：治疗后治疗组及对照组总蛋白、白蛋白含量明显升高（P〈0．05）,治疗组优于对照组;治疗组治疗后与治疗前相比,24h尿17一酮类固醇、血17一酮类固醇含量差异无显著性（P〉0．05）;对照组治疗后与治疗前相比,两者含量明显降低（P〈0．05）;两组治疗后相比,对照组24h时尿17一酮类固醇、血17一酮类固醇含量明显低于治疗组（P〈0．05）。结论：温肾I号可提高激素依赖性难治性肾病患者的总蛋白、白蛋白水平,对肾上腺皮质功能具有改善作用。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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…     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.