血液透析滤过对慢性肾功能衰竭患者血清瘦素水平的影响

目的探讨血液透析滤过对慢性肾功能衰竭患者血清瘦素的清除及血清瘦素水平与营养不良的关系。方法测定41例维持性血液透析患者透析前、后(血液透析组22例,血液透析滤过组19例)及35例对照组血清瘦素、尿素氮、肌酐、白蛋白、总胆固醇和血红蛋白水平,计算体重指数(BM I)。结果维持性血液透析患者透析前血清瘦素水平均较对照组明显增高。血液透析滤过组透析后血清瘦素水平较透析前明显降低。维持性血液透析患者的血清瘦素水平分别与BM I呈正相关,与血清白蛋白呈负相关。结论慢性肾功能衰竭患者存在高瘦素血症,血清瘦素水平升高与营养不良有相关性,血液透析滤过可清除血清瘦素。     

组合型人工肾对老年血液透析患者甲状旁腺素水平的影响

目的研究血液灌流、血液透析滤过对维持性血液透析患者血清甲状旁腺素(PTH)的清除效果。方法将46例老年维持性血液透析患者分为血液透析组(HD)、血液灌流+血液透析组(HD+HP)、血液透析滤过组(HDF)。HD组应用常规血液透析治疗,HD+HP组应用树脂吸附联合血液透析治疗,HDF组应用透析滤过治疗。监测血清肌酐、尿素氮、血磷、血清全段PTH水平。结果血液灌流联合血液透析组与血液透析滤过组患者血清甲状旁腺素(PTH)治疗前后均有显著差异(P<0.05)。结论血液灌流联合血液透析与血液透析滤过均能有效清除血液透析患者血清甲状旁腺素,血掖透析组清除血清甲状旁腺素(PTH)效果不佳。     

腹膜透析对老年慢性肾衰竭患者机体炎症状况及肾功能的影响

目的探讨腹膜透析对老年慢性肾衰竭(CRF)患者机体炎症状况及肾功能的影响。方法将90例老年CRF患者随机分为观察组和对照组,其中观察组(45例)采用腹膜透析治疗,对照组(45例)采用血液透析治疗。观察两组透析治疗后机体炎症状况及肾功能变化;记录两组透析治疗过程中并发症情况。结果透析后,观察组炎症指标C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α均显著低于对照组(P0.05);与对照组比较,观察组透析后尿素氮(BUN)、血肌酐(Scr)及尿素浓度均显著降低,肾小球滤过率(GFR)则明显升高(P0.05)。观察组透析后血清白蛋白(ALB)、血红蛋白(Hb)及总蛋白(TP)水平明显高于对照组,差异有统计学意义(P0.05)。观察组治疗过程中并发症总发生率显著低于对照组(P0.05)。结论腹膜透析能有效降低老年CRF患者机体炎症状态,保护患者残余肾功能,提高透析充分性和治疗安全性。     

不同血液净化方式对尿毒症患者动脉钙化的影响

目的 探讨不同血液净化方式对尿毒症患者动脉钙化程度的影响.方法 选取我院长期进行血液净化治疗的尿毒症患者97例,按血液净化方式不同分为血液透析滤过(HDF)组、血液透析(HD)组,利用多层螺旋CT进行全腹扫描,评价腹主动脉及髂动脉钙化程度,分析不同血液净化方式对患者血管钙化分级的影响.结果 HDF组和HD组患者动脉不同程度血管钙化分别为42例(72.4％)和37例(94.9％),两组血管钙化程度分级比较差异有统计学意义(P＜0.05),HDF、HD组原发疾病构成、年龄、透析龄、透析前血压比较差异无统计学意义(P＞0.05),HDF组甲状旁腺激素(PTH)低于HD组(P＜0.05),HDF组C反应蛋白低于HD组(P＜0.05),HDF组血红蛋白高于HD组(P＜0.01),差异有统计学意义.结论 尿毒症患者动脉钙化发生率高,血液透析滤过治疗的患者血管钙化程度轻.     

HDF与常规血液透析(HD)治疗糖尿病并重症肾衰竭对肾功能指标改善作用及生存质量影响比较

目的 比较血液透析滤过(HDF)与低通量血液透析(HD)治疗糖尿病并重症肾衰竭对肾功能指标改善作用及生存质量影响。方法 选择2016年7月至2017年8月在我院行血液透析的67例糖尿病并重症肾衰竭患者,根据随机数表法分组。HD组30例,实施常规血液透析;HDF组37例,实施血液透析滤过治疗。于透析前、透析后观察两组肾功能、生存质量变化,并统计两组临床疗效及并发症。结果 透析后HDF组肌酐(Cr)、血清微球蛋白(β₂-MG)、血红蛋白(HGB)、甲状旁腺激素(PTH)、血磷(P)较HD组低,白蛋白(Alb)水平较HD组高,差异有统计学意义(P＜0.05);HDF组治疗总有效率97.30%(36/37)较HD 76.67%(23/30)组高,差异有统计学意义(P＜0.05);透析后HDF组情绪角色(RE)、心理健康(MCS)、总体健康(GH)、躯体角色(RP) 社会功能(SF)评分较HD组高,差异有统计学意义(P＜0.05);HDF组皮肤瘙痒发生率较HD组低,差异有统计学意义(P＜0.05)。结论 与HD相比,HDF治疗糖尿病并重症肾衰竭患者效果更佳,可改善肾功能,降低并发症发生,提高生存质量,利于预后。     

血液透析与血液透析滤过对糖尿病肾病尿毒症毒素 MMS 和 PENT 的清除观察

目的：观察糖尿病肾病尿毒症患者接受血液透析（HD ）和血液透析滤过（HDF ）治疗对中分子毒素（MMS ）、晚期糖基化终产物戊糖素（PENT ）的清除效果。方法选择符合入选标准的36例维持性血液透析DKD尿毒症患者,分为HD组（n＝24）、HDF组（n＝12）,于单次治疗前后取血,测定血清尿素氮（BUN ）、MMS、PENT ,应用Daugirdas公式计算单次透析充分性（KT/V）。结果各组患者治疗后血清BUN水平均显著下降（ P＜0.01）,KT/V均超过1.3,但各组间BUN下降率及KT/V差异无统计学意义。各组均能部分降低血清MMS、PENT水平,HDF对MMS、PENT的清除率优于常规HD清除（ P＜0.05）。结论血液透析滤过对糖尿病肾病尿毒症患者MMS、PENT清除明显优于常规血液透析。     

影响老年血液透析患者生存期的相关因素分析

目的 分析影响老年血液透析患者生存期的临床相关因素.方法 选择2006年6月至今在我院进行血液透析的59例老年患者设为老年组,选择同期51例非老年血液透析患者设为非老年组,对两组患者的诊治资料进行分析,统计两组患者的生存时间、透析期间的严重并发症发生率、透析前的血红蛋白水平、血清白蛋白水平、每周透析时间等,分析上述因素与患者生存时间的关系.结果 两组患者1～3年期生存率、5年期生存率情况显示,老年组均明显低于非老年组,两组比较差异具有统计学意义(P＜0.05);老年组患者生存时间小于1年的患者18例,其中严重心血管并发症发生率为77.78％,41例生存期大于1年的患者严重心血管并发症发生率为41.46％,两者比较差异明显;老年患者中,每周透析时间比较,生存期小于3年患者的平均每周透析时间为(11.2±1.2)h;生存期大于3年的患者为(15.3±2.1)h;老年组患者生存期小于3年的患者透析前血红蛋白平均水平为(39.7 ±5.3)g/L、血清白蛋白水平为(25.2 ±3.4)g/L,生存期＞3年患者的血红蛋白水平为(64.2±6.1) g/L、血清白蛋白水平为(33.6±3.8) g/L;上述所有组间比较均有显著性差异(P＜0.05).结论 严重并发症、营养不良、透析时间等是导致老年透析患者死亡的主要原因.     

腹膜透析联合血液透析对老年终末期肾病患者心功能的影响

目的探讨腹膜透析联合血液透析对老年终末期肾病(ESRD)患者心功能的影响。方法 ESRD患者50例依据治疗方法不同分为腹膜透析组、血液透析组各16例,联合组18例。观察三组治疗前后心功能、尿素清除指数(KT/V)、肾脏形态大小、各项生化指标及并发症发生情况等。结果治疗前三组左心室射血分数(LVEF)、肾脏形态大小、白蛋白(ALB)、血红蛋白(Hb)、血清尿素氮(BUN)、血清肌酐(Scr)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)水平差异无统计学意义(P0.05);治疗后联合组LVEF、KT/V显著优于血液透析组、腹膜透析组,同时联合组肾脏形态大小显著优于血液透析组(P0.05);治疗后联合组ALB、Hb水平显著优于血液透析组,同时联合组ALB、Hb、BUN、Scr、TG、HDL-C测定结果均显著优于腹膜透析组(P0.05);联合组相关并发症发生率显著低于腹膜透析组、血液透析组(P0.05)。结论腹膜透析与血液透析联合治疗利于改善老年ESRD患者心功能,延缓肾衰竭,降低相关并发症,对延缓病症进展与提升生存率影响重大。     

在线血液透析滤过联合血液透析对肾陛贫血的治疗作用

目的观察血液透析（HD）与HD联合在线血液透析滤过（online—HDF）治疗肾性贫血的临床疗效。方法将32例维持性血液透析患者随机分为HD组15例,HD＋online-HDF组17例。HD组采取维持性HD治疗,每周透析3次,每次透析4h。HD＋online—HDF组每周行online-HDF1次,HD治疗2次,时间均4h。观察6个月后两组在使用红细胞生成素（EPO）并常规补充铁剂、叶酸,维生素B12的情况下血红蛋白（Hb）、血清白蛋白（ALB）、血清铁蛋白（FER）、血清甲状旁腺激素（fyrH）、二氧化碳结合力（TCO2）及透析充分性指标（KT／V及URR）的变化。结果两组治疗后KT／V、URR、ALB、FER、PTH、TCO2比较无统计学差异（P均〉0．05）;治疗后HD＋online—HDF组Hb明显升高,与HD组比较有统计学差异（P〈0．05）。结论online-HDF联合HD治疗肾性贫血效果良好。     

慢性肾功能衰竭患者首次血液透析治疗预后因素分析

目的探讨慢性肾功能衰竭(CRF)患者肾功能恶化首次血液透析治疗预后因素。方法接受首次血液透析230例CRF患者,随机分成脱离透析组和未脱离透析组,观察患者体重、平均动脉压、透析前生化指标(血红蛋白、尿素氮、肌酐、血浆白蛋白、总胆固醇、甘油三酯)、不同原因(感染、心脑血管疾病、肾前性血容量不足、肾脏原发病、肾后梗阻、药物性、其他)诱发CRF恶化与透析预后的关系。结果脱离透析组体重、平均动脉压均低于未脱离透析组(P<0.05);血浆白蛋白高于未脱离透析组(P<0.05);感染、肾前性血容量不足、肾后梗阻引起CRF恶化者,脱离透析组显著高于未脱离透析组(P<0.05或P<0.01);肾脏原发病引起CRF恶化者,脱离透析组显著低于未脱离透析组(P<0.01)。结论体重、平均动脉压、白蛋白是引起CRF恶化及影响CRF患者首次透析的预后。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.