健康人群尿汞本底值的调查

目的探讨不同地区非接触汞正常人群尿汞正常值.方法在上海、黑龙江、广东、四川等省市,收集非接触汞正常人群尿样共2 248例.样本采集采用随意尿,统一使用聚乙烯塑料瓶收集不少于25 ml的尿样,统一使用上海光华仪器厂生产的F732-G型测汞仪,测定方法采用尿中汞的酸性氯化亚锡还原-冷原子吸收法和尿中汞的碱性氯化亚锡还原-冷原子吸收法.并用肌酐和比重校正.采用苦味酸法测定肌酐,采用比重计测定比重.结果尿汞测定值呈偏态分布,采用对数转换成正态或近似正态分布,用几何均数表示平均水平.酸性法和碱性法2种测定方法的比较,差异无统计学意义（P=0.099）.男女间各地区比较,差异无统计学意义（P＞0.05）.尿汞正常值95%上限为≤4.25μg/L（21.22 nmol/L）,用肌酐校正后为3.724 5 μg/g Cr（18.38 mol/g Cr）,比重校正后为4.45μg/L（22.50 nmol/L）.结论建议尿汞正常参考值为≤5μg/L（25 mol/L）,肌酐校正后为≤4 μg/L Cr（20nmol/Cr）,比重校正后为≤5 μg/L（25 nmol/L）.     

凯时联合银杏达莫注射液治疗早期糖尿病肾病的临床观察

目的探讨凯时联合银杏达莫注射液治疗早期糖尿病肾病的临床疗效。方法116例患者分为两组，治疗组和对照组。两组患者均给予糖尿病饮食和优质低蛋白饮食，并给予降糖、降压、降脂等治疗，同时予以银杏达莫注射液20m1加入0．9％的生理盐水250ml中静脉滴注。治疗组在其基础上给予凯时10μg，加入生理盐水100ml中静滴，14d为一个疗程，观察治疗前后空腹血糖、肌酐、尿素氮、24h尿蛋白定量、尿β2-MG。结果治疗14d后治疗组治疗前后肌酐、24h尿蛋白定量、尿β2-MG差异有统计学意义（P〈0．05），而对照组治疗前后肌酐、尿素氮、24h尿蛋白定量、尿β2-MG、空腹血糖差异均无统计学意义（P〉0．05）。治疗后治疗组肌酐、24h尿蛋白定量、尿β2-MC,明显低于对照组（P〈0．05）。结论凯时和银杏达莫注射液联合应用治疗早期2型糖尿病肾病安全、有效，值得临床推广。     

钆对比剂沉积机制与不良反应

钆对比剂广泛应用于磁共振成像中,是公认的安全性及耐受性良好的对比剂。然而最近有不少研究发现,在严重肾损害患者中,钆对比剂的使用与肾源性系统纤维化的发展存在一定关系。本研究综述了钆对比剂毒性的生化机制和分子基础以及限制钆人体负荷的方法。应用PubMed及中国知网、万方等数据库,以"钆""钆对比剂""钆毒性""磁共振成像""生化机制"为关键词,检索2008-2018年的相关文献,共检索到98篇文献。纳入标准:(1)钆对比剂的分子基础及成像原理。(2)钆对比剂在组织中沉积的不良影响。(3)钆的生化和毒理学机制。(4)钆组织沉积不良反应的治疗和预防措施。根据纳入标准,最后分析28篇高度相关的文献。无论肾功能是否损害,钆都能在组织中沉积,并对神经系统、骨肌系统及皮肤等产生一定的不良反应。钆毒性反应与细胞凋亡、氧化应激、金属转移以及Gd~(3+)与Ca~(2+)在细胞生物过程中的竞争作用有关。关于多次接受钆对比剂造影检查对健康影响的研究较为有限,目前已明确钆对比剂在组织沉积中会产生不良反应,为明确更多钆潜在毒性方面的问题,需进一步研究。     

黄葵胶囊治疗早期慢性肾脏病观察

目的探讨黄葵胶囊治疗早期慢性肾脏病的疗效。方法将32例早期慢性肾脏病分为2组,黄葵胶囊治疗组16例,对照组16例,疗程为8周,均观察治疗前后24 h尿蛋白、24 h尿白蛋白、血肌酐、血尿酸及临床症状积分。结果治疗组与对照组治疗前24 h尿蛋白、24 h尿白蛋白,血肌酐差异无统计学意义（P〉0.05）。治疗组总有效率68.7%,对照组总有效率37.5%,2组总有效率差异有统计学意义（P〈0.05）。治疗组24 h尿蛋白、24 h尿白蛋白、血尿酸治疗前后差异有统计学意义（P〈0.05）。2组临床症状积分治疗后差异有统计学意义（P〈0.05）。结论黄葵胶囊通过减少尿蛋白和血尿酸干预治疗早期慢性肾脏病,有确切疗效,值得临床推广。     

与含钆造影剂相关的肾源性系统纤维化

1988年开始含钆造影剂已应用于磁共振成像（MRI）增强检查，它能提高MRI的图像对比度，使病变显像更清晰。由于用于X线及CT增强检查的含碘造影剂具有肾毒性，可能诱发造影剂肾病，因此其在肾功能不全等高危患者中被禁用，而含钆造影剂无肾毒性，故临床医师从前就常在此时用其行MRI增强显影来替代上述X线及CT增强检查。但是，现在这一观点必须改变，因为近年发现肾功能不全患者应用含钆造影剂虽然不伤肾，但却可引起一个更严重的全身疾病——肾源性系统纤维化（nephrogenic systemic fibrosis，NSF）。     

14例美白化妆品致汞中毒合并肾脏损害的临床分析

目的 探讨使用美白化妆品致汞中毒并发肾脏损伤的临床特征及治疗方法。
方法 回顾性分析14例使用美白化妆品致汞中毒并发肾脏损伤患者的临床表现、病理资料、尿汞检测及治疗过程。
结果 14例患者均出现了蛋白尿、水肿, 伴有头晕等神经系统症状, 入院时尿汞水平25.1~128.5 μg/g Cr, 病理提示肾脏有病变。经过2~5个疗程的驱汞治疗以及糖皮质激素和保肾针治疗后, 总排汞量840~12 405 μg, 尿汞水平下降, 蛋白尿转阴, 白蛋白升至正常, 血脂降至正常, 神经系统症状完全缓解。患者使用美白化妆品的时间与驱汞治疗前的尿汞水平无相关性(P>0.05), 空白尿汞水平与患者驱汞总排出尿汞值存在正相关(r=0.785, P < 0.01)。
结论 使用伪劣美白化妆品会导致汞中毒, 以肾脏为主要靶器官。大部分汞中毒导致的肾脏损伤患者经驱汞治疗后可以康复。
     

服用中药致急性砷、铅中毒1例报告

目的 报告1例服用中药所致严重砷、铅中毒病例的发病情况、临床表现及治疗转归.方法 回顾性分析本院近期收治的1例急性重度砷中毒、急性中度铅中毒病人的临床资料和治疗结果.结果 病人服用含朱砂中药后出现消化道、皮肤、造血等器官严重损伤;入本院后进行实验室检查,用二巯基丙磺钠0.125 g肌内注射后留取24 h尿,查尿砷值为14.8 μmol/L、尿铅值为12.8 μmol/L,立即采用络合剂二巯基丙磺钠,后用依地酸钠钙驱砷、铅,同时进行抑酸、止血、防治感染对症支持等治疗,治疗4d后患者症状明显减轻,住院29 d后好转出院,患者出院半年后症状消失,各项实验室检查恢复至正常,达到治愈标准.结论 服用含朱砂等中药时因药物杂质可能发生砷、铅中毒,在络合剂的选择上,先采用对砷、铅中毒均有络合作用的二巯基丙磺钠进行治疗,后用依地酸钙钠进行驱铅治疗.     

祛斑化妆品引起汞中毒的病例报道

在某县城关发生两起由于使用祛斑化妆品造成慢性汞中毒事件。患者为年轻教师及其母亲 ,使用深圳某化妆品厂生产的祛斑霜。该化妆品为特殊用途化妆品 ,没有有效批准文号 ,属非法产品。使用后 1个月出现头晕 ,记忆力减退、腰酸等症状。经省职业病防治院专家会诊 ,怀疑汞中毒 ;经特异性检查确诊为慢性汞中毒 ,患者甲尿汞含量 5 7 72 μg/L ,患者乙尿汞含量117 10 μg/L(正常值 2 0 μg/L)。驱汞试验后 2 4h尿汞 (甲 )为411 44 μg/L ,(乙 )为 80 8 40 μg/L。经检验患者所用祛斑霜其汞含量超标达近万倍。病人经驱汞与对症治疗症状逐渐缓解 ,3…     

低浓度职业性苯乙烯接触对线粒体DNA拷贝数和微核率的影响研究

  目的  探讨接触低浓度苯乙烯对线粒体DNA含量和微核率的影响,以寻找潜在的生物标志。
  方法  招募上海某塑料生产企业接触苯乙烯的男性工人127名为研究对象,检测工作车间空气中苯乙烯浓度,应用高效液相色谱法对苯乙烯的尿中代谢物进行检测,应用分光光度法测定尿中肌酐进行校正;按照尿中苯乙醇酸水平,将≤ 0.000 9 mg/g（以肌酐校正）者纳入低接触组,> 0.000 9~0.001 4 mg/g（以肌酐校正）者纳入中接触组,> 0.001 4 mg/g（以肌酐校正）者则纳入高接触组。通过实时荧光定量PCR实验检测工人外周血的线粒体DNA含量,通过胞质分裂阻滞微核实验检测外周血淋巴细胞的微核率。
  结果  工作场所定点采样显示环境空气中苯乙烯浓度低于1.2 mg/m3,尿中苯乙醇酸水平的中位数和四分位数为0.001 1（0.000 8,0.001 8）mg/g（以肌酐校正）。广义线性模型分析结果显示:与低接触组相比,中接触组工人的mtDNAcn（自然对数转换后）升高0.271（P=0.042）;中性粒细胞计数与淋巴细胞计数比值每升高1个单位,mtDNAcn（自然对数转换后）降低0.227（P < 0.01）。泊松回归模型分析结果显示:年龄每增加1岁,微核率升高至原来的1.043倍（P < 0.001）;尿中苯乙醇酸水平并非微核率的影响因素（P>0.05）。
  结论  即使是低于职业接触限值的苯乙烯接触亦可引起线粒体DNA拷贝数水平的改变,但未引起微核率的遗传毒性指标的改变,提示低浓度的苯乙烯可能通过氧化应激引起早期效应。
     

中国9个长寿地区65岁及以上老年人尿镉水平与体重指数及身体围度的关联研究

目的研究我国9个长寿地区65岁及以上老年人尿镉与体重指数(BMI)及身体围度的关联。方法研究对象来自2017—2018年在我国9个长寿地区开展的"中国老年健康生物标志物队列研究", 共计1 968名65岁及以上老年人被纳入本研究。通过问卷调查和体格检查, 收集调查对象的社会人口学特征、生活方式、膳食摄入和健康状态等信息, 采集调查对象晨尿以检测尿镉和尿肌酐水平;身体围度包括腰围、臀围和小腿围。根据尿肌酐校正后尿镉水平三分位数将调查对象分为低水平组(<0.77 μg/g·肌酐)、中水平组(0.77～1.69 μg/g·肌酐)和高水平组(≥1.69 μg/g·肌酐), 采用多重线性回归模型分析尿肌酐校正后尿镉不同水平与BMI及身体围度的关联, 采用限制性立方样条拟合多重线性回归模型分析尿肌酐校正后尿镉水平与BMI及身体围度的剂量-反应关系。结果 1 968名研究对象年龄为(83.34±11.14)岁, 尿肌酐校正后尿镉水平的M(Q1, Q3)为1.13(0.63, 2.09)μg/g·肌酐, BMI为(22.70±3.82)kg/m2, 腰围为(85.42±10.68)cm, 臀围为...     

与含钆造影剂相关的肾源性系统纤维化

1988年开始含钆造影剂已应用于磁共振成像(MRI)增强检查,它能提高MRI的图像对比度,使病变显像更清晰.由于用于X线及CT增强检查的含碘造影剂具有肾毒性,可能诱发造影剂肾病,因此其在肾功能不全等高危患者中被禁用,而含钆造影剂无肾毒性,故临床医师从前就常在此时用其行MRI增强显影来替代上述X线及CT增强检查.但是,现在这一观点必须改变,因为近年发现肾功能不全患者应用含钆造影剂虽然不伤肾,但却可引起一个更严重的全身疾病--肾源性系统纤维化(nephrogenic systemic fibrosis.NSF).     

Effects of gadolinium on the retention and translocation of 239Pu-hydroxide

The effect of gadolinium on the lung retention, excretion, and translocation of plutonium was studied in rats instilled intratracheally with plutonium hydroxide with and without gadolinium. Three types of plutonium hydroxide were prepared: pure 239Pu-hydroxide colloid, that containing a high concentration of gadolinium, and that containing a low concentration of gadolinium. The lung retention of 239Pu was higher and the fecal excretion was lower in the rats administered 239Pu-hydroxide containing a high concentration of gadolinium than those administered pure 239Pu-hydroxide colloid. The translocation of 239Pu from lung to other organs including the liver, spleen, femur, and kidney was not affected by gadolinium. The cytological examination of bronchoalveolar lavage cells showed that the administration of 239Pu-hydroxide containing a high concentration of gadolinium induced the inflammatory reactions in the lung. The delayed alveolar clearance of plutonium in the rats administered 239Pu-hydroxide colloid containing a high concentration of gadolinium may be attributable to the change in physicochemical characteristics of colloid and the inflammation induced in the lung by gadolinium.     

Acute alcohol intoxication and gadolinium chloride attenuate endotoxin-induced release of CC chemokines in the rat.

This work tests the hypotheses that Kupffer cells are a major source of CC-chemokines (MIP-1alpha, MCP-1, RANTES) during acute endotoxemia and that acute ethanol intoxication modulates Escherichia coli lipopolysaccharide (LPS, 1 mg/Kg, i.v.)-induced chemokine release in the rat. LPS stimulated the release of CC-chemokines into the circulation, hepatic sequestration of leukocytes and liver injury. LPS-induced serum chemokines peaked at 1-3 h and could not be detected at 24-h posttreatment. Splenectomy significantly suppressed LPS-induced RANTES release, but not MIP-1alpha and MCP-1. Kupffer cell depletion by gadolinium chloride or acute ethanol intoxication significantly attenuated LPS-induced CC-chemokine release and hepatic injury. Hepatic sequestration of leukocytes during endotoxemia was also suppressed by acute ethanol. LPS downregulated the expression of MIP-1alpha and MCP-1 mRNAs and upregulated RANTES mRNA in Kupffer cells at 3-h post endotoxin. The expression of mRNAs was further suppressed in ethanol plus the LPS-treated group. Ethanol also suppressed the LPS-mediated priming of Kupffer cells for enhanced CC-chemokine release in vitro. Ethanol alone significantly upregulated the expression of CC-chemokine mRNA, and primed the Kupffer cells for enhanced RANTES release. CC-chemokine release and mRNA expression in hepatic sinusoidal endothelial cells were not significantly altered by ethanol, except for MCP-1 release. These data show that acute ethanol may be beneficial in tissue injury during acute endotoxemia.     

A Monte Carlo study on tissue dose enhancement in brachytherapy: a comparison between gadolinium and gold nanoparticles

The aim of this study was to quantify the dose enhancement by gadolinium and gold nanoparticles in brachytherapy. MCNPX Monte Carlo code was used to simulate four brachytherapy sources: (60)Co, (198)Au, (192)Ir, (169)Yb. To verify the accuracy of our simulations, the obtained values of dose rate constants and radial dose functions were compared with corresponding published values for these sources. To study dose enhancements, a spherical soft tissue phantom with 15 cm in radius was simulated. Gadolinium and gold nanoparticles at 10, 20 and 30 mg/ml concentrations were separately assumed in a 1 × 1 × 1 cm(3) volume simulating tumour. The simulated dose to the tumour with the impurity was compared to the dose without impurity, as a function of radial distance and concentration of the impurity, to determine the enhancement of dose due to the presence of the impurity. Dose enhancements in the tumour obtained in the presence of gadolinium and gold nanoparticles with concentration of 30 mg/ml, were found to be in the range of -0.5-106.1 and 0.4-153.1 % respectively. In addition, at higher radial distances from the source center, higher dose enhancements were observed. GdNPs can be used as a high atomic number material to enhance dose in tumour volume with dose enhancements up to 106.1 % when used in brachytherapy. Regardless considering the clinical limitations of the here-in presented model, for a similar source and concentration of nanoparticles, gold nanoparticles show higher dose enhancement than gadolinium nanoparticles and can have more clinical usefulness as dose enhancer material.     

A comparison of the COG and MCNP codes in computational neutron capture therapy modeling, Part II: gadolinium neutron capture therapy models and therapeutic effects

The goal of this study was to evaluate the COG Monte Carlo radiation transport code, developed and tested by Lawrence Livermore National Laboratory, for gadolinium neutron capture therapy (GdNCT) related modeling. The validity of COG NCT model has been established for this model, and here the calculation was extended to analyze the effect of various gadolinium concentrations on dose distribution and cell-kill effect of the GdNCT modality and to determine the optimum therapeutic conditions for treating brain cancers. The computational results were compared with the widely used MCNP code. The differences between the COG and MCNP predictions were generally small and suggest that the COG code can be applied to similar research problems in NCT. Results for this study also showed that a concentration of 100 ppm gadolinium in the tumor was most beneficial when using an epithermal neutron beam.