对比剂急性肾损害的研究进展

随着对比剂在临床影像诊断及介入治疗过程中的广泛应用,对比剂急性肾损害(CIAKI)的发病人数越来越多.有资料表明,CIAKI已成为住院患者获得性急性肾损伤的第3位原因以及介入领域3大难题之一.由于临床症状不典型、医师重视程度不够,可造成患者住院时间延长,住院费用增高,病死率增加,加强对CIAKI的了解及防治具有重要临床意义.我们对CIAKI的研究现状进行综述.     

超敏C反应蛋白与对比剂肾病关系的研究

目的:研究冠状动脉介入诊疗(包括冠状动脉造影及冠状动脉介入治疗)对对比剂肾病(CIN)的影响因素;进一步探讨超敏C反应蛋白(hsCRP)对对比剂肾病的预测价值.方法:入选我院择期行冠状动脉介入诊疗手术患者145例,记录患者基本资料,留取冠状动脉造影术前清晨空腹血常规及生化,记录术前血红蛋白(HGB)、白蛋白(ALB)、空腹血糖、血脂、尿酸、基础肌酐值以及hsCRP等资料;分别于术后24 h、48 h、72 h留取血样,测定血肌酐值.术后即刻记录手术所用对比剂剂量.结果:①冠状动脉介入诊疗术后对比剂肾病的发生率为10.3%,其中53.3%发生于术后24 h,26.7%发生于术后48 h,20.0%发生于术后72 h;②单因素分析发现有对比剂肾病的患者对比剂剂量及hsCRP明显高于无对比剂肾病患者,差异有统计学意义(P<0.05);logistic回归分析发现,术前hsCRP对对比剂肾病的发生具有统计学意义(P<0.05);③经皮冠状动脉介入治疗患者对比剂肾病的发生率为16.1%,术前hsCRP在对比剂肾病患者中显著升高,差异具有统计学意义(P<0.05).结论:冠状动脉介入诊疗术前hsCRP水平对对比剂肾病的发生有重要临床意义.在冠状动脉介入诊疗过程中对比剂剂量是影响对比剂肾病的发生重要因素.     

对比剂肾病的诊治进展

<正>随着影像学应用的普及、影像学成像方式的发展及血管造影和经皮冠脉介入(PCI)的开展,患者接触碘对比剂的概率增高,出现对比剂肾病(CIN)或对比剂诱导的急性肾损伤(CIAKI)的风险亦升高。1定义及发病率CIN是指与应用碘对比剂(CM)相关的肾功能的突然恶化。2%~25%的行PCI的患者会发生CIN〔1〕。不同的诊断标准,评价CIN的发生率不同。目前CIN尚无统一的标准,在临     

走出误区，关注黏度（一）——正确解读对比剂肾病的发病机制

2009—03—19下午，2009中国介入心脏病学大会（CIT大会）新闻发布会在北京国际会议中心召开。会上来自国内外的专家学者分别就我国对比剂临床应用的现状和发展以及目前备受关注的对比剂黏度影响对比剂肾病的机理进行了详细介绍。     

CARE长期随访研究:再度敲响对比剂肾病的预防警钟

近年来,随着接受碘对比剂检查的患者逐渐增多,尤其是目前我国心血管内科介入手术水平的高速发展,使得碘对比剂的使用愈来愈广泛,而对比剂肾病（CIN）这一与对比剂使用密切相关的并发症也越来越受到心血管医生的重视。CIN是指血管内注射碘对比剂后48～72h内发生的急性肾功能损害。它是使用碘对比剂的重要并发症,同时也是获得性急性肾功能损害的主要原因,尤其对于合并肾功能不良的患者,明显导致近、远期不良事件的增加和医疗费用的增加。     

慢性肾脏病患者对比剂肾病的危险因素

对比剂肾病(contrast-induced nephropathy,CIN)是碘对比剂应用过程中的重要并发症,也是医源性急性肾损伤的重要组成部分。由于接受造影检查和介入手术的患者不断增多,会有更多的患者应用碘对比剂;与此同时,作为CIN最主要的危     

他汀类药物预防对比剂肾病的研究进展

对比剂肾病(CIN)是一种血管造影术中使用对比剂出现的严重并发症,它在常见的医院获得性急性肾损伤中居第三位。对比剂肾病的发病机理尚不完全清楚,一些研究发现他汀类药物对预防对比剂肾病具有重要意义。虽然在一些患者中需要使用透析治疗,但CIN的治疗主要为支持治疗,包括小心液体的输入和电解质纠正,因此,最佳的治疗就是预防为主。该文主要对CIN的流行病学、发病机理和他汀类药物预防作用及可能机制进行综述。     

冠状动脉介入术导致对比剂肾病危险因素分析

目的探讨冠状动脉介入术患者对比剂肾病的危险因素。方法收集我院2008年1月~2009年12月期间住院的172例接受冠状动脉介入术患者的临床资料,比较对比剂使用剂量,测定介入治疗前后血清肌酐,分析发生对比剂肾病危险因素。结果 172例患者发生对比剂肾病32例,发生率18.61%(32/172),肾小球滤过率>60 mL/min患者发生对比剂肾病21例(13%),肾小球滤过率<60 mL/min患者发生对比剂肾病19例(40%)(P<0.001),年龄≥75岁、3支病变、左心室射血分数<40%、血清肌酐>133μmol/L及对比剂剂量>300 mL与对比剂肾病相关(P<0.001)。糖尿病或高血压合并肾功能不全对比剂肾病发病率高于单纯糖尿病或高血压患者(P<0.01)。结论介入治疗术前肾功能受损及其损害程度是术后出现对比剂肾病的最主要危险因素,肾功能不全、年龄≥75岁、多支冠状动脉病变、左心室射血分数<40%、对比剂剂量>300 mL均为对比剂肾病的独立危险因素。糖尿病或高血压病合并肾功能不全可以增加对比剂肾病的临床风险。     

不同剂量碘海醇对冠状动脉介入术患者肾功能的影响

目的 研究不同剂量的低渗性非离子型对比剂碘海醇对冠状动脉造影(CAG)和经皮冠状动脉介入治疗( PCI)患者肾功能的影响. 方法 选择我院2010年10月至2011年4月672例接受冠状动脉介入诊疗术的患者,根据对比剂用量分为2组:A组剂量＜ 200 ml,435例;B组剂量为200~ 400 ml,237例.以术后48 h血肌酐(SCr)较术前升高25％或升高44.2 μmol/L(0.5 mg/dl)作为对比剂肾病(CIN)的诊断标准,观察不同剂量碘海醇对肾功能的影响. 结果 672例患者中55例发生CIN,发生率为8.2％,其中A组26例(6.0％),B组29例(12.2％),2组间发生率有统计学差异(P＜0.05). 结论 对比剂碘海醇对冠状动脉介入诊疗术患者肾功能有影响,对比剂用量≥200 ml患者CIN发生率高.     

血管内超声指导下零对比剂行经皮冠状动脉介入治疗

目的评价血管内超声(IVUS)指导下零对比剂经皮冠状动脉介入治疗的可行性和安全性。方法入选2016年10月至2020年4月于大庆油田总医院和天津第四中心医院住院的8例冠心病患者中,在冠状动脉造影或前1次经皮冠状动脉介入治疗(PCI)时发生对比剂过敏,无法再次应用对比剂进行介入诊断和治疗者,在IVUS指导下零对比剂完成介入治疗。结果8例患者介入治疗术中未使用对比剂,参考前1次造影结果,零对比剂导引导管、导丝到位,在IVUS指导下完成病变评估、确定介入治疗部位、支架尺寸选择、置入支架后效果评估。未发生手术相关并发症,手术即刻成功率为100%。结论适当选择的对比剂过敏和严重肾功能不全患者可以在IVUS指导下零对比剂完成PCI。     

Morbidity in cardiovascular diseases in immigrants in Sweden

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.     

青少年高血压的研究进展

随着人们生活和行为方式的改变,高血压发病明显呈年轻化趋势。在青少年时期识别高血压病高危人群有助于早期进行有效干预和治疗,降低未来高血压的发生率及其严重性。现试从青少年高血压的诊断、发病因素、特点、治疗策略等方面的研究进展作一综述。     

C·肉毒杀鼠素(冻干剂)应用研究

目的为研究C·肉毒杀鼠索对杀灭达乌尔黄鼠(简称黄鼠)的大面积应用情况和对家畜、家禽的毒害作用,进行了C·肉毒杀鼠素的应用研究.方法大面积投毒采用ES-2药饵撒播机[1],间隔约80m进行条投.羊、鸡采用直接灌胃.结果大面积应用的灭鼠率为83.72%.对羊、鸡最高剂量分别为500万MLD、150万MLD,均未出现中毒现象.结论 C·肉毒杀鼠素是较为理想的草原大面积杀灭黄鼠的理想、首选药物.     

Sex Differences in Ethanol-induced Dopamine Release in Nucleus Accumbens and in Ethanol Consumption in Rats

In vivo microdialysis was used to examine changes in nucleus accumbens and striatal dopamine, dihydrophenylacetic acid (DO-PAC), and homovanillic acid (HVA) following acute administration of ethanol (0.0, 0.25, 0.5, 1.0, or 2.0 g/kg) in male and female Long-Evans rats. Following dialysis, rats were trained to bar-press for oral ethanol reinforcement. In nucleus accumbens, females showed significant increases in extracellular dopamine following 0.25 or 0.5 g/ kg ethanol, but did not show significant increases over baseline at the higher doses. Males showed slight increases in dopamine at the lower doses and decreased dopamine at 2.0 g/kg. In striatum, both sexes showed increased dopamine at the lower doses and decreased dopamine at 2.0 g/kg. There were slight increases in nucleus accumbens DOPAC and HVA at some doses in both sexes, but no changes in striatal metabolite levels. In addition to showing increased responsiveness to ethanol-induced mesolimbic dopamine stimulation, females consumed more ethanol than males during behavioral testing. The pattern of both greater ethanol-induced nucleus accumbens dopamine release and greater ethanol consumption in females supports the hypothesis that ethanol reward is mediated, at least in part, by the mesolimbic dopamine system.     

Progress in diabetes research in China

The prevalence of diabetes, especially Type 2 diabetes mellitus (T2DM), is increasing markedly throughout the world, including in China. Because T2DM and its complications are associated with considerable socioeconomic burden and mortality, there is increasing interest in developing strategies to prevent or delay progression of the disease. In recent decades, many researchers have focused on the mechanism of onset of diabetes, as well as examining the benefits of various interventions in subjects with different glucose tolerance status to prevent or delay development of the disease. In the present article, we focus on five areas (epidemiology, early intervention, insulin sensitivity and β-cell function, adipocytokines, and traditional Chinese medicine) to review the progress of research into diabetes in China today. The prevalence of diabetes in China is one of the highest in the world. However, with lifestyle interventions and appropriate pharmacological therapies (including traditional Chinese medicine), T2DM may be prevented, well controlled, or even put into remission. Accurate estimation of insulin secretion and insulin sensitivity, as well as better characterization of the physiological function of adipocytokines, could give us a better understanding of the basic mechanisms underlying the onset of diabetes and could lead to better interventions in people with impaired glucose tolerance and T2DM.     

Typhoid fever in children in Africa

Estimates for the year 2000 suggested that there were approximately 21.5 million infections and 200,000 deaths from typhoid fever globally each year, making the disease one of the most serious infectious disease threats to public health on a global scale. However, these estimates were based on little data, especially from Africa. Global prominence and high-profile outbreaks have created the perception in Kenya that typhoid is a common cause of febrile illness. The Widal test is used widely in diagnosis. We have reviewed recent literature, taking the perspective of a healthcare provider, to collate information on the prevalence of typhoid in children particularly, and to explore the role of clinical diagnosis and diagnosis based on a crude, but common, interpretation of the Widal test. Data suggest that typhoid in children in rural Africa is uncommon, perhaps 100 times or 250 times less common than invasive disease because of Haemophilus influenzae or Streptococcus pneumoniae, respectively. Frequent use of the Widal test may result in many hundreds of over-treatment episodes for every true case treated and may perpetuate the perception that typhoid is common. Countries such as Kenya need better bacterial disease surveillance systems allied to better information for healthcare providers to promote appropriate decision-making on prevention and treatment strategies.     

高龄老年高血压的临床研究进展

随着社会老龄化进程的加快,80岁以上高龄老人的绝对数量以及占总人口的比例均在增加,如何提高高龄老年高血压的防治水平备受关注。现试从高龄老年高血压的临床特点、治疗策略等方面的临床研究进展作一综述。     

广州市鼠类动物钩端螺旋体的感染调查

目的 调查广州市鼠类动物中钩端螺旋体病的流行情况和遗传特征。方法 笼捕法捕捉鼠类动物,采集脾组织提取总DNA,通过PCR技术检测钩端螺旋体16S rRNA和LipL32基因,测序后进行系统进化分析。结果 采集褐家鼠170只、板齿鼠4只、黄胸鼠3只、黄毛鼠1只和臭鼩鼱22只,共200只鼠类动物,在褐家鼠中检测到钩端螺旋体阳性样本3个,总阳性率1.5%,系统发育分析显示,3份阳性样本序列与致病性问号钩端螺旋体位于进化树上的同一个分支。结论 广州地区鼠类动物中存在致病性问号钩端螺旋体,本地人群存在一定的感染风险。     

Gender differences in health in Havana versus in Mexico City and in the US Hispanic population

Health progress in the 1960s and 1970s placed Cuba at the vanguard of longevity in Latin America and the Caribbean. This success has often been attributed to equity of access to the health care system and its cost-effectiveness in the country. Cuba also has a small gender gap in life expectancy. In this study, we examined how this pattern is reflected in the gender differences in health among the population aged 60+ in Havana. We compared gender differences in health in samples drawn from Havana, Mexico City, and the US Hispanic population: three geographic settings with very different political, health care, and social systems. The data come from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean and the 2000 Health and Retirement Study. Age-adjusted prevalence and logistic regressions were estimated for poor self-rated health, limitations on activities of daily living, depression, and mobility limitations. While an absolute female disadvantage in health was apparent in all three populations, the relative gender differences were inconsistent across all four health domains. Gender differences were most pronounced in Havana, even after adjusting for age, socio-economic status, family characteristics, and smoking behaviour. Despite having higher overall life expectancy and more equitable and universal access to primary care and preventive medicine, women in Havana appear to have a larger burden of ill health than women in less equitable societies. The study provides indirect evidence that Cuba faces challenges in combating the health threats posed by chronic diseases and other diseases and conditions common among the population aged 60+.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00563-w) contains supplementary material, which is available to authorized users.