多发性骨髓瘤肾损害临床特征及有关因素分析

目的了解多发性骨髓瘤（MM）肾损害的临床特征及相关因素。方法对经临床、病理明确诊断的28例MM肾损害患者的临床特征及实验室检查进行问顾性分析。结果bin肾损害发生率为45．16％，男女比例为3：1（P〈0．01）。临床症候群为孤立性蛋白尿（占53．57％），其次为肾功能不全（占35．71％）、中重度贫血（占82．14％）、骨损害（占67．86％）、M蛋白阳性（占57．14％）、高血压（占25％），而B超双肾大小体积均正常。MM有肾损害与无肾损害患者比较，存在高钙血症（P〈0．05）、高尿酸血症（P〈0．05），有显著性差异；肾功能Ser≥177／μmol／L组与Ser〈177μmol／L组比较，同样存在高钙血症（P〈0．01）、高尿酸血症（P〈0．05），有显著性差异；而与其他因素如年龄、贫血、血浆白蛋白、血浆球蛋白、骨髓瘤细胞、M蛋白、骨损害程度、继发感染无显著性差异（P〉0．05）。结论MM肾损害以贫血、孤立性蛋白尿最为常见，其次为肾功能不全。高钙血症与高尿酸血症是MM肾损害主要危险表现，又加重肾脏的损害。     

多发性骨髓瘤合并肾损害患者的临床特征及相关危险因素分析

目的 探讨多发性骨髓瘤(multiple myeloma,MM)合并肾损害患者的临床特征及其相关危险因素.方法 回顾性分析49例MM合并肾损害患者的临床特征及实验室检查,分析其中14例肾脏病理活检资料;以血肌酐为肾损害的指标进行MM合并肾损害的相关因素分析.结果 MM合并肾损害的临床表现呈现多样性,以贫血、骨损害、血压升高常见.肾脏病理表现多样,14例肾活检中肾小球系膜增生性病变5例,淀粉样变性(ALD)4例,急性肾小管损伤2例,轻链沉积病(LCDD)2例,管型肾病(CastN)1例.血肌酐升高与高钙血症的发生率呈正相关(OR=12.591,P=0.020).结论 MM合并肾损害的临床表现复杂多样,以贫血、骨损害、血压升高常见;肾损害病理类型多样,肾小球系膜增生性病变及淀粉样变性所占比例较大.高钙血症是MM患者以血肌酐升高为表现的肾损害的独立危险因素.     

多发性骨髓瘤伴肾损害16例分析

多发性骨髓瘤（Multiple Myeloma，MM）为骨髓异常浆细胞增生的恶性疾病，50％患者早期有蛋白尿、镜下血尿、管型尿。约20％患者确诊时有肾功能不全121。我院自1999年6月-2005年6月收治的初诊尿检查异常或伴肾损害的MM患者16例，现对其临床特征进行分析。以提高对MM肾损害的认识。     

2型糖尿病患者合并非糖尿病肾损害的临床病理分析

目的分析2型糖尿病（DM）合并非糖尿病肾损害（NDRD）的临床病理特点。方法回顾性分析41例2型DM伴肾损害患者的临床病理资料,比较分析糖尿病肾病（DN）与NDRD患者的糖尿病病程、血尿、蛋白尿、视网膜病变等临床病理特点及治疗情况。结果（1）2型DM可以合并多种NDRD,以原发性肾小球疾病为主,常见病理类型有系膜增生性肾小球肾炎、IgA肾病、膜性肾病;（2）NDRD患者糖尿病病程及血尿、视网膜病变发生率,与DN比较差异有显著意义（P〈0.05）;（3）NDRD、DN患者治疗转归截然不同。结论2型DM可以合并多种NDRD;当2型DM患者出现肾损害而不符合DN特征时,应及早行肾活检明确诊断;结合临床及病理类型,选择相应治疗方法可改善预后。     

血清BMP⁃7与99mTc⁃DTPA肾动态显像在糖尿病肾病中的相关性研究

目的：探讨血清骨形态发生蛋白?7（BMP?7）与99mTc?二乙基三胺五乙酸（99mTc?DTPA）肾动态显像肾小球滤过率（GFR）测定在糖尿病肾病中的相关性。方法：选择本院2015年7月至2017年7月内分泌科收治的糖尿病患者64例,根据尿白蛋白排泄率分为尿蛋白正常组（18例）、微量蛋白尿组（31例）和临床蛋白尿组（15例）,另选取同期健康体检者30例作为对照组,测定血清BMP?7水平,肾动态显像测定GFR,对比分析各组检测结果。结果：随着糖尿病肾损害的加重,血清BMP?7水平逐渐降低;与对照组相比,尿蛋白正常组糖尿病患者的GFR显著升高,而微量蛋白尿组和临床蛋白尿组患者的GFR却显著降低;相关分析提示糖尿病肾病患者血清BMP?7和GFR呈显著正相关。结论：血清BMP?7与99mTc ?DTPA肾动态显像GFR测定联合应用在糖尿病肾病的早期诊断或筛查中具有重要临床意义。     

肾意义的单克隆免疫球蛋白血症病例报道并文献复习

肾意义的单克隆免疫球蛋白血症（MGRS）是由低级别淋巴浆细胞增殖性疾病分泌的单克隆免疫球蛋白（Ig）介导的肾损害,为疾病早期阶段,尚不足以诊断为多发性骨髓瘤（MM）或淋巴瘤。本文分析了2018年3月-2020年2月首都医科大学附属北京朝阳医院西院血液科收治的1例MM合并肾损害和3例不同类型的MGRS患者的临床特点及诊治过程,对其肾损害进行了鉴别诊断,并结合病例和文献进行了系统分析。建议对表达浆细胞克隆或B淋巴细胞克隆的患者分别采用硼替佐米或利妥昔单抗为基础的治疗方案,提示临床医生对存在单克隆Ig和无法解释的肾脏疾病患者,需早期进行肾活检以确诊MGRS,遵循国际肾病和单克隆免疫球蛋白病研究组（IKMG）提出的诊断共识和诊断流程,进一步明确MGRS的诊断分型,有利于早期进行克隆指导的靶向治疗,改善患者的肾功能和预后。     

IgA肾病50例临床病理分析

目的：探讨IgA肾病（IgAN）患者临床与病理类型间的关系，为临床治疗及判断预后提供依据。方法：本文收集经肾活检诊断为原发性IgA肾病的患者资料50例进行临床特点、病理及免疫病理等资料回顾性分析。结果：IgA肾病以血尿并发蛋白尿最多见，占90％，伴发高血压占46％，伴发急性肾功能不全及慢性肾功能不全各占30％，病理分级与临床类型未发现有相关性，与免疫病理类型无密切关系．但病理分级高，提示肾损害严重，预后不良。重度蛋白尿组的血肌酐显著高于轻、中度蛋白尿组。高血压是预后不良因素。结论：大量蛋白尿和高血压可能促进IgA肾病的肾功能损害进展。     

肾病综合征表现的IgA肾病临床病理特点及危险因素

目的：探讨肾病综合征表现的IgA肾病患者临床病理特点及其危险因素。方法：选择我科1993年6月～2008年12月经肾活检确诊IgA肾病并表现为肾病综合征的患者48例,分析其临床病理特点,按治疗是否完全缓解分为完全缓解组（A组,n=13）、不完全缓解组（B组,n=35）,比较两组临床、实验室指标及病理指标,分析影响肾病综合征表现的IgA肾病患者肾脏损害的危险因素。结果：IgA肾病肾病综合征患者合并高血压占56.3%,合并慢性肾功能不全占20.8%;肾活检病理Lee分级Ⅰ级4例（8.3%）,Ⅱ级9例（18.8%）,Ⅲ级6（12.5%）,Ⅳ级19例（39.6%）、Ⅴ级10例（20.8%）。B组较A组平均动脉压、血肌酐水平高,镜下大量尿红细胞发生率高（P〈0.01）;而24h尿蛋白定量、血红蛋白低于A组（P〈0.05）;病理参数分析示B组肾脏病理损害积分显著高于A组（P〈0.05）,系膜区IgA＋IgG＋IgM沉积显著高于A组（P〈0.001）。结论：IgA肾病肾病综合征患者临床、病理表现存在差异,高血压、贫血、血肌酐高、镜下大量尿红细胞是其预后不良的临床危险因素,预后差者肾脏病理损害重、免疫复合物沉积以系膜区IgA＋IgG＋IgM沉积多见。     

血清骨形态发生蛋白-7与99Tcm-DTPA肾动态显像在糖尿病肾病中的相关性研究

目的：探讨血清骨形态发生蛋白-7（BMP-7）与99Tcm-二乙基三胺五乙酸（99Tcm-DTPA）肾动态显像肾小球滤过率（GFR）测定在糖尿病肾病中的相关性。方法：选择本院2015年7月至2017年7月内分泌科收治的糖尿病患者64例,根据尿白蛋白排泄率分为尿蛋白正常组（18例）、微量蛋白尿组（31例）和临床蛋白尿组（15例）,另选取同期健康体检者30例作为对照组,测定血清BMP-7水平,肾动态显像测定GFR,对比分析各组检测结果。结果：随着糖尿病肾损害的加重,血清BMP-7水平逐渐降低;与对照组相比,尿蛋白正常组糖尿病患者的GFR显著升高,而微量蛋白尿组和临床蛋白尿组患者的GFR却显著降低;相关分析提示糖尿病肾病患者血清BMP-7和GFR呈显著正相关。结论：血清BMP-7能反映糖尿病早期肾功能的损害,结果准确,易于操作,99Tcm -DTPA肾动态显像GFR测定已成为评价肾功能常用的影像方法,可准确反映糖尿病患者肾功能,二者联合应用在糖尿病肾病的早期诊断或筛查中具有重要临床意义。     

糖尿病肾小管功能损害57例临床分析

57例分24小时尿白蛋白排泄量（UAE）正常组14例，微量白蛋白尿（亚临床期糖尿病肾病）组21例，临床蛋白尿22例。结果：57例中53例存在尿β2-MG和α1－MG浓度升高，占93％，其中14例UAE正常组患者尿β2-MG、α1－MG明显高于正常，对照组20例（P＜0．05～001）。表明糖尿病肾损害除肾小球病变外，还较普遍存在小管功能的损害。临床蛋白尿组尿β2-MG低于微量蛋白尿组．而β2-MG和α1－MG重吸收率与微量蛋白尿组相似。经治疗后尿电MG、a；－MG有所下降，但均未恢复正常，示糖尿病所致肾小管功能损害改善经侵，可逆性差。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.