高磷饮食对慢性肾衰竭大鼠肾脏Ⅱa型Na-Pi转运体的影响

目的:研究高磷饮食对慢性肾衰竭(CRF)大鼠肾脏Ⅱa型钠-磷协同转运体(NaPi鄄2)mRNA表达的影响。方法:24只SD大鼠,随机分为CRF高磷饮食组、CRF低磷饮食组、假手术高磷饮食组与假手术低磷饮食组,用5/6肾大部切除术构建CRF大鼠模型,分别予高磷(含磷1.2%)或低磷(含磷0.2%)饮食,测定2、7、14天血离子钙(iCa)、磷(P)、全段甲状旁腺激素(iPTH);第14天测血1,25鄄(OH)2D3,RT鄄PCR法检测NaPi鄄2mRNA表达。结果:2周后CRF模型中高磷饮食组较低磷组肾脏NaPi鄄2mRNA表达明显减低(P<0.01),血P明显增高(P<0.05),iPTH明显增高(P<0.01),血iCa及1,25鄄(OH)2D3两组无明显差异(P>0.05)。假手术组中高磷饮食组较低磷组NaPi鄄2mRNA表达减低(P<0.05),血iCa、P、iPTH及1,25鄄(OH)2D3均无变化(P>0.05)。CRF组较假手术组NaPi鄄2mRNA表达明显减少(P<0.05)。结论:高磷饮食引起CRF大鼠NaPi鄄2mRNA表达减少,高磷血症可能是iPTH增高、不受钙和1,25鄄(OH)2D3影响的独立因素。     

血液透析与血液灌流联合治疗对长期血液透析患者微炎性因子及钙磷代谢的影响

目的探讨血液透析与血液灌流联合治疗对长期血液透析患者微炎性因子及钙磷代谢的影响。方法选择2009年1月至2011年12月在长沙市第一医院收治的维持性血液透析患者98例,按随机数字表法分为对照组和观察组,各49例。对照组采用血液透析治疗,观察组采用血液透析与血液灌流联合治疗。观察两组治疗前、治疗6个月时血清CRP、Hb、Alb、TC、TG、BUN、Scr以及血钙、血磷、1,25-(OH)2D3、FGF-23、iPTH改善情况。结果治疗6个月时观察组患者CRP、Hb、Alb、TC、TG水平较本组治疗前及对照组治疗后明显改善,差异有统计学意义(P<0.05);两组治疗前后血清BUN、Scr水平变化的差异无统计学意义(P>0.05);观察组患者血磷、血清FGF-23、iPTH均较治疗前下降,差异具有统计学意义(P<0.05),血清1,25-(OH)2D3较治疗前升高,差异有统计学意义(P<0.01)。结论定期采用血液透析与血液灌流联合治疗长期血液透析患者,有助于改善机体微炎症状态,维持钙磷代谢平衡,进一步提高患者的生活质量和存活率,值得临床推广应用。     

泼尼松联合阿法骨化醇治疗原发性肾病综合征的临床观察

目的观察泼尼松联合阿法骨化醇治疗原发性肾病综合征的临床疗效。方法选择2008年1月—2009年10月住院及门诊治疗的原发性肾病综合征患者56例,随机分为2组:C组28例常规泼尼松治疗,T组28例常规泼尼松联合阿法骨化醇(0.5μg/d)治疗,比较2组治疗前后临床症状的改善,血清钙、磷、甲状旁腺激素(PTH)、25-(OH)_2D_3以及1,25-(OH)_2D_3水平以及尿蛋白定量变化。结果治疗3、6及12个月后,T组缓解率均明显高于C组(P<0.05)。治疗6个月,C组患者24 h尿蛋白下降(P<0.05),血钙、血磷、血25-(OH)_2D_3及1,25-(OH)_2D_3、PTH水平稍有改善,但差异无统计学意义(P>0.05);T组血钙、25-(OH)_2D_3及1,25-(OH)_2D_3水平上升(P<0.05),24 h尿蛋白、PTH水平下降(P<0.05),且与C组治疗后相比,差异具有统计学意义(P<0.05),而血磷水平无明显变化(P>0.05)。结论泼尼松联合阿法骨化醇治疗原发性肾病综合征疗效明显。     

血液透析患者FGF23水平与钙磷代谢的相关性分析

目的探讨血液透析患者成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)水平与钙磷代谢的相关性。方法选取90例维持性血液透析患者及60例健康体检者作为研究对象,根据甲状旁腺激素(parathyroid hormone,PTH)水平,将维持性血液透析患者分为A组(PTH<300pg/mL)、B组(PTH 300~500pg/mL)、C组(PTH>500pg/mL),检测和比较各组血清FGF23、1,25-二羟活性维生素D3[1,25-(OH)2D3]、PTH、血钙、血磷、碱性磷酸酶、白蛋白等指标浓度。结果与健康体检者相比,血液透析患者logFGF23水平明显升高,log1,25-(OH)2D3水平显著降低,差异有统计学意义(P<0.05);与A组相比,C组logFGF23水平明显升高,差异有统计学意义(P<0.05);logFGF23水平与logPTH、血磷、logALP呈正相关性,与log1,25-(OH)2D3呈负相关性。结论血液透析患者血清FGF23水平明显升高,与PTH、血磷、ALP呈正相关,与1,25-(OH)2D3呈负相关。     

终末期肾病患者血清成纤维细胞生长因子23的变化及临床意义

目的:观察终末期肾病患者血清成纤维细胞生长因子23(FGF-23)水平及其与钙磷代谢的关系.方珐:采集50例血透患者、24例腹透患者及20名健康对照者的静脉血,离心取血清.采用ELISA法测定FGF一23水平.同时检测水平在1,25-二弪维生素D[1,25一(OH)2 VitD]、全段甲状旁腺激素(iPTH)、血清肌酐(Scr)、钙(Ca)、磷(P)等水平.结果:FGF-23水平在血透组患者[(88.51±35.01)ng/L]、腹透组患者[(87.85±33.65)ng/L]均明显高于健康人群[(11.76±3.63)ng/L],但血透组和腹透组无统计学差异.而血透组、腹透组患者血清1,25-(OH)2VitD水平均明显低于健康对照组(P<0.01),且血透组明显低于腹透组(P<0.01).Pearson相关性分析结果显示血清FGF-23与血清肌酐、iPTH、磷、透析时间呈正相关(P<0.01),与1,25-(OH)2VitD负相关(P<0.01).结论:终末期肾病患者FGF-23水平明显升高,1,25-(OH)2VitD明显降低.FGF-23水平变化与血清肌酐、iPTH、磷、透析时间、1,25-(OH)2VitD等多种因素有关.     

碳酸镧在维持性血液透析患者高磷血症中的应用研究

目的探讨碳酸镧对伴有高磷血症的维持性血液透析（maintenance hemodialysis,MHD）患者磷酸盐代谢、微炎症、血脂及营养状态的影响。方法 80例伴有高磷血症的MHD患者随机分为碳酸镧组和碳酸钙组各40例,治疗12周。比较两组患者治疗前后磷酸盐代谢、微炎症、血脂及营养状态相关指标变化。结果在第12周末碳酸镧组皮肤瘙痒评分、血钙、磷、钙磷乘积、成纤维细胞生长因子23（fibroblast growth factor 23,FGF23）较基线显著下降（P<0.05）,1,25二羟基维生素D[1,25-Dihydroxy vitamin D,1,25（OH）₂D]较基线显著升高,并与碳酸钙组相比有显著变化（P<0.05）;碳酸钙组第12周末血钙及钙磷乘积与基线相比显著升高（P<0.05）,而血磷、FGF23、1,25（OH）₂D无显著变化。结论碳酸镧能显著降低血磷、FGF23,使1,25（OH）₂D升高,而全段甲状旁腺激素（intact.parathyroid hormone,iPTH）、血清25羟维生素D[25-hydroxyvitamin D,25（OH）D]、血脂、微炎症及营养状态未受影响。     

腹膜透析患者钙磷代谢状况的临床分析

目的调查我院腹膜透析患者血钙、磷及甲状旁腺激素(PTH)达标情况,观察低钙透析液的治疗效果。方法横断面调查2011年12月在北京大学深圳医院规律随访腹膜透析时间大于6个月的腹膜透析患者血钙、磷及全段甲状旁腺激素(iPTH)水平。将最近6个月及6个月以上一直用普通钙腹透液(钙离子浓度为1.75mmol/L)的患者定义为普钙组,用低钙腹透液(钙离子浓度为1.25mmol/L)的患者定义为低钙组,比较两组患者各指标差异。比较低钙组患者改用低钙透析液前后钙、磷、iPTH指标变化。结果 178名腹膜透析患者血钙达标率73.6%;血磷达标率49.4%;iPTH达标率仅26.4%,53.4%患者iPTH低于目标值。低钙组患者血磷、iPTH高于普钙组(P<0.05)。用低钙透析液后患者血钙降低,血磷、iPTH升高(P<0.05)。结论腹膜透析患者血钙、磷和iPTH达标率低,半数以上患者iPTH低于目标值。对高血钙、iPTH低的患者建议使用低钙透析液,但必须同时加强降磷治疗。     

血清维生素D水平与PCOS患者胰岛素抵抗、骨代谢的相关性分析

目的探讨血清维生素D水平与多囊卵巢综合征(PCOS)患者胰岛素抵抗、骨代谢的相关性。方法选取2019年1月至2020年12月在郑州美中商都妇产医院确诊的122例PCOS患者作为PCOS组,同时选取110例正常体检的育龄期妇女作为对照组。PCOS组患者根据是否发生胰岛素抵抗分为胰岛素抵抗组(n=93)和非胰岛素抵抗组(n=29),根据是否发生骨代谢异常分为骨代谢异常组(n=73)和非骨代谢异常组(n=49)。统计PCOS组与对照组年龄、体质量指数(BMI)等一般资料,检测血清25羟维生素D[25(OH)D]、空腹血糖(FBG)、血清钙、甲状旁腺素(iPTH),计算胰岛素抵抗指数(HOMA-IR),Pearson相关性分析PCOS患者血清25(OH)D水平与胰岛素抵抗、骨代谢之间的相关性。结果PCOS组血清25(OH)D低于对照组,FINS、HOMA-IR、血清钙及iPTH均高于对照组(P<0.05);PCOS组内,胰岛素抵抗组患者血清25(OH)D低于非胰岛素抵抗组,血清钙及iPTH水平高于非胰岛素抵抗组,骨代谢异常组患者血清25(OH)D低于非骨代谢异常组,血清FINS水平及HOMA-IR高于非骨代谢异常组(P<0.05);Pearson相关性检验结果显示,血清25(OH)D水平与FINS、HOMA-IR、血清钙、iPTH呈负相关(P<0.05)。结论血清维生素D水平与PCOS患者胰岛素抵抗、骨代谢呈负相关。     

维持剂量活性vitD3联合组合型人工肾对维持性血液透析患者钙磷代谢紊乱的影响

目的探讨组合型人工肾通过血液灌流(hemoperfusion,HP)串联血液透析(hemodialysis,HD)对维持性血液透析患者服用活性vitD3时高血磷、高血清甲状旁腺素(iPTH)等症状的影响。方法随机选择42例维持性血液净化治疗的患者,按血液净化方法分为:HD组,予以HD治疗,共20例;HD+HP组,予以HD和HP串联治疗,共22例。治疗疗程为4周,在治疗前、后分别检测并比较两组的血钙、血磷及血清甲状旁腺素水平。结果 HD组血磷水平和治疗前比有所升高,但未有统计学意义;血iPTH下降,和治疗前比有统计学意义(P<0.05);HD+HP组血磷和血iPTH水平均下降,和治疗前比有统计学意义(P<0.05);两组血钙水平均未见明显改变。结论组合型人工肾(HD+HP)更能清除维持性血液透析患者的磷负荷,改善代谢紊乱,可有效避免使用活性vitD3时的高磷血症。     

低钙透析液联合鲑鱼降钙素治疗血透患者高磷血症的临床研究

目的 观察低钙透析液联合鲑鱼降钙素对血透患者高磷血症的影响.方法 选取近期维持性血液透析患者中高磷血症患者40例,随机分为对照组和实验组各20例,对照组用正常钙透析液(钙离子浓度为1.5 mmol)配合碳酸钙和活性维生素D3治疗.实验组用低钙透析液(钙离子浓度为1.25 mmol)联合鲑鱼降钙素注射液同时服用碳酸钙和活性维生素D3治疗.观察治疗后第1、3、6个月时患者的血钙、血磷、钙磷乘积以及全段甲状旁腺激的水平.结果 对照组透析后,与透析1个月比较,6个月血钙、血磷、钙磷乘积均轻度增高(P＜0.05),而iPTH水平无明显变化(P＞0.05);实验组透析后,与透析1个月比较,3个月血钙、血磷、钙磷乘积均轻度减低(P＜0.05),而iPTH水平明显增高(P＜0.05);6个月血钙、血磷、钙磷乘积均轻度减低(P＜0.05),而iPTH水平趋于稳定(P＞0.05);与对照组比较,实验组患者3个月血磷、钙磷乘积均轻度减低(P＜0.05),而iPTH水平明显增高(P＜0.05);实验组患者6个月血磷、钙磷乘积、iPTH均轻度减低(P＜0.05).结论 低钙透析液联合鲑鱼降钙素治疗HD患者能有效的维持血磷水平,降低钙磷乘积,而不致影响iPTH.     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.