苯扎贝特治疗儿童ApoE Tokyo(Arg25Cys)突变型脂蛋白肾病1例

脂蛋白肾病(Lipoprotein glomerulopathy,LPG),1989年首次由日本学者Saito报道,LPG主要累及肾脏,且以肾小球病变为主[1]。几乎所有患者均有不同程度的蛋白尿,多数表现为肾病综合征,少数表现为轻微蛋白尿和镜下血尿,部分患者伴有不同程度的贫血及高血压,血脂异常易被忽略为肾病综合征的低蛋白血症所致。载脂蛋白E(apolipoprotein E,ApoE)增高是LPG血脂改变的主要特点[2-3]。LPG为一种与脂质代谢紊乱密切相关的肾脏疾病,目前世界范围内有报道的病例不足200例,儿童报道仅10余例[2]。本病进展缓慢,临床常误诊为原发性肾病综合征[4]。因此,为增强对LPG的认识,提高诊治水平,现分析1例确诊的儿童LPG临床资料,总结LPG的临床特点、诊断、治疗及预后。     

Renoprotective effects of combination of angiotensin converting enzyme inhibitor with mycophenolate mofetil in diabetic rats

Objective and design Previously it was shown that blocking of the renin-angiotensin system (RAS) by angiotensin converting enzyme (ACE) inhibitors, or suppression of inflammatory responses by immunosuppressive drugs such as mycophenolate mofetil (MMF) could attenuate renal injury in diabetic rats. Whether RAS blockade combined with an immunosuppressive drug provides superior renoprotection against diabetic nephropathy has not been clearly delineated. Materials Diabetes was induced by injection of streptozotocin after uninephrectomy. Treatment Rats were randomly separated into five groups: control, diabetes, diabetes treated with enalapril (an ACE inhibitor, 10 mg/kg/d by gastric gavage), diabetes treated with MMF (10 mg/kg/d by gastric gavage), or diabetes treated with a combination of both agents and were followed for 8 weeks. Methods 24 h urinary albumin excretion rate (AER) was determined, renal injury was evaluated, immunohistochemistry for ED-1 macrophage marker, intercellular adhesion molecule-1 (ICAM-1) and monocyte chemoattractant protein-1 (MCP-1) were performed, and expression of transforming growth factor (TGF)-β1 protein was determined by Western blotting analysis. Results Diabetes was associated with a considerable increase in AER. Both enalapril and MMF retarded the increase in albuminuria, which was nearly completely abrogated by combination therapy. Increased glomerular volume and tubulointerstitial injury index in diabetic rats was attenuated by treatment with either enalapril or MMF and further reduced by the combination of the two. Elevated malondialdehyde levels in renal tissue were reduced by enalapril or MMF and, more effectively, by combined enalapril with MMF. Renal overexpression of ICAM-1 was not retarded by enalapril and attenuated by MMF or combined enalapril with MMF. Combination therapy was associated with a superior suppression of diabetes-induced macrophage recruitment and overexpression of MCP-1 and TGFβ1 compared to either monotherapy in renal tissue. Conclusion The combination of enalapril and MMF confers superiority over monotherapy in renoprotection, a mechanism which may be at least partly correlated with synergistic suppression of increased macrophage recruitment and overexpression of MCP-1 and TGF-β1 in renal tissue in diabetic rats. Received 26 July 2005; returned for revision 5 October 2005; returned for final revision 9 January 2006; accepted by M. Katori 23 January 2006     

PBL-CBL整合教学在内分泌科轮转临床医学专业学位研究生培养中的应用

目的 探讨以问题为基础的学习（problem-based learning,PBL）-以案例为基础的学习（case-based learning,CBL） 整合教学在内分泌科轮转临床医学专业学位研究生培养的效果。方法 将80名在内分泌科轮转的临床医学专业学位研究生随机分为试验组（采用PBL-CBL整合教学）和对照组（采用传统教学）,每组40人,轮转期为3个月。记录两组学生入科和出科时专业考试成绩,并通过问卷调查分析自信心、学习主动性和人际交往能力。采用SPSS 20.0进行t检验、卡方检验。结果 两组学生基线情况一致,经过3个月的转轮期后,与入科前相比,试验组学生的出科考试成绩、自信心、学习主动性和人际交往能力明显提升,差异均有统计学意义（P<0.001）。结论 PBL-CBL整合教学效果优于传统教学,有助于提高临床医学专业学位研究生在内分泌轮转的学习能力和成绩,值得推广。     

B/C基因型的乙型肝炎病毒在不同ALT状态下对乙型肝炎相关性肾炎的差异性影响

【目的】探讨不同ALT状态下B/C基因型的乙型肝炎病毒对乙型肝炎相关性肾小球肾炎的差异性影响。【方法】回顾性分析兰州大学第一医院确诊为乙型肝炎相关性肾小球肾炎的患者558例,所选病人均病历完整,均接受过肾组织病理学检查,化验指标包括：丙氨酸氨基转移酶、肌酐、尿β2微球蛋白、尿N-乙酰-β-D-葡萄糖苷酶、血尿素氮、肾小球滤过率、乙型肝炎病毒载量及基因型。【结果】B型C型基因型的乙肝相关性肾小球肾炎均以弥漫性膜增生性肾病为主（57.9%vs.54.4%）,其次为毛细血管内增生性肾小球肾炎（25.3%vs.28.0%）,局灶节段肾小球硬化（9.7%vs.9.0%）和系膜增生性病变（7.1%vs.8.6%）较为少见。在ALT正常组B/C基因型的乙型肝炎病毒对肾脏功能影响差异无统计学意义（P>0.05）。而在ALT≥2倍上限组中,C型基因型较B型基因型的乙型肝炎相关性肾小球肾炎患者中,血肌酐、血尿素氮、24h尿蛋白定量、尿NAG、尿β2M明显增高（P<0.05）,而肾小球滤过率GFR明显下降（P<0.05）,差异有统计学意义。在ALT正常组中B/C型的乙型肝炎病毒对慢性肾脏病分期差异无统计学意义（P>0.05）。而在ALT≥2倍上限组中,C型基因型较B型基因型的乙型肝炎相关性肾小球患者中,慢性肾脏病分期有趋于加重的倾向（χ2=11.144,P=0.025）。【结论】对比分析不同基因型的乙型肝炎病毒对乙型肝炎相关性肾炎的差异性影响,将有助于帮助临床诊治乙型肝炎相关性肾炎。     

Assessment of static and perfusion methods for decellularization of PCL membrane-supported periodontal ligament cell sheet constructs

ObjectivesDecellularization aims to harness the regenerative properties of native extracellular matrix. The objective of this study was to evaluate different methods of decellularization of periodontal ligament cell sheets whilst maintaining their structural and biological integrity.DesignHuman periodontal ligament cell sheets were placed onto melt electrospun polycaprolactone (PCL) membranes that reinforced the cell sheets during the various decellularization protocols. These cell sheet constructs (CSCs) were decellularized under static/perfusion conditions using a) 20 mM ammonium hydroxide (NH4OH)/Triton X-100, 0.5% v/v; and b) sodium dodecyl sulfate (SDS, 0.2% v/v), both +/− DNase besides Freeze–thaw (F/T) cycling method. CSCs were assessed using a collagen quantification assay, immunostaining and scanning electron microscopy. Residual fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) were assessed with Bio-plex assays.ResultsDNA removal without DNase was higher under static conditions. However, after DNase treatment, there were no differences between the different decellularization methods with virtually 100% DNA removal. DNA elimination in F/T was less efficient even after DNase treatment. Collagen content was preserved with all techniques, except with SDS treatment. Structural integrity was preserved after NH4OH/Triton X-100 and F/T treatment, while SDS altered the extracellular matrix structure. Growth factor amounts were reduced after decellularization with all methods, with the greatest reduction (to virtually undetectable amounts) following SDS treatment, while NH4OH/Triton X-100 and DNase treatment resulted in approximately 10% retention.ConclusionsThis study showed that treatment with NH4OH/Triton X-100 and DNase solution was the most efficient method for DNA removal and the preservation of extracellular matrix integrity and growth factors retention.     

丹红注射液对肾病综合征患者肾血流动力学及血液黏稠状态的影响研究

目的探讨丹红注射液对肾病综合征患者肾血流动力学及血液黏稠状态的影响。方法选取2008年7月～2010年12月于某院进行治疗的64例初发原发肾病综合征患者为研究对象,将其随机分为对照组和观察组各32例,对照组采用泼尼松联合双嘧达莫进行治疗,观察组在对照组的基础上加用丹红注射液进行治疗,后将两组患者治疗前及治疗后4周的肾动脉血流动力学及血液流变学指标进行对比。结果治疗后观察组的肾动脉血流动力学及血液流变学指标的改善幅度均大于对照组,治疗后两组上述检测项目比较,P均﹤0.05,差异均有统计学意义。结论丹红注射液在改善肾病综合征患者肾血流动力学及血液黏稠状态方面均发挥着积极的作用,对于改善肾脏血液循环效果明显。     

糖尿病肾病相关生物学标志物的研究进展

糖尿病肾病(diabetic nephropathy,DN)是引起糖尿病相关性死亡的主要原因之一。尿微量白蛋白是目前诊断DN最常用的临床指标,然而部分DN患者虽然已经有了晚期肾组织病理上的改变,但尿微量白蛋白仍然处于正常范围内。因此,寻找新的灵敏、特异的生物学指标对于DN的诊断及判断疾病进程有重要意义。近年来,肾损伤相关标志物、与DN发病机制相关的生物标志物等已经逐渐成为临床研究的热点,而蛋白质组学技术的发展也为寻找DN相关的生物标志物提供了新的指导方向。     

草乌甲素片联合雷公藤多甙片对膝骨性关节炎的作用

目的观察草乌甲素片联合雷公藤多甙片治疗膝骨性关节炎(KOA)的疗效。方法按中华风湿病学会KOA诊断标准随机分为草乌甲素片+雷公藤多甙片组(CL)及雷公藤多甙片组(L),观察4周。结果治疗前,2组患者膝关节疼痛症状量化积分比较,差异无统计学意义(P>0.05)。治疗4周后,2组患者的膝关节疼痛症状量化积分较治疗前均显著降低(P<0.05,P<0.01);且治疗4周后CL组患者的膝关节疼痛症状量化积分较L组显著降低(P<0.05)。治疗前,2组患者膝关节疼痛VAS评分比较,差异无统计学意义(P>0.05).治疗4周后,2组患者的膝关节疼痛VAS评分较治疗前均显著降低(P<0.05,P<0.01);且治疗4周后CL组患者的VAS评分较L组显著降低(P<0.05)。结论草乌甲素片联合雷公藤多甙片治疗膝骨性关节炎疗效显著。     

Effects of respiratory training on pulmonary function,bad mood,and quality of life in patients with COVID-19: A protocol for systematic review and meta-analysis

Background:At present, whether respiratory training can improve the lung function, quality of life, and mental health of patients with Coronavirus Disease 2019 (COVID-19) is still controversial. Therefore, in order to provide new evidence-based medicine for clinical treatment, we conducted a systematic review and meta-analysis to evaluate the effects of respiratory training in improving lung function, quality of life, and mental health of patients with COVID-19.Methods:Relevant publications were searched from clinical trials. Computer was used to retrieve Cochrane Central Register of Controlled Trials Repositories, PubMed, Embase, and Web of Science databases. The retrieval time limit was from the establishment of the database to April 2021. Two researchers independently carried out data extraction and literature quality evaluation on the quality and meta-analysis of the included literature was performed with Revman 5.3 software.Results:The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusion:This study will provide reliable evidence-based evidence on the effects of breathing training on lung function, bad mood, and quality of life in patients with COVID-19.Ethics and dissemination:Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.OSF Registration number:DOI 10.17605/OSF.IO/ZQTGY.     

芪苈强心胶囊辅治慢性肾衰竭合并慢性心力衰竭的疗效观察

目的观察芪苈强心胶囊对慢性肾衰竭合并慢性心力衰竭患者心功能的影响。方法符合诊断标准的患者100例按照随机数字表法分为对照组和研究组各50例。2组患者均常规应用利尿、强心等药物及血液透析治疗,研究组在常规治疗基础上加服芪苈强心胶囊。观察治疗前及治疗8周后2组患者血浆脑钠肽(BNP)、醛固酮(ALD)表达水平、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、6 min步行距离及肾功能的变化。结果治疗前2组患者血浆BNP、ALD表达水平及LVEDD、LVEF、6 min步行距离、血肌酐、尿素氮、血钾比较差异均无统计学意义(P>0.05)。与治疗前比较,2组患者治疗8周后血浆BNP、ALD表达水平、血肌酐、尿素氮、血钾均下降(P<0.05),LVEDD、LVEF及6 min步行距离均改善(P<0.05),且研究组比对照组均改善显著(P<0.05)。结论芪苈强心胶囊辅治能明显降低慢性肾衰竭合并慢性心力衰竭患者血浆BNP、ALD及血肌酐、尿素氮、血钾水平,显著改善心肾功能,提高患者生活质量。