不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。     

系膜细胞的功能对肾小球滤过作用的影响

系膜细胞有两种类型即肾小球内系膜细胞和肾小球外系膜细胞，研究表明系膜细胞内有收缩系统存在，肾上球内系膜细胞与收缩功能有密切的关系，肾小球外系膜细胞功能的改变在管－球反馈的信号转导中起关键作用。此外，系膜细胞还有吞噬及产生并分泌多种生物活性物质等功能。其中系膜细胞的收缩在调节肾小球血液动力学如滤过系数和管－球反馈的变化方面可能具有重要的生理意义。     

Renal interstitial pressure and tubuloglomerular feedback control in rats during infusion of atrial natriuretic peptide (ANP)

Atrial natriuretic peptide (ANP), injected at physiological concentrations, is known to induce both natriuresis and diuresis. It has been suggested by some investigators that these changes result from an increasing glomerular filtration rate (GFR), but others have been unable to demonstrate an increased GFR. The tubuloglomerular feedback (TGF) mechanism is an important regulator of GFR, and the sensitivity of TGF is decreased during ANP administration. Furthermore, resetting of TGF is, in most instances, related to changes in renal interstitial hydrostatic and oncotic pressures. It is also known that ANP may increase capillary permeability which may change renal interstitial pressure. The present study was performed to examine renal interstitial pressures and the TGF mechanism during ANP infusion. In accordance with previous studies, TGF sensitivity was found to be decreased. The tubular flow rate which elicited half the maximal drop in stop-flow pressure (P_sf) was increased from 18.5 to 25.7 nl min^-1. In contrast, ANP infusion resulted in a decreased interstitial hydrostatic pressure and an increased interstitial oncotic pressure. From previous experiments, such changes in interstitial pressures would be expected to increase TGF sensitivity. The changes in interstitial pressure cannot, therefore, directly explain the resetting of the feedback mechanism. In conclusion, the present paper shows a decreased renal net interstial pressure after intravenous administration of ANP.     

Cerebrospinal fluid-filtration reduces TNF alpha in bacterial meningitis-CSF

A 37 year old male was admitted with the diagnosis of bacterial meningitis. Pneumococci were seen in the Gram stain of the cerebrospinal fluid. The clinical condition did not suggest severely raised intracranial pressure, there were no localizing signs and symptoms. CSF was turpid, with 20.100/3/mm³, mainly polymorphonuclear cells. Tumor necrosis factor alpha in CSp was greatly increased with 813 pg/ml. Parallel to the application of intravenous Penicillin G a CSF filtration was carried out. Within 214 h 225 ml CSF were filtrated through a Pall-filter, using a bidirectional pump. Cell count dropped to 720/3 cells/mm³, TNF-alpha to 39 pg/ml. The clinical course was uneventful, on day 12 the patient could be discharged without sequelae. CSF filtration may be a highly effective method to reduce from the CSF pathogenetically important cytokines, such as TNF-alpha, being responsible for intrathecal/meningeal inflammatory processes and triggered by cell-wall components of bacteria, e.g. pneumococci.     

血液透析治疗急性肾功能衰竭48例

本文总结了运用血液透析疗法治疗各种病因所致的急性肾功能衰竭（ＡＲＦ）４８例，结果治愈４４例（治愈率９１６７％）。认为血液透析疗法是治疗ＡＲＦ的主要措施，对ＡＲＦ患者进行早期预防性，充分的透析治疗，可以减轻ＡＲＦ引起的病理生理改变，保持机体内环境的稳定，有利于肾功能的恢复，并能预防其它系统脏器功能衰竭的发生，尤其对ＡＲＦ并发多脏器功能衰竭（ＭＳＯＦ）者，早期充分地透析，可以提高救治成功率，减少死亡率。     

Relative weight of glucose, insulin and parathyroid hormone in the urinary loss of phosphate by chronically diabetic rats

This report deals with the relationships between glucose (G) and insulin on the tubular transport of phosphate (P) in chronically diabetic rats with high plasma levels of parathyroid hormone (PTH). Alloxan-induced diabetes leads to phosphorus depletion of the soft tissues. This phenomenon appears associated with weight loss and negative P balances caused by the increased urinary P excretion. Administration of 2 IU of insulin/100 g body weight (bw) to diabetic rats normalized their P balance and body weight. The effect of parathyroid function on the P metabolism of diabetic rats was investigated with balance experiments. Diabetic rats, intact or thyroparathyroidectomized (TPTX), have a greater urinary excretion of P than their controls. However, in control rats, the ratio intact:TPTX for urinary P is 1.0:0.76, showing the antiphosphaturic effect of parathyroid ablation. For diabetic animals, on the other hand, the ratio is 1.0:1.44. The simultaneous deficit of insulin and PTH thus quadruples the urinary P loss, instead of compensating for each other. The contribution of insulin deficit and hyperglycemia to the defect in tubular reabsorption (TRP) was investigated with clearance experiments (done on anesthetized, perfused rats). Five experimental groups were used: Controls (C), diabetics (D), controls+glucose (C+G), diabetics+insulin (D+I) and diabetics+insulin+glucose (D+I+G). All experimental groups showed a linear relationship between the TRP of P and G. The regression equation for C is significantly different (F=40.1, P<0.001) from that of D animals. The slope value measure the number of μmoles of P per μmol of G reabsorbed. For C and D rats, the ratio P:G approximates 1:4 and 1:20, respectively. The increase in P:G ratios represents the competition between both substrates for tubular resorption. Glycemias up to 11 mM (C and D+I) exist concurrent with the P:G ratio 1:4. Glycemias above 25 mM (D, C+G and D+I+G) produce a P:G ratio of 1:20. Fractional excretion of P (FEP) increased significantly in untreated, chronically diabetic rats (0.47± 0.12 vs controls=0.05±0.01, P<0.001). After a single intramuscular injection of insulin, the FEP decreased as a function of insulin levels. To normalize the FEP of diabetic rats in short-term experiments, insulin had to be administered in doses that produce plasma insulin levels 25 times greater than normal. The general information afforded by the present experiments shows that in untreated, chronically diabetic rats, insulin deficit plays an indirect role. The absence of PTH enhances the effect of hyperglycemia. The latter and the concurrent tubular overload of glucose are the cause of hyperphosphaturia in these animals. Received: 10 September 1996 / Accepted in revised form: 18 April 1997     

枸橼酸抗凝血液透析

研究解剖高危出血患者血液透析的抗凝方法－局部枸橼酸抗凝的临床应用和疗效。方法：采用１．６ｍｏｌ／Ｌ的枸橼酸钠、空心纤维透析器和普通含钙碳酸氢盐透析，观察ＲＣＡ透析对患者出血、体外循环凝血、血游离钙、总钙、Ｋ＾＋，Ｎａ＾＋，ｐＨ，ＨＣＯ＾－３，Ｓｃｒ，ＢＵＮ及血清枸橼酸浓度的影响。     

Insulin, branched-chain amino acids, and growth failure in uremia

Insulin and branched-chain amino acid (BCAA) metabolism was studied in 14 adolescents with uremia on hemodialysis. Glucose tolerance was measured by intravenous glucose tolerance tests. Insulin sensitivity was measured by the euglycemia clamp technique. Insulin secretion during constant hyperglycemia was measured by the hyperglycemic clamp technique. Fasting plasma BCAA concentrations were compared with data from 8 adolescent controls, whereas insulin indices were compared with 8 young adults controls and with published normal data in adolescents. The patients could be further sub-divided into two groups with respect to their growth velocity standard deviation score (GVSDS). Group 1 consisted of 7 patients with GVSDS less than −2. This group demonstrated insulin resistance, glucose intolerance, and low insulin secretion. This group also had low plasma valine, leucine, and isoleucine concentrations compared with control values. Group 2 consisted of 7 patients with GVSDS more than −2. This group demonstrated insulin resistance, but normal glucose tolerance and normal insulin secretion. Plasma valine, leucine, and isoleucine concentrations in group 2 were not different from control values. Total plasma BCAA correlated with glucose tolerance index and with insulin secretion, but not with insulin sensitivity. Growth failure in uremia is associated with glucose intolerance, hypoinsulinemia, and low plasma BCAA concentrations. Impaired utilization of conventional energy sources leading to preferential oxidation of BCAA may contribute to reduced anabolism and growth failure in uremia. Received October 8, 1997; received in revised form February 3, 1998; accepted February 6, 1998     

丝裂霉素C与5—Fu用于抗青光眼滤过性手术的对比研究

采用随机、双讯，前瞻对照的方法比较了丝裂霉素Ｃ（ＭＭＣ）和５－氟尿嘧啶对难治性青光眼小梁切除手术的安全性和有效性。３９例病人随机分成二组，一组使用ＭＭＣ，另一组使用５－Ｆｕ。结果提示：（１）ＭＭＣ组手术成功率高于５－Ｆｕ组；（２）ＭＭＣ组角膜上皮缺损发生率，结膜创口渗漏率明显低于５－Ｆｕ组。     

社区人群空腹血糖受损对估算肾小球滤过率的影响研究

背景 估算肾小球滤过率(eGFR)是反映慢性肾脏病严重程度的量化指标之一。研究表明糖尿病前期血糖升高可增加慢性肾脏病风险,但对eGFR直接影响报道较少。目的 探讨社区人群中空腹血糖(FPG)受损患者血糖水平对eGFR的影响。方法 选择2020年1—12月于南昌大学第二附属医院体检中心体检的人群,收集一般资料与临床资料(包括既往史、性别、年龄、体质指数、血压、尿酸、血脂、FPG、尿常规、血肌酐),经相应纳入标准与排除标准筛选,最终纳入28 601例受试者。根据FPG水平将受试者分为FPG升高组(5.6 mmol/L≤FPG<7.0mmol/L)、FPG正常组(3.9 mmol/L≤FPG<5.6 mmol/L),比较两组一般资料与临床资料。为明确FPG对e GFR影响,采用个案匹配控制对两组受试者进行多因素(性别、年龄、平均动脉压、尿酸、总胆固醇、体质指数)匹配,采用Mann-Whitney U秩和检验比较匹配后两组一般资料。采用Spearman秩相关检验分析FPG与eGFR在FPG升高组、FPG正常组及匹配后FPG升高组、FPG正常组间的相关性。结果 共获得FPG正常组患者...