经皮肾囊穿刺封闭术治疗难治性肾病综合征临床研究

目的　探讨介入疗法对难治性肾病综合征 (RNS)的疗效。方法　将 6 4例RNS随机分为A ,B两组 ,A组 32例 ,经皮肾囊穿刺向每一肾脂肪囊 (肾囊 )内注入 2 %利多卡因 ,每周 2次 ,同时口服强的松、洛汀新、潘生丁等治疗 ,B组 32例 ,应用强的松、洛汀新、潘生丁等治疗。结果　A组总有效率为 84 .4 % ,B组为 6 5 .6 % ,两组比较 (P <0 .0 5 ) ,A组 1年内复发率低 ,为 2 9.6 % ,B组为 71.4 % ,比较两组 (P <0 .0 1)。结论　利多卡因经皮肾囊内穿刺注射封闭疗法是目前治疗RNS最有效的方法之一 ,值得临床进一步的推广应用。     

Zinc deficiency and hyperprolactinaemia are not reversible causes of sexual dysfunction in uraemia

We selected a group of male dialysis patients complaining of sexual dysfunction in whom penile vascular insufficiency and drug-induced impotence had been excluded. Monitoring of nocturnal penile tumescence was used to confirm organic disturbance. Patients with normal serum prolactin concentrations (n = 18) had significantly lower serum zinc values than normal controls (P less than 0.001) and were entered in a 6-month double-blind study comparing oral zinc acetate with placebo. Patients with elevated prolactin concentrations (n = 8) were entered in a 3-month double-blind crossover study comparing oral pergolide mesylate with placebo. In the zinc study, serum zinc concentrations increased (P less than 0.05) in the zinc-treated but not the placebo-treated group. One of nine patients receiving zinc reported improved sexual function, as did two of nine patients receiving placebo. There were no significant changes in sperm counts, nocturnal penile tumescence, testosterone, sex hormone binding globulin or gonadotrophin concentrations in either treatment group. In the pergolide study, serum prolactin values decreased (P less than 0.01) in the pergolide but not in the placebo treatment period. One patient reported improved sexual function during the pergolide treatment period and two during the placebo period. There were no significant changes in sperm counts, nocturnal penile tumescence, testosterone, sex hormone binding globulin or gonadotrophin concentrations after pergolide. These studies show no benefit of zinc or pergolide compared with placebo in the treatment of uraemic impotence.     

前列腺素E1对尸体肾移植术后肾功能延迟恢复的影响

目的探讨前列腺素E1(PGE1)应用于尸体肾移植术后肾功能延迟恢复(DGF)患者对移植肾功能恢复的影响.方法回顾性分析因急性排斥(AR)和急性肾小管坏死(ANT)导致DGF的127例临床资料,其中应用PGE1治疗56例(PGE1组),未用PGE1者71例(对照组).比较两组在出现DGF后的透析治疗时间、肾功能恢复情况、彩超的移植肾血流阻力指数(RI)及6个月内AR发生率.结果与对照组比较,PGE1组透析治疗时间明显缩短(P＜0.05),移植肾的血肌酐下降速度快(P＜0.05),RI及6个月内AR发生率低(P＜0.05).结论PGE1有利于尸体肾移植术后DGF患者移植肾功能的早期恢复,并能降低AR的发生率.     

长段同种异体骨与自体活骨复合移植的实验研究

目的 研究长段同种异体骨与带血管腓骨套叠式复合骨移植体的愈合机制和规律。方法 采用健康成年杂种犬36只胫骨结节下切除3．0cm骨干和骨膜实验动物模型。随机分为实验组和对照组。实验组植入深低温保存的同种异体骨与带血管自体腓骨，对照组仅植入深低温保存的同种异体骨，均用7孔93cmAO加压钢板内固定及石膏外固定。术后1、2、3、4个月分别行X线摄片、ECT检查、大体标本及组织学观察。结果 X线示实验组较同时期对照组异体骨吸收、新骨形成明显，第4个月实验组宿主骨一异体骨接合部愈合率83．3％，对照组未愈合或不愈合。ECT检查：实验组较同期对照组骨代谢活跃，但变化规律相似，均为术后1、2个月活跃，于第2个月达高峰，第3、4个月呈下降趋势。组织学观察：实验组较同期对照组异体皮质骨髓腔内壁及哈佛管内的内吸收、成骨活动显著增强。结论 长段同种异体骨与带血管自体腓骨复合移植修复骨缺损效果良好，带血管自体腓骨能促进长段同种异体骨的血管化，加速其爬行替代过程。     

小剂量FK778对大鼠移植肾慢性排斥反应的预防作用

目的探讨小剂量FK778对大鼠移植肾慢性排斥反应的预防作用。方法应用显微外科技术制作移植肾慢性排斥反应大鼠模型，将肾移植大鼠分为两组。肾移植后第16周开始治疗组大鼠接受FK778每日5mg／kg体重灌胃，对照组接受赋形剂。移植后每4周行24h尿蛋白含量测定，第24周处死大鼠，对移植肾组织行组织学、免疫组织化学及实时定量RT—PCR检测。结果治疗组大鼠蛋白尿、肾组织病理损害程度，淋巴细胞和单核／巨噬细胞浸润程度和对照组比较显著减轻，肾组织生长因子TGF-β基因的表达也减少。结论小剂量FK778能预防大鼠移植肾慢性排斥反应。移植肾组织T淋巴细胞和单核／巨噬细胞浸润减轻，TGF-β生长因子基因表达的减少，可能是其预防同种移植肾慢性排斥反应机制中的重要环节。     

ABO血型不合的异基因造血干细胞移植--2例报告附文献复习

探讨ABO血型不合的异基因造血干细胞移植 (Allo -HSCT)的造血问题。方法 :对 2例患者分别进行异基因外周血造血干细胞移植 (Allo -PBSCT)及脐血造血干细胞移植 (CBSCT) ,用血细胞分离机或 6 %羟乙基淀粉去除移植物中的红细胞 ,定期检测受者血型 ,根据情况输注血细胞。结果 :2例患者全部获得造血重建 ,未出现溶血反应。结论 :ABO血型不合可以进行Allo -HSCT ,去除供者移植物中的红细胞能有效地防止急性溶血反应的发生 ,定期检测受者血型 ,及时调整输血方案有重要的临床意义。     

糖尿病早期肾损害指标的探讨

目的　探讨早期诊断糖尿病肾损害的方法。方法　采用免疫透射比浊法检测尿转铁蛋白 (TF)和尿微量白蛋白(mALB) ,速率法检测尿N 乙酰 B D 氨基葡萄糖苷酶 (NAG) ,Jaffe速率法测尿肌酐。结果　糖尿病患者尿蛋白定性阴性的尿TF、mALB、NAG均较对照组显著增高 (p <0 0 1) ,单项及双项检测TF、mALB、或NAG这三项指标阳性率偏低 ,联合三项检测阳性率可达 91 1%。结论　检测尿中TF、mALB、NAG是诊断糖尿病早期肾损害指标的敏感指标     

The development of anti-glomerular basement membrane nephritis in two children with Alport's syndrome after renal transplantation: characterization of the antibody target

Two children with Alport's syndrome are described, who developed anti-glomerular basement membrane (GBM) antibody-mediated nephritis after renal transplantation. The reactivity of antibodies in their serum with collagenase-solubilized normal GBM was examined by SDS-PAGE with one- and two-dimensional immunoblotting. The specificity was compared with that of antibodies present in serum from a patient with Goodpasture's syndrome, and a mouse monoclonal antibody (MCA-P1), directed against the Goodpasture antigen. All reacted in a similar way with collagenase-solubilized GBM. Since abnormalities in the composition of the GBM are present in Alport's syndrome, it is proposed that differing antigen composition of GBM in the host compared with the donor kidney, together with transplant rejection, may have provoked the development of post-transplant anti-GBM antibodies.     

肾盏切开联合经肾实质气压弹道碎石治疗复杂鹿角形结石

目的探讨肾盏切开联合经肾实质气压弹道碎石治疗复杂鹿角形结石的疗效。方法电刀切开积水较重的肾盏,气压弹道碎石杆对准结石碎石后分块取出。盏颈口狭窄但肾盏积水不严重者,将直径1 mm气压弹道碎石杆于肾实质处刺入结石位置,将肾盏内结石击碎后从盏颈口取出。结果19例均未阻断肾蒂,手术时间90-150 min,平均120 min。术中出血量100-250 ml,未输血。17例一次取石成功,术后无结石残余;1例术中残余泥沙状结石,术后经肾造瘘管冲洗引流排出;1例肾盏结石术中取石遗漏,术后经ESWL碎石后排净结石。15例随访10-60个月,平均18个月,结石复发2例,体外震波碎石后排净结石。结论肾盏切开联合经肾实质气压弹道碎石治疗复杂性鹿角形结石出血少,疗效可靠。     

免疫吸附治疗在肾移植致敏受者中的应用

目的：探讨蛋白A免疫吸附（immunoads Orption，IA）治疗对清除肾移植致敏受者体内特异性抗HLA抗体的疗效和安全性。方法：10例肾移植致敏（PRA〉50％）受者用彤新蛋白A免疫吸附柱行IA治疗，测定治疗前后血免疫球蛋白及PRA水平。结果：10例患者IA治疗次数为4～15次（中位数9）。所有患者IA治疗后血清总IgG水平都明显下降（P〈0．001），IgA和IgM也较治疗前显著降低（P〈0．01）。PRA8例转阴，1例〈30％，1例仍为100％。结论：对于肾移植致敏受者，IA是一种特异性高、安全有效的治疗措施。