肾小管泌氢功能试验在肾移植监测中的价值

对36例肾移植患者肾移植前与术后8周内的肾小管泌氢功能，包括尿pH、可滴定酸（TA）、NH4＋、酸净排出量（NAC）及HCO3-浓度进行动态监测，以探讨该试验在术后监测中的价值。结果发现，移植前pH及HCO3-明显高于正常，TA、NH4＋及NAC明显低于正常。移植后肾功能稳定恢复组的五个参数均逐渐恢复，其中完全恢复正常者占62．5％；排斥组出现排斥反应时TA、NH4＋及NAC合量下降，随排斥逆转而有所恢复，完全达正常者占37．5％；肾失功组患者TA、NH4＋及NAC始终波动于低水平，而pH与HCO3-增高。结果表明，肾移植术活动态监测肾小管泌氢功能对了解移植肾功能状态、预测排斥反应的发生以及判断疗效和预后具有一定参考价值。     

Relationship between renal capsular artery feeding and size of VX-2 carcinoma implant in the rabbit kidney

When regional intraarterial infusion is applied in the treatment of malignant tumors it is essential to reach the tumor via all its major feeder vessels. In this study VX-2 carcinoma was implanted into the lower pole of the left kidney in 24 rabbits to investigate whether the renal capsular artery takes part in tumor feeding. The rabbits were divided into four groups that were followed for 8, 10, 12 or 14 days after tumor implantation. At that time the renal artery was ligated close to the kidney and subsequently silicone rubber or barium sulfate/gelatin suspension was injected into the capsular artery. The tissue was cleared, and the tumor carefully removed and examined microscopically for traces of silicone rubber. When barium sulfate had been injected, the kidney was examined radiographically in order to detect possible presence of contrast medium in the tumor. This study revealed no vascular supply to the implanted VX-2 carcinoma from the capsular artery when the tumor was confined intracapsularly, i.e., up to 12 days after tumor implantation in untreated rabbits.This investigation was performed at the Oncological Research Laboratory, Department of Diagnostic Radiology, University of Bergen, Bergen, Norway     

SPECT监测移植肾功能

利用单光子发射型计算机断层显象仪监测移植肾功能２５例，计３４例次。观察表明，在肾移植早期，ＳＰＥＣＴ有利于鉴别少层原因，避免冒然切除移植肾；肾移植后期，如有肾功能减退，肾小球滤过率的降低较肌酐升高更敏感，更准确，故ＳＰＥＣＴ监测是了解肾功能及判断预后的最佳方法之一。     

Altered enzyme activities of xenobiotic biotransformation in kidneys after subchronic administration of 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) to rats

Activities of the xenobiotic metabolizing enzymes were measured in the liver, kidney, duodenum and lung microsomes and cytosol fractions of Wistar rats after subchronic administration of 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX), a potent bacterial mutagen in chlorinated drinking water. MX was administered by gavage at the dose level of 30 mg/kg for 18 weeks (low dose), or at the dose level which was raised gradually from 45 mg/kg for 7 weeks via 60 mg/kg for 2 weeks to a clearly toxic dose of 75 mg/kg for 5 weeks (high dose). Microsomal and cytosolic preparations were made and the activities of 7-ethoxyresorufin-O-deethylase (EROD), pentoxyresorufin-O-dealkylase (PROD), NADPH-cytochrome-c-reductase, UDP-glucuronosyltransferase (UDPGT) and glutathione-S-transferase (GST) were measured. Kidneys were affected most. A dose-dependent decrease was observed in EROD (90% in males, 80% in females at the high dose) and in PROD (58% in females, at the high dose) in kidneys. An increase was, however, detected in kidney NADPH-cytochrome-c-reductase (66% in females at high dose), UDPGT (89% in males and 97% in females at high dose) and GST activities (56% in males and 50% in females at high dose). MX caused only a few changes in the enzyme activities of the liver. The EROD activity was decreased 25% to 37%, both in the livers of males and females, but the total content of P450s was not altered. Hepatic GST activity was elevated in females in a dose-dependent manner (31% and 44%). GST activity was elevated in duodenum in females (59%) at the high dose. There were no marked changes in the enzyme activities in the lungs. MX was a weak inhibitor of EROD activity both in the liver and kidney microsomes in vitro, decreasing the EROD activity by 53% and 43%, respectively at the concentration of 0.9 mM. The results indicate that MX decreases the activity of phase I metabolism enzymes, but induces phase II conjugation enzyme activities, particularly in kidneys in vivo. It is possible that these changes contribute to metabolism of MX in kidneys and renders them susceptible to MX in the course of repeated exposure.     

白细胞介素-13对肾小球系膜细胞增殖及细胞周期的影响

目的：探讨白细胞介素—13(IL—13)对肾小球系膜细胞(MC)增殖及其细胞周期的影响。方法：用甲基偶氮唑法(MTT)测定MC增殖，流式细胞术分析细胞周期。结果：IL—13在1ng／ml、5ng／ml、10ng／ml、100ng／ml浓度范围呈剂量依赖性抑制5％FCS培养的和脂多糖(LPS)诱导的MC增殖，抑制率分别为19．8％和29．23％、24．35％和37．05％、30．03％和46．6％、46．93％和55．23％。IL—13作用MC48h，使MC较多滞留于G1期，而S期细胞减少。结论：IL—13通过参与细胞周期的调控而抑制MC增殖。     

大剂量免疫化疗预防肾癌复发和转移的临床研究

目的 观察免疫化疗对肾癌远期复发及转移的预防作用。方法 肾癌根治术后患者18例。男13例，女5例。年龄37～78岁，平均56岁。分2组：①免疫化疗组13例。T1 1例，T2 8例，T3 4例。根治术后第10天起联合应用大剂量白细胞介素-2(远策欣，重组人白细胞介素-2，IL-2)和干扰素(远策素，重组人干扰素α2b，IFN-α)皮下注射以及5-氟脲嘧啶(5-Fu)静滴治疗。②对照组5例。T1 1例，T2 3例，T3 1例。均因为经济原因未行免疫化疗，仅行肾癌根治术。免疫治疗方法：IL-2800万U／次，皮下注射，每周3次，第1、4周；400万U／次，皮下注射，每周3次，第2、3周；IFN-α 600万U／次，皮下注射，每周3次，第2、3、6、7周；900万U／次，皮下注射，每周3次，第5、8周；用药后1h直肠应用消炎痛栓50mg。5-Fu1000～1250mg加入5％葡萄糖液500ml缓慢静滴(4～6h)，每周1次，第5～8周。2个月为1个治疗周期，间隔3个月可重复进行。治疗后每月检查血常规、肝肾功能、腹部B超、胸部及骨X线。结果 治疗组13例完成1～4个治疗周期，平均1．9个周期。未见严重毒副反应发生。随访60—87个月，12例无癌生存，1例术后43个月出现股骨转移，现行放疗，病灶稳定。对照组5例术后3—14个月发现远处转移，首发转移病灶：肺3例，肝1例，皮下1例。5例术后生存6～21个月，平均12．8个月。结论 以大剂量IL-2为主的免疫化疗方法安全，可有效地预防肾癌的远期复发和转移。     

哌拉西林/他佐巴坦治疗肾移植患者中重度肺部感染(附35例报告)

目的评价哌拉西林/他佐巴坦治疗肾移植患者中重度肺部感染的疗效与安全性。方法 对35例肾移植患者应用哌拉西林/他佐巴坦治疗中重度肺部感染的临床资料进行回顾性分析。结果 34例存活，1例死亡。哌拉西林/他佐巴坦治疗的有效率是91.43％，细菌清除率为92.59％，不良反应发生率为8.57％，主要是血肌酐轻度升高，但1周后逆转正常。结论 对于肾移植后的中重度肺部感染应给予高度重视和积极救治，及时给予有效的抗生素和联合治疗措施，调整免疫抑制方案和纠正低蛋白血症是治疗成功的关键。     

输尿管硬镜处理复杂肾结石残余结石

目的：提高复杂肾结石的治疗水平。方法：采用输尿管硬镜在术中从肾实质切口，术后从肾造接口取肾内残余结石。结果：5例手术中取石，4例取净；11例手术后取石，其中3例一次取石，5例二次取石，3例三次取石，7例取净。结论：复杂肾结石术中、术后配合输尿管硬镜取石可有效处理残余结石。     

移植肾组织TGF-β1和MMP-2表达及IV型胶原沉积与慢性移植肾肾病的关系

目的 探讨移植肾组织中转化生长因子β1(TGF-β1)和基质金属蛋白酶2(MMP-2)的表达及IV型胶原沉积与慢性移植肾肾病(CAN)的关系.方法 对18例CAN患者进行了移植肾切除术.光镜下观察切除的肾组织标本并根据其纤维化的程度进行分期,用免疫组织化学技术和图像分析法检测移植肾组织中TGF-β1和MMP-2表达量及IV型胶原沉积情况,并分析患者血肌酐(Cr)和尿素氮(BUN)的水平与移植肾纤维化程度的关系.结果 随着患者移植肾纤维化程度的加重,血清肌酐、尿素氮及肾组织中TGF-β1、IV型胶原基因表达量均增加,MMP-2表达量于移植肾纤维化早期明显升高,并随移植肾纤维化程度加重而逐渐降低.结论 移植肾组织中TGF-β1表达量增高及IV型胶原沉积可以促进CAN的进程,而MMP-2则可抑制其进展.     

“津血同源”“肾为唾”的研究

以23例肾功能不全与20例肾功正常患者的唾液尿素氮、钠、钾、舌面pH值和血液的相应生化检查作对照。结果唾液尿素氮、钾与血尿素氮、钾成正相关性。证实了中医“津血同源”“肾为唾”的理论。