补肾活血法改善乳腺癌认知功能下降的临床观察

目的：探讨补肾活血方药治疗化疗后认知功能下降乳腺癌患者的临床疗效。方法：选取2015年11月至2017年11月首都医科大学附属北京中医医院收治的化疗后不同程度认知障碍的乳腺癌患者72例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组36例。对照组给予对应的安慰剂，观察组给予补肾活血为主的方药，均为2次/d，共治疗6周。分别在治疗前后观察2组患者的认知功能（蒙特利尔量表、FACT量表）、生命质量、中医症候评分等。结果：在认知功能评价中，药物观察组患者蒙特利尔量表评分治疗后较治疗前显著提高（P<0.05），与对照组比较也有明显提高（P<0.05）。中药观察组患者的FACT-cog量表积分治疗后较治疗前有显著提高（P<0.05），且与对照组比较有显著提高（P<0.05）。观察组治疗后中医证候评分较治疗前及对照组治疗后均明显提高（P<0.05），观察组与对照组治疗前后的生命质量评分差异无统计学意义(P>0.05)。结论：补肾活血中药一定程度上可以有效改善乳腺癌患者化疗后导致的认知功能下降，但对生命质量的改善并不明显。     

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.     

基于Klotho基因的生物活性探讨中医“心肾相交”理论

"心肾相交"是指肾水上济于心,心火下降于肾。Klotho作为肾精的物质基础,在生理功能上与肾精作用相同,二者均秉承于父母,具有抗衰老、主生殖和生长发育、保护骨骼调节钙磷代谢等功用。Klotho衍生物可溶性Klotho(soluble Klotho,sKlotho)延续了Klotho的生理功能,并参与调节心肌细胞和血管平滑肌细胞的钙离子代谢,抑制钙离子沉积,调节脉道,保护心血管,具有交通心藏系统的功能。Klotho基因的这种微观调节作用,使得心藏系统和肾藏系统之间的关系更加紧密,加强了中医心肾之间的交互关系,也丰富了中医"心肾相交"理论。     

代谢组学在肾脏疾病中的研究进展

目前肾脏疾病的准确诊断最终仍需要肾穿刺活检技术。代谢组学可以定性和定量分析生物机体包括系统、器官或细胞在受到外界因素影响下引起的内源性代谢产物的变化；肾脏疾病的发生发展会受到生物体内外多种因素的影响，与机体代谢异常密切相关，表现为各类代谢产物的变化。近年来，代谢组学为肾脏疾病的研究做出了很多贡献，本文就代谢组学在肾脏疾病中的研究进展作以综述，希望为肾脏病发生发展及诊断提供新的研究思路和方向。     

“两阶段三部曲”在结直肠癌辅助化疗期的应用＊

辅助化疗有助于改善高危II/III期结直肠癌患者的生存。然而，辅助化疗的不良反应影响患者的生活质量，严重的不良反应甚至可能导致化疗的延期或终止，使得患者不能从辅助化疗中获益。中国中医科学院西苑医院杨宇飞教授根据多年临床经验，创新性提出辅助化疗期的“两阶段三部曲”，即补肾健脾序贯疗法，第1阶段应用自拟六君安胃方健脾和胃，针对化疗导致的胃肠道反应；第2阶段运用芪菟二至方健脾益肾，针对化疗导致的骨髓抑制；以及辛凉解表感冒方，针对化疗期间的外感。临床应用取得了显著的疗效。文章详细阐述“两阶段三部曲”提出的背景及其主要内容。     

“血尿”“三问十二字”临床教学思路探讨

血尿是肾病科常见的临床表现,对于血尿的病因诊断分析在临床中不容易掌握,有漏诊的风险,因此需要系统而全面的诊断思路。我科在临床教学中总结了"三问十二字"的教学思路,收到较好的效果。三问包括第一问尿液呈现红色是否为血尿?第二问为符合血尿是否为病理状态?第三问为血尿一定是否只有肾脏疾病?通过三问来明确血尿的定义,并逐渐剖析临床非血尿、真性血尿、假性血尿、内科性血尿以及外科性血尿的意义。再通过内科性血尿的特点高度概括出"十二个字",以帮助学生区分内科性血尿及外科性血尿。通过"三问十二字"的深入浅出学习,可以将血尿复杂的诊断思路由繁入简掌握,并实践于临床。     

儿童肾脏疾病合并后部可逆性脑病综合征临床特点（附4例报告）

目的　提高对儿童肾脏疾病合并后部可逆性脑病综合征（PRES）的临床表现、影像学特征和治疗策略的认识。方法　回顾性分析2010年7月至2018年6月首都儿科研究所附属儿童医院肾脏内科收治的4例肾脏疾病合并PRES患儿的临床资料及影像学结果，结合文献分析其临床特点。结果　患儿原发病分别为急性链球菌感染后肾小球肾炎1例、肾病综合征2例、非典型溶血尿毒综合征1例，起病前有血压控制不良或细胞毒性药物使用史，以抽搐为首发症状，伴有头痛、头晕、视物模糊、血压急剧增高。典型头颅磁共振成像（MRI）示双侧大脑顶枕叶皮质或皮质下白质片状长T1T2 信号，对称或不对称，严重者可累及侧脑室旁、小脑、脑干。4例PRES经过及时降血压和对症治疗后，1～2 d症状缓解，2 ～3周影像学异常完全消失。结论　高血压、药物引起的血管源性脑水肿是发生儿童肾脏疾病合并PRES的主要原因，PRES的诊断依赖于头颅MRI的特征性改变，及时有效的降压和对症治疗可在短期内有效控制病情，治疗中应积极控制高血压，及时停用或减量诱发PRES的细胞毒性药物。     

Concomitant vancomycin and piperacillin/tazobactam treatment is associated with an increased risk of acute kidney injury in Japanese patients

IntroductionRecent studies have corroborated that the co-administration of vancomycin (VCM) and piperacillin/tazobactam (PT) is correlated with an increased incidence of acute kidney injury (AKI). However, evidence directed at the Japanese population is scarce. Therefore, we conducted a retrospective study to compare the occurrence of AKI among Japanese patients who received VCM with PT (VP therapy) and VCM with another β-lactams (VA therapy).MethodsThe present study, performed at Tsuyama Chuo Hospital between June 2012 and December 2018, included adult patients who received VCM and β-lactam antibiotics for ≥48 h. We defined the primary outcome as the incidence of AKI based on the risk, injury, failure, loss, and end-stage kidney disease criteria. Patients' clinical characteristics and outcomes were reviewed and compared between the two groups with univariate and multivariate logistic regression analyses. Subgroup analysis was conducted by stratifying the patients’ baseline hospital admittance status, as intensive care unit or general wards.ResultsWe analyzed 272 patients (92 V P therapy and 180 VA therapy). Univariate analysis revealed a significant difference in AKI development between VP and VA therapy (25.0% vs 12.2%; p < 0.01). A multivariate analysis demonstrated that VP therapy and VCM initial trough levels ≥15 μg/mL were associated with an incidence of AKI. Patients at general wards, rather than those admitted at an intensive care unit, developed AKI with VP therapy (p = 0.02).ConclusionVP therapy was associated with an increased risk of AKI compared to that with VA therapy among the Japanese population.     

“治未病”思想在老年高血压病防治中的应用探讨

老年高血压病以肾气亏虚为主要病机,具有特殊的发病基础、临床症状、传变规律和预后。以"治未病"思想为指导,在老年高血压病发生、发展、预后的各个阶段进行提前干预,有利于扶助正气,增强抗病能力,延缓病情进展。具体而言,未病之时,应通过调整生活方式、服用中药保养和培补肾气,做到未病先防。已病之时,既病防变,阴阳俱虚者,治以补益肾气,方选肾气丸加减;肾阴虚者,治以滋阴补肾,方选左归丸合天麻钩藤饮加减;肾阳虚者,治以温补肾阳,方选右归丸加减。疾病初愈之时,继续以中药补肾虚、调气血,同时避免六淫邪气与情志内伤对机体的损害,以防疾病复发。     

慢性肾脏病患者血压形态特点及临床疗效分析

目的 研究慢性肾脏病（chronic kidney disease，CKD）患者血压形态特点，以及睡前服用降压药对患者临床疗效影响。方法 2018年1月至2019年9月住院的182例CKD合并高血压患者的动态血压数据和临床指标，描述患者的血压昼夜节律特点和特殊血压类型分布。分析睡前服用降压药对患者临床疗效影响。结果 不同CKD分期患者的年龄、24 h收缩压、白天收缩压、夜间收缩压差异有统计学意义。CKD合并高血压患者血压形态以非杓型为主。与杓型血压组患者比较，非杓型或反杓型患者的年龄、超敏C反应蛋白（hypersensitive C reactiveprotein，hs CRP）偏高，血红蛋白偏低（P＜0.05）；多因素回归分析显示年龄、hs CRP是发生异常血压节律的独立危险因素。患者的诊室血压控制率25.3%，动态血压控制率14.3%，均控制率5.5%，夜间血压未控制率83.5%。19.8%的患者有隐匿性高血压，8.8%的患者有白大衣性高血压。将降压药改为睡前服用的患者3个月后的24 h尿蛋白和血尿酸显著改善（P＜0.05）。结论 CKD合并高血压患者的血压形态以非杓型为主。年龄、hs CRP是发生血压节律异常的独立危险因素，血红蛋白越低的患者更容易发生非杓型血压。睡前服用降压药可能通过恢复血压昼夜节律来减少尿蛋白及降低血尿酸。