占永立教授从咽论治IgA肾病的理论与实践探析

本文从理论与临床实践2方面总结了占永立教授从咽论治IgA肾病的经验。占教授将Ig A肾病分为3型进行辨证论治:1)肺气不足,热毒扰咽证; 2)脾气虚弱,热邪客咽证; 3)肾阴亏虚,余热留咽证。治疗上以清热解毒利咽为主,兼以扶正,根据病情灵活选方用药,取得较好的临床疗效。     

Ⅲ~Ⅳ期糖尿病肾病不同中医证型的血清蛋白组学研究

目的:探索Ⅲ~Ⅳ期糖尿病肾病(DN)患者血清差异蛋白,同时筛选不同中医证型的血清差异蛋白。方法:收集Ⅲ~Ⅳ期DN患者70例(气阴两虚证19例,脾肾气虚证18例,血瘀证16例,湿热证17例),同时选择健康受试者35例(健康对照组),应用表面加强激光解吸电离-飞行时间-质谱(SELDI-TOF-MS)技术检测各组血清蛋白指纹图谱,并对差异蛋白峰进行对比分析。结果:1) DN组与健康对照组之间共有9个蛋白峰存在显著差异,质荷比(M/Z)分别为2042.57、3291.28、4986.15、5312.69、5564.09、9861.47、10786.53、13392.89、17395.27;2)气阴两虚证与脾肾气虚证之间共有4个蛋白峰存在显著差异,M/Z分别为2994.77、4986.15、7937.25、2758.91;3)气阴两虚证与血瘀证之间共有4个蛋白峰存在显著差异,M/Z分别为4986.15、16982.62、6819.69、9947.36;4)气阴两虚证与湿热证之间共有3个蛋白峰存在显著差异,M/Z分别为4986.15、11741.33、7001.54;5)脾肾气虚证与血瘀证之间共有3个蛋白峰存在显著差异,M/Z分别为3448.22、8063.43、9787.21;6)脾肾气虚证与湿热证之间共有5个蛋白峰存在显著差异,M/Z分别为2144.34、3992.01、8871.35、10568.32、14643.47;7)血瘀证与湿热证之间共有6个蛋白峰存在显著差异,M/Z分别为4233.15、5771.32、5987.18、8496.76、6651.25、13551.94。结论:Ⅲ~Ⅳ期DN组与健康对照组血清蛋白表达存在差异,该差异或可作为相关临床诊断的标志物,对探索DN的发病机制具有重要的参考价值;在不同中医证型之间能够找到差异血清蛋白,可能反映"证"的实质内涵,对今后建立诊断决策模型具有积极意义。     

Short-term prognostic effects of circulating regulatory T-Cell suppressive function and vascular endothelial growth factor level in patients with non-small cell lung cancer and obstructive sleep apnea

ObjectiveTo determine if suppressive function of regulatory T-cells (Tregs) and vascular endothelial cell growth factor (VEGF) levels are closely associated with prognosis of patients with non-small cell lung cancer (NSCLC) and obstructive sleep apnea (OSA).MethodsPeripheral blood from 20 OSA patients, 44 newly diagnosed NSCLC patients with (n = 22) and without (n = 22) OSA was collected. Forkhead box protien 3 plus (Foxp3⁺) and CTLA-4⁺ Tregs ratio were analyzed with flow cytometry. Levels of VEGF, IL-10 and TGF-β₁ were analyzed with enzyme-linked immuno sorbent assay. NSCLC patients with and without OSA were followed up for two years. Optimal cutoff values were determined by receiver operating characteristic curves. Survival analysis were performed using the Kaplan–Meier test.ResultsNSCLC patients with OSA showed higher Foxp3⁺Tregs ratio, higher plasma VEGF and TGF-β₁ levels when compared with NSCLC patients without OSA (P < 0.05). In NSCLC patients with OSA or not, subjects with higher Foxp3⁺Treg ratio, higher TGF-β₁ and VEGF levels tended to have poor mean survival time and two-year overall survival (OS, Foxp3⁺Treg: 636.7 vs. 704.8 days, 59.0% vs. 82.6%, P = 0.125; TGF-β₁: 637.8 vs. 698.4 days, 57.0% vs. 84.4%, P = 0.054; VEGF: 642.9 vs. 677.5 days, 48.6% vs. 81.3%, P = 0.074). Multivariate Cox regression adjusted for disease stage and receipt of systemic treatments, confirmed the links between high VEGF level and worse OS (HR: 1.003; 95% CI: 1.001–1.005; P = 0.021).ConclusionsOSA may up-regulate the expression of circulating TGF-β₁, VEGF and Foxp3⁺Tregs expression in NSCLC patients. Elevated VEGF level is closely associated with worse short-term survival in NSCLC patients with OSA or not.     

IgA nephropathy associated with axial spondyloarthritis responding to treatment by etanercept: A case report

IntroductionImmunoglobulin A (IgA) nephropathy may be associated with spondyloarthritis (SpA). This association raises the possibility of a common pathogenesis. Tumor necrosis factor alpha (TNFα) blockers showed good efficiency in SpA and may be efficient in IgA nephropathy.Case reportA case of a 28-year-old man diagnosed with axial SpA is reported. The patient’s Bath ankylosing spondylitis disease activity index (BASDAI) was 7 and functional index (BASFI) 9. Laboratory investigations revealed: erythrocyte sedimentation rate (ESR) 38 mm/1st hour, C-reactive protein (CRP) 6 mg/L, serum creatinine 72 μmol/L with a clearance of 108 ml/min; proteinuria 1.55 g/24 h, leucocyturia at 60,000 cells/ml and haematuria 80,000 red cells/ml. The serum IgA level was normal (238.8 mg/dL). Salivary gland and subcutaneous fat biopsies were normal. The renal biopsy showed moderate focal interstitial fibrosis. The glomerular basement membranes were not thickened while the mesangium was slightly thickened. There was no vascular damage. Congo red staining was negative. By immunofluorescent microscopy, there were mesangial deposits of IgA mainly; leading to the diagnosis of IgA nephropathy. Infliximab was initially given with limited efficacy and the patient was switched to etanercept which was effective especially in the osteoarticular symptoms. Leucocyturia, haematuria and proteinuria decreased but did not disappear, and the renal function and blood pressure remained normal. After 2 years there remained a persistent efficacy and good profile of tolerance (BASDAI = 2.2, BASFI = 4, CRP = 2, ESR = 21, proteinurua = 0.5 g/24 h).ConclusionEtanercept may be a potentially effective option for treating IgA nephropathy associated with axial SpA.     

IgA Nephropathy-Associated Uveitis: A Case Presentation

ABSTRACT

Purpose: To describe a case of bilateral panuveitis in the setting of IgA nephropathy.

Methods: Retrospective review of clinical records, fundus, and optical coherence tomographic (OCT) images, and fluorescein angiography.

Results: A 36-year-old female presented with IgA nephropathy and contemporaneous ocular manifestations of one-year duration. Clinical exam demonstrated bilateral panuveitis, 3+ anterior chamber (AC) cell in the right eye (OD), and 0.5+ AC cell in the left eye (OS). Funduscopic exam demonstrated diffuse yellow drusenoid deposits bilaterally (OU), accentuated on fundus autofluorescence as focal areas of hyperautofluorescence. Deposits correlated with retinal pigment epithelium hyper-reflectivity on OCT, and choroidal hypo-fluorescence on fluorescein angiography. The patient was managed with oral prednisone.

Conclusion: IgA nephropathy is a systemic autoimmune disease that may be associated with uveitis. Immunosuppression with corticosteroids appears to be an effective therapy.     

Narcolepsy in Slovakia – Epidemiology,clinical and polysomnographic features,comorbid diagnoses: a case-control study

ObjectiveAn increase in the incidence of narcolepsy after the pandemic influenza with the H1N1 vaccination in 2009 resulted in an interest in narcolepsy epidemiology. The aim of the study was to examine the incidence and prevalence rates of narcolepsy and to describe the associated characteristics in Slovakia.MethodsEpidemiology data were calculated for each year from 2000 to 2017 based on records found in specialized centres. In sum, 61 narcoleptic patients were diagnosed, of which 51 (84%) had narcolepsy type 1 (NT1). Clinical data and results of polysomnography (PSG), Human Leukocyte Antigen (HLA)-typing, hypocretin (HCRT)-1 levels and body mass index (BMI) were summarised and evaluated for NT1 and narcolepsy type2 (NT2). Later, 244 sex and age matched controls were chosen to evaluate the comorbid diagnoses.ResultsThe prevalence of narcolepsy in 2017 in Slovakia was 10.47 (CI 95% 8.26–14) cases/million inhabitants, and the mean incidence rate (2000–2017) was 0.57 (CI 95% 0.4–0.74) cases/million inhabitants.Narcoleptic patients were comorbid with arterial hypertension (17%), ischemic heart disease (8%), dyslipidaemia (18%), diabetes mellitus type 2 (10%), cardiac arrhythmia/atrial fibrillation (5%), autoimmune disorders (20%), allergy (11%), malignancy (3%), headache (15%) and mental disorders (20%). Patients with narcolepsy showed double the excess prevalence in mental disorders (OR 2.15, p < 0.05), and dyslipidaemia (OR 2.22, p < 0.05). The presence of autoimmune disorders and allergy showed a mild increase in the narcolepsy group (OR 1.46, resp. 1.63). Hashimoto thyroiditis (HT) was the most frequent autoimmune disorder.ConclusionsNarcolepsy is a rare disorder in Slovakia. From the phenotype, genetic characteristics and comorbidities the disorder does not vary from other European countries.     

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。