红细胞生成素对慢性肾衰竭大鼠残肾组织归巢因子表达的影响

目的 观察红细胞生成素(EPO)对慢性肾衰竭(CRF)大鼠肾组织归巢因子表达的影响.方法 采用分阶段5/6肾切除制备大鼠CRF模型.实验动物随机分为3组:假手术组、CRF模型组和EPO治疗组.从第3周开始,治疗组大鼠每次皮下注射重组人EPO 50 IU/kg,每周3次,共6周.8周后检测各组大鼠血肌酐(Scr)、血尿素氮(BUN)、尿蛋白、血红蛋白(Hb)；采用实时荧光定量PCR、Western印迹和免疫组化方法检测残肾组织EPO及其受体(EPOR)、归巢因子及其受体(SDF-1、CXCR4、Ang-1、Tie2、SCF、c-Kit)的表达.结果 与模型组比较,EPO治疗可上调残肾组织归巢因子及其受体(SDF-1、CXCR4、Ang-1、Tie2、SCF、c-Kit)mRNA和蛋白的表达(均P＜0.05)；同时,EPO治疗还可上调残肾组织EPO及EPOR的mRNA和蛋白的表达(均P＜ 0.05).此外,EPO治疗还能下调大鼠Scr、BUN和尿蛋白水平(均P＜0.05),上调Hb水平(P＜0.05).结论 EPO能改善慢性肾衰竭大鼠的肾功能,这种作用可能与其激活残肾组织归巢因子而参与损伤肾脏的修复有关.     

临床活动性评分、血清透明质酸、促甲状腺素受体抗体与Graves眼病间的关系

目的　探讨临床活动性评分 (CAS)、血清透明质酸 (HA) ,促甲状腺素受体抗体 (TRAb)水平与Graves眼病 (Gravesophthalmopathy ,GO)活动性、严重度以及糖皮质激素治疗效果间的关系。 方法　GO组 33例 ,Graves病无眼病组 (noGravesophthalmopathy ,NGO) 2 5例 ,正常对照组 2 0例 ,用放免分析法和放射受体分析法测定 3组人群血清HA ,TRAb水平 ,GO患者计算CAS ,并用泼尼松治疗。以NOSPECS分级判断眼病严重度和激素治疗效果 ,比较 3组间及激素治疗有效组与无效组间各指标的差别和相关性。结果　GO组血清HA高于NGO组与正常对照组 ,差异有统计学意义。 3组TRAb水平比较 ,差异有统计学意义 ,表现为GO组 >NGO组 >正常对照组。血清TRAb水平与眼病严重度相关。治疗有效组CAS与血清HA水平高于治疗无效组 ,差异有统计学意义。结论　CAS、血清HA测定可作为判断GO活动性、预测糖皮质激素治疗效果的辅助手段。血清TRAb滴度在GO患者中高于NGO患者 ,可能预测GO的发生 ,并与眼病严重度评分相关     

连续性肾脏替代治疗剂量问题

<正>在重症监护病房危重患者中,急性肾衰竭(acute renal failure,ARF)是常见的严重并发症,发生率约5%,病死率高达50%～70%。近年来,危重ARF的血液净化治疗,尤其是连续性肾脏替代治     

骨髓间充质干细胞修复损伤肾小管上皮细胞：可能与可行？

背景：研究表明骨髓间充质干细胞在急性肾损伤后能够通过直接分化为肾小管上皮细胞而促进肾功能的恢复,其修复肾脏的作用机制尚不清楚,能否直接分化为肾小管上皮细胞,目前仍有争议。目的：观察骨髓间充质干细胞输注后急性肾衰竭小鼠肾功能改变,外源性骨髓间充质干细胞在肾组织的分布以及是否向肾小管上皮细胞分化。方法：骨髓间充质干细胞来源于绿色荧光蛋白转基因小鼠。8～10周龄的健康雌性昆白小鼠90只随机随机分为3组。急性肾衰竭组和骨髓间充质干细胞组注射顺铂建立急性肾衰竭模型,骨髓间充质干细胞组在建模后24h经尾静脉输注绿色荧光蛋白转基因小鼠的骨髓间充质干细胞悬液。正常对照组不进行任何干预。建模后第1,4,7,14,28天测定血尿素氮和血肌酐,观察肾组织病理变化,荧光显微镜下观察绿色荧光蛋白阳性的骨髓间充质干细胞在肾组织的分布,共聚焦显微镜下观察骨髓间充质干细胞向肾小管上皮细胞的分化情况。结果与结论：骨髓间充质干细胞组顺铂注射4～14d后,尿素氮、肌酐值比急性肾衰竭组明显降低（P〈0.01或P〈0.05）。骨髓间充质干细胞组第4天肾组织中可见绿色荧光的绿色荧光蛋白细胞,分布在外髓质区肾小管,第7天仍可见少量荧光细胞,同时表达肾小管上皮特异性的功能蛋白megalin。结果提示骨髓间充质干细胞在损伤肾脏可直接分化为肾小管上皮细胞,并改善急性肾衰竭小鼠的肾功能。     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.     

案例教学法在肾脏病临床教学中的应用

在制作典型、合格、完整而全面的肾脏病临床案例库的基础上,使用案例教学法和传统教学法分别对实验组及对照组进行教学,并使用同一试卷及调查问卷对两组学生进行考评。结果显示,实验组教学效果明显优于对照组。证明案例教学法可以在临床教学中推广使用。     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.     

重症急性肾功能衰竭连续性肾脏替代治疗与间歇性血液透析

目的　比较连续性肾脏替代治疗 (CRRT)与间歇性血液透析 (IHD)治疗重症急性肾功能衰竭 (ARF)的疗效。　方法　 ARF重症患者 75例 ,CRRT组 33例 ,IHD组 4 2例 ,回顾性对比分析两组的临床资料和疗效。　结果　 CRRT组病情明显重于 IHD组 :患者年龄大 ,平均动脉压低 ,APACHE 积分高 ,衰竭器官数目多 ,需要机械通气和升压药物的患者数高于 IHD组 (P<0 .0 1 )。但 CRRT组存活 2 4例 (72 .7% ) ,死亡 9例 (2 7.3% ) ;IHD组存活 2 3例 (5 4 .8% ) ,死亡 1 9例 (4 5 .2 % )。两组存活率比较差异有极显著性 (P<0 .0 1 )。　结论　 CRRT治疗重症ARF的疗效优于 IHD,能提高重症 ARF患者的存活率 ,改善重症 ARF的预后     

泽泻醇B抑制C3a介导的人肾小管上皮细胞间充质转分化的实验研究

目的 探讨泽泻醇B能否抑制C3a介导的肾小管上皮细胞间充质转分化(epithelial-mesenchymal transition,EMT)。方法 将体外培养的人肾小管上皮细胞(HK-2)分别用5 ng/mL转化生长因子β(transforming growth factor-β,TGF-β)、0.1 μmol C3a和0.1 μmol C3a加10 μmol泽泻醇B进行干预。分别采用RT-PCR、Western blot和细胞免疫荧光法检测HK-2细胞C3、α-平滑肌肌动蛋白（α-SMA）和上皮钙黏蛋白（E-cadherin） mRNA及蛋白表达。结果 经C3a刺激后,HK-2细胞C3 mRNA和蛋白表达明显增加(P<0.01),α-SMA mRNA及蛋白表达明显增加(P<0.01),E-cadherin mRNA及蛋白表达明显减少(P<0.01)。与经外源性C3a干预组比较,经泽泻醇B干预后,HK-2细胞α-SMA mRNA及蛋白表达明显减少(P<0.01),E-cadherin mRNA及蛋白表达明显增加(P<0.05)。结论 外源性C3a能诱导肾小管上皮细胞发生EMT,泽泻醇B可抑制C3a诱导的EMT。