血小板及其相关分泌产物与肾小球疾病关系研究近况

激活的血小板可分泌大量活性产物，对靶细胞行为有着广泛的影响。本文在复习近年来有关文献的基础上，因小板及其活性产物在肾小球疾病中作用证据、如何改变肾小球其底膜通透透性并促进免疫事物沉积以及促进小球球重建的机制作一综述。     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

肝炎病毒感染的肾移植受者术后并发症

目的：了解ＨＢｓＡｇ或Ａｎｔｉ－ＨＣＶ阳性对肾移植受者术后并发肝外感染、急性排异及移植肾功能不全的影响。方法：回顾分析１０１例肾移植受者的临床资料。结果：在ＨＢｓＡｇ（＋）与Ａｎｔｉ－ＨＣＶ（＋）组间上述三大并发症发生率差异不显著（Ｐ＞０．０５）；ＨＢｓＡｇ（＋）组或Ａｎｔｉ－ＨＣＶ（＋）组移植肾急性排异及肾功能不全的发生率较高，尽管较阴性组无显著差异（Ｐ＞０．０５），但肝外感染的发生率明显升高（Ｐ＜０．０５）。结论：对ＨＢｓＡｇ（＋）或Ａｎｔｉ－ＨＣＶ（＋）的肾移植受者必须密切监测肝功能，环孢素Ａ（ＣｓＡ）浓度及机体免疫状态，以选择适当的免疫抑制剂方案及剂量     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

系统性红斑狼疮患者外周血单个核细胞IL-17表达的初步观察

目前ＩＬ 17的研究已发现 ,其在一些自身免疫性疾病如移植肾排斥反应、类风湿性关节炎、多发性硬化、支气管哮喘等存在表达、分泌的异常 ,但在系统性红斑狼疮 (ＳＬＥ)患者中 ,其表达、分泌是否存在异常 ,目前国内、外尚未见研究报告〔1〕。本研究通过测定ＳＬＥ患者血清、无刺激或加不同刺激培养外周血单个核细胞 (ＰＢＭＣ)上清液ＩＬ 17蛋白水平和其ＰＢＭＣ内ＩＬ 17ｍＲＮＡ水平的表达量 ,以了解ＳＬＥ患者ＰＢＭＣ表达、分泌ＩＬ 17有无异常及其与ＳＬＥ疾病活动性的关系。材料与方法病例选择 :30例患者 ,全部符合美国风湿病协会1982…     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

急性肾功能衰竭治疗的研究近况

急性肾功能衰竭（ａｃｕｔｅｒｅｎａｌｆａｉｕｒｅ，ＡＲＦ）是临床常见的危重急症之一,多数ＡＲＦ病例经适当治疗病情好转直至痊愈,少数则可发展成慢性肾衰,甚至因并发症而死亡。近年来ＡＲＦ的治疗已有长足的进步,但重症ＡＲＦ病死率仍高达５０%左右［１～３］。除了一般处理措施及积极治疗原发疾病外,ＡＲＦ治疗主要包括药物、营养和血液净化,近年来这些专题有不少进展,综述如下。１ＡＲＦ药物治疗１１甘露醇甘露醇在ＡＲＦ预防中的作用研究颇多,结论不尽一致。动物实验表明,甘露醇通过增加尿量对ＡＲＦ起保护作用,其作用机制在于:甘露…     

尿路感染的分类及致病菌

尿路感染,简称尿感,这里指的是尿路的细菌性感染.尿感是所有的细菌性感染疾病中最常见的一种,以女性病人最常见.尿感的发病率根据我国普查统计,占人口的0.91%,叶氏等曾报道普查30196名妇女,其发病率为2.05%.叶任高教授是我国著名内科学肾脏病专家,在国内最早进行尿路感染的诊断与治疗系列研究,取得了很多重要成果,得到国内外学者的广泛关注,多次获得国家及广东省科研成果大奖,为提高我国尿路感染的诊治水平做出了重要贡献.下面结合国内外研究进展系统地阐述一下叶老的这方面研究成果.     

尿路感染的流行病学及病理改变

１流行流学１岁以前尿感发生率为１％，男性与女性之比为３∶１，此乃由于男性先天性尿路畸形较多之故。婴儿期以后则主要见于女性，直至１０岁，女性尿感发生率为１．２％，其中约７０％为无症状细菌尿，男性仅０．０４％，女童在首次发生菌尿后，约８０％有１次以上再发，再发中的８０％为重新感染。未婚女青年尿感的发病率为２％，而已婚女性的发病率增至５％，这与女性成年后开始月经周期、性生活和妊娠等有关。６０岁以上女性尿感的发生率高达１％，但不一定有临床症状。有临床症状的尿感，仍以生育年龄（１８～４０岁）的已婚妇女最多…     

微环境预处理的骨髓间充质干细胞治疗大鼠心肌梗死

目的 观察骨髓间充质干细胞(BMSC)或经预处理分化的BMSC(induced BMSC,iBMSC)移植能否改善心肌梗死大鼠的心功能.方法雄性SD大鼠32只(250～300 g),分为假手术组、磷酸缓冲液(PBS)注射组、BMSC移植组和iBMSC移植组共4组,每组8只.将分离的BMSC与心肌细胞(微环境)共培养2周进行预分化,大鼠心肌梗死模型建立1周后,将BMSC或iBMSC细胞悬液注入梗死区的边缘位置.分别于细胞移植后的第1、2和4周,超声心动图检测各组大鼠心脏的左心室射血分数(LVEF),左心室舒张末期内径(LVIDd),左心室收缩末期内径(LVIDs)及短轴缩短率(FS).移植后第4周进行组织学观察,心脏组织石蜡包埋切片后采用免疫荧光技术检测移植细胞的示踪标记物及心肌标志蛋白的表达情况.结果iBMSC组LVEF在第4周时是(77.3±2.6)%,与假手术组(81.8±3.6)%比较差异无统计学意义(P＞0.05),而PBS组及BMSC组的LVEF值均低于假手术组(P均＜0.05).PBS组FS移植前后没明显变化,iBMSC组FS从移植前的(24.1±3.9)%上升到第4周的(45.1±3.1)%.M型超声心电图显示iBMSC治疗组左心室收缩能力较细胞移植前明显改善.免疫荧光分析显示,SPIO标记的移植细胞在体内表达心肌细胞标志蛋白α-辅肌动蛋白和缝隙连接蛋白43.结论经过微环境预处理的BMSC较未处理的干细胞改善心功能效果更好.这一研究为干细胞的改造与细胞移植修复心肌梗死提供了强有力的证据.