尿酸与慢性肾脏病-矿物质和骨代谢异常的研究进展

随着生活水平和饮食结构的改变,高尿酸血症的发病率呈不断上升趋势,流行病学调查显示,我国成年人高尿酸血症的患病率为8.4%~13.3%,高尿酸血症不仅是痛风的主要病因,而且是慢性肾脏病（CKD）进展和心血管疾病死亡的独立危险因素,已经成为威胁人类健康的代谢性疾病之一。矿物质和骨代谢异常（MBD）是CKD常见的并发症,其包括矿物质代谢紊乱、骨骼病变和骨外钙化,可导致CKD患者住院率、心血管事件及死亡率增加。近年研究发现尿酸与CKD-MBD之间可能密切相关,但其相关性目前仍存在争议,尚需深入研究论证。本文综述了尿酸的病理生理功能、尿酸与CKD-MBD的关系及相互作用机制的研究进展,认为调控尿酸水平可能成为CKD-MBD治疗的靶点。     

丙型肝炎病毒相关性肾炎的研究进展

丙型肝炎病毒（hepatitisCvirus,HCV）引起肝细胞受损,从而导致肝炎、肝硬化,甚至进展为肝癌,而且可能导致肝外组织损伤,引起多种器官病变,其导致的肾小球疾病称为丙型肝炎病毒相关性肾炎（hepatitisCvirusassociatedglomerulonephritis,HCV—GN）,对于其发病机制、临床表现、治疗方案及预后,研究相对不够完善,就其发病机制上说,考虑为混合性冷球蛋白介导和非混合性冷球蛋白介导肾脏损伤两种。最常见的临床表现包括蛋白尿、镜下血尿伴或不伴有肾功能受损。为排除是HCV-GN还是丙型肝炎合并原发性肾脏疾病,其鉴别主要肾脏病理检查及抗病毒治疗后肾脏疾病预后情况。故其治疗方案制订上相对复杂,目前尚无最佳治疗方案,其导致的肾脏疾病有不同的转归,对其预后说法不一,因此,探讨丙型肝炎病毒与。肾小球肾炎关系,总结其发病机制、临床表现、治疗方案,为将来研究提供理论基础。     

血栓性血小板减少性紫癜误诊1例

患者,女,37岁,因出现间断月经增多15 d,四肢麻木1周,加重伴头晕、恶心、呕吐3 d于2016年6月24日入院.入院体格检查:身高160 cm,体重50 kg,体温37.9℃,脉搏100次/min,呼吸18次/min,血压105/68 mmHg,意识躁动,贫血貌,伸舌居中,无齿龈出血,四肢可见散在出血点,双肺呼吸音粗,未闻及明显干、湿性啰音.心脏听诊节律规整,各瓣膜听诊区未闻及病理性杂音及额外心音.     

促红细胞生成素与骨髓间充质干细胞相互作用研究进展

促红细胞生成素（ erythropoietin,EPO）是由肾脏和肝脏分泌的一种激素样物质,能刺激骨髓中幼稚红细胞增生、分化、成熟。骨髓间充质干细胞（ Bone Mesenchymal Stem Cells,BMSCs）是存在于骨髓中除造血干细胞以外的另一类具有“无限”增殖和多向分化潜能的干细胞。近年来,发现 EPO和 BMSCs相互影响、相互作用并从基因水平上治疗各种疾病。本文关于EPO联合BMSCs在生物医学研究界的应用予以综述。     

Decreased Number of CD14+TLR4+ Monocytes and Their Impaired Cytokine Responses to Lipopolysaccharide in Patients with Chronic Kidney Disease

This study aimed to examine the number of circulating Toll-like receptor 4(TLR4) + CD14+ monocytes in patients with different stages of chronic kidney disease(CKD), their responses to lipopolysaccharide(LPS), and to explore the potential association of the number of TLR4+CD14+ monocytes with clinical laboratory measures. The numbers of TLR4+CD14+, LPS-stimulated TNF-?+CD14+ and interleukin(IL)-6+CD14+ monocytes were determined by flow cytometry in 9 patients with stage 3 CKD, 11 with stage 4 CKD, 16 with stage 5 CKD, and 19 healthy controls(HCs). Their laboratory tests were performed by routine methods and the potential association among these measures was analyzed by Pearson’s correlation analysis. The numbers of CD14+, CD14+TLR4+, LPSstimulated TNF-?+CD14+ and IL-6+CD14+ monocytes in patients with CKD were significantly less than those of HCs(all P<0.05), and were negatively associated with patient disease severity. The number of CD14+TLR4+ monocytes was positively correlated with estimated glomerular filtration rate(e GFR, P<0.001) and the levels of hematocrit(P<0.01), but negatively correlated with the levels of blood urine nitrogen, serum creatinine, and C-reactive protein(P<0.001 for all), in the CKD patients. Our data indicate that significant reduction in the number of TLR4+ monocytes and their impaired responses to LPS may be associated with the progression of CKD in Chinese patients.     

Differences in pathological characteristics and laboratory indicators in adult and pediatric patients with Henoch-Schönlein purpura nephritis

We aimed to investigate the differences in renal histopathological changes and laboratory parameters between adult and pediatric patients with Henoch-Schönlein purpura nephritis (HSPN), and to analyze the correlation between laboratory parameters and renal histopathological grading. A total of 139 patients diagnosed with HSPN between September 2010 and December 2014 at the First Hospital of Jilin University, China, were retrospectively reviewed. The clinical and pathological characteristics were examined and compared between the adult and the pediatric patients. A majority of adult (75.0%) and pediatric (66.2%) patients were categorized as pathological grade III HSPN. Adults having crescent lesions, interstitial fibrosis and renal artery involvement significantly outnumbered child counterparts (all P<0.05). Pathological grading showed a positive correlation with 24-h urine protein (r=0.307, P=0.009), microalbuminuria (r=0.266, P=0.000) and serum globulin (r=0.307, P=0.014), and a negative correlation with serum albumin (r=0.249, P=0.037) in pediatric patients with HSPN. Among adult patients with HSPN, histopathological grading showed a positive correlation with 24-h urine protein (r=0.294, P=0.015), microalbuminuria (r=0.352, P=0.006), α1-microglobulin (r=0.311, P=0.019) and immunoglobulin G (r=0.301, P=0.023) in urine, and serum creatinine (r=0.292, P=0.018). Further, a negative correlation between serum albumin and pathological grading was also observed (r=0.291, P=0.018). In conclusion, the severity of renal pathological lesions in HSPN patients is well reflected by the levels of proteinuria. Adult patients have more severe renal histopathological changes than pediatric patients.     

某污水处理厂对改变污水诱变性效果观察

通过波动试验和蚕豆根尖细胞微核试验,检测了某污水处理厂的进厂水和出厂水的诱变性。结果表明,废水经污水处理厂二级处理后,COD、BOD_5等化学监测指标有明显改善,但对去除或降低废水中的致癌/致突变物质却无明显效果。提出为降低污水的诱变性,须研究新的净化措施。並且指出波动试验和蚕豆根尖细胞微核试验很适于污水诱变性的检测。