特发性膜性肾病患者免疫抑制剂治疗后新发糖尿病的危险因素分析

目的分析特发性膜性肾病（IMN）患者采用免疫抑制剂治疗后新发糖尿病（NODM）的危险因素。方法选取2013年9月至2019年8月浙江省人民医院收治的IMN患者102例,均采用他克莫司联合低剂量皮质类固醇治疗,至少3个月。其中治疗后发生NODM患者38例（NODM组）,未发生NODM患者64例（no-NODM组）。比较两组患者的临床特征,并分析影响患者NODM的危险因素。结果IMN患者免疫抑制剂治疗后NODM发生率为37.2%;疾病完全缓解55例,部分缓解25例,缓解率为78.4%。与no-NODM组相比较,NODM组患者年龄较大,空腹血糖水平较高,LDL-C水平较低（均P＜0.05）。多因素logistic回归分析提示,年龄增长（OR=1.78,95%CI：1.27~2.51）、空腹血糖偏高（OR=2.54,95%CI：1.08~5.99）是IMN患者免疫抑制剂治疗后NODM的独立危险因素（均P＜0.05）。结论他克莫司联合低剂量皮质类固醇治疗IMN是有效的,但存在NODM风险。年龄增长和空腹血糖水平偏高是接受他克莫司联合低剂量皮质类固醇治疗的IMN患者发生NODM的主要危险因素。     

枸橼酸抗凝在基于含钙置换液的日间连续性肾脏替代治疗中的应用及护理

目的总结57例终末期肾脏疾病患者或急性肾损伤患者,采用枸橼酸抗凝方式进行含钙置换液处方的日间连续性肾脏替代治疗的效果及护理体会。方法以2015年3月至2017年8月浙江省人民医院57例患者239例次治疗为研究对象,护理要点包括：保证连续性血液净化设备正常运转,确保正确采血点及采血方式的情况下密切监测血清离子钙及酸碱平衡,严密监测出血情况,安全有效地液体管理及并发症的护理。结果57例患者行日间连续性肾脏替代治疗（DCRRT）共239例次,除1例次在治疗5h时出现滤器Ⅲ级凝血提前结束治疗外,其余238例次均按预计治疗目标顺利完成治疗,且无枸橼酸抗凝相关并发症出现。治疗后WBC、CRP、ALB、TC、TG、ALT、AST、Cr、BUN、IgG、IgA、IgM等水平均明显低于治疗前（均P＜0.05）,治疗前后Hb、PLT、PT差异均无统计学意义（均P＞0.05）。治疗后左心房内径、左心室舒张末期内径明显低于治疗前水平,左心室射血分数明显高于治疗前水平（均P＜0.05）。治疗前后患者心包积液发生比例无统计学意义（P＞0.05）。结论在行枸橼酸抗凝的DCRRT治疗中,护理人员首先应保证连续性血液净化设备的正常运转,并密切监测血电解质及酸碱平衡,预防相关并发症的发生,以保证治疗的顺利完成。     

基于慢病毒的SHARP-2特异的RNA干扰延长肾移植受者大鼠存活时间

Objective To investigate if rat enhancer of split- and hairy-related protein-2 (SHARP-2) short hairpin RNA interference (shRNAi) prolongs the survival time of rat kidney transplant recipients. Methods Gene recombinant procedures, transfection and co-transfection were carried out to introduce short hairpin RNA interference sequences target for SHARP-2 into 3rd generation self-inactivated lentiviral-ViraPower packaging mix. Limiting dilution method was used for viral titration. Real-time PCR was employed for quantification of gene expression. Rat kidney transplantation was utilized to investigate the effect of SHARP-2 gene silence on the recipient survival. Results A lentiviral-based shRNAi construct LV-SHARP-2iC showed 84% SHARP-2 gene silence efficiency in normal rat kidney cells. At multiplicity of infection 20, 57% T cells could be transfected by lentivirus with spinoculation method. In activated T cells, SHARP-2 g ene silence resulted in 61.3% and 68.7% reduction of intedeukin 2 (IL-2) and interferon γ (IFN-γ) gene expression. When donor kidney was perfused with 5×107 TU LV-SHARP-2iC, the median survival time prolonged for 4-5 days as compared to blank and scramble control groups. Conclusions A recombinant lentivirus LV-SHARP-2iC that effectively silence SHARP-2 gene expression is constructed successfully, leading to the inhibition of IL-2 and IFN-γ. LV-SHARP-2iC treatment can prolong the survival time of rat kidney transplant recipients.     

基于慢病毒的SHARP-2特异的RNA干扰延长肾移植受者大鼠存活时间

Objective To investigate if rat enhancer of split- and hairy-related protein-2 (SHARP-2) short hairpin RNA interference (shRNAi) prolongs the survival time of rat kidney transplant recipients. Methods Gene recombinant procedures, transfection and co-transfection were carried out to introduce short hairpin RNA interference sequences target for SHARP-2 into 3rd generation self-inactivated lentiviral-ViraPower packaging mix. Limiting dilution method was used for viral titration. Real-time PCR was employed for quantification of gene expression. Rat kidney transplantation was utilized to investigate the effect of SHARP-2 gene silence on the recipient survival. Results A lentiviral-based shRNAi construct LV-SHARP-2iC showed 84% SHARP-2 gene silence efficiency in normal rat kidney cells. At multiplicity of infection 20, 57% T cells could be transfected by lentivirus with spinoculation method. In activated T cells, SHARP-2 g ene silence resulted in 61.3% and 68.7% reduction of intedeukin 2 (IL-2) and interferon γ (IFN-γ) gene expression. When donor kidney was perfused with 5×107 TU LV-SHARP-2iC, the median survival time prolonged for 4-5 days as compared to blank and scramble control groups. Conclusions A recombinant lentivirus LV-SHARP-2iC that effectively silence SHARP-2 gene expression is constructed successfully, leading to the inhibition of IL-2 and IFN-γ. LV-SHARP-2iC treatment can prolong the survival time of rat kidney transplant recipients.     

口服大剂量环丙沙星致急性肾功能衰竭1例

患者男,50岁,因恶心,上腹不适伴少尿9天入院。发病前患者因饮食不洁出现腹泻水样便4～5次/日,本院肠道门诊诊断为急性肠炎,给予环丙沙星0.5g 2次/日口服.患者自行增至1g 3次/日,其后自觉头晕,口干,口苦,上腹不适,恶心呕吐胃内容物,每天尿量50～350ml,伴便秘,入院前1天查血Cr 1796μmol/L,BUN 226 mmol/L,诊为急性肾功能衰竭收住入院。体检:T37.5℃,P84次/分,R20次/分,BP21.5/12.5kPa,精神软,颜面及下肢轻度浮肿.全身皮肤无阏点瘀斑,颈软,心、肺听诊正常,腹平软,肝脾肋下未及,双侧肾区叩痛( ),神经系统正常。实验室检查血Hb 109g/L,WBC 7.8×10~9/L,N 0.82,L 0.18;大便常规正     

基于慢病毒的SHARP-2特异的RNA干扰延长肾移植受者大鼠存活时间

Objective To investigate if rat enhancer of split- and hairy-related protein-2 (SHARP-2) short hairpin RNA interference (shRNAi) prolongs the survival time of rat kidney transplant recipients. Methods Gene recombinant procedures, transfection and co-transfection were carried out to introduce short hairpin RNA interference sequences target for SHARP-2 into 3rd generation self-inactivated lentiviral-ViraPower packaging mix. Limiting dilution method was used for viral titration. Real-time PCR was employed for quantification of gene expression. Rat kidney transplantation was utilized to investigate the effect of SHARP-2 gene silence on the recipient survival. Results A lentiviral-based shRNAi construct LV-SHARP-2iC showed 84% SHARP-2 gene silence efficiency in normal rat kidney cells. At multiplicity of infection 20, 57% T cells could be transfected by lentivirus with spinoculation method. In activated T cells, SHARP-2 g ene silence resulted in 61.3% and 68.7% reduction of intedeukin 2 (IL-2) and interferon γ (IFN-γ) gene expression. When donor kidney was perfused with 5×107 TU LV-SHARP-2iC, the median survival time prolonged for 4-5 days as compared to blank and scramble control groups. Conclusions A recombinant lentivirus LV-SHARP-2iC that effectively silence SHARP-2 gene expression is constructed successfully, leading to the inhibition of IL-2 and IFN-γ. LV-SHARP-2iC treatment can prolong the survival time of rat kidney transplant recipients.     

基于慢病毒的SHARP-2特异的RNA干扰延长肾移植受者大鼠存活时间

Objective To investigate if rat enhancer of split- and hairy-related protein-2 (SHARP-2) short hairpin RNA interference (shRNAi) prolongs the survival time of rat kidney transplant recipients. Methods Gene recombinant procedures, transfection and co-transfection were carried out to introduce short hairpin RNA interference sequences target for SHARP-2 into 3rd generation self-inactivated lentiviral-ViraPower packaging mix. Limiting dilution method was used for viral titration. Real-time PCR was employed for quantification of gene expression. Rat kidney transplantation was utilized to investigate the effect of SHARP-2 gene silence on the recipient survival. Results A lentiviral-based shRNAi construct LV-SHARP-2iC showed 84% SHARP-2 gene silence efficiency in normal rat kidney cells. At multiplicity of infection 20, 57% T cells could be transfected by lentivirus with spinoculation method. In activated T cells, SHARP-2 g ene silence resulted in 61.3% and 68.7% reduction of intedeukin 2 (IL-2) and interferon γ (IFN-γ) gene expression. When donor kidney was perfused with 5×107 TU LV-SHARP-2iC, the median survival time prolonged for 4-5 days as compared to blank and scramble control groups. Conclusions A recombinant lentivirus LV-SHARP-2iC that effectively silence SHARP-2 gene expression is constructed successfully, leading to the inhibition of IL-2 and IFN-γ. LV-SHARP-2iC treatment can prolong the survival time of rat kidney transplant recipients.     

六、关注“子宫脱垂”

33岁的刘女士,最近被一件难以启齿的尴尬事困扰着。两年前,她自然分娩产下一男孩,3个月以后,为了尽快恢复身材,她每天坚持1～2个小时的步行锻炼。没想到,自此她开始尿频、尿急,尤其是在长时间步行或疲劳后,症状更加明显;再后来,只要咳嗽、打喷嚏小便就会流出。前不久她发现,阴道内居然有东西掉了出来,急忙去医院妇科检查,才知道掉出来的东西竟然是子宫。医生告诉她患了"子宫脱垂"症。