终末期狼疮性肾炎透析中狼疮活动的研究

目的探讨６１例终末期狼疮性肾炎（ＬＮ）患者长期透析后狼疮活动性改变以及慢性维持性血液透析（ＨＤ）和持续性非卧床腹膜透析（ＣＡＰＤ）对其影响。方法调查所有病人透析前后５年间的临床和血清学资料。根据ＳＬＥ活动指数（ＳＬＥＤＡＩ）计算其得分。结果肾衰后狼疮活动和药物使用均显著减少（Ｐ＜０．０５），而某些肾外狼疮临床表现的发生率却无显著减少，透析治疗５年存活率为８０％。在ＨＤ和ＣＡＰＤ治疗中，两组存活率、狼疮活动和药物的使用率均无明显差异（Ｐ＞０．０５）。结论ＬＮ透析的存活率良好，肾衰后狼疮活动发生率减少，而用ＨＤ和ＣＡＰＤ治疗在存活率和狼疮活动发生率上并无明显差异（Ｐ＞０．０５）     

终末期狼疮性肾炎透析中狼疮活动的研究

目的 探讨６１例终末期狼疮性肾炎（ＬＮ）患者长期透析后狼疮活动性改变以及慢性维持性以及慢性维持性血液透析（ＨＤ）和持续性非卧床腹膜透析（ＣＡＰＤ）对其影响。方法 调查所有病人透析前后５年间的临床和血清学资料。根据ＳＬＥ活动指数（ＳＬＥＤＡＩ）计算其得分。结果 肾衰后狼疮活动和药物使用均显著减少（Ｐ〈０．０５），而某些肾外狼疮临床表现的发生率却无显著减少，透析治疗５年存活率为８０％。在ＨＤ和ＣＡＰＤ     

几种自身抗体在狼疮患者和活动性狼疮肾炎患者对比分析

目的对狼疮患者和活动性狼疮肾炎患者进行多重抗体检测,以期发现相关自身抗体的表达差异及其意义。方法选取2007年1月～20O9年4月的SLE并发LN的患者48例与狼疮患者50例,进行LN的诊断、肾活检评分,应用免疫斑点法检测狼疮患者和活动性狼疮肾炎患者的抗ds-DNA、抗RNP以及ANCA,观察几种自身抗体与阳性率的关系。结果抗ds-DNA、抗RNP以及ANCA在活动性LN患者中的阳性率高于未发生肾病者,差异有统计学意义（P〈0.05）。抗Sm、SSA以及SSB在两者中的阳性率无明显差别。结论检测SLE患者的ANCA可能有助于判断该疾病的活动性。以抗RNP反映SLE的疾病活动,对于SLE的早期诊断、监测更有意义。     

终末期狼疮性肾炎肾外狼疮活动的临床及免疫学分析

目的　了解狼疮肾炎终末期肾功能衰竭患者肾外狼疮活动情况。方法　对 1 990年至 1 998年间住院并定期进行持续不卧床腹膜透析或血液透析的狼疮肾炎终末期肾功能衰竭患者 6 9例透析前后肾外狼疮活动情况进行回顾性总结。结果　透析前 1个月至 3月 3 5 %(2 4 /6 9)的狼疮肾炎终末期肾衰患者具有肾外狼疮活动表现 ,透析第 1年中狼疮活动病例较透析前增加 5 7%(3 9/6 9) (P <0 .0 5 )。以后 ,随透析时间延长狼疮活动逐渐减少 (P <0 .0 5 )。抗核抗体 ,抗双链DNA抗体 ,低C3血症阳性率也随时间延长降低 (P <0 .0 5 )。结论　狼疮肾炎终末期肾功能衰竭患者开始透析第 1年狼疮活动增加 ,短期激素治疗缓解肾外狼疮活动症状。     

血浆骨调素水平与系统性红斑狼疮活动性的关系

目的研究系统性红斑狼疮（SLE）病人血浆骨调素（OPN）水平与SLE活动性的关系。方法采用酶联免疫吸附试验（ELISA）检测了90例SLE病人及30例对照者血浆OPN的水平,观察OPN与SLE疾病活动指数标准（SLEDAI）及其他疾病活动指标[抗双链-DNA（抗ds-DNA）抗体,补体C3和C4,红细胞沉降率]的相关性。结果SLE病人血浆OPN水平显著高于正常对照组（t=4.748,P〈0.01）;狼疮肾炎（LN）组OPN高于非LN组（t=3.163,P〈0.01）;活动组血浆OPN水平较非活动组明显增高（t=3.305,P〈0.01）。血浆OPN水平与抗ds-DNA抗体滴度和SLEDAI评分呈正相关（r=0.573、0.315,P〈0.01）,与C3呈负相关性（r=-0.348,P〈0.05）,与C4、红细胞沉降率无显著相关性（P〉0.05）。结论SLE病人OPN水平升高,且与SLE活动性呈显著正相关,检测血浆OPN水平可以作为诊断SLE活动性的有效指标之一。     

双侧脉络膜病变作为系统性红斑狼疮首发表现1例

系统性红斑狼疮（systemic lupus erythematosus,SLE）是一种多系统自身免疫性疾病,狼疮引起的脉络膜病变作为SLE的一种罕见并发症是与疾病活动性相关的敏感指标,通常预示着不良预后,可在SLE得到控制后好转。本文报告了一例以双侧脉络膜病变伴浆液性视网膜脱离为首发表现的SLE患者,经眼科多模式成像确诊狼疮脉络膜病变,积极治疗后脉络膜病变得到控制。     

66例系统性红斑狼疮患者的妊娠转归

目的研究系统性红斑狼疮（SLE）患者妊娠后母婴结局及其相关的危险因素。方法回顾性分析（2006年10月~2015年9 月）南方医院SLE妊娠住院患者的临床资料,比较疾病缓解-轻度活动组（SLEDAI≤9分）和中-重度活动组（SLEDAI>9分）妊娠 结局、母婴并发症,分析不良妊娠结局的危险因素。结果66位SLE 患者共妊娠69次,确诊SLE时平均年龄22.9±5.1岁;妊娠时 SLE平均病程4.1±3.6 年;妊娠期间45 例（65.2%）接受药物治疗,44 例（63.8%）应用糖皮质激素,其中27 例（39.1%）剂量小于 20 mg/d,17例（24.6%）剂量高于20 mg/d,19例（27.5%）应用羟氯喹,孕期SLEDAI最高评分平均为6.8±7.4分。同病情缓解-轻 度活动组相比,中-重度活动组胎儿丢失率［12（54.5%）vs 12（25.5%）］高于前者,新生儿出生体质量［（2073.0±778.7）g vs （2817.8±533.7）g］低于前者（P<0.05）;中-重度活动组SLE新发［9（40.9%）vs 6（12.8%）］、高血压［12（54.5%）vs 3（6.4%）］、活动 性狼疮肾炎［22（100%）vs 4（8.5%）］、肺部感染［5（22.7%）vs 2（4.3%）］、肾功能不全［8（36.4%）vs 2（4.3%）］多于病情缓解-轻度活 动组,差异有统计学意义（P<0.05）;活动性狼疮肾炎（OR=6.10,95% CI：1.43-25.96）是不良妊娠结局的独立危险因素。结论 SLE患者孕期狼疮中-重度活动增加胎儿丢失、母亲并发症的发生,活动性狼疮肾炎是不良妊娠结局的独立危险因素。狼疮患 者妊娠转归仍有待进一步提高,妊娠期间应定期监测SLE患者各项指标,合理用药,控制狼疮活动,以获得良好的妊娠结局。     

自身抗体与狼疮活动性相关的临床研究

目的探讨自身抗体中抗dsDNA抗体，ANCA，抗磷脂抗体及补体C3、C4与系统性红斑狼疮（SLE）患者狼疮活动相关的临床研究。方法回顾性分析88例符合美国ARA标准（1982）的SLE病人的临床情况，并对抗dsDNA抗体，补体，ANCA，抗磷脂抗体等指标与SLE活动的关系进行了探讨与分析。结果C3下降较C4下降对诊断SLE活动更具价值，dsDNA抗体升高（尤其是〉30％），对SLE活动的判断很有价值。C3下降（尤其是〈0．5s／L）及dsDNA抗体升高，应对病情活动加以判断，当补体C，、C。均低而dsDNA抗体升高时对诊断SLE活动价值最大。64例活动期患者ANCA阳性率略高于非活动期患者，检测SLE患者的ANCA可能有助于判断该疾病的活动性。抗磷脂抗体对病情活动监测有意义，联合测定对于SLE的早期诊断、监测、治疗更有意义。结论血清中自身抗体：ds-DNA抗体、ANCA、抗磷脂抗体及补体与系统性红斑狼疮病情活动性高度相关。     

碳酸氢盐和醋酸盐血液透析结果比较

目的：探讨两种不同透析液血透后结果异同点。方法：对１０例终末期肾衰采用醋酸盐透析（ＡＨＤ组）１７２３例次、９例终末期肾衰采用碳酸盐透析（ＢＨＤ组）１６１４例次，观察结果并比较。结果：两 透析后血ＢＵＮ、Ｓｃｒ和电解质无明显差异，血ＨＣＯ３及发压ＢＨＤ优于ＡＨＤ，“醋酸直不耐受”现象ＢＨＤ比ＡＨＤ轻。结论：碳酸盐透析较卤透析更接近人体正常生理。     

20例慢性肾衰透析患者血液透析前后氨基酸谱的变化分析

目的观察慢性肾衰终末期患者血液透析前后血清氨基酸谱的变化,以纠正慢性肾衰透析患者负氮平衡。方法选择20例慢性肾衰终末期血液透析病人,测定其透析前后血清氨基酸浓度的变化。结果与透析前比较,全部非必需氨基酸水平显著下降（P〈0.01）;必须氨基酸中蛋氨酸含量增加,缬氨酸透析前后没有变化,其余的均较透前明显下降（P〈0.01）。结论血液透析影响机体氨基酸代谢,加重机体营养不良,应给予补充必需氨基酸等支持治疗。     

Survival of patients treated for end-stage renal disease by dialysis and transplantation.

The results of treatment in 213 patients with end-stage renal disease who underwent hemodialysis, peritoneal dialysis or transplantation, or a combination, between 1962 and 1975 were analysed. Comparison by censored survival analysis showed significantly better (P less than 0.01) patient survival with the integrated therapy of dialysis and transplantation than with either form of dialysis alone. There was no significant difference in survival of males and females but survival at the extremes of age was poorer. Analysis of survival by major cause of renal failure indicated best survival in patients with congenital renal disease. Graft and patient survival rates at 1 year after the first transplantation were 42% and 69%. The major cause of death in this series was vascular disease but infection was responsible for 50% of deaths after transplantation. While integration of dialysis with transplantation produces best patient survival, this course is possible only when sufficient cadaver kidneys are available.     

血清和唾液抗核小体抗体在系统性红斑狼疮中的诊断意义

目的:检测血清和唾液抗核小体抗体(AnuA)对系统性红斑狼疮(SLE)诊断的敏感性和特异性,探讨二者关系及其与SLE活动性和SLE机体损伤机制的关系。方法:用双抗体夹心ELISA法定量检测72例SLE组、30例疾病对照组和24例正常组血清AnuA水平,并检测42例SLE患者和20例正常人唾液AnuA水平,记录SLE患者的各种临床表现及实验室指标,并分析它们之间的关系。结果:血清AnuA在SLE检测中的敏感性和特异性分别为56.94%和98.15%。血清AnuA和抗双链DNA抗体水平呈正相关(r=0.55,P<0.01),且与系统性红斑狼疮疾病活动性指数(SLEDAI)记分正相关(r=0.629,P<0.001)。唾液AnuA水平与血清AnuA水平正相关(r=0.380,P<0.01)。结论:血清AnuA对SLE诊断的敏感性高、特异性强,可作为判断疾病活动性的指标;唾液AnuA水平与血清AnuA水平正相关,对SLE的诊断和疾病活动性的判断有一定意义。     

慢性肾功能衰竭患者肾上腺髓质素与系统血管顺应性的关系

目的：探讨慢性肾功能衰竭患者不同阶段肾上腺髓质素（ADM）的特点及其与系统血管顺应性（SVC）的关系。方法：采用放射免疫法测定19例终末期肾病（ESRD）长期透析患者和15例慢性肾功能衰竭（CRF）尚未透析患者的ADM水平，同时所有患者均采用Dynapulse200M动脉功能测定仪检测SVC，并和15例正常人作对照。比较13例ESRD透析患者透析前后的ADM的变化并分析了ADM与SVC的关系。结果：与正常对照组比较，CRF组和透析组患者的ADM明显增高（P〈0．01），透析组与CRF组比较，透析组的ADM比CRF组明显升高（P〈0．01）。透析后即刻SVC明显的改善（P〈0．01），ADM明显增加（P〈0．05），而透析后5h，SVC、ADM与透析前比较无明显变化（P〉0．05），SVC的变化与ADM无明显相关性。结论：慢性肾衰患者ADM明显增高，透析中ADM的变化是暂时的，与SVC无明显相关性。     

Survival analysis of patients undergoing dialysis

We analyzed the five-year survival of 4661 patients with end-stage renal disease whose first dialysis occurred in 1977. The analysis incorporated characteristics of patients and dialysis institutions. Results showed that mortality was positively correlated with patient age, initial conditions leading to renal failure, being male and white, open staffing, and the number of staff physicians. In addition, lower death rates were observed for patients treated in larger dialysis units and units that had been long-term reusers of dialyzers. Patients treated in for-profit and not-for-profit units appeared to have the same mortality, although patients treated in freestanding units had lower mortality. The direction of causation was not always clear in these results.     

A large regional hospital's experience with treatment of end-stage renal disease.

During the first 10 years of the treatment program for end-stage renal disease at the Saint John (New Brunswick) Regional Hospital 164 adults were treated by hemodialysis (with or without renal transplantation, performed outside of the province) or peritoneal dialysis. The primary causes of renal disease were not significantly different in men and women except for glomerulonephritis, which was twice as common in men as in women. Life-table analysis showed that the younger transplant recipients had the highest survival rate, but that the prognosis was almost as good among the much older patients who received continuous ambulatory peritoneal dialysis. Probably because they tended to be younger and their renal disease was caused by less threatening conditions, men survived longer than women. The survival rates were significantly related to the primary cause of the renal disease; patients with diabetes or systemic disease had the worst prognosis. Overall, these results compare well with those obtained in major university centres.     

Kidney transplantation in Canada, 1981-84.

The Canadian Renal Failure Register was established in 1980. Data have been collected annually for all Canadian patients in whom irreversible kidney failure developed and who required dialysis or transplantation. The authors present actuarial patient and graft survival rates for 1981-84. In 1984, patients with a functioning renal graft accounted for 43.9% of the patients with end-stage renal disease. The number of transplants performed increased from 482 in 1981 to 662 in 1984; however, 1,022 patients undergoing dialysis (25.2%) were on an active waiting list for a transplant at the end of 1984. Greater effort is needed to increase the transplantation rate.     

Delayed referral to a nephrologist: outcomes among patients who survive at least one year on dialysis

OBJECTIVE: To investigate whether late referral to a nephrologist of patients with chronic renal insufficiency influences the likelihood of both transplantation and mortality among those who survive at least one year on dialysis. DESIGN: Retrospective national cohort study, using data from the Australia and New Zealand Dialysis and Transplant Registry database. PARTICIPANTS: All patients with end-stage renal disease who started renal replacement treatment in Australia between 1 April 1995 and 31 December 1998, excluding those who received transplants or who died in their first year of dialysis. Patients referred "late" were defined as those who needed to commence dialysis within three months of referral to a nephrologist. MAIN OUTCOME MEASURES: Length of patient survival, and whether patients received a transplant at any time between one year after starting dialysis and completion of the study on 31 March 2000. RESULTS: Of the 4243 patients included in the study, 1141 (26.9%) were referred late. Late-referral (LR) patients were significantly less likely to receive a transplant in their second and subsequent years on dialysis (adjusted rate ratio, 0.78; 95% CI, 0.64-0.95). LR patients were at significantly increased risk of death after their first year on dialysis (adjusted hazard ratio, 1.19; 95% CI, 1.04-1.35). CONCLUSIONS: Late referral is associated with increased mortality, even among those who survive their first year on dialysis. Improving the quality of pre-dialysis care might improve access to transplantation and long-term survival. General practitioners could minimise late referrals through targeted screening of high-risk individuals.     

维持性血液透析患者心理特征分析及护理

目的探讨维持性血液透析患者的心理特征,并采取有针对性的护理措施。方法回顾性分析我院近年来收治的65例采取维持性血液透析治疗的终末期肾病患者的临床资料。结果 65例采取维持性血液透析治疗的终末期肾病患者,经心理调查,均存在不同程度的心理问题,严重影响透析的效果,经过有针对性的心理护理,患者的不良情绪与心理护理前比较均有所改善,P〈0.05,差异有统计学意义,患者接受维持性血液透析治疗的依从性明显提高。结论维持性血液透析治疗期间,根据患者不同的心理状态,采取有效的护理,才能使患者形成健康的情绪,以最佳的心理状态积极主动配合治疗,延长透析寿命。     

Selection of neuromuscular blocking agents in patients undergo ing renal transplantation under general anesthesia

目的：研究终末期肾衰患维库溴铵、阿曲库铵、美维松和罗库溴铵的药效。方法：46例作肾移植术的终末期肾衰患和53例肾功能正常的患分别给予维库溴铵、阿曲库铵、美维松和罗库溴铵。用四个成串刺刺激尺神经,监测拇内收肌肌颤搐。结果：肾衰组维库溴铵、阿曲库铵和美维松的起效增快或有增快趋势,罗库溴铵的起效在两组间无显性差异。阿曲库铵的无反应时间、作用持续时间和恢复在两组间无差异。美维松的作用持续时间和恢复在两组间无显性差异,但是肾衰组美维松的无反应期显延长。肾衰组维库溴铵和罗库溴铵初量的无反应期和作用持续时间与肾功能正常组无明显差异;然而,多次间断追加后,肾衰组维库溴铵箩库溴铵的无反应期和作用持续时间随追加次数增多而延长或有逐渐延长的趋势。结论：本研究的四个肌松均能安全地运用于终末期肾功能衰竭患。长期透析治疗的终末期肾衰患肌松药的起效时间可能缩短,美维松的无反应期延长。终末期肾衰患多次追加维库溴铵和罗库溴铵后,其时效延长,而阿曲库铵的时效和恢复均未见延长。     

End-stage renal failure in children: 16 years' experience at one Australian centre

Sixty-five children over one year and under 15 years of age began treatment for end-stage renal failure between 1973 and 1988. Sixty-one renal transplants were performed in 53 children, 39 of these were from living donors (38 were first-degree relatives and one was an emotionally related volunteer). Thirteen children, of whom seven had received transplants and six had not, died, including three children with functioning transplants; nine deaths occurred in the first eight years of the programme. Cumulative five-year and 10-year patient survival rates were 78% and 75%, respectively. Eighteen transplants failed, 12 as a result of rejection, five as a result of disease recurrence and one due to primary non-function. Cumulative five-year and 10-year transplant survival rates for first grafts were 66% and 53%, respectively. For living donor transplants these rates were 85% and 68%, respectively. Growth rates fell by 0.4 +/- 0.05 standard deviation score (SDS) per year in children undergoing dialysis, were normal in children with renal transplants receiving prednisone (change in SDS per year, -0.02 +/- 0.08) and increased by 0.36 +/- 0.07 SDS per year in children with transplants receiving cyclosporin A alone. Currently, 32 (82%) of 39 transplant recipients and 7 (58%) of 12 patients undergoing dialysis attend school or work full time. Although both dialysis and transplantation are acceptable therapies for children with end-stage renal failure, successful transplantation provides the best opportunity for satisfactory growth and development.