慢性肾衰竭患者药物性脑病91例临床分析

目的 探讨引起慢性肾衰竭患者发生药物性脑病的常见抗生素种类、危险因素、临床特点、治疗及转归.方法 对发生药物性脑病的91例慢性肾衰竭患者所使用的药物种类、发病后的临床特点、治疗及转归进行分析.结果 91例慢性肾衰竭患者引起药物性脑病发生的抗生素包括:头孢他啶、头孢吡肟、头孢哌酮钠、拉氧头孢、头孢呋辛钠、加替沙星、哌拉两林.药物性脑病的发生与抗生素剂量有明显关系.结论 各种抗生素致慢性肾衰竭患者发生药物性脑病如能及早发现、及早停药及对症治疗如强化血液透析,绝大多数病人预后良好.     

慢性肾衰竭患者药物性脑病91例临床分析

目的 探讨引起慢性肾衰竭患者发生药物性脑病的常见抗生素种类、危险因素、临床特点、治疗及转归.方法 对发生药物性脑病的91例慢性肾衰竭患者所使用的药物种类、发病后的临床特点、治疗及转归进行分析.结果 91例慢性肾衰竭患者引起药物性脑病发生的抗生素包括:头孢他啶、头孢吡肟、头孢哌酮钠、拉氧头孢、头孢呋辛钠、加替沙星、哌拉两林.药物性脑病的发生与抗生素剂量有明显关系.结论 各种抗生素致慢性肾衰竭患者发生药物性脑病如能及早发现、及早停药及对症治疗如强化血液透析,绝大多数病人预后良好.     

91例慢性肾功能衰竭患者并发药物性脑病的临床分析

目的 探讨引起慢性肾功能衰竭患者药物性脑病的抗生素种类、发病机制、临床特点、治疗方法及转归.方法 对91例慢性肾功能衰竭患者所使用的药物种类、发病后的临床特点、治疗及转归进行分析.结果 91例慢性肾功能衰竭患者并发药物脑病中引起脑病发生的抗生素包括:头孢他啶、头孢吡肟、头孢哌酮钠、拉氧头孢、头孢呋辛钠、加替沙星、哌拉西林.药物性脑病的发生与抗生素剂量有明显关系.结论 各种抗生素致慢性肾功能衰竭药物性脑病如能及早发现、及早停药及对症治疗(如强化血液透析),绝大多数患者预后良好.     

尿毒症应用头孢类抗生素引起药物性脑病的回顾性研究

目的:探讨尿毒症患者使用头孢类抗生素后引起药物性脑病的临床特点,以指导头孢类抗生素在尿毒症患者中的合理应用。方法:回顾性分析2005年7月～2012年12月在头孢类抗生素治疗过程中出现神经精神症状的36例尿毒症患者,并对其进行临床症状和用药情况的分析和统计。结果:36例患者均在2～10d出现神经精神症状,症状表现多样,所有患者均无神经系统定位体征,经颅脑CT检查无急性病变。所有患者经停药、调整抗生素及继续透析治疗后症状完全消失。结论:尿毒症患者使用头孢类抗生素可引起药物性脑病,由于肾脏的排泄功能下降,故用药前应根据肾功能减退程度调整药物剂量,有条件者可进行血药浓度监测,用药过程中应密切观察,一旦出现症状及时停药及对症处理。     

药物致急性肾衰竭92例临床分析

近年来随着抗生素和各种化学药物在临床的广泛应用,药物引起的急性肾衰竭(ARF)也日益增加.药物性ARF发病急骤、临床表现复杂多样,已逐渐成为危害病人生命的主要药源性肾脏疾病之一.本文回顾性分析我院14年来药物性ARF的临床特点及其预后.     

规律透析尿毒症患者抗生素脑病报告

目的:探讨头孢素类抗生素在尿毒症患者中的如何使用.方法:对5例尿毒症血透病人,在使用常规剂量头孢类抗生素后出现神经精神症状进行分析.结果:神经精神症状表现多样:头昏、兴奋、定向障碍、记忆障碍、共济失调、无定位体征,停药透析后症状完全消失.结论:尿毒症患者使用常规剂量头孢类抗生素可引起一过性脑病,可能与药物半衰期延长有关,该类患者在使用头孢时,应调整剂量,密切观察,一旦有脑病症状出现、予以停用及血液透析治疗.     

74例药物性肝损伤临床分析

目的研究药物性肝损伤的病因、临床特点及预后，为临床合理用药及药物安全性评价提供依据。方法根据Maria的“临床诊断量表”，对药物性肝损伤患者的临床资料进行评分，对≥10分的74例患者的病因进行回顾性研究，分析其所用药物、临床表现及转归。结果引起肝损伤的药物种类繁多，肿瘤化疗药占首位，其次为解热镇痛药和抗结核药。肝损伤的临床表现无特异性，主要表现为乏力、纳差、尿黄和肝区不适。74例病例中有13例患者仅有实验室检测异常，经正规治疗后，30d内均有ALT降低〉50％，未出现死亡病例。结论肿瘤化疗药、解热镇痛药和抗结核药是引起药物性肝损伤的主要病因，其临床表现无特异性，预后较好，但临床医师用药时应注意监测肝功能。     

慢性肾衰竭急剧加重危险因素分析

目的:了解慢性肾衰竭急剧加重因素的发病情况及临床特点.方法:对我院2000年3月～2003年3月收治的61例患者的病因、年龄、基础肾脏病及相关药物等进行分析.结果:在导致慢性肾衰竭急剧加重的因素中,老年组与青壮年组有明显的差异,老年组以肾毒性药物、严重感染及血容量不足等为主要原因,而青壮年组以恶性高血压、原发疾病活动及急性左心衰等常见.61例患者中,8例患者因原发病活动而导致慢性肾衰竭急剧加重(13.11%),9例患者与药物相关(14.75%),常见的药物主要有抗菌素(特别是氨基糖甙类)、血管紧张素转换酶抑制剂(ACEI)及一些含马兜铃酸的中草药等.结论:慢性肾衰竭急剧加重的因素多种多样,老年患者尤其要警惕药物性肾损害、严重感染及血容量不足,青壮年患者积极控制高血压、结缔组织病的活动及急性左心衰对于预防慢性肾衰竭急剧加重具有十分重要的意义.     

老年高血压合并慢性肾衰竭的治疗对策

我国原发性高血压患者中约10%～15%将进展至慢性肾衰竭[1],而高血压肾病占老年人慢性肾衰竭发病原因的第一位[2].老年高血压患者由于其各脏器存在生理上的老化,特别是肾功能的减退,故其临床特征、转归及治疗与中青年患者不同.现将我院收治的老年高血压合并慢性肾衰竭的患者进行回顾性分析,以期探讨更有效的治疗对策.     

中药保留灌肠辅助治疗慢性肾衰竭效果观察

目的观察中药保留灌肠辅助治疗慢性肾衰竭的效果.方法将91例慢性肾衰竭患者随机分为观察组(55例)及对照组(36例).对照组采用常规口服中药治疗,观察组在此基础上加用中药保留灌肠治疗.结果观察组治疗后症状评分及血肌酐、尿素氮显著低于对照组(均P＜0.05),总有效率显著高于对照组(P＜0.01).结论中药保留灌肠辅助治疗有利于排出体内毒素,能提高慢性肾衰竭患者的疗效.     

狼疮肾炎终末期狼疮活动情况和预后的观察

目的探讨狼疮肾炎（ＬＮ）患者发展至终末期肾病（ＥＳＲＤ）时狼疮活动情况和预后的关系。方法分析１９８７～１９９７年资料完整的７１例ＬＮ的ＥＳＲＤ患者临床性ＳＬＥ活动和血清学ＳＬＥ活动的各项指标、死亡原因,分析比较ＬＮ的ＥＳＲＤ患者与非ＬＮ的ＥＳＲＤ患者的存活率。结果本组ＬＮ的ＥＳＲＤ患者在进行透析治疗前有６４８％已没有ＳＬＥ临床活动表现。进行透析治疗后,ＳＬＥ临床性活动渐趋静止状态,活动率从第一年５６３％下降至第十年２８％;ＳＬＥ血清学活动表现的消退,要比临床活动表现的消退缓慢;ＬＮ的ＥＳＲＤ透析治疗患者第２、５、１０年的存活率与非ＬＮ透析患者相近,分别为７９６％、５２５％、３０５％,其死亡原因似与ＳＬＥ活动无关。结论在ＬＮ的ＥＳＲＤ期间,ＳＬＥ活动的静止趋势与时俱增,死亡原因与ＳＬＥ活动性似无明显关系,ＬＮ的ＥＳＲＤ替代治疗患者的预后与非ＬＮ的ＥＳＲＤ替代治疗患者相同。当ＬＮ发展至不可逆的ＥＳＲＤ时,需长期作肾脏替代治疗,无必要再应用免疫抑制治疗。     

Clinical,pathological, therapeutic and prognostic analysis of primary membranous nephropathy in 218 children

Objective To analyze the clinical and pathological features, treatment and prognosis of primary membranous nephropathy (PMN) in children. Methods A retrospective study was conducted in patients with PMN diagnosed by renal biopsy in the Eastern Theater General Hospital from July 1, 2008 to September 30, 2017. The data of patients' general information, laboratory examination, renal pathology and therapeutic regimen were collected. The effects of different drugs in treatment and prognosis of PMN children were analyzed. Results Among 218 patients with PMN, the ratio of male to female was about 1.32∶1. The age group from 13 to 18 years old (adolescent) accounted for 87.6%, and there was no significant difference in age between the sexes (P=0.839). The main clinical manifestation was nephrotic syndrome (157 cases, 72.0%). The most common renal pathology stage was stageⅡ(101 cases, 46.3%). The positive rates of IgG1 and IgG4 in immunofluorescence staining were 100.0% and 98.5%, respectively, and IgG4 (45 cases, 33.8%) was the most common deposit. The positive rates of serum anti-PLA2R-Ab and kidney tissue PLA2R immunostaining were 53.97% and 82.54%, respectively. The total remission rate of PMN in children treated with tacrolimus combined with steroid was 83.6% and the recurrence rate was 33.3%. After follow-up time of 45.0(23.5-74.0) months, 11 cases (5.0%) developed end-stage renal disease (ESRD). The cumulative survival rates of ESRD at 5 and 10 years after renal biopsy were 95.4% and 63.7%, respectively. The cumulative renal survival rates of ESRD or a 30% decline in eGFR at 5 and 10 years after renal biopsy were 92.7% or 55.9%. Univariate Cox regression analysis demonstrated that hypertension and heavy proteinuria (24-hour urinary protein≥50 mg/kg) predicted a high risk of ESRD, and renal pathologic parameters were not associated with disease progression. Multivariate Cox regression analysis showed that hypertension (HR=9.517, 95%CI 1.181-76.715, P=0.034) and heavy proteinuria (HR=3.946, 95%CI 1.126-13.832, P=0.032) were independent risk factors for developing ESRD in PMN patients. However, the effectiveness of Cox regression analysis was analyzed by PASS software, and it was concluded that hypertension was not related with disease progression. Conclusions PMN should be considered in adolescent patients with nephrotic syndrome. Tacrolimus combined with steroid is more effective than steroid combined with other immunosuppressive agents in treating PMN. After follow-up time of 45.0(23.5-74.0) months, the prognosis of PMN children is acceptable. Heavy proteinuria is an independent risk factor for developing ESRD in children with PMN.     

中国大陆原发性高草酸尿症1型临床特点及诊治情况总结

目的探讨原发性高草酸尿症1型(PH1)的临床表现、治疗及预后。方法检索维普网、中国知网、万方数据库、PubMed、Web of Science、Embase和Cochrane数据库中的相关文献,收集57例PH1患者的临床资料,对其临床表现、诊疗经过及预后情况进行分析。结果共纳入符合标准的文献35篇,共57例PH1患者,其中男39例,女18例,年龄0.2~57.0岁,发病年龄为出生后至42岁。57例PH1患者的临床症状表现特异性较低,肾结石41例,肾钙化和(或)肾钙质沉积21例,泌尿系统外草酸沉积12例,腰背腹痛12例,输尿管结石8例,此外尿量减少、代谢性酸中毒、水电解质紊乱、贫血、肉眼血尿等症状均有报道,有33例在诊断时已进入终末期肾病(ESRD)阶段。26例患者接受移植治疗,肾移植17例(2例因结石复发、恢复透析再次接受肝肾联合移植,1例恢复透析并再次接受肝移植),肝肾联合移植7例,肝移植2例,肝肾序贯移植3例。31例患者未接受移植治疗。接受移植治疗的患者与未接受移植治疗的患者存活率差异有统计学意义(85%比58%,P<0.05)。结论PH1的临床表现多样且缺乏特异性,发现时多已进入ESRD阶段,接受移植治疗较未接受移植治疗的患者预后更佳,应优先考虑预先肝移植或肝肾联合移植。     

评价对比剂肾病患者继发终末期肾脏病的风险模型及应用性研究

目的搜集与对比剂肾病(CIN)相关的临床指标,构建评判该患者继发终末期肾脏病(ESRD)的风险性模型,并验证其应用性。方法连续性纳入CIN患者为研究队列,分析研究对象初始入院时的各项临床资料及实验室检查结果,并对其进行为期18个月的随访以确认预后,依据随访结果,进行远期风险性预测和相关危重度评判分析。结果本次研究纳入215例CIN患者,14例失访,19例随访期内进展至ESRD。Cox回归分析显示,近期重复接受造影、高MRS量表评分、高尿肾损伤分子-1(uKIM-1)含量、高尿微量蛋白(umAlb)含量、高尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)含量为CIN患者发病18个月内继发ESRD的独立危险因素。以umAlb=36.80ng/ml、uNGAL=128.21ng/ml、uKIM-1=137.56pg/ml为临界值预测CIN患者进展至ESRD的ROC曲线下面积分别为0.746、0.756、0.768。结论本研究建立CIN患者继发ESRD的风险预测模型,并对相关危险因素进行了量化,进一步完善了CIN的诊疗体系。     

单中心170 例足踝部肿瘤及瘤样病变临床分析

 目的 探讨足踝部肿瘤和瘤样病变的流行病学特点、临床表现以及恶性肿瘤的预后。方法 通过对25年间170例足踝部肿瘤及瘤样病变的临床资料进行回顾性分析,并对恶性肿瘤进行随访,分析其年龄和性别分布、临床表现、肿瘤组织类型、解剖学部位分布、肿瘤大小与良恶性的关系以及恶性肿瘤的预后。结果 170例足踝部肿瘤及瘤样病变中,男91例,女79例。骨肿瘤51例,软组织肿瘤119例。良性126例,恶性44例。年龄7个月~76岁,中位年龄32岁,平均年龄33.1岁。良性肿瘤以10~19岁和20~29岁最多,平均年龄29.54岁;恶性肿瘤以40~49岁和50~59岁最多,平均年龄为43.73岁。临床出现皮损往往提示恶性肿瘤。足踝部肿瘤主要以软组织肿瘤和良性肿瘤为主。软组织良性肿瘤以腱鞘巨细胞瘤最为多见;骨的良性肿瘤以甲下外生骨疣和内生软骨瘤最为多见。软组织恶性肿瘤以黑色素瘤和滑膜肉瘤最为常见。骨的原发恶性肿瘤和转移瘤均非常罕见。前足是肿瘤好发的解剖学部位。软组织肿瘤的大小与良恶性没有相关性,骨肿瘤的肿瘤大小与良恶性显著相关。44例恶性肿瘤中16例采用保肢术,28例截肢(趾)。平均随访时间32.4月,6例无瘤存活,5年无瘤生存率16.13%。结论足踝部肿瘤和瘤样病变以软组织肿瘤和良性肿瘤最为常见,恶性肿瘤发病年龄较高,出现皮损提示恶性肿瘤可能,前足是肿瘤的好发部位,骨肿瘤大小与良恶性相关,恶性肿瘤的预后较差。     

Antibiotic-induced neurotoxicity in dialysis patients: a retrospective study

Abstract

Objective: The study was to evaluate neurotoxicity caused by antibiotics in dialysis patients, including incidence, clinical features, treatments and prognosis. Methods: In this retrospective study, we reviewed the medical records of 1066 dialysis patients (254 peritoneal dialysis [PD] cases and 812 hemodialysis [HD] cases) who also received intravenous antibiotics in our hospital during July 2006 – April 2012. Naranjo scale was used for estimating the probability of an adverse drug reaction. Results: The incidence of antibiotic-induced neurotoxicity was 5.66% in patients receiving HD, and 7.87% in patients receiving PD. There was no significant difference between the two dialysis modalities about the incidence of antibiotic-induced neurotoxicity (p?>?0.05). The risk factors included extremely old age, history of central nervous system disorder, low residual renal function, hypoalbuminemia, and the use of multiple antibiotics that share one mechanism. The neurotoxic antibiotics included cephalosporins, penicillins, carbapenems and quinolones in our study. Most patients could be properly diagnosed early according to their medical history, symptoms, signs, electroencephalography (EEG), other related auxiliary examination, and with the help of experienced neurologists. Most neurotoxic patients showed clinical improvement after the discontinuation of antibiotics and active treatment. Conclusions: The adverse neurotoxic effects of antibiotics were common in dialysis patients due to wide and incorrect usage. Neurotoxicity could be prevented in high-risk cases with dosage adjustments. Better prognosis can be achieved with early and proper diagnosis, decisive withdrawal, and aggressive treatment including enhanced HD.     

维持性血液透析患者合并皮层下动脉硬化性脑病8例临床分析

目的：提高对维持性血液透析患者合并皮层下动脉硬化性脑病的认识。方法：回顾性总结8例维持性血液透析患者合并皮层下动脉硬化性脑病的诊断、治疗及预后。结果：患者当时经治疗症状有改善,但最终均发展为痴呆。结论：维持性血液透析患者出现神经精神症状,需注意排除皮层下动脉硬化性脑病;皮层下动脉硬化性脑病将逐渐发展为痴呆,值得国内同道加以注意。