慢性肾脏病非透析患者的营养治疗

目的:探讨慢性肾脏病非透析患者的营养治疗干预,以改善患者营养不良,保护残余肾功能,延缓透析时间。方法 :选择80例CKD 3~5期的患者,在治疗前测每位患者身高、体重计算体重指数(BMI),并空腹取静脉血测肾功能、电解质、血脂等;在营养师的指导下给予营养治疗6个月后,再次测BMI及上述生化指标。结果:完成随访的80例患者经营养治疗后,BMI基本达标,营养不良情况、肾功能、电解质和血脂情况明显改善,与干预前对比差异具有统计学意义(P0.05),固然血肌酐改善无统计学意义,但营养治疗并未导致肌酐进一步上升。结论:慢性肾脏病非透析患者经营养治疗可改善患者营养不良和肾功能恶化、血脂异常及电解质紊乱,延缓进入透析的时间。     

急性白血病患者血清白细胞介素-6白细胞介素-8的变化

目的　探讨血清IL- 6、IL -8水平变化与急性白血病(AL)发生、发展及预后的关系。方法　采用放射免疫法检测5 6例AL患者血清IL- 6、IL- 8水平,2 8例正常健康者血清IL- 6、IL- 8水平。结果　AL患者血清IL- 6、IL -8水平明显增高,完全缓解后,IL- 6、IL -8恢复正常。结论　血清IL- 6、IL- 8的异常升高在急性白血病的发生、发展中可能起一定作用,检测AL患者血清IL- 6、IL- 8水平对判断疗效、估计预后、监测复发有一定意义。     

慢性肾脏病患者门诊治疗依从性调查及影响因素分析

目的探讨慢性肾脏病患者门诊治疗依从性及其影响因素。方法采用问卷调查的方法采集了96例门诊治疗的慢性肾脏疾病患者的资料,采用前瞻性研究方法了解慢性肾脏病患者的依从性及影响用药依从性的因素,并观察其预后及转归。结果慢性肾脏病门诊治疗的患者依从性普遍偏低,56%的患者依从性差,23%的患者依从性好。依从性好的患者随访6月后,好转或稳定为86.4%,恶化或死亡为13.6%;而依从性差的患者随访6月后好转或稳定为52.2%,恶化或死亡为48.0%。患者依从性与患者年龄、受教育程度、经济收入、治疗状况等有关。结论慢性肾脏病患者门诊治疗依从性普遍偏低,与多种因素有关,其依从性与其预后有关系。因此对患者给予合理有效的指导,可能对延缓慢性肾衰的进展具有重要的现实意义。     

CKD患者左心室结构与功能的超声心动图定量评价研究

【摘要】目的：应用超声心动图定量评价慢性肾脏病(CKD)患者左心室结构与功能的改变情况。方法：以2015年2月-2017年1月我院收治的131例CKD患者为研究对象,按照GFR水平将131例CKD分为CKD2-3组(n=68)与CKD4-5组(n=63),同时以同期的60例正常者为对照组。采用超声心动图技术获得三组的左心室结构参数[左心室的质量(LVM)、质量指数(LVMI)、相对室壁厚度(RWT)]及功能参数[左心室射血分数(LVEF)、二尖瓣舒张早期血流速度(E)、二尖瓣舒张早期血流速度(A)、二尖瓣环舒张早期运动速度(Em)、E/A、E/Em],比较三组的左心室结构及功能参数、并对RWT与E/Em的影响因素及相关性进行分析。结果：CKD4-5组出现左心室结构改变53例(84.1%),CKD2-3组出现左心室结构改变19例(27.9%),两组比较差异具有统计学意义(P<0.05);CKD2-3组LVM、LVMI、RWT均明显高于对照组(P<0.05),CKD4-5组LVM、LVMI、RWT、A、E/Em均明显高于CKD2-3组与对照组(P<0.05),Em、DTE、E/A均明显低于CKD2-3组与对照组(P<0.05);PWVcF、eGFR是RWT的独立相关因素,PWVcF、RWT是E/Em的独立相关因素。结论：左心室结构改变发生在CKD患者早期,功能改变发生在晚期,且改变明显;左心室结构及功能的改变与动脉僵硬度密切相关。     

白细胞介素-8、白三烯B4与慢性阻塞性肺疾病气道炎症的关系

目的 探讨慢性阻塞性肺疾病(COPD)患者白细胞介素-8(IL-8)及白细胞三烯B4(LTB4)水平的变化及在发病中的作用.方法 采用酶联免疫吸附法(ELISA)测定30例COPD患者急性加重期和缓解期及20例健康成人的血清及痰液中IL-8及LTB4含量.结果 COPD患者急性加重期血清及痰液中IL-8含量分别为(181.41±18.49)ng/L和(74.03±20.64)ng/L,高于缓解期[(152.33±17.48)ng/L和(42.30±14.99)ng/L,均P＜0.05],缓解期显著高于健康对照组(52.75±13.79)ng/L和(17.15±5.36)ng/L,均P＜0.05);COPD患者急性加重期痰液LTB4含量[(2300.91±496.01)ng/L],显著高于缓解期[(1884.14±651.37)ng/L,P＜0.05],COPD患者急性加重期血清LTB4含量[(2044.12±309.43)ng/L]与缓解期及对照组比较差异均无统计学意义[(1941.30±301.62)、(1880.77±302.11)ng/L,均P＞0.05].结论 IL-8与LTB4共同参与了COPD气道炎症反应的过程.     

血清胱抑素C和MDRD方程在慢性肾脏病诊断中的临床应用

目的探讨血清胱抑素-C（Cys—C）在诊断慢性肾脏病（CKD）的意义,以及Cys-C与MDRD方程估计肾小球滤过率（GFR）的准确性及相关性。方法根据MDRD方程7计算的肾小球滤过率（GFR）将CKD患者分为5期,ELISA法检测CKD患者的Cys—C的水平,观察Cys—C与血肌酐（Scr）、GFR的相关性。结果Cys—C与Scr呈正相关,与GFR呈负相关;在肾功能轻度损伤时,Cys-C反映肾功能恶化程度的敏感度较Scr高。结论ELISA法能够检测Cys—C的水平,Cys—C能够作为反映肾功能的可靠指标,并且是肾功能的早期诊断指标。CKD2-5期,Cys—C与MDRD方程7有良好的相关性;Cys-C与MDRD方程7能够作为CKD2-5期患者估计GFR的指标。     

个体化膳食营养教育模式对慢性肾脏病患者营养及生活质量的影响

目的 探讨个体化膳食营养教育模式对慢性肾脏病患者营养及生活质量的影响.方法 随机选取2014年1月至2015年12月我院收治的1 000例慢性肾脏病患者为研究对象,将其分为对照组和观察组各500例.对照组实施常规营养健康教育模式,观察组实施个体化膳食营养教育模式.对两组患者的营养认知、营养知识水平合格情况、生活质量、并发症发生率等指标进行观察比较.结果 观察组患者的营养状况与对照组比较,差异有统计学意义(P＜0.05);观察组患者的生活质量评分与实施前及对照组比较,差异有统计学意义(P＜0.05);观察组患者的营养知识水平合格率为95.20％,对照组患者为64.40％,差异有统计学意义(P＜0.05);观察组患者的并发症发生率为5.40％,对照组为15.60％,差异有统计学意义(P＜0.05).结论 在慢性肾脏病患者的治疗过程中,对其实施个体化膳食营养教育模式,可以降低营养不良的发生率,提高患者的膳食营养认知,改善患者的生活质量,降低并发症的发生,总体实施效果显著,值得临床推广.     

慢性阻塞性肺疾病患者诱导痰液中IL-6和IL-8水平变化的临床意义

目的探讨慢性阻塞性肺疾病(COPD)患者诱导痰液中白细胞介素-6(IL-6)和白细胞介素-8(IL-8)水平变化的临床意义。方法选取COPD患者35例为COPD组,另选取健康体检者40例为健康组,根据有无吸烟史分为无吸烟22例和吸烟18例。2组受试者行肺功能检测,运用诱导痰液方法收集痰液,酶联免疫吸附试验(ELISA)测定痰液上清中IL-6和IL-8水平变化,Spearman相关性检验分析IL-6、IL-8水平与肺功能的相关性。结果 COPD组诱导痰液中性粒细胞百分比显著高于健康组无吸烟者和吸烟者(P0.05或P0.01);痰上清中IL-6、IL-8水平显著高于健康组无吸烟者和吸烟者(P0.05)。相关性分析显示,COPD组诱导痰上清IL-6与第1秒用力呼气容积占预期值百分比(FEV1%)和第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)呈负相关(P0.01),IL-8与FEV1%和FEV1/FVC呈负相关(P0.01)。结论 COPD患者气道腔内存在以中性粒细胞浸润为主的慢性气道炎症,IL-6和IL-8可能在气道损伤和重塑过程中扮演重要作用。     

Predictive role of interleukin-6 and CAT score in mechanical ventilation in patients with chronic obstructive pulmonary disease at the acute exacerbation stage in the emergency department

BACKGROUND:The study aimed to evaluate the predictive role of interleukin-6(IL-6)and chronic obstructive pulmonary disease(COPD)assessment test(CAT)score in mechanical ventilation(MV)in COPD patients at the acute exacerbation stage in the emergency department(ED).METHODS:For a one-year period,among adult patients in the ED who met the criteria of acute exacerbation of COPD,158 who received MV within 48 hours after admission were compared to 294 who didn't require MV within the same period after admission.IL-6 level and CAT score were compared between the two groups.The predicted value of IL-6 and CAT score was assessed by logistic regression analysis and a receiver operating characteristic(ROC)curve.RESULTS:The IL-6 and CAT scores in the 158 MV patients were much higher than those without.IL-6 and CAT scores were independent predictors of MV within 48 hours using logistic regression analysis(IL-6:odds ratio[OR]1.053,95%confidence interval[CI]1.039–1.067,P<0.001;CAT score:OR 1.122,95%CI 1.086–1.159,P<0.001).The combination of IL-6 and CAT scores(area under ROC curve[AUC]0.826,95%CI 0.786–0.866,P<0.001)improved the accuracy of predicting MV within 48 hours when compared with IL-6(AUC 0.752,95%CI 0.703–0.800,P<0.001)and CAT scores alone(AUC 0.739,95%CI 0.692–0.786,P<0.001).The sensitivity and specificity were 69.6%,74.1%,75.32%and 63.6%,respectively.CONCLUSION:The combined of IL-6 and CAT scores is useful for evaluating the risk of COPD patients at acute exacerbation in ED,and can provide a predictive value for MV or not within 48 hours.     

肝硬化合并感染及慢性肝病患者血清白介素-8的变化

目的观察慢性病毒性肝炎、肝硬化及肝硬化合并自发性细菌性腹膜炎患者血清白介素－８（ＩＬ－８）的变化,探讨其与肝细胞损伤及感染的关系。方法采用ＥＩＩＳＡ法检测２５例慢性病毒性肝炎,３０例肝硬化及１５例肝硬化合并自发性细菌性腹膜炎患者血清ＩＬ－８的变化。常规方法检测慢性肝病患者谷丙转氨酶（ＡＬＴ）的变化。结果慢性病毒性肝炎及肝硬化患者血清ＩＬ－８均明显高于正常对照组（Ｐ＜０．００１和Ｐ＜０．０１）。肝硬化合并自发性细菌性腹膜炎患者ＩＬ－８分别高于慢性病毒性肝炎（Ｐ＜０．０５）和肝硬化无自发性腹膜炎者（Ｐ＜０．０１）。慢性肝病患者血清ＩＬ－８水平与ＡＬＴ呈正相关（ｒ＝０．６１,Ｐ＜０．０５）。结论ＩＬ－８可能参与了慢性肝病时肝细胞的免疫损伤,但ＩＬ－８与感染的关系更为密切。     

Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis

Purpose

To prospectively evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) as percentage of baseline (POB) in predicting hospital survival, we studied 64 consecutive, postoperative patients with severe sepsis.

Materials and Methods

Plasma PCT, IL-6, and CRP were serially measured from day 1 (onset of sepsis) to day 14 in parallel with clinical data until day 28. Multivariate logistic regression and univariate analysis of predictive accuracy of PCT-, IL-6-, and CRP-POB were performed. Newly derived binary prediction rules were evaluated by calculating sensitivity, specificity, positive predictive value, and negative predictive value.

Results

In survivors, PCT and IL-6 significantly decreased from days 1 to 14, whereas CRP did not. In nonsurvivors, the inflammation markers mostly increased within the second week. At day 7, logistic regression analysis revealed PCT-POB as an independent determinant for survival. Especially, PCT-POB not exceeding 50% and PCT-POB not exceeding 25% with CRP-POB not exceeding 75% on day 7 indicated a favorable outcome with a positive predictive value/sensitivity of 75%/97% and 92%/67%, respectively. In comparison, pretest likelihood to survive by day 28 and observed survival rate were 60% and 67%, respectively.

Conclusions

Prediction rules of decrease in PCT-POB on day 7 in combination with CRP-POB may serve to monitor efficacy and guide duration of therapy in critically ill patients.     

慢性肾脏病非透析患者甲状旁腺素和心率变异性关系的研究

目的探讨慢性肾脏病(CKD)患者甲状旁腺素(PTH)和心率变异性(HRV)之间的关系。方法入选2010年6月至2012年6月间于肾内科住院CKD 3～5期非透析患者158例,收集心率变异性数据、血PTH和临床生化结果并进行分析。结果 158例CKD 3～5期非透析患者中HRV降低112例(70.89%),CKD3、4、5期患者的全程NN间期的标准差(SDNN)、全部相邻NN之差的均方根(RMSSD)、相邻NN之差大于50 ms的个数占总窦性心搏个数的百分比(PNN50)、全程每5 min NN间期平均值的标准差(SDANN)呈递减趋势,PTH和RMSSD、PNN50均呈负相关,血红蛋白、血钠、血钾水平也与HRV指标相关。结论 CKD 3～5期非透析患者HRV下降的比率较高,且随着CKD分期增加,发生HRV下降的比率增加。血PTH水平升高可能主要影响CKD患者的副交感神经系统,从而恶化了心脏自主神经系统的功能。     

慢性阻塞性肺疾病急性加重期白细胞介素-6与C-反应蛋白水平的相关研究

目的 探讨人血清白细胞介素-6(IL-6)与C-反应蛋白(CRP)水平与慢性阻塞性肺疾病(COPD)急性加重期的关系.方法 以40例慢性阻塞性肺疾病患者为研究对象,其中急性加重期的28例为试验组,稳定期的12例为对照组,所有研究对象均于入院时及治疗2周后行血清IL-6与CRP水平的检测,同时行肺功能及其他常规化验指标的检查.结果 ①慢性阻塞性肺疾病患者急性加重期血清中IL-6与CRP水平,治疗后较治疗前显著降低(P<0.01);而稳定期患者IL-6与CRP的水平,治疗前后差异无统计学意义(P＞0.05).②与稳定期相比,急性加重期IL-6与CRP的水平显著升高(P<0.01).③1 秒率(FEV1/FVC)与IL-6及CRP的水平呈负相关.结论 血清IL-6与CRP水平随COPD的病情缓解呈进行性下降,IL-6与CRP联合检测可作为早期判断COPD急性加重的敏感指标.     

白介素-6和内皮素-1在慢性阻塞性肺疾病合并肺动脉高压患者中的表达

目的:研究白介素-6(IL-6)和内皮素-1 (ET-1)在慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者和COPD无PH患者中的表达水平.方法:66例COPD合并PH患者和64例COPD无PH患者,检测IL-6和ET-1水平,心脏多普勒检测肺动脉收缩压力(PASP),PASP≥36 mmHg为PH,检查肺功能、动脉血气、6 min步行距离.结果:COPD合并PH患者IL-6和ET-1水平高于COPD无PH患者,分别是中位数3.6 pg/L(四分位间距2.3 ～ 4.9 pg/L)与中位数2.3 pg/L(四分位间距1.2 ～ 3.7 pg/L),差异有统计学意义(z=-2.756,P＜0.01);中位数4.7 pg/L(四分位间距,1.8 ～ 7.9 pg/L)与中位数1.5 pg/L(四分位间距,0.9～3.7 pg/L),差异有统计学意义(z=-2.945,P＜0.01).所有患者IL-6和ET-1水平呈正相关(r=0.782,P=0.001);肺动脉压力水平与IL-6(r=0.381,P=0.001)和ET-1(r=0.529,P=0.001)水平有关;6 min步行距离分别和氧分压负相关(r=-0.728,P=0.032),和ET-1正相关(r=0.625,P=0.001),和IL-6正相关(r=0.461,P=0.001).结论:IL-6和ET-1可能与COPD并PH形成有关,具体机制有待进一步研究.     

急性心肌梗死介入治疗中Percusurge远端保护装置对血浆内皮素-1及白细胞介素-6变化的影响

目的 探讨Percusurge远端保护装置（DPD）在急性心肌梗死（AMI）介入治疗中时冠状窦血浆内皮素-1（ET-1）、白细胞介素-6（IL-6）的影响及作用机制。方法 48例接受急诊PCI治疗的AMI患者，随机分为DPD组（25例）、对照组（23例），经股静脉将6F右冠状动脉造影导管置入冠状静脉窦，于FYCA前、术后即刻、术后2h、术后6h共4个时间点采血，分别检测血浆中ET-1、IL-6水平。结果 PCI术前两组ET-1、IL-6含量差异无统计学意义（P〉0．05）。DPD组术前及术后3个时间点血浆ET-1含量差异无统计学意义，对照组术后2h、6h血浆ET-1水平明显升高（P〈0．05），与DPD组比较差异有统计学意义（P〈0．05）。DPD组术后即刻至6h IL-6浓度显著降低（P〈0．05），明显低于对照组（P〈0．05）。结论 Percusurge远端保护装置能有效保护远端血管，避免内皮损伤，降低炎症反应。     

Inhibition of intracellular tumour necrosis factor (TNF)-alpha and interleukin (IL)-6 production in human monocytes by iloprost

BACKGROUND: To investigate the effects of iloprost as a stable prostacyclin analogue on intracellular expression of IL-6 and TNF-alpha of lipopolysaccharide (LPS)-stimulated human monocytes in a whole blood system assessed by flow cytometry. MATERIAL AND METHODS: Whole blood of six healthy volunteers processed immediately after withdrawal and twice on different days (six measurements per experiment) was stimulated in two different settings with LPS (final concentrations 0.2 ng mL(-1) and 10 ng mL(-1)) and incubated with iloprost (final concentrations in each experiment were 0.01 nm, 0.1 nm, 0.3 nm, 1 nm, 3 nm, 10 nm, 30 nm and 100 nm) for 3 h at 37 degrees C and 5% CO2. Intracellular expression of IL-6 and TNF-alpha was assessed by flow cytometry. RESULTS: Our investigations showed, for the first time, that iloprost (0.1 nm up to 100 nm) caused a dose-dependent inhibitory effect of IL-6 production in human monocytes stimulated with LPS (10 ng mL(-1)), which was even more obvious in monocytes stimulated with lower concentrated LPS (0.2 ng mL(-1)). Iloprost (0.1 nm up to 100 nm) was found to inhibit TNF-alpha production of LPS-stimulated monocytes in a dose-dependent fashion not influenced by LPS concentration. CONCLUSIONS: Apart from the vasodilatory and antithrombotic effects, iloprost may also down-regulate the intracellular expression of IL-6 and TNF-alpha in human monocytes.     

Erythrocyte and reticulocyte indices in iron deficiency in chronic kidney disease: comparison of two methods

Objective. Anaemia is a common complication of chronic kidney disease (CKD), particularly in dialysis patients. The recent European guidelines for anaemia treatment in CKD indicate the percentage of hypochromic red cells (%HYPO) and reticulocyte haemoglobin content (CHr) calculated by Siemens ADVIA haematology analysers as a useful tool indicating iron deficiency. The aim of this study was to evaluate the agreement between CHr and %HYPO parameters and the reticulocyte haemoglobin equivalent (RET‐He) and red blood cell haemoglobin equivalent (RBC‐He) calculated by the Sysmex XE‐2100 haematology analyser in a cohort of 200 dialysis patients referred to the Nephrology Unit of our hospital. Furthermore, we evaluated a new index, the DF‐Hypo XE, obtained from haemoglobin (Hb), haematocrit (Hct) and RET‐He, provided by the Sysmex XE‐2100, as a new potential marker of %HYPO in dialysed patients. Material and methods. Blood samples collected in EDTA anticoagulant from 200 CKD patients receiving erythropoietin and iron to maintain haemoglobin level between 10 and 12?mg/dL were analysed on both the Siemens ADVIA 2120 and the Sysmex XE‐2100 within 2?h of collection. Results. There was good correlation between CHr and RET‐He (r = 0.88; p<0.0001), %HYPO and DF‐Hypo XE (r = 0.89; p<0.0001) and between RBC‐He and CH (r = 0.96; p<0.0001), but there was a lower correlation, even though statistically significant, between RBC‐He and %HYPO (r = ?0.59; p<0.0001). The Altman‐Bland analysis showed a very good level of agreement between CHr and RET‐He (mean bias = 1.04?pg), %HYPO and DF‐Hypo XE (mean bias = 1.73). Using a cut‐off value of 29.4?pg for the RET‐He and of 10.2 for the DF‐Hypo XE, 15 out 17 patients with a CHr <29.0?pg and 9 out 11 patients with a %Hypo <10.0% were respectively correctly identified. Conclusions. Our study shows good correlation and agreement between CHr and RET‐He and between %HYPO and DF‐Hypo XE in evaluating CKD patients needing iron support.     

缺氧缺血性脑病患儿血清IL-6、TNF—α和NPY水平检测的临床意义

目的探讨缺氧缺血性脑病患儿血清IL-6、TNF—α和NPY水平检测的临床意义。方法应用放射免疫分析法对32例缺氧缺血性脑病患儿进行了血清IL-6、TNF-α和NPY水平测定,并与35名健康人作比较。结果缺氧缺血性脑病患儿血清IL-6、TNF—α和NPY水平非常显著地高于正常人组（P〈0．01）,且血清IL-6、TNF-α和NPY水平呈正相关（r=0．6045、0．5714．P〈0．01）。结论检测血清IL-6、TNF-α和NPY水平的变化对了解病情、观察预后均具有十分重要的临床价值。     

大手术后MODS患者血清sgp130/lL-6比值变化及意义

目的：探讨大手术后MODS患者血清可溶性糖蛋白130（sgp130）和白细胞介素6(IL-6)比值的变化及临床意义。方法将56例大手术后MODS患者按MODS评分（Marshall标准）[1]分为轻、中、重三组,再采用双抗体夹心酶联免疫吸附（ELISA）法检测各组患者和30例健康体检者（对照组）血清sgp130、IL-6的水平以及sgp130/IL-6比值,并观察各组sgp130/IL-6比值间的关系。结果三组MODS患者sgp130、IL-6的水平均明显升高,与健康对照组比较差异有显著性（P<0.01）,并且sgp130、IL-6的水平有随MODS严重程度增加而逐渐升高;三组MODS患者sgp130/IL-6比值均明显降低,与健康对照组比较差异有显著性（P<0.01）,并且sgp130/IL-6比值有随MODS严重程度增加而逐渐降低,且各组间差异显著（P<0.01）。结论血清sgp130、IL-6参与MODS的发生、发展,sgp130/IL-6比值可作为评估大手术后MODS患者病情严重程度的有效指标。     

慢性阻塞性肺疾病急性发作期血清白介素-8·超氧化物歧化酶和丙二醛的测定

目的 :观察血清白介素 -8(IL -8)、超氧化物歧化酶 (SOD)和丙二醛 (MDA)在慢性阻塞性肺疾病 (COPD)急性加重期和缓解期的变化并评价其临床意义。方法 :COPD急性加重期病人 2 3例列为观察组 ,选择非呼吸道疾病的同期住院患者 3 0例为对照组。两组年龄、性别无显著差异。分别观察两组病人的IL -8、SOD和MDA ,并进行分析对比。结果 :观察组在急性发作期或缓解期IL -8、MDA与对照组相比均有显著增高 ,SOD降低 ,经治疗IL -8和MDA有显著下降 ,SOD增高。与治疗前比较有显著性差异 (P <0 .0 1,P <0 0 5 )。结论 :测定血清IL -8时 ,结合SOD、MDA测定可有助于反映COPD病情或用于疗效评定。