弥漫增生型狼疮肾炎的远期预后及影响因素分析

目的调查研究弥漫增生性狼疮肾炎(DPLN)的远期预后及影响因素。方法回顾性观察2000年1月至2014年12月在温州医科大学附属第一医院住院的所有DPLN患者的长期随访终点并分析预后影响因素。将病例按入院时估算肾小球滤过率(eGFR)分为3组:eGFR≥60 ml·min^-1·1.73 m^-2为普通组;15 ml·min^-1·1.73 m^-2≤eGFR<60 ml·min^-1·1.73 m^-2为重症组;eGFR<15 ml·min^-1·1.73 m^-2或需透析患者为危重组。分析3组患者临床,病理和预后的差异。统计学方法采用单因素方差分析、χ^2检验和Kaplan-Meier生存曲线和Cox回归分析。结果167例患者符合纳入标准,女性155例,平均年龄(30±10)岁,平均随访(61±45)个月。所有患者5年和10年累计人肾存活率分别为86%和79%。Kaplan-Meier生存分析显示普通组、重症组和危重组10年累计人肾存活率分别为91%,70%和8%,3组间差异有统计学意义(χ^2=121.93,P<0.01);普通组和重症组(χ^2=4.05,P<0.05)、普通组和危重组(χ^2=97.05,P<0.01)、重症组和危重组(χ^2=52.28,P<0.01)相比,差异均具有统计学意义。多因素Cox回归分析显示:血红蛋白<80 g/L[HR=2.7,95%CI(1.2,6.3),P=0.019],eGFR<60 ml·min^-1·1.73 m^-2[HR=4.1,95%CI(2.0,8.2),P<0.01]和大新月体比率≥30%[HR=1.8,95%CI(1.1,2.9),P=0.021]是ESRD的主要影响因素。结论DPLN伴基线肾功能正常或轻度下降的患者长期预后较好,基线中重度肾功能损害,贫血和大新月体比率高是预后不良的预测因素。     

Epidemiology of cerebrovascular disease in the elderly in East Asia

Cerebrovascular disease (CVD) is one of the leading causes of mortality, and is also the most common cause of physical and mental disability in the elderly worldwide, particularly East Asian populations. CVD mortality accounts for 10–16% of total deaths and has declined moderately since the mid-1960s in East Asia. However, with increased aging populations, no alteration of age-specific stroke incidence, Westernization of lifestyle, and socioeconomic alteration, the burden of CVD in the elderly in East Asia may still escalate in the forthcoming decades. There are prominent race–ethnic differences in stroke types between East Asian and Caucasian populations. The proportions of cerebral hemorrhage, small artery lacunar infarct, and intracranial atherosclerosis are more common in East Asian populations than Caucasians. Environmental and genetic factors may account for the race–ethnic differences and trends of stroke types. Hypertension is still the major risk factor for CVD in East Asia. Control of blood pressure in the population level should be the important strategy for the prevention of CVD. With aging populations, CVD-related dementia becomes more and more critical, particularly in East Asia. Urbanization, industrialization, and lifestyle are altering in this area, thus, monitoring the impact of these changes on CVD risks is essential to enable the implementation of appropriate strategies towards better prevention of CVD.     

小儿局灶增生性肾炎的临床与病理

本文分析20例小儿局灶增生性肾炎的临床与病理改变,占同期肾小球疾病发生率的8.7％。临床表现为肾病综合征10例,其它分别为IgA肾病、紫癜性肾炎、单纯性血尿及各种肾炎。病理改变中半数病例合并肾间质灶性炎症或伴纤维化,少数病例有个别小球节段性硬化或全球硬化。肾病患儿对激素治疗反应多数较差,作者强调综合治疗及更改激素投入方式、剂型能获得较好疗效。     

Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy

Impaired renal function is associated with a high risk of chronicity of hepatitis B virus (HBV) infection. Patients on hemodialysis (HD) or peritoneal dialysis are at an increased risk of viral transmission due to frequent necessity of blood product transfer as well as use of contaminated dialysate or dialysis materials. Additionally, health professionals may cause viral spread via contaminated hands and carelessness against hygiene rules. The frequency of chronic HBV infection may be as high as 80% in patients on renal replacement therapies. This is because HBV vaccination is essential to eliminate chronic HBV infection. However, response rates of HD patients to HBV vaccination vary between 10%-50%. Dialysis adequacy and early vaccination before the onset of dialysis therapy seem to be major determinants of high seroconversion rates. Older age, male gender, duration of dialysis therapy and nutritional status are other well-known factors associated with seroconversion rate. There are controversial reports regarding the role of the presence of diabetes mellitus, HCV positivity, erythropoietin resistance, hyperparathyroidism, and vitamin D inadequacy. The role of genetic alteration in the functions or production of cytokines still needs to be elucidated.     

The burden of influenza in East and South‐East Asia: a review of the English language literature

Abstract While human infections with avian influenza A (H5NI) viruses in Asia have prompted concerns about an influenza pandemic, the burden of human influenza in East and Southeast Asia has received far less attention. We conducted a review of English language articles on influenza in 18 countries in East and Southeast Asia published from 1980 to 2006 that were indexed on PubMed. Articles that described human influenza‐associated illnesses among outpatients or hospitalized patients, influenza‐associated deaths, or influenza‐associated socioeconomic costs were reviewed. We found 35 articles from 9 countries that met criteria for inclusion in the review. The quality of articles varied substantially. Significant heterogeneity was noted in case definitions, sampling schemes and laboratory methods. Early studies relied on cell culture, had difficulties with specimen collection and handling, and reported a low burden of disease. The recent addition of PCR testing has greatly improved the proportion of respiratory illnesses diagnosed with influenza. These more recent studies reported that 11–26% of outpatient febrile illness and 6‐14% of hospitalized pneumonia cases had laboratory‐confirmed influenza infection. The influenza disease burden literature from East and Southeast Asia is limited but expanding. Recent studies using improved laboratory testing methods and indirect statistical approaches report a substantial burden of disease, similar to that of Europe and North America. Current increased international focus on influenza, coupled with unprecedented funding for surveillance and research, provide a unique opportunity to more comprehensively describe the burden of human influenza in the region.     

Hepatolithiasis in East Asia: Comparison between Japan and China

The incidence of hepatolithiasis is high throughout East Asia compared with the West, but the marked difference in the relative proportion of hepatolithiasis to all cholelithiasis cases exists even among countries of similar ethnic backgrounds. A retrospective study of cases was conducted in two areas in China with the aim of clarifying the presence of such regional difference in China itself. The relative proportion of hepatolithiasis was 21.2% in Shenyang, 9.2% in Beijing and 4.1% in Fukuoka, Japan. A significant difference in the location of stones was also found between Shenyang, Beijing and Fukuoka. Intra- and extrahepatic hepatolithiasis in all hepatolithiasis cases was 95% in Shenyang and 75% in Beijing. Involvement of both hepatic lobes was found in 73% in Shenyang and less than 60% in the other two, suggesting that hepatolithiasis of the old form or of an advanced stage still lingers in Shenyang. In conclusion, regional differences in the proportion and the type of hepatolithiasis exist in China itself, as well as in the Chinese population in Taiwan, Hong Kong and Singapore, as previously reported. The possible contribution of environmental factors to the occurrence of hepatolithiasis is again emphasized.     

Heart Failure in East Asia

Heart failure (HF) carries a major burden of disease in East Asia, with high associated risk of mortality and morbidity. In recent decades, the epidemiology of HF has changed with social and economical development in East Asia. The burden of HF is still severe in East Asia.The prevalence of HF ranges from 1.3% to 6.7% throughout the region. As aetiological factors, ischaemic heart disease has increased and valvular disease reduced in most East Asian countries. Diuretics are the most commonly used drugs (51.0%-97%), followed by renin-angiotensin system (RAS) inhibitors (59%-77%), with angiotensin-converting enzyme inhibitors, ACEI, (32%-52%) and has angiotensin-2 receptor blockers, ARBs (31%-44%) in similar proportions. β-blocker use has also increased in recent years.Total mortality from HF ranges from 2% to 9% in China, Taiwan, Singapore, Thailand, and Japan. Age>65 years, diabetes mellitus, anaemia, renal dysfunction and atrial fibrillation (AF) are associated with adverse outcome. More prospective, region-specific data are still required, particularly regarding new drug therapies such as eplerenone and ivabradine.     

Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10‐g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South‐East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug‐induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B₁, B₆, B₁₂, D) should be actively excluded.     

Origin and dissemination of hepatitis B virus genotype C in East Asia revealed by phylodynamic analysis and historical correlates

Hepatitis B virus disease progression in East Asia is most frequently associated with genotype C (HBV/C). The increasing availability of HBV/C genetic sequences and detailed annotations provides an opportunity to investigate the epidemiological factors underlying its evolutionary history. In this study, the Bayesian phylogeography framework was used to investigate the origins and patterns in spatial dissemination of HBV/C by analyzing East Asian sequences obtained from 1992 to 2010. The most recent common ancestor of HBV/C was traced back to the early 1900s in China, where it eventually diverged into two major lineages during the 1930s‐1960s that gave rise to distinct epidemic waves spreading exponentially to other East Asian countries and the USA. Demographic inference of viral effective population size over time indicated similar dynamics for both lineages, characterized by exponential growth since the early 1980s, followed by a significant bottleneck in 2003 and another increase after 2004. Although additional factors cannot be ruled out, we provide evidence to suggest this bottleneck was the result of limited human movement from/to China during the SARS outbreak in 2003. This is the first extensive evolutionary study of HBV/C in East Asia as well as the first to assess more realistic spatial ecological influences between co‐circulating infectious diseases.     

腹部小手术史患者单通道输尿管镜辅助下腹膜透析管置入技术的应用

目的 探讨既往有腹腔小手术史患者单通道输尿管镜辅助下腹膜透析管置入技术临床应用的安全性及其意义.方法 选择既往有腹部小手术史的终末期肾脏病患者13例,所有患者均自愿选择腹膜透析替代治疗,使用Peer-Away鞘建立腹腔单通道,输尿管镜进入腹腔,观察腹腔内是否存在粘连,并酌情分离粘连,将腹膜透析管放置于膀胱直肠窝或子宫直肠窝,近端建立皮下隧道并经左下腹戳洞引出.结果 13例患者中12例见腹腔内粘连,通过输尿管镜简单分离粘连并直视下置管,所有腹膜透析管均放置成功,手术时间（44 ±13）分钟,术中追加麻药（15±6）ml,术中出血极少,无出血导致输血情况发生.所有患者随访时间6个月,腹膜透析顺利,未见漂管、渗漏、堵管等并发症.结论 既往有腹部小手术史患者,单通道输尿管镜辅助下腹膜透析管定位精确,安全可靠,并发症少,有助于观察腹腔内情况,并可酌情分离腹腔内粘连.     

Increasing gender difference in the incidence of chronic dialysis therapy in Japan

The incidence of chronic kidney disease and its progression to end-stage renal disease (ESRD) differs between genders, so it can be surmised that the incidence of ESRD is different between men and women. We analyzed the annual incidence of ESRD by gender for a 20 year period, from 1983 to 2002, using Japanese Society for Dialysis Therapy (JSDT) registration data. The annual incidence of ESRD was calculated as the number of incident dialysis patients divided by the census population of the previous year in each gender, and expressed per million of each population (male and female). In men, the incidence of ESRD increased from 99.9 in 1983 to 330.2 in 2002, whereas it was 66.6 in 1983 and 184.9 in 2002 in women. The difference of incidence of ESRD from men to women increased from 33.3 in 1983 to 145.3 in 2002. The mean age at the start of dialysis was 51.5 years (men) and 52.5 years (women) in 1983, it increased to 63.8 years (men) and 66.1 years (women) in 2002. The difference in mean age increased from 0.9 years in 1983 to 2.3 years in 2002. There was no clear relationship between the available dialysis station per 100,000 population and the men to women ratio in the prevalent dialysis patients among the 47 prefectures. The acceptance of dialysis therapy might not be strong enough to explain the increasing difference in ESRD incidence between men and women in Japan. Differences in the socioeconomic conditions and lifestyles between men and women, which might be related to the gender difference in incidence in ESRD, should be studied further.     

Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program

BackgroundThe low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy.MethodsThis retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start).ResultsEighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy.ConclusionsOur study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy.     

A(H5N1) Virus Evolution in South East Asia

Highly Pathogenic Avian Influenza (HPAI) H5N1 virus is an ongoing public health and socio-economic challenge, particularly in South East Asia. H5N1 is now endemic in poultry in many countries, and represents a major pandemic threat. Here, we describe the evolution of H5N1 virus in South East Asia, the reassortment events leading to high genetic diversity in the region, and factors responsible for virus spread. The virus has evolved with genetic variations affecting virulence, drug-resistance, and adaptation to new host species. The constant surveillance of these changes is of primary importance in the global efforts of the scientific community.