内皮素在急性肾功能衰竭发病中的作用

用甘油肌注法复制大鼠急性肾功能衰竭（ＡＲＦ）模型,动态观察了肾脏功能与形态学变化,并用放免检测和免疫组化方法对ＡＲＦ大鼠肾组织中内皮素－１（ＥＴ－１）进行了定量与定位分析。结果显示,ＡＲＦ时血、尿和肾组织匀浆中ＥＴ－１含量增较正常值增高,免疫组化标记表明ＥＴ－１表达增强主要在肾小管上皮,且ＥＴ－１含量增长情况与ＡＲＦ肾组织学改变程度相一致,提法ＥＴ－１在ＡＲＦ发病机制中起重要作用。     

肾功能放免联检在严重烧伤的应用

严重烧伤肾功能放免七项蛋白系列联检是早期判断肾功能的灵效指标。我们对71例烧伤面积30％以上的病人（平均烧伤面积60.40±19．24）按四个时相期（休克、回收、感染、感染后期），进行尿蛋白（ALb）、血清和尿β2-微球蛋白（β2－m）、免疫球蛋白G（IgG）、粘蛋白（THP）肾功能放免七项动态系列联检，结果提示伤后尿ALb、IgG、THP、血清和尿β2-m均明显升高，但血清IgG下降。通过检测尿中分子量不同的蛋白质便可反映肾小球通透性的变化和肾小球功能受损的程度。血β2-m是估价肾小球滤过功能的灵效指标且灵敏于Cr（血肌酐），特别是在血Cr处于盲区，同时可作为测量GFR（肾小球滤过率）理想的内生物质，尿β2－m及THP的RIA（放射免疫测定）对肾小管（近曲、远曲）损伤部位具有定位作用，通过对系列联检数据的综合分析可以全面了解和评估全肾功能损伤情况，它们之间互补性很强，对临床诊断有指导意义。     

糖尿病性视网膜病变与肾病变的关系

本文对病程５￣２０年的８３例糖尿病患者进行了直接检眼镜和眼底荧光血管造影（ＦＦＡ）检查，与２４小时尿白蛋白排出置放射免疫法检测对照。结果表明直接检眼镜和ＦＦＡ检查均是糖尿病性视网膜病变（ＤＲ）不可缺少的检查手段，而ＦＦＡ对早期ＤＲ发现率更高，随ＤＲ的发生和病变程度的加重，２４小时尿白蛋白排出量增加，肾病变程度与ＯＲ程度有十分密切关系。     

尿转铁蛋白在糖尿病肾病早期诊断中的价值

采用激光免疫比浊法测定７５例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人尿转铁蛋白排泄率（ＵＴＥＲ）。结果表明：临床蛋白尿组及微量白蛋白尿组ＵＴＥＲ升高率分别为１００％、９６２％，而在尿白蛋白正常组，ＵＴＥＲ升高率仍可达２５０％，与尿白蛋白排泄率（ＵＡＥＲ）升高率比较，差异有非常显著意义（χ２＝７１，Ｐ＜００１）。提示尿ＵＴＥＲ确为更敏感的糖尿病肾病早期诊断指标     

急性颅脑伤后抗氧化能力变化的临床研究

目的研究氧自由基在继发性脑损伤中的病理生理作用及其临床意义。方法用比色法动态检测１５６例急性颅脑外伤病人血液中丙二醛（ＭＤＡ）、超氧化物岐化酶（ＳＯＤ）、谷胱甘肽（ＧＳＨ）、谷胱甘肽过氧化物酶（ＧＳＨ－ＰＸ），ＶｉｔＥ及总抗氧化能力（ＴＡＯＰ）的变化，与２３５例正常平均值对照。结果（１）伤后２４小时内血清ＭＤＡ、ＳＯＤ、ＴＡＯＰ升高，ＧＳＨ、ＧＳＨ－ＰＸ、ＶｉｔＥ下降；（２）受伤２４，４８，７２小时后ＭＤＡ呈持续升高趋势，其他指标则逐渐下降。这种变化均以７２小时后最为明显；（３）重型、特重型颅脑外伤ＭＤＡ升高及ＴＡＯＰ下降尤为显著且超早期发生。结论提示原发脑损伤愈重，氧自由基继发性损害作用愈强，预后愈差。早期联合应用自由基清除剂可改善预后     

^99mTc—DTPA肾显像在早期诊断SLE肾损害和观察早期治疗效果中的应用

本文报道了４５例ＳＬＥ患者~（９９ｍ）Ｔｃ－ＤＴＰＡ肾显像结果，并通过分析ＧＦＲ及~（９９ｍ）Ｔｃ－ＤＴＰＡ肾图定量指标且与血ＣＲ、血ＢＵＮ、血、尿β２－ｍ和尿旦白等生化指标的比较显示，~（９９ｍ）Ｔｃ－ＤＴＰＡ肾显像及其肾图分析在早期诊断ＳＬＥ肾损方面具有显著意义。以Ｃ段下降半排时间（Ｃ＿（１／２））最敏感。ＧＦＲ在判定肾损害程序以及治疗效果方面较有意义。我们认为，~（９９ｍ）Ｔｃ－ＤＴＰＡ肾显像及其肾图分析比单纯ＧＦＲ检查及其它生化检查优越，值得临床推广。     

颅脑损伤后肌酸磷酸激酶活性和循环血内皮细胞变化

目的：寻找有利于颅脑外伤早期诊断的指标．方法：制作大鼠颅脑撞击损伤模型．伤后测定循环血内皮细胞（ＣＥＣ）数和ＢＢ型肌酸磷酸激酶（ＣＫ－ＢＢ）活性，２４小时活杀后测脑含水量．结果：伤后损伤组血浆ＣＫ总活性明显高于对照组，尤以伤后０．５、２、２４小时最为显著（Ｐ＜０．０１）．脑脊液（ＣＳＦ）中ＣＫ－ＢＢ活性于伤后０．５小时即有显著升高，但血浆ＣＫ－ＢＢ此时未见升高．伤后２小时无论ＣＳＦ和血浆ＣＫ－ＢＢ均达峰值，ＣＳＦ－ＣＫ－ＢＢ较血浆ＣＫ－ＢＢ升高更为明显（Ｐ＜０．０１）．伤后８小时和２４小时ＣＳＦ－ＣＫ－ＢＢ虽稍有回落，但仍高于正常值（Ｐ＜０．０１），而血浆ＣＫ－ＢＢ已回至正常水平．ＣＥＣ计数在伤后各时相点均显著高于正常（Ｐ＜０．０１）．脑水含量伤后显著增加（Ｐ＜０．０５）．结论：ＣＥＣ计数和Ｃ－ＢＢ活性测定在脑损伤早期诊断中具有重要的作用，其中ＣＳＦ－ＣＫ－ＢＢ活性变化敏感性更高．     

2型糖尿病患者早期肾病生化指标变化观察

目的：观察2型糖尿病患者早期肾病生化指标的变化。方法：将2型糖尿病339例按照尿微量清蛋白排泄是否≥20μg/min分为糖尿病早期肾病组（观察组）164例,无糖尿病早期肾病组（对照组）175例。比较两组血清胱抑素C（Cys C）、糖化血红蛋白、血清肌酐、血清β2微球蛋白、尿β2微球蛋白和尿α微球蛋白水平的差异。结果：观察组血清Cys C、尿β2微球蛋白和尿α微球蛋白水平均非常显著高于对照组（P〈0.01）;糖化血红蛋白、血清肌酐及血清β2微球蛋白水平均有不同程度升高,但两组差异不显著（P〉0.05）。Logistic回归分析结果显示,血清Cys C、尿β2微球蛋白和尿α微球蛋白与糖尿病早期肾病显著相关（P〈0.05）。结论：血清CysC、尿β2微球蛋白及尿α微球蛋白水平升高可作为糖尿病早期肾损害的指标,有利于糖尿病早期肾病的诊断和治疗。     

酪氨酸磷酸酶抑制剂过矾酸钠对受照NFS—60细胞周期及细 …

目的：观察辐射对造血细胞的细胞周期及细胞凋亡的影响。蛋白质酪氨酸磷酸酶（ＰＴＰ）在造血细胞受体信号传递过程中，参与ＪＡＫ／ＳＴＡＴ通路及ＲＡＳ激活的负调控，与细胞增殖关系密切。过矾酸钠（ｓｏｄｉｕｍ ｐｅｒｖａｎａｄａｔｅ，ＰＥＲＶ）是ＰＴＰ特异性抑制剂，从而观察ＰＥＲＶ对受照ＮＦＳ－６０细胞周期及细胞凋亡的影响。方法：ＮＦＳ－６０细胞以适当数理接种于含１０％胎牛血清的ＲＰＭＩ１６４０培养基中，加     

超声观察早期糖尿病性肾病的肾脏形态改变

目的：评价超声测量肾脏大小在糖尿病肾病（ＤＮ）早期诊断中的价值。材料和方法：对７８例糖尿病（ＤＭ）患者超声测量肾脏大小及最大切面面积，与２４例非ＤＭ，亦无任何肾脏器质性病变正常人的肾脏大小进行对照，并分析ＤＭ肾脏大小与２４ｈ尿微量蛋白排泄量（ＲＡＥＲ）及肾小球滤过率（ＧＦＲ）的关系。结果：早期（ＤＮ）患者肾脏面积明显大于正常对照组，且肾脏面积增大先于ＵＡＥＲ。结论：超声检查可作为早期无创诊断ＤＮ的首选方法之一     

甘油所致急性肾功能衰竭的血液流变学变化及其意义

目的：研究甘油所致急性肾功能衰竭的血液流变学变化及其意义．方法：用离体实验方法对ＳＤ大鼠甘油所致急性肾功能衰竭发病过程中血液流变学指标进行动态研究．结果：急性肾功能衰竭的早期存在明显的全血粘度，血浆粘度、相对粘度、红细胞电泳率和电泳时间的变化，且持续维持至注射甘油后的第５天；纤维蛋白原从注射甘油后第２小时起就逐渐增高，第５天时最高；血球压积第２～４小时增高明显，第２４小时明显低于对照组；血液的还原粘度第４～２４小时明显高于对照组；血ｐＨ值在注射甘油后１小时即明显低于对照组．结论：血液流变学变化存在于急性肾功能衰竭发病的全过程，是其发生、发展和维持的重要原因     

厄贝沙坦联合百令胶囊对肾小管损害保护作用的临床观察

目的研究厄贝沙坦联合百令胶囊对慢性肾脏病（CKD）患者肾小管损害的保护作用。方法慢性肾脏病患者70例随机分为对照组和联合组,每组各35例,两组均给予激素和厄贝沙坦治疗,联合组在此基础上加用百令胶囊治疗,比较两组肾小管损害标志蛋白（尿NAG酶和尿视黄醇结合蛋白）和肾功能治疗后的变化。结果治疗后,两组24 h尿蛋白定量、尿NAG酶和尿视黄醇结合蛋白均显著下降（P〈0.05）,但联合组比对照组下降更明显（P〈0.05）。结论厄贝沙坦联合百令胶囊能较好改善肾小管损害,保护肾功能。     

Contrast and electrolyte dynamics of the intravenous pyelogram. II. Disparities in serum and urine concentrations of meglumine and anion.

Intravenous or intra-aortic injections of meglumine iothalamate in dogs indicate a slightly different tissue distribution and excretory pattern of the meglumine cation and the iothalamate anion. Differences in serum and urinary concentrations of these ions suggest some cellular penetration of the meglumine anion. In addition, there seems to be some evidence for both tubular absorption and tubular excretion of meglumine as a minor component in the renal excretion of this ion. No significant differences could be demonstrated for either urinary load or concentration when the sodium salts of iothalamate were compared to the methylglucamine salts.     

高原地区原发性肾病综合征肾小管功能损害及预后的关系

目的 :探讨高原地区 (海拔 3 680m)原发性肾病综合征 (PNS)肾小管功能损害及与泼尼松疗效的关系 ;方法 :PNS患者经泼尼松 1mg (kg·d)正规治疗 8周后根据疗效分为有效组 (n =3 8)和无效组 (n =1 2 ) ,与泼尼松治疗前后对 50例高原地区PNS患者酶联免疫法测定尿视黄醇结合蛋白 (RBP)及N -乙酰 -β-D氨基葡萄糖苷酶 (NAG)、冰点法测定次晨尿渗透压、磺基水杨酸比浊法测定 2 4小时尿蛋白量、碱性苦味酸法测定血清肌酐 ;结果 :①高原地区PNS患者泼尼松治疗前尿RBP( 0 .54± 1 .1 9)mg L、NAG( 1 1 2 .84± 42 .82 )u L及次晨尿渗透压 ( 553 .62± 2 48.91 )mosm L ,与正常对照组间有显著差异 (P <0 .0 1 ) ;②有效组与无效组相比 ,泼尼松治疗前尿RBP( 0 .3 3± 0 .1 6或 0 .68± 0 .1 4 )mg L、NAG( 97.46± 3 2 .53或 1 58.65± 1 2 .98)u L及次晨尿渗透压 ( 61 9.45± 48.92或 3 3 7.81± 2 6.56)mosm L差别有显著性 (P <0 .0 1 ) ,而 2 4小时尿蛋白定量、血清肌酐差别无显著性 (P >0 .0 5) ;③有效组治疗后尿RBP、NAG及渗透压恢复正常 ,而无效组无明显变化 ;结论 :高原地区PNS存在肾小管功能损害 ,其泼尼松疗效可能与肾小管功能损害程度有关     

Sonography vs. excretory urography in acute flank pain

A prospective study compared the diagnostic accuracy of sonography and excretory urography in determining the cause of acute flank pain in 61 patients. Forty-one patients had urinary tract stone disease. Of these, five had nonobstructing renal stones and 36 had obstructing stones. A correct diagnosis was made by urography in 85% and by sonography in 66%. Small stones at the ureterovesical junction were more accurately diagnosed by sonography (79%) than by urography (68%). In all the patients where sonography failed to detect the offending stone, the stone was calcified and evident on the plain radiographs. There were no false-positive diagnoses in the patients clinically judged to have passed a renal stone (nine patients) or whose pain was arising outside of the urinary tract (five patients). Neither sonography (17%) nor urography (50%) was accurate in diagnosing acute pyelonephritis in the six patients with this diagnosis. Although sonography is not as accurate overall as urography in acute flank pain, it is a viable alternative in those with recurrent renal colic due to stone disease and in the pregnant patient.     

力竭运动导致大鼠急性肾小管损伤机制的研究

通过测定力竭运动后大鼠肾脏组织脂质过氧化水平（ＬＯＰ）、超氧化物歧化酶活性（ＳＯＤ）和谷胱甘肽过氧化物酶活性（ＧＳＨ－Ｐｘ）的变化,以及大鼠尿液中ｒ－谷氨酸转肽酶（ｒ－ＧＴ）和Ｎ－乙酰－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）排出率的变化及其相互关系,来研究力竭运动导致大鼠急性肾小管损伤的机制。结果表明：大鼠肾组织ＬＰＯ水平显著升高,Ｐ＜０．０５,ＳＯＤ活性无明显变化（Ｐ＞０．０５）,ＧＳＨ－Ｐｘ显著性下降（Ｐ＜０．０５）。尿液中ｒ－ＧＴ及ＮＡＧ含量都显著增加。ＬＰＯ水平升高与ｒ－ＧＴ和ＮＡＧ增加之间有显著相关性（Ｐ＜０．０５）。说明一次性力竭运动导致大鼠肾脏组织自由基水平显著升高,而自由基与肾小管上皮细胞膜性结构中的不饱和脂肪酸发生强烈的过氧化反应,从而导致肾小管上皮细胞膜性结构的完整性丧失和损害以及正常生理功能受到破坏,造成肾小管的急性损伤。     

螺旋CT后处理技术在泌尿系病变诊断中的临床价值

目的 探讨螺旋CT后处理技术在泌尿系病变的临床应用价值。方法 对20例泌尿系统疾病患者（肾盂、输尿管积水6例，巨输尿管1例，输尿管移行细胞癌1例，肾癌4例，肾错构瘤1例，肾囊肿3例，膀胱癌4例）分别行螺旋CT平扫、增强扫描和增强延时扫描，保留原始数据对图像进行后处理。结果 螺旋CT扫描并行图像后处理良好地显示了泌尿系统病变的位置、形态、解剖关系、性质、毗邻关系、血供情况。1例肾错构瘤术前误诊为肾癌。本组诊断准确率95%，敏感性100%，特异性91%，阳性预测值100%，阴性预测值91%。结论 泌尿系病变螺旋CT后处理技术可提供高清晰的直观的尿路图像，因而它对指导临床治疗具有重要价值。     

Unilateral acute renal cortical necrosis: correlative imaging

Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis of the renal cortex and sparing of the medulla. Little information on the imaging presentation of bilateral acute renal cortical necrosis is available. The enhanced CT appearance is pathognomonic and diagnostic. The unilateral presentation of acute cortical necrosis is extremely rare, and no imaging methods have been described. The authors chose to apply scintigraphic evaluation to this unique condition complementary to CT to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of some tubular function and clear delineation of the shrunken kidney was found. Conversely, in the DTPA study the kidney was not visualized. A DMSA scan was performed for assessment of viability of the renal cortex and showed a photopenic halo around the small area of the viable cortex of the upper pole. The halo sign represents a cortical loss. The visualization of the upper pole as evidence of cortical viability as a consequence of collateral blood flow from capsular vessels was seen on angiography. Radiographic and scintigraphic correlation of this rare condition may be an effective means to confirm the diagnosis and to establish the extent of involvement. However, contrast CT remains the preferred method in the diagnosis of acute cortical necrosis.     

Transureteroureterostomy obstruction mimicking acute tubular necrosis.

A patient receiving nephrotoxic chemotherapy for metastatic cervical cancer was examined for acute renal failure. A Tc-99m MAG3 scan showed symmetric function, bilateral increasing parenchymal activity, and no tracer excretion in either collecting system. The differential diagnosis included cisplatin-induced nephrotoxicity, dose infiltration, and obstruction of the common ureter. Analysis of the scan, an image over the injection site, and a delayed image of the urinary tract indicated obstruction of the common ureter at the anastomotic site of the transureteroureterostomy. In patients with a transureteroureterostomy, symmetric renal dysfunction, and no bladder activity, a delayed image of the urinary tract should be obtained to distinguish obstruction from acute tubular necrosis.     

Renal handling of technetium-99m DMSA: evidence for glomerular filtration and peritubular uptake

The finding of an enhanced excretion of [99mTc]dimercaptosuccinic acid (DMSA) in patients with tubular reabsorption disorders prompted us to investigate the role of filtration in the renal handling of [99mTc]DMSA. Our studies in human serum indicated that binding to serum proteins was approximately 90%. Chromatography of human urine and studies in rats showed that the complex was excreted unaltered into the urine. Renal extraction of [99mTc]DMSA in a human volunteer was 5.8%. Continuous infusion of [99mTc]DMSA in 13 individuals with normal renal function gave the following results (mean +/- s.d.): plasma clearance of [99mTc]DMSA 34 +/- 4 ml/min, urinary clearance of [99mTc]DMSA 12 +/- 3 ml/min. The calculated filtered load of [99mTc]DMSA closely resembled the urinary clearance, whereas the plasma clearance was about three times faster. This indicates that peritubular uptake accounts for approximately 65% and filtration for approximately 35% of the renal handling of [99mTc]DMSA.