肾素血管紧张素系统抑制剂对心脏术后急性肾损伤和Ⅰ型心肾综合征的影响

<正>急性肾损伤(AKI)是肾功能在短时间内迅速下降的临床综合征,常伴少尿,且往往增加患者短期和长期病死率以及日后发展为慢性肾脏病(CKD)的风险[1-3]。最新一项关于全球AKI的Meta分析指出,AKI发病率达10.7%[4]。国内一项关于住院成人患者AKI的流行病学调查报道AKI患者占住院患者的3.2%,心血管疾病是这些患者最常见的入院诊断,提示心血管疾病与AKI密切相关[5]。有报道指出     

急性肾损伤生物标志物研究进展

急性肾损伤(acute kidney injury,AKI)最初被称为急性肾功能衰竭(acute renal failure,ARF),临床多见,危害大,其住院患者发病率在国内为0.12%～0.41%[1,2],病死率为5%～37.9%[1,3,4]。国外发病率为2.38%～20%[5,6],病死率约为47.8%～56.4%[6,7],在重症监护病房(ICU)中病死率高达37%～     

心脏术后患者尿白细胞介素-18水平及其与急性肾损伤的关系

急性肾衰竭是临床常见的危重病,综合性医院发病率为5%,ICU高达30%,病死率达30%～80%.缺乏预测和早期诊断手段,是其发病率和病死率居高不下的最重要原因之一.近年来提出了急性肾损伤(AKI)的概念[1],旨在将急性肾衰竭的临床诊断提前,故寻找早期诊断AKI指标显得极为重要.     

中性粒细胞明胶酶相关脂质运载蛋白早期预测心力衰竭患者并发急性肾损伤的研究进展

正心力衰竭(心衰)的发病率逐年升高,已成为全球的公共卫生问题,严重威胁人类健康。有文献报道[1],根据美国和欧洲的统计数据,心衰发病率约在1%~12%。病程中易出现急性肾损伤(AKI),其发病率高,早期症状不典型,缺乏早期诊断指标,使诊治延迟,影响预后。近期相关研究[2]显示,中性粒细胞明胶酶相关脂质运载蛋白(NGAL)可作为早期预测AKI新型的特异性指标。NGAL能否早期预测心衰患者并发AKI的观点尚不统一,本文对此做一综述。     

脓毒症急性肾损伤研究进展

正感染所致的全身炎症反应综合征定义为脓毒症,在脓毒症患者中急性肾损伤(acute kidney injury,AKI)的发生率高达47.9%,28 d病死率为32.7%~[1]。目前认为脓毒症相关急性肾损伤(sepsis-associated AKI,SAAKI)与死亡风险增加和住院时间延长独立相关~[2],相当大一部分AKI患者发展成终末期肾病~[3]。因此,SAAKI需要尽早干预,而其中的机制并未得到明确。在AKI相关的主要病因中脓毒症、     

肝硬化并发急性肾损伤诊治进展

<正>急性肾损伤(acute kidney injury,AKI)是失代偿期肝硬化腹水患者常见且严重的并发症之一,其发病率达27%～53%^[1]。一旦发生AKI,28 d病死率达29%～44%^[2,3]。我国学者^[4]对1071例肝硬化患者进行回顾性分析发现,AKI发生率为11.1%,Child A级、B级和C级肝硬化人群AKI发生率依次为3.8%、10.9%和27.7%。AKI患者2个月病死率达37.0%。1期、2期和3期AKI患者2个月病死率分别为20.3%、36.0%和73.3%。随着疾病的进展及腹水、感染、出血等并发症的发生,肝硬化患者AKI发生风险呈递增趋势,严重影响患者的生存状况。     

肝硬化并发急性肾损伤早期诊断生物标志物研究进展

正肝硬化患者发生急性肾损伤(acute kidney injury,AKI)非常普遍并严重影响预后。研究表明,肝硬化合并AKI的住院患者,30天病死率是未合并AKI住院患者的10倍~([1])。AKI是增加肝硬化患者病死率和促进死亡的独立危险因素[2]。AKI在住院肝硬化患者发生率约19%,病因以肾前性肾损伤(pre-     

重视肝硬化的急性肾损伤

正(AKI)、慢性肾脏病(CKD)或两者同时存在。2015年国际腹水俱乐部(ICA)提出AKI新的分类标准,主要基于肌酐值的升高及发生时间来定义AKI,而不是肌酐绝对值1.5 mg/dL(132μmol/L),肝肾综合征(HRS)是AKI的一种新表型,即HRSAKI,肌酐峰值越高,死亡率越高[1-2]。因此,早期识别AKI至关重要,AKI的管理必须基于其严重程度进行分期,识别及治疗其加重因素十分重要,而最初48 h内的表型并不十分重要[3]。住院的肝硬化患者AKI发生率为20%～40%,近年来肝硬化的研究多集中在AKI、CKD,AKI与CKD关系的研究则较为缺乏。CKD是全球范围内的公共卫生问题,普通人群患病率约     

围手术期急性肾损伤临床特征及预后180例分析

目的探讨围手术期急性肾损伤(AKI)患者的临床特征。方法收集第二军医大学附属长征医院肾内科2011年度手术患者的肾功能指标,根据2012年改善全球肾脏病预后组织(KDIGO)的AKI诊断标准筛选出符合标准的AKI患者,回顾性分析患者的临床资料,分析总结其临床特征。结果 2011年1—12月手术患者共16681例,符合入选标准的围手术期AKI患者共180例,围手术期AKI发生率为1.1%,识别率仅为3.3%,AKI 1~3期患者所占比例分别为63.9%、16.7%和19.4%。构成比最高的科室为泌尿外科,占30%,其次为肝移植科、神经外科、普外科等。所有AKI住院患者中,83.3%的患者好转出院,7.2%死亡,另有9.4%放弃治疗。Logistic回归分析显示,AKI分期、手术时间是患者死亡的危险因素,AKI分期越高,手术时间越长,患者死亡风险越大。结论围手术期AKI在住院患者中较常见,病死率高,识别率较低。年龄增长、疾病严重程度增加可增加围手术期AKI患者的死亡风险。因此,围手术期AKI的早期诊断和治疗对疾病的防治、提高患者生存率和改善预后有积极作用。     

心脏术后急性肾损伤早期诊断标志物研究进展

急性肾功能损害是心脏术后常见并发症,其发生率为5%～30%,术后需行透析治疗者占5%;患者一旦发生急性肾衰竭(ARF),其病死率达15%～30%[1]。目前,因ARF的诊断标准不统一,缺乏早期诊断的生物学标志物,疾病早期不易发现。因此,2005年在阿姆斯特丹召开的急性肾脏损伤网(A-KIN)会议上,提出了急性肾损伤(AKI)的概念,并     

microRNA与甲状腺肿瘤的研究进展

microRNA( miRNA)是一种长度约22 nt的非编码单链小分子RNA,通过与mRNA互补结合,降解靶mRNA或阻止其翻译.miRNA作为一种调控因子,在细胞的分化、增殖和凋亡中起重要作用,其突变、缺失或表达水平的异常与人类肿瘤发生、发展密切相关.甲状腺肿瘤起源于甲状腺滤泡上皮细胞或甲状腺滤泡旁细胞,是内分泌系...     

Clinical value of circular RNAs and autophagy-related mi RNAs in the diagnosis and treatment of pancreatic cancer

Background: Circular RNAs(circRNAs) are a special group of long-chain and non-coding RNAs characterized by a closed-loop structure without 3 and 5 polarity. In recent years, studies have demonstrated that circRNAs act as microRNA(miRNA) sponges to regulate the function of miRNAs. Increasing evidence indicates that circRNAs and targeted miRNAs are involved in the development, progression and metastasis of various cancers and drug resistance. A number of miRNAs are known to be associated with the pathogenesis, development and treatment of pancreatic cancer by regulating the autophagic activity. Data sources: A comprehensive literature search was executed in PubMed and EMBASE using the medical subject headings(MeSH) terms "Pancreatic Neoplasms", "autophagy", "RNA, circular" and "microRNA". We also used text terms such as "diagnosis", "prognosis" and "biomarker" to supplement the results. Results: Autophagy-related miRNAs is closely related to pancreatic cancer. On basis of the retrieval results, we summarized the synthesis, features and functions of circRNAs and analyzed the association between autophagy-related miRNAs and pancreatic cancer. Conclusions: circRNAs act as the miRNA sponges and there is an association between miRNAs and autophagy, which provides a new concept to broaden the knowledge about the mechanisms underlying the development, progression and metastasis of pancreatic cancer. Additionally, clinical value of circRNAs and autophagy-related miRNAs in the diagnosis and treatment of pancreatic cancer would be further verified with in-depth researches.     

Akutes Nierenversagen

Previously often regarded as only simple organ dysfunction which can easily compensated by modern renal replacement therapies, acute kidney injury (AKI) has lately been recognized as systemic proinflammatory, prooxidative syndrome, which independently from the severity of the underlying disease, exerts a fundamental impact on the course of disease, the evolution of complications, and outcome. Patients do not only die with but also from AKI. The causes of this fundamental impact of AKI on the course of disease and prognosis are based on the fact that AKI not only results in the well-known effects on volume and electrolyte balance but affects all biological functions and organ systems. AKI augments any inflammatory reaction, which results in distant organ injury of nonrenal organs, such as the lung, the heart, or the liver. Immunocompetence is massively compromised in AKI patients, and infections represent the most important cause of death in this patient group. These negative effects of AKI are mediated by three interrelated mechanisms: by acute uremic intoxication per se, by activation of cellular elements and release of cytokines by the injured kidney (the kidney as the “offender”), and by side effects caused by the type and intensity of renal replacement therapy. Because of the profound impact of AKI on the course of disease on short- and long-term prognosis, early diagnosis and initiation of preventive measures is of outmost importance to avoid the evolution of AKI. If AKI had become manifest, renal replacement therapy has to be adapted – regarding the optimal treatment modality, the timing, and therapy dose – in such manner as to minimize the negative side effects of AKI on the organism. Unfortunately, even modern renal replacement therapies are not able to simulate the complex renal functions and to fully compensate for the negative impact of AKI.     

role of microRNAs in the main molecular pathways of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the most common primary liver malignant neoplasia. HCC is characterized by a poor prognosis. The need to find new molecular markers for its diagnosis and prognosis has led to a progressive increase in the number of scientific studies on this topic. MicroRNAs(miRNAs) are small noncoding RNA that play a role in almost all main cellular pathways. miRNAs are involved in the regulation of expression of the major tumor-related genes in carcinogenesis, acting as oncogenes or tumor suppressor genes. The aim of this review was to identify papers published in 2017 investigating the role of miRNAs in HCC tumorigenesis. miRNAs were classified according to their role in the main molecular pathways involved in HCC tumorigenesis:(1) m TOR;(2) Wnt;(3) JAK/STAT;(4) apoptosis; and(5) MAPK. The role of miRNAs in prognosis/response prediction was taken into consideration. Bearing in mind that the analysis of miRNAs in serum and other body fluids would be crucial for clinical management, the role of circulating miRNAs in HCC patients was also investigated. The most represented mi RNA-regulated pathway in HCC is m TOR, but apoptosis, Wnt, JAK/STAT or MAPK pathways are also influenced by mi RNA expression levels. These miRNAs could thus be used in clinical practice as diagnostic, prognostic or therapeutic targets for HCC treatment.     

miRNAs与内分泌疾病

小RNA（miRNAs）是一类含有21～23个核苷酸的小RNA,具有潜在的在转录后水平负性调节基因表达的作用。miRNAs具有多种表达模式,调节多个生理学和生物学进程。在哺乳动物miR-NAs具有调节脂肪细胞分化、胰岛素分泌、β细胞发育和神经干细胞分化的功能,并参与自身免疫性疾病的发生。miRNAs调节靶基因的机制尚不清楚,但其失调节可能与糖尿病的发病有关。本文对miR-NAs的结构、功能及其对内分泌系统的潜在调节作用进行综述。     

Acute Kidney Injury in the Cirrhotic Patient: Unique Features and Challenges

Acute kidney injury (AKI) is a frequent complication in patients with cirrhosis which is associated with significant mortality and morbidity in these patients. AKI has been recently defined either by an increase in serum creatinine (sCr) of more than 0.3 mg/dl (≥26.5 μmol/l) within 48 h or by a percentage increase in sCr of more than 50 % from the baseline, which is known, or presumed, to have occurred within the previous 7 days. The main advantage of this new definition for AKI is the sensitivity in identifying patients in the very early stage of AKI by small incremental changes in sCr allowing institution of appropriate treatment and preventing progression. This article details the unique features of AKI in patients with cirrhosis, the challenges in the diagnosis prognosis and management of AKI, and the outcomes of different forms of AKI including the potential role of novel biomarkers.     

尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-18对重症患者急性肾损伤的早期诊断价值

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)和尿IL-18(uIL-18)对重症患者急性肾损伤(AKI)的早期诊断价值.方法 以我院ICU收治的92例危重症患者为观察对象,将1周内符合RIFLE诊断标准的AKI患者纳入AKI组(46例),对照组(46例)由匹配的非AKI患者构成.每日收集尿标本,持续1周.ELISA检测uNGAL和uIL-18水平.用受试者工作特征曲线(ROC)评价uNGAL、uIL-18和血肌酐(SCr)对AKI的诊断作用.结果 与AKI诊断前3天比较,AKI诊断前2天患者uNGAL明显增高(P<0.05),但uIL-18和SCr无明显改变(P值均>0.05);AKI诊断前1天AKI患者uNGAL和uIL-18明显增高(P值均<0.05),但SCr无明显改变(P>0.05);观察期间对照组uNGAL、uIL-18和SCr均无明显变化(P值均>0.05).AKI诊断前3天uNGAL、uIL-18和SCr对AKI均无诊断作用;AKI诊断前2天uNGAL的ROC曲线下面积为0.840(95%CI 0.672～1.009,P<0.05),对AKI具有诊断作用,而uIL-18和SCr均无诊断作用;AKI诊断前1天uNGAL和uIL-18的ROC曲线下面积分别为0.830(95%CI 0.711～0.950,P<0.05)和0.818(95%CI 0.697～0.938,P<0.05),对AKI具有诊断作用,而SCr无诊断作用.结论 uNGAL和uIL-18对重症患者AKI可能具有早期诊断价值.     

Acute kidney injury in acute on chronic liver failure

Acute on chronic liver failure (ACLF) is a distinct clinical entity; however, there is still debate in the way it is defined in the East as compared to the West, especially with respect to incorporation of kidney dysfunction or failure in the definition of ACLF. Kidney dysfunction is defined as serum creatinine between 1.5 and 1.9 mg/dl and kidney failure as serum creatinine of more than 2 mg/dl or requirement of renal replacement therapy according to the EASL-CLIF Consortium. Kidney dysfunction or failure is universally present in patients with ACLF according to the definition by the EASL-CLIF Consortium while on the contrary the APASL definition of ACLF does not incorporate kidney dysfunction or failure in its definition. Recently, both the diagnosis and management of renal failure in patients with cirrhosis has changed with the advent of the acute kidney injury (AKI) criteria defined as an abrupt decline in renal functions, characterized by an absolute increase in serum creatinine of 0.3 mg/dl within 48 h or an increase of more than 50 % from baseline, which is known or presumed to have occurred in the previous 7 days. Further, recent studies in patients with cirrhosis have shown the utility of biomarkers for the diagnosis of AKI. The present review covers the pathogenetic mechanisms, diagnosis, prognosis as well as management of AKI in patients with ACLF from both a Western as well as an Eastern perspective. The review identifies an unmet need to diagnose AKI and prevent this ominous complication in patients with ACLF.