来氟米特联合甲泼尼龙治疗IgA肾病的疗效观察

目的评价来氟米特联合甲泼尼龙治疗IgA肾病的疗效和安全性。 方法收集2008年12月至2016年10月在中国人民解放军总医院肾脏病科诊断为IgA肾病的患者75例,分别观察吗替麦考酚酯联合甲泼尼龙(MMF组,44例)与来氟米特联合甲泼尼龙(LEF组,31例)治疗IgA肾病的疗效和安全性。 结果两组患者基线资料无统计学差异(P>0.05)。分别治疗2、6、10个月之后,患者24 h尿蛋白定量显著减低,血清白蛋白水平得到明显改善。但两组间的2、6、10个月后的缓解率(20.45% vs 29.03%、70.45% vs 77.42%、72.73% vs 83.87%)和完全缓解率(9.09% vs 6.45%、38.64% vs 45.16%、40.91% vs 48.39%)、24 h尿蛋白定量、血清白蛋白、肌酐、复发率[4例(9.09%) vs 1例(3.23%)]以及不良反应[6例(13.64%) vs 4例(12.9%)]无统计学差异的意义(P>0.05)。 结论来氟米特联合甲泼尼龙与吗替麦考酚酯结合甲泼尼龙疗效相当,是治疗IgA肾病的安全有效方案之一。     

吗替麦考酚酯联合拉米夫定治疗乙型肝炎病毒相关性肾炎

目的:观察吗替麦考酚酯联合拉米夫定治疗乙型肝炎病毒相关性肾炎(HBV-GN)的疗效,并评价其安全性.方法:13例临床表现为肾病综合征、肾功能正常并经肾活检确诊的HBV-GN患者,给予吗替麦考酚酯联合拉米夫定治疗,观察治疗前后24 h尿蛋白定量、血清白蛋白、肝功能(ALT、AST)、肾功能、HBV复制情况(HBeAg、HBV-DNA)以及不良反应.结果:11例患者完成随访.吗替麦考酚酯联合拉米夫定治疗1年总有效率81.8%,其中显效4例(36.4%),有效5例(45.5%).治疗后尿蛋白较治疗前明显降低,血清白蛋白明显升高(P<0.01).无1例HBV-DNA滴度进行性增高,无1例肝功能损害.结论:初步观察显示吗替麦考酚酯联合拉米夫定治疗HBV-GN安全有效.     

滋肝补肾中药联合拉米夫定治疗乙型肝炎病毒相关性肾炎

目的观察滋肝补肾中药联合拉米夫定治疗乙型肝炎病毒相关性肾炎（HBV—GN）的疗效。方法将66例患者随机分为对照组及治疗组。观察两组治疗前后24h尿蛋白定量,肝、肾功能及HBV-DNA定量。结果治疗组疗效优于对照组。结论滋肝补肾中药与西药拉米夫定联用具有协同作用,对治疗HBV-GN具有一定疗效。     

乙型肝炎病毒相关性肾炎的诊治——附20例报告

目的总结乙型肝炎病毒相关性肾炎（HBV-GN）患者的临床及病理特点,以提高HBV-GN的诊治水平。方法经肾活检确诊为HBV-GN的患者20例,回顾性分析患者临床表现、实验室检查（尿常规、24h尿蛋白定量、转氨酶、血清清蛋白、HBV-DNA等）、肾组织光镜改变及免疫荧光（IgG、IgA、IgM、C3、C1q、FRA、HBsAg、HBcAg、HBeAg）染色结果,并分析其临床及病理特点。结果本组20例,其中肾病综合征10例,肾炎综合征9例,无症状镜下血尿1例。病理分型以非典型膜性肾病最多见（MN）,共16例（占78％）,系膜增生性肾小球肾炎（MsPGN）2例（占10％）,系膜毛细血管性肾炎（MPGN）2例（占10％）。7例患者HBV-DNA阴性。给予抗病毒联合激素治疗后,大多数患者肾功能稳定。结论目前HBV-GN的确诊仍依赖肾活检,在乙型肝炎高发区应常规进行肾活检组织乙型肝炎病毒标志物检测。     

乙型肝炎病毒相关性肾病中C4d沉积特点及其意义

乙型肝炎病毒相关性肾病(HBV-GN)有多种病理类型,其中不典型膜型和膜增殖型.HBV-GN的发病机制被认为与乙型肝炎病毒抗原(HBV-Ag)在肾脏中沉积有关.但乙型肝炎病毒相关性IgA肾病(IgAN)是否与HBV-Ag沉积有关,目前仍有争议.     

毛细血管内增生性肾炎伴乙肝病毒抗原沉积的临床特征及治疗探讨

乙型肝炎病毒相关性肾炎(HBV-GN)肾脏病理改变以膜性肾病最多见,其次是膜增生性肾炎及系膜增生性肾炎[1].然而对毛细血管内增生性肾炎伴乙肝病毒抗原沉积却罕见报道.本研究报道10例如下.     

激素联合来氟米特治疗狼疮性肾炎疗效的观察

目的 了解来氟米特治疗Ⅳ型狼疮性肾炎的临床效果、安全性和不良反应.方法 59例狼疮性肾炎患者的肾活组织检查(简称活检)显示为狼疮性肾炎,应用来氟米特联合糖皮质激素治疗6个月.用药期间监测血、尿常规、24 h尿蛋白定量、肝、肾功能、抗核抗体及抗双链抗体滴度、红细胞沉降率和补体C3等,6个月后行疗效和安全性的评价.结果 来氟米特治疗狼疮性肾炎尿蛋白缓解率为72.4%,高于环磷酰胺冲击治疗缓解率(57%),狼疮性肾炎活动性指标缓解率也高于后者.结论 来氟米特联合糖皮质激素治疗能有效地控制狼疮活动且不良反应轻,耐受性好.     

来氟米特联合糖皮质激素治疗系膜增生性肾小球肾炎的临床研究

目的探讨来氟米特（LEF）治疗系膜增生性肾小球肾炎（MsPGN）的临床效果、安全性和副作用。方法选择经病理证实为MsPGN的慢性肾脏疾病患者19例，采取激素联合LEF治疗。用药期间监测血尿常规、24h尿蛋白定量、肝肾功能等并记录所有不良反应，6个月后行疗效和安全性的评价。结果17例（89．47％）完全缓解，2例（10．53％）部分缓解，0例无效；1例出现皮疹，1例发生轻度脱发，未见肝功能异常。结论LEF联合糖皮质激素治疗MsPGN疗效明显、耐受性好，其在维持缓解期的长期疗效及安全性有待更长期的观察。     

阿德福韦酯治疗乙型肝炎病毒相关肾炎的持续疗效

目的:探讨乙型肝炎病毒相关肾炎(HBV-GN)的抗病毒治疗方法.方法:45例乙型肝炎病毒相关肾炎患者随机分为治疗组和对照组,治疗组(n=26)应用核苷类阿德福韦酯(Adefovir dipivoxil,ADV)治疗;对照组(n=19)采用拉米夫定治疗.观察每组的近期(1年)疗效和长期(3年及以上)的持续疗效.结果:近期疗效:治疗组有效率88.5%(23/26)和对照组的89.5%(17/19)相似(P＞0.05).长期的持续疗效:对照组的持续有效率仅为58.8%(10/17),显著低于治疗组的91.3%(21/23)(P＜0.05).结论:ADV治疗HBV-GN,可以获得比拉米夫定更高的持续有效率.     

抗乙肝病毒联合免疫抑制治疗成人乙肝相关性肾炎Meta分析

目的:评价抗乙肝病毒联合免疫抑制治疗成人乙型肝炎病毒相关性肾炎(HBV-GN)的有效性和安全性。方法:计算机检索Cochrane图书馆,Pubmed,Web of Science,中国期刊全文数据库(CNKI)和万方数据库(1990.1~2014.5)。筛选关于抗乙肝病毒联合免疫抑制治疗成人HBV-GN疗效和安全性的临床研究,以尿蛋白定量,血清白蛋白,血肌酐,谷丙转氨酶和HBV-DNA定量为结局指标。根据Cochrane系统评价员手册进行质量评价,采用Rev Man5.3软件进行Meta分析。结果:纳入12项临床研究共236名HBV-GN患者,其中男性发病率显著高于女性[RR=2.85,95%CI(1.97,4.11),P0.000 01]。抗乙肝病毒联合免疫抑制治疗后较治疗前尿蛋白定量显著降低[MD=4.26,95%CI(3.79,4.72),P0.000 01],血清白蛋白显著升高[MD=-11.1,95%CI(-12.22,-9.98),P0.000 01],血肌酐显著降低[MD=45.8,95%CI(32.04,59.55),P0.000 01],谷丙转氨酶显著降低[MD=15.65,95%CI(10.7,20.6),P0.000 01],HBV复制无明显增加[MD=0.23,95%CI(-0.32,0.79),P=0.41]。结论:抗乙肝病毒联合免疫抑制对治疗成人HBV-GN有效,能有效降低蛋白尿,改善肝肾功能,且不影响乙肝病毒复制。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.