Kimura病、血管淋巴样增生伴嗜酸性粒细胞增多症和肾损伤发生于同一病例

目的:报道1例少见的同时合并Kimura病和血管淋巴样增生伴嗜酸性粒细胞增多症(ALHE)的患者,并有微小病变性肾小球病导致的肾病综合征;对相关文献进行回顾总结.方法:对患者的活检标本进行组织学、免疫组织化学、免疫荧光以及电镜检查.结果:患者为37岁男性,5年来反复发作皮疹、皮肤结节、颈部淋巴结无痛性肿大和肾病综合征,经病理检查证实,肿大的淋巴结为Kimura病,皮下结节为ALHE,肾病变为微小病变性肾小球病.结论:imura病和ALHE可能是同一种疾病的不同病理表现,并可合并肾小球疾病.     

伴嗜酸性粒细胞增多性血管淋巴样增生的临床病理分析

目的：探讨伴嗜酸性粒细胞增多性血管淋巴样增生的临床病理学特征。方法：对我科1950-1999年期间所诊治的伴嗜酸性粒细胞增多性血管淋巴样增生的7名患者的病理标本重新切片,进行病理学上的分析。结果：伴嗜酸性粒细胞增多性血管淋巴样增生在病理学上有其特征,形态学上的改变主要表现在以下3个方面：①真皮内大量毛细血管增生;②血管内皮细胞增生肿大,似“墓碑”状突入血管腔;③病变处有淋巴细胞、嗜酸性粒细胞混合浸润。结论：伴嗜酸性粒细胞增多性血管淋巴样增生是一种良性局限性血管增生,其病因及发病机制尚不清楚。熟悉这一疾病的组织学改变对避免误诊为其他类拟疾病有重要意义。     

血管淋巴样组织增生伴嗜酸性粒细胞增多症3例

1 临床资料 患者1,男性,46岁.右颞部无痛性逐渐生长肿块2年余.2年前无明显诱因下,右颞部出现米粒大小硬块,无自觉不适症状.2001年11月起肿块明显逐渐增大.查体,一般情况可,右颞部皮下可触及活动性肿块,类圆形,与周围组织无粘连,直径约3.5 cm,无压痛,可推动,质硬.     

血管淋巴样增生伴嗜酸性粒细胞增多症一例报道及文献复习

目的 报道1例血管淋巴样增生伴嗜酸性粒细胞增多症(ALHE),并结合文献对其临床病理学特点进行探讨.方法 应用常规HE染色方法,分析和观察1例ALHE的临床资料和组织学形态.结果 该病例以枕后包块就诊,组织学主要表现为血管的增生,增生的血管内皮细胞呈特征的上皮样,可内衬血管腔,突入血管腔内生长,或在血管旁间质内呈实性片状或条索状生长.间质伴有大量的嗜酸性粒细胞为主的炎细胞浸润,而淋巴细胞的浸润相对不明显.结论 ALHE主要表现为血管内皮细胞的上皮样增生,以上皮样血管瘤进行命名较为妥当.ALHE与Kimura病应为两种性质不同的疾病.     

嗜酸性粒细胞增多性血管淋巴样增生1例

1临床资料 患者,女,40岁。因头皮、耳后大小不等结节15年,于2013年1月5日就诊。15年前,患者无明显诱因头皮出现一绿豆大小皮色类圆形结节,表面光滑,质韧,不可活动,不伴瘙痒及疼痛,未引起患者重视未作特殊处理。该结节逐渐长大至胡豆大小,其周及左耳后亦出现多个类似结节,大小不一,散在分布,     

血管淋巴样增生伴嗜酸性粒细胞浸润5例

目的 提高临床对血管淋巴样增生伴嗜酸性粒细胞浸润（脚）的认识。方法 回顾性地分析近8年收治的5例ALI-IE的临床表现、实验室及病理检查特点。结果 5例患者中4例表现为头颈部肿物，1例表现为下肢肿物，病程2—16年，病情反复，2例外周血嗜酸粒细胞升高，病理特点为血管增生明显，内皮细胞呈上皮样，周围有较多嗜酸粒细胞浸润，无嗜酸性脓肿。结论 ALHE的临床表现以头颈部肿物多见，可伴有皮肤表现，诊断主要靠特征性病理学特点，但要注意和木村病鉴别，治疗以手术切除为主，随诊注意有无复发。     

耳后血管淋巴样增生伴嗜酸性粒细胞增多1例报告

耳后血管淋巴样增生伴嗜酸性粒细胞增多１例报告王德福，胡叶芬，邓良珍，韩飞（山东省千佛山医院）关键词耳；淋巴组织增生性疾病；嗜酸细胞增多症１临床资料女，２９岁。因右耳后肿物４＋年疑为血管瘤于１９９３年４月２３日入院。４年前发现右耳后一约豆粒大肿物，无红...     

嗜酸性粒细胞增多性血管淋巴样增生2例

例1,患者女,30岁,因左耳后起丘疹及结节伴痒1 年于2007年7月来我科就诊.     

儿童Kimura病1例

目的 探讨Kimura病的临床特点及诊断治疗.方法 报道1例儿童Kimura病,结合文献对其临床表现、病理改变、诊断及治疗方法进行分析.结果 患儿为5岁男童,临床以肾病综合征起病,伴有血嗜酸性粒细胞及血清IgE明显升高,经予激素治疗后肾病综合征缓解.停药后复发,并出现头颈部淋巴结肿大,淋巴结病理学检查支持Kimura病,经手术切除颈部部分肿大淋巴结后,蛋白尿及颈部其他肿大的淋巴结自动消退,病情缓解.结论 Kimura病常见于中青年男性,但儿童亦可发病,可合并肾脏损害,临床甚至可单纯以肾病综合征起病.手术切除肿大淋巴结有可能同时治疗肾脏损害.     

Clinical features of acute kidney injury in patients with nephrotic syndrome and minimal change disease: a retrospective,cross-sectional study

Background:Minimal change nephropathy (MCD) is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic syndrome.Methods:Patients from Chinese People''s Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1, 2013 to December 31, 2017. Patients diagnosed with membranous nephropathy (MN) by renal biopsy from January 1, 2013 to December 31, 2017 are included as a control population. We retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age groups. We assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression analysis.Results:A total of 367 patients with MCD were included in the analysis, with a sex ratio of 1.46: 1 (male: female) and an age range of 6 to 77 years. Among all the patients, 109 developed AKI (29.7%), and of these patients, 85 were male (78.0%). In the 586 patients with MN, 27 (4.6%) patients developed AKI. The percentage of AKI in MCD patients was significantly higher than that in MN patients (χ² = 41.063, P < 0.001). The percentage of AKI increased with age in the MCD patients. The percentage of AKI in patients aged 50 years or older was 52.9% (46/87), which was significantly higher than that [22.5% (63/280)] in patients under 50 years (χ² = 6.347, P = 0.013). We observed statistically significant differences in age (43 [27, 59] years vs. 28 [20, 44] years, Z = 5.487, P < 0.001), male (78.0% vs. 51.4%, χ² = 22.470, P < 0.001), serum albumin (19.9 ± 6.1 g/L vs. 21.5 ± 5.7 g/L, t = 2.376, P = 0.018), serum creatinine (129.5 [105.7, 171.1] μmol/L vs. 69.7 [57.7, 81.9] μmol/L, Z = 14.190, P < 0.001), serum urea (10.1 [6.2, 15.8] mmol/L vs. 4.7 [3.6, 6.4] mmol/L, Z = 10.545, P < 0.001), IgE (266.0 [86.7, 963.0] IU/ml vs. 142.0 [35.3, 516.5] IU/ml, Z = 2.742, P = 0.007), history of diabetes (6.4% vs. 1.2%, P = 0.009), and history of hypertension (23.9% vs. 5.1%, χ² = 28.238, P < 0.001) between the AKI group and the non-AKI group. According to multivariate linear regression analysis, among the renal pathological features analyzed, renal tubular epithelial cell damage (β = 178.010, 95% CI: 147.888−208.132, P < 0.001) and renal interstitial edema (β = 28.833, 95% CI: 11.966−45.700, P = 0.001) correlated with serum creatinine values.Conclusions:The percentage of AKI in MCD patients is significantly higher than that in MN patients. Patients over 50 years old are more likely to develop AKI. Renal tubular epithelial cell injury and renal interstitial edema may be the main pathological lesions that are associated with elevated serum creatinine in patients with MCD.     

温肾潜阳法治疗肿瘤晚期戴阳证1例

目的:观察中医药治疗肿瘤晚期戴阳证的临床疗效。方法:以温肾潜阳为法,处方以四逆汤合白通汤加味治疗一出现戴阳证的肾癌晚期病人。结果:经中医药治疗后,患者戴阳症状明显好转,住院期间未再发作。结论:对于晚期肿瘤病人,只要中医辨证施治得当,亦可以显著改善患者临床症状,提高癌症患者的生活质量。     

从风、痰论治肾脏病的理论与实践

肾脏病在中国的发病率逐年攀升，肾脏病的治疗是目前医学研究的热点与难点之一，而中医药对于肾脏病的治疗具有一定优势。长期以来，从风邪论治肾脏病已经达成一定共识，而对痰邪与肾脏病的关注略显不足。肾脏病的发生发展与风、痰密切相关，风邪、痰邪既是肾脏病的发病因素，又可作为病理产物影响肾脏病的预后。文章结合西医的研究进展与临床实践总结，试述从风、痰论治肾脏病的临证思路与治疗体会，以期为制定肾脏病的中医诊疗方案提供借鉴与参考。     

血清脂肪酶水平与慢性肾病临床分型和分期相关性研究

目的 探讨血清脂肪酶(LPS)在慢性肾脏疾病患者血清中表达的变化.方法 140例慢性肾脏病患者,入选标准:1)原发性慢性肾脏病;2)排除肿瘤、系统性红斑狼疮、急/慢性胰腺炎;3)年龄小于70岁;4)药物治疗前.健康对照为当天健康人血清样本60例,测定LPS水平,并计算肾小球滤过率(GFR).根据临床诊断分为肾病综合征组(NS)、慢性肾炎综合征组(CNS);根据慢性肾脏病(CKD)分级分为CKDl组、CKD2-3组、CKD4-5组及透析组.进行相关性统计分析.结果 健康组、CNS组、NS组的CKD1组、CKD2-3组、CKD4-5组、透析组血清LPS水平分别为78.55U/L、194.05U/L、163.04U/L,140.72U/L、158.25U/L、314.53U/L、322.13U/L,均与健康组有显著差异(P<0.01);CKD1、CKD2-3与CKD4-5组,透析组均有统计学差异(P<0.01,P<0.05,P<0.01).LPS与GFR、血清肌酐具有相关性(P<0.05,P<0.01).结论 当慢性肾脏病患者有明显的临床表现时(肾病综合征或慢性肾炎综合征),疾病本身可引起血清脂肪酶水平升高;同时其水平与肾小球滤过率成负相关,与血清肌酐呈正相关.血清脂肪酶有随着CKD进展而升高的趋势.     

临床药师对慢性阻塞性肺疾病合并肾功能不全患者药学监护1例

本文报道了1例老年慢性阻塞性肺疾病急性加重伴肾功能不全患者进行临床药师药学监护。此患者入院给予注射用哌拉西林舒巴坦等药物治疗。由于指南中未提及肾功能减退患者哌拉西林舒巴坦的剂量调整方法,临床药师考虑哌拉西林舒巴坦与哌拉西林他唑巴坦的半衰期、排泄时间和排泄比率相似,因此用药方案采用哌拉西林他唑巴坦的剂量调整方法;患者入院第3天复查血常规提示白细胞、血小板计数低于正常值范围,临床药师考虑为哌拉西林舒巴坦的不良反应,停药后白细胞、血小板计数升至正常值范围;另外,临床药师根据患者用药情况,对支气管舒张剂的注意事项、氟康唑胶囊与其他药物的相互作用、双歧杆菌四联活菌片与美罗培南应用时间等方面进行药学监护,后患者病情好转出院。临床药师针对慢性阻塞性肺疾病的正规治疗方案对患者进行用药教育及出院注意事项的指导。     

对“同病异治、异病同治”与体质关系的思考

“同病异治、异病同治”其实质是“证同治亦同,证异治亦异”,而体质对“证”的转化又起主要作用．分析“证”时,考虑患者体质对“证”产生影响的同时,也要关注病邪对体质的改变而影响证的形成。     

Age, estimated glomerular filtration rate and ejection fraction score predicts contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease: insight from the TRACK-D study

Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate （eGFR） and ejection fraction （AGEF） score （age/EF（％）＋1 （if eGFR was ＜60 ml·min-1·1.73 m2）） as an predictor of CIAKI in patients with diabetes mellitus （DM） and concomitant chronic kidney disease （CKD）.Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl （44.2 mmol/L） or 25％ above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic （ROC） analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows：AGEFlow ≤0.92 （n=1 006）; 0.92 ＜AGEFmid ≤1.16 （n=1 000）,and ACEFhigh ＞1.16 （n=992）.The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores （AGEFlow=1.1％,AGEFmid=2.3％ and AGEFhigh=5.8％,P ＜0.001）.By multivariate analysis,AGEF score was an independent predictor of CIAKI （odds ratio=4.96,95％ CI：2.32-10.58,P ＜0.01）.ROC analysis showed that the area under the curve was 0.70 （95％ CI：0.648-0.753,P ＜0.001）.Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.     

肠和肾血氧饱和度能较好预测小儿先天性心脏病术后急性肾损伤

目的：研究脑、肠、肾区域血氧饱和度(rSO₂)预测小儿先天性心脏病术后急性肾损伤(AKI)发生的价值。方法：选择2020年1—12月在上海交通大学医学院附属上海儿童医学中心进行体外循环先天性心脏病纠治术、体重大于2.5 kg且年龄在1岁及以下的患儿57例。采用近红外光谱连续监测患儿术后48 h内脑、肠、肾rSO₂。比较AKI组与非AKI组,以及发生与未发生2级及以上AKI患儿脑、肠、肾rSO₂的变化差异,并采用ROC曲线分析肠、肾rSO₂对术后发生AKI及严重程度的预测价值。结果：57例患儿中,38例(66.7%)发生AKI,其中AKI 1级18例(47.4%),AKI 2级9例(23.7%),AKI 3级11例(28.9%),AKI总发生率约为66.7%。AKI组与非AKI组脑rSO₂的变化差异无统计学意义(F=0.012,P>0.05),但AKI组肠rSO₂和肾rSO₂明显低于非AKI组(F=5.017和5.003,均P&l...