慢性肾功能衰竭患者血粘度指标的观察

目的：探讨慢性肾功能衰竭患者血流变指标的变化。方法：对80例慢性肾功能衰竭患者及50名正常对照者进行血流变指标的检测。结果：慢性肾功能衰竭患者组的全血粘度,血沉,红细胞压积,全血还原粘度,血浆粘度及纤维蛋白原含量等与正常结果组比较均有显著性差异（P＜0．05或P＜0．01）,结论：慢性肾功能衰竭病人的高粘滞状态是引起高凝状态的原因之一。     

连续血液净化治疗在妊娠合并急性肾衰竭中的应用观察

目的观察连续性血液净化治疗在妊娠合并急性肾衰竭的应用。方法18例妊娠合并急性肾衰竭的患者行连续性血液净化治疗,用前稀释连续静-静脉血液透析滤过(CVVHDF)治疗,观察治疗前后血尿素氮(BUN)、血肌酐(Scr)、电解质、血pH值、血常规、C反应蛋白(CRP)、APACHE Ⅱ评分,用放射免疫法测定治疗前、12h、24h、治疗后血液及废液中白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平。结果18例患者中,16例痊愈,1例死亡,1例转为慢性肾衰竭。治疗后血BUN、Cr较治疗前明显下降(P0.05);血电解质、血白细胞数及血pH值正常;CRP、APACHEⅡ评分、IL-6、TNF-α水平较治疗前下降,有显著差异(P0.05)。结论妊娠合并急性肾衰竭早期行连续性血液净化治疗疗效好,其机制明显降低IL-6、TNF-α水平,降低炎症反应,使抗炎因子和促炎因子趋于动态平衡。     

采用连续性血液净化技术救治重症急性肾衰患者的护理

目的观察采用连续性血液净化(CBP)技术救治重症急性肾衰患者的临床疗效,评价护理方法在治疗中的作用。方法对北京安贞医院血液净化中心采用CBP技术救治重症急性肾衰272例患者的临床资料进行回顾性分析,观察全部患者在治疗前、后的生化参数、电解质、生命体征等变化;总结护理体会。结果CBP治疗后,血尿素氮、血肌酐显著改善,电解质维持在平衡状态,血流动力学稳定;采用CBP救治重症急性肾衰患者272例,治愈107例,维持性血透状态11例,转院2例,继续接受治疗5例,放弃10例,死亡137例,死亡率为50.4%。结论连续性血液净化能纠正电解质紊乱、维持酸碱平衡、改善肾功能,清除大量炎症介质,是治疗重症急性肾衰患者的重要手段之一;在治疗过程中实施正确的护理可保证连续性血液净化安全的进行,是提高重症急性肾衰患者救治成功率不可缺少的重要环节。     

应用回归方程探讨男性生化指标与血流变关系

目的 本文对男性成年人中常见的生化指标与血液流变学进行了分析，有助于临床医生分析异常生化指标与血液变学之间的关系及疾病的诊断和治疗。方法 以全自动生化分析仪测定血清生化指标，粘度计测量血流变指标，微量毛细管测定红细胞压积（HCT）。结果 根据174例男性人群血液中28项生化指标与11项血流变参数间的关系，建立相应的回归方程，推算它们的关系。结论 血液流变学结果受多种异常生化指标的影响。     

连续血液净化治疗儿童急性肾功能衰竭

目的　观察连续血液净化 (CBP)对儿童急性肾功能衰竭 (ARF)的疗效及安全性 ,探讨其治疗机制。方法　采用CBP的主要模式CVVH治疗 13例ARF患儿 ,检测治疗前后其血浆生化、水 -电解质及酸碱平衡、中分子物质浓度、凝血功能等变化 ,并观测临床症状及生命体征。结果　 13例患儿体重 2 6～18kg,治疗前少尿或无尿 ,或合度重度代谢性酸中毒、高钾血症、心力衰竭、多器官功能不全 ,pH为 7 2 3± 0 2 3,BE - (10 1± 3 83)mmol/L ,K+ (7 0 8± 1 84 )mmol/L ,BUN (38 4± 11 33)mmol/L ,Cr (379±10 3) μmol/L ,MMS (342 2± 4 18)U L ,AG 2 9 5± 5 13。CBP治疗结束时pH为 7 38± 0 11,BE - (2 0±1 6 2 )mmol/L ,K+ (3 85± 0 6 2 )mmol/L ,BUN (4 5± 2 6 4 )mmol/L ,Cr (181± 5 1) μmol/L ,MMS (2 2 5 7± 36 7)U/L ,AG 10± 3 84 ,各观察指标治疗前后比较 ,好转非常显著 (P <0 0 1) ,治疗过程中BPC有减少 ,PT、APTT比治疗前明显延长 (P <0 0 1) ,但无出血 ,患儿生命体征平稳 ,血流动力学稳定。结论　CBP具有清除中分子物质、血流动力学稳定等特点 ,是治疗儿童ARF的一种快速有效和安全的方法。     

Alternating therapeutic plasma exchange (TPE) with double plasma molecular adsorption system (DPMAS) for the treatment of fulminant hepatic failure (FHF)

Alternating therapeutic plasma exchange with double plasma molecular adsorption system can rapidly remove bilirubin and ammonia and supplement the essential substance from the blood, which could be used as an effective treatment for fulminant hepatic failure.     

血清生长分化因子-15与慢性心力衰竭患者左室重构相关性的研究

目的：探讨慢性心力衰竭（CHF）患者血清生长分化因子-15（GDF-15）水平的变化及其与左心室重构的相关性。方法：选择CHF患者60例,采用纽约心脏病协会心功能分级诊断标准。采集患者外周静脉血,检测常规生化项目,采用酶联免疫吸附法检测外周血GDF-15水平,心脏超声测定左房内经、左室舒张末内径、心脏射血分数,并与对照组（30例）进行比较。结果：CHF患者血清GDF-15水平明显高于对照组（P〈0．05）,且与心功能严重程度呈正相关（r=0．48,P〈0．05）;血清GDF-15的水平与左心房内径（r=0．64,P〈0．05）、左心室舒张末内径（r=0．57,P〈0．05）呈正相关,与射血分数（r=-0．42,P〈0．05）呈显著负相关,与病因无相关性。结论：CHF患者外周血GDF-15的水平显著升高,且随心力衰竭程度加重其水平明显升高;外周血GDF-15水平可作为CHF患者左心室重构的评价指标。     

连续性血液净化对全身炎性反应综合征合并急性肾衰患者血浆炎性介质水平的影响

目的　应用连续静静脉血液滤过 (CVVH)技术 ,探讨其对全身炎性反应综合征 (SIRS)合并急性肾衰 (ARF)患者体内促炎与抗炎细胞因子水平的影响。方法　 16例SIRS合并ARF患者经右侧股静脉插管留置单针双腔导管 ,使用DiapactCRRT机行高容量连续静脉—静脉血液滤过 (HV -CVVH)模式治疗。治疗上除连续性血液净化 (CBP)外 ,主要包括原发病的处理和重要脏器或系统功能的支持或维护。于CVVH治疗前和治疗后 2、4、6h以及停止CVVH后 6h ,分别抽取静脉血检测血液电解质、肾功能和有关细胞因子 ,动脉血做血气分析 ,其中采用ELISA法测定有关细胞因子。结果　 16例患者CVVH后血清BUN、Scr、K+ 均逐渐地呈明显下降趋势 (P均 <0 0 5或 0 0 1) ,血浆TNF -α、IL - 1β、IL - 2、IL - 2R以及IL - 8水平均逐渐降低 ,血浆IL - 6、IL - 4、IL - 10水平在CBP治疗前后均无统计学差异 (P均 >0 0 5 )。结论　CBP能清除SIRS合并ARF患者血浆多种致炎细胞因子 ,并可改善血液生化指标。     

从阴阳两虚心脉瘀滞证辨治充血性心力衰竭的研究

目的 :观察养心通脉冲剂治疗充血性心力衰竭 (心衰 )的疗效 ,并探讨其作用机制。方法 :针对充血性心衰阴阳两虚、心脉瘀滞基本病机、病证 ,确立益阴助阳、活血通脉法 ,研制成养心通脉冲剂 ,临床治疗本病6 5例 ,随机设对照组 (西医常规治疗 ) 37例。实验研究建立充血性心衰大鼠模型 ,观察养心通脉冲剂对模型动物的血流动力学和心、肺重量的影响。结果 :临床研究 :总有效率治疗组为 93.85 %,明显优于对照组的 72 .97%(P<0 .0 1) ;用药后心功能改善、心肌耗氧指数下降均值、主证消失率及明显增加尿量等作用 ,治疗组均明显优于对照组 (P<0 .0 5或 P<0 .0 1)。养心通脉冲剂能改善模型大鼠血流动力学和降低心肺指数。结论 :养心通脉冲剂通过增强心肌收缩力、改善心肌能量代谢及心血泵功能 ,增加肾血流量 ,抗氧化等作用 ,达到减轻心肌损伤 ,降低心脏前负荷 ,改善心功能 ,使心衰患者的症状明显改善或消失。     

脐血间充质干细胞移植治疗肾性贫血：热点与问题

背景：脐血作为造血干细胞来源已成为研究热点,脐血输注辅助治疗已在国内使用,临床已将脐血输注用于纠正尿毒症患者的肾性贫血。目的：评价脐血间充质干细胞移植治疗肾性贫血的有效性及安全性,并与不同来源的间充质干细胞不同移植途径对肾脏病的治疗作用进行比较。方法：回顾分析2010年1月至2012年12月在河南省红十字血液中心门诊部收治的6例肾性贫血患者,实验经医学伦理委员会批准,6例患者对治疗方案均知情同意,产妇及其家属均签署知情同意书,以无菌塑料采血袋密闭式采集足月新生儿脐血80-140mL,分离获得的人脐血间质干细胞通过手背浅静脉输注入肾性贫血患者体内,细胞数≥1×108/份,2份/次,间隔4d后再次输注,共3次,观察治疗前后血红细胞压积、血红蛋白、尿中红细胞、肾血流量变化。结果与结论：治疗前后患者的血红蛋白、血红细胞压积、尿中红细胞、肾血流量显著增加（P〈0.05）。经手背浅静脉多份输注脐血间充质干细胞,方法简便且安全有效,是治疗肾性贫血的一种新方法。但此次临床研究设计为自身前后对照,数据结论具有一定局限性,需进一步验证。     

Attenuation of the alcohol preference of C57BL/6 mice during chronic renal failure

The C57BL/6 inbred mouse strain is known for its strong, genetically determined preference for alcohol over water. In this study we examined the voluntary alcohol consumption (VAC) of C57BL/6 mice during chronic renal failure (CRF). Two weeks after the surgical induction of renal failure, CRF mice, together with normal and sham-operated control mice, were submitted to a standard 24-day VAC protocol. The mice were offered water for the first 6 days (period of acclimatization), alcohol (10% ethanol solution) for the next 4 days (period of forced alcohol exposure), and a choice between water and alcohol for the last 14 days (VAC period). The results (mean +/- SEM) obtained from the last 8 days of the VAC period were significantly different (P <.05) between CRF mice and the 2 control groups. As expected, CRF mice had a higher total fluid intake than did normal and sham-operated controls (9.5 +/- 0.2 vs 5.4 +/- 0.2 and 5.4 +/- 0.2 g/d). Surprisingly, despite their increased total fluid consumption, CRF mice nearly abolished their absolute alcohol intake compared with that of both control groups (3.2 +/- 0.5 vs 13.1 +/- 0.8 and 14.2 +/- 1.1 g alcohol/kg body wt/d). The resulting alcohol preference ratio (g alcohol/g total fluid) was markedly decreased in the CRF mice compared with that in both control groups (0.09 +/- 0.01 vs 0.62 +/- 0.03 and 0.64 +/- 0.05). We conclude that the innate alcohol preference of C57BL/6 mice is nearly abolished during CRF. Additional studies to clarify the mechanism of this striking change in drinking pattern are required, with special emphasis on the possible role of angiotensin II, which is involved in thirst regulation and known to reduce the alcohol consumption of normal alcohol-preferring rats.     

The effects of age and hyperhomocysteinemia on the redox forms of plasma thiols

We assayed the redox forms of cysteine (reduced [CSH], oxidized [CSSC], and bound to protein [CS-SP]), cysteinylglycine (CGSH; cysteinylgycine disulfide [CGSSGC] and cysteinylglycine-protein mixed disulfide [CGS-SP]), glutathione (GSH; glutathione disulfide [GSSG] and glutathione-protein mixed disulfide [GS-SP]), homocysteine (Hcy; homocystine [HcyS] and homocystine-protein mixed disulfides [bHcy]), and protein sulfhydryls in the plasma of healthy subjects (divided into 8 groups ranging in age from birth to 70 years) and patients with mild hyperhomocysteinemia associated with cardiovascular disease (heart-transplant patients) or vascular atherosclerosis, with or without renal failure. In healthy individuals, levels of disulfides and protein-mixed disulfides were more abundant than those of thiols, and those of protein-thiol mixed disulfides were higher than disulfides. Concentrations of CSH, GSH, and CGSH in the various groups had profiles characterized by a maximum over time. The concentration of Hcy was unchanged up to the age of 30 years, after which it increased. CSSC concentration increased gradually with age, whereas concentrations of the other disulfides were essentially unchanged. By contrast, the concentrations of all protein-thiol mixed disulfides, especially those with CSH, increased gradually with age. Ranks of distribution of the reduced forms changed with age (at birth, CSH > CGSH > GSH > Hcy; in 1- to 2-year-olds, CSH > GSH > CGSH > Hcy; and in 51- to 70-year-olds, CSH > CGSH = GSH > Hcy), whereas those of disulfides and protein-thiol mixed disulfides were substantially unchanged (in all age groups, CSSC > CGSSGC > GSSG = HcyS and CS-SP > CGS-SP > bHcy > GS-SP). In patients with pathologic conditions, plasma levels of disulfide forms CSSC, HcyS, CS-SP, and bHcy were significantly increased, whereas other redox forms of thiols were unchanged or showed variations opposite (increasing or decreasing) to control values. Maximal increases in disulfides and protein-thiol mixed disulfides were associated with renal failure. Our data suggest that increases in plasma bHcy concentrations in subjects with pathologic conditions were more likely the result of activation of thiol-disulfide exchange reactions between free reduced Hcy and CS-SP than of a direct action of reactive oxygen species.