同种肾组织移植改善肾性贫血的基因水平检测*

背景：促红细胞生成素分泌不足使慢性肾衰所引起的贫血(肾性贫血)难以改善。 目的：观察肾组织移植对肾性贫血大鼠促红细胞生成素基因表达的影响。 方法：80只Wistar大白鼠随机均正常对照组,病例对照组、重组人类促红细胞生成素组和肾组织移植组,后3组建立慢性肾功能衰竭动物模型。 结果与结论：60 d时移植组血红蛋白水平及血清促红细胞生成素高于病例对照组(P < 0.05),与重组人类促红细胞生成素组比较,差异无显著性意义(P > 0.05)。移植组肾组织EPO mRNA表达显著高于病例对照组,差异有显著性意义(P < 0.05)。提示肾组织移植改善肾性贫血的作用机制是促进肾组织EPO mRNA的基因表达,使肾脏合成促红细胞生成素增多,从而提高血红蛋白水平。     

肥大细胞在腺嘌呤致慢性肾功能衰竭模型大鼠肾组织中的浸润

背景：近年研究提示肥大细胞的浸润与人类多种肾病患者的肾间质纤维化关系密切。肥大细胞是否参与了腺嘌呤致慢性肾功能衰竭大鼠模型肾间质纤维化？作者未检索到此类报道。目的：探讨肥大细胞在腺嘌呤致慢性肾功能衰竭大鼠模型肾组织中的分布特点及其与肾间质纤维化之间的关系。方法：46只雄性Wistar大鼠,随机分成对照组和模型组。模型组予腺嘌呤灌胃,剂量为150 mg/(kg•d);对照组以等量生理盐水灌胃。分别于不同时间点检测血尿指标,并对肾组织进行苏木精-伊红染色、Masson染色及肾小管间质纤维化评分;采用甲苯胺蓝和免疫组化方法观察肥大细胞在肾脏的分布及浸润数量,并分析它们与肾间质纤维化的相关性。结果与结论：模型组大鼠随着灌胃时间的延长,尿蛋白/ 尿肌酐、血清肌酐和血清尿素氮持续升高,肾间质纤维化评分也逐渐增加,不同时间点之间及其与对照组比较,差异均有显著性意义(P < 0.01);肥大细胞主要分布在模型鼠的肾小管间质、肾小球囊外及血管周围,间质纤维化较重区域浸润较多,其浸润数量随着模型鼠肾损害的加重逐渐增加,不同时间点之间比较,差异均有显著性意义(P < 0.01),并且与肾间质纤维程度呈显著正相关(r =0.96,P < 0.001)。提示肥大细胞可能促进了腺嘌呤致慢性肾功能衰竭大鼠模型肾间质纤维化的进展。     

慢性肾功能衰竭病人的护理体会

1 临床资料 患者耿某,男,1931-01出生, 自1951年开始在空军部队飞行,飞行机种为歼击机,1982年因胆囊疾患在医院行B超检查:见左肾饱满(长径13 cm,横径7.2 cm,厚径8.3 cm),包膜光滑,结构正常;右肾区未见肾脏结构.静脉肾盂造影结果:左肾和左输尿管显影正常,右肾和右输尿管未显影.诊断:先天性右肾缺如,左肾代偿性增大.遂因先天性右肾缺如、高血压、胆囊炎、胆囊结石于1982年停飞,共飞行31年.     

慢性肾功能衰竭并发脑出血的研究进展

<正>慢性肾功能衰竭(chronic renal failure,CRF)与脑血管病密切相关^[1]。与肾功能正常的脑出血相比,CRF合并脑出血的血肿体积增加概率是前者的三倍,死亡概率是前者的四倍^[2]。CRF并发脑出血的病死率和致残率较高,其诊疗缺乏循证医学证据指引。本文就CRF并发脑出血的机制、影响因素及治疗方式等研究进展作一综述,     

慢性肾功能衰竭患者血液透析前后脑干听觉诱发电位分析

目的 观察慢性肾功能衰竭患者血液透析前后脑干听觉诱发电位(BAEP)的变化。方法 对30例慢性肾功能衰竭患 者血液透析前及平均透析5个月后分别行BAEP测定。结果 30例慢性肾功能衰竭患者BAEP异常率为83.3％,主要表现为Ⅰ、Ⅲ、 Ⅴ主波潜伏期(PLs)延长及Ⅰ-Ⅲ、Ⅰ-Ⅴ峰间潜伏期(IPLs)延长;平均透析5个月,患者透析前后比较,透析后Ⅲ、Ⅴ PLs和Ⅰ-Ⅲ、 Ⅰ-Ⅴ IPLs缩短有显著性意义。结论 BAEP的测定及动态观察是慢性肾功能衰竭时听觉神经系统损害的客观指标。     

94例老年慢性肾功能衰竭患者个体化血液透析治疗分析

目的探讨个体化血液透析治疗在老年慢性肾功能衰竭(CRF)患者中的临床应用。方法回顾性分析自2007-05～2010-12于我院血透中心接受血液透析个体化治疗的94例老年CRF患者的临床资料。结果 94例患者通过个体化透析治疗后,透析期间心血管系统并发症明显减少,患者病情稳定,生活质量提高。结论根据患者的病情特点和实际情况,开展个体化血液透析治疗,能有效提高老年CRF患者的治疗成功率。     

移植肾慢性功能不全22例

移植肾存活到一定时间后，由于多种不利因素的影响，逐步出现慢性功能不全的临床表现，而如何对其延长移植肾功能和患者生命，一直是肾移植后患者转归有关临床研究的重要课题。实验就此问题回顾性病例分析农垦三亚医院血液净化科移植肾慢性功能不全的22例患者，根据患者移植肾慢性功能不全出现不等时期的损伤，通过更换免疫抑制剂他克莫司FK506代替环孢素A或/和血液净化(血液透析或/和血液吸附)治疗，治疗后所有患者有关异常生化指标水平显著下降，且临床治愈7例(7/22, 31.8%)；好转10例(10/22, 45.5%)；放弃治疗5例(5/22, 22.7%)，使患者移植肾存活功能得到不同程度的转归，提高患者生活质量。     

持续性腹膜透析和血液透析对慢性肾功能衰竭多发性神经病转归的影响

多发性神经病（MN）是慢性肾功能衰竭患者中较为常见的并发症之一。随着慢性肾功能衰竭的发病率升高,MN发病率也呈逐年递增趋势,以往文献研究表示,这可能与肾功能衰竭恶化尿毒症有关。对于尿毒症患者,临床治疗首选透析治疗,也是该病的主要治疗手段,但临床统计称,即使尿毒症患者能够及时进行透析,体内毒素被清除干净,     

胰肾联合移植后应用连续性肾脏替代治疗1例

目的：探讨连续性肾脏替代治疗在胰肾联合移植后急性肾功能衰竭及多器官功能衰竭中应用的疗效。 方法：1例胰肾联合移植患者在术后出现移植肾急性肾功能衰竭、移植胰急性胰腺炎、肺感染、十二指肠空肠吻合口出血、腹膜炎等并发症,在积极的抗排斥、抗感染、抑制胰酶、止血、营养支持治疗的同时进行床边连续性肾脏替代治疗治疗,应用百特BM25机器进行连续性静脉-静脉血液滤过治疗,共治疗22 d。 结果：连续性肾脏替代治疗治疗期间生命体征、血流动力学稳定。并迅速控制了肺水肿,维持了水电解质酸碱平衡稳定。经过22 d共计180 h的连续性肾脏替代治疗治疗,患者移植胰肾功能逐渐恢复,患者住院40 d痊愈出院。 结论：连续性肾脏替代治疗在胰肾联合移植后急性肾功能衰竭及多器官功能衰竭的治疗中发挥了重要作用,是胰肾联合移植后良好的肾脏支持方式。     

精原干细胞和睾丸组织的同种异体移植

背景：精原干细胞作为精子发生过程的基础和前提，其自我更新和分化途径目前仍不完全清楚。 目的：观察非免疫缺陷动物新生Wistar大鼠的精原干细胞和睾丸组织移植于去势成年Wistar大鼠后的成活及生长发育情况。 设计、时间及地点：组织细胞形态学水平的随机动物对照实验，于2007-04/08在广西医科大学实验动物中心外科实验室完成。 材料：选用健康新生7~9 d雄性Wistar大鼠为供体，受体为经过严格检疫合格的8~12周的成年雄性Wistar大鼠，体质量180~220 g。 方法：取新生雄性大鼠睾丸，采用两步法组合酶顺序消化制备大鼠精原干细胞悬液，以Percoll不连续密度梯度离心法初步纯化精原干细胞。取10只成年雄性大鼠，切除双侧睾丸形成去势大鼠，按随机数字表法分为2组，每组5只。精原干细胞悬液移植组将制取好的1 mL精原干细胞悬液在5 min内注射至受体背部皮下。睾丸组织块移植组将制备好的已剖开的睾丸组织植入受体背部皮下, 每个受体移植2个睾丸4块睾丸组织。 主要观察指标：移植物的生长发育情况，移植8周末移植物的组织学特点及C-kit免疫组化定性分析结果。 结果：精原干细胞悬液移植后，移植物未见成活生长。睾丸组织块移植后移植物部分成活，移植8周末组织学检查可见特征性的精曲小管和细胞结构，可见精子细胞，部分生精小管退化；睾丸间质中可见淋巴细胞浸润；免疫组化鉴定可见睾丸组织内C-kit阳性细胞表达。 结论：同种异体异位移植于非免疫缺陷鼠中，新生睾丸组织块可以成活并能形成精子细胞，而精原干细胞悬液移植后未见移植物生长。     

Evaluation of the cognitive functions in patients with chronic renal failure before and after renal transplantation

Chronic renal failure (CRF) and dialysis treatment affect central nervous system and studies have shown that neurocognitive dysfunctions are caused by CRF and dialysis treatment. The aim of this study was to evaluate the changes in cognitive functions of CRF patients after renal transplantation. Neurocognitive functions of 40 renal transplantation patients aged 18–65 years were determined before, 6 and 12 months after transplantation between 2008 and 2010 using neuropsychological tests. Rey Auditory-Verbal Learning Test (RVLT), Rey Complex Figure Test (RCFT), ADAS-cog Test, Stroop Test (ST), Digit Span Test (DST), and Trail Making Test (TMT) were applied. The test results were statistically compared taking into consideration the patients’ levels of education, age, gender, donor type, duration of dialysis, dialysis type, and duration of CRF. Neuropsychological test results statistically significantly increased in all the patients after renal transplantation (p < 0.05). The female patients’ RVLT test results were statistically higher than the test results of the male patients (p < 0.05). DST, RCFT, RVLT, and (Verbal Fluency Test) VFT results were statistically higher in the patients who were 33 years old or younger (p < 0.05). The patients with high school and college education had statistically significantly higher results in all the tests when compared with the patients that were elementary school graduates (p < 0.05). DST forward task, ST, and RVLT results of the patients, who had received dialysis treatment for 1 year or less, were found to be statistically higher than the results of the patients who had received dialysis for more than 1 year (p < 0.05). The results of RCFT, RVLT, DST backward task, and VFT were statistically higher in the peritoneal dialysis patients than in the hemodialysis patients (p < 0.05). The donor type and the duration of CRF had no significant effects on the results (p > 0.05). The results of this study showed significant improvement in attention, memory, executive functions, pace of data processing and language functions in CRF patients after renal transplantation, as proven with neuropsychological tests.     

Tranexamic acid inhibits fibrinolysis, shortens the bleeding time and improves platelet function in patients with chronic renal failure.

BACKGROUND: A defect in platelet function is the main determinant of the prolonged bleeding time in chronic renal failure (CRF). We previously reported a significant correlation between platelet abnormalities and elevated plasma markers of plasmin and thrombin generation. Our aim was to explore the effect of inhibiting both plasmin action with tranexamic acid (TA) and thrombin production with low molecular weight heparin (LMWH), on the bleeding time (BT) and platelet function in patients with CRF. METHODS: 37 patients with CRF (mean creatinine 8.6 +/- 4.4 mg/dl) under conservative treatment, with prolonged BT, entered this study and received TA during 6 days, with (n = 24) and without LMWH (n = 13). BT, platelet aggregation/secretion, platelet granule contents, von Willebrand factor and parameters of coagulation and fibrinolysis were recorded before and at the end of treatment. RESULTS: The BT was shortened in 26/37 (67%) patients. This effect was associated with significant improvement of platelet aggregation and secretion, with decrease to a normal range of fibrin/fibrinogen degradation products, mild increase in plasmin-antiplasmin complexes and pronounced reduction of circulating plasminogen. No differences were seen among patients with or without LMWH. No serious side effects or complications were observed. INTERPRETATION: These findings indicate that the activation of fibrinolysis plays a significant role in the defect of primary hemostasis in patients with CRF. Inhibition of plasmin activity with TA shortens the BT and improves platelet function in the majority of patients with severe disease.     

Sleep quality in patients with chronic renal failure: a 3-year longitudinal study

BACKGROUND: Despite the high prevalence of sleep disorders in patients with kidney disease, no relationship has been demonstrated between sleep quality and the degree of renal function in cross-sectional studies. A prospective trial was, therefore, started in patients with chronic renal failure (CRF) to evaluate whether a link exists between the modifications of these parameters observed during a three-year follow-up period. METHODS: Sleep quality was determined by the Pittsburgh Sleep Quality Index (PSQI) at baseline and after two and three years (Time 0, 2 and 3, respectively) in 78 patients with various degrees of CRF in association with the main clinical and biochemical variables. RESULTS: The baseline PSQI averaged 6.2+/-3.8 (range: 0-21, with higher values indicating worse sleep quality) and was significantly increased at both Time 2 and 3 (8.8+/-3.7 and 10.2+/-3.5, respectively, P<0.0001 vs baseline), whereas creatinine clearance progressively decreased (45+/-24 vs 41+/-26 and 32+/-20ml/min, at time 0, 2 and 3, respectively, P<0.0001), although an independent association with PSQI could not be demonstrated after adjustment for confounding factors (P=0.90, mixed linear model). CONCLUSIONS: Our data suggest that the progression of renal disease is accompanied by a progressive worsening of sleep quality; age is strongly related to both phenomena. PSQI represents an easy tool to use to detect sleep disorders and to more effectively evaluate renal patients; the prevention of sleep disorders by early and appropriate treatments could beneficially influence the course of the disease.     

慢性肾衰竭患者并发神经精神症状临床分析

目的 分析慢性肾衰竭并发神经精神症状的原因.方法 回顾性分析我院34例出现神经精神症状的慢性肾衰竭患者的资料.结果 慢性肾衰竭并发神经精神症状的原因主要是尿毒症毒素蓄积及代谢紊乱;此外与透析不充分、失衡综合征、脑血管病变、精神压力及药物等因素有关.结论 慢性肾衰竭患者出现神经精神症状与多因素有关,应积极治疗原发病,早期充分透析.     

Neurophysiologic parameters and symptoms in chronic renal failure

We studied: (1) the sensitivity of various neurophysiologic parameters in the diagnosis of uremic polyneuropathy, (2) the relationship between subjective symptoms and neurophysiologic parameters, and (3) the effect of a single hemodialysis on the neurophysiologic parameters in 21 patients undergoing hemodialysis. The following parameters were studied: sensory and motor nerve conduction, including F-wave parameters; vibration detection thresholds; and thermal thresholds. The clinical findings and subjective symptoms were studied using a standardized questionnaire. The most sensitive parameters in the diagnosis of uremic neuropathy were F-wave parameters from lower limbs, vibration detection thresholds from the feet, and the sural nerve sensory action potential amplitude. The nerves from the upper extremities on the side of the fistula should not be used in the diagnosis of uremic polyneuropathy due to numerous mild local nerve lesions. The positive neuropathic symptoms correlated with quantitative vibratory detection thresholds and sensory nerve conduction studies, especially the amplitude of the sensory nerve action potential in the sural nerve. We found no significant change in any of the neurophysiologic parameters following a single hemodialysis session.     

A comparative study of brain atrophy by computerized tomography in chronic renal failure and chronic hemodialysis

Measurement of the cerebral ventricular system, by means of computerized tomography, was performed in 25 patients suffering from end-stage chronic renal failure (ESCRF) and in 45 undergoing chronic hemodialysis (CH), in order to estimate the degree of brain atrophy. Significant enlargement of the ventricular size was found in both groups in comparison with the controls, with the greatest enlargement in the group of patients undergoing hemodialysis. This ventricular enlargement expresses the degree of brain atrophy, which in the patients with ESCRF may be due to the metabolic factors of the renal disease and in the hemodialysed patients, to aluminum toxicity.     

Melatonin improves sleep quality of patients with chronic schizophrenia

BACKGROUND: Accumulating evidence indicates decreased melatonin levels in patients with schizophrenia. Insomnia, mainly difficulty in falling asleep at night, is commonly reported in this population. Association of insomnia with low or abnormal melatonin rhythms has been repeatedly documented. Melatonin is an endogenous sleep promoter in humans. We hypothesized that insomnia in patients with schizophrenia may be partially due to diminished melatonin output. In this study, we measured melatonin output in patients with chronic schizophrenia and assessed the effects of melatonin replacement on their sleep quality. METHOD: In a randomized, double-blind, cross-over, clinically based trial, 19 patients with DSM-IV schizophrenia who were treated with the normal treatment regimen were given melatonin (2 mg, controlled release) or placebo for 2 treatment periods of 3 weeks each with 1 week washout between treatment periods (7 weeks total). For measuring endogenous melatonin production, urine was collected from each patient every 3 hours between 9:00 p.m. and 9:00 a.m. Actigraphy was performed for 3 consecutive nights at the end of each period. Activity- and rest-derived sleep parameters were compared for the whole population with treatment arm as the intervening variable. A separate analysis was performed for patients subgrouped into high versus low sleep efficiency. RESULTS: All patients had low melatonin output. Melatonin replacement significantly improved rest-derived sleep efficiency compared with placebo (83.5% vs. 78.2%, p = .038) in this population. Improvement of sleep efficiency was significantly greater (p < .0014) in low-efficiency (80% vs. 67%) than high-efficiency sleepers (88% vs. 90%). In addition, during melatonin therapy, tendencies toward shortened sleep latency (by 40 minutes, p < .056) and increased sleep duration (by 45 minutes, p < .078) were observed in low- but not high-efficiency sleepers. CONCLUSION: Melatonin improves sleep efficiency in patients with schizophrenia whose sleep quality is low.