供受者围手术期应用乌司他丁对移植肾功能保护机制的探讨

目的 研究活体肾移植供受者围手术期应用乌司他丁(ulinastatin,UTI)对受者肾功能的影响,探讨其肾功能保护机制. 方法 将40对全身麻醉下活体肾移植供、受者按随机数字表法分为两组(每组20对):UTI组(U组)和对照组(C组).U组供者于阻断肾动脉前1h静脉泵注UTI5 000 U/kg(稀释至50 ml,输注时间20 min),受者于吻合肾血管开放后即刻泵注UTI 5 000 U/kg(稀释至50 ml,输注时间20min);C组供、受者以同U组相同方案泵注等量生理盐水.两组受者在麻醉诱导前(T1)、吻合血管开放前15 min(T2)、吻合血管开放即刻(T3)、手术结束时(T4)、术后6 h(T5)、术后24 h(T6)时的血浆血栓素A2(thromboxane A2,TXA2)、前列环素I2(prostacyclin I2,PGI2)浓度[采用ELISA法检测T1～T6时待测血样中血栓素B2(thromboxane B2,TXB2)、6-酮-前列腺素F1α(6-ketone-prostaglandin F1α,6-keto-PGF1α)浓度(TXA2和PGI2在血浆中极不稳定,但通过测量两者的稳定代谢产物TXB2、6-keto-PGF1α可间接了解TXA2和PGI2的生成情况)及TXA2/PGI2比值和T11T6、术后48 h(T7)时的血肌酐(serum creatinine,Scr)、半胱氨酸蛋白酶抑制剂C(cystatin C,CysC)浓度及尿量. 结果 与T11比较,两组受者T2～T6时血浆TXB2浓度均明显升高(P＜0.05),T4时达到峰值,之后降低,T6时仍高于术前水平;T2～T6时血浆6-keto-PGF1α浓度均升高(P＜0.05),T3时达到峰值,之后降低,T6时升高虽有统计学意义(P＜0.05),但基本恢复至术前水平;T2～T6两组TXB2/6-keto-PGF1α均明显升高(P＜0.05);T6～T2时Scr及CysC水平明显降低(P＜0.05),尿量明显增多(P＜0.05).与C组比较,U组T2～T6时血浆TXB22度明显降低(P＜0.05);T4～T5时血浆6-keto-PGF1α浓度降低幅度明显下降(P＜0.05);T2～T6时TXB2/6-keto-PGF1α明显降低(P＜0.05);T6～～7时Scr、CysC水平明显降低(P＜0.05);T6～～7时虽尿量增多,但差异无统计学意义(P＞0.05). 结论 UTI对TXA2/PGI2比例失衡有一定的调节作用,可通过此机制改善移植肾的血流灌注,对缺血//灌注损伤(ischemia/reperfusion injury,I/RI)导致的移植肾功能受损有一定保护作用.     

创伤性休克家兔血浆TXA2和PGI2的动态变化以及葛根素的调控作用

目的探讨创伤性休克家兔血浆血栓素A2(TXA2)和前列环素(PGI2)的变化以及葛根素的调控作用。方法日本大耳白兔40只,随机分成4组:对照组、休克组、复苏组和治疗组,每组10只。制作创伤性休克模型,复苏组和治疗组分别在休克1.5小时后予以林格氏液进行复苏、复苏的同时静脉输注葛根素治疗。各组于休克前,休克后0.5,1.5,2,3,4小时采集血液以放免法检测血浆中TXB2和6-keto-PGF1α的水平。结果家兔创伤性休克后各时点血浆TXB2水平显著升高(P<0.05);休克后3小时和4小时血浆中6-keto-PGF1α水平明显降低(P<0.05)。与休克组相比,复苏组于复苏后1.5小时和2.5小时TXB2水平明显降低(P<0.05);复苏后0.5小时6-keto-PGF1α水平明显降低(P<0.05),其它时点6-keto-PGF1α水平无显著差别(P>0.05)。与对照组相比,复苏组各时点TXB2水平均显著升高(P<0.05)而6-keto-PGF1α水平均明显降低(P<0.05)。与休克组和复苏组相比,治疗组在静脉输注葛根素后各时点TXB2水平均显著降低(P<0.05)而6-keto-PGF1α水平明显升高(P<0.05)。治疗组于输注葛根素后1.5小时和2.5小时TXB2水平与对照组相比无显著差别(P>0.05)而各时点6-keto-PGF1α水平明显升高(P<0.05)。结论创伤性休克家兔血浆中TXA2水平显著增高而PGI2水平降低,葛根素能调控创伤性休克血浆中TXA2和PGI2水平,在创伤性休克的救治中发挥作用。     

门静脉高压犬肝缺血再灌注时肺循环血液动力学及NO/ET和PGI2/TXA2的变化

目的 评价门静脉高压犬肝缺血再灌注时肺循环血液动力学及肺循环一氧化氮(NO)/内皮素(ET)和前列腺素I2(PGI2)/血栓素A2(TXA2)的变化.方法 健康家犬12只,雌雄不拘,体重10～18 kg,随机分为2组(n=6):对照组和模型组.模型组采用部分结扎门静脉的方法 建立犬门静脉高压模型,12周后完全阻断门静脉、肝后下腔静脉30 min,再灌注60 min制备肝缺血再灌注模型.于第2次麻醉后即刻、肝缺血前即刻、缺血5、30 min、再灌注前即刻、再灌注5、10、15、30和60 min(T1-10)时记录心率(HR)、心输出量(CO)、中心静脉压(CVP)、肺动脉楔压(PAWP)和平均肺动脉压(MPAP),计算心脏指数(CI)、肺血管阻力(PVR)和肺血管阻力指数(PVRI),并计算T2-10时CI、CVP、MPAP、PAWP和PVRI相对于T1的变化幅度;于T2、T4和T9时测定肺动脉血浆NO、ET、TXA2和PGI2的浓度,并计算NO/ET和PCI2/TXA2比值.结果 两组肝缺血时CI、CVP、PVRI、PAWP和MPAP均降低,且模型组CI、CVP、PAWP、MPAP降低幅度低于对照组,两组再灌注时CVP、PAWP、MPAP和PVRI均升高,且模型组PAWP和PVRI升高幅度高于对照组(P<0.05或0.01);模型组肝缺血再灌注时肺动脉血浆NO浓度、NO/ET比值和肝缺血时肺动脉血浆TXA2浓度、PGI2/TXA2比值均低于对照组(P<0.01).模型组PVR与肺动脉血浆NO浓度呈负相关(r=-0.567,P<0.05).结论 门静脉高压犬肝缺血再灌注时肺动脉压升高,可能与肺循环NO水平降低、NO与ET失衡有关.     

帕瑞昔布钠对急性心肌梗死大鼠心功能的影响

目的 评价帕瑞昔布钠对急性心肌梗死大鼠心功能的影响.方法 成年雄性SD大鼠24只,体重230～250 g,随机分为3组(n=8):假手术组(S组)、急性心肌梗死组(AMI组)和帕瑞昔布钠组(P组).AMI组和P组采用结扎左冠状动脉前降支的方法制备大鼠急性心肌梗死模型,S组冠状动脉穿线但不结扎;24 h后P组腹腔注射帕瑞昔布钠8 mg/kg,1次/d,连续3 d,AMI组用生理盐水替代.术后第4天测定并记录左心室收缩压(LVSP)、左心室舒张末期压(LVEDP)、左心室收缩压最大上升速率(+dp/dtmax)和左心室收缩压最大下降速率(-dp/dtmax);采集颈总动脉血样3 ml,采用放射免疫法测定血浆血栓素A2(TXA2)和前列腺素I2(PGI2)的浓度,并计算PGI2/TXA2;采血后取左心室心肌组织,测定梗死面积,计算心肌梗死体积.结果 与S组比较,AMI组和P组LVSP、±dp/dtmax、血浆PGI2浓度和PGI2/TXA2降低,LVEDP和血浆TXA2浓度升高(P＜0.05).与AMI组比较,P组LVSP、±dp/dtmax、血浆PGI2浓度和PGI2/TXA2升高,LVEDP和血浆TXA2浓度降低(P＜0.05).AMI组和P组心肌梗死体积比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠可改善急性心肌梗死大鼠左心室功能,其机制与调节PGI2/TXA2相对平衡有关.     

止血芳酸对体外循环中血栓素A2、前列腺环素的影响

目的 通过观察止血芳酸（PAMBA）对体外循环（CPB）心脏手术中血栓素A2（TXA2）、前列腺环素（PGI2）对影响，探讨其对CPB中血小板功能的保护作用。方法 40例择期CPB心脏手术病人，随机分为两组（每组20例），观察组（A组）于CPB前、CPB预充液中以及鱼精蛋白中和后10min，经中心静脉分别给予PAMBA250mg；对照组（B组）分别给予等容量的生理盐水。分别在切皮前、CPB开始后30min、CPB停机及手术结束时检测血小板计数，采用ELISA法测定血浆TXB2和6－keto-PGF1α的浓度。结果 CPB前两组血小板计数无明显差异。转流后两组各时点和基础值相比显著下降（P＜0.01)，但A组和B组相比血小板计数降低程度明显减轻（P＜0.05)；B组TXB2明显升高，6-keto-PGF1α与转流前比较有所升高，TXB2／6-keto-PGF1α比值明显升高；观察组TXB2的增加及TXB2／6-keto-PGF1α比值明显低于对照组（P＜0.01)，而6-keto-PGF1α的增加则明显高于对照组（P＜0.05)。结论 CPB前和CPB中给予PAMBA有利于维持TXA2和PGI2在体内的平衡，从而在一定程度上保护了血小板的功能，显著减少了CPB和术后非外科性出血。     

新风胶囊对膝骨关节炎患者血液流变学指标及血栓素、前列环素的影响

目的:观察新风胶囊治疗膝骨关节炎的临床疗效,并从血液流变学、血栓素、前列环素等方面探讨新风胶囊治疗膝骨关节炎的作用机制。方法:将80例脾虚湿盛、瘀血痹阻证膝骨关节炎患者随机分为治疗组和对照组,每组40例,另设正常组30例,均为健康体检者。对照组给予硫酸氨基葡萄糖每次314 mg,每日3次,口服;治疗组在对照组治疗基础上加服新风胶囊,每次1.2 g,每日3次。连续治疗2周。观察各组治疗前后血液流变学指标(全血黏度、血浆黏度、纤维蛋白原)、血栓素(TAX2)、前列环素(PGI2)、血清炎性细胞因子[(肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-10(IL-10)]的变化。结果:与正常组比较,治疗组和对照组患者血液流变学指标异常,TAX2、IL-1、TNF-α含量升高(P0.05),PGI2、IL-10降低(P0.05)。与治疗前比较,治疗后治疗组和对照组疼痛VAS评分、Lequesne评分、WOMAC评分及中医证候评分均下降(P0.05),治疗组和对照组血液流变学指标(全血黏度、血浆黏度、纤维蛋白原)改善,TXA2、IL-1、TNF-α含量下降(P0.05),PGI2、IL-10上升(P0.05);治疗组在降低VAS评分、Lequesne评分、WOMAC评分及中医证候评分方面与对照组比较,差异无统计学意义(P0.05),在改善血液流变学指标,调节TXA2、PGI2平衡,血清炎性细胞因子平衡方面优于对照组(P0.05)。结论:膝骨关节炎存在血瘀现象,新风胶囊治疗膝骨关节炎有一定疗效,并可改善血液流变学指标,调节TXA2、PGI2平衡,上调致炎因子,下调抑炎因子,为中医药防治骨关节炎提供理论和实验依据。     

维生素C减轻失血性休克引起的大鼠肺树突细胞聚集及肺损伤

目的 探讨失血性休克对大鼠肺组织树突细胞聚集及肺损伤的影响,以及维生素C的保护作用.方法 SD大鼠(6～7周龄)42只,按数字随机法随机分为对照组、失血性休克2h、6h、24 h组及失血性休克+维生素C2h、6h、24 h组等7组,每组各6只.以股动脉放血法建立大鼠失血性休克模型.免疫组化和逆转录聚合酶链反应(RT-PCR)法检测肺组织树突细胞特异性细胞间粘附分子非整合素蛋白-3(DC-SIGN)表达情况.同时检测肺TNF-α、IL-6含量,髓过氧化物酶(MPO)活性,并进行肺损伤评分.结果 对照组肺中DC-SIGN蛋白表达很少,失血性休克组表达显著升高(P＜0.05),失血性休克后2h肺DC-SIGNmRNA含量就开始增高,休克后24 h仍呈升高趋势.失血性休克组大鼠肺TNF-α、IL-6 mRNA水平升高(P＜0.05),MPO活性增加(P＜0.05),病理损伤显著加重(P＜0.05).失血性休克大鼠在复苏前给予维生素C干预后,上述现象均减轻(P＜0.05).结论 失血性休克可能通过促进肺组织树突细胞聚集引起急性肺损伤.维生素C对这一过程有抑制作用.     

右美托咪定对高血糖冠心病患者围术期血糖变异性及血栓素A2和前列环素平衡的影响

目的探讨右美托咪定对高血糖冠心病患者围术期血糖变异性及血栓素A2(TXA2)和前列环素(PGI2)平衡的影响。方法择期行下肢骨科手术患者40例,年龄>65岁,ASAⅡ或Ⅲ级,符合WHO冠心病诊断标准,糖化血红蛋白(HbA1c)>6.5%。患者随机均分为两组,在麻醉诱导前至术毕分别泵注右美托咪定组(D组)和生理盐水组(C组)。两组患者均采用静注芬太尼3μg/kg、维库溴铵0.1mg/kg、丙泊酚1～2mg/kg麻醉诱导,BIS≤50并维持3min后行气管插管。分别于插管和拔管前后测定血糖值及血浆血栓素B2(TXB2)和6-酮-前列腺素F1α(6-keto-PGF1α)浓度,并计算血糖变异系数(GluCV)。结果插管和拔管前后两组TXB2和6-keto-PGF1α均显著升高(P<0.05);且D组TXB2明显低于C组(P<0.05),6-keto-PGF1α明显高于C组(P<0.05);C组TXB2/6-keto-PGF1α显著升高,且明显高于D组(P<0.05)。D组GluCV显著小于C组(P<0.05)。结论右美托咪定对全麻插管和手术创伤所诱发的应激反应有明显的抑制作用,能有效控制高血糖冠心病患者围术期血糖波动,改善TXA2和PGI2的平衡。     

腹腔扩容术对猪休克复苏后腹腔高压症心脏的影响

目的 观察腹腔扩容术对腹腔高压症(IAH)心脏影响.方法 建立失血性休克、门静脉不全阻断复苏后猪IAH模型,随机分腹腔扩容组(n=4)及假手术组(n=4),分别观察心率、平均动脉压(MAP)、缩短分数(FS)和射血分数(EF),测心脏干湿比及苏木素-伊红(HE)染色结果结果 与休克前比,IAH后2 h心率加快(154次/min比123次/min),MAP下降[110.0 mm Hg(1 mm Hg =0.133 kPa)比127.5 mm Hg],FS下降(29.8％比40.4％),EF下降(55.5％比72.0％)(P＜0.05).与IAH后2h比,腹腔扩容组手术后8h及12h较假手术组心率减慢(124次/min比156次/min,120次/min比156次/min)( P＜0.05) 腹腔扩容组22 h后与IAH后2h比,EF上升(P ＜0.05).结论 腹腔扩容术可显著改善本IAH模型的心率及EF.     

依托咪酯与丙泊酚对异位妊娠失血性休克患者全身麻醉诱导时循环系统的影响

目的探讨依托咪酯与丙泊酚对异位妊娠失血性休克患者全身麻醉诱导时循环系统的影响。方法随机将98例选异位妊娠失血性休克患者分为2组,各49例。对照组实施丙泊酚麻醉诱导,观察组实施依托咪酯麻醉诱导,比较2组患者麻醉前(T_1),诱导中(T_2)、维持后10 min(T_3)、维持后(T_4)及维持后50 min(T_5)的平均动脉压(MAP)、心率及脉搏血氧饱和度(Sp O2)。结果麻醉前,2组患者心率及MAP比较,差异无统计学意义(P0.05),麻醉后各时间点观察组心率及MAP较对照组明显提高,差异有统计学意义(P0.05);2组患者SpO_2差异无统计学意义(P0.05)。结论对异位妊娠失血性休克患者实施依托咪酯全身麻醉诱导,可保持患者的循环系统稳定。     

乌司他丁对创伤性休克患者肝脏和凝血功能影响的回顾性研究

目的 探讨不同程度创伤性休克患者肝功能、凝血功能的变化及乌司他丁(ulinastatin,UTI)的治疗作用.方法 收集2013年1月～2015年3月唐都医院ICU收治的128名创伤性休克患者病历资料,根据患者损伤严重度评分及住院期间是否应用UTI治疗,分为6组:轻度、中度、重度休克UTI治疗组及轻度、中度、重度休克常规抗休克治疗组.统计分析患者入院时的急性生理学及慢性健康状况评分系统(acute physiology and chionic health evaluation scoring system,APACHEⅡ)评分、总住院时间、ICU住院时间、病死率以及两组患者治疗前后各时间点血AST、ALT、血小板(blood platelet,PLT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血浆纤维蛋白原(plasma fibrinogen,Fib)、纤维蛋白(原)降解产物[fibrin(agen) degradation products,FDP]、D-二聚体(D-dimer,D-D)的值,分析UTI对不同程度创伤性休克患者的救治效果.结果 ①轻度、中度创伤性休克组,UTI治疗后患者总住院时间分别为(11.0±3.0)、(14.0±4.0)d,较常规治疗组分别降低26.7％、30％;ICU住院时间(6.2±1.8)、(9.5±2.0)d,较常规治疗组分别降低42.1％、33.6％(P＜0.05).②轻度、中度、重度创伤性休克组,UTI治疗7d后患者AST值分别为(46±19)、(68±63)、(258±133)U/L,较常规治疗组分别降低21.1％、29.4％、32.1％;ALT值为(58±16)、(68±25)、(199±53) U/L,分别降低13.9％、41.3％、41.3％(P＜0.05);③轻度、中度创伤性休克组,UTI治疗7d后患者FDP (20.6±3.2)、(32.0±8.5) mg/L、较常规治疗组分别降低42.0％、34.0％;D-D为(2.2±0.5)、(4.0±0.9) mg/L,分别降低35.76％、24.5％;PT为(10.5±1.2)、(11.2±1.2)s,分别降低7.1％、11.4％;APTT为(26.5±2.8)、(34.2±3.1)s,分别降低15.6％、9.6％;Fib为(4.3±0.4)、(4.1±0.4) g/L,分别升高19.3％、22.1％;PLT为(200±24)×109/L、(186±28)×109/L,分别升高9.6％、40.0％(P＜0.05).结论 创伤性休克患者肝功能、凝血功能存在异常,UTI可改善轻中度患者肝功能、凝血功能,缩短总住院时间、ICU住院时间,对改善预后具有积极意义;对重度患者无明显治疗作用.     

术前应用乌司他丁对择期下肢关节置换术患者血清炎性因子和术后谵妄的影响

目的 探讨术前应用乌司他丁(ulinastatin,UTI)对下肢关节置换术患者血清炎性因子和术后谵妄(postoperative delirium,POD)的影响.方法 采用前瞻性、双盲、随机对照研究设计.选择65~85岁,ASA分级Ⅰ~Ⅲ级,择期行下肢关节置换术的老年患者80例,采用随机数字表法分为UTI组和对照组(每组40例).UTI组于手术开始前将30万单位UTI加入100 ml生理盐水中,30 min内静脉滴注;对照组予以等量生理盐水30 min内静脉滴注.气管插管全身麻醉下完成手术,术后行髂筋膜间隙阻滞.术前1 d行简易智能精神状态检查量表(minimum mental state examination,MMSE)评分,术后24 h(T2)、48 h(T3)、72 h(T4)用意识混乱评估法(confusion assessment method,CAM)进行谵妄评分.记录患者一般情况、术中指标(麻醉时间、手术时间、术中出血及输血量等)及术后指标(VAS评分、术后住院时间及副作用等).术前(T0)、术毕即刻(T1)、T2、T3分别采集外周静脉血3 ml,离心后批量检测血清促炎细胞因子TNF-α、IL-1β、IL-6及S100β蛋白的含量.结果 T2和T3时点CAM评分UTI组[(12.8±2.1)、(13.1±2.9)分]均显著低于对照组[(14.0±2.5)、(14.7±3.1)分](P<0.05);T2、T3和T4时点两组POD发生率比较,差异无统计学意义(P>0.05).两组患者血清S100β蛋白浓度在T1时达高峰(P<0.05),与对照组比较,UTI组T1时血清S100β蛋白浓度升高水平显著降低[(304±142)ng/L比(396±208)ng/L](P<0.05).两组患者血清IL-1β和IL-6浓度在T1、T2时点呈上升趋势,T2时达高峰(P<0.05);与对照组相比,UTI组T1、T2时血清IL-1β[(70.4±7.3)ng/L比(81.6±8.5)ng/L,(99.6±7.7)ng/L比(105.7±8.0)ng/L)]和IL-6浓度[(55±8)ng/L比(62±8)ng/L,(88±8)ng/L比(99±11)ng/L)]升高水平显著降低(P<0.05).结论 术前应用UTI可降低择期下肢关节置换术老年患者术后48 h CAM评分,改善术后认知功能,其机制可能与抑制炎性因子活化通路有关.     

乌司他丁和全肠外营养对胃肠道恶性肿瘤患者术后急性相蛋白代谢的影响

目的探讨乌司他丁 (UTI)和全肠外营养 (TPN)对胃肠道恶性肿瘤患者术后急性相蛋白代谢的影响。方法 6 0例胃肠道恶性肿瘤患者行根治性切除术后 ,随机分为对照组、UTI组、TPN组和UTI+TPN组 ,每组各 15例。结果急性相蛋白于术后 3d ,对照组、TPN组显著低于其余两组 (P <0 0 1) ;术后 7d ,UTI+TPN组显著高于其余组 (P <0 0 1)。术后 4d起UTI+TPN组已接近正氮平衡 ,与其余组比较 ,差异有显著性意义 (P <0 0 1)。结论胃肠道恶性肿瘤患者术后应用UTI和TPN可促进急性相蛋白合成 ,减少净蛋白丢失 ,有利于机体顺利度过应激反应期。     

Are large nonfunctional kidneys risk factors for posttransplantation urinary tract infection in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease?

OBJECTIVES: The objective of this study was to evaluate the effect of bilateral nephrectomy on posttransplantation urinary tract infection (UTI) among patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD). METHODS: In a retrospective case-control design, 62 patients with ESRD with ADPKD were divided into 2 groups: (A) 24 patients who underwent bilateral nephrectomies, and (B) 38 patients in whom bilateral nephrectomies had not been done. Pretransplantation and posttransplantation urine cultures were evaluated for UTI. RESULTS: Sixty-two patients with ESRD with ADPKD were enrolled in this study. The average age was 42 years (range, 6-60 years). Forty patients (64.5%) were male and 22 (35.5%) were female. The mean duration of hemodialysis was 24 months (range, 2-120 months), which was the same for both groups. Bilateral nephrectomies were done for 24 participants (38.7%). There were 38 patients (61.3%) in group B who did not have the operation. UTI occurred in 23 patients (37.1%): 6 patients (25%) in group A and 17 patients (44.7%) in group B. The incidence of UTI was not statistically different between the 2 groups (P>.05). Furthermore, no relationship was found between age, gender, blood group, and UTI in patients with ADPKD (P>.05). CONCLUSION: According to our study, the presence of large nonfunctional kidneys is not a risk factor for posttransplantation UTI in patients with ADPKD and ESRD.     

Urine heat shock protein 70 levels as a marker of urinary tract infection in children

Background

Heat shock proteins (HSPs) are a multi-family group of proteins which are upregulated by the cell in response to exposure to hazardous (stress) factors, including infectious agents, to prevent changes in protein structure. The aim of our study was to assess whether urine levels of the 70-kDa family of HSPs (HSP70s) increase in children with urinary tract infection (UTI) and to determine the optimal urine (u) HSP70 cut-off level to predict UTI in children.

Methods

Forty patients with symptomatic UTI (UTI group), 30 healthy children (control group), 21 asymptomatic patients with proven bacterial contamination in their urine culture (contamination group) and 30 patients with fever caused by other infections (non-UTI infection group) were enrolled in the study. Random urine samples were obtained for measurement of HSP70 and creatinine (Cr) from all groups. Urine was collected prior to the treatment of UTI at the time of presentation and after treatment. Urine HSP70 levels were measured by enzyme-linked immunosorbent analysis. A dimercaptosuccinic acid (DMSA) scan was performed at 5–7 days after presentation in UTI group to distinguish patients with acute pyelonephritis from those with cystitis; based on this scan, no patients had acute pyelonephritis. Patients were classified with pyelonephritis in the presence of all of the following signs: axillary fever of?≥39 °C, leukocytosis and positivity for C-reactive protein.

Results

The mean urine HSP70:Cr ratio (uHSP70/Cr) prior to treatment was significantly higher in the UTI group (449.86?±?194.33 pg/mg) than in the control, contamination and non-UTI infection groups (39.93?±?47.61, 32.43?±?9.09 and 45.14?±?19.76, respectively; p?=?0.0001). Using a cut-off of 158 pg/mg uHSP70/Cr for the prediction of UTI, the sensitivity and specificity of the assay were 100 and 100 %, respectively (area under the time–concentration curve?=?1). The uHSP70/Cr was highest in the patients with clinical pyelonephritis (p?=?0.001). Mean uHSP70/Cr after treatment decreased to 60.68?±?51.11 pg/mg in UTI group (p?=?0 .0001).

Conclusions

Our findings suggest that elevated uHSP70/Cr may be a useful biomarker for the prediction of UTI in children, with a high sensitivity and specificity, and that they may help to distinguish UTI from other infections as well as bacterial contamination of the urine.

     

乌司他丁对恶性肿瘤根治术患者凝血功能的影响

目的探讨乌司他丁（ulinastatin,UTI）对恶性肿瘤根治术患者凝血功能的影响。方法择期ASAⅠ或Ⅱ级腹部恶性肿瘤根治术患者60例,随机均分为三组。所有患者采用气管插管全麻,麻醉诱导后Ⅰ组静注UTI 5 kU/kg;Ⅱ组静注UTI 10 kU/kg,均加入生理盐水100 ml;Ⅲ组给予等容量生理盐水。于入室时（T₀）、切除肿瘤时（T₁）、术毕（T₂）、术后24 h（T₃）采静脉血检测血常规及凝血功能指标及D-D二聚体,并记录术中出血量、输血量及术后24 h引流量等。结果 T₁～T₃时三组血小板计数（Plt）均明显低于、纤维蛋白原（FIB）、D-D二聚体均明显高于T₀时（P<0.05）,Ⅲ组Plt明显低于、FIB、D-D二聚体均明显高于Ⅰ、Ⅱ组,Ⅰ组Plt明显低于、FIB、D-D二聚体均明显高于Ⅱ组（P<0.05）。T₁～T₃时凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）Ⅲ组明显短于Ⅰ、Ⅱ组,Ⅱ组明显长于Ⅰ组（P<0.05）。围术期出血量、输血量及24 h引流量Ⅲ组明显高于Ⅰ、Ⅱ组,Ⅰ组则明显高于Ⅱ组（P<0.05）。结论 UTI可以抑制凝血酶和凝血因子的激活,抑制纤溶系统的激活,保护血小板功能,改善凝血系统功能。5 kU/kg UTI可适当改善患者的凝血状态,而10kU/kg则对凝血功能有显著的改善。     

Therapeutic effects and influence on the urinary enzyme activity of human urinary trypsin inhibitor (urinastatin) in cases with acute renal failure--changes in the urinary activities of NAG and AAP

We studied the therapeutic effects of human urinary trypsin inhibitor (UTI) in 5 cases with acute renal failure, resulting from traumatic shock in 1 case, post-operative shock in 2 cases, septic shock in 1 case, and dehydration in 1 case. We administered 300,000 u/day of UTI intravenously at the initial phase of acute renal failure for 7 days. We measured the activities of urinary N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP) and the activities of serum beta-glucuronidase, PMN-elastase serially. As a control, we also studied same markers in 5 cases with acute renal failure without the administration of UTI. We could obtain the following results. 1) Urinary activities of NAG and AAP were already elevated markedly at the onset phase of acute renal failure. 2) The administration of UTI caused a significant decrease of the activities of NAG and AAP in the urine as compared with those in the controls. 3) The administration of UTI caused also the significant suppression of the activities of beta-glucuronidase and PMN-elastase in the serum. These results suggested that UTI has the protective effects on the tubular epithelial cell injuries in cases of acute renal failure.     

alpha1-microglobulin as a marker of proximal tubular damage in urinary tract infection in children

The urinary alpha1-microglobulin (alpha1-M) as a marker of proximal tubular damage was measured in 86 children, aged 3/12 to 12 years, with a diagnosis of urinary tract infection (UTI) and fever. All patients had normal glomerular filtration rates (GFR). They were divided into 2 groups: A: with UTI and etiological factor E. coli, B: with UTI and etiological factor Proteus sp. Similar measurements of alpha1-M were obtained for a control group of healthy children. An increased mean level serum alpha1-M was observed in patients with UTI and fever compared to control group (p < 0.001). Urinary alpha1-M as the alpha1-microglobulin/creatinine ratio was higher in both tested group of patients with UTI and fever. Those found in group A1 and B1 before treatment were the highest and statistically significantly elevated after treatment (group A2 and B2: p < 0.001). Our results indicate the usefulness of the urinary alpha-microglobulin/creatinine ratio as a marker of proximal kidney tubule damage in children with E. coli and Proteus sp. infections. Additionally, it seems to be associated with the humoral and cellular immune response.     

Effect of circumcision on urinary tract infection after successful antireflux surgery

OBJECTIVE: To evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patients with primary vesico-ureteric reflux (VUR). PATIENTS AND METHODS: Children who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents' request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >10(5) colony-forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with (99m)Tc-dimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the follow-up studies at 4-6 months after surgery. RESULTS: There was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow-up of 151.3 (114-207) months after antireflux surgery. Also there was no significant morphological change on follow-up renal scans and no difference between the groups. CONCLUSION: These findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.     

Effects of ulinastation on rat renal energy metabolism and blood flow in hemorrhagic shock

The effect of ulinastation on rat renal energy metabolism and blood flow in hemorrhagic shock was studied by³¹P nuclear magnetic resonance spectroscopy. Hemorrhagic shock was induced by withdrawing blood from the left carotid artery into a reservoir until mean femoral arterial blood pressure stabilized as 20 mmHg. Ulinastatin (50000 units·kg⁻¹; UTI group, n=10) or saline (0.9% NaCl; NS group, n=10) was injected continuously during 30 min of hemorrhagic shock. Next, the total volume of blood shed in the reservoir was transfused into the right femoral vein over a period of 5 min. In the UTI group, 23.2±15.1% of adenosine triphosphate (ATP) remained and intracellular pH (pHi) was 6.77±0.07 at 30 min of hemorrhagic shock. However, ATP was not detected and pHi showed severe acidosis (pHi: 6.49±0.04) in the NS group. After the transfusion of shed blood, the UTI group exhibited higher ATP levels and pHi values than the NS group. Rats treated with UTI maintained mean arterial blood pressure and renal blood flow at significantly higher values than those administered NS. Ulinastatin improved the energy metabolism of the shocked kidney. We believe that ulinastatin maintains mitochondrial function against hemorrhagic shock by its membrane-stabilizing actions and might contribute beneficially in hemorrhagic shock.