氯沙坦对原发性高血压患者微量蛋白尿的影响

目的 研究氯沙坦对原发性高血压患者微量蛋白尿的影响.方法 选自2008年6月～2010年12月在笔者所在医院诊断为原发性高血压的52例患者,随机分成两组,其中,A组每天服用科素亚50mg,B组每天服用科素亚100mg,1个月后观察各组的患者的微量蛋白尿的含量.结果 A组的降压及微量蛋白尿减少情况不如B组.结论 经氯沙坦治疗后患者尿微量蛋白皆有不同程度地下降,较大剂量氯沙坦对微量蛋白尿减少有更明显的影响.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

目的 观察氯沙坦对肾移植术后受者血红蛋白的影响,探讨其使用的安全性.方法 选取肾移植术后超过3个月,移植肾功能稳定,有高血压的受者66例.随机将受者分为两组.实验组:34例,加用氯沙坦或使用氯沙坦替换原有的降压药物;对照组32例,不使用氯沙坦.分组后对受者进行6个月的观察,分别测定0(基础值)、1、2、3及6个月共5个时间点受者的血红蛋白、血肌酐、肾小球滤过率(GFR)及血压等指标,并观察各指标的变化趋势.结果 实验组受者在使用氯沙坦1～2个月时的血红蛋白水平较基础值显著下降(P<0.05),2～6个月时趋于稳定;对照组受者的血红蛋白水平较基础值轻度上升(P>0.05).实验组中伴有高血红蛋白血症(PTE)的受者使用氯沙坦1～3个月时血红蛋白水平呈持续下降趋势(P<0.05),3～6个月时趋于稳定;对照组中伴有PTE的受者血红蛋白水平较基础值轻度下降(P>0.05).实验组中不伴有PTE的受者血红蛋白水平呈先下降后回升趋势;对照组中不伴有PTE的受者血红蛋白水平较基础值显著升高(P<0.05).实验组受者使用氯沙坦1个月时血肌酐水平呈升高趋势,2～6个月时逐渐恢复到基础值;对照组受者血肌酐水平无显著变化(P>0.05).实验组受者的GFR轻度下降后逐渐恢复到基础值;对照组受者的GFR呈逐渐上升趋势.实验组受者的血压呈明显下降趋势(P<0.05);对照组受者的血压较基础值无显著变化.结论 肾移植术后使用氯沙坦能降低受者的高血红蛋白水平,对PTE有一定的治疗和预防作用,并且不会影响受者的移植肾功能.对于肾移植术后有高血压且发生高血红蛋白血症的受者,使用氯沙坦是安全的.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

肾移植术后将CCB替换为ARB控制高血压和蛋白尿的效果

目的 研究肾移植术后将钙通道阻滞剂(CCB)替换为血管紧张素受体阻滞剂(ARB)控制肾移植远期高血压和蛋白尿的有效性和安全性.方法 将肾移植术后5～20年,并服用CCB药物治疗高血压的127例受者纳入研究,所有受者均无糖尿病,移植肾功能保持稳定.采用随机数字表法将受者分为2组,实验组65例,纳入研究前受者均单用CCB,纳入研究后停用CCB,改用氯沙坦50～100 mg/d;对照组62例,维持CCB用药不变.对两组受者进行随访,随访时间为2年,观察血、尿常规,肝、肾功能,血脂,电解质,24 h尿蛋白定量,以及CNI血药浓度等指标的变化.结果 随访期间,两组受者的血压均能保持在正常水平.实验组受者24h尿蛋白定量由随访前的(176.32±54.54)mg下降至随访2年时的(155.69±62.25)mg,差异有统计学意义(P＜0.05);随访2年时,对照组受者的尿蛋白水平略有上升,但差异无统计学意义(P＞0.05);实验组受者的血脂水平与随访前相比,差异无统计学意义(P＞0.05),但高密度脂蛋白水平由随访前的(2.25±0.26)mmol/L升高到随访2年时的(2.46±0.31)mmol/L,差异有统计学意义(P＜0.05).两组受者随访前与随访2年后的血常规、肝肾功能、血钾及CNI血药浓度等检查指标的差异均无统计学意义.结论 肾移植术后远期使用CCB和ARB治疗高血压都是安全、有效的,而应用ARB对于减少蛋白尿和降低心血管事件的风险可能会更好.     

Long-term follow-up of renal transplant recipients treated with losartan for post-transplant erythrosis

Post-transplant erythrosis (PTE) develops in 9 %–22 % of all renal transplant recipients. Defined as a persistently elevated hematocrit (> 0.51), it occurs most commonly during the first 2 years post-transplantation in hypertensive males with excellent allograft function. Several studies have focused on a major role for angiotensin II in PTE pathogenesis, and some case reports have suggested that losartan is an effective treatment for PTE. Nevertheless, its long-term safety and efficiency have not been reported in renal transplant recipients suffering from PTE. We describe four patients successfully treated with losartan for PTE. Hematocrit remained normal for 21, 18, 15, and 15 months, respectively, after the beginning of losartan therapy. Mean erythropoietin concentration was not modified by treatment (17 ± 3.7 mU/ml vs 17 ± 3.8 mU/ml) and serum creatinine concentration remained stable. We conclude that losartan is a safe and effective long-term treatment for PTE. Received: 18 December 1997 Received after revision: 6 March 1998 Accepted: 16 March 1998     

Renal funtional reserve in kidney transplant recipients

In the last few years different authors have observed that kidney transplant recipients with good organ function do not have a renal functional reserve (RFR). This condition is accompained by a high glomerular filtration rate (GFR) [2–6]. We studied RFR in patients with very good organ function under different immunosuppressive therapies, who were divided into groups based on the presence or absence of RFR.     

肾移植后特定尿微量蛋白分析的临床意义

为探讨尿微量排泄蛋白与肾移植的关系，应用免疫散射测浊技术检测了３０例肾移植患者四种特定尿微量蛋白：尿微量白蛋白（ＵＡＬＢ）、尿转铁蛋白（ＵＴｆ）、尿α１微球蛋白（Ｕα１Ｍ）、尿免疫球蛋白Ｇ（ＵＩｇＧ）。结果显示，除ＵＩｇＧ外，ＵＡＬＢ、Ｕα１Ｍ与ＵＴｆ均与血清肌酐（Ｓｃｒ）呈显著正相关。动态观察发现，Ｓｃｒ升高前１周左右，在常规蛋白尿尚不明显时，特定尿微量蛋白已开始出现异常，并于Ｓｃｒ增高期间达到高峰。肾移植急性排斥以ＵＡＬＢ增幅最大（２０７５±１１２７ｍｇ／Ｌ），而慢性ＣｓＡ肾中毒则以Ｕα１Ｍ增高为主（９５０±３４１ｍｇ／Ｌ）。结果认为：特定尿微量蛋白变化与移植肾功能密切相关，对移植后并发症的鉴别有一定帮助     

肾移植受者新发恶性肿瘤的生存分析

目的 探讨肾移植受者术后新发恶性肿瘤的预后.方法 分析1978年1月至2008年12月期间3150例次肾移植受者的资料,其中共有59例患者术后新发恶性肿瘤,肿瘤的发生部位分别为:原肾肾癌6例,原肾肾盂输尿管癌4例,膀胱癌14例,前列腺癌7例,肝癌9例,胃癌3例,肠癌2例,胰腺癌1例,乳腺癌4例,宫颈癌3例,皮肤癌2例,肺癌2例,甲状腺癌1例,移植后淋巴增殖性疾病1例.将上述肾移植后新发恶性肿瘤的59例患者作为移植人群肿瘤组;另选择同期普通人群中性别相同、肿瘤确诊时年龄相同、肿瘤病理诊断以及病理分期相同的59例患者作为普通人群肿瘤组,比较两组患者肿瘤发生后的存活情况.用Cox风险分析模型对影响移植后新发肿瘤患者存活的因素进行分析.结果 肾移植术后恶性肿瘤的总体发生率为1.9%(59/3150),以泌尿系统恶性肿瘤最为常见.移植人群肿瘤组和普通人群肿瘤组患者的5年存活率分别为30%和75%,两组比较,差异有统计学意义(P<0.01).多因素分析表明,肿瘤病理分期是影响移植后新发肿瘤患者存活率的主要不利因素;外科手术和肿瘤发病时移植肾功能正常则是提高患者存活率的保护性因素.结论 与普通人群中的肿瘤患者相比,肾移植受者发生恶性肿瘤后的5年存活率明显降低.     

个体化免疫抑制治疗在肾移植的疗效观察

目的：探讨个体化免疫抑制治疗对肾移植患者的临床价值。方法：将肾移植患者分为个体化组(42例)和常规组(50例),分别采用个体化免疫抑制治疗和常规免疫抑制治疗,并对术后两组的临床指标进行比较。结果：个体化组比较常规组,术后肝功能损害、高血糖、胃肠功能紊乱、呼吸系统感染、急性排斥反应发生率均明显降低(P＜0．05);而巨细胞病毒感染发生率及移植肾切除人数无差异(P＞0．05)。结论：个体化免疫抑制治疗既能维持免疫抑制效果,又能最大限度减少药物不良反应,对肾移植患者有较好治疗价值。     

肾移植术后带状疱疹的诊断与治疗

免疫抑制剂的使用或免疫抑制过度是器官移植术后病毒感染的最重要原因。３０１例肾移植患者术后３１例发生带状疱疹，发病率为１０．３％，发病时间以术后１～２年间最多见，多伴有细胞免疫功能下降。治疗包括抗病毒药物应用、调整免疫抑制剂方案、防止合并细菌感染和对症处理等四个方面。认为阿昔洛韦抗病毒效果较好，而适当减少免疫抑制剂的用量则是治疗的关键     

Treatment of proteinuria with low-molecular-weight heparin after renal transplantation

The development of nephrotic-range proteinuria after renal transplantation is an unfavourable prognostic factor for graft survival. In contrast to that in other nephropathies, the role of renin–angiotensin blockade in kidney transplantation is less well defined, and its anti-proteinuric effect is markedly reduced in the presence of segmental glomerulosclerosis. Here, we describe two patients who developed severe proteinuria after renal transplantation, despite effective blood pressure control with an ACE inhibitor. Histological changes were consistent with IgA-nephropathy and focal segmental glomerulosclerosis. Both patients were treated with low-molecular-weight heparin in addition to pre-existing ACE inhibition. This regimen led to a significant and long-lasting reduction of proteinuria. Our data suggest that low-molecular-weight heparin possesses strong renoprotective properties, thus confirming previous data from experimental nephropathies. This approach might represent a promising new strategy for treatment of proteinuria after kidney transplantation.     

Bilateral native ureteral ligation without nephrectomy in the management of kidney transplant recipients with native proteinuria

The aim of this study was to assess the safety of bilateral native ureteral ligation (BNUL) without nephrectomy in the management of native proteinuria in kidney transplant (KTx) recipients. We retrospectively studied 17 patients who underwent BNUL between 2002 and 2010 with a median preoperative 24 h protein concentration of 2140 (range 1020-25 000) mg/L. Fifteen of the 17 patients had focal segmental glomerulosclerosis as their primary renal disease and ligation was employed to facilitate the diagnosis of early recurrence. The BNUL was performed simultaneously with KTx in 14 patients. Surgical techniques were: open (n = 5), pure laparoscopic (n = 1) and a hybrid of hand-assisted laparoscopic surgical/open approach (n = 12) used at the time of transplantation via the transplant incision. At a median follow-up of 46 months (range 1-59), no patient had a complication related to BNUL and none required interventions associated with their native kidneys. BNUL without nephrectomy seems to be a safe technique to manage native proteinuria in renal transplant candidates.