The level of thromboxane A2 and prostacyclin in patients with chronic kidney failure undergoing hemodialysis

Overall 14 patients with chronic renal failure treated by hemodialysis were examined. The content of the key metabolites of the arachidonic cascade thromboxane B2, 6-keto-prostaglandin F1 alpha and 12-hydroxyeicosatetraene acid (12-HETE) in blood plasma was reduced in the patients as compared to donors. By the end of hemodialysis, part of the patients showed a tendency towards its normalization, however, no complete recovery was practically recorded. Derangement of the formation of thromboxane A2, prostacyclin and 12-HETE in uremia is likely to be related to reverse inhibition of the function of platelet cyclooxygenase and lipoxygenase by plasma inhibitor. The recovery of the function can be attained after adequate hemodialysis.     

慢性肾病患者血1,25-二羟基维生素D3水平变化

目的 研究慢性肾病(CKD)患者血1,25-二羟基维生素D3(维生素D3)水平异常与肾功能受累程度的关系.方法 研究对象包括150例健康对照者和101例CKD患者,检测其血维生素D3、甲状旁腺素、钙、磷、肌酐、清蛋白及尿素氮水平,计算肾小球滤过率(GFR).结果 与对照组相比,第4~5期患者的血维生素D3水平显著降低(P<0.05),第3~5期患者的血甲状旁腺素(PTH)、肌酐及尿素氮(BUN)水平显著升高(P<0.05),第4~5期患者的血磷水平显著升高(P<0.05),各期CKD患者的清蛋白水平均显著降低(P<0.05),仅第5期CKD患者的血钙浓度显著降低(P<0.05).血维生素D3水平与血PTH、尿素氮及肌酐水平呈负线性相关关系,与血钙、清蛋白及GFR水平呈正线性相关关系.结论 第4~5期CKD患者缺乏维生素D3,说明只有当肾功能受损严重时,CKD患者血维生素D3水平才会出现明显异常.此外,本研究还表明CKD患者血维生素D3水平与其他肾功能相关生化指标存在一定的相关性.     

Illness representations in patients with chronic kidney disease on maintenance hemodialysis.

A sample of patients with chronic kidney disease on maintenance hemodialysis participated in a study to explore the relationship between illness perception and quality of life. Illness perception was examined based on the Common-Sense Model of Illness as described by Leventhal. Forty-two participants completed the Revised Illness Perception Questionnaire (IPQ-R), the Index of Well-being (IWB) and a brief demographic form. All of the subscales of the IPQ-R and the IWB demonstrated adequate reliability (alpha levels > or = .70) except for the treatment control subscale (alpha = .46). More perceived consequences of kidney disease and higher scores on the emotional representation scale were negatively correlated with scores on the IWB. Future research is needed to assess the influence of factors such as coping strategies on illness representations and on well-being. Nephrology nurses are in an optimal position to identify the illness perceptions of patients on chronic hemodialysis and can introduce specific coping mechanisms to enhance overall well-being. As well nephrology nurses can function as part of the overall health care team to identify the resources available to minimize the perceived consequences of chronic kidney disease.     

慢性阻塞性肺疾病患者血浆基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂-1水平变化的研究

目的:探讨慢性阻塞性肺疾病患者血浆基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂-1水平变化.方法:慢性阻塞性肺疾病患者30例为观察组,同期健康体检者30例为对照组.检测观察组急性加重期、稳定期及对照组第1秒用力呼气量,第1秒用力呼气量/用力肺活量,血浆基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂-1水平并进行比较,并对基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂-1进行相关性检验.结果:观察组急性加重期、稳定期第1秒用力呼气量,第1秒用力呼气量/用力肺活量较对照组显著降低(P<0.05),血浆基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂-1水平及基质金属蛋白酶-12/基质金属蛋白酶组织抑制剂-1比值较对照组显著增高(P<0.05).血浆基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂水平呈显著的正相关.结论:基质金属蛋白酶-12/基质金属蛋白酶组织抑制剂-1的平衡失调参与了慢性阻塞性肺疾病的发病,监测基质金属蛋白酶-12和基质金属蛋白酶组织抑制剂-1水平可反映病情变化并指导治疗.     

维持性血液透析患者血清MMP-2、MMP-9检测的临床意义

目的观察维持性血液透析患者血清基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)水平的变化及临床意义。方法应用酶联免疫分析法测定60例维持性血液透析患者及30名健康体检者血清MMP-2、MMP-9的水平。结果维持性血液透析患者血清MMP2水平明显高于健康体检者(P<0.01),而MMP9水平则明显地低于健康体检者(P<0.01)。MMP-2水平与尿素氮和肌酐水平呈正相关(P<0.01),MMP-9水平与尿素氮和肌酐水平呈负相关(P<0.01)。结论检测维持性血液透析患者血清MMP2、MMP9水平的变化对尿毒症病情和预后判断均具有重要的临床价值。     

Comparison of muscle strength between hemodialysis patients and non-dialysis patients with chronic kidney disease

[Purpose] Muscle weakness in patients with chronic kidney disease is associated with several disease-related factors, and this study aimed to examine whether hemodialysis is one of risk factors for muscle weakness in patients with chronic kidney disease. [Participants and Methods] We conducted a cross-sectional study with 74 non-dialysis and 84 hemodialysis patients. Muscle strength evaluations were performed by measuring isometric knee extensor muscle strength and grip strength. Each evaluation item was compared between the hemodialysis and non-dialysis groups, and multiple regression analysis was performed to determine the factors associated with muscle strength. In addition, the correlation between lower-extremity muscle strength and grip strength was examined in each group. [Results] Isometric knee extensor muscle strength was significantly lower in the hemodialysis group than in the non-dialysis group. Grip strength was also significantly lower in the hemodialysis group than in the non-dialysis group. Hemodialysis was determined to be an independent risk factor associated with lower limb muscle strength as well as grip strength. The positive correlation between isometric knee extensor muscle strength and grip strength was almost the same in the groups. [Conclusion] Hemodialysis treatment was an independent risk factor for muscle weakness. Regular monitoring of grip strength may facilitate better management with physical therapy in hemodialysis patients.     

幽门螺杆菌感染对冠心病患者血清MMP-2和MMP-9的影响

目的：探讨幽门螺杆菌（HP）感染对冠心病（CHD）患者血清MMP-2和MMP-9的浓度的影响。从而探讨CHD与HP感染的关系及其可能的发病机制,为CHD的早期防治探讨-种新的手段和依据。方法：选取2011年3月至2013年1月菏泽市立医院心内科住院,回顾性分析行心电图、冠状动脉造影检查并结合病史诊断为急性冠状动脉综合征（ACS）患者97例、急性心肌梗死（AMI）患者74例共171例患者为CHD组,并同时选取无CHD体征的健康体检者146例为对照组,对各组进行尿素[Cl4]呼气实验及ELLSA法测HP细胞毒素相关基因蛋白（HP—CagA-IgG）试验,比较各组HP感染阳性率。再把上述二试验均HP阳性的CHD患者分为HP重度感染组、HP轻度感染组,把HP阴性的无CHD体征的健康体检组为HP感染阴性组。对2L．F-组分别用ELLSA法罗氏全自动酶标仪进行MMP-2和MMP-9检测,对各组检测结果进行统计学分析,比较各组与对照组间的差异及HP轻度感染组与HP重度感染组间的差异。结果：①CHD组尿素fCl41呼气试验阳性率（76．7％）、HP—CagA—IgG试验阳性率（71．9％）明显高于无CHD体征的健康体检组尿素[C14]呼气试验阳性率（51．4％）、HP—CagA-IgG试验阳性率（43．4％）（P〈0．01）。②HP重度感染组MMP-2（337±131）ug／L、MMP-9（375±143）ug／L明显高于HP感染阴性组MMP-2（136±69）ug／L、MMP-9（145±91）ug／L（P〈0．001）;HP轻度感染组MMP-2（235±129）ug／L、MMP-9（286±137）ug／L亦明显高于Hp感染阴性组（P〈0．001）;HP重度感染组与HP轻度感组之间亦有显著性差异（P〈0．01）。结论：HP感染可能通过炎性细胞的浸润分泌多种炎性因子和脂质过氧化物。诱导内皮细胞大量分泌MMP-2和MMP-9,从而加速动脉粥样硬化斑块的形成和发展;HP感染阳性患者发生CHD的几率可能增高。     

慢性肾脏病患者血清β2微球蛋白与颈动脉粥样硬化的关系

目的 研究慢性肾脏病（CKD）患者血清β2微球蛋白（β2MG）水平的变化及与颈动脉粥样硬化的关系.方法 对168例CKD患者（非透析治疗120例,血液透析48例）的临床及实验室资料作回顾性研究,采用电化学发光免疫法（ECLIA）检测血清β2MG水平,应用颈动脉超声检查颈动脉病变的程度,分析β2MG水平与颈动脉粥样硬化的关系.结果 CKD患者无论透析与否,β2MG水平均较健康对照组显著升高[（18.6±2.91）比（2.18±0.49） μg/mL,P＜0.01],在非透析CKD患者中,随着肾小球滤过率（GFR）的逐渐下降,血β2MG水平也逐渐升高,各组间比较差异有统计学意义（P＜0.05或P＜0.01）,且CKD5D期β2MG水平较CKD5期更高（P＜0.05）;CKD患者颈动脉内膜中层厚度（IMT）[（0.71±0.18）比（0.67±0.21）mm,P＜0.01]及斑块形成（28.7％比12.0％,P＜0.01）、颈动脉硬化的患病率（32.9％比12.0％,P＜0.01）较健康对照组均显著升高,CKD5D期上述指标较CKD5期均更高（均P＜0.05）;直线相关分析显示,血β2MG水平与hsCRP、TG、Lp （a）、血磷、iPTH、24h尿蛋白定量、透析龄及IMT、斑块形成、颈动脉硬化的患病率呈正相关（P ＜0.05或P＜0.01）,而与GFR、血白蛋白（SA1b）、血红蛋白（Hb）、血钙呈负相关（P ＜0.05或P＜0.01）;多因素逐步回归分析显示,β2MG、hsCRP和年龄是CKD患者颈动脉病变的独立危险因素. 结论 各期CKD患者β2MG水平均显著升高,且与hsCRP及颈动脉病变相关,血β2MG升高可能是CKD患者并发动脉粥样硬化的危险因素之一.     

阿托伐他汀强化治疗对急性冠脉综合征患者血脂及血清超敏C-反应蛋白、基质金属蛋白酶-9水平的影响

目的：探讨阿托伐他汀强化治疗对急性冠脉综合征（ACS）患者血脂及血清超敏C-反应蛋白（hs-CRP）、基质金属蛋白酶-9（MMP-9）水平的影响。方法选取本院治疗的131例行冠脉介入治疗（PCI）的ACS患者,随机分为2组：常规组63例,采用阿托伐他汀常规治疗方案;强化组68例,采用阿托伐他汀强化治疗方案。治疗4周后,记录2组治疗前后血脂、hs-CRP、MMP-9水平变化及不良反应发生情况。至随访截止,观察2组预后情况。结果治疗4周后,强化组总胆固醇、甘油三酯、低密度脂蛋白、hs-CRP、MMP-9水平显著低于治疗前及常规组（P＜0．05或P＜0．01）,高密度脂蛋白显著高于治疗前及常规组（P＜0．01）。常规组未见明显不良反应,而强化组不良反应轻微,患者耐受性好。至随访结束,强化组预后情况显著优于常规组（P＜0．05）。结论与常规治疗相比,阿托伐他汀强化治疗ACS的疗效更优,能显著提高患者的临床获益。     

The treatment of coronary artery disease in patients with chronic kidney disease

Premature cardiovascular disease is the largest cause of mortality, and a major cause of morbidity, in patients with chronic kidney disease (CKD). Patients with end-stage kidney disease (ESKD) are at extreme risk, but cardiovascular event rates are increased even in early CKD. There is little controlled trial evidence on which to base treatment, as most therapeutic trials have excluded CKD patients. Current treatment strategies are therefore based upon small prospective studies or retrospective analyses of controlled trials and registry data. It is thus unclear whether CKD patients benefit from modern secondary preventive treatments in the same manner as patients with normal renal function. There is a need for randomized trials to identify effective drugs to prevent and treat coronary artery disease in CKD. Revascularization by CABG in CKD has been widely reported in registry data to provide better results than medical treatment or angioplasty. Recent angioplasty data in patients with CKD, however, show improving results, and the risks of CABG in CKD remain high. It is not clear which revascularization technique has a better outcome in patients 'equally suitable' on angiographic criteria for either procedure. The high rate of late adverse cardiovascular events after both CABG and angioplasty accentuates the need for effective secondary preventive therapy disease in these high-risk patients.     

血清低密度脂蛋白胆固醇对慢性肾病患者病情进展的影响

目的探讨血清低密度脂蛋白胆固醇对慢性肾病(CKD)患者病情进展的影响。方法选取2012年1月至2014年12月该院门诊规律随访1年以上,年龄18~70岁的1~2期CKD患者115例作为研究对象。根据CKD进展情况,通过筛选将所有患者分为非进展组60例和进展组40例。结果进展组患者女性比例大于非进展组,他汀类药物使用率、高密度脂蛋白胆固醇(LDL-C)达标率、终点估计肾小球滤过率(eGFR)低于非进展组,基线eGFR,终点总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)高于非进展组,差异均有统计学意义(P0.05)。结论 LDL-C较基线升高(即水平大于1.075mmol/L)是CKD进展的独立危险因素。因此需要更加严格控制LDL-C达标标准,更加积极的采用药物治疗。     

The effect of recombinant human erythropoietin on thrombocyte aggregation capacity and on the blood prostanoid level in patients with chronic kidney failure on hemodialysis]

Overall 16 patients with chronic renal failure on regular hemodialysis were examined. Of these, 8 received recombinant human erythropoietin (rhERP). A study was made of platelet aggregation and the level of some prostanoids in the blood of these patients. As the time of the treatment with rhERP was increased, the hemodialyzed patients demonstrated a tendency toward a rise of platelet aggregation induced by thrombin together with an increase of the content of PGF2 alpha, TxB2, in some cases of 6-keto-PGF1 alpha and a lowering of plasma PGE [correction of RGE] level. The data concerning activation of the synthesis of arachidonic acid metabolites (PGF2 alpha and TxB2) that enhance platelet aggregation on prolonged use of rhERP suggest the role these substances may play in the mechanism of the development of thrombotic complications in the given patients' category.     

护理干预联合中药辅助治疗慢性肾脏疾病血液透析患者皮肤瘙痒的效果

目的探讨护理干预联合中药辅助治疗对慢性肾脏疾病血液透析患者皮肤瘙痒及负面情绪的影响。方法选取2016年1月~2017年1月在该院慢性肾脏疾病进行血液透析并出现皮肤瘙痒的患者90例,随机分为对照组和观察组,各45例。对照组患者在治疗过程中采用常规护理干预,观察组患者在对照组患者护理的基础上联合中药皮肤透析辅助治疗,在护理干预8周后,比较两组患者的皮肤瘙痒症状积分,血磷、甲状旁腺素的水平变化,并采用焦虑自评量表(SAS)、抑郁自评量表(SDS)比较两组患者干预前后的负面情绪评分。结果护理干预后观察组患者皮肤瘙痒症状评分低于对照组患者,差异有统计学意义(P<0.05);观察组患者血磷、甲状旁腺激素水平均明显低于对照组患者,差异均有统计学意义(均P<0.05);观察组患者的SAS、SDS评分均明显低于对照组患者,差异均有统计学意义(均P<0.05)。结论针对出现皮肤瘙痒症状的慢性肾脏疾病血液透析患者采用护理干预联合中药辅助治疗,能够有效改善患者皮肤瘙痒的症状,降低患者血磷及甲状旁腺素的水平,改善患者的负面情绪,值得推广应用。     

Proteomics analysis of blood plasma in HIV-infected patients with chronic kidney disease

BackgroundPatients treated for human immunodeficiency virus (HIV) infection are prone to developing chronic kidney disease (CKD). Current methods used in assessing kidney function suffer inaccuracy in HIV-infected patients. This study aims to identify biomarkers that could complement existing methods of kidney assessment among HIV-infected subjects.MethodsPlasma protein profiling was performed for HIV patients with CKD presented with negative/trace proteinuria (non-proteinuric) (n = 8) and their matched non-CKD controls, using two-dimensional gel electrophoresis (2DE); selected protein candidates were identified using mass spectrometry. Subsequently, altered plasma abundance of protein candidates were verified using Western blotting in HIV-infected subjects with non-proteinuric CKD (n = 8), proteinuric CKD (n = 5), and their matched non-CKD controls, as well as in HIV-uninfected subjects with impaired kidney function (n = 3) and their matched controls.ResultsAnalysis of 2DE found significantly altered abundance of five protein candidates between HIV-infected patients with non-proteinuric CKD and without CKD: alpha-1-microglobulin (A1M), serum albumin (ALB), zinc-alpha-2-glycoprotein (AZGP1), haptoglobin (HP), and retinol binding protein (RBP4). Western blotting showed an increased abundance of A1M and HP in HIV-infected patients with non-proteinuric CKD compared to their non-CKD controls, whereas A1M, AZGP1, and RBP4 were significantly increased in HIV-infected patients with proteinuric CKD compared to their non-CKD controls. Such pattern was not found in HIV-uninfected subjects with impaired kidney function.ConclusionThe data suggests four proteins that may be used as biomarkers of CKD in HIV-infected patients. Further validation in a larger cohort of HIV-infected patients is necessary for assessing the clinical use of these proposed biomarkers for CKD.     

慢性肾脏病管理模式对慢性肾脏病伴高尿酸血症患者的影响

目的探讨慢性肾脏病(CKD)管理模式用于CKD伴高尿酸血症患者的临床效果。方法选取2013年11月至2014年4月该院住院诊断为CKD伴高尿酸血症患者117例,随机分为CKD管理组58例,对照组59例,两组均采用常规药物治疗,CKD管理组在此基础上实施CKD管理模式。观察患者尿酸控制水平、生活方式改变情况,进行6个月随访。结果 CKD管理组尿酸控制水平、生活方式的改变优于对照组,差异有统计学意义(P0.05)。结论 CKD管理模式用于CKD伴高尿酸血症效果显著,值得推广。