慢性肾衰及血液透析过程中多肽生长因子与凋亡因子表达

目的：探讨慢性肾功能衰竭（ＣＲＦ）患者及血液透析（ＨＤ）过程中多肽生长因子及凋亡因子的含量变化及相互关系。方法：采用流式细胞术及放射免疫分析分别测定ＣＲＦ及ＨＤ前后外周血单核细胞（ＰＢＭＣ）中ＣＤ９５、Ａｐｏ２．７和ＢＣｌ－１蛋白的阳性细胞数及血清中ＴＧＦ－α、ＩＧＦ－Ⅱ的含量。结果：ＣＲＦ（非透析组）ＣＤ９５、Ａｐｏ２．７、ＩＧＦ－Ⅱ明显高于对照组，差异显著。ＢＣｌ－２与ＴＧＦ－α含量均明显低于     

慢性肾衰血透患者骨代谢的评估

用ＩＲＭＡ、ＲＲＡ和ＲＩＡ等对２４例维持血透患者（ＭＨＤ）测定其血甲状旁腺激素、ＰＴＨ（１￣８４）、２５（ＯＨ）Ｄ３、１，２５（ＯＨ）２Ｄ３、ＢＧＰ、血钙和磷的变化，以探讨它们之间的关系和评估患者骨代谢的状况。ＭＨＤ患者ＰＴＨ和ＢＧＰ升高，透析后则降低；２５（ＯＨ）Ｄ３和１，２５（ＯＨ）２Ｄ３降低，透析对其无明显影响；ＰＴＨ与２５（ＯＨ）Ｄ３、１，２５（ＯＨ）２Ｄ３呈负相关，Ｐ分别小于０．０５和０     

血浆HCY检测在慢性肾衰血透患者中的临床意义

目的:观察慢性肾衰血透患者的血浆同型半胱氨酸(HCY)水平及与心脑血管并发症的关系。方 法:对38例透析组患者在服用叶酸和VitB12前后及40例健康对照组作了HCY的测定。结果:慢性肾功能衰竭 (CRF)血透患者血浆HCY水平为(25.12±12.51)μmol/L,明显高于正常对照组(8.2±4.51)μmol/L(P< 0.01)。伴有心脑血管病变者血浆HCY水平(36.8±16.54)μmol/L,明显高于无心脑血管病变者血浆HCY水 平(17.9±5.32)μmol/L(P<0.01)。透析组患者服用叶酸和VitB128周前后HCY水平分别为(25.1±12.51) μmol/L,(13.2±5.74)μmol/L(P<0.01)。结论:CRF血透患者存在高同型半胱氨酸血症,其血浆HCY水平的 升高为心脑血管疾病的独立危险因子,服用叶酸、VitB12可降低HCY水平及防止心脑血管并发症的发生。     

慢性肾衰血透过程中血浆心房利钠因子水平的动态观察

本文研究了20例慢性肾衰(CRF)患者血透(HD)过程中血浆心房利钠因子(ANF)水平的动态变化和超滤量的关系.结果提示:CRF患者血浆ANF水平与肾功能衰竭程度有关,HD后血浆ANF的下降主要由于血容量减少所致.由于影响ANF的因素颇多.因此,HD前后血浆ANF变化幅度的大小难以准确地反映体内钠水潴留的纠正情况.     

慢性肾衰患者血浆胃泌素的变化

本文通过对慢性肾衰患者血清胃泌素的测定,以了解这种激素在慢性肾衰患者中的变化,以及这种激素与肾功能损害之间的关系。现报告如下。 对象和方法一、对象:（一）健康对照组:60例（男32,女28）,平均年龄     

骨质疏松骨折愈合中软骨细胞凋亡与血管内皮生长因子的表达

目的：探讨骨质疏松骨折愈合过程中血管内皮生长因子(VEGF)的表达变化及其与软骨细胞凋亡发生的关系。方法：建立SD大鼠骨质疏松股骨骨折模型,分别于骨折后1、2、3、4w取材进行HE染色及VEGF免疫组化染色,并用TUNEL法和琼脂糖凝胶电泳法检测细胞凋亡。,结果：在骨折后第1w,间充质细胞未见VEGF表达;第2、3w时软骨细胞VEGF反应呈强阳性;第4w其表达强度开始下降。骨折愈合的不同时期都有软骨细胞凋亡的发生,第3w表现最为明显。结论：VEGF在骨折的第2w表达最强,到第3、4w开始下降。软骨细胞的凋亡主要发生在骨折后的第3w。VEGF可能直接与软骨细胞凋亡发生有关。     

可溶性细胞间粘附分子-1在慢性肾衰患者中检测的临床意义

可溶性细胞间粘附分子(Soluble Intercellular Adhesion Molecule-1,ICAM-1)为细胞粘附分子中可溶性免疫球蛋白超家族成员之一,其配体为淋巴细胞功能相关抗原-1(LFA-1)[1].已知感染是引起慢性肾衰血透患者死亡的重要原因[2].我们检测尿毒症血透患者血清、透析液中sICAM-1水平变化,目的是探讨其对机体免疫功能的影响.     

慢性肾衰血透患者并发脑出血：（附8例临床分析）

本文报道慢性肾衰血透并发脑出血患者8例,占同期总透析人数的2.14％,死亡5例。提出高血压和抗凝剂是促发脑出血的主要因素,并对脑出血治疗期间的透析处理进行了讨论。     

慢性肾衰竭血透患者血清瘦素水平及其意义

为探讨慢性肾衰竭（CRF）血透患者的血清瘦素水平及其与残余肾功能、人体构成和营养状况的关系，分别采用放射免疫分析技术、生物电阻 抗技术和常规生化方法测定31例终末期CRF血透患者的血清瘦素水平、人体构成和营养相关指标。结果显示，CRF患者血清瘦素水平显著高于对照组（P＜0．001）；瘦素水平与体重指数和脂肪百分比呈正相关，与去脂体重呈负相关（P均＜0．001），与肌酐清除率、血肌酐、尿素氮以及血白蛋白、胆固醇、血红蛋白无相关性（P均大于0．05）。结论：终末期CRF患者存在高瘦素血症，其瘦素水平与残余肾功能无关，但可能导致去脂体重丢失。瘦素可以作为评价机体脂肪含量的营养指标，但没有在终末期CRF患者蛋白质营养不良中发挥显著作用。     

慢性肾功能衰竭患者血液透析发生院内感染的临床分析

目的分析慢性肾功能衰竭患者血液透析发生院内感染的临床特点以及相关危险因素。方法回顾性分析2005年5月至2010年5月期间在我院长期行血液透析的383例患者的相关临床资料,将其中160例患者出现了不同程度的院内感染设为感染组,223例患者未出现院内感染为未感染组。结果血液透析患者发生院内感染的发生率为41.78%,其中以肺部感染最为常见;感染组与未感染组患者之间的相关临床指标相比较,年龄、住院天数、是否左心衰、是否有糖尿病、是否存在低蛋白血症、插管时间以及C反应蛋白具有统计学差异（P〈0.05或0.01）,而性别、血肌酐、甘油三脂不具有统计学差异（P〉0.05）。结论对于长期血液透析患者,我们应该控制好各个危险因素,规范化管理防治院内感染的相关制度,对患者采取正规的营养支持、纠正贫血、抗感染等支持治疗,及时的作相关病原学检查,严防滥用抗生素。     

慢性心力衰竭大鼠肾组织中血小板源性生长因子及结缔组织生长因子的表达

目的:探讨血小板源性生长因子BB(PDGF-BB)及结缔组织生长因子(CTGF)在慢性心力衰竭大鼠肾组织的表达及意义。方法:采用肾上腹主动脉缩窄法制作Wistar大鼠慢性心力衰竭模型,随机分为假手术组,心衰10 d、20 d、30 d组。观察及比较各组大鼠的血流动力学数值;Masson染色方法观察大鼠慢性心衰时肾组织结构变化;免疫组织化学方法检测各组大鼠肾组织的PDGF-BB及CTGF的表达部位;免疫印迹半定量检测各组大鼠肾组织的PDGF-BB、CTGF的表达水平。结果:心衰模型各组大鼠PDGF-BB、CTGF的蛋白表达均较假手术组高,且随心衰程度的加重而表达升高。结论:慢性心衰可引起肾间质纤维化,其发生发展与心衰的严重程度密切相关。     

Expression of epidermal growth factor and its receptor in rabbits with ischaemic acute renal failure

Urinary immunoreactive epidermal growth factor (EGF) levels decrease, and renal immunoreactive EGF levels increase in rats with ischaemic acute renal failure (ARF). We investigated the immunohistochemical localization of EGF and EGF receptor in rabbits with ischaemic ARF to clarify the significance of renal EGF. Male New Zealand White rabbits underwent right nephrectomy prior to a 60 min renal artery clamp. At 3, 6, 24, 48, 72 and 96 h after ischaemia, serum urea nitrogen and serum creatinine were determined. Guinea pig anti-rabbit EGF antibody and monoclonal anti-EGF receptor antibody were used for the primary incubation. EGF was immunolocalized to the ascending limb of Henle and the distal convoluted tubule in the normal right kidneys. However, in the post ischaemic left kidneys at 6, 24, 48 and 72 h, immunoreactivity of EGF was associated with proximal tubules. In the normal kidneys, antibody to EGF receptor reacted with distal tubules and collecting ducts. In the ischaemic kidneys, EGF receptor was localized in the basolateral membrane in the proximal tubules. The expression of EGF and EGF receptor in renal tubules may play an important role in repair following ischaemic renal damage.     

百令对慢性肾衰竭模型大鼠肾脏保护和肾结缔组织生长因子表达的影响

目的 观察百令对5/6肾切除大鼠的肾脏保护作用及对肾结缔组织生长因子(CTGF)表达的影响,探讨其延缓肾衰竭进展及抗纤维化的相关机制. 方法 50只SD大鼠随机取8只为假手术组,其余行5/6肾切除术.根据术后3周血肌酐(Scr)值分为模型组、天然虫草组(2.0 g·kg-1·d-1)、百令治疗组(2.0 g·kg-1·d-1)和百令高剂量组(3.0 g·kg-1·d-1).术后4周给药.治疗1个月后检测Scr、尿素氮(BUN)浓度;光镜下观察肾脏病理改变,免疫组化方法检测肾组织CTGF、α平滑肌肌动蛋白(α-SMA)的表达水平,采用图像分析系统进行定量分析. 结果 治疗后模型组大鼠Scr、BUN明显高于假手术组(P<0.01),肾小球与肾小管间质均有明显病理改变,CTGF、α-SMA的表达明显上调;而药物治疗组的Scr、BUN明显低于模型组(P<0.05),肾脏病理损伤减轻,CTGF、α-SMA的表达降低(P<0.05). 结论 百令能改善5/6肾切除大鼠的肾功能,减轻肾脏病理损害,其机制可能与下调肾组织CTGF的表达有关.     

Neutrophil apoptosis: impact of granulocyte macrophage colony stimulating factor on cell survival and viability in chronic kidney disease and hemodialysis patients

Introduction

Altered neutrophil apoptosis might be responsible for recurrent bacterial infections encountered in hemodialysis (HD) and chronic kidney disease (CKD) patients. This work was designed to assess the neutrophil apoptotic activity and the impact of implementation of granulocyte macrophage colony stimulating factor (GM-CSF), as a survival factor, on neutrophil apoptosis among these patients.

Material and methods

Twenty-five patients on regular HD along with 34 CKD patients on conservative treatment, as well as 15 healthy controls, were investigated for apoptotic rate via assessment of neutrophil expression of Annexin-V by flow cytometry, before and after 20 h culture in absence and presence of GM-CSF. Neutrophil viability was determined using light microscopy. The preservation of neutrophil activation in these patients was analyzed by flow cytometric CD18 neutrophil expression. Chronic inflammatory state was evaluated by estimating C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1). Obtained data were statistically analyzed.

Results

Compared to controls, both HD and CKD groups had a significant increase of Annexin-V and CD18 expression and significant decrease in neutrophil viability. Culture of their neutrophils with GM-CSF showed significant decrease of apoptosis accompanied by improvement of neutrophil viability compared to their cultured cells without GM-CSF. These patients also showed significant elevation of CRP and sICAM-1.

Conclusions

Granulocyte macrophage colony stimulating factor demonstrated an evident impact on improving in vitro neutrophil survival and viability in HD and CKD patients. Therefore, this may represent promising preventive and/or therapeutic strategies against infection frequently observed in these patients and causing morbidity and mortality.     

慢性肾衰血透患者TTV检测及其与细胞免疫功能的关系

目的　观察慢性肾衰 (CRF)血液透析 (HD)患者中 ,输血传播病毒 (TTV)的感染与患者细胞免疫功能的关系。方法　应用巢式逆转录 -聚合酶链反应 (RT PCR) ,双抗体夹心ELISA法及流式细胞仪 ,分别检测了 90例CRF血透患者和 12 8例对照组血清TTV DNA ,可溶性白细胞介素 2受体 (sIL 2R)和外周血T淋巴细胞亚群。并随机选择对其中1株TTV的部分基因序列进行测定 ,分析TTV与细胞免疫功能、输血次数、HD时间和肝功能的关系。结果　⑴ 90例CRF血透患者中 ,TTV DNA阳性率为 46 6 7% ,明显高于正常对照组 (P <0 0 0 1) ,与日本报道的TTV DNA序列(AB0 0 8394)相应片段的同源性为 98 5 %。⑵CRF血透患者血清中 ,sIL 2R水平明显高于正常对照组 (P <0 0 1) ;CD3 ,CD4 和CD4 /CD8 T细胞比例明显降低 (P <0 0 1)。⑶TTV DNA阳性率与sIL 2R、输血次数及HD时间呈显著的正相关 (r =0 486 ,P <0 0 1;r =0 .5 86 ,P <0 0 0 1;r =0 492 ,P <0 0 1) ,与CD ,CD4 和CD4 /CD8 T细胞比例呈负相关 (r = 0 476 ,P <0 0 1;r = 0 483,P <0 0 1;r= 0 496 ,P <0 0 1) ,而与年龄、性别及手术史均无显著的差别和相关性。结论　CRF血透患者有严重的TTV感染 ;其高发生率可能与细胞免疫功能明显低下及其与血液紧密接触有关     

Blood Serum Levels of IL-2, IL-6, IL-8, TNF-α and IL-1β in Patients on Maintenance Hemodialysis

Cytokines are essential mediators of immune response and inflammatory reactions. Patients with chronic renal failure (CRF) commonly present with abnormalities of immune function related with impaired kidney function and the accumulation of uremic toxins in addition to bioincompatibility of dialyzer membranes. During a hemodialysis (HD) session, cytokines are released mainly by monocytes activated by endotoxin-type compounds in dialyzer fluid, complement factors and direct contact with dialyzer membrane. The study included 15 CRF patients, aged 36.4±2.9 years, on regular HD maintenance therapy for mean 68±10 months and 15 healthy controls. It was designed to assess serum levels of a panel of inflammatory cytokines: IL-1β, IL-2, IL-6, IL-8 and TNF-αin CRF patients on regular maintenance HD before, 20, 60 and 240 minutes of a single HD session in parallel with C-reactive protein (CRP) as an additional parameter. CRP concentration was increased in HD patients when compared with healthy controls. The concentrations of IL-1, IL-6, IL-8 and TNF-αwere increased, whereas the serum level of IL-2 was not altered during a single HD session.     

慢性肾衰竭大鼠肾细胞外基质变化

目的:分析慢性肾衰竭大鼠肾去细胞组织结构特点,探讨慢肾衰大鼠肾细胞外基质的病理变化。方法:SD大鼠实验组腺嘌呤灌胃,行去细胞处理后,H-E、Masson染色及电镜观察慢肾衰大鼠肾形态学结构变化及去细胞支架的生物学特性,免疫荧光分析其细胞外基质成分的变化。结果:腺嘌呤灌胃造模组慢肾衰血尿素氮、血肌酐明显增高,肾大体显示透明度降低,且随灌胃时间延长,H-E染色整体支架更加粗大,同时细胞数目以及小管区结晶数目明显增多;Masson三色染色显示实验组肾支架可见大量蓝色的胶原纤维沉积;扫描电镜显示2组肾细胞外基质三维结构紊乱,细胞外胶原纤维更加致密且有不同程度的增生;进一步免疫荧光检测,显示实验组支架的层黏连蛋白、胶原蛋白Ⅰ及Ⅳ都有明显的绿色荧光表达。结论:慢性肾衰肾支架病理形态结构改变及细胞外基质增生,为进一步研究慢肾衰肾支架是否可作为复细胞支架提供依据。     

The activity of erythrocyte glutathione peroxidase in chronic renal failure

Summary In 18 patients with terminal chronic renal failure on twice weekly maintenance hemodialysis, the predialysis activity of glutathione peroxidase was not impaired but rather slightly but significantly elevated when compared with healthy controls (2.7 versus 2.1 units/p<0.01). This was attributed to the reduced mean cell age.     

Review article--involvement of gastric APUD cells in chronic renal failure

Uremia leads to a number of metabolic and hormonal disorders induced by renal failure with definite biological and clinical sequels. Most frequently, alimentary disorders are the first to appear, followed by symptoms from other organs and systems. The gastrointestinal tract is a site of synthesis of many compounds that have hormonal or hormonal-like biological activity. These substances are produced by highly-specialised receptor-effector cells, that are dispersed in the gastrointestinal mucosa and classified as APUD cells. The present review is an attempt to make a synthesis of current opinions and views concerning the effect of homeostatic dysfunction of the kidneys on the morphology and action of APUD cells in the stomach.