黑龙江省肾综合征出血热患者血清汉坦病毒致病株分析

目的 对黑龙江省肾综合征出血热(HFRS)患者血清中汉坦病毒(HV)进行分离、扩增,寻找其与国际标准株(76-118株)之间的差异.方法 应用反转录-巢式-聚合酶链反应(RT-nested-PCR),对50例发病不同时期的HFRS患者血清中HV进行分离、扩增,并将扩增产物进行序列测定及同源性分析.结果 发病7 d内患者血清HV检出率为36.36%(8/22),发病8～14 d的患者血清HV检出率为13.04%(3/23),发病15 d以上的5例患者均未检出.选取的7例样本(第1、9、18、31、37、38、44号标本)HV S基因片段序列与76-118株S基因片段的同源性分别为90.24%、86.72%、89.97%、89.16%、86.45%、87.26%和89.43%.结论 发病7 d内患者检出率明显高于其他时期;黑龙江省HV致病株与国际标准株存在一定差异,说明HV除具有宿主依赖性外,还具有地域的影响.     

Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria

Acute kidney injury (AKI) is often overlooked in hospitalized patients, despite the fact that even mild forms are strongly associated with poor clinical outcomes such as increased mortality, morbidity, cardiovascular failure and infections. Research endorsed by the Acute Dialysis Quality Initiative led to the publication of a consensus definition for AKI--the RIFLE criteria (Risk, Injury, Failure, Loss of function, and End-stage renal disease)--which was designed to standardize and classify renal dysfunction. These criteria, along with revised versions developed by the AKI Network (AKIN), can detect AKI with high sensitivity and high specificity and describe different severity levels that aim to predict the prognosis of affected patients. The RIFLE and AKIN criteria are easy to use in a variety of clinical and research settings, but have several limitations: both utilize an increase in serum creatinine level from a hypothetical baseline value and a decrease in urine output, but these surrogate markers of renal impairment manifest relatively late after injury has occurred and do not consider the nature or site of the kidney injury. New biomarkers for AKI have shown promise for early diagnosis and prediction of the prognosis of AKI. As more data become available, they could, in the future, be incorporated into improved definitions or criteria for AKI.     

Characterization of Hantaan virions, the prototype virus of hemorrhagic fever with renal syndrome

Hantaan virus, strain 76-118, was propagated to high titer in a clone of Vero cells, and infectious virions were successfully concentrated and purified. Infectivity and virus antigenic activity were closely associated with a virus particle that exhibited a sedimentation rate indistinguishable from a representative member of the Bunyaviridae. Purified virions sedimented to a density of 1.16-1.17 in sucrose and 1.20-1.21 in cesium chloride. Detergent disruption of virions resulted in a nucleocapsid structure (density, 1.18 in sucrose and 1.25 in cesium chloride) and soluble protein antigens. Three separate nucleocapsids were resolved by rate-zonal centrifugation and contained a single but common polypeptide of 50,000 daltons. Electrophoresis of radiolabeled RNA extracted from purified virions yielded a profile of three RNA species with apparent molecular weights of 2.7, 1.2, and 0.6 X 10(6). These data support earlier electron microscopy reports which suggested that Hantaan virus has characteristics similar to some members of the virus family Bunyaviridae.     

应用巢式RT-PCR结合RFLP、SSCP对山东肾综合征出血热病人血清中HV基因检测和分型研究

目的探讨山东肾综合征出血热重疫区病人血清中HV分子生物学特征,同时寻找准确、简便、迅速的HV检测与分型方法,从而为制定防治决策提供科学根据。方法从山东肾综合征出血热重疫区临沂市费县收集病人早期血清,应用巢式RT-PCR对病人血清中的HV进行基因扩增,采用RFLP、SSCP分型,并进行序列测定与分析。结果48份临床和ELISA检测确诊的HFRS病人血清经巢式RT-PCR扩增后,41份阳性,阳性率85.42%。41份阳性标本巢式RT-PCR产物经HindIII、HinfI酶切后,呈现2种不同的RFLP图谱:33份显示与R22株相似的酶切图谱,应属SEOV型;另外8份显示出与HTN76-118株相似的图谱,属HTNV型,这8份HTNV型标本均为10-12月间收集的病人血清。41份阳性标本巢式RT-PCR产物经SSCP分析,亦呈现2种不同的图谱:33份具有与R22株相似的SSCP图谱,应属SEOV型;而另8份则与HTN76-118株具有相似的SSCP图谱,属HTNV型。对部分扩增产物序列采用系统进化树分析也得出类似的结果:sdp1、sdp2、sdp3与HTN型76-118株亲缘关系相近,属同一簇,而sdp22、sdp37与SEOV型Z37、R22株亲缘关系相近,属另外一簇,这与RFLP和SSCP获得的结果相一致。结论山东肾综合征出血热重疫区病人基因型以SEOV型为主,但在秋冬季节也存在HTNV型。巢式RT-PCR结合RFLP、SSCP法可对HV准确分型,而且简便、迅速,适合于大规模流行病学调查。     

肾综合征出血热感染者尿液RT-PCR法检测

目的应用逆转录聚合酶链反应法(RT-PCR)对临床诊断及拟诊断为肾综合症出血热(HFRS)病例尿样标本进行检测,为临床诊断及科研提供一种新的检测手段。方法对临床诊断和拟诊断为HFRS病例者125名(男91例,女34例)和30名健康者的尿液样本,用RT-RCR法进行检测,同时设置标准病毒株进行对照。结果临床诊断为HFRS病例的125人,其中103人尿样标本为阳性,阳性率为82.4%;标准病毒株为阳性;30名健康者尿样标本为阴性。结论RT-PCR法具有方法简便、灵敏度高、特异度好,而且快速的特点,适用于临床对HFRS的检测及科研应用。     

重症肾综合征出血热患者心脏损害的多普勒超声心动图的研究

目的研究重症肾综合征出血热（ＨＦＲＳ）患者的心脏损害。方法应用多普勒超声（ＵＣＧ）随访观测５０例急性期、恢复期ＨＦＲＳ患者及３０例正常对照组的心脏解剖结构及心脏功能。结果急性期患者室壁及心包较正常对照组轻度增厚、动度减弱，不同程度的回声改变。１８例有心包积液，３８例瓣膜返流，心脏舒缩功能减退。结论重症ＨＦＲＳ患者心脏损害是心肌、心内膜及心包广泛受累的全心炎症，与预后密切相关。     

肾综合征出血热并发中枢神经系统损伤的心电图分析

目的探讨肾综合征出血热(HFRS)并发中枢神经系统损伤患者的心电图(ECG)改变与损伤原因、严重程度及预后的关系。方法前瞻性研究HFRS并发中枢神经系统损伤患者ECG的变化,统计并分析ECG在不同患者中的异常类型及异常发生率。结果HFRS并发中枢神经系统损伤患者ECG异常率与总的HFRS患者ECG异常率比较差异有显著性(P<0.01);与无神经系统并发症的重型、危重型HFRS患者ECG异常率及心肌酶学水平比较差异有显著性(P值均<0.05);不同严重程度、不同预后患者ECG异常率比较差异有显著性(P值分别为<0.05、<0.01);不同损伤原因患者ECG异常率比较差异无显著性(P>0.05);心电图逐渐改善患者预后良好。结论HFRS并发中枢神经系统损伤患者的ECG改变与中枢神经系统损伤有关,与损伤严重程度及预后密切相关。     

西安市肾综合征出血热病例的相关特征

目的 了解肾综合征出血热流行大高峰期与其他时间段的病例特征,指导该病的预防治疗工作.方法 采用回顾性调查研究,对西安市肾综合征出血热高发地区病例进行调查,调查内容包括病例基本情况、临床症状特点、实验室检查结果等.统计学处理采用x2检验和rank检验.结果 共调查病例429例,其中男280例,占65.3％,男女比例为1.9∶1.16～60岁的青壮年为发病主要人群,占74.8％.流行大高峰期和其他时间段年龄为16～60岁患者的构成比分别为76.1％(245/322)、71.0％(76/107),男女性别比分别为1.93∶1、1.74∶1,发热距入院时间分别为3d和4d,住院时间均为10 d,入院时病情急患者的比例分别为59.8％(189/316)、67.6％(71/105),出院时治愈患者的比例分别为56.4％(181/321)、43.4％(46/106),两个时间段患者的基本特征差异均无统计学意义(x2=0.117,P=0.572;x2 =0.185,P=0.667;Z=-1.430,P=0.153;Z=-1.254,P=0.213;x2 =3.145,P=0.208;x2=8.215,P=0.084).IgM抗体阳性率为85.4％(315/369),其中大高峰期IgM抗体阳性率为88.4％(251/284),其他时间段为75.3％(64/85),大高峰期IgM抗体阳性率较其他时间段高(x2 =8.968,P＜0.01).患者临床症状的严重程度与出院情况之间存在相关性(x2 =18.558,P＜0.01),症状越轻,结局转归越好.结论 西安市2008年1月至2011年6月肾综合征出血热病例在大高峰期与其他时间段内表现的特征基本一致.     

肾功能评分在心脏瓣膜术后急性肾损伤的应用

目的:研究旨在探讨肾脏衰竭危险、肾脏损伤、肾功能衰竭、肾功能丧失及终末期肾病(RIFLE)分级,对我院成年心脏瓣膜手术后患者临床转归的应用价值。方法:收集2006年10月至2007年3月首次行心脏瓣膜手术的成年患者资料。记录患者性别、年龄、手术类型、尿量、血生化指标和临床转归等。按照RIFLE分级在术后对患者进行评分并记录最高分值。结果:465例患者,男性182例(39.1%),女性283例(60.9%),平均年龄(50.0±11.9)岁。住院病死率2.4%。根据RIFLE分级,最终发生不同程度急性肾功能损伤(AKI)的患者共占32.0%;R级、I级和F级4组患者的住院病死率分别为:1.4%、7.7%和16.3%,以F级患者的病死率为最高(P<0.01)。受试者工作特征曲线(ROC)曲线下面积分析RIFLE和死亡之间有很好的相关性。结论:AKI是心脏瓣膜手术后的常见并发症之一,明显增加术后病死率。RIFLE分级对此类患者的预后及住院病死率有较好预测能力。     

肾综合征出血热患者尿沉渣细胞中病毒RNA的检测

目的进一步阐明病毒在肾综合征出血热肾脏损害中的作用。方法应用套式－逆转录－聚合酶链反应对３１例肾综合征出血热患者７９份尿液沉渣细胞中病毒核酸进行检测。结果７９份样本中５８份阳性，阳性率为７３．４％在病程早期（１～７天）各型患者的检出率为１００％；在病程后期（≥１３天），轻、中、重型患者的检出率分别为０％、１６％和８５％，重型患者的检出率较中型、轻型患者高（Ｐ＜０．０１，Ｐ＜０．０５）；且检出率与肾功能损害密切相关。结论早期存在病毒对肾脏有直接损伤作用，在重型患者病毒的直接作用为肾脏损害的主要因素。     

肝功能参数在肾综合征出血热中的意义

肾综合征出血热(HFRS)的三大病理损害是出血、休克、肾功能衰竭。本研究对369例患者进行肝功能的临床研究，重点观察少尿期肝功能的变化，探讨肝脏损害在HFRS患者的意义。HFRS患者中，肝脏损害程度及发生率不亚于肾脏损害，肝功能衰竭等同于肾功能衰竭，同样是致死的主要原因。     

Acute kidney injury in dengue fever using Acute Kidney Injury Network criteria: incidence and risk factors

The aim of this study was to assess incidence and risk factors for acute kidney injury (AKI) in patients with dengue fever (DF). A total of 223 patients (males, 130; females, 93; mean age, 26.2 ± 18.2 years) from a tertiary care centre in southern India were retrospectively analysed. Acute renal failure (ARF) developed in 24 (10.8%) patients. Based on the Acute Kidney Injury Network (AKIN) criteria, the results revealed that: 12 (5.4%) had mild AKI; seven (3.1%) had moderate AKI; and five (2.2%) had severe AKI. A further 54 (24%) were diagnosed with dengue haemorrhagic fever (DHF); 11 (5%) were co-infected with leptospirosis; thrombocytopenia was present in 157 (70%); and 64 (29%) were hypotensive. Patients were divided into either group A (with AKI) or group B (without AKI), and group A was divided into mild (A1), moderate (A2) and severe (A3) subgroups. We recorded: a higher total white count (A = 9824; B = 6706; P = 0.01); serum glutamic pyruvic transaminase (SGPT; A = 450; B = 144; P = 0.001); alkaline phosphatase (ALP) levels (A = 207; B = 42; P = 0.001); lower albumin (A = 2.65; B = 3.09; P < 0.001); and serum bicarbonate (A = 20.57; B = 23.21; P = 0.009). Hypotension (P = 0.01), coexisting viral hepatitis (P < 0.001), sepsis (P < 0.001), multiple organ dysfunction syndrome (MODS; P < 0.001) and the need for inotropes (P < 0.001) were associated with DF. Total white count (P = 0.038), glomerular filtration rate (GFR) on discharge (P = 0.034), specific gravity of urine (P = 0.006), ALP (P = 0.013), SGPT (P = 0.042), MODS (P = 0.05) and use of platelet fresh frozen plasma (FFP; P = 0.007) were significantly different between mild, moderate and severe AKI subgroups. Twenty-two (9%) died. AKI is associated with an increased mortality in DF (P = 0.005).