表现为肾病综合征的IgA肾病病理特征及其与预后的关系

目的探讨表现为肾病综合征(肾综)的IgA肾病病理特性及其与预后关系。方法分析1987~2002年中山大学附属第一医院肾内科确诊的IgA肾病723例,表现为肾综的IgA肾病的临床、病理特征及疗效,与非肾综IgA肾病进行比较并长期随访。结果7.1%(51/723)IgA肾病表现为肾综。肾综组高血压和肾功能不全发生率显著高于非肾综组(35.3%对13.8%和47.1%对19.2%,P<0.05);而肾小球指数和新月体指数均显著高于非肾综组(P<0.05)。IgA肾综组存活率显著低于无肾综组(P<0.01),1、3、5年肾存活率分别为100.0%、84.9%、68.6%和100.0%、95.9%、91.9%(P<0.05)。64%(7/11)Lee氏Ⅰ~Ⅱ级的肾综对激素敏感。结论呈肾综的IgA肾病病理损害较重,预后差,但有少数病理病变轻微,可能对激素敏感。     

IgA肾病合并高血压患者的临床与病理特点分析

目的探讨IgA肾病合并高血压患者的临床与病理特点。方法根据血压状况将317例IgA肾病患者分为高血压组119例和非高血压组198例,分析两组临床和病理特点。结果高血压组肾功能不全的发生率明显高于、血尿的发生率明显低于非高血压组(P<0.05);高血压组24 h尿蛋白定量、尿NAG酶、血肌酐、血尿酸及年龄均显著高于非高血压组,血浆白蛋白水平显著低于非高血压组(P均<0.05);高血压组肾小球硬化指数、间质指数和血管指数均高于非高血压组,病理损害程度为重度者的比例明显高于非高血压组(P均<0.05)。结论合并高血压的IgA肾病患者临床上高尿酸血症、贫血、肾功能不全等的发生率高,肾脏病理损害程度较重,其可能的临床风险因素是高蛋白尿及高血肌酐水平;可能的病理风险因素为肾小球硬化、间质小管病变及肾血管病变。     

影响IgA肾病预后的危险因素分析

目的通过分析IgA肾病患者的临床资料及病理特征,探讨影响IgA肾病患者长期肾存活率的危险因素。方法分析724例肾活检确诊为IgA肾病患者肾活检时的临床资料及病理特征。对所有患者进行随访,每3~6个月检测尿蛋白、血肌酐(Scr)等指标,以Scr值比基础值升高1倍以上为观察终点。随访时间>6个月者才纳入成功随访病例。用非参数乘积限估计法(Kaplan-Meier法)分析生存率,用Cox回归模型分析影响预后的危险因素。结果共有317例IgA肾病患者成功随访,肾活检后平均随访时间为(43·5±32·2)个月。有39例(12·3%)患者进入随访终点,其1、3、5、10年肾存活率分别为99·5%、93·1%、84·5%和60·1%。Cox比例风险模型单因素分析发现病程长、肾活检时血Scr>115μmol/L、尿蛋白>1·0g/24h、高血压、Lee氏分级Ⅳ级或Ⅳ级以上、中重度肾小球硬化、新月体形成、中重度肾间质纤维化和肾小血管损害是影响IgA肾病预后的危险因素;多因素分析结果显示,蛋白尿、血Scr水平、肾小球硬化、新月体形成、肾间质纤维化是影响IgA肾病预后的独立危险因素。结论蛋白尿、肾功能不全、肾小球硬化、新月体形成和肾间质纤维化是影响IgA肾病预后的独立危险因素。     

IgA肾病患者血清低糖基化IgA1水平的变化及其临床意义

目的　探讨IgA肾病患者血清低糖基化IgA1的程度与临床表现、肾脏病理及近期疗效间的关系。方法　用ELISA法对 68例IgA肾病及 2 0例肾病综合征肾小球微小病变 (MCD )患者血清IgA1糖基化程度进行检测 ,并经治疗后随访。 结果　IgA肾病患者蚕豆凝集素与血清IgA1的结合力明显高于对照组 (P <0 .0 2 5 )。IgA肾病患者中 2 0例低糖基化组和 48例正常糖基化组比较 ,前者发病年龄轻、血IgA浓度及肌酐清除率低于后者 (P值均 <0 .0 5 ) ,而病程、尿蛋白排泄量、总胆固醇水平、血压、肾小球病理分级和近期疗效比较差异无显著性 (P值均 >0 .0 5 )。结论　IgA肾病患者血清IgA1呈低糖基化 ,血清低糖基化程度重者发病年龄较轻 ,但肾功能损伤较重 ,血IgA1低糖基化程度不能推测肾脏病理轻重或近期疗效     

新月体IgA肾病的临床和病理

目的　了解新月体IgA肾病的临床、病理和免疫病理特征。方法　选择新月体IgA肾病 2 0例 ,男性 13例 ,女性 7例 ,平均发病年龄为 2 8 5± 12 6岁 ,平均病程为 5 1± 5 3个月 ;占IgA肾病 3 1%及新月体肾炎 16 4% ;并与总体IgA肾病患者的临床及免疫病理进行比较。结果　本组患者临床多数表现为急进性肾炎综合征 (90 % ) ,肉眼血尿发生率高达 75 % ,有高血压者占 6 5 % ,有肾病综合征者占 45 %。病理上肾小球病变除表现为新月体 (平均 6 5 % )外 ,还有节段性袢坏死 (6 0 % )、内皮增生 (30 % )、炎细胞浸润 (40 % )等急性病变 ,以及肾小球全球硬化、节段硬化、包囊壁断裂等慢性病变 ;小管间质病变较重 ,中重度小管萎缩、间质纤维化及间质炎细胞浸润分别为 70 %、80 %及 85 % ;间质血管炎和 (或 )纤维素样坏死的发生率为 40 % ;免疫病理表现为IgA、IgA G、IgA M及IgA G M沉积四种类型。此外 ,肾组织CD 4、CD 8、CD 68及PCNA 细胞浸润数均明显高于正常供肾组织。结论新月体IgA肾病患者临床上主要表现为急进性肾炎综合征 ,肉眼血尿发生率高 ;病理上具有小球、小管、间质及血管等多部位及多种多样病理改变。尽管多数患者病情急 ,病程短 ,然而小管间质病变仍较重 ;免疫病理也多样化 ,IgA M和IgA M     

系膜IgA沉积的供肾移植后的转归

目的 :探讨接受系膜IgA沉积的供肾移植后的临床转归。　 方法 :对供肾进行常规活检 ,比较系膜IgA沉积供肾 (IgA供肾组 ,n =83)与系膜无IgA沉积供肾 (无IgA供肾组 ,n =2 5 9)移植后的转归 ,以及两组之间性别、年龄、透析时间、供肾冷热缺血时间、补体依赖性微量淋巴细胞毒、群体反应性抗体水平和原发病的分布。　 结果 :2 4 3%的受者接受了IgA沉积的供肾。IgA沉积供肾组术后浮肿、蛋白尿、血尿、低白蛋白血症、高血压和移植肾功能延迟恢复的发生率明显高于无IgA供肾组。肾移植 3个月内 ,IgA沉积供肾组急性排斥反应发生率明显高于无IgA沉积供肾组 ,分别为 31 3%和 19 3%(P <0 0 0 1)。临界改变发生率分别为 37 3%和 16 2 %(P <0 0 0 1)。随着移植时间推移 ,IgA沉积供肾组IgA沉积例数逐渐减少 ,术后 1、3和 6个月仍有系膜IgA沉积者分别为 2 6例(31 3%)、9例 (10 8%)和 2例 (2 4 %) ,至 6个月时与对照组比较差异不明显。两组间 1年肾存活率差异不显著 ,分别为 93 8%和 95 6 %,3年存活率分别为 86 7%和 88 3%。　 结论 :系膜IgA沉积的供肾移植后移植肾功能延迟恢复和急性排斥反应的发生率明显高于无IgA沉积供肾组 ,但不影响远期肾存活率 ,且系膜区IgA沉积可以逐渐消失。     

CD71在IgA肾病肾组织中的表达与临床病理关系

目的研究CD71在人类IgA肾病肾组织中的表达强度及与IgA肾病临床病理关系,分析其作为IgA肾病病理和预后标记物的可能性。方法选取该院180例肾穿刺活检为IgA肾病患者,收集患者临床资料,采用光镜、免疫组织化学、免疫荧光、IgA肾病半定量评分等方法检测IgA肾病组肾组织中CD71的表达,并与正常对照组比较;分析CD71与病理严重程度及临床的相关性。结果 (1)在IgA肾病组,CD71的表达明显高于正常对照组(P0.05),且CD71的表达强度随肾组织病理损害加重而增强;(2)IgA肾病肾组织中CD71表达量与IgA肾病组织学半定量评分法中的系膜细胞增生指数(Ms HI)和系膜基质增多指数(Ms MI)呈正相关(P0.05);(3)IgA肾病肾组织中CD71的表达量与患者的蛋白尿水平呈正相关,与肌酐清除率水平呈负相关(P0.05),而与患者血尿水平无明显相关性(P0.05)。结论 CD71在IgA肾病不同病理肾组织表达不同,随病理损害的加重而增强,且CD71的表达与反应系膜细胞和系膜基质增多指数相关,提示CD71与系膜细胞增殖关系密切;另外,CD71表达量与蛋白尿呈正相关,与肌酐清除率呈负相关,提示其与IgA肾病肾功下降及预后不良有关。因此,肾组织CD71的表达可作为判断该症严重程度和预后的生物学标记物之一。     

伴高尿酸血症的IgA肾病临床与病理分析

目的 探讨血清尿酸对IgA肾病临床、病理及预后的影响.方法 回顾性分析我院2007年1月至2010年10月456例经肾穿刺活检病理确诊为原发性IgA肾病住院患者的临床和肾脏病理特点资料.采用t检验和x2检验进行统计学处理.结果 456例IgA肾病患者中高尿酸血症者127例,发生率为27.9％,高尿酸血症组平均年龄、男性所占比例、高血压发生率、血清胆固醇、甘油三酯、体质量指数、肌酐、尿蛋白定量(24h)水平显著高于血尿酸正常组(P＜0.05,P＜0.01);高尿酸血症组肾组织病理病变程度显著重于血尿酸正常组(P＜0.01),分别为肾小球积分(8.1±0.8和5.3±0.9),肾小管间质积分(4.2±0.4和2.7±0.4),血管病变积分(1.43±0.60和0.76±0.29).结论 高尿酸水平对IgA肾病有明显影响,积极降低血清尿酸,有效控制上述临床指标,可望减轻肾组织损害,延缓IgA肾病的进展.     

老年患者IgA肾病的临床与病理分析

目的了解老年IgA肾病的临床与病理特点。方法回顾性对比分析该院近20年老年IgA肾病(老年组)患者并将同期年龄<60岁的患者作为对照组。结果①两组均以男性多见,分别占59.18%(29/49)及60.71%(924/1 522),两组在性别构成方面差异无统计学意义(P>0.05);②两组的患者占该院同期同年龄肾活检患者的比例分别是12.60%及35.99%,二者差异显著(P<0.01);③老年患者在发生水肿、高血压、尿素氮、肌酐升高比例、合并肾功能不全、尿蛋白定量均较对照组高,而血浆白蛋白低于对照组(P<0.05)。血尿的发生率两组无差别(P>0.05);④临床诊断老年患者慢性肾小球肾炎及肾病综合征常见,而对照组则以慢性肾小球肾炎及隐匿性肾小球肾炎常见(P<0.01);⑤血中IgG、IgA、IgM、C3、C4平均浓度、IgA/C3浓度之比两组差别无统计学意义(P>0.05)。结论①IgA肾病男性多于女性,老年患者较年轻患者少见;②老年患者临床表现较年轻患者重。肾病综合征表现明显高于年轻患者;③IgA浓度及血清IgA/C3比值对IgA肾病的诊断有一定的帮助。     

以毛细血管内皮细胞弥漫增生为主要表现的IgA肾病的临床病理特点及其预后

目的探讨以毛细血管内皮细胞弥漫性增生为主要表现的IgA肾病(EPIgAN)的临床、病理特点和预后。方法分析北京大学第一医院近15年来IgA肾病(IgAN)的临床和病理资料,比较EPIgAN与非EPIgAN临床病理特点和肾脏存活率;分析EPIgAN预后及其影响因素;观察激素治疗对EPIgAN预后的影响。结果920例IgAN中符合EPIgAN47例,占5·1%。EPIgAN与非EPIgAN相比,肾穿时尿蛋白升高、高血压和水肿多见,细胞新月体明显,而肾小球硬化和肾间质纤维化则较轻;对所有研究对象进行随访,其中36例EPIgAN患者完成随访,平均随访62个月。100例非EPIgAN患者完成随访,平均随访时间64个月。两组共7例到达随访终点。Kaplan-Meier分析两组自然预后差异无显著性(LogRank,P=0·52);Cox回归分析内皮弥漫增生不是影响IgAN预后的危险因素(P=0·27);激素治疗能降低EPIgAN尿蛋白,但随访期内肾脏存活率与对照组差异无显著性。结论EPIgAN肾穿时临床表现重、组织活动性病变多而慢性化指标少,内皮弥漫增生不是影响IgAN预后的危险因素。     

高尿酸血症与IgA肾病临床病理的相关性分析

目的 探讨高尿酸血症与IgA肾病临床病理的相关性.方法 选取2007年1月至2010年12月在吉林大学第一医院肾内科肾活检确诊为IgA肾病患者148例,根据血尿酸水平分为血尿酸正常组(107例)和血尿酸增高组(41例),并对两组年龄、性别、高血压、病程、体重指数、生化指标及病理情况进行比较.结果 二组患者间性别、年龄等差异均无统计学意义(P>0.05).血尿酸增高组患者高血乐发病率、病程(月)、体重指数(kg/m2)、血尿素氮(mmol/L)、肌酐(μmol/L)、TG (mmol/L)及24 h尿蛋白定量(mg/24 h)分别为63.4%、18.90 ±10.12、22.81±3.60、8.93±4.28、155.96±107.72、2.11±1.06和4328.16±1434.25,而血尿酸止常组分别为38.3%、9.46±3.91、15.32±2.54、5.21±2.18、79.52±40.01、1.86±1.20和2885.10±1388.15,两组患者差异均有统计学意义(P值均<0.05).Lee's分级血尿酸增高组I+Ⅱ级占12.2%、IV+V级占39.0%,而血尿酸正常组I+Ⅱ级占25.2%、IV+V级占16.9%,两组患者差异均有统计学意义(P值均<0.05).肾小管间质损害(TIL)分级血尿酸增高组以Ⅲ十Ⅳ级多见,占68.3%,而血尿酸正常组以Ⅱ级多见,占76.6%.肾小动脉病变分级血尿酸增高组以Ⅱ+Ⅲ级多见,占73.2%,而血尿酸止常组以0+I级多见,占69.2%.结论 IgA肾病患者血尿酸水平与24 h尿蛋白定量、血压、肾功能损害相关,血尿酸升高者Lee's分级、TIL分级及肾小动脉病变分级较差.

Abstract：

objective To analyze the correlation between the level of serum uric acid and the clinical and pathological features of IgA nephropathy.Methods Totally 148 patients diagnosed as IgA nephropathy by renal biopsy in our hospital from January 2007 to December 2010 were divided into hyperuricaemic group(41 cases)and non-hyperuricaemic group(107 cases)according to the level of serum uric acid.The clinical parameters and renal pathology grade were compared.Results There were significant differences between hyperuricaemic group and non-hyperuricaemic group in the incidences of hypertension(63.4%vs 38.3%),disease duration[(18.90±10.12)months vs(9.46±3.91)months]and body mass index[(22.81±3.60)kg/m2vs(15.32±2.54)kg/m2](all P<0.05),while no differences in age and sex(both P>0.05).The blood urea nitrogen(BUN)[(8.93±4.28)mmol/L vs (5.21±2.18)mmol/L],creatinine(Cr)[(155.96±107.72)μmol/L vs(79.52±40.01)μmol/L],serum triglycerides[(2.11±1.06)mmoVL vs(1.86±1.20)mmol/L]and 24-hour urine protein amount [(4328.16±1434.25)mg/24 h vs(2885.10±1388.15)mg/24 h]were significantly different between the two groups(all P<0.05).The percentage of Lee's grade I+Ⅱin hyperuricaemic group was 12.2%,and IV+V grade was 39.0%,while percentage of Lee's grade I+Ⅱin non-hyperuricaemic group was 25.2%,and IV+V grade was 16.9%(P<0.05).Tubulointerstitial lesions(TIL)gradeⅢ+IV was more in hyperuricaemic group,which was 68.3%,while TIL grade II was more in non-hyperuricaemic group,which was 76.6%.Renal artery damage grade II+Ⅲ was more in hyperuricaemic group.which was 73.2%,while renal artery damage grade 0+1 was more in non-hyperuricaemic group,which was 69.2%.Conclusion The level of serum uric acid was related with 24-hour urine protein amount,blood pressure and kidney function in IgA nephropathy,and Lee's grade,TIL grade and renal artery damage grade were severe in hyperuricaemic group.     

Acute myocardial infarction in patients aged under 45 years.

INTRODUCTION: Coronary artery disease (CAD) becomes an important cause of morbidity and mortality after the age of 45 years. OBJECTIVE: To evaluate the epidemiology and clinical features of all patients under 45 years old admitted with myocardial infarction. METHODS: We studied 595 patients admitted with myocardial infarction between January 2000 and December 2002. We analyzed risk factors for CAD, clinical profile, therapeutics and complications (arrhythmic, mechanical and ischemic). The patients were divided into two groups: A--under 45 years old and B-- aged 45 or over. RESULTS: Group A--56 patients (9.4%); group B--539 patients (90.6 %). There was a higher prevalence of smoking in group A (57% vs. 23.6%; p < 0.01). Hypertension, diabetes and history of CAD were significantly more common in group B. There were no differences in hyperlipidemia (group A: 43% vs. group B: 43.5%). Fibrinolysis was performed in 28 patients (70%) from group A compared to 40 patients (45.9%; p < 0.01) from group B. Use of digitalis and inotropic agents was greater in group B. No differences were found in other pharmacological therapeutics. We found more complications in group B (24% vs. 11%). CONCLUSIONS: There was a higher prevalence of smoking in patients under 45 years old and of hypertension, diabetes and CAD in patients aged over 45. The high rate of hyperlipidemia in both groups highlights the importance of primary prevention. Fibrinolysis was performed more frequently in younger patients. There were more complications in older patients.     

中老年男性冠心病危险因素的分布及演变

目的 探讨冠状动脉粥样硬化性心脏病(CHD)危险因素在中老年男性人群中的分布及其演变,为不同年龄男性人群CHD的防治提供依据. 方法 集中对我院部分在职干部和所属134个军队社区及离退休干部2176人进行体检,选择资料完整,年龄45以上的男性受检者1639人,将其分为非老年组(45～59岁)及老年组(60～93岁)进行CHD危险因素分析;再将60岁以上受检者分为3组(60～69岁、70～79岁、80～93岁),对老年人随增龄CHD危险因素的演变进行逐项分析.结果 非老年组饮酒、吸烟、舒张期高血压、低高密度脂蛋白胆固醇(HDL-C)的检出率分别为48.0%、24.6%、22.7%、8.3%,高于老年组31.6%、14.1%、13.2%、3.2%(x2分别为28.80、18.35、15.72和17.84,均为P<0.01);老年组超体质量、收缩期高血压、高空腹血糖、高餐后2 h血糖(2 hPBG)的检出率分别为45.5%、33.2%、15.2%、40.5%,高于非老年组25.4%、11.1%、8.1%2、6.2%(x2分别为36.40、50.97、9.09和18.98,均为P<0.01);两组高三酰甘油(TG)、高胆固醇的检出率分别为36.9%、31.5%及18.0%、16.2%,组间比较差异无统计学意义(均为P>0.05).70～79岁组超体质量及高2 h PBG的检出率降低(P<0.05);饮酒、吸烟、舒张期高血压、高TG的检出率减少,差异均有统计学意义(均为P<0.01);80～93岁组超体质量、高2 h PBG及高TG的检出率与70岁以上老年组比较降低(x2分别为10.05、4.16、5.97,均为P<0.01);收缩期高血压的检出率70岁及以上老年组明显高于60～69岁组,差异均有统计学意义(X2=21.25,P<0.01);其他CHD危险因素老年各年龄组间比较,差异无统计学意义(P>0.05). 结论 非老年人CHD危险因素干预的重点为戒烟、限酒、低脂饮食、改变不良牛活习惯,控制舒张期高血压及有效的调脂治疗;老年人CHD危险因素干预重点则为限制总热量摄入、适量运动、减轻体质量、控制收缩期高血压、高血糖及进行有效调脂.     

不同年龄老年急性心肌梗死住院患者近期预后的临床分析

目的 探讨年龄对老年住院急性心肌梗死(AMI)患者近期预后的影响.方法 对2535例老年AMI住院患者按年龄、预后分别分组.回顾性分析年龄、并存疾病对AMI患者预后的影响.结果 80v94岁组与65～79岁组、60～64岁组比较,住院病死率升高,分别为7.5%、14.2%和22.9%(χ2=46.378,P<0.01),30 d病死率亦升高(χ2=44.534,P<0.01);60～64岁AMI患者30 d死亡组陈旧性心肌梗死、肾功能不全、肺功能不全例数高于存活组,心绞痛例数低于存活组(P<0.05);65～79岁AMI患者30 d死亡组合并陈旧性心肌梗死、高血压、糖尿病,脑血管病、肾功能不全、肺功能不全例数均高于存活组;合并心绞痛例数低于存活组(P<0.05).80～94岁AMI患者30d死亡组陈旧性心肌梗死、糖尿病、脑血管病、肾功能不全、肺功能不全例数均高于存活组,心绞痛低于存活组(P<0.05);80～94岁以上30 d死亡组与60～64岁、65～79岁的死亡组比较,陈旧性心肌梗死、高血压、糖尿病、脑血管病、肺功能不全患者增加(P<0.05).结论 AMI患者病死率随增龄而升高,不典型心绞痛是80岁及以上AMI患者死亡的独立危险因素.     

IgA肾病病理特征及危险因素分析

目的研究IgA肾病的临床及病理变化特点。方法回顾性分析2005年3月至2009年7月在沈阳军区总院肾内科住院接受肾活检并经免疫病理检查确诊为原发性IgA肾病211例患者的临床及病理资料。结果肉眼血尿发病率38.3%,镜下血尿+蛋白尿发病率45.9%。具有明确的黏膜感染病史者占9.4%,发病前有明确诱因的患者占37.8%。镜下血尿+蛋白尿组水肿发病率11.1%,高血压发病率17.9%,肾功能损害发病率7.2%。211例IgA肾病患者病理分级以IgA肾病Ⅲ级为主,占63.1%。肾小球病理损害评分、系膜增殖程度积分、球性硬化积分、血管病变积分均以蛋白尿组最高(P<0.05),球性硬化积分、肾小管-间质积分以镜下血尿+蛋白尿组最高(P<0.05),对单纯蛋白尿组进行多因素Logistic回归分析显示,血清甘油三酯、高血压升高幅度是单纯蛋白尿组病情进展的危险因素(OR值分别17.063,27.927)。结论镜下血尿+蛋白尿组及单纯蛋白尿组临床及病理改变较重,血清甘油三酯、高血压升高幅度是单纯蛋白尿组病情进展的危险因素。     

Evaluation and outcome of proteinuria in older and younger adults

BACKGROUND: The spectrum of proteinuric renal disease in older adults remains incompletely defined. The purpose of the present study was to determine if differences exist in diagnostic approach, etiology, therapy, and outcome between older (> or = 60 years) and younger (<60 years) patients referred for evaluation of proteinuria. METHODS: We conducted a retrospective review of outpatient office charts in a 7-physician, hospital-based nephrology practice. RESULTS: We identified 69 patients with at least 1 subsequent follow-up assessment after reviewing approximately 500 sequential charts. Forty-five were younger (mean +/- SD age, 38 +/- 2 years), and 24 were older (69 +/- 1 years). The degree of proteinuria at presentation was similar (4.5 +/- 0.7 vs 3.9 +/- 0.6 g/d, older vs younger, p = NS), but older patients had higher creatinine levels (1.7 +/- 0.2 vs 1.2 +/- 0.07 mg/dl, p <.01), lower creatinine clearances (64 +/- 7 vs 111 +/- 7 ml/min., p <.05), and higher systolic blood pressure (164 +/- 8/88 +/- 2 vs 145 +/- 4/94 +/- 2 mm Hg, p <.01). Older patients were more likely to decline a renal biopsy (21% vs 7.6%, p <.01). The most common final renal diagnoses were immunoglobulin A nephropathy (31%), focal segmental glomerulosclerosis (24%), hypertension (13%), and membranous nephropathy (11%) in the younger patients, and membranous nephropathy (29%), hypertension (25%), diabetic nephropathy (17%), and minimal change disease (8%) in the older patients. Steroids were given to 17.7% of younger patients and 16.7% of older patients (p = NS). The percentage of patients with improvement, defined as a 50% reduction in proteinuria with stable or improved renal function, was similar among older and younger patients (33.3% vs 35.5%). However, older patients were more likely to develop progression of renal disease (33.3% vs 8.8%) and less likely to retain stable renal function (29.2% vs 53.3%). CONCLUSION: Significant differences exist in proteinuric renal disease between older and younger adults.     

IgA肾病随增龄变化的特点及其与预后指标的关系

目的　研究不同年龄组 Ig A肾病临床预后指标、病理改变的特点及其相关性。方法　回顾性分析 90 7例 Ig A肾病患者的临床与肾活检病理资料。结果　 Ig A肾病主要临床预后指标 ,如蛋白尿水平、高血压及肾功能状态随增龄有逐渐加重的趋势 ,随增龄 Ig A肾病患者的病理分级加重。全球硬化、间质纤维化、间质炎细胞浸润、肾小管萎缩、血管病变等各项积分随年龄增加升高 ,系膜增殖、节段硬化、球囊粘连及新月体积分在各年龄组之间无统计学差异。结论　 Ig A肾病在不同年龄组的临床表现、病理改变特点不同 ,随年龄增加 ,主要临床预后指标、病理分级及病理预后指标积分均有加重趋势 ,因此年龄可能是影响预后的一个重要指标。这提示对于不同年龄段的 Ig A肾病患者应该采取不同的治疗措施     

老年人原发性肾病综合征52例临床分析

目的 观察老年原发性肾病综合征患者临床特征及预后.方法 回顾性分析52例老年原发性肾病综合征患者的临床病理特点,并与64例非老年原发性肾病综合征患者进行比较.对老年原发性肾病综合征患者给予常规治疗,口服糖皮质激素泼尼松1 mg·kg-1·d-1,维持治疗8周后,若症状得到缓解,逐渐降低剂量至维持量后,再逐渐停药;若症状没有缓解,则加用环磷酰胺或环孢霉素、骁悉等治疗.结果 老年组并存高血压、感染、慢性肾功能不全和血尿者,与非老年组比较差异均有统计学意义(P＜0.05),两组血白蛋白、24 h尿蛋白定量和急性肾功能不全发生率,差异无统计学意义(P＞0.05).老年人肾病综合征病理类型以膜性肾病、IgA肾病和局灶节段性肾小球硬化为主,分别占46.2%、23.1%和11.5%,非老年组以系膜增生性肾小球肾炎IgA肾病和微小病变性肾病为主,分别占32.8%、25.0%和20.3%.治疗后完全缓解31例,部分缓解18例,无效3例,完全缓解率为59.6%.结论 老年人原发性肾病综合征临床病理以膜性肾病为主,采用糖皮质激素和免疫抑制剂治疗临床疗效显著,但在不同病理类型中具有差异.

Abstract：

Objective To observe the clinical characteristics and prognosis of primary nephrotic syndrome (PNS) in the elderly. Methods The clinical and pathological features of 52 elderly patients with PNS and 64 non-elderly patients with PNS were retrospectively analyzed and compared.The elderly patients with PNS received routine treatment:oral corticosteroids prednisone 1mg·kg-1 ·d-1.After 8 weeks maintenance treatment,if symptoms were alleviated,the prednisone dose was gradually reduced to a maintenance dose, then was stopped gradually. If symptoms were not alleviated, the cyclophosphamide or cyclosporine, mycophenolate mofetil was added. Results There were significant differences in the numbers of patients complicated with hypertension, infection,chronic renal insufficiency and hematuria between the elderly group and non-elderly group (P＜0. 05＝.But there were no significant differences in the level of blood albumin, quantitative measurement of 24 hours urinary protein and incidence rate of acute renal insufficiency between the two groups (P＞0.05). The major pathological types of PNS in the elderly were membranous nephropathy (46.2 %),IgA nephropathy (23. 1 %) and focal segmental glomerulosclerosis ( 11.5 %), respectively. And the major pathological types of PNS in non-elderly group were mesangial proliferative glomerulonephritis (32.8%), IgA nephropathy ( 25.0% ) and minimal change nephropathy ( 20. 3 %), respectively.Complete remission after treatment was found in 31 patients(59.6%), partial remission in 18 cases and inefficacy in 3 cases. Conclusions The major clinicopathological type of PNS in the elderly is membranous nephropathy and should be treated using corticosteroids and immunosuppressive agents,with different effects in different pathological types.     

Acute myocardial infarction in patients under 45 years

INTRODUCTION AND OBJECTIVE: To evaluate the differential features of acute myocardial infarction in patients younger than 45 years old compared to older patients. PATIENTS AND METHODS: From 1995 to 1999, delays in the assistance, evaluation, and therapeutic strategies as well as complications in patients hospitalized with a diagnosis of acute myocardial infarction, have been registered in the intensive care units of the 17 hospitals participating in the PRIMVAC Register. RESULTS: During the study, 10,213 patients were registered, 6.8% younger than 45 years old (691 patients). Young patients show a greater prevalence of cigarette smoking (80.9 vs 34.1%; p < 0.0001) and hypercholesterolemia (39.9 vs 28.6%; p < 0.0001), whereas arterial hypertension, diabetes, and history of coronary disease were significantly more frequent in the older group. This subgroup reached the healthcare system at an earlier stage (120 vs 160 min; p < 0.0001). Thrombolysis was performed in 59.9% of patients younger than 45 years and in 45.9% of patients older than 45 years. Young patients were more frequently given aspirin (94.5%), heparin (70.6%), and beta-blocker drugs (38.4%), whereas patients older than 45 years were given a higher percentage of ACEI, digoxin, and inotropic drugs. Younger patients had a better prognosis and a lower mortality rate (3.5 vs 14%; p < 0.00001). CONCLUSIONS: Acute myocardial infarction in patients younger than 45 years had different clinical features and responded to different therapeutic and diagnostic approaches than acute myocardial infarction in patients over 45 years, as well as a better short-term prognosis.