雷公藤多苷对系膜增生性肾炎患者肿瘤坏死因子水平的影响

 目的观察系膜增生性肾炎(MsPGN)患者应用雷公藤多苷前后血、尿TNFα变化.方法检测了80例MsPGN患者雷公藤多苷治疗前及用雷公藤多苷后3,6,10周血、尿TNFα变化,并与20例正常人血、尿TNFα进行比较.结果MsPGN患者80例治疗前血、尿TNFα明显增高[血正常(67±21) kU/L,MsPGN(442±352)kU/L,尿正常0 MsPGN(218±136)kU/L,P＜0.01],雷公藤多苷治疗后60例患者显效,20例无效,显效率为75%.显效者血、尿TNFα早期即开始下降[血治疗前(442±352)kU/L,治疗后(289±176)kU/L,尿治疗前(218±136)kU/L,治疗后(106±70)kU/L,P＜0.01],而雷公藤多苷治疗无效者血、尿TNFα无明显变化.结论TNFα参与系膜增生性肾炎发病及疾病进展;雷公藤多苷治疗MsPGN有效,其作用机制可能与其抑制TNFα产生有关;血、尿TNFα可作为判断雷公藤多苷疗效与预后的参考指标.     

慢性前列腺炎与IgA肾病关系初探

目的 探讨慢性前列腺炎（CP）在IgA肾病（IgAN）发生、发展中的作用。方法 选择系膜增生性肾小球肾炎患者89例,其中IgAN组38例,非IgAN系膜增生性肾小球肾炎组51例,比较其CP的发生率。另选择IgAN男性患者51例,分为无CP组24例和CP组27例,比较二者的临床和病理指标。观察伴CP的IgAN患者抗炎治疗后的疗效。结果 38例IgAN患者的CP发生率为44．7％,51例非IgAN患者的CP发生率为21．6％,两者间比较差异显著（P〈0．05）。伴CP组肾小球硬化发生率和血管襻免疫复合物沉积率较不伴CP组高（P〈0．05）,其他病理指标及临床指标两组间无差异。抗CP治疗可使部分IgAN患者病情获得好转。结论 CP可能参与了IgAN的发生和发展过程。     

雷公藤多甙并潘生丁治疗小儿过敏性紫癜性肾炎临床观察

目的:观察口服雷公藤多甙加潘生丁对治疗过敏性紫癜性肾炎的疗效。方法:回顾性调查并随访2003—2006年用雷公藤多甙加潘生丁治疗50例小儿过敏性紫癜性肾炎为治疗组,并随机选择同期患儿口服单剂雷公藤多甙30例作为对照。结果治疗组治愈44例(88%),有效6例(12%),对照组治愈18例(60%),有效12例(40%),两组间差异显著(P<0.05),对蛋白尿、血尿、高血压及水肿疗效亦差异显著(均为P<0.01)。结论:提示雷公藤多甙加潘生丁治疗小儿过敏性紫癜性肾炎优于单剂雷公藤多甙,值得临床应用。     

中药肠宁合剂治疗肠易激综合征32例临床观察

目的：观察及评价肠宁合剂治疗肠易激综合征（IBS）的疗效。方法：对治疗组32例IBS患者服用肠宁合剂3周,治疗前后进行自身对照并与接受一般西药（对照组）进行对比分析。结果：治疗组总有效率93．75％,对照组总有效率72．22％,治疗组与对照纽间差异有显著性意义（P〈0．01）。结论：肠宁合剂用于治疗IBS有良好疗效。     

成人原发性肾病综合征的病理类型及治疗对策

通过回顾性研究，分析或人原发性肾病综合征１７９例的病理类型、激素疗效及可能并发症。结果表明：（１）病理改变以系膜增生性肾炎、肾小球微小病变病多见膜性肾病和局灶节段性肾小球硬经其次；（２）病理改变是预测疗效的可靠依据，常规激素治疗８周，肾小球微小病的疗效最好，而７便膜增生性肾炎的效果较差；（３）病理改变是指导治疗的主要方法。适当延长激素的疗程，可进一步提高肾小球微小病变病，膜性肾病及局灶节段性肾小球     

艾司唑仑治疗抑郁及焦虑临床效果观察

目的：观察艾司唑仑治疗抑郁及焦虑的临床效果。方法：采用Hamilton焦虑量表（HAMA）和Hamilton抑郁量表（HAMD）对抑郁及焦虑104例,分别在治疗前、治疗后第4周与第8周进行测评。结果：本组病例治疗前后HAM]）总分分值差异显著（P〈0．05）。治疗后HAMD总分分值呈下降趋势,第4周分值显示有效46例,有效率44．2％;第8周分值显示累计有效78例,累计有效率75．0％。治疗前后HAMA总分分值差异显著（P〈0．05）;同样,治疗后HAMA总分分值呈下降趋势（P〈0．05）,第4周分值显示有效54例,有效率51．9％;第8周分值显示累计有效89例,累计有效率85．6%。结论：艾司唑仑治疗抑郁及焦虑安全、有效。     

原发性IgA肾病临床及病理类型与免疫病理学相关性分析

目的：分析IgA肾病（IgAN）临床及病理类型与免疫病理学的相关性。方法：回顾性分析了IgAN 112例的临床、病理和免疫病理学类型。结果：临床表现为发作性肉眼血尿和无症状尿检异常型者,病理改变以系膜增殖为主,占45．0％;临床表现以高血压型为主者,病理改变多为局灶节段硬化,占41．7％。免疫病理分型IgAGM型占36．6％,IgAG型占31．3％,IgA型占17．9％IgAM型占14．3％。结论：IgAN临床及病理类型与免疫病理学间存在一定的相关性。     

BAI加非常规分割放射治疗肺腺癌近期疗效观察

目的：探索支气管动脉灌注化疗（BAI）后,大剂量低分割放射治疗对中晚期肺腺癌患者的近期疗效及其放射副反应。方法：23例Ⅱ、Ⅲ期肺腺癌患者在BAI治疗2－5次后,行放射治疗,剂量DT2．5GY／F,4／W,肿瘤灶总剂量60GY／24F,6W。结果：原发灶完全缓解（CR）2例,占8％;部分缓解（PR）16例,占69％,总有效率78％（CR＋PR）;无效或进展（NC＋PD）3例,占13％;2例无法评价疗效。23例中放射性皮肤反应Ⅱ度15例,占65％,Ⅲ度3例,占13％;急性放射性食管炎17例,占74％;放射性肺炎8例,占35％;治疗后KPS提高7例,不变8例,下降8例;血液学检查外周血白细胞I－Ⅱ度下降15例,占65％;血小板I－Ⅱ度下降10例,占43％。结论：BAI加常规放射治疗肺腺癌,有较好的近期疗效,急性副反应患者可耐受。远期疗效及晚期并发症有待进一步随访。     

甘氨双唑钠对食管癌放疗增敏作用的临床观察

目的探讨单纯适形放疗与适形放疗联合希美钠（cMNa）治疗食管癌的疗效。方法81例食管癌患者随机分为单纯放疗组（对照组）与放疗加希美钠组（治疗组）。放疗剂量均为DT66Gy／30次,5次／周,治疗组加用希美钠800mg／m2。滴注,每周3次,隔天静脉滴注,30min滴完。结果对照组：CR24.3％,PR65．8％,总有效率90．1％。治疗组：CR60．0％,PR37．5％,总有效率97．5％,两组CR比较疗效有显著差异（P〈0．05）,总有效率比较疗效无显著差异（P〉0．05）。结论两组治疗方式对食管癌疗效无显著差异,但使用甘氨双唑钠组CR率更高。     

四联疗法治疗儿童中、重度系膜增生性肾炎

目的　探讨儿童系膜增生性肾炎 (MsPGN)的有效治疗方法。方法　选择确诊的中、重度MsPGN 12例 ,应用泼尼松、环磷酰胺、保肾康、血竭粉四种药物联合治疗 ,疗程 10～ 12个月 ,观察其疗效。结果　疗程结束完全缓解 4例 ,部分缓解 5例 ,有效率为 75 % ,无效 3例 ,随访 6～ 10个月 ,缓解病例无复发。结论　四联疗法是治疗儿童MsPGN的安全有效方法     

血管病变在IgA肾病、系膜增殖性肾小球肾炎及膜性肾病中的比较

目的:了解血管病变在IgA肾病(IgAN)与系膜增殖性肾小球肾炎(MsPGN)及膜性肾病(MN)中的不同特点。方法:回顾性分析1005例IgAN患者、627例MsPGN患者和221例MN患者血管病变的发生率、病变程度及病变类型。结果:1005例IgAN患者、627例MsPGN患者和221例MN患者肾活检组织中血管病变的发生率分别为54.6%,26.6%和47.1%,血管病变发生的平均年龄分别为34.6,40.4和47.7岁,中/重度血管病变的比例分别为37.0%,21.6%和23.1%,合并血管玻璃样变的比例分别为43.7%,16.8%和21.2%,上述4项指标三者之间均存在明显差异(P<0.05)。在IgAN患者中,有高血压者出现血管壁增厚合并玻璃样变的比例明显高于无高血压者(P<0.001)。结论:IgAN患者较MsPGN及MN患者血管病变的发生比例高,出现的年龄轻、程度重,合并玻璃样变的比例高。在IgAN患者中高血压的发生可能与血管的玻璃样变关系密切。     

恶性高血压为主要表现的IgA肾病的临床和病理特点分析

目的探讨以恶性高血压(MHT)为主要表现的IgA肾病(IgAN)的临床、病理特点和预后。方法对32例主要表现为MHT的IgAN患者(IgAN-MHT组)的临床、病理资料进行回顾性分析,随访其预后。并与30例无MHT的IgAN患者(IgAN组)进行比较。结果 IgAN-MHT组13例表现为急性肾损伤,8例为肾病综合征,7例为肉眼血尿。随访期内多数病例均表现为进行性肾功能损害。IgAN组4例表现为肾病综合征,3例呈肉眼血尿。随访期内肾功能无明显进展。IgAN-MHT组前驱感染发生率明显高于IgAN组(P<0.05),从发病至肾活检的时间明显较IgAN组短(P<0.01),血清肌酐、尿酸、C-反应蛋白及尿蛋白水平均较对照组明显升高(P<0.01)。肾活检病理示IgAN-MHT组肾小球、间质、血管病变明显较IgAN组重,IgAN-MHT组Lee’s分级≥Ⅲ级所占比例明显较IgAN组高(100%比53.3%,P<0.01)。结论主要表现为MHT的IgAN临床病情及肾脏病变严重,预后差。影响肾功能转归的因素可能包括肾活检前MHT持续的时间、肾活检时血肌酐值、肾脏病变的严重程度和降压治疗是否达标。     

强的松联合霉酚酸酯与联合环磷酰胺治疗重症IgA肾病疗效比较

 目的比较强的松联合霉酚酸酯(mycophenolatemofetil,MMF)与强的松联合环磷酰胺(cyclophosphamide,CYC)治疗重症IgA肾病的临床疗效。方法84例重症IgA肾病患者分别给予强的松联合MMF治疗(MMF组,n=42),强的松联合CYC治疗(CYC组n=42)。强的松起始剂量40mg/d,MMF诱导期剂量1.5g/d,持续6个月;维持期剂量0.75~1.0g/d,持续12个月。CYC诱导期剂量为0.8~1.0g/月,静脉滴注,持续6个月;维持期剂量0.8~1.0g/3月,持续12个月。两组患者基础病情无差异,随访时间18个月,观察两组患者临床缓解率及相应实验室指标,如24h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化,并比较两组治疗的不良反应。结果(1)临床缓解率:治疗18个月时MMF组临床总有效率高于CYC组,分别为85.7%vs61.8%(P＜0.05);(2)观察期末,MMF组患者24h尿蛋白定量(0.6±0.3)明显低于CYC组(1.4±0.5)(P＜0.05),血浆白蛋白和总蛋白(43.2±4.3和70.2±8.1)均显著高于CYC组患者(36.9±3.6和60.3±7.6)(P＜0.05);(3)血脂变化:MMF组血脂较治疗前明显降低,而CYC组无变化(P＜0.05);(4)不良反应发生率:MMF组不良反应发生率(4.76%)明显低于CYC组(19.0%)。结论MMF组治疗重症IgA肾病,临床缓解率高于CYC组疗法,能更有效降低患者24h尿蛋白定量,改善患者血脂和血浆白蛋白水平,维持患者肾功能稳定,并且MMF组不良反应发生率显著低于CYC组疗法。     

Evaluation of remission of progressive tumors treated with a simultaneous combination of radiation and platinum therapy

Since January 1982, we have treated in a phase-II study 28 patients with a low-dose cis-platinum therapy combined with radiotherapy. We wanted to study the effect of reduced doses of cis-diamino-dichloroplatinum (II) in three different dose patterns: 1. "higher" dosage (150 mg/m2 within six weeks), single dose: 25 mg/m2 one time per treatment week), 2. "medium" dosage (80 mg/m2 within six weeks), single dose: 20 mg/m2 two times weekly during the first, fourth, seventh, and tenth treatment week, 3. "lower" dosage (75 mg/m2 within six weeks), single dose: 12.5 mg/m2 three times weekly during the first, fourth, seventh, and tenth treatment week. In one patient group the simultaneous radiotherapy was performed with a tumoricide dose of 2 Gy single dose with 4 fractions per week in two series (first series about 40 to 48 Gy tumor dose, pause of three to four weeks, second series about 16 Gy focal dose). The other group received palliative radiation doses (10 to 35 Gy tumor dose in one series), and the total platinum doses were lower corresponding to the shorter irradiation time. All patients were in advanced or recurrent stages of the disease. They suffered from different carcinomas and sarcomas with measurable parameters of response. Results: 1. Manifestations beyond the irradiation field showed no remission. Within the irradiation field, all cases responded (CR/PR) for at least two months. 2. There was no reliable dependence from the platinum dose. A tendency in favor of higher single doses could be supposed. The response of even extreme palliative cases with low radiation and platinum doses was surprising. Limitating toxicities were not observed.     

Haemodialysis for the prevention of contrast-induced nephropathy: outcome of 31 patients with severely impaired renal function,comparison with patients at similar risk and review

RATIONALE AND OBJECTIVES: To investigate whether haemodialysis prevents contrast-induced nephropathy (definition: increase of serum-creatinine of >or= 0.5 mg/dL within 7 days). MATERIALS AND METHODS: Thirty-one patients (mean serum-creatinine 4.01 +/- 1.83 mg/dL) were dialyzed for 4.36 +/- 1.0 hours within one hour after 278.4 +/- 160.5 mL of contrast medium. RESULTS: Dialysis resulted in a significant reduction of serum-creatinine (2.25 +/- 1.46 mg/dL; P< 0.0001) and stable mean serum-creatinine levels 2, 3, 4, and 7 days after contrast medium and at discharge compared with baseline values. However, 19 patients (61%) developed contrast-induced nephropathy within 7 days. Four patients had to be repeatedly dialyzed. A comparison of our patients' 48 hours-incidence of contrast-induced nephropathy (9/31; 29%) versus patients at comparable risk included in seven previous studies demonstrated a prophylactic effect of dialysis only versus a subgroup in one study. CONCLUSIONS: Data provide no hint that haemodialysis prevents contrast-induced nephropathy. Therefore, postprocedural dialysis should be restricted to patients participating in clinical studies.     

尿激酶联合血管紧张素转换酶抑制剂治疗IgA肾病的疗效及其对PA／PAI的影响

75例Lee分级≥Ⅲ级的IgA肾病 (IgAN)患者随机分为单用血管紧张素转换酶抑制剂 (ACEI) (苯那普利 10mg/d)组 (A组 )及尿激酶 (UK)联合苯那普利组 (UA组 ) ,观察两组的疗效及联合用药对血浆PA/PAI的影响。治疗 3个月时UA组与A组总有效率分别为 6 9 5 7%、39 47% (P <0 0 5 )。A组尿NAG酶无显著变化 ,肌酐清除率 (Ccr)显著下降 ,PT及纤维蛋白原 (FIB)无显著变化。UA组尿NAG酶明显下降 ,Ccr无明显变化 ,PT延长 ,FIB水平明显降低 ,可使患者低下的血浆t PA及尿PA活性得以恢复 ,而不影响其血浆PAI 1水平 ,使血肌酐 (Scr)稳定 ,80 95 % ( 17/ 2 1)患者尿蛋白在 1 0g/d以下 ,37例中仅 3例轻微出血。结果表明 ,UK联合ACEI治疗中晚期IgAN疗效优于单用ACEI者 ,可使IgAN患者的纤溶能力提高 ,为一种安全有效的方案。     

Radiotherapy plus a combination of cisplatin and 5-fluorouracil for locally advanced head and neck neoplasms. Study of feasibility and preliminary results

In March 1989 we started a feasibility study of combined radio-chemotherapy in patients with locally-advanced head and neck cancer. The first phase of treatment consisted of conventional radiotherapy (2 Gy/day, 5 days/week for a total dose of 70 Gy to primary tumor and +/- 50 Gy to nodes) and cisplatinum (20 mg/m2, i.v., for 4 days) +5FU (200 mg/m2, i.v., for 4 days) every 4th week, during radiant sessions. The second phase of treatment was started about one month after the end of simultaneous chemotherapy and radiotherapy: patients in complete remission received 1 more cycle of chemotherapy, as consolidation, while patients in partial remission received two more cycles of chemotherapy. Non-responding patients received no more chemotherapy. During the second phase the days of cisplatinum and 5FU were 5. Up to April 1990, 17 patients have been included in the study. They were stage III (64%) and IV (36%). The mean administered dose of radiotherapy was 66 Gy (range: 60-70 Gy) to primary tumor and 60 Gy (range: 40-70 Gy) to nodes. The total number of chemotherapy cycles administered during radiant sessions was 37, the mean number of cycles was 2 (range: 1-3), with 100% dose percentage. The interval between cycles was 3 weeks in 84% of patients. The relationship between number of cycles administered and planned cycle was 37/39 (feasibility: 95%). Acceptability was 100% (no patient refused the treatment). Feasibility of the second phase was 77% and acceptability 90% (1 patient refused the treatment). Toxicity was moderate during the first and the second phases. After the first phase 14/15 evaluable patients (92%) had major response (complete remission: 46%). After the second phase 10/10 evaluable patients had a complete remission. In conclusion, this combined treatment is very easy to administer, and very well accepted. Moreover, it yields a high number of objective responses.     

Radiotherapy of Kaposi's sarcoma in AIDS

Between June 1986 and August 1988, 129 patients with AIDS-related Kaposi's sarcoma were treated by cutaneous irradiation in our department. According to Mitsuyasu's staging, 25 patients (19%) were stage 1.76 (59%) stage II, no stage III was reported and 28 (22%) stage IV. Fifty four patients (42%) had previously presented with one or multiple opportunistic infections. Eighty six (66%) had previously received treatment: by interferon in 80 patients (62%) and/or Velbe in 40 (31%). Seventy six patients (59%) were treated by extensive cutaneous irradiation using 4 and/or 8 MeV electron beam energy and 53 patients (41%) by localized irradiation using 45 kV X-ray energy, 2.5 Gy/fraction, 4 times/week by split course 20 Gy then 10 Gy two weeks later. Only 111 patients were evaluable; 61% obtained complete remission and 33% partial remission after a mean period of 1.5 months (0.5-3 months). The overall tolerance was acceptable. The complications were epidermitis with some necrosis (8%), exudative epidermitis (26%) moderate epidermitis (63%) and slight reactions in 4%. The mean recurrence time was 5 1/2 months.