影响维持性血液透析患者长期存活的因素

维持性血液透析（maintained hemodialysis, MHD）是治疗终末期肾脏病（end-stage renal disease, ESRD）患者的一种安全而有效的方法,近年来,MHD患者的存活率明显改善,但其生存率仍较低[1],其中心血管疾病（CVD）是血液透析患者住院的主要原因,其发生率是正常人群的10～20倍,同时也是最主要的死亡原因,占50%以上[2].大多数ESRD患者在进入MHD治疗前即有明显的心血管系统损伤.贫血、高血压、心血管的钙化以及高磷血症和继发性甲状旁腺功能亢进均可增加ESRD患者CVD的发生率和死亡率,影响患者长期生存.在慢性肾脏病早期开始干预,并选择适当的透析方式可以有效改善患者的长期存活率,本文对此加以简述.     

改良主观法评价老年血液透析患者营养状况

随着血液透析技术的发展和普及,终末期肾脏病患者的生存期明显延长,老年血液透析患者的数量也明显增多.营养不良是影响维持性血液透析(MHD)患者长期存活和生活质量的重要因素.     

超声评价维持性血液透析患者心脏结构功能改变的危险因素

据美国肾脏病资料系统(USRDS)及国内文献资料统计,80%维持性血液透析(MHD)患者存在不同程度及类型的心血管并发症,心脏疾患是终末期肾病患者主要的死亡原因,维持性血液透析患者50%的死亡原因是心血管疾病.本文应用超声心动图检测MHD患者心脏结构和功能,并分析其危险因素.     

新型骨相关生物标志物在慢性肾脏病血管钙化中的应用价值

慢性肾脏病(chronic kidney diseases,CKD)发病率高,我国CKD患病率达10.8%,终末期肾脏病(end stage renal diseases,ESRD)患者数量逐年增加[1-2]。最新版美国肾脏病数据系统(United States Renal Data System,USRDS)报告显示,超过40%的维持性血液透析(maintenance hemodialysis,MHD)     

生长激素治疗成人维持性血液透析患者营养不良的研究进展

成人终末期肾脏病维持性血液透析（MHD）患者有较高的死亡率,主要与并发心血管事件（50％）、感染（20％）、恶性肿瘤（7％）等相关。研究发现,患者的高死亡率与营养指标（血清白蛋白、去脂肪体重等）密切相关。维持性血液透析患者存在生长激素-胰岛素生长因子-I轴紊乱状态,推测维持性血液透析患者营养不良可能与内分泌功能改变有关。生长激素在促进物质代谢方面的作用可能改变这种紊乱状态。     

高龄终末期肾脏病患者肾脏替代治疗时机和治疗方式的选择

高龄(≥80岁)终末期肾脏病(ESRD)患者人数不断增加,年龄是透析患者生存率的独立危险因素,有关高龄ESRD患者治疗时机与治疗方式选择的报道较少。本文从保守治疗与肾脏替代治疗对高龄患者生存率的差异、透析时机对患者生活质量及预后的影响、肾脏替代治疗方式的选择、血液透析和腹膜透析治疗效果和并发症的差异等方面总结了国内外的相关文献报道,以期为高龄ESRD患者的治疗决策提供参考。     

维持性血液透析病人高血压的临床治疗对策

维持性血液透析(MHD)是目前治疗终末期肾病(ESRD)最有效的方法之一。高血压是MHD患者最常见的并发症,是导致患者心血管病变的高危因素;高血压使MHD患者心血管疾病患病率和病死率增加,是影响预后的独立危险因子。本文回顾性分析96例MHD病人的血压情况。     

单中心维持性血液透析297例临床分析

维持性血液透析（MHD）是终末期。肾病（ESRD）患者的主要治疗手段。了解血液透析患者的流行病学资料,认识ESRD的发病规律,对减少ESRD及相关并发症的发生,指导临床制定预防、治疗方案具有重要临床意义。     

维持性血液透析患者的血磷水平与冠状动脉钙化的关系研究

<正>近年来,随着慢性肾脏病（CKD）发病率不断增高,进展至终末期肾脏病（ESRD）的患者数量也逐年攀升。维持性血液透析（MHD）作为目前ESRD患者重要的肾脏替代治疗方法,可使ESRD患者远期生存率较以往得到很大提升^[1-2]。ESRD透析的患者中普遍存在血管钙化现象,由此引发的心脑血管并发症是导致透析患者死亡的主要原因。血管钙化已成为患者心脑血管并发症高发和心血管事件增加的独立危险因素^[3-4]。近年来,随着一些新的无创检测手段如电子束CT、多排螺旋CT等广泛应用于临床,其在定性、定量研究血管钙化方面逐渐深入^[5-6]。研究发现,影响CKD患者血管钙化的因素错综复杂,     

终末期肾病维持性血液透析患者颈动脉结构、形态及血流动力学检测结果分析

目的探讨终末期肾病(ERD)维持性血液透析(MHD)患者动脉粥样硬化情况。方法将81例ERD患者按治疗情况分为MHD组50例和非MHD组31例,MHD组行MHD,非MHD组未行MHD,另选30例健康体检者作为对照组,采用彩色多普勒超声检测各组颈动脉内膜中层厚度,计算其斑块积分及血流阻力指数(RI)。结果MHD组及非MHD组IMT、斑块积分、RI均明显高于对照组,MHD组RI明显高于对照组,P<0.05或0.01。结论MHD治疗对ERD患者粥样硬化进程无明显影响。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.