血液透析患者PCT水平与透析充分性、微炎症状态及营养不良的关系研究

目的分析维持性血液透析患者血清降钙素原（PCT）水平与透析充分性、微炎症状态及营养不良的关系。方法选取行维持性血液透析治疗的慢性肾脏病患者120例为观察组,另择同期行健康体检者120例为对照组。观察组患者行透析前后检测血清尿素氮水平,计算尿素清除率(Kt/V)以评估透析充分性,并根据Kt/V将观察组患者分为透析充分组（Kt/V≥1.2,69例）和透析不充分组（Kt/V＜1.2,51例）。比较观察组与对照组及透析充分组与透析不充分组PCT、hs-CRP、Hb、血清白蛋白水平;分析观察组患者PCT水平与超敏C反应蛋白（hs-CRP）、Hb、血清白蛋白水平及Kt/V的相关性;分析PCT水平对血液透析充分性的评估价值。结果观察组患者PCT、hs-CRP水平均高于对照组（均P＜0.05）,Hb、血清白蛋白水平均低于对照组（均P＜0.05）。与透析充分组相比,透析不充分组患者PCT、hs-CRP水平均增高（均P＜0.05）,血清白蛋白水平降低（P＜0.05）,两组患者Hb水平比较无统计学差异（P＞0.05）。相关性分析显示,观察组患者PCT水平与hs-CRP呈正相关（r=0.580,P＜0.05）,与Hb（r=-0.462）、血清白蛋白（r=-0.528）、Kt/V（r=-0.554）均呈负相关（均P＜0.05）。ROC曲线分析得出,当PCT水平为0.243ng/ml时,判断透析是否充分的灵敏度为0.85,特异度为0.51,是最理想的透析充分性判断点。结论维持性血液透析患者血清PCT水平升高提示透析不充分,微炎症状态、营养不良加重。     

血液透析患者红细胞分布宽度及相关因素分析*

目的：分析血液透析患者红细胞分布宽度（RDW）及其影响因素。方法：165例维持性血液透析患者,男性103例,女性62例;平均年龄（52.2±12.9）岁;平均透析龄（5.8±3.3）年,以RDW正常值上限14.6%为界分为RDW正常组124例和RDW升高组41例,比较两组患者的一般资料和相关实验室检查指标,分析RDW与各指标的相关关系。结果：RDW正常组平均年龄、转铁蛋白低于RDW升高组,血清前白蛋白、肌酐、血钾、铁蛋白高于RDW升高组,差异均有统计学意义（P＜0.05）。Pearson相关分析显示,RDW与血清前白蛋白（r=-0.216,P=0.005）、透析前血肌酐（r=-0.156,P=0.046）、血清铁蛋白（r=-0.170,P=0.040）呈负相关（P＜0.05）,与C反应蛋白（r=0.207,P=0.008）、转铁蛋白（r=0.216,P=0.005）呈正相关（P＜0.05）。结论：RDW与血液透析患者年龄、营养状况、炎症状态等因素有关,对RDW的监测有助于发现预后不良的高危人群,并可以通过干预其相关影响因素达到提高透析质量及改善透析患者预后的目的。     

维持性血液透析患者血压控制情况及相关因素分析

目的探讨维持性血液透析（MHD）患者透析过程中血压控制情况及其不良因素。方法根据血压控制良好与否,将135例MHD患者分为血压控制良好组41例和血压控制不良组94例,采用单因素及多因素logistic回归分析透析过程中血压控制不良的影响因素。结果135例MHD患者血压控制不良发生率为69．63％（94／135）。两组性别、年龄、血红蛋白、白蛋白方面比较,差异无统计学意义（P〉0．05）;血压控制良好组透析时间、体重指数、甲状旁腺激素明显短于或低于血压控制不良组（P〈0．05）,尿素清除率、肾小球率过滤、尿素氮、血肌酐水平明显高于血压控制不良组（P〈0．05）。多因素logistic回归分析结果显示,透析时间、尿素清除率、肾小球率过滤是MHD患者透析过程中血压控制不良的独立相关因素（P〈0．05）。结论MHD患者血压控制不良发生率较高,透析时间、尿素清除率、肾小球率过滤是MHD患者血压控制不良的独立相关因素。     

维持性血液透析的老年慢性肾脏病患者营养状况影响因素分析

目的 分析维持性血液透析的老年慢性肾脏病患者营养状况的影响因素。方法 回顾性收集2020年3月至2022年4月江苏省人民医院收治的153例老年慢性肾脏病行维持性血液透析治疗患者的临床资料,根据是否出现营养不良将其分为营养不良组（84例）和营养正常组（69例）,比较两组临床资料,采用多因素logistic回归模型分析患者出现营养不良的影响因素。结果 营养不良组体重指数、基础代谢率及血清白蛋白（Alb）、血红蛋白（Hb）、前蛋白（PA）、肌酐水平均低于营养正常组,年龄、透析时间>12个月占比、尿素清除指数（Kt/v）<1.2占比、焦虑症状占比、抑郁症状占比及血尿素氮水平均高于营养正常组,差异有统计学意义（P<0.05）。多因素分析结果显示,年龄、透析时间>12个月、Kt/v<1.2、焦虑、抑郁及血清Alb、Hb、PA水平均为维持性血液透析的老年慢性肾脏病患者营养状况的影响因素（P<0.05）。结论 年龄、血清Alb、Hb、PA水平、透析时间、Kt/v、有焦虑抑郁症状均为维持性血液透析的老年慢性肾脏病患者营养不良的影响因素,临床可据此对有以上特征的患者进行...     

舒洛地特对维持性腹膜透析患者微炎症状态的影响

目的 探讨舒洛地特对维持性腹膜透析患者微炎症状态的影响.方法 选择笔者医院肾内科维持性腹膜透析患者80例,采用数字表随机分为常规治疗对照组(B组)和舒洛地特治疗观察组(C组),另选择体检中心20例健康者作为正常组(A组),观察治疗前后患者血清炎症因子超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及营养学指标(血浆白蛋白、血浆前白蛋白、血红蛋白浓度)与凝血功能、肾功能的变化.结果 与A组相比较,B组、C组患者的炎症因子hs-CRP、IL-6、TNF-α水平均显著升高(P＜0.05),而营养学指标(血浆白蛋白、血浆前白蛋白、血红蛋白)含量明显降低(P＜0.05),舒洛地特液治疗12周后,C组患者CRP、IL-6、TNF-α水平降低,与治疗前以及B组治疗后相比,差异均有统计学意义(P＜0.05),血清白蛋白、前白蛋白、血红蛋白明显升高,与治疗前以及B组治疗后相比,差异均有统计学意义(P＜0.05).B、C组患者治疗前后凝血功能、肾功能无明显变化.结论 腹膜透析患者存在微炎症状态,舒洛地特治疗可以显著改善维持性腹膜透析患者微炎症状态,改善营养状态,且不影响其凝血功能.     

血液透析及腹膜透析对尿毒症患者血脂的影响及分析

目的 观察尿毒症患者行血液透析或腹膜透析治疗前后的血脂水平的变化,对比血液透析及腹膜透析对尿毒症患者血脂影响的差别,并分析其可能的原因.方法 纳入血液透析治疗组56例,腹膜透析组48例,所有患者均在透析治疗前及治疗 12个月时测定血浆胆固醇（TCH）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、血浆白蛋白（ALB）、血肌酐（Scr）、血糖（Glu）等指标.结果 经血液透析治疗的患者,TG较透析前明显升高（P＜0.05）,接受腹膜透析治疗的患者,TCH,TG,LDL,LDL/HDL较透析前均明显升高（P＜0.05）,腹膜透析与血液透析患者比较,前者TCH,LDL,LDL/HDL高于后者,ALB明显低于后者（P＜0.05）.结论 透析治疗加重脂代谢紊乱,腹膜透析患者脂代谢紊乱更明显,可能与含糖腹透液的使用及白蛋白大量丢失等因素相关.     

维持性血液透析患者认知功能异常发生情况及危险因素分析

目的分析维持性血液透析（MHD）患者认知功能异常的发生情况,并探讨MHD患者发生认知功能异常的危险因素。方法选取2018年1月至2018年12月在浙江中医药大学附属第一医院血液净化中心接受MHD治疗且治疗时间≥3个月的18岁以上患者78例,收集患者的一般资料。使用中文版蒙特利尔认知评估（C-MoCA）量表测定MHD患者的认知水平。将患者分为认知功能异常患者（C-MoCA评分＜26分）和认知功能正常患者（C-MoCA评分≥26分）,比较两者的一般资料、生化指标、营养指标。采用logistic回归分析MHD患者发生认知功能异常的危险因素。结果78例MHD患者中认知功能异常38例（48.7%）。与认知功能正常患者相比,认知功能异常患者透析龄、血清磷和血尿素氮水平均较低,年龄较大（均P＜0.05）。在营养指标方面,除BMI外,认知功能异常患者相较认知功能正常患者上臂肌围、握力、前白蛋白、每日蛋白质摄入和每日能量摄入均低（均P＜0.05）。多因素logistic回归分析显示,低上臂肌围、低前白蛋白水平和低每日能量摄入是MHD患者发生认知功能异常的独立危险因素（均P＜0.05）。结论MHD患者认知功能异常的发生率较高,低上臂肌围、低前白蛋白水平、低每日能量摄入是其发生认知功能异常的独立危险因素。     

终末期多囊肾患者行腹膜透析的疗效及安全性分析

目的:探讨终末期多囊肾患者行腹膜透析的疗效及安全性。方法:回顾性分析随访治疗满1年的多囊肾病腹膜透析患者18例,及同期年龄、性别与多囊肾病组匹配的肾炎腹膜透析患者20例的临床资料。分析比较两组患者透析前、透析3月、透析12月时尿量、血肌酐、二氧化碳结合力、血白蛋白、血红蛋白、每周尿素清除指数(kt/v),观察两组术中术后并发症、腹透相关性并发症。结果:两组患者间基础的尿量、肌酐、血红蛋白、二氧化碳结合力、血白蛋白比较差异均无统计学意义(P>0.05);两组患者透析后3月、透析后12月与其腹膜透析前的肌酐、血红蛋白、血白蛋白、二氧化碳结合力相比较,均有明显改善,且差异均有统计学意义(P<0.05);两组患者间透析后3月的尿量、血红蛋白、血白蛋白、二氧化碳结合力、kt/v差异无统计学意义(P>0.05);两组透析后12月的尿量、血红蛋白、血白蛋白、二氧化碳结合力、kt/v差异亦无统计学意义(P>0.05);两组患者均顺利完成腹膜透析管置管手术,术中无并发症出现,术后未出现管周渗漏、透析管移位、大网膜包裹、内脏损伤等并发症;两组患者腹膜炎及出口感染的并发症比较差异无统计学意义(P>0.05)。结论:终末期多囊肾患者,特别是存在残余肾功能时,腹膜透析可以作为其首选的透析方式,多囊肾本身也并非腹膜透析的禁忌证。     

尿毒症患者血液透析前后实验室检查结果分析

目的观察血液常规透析前后尿毒症患者尿素氮（BUN）、肌酐（Cr）、血尿酸（UA）、电解质（K＋、Na＋、Cl-、Ca2＋）、血磷（P）、二氧化碳结合力（CO2CP）、白蛋白（Alb）等变化,探讨其临床意义。方法选择我院血液透析中心2010年6月—12月70例尿毒症维持性常规血液透析患者,观察透析前后10个基本参数的变化,同时采集40例正常健康体检者空腹静脉血进行对照。结果尿毒症组患者BUN、Cr、K＋、Na＋、Cl-、P、UA均值显著高于正常对照组（P〈0.01）,而Ca2＋、CO2CP、Alb均值明显低于正常对照组（P〈0.01）。透析后患者BUN、Cr、K＋、P较透析前明显下降（P〈0.01）,UA、Na＋、Cl-、Ca2＋、Alb变化不明显（P〉0.05）,CO2CP较透析前上升（P〈0.05）。结论测定尿毒症患者透析前后的BUN、Cr、K＋、CO2CP含量变化有临床参考价值。     

血液灌流联合血液透析对维持性血液透析患者营养状态的影响

目的 观察血液灌流（HP）联合血液透析（HD）的血液净化模式相对单纯血液透析模式对维持性血液透析（MHD）患者营养状态的影响.方法 将21例MHD患者随机分为两组,分别为血液透析联合血液灌流组（联合组9例）和单纯血液透析组（HD组12例）,两组均给予营养干预,治疗6个月后用主观综合性营养评估（subjective global assessment,SGA）、人体测量指标和临床指标比较两组透析模式对MHD患者营养状态的影响.结果 两组患者治疗6个月后,联合组营养状况较单纯透析组显著改善,两组差异有统计学意义（P＜0.05）,联合治疗组相对单纯透析组血浆白蛋白、前白蛋白和胆固醇显著升高（P＜0.05）.结论 对MHD患者营养不良的改善,HP＋HD联合治疗效果明显优于单纯HD治疗.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.