1137例慢性肾功能衰竭病人病因分析

目的：探讨慢性肾功能衰竭(chronic renal failure，CRF)病人主要病因及次要病因的发病情况。统计CRF与年龄和性别的关系及贫血和高血压的发病率。方法：选取确诊为CRF的1137例患者，并从患者病历中收集性别、年龄、病因及功能诊断、血压、血常规、肾功能，肌酐清除率等资料进行统计分析。结果：慢性肾炎发病率最高(56．4％)，其次为高血压肾病(14．3％)、梗阻性肾病(7．2％)和糖尿病肾病(6．7％)。多数CRF患者合并贫血(90．7％)和高血压(72．6％)。结论：慢性肾功能衰竭的最主要病因为慢性肾小球肾炎，其次为高血压肾病、梗阻性肾病和糖尿病肾病。     

82例老年慢性肾功能衰竭的临床分析

随着透析疗法的广泛开展和技术的改进，人类寿命的延长，老年设性肾功能衰竭（简称慢性肾衰）的病人亦不断增加，其防治的重要性日益突出．我们回顾了82例老年漫性肾衰患者的临床资料，现报道如下．1、临床资料1．1一般资料：82例均为1988年1月～1995年12月我院住院病人，男49例，女对削，年龄60～80岁，平均年龄67.25岁。1．2原发病：高血压肾动脉硬化25例（30．47％）、慢性肾小球肾炎24例（29．27％）、糖尿病肾病13例（5．85％）、多囊肾7例（8．54％）、慢性肾孟肾炎6例（7．32％）、梗阻性肾病6例（7.32％）、尿酸性肾病1例（1．22％…     

慢性肾功能衰竭60例原发病分析

目的 对60例慢性肾功能衰竭患者的原发病进行分析。方法 对60例慢性肾功能衰竭患者的临床及实验室资料作回顾性分析，分析引起慢性肾功能衰竭的常见原发病。结果60例CRF患者，慢性肾炎24例，占40％；高血压肾损害9例，占15％；马兜铃酸肾病11例，占18．3％；糖尿病肾病6例，占1％；慢性肾盂肾炎4例。占6．6％肾结核2例，占3．3％；狼疮性肾炎及紫癜性肾炎各1例，各占1．6％；60例中48例进入终末期肾衰。其中1例改腹膜透析，死亡14例，32例采取中西医结合药物治疗。结论定期体检，早期治疗，防止原发病进展及并发症出现，合理使用药物，积极控制引起慢性肾功能衰竭的原发病。     

1137例慢性肾功能衰竭病人病因分析

目的 :探讨慢性肾功能衰竭 (chronicrenalfailure ,CRF)病人主要病因及次要病因的发病情况。统计CRF与年龄和性别的关系及贫血和高血压的发病率。方法 :选取确诊为CRF的 1137例患者 ,并从患者病历中收集性别、年龄、病因及功能诊断、血压、血常规、肾功能 ,肌酐清除率等资料进行统计分析。结果 :慢性肾炎发病率最高 (5 6 .4 % ) ,其次为高血压肾病 (14 .3% )、梗阻性肾病 (7.2 % )和糖尿病肾病 (6 .7% )。多数CRF患者合并贫血(90 .7% )和高血压 (72 .6 % )。结论 :慢性肾功能衰竭的最主要病因为慢性肾小球肾炎 ,其次为高血压肾病、梗阻性肾病和糖尿病肾病。     

慢性肾功衰竭的病因变化趋势探讨

对近十年慢性肾功能衰竭患者６０８例病因学进行分析，将其分为前后五年并与既往文献报道比较，探讨其病因结构变化趋势。常见病因：慢性肾小球肾炎（４７５３％）慢性肾盂肾炎（７５７％）比例下降；糖尿病肾病比例（１４９７％）明显增加；肾小动脉硬化比例（１２６７％）有所上升。提示近十年来慢性肾功能衰竭的病因结构发生较大变化，临床上应加强对有上升趋势病因的早期诊治，这对减少慢性肾功能衰竭的发生及延缓其进展意义重大     

189例海员慢性肾功能衰竭病因分析

目的 探讨海员慢性肾功能衰竭(chronic renal failure,CRF)的主要病因及次要病因,统计海员CRF与年龄的关系及贫血和高血压的发病率.方法 选取确诊为CRF的189例患者,并从患者病历中收集年龄、病因及功能诊断、血压、血常规、肾功能、肌酐清除率等资料进行统计分析.结果 慢性肾炎发病率最高(41.3%),其次为高血压肾病(16.9%)、梗阻性肾病(15.3%)和糖尿病肾病(14.8%).多数患者合并贫血(91.0%)和高血压(72.5%).结论 海员慢性肾功能衰竭病人的最主要病因为慢性肾小球肾炎,其次为高血压肾病、梗阻性肾病和糖尿病肾病.     

中西医综合治疗慢性肾功能衰竭162例临床总结

目的：总结中西医综合疗法对慢性肾功能衰竭的疗效。方法：采用自身前后对照，选择广州中医药大学第二附属医院肾内科1997－2000年收住院的慢性肾功能衰竭患者162例，均常规给予中西医综合措施治疗，即在一般治疗的基础上，给予中药辨证分型治疗，口服尿毒康、通脉口服液、大黄胶囊等专科制剂，保留灌肠，静脉滴注活血化瘀中药复方丹参注射液，疗程30d。对比治疗前后临床症状、肌酐及尿素氮的变化情况，同时分析疗效与病情分期、原发病及中医证型的关系。结果：162例病人经治疗1个月后症状和体征均有明显的好转，显效41例，有效71例，稳定22例，无效28例，总有效稳定率82．7％。肾功能衰竭期总有效稳定率明显高于尿毒症期（x^2检验，P＜0．01）；氮质血症期总有效稳定率与其他两组相比无统计学差异（x^2检验，均P＞0．10）；原发病为梗阻性肾病、高血压肾病、肾病综合征的总有效稳定率虽然高于慢性肾小球肾炎、糖尿病肾病，但无统计学意义（x^2检验，P＞0．25或P＞0．05）；各中医证型之间疗效亦无统计学差异。结论：中西医综合措施对于慢性肾功能衰竭各期患者均有较好疗效，尤以肾功能衰竭患者疗效最好。各原发病之间、中医证型之间疗效无明显差异。     

189例海员慢性肾功能衰竭病因分析

目的 探讨海员慢性肾功能衰竭(chronic renal failure,CRF)的主要病因及次要病因,统计海员CRF与年龄的关系及贫血和高血压的发病率.方法 选取确诊为CRF的189例患者,并从患者病历中收集年龄、病因及功能诊断、血压、血常规、肾功能、肌酐清除率等资料进行统计分析.结果 慢性肾炎发病率最高(41.3%),其次为高血压肾病(16.9%)、梗阻性肾病(15.3%)和糖尿病肾病(14.8%).多数患者合并贫血(91.0%)和高血压(72.5%).结论 海员慢性肾功能衰竭病人的最主要病因为慢性肾小球肾炎,其次为高血压肾病、梗阻性肾病和糖尿病肾病.     

右旋糖酐40致急性肾功能衰竭9例

我院 1997— 2 0 0 2年共收治右旋糖酐 4 0引起急性肾功能衰竭 9例 ,现报告如下。1　临床资料1.1.　一般资料　共 9例 ,男 7例 ,女 2例 ,年龄 30～ 6 9岁 ,平均 5 0 .7岁。原发病为 :原发性肾病综合征 2例 (肾活检病理均为系膜增生性肾炎 ) ,2型糖尿病并糖尿病性肾病Ⅳ～Ⅴ期1例 ,慢性肾炎并发慢性肾功能衰竭氮质血症期 1例 ,风湿性心脏病并发心力衰竭 2例 ,高血压并发脑动脉硬化症 2例 ,截瘫并发梗阻性肾病慢性衰竭肾功能代偿期 1例。9例患者均使用 2 5 0～ 5 0 0ml右旋糖酐 4 0静滴 ,1/d ,其中 4例在右旋糖酐 4 0中加复方丹参 ,2例加脉络…     

慢性肾功能衰竭血小板计数及平均体积的变化

本文观察了慢性肾功能衰竭患者的血小板子数及平均血小板体积的变化，报道如下。1一般资料1．1病例选择。本组共73例，按Scr分为3个组，为氛质血Q组（Scr142～442umol／L）．慢性肾衰（Scr＞442umol／L），未透析组及透析组。原发病：慢性肾益肾炎13例，慢性肾小球肾炎35例，肾小动脉硬f症10例，糖尿病肾病9例，梗阻性肾病6例。1．2正常对照组为健康体检者4O例，平均年9389岁（21～51岁）。1.3指标测定。应用美国产CDI700型血球自动分析仪，检8血小板计数（BPC），平均血小板体积（MPV）。互．4统计学方法。用t检验对各项指标的差异…     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.