无创血红蛋白监测在脊柱融合术中的应用研究

目的探讨无创血红蛋白浓度(SpHb)监测与动脉血气分析血红蛋白浓度(Thbc)监测在脊柱融合术中的准确性及影响因素,旨在明确SpHb监测能否用于指导术中输血。方法全麻下行择期脊柱融合术的成年患者53例,ASAⅠ~Ⅲ级。于切皮前、植骨融合、手术结束和出血量每超过400ml即刻,记录SpHb、Thbc、静脉血常规血红蛋白浓度、手术时间、术中出血量、末梢灌注指数(PI)、MAP、CVP、体温、输注液体种类及总量。结果用一致性检验、回归分析和非参数检验进行统计分析。结果 SpHb与血红蛋白浓度的一致性弱于Thbc与血红蛋白浓度的一致性;SpHb与血红蛋白浓度成正相关(r=0.77,P0.01),Thbc与血红蛋白浓度成正相关(r=0.89,P0.01);SpHb与血红蛋白浓度、Thbc与血红蛋白浓度差值的平均值分布差异有统计学意义(P0.01)。出血量、输注胶体、PI对SpHb监测的准确性有影响(P0.05)。结论 SpHb监测总体上能反映体内血红蛋白浓度的变化趋势,可为临床有创测定血红蛋白浓度的采血时机提供参考。其准确性受众多因素影响,其在指导术中输血中的应用宜与动脉血气分析或静脉血常规测定相结合。     

三种检测血红蛋白水平的方法在行脊柱手术患者中的比较

背景测定血红蛋白（hemoglobin，Hb）值有助于围术期输血管理。目前可以通过有创抽取血标本经实验室Co-血氧计法（mb）测定血红蛋白，或是实时现场检验HemoCue法（HCue）。最近临床上采用了一种新型的无创连续分光光度传感器法（MasimoSpHb）。我们对tHb、SpHb和HCue三种方法的准确性进行了比较研究。方法选择20例、年龄40—80岁、全麻在俯卧位下行脊柱手术的患者。所有血标本均采自桡动脉导管。在诱导后即刻、手术开始前及此点后大约每小时分别测定一次SpHb、tHb和HCue。主要评定结果的依据是SpHb和tHb或HCue和tHb的差值。所有患者的每次检测均有3-5个观察数据。为评估精确度采用几种技术去分析它们的差异值与绝对差异值。我们还同时调查了所得数据的偏差和下列变量：tHb水平、手术持续时间、年龄、体重和灌注指数之间的关系。结果数据由20例患者的SpHb、tHb和HCue的78组测量值构成。结果中SpHb和tHb之间绝对差值〈1．5g／dI的占61％；在1．6—2．0g／dI之间的占16％；〉2．og／dI的占22％。随着手术时间的延长和灌注指数增加，差值显著下降。与年龄或体重之间无系统相关性。除一个数值外，所有的HCue值均比tHb低1．Og／DI。结论虽然HCue始终是精确的，但是我们的数据证实SpHb与tHb值之间的相关性通常是良好的。不过，在某些病例，本研究显示SpHb可能还未达到临床需要的精确性。通过对诸如SpHb此类无创连续监测技术的不断改进，将可以达到临床必需的要求。     

罗沙司他与重组人促红细胞生成素治疗肾性贫血的研究进展

正肾性贫血是慢性肾脏病(chronic kidney disease,CKD)患者最常见的并发症之一,也是CKD患者合并心血管事件的独立危险因素~([1])。流行病学研究显示~([2]),我国CKD血液透析患者肾性贫血发生率高达62.1%。改善全球肾脏病预后组织推荐~([3]),成人CKD5期透析患者,血红蛋白(hemoglobin,Hb)下降至90～100 g/L时应启动红细胞生成刺激剂(erythropoiesisstimulating agents,ESAs)来提高Hb水平。目前治疗肾性贫血最为常用的ESA是重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)。     

右旋糖酐氢氧化铁注射液联合促红素治疗难治性肾性贫血30例临床观察

目的:观察右旋糖酐氢氧化铁注射液(科莫非)联合促红细胞生成素治疗肾性贫血的疗效及安全性.方法:46例口服铁剂联合促红素治疗不理想的尿毒症维持性血液透析患者30例(治疗组)改用静脉滴注科莫非100 mg,2/周,总量达1 000 mg后改为100 mg,1/1～2周;16例(对照组)继续口服速力菲0.2,3/d治疗,促红细胞生成素的使用剂量和方法两组相同,总疗程均为8周.结果:科莫非治疗组较对照组血红蛋白显著升高(P＜0.001),红细胞比容显著升高(P＜0.001),血清铁蛋白显著增加(P＜0.001);患者精神、食欲、体力、生活质量等均有明显改善.偶有恶心、呕吐,皮肤刺痒,均无明显副作用;对照组血红蛋白水平上升幅度有限,多数有恶心、上腹不适,影响食欲.结论:科莫非联合促红细胞生成素治疗肾性贫血疗效优于口服铁剂联合促红素治疗组,不良反应较少.     

促红素治疗肾性贫血的临床观察

贫血是慢性肾衰竭患者最常见的并发症之一 ,在肾性贫血的众多因素中 ,促红细胞生成素 (简称促红素 )的绝对或相对缺乏是最重要的因素。近年来 ,随着人重组促红素的开发以及临床广泛应用 ,对于纠正慢肾衰患者贫血、改善生存质量起到了重要作用。为此 ,我科于 2 0 0 1年 1月开始观察 40例促红素治疗肾性贫血患者 ,收到满意效果 ,现报道如下。资料与方法1　研究对象　所有患者均为本科血液透析的尿毒症患者 ,其中男性 2 9例 ,女性 11例 ;年龄 18岁～ 75岁 ,平均(38.6± 13 .9)岁。(1)入院标准 :①各种原发或继发性肾病致慢肾衰患者 ;②血红蛋白…     

IgA肾病患者合并高尿酸血症临床及病理特征分析

目的探讨IgA肾病高尿酸血症的临床病理特征及相关危险因素。 方法选取2010年1月至2015年7月于山西医科大学第二医院行经皮肾穿刺活检确诊为IgA肾病的188例患者,根据血尿酸水平将患者分为正常血尿酸组与高尿酸血症组,收集患者一般资料、尿蛋白定量、肾功能等临床生化指标以及病理指标,并对肾脏病理组织进行牛津病理分型。分析两组患者临床表现、肾脏病理特点,应用多元回归统计学方法分析高尿酸血症发生的影响因素。其他数据采用SPSS13.0软件进行统计分析。 结果本研究中心188例IgA肾病患者中合并高尿酸血症的患者有42例,高尿酸血症发生率为22.3%;高尿酸血症组中男性患者36例,女性患者6例;与正常血尿酸组(男性患者61例、女性患者85例)相比,高尿酸血症组男性患者明显增多(χ²＝25.2,P<0.001)。本组研究IgA肾病患者肾脏组织牛津病理分型以M1E1S0T0多见;与正常血尿酸组比较,高尿酸血症组患者肾小管－间质损伤重,差异有统计学意义(χ²＝5.056,P＝0.025)。肾组织免疫复合物IgA沉积于毛细血管袢者高尿酸血症发生率明显升高(χ²＝44.69,P<0.001)。IgA肾病患者合并高尿酸血症的相关因素为性别、体质量指数、甘油三酯、IgA沉积于毛细血管袢。 结论IgA肾病高尿酸血症的危险因素为男性、肥胖、高甘油三酯血症,并可能与IgA在毛细血管区沉积相关。     

507例2型糖尿病合并慢性肾脏病患者肾活检的临床病理特点

目的 总结和分析糖尿病肾病(diabetic kidney disease,DKD)与非糖尿病肾病(non-diabetic kidney disease,NDKD)患者临床病理特点,为临床2型糖尿病合并慢性肾脏病患者肾活检指征提供循证医学证据.方法 通过南方医科大学南方医院大数据库收集2002年2月至2018年6月在该院接受肾活检的2型糖尿病合并慢性肾脏病患者,并根据肾活检结果将其分为DKD组和NDKD组(包括DKD合并NDKD),比较两组间临床表现及病理类型特点,并采用Logistic回归模型分析DKD和NDKD患者的相关因素.结果 共纳入507例患者,DKD患者114例(22.5%),NDKD患者393例(77.5%).病理表现:NDKD的最常见病理类型为膜性肾病(30.0%)和IgA肾病(19.1%),其中有5.6%患者为DKD合并NDKD.临床表现:与NDKD组患者相比,DKD组患者有更长的糖尿病史(>1年,76.3%比36.1%,P<0.001),更易发生糖尿病视网膜病变(42.1%比4.8%,P< 0.001),24h尿蛋白量更高[3.69(1.70,6.74)g比2.21 (0.91,4.97)g,P<0.001],血肌酐更高[117.5 (85.8,194.5) μmol/L比89.0 (68.0,143.8) μmol/L,P<0.001],血红蛋白更低[(105.07±20.85) g/L比(124.41±25.02) g/L,P=0.002],胆固醇更低[(5.69±1.87) mmol/L比(6.43±2.75) mmol/L,P=0.001].Logistic回归分析显示,糖尿病史(OR=4.162,95%CI 1.717~10.098,P=0.002)、较高收缩压(每增加1 mmHg,OR=1.028,95%CI 1.011~1.045,p=0.001)、降压药服用史(OR=3.141,95%CI 1.496~6.591,P=0.002)、糖尿病视网膜病变(OR=5.561,95%CI2.361~13.100,P<0.001)、较高糖化血红蛋白(每增加1%,OR=1.680,95%CI1.333~2.118,P<0.001)是DKD的相关因素,而血尿(OR=2.781,95%CI 1.334~5.798,P=0.006)和较高血红蛋白(每增加1g/L,OR=1.022,95%CI1.008~1.037,P=0.002)则为NDKD的相关因素.结论 DKD与NDKD之间的临床表现及病理类型存在差异,糖尿病病史、眼底检查、大量蛋白尿、降压药服用史、较高的糖化血红蛋白水平对DKD的诊断有较好的预测作用,而血尿和较高的血红蛋白水平对NDKD的诊断有一定指导意义.糖尿病合并慢性肾脏病患者行肾活检的指征需根据各临床表现综合分析.     

慢性肾脏病患者肾性贫血相关因素及中医学研究

目的:探讨慢性肾脏病(CKD)患者肾性贫血(renal anemia,RA)相关因素及中医证候特点。方法:130例CKD3~5期住院患者进行研究,收集贫血、肾功能等临床资料,进行中医证候辨证;将130例CKD3~5期并RA患者根据e GRF分为3组,应用方差分析比较各组间差异,多元回归法分析肾性贫血的相关影响因素。结果:随着e GFR下降,血红蛋白、血清铁指标,P值均0.05,差异有统计学意义;多元回归提示血红蛋白下降与肾功能进展呈正相关。肾性贫血患者的中医病机为本虚标实、气血阴阳亏虚;本虚证以阴阳两虚证比例最高(30.1%),标实证以湿毒最高(26.4%)。结论:CKD患者肾性贫血程度与e GRF下降呈正相关。中医病机以阴阳两虚证、湿毒症最多见,值得临床加以关注。     

血红蛋白在鉴别糖尿病肾病与非糖尿病肾脏疾病中的作用

目的探讨血红蛋白在鉴别糖尿病肾病(DN)与非糖尿病肾脏疾病(NDRD)中的临床意义。 方法对2004年1月至2012年4月在解放军总医院肾脏病科行肾活检、病理诊断明确且病史资料完整的66例DN、78例NDRD患者进行回顾性分析,比较两组临床指标及合并症的差异,采用多因素Logistic回归分析方法明确DN的独立危险因素;比较DN及NDRD组不同CKD分期的血红蛋白水平差异,明确其贫血性质及贫血相关的独立危险因素。 结果DN组糖尿病罹病时间、肾病罹病时间、平均动脉压、血清肌酐、尿素氮、24 h尿蛋白定量水平及合并糖尿病视网膜病变、心血管病、贫血的比例均高于NDRD组,差异具有统计学意义(P<0.05);多因素分析显示糖尿病罹病时间长(OR＝1.012,95%CI 1.005～1.019)、合并糖尿病视网膜病变(OR＝ 4.265,95%CI 1.616～11.255)、血红蛋白水平低(OR＝ 0.952,95%CI 0.929～0.976)及合并心血管病(OR＝2.875,95%CI 1.089～7.593)是DN的独立危险因素;CKD1～3期DN组及NDRD组的血红蛋白水平均存在显著性差异(P<0.05),该差异在CKD 4～5期消失;DN及NDRD组共有60例诊断为贫血,均为正细胞正色素性贫血;多因素Logistic回归分析显示白蛋白降低(OR＝0.928,95%CI 0.879～0.980)、血清肌酐升高(OR＝1.011,95%CI 1.004～1.019)、病理诊断为DN(OR＝6.213,95%CI 2.690～14.347)是贫血的独立危险因素。 结论血红蛋白与DN显著独立相关,早期对血红蛋白水平的监测可能为临床鉴别DN与NDRD提供新线索。     

尿NGAL在2型糖尿病肾病肾小管间质损伤评价中的价值

目的探讨尿中性粒细胞明胶酶相关载脂蛋白(NGAL)对评价2型糖尿病肾病(DN)患者肾小管间质损伤的价值。 方法研究对象为2012年1月至2015年12月第三军医大学大坪医院2型糖尿病患者167例(2型糖尿病组);将2型糖尿病组再分为正常白蛋白尿组(n＝56)、微量白蛋白尿组(n＝58)、大量白蛋白尿组(n＝53),其中51例患者进行了肾活检。50例非糖尿病患者作为正常对照组。采用酶联免疫吸附测定方法检测尿液中NGAL水平,分光光度法测定尿N-乙酰-β-D-葡萄糖苷酶(NAG)。分析尿NGAL水平与肾功能相关指标[尿NAG、尿白蛋白/肌酐比值(ACR)、eGFR]及肾组织损伤病理评分之间的相关性,以及NGAL对DN肾小管间质损伤严重程度的评价效能,采用SPSS软件进行统计学分析,相关性分析采用Pearson或Spearman方法。 结果糖尿病患者尿NGAL水平较非糖尿病正常对照组明显增加;尿NGAL水平与尿NAG、ACR呈正相关(r＝0.528, 0.578,P<0.001),与eGFR呈负相关(r＝－0.637,P<0.001);尿NGAL水平与DN肾小管萎缩与间质纤维化(IFTA)的严重程度呈显著正相关(r＝0.652,P<0.001);尿NGAL曲线下面积最大(AUC＝0.868),特异度94.7%,敏感度71.9%。 结论尿NGAL是评价DN肾小管间质损伤理想的生物标志物之一。     

Non-invasive measurement of hemoglobin during cesarean hysterectomy: a case series

Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy. Obstetric anesthesiologists are primarily involved in intraoperative transfusion management in these cases. Hemoglobin assessment is invaluable for assisting transfusion decision-making during the acute period of obstetric hemorrhage. However, laboratory and point-of-care tests of hemoglobin concentration are time-dependent and intermittent, and do not provide a real-time assessment of change during the acute phase of blood loss. A new non-invasive hemoglobin monitor has been introduced recently, which provides real-time measurement of hemoglobin values (SpHb) using multi-wavelength pulse co-oximetry. We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy.     

Delay in detection and treatment of perioperative anemia in hip fracture surgery and its impact on postoperative outcomes

BackgroundElderly patients with hip fractures are at high risk for perioperative anemia as a result of fracture- and surgery-related blood loss. The detection of anemia is dependent on intermittent blood samples and therefore might be delayed, potentially leading to a significant delay in transfusion. This study aimed to investigate the possible delay in perioperative anemia detection, accumulated perioperative anemia-associated burden, peripheral perfusion, and their association with patient outcomes in elderly patients with hip fracture.MethodsElderly patients with acute hip fracture scheduled for surgery were enrolled in this prospective study from August 2016 to December 2016. All patients were monitored continuously for hemoglobin concentration (SpHb) and perfusion index (PI) with the Radical-7® Pulse CO-Oximeter® and Rainbow® R1 Adhesive Multi-parameter Sensors (Masimo Corp., Irvine, CA, US) from 12 h presurgery to 24 h postsurgery.ResultsFifty-one patients were enrolled, and 41 were included in the final analyses. Mean delay in the detection of low Hb (<10 g/dL) using intermittent blood samples, when compared with SpHb, was 1.07 h (standard deviation, ±2.84 h). Median perioperative cumulated time with low SpHb (<10 g/dL for at least one min) was 25 min (interquartile range [IQR]: 21–690). There was a significant association between perioperative time with low SpHb and the occurrence of postoperative delirium (median cumulated time with low SpHb: 162 min in patients with delirium vs 22 min in patients without delirium, P = 0.034) and a nonsignificant trend for an association between perioperative time with low SpHb and 90-day mortality or medical complications (median cumulated time with low SpHb: 119 min for patients with mortality or severe complication vs 22 min for patients without mortality or severe complication, P = 0.104). PI values during the perioperative period were not significantly associated with patient outcomes. Cumulated time with low PI (<0.5) preoperatively (but not perioperatively) was significantly associated with the occurrence of postoperative delirium (P = 0.047).ConclusionsThis study showed a delay in transfusion threshold detection, and the presence of significant associations between low SpHb or time with low SpHb and postoperative outcomes.     

Continuous Noninvasive Hemoglobin Monitor from Pulse Ox: Ready for Prime Time?

Background

Advances in technology have allowed for continuous noninvasive hemoglobin monitoring (SpHb), which may enable earlier detection of hemorrhage and more efficient surgical and/or blood transfusion management. The use of SpHb has not been described in the trauma population. The purpose of the present study was to evaluate the accuracy of a SpHb measurement device in severely injured trauma patients.

Methods

We performed a prospective cohort analysis of severely injured trauma patients admitted to the intensive care unit (ICU) at our level I trauma center over a 6 month period. Serial IHb (invasive hemoglobin) levels and SpHb for the first 72 h were measured. Each SpHb measurement was matched with a corresponding IHb measurement. We defined normal Hgb as >8 mg/dL and low Hgb as <8 mg/dL. Data were then grouped based on Hgb level. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Spearman correlation coefficient plot were calculated.

Results

A total of 23 trauma patients with 89 data pairs were reviewed. Eighty-six percent of the patients were male with a mean age of 32 years and a mean injury severity score (ISS) of 21.1 ± 14. Invasive hemoglobin had a range of 7.2–16.9 and SpHb had a range of 3.3–15.2. The average mean and difference between IHb and SpHb were 10.7 and 1, respectively. Continuous noninvasive hemoglobin measurement did not record data points 13.5 % of the time. The Spearman correlation plot revealed a correlation of R = 0.670 (p < 0.001). After dichotomization with Hgb > 8, SpHb was found to have a sensitivity of 91 %, PPV 96 %, specificity 40 %, NPV 20 %, and an accuracy of 88 %.

Conclusions

The continuous noninvasive hemoglobin monitor does not appear to represent serum hemoglobin levels accurately in severely injured trauma patients. However, we were able to identify utility for this noninvasive tool when Hgb was dichotomized into normal or low levels.     

Erythropoietin and anemia in the progression of Balkan endemic nephropathy and other renal diseases

We have investigated anemia in patients at different stages of the evolution of three chronic renal diseases: Balkan endemic nephropathy (BEN), chronic pyelonephritis (PN) and chronic glomerulonephritis (GN). A total of 88 patients with creatinine clearances from 9 to 118 ml/min and hemoglobin concentrations from 70 to 160 g/l were studied with regard to the relationship, if any, between erythropoietin production and the type and stage of nephropathy. Anemia in BEN was a particular focus of interest since it had been stated that in BEN, anemia precedes renal failure. Our data neither prove nor disprove this statement. A significant positive correlation between creatinine clearance and hemoglobin concentration was found in all three nephropathies, indicating that in the patients studied the severity of anemia increased with the impairment of renal function regardless of the underlying disease. Serum levels of immunoreactive erythropoietin were in the normal range in 54 patients, moderately increased in 20 and slightly decreased in 14. The erythropoietin level appears to be unrelated to the stage of renal failure or the type of nephropathy. The only exception was the subgroup where the patients with glomerulonephritis and normal renal function had increased serum erythropoietin levels and significantly higher parameters of red blood cell concentration than the patients from the same subgroup with tubulointerstitial nephropathies. In patients with severe renal failure and anemia, serum erythropoietin levels were inappropriately low for the degree of anemia, indicating that erythropoietin plays a role in the pathogenesis of the anemia.     

Validation of noninvasive hemoglobin measurements using the Masimo Radical-7 SpHb Station

Background

Hemoglobin levels must be obtained through blood draws, which are invasive, time-consuming, and provide only 1 data point at a time rather than continuous measurements. The Masimo Radical-7 SpHb Station (Masimo Corporation, Irvine, CA) has been shown by its manufacturers to provide accurate noninvasive hemoglobin measurements in physiologically normal patients. The objective of this study was to validate noninvasive hemoglobin measurements using the Masimo Radical-7 device.

Methods

Data were prospectively collected in 2 cohorts of patients: major operations requiring hemodynamic monitoring (operating room [OR]) and critically ill patients (intensive care unit [ICU]). Noninvasive hemoglobin measurements (SpHb) were recorded and were then compared with laboratory hemoglobin measurements.

Results

Data were collected on 60 patients (OR = 25 and ICU = 45). The overall correlation of the Masimo SpHb and the laboratory Hb was .77 (P < .001) in the OR group with a mean difference of .29 g/dL (95% confidence interval [CI], .08–.49). The overall correlation in the ICU group was .67 (P < .001) with a mean difference of .05 g/dL (95% CI, −.22 to −.31).

Conclusions

Noninvasive hemoglobin monitoring is a new technology that correlated with laboratory values and supports the continued study of noninvasive hemoglobin monitoring.     

The Anemia of Acute Renal Failure: Association with Oliguria and Elevated Blood Urea

Anemia is very frequent in patients with acute failure but the nature of the relationship between the two conditions has remained unclear. We studied all patients with well-documented acute renal failure seen in consultation by our nephrology division during 1991. Fifty-three of the 56 patients had at least mild anemia (hematocrit < 35%) at some point during their hospital stay. Forty-three of the patients had a hematocrit below 30% and 14 had a hematocrit below this level on admission. Twenty-four of the patients underwent mujor operations and all of these patients required blood transfusions. In this group there was a significant correlation between maximum serum urea and lowest hemoglobin (r = 0.4, p <. 05) but no similar correlation between maximum creatinine and lowest hemoglobin. Oliguric patients had a mean lowest hemoglobin of 7.3 ± 0.4 g/dL., which was significantly lower than the value for nonoliguric patients, 9.0 ± 0.4 g /dL. This study confirms the presence of anemia in 91% of patients with acute renal failure and shows it to be related to rise in urea and presence of oliguria. Clearly, however, the anemia is multifactorial, since in one-quarter of the patients it precedes onset of renal failure.     

Effect of erythropoietin treatment on physical exercise capacity and on renal function in predialytic uremic patients.

Anemia is already present in patients with moderate renal failure and is a major cause of the decline in exercise capacity seen in these patients. We examined the effects of erythropoietin (EPO) treatment in 12 predialytic uremic patients (EPO group: mean age 46 +/- 12 years; 6 men, 6 women) with a mean glomerular filtration rate (GFR) of 10 +/- 4 ml/min x 1.73 m2. These patients were compared to a control group of 8 patients (5 men, 3 women). The observation period was 3 months. The EPO group received 300 U/kg body weight i.v. once a week. The EPO group increased their total hemoglobin (THb) from 323 +/- 89 to 466 +/- 128 g (p less than 0.001) and their hemoglobin concentration from 86 +/- 8 to 117 +/- 11 milligrams (p less than 0.001). Their exercise capacity, measured by a standardized exercise test on a bicycle ergometer, increased from 128 +/- 45 to 147 +/- 57 W (p less than 0.01). The control group did not change their THb (349 +/- 124 and 357 +/- 131 g), hemoglobin (93 +/- 8 and 94 +/- 10 milligrams) or exercise capacity (98 +/- 49 and 101 +/- 50 W) during the observation period. There was a significant correlation between the increase in THb and the increase in exercise capacity in the EPO group (r = 0.81, p less than 0.005). The GFR was unchanged in both groups (EPO group: 10 +/- 4 and 10 +/- 6 ml/min x 1.73 m2; control group: 8 +/- 3 and 8 +/- 3 ml/min x 1.73 m2).(ABSTRACT TRUNCATED AT 250 WORDS)     

老年患者炎症因子水平与肾性贫血的相关分析

目的 探讨老年患者贫血的发生与炎症因子水平及。肾功能的相关性。方法 选择老年患者（年龄≥60岁）200例为研究对象,另设30例健康体检者为正常对照组。根据血红蛋白水平将200例老年患者分为贫血组和非贫血组;根据估算肾小球滤过率（eGFR）又分为A组[eGFR〉50ml·min^-1·（1．73m^2）^-1]、B组[eGFR30～50ml min^-1·（1．73m^2）^-1和C组[eGFR〈30mlmin^-1·（1．73m^2）^-1],测定血清超敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）水平。结果随着肾功能水平减退,贫血患病率逐渐增高,血清hs-CRP、IL-6、TNF-α水平亦逐渐增高,但仅hs-CRP组间有显著差异（P〈0．05）;血清hs-CRP、IL-6、TNF-α与血红蛋白均呈负相关（r=-0．271、-0．148、-0．155,P〈0．05）;hs-CRP、TNF-α与eGFR亦呈负相关（r=-0．140、-0．142,P〈0．05）,IL-6与eGFR无相关性。结论老年人肾功能减退时的高贫血患病率与炎症因子参与的致病机制有关;hs-CRP在评价。肾功能减退者的机体炎症状态时优于TNF-α和IL-6。     

血红蛋白与IgA肾病患者肾小管萎缩/间质纤维化的关系

目的探讨IgA肾病(IgA nephropathy,IgAN)患者血红蛋白(Hb)水平与肾脏病理牛津分级中肾小管萎缩/间质纤维化(T)的关系。方法回顾性分析2010年1月1日至2015年12月31日在深圳市第二人民医院肾活检确诊为IgAN、同时有完整实验室及影像学资料的患者。将所有患者分为贫血组与非贫血组。采用Logistic回归分析确定Hb与肾小管萎缩/间质纤维化的关系;采用平滑曲线拟合分析Hb与肾小管萎缩/间质纤维化可能的曲线关系;采用受试者工作特征曲线(ROC)分析Hb对肾小管萎缩/间质纤维化的诊断价值。结果本研究共纳入IgAN患者630例,贫血组130例(20.63%),非贫血组500例(79.37%);两组间年龄差异无统计学意义,而性别差异有统计学意义(男性35.38%比53.80%,χ2=10.740,P<0.001)。与非贫血组相比,贫血组的患者肾小管萎缩/间质纤维化的比例和24 h尿蛋白量较高(χ2=62.586,P<0.001;Z=-6.082,P<0.001),估算的肾小球滤过率(eGFR)较低(t=7.126,P<0.001)。Logistic回归分析显示,高Hb水平为肾小管萎缩/间质纤维化发生风险减少的独立保护因素(OR=0.973,95%CI 0.958~0.987,P<0.001)。平滑曲线拟合分析显示Hb与肾小管萎缩/间质纤维化呈线性负相关。ROC曲线提示Hb诊断肾小管萎缩/间质纤维化的最佳临界值为120.5 g/L,即提示Hb>120.5 g/L时,肾小管萎缩/间质纤维化的程度可能降低。结论IgAN合并贫血的患者其肾小管萎缩/间质纤维化发生率较高。Hb>120.5 g/L可能减少肾小管萎缩/间质纤维化发生的风险。