老年男性原发性骨质疏松症患者血清性激素的变化

目的探讨血清多种性激素的变化对老年男性原发性骨质疏松的影响。方法182例老年男性患者测定腰椎及髋部骨密度(双能X线骨密度仪)，分为正常、骨量减少与骨质疏松组，40例健康青年男性为对照组。所有受试者用放射免疫法测定血清总睾酮(TT)、雌二醇(E2)、硫酸脱氢表雄酮(DHEAS)、性激素结合球蛋白(SHBG)，用免疫比浊法测定血清白蛋白，并计算游离睾酮(FT)、生物有效性睾酮(Bio-T)、游离雄激素指数(FAI)、游离雌二醇(FE2)及生物有效性雌二醇(Bio-E2)结果老年男性在股骨颈、Ward三角及大转子骨密度明显低于青年男性；随年龄的增长，除SHBG外，其他性激素均有明显下降；老年男性中，Bio—T及FAI在骨质疏松组明显降低，其他激素无明显变化。结论老年男性骨密度降低与增龄引起的性激素下降密切相关，而具有生物活性的睾酮的降低是影响老年男性原发性骨质疏松的重要因素。     

血清前白蛋白在围手术期脊柱结核患者的变化研究

目的:观察围手术期脊柱结核患者的血清前白蛋白(PA)水平,初步探讨其对临床诊治的指导价值.方法:选取2013年6月—2017年6月我院收治的162名脊柱结核患者作为研究对象,以年龄大于65岁为老年组、小于65岁为非老年组,其中老年组35例,非老年组127例.男82例,女80例.化疗方案为3 HREZ/5-7 HRE,手...     

中老年人性激素与骨密度关系初步探讨

本文诵过对332例正常中老年人血清性激素放射免疫分析与单光子骨密度的测定旨在探讨中老年人骨矿物质丢失与血清性激素水平的关系。结果表明男性145人中12人(8．3%)血清睾酮含量低于正常标准．这12人骨密度明显低于正常标准，女性187人中75人(40％)血清雌二醇含量低于正常标准，而这75人中49人骨密度明显低于正常。血清睾酮含量低于正常标准之男性全部显示骨密度明显降低(100%)而女性仅49人(65％）显示骨密度明显降低。故可以认为中老年人骨矿物质丢失量与血清性激素含量呈负相关。     

健康人群中eGFR不是颈动脉内中膜厚度的危险因素

目的:探讨健康人群中伴随增龄的肾功能改变与颈动脉内中膜厚度关系。方法:随机抽取北京市10个社区,按入选标准筛选健康居民1 112例,采用CKD-EPI公式估算肾小球滤过率(e GFR),超声检测颈动脉内中膜厚度(CIMT)。分为动脉壁增厚组(CIMT≥0.9 mm)与正常组(CIMT0.9 mm);以及年轻组(65岁)和老年组(≥65岁)。结果:与年轻组比较,老年组收缩压明显升高,e GFR水平明显降低;CIMT明显增厚,颈动脉斑块比例明显增加。与CIMT正常组比较,CIMT增厚组年龄、BMI、SBP、DBP、PP、FBG、TC、TG、LDL、HDL、Scr、BUN及UA水平明显升高,Alb和e GFR水平明显降低。单因素相关分析结果显示CIMT与年龄SBP、DBP、PP、FBG及BUN呈明显正相关,与e GFR呈明显负相关。非条件Logistic回归分析显示,年龄、SBP、FBG、Alb是CIMT增厚的独立危险因素,未发现e GFR与CIMT的增厚独立相关。结论:北京健康居民中,增龄性e GFR减退与CIMT增厚未见独立相关;更严格的血压、血糖控制,更好的营养状态可能对于防治健康人群动脉硬化更为重要。     

胃肠道癌症患者血清性激素含量变化及其意义

目的 探讨血清性激素水平变化在胃肠道癌症的诊断和治疗的作用。方法 检测58例胃肠道癌症患和50例胃肠道良性疾病患手术前后血清性激素含量变化，并与50名健康人对照。结果 男女癌症患的睾酮水平在术前均低于良性疾病组和健康组(P<0.01)，手术后明显提高(P<0.01)。女性患的雌二醇水平在术前低于良性疾病组和健康组(P<0．01)，手术后明显提高(P<0.01)：男性患的雌二醇水平在术前高于良性疾病组和健康组(P<0.05)，手术后明显降低(P<0.01)良性疾病组与健康组比，良性疾病组手术前后比，上述两种激素水平均无明显差异(P>0.05)。结论 血清性激素水平测定对胃肠道癌症的诊断和治疗有一定的意义。     

特发性膜性肾病患者临床与肾脏病理表现的相关因素分析

目的探讨特发性膜性肾病患者(idiopathic membranous nephropathy,IMN)的临床及病理特征及对肾小球滤过率的影响。方法纳入2017年1月至2018年12月在新疆维吾尔自治区人民医院确诊为IMN的119例患者,根据估算的肾小球滤过率(eGFR)将患者分为eGFR正常组58例[eGFR≥90 mL·min~(-1)·(1.73 m~2)~(-1)]和eGFR下降组61例[eGFR90 mL·min~(-1)·(1.73 m~2)~(-1)],收集患者的临床及病理资料并进行对比分析。结果在临床资料方面,eGFR下降组患者的年龄、高血压患者比例、血肌酐、尿素氮显著高于eGFR正常组(P0.05),血清白蛋白、血清总蛋白水平显著低于eGFR正常组(P0.05);在肾脏病理方面,eGFR下降组患者的肾小球硬化、肾小管萎缩、肾间质纤维化、间质炎性细胞浸润、小动脉增厚的比例显著高于eGFR正常组(P0.05)。Logistic回归分析表明高龄、肾间质炎性细胞浸润是IMN患者eGFR下降的独立危险因素,高血清白蛋白水平是IMN患者eGFR下降的保护因素。结论对于IMN患者应积极采取改善血清白蛋白水平、控制肾间质炎性细胞浸润等办法,保护患者肾功能,延缓疾病进展。     

2型糖尿病肾脏病患者贫血的相关因素分析

目的探讨2型糖尿病肾脏病(diabetic kidney disease, DKD)患者贫血的相关因素。方法选取2017年9月至2019年8月在昆明医科大学第一附属医院确诊为2型DKD的患者334例,分为贫血组和非贫血组。分析两组患者在一般资料、实验室指标的差异;采用Logistic回归分析不同性别DKD患者贫血的影响因素。结果男性DKD患者中,非贫血组补体C4、血肌酐、胱抑素C、视黄醇结合蛋白、铁蛋白、尿白蛋白/肌酐比值、糖尿病病程低于贫血组(P0.05),体重指数(body mass index, BMI)、血红蛋白、糖化血红蛋白、补体C3、白蛋白(albumin, Alb)、间接胆红素、估算肾小球滤过率(estimated glomerular filtration rate, eGFR)、总胆固醇、血清铁、血钙高于贫血组(P0.05);女性DKD患者中,非贫血组血肌酐、胱抑素C、视黄醇结合蛋白、尿白蛋白/肌酐比值低于贫血组(P0.05),血红蛋白、Alb、血清铁、间接胆红素、eGFR、补体C3、血钙高于贫血组(P0.05)。Logistic回归分析发现,DKD患者中BMI、Alb、eGFR、血清铁、血钙可能是贫血的独立危险因素(P0.05);男性患者中BMI、eGFR、Alb与贫血相关(P0.05);女性患者中BMI、eGFR、血钙与贫血相关(P0.05)。结论肾功能恶化、铁缺乏、低钙血症、营养不良是2型DKD人群贫血的独立危险因素。     

老年腹膜透析患者甲状旁腺激素水平达标率及其与年龄相关性研究

目的调查分析老年维持性腹膜透析(peritoneal dialysis, PD)患者甲状旁腺激素(parathyroid hormone, PTH)水平达标率及其与年龄的相关性。方法收集2011年1月至2012年1月期间在四川大学华西医院接受PD治疗3个月以上并规律随访的235例患者的临床资料进行横断面研究,根据年龄分为老年组和非老年组(≥65岁和65岁),比较两组血钙、血磷、PTH及其他生化、营养指标,分析年龄与PTH的相关性。结果两组性别构成、身高、体质量、透析龄等差异无统计学意义(P0.05),糖尿病和高血压患病率在老年组患者更高(P0.05)。老年组PTH达标率低于非老年组(16.66%vs. 25.66%),低PTH水平者(150 pg/mL)老年组高于非老年组(70.83%vs. 48.66%)。老年组血磷、血清白蛋白值水平低于非老年组(P0.05),而血钙及血红蛋白高于非老年组(P0.05)。相关分析显示年龄与PTH水平呈负相关(r=-0.275,P0.05)。结论 PD患者PTH水平与年龄相关,老年PD患者PTH水平明显偏低,这可能是老年患者营养状况较差、血磷下降带来的影响。     

成都市铁路职工糖尿病人群慢性肾脏病患病情况及相关危险因素

目的探讨成都市铁路职工糖尿病人群慢性肾脏病(chronic kidney disease,CKD)的患病情况及相关危险因素。方法从2009年9月至2013年12月在成都铁路分局医院健康体检的铁路职工(分散居住在成都市各区)的资料中,选取有完整资料的967例糖尿病人群列入本次研究,资料包括问卷调查(性别、年龄、吸烟、饮酒、既往病史)、体格检查(血压、身高和体质量)、血液和尿液检测(尿素氮、血肌酐、血尿酸、血糖、胆固醇、三酰甘油、尿微量白蛋白、尿肌酐和尿常规)等,根据CKD诊断标准[白蛋白尿:尿微量白蛋白/肌酐≥30 mg/g;血尿:尿沉渣红细胞3个/高倍镜;肾小球滤过率(estimated glomerular filtration rate,eGFR)下降:简化肾脏病饮食改良(modification of diet inrenal disease,MDRD)公式计算eGFR60 ml·min~(-1)·(1.73 m~2)~(-1)]对资料进行分析。结果①糖尿病人群白蛋白尿、血尿和eGFR下降的发生率分别为28.02%、1.45%和13.75%。该人群中CKD的患病率为37.64%。糖尿病人群白蛋白尿发生率明显高于糖尿病前期人群和无高血糖的人群。糖尿病合并高血压、高血脂和高尿酸人群白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症人群。②空腹血糖水平与尿微量白蛋白/肌酐比值呈正直线相关。③年龄、体质量指数、高血压和空腹血糖水平是白蛋白尿的独立危险因素,女性是血尿的独立危险因素,年龄、高尿酸和空腹血糖水平是eGFR下降的独立危险因素,年龄、体质量指数、高血压、高尿酸和空腹血糖水平是CKD的独立危险因素。结论成都市铁路职工糖尿病人群,CKD的患病率与空腹血糖、体质量指数、血压、血尿酸和血脂相关。     

SLE患者血清性激素异常及意义

目的探讨系统性红斑狼疮(SLE)性激素异常与Th2细胞因子之间的关系。方法用放射免疫法对30例SI。E女性患血清的雌二醇(E2)、睾酮(T)及IL-6水平进行测定。结果SLE患E2与对照组无显差异，T水平低于对照组，E2／T高于对照组。患IL-6水平较对照组升高，患E2／T与IL-6呈正相关。结论SLEE2／T异常可能参与Th2细胞因子的异常产生。     

Serum concentrations of sex hormones in men with severe lower urinary tract symptoms and benign prostatic hyperplasia

OBJECTIVE: To find out the impact of age-related changes in serum concentrations of sex hormones on the development of severe lower urinary tract symptoms and benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The study group consisted of 61 consecutive patients subjected to prostatectomy for BPH between 2000-2001 in our clinic. Forty-five randomly assigned, age and socioeconomically matched cases without any lower urinary tract symptoms were taken as the control group. Both clinical BPH and control groups were divided to 3 age groups (namely 50-59, 60-69 and > or = 70 years) and age-related changes in serum concentrations of sex hormones were investigated. RESULTS: Prostate adenoma weight was found to be increased significantly (p = 0.02) with advancing age in clinical BPH group. There was no difference between serum concentrations of measured sex hormones between small and large prostates except for serum estradiol levels, which were found to be significantly higher in patients who had an adenoma weight of > 50 g (p = 0.047). Similar results were obtained in both clinical BPH and control groups with respect to age-related changes in serum concentrations of sex hormones. Briefly there was an age-related decrease in serum free testosterone levels and increase in serum estradiol, prolactin and gonadotropin levels. Serum free testosterone concentration was significantly higher in the control group for ages 60-69 (p = 0.015) while total testosterone was higher in BPH patients for patients older than 70 years of age (p = 0.027). No other significant change was documented between 2 groups. An age-dependent increase in serum E/freeT ratio was documented in both clinical BPH and control patients whereas serum freeT/T ratio was decreased in the BPH group with advancing age (p = 0.008). CONCLUSION: The decrease in serum free testosterone concentrations with a relative rise in serum estradiol levels with advancing age might be an important factor in the development of BPH. However it is likely that serum concentrations of sex hormones play little impact on the clinical severity of BPH.     

Bone Mineral Density and Androgen Levels in Elderly Males

To clarify the relationship of sex male hormones and bone in men, we studied in 140 healthy elderly men (aged 55–90 years) the relation between serum levels of androgens and related sex hormones, bone mineral density (BMD) at different sites, and other parameters related to bone metabolism. Our results show a slight decrease of serum-free testosterone with age, with an increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in a third of the elderly subjects studied. BMD decreased significantly with age in all regions studied, except in the lumbar spine. We found a positive correlation between body mass index (BMI) and BMD at the lumbar spine and femoral neck (P < 0.001). No relationship was found (uni- and multivariate regression analysis) between serum androgens or sex hormone-binding globulin (SHBG) and BMD. We found a positive correlation of vitamin D binding protein (DBP) and osteocalcin with lumbar spine BMD and with BMI, DBP, IGF-1, and PTH with femoral neck BMD. In conclusion, there is a slight decline in free testosterone and BMD in the healthy elderly males. However, sex male hormones are not correlated to the decrease in hip BMD. Other age-related factors must be associated with bone loss in elderly males. Received: 29 April 1997 / Accepted: 9 November 1997     

老年2型糖尿病患者血尿酸水平与骨代谢、骨密度及骨质疏松的关系

目的探讨老年2型糖尿病患者血尿酸水平与骨代谢标志物、骨密度及骨质疏松的相关关系。方法选取2018-2019年于北京大学国际医院内分泌科门诊就诊及住院的年龄60岁以上的老年2型糖尿病患者,共计577人,其中男性289人,女性288人(均为绝经后女性)。对所有研究对象进行一般临床资料调查、生化指标及甲状旁腺素(PTH)、25羟维生素D[25(OH)D]、骨钙素(OC)、血清I型前胶原N-末端前肽(P1NP)、I型胶原交联C-末端肽(β-CTX)测定,计算估算肾小球滤过率(eGFR),双能X线吸收法(DXA)测定股骨颈(FN)及腰椎(L1~4)骨密度(bone mineral density,BMD)。将血尿酸(SUA)四分位法分层比较分析股骨颈及腰椎总BMD变化趋势,Pearson和Spearman相关分析SUA与血钙(Ca)、PTH及OC、P1NP、CTX、25(OH)D、腰椎及股骨颈BMD的关系,多因素Logistic回归分析SUA与骨质疏松的关系。结果SUA第4分组BMI、肌酐(Cr)、股骨颈及总腰椎BMD水平明显高于第1分位组,SUA第4分组eGFR水平明显低于第1分位组,差异具有统计学意义(P<0.05);Pearson相关分析显示SUA与股骨颈BMD(r=0.082,P=0.002)、糖尿病病程(r=0.129,P=0.005)、BMI(r=0.201,P=0.000)正相关,与eGFR负相关(r=-0.434,P=0.000),Spearman相关分析显示SUA与腰椎总BMD(r=0.168,P=0.003)、Ca(r=0.147,P=0.001)正相关,与β-CTX负相关(r=-0.157,P=0.001),与PTH、25(OH)D、OC、P1NP无相关性(P>0.05)。以老年2型糖尿病合并骨质疏松为因变量,多因素Logistic回归显示,调整年龄、eGFR、BMI、HbA1c后,SUA是老年2型糖尿病患者发生骨质疏松的保护因素(P=0.039,OR=0.452,95%CI:0.212~0.962)。结论在老年2型糖尿病患者中,正常偏高的血尿酸水平可能减少骨质疏松的发生风险。     

Indices of testicular endosecretory function and of the status of the hypophyseal-gonadal system in varicocele

Testicular intrasecretory function and gonad-hypophyseal regulation were studied in 28 patients with the left-sided varicocele whose age varied from 11 to 36 years. Radioimmunoassay was used for the assessment of testosterone, estradiol, progesterone, follicle-stimulating (FS) and luteinizing (L) hormones and prolactin levels in the blood samples from femoral and internal testicular veins taken during endovascularization of varicocele. With regard to the age and manifestations of the secondary sexual signs the patients were divided into three groups. The first group (11-12-year-old) enrolled the patients with normal age-related levels of FS and L hormones in the presence of hyperprolactinemia. The positive testiculoperipheral gradient was revealed in 3 cases for estradiol and in 2 patients for testosterone and progesterone. The peripheral blood testosterone was normal in all the patients whereas estradiol and progesterone were decreased in 2 and 4 cases, respectively. All the patients of the second group (13-15-year-old) demonstrated an increase in testicular blood testosterone and estradiol as compared to their levels in the peripheral blood (1.46-1.8-fold and 1.3-7.1-fold, respectively). In 6 patients, this ratio was 1.65-2.33-fold higher. The levels of FS and L hormones were normal. In all cases hyperprolactinemia was observed. The third group (16-36-year-old) patients demonstrated a 1.4-3.1-fold gradient of testosterone in the testicular blood versus its levels in the peripheral blood. The authors defined 1.1-239-fold (mean, 8.95) estradiol gradients and 0-979-fold (mean, 2.5) progesterone gradients. In all cases but one, the levels of FS and L hormones were equal to the control.(ABSTRACT TRUNCATED AT 250 WORDS)     

Leptin, ghrelin, and adiponectin evaluation in transsexual subjects during hormonal treatments

Gender differences in leptin, ghrelin, and adiponectin levels have been described in a normal population. This is important for understanding differences between males and females in the regulation of food intake, weight gain, body fat distribution, and cardiovascular risk. It is unclear how endogenous and exogenous sex hormones may regulate circulating levels of these factors. Transsexuals during hormonal treatment may represent an ideal model to ascertain the role of exogenous sex hormones on these parameters. In this study, our objective was to evaluate adiponectin, ghrelin, and leptin levels in transsexual subjects during hormone therapy and to compare the results of males and females. Subjects were 26 nondiabetic transsexuals, which included 15 male-to-female (M-to-F, group 3) and 11 female-to-male (F-to-M, group 4) individuals, and 29 age- and BMI-matched controls, which included 15 males (group 1) and 14 females (group 2). Results showed that leptin levels were significantly lower in group 1 compared with group 2 (P = .04) and group 3 (P = .01); no differences were recorded between the other groups. Adiponectin levels were significantly higher in group 3 compared with group 4 (P = .03). No differences were found between the 4 groups for ghrelin levels. In conclusion, our data confirm the sexual dimorphism in serum leptin levels in normal subjects and demonstrate an increase in M-to-F transsexuals. While ghrelin does not show any sexual differences and seems not to be influenced by exogenous sex hormone administration, the lower adiponectin levels in F-to-M transsexuals during treatment confirm that androgens may decrease plasma adiponectin levels. This latter observation suggests that F-to-M transsexual patients could have a higher cardiovascular risk.     

The differential effects of neonatal androgen, estrogen and progesterone on adult rat prostate growth

Physiologic surges of serum androgen, estrogen and progesterone normally occur in both rat and human males during the neonatal periods. The effect of these hormone surges on the sex accessory tissues is not known. This study demonstrates that neonatal dihydrotestosterone, 17 beta-estradiol, or progesterone can permanently alter the androgen sensitivity of adult rat sex accessory tissues. Neonatal dihydrotestosterone or progesterone can permanently increase the androgen sensitivity of the adult prostate above normal while neonatal estradiol permanently decreases adult prostate androgen sensitivity below normal. The results of this preliminary study suggest that normally occurring neonatal hormone surges may permanently mark, or imprint, the prostate and determine its future growth in adulthood.     

Bone Mineral Density in Femoral Neck is Positively Correlated to Circulating Insulin-Like Growth Factor (IGF)-I and IGF-Binding Protein (IGFBP)-3 in Swedish Men

Studies on the hormonal regulation of bone metabolism in men have indicated covariation between insulin-like growth factor-I (IGF-I) and sex hormones with bone mineral density (BMD). In this study the relationships between BMD in total body, lumbar spine, femoral neck, distal and ultradistal (UD) radius and circulating levels of IGFs, IGF binding proteins (IGFBPs), and sex steroids were investigated in 55 Swedish men between 22 and 85 (52 +/- 18, mean +/- SD) years of age. BMD in total body, distal and UD radius, and femoral neck was positively correlated with serum IGF-I (r = 0.31 to 0.49), IGF-II (r = 0.32 to 0.48), IGFBP-3 (r = 0.37 to 0.53), and free androgen index (FAI) (r = 0.32 to 0.40), and negatively with IGFBP-1 (r = -0.37 to -0.41) and IGFBP-2 (r = -0.29 to -0.41) levels. A positive correlation was observed between BMD in femoral neck and estradiol/SHBG ratio (r = 0.34, P = 0.01). Age correlated negatively with serum IGF-I, IGF-II, IGFBP-3, FAI, estradiol/SHBG ratio, and BMD in total body, distal and UD radius, and femoral neck, and positively with IGFBP-1, IGFBP-2, and SHBG levels. According to stepwise multiple regression analyses, a combination of weight, IGFBP-3, and testosterone accounted for 43% of the variation in BMD in femoral neck, 34% in ultradistal radius and 48% in total body (P < 0.0001). These findings indicate that sex hormones and the different components of the IGF system are associated with BMD in Swedish men, suggesting that age-related changes in these systems could contribute to the development of osteoporosis in elderly men.     

BLADDER INFECTION IN THE MENOPAUSAL MONKEY

PURPOSE: The highest incidence of urinary tract infection in females occurs in elderly women. This study was done to determine whether this is due to the declining immune response that occurs during advancing age, or the menopausal state in the aged. MATERIALS AND METHODS: Adult female monkeys (average age 19 years) were studied, half being subjected to bilateral oophorectomy to produce the menopause. In addition, old females (average age 29 years) already at menopause were studied before and after hormonal replacement with estradiol and progesterone. Bacterial adherence to vaginal cells was studied prior to and after urethral infection with E. coli. Plasma estradiol and progesterone levels were done, as well as white blood counts, plasma cytokine assays and serum antibody titers. RESULTS: Bacteriuria was not prolonged, nor was there a significant difference in bacterial adherence to vaginal cells due to menopause. Interleukin-1 levels were depressed after surgical menopause but not as much as found in the old menopausal females and this low level was not corrected by hormonal replacement. The initial interleukin-2 levels were higher after spontaneous menopause, but the increasing plasma levels seen in cycling animals after infection did not occur in the aged menopausal females following infection even after hormone replacement. The antibody titers to the E. coli infection showed a trend to a lessened response to infection after menopause but were not significantly decreased. CONCLUSIONS: The deficient Il-1, Il-2 and antibody response following infection was not corrected by hormone replacement and thus appears to be due to aging rather than lack of female hormones. These facts may be explained by the T cell senescence known to occur in aged individuals.     

Brazilian normal static bone histomorphometry: effects of age,sex, and race

Bone histomorphometry values for normal individuals within different populations have been well established. We studied iliac crest bone samples from 125 healthy Brazilian subjects. The effect of sex, race, and age variables on histomorphometric parameters was evaluated. Bone volume showed a trend to decrease with age in both sexes, being significantly higher in black females and Caucasian males. Interactions among sex, race, and age had no effect on trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). However, age had a significant effect on Tb.Th and Tb.Sp, and sex had an impact on Tb.Sp. Trabecular number (Tb.N) was higher in black females than in males and was higher in Asian males than in females. Among females, Tb.N was lower in Asians than in other races and was higher in blacks than in Caucasians and or in those of mulattos. In addition, Tb.N was higher in males under 10 than in males over 50 years old, was higher in females under 10 than in females in any other age bracket, and was lower in females in the 41–50 age bracket than in younger females. Osteoid volume and osteoid surface were significantly higher in males than in females, and a significant age-related difference in osteoid thickness was observed. No significant sex-related or race-related differences were found in terms of resorption, although eroded surface decreased with age. In conclusion, sex, race, and age, as well as interactions among these three variables, were found to affect some static histomorphometric indexes in healthy Brazilian subjects.     

成人微小病变肾病综合征发生急性肾损伤的相关影响因素分析

目的探讨成人微小病变肾病综合征发生急性肾损伤( AKI)的相关影响因素。 方法回顾性分析2002年1月1日至2015年12月31日在解放军总医院病理诊断为微小病变肾病,临床表现为首发肾病综合征的成年患者。记录其横断面临床及病理指标,并将其分为AKI组及非AKI组进行比较。用单因素及多元Logistic回归分析与AKI发生相关的影响因素。并对AKI相关的各影响因素进行交互作用检验。 结果共纳入403例患者,男女比例为1∶1.13,肾活检时平均年龄为(39.5 ± 15.1)岁,其中118(29.3%)例发生了AKI。AKI组与非AKI组相比,年龄、性别、尿蛋白定量、血清白蛋白、血肌酐、血尿素氮、估算的肾小球率过滤、肾小管萎缩、肾间质病变差异均有统计学意义(P<0.05)。单因素Logistic回归分析显示高龄、男性、尿蛋白定量多、肾小管萎缩、肾间质水肿、间质纤维化及炎细胞浸润、高血压是成人微小病变肾病发生AKI的危险因素。交互作用检验表明血清白蛋白对AKI的作用受到肾间质纤维化的显著影响(P＝0.0 050),且在调整年龄分组、性别、高血压、尿蛋白定量、肾小管萎缩、肾间质水肿、肾间质炎细胞浸润混杂因素后,其交互作用仍显著(P＝0.0 263)。从多元Logistic回归分析可见,在无肾间质纤维化的人群中,血清白蛋白水平的升高是AKI的独立保护因素(调整后的OR 0.8,95%CI 0.7～ 0.9,P<0.001)。在有肾间质纤维化人群中,血清白蛋白的升高对AKI肾脏的保护作用不显著(调整后的OR 1.0,95%CI 0.9～1.0,P＝0.0 278)。 结论高龄、男性、尿蛋白定量多、肾小管萎缩、肾间质水肿、间质纤维化及炎细胞浸润、高血压是成人微小病变肾病综合征发生AKI的危险因素。血清白蛋白升高对AKI的保护作用受到肾间质纤维化的影响。