肾小球滤过率估测值评判老年高血压及2型糖尿病并发终末期肾病患者血红蛋白浓度的变化

目的探讨用肾小球滤过率估测值(eGFR)评判的老年高血压及2型糖尿病并发终末期肾病(ESRD)患者血红蛋白(Hb)浓度改变。方法收集高血压及2型糖尿病并发慢性肾病且≥60岁患者230例,将eGFR15ml.min-1.1.73m-2(7.80±3.14ml.min-1.1.73m-2)者归为ESRD组,eGFR≥15ml.min-1.1.73m-2(29.76±12.90ml.min-1.1.73m-2)者归为非ESRD组,回顾性比较两组间Hb浓度。结果较非ESRD组〔Hb(100.8±23.0)g/L〕,ESRD组Hb浓度〔(74.4±22.5)g/L〕显著降低(P0.05),且在ESRD与非ESRD组中eGFR均与Hb浓度显著正相关(P0.05)。结论eGFR评判的老年高血压及2型糖尿病并发ESRD患者Hb浓度显著降低,且eGFR与Hb浓度具有显著正相关性。     

老年冠心病无症状心肌缺血和心绞痛并发慢性左心室收缩功能不全患者肾小球滤过率估测值与血红蛋白浓度的相关性

目的探讨老年冠心病无症状性心肌缺血和心绞痛并发慢性左心室收缩功能不全(CLVSD)患者肾小球滤过率估测值(eGFR)与血红蛋白(Hb)浓度的相关性。方法收集≥60岁冠状动脉造影证实冠心病无症状性心肌缺血和心绞痛患者235例,其中,超声心动图检测左心室射血分数(LVEF)50%110例归为CLVSD组〔LVEF(37.72±5.68)%〕;LVEF≥50%余125例归为非CLVSD组〔LVEF(60.25±5.56)%〕。上述两组据eGFR分别再分为eGFR60 ml.min-1.1.73 m-2组与eGFR≥60 ml.min-1.1.73 m-2组,回顾性分析此两组间Hb浓度差异。结果与非CLVSD组比较,CLVSD组Hb浓度显著增高〔(114.57±23.34)和(120.92±18.92)g/L,P0.05〕。LVEF与Hb浓度显著负相关(r=-0.18,P0.05)。CLVSD组中,与≥60 ml.min-1.1.73 m-2组比较〔(84.36±16.80)ml.min-1.1.73 m-2〕,eGFR60 ml.min-1.1.73 m-2组〔(46.28±11.90)ml.min-1.1.73 m-2〕,Hb浓度显著降低〔(123.12±18.98)和(112.79±16.10)g/L,P0.05〕,eGFR与Hb浓度显著正相关(r=0.24,P0.05)。在非CLVSD组中,与eGFR≥60 ml.min-1.1.73 m-2组比较〔(90.39±20.75)ml.min-1.1.73 m-2〕,eGFR60 ml.min-1.1.73 m-2组〔(44.11±12.44)ml.min-1.1.73 m-2〕Hb浓度亦显著降低〔(116.47±20.63)和(108.10±30.08)g/L,P0.05〕,eGFR与Hb浓度亦显著正相关(r=0.18,P0.05)。结论老年冠心病无症状性心肌缺血和心绞痛并发CLVSD患者Hb浓度显著增高,Hb浓度与LVEF显著负相关,而与eGFR显著正相关。     

肾小球滤过率水平对老年患者死亡情况的影响

目的分析基线估算肾小球滤过率(eGFR)对老年患者的死亡情况的影响。方法回顾性分析60岁及以上患者的临床资料。利用CKD-EPI公式计算基线eGFR,将其分为A组(eGFR<60 ml.min-1.1.73 m-2)及B组(eGFR≥60 ml.min-1.1.73 m-2),分析两组患者死亡情况。并将A组患者根据基线eGFR分为Aa组(eGFR≥45 ml.min-1.1.73 m2)和Ab组(eGFR<45 ml.min-1.1.73 m-2),通过χ2检验分析两组患者的全因死亡有无差异。结果初始年龄60岁及以上患者共582例,符合入选标准的568例,A组患者145例,B组423例,平均研究时间为(8.22±1.77)(3～14)年,死亡患者共72例(全因死亡率12.68%),A组死亡35例(全因死亡率24.14%),B组死亡37例(全因死亡率8.75%),两组间全因死亡率差异具有统计学意义(P=0.001)。χ2检验分析显示A与B组心血管疾病(CVD)死亡率、严重感染死亡率、死前行CRRT比率有统计学差异;Aa组共121例,死亡24例(死亡率19.84%),Ab组24例,死亡11例(死亡率45.83%),两组间有统计学差异(P=0.007)。结论eGFR<60 ml.min-1.1.73 m-2的老年患者的全因死亡率、CVD死亡率、严重感染死亡率及死前行连续性肾脏替代治疗(CRRT)比率均高于eGFR≥60 ml.min-1.1.73 m-2的患者;老年患者的全因死亡率随着基线eGFR的降低明显增加。     

不同状态肾功能与冠心病发病率及冠状动脉病变严重程度的分析

目的探讨不同程度肾功能降低患者的冠心病发病率及其冠状动脉病变的严重程度。方法收集9608例行诊断性冠状动脉造影疑诊冠心病的患者进行回顾性分析,依据适合中国人的改良MDRD方程估算的肾小球滤过率(eGFR)水平将患者分为肾功能正常(>90ml·min-1.1.73m-2)、轻度降低(60～89ml·min-1.1.73m-2)、中度降低(30～59ml·min-1.1.73m-2)和重度降低(<29ml·min-1.1.73m-2)4组,探讨不同程度肾功能损害患者的冠心病发病率及其冠状动脉狭窄的严重程度。结果 9608例患者中存在肾功能降低(eGFR<90ml·min-1.1.73m-2)者4939例,占51.4%。肾功能降低组患者冠心病发病率显著高于肾功能正常组(55.7%比44.3%,P<0.001),且冠状动脉狭窄程度更为严重,表现为患者病变支数更多(1.38±1.13比1.06±1.08,P<0.001)、Gensini积分更高(29.36±35.53比21.32±30.30,P<0.001)。肾功能正常组与轻度、中度、重度降低组患者冠心病的发病率分别为59.7%、69.4%、79.1%、92.3%,冠心病发病率随肾功能降低的程度而明显增高(P<0.001)。线性回归分析显示:Gensini积分与慢性肾病(Chronic kidney disease,CKD)分期(β=0.061,OR值3.219,95%CI:2.075～4.364,P<0.001)呈独立正相关。Logistic回归分析证实:CKD与冠心病诊断存在显著关联(OR值1.330,95%CI:1.177～1.503,P<0.001)。结论肾功能降低患者的冠心病发病率明显升高,且其冠状动脉狭窄程度更为严重;患者肾功能降低越显著,则冠心病发病率越高;肾功能降低与冠状动脉狭窄程度呈独立正相关;CKD与冠心病发生存在显著关联。     

入院肾小球滤过率对ST段抬高心肌梗死患者急诊介入治疗术后心肌灌注及预后的影响

目的 评价入院估算的肾小球滤过率(eGFR)对接受急诊PCI治疗的ST段抬高型心肌梗死(STEMI)患者冠状动脉血流和预后的影响.方法 回顾性收集因STEMI而在12 h内接受急诊PCI治疗的患者495例.根据患者入院时eGFR分为两组:eGFR≥60 ml·min-1·1.73 m-2组和eGFR ＜60 ml·min-1·1.73 m-2组.比较两组患者的临床资料、介入手术资料和1年随访资料.结果 eGFR＜ 60 ml·min-1·1.73 m-2组96例,eGFR≥60 ml·min-1·1.73 m-2组399例.与eGFR≥60 ml·min-1 ·1.73 m-2组相比,eGFR ＜60 ml·min-1·1.73 m-2组患者入院时年龄更大,男性患者更多,多支病变患者更多,高血压患者更多,既往心肌梗死病史患者增加,入院及出院eGFR更低,Killip's分级更高.eGFR ＜60 ml·min-1 ·1.73 m-2组校正TIMI计帧数比eGFR≥60 ml·min-1 ·1.73 m-2组更高,并且TIMI心肌灌注分级(TMP)0 ～1级患者更多(5.0％比14.6％).入院eGFR＜ 60 ml· min-1·1.73 m-2是接受急诊PCI的STEMI患者心肌灌注不良(校正相对危险度OR=3.95,95％CI:1.23 ～ 6.89)和1年死亡率(校正OR=1.48,95％ CI:1.21 ～ 2.97)的独立预测因子.结论 入院eGFR下降与急诊PCI治疗的STEMI患者心肌灌注不良和预后不良相关.     

慢性肾脏疾病增加慢性心力衰竭患者死亡率

目的探讨慢性肾脏疾病(CKD)对慢性心力衰竭(CHF)患者死亡率的影响。方法对2007年1月1日至2009年12月31日在北京协和医院心内科住院,年龄≥21岁,临床诊断为心力衰竭,且左心室射血分数(LVEF)≤45%的缺血性(心肌梗死后至少40 d以上)或非缺血性心肌病患者进行回顾性研究,根据肾小球滤过率(eGFR)情况分为两组,一组为eGFR<60 ml.min-1.1.73 m-2(CKD组),另一组为eGFR≥60 ml.min-1.1.73 m-2(对照组),并进行电话随访。结果共筛选242例患者,除外41例不符合入选标准者,对201例进行随访,14例(7%)失访,经过2～41个月[平均(20±9)个月]的随访,共36例(19%)发生全因死亡,包括CKD组21例(30%)和对照组15例(13%)(P=0.003)。结论 CKD增加CHF患者死亡率。合并CKD的CHF患者,积极处理CHF的同时应高度重视CKD处理。     

老年2型糖尿病患者心率变异性与肾小球滤过率的关系

目的 探讨老年2型糖尿病患者心率变异性(HRV)与肾小球滤过率(GFR)的关系.方法采用24h动态心电图HRV频谱分析技术检测89例老年2型糖尿病患者及30例对照组的HRV.按照估算GFR将89例患者分为A组(GFR≥60 ml·min-1.1.73 m-2)和B组(GFR＜60ml·min-1.1.73 m-2).比较三组之间的HRV,并与GFR作相关分析.结果 A组和B组的HRV各项指标参数均低于对照组(P＜0.05),B组的HRV各项参数小于A组(P＜0.05).GFR与HRV各参数呈正相关(P＜0.05).结论 老年2型糖尿病患者GFR下降与HRV降低密切相关.     

评估抗M型磷脂酶A2受体抗体阳性无创诊断我国老年特发性膜性肾病的可行性

目的评估抗M型磷脂酶A2受体(PLA2R)抗体阳性在我国老年人群中替代肾活检诊断特发性膜性肾病(IMN)的可行性。方法收集2021年6月至2022年3月在郑州大学第一附属医院肾内科就诊, 抗PLA2R抗体阳性(酶联免疫吸附实验≥14 RU/ml)且有完整肾脏病理资料并排除继发因素及糖尿病的96例老年肾病患者(≥60岁)的临床病理资料, 分为高估算肾小球滤过率(高eGFR组, ≥60 ml·min-1·1.73 m-2)和低eGFR组(<60 ml·min-1·1.73 m-2)。结果 96例患者中IMN 95例占99.0%(其中Ⅰ期1例、Ⅱ期59例、Ⅲ期34例、Ⅳ期1例), 不典型膜性肾病(AMN)1例(1.0%)。IMN患者中高eGFR组81例(85.3%), 以Ⅱ期IMN最多见(66.7%), 其中10例(12.3%)合并其他病理表现, 以轻度系膜增生性IgA肾病(2例)、亚急性肾小管间质性肾病(2例)最多见;低eGFR组IMN患者14例(14.7%), Ⅲ期IMN最多见(57.1%), 其中10例(71.4%)合并其他病理表现, 高于高eGFR组(χ2=21.642, P&...     

脂蛋白a与冠心病患者心肾功能的相关性研究

目的:探讨冠心病患者体内血清脂蛋白a[Lp(a)]与肾小球滤过率估测值(eGFR)和左室射血分数(LVEF)的相关性。方法:入选经冠状动脉(冠脉)造影检查确诊的冠心病住院患者555例。将所有患者根据性别分为两组。收集患者一般临床资料及冠脉造影结果。比较不同eGFR、LVEF及Gensini积分情况下Lp(a)的分布特征。采用Pearson相关分析法分析相关性,多元线性回归分析Lp(a)的影响因素。结果:1Lp(a)水平在不同性别、eGFR、LVEF和Gensini积分间的差异有统计学意义(均P0.05)。与eGFR≥90(ml·min-1·1.73m-2)相比,60(ml·min-1·1.73m-2)≤eGFR90(ml·min-1·1.73m-2)和eGFR60(ml·min-1·1.73m-2)两组患者(ml·min-1·1.73m-2)水平更高(均P0.05)。2Lp(a)与eGFR和LVEF呈负相关(均P0.05),与性别、载脂蛋白B、Gensini积分、血肌酐、总胆固醇、低密度脂蛋白胆固醇及年龄呈正相关(均P0.05)。在校正其他因素影响后,Lp(a)与性别、eGFR、载脂蛋白B、Gensini积分及LVEF仍有相关性(β值分别为0.094、-0.123、0.186、0.083和-0.074,均P0.05)。结论:Lp(a)与载脂蛋白B、eGFR、LVEF和Gensini积分相关,对冠心病患者心肾功能有影响。     

苯磺酸氨氯地平联合吲达帕胺或氯沙坦对高血压患者肾脏保护作用的比较

目的比较苯磺酸氨氯地平联合吲达帕胺或联合氯沙坦对高血压患者的肾脏保护作用。方法将120例高血压患者等比例随机分为苯磺酸氨氯地平+吲达帕胺组和苯磺酸氨氯地平+氯沙坦组各60例。观察8周,比较应用药物后两组患者血压、内生肌酐清除率、24 h尿蛋白总量及8-异前列腺素F2a(8-iso-PGF2a)浓度的差异。结果应用药物后两组患者血压均降至正常范围,两组间差异无统计学意义;与治疗前比较,治疗后两组患者内生肌酐清除率均有上升趋势,苯磺酸氨氯地平+氯沙坦组上升显著[(66.9±11.2)ml.min-1.1.73 m-2比(51.4±8.1)ml.min-1.1.73 m-2,P<0.01];治疗后两组24 h尿蛋白总量均显著降低,苯磺酸氨氯地平+氯沙坦组更为明显[(0.30±0.05)g/24 h比(2.02±0.64)g/24 h,P<0.01];治疗后两组8-iso-PGF2a浓度均显著降低,苯磺酸氨氯地平+氯沙坦组更为明显[(27.5±14.5)ng/L比(48.7±24.8)ng/L,P<0.05]。结论苯磺酸氨氯地平联合氯沙坦对高血压患者的肾脏保护作用优于苯磺酸氨氯地平联合吲达帕胺治疗。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.