超声心动图对慢性肾功能衰竭心脏病变的分析

目的：应用超声心动图探讨慢性肾功能衰竭患者心脏病变情况。方法：选择62例慢性肾功能衰竭患者进行超声心动图检查,并测量心脏腔径及心功能参数。结果：本组慢性肾功能衰竭患者心脏病变55例发生率为88.7%,表现为左室扩大39例（62.9%）,左房扩大37例（59.7%）,左室后壁增厚43例（69.4%）,室间隔增厚39例（62.9%）,左室舒张功能减低47例（75.8%）,心包积液28例（45.2%）,二尖瓣返流34例（54.8%）,主动脉瓣返流29例（46.8%）,肺动脉高压12例（19.4%）。结论：慢性肾功能衰竭所致的心脏病变发生率极高,且表现多样,及时应用超声心动图检测心脏,对临床早期诊断、防治及预后具有重要的指导意义。     

应用血清半胱氨酸蛋白酶抑制剂C评价肾小球滤过功能的临床研究

目的探讨血清半胱氨酸蛋白酶抑制剂C（serum cystatin C,SCysC）评价肾功能损伤不同时期肾小球滤过率（GFR）的临床应用价值。方法随机选择近2年来在我院住院的慢性肾脏病（CKD）患者146例。根据1992年中华肾脏病学会全国肾小球疾病座谈会制定的慢性肾功能衰竭（CRF）诊断标准及分期分成肾功能正常组及慢性肾功能不全代偿期、失代偿期、衰竭期、终末期。各组同时进行SCysC和血肌酐（Scr）检测,并计算出肌酐清除率（creatinine clearance,Ccr）。结果本文146例慢性肾脏病患者中,肾功能正常者Ccr正常,SCysC也正常,随着Ccr值逐渐下降,SCysC值随之上升。各组SCysC与Ccr之间均呈高度负相关关系。结论SCysC可以单独作为评价GFR的敏感指标,而且,比Ccr更客观地反映肾功能损伤不同时期GFR的功能。     

结肠透析机治疗不同程度慢性肾功能衰竭94例疗效观察

目的:观察结肠透析机治疗不同程度慢性肾功能衰竭的疗效。方法:94例慢性肾功能衰竭患者,按其在治疗前的血肌酐水平分为四组:肾功能代偿期(血肌酐:133~177μmol/L);肾功能失代偿期(血肌酐:178~422μmol/L);肾功能衰竭期(血肌酐:443~707μmol/L);尿毒症期(血肌酐:707μmol/L)。四组患者均在常规治疗的基础上应用结肠透析机治疗。观察期为4周,观察临床症状、临床效果、血肌酐的变化,以血肌酐的变化作为判断结肠透析治疗的疗效。结果:结肠透析治疗可明显改善慢性肾功能衰竭患者的临床症状,其好转率80%;临床效果较好,总有效率88%;结肠透析治疗对不同程度的慢性肾功能衰竭的疗效进行比较,发现肾功能代偿期、失代偿期和衰竭期明显好于尿毒症期(P0.01)。代偿期和失代偿期明显好于衰竭期(P0.05),且前两者之间差别不明显。结论:结肠透析机治疗中、早期慢性肾功能衰竭疗效确切,且价格便宜,操作简单,值得推广使用。     

不同生化指标在肾功能衰竭患者血液透析治疗价值

目的 探讨甲状旁腺素（parathyroid hormone,PTH）、钙（calcium,Ca）联合磷（phosphorus,P）在慢性肾功能衰竭患者中的表达及维持性血液透析的治疗指导价值。方法 选择2020年4—10月肾功能衰竭患者200例为对象,设为观察组,采用维持性血液透析治疗;选择同期治疗的健康体检者84例设为对照组。采用全自动生化分析仪完成Ca、P、尿素氮（blood urea nitrogen,BUN）、血肌酐（serum creatinine,Scr）水平测定,采用化学发光仪完成PTH水平测定,并完成PTH、Ca、P与肾功能Scr及BUN相关性分析。结果 治疗前,观察组PTH、P水平高于对照组（P <0.05）;Ca低于对照组（P <0.05）;治疗后观察组PTH、P水平低于治疗前（P<0.05）;Ca水平高于治疗前（P <0.05）;治疗后观察组PTH、P水平高于对照组（P <0.05）;Ca低于对照组（t=7.229,P <0.05）;慢性肾功能不全代偿期患者PTH、P、Scr及BUN均低于慢性肾功能不全失代偿期、慢性肾功能衰竭及...     

地灵丹治疗慢性肾功能衰竭的实验研究

目的 观察中药复方地灵丹对慢性肾功能衰竭大鼠的治疗作用，探讨其可能的作用机制。方法 采用5／6肾切除法制作大鼠慢性肾功能衰竭模型，分正常对照组、地灵丹治疗组、贝那普利治疗组、模型对照组、假手术组，分别测定用药后尿蛋白定量、血清肌酐、尿素氮、尿酸及尿肌酐。结果 用药42d后地灵丹组、贝那普利组血肌酐、尿素氮、尿酸值明显低于模型对照组（P〈0．05）；尿肌酐值、肌酐清除率值明显高于模型对照组（P〈0．01，P〈0．05）。贝那普利组、地灵丹组24h尿蛋白增量小于模型对照组（P〈0．05）。地灵丹组与贝那普利组各项检测指标值差异无统计学意义。结论 地灵丹具有延缓慢性肾功能衰竭进展的作用。     

地灵丹治疗慢性肾功能衰竭的实验研究

目的 观察中药复方地灵丹对慢性肾功能衰竭大鼠的治疗作用，探讨其可能的作用机制。方法 采用5／6肾切除法制作大鼠慢性肾功能衰竭模型，分正常对照组、地灵丹治疗组、贝那普利治疗组、模型对照组、假手术组，分别测定用药后尿蛋白定量、血清肌酐、尿素氮、尿酸及尿肌酐。结果 用药42d后地灵丹组、贝那普利组血肌酐、尿素氮、尿酸值明显低于模型对照组（P〈0．05）；尿肌酐值、肌酐清除率值明显高于模型对照组（P〈0．01，P〈0．05）。贝那普利组、地灵丹组24h尿蛋白增量小于模型对照组（P〈0．05）。地灵丹组与贝那普利组各项检测指标值差异无统计学意义。结论 地灵丹具有延缓慢性肾功能衰竭进展的作用。     

血清瘦素及IL-6、IL-8检测在慢性肾功能衰竭患者中的临床意义

目的通过对134例慢性肾功能衰竭患者血清瘦素（Leptin）及白细胞介素6（Interleukin 6；IL-6）、IL-8（Interleukin 8；IL-8）水平的检测，探讨慢性肾功能衰竭与瘦素、IL-6、IL-8的关系及发生机制。方法患者134例（男73，女71），年龄（36～80）岁，均经确诊。入院后第2d抽取空腹静脉血，用酶联免疫分析法（ELISA）检测IL-6及IL-8；用放射免疫分析法（RIA）检测血清瘦素，同时检测40例健康成人作对照组。结果慢性肾功能衰竭组瘦素水平显著高于对照组（t=2．39，P〈0．01）。慢性肾功能衰竭早期、肾衰竭期，尿毒症期患者瘦素无差异，而细胞介素6、8随病情的加重而升高，差异显著。结论慢性肾功能衰竭患者存在高瘦素血症和瘦素抵抗，瘦素参与了能量平衡的调节，瘦素水平增高是慢性肾功能衰竭的危险标志物。其发生机理有待深入研究。     

不同病变程度慢性肾病患者尿蛋白/肌酐比值、24h尿蛋白及肾功能指标分析

目的探讨不同病变程度慢性肾病患者尿蛋白/肌酐比值（Up/Ugcr）、24 h尿蛋白（24 hUp）及肾功能指标。方法根据患者肌酐清除率（Ccr）将138例慢性肾病患者分为A组（肾功能正常）、B组（轻度损害）、C组（中度损害）、D组（重度损害）及E组（尿毒症）,比较各组Up/Ugcr、24 hUp及血肌酐（Scr）的差别。结果 C、D及E组Scr值显著高于A组与B组,差别具有统计学意义（P〈0.05）,但A、B两组未见显著差别（P〉0.05）;A、B、C、D组患者Up/Ugcr与24 hUp显著正相关（均P〈0.05）;E组患者Up/Ugcr与24 hUp无相关性（r=0.320,P〉0.05）。结论Up/Ugcr可用于慢性肾病患者早期病变的评估及疗效监测。     

达力全治疗慢性充血性心力衰竭的临床观察

目的探讨达力全治疗慢性充血性心力衰竭的有效性及安全性。方法选择40例缺血性心肌病患者，随机分为治疗组（达力全）和对照组，治疗12个月。治疗前后分别应用超声心动图测量左室射血分数（LVEF）、左室收缩末直径（LVESD）和左室舒张末直径（LVEDD）。结果所有病例治疗后，左室射血分数升高，左室收缩末直径、左室舒张末直径降低，与治疗前相比差异显著（P〈0．01）。达力全治疗组与对照组相比，治疗后各参数明显改善，差异显著（P〈0．01），达力全治疗心力衰竭安全有效。     

慢性肾功能衰竭血载脂蛋白水平与肾功能的关系探讨

为探讨慢性肾功能衰竭患者（ＣＲＦ）的载脂蛋白（Ａｐｏ）水平与血肌酐（Ｃｒ）和肌酐清除率（Ｃｃｒ）的关系。采用免疫法测定３６例ＣＲＦ病人及正常对照者２０例血清Ａｐｏ的水平。结果显示：ＣＲＦ病人血浆Ａｐｏ水平明显异常并与血肌酐及肌酐清除率相关（Ｐ＜００５）。结论说明：Ａｐｏ异常不仅是肾功能减退的结果，而且还影响肾脏疾病的进程。     

Assessment of serum osteocalcine level in pre-dialysis patients with chronic renal failure

The application of serum osteocalcine as a marker of osseous synthesis in patients with renal osteodystrophy is still disputable because of its predominantly renal excretion. The aim of the present study was to investigate the level of serum osteocalcine in pre-dialysis patients with chronic renal failure (CRF). MATERIAL AND METHODS: 47 patients aged 22-60 years (26 males and 22 females) with chronic renal failure were studied. 23 of them were stage I CRF patients (creatinine up to 353.6 mumol/l) and 24 were stage II and III CRF patients (creatinine up to 800 mumol/l). 35 healthy subjects (15 males and 20 females) were used as controls. Serum osteocalcine was measured by a radioimmunologic assay (ELSA-OSTEO-CIS, France). Serum creatinine, calcium, phosphorus and alkaline phosphatase were detected on a biochemical analyzer "Optima" (Kone Instruments, Finland) using the standard techniques recommended by IFCC. RESULTS: Serum osteocalcine was significantly elevated in patients with stage I CRF (45.61 +/- 7.75 ng/ml), compared to the control group (14.61 +/- 1.02, p < 0.001; u = 3.96). A significant increase was also found in patients with stage II and III CRF (120.48 +/- 15.96 ng/ml, p < 0.001; u = 4.22). No significant difference in osteocalcine level was found between male and female patients (83.77 +/- 15.09 vs. 94.52 +/- 16.88). 32 (68%) patients of the entire sample had osteocalcine above the reference values. These included 11 out of 23 patients with stage I CRF (47%) and 21 out of 24 patients with stage II and III CRF (87%). A moderately positive correlation was established between osteocalcine level and the duration of CRF (0.57), as well as between serum creatinine (0.39) and phosphorus (0.34). A moderately negative correlation was discovered between creatinine clearance (-0.42) and total serum calcium (-0.37). CONCLUSIONS: Serum osteocalcine could be used as a marker for bone synthesis in pre-dialysis patients with CRF. Our results indicate that more than 50% of the patients show evidence for renal osteodystrophy.     

普拉固在非糖尿病肾病早期肾功能衰竭治疗中的应用

目的　研究羟甲戊二酰辅酶A还原酶抑制剂 (他汀类药物 )普拉固对延缓慢性肾衰进展的临床疗效。方法　选择非糖尿病肾病的慢性肾脏病患者共 48例 ,随机分成两组 ,在原有基础治疗上治疗组 2 6例患者予以普拉固治疗 ,对照组 2 2例单纯予以基础治疗 ,分别在 0 ,1,6,12个月时监测血脂、血清肌酐、肌酐清除率、尿视黄醇结合蛋白和尿蛋白定量。结果　与对照组相比 ,普拉固组血脂有显著下降 (P <0 0 5 ) ,而且尿视黄醇结合蛋白和尿蛋白水平有显著下降 (P <0 0 1) ,从 6月始治疗组肌酐上升幅度明显减缓 (P <0 0 5 )。一年后治疗组肌酐明显低于对照组 (P <0 0 1)。结论　普拉固有益于延缓慢性肾衰的进展     

Ionized calcium in patients with chronic renal failure.

Parameters of various renal disorders were studied in 31 patients (17 men and 14 women) who all were in the stage of chronic renal failure (CRF). These parameters included total serum creatinine, ionized calcium, serum creatinine, creatinine clearance and acid-base balance. The results were compared with a control group of 30 healthy subjects. In the patients with first stage CRF, the total serum calcium did not significantly decrease (mean = 2.19 +/- 0.12 mmol/l) and ionized calcium was within reference value limits (mean = 1.28 +/- 0.02 mmol/l). The percentage of ionized calcium in total serum calcium was higher for these patients (mean = 58.43%) than for the control group (mean = 52.25%). For patients with first and second stage CRF, the total serum was significantly lower (mean = 1.92 +/- 0.03 mmol/l) than for the healthy controls (p < 0.001) as well as for patients with first stage CRF (p < 0.05). The ionized calcium in these patients was not significantly lower (mean = 1.14 +/- 0.01 mmol/l); however, its percentage was higher than that of serum calcium (mean = 59.38%). There was a slight negative correlation between the levels of ionized calcium and serum creatinine in patients with first stage CRF (r = -0.30) and a significant correlation in patients with second and third stage CRF.     

慢性肾功能衰竭患者血压变化特点的临床研究

目的探讨慢性肾功能衰竭(肾衰)合并高血压的非透析患者血压昼夜节律特点,以及与肾功能、钙、磷、白蛋白、血脂、心脏结构和功能的关系。方法慢性肾衰合并高血压的非透析患者(A组)30例,男16例,女14例,血肌酐(307.93±97.13)μmol/L;肾功能正常的原发性高血压患者(B组)30例,男、女各15例,分别检测24h动态血压、血生化,计算肌酐清除率,行心脏彩超检查,记录左心房内径、左心室舒张末期内径、室间隔舒张期厚度和左室后壁舒张期厚度,计算射血分数,6个月后重复上述检查。分析血压节律改变的影响因素,昼夜血压的改变对肾功能及心脏结构和功能的影响。按夜间与日间平均动脉压比值是否大于0.9,根据血压昼夜变化曲线分为杓型组(A1和B1)与非杓型组(A2和B2)。结果A2组和B2组患者夜间血压明显升高;A组非杓型比例高于B组,其夜间高血压对肾功能及心脏结构和功能均有影响。结论慢性肾衰合并高血压患者与肾功能正常的原发性高血压患者相比,非杓型比例增加,夜间血压水平对肾功能及心脏结构和功能均有影响。     

慢性肾衰竭患者不同疾病发展阶段的信息需求及护理对策

目的：了解慢性肾衰竭患者不同疾病发展阶段的信息需求,为提供个体化护理措施提供依据。方法：分别设立代偿组、失代偿组、肾衰竭组和尿毒症组,每组各50人,用一般资料和CRF患者不同疾病发展阶段的信息需求问卷进行调查。结果：四组患者的信息需求得分依次是（55.34±1.32）、（57.48±1.41）、（61.58±1.45）、（67.25±1.33）分,平均秩次分别是64.67、69.88、81.63、89.96,四组患者比较差异具有统计学意义（P〈0.05）;代偿期组最希望知道的疾病信息是用药原则;失代偿期组最希望知道的疾病信息是血压相关知识;肾衰竭期组最希望知道的疾病信息是加重肾损害的危险因素;尿毒症期组最希望知道的疾病信息是血液透析的相关因素。结论：随着CRF的发展,患者的信息需求量增加;而CRF不同发展阶段患者对疾病的信息需求侧重点有所不同。因此,要求护理人员根据患病的不同进展阶段,提供个性化护理措施。     

Nephropathy in Chronic Lead Poisoning

This paper presents a study of renal function in 102 patients with lead poisoning admitted to the Occupational Diseases Clinic in Bucharest during the past 10 years; nearly half the patients had no history of lead colic. Every possible cause of renal damage, other than lead, was excluded by a careful differential diagnosis.

Renal function was investigated by repeated determinations of blood urea, creatinine and uric acid, urea clearance, and endogenous creatinine clearance tests.

Significant decreases of the clearance values (less than 50 ml./min. urea clearance and less than 80 ml./min. creatinine clearance), persistent high blood urea (more than 50 mg./100 ml.), and high blood creatinine (more than 1·2 mg./100 ml.) were found in a significant number of cases. These signs of impaired renal function were more frequent in the group of patients with chronic lead poisoning who had had several episodes of colic and an occupational exposure of more than 10 years. A high blood pressure was also found more frequently in this group of patients.

Undercompensated and decompensated renal failure was found in 17 patients, most of whom had been exposed to lead for more than 10 years and had a history of several attacks of colic. Arterial hypertension accompanied the chronic renal failure in 13 patients, the renal impairment generally preceding the rise in blood pressure by several years.

The duration of occupational lead exposure, the high absorption in the past, and the long period of observation of these patients, most of whom were repeatedly hospitalized, may explain the relatively high incidence (17 cases) of nephropathy with chronic renal failure in the present group.

Impairment of urea clearance seems to be the earliest sign, at a time when the creatinine clearance is still normal. As the duration of exposure lengthens and the patient is subjected to active episodes of poisoning the creatinine clearance also deteriorates. Persistent urea retention and high creatininaemia may follow in time, accompanied rather frequently by arterial hypertension. A study of some of the cases followed for several years demonstrated this progressive evolution of lead nephropathy.

A functional and transitory impairment of renal function is very probably caused by an impairment of intrarenal circulation, resulting from marked vasoconstriction of the renal vessels, forming part of the generalized vasoconstriction of lead poisoning. Prolonged exposure and frequently recurring episodes of acute poisoning may lead to progressive impairment of renal function and to the development of organic lesions.

Special attention should be paid to renal function tests in all cases with prolonged exposure to lead in order to prevent the development of severe lead nephropathy.

     

Serum levels of vitamin A and retinol binding protein in chronic renal patients treated by continuous ambulatorial peritoneal dialysis.

The possible causes and consequences of hypervitaminosis A and retinol binding protein (RBP) levels were investigated in patients with chronic renal disease submitted or not to dialysis treatment. The study was conducted on 20 patients divided into two groups: 10 patients with chronic renal failure (CRF) treated by continuous ambulatorial peritoneal dialysis (CAPD), and 10 CRF patients with no dialysis treatment. Ten normal subjects formed the control group. Retinol levels were determined by HPLC, and RBP levels by immunoassay in plasma and in post-dialysis fluid at different periods of time. Laboratory tests were carried out on all subjects, and dietary history was taken. Patients on dialysis had higher retinol levels than untreated patients. Retinol levels were found to be correlated with RBP levels. Serum retinol and RBP levels did not vary with diet, age or time of disease, dialysis group or time of dialysis, nor were they correlated with the levels measured in the dialysis fluid (CAPD). There was no significant correlation in retinol levels between chronic patients and controls. It is suggested that vitamin A and RBP clearances during dialysis do not accompany urea or creatinine clearance. Hypervitaminosis A did not show any toxic effect.     

慢性肾功能衰竭患者血清瘦素、白细胞介素-13和白细胞介素-18水平变化及其临床意义

目的探讨血清瘦素（leptin）、白细胞介素-13（IL—13）及白细胞介素-18（IL～18）水平在慢性肾功能衰竭患者中的变化及其临床意义。方法分别采用ELISA法和RIA检测86例慢性肾功能衰竭患者血清IL-13、IL-18和leptin含量,并与80例正常对照组比较分析。结果慢性肾功能衰竭组与正常对照组相比较,血清leptin、IL-13及IL-18水平均明显升高（P〈0．01）;慢性肾功能衰竭早期、肾衰竭期和尿毒症期患者leptin无差异（P〉0．05）,而IL-13、IL～18水平随病情的加重而逐步升高（P〈0．05）;血清leptin水平与血清IL-13、IL—18水平呈正相关（r=0．527,r=-0．489;均P〈0．05）,IL-13与IL-18也呈显著正相关（r=0．731,P〈0．01）。结论慢性肾功能衰竭患者leptin、IL-13及IL-18水平升高,其在慢性肾功能衰竭发生发展过程中可能起重要作用,且存在一定的相关性,IL—13和IL—18影响慢性肾功能衰竭患者的疾病进程。     

比索洛尔治疗稳定性心力衰竭的临床疗效

目的观察比索洛尔治疗稳定性心力衰竭的临床疗效。方法76例稳定性心力衰竭患者在常规治疗心衰的基础上,随机分成比索洛尔组39例和对照组37例,治疗组口服比索洛尔1.25～5.00mg/天,对照组口服安慰剂,疗程6个月。观察治疗前后心率、左室舒张末期内径、左室射血分数和6min步行距离。结果比索洛尔治疗组2个月后气促症状明显改善、心率明显下降(p<0.05);4个月后左室射血分数和6min步行距离明显改善(p<0.05),6个月后左室射血分数和6min步行距离明显进一步改善(p<0.01);6个月后左室舒张末期内径明显缩小(p<0.05)。安慰剂对照组治疗4月心率才显著下降(p<0.05),左室射血分数和6min步行距离治疗6月明显改善(p<0.05),左室舒张末期内径随访有缩小,但无统计学差异(p>0.05)。与对照组比较,比索洛尔治疗组因心衰再次入院、心血管死亡率、总死亡率复合终点明显减少(p<0.05)。结论比索洛尔治疗稳定性心力衰竭有效安全。