肾康注射液治疗慢性肾衰竭的临床研究

目的：探讨肾康注射液治疗慢性肾衰竭(CRF)的临床效果。方法将60例CRF患者依据治疗方式不同随机分为治疗组30例(肾康注射液治疗组)和对照组(常规治疗组)30例。结果观察组Scr、BUN、Cys-c明显下降,均优于对照组;同时通过临床疗效评价,观察组临床治疗总有效率明显优于对照组,<0.05,差异均有统计学意义。结论肾康注射液治疗CRF临床症状改善明显,效果显著。     

慢性肾衰患者骨密度及调钙激素测定的临床意义

慢性肾衰(CRF)特别是血液透析(HD)患者所伴发的骨质疏松、骨软化、肾性佝偻病等肾性骨病已为临床广泛重视。为了解CRF患者钙、磷代谢对骨矿含量的影响，我们对CRF患者进行了骨密度(BMD)及钙、磷调节激素-甲状旁腺素(PTH)、降钙素(CT）、骨钙素(BGP)含量的测定，并与正常对照组进行比较分析。     

尿毒清结肠透析对慢性肾衰竭的疗效观察

目的：观察尿毒清颗粒结肠透析(保留灌肠疗法)对早中期慢性肾功能衰竭(CRF)的临床疗效及安全性。方法选择各种肾病导致慢的CRF患者80例随机分为两组,对照组40例,给予原发病治疗及基础治疗;治疗组40例在原发病及基础治疗上,给予尿毒清保留灌肠,疗程8w,观察用药前后临床症状、肾功能指标变化。结果治疗组、对照组总有效率为87.5%、70%,治疗组优于对照组(<0.05),肾功能改善情况治疗组优于对照组。少数患者出现轻度腹泻,经减少药物剂量或对症处理后症状消失,无其他严重不良反应。结论尿毒清保留灌肠对早中期CRF患者可缓解临床症状、保护肾功能,值得临床推广。本文通过结肠透析结合尿毒清药物对中早期慢性肾衰竭症状的联合治疗,观察结肠透析的临床效果,对疗效进行总结。通过将我院80例早、中期慢性肾衰竭患者进行随机分类,其中对40例患者进行单纯的西医,作为结肠透析治疗的对照,而另外40例患者在使用同样西医治疗的基础上结合尿毒清结肠透析治疗,将两组对照总结出此种方法的疗效。     

PTH在CRF诊治中的应用

目的：探讨测定血清中甲状旁腺激素（PTH）的水平在慢性肾功能衰竭（CRF）诊治中的临床意义。方法：测定30例CRF患者血清PTH、25-（OH）VitD3和血钙,与健康人做对照。分别检测30例糖尿病肾病（DN）、高血压肾病患者血清内PTH浓度与血尿素氮（BUN）、血肌酐（Scr）的相关程度。结果：与正常对照组相比,CRF患者血清PTH水平显著升高,25-（OH）VitD3和血钙降低,差异有统计学意义（P〈0.05）。DN患者和糖尿病（DM）患者相比较,高血压肾病患者和高血压患者相比较,前者血清PTH水平均比后者要高,且与血BUN、Scr及尿中微量白蛋白（MA）与肌酐（Cr）的比值（MA/Cr）有较好的相关性。结论：CRF导致患者血清PTH浓度升高,测定血清PTH水平可作为判断肾功能的指标之一,更有助于临床对CRF的提早发现和及时治疗,对钙磷代谢的调节评价及预防继发性甲状旁腺功能亢进具有重要的临床意义。     

妇科恶性肿瘤住院患者心理弹性与癌因性疲乏的关系:正负性情绪的中介作用

目的:分析妇科恶性肿瘤患者心理弹性、正负性情绪和癌因性疲乏的关系,并探讨正性和负性情绪在心理弹性与癌因性疲乏间的中介作用。方法:选取河北省某三级甲等医院妇科恶性肿瘤住院患者141例,采用一般资料调查表、心理弹性量表(CD-RISC10)、癌症疲乏量表(CRF)及正负性情绪量表(PANAS)进行调查。应用结构方程模型探讨正负性情绪在心理弹性与癌因性疲乏间的中介作用,并用Bootstrap方法进行中介效应检验。结果:妇科恶性肿瘤患者的CRF评分为25.1±7.8。心理弹性评分与CRF评分及其各维度呈负相关(r=-0.31~-0.44,P0.01);正性情绪与CRF评分及其各维度呈负相关(r=-0.21~-0.60,P0.01);负性情绪与CRF评分及其各维度呈正相关(r=0.38~0.63,P0.01)。Bootstrap检验结果显示间接效应的95%CI为(-0.14~-0.52,P0.001),说明正负性情绪在心理弹性与癌因性疲乏间存在中介效应。结论:妇科恶性肿瘤患者存在癌因性疲乏的问题,心理弹性、正负性情绪是影响癌因性疲乏的因素,正负性情绪可以中介心理弹性与癌因性疲乏的关系。     

血清PCT、hs-CRP水平与慢性肾功能衰竭患者血液透析预后的相关性

目的:探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平与慢性肾功能衰竭(CRF)患者血液透析预后的相关性.方法:选取2018年1月-2020年12月期间于医院接受诊疗的60例CRF患者为研究对象,随访3 m,观察患者预后情况并分为预后不良组与预后良好组,所有患者治疗前均接受血清PCT、hs-CRP水平检测,分析血清PCT、hs-CRP水平与CRF患者血液透析预后的相关性.结果:60例CRF患者预后不良19例(31.67％),预后良好41例(68.33％);预后不良组血清PCT、hs-CRP水平高于预后良好组,差异有统计学意义(P<0.05);绘制ROC曲线,结果显示,血清PCT、hs-CRP水平单独及联合评估慢性肾功能衰竭患者血液透析预后的AUC均>0.8,具有一定预测价值,其中联合检测评估价值最高.结论:血清PCT、hs-CRP水平与CRF患者血液透析预后密切相关,临床可通过检测血清PCT、hs-CRP水平预测CRF患者血液透析预后情况.     

促红细胞生成素对尿毒症患者血液流变学改变的影响

本文观察了促红细胞生成素(EPO)对慢性肾功能衰竭尿毒症(CRF)患者血液流变特性改变的影响。20例CRF患者随机分为EPO治疗组(9例,疗程12月)及输血治疗对照组(11例,疗程19.2±8月),两组临床     

促红细胞生成素和转换酶抑制剂对慢性肾功能衰竭贫血患者红细胞的影响

贫血、高血压均是慢性肾功能衰竭 (CRF)常见的并发症 ,促红细胞生成素 (EPO)的应用已成为治疗肾性贫血的首选药物治疗 ,转换酶抑制剂 (ACEI)也因降低血压 ,改善心功能等广泛用于临床 ,但文献报道 ACEI有加重贫血作用 〔1〕。至于二者对 CRF红细胞的影响报道甚少 ,本文就 EPO和ACEI对 CRF患者红细胞的影响及 ACEI对 EPO的作用作一综述 ,为临床治疗提供依据。1　 EPO对 CRF患者贫血的作用EPO是一种能刺激细胞增殖、分化、成熟的糖蛋白造血因子。自 1983年分离克隆出人体 EPO基因 ,随后应用基因工程技术获得人类重组促红细…     

心理疏导结合感知控制对鼻咽癌放疗患者癌因性疲劳和生活质量的影响

目的:研究心理疏导结合感知控制对鼻咽癌放疗患者癌因性疲劳(CRF)和生活质量的影响。方法:70例鼻咽癌患者根据干预方法不同分为观察组和对照组各35例,观察组放疗期间全程给予心理疏导结合感知控制,对照组仅给予感知控制干预。评估放疗近期疗效、心理状态、CRF程度及生活质量。结果:两组放疗近期疗效分布比较无统计学意义(χ~2=0.38,P0.05)。两组干预后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较干预前明显降低(t_(观察组)=-10.29,-10.65,P0.001;t_(对照组)=-9.51,-10.05,P0.001),而观察组降低幅度明显较对照组大(t=-2.60,-2.47,P0.05)。观察组、对照组干预后CRF程度较干预前明显轻(U=21.14,5.69;P0.05),且干预后观察组CRF程度明显较对照组轻(U=8.59,P0.05)。干预后观察组癌症患者生活质量核心问卷调查表(QLQC30)评分中5项功能量表评分显著较对照组高,3项症状量表评分显著较对照组低,差异有统计学意义(t_(功能量表评分)=3.41,3.49,5.07,3.47,2.73;t_(症状量表评分)=-5.02,-3.66,-2.36;P0.05)。结论:对严格筛选的鼻咽癌放疗患者实施心理疏导结合感知控制可有效改善心理状态,减轻CRF,提高生活质量。     

慢性肾功能衰竭患者血液透析和肾移植前后凝血-血栓形成指标的变化

目的:观察慢性肾功能衰竭(CRF)患者血液透析(血透)和肾移植前后凝血-体外血栓形成指标的变化。方法:CRF病人53例,46例采用血透治疗,7例采用同种异体肾移植。分别于治疗前、血液透析10次后、肾移植18个月后检查血浆内皮素-1(ET-1)、抗凝血酶-Ⅲ(AT-Ⅲ)水平以及体外血栓形成的长度和重量。结果:CRF患者ET-1增加,AT-Ⅲ降低,体外血栓较长、较重,与健康对照组比较P均<0.01;血透治疗后ET-1有所降低,AT-Ⅲ有所增加,但体外血栓长度和重量无显著变化(P>0.05);肾移植治疗后血浆ET-1、AT-Ⅲ以及血栓长度和重量均较治疗前有非常显著性统计学差异,P均<0.01,接近健康对照组水平。结论:ET-1和AT-Ⅲ异常变化可促进CRF患者凝血功能增强和血栓形成,肾移植能改善凝血功能,防治血栓形成。     

Cancer fatigue: a neurobiological review for psychiatrists

BACKGROUND: Fatigue, both during and subsequent to treatment, is a ubiquitous and debilitating phenomenon for patients undergoing treatment for cancer of all types. OBJECTIVE: This review will focus on understanding the complex neurobiological mechanisms underlying the phenomenon of cancer-related fatigue (CRF) and their relevance for various treatment routes. METHOD: The review will describe the prevalence of CRF, differential diagnosis, consideration of neurobiological mechanisms, and routes for intervention. DISCUSSION: The review will provide suggestions for future study and research, and a future article will describe behavioral and educational strategies psychiatrists may use in alleviating cancer fatigue.     

Molecular epidemiology of HIV-1 subtypes and drug resistant strains in Taiwan

The Taiwanese government has provided free highly active antiretroviral therapy since April 1997. Previously, we have reported on the molecular epidemiology of HIV‐1 in Taiwan from 1988 to 1998. In addition, an outbreak of circulating recombinant form (CRF) 07_BC among intravenous drug users was noted in 2004. Therefore, the purposes of this study were to elucidate the distribution of HIV‐1 subtypes among different high‐risk groups in Taiwan from 1999 to 2000 and to conduct surveillance on drug resistance among treatment naïve patients from 1997 to 2000. Blood samples from 239 HIV‐1/AIDS patients and their subtypes were examined using DNA sequencing and phylogenetic analysis. The results showed that among 226 male patients, 213 (94.2%) had subtype B, 11 (4.9%) had CRF01_AE, 1 had unique recombinant strain related to both CRF07_BC and CRF08_BC (strain T12‐99TW) and 1 had CRF08_BC (strain L9312‐00TW). The patients infected with T12‐99TW and L9312‐00TW were intravenous drug users and had needle‐sharing experiences in Yunnan Province, China. Of the 13 HIV‐1‐infected females, 7 (53.8%) had subtype B, 5 (38.5%) had CRF01_AE, and 1 (7.7%) had subtype C. Phylogenetic analysis demonstrated that the neither strain T12‐99TW nor L9312‐00TW clustered with CRF07_BC strains isolated from Taiwanese intravenous drug users in 2004. In addition, 126 treatment naïve patients were selected for genotypic DR analysis and the results showed that 4.3% (2/47) homosexual males had M184V mutations. This is the first report on the identification of CRF08_BC and a unique recombinant strain related to both CRF07_BC and CRF08_BC in Taiwan. J. Med. Virol. 80:183–191, 2008. © 2007 Wiley‐Liss, Inc.     

Genomic instability in chronic renal failure patients

Patients suffering chronic renal failure (CRF) exhibit a high incidence of cancer, as well as high levels of genetic damage. We hypothesized that these patients show genomic instability as measured by increased radiosensitivity to the induction of genetic damage. The background levels of genetic damage and the net genetic damage after in vitro irradiation with 0.5 Gy were analyzed using the micronucleus assay in peripheral blood lymphocytes of 174 CRF patients and 53 controls. The net radiation‐induced genetic damage was significantly higher in CRF patients with respect to controls. Among CRF patients, the levels of genetic damage were higher in those with prior incidence of cancer than in those without cancer; in addition, those CRF patients undergoing hemodialysis presented with higher levels of genetic damage than those in the advanced Stages (4–5) of the pathology. A positive association was observed between basal and net micronucleus frequency among CFR patients. However, no association was found between net genetic damage and parameters linked to the different stages of the pathology, such as urine creatinine levels and glomerular filtration rate. Our results indicate that CRF patients show increased radiosensitivity and that the degree of radiosensitivity is associated with the progression of the pathological stage of the disease. Environ. Mol. Mutagen., 2012. © 2012 Wiley Periodicals, Inc.     

A study of gastric emptying in chronic renal failure

In a prospective controlled study, 32 patient with chronic renal failure (CRF) and 11 healthy volunteers were evaluated for solid gastric emptying at our institute over a period of 2 years. The study sought to identify the incidence of abnormal gastric emptying in these patients, the factors influencing the development of abnormal gastric emptying and whether gastrointestinal symptoms correlated with abnormal gastric emptying. The efficacy of prokinetic drugs Cisapride and Erythromycin in improving delayed gastric emptying in these patients with CRF was also compared and evaluated. We observed delayed gastric emptying in 69% of our patients. About 50% of our patients with delayed gastric emptying had no gastrointestinal symptoms suggesting a poor correlation between the two. Delayed gastric emptying was observed frequently in patients with peripheral neuropathy and/or autonomic neuropathy. Gastric emptying in CRF appears to be independent of age, sex, duration of disease, BUN, creatinine and H. phylori infection. Oral Cisapride and Erythromcin are effective gastrokinetic agents in these patients. Identification of delayed gastric emptying in patients with CRF and treatment with these drugs may reduce gastrointestinal symptom related morbidity.     

Evaluation and management of fatigue in oncology: a multidimensional approach

Fatigue, one of the most common symptoms experienced by cancer patients, is multidimensional and is associated with significant impairment in functioning and overall quality of life. Although the precise pathophysiology of cancer-related fatigue (CRF) is not well understood, a number of metabolic, cytokine, neurophysiologic, and endocrine changes have been described in these patients. A better understanding of these abnormalities is likely to lead to novel therapeutic interventions. Clinically, all patients presenting with significant fatigue should be evaluated for treatable conditions that might contribute to this symptom. Exercise and treatment of anemia are the two most established interventions for CRF. Psychostimulants seem promising based on early studies. Several complementary medicine treatments that showed efficacy in preliminary studies merit further testing.     

Amphetamine treatment increases corticotropin-releasing factor receptors in the dorsal raphe nucleus

Psychostimulant use increases anxious behavior, likely through interactions between central corticotropin-releasing factor (CRF) and serotonergic systems. The current study examined whether chronic amphetamine treatment (2.5mg/kg, 14 days) or withdrawal altered CRF receptor densities in the serotonergic dorsal raphe nucleus (dRN). Amphetamine treatment increased CRF(2) receptor densities in most subregions of the dRN, and CRF(2) receptors were still elevated following 6 weeks of withdrawal. No changes in CRF(1) receptor densities were observed following amphetamine treatment or during withdrawal. Selective increases in dRN CRF(2) receptors may be related to increased anxiety-like behaviors following psychostimulant use.     

基于血清蛋白组学的慢性肾衰预测模型探讨

 目的 通过比较慢性肾衰（CRF）患者与正常人血清蛋白表达谱的差异,筛选血清蛋白标志物并建立诊断模型,探讨其在慢性肾衰血清学诊断中的意义。方法 收集62例CRF患者和28例正常人的血清,经表面增强激光解析离子化飞行时间质谱(SELDI-TOF-MS)检验并筛选血清蛋白标志物。经生物信息学分析建立预测模型并进行验证。结果 在质荷比(m/z)1500～30000范围内,检测到51个有效蛋白峰,发现有19个峰有显著差异 (P<0.001),其中18个峰呈低表达,1个峰呈高表达;且CRF组和正常组的聚类性质明显不同;组内样本彼此靠近,组间样本彼此分开。构建的"慢性肾衰组－正常组"诊断决策树模型,预测正确率为87.8%,灵敏度为87.1%,特异度为89.3%。结论 该决策树模型能对慢性肾衰做出较为准确的预测判断,为慢性肾衰的临床早期发现提供一定的实验依据     

Urinary indoxyl sulfate is a clinical factor that affects the progression of renal failure

We recently demonstrated that indoxyl sulfate is a stimulating factor for the progression of chronic renal failure (CRF). In this study we determined whether the urine or serum levels of indoxyl sulfate are related to the progression rate of CRF in undialyzed uremic patients. Fifty-five CRF patients with a serum creatinine of >2 mg/dl who had not been treated with an oral sorbent (AST-120) were randomly enrolled in the study. We measured the serum and urine levels of indoxyl sulfate, and estimated the recent progression rate of CRF as the slope of the reciprocal serum creatinine versus time (1/S-Cr-time) plot. The mean urinary amount of indoxyl sulfate in the patients was 60 mg/day. Those with indoxyl sulfate urine levels of >60 mg/day had a significantly faster progression rate of CRF than those with <60 mg/day. Especially, those patients with indoxyl sulfate urine levels of >90 mg/day had the highest CRF progression rate and those with indoxyl sulfate urine levels of <30 mg/day had the slowest CRF progression rate. Urinary indoxyl sulfate had a significantly negative correlation with the slope of the 1/S-Cr-time plot. However, the serum level of indoxyl sulfate or the ratio of serum indoxyl sulfate to creatinine was not significantly correlated with the slope of the 1/S-Cr-time plot. In conclusion, high urine levels of indoxyl sulfate are related with a rapid progression of CRF in undialyzed uremic patients. Thus, urinary indoxyl sulfate is one of the clinical factors that affect CRF progression.     

慢性肾功能衰竭患者血浆同型半胱氨酸及血脂水平变化

目的 :了解慢性肾功能衰竭 (CRF)患者血浆中同型半胱氨酸(Hcy)和血脂水平的变化和透析治疗CRF前后血浆中Hcy水平的变化。方法 :以微板底物诱导法测定CRF患者、冠心病 (CHD)患者和健康者血浆中Hcy和其它血脂指标的浓度 ,并讨论与分析。 结果 :CRF患者血浆Hcy水平明显高于正常组 (P <0 .0 5 )。透析治疗观察发现CRF患者血液透析后 2hHcy水平较透析前下降 45 .7% ,透析后 2 4hHcy水平较透析前仅下降 8.9%。CRF患者血清Hcy和TG之间存在正相关性 (r =0 .719)。结论 :CRF患者普遍存在高Hcy血症 ,动态观察患者血脂、Hcy和肾功能水平 ,对了解病情进展和治疗效果有积极作用