血清Cystatin C评价慢性肾脏病患者肾小球滤过功能的对照研究

目的:通过比较血清半胱氨酸蛋白酶抑制剂(Cystatin C)与临床常用的测定肾小球滤过率(GFR)的方法,评估Cystatin C检测肾小球滤过功能的价值.方法:选取我科住院确诊的慢性肾脏病(CKD)病人196例,测定血清肌酐(Scr)、尿素氮(BUN)和血清Cystatin C,并分别利用MDRD方程、Cockcroft-Gault方程计算GFR,比较各种方法与99mTc-DTPA测得GFR之间的相关性,应用受试者工作特征曲线下面积(AUCROC)比较各种方法的准确性.结果:血清CystatinC与GFR呈明显负相关(P＜0.01)较CG方程计算值及Scr、BUN相关性好.MDRD方程、血清Cystatin C及Cockcroft-Gault方程的受试者AUCROC分别为0.98、0.94、0.92,与Scr、BUN有统计学差异(P＜0.01).结论:血清Cystatin C是反映肾小球滤过功能比较敏感的指标,尤其在评价早期肾功能损害时的意义更大.     

血清胱抑素C在评价慢性肾脏病患者肾小球滤过率中的价值

目的：探讨血清胱抑素C（CystC）在评价慢性肾脏病（CKD）患者肾小球滤过率中的临床价值。方法：选取2009年4月～2009年11月住院的CKD患者76例,检测其血清CystC浓度,血清肌酐浓度（Scr）,以99mTc-二乙三胺五醋酸（99mTc-DTPA）法测定肾小球滤过率（GFR）,并用简化MDRD和Cockcroft-Gault（C-G）方程分别估测GFR（M-GFR,C-GFR）,以99mTc-GFR作为金标准,比较不同CKD分期间各指标间的相关性及其敏感度和特异度。结果：患者血清CystC、Scr、C-GFR、M-GFR与99mTc-GFR的相关系数分别为-0.81、-0.73、0.90、0.89,P均〈0.01,CystC在CKD1～3期与99mTc-GFR均有相关性,相关系数分别为-0.57（P〈0.05）,-0.44（P〈0.05）,-0.74（P〈0.01）,但在4～5期两者无明显相关关系（相关系数-0.30,P〉0.05）而Scr、C-GFR、M-GFR与99mTc-GFR仅在CKD3期患者中有相关性;在CKD1期患者中,CystC的敏感性和特异性均高于C-GFR和M-GFR。结论：血清CystC是一个反映CKD患者肾功能的较为敏感的指标,尤其在早期CKD患者中应用价值更大。     

粪便隐血试验在慢性肾脏病患者发生结直肠病变的预测意义

目的：通过研究慢性肾脏病（CKD）患者粪便隐血阳性的发生率,探讨粪便隐血试验在慢性肾脏病患者发生结直肠病变的预测意义。方法：使用免疫法粪便隐血试验（IFOBT）检测2007年03月～2007年06月于我院肾脏科就诊的176例CKD患者和同期我院体检中心180例健康体检者,比较粪便隐血阳性发生率,同时对CKD患者的临床、生化等指标进行统计分析。结果：176例CKD患者IFOBT阳性率17%,180例正常对照组IFOBT阳性率5%,CKD组高于正常对照组（χ2=13.236,P〈0.01）。CKD组血红蛋白低于正常对照组[（105.59±27.03）g/dlvs（121.00±25.62）g/dl,P〈0.05],血沉[（59.77±32.91）mm/hvs（9.54±3.21）mm/h,P〈0.05]、血肌酐[203.75（74.50～567.25）μmol/Lvs68.00（45.00～95.00）μmol/L,P〈0.05]高于正常对照组。CKD组中,IFOBT阳性的患者与IFOBT阴性的患者相比,年龄大（P〈0.01）、血沉升高（P〈0.05）、C反应蛋白升高（P〈0.05）,而血红蛋白（P〈0.05）及肾小球滤过率（P〈0.01）降低。IFOBT阳性患者血红蛋白随肾小球滤过率下降而降低,血沉、血磷、iPTH随GFR下降而升高。相关法分析显示CKD患者IFOBT检测值与GFR（r=-0.191,P〈0.05）呈负相关;与年龄呈正相关（r=0.175,P〈0.05）。对CKD患者IFOBT阳性的30例患者行肠镜检查,结果发现结肠癌2例（6.7%）,结直肠腺瘤性息肉11例（36.7%）,活动期溃疡性结肠炎4例（13.3%）,出血性肠炎9例（30%）,4例患者未见明显异常（13.3%）。结论：CKD患者易发生结直肠出血性疾病,随着患者GFR的下降,发生病变的几率升高。而IFOBT是可行有效地检测方法,对于CKD患者结直肠病变的预测具有重要的临床意义。     

慢性肾脏病不同分期血二氧化碳结合力的变化及其影响因素分析

目的：调查慢性肾脏病（CKD）患者血二氧化碳结合力（CO2-CP）水平的基础状况。方法：对中山大学附属第三医院肾内科门诊就诊的CKD患者进行为期9个月的前瞻性横断面调查,分析其病例基线特征及各期血CO2水平与代谢性酸中毒的发生率。结果：共有715例CKD病例入选。前4位CKD的病因分别为原发性肾小球疾病、高血压肾病、狼疮肾炎和糖尿病肾病。CKD3期以后,随着CKD分期的进展,血CO2-CP水平逐级显著性降低,代谢性酸中毒的发生率逐级显著性升高。多元回归分析结果显示,血CO2-CP水平和肾小球滤过率呈显著性正相关,血CO2-CP水平和血清钾以及蛋白尿程度呈显著性负相关。结论：对CKD患者血CO2-CP水平单中心横断面调查,将有助于确定CKD患者血CO2-CP水平的变化规律,为进一步综合防治CKD及其并发症奠定基础。     

普伐他汀对慢性肾脏病患者肾功能及尿蛋白作用的临床研究

目的：研究普伐他汀对慢性肾脏病患者（CKD）肾功能及尿蛋白的影响,探讨其在 CKD 患者中应用的价值。方法：符合入选标准的48例临床诊断 CKD 的患者,在给与 CKD 常规治疗的基础上随机分组为普伐他汀组（n =25）和对照组（n =23）。普伐他汀组加用普伐他汀20 mg 每晚,维持治疗48周。于治疗前、治疗后4周、12周、24周、36周及48周监测患者血肌酐、血脂、尿蛋白等情况,评估肾小球滤过率。结果：普伐他汀组与对照组在年龄、性别、蛋白尿、肾功能等基线水平的差异无统计学意义。治疗后,普伐他汀组血胆固醇、三酰甘油、低密度脂蛋白均较对照组有所下降,36周后组间达到统计学差异（P ﹤0．05）。普伐他汀组24 h 尿蛋白在治疗8周后与对照组差异存在统计学意义（P ﹤0．05）,48周后普伐他汀组尿蛋白较对照组下降52．3%。两组高敏 C 反应蛋白均呈下降趋势,普伐他汀组更为显著。两组估算肾小球率过滤（eGFR）的改变差异无统计学意义。结论：普伐他汀可能可有效改善 CKD 患者的血脂情况,减少蛋白尿,抑制炎症反应,延缓 CKD 进展。     

血清半胱氨酸蛋白酶抑制剂C在各期慢性肾脏病诊断中的应用价值

目的：探讨血清半胱氨酸蛋白酶抑制剂c（CystatinC）与血清肌酐（Scr）在不同时期慢性肾脏病（chronic kidney disease，CKD）患者肾功能检测中的敏感性，评价血清Cystatin C在各期CKD患者中的临床应用价值。方法：对129例不同时期CKD患者检测CystatinC，以^99mTc—DTPA清除率测得的肾小球滤过率（GFR）作为诊断评价的金指标，乳胶颗粒增强免疫透射比浊法检测血清CystatinC浓度，用全自动生化分析仪检测血清Scr。结果：与正常对照组比较，各期CKD组CystatinC值均有统计学差异，而各期CKD组Scr值与正常组比较，CKD1、CKD2期无统计学差异，CKD3～5期才有统计学差异；各期CKD组间比较显示CystatinC值均有统计学差异，而Scr值差异仅局限于CKD3～5期。并且血清CystatinC，Scr与^99mTc-DTPA清除率呈显著相关，尤其CystatinC相关性更好。结论：血清CystatinC在各期CKD中均能准确反映肾小球滤过功能，尤其能敏感提示早期肾功能损害，可成为判断肾功能损害程度的敏感指标，而且方法简便、敏感。     

Differential Characteristics of Kidney Transplant Recipients According to 1‐Year Chronic Kidney Disease Stage 3a and Stage 3b Graft Function

The outcomes of transplantation have improved, but more than 50% of kidney transplantation (KT) recipients are still reported to have renal function of chronic kidney disease (CKD) stage 3 at 1 year after KT. We reviewed all 1235 patients who received a KT in our institution between 2008 and 2012. Among these recipients, 77 and 289 cases were included in the estimated glomerular filtration rate (eGFR) at 1 year after KT 30–44 (CKD stage 3b) group and eGFR 45–59 (CKD stage 3a) group, respectively. Longer duration of dialysis (odds ratio [OR] = 1.007, 95% confidence interval [CI], 1.000–1.014, P = 0.047), older donors (OR = 1.064, 95% CI, 1.031–1.098, P < 0.001), delayed graft function (OR = 3.601, 95% CI, 1.031–1.098, P < 0.001), BK virus infection (OR = 2.567, 95% CI, 1.242–5.305, P = 0.011), and pneumonia (OR = 4.451, 95% CI, 1.388–14.279, P = 0.012) were contributing factors to eGFR 30–44 mL/min. Especially, ureteral stricture occurred more frequently in eGFR 30–44 group of deceased donor KT. However, acute rejection was not a significant risk factor of lower eGFR. Graft survival was better in the eGFR 45–59 group. However, this difference was smaller in deceased donor KT. Infections and urologic complications are also important contributing factors of lower graft function in CKD stage 3. In addition, dividing CKD stage 3 into subgroups might be more useful in living donor kidney transplantation.     

43例起病与妊娠相关的肾脏病患者的临床分析

目的：了解起病与妊娠相关的肾脏病女性患者的发病率、病因及一般情况。方法：收集2004年8月~2013年1月肾脏科,于妊娠期间及产后6个月内诊断为肾脏病的女性患者,并记录其临床资料。结果：起病与妊娠相关的肾脏病女性的发病率为1.49%（43/2 891）,53.4%为CKD1~2期患者,6名女性进入终末期肾脏病（0.208%）。67.4%在妊娠期间诊断为肾脏病,大部分因蛋白尿发现（46.5%）。最多的临床诊断为慢性肾小球肾炎（27.9%）,最多的病理诊断为Ig A肾病（50%）。平均血红蛋白浓度为（105±30）g/L,血钙磷代谢异常比例为20.9%。妊娠至诊断肾脏病的平均时间为（128±288）周（中位数25周）,她们的剖宫产比例及死产比例均高于健康妊娠女性（53.8%比16.7%,60%比0%,P〈0.05）。43名中的8名女性接受肾脏替代治疗。结论：起病与妊娠相关的肾脏病女性患者的发病率高于文献报道,这些女性的临床及病理诊断与我国慢性肾脏病的流行病学一致,他们贫血及钙磷代谢的控制情况不理想。     

Hyperlipidemia Is Associated With Accelerated Chronic Kidney Disease Progression After Lung Transplantation

Hyperlipidemia is associated with faster progression of chronic kidney disease (CKD) in the general public. We sought to investigate this association after lung transplantation. Data was retrospectively collected on 230 lung recipients transplanted between January 1997 and December 2003. Estimated glomerular filtration rates (eGFR) and lipid levels were recorded at regular intervals posttransplant. Independent associations between lipid levels early posttransplant and pertinent renal endpoints were investigated. Baseline LDL was 110 ± 35 mg/dL and remained unchanged at 6 months. A faster decline in eGFR was seen in those with 6 month LDLs > versus < the mean level of 110 mg/dL (p = 0.05). By 6 months posttransplant eGFRs were lower in the 6 month LDL > versus < 110 mg/dL group (53 ± 23 vs. 62 ± 29 mL/min/1.73 m², p = 0.01), a difference that persisted at 60 months (39 ± 24 vs. 73 ± 57 mL/min/1.73 m², p = 0.05). On univariate analysis, a 6 month LDL in the highest quartile, i.e. >140 mg/dL, predicted faster progression to CKD, defined as declining to an eGFR < 30 mL/min/1.73 m² (HR 1.5, p = 0.01). This finding persisted in the multivariate Cox-proportional model (HR 1.4, p = 0.02). Hyperlipidemia predicts faster decline in renal function after lung transplant. Prospective trials are needed to confirm this finding.     

Detection of Occult Renovascular Disease in Unexplained Chronic Kidney Disease

Atherosclerotic renal artery stenosis (RAS) is a recognized cause of renal impairment. RAS is often overlooked in unexplained chronic kidney disease (CKD). A retrospective analysis of renal angiograms was performed to determine the prevalence of occult renovascular disease in 64 (M:F, 46:18; ages 21–81 years [median 60 years]) patients with unexplained CKD. Twelve patients had diabetes mellitus (type II: 11) and 43 were smokers. Median serum creatinine was 5.2 mg/dl (range 1.5–10.6 mg/dl). Group A included patients with unexplained CKD and with no risk factors for RAS and Group B had patients with increased risk for RAS. A narrowing of the renal vessel, main artery or branch, by >50% on renal arteriography was used as diagnostic criteria for RAS. 31/64 patients had positive angiographic findings. Thirteen patients had unilateral RAS, 9 had bilateral RAS, 5 had unilateral stenosis with occlusion on the opposite side, 3 had unilateral occlusion and 1 had a solitary kidney with RAS. 19/34 (54%) in Group A and 12/30 (40%) in Group B had a positive renal angiogram. In 10 patients with a rise in serum creatinine on recent introduction of ACE inhibition, 2 had evidence of RAS on renal arteriography. Eleven patients underwent angioplasty and 2 reconstructive surgeries. In 4 patients, blood pressure control improved and anti-hypertensive drug requirements were reduced, whilst renal replacement therapy was postponed in 4, by 2–24 months. In 18 patients, the lesions were not amenable to angioplasty or reconstructive surgery. Four patients did not benefit in any form with intervention. Occult atheromatous renal vascular disease is a common, not readily predictable and potentially correctable etiology of unexplained CKD.     

合并慢性前列腺炎的慢性肾脏病患者临床病理特点

目的：探讨合并慢性前列腺炎（CP）的男性慢性肾脏病（CKD）患者临床病理特点。方法：比较伴CP与不伴CP的CKD患者的年龄、婚姻情况、蛋白尿、血尿、肾功能水平及病理类型等临床病理指标。结果：（1）合并CP组平均年龄较不伴CP组大[（232.6±12.7）岁vs（9.5±11.4）岁],CP组已婚率高（63.7%vs47.3%）（P均〈0.05）;大量蛋白尿（〉3.5g/24h）52例（57.1%）,CP组中最常见的3种肾脏病为IgA肾病31例（34.1%）,非IgAN系膜增生性肾小球肾炎24例（26.4%）,膜性肾病12例（13.2%）,其中膜性肾病的发生率较不伴CP组（4.4%）高（P〈0.05）;伴CP的IgAN患者血管襻IgA沉积率较不伴CP患者高（P〈0.05）。（3）CP组与不伴CP组在蛋白尿、血尿、肾功能方面比较差异无统计学意义。结论：伴CP的CKD者年龄较大,多为已婚,半数伴大量蛋白尿,具有一定的临床病理特点,CP可能造成某些CKD患者慢性化改变。