黄芪对肾病综合征与充血性心力衰竭时血管加压素系统异常的不同改…

应用阿霉素所致大鼠肾病综合征模型与腹主动脉－下腔静脉造瘘所致大鼠充性心力衰竭模型，研究了精氨酸血管加压素系统在其中的变化以及黄芪的保护作用。斑点杂交显示下丘脑ＶＡＰｍＲＮＡ表达在ＮＳ增加，在ＣＨＦ降低。     

黄芪对肾病综合征大鼠治疗作用的研究

目的：了解黄芪对肾病综合征大鼠的治疗作用。方法：选Wistar大鼠24只,8只作为正常对照,余一次性尾静脉注射盐酸阿霉素（6．5mg/kg)制成肾病综合征模型。选8只作为用药组,每日灌服黄芪煎剂,8只作为对照组,每日以2ml来自水喂饲,实验周期19周。观察指标有24h尿蛋白定量、血白蛋白、血肌酐、尿素氮、胆固醇、甘油三酯、肾对白蛋白排泌率、肾组织病理学变化。结果：注射盐酸阿霉素20d肾病综合征模型制成。于喂黄芪1月－4月,尿蛋白定量均无减少,肾功能无改善;喂黄芪后血白蛋白升高,于2月时与治疗组及对照组比较,即有显性差异,P＜0．05;于3、4月时,有非常显性差异,P＜0．001;于喂黄芪后血胆固醇、甘油三酯均有不同程度降低,且肾对白蛋白排泌率也下降,于3月时有统计学意义,P＜0．05;于4月时有非常显性差异,P＜0．001。结论：对肾病综合征大鼠,黄芪不减少尿蛋白排泄,但使肾脏对白蛋白排泌率降低,且可使血白蛋白高,血胆固醇及甘油三酯降低,使肾脏的组织病理学损害减轻,但对肾功能无明显改善。     

参芎注射液联合黄芪改善肾病综合征高凝状态

目的 观察参芎注射液联合黄芪对肾病综合征高凝状态的疗效.方法 将42例患者随机分为治疗组（n=22）和对照组（n=20）.2组均给予一般对症治疗及泼尼松治疗,不用任何抗凝血药物.治疗组同时给予参芎注射液200 ml联合黄芪注射液30 ml加入250 ml 10%葡萄糖中静脉滴注,1次/d,15 d为1个疗程,治疗1个疗程;对照组给予阿司匹林80 mg,1次/d,共15 d.比较2组治疗前、后的全血黏度、血浆黏度、纤维蛋白原、血小板计数、凝血酶原时间和红细胞变形指数.结果 与治疗前相比,2组治疗后全血黏度、血浆黏度、纤维蛋白原、血小板计数和红细胞变形指数降低（P＜0.05）,凝血酶原时间升高（P＜0.05）.治疗后,治疗组较对照组全血黏度、血浆黏度、纤维蛋白原、血小板计数和红细胞变形指数降低（P＜0.05）,凝血酶原时间升高（P＜0.05）.治疗组总有效率为90%,对照组总有效率为60%,治疗组总有效率高于对照组（P＜0.01﹚.结论 参芎注射液联合黄芪能改善肾病综合征患者高凝状态,改善微循环,保护肾功能.     

黄芪改善肾病综合征患者血液高凝状态的临床观察

多种因素导致肾病综合征患者存在着血液高凝状态 ,其在血脂、血液流变学等方面有着明显的变化。黄芪是具广泛药理活性的中药。本文观察了黄芪对肾综患者血脂、血液流变学的影响 ,以改善肾综患者的血液高凝状态 ,提高临床疗效 ,旨在探讨其对肾综的治疗机制。资料与方法1　研究对象　 5 6例原发性肾综患者 ,均符合肾综的诊断标准[1] ,并排除了继发性肾小球疾病。其中 :男 34例 ,女 2 2例 ;年龄 15岁～ 5 8岁 ,平均 38.2岁。 5 6例肾综患者随机分成 2组 ,各组间年龄、性别、病程等均较匹配。2　治疗方法　对照组 (2 0例 )采用常规激素治疗 ;治…     

黄芪对肾病综合征患者氧化应激影响的研究

目的:探讨原发性肾病综合征(PNS)患者氧化应激状态以及中药黄芪的抗氧化作用.方法:47例PNS患者随机分为A、B两组,分别给予激素和激素加黄芪治疗,于治疗前后测定血浆及红细胞丙二醛(MDA)浓度、红细胞超氧化物歧化酶(SOD)、全血谷胱甘肽过氧化物酶(GSH-px)的活性、维生素E(Vit E)的含量和主要生化指标.结果:与正常对照组比较,PNS患者MDA浓度增高, SOD 、GSH-px活性和Vit E含量显著降低;与治疗前比较,A组氧化应激指标无显著性改变,B组患者MDA浓度降低,SOD 、GSH-px活性增加(P<0.05).结论:PNS患者氧化应激增强,中药黄芪有一定的抗氧化作用.     

黄芪当归合剂治疗原发性肾病综合征的临床研究

目的:探讨黄芪当归合剂联合强的松对原发性肾病综合征患者尿蛋白、血象白蛋白、血胆固醇、尿β<,2> 微球蛋白(β<,2>-MG)的影响.方法:将84例原发性肾病综合征患者随机分为治疗纽、对照组各42例,治疗组给予强的松、抗凝等治疗的同时给予黄芪当归合剂治疗;对照组删只给予强的松、抗凝等治疗.检测两蛆治疗前后的24小时尿蛋白、血清白蛋白、血胆固醇、尿β<,2>-MG.结果:治疗组较对照组在治疗过程中,24小时尿蛋白明王下降及血象白蛋白回升在治疗4周后有显著性统计学差异(P<0.05),血胆固醇较对照组在治疗4用后明显下降(P<0.05).尿β<,2>-MG较对照组在治疗4用后明显下降(P<0.05).结论:黄芪当归合剂能有效地增加原发性肾病综合征患者血浆白蛋白水平,降低尿蛋白,并能降低患者血清胆固醇水平,减轻蛋白尿对肾小管、肾问质的损害,但对肾功能的远期保护作用尚待进一步研究.     

肝硬化大鼠肾脏水通道蛋白2和血管加压素V2受体的表达及黄芪对其的作用

目的 观察肝硬化大鼠肾脏水通道蛋白2（AQP2）和血管加压素（AVP）-V2受体的表达情况，及中药黄芪对其的作用。方法 肾脏皮髓制裁AQP2mRNA检测采用半定量RT-PCR法，肾脏AQP2和AVP-V2受体蛋白检测采用免疫组织化学法。结果 肝硬化2周和5周大鼠肾脏皮髓质AQP2mRNA，肾脏AQP2和AVP-V2受体蛋白表达上调，黄芪在2周时可纠正这些指标的升高，5周时则不能。结论 肝硬化大鼠存在AVP系统和AQP2表达的异常。黄芪在早期对其有改善作用。     

黄芪注射液对儿童肾病综合征尿蛋白与血浆蛋白的影响

目的 :观察黄芪注射液对儿童肾病综合征尿蛋白与血浆蛋白的影响。方法 :将我科 1996年 10月～2 0 0 2年 10月收治的小儿肾病综合征 30例 ,随机分为 2组。治疗组 17例 ,采用强的松加黄芪注射液治疗 ;对照组 13例仅给强的松治疗。结果 :治疗 1个月后 ,治疗组临床症状及血液生化指标等明显优于对照组 ,2 4h尿蛋白降低与血浆白蛋白升高与对照组比较 ,差异有统计学意义 (P <0 .0 1)。结论 :黄芪注射液对儿童肾病综合征有明显疗效 ,尤其在减轻蛋白尿 ,提高血浆蛋白方面 ,值得临床应用     

黄芪注射液对肾病综合征患者血脂和血液流变学的影响

高脂血症是原发性肾病综合征的主要表现之一 ,脂质代谢异常可导致肾小球的损害及肾脏疾病的进行性发展 ,而血液高凝状态是肾病综合征客观的病理过程 ,其程度常与肾小球病变的严重性和活动性相平行。实验研究表明 ,中药黄芪可明显改善肾病大鼠的高胆固醇血症〔1〕,因此 ,为在临床上探讨黄芪对肾病综合征患者血脂、血液流变学的影响 ,本文对诊断为肾病综合征的 2 8例患者予黄芪注射液进行治疗 ,现将结果报告如下。资料与方法1　临床资料　本文 2 8例为住院患者 ,年龄 16岁～ 5 8岁 ,平均 30 .4岁 ;其中男 19例 ,女 9例 ;全部病例经临床和实验…     

Ultrafiltration in the treatment of severe congestive heart failure

BACKGROUND: Fluid removal remains a fundamental goal in the treatment of congestive heart failure (CHF). Vacuum ultrafiltration, hemodialysis, or a combination of both was used in patients with severe CHF (NYHA class IV), severe edema, and insensitivity to pharmacological treatment with diuretics. METHODS: The aim of the study was to remove the overload fluid in eighteen patients, 13 men and 5 women, aged 38 to 83, with a man age of 66 years with intractable congestive heart failure. All patients were hospitalized because of severe congestive heart failure and did not respond to treatment with intravenous administration of a high dose of diuretics and positive inotropic agents. They thus underwent vacuum ultrafiltration (1 to 27 sessions) while in 4 of them hemodialysis was also performed because of high serum creatinine levels (over 4 mg/dl). Subclavian catheters were used in all patients and arteriovenous fistula was later performed in 2, because of the need for long term treatment. The average fluid removed was 2 L per session and the total fluid removed ranged from 4 to 29 L. RESULTS: Fourteen of the 18 patients (78%) showed significant improvement in their clinical status. Ten patients (56%) had a short term improvement but expired after 7 to 107 days of hospitalization. Four patients (22%) died after only one session of dialysis and 4 patients (22%) recovered after 8 to 23 dialysis sessions and were discharged from hospital. CONCLUSION: The majority of patients with severe chronic CHF which is intractable to conventional therapy including intravenous diuretics and inotropes improve by the use of ultrafiltration. However, a limited proportion of them survive to be discharged from the hospital.     

Effects of ascites on outcomes of colorectal surgery in congestive heart failure patients

Background

There are limited data regarding the effects of ascites on outcome of patients undergoing colorectal resection. We sought to identify complications related to ascites.

Methods

The National Surgical Quality Improvement Program database was used to evaluate congestive heart failure (CHF) patients who had ascites before colorectal resection between 2005 and 2012. Multivariate regression analysis was performed to identify affected outcomes.

Results

We sampled a total of 2,178 patients who suffered CHF and underwent colorectal resection, of which 195 (9%) had preoperative ascites. The mortality rate of patients who had preoperative ascites was 46.2% compared to 25.7% for patients without ascites (adjusted odd ratio [AOR], 3.38; P < .01). Complications affected by ascites include (P < .05) ventilator dependency (AOR, 2.40), acute renal failure (AOR, 2.18), and wound disruption (AOR, 2.44; P < .05). There was no increase in superficial surgical site infection rate in patients with ascites (AOR, 1.01; P = .9).

Conclusions

The presence of ascites in CHF patients is associated with increased mortality in patients undergoing colorectal surgery. There is no correlation between ascites and surgical site infection but wound disruption increases in the presence of ascites.     

Atrial natriuretic peptide as a preload depressor in acute renal failure secondary to congestive heart failure

The present study was undertaken to verdy the hypothesis that infusion of atrial natriuretic peptide (ANP) might lower preload and be beneficial in the treatment of pulmonary congestion even without a diuresis in patients with acute renal failure (ARF) secondary to severe congestive heart failure (CHF). We studied 22 patients with ARF secondary to CHF. The mean age of the patients (14 men and 8 women) was 72 years (range 36 to 85 years). Seven of the patients had dilated cardiomyopathy, ten had ischemic heart disease, and five had valvular heart disease. ANP was infused intravenously and the following data before and 1 hour after the start of ANP infusion were recorded; urinary output, systemic blood pressure (SBP), pulmonary blood pressure (PBP), right atrial pressure (RAP), cardiac index (CI), heart rate (HR), and arterial blood oxygen pressure. Diastolic PBP were employed as plumonary capillary wedge pressure. Urinary output did not change. Mean SBP decreased from 92 to 85 mmHg (p < 0.05), and mean PBP decreased from 34 to 28 mmHg (p < 0.01). Mean RAP decreased from 11 to 9 mmHg (p < 0.01) and diastolic PBP decreased from 25 to 19 mmHg (p < 0.01). HR did not change significantly and CI increased 2.4 to 2.5 mi/min/m² (p < 0.05). Arterial blood oxygen partial pressure increased significantly from 71 to 82 mmHg (p < 0.05). In conclusion, ANP decreased and improved arterial blood oxygen partial prissure, though diuretic response to ANP is attenuated in ARF secondary to CHE. Infusion of ANP will be very beneficial in cases in which dyspnea and pulmonary edema due to elevation of preload are the principal clinical problems.     

苯那普利与螺内酯合用治疗高血压性心脏病充血性心力衰竭的临床疗效

目的：对苯那普利联合螺内酯治疗高血压性心脏病充血性心力衰竭的临床治疗效果进行观察。方法选取我院2011年4月~2013年4月所接收的高血压性心脏病充血性心力衰竭患者80例作为研究对象,并将其随机分为两组,即对照组与治疗组,对照组给予苯那普利进行治疗,而治疗组采取苯那普利联合螺内酯进行治疗,对两组患者的临床治疗效果进行观察。结果通过治疗,治疗组有显效18例,有效20例,总有效率为95.0%,对照组有显效15例,有效19例,总有效率为85.0%,两组比较,差异有统计学意义（P＜0.05）;而在步行6min运动耐量与LVEF上,治疗组明显优于对照组,差异有统计学意义（P＜0.05）。结论对高血压性心脏病充血性心力衰竭患者采取苯那普利联合螺内酯予以治疗,能够有效改善患者的心功能,且治疗效果显著,值得大力推广。     

参麦注射液对充血性心力衰竭患者微循环的影响研究

目的研究观察参麦注射液对充血性心力衰竭患者微循环的影响。方法将本院于2011年12月-2013年12月收治的70例充血性心力衰竭患者随机分为对照组（常规充血性心力衰竭治疗组）35例和观察组（常规充血性心力衰竭治疗加参麦注射液组）35例,然后将两组患者治疗前和治疗后1周与2周时的甲襞微循环积分值及其他指标进行统计与比较。结果观察组治疗后1周与2周时的甲襞微循环积分值均低于对照组,而其他指标也均好于对照组（P〈0.05）,两组患者治疗后1周与2周时统计结果之间差异均有统计学意义。结论参麦注射液对充血性心力衰竭患者微循环的影响较大,在充血性心力衰竭患者中的应用价值较高。     

Renal effects of human urotensin-II in rats with experimental congestive heart failure.

BACKGROUND: Urotensin II (U-II) and its receptor GPR-14 are expressed in the kidney and the cardiovascular system of various mammalian species. Recent studies suggested that the U-II/GPR-14 system is upregulated in patients with congestive heart failure (CHF). However, the involvement of the peptide in the alterations of renal function in CHF remains unknown. METHODS: The effects of incremental doses (1.0-100.0 nmol/kg) of human U-II (hU-II) on renal haemodynamic and clearance parameters were assessed in rats with an aorto-caval fistula, an experimental model of CHF, and sham controls. Additionally, the effects of pre-treatment with the nitric oxide (NO) synthase blocker, nitro-L-arginine methyl ester (L-NAME), and the cyclooxygenase inhibitor, indomethacin, on the renal haemodynamic response to hU-II were studied in CHF rats. RESULTS: hU-II caused a decrease in mean arterial pressure in control and CHF rats. In controls, hU-II did not alter renal blood flow (RBF), and caused a minimal decrease (-12.5%) in renal vascular resistance (RVR). However, in CHF rats, the peptide induced a marked increase in RBF (+28%) and a decrease in RVR (-21.5%). These effects were attenuated by L-NAME, but not by indomethacin. Furthermore, hU-II caused a significant increase (+29%) in glomerular filtration rate (GFR) in CHF rats, whereas GFR tended to decrease in controls. Sodium excretion was not altered in control or in CHF rats in response to hU-II. CONCLUSIONS: hU-II exerts an NO-dependent renal vasodilatation that is more pronounced in rats with CHF. The data further suggest that the U-II/GPR-14 system may be involved in the regulation of renal haemodynamics in CHF.     

充血性心力衰竭时肾脏水通道蛋白mRNA表达的改变及意义

目的 研究在不同程度的充血性心功能衰竭（心衰）时肾脏水通道蛋白2（AQP2），上皮性钠通道（ENaC)和髓襻升支粗段的Na-K-2Cl转运子（rBSC1)表达的情况。方法 将SD大鼠通过腹主动脉－下腔静脉穿刺造瘘和冠状动脉结扎的方法建成不同的心衰模型，设正常对照组，穿刺造瘘1孔组，穿刺造瘘3孔组和冠脉结扎组。用Doppler超声心动图及心脏秤重的方法比较其心功能的各项参数，并用RT－PCR的方法检测肾脏AQP，ENaCα亚单位和rBSC1mRNA表达。结果 穿刺造瘘大鼠心功能损害较轻，而冠脉结扎大鼠心功能严重失代偿。AQP2仅在冠脉结扎大鼠肾皮质表达增高，而rBSC1在造瘘1孔，3孔和结扎大鼠的肾髓质表达均显著上调。肾皮质αENaC含量3组心衰大鼠都显著增高，而在肾髓质仅冠脉结扎大鼠明显升高，造瘘大鼠虽有上升趋势，但差异无显著性意义。结论 在不同类型的充血性心力衰竭大鼠模型中存在着肾脏AQP，rBSC1和ENaC mRNA表达的上调，其中rBSC1增高可能和心脏受累早期肾脏排钠障碍有一定关系。     

Anaemia and congestive heart failure early post-renal transplantation.

BACKGROUND: Anaemia is common following renal transplantation and is associated with the development of congestive heart failure (CHF). However the prevalence of anaemia in the first year following transplantation and the association between anaemia occurring early and the development of CHF have been understudied. METHODS: In this study, 132 incident patients undergoing tacrolimus and mycophenolate mofetil-based renal transplantation were studied for the prevalence of, and risk factors for, anaemia and CHF in the early period post transplantation. RESULTS: Anaemia occurred in 94.5% and 53.1% of patients at 1 week and 12 months, respectively, and was associated with allograft dysfunction, hypoalbuminaemia, higher mycophenolic acid (MPA) levels, bacterial infection and hypoalbuminaemia. The association with hypoalbuminaemia may reflect the presence of chronic inflammation post-transplantation. Of patients displaying haemoglobin <11 g/dl, 41.1% and 29.4% were treated with erythropoiesis stimulating agents (ESAs) at 1 and 12 months respectively. CHF developed in 26 patients beyond 1 month post-transplantation, with echocardiographic left ventricular systolic function preserved in all but one. CHF was associated with anaemia and lower haemoglobin, allograft dysfunction, duration of dialysis and left ventricular hypertrophy on echocardiography prior to transplantation, suggesting the aetiology of CHF may involve the interplay of diastolic cardiac dysfunction, pre-load mismatch and after-load mismatch. CONCLUSIONS: Modification of risk factors may improve anaemia management post transplantation. Reducing the prevalence of anaemia may in turn reduce the incidence of CHF-these observations support the need for clinical trials to determine how anaemia management may impact CHF incidence.     

The impact of anaemia and kidney function in congestive heart failure and preserved systolic function.

BACKGROUND: The importance of anaemia in chronic heart failure was highlighted recently by different cohort studies. The aim of this study was to assess the prevalence of anaemia and its relationship to renal function, left ventricular function and symptoms of heart failure. METHODS: We surveyed cases of patients admitted to the Department of Cardiology during 22 consecutive months. Laboratory measurements, blood pressure and echocardiographic parameters were obtained with standardized methods. RESULTS: Out of a total number of 2941 patients, 238 patients (8.1%) had haemoglobin values <11 g/dl. There was a positive association of anaemia with the symptoms of heart failure with a lowering of the median haemoglobin from 14.2 g/dl [New York Heart Association (NYHA) I] to 12.9 g/dl (NYHA IV, P<0.001). Interestingly, anaemia was not associated with left ventricular function or any left ventricular parameters. Symptoms of heart failure, however, were associated with kidney function. The estimated glomerular filtration rate (GFR) was 82 ml/min at NYHA I and 59 ml/min at NYHA IV, P<0.05. There was an association between impaired renal function and haemoglobin values. Haemoglobin was 14.2 g/dl in the group with normal renal function and 11.1 g/dl in the group with a GFR <25 ml/min (P<0.001). Even in patients with normal renal function (878 patients, GFR >85 ml/min), we still found an association of anaemia with the symptoms of heart failure. Haemoglobin was 14.5 g/dl at NYHA I and 13.4 g/dl at NYHA IV, P<0.0001. CONCLUSION: Anaemia is found in 8.1% of patients admitted to cardiology service. Anaemia was clearly associated with symptoms of congestive heart failure even in patients with normal renal function. Anaemia was not associated with left ventricular function.