成人无症状尿检异常59例分析

尿检异常是肾小球疾病的常见临床征之一,肾组织活检是最直接的诊断手段,对无症状尿检异常患者做肾组织活检的临床价也日渐明确[1].本文成人无症状尿检异常多在健康体检或其他疾病(尤其是高血压、糖尿病等导致肾损害的早期指标)尿检时被发现,无肾脏疾病的阳性体征.通过对本组病例尿红细胞形态分析和肾穿分析无症状尿检异常的可能原因,进一步探讨无症状血尿和(或)蛋白尿(微量)的临床意义,为基层医疗尤其健康体检的进一步筛查提供参考.1临床资料1.1 一般资料2008-01-2010-07在我院健康体检、门诊及住院的无症状尿检异常患者59例,男24例,女35例,年龄16～59(平均32.5)岁.尿检提示单纯持续性镜下或(和)血尿22例;持续性镜下血尿伴蛋白尿(微量)8例;单纯持续性蛋白尿(微量)19例.经尿红细胞形态分析均为肾性血尿且肾功能正常.     

过敏性紫癜肾脏损害的临床因素分析

目的探讨过敏性紫癜肾脏损害的临床因素。方法回顾性分析72例过敏性紫癜患儿的临床资料，根据尿常规检查，分为尿检正常组和紫癜肾损害组；紫癜肾损害组分为一过性尿异常组及持续性尿异常组。观察相应的临床因素，并行统计学分析。结果紫癜肾损害组年龄，皮疹反复、皮疹持续时间，消化道出血的发生率及严重程度均高于尿检正常组，差异有显著性（P〈0．05）。持续性尿异常组皮疹持续时间、血尿并蛋白尿发生率均高于一过性尿异常组，差异有显著性（P〈0．05）。单纯皮肤紫癜者、紫癜加关节症状者、紫癜加消化道症状者以及同时有紫癜、关节症状和消化道症状者肾损害发生率分别是33．3％、41．7％、54．5％和75．0％，混合型和单纯紫癜者肾损害发生率的差异有显著性（P〈0．01）。结论发病年龄较大，皮疹反复及持续时间长，消化道出血者易发生肾损害；除皮肤紫癜外，合并关节症状和消化道症状者易发生肾损害；皮疹持续时间长、血尿合并蛋白尿与肾脏持续受累有关。     

彩色多谱勒超声对高血压肾损害的研究

目的:探讨彩色多谱勒超声诊断高血压(EH)早期肾损害的价值。方法:彩色多谱勒超声诊断仪测定肾内叶间动脉血流状况,测定尿蛋白、肾功能及早期肾损害实验室指标。结果:早期肾损害实验室指标犤α1微球蛋白(α1-MG)犦、微量白蛋白排泄率(UAER)、NAG酶犦正常者为EHⅠ组,其叶间动脉的收缩期最大流速(PSV)和舒张末期流速(EDV)较正常对照组轻度降低(P<0.05),搏动指数(PI)和阻力指数(RI)较之轻度升高(P<0.05);EHⅡ组为早期肾损害实验室指标升高者,其叶间动脉的PSV和EDV较正常对照组、EHⅠ组明显降低(P<0.01),PI和RI较之明显升高(P<0.01)。结论:联合早期肾损害实验室指标,肾内血管彩色多谱勒超声更能早期发现高血压肾损害。     

类风湿性关节炎的肾脏损害

类风湿性关节炎(RA)是常见的结缔组织病,以往被认为很少累及肾脏,即便发生肾损害,也以淀粉样变性和继发于药物毒副作用者多见。近年来随着诊断技术的更新,人们对RA肾损害的认识不断提高。 1 发病率 RA肾损害的发病率由于研究方式和资料为源不同而难以确定,但近十余年来诸多文献从各个角度报道了RA时伴发的肾损害并非少见。 1.1 尿检异常发生率:齐藤元章等报道一组170例RA中,血尿和(或)蛋白尿的检出率为31.2％。其尿检异常的标准为:血尿为新鲜尿沉渣中RBC≥5个/Hp,并持续3个月以上;蛋白尿指尿蛋白浓度在30mg/dl以上。 Hordon等14总结了285例RA尿常规及尿白蛋白、β_2-mG和α_1-mG的检测结果,显示尿检异常者占28.2％,其     

1例冷球蛋白血症肾损害病人的护理

<正>冷球蛋白血症是由于冷球蛋白沉积于血管内皮,导致皮肤、肾脏、周围神经等病变,产生皮肤血管炎、肾小球肾炎和神经系统症状等主要累及中小动脉的系统性血管炎。冷球蛋白血症导致的肾脏损害常见的是膜增生性肾小球肾炎(MPGN)[1]。我科于2013年8月收治1例冷球蛋白血症肾损害病人,经医护人员积极治疗及护理,病情稳定出院。现介绍如下。1病例介绍病人,男,62岁,因尿检异常7月余,血肌酐升高2     

血清胱抑素C联合尿微量白蛋白检测在妊娠期高血压疾病早期肾损害诊断中的价值

目的 探讨血清胱抑素C(Cys C)联合尿微量白蛋白(mALB)对妊娠期高血压疾病(HDCP)早期肾损害的诊断价值。方法 选取本院产科收治的HDCP孕妇150例(患者组)及正常妊娠孕妇147例(对照组),患者组孕妇按照病情严重程度进一步分为妊娠期高血压组60例,轻度子痫前期组51例,重度子痫前期组39例,检测患者组及对照组血清Cys C、BUN、肌酐(SCr)及尿mALB。结果 患者组各指标水平明显高于对照组(P<0.05);妊娠期高血压组与轻度子痫前期组各检测指标比较,BUN与SCr指标无显著差异(P>0.05),CysC与尿mALB差异有统计学意义(P<0.05);轻度子痫前期组与重度子痫前期组各检测指标比较,差异均有统计学意义(P<0.05)。相关分析发现,患者组血清CysC与尿mALB水平呈正相关(r=0.671,P<0.05)。结论 HDCP孕妇早期即存在血清Cys C及尿mALB水平增高,且随病情加重呈上升趋势,两者联合检测有利于尽早发现HDCP孕妇早期的肾损害。     

振幅整合脑电图在新生儿缺氧缺血性脑损伤中的应用价值

目的探讨振幅整合脑电图(aEEG)对缺氧缺血性脑损伤(HIE)早期诊断及预后评价的应用价值。方法对2010年10月至2014年10月,60例住院足月新生儿中HIE患儿出生后6h内进行aEEG、头颅核磁共振(MRI)检查及神经行为学评分,收集并保存资料,分析HIE的诊断及分度,并结合患儿临床症状进行比较。结果 aEEG异常程度与HIE的临床分度及其头颅MRI分度、HIE患儿预后密切相关;重度aEEG异常组发育商比正常aEEG组和轻度异常组低。结论 aEEG早期诊断脑损伤的敏感性较高,对HIE的早期诊断及评估预后有重要的价值。     

24h尿蛋白及UA、Cr水平测定对妊娠高血压综合征的价值及肾损害的评估

目的研究妊娠高血压综合征的诊断价值及肾损害的评估指标。方法采用全自动生化分析仪,测定20例健康孕妇和36例妊娠高血压综合征孕妇在孕早期(11~12周),孕中期(18~20周)及孕晚期(36~38周)的24 h尿蛋白及血尿酸(UA)、肌酐(Cr)水平。结果从孕中期开始,妊娠高血压综合征组与健康孕妇组的24 h蛋白尿比较差异有统计学意义(P<0.01),且妊娠高血压综合征组的阳性率为91.7%;UA水平健康孕妇组与中、重度妊娠高血压综合征组比较差异有统计学意义(P<0.01),轻度妊娠高血压综合征组与中、重度妊娠高血压综合征组比较差异有统计学意义(P<0.05),且其随着病情的严重程度逐渐升高。结论 24 h蛋白尿对妊娠高血压综合征的早期患病风险提示有一定临床意义,可将它作为妊娠妇女在孕中期的常规检验项目,有助于早期发现妊娠高血压综合征;UA可作为判断轻、中、重度妊娠高血压综合征肾损害程度的重要指标。     

喘息性疾病并肾脏损害患者尿NAG的检测

近年来喘息性疾病的发病率逐渐增加,其发生发展过程中可以引起肾脏损害,常规的肾脏损害指标如血尿素氮、血肌酐(Cr)难以发现早期肾损害,若异常时往往病情已较重。N-乙酰-β-D氨基葡萄糖苷酶(NAG)检测在早期发现肾损害方面有其独特的临床意义。     

严重急性呼吸综合征的肾损害

目的　探讨严重急性呼吸综合征 (SARS)患者的肾损害情况及其临床意义。方法　比较 85例SARS患者和 78例普通肺炎患者血浆肌酐清除率 (CCr)。结果　SARS组有 36 .99%早期发生肾损害 ,程度轻度至中度 ,年龄≥ 5 0岁的CCr异常率 6 0 .0 0 % ,明显高于 <5 0岁的 2 5 .71% (P <0 .0 5 ) ,均值分别为 (1.0 2± 0 .2 2 )ml/s、(1.2 7±0 .2 3)ml/s(P<0 .0 5 ) ;2 4例病程 2周左右恢复 ,5例恢复期出现肾损害 ;SARS组与对照组发生肾损害概率差异无统计学意义 (P >0 .0 5 ) ;SARS组肾损害发生率与病程之间无相关性 (P >0 .0 5 ) ;SARS组CCr与动脉血氧饱和度(SaO2 )之间无相关性 (P >0 .0 5 )。结论　SARS的肾损害是存在的 ,但不是其特异性表现 ,且是可逆的 ;年龄大者容易发生且偏重 ;非缺氧所致 ,与病程无关 ;临床上注意保护肾功能以免转为后遗症     

传染性单核细胞增多症合并肝损害的临床特征

目的总结儿童传染性单核细胞增多症(IM)合并肝损害的临床特点及相关因素。方法对2000年1月-2012年1月入院收治48例合并肝损害IM与120例无肝损害IM的患儿年龄、性别、主要症状和体征、系统损害、实验室检查等资料进行回顾性分析。结果合并肝损害IM患儿血小板减少、异形淋巴细胞增加、丙氨酸氨基转换酶和天门冬氨酸氨基转移酶等血清酶学异常、持续发热、中重度肝脾肿大,以及多系统损害发生率较高;而咽峡炎、皮疹和浅表淋巴结肿大发生率较低;IM合并肝损害与发病年龄、性别无明显相关(r=0.127,0.075,P<0.05)。结论 IM合并肝损害表现为持续发热、肝脾肿大、肝酶异常、血小板减少、异形淋巴细胞增加较常见。及时作肝功能等辅助检查,及早发现和干预IM肝损害,有助于减少重症IM的发生。     

484例登革热临床实验诊断的分析

目的分析2006年广州地区484例登革热患者体检及实验室检查结果的特点。方法对入院患者进行常规检查，并收集急性期和恢复期血清进行病原学检查，分析统计各种临床症状、体征和检测项目结果的阳性例数及阳性率。所有患者确诊依据符合中华人民共和国卫生部颁布的《登革热诊断标准及处理原则》。结果本次登革热流行临床表现典型，以发热、头痛、全身酸痛、皮疹为多见。WBC减少368例（76．0％），PLT减少303例（62．6％），ALT升高270例（56．7％），AST升高400例（84．0％），223例（46．1％）的患者出现低钾血症。登革热病毒抗体IgM（DF—IgM）可在发病第1—16天内检测到，第8天内阳性率达85．9％。DF—IgM始终阴性的51例中7例急性期血清用实时荧光定量PCR检测病毒载量（DEVRNA）均阳性，结果为10^5～10^6拷贝／ml。结论2006年广州地区登革热流行患者临床表现典型，多数患者WBC、PLT减少明显，合并肝脏损害较多，肾脏损害表现较轻，近半数出现低钾血症。DF—IgM出现早，持续时间长，在发病7d内检测DF—IgM有助于登革热的早期诊断。实时荧光定量PCR检测DEV RNA可作为登革热早期病原学诊断的另一指标，且可以弥补抗体检测的不足。     

Rickettsia: an unusual cause of sepsis in the emergency department

Mediterranean spotted fever (caused by Rickettsia conorii) is one of the tick-borne rickettsioses. It is prevalent in southern Europe, Africa and central Asia and may also be seen in travellers returning from these areas. It presents with various non-specific symptoms, including fever, maculopapular rash, headache, myalgia or diarrhoea and vomiting. A visible eschar at the site of the tick bite is characteristic but not present in all cases. There is no test that reliably confirms the disease in its early stages and diagnosis is often made on clinical grounds. Delay in diagnosis and in providing correct antibiotic treatment increases the mortality rate of this condition. Emergency clinicians should be aware of the possible diagnosis in travellers returning from endemic areas in order to start the correct treatment as early as possible and minimise subsequent complications and mortality.     

Diagnosis and treatment of acute pyelonephritis in women

Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidney most often seen in young adult women. History and physical examination are the most useful tools for diagnosis. Most patients have fever, although it may be absent early in the illness. Flank pain is nearly universal, and its absence should raise suspicion of an alternative diagnosis. A positive urinalysis confirms the diagnosis in patients with a compatible history and physical examination. Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empiric antibiotic regimens. Escherichia coli is the most common pathogen in acute pyelonephritis, and in the past decade, there has been an increasing rate of E. coli resistance to extended-spectrum beta-lactam antibiotics. Imaging, usually with contrast-enhanced computed tomography, is not necessary unless there is no improvement in the patient's symptoms or if there is symptom recurrence after initial improvement. Outpatient treatment is appropriate for most patients. Inpatient therapy is recommended for patients who have severe illness or in whom a complication is suspected. Practice guidelines recommend oral fluoroquinolones as initial outpatient therapy if the rate of fluoroquinolone resistance in the community is 10 percent or less. If the resistance rate exceeds 10 percent, an initial intravenous dose of ceftriaxone or gentamicin should be given, followed by an oral fluoroquinolone regimen. Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole are generally inappropriate for outpatient therapy because of high resistance rates. Several antibiotic regimens can be used for inpatient treatment, including fluoroquinolones, aminoglycosides, and cephalosporins.     

Severe leptospirosis: treatment with intravenous corticosteroids and supportive care

Leptospirosis is a common zoonotic infection worldwide and is recognized as an emerging public health problem. Although commonly thought of as a tropical disease, incidence in temperate climates is increasing, with recent outbreaks in the United States and Germany, among other countries. The disease presents with symptoms ranging from fever, headache, nausea, and vomiting to life-threatening multiorgan failure characterized by acute liver failure, nephritis, pulmonary hemorrhage, meningitis, and cardiac arrhythmia. We describe a case of an otherwise healthy 28-year-old man who had just returned from a 2-month trip to Southeast Asia. He presented to our emergency department twice after his return with the complaint of fever and malaise. Initially, he was treated with symptomatic measures and discharged home with malaria smears and blood cultures pending. On his final presentation before admission, he presented with severe fatigue, myalgia, acute renal failure, and marked thrombocytopenia. After several days, inpatient testing revealed the patient's leptospira antibody titer was markedly positive. Given the nonspecificity of patient symptoms, early diagnosis of leptospirosis can be challenging. Diagnostic uncertainty may lead to delay in recommended intravenous antibiotic treatment. We present a case of severe leptospirosis treated exclusively with supportive measures and intravenous corticosteroids.     

Clinical aspects and treatment of emergency states in hemorrhagic fever with renal syndrome

Clinical, laboratory and original data collected for many years served the basis for proposed guides on intensive care in severe hemorrhagic fever with renal syndrome (HFRS) involving acute cardiovascular and renal insufficiency, shock, rupture of the kidney, eclampsia, pulmonary edema, massive hemorrhage. The conclusion is made on the value of early diagnosis and adequate treatment of emergency states in reduction of HFRS mortality.     

药物超敏反应综合征14例漏误诊原因分析

目的 探讨药物超敏反应综合征(DIHS)的临床特点以及漏误诊原因.方法 回顾性分析2014年1月—2018年10月住院诊断为重症药疹的患者,按照RegiSCAR评分系统筛选出DIHS的病例,将其他重症药疹患者纳入非DIHS组.记录2组的致敏药物、一般资料、临床症状、实验室检查等,并对相关数据进行统计分析.结果 本次研究...     

The identification of risk factors for critically ill patients with acute fever and formulation of activation criteria to alert outpatient clinic doctors

Rationale, aims and objectives Acute fever is the most common early clinical symptom of many critical illnesses with a high mortality rate. It is necessary to identify patients with severe acute fever early and accurately. The aim of this study is to identify risk factors for critically ill outpatients with acute fever and formulate activation criteria of adult fever state score (AFSS) to alert outpatient clinic doctors. Methods Retrospectively, 357 adult patients with acute fever were divided into two groups: 180 patients with a severe state and 177 patients with a mild state. Logistic regression was used to determine risk factors for the severe state. Risk factors were weighted and an AFSS was formulated. A receiver operating characteristic (ROC) analysis of weighted cumulative scores was performed to evaluate the diagnostic accuracy of AFSS, and the kappa test was used to confirm diagnostic reliability. A χ²‐test for trend was applied to determine the relevance between AFSS and admission rate and in‐hospital mortality. A Kruskal–Wallis test was used to examine the relationship between AFSS and length of stay. Results Risk factors for state included: old age, long fever course, past medical history, abnormal temperature, abnormal respiratory rate, abnormal heart rate, abnormal mean arterial pressure and abnormal peripheral white blood cell count. The area under the ROC curve of AFSS was 0.964 and ≥8 points predicted severe state; the Kappa value was 0.801. With an increase in score, there was an increase in admission rate, mortality rate and length of stay. The forecast performance of AFSS was superior to the modified early warning score. Conclusions The AFSS has high diagnostic accuracy and reliability for the early identification of patients with severe acute fever.     

社区成年危重发热患者的早期预警技术研究

目的:建立社区成年发热患者病情严重度评分标准(adult fever state score,AFSS),形成社区成年危重发热患者的早期预警技术.方法:回顾性收集357例急性发热患者临床资料,通过Logistic回归筛选发热患者病情严重度的独立危险因素,并赋予各指标反映病情严重度的权重分值,据此建立AFSS.应用ROC曲线评价其诊断准确性,Kappa检验评估诊断可靠性,病情轻重的临界值为cutoff值.AFSS与住院率、住院病死率的相关性分析采用γ2检验,与住院时间相关性采用Kruskal-Wallis 检验.结果:筛选出年龄、发热病程、既往体健与否、体温、呼吸频率、心率、平均动脉压、白细胞计数为反映发热患者病情轻重的独立危险因素,每个指标根据其权重分别赋予0～3分,建立AFSS.AFSS的ROC曲线下面积为0.964,cutoff值为7分,Kappa值为0.801.随着AFSS评分的增加,患者病情加重,住院率、住院病死率及住院时间随之增加(P＜0.05),AFSS对预后的预测效能明显高于早期预警评分.结论:AFSS具有很高的诊断准确性和可靠性,利于急诊医师早期识别社区发热危重患者.     

难治性小儿支原体肺炎的临床研究

目的探讨难治性肺炎支原体肺炎的临床特点和诊治经验。方法对26例难治性肺炎支原体肺炎患儿的临床资料进行回顾性分析。结果 26例患儿均以发热、咳嗽起病,以高热为主,热型不规则,咳嗽剧烈。肺部受损表现为肺实质浸润、胸腔积液、肺不张等,多伴肺外多系统损伤。采用大环内酯类药物及其他敏感抗生素治疗,部分病例行纤维支气管镜灌洗治疗。结论难治性肺炎支原体肺炎病情复杂、迁延,但使用综合治疗方案后预后良好。