补肾活血汤治疗系膜增生性肾炎的临床研究

目的:探讨活血化瘀中药补肾活血汤对系膜增生性肾炎的疗效及其作用机制.方法:将96例经皮肾穿刺活检证实的系膜增生性肾炎患者分成两组,两组患者在接受一般及对症治疗的同时,治疗组50例用补肾活血汤加苯那普利(洛汀新)治疗,对照组46例加用苯那普利治疗.治疗前及治疗2月后分别观察24 h尿蛋白定量、血尿素氮、肌酐、尿红细胞、尿纤维蛋白原降解产物(FDP)、尿补体C3、尿N-乙酰β-D氨基葡萄糖苷酶(NAG)及尿β2-微球蛋白(β2-MG)的变化.结果:两组治疗前、后24 h尿蛋白定量及尿红细胞均有显著下降.补肾活血汤治疗组总有效率明显高于苯那普利对照组(P＜0.05).治疗组经治疗后尿FDP、尿NAG及尿β2-MG有明显下降,而对照组则下降不明显.结论:补肾活血汤对系膜增生性肾炎具有治疗作用,其作用机制可能与降低尿中FDP有关.     

Hypertension in adults with idiopathic glomerulonephritis and normal serum creatinine. A report from the MRC Glomerulonephritis Registry

The Medical Research Council's Glomerulonephritis Registry wasused to determine the prevalence and clinical characteristicsof hypertension occurring in patients with idiopathic glomerulonephritis(GN) and normal serum creatinine (males <120µmol/l,females <100µmol/l). The hypertension prevalence ratewas 23.0% in 1221 such patients, increased significantly withage, and within each age group was greater in males than infemales. These patterns closely mirror those seen for hypertensionin the United Kingdom general population. However, the hypertension prevalence rates in the GN patientssignificantly exceeded those seen in the corresponding age/sexbands in the general UK population and varied considerably betweenGN subtypes; thus hypertension in patients with GN and ‘nearnormal’ renal function is not solely due to essentialhypertension. Logistic regression analysis demonstrated thatin addition to increasing age, the presence of hypertensionwas significantly associated with increased serum creatinine,even in these patients with serum creatinines within the normalrange. One possible explanation for these findings may be that peoplewith an inherited tendency to essential hypertension may alsobe more prone to hypertension if they develop GN. Our data suggeststhat this early hypertension is closely associated with mildimpairment of GFR, occurring within the accepted normal rangefor serum creatinine.     

人参对家兔系膜增生性肾小球肾炎模型循环免疫复合物的影响

目的：观察人参对家兔系膜增生性肾小球肾炎模型循环免疫复合物（CIC）的影响。方法：制成家兔系膜增生性肾小球肾炎模型,将该模型分成对照组、全剂量泼尼松组、半剂量泼尼松组、人参合用半剂量泼尼松组及单用人参组,分组给药,观察用药前后家兔血清循环免疫复合物水平的变化。结果：模型兔肾功能基本正常,但24 h尿蛋白较正常组显著升高,肾脏组织学提示系膜增生明显（以基质增生为主）,足突融合明显;人参可使模型家兔血清循环免疫复合物下降至基本正常水平,而血清免疫球蛋白水平仍保持正常;虽然全剂量和半剂量泼尼松组较模型后组、对照组血清CIC的水平下降,但血清IgG水平亦同时下降,降低其免疫功能。结论：人参在使家兔系膜增生性肾小球肾炎模型血清循环免疫复合物下降的同时,不降低其正常的免疫功能。     

缬沙坦对Thy1肾炎大鼠肾小球系膜细胞CDK2表达的影响

目的：观察Thy1肾炎大鼠系膜细胞增生及CDK2表达，以及血管紧张素Ⅱ受体拮抗剂缬沙坦对其干预作用。方法：设正常组、Tby1。肾炎组及Tby1肾炎＋缬沙坦治疗组。分别于各组疾病诱导后第1、3、5、7d取。肾脏行病理检查，免疫组化检测肾小球内PCNA、CDK2蛋白的表达，Western blot分析肾小球内CDK2的表达。结果：在正常大鼠系膜细胞CDK2存在低表达，而在肾炎大鼠随系膜细胞增生，其CDK2表达增加。缬沙坦治疗组第3～7d。肾小球系膜细胞增生、系膜区扩张程度以及肾小球内PCNA表达低于。肾炎组（P〈0．05），肾小球内CDK2表达也低于。肾炎组相应时间点（P〈0．05）。结论：。肾小球系膜细胞的增生与其CDK2的高表达相关，缬沙坦可抑制系膜细胞CDK2的高表达，抑制系膜细胞增殖及系膜扩张。提示缬沙坦对Thy1肾炎大鼠有一定治疗作用。     

骨碎补总黄酮对系膜增生性肾炎大鼠血清白细胞介素-6的影响

目的：观察骨碎补总黄酮对系膜增生性肾小球肾炎大鼠血IL-6及尿蛋白的影响。方法：利用免疫法制备大鼠系膜增生性肾小球肾炎模型,将大鼠分为骨碎补总黄酮组（治疗组）、病理对照组（模型组）、正常对照组,检测各组24h尿蛋白、血清IL-6,并观察肾脏病理改变。结果：模型组大鼠肾脏系膜细胞明显增生,与正常对照组比较24h尿蛋白定量及血清IL-6明显升高（P＜0．05）;治疗组大鼠肾脏系膜细胞增生减轻,24h尿蛋白、血IL-6均明显低于模型组（P＜0．05）。结论：骨碎补总黄酮能降低系膜增生性肾小球肾炎大鼠尿蛋白,降低血清IL-6水平,减轻系膜细胞增生和细胞外基质增加,延缓或减轻肾组织损伤,保护肾功能。     

LTAA方案治疗呈肾病综合征的儿童乙型肝炎病毒相关性肾炎

目的：探讨拉米夫定、雷公藤多苷、血管紧张素转换酶抑制剂及抗凝（LTAA方案）联合治疗儿童乙型肝炎病毒相关性肾炎（HBV—GN）的疗效。方法：以拉米夫定（100mg／d）、雷公藤多苷片（0．5mg·kg^-1·d^-1）、血管紧张素转换酶抑制剂（洛汀新5～10mg／d）及抗凝治疗7例呈肾病综合征或大量蛋白尿且血HBV—DNA≥1．0×100copy／ml的儿童HBV—GN，疗程12月。结果：6例为膜性肾病、1例膜增生性肾炎。6月时完全缓解（cR）者4例、部分缓解（PR）者3例，有效率57．14％，治疗12月时CR者6例、PR者1例，有效率100％。12月血清HBV—DNA均转阴。12月后停用拉米夫定和雷公藤多苷，继续服用其他药物，随访6～55个月[平均随访（24．1±15．4）个月]，血清HBV—DNA3例再次转阳，4例阴性，复发2例，CR者5例、PR者1例、无效（NR）者1例。其中2例出现轻度肝功能异常，保肝治疗后恢复正常。未出现乙型肝炎病毒变异株。结论：ITAA治疗方案是治疗儿童HBV—GN安全有效的方案。     

火把花根对实验性肾炎大鼠肾脏病理改变的影响

目的:观察中药火把花根对肾炎大鼠模型肾脏病理改变的影响,评价火把花根对肾炎的治疗作用.方法:用兔抗大鼠胸腺细胞免疫血清(ATS),复制大鼠系膜增生性肾炎模型即抗-Thy1肾炎,将实验动物分为3组:对照组、模型组及火把花根治疗组.于治疗第1、2及4周末,各组动物留尿测定尿蛋白,并取肾组织进行常规肾脏病理检查,免疫组织化学方法测定肾小球系膜区纤维连接蛋白(FN)表达,透视电镜观察肾脏超微病理变化,尤其是足细胞变化.结果:实验第1周末模型组尿蛋白明显增多,第4周末仍显著高于对照组(P＜0.01).治疗组在各时间点尿蛋白量均较模型组显著下降(P＜0.01).肾脏病理学检查见模型组肾小球系膜细胞增生,基质增多,治疗组系膜增生明显减轻;免疫组织化学染色表明见模型组肾小球系膜基质成分FN蛋白表达明显增高,治疗组FN蛋白表达较模型组显著下降(P＜0.01).超微病理检查见模型组肾小球足细胞肿胀,大部分节段足突弥漫性融合,系膜基质轻-中度增生,治疗组足细胞无明显肿胀,大部分节段足突排列整齐,少数节段足突部分融合,系膜基质无明显增生.结论:抗-Thy1肾炎模型肾小球存在足细胞病变,主要表现为足细胞肿胀及足突融合,足细胞病变可能是引起蛋白尿的原因之一;火把花根可能部分通过改善足细胞病变而减少蛋白尿;火把花根可以改善其肾脏病理变化,延缓肾硬化的发展.     

Effect of the Absence of Interleukin-12 on Mesangial Proliferative Glomerulonephritis Induced by Habu Snake Venom

Background. Interleukin-12 (IL12) participates in the pathophysiology of various experimental types of progressive glomerulonephritis, but its role in acute mesangial glomerulonephritis (AMG) induced by habu snake venom (HSV) has not been determined. This study aims to evaluate the effect of the absence of IL12 on AMG induced by HSV.?Methods.?AMG was induced in IL12 knockout (IL12–/–) and C57Bl/6 (IL12+/+) mice by a single i.v. administration of HSV. Vehicle was used in control animals. Mice were studied after 3, 7, and 14 days (D3, D7, and D14). Results.?After treatment with HSV, IL12+/+ and –/– mice developed focal glomerular lesions, but groups of both lineages showed no statistical difference concerning albuminuria, serum creatinine, histopathology, number of cells by glomerular tuft, and glomerular tuft area. Compared to IL12+/+ mice, IL12–/– mice showed lower scores of glomerular desmin expression on D7 [1.55 (1.32; 1.65) vs. 1.12 (1.07; 1.22); p < 0.01] and D14 [1.60 (1.55; 1.75) vs. 1.20 (1.15; 1.20); p < 0.001], respectively, and lower scores of glomerular α-SMA expression on D14 [0.30 (0.21; 0.38) vs. 0.16 (0.26; 0.36); p < 0.001], respectively.?Conclusion.?The absence of IL12 reduced the activity of mesangial cells, but did not modify the course of HSV-induced AMG in mice.     

骨碎补类黄酮对系膜增殖性肾小球肾炎大鼠模型的抑制作用

目的:探讨骨碎补类黄酮提取物(flavonoid fraction,FF)对单克隆抗体OX-7诱导的系膜增殖性肾小球肾炎大鼠模型(anti-Thy 1.1 GN)的作用.方法:利用单克隆抗体OX-7诱导的anti-Thy 1.1 GN动物模型,将大鼠随机分成正常对照组、模型组(Thy 1.1 GN)、Thy 1.1 GN FF组、FF组.检测尿蛋白,三色染色评估肾小球细胞外基质改变,免疫组化染色检测增殖细胞核抗原(PCNA)、ED-1及α-SMA在肾小球的表达,同时检测肾皮质超氧化物歧化酶(SOD)活性.结果:Thy 1.1 GN FF组尿蛋白量及三色染色面积均比Thy 1.1 GN组减少(分别P＜0.05和P＜0.01);免疫组化显示PCNA、ED-1阳性细胞数及α-SMA在肾小球表达下调,均与Thy 1.1 GN组有统计学差异(P＜0.01);FF还可加快anti-Thy 1.1 GN模型肾皮质SOD活性的恢复(P＜0.01).结论:FF通过抗氧化活性,抑制大鼠系膜增殖性肾小球肾炎系膜细胞的增殖及基质的增加.     

骨水泥并椎弓根螺钉脊柱内固定的力学效应

目的通过用骨水泥强化椎弓根螺钉固定新鲜尸体胸腰段脊椎标本,在电子万能力学试验机上进行生物力学测试,探讨骨水泥对椎弓根钉固定强度的影响。方法选用30个新鲜胸腰段椎体作为实验对象,随机分2组,每组15个,每个椎体自身对照,第一组一侧椎弓根用聚甲基丙烯酸甲酯强化椎弓根螺钉固定;另一侧椎弓根作为对照单纯椎弓根螺钉固定,第二组一侧椎弓根扩大钻孔,然后用聚甲基丙烯酸甲酯强化椎弓根螺钉固定（模拟骨水泥强化翻修侧）;另一侧椎弓根作为对照,扩大钻孔后用粗大螺钉固定（模拟粗大螺钉翻修侧）。将标本固定于特制的模具上,用电子万能力学试验机,沿人体纵轴线作向上螺钉受力测试,至椎骨损坏或螺钉拔出时受力即为耐受负荷临界值,对所得数据进行分析。结果骨水泥强化侧耐受负荷临界值为（1 198±122）N,单纯螺钉固定侧耐受负荷临界值为（805±64）N,两组比较存在显著性差异（P〈0.05）;骨水泥强化翻修侧耐受负荷临界值为（1 775±203）N,粗大螺钉翻修侧耐受负荷临界值为（953±97）N,两组比较存在显著性差异（P〈0.05）。说明骨水泥在耐受螺钉对椎体切割破坏方面有明显的加强作用,骨水泥强化翻修的效果优于粗大螺钉翻修的效果。结论经骨水泥强化及强化翻修的椎弓根内固定有更强的力学效应,有一定的防止螺钉对椎骨损坏的作用,可提高骨质疏松患者脊椎内固定及脊椎内固定翻修手术的疗效。     

高尿酸血症在乙型肝炎病毒相关性肾炎中的作用

目的：探讨高尿酸血症在乙型肝炎病毒相关性肾炎（HBV-GN）中的作用。方法：对227例HBV-GN临床病理资料进行病例对照研究,将其分为高尿酸血症组（A组）及血尿酸正常组（B组）,比较两组临床病理资料,分析血尿酸水平与临床病理指标的关系。结果：高尿酸血症组高血压发生率为29.58%（21/71）,明显高于尿酸正常组17.95%（28/156）,P〈0.05。A组eGFR〈60ml/min者发生率达32.39%（23/71）,明显高于B组（9.61%,P〈0.01）。A组血清肌酐和尿素氮水平明显高于B组（P〈0.01）。A组的膜性肾病（MN）发生率低于B组（P〈0.05）,而增生硬化性肾炎（SGN）明显高于B组（P〈0.01）。高尿酸血症组肾小球硬化≥50%、新月体形成、系膜中度增生和肾小管间质中度病变重比例明显高于尿酸正常组（P〈0.05）。MN与系膜增生性肾炎（MsPGN）两个亚组中高尿酸血症患者eGFR〈60ml/min者发生率明显高于其血尿酸正常者（P〈0.05）。结论：高尿酸血症会促进HBV-GN高血压的发生、加重肾小管间质损害,是影响HBV-GN进展的危险因素之一。     

肾疏宁对大鼠系膜增生性肾炎的肾小管间质损害的形态学影响

目的 :观察中药肾疏宁对系膜增生性肾炎 (MsPGN )的肾小管间质损伤的影响。方法 :制作大鼠MsPGN模型。予肾疏宁治疗并以肾炎康复片为对照组 ,观察肾脏形态学及 2 4h尿蛋白定量。结果 :肾疏宁能明显减轻MsPGN大鼠的蛋白尿 ,减轻肾组织病理病变尤其是肾小管间质损伤 ,且对损伤的肾组织有修复作用。与模型组相比 ,有显著性差异 (P <0 .0 1) ,与肾炎康复片组相比 ,有显著性差异 (P <0 .0 5 ) ;与正常组相比 ,无显著性差异 (P >0 .0 5 )。结论 :肾疏宁能降低尿蛋白、保护肾功能、减轻MsPGN的肾小球病变及肾小管间质损伤。     

中药联合苯那普利治疗慢性肾脏病3期的临床研究

目的：为探讨中药联合苯那普利治疗慢性肾脏病（CKD）的疗效。方法：将60例CKD（3期）患者随机分为中药（简称1组）、西药（简称2组）、中西治疗组（简称3组）,每组20例;采用双盲法给予中药、苯那普利、中药联合苯那普利治疗,疗程24周;对患者在投药初始以及12、24周的实验室指标及中医症状积分进行对照分析。结果：中医症状积分：在24周,各组较治疗前均下降（P〈0.01）,其中,3组下降较1、2组差异有统计学意义（P〈0.05）。24h尿蛋白定量：在12周,2、3组下降较1组差异有统计学意义（P〈0.05）;在24周,3组下降较1组差异有统计学意义（P〈0.05）。血红蛋白（Hb）：在24周,2、3组较治疗前明显下降（P〈0.05）。血清白蛋白（Alb）：在24周,2、3组较治疗前明显升高（P〈0.05）,而2组较3组升高明显（P〈0.05）。血尿素氮（BUN）：在24周,2组较治疗前明显升高（P〈0.05）。血肌酐（Scr）：在24周,2组较1组及3组升高明显（P〈0.05）。肾小球滤过率（eGFR）：在12周,2组较1组明显降低（P〈0.01）。总疗效比较：在24周,依据中医证候疗效标准判定,3组有效率为89%、1组为65%、2组为40%,组间比较（P〈0.01）;根据西医疗效标准判定,3组有效率为94%、2组为85%、1组为75%,组间比较（P〈0.05）。结论：中药联合苯那普利较单纯中药或苯那普利能更好的改善CKD的临床症状,降低尿蛋白,延缓肾功能减退。     

Plasmapheresis in Treatment of Acute Oligoanuria in Crescentic Glomerulonephritis

Plasmapheresis therapy can provide an approach in the treatment of crescentic glomerulonephritis by mechanically removing nephritogenic factors from the circulation, both antiglomerular basement membrane antibodies and circulating immune complexes as well as antineutrophil cytoplasmic antibodies (ANCAs). We present our experience with plasmapheresis treatment in patients with acute oligoanuria caused by crescentic glomerulonephritis. We used membrane plasmapheresis to treat 11 patients with crescentic glomerulonephritis with more than 80% crescent formation on biopsy and with acute onset of the disease and acute oligoanuria. The immune complex form of the disease was documented in 7, the anti-glomerular basement membrane antibodies mediated (anti-GBM) form in 2, the ANCA-associated form in 1 case, and the recurrent anti-GBM form in 1 patient. Plasmapheresis was performed 2–3 times weekly using Bellco BL 500 and Gambro 2000 PF plasma filters. The total number of plasma exchanges (2,000–2,200 ml each) for each patient was 5–9. The treatment was associated with steroids and cyclophosphamide. The improvement of renal function with the start of diuresis and significant decrease of creatinine from the range of 786–1,301 μ M at the start of the treatment was noted in 5 of the 11 patients. The duration of remission without hemodialysis was 6–12 months. Treatment with plasmapheresis in cases with recurrent anuria was without benefit. We can conclude that plasmapheresis can delay end-stage renal failure in cases with acute onset of crescentic glomerulonephritis.     

The Spectrum of Adult Postinfectious Glomerulonephritis in the New Millennium

Background. Postinfectious glomerulonephritis is rare in adults. The characteristics of the disease now differ from what were described decades ago. The goal of this study is to illustrate the clinicopathological spectrum of the disease in the modern era. Methods. Between July 2000 and June 2008, 20 adult cases of postinfectious glomerulonephritis were identified at a medical center in Taiwan. The patients' records were retrospectively reviewed with respect to clinical presentation, microbiology, serology, morphology of renal biopsy, and clinical course. Results. There were 14 males and 6 females. The mean age was 61 years. All patients developed acute renal failure, and the majority (65%) required dialysis support during the disease course. Hypocomplementemia was present in 60% of patients. The most frequently identified infectious agent was Staphylococcus (60%). Histological characteristics showed two distinct patterns of glomerulonephritis: diffuse endocapillary proliferative glomerulonephritis (65%) and focal mesangial proliferative glomerulonephritis (35%). There were no significant differences in the clinical presentation and outcome between the two groups. However, glomerular neutrophil infiltration was more commonly present in diffuse endocapillary proliferative pattern (p = 0.017). The percentage of patients with focal mesangial proliferative pattern significantly increased over time (p < 0.001). At the last follow-up, 6 patients (30%) had died, 6 (30%) were in complete remission, 4 (20%) had partial remission with renal insufficiency, and 4 (20%) were on chronic dialysis. Conclusions. Our data suggested that Staphylococcus had become the leading pathogen in adult postinfectious glomerulonephritis over the past 10 years. Furthermore, atypical histological feature with focal mesangial proliferative pattern was increasingly identified over time. The prognosis was still guarded, carrying a considerable mortality rate and risk for developing chronic renal failure.     

乙型肝炎病毒相关性肾炎高尿酸血症发生影响因素的分析

目的：探讨乙型肝炎病毒相关性肾炎（HBV—ON）高尿酸血症的发生情况和影响因素。方法：对227例HBV—GN临床病理资料进行回顾性病例对照研究,运用单因素及多因素方法分析其高尿酸血症发生与临床病理因素的关系。结果：227例HBV—GN患者中高尿酸血症71例,总发生率31．28％,随着eGFR的下降,高尿酸血症发生率逐渐增高。单因素分析发现Scf≥132．6μmol／L、高血压、系膜增生程度、肾小球硬化率、新月体形成者、肾小管间质病变程度等是其危险因素。多因素Logistic回归结果显示Scr水平、肾小管间质病变为HBV—GN高尿酸血症发生的独立影响因素。结论：HBV—GN是继发性高尿酸血症常见的病因之一,其高尿酸血症的发生与血肌酐水平、肾小管间质病变等有关。