维持性血液透析患者循环内皮细胞与动脉粥样硬化的关系

目的 探讨维持性血液透析（MHD）患者循环内皮细胞（CEC）与动脉粥样硬化（AS）的关系。 方法 选取MHD患者65例、慢性肾脏病4~5期非透析患者（CKD-non-HD）25例和健康对照者24例为研究对象。抽取外周血,多参数流式细胞仪计数CEC数目。用CD3-PerCP和CD146-PE进行标记,确定CD3-CD146+ 的细胞为CEC。检测颈总动脉内中膜厚度（CCA-IMT）及有关临床参数。对CEC与IMT及有关参数进行相关和回归分析。 结果 MHD组透前和CKD-non-HD组CEC数目[（151.52±98.24）和（183.00±81.38）个/ml] 均显著高于健康对照组[（106.50±24.14）个/ml]（分别为P < 0.05和P < 0.01）,但MHD组和CKD-non-HD组间差异无统计学意义。MHD组和CKD-non-HD组CCA-IMT [（0.94±0.36）和（1.02±0.37）mm]均显著高于健康对照组[（0.75±0.15） mm]（分别为P < 0.05和P < 0.01）。MHD组透前血CEC数目和CCA-IMT呈正相关（r = 0.328,P < 0.01）。多元回归分析显示,MHD组CEC是颈动脉IMT的独立危险因素。 结论 CEC是MHD患者AS的独立危险因素,可作为评价MHD患者血管内皮损伤程度的新指标。     

胰岛素抵抗与非糖尿病维持性血液透析患者颈动脉粥样硬化相关性分析

目的探讨维持性血液透析患者胰岛素抵抗与颈动脉粥样硬化的相关性。方法将78例非糖尿病肾脏疾病的维持性血液透析患者,根据胰岛素敏感度分为胰岛素抵抗组（A组）和胰岛素敏感组（B组）,比较2组颈动脉粥样硬化发生率和各相关因素指标;同时,对颈动脉粥样硬化影响因素进行Logistics回归分析,胰岛素抵抗与颈动脉粥样硬化相关因素进行单因素回归分析。结果A组血脂、血磷、同型半胱氨酸、超敏c反应蛋白（hs—CRP）、白细胞介素6（IL-6）、甲状旁腺素（iPTH）、颈动脉粥样硬化发生率与B组存在明显差异（P〈0．05）,对胰岛素敏感性与各危险因素进行Logistic回归分析,发现胰岛素抵抗与高血脂、微炎症相关（P〈0．05）。结论胰岛素抵抗是颈动脉粥样硬化的危险因素,其机制可能与微炎症、脂代谢异常有关。     

维持性血液透析患者血清脂联素与动脉粥样硬化的相关性分析

目的探讨维持性血液透析患者血清脂联素水平与动脉粥样硬化的相关性。方法将30例维持性血液透析患者设为透析组,10名相匹配的健康体检者设为对照组,测定血清脂联素水平,同时测定相应的生化指标及颈总动脉内膜中层厚度,并根据颈动脉内膜厚度,将维持性血液透析患者分为颈动脉正常组和颈动脉硬化组。结果维持性血液透析患者血清脂联素水平明显高于对照组（P〈0．05）,与颈动脉内膜中层厚度呈显著负相关（r=－0．378,P〈0．05）;而颈动脉硬化组血清脂联素水平低于颈动脉正常组（P〈0．05）。结论维持性血液透析患者血清脂联素明显高于正常人,其浓度与动脉硬化程度呈负相关,对其更深一步的研究有助于对维持性血液透析患者动脉硬化的发生提供更好、更敏感的检测方法。     

骨硬化蛋白与维持性血液透析患者冠状动脉钙化的关系

Objective To evaluate the potential association of serum sclerostin with the development of coronary artery calcifications(CAC)in maintenance hemodialysis (MHD) patients. Methods Ninety-two patients who were on MHD between Jan 2014 and Jan 2015 in the dialysis center were enrolled prospectively. Serum sclerostin was tested. CAC was measured by multi-slice computed tomography (MSCT) scanning, and the CAC score (CACs) was calculated. Logistic regression analysis was used to determine the risk factor of CAC in MHD patients. The diagnostic value of serum sclerostin for CAC was assessed using receiver operator characteristic curve (ROC). Results CAC (Agatston score>100) was present in 65.2% (60/92) patients, the median CAC score was 446 (26, 1 000). The median of serum sclerostin levels was 37.05 (29.99, 49.04) ng/L. The serum sclerostin levels were significantly elevated in the group of CACs＞400 compared to that in the group of CACs＜100 [40.71(36.69, 74.21) ng/L vs 28.16 (25.27, 33.64) ng/L, P＜0.05]. Multivariate logistic regression analysis showed that serum sclerostin level was independent risk factor for CAC (OR=1.292, 95%CI 1.017-1.641, P＜0.05). The area under the ROC curve (AUC) of serum sclerostin for CAC was 0.846 (95%CI 0.717-0.975, P=0.001), sensitivity was 0.826, and specificity was 0.769 for a cutoff value of 35.165 ng/L. Conclusions Serum sclerostin level is associated with CAC. Serum sclerostin level may have a diagnostic value for CAC in MHD patients.     

维持性血液透析患者血清胱抑素C与细胞因子及颈动脉病变的关系

目的 研究维持性血液透析（MHD）患者的血清胱抑素C（半胱氨酸蛋白酶抑制剂,CysC）水平的变化及其与细胞因子及颈动脉病变的关系。 方法 选择透析龄超过6个月的MHD患者110例（MHD组）和健康对照组60例为对象。用免疫透射比浊法检测CysC;超声检查颈动脉病变的程度;检测高敏C反应蛋白（hsCRP）、总同型半胱氨酸（tHcy）、血清白介素1β（IL-1β）、IL-6、肿瘤坏死因子α（TNF-α）水平。分析CysC水平与细胞因子及颈动脉病变的关系。 结果 MHD组血清CysC水平为（6.19±0.95） mg/L,显著高于健康对照组的（0.76±0.21） mg/L（P < 0.01）。MHD组hsCRP、tHcy、IL-1β、IL-6、TNF-α水平均显著高于健康对照组（P < 0.05或<0.01）。MHD组患者颈动脉内膜中层厚度（IMT）及斑块形成、颈动脉硬化的患病率均显著高于健康对照组（P < 0.05或P < 0.01）。直线相关分析显示,MHD组血CysC水平与hsCRP、tHcy、IL-1β、IL-6、TNF-α、IMT及斑块形成、颈动脉硬化的患病率呈正相关;与透析龄、收缩压、iPTH亦呈正相关（P < 0.05或P < 0.01）。多因素逐步回归分析显示,CysC、hsCRP、tHcy和年龄是MHD患者颈动脉病变的危险因素。 结论 血液透析不能有效清除CysC等大分子物质,随着透析龄的增加,MHD患者血清CysC水平逐渐升高。CysC与hsCRP等微炎性反应指标及tHcy、颈动脉病变呈正相关,血清CysC水平升高可能是MHD患者并发动脉粥样硬化的危险因素之一。     

Thyroid disorders in hemodialysis patients in an iodine-deficient community

There are various changes in the thyroid gland and its function in chronic renal failure (CRF). These changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland. This study is designed to investigate the prevalence of goiter and thyroid dysfunction in patients with end-stage renal disease (ESRD) on hemodialysis (HD) in an iodine-deficient community. Eighty-seven (40 females and 47 males) HD patients and 169 (79 females and 90 males) healthy individuals as controls are included. Sex ratios for the patient and control groups are 0.85 and 0.88, respectively. Mean ages for the patient and control groups are 42.94 +/- 11.88 and 40.20 +/- 10.72 years, respectively. Examination of the thyroid gland using ultrasonography along with simultaneous measurement of blood levels of free-T4 (FT4), free-T3 (FT3), and thyrotropin (TSH) are made for every individual. The presence of goiter demonstrable by ultrasonography is found in 32.2% of the uremic patients and in 23.5% of the controls and its prevalence increases with age (P = 0.01). In 32 (36.8%) of the patients and 29 (17.1%) of the controls at least one thyroid nodule is found in ultrasonography. Between patients with or without a nodular goiter the authors could not observe any difference for duration of dialysis and serum levels of TSH, FT4, FT3, calcium, and albumin. In ESRD patients the prevalence of nodular goiter is higher for females (47.5% vs. 27.7%, P = 0.045) and increases with age (P = 0.04). Though incidence of hyperthyroidism is found to be similar for the two groups (1.14% in ESRD patients vs. 1.10% in controls), hypothyroidism is observed in 3.4% of ESRD patients but only 0.6% of controls. This high incidence of hypothyroidism and nodular goiter in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests and ultrasonography, should be considered in evaluation of every ESRD patient.     

Relationship between insulin resistance and increased carotid artery intima-media thickness in non-diabetic kidney disease patients

Objective To evaluate the relationship of insulin resistance (IR) and carotid artery intima-media thickness (CA-IMT), plaque status in non-diabetic non-dialysis chronic kidney disease (CKD) patients with different stages. Methods One hundred and seventeen non-diabetes non-dialysis CKD patients were enrolled into this cross-sectional observational study. Insulin resistance index (HOME-IR) was assessed by the homeostasis model assessment. Patients with HOME-IR≥1.73 were defined as insulin resistance. And patients with CA-IMT≥0.9 mm were defined as thickening. The blood pressure measurement, heart Doppler ultrasound, bilateral carotid artery ultrasound examination, blood biochemistry and urine protein test were performed, eGFR was calculated by EPI formula. Results The prevalence of IR was 47.01% in 117 non-diabetic non-dialysis CKD patients, and it was 35.71%, 50.00% and 54.55% in eGFR≥60ml•min-1•(1.73 m2)-1 group, 30≤eGFR＜60ml•min-1•(1.73 m2)-1 group, and eGFR＜30ml•min-1•(1.73 m2)-1 group separately. In eGFR＜30ml•min-1•(1.73 m2)-1 group, cystain C, homocysteine, parathyroid hormone, Scr, BUN, uric acid, interventricular septal thickness, left ventricular dimension, left ventricular posterior wall thickness were significantly higher than that in the other two groups (P＜0.01), while the level of hemoglobin was significantly lower (P＜0.01); then the levels of serum albumin and systolic pressure were higher than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group, however, the levels of total cholesterol and low-density lipoprotein-cholesterol were lower than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group. Correlation analysis showed that insulin resistance index was significantly correlated with CA-IMT (r=0.444, P=0.006）in the eGFR＜30ml•min-1•(1.73 m2)-1 group, however, there wasn’t correlation in other two groups. And although insulin resistance wasn’t correlated with soft plaque, it was significantly correlated with hard plaque (χ2=6.476, P=0.011) in the eGFR＜30ml•min-1•(1.73 m2)-1 group. The Logistic regression analysis results displayed aging increase was the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients but not insulin resistance. Conclusions HOMA-IR is correlated with CA-IMT and hard plaque when eGFR＜30ml•min-1•(1.73 m2)-1 in non-diabetes non-dialysis CKD patients. However, the insulin resistance isn’t the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients.     

维持性血透患者颈动脉内膜中层厚度增厚及其影响因素分析

目的研究维持性血透(MHD)患者颈动脉内膜中层厚度(IMT)增厚情况并分析其可能影响因素。方法75例MHD患者为MHD组,30例健康体检者为对照组。采用高频B超检测其颈动脉IMT值,并记录各患者的临床及生化数据。MHD组按IMT值分为正常、异常和增厚3个亚组。对各组数据进行比较并对IMT的各危险因素进行相关性分析。结果MHD组患者颈动脉IMT值明显大于对照组[(1.03±0.42)比(0.63±0.11)mm,P<0.01]。IMT增厚组年龄、收缩压、血浆白蛋白、前白蛋白、胆固醇、血磷水平与IMT正常组相比,差异有统计学意义(P<0.05或P<0.01)。IMT异常组的收缩压、血磷水平明显高于IMT正常组(P<0.01)。单因素相关分析(Model1)结果显示,MHD患者颈动脉IMT与年龄(r=0.247,P=0.032)、收缩压(r=0.758,P<0.01)、血磷(r=0.604,P<0.01)呈显著正相关;与血浆白蛋白(r=-0.292,P=0.011)、前白蛋白(r=-0.681,P<0.01)呈显著负相关。经控制年龄因素后的偏相关分析(Model2)结果与Model1结果一致。多元线性回归分析结果显示高收缩压(B=0.446,P<0.01)、低前白蛋白(β=-0.336,P<0.01)和高血磷(β=0.248,P=0.01)是颈动脉IMT增厚的独立影响因素。结论MHD患者颈动脉IMT明显增厚。高收缩压、低前白蛋白及高血磷是颈动脉IMT增厚的独立危险因素并可能与MHD患者动脉粥样硬化进展相关。     

叶酸对血液透析患者动脉粥样硬化影响

目的通过比较维持性血液透析（maintenance hemodialysis,MHD）患者叶酸干预治疗前后的同型半胱氨酸（homocysteine,Hcy）及颈动脉动脉内膜-中层厚度（intima-media thickness, IMT）改变情况,旨在探讨叶酸对动脉粥样硬化的保护作用。方法选择 MHD治疗时间超过3个月患者60例,分为对照组和叶酸组,每组各30例。所有患者均进行普通低通量透析器透析,每周3次,每次4h,常规降压、纠正贫血、纠正酸碱失衡及电解质紊乱等处理,以及口服维生素 B121mg/d,叶酸组口服叶酸15mg/d,疗程为6个月,所有患者进入观察前及干预治疗半年后于透析前10 min,抽取空腹血10ml,比较治疗前后2组间Hcy值,并超声测量IMT的变化。结果①治疗半年后叶酸组 Hcy水平下降（P〈0.01）,对照组治疗前后 Hcy 水平变化不明显（P〉0.7）;且2组治疗半年后Hcy比较。②叶酸组治疗半年后颈动脉IMT值差异不明显（P〉0.05）,而对照组半年后IMT值明显升高（P〈0.05）,且半年后2组IMT值之间比较差异有统计学意义（P〈0.05）。结论叶酸组经干预治疗后 Hcy水平明显下降,而颈动脉 IMT值变化不明显;对照组 Hcy变化不明显,而颈动脉 IMT明显升高,提示 Hcy可能参与了动脉粥样硬化的发生和发展。推测叶酸可能通过下调 Hcy水平,起到延缓动脉粥样硬化病情发展的作用。     

Association between osteopontin and intact parathyroid hormone in maintenance hemodialysis patients

Objective To explore possible associations between osteopontin(OPN) and intact parathyroid hormone(iPTH), to investigate effects of them on the progression of carotid artery calcification in patients receiving long-term hemodialysis. Methods Forty-eight maintenance hemodialysis (MHD) patients and 28 age- and sex-matched healthy volunteers were recruited. The concentration of OPN in peripheral blood was determined by enzyme linked immunosorbent assay (ELISA). Levels of iPTH and presence of plaques in the common carotid arteries were also measured. The demographics were recorded. Results Compared with controls, levels of OPN[(137.4±80.8)ng/L vs (31.6±6.7) ng/L, P＜0.01] and iPTH[(456.4±326.4) ng/L vs (66.9±19.3)ng/L, P＜0.01] were higher inMHD patients before hemodialysis, the numbers of calcific plaques in the common carotid arteries were increased in MHD patients (P＜0.01). There was a positive correlation between pre-dialysis OPN levels and iPTH levels (r＝0.620, P＜0.01) in MHD patients. Higher levels of OPN and iPTH correlated with greater numbers of calcific plaques in the common carotid arteries after division into three subgroups of MHD patients based on calcific plaques. In multiple linear regression analysis, the correlation between the pre-dialysis OPN and iPTH levels remained the same even if adjusting for confounding effects[β＝0.468, 95%CI (0.036, 0.195), t＝2.936, P＝0.005]. Conclusion OPN level is positively correlated with iPTH level in hemodialysis patients, which suggesting that both of them play important roles in the progression of carotid artery calcification.     

Relationship between gut microbiota and vascular calcification in hemodialysis patients

IntroductionVascular calcification (VC) is an independent risk factor for cardiovascular mortality in end-stage renal disease (ESRD) patients. The pathogenesis of VC is complicated and unclear. Uremic toxins produced by gut microbiota can promote VC. This study aims to identify the differences in gut microbiota between the different VC groups and the main bacteria associated with VC in hemodialysis (HD) patients in an attempt to open up new preventive and therapeutic approaches and define the probable mechanism for VC in HD patients in the future.MethodsA total of 73 maintenance HD patients were enrolled in this cross-sectional study. According to the abdominal aortic calcification (AAC) scores, the participants were divided into the high AAC score group and the low AAC score group. High-throughput sequencing of the gut microbiota was performed and the results were evaluated by alpha diversity, beta diversity, species correlation, and model predictive analyses.ResultsThe prevalence of VC was 54.79% (40/73) in the study. The majority of phyla in the two groups were the same, including Firmicutes, Actinobacteriota, Proteobacteria, and Bacteroidota. The microbial diversity in the high AAC score group had a decreasing trend (p = 0.050), and the species abundance was significantly lower (p = 0.044) than that in the low AAC score group. The HD patients with high AAC scores showed an increased abundance of Proteobacteria and decreased abundances of Bacteroidota and Synergistota at the phylum level; increased abundances of Escherichia-Shigella, Ruminococcus_gnavus_group, and Lactobacillus; and decreased abundances of Ruminococcus and Lachnospiraceae_NK4A136_group at the genus level (p<0.05). Escherichia-Shigella and Ruminococcus_gnavus_group were positively correlated with VC, and Ruminococcus, Adlercreutzia, Alistipes, and norank_f__Ruminococcaceae were negatively correlated with VC. Escherichia-Shigella had the greatest influence on VC in HD patients, followed by Ruminococcus and Butyricimonas.ConclusionsOur results provide clinical evidence that there was a difference in gut microbiota between the different VC groups in HD patients. Escherichia–Shigella, a lipopolysaccharide (LPS)-producing bacterium, was positively correlated with VC and had the greatest influence on VC. Ruminococcus, a short-chain fatty acid (SCFA)-producing bacterium, was negatively correlated with VC and had the second strongest influence on VC in HD patients. The underlying mechanism is worth studying. These findings hint at a new therapeutic target.     

对侧颈动脉闭塞患者颈动脉成形支架置入术的临床分析

目的 探讨对侧颈动脉闭塞患者颈动脉成形支架置入术(CAS)的有效性及安全性.方法 回顾性分析2001年1月至2010年1月治疗的56例对侧颈动脉闭塞、同侧颈动脉狭窄患者的病例特点及CAS的疗效.患者均经数字减影血管造影(DSA)证实为一侧颈动脉闭塞、另一侧颈动脉狭窄,狭窄程度在50%～90%,平均72%±15%.经常规准备后在远端脑保护装置保护下行CAS.结果 56例对侧颈动脉闭塞、同侧颈动脉狭窄患者行CAS的技术成功率100%,术后颈动脉直径狭窄率即术后残余狭窄率为0～30%,平均为13%±8%.患者术后脑缺血症状均获改善,仅1例于术后3 d发生原脑梗死部位的慢性出血(CAS侧),开颅手术后遗留轻微神经功能障碍,无缺血性并发症发生,无死亡病例.患者随访6个月～3年,平均27个月,均无脑缺血症状发作,经颈部血管彩色超声复查47例、DSA复查2例均未发现支架内再狭窄.结论 对侧颈动脉闭塞的高危患者的CAS治疗是安全、有效的,严格的病例筛选、经验丰富的医生操作及术后严谨的综合处理均可以降低手术并发症的发生.

Abstract：

Objective To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion. Methods From January 2001 to January 2010,56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases. Results The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and postprocedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent. Conclusions CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous postprocedure general management can decrease the rate of complication.     

可溶性Klotho蛋白对维持性血液透析患者血管硬化的影响

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血管硬化与可溶性Klotho蛋白(serum soluble Klotho,sKL)之间的关系.方法 收集60例MHD患者的临床资料,采用ELISA法检测sKL浓度.检测MHD患者踝一臂脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)和颈动脉内中膜厚度(intima-media thickness,IMT),以评价MHD患者血管硬化的程度.用Logistic回归分析法分析MHD患者发生血管硬化的危险因素;用Pearson相关分析法分析sKL浓度与baPWV、IMT的相关性.结果 60例MHD患者中,47例患者baPWV≥1 400 cm/s,血管硬化者占78.3％.根据患者血sKL水平分布范围的四分位数分为4组,Ⅰ组sKL＜405 ng/L,Ⅱ组sKL范围为405～624 ng/L,Ⅲ组sKL范围为624～832 ng/L,Ⅳ组sKL＞832 ng/L;各组的baPWV、Max IMT随着sKL水平的降低而升高(P＜0.01);sKL浓度与baPWV呈负相关(r=-0.115,P＜0.01),血清sKL浓度与Max IMT呈负相关(r=-0.224,P＜0.01),差异有统计学意义.Logistic回归分析法分析结果显示,血清sKL浓度降低(OR=2.336,95％ CI 1.153～7.315)和吸烟(OR =4.025,95％ CI 2.305～11.234)是MHD患者血管硬化的独立危险因素.结论 血清sKL浓度下降与血管硬化相关,血清sKL浓度的测定可能有助于血管硬化的诊断.     

碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的Meta分析

目的 评价碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的疗效和安全性.方法 计算机检索MEDLINE(1996-2012.12)、EBCO (1996-2012.12)、Cochrane图书馆临床对照试验资料库和中文万方数据库(1996-2012.12).手工检索已发表或未发表的相关文献,包括会议摘要等.检索无语种限制.纳入碳酸镧与传统磷结合剂比较治疗维持性血液透析患者高磷血症的随机对照试验.由两名评价员独立评价纳入研究的质量和提取资料,并用RevMan 5.0软件进行Meta分析.结果 共纳入10项研究.Meta分析结果显示,碳酸镧与传统磷结合剂相比,降低血磷水平的疗效差异无统计学意义[WMD=-0.06,95％ CI(-0.27～0.15),P=0.57],但碳酸镧治疗组血钙水平低于含钙磷结合剂,两组间因不良反应退出情况差异无统计学意义,碳酸镧治疗组高钙血症发生率低于传统磷结合剂.结论 碳酸镧治疗对终末期肾脏疾病维持性血液透析患者高磷血症有效,且其高钙血症发生率低于传统磷结合剂.     

糖尿病对维持性血液透析患者口腔卫生状况的影响分析

目的 探讨患2型糖尿病的维持性血液透析(maintenance hemodialysis,MHD)患者口腔卫生状况,以及2型糖尿病对MHD患者龋病和牙周病的影响.方法 选择黄石市第二医院血液净化中心85例MHD患者,其中糖尿病患者19例(糖尿病组),非糖尿病患者66例(非糖尿病组).记录所有患者的性别、年龄、透析时间、透析频率、相关病史及引起慢性肾衰竭的原发病、吸烟史、目前心力衰竭发生情况、口干情况、高血压情况、体质量指数.测取空腹血糖、糖化血红蛋白等实验室检查指标.对MHD患者进行口腔状况检查,记录已龋损尚未充填的牙(decayed teeth,D)、缺失牙(miss-ing teeth,M)、充填牙(filled teeth,F)、龋失补指数(decayed missing and filled teeth,DMFT)、软垢指数(debris index,DI),牙石指数(calculus index,CI),牙周病指数(periodontal disease index,PDI),对口腔检查结果进行比较.寻找糖尿病对MHD患者龋病和牙周病影响因素.结果 糖尿病组19例患者中龋病患者17例,患病率为89.5％;非糖尿病组66例患者中龋病患者41例,患病率为62.1％.糖尿病组和非糖尿病组的D分别为3.58±1.30和2.08±1.76,M分别为10.47±3.27和6.81±1.63,DMFT分别为15.00±3.83和10.78±2.02、DI分别为3.42±1.21和1.61±0.74,CI分别为2.37±0.60和1.46±0.78,PDI分别为5.37±1.67和3.28±2.02,2组比较,糖尿病组高于非糖尿病组(P＜0.01).结论 患有2型糖尿病的MHD患者口腔卫生状况更差.血糖控制差可增加MHD患者龋病发病风险及严重程度.     

Magnesium carbonate for phosphate control in patients on hemodialysis. A randomized controlled trial

Background Magnesium salts bind dietary phosphorus, but their use in renal patients is limited due to their potential for causing side effects. The aim of this study was to evaluate the efficacy and safety of magnesium carbonate (MgCO₃) as a phosphate-binder in hemodialysis patients. Methods Forty-six stable hemodialysis patients were randomly allocated to receive either MgCO₃ (n = 25) or calcium carbonate (CaCO₃), (n = 21) for 6 months. The concentration of Mg in the dialysate bath was 0.30 mmol/l in the MgCO₃ group and 0.48 mmol/l in the CaCO₃ group. Results Only two of 25 patients (8%) discontinued ingestion of MgCO₃ due to complications: one (4%) because of persistent diarrhea, and the other (4%) because of recurrent hypermagnesemia. In the MgCO₃ and CaCO₃ groups, respectively, time-averaged (months 1–6) serum concentrations were: phosphate (P), 5.47 vs. 5.29 mg/dl, P = ns; Ca, 9.13 vs. 9.60 mg/dl, P < 0.001; Ca × P product, 50.35 vs. 50.70 (mg/dl)², P = ns; Mg, 2.57 vs. 2.41 mg/dl, P = ns; intact parathyroid hormone (iPTH), 285 vs. 235 pg/ml, P < 0.01. At month 6, iPTH levels did not differ between groups: 251 vs. 212 pg/ml, P = ns. At month 6 the percentages of patients with serum levels of phosphate, Ca × P product and iPTH that fell within the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were similar in both groups, whereas more patients in the MgCO₃ group (17/23; 73.91%) than in the CaCO₃ group (5/20, 25%) had serum Ca levels that fell within these guidelines, with the difference being significant at P < 0.01. Conclusion Our study shows that MgCO₃ administered for a period of 6 months is an effective and inexpensive agent to control serum phosphate levels in hemodialysis patients. The administration of MgCO₃ in combination with a low dialysate Mg concentration avoids the risk of severe hypermagnesemia.     

Relationship between endothelial progenitor cells and cardiovascular diseases in maintenance hemodialysis patients

Objective To investigate the relationship between the variation of endothelial progenitor cells (EPC) number and cardiovascular diseases (CVD) in maintenance hemodialysis (MHD) patients,and discuss the function of EPC in the progression of CVD in MHD. Methods One hundred and fifteen MHD patients over 18 years whose dialysis vintage was over six months from Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. They were divided into CVD group and non - CVD group by medical history, electrokardiographie (EKG), cardiac ultrasound, peripheral vascular imaging and cardiovascular imaging. Peripheral blood (5 ml) was collected for detecting EPC number by flow cytometry as CD34/CD133/vascular endothelial growth factor receptor 2 (VEGFR2) cells. The EPC number between CVD group and non-CVD group was compared. The relationship between the decrease of EPC number and CVD risks in MHD patients was analyzed by logistic regression analysis. In a three-year follow-up, the death and new CVD events of the two groups were compared in order to discuss the relationship between EPC number and adverse events. Results Among 115 MHD patients, the average age was 61.57 ± 12.76, male/female was 71/44, the average dialysis vintage was (86.24 ± 56.31) months, the average Kt/V was 1.69±0.29 and average ultrafiltration volume was (2.48±0.90) L. Forty-four patients in 115 (38.3%) were with concurrent CVD. The EPC number in CVD group was significantly lower than that in non CVD group (P=0.015). The CVD group had higher serum phosphate (P=0.013), higher glycosylated hemoglobin (P＜0.001), but serum calcium, intact parathyroid hormone (iPTH) and other indicators had no significant difference between two groups. Multiple Logistic regression analysis showed that older age (OR=1.061), history of diabetes (OR=9.796), dialysis vintage (OR=1.015), serum phosphate (OR=3.766), decrease of EPC number (OR=0.909) were the independent impact factors of CVD events in MHD patients. There were 22 patients of the 115 MHD patients had encountered a new CVD event in a three-year follow-up between December 2012 and December 2015, 9 patients from the CVD group and 13 patients from the Non-CVD group, and there was no significant difference between two groups (P=0.776). Nine patients from the CVD group and 7 patients from the Non-CVD group died in the follow-up, and there was no significant difference (P=0.111). Seventy-one MHD patients from the non-CVD group were divided into two groups by the median of EPC number. There were 3 patients in the higher EPC number group encountered CVD events and 10 patients in the lower EPC number group encountered CVD events, which had significant difference (P=0.024). Conclusion The decrease of circulating EPC number may be related with CVD events in MHD patients. Even adjusted by age, sex, diabetes, dialysis vintage and serum phosphate, decreased EPC number is still the independent risk factor of CVD events in MHD patients. The decrease of EPC number in MHD patients may be used to predict the occurrence of cardiovascular events.     

Comparison of sleep quality between hemodialysis and peritoneal dialysis patients

AIM: Sleep disorders are common in patients with end-stage renal disease. Although studies have been conducted on the type and frequency of sleep disturbances in hemodialysis and peritoneal dialysis patients, there has been no study comparing the sleep quality between these two groups. Therefore, we aimed to compare sleep quality between hemodialysis and peritoneal dialysis patients. METHODS: A total of 102 patients (52 hemodialysis and 50 peritoneal dialysis) were included in the study. The Pittsburgh sleep quality index (PSQI) was used for the assessment of sleep quality. Two groups were compared for seven components of the PSQI questionnaire and global score as well as for clinical and laboratory findings. We also assessed the independent predictors of sleep quality. RESULTS: There were 51 male and 51 female patients (29 male and 23 female in hemodialysis group versus 22 male and 28 female in peritoneal dialysis group). The mean age was 55.5 +/- 14.6 years in the hemodialysis and 51.5 +/- 18.1 years in the peritoneal dialysis group. The median dialysis duration was 36 (77.0) months. The sleep quality was poor in 88.5% of the hemodialysis patients and 78.0% of the peritoneal dialysis patients. However, this difference in sleep quality was not significant between the two groups (P > 0.05). There was a significant association between the sleep quality and the age, presence of diabetes mellitus, and serum albumin. Among these variables, only age was found to be an independent predictor of sleep quality. CONCLUSIONS: Hemodialysis and peritoneal dialysis patients had a similar high rate of poor sleep quality. Further studies are necessary to investigate the causes of poor quality of sleep and to investigate methods to improve sleep quality in this population.     

Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis

Background  The atherosclerotic process progresses more dynamically in hemodialysis (HD) patients than in the general population. In HD patients, lower magnesium levels were reported to be associated with increased atherosclerosis of the common carotid artery. We tested the hypotheses that magnesium supplementation helps to improve carotid intima media thickness (IMT) in HD patients. Materials and methods  A total of 47 patients on HD were included in the study. Patients were randomly divided into two groups: group A (Mg group), in which patients were given magnesium citrate orally at a dosage of 610 mg every other day for 2 months and group B (control group), in which patients received only calcium acetate therapy as a phosphate binder. At baseline and 2 months later, all patients underwent a carotid artery ultrasound scan to measure carotid IMT. Results  At the end of 2 months, mean serum calcium, phosphorus, and calcium × phosphorus product were not changed in both groups. As expected, mean serum Mg level significantly increased in the Mg group at the end of 2 months. In addition, serum parathyroid hormone (PTH) level significantly decreased in the Mg group at the end of 2 months (P = 0.003). Baseline carotid IMT was similar between the groups. Bilateral carotid IMT was significantly improved in patients treated with magnesium citrate compared to initial values (P = 0.001 for left, P = 0.002 for right). Conclusion  Based on the present data, magnesium may play an important protective role in the progression of atherosclerosis in patients on dialysis. Further studies are needed to assess more accurately the role of magnesium in atherosclerotic regression in dialysis patients.     

中年人颈动脉粥样硬化与认知功能的关系

目的 探讨颈动脉粥样硬化对中年人认知功能的影响。方法 采用简易精神状态量表对300例研究对象进行认知功能检查。结果 颈动脉正常组MMSE评分为（27.83±2.16）分,粥样硬化组为（27.55±2.66）分,粥样斑块组为（27.49±2.56）分,3组的MMSE评分比较,差异无统计学意义（P〉0.05）。结论 颈动脉粥样硬化对中年人的认知功能没有影响。