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黄芪改善肾病综合征患者血液高凝状态的临床观察 总被引:28,自引:4,他引:28
樊瑞芬 《中国中西医结合肾病杂志》2001,2(11):672-673
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… 相似文献
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黄芪注射液对肾病综合征细胞因子及其基因表达的影响 总被引:10,自引:2,他引:10
目的:探讨儿童肾病综合征(NS)外周血白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子α(TNFα)的变化,糖皮质激素(简称“激素”)加黄芪注射液对IL-1、IL-6、IL-8和TNFα的产生及其基因表达的影响。方法:将观察对象分为四组:①治疗前组;②激素组;③黄芪组;④对照组。应用酶联免疫吸附试验(ELISA)方法检测血清中IL-1、IL-6、IL-8和TNFα的水平。应用原位聚合酶链反应(原位PCR)方法,检测外周血单个核细胞(PBMC)激素加黄芪注射液对IL-1、IL-6、IL-8和TNFαmRNA表达的影响。结果:NS患儿外周血IL-1、IL-6、IL-8和TNFα水平明显高于正常儿童,有显性差异(P<0.01);mRNA的表达增加。激素治疗后IL-1、IL-6、IL-8和TNFα水平明显降低(P<0.05),mRNA的表达下降。激素加黄芪注射液对上述细胞因子和mRNA表达其降低更加显(P<0.01)。结论:NS患IL-1、IL-6、IL-8和TNFα水平明显增高,激素对IL-1、IL-6、IL-8和TNFα的产生与mRNA表达有抑制作用,黄芪具有辅助糖皮质激素治疗的作用。 相似文献
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黄芪注射液联合低分子量肝素治疗原发性肾病综合征临床观察 总被引:1,自引:0,他引:1
肾病综合征(Nephrotic Syndrome,NS)常合并高凝状态,易并发血栓形成,另外,肾上腺皮质激素、兔疫抑制剂及利尿剂的应用,可进一步加剧血栓的形成,严重影响该病的治疗效果及预后。因此,抗凝治疗为目前原发性肾病综合征(PNS)治疗的关键之一。黄芪是具有广泛药理活性的 相似文献
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黄芪对肾病综合征大鼠治疗作用的研究 总被引:13,自引:4,他引:13
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。 相似文献
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黄芪注射液对肾病综合征患者血脂和血液流变学的影响 总被引:14,自引:1,他引:14
韦日周 《中国中西医结合肾病杂志》2001,2(5):278-279
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… 相似文献
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黄芪注射液对儿童肾病综合征尿蛋白与血浆蛋白的影响 总被引:5,自引:2,他引:5
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 相似文献
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黄芪注射液对肾病综合征患者血小板活化功能的影响 总被引:12,自引:0,他引:12
肾病综合征 (NS)是常见病 ,研究表明其血栓塞性合并症 ,约占 8%~ 5 0 % 〔1〕。而研究血小板功能变化及药物影响的报道还较少。我们检测了 2 3例NS患者外周血血小板活化特异标志物血小板CD62 P和血小板膜Fg表达水平 ,并观察黄芪注射液治疗对其影响 ,探讨它们在NS发病中的作用和意义。资料与方法1 病例选择 具备以下临床表现 :(1)尿蛋白≥35 g/ 2 4h;(2 )血浆白蛋白≤ 30 g/L ;(3)水肿 ;(4)血脂高。其中 (1) (2 )两项必备 ,并排除其他继发性肾病综合征。NS组 2 3例 ,男性 16例 ,女性 7例 ;年龄 17岁~ 5 6岁 ,平均年龄 3… 相似文献
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黄芪当归合剂降低肾病综合征大鼠血脂机制的探讨 总被引:95,自引:2,他引:95
目的 探讨黄芪当归合剂降低肾病综合征(NS)大鼠血脂的机制。方法 采用加速型肾毒血清肾炎致NS模型。治疗组灌服黄芪当归合剂,正常组和肾病对照组灌水。检测各组血清脂谱,以Northern 杂交检测肝脏羧甲基戊二酰辅酶A(HMGCoA) 还原酶和低密度脂蛋白受体(LDLR)mRNA表达。结果 肾病大鼠呈高脂蛋白血症,该组肝脏HMGCoA还原酶的mRNA在早期呈短暂上调( P < 0-001) ,LDL受体mRNA 表达随病程逐渐下调( P < 0-001);黄芪当归治疗组,血清胆固醇、甘油三酯、低密度脂蛋白和极低密度脂蛋白低于肾病对照组,虽肝脏HMGCoA 还原酶mRNA 无明显变化,但LDL受体mRNA表达较肾病对照组显著上调( P< 0-01) 。结论 黄芪当归组显著降低NS大鼠血脂水平,这一改善脂代谢紊乱的作用可能部份是通过肝脏LDL受体mRNA 表达上调而实现。 相似文献
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肾病综合征患者肾组织podocin的表达 总被引:6,自引:4,他引:6
目的 观察不同病理类型65380; 不同激素反应性肾病综合征(NS)患者肾小球足细胞中podocin的表达和分布特征65377;方法 肾组织作冰冻切片免疫荧光双染色, 以激光共聚焦显微镜采集图像65377;与定位标志Ⅳ型胶原α3链比较65377; 受检NS患者21例, 其中局灶节段性肾小球硬化(FSGS)12例(难治性7例, 非难治性5例)65380; 微小病变(MCD)5例65380; 膜性肾病(MN)4例;正常肾组织对照3例65377;采用LSM 510图像处理系统进行处理65377;荧光强度以吸光度表示65377; 结果 (1)podocin在正常肾组织沿肾小球基底膜呈连续65380; 线形分布65377;部分FSGS患者podocin的分布呈点状65380; 短线条状, 少数患者未见podocin沉积65377;(2)FSGS患者肾小球中podocin表达量(80.5±33.5)与对照正常肾组织(138.4±38.1)比较,显著减少(P=0.0211), 其中难治性FSGS(67.2±30.5)与正常肾组织的差异有统计学意义(P=0.0131); 非难治性FSGS患者(99.0±31.0)与正常肾组织的差异无统计学意义(P=0.1585)65377;(3)MCD(112.1±47.6)65380; MN(92.5±34.8)患者podocin的表达量亦降低,与正常肾组织比较,无统计学意义(P=0.4497, P=0.1570)65377;(4)不同病理类型各组NS患者肾小球中podocin表达量的差异均无统计学意义(P > 0.05)65377;结论 FSGS的NS患者肾小球中podocin的表达减少, 难治性FSGS患者尤为明显, 部分FSGS患者podocin分布发生改变65377;podocin的检测可能在FSGS激素疗效评价方面有一定价值65377; 相似文献
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Hypothyroidism in infants with nephrotic syndrome 总被引:10,自引:0,他引:10
Tej K. Mattoo 《Pediatric nephrology (Berlin, Germany)》1994,8(6):657-659
Thyroid function indices were studied in five children with nephrotic syndrome in the 1st year of life. Four had primary hypothyroidism as defined by low serum free tri-iodothyronine (FT3) and free thyroxine (FT4), and high serum thyroid-stimulating hormone (TSH) levels. One patient with low serum FT3 and FT4 had a normal TSH level. T4 replacement therapy lowered TSH to normal levels in all four patients and normalized FT4 in three of them. There were no significant changes in serum FT3 levels. Adrenal function was studied in three patients, none had adrenal calcification or hypoadrenocorticism. This study supports the existence of a hypothyroid state in some infants with nephrotic syndrome. Routine thyroid screening and early replacement therapy is recommended. 相似文献
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F. Bryson Waldo Mark R. Benfield Edward C. Kohaut 《Pediatric nephrology (Berlin, Germany)》1992,6(6):503-505
Treatment with a combination of pulse methylprednisolone (MP) and an alkylating agent has been reported to induce long-term remission of proteinuria in patients with steroid-resistant nephrotic syndrome (SRNS). We have treated 13 patients with SRNS with a course of pulse MP. There were 8 black patients and 5 white; 10 had a biopsy diagnosis of focal segmental glomerulosclerosis (FSGS) and 3 nil lesion. Initially 5 patients responded and 2 partially responded. Of the responding patients, 5 relapsed while treated with alternate-week MP therapy. Of these relapsing patients, 3 received a second course of MP plus chlorambucil; 2 responded. The patients were observed for a mean of 47 months (range 4–64 months). When last seen only the 3 patients with a biopsy diagnosis of nil lesion were protein free. There were no complications of steroid therapy. Six patients currently have end-stage renal disease and 2 have renal insufficiency. All of the 6 patients with no response to treatment were black. These data suggest that a course of pulse MP therapy alone induces short-term remission of the nephrotic syndrome in some white patients with FSGS, but in almost no blacks. Patients who relapse may respond to retreatment, but addition of an alkylating agent does not appear to induce longterm remission in patients with FSGS. 相似文献
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目的观察长春西汀联合泼尼松治疗原发性肾病综合征的临床疗效。方法选取原发性肾病综合征患者62例,随机分为观察组和对照组。对照组采用泼尼松及常规治疗,观察组在对照组治疗基础上给予长春西汀注射液静脉滴注,两组疗程均为3周。观察两组患者临床改善情况。结果观察组总有效率(83.9%)明显高于对照组总有效率(61.3%)(P〈0.05),两组治疗后血浆白蛋白、24h尿蛋白定量与本组治疗前比较有统计学差异(P〈0.05),观察组较对照组改善更显著(P〈0.05),观察组尿素氮、血肌酐、活化部分凝血活酶时间、纤维蛋白原、D-二聚体较治疗前明显改善(P〈0.05),与对照组相比有统计学差异(P〈0.05)。结论长春西汀联合泼尼松治疗原发性肾病综合征安全有效,能有效改善血液高凝状态。 相似文献
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目的 对血清D二聚体(D-Dimer,简称D-D)与原发性肾病综合征(primary nephrotic syndrome,PNS)临床及病理资料相关性进行分析,探讨血清D-D在PNS中的临床意义.方法 符合肾病综合征的诊断标准及本研究排除标准的肾病综合征患者为PNS组,健康体检者为对照组,收集一般临床指标和患者的病理资料,进行病例对照研究与临床及病理资料分析.结果 (1)120例PNS患者血清D-D水平较60例正常人的血清D-D水平明显升高,差异有统计学意义(P<0.05).(2)临床资料显示120例PNS患者中,血清D-D水平与C-反应蛋白(CRP)、24 h尿蛋白之间存在正相关(r=0.429,P=0.000;r=0.481,P=0.000),但与白蛋白(Alb)、血尿素氮(BUN)、血肌酐(SCr)、血清三酰甘油(TG)、血清总胆固醇(CHOL)之间无相关性(P>0.05).(3)微小病变型肾病、系膜增生性肾小球肾炎、系膜毛细血管性肾小球肾炎、膜性肾病及局灶性节段性肾小球硬化5种病理类型间血清D-D水平相比有统计学意义(P<0.05),其中微小病变型肾病和膜性肾病患者的血清D-D水平均较其他3种病理类型患者的血清D-D水平明显升高,有统计学意义(P<0.05),而微小病变型肾病和膜性肾病患者间及其余3种病理类型患者间的血清D-D水平相比无统计学意义(P>0.05).结论 PNS存在高凝状态,血清D-D水平可间接提示蛋白尿严重程度,并且可能间接预测PNS病理的类型. 相似文献
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S. Gulati V. Kher A. Gupta P. Arora P. K. Rai R. K. Sharma 《Pediatric nephrology (Berlin, Germany)》1995,9(4):431-434
We conducted a retrospective analysis of infections in 154 children (114 boys, 40 girls) with nephrotic syndrome who satisfied the International Study of Kidney Disease in Children criteria. Their mean age at onset of symptoms was 6.2 years (range 6 months to 16 years) and the mean duration of follow-up was 32 months (range 6–55 months). One or more infectious complications were observed in 59 of the 154 children (38%), with urinary tract infection being the commonest (13.7%), followed by pulmonary tuberculosis (10.4%), peritonitis (9.1%), skin infections (5.2%), upper respiratory infections (5.2%), lower respiratory tract infections (3.9%) and pyomeningitis (0.6%). There were 3 deaths, the mortality in 2 patients being attributable to infections. There was no significant difference between children who developed infection and those who didn't in terms of age of onset, sex, duration of disease, serum creatinine, blood urea nitrogen and 24-h proteinuria. However, the children who developed infectious complications had significantly higher serum cholesterol levels (P<0.01) and lower serum albumin levels (P<0.02). The frequency of infections was higher inchildren who were frequent relapsers, steroid dependent and subsequent non-responders (28/60) compared with infrequent relapsers and initial non-responders (29/94). 相似文献
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Efficacy of mycophenolate mofetil in pediatric patients with steroid-dependent nephrotic syndrome 总被引:3,自引:0,他引:3
Novak I Frank R Vento S Vergara M Gauthier B Trachtman H 《Pediatric nephrology (Berlin, Germany)》2005,20(9):1265-1268
Most patients with minimal change nephrotic syndrome are steroid responsive and tolerate this medication. However, a substantial number of patients relapse frequently and become steroid dependent. These patients often require treatment with alternative immunosuppressive drugs to maintain remission and minimize steroid toxicity. Previous studies have suggested that mycophenolate mofetil is effective in treating these patients. However, there are limited data on the effectiveness of this agent in pediatric patients, specifically those with steroid-dependent nephrotic syndrome. The purpose of this study was to assess the efficacy and safety of mycophenolate mofetil therapy in children and adolescents with steroid-dependent nephrotic syndrome who failed other treatments. A retrospective chart review was performed on all patients with steroid-dependent nephrotic syndrome. Clinical characteristics, laboratory data and the relapse rate were assessed prior to and during mycophenolate mofetil treatment. Twenty-one patients, ages 2–17 years, with steroid-dependent nephrotic syndrome who were treated with mycophenolate mofetil between 2001–2005 were included in this review. The indication for mycophenolate mofetil use was steroid dependence in 17 and steroid toxicity in 4 patients. The mean duration of treatment was 1.0±0.5 years (range: 0.2–2.0 years). Patients treated with mycophenolate mofetil had a reduction in relapse rate from 0.80±0.41 to 0.47±0.43 relapses per month ( P <0.02). Side effects were mild and mostly gastrointestinal in nature. In 1 child, mycophenolate mofetil was discontinued due to varicella infection and not restarted. The findings indicate that mycophenolate mofetil is a useful adjunctive therapy in the treatment of patients with steroid-dependent nephrotic syndrome. It lowers the relapse rate by 40% and is well tolerated by patients with steroid-dependent nephrotic syndrome. 相似文献
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目的观察原发性。肾病综合征(PNS)并发急性肾损伤(AKI)患者甲状腺功能的变化及其影响因素。方法回顾性分析PNS患者77例,其中PNS并发AKI患者27例为PNS+AKI组;PNS肾功能正常者50例为PNS组;同时设原发性慢性肾小球肾炎肾功能正常组(CGN1组)和CGN肾功能异常组(CGN2组)作为对照组,每组各40例。比较4组患者的血浆总蛋白(TP)、血清白蛋白(Alb)、血肌酐(SCr)、甘油三脂(TG)、胆固醇(TC)、24h尿蛋白定量及甲状腺功能指标游离三碘甲腺原胺酸(盯3)、游离四碘甲腺原胺酸(FT4)、促甲状腺素(TSH)。结果(1)PNS+AKl组FT3、FT4值较各组明显降低(P〈0.05);而TSH无明显差异(P〉0.05)。(2)PNS+AKI组和PNS组TP、Alb、SCr有显著差异(P〉0.05)。(3)多元回归分析示Alb、SCr对FT3影响显著(P〈0.05)。结论PNS合并AKI时较PNS患者FT3、FT4明显降低,而TSH无明显变化,这种改变可能与Alb的进一步降低和肾功能损伤有关。 相似文献