共查询到17条相似文献,搜索用时 609 毫秒
1.
目的 观察e抗原阳性慢性乙型肝炎替比夫定初治的抗病毒疗效。方法 将30例HBeAg阳性的慢性乙型肝炎患者,根据1∶1∶1随机分为替比夫定(LDT)单药组、替比夫定联合阿德福韦酯(LDT+ADV)组、拉米夫定联合阿德福韦酯(LAM+ADV)组,每组10例,疗程均为96 周。观察各组治疗12、24、48、72、96 周时ALT复常率、HBV-DNA 转阴率、HBeAg/抗-HBe血清学转换、肾小球滤过率。结果 在48周时,3组病毒学应答率均达到100%。替比夫定组最先出现生化学应答,在48周后,3个治疗组均达到100%。血清学应答在72周时,替比夫定组(50%)明显高于替比夫定联合阿德福韦酯组(40%)、拉米夫定联合阿德福韦酯组(0%), 差异具有统计学意义(P<0.05)。96周后替比夫定组肾小球滤过率(112.26±2.86) ml/(min·1.73 m2)较基线明显升高,替比夫定联合阿德福韦酯组(100.65±2.61)ml/(min·1.73 m2)较基线逐渐升高,拉米夫定联合阿德福韦酯组(92.03±2.08)ml/(min·1.73 m2)基本无变化。结论 替比夫定具有强效、快速抑制HBV DNA复制,并有高效的e抗原血清转换作用,替比夫定单药或联合阿德福韦酯,可明显提高患者的肾小球滤过率,进而改善肾功能。
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目的 建立糖尿病合并肾功能不全患者糖化血红蛋白(HbA1c)估算平均血糖的校正模型。方法 回顾性分析2018年1月-2021年12月于陆军特色医学中心(大坪医院)高血压内分泌科住院治疗的329例2型糖尿病患者的临床资料,依据肾小球滤过率(eGFR)水平分为对照组[eGFR≥60 ml/(min.1.73 m2),n=165]与肾功能不全组[eGFR<60 ml/(min.1.73 m2),n=164]。收集两组患者的人口学基本特征、口服葡糖糖耐量试验(OGTT) 2 h血糖水平及其他实验室检查结果,分别采用HbA1c和OGTT两种模型估计入组患者的24 h平均血糖,并计算24 h平均血糖差值,分析影响肾功能不全患者HbA1c估算血糖偏差的影响因素,建立HbA1c估算平均血糖的校正模型。收集2022年1-3月于陆军特色医学中心(大坪医院)高血压内分泌科住院治疗的29例2型糖尿病合并肾功能不全患者进行外部验证。... 相似文献
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目的 探讨基于CT平扫的深度学习自动分割模型对肾积水病人分侧肾功能评估的价值。方法 回顾性收集2所医院共209例肾积水病人的平扫CT影像、年龄、性别、体质量指数(BMI)以及基于单光子发射计算机体层成像(SPECT)测量的肾脏肾小球滤过率(GFR),并以其来源医院确定为训练集(137例)和测试集(72例)。采用U-Net方法构建肾脏自动分割模型,用于自动分割平扫CT影像上肾积水和肾实质区域,计算肾积水、肾实质体积及两者的体积比作为肾脏形态特征。根据GFR值将肾功能分为正常[GFR≥30 mL/(min·1.73 m2)]与异常[GFR<30 m L/(min·1.73 m2)]。使用多因素逻辑回归筛选独立预测特征并建立分侧肾功能评估模型。采用Dice相似性系数(DSC)评价自动分割结果,采用受试者操作特征曲线下面积(AUC)评价分侧肾功能评估模型的效能,使用DeLong检验比较AUC的差异。结果 影像采用自动分割平均耗时为每例病人2.2 s,而手动分割耗时是自动分割的671.8倍。肾实质和肾积水自动分割的平均DSC分别为0.89和0.6... 相似文献
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《国际医学放射学杂志》2017,(3)
正摘要目的验证先前提出的2个模型包含的危险因素,病人的肾小球滤过率(e GFR)60 m L/(min·1.73 m2)或e GFR45 m L/(min·1.73 m2)。方法随机选取病人行静脉注射对比增强CT(CECT),对以下风险因素进行评估:泌尿/肾脏疾病史、高血压、糖尿病、贫血、充血性心力衰竭、其他心血管疾病或多发性骨髓瘤或Waldenstr觟m病。记录以下数据:肾功能、年龄、性别、增强CT(CECT)的部位和疾病类型。对2个模型进行研究:模型A——糖尿病、泌尿系统/肾脏疾病史、心血管疾病,高血压;模型B——糖尿病、泌尿/肾脏疾病史、 相似文献
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目的比较肾脏疾病饮食改良研究方程式(MDRD)、新慢性肾脏疾病流行病学合作研究方程式(CKD-EPI)以及胱抑素C(Cys C)估算公式(eGFR-Cys)对慢性肾脏病(CKD)患者肾小球滤过率(GFR)的预测性能。方法测定93例CKD患者的99mTc-二乙烯三胺戊乙酸(DTPA)血浆清除率(rGFR)作为GFR金标准,另用MDRD、CKD-EPI和eGFR-Cys公式分别计算GFR估测值(eGFR),并将rGFR与3种公式计算的eGFR进行比较。结果相对于rGFR,CKD-EPI公式偏倚为-3.4±10.7ml/(min·1.73m2),eGFR-Cys公式为-4.8±11.9ml/(min·1.73m2),MDRD公式为-5.4±10.4ml/(min·1.73m2),三者间差异均无统计学意义。对于rGFR测定值30%误差范围内GFR估测值的百分率,CKD-EPI公式e、GFR-Cys公式、MDRD公式分别为74.2%7、2.0%和64.5%,差异无统计学意义。当rGFR>60ml/(min·1.73m2)时,CKD-EPI公式30%准确度(75.7%±5.1%)明显高于MDRD公式(54.1%±7.7%,P<0.05)。以放射性核素法的GFR作为标准,以rGFR≤60ml/(min·1.73m2)作为GFR受损标准,进行3种eGFR诊断GFR受损性能的受试者工作特征(ROC)曲线分析,MDRD eGFR的ROC曲线下面积为0.862,CKD-EPI为0.863,eGFR-Cys为0.877,3个曲线下面积的差异无统计学意义。结论 3个公式对GFR的估算能力基本相似。CKD-EPI公式和eGFR-Cys公式是否可以取代MDRD公式尚需进一步研究。 相似文献
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目的 探讨血清视黄醇结合蛋白4(RBP-4)与妊娠肥胖、妊娠糖尿病的关系。方法 选用2015-01至2016-12住院的32例BMI>28 kg/m2的妊娠糖尿病(GDM)孕妇(肥胖型GDM组),30例BMI 18.5~23.9 kg/m2 (单纯型GDM组),29例BMI>28 kg/m2 (妊娠肥胖组),27例BMI18.5~23.9 kg/m2的健康孕妇(健康对照组),采用酶联免疫吸附法(ELISA)检测4组孕妇血清RBP-4水平、脂联素(APN)水平;同时测定所有受试者的糖、脂生化指标,并计算胰岛素抵抗指数(HOMA-IR)。结果 (1)肥胖型GDM组孕妇血清RBP-4明显高于其他3组孕妇(P<0.05),妊娠肥胖组孕妇血清RBP-4高于单纯型GDM组及健康对照组(P<0.05);(2)血清RBP-4与孕前BMI、FINS、TG、HOMA-IR呈正相关,与APN呈负相关(r分别为0.562,0.409,0.484,0.618,-0.412,P均<0.05)。结论 RBP-4水平在妊娠肥胖组及肥胖型GDM组均高于健康对照组,其中肥胖型GDM组孕妇血清升高明显,可见血清RBP-4水平与妊娠肥胖、妊娠糖尿病均有密切联系,特别是对肥胖型GDM患者易生产巨大儿起到非常关键的作用。 相似文献
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目的 探讨双源CT灌注成像在活体肝移植后对移植肝的评价作用。方法 招募解放军总医院第三医学中心2013-06至2018-11进行活体肝移植术后1个月经超声及CTA检查肝动脉无狭窄患者25例;术后3个月患者61例,其中肝动脉无狭窄25例,轻度狭窄13例,中度狭窄12例,重度狭窄11例;同时收集同时期因怀疑有肝脏肿瘤行CT灌注扫描,后经临床及影像证实无肿瘤的患者(25例)作为对照组。上述所有研究对象均行双源CT全肝灌注成像检查并测量肝动脉灌注量(hepatic artery perfusion,HAP)、门静脉灌注量(portal vein perfusion, PVP)、肝总灌注量(total liver perfusion, TLP)及肝动脉灌注指数(hepatic perfusion index, HPI)。同时补充检测肝动脉狭窄人群的谷丙转氨酶(alanine transaminase, ALT)。结果 与对照组人群[(0.28±0.13) ml/(min·ml)]相比,肝移植术后1个月无肝动脉狭窄人群HAP[(0.36±0.17) ml/(min·ml)]显著增高(P<0.05),术后3个月中度及重度肝动脉狭窄人群HAP显著降低[(0.12±0.09)ml/(min·ml),(0.06±0.03) ml/(min·ml),P<0.05]。中度及重度肝动脉狭窄人群HPI较对照组显著降低(0.07±0.05、0.03±0.02 vs. 0.23±0.16, P<0.05)。重度肝动脉狭窄人群PVP较对照组显著升高[(1.81±0.36)ml/(min·ml) vs. (1.23±0.62) ml/(min·ml),P<0.05])。在肝动脉狭窄患者中,ALT对数与HAP对数成线性相关。结论 双源CT能对活体肝移植患者术后的移植肝进行血流灌注评价,能够为临床提供更为精准的信息,提高患者后续治疗的准确性。 相似文献
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目的 探讨非透析慢性肾脏病(chronic kidney disease,CKD)患者血红蛋白(Hemoglobin,Hgb)、肾小球滤过率(glomerular filtration rate,GFR)、血清肌钙蛋白T(cardiac troponin T,cTnT)的水平与肾性贫血(renal anemia,RA)的相关性。方法 收集中部战区总医院肾脏病科891例非透析CKD患者的住院资料,对入院时Hgb、cTnT及GFR等指标进行回顾性分析;根据Hgb水平将患者分为无、轻、中、重度贫血组,观察并分析各组GFR、cTnT水平;另外,根据GFR水平将患者分为CKD1-5期,观察并分析CKD各期Hgb水平以及Hgb低于90g/L的比例。结果 非透析CKD患者中,无、轻、中、重度贫血组的GFR(ml/min)水平分别为62.6(46.3,82.6)、37.9(25.5,51.4)、20.7(14.7,29.9)、16.4(13.0,27.4),不同贫血组的GFR水平经比较差异具有统计学意义(P<0.05);GFR水平随着贫血程度加重呈逐渐下降趋势;经Pearson相关性检验,GFR与Hgb存在正线性相关(R=0.653,P<0.05)。贫血分组中无、轻、中、重度组的cTnT(ng/ml)水平分别为0.010(0.006,0.015)、0.016(0.011,0.028)、0.028(0.016,0.045)、0.036(0.021,0.046);不同贫血组cTnT水平比较,差异有统计学意义(P<0.05);cTnT水平随着贫血程度加重呈逐渐上升趋势;经Pearson相关性检验,cTnT与Hgb存在负线性相关(R=-0.300,P<0.05)。随着CKD分期增加,Hgb平均水平呈逐渐下降趋势,Hgb低于90g/L的比例呈逐渐上升趋势。结论 积极纠正非透析CKD患者的贫血状况,可改善心肌受损状态,对控制肾脏病进展有一定作用。 相似文献
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目的 探讨柚皮素预处理对心肌缺血/再灌注损伤大鼠能量代谢的影响。方法 将大鼠随机分为5组(n=10):假手术组、模型组,柚皮素分为三个剂量组(100、50、25 mg/kg),于建立模型前7 d开始腹腔注射给药,通过结扎冠脉30 min再灌注2 h建立心肌缺血/再灌注损伤模型;再灌注结束后,采用比色法测定血清肌酸激酶(CK)和乳酸脱氢酶(LDH)活性,采用定磷法测定心肌组织Na+/K+-ATP酶和Ca2+/Mg2+-ATP酶的活力,采用染色法测定心肌梗死面积(myocardial infarction surface, MIS)。结果 柚皮素高剂量组MIS缩小至32.91%,与模型组MIS(39.78%)比较差异有统计学意义(P<0.05);柚皮素各剂量组CK活性分别降低为658.03、650.12、621.89 U/L,与模型组(809.45 U/L)比较,差异均有统计学意义(P<0.05或P<0.01);各剂量组LDH活性分别降低为1543.08、1506.27、1326.97 U/L,与模型组(2034.56 U/L)比较差异均有统计学意义(P<0.05或P< 0.01);柚皮素各剂量组可显著升高Na+/K+-ATP酶活力为6.82、6.83、6.94 mmol Pi/(g·h),与模型组[5.54 mmol Pi/(g·h)]比较差异均有统计学意义(P<0.05);高、中剂量组可显著升高,Ca2+/Mg2+-ATP酶活力为8.42、8.97 mmol Pi/(g·h),与模型组[7.06 mmol Pi/(g·h)]比较差异均有统计学意义(P<0.05)。结论 柚皮素预处理对心肌缺血/再灌注所致心肌损伤的保护作用可能与改善心肌组织的能量代谢有关。 相似文献
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目的 比较艾塞那肽与二甲双胍治疗新诊断2型糖尿病的疗效及其对血糖波动的影响。方法 将68例新诊断2型糖尿病患者随机分为2组,分别为二甲双胍组35例,艾塞那肽组33例。治疗12周,比较2组治疗前后空腹血糖(FBG),餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、血脂、体重指数,以及血糖波动指标日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、平均餐后血糖波动幅度(MPPGE)的变化。结果 治疗12 周后,两组FBG、2 h PG、HbA1c、血糖波动指标较治疗前均明显下降,两组治疗后无统计学差异;两组治疗后三酰甘油(TG)较治疗前明显降低(P<0.05),二甲双胍组(1.88±0.57)mmol/L,艾塞那肽组(1.58±0.21)mmol/L,相比二甲双胍组,艾塞那肽组下降更为明显(P<0.05);体重指数艾塞那肽组治疗前体重(25.14±2.21)kg/m2,治疗后(23.16±1.46)kg/m2,治疗前后比较具有统计学差异(P<0.05)。结论 艾塞那肽与二甲双胍对新诊断2型糖尿病控制血糖效果具有同等的疗效,艾塞那肽在降低三酰甘油及体重方面更为显著。 相似文献
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AIM: Currently, the widely adopted renal dynamic imaging in clinical practice uses Gates' method to calculate the glomerular filtration rate (GFR), but many researchers have proven that Gates' method may result in bias. Thus, this article explores alternative improved formulae to calculate GFR by renal dynamic imaging. METHODS: Three hundred and sixty-seven patients were selected and their GFR values were measured using renal dynamic imaging and the two-plasma method with 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) as the imaging agent. With the two-plasma GFR as reference value, two equations were obtained from linear and non-linear regression analyses between the renal uptake percentage and two-plasma GFR. The 367 patients were divided into two random groups, with the first group used to derive the regression formulae and the second to verify the formulae. Finally, all patients were studied to derive the formulae to calculate GFR. The comparison of our formulae with the commonly used Gates' formula was conducted by the Bland-Altman method. RESULTS: The linear and non-linear GFR formulae were as follows: GFR (ml/min/1.73 m2)=(631.633 x renal uptake percentage - 2.040) x 1.73/BSA (BSA, body surface area) and GFR (ml/min/1.73 m2)=(-1996.585 x renal uptake percentage2 + 1013.526 x renal uptake percentage - 12.739) x 1.73/BSA, respectively. The biases of the GFR values calculated using the linear and non-linear formulae and Gates' formula relative to the two-plasma GFR were -2.5 +/- 19.1 ml/min/1.73 m2, -2.0 +/- 19.3 ml/min/1.73 m2 and 3.4 +/- 19.4 ml/min/1.73 m2, respectively. CONCLUSIONS: The GFR values calculated using our new formulae correlate better with the reference GFR value than does GFR calculated by Gates' formula, and the GFR values measured using the non-linear formula are more accurate than those obtained using the linear formula. 相似文献
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OBJECTIVE: Cardiac iodine-123 metaiodobenzylguanidine (MIBG) can be used to evaluate cardiac sympathetic nerve function and is useful for assessing the prognosis of patients with heart disease. Renal impairment in heart failure patients has been recognized as an independent risk factor for morbidity and mortality, and has been observed as abnormal uptake and washout of cardiac MIBG imaging. The purpose of this study was to evaluate the prognostic value of cardiac MIBG imaging in heart disease patients with a glomerular filtration rate (GFR) either > or = 60 ml/min/1.73 m2 or < 60 ml/min/1.73 m2. METHODS: Heart disease patients (n: 135, male/female: 87/48, mean age: 63 years, coronary artery disease/dilated cardiomyopathy/myocarditis: 41/62/32, mean left ventricular ejection fraction: 51%, GFR > or = 60 ml/min/1.73 m2/ GFR < 60 ml/min/1.73 m2: 103/32) underwent cardiac MIBG imaging and were followed-up for 2.7 years. GFR was calculated by the Modification of Diet in Renal Disease (MDRD) equation. Cardiac MIBG imaging was obtained 15 min and 4 h after isotope injection. The parameters analyzed for cardiac MIBG imaging were the heart-to-mediastinum ratio (H/M) on the delayed planar image and the cardiac washout rate. RESULTS: Cardiac death was observed in 9 of 103 patients (9%) with a GFR > or = 60 ml/min/1.73 m2 and in 6 of 32 patients (19%) with a GFR < 60 ml/min/1.73 m2. The mortality ratio tended to be higher in patients with a GFR < 60 ml/min/1.73 m2 than in patients with a GFR > or = 60 ml/min/1.73 m2 (p = 0.10 with Kaplan-Meier survival curves). In patients with a GFR > or = 60 ml/min/1.73 m2, Cox regression analysis showed that a delayed H/M < 146% was the most powerful predictor for cardiac death (Hazard ratio: 6.9, p = 0.014). However, in patients with a GFR < 60 ml/min/1.73 m2, the utility of cardiac MIBG imaging could not be proved. CONCLUSIONS: A delayed H/M is a powerful predictor of cardiac death if the GFR is 60 ml/min/1.73 m2 or more. 相似文献
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Accuracy of plasma sample methods for determination of glomerular filtration rate with<Superscript>99m</Superscript>Tc-DTPA 总被引:3,自引:0,他引:3
The plasma sample method following a single injection of radioactive markers has been proved to be simple and accurate for the determination of glomerular filtration rate (GFR) in clinical practice. The aim of this study was to assess clinical accuracy of single-, two- and multi-sample methods. METHODS: The study was performed on 50 patients with various degrees of renal dysfunction (29 males and 21 females; aged 27 to 90 years). As a reference the true GFR (GFRt) was determined by means of the two-compartment model curve fitting 10 plasma samples following a single-injection of 99mTc-DTPA. The GFRt was compared to the GFR estimated by the Christensen and Groth's single-sample (GFRcg), two-sample (GFR2s) and multi-sample (GFRm) between 75 and 300 min after the injection. The GFRs by two- and multi-sample methods were determined with the slope and intercept algorithm and its overestimation was corrected by Brochner-Mortensen's formula. RESULTS: In 49 patients with GFR between 12 and 169 ml/min/1.73 m2, the standard deviation of difference (95% limits of agreement) between GFRt and GFRcg at 180 min was 6.513 ml/min/l73 m2 (-16.5 approximately 9.5 ml/min/1.73 m2), which was somewhat closer than 7.311 ml/min/1.73 m2 (-12.5 approximately 16.5 ml/min/1.73 m2) in GFR2s in slow clearance phase at 120 min and 240 min. However, the single-sample method tended to show some scattering in GFR below 30 and above 140 ml/min/ 1.73 m2. On the contrary, the 2-sample method tended to be scattered in GFR above 120 ml/min/ 1.73 m2. CONCLUSION: In view of its accuracy and technical simplicity, the single-sample method is first choice in a routine practice. The two-sample method is essential of choice for a patient in whom the GFR is expected to be below 30 ml/min/1.73 mi2. These two methods may be chosen selectively in dependence on the preserved renal function which is expected at time of the test. 相似文献
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The renal images recorded during 1 to 2 1/2 min postinjection in 99Tcm-DTPA gamma camera renography were used for determination of the total cleared renal fraction (TCRF) of cardiac output with respect to the radioactive indicator. The left and right cleared renal fractions of cardiac output were determined directly, i.e., assessment of single-kidney uptake function within a few minutes postinjection was also possible. TCRF was proportional to the glomerular filtration rate (GFR) determined by the 51Cr-EDTA plasma clearance in a group of 23 subjects with GFR in the interval 15 to 130 ml/min/1.73 m2. The slope of the regression line of TCRF against GFR was in agreement with the theoretical estimate for it. GFR could be predicted from TCRF with a standard error of estimate from 4 to 15 ml/min/1.73 m2 for values of GFR in the above interval. Intra-observer variability of TCRF was unbiased and varied between 4% (normal GFR) and 9% (decreased GFR). TCRF is proposed to represent an alternative to renal clearance for evaluation of renal uptake function. 相似文献