IgA肾病临床表现与病理特点分析

目的探讨IgA肾病患者临床表现、病理特点及其相关性。方法回顾性总结我院肾内科2006年8月至2009年7月期间经肾活检明确诊断为原发性IgA肾病34例,对临床表现与病理特点进行分析。结果 34例IgA肾病临床表现以血尿合并蛋白尿最多见,16例（47%）。其次为单纯血尿,9例（26.5%）。肾小球病理改变以Ⅱ、Ⅲ、Ⅳ级为主。结论 IgA肾病的临床病理表现多样化并具有一定特点,其病理和临床表现及肾功能变化有密切关系。     

363例IgA肾病气阴两虚证临床和病理特点

目的观察IgA肾病气阴两虚证的临床及病理特点。方法对363例IgA肾病气阴两虚证患者的临床资料进行横断面调查．分析其发病情况及病理分布特点等。结果20～39岁年龄段所占的比例最大（63．6％），分别有35．0％和36．6％的患者有慢性咽炎、慢性扁桃体炎病史，尿检特点以血尿伴蛋白尿为主（占78．3％），病理类型以系膜增生性肾小球肾炎者最多，为182例（50．1％）。结论IgA肾病气阴两虚证多发于中青年，上呼吸道感染在其发病中占有重要地位，临床以血尿伴蛋白尿多见，其病理类型以系膜增生性肾小球肾炎最多，分级以Ⅲ级居多。     

50例小儿IgA肾病临床与病理分析

目的分析整理儿童IgA肾病的临床表现、实验室检查、病理分级和随访，探讨小儿IgA肾病的特点。方法测定血清IgG、IgA、IgM、C3、C4、抗“O”，BUN，Scr，Ccr，CysC，MALB，TRF，α1M，NAG酶，乙肝抗原；尿红细胞位相镜检。B超引导下TRU—CUT针经皮肾活检，肾组织分送免疫荧光、光镜和电镜检查，病理分级按Meadow标准分Ⅰ-Ⅴ级。结果50例IgA肾病占同期肾活检原发性肾小球疾病的26．4％，以单纯性血尿为主（76％），肾病综合征（15．4％），有4例以持续肉眼血尿1-1．5个月起病。病理改变以轻、中度系膜增生为主（93．1％）。对31例进行平均4年随访，60％已临床痊愈，无慢性肾功能不全者。结论儿童IgA肾病多以血尿为主，病理类型较轻，预后较好。     

儿童IgA肾病临床与病理的关系

目的：探讨儿童IgA肾病(IgA nephropathy)临床特点、预后及其与病理的关系。方法：对肾活检病理诊断为IgA肾病52例儿童病例进行临床与病理分析。结果：本组儿童IgA肾病发生率占同期肾活检的13．6％，男性多于女性，临床表现以单纯血尿最常见，其次为蛋白尿伴血尿、肾病综合征，肾功能不全、高血压少见。蛋白尿伴或不伴血尿较单纯血尿光镜下病理改变严重，且免疫球蛋白的沉积以复合型为主，IgM沉积的比率高。结论：儿童IgA肾病临床特征与病理有一定的关系，单纯血尿者病理改变轻微，预后良好，蛋白尿者病理改变严重，应加强随访。     

血尿和轻度蛋白尿IgA肾病临床病理分析

目的探讨临床表现轻微IgA肾病患者病理特点。方法对68例临床表现轻微的IgA肾病（单纯血尿和/或伴有少量蛋白尿≤1.0g/d），血压、肾功能均正常，不伴水肿。进行Hass病理分级。结果①临床特点：33例（48.5%）患者同时存在血尿和蛋白尿，29例（42.6%）为单纯血尿，6例（8.8%）为单纯蛋白尿；②病理特点：23例（33.8%）病理损伤偏重，Hass分级Ⅱ-Ⅳ级。有蛋白尿者病理损伤偏重（HassⅡ级以上）。结论相当一部分临床表现轻微的IgA肾病患者病理偏重，蛋白尿和病理损伤明显相关，IgA肾病患者提倡早期肾穿早期诊断。     

单纯镜下血尿肾活检病理分析及诊治对策

目的探讨单纯镜下血尿的临床与病理关系，了解其早期肾功能变化。方法47例临床诊断为单纯镜下血尿的患者均行肾组织活检术，肾组织行光镜、免疫组化及电镜检查；同时查肝肾功、血脂、尿蛋白定量、肾功放免、自身抗体、乙肝系列等。患者为我院近三年临床呈单纯镜下血尿行肾活检的患者，肾功能和血压正常。结果肾脏病理改变以轻度系膜增生性肾炎（MsPGN19例）及IgA肾病（IgAN 17例）为主，分别占40．4％、36．1％，肾小球轻微病变5例（占10．6％），余为局灶增生性肾炎（FPGN）、局灶节段肾小球硬化症（FSGS）、IgM肾病、薄基底膜肾小球病。结论单纯镜下血尿其病理类型多样，但以MsPGN及IgAN为主，对于单纯性血尿，肾活检有重要价值。对这一部分单纯镜下血尿临床表现轻微的病人，其中一部分人肾脏病理损伤偏重。因此对临床表现为单纯镜下血尿的患者，也应进行肾活检，有助于发现病理损伤偏重的患者，并根据临床病理诊断制定相应的治疗对策。     

102例IgA肾病临床与病理特征相关分析

目的研究IgA肾病患者的临床表现及病理类型两者之间的关系，进一步评价肾活检在肾脏病诊治中的作用及临床意义。方法对300例有肾穿刺活检适应症的患者行B超介导下肾活栓，并作光镜、免疫组化检查，对其中确诊为IgA肾病者作病理及临床特点分析。结果102例IgA肾病患者临床表现为肾病综合征者21侧，急性肾小球肾炎者3例，血尿者12例，隐匿性肾小球肾炎者27例，慢性肾小球肾炎者37例，妊娠合并慢性肾小球肾炎者1例，肾病综合征伴急性肾功能不全者1例。而病理类型轻微病变型为18例（17．65％）；系膜增殖型为19例（18．63％）；系膜增殖型伴局灶节段性硬化为31例（30．39％）；增生硬化型为9例（8．82％），FSGS型为13例（12．75％）。结论IgA肾病临床表现的严重程度与病理表现的严重程度并不一定相符，肾活栓对明确肾脏疾病的病理类型，确定有效的治疗方案及评估预后均有十分重要的意义。     

IgA肾病诊疗进展

IgA肾病（IgA nephropathy）于1968年由Berger和Hin-glais首先提出，故又称Berger病。其特点是肾组织免疫病理检查在系膜区以IgA为主，也可伴IgG、IgM及C3沉积，其临床表现以血尿最常见，但有多种类型。IgA肾病是一组在小儿中较常见的原发性肾小球疾病，近年来发病率有上升趋势。因部分仅有血尿和（或）蛋白尿的患儿未做肾活检确诊，故其确切发病率不详。我国33家医院儿科报道1995-2004年诊断14岁以内IgA肾病患儿1349例，占同期泌尿系统疾病住院患儿的1．37％，占肾穿刺活检患儿的11．18％。     

62例儿童IgA肾病的临床表现与病理分析

目的探讨儿童IgA肾病的临床与病理特点。方法2000～2006年重庆医科大学附属儿童医院62例经活栓确认为IgA肾病患儿的临床表现，肾活检病理及相关实验室检查进行分析。结果62例中孤立血尿12例，肾病综合征15例，急性肾炎15例，血尿合并蛋白尿16例，单纯蛋白尿2例，慢性肾炎2例。病理分级Ⅰ级和Ⅴ级各2例，Ⅲ级36例，Ⅱ级9例，Ⅳ级13例。结论儿童IgA肾病临床表现多样，以血尿合并蛋白尿多见。病理表现以系膜增生为多见．病理程度与尿蛋白程度有关。     

50例IgA肾病临床及病理分析

目的探讨IgA肾病（IgAN）患者临床与病理类型间的关系及大量蛋白尿对肾功能的影响。方法50例经皮肾穿刺活检确诊为IgA肾病的病人，根据24h尿蛋白定量是否大于3g分为大量蛋白尿组与非大量蛋白尿两组，进行临床特点、病理等资料的回顾性分析。结果IgA肾病以血尿并发蛋白尿最多见，占92％，伴发高血压占48％，伴发急性肾功能不全26％，慢性肾功能不全各占30％．病理分级高，提示肾损害严重，预后不良。大量蛋白尿组的血肌酐显著高于非大量蛋白尿组。结论大量蛋白尿可能是促进IgA肾病的肾功能损害进展的独立因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.