联机血液透析滤过治疗尿毒症的临床应用研究

目的：探讨联机血液透析滤过（On-line hemodiafiltration,On-line HDF)对尿毒症患不同分子量物质的清除率、患耐受性及临床疗效。方法：回顾性分析18例伴有血透并发症及不适症状的尿毒症患行后稀释法On-line HDF 231例次，并与23例仍行常规血液透析（HD）治疗的患（887例次）进行比较，观察Kt/V，血清肌酐（Scr)、尿素氮（BUN）、血磷（SP）、β2－微球蛋白（β2－M）下降率及治疗中患血透常见并发症和不良反应发生率。结果：患对联机HDF治疗效果和耐受性显优于HD，透析并发症和不适症状发生率显低于HD（P＜0．01），联机HDF治疗后血清Scr、BUN、SP、β2－M水平显降低，KT／V明显增高。结论：后稀释法联机HDF能有效清除尿毒症患血中大、中、小分子物质，透析效果显提高，患对该法治疗的耐受性明显提高，适用于易出现血透并发症及不适症状的尿毒症患。     

内皮素和降钙素基因相关肽在慢性肾小球疾病中的作用

目的：通过观察慢性肾小球疾病患血尿内皮素（ET）和降钙素基因相关肽（CGRP）水平的变化，探讨ET和CGRP在慢性肾小球疾病的病理过程中的作用。方法：采用放免法测定了25例原发性肾病综合征（PNS），2例慢性肾小球肾炎（CGN），34例慢性肾衰竭（CRF）患和19例健康查体血，尿ET和CGRP的水平。结果：（1）血浆和尿的ET水平：PNS，CGN和CRF组 高于正常对照组（P＜0．05，P＜0．01）；（2）血浆和尿的CGRP水平，PNS，CGN和CRF组均低于正常对照组（P＜0．05，P＜01）。结论：慢性肾小球疾病患血尿ET水平明显升高，而血尿CGRP水平明显下降，提示血尿ET的升高和CGRP的下和可能在促进慢性肾小球疾病的病情发展中具有重要作用。     

先天性心脏病肺动脉高压病儿血浆ET、CGRP水平及临床意义

血浆内皮素(ET)具有强烈而持久的血管收缩作用，降钙素基因相关肽(CGRP)是体内最强的舒血管物质之一，两者相互拮抗参与了血管张力的调节。为研究血浆ET、CGRP水平与先天性心脏病(先心病)肺动脉高压的相关关系及调控作用，我们随机选择了33例先心病伴有不同程度肺动脉高压病儿，观察其血浆ET、CGRP水平。     

血液透析联合结肠透析对尿毒症患者Hcy、IS、PCS的影响

目的:探讨血液透析(hemodialysis,HD)联合结肠透析(colon dialysis,CD)对尿毒症患者心血管疾病(cardiovascular disease,CVD)相关蛋白同型半胱氨酸(Hcy)、硫酸吲哚酚(IS)、硫酸对甲酚(PCS)的影响。方法:入选尿毒症维持性血液透析患者50例,其中单纯性血液透析组(HD组)25例,血液透析联合结肠透析组(HD+CD组)25例;HD组每周3次血透,每次4 h,HD+CD组在HD组基础上加用每周2次,每次1 h的结肠透析;总疗程为12周。分别检测两组患者治疗前及治疗后BUN、Scr、UA、Hcy、IS、PCS等变化。结果:HD组治疗前后BUN、Scr、UA、Hcy、IS、PCS差异无统计学意义(P0.05)。HD+CD组透析前后BUN、Scr、UA差异无统计学意义(P0.05),Hcy、IS、PCS明显下降(P0.05);HD+CD组较HD组治疗后Hcy、IS、PCS水平显著降低(P0.05)。结论:HD联合CD能够减轻尿毒症患者CVD相关蛋白Hcy、IS、PCS水平,为尿毒症患者清除此类毒素提供了新的治疗方法。     

肢体负压对动脉闭塞犬血浆内皮素和降钙素基因相关肽的影响

目的观察肢体负压(LNP)对肢体动脉闭塞犬血浆内皮素(ET)和降钙素基因相关肽(CGRP)的影响,以探讨肢体负压的作用机理.方法犬15只,分治疗组10只和对照组5只,采用切断左后肢股动脉分支,动脉腔内置入螺旋状金属丝的方法,制作肢体动脉闭塞模型.2周后,治疗组行患肢负压治疗,连续10 d;对照组不做负压治疗.于模型制作前、制作后2周及负压治疗10 d时,用放射免疫分析法检测患肢股静脉血浆ET及CGRP水平.结果治疗组经负压治疗后,血浆ET水平显著低于治疗前(P<0.01),血浆CGRP水平显著高于治疗前(P<0.01),两者呈负相关;而对照组无明显变化(P>0.05).结论肢体负压可显著降低肢体动脉闭塞犬的血浆ET水平,提高CGRP水平.     

血液透析联合结肠透析治疗尿毒症患者高磷血症的临床研究

目的:了解血液透析(HD)联合结肠透析(CD)治疗尿毒症患者高磷血症的疗效,为血透患者控制高磷血症提供新的治疗方法。方法:入选维持性血液透析(MHD)伴高磷血症患者60例,随机分为单纯性血液透析组(HD组)30例,血液透析联合结肠透析组(HD+CD组)30例;HD组维持每周3次血透,每次4 h,HD+CD组在HD组基础上加用每周3次,每次1 h的结肠透析。总疗程为12周。观察治疗前后两组患者食欲、皮肤瘙痒及骨痛临床症状的改善情况。分别检测两组患者治疗前及治疗后肾功能、KT/V、血钙(Ca~(2+))、血磷(P~(3-))、血清全段甲状旁腺激素(iPTH)、1,25二羟维生素D[1,25(OH)_2D_3]及成纤维细胞生长因子-23(FGF-23)。结果:治疗后,HD+CD组较HD组食欲、皮肤瘙痒及骨痛的临床症状改善显著(P0.05)。HD组治疗前后肾功能、KT/V、Ca~(2+)、P~(3-)、1,25(OH)_2D_3及FGF-23差异无统计学意义(P0.05)。HD+CD组透析前后Ca~(2+)及1,25(OH)_2D_3差异无统计学意义(P0.05),但P~(3-)、iPTH及FGF-23有明显下降(P0.05);HD+CD组较HD组治疗后P~(3-)、iPTH、FGF-23水平显著降低,差异有统计学意义(P0.05)。结论:对于尿毒症伴高磷血症患者,结肠透析可有效改善患者高磷血症。     

血液灌流对维持性血液透析难治性高血压患者治疗效果的临床观察

目的观察血液灌流对维持性血液透析患者难治性高血压的疗效并探讨其可能机制。方法选取68例维持性血液透析难治性高血压患者，随机分为治疗组（34例）与对照组（34例）。对照组应用常规治疗和血液透析，治疗组在常规治疗基础上加用血液灌流治疗。结果治疗组控制血压的程度明显优于对照组，治疗组与对照组治疗后血清内皮素和同型半胱氨酸的表达均下降，但是治疗组下降值明显高于对照组。结论在常规治疗基础上应用血液透析和血液灌流，能较好的纠正维持性血液透析患者的难治性高血压，其治疗作用可能与血液灌流清除血浆中内皮素和同型半胱氨酸有关。     

高通量血液透析对维持性透析患者生活质量的影响

目的:探讨血液透析对慢性维持性血液透析患者生活质量的影响.方法:选择39例长期血液透析的终末期肾衰竭患者,高通量组19例,常规透析组20例,分别测定两组患者研究开始第1次治疗前、后治疗2周和12个月时透析前血清β2-MG浓度,同时观察生活质量.结果:两种透析方式清除小分子毒素BUN、Cr无差异,但治疗12个月后H-HD清除中大分子尿毒物质,如β2-MG的能力较CHD提高;H-HD组患者血清白蛋白、血Hb水平明显高于HD组;高通量透析能够明显减少感染发生,改善长期血液透析患者的营养状况,改善贫血、减轻和缓解关节痛、皮肤瘙痒症状,生活满意度明显优于HD组,均具有统计学差异(P＜0.05).结论:高通量透析能够明显提高长期血液透析患者的生活质量,这与高通量透析有效清除并持续降低患者血清β2-MG浓度有关.     

组合型人工肾在透析患者肾性贫血中的疗效观察

目的:探讨组合型人工肾(HP/HD)在治疗血液透析患者肾性贫血中的临床疗效。方法:将维持性血液透析1年以上的患者60例随机分为普通透析HD组30例,组合型人工肾(HP/HD)组30例。HD组采取维持性HD治疗,每周透析3次,每次透析4h,组合型人工肾(HP/HD)组每周行1次HP/HD,HD治疗2次,时间均4 h。所有患者均在上机治疗前后及6个月后空腹采血,观察两组各项指标的变化。结果:治疗后组合型人工肾(HP/HD)组中大分子量毒素β2-MG、iPTH与HD组比较明显下降,与HD组比较Hb明显升高,有统计学差异(P<0.05)。结论:组合型人工肾(HP/HD)增加了对中大分子量毒素的清除,治疗肾性贫血效果优于普通HD。     

老年患者的血液透析护理探讨

随着透析疗法的不断发展，如何提高老年血液透析(HD)患治疗、护理已成为血液净化工作的重要课题。我们通过血管通路，透析中并发症对老年血透中所遇到的问题进行护理探讨。     

中西医结合治疗动脉粥样硬化闭塞症疗效观察

目的：观察动脉粥样硬化闭塞症（ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓｏｂｌｉｔｅｒａｎｓ,ＡＳＯ）中西医结合疗效,探讨血浆内皮素（ｅｎｄｏｔｈｅｌｉｎｓ,ＥＴ）、一氧化氮（ｎｉｔｒｉｏｘｉｄｅ,ＮＯ）同临床治疗的关系。方法：选择９０例ＡＳＯ患者,采用常用的治疗方法,随机分为中医、西医和中西医结合治疗３组,动态观察治疗过程中的临床表现,同时利用放射免疫测定、亚硝酸盐比色法于治疗前、治疗后１、２、３、４、５个疗程后检测血液ＥＴ、ＮＯ的变化。结果：临床治愈率中西医结合组为４６６７％,中医组为２６６７％,西医组为３３３３％;显著疗效率中西医结合组４３３３％,西医组４０００％,中医组２６６７％。血浆ＥＴ、ＮＯ的改变同ＡＳＯ１～３期存在正相关系,且随ＡＳＯ有效治疗后逐渐恢复,并于临床治愈期接近正常水平。结论：中西医结合治疗ＡＳＯ具有较好的临床疗效,动态观察ＡＳＯ治疗前后ＥＴ、ＮＯ的变化,有助于判断病情轻重,有助于了解疾病进程和效果,具有较大的临床意义。     

冠状动脉旁路术围术期肺动脉血浆内皮素和降钙素基因相关肽的变化及其对肺循环血液动力学的影响

目的：研究冠状动脉旁路术围术期肺动脉血浆内皮素（ET）和降钙素基因相关肽（CGRP）的变化及其对肺循环血液动力学的影响。方法：将30例拟行冠状动脉旁路手术（CABG）病人,按是否合并高血压病分为高血压病组（17例）和非高血压病组（13例）,在围术期抽取肺动脉血用放免法测定ET和CGRP值;同时记录抽血时点病人肺循环血液动力学参数。结果：肺动脉血浆中ET和CGRP水平虽有明显动态变化,但CGRP／ET比值变化无统计学意义,与相应抽血时点肺循环血液动力学参数呈明显负相关（P＜0.05）。结论：在行CABG围术期中,肺动脉血浆中ET和CGRP的变化可能是机体的一种自我保护机制,使CGRP／ET比值稳定在一定范围。     

腰椎间盘突出症患者手术前后血浆内皮素及降钙素基因相关肽的变化

目的　探讨血浆内皮素 (ET)及降钙素基因相关肽 (CGRP)在腰椎间盘突出症(PLID)患者手术前后的变化及其意义。方法　采用放射免疫法检测 40例正常人及 40例患者手术前后的血浆CGRP及ET值。结果　 40例PLID患者术前血浆ET值明显高于正常对照组 ,术后ET值明显低于术前 (P <0 .0 1) ,但患者术后血浆ET值与正常对照组差异无显著性 (P >0 .0 5 )。40例PLID患者术前血浆CGRP值与正常对照组比较差异无显著性 (P >0 .0 5 ) ,40例PLID患者术后疼痛明显改善 ,且其血浆CGRP值明显高于术前及正常对照组 (P <0 .0 1)。正常对照组ET与CGRP无明显相关 ,病组术前ET与CGRP呈正相关 ,而术后两者无明显相关。结论　ET与CGRP共同参与了PLID的发病过程 ,为探讨PLID保守治疗方法提供了依据。     

普鲁卡因静脉麻醉对内皮素及降钙素基因相关肽的影响及其临床意义

目的：探讨普鲁卡因静脉麻醉期间ＥＴ和ＣＧＲＰ的变化及其临床意义。方法：观察１９例腹部择期手术病人在普鲁卡因静脉麻醉下ＥＴ、ＣＧＲＰ及血流动力学的变化。结果：血浆ＥＴ水平在术中明显升高,血浆ＣＧＲＰ水平在术中明显降低,麻醉期间ＣＯ明显降低,而ＳＶＲ则明显升高;相关分析表明,血浆ＥＴ水平与ＣＯ、ＣＧＲＰ水平与ＳＶＲ均呈显著负相关关系。结论：在普鲁卡因静脉麻醉所致的循环抑制中,ＥＴ、ＣＧＲＰ的变化可能具     

Reduction of left ventricular hypertrophy in children undergoing hemodialysis

Left ventricular hypertrophy (LVH) is related to a 1,000-fold increased risk of cardiovascular morbidity and mortality in young adults with end-stage renal disease (ESRD) treated with hemodialysis (HD) or peritoneal dialysis. We report a series of 17 children (5 girls, 12 boys), with a median (range) age of 11 (2–18) years, all treated by HD, who presented with an increased left ventricular mass (LVM) index of 54.8±4.5 g/m^2.7 at onset of HD and reached 36.2±2.6 g/m^2.7 (mean±SEM, P<0.0001) at last follow up. Over the observation period, systolic (P<0.0001) and diastolic (P<0.0001) blood pressure (indexed for height, gender, and age) decreased and hemoglobin (+2.8 g/dL; P<0.0001) increased compared to initial values. Only BP as well as plasma protein level at onset of HD session correlated with LVM in multiple correlation analysis. In conclusion, increased LVM is a common feature in pediatric patients with ESRD. Normalization of BP and reduction of the extracellular volume (represented by plasma protein at onset of HD session) are key points in reducing LVH during HD in children.     

中药内外治疗对糖尿病足0～1级病变临床疗效的观察

目的:观察中药内服、外洗对糖尿病足0～1级病变的影响.方法:共54例,观察肢端症状体征、血液流变学、血流动力学、血浆内皮素、血管多普勒超声等变化,治疗组30例与对照组24例比较.结果:治疗组有效率86.66%,对照组有效率37.50%,有显著差异(P<0.01).治疗组临床症状体征有显著改善(P<0.01),踝臂血压指数略有提高,血液流变学各指标有不同程度的降低,血浆内皮素明显降低,血糖、血脂、糖化血红蛋白两组治疗后均明显降低.下肢血管超声显示股动脉、动脉内膜有明显改善.结论:中药在糖尿病足0～1级病变的治疗中起一定的干预作用,尤其对临床症状有明显的改善.     

Discrepancies in Serum Albumin Measurements Vary by Dialysis Modality

Background.?Serum albumin level is an important prognostic marker in patients with chronic renal failure. However there are discrepancies in the methods of estimation of serum albumin. The objective of this study is to evaluate the magnitude of the discrepancy in the serum albumin levels as measured by Bromcresol Green (BCG) and Bromcresol Purple (BCP) dye methods in patients on hemodialysis (HD) and peritoneal dialysis (PD) and to ascertain the clinical determinants of the discrepancy (ΔSA = BCG-BCP; g/dL) in each of the modalities. Method.?We measured serum and plasma albumin levels by BCG and BCP methods in 19 adult HD patients and 18 adult PD patients treated in the dialysis units of the University of Colorado Health Sciences Center. Similar measurements were performed in 10 normal adult subjects. In all groups, paired blood samples were taken to estimate the albumin in both serum and plasma. Nephelometry (NM) was subsequently performed on the serum of 13 of the HD patients, 14 of the PD patients, and each of the 10 normal subjects. Results.?We found that for both the dye methods serum and plasma albumin levels are almost identical in each of the three subject groups. In the normal subjects serum albumin estimated by BCP is in good agreement with NM values but BCG overestimates the albumin levels. In the PD group the discrepancy between the BCG and BCP (ΔSA) is statistically significant with the BCG averaging 0.59 ± 0.12 g/dL more than the BCP. The BCG values are closer to those obtained by the “gold standard”, NM. In the HD group the ΔSA is significantly (p<0.001) less than in the PD group (0.34 ± 0.11 g/dL). As for PD, BCG values are closer to NM values. Increasing age, female gender, and higher dialysis adequacy are associated with higher ΔSA in the HD but not in the PD group. Utilizing linear regression analysis we developed equations for each dialysis modality to convert albumin measurements from one method to the other. Conclusion.?We confirm that a discrepancy exists between the commonly used dye methods (BCG and BCP) for serum albumin estimation. This discrepancy is significantly lower in HD patients than in PD patients. Nephrologists should be aware of this discrepancy and appropriate corrections should be made during quality improvement analysis.     

乌拉地尔对高血压患者血浆4种神经肽含量的影响

目的 观察乌拉地尔（ＵＲＡ）对高血压患者血浆４种神经肽：内皮素（ＥＴ）、降钙素基因相关肽（ＣＧＲＰ）、神经肽Ｙ（ＮＰＹ）及神经降压素（ＮＴ）水平的影响。方法 选择麻醉前高血压患者２０例。于麻醉诱导前静脉注射ＵＲＡ０．５ｍｇ／ｋｇ。应用放射免疫方法测定ＵＲＡ治疗前后血浆４种神经肽的水平,并以２０例健康者作对照。结果 高血压组血浆ＥＴ、ＮＰＹ水平明显高于正常组（Ｐ〈０．０１）、血浆ＣＧＲＰ、ＮＴ水平明     

通关胶囊治疗前列腺增生症临床观察及机理探讨

目的为了评估中药通关胶囊对良性前列腺增生症(BPH)的疗效和安全性.方法对90例BPH进行了临床观察,治疗组60例给予通关胶囊,对照组30例给予前列康,治疗观察3个月.结果治疗组总有效率为88.3%,明显优于对照组,经统计学处理P＜0.05.不良反应的发生率为3%.结论认为通关胶囊治疗BPH疗效肯定,副作用少.     

Brain Natriuretic Peptide and Its Relationship to Left Ventricular Hypertrophy in Patients on Peritoneal Dialysis or Hemodialysis Less Than 3 Years

An increase of brain natriuretic peptide (BNP) levels is commonly observed in patients on dialysis. Increased circulating levels of BNP are related to future cardiac events and associated with shorter survival in patients on chronic hemodialysis (HD). During the first 1 or 2 years on dialysis, patients on peritoneal dialysis (PD) have been shown to have an improvement in left ventricular hypertrophy, blood pressure, and volume status. This study compares BNP levels and cardiac status of PD and HD patients without cardiovascular disease and on dialysis for less than 36 months. The correlation between plasma BNP concentration and findings of echocardiography before HD scans were examined and compared with findings of PD. Twenty-two HD patients (15 men, 7 women; mean age, 52.5 ± 13.9 years) and 19 PD patients (10 men, 9 women; mean age, 47.6 ± 11.3 years) were studied. There were no significant differences between HD and PD patients with regard to age, gender, duration of dialysis, left ventricular mass, left ventricular mass index (p > 0.05). Plasma BNP levels were markedly greater in HD patients (467.8 ± 466.5 pg/mL) than those of PD patients (143.1 ± 165.2 pg/mL). Urine output was significantly higher in PD patients compared with HD patients (p < 0.05). A positive correlation between systolic blood pressure, diastolic blood pressure, and plasma BNP in HD patients (r: 0.653, p: 0.001; r: 0.493, p: 0.023, respectively) was detected. Additional studies are needed to investigate whether lower BNP level in PD patients is an advantage.