TGM2在过敏性紫癜肾损伤中的意义

目的探讨转谷氨酰胺酶2C多肽(TGM2)在过敏性紫癜(HSP)肾损伤中的表达及其临床意义。方法采用实时荧光定量PCR检测HSP患儿(HSP组,20例)、HSPN患儿[HSPN组,20例,其中HSPN(Ⅱ,ISKD)4例,HSPN(Ⅲ,ISKD)12例,HSPN(Ⅳ,ISKD)4例]和健康对照组20例外周血有核细胞TGM2mRNA的表达;应用免疫组织化学的方法检测HSPN组患儿和对照组(5例)肾组织TGM2蛋白的表达。结果 HSPN组外周血TGM2mRNA表达高于健康对照组和HSP组(P<0.05),健康对照组和HSP组外周血TGM2mRNA表达水平比较差异无统计学意义(P>0.05)。HSPN组和对照组肾组织的表达差异有统计学意义(P<0.01),且TGM2的表达水平与HSPN病理分级严重程度有关联,即病理分级越重,TGM2的表达越强(P<0.001)。结论 TGM2的表达与HSP肾脏损害有关,且与肾脏损害病理程度有关,TGM2可能参与了HSPN的发病机制。     

初诊过敏性紫癜患儿血清25羟维生素D水平变化及临床意义

目的 分析初诊过敏性紫癜(HSP)患儿急性期25羟维生素D[25(OH)D]水平变化及与免疫球蛋白(Ig)水平、肾脏病理学改变的关系,探讨其临床价值.方法 选取2019年1月至2020年1月安徽医科大学第一附属医院初诊的190例HSP患儿,其中紫癜性肾炎(HSPN)患儿79例,46例HSPN患儿行肾穿刺术(HSPN肾穿组);非HSPN患儿111例,包括皮肤型19例,关节型34例,腹型25例,混合型33例.将同期于门诊接受健康体检且测25(OH)D的40名儿童纳入对照组.分析多组或两组间25(OH)D水平差异,采用Pearson检验分析HSP和HSPN肾穿组患儿的25(OH)D水平与免疫球蛋白、补体等的关系.结果 在25(OH)D水平上,相较于对照组,HSPN组与非HSPN组皆偏低(P<0.05);而HSPN组和非HSPN组间、非HSPN不同亚型间及4个季节分组的组间25(OH)D水平差异均无统计学意义(P>0.05);HSPN肾穿组25(OH)D水平在不同肾脏病理分级及免疫复合物沉积类型间差异均无统计学意义(P>0.05).HSP患儿25(OH)D与IgA水平呈负相关(r=-0.353,P<0.05),与IgG、IgE和补体C3无相关关系(P>0.05).在HSPN肾穿患儿中25(OH)D与IgA水平也呈负相关(r=-0.414,P<0.05),与IgG、IgE、C3无相关关系(P>0.05).结论 维生素D不足与儿童HSP的发生有关,可能是通过调节体液免疫诱发HSP发生,但不能区分HSP发生时脏器受累情况.     

紫癜性肾炎患儿肾组织podocalyxin 的表达及其与尿足细胞数的相关分析

目的：分析肾脏足细胞特异蛋白podocalyxin(PCX) 的表达和尿足细胞数在紫癜性肾炎(Henoch-Schönlein purpura nephritis,HSPN) 病理进展过程中的变化。方法：56 例HSPN 患儿为病例组,根据肾脏病理改变分为4 组：HSPN II (IIa+IIb) 级组(n=10),III (IIIa+IIIb) 级组(n=21),Ⅳ级组(n=16) 和Ⅴ级组(n=9);另取非肾脏疾病死亡病例尸检切取的肾脏标本4 例作为正常肾组织对照组;同时收集8 例健康儿童的晨尿作正常尿液对照组。应用免疫荧光方法检测PCX 在4 例正常肾组织及56 例HSPN 肾组织中的表达,并对其结果进行定量分析;同时检测8 例健康儿童及56 例HSPN 患儿尿足细胞阳性的发生率和尿足细胞数。结果：在正常对照组和HSPN II (IIa+IIb) 级组的肾组织中,PCX 表达完整,2 组之间肾组织PCX 阳性面积占肾小球面积的百分比差异无统计学意义(P>0.05);在HSPN III(IIIa+IIIb) 级﹑Ⅳ级和Ⅴ级组的肾组织中,PCX 表达均有不同程度缺失,从III (IIIa+IIIb)~V 级其表达依次下降,各组间比较差异有统计学意义(P<0.01);病理分级在III (IIIa+IIIb)级以上的HSPN,尿中有PCX 的阳性表达,提示尿中有足细胞存在;肾组织PCX 荧光阳性面积占肾小球的百分比与尿中足细胞数呈负相关(r=-0.637,P<0.01)。结论：足细胞损伤在儿童HSPN 病理进展中发挥一定作用;可以在一定程度上反映HSPN 的病理损伤程度。     

过敏性紫癜患儿基质金属蛋白酶-9水平的变化及临床意义

目的 通过检测过敏性紫癜(HSP)和紫癜性肾炎(HSPN)患儿血清和尿液中基质金属蛋白酶-9(MMP-9)水平及部分自身抗体指标,探索它们与HSP病变程度的关系.方法 收集20例HSP(HSP组)、15例HSPN患儿(HSPN组)以及20例健康儿童(对照组)的血清和尿液,ELISA检测血清和尿液中MMP-9水平,间接免疫荧光法检测血清抗核抗体(ANA)和抗中性粒细胞胞浆抗体(ANCA),免疫斑点法检测抗可提取性核抗原抗体谱.结果 (1)HSPN组血清MMP-9为(469.82±38.34)ng/mL,显著高于HSP组的(244.71±88.23)ng/mL和对照组的(50.81±24.91)ng/mL,HSPN组尿液MMP-9为(76.46±24.25)ng/mL 也显著高于HSP组的(27.03±8.85)ng/mL和对照组的(6.32±3.20)ng/mL,差异均有统计学意义(均P<0.01).(2) 35例患儿,ANA阳性1例,ANCA阳性1例(pANCA阳性),抗可提取性核抗原抗体谱(nRNP、Sm、JO-1、SS-A、SS-B、scl-70)均为阴性.结论 HSPN患儿血清及尿液中MMP-9水平均显著高于HSP患儿和健康儿童,提示MMP-9不仅参与HSPN的发生发展过程,且可能与肾损害有关.HSP患者ANA、ANCA等自身抗体检测的临床意义有待进一步评估.     

过敏性紫癜患儿血浆血管内皮细胞生长因子水平的变化

目的:探讨内皮细胞生长因子在过敏性紫癜(HSP)患儿血浆的水平变化及其临床意义。方法:采用双抗体ELISA方法,检测56例确诊为HSP患儿(其中24例并肾脏损伤)及42例健康儿童血清内皮生长因子水平,比较有和无合并肾脏损害HSP患儿及HSP患儿与健康儿童血浆血管内皮生长因子水平。结果:(1)HSP患儿血浆内皮细胞生长因子明显高于健康对照组(P<0.01);(2)无肾脏损伤HSP与紫癜性肾炎(HSPN)组血浆内皮生长因子无统计学差异(P>0.05)。结论:血浆内皮细胞生长因子可能直接或间接参与HSP/HSPN发病过程。     

紫癜性肾炎患儿肾组织podocalyxin的表达及其与尿足细胞数的相关分析(英文)

目的:分析肾脏足细胞特异蛋白podocalyxin(PCX)的表达和尿足细胞数在紫癜性肾炎(Henoch-Schnlein purpura nephritis,HSPN)病理进展过程中的变化。方法:56例HSPN患儿为病例组,根据肾脏病理改变分为4组:HSPN Ⅱ(Ⅱa+Ⅱb)级组(n=10),Ⅲ(Ⅲa+Ⅲb)级组(n=21),Ⅳ级组(n=16)和Ⅴ级组(n=9);另取非肾脏疾病死亡病例尸检切取的肾脏标本4例作为正常肾组织对照组;同时收集8例健康儿童的晨尿作正常尿液对照组。应用免疫荧光方法检测PCX在4例正常肾组织及56例HSPN肾组织中的表达,并对其结果进行定量分析;同时检测8例健康儿童及56例HSPN患儿尿足细胞阳性的发生率和尿足细胞数。结果:在正常对照组和HSPN Ⅱ(Ⅱa+Ⅱb)级组的肾组织中,PCX表达完整,2组之间肾组织PCX阳性面积占肾小球面积的百分比差异无统计学意义(P>0.05);在HSPN Ⅲ(Ⅲa+Ⅲb)级﹑Ⅳ级和Ⅴ级组的肾组织中,PCX表达均有不同程度缺失,从Ⅲ(Ⅲa+Ⅲb)~Ⅴ级其表达依次下降,各组间比较差异有统计学意义(P<0.01);病理分级在Ⅲ(Ⅲa+Ⅲb)级以上的HSPN,尿中有PCX的阳性表达,提示尿中有足细胞存在;肾组织PCX荧光阳性面积占肾小球的百分比与尿中足细胞数呈负相关(r=-0.637,P<0.01)。结论:足细胞损伤在儿童HSPN病理进展中发挥一定作用;可以在一定程度上反映HSPN的病理损伤程度。     

过敏性紫癜性肾炎患儿血清总IgE及嗜酸性阳离子蛋白检测的临床意义

目的探讨过敏性紫癜性肾炎患儿血清中的总IgE及嗜酸性阳离子蛋白(ECP)的变化及临床意义。方法 50例急性期过敏性紫癜患儿中无肾损害HSP组患儿26例,HSPN患儿共24例,另选同期来我院进行健康体检的30例健康儿童作为正常对照组,应用酶联免疫荧光法检测各组血清总IgE和ECP浓度的变化情况。结果①HSP急性期HSPN组的血清总IgE、ECP均分别明显高于无肾损害组及健康对照组(P<0.05或P<0.01),且无肾损害组的血清总IgE、ECP分别明显高于健康对照组(P<0.01)。②HSP恢复期HSPN组的血清总IgE、ECP均分别明显高于无肾损害组及健康对照组(P<0.05)。③HSP急性期血清ECP与血清IgE二者间呈明显正相关(r=0.68,P<0.05)。结论血清总IgE和ECP协同,均参与了过敏性紫癜及肾损害的发生、发展过程,可以作为临床诊断及判断HSP及HSPN病情进展程度的有效监测指标之一。     

儿童紫癜性肾炎肾组织VCAM-1的表达及其意义

目的：探讨紫癜性肾炎（HSPN）患儿肾活检组织血管细胞黏附分子-1（VCAM-1）的表达情况及其意义。方法：应用免疫组化技术检测8例HSPN和7例薄基底膜病（对照组）通过肾穿刺活检术获得的肾组织VCAM-1表达情况（用IOD值表示）,分析其与肾脏病理、主要临床指标（包括24h尿蛋白、尿红细胞）的关系。结果：对照组的肾组织仅少量表达VCAM-1;HSPN患儿的肾小管、肾间质及肾小球中VCAM-1表达均增加,以小管间质部位为著,并随ISKDC肾病理级别的增加而增强;平均肾组织VCAM-1表达的IOD值在Ⅲ-Ⅳ级组为（6.54±2.02）×105,在Ⅰ-Ⅱ级组为（2.45±0.07）×105,对照组为（0.76±0.12）×105,Ⅲ-Ⅳ级组与Ⅰ-Ⅱ级组均明显高于对照组（均P＆lt;0.01）,且Ⅲ-Ⅳ级组高于Ⅰ-Ⅱ级组（P＆lt;0.05）。HSPN患儿的肾组织VCAM-1表达的IOD值与其ISKDC肾病理分级呈显著正相关（r=0.866,P＆lt;0.01）,与IgA和C3沉积量均无显著性相关（r分别为0.339、-0.436,均P＆gt;0.05）,与24h尿蛋白量呈显著正相关（r=0.755,P＆lt;0.05）,而与尿沉渣红细胞量无显著性相关（,分别为0．339、-0．436,均P〉0．05）,与24h尿蛋白量呈显著正相关（r=O．755,P〈0．05）,而与尿沉渣红细胞量无显著性相关（r=0．626,P〉0．05）。结论：VCAM-1参与了HSPN的发生、发展过程,其肾组织的VCAM-1表达可反映其病情的严重程度。     

过敏性紫癜患儿血浆中血栓调节蛋白水平的测定及意义

目的探讨过敏性紫癜（HSP）患儿血浆血栓蛋白（TM）水平的变化及意义。方法采用ELASA法测定42例确诊为HSP的惠儿急性期、恢复期及不同临床表现者（合并肾损害组与无肾损害组）的血浆TM水平。并与40例健康对照儿童进行比较。结果HSP患儿血浆TM水平在急性期为（7．49±1．95）μg／L、恢复期为（3．99±1．16）μg/L,均明显高于正常对照组（2．86±0．59）μg/L;急性期又明显高于恢复期。差异均有统计学意义（g值分别为15．38、18．63、4．50,P〈0．01）。急性期紫癜性肾炎患儿血浆TM水平较未合并肾脏损害的过敏性紫癜患儿升高更明显[（9．15±2．14）μg/L VS（6．65±1．19）μg/L]（t=4．077,P〈0．05）。结论血浆TM水平在HSP患儿急性期、尤其有肾脏损害时明显升高;血浆TM可能参与HSP血管内皮细胞受损的病理过程;动态检测血浆TM水平有助于观察病情、判断预后及指导治疗。     

过敏性紫癜性肾炎患儿血清异常糖基化免疫球蛋白A1水平变化

目的探讨异常糖基化免疫球蛋白(Ig)A1与儿童过敏性紫癜性肾炎(HSPN)的关系。方法选择2013年3月至2014年5月在襄阳市第一人民医院接受治疗的过敏性紫癜(HSP)患儿40例(HSP组)和HSPN患儿20例(HSPN组),另选取同期体检健康儿童40例作为对照组;对各组儿童血清中炎症及免疫学相关指标进行比较。结果3组儿童血清白细胞、C反应蛋白、补体3、Ig M、Ig G水平比较差异均无统计学意义(P>0.05);HSP组和HSPN组患儿血清Ig A、Ig A1、异常糖基化Ig A1水平显著高于对照组(P<0.05),HSPN组患儿血清Ig A、Ig A1、异常糖基化Ig A1水平显著高于HSP组(P<0.05)。结论 HSPN患儿血清中异常糖基化Ig A1水平显著升高,异常糖基化Ig A1可能与HSPN的发生有关。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.