慢性肾功能衰竭病人的性功能障碍

慢性肾功能衰竭病人性功能障碍十分常见 ,且已成为影响其生活质量的一个重要问题 ,却很少得到关注。其病因包括生理、心理和器质性因素。本文就近年来有关慢性肾功能衰竭病人性功能障碍的发病情况、主要表现形式、评定方法、发病的危险因素和治疗方法等进行了综述。     

慢性肾炎致慢性肾衰竭患者心衰发生相关危险因素分析

目的：了解慢性肾炎致慢性肾衰竭患者血压、血红蛋白、血清白蛋白、血脂、血肌酐、电解质及尿素氮、胱抑素C、同型半胱氨酸及高敏C反应蛋白等指标与心力衰竭发生之间的关系,分析并探讨相关危险因素。方法：回顾性分析我院343例慢性肾炎致慢性肾衰竭患者心衰发生及其同期血压等指标变化情况,了解其规律及相互关系。结果：（1）343例患者有77例合并发生心衰（22．4％）,其中19岁～39岁占20．5％,40岁～59岁占22．8％,〉60岁占33．3％;合并发生心衰多为CKD5期患者（97．4％）。（2）血压、血红蛋白、CO2CP、血肌酐、高敏C反应蛋白在有无心衰发生组存在统计学差异（P〈0．01）,其中血压、血肌酐、光抑素C、高敏C反应蛋白等与心衰发生呈负相关（P〈0．05）,而年龄、钙磷、血清白蛋白及血脂、尿素氮、同型半胱氨酸组间无统计学差异。结论：慢性肾炎致慢性肾衰竭患者心力衰竭发生率很高,其发生可能与高血压、贫血、酸中毒、血肌酐及微炎症状态等因素有关。     

Mononuclear Cell Adenosine Deaminase in Patients with Chronic Renal Failure

Infections are considered as an important complication of uremia. The cause of immunosuppression in patients with renal failure is not exactly localized. Defect in the mononuclear cells with disturbance related to adenosine metabolism was presumed to be an important contributor to immune dysfunction in patients with renal failure. The study was carried out on 30 patients with chronic renal failure on regular hemodialysis (HD) (group 1), 30 patients with chronic renal impairment in predialysis periods (group 2), and 30 healthy control subjects (group 3). The complete medical history of all the patients, with respect to clinical examination, echocardiography, and nerve conduction studies was obtained. The mononuclear cell adenosine (MCAD) level, and mononuclear cell adenosine deaminase (MCADA) activity were measured. The MCAD level was higher in group 1 than in group 2, and was significantly higher in both groups than in the control group. However, the MCADA activity was found to be significantly lower in group 1 than in group 2, and was considerably lower in both groups when compared with the control group. The MCAD was found to be positively correlated to the history of infection and negatively correlated to the ejection fraction in groups 1 and 2. There was a positive correlation between MCAD and the presence of neuropathy in group 1, but not in group 2. The MCADA activity was found to be low in patients with chronic renal failure, which further decreased with HD. This condition may lead to high level of MCAD, which is related to the development of infection, neuropathy, and myocardial depression in those patients.     

Abnormalities of the Peripheral Circulation in Patients with Chronic Renal Failure

Resting forearm venous tone and forearm blood flow at rest andfollowing ischaemia were measured in patients with chronic renalfailure and compared with normal control subjects and patientswith anaemia of non-renal origin. Patients with renal failure were venoconstricted compared tothe normal controls. Venous tone in the anaemic patients withnormal renal function was intermediate between the two othergroups. Resting forearm blood flow was higher in the patientswith renal failure compared to the normal controls but it wasnot significantly different from the patients with anaemia.Forearm blood flow immediately after 10 min of forearm ischaemiawas lower in the patients with renal failure compared with thecontrol subjects. It was highest in the patients with anaemia.These results suggest important abnormalities in the controlof peripheral vascular tone in patients with chronic renal failure.     

慢性肾功能衰竭病人实施心理干预的研讨

对慢性肾功能衰竭病人进行心理干预以改善病人的生活质量。随机将１５６例病人分成观察组和对照组。观察组除常规中西药物治疗外，通过健康教育、自编自导肾病保健功，作放松治疗及心理咨询；对照组常规中西药物治疗。治疗前后两组均用ＳＣＬ－９０量表和慢性肾功能衰竭病人专用生活质量表进行评估。结果表明心理干预后观察组较对照组心理障碍发生率低（Ｐ〈０．０５），并且有较高的生活满意度（Ｐ〈０．０５）。提示对慢性肾功能衰     

The Effects and Pharmacokinetics of rhG-CSF in Patients with Chronic Renal Failure

Abstract: The pharmacokinetics and effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on neutrophils and immunological function were studied in 10 patients wtih end-stage renal failure. A single dose and 2–week consecutive dosing of 50 μ-g/m² of rhG-CSF were drip infused intravenously, and plasma rhG-CSF levels, peripheral blood cell counts, coagulation, and neutrophil and immunological functions were determined during treatment. The mean half-life of rhG-CSF in patients (2.47 ± 0.64 h) was prolonged to about twice that of healthy subjects, and hemodialysis did not affect the pharmacokinetics. A marked increase in neutrophils and a slight increase in lymphocytes were observed with the single and consecutive administration of rhG-CSF, but no significant changes were noted in other leukocyte fractions and erythrocyte and platelet counts. The neutrophil alkaline phosphatase value increased significantly following rhG-CSF administration, and other neutrophil functions were also ameliorated in several patients with neutrophil dysfunction. In consecutive administration, however, mild bone pain and increased serum alkaline phosphatase were observed in about half the patients, but neither accumulation of rhG-CSF nor antibody production was detected. From these results, it is concluded that rhG-CSF is safe and effective for the treatment of neutropenia and neutrophil dysfunction in patients with renal failure.     

Antidepressant Treatment Increases Quality of Life in Patients with Chronic Renal Failure

To evaluate the effect of citalopram treatment on quality of life (QoL) and depression in 141 patients with chronic renal failure (CRF), QoL was measured by means of the Short Form 36 (SF-36). Patients diagnosed with depression were treated with citalopram for eight weeks and evaluated for the effect of treatment on depressive symptoms and QoL. Thirty-four of 141 patients (24.1%) had depression and treatment with citalopram decreased Beck Depression Inventory Scores and increased the emotional role limitation and the mental health subscale scores of SF-36. This study suggests that citalopram can treat depression and improve QoL in patients with CRF.     

Incidence of Demodex Folliculorum in Patients with End Stage Chronic Renal Failure

Background. Demodex folliculorum (DF), found in the pilosebaceous unit, is the most common ectoparasite in humans. It has been implicated in various clinical lesions such as pustular folliculitis, papulopustular scalp eruption, perioral dermatitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). Objective. We aimed to determine DF carriers and location of DF among patients on chronic dialysis because of end stage renal failure (ESRF), to compare them with healthy controls, and to examine the relationship between DF incidence and dialysis method and symptoms. Methods. Sixty-seven patients on dialysis and 67 healthy controls were taken into the study. The patient groups were classified according to the diseases causing ESRF [diabetes mellitus (DM), polycystic disease (PCD), glomerulonephritis (GN), hypertensive nephrosclerosis (HTNS), others (OT), unknown etiology (UE)], and mode of dialysis. Five standardized skin surface biopsies (SSSB) were taken. The determination of five and more living parasites/cm² area was diagnosed as infestation. Results. The mean mite count in the ESRF group, 6.12/cm², was significantly higher than that in controls, 0.31/cm², (Independent Samples Test, p = 0.000). The DF positivity according to primary disease causing ESRF revealed that it was most frequent in DM with 12 patients (44.4%), followed by UE with nine patients (33.4%). Conclusions. Our findings indicate that the DF number is increased in ESRF patients on dialysis treatment. We recommend that demodicidosis should be included in the differential diagnosis of facial eruptions in patients with ESRF.     

黄芪注射液治疗慢性肾衰竭合并心力衰竭的临床疗效

目的:观察黄芪注射液治疗慢性肾衰竭合并心力衰竭的疗效。方法:将60例慢性肾衰合并心力衰竭病人分为两组。对照组30例予西医治疗。治疗组30例在西医治疗基础上加用黄芪注射液30 ml溶入10％G.S 250 ml中静脉滴注,qd连用10 d。结果:治疗组心功能明显改善,总有效率90％,明显高于对照组(P<0.05);治疗组左室射血分数(LVEF)和左室短轴缩短率(ΔD％)均显著提高(P<0.05)。结论:黄芪注射液能明显改善慢性肾衰病人的心功能。     

肾维宁冲剂对慢性肾衰竭患者机体细胞免疫和肾功能的影响

目的:探讨中药肾维宁冲剂对慢性肾衰竭(氮质血症期)患者机体细胞免疫功能和肾功能的影响.方法:将62例慢性肾衰竭(CRF)患者随机分成两组,治疗组32例予肾维宁冲剂,对照组30例予包醛氧淀粉.观察两组治疗前和治疗后3个月CD 3、CD 4、CD 8、CD 4/CD 8、IL-1、IL-2、IL-6和BUN、Scr、Ccr水平的变化.结果:治疗组治疗后CD 3、CD 4、CD 8、CD 4/CD 8、IL-2和Ccr均显著上升(P＜0.05),CD 8、IL-1、IL-6、BUN、Scr则明显下降(P＜0.05).对照组治疗前后对比,仅BUN明显下降(P＜0.05),其余无统计学差异(P＞0.05).结论:肾维宁冲剂具有提高CRF患者CD 3、CD 4、CD 8、CD 4/CD 8、IL-2、Ccr水平,降低CD 8、IL-1、IL-6、BUN、Scr水平的作用.有效地改善患者的细胞免疫功能和肾功能.     

综合护理干预在慢性肾功能衰竭血液透析患者皮肤瘙痒中的应用效果

探讨综合护理干预在慢性肾功能衰竭血液透析患者中的应用及对皮肤瘙痒的改善效果。 方法 选取2021年3月-2023年3月山东大学附属威海市立医院收治的60例慢性肾功能衰竭血液透析患者为 研究对象，随机分为对照组和观察组，各30例。对照组实施常规护理，观察组实施综合护理干预，比较 两组皮肤瘙痒改善效果、肾功能指标、负面情绪及护理满意度。结果 观察组皮肤瘙痒改善总有效率为 96.67%，高于对照组的70.00%，差异有统计学意义（P ＜0.05）；观察组干预后肾功能指标BUN、 Cr水平低于对照组，差异有统计学意义（P ＜0.05）；观察组干预后SAS、SDS评分均低于对照组， 差异有统计学意义（P ＜0.05）；观察组护理满意度为96.67%，高于对照组的73.33%，差异有统计学意 义（P ＜0.05）。结论 综合护理干预在慢性肾功能衰竭血液透析患者中应用效果确切，可减轻患者皮肤瘙 痒状况，缓解负面情绪，改善肾功能，提高护理满意度。     

Protein Intake in Patients with Renal Failure: Comments on the Current NKF-DOQI Guidelines for Nutrition in Chronic Renal Failure

The National Kidney Foundation Clinical Practice Dialysis Outcomes Quality Initiative (DOQI) guidelines recently recommended dietary protein intake for patients with chronic renal failure as follows: predialysis patients should receive 0.60 g/kg/day of protein and increase intake to 0.75 g/kg/day for subjects who cannot follow such a diet. For stable maintenance hemodialysis patients, the recommended protein intake is 1.2 g/kg/day, and for chronic peritoneal dialysis patients, 1.2–1.3 g/kg/day. We differ with these recommendations and believe that a dietary protein intake of 0.8 g/kg/day is appropriate for the predialysis population; an intake of 0.9–1.0 g/kg/day and 1.0–1.1 g/kg/day for maintenance hemodialysis patients and peritoneal dialysis patients, respectively, should be adequate. The rationale and the evidence supporting our arguments are outlined and discussed.     

Mucormycosis in Patients with Renal Failure

Nine fatal cases of systemic mucormycosis observed in association with renal failure are described. Four patients were hospitalized for chronic renal failure as a consequence of chronic glomerulonephritis, myeloma kidney, chronic pyelonephritis, and polycystic kidney disease, respectively; and five patients presented with acute renal failure. The underlying causes in three of these five patients were gentamycin nephrotoxicity, acute gastroenteritis, and allograft rejection, respectively, and in the remaining two, acute renal failure was the result of extensive renal vascular and parenchymal invasion by mucor hyphae. Tissue invasion with mucormycosis was documented during life in two patients and at autopsy in seven patients. The infection was disseminated in five patients, and isolated pulmonary and rhinocerebral involvement occurred in two patients each. Our observations have shown that patients with renal failure are prone to develop mucormycosis, which carries a grave prognosis if therapy is not instituted in time.     

抗纤灵冲剂对慢性肾衰竭肾功能及纤维化指标影响的临床研究

目的 :研究抗纤灵冲剂对慢性肾衰竭 (CRF)患者肾纤维化、肾功能的作用。方法 :观察抗纤灵冲剂对慢性肾衰竭患者的肾功能指标即血清肌酐 (Scr)、尿素氮 (BUN)和纤维化指标即血清层粘连蛋白 (LN)、纤维连结蛋白(FN)、Ⅲ型前胶原 (PC -Ⅲ )、Ⅳ型胶原 (C -Ⅳ )的影响。结果 :与服用包醛氧淀粉的对照组患者比较 ,抗纤灵冲剂有明显的降低慢性肾衰竭患者的血清Scr、BUN、LN、PC -Ⅲ、C -Ⅳ和升高FN的作用 ,二者有统计学意义 (P <0 .0 5 )。结论 :该方能改善肾纤维化、延缓慢性肾衰竭的进程。     

Coronary Artery Bypass Grafting in Patients with Chronic Renal Failure:A Reappraisal

A bstract Background and Aims : Chronic renal failure (CRF) is known to increase the morbidity and mortality in patients undergoing cardiac operations. Successful outcome of coronary artery bypass grafting (CABG) in some patients with CRF has been reported, but remains controversial. Methods : Forty-four patients with CRF who underwent CABG were examined. Two groups were analyzed. Group I consisted of 13 patients with end-stage renal disease on hemodialysis. Group II consisted of 31 patients with a creatinine ± 1.6 gm/dL for a minimum of 6 months, but were not on dialysis. There were 36 male and 8 female patients, with a mean age of 71 years. Results : The hospital mortality was 10 patients (23%) with 4 (31%) hospital deaths in Group I, and 6 (19%) in Group II. There was major morbidity in 35 (80%) patients. In Group II there were 8 (26%) patients who required permanent postoperative dialysis. A control group of 547 patients 70 years of age who underwent CABG had 30 hospital mortalities (5%) and 75 morbidities (13%). The average length of stay was 27 days. Fifteen patients died at a mean of 34 months after being discharged from the hospital. Nineteen of the original 44 patients remain alive at a mean of 32 months. The total mortality at 6 years and 4 months was 57%. Conclusions : Older and sicker patients with CRF who undergo CABG are at an exceptionally high risk for mortality and morbidity. For CRF patients not on dialysis with a creatinine 2.5 gm/dL, there is a strong likelihood of permanent postoperative dialysis. Long-term follow-up shows survival to be well below their non-CRF counterparts.     

Inhibitory Factors of Serum Opsonic Activity in Serum from Patients with Chronic Renal Failure

We investigated the mechanism of impaired serum opsonic activity in patients suffering from chronic renal failure (CRF). Prehemodialysis pooled serum from CRF patients was fractionated using Sephadex G-50 gel chromatography, and the effects of the obtained fractions on serum opsonic activity were examined using luminol-dependent chemiluminescence responses. Number 25–30 fractions in the prehemodialysis serum contained factors that may inhibit serum opsonic activity. The presumed molecular weight of these fractions is between 300 and 2800 daltons. These findings indicate that the inhibitory factors of serum opsonic activity may belong to middle molecules.