氯沙坦治疗慢性肾小球肾炎蛋白尿的临床研究

①目的　探讨氯沙坦对原发性慢性肾小球肾炎蛋白尿患者肾脏的保护作用。②方法　将 68例患者血压控制于 1 4 0 90 mmHg以下 ,稳定 1周后随机分为两组。氯沙坦治疗组 34例 ,给予氧沙坦 50mg,每日 1次 ;苯那普利组 34例 ,给予苯那普利 1 0mg ,每日1次 ,疗程 1 2周 ,观察治疗前后血压、2 4小时尿蛋白、肾功能、血钾的变化及不良反应的发生情况。③结果　两组血压于治疗前后无显著变化 ,氯沙坦与苯那普利均能显著降低尿蛋白 ,治疗前后差异均有显著性 (P <0 .0 5) ,而两组间无显著性差异 (P >0 .0 5) ;对肾功能的影响 ,于第 4周结束时两组治疗均无明显改变 ,但在 1 2周结束时两组治疗前后均出现显著性差异 (P <0 .0 5) ,两组间比较 ,差异无显著性 (P >0 .0 5) ;氯沙坦能明显降低血尿酸 ,且无干咳、高血钾等不良反应。④结论　氯沙坦治疗慢性肾小球肾炎安全、有效 ,具有非降压依赖性降低蛋白尿、保护肾功能的作用。     

Low-grade inflammation in white-coat hypertension.

BACKGROUND: C-reactive protein (CRP), a marker of systemic low-grade inflammation, is frequently elevated in essential hypertension and predicts cardiovascular prognosis independently of conventional risk factors. The risk profile of white-coat hypertension is not yet completely clear. The aim of this study was to determine the levels of high-sensitivity CRP (hs-CRP) in white-coat hypertensive subjects. MATERIAL/METHODS: Thirty-six age-, sex-, and body mass index-matched white-coat hypertensive subjects, 36 essential hypertensive patients, and 36 normotensive subjects were included in the study. RESULTS: Hs-CRP levels were significantly higher in the essential hypertensive and white-coat hypertensive groups than in the normotensive group (0.66+/-0.29, 0.47+/-0.32, and 0.27+/-0.22 mg/dl, respectively, p<0.001). It was also higher in the essential hypertensive group than in the white-coat hypertensive group (p=0.014). CONCLUSIONS: Our data show that patients with white-coat hypertension have higher hs-CRP levels than normotensive patients and this may be an indication of increased risk.     

中医辨证治疗慢性肾脏病蛋白尿的多中心前瞻性临床研究

目的研究中医辨证组方联合基础治疗与氯沙坦联合基础治疗对慢性肾脏病蛋白尿的临床疗效。方法对入组人群采用
多中心、前瞻性、随机、对照研究的方法,将符合方案的81例患者分为中药组（60例）,按脾肾气阴两虚、脾肾气阳两虚予中医辨
证组方内服;西药组（21例）予氯沙坦50 mg/d口服。总疗程24周,观察两组临床疗效。结果中药组临床总有效率93.33%,优于
西药组76.20%（P<0.05）;两组患者治疗后的中医证候积分值均较基线时明显改善（P<0.01或P<0.05）,中药组较西药组下降更
为明显（P<0.05）。中药组用药后8周血肌酐、肾小球滤过率估算值下降值以及24周血血胱抑素C和24 h尿蛋白定量、尿微量白
蛋白/尿肌酐比值下降值均有统计学意义（P<0.05）,而西药组无明显变化（P>0.05）。结论中医辨证组方联合基础治疗对慢性肾
脏病蛋白尿在改善症状、降低证候积分值、减少尿蛋白、保护肾功能方面显示了良好的临床疗效。
     

Cyclosporin A in refractory idiopathic nephrotic syndrome: 5 years clinical experience.

The use of cyclosporin A (Cy A) in idiopathic nephrotic syndrome, particularly lesions of focal segmental glomerular sclerosis, is controversial. A retrospective study of 10 adult patients with nephrotic syndrome treated with Cy A was performed. Histological diagnosis was established in all patients: focal segmental glomerular sclerosis (n = 6), focal global sclerosis (n = 1), mesangial proliferative glomerulonephritis (n = 1), focal proliferative glomerulonephritis (n = 1) and minimal change disease (n = 1). All patients had previously received immunosuppressive therapy (duration of steroids 1-76 months; 35.0 +/- 12.1, mean +/- SEM). Cy A in a dose of 3-5 mg/kg/day, reduced proteinuria from 16.85 +/- 6.67 to 3.37 +/- 1.48 g/24 hours (P = 0.008), with an associated increase in serum albumin from 15.2 +/- 2.6 to 34.3 +/- 2.5 g/l (P < 0.001). In six patients steroid therapy was discontinued. Cy A was well tolerated for up to 5 years. There was no significant nephrotoxicity. In conclusion, Cy A was effective treatment of refractory idiopathic nephrotic syndrome, including those cases with focal segmental glomerular sclerosis.     

Study of serum electrolytes in pregnancy induced hypertension

Hypertension complicating pregnancy is an important cause of foetal and maternal mortality and morbidity. Serum sodium, potassium, calcium and magnesium were evaluated in cases with gestational hypertension and pre-eclampsia and compared with normotensive pregnant women of corresponding period of gestation. Taking urinary micro-albumin creatinine ratio as standard to predict pregnancy induced hypertension, the role of serum electrolytes to predict the same was studied. A total of 200 patients were evaluated. There were no change in serum sodium and potassium in gestational hypertensive cases as well as in pre-eclamptic cases when compared with control group. Similar results were obtained when serum calcium level was evaluated. Mean serum magnesium level (1.53 +/- 0.29 mg/dl) was significantly low in cases of pre-eclampsia, while it was 1.79 +/- 0.25 mg/dl in patients with gestational hypertension and 2.19 +/- 0.2 mg/dl in control group. Patients having gestational hypertension along with increased micro-albumin creatinine ratio had significantly low mean magnesium level (1.68 +/- 0.1 mg/dl) when compared with gestational hypertensive patients with normal microalbumin creatinine ratio (serum magnesium level 1.87 +/- 0.1 mg/dl).     

EFFECT OF ANGIOTENSIN II RECEPTOR ANTAGONIST AND ENDOTHELIN RECEPTOR ANTAGONIST ON NITROGLYCERIN TOLERANCE IN RATS

INTRODUCTION Nitroglycerin (Nit) and other nitrovasodilators have been widely used to treat angina pectoris and congestive heart failure. The vasorelaxing effect of Nit is mediated by elevating intracellular cGMP levels, which results from the activation of soluble guanylate cyclase (sGC) by the active intermediate metabolite of Nit— nitric oxide (NO) in vascular smooth muscle cells(1).However, during the long- term or chronic administration,the hemodynamic and anti- ischemic efficacy…     

围手术期肠外营养支持对不同营养状态Crohn病患者免疫球蛋白、体重以及与感染有关并发症的影响

目的探讨围手术期肠外营养支持对不同营养状态Crohn病患者的免疫球蛋白、体重和并发症的影响.方法将在本院确诊、计划手术治疗的32例Crohn病患者按术前有无营养不良分组,体重下降在15%～30%者为营养不良组,共16例;体重下降＜15%者为对照组,共16例.两组患者均在手术前1周和手术后3周应用肠外营养(PN)支持(共4周);于PN前后测定血清中IgM、IgG和IgA水平、肝功及体重变化.监测术后并发症.结果两组患者的IgM水平于PN前均高于正常值[对照组(133±16)mg/dl,营养不良组(139±41)mg/dl;正常值(110±35)mg/dl;P=0.04];PN治疗后营养不良组患者明显下降[(105±29)mg/dl,P=0.02)],达到正常水平,对照组无明显变化[(129±13)mg/dl,P=0.34].两组患者的IgA和IgG水平于PN前在正常范围,PN后无明显变化(P值在0.20～0.57之间).体重对照组PN前后无明显变化[PN前(55.6±6.1)kg,PN后(56.3±6.0)kg;P=0.46],营养不良组较PN前升高[(PN前(45.8±8.9)kg,PN后(48.0±8.8)kg;P=0.005)].对照组患者与感染有关性并发症较营养不良组多(对照组4例,25%;营养不良组2例,12.5%;P=0.13),但无统计学差别.结论围手术期应用肠外营养支持,能改善有明显营养不良Crohn病患者的体液免疫状态,增加体重;而无明显营养不良的患者获益较少.     

Relationship between iron deficiency anaemia and serum lipid levels in Indian adults

Both iron deficiency anaemia and dyslipidaemia are widely prevalent public health problems, especially in the Indian population. Some link has been suggested between the two potentially morbid conditions but a sufficient Indian study could not be found in this regard. This study was planned to find the changes in serum lipid profile in adult Indian patients with iron deficiency anaemia and the effect of oral iron therapy on them. Seventy patients with iron deficiency anaemia and 70 age and sex matched healthy controls, in the age group of 18-35 years were investigated for any possible changes in serum lipid profile ie, triglycerides, total cholesterol, high density lipoprotein cholesterol, very low density lipoprotein cholesterol and low density lipoprotein cholesterol. The patients were followed up after 3 months of oral iron therapy. The results are shown as mean +/- standard deviation. Triglycerides and very low density lipoprotein cholesterol levels were found to be significantly (p < 0.001) elevated in the iron deficiency anaemia group (151.87 +/- 48.06 mg/dl and 30.40 +/- 9.71 mg/dl) as compared to controls (109.99 +/- 30.81 mg/dl and 21.96 +/- 6.69 mg/dl), whereas levels of low density lipoprotein cholesterol were found to be significantly (p = 0.02) lower in patients (90.96 +/- 41.55 mg/dl) as compared to controls (105.24 +/- 26.45 mg/dl). However, after treatment (in 43 patients) there was significant (p < 0.001) reduction in the levels of triglycerides and very low density lipoprotein cholesterol (111.56 +/- 26.87 mg/dl and 22.30 +/- 5.36 mg/dl) when compared to their pretreatment levels (154.70 +/- 53.89 mg/dl and 30.93 +/- 10.84 mg/dl), whereas low density lipoprotein cholesterol levels did not show any significant change. These findings indicate that iron deficiency anaemia in Indian adults is attended by abnormal serum lipid profile, which responds significantly to iron therapy.     

Takayasu's disease presenting as a nephrotic syndrome due to amyloidosis.

We report an 18 year old black woman who presented with nephrotic syndrome in whom the investigations led to the diagnosis of diffuse Takayasu''s disease, renal amyloidosis of AA type and interstitial lung disease. Proteinuria in Takayasu''s disease is usually ascribed to hypertension or more rarely to glomerulonephritis. This case suggests that amyloidosis should be considered also in the investigation of proteinuria in these patients in view of the serious prognostic implications. This case represents further evidence that Takayasu''s disease can be the cause of systemic reactive amyloidosis which may also be the presenting feature.     

Homocysteinemia in hypertensive patients with renal target organ damage (mild renal dysfunction)

The prevalence of high plasmatic levels of homocysteine in hypertensive patients with mild renal dysfunction (MRD) defined by 2003 European Hypertension Society Guidelines (men plasmatic creatinine between 1.3 and 1.5; women plasmatic creatinine between 1.2 and 1.4 mg/dl) has not been previously reported. To evaluate this item 18 MRD patients were recruited (54% males, mean age 59.2 +/- 17.3 years, mean plasmatic creatinine 1.30 +/- 0.12 mg/dl). They were compared with a control group of hypertensives with normal renal function (n = 87, 42,9% males, mean age 53.6 +/- 12.3 years, mean plasmatic creatinine 0.83 +/- 0.21 mg/dl) and a group of 29 chronic renal failure patients (51.7% males, mean age 56.9 +/- 15.0 years, mean plasmatic creatinine 2.39 +/- 0.95 mg/dl). Age and sex differences are not significant, plasmatic creatinine levels are different among three groups (p <0.001, t student test). Basal homocysteine levels of CRF (19.3 +/- 7.1 micromol/l) were higher than those of control group (11,0 +/- 4,3 micromol/l) and MRD patients (14.8 +/- 5.5 micromol/l; p = 0.027 vs. CRF and p = 0.007 vs. control, Mann-Whitney test). Mean creatinine clearance was 30.3 +/- 11.5 ml/min for CRF group, significantly lower than MRD patients creatinine clearance (54.5 +/- 9.4 ml/min, p <0.001, t student test) and control ones (88,9 +/- 18,9 ml/min, p <0.001, t student test). Hypertensive patients with mild renal dysfunction showed higher and pathological levels of homocysteinemia as compared with controls, this finding might be related to the higher cardiovascular risk described in this group of patients.     

肾局部血流在蛋白尿产生中的机制初探

目的 了解肾局部血流在蛋白尿发生发展过程中的变化及产生机制。方法 ①一次性注射法复制大鼠阿霉素肾病综合征模型。并测取２４ｈ尿蛋白含量;②分别于蛋白尿的前期、上升期、高峰期及下降期和多功能监护仪测量血压变化,激光多普勒微血管流量测定仪测定肾皮质血流;③取血及肾皮质匀浆用放射免疫法检测内皮素（ＥＴ）含量,用Ｇｒｉｅｓｓ法检测一氧化氮（ＮＯ）代谢产物ＮＯ２＾－,代表ＮＯ水平;④分别研究肾皮质血流与血浆、肾皮质的ＥＴ、ＮＯ、尿蛋白排泌量的变化及相关性。结果 ①平均动脉压（ｍｍＨｇ）正常鼠４个时间点数值为１１８,１１９,１１８,１１７;肾病鼠为１１６,１２４,１２９,１２１;各时间点与同期正常鼠间差异无显著性;②肾局部血流量（Ｐｕ）：正常鼠４个时间点值为６６．２,６８．４,６７．２,７０;肾病鼠为５８,５２,１９,２３;     

肾脏淀粉样变性病的分型诊断及临床特点分析

目的 总结肾脏淀粉样变性病的分型诊断,并分析其临床特点.方法 选择1990年1月至2011年12月在北京大学第一医院肾内科经肾活检诊断为肾脏淀粉样变性病的住院患者共104例,收集患者的临床资料;对所有患者肾活检组织切片进行免疫组化染色,使用以下几种常见的淀粉样变前体蛋白的抗体,包括免疫球蛋白轻链κ、λ,血清淀粉样蛋白A...     

EFFECT OF LOSARTAN ON SLOWING PROGRESSION OF CHRONIC ALLOGRAFT NEPHROPATHY

Objective To investigate the effects of losartan, a specific angiotensin Ⅱ receptor blocker, on slowing progression of renal insufficiency in patients with biopsy-proven chronic allograft nephropathy (CAN) and the molecular mechanism of the therapy.Methods Twenty-two renal transplant recipients with biopsy-proven CAN (group A) were treated with losartan within two months after renal dysfunction for at least one year. Losartan was administered at a dose of 50 mg/d. Twenty-four recipients in the same fashion (group B) who never received angiotensin Ⅱ receptor antagonist were studied as control. The investigation time for each patient lasted one year. Renal functions and concentrations of plasma and urine transforming growth factor-beta1 (TGF-beta1) were compared between the two groups at the initiation and end of the study. In group A, expressions of TGF-beta1 mRNA and immunofluorescence intensity of TGF-beta1 protein and pathological alterations in renal biopsy specimens were compared between before losartan therapy and after one year of the therapy.Results At the initiation of the investigation, no significant differences were found between group A and group B in clinical data such as donor age, cold-ischemia time, HLA mismatch, levels of creatinine clearance (Ccr), plasma and urineTGF-beta1 concentrations. One year later, 14 of 22 (63.6%) patients showed stable or improved graft functions in group A,and 4 of 24 (16.7%) in group B. The difference was significant (P＜0.05). At the end of the study, urine TGF-beta1 loss of Ccr was 6.6±5.4 mL/min in group A and 16.2±9.1 mL/min in group B. Both of the differences were significant between the two groups (P＜0.01). No significant differences were found in plasma TGF-beta1 concentrations between the four values determined at the initiation and end of the study in the two groups (F = 2.56, P ＞ 0.05). After one year losartan therapy, group A showed a significant decrease in expressions of TGF-beta1 mRNA and TGF-beta1 protein in renal biopsy specimens [from 1.59±0.35 to 0.96±0.27 and from (10.83 ± 2.33)×106 to (6.41±1.53)×106, respectively; both P＜0.01],but in light microscopy the histological changes were similar to the first renal biopsy. Losartan was excellently tolerated in all patients in group A. No cases with losartan therapy showed too low blood pressure and other side effects.Conclusion This study suggests that losartan have an effect on slowing progression of CAN. Reducing production of intrarenal TGF-betal may play a decisive role in the efficacy of losartan.     

重症SARS患者的临床营养支持及血糖水平和胰岛素用量与结局的关系

目的观察重症SARS患者接受临床营养支持前后部分与营养有关指标的变化,并分析血糖水平/胰岛素用量与结局的关系。方法以我所英东重症医学监护中心收治的21例临床诊断重症SARS患者为研究对象,转入ICU后均给予呼吸支持及临床营养支持。经肠内营养接受的热量约4184kJ/d(1000kcal/d),蛋白质约38g/d;经肠外营养接受的热量约3347.2kJ/d(800kcal/d)。监测给予患者肠内、肠外营养支持前后的血糖、血清白蛋白、血淋巴细胞总数及谷丙转氨酶等指标的变化。所有患者均接受甲基强的松龙约200mg/d。为将血糖保持在4.44～7.78mmol/L(80～140mg/dl)的较低水平,应用静脉泵入胰岛素,记录血糖及胰岛素用量,再分析其与结局的关系。结果在发病(11.0±2.8)d后转入ICU的21例患者中,16例(76.2%)伴有营养不良。经过平均12d肠内与肠外营养支持后,患者血清白蛋白显著升高犤(28.5±2.2)g/Lvs(37.0±4.1)g/L犦(P=0.0001);血淋巴细胞总数升高犤(0.74±0.47)×109/Lvs(1.22±0.73)×109/L犦(P=0.02);血谷丙转氨酶升高的病例有所下降,但差异不显著(81.0%vs57.1%,P=0.18);生存组血糖降至较低水平犤(9.5±2.3)mmol/Lvs(6.3±1.8)mmol/L犦(P=0.0002);死亡组血糖也有下降犤(13.0±3.3)mmol/Lvs(9.5±1.3)mmol/L犦(P=0.04);生存组血糖水平低于     

儿童原发性肾病综合征尿蛋白转阴时间的多因素分析

目的分析儿童原发性肾病综合征激素治疗后尿蛋白转阴时间的影响因素。方法 146例原发性肾病综合征患儿行激素治疗后,可评价疗效136例。按照尿蛋白转阴时间分为A组（尿蛋白转阴时间≤1周）和B组（1周〈尿蛋白转阴时间≤2周）。其中A组男44例,女4例;B组男74例,女14例。对患儿各种常规情况、生化指标行单因素分析及多因素Logistic回归分析。结果单因素分析显示,父母认知情况、水肿程度、水肿至口服激素时间、是否存在合并感染、入院时血浆IgM水平、血浆白蛋白水平、胶体渗透压等指标在A、B组间差异有统计学意义（P〈0.05）。多因素Logistic回归分析提示：父母认知情况差（P=0.004,OR=0.087）、水肿至口服激素时间长（P=0.000,OR=20.676）、胶体渗透压低（P=0.025,OR=0.649）与尿蛋白转阴时间有关。结论父母认知情况差、水肿至口服激素时间长、胶体渗透压低为原发性肾病综合征患儿尿蛋白转阴时间〉1周的危险因素,与患儿的不良预后相关,临床应予以高度重视。     

Sympathetic activity and response to ACE inhibitor (enalapril) in normotensive obese and non-obese subjects

BACKGROUND: Angiotensinogen has been proposed as a possible link between obesity and hypertension because the adipocyte produces angiotensinogen and contains the enzymes required for its conversion. Moreover, sympathetic overactivity has been reported in obese subjects. The aim of this study was to compare heart sympathetic activation and serum angiotensinogen levels in obese and non-obese normotensive subjects, their relationship, and the effect of a drug that modifies the renin-angiotensin system. METHODS: Serum angiotensinogen, leptin, lipids, glucose, and insulin levels were measured and 24-h electrocardiograph monitoring was carried out in 41 (20 non-obese and 21 obese) volunteers before and after administration of 5 mg enalapril twice/day for 7 days. RESULTS: Obese subjects had higher values than non-obese subjects for % body fat (35.1+/-4.6 vs. 30.5+/-5.2; p=0.005), triglycerides (1.93+/-0.9 vs. 1.25+/-0.7 g/L, p=0.002), insulin (114.8+/-82.5 vs. 45.9+/-22.2 pmol/L), leptin (31.4+/-20.4 vs. 14.1+/-11.2 ng/mL, p=0.002), and LF/HFn index (4.3+/-2.9 vs. 2.2+/-1.3, p<0.005). Enalapril increased angiotensinogen levels only in the non-obese group (4.2+/-3.9 vs. 9.7+/-5.4 ng/mL, p=0.001) and diminished the LF/HFn index (4.3+/-2.9 vs. 3.0+/-1.4, p=0.007) in the group of obese subjects. There was no association between angiotensinogen levels and sympathetic activity. CONCLUSIONS: Higher level of sympathetic activity was found in normotensive obese as compared with non-obese subjects. Enalapril treatment reduced heart sympathetic activity in obese subjects but did not change angiotensinogen levels.     

肾纤复元胶囊延缓5/6肾切除大鼠肾衰进展机制的实验研究

目的探讨中药复方制剂“肾纤复元胶囊”治疗慢性肾功能衰竭的作用机制．方法将Wistar大鼠随机分为模型组、肾纤复元胶囊治疗组、氯沙坦治疗组与假手术组,前三组以5／6肾切除方法建立肾衰模型。分别于建模后4、8、12周检测各组鼠血尿生化指标、残肾组织α-SMA、Ⅰ型胶原和结缔组织生长因子（CTGF）的表达。结果两治疗组4、8、12周血BUN、Cr、24h尿蛋白定量明显低于模型组（P〈0．01）,治疗组之间差异无统计学意义（P〉0．05）;光镜下肾组织病理切片显示治疗组损害轻于模型组,其α-SMA及Ⅰ型胶原染色阳性面积亦低于模型组（P〈0．01）,治疗组之间差异无统计学意义（P〉0．05）;治疗组残肾组织CTGF表达低于模型组（P〈0．01）,治疗组之间差异无统计学意义（P〉0．05）．结论“肾纤复元胶囊”通过下调CTGF在残肾组织的表达,抑制细胞外基质的积聚和细胞转分化,防止肾纤维化,对5／6肾切除后的大鼠残肾组织有明显保护作用。     

LUPUS NEPHRITIS-A CRITICAL ANALYSIS OF 17 PATIENTS

Over a 3 year period from June 94 to June 97, out of 28 patients of systemic lupus, 17 were diagnosed as renal lupus. Demographic data showed 12 females and 5 males, mean age being 32.2 years (range 12 to 54 years). Mean time gap between presentation and definitive diagnosis was 32.4 days (7 days to 5 years). 2 patients (11.76%) presented renal lupus, one (5.88%) with acute interstitial lung disease and the remaining had the usual systemic manifestations of lupus. Anti dsDNA antibodies were positive in all patients while ANA was negative in 3 cases. Renal involvement consisted of rapidly progressive glomerulonephritis in 2 patients (11.76%), nephrotic syndrome in 4 (23.52%) and non nephrotic range proteinuria in 11 (64.70%) patients. Mean serum creatinine at presentation was 2.4mg/dl (0.8mg/dl to 8.9 mg/dl). Three patients were dialysis dependent. Renal histology on light microscopy comprised of class II lesions in one (5.88%), class III in 4 (23.52%), class IV in 11 (64.70%-including one with crescents) and class V in one (5.88%) patient. All patients with advanced class III/IV lesions were treated with corticosteroids and cyclophosphamide pulses. Except one patient who died of pyopericardium all others improved and their serum creatinine stabilised around 2.3 mg/dl (0.8 to 4.6 mg/dl). The study highlights the importance of early diagnosis and aggressive management in this potentially treatable disease.KEY WORDS: Lupus nephritis, Pulse cyclophosphamide     

Levels of plasma fibrinogen and D-dimer in subjects with subclinical hyperthyroidism.

BACKGROUND: During the last 15 years, several risk markers for atherosclerosis, such as fibrinogen and D-dimer, have been identified. The role of elevated fibrinogen levels as an independent risk factor for coronary, cerebral, and peripheral vascular disease is well established on the basis of clinical and epidemiological studies. Increased D-dimer levels are associated with increased risk of future myocardial infarction, stroke, and peripheral vascular disease. The aim of this study was to evaluate the alterations in fibrinogen and D-dimer, which indicates overall thrombotic activity, in subjects with subclinical hyperthyroidism. MATERIAL/METHODS: Thirty-six subclinical hyperthyroidic subjects and 36 euthyroidic control subjects matched for age, gender, and body mass index were selected. The levels of plasma fibrinogen and D-dimer in all subjects were measured. RESULTS: The level of fibrinogen was significantly higher in the subclinical hyperthyroidic group than in the euthyroidic group (296.9+/-74.3 mg/dl vs. 255.0+/-41.7 mg/dl, p<0.001). The level of D-dimer was significantly higher in the subclinical hyperthyroidic group than in the euthyroidic group (261.9+/-47.8 mg/dl vs. 216.4+/-32.1 mg/dl, p<0.000). CONCLUSIONS: The results suggest that subjects with subclinical hyperthyroidism present a relatively hypercoagulable state. This state could contribute to increased thromboembolic risk in subclinical hyperthyroidism.     

阿托伐他汀对高血压肾病蛋白尿和炎症的治疗作用

目的评价阿托伐他汀对血压控制正常的高血压肾病患者蛋白尿和炎症的治疗作用.方法52例血压已控制正常的高血压肾病患者随机给与阿托伐他汀(10mg)或安慰剂治疗3个月,观察血压(SBP/DBP)、血浆C-反应蛋白(CRP)、白介素-1β(IL-1β)、血脂(TG、TC、HDL-C、LDL-C)、肌酐(Cr)、肌酐清除率(Ccr)、24 h尿蛋白(U-pro)和尿酸(UA)的变化.结果治疗3个月后,阿托伐他汀组的TC(3.93±0.58)vs(5.41±0 77)mmol/L、LDL-C(2.44±0.43)vs(3.49±0.66)mmol/L、CRP(2.59±1.02)vs(3.66±1.39)mg/L、IL-1β(98.79±24.06)vs(126.09±30.11)ng/L和U-pro(510 32±320.69)vs(748.34±411.60)ng/d较安慰剂组均显著降低(P＜0.05～0.01),而两组间的Cr、Ccr无明显改变(P＞0.05).多元线性回归分析显示,U-pro与Ccr(P=0.000)、Cr(P=0.000)、TC(P=0.000)和CRP(P=0.025)呈线性相关,阿托伐他汀组的尿蛋白减少量(△U-pro)与△CRP(P=0.000)、△Cr(P=0.013)呈线性相关.结论炎症参与了高血压肾病的肾脏损害,阿托伐他汀能通过抗炎作用减轻高血压肾病的蛋白尿.