Cholesterol emboli syndrome

The cholesterol emboli syndrome is a disorder caused by showers of microemboli which impact the small arteries. It can occur spontaneously or be precipitated by vascular surgery, arteriography or anticoagulation. The typical patient is a man older than 60 years with risk factors for atherosclerotic disease. The organs most often affected are the kidneys, skin, muscles and abdominal viscera. Common clinical presentations include renal failure and livedo reticularis or gangrene of the toes with intact pulses. Eosinophilia and hypocomplementemia may occur. The syndrome can be fatal or result in end-stage renal disease, but partial recovery can also occur.     

Spinal cord infarction following therapeutic renal artery embolization

A patient with dialysis cachexia became paraparetic within hours of therapeutic renal artery embolization. At autopsy, emboli of absorbable gelatin sponge filled spinal arteries, accompanied by spinal cord infarcts. The renal arteries of patients with end-stage renal disease are smaller than normal becaue of intimal fibrosis associated with prolonged dialysis. Embolic material can reflux more readily in these patients than in patients with renal tumors.     

Follow up study of 70 patients with renal artery stenosis treated by percutaneous transluminal dilatation

Between April 1978 and April 1981, 70 patients with hypertension and renal artery stenosis were treated by percutaneous transluminal arterial dilatation. Selection of the patients was based solely on arteriographic criteria. Arteriography after dilatation showed considerable widening of the stenosed area in all patients. In 65 patients the effect of treatment on the blood pressure was assessed during follow up periods of one to four years. In 14 of these patients the hypertension was cured, in 29 it was improved, and in 22 there was no change. Patients with fibromuscular lesions benefited distinctly more than did those with atheromatous stenosis, only one of the 21 patients with fibromuscular lesions showing no change as compared with 21 of the 44 patients with atheromatous lesions. The only serious complication encountered was microcholesterol emboli, which developed in two patients with severe atheromatous lesions of the aorta. In the atheromatous group age and overall renal function had no influence on the blood pressure response. In the subgroup of patients with a unilateral lesion the renal vein renin ratios and asymmetrical curves obtained by renography had only a very limited predictive value. In experienced hands percutaneous transluminal arterial dilatation is relatively safe, and this study suggests that it should be attempted in all patients with renal artery stenosis. Only in patients with severe atheromatosis of the aorta should the risk associated with the catheterisation be weighed against the 50% or so chance of benefit from the procedure.     

Myositis due to cholesterol emboli.

Myositis due to spontaneous cholesterol embolization is uncommon and usually associated with cutaneous abnormalities at presentation. A case of myositis due to cholesterol emboli is reported. The patient presented with painful weak legs, and the diagnosis was confirmed by muscle biopsy.     

OSA HS 患者不同程度氧减指数与血脂、肾功能相关性研究

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）不同程度的氧减指数（ODI）与患者血脂、肾功能的相关性。方法选取经多导睡眠图（PSG）监测并诊断为 OSAHS 的患者208例,按照不同 ODI 区间（ODI ≤7、7＜ ODI ≤18、18＜ ODI ≤38和 ODI ＞38）分为4组,比较4组患者在总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL‐C）、低密度脂蛋白胆固醇（LDL‐C）、载脂蛋白 A1（ApoA1）、载脂蛋白 B（ApoB）、尿素、肌酐、尿酸等方面的差异,分析不同程度的 ODI 与血脂及肾功能的相关性。结果4组不同程度 ODI 的患者在 TC 、TG 、HDL‐C 、LDL‐C 、ApoB 、尿素、肌酐、尿酸等方面差异有统计学意义（P＜0．05）;ODI 与 TC 、TG 、LDL‐C 、ApoB 、尿素、肌酐、尿酸水平呈正相关,与 HDL‐C 水平呈负相关。结论 OSAHS 患者 ODI 增加与血脂代谢异常及肾功能改变相关。     

多层螺旋CT对肺动脉栓塞及下肢深静脉血栓形成的诊断价值

目的 探讨多层螺旋CT对肺动脉栓塞及下肢深静脉血栓形成的诊断价值。方法 将广东省珠海市第二人民医院38例可疑肺动脉栓塞患者作为研究对象,进行多层螺旋CT扫面,采用最大表面覆盖法、多平面投影法、曲面重建法及最大密度投影法,由2名经验丰富医师进行双盲观察。结果 共发现单纯肺动脉栓塞（pulmonary embolism,PE）栓子113处,右侧栓子44处（38.9%）,左侧栓子16处（14.2%）,双侧栓子53处（46.9%）;单纯下肢深静脉血栓（deep vein thrombosis,DVT）栓子49处,右侧栓子26处（53.1%）,左侧栓子16处（32.7%）,双侧栓子7处（14.3%）;PE合并DVT栓子14处,右侧8处（57.1%）,左侧2处（14.3%）,双侧4处（28.6%）。结论 DVT与PE发病关联密切,多层螺旋CT在诊断PE上具有准确率高、操作简单、快速及方便等优势,尤其适宜对PE小病变的诊断。     

肾衰宁颗粒对慢性肾功不全患者肾功能及脂质代谢的影响

目的观察肾衰宁颗粒对慢性肾功不全患者肾功能及脂质代谢的影响。方法 240例确诊为慢性肾功不全的患者在基础治疗基础上给予肾衰宁颗粒15-40g/d,于治疗前和治疗后12周分别检测血清CHO、TG、HDL-C、LDL-C、Scr和BUN的浓度。结果 CRF-2、CRF-3期患者治疗前较治疗后血清BUN、Scr水平明显下降（P〈0.05或P〈0.01）,CRF-1、2、3期患者治疗前后各项指标（CRF-3期患者的HDL无明显改变）比较差异有显著性（P〈0.05或P〈0.01）。结论肾衰宁颗粒能够明显降低早中期CRF患者的尿素氮和肌酐值,能部分改善CRF患者的脂质代谢。     

Influence of proteinuria on vascular disease, blood pressure, and lipoproteins in insulin dependent diabetes mellitus

Patients with insulin dependent diabetes mellitus who develop proteinuria may die prematurely, whereas those who do not develop this complication have a comparatively normal life span. The excess mortality in diabetics with proteinuria is from cardiovascular as well as renal disease, but the reason is unclear. Risk factors for vascular disease were therefore assessed in 22 insulin dependent diabetics with proteinuria, but not renal failure, who were matched for sex, age, duration of diabetes, and glycated haemoglobin (HbA1) values with a similar number who had normal urinary albumin excretion rates. Macrovascular disease (ischaemic heart disease and peripheral vascular disease) was present in 10 patients with proteinuria but in only three with normal albumin excretion rates, and proliferative retinopathy was detected in 11 and four patients in the two groups. There was no significant excess of smokers in the group with proteinuria. Blood pressure was, however, higher in the patients with proteinuria--mean systolic pressure 161 (SD 18) mm Hg compared with 135 (19) mm Hg (95% confidence interval of difference between means 15 to 38 mm Hg); mean diastolic pressure 90 (SD 12) mm Hg compared with 79 (15) mm Hg (confidence interval 3 to 19 mm Hg). The concentration of serum high density lipoprotein (HDL) cholesterol isolated by precipitation was lower in the patients with proteinuria (confidence interval 0.02 to 0.41 mmol/l). Their concentration of HDL2 cholesterol isolated by ultracentrifugation was also decreased (confidence interval 0.02 to 0.40 mmol/l), whereas HDL3 cholesterol tended to be increased (confidence interval -0.01 to 0.23 mmol/l). There was also a trend for serum cholesterol concentrations to be higher in the presence of proteinuria (confidence interval -0.39 to 1.20 mmol/l). The aggregation of risk factors for atherosclerosis in insulin dependent diabetes mellitus complicated by proteinuria helps to explain the increased prevalence of ischaemic heart disease and peripheral vascular disease reported in these patients. Early renal disease in insulin dependent diabetes may have an important role in hypertension and altered lipoprotein metabolism.     

动态动脉硬化指数和高血压患者早期肾功能损害的相关性观察

目的探索动态动脉硬化指数（ambulatory arterial stiffness index,AASI）对高血压患者早期肾功能损害的评价作用。方法以AASI≥0.55作为异常升高的临界值,将患者分为两组。两组患者性别构成、年龄、体质量、空腹血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、肌酐、心率均无统计学显著差异。以AASI为自变量,eGFR为因变量行Pearson相关分析。结果eGFR与AASI呈显著负相关（Pearson积差相关系数-0.312,P值0.000）。结论动态动脉硬化指数与早期肾功能减退相关。     

慢性肾功能不全时测定左心室收缩时间间期的意义

本文报道了36例慢性肾功能不全患者的左心室收缩时间间期测定结果,并探讨其临床意义。作者认为,该项检查在慢性肾功能不全患者中有实际应用的价值;有关PEP/LVET比值和多种病理因素的相关分析表明,尿毒症晚期心肌病变确非单一因素引起。     

肾功能正常糖尿病患者血脂生化检测的临床价值

目的 探讨肾功能正常的糖尿病患者血脂生化指标检测的临床价值.方法 选取2018年12月至2019年12月本院收治的62例肾功能正常且尿蛋白阴性的糖尿病患者,另选取同期48名健康体检者为研究对象,其中62例肾功能正常且尿蛋白阴性的糖尿病患者为观察组,48名健康体检者为对照组.两组受试者均接受肾功能、血脂生化检测,比较两组...     

Studies on post-transplant dyslipidemia in kidney transplant patients

This study was performed to retrospectively compare changes in the levels of total cholesterol, non-HDL cholesterol, triglycerides, and immunosuppressive drugs, cyclosporine A and steroids in patients with living-relation renal transplants with those from non-heart-beating donors. We experienced 11 cases of kidney transplants from non-heart-beating donors during the period from April 1995 to May 2003. We evaluated 13 cases of kidney transplants from living-relation donors during the same period. The immunosuppressants used included mainly cyclosporine A as well as mycophenolate mofetil or azathioprine, steroid and ALG, or basiliximab. Over-night fasting lipids (total cholesterol, triglycerides and HDL cholesterol) were studied before renal transplantation and repeated after renal transplantation at 1, 3, 6 and 12 months. The levels of total cholesterol and triglycerides remained in the normal range before transplantation. However, the levels of total cholesterol increased siginificantly 1 and 3 months after transplantation from non-heart-beating donors and remained at higher levels up to 12 months after transplantation. A similar pattern in the levels of triglycerides was observed. The levels of HDL cholesterol remained unchanged and stayed in the normal range before and 1, 3, 6, and 12 months after transplantation from non-heart-beating donors. On the other hand, significant increases in non-HDL cholesterol were observed 3 and 6 months after transplantation from non-heart-beating donors. After transplantation from living-relation donors, levels of total cholesterol, triglycerides, and non-HDL cholesterol remained unchanged and remained in the normal range up to 12 months after transplantation. Although there were no significant differences in the total dosage of cyclosporine A between the patients with living-relation donors and those with non-heart-beating donors, a significant increase in the total dosage of methylprednisolone was observed in patients with non-heart-beating donors compared with those in the patients with living-relation donors. Renal function recovery in patients with living-relation donors was better than in those with non-heart-beating donors. These results may suggest that significant increases in total cholesterol, especially non-HDL cholesterol and triglycerides, were probably partly due to an increased use of immunosuppressants, steroids. It is necessary to aggressively control post-transplant hyperlipidemia and important to reduce or withdraw steroids in the selected, low-risk recipients as early as possible from the viewpoint of preventing post-transplant hyperlipidemia.     

Renal vein thrombosis with recurrent pulmonary emboli in the nephrotic syndrome: use of the Greenfield filter

We describe a case of renal vein thrombosis in association with the nephrotic syndrome. The patient had recurrent pulmonary emboli which, having failed to respond to routine anticoagulant treatment, were managed successfully by the insertion of a Greenfield filter into the inferior vena cava above the renal vein thrombosis site. The only coagulation abnormality in this patient was a deficiency of antithrombin III.     

Fluvastatin prevents renal injury and expression of lactin-like exidized low-density lipoprotein receptor-1 in rabbits with hypercholesterolemia

Background Lipid abnormalities are often complicated by renal dysfunction. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the first-line choice for lowering cholesterol levels. The present study was designed to investigate whether statins could prevent and invert the development of renal injury in cholesterol-fed rabbits and to find the possible mechanism of their effects by detecting gene and protein expression of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) in the renal artery.Methods Twenty-four male New Zealand white rabbits were divided into three groups: (1) control group, regular granules chow; (2) HC-diet group, granules chow with 1% cholesterol and 5% lard oil; and (3) fluvastatin group, 1% cholesterol and 5% lard oil diet plus fluvastatin ［10 mg·kg（-1）·d（-1）］ . After 16 weeks, serum total cholesterol (TC), low-density lipoprotein(LDL) and creatinine (Cr) levels were measured. Renal hemodynamics and function, mainly including glomerular filtration rate (GFR) in vivo were quantified using 99mTc-DTPA single photon emission computed tomograph (99mTc-DTPA SPECT). The thickness of the renal artery intima was quantitated in HE-stained segments by histomorphometry. Gene expression of LOX-1 in the renal artery was examined by semi-quantitative RT-PCR and its protein expression was evaluated by immunohistochemistry.Results High cholesterol diet induced hypercholesterolemia (HC) complicated by renal dysfunction with increased levels of serum lipid and Cr, decreased GFR and delayed excretion and extensively thickened renal arterial intima in the HC-diet group. Rabbits in the control group showed a minimal LOX-1 expression (mRNA and protein) in the endothelium and neointima of the renal artery. Intimal proliferation of the renal artery in the HC-diet group was associated with a marked increase of LOX-1 expression (protein and mRNA). Treatment with fluvastatin improved renal function, attenuated intimal proliferation of the renal artery and markedly decreased the enhanced LOX-1 expression in the endothelium and neointima of the renal artery in rabbits. Conclusions Fuvastatin treatment could prevent the development of renal injury in patients with HC and early atherosclerosis (AS). This beneficial effect might be mediated by its pleiotropic effects including a decrease in total cholesterol exposure level and prevention of LOX-1 expression in atherosclerotic arteries.     

医源性肾动脉损伤的介入治疗

目的 回顾性分析超选择性肾动脉栓塞在治疗医源性肾动脉损伤的临床应用价值,探讨医源性肾动脉损伤的介入诊疗规程.方法 经皮肾镜取石术后大出血患者28例,采用Seldinger技术经股动脉插管,先行腹主动脉造影后,将导管选择至受损肾行肾动脉造影,确定出血动脉,行超选择性栓塞治疗;术后观察疗效及并发症.结果 27例患者肾动脉造影呈阳性,其中假性动脉瘤15例,动静脉瘘7例,造影剂外溢4例,血管中断1例,行超选择性受损动脉分支栓塞均成功,术后出血停止;1例肾动脉造影呈阴性,术中肾动脉狭窄、大量血栓形成,致使手术中途停止,术后再次大量出血,行急诊肾脏探查及修补术后止血成功.所有患者未出现严重并发症.结论 超选择性肾动脉栓塞治疗医源性肾动脉损伤出血,安全、高效,值得临床广泛推广;规范的诊疗路径是治疗成功的保证.     

阿托伐他汀对充血性心衰患者肾功能的影响

目的观察阿托伐他汀辅助治疗慢性充血性心力衰竭（CHF）合并肾功能不全患者的疗效及安全性。方法将同期收治的60例CHF患者随机分为阿托伐他汀组和对照组各30例,2组均根据NYHA心功能分级予常规治疗,在此基础上观察组加用阿托伐他汀40mg/d,每晚口服,疗程均为6个月。观察2组治疗前后血尿素氮、血肌酐、尿蛋白、血脂的改变,并判定预后疗效,同时记录不良反应。结果阿托伐他汀组和对照组总有效率分别为90%、66.7%,差异有统计学意义（P〈0.05）,阿托伐他汀组肾功能BUN、Cr、尿蛋白及血脂总胆固醇、低密度脂蛋白均明显比对照组有改善（均P〈0.05）,2组均无明显不良反应发生。结论对于慢性充血性心力衰竭合并肾功能不全的患者,长期接受40mg阿托伐他汀治疗可能改善肾功能。     

PE患者应用GE宝石能谱CT诊断的临床价值分析

目的探讨肺栓塞(PE)患者应用GE宝石能谱CT诊断的临床价值。方法收集2017年8月~2018年12月我院临床疑似PE并行能谱CT检查的患者120例,以CT肺动脉造影(CTPA)确诊的PE患者为研究对象,通过数据处理获取CTPA图像及肺组织碘基物质图像。根据CTPA图像观察栓子分布情况并进行类型,于碘基图中测定栓塞区与与对侧正常区相比碘含量值。结果 120例临床可疑PE患者,经能谱CTPA证实为阳性57例,共发现289个栓子,其中完全型栓子172个,不完全型117个(包括中心型17个、偏心型86个、附壁型14个)。完全型栓子、中心型及偏心型栓子栓塞区碘基值均明显低于对照区(P<0.05);附壁型栓子碘基值在栓塞区与对照组之间无统计学差异(P>0.05)。完全型栓子灌注减低区检出率明显高于不完全型栓子(P<0.05)。结论宝石能谱CT能够显示肺组织血流灌注异常改变,对PE诊断及病情评估有重要价值。     

高胆固醇血症加剧肾病大鼠肾小球损伤及降脂治疗的实验研究

目的探讨高脂血症在进行性肾小球损伤中的作用及降脂治疗对其影响．方法２４只雄性Ｗｉｓｔａｒ大鼠．阿霉素诱导肾病模型后随机分为３组．Ａ组：普通饲料喂养；Ｂ组：高胆固醇饲料喂养；Ｃ组：高胆固醇饲料喂养加服美降脂．ＺＷｋ测一次尿蛋白，４ｗｋ测一次血脂，１２ｗｋ肾脏病理检查．结果Ｂ组血胆固醇、甘油三酯、低密度脂蛋白、肾脏病理积分和含有泡沫细胞肾小球百分率高于Ａ、Ｃ两组．血胆固醇与病理积分、含有泡沫细胞肾小球百分年三者之间均呈正相关．结论高胆固醇血症可加剧肾小球损伤；美降脂有降低血脂．减轻肾小球损伤的作用；肾病综合征患者应适当限制脂质摄入．     

绞股蓝总甙治疗高血脂症合并脂肪肝的疗效观察

目的 通过常规护肝治疗与联合调脂药绞股蓝总甙治疗进行对比,了解绞股蓝总甙对高血脂症合并脂肪肝的临床疗效及安全性.方法 随机将非酒精性脂肪肝门诊患者分为对照组54例,给予能量合剂及甘利欣静脉给药治疗;治疗组98例,在应用上述治疗的同时,给予绞股蓝总甙胶囊1粒,3次/d,口服.两组疗程均4周.结果 对照组TC、TG、LDL...     

普伐他汀治疗肾移植术后血脂异常的临床研究

目的 探讨他汀类药物对肾移植术后血脂异常患者疗效及安全性。方法 21例肾移植术后高胆固醇血症患者（血浆总胆固醇TC水平〉6．2mmol／L），患者每日口服普伐他汀10mg，每晓1次，疗程8周。治疗前后测定本组及30例健康人（对照组）血清总胆固醇（TC）、低密度脂蛋白胆圊醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、血浆内皮素（ET）、一氧化氮（NO）的变化。并采用高分辨血管外超声技术测定所有个体肱动脉血流介导的舒张功能及硝酸甘油介导的舒张功能。结果 血浆ET在肾移植组显著高于对照组，而NO显著低于对照组；降脂治疗8周后，ET明显下降（P〈0．01），NO明显升高（P〈0．01），血TC、LDL-C明显降低（P〈0．01），HDL-C亦升高，但无统计学意义。治疗组肱动脉血流介导的舒张低于对照组，治疗后较治疗前明显好转。没有病例发生横纹肌溶解。结论 肾移植患者普伐他汀调脂治疗的同时，可显著改善血管内皮细胞功能。普伐他汀治疗肾移植后高脂血症安全有效。