辛伐他汀对尿毒症非透析患者微炎症反应的影响

目的探讨辛伐他汀治疗对尿毒症非透析患者微炎症反应的影响。方法选择湖北省黄石市第二医院肾内科尿毒症非透析患者61例,随机分为他汀治疗组和对照组,监测治疗前、治疗后C反应蛋白(CRP)、白细胞介素-6(IL-6)和营养学指标的变化。并选择22例健康志愿者作为正常对照。结果与正常人组比较,治疗前尿毒症患者的CRP、IL-6水平显著升高(P<0.05),血浆白蛋白(ALB)、血浆前白蛋白(PALB)、血红蛋白(Hb)均显著降低(P<0.05)。治疗后24周,他汀治疗组CRP、IL-6的水平均明显下降,Salb、Spalb、Hb明显升高,与治疗前及对照组相比,差异有显著性,P<0.05和P<0.05;同时患者血肌酐(SCr)、尿素氮(BUN)也呈下降趋势,但肌酐清除率(Ccr)、变化无显著性。结论辛伐他汀治疗可以抑制尿毒症非透析患者的微炎症反应,改善营养状态。     

糖尿病肾病肾衰竭患者的营养状况与C-反应蛋白及白介素-6的关系

目的：探讨糖尿病肾病肾衰竭患者的营养状况及其与微炎症状态的关系。方法：选择40例非尿毒症期的2型糖尿病肾病患者,根据内生肌酐清除率（Ccr）分为肾功能正常组（A组）与肾衰竭组（B组）各20例,另选择20例无糖尿病的非尿毒症期肾衰竭患者为C组。对比观察3组患者的一般情况、血常规、血生化、肾功能等指标及CRP、IL-6水平,检测尿白蛋白排泄率（UAER）、24 h尿蛋白排泄量（UPER）、Ccr,测量及计算体质量指数、肱三头肌皮褶厚度、上臂围,进行主观综合营养评估（SGA）,并分别对B组患者的炎性因子CRP、IL-6与血红蛋白、血清肌酐、血清白蛋白、血清前白蛋白、总胆固醇、UAER、Ccr的关系进行直线相关分析。结果：与A组比较,B组患者年龄较大,血压较高,血红蛋白、血清白蛋白、血清前白蛋白较低,红细胞较少,血尿素氮、血清肌酐明显升高,Ccr明显下降（P均〈0.05）。B组患者的血红蛋白、血尿素氮、血清肌酐、血清白蛋白、血清前白蛋白明显低于C组,空腹血糖明显高于C组患者（P均〈0.05）。B组患者的总胆固醇、甘油三酯、UAER、UPER、CRP、IL-6水平均明显高于A、C组（P均〈0.05）。B组SGA分级重度营养不良及总营养不良发生率明显高于A、C组（P均〈0.05）。B组患者的血红蛋白、血清白蛋白、血清前白蛋白、Ccr与CRP呈负相关（P均〈0.05）,总胆固醇、UAER与IL-6呈正相关（P〈0.05）,血红蛋白、血清白蛋白、血清前白蛋白、Ccr与IL-6呈负相关（P〈0.05）。结论：糖尿病肾病肾衰竭患者的总体状况差,高血压、高脂血症、肾性贫血、营养不良、微炎症状态等并发症均更为严重。其营养不良与微炎症状态呈正相关,微炎症可能是影响糖尿病肾病肾衰竭患者营养不良的主要机制之一。     

辛伐他汀对尿毒症非透析患者血清白介素-6、C反应蛋白和营养学指标的影响

目的探讨辛伐他汀治疗对尿毒症非透析患者微炎症反应和营养学指标的影响。方法选择湖本院肾内科尿毒症非透析患者86例,随机分为他汀治疗组和对照组,监测治疗前、治疗后C反应蛋白(CRP)、白细胞介素-6(IL-6)和基础营养状态指标的变化。结果与正常人组比较,治疗前尿毒症患者的CRP、IL-6水平显著升高,血浆白蛋白(ALB)、血红蛋白(Hb)均显著降低。治疗后24周,他汀治疗组CRP、IL-6、血肌酐(Scr)、尿素氮(BUN)水平均明显下降,Alb、Hb水平明显升高,与治疗前及对照组相比,差异有统计学意义:同时对照组Alb、Hb、Ccr也呈下降趋势,2组肌酐清除率(Cer)变化无显著性。结论辛伐他汀治疗可以抑制尿毒症非透析患者的微炎症反应,改善营养状态。     

早期低剂量腹膜透析对尿毒症患者残存肾功能的保护及微炎症状态的影响

目的 探讨早期低剂量腹膜透析对尿毒症患者残存肾功能的保护及微炎症状态的影响.方法 将2008年3月至2011年2月收治的68例慢性肾功能衰竭患者分为两组,其中腹透组34例,接受常规药物治疗,并给予间歇性腹膜透析,每日4000～6000 ml,每周4～5 d;对照组34例,只接受常规药物治疗.所有患者每3个月行残存肾功能测定(RRF)及C-反应蛋白(CRP)检测,研究前后检测肌酐清除率(Ccr)、血钾、血红蛋白,并记录血压和24 h尿量.结果 研究结束时,早期低剂量腹膜透析组和对照组的收缩压、舒张压、血红蛋白、血钾水平差异均无统计学意义;腹透组Ccr高于对照组,但对照组较腹透组减少明显(P<0.05).前6个月两组RRF的明显下降,6个月后腹透组下降变缓,研究结束时腹透组RRF较对照组高(P<0.05).而从第3个月时腹透组CRP较对照组高(P<0.05).结论 早期使用低剂量腹膜透析可以延缓尿毒症患者残存肾功能的丢失及降低尿毒症患者微炎症状态.     

慢性肾功能衰竭患者血清晚期糖基化终产物与颈动脉粥样硬化、微炎症的关系

目的:本研究拟通过应用ELISA法检测慢性肾功能衰竭(CRF)患者血清晚期糖基化终产物(AGEs)水平,同时测血肾功能水平(Scr)、内生肌酐清除率(Ccr)、C反应蛋白(CRP)等指标及B超测量颈动脉内膜中层厚度(IMT),来探讨CRF患者AGEs的变化水平,AGEs与微炎症、动脉粥样硬化之间的相互作用。方法:选择60例(慢性肾脏病Ⅳ～Ⅴ期)患者,分为两组:肾功能衰竭未透析组30例(简称肾衰组);肾功能衰竭血液透析组30例(简称血透组),并设正常组30例。检测上述患者的血清AGEs及CRP、BUN、Cr等指标及测定IMT。结果:血透组与正常组、血透组与肾衰组、肾衰组与正常组的AGEs、Scr、Ccr、CRP、IMT比较均有明显差异(P<0.05);AGEs与Scr、CRP、IMT及CRP与IMT之间均具有正相关性(P<0.01);AGEs与Ccr则存在负相关性(P=0.003)。结论:AGEs的潴留部分是由于肾功能损害对AGEs的清除减少;肾功能衰竭患者存在着一定的微炎症-动脉粥样硬化状态;AGEs在肾衰患者动脉粥样硬化的发生、发展中起着重要的作用,有可能促进其心血管病变的发生或加重。     

慢性肾功能衰竭行腹膜透析炎症因子与肾功能指标的变化观察

分析炎症因子与肾功能指标在慢性肾功能衰竭行腹膜透析中的变化情况及意义。选取收治入院的80例慢性肾功能衰竭行腹膜透析患者作为研究对象,设为观察组;选取同期行健康体检的80例健康体检者为对照组。观察组予以腹膜透析治疗,比较对照组和观察组透析前、后炎症因子与肾功能指标之间的差异。观察组透析前TNF-α、CRP、IL-6、IL-8等炎症因子与BUN、SCR等肾功能指标水平明显高于对照组,差异有统计学意义(P0.05);观察组经过透析治疗1d后,TNF-α、CRP、IL-6、IL-8等炎症因子与BUN、SCR等肾功能指标水平明显低于透析前,差异有统计学意义(P0.05);观察组透析治疗30d后,TNF-α、CRP、IL-6、IL-8等炎症因子与BUN、SCR等肾功能指标水平明显低于透析治疗1d后,差异有统计学意义(P0.05)。腹膜透析能明显清除血清炎症因子,改善微炎症状态,同时有效清除体内毒素及代谢废物,降低肾功能指标,对临床治疗有积极作用。     

左卡尼汀对慢性肾衰竭腹膜透析患者微炎症状态的影响

目的观察左卡尼汀对慢性肾衰竭腹膜透析(CAPD)患者微炎症状态的影响。方法选择30例慢性肾衰竭CAPD患者。所有患者均行规律持续不卧床CAPD 6个月以上,予左卡尼汀1 g加入0.9%的氯化钠注射液20 ml静脉注射治疗,每周3次,连续应用12周。在治疗前后检测血尿素氮(BUN)、肌酐(Scr)、血红蛋白(Hb)、白蛋白(Alb)、高敏C-反应蛋白(hs-CRP)、白介素-6(IL-6)。结果 30例CAPD患者在治疗后Hb、Alb较治疗前升高,而hs-CRP、IL-6与治疗前比较降低,差异有统计学意义(P<0.05);BUN、Scr较治疗前有所升高,但无统计学差异。结论左卡尼汀可以改善慢性肾衰竭CAPD患者的微炎症状态。     

不同透析膜对血透患者血清C-反应蛋白及白细胞介素-6水平的影响

目的:探讨不同透析膜对维持性血液透析患者血清C-反应蛋白(CRP)及白细胞介素-6(IL-6)水平的影响。方法:选取尿毒症透析患者54例,分为醋酸纤维素膜(CA130)组、低通量聚砜膜(F6)组及高通量聚砜膜(F60)组,另选取30例尿毒症非透析患者作为非透析组,30例健康体检者作为正常对照组,监测透析前后患者炎症指标水平的变化。结果:透析组患者透析前及非透析组患者CRP、IL-6水平均较正常对照组显著升高(P<0.01)。F6组及F60组透析后CRP、IL-6水平与透析前相比差异均无统计学意义(P>0.05),CA130组透析后CRP、IL-6水平与透析前相比明显升高(P<0.01)。结论:尿毒症患者存在着微炎症状态,这种炎症状态与透析膜的生物相容性有关,而采用高通量透析器透析并不增加这种炎症反应。     

百令胶囊对慢性肾衰竭非透析患者的生活质量改善作用及机制研究

目的:研究百令胶囊对慢性肾衰竭(CRF)非透析患者生活质量的影响及其作用机制。方法:选择2014年6月~2015年6月于我院肾内科就诊的CRF非透析患者64例,给予规范西医治疗,待患者病情稳定后,在上述治疗基础上给予百令胶囊2.0 g,口服,每日3次,4周为1个疗程,连用2个疗程。比较治疗前后的临床症状评分、血肌酐水平、生活质量各维度评分及血清IL-6和CRP表达变化。结果 :治疗前后临床症状评分相比,差异具有统计学意义(P0.05)。64例CRF非透析患者临床总有效率为51.6%。与治疗前相比,治疗后患者血肌酐水平显著下降(P0.05)。除体能评分外,治疗后各项生活质量评分均较治疗前显著改善(P0.05)。治疗后,患者血清IL-6和CRP水平较治疗前均显著降低(P0.05)。所有患者在治疗期间均未出现明显不良反应,顺利完成治疗过程。结论:百令胶囊辅助治疗CRF非透析患者可显著改善患者临床症状,降低血肌酐水平,改善肾功能,从而对患者生活质量各维度起到了积极的影响,提高了患者生活质量,其作用机制可能为下调血清IL-6和CRP水平,改善机体微炎症状态。     

慢性肾功能衰竭患者低瘦素基因表达与高瘦素血症的相关病因研究

目的探讨慢性肾衰竭患者高瘦素血症与瘦素基因的表达、肾小球滤过率、体质指数及炎症之间的相关性。方法150例患者处于不同的慢性肾功能衰竭阶段,对其进行血清瘦素水平、肾小球滤过率、同型半胱氨酸、C-反应蛋白检测,并计算其体质指数。RT-PCR法检测15例终末期肾功能衰竭患者腹部脂肪的瘦素基因表达。结果137例肾功能损伤患者的血清平均瘦素水平为(20.8±1.9)μg/L,明显高于健康对照组的(9.0±1.0)μg/L(P<0.001)。肾衰竭患者的血清瘦素水平与体质指数之间呈显著正相关(r=0.47,P<0.001),血清瘦素水平与肾小球滤过率呈负相关(r=-0.26,P<0.001)。相关性分析发现血清瘦素与CRP、tHcy之间呈正相关(r分别为0.60、0.57,均P<0.05)。终末期肾功能衰竭患者瘦素mRNA表达水平显著低于健康对照组(P<0.01)。这些患者的血清瘦素水平与瘦素基因表达水平呈负相关(r=-0.55,P<0.05)。结论慢性肾衰竭患者血清瘦素水平的升高与肾小球滤过率下降所导致的瘦素清除减少有关;体质指数的增加及全身微炎症反应可引起高瘦素血症;高瘦素血症可通过反馈抑制使患者瘦素基因表达下降。     

Ruptured renal angiomyolipoma presenting as renal colic

The case of a patient with acute onset of flank pain and hematuria is presented. Initial therapy was directed toward relief of pain believed to be caused by renal colic. It was not until the patient developed atypical features that the true diagnosis, ruptured renal angiomyolipoma, was discovered. The case and discussion emphasize the need to carefully consider a complete differential diagnosis when evaluating patients with flank pain and hematuria who have atypical clinical features or an atypical course.     

Functional renal imaging: nonvascular renal disease

Functional renal imaging—a fast-growing field of MR-imaging—applies different sequence types to gather information about the kidneys other than morphology and angiography. This update article presents the current status of different functional imaging approaches and presents current and potential clinical applications. Apart from conventional in-phase and opposed-phase imaging, which already yields information about the tiusse composition, BOLD (blood-oxygenation level dependent) sequences, DWI (diffusion-weighted imaging) sequences, perfusion measurements, and dedicated contrast agents are used.     

Cortical renal leiomyoma with extension to renal pelvis

We describe a case of renal leiomyoma in a 21-year-old woman who presented with flank pain and hematuria. Urographic and computed tomographic (CT) studies revealed a large right renal mass with polypoid outgrowth protruding into the renal pelvis. Cortical renal leiomyoma with this radiographic manifestation is extremely rare.     

Epidemiology of renal recovery after acute renal failure

PURPOSE OF REVIEW: Recovery of renal function after acute renal failure is an important clinical determinant of patient morbidity. Herein, the epidemiology of renal recovery after acute renal failure will be described, along with potential predictive factors and interventions. RECENT FINDINGS: Renal recovery has been variably defined, most often as recovery to independence from renal replacement therapy. A recent consensus definition for acute renal failure has been published and included provisions for defining renal recovery. Renal recovery to renal replacement therapy independence occurs in the majority by hospital discharge and peaks by 90 days. All of older age, female sex, co-morbid illnesses, especially chronic kidney disease, and late initiation of renal replacement therapy or conventional intermittent renal replacement therapy have been coupled with non-recovery. Analysis of the literature suggests several interventions may influence recovery. SUMMARY: The prognosis is generally good for recovery after acute renal failure. Most patients will be independent of renal replacement therapy by 90 days. Additional research is necessary, however, to understand recovery rates not only to independence from renal replacement therapy, but also to complete and partial recovery. Future studies need to consider the health economic implications for survival and non-recovery. Finally, questions on the role of various interventions require characterization in randomized controlled trials to determine how they may influence renal prognosis.     

急性肾功能损伤与衰竭生物标志物

急性肾功能损伤（ARI）与急性肾功能衰竭（ARF）是加强医疗病房（ICU）的常见疾病．ICU中80％的ARF由急性肾小管损伤所致，而非肾小球或间质性病变引起。其死亡率较高，寻找敏感性和特异性较好的ARI或ARF生物标志物，对早期诊断、治疗和改善预后有着重要意义。本文介绍和评估了ARI或 ARF生物标志物的研究现状。并展望了其未来的前景。[第一段]     

Biomarkers of acute renal injury and renal failure

Acute renal failure (ARF) is a frequent problem in the intensive care unit and is associated with a high mortality. Early recognition could help clinical management, but current indices lack sufficient predictive value for ARF. Therefore, there might be a need for biomarkers in detecting renal tubular injury and/or dysfunction at an early stage before a decline in glomerular filtration rate is noted by an increased serum creatinine. A MEDLINE/PubMed search was performed, including all articles about biomarkers for ARF. All publication types, human and animal studies, or subsets were searched in English language. An extraction of relevant articles was made for the purpose of this narrative review. These biomarkers include tubular enzymes (alpha- and pi-glutathione S-transferase, N-acetyl-glucosaminidase, alkaline phosphatase, gamma-glutamyl transpeptidase, Ala-(Leu-Gly)-aminopeptidase, and fructose-1,6-biphosphatase), low-molecular weight urinary proteins (alpha1- and beta2-microglobulin, retinol-binding protein, adenosine deaminase-binding protein, and cystatin C), Na+/H+ exchanger, neutrophil gelatinase-associated lipocalin, cysteine-rich protein 61, kidney injury molecule 1, urinary interleukins/adhesion molecules, and markers of glomerular filtration such as proatrial natriuretic peptide (1-98) and cystatin C. These biomarkers, detected in urine or serum shortly after tubular injury, have been suggested to contribute to prediction of ARF and need for renal replacement therapy. However, excretion of these biomarkers may also increase after reversible and mild dysfunction and may not necessarily be associated with persistent or irreversible damage. Large prospective studies in human are needed to demonstrate an improved outcome of biomarker-driven management of the patient at risk for ARF.     

Cardiac enzymes, renal failure and renal transplantation

Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin, creatine kinase and its myocardial isoform, are altered in patients with renal failure. It is shown that cardiac troponins have decreased diagnostic sensitivity and specificity in patients receiving renal replacement therapy. Data regarding serum levels of these cardiac biomarkers, especially those of the cardiac troponins, in patients with a transplanted kidney are limited. Current data show that levels of cardiac troponin I are unaltered in patients who have undergone renal transplantation, while levels of cardiac troponin T may be elevated.We believe that cardiac troponin I should be the biomarker of choice for diagnosis of myocardial injury in these patients. However, further trials are required for conclusive results.     

支架植入术治疗肾血管性高血压的中远期疗效

目的:评价肾动脉内支架植入术(PTRAS)治疗肾血管性高血压的中远期疗效。方法:对42例肾血管性高血压(动脉粥样硬化性肾动脉狭窄21例,静止性大动脉炎肾动脉狭窄18例,肌纤维发育不良肾动脉狭窄3例),成功的施行PTRAS治疗肾动脉狭窄,采用彩色多普勒超声、CTA、定期门诊检查及肾动脉造影随访12～60月。全部病例均根据临床血压进行疗效评价。结果:支架植入术技术成功率100%。近期疗效(≤3月):42例患者高血压治愈者24例(57.14%)、改善者13例(30.95%)、无效者5例(11.90%)。中期疗效(4～12月):42例患者高血压治愈者17例(40.5%)、改善者19例(45.2%)、无效者6例(14.3%)。远期疗效(≥13月):42例患者高血压治愈者16例(38.1%)、改善者17例(40.5%)、无效者9例(21.4%)。≥3年疗效:24例高血压患者治愈者16例、改善者6例、2例无效。随访中有10例发生支架内再狭窄,行经皮腔内肾动脉成形术(PTRA)后,有6例血压改善。结论:PTRAS治疗肾血管性高血压中远期临床疗效肯定,支架内再次狭窄,大部分病例行PTRA可取得满意的疗效。