高频声像图与彩色多普勒能量图在乳腺良恶性肿瘤鉴别诊断中的应用

目的　探讨乳腺良恶性肿瘤的高频声像图及能量多普勒血流特征 ,提高乳腺良恶性肿瘤鉴别诊断的准确率。方法　对经手术病理证实的 3 6例乳腺癌及 3 3例乳腺良性肿瘤的高频声像图与能量多普勒血流特点进行回顾性分析。结果　乳腺良恶性肿块声像图的鉴别以肿块边界特征最为重要 ,能量多普勒显示乳腺癌内的血流较良性肿瘤明显丰富 (P <0 .0 1) ,乳腺癌的血管分布特征异常 ,血流阻力指数 (RI)在良恶性肿块有显著性差异 (P <0 .0 5 )。结论　高频声像图结合能量多普勒血流特征可以较准确鉴别乳腺良恶性肿瘤。     

结节性甲状腺肿的声像图表现及鉴别诊断

目的：分析结节性甲状腺肿（结甲）的声像图特征,探讨结甲与甲状腺腺瘤、甲状腺癌的鉴别诊断。方法：结甲２３７例,腺瘤３９例,甲状腺癌５７例,术前７．５ＭＨｚ高频探头观察结节数目和内部回声结构。结果：１７１例结甲（７２％）表现为多结节不对称分布在一侧或双侧肿大的甲头腺内,６６例（２８％）单结节,内部情况分囊性、实性、混合性回声结构,并分析了１４例误诊为腺瘤的原因和甲状腺癌的声像图特征。结论：结甲声像图多     

诊断甲状腺癌的高频声像图特征及血流显像探讨

目的：探讨高频超声与CDFI对甲状腺癌的诊断价值,从而提出及完善高频超声诊断甲状腺癌的标准。方法：对具有甲状腺癌高危因素的临床检查触及甲状腺肿大或有肿块的382例患者,进行高频超声和手术病理检查,将笔者曾总结发表过的甲状腺癌的高频声像图特征作为超声诊断甲状腺癌的阳性标准。结果：382例患者依病理检查结果分为甲状腺癌组及非甲状腺癌二组,其中甲状腺癌患者59例,非甲状腺癌患者323例,将超声检查结果与标准诊断法病理结果作对照,分别计算出超声检查的敏感度为76．3％,特异度为94．4％,准确度为91．6％,阳性预值为71．4％,阴性预值为95．6％。结论：本组甲状腺癌的高频声像图具有特征性表现,将其作为诊断甲状腺癌的标准,具有很大的临床应用价值及较高的符合率。     

胰腺囊性病变的声像图的鉴别诊断

本文追溯分析胰腺囊性病变２４例，并根据其声像图表现与最后诊断结果提出鉴别诊断。     

流行性出血热肾声像图分析

流行性出血热肾声像图分析王增华，姜淑梅，鹿瑶，王宏１资料与方法本文２８例流行性出血热患者均系我院住院病人，男１９人，女９人，年龄１８～３８岁，同期以１００例正常人肾脏做对照观察。用日本ＡｌｏｋａＳＳＤ－２５６型和ＧＥＲＴ─２６００型线阵超声诊断仪，探...     

高频超声对乳腺癌与乳腺纤维瘤鉴别诊断的意义

目的 探讨乳腺癌和乳腺纤维瘤的超声鉴别诊断。方法 对经手术证实的64枚乳房肿块进行回顾性分析，从病灶形态、边界及内部、周围、后方回声等方面比较。结果 浸润性导管癌22例，浸润性乳腺癌15例，粘液腺癌1例，超声诊断正确率89．5％；纤维瘤26例，诊断正确率92．3％。结论 大于2cm以上的乳腺癌与纤维瘤超声诊断正确率较高，但要注意二者声像图的重叠现象。     

外周神经源肿瘤的声像图诊断与鉴别诊断分析

目的：探讨超声显像在外周神经源肿瘤的诊断与鉴别诊断中的应用价值。方法：对21例经手术病理证实的外周神经源肿瘤的声像图进行了分析。结果：各类外周神经源肿瘤的声像图间具有不同的特征,超声诊断应结合神经系统症状与体征,并仔细寻找肿瘤与神经的连接处。结论：超声检查在此病诊断与鉴别上有重要的临床价值。     

乳腺癌高频超声声像图分析

目的：研究乳腺癌高频超声表现，提高诊断准确性。方法：回顾分析390例病理证实的乳腺癌超声资料。结果：乳腺癌超声声像图表现复杂。有形态不规则、毛刺样改变、高回声晕环、簇状钙化斑、回声衰减、纵横比大于1等表现的乳腺癌超声诊断正确率较高，形态规则、边界清晰、后方回声增强、囊实性、肿块小于10mm及中、高回声的乳腺癌超声诊断正确率较低。结论：充分认识乳腺癌各种超声表现，有助于乳腺癌的超声诊断。     

卵巢冠囊肿声像图特征及鉴别诊断

我院在诊断妇科盆腔囊性肿块经手术、病理证实的卵巢冠囊肿20例；其中腹部超声术前诊断卵巢冠囊肿11例，术后7例为卵巢冠囊肿，4例为妇科其它囊性肿块，术后超声诊断的13例卵巢冠囊肿，术前均诊断为卵巢囊肿，现将其声图像特征报告如下，同时探讨其鉴别诊断。     

对比剂肾病与肾动脉硬化的相关性研究

目的:探讨行冠状动脉介入诊疗术(percutaneous coronary artery interventional therapy,PCI)患者对比剂肾病(contrast-induced nephropathy,CIN)和肾动脉硬化的相关性.方法:选取接受PCI的患者468例,按年龄和CIN诊断标准分组,其中<70岁组中CIN 42例,非CIN 241例;≥70岁组中CIN57例,非CIN 128例.分析CIN与肾动脉硬化的相关性.结果:在同一年龄组中CIN与非CIN肾动脉硬化、肾动脉狭窄、肾血流峰速度及肾血流峰速度RI差异有显著性(P<0.05).结论:本文研究发现在CIN患者中肾动脉硬化的发生率明显升高,CIN与肾动脉硬化明显相关,肾动脉硬化、肾血流峰速度是CIN独立危险因素.     

The ACE inhibitor spirapril in chronic renal failure, hypertension and diabetic nephropathy

The evidence from recent clinical outcome trials in arterial hypertension (AH) and the treatment guidelines from national and international authorities have placed a clear emphasis on "tight" blood pressure (BP) control. This has been particularly well illustrated in the treatment of patients with diabetes mellitus and AH where "tight" BP control clearly improves the outcome with reduced numbers of fatal and non-fatal cardiovascular events. Whilst the clinical trials in AH have identified benefits through BP reduction with a range of antihypertensive drugs there is a considerable volume of evidence to suggest that the optimal treatment for diabetic nephropathy and microalbuminuria should be based upon ACE inhibition. It is widely held that inhibition of intra-renal renin angiotensin systems leads to greater benefit than can be achieved by hemodynamic changes alone. Thus, management of AH and nephropathy in both DM and other forms of renal disease revolves around BP reduction through an ACE inhibitor-based treatment regimen. Where there is renal failure it may be prudent to administer a drug such as spirapril which has non-renal elimination mechanisms and which has been shown to have no accumulation problems or increased adverse effects.     

Relationship between renal anemia and prognostic stages of IgA nephropathy

In 2002, the Joint Committee of the Special Study Group on Progressive Glomerular Diseases, Ministry of Health, Labor and Welfare of Japan newly revised the clinical guidelines for IgA nephropathy (Sakai et al.: Jpn J Nephrol 37:417-421, 1995; Tomino and Sakai: Clin Exp Nephrol, 7, 93-97, 2003). The prognostic stages were classified into four groups: the good prognosis group (Group I), relatively good prognosis group (Group II), relatively poor prognosis group (Group III), and poor prognosis group (Group IV). The relationship between the levels of Hb, Ht, and RBC in peripheral blood and the renal prognostic stages was determined in 62 patients with IgA nephropathy in the present study. The mean levels of Hb, Ht, and RBC were significantly lower in Group IV than in Group I (P<0.05). However, there were no significant changes in the levels of serum creatinine (s-Cr) or creatinine clearance (CCr) among these four groups. It appears that the levels of Hb, Ht, and RBC in peripheral blood may be important clinical parameters for the evaluation of prognostic stages in patients with IgA nephropathy.     

Relationships between arterial hypertension, metabolic disturbances and uric acid nephropathy

AIM: To study effects of uric acid disbolism in combination with other metabolic disturbances on prevalence and clinical symptoms of arterial hypertension; contribution of uric acid nephropathy to its development. MATERIAL AND METHODS: A cohort of 243 representatives from a general population (107 males, 136 females, age 19-59 years) was studied in 1986 and 15 years later. At the beginning and end of the trial the participants were examined for arterial hypertension, microalbuminuria, uric acid nephropathy, blood biochemical tests were made. RESULTS: For 15-year follow-up prevalence of arterial hypertension doubled, incidence of hyperuricemia and hyperuricosuria, hypertriglyceridemia increased considerably. The number of hypertensive subjects was maximal in the group with the greatest number of signs of uric acid nephropathy. CONCLUSION: The population studied exhibited increasing frequency of some risk factors, especially of uric acid metabolism, contributing to formation of arterial hypertension.     

Association between urinary VEGFA and renal pathology of IgA nephropathy patients

BackgroundRenal biopsy remains the golden standard for diagnosing and monitoring IgA nephropathy (IgAN). Vascular endothelial growth factor A (VEGFA) was crucial for the survival of glomerular cells. Our aim was to screen the expression pattern of urinary, circulating and renal VEGFA in IgAN patients to reveal their relationship with renal pathology and outcomes.MethodsBaseline VEGFA levels were determined with ELISA, real‐time PCR and immunohistochemistry. Associations between VEGFA expression and clinical–pathological parameters, and renal outcomes were evaluated.ResultsCompared with healthy controls, urinary VEGFA level was obviously elevated in IgAN patients (76.19 ± 63.67 pg/mg Cr vs 146.67 ± 232.71 pg/mg Cr, p = 0.0291) and not correlated with serum VEGFA level. Baseline urinary VEGFA was significantly associated with gender and tubular atrophy/interstitial fibrosis by stepwise multivariate regression analysis. Urinary VEGFA was higher in male patients accompanied with higher serum creatinine, larger proportion of hypertension and recurrent hematuria than in female patients. In the kidney of IgAN patients, VEGFA were robustly expressed in the parietal epithelial cells, podocytes, mesangial cells and tubular epithelial cells. After a follow‐up duration of 38.53 ± 27.14 months, IgAN patients with higher urinary VEGFA level were found to have a poorer renal outcome of renal replacement therapy (HR = 1.027, p = 0.037) or composite outcome (HR = 1.023, p = 0.039) after adjusting for confounders.ConclusionsIncreased urinary VEGFA might reflect certain renal pathology and, although not fully specific, still could be served as a valuable noninvasive indicator in predicting renal progression of IgAN.     

肾动态显像与IgA肾病病理学改变相关性研究

目的:研究肾动态显像与IgA肾病(IgAN)病理学改变的关系。方法:选择经病理学证实为IgAN患者67例,对其肾小球、肾小管间质和血管损害程度进行Katafuchi’s积分和Lee氏分级。全部患者均接受99mTc-DTPA肾动态显像,计算出灌注指数(PI)、肾小球滤过率(GFR)和20min清除率(C20)。分析不同病理分级之间显像指标与病理积分间的关系。结果:PI与血管损害积分正相关(P<0.01),GFR与肾小球损害(P<0.01)及肾小管间质损害积分(P<0.05)负相关,C20与肾小管间质损害积分(P<0.05)负相关。随着病理分级增高,GFR和C20值逐渐降低,PI值逐渐增高,且各级之间显像参数均有显著性差异(P<0.05)。结论:肾动态显像结果与肾脏组织病理学改变明显相关,能较好地反映病理损伤的进程,对IgAN病情评价及预后判断具有实用价值。     

糖尿病患者肾脏动脉血流改变与糖尿病肾病的关系

目的探讨糖尿病患者肾内动脉血流动力学变化对糖尿病肾病(DN)诊断的临床价值。方法以24小时尿蛋白排泄率(UAER)作为DN的诊断指标,应用彩色多普勒血流显像技术对2型糖尿病患者54例行肾脏动脉血管超声检查,以20例同期健康体检者为正常对照,对其收缩期最大血流速度、舒张期末最低血流速度和阻力指数进行统计学分析。结果糖尿病组舒张末血流速度下降及血流阻力指数增高程度与正常对照组之间差异均有统计学意义(P<0.01);其中肾内各级动脉血流阻力指数增高与肾功能损害程度相关。结论彩色多普勒超声检测糖尿病患者肾血流动力学变化有助早期DN诊断及肾功能不全的判断。     

Alteration of glycosylation in serum proteins: a new potential indicator to distinguish non-diabetic renal diseases from diabetic nephropathy

Diabetic nephropathy (DN) and nondiabetic renal disease (NDRD) are two major categories of renal diseases in diabetes mellitus patients. The clinical differentiation among them is usually not so clear and effective. In this study, sera from DN and NDRD patients were collected, and glycan profiles of serum proteins from DN and NDRD patients were investigated and compared by using lectin microarray and lectin blot. Then, altered glycoproteins were enriched by lectin coupled magnetic particle conjugate and characterized by LC-MS/MS. We found significant change in glycan patterns between DN and NDRD patients. In particular, the relative abundance of the glycopattern of Galβ1-3GalNAc which was identified by BPL (Bauhinia purpurea lectin) was significantly decreased in DN patients compared to four types of NDRD patients (p < 0.05). Moreover, BPL blotting indicated that the proteins with a molecular weight of about 53 kDa exhibited low staining signal in DN compared to all NDRD groups, which was consistent with results of lectin microarrays. After enriching by BPL and identification by LC-MS/MS, a total of 235 and 258 proteins were characterized from NDRD and DN respectively. Among these, the relative abundance of 12 isolated serum proteins exhibited significantly alteration between DN and NDRD (p < 0.05). Our findings indicated not only the relative abundance of Galβ1-3GalNAc on serum proteins but also certain glycoproteins modified with this glycopattern showed a difference between DN and NDRD patients. This suggested that the analysis of this alteration by using urine specimens may constitute an additional valuable diagnostic tool for differentiating DN and NDRD with a non-invasive method.

Glycomics strategies to screen serum biomarker for distinguishing diabetic nephropathy (DN) and nondiabetic renal disease (NDRD).     

副肾动脉直径与肾血管性高血压的相关性

目的探讨副肾动脉(ARA)直径与肾血管性高血压的关系。方法回顾性分析28例肾血管性高血压伴ARA患者及81例存在ARA但无高血压者,采用MSCTA观察ARA的支数、起源及走行。测量ARA直径,分析ARA直径与肾血管性高血压的关系。结果病例组年龄(30.6±7.5)小于对照组(49.1±13.1),差异有统计学意义(P<0.05)。病例组及对照组共检出133支ARA,其中右侧62支(62/133,46.62%),左侧71支(71/133,53.38%)。89支(89/133,66.92%)ARA主要起源于腹主动脉,41支(41/133,30.83%)为早发分支,另有2支(2/133,1.50%)起源于肠系膜下动脉,1支(1/133,0.75%)起源于肠系膜上动脉。109例中,1支型89例(89/109,81.65%),2支型17例(17/109,15.60%),3支型2例(2/109,1.83%),4支型1例(1/109,0.92%)。病例组ARA直径与同侧肾动脉直径比值(0.87±0.11)大于对照组(0.33±0.13),双侧肾动脉直径比值(0.71±0.17)小于对照组(0.94±0.05),二者差异均有统计学意义(P均<0.05)。结论 MSCTA检查能够清晰显示ARA支数、起源及走行。ARA直径粗大与肾血管性高血压有关。     

Treating hypertension in diabetic nephropathy

OBJECTIVE: Control of hypertension in patients with diabetic nephropathy improves mortality and slows progression to end-stage renal disease. However, blood pressure is difficult to treat; multiple drug combination therapy is required and treatment algorithms to establish this are lacking. We used a stepped-care algorithm, centered on maximum doses of an ACE inhibitor or angiotensin II receptor blocker, to treat hypertension according to American Diabetes Association recommended blood pressure target goals (<130/80 mmHg) in patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS: We treated 49 consecutive patients with diabetes (13 with type 1 and 36 with type 2), diabetic nephropathy, and proteinuria > or =500 mg/24 h with a stepped-care blood pressure treatment algorithm. The level of blood pressure control achieved at most recent follow-up was assessed. RESULTS: Patients were followed for a median of 18 months (range 9-48). Mean blood pressure achieved was 140/75 +/- 23/14 mmHg in patients with type 1 diabetes and 146/76 +/- 22/14 mmHg in patients with type 2 diabetes. Target blood pressure was reached in 16 (33%) patients, 6 of 13 patients with type 1 diabetes and 10 of 36 patients with type 2 diabetes, whereas systolic blood pressure remained above the target level in the remaining patients. There was no difference in baseline blood pressure, proteinuria, or serum creatinine level between patients who were treated to target and those who were not. CONCLUSIONS: Levels of blood pressure control similar to those achieved in clinical trials in diabetic nephropathy were obtained with a stepped-care algorithm. However, in most patients, systolic blood pressure was difficult to control to target despite the use of multiple drug combination therapy.