脂蛋白肾小球病--由载脂蛋白E变异诱导的肾脏脂质沉积症

许多研究证实,继发于肾病综合征、高血压及饮食失衡的高脂血症可以引起肾小球硬化,其病变性质与被氧化的低密度脂蛋白(ＬＤＬ)所致的动脉性硬化性病变相似,一些遗传性脂质代谢异常引起的全身性疾病如Ｆａｂｒｙ病(卵磷脂酰基转移酶缺乏)和ＶｏｎＧｉｅｒｋｅ病也可引起特殊的肾脏脂质沉积[1～3];与上述肾脏脂质沉积症相比,脂蛋白肾小球病(ＬｉｐｏｐｒｏｔｅｉｎＧｌｏｍｅｒｕｌｏｐａｔｈｙ,ＬＰＧ)是近十年来发现的一种新的独立的肾小球疾病,它以毛细血管袢高度扩张,袢内充满脂蛋白栓塞为特征。Ｓａｉｔｏ的研究强调ＬＰＧ的发生与载脂蛋…     

100例肾小球疾病脑干听觉诱发电位检测及其临床意义

作者检测了100例肾小球疾病(肾病综合征75例,急性肾炎25例)患者的脑干听觉诱发电位(BAEP)。结果表明,肾病综合征组脑干听觉诱发电位异常者达69.3%,急性肾炎组为32%。提示肾小球疾病与脑干听觉诱发电位异常有一定的相关性,肾小球疾病的临床四项指标(水肿、病程、内生肌酐清除率、血压)与脑干听觉诱发电位异常也有一定关系。并证明肾小球疾病的病情越重,脑干听觉诱发电位的异常越明显,随着病情的缓解或治愈,脑干听觉诱发电位可恢复正常。     

原纤维性肾小球肾炎

原纤维性肾小球肾炎是一组新的肾小球疾病。本文从临床情况、光镜检查、电镜检查以及免疫荧光检查等方面作一综合介绍。     

肾小管间质损害在IgA肾病中的临床意义

目的：探讨肾小管间质损（TIL）在IgA肾病（IgAN）中的临床意义。方法：分析609例IgAN患者的临床与病理资料。结果：肾小管间质损害情况,肾小管间质损害轻度占47．1％,中度者占21．7％,重度者占16．6％,无肾小管间质损害者仅占14．6％。肾小管间质损害与临床指标的关系;随着肾小管间质损害程度的加重。IgAN患者的病情亦逐渐加重,表现为知血压升高,尿蛋白定量增加,血清白蛋白下降及肾功能减退。肾小管间质损害与病理参数的关系。血管损害、肾小球总体损害、系膜增殖程度及球性硬化的积分随着肾小管间质损害程度的加重逐渐增高,反之,随着肾小球和血管病变的加重,肾小管间质损害程度亦相应加重,结论：肾小管间质损害在IgAN患者病理改变中广泛存在,并随其损害程度的加重,IgAN患者的病情亦逐渐加重,肾小管间质损害可能是决定IgAN预后不良的关键因素之,且其与肾小球及血管病程度均呈平行关系,从而提示肾小管间质害与肾小球和血管的病变有直接的关系。     

肾小球疾病患者血清唾液酸水平的研究

通过动态观测急性肾小球肾炎（ＡＧＮ）及原发性肾病综合征（ＰＮＳ）患者不同时期血清唾液酸（ＳＡ）水平，结果发现：ＡＧＮ、ＰＮＳ发作期血清ＳＡ浓度显著高于正常对照组，缓解期较发作期显著下降，未缓解患者血清ＳＡ浓度持续升高。动态监测血清ＳＡ浓度的变化，可了解ＡＧＮ、ＰＮＳ疾病的活动与预后，并可作为观察ＰＮＳ激素敏感程度的指标。     

急进性肾小球肾炎中抗肾小球基底膜抗体的检测及其临床意义

急进性肾小球肾炎中抗肾小球基底膜抗体的检测及其临床意义刘娜赵明辉章友康郑欣王海燕国外报道抗肾小球基底膜（ＧＢＭ）抗体在包括所有的原发性和继发性急进性肾小球肾炎（ＲＰＧＮ）中阳性率为２０％左右［１］，而国内以往报道的仅为５％～１０％左右［２，３］，这种...     

粘附分子与肾脏疾病

粘附分子是介导细胞与细胞以及细胞与基质相互连接的一类分子，它参与体内的一些生理病理过程，本文对粘附分子的分类及生物学特性，粘附分子炎症反应和信号传递过程中的作用，粘附分子异常表达在肾小球肾炎，肾移植，血液透析时的致病作用等进行了综述。     

肾小球基底膜的遗传性疾病

肾小球基底膜的遗传性疾病陈惠萍，陈明魁肾小球基底膜的遗传性疾病包括Ａｌ－ｐｏｒｔ综合征（Ａｌｐｏｒｔｓｙｎｄｒｏｍｅ，ＡＳ）、甲－膑综合征（ｎａｉｌ－ｐａｔｅｌｌａｓｙｎｄｒｏｍｅ，ＮＰＳ）及薄基底膜肾病（ｔｈｉｎｂａｓｅｍｅｎｔｍｅｍｂｒａｎｅｎｅ...     

检测慢性肾小球肾炎患者血浆和尿液透明质酸的临床意义

慢性肾小球肾炎发展至尿毒症的病理改变是肾小球硬化和间质纤维化,其根本病变是细胞外基质增生,透明质酸（HA）是细胞外基质的基本成分之一.我们对40例慢性肾小球肾炎和（或）合并尿毒症患者的血清和尿HA的水平进行检测.     

高尿酸血症与IgA肾病临床病理的相关性分析

目的 探讨高尿酸血症与IgA肾病临床病理的相关性.方法 选取2007年1月至2010年12月在吉林大学第一医院肾内科肾活检确诊为IgA肾病患者148例,根据血尿酸水平分为血尿酸正常组(107例)和血尿酸增高组(41例),并对两组年龄、性别、高血压、病程、体重指数、生化指标及病理情况进行比较.结果 二组患者间性别、年龄等差异均无统计学意义(P>0.05).血尿酸增高组患者高血乐发病率、病程(月)、体重指数(kg/m2)、血尿素氮(mmol/L)、肌酐(μmol/L)、TG (mmol/L)及24 h尿蛋白定量(mg/24 h)分别为63.4%、18.90 ±10.12、22.81±3.60、8.93±4.28、155.96±107.72、2.11±1.06和4328.16±1434.25,而血尿酸止常组分别为38.3%、9.46±3.91、15.32±2.54、5.21±2.18、79.52±40.01、1.86±1.20和2885.10±1388.15,两组患者差异均有统计学意义(P值均<0.05).Lee's分级血尿酸增高组I+Ⅱ级占12.2%、IV+V级占39.0%,而血尿酸正常组I+Ⅱ级占25.2%、IV+V级占16.9%,两组患者差异均有统计学意义(P值均<0.05).肾小管间质损害(TIL)分级血尿酸增高组以Ⅲ十Ⅳ级多见,占68.3%,而血尿酸正常组以Ⅱ级多见,占76.6%.肾小动脉病变分级血尿酸增高组以Ⅱ+Ⅲ级多见,占73.2%,而血尿酸止常组以0+I级多见,占69.2%.结论 IgA肾病患者血尿酸水平与24 h尿蛋白定量、血压、肾功能损害相关,血尿酸升高者Lee's分级、TIL分级及肾小动脉病变分级较差.

Abstract：

objective To analyze the correlation between the level of serum uric acid and the clinical and pathological features of IgA nephropathy.Methods Totally 148 patients diagnosed as IgA nephropathy by renal biopsy in our hospital from January 2007 to December 2010 were divided into hyperuricaemic group(41 cases)and non-hyperuricaemic group(107 cases)according to the level of serum uric acid.The clinical parameters and renal pathology grade were compared.Results There were significant differences between hyperuricaemic group and non-hyperuricaemic group in the incidences of hypertension(63.4%vs 38.3%),disease duration[(18.90±10.12)months vs(9.46±3.91)months]and body mass index[(22.81±3.60)kg/m2vs(15.32±2.54)kg/m2](all P<0.05),while no differences in age and sex(both P>0.05).The blood urea nitrogen(BUN)[(8.93±4.28)mmol/L vs (5.21±2.18)mmol/L],creatinine(Cr)[(155.96±107.72)μmol/L vs(79.52±40.01)μmol/L],serum triglycerides[(2.11±1.06)mmoVL vs(1.86±1.20)mmol/L]and 24-hour urine protein amount [(4328.16±1434.25)mg/24 h vs(2885.10±1388.15)mg/24 h]were significantly different between the two groups(all P<0.05).The percentage of Lee's grade I+Ⅱin hyperuricaemic group was 12.2%,and IV+V grade was 39.0%,while percentage of Lee's grade I+Ⅱin non-hyperuricaemic group was 25.2%,and IV+V grade was 16.9%(P<0.05).Tubulointerstitial lesions(TIL)gradeⅢ+IV was more in hyperuricaemic group,which was 68.3%,while TIL grade II was more in non-hyperuricaemic group,which was 76.6%.Renal artery damage grade II+Ⅲ was more in hyperuricaemic group.which was 73.2%,while renal artery damage grade 0+1 was more in non-hyperuricaemic group,which was 69.2%.Conclusion The level of serum uric acid was related with 24-hour urine protein amount,blood pressure and kidney function in IgA nephropathy,and Lee's grade,TIL grade and renal artery damage grade were severe in hyperuricaemic group.     

Immunomodulation effects and clinical evidence of apheresis in renal diseases

This article overviews the immunomodulation effects and clinical evidence of apheresis in renal diseases, in particular primary and secondary glomerulonephritis. A considerable permeability factor(s) derived from circulating T cells is speculated to have a crucial role in the proteinuria of nephrotic syndrome (NS). Plasma exchange (PE), immunoadsorption using Protein A sepharose cartridges, low-density lipoprotein apheresis and lymphocyte apheresis (LCAP) were tried to remove such factors or pathogenic T cells. Other glomerular diseases induced by specific antibodies such as antiglomerular basement membrane antibodies, antineutrophil cytoplasmic antibodies and immune-complexes such as lupus nephritis were also treated with PE, double filtration plasma apheresis. IAPP and LCAP. Many reports suggested that apheresis might have beneficial immunomodulation effects for the treatment of glomerular diseases: however, the recommendations based on evidence from small cohorts remain at low-level in most.     

高血压病患者血清载脂蛋白与主动脉壁厚度和视网膜动脉硬化的关系

从住院的高血压病患者中选择高脂血症者７６例（高脂组），血脂正常者５２例（对照组）。同时进行血清载脂蛋白（ａｐｏ）、主动脉壁厚度（ＡＷＴ）及眼底检查。结果：与对照组比较，高脂组血清ａｐｏＢ、ＡＷＴ、视网膜动脉硬化（ＲＡＳ）程度及冠心病患病率均显著增加，ａｐｏＡＩ及ａｐｏＡＩ／ａｐｏＢ均显著降低。相关分析显示，ＡＷＴ与ＲＡＳ呈正相关；ＡＷＴ和ＲＡＳ各自与ａｐｏＢ呈正相关，与ａｐｏＡＩ、ａｐｏＡＩ／ａｐｏＢ呈负相关（均Ｐ＜０．０１）。经逐步回归，筛选对ＡＷＴ和ＲＡＳ有显著作用的血脂指标均为ａｐｏＡＩ／ａｐｏＢ。提示ａｐｏＡＩ／ａｐｏＢ是反映Ａｓ疾病较可靠的血脂指标。     

冠心病患者胰岛素抵抗与血脂、载脂蛋白异常的关系

目的探讨冠心病(CHD)患者胰岛素抵抗(IR)与血脂、载脂蛋白异常的关系。方法以空腹胰岛素(FIns)／空腹葡萄糖(FBG)比值和口服葡萄糖负荷之后胰岛素曲线下面积(RIAUC)／葡萄糖曲线下面积(GAUC)比值作为IR指标,与空腹血脂、载脂蛋白进行直线相关分析。结果与正常对照组比较,冠心病组血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(apoB);FIns／FBG比值以及RIAUC、GAUC和RIAUC／GAUC比值均显著增加(P<0．05～0．001),高密度脂蛋白胆固醇(HDL-C),HDL2-C,apoAI及apoAI／apoB比值均显著降低(P<0．05～0．001);冠心病组FIns/FBG比值和RIAUC／FBG比值均分别与TG、LDL-C和apoB呈正相关(P<0．05～0．01),与HDL2-C、apoAI和apoAI／apoB比值呈负相关(P<0．05～0．001),正常对照组与上述指标间则无相关(P>0．05)。结论CHD患者IR与血脂、载脂蛋白异常密切相关。     

The relationship between clinical and echocardiographic findings in mitral valve prolapse

Incorporating prognostically related auscultatory, M-mode, 2DE and recent Doppler echocardiographic features, the following strict criteria for establishing the diagnosis of mitral valve prolapse (MVP) have been advanced: 1. auscultatory; mid-to-late systolic clicks and a late systolic murmur at the apex or mid-to-late systolic clicks at the apex which move appropriately with maneuvers that alter LV volume or late systolic murmur at the apex in young patients (coinciding that a similar murmur in elderly population is non-specific for MVP); 2. two-dimensionally "targeted" M-mode criterion: marked (greater than 3 mm) late systolic buckling posterior to C-D line (moderate 2 mm late systolic buckling or 3 mm holosystolic displacement "arouse suspicion" but do not establish MVP); 3. two-dimensional echocardiographic criteria: severe bowing of leaflet(s) on the parasternal long axis and four-chamber view (mild to moderate bowing alone are unacceptable) or left atrial coaptation point; 4. Doppler echocardiographic criteria: moderate or severe Doppler mitral regurgitation with any degree of leaflet bowing or mild Doppler mitral regurgitation with at least moderate bowing of one leaflet (mild leaflet bowing and mild mitral regurgitation can be regarded as "probable MVP"). The concept of mitral valve prolapse syndrome encompasses that which was earlier described in patients with a high prevalence of symptoms. In controlled studies, however, it has become apparent that cardiac and psychiatric symptoms can be found as frequently in normal subjects as in those with MVP. These results indicate that clinicians may have erroneously diagnosed patients with MVP because of premature acceptance that MVP is the cause of a distinctive syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)     

慢性肝病临床与病理关系的对比研究

目的 探讨慢性肝病患者临床与病理学分级、分期的关系。方法 对２００例慢性肝病虱的临床表现、血清生化指标与病理学分级、分期进行对比分析。结果 患者的年龄、临床症状及体征积分数与病理分级、分期显著相关（Ｐ〈０．０５）；ＰＬＴ、ＲＢＣ、ＡＳＴ、ＰⅢＮＰ与炎症程度有关：ＰＧＡ指数、ＰＧＡＡ指数、Ａ、Ａ／Ｇ与炎症及纤维化均显著相关；透明质酸是反映慢性肝病炎症及纤维化严重程度的准确指标。血清纤维化指标的优化组合有提高准确性的趋势。病毒复制指标与炎症及纤维的化未见相关。结论 慢性肝病临床与纤维化病理分级、分期有良好相关性、有助于肝纤维化的非创伤性诊断。     

载脂蛋白E血浆水平和基因多态性与胰岛素抵抗关系研究

目的 :本文旨在探讨载脂蛋白E血浆水平和基因多态性与胰岛素抵抗关系。方法 :我们进行了大样本北京自然人群横断面研究 ,应用聚合酶链反应 限制性片段长度多态性技术 (PCR RFLP)进行apoE基因分型 ,比较不同基因型人群载脂蛋白E血浆水平 ;分析不同apoE血浆水平和基因型与HOMA IR、胰岛素水平、IRS患病率、IRS中各异常组分患病率的关系。结果 :1 ε2 2 ,ε2 3,ε2 4基因型者较ε3 3者有较高的apoE血浆水平 ;2 高apoE血浆水平IRS患病率增高 ,HOMA IR指数增加 ;3 高apoE血浆水平与高血糖、高血压、脂代谢紊乱和中心型肥胖等IRS各组分均有一定关系 ;4 在高apoE血浆水平下 ,ε2 3基因型对胰岛素抵抗有保护作用 ,而ε3 4者易合并胰岛素抵抗。结论 :载脂蛋白E血浆水平和基因多态性和胰岛素抵抗密切相关     

载脂蛋白E基因多态性与散发性阿尔茨海默病的关系

目的：探讨载脂蛋白E（apoE)基因多态性与散发性阿尔茨海默病（SAD）遗传易感性的关系。方法：应用限制性片段长度多态分析－聚合酶链反应（RFLP－PCR）方法，测定58例SAD和60例同龄对照者apoE基因型和等位基因，并与59例血管性痴呆（VD）患者进行对比研究。结果：SAD组ε4等位基因频率（19．82％）和3／4型频率（25．86％）均明显高于对照组（5．00％和6．67％；χ2＝13．87，P＜0．01）和VD组（6．70％和10．17％，χ2＝11．5，P＜0．05），VD组ε4频率（6．70％）与对照组比较，差异无显著性（χ2＝11．61，P＞0．05），结论：apoEe4等位基因是SAD的遗传易感基因。     

原发性高血压病患者血清抵抗素与血脂及载脂蛋白的相关性

在71例原发性高血压病患者测量体重指数、体内脂肪百分比、腰臀比和测定空腹血抵抗素、血糖、胰岛素、脂类及载脂蛋白浓度。结果显示原发性高血压病患者血清抵抗素水平与血糖、血脂和载脂蛋白代谢有关，提示抵抗素对能量代谢有重要的影响。