肾病范围蛋白尿在判断IgA肾病预后中的意义

目的：研究ＩｇＡ肾病进展为慢性肾功能不全（ＣＲＩ）的临床危险因素。方法：对８４５例经肾活检确诊的ＩｇＡ肾病患者进行追踪观察。用病例对照研究方法研究血肌酐水平、高血压、肾病范围蛋白尿、年龄、性别与ＩｇＡ肾病预后的关系。结果：血肌酐≥１２０μｍｏｌ／Ｌ、高血压、男性、年龄＞４０岁、肾病范围蛋白尿的比值比（ＯＲ）分别为１１４，４７，２８，２１，１９８。比较发病时血肌酐＜１２０μｍｏｌ／Ｌ，５年后发展为ＣＲＩ及５年后肾功能仍正常的病例，发现肾病范围蛋白尿的ＯＲ值为１８（Ｐ＜００１）。结论：血肌酐≥１２０μｍｏｌ／Ｌ、高血压、肾病范围蛋白尿、年龄＞４０岁、男性均为ＩｇＡ肾病进展为ＣＲＩ的临床危险因素。其中肾病范围蛋白尿判断预后的意义更大。     

狼疮肾炎并发高血压729例相关因素分析

目的探讨影响狼疮肾炎(LN)高血压发生的相关因素。方法对729例LN患者完整临床病理资料进行回顾性分析，比较LN并发高血压组与LN不伴高血压组患者临床表现、实验室检查和病理学改变等方面的差别，利用单因素及多因素分析探讨LN并发高血压的危险因素。结果本组高血压发生率为34．3％，高血压发生率随着患者年龄增加、病程延长和肾功能恶化而逐渐增加，组间差异存在统计学意义；单因素分析提示男性，年龄≥45岁，病程≥3年，高血压家族史，尿蛋白≥2．0g／d，血肌酐≥133μmol／L，高胆固醇血症，肾小管间质指数≥5，新月体指数≥2，肾小球硬化指数≥2等是LN患者并发高血压的危险因素；多因素Logistic回归分析结果显示性别、年龄、血肌酐水平、肾小球硬化程度是LN高血压发生的独立影响因素。结论高血压是LN常见并发症。发生率高，其发生与家族史、性别、病程长短、蛋白尿程度、血肌酐水平等因素有关，应及时有效地控制血压水平。     

IgA肾病高血压发生的危险因素分析

目的 探讨我国南方地区IgA肾病高血压发生的危险因素.方法 收集280例肾活检确诊为IgA肾病患者的临床病理资料,分析与高血压发生的相关危险因素.结果 280例患者中高血压患者96例,占34.3%.单因素分析发现年龄≥40岁、体重≥60 kg、尤肉眼血尿、病程≥60个月、血尿素氮≥18 mmol/L、血肌酐≥133/μmol/L、高尿酸血症、24 h尿蛋白≥1.5 g、肾小球节段损害≥25%、全球硬化≥10%、肾小管萎缩≥25%、炎性细胞浸润≥25%、间质纤维化≥25%、血管壁增厚≥10%等因素影响到高血压的发生;多因素logistic回归分析提示血肌酐、年龄、血管壁增厚、体重和24 h尿蛋白为IgA肾病高血压发生的独立危险因素.结论 IgA肾病高血压的发生与多种危险因素有关,血肌酐、年龄、血管肇增厚、体重和24 h尿蛋白是高血压发生的独立危险因素. 血尿、病程≥60个月、血尿素氮≥18 mmol/L、血肌酐≥133/μmol/L、高尿酸血症、24 h尿蛋白≥1.5 g、肾小球节段损害≥25%、全球硬化≥10%、肾小管萎缩≥25%、炎性细胞浸润≥25%、间质纤维化≥25%、血管壁增厚≥10%等因素影响到高血压 发生;多因素logistic回归分析提示血肌酐、年龄、血管壁增厚、体重和24 h尿蛋白为IgA肾病高血压发生的独立危险因素.结论 lgA肾病高血压的发生与多种危险因素有关,血肌酐、年龄、血管肇增厚、体重和24 h尿蛋白是高血压发生的独立危险因素. 血尿、病程≥60个月、血尿素氮     

糖尿病、高血压病患者尿白蛋白、免疫球蛋白G和β2微球蛋白放射免疫分析的诊断价值

本文采用放射免疫分析（ＲＩＡ）方法检测了６８例糖尿病、４４例高血压病患者及３０名正常人２４小时尿白蛋白（Ａｌｂ）、免疫球蛋白Ｇ（ＩｇＧ）和β２微球蛋白（β２ｍＧ）排泄量。观察到糖尿病肾病、高血压肾病尿Ａｌｂ、ＩｇＧ、β２ｍＧ增高。结果表明，糖尿病和高血压病患者并发肾脏病变时并非局限于肾小球，而且常伴有或仅存在肾小管病变；病程与肾损害的发生、发展及严重程度有关；糖尿病较高血压病患者一般发生肾损害早、进展快，高血压肾病肾小管病变早于肾小球。提示用ＲＩＡ方法检测糖尿病和高血压病患者尿Ａｌｂ、ＩｇＧ、β２ｍＧ有助于早期、确切判断并发肾病时的病变部位及病损程度。     

泌尿系统疾病

泌尿系统疾病０６１血管紧张素转换酶抑制剂治疗严重ＩｇＡ肾病的远期疗效：与用其他抗高血压药治疗及未治疗者比较［英］／ＣａｔｔｒｉａｎＤＣ…／／ＡｍＪＫｉｄｎｅｙＤｉｓ．－１９９４，２３（２）．－２４７～２５４作者对１１５例严重ＩｇＡ肾病（ＩｇＡＮ）患者...     

肾性高血压和IgA肾病病人红细胞钠／锂逆转运率的变化

肾性高血压和ＩｇＡ肾病病人红细胞钠／锂逆转运率的变化陈韵岱，等．中华医学杂志，１９９４，７４：２１４应用改良的Ｃａｎｅｓｓａ法，测定了２１例ＩｇＡ肾病病人（ＩｇＡＮ）。１３例肾实质性高血压病人（ＲＨＴ）的红细胞钠／理逆转运率（ＲＢＣＮａ￣＋／Ｌｉ￣＋...     

慢性肾小球疾病高血压及其对肾功能的影响

作者分析５２０例经肾活检的慢性肾小球疾病患者的临床资料，发现其高血压发病率为３２．７％，膜增生性肾炎、新月体肾炎及硬化性肾炎高血压发病率较高，ＩｇＡ肾病和微小病变肾病Ｙ高血压发病率较低。不同病理类型慢性肾脏病高血压发病率不同，降压疗法可改善肾功能，延缓肾衰发展速率。     

肾组织中乙型肝炎病毒抗原检测与IgA肾病的联系

目的：比较ＩｇＡ肾病（ＩｇＡＮ）肾组织中乙型肝炎病毒抗原（ＨＢＡｇ）阳性和阴性患者的临床与病理特点，方法：收集经免疫组化技术检测证实的肾组织ＨＢＡｇ阳性组２６例和阴性组５９例ＩｇＡＮ患者的临床和病理及随访资料，结果：与阴性组相比，阳性组肾病综合征者多见。血红蛋白，血清ＩｇＡ水平和肌酐清除率显著下降，２４ｈ尿蛋白定量显著增加（Ｐ〈０．０５），免疫荧光以ＩｇＡ＋ＩｇＧ＋ＩｇＭ水平和肌酐清除率显著下降，     

IgA肾病90例活检中肾小管间质损害对肾小球功能的影响

为进一步评价ＩｇＡ肾病活检中肾小管间质损害的临床意义，对９０例ＩｇＡ肾病患者活检时，肾小球滤过率与多个临床病理因素作相关分析和ｌｏｇｉｓｔｉｃ回归。结果发现，在诸多临床病理因素中，与内生肌酐清除率（Ｃｃｒ）相关程度最高的是间质炎症细胞浸润程度，其次是肾小管萎缩和间质纤维化，肾小管间质损害越重，Ｃｃｒ越小。ｌｏｇｉｓｔｉｃ回归方程表明，根据间质炎症细胞浸润程度、肾小管萎缩、血压持续升高及Ｍｅａｄｏｗ分级，可准确判断ＩｇＡ肾病患者Ｃｃｒ的下降情况。提示ＩｇＡ肾病患者中肾小管间质病变，在肾小球功能损害过程中起重要作用，应引起临床医生的高度重视。     

纤维连接蛋白在IgA肾病肾组织内的分布及意义

为了解纤维连接蛋白（Ｆｎ）在ＩｇＡ肾病中的意义，对１０７例ＩｇＡ肾病患者肾组织内Ｆｎ的变化及其与病理和临床的关系进行了观察，发现Ｆｎ分布与系膜增宽程度平行，并在新月体、严重系膜增生及肾小球硬化区明显增多。与单纯系膜区分布者相比，Ｆｎ沿毛细血管襻分布者的病理变化程度、新月体形成、ＩｇＧ、ＩｇＡ及Ｃ３沿肾小球基底膜的沉积，高血压、肾病综合征及非选择性蛋白尿发生率均增高（０．０１＜Ｐ＜０．０５），同时血肌酐清除率下降（０．０１＜Ｐ＜０．０５），２４小时尿蛋白量明显增加（Ｐ＜０．０１）。对４４例的随访表明，Ｂ组慢性肾功能不全的发生率显著高于Ｍ组。结果显示：Ｆｎ在毛细血管襻上的增加反映了系膜增生及毛细血管壁免疫损伤严重程度，并伴有严重的临床表现和不良的预后。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.