慢性肾功能衰竭患者血清脂蛋白a的意义

目的：了解慢性肾功能衰竭患的血清蛋白a的变化。方法：利用免疫比浊法检测36例慢性肾功能衰竭(CRF)患血清脂蛋白a[Lp(a)]水平，并与89例正常人对照。结果：CRF患血清Lp(a)明显于高于正常对照组（P＜0．001），结论：CRF患易发生动脉粥样硬化（AS）。并发心肌梗死，脑血管和周围血管疾病的机率较高。     

慢性肾功能衰竭(CRF)血液透析患者血清脂蛋白(a)的变化及意义

目的　观察慢性肾功能衰竭 (CRF)血液透析患者血清脂蛋白 (a) [Lp(a) ]水平的变化及其临床意义。方法　对 60例慢性肾功能不全患者的临床及实验室资料作回顾总结 ,分析血清脂蛋白 (a)的水平与心血管事件的关系。结果　CRF患者无论透析与否 ,其血Lp(a)水平均较对照组显著性升高(P <0 .0 5 )。血液透析 (HD)组Lp(a)水平升高及HDL C水平下降更明显 (P <0 .0 5 ) ,而血透组与非透析组血总胆固醇 (CHOL)、低密度脂蛋白 (LDL C)浓度差异无显著性。Lp(a)水平与心电图异常、超声心动图异常及心血管事件的发生呈正相关。结论　CRF患者存在严重的脂代谢紊乱 ,Lp(a)水平的变化可能是CRF患者尤其HD并发心血管疾病的危险因素之一     

慢性肾功能衰竭甲状旁腺激素和甲状旁腺激素相关蛋白的变化及相关性的临床研究

目的　探讨慢性肾功能衰竭 (CRF)患者甲状旁腺激素 (PTH)和甲状旁腺激素相关蛋白 (PTHr P)的关系。方法　采用放免法测定 92例 CRF患者和 30例正常人血清 PTH和血浆 PTHr P含量 ,并按 CRF分期 ,将 CRF患者分为四期。结果　 (1 )在慢性肾功能衰竭各个阶段 ,血清 PTH、血浆 PTHr P含量较正常对照组明显升高 (P<0 .0 1 )。 (2 )相关分析显示血清 PTH与血肌酐 (Scr)、血尿素氮 (BUN)、碱性磷酸酶 (AL P)、血压 (BP)存在显著正相关 (P<0 .0 1 ) ,与血红蛋白 (Hb)存在显著负相关 ,与钙 (Ca)、磷 (P)无相关性 (P>0 .0 5)。血浆 PTHr P与Scr、 BUN存在显著正相关 (P<0 .0 1或 P<0 .0 5) ,与 Ca、 P、 Hb、 ALP、 BP无显著相关性 (P>0 .0 5)。两者与年龄、病程均无显著相关性 (P>0 .0 5)。结论　 (1 )血清 PTH含量及血浆 PTHr P均可反映慢性肾功能衰竭的程度 ,其含量随肾功能损害的加重而逐渐升高。 (2 )血清 PTH含量及血浆 PTHr P反映肾功能损伤基本一致 ,但两者与 Ca、P、Hb、ALP、 BP相关性不完全相同     

肾脏疾病患者血清脂蛋白(a)的浓度变化及临床研究

目的为探讨肾脏疾病患者血清脂蛋白(a)〔Lp(a)〕的浓度变化与肾功能损害程度的关系。方法应用ELISA法检测50例来我院就诊的肾脏疾病患者血清脂蛋白(a)〔Lp(a)〕及血脂水平。结果检测发现肾病患者存在不同程度的Lp(a)等脂类代谢紊乱,其中肾病综合征患者和糖尿病肾病患者Lp(a)及血脂水平均明显高于正常对照组,(P<0.O1),而慢性肾小球肾炎患者Lp(a)及血脂水平正常或偏低。结论肾脏疾病患者LP(a)水平与肾脏早期损害有关。     

慢性肾功能衰竭病人血清肿瘤坏死因子-α和白细胞介素-1β水平的检测及分析

目的探讨慢性肾功能衰竭(CRF)病人血清肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平的变化。方法用ELISA法对16例慢性肾功能衰竭病人和23例体检健康者的血清TNF-α和IL-1β水平进行检测和分析。结果慢性肾功能衰竭病人血清TNF-α和IL-1β水平显著高于健康对照组。结论慢性肾功能衰竭的发生和功能紊乱可能与血清TNF-α和IL-1β水平异常有关。     

慢性肾功能衰竭伴发精神神经系统障碍80例临床分析

我科自1991年6月～1995年12月共收治由各种原因所致的慢性肾功能衰竭(CRF)患者并发精神。神经系统障碍80例,现将临床表现、治疗、预后进行分析如下: 1 临床资料 1.1 一般资料:80例慢性肾功能衰竭(CRF)均为住院患者,男性49例占61.25％,女性31例占38.75％,男∶女=1.58∶1;职业以农民为主占92.00％,市居民占8.0％,慢性肾功能衰竭(CRF)原发病因以慢性肾小球肾炎为主,其次为慢性肾盂肾炎、肾结核、高血压肾动脉硬化、结缔组织病、糖尿病肾病、乙肝肾、多囊肾等。 1.2 临床表现:烦躁不安30例、全身抽搐20例、嗜睡15例、昏迷5例、谵妄10例。     

118例肾脏病患者血清谷氨酰转肽酶测定的临床意义

本文报导118例肾脏病住院患者血清谷氨酰转肽酶(γ-GT)及有关酶学检测结果,除慢性肾功能衰竭(CRF)5例外,113例均作了肾活检组织学,免疫荧光等资料,其中狼疮性肾炎(LN)62例,肾小球肾炎45例,其他肾脏病11例(包括急性肾功能衰竭2例,CRF5例,多动脉炎1例,先天性肾血管畸形1例,肾小管间质病2例)。118例肾脏病中60例患者血清γ-GT 活性增高(占50.8%),狼疮性肾炎62例     

慢性肾衰患者血清转铁蛋白受体的研究

目的 探讨血清转铁蛋白受体(sTfR)在慢性肾功能衰竭(CRF)伴缺铁性贫血患者中的意义.方法 对60例CRF患者,20例健康对照者进行血红蛋白(Hb)、红细胞压积(Hct)、血清铁(SI)、血清铁蛋白(SF)、sTfR测定.结果 sTfR在CRF伴缺铁组明显升高;与CRF不伴缺铁组比较有显著性差异(P<0.01).结论 血清sTfR含量能更加快速、真实地反映体内铁贮存情况,对患者的诊断、治疗具有重要意义.     

肾康注射液治疗慢性肾功能衰竭的临床观察

目的观察肾康注射液对慢性肾功能衰竭的疗效。方法将慢性肾功能衰竭患者80例随机分组,治疗组及对照组各40例。治疗组在慢性肾功能衰竭(CRF)常规治疗方法基础上,给予静脉点滴肾康注射液,对照组采用慢性肾功能衰竭常规非透析方法治疗,疗程均为4周。结果治疗组患者临床症状改善,血尿素氮、肌酐明显降低,与对照组比较有显著性差异(P<0.05)。结论治疗组能显著改善慢性肾功能衰竭患者的肾功能,延缓慢性肾功能衰竭的速度。     

血清甲状旁腺激素、视黄醇结合蛋白及β2-微球蛋白水平与慢性肾功能衰竭的相关性分析

目的：探讨血清中甲状旁腺激素（ iPTH）、视黄醇结合蛋白（ sRBP）及β2-微球蛋白（β2-MG）水平与慢性肾功能衰竭（ CRF）的相关性。方法选取确诊为慢性肾功能衰竭的患者100例作为观察组,另选取体检健康的志愿者100例为健康组,比较2组血清iPTH、sRBP及β2-MG水平,分析CRF患者血清iPTH、sRBP及β2-MG水平三者的相关性。结果观察组血清iPTH、sRBP和β2-MG三者水平均高于健康组,差异均有统计学意义（ P＜0．05或P＜0．01）;血清iPTH水平与sRBP和β2-MG水平呈明显正相关（r＝0．6889、07456,P＜0．05）,sRBP水平和β2-MG水平呈明显正相关（r＝0．8123,P＜0．05）。结论血清中iPTH、sRBP和β2-MG三者水平在慢性肾功能衰竭时都显著性的增加,以上三项指标均可用于肾功能是否衰竭的判断指标。     

脑部疾病患者血清脂蛋白(a)检测的临床意义

目的:探讨脑部疾病患者与血清脂蛋白(a)的关系。方法:采用单克隆抗体浊度法测定了852例脑部疾病患者和94例健康者的脂蛋白(a),并与胆固醇、甘油三酯含量进行了比较。结果:除了癫痫脂蛋白(a)平均水平低于健康对照组外,其余各组脑部疾病患者的脂蛋白(a)平均水平均高于健康对照组。其中脑梗塞、颅脑损伤、脑动脉硬化、颅内肿瘤的增高有非常显著差异(P<0.01);短暂脑缺血发作、头痛的增高有显著性差异(P<0.05);脑出血、眩晕的增高则无显著性意义(P>0.05);癫痫的降低亦无显著性意义(P>0.05)。胆固醇、甘油三酯增高的患者,其脂蛋白(a)与胆固醇无明显相关性,与甘油三酯有正相关关系。结论:血清脂蛋白(a)可作为脑梗塞、颅脑损伤、脑动脉硬化、颅内肿瘤等脑部疾病的临床诊断生化指标之一。     

In vivo effect of lipoic acid on lipid peroxidation in patients with diabetic neuropathy

BACKGROUND: The diabetic state, in both humans and experimental animals, is associated with oxidative stress. Lipid peroxidation of nerve membranes has been suggested as a mechanism by which peripheral nerve ischemia and hypoxia could cause neuropathy. Lipoic acid (LA) is a powerful inhibitor of iron-dependent lipid peroxidation and reactive oxygen species. The treatment of diabetic peripheral and cardiac autonomic neuropathy with LA is based on good clinical and experimental evidence. MATERIALS AND METHODS: To investigate the magnitude of the oxidative stress, serum ceruloplasmin (Cp) and lipid peroxide (Lp) levels were measured in 10 patients with diabetic neuropathy, before and 70 days after treatment with single dose of 600 mg LA/day. For other 12 healthy age- and sex-matched control subjects the serum Cp and Lp levels were evaluated. RESULTS: Our results show that hyperglycemia is a factor for an increase in serum ceruloplasmin in patients with diabetic neuropathy compared to healthy subjects (p < 0.0001). High serum ceruloplasmin (Cp) level in patients with diabetes may be related to antioxidant defense. The treatment of diabetic neuropathy with LA does not affect significantly the serum Cp activity. The serum Lp levels after LA administration were significantly lower (p < 0.005) than those before treatment. CONCLUSIONS: The antioxidant therapy with LA improves and may prevent diabetic neuropathy. This improvement is associated with a reduction in the indexes of lipid peroxidation. Oxidative stress appears to be primarily due to the processes of nerve ischemia and hyperglycemia autooxidation.     

急性冠状动脉综合征患者脑钠肽及高敏C反应蛋白与脂蛋白水平的相关研究

目的 探讨血清脑钠肽(BNP)与急性冠状动脉综合征之间的相关性及可能的临床意义.方法 研究对象为急性心肌梗死患者36例(AMI组),不稳定型心绞痛患者38例(UAP组),稳定型心绞痛患者30例(SAP组),健康体检者30例(对照组).用酶联免疫吸附分析法测定所有研究对象的血清BNP、hs-CRP和Lp(a)浓度,并行心脏超声检查,测定左心室射血分数(LVEF)、左心室收缩末期容积(LVEDV)及舒张末期容积( LVESV).结果 AMI组的BNP、hs-CRP、Lp(a)水平分别为(391±136) ng/L、( 16±15) mg/L、(367±191 )mg/L.UAP组分别为(267±80) ng/L、(11±7) mg/L、(324±171) mg/L.SAP组分别为(36±21) ng/L、(2±1)mg/L、(191±130) mg/L.对照组分别为(33±14) ng/L、(1.0±0.4)mg/L、(150±116)mg/L.AMI组和UAP组上述指标与对照组及SAP相比,差异有统计学意义(P＜0.05或P＜0.01).AMI组与SAP组上述指标比较,差异有统计学意义(均P ＜0.05).AMI组与UAP组比较,差异无统计学意义(均P＞0.05).AMI组LVEDV、LVESV、LVEF分别为(95±19)、(43±9)ml,(0.51±0.08);UAP组分别为(93±23)、(42±8)ml,(0.55 ±0.08);AP组分别为(86±18)、(32±9)ml,(0.64±0.09);对照组分别为(86±18)、(29±9)ml,(0.66±0.09).AMI组、UAP组与SAP组及对照组比较,差异均有统计学意义(P＜0.01).AMI组与UAP组比较,差异无统计学意义(P＞0.05).SAP组与对照组比较,差异无统计学意义(P＞0.05).多元回归分析表明,在ACS患者中,BNP浓度与hs-CRP和Lp(a)呈正相关,(r=0.53,P＜0.01;r=0.543,P＜0.01).BNP浓度与LVEF明显负相关(r=-0.44,P＜0.01).控制年龄、性别、体表面积后计算两变量间偏相关系数.急性冠状动脉综合征患者首次发病48 h内BNP浓度与同期测定的左心室舒张末容积、收缩末 容积呈正相关(r =0.42、0.40,均P＜0.01).结论 血清BNP浓度在ACS患者中明显升高,可作为重要的诊断指标之一.ACS患者BNP浓度的升高除了与心脏大小和射血分数相关外,也可能与缺血损伤造成的急性期炎症反应有关.     

脑钠肽对慢性肾衰竭合并心力衰竭的诊断价值

目的观察肾小球滤过率（eGFR）与脑钠肽（BNP）之间的关系,比较慢性肾衰竭合并心力衰竭（心衰）患者不同eGFR水平BNP的诊断界值（cut—off值）,研究肾功能对BNP应用于心衰诊断的影响。方法对老年eCRF合并心衰未透析患者52例及无心衰29例和老年健康体检者30例（健康对照组）采用酶联免疫吸附法测定血清BNP浓度,根据eGFR分组进行对比。结果eGFR小于30ml、30～60ml心衰组BNP水平均高于eGFR小于30ml、30—60ml无心衰对照组和eGFR大于60ml健康对照组（P〈0．05）,eGFR小于30ml、30—60ml无心衰对照组BNP水平较eGFR大于60柚健康对照组显著升高（P〈0．05）。eGFR小于30ml心衰组与eGFR30—60ml心衰组BNP相比较,差异无统计学意义（t=0．62,P〉0．05）。eGFR与BNP心衰组无相关,无心衰对照组呈负相关（心衰组γ=-0．081,P〉0．05,对照组γ=-0．581,P〈0．01）。eGFR30～60ml心衰组ROC曲线下面积（AUC）为0．951,1500ng／L作为临界值的敏感度为96．4％,特异度为86．7％;eGFR小于30ml心衰组AUC为0．860,1850ng/L作为临界值的敏感度为66．7％,特异度为92．9％。结论CRF合并心衰时心衰是导致BNP升高的主要原因,BNP可作为判断CRF患者是否合并心衰的诊断指标。     

他汀类药物对慢性肾功能衰竭患者炎性反应的影响

目的 观察慢性肾功能衰竭(CRF)患者C-反应蛋白(CRP)、纤维蛋白原(Fg)的变化,探讨他汀类药物对CRF患者炎性反应的影响.方法 将54例CRF患者随机平均分为两组:非他汀组予常规治疗;他汀组予常规治疗加普伐他汀20 mg/d或辛伐他汀20 mg/d.同时设健康对照组20例.测定各组治疗前和治疗4周后CRP、Fg水平.结果 CRF患者治疗前CRP、Fg显著高于对照组,差异有统计学意义(P＜0.05).治疗4周后,他汀组CRP、Fg水平下降,与治疗前及同期非他汀组相比,差异有统计学意义(P＜0.05).结论 (1)CRF患者中存在CRP水平升高的炎性反应;(2)他汀类药物可以降低CRP、Fg水平,提示其具有降脂以外的抗炎作用.     

Effect of severe renal failure and haemodialysis on the pharmacokinetics of levosimendan and its metabolites

BACKGROUND AND OBJECTIVES: Levosimendan is a calcium sensitiser developed for the treatment of congestive heart failure. It increases myocardial contractility, reduces the filling pressure and dilates both the peripheral and coronary vessels. The circulating metabolites of levosimendan, OR-1855 and OR-1896, are formed and eliminated slowly after intravenous administration of levosimendan. The aim of this study was to investigate the effect of impaired renal function and haemodialysis on the pharmacokinetics of levosimendan, OR-1855 and OR-1896. STUDY DESIGN: This study was an open-label, nonrandomised, phase I pharmacokinetic study. Levosimendan was administered as a single-dose infusion of 0.1 microg/kg/minute for 24 hours. The follow-up period lasted 3 weeks. STUDY SETTING: Twenty-fivepatients were included:12 patients with severe chronic renal failure (CRF) with creatinine clearance of < 30 mL/minute/1.73 m(2) and 13 patients with end-stage renal disease (ESRD) undergoing haemodialysis. A group of 12 healthy subjects served as controls. RESULTS: Levosimendan, the parent drug, was eliminated rapidly from the plasma after discontinuation of its infusion, with an elimination half-life (t(1/2)) [mean +/- standard error of mean] of 1.5 +/- 0.09 hours in ESRD patients undergoing haemodialysis, 1.0 +/- 0.2 hours in patients with severe CRF and 0.91 +/- 0.03 hours in healthy subjects. The t(1/2) of levosimendan was significantly longer (p < 0.001) in ESRD patients undergoing haemodialysis than in healthy subjects. The t(1/2) of OR-1855 and OR-1896 were 94.0 +/- 20.4 hours and 96.5 +/- 19.5 hours, respectively, in ESRD patients undergoing haemodialysis compared with 60.8 +/- 5.2 and 61.6 +/- 5.2 hours, respectively, in healthy subjects (p = not significant). The t(1/2) of OR-1855 was significantly longer (85.0 +/- 13.6 hours) in patients with severe CRF than in healthy subjects (60.8 +/- 5.2 hours, p < 0.05). The area under the plasma concentration-time curve (AUC) and the peak plasma concentration (C(max)) of the metabolites were approximately 2-fold in patients with ESRD undergoing haemodialysis and patients with severe CRF compared with healthy subjects. The mean unbound fraction (f(u)) of levosimendan in plasma was approximately 2% in each study group, whereas the f(u) of the metabolites was considerably higher (63-70%). In contrast to levosimendan, the metabolites were dialysable, with dialysis clearance of approximately 100 mL/minute. The haemodynamic responses and adverse event profiles were similar in the study groups, with headache, palpitations and dizziness being the most frequently recorded adverse events. CONCLUSION: The t(1/2) of the levosimendan metabolites was prolonged 1.5-fold and their AUC and C(max) were 2-fold in patients with severe CRF and ESRD patients undergoing haemodialysis as compared with healthy subjects. These results suggest that the dose should be reduced when levosimendan is used for the treatment of congestive heart failure in patients with severe renal insufficiency.     

脂蛋白（a）在动脉粥样硬化患者中的变化及血脂康干预的影响

目的：探讨冠心病（CHD）患者及脑梗死患者血清脂蛋白（a）[Lp(a)]水平及药物干预的影响。方法：151例CHD病人，其中急民生心肌梗死（AMI）20例，陈旧性心肌梗死（OMI）49例，心绞痛（AP）82例；脑梗死患者42例及正常对照组30例，测定其血清Lp(a)浓度。对高Lp(a）水平随机分组用血脂康胶囊及维生素C治疗。结果：CHD及脑梗死组其血清Lp(a)水平明显高于对照组（均P＜0.01)；CHD组高于脑梗死组（P＜0.01)。CHD组中，AMI组＞AP组＞OMI组（P＜0.01或P＜0.05）。用血脂康胶囊4粒/日治疗40例，12周末血清Lp(a)下降19.66%，与治疗前比较差异显著（P＜0.05)。结论：提示Lp(a)有致动脉粥样硬化的作用；血脂康胶囊对高血清Lp(a)水平安全有效。     

糖尿病肾病患者血清脂蛋白(a)水平变化及其意义

目的探讨血清脂蛋白(a)犤Lp(a)犦在糖尿病肾病中的意义。方法检测132例尿白蛋白排泄量不同的糖尿病患者血清Lp(a)等指标,并以正常人为对照。结果糖尿病肾病组Lp(a)水平为359±293mg/L,明显高于糖尿病无肾病组的208±221mg/L及正常对照组123±91mg/L(P<0.01)。临床蛋白尿组Lp(a)水平为(482±341)mg/L,明显高于微量蛋白尿组254±179mg/L(P<0.05)。Lp(a)与尿白蛋白呈正相关(r=0.498,P<0.01)。结论糖尿病肾病患者伴有Lp(a)代谢紊乱,并随着肾损害加重,Lp(a)水平呈进行性增高。     

老年冠心病患者载脂蛋白(a)多态性与血清脂蛋白(a)水平的关系

目的方法:应用SDS-聚丙酰胺凝胶电泳和免疫印迹分析,检测了68例健康老人和104例老年冠心病(CHD)患者的载脂蛋白(a)[Apo(a)]异构体多态性表型,同时也检测了血清脂蛋白(a)[Lp(a)]及血脂水平。结果:CHD组Lp(a)和血脂水平明显高于对照组(P<0.05或P<0.01)。检出11种不同Apo(a)表型,其检出率冠心病组为82.7％,对照组为75％。含有B,S_1和S_2带的Apo(a)低分子量表型CHD组明显高于对照组(29.8％比16.2％,P<0.05)。回归分析显示Apo(a)表型的分子量与Lp(a)水平呈显著负相关(CHD)组r=-0.9091,对照组r=-0.9479,P<0.05)。结论:Apo(a)表型是血清Lp(a)水平的主要决定因素,其低分子量表型可作为老年CHD的独立的危险因子。     

Role of altered prednisolone-specific lymphocyte sensitivity in chronic renal failure as a pharmacodynamic marker of acute allograft rejection after kidney transplantation

Summary The effects of four immunosuppressive agents on the in vitro blastogenesis of peripheral blood lymphocytes activated by concanavalin A have been studied using cells from 26 healthy subjects, 34 patients with chronic renal failure (CRF) and 30 kidney transplant recipients.Differences in lymphocyte sensitivity to prednisolone between the healthy subjects and the CRF patients were statistically significant (P<0.0002), with impaired sensitivity in CRF. Impaired lymphocyte sensitivity occurred in 3.8% and 52.9% of the healthy and CRF subjects, respectively. Lymphocyte sensitivity to prednisolone, both preoperatively and 3 months post-operatively, was strongly correlated with early allograft rejection during co-administration of prednisolone with cyclosporin or azathioprine. Lymphocyte sensitivity to cyclosporin, azathioprine, and mizoribine in CRF was not significantly less than that in healthy subjects.Since the pharmacokinetics of prednisolone are little altered in renal transplantation, it is concluded that lymphocyte sensitivity specific to prednisolone may be a pharmacodynamic marker characteristic of successful graft survival in patients with histo-incompatibility and/or drug resistance.