急性肾损伤新型早期生物标志物的研究进展

急性肾损伤(acute kidney injury, AKI)是由各种原因引起的肾功能在短时间内急剧下降而出现的一组临床综合征,因其发病率高、死亡率高逐渐受到大家的关注,早期诊断和及时治疗是改善预后的关键。传统的AKI诊断标志物“血肌酐(serum creatinine, Scr)、尿量”等会不同程度受到“年龄、性别、蛋白质摄入量、利尿剂”等的影响而在早期诊断方面具有局限性,因此,越来越多的研究者开始着眼于具有早期诊断价值的新型生物学标志物,以期改善预后。近年来的研究发现肾损伤因子-1、中性粒细胞明胶酶相关脂质运载蛋白、血清胱抑素C等在早期诊断AKI方面有一定的价值,根据作用机制不同,有的还可以反映肾损伤部位,判断病因,甚至预测预后,本文将就近年来发现的AKI早期诊断生物学标志物的研究进展进行综述。     

急性肾损伤的病因及预后分析

目的 调查笔者所在医院患者急性肾损伤(AKI)患病情况,以了解AKI的发病率、病因构成及预后.方法 通过调查本院近年收治患者的肾功能及尿量检测结果,筛检出AKI患者,总结分析患者的临床特征及其转归等情况.结果 引起AKI的主要病因依次为药物、严重感染、外科手术、肾后性梗阻.结论 及早诊断AK1对早期预防和积极干预AKI,提高AKI的生存率和改善预后具有重要意义.     

急性肾损伤预后相关指标的研究进展

急性肾损伤(AKI)的诊断已得到广泛的研究,临床上通常能根据尿量、血肌酐和其他的一些指标而迅速作出早期诊断。目前,AKI患者的预后情况如何,那些AKI的幸存者,是否会有向慢性肾脏病发展的趋势,他们的肾脏功能是否得到完全恢复等问题也逐渐得到大家的关注。现对AKI预后的相关指标进行综述,包括AKI预后生物标志物以及预后的指标。     

NGAL在新生儿肾损伤中的研究进展

新生儿由于肾脏发育不成熟,且易暴露于缺氧等危险因素中,因而急性肾损伤(AKI)的发生率较其他年龄阶段高。AKI的发生又大大增加了新生儿的病死率和患慢性肾脏病的危险性。因此,对重症新生儿进行肾功能的实时监测,早期发现AKI,并进行及时、有效的临床干预,对改善患儿的预后至关重要。中粒细胞明胶酶相关脂质运载蛋白作为一种新兴的早期诊断和预测肾损伤的生物标志物而备受关注,其在窒息、脓毒症、早产等多种危险因素相关性新生儿肾损伤的早期诊断中有重要临床价值,是预测新生儿肾损伤的敏感指标。     

急性肾损伤早期标志物及其在体外循环术后应用的研究进展

急性肾损伤(AKI)是体外循环心脏手术后常见而又严重的并发症,早期发现AKI并及时进行干预治疗影响着患者的预后。传统的AKI诊断指标为血清肌酐水平上升,但血清肌酐的上升往往发生在AKI出现后的48～72 h,不利于AKI的早期诊断。近来越来越多的研究发现,中性粒细胞明胶酶相关性脂质运载蛋白、肾损伤分子1、胱抑素C、白细胞介素(IL)18、IL-6、IL-8、脂肪酸结合蛋白、神经生长因子1等的检测可能会更早地预测AKI的发生。     

慢加急性肝衰竭并发急性肾损伤的研究进展

急性肾损伤(AKI)是由各种因素导致肾功能突然损伤、肾小球滤过率急剧下降的一组临床综合征。AKI是慢加急性肝衰竭(ACLF)患者常见并发症之一,是影响肝衰竭患者预后的独立危险因素。AKI的早期诊断、有效处理对降低ACLF患者病死率,改善预后意义重大。文章对ACLF患者AKI的发病机制、生物学标志物、诊断标准、分类、治疗等方面的最新研究进行了综述。     

急性肾损伤56例临床分析

目的:探讨急性肾损伤(acute kidney injury,AKI)的发病情况、致病原因及治疗措施等,为明确诊断、及早防治提供依据。方法:对56例AKI患者的病因、临床表现、病变程度以及治疗和预后等进行回顾性分析。结果:不同病因AKI患者的转归差异无统计学意义(P0.05),AKI分级越高病死率越高(P0.05),透析和非透析治疗的病死率相似(P0.05)。结论:AKI的预后与其病因和分级关系密切,透析治疗对AKI患者的预后无显著改善,AKI早期诊断、及早治疗,有助于改善患者预后,提高存活率。     

脓毒症性急性肾损伤诊断和预后评估相关生物标志物的研究进展

脓毒症是指由感染引起的全身炎症反应综合征,容易导致患者出现多器官功能衰竭,急性肾损伤(AKI)是脓毒症发展过程中最常见、最严重的并发症之一。对脓毒症并发AKI患者进行早期诊断、早期干预、延缓肾功能恶化是治疗的关键。因此,探寻脓毒症急性肾损伤(SIAKI)诊断以及预后评估的相关生物标志物具有重要的临床意义。本文主要针对SIAKI诊断和预后的相关生物标志物进行探讨并做简要综述,为改善预后提供合理的参考依据。     

急性肾损伤相关新型生物标志物的研究进展

急性肾损伤(AKI)在临床上发病率高且病情危重,临床上基于血清肌酐和尿量对早期诊断AKI具有迟滞性,存在不足。临床需要敏感性强、特异性高的生物标志物,帮助早期诊断AKI,以便采取措施来减轻肾损伤、保护肾功能。一些与AKI发病机制密切相关的新型生物标志物正逐步用于AKI早期识别、临床监测和预后评估。本文主要对近年来发现的AKI相关生物标志物,如白介素24、肝型脂肪酸结合蛋白、几丁质酶3样蛋白1、微RNA、PARK7和CDH16的生物学功能、研究现状及应用前景方面进行综述。     

AKI预警标志物的研究进展

急性肾损伤(acute kidney injury,AKI)是由各种因素导致的临床综合征,尽管科学在发展,发病率、死亡率一直居高不下,并且严重影响患者的预后,这主要是由于对肾脏损伤的早期诊断缺乏敏感的、特异性的指标,使得患者错过了最佳的治疗窗口。研究发现在AKI的早期给予干预,能够明显提高患者的预后,达到满意的治疗效果。所以AKI的早期诊断是提高患者的生活质量的关键措施,期间出现了一系列AKI的早期分子标志物,包括NGAL、IL-18、miRNA、KIM-1、NAG、L-FABP、TIMP-1、IGFBP-7、TFF-3、GST-π、MYL12B等。本文就这些AKI分子标志物进行总结,阐述这些分子标志物在AKI诊断及预后预测中的价值,以便于及早制定有针对性的AKI治疗及护理策略,使早期诊断、早期干预AKI成为可能。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.