25-Hydroxyvitamin D metabolism and its effect on calcitriol metabolism in experimental renal failure

We studied 25-hydroxyvitamin D3 (25(OH)D3) metabolism and its effect on calcitriol metabolism in renal failure achieved by partial nephrectomy in rats. Metabolic clearance rates (MCRs) of 25(OH)D3 were significantly decreased in rats with renal failure (creatinine clearance, 0.21 +/- 0.02 ml/min/100 gm; MCR, 54.6 +/- 3.5 microliters/min/kg, n = 6) in comparison with normal control rats (creatinine clearance, 0.56 +/- 0.03 ml/min/100 gm; MCR, 73.4 +/- 1.6 microliters/min/kg, n = 5, both p less than 0.01). Because production rates (PRs) of 25(OH)D3 were not different between the two groups of rats (renal failure, 1.8 +/- 1.1; control, 1.8 +/- 0.42 microgram/kg/day), the decreased MCR resulted in elevation of plasma levels of 25(OH)D3 (22.7 +/- 1.6 vs control 17.1 +/- 0.28 ng/ml, p less than 0.01). Injection of 600 ng 25(OH)D3 per day for 6 days significantly increased the MCR of 25(OH)D3 in both normal rats (89.6 +/- 3.2 microliters/min/kg, n = 6, p less than 0.01) and rats with renal failure (84.9 +/- 9.7 microliters/min/kg, n = 6, p less than 0.01) when compared with normal rats (73.4 microliters/min/kg) and rats with renal failure (54.6 microliters/min/kg) injected with vehicle, respectively. To study the effect of 25(OH)D3 on calcitriol metabolism, MCRs of calcitriol were measured in normal rats and in rats with renal failure that received daily injection of 600 ng 25(OH)D3 for 6 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

不同给药途经的1,25 (OH)2 VitD3治疗慢性肾衰竭继发甲旁亢的疗效观察

目的 为观察不同给药途经的1,25(OH)_2VitD_3治疗慢性肾衰竭继发甲旁亢的临床疗效。方法 对长期透析的25例继发甲旁亢病人采用口服或静脉注射1,25(OH)_2VitD_3,2ug/次,2次/周,连续观察6月。结果 两种治疗方式均有效,患者血中iPTH均较治疗前有下降,但静脉给药组iPTH下降幅度高于口服给药组且稳定。而口服给药组易发生高钙血症而中断治疗。两种治疗方法对肝功能、碱性磷酸酶及血肌酐均无影响。结论 静脉注射及口服1,25(OH)_2vitD_3治疗慢性肾功能不全并甲状旁腺功能亢进均有效,但后者易出现高钙血症。     

Acute renal effects of sulindac and indomethacin in chronic renal failure

The effects of 2 days of oral dosing with sulindac (200 mg twice a day) or indomethacin (75 mg twice a day) on glomerular filtration rate, urinary excretion of prostaglandin E2, sodium homeostasis, and other renal function parameters were investigated in eight patients with chronic stable impaired renal function. Indomethacin reduced creatinine clearance (from 41.0 +/- 7.9 to 30.3 +/- 6.3 ml/min) and increased serum levels of creatinine and beta 2-microglobulin. Sulindac had no effect on any of these parameters. Both drugs induced depression of urinary prostaglandin E2 excretion; this depression was greater after indomethacin. Urinary sodium excretion fell from 144.4 +/- 18.7 to 85.5 +/- 9.7 mmol/24 hr after indomethacin and from 131.7 +/- 11.6 to 103.4 +/- 13.3 mmol/24 hr after sulindac. Body weight increased 1.2 kg after indomethacin but was not changed by sulindac. Plasma renin activity was reduced from 2.3 +/- 0.8 to 1.7 +/- 0.6 nmol/L/hr by sulindac and from 2.8 +/- 0.8 to 1.5 +/- 0.5 nmol/L/hr by indomethacin. Urinary N-acetyl-beta-glucosaminidase and kallikrein excretion was not changed by either drug. Our data suggest that sulindac affects renal prostaglandin E2 synthesis and sodium excretion in patients with severe renal failure to a lesser extent than does indomethacin. Sulindac still seems to be the drug of choice in this group of patients, but glomerular filtration rate, body weight, and electrolyte balance should be carefully monitored.     

饮食干预对慢性肾衰竭病人病程进展的影响

近年慢性肾衰竭（chronic renal failure，CRF）的发病率、患病率持续升高。CRF的治疗费用持续增长，给个人、家庭、社会造成严重的经济负担。如何延缓和阻止CRF的持续发展一直是肾脏病学界研究的焦点之一。大量研究已证实低蛋白饮食（LPD）可以改善CRF病人症状，延缓肾功能进展。我科对临床上尚未透析的CRF病人进行膳食干预研究，并对干预后肾功能等指标进行长期随访，以探讨现代营养疗法对减轻CRF症状，改善病人生活质量，延缓CRF的发展的影响。现报告如下。     

饮食干预对慢性肾衰竭病人病程进展的影响

近年慢性肾衰竭(chronic renal failure,CRF)的发病率、患病率持续升高[1]。CRF的治疗费用持续增长,给个人、家庭、社会造成严重的经济负担。如何延缓和阻止CRF的持续发展一直是肾脏病学界研究的焦点之一。大量研究已证实低蛋白饮食(LPD)可以改善CRF病人症状,延缓肾功能进展[2]     

骨化三醇对慢性肾衰竭继发甲状旁腺功能亢进患者血全段甲状旁腺激素的影响

目的探讨骨化三醇对慢性肾衰竭(CRF)继发甲状旁腺功能亢进(SHPT)患者血全段甲状旁腺激素(iPTH)的影响。方法选择106例CRF患者为研究对象,分为研究组和对照组各53例,对照组采用常规方法治疗,研究组在此治疗基础上加用骨化三醇治疗6个月,比较治疗前后iPTH、钙(Ca)、磷(P)、肌酐(Cr)水平变化并统计分析。结果研究组与对照组治疗前血iPTH、Cr、Ca和P的水平均无统计学差异,治疗后研究组血iPTH、Cr显著低于对照组,血Ca水平显著高于对照组(P0.05)。血P水平无显著变化(P0.05)。结论骨化三醇治疗CRF患者的SHPT取得了较好的效果,值得临床进一步推广应用。     

2种灌肠方法对慢性肾功能衰竭疗效的比较研究

中药保留灌肠治疗慢性肾功能衰竭是一种有效、经济、方便、实用的方法。临床实践发现,不同的灌肠方法对临床疗效有一定影响。2003年6月-2005年12月,课题组运用自拟大黄降浊汤,对120例慢性肾功能衰竭患者进行了滴注保留灌肠方法与传统保留灌肠方法的比较研究,现报道如下。资料与     

LAK免疫支持治疗对慢性肾功能衰竭大鼠残余肾功能的影响

目的 研究 LAK(Lymphokine-activated killer cells)免疫支持治疗对大鼠慢性肾功能衰竭(Chr-onic renal failure,CRF)肾功能的影响,以评估该治疗在CRF临床治疗中的应用前景。方法 对SD大鼠采用两步法行5/6肾脏切除术建立CRF动物模型,并制备LAK,在此基础上分别对CRF大鼠进行LAK治疗与生理盐水对照处理;对大鼠肾切术前后及LAK治疗后3周、6周血尿毒氮(BUN)、肌酐(Cr)进行测定,并应用酶联免疫吸附试验(ELISA)测定血浆白细胞介素-1β(IL-1β)水平来反映CRF肾脏慢性纤维化。结果 5/6肾脏切除术后,大鼠BUN,Cr及血浆IL-1β水平较显著升高(P<0.01);LAK治疗后3周、6周,BUN、Cr及血浆IL-1β水平较同期生理盐水对照处理组大鼠显著降低(P<0.01);结论 LAK可能通过改善机体免疫状态,减少血液循环中某些细胞因子(如IL-1)异常升高,最终延缓肾小球及肾间质慢性纤维化的病理进程及并行的残余肾功能进行性破坏;LAK作为一种过继性细胞免疫支持治疗,可能在今后的CRF患者支持治疗中有着相当的临床应用前景。     

谷红注射液对老年慢性肾功能衰竭患者血液流变学及肾功能的影响

目的观察谷红注射液(金特佳)对老年慢性肾功能衰竭患者的血液流变学及肾功能的影响。方法肾功能不全失代偿期及肾功能衰竭组30例和尿毒症组26例,2组患者每日静脉滴注金特佳5~20m l,连用半月为一疗程。观察治疗前后血压、胆固醇、甘油三酯、血黏度、血尿素氮、肌酐等指标的变化,进行治疗前后自身对比。结果治疗后2组BUN、SCr均下降,以肾功能不全失代偿及肾功能衰竭组下降显著(P<0.05),收缩压(SBP)和舒张压(DBP)均下降,以SBP下降尤为显著(P<0.01),高密度脂蛋白升高显著(P<0.05),血浆黏度、全血低切黏度、纤维蛋白原下降均显著(P<0.05);胆固醇、甘油三酯和血小板最大聚集率亦有下降,但差异无统计学意义。结论金特佳对老年慢性肾功能衰竭患者具有降低血黏度和血小板最大聚集率及改善肾功能的作用。     

Intestinal morphometry and bile acid-induced mucosal injury in chronic experimental renal failure

To examine whether the intestinal mucosa in uremia is more prone to injury, we studied acute intestinal mucosal injury in rats with experimental chronic renal failure (RF) and sham-operated and starved control animals. Intestinal injury was produced by perfusing intestinal segments in vivo with 5 mmol/L chenodeoxycholic acid. Histologic specimens were then taken from the proximal and distal perfused and unperfused intestinal segments. Quantitative morphometry was done with computerized image analysis, and samples of the unperfused intestine were assayed for protein and DNA content. Chronic RF did not significantly affect the functional or morphologic injury caused by chenodeoxycholic acid. However, it was noted that RF rats had consistently taller villi and deeper crypts in all the samples studied. The protein content and the ratio of DNA to protein was similar among the three groups. The mechanism of the increase in villus height and crypt depth in the RF rats was not related to increases in tissue water content or to alterations in protein or DNA content, and the mechanism thus remains unexplained. This study clearly demonstrates, however, that the intestinal mucosa of rats with chronic renal insufficiency is not more susceptible to mucosal injury by bile acids than is the mucosa of appropriate control animals.     

促红细胞生成素对慢性肾衰竭患者免疫功能的影响

目的　探讨重组人促红细胞生成素(rh -EPO)对慢性肾衰竭患者红细胞免疫、体液免疫、细胞免疫、红细胞膜流动性等方面的影响。方法　6 9例慢性肾衰竭患者被随机分成3组,每组各2 3例。A组:采用透析和EPO治疗;B组:单纯采用EPO治疗;C组:为对照组,不采用透析,不进行EPO治疗。采用改良郭氏法测定红细胞免疫功能;用荧光偏振法测定红细胞膜脂分子流动性;用放射免疫法测定血清免疫球蛋白;用APAAP酶联免疫分析法测定T淋巴细胞亚群。同时观察3组患者治疗期间的感染发生率。结果　主要免疫学检测指标在药物治疗前在A、B和C组间没有统计学差异。A、B两组患者治疗8周后,C3b、RFER、IgG、IgA、CD3亚群、CD4亚群及CD4 /CD8比率显著升高,与对照组相比统计学差异有非常显著性,而RFIR %无明显变化,与对照组相比统计学差异无显著性。结论:rh -EPO可以提高CRF患者的免疫功能,降低患者的感染率。     

Brainstem auditory evoked responses in rats with experimental chronic renal failure

1. Chronic renal failure was induced in rats by five-sixths nephrectomy. Brainstem auditory evoked response (BAER) was recorded after 3 months. 2. In the uraemic rats latency of the first wave was delayed, while the interpeak I-V latency was similar to that of the controls. 3. These results suggest a delayed neural conduction along the acoustic nerve or cochlear changes in uraemic rats.     

瘦素与慢性肾功能不全

瘦素作为一种由脂肪细胞合成的激素,主要调节机体摄入和能量消耗的平衡,同时还能调节炎症反应及全身多个脏器的生理功能。在慢性肾功能不全及终末期肾病(ESRD)患者中血清瘦素水平明显升高且,引起了肾脏病界的广泛关注。本文将对瘦素及其受体、瘦素的功能、瘦素的清除、     

灯盏花注射液对老年慢性肾功能衰竭患者血液流变性及肾功能影响的观察

目的：观察灯盏花注射液对老年慢性肾功能衰竭患者的血液流变性及肾功能的影响。方法：根据１９９２年全国肾小球疾病座谈会制订的慢性肾功能衰竭评定标准进行临床分组。肾功能不全失代偿组３４例和尿毒症组１０例，２组患者每日静滴灯盏花注射液２０ｍｌ（含黄酮９００ｍｇ），连用１４日为１个疗程。观察治疗前后血压、胆固醇（ＣＨ）、甘油三酯（ＴＧ）、血粘度、血尿素氮（ＢＵＮ）、血肌酐（ＳＣｒ）等指标的变化，进行治疗前后自身对比。结果：治疗后２组ＢＵＮ、ＳＣｒ均下降，以肾功能不全失代偿组下降显著（Ｐ＜０．０５）；收缩压（ＳＢＰ）和舒张压（ＤＢＰ）均下降，以ＳＢＰ下降极为显著（Ｐ＜０．０１）；高密度脂蛋白（ＨＤＬ）升高显著（Ｐ＜０．０５）；全血粘度、全血低切粘度、纤维蛋白原（Ｆｉ）下降均显著（Ｐ均＜０．０５）；ＣＨ、ＴＧ、血小板最大聚集率（ＰＭＡ）略有下降，但无统计学意义（Ｐ均＞０．０５）。结论：灯盏花注射液对老年慢性肾功能衰竭患者具有降低血粘度及改善肾功能的作用。     

中药抗纤维化治疗慢性肾衰竭的临床研究

目的 :探讨通过抑制纤维化延缓慢性肾衰竭进展的方法。方法 :采用活血化瘀、扶正降浊的肾衰康联合人工虫草制剂心肝宝、黄芪注射液 ,对 30例慢性肾衰竭 2、3期患者进行了前瞻性研究 ,观察治疗前后血清纤维化指标及肾功能改变。结果 :慢性肾衰竭患者血清 型胶原 (C )、层黏蛋白 (L N)及 型前胶原 (PC )均明显高于健康人 (P<0 .0 5或 P<0 .0 1) ,组织纤溶酶原激活物 (t PA)降低 (P<0 .0 1) ,t PA抑制物 (PAI1)增高 (P<0 .0 1) ;治疗组治疗后与治疗前比较 ,C (P<0 .0 1)、L N (P<0 .0 5 )及 PC (P <0 .0 1)均显著降低 ,t PA活性增高 (P<0 .0 1) ,PAI 1降低 (P<0 .0 1) ,血尿素氮 (BU N,P<0 .0 5 )及血肌酐 (SCr,P<0 .0 1)降低 ,内生肌酐清除率 (CCr)增高 (P<0 .0 5 )。结论 :肾衰康联合心肝宝及黄芪注射液对慢性肾衰竭有抗纤维化、抑制细胞外基质 (ECM)成分积聚和促进其降解作用 ,从而改善肾功能 ,延缓慢性肾衰竭进展。