激素与免疫抑制剂在原发性肾病综合征的应用

原发性肾病综合征（NS）由多种疾病组成,主要包括：微小病变肾病（MCD）、局灶节段性肾小球硬化（FSGS）、膜性肾病（MN）、IgA肾病、膜增生性肾小球肾炎等。不同疾病类型的治疗方案和治疗反应差异很大,对单纯使用糖皮质激素（以下简称激素）疗效最好的是MCD和轻度系膜增生性肾小球肾炎,成人患者大约80％可以完全缓解.     

儿童肾活检977例病理及临床分析

目的回顾性分析小儿肾脏疾病的病理类型及临床特点。方法收集977例接受经皮肾活检患儿的病理诊断和临床资料,分析比较原发性肾小球疾病与继发性肾小球疾病的病理类型和临床特征。培果成功肾活检971例,其中原发性肾小球疾病755例（77．8％）,继发性肾小球疾病183例（18．8％）,先天性遗传性代谢性肾小球疾病18例（1．9％）。原发性肾小球疾病中,临床诊断前3位依次为孤立性血尿、肾病综合征和迁延性肾小球肾炎;病理类型前3位依次为肾小球轻微病变、局灶节段性肾小球硬化和局灶性肾小球肾炎。继发性肾小球疾病中,临床诊断前3位依次为紫癜性肾炎、乙型肝炎相关性肾小球肾炎和狼疮性肾炎;病理类型前3位依次为系膜增生性肾小球肾炎、肾小球轻微病变和膜性肾病。在18例先天性遗传性代谢性肾脏疾病中,有7例为薄基膜肾病。在临床诊断为孤立性血尿的患儿,肾活检病理类型中肾小球轻微病变所占百分比随患儿年龄的增长逐渐降低（P〈0．05）,而IgA肾病和局灶性肾小球肾炎所占百分比随患儿年龄的增长逐渐升高（P〈0．05）。结论本组资料中,儿童肾小球疾病以原发性肾小球疾病为主,临床表现和病理类型以血尿和肾小球轻微病变最为常见;小儿继发性肾小球疾病以紫癜性肾炎最为常见,病理类型以系膜增生性肾小球肾炎、肾小球轻微病变和膜性肾病为主;先天性遗传性肾脏疾病中薄基膜肾病最为常见。建议对6岁以上的孤立性血尿患儿行肾穿刺活检术。     

基层医院原发性肾小球疾病病理类型分析

目的探讨基层医院原发性肾小球疾病的的病理类型构成情况。方法回顾性选取原发性肾小球疾病患者222例,均行肾穿刺病理诊断。观察其病理类型及临床特征,并与安徽及大连两家省市级医院收治的原发性肾小球疾病的病理类型进行比较。结果本组患者的原发性肾小球疾病病理类型共7种,分别为IgA肾病（IgA-N）、膜性肾病（MN）、微小病变肾病（MCD）、系膜增生性肾小球肾炎（MsPGN）、局灶节段肾小球硬化（FSGS）、新月体性肾炎（CREGN）和毛细血管内增生性肾炎（ENPGN）。IgA-N、MN、MCD构成比居前3位,分别占36.49%、27.03%和20.27%。本基层医院与另两家省市级医院比较,IgA-N、MN、MCD、MsPGN构成比在3家医院均居前4位;3家医院IgA-N、MN及FSGS构成比比较均无统计学差异（均P＞0.05）,MCD、MsPGN、CREGN及ENPGN构成比比较均有统计学差异（均P＜0.05）。结论基层医院原发性肾小球疾病病理类型的构成情况与省市级医院是基本一致的,IgA-N、MN、MCD、MsPGN构成比居前4位。     

儿童孤立性血尿32例临床和病理分析

目的探讨儿童孤立性血尿的临床和病理特点。方法对32例临床诊断为孤立性血尿的患儿进行肾穿刺,肾组织行光镜、免疫荧光和电镜检查。结果32例患儿系膜增生性肾小球肾炎13例,IgA肾病8例,肾小球轻微病变5例,局灶节段性肾小球硬化1例,薄基底膜肾病（TMN）2例,毛细血管内增生性肾小球肾炎（EnPGN）2例,Alport综合征1例。结论本组病例主要的病理类型依次为系膜增生性肾小球肾炎、IgA肾病、肾小球轻微病变。     

353例小儿肾小球疾病的病理及临床分布特点

目的：了解小儿肾小球疾病病理与临床分布特点。方法收集353例肾活检患儿资料进行回顾性分析。结果353例患儿中诊断为紫癜性肾炎117例（33.1%）,孤立性血尿94例（26.6%）,原发性肾病综合征87例（24.6%）,急性肾炎综合征23例（6.5%）,其次还有乙肝相关性肾炎、狼疮性肾炎、孤立性蛋白尿、慢性肾炎等。肾小球疾病中以原发性肾小球疾病最为常见（206例,占58.4%）,病理改变主要为：系膜增生性肾小球肾炎（MsPGN）66例,占32.0%;IgA 肾病（IgA N）54例,占26.2%;轻微病变37例,占18.0%;其他还包括微小病变（MCD）、膜增生性肾小球肾炎（MPGN）、膜性肾病（MN）、毛细血管增生性肾小球肾炎等。继发性肾小球疾病以紫癜性肾炎最常见。结论肾小球疾病以原发性肾小球疾病为主,临床诊断以孤立性血尿最常见,继发性肾炎以紫癜性肾炎最常见。     

成人原发性肾病综合征病理类型与激素疗效的关系

目的：探讨成人原发性肾病综合征（ PNS）的肾脏病理类型分布及与激素疗效的关系。方法回顾性分析982例成人PNS的病理类型及激素治疗效果。结果982例PNS患者行肾活检时的平均年龄（36.0±15.9）岁,男女比例1.68∶1;PNS常见的病理类型主要为：轻微病变（ MCD）、膜性肾病（ MN）、局灶节段硬化症（ FSGS）。其中激素敏感型患者病理类型依次为MCD、MN、系膜增生性肾病,激素抵抗型患者病理类型依次为FSGS、MN、MCD等。不同性别间激素疗效差异无统计学意义（ P＞0.05）。 MCD是14～23岁、24～33岁、34～43岁这3个年龄段是PNS患者最常见的病理类型;MN在＞34岁各年龄段所占比例较高。结论成人PNS多见于青壮年,男性多于女性。 MCD多对激素敏感,而FSGS多对激素抵抗。     

霉酚酸酯联合他克莫司治疗激素抵抗型难治性肾病综合征的疗效观察

【目的】探讨霉酚酸酯（MMF）联合他克莫司（TAC）治疗激素抵抗型肾病综合征（SRNS）的疗效、不良反应。【方法】收集SRNS患者74例,其中微小病变（MCD）32例、局灶节段性肾小球硬化（FSGS）22例、弥漫性系膜增生（DMP）20例,所有患者采用 MMF 1 g/d和糖皮质激素50 mg（隔日一次）治疗（第一步治疗）;第一步治疗仍未实现临床缓解的患者,则自动进入第二步治疗方案,即停用激素,采用MMF 1 g/d联合T AC 3 mg/d治疗6个月,观察不同治疗方案和病理类型的疗效及不良反应。【结果】74例SRNS患者接受第一步治疗,24例（32．4％）患者达到完全缓解,4例（5．4％）部分缓解;余下46例未出现临床缓解的患者停用激素,接受第二步治疗,22例（47．8％）患者达到完全缓解,4例（8．7％）患者达到部分缓解。不同病理类型缓解率比较有显著性差异（ P＜0．05）,其中MCD缓解率最高,FSGS缓解率最低。治疗过程中所有患者均无明显不良反应。【结论】MMF联合TAC治疗SRNS ,疗效满意,值得临床推广应用。     

67例儿童单纯性血尿的肾脏病理及临床分析

目的 探讨儿童单纯性血尿的病理类型.方法 对67例临床诊断为单纯性血尿的患儿进行肾组织活检,并行光镜、电镜和免疫荧光检查.结果 本组单纯性血尿肾脏病理类型最常见的依次为IgA肾病22例(32.8%)、系膜增生性肾小球肾炎17例(25.3%)和毛细血管内增生性肾小球肾炎8例(11.9%).结论 本组资料单纯性血尿最常见的病理类型是IgA肾病,其次是系膜增生性肾小球肾炎、毛细血管内增生性肾小球肾炎.     

新疆地区无症状镜下血尿患者158例分析

目的探讨新疆地区无症状镜下血尿患者临床与病理特点及其意义。方法对158例接受经皮肾活检的无症状镜下血尿患者进行临床及病理资料分析。结果本组158例患者中,非IgA系膜增生性肾小球肾炎者最多见79例（50%）,IgA肾病54例（34.2%）,局灶节段性硬化性肾炎15例（9.5%）,其次为毛细血管内增生性肾炎10例（6.3%）。汉族患者原发性肾小球疾病病理类型以IgA肾病为主（26.0%）,其次为非IgA系膜增生性肾小球肾炎（14.6%）;维吾尔族原发性肾小球疾病患者病理类型以非IgA系膜增生性肾小球肾炎为主（35.4%）其次为IgA肾病（8.2%）。结论无症状镜下血尿患者的病理类型为原发性肾小球疾病,以男性青壮年为主,其中汉族患者以IgA肾病为主,维吾尔族患者以非IgA系膜增生性肾小球肾炎为主。     

小儿孤立性血尿病理分析与临床诊断

目的：探讨小儿孤立性血尿的病理类型。方法：结合肾组织光镜、电镜及免疫荧光检查结果对207例符合孤立性血尿诊断标准的患儿病历进行考察。结果：正常肾小球61例（29．5％）（其中局灶节段性肾小球透明样变性5例）;轻微病变72例（34．8％）;IgA肾病36例（17．4％）;薄基底膜肾病21例（10．1％）（其中正常肾小球7例,伴轻微病变14例）;系膜增生性肾小球肾炎13例（6．3％）（其中伴薄基底膜肾病2例）;局灶增生性肾炎4例（1．9％）。结论：轻微病变与正常肾小球占第一位,表现为孤立性血尿的IgA肾病病理变化相对较轻,为轻微病变或轻度系膜增生。所有病例均无新月体形成、肾小球硬化和小管间质受累。提示孤立性血尿患儿预后良好。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.