Serum Immunoreactive Trypsin Response to Secretin Injection in Patients with Chronic Pancreatitis

Serum immunoreactive trypsin response to secretin injection (75 clinical units iv over a 2-min period) was studied in patients with chronic pancreatitis and in control subjects. Secretin stimulation caused a slight but significant increase of basal serum immunoreactive trypsin concentration in normal subjects and a marked increase in cbronic pancreatitis patients with mild to moderate insufficiency. In patients with severe insufficiency and steatorrbea it bad very little effect. The integrated immunoreactive trypsin response to secretin injection in patients with mild to moderate insufficiency was significantly bigber compared to controls and to patients with severe insufficiency. In the latter patients it was significantly lower than in controls. A markedly elevated response of serum immunoreactive trypsin to secretin administration seems to differentiate cbronic pancreatitis patients with mild to moderate insufficiency from those with severe insufficiency and from controls.     

慢性肾功能衰竭患者血脂质变化

为研究慢性肾功能衰竭患者血脂质变化，检测40例慢性肾功能衰竭患者血清甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白AI和B水平。结果显示，慢性肾功能衰竭患者血清甘油三酯及载脂蛋白B较对照组明显升高（1．27±0．60mmol／L比0．79±0．23mmol／L，P＜0．01；0．89±0．18g／L比0．80±0．17g／L，P＜0．05）；高密度脂蛋白胆固醇、载脂蛋白AI和载脂蛋白AI／B比值均明显降低（分别为1．07±0．47mmol／L比1．41±0．29mmol／L；1．26±0．28g／L比1．46±0．10g／L；1．41比1．82，P均＜0．01）。以上提示，慢性肾功能衰竭患者脂质代谢紊乱主要表现为甘油三酯和载脂蛋白B浓度升高，高密度脂蛋白胆固醇和载脂蛋白AI浓度降低。     

Assessment of Osteodystrophy in Patients with Chronic Renal Failure

Abstract: Assessment of osteodystrophy in patients with chronic renal failure. D. J. Brown, J. K. Dawbom, D. P. Thomas and J. M. Xipell, Aust. N.Z.J. Med., 1982, 12, pp. 250–254.
Nine patients with chronic renal failure were followed for more than one year by serial bone biopsies which were assessed by quantitative histological techniques.¹Ail patients had evidence of bone disease; this progressed during the interbiopsy period in eight. Patients who had the most advanced histologic disease at initial biopsy showed the most progression in resorption and demineralisation, but with greater progression of hyperparathyroid bone disease than osteomalacia. The type of bone disease and its rate of progression could only be accurately assessed histologically. No predictive parameters of early bone disease were found from clinical history, biochemistry or radiology. Raised serum alkaline phosphatase occurred only in advanced hyperparathyroid bone disease. Minor radiological abnormalities in magnified views of the hands were indicative of histologically advanced asymptomatic hyperparathyroidism.     

Sleep-Disordered Breathing in Nondialyzed Patients with Chronic Renal Failure

The prevalence and significance of sleep-disordered breathing (SDB) in dialysis-independent chronic renal failure (CRF) remains unknown. We studied the presence of SDB in nondialyzed CRF patients. Diagnostic polysomnography was performed in consecutive stable nondialyzed CRF patients. Inclusion criteria were age ≤70 years, absence of systolic dysfunction or history of pulmonary edema, FEV₁ > 70% pr, absence of neurologic disease or hypothyroidism, and calculated creatinine clearance <40 ml/min. Thirty-five patients (19 male, 16 female) were studied. An apnea–hypopnea index (AHI) ≥5/h was present in 54.3% (almost exclusively obstructive events). AHI correlated with urea (r = 0.35, p = 0.037), age (r = 0.379, p = 0.025), and body mass index (BMI) (r = 0.351, p = 0.038), but not with creatinine clearance. AHI or SDB were unrelated to gender. In nondiabetics (n = 25), AHI correlated with urea (r = 0.608, p = 0.001) and creatinine clearance (r = −0.50, p = 0.012). Nondiabetics with severe CRF (calculated GFR < 15 ml/min/1.73 m²) had a significantly higher AHI compared with less severe CRF. Restless legs syndrome (RLS) was present in 37.1% and periodic limb movements in 28.6%. Daytime sleepiness was not associated with respiratory events, but was more common in patients with RLS. The prevalence of SDB and RLS is high in dialysis-independent CRF. SDB weakly correlates with indices of kidney function and this association becomes stronger in nondiabetics.     

Impaired Gastric Myoelectrical Activity in Patients with Chronic Renal Failure

Dysmotility and delayed emptying of the stomachhave been reported in patients with chronic renalfailure (CRF). The aim of this study was to investigatewhether gastric myoelectrical activity was impaired in patients with CRF using electrogastrography.The electrogastrogram (EGG) was recorded in 24symptomatic patients with CRF (15 with diabetes) and 12normal subjects. Two 30-min EGG recordings before and after a test meal were analyzed using spectralanalysis methods. It was found that patients with CRFshowed a significantly lower percentage of normal 2-4cpm slow waves in both fasting and fed states in comparison with healthy controls (in fastingstate: 88.9 ± 2.5% vs 67.4 ± 6.6%/63.27.0%, P < 0.01; in fed state: 89.6 ± 1.8% vs64.6 ± 6.2%/62.0 ± 8.3%, P < 0.01;controls vs diabetic patients/nondiabetic patients). Both patient groups showed a significantlyhigher prevalence of the abnormal EGG, which was definedas the percentage of 2-4 cpm slow waves lower than 70%(fasting state: 8% vs 60%/56%, P < 0.01/0.05; fed state: 0% vs 53%/56%, P < 0.005/0.002;controls vs diabetic patients/nondiabetic patients). Nosignificant difference was observed in the regularity ofthe gastric slow waves between the two patient groups. The healthy controls showed a significantincrease in the dominant power and frequency of the EGGafter the test meal. However, this increase was absentin the two patient groups. It was concluded that patients with chronic renal failure haveabnormal gastric myoelectrical activity, includingimpaired regularity of the gastric slow wave and afailed increase in the power of the EGG at 3 cpm.Electrogastrography is an attractive noninvasive method for thestudy of gastric motility in patients with severechronic renal failure.     

Effects of Triiodothyronine Administration in Patients with Chronic Renal Failure

Clinically euthyroid patients with severe, chronic, non-thyroidal illnesses usually have decreased serum total and absolute free T₃ concentrations. Since T₃ is the metabolically more active of the two thyroid hormones, it has been suggested that these patients may be hypothyroid and thus may benefit from T₃ therapy. To test this hypothesis, five patients with chronic renal failure requiring maintenance haemodialysis were treated with 5 μg T₃ eight hourly, increasing at three weekly intervals to 10 μg eight hourly, 20 μg eight hourly and finally 30 μg eight hourly. The mean ± SD serum T₃ level did not change over the 12 week period (1–42± 0–17 vs. 141 ± 0–26 nmoll ^-1)whilst the mean serum T₄ and TSH levels fell from 87 0± 15 2 to 47 5± 18 8 nmol l^-1 and 19 ± 0–9 to 1 3± 1 6 mU 1^-1respectively. Only the change in T₄ levels was significant (P < 0005). A significant decrease in mean serum T₄ levels was apparent even after the treatment period with 5 μg T₃ eight hourly (87 0±15-2 vs. 51 2±15 7; P <0005). The mean fasting serum triglyceride level fell from 1 16 ± 0 74 to 0 94 ± 0 74 mmoll^-1(P <005) and the mean fasting serum cholesterol level fell from 6 06± 1 13 to 4 69± 1 10 mmoll^-1 (P < 005). There were no subjective improvements in any of the patients. From the marked changes in serum T₄ levels during the administration of T₃, it is concluded that, prior to treatment, the patients were biochemically euthyroid and not hypothyroid and thus did not require T₃ therapy.     

Sensitivity of Gastric Acid Secretion in Patients with Chronic Renal Failure

By means of a dose-response secretion test the sensitivity of gastric acid secretion was investigated in 85 patients with chronic renal failure and in 85 age- and sex-matched controls. The renal patients were also gastroscoped, with biopsy specimens taken from the gastric body. The examinations were repeated on 18 patients undergoing regular dialysis and 8 patients after successful transplantation. The acid secretion sensitivity of the stomach among the non-dialyzed patients was decreased when compared with the controls (p < 0.01) but tended to normalize during the intermittent dialysis treatment (p < 0.05) and particularly after transplantation (p < 0.01). The low secretion responses were independent of gastric body histology and were also seen in patients with normal body mucosa. The maximum theoretic acid output did not differ significantly from that of the controls. It is concluded that there is an inhibition of gastric acid secretion in chronic renal failure. This inhibition depends on the decreased sensitivity to stimulation and is diminished by treatment of renal failure by dialysis or transplantation.     

Small Intestinal Absorption of Glycine and Glycyl-Glycine in Patients with Chronic Renal Failure

ABSTRACT Intestinal absorption of glycine and glycyl-glycine was studied in 9 patients with chronic renal insufficiency (mean creatinine clearance 9 ml/min) and 7 healthy controls. After an oral load of the amino acid or dipeptide, plasma α-amino nitrogen (α-NH₂N) was measured repeatedly for two hours and the area under curve (AUC) was calculated using the trapezoidal rule. In uremic patients, plasma α-NH₂N was significantly lower after glycine than after glycyl-glycine at 30, 45 and 60 min and also AUC was smaller after the amino acid indicating a reduced total uptake. One patient with severe, terminal uremia had a flat curve after glycine administration. In control subjects, plasma levels were lower after glycine than after glycyl-glycine at 30 min but AUC did not differ between the amino acid and the dipeptide. Generally these results agree with those in earlier studies of non-uremic man showing that, in small intestine, dipeptides are taken up better and by a different mechanism than amino acids.     

Red-Cell Organic Phosphates in Patients with Chronic Renal Failure on Maintenance Haemodialysis

S ummary . The red cells of 17 patients with chronic renal failure and anaemia were studied after a mean duration of 4 hr haemodialysis; red-cell 2, 3-diphosphoglycerate (DPG) showed a significant fall whereas red-cell adenosine triphosphate (ATP) remained unchanged. During the same period arterial blood pH showed a significant rise and in 10 out of 17 instances, reached frankly alkalotic values (> 7.45). Serum inorganic phosphate (P_i) fell by 40% during this time and may have been a factor in the fall of 2, 3-DPG. This fall in 2, 3-DPG in red cells was more pronounced in four patients who were given transfusions of banked blood during the haemodialysis period.
There was no correlation between 2, 3-DPG and arterial blood pH or between ATP and pH. There was no correlation between the degree of change of 2, 3-DPG and the predialysis serum P_i or the degree of change, although the mean value of both declined after dialysis. Similarly, no correlation was observed between ATP and predialysis P_i. Constantly occurring complex biochemical alterations may be limiting factors responsible for this lack of expected relationship between these measurements.
These changes might result in decreased oxygen delivery to tissues in uraemic patients since the haemoglobin oxygen affinity may be increased after haemodialysis by the dual effect of a fall in red-cell 2, 3-DPG and an increase in blood pH.     

Disordered Spermatogenesis in Patients with Chronic Renal Failure Undergoing Maintenance Haemodialysis*

Summary: Testicular function has been evaluated in six patients with chronic renal failure undergoing maintenance dialysis. Spermatogenesis was impaired in six patients when quantitative cytological study of the testicular biopsy was employed. This impairment was mild in one patient, moderately severe in two and extreme in the remaining three patients. Concomitant elevation of serum FSH levels as measured by specific radio-immunoassay was associated only with the most severe impairment of spermatogenesis. Serum LH levels were elevated in the majority of patients and plasma testosterone levels were low in 50%. It is concluded that chronic renal failure significantly decreases testicular function, especially spermatogenesis.     

慢性心力衰竭患者血清脂联素水平改变及其临床意义的研究

目的探讨慢性心力衰竭(CHF)患者血清脂联素(APN)水平改变及其与CHF患者心功能、超敏C反应蛋白(hs-CRP)、尿酸(UA)的相关性。方法选择CHF患者60例为心力衰竭组,然后按NYHA心功能分级将其分为3组,心功能Ⅱ级组25例,心功能Ⅲ级组21例,心功能Ⅳ级组18例;根据CHF病因分为冠心病组、高血压性心脏病组及扩张性心肌病组。选择同期无器质性心脏病且心功能正常的阵发性室上性心动过速(PSVT)患者20例作为对照组。采用酶联免疫吸附法测定血清APN水平,免疫比浊法测定hs-CRP、UA。结果心力衰竭组与对照组APN水平、hs-CRP、UA比较,差异均有统计学意义(P<0.05);不同心功能组间APN水平比较,差异无统计学意义(F=0.308,P>0.05);治疗前后心力衰竭组APN水平比较,差异有统计学意义(P<0.05)。APN与hs-CRP、UA呈正相关(r=0.325,P=0.009;r=0.248,P=0.048)。结论心力衰竭患者血清APN水平明显升高,且随着心功能损害程度加重而升高更加明显,APN在心力衰竭发展过程中起着重要作用,可作为评价心力衰竭患者病情严重程度的易测指标。