妊娠相关肾损伤的临床调查

目的：探讨妊娠相关性肾损伤的病因、发生率、预后转归。方法：采用回顾性分析方法调查2004年9月～2007年8月期间2988例住院妊娠患者在妊娠过程中肾损伤的发生情况。结果：75例妊娠患者存在肾损伤,占2.58%,22例为肾脏病合并妊娠。轻度肾损伤组血浆白蛋白显著高于重度肾损伤组（P值均〈0.001）。各组间总胆固醇与三酰甘油差异均无统计学意义（P〉0.05）。轻度肾损伤组血红蛋白水平显著高于重度肾损伤组（P〈0.01）,但轻度与中度肾损伤组间、中度与重度肾损伤两组间差异无统计学意义（P〉0.05）。与中度肾损伤组和重度肾损伤组相比,轻度肾损伤组SBP（P值分别为0.001,0.002）、DBP（P值分别为0.022,0.009）及MBP（P值分别为0.005,0.004）差异均有统计学意义,但中度肾损伤组与重度肾损伤组间差异无统计学意义。29例资料完整患者Scr均值由妊娠初期时的（176.97±108.83）μmol/L上升到妊娠后期的（193.69±148.63）μmol/L（P〈0.001）;MBP均值由妊娠前期的（97.00±10.91）mmHg上升到后期的（119.94±19.00）mmHg（P〈0.001）。发生子痫前期的患者共有37例（49%）,其中轻度肾损伤组24例（42%）,中度肾损伤组7例（58%）,重度肾损伤组6例患者都存在着子痫前期。9例资料完整的患者中,肾小球滤过率（1/Scr）在妊娠晚期比早期下降的有14例（48%）,其中有4例肾小球滤过率严重下降（超过25%）。结论：妊娠相关肾损伤并不少见,可随着妊娠而进展,值得关注和研究。     

妊娠并发肾病综合征的临床研究

目的 探讨妊娠并发肾病综合征患者的妊娠结局及肾功能的变化。 方法 回顾性调查我院2003年至2007年间59例妊娠并发肾病综合征患者的临床资料,包括患者出现肾病的时间、尿蛋白量、血浆白蛋白、Scr、血尿酸、血压;胎儿存活率、死亡率、早产率、出生体质量;以及孕妇产后随访蛋白尿、肾功能和血压情况。采用Logistic回归方法,分析影响妊娠患者的肾脏转归及胎儿预后的危险因素。 结果 孕妇出现蛋白尿孕周平均为（20.35±9.40）周,尿蛋白量（24 h）3.5~15.0 g,中位数5.1 g;血浆白蛋白10~28 g/L,中位数22.5 g/L;Scr 32~825 μmol/L,中位数84 μmol/L;血尿酸196~793 μmol/L,中位数385.5 μmol/L。妊娠高血压综合征发生率为75%,其中先兆子痫占55.5%。胎儿存活率72.9%（43/59）,其中早产占76.7%（33/43）;低体质量儿占62.8%（27/43）。产后50%患者持续肾病综合征。24例原有慢性肾炎,其中75%患者蛋白尿较怀孕前有不同程度的增加。38例伴有肾功能受损,其中36.8%患者产后肾功能受损加重,23.7%进入终末期肾衰竭;其中80%发生在Scr≥265 μmol/L的患者。89%患者产后持续高血压。Logistic 回归结果提示,孕期高尿酸血症（P=0.018,OR=1.012）和Scr升高（P=0.039,OR=1.005）是孕妇产后肾功能受损加重的危险因素。高尿酸血症（P=0.012,OR=1.006）也是胎儿死亡的危险因素。 结论 妊娠并发肾病综合征患者的胎儿存活率低,其中高尿酸血症是威胁孕妇和胎儿的首要危险因素。     

复方丹参注射液对妊娠高血压综合征患者肾功能及妊娠结局的影响

目的：探讨中西医结合疗法治疗妊娠高血压综合征及其对肾功能的影响。方法：选择近期于本院接受中西医结合疗法治疗的72例妊高征患者作为观察组,将之前在本院只行西医治疗的41例妊高征孕妇作为对照组。观察两组产妇血压变化、肾功能指标及母婴结局等情况。结果：中西医结合治疗观察组患者的显效率为52.8%,总有效率为97.2%,明显优于单纯西医治疗对照组的31.7%、85.4%;观察组治疗后患者平均动脉压为（106.7±9.6）mmHg、血尿素氮（3.3±1.3）mmol/L、尿酸（244.8±48.5）μmol/L、肌酐（39.1±8.1）μmol/L,均优于对照组治疗后的各指标,差异均具统计学意义（P〈0.05）。两组的分娩并发症主要包括宫缩乏力、新生儿窒息、胎儿宫内窘迫及产后出血,但观察组发生率均显著低于对照组（P〈0.05）。结论：中西医结合治疗妊娠高血压综合征临床疗效更显著,且在改善患者肾功能方面有重要作用。     

尿毒清颗粒预防对比剂肾病的临床研究

目的：探讨用尿毒清颗粒预防对比剂肾病（CIN）的临床效用。方法：将拟行择期冠状动脉造影和/或经皮冠状动脉介入术治疗的患者150例,随机分为尿毒清组（75例）及对照组（75例）。尿毒清组患者于术前1 d至术后3 d服用尿毒清颗粒。入院时及术后连续3 d查肾功能。比较两组组间和组内血清肌酐（Scr）的差别。结果：两组患者的主要基线指标差异无统计学意义。两组患者术后3 d Scr最高值均比术前基线Scr值增高[（91.4±40.2）μmol/L vs（71.7±27.4）μmol/L,P〈0.01;（103.7±35.4）μmol/L vs（77.1±21.7）μmol/L,P〈0.01],差异均有统计学意义。CIN的发病率尿毒清组为3例（4.0%）,对照组为10例（13.3%）。与对照组相比,尿毒清组术后3 d Scr最高值降低[（91.4±40.2）μmol/L vs（103.7±35.4）μmol/L,P〈0.05],术前、术后Scr差值降低[（19.7±16.8）μmol/L vs（26.5±20.4）μmol/L,P〈0.05],CIN发生率降低（4.0%vs 13.3%,P〈0.05）,差异均有统计学意义。结论：尿毒清颗粒可以降低动脉内使用对比剂后3 d Scr的最高值和CIN发生率,有一定的预防CIN的作用。     

关于慢性肾衰竭患者对低蛋白饮食治疗顺应性的研究

目的：为了提高慢性肾衰竭患者对低蛋白饮食治疗的顺应性,本文就低蛋白饮食治疗的实际情况及存在的问题进行了调查和探讨。方法：慢性肾衰竭患者597例,血清肌酐132.6-1317.2μmol/L,蛋白质处方指示量20-40g/d。坚持低蛋白饮食1年以上,每日实际蛋白摄入量超过指示量不足5g的定为顺应性良好,即使超过指示量在5g以内,但持续时间不足1年以及超过指示量在5g以上为不良。结合以下4个方面的因素讨论患者的顺应性是否良好,（1）不同的蛋白质指示量（20g/d,25g/d,30g/d,40g/d）,（2）性别,（3）年龄（65岁以上和65岁以下）,（4）肾功能状态（根据Scr不同分为Scr〈265.2μmol/L、265.2μmol/L≤Scr〈530.4μmol/L、530.4μmol/L≤Scr〈884μmol/L、Scr〉884μmol/L4个级别）。结果：每日摄入蛋白质30g以下的患者中,顺应性良好的占65%。在性别、年龄、肾功能程度方面没有差异。结论：为了获得良好的顺应性,医师、营养师进行营养指导是重要的;患者自己进行饮食内容记录、食品计量、营养素计算与良好的顺应性密切相关;经常食用治疗用特殊低蛋白食品是不可缺的。     

黄芪注射液防治慢性肾脏病基础上急性肾损伤的疗效观察

目的：观察黄芪注射液治疗慢性肾脏病基础上急性肾损伤（acute-on-chronic kidney injury,A-on-C）的疗效。方法：采用前瞻性、自身前后对照的方法。确诊A-on-C的患者中,在一般治疗的基础上加用黄芪注射液20ml静脉滴注,每日1次,共用14d。比较黄芪注射液治疗前和治疗后患者的尿蛋白、C反应蛋白（CRP）及肝、肾功能等指标变化。结果：共61例A-on-C患者参与本项研究,其中男37例,女24例,平均年龄（57.1±16.91）岁。患者肾功能有所改善,有效率达63.2%。血肌酐（Scr）治疗前为（330.61±186.58）μmol/L,治疗后为（303.26±184.64）μmol/L,差异有统计学意义（P〈0.05）;尿血酸（UA）治疗前治疗后分别为（497.34±120.81）μmol/L、（462.21±122.29）μmol/L,差异有统计学意义（P〈0.05）。但治疗前后血常规、电解质、尿蛋白、肝功能、血脂、CPR无明显改变（P〉0.05）。结论：在A-on-C的患者中黄芪注射液可能可以改善肾功能,延缓肾功能恶化。     

1,25（OH）2D3延缓慢性肾衰竭进展的临床随机对照研究

目的：观察1,25（OH）2D3联合血管紧张素Ⅱ受体拮抗剂（angiotensin Ⅱ receptor blocker,ARB）延缓慢性肾衰竭（chronic renal failure,CRF）进展的疗效.方法：选取40例血清肌酐（Scr）水平处于104-265.2 μmol/L,24 h尿蛋白定量≥1 g,临床排除继发性肾脏病,前期随访肾功能无明显恶化的患者,将其随机分为对照组（缬沙坦80 mg/d）及骨化三醇组（缬沙坦80 mg/d＋骨化三醇0.25 μg/晚）,随访6个月,随访时间点为0,2,4,6月,比较治疗前后患者24 h尿蛋白定量、Scr、钙磷及甲状旁腺激素水平的变化.结果：至随访终点时,与对照组相比,两组患者Scr、血钙、PTH水平差异有统计学意义[（158.95±24.30）μmol/L vs（186.05±46.18）μmol/L,P〈0.05],[（2.27±0.21）mmol/L vs（2.10±0.20）mmol/L,P〈0.01],[（145.22±42.30）pg/ml vs（193.44±55.04）pg/ml,P〈0.01];两组患者蛋白尿、血磷水平差异无统计学意义[（2.16±0.69）g vs（2.48±0.79）g,P〈0.05],[（1.41±0.30）mmol/L vs（1.49±0.34）mmol/L,P〈0.05];但与0月比较,骨化三醇组蛋白尿水平下降明显[（2.16±0.69）g vs（3.36±1.10）g,P〈0.01].结论：1,25（OH）2D3联合ARB能有效延缓慢性肾衰竭的进展,其疗效较单纯使用ARB药物为佳.     

非清髓性外周造血干细胞移植后早期急性肾损伤的多中心临床研究

目的 观察白血病患者非清髓性外周造血干细胞移植后早期急性肾损伤（AKI）的患病率、危险因素及对生存的影响。 方法 对象为2002年1月至2007年5月,在东南大学附属中大医院、南京医科大学附属淮安医院、江苏大学附属镇江第一人民医院3个移植中心接受非清髓性外周造血干细胞移植的白血病患者。观察移植前、移植后100 d内肾功能改变情况及并发症,并随访观察1年。AKI分为3期：1期,Scr升高 ≥26.5 μmol/L,或升高50%~200%;2期,Scr升高>200%~300%;3期,Scr升高>300%,或升高>353.6 μmol/L（急性升高≥44.2 μmol/L）。 结果 62例患者移植后造血均顺利恢复。18例（29%）患者出现不同程度的AKI,其中1期11例,2期6例,3期1例。Logistic多因素回归分析表明,人类白细胞抗原（HLA）不完全匹配、移植后并发症（感染、肝静脉闭塞病、急性移植物抗宿主病）是AKI的独立危险因素,其优势比OR（95% CI）分别为3.6（1.1~13.0）、12.1（2.4~62.4）。移植后1年患者总的病死率为27.4%,且病死率随着AKI的严重程度逐渐增加（log-rank检验,P < 0.01）。 结论 AKI是非清髓性外周造血干细胞移植后的常见并发症之一。HLA不完全匹配、移植后并发症是发生AKI的独立危险因素。AKI对患者移植后1年生存率有重要影响。     

霉酚酸酯联合激素治疗IgA肾病的疗效观察

本研究主要观察霉酚酸酯（MMF）联合激素对IgA肾病的临床疗效和安全性。 一、对象和方法 1．对象：病理确诊为IgA肾病，尿蛋白量（24h）≥1．0g，Scr〈265μmol／L，年龄14-70岁，1个月内未使用激素和免疫抑制剂的患者。排除标准：（1）既往曾对本药严重过敏；（2）白细胞〈3×10^9／L；（3）妊娠或可能妊娠；（4）Scr〉265μmol／L；（5）继发IgA肾病；（6）有肝功能损害。     

慢性肾脏病患者妊娠的研究进展

妊娠期的肾脏发生一些改变。妊娠期细胞外液增加4～6L,妊娠中期增加达50%,对肾脏造成负担。肾小球滤过率(GFR)和肾血浆流量增加约50%～70%,肌酐(Scr)水平下降,由妊娠早期的73μmol/L下降至65μmol/L,再下降至妊娠中期的51μmol/L,妊娠晚期的47μmol/L,尿素氮分别降至3.5mmol/L、3.3mmol/L和3.1mmol/L,尿酸减少约25%[1]。合并肾脏病的女性早期临床和生化可能没有表现,有些女性可能等GFR减少超过25%才出现临床表现。不合并妊娠时,对肾功能减退的女性可能无显著影响,然而一旦合并妊娠,妊娠     

Chronic kidney disease and pregnancy: maternal and fetal outcomes

Chronic kidney disease complicates an increasing number of pregnancies, and at least 4% of childbearing-aged women are afflicted by this condition. Although diabetic nephropathy is the most common type of chronic kidney disease found in pregnant women, a variety of other primary and systemic kidney diseases also commonly occur. In the setting of mild maternal primary chronic kidney disease (serum creatinine <1.3 mg/dL) without poorly controlled hypertension, most pregnancies result in live births and maternal kidney function is unaffected. In cases of more moderate and severe maternal primary chronic kidney disease, the incidence of fetal prematurity, low birth weight, and death increase substantially, and the risk of accelerated irreversible decline in maternal kidney function, proteinuria, and hypertensive complications rise dramatically. In addition to kidney function, maternal hypertension and proteinuria portend negative outcomes and are important factors to consider when risk stratifying for fetal and maternal complications. In the setting of diabetic nephropathy and lupus nephropathy, other systemic disease features such as disease activity, the presence of antiphospholipid antibodies, and glycemic control play important roles in determining pregnancy outcomes. Concomitant with advances in obstetrical management and kidney disease treatments, it appears that the historically dismal maternal and fetal outcomes have greatly improved.     

体外受精-胚胎移植妊娠数目与母儿结局分析

目的探讨体外受精-胚胎移植(IVF-ET)妊娠数目与母儿结局的关系。方法回顾性分析我中心2005年1月至2007年9月IVF-ET术后受孕322例,比较单胎妊娠及多胎妊娠母儿结局。结果临床妊娠322例,分娩243例,多胎妊娠率为27.6%(89/322)。多胎妊娠各种并发症中妊高征发生率最高(25.42%),多胎妊娠组其卵巢过度刺激综合征(OHSS)以及胎膜早破、妊高征等妊娠并发症的发病率均明显高于单胎妊娠组(P0.05),单胎妊娠者其孕龄及新生儿出生体重均大于双胎妊娠者(P0.01)。结论IVF-ET术后多胎妊娠率较高,多胎妊娠者其OHSS、胎膜早破、妊高征等并发症及早产、低出生体重儿发病率均较单胎妊娠者高,应限制胚胎移植数目以改善IVF-ET妊娠后母儿结局。     

Effect ofpreeclampsia and varying degrees proteinuria on perinatal outcome

Objective To explore the impacts of preeclampsia and the different extent of proteinuria on maternal and perinatal outcomes. Methods The retrospective analysis was conducted according to the perinatal clinical data of preelacmpsia, pregnancy-induced hypertension in pregnant women and normal pregnant women from the Fifth People's Hospital of Shanghai, excluding twins, diabetic mellitus and patients with chronic kidney disease previously. Patients were divided into three groups on the basis of their conditions: ① preeclampsia patients (A group, 220 cases); ② patients with gestational hypertension (B group, 189 cases); ③ normal pregnant (C group, 220 cases). Patients with pre-eclampsia according to the degree of proteinuria were further divided into three subgroups: A1: patients with mild proteinuria (n＝109); A2: patients with moderate proteinuria (n＝72); A3: patients with severe proteinuria (n＝39). Results Compared with the other two groups, the patients in A group had higher blood pressure, serum creatinine, uric acid, cesarean section rate, perinatal prematurity, stillbirth, fetal distress and neonatal asphyxia in preeclampsia group. However, the serum albumin level, eGFR, neonatal birth weight, length and Apgar scores were lower in A group compared with B and C group (P＜0.05). In three subgroups, serum creatinine level, uric acid level, cesarean section rate, perinatal prematurity and fetal distress were significantly increased in A3 group compared with A1 group, while the serum albumin level, eGFR, gestational age and neonatal birth weight were obviously lower in A3 group than in A1 group (P＜0.05). In patients with preeclampsia, 24 h urinary protein wasnegatively related with the levels of serum albumin and eGFR (P＜0.05), and positivly related with the blood pressure, serum creatinine and caesarean production rate (P＜0.05). Large amounts of proteinuria was a risk factor of adverse outcome for pregnant patients with preeclampsia (OR＝2.899，P＜0.05) . Conclusions Preeclampsia patients with large amount of proteinuria have poor maternal and perinatal outcomes. Massive proteinuria is a risk factor of adverse outcome for patients with pre-eclampsia.     

妊娠合并甲状腺功能减退症规范激素替代治疗后的妊娠结局

目的分析妊娠合并甲状腺功能减退症(甲减)或亚临床甲减者经过激素替代治疗的妊娠结局。方法回顾性分析2010年1月至2011年9月在本院妇产科分娩的单胎妊娠合并临床甲减(64例)或亚临床甲减(65例)共129例(病例组)患者,均在我院产科和内分泌科定期随诊,其中121例患者孕期甲功控制在正常范围。选取同期正规产检并分娩的无甲状腺疾病合并症产妇2,355例作为对照。比较病例组与对照组的一般情况和妊娠结局,并进一步分析病例组中甲状腺球蛋白抗体(TG-Ab)和抗甲状腺过氧化物酶抗体(TPO-Ab)对妊娠结局的影响。结果(1)临床甲减组妊娠期高血压疾病(子痫前期+妊娠期高血压)的发病率(7.7%)高于对照组(2.3%,P<0.05),新生儿结局(新生儿孕周及出生体重)及其它妊娠并发症[胎心率不可靠(nonassuring fetal heart rate)、妊娠期糖尿病、羊水过少、胎膜早破、新生儿窒息、早产等并发症]的发生率在三组间没有统计学差异(P>0.05)。(2)病例组中,99例患者进行了抗体的检查,TPO-Ab阳性率为48.5%,TG-Ab的阳性率为40.4%,抗体异常与无异常的患者、新生儿结局及妊娠合并症发生率均无显著性差异(P>0.05)。结论本研究纳入病例中,除妊娠期高血压疾病的发生率在临床甲减的孕妇组中有升高以外,孕期临床甲减或亚临床甲减患者经过激素替代治疗控制甲功在正常范围内,妊娠不良结局的发生率较对照组无明显增加,也没有观察到甲状腺自身抗体对妊娠结局的不良影响。     

Clinical features and influence factors of pregnancy-induced hypertension with renal impairment at high altitude

Objective To investigate the incidence and clinical features of women with hypertension disorders of pregnancy complicated with renal impairment at high altitude, and explore the impact of proteinuria, renal insufficiency and preexisting chronic kidney disease (CKD) on these patients. Methods A pool of 1790 pregnant women admitted to Yunnan Diqing Tibetan Autonomous Prefecture People's Hospital from September 2017 to September 2018. Data of 123 patients who met the criteria of hypertension disorders in pregnancy were collected and retrospectively studied. Their clinical characteristics and pregnancy outcomes were analyzed. Patients with hypertension and renal impairment, simple hypertension patients as well as normal pregnant women were compared. Hypertensive patients with proteinuria, renal insufficiency (Scr＞70 μmol/L) and preexisting CKD were also compared with simple hypertension patients. The impact of proteinuria, renal insufficiency and preexisting CKD on patients with hypertension disorders of pregnancy was assessed by multivariate logistic analysis. Results Of these 123 patients, 61 cases (49.6%) had renal impairment, 57 cases (46.3%) had proteinuria, 15 cases (12.2%) had renal insufficiency and 6 cases (4.9%) had preexisting CKD. Compared with normal pregnant women and simple hypertension patients, patients with hypertension and renal impairment had higher blood pressure, Scr, primipara rate and caesarean section rate (all P＜0.05), lower gestational age, neonatal Apgar scores and plasma albumin level (all P＜0.05), as well as adverse pregnancy outcomes, including premature birth, stillbirth/neonatal death, intrauterine growth restriction, infants of low-birth weight and admission to the neonatal intensive care unit (NICU) (all P＜0.05). The clinical features and pregnancy outcomes of 57 patients with proteinuria correlated with the proteinuria. Compared with non-nephrotic syndrome patients and patients without proteinuria, patients with nephrotic syndrome (NS) had lower plasma albumin level and higher rates of premature birth, infants of low-birth weight and admission to NICU (all P＜0.05). Among 15 patients with renal insufficiency, there were 13 mild abnormal cases (70 μmol/L＜Scr≤123 μmol/L, 86.7%). Compared with those with normal renal function, patients with renal insufficiency had higher Scr, uric acid and rates of preeclampsia/eclampsia, intrauterine growth restriction, infants of low-birth weight and admission to NICU, while lower plasma albumin level (all P＜0.05). Among 6 patients with preexisting CKD, 4 had NS, 2 had renal insufficiency, 5 delivered before 37 weeks, and 2 infants died. Logistic regression analysis showed that NS (OR=4.863, P=0.032), renal insufficiency (OR=7.550, P=0.017) and systolic pressure (OR=1.061, P=0.002) were independent risk factors for adverse pregnancy outcomes among patients with hypertension disorders in pregnancy. Conclusions Renal impairment is common among patients with hypertension disorders in pregnancy at high altitude and has adverse effects on pregnancy outcomes. Massive proteinuria, renal insufficiency and systolic pressure are risk factors for these patients.     

Pregnancy Outcomes After Kidney Donation

The outcome of pregnancy in kidney donors has generally been viewed to be favorable. We determined fetal and maternal outcomes in a large cohort of kidney donors. A total of 2102 women have donated a kidney at our institution; 1589 donors responded to our pregnancy surveys; 1085 reported 3213 pregnancies and 504 reported none. Fetal and maternal outcomes in postdonation pregnancies were comparable to published rates in the general population. Postdonation (vs. predonation) pregnancies were associated with a lower likelihood of full-term deliveries (73.7% vs. 84.6%, p = 0.0004) and a higher likelihood of fetal loss (19.2% vs. 11.3%, p < 0.0001). Postdonation pregnancies were also associated with a higher risk of gestational diabetes (2.7% vs. 0.7%, p = 0.0001), gestational hypertension (5.7% vs. 0.6%, p < 0.0001), proteinuria (4.3% vs. 1.1%, p < 0.0001) and preeclampsia (5.5% vs. 0.8%, p < 0.0001). Women who had both pre- and post-donation pregnancies were also more likely to have these adverse maternal outcomes in their postdonation pregnancies. In this large survey of previous living donors in a single center, fetal and maternal outcomes and pregnancy outcomes after kidney donation were similar to those reported in the general population, but inferior to predonation pregnancy outcomes.     

Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation

The aim of this study is to evaluate the hemodynamics and pregnancy outcome of women with prior orthotopic liver transplantation. Hemodynamic measurements by Doppler technique were performed on pregnant subjects with prior orthotopic liver transplantation. Maternal characteristics, renal function, pregnancy complications, delivery indications, delivery mode, and neonatal outcomes were evaluated. Six pregnancies occurred in 5 women after orthotopic liver transplantation at the University of Washington Medical Center (Seattle, WA) between 1991 and 1999. Four of the 6 pregnancies were complicated by chronic hypertension, fetal growth restriction, and preterm delivery. Two pregnancies had worsening hypertension characterized by vasoconstriction in the second trimester despite antihypertensive therapy. These 2 subjects were administered cyclosporine for maintenance immunosuppression and had greater mean arterial pressures preconception and in the first trimester than the other subjects. One of these pregnancies resulted in fetal demise at 25 weeks' gestation. The other subject was delivered at 28 weeks' gestation for nonreassuring fetal status and superimposed preeclampsia. All pregnancies were complicated by renal insufficiency; however, the 2 subjects with poor obstetric outcome had preconception serum creatinine levels greater than 1.5 mg/dL and creatinine clearances less than 40 mL/min. Pregnancies complicated by second-trimester vasoconstriction and moderate renal insufficiency are at risk for preeclamspia, fetal growth restriction, and fetal demise. Good obstetric outcome can occur in women with mild renal insufficiency and well-controlled chronic hypertension. Improved hypertensive control preconception may decrease the risk for preeclampsia and poor obstetric outcome.     

肾小球疾病伴发急性肾损伤患者18例临床特点分析

目的研究分析肾小球疾病伴发急性肾损伤患者的诱发因素、临床病理特点、治疗及转归,以提高此类疾病的防治水平。方法回顾性分析长征医院肾内科病理确诊为肾小球疾病伴发急性肾损伤患者的临床、病理、治疗和预后资料。采用SPSS 13．0软件进行分析。结果（1）共收集病例18例,其中13例存在感染或使用药物等明确诱发因素;（2）临床表现：高血压15例,无尿或少尿11例,肉眼血尿7例,17例血肌酐〉353．6μmol／L,均存在尿蛋白;（3）病理类型：新月体肾炎5例、IgA肾病4例、其他肾小球疾病9例;小管问质重度病变12例,中、轻度6例;（4）常规给予患者对症支持治疗,予激素和（或）免疫抑制剂治疗12例,行肾脏替代治疗15例。3个月内血肌酐降至正常14例,1例降至200μmol／L。结论肾小球疾病伴发急性肾损伤常可能存在诱发因素;临床和病理表现多样;及时控制感染,根据病情应用激素及免疫抑制剂治疗,适时行肾脏替代治疗,多数患者预后较好。     

抗梅毒治疗对妊娠梅毒预后的影响分析

目的：探讨不同时期抗梅毒治疗对妊娠梅毒的妊娠结局及新生儿预后的影响。方法将本院280例妊娠梅毒孕妇根据孕期抗梅毒治疗的不同时期,分为孕前治疗组（60例）、孕早期（孕期≤20周）治疗组（85例）、孕晚期（孕期＞20周）治疗组（97例）和未治疗组（38例）,比较各组患者的不良妊娠结局及先天梅毒的发生率。结果流产、早产、死胎、低体重儿以及新生儿重度窒息等不良妊娠结局发生率在孕前治疗组、孕早期治疗组、孕晚期治疗组和未治疗组分别为13.33%（8/60）、28.24%（24/85）、31.96%（31/97）和47.37%（18/38）,即孕前治疗组与孕早期治疗组的不良妊娠结局发生率显著低于未治疗组（χ2分别为10.206和4.275,P＜0.05）。先天梅毒的发生率在孕前治疗组、孕早期治疗组、孕晚期治疗组和未治疗组分别为0（0/58）、2.82%（2/71）、8.64%（7/81）和12.00%（3/25）。结论早期规范的抗梅毒治疗是改善妊娠梅毒不良妊娠结局,改善新生儿预后及降低先天梅毒发生率的关键。