15例表现为恶性高血压的IgA肾病临床与病理分析

恶性高血压(MHT)常危及心、脑、肾等重要脏器,据统计,未获得有效治疗的MHT患者存活1年者不足25%,而存活5年以上者仅有1%[1].在MHT的病因中,15%为慢性肾小球肾炎[2],而在慢性肾小球肾炎中以IgA肾病占首位[3].现将我院近6年来,以MHT为主要表现的15例IgA肾病患者的临床资料进行回顾性分析,报道如下.     

恶性高血压与肾脏损害

恶性高血压与肾脏损害上海市第六人民医院唐令铨，上海２０００４０恶性高血压是指舒张压持续＞１７．３ｋＰａ，病情严重，发展迅速，并有视网膜病变及肾功能很快衰竭者，此种高血压如及时给予有效治疗，则完全可能解除生命危险，称恶性欠妥；故ＷＨＯ称为急进型高血压（...     

急进型高血压及肾功能损害的治疗（附二例报告）

急进型高血压（Ａｃｃｅｌｅｒａｔｅｄｈｙｐｅｒｔｅｎｓｉｏｎ）又称为恶性高血压（Ｍａｌｉｇｎａｎｔｈｙｐｅｒｔｅｎｓｉｏｎ），预后较差，病人多死于肾功能衰竭。因此，选择合理的药物治疗急进型高血压，保护肾功能显得很有必要。现报告二例经临床诊断为急进型高血压，采用卡托普利、氨氯地平和利尿剂治疗，取得良好疗效，结合文献复习进行讨论。病历摘要　　病例１，患者男，５５岁。因夜尿增多三个月，言语欠清，头痛十余天于１９９９年４月４日入院。患者近三月来夜尿增多，每晚３～４次，伴体重下降，多饮；近十余天来头痛，言…     

老年肾病综合征并发急性肾功能衰竭临床及病理分析

目的探讨老年肾病综合征(NS)并发急性肾功能衰竭(ARF)临床、病理特点及转归。方法对经皮肾活检病理检查确诊的30例老年NS并发ARF患者的临床、病理特点及转归进行回顾性分析,并与同期54例非老年NS并发ARF患者进行比较。结果两组病因均以原发性肾小球疾病为主,其中老年组以继发糖尿病肾病、恶性肿瘤为主;老年组肾活检病理类型以膜性肾病、局灶节段性肾小球硬化为主,非老年组的肾活检病理类型多样;老年组NS并发ARF发病率较高,为25.0%(30/120),且男性多于女性,非老年组发病率为7.15%(54/755);老年组病死率高,治愈率低。结论老年NS并发ARF患者的病理类型以膜性肾病、局灶节段性肾小球硬化多见,发病率高,治愈率低,预后差。     

急进性/恶性高血压引起的血栓性微血管病变一例并文献复习

<正>1病例资料患者男性,26岁,主因“胸闷伴头晕、头痛及视物模糊3 d”于2021年5月20日入院。患者3 d前无明显诱因平卧时出现胸闷,伴头晕、头痛,轻度视物模糊。就诊于外院,测血压240/140 mm Hg,血常规:血红蛋白102 g/L,血小板计数63×109/L;N末端B型利钠肽原8 562 pg/ml,乳酸脱氢酶1 670 U/L,肌酐270μmol/L。     

腹膜恶性间皮瘤6例临床病理分析

腹膜间皮瘤（PM）是来自腹腔浆膜的问皮和间皮下层细胞的肿瘤,是一种罕见病。该病起病隐匿,临床表现无特异性,病情进展迅速,预后较差。笔者收集青海省肿瘤医院1994～2008年6例PM患者,结合文献探讨其临床病理特征。     

以心肌受累为早期主要表现的恶性组织细胞病1 例

恶性组织细胞病(malignanthistiocytosis,MH)临床上以持续高热、肝脾淋巴结肿大、全血细胞减少为主要表现,晚期可出现黄疸、恶病质等症状,病情复杂,凶险,死亡率高。但很少会以心肌受累为早期主要表现,从而耽误病情。现将我科收治的1例以心肌受累为早期主要表现的MH报告如下。     

皮肤恶性黑素瘤临床病理分析

恶性黑素瘤占所有恶性肿瘤的1%～2%〔1,2〕,占皮肤恶性肿瘤的7%～20%〔3〕,好发于老年人,绝大部分发生于皮肤,也可发生于眼、外阴、直肠和肛门、生殖道、消化道、鼻窦、喉及软脑膜等处。该病的发病与紫外线、外伤、色素痣及遗传等因素有关〔4～6〕,恶性程度高,早期易发生淋巴和血液转移,治疗困     

IgA肾病牛津分类的理论依据及临床病理相关性分析

IgA肾病(IgAN)是最常见的肾小球疾病,但迄今为止尚缺乏国际公认的临床或病理分类.肾脏病医生往往根据IgAN患者的临床表现来判断其慢性肾脏病进展的危险性.大量研究表明以下危险因素有助于预示慢性肾脏疾病的进展:大量蛋白尿,高血压,肾功能[1-5].     

肺原发性恶性黑色素瘤的临床病理分析

肺原发性恶性黑色素瘤(primary malignant melanoma of the lung,PMML)临床极为少见，截至2004年6月，国内献公开报道且资料完整的病例仅11例，现对上述病例进行综合分析，以探讨PMML的临床病理特征，提高对本病的认识。     

Malignant hypertension and oral contraceptives: four cases, with two due to the 30 micrograms oestrogen pill

Malignant phase hypertension can occur in women taking combinedoestrogen-progestagen oral contraceptives and is almost certainlycaused by the medication. In previous reports the preparationsused contained 50–100 µg oestrogen. We describefour cases, two of which we believe to be the first recordedexamples of the malignant phase induced by preparations containingonly 30µg of oestrogen. In one case, brain damage dueto over-rapid reduction of very high blood pressure is described. Malignant phase hypertension may occur within weeks of commencingtherapy, or after several years. Although recent preparationscontain lower doses of oestrogen, there is no room for complacencywhen prescribing oral contraceptives. Close medical supervisionand regular blood pressure measurements during such treatmentare mandatory.     

特发性门脉高压症的临床病理学特点

目的 探讨特发性门脉高压症(idiopathic portal hypertension,IPH)的临床病理学特点.方法 回顾性分析了9例IPH的临床及病理学资料,并对其肝脏标本进行常规病理学及免疫组化研究.结果 9例IPH中,5例首发症状为上消化道出血和黑便,3例体检发现脾大脾亢而无临床症状,1例以血管瘤入院.人院检查脾肿大7例,胃底食道静脉曲张6例,腹水征4例,贫血者6例,肝功能正常或接近正常9例.病理组织学显示9例肝小叶结构基本正常.均未见假小叶形成及肝细胞坏死;9例均有不同程度汇管区纤维化,3例汇管区纤细的不全纤维间隔形成并向肝实质延伸,6例有门脉末支管壁纤维化;9例中有6例小叶内肝细胞有不同程度的水肿变性,5例肝窦有不同程度的扩张,2例肝窦扩张较明显,肝细胞萎缩,呈血管瘤样结构,2例有轻-中度肝腺胞3区大泡脂变.脾脏组织学符合淤血性脾肿大病理表现.结论 IPH的临床表现与其他原因所致的肝硬化门脉高压相似,肝穿组织病理学可除外肝硬化,并有一定的特征.诊断时应与各种原因所致肝硬化门脉高压,肝窦阻塞综合征等相鉴别.     

双倍剂量科素亚治疗慢性肾炎肾性高血压的临床分析

目的探讨双倍剂量科素亚治疗慢性肾炎肾性高血压的临床疗效和安全性。方法将50例肾性高血压患者分为科素亚单倍剂量组和科素亚双倍剂量组,分别应用科素亚50mg和100mg治疗12周,观察两组患者治疗前后血压、24小时尿蛋白定量、肝肾功能、血脂的变化和不良反应。结果两组患者的血压、24小时尿蛋白定量和尿酸水平均有显著性下降(P<0.05),而血肌酐、血钾、肝功能无显著变化(P>0.05);与单倍剂量科素亚治疗组比较,双倍剂量组患者治疗后24小时尿蛋白定量显著下降(P<0.05)。结论两组剂量科素亚治疗肾性高血压均有效,具有良好的安全性,但双倍剂量较单倍剂量科素亚对肾脏的保护作用更好。     

Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment

Hypertension is a very common modifiable risk factor for cardiovascular morbidity and mortality. Patients with hypertension represent a diverse group. In addition to those with primary hypertension, there are patients whose hypertension is attributable to secondary causes, those with resistant hypertension, and patients who present with a hypertensive crisis. Secondary causes of hypertension account for less than 10% of cases of elevated blood pressure (BP), and screening for these causes is warranted if clinically indicated. Patients with resistant hypertension, whose BP remains uncontrolled in spite of use of 3 or more antihypertensive agents, are at increased cardiovascular risk compared with the general hypertensive population. After potentially correctible causes of uncontrolled BP (pseudoresistance, secondary causes, and intake of interfering substances) are eliminated, patients with true resistant hypertension are managed by encouraging therapeutic lifestyle changes and optimizing the antihypertensive regimen, whereby the clinician ensures that the medications are prescribed at optimal doses using drugs with complementary mechanisms of action, while adding an appropriate diuretic if there are no contraindications. Mineralocorticoid receptor antagonists are formidable add-on agents to the antihypertensive regimen, usually as a fourth drug, and are effective in reducing BP even in patients without biochemical evidence of aldosterone excess. In the setting of a hypertensive crisis, the BP has to be reduced within hours in the case of a hypertensive emergency (elevated BP with evidence of target organ damage) using parenteral agents, and within a few days if there is hypertensive urgency, using oral antihypertensive agents.     

原发性高血压患者微量蛋白尿与早期肾损害

目的：探讨尿液微量蛋白与高血压病(EH)早期肾功能损害的关系。方法：用速率免疫散射比浊法测定了105例EH思考和32例正常对照市的尿液微量白蛋白(mAL)、白蛋白(ALB)、α1微球蛋白(α1—MG)、β2微球蛋白(β2—MG)。结果：EH患早期即有α1—MG水平的升高(P＜0．05)。结论：尿液α1—MG的测定有利于EH患肾功能损害的早期诊断、治疗。     

Association between the chemokine receptor 5 delta32 polymorphism and rheumatoid arthritis: a meta-analysis

Abstract

Objectives. In the study cohort enrolled in a prospective open-label, multicenter trial conducted by the Japanese Study Group for MPO-ANCA-associated vasculitis (JMAAV), we conducted this sub-analysis to establish the validity of the Birminghan vasculitis activity score (BVAS) for Japanese patients with MPO-ANCA-associated vasculitis.

Methods. We recorded the BVAS at the time of diagnosis, at 6 weeks after the diagnosis, and at 3, 6, 9, 12, 15 and 18 months after the diagnosis in this study.

Results. The most frequently involved organs in the patients were the lungs, kidneys and the nervous system. The kidney (BVAS; new/worse 69.2 %, persistent 40.4 %), general (BVAS; new/worse 67.3 %, persistent 53.8 %), chest (BVAS; new/worse 36.5 %, persistent 46.2 %) and nervous system (BVAS; new/worse 38.5 %, persistent 25.0 %) were the organ systems most frequently involved by the disease at the baseline. The BVAS for new/worse disease decreased immediately after induction therapy, while improvement of the BVAS for persistent disease after therapy differed among the organ systems.

Conclusions. BVAS was demonstrated to be a valuable guide for selection of the optimal treatment. Thus, BVAS was also found to be a useful tool in Japanese patients for the assessment of disease activity and degree of organ damage in patients with MPO-ANCA-associated vasculitis.     

Erythromelalgia as a presenting manifestation in a patient with essential thrombocythemia complicating renovascular hypertension due to unilateral renal artery stenosis

Erythromelalgia is a kind of cutaneous manifestation, which appears as a thrombotic complication in patients with myeloproliferative disorders such as essential thrombocythemia and polycythemia vera. It is characterized by red, congested distal extremities and a painful burning sensation, and is usually confined to the feet and one or more toes or fingers. A 28-year-old woman visited our hospital due to severe pain in the left thumb, index fingers and right toes. Her right toes and left thumb were erythematous, congested, and warm. She had a high blood pressure level of 190/100 mmHg, and laboratory evaluation revealed marked thrombocytosis. Bone-marrow findings were compatible with essential thrombocythemia. Renal angiography showed obvious stenosis in unilateral right renal artery. Her erythromelalgia immediately disappeared following interventional therapy along with aspirin. A careful history and appropriate evaluation of underlying diseases are important, because erythromelalgia as a microscopic thrombotic complication may be accompanied by vascular stenosis and all the resulting manifestations.     

21例特发性门脉高压临床及病理特点分析

目的分析特发性门脉高压(idiopathic portal hypertension,IPH)的临床及病理特点。方法回顾性分析2012年1月—2016年12月在解放军第三〇二医院住院治疗(资料完整)的21例IPH患者的临床及病理特点。结果 21例IPH患者中,男女比例6∶15,平均发病年龄(38.1±12.7)岁,临床以门脉高压症表现为主,肝功能无明显减退,主要并发症为上消化道出血及腹水。21例肝组织病理主要表现为肝细胞板排列基本正常,无假小叶形成,汇管区扩大,门静脉周围纤维化,门脉周围有不同程度的细胞浸润,血管紊乱,中央静脉及小叶间静脉扩张,肝窦扩张,窦周纤维化。结论 IPH患者门脉高压和肝功能损害不平行,门脉高压表现较重,确诊仍须病理学检查,治疗以防治并发症为主。     

动态心率与高血压患者早期肾损害的相关性研究

目的 探讨原发性高血压患者24 h动态心率(24hAHR)与高血压早期肾损害的相关性.方法 回顾性分析2017年6月至2018年1月于山东大学附属山东省千佛山医院心内科就诊的原发性高血压患者441例.收集患者临床资料,行24 h动态血压监测,收集24hAHR、24 h平均收缩压(24hSBP)、24 h平均舒张压(24...     

原发性高血压患者高血压类型、脉压、脉压指数与早期肾损害的关系

目的 探讨原发性高血压患者不同高血压类型、脉压、脉压指数与早期肾损害的关系.方法 将原发性高血压患者182例作为高血压组,另选取体检健康者30例作为对照组.收集各组清晨首次清洁中段尿,测定尿微量白蛋白（mALB）、尿足细胞标志蛋白podocalyxin （PCX）,计算比较高血压组和对照组及不同类型高血压组[单纯收缩期高血压（ISH）组,单纯舒张期高血压（IDH）组,收缩期高血压合并舒张期高血压（SDH）组]、不同脉压组（≤50 mmHg组、51 ～60 mmHg组、＞60 mmHg组）、不同脉压指数组（＜0.4％组、0.4％ ～0.5％组、＞0.5％组）mALB、PCX阳性率.结果 高血压组mALB、PCX阳性率较对照组高（P＜0.05或＜0.01）;且高血压组PCX阳性率较mALB阳性率高（P＜0.01）.高血压类型中ISH组、SDH组mALB、PCX阳性率较IDH组高（P均＜0.01）;且ISH组、SDH组PCX阳性率较mALB阳性率高（P均＜0.01）.脉压＞60 mmHg组mALB、PCX阳性率较≤50 mmHg组高（P均＜0.01）,且各不同脉压组PCX阳性率较mALB阳性率高（P均＜0.05）.脉压指数0.4％ ～0.5％组、＞0.5％组mALB、PCX阳性率较＜0.4％组高（P＜0.05或＜0.01）;且不同脉压指数组PCX阳性率较mALB阳性率高（P＜0.01）.结论 原发性高血压患者ISH、SDH比IDH更易发生肾损害,脉压和脉压指数越大肾损害的发生率越高,所以联合检测尿中mALB、PCX有利于早期诊断高血压肾损害.