106例2型糖尿病患者合并非糖尿病性肾脏损害的临床病理研究

目的探讨2型糖尿病患者合并非糖尿病性肾脏病变（NDRD）的临床表现与病理特点。方法回顾分析了2000年7月至2005年7月在中日友好医院肾活检证实的106例2型糖尿病患者合并的NDRD的临床表现和病理类型，依据年龄不同，分为青年（≤35岁）、中年（36～59岁）和老年（≥60岁）组，分析了三组患者合并NDRD的临床表现和病理特点。结果在青年组10例糖尿病患者中，NDRD临床主要表现为慢性肾炎综合征，占50．0％，肾脏病理主要为IgA肾病，占40．0％；中年组81例，临床表现多样化，肾病综合征占29．6％、慢性肾炎综合征占29．6％、隐匿型肾炎占16．1％以及非糖尿病肾病（DN）性肾功能减退者占24．7％，四者之间差异没有显著统计学意义，但肾脏病理主要为IgA肾病，占42．0％；老年组15例，临床主要表现为非DN性肾功能减退，占66．7％，肾脏病理主要为慢性肾小管间质性肾病，占40．0％。在青年和中年组患者中IgA肾病的患病率显著高于老年组，而老年组非DN性肾功能减退和慢性肾小管间质性肾病的患病率则明显多于青年和中年组。结论青年和中年糖尿病患者合并的NDRD主要为IgA肾病，老年组患者则主要为慢性肾小管间质性肾病。     

未分化结缔组织病致继发性膜性肾病1例

未分化结缔组织病(UCTD)患者中有20%～40%发展成一种确定的结缔组织病(CTD);50%～60%的患者仍然维持在UCTD状态;10%～20%的患者症状逐渐减轻,但始终未发展成一种肯定的CTD。目前报道的CTD累及肾脏时通常临床表现轻微,多为镜下血尿或少量蛋白尿,且对肾脏受累病理类型报道较少。本文报道1例确诊UCTD合并继发性膜性肾病(MN)     

IgA肾病继发恶性高血压和急性肾损伤的临床病理分析

目的对IgA肾病继发恶性高血压和急性肾损伤临床特点和病理特点进行探讨分析。方法于2013年5月-2018年5月期间从我院选取12例IgA肾病继发恶性高血压和急性肾损伤患者作为观察组,并从同一时期选取15例不继发恶性高血压且肾功能正常的IgA肾病,分析两组患者的临床资料和病理资料。结果对观察组患者进行随访后发现,急进性肾炎综合征的患者有6例,其中合并肾病综合征患者有4例,肉眼血尿有3例;剩余6例患者为镜下血尿、蛋白尿以及急性肾损伤,随访期间所有患者均表现为进行性肾功能损害。而在对照组患者中合并肾病综合征患者有3例,肉眼血尿有3例,慢性肾小球肾炎有8例,隐匿性肾小球疾病有1例,在随访的时间段中肾功能没有显著的进展变化。相较于对照组,观察组患者从发病至肾活检的时间明显较短(P0.05);血清肌酐、尿酸、IgA、C反应蛋白及尿蛋白水平观察组高于对照组(P0.05)。结论 IgA肾病继发恶性高血压和急性肾损伤的病情较重,同时肾脏病理病变较重,预后效果也较差。     

强直性脊柱炎相关IgA肾病临床与病理特征

目的：回顾性分析强直性脊柱炎伴IgA肾病的临床病理特点.方法：15例（男12例,女3例）强直性脊柱炎患者,临床有肾脏损害表现,肾活检光镜以系膜增生性病变伴或不伴新月体形成,免疫荧光检查以IgA系膜区沉积为主,回顾分析其临床及病理特征.结果：发生肾损害时强直性脊柱炎病史平均为49.7月（1～240月）,5例患者诊断肾病后才确诊有强直性脊柱炎.13例患者（86.7%）HLA-B27阳性.7例（46.7%）肾损害表现为尿检异常,临床有蛋白尿和镜下血尿;2例（13.3%）以肉眼血尿起病,表现为急性肾炎综合征;6例（40%）起病时表现为慢性肾功能不全.肾活检病理,所有患者均有肾小球系膜和基质增生性病变,8例患者（53.3%）有新月体形成,2例（13.3%）可见节段袢坏死.4例（26.7%）有间质小血管纤维素样坏死,6例（40%）见血管透明变性,3例（20%）间质血管有小血栓形成.10例（66.7%）患者有不同程度的肾小球废弃,4例（26.7%）有半数以上肾小球废弃.8例（53.3%）小管间质中重度纤维化.间质CD68阳性细胞浸润均数为394（188～764）个/mm2.结论：强直性脊柱炎肾脏损害并不少见,临床症状隐匿,容易误诊或漏诊.其肾脏病理改变中突出的血管病变,提示其发病机制不同于原发性IgA肾病,而是继发于强直性脊柱炎.     

继发性淀粉样变的临床特点

目的：研究继发性淀粉样变的临床特点、治疗与预后。方法：对诊为继发性淀粉样变的全部住院病例进行回顾性临床分析。结果：在8例继发性淀粉样变病人中，其原发病分别为结缔组织病4例，多发性骨髓瘤3例，慢性乙型肝炎1例。由结缔组织病至继发淀粉样变平均6.2年，肾脏为其主要累及器官，表现为蛋白尿（4例），1例发生肾功能衰竭，以免疫抑制剂及/或激素治疗后，患者平均生存期长于10年。多发性骨髓瘤继发淀粉样变的时间较短，以舌组织及心肌受累为主，化疗效果差，病人的生存期平均不超过2年。而继发于慢性肝炎后的淀粉样变主要表现为胸腔积液与肝脾大，病情相对平缓。结论：淀粉样变可以继发于结缔组织病、多发性骨髓瘤或慢性炎性疾病，他们的起病时间、受累脏器以及临床表现差异很大，继发于多发性骨髓瘤的淀粉样变预后差，但结缔组织病继发的淀粉样变经积极有效的治疗可以明显改善预后。     

未分化结缔组织病合并IgA肾病一例

未分化结缔组织病（undifferentiated connective tissue diseases,UCTD）可以为某一种弥漫性结缔组织病的早期阶段或顿挫型，部分患者可能是一种独立的疾病。UCTD的肾损害发生率在11％左右，多有抗核抗体（ANA）阳性，临床表现可有水肿、高血压、蛋白尿、血尿和血清肌酐水平升高等，较少有造成严重肾功能不全者。UCTD的肾脏病理类型未见系统报道，现将1例UCTD合并IgA肾病的患者报告如下。     

IgA肾病合并线粒体病

16岁女性,典型肾病综合征起病,且足量激素治疗有效.肾活检病理组织学见肾小球节段轻度系膜增生性病变,免疫荧光IgG、IgA及Clq系膜区沉积,电镜下系膜区增宽,并见系膜区电子致密物沉积,肾小球足细胞足突广泛融合,病理诊断为IgA肾病(微小病变型).2年后患者肾病综合征复发,并出现多系统损害,血白细胞基因检测示8969G＞A基因突变,符合线粒体病.尽管重切电镜标本观察到肾小管上皮细胞胞浆中异常线粒体蓄积,但不能证实肾脏疾病与线粒体相关,最终诊断为IgA肾病合并线粒体病.     

IgA肾病合并抗肾小球基底膜病病例报告并文献复习

目的:探讨IgA肾病合并抗肾小球基底膜(GBM)病的临床表现、诊断、治疗及预后。方法:回顾性分析我院1例IgA肾病合并抗GBM病患者的临床资料,并对相关文献进行复习。结果:以肉眼血尿和进行性升高血肌酐为主要表现,既往肾活检示IgA肾病,此次入院查抗GBM阳性,考虑IgA合并抗GBM病,给予激素免疫抑制剂冲击治疗、血浆置换、规律透析治疗,但是肾功能无明显恢复。结论:IgA肾病和抗GBM病均是免疫复合物相关性疾病,两者可同时出现,及早发现、及早诊治,可有助于挽救患者的肾脏功能。     

IgA肾病合并原发性膜性肾病二例并文献复习

目的探讨IgA肾病合并原发性膜性肾病的临床表现及病理特点.方法分析2例经临床、常规病理检查以及进一步的免疫电镜证实的IgA肾病合并原发性膜性肾病患者的临床表现及病理特点.结果2例患者临床上均可除外继发性肾脏病;免疫电镜证实,IgA沉积于系膜区电子致密物内,IgG沉积于上皮下电子致密物内;2例患者均表现为中～大量的蛋白尿,血尿轻微,肾功能正常.经9个月的随访,肾功能稳定.结论IgA肾病合并原发性膜性肾病较为罕见,临床表现更似于膜性肾病,这两种肾小球疾病合并存在可能对患者的预后并无负面影响.     

成人和儿童过敏性紫癜的对比研究

目的　研究分析成人和儿童过敏性紫癜 (HSP)在临床及肾脏病理方面的不同特点以及影响HSP预后的危险因素。方法　对 15 6例HSP进行回顾性随访分析。患者发病年龄 <16岁为儿童组 ,≥ 16岁者为成人组 ,比较两组HSP在临床、肾脏病理和预后方面的差异 ,分析各种参数对HSP预后的影响程度。结果　成人和儿童HSP的发生均以男性较多见。成人因服用药物和食物诱发HSP者明显多于儿童组。临床上成人HSP肾脏受累 ,血沉和血清IgA升高的发生率明显比儿童组高。儿童HSP患者关节受累和呕吐者更多见。上呼吸道感染、发热、腹痛、黑便和肾病综合征的发生率两组差异无显著性。肾脏受累风险的增加与患者的发病年龄 [相对风险系数 (RR) =7 8],上呼吸道感染史 (RR =4 1)和腹痛病史 (RR =4 6 )密切相关。HSP肾脏的病理类型两组间差异无显著性 ,但成人肾小球外病变 (肾小管和间质病变 )的发生率明显高于儿童组。随访发现儿童HSP的完全缓解率 (76 7% )明显高于成人组 (45 2 % ) ,不全缓解者均表现为肾脏病变。临床蛋白尿和病理有肾小球外病变与HSP的预后密切相关 (RR分别为 5 3和 6 7)。结论　成人和儿童HSP在临床及肾脏病理上有明显不同的特点。成人HSP临床表现相对较重 ,肾脏受累多见 ,完全缓解率低。蛋白尿和肾小球外病变     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.