血液透析对尿毒症患者全段甲状旁腺素的影响

用免疫放射分析，对１０例尿毒症维持血透患者透析时间和间期的血清全段甲状腺素，进行了测定。结果显示一次性血透可清除全段甲状腺素、血磷和补充血钙，有利于纠正患者钙磷人谢，但持续作用时间短暂。     

血浆全段甲状旁腺激素测定在肾脏疾病中的临床应用

目的:探讨全段甲状旁腺激素(i-PTH)在肾脏疾病中的临床应用价值.方法:检测和分析了46例肾功能不全失代偿期组、39例肾功能衰竭期组、35例尿毒症期组患者的全段甲状旁腺激素(i-PTH),并和41例正常对照组进行比较.结果:i-PTH浓度病例组与正常对照组有显著性差异(P＜0.01),各组间i-PTH也有显著性差异(...     

全段甲状旁腺激素测定在肾脏疾病中的应用

为评价在肾脏疾病中检测全段甲状旁腺激素的临床应用价值,测定44例尿毒症组,29例透析治疗组和26例肾炎组患者血浆全段甲状旁腺激素(iTPH)。结果表明尿毒症组、透析治疗组血浆iTPH浓度与31名对照组有显著性差异(P<0.01),肾炎组iTPH浓度与对照组无显著性差异(P>0.05)。提示:肾功能衰竭期iTPH浓度增高,甲状旁腺功能亢进。     

西那卡塞对维持性血液透析继发性甲状旁腺功能亢进患者FGF-23的影响

目的 研究西那卡塞对维持性血液透析继发性甲状旁腺功能亢进患者FGF-23的影响。方法 选取2015年1月~2016年10月在天津市第一中心医院血液净化中心行维持性血液透析治疗合并继发性甲状旁腺功能亢进的患者,按入院顺序随机分为观察组及对照组,对照组40例,给予骨化三醇治疗,观察组39例,给予对照组患者相同的骨化三醇治疗的基础上,再加用盐酸西那卡塞片,两组均连续治疗3个月。监测两组治疗前后的尿素氮、血肌酐、KT/V、血清钙、血清磷、碱性磷酸酶、钙磷乘积、全段甲状旁腺激素 (iPTH)及血清FGF-23。结果 治疗后,两组患者的BUN、SCr和Kt/V 较治疗前,差异无统计学意义（P＞0.05）;血清钙观察组治疗后低于对照组（P＜0.05）,对照组治疗前后,差异无统计学意义（P＞0.05）;两组血清磷、ALP、钙磷乘积、iPTH、FGF-23治疗后降低,且治疗后观察组优于对照组,差异有统计学意义 (P<0.05)。结论 西那卡塞对于维持性血液透析合并继发性甲状旁腺功能亢进的患者能够降低甲状旁腺激素及FGF-23水平,缩小甲状旁腺体积。     

Immunolocalization of Parathyroid Hormone in Human Parathyroid Glands with Special References to Microwave Antigen Retrieval

The subcellular localization of parathyroid hormone (PTH) in the normal human parathyroid glands with particular reference to microwave antigen retrieval was investigated using peroxidase-labeled PTH antibody, immunohistochemical, and immunoelectron microscopic methods. The results revealed that PTH granules existed mainly as pro-PTH on the trans side of Golgi and in the regions adjacent to Golgi apparatus. Only a small proportion of secretory granules were stored near the plasma membrane. Microwave irradiation was essential for the immunodetection of PTH. As the irradiative time extended from 1 to 30 min, the staining intensity increased, and the subcellular preservation decreased. Microwave irradiation for 15 min (with the sections in citrate buffer) with a power output of 500 W is the most ideal for PTH antigen retrieval, as well as for subcellular preservation.     

PTH在CRF诊治中的应用

目的：探讨测定血清中甲状旁腺激素（PTH）的水平在慢性肾功能衰竭（CRF）诊治中的临床意义。方法：测定30例CRF患者血清PTH、25-（OH）VitD3和血钙,与健康人做对照。分别检测30例糖尿病肾病（DN）、高血压肾病患者血清内PTH浓度与血尿素氮（BUN）、血肌酐（Scr）的相关程度。结果：与正常对照组相比,CRF患者血清PTH水平显著升高,25-（OH）VitD3和血钙降低,差异有统计学意义（P〈0.05）。DN患者和糖尿病（DM）患者相比较,高血压肾病患者和高血压患者相比较,前者血清PTH水平均比后者要高,且与血BUN、Scr及尿中微量白蛋白（MA）与肌酐（Cr）的比值（MA/Cr）有较好的相关性。结论：CRF导致患者血清PTH浓度升高,测定血清PTH水平可作为判断肾功能的指标之一,更有助于临床对CRF的提早发现和及时治疗,对钙磷代谢的调节评价及预防继发性甲状旁腺功能亢进具有重要的临床意义。     

Different Seasonal Variations of Potassium in Hemodialysis Patients with High Longitudinal Potassium Levels: A Multicenter Cohort Study Using DialysisNet

PurposeTo determine seasonal variations in serum potassium levels among hemodialysis patients.Materials and MethodsThis was a multicenter cohort study of patients whounderwent hemodialysis and were registered in DialysisNet at our four associated general hospitals between January and December 2016. Month-to-month potassium variability was quantified as SD/√ {n/(n−1)}, and a non-hierarchical method was used to cluster groups according to potassium trajectories. Seasonal variations in potassium levels were analyzed using a cosinor analysis.ResultsThe analysis was performed on 279 patients with a mean potassium level of 5.08±0.58 mmol/L. After clustering, 52.3% (n=146) of patients were included in the moderate group (K⁺, 4.6±0.4 mmol/L) and 47.7% (n=133) in the high group (K⁺, 5.6±0.4 mmol/L). The mean potassium level peaked in January in the moderate group (4.83±0.74 mmol/L) and in August in the high group (5.51±0.70 mmol/L). In the high potassium group, potassium levels were significantly higher in summer than in autumn (p<0.001) and spring (p=0.007). Month-to-month potassium variability was greater in the high group than in the moderate group (0.59±0.19 mmol/L vs. 0.52±0.21 mmol/L, respectively, p=0.012). Compared to patients in the first quartile of potassium variability (≤0.395 mmol/L), those with higher variability (2nd–4th quartiles) were 2.8–4.2 fold more likely to be in the high potassium group.ConclusionDifferent seasonal patterns of serum potassium were identified in the moderate and high potassium groups, with potassium levels being significantly higher in the summer season in the high potassium group and in winter for the moderate potassium group.     

慢性肾衰患者外周血IL-18水平及血液透析对其的影响

为探讨慢性肾衰竭 (CRF )患者外周血IL 18表达量的变化以及血液透析 (HD )对其表达的影响 ,选取 10名健康志愿者及 2 9例CRF患者 ,应用ELISA测定血浆IL 18水平 ,同时采用半定量逆转录多聚酶链反应 (RT PCR )技术 ,检测PBMC中IL 18mRNA表达量。结果是未行HD的CRF患者血浆IL 18水平及PBMCIL 18mRNA表达量较正常对照组增高 ,差异有显著统计学意义 (P <0 0 1) ,单次HD对CRF患者血浆IL 18水平及基因表达无明显影响 (P >0 0 5 ) ,但长期维持HD则可使CRF患者外周血IL 18水平及基因表达增高 (P <0 0 5 )。提示外周血IL 18的高表达可能参与CRF的发病过程及HD相关并发症的发生发展     

The association of diabetes with all-cause mortality in patients with end-stage renal disease compared to the general population in Poland – a comparative analysis

IntroductionEnd-stage renal disease (ESRD) is an important complication of diabetes, which is the leading cause of ESRD worldwide. The aim of the study was a comparative analysis of all-cause mortality in patients with ESRD with diagnosed diabetes mellitus (DM) and no diagnosed DM.Material and methodsData for the analysis were obtained from the resources of the Polish National Health Fund, and they concerned patients with end-stage renal disease from the entire population of Polish patients in the period from 1.01.2011 to 31.12.2013. In addition, the period from 1.01.2012 to 31.12.2012 was analysed for two subpopulations: diabetic and non-diabetic patients.ResultsThe all-cause mortality in patients with end-stage renal disease in Poland per 100,000 representatives of the general population was 17.7, 15.9, and 12.50 persons in 2011, 2012, and 2013, respectively. The all-cause mortality rates for patients with ESRD and diabetes in Poland in 2012 were more than 15 times higher, for both men and women, than the all-cause mortality rates for non-diabetic patients with ESRD. Mortality in the study group of diabetic men with ESRD amounted to 147.59 ±29.07/100,000 men, whereas in the study group of diabetic women with ESRD it was 105.13 ±26.77/100,000 women. Regarding non-diabetic men with ESRD and non-diabetic women with ESRD, mortality amounted to 9.58 ±6.29/100,000 and 6.87 ±2.27/100,000 men and women, respectively.ConclusionsThe occurrence of diabetes in patients with ESRD significantly increases the risk of death compared to patients with ESRD without diabetes.     

不同血液净化方式对CRF患者血清PTH、leptin和Hcy水平的影响

目的：探讨不同净化方式对慢性肾衰（CRF）患者血清甲状旁腺素（PTH）、瘦素（leptin）和同型半胱氨酸（Hcy）水平的影响。方法：选择维持性血液透析患者60例,随机分成2组：血液透析（HD）组30例,血液透析滤过（HDF）组30例。检测治疗前后血清PTH、leptin和Hcy水平。结果：维持性血液透析患者HDF组治疗后血清PTH从（60.8±32.5）pmol/L降至（28.2±17.2）pmol/L,治疗前后比较有显著性差异（P〈0.01）;leptin从（19.7±11.8）μg/L降至（14.1±10.6）μg/L,治疗前后比较有显著性差异（P〈0.05）;Hcy从（32.3±10.7）μmol/L降至（21.1±8.9）μmol/L,治疗前后比较有显著性差异（P〈0.01）。HD组治疗后血清PTH从（61.6±30.8）pmol/L降至（42.2±16.5）pmol/L,治疗前后比较有显著性差异（P〈0.05）;leptin从（19.3±12.1）μg/L降至（18.9±12.3）μg/L治疗前后比较无显著性差异（P〉0.05）;Hcy从（31.5±10.5）μmol/L降至（20.4±8.5）μmol/L,治疗前后比较有显著性差异（P〈0.01）。结论：HDF组与HD组相比较能更好地清除PTH及leptin。     

Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients

Background

Pre-sensitization to human leukocyte antigen (HLA) is closely related to the prognosis of renal transplantation. Concerning the risk factors for HLA sensitization, most studies focused only on selected transplant candidates.

Methods

All patients with end-stage renal disease (ESRD) in a single teaching hospital and a group of healthy subjects were enrolled for the tests of panel-reactive antibodies (PRA).

Results

A total of 1177 subjects were recruited, including 289 ESRD patients (140 hemodialysis, 98 peritoneal dialysis, and 51 pre-dialysis) and 888 healthy volunteers. The prevalence of PRA positivity (for either type I or II HLA) for ESRD patients was higher than for healthy subjects (23.2% vs. 12.8%, p = 0.000). Only pregnancy and transfusion showed independent correlations with PRA positivity, and not ESRD itself. The PRA-positive ESRD patients were prone to be female, have histories of pregnancy, transfusion, no hepatitis B, and use of graft shunt for dialysis. Multivariate analyses showed that pregnancy and time interval of the latest transfusion had independent correlations with PRA positivity. The time interval of less than 1 year had the highest odds ratio 10.06 (p = 0.000).

Conclusions

Pregnancy and recent transfusion, not ESRD itself or dialysis modality, remain the independent risk factors for HLA sensitization.     

Optimizing bone health in chronic kidney disease

Phosphocalcic metabolism disorders often complicate chronic kidney disease (CKD) and worsen as kidney function declines, with a consequence on bone structural integrity. The risk of fracture exceeds that of the normal population in both patients with pre-dialysis CKD and end-stage renal disease (ESRD). The increasing incidence of CKD, the high mortality rate induced by hip fracture, the decreased quality of life and economic burden of fragility fracture make the renal bone disorders a major problem of public health around the world. Optimizing bone health in CKD patients should be a priority. Bone biopsy is invasive. Dual-energy X-ray absorptiometry, commonly used to screen individuals at risk of fragility fracture in the general population, is not adequate to assess advanced CKD because it does not discriminate fracture status in this population. New non-invasive three-dimensional high-resolution imaging techniques, distinguishing trabecular and cortical bone, appear to be promising in the assessment of bone strength and might improve bone fracture prediction in this population. Therapeutic intervention in the chronic kidney disease-mineral and bone disorders (CKD-MBD) should begin early in the course of CKD to maintain serum concentration of biological parameters involved in mineral metabolism in the normal recommended ranges, prevent the development of parathyroid hyperplasia, prevent extra-skeletal calcifications and preserve skeletal health.