单纯性血尿患儿中尿微量蛋白系列检测的意义探讨

目的：分析单纯性血尿患儿开展尿微量蛋白系列检测的意义，探讨其在单纯性血尿患儿肾活检时机选择中的参考作用。方法：回顾分析82例单纯性血尿住院病例，检测患者尿微量蛋白系列：尿白蛋白（ALB）、转铁蛋白（TRF）、免疫球蛋白G（IgG）、尿视黄醇结合蛋白（RBP）、N-乙酰β-D-葡萄糖苷酶（NAG），所有患者均进行肾活检。对IgA肾病组和薄基底膜病组的数据进行统计学处理。结果：82例单纯性血尿患儿中薄基底膜病52例（63．4％），IgA肾病18例（22％），IgA肾病组尿微量蛋白系列总阳性率高于薄基底膜病组，但无显著性。两组间ALB、IgG、TRF阳性率差异有显著性（P〈0．05）；两组间IgG有显著差异（P〈0．01）；ALB、TRF无差异；NAG、RBP阳性率和数值比较无差异。结论：在单纯性血尿患儿中尿微量蛋白有明显升高，特别是IgG升高时，提示肾小球滤过膜受损严重，应尽早建议肾活检，明确病理类型，以便早期干预治疗。     

儿童孤立性血尿128例临床分析

目的: 总结儿童孤立性血尿的临床特点,为临床诊治提供参考.方法: 回顾性分析128例儿童孤立性血尿患儿的临床资料,重点分析其阳性家族史、合并症及病理类型特点.结果: 有阳性家族史者24.2%(31/128).并发高尿钙者占13%(12/94),并发左肾静脉压迫综合征者37%(13/35).病理类型:IgA肾病占40.6%(52/128),系膜增生性肾小球肾炎占24.2%(31/128),肾小球轻微病变占18%(23/128),其它类型占17.2%,包括遗传性肾炎、薄基底膜肾病、毛细血管内增生性肾小球肾炎、硬化性肾小球肾炎、IgM肾病.其中31.3%(40/128)有慢性化表现.结论: 儿童孤立性血尿常有阳性家族史,可合并高尿钙或左肾静脉压迫综合征,病理类型以IgA肾病、系膜增生性肾小球肾炎和肾小球轻微病变多见.部分患儿有慢性化表现.     

小儿血尿98例临床分析

[目的]探讨小儿血尿的病因及肾活检病理检查的临床意义.[方法]对98例以血尿为首发或主要症状患儿的临床及病理资料进行回顾性分析.[结果]急性肾小球肾炎39例(39.8%),肾病综合征19例(19.4%),泌尿系感染12例(12.2%),药物性血尿10例(10.2%),孤立性血尿6例,紫癜性肾炎4例(4%),胡桃夹现象2例(2%),泌尿系结石、特发性高钙尿症、遗传型肾炎、狼疮性肾炎、乙型肝炎相关性肾炎各1例(1%).30例肾活检病理结果:系膜增生性肾炎(MsPGN)12例,膜增生性肾炎(MPGN)4例,膜性肾病(MN)4例,局灶性节段性肾小球硬化(FSGS)3例,IgA肾病(IgAN)3例,微小病变型(MCD)2例,毛细血管内增生型肾炎(EnPGN)、狼疮性肾炎(LN)各1例.[结论]小儿血尿病因复杂,主要来自泌尿系统本身,以肾脏免疫系统疾病为主.肾活检病理检查对小儿血尿的诊断、治疗以及了解预后有着重要意义.     

老年高血压患者微量白蛋白尿的检出率及其与靶器官损害的关系

目的 探讨老年高血压患者中微量白蛋白尿的检出率与靶器官损害之间的关系.方法 时153例入选患者分别记录年龄、体重指数、吸烟情况、生活方式、靶器官损害、心脑血管疾病、周围血管疾病、眼底视网膜病变、血脂、血压、高血压患病时间以及是否存在微量白蛋白尿等.根据尿白蛋白排泄率将患者分为微量白蛋白尿阴性(NAU)组及微量白蛋白尿阳性(MAU)组.根据年龄将患者分为:A组,年龄≥70岁;B组,年龄<70岁.结果 153例患者中,共有21例表现为微量白蛋白尿(13.7%);MAU组HDL-C水平明显低于NAU组[分别为(1.81±0.22)、(1.05±0.35)mmol/L,P=0.03];在所有患者中至少有一个靶器官损害者占48.4%(74/153),2组相比差异有统计学意义[NAU组43.9%(58/132),MAU组76.2%(16/21),P=0.006],其中以心血管损害更为常见(41.8%,64/153),2组比较差异有统计学意义[NAU组37.1%(49/132),MAU组71.4%(15/21),P=0.003];A组患者中MAU组与NAU组心血管损害比较,差异有统计学意义[NAU组40.9%(27/66),MAU组83.3%(10/12),P=0.006],应用logistic回归分析,MAU与心血管损害明显相关(P=0.005),与年龄无关.结论在老年高血压患者中MAU与靶器官损害明显相关,应给予更积极的治疗,从而减少心脑血管并发症,改善预后.     

107例IgA肾病的临床表现与病理分析

随着肾穿刺病理活检的开展,IgA肾病越来越被人们所认识,该病临床表现多样化、组织形态学轻重不一,预后各不相同,本文就107例IgA肾病的临床与病理关系报告如下。1资料与方法1．1病例选择资料来源于1992～1998年107例肾穿制病理活检证实的IgA肾病。1．2方法临床上分为4组：（l）单纯血尿组（分为肉眼血尿与镜下血尿）,（2）单纯蛋白尿组（分为轻、中皮蛋白尿与肾病综合症）;（3）血尿同时伴蛋白尿组;（4）肾功能不全组。肾组织活检分别作光镜、免疫荧光及电镜检查,病理上肾脏病变分为：（1）微小病变型;（2）系膜增生型肾小球肾炎…     

2型糖尿病患者骨转换标志物和尿白蛋白/肌酐比的关系

目的 探讨2型糖尿病(T2DM)患者尿白蛋白/肌酐比(UACR)与骨转换标志物的关系。方法纳入2019年1月至2020年7月合肥市第一人民医院滨湖院区内分泌科收治住院的87例T2DM患者,收集患者一般资料以及血尿标本,检测N端-骨钙素(N-MID)、总Ⅰ型胶原氨基端延长肽(PINP)和I型胶原羧基端Beta特殊序列(β-CTX)和UACR等项目。根据UACR分成3组:正常组(38例),UACR≤30 mg/g;微量白蛋白组(37例),30 mg/g UACR 300 mg/g;临床蛋白尿组(12例),UACR≥300 mg/g。对组间资料和N-MID、β-CTX、PINP等指标进行统计学分析。结果 三组间患者N-MID、β-CTX、PINP和糖化血红蛋白(Hb A1c)差异有统计学意义(P 0. 05);临床蛋白尿组和微量白蛋白组的N-MID、β-CTX和PINP的水平较正常组低(P 0. 05);临床蛋白尿组的N-MID水平较微量白蛋白组低(P 0. 05);与正常组比较,临床蛋白尿组的Hb A1c水平升高(P 0. 05)。Pearson相关性分析提示UACR与N-MID、β-CTX呈负相关(r=-0. 272、r=-0. 483,P值均0. 05)。结论T2DM患者在出现微量白蛋白和临床蛋白尿时,存在明显的骨转换指标降低,N-MID和β-CTX是糖尿病肾病患者早期提示低骨转换的状态较为敏感的实验室检测指标。     

原发性膜性肾病合并IgA肾病3例临床病理分析

目的 探讨原发性膜性肾病合并IgA肾病的临床病理特征.方法 分析3例经肾活检病理检查及实验室检查证实的原发性膜性肾病合并IgA肾病患者的临床表现及病理特点.结果 2例患者呈肾病综合征表现,伴或不伴轻微镜下血尿,肾小球基底膜增厚,系膜无明显增生/轻度增生;1例呈慢性肾炎综合征表现,有发作性肉眼血尿并伴有高血压,肾小球基底...     

2型糖尿病患者微量白蛋白尿与冠心病的关系

目的探讨2型糖尿病患者微量白蛋白尿(MAU)与冠心病(CHD)的关系。方法98例2型糖尿病患者,依有无并发CHD分为糖尿病并CHD组(28例)和糖尿病不并CHD组(70例),分析比较两组心血管疾病危险因素。再依微量白蛋白尿含量分为微量白蛋白尿组(43例)和非白蛋白尿组(55例),比较两组CHD的发生率。结果糖尿病并CHD组微量白蛋白尿含量明显高于不并CHD组[(56±32)mg/L和(22±15)mg/L,P<0.01];微量白蛋白尿组并发CHD的发生率显著高于非白蛋白尿组(41.86%和18.18%,P=0.01)。结论检测微量白蛋白尿是预测2型糖尿病患者CHD发病率的有意义的指标。     

肾脏疾病患儿尿TRF、MA和IgG的检测及其临床意义

目的探讨肾脏疾病患儿尿转铁蛋白(TRF)、微量白蛋白(MA)和IgG浓度变化及其临床意义.方法速率散射比浊法检测60例肾病综合征(肾病),25例肾小球肾炎(肾炎)及30例健康对照尿TRF、MA及IgG浓度.结果(1)肾病活动期尿TRF、MA及IgG浓度分别高于缓解期和对照组(P＜0.01),而肾病缓解期组尿TRF、MA及IgG浓度与对照组间差别无显著意义(P＞0.05);(2)肾炎组尿TRF、MA及IgG浓度与对照组间差别有显著意义(P＜0.01);(3)肾小球基底膜轻微损害的患者,尿IgG与TRF浓度比值(IgG/TRF)小于0.09,而肾小球基底膜严重损害的患者,IgG/TRF大于0.23.结论肾炎和肾病活动期尿TRF、MA及IgG浓度显著升高;尿IgG与TRF浓度比值作为蛋白尿选择指数(SPI),有临床参考价值.     

2型糖尿病患者尿白蛋白与葡萄糖负荷后2小时血糖增值的关系

目的 探讨2型糖尿病患者尿白蛋白与口服75 g葡萄糖耐量试验(OGTT)葡萄糖负荷后2小时血糖增值(2 hPG-FBG)关系。方法 利用电子病历系统,回顾性收集我院内分泌科住院的2型糖尿病患者120例。依据尿白蛋白/肌酐比值(UACR)分为尿白蛋白正常组(N组:UACR<30 mg/g)、微量白蛋白尿组(A组:30 mg/g≤ UACR<300 mg/g)和大量白蛋白尿组(B组:UACR≥300 mg/g), 比较三组间各指标是否存在差异。结果 2 hPG-FBG中位数在微量白蛋白尿组高于尿白蛋白正常组,大量白蛋白尿组高于微量白蛋白尿组(P<0.05),HbA₁c均值在微量白蛋白尿组和大量白蛋白尿组均高于尿白蛋白正常组(P<0.05)。Spearman相关分析显示,UACR与HbA₁c(r=0.294)和2 hPG-FBG(r=0.516)呈正相关关系(均P<0.05),多元线性逐步回归分析显示2 hPG-FBG是UACR独立危险因素(β=0.211)。结论 以葡萄糖负荷后2 h血糖增值为代表的餐后血糖波动是造成2型糖尿病患者尿白蛋白增加的重要因素,其作用较持续血糖水平更为明显。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.