原发性肾病综合征患儿539例病理类型及随访

目的分析原发性肾病综合征（PNS）患儿的病理类型、治疗及随访情况。方法纳入2005年1月至2009年12月在湖南省儿童医院肾内科住院的诊断为PNS,进行肾脏病理学检查且随访时间≥6个月的患儿,根据年龄分为〈2岁组、～5岁组、～10岁组和〉10岁组,对不同年龄组肾脏病理类型、对糖皮质激素的反应、转归及随访资料进行分析。结果共纳入539例PNS患儿,男性402例,女性137例,男女比例为2.9∶1;〈2岁组159例（29.5%）,～5岁组269例（49.9%）,～10岁组84例（15.6%）,〉10岁组27例（5.0%）（P〈0.01）。①微小病变274例（50.8%）,局灶节段性肾小球硬化79例（14.6%）,系膜增生性肾小球肾炎173例（32.1%）,膜增生性肾小球肾炎6例（1.1%）,膜性肾病4例（0.74%）,增生硬化性肾小球肾炎2例（0.37%）,脂蛋白肾病1例（0.18%）。不同年龄组间肾脏病理类型的分布差异有统计学意义（P〈0.05）。②对糖皮质激素敏感和依赖的PNS患儿以微小病变为主（分别为62.4%和69.6%）,对糖皮质激素耐药的PNS患儿以系膜增生性肾小球肾炎为主（48.4%）。③539例中239例完全缓解,75例部分缓解,61例无效,158例症状控制,尿蛋白（-）,但仍在服用泼尼松。6例患儿分别因对糖皮质激素耐药,病情不能缓解,合并严重感染或进展至终末期肾病放弃治疗而死亡。结论儿童PNS的发病高峰年龄、肾脏病理类型以及对糖皮质激素耐药的发生率可能已发生改变,并且在不同年龄患儿间存在差异。     

Rituximab treatment for difficult-to-treat nephrotic syndrome in children:a multicenter,retrospective study

Background/aimThis study aimed to evaluate the efficacy of rituximab in children with difficult-to-treat nephrotic syndrome, considering the type of disease (steroid-sensitive or –resistant) and the dosing regimen.Materials and methodsThis multicenter retrospective study enrolled children with difficult-to-treat nephrotic syndrome on rituximab treatment from 13 centers. The patients were classified based on low (single dose of 375 mg/m²) or high (2-4 doses of 375 mg/m²) initial dose of rituximab and the steroid response. Clinical outcomes were compared.ResultsData from 42 children [20 steroid-sensitive (frequent relapsing / steroid-dependent) and 22 steroid-resistant nephrotic syndrome, aged 1.9–17.3 years] were analyzed. Eleven patients with steroid-sensitive nephrotic syndrome (55%) had a relapse following initial rituximab therapy, with the mean time to first relapse of 8.4 ± 5.2 months. Complete remission was achieved in 41% and 36% of steroid-resistant patients, with the median remission time of 3.65 months. At Year 2, eight patients in steroid-sensitive group (40%) and four in steroid-resistant group (18%) were drug-free. Total cumulative doses of rituximab were higher in steroid-resistant group (p = 001). Relapse rates and time to first relapse in steroid-sensitive group or remission rates in steroid-resistant group did not differ between the low and high initial dose groups. ConclusionThe current study reveals that rituximab therapy may provide a lower relapse rate and prolonged relapse-free survival in the steroid-sensitive group, increased remission rates in the steroid-resistant group, and a significant number of drug-free patients in both groups. The optimal regimen for initial treatment and maintenance needs to be determined.     

促肾上腺皮质激素应用于原发性肾病综合征频复发及激素依赖患儿疗效及安全性初探

目的探讨促肾上腺皮质激素（ACTH）治疗原发性肾病综合征（PNS）频复发或激素依赖患儿的疗效和安全性。方法以符合PNS频复发或激素依赖患儿为ACTH组,每月给予ACTH缓慢静滴3—5d,并逐渐激素减量至停药;以激素维持治疗PNS患儿为对照组。观察治疗前与治疗后3、6和12个月两组激素剂量、复发次数、肾上腺皮质功能及不良反应。结果2010年9～12月ACTH组纳入14例,对照组纳入6例。（1）ACTH组12／14例均能顺利将激素减量至停药,无复发;2例因感染尿蛋白波动,感染控制后尿蛋白仍阳性,激素加量至尿蛋白转阴后减量,继续ACTH冲击,其中1例因感染后再次复发,停用ACTH改用他克莫司。ACTH组13例进入分析。（2）ACTH组治疗后3、6和12个月激素剂量与治疗前差异有统计学意义（P〈0．05）;对照组治疗后3、6和12个月激素剂量与治疗前差异无统计学意义（P〉0．05）;ACTH组与对照组治疗后6、12个月激素剂量差异有统计学意义（P〈0．05）。③治疗前ACTH组和对照组均存在肾上腺皮质功能低下,ACTH组13例在治疗3、6和12个月分别有9、11和13例肾上腺皮质功能恢复正常;对照组6例12个月治疗期间均表现为肾上腺皮质功能低下。（4）ACTH组观察到腰部皮疹和心率加快各1例。（5）ACTH组治疗后6、12个月身高与治疗前差异有统计学意义,对照组治疗前后身高差异无统计学意义（P〉0．05）。ACTH组治疗前后体重差异无统计学意义,对照组治疗后6、12个月体重与治疗前差异有统计学意义（P〈0．05）。（6）ACTH组和对照组治疗前后骨密度差异均无统计学意义（P〉0．05）。结论ACTH治疗PNS频复发或激素依赖患儿有一定疗效,可避免长期激素治疗的不良反应,值得进一步探讨。     

Antibiotic resistance of Helicobacter pylori: a cross-sectional study in consecutive patients, and relation to ethnicity

Objectives  To assess primary antibiotic resistance in a given population and relate the results to ethnicity.
Materials and methods  Consecutive cultures were tested for antibiotic susceptibility with the Etest. Three populations were studied separately: ethnic Dutch people, patients of Turkish descent, and patients originating from Africa and the Middle East.
Results  Over a period of 5.5 years, 976 (32%) biopsy specimens from 3010 patients were positive for Helicobacter pylori . Metronidazole and clarithromycin resistance were present in 25.8% and 4.8% of the strains, respectively. The number of metronidazole-resistant strains showed a gradual decrease, while clarithromycin resistance showed a slight increase during the study period. Antimicrobial resistance in patients of Turkish descent and in those originating from Africa or the Middle East was significantly higher than in ethnic Dutch people, 35% and 9.1% versus 21% and 2.9%, respectively ( P  = 0.003 and P  = 0.002).
Conclusion  It is important to take ethnicity into account when studying antibiotic resistance. The numbers of metronidazole- and clarithromycin-resistant strains can vary considerably between people of different ethnic origin living in the same region.     

High seroprevalence of Helicobacter pylori infection in non-institutionalised children with mental retardation

Eighty-four children with mental retardation (34 boys, 50 girls; age range 2-18 years, median 6 years) and 84 age- and gender-matched outpatient controls were studied. All children were living at home, had never stayed in an institution, and came from the same urban area. Seropositivity for Helicobacter pylori was found in 42 (50%) of 84 mentally retarded children and 16 (19%) of 84 controls (p < 0.01). Socio-economic factors did not differ between the two groups. The findings indicated that a higher prevalence of H. pylori infection occurs in children with mental retardation, regardless of whether they are institutionalised.     

老年原发性肾病综合征患者肾组织和外周血CD62P的表达及意义

目的研究老年原发性肾病综合征(APNS)患者外周血和肾组织CD62P表达水平的变化,并探讨CD62P在APNS病理过程中的作用.方法采用流式细胞术和直接免疫荧光法,对36例APNS患者外周血和肾活检组织CD62P的表达进行研究.结果APNS患者外周血CD62P的表达明显高于正常对照组,有显著性差异(P＜0.01);肾组织CD62P的表达32例(88.89%),表达部位主要在肾小球系膜区和毛细血管袢,与常规肾脏病理检查所观察到的病变部位及其病变程度相一致.正常对照组肾组织中无CD62P表达.结论CD62P在APNS患者外周血和肾组织中表达增强,CD62P可能参与了APNS的病理过程,外周血和肾组织CD62P的变化可反映APNS的病情严重程度,具有重要的临床价值.     

Clinicopathologic characteristics and steroid response of IgM nephropathy in children presenting with idiopathic nephrotic syndrome

There is no detailed information on clinical and immunopathologic features of immunoglobulin M nephropathy (IgMN) in children with idiopathic nephrotic syndrome (INS) in Pakistan. We reviewed our native renal biopsies over 15 years (July 1995-July 2010) and identified 135 cases of IgMN in nephrotic children (≤17 years). Their demographic, clinical and immunopathologic data were retrieved from biopsy reports and case notes. Mean age of this cohort was 7.6 ± 4.2 years. Males were 92 (68.1%) and females were 43 (31.9%). Steroid-dependent NS was seen in 88 (65.2%) cases and steroid-resistant NS in 47 (34.2%). Hematuria was found in 42 cases (31.2%) and hypertension in 27 (19.5%). The most common morphologic change was glomerular mesangial proliferation, found in 89 (65.9%) biopsies. Minor changes were seen in 46 (34.1%) cases and focal segmental glomerulosclerosis (FSGS) in 37 (27.4%). Immunofluorescence microscopy showed diffuse mesangial positivity of IgM in all cases. C3 and C1q were found in 72 (53.3%) and 40 (29.7%) cases, respectively. Our results show that IgMN is a fairly common cause of INS in children in Pakistan. It shows a spectrum of morphologic changes ranging from minor changes to FSGS.     

Management of Helicobacter pylori among medical doctors working in Khartoum,Sudan 2019: a cross-sectional study

BackgroundVarious international guidelines have been developed regarding Helicobacter pylori (H. pylori) management, as it is infecting more than half of the world''s population. Sudan''s health system lacks guidelines regarding H. pylori management, leading to a discrepancy in practice. Investigating the current approach could be a step forward in the formulation of a national consensus in the management of H. pylori.MethodsA cross-sectional study was conducted among medical doctors currently working in Khartoum, Sudan. Participants were enrolled from platforms of medical associations through an online questionnaire. The questionnaire was scored out of 25 points, and scoring 13 or above considered a good approach. Data analysis was carried out using Statistical Package for Social Sciences (SPSS).ResultsA total of 358 medical doctors participated in the study. The mean (±SD) score was 12.9(±4.5). Those who were using textbooks, campaigns, symposiums or general medical information to their primary Source of knowledge significantly scored higher. The most selected indication for both diagnosis (76.8%) and treatment (67.6%) was an active peptic ulcer. Stool antigen test (SAT) was the most preferred test (70.7%). The majority of respondents selected triple therapy (82.1%) as a first-line regimen. Only 37.7% confirmed the eradication after four weeks of stopping the treatment. They ensure eradication mainly through SAT (29%).ConclusionA suboptimal approach was noted among medical doctors of Khartoum, Sudan, regarding H. pylori management. Efforts should be invested in forming national guidelines and the implementation of continuous medical education programs.     

The role of Helicobacter pylori in primary gastric MALT lymphoma

AIMS: Helicobacter pylori has been claimed to be an important aetiological factor which raises the risk of mucosa-associated tissue lymphoid (MALT) lymphoma. However, some studies on gastric MALT lymphoma revealed a low rate of H. pylori infection suggesting that not all gastric lymphomas are related to H. pylori infection. The aim of this study was to verify the H. pylori infection frequency in a series of patients with primary gastric MALT lymphomas and to examine the relationship between H. pylori and the pathological features of those lymphomas. METHODS AND RESULTS: Thirty-one cases of resected gastric lymphoma were analysed: 10 cases (32%) were low-grade MALT lymphomas and 21 cases (68%) were high-grade MALT lymphomas. Helicobacter pylori was found in only 18 of 31 (58%) cases. Helicobacter pylori infection was significantly correlated with the grade and depth of invasion of MALT lymphoma since 63% of superficial low-grade MALT lymphomas were positive for H. pylori compared with 38% of advanced high-grade MALT lymphomas (P = 0.02). CONCLUSION: We confirmed the relationship between H. pylori infection and a subset of gastric MALT lymphoma. Our results also showed that not all low- and high-grade gastric MALT lymphomas are H. pylori-dependent. This suggests that H. pylori infection may play a promoter role in the development of MALT lymphoma, but its presence is not mandatory for the progression of the lymphoma in view of its low frequency in advanced high-grade MALT lymphoma.     

根除儿童口腔幽门螺杆菌预防胃内幽门螺杆菌感染的多中心研究

目的:探讨根除儿童口腔幽门螺杆菌（Hp）预防胃内Hp感染的可能性。方法:采用多中心前瞻随机研究,选取口腔Hp阳性但胃内Hp阴性的幼儿园儿童共计427例,随机分为使用“无幽梅”牙膏组与普通牙膏组,分别接受“无幽梅”牙膏和普通牙膏。疗程结束后,再次检测口腔Hp,将口腔Hp阳性及阴性患者各分为一组,1年后行C13呼气试验检查,分析两组患者胃内Hp感染情况。口腔Hp检测方法采用特异度及敏感度双高的套式PCR方法。结果:随访1年,口腔Hp阴性组胃内Hp感染率为0.51%,口腔Hp阳性组胃内Hp感染率为6.51%,两组统计差异具有显著性（P<0.01）。结论:儿童根除口腔Hp可以降低胃内Hp感染的发生。     

糖皮质激素对原发性肾病综合征患儿T辅助细胞平衡的影响

目的　探讨糖皮质激素治疗对原发性肾病综合征患儿TH1/TH2平衡的影响。方法　运用三色荧光标记法流式细胞术检测 2 1例初发 (NS组 )和 15例复发 (NS +Pred组 )的肾病患儿外周血TH1和TH2细胞百分率 (% ) ,并以 9例缓解期患儿 (NS缓解 +Pred组 )和 10例正常儿童 (正常组 )作对照。结果　正常儿童外周血TH1、TH2细胞百分率分别为 (13.42± 4.36 ) %和 (2 .5 3± 1.97) %。初发的原发性肾病患儿均明显减低 (P <0 .0 5 ) ,分别为 (2 .34± 2 .0 9) %和 (1.0 2± 0 .96 ) %。复发的肾病患儿除TH1细胞百分率减低 [(1.2 0± 0 .91) % ,P <0 .0 1]、TH2细胞百分率增高 [(7.6 5± 4.5 3) % ,P <0 .0 1)外 ,TH1细胞百分率也较初发病例进一步下降 (P <0 .0 5 )。缓解期肾病患儿TH1和TH2细胞百分率均正常 ,分别为 (12 .0 4± 4.92 ) %和 (2 .81± 2 .6 5 ) % (P >0 .0 5 )。TH1/TH2比值在正常儿童为 5 .41± 2 .77,在初发的肾病患儿明显减低 (2 .43± 2 .6 5 ,P <0 .0 5 ) ,在复发的患儿较初发患儿进一步下降 (0 .77± 1.0 7,P <0 .0 5 ) ,在缓解患儿则正常 (4 .2 5± 2 .12 ,P >0 .0 5 )。肾病患儿也存在着Tc2细胞占优势的免疫平衡失调。结论　糖皮质激素在体内是通过促进TH2细胞向TH1细胞迁移 ,逆转肾病患儿TH2细胞     

Disseminated cryptococcosis in a patient with nephrotic syndrome

Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared.     

Failure of regulation results in an amplified oxidation burst by neutrophils in children with primary nephrotic syndrome

The mechanism responsible for proteinuria in non‐genetic idiopathic nephrotic syndrome (iNS) is unknown. Animal models suggest an effect of free radicals on podocytes, and indirect evidence in humans confirm this implication. We determined the oxidative burst by blood CD15⁺ polymorphonucleates (PMN) utilizing the 5‐(and‐6)‐carboxy‐2′,7′‐dichlorofluorescin diacetate (DCF‐DA) fluorescence assay in 38 children with iNS. Results were compared with PMN from normal subjects and patients with renal pathologies considered traditionally to be models of oxidative stress [six anti‐neutrophil cytoplasmic autoantibody (ANCA) vasculitis, seven post‐infectious glomerulonephritis]. Radicals of oxygen (ROS) production was finally determined in a patient with immunodeficiency, polyendocrinopathy, enteropathy X‐linked (IPEX) and in seven iNS children after treatment with Rituximab. Results demonstrated a 10‐fold increase of ROS production by resting PMN in iNS compared to normal PMN. When PMN were separated from other cells, ROS increased significantly in all conditions while a near‐normal production was restored by adding autologous cells and/or supernatants in controls, vasculitis and post‐infectious glomerulonephritis but not in iNS. Results indicated that the oxidative burst was regulated by soluble factors and that this regulatory circuit was altered in iNS. PMN obtained from a child with IPEX produced 100 times more ROS during exacerbation of clinical symptoms and restored to a near normal‐level in remission. Rituximab decreased ROS production by 60%. In conclusion, our study shows that oxidant production is increased in iNS for an imbalance between PMN and other blood cells. Regulatory T cells (T_regs) and CD20 are probably involved in this regulation. Overall, our observations reinforce the concept that oxidants deriving from PMN are implicated in iNS.     

Mesangial alterations in steroid-responsive minimal change nephrotic syndrome

Summary Renal biopsies from 25 children with steroid-sensitive minimal change nephrotic syndrome were evaluated retrospectively to determine whether there is any relation between the morphological changes and the frequency of relapses. Biopsy material was examined by light-, immunofluorescence-, and electron microscopy, and by morphometric methods. The patients were divided in a group of 15 children with frequent relapses (FR) and another group of 10 children with an absence of, or only infrequent, relapses (NR/IR). Semiquantitative evaluation of biopsy specimens disclosed no significant differences between groups, but morphometric measurements performed on toluidine stained semithin sections showed a significant increase of mesangial nuclei in FR compared with NR/IR (P<0.01). Furthermore, the mean area of mesangial nuclei was decreased and the relative frequency of smaller nuclear profiles was higher in patients with FR compared to NR/IR (p<0.01). These findings suggest mesangial cell activation in FR which may be related to a longer course of the disease prior to renal biopsy (mean 4.0 years in FR vs. 1.4 years in NR/IR). In our opinion, morphometric assessment of discrete mesangial alterations is a promising method for exploring clinicopathological correlations in minimal change nephrotic syndrome.Presented in part at the 5th International Symposium of Pediatric Nephrology, Philadelphia, USA, October 6–10, 1980     

Helicobacter pylori antibodies and gastric cancer in Iceland - The decline in IgG antibody level is a risk factor

H. pylori infection is considered a causal agent of duodenal ulcer and a significant risk factor for gastric cancer. Retrospective cohort studies have demonstrated a significant association between presence of antibody to H. pylori and gastric cancer when using samples obtained years before the diagnosis but not at the time of diagnosis. The present study investigates, in a population-based cohort, whether a decline occurs in H. pylori antibody levels before the diagnosis of stomach cancer. Repeat samples (2 to 5) were available from 23 persons with gastric cancer taken up to 20 years before the diagnosis and 128 control subjects matched for gender, age, time and number of repeat samples. The odds ratio of developing stomach cancer was 1.16 (95% CI 1.05-1.28) for those showing decline in antibody levels of 1 relative antibody activity unit per year versus those with constant or rising levels. We conclude that this decline in antibody levels in cases, and not in controls, supports an active role of H. pylori in the pathogenesis of gastric cancer by causing atrophic gastritis, and provides a better risk assessment for gastric cancer compared to single measurements.     

High frequency of CagA+ Helicobacter pylori infection in high-grade gastric MALT B-cell lymphomas

A high incidence of Helicobacter pylori infection has been found in patients with gastric MALT (mucosa-associated lymphoid tissue) B-cell lymphoma. Recent studies have indicated that the aggressive strains of the bacterium containing the CagA gene may have direct effects on tumourigenesis. To investigate the involvement of CagA+ strains in MALT lymphomagenesis, a sensitive polymerase chain reaction (PCR)-based detection assay for the gene was developed. DNA extracts from paraffin sections of 123 H. pylori-related gastric biopsies from Italy were analysed, including 56 cases of chronic gastritis, 37 low-grade, and 30 high-grade MALT lymphomas: 30·3 per cent (17/56) of the gastritis cases, 37·8 per cent (14/37) of the low-grade, and 76·7 per cent (23/30) of the high-grade MALT lymphomas were found to contain the CagA gene. The frequency of CagA+ strain infection was signfiicantly higher (P<0·05) in high-grade than in low-grade MALT lymphoma or gastritis. These results suggest that high-grade gastric MALT lymphoma transformation may be more likely to occur following infection by CagA+ strains of H. pylori. © 1998 John Wiley & Sons, Ltd.     

原发性肾病综合征患者免疫指标变化的临床意义探讨

目的:探讨原发性肾病综合征(primary nephrotic syndrome,PNS)患者体液免疫指标、T细胞亚群、调节性T细胞(Treg)在外周血中表达情况及其临床意义。方法:选择2009年2月至2010年7月住我院初次诊治的PNS患者52例(PNS组),男30例,女22例,平均年龄为27.7±12.30岁。其中A组(普通型24/52)、B组(重症型28/52),另设C组(对照组50例)。观察指标包括:①临床指标:浮肿程度及激素疗效。②实验室指标:24小时尿蛋白定量、血浆白蛋白(A)、IgG、IgA、IgM、胆固醇(CH)、甘油三酯(TG)、C3、C4、尿素氮(BUN)、肌酐(Cr)、CD3%、CD4%、CD8%、CD4/CD8的比值、CD4+CD25+highCD127low/CD4(Treg/CD4)。③肾穿刺活检。结果:1.体液免疫指标:①PNS患者较C组,外周血中IgG、C3、C4明显降低(P<0.01);IgM显著升高(P<0.01);②B组与A组相比,C3明显下降(P<0.05),而其他体液免疫指标IgA、IgM、IgG、C4改变无统计学意义(P>0.05)。2.T细胞亚群及Treg/CD4:①PNS患者与C组相比,CD4%、CD4/CD8比值降低,CD8%增高,差异有统计学意义(P<0.05);CD3%、Treg/CD4比值改变无统计学意义(P>0.05)。②PNS患者治疗后与治疗前相比,CD4%、CD4/CD8的比值增高,CD8%下降,差异有统计学意义(P<0.05);CD3%、Treg/CD4改变无统计学意义(P>0.05)。③B组与A组相比,CD4/CD8明显降低,差异有统计学意义(P<0.05);CD3%、CD4%、CD8%、Treg/CD4比值改变无统计学意义(P>0.05)。结论:PNS患者存在体液免疫指标的改变、T细胞数量的异常、T细胞亚群间的比例失调,糖皮质激素治疗可明显改善PNS的免疫异常。Treg可能不参与PNS的发病。     

Cyclosporin a treatment in children with minimal change nephrotic syndrome and focal segmental glomerulosclerosis

Summary In a pilot study 23 children with nephrotic syndrome were treated with cyclosporin A (Cs) for 6–45 months. 8 children suffered from steroid dependent minimal change nephrotic syndrome (MCNS) and had experienced at least one course with cytotoxic drugs, but had relapsed thereafter. 2 children had diabetes mellitus type I with nephrotic syndrome and 13 children had steroid resistant focal segmental glomerulosclerosis (FSGS). Cs was started with 100 mg/m2/day in two doses and increased stepwise to obtain a Cs whole blood trough level of 200–400 ng/ml. In steroid dependent MCNS treatment with Cs reduced relapse rate significantly, and prednisone therapy could be stopped completely. After discontinuation of Cs, relapses reoccurred as frequently as before. Renal function remained unimpaired despite repeated Cs treatment courses up to 38 months. In cases of nephrotic syndrome with diabetes type I Cs treatment led to complete remission without changing the insulin requirement. However, after discontinuation of Cs relapses reoccurred. In steroid resistant FSGS 6 children benefited from Cs treatment: 4 went into complete remission, 2 into partial remission. The 2 children with complete remission relapsed but remained Cs responsive. The remaining 7 children with FSGS did not respond to Cs but continued the course of their disease, with two patients rapidly progressing to terminal renal failure. Side-effects of Cs treatment were mild. It is concluded that Cs is an effective agent in steroid dependent MCNS and can be used as an alternative drug in specific cases like steroid toxicity or diabetes mellitus. In steroid resistant FSGS a trial with Cs seems to be warranted since some cases do respond favorably. To avoid nephrotoxicity treatment with Cs should always be monitored closely by determination of blood levels and renal function.Abbreviations MCNS minimal change nephrotic syndrome - FSGS focal segmental glomerulosclerosis - Cs Cyclosporin A     

The incredible journey of mankind: Helicobacter pylori as the narrator

Over the past decade, sequence differences between microbes from various geographical areas have been studied with the intent to interpret population movements of their hosts. An organism that is a reliable storehouse of such data, by virtue of its long association with its human host, is Helicobacter pylori. Functional and comparative analyses of its genome provide fascinating insights into human behaviour in the ancient past.     

难治性肾病综合征患儿载脂蛋白E基因多态性的研究

目的：研究难治性肾病综合征（steroid-resistant idiopathic nephrotic syndrome,SRINS)患儿载脂蛋白E基因多态性,为临床上正确选择合适的脂质代谢紊乱病例进行降脂治疗提供依据。方法：用酶法测定了60例SRINS患儿及80例健康儿童血脂、脂蛋白、载脂蛋白3种物质共7个脂质代谢指标,用PCR－SSCP法检测载脂蛋白E（apoE)基因型,并行肾穿刺活检术检查肾病综合征患儿病理类型。结果：SRINS患儿存在明显脂质紊乱,与健康儿童比较差异有显著性（P＜0．01）,随诊半年后仍有绝大多数SRINS患儿存在明显脂质代谢紊乱。难治性肾病综合征apoε2等位基因显著多于健康儿童（P＜0．05）。结论：SRINS患儿脂质代谢紊乱持续的时间较长,这类患儿,尤其携带ε2等位基因者,更易发生进行性肾脏损害,动脉粥样硬化及冠心病。应考虑给这类患儿使用降脂药物。