高同型半胱氨酸血症与血管性认知功能障碍的关系

目的:分析高同型半胱氨酸血症与血管性认知功能障碍的关系。方法:取本院于2008年3月～2011年3月收治的血管性认知功能障碍患者74例作为观察组,均经临床确诊,另取同期至本院进行常规体检的健康人74例作为观察组,抽取所有研究对象的空腹静脉血,使用免疫比浊法测定其静脉同型半胱氨酸浓度,观察其同型半胱氨酸平均浓度、高同型半胱氨酸血症人数的情况,比较两组之间的差异。结果:观察组患者的一般情况如性别、年龄等与对照组无统计学差异,P>0.05,具有可比性;观察组患者的同型半胱氨酸平均浓度、高同型半胱氨酸血症人数明显高于对照组,两者有统计学差异,P<0.05。结论:同型半胱氨酸在血管性认知功能障碍患者血液中的浓度明显高于正常人,其参与血管性认知功能障碍的发病。     

高同型半胱氨酸血症与再发脑出血的关系

近年来,有大量研究结果表明高同型半胱氨酸（Hcy）症与脑卒中密切相关。因此,我们回顾性分析了435例脑出血患者Hcy水平,旨在探讨高Hcy血症与再发脑出血的关系。 一、对象与方法     

高同型半胱氨酸血症与紫癜性肾炎的关系

同型半胱氨酸（HCY）是一种反应性血管损伤氨基酸，高HCY血症可能是心、脑及外周血管病变的独立危险因素^[1]。近来发现紫癜性肾炎（HSPN）患者普遍存在高HCY血症，HCY水平的升高可能参与了紫癜性肾炎患者心脑血管疾病的发生和发展。为此，我们对42例住院的紫癜性肾炎患者进行了血HCY水平的测定，现将结果报告如下。     

多囊卵巢综合征与高同型半胱氨酸血症相关性的研究进展

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是一组以内分泌代谢紊乱为主的综合征,临床表现主要包括月经稀发、排卵障碍、高雄激素血症以及卵巢多囊样改变。PCOS患者发生2型糖尿病、动脉硬化以及心血管疾病的风险增加,这主要和PCOS患者体内各种因素导致的胰岛素代谢紊乱和血管内皮系统损伤有关。同型半胱氨酸(homocysteine,HCY)作为血管内皮损伤的标志之一,是心血管疾病发病的独立危险因素,PCOS患者往往伴有高同型半胱氨酸血症(hyperhomocysteinemia,HHCY),这可能是导致PCOS患者心血管并发症的重要因素之一。目前PCOS患者体内HCY水平升高的机制尚未完全清楚,现就国内外这方面的研究进展做一综述。     

高同型半胱氨酸血症与终末期肾病

近年来,发现终末期肾病（ESRD）患者普遍存在高同型半胱氨酸血症,并发现高同型半胱氨酸血症与动脉粥样硬化性心血管疾病（CVD)的姓密切相。本文综述了高同型半胱氨酸血症（Hyperhomocysteinemia)在终末期肾病患者中发生的原因及其与CVD发生的关系等方面的研究进展。     

维持性血液透析患者高同型半胱氨酸血症的影响因素和大剂量叶酸治疗的效果

目的 观察慢性肾功能衰竭（CRF）维持性血液透析（HD）患者血浆总同型半胱氨酸（tHcy)的影响因素和大剂量叶酸治疗是否可以纠正其高同型半胱氨酸血症（HHcy)。方法 77例稳定的HD患者被分为4组，分别口服叶酸0、5、15或30mg/d，3个月以上（所有患者均不使用维生素B12），用放射免疫分析法测定透析前血浆叶酸，全血叶酸和维生素B12，用高效液相法测定透析前和部分患者透析后血浆总同型半胱氨酸（tHcy)。用常规方法测定总胆固醇（TC），甘油三酯（TG），高密度脂蛋白（HDL），低密度脂蛋白（LDL），血清白蛋白（Alb)，肌酐（Scr），尿素（Urea)。观察不同剂量的叶酸治疗对血浆和全血叶酸的影响。以及血浆和全血叶酸与tHcy的关系。结果 叶酸治疗可以明显提高血疗对血浆和全血叶酸的影响，以及血浆和全血叶酸与tHcy的关系。结果 叶酸治疗可以明显提高血浆和全血叶酸水平。血浆和全血叶酸水平呈线性正相关。血浆和全血叶酸与tHcy均呈非线性负相关，口服叶酸5-15mg/d均可使血浆叶酸大于200ng/ml，此时血浆和全血叶酸的进一步上升不引起tHcy的进一步下降，结论 对HD患者，治疗HHcy的叶酸的合适剂量是5-15mg/d，进一步增大叶酸剂量并不能使tHcy水平进一步下降，口服叶酸结合HD治疗不能完全纠正HD患者HHcy。     

高同型半胱氨酸血症与勃起功能障碍

同型半胱氨酸作为心脑血管疾病的一个独立危险因素,最近越来越多研究开始关注它与作为心脏疾病先兆的勃起功能障碍之间的关系,本文通过综述同型半胱氨酸的代谢、致病机制及近年来对同型半胱氨酸与勃起功能障碍关系的研究进展,探讨高同型半胱氨酸血症与勃起功能障碍关系,进而为防治勃起功能障碍提供新的理论依据。     

高同型半胱氨酸血症--血管疾病的一个独立危险因素(文献综述)

由各种原因引起的高同型半胱氨酸血症与血管疾病有着密切的关系。本文就高同型半胱氨酸血症引起的血管疾病及其机制的研究进展作一综述     

高同型半胱氨酸血症对皮层下动脉硬化性脑病所致认知功能障碍关系的探讨

目的:探讨高同型半胱氨酸血症(Hhcy)对脑小血管病之一的皮层下动脉硬化性脑病(Binswanger's)所致的认知功能障碍的相关性.方法:选取符合皮层下动脉硬化性脑病诊断标准的病历88例,进行MoCA评分,分为有认知功能障碍组及无认知障碍组,两组患者均测定同型半胱氨酸(hcy)的水平,观察两组之间同型半胱氨酸水平的差异,并对有认知功能障碍组再进行进一步的分析,评定各项认知功能受损程度的轻重有无差别.结果:有认知功能障碍组的同型半胱氨酸的水平明显高于无认知功能障碍组,而且在认知功能障碍受损程度上执行功能、视空间功能受损程度更严重,同型半胱氨酸的水平也更高.结论:高同型半胱氨酸血症是脑小血管病所致认知功能障碍的危险因素之一,而且对执行功能及视空间功能的影响更明显.     

高同型半胱氨酸血症与勃起功能障碍研究进展

高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)是心血管疾病的一个重要危险因素之一。流行病学研究表明勃起功能障碍(ED)与心血管疾病的发生密切相关。HHcy可能是ED的一个新的独立危险因素,HHcy导致ED的机制尚不十分清楚,可能与血管内皮细胞损伤、活性氧(ROS)、动脉粥样硬化等有关。HHcy与ED的关系仍需进一步研究,检测血浆Hcy和叶酸水平以及亚甲基四氢叶酸还原酶(MTHFR)基因型有助于ED诊断,尤其是对于年轻患者以及有心血管病家族史患者。对于HHcy伴ED患者的治疗,可先通过单独服用叶酸或结合维生素B6和维生素12来降低Hcy水平,然后进行5型磷酸二酯酶抑制剂(PDE5i)的治疗。本文就HHcy与ED的研究进展作一综述。     

Tacrolimus, cyclosporine and plasma lipoproteins in renal transplant recipients

To compare the effect of tacrolimus (FK506) and cyclosporine (CsA) on plasma lipoproteins in renal transplant recipients receiving maintainance therapy, the following prospective study was undertaken. Blood from nineteen recipients on tacrolimus (FK group) and from twenty-one on CsA (CsA group) was collected at baseline, 3-, 6-, and 10-month intervals. Plasma lipids, lipoproteins and oxidation properties of lipoproteins were determined. Plasma total cholesterol, low density lipoprotein (LDL) cholesterol, and apolipoprotein B (apoB) were substantially increased in both groups, although only the CsA group showed significant differences at all time intervals and at the baseline. High density lipoprotein cholesterol, triglycerides, and apolipoprotein A varied in both groups at time intervals from the baseline, but not significantly. The susceptibility to oxidation of LDL isolated from the FK group at all times was uninfluenced by the tacrolimus treatment, and values were comparable to those obtained from LDL isolated from healthy individuals. A significantly higher susceptibility to oxidation as indicated by the shorter time required to start the formation of conjugated dienes was observed in LDL isolated from the CsA group at 3 and at 6 months of therapy. Tacrolimus-treated patients appear to have less hyperlipidemic and have LDL less susceptible to oxidation than patients treated with CsA. Received: 5 July 2000 Revised: 9 January 2001 Accepted: 4 September 2001     

Dream anxiety in renal transplant recipients

Abstract

Objective: Although low quality of sleep has been reported in kidney transplant patients with functioning allografts, there are no previous studies investigating the dreams of these patients. We aimed to investigate the differences in dream anxiety level between renal transplant patients and healthy control subjects. We also planned to compare depression and anxiety symptoms, sleep quality and sleepiness level between these two groups. Methods: Twenty-two living-donor renal transplant recipients followed at an outpatient nephrology clinic and 22 healthy controls were enrolled in this observational cross-sectional study. Sociodemographic Data Collection Form, and the Van Dream Anxiety Scale (VDAS), the Pittsburg Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), Beck Depression and Anxiety Inventories were used for the assessment of the necessary features. Hemoglobin (Hb), blood urea nitrogen (BUN), creatinine (Cr) and glucose levels were measured. Results: There were no significant differences between the groups in terms of dream anxiety (p?=?0.45), depression (p?=?0.76), sleep quality (p?=?0.8), insomnia severity (p?=?0.08) and Hb (p?=?0.11) and glucose levels (p?=?0.14). Although, BUN (p?=?0.00) and creatinine (p?=?0.00) levels differed significantly between the two groups, both parameters were found to be within their normal range. Conclusions: In our study, chronic renal failure patients with a successful kidney transplant were found to be able to completely return to normal in terms of metabolic parameters, sleep quality and mood. Similar levels of dream anxiety are also consistent with these findings.     

肾移植术后并发卡氏肺孢子虫肺炎

３例卡氏肺孢子虫肺炎生前经纤维支气管镜支气管肺活检（２例）和经气管插管冲洗吸引物检查（１例）确诊，分别发生于肾移植术后５０、９０、９７天。复方新诺明治疗均获痊愈，其中２例随访至今无复发，结合国内外文献，探讨并提出了肾移植术后并发ＰＣＰ诊治的初步体会和经验。     

Potential cardiovascular risk factors in paediatric renal transplant recipients

Cyclosporin (CsA) therapy is associated with side effects such as hypertension, hyperlipidemia and nephrotoxicity. Tacrolimus (Tac) has been shown to be more favourable in this respect. We retrospectively analysed office blood pressure (BP), serum total cholesterol (TC) and fasting glucose levels, and estimated graft function profiles in paediatric (n =56) and young adult (n =14) renal transplant recipients whose maintenance immunosuppressive regimen was based upon CsA (n =38) or Tac (n =32) given with mycophenolate mofetil and corticosteroids. The analysis was performed at four different time-points: at 1, 6, 12, and 24 months post-transplant, respectively. Baseline characteristics were comparable between treatment groups. Differences for both systolic and diastolic BP, and graft function between treatment groups became significant from month 1 and throughout the 2-year period. Values (mean ± SD) for CsA-treated and Tac-treated recipients at 2 years were 118.8±11.1 / 74.6±7.4 mmHg vs 109.3±11.2 / 67.2±7.8 mmHg for systolic and diastolic BP, respectively, p <0.005/0.005; and 72.0±18.5 ml/min vs 84.0±22.4 ml/min per 1.73 m² for graft function, respectively, p <0.01. Office hypertension, defined as the use of antihypertensive medication at month 24, was significantly associated with CsA-therapy (², p <0.01). TC levels became significantly lower at months 6, 12, and 24 in the Tac group compared with the CsA group. Hypercholesterolemia, defined as TC200 mg/dl, was significantly associated with CsA-based immunosuppressive regimen at months 6, 12, and 24 post-transplant (², p <0.05, p <0.001, and p <0.01, respectively). Although Tac therapy was associated with higher glucose levels, no recipient developed post-transplant diabetes mellitus. The number of recipients who experienced acute rejections was comparable in both groups. In conclusion, Tac-based immunosuppressive therapy was found to be associated with more favourable potential risk-factor profiles for cardiovascular disease and better graft function at 2 years post-transplant compared with CsA-therapy.     

肾移植术后患者骨代谢的改变

目的:研究肾移植术后患者骨代谢生化指标的改变.方法:采用竞争性放射免疫分析法测定30例肾移植患者和25例健康献血者的血清骨代谢生化指标:骨钙素(BGP)、降钙素(CT)、甲状旁腺激素(PTH)和25羟基维生素D(25-OH-D)、Ⅰ型胶原羧基端交联肽原(ICTP)和Ⅰ型前胶原氨基端伸展肽(PINP)水平.结果:肾移植术后患者的BGP、PINP和ICTP水平明显高于正常对照组(P＜0.01),但两组的CT、25-OH-D和PTH水平差异无统计学意义(P＞0.05).结论:肾移植术后患者出现明显的骨代谢紊乱,主要表现为血清成骨细胞活性增强,同时伴有破骨细胞功能增强,骨转换活跃,其发病机制可能主要与术后长期使用免疫抑制剂有关.     

Cyclosporine-induced transient renal hypoperfusion in adolescent transplant recipients

We investigated the acute hemodynamic effect of a single oral dose of cyclosporine A (CsA) given as part of the immunosuppressive schedule in six adolescents with renal transplants. Renal plasma flow (RPF) and glomerular filtration rate (GFR) were determined by continuous infusion of inulin and amino-hippuric acid for 12 h. A fall in both GFR and RPF was observed 4–6 h after peak plasma CsA levels. No significant correlation was found with CsA dosage or any pharmacokinetic parameters. This study demonstrates that CsA also has a vasoconstrictory effect in adolescent recipients; this could be one of the causes of its nephrotoxicity.     

Pelvic reconstructive surgery in renal transplant recipients

Introduction and hypothesis  Thousands of women undergo renal transplantation each year. Many develop pelvic floor conditions after transplantation requiring surgical correction. This study describes our experience with pelvic reconstructive surgery in renal transplant recipients. Methods  Retrospective chart review identified five renal transplant patients who had pelvic reconstructive surgery for urodynamic stress incontinence and prolapse between January 2000 and May 2008. Data included medical and surgical history, POP-Q measurements, and classification of perioperative complications. Results  The mean age was 56.5 years (range 50−70). A total of two vaginal hysterectomies with vault suspension, three anterior repairs, two posterior repairs, and three synthetic midurethral slings were performed. No intraoperative or postoperative complications occurred. At a mean follow-up of 12.6 months (range 4−36), all patients were cured of their prolapse and incontinence with no evidence for synthetic mesh infection, rejection, or erosion. Conclusions  Pelvic reconstructive surgery can safely be performed in renal transplant patients.     

肾移植术后血脂的变化对移植肾功能的影响

目的:探讨肾移植患者血脂代谢情况及其对移植肾功能的影响。方法:检测89例肾移植患者肾移植前、后的血脂水平,并与移植后1年内发生急性排斥反应及移植后1年时发生慢性移植肾功能不全的患者进行血清肌酐水平相关性分析。结果:与正常对照组比较,肾移植前、后的血清总胆固醇、低密度脂蛋白胆固醇的水平显著升高(P<0.01),甘油三酯、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇水平无显著差异。血载脂蛋白A1水平显著低于正常对照组(P<0.01)。移植前、后上述血脂水平无显著差异。移植前高胆固醇血症与急性排斥反应的发生存在相关性,高胆固醇血症对慢性移植肾功能不全患者血清肌酐水平升高存在影响。结论:肾移植患者血脂代谢紊乱明显不同于正常人群,高脂血症对急性排斥反应及慢性移植肾功能不全的发生具有不良影响。