腹膜透析患者退出原因分析

目的 调查腹膜透析患者退出的原因,为临床改善腹透预后提供依据.方法 分析随访持续性非卧床腹膜透析(CAPD)病人145例,统计退出患者例数,调查其退出原因,同时评估营养状况、透析充分性、容量负荷指标.结果 145例腹膜透析患者中64例退出,占腹透总数44.1%.其中死亡40例(62.5%),余为改血液透析,肾移植或因经济困难放弃治疗患者.退出原因中,心脑血管疾病占首位34例(53.1%);顽固性腹膜炎10例(15.6%),余为超滤衰竭,严重营养不良,极少数为胸腔积液,恶性肿瘤,腹透漂管退出腹透.在死亡患者中,心脑血管急症如心衰、心梗、脑出血等构成了主要死因(51.6%),其次依次为严重感染如肺炎、腹膜炎、败血症(20.1%)呼吸衰竭;多器官功能障碍;消化道出血;恶性肿瘤及放弃治疗.死亡组较存活组具有更明显的营养不良、容量负荷过重及透析不充分,两组间有统计学差异(P＜0.05).结论 脑血管事件是CAPD 患者死亡退出的最主要原因.炎症感染,包括腹腔外感染是PD 中断及预后不良的重要因素之一.经济原因一定程度上制约腹透的开展与维持.营养不良、容量超负荷、透析不充分与心脑血管并发症及腹透患者退出率、死亡率呈正相关.     

腹膜透析患者死亡危险因素分析

目的 分析腹膜透析患者的死亡危险因素,指导临床诊治。方法 回顾性分析该院2008年6月—2013年9月收治的并在该院初次行腹膜透析、随访3个月以上的患者143例,其中死亡35例,存活108例,存活患者中肾移植6例,拔管12例,失访2例,采用多变量COX回归分析方法分析患者接受腹膜透析前各项临床指标对其预后的影响。结果 原发病中,以慢性肾小球肾炎为主,63例(44.06%),糖尿病肾病46例(32.17%),高血压肾损伤21例(14.68%),马兜铃酸肾病5例(3.5%),止痛剂肾病3例(2.1%),多囊肾2例(1.4%),血管炎肾损伤、梗阻性肾病各1例(0.7%),原因不明的患者1例(0.7%)。死亡患者中,死于心血管疾病10例(28.57%),脑血管疾病7例(20%),腹膜炎5例(14.29%),肺内感染4例(11.43%),消化道出血2例(5.71%),原因不明4例(11.43%), 肿瘤、营养不良、多器官功能衰竭各1例(2.86%)。总体透析时间(28.3±16.42)个月,死亡组平均透析时间(24.53±17.13)个月。单因素分析显示,进入腹膜透析时的年龄大、既往脑血管疾病病史为腹膜透析患者死亡的危险因素,再进行多因素COX回归,结果显示透析前高龄、高磷为腹膜透析患者死亡的独立危险因素。结论(1)腹膜透析患者原发病仍是以慢性肾小球肾炎为主(44.06%),符合我国目前慢性肾功能不全原发病构成;(2)该透析中心腹膜透析患者死亡疾病构成、生存率与国际报道接近;(3)腹膜透析前患者高龄、血磷升高为腹膜透析患者死亡的独立危险因素。     

腹膜透析患者退出原因分析及对策

目的通过分析94例持续非卧床腹膜透析(CAPD)患者退出腹膜透析的原因,探讨导致腹膜透析退出率较高的因素,并讨论其对策。方法回顾5年来因慢性肾衰竭行CAPD的患者94例,分析导致患者退出的各种原因及其所占比例。结果共统计94例入选本研究,有40例患者退出腹膜透析,占42.5%,主要原因为腹膜炎19例(47.5%),超滤衰竭10例(25%),透析引流不畅6例(15%),经济原因3例(7.5%),肾移植2例(5%)。结论腹膜炎和超滤衰竭是患者退出腹膜透析的主要原因,应注意严格无菌操作,尽早控制感染,限制水盐摄入,制定个体化透析处方。     

23例腹膜透析患者退出原因分析

目的分析23例不卧床持续性腹膜透析（CAPD）患者退出透析的原因。方法回顾性分析上海市第六人民医院金山分院2007年1月至2010年12月期间60例CAPD≥3个月患者中退出腹膜透析的原因。结果共有23例患者退出腹膜透析治疗,腹膜透析治疗平均时间25.74个月。原因为：腹膜透析相关感染（34.78%）、心脑血管事件（21.74%）、透析不充分（17.39%）、肿瘤、恶液质、营养不良（13.05%）、经济原因（13.04%）。结论腹膜炎和心脑血管事件、透析不充分是退出腹膜透析的重要原因,应注意严格无菌操作,尽早控制感染,限制水盐摄入,制定个体化透析处方。     

腹膜透析患者生存率及影响因素的年龄分层分析

目的 探讨腹膜透析患者生存率及影响因素的年龄差异.方法 回顾性分析行腹膜透析治疗的223例终末期肾脏病(ESRD)患者临床资料.其中,年龄＜65岁患者115例(A组),65～79岁患者88例(B组),≥80岁患者20例(C组),分析三组患者生存率及影响因素的差异.结果 随访至2019年12月31日,126例(56.5％)患者死亡,主要死亡原因为脑血管病变(52例).三组患者合并糖尿病肾病、慢性肾小球肾炎、糖尿病、心血管病变及脑血管病变比例差异有统计学意义(P＜0.05或P＜0.01).与治疗前比较,治疗后三组患者血全段甲状旁腺激素(iPTH)和血β2微球蛋白浓度均升高(P＜0.05).治疗前及治疗后,三组血Hb、血白蛋白、血磷、血iPTH浓度比较均有统计学差异(P＜0.05或P＜0.01).三组患者的生存时间和1年、3年、5年生存率差异有统计学意义(P＜0.01).Cox回归分析显示,A组患者死亡的独立危险因素为合并糖尿病、低白蛋白、高血磷(P＜0.05),B组为合并脑血管病变、低Hb、低白蛋白、高iPTH和高血磷(P＜0.05),C组为合并糖尿病、合并脑血管病变、合并心血管病变、低Hb、低白蛋白、高iPTH和高血磷(P＜0.05).结论 影响不同年龄段腹膜透析患者生存的因素较多,针对影响生存因素采取相应的措施能改善老年腹膜透析患者的生存质量.     

持续性非卧床腹膜透析患者退出原因分析

目的：通过对腹膜透析（PD）患者退出原因的分析,探讨防治对策。方法：回顾分析因慢性肾功衰竭（CRF）接受持续性非卧床腹膜透析（CAPD）患者的临床资料,了解退出原因,并分析死亡病例的死因。结果：共有87例患者符合条件,因各种原因退出PD共21例,退出率为24．1％（21／87）。其中死亡13例,转血液透析（HD）6例,肾移植2例。结论：死亡是CAPD患者短期内退出PD的主要原因,而心血管事件、腹膜炎是导致CAPD患者死亡的主要原因。因此应积极加强透析前的一体化治疗及PD患者透析后的持续管理。     

上海桃浦镇社区糖尿病门诊患者失访原因分析

目的:分析桃浦镇社区糖尿病门诊患者的失访原因。方法:跟踪随访我中心糖尿病门诊纳入信息管理系统的719名糖尿病患者,对其中106例失访者通过电话调查其失访原因。结果:失访率为16.0%,失访原因中前4位分别为:到上级医院就诊(34.5%),药店自己买药(31.9%),经济困难(10.3%),服用保健品(10.3%)。结论:糖尿病电子管理系统可帮助社区医生提高管理效果,但更重要的是加强糖尿病患者健康教育,提高患者的就医依从性,减少失访率。     

220例次紧急血液透析临床分析

目的探讨紧急血液透析的特点。方法对220例次紧急血液透析的原因、并发症及转归进行探讨。结果紧急血液透析的原因高血容量性心衰占54.5%,并发症发生率41.8%,其中低血压占71.7%,老年患者并发症率明显增高(P<0.01),无症状低血压和非典型症状低血压占低血压并发症72.7%,因透析并发症死亡占死亡病例14.3%。结论紧急血液透析的主要原因是高血容量性心衰,主要并发症是低血压,老年患者发生率明显增高,你血压以无症状及非典症状为主要表现,透析并发症不是死亡主要因素。     

老年人上消化道出血临床分析

目的:探讨老年人上消化道出血及导致死亡的原因。方法:回顾性总结分析上消化道出血老年组100例,并与同期非老年组82例相比较。结果:老年人上消化道出血病因主要为消化性溃病56例,占56%;胃癌15例,占15%。发生低血压或休克老年组16例,非老年组7例(P<0.05),使用阿司匹林抗凝药物,老年组23例,非老年组6例(P<0.01),老年组死亡22例,其中18例因全身慢性疾病恶化和出血后并发症死亡;非老年组死亡6例(P<0.01)。结论:消化性溃疡是老年人上消化道出血的主要病因,其次为胃癌。全身慢性疾病恶化和出血后并发症是影响老年人上消化道出血预后的重要原因,尤其是肺部感染、心脑血管疾病是主要的死亡原因。     

尿毒症维持性透析患者死亡原因分析及对策

目的分析尿毒症维持性透析患者的死亡原因,探讨其风险因素。方法回顾性分析我院5年来35例维持性透析患者的死亡原因,比较每位死亡患者的透析充分性、血压、贫血程度等方面的情况。结果 35例死亡患者维持性血液透析34例,维持性腹膜透析1例。其中死亡于心血管疾病16例、脑出血11例、感染5例、上消化道出血1例、放弃治疗2例,占总死亡率的百分比分别为45.7%、31.5%、14.2%、2.9%、5.7%。结论心血管疾病、脑血管意外、感染为维持性透析患者最主要的死亡原因。高龄、高血压、低蛋白血症、严重贫血和左心室肥厚是尿毒症维持性透析患者的主要危险因素。积极控制透析患者的高血压、贫血,纠正钙磷代谢紊乱及营养支持治疗,可提高患者生存率及生活质量,达到临床预防目的。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.