肾实质性恶性高血压患者16例临床及肾脏病理分析

目的:探讨肾实质性恶性高血压的临床及肾脏病理特点。方法:回顾分析16例肾实质性恶性高血压患者的临床及病理资料。结果:16例肾实质性恶性高血压中,临床诊断为肾病综合征4例(25%),慢性肾小球肾炎8例(50%),硬皮病肾危象1例(6.25%),间质性肾炎1例(6.25%),狼疮性肾炎2例(12.5%)。16例患者均表现为进行性肾功能损害;临床表现以蛋白尿为主,其次为蛋白尿伴血尿。肾脏病理改变以肾小球病变为主者15例(93.75%),肾小管间质疾病1例(6.25%)。结论:肾实质性恶性高血压患者年龄较轻,主要表现为肾功能进行性恶化,肾脏结构多数异常;肾脏病理改变以增生硬化性肾小球病变为主。肾实质性恶性高血压患者疗效较差,预后不好。     

呈慢性肾炎的IgA肾病96例临床病理和预后分析

目的：探讨在原发性IgA肾病（IgAN）中如何早期作出慢性肾小球肾炎（慢性肾炎）的临床诊断。方法：于1993年3月-2009年8月我院肾活检资料库中选取成人原发性IgAN 96例,所有病例血肌酐（Scr）在正常高值（苦味酸法≥105μmol/L或酶法≥77μmol/L）持续3月以上;按内生肌酐清除率（Ccr）分2组：A组Ccr≥60 mL/min 43例,B组Ccr〈60mL/min 53例;行临床病理及预后比较分析。随访终点为Scr翻倍或Ccr〈15 mL/min。结果：96例IgAN,病程中出现尿蛋白〉1.0 g/d 70例（73.0%）,肾活检时平均Ccr（59.15±20.73）mL/min,重度肾小球硬化79例（占82.3%）,中重度小管间质病变73例（占76.0%）。随访中位数18.5个月,21例进入终点。B组中重度肾小管间质病变和肾病范围蛋白尿的发生率均显著高于A组,分别为84.9%vs 65.1%和41.5%vs 18.6%,差异有统计学意义（均P〈0.05）。B组和A组的平均随访中位数分别为33个月和21个月（0.25～102个月）,终点事件的发生率分别为28.0%和14.0%。结论：在IgAN中,慢性肾炎的基本临床病理特征是：①持续性尿蛋白〉1.0 g/d;②持续性Ccr下降;③肾活检病理存在伴重度肾小球硬化的中重度小管间质病变。该3项可作为慢性肾炎临床诊断的早期指标。     

无症状尿检异常患者的临床病理和预后分析

目的观察体检发现尿检异常患者的肾脏临床和病理情况,并对病理类型较重者给予积极的干预治疗,以延缓肾脏病的进展。方法选取体检发现尿检异常患者共60例,进行肾活检检查,其中定期随访的患者20例。结果临床表现为血尿合并蛋白尿者多见38例,占63.3%;单纯血尿7例,占11.7%;单纯蛋白尿15例,占25%。肾活检时已有肾功能不全者8例,占13.3%。病理类型多样,其中以IgA肾病最多29例,占48.3%;非IgA系膜增生性肾炎13.3%,肾小球轻微病变11.7%,膜性肾病和局灶性肾小球肾炎各6.7%,局灶节段性肾小球硬化5.0%,微小病变3.3%,膜增生性肾炎1.7%,狼疮性肾炎3.3%。20例患者平均随访14～24(18.8±11.3)个月,2例患者肾功能明显恶化。结论尿检异常患者临床无任何症状,容易延误病情。应尽早行肾活检明确病理性质,部分病变重的病例应长期随访。对病理类型较重者应及早进行药物干预。     

IgA肾病的预后及其影响因素(附140例临床、病理及随访资料分析)

140例 IgA 肾病患者自肾活检后随访6～72个月(平均21个月),其中25例(17.9%)发展至慢性肾功能不全,4例(2.9%)进入终末期肾衰。本文资料表明,激素治疗可减少 IgA 肾病患者的尿蛋白量,改善低蛋白血症,但不能改善其肾功能。临床上呈反复发作性肉眼血尿者预后良好。多因素分析结果表明,提示预后不良的因素有:重度蛋白尿、高血压,肾小球硬化(特别是节段性硬化)、间质纤维化、新月体形成,以及在肾小球内伴随有 IgG 和 IgM 沉积者。     

儿童原发性肾小球肾炎转铁蛋白与肾小管-间质病变的观察

目的　观察儿童肾小球疾病时尿蛋白和尿转铁蛋白(TRF)与肾小管-间质病变的关系及其临床意义。方法　对22例肾小球肾炎患儿(单纯性血尿9例,单纯性肾病5 例,血尿伴蛋白尿8 例)进行肾组织活检,并对肾小球、肾间质病变程度进行评分,同时测定尿TRF。结果　①儿童肾小球肾炎单纯性血尿、单纯性肾病者的肾小管间质病变较轻,预后较好;血尿伴蛋白尿者肾小管间质病变明显,与单纯性血尿和单纯性肾病患儿的差异有显著性(P<0.05),易发生慢性肾功能不全。②3组间肾小球损害的差异无显著性(P>0.05),22 例患儿的肾小球病变与肾小管间质病变不相关(P=0.234)。③单纯性肾病、血尿伴蛋白尿患儿的尿TRF明显增高,与单纯性血尿患儿的差异均有显著性(P<0.05)。④血尿伴蛋白尿患儿肾小管间质病变与尿TRF增高呈正相关性(r=0.615,P=0.025)。⑤单纯性肾病患儿尿TRF亦明显增高,其肾小管间质病变较轻,可能与治疗效果较好、尿蛋白和尿TRF持续时间较短有关。结论　儿童肾小球疾病的发展和预后不仅与肾小球本身的病变有关,更与肾小管间质病变的严重程度密切相关,尿蛋白和尿铁离子可导致肾小管间质损害。     

成人特发性膜性肾病临床病理特征及预后研究

目的:总结成人特发性膜性肾病临床病理特征及预后相关因素。方法:回顾性分析82例IMN患者临床、病理及随访资料,总结其临床病理特点,并以e GFR<30m L/min为随访终点,将患者分为肾功能进展组及肾功能稳定组,比较两组患者临床资料。结果:82例患者中有肾病综合征者56例(68.29%),合并高血压31例(37.8%),病理分期I期25例(30.48%),Ⅱ期50例(60.98%),随访过程中有12例患者e GFR<30m L/min,两组患者比较在平均动脉压、临床表现为肾病综合征比例、e GFR、胆固醇、24h尿蛋白定量、合并肾小管间质损害比例方面差异有统计学意义(P<0.05)。结论:成人特发性膜性肾病患者临床以肾病综合征多见,病理分期以Ⅰ期、Ⅱ期为主,高血压、临床出现肾病综合征、大量蛋白尿、肾功能损伤、高胆固醇血症及合并肾小管间质损害与IMN患者肾功能恶化进展有关。     

特发性膜性肾病预后影响因素

目的　总结 86例特发性膜性肾病 (IMN)患者早期临床及病理资料特点 ,分析肾脏存活率 ,探讨预后影响因素。方法　回顾性分析 1 983- 2 0 0 1年我院经肾活检证实的 86例IMN患者的临床病理资料特点 ,对其中获得随访的 4 4例 ,以进展至终末期肾衰 (ESRF)或血肌酐浓度 (Scr)增加 1倍 (肾功能恶化 )作为终点判断标准 ,采用Kaplan Meier曲线和COX比例风险模型分别进行预后分析。 结果　 86例IMN患者中 ,蛋白尿 >3.5 g/ 2 4h占 5 4 .7%,肾病综合征占 4 4 .2 %,血尿 2 9.1 %(肉眼血尿仅 1例 ) ,高血压 2 3.3%,肾静脉血栓 3.5 %。病理分期以Ⅰ、Ⅱ期为主 ,占 96 .5 %,小管 间质病变程度较轻。病理改变与肾活检前病程、Scr正相关 ,与内生肌酐清除率呈负相关。以发病日为随访起点 ,5年肾脏存活率 96 %,1 0年 6 1 .8%;以肾穿刺日为起点 ,5年肾脏存活率84 .5 %,1 0年 5 5 .6 %。肾活检时的Scr和血胆固醇浓度与IMN预后相关。结论　肾活检时的Scr和血胆固醇浓度可能是预测IMN预后的有用指标。IMN患者应早就诊 ,早穿刺 ,以了解病情指导治疗 ,从而更好地保护肾功能。     

膜性肾病的治疗策略

特发性膜性肾病（IMN）是成人肾病综合征中常见的病理类型，其特征是肾小球上皮下免疫复合物沉积导致毛细血管基底膜弥漫性增厚。70％～85％患者表现肾病性蛋白尿，5％～10％患者伴有肾功能不全，血尿发生率较少。对1189例患者的随访研究发现，老年患者（年龄〉50岁）、大量蛋白尿、肾功能不全及肾活检时小管间质病变重者，是进入终末期肾病（ESRD）的高危因素，大量蛋白尿及其持续时间是IMN患者预后的最重要因素。起病时尿蛋白越多越易进展至ESRD。     

难治性原发性肾病综合征患儿蛋白尿与肾损害的关系

目的 探讨蛋白尿与肾损害及疾病进展的关系.方法 难治性原发性肾病综合征患儿49例,男35例,女14例;年龄1.4～15岁,随访24～92个月者18例.病例分为持续蛋白尿组(甲组)18例,间歇蛋白尿组(乙组)31例.比较两组患儿肾小管间质和肾小球病理损害、肾功能损害和病情进展的差异.结果 甲组较乙组肾小管间质病理损害(平均秩和:33.44比20.10)、肾小球系膜增生程度(平均秩和:29.67比22.29)、肾功能损害[血肌酐65.5(14.0,805.0)比46.0(16.0,353.0)μmol/L]均严重(P＜0.05).甲组患儿随访后较随访前血肌酐升高[208.0(90.0,586.0)比57.0(36.0,125.0)μmol/L](P＜0.05);乙组差异无显著性.肾小管间质病理损害Ⅰ Ⅱ Ⅲ级患儿,随访后血肌酐较随访前升高[120.0(46.0,586)比54.0(35.0,125.0)μmol/L],P＜0.05.随访后重复肾活检甲组2例,病理改变均较随访前加重;乙组1例,较随访前无明显加重.结论 在难治性原发性肾病综合征,持续蛋白尿患儿肾小管间质和肾功能损害严重.持续蛋白尿和肾小管间质损害与病情进展相关.     

86例IgA肾病预后影响因素分析

目的　探讨IgA肾病患者预后的影响因素。方法　对 1984 .6 - 2 0 0 0 .12间经肾活检证实为IgA肾病患者 86例住院和随访资料进行分析。结果　 86例患者中 4例男性在随访结束时发生尿毒症 ,病程 (115 .9±3.2 )月。年龄≥ 4 5岁组、肾小球硬化组、间质存在纤维化组、肾小管萎缩组患者内生肌酐清除率 (Ccr)在肾穿刺和随访结束时均分别显著低于 <4 5岁组 ;高血压组肾穿刺时Ccr与无高血压患者无显著差别 ,而随访结束时则显著低于无高血压组。多因素逻辑回归分析显示年龄和肾小管萎缩是影响IgA肾病预后的主要因素。 结论　性别、年龄、高血压、肾小球硬化程度、肾小管萎缩及间质纤维化是影响IgA肾病预后不良的重要因素 ,其中年龄和肾小管萎缩是主要影响因素     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.