肾移植与血液透析治疗对尿毒症患者阴茎勃起功能影响的临床对照研究

目的:研究对比男性尿毒症患者接受肾移植与接受血液透析治疗勃起功能的变化及与生殖激素水平变化的关系。方法:收集2009年5月至2012年1月在我院门诊进行随访的肾移植男性患者35例、血液透析治疗的尿毒症患者30例,应用国际勃起功能指数(IIEF-5)调查表、夜间勃起功能(NEVA)测定仪评估阴茎勃起功能,同时测定生殖激素水平。结果:接受肾移植手术者勃起功能障碍(ED)患病率为51.4%,血液透析者ED患病率为73.3%(P<0.05);肾移植后的ED患者发病情况要明显轻于单纯血液透析的ED患者;肾移植中重度ED患者(25.7%)要明显少于单纯血液透析者(46.6%);肾移植组中ED患者夜间阴茎勃起次数、勃起强度及持续时间均强于单纯血液透析组ED患者(P<0.05);接受肾移植患者较单纯血液透析血清睾酮水平上升[(4.32±1.37)vs(2.53±1.12)ng/ml,P<0.05],雌二醇[(19.57±2.29)vs(43.38±5.58)pg/m)]和催乳激素[(8.59±1.19)vs(17.22±3.31)mIu/ml]明显下降(P均<0.05)。结论:肾移植受者肾功能良好时其总体勃起功能要优于单纯血液透析的尿毒症患者。     

影响尿毒症患者接受肾移植的因素初探

肾移植是治疗终末期肾脏病的有效方法，但在临床工作中发现相当多的尿毒症患对肾移植不甚了解或不认同，为此我们以问卷调查的形式对陕西省近10家医院的274名尿毒症患进行了调查，结果报道如下。     

不同剂量的十一酸睾酮对大鼠生精功能影响

目的 :进一步了解睾丸内睾酮和生精功能的关系。　方法 :大鼠给予不同剂量的十一酸睾酮 (TU)后测定大鼠血清、睾丸间质液和睾网液内睾酮水平 ,以及附睾精子的数量、活力 ,以观察二者之间关系。结果 :大鼠给予不同剂量的十一酸睾酮后 ,睾丸内睾酮水平发生不同的变化 ,随之睾丸内生精功能也发生变化。低剂量十一酸睾酮(8mg/kg)不影响睾丸内睾酮水平 ,也不影响睾丸内的生精过程。附睾精子的数量、活动力与对照组无显著性差异。但给予超生理剂量 (30mg/kg) ,则抑制睾丸内睾酮的产生 ,睾丸内睾酮水平显著下降 ,使精子的发生明显受到抑制。而给予超大剂量的外源性睾酮 (6 2 5mg/kg) ,尽管抑制了睾丸内睾酮的产生 ,但由于补充了大量外源性睾酮 ,使睾丸内睾酮维持在正常水平。精子的发生能维持在正常水平。附睾精子的数量与活动力与对照组无显著性差异。　结论 :进一步论证了睾丸内高浓度的睾酮对维持生精过程起到决定性的作用     

尿毒症频发心力衰竭患者肾移植15例

目的：探讨尿毒症频发心力衰竭(心衰)患者肾移植的可行性及安全性。方法：回顾性分析15例继发于尿毒症的顽固性心衰患者肾移植围手术期处理方法及临床效果。结果：14例患者安全度过围手术期，3个月后心脏缩小，心功能明显改善，移植肾功能正常；1例在术后第8天死于心肺功能衰竭。结论：顽固性心衰尿毒症患者可行肾移植，心衰并非肾移植的绝对禁忌证，只要受体选择合适，治疗及时得当，患者可安全度过肾移植围手术期。     

生精固本丸对小鼠免疫功能的影响

Ｐ＜０．０１结果如表２所示，生精固本丸在２．５ｇ／ｋｇ、５ｇ／ｋｇ、１０ｇ／ｋｇ的剂量体内用药，对ＣｏｎＡ诱导的小鼠的Ｔ细胞的增殖反应有增强作用，而对ＬＰＳ诱导的小鼠Ｂ细胞的增殖反应效果不显著。香菇多糖是已知的免疫增强剂，生精固本丸与之相比作用相似。２．３生精固本丸对小鼠游泳耗竭的影响结果见表３。表３生精固本丸对小氧游泳耗竭的影响注：与对照组相比＊Ｐ＜０．０５，Ｐ＜０．００１结果表明，动物给药５ｇ／ｋｇ、１０ｇ／ｋｇ，连用４ｄ，游泳耗竭时间分别为１５．１±３．５及３５．０±５．３ｍｉｎ，与对照组相比均有显著性差异，表明本品具有较强的抗疲劳作用。而给药２．５ｇ／ｋｇ时，与对照组相比则无明显差异，提示本品具有明显的量效关系。     

严重尿毒症患者肾移植术的麻醉处理

我院共做肾移植手术千余例 ,有 8例尿毒症症状特别严重 ,1例患者接入手术室即出现心衰、肺水肿 ,另 1例硬膜外穿刺后给第一个局麻药剂量亦出现心衰、肺心肿 ,2例均放弃手术。 6例采用气管内插管 ,全凭静脉或静吸复合麻醉获得成功 ,现报告如下。临床资料6例均为男性 ,年龄 5 4～ 73岁 ,病史 3～ 9年 ,1例首次 ,2例第 2次 ,3例第 3次肾移植术。入院时均有明显尿少、全身乏力、头晕、恶心、浮肿、胸闷心悸、呼吸急促或端坐呼吸、颈静脉怒张、肝肿大。 5例反复出现心衰 ,经抢救好转 ,血压最高者 33 3/ 2 0 3ｋＰａ(2 80 / 15 2ｍｍＨｇ)。 6例…     

肾移植术前尿毒症患者合并症的手术治疗体会

目的 总结肾移植术前尿毒症合并症的手术治疗体会。以提高肾移植预后，方法 回顾性分析１９７８年至今尿毒症合并症３９例的手术指征。围手术期治疗以及肾移植预后情况，其中成人性多囊肾９例、药物不可控制性高血压２１例、脾功能亢进４例、胃溃疡５例。结果 ９例多囊肾切除术后１～６个月行肾移植术。随访肾功能正常；２１例高血压患者术后血压不同程度下降，术后６～１２个月行同种肾移植术，肾功能稳定；４例脾脾切除患者肾移     

尿毒症和肾移植患者精液参数的变化

目的:探讨尿毒症和肾移植患者精液参数的变化。方法:检测25例尿毒症患者(尿毒症组)和25 例肾移植术后患者(肾移植组)以及12例正常志愿者(正常对照组)的精液,并对其主要参数进行比较。结果:尿毒症组、肾移植组及正常对照组的精子活动力分别为(14.8±3.4)%、(50.7±4.8)% 和(63.8±3.6)% ;精子存活率分别为(27.2±4.8)% 、(71.9±6.0)%和(80.4±2.2)% ;精子密度分别为(22.2±3.8)×106/ml、(53.0±10.7)×106/ml和(67.6±14.9)×106/ml。肾移植组精液主要参数明显好于尿毒症组,差异有统计学意义(P<0.01),但与正常对照组比较,差异无统计学意义(P>0.05)。结论:肾移植可明显改善尿毒症患者的精液质量。     

合并海洋性贫血的尿毒症患者肾移植的临床观察

目的探讨海洋性贫血对尿毒症患者肾移植效果的影响。方法为46例合并海洋性贫血的尿毒症患者施行。肾移植（海洋性贫血组），其中α海洋性贫血26例，β海洋性贫血20例，观察患者术后移植。肾功能恢复延迟（DGF）和排斥反应的发生率以及贫血的纠正情况，对于移植。肾功能恢复正常者，记录其。肾功能恢复正常的时间，并测定血肌酐值。以同期施行的131例。肾移植（均伴有程度不等的贫血，但非海洋性贫血）为对照。结果海洋性贫血组DGF的发生率为26．1％，对照组为23．7％，二者比较，差异无统计学意义。术后6个月，人、肾均存活，且未失访的患者，海洋性贫血组有39例，对照组有109例，6个月内，海洋性贫血组30．8％发生排斥反应，对照组32．1％发生排斥反应，两组比较，差异无统计学意义；海洋性贫血组的血肌酐值为（121±20）μmol／L，对照组为（128±33）μmol／L，两组比较，差异无统计学意义；海洋性贫血组79．5％的贫血得到纠正，对照组76．1％的贫血得到纠正，两组比较，差异无统计学意义。结论合并海洋性贫血的尿毒症患者可接受肾移植治疗，临床效果与不合并该病者相仿。     

Kidney Transplantation Substantially Improves Endothelial Progenitor Cell Dysfunction in Patients with End-Stage Renal Disease

Endothelial progenitor cells (EPC) are involved in endothelial repair and maintenance. Dysfunction of EPC may contribute to accelerated arteriosclerosis in chronic kidney disease. Kidney transplantation (KTx) improves both survival and endothelial function of dialysis patients. In a prospective study, we tested to which extent KTx changes EPC biology. We studied number and function (migratory activity, adhesion to extracellular matrix proteins and to mature endothelial cells [EC]) of EPC in 20 patients during dialysis and 3, 6, 9 and 12 months after KTx. Twenty-two healthy volunteers served as matched controls. Circulating precursor populations were measured by flow cytometric analysis. Cytokines relevant for EPC mobilization were monitored. Compared to the dialysis state, KTx increased the migration of EPC to approximately 2-fold. Adhesion to fibronectin and to collagen type IV was significantly increased after KTx. An improved adhesion rate of EPC to mature EC was observed. The number of EPC decreased. The amount of precursor populations showed no difference compared to the pretransplant state. Our study shows an improved function of EPC after KTx. This finding indicates an improved potential for endothelial repair which in turn may contribute to enhanced endothelial function and reduced cardiovascular morbidity after KTx.     

老年尿毒症患者肾移植的围手术期处理（附23例报告）

目的：探讨老年患者肾移植围手术期的处理原则及治疗方案。以提高手术成功率。方法：对23例施行肾移植手术的老年尿毒症患者进行临床分析：术前详细检查，排除手术禁忌证；严格组织配型，采取恰当的手术方式；术后严密观察病情变化；采用合适的免疫抑制治疗方案。结果：23例患者手术全部成功。术后发生肺部感染5例．其中1例并发呼吸衰竭、心功能衰竭抢救无效死亡，1例再次肾移植患者出现移植肾功能延迟恢复（DGF）并出现急性排斥反应、心功能衰竭、肺部感染，经抢救无效死亡；心力衰竭1例，脑出血1例，急性排斥反应3例次，消化道出血1例，CsA、FK506浓度中毒各1例，经治疗后，患者均顺利度过围手术期。绪论：应严格掌握适应证，良好的组织配型、高质量的供体、完备的术前准备、个体化的手术方式及免疫抑制治疗方案、防治并发症是手术成功的重要保证。     

Impact of Donor Dopamine on Immediate Graft Function after Kidney Transplantation

Optimizing medical donor management may have a considerable impact on transplantation outcome. This study investigated the effect of donor dopamine on initial graft function in renal allograft recipients, involving 254 consecutive recipients of a cadaver kidney, aged 18-74 years, transplanted between 1990 and 2003. Immunosuppression was based on cyclosporine. Patients were grouped according to donor use of dopamine during intensive care. Delayed graft function (DGF), and serial creatinine concentrations were compared between the groups. Dopamine-treated and -untreated donors were very similar regarding hemodynamics and renal function. Delayed graft function occurred in 47/158 treated and 48/96 untreated kidneys (p = 0.001). Donor dopamine was associated with a more rapid decrease of s-creatinine, which became obvious on the first postoperative day. Of patients in the treated and untreated group, respectively, 81.9% and 65.8% reached a s-creatinine level less than 2 mg/dL during the first month (p = 0.005). Donor dopamine remained predictive of a normalized s-creatinine level [HR 1.71; 95% CI 1.22-2.41] after controlling for confounding factors by multivariate Cox regression. Donor dopamine is associated with improvements of initial graft function after kidney transplantation. The beneficial effect of dopamine is achievable without side-effects for the recipients, and correlates with superior long-term graft survival.     

再次肾移植对尿毒症患者性功能的影响

目的:探讨再次肾移植对尿毒症患者性功能的影响。方法:对接受2次肾移植和同期双肾移植的30例患者术后的性功能状态进行问卷调查及阴茎血流多普勒超声检查。2次移植选用髂外动脉与供肾动脉吻合者9例(A组);一侧选用髂内动脉另一侧选用髂外动脉吻合者11例(B组);均选用髂内动脉与供肾动脉吻合者10例(C组),其中包括同期行双肾移植的1例患者。结果:术后半年恢复正常性生活者,A组8例;B组7例;C组5例。C组患者的阴茎海绵体动脉收缩期最大血流速度明显低于A及B组。结论:2次肾移植均选用髂内动脉与供肾动脉吻合,对患者的性生活有影响;但通过侧支循环代偿一段时间后,一部分患者仍可有满意的性生活。     

Kidney Transplantation Halts Cardiovascular Disease Progression in Patients with End-Stage Renal Disease

Morbidity and mortality from cardiovascular disease have a devastating impact on patients with chronic kidney disease (CKD) and end-stage renal disease. Renal function decline in itself is thought to be a strong risk factor for cardiovascular disease (CVD). In this study, we investigated the hypothesis that the elevated CV mortality in kidney transplant patients is due to the preexisting CVD burden and that restoring renal function by a kidney transplant might over time lower the risk for CVD. We analyzed 60,141 first-kidney-transplant patients registered in the USRDS from 1995 to 2000 for the primary endpoint of cardiac death by transplant vintage and compared these rates to all 66813 adult kidney wait listed patients by wait listing vintage, covering the same time period. The CVD rates peaked during the first 3 months following transplantation and decreased subsequently by transplant vintage when censoring for transplant loss. This trend could be shown in living and deceased donor transplants and even in patients with end-stage renal disease secondary to diabetes. In contrast, the CVD rates on the transplant waiting list increased sharply and progressively by wait listing vintage. Despite the many mechanisms that may be in play, the enduring theme underlying rapid progression of atherosclerosis and cardiovascular disease in renal failure is the loss of renal function. The data presented in this paper thus suggest that the development or progression of these lesions could be ameliorated by restoring renal function with a transplant.     

Kidney Transplantation in Patients with Neurovesical Dysfunction

Background: Five renal recipients with neurovesical dysfunction (NVD) were retrospectively reviewed focusing on anatomical and urodynamic abnormalities of the lower urinary tract and their management prior to kidney transplantation.
Methods: The underlying anomalies in these 5 patients were a posterior urethral valve (1 with an imperforate anus; n = 2), meningomyelocele (n = 2) and a congenital short urethra with an imperforate anus (n = 1). Their urinary tracts were evaluated prior to transplantation with voiding cystourethrography, urethrocystoscopy, cystometrography and electromyography of the external urethral sphincter to identify a possible focus of urinary tract infection, urine storage and voiding function.
Results: All 5 patients had NVD proven by urodynamic studies or by documentation of urinary retention in the absence of mechanical outlet obstruction. Bilateral high grade vesicoureteral reflux was noted in all patients, requiring ureteroneocystostomy. Clean intermittent catheterization (CIC) was ultimately employed for bladder emptying in all patients. Two patients with poor bladder compliance underwent augmentation cystoplasty before transplantation. The Mitrofanoff procedure was used in 2 patients with structural urethral abnormalities to access the bladder for catheterization. After eradication of possible sources of infection and establishment of a low-pressure urine storage system with bladder emptying by CIC, kidney transplantation was performed. Following kidney transplantation, all of the recipients were asymptomatic for urinary tract infections using CIC. Although 1 patient lost his graft due to chronic rejection, the other 4 other patients have good renal function.
Conclusion: Kidney transplantation in patients with NVD can be performed provided that their urinary tract problems are properly resolved.     

The Clinical Impact of an Early Decline in Kidney Function in Patients Following Heart Transplantation

Renal dysfunction is a well-known complication following heart transplantation. We examined an early decline in kidney function as a predictor of progression to end-stage renal disease and mortality in heart transplant recipients. We performed a retrospective cohort study of 233 patients who received a heart transplant between July 1985 and July 2004, and who survived >1 month. The decline in estimated creatinine clearance (CrCl) was used to predict the outcomes of need for chronic dialysis or mortality >1-year posttransplant. The earliest time to chronic dialysis was 484 days. A 30% decline in CrCl between 1 month and 12 months predicted the need for chronic dialysis (p = 0.01), all-cause mortality (p < 0.0001) and time to first CrCl ≤30 mL/min at >1-year posttransplant (p = 0.02). A 30% decline in CrCl between 1 month and 3 months also independently predicted the need for chronic dialysis (p = 0.04) and time to first CrCl ≤ 30 mL/min at >1-year posttransplant (p = 0.01). In conclusion, an early drop in CrCl within the first year is a strong predictor of chronic dialysis and death >1-year postheart transplantation. Future studies should focus on kidney function preservation in those identified at high risk for progression to end-stage kidney disease and mortality.     

The Outcome of Patients with Nephrogenic Systemic Fibrosis after Successful Kidney Transplantation

Nephrogenic systemic fibrosis (NSF) is a debilitating disease in patients with severely diminished kidney function. Currently, no standard treatment exists but improvement has been reported after restoration of kidney function. We retrospectively studied 17 NSF patients with and without successful kidney transplantation (KTx) to evaluate the effects of KTx on NSF. Nine of the 11 KTx developed NSF pretransplant whereas two developed NSF immediately after KTx with delayed graft function. Two of the six dialysis patients had previous failed kidney transplants. Age and sex were well matched. All but one patient was dialysis dependent at the time of NSF. Median follow‐up was 35 months for KTx patients and 9 months for dialysis patients. Kidney transplants achieved adequate renal function with median serum creatinine of 1.4 (0.9–2.8) mg/dL and a glomerular filtration rate of 42 (19–60) mL/min/1.73 m². NSF improved in 54.6% of the transplanted patients and 50% of the nontransplanted patients (p = 0.86). Two KTx patients had complete resolution of their symptoms whereas four had partial improvement. Improvement in the dialysis patients was all partial. Successful KTx did not insure improvement in NSF and in fact appeared to have no significant benefit over dialysis.     

Combined Kidney and Intestinal Transplantation in Patients With Enteric Hyperoxaluria Secondary to Short Bowel Syndrome

Kidney transplantation is the treatment of choice for end‐stage renal disease whereas indications for intestinal transplantation are currently restricted to patients with irreversible small bowel failure and severe complications of total parenteral nutrition (mostly shortage and infection of venous accesses, major electrolyte disturbances and liver failure). Enteric hyperoxaluria is secondary to certain intestinal diseases like intestinal resections, chronic inflammatory bowel disease and other malabsorption syndromes and can lead to end‐stage renal disease requiring kidney transplantation. We report two patients suffering from renal failure due to enteric hyperoxaluria (secondary to extensive intestinal resection) in whom we elected to replace not only the kidney but also the intestine to prevent recurrence of hyperoxaluria in the transplanted kidney.