指甲肌酐测定对鉴别急、慢性肾功能衰竭的临床意义

长期以来 ,人们一直在寻求一种行之有效的方法来鉴别急性肾功能衰竭 (ARF)与慢性肾功能衰竭 (CRF)。L evitt[1 ] 和Bergamo[2 ] 等曾报道指甲肌酐 (NCr)含量与指甲形成当时的血肌酐 (SCr)水平存在着一种线性关系。为此 ,我们测定了健康人、ARF及 CRF患者的 NCr含量 ,旨在探讨 NCr含量对鉴别 ARF和 CRF的临床价值。1　资料与方法1.1　研究对象　健康人组 32例 ,其中男 15例 ,女 17例 ;平均年龄 38岁。 ARF组 12例 ,其中男 5例 ,女 7例 ;平均年龄42岁 ;病例选择标准 :4月前 SCr<144 .5μm ol/ L和 (或 )肾活检病理表现、临床表…     

指甲肌酐ROC曲线下面积对急慢性肾衰竭的鉴别诊断

目的：寻找指甲肌酐（NCr）鉴别急慢性肾衰竭的诊断界值。方法：应用ROC曲线的方法评价NCr作为鉴别诊断急慢性肾衰竭指标的界值及其优劣。结果：于急慢性肾衰竭时NCr个体分布的重叠,选取各截断点下判定值的不同,其灵敏度、特异率发生变化,并使得ROC曲线下的面积不同。本研究所取5个截断点下曲线面积为78.9,NCr取值84.9处为曲线最凸点。结论：ROC曲线的面积在0.7-0.9之间有一定的准确性;以NCr测值84.9作为急慢性肾衰竭NCr的鉴别诊断界值有一定的临床价值。     

儿童急慢性肾功能衰竭的对比分析

目的了解儿童急、慢性肾功能衰竭的特点 ,提高对本病的诊治水平。方法对 2 9例儿童急、慢性肾功能衰竭的临床资料进行对比分析。结果急性肾功能衰竭患儿年龄 ( 8.18± 3.8)岁 ,病因以感染为多见 ;慢性肾功能衰竭患儿年龄 ( 11.82± 2 .7)岁 ,病因除感染外 ,先天性泌尿系统畸形、遗传代谢病多见。实验室检查结果显示两组酸碱平衡、离子代谢以及免疫功能紊乱方面差别明显 ,其他如两组血肌酐、尿素氮、血及尿β2 -MG等无统计学意义。结论儿童急、慢性肾功能衰竭各有其自己的临床特点 ,尽早诊断、积极治疗急性肾功能衰竭 ,各种泌尿系统疾病诊断后的持续治疗、定期随访 ,推广、开展连续性肾脏替代治疗对肾脏病的防治十分有益     

碱性苦味酸法测定头发中肌酐含量

用碱性苦味酸法建立了头发肌酐含量的测定。结果表明：本法有较高的精密度和准确度。批内ＣＶ为４．５％，批间ＣＶ为６．７％，平均回收率为９４．２％，与高效液相色谱法测定结果相关性良好。     

酚磺乙胺对不同方法测定肌酐的干扰

目的探讨酚磺乙胺对苦味酸法和肌氨酸氧化酶法测定肌酐的干扰情况。方法参照临床化学检验的干扰评价(CLSI EP7-A2)规则,设计配对差异试验和剂量试验,判断酚磺乙胺对苦味酸法和肌氨酸氧化酶法测定肌酐是否有干扰及干扰效应与酚磺乙胺浓度的关系。结果酚磺乙胺对苦味酸法测定肌酐有正干扰,对肌氨酸氧化酶法测定肌酐有负干扰,其干扰效应与酚磺乙胺浓度的关系均为二次曲线关系,酚磺乙胺对苦味酸法和肌氨酸氧化酶法测定肌酐的最小干扰浓度分别为0.070 g/L和0.016 g/L。结论酚磺乙胺对苦味酸法和肌氨酸氧化酶法测定肌酐均有干扰,在临床上必须采取措施避免这种干扰的出现。     

血清脂肪酶在急慢性肾功能衰竭中的应用

目的 在血清酶学中寻找反映急、慢性肾功能衰竭的血清酶.方法 以常规工作同步监测各组标本,英国郎道公司定值血清作质量控制,用带标准的速率比浊法测定血清脂肪酶.结果 血清脂肪酶在急、慢性肾功能衰竭(特别是尿毒症期)组的含量与正常对照组、肾结石组、肾炎组、肾病综合征组比较差异均有统计学意义(P＜0.01),而其它4组间的两两比较差异均无统计学意义(P＞0.05).结论 脂肪酶测定是诊断急、慢性肾功能衰竭患者良好的血清酶学指标.     

甲状旁腺素测定在慢性肾功能衰竭诊断中的应用价值

目的:探讨慢性肾功能衰竭患者机体甲状旁腺素水平以及不同分期甲状旁腺素与血肌酐的关系.方法:应用化学发光法检测62例慢性肾功能衰竭患者甲状旁腺素和血肌酐水平,并与40例正常者(对照组)进行对照.结果:慢性肾功能衰竭组甲状旁腺素明显升高.与正常对照组比较差异有统计学意义(P<0.01);肾功能衰竭不同分期其甲状旁腺素值比较差异均有统计学意义(P<0.01);肾功能衰竭不同分期甲状旁腺素值与血肌酐值之间均呈线性相关,且有显著相关性.结论:对慢性肾功能衰竭患者检测甲状旁腺素可监测其肾功能衰竭程度;同时甲状旁腺素值对慢性肾功能衰竭新的分期具有较高的临床价值.     

瞬目反射正常值测定和在慢性肾功能衰竭患者中的应用

本文报告了30例瞬目反射(BR)正常值,并对17例慢性肾功能衰竭患者BR进行监测。测得健康成人瞬目反射早期反应即R_1的潜伏期为10.50±0.71ms,波幅为251.00±119.00uv,晚期反应其中刺激侧的晚期反应即R_2的相应值为30.30±3.26ms,313.00±147.00uv,对侧晚期反应即R_2相应值为30.39±3.26ms,300±130.00uv,与国内一些作者报告基本一致。慢性肾功能衰竭患者BR的各期反应潜伏期较对照组明显延长(P<0.05),提示BR监测有助于慢性肾功能衰竭患者神经系统损害的早期诊断。     

综合评价慢性肾衰竭常用检测指标的临床价值

目的评估内生肌酐清除率(Ccr),血清肌酐(SCr)、尿素氮(Urea)、半胱氨酸蛋白酶抑制剂C(s-Cys-C)、视黄醇结合蛋白(s-RBP),尿液微量总蛋白(u-Pro)、微量清蛋白与肌酐比值(u-Alb/Cr)、视黄醇结合蛋白(u-RBP)、半胱氨酸蛋白酶抑制剂C(u-Cys-C)、N-乙酰-β-D-氨基葡萄糖苷酶(u-NAG)等项目诊断慢性肾衰竭(CRF)的临床价值,寻找合适、有效的组合以提高CRF诊断率。方法选择住院患者206例,分别检测SCr、Urea、s-Cys-C、s-RBP、u-Pro、u-Alb/Cr、u-RBP、u-Cys-C、u-NAG等,计算Ccr值;联合检测分别为双项目和四项目组合。应用Excel软件和SPSS19.0统计软件对数据进行分析。结果 s-Cys-C的约登指数(YI)为0.59,受试者工作特征(ROC)曲线下面积为0.872,在单项目检测中均最高。SCr和s-Cys-C双项目并联试验的YI(0.60)最高,Urea、SCr、s-RBP、s-Cys-C四项目串联试验的阳性预测值(100.00%)最高,u-RBP和u-Cys-C双项目并联试验的阴性预测值(100.00%)最高。结论联合检测更有利于CRF的诊断,其中SCr和s-Cys-C双项目联合检测对CRF的诊断最有价值。s-CysC单项目检测拥有较合适的灵敏度和特异性,诊断效率较其他项目高。排除肾功能损伤可选择联合检测u-RBP和u-Cys-C,且具有无创伤性、取样方便等优势。     

慢性肾衰竭患者甲状旁腺素与肌酐、尿素氮、尿酸的相关性研究

目的探讨慢性肾衰竭(CRF)患者血浆甲状旁腺素(PTH)的水平与血清肌酐、尿素氮、尿酸水平的关系。方法 72例CRF患者采用罗氏E170电化学发光免疫分析仪检测PTH,OlympusAU2700全自动生化分析仪检测血清肌酐、尿素氮及尿酸水平。结果 CRF患者血浆PTH水平与血清肌酐、尿素氮、尿酸水平均呈正相关。结论 PTH水平可以作为CRF患者病情严重程度判断和评价预后的一个重要指标。     

Protein biomarkers associated with acute renal failure and chronic kidney disease

Acute renal failure (ARF) as well as chronic kidney disease (CKD) are currently categorized according to serum creatinine concentrations. Serum creatinine, however, has shortcomings because of its low predictive values. The need for novel markers for the early diagnosis and prognosis of renal diseases is imminent, particularly for markers reflecting intrinsic organ injury in stages when glomerular filtration is not impaired. This review summarizes protein markers discussed in the context of ARF as well as CKD, and provides an overview on currently available discovery results following 'omics' techniques. The identified set of candidate marker proteins is discussed in their cellular and functional context. The systematic review of proteomics and genomics studies revealed 56 genes to be associated with acute or chronic kidney disease. Context analysis, i.e. correlation of biological processes and molecular functions of reported kidney markers, revealed that 15 genes on the candidate list were assigned to the most significant ontology groups: immunity and defence. Other significantly enriched groups were cell communication (14 genes), signal transduction (22 genes) and apoptosis (seven genes). Among 24 candidate protein markers, nine proteins were also identified by gene expression studies. Next generation candidate marker proteins with improved diagnostic and prognostic values for kidney diseases will be derived from whole genome scans and protemics approaches. Prospective validation still remains elusive for all proposed candidates.     

Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure

Objective Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery. Design Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years. Setting Thirty-two Swedish intensive care units. Patients and participants Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete. Interventions None. Measurements and results The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6–10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0–23.2) developed need for chronic dialysis. Conclusions The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

同型半胱氨酸测定在慢性肾病诊断中的应用

目的探讨血清同型半胱氨酸(homocysteine,HCY)测定在慢性肾脏疾病诊断中的应用。方法健康对照组40例,实验组共120例,其中肾功能代偿组32例、氮质血症组27例、肾衰竭组35例、尿毒症组26例。采用酶转换法测定血清HCY的浓度,同时测定血清尿素氮(BUN)、血清肌酐(Scr)。结果对照组和实验组血清HCY比较,差异有统计学意义(P0.01);对照组与肾功能代偿组比较,差异有统计学意义(P0.05);氮质血症组、肾衰竭组、尿毒症组,血清HCY逐渐升高,与肾功能代偿组比较,差异有统计学意义(P0.01)。结论血清HCY在慢性肾衰竭患者的肾功能代偿期即可增高,比传统的血清BUN、Scr能更敏感地反映肾功能损伤。     

慢性肾衰竭患者止凝血功能的变化

目的探讨止血、凝血系统的变化与慢性肾衰竭并发出血的关系。方法检测55例慢性肾衰竭患者血小板聚集率(PAgT)、P-选择素、血管性血友病因子∶抗原(vWF∶Ag)含量;凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、抗凝血酶Ⅲ(AT-Ⅲ)活性、血浆蛋白C(PC)活性,并与40例健康者比较。结果慢性肾衰竭患者PAgT、P-选择素、AT-Ⅲ活性、血浆PC明显降低,与对照组比较,差异有统计学意义(P<0.01);vWF∶Ag含量升高,与对照组比较,差异有统计学意义(P<0.01),PT、APTT与对照组比较,差异无统计学意义(P>0.05)。结论慢性肾衰竭患者存在出血和血栓栓塞两种状态。     

机器学习用于慢性肾衰竭研究进展

慢性肾衰竭(CRF)为多因素所致慢性进行性肾实质损害,进而可累及全身多系统。机器学习(ML)可对高维医学数据进行数据分析和挖掘,对于解决临床复杂问题具有显著潜力。本文围绕ML用于CRF研究进展进行综述。     

非透析慢性肾功能衰竭患者的微炎症反应与肾功能的关系

目的探讨非透析慢性肾功能衰竭(肾衰竭)患者慢性微炎症反应与肾功能的关系。方法测定50例非透析慢性肾衰竭患者慢性炎症指标血C反应蛋白(CRP)、白细胞介素6(IL-6)及肾功能指标,分析它们之间的关系。结果有32%慢性肾衰竭患者CRP超过正常参考值(5mg/L),内生肌酐清除率(Ccr)<5ml/min组的CRP明显高于Ccr≥5ml/min组(P<0.05)和对照组(P<0.05);CRP与IL-6呈明显正相关(r=0.313,P<0.05);血CRP、IL-6与Ccr呈明显负相关(P<0.05~0.01),与血清肌酐(SCr)、血尿素氮(BUN)呈明显正相关(P<0.05、P<0.01)。结论非透析慢性肾衰竭患者存在慢性微炎症状态,慢性微炎症反应与肾功能下降程度密切相关。