慢性铅接触早期肾损害指标的比较研究

目的在慢性铅接触者中发现早期肾损害指标。方法对62例血铅增高的慢性铅接触工人按工龄分组,并测定尿N乙酰B D氨基葡萄糖苷酶(NAG)、尿溶菌酶(Lys)、尿β2微球蛋白(β2MG)、内生肌酐清除率(CCr)等指标。同时按是否单纯NAG增高分组,说明NAG在其中的意义。结果铅接触工龄1年以上者,NAG即有明显增高,单纯NAG增高组血铅水平明显低于非单纯NAG增高组。结论尿NAG是铅所致肾损害最敏感的指标之一。     

高血压病肾损害早期诊断指标探索

晚近研究证实,血尿素氮、肌酐及肌酐清除率作为肾损害早期诊断指标极不敏感。血β_2-微球蛋白、尿β_2-微球蛋白、尿白蛋白及免疫球蛋白G的测定使肾损害早期诊断已成可能,为证实其敏感性,对高血压病不同分期病人应用上述指标进行对比研究,现报告如下。     

新生儿窒息后早期肾损害检验指标分析

目的探讨胱抑素C(Cys-C)、β2微球蛋白(β2-MG)、尿素氮(BUN)和肌酐(CR)的血中水平对新生儿窒息后早期肾损害的敏感性。方法统计2011年1月~2014年3月住院治疗的44例新生儿窒息的相关资料,其中轻度窒息31例,重度窒息13例,同时以滞留产科观察的18例无窒息新生儿作对照。所有新生儿均在出生后12h内从股静脉取血标本进行血Cys-C、β2-MG、BUN和CR水平检测,对所有结果分组进行统计分析。结果血Cys-C异常率为75.6%、β2-MG异常率为77.1%,两者联合检测的异常率高达91.3%;窒息组新生儿血Cys-C、β2-MG水平明显高于无窒息组,分别比较均具有统计学意义(P0.01),而两组血BUN和CR分别比较均无统计学意义(P0.05)。结论血Cys-C、β2-MG水平可作为判断新生儿窒息后早期肾损害的敏感指标,而两者联合检测更具有临床意义;血BUN和CR的水平反应早期肾损害不灵敏。     

高血压早期肾损害不同诊断指标临床意义

目的探讨尿视黄醇结合蛋白（retinol combined with protein,RBP）、尿N-乙酰-β-D-氨基葡萄糖苷酶（N-acetyl-β-D-glucosaminidase,NAG）、尿半胱氨酸蛋白酶抑制剂C（cystatin C,Cys C）诊断原发性高血压早期肾损害的敏感性及临床意义。方法原发性高血压患者52例（观察组）,同期体检健康者30名（对照组）,采用ELISA法检测2组尿RBP及尿Cys C水平,采用对硝基苯酚比色法检测2组尿NAG水平,并进行比较分析。结果观察组尿RBP,Cys C,NAG水平均高于对照组（P〈0.05）;观察组尿NAG,RBP,Cys C阳性率分别为98.1%,96.1%,86.5%;ROC曲线下面积分别为0.952,0.932,0.853;95%CI分别为0.911～0.993,0.875～0.981,0.738～0.926。结论尿NAG,RBP,Cys C有助于高血压肾损害的早期诊断。     

糖尿病早期肾损害的实验室检查

糖尿病肾病(DN)是糖尿病的3大并发症之一.美国疾病预防控制中心统计资料显示,DN患者占糖尿病的67%以上,欧美国家慢性肾功能衰竭(CRF)透析患者中DN占43%左右,DN是糖尿病患者终末期肾衰(ERDS)死亡的主要原因.     

糖尿病早期肾损害两种检测指标的观察

本文采用准确性高的速率散射比浊法对73例糖尿病患者进行Alb、α1-MG蛋白的测定,旨在探讨其在糖尿病肾脏疾病早期诊断上的作用。 1 材料与方法 1.1 分组 正常对照组39例。男21例,女18例;平均年龄42.90±8.62 y。血压正常,无心、肝、肾及内分泌或代谢性发病。临床诊断糖尿病(DM)组73例,男40例,女33例;平均年龄47.2±8.90y.其中非胰岛素依赖型69例,胰岛     

炎症因子与高血压早期肾损害

原发性高血压(essential hypertension,EH)是严重影响人类健康的慢性疾病,可出现心、脑、肾的严重并发症,直接影响患者的预后和生活质量.目前高血压早期肾损害确切机制尚不明确,可能是多方面因素共同作用的结果.近年越来越多的研究显示,高血压促进肾动脉粥样硬化形成所致的肾组织缺血性改变,可导致局灶性肾小球硬化,最终导致肾脏损害.肾动脉粥样硬化是一种慢性低程度的炎症过程,有炎症因子和炎症细胞参与其发生发展,由此可见,炎症在高血压早期肾损害中发挥着重要作用.     

221例铅接触作业人员的血液流变学指标探讨

目的探讨血液流变学结果与铅接触作业人员的关系。方法使用全自动血液流变学仪器测定221例铅接触作业人员和68例健康对照者血液流变学指标,并统计分析。结果铅接触作业组全血黏度高切、中切、低切的血浆黏度均显著低于健康对照组,差异有统计学意义(P0.05)。结论铅接触作业人员的血液流变学指标异常与作业环境有很大关系。     

低浓度铅环境作业工人周围神经传导速度与生物学指标的变化

背景：在国家最高容许铅浓度范围内作业长期接触铅时，是否仍可对人体健康产生影响？目的：调查分析低浓度铅作业工人周围神经传导速度和生物学指标的变化。设计：以低浓度铅作业工人为观察对象的检验。单位：上海第二医科大学新华医院职业病科及电生理科。对象：以2000-09／2002-10上海第二医科大学附属新华医院职业病科职业健康体检的铅作业工人和同地科室人员为调查对象，共106例。接触组为热处理工人66人，对照组为同期同地科室人员40人。方法：采用问卷调查和实验室检查对接触组和对照组进行周围神经传导速度和生物学指标血铅、血锌原卟啉、游离原卟啉、血红蛋白的检测。对检测数据进行相对危险度分析。主要观察指标：①接触组和对照组周围神经传导速度。②各项生物学指标变化。结果：进入结果分析106人，对照组40人，接触组66人，接触组中工龄〉10年34例，〈10年32例。①接触组工龄〉10年工人周围神经运动传导速度中正中神经比对照组加快[（50．1&;#177;4．76），（47．59&;#177;4．86）m/s，P〈0．05]，尺神经比对照组加快[（63．11&;#177;2．58），（61．83&;#177;3．03）m／s，P〈0．05]。②接触组工龄〉10年工人血铅高于〈10年工人[（0568&;#177;028），（0．425&;#177;0．31）μmol／L，P〈0．05]，接触组工龄〉10年工人血游离原卟啉高于〈10年工人[（2．24&;#177;0．32），（2．09&;#177;0．27）μmol／L，P〈0．05]，接触组工龄〉10年工人尿铅高于〈10年工人[（0．087&;#177;0．008），（0．083&;#177;0．007）mg／L，P〈0．05]。接触组工龄〉10年工人血锌原卟啉为（1．42&;#177;0．33）μxmol／L，高于接触组工龄〈10年工人[（1．25&;#177;0．35）μxmol／L，P〈0．05]及对照组[（1．22&;#177;0．44）μmol／L，P〈0．05]。接触组工龄〉10年工人血红蛋白为（12．26&;#177;4．5）g/L，低于接触组工龄〈10年工人[（14．55&;#177;4．81）μxmol／L，P〈0．051及对照组[（14．88&;#177;4．30）μxmol／L，P〈0．051。⑧接触组工龄〈10年工人周围神经感觉传导异常1例，异常率3％（1／32），接触组工龄〉10年工人4例，异常率12％（4／34）。接触组工龄〈10年工人有生物指标超过正常范围1例，异常率3％（1／32），接触组工龄〉10年工人5例，异常率15％（5／34）。工龄〉10年工人神经传导速度、生物指标异常率较工龄〈10年工人高，相对危险度分别为4．1，5.3倍。结论：长期接触低浓度铅不仅能使牛物学指标有改变，同时会对周围神经系统产生不同程度的损害，以下肢感觉神经、上肢运动神经潜伏期较先受累。工龄大于10年的铅作业工人已存在周围神经病损。由于神经系统再生能力差，损害往往是不可逆的，神经电生理变化是预示神经损害的早期变化，可以此做为预防的监测手段。     

低浓度铅环境作业工人周围神经传导速度与生物学指标的变化

背景:在国家最高容许铅浓度范围内作业长期接触铅时,是否仍可对人体健康产生影响?目的:调查分析低浓度铅作业工人周围神经传导速度和生物学指标的变化.设计:以低浓度铅作业工人为观察对象的检验.单位:上海第二医科大学新华医院职业病科及电生理科.对象:以2000-09/2002-10上海第二医科大学附属新华医院职业病科职业健康体检的铅作业工人和同地科室人员为调查对象,共106例.接触组为热处理工人66人,对照组为同期同地科室人员40人.方法:采用问卷调查和实验室检查对接触组和对照组进行周围神经传导速度和生物学指标血铅、血锌原卟啉、游离原卟啉、血红蛋白的检测.对检测数据进行相对危险度分析.主要观察指标:①接触组和对照组周围神经传导速度.②各项生物学指标变化.结果:进入结果分析106人,对照组40人,接触组66人,接触组中工龄＞10年34例,＜10年32例.①接触组工龄＞10年工人周围神经运动传导速度中正中神经比对照组加快[(50.11±4.76),(47.59±4.86)m/s,P＜0.05],尺神经比对照组加快[(63.11±2.58),(61.83±3.03)m/s,P＜0.05].②接触组工龄＞10年工人血铅高于＜10年工人[(0.568±0.28),(0.425±0.31)μmol/L,P＜0.05],接触组工龄＞10年工人血游离原卟啉高于＜10年工人[(2.24±0.32),(2.09±0.27)μmol/L,P＜0.05],接触组工龄＞10年工人尿铅高于＜10年工人[(0.087±0.008),(0.083±0.007)mg/L,P＜0.05].接触组工龄＞10年工人血锌原卟啉为(1.42±0.33)μmol/L,高于接触组工龄＜10年工人[(1.25±0.35)μmol/L,P＜0.05]及对照组[(1.22±0.44)μmol/L,P＜0.05].接触组工龄＞10年工人血红蛋白为(12.26±4.5)g/L,低于接触组工龄＜10年工人[(14.55±4.81)μmol/L,P＜0.05]及对照组[(14.88±4.30)μmol/L,P＜0.05].③接触组工龄＜10年工人周围神经感觉传导异常1例,异常率3%(1/32),接触组工龄＞10年工人4例,异常率12%(4/34).接触组工龄＜10年工人有生物指标超过正常范围1例,异常率3%(1/32),接触组工龄＞10年工人5例,异常率15%(5/34).工龄＞10年工人神经传导速度、生物指标异常率较工龄＜10年工人高,相对危险度分别为4.1,5.3倍.结论:长期接触低浓度铅不仅能使生物学指标有改变,同时会对周围神经系统产生不同程度的损害,以下肢感觉神经、上肢运动神经潜伏期较先受累.工龄大于10年的铅作业工人已存在周围神经病损.由于神经系统再生能力差,损害往往是不可逆的,神经电生理变化是预示神经损害的早期变化,可以此做为预防的监测手段.     

丹参水提液对染镉大鼠肾损伤的干预作用

目的探讨丹参水提液对染镉大鼠肾损伤的干预作用及其可能的作用机制。方法健康Wistar大鼠,雌雄各20只,鼠龄6周。适应性喂养1周,随机分组,空白组8只,模型组32只,空白组腹腔注射生理盐水5 m L/(kg·d),模型组以2.8 mg/(kg·d)氯化镉溶液腹腔注射。连续造模4周,观察大鼠一般情况,检测大鼠肾功能指标、肾脏组织病理改变。造模成功后,将模型组随机分为给药组、阴性、阳性对照组及空白对照组。给药组[丹参水提液高剂量2.7 g/(kg·d)、丹参水提液低剂量1.35 g/(kg·d)]灌胃,阳性对照组亚硒酸钠溶液0.05 mg/(kg·d)灌胃,阴性及空白对照组给予同体积生理盐水2.7 m L/(kg·d)。各组治疗10周,实验终末收集血清、尿液,并留取肾脏组织,待检测。结果丹参水提液低、高剂量组24 h尿量低于阴性对照组,而血清超氧化物歧化酶(SOD)明显升高,丙二醛(MDA)显著降低,总抗氧化能力(T-AOC)增强明显,血尿素氮、血清肌酐含量降低,尿蛋白(β2-MG)含量下降。病理切片可见阴性对照组肾脏近曲小管上皮细胞浑浊、肿胀变性、坏死;丹参水提液低、高剂量组血清、皮质镉含量低于阴性对照组;丹参水提液低、高剂量组凋亡率低于阴性对照组。结论丹参水提液能加速体内镉代谢,可有效干预镉致肾损伤,有助于延缓慢性肾功能衰竭,改善肾功能,保护肾脏。     

Vulnerability to distress: Cognitive and emotional reactivity in chronically self-focused individuals

Self-focused attention has been related to a number of both normal and dysfunctional processes. Several recent studies have suggested that the dispositional equivalent of self-focused attention, private self-consciousness, may serve as a vulnerability factor for emotional distress. To test this proposition, two studies were conducted. In the first, individuals high and low in chronic self-focus were provided with either success or failure feedback, and reactions to this feedback on several cognitive and affective variables were assessed. Results indicated that chronically self-focused individuals responded with significantly more negative affect, dysfunctional negative thoughts, and less self-deception. In the second study, a naturalistic experiment was conducted where chronically self-focused subjects were assessed weekly over a 10-week period to determine if they encountered more negative affect than a non-self-focused comparison group. Although self-focused and non-self-focused subjects started out with equal levels of negative emotion, self-focused subjects reported reliably higher levels of negative affect during the last two-thirds of the assessment period. Results from both studies are discussed in terms of implications of the vulnerability of individuals who are typically high in internal attention.     

Comparative study of indices of activity evaluation in rheumatoid arthritis

IntroductionChoosing between the different indices of activity evaluation in RA is often difficult considering the very heterogeneous clinical expression of the disease. The objective of our study was to evaluate the level of similarity between SDAI, CDAI, DAS28-_ESR and DAS28-_CRP indices in the evaluation of RA activity.Patients and methodsIn this transversal study, a total of 100 patients with RA responding to the ACR 87 criteria were followed up for a period of 20 months. The correlations between the four indices were studied through the Pearson's correlation coefficient (r). The similarity between these tools was evaluated through Kendall's (K) “tau” similarity coefficient.ResultsThe 87 female and 13 male patients (sex ratio: 6.7F/1M) were of a mean age of 52.9 ± 11.6 years (17–77) and have been living with RA for a mean of 8.3 ± 9 years (2 months–41 years). The DAS28-_ESR mean score was 5.53 ± 1.46 [1.25–8.05]. The DAS28-_CRP mean score was 5.01 ± 1.44 [1.68–7.81]. The CDAI mean score was 30.72 ± 15.04 [2–62] and that of SDAI was 28.86 ± 15.86 [2.3–71.3]. A positive, statistically significant correlation was noted between the four indices of RA activity. The level of similarity between the different indices was good (K variation between 0.758 and 0.943). DAS28-_ESR allowed classifying the patients in the same category of disease activity than DAS28-_CRP in a proportion of 85%. This proportion was 88% when comparing DAS28-_ESR to CDAI and SDAI, respectively. Regarding DAS28-_CRP and CDAI, these two indices classified the patients in the same category in a proportion of 80%, compared to 87% regarding DAS28-_CRP and SDAI. Finally, CDAI and SDAI classified the patients in the same category in a proportion of 92% with an excellent level of similarity.ConclusionDifferent evaluation indices of RA activity are currently available. DAS28 is the most used. CDAI and especially SDAI have a good level of similarity with DAS28. Their advantage is to be simple and quick, and seem therefore well adapted to the follow-up of outpatients.     

No cognitive deficits in men formerly exposed to lead

OBJECTIVES: The objective of the study was to investigate long-term cognitive effects resulting from low to moderate lead exposure below current threshold values. Executive functions, attention, visuospatial and visuomotor functioning in workers formerly exposed to lead were investigated. METHODS: 48 men formerly exposed to lead and with a mean current blood level (PbB) of 5.4 microg Pb/100 ml were investigated, together with 48 matched controls (PbB, 4.7 microg Pb/100 ml) out of a pool of 61 males. The two groups were matched for age, years spent in education, verbal intelligence and gram alcohol consumption per week. The following neuropsychological tests were used: modified Wisconsin card sorting test, block design test, visual recognition test, simple reaction time, choice reaction and digit-symbol substitution. Lead exposure was assessed using both current and cumulative measurements. RESULTS: There were no significant differences in cognitive parameters between the two groups. When analyzing dose-response relationships, negative correlations were found between PbB and performance in the block design test, and between PbB and scores in the visual recognition and digit-symbol substitution tests. High cumulative exposure (IBL, >5000; duration of exposure, >5 years) correlated only with wrong reactions in the choice reaction test. CONCLUSIONS: The results of our study indicate that cognitive deficits resulting from low-level exposure to lead are reversible. The study was limited to low-level long-term exposure (all PbB values were always below 55 microg Pb/100 ml), and extrapolation of these results to persons heavily exposed to lead is not possible.     

Simple liquid-chromatographic determination of urinary coproporphyrin in workers exposed to lead

We developed a simple method for the determination of urinary coproporphyrin (CP) in lead workers, using a "high-performance" liquid chromatograph (HPLC) equipped with a fluorescence detector. The detection limit of urinary CP in this method was 5 micrograms per liter of urine. The working linear range of urinary CP concentration was 5 to 1500 micrograms/L. In 41 lead-exposed workers, the urinary CP values obtained by the present HPLC method were well correlated with those obtained by a conventional spectrophotometric method (r = 0.94). The present method is useful for screening workers exposed to lead.     

Amphetamine metabolism in mice exposed chronically to phenobarbital and to phenobarbital with carbon tetrachloride.

The metabolism of amphetamine was studied in three groups of mice, including normal mice (N), mice given chronic doses of phenobarbital via their drinking water (PB), and mice exposed to carbon tetrachloride vapors daily during the course of chronic phenobarbital consumption (PB/CCl4). Renal and hepatic tissue from animals of each group were examined by electron microscopy. Mice in the PB/CCl4 group demonstrated the classical symptoms of carbon tetrachloride-induced hepatic cirrhosis, and structural damage to the kidney. The PB group presented a normal renal pathology, but ultrastructural changes including swollen mitochondria and dilation of the endoplasmic reticulum were evident in the hepatocytes. The N, PB and PB/CCl4 mice excreted 84.5, 61.5 and 72.3 percent respectively of a dose of 14C-amphetamine sulfate in the 0-72 hour urine. Seven major urinary metabolites were detected in the normal group, 4 in PB group, and 3 in the PB/CCl4 group. Unchanged amphetamine, rho-hydroxyamphetamine and benzoic acid were tentatively identified by combined techniques of gas chromatography and thin-layer chromatography with autoradiography.