超声检查诊断腹膜后纤维化的应用价值分析

腹膜后纤维化是由腹膜后纤维脂肪组织增生引起的非特异性非化脓性慢性炎症.现将我院收治的11例经组织细胞学或药物治疗证实的腹膜后纤维化患者的超声表现进行回顾性总结,现报道如下.1对象与方法1.1对象总结我院2001年3月至2010年6月收治的11例腹膜后纤维化患者,其中男8例,女3例,男:女为2.7:1,年龄为38 ～72岁,中位年龄55岁;病程5～21个月,平均9.8个月.诊断标准参照《实用腹部超声诊断学》(第2版).临床表现为腰腹部疼痛,自觉乏力,不适(7例);少尿、无尿甚至出现血尿(4例),其中伴下肢浮肿1例.11例腹膜后纤维化患者中经手术后免疫组织化学(免疫组化)证实者7例,经穿刺活检免疫组化证实者2例,经临床药物治疗随访证实者2例.     

特发性腹膜后纤维化致急性肾损害1例诊治及文献复习

目的加深对特发性腹膜后纤维化疾病的认识,提高早期诊断和治疗水平。方法分析我科收治1例特发性腹膜后纤维化导致急性肾损害患者的诊治过程,并复习近年国内外有关腹膜后纤维化的文献资料。结果本例患者以双下肢浮肿就诊。腹部彩超:双肾积水。CT腹主动脉周围及后方可见不规则软组织密度影,左侧髂动脉前移,双侧肾盂扩张积水改变,双侧输尿管中上端扩张,腹主动脉下段及髂动脉扩张。化验:肾功能:血肌酐186μmol/L,尿素氮10.89mmol/L,血沉74mm/h,γ球蛋白25.3%,α2球蛋白8%。结合影像学检查及化验确诊为:特发性腹膜后纤维化并急性肾损害。经过强的松治疗近期临床效果满意。结论特发性腹膜后纤维化发病率低,临床表现缺乏特异性,早期误诊率高,影像学检查是明确诊断的重要举措。糖皮质激素对特发性腹膜后纤维化治疗效果较好。     

CT诊断特发性腹膜后纤维化3例报告

腹膜后纤维化（retroperitoneal fibrosis，RPF）临床少见，发病率仅二十万分之一。无明确诱因引起的腹膜后纤维化称特发性腹膜后纤维化（idiopathic ret roperitoneal fibrosis，IRF）临床症状缺乏特异性，诊断主要依靠影像学检查。CT、MRI对其诊断率较高，现回顾作者收集三例经CT诊断并确诊的特发性腹膜后纤维化病例报告，并结合文献就其病因、影像及临床诊断和治疗进行综述如下。     

特发性腹膜后纤维化的超声诊断

目的 特发性腹膜后纤维化(RPF)的超声诊断特征及其相关临床分析.方法 2007年5月至2012年5月期间,我院诊治的10例特发性腹膜后纤维化患者,对其临床症状和体征,实验室检查结果,以及超声声像图特点,进行回顾性分析.结果 本组10例患者没有明显的外伤、感染、手术,以及肿瘤用药史,其中,6例出现疼痛、4例腹胀、3例浮肿、3例食欲不振、2例乏力、2例恶心呕吐,以及2例尿改变;阳性体征相对较少;9例患者红细胞沉降率加快、7例免疫球蛋白Ig异常、5例自身免疫相关抗体阳性、4例贫血、4例尿素氮和(或)肌酐升高,以及3例C反应蛋白升高.8例超声检查显示不同程度的肾积水;6例显示腹膜后低回声,并且没有血流.结论 对于特发性腹膜后纤维化患者,不具备典型的症状、体征,以及实验室检查,超声检查的敏感性也相对较低,应该多个方面综合考虑,进行最终诊断.     

腹膜后纤维化的诊断和治疗

目的 探讨腹膜后纤维化的临床病理特征，提高对腹膜后纤维化的诊断及治疗水平。方法 回顾总结了12例腹膜后纤维化患者的诊断及治疗情况，9例进行外科治疗，12例均给予糖皮质激素治疗。结果 随防3～36个月，肾功能均改善或恢复正常，3例继发于恶性肿瘤的患者死亡。结论 静脉尿路造影（IVU）、CT及MRI是诊断的主要手段，外科治疗的主要目的是解除腹膜后器官受压或梗阻以及防止再狭窄，应用糖皮质激素是内科治疗的主要手段。     

腹膜后纤维化三例

腹膜后纤维化(Retroperitoneal fibrosis)是临床罕见病。是以腹膜后非特异性炎症引起纤维组织过度增生形成纤维团块,导致腹膜后空腔脏器受压而发生梗阻。最多见的是尿管梗阻,而以腹块和肠梗阻就诊的相当少见。我们在近年收治3例,术前均未能确诊而以腹块行探查术,经病理确     

腹膜后纤维化的CT及MRI影像学分析

目的探讨腹膜后特发性纤维化的CT及MRI影像学表现和诊断。方法回顾性分析经手术病理证实的7例腹膜后纤维化患者的CT及MRI影像检查资料,男5例,女2例,将两种检查结果进行分析。结果 7例腹膜后纤维化患者在CT上均表现为后腹膜腹主动脉周围不规则肿块,呈轻中度强化,伴有周围组织的包埋,一侧或双侧输尿管上段扩张,肾积水。在MRI上表现为腹膜后纤维化早期病灶呈稍长T1稍长T2信号,中度强化;腹膜后纤维化晚期呈稍长T1稍短T2信号,延迟期轻度强化。结论腹膜后特发性纤维化起病隐匿,早期临床表现无特征性,CT及MRI检查对腹膜特发性纤维化具有重要的诊断价值,腹膜后出现弥漫或肿块样病变合并肾及输尿管积水可作为诊断腹膜后特发性纤维化的依据。     

64排螺旋CT在诊断腹膜后纤维化中的应用价值

目的通过回顾性分析腹膜后纤维化的64层螺旋CT资料表现特点,简单探讨64层螺旋CT在诊断腹膜后纤维化中的优势。方法对经临床病理证实的13例腹膜后纤维化（RPF）患者的64层螺旋CT资料进行分析,比较,总结。结果64层螺旋CT扫描主要表现为腹膜后弥漫性不规则肿块并发腹膜后脏器的粘连,多伴有不同程度的肾盂积水和不同程度的输尿管扩张,增强扫描以后描显示不规则病灶呈不同程度的不均强化。结论64层螺旋CT在显示病灶的同时能够更加清晰显示与周围组织的关系,能够为临床提供及其重要的指导意义,已经成为诊断腹膜后纤维化的首选检查。     

腹膜后纤维化3例报告

我们于1987－1990年收治3例腹膜后纤维化病例，现结合文献报告讨论如下。1病例介绍例1男，58岁，反复腰痛4年，按脊椎增生人院。体检：左肾区及腰能部压痛；尿常规：WhCg－11／HP；KuBly。椎体有唇样骨质增生，IVU示左肾左输尿管上段积水扩张，输尿管变细后下段未显影，右肾有轻度积水；左输尿管逆行造影，导管进10cm受阻，造影显示肾盂输尿管上段积水扩张，在输尿管中下段交界部有一3cm以上狭窄段，管腔光滑。考虑左输尿管狭窄而于9月对日施行手术探查，术中见腹膜后广泛粘连，暴露增粗的上段输尿管后，其远端被一层发亮的纤维组织包裹…     

腹膜后纤维化5例诊治并文献复习

目的:分析对腹膜后纤维化(RPF)的诊断、治疗状况,提高RPF的早期诊断率。方法:总结5例RPF患者的诊断、治疗和预后情况。结果:5例患者的初发症状各异,但腰背痛、腹痛为多见,后期症状因受累脏器的不同而异,其中以腹部包块、腹腔积液、泌尿系统症状及肠梗阻常见。CT和磁共振成像表现为主要诊断依据,但B超检查有利于合并肾积水及输尿管病变患者的诊断。当疾病在活动期,应积极给予足量激素和免疫抑制剂治疗;当纤维化已形成并发展到梗阻时,需及时手术治疗。结论:腹膜后纤维化发病率低,误诊率高。糖皮质激素对该病效果比较好,后期常需要手术治疗。     

原发性腹膜后肿瘤的诊治分析

目的总结原发性腹膜后肿瘤（PRT）的诊断和治疗经验。方法回顾性分析2004-2008年经安徽医科大学附属第一人民医院收治的50例原发性腹膜后肿瘤,分析总结患者基本特征、其病理学类型、影像学检查,外科手术治疗等临床资料。结果男23例,女27例,中位年龄43.7岁。病程3 d-2年半。临床表现主要以腹部包块、腹痛、腹胀和腰背痛为主,超声、CT、MR I等影像学检查是目前PRT最主要的诊断方法,本组病例中良性20例,恶性30例。完整切除39例,肿瘤完全切除率78%,其中联合脏器切除12例。3例部分切除。病理学类型主要是脂肪肉瘤9例,畸胎瘤6例,梭形细胞瘤5例,神经鞘瘤4例,嗜络细胞瘤4例,平滑肌瘤4例,余下少见类型有18例。结论影像学检查对术前诊断和确定手术切除范围有重要意义;手术切除是PRT的最主要的手段,充分的术前准备、多专科的参与,是完成手术的关键;联合脏器切除可以提高肿瘤完整切除率,对其诊治有重要意义。     

Pirfenidone for the treatment of idiopathic pulmonary fibrosis

Although multidrug therapy is required in order to achieve good blood pressure control in many hypertensives, there are no studies directly comparing fixed-dose combinations as initial therapy. The Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial compares regimens of benazepril plus amlodipine versus benazepril plus hydrochlorothiazide, force-titrated to 40/10 and 40/25mg, respectively. A total of 12,600 high-risk hypertensives have been randomised and will be followed for 3 – 5years, during which cardiovascular events will be monitored. The investigators hypothesise that the benazepril plus amlodipine regimen will decrease cardiovascular events by 15% compared with benazepril plus hydrochlorothiazide. Recruitment began in 2003, and the trial is expected to end in 2008. The ACCOMPLISH trial shares important limitations with many other recent trials that will make it difficult to apply the results in clinical practice. These include the focus on high-risk hypertensive patients, in whom significant reductions in relative risk will translate into meaningful reductions in absolute risk: in lower-risk hypertensives with a low absolute risk, similar relative risk reductions may not be of great impact on the population disease burden. In ACCOMPLISH, as in most industry-sponsored clinical trials, the main goal appears to be market-driven: doses of drugs tested are not those available for clinical practice. The question asked, whether the combination of benazepril with either diuretic or dihydropyridine calcium channel blocker is more efficacious, is not a clinically compelling one. Finally, the univariate subgroup analyses proposed are unlikely to lead to an understanding of whether either combination has specific advantages for patients encountered clinically, most of whom have multiple risk factors. Thus, it appears that ACCOMPLISH, as with many recent pharmacological trials, will not greatly impact the treatment of hypertension.     

Nintedanib for the treatment of idiopathic pulmonary fibrosis

Introduction: Idiopathic Pulmonary Fibrosis (IPF) is an interstitial lung disease characterized by the progressive loss of pulmonary function, ultimately leading to respiratory failure and death. Two novel compounds, nintedanib and pirfenidone, have shown efficacy in reducing the rate of decline of lung function in IPF patients. The multiple tyrosine kinase inhibitor nintedanib has extensively being studied as a potential angiogenesis inhibitor in clinical against various neoplastic disorders. Afterwards, this compound was successfully tested in IPF.

Areas covered: Herein, the authors review the working mechanisms of nintedanib, its pharmacological profile, and its efficacy and safety for patients with IPF.

Expert opinion: Nintedanib has shown to be safe and effective in patients with IPF, with a favorable long-term safety profile. There is a lack of comparative trials of pirfenidone and nintedanib, and the choice of treatment is left to the physicians’ judgement. Future directions of nintedanib use are represented by the treatment of progressive fibrosing interstitial lung disease other than IPF, IPF with advanced functional impairment, and lung fibrosis secondary to connective tissue diseases. A promising safety profile for the combinational use of nintedanib and pirfenidone in IPF has also recently emerged.     

Targeting the endothelin pathway in the idiopathic pulmonary fibrosis: the role of bosentan

Background: Idiopathic pulmonary fibrosis (IPF) is a rapidly lethal disease characterized by anarchic, progressive fibrosis. Pulmonary fibrosis is the result of interactions between many effector cells and cytokines and better understanding of this can help with identification of novel therapeutic targets. Objective: To evaluate the role of the endothelin-1 (ET-1) pathway in IPF pathogenesis and the effects of therapeutic targeting with bosentan, an ET-1 antagonist. Methods: Data on ET-1's pathogenic involvement in IPF and the preclinical and clinical data on bosentan in this context are discussed and analyzed. A parallel overview of existing and upcoming therapies for IPF is presented. Conclusions: Bosentan is a promising antifibrotic therapy for IPF and clinical data on its long-term efficacy support its use.     

成纤维细胞在特发性肺纤维化发病机制及治疗中的研究进展

目前治疗特发性肺纤维化(IPF)的主要药物为糖皮质激素和免疫抑制剂,但其疗效尚未获得明确的临床证据.IPF中的主要效应细胞为成纤维细胞,干扰成纤维细胞的增殖对抑制IPF的进展有重要的临床意义.本文重点论述IPF的诊断标准并综述成纤维细胞在IPF发病机制及治疗中的研究进展.     

Somatostatin analogs for idiopathic pulmonary fibrosis therapy

Background: Idiopathic pulmonary fibrosis (IPF) is a potentially lethal disease characterized by diffuse multifocal fibrosis. SOM230 (also known as pasireotide), a somatostatin analog, is a potential antifibrotic therapy in early evaluative phase. Objective: Evaluation of data on the role of somatostatin receptors in pulmonary fibrosis and of in vivo and in vitro SOM230 antifibrotic activities. Methods/results: This study assessed somatostatin receptor expression in human normal and IPF lungs, and in animal lungs with bleomycin-induced fibrosis, as well as the effects of SOM230. The overall overexpression of somatostatin receptor subtype 2 and the anti-inflammatory/antifibrotic activities of SOM230 were demonstrated. Conclusion: These results are promising for further preclinical and clinical testing of SOM230 as an antifibrotic therapy.