双重阻断肾素-血管紧张素系统对慢性肾脏疾病血压、蛋白尿和肾功能的影响

目的 观察长程应用ACEI联合ARB治疗慢性肾脏疾病的疗效和安全性。 方法 60例慢性肾脏疾病患者随机分为3组：ACEI组、ARB组和联合组，ACEI组接受贝那普利治疗，ARB组接受缬沙坦治疗，联合组接受贝那普利联合缬沙坦治疗。观察治疗后1、3、6、9和12个月的相关临床指标变化，并进行评价。 结果 3 组患者经过12个月治疗后，24 h尿蛋白从(1.08±0.68) g降至(0.27±0.29) g，P < 0.05；收缩压从(129±24) mm Hg降至(116±18) mm Hg(P < 0.05)；肾小球滤过率从(67.5±30.2)ml/min升至(69.3±34.6)ml/min(P > 0.05)；血钾变化不大(P > 0.05)；不良反应轻微。3 组相比，联合组有最强的减少尿蛋白和降低舒张压作用(P < 0.05)，而在肾功能改善、血钾变化及不良反应方面，3 组间差异无统计学意义(P > 0.05)。结论 长期联合治疗双重阻断RAS系统有更强地降低蛋白尿和舒张压作用，而不良反应轻微。     

透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响

目的探讨透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响。方法本院维持性血液透析患者114例入选。检测指标包括（1）整体营养状况：使用MQSGA评估表并测定血清胰岛素样生长因子（IGF）1、胰岛素样生长因子结合蛋白3（IGFBP-3）、Hb、Alb。（2）人体指数学测定。（3）血液透析充分性：测定血清iPTH、β2-MG、BUN并计算Kt／V、nPCR。（4）残存肾功能：测量患者24h尿量。（5）微炎症：测定血清CRP、IL-6、TNF-α。结果（1）Kt／V、iPTH、β2-MG分别与测量握力（HGS）、上臂中部肌肉周径（MAMC）、无骨上臂肌肉面积（AMA）、Alb、Hb、nPCR、IGF-1相结合，MQSGA呈不同程度的相关和回归关系。（2）残存尿量在血透第1年内，与HGS、肱三头肌皮褶（TSF）、MAMC、Alb、nPCR、IGF-1呈显著相关和回归关系。（3）IL-6、TNF-α、CRP分别与HGS、MAMC、AMA、Alb、TSF、Hb、nPCR、IGF-1呈不同程度的相关和回归关系。（4）影响血透患者营养状况的因素分别是Kt／V、iPTH、IL-6、TNF—α、β2-MG、残存尿量，其中Kt／V、iFFH、IL-6、TNF—α是独立影响因素。结论血液透析中小分子毒素的透析不充分，微炎症可能是患者营养不良的关键因素之一。残存肾功能可能在透析第1年内对营养状况有显著影响。在上述诸因素中。Kt／V、iPTH、IL-6、TNF-α是影响营养状态的独立因素。     

来氟米特联合泼尼松治疗难治性原发性肾病综合征的随机对照试验

目的:观察长程应用来氟米特联合泼尼松治疗难治性原发性肾病综合征的疗效。方法:60例激素治疗难治性肾病综合征病人随机分为2组,每组30例。试验组予来氟米特联合泼尼松治疗,对照组予麦考酚酸酯联合泼尼松治疗,疗程均为12 mo。观察治疗后2组疗效与不良反应,并于治疗后3,6,9和12 mo检查血清蛋白、尿蛋白定量、肾小球滤过率等指标。结果:2组治疗12 mo后,24 h尿蛋白均下降,其中试验组在治疗后3 mo尿蛋白定量与对照组有显著差异(P<0．05),其余时间点2组尿蛋白无显著差异(P>0．05);而血清蛋白与肾小球滤过率均有不同程度升高,各时间点2组无显著差异(P>0．05)。试验组有效率87％(16／30),对照组为93％(28／30),2组疗效差异无显著意义(P>0．05)。治疗3 mo时,试验组有效率高于对照组(P<0．05)。试验组不良反应发生率33％,对照组10％,差异显著(P< 0．05)。结论:来氟米特联合泼尼松能够有效缓解难治性肾病综合征。     

狼疮肾炎患者肾组织CD40及其配体表达的免疫组织化学分析

目的　探讨CD40 CD40配体 (CD40L)相互作用在狼疮肾炎 (LN)发病机制中的可能作用。方法　用免疫组织化学方法对 2 0例LN患者肾组织CD40和CD40L的表达进行检测 ,并对其与肾脏病变的相关性进行分析。结果　Ⅲ、Ⅳ型LN肾组织CD40表达较正常对照组显著上调 (P <0 0 1) ,除系膜细胞、内皮细胞和肾小管上皮细胞CD40表达增强外 ,还出现CD40阳性的间质浸润细胞。Ⅲ、Ⅳ型LN患者肾组织CD40L表达亦显著增强 (P <0 0 1) ,其分布范围与CD40一致。Ⅱ、Ⅴ型LN患者肾组织CD40表达范围和强度与正常肾组织大致相似。LN肾组织CD40表达与病变活动指数相关 (r =0 78,P <0 0 1)。结论　CD40 CD40L在肾脏局部的相互作用可能在LN发生和发展中起重要作用。     

六君子汤治疗透析中终末期肾脏病合并营养不良

目的:观察中药(六君子汤)对终末期肾脏病(ESRD)合并营养不良的治疗效果.方法:60例ESRD并营养不良患者随机分为两组:①六君子汤治疗组30例,在优质高蛋白饮食及充分透析基础上予六君子汤治疗.每日1剂,分2次服用;②对照组30例,给予优质高蛋白饮食同时予充分透析,但不予中药治疗.两组均以60日为1疗程.同时测定两组患者治疗前后血前白蛋白、白蛋白、转铁蛋白等水平,并予临床上常用的整体评估(subjectiveglobalassessment,SGA)作营养不良分级,比较两组治疗前后营养不良改善情况.结果:治疗组血前白蛋白、白蛋白在充分透析的同时、转铁蛋白的水平明显提高,SGA分级好转.与对照组比较,营养不良的改善有显著性差异(P<0.05).结论:在充分透析的同时六君子汤治疗ESRD合并营养不良患者有较好疗效.可作为尿毒症患者并营养不良的辅助治疗.     

狼疮性肾炎发病机理和临床研究

系统性红斑狼疮(SLE)是常见的自身免疫性疾病,几乎累及肾脏,称为狼疮性肾炎(LN),其确切病因及发病机理未明,临床诊治及预后都存在很多未解决的问题。在我国虽然有不少有关SLE或LN的研究报道,但均缺乏系统性的研究。本项目从1989年开始,对LN进行了系统的实验及临床研究。     

反义寡核苷酸对间质性肾炎肾小管上皮细胞骨调素表达的调节

目的 探讨骨调素（ＯＰＮ）反义寡核苷酸对间质性肾炎肾小管上皮细胞ＯＰＮ表达的影响。方法 以一侧输尿管梗阻（ＵＵＯ）所致的间质性肾炎为研究模型,肾动脉内注射全硫代修饰的ＯＰＮ反义寡核苷酸,免疫组织化学双染及原位杂交技术检测ＯＰＮ的表达及巨噬细胞的浸润。结果 ＯＰＮ及其ｍＲＮＡ在间质性肾炎的发展过程中表达明显升高,巨噬细胞的局部浸泣均发生在过度表达ＯＰＮ的肾小管周围;ＯＰＮ反义寡核苷酸能显著抑制肾小管     

Pro-inflammatory effect of transforming growth factor β1 in rat peritoneal mesothelial cells

Objective To investigate the pro-inflammatory effect of transforming growth factor β1 (TGF-β1) in rat peritoneal mesothelial cells (RPMCs) and its machanism. Methods TGF-β1-induced RPMCs model in vitro was established, and the expression of MCP-1 in the TGF-β1-induced RPMCs was observed. The intervention of Smad7 on the expression of MCP-1 and p38 signal proteins induced by TGF-β1 in RPMCs was explored as well as the intervention of p38 inhibitor SB203580 on the expression of MCP-1 induced by TGF-β1 in RPMCs. Results TGF-β1 could stimulate MCP-1 expression in RPMCs. Compared with control group, MCP-1 mRNA levels were significantly increased after 3 h treatment with TGF-β1 (P<0.05), peak MCP-1 induction occurred at 6 h (P<0.01), and the stimulatory effect of TGF-β1 persisted through 24 h (P<0.05). MCP-1 protein levels were significantly increased after 6 h treatment with TGF-β1(P<0.05), peak MCP-1 induction occurred at 48 h(P<0.01). Over-expressed Smad7 and p38 inhibitor could reduce the expression of MCP-1 induced by TGF-β1 (P<0.05). TGF-β1 could activate p38 signaling pathway, but over-expressed Smad7 could inhibit this role of TGF-β1. Compared with control group, the expression level of p-p38 was increased in TGF-β1-stimulated group. Compared with TGF-β1-stimulated group, the expression level of p-p38 was reduced in Smad7 gene transfer group. Conclusions TGF-β1-induced MCP-1 expression in rat peritoneal mesothelial cells is p38MAPK dependent.     

Pro-inflammatory effect of transforming growth factor β1 in rat peritoneal mesothelial cells

Objective To investigate the pro-inflammatory effect of transforming growth factor β1 (TGF-β1) in rat peritoneal mesothelial cells (RPMCs) and its machanism. Methods TGF-β1-induced RPMCs model in vitro was established, and the expression of MCP-1 in the TGF-β1-induced RPMCs was observed. The intervention of Smad7 on the expression of MCP-1 and p38 signal proteins induced by TGF-β1 in RPMCs was explored as well as the intervention of p38 inhibitor SB203580 on the expression of MCP-1 induced by TGF-β1 in RPMCs. Results TGF-β1 could stimulate MCP-1 expression in RPMCs. Compared with control group, MCP-1 mRNA levels were significantly increased after 3 h treatment with TGF-β1 (P<0.05), peak MCP-1 induction occurred at 6 h (P<0.01), and the stimulatory effect of TGF-β1 persisted through 24 h (P<0.05). MCP-1 protein levels were significantly increased after 6 h treatment with TGF-β1(P<0.05), peak MCP-1 induction occurred at 48 h(P<0.01). Over-expressed Smad7 and p38 inhibitor could reduce the expression of MCP-1 induced by TGF-β1 (P<0.05). TGF-β1 could activate p38 signaling pathway, but over-expressed Smad7 could inhibit this role of TGF-β1. Compared with control group, the expression level of p-p38 was increased in TGF-β1-stimulated group. Compared with TGF-β1-stimulated group, the expression level of p-p38 was reduced in Smad7 gene transfer group. Conclusions TGF-β1-induced MCP-1 expression in rat peritoneal mesothelial cells is p38MAPK dependent.     

持续性非卧床腹膜透析腹膜炎的致病菌及其耐药性

目的：探讨持续性非卧床腹膜透析（CAPD）腹膜炎的致病菌及其耐药性。方法：回顾性分析109例CAPD腹膜炎的临床表现、致病菌、耐药性和转归情况。结果：43例培养阳性,透出液培养阳性率为39．4％,其中11例为革兰阳性球菌,19例为革兰阴性杆菌,13例为真菌。主要的革兰阴性杆菌包括肺炎克雷白氏杆菌、大肠杆菌、不动杆菌和铜绿假单胞菌。革兰阴性杆菌对氨苄西林的耐药率最高,达85．7％;对阿米卡星的耐药率最低,为17．6％;庆大霉素的耐药率为44．4％;而头孢他啶的耐药率也高达42．9％。所有革兰阳性球菌对万古霉素敏感,大部分（71．4％）对头孢唑林敏感。腹腔内用抗真菌药对真菌性腹膜炎疗效不佳。腹膜炎CAPD的退出率为20．2％（22／109）。结论：革兰阴性杆菌腹膜炎比例有所增加,致病菌对庆大霉素和头孢他啶的耐药性较高,而对阿米卡星较敏感,宜作为经验用药。