低蛋白饮食对腹膜透析患者氮平衡的影响

Objective To observe the influence of different dietary protein intake (DPI) on nitrogen balance and nutritional indices in peritoneal dialysis (PD) patients, and explore the minimal DPI to maintain nitrogen balance. Methods Thirty-four PD patients were randomly divided into group A, B and C with DPI as 1.2, 0.9 and 0.6 g·kg-1·d-1 respectively. All the patients admitted into our hospital and completed a 10-day assessment for nitrogen balance, as well as nutritional status including serum albumin (Alb), pre-albumin at baseline, the 7th and 10th day. Results The DPI of group A, B and C was (1.18±0.05), (0.87±0.02), (0.66±0.03) g·kg-1·d-1, whose differences were significant (P<0.01). The dietary energy intake (DEI) was 129.29 (117.57-133.89), 111.71 (100.42-133.47), 146.86 (128.03-163.18) kJ·kg-1·d-1 respectively. Nitrogen balance was positive in group A, B, C [2.99 (2.15-4.72) g, 1.20(0.59-1.89) g, 0.24 (-0.87-1.27) g]. The BUN decreased at the 7th and 10th day (P<0.01) in group C. The BUN and phosphorus in group A increased, but without significant difference as compared to baseline. No significant differences of nutritional status were found among three groups throughout the trial. Conclusion Minimal DPI 0.65 g·kg-1·d-1 plus the supplement of protein loss in dialysate can maintain the nitrogen balance in peritoneal dialysis patients.     

可溶性酪氨酸激酶2融合蛋白对尿毒症腹膜透析大鼠腹膜形态和功能的影响

目的 研究可溶性酪氨酸激酶2融合蛋白（sTie-2-Fc）对尿毒症腹膜透析大鼠腹膜血管新生、溶质转运和超滤功能的影响。 方法 32只雄性Wistar大鼠按数字随机法分为假手术组、尿毒症组、尿毒症腹透组和sTie-2-Fc干预组（均n=8）。尿毒症腹透组和sTie-2-Fc干预组大鼠经腹透管每天2次腹腔灌注4.25%葡萄糖透析液（3 ml/100 g体质量）共4周,sTie-2-Fc干预组大鼠每次灌注时在透析液中加入1 μg sTie-2-Fc。各组大鼠处死前行腹膜平衡试验,检测腹膜转运和超滤功能,取大网膜标本行抗CD31免疫组化染色并计血管数。 结果 与假手术组大鼠相比,尿毒症组大鼠的2 h腹透液和血肌酐比值（D/Pcr）增高（0.78±0.05比0.70±0.09,P = 0.028）,腹透液2 h与0 h葡萄糖比值（D/D0）降低（0.69±0.05比0.76±0.07,P = 0.033）,腹膜超滤量（UF,ml）减少（2.29±0.50比4.58±1.64,P = 0.005）,腹膜血管数量增加[（5.8±3.0）/HP比（1.6±0.5）/HP,P < 0.01]。尿毒症腹透组大鼠的溶质转运较尿毒症组大鼠进一步增高（D/Pcr: 0.89±0.05比0.78±0.05,P < 0.01;D/D0:0.47±0.09 比0.69±0.05, P < 0.01）,UF（ml）减少（0.40±0.59比2.29±0.50,P = 0.005）,腹膜血管数量增多[（16.7±1.2）/HP比（5.8±3.0）/HP,P < 0.01]。干预组大鼠使用sTie-2-Fc后,UF（ml）较尿毒症腹透组大鼠显著增加（1.56±0.48比0.40±0.59,P = 0.014）,腹膜血管数量显著减少[（9.2±1.2）/HP比（16.7±1.2）/HP,P ＜ 0.01],但两组大鼠的D/Pcr和D/D0差异均无统计学意义。 结论 sTie-2-Fc使尿毒症腹透大鼠腹膜血管新生减少,超滤增加,有利于保护腹膜结构和功能,可能是防治腹透后腹膜结构和功能改变的另一靶点。     

黄芪注射液防治慢性肾脏病基础上急性肾损伤的疗效观察

目的：观察黄芪注射液治疗慢性肾脏病基础上急性肾损伤（acute-on-chronic kidney injury,A-on-C）的疗效。方法：采用前瞻性、自身前后对照的方法。确诊A-on-C的患者中,在一般治疗的基础上加用黄芪注射液20ml静脉滴注,每日1次,共用14d。比较黄芪注射液治疗前和治疗后患者的尿蛋白、C反应蛋白（CRP）及肝、肾功能等指标变化。结果：共61例A-on-C患者参与本项研究,其中男37例,女24例,平均年龄（57.1±16.91）岁。患者肾功能有所改善,有效率达63.2%。血肌酐（Scr）治疗前为（330.61±186.58）μmol/L,治疗后为（303.26±184.64）μmol/L,差异有统计学意义（P〈0.05）;尿血酸（UA）治疗前治疗后分别为（497.34±120.81）μmol/L、（462.21±122.29）μmol/L,差异有统计学意义（P〈0.05）。但治疗前后血常规、电解质、尿蛋白、肝功能、血脂、CPR无明显改变（P〉0.05）。结论：在A-on-C的患者中黄芪注射液可能可以改善肾功能,延缓肾功能恶化。     

2型糖尿病患者非糖尿病肾脏疾病的患病率分析

目的 鉴别2型糖尿病患者蛋白尿的肾脏病因,估算非糖尿病肾病的患病率.方法 回顾性研究分析46例2型糖尿病合并肾损伤的患者,比较病史、心脏彩超、颈动脉多普勒彩超、眼底检查结果、肾小球滤过率、肝功能、肾功能、血脂、血糖、HbA1c、尿蛋白等临床指标,所有患者通过肾脏穿刺明确诊断,根据病理结果分为糖尿病肾病组和非糖尿病肾病组.结果 46例患者确诊糖尿病肾病比例占47.8%,52.2%患者是糖尿病合并其他肾小球疾病,即非糖尿病.肾病,在非糖尿病肾病组中以局灶节段肾小球硬化比例最高.糖尿病肾病组空腹血糖较高(P<0.05).心脏彩超各项指标中,糖尿病肾病组的射血分数显著低于非糖尿病肾病组(P<0.05).颈动脉彩超检测中发现,糖尿病肾病组存在动脉粥样斑块患者显著高于非糖尿病肾病组,其颈动脉内膜中层厚度均较非糖尿病肾病组高(P<0.05).值得注意的是,非糖尿病肾病与糖尿病视网膜病变关系不大,糖尿病视网膜病变对诊断糖尿病肾病具有较高的敏感性(72.2%)和特异性(91.7%,P<0.01).结论 2型糖尿病合并有蛋白尿时,空腹血糖、心脏射血分数、颈动脉粥样斑块和内膜中层厚度,以及眼底的改变作为临床鉴别糖尿病肾病和非糖尿病肾病的参考指标,肾活检则是明确糖尿病伴肾脏病变性质的重要手段.     

神经外科学PBL教案设计、撰写与应用探讨

神经外科学PBL教学模式中,高水平的PBL教案是开展教学的关键。作者认为在教案设计、撰写与应用中,遵循以下原则:①使用教师亲自诊治的病例,设计、撰写个体化的案例;②案例的内容与现代先进的设备、技术密切结合,特别是微创神经外科技术;③基础知识、临床应用与人文关怀、医疗道德及专业态度想结合,让学生从单向思维向多向思维转变。教学实践证明,这些原则提高了教学质量和学生的整体素质。     

低蛋白饮食对腹膜透析患者氮平衡的影响

Objective To observe the influence of different dietary protein intake (DPI) on nitrogen balance and nutritional indices in peritoneal dialysis (PD) patients, and explore the minimal DPI to maintain nitrogen balance. Methods Thirty-four PD patients were randomly divided into group A, B and C with DPI as 1.2, 0.9 and 0.6 g·kg-1·d-1 respectively. All the patients admitted into our hospital and completed a 10-day assessment for nitrogen balance, as well as nutritional status including serum albumin (Alb), pre-albumin at baseline, the 7th and 10th day. Results The DPI of group A, B and C was (1.18±0.05), (0.87±0.02), (0.66±0.03) g·kg-1·d-1, whose differences were significant (P<0.01). The dietary energy intake (DEI) was 129.29 (117.57-133.89), 111.71 (100.42-133.47), 146.86 (128.03-163.18) kJ·kg-1·d-1 respectively. Nitrogen balance was positive in group A, B, C [2.99 (2.15-4.72) g, 1.20(0.59-1.89) g, 0.24 (-0.87-1.27) g]. The BUN decreased at the 7th and 10th day (P<0.01) in group C. The BUN and phosphorus in group A increased, but without significant difference as compared to baseline. No significant differences of nutritional status were found among three groups throughout the trial. Conclusion Minimal DPI 0.65 g·kg-1·d-1 plus the supplement of protein loss in dialysate can maintain the nitrogen balance in peritoneal dialysis patients.     

终末期肾脏病腹膜透析患者的心血管疾病

目的 了解终末期肾脏病（ESRD）腹膜透析患者的心血管疾病（CVD）发病率和有关高发危险因素,以及并发CVD的腹膜透析患者治疗时需关注的问题。 方法 研究对象为上海交通大学医学院附属仁济医院慢性肾脏病（CKD）5期接受腹膜透析的患者,共254例入选,采用横断面回顾性调查分析方法。平均随访时间中位数为49个月。采集病史、血生化检测结果、腹膜透析充分性评估、颈动脉及心脏彩色多普勒超声检测结果。评估CVD事件的发生、发展和预后,以及进行相关因素分析。 结果 CVD事件发生率为37%（93/254）。发生CVD的患者多伴有糖尿病、透析龄较长、血三酰甘油水平较高、血清白蛋白较低、前白蛋白较低。彩色多普勒超声显示,发生CVD组的左房内径（LAD）（mm）、室间隔厚度（LVST）（mm）、左室心肌质量指数（LVMI）（g/m2）显著高于未发生CVD组（43.16±4.93比 38.02±4.77、11.19±2.05比10.01±1.45、中位数192.03比150.28,均P < 0.05）;颈动脉内膜中层厚度（IMT）较厚（中位数0.80比0.65）,颈动脉内径增宽;收缩期峰值流速（SPV）和舒张期峰值流速（DV）流速降低。既往无CVD的患者在随访过程中发生CVD时,其Ccr、Kt/V、D/Pr、理想体质量校正的蛋白分解率（nPCR）及血清白蛋白水平与无发生CVD组差异有统计学意义（P = 0.045、0.015、0.051、0.029及0.005）。在随访过程中出现新发CVD或CVD病情恶化的原有CVD的患者,都是透析龄较长以及三酰甘油水平较高者。LAD、LVST、LVMI及IMT在新发CVD和未发CVD两组间差异有统计学意义（P=0.033、0.022、0.045及0.029）。Kaplan-Meier生存分析显示,既往CVD史和CVD症状是生存的独立危险因素。血清白蛋白<330 g/L、LAD>39.6 mm及曾患腹膜炎的患者生存率较低。 结论 ESRD腹膜透析患者是CVD的高发群体,需了解这些患者的病史和伴随症状;保持透析的充分性;同时要防止腹膜炎的发生。     

低蛋白饮食对腹膜透析患者氮平衡的影响

Objective To observe the influence of different dietary protein intake (DPI) on nitrogen balance and nutritional indices in peritoneal dialysis (PD) patients, and explore the minimal DPI to maintain nitrogen balance. Methods Thirty-four PD patients were randomly divided into group A, B and C with DPI as 1.2, 0.9 and 0.6 g·kg-1·d-1 respectively. All the patients admitted into our hospital and completed a 10-day assessment for nitrogen balance, as well as nutritional status including serum albumin (Alb), pre-albumin at baseline, the 7th and 10th day. Results The DPI of group A, B and C was (1.18±0.05), (0.87±0.02), (0.66±0.03) g·kg-1·d-1, whose differences were significant (P<0.01). The dietary energy intake (DEI) was 129.29 (117.57-133.89), 111.71 (100.42-133.47), 146.86 (128.03-163.18) kJ·kg-1·d-1 respectively. Nitrogen balance was positive in group A, B, C [2.99 (2.15-4.72) g, 1.20(0.59-1.89) g, 0.24 (-0.87-1.27) g]. The BUN decreased at the 7th and 10th day (P<0.01) in group C. The BUN and phosphorus in group A increased, but without significant difference as compared to baseline. No significant differences of nutritional status were found among three groups throughout the trial. Conclusion Minimal DPI 0.65 g·kg-1·d-1 plus the supplement of protein loss in dialysate can maintain the nitrogen balance in peritoneal dialysis patients.     

中药莲必治(穿心莲内酯)注射液致急性肾衰竭的临床病理分析

目的:探讨中药莲必治(穿心莲内酯)注射液致急性肾衰竭(ARF)的临床特点.方法:对9例中药莲必治治疗相关的ARF患者、7例非莲必治药物过敏引起的ARF患者和3例氨基糖苷类致ARF患者的临床与病理进行回顾性比较分析.结果:(1)9例中药莲必治注射液治疗相关的ARF病例中,年龄22岁～66岁,平均(38±12)岁;其中少尿型7例,非少尿型2例,少尿期为1～8 d,平均(4±2)d;入院时血清BUN平均为(12.23±4.97)mmol/L,Scr平均为(596.5±412.3)μmol/L.9例患者中,4例经肾活检证实为急性肾小管坏死(ATN),其余5例根据临床表现、实验室检查结果以及病情演变诊断为ATN.所有患者经停用莲必治注射液,内科保守治疗,其中5例患者行肾脏替代治疗(主要是血液透析)后,肾功能均恢复正常.所有患者的临床特点均与氨基糖苷类致ARF患者的相同.(2)7例非中药莲必治药物过敏的ARF病例中,年龄23岁～67岁,平均(45±13)岁;其中少尿型5例,非少尿型2例,少尿期为2～14 d,平均(6±4)d;入院时BUN平均(16.15±4.55)mmol/L,Scr(643.4±462.2)μmol/L.7例患者中,5例经肾活检证实为急性肾间质炎症(AIN),其余2例根据临床表现、实验室检查结果以及病情演变诊断为AIN.所有患者停用相关药物,均行血液透析,并须加用肾上腺皮质激素治疗,7例患者中5例肾功能恢复正常,另外2例好转.结论:中药莲必治注射液有一定肾毒性作用.     

低蛋白饮食对腹膜透析患者氮平衡的影响

Objective To observe the influence of different dietary protein intake (DPI) on nitrogen balance and nutritional indices in peritoneal dialysis (PD) patients, and explore the minimal DPI to maintain nitrogen balance. Methods Thirty-four PD patients were randomly divided into group A, B and C with DPI as 1.2, 0.9 and 0.6 g·kg-1·d-1 respectively. All the patients admitted into our hospital and completed a 10-day assessment for nitrogen balance, as well as nutritional status including serum albumin (Alb), pre-albumin at baseline, the 7th and 10th day. Results The DPI of group A, B and C was (1.18±0.05), (0.87±0.02), (0.66±0.03) g·kg-1·d-1, whose differences were significant (P<0.01). The dietary energy intake (DEI) was 129.29 (117.57-133.89), 111.71 (100.42-133.47), 146.86 (128.03-163.18) kJ·kg-1·d-1 respectively. Nitrogen balance was positive in group A, B, C [2.99 (2.15-4.72) g, 1.20(0.59-1.89) g, 0.24 (-0.87-1.27) g]. The BUN decreased at the 7th and 10th day (P<0.01) in group C. The BUN and phosphorus in group A increased, but without significant difference as compared to baseline. No significant differences of nutritional status were found among three groups throughout the trial. Conclusion Minimal DPI 0.65 g·kg-1·d-1 plus the supplement of protein loss in dialysate can maintain the nitrogen balance in peritoneal dialysis patients.