血红蛋白在鉴别糖尿病肾病与非糖尿病肾脏疾病中的作用

目的探讨血红蛋白在鉴别糖尿病肾病(DN)与非糖尿病肾脏疾病(NDRD)中的临床意义。 方法对2004年1月至2012年4月在解放军总医院肾脏病科行肾活检、病理诊断明确且病史资料完整的66例DN、78例NDRD患者进行回顾性分析,比较两组临床指标及合并症的差异,采用多因素Logistic回归分析方法明确DN的独立危险因素;比较DN及NDRD组不同CKD分期的血红蛋白水平差异,明确其贫血性质及贫血相关的独立危险因素。 结果DN组糖尿病罹病时间、肾病罹病时间、平均动脉压、血清肌酐、尿素氮、24 h尿蛋白定量水平及合并糖尿病视网膜病变、心血管病、贫血的比例均高于NDRD组,差异具有统计学意义(P<0.05);多因素分析显示糖尿病罹病时间长(OR＝1.012,95%CI 1.005～1.019)、合并糖尿病视网膜病变(OR＝ 4.265,95%CI 1.616～11.255)、血红蛋白水平低(OR＝ 0.952,95%CI 0.929～0.976)及合并心血管病(OR＝2.875,95%CI 1.089～7.593)是DN的独立危险因素;CKD1～3期DN组及NDRD组的血红蛋白水平均存在显著性差异(P<0.05),该差异在CKD 4～5期消失;DN及NDRD组共有60例诊断为贫血,均为正细胞正色素性贫血;多因素Logistic回归分析显示白蛋白降低(OR＝0.928,95%CI 0.879～0.980)、血清肌酐升高(OR＝1.011,95%CI 1.004～1.019)、病理诊断为DN(OR＝6.213,95%CI 2.690～14.347)是贫血的独立危险因素。 结论血红蛋白与DN显著独立相关,早期对血红蛋白水平的监测可能为临床鉴别DN与NDRD提供新线索。     

The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy

BACKGROUND: Little information has been available until now about the clinical efficacy of tonsillectomy on long-term renal survival of patients with idiopathic immunoglobulin A nephropathy (IgAN). METHODS: To investigate the effect of tonsillectomy on long-term renal survival, we reviewed the clinical course of 118 patients with idiopathic biopsy-diagnosed IgAN from 1973 to 1980. Of those, 48 patients received tonsillectomy and 70 patients did not. The starting point of observation was defined as the time of the diagnostic renal biopsy, and the end point as when requiring the first dialysis. Up to 2001, the mean observation time was 192.9 +/- 74.8 months (48-326 months). Renal survival and impact of covariates were evaluated by Kaplan-Meier analysis and Cox proportional hazards regression model. RESULTS: Age, gender, amount of urinary protein excretion, serum creatinine, serum IgA, blood pressure, and histopathologic findings at the time of renal biopsy and treatments during the observation period were not significantly different between patients with and without tonsillectomy. Five (10.4%) of the patients with tonsillectomy and 18 (25.7%) of the patients without tonsillectomy finally required dialysis therapy (chi-square test, P = 0.0393). By Kaplan-Meier analysis, renal survival rates were 89.6% and 63.7% at 240 months in the patients with and without tonsillectomy, respectively, and were significantly different (log-rank test, P = 0.0329). In the multivariate Cox regression model, tonsillectomy (hazard ratio, 0.22; 95% CI, 0.06 to 0.76; P = 0.0164) had a significant effect on renal outcome. CONCLUSION: These results indicate that tonsillectomy has a favorable effect on long-term renal survival in patients with IgAN.     

Characteristics and risk factors of intrarenal arterial lesions in patients with IgA nephropathy.

BACKGROUND: Although the clinical importance of immunoglobulin-A nephropathy (IgAN) is widely recognized, the characteristics of intrarenal arterial lesions in this disease and the main factors associated with them have not been studied extensively, and a large-scale analysis of intrarenal arterial lesions in IgAN has not been performed. METHODS: To clarify these issues, we investigated the prevalence, underlying factors and significance of intrarenal arterial lesions in 1005 patients with IgAN. We distinguished different degrees of severity of small artery and arteriolar lesions (mild, moderate and severe), using a semi-quantitative scoring system. We compared the arterial lesions of IgAN patients with those of 627 non-IgAN patients, who had mesangial proliferating glomerulonephritis without IgA deposits, and of 221 patients with membranous nephropathy (MN). RESULTS: The IgAN patients with arterial lesions were significantly younger than the non-IgAN and MN patients (mean ages 34.6 vs 40.4 and 47.7 years, respectively). The prevalence of intrarenal small artery and arteriolar lesions was 54.6% in IgAN patients, compared with 26.6 and 47.1% in non-IgAN and MN patients, respectively; the percentages of moderate/severe arterial lesions were 37.0 vs 21.6 and 23.1%, respectively; and the percentages of hyaline changes were 43.7 vs 16.8 and 21.2%, respectively. The differences in the prevalence of lesions between IgAN patients and the two other groups were statistically significant for all three parameters. Our search for possible relationships between arterial-arteriolar lesions and various indirect outcome markers disclosed significant associations with hypertension, higher serum creatinine and uric acid, high urinary protein excretion, glomerulosclerosis, tubular atrophy and interstitial fibrosis. Furthermore, these parameters were changed more markedly in IgAN patients with moderate/severe arterial lesions and hyaline changes than in IgAN patients who had mild arterial lesions and wall thickening alone. CONCLUSIONS: The prevalence of small intrarenal arterial-arteriolar lesions was higher in IgAN patients than in non-IgAN and MN patients; moreover, the lesions in IgAN patients were associated with younger age, were more severe and exhibited a higher degree of hyaline changes. Finally, the severity of small arterial- arteriolar lesions was linked to several markers of adverse outcome.     

Modulation of cyclins and p53 in mesangial cell proliferation and apoptosis during Habu nephritis

Background

Mesangial cell (MC) proliferation and apoptosis are the main pathological changes observed in mesangial proliferative nephritis. In this study, we explored the role of cyclins and p53 in modulating MC proliferation and apoptosis in a mouse model of Habu nephritis.

Methods

The Habu nephritis group was prepared by injection of Habu toxin. Mesangiolysis and mesangial expansion were determined by periodic acid-Schiff (PAS) reagent staining. Immunohistochemical analysis of PCNA and KI67, and TUNEL staining were used to detect cell proliferation and apoptosis, respectively. Expression levels of cyclins and p53 were examined by Western blotting.

Results

PAS staining showed that mesangial dissolution appeared on days 1 and 3, and mesangial proliferation with extracellular matrix accumulation was apparent by days 7 and 14. Both PCNA and KI67 immunohistochemical analysis showed that MC proliferation began on day 3, peaked on day 3 and 7, and recovered by day 14. TUNEL staining results showed that MC apoptosis began to increase on day 1, continued to rise on day 7, and peaked on day 14. Western blot analysis showed that cyclin D1 was upregulated on day 1, cyclins A2 and E were upregulated on days 3 and 7, and p53 was upregulated on days 3, 7 and 14. There was no change in the expression levels of Bax or p21.

Conclusion

We explored the tendency for MC proliferation and apoptosis during the process of Habu nephritis and found that cyclins and p53 may modulate the disease pathology. This will help us determine the molecular pathogenesis of MC proliferation and provide new targets for disease intervention.

     

The role of urine IgG in the progression of IgA nephropathy with a high proportion of global glomerulosclerosis

International Urology and Nephrology - IgA nephropathy (IgAN), the most common glomerulonephritis in the world, is an important cause of end-stage renal disease (ESRD). It is necessary to explore...     

玉屏风颗粒联合孟鲁司特和布地奈德治疗儿童感染后咳嗽的疗效观察

目的对玉屏风颗粒联合孟鲁司特和布地奈德治疗儿童感染后咳嗽的临床疗效进行分析和探讨。方法将我院2011年8月至2013年8月收治的120例感染后咳嗽患儿按随机数字表法随机分为治疗组和对照组,每组60例。治疗组患儿给予玉屏风颗粒联合孟鲁司特和布地奈德治疗,对照组患儿给予孟鲁司特+布地奈德治疗。分析和比较两组患儿的治疗效果。结果治疗组显效38例;有效15例,无效7例;总有效率为88.33%。对照组患儿显效22例,有效18例,无效20例;总有效率为66.67%。两组间的比较具有统计学意义(P<0.05)。治疗组患儿咳嗽缓解时间为(5.6±1.5)d,咳嗽消失时间为(7.1±1.2)d,半年内因感染咳嗽就诊的次数为(1.4±0.9)次。对照组患儿咳嗽缓解时间为(7.0±2.5)d,咳嗽消失时间为(8.6±1.8)d,半年内因感染咳嗽就诊的次数为(2.6±1.7)次。两组间的比较差异显著(P<0.05)。结论应用玉屏风颗粒联合孟鲁司特及布地奈德治疗儿童感染后咳嗽效果显著,安全可靠,可有效降低患儿气道的高反应性,在改善患儿临床症状的同时大大提高了患儿的机体免疫力,值得临床推广使用。     

早期再灌注对急性心肌梗死患者血浆脑钠素水平的影响

目的 :探讨早期再灌注对急性心肌梗死 (AMI)患者血浆脑钠素 (BNP)水平的影响。方法 :选择AMI患者 5 6例 ,胸痛发作 12h内成功再灌注者 (38例 )为试验组 ,再灌注失败或未进行再灌注者 (18例 )为对照组。ELISA法测定入院即刻、1、2、7、14、2 8d时血浆BNP水平。结果 :AMI患者血浆BNP水平较正常人明显升高 ;试验组血浆BNP水平呈单峰曲线 ,对照组呈双峰曲线 ;再灌注可明显降低AMI患者BNP水平 ,第 7天时浓度升高不明显 ,未形成第 2个高峰。结论 :早期再灌注可明显降低血浆BNP水平。     

中药标准组分制备与组分库的构建

本研究通过对多种现代分离技术的集成，构建了中药系统分离制备的标准化平台，并制定了一系列标准操作规范控制提取分离过程。通过平台运行，已完成了50味中药和8个复方的1100多个标准组分的分离制备，建立了一定规模的标准组分库和相应的标准操作规范。初步形成了中药标准组分库，为中药物质基础研究和创新中药研发提供了丰富的组分资源。     

老年抑郁障碍患者的心理干预对比分析

目的 :探讨老年抑郁障碍心理干预的效果。方法 :采用对比研究的方法 ,在流行病学调查的基础上选择符合CCMD -Ⅱ -R诊断标准的 72例抑郁性神经症和 10例抑郁症患者 ,按性别、年龄、文化等基本相同 ,分成对照和实验组各一半 ,实验组给以 6周的心理干预 ,两组均不用药物治疗 ,分别于治疗前及三个月后 ,测评老年抑郁量表、生活满意度指数及社会支持评定量表 ,并进行对比分析。结果 :心理干预前两组老年抑郁量表 (SDS)得分分别为 17 41± 3 19、 17 5 1± 2 44,三个月后对照组下降不显著 ,而实验组明显下降 ( 17 5 1± 2 44/ 8 93± 5 5 2 ,t=10 89,P <0 0 0 1) ;生活满意度 (t=4 33,P <0 0 0 1)实验组显著提高 ;对照组无明显变化 ,社会支持评定实验组 ( 31 15± 6 37/ 36 32± 6 86 ,t =4 93,P <0 0 0 1)也显著提高 ,而对照组则不明显。结论 :社区综合性心理干预可改变抑郁性神经症患者的抑郁情绪 ,改善认知水平 ,从而提高生活满意度。