病历存储系统升级及安全备份方案

病历作为医院信息化的数据源,医院作为“举证倒置”的依据,其存储管理变得非常重要,其可靠性和安全性是很关键的问题。对于已经通过计算机技术数字化的病历资料进行深化技术管理,显得更加必要。     

上调Smad7表达对腹膜纤维化大鼠腹膜间皮细胞转分化的影响

目的探讨上调TGF-β抑制性信号蛋白Smad7表达对大鼠腹膜纤维化模型腹膜间皮细胞转分化的影响。方法30只160～170 g SD雄性大鼠.随机分为4组：正常对照组（n=6）;腹膜纤维化模型组（n=12）：予腹腔注射4.25%腹膜透析液与脂多糖;空载体组（n=6）：模型成功后转染pTRE与pEFpurop-Tet-on质粒;Smad7治疗组（n=6）：模型成功后转染pTRE- m2 Smad7与pEFpurop-Tet-on质粒。第14、28天杀检大鼠,取脏层腹膜组织,用RT-PCR方法检测TGF-B1、α-SMA、E-钙黏蛋白（E-cadherin）基因的表达;用Western杂交或间接免疫荧光的方法检测TGF-β1、Smad7、磷酸化（p）-Smad2/3、α-SMA、E-cadherin的表达。结果与正常对照组比较,模型组TGF-β1、p-Smad2/3及α-SMA的表达显著上调（p〈0.01）;E-cadherin的表达显著下调（P〈0.01）。与模型组、空载体组比较,Smad7治疗组p-Smad2/3及α-SMA表达水平显著下调（P〈0.01）;E-cadherin的表达显著上调,但仍低于正常对照组（P〈0.05）。结论Smad7可通过抑制受体调控信号蛋白Smad2/3的活化,阻止高糖透析液及脂多糖介导的腹膜间皮细胞转分化,从而防止腹膜纤维化的发生和发展。     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

持续性非卧床腹膜透析患者生存质量影响因素的研究

目的评估持续性非卧床腹膜透析(CAPD)患者的生存质量状况,探讨营养状态、透析充分性、微炎症、腹膜转运和残余肾功能对腹透患者生存质量的影响。方法选择稳定的CAPD3个月以上的患者88例,使用KDQOL-SFTM生存质量研究量表计分。同时检测患者营养状态、透析充分性、微炎症、腹膜转运功能和残存肾功能,用SPSS10软件包分析数据。结果(1)CAPD患者肾病、透析相关生存质量(KDTA)评分为:58.6±14.2,SF-36总分为50.4±12.8。(2)营养指标(MQSGA、白蛋白和血红蛋白等)与KDTA和SF-36总分及其部分领域呈显著相关,其中以MOSGA相关性最好。(3)微炎症(IL-6、CRP和TNFα)与KDTA和SF-36总分及其分支领域呈显著相关,其中以IL-6相关性最为显著。(4)腹膜转运功能与KDTA和SF-36总分呈显著等级相关。(5)残存尿量与KDTA和SF-36总分及部分领域呈显著相关。(6)Kt/V与KDTA和SF-36无显著相关。(7)对KDTA的影响分别为腹膜转运功能、残存尿量、MQSGA、IL-6、Kt/V、TNFα、CRP,其中腹膜转运功能、残存尿量、MQSGA、IL-6是独立影响因素。(8)对SF-36的影响分别为腹膜转运功能、MQSGA、残存尿量、IL-6、Kt/V、TNFα、CRP,其中,腹膜转运功能、MQSGA、残存尿量、IL-6是独立影响因素。结论(1)腹膜转运功能、残存尿量影响腹透患者生存质量,但是,     

膀胱输尿管反流与肾疤痕形成

本文综述了近年来对膀胱输尿管返流引起肾脏疤痕的研究，包括发病的决定因素、诊断方法、治疗和预防的某些研究进展。     

肾病综合征并发急性肾功能衰竭1例

1 引 言肾病综合征并发急性肾功能衰竭在临床并不常见，有报道[1]其发生率为2．1％至8．8％。笔者在中山医科大学附属第一医院进修期间经治1例老年原发肾病综合征并发急性肾功能衰竭，现报告如下。2 病例报告男，55岁，因反复浮肿13个月，少尿2周，恶心1周于1997年9月4日入院。患者13个月前因“浮肿、蛋白尿”在当地医院诊断为“肾病综合征”对标准激素治疗方法敏感。但9个月前因“感冒”后复发，再次用激素治疗无效。入院前泼尼松已减至10 mg／d。入院前2周患者出现尿量减少，浮肿加重，血肌酐、血尿素氮急剧上升，当地予以利尿、血液透析…     

丙基硫氧嘧啶致血管炎一例

患者女 ,2 2岁。因怕热、消瘦 3年余 ,关节疼痛伴头晕 2个月 ,咯血 2周于 2 0 0 1年 8月 14日入院。患者 3年前因怕热、消瘦、心悸在外院诊断为Ｇｒａｖｅｓ病 ,用他巴唑治疗出现皮疹和瘙痒而改服丙基硫氧嘧啶 (ＰＴＵ) ,甲状腺功能控制良好后一直用ＰＴＵ 5 0ｍｇ/ｄ维持。 2个月前出现关节疼痛、头晕、乏力等症状 ,2周前出现咳鲜红色血痰 ,无关节红肿、发热、鼻衄、牙龈出血、肉眼血尿、黑便等。以“缺铁性贫血 ,ＧｏｏｄＰａｓｔｕｒｅ综合征 ,Ｇｒａｖｅｓ病”而收入我院血液科 ,后经内分泌科和肾内科会诊 ,考虑继发性血管炎拟进行肾穿…     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

糖皮质激素预防逆行性肾盂肾炎大鼠肾脏纤维化的作用及其机制的初步探讨

目的：探讨糖皮质激素有否预防或减轻肾盂肾炎大鼠肾脏纤维化的作用。方法：雌性成年SD大鼠随机分为对照组和实验组：（1）正常对照组：未经任何处理;(2）实验组：建立逆行性肾盂肾炎模型，按治疗的不同分为4组：（1）早期治疗组；（2）延迟治疗组；（3）延迟加激素组；（4）未治疗组，所有实验对象在接种细菌前和接种细菌后分别检测血清肌酐，血尿氨氮，尿渗透浓度，尿蛋白／肌酐比值，尿NAG酶及β2-m，膀胱穿刺取尿行细菌培养。接种细菌后12周处死大鼠取肾行大体标本，肾组织切片普通光镜检查，肾组织免疫组织化学检测胶原蛋白Ⅲ（COⅢ）和纤连蛋白（FN）在肾脏的表达。结果：早期治疗组无肉眼肾疤痕形成，肾小球未见明显异常，肾小管形态基本正常，延迟治疗组有明显肾疤痕形成，明显的间质纤维化，小管萎缩，尿渗透浓度在接种细菌后第8周开始下降，NAG酶在接种细菌后12周开始升高，延迟加激素组仅见轻度疤痕，疤痕外组织基本正常，与未治疗组和延迟治疗组比较差异有显著性意义。结论：糖皮质激素联合抗生素治疗可预防和减轻实验性肾盂肾炎间质纤维化。