Decreased serum thrombospondin-1 and elevation of its autoantibody are associated with multiple exacerbated clinical manifestations in systemic lupus erythematosus

The pathological effects of thrombospondin-1 (TSP-1) have been studied in many preclinical tumor models and rheumatoid arthritis. However, the role of TSP-1 and anti-thrombospondin-1 autoantibodies (ATSA) in systemic lupus erythematosus (SLE) has not been specifically defined. In this study, we investigated the clinical relevance and functional significance of TSP-1 and ATSA in SLE patients. Serum levels of TSP-1 and ATSA were measured by ELISA in 138 adult SLE patients and 60 healthy controls. Blood cell counts, rheumatoid factor (RF), immunoglobulins, erythrocyte sedimentation rate (ESR), complements, and SLE-related autoantibodies were measured by standard laboratory techniques. Disease activity was assessed by systemic lupus erythematosus disease activity index (SLEDAI). TSP-1 concentrations were significantly lower in SLE patients compared with those in healthy controls. A significant difference of TSP-1 was observed in the patients with serositis, C3 decrease, RF positive, leukocytopenia, and thrombocytopenia. The levels of TSP-1 showed a positive correlation with the number of leukocyte and thrombocyte, while a negative correlation with anti-dsDNA antibody, IgG, ESR, and SLEDAI. ATSA was observed in 58.7% (81/138) of SLE patients, which was significantly higher than that in healthy controls (7/60, p?<?0.05). Patients with active SLE showed higher ATSA positivity (67.1%) than those with inactive disease (47.1%, p?<?0.05). ATSA was positively correlated with anti-rRNP antibody, IgG, total protein, and C4. This study revealed the opposite clinical relevance of TSP-1 and its autoantibody in SLE for the first time. TSP-1 may play an anti-inflammatory and immunoregulatory role in SLE autoimmunity. ATSA increased more frequently in disease-active patients and was associated with more severe clinical manifestations, which implicated its antagonistic role on TSP-1 and its involvement in the pathogenesis of SLE.     

Preoperative proteinuria may be a risk factor for postoperative acute kidney injury：a meta-analysis

ObjectiveTo investigate the relationship between preoperative proteinuria and postoperative acute kidney injury (AKI).MethodsWe performed a search on databases included PubMed, Embase, the Cochrane Library, and Web of Science, from December 2009 to September 2020. Data extracted from eligible studies were synthesized to calculate the odds ratio (OR) and 95% confidence interval (CI). A fixed or random effects model was applied to calculate the pooled OR based on heterogeneity through the included studies.ResultsThis meta-analysis of 11 observational studies included 203,987 participants, of whom 21,621 patients suffered from postoperative AKI and 182,366 patients did not suffer from postoperative AKI. The combined results demonstrated that preoperative proteinuria is an independent risk factor for postoperative AKI (adjusted OR = 1.65, 95%CI:1.44–1.89, p < 0.001). Subgroup analysis showed that both preoperative mild proteinuria (adjusted OR = 1.30, 95%CI:1.24–1.36, p < 0.001) and preoperative heavy proteinuria (adjusted OR = 1.93, 95%CI:1.65–2.27, p < 0.001) were independent risk factors for postoperative AKI. The heterogeneity was combined because its values were lower. Further subgroup analysis found that preoperative proteinuria measured using dipstick was an independent risk factor for postoperative AKI (adjusted OR = 1.48, 95%CI:1.37–1.60, p < 0.001). Finally, preoperative proteinuria was an independent risk factor for postoperative AKI in the non-cardiac surgery group (adjusted OR = 2.06, 95%CI:1.31–3.24, p = 0.002) and cardiac surgery group (adjusted OR = 1.69, 95%CI:1.39–2.06, p < 0.001)ConclusionPreoperative proteinuria is an independent risk factor for postoperative AKI and in instances when proteinuria is detected using dipsticks.     

The application of neutrophil gelatin-related lipid delivery protein in evaluation of renal function,nutrition, anemia and inflammation in patients with CKD

ObjectiveTo investigate the role of neutrophil gelatinase-associated lipocalin in the evaluation of renal function, nutrition, anemia and inflammation in patients with chronic kidney diseases.Materials and methodsA total of 302 patients with chronic kidney diseases were selected, and their clinical data, blood neutrophil gelatinase-associated lipocalin levels, renal function, nutrition, anemia, inflammation and calcium, and phosphorus metabolism were analyzed.ResultSerum neutrophil gelatinase-associated lipocalin level increased with the progression of chronic kidney diseases. Higher neutrophil gelatinase-associated lipocalin levels were observed in patients with chronic kidney diseases stage 3b compared with healthy individuals (P < 0.05), while the patients with chronic kidney diseases stage 5 showed higher levels compared with other chronic kidney diseases stages (P < 0.01). Moreover, the ROC curve showed that neutrophil gelatinase-associated lipocalin had a better diagnostic performance from the chronic kidney diseases stage 3b to 5 (P < 0.05). In addition, the serum neutrophil gelatinase-associated lipocalin levels in patient with chronic kidney diseases were negatively correlated with body mass index, number of red blood cells, hemoglobin, transferrin, the estimatedglomerular filtration rate (eGFR), serum calcium (P < 0.01); and were positively correlated with mean arterial blood pressure, blood BUN, SCr and alpha 1 microglobulin, beta 2 microglobulin, urinary inhibition C, homocysteine, PTH levels, neutrophils ratio, free serum ferritin and c-reactive protein (P < 0.01); while no significant correlation was found with gender, and age (P > 0.05).ConclusionSerum neutrophil gelatinase-associated lipocalin levels are closely related to renal function injury, inflammatory response and anemia-related indicators in patients with chronic kidney diseases, and thus could be used as a diagnostic biomarker for evaluating the degree of renal injury and related complications in patients with chronic kidney diseases.     

Diagnostic performance of pulmonary ultrasonography and a clinical score for the evaluation of fluid overload in haemodialysis patients

IntroductionThere is no feasible benchmark in daily routine to estimate the hydration status of haemodialysis patients, which is essential to their management.ObjectiveWe performed a study in haemodialysis patients to assess the diagnostic performance of pulmonary ultrasound and clinical examination for the evaluation of fluid overload using transthoracic echocardiography as a gold standard.MethodsThirty-one patients receiving chronic haemodialysis patients were included. Evaluation of hydration status was assessed weekly before haemodialysis sessions using clinical and Echo Comet Score from pulmonary ultrasound and transthoracic echocardiography (reference method).ResultsFive patients had a transthoracic echocardiography overload. Compared with transthoracic echocardiography, the diagnostic performance of the clinical overload score has a sensitivity of 100%, a specificity of 77%, a positive predictive value of 50% and a negative predictive value of 100% with a κ of 0.79. Only orthopnoea (P = 0.008), jugular turgor (P = 0.005) and hepatic-jugular reflux (P = 0.008) were significantly associated with transthoracic echocardiography overload diagnosis. The diagnostic performance of Echo Comet Score by pulmonary ultrasound has a sensitivity of 80%, a specificity of 58%, a positive predictive value of 26% and a negative predictive value of 94%. Ten patients (32.3%) had an increase of extravascular pulmonary water without evidence of transthoracic echocardiography or clinical overload.ConclusionsOur clinical score has a convincing diagnostic performance compared to transthoracic echocardiography and could be easily used in daily clinical routine to adjust dry weight. The evaluation of the overload using pulmonary ultrasound seems poorly correlated with the overload evaluated by transthoracic echocardiography. Extravascular pulmonary water undetected by clinical examination and transthoracic echocardiography remains a parameter that requires further investigation.     

淫羊藿苷对实验性IgA肾病大鼠的作用及相关机制

目的探究不同剂量的淫羊藿苷对实验性Ig A肾病大鼠的影响,并研究其相关作用机制。方法建立实验性Ig A肾病大鼠模型,实验共分为5组,正常对照组(con),造模组(Ig A),淫羊藿苷低剂量组(ICA-L),淫羊藿苷中剂量组(ICA-M)和淫羊藿苷高剂量组(ICA-H);各组经相应处理后,测定各组大鼠尿红细胞、尿蛋白和尿NAG水平;免疫荧光染色检测Ig A沉淀情况;免疫组化染色法与实时荧光定量PCR分别检测NF-κBp65与MCP-1的蛋白表达水平和IL-4,IL-10与IL-13的mRNA表达变化。结果给予淫羊藿苷处理后,降低实验性Ig A肾病大鼠的尿红细胞、尿蛋白和尿NAG水平与减少Ig A沉淀,并降低NF-κBp65与MCP-1的蛋白表达水平和IL-4,IL-10与IL-13的mRNA表达。结论淫羊藿苷对实验性Ig A肾病有一定的疗效,可能与调控NF-κBp65,MCP-1因子的表达以及机体免疫调节有关。     

陈莲舫治疗淋证经验

通过文献研究法挖掘陈莲舫先生对淋证的立法施药经验。归纳整理分析可以发现,陈莲舫先生对于淋证的治疗大法分为4类,即清法、分泄法、和养法和升降法。其中清法又可分为清解法、清降法、清养法和清泄摄补法4种,分泄法包括分解法和分降法。陈莲舫先生对于淋证的诊治师古而不泥古,随证立法施药,每于平常处见神奇;用药贵乎守衡,醇和而无偏;燮理阴阳,升降相宜;泄中有敛,补中有通。     

肾康颗粒对慢性肾炎脾肾亏虚证患者血清超敏C-反应蛋白及凝血功能的影响

目的 观察慢性肾炎脾肾亏虚证患者血清超敏C-反应蛋白（high-sensitive C-reactive protein, hs-CRP）和凝血功能的变化及肾康颗粒对其干预作用。方法 选择慢性肾炎脾肾亏虚证患者55例,随机将其分为对照组28例和试验组27例,并设正常组20例。两组患者均给予常规基础治疗,试验组在此基础上加服肾康颗粒,疗程共8周。比较两组治疗后临床疗效,检测治疗前后尿白蛋白肌酐比值(urinary albumin to creatinine ratio,UACR)、24 h 尿蛋白定量(24-hour urine protein,24hUP)、血白蛋白（albumin, Alb）、血尿素氮(blood urea nitrogen, BUN)、血肌酐(serum creatinine, SCr)、hs-CRP、凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间（thrombin time,TT）和纤维蛋白原(fibrinogen,Fib)的变化。结果 试验组临床疗效显著优于对照组(P<0.05)。两组患者治疗后24hUP、UACR均较治疗前降低,血Alb较治疗前升高(P<0.05),试验组改善程度优于对照组(P<0.05)。两组患者治疗前血清hs-CRP、Fib水平较正常组显著升高,PT、APTT、TT明显缩短(P<0.05),治疗后两组血清hs-CRP、Fib水平较治疗前明显下降,PT、APTT、TT较治疗前明显延长(P<0.05）,试验组改善程度优于对照组(P<0.05)。结论 肾康颗粒能有效改善慢性肾炎脾肾亏虚证患者的临床症状,减少尿蛋白,其作用机制可能与降低血清hs-CRP,抑制体内微炎性反应,改善高凝状态有关。     

左卡尼汀联合促红细胞生成素纠正维持性血液透析患者肾性贫血的效果及对内皮素和左室重构的影响

目的探讨左卡尼汀纠正维持性血液透析患者肾性贫血效果及对内皮素和左室重构的影响。方法将安阳市人民医院自2010年11月-2014年11月收治的维持血液透析6个月以上的尿毒症患者206例作为研究对象,随机分为研究组和对照组各103例,对照组患者给予促红细胞生成素,研究组患者在对照组治疗的基础上静脉推注左卡尼汀注射液,治疗6个月后,检测血红蛋白（Hb）、红细胞比容（HCT）,测定血清内皮素（ET）,并由有经验的超声诊断医师测量左心房内径（LAD）、左心室收缩末期内径（LVDs）、左心室舒张末期内径（LVDd）的变化等。结果治疗后两组Hb和HCT均明显升高,ET水平明显降低,与同组治疗前比较差异具有统计学意义（P<0.05）;且研究组患者以上指标的改变水平显著优于对照组,组间比较差异具有统计学意义（P<0.05）;两组患者治疗后LAD、LVDs、LVDd均发生不同程度的降低,且研究组显著低于对照组,组间比较差异具有统计学意义（P<0.05）。结论左卡尼汀联合促红细胞生成素治疗维持性血液透析患者肾性贫血可提高治疗效果,降低血浆内皮素水平,有效改善或抑制左室重构的发生和发展,有效预防心衰的发生,效果显著,可推广使用。     

胸腺肽肠溶片联合复方硫酸软骨素治疗类风湿性关节炎的临床研究

目的探讨胸腺肽肠溶片联合复方硫酸软骨素治疗类风湿性关节炎的临床疗效。方法选取2015年5月—2016年5月南阳市骨科医院收治的类风湿性关节炎患者90例,随机分为对照组和治疗组,每组各45例。对照组口服复方硫酸软骨素片,4片/次,3次/d。治疗组在对照组的基础上口服胸腺肽肠溶片,2片/次,3次/d。两组患者治疗时间均为3个月。评价两组患者临床疗效,同时比较治疗前后两组患者临床症状、关节炎相关指标和免疫球蛋白水平。结果治疗后,对照组和治疗组总有效率分别为80.00%和93.33%,两组比较差异具有统计学意义(P0.05)。治疗后,两组肿胀关节数、压痛关节数和晨僵时间均出现明显下降,握力则明显升高,同组比较差异具有统计学意义(P0.05)。且治疗组这些临床症状则明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者类风湿因子(RF)、血沉(ESR)和C反应蛋白(CRP)水平均显著降低(P0.05)。且治疗组上述关节炎相关指标均明显低于对照组(P0.05)。治疗后,两组患者IgG、IgA及IgM均明显降低(P0.05);且治疗组上述指标含量明显低于对照组(P0.05)。结论胸腺肽肠溶片联合复方硫酸软骨素治疗类风湿性关节炎临床疗效确切,具有一定的临床推广应用价值。     

以人文关怀为依托的延续性护理对动静脉内瘘术病人居家休养的干预效果观察

目的分析以人文关怀为依托的延续性护理对动静脉内瘘术（AVF）病人居家休养的干预效果。方法对照组30例,给予常规护理干预;观察组30例,在常规护理干预基础上给予以人文关怀为依托的延续性护理。干预2个月后,比较2组居家期间自我管理能力、内瘘相关知识掌握情况、负性情绪及内瘘初期失功情况。结果观察组焦虑自评量表、抑郁自评量表评分显著低于对照组（P < 0.01）,内瘘震颤弱、血肿/渗血发生率均低于对照组（P < 0.05）,并发症管理、疾病监测、饮食管理、用药依从性和操作技术评分均高于对照组（P < 0.05~P < 0.01）。结论在常规护理基础上实施以人文关怀为依托的延续性护理,可以显著提高AVF病人的内瘘相关知识掌握程度以及居家期间的自我管理能力,缓解病人的负性情绪,减少内瘘初期失功的发生,值得临床重视。