X线平片钙化积分预测维持性血液透析患者冠状动脉钙化的研究

目的探讨不同部位X线平片钙化积分对维持性血液透析（MHD）患者冠状动脉钙化的预测价值。方法选择四川省人民医院血液透析中心MHD患者36例,行多层螺旋CT、X线平片（包括骨盆正位、侧腹位、双手正位）,以多层螺旋CT作为评价冠状动脉钙化的金标准,应用受试者工作曲线（ROC）比较不同X线平片钙化积分对冠状动脉钙化积分（CACs）≥100的预测价值。结果比较CACs〈100组与CACs≥100组,2组在年龄、透析前舒张压、心血管不良事件差异有统计学意义（P〈0.05）,余均无统计学意义的差异。骨盆正位X线平片钙化积分的ROC曲线下面积（AUC）最大且有统计学意义（P=0.002）,其它部位X线平片钙化积分对CACs≥100的预测能力无统计学意义,当骨盆正位X线平片钙化积分〉0、〉1、〉2、〉3时,其敏感性和特异性分别为95.65%和53.85%、73.91%和61.54%、56.52%和92.31%、47.83%和92.31%。结论 X线平片钙化积分可以预测MHD患者冠状动脉钙化,可以选择骨盆正位X线平片进行初步筛查,骨盆正位X线平片钙化积分〉2时应高度怀疑MHD患者存在100的冠状动脉钙化积分。     

#85 Association of serum antibodies to the helicobacter pylori caga antigen with precancerous gastric lesions in chinese populations with contrasting gastric cancer rates

PURPOSE: To assess whether serologic markers of Helicobacter pylori infection can account for the differences in prevalence of advanced precancerous gastric lesions (APGL) between two rural Chinese villages.METHODS: We studied asymptomatic adult subjects in Bei Duan village (N = 196) in Linqu County (a high-risk area for gastric cancer) and in Shi Huang village (N = 192) in Cangshan County (a low-risk area for gastric cancer) in Shandong Province, China. Prevalence of APGL was assessed by microscopic examination of endoscopic stomach biopsies. Enzyme-linked immunosorbent assays (ELISA) were used to detect IgG to the H. pylori whole-cell antigen, and to the CagA protein. A logistic regression model was used to quantify the role of the two H. pylori seromarkers in explaining the differences in prevalence of APGL between the two villages, after adjusting for age and sex.RESULTS: The prevalence of APGL was much greater in Bei Duan than in Shi Huang. Although H. pylori seroprevalence by the whole-cell ELISA was similar in the two populations, seroprevalence of CagA was significantly greater in Bei Duan. Although age, sex, and both H. pylori seromarkers were associated with APGL in the logistic regression model, the effect of village of residence remained strong after adjustment for all four covariates.CONCLUSION: Only a relatively small proportion of the variation in prevalence of APGL in the rural Chinese population can be explained by differences in H. pylori seroprevalence, or by differences in CagA seroprevalence.     

MicroRNAs in peritoneal dialysis effluent are promising biomarkers for peritoneal fibrosis in peritoneal dialysis patients

Peritoneal fibrosis is a common complication of long-term peritoneal dialysis, and contributes to encapsulating peritoneal sclerosis and eventually peritoneal ultrafiltration failure, which restricts the wide application of peritoneal dialysis. Therefore, the prevention and treatment of peritoneal fibrosis is important to maintain peritoneal membrane integrity and prolong peritoneal dialysis treatment. Unfortunately, neither specific biomarkers nor effective therapies are available for peritoneal fibrosis in the clinic up to now. Emerging evidence suggests that extracellular microRNAs in body fluids are promising biomarkers for the diagnosis of diseases. microRNAs were reported to be involved in multiple fibrotic diseases and the serum levels of specific microRNAs were correlated with the degree of fibrosis. Moreover, extracellular microRNAs were found in peritoneal fluids and ascites. Based on these findings, here we present our hypothesis that extracellular microRNAs associated with peritoneal epithelial-to-mesenchymal transition and fibrosis could potentially be detected in peritoneal dialysis effluent, and serve as novel biomarkers for early assessment and diagnosis of peritoneal fibrosis.     

那格列奈联合二甲双胍治疗初发2型糖尿病患者的疗效观察

目的 比较那格列奈和阿卡波糖联合二甲双胍对初发2型糖尿病患者的疗效。方法对我院收治的96例新诊断的2型糖尿病患者随机分别予那格列奈联合二甲双胍（A组,46例）和阿卡波糖联合二甲双胍（B组,42例）治疗4个月,每2周调整一次药物剂量,治疗前后分别行口服葡萄糖耐量试验和胰岛素释放试验,观察糖耐量、稳态模型胰岛素抵抗指数（HOMA—IR）、B细胞分泌功能及葡萄糖处置指数（DI）的变化。结果治疗后,A组有6例恢复为正常糖耐量,13例恢复为糖耐量受损,B组有12例恢复为糖耐量受损;治疗后两组HOMA—IR均较治疗前明显改善,A组从8．6±1．2降至7．1±1．3,B组从8．6±1．7降至6．9±1．7（P〈0．05）;治疗后A组早时相胰岛素分泌较B组明显恢复[（1．9±0．8）与（1．6±0．6）mU／mmol,P〈0．05];治疗后A组DI较B组明显改善（1．05±0．25与0．89±0．21,P〈0．05）。结论那格列奈联合二甲双胍可显著改善初发2型糖尿病患者胰岛素早时相分泌功能和胰岛素抵抗,促进糖耐量恢复。     

MicroRNA-29与纤维化疾病

小分子RNA( microRNA,miRNA,miR)是一类由21 ～ 23个核苷酸构成的功能性非编码小分子RNA.microRNA-29( miR-29)是新近发现的一类与纤维化疾病密切相关的小分子RNA家族,研究发现miR-29可通过直接抑制多种细胞外基质蛋白表达和调控多种与纤维化相关的信号通路参与纤维化过程,并且...     

农村维吾尔族成人慢性牙周炎与高血压的相关性

目的 探讨农村维吾尔族成人慢性牙周炎与高血压的相关性.方法 采用分层随机抽样的方法从新疆维吾尔自治区墨玉县364个自然村按容量比例概率抽样,随机抽取1415名维吾尔族成人(≥18岁),进行问卷调查、体格测量、实验室检查及口腔检查.依据慢性牙周炎的诊断标准,将调查对象分为牙周炎组和非牙周炎组,其中牙周炎组按其严重程度进一步分为:轻度牙周炎组,中度牙周炎组和重度牙周炎组.牙周炎与高血压的关系采用Spearman相关分析.应用logistic回归模型对高血压相关影响因素进行分析.结果 慢性牙周炎患病粗率为66.0％( 934/1415),高血压患病粗率为33.8％ (478/1415),非牙周炎及轻度、中度、重度牙周炎组高血压的患病比例为18.7％(90/481),35.1％ (131/373),32.3％ (62/192),52.8％ (195/369).Speaman相关分析结果显示牙周炎与高血压呈正相关(rs =0.273,P＜0.01).校正年龄、性别、体质指数、腰围、糖代谢异常、高脂血症、慢性肾脏病后,多因素logstic回归分析显示牙周炎组高血压患病风险为非牙周炎组的1.75倍(OR= 1.75,95％CI:1.30 ～2.36,P＜0.01),轻度牙周炎组高血压患病风险为非牙周炎组的1.76倍(OR=1.76,95％ CI:1.26 ～2.48,P＜0.01),中度牙周炎组高血压患病风险为非牙周炎组的1.21倍(OR= 1.21,95％ CI:0.80～1.84,P＞0.05),重度牙周炎组高血压患病风险为非牙周炎组的2.26倍(OR =2.26,95％ CI:1.57 ～3.26,P＜0.01).结论 农村维吾尔族成人慢性牙周炎与高血压独立相关.     

肾移植后移植肾功能的延迟恢复

背景:移植肾功能延迟恢复是肾移植常见的并发症,充分探究其发生的危险因素,及时预防与对应综合治疗是肾移植成功的关键。目的:探讨肾移植后移植肾功能延迟恢复发生的病因及治疗方法。方法:回顾性分析2000-12/2011-01在武警后勤学院肾移植中心明确诊断为肾移植后肾功能延迟恢复108例患者的临床资料,均为尸肾移植,给予相应治疗,观察临床疗效并综合分析出现肾功能延迟恢复的原因。结果与结论:发生肾移植后移植肾功能延迟恢复的病因包括急性排斥反应52例(48.2%),急性肾小管坏死45例(41.5%);动脉吻合口狭窄5例(4.6%),输尿管梗阻3例(2.8%),环孢素A中毒肾病6例(5.6%)。89例患者经治疗后移植肾功能恢复正常,12例血肌酐稳定在200μmol/L左右,2例因应用抗淋巴细胞球蛋白后并发肺部感染死亡,5例应用甲基强的松龙冲击治疗后移植肾功能未好转而恢复血液透析治疗。提示急性排斥反应及急性肾小管坏死是引起肾移植后肾功能延迟恢复的主要因素,应采取综合治疗措施积极纠正。     

腹膜透析相关感染性腹膜炎致病菌及耐药性的单中心分析

目的分析腹膜透析(简称腹透)相关感染性腹膜炎患者病原菌分布及耐药性变化。方法回顾中南大学湘雅二医院近5年来腹透相关感染性腹膜炎患者一般情况、细菌培养及药敏试验、疗效及转归,并进行统计学分析。结果①46例次病原菌培养阳性24例次(52.2%),其中G+菌9例次(37.5%),G-菌8例次(33.3%),真菌7例次(29.2%)。②G+菌对头孢类抗生素耐药率高,对万古霉素、替考拉宁等的耐药率低。G-菌对替卡西林/棒酸、阿米卡星、环丙沙星、左氧氟沙星、泰能等耐药率低。③G+菌、G-菌、培养阴性腹膜炎患者治愈率分别为88.9%、75%、73%;真菌性腹膜炎患者均拔管。结论腹膜透析相关感染性腹膜炎病原菌及耐药性已发生很大变化,需努力提高腹透液培养阳性率及腹膜炎的治愈率。     

肾小球疾病尿蛋白肌酐比与24h尿蛋白定量的相关关系及影响因素

目的:了解肾小球疾病尿蛋白肌酐比(UPCR)与24h尿蛋白(U-TP)定量的相关性及其相关性的影响因素。方法:选取125例低白蛋白血症肾小球疾病患者和20例健康对照者采用等级相关分析判断UPCR与24hU-TP定量的相关性;按性别、年龄、肾脏功能(根据Ccr)、血浆ALB浓度,24hU-TP定量、疾病种类进行分层,了解其对相关性的影响,同时采用ROC曲线判断UPCR的界点值。结果:病例组与对照组UPCR与24hU-TP定量的相关系数(r)分别为0.825、0.992;性别、年龄、肾功能(Ccr>10ml/min)、血浆ALB浓度,疾病种类对其相关性无影响,但U-TP定量影响其相关性,当24hU-TP定量≥5.0g时,r=0.338(P=0.134);通过ROC曲线得到当24hU-TP定量分别为1g和3.5g时UPCR值分别为1.05g/g和3.518g/g。结论:肾小球疾病患者及健康对照者UPCR与24hU-TP定量均有显著的正相关性;其相关性不受性别、年龄、肾功能(Ccr>10ml/min)、血浆ALB浓度,疾病种类的影响,但U-TP定量影响其相关性,当24hU-TP定量≥5.0g时,其不具有相关性;通过ROC曲线得到当UPCR大于3.5g/g可考虑为大量蛋白尿协助临床诊断。