低分子右旋糖酐致急性肾功能衰竭13例临床分析

目的:探讨低分子右旋糖酐治疗缺血性脑血管病致急性肾功能衰竭的易感因素、可能原因及临床使用注意事项。方法:回顾性分析13例低分子右旋糖酐致急性肾功能衰竭的临床资料。结果:该现象易发生于老年、合并高血压、高血脂、糖尿病及有肾功能不全史的患者。结论:在治疗有上述合并症的缺血性脑血管病患者时,应禁用或慎用低分子右旋糖酐。     

Relationship between alterations of p16INK4a and p14ARF genes of CDKN2A locus and gastric carcinogenesis

Objective To investigate the relationship between alterations of p16INK4a and p14ARF genes and gastric carcinogenesis. Methods The tumors and neighboring gastric tissues from 48 patients with gastric cancer were studied. The homozygous deletion, mutation, methylation of the CpG islands, and mRNA expression of p16INK4a and p14ARF genes were assessed by PCR, PCR-SSCP, PCR based methylation assay, and RT-PCR. Results ① The homozygous deletion rate of p16INK4a and p14ARF was 35.4% （17/48）, and no homozygous deletion was examined in any gastric tissue neighboring the tumor. ② There was no point mutation of p16INK4a and p14ARF in 31 gastric cancers without homozygous deletion or in the matched gastric tissues adjacent to the tumor. ③ Methylation of the CpG islands of p16INK4a and p14ARF was detected in 47.9% (23/48) of gastric cancers, while methylation was observed only in 2 of 48 gastric tissues neighboring the cancer with a significant difference (P<0.01). ④ The loss rate of p16INK4a mRNA was 47.9% (23/48) in gastric cancer, and the patients of the combined methylation of exons 1α and 2 had a higher loss rate (100%, 6/6) of p16INK4a mRNA than those of the methylation of the other exons (11.8%, 2/17, P<0.01); the loss rate of p14ARF mRNA was 45.8%(22/48) in gastric cancer, and patients with the combined methylation of exons 1β and 2 had a higher loss rate (100%, 3/3) of p14ARF mRNA than those of the methylation of the other exons (15%, 3/20, P<0.05). ⑤ The combined loss of p16INK4a and p14ARF mRNAs was examined in 1 (5.6%) of 18 patients of well and moderately-differentiated carcinomas, and 11 (36.7%) of 30 patients of poorly and not-differentiated carcinomas with a significant difference (P<0.05). Conclusion p16INK4a and p14ARF genes are frequently inactivated by homozygous deletion and methylation of the 5’CpG islands in gastric cancer, which may play an important role in the carcinogenesis of gastric cancer.     

阴离子间隙测定在急性肾衰竭诊治及预后中的应用

目的　探讨阴离子间隙 (AG)和电解质变化在急性肾衰竭诊治及预后临床意义。方法　 87例急性肾衰竭的临床资料及实验室检查结果 ,并按AG高低分成 3组 ,分析AG与代谢性酸中毒的关系 :按预后分为恢复组和死亡组 ,分析AG与预后的关系。结果　AG组代谢性酸中毒率 (80 .8% ) ,高于正常 ,低AG值组 (P <0 .0 5) ;治疗后恢复组的AG水平能够恢复正常 ,而死亡组AG水平仍然高 ,两组比较差异有显著性 (P <0 .0 1 ) ;AG水平恢复与否与急性肾衰竭预后具有一定的关系 ;血 pH、Cl-变化在判断预后无临床意义。 结论　在急性肾衰竭患者诊疗过程中阴离子间隙的监测有助于了解病情、判断酸碱平衡紊乱及进一步判断其预后。     

重症急性胰腺炎并发急性肾功能衰竭的临床研究

目的 探讨重症急性胰腺炎(severe acute pancreatitis,SAP)并发急性肾功能衰竭(acute renal failure,ARF)的诱发因素和防治方法。方法根据Ranson系列预后判断标准和APACHEⅡ评分,结合影像学和病理学检查(手术病例),将我院274例急性胰腺炎患者分为:轻型AP组(A组)(182例),SAP非手术治疗组(B组)(54例)和手术治疗组(C组)(38例),取同期不伴急性炎症的胆囊结石患者80冽为对照组。研究各组血清生化检验结果和治疗、预后:结果B组和C组平均血钾、血尿素氮和肌酐高于对照组和A组(P<0.01),A组患者的各项指标高于对照组(P<0.05),SAP患者腹腔内渗液量与ARF严重程度呈正相关关系(r=0.33.p<0.05)。结论ARF是SAP致命性的严重并发症,尽早明确SAP诊断、及时手术治疗、切实可靠的引流,是防治SAP并发ARF,改善预后的重要手段。     

老年人急性肾功能衰竭32例临床分析

急性肾功能衰竭(ARF)是一组由多种病因引起的临床综合征,表现为肾功能在数日或数周内迅速恶化,是临床危重疾病之一,随着年龄增长,尤其是老年人由于血管硬化,肾功能不同程度减退,更易发生ARF。为探讨其临床特点,本文对1999年至2003年我院收治的老年ARF病例作一回顾性分析,现报道如下。1对象和方法选择我院1999年至2003年住院的101例ARF病人。ARF的诊断标准为:在数小时至数天的短时间内肾小球滤过率较基础值降低50%或血清肌酐(SCr)较基础值上升50%或肾功能急剧减退到需要透析程度[1]。将其分为老年组和中青年组进行分析,老年组32例,男1…     

Pharmacokinetic changes of ipriflavone in rats with acute renal failure induced by uranyl nitrate

Pharmacokinetic parameters of ipriflavone were compared after intravenous (20 mg/kg) and oral (200 mg/kg) administration in control rats and in rats with acute renal failure induced by uranyl nitrate (U-ARF rats). It was expected that the time-averaged nonrenal clearance (Cl(nr)) of ipriflavone in U-ARF rats could be significantly slower than in the control rats, since it was reported that ipriflavone was metabolized via the hepatic microsomal cytochrome P450 (CYP) 1A1/2 and 2C11 and the expression and mRNA level of CYP1A2 were not changed, but those of CYP2C11 were decreased in U-ARF rats compared with control rats. Unexpectedly, after intravenous administration in U-ARF rats, the Cl(nr) of ipriflavone was significantly faster than in the controls (40.8 compared with 29.0 ml/min/kg). This may be due to an increase in the glucuronide conjugate formation of ipriflavone metabolites in U-ARF rats. After oral administration of ipriflavone in U-ARF rats, the AUC(0-24 h) was significantly smaller (194 compared with 295 microg min/ml) than in the controls.     

Causes and Prognosis of Acute Renal Failure in Elderly Patients

In this retrospective study, 287 patients with acute renal failureobserved between 1980 and 1985 were divided into 2 groups, accordingto age: group 1 of 65 years or more (n = 100) and group 2 between17 and 64 years (n = 187). In both age groups the whole spectrumof causes of acute renal failure was found, but within thatspectrum a higher incidence of post-renal failure, acute renalvascular disease and of hypovolaemic acute renal failure wasnoted in group 1 versus group 2. On the other hand, pigment-inducedacute renal failure was lower in group 1 (4%) versus group 2(13%). The overall survival was 54% in the elderly versus 56% in theyounger patients (NS). A close relationship between survivaland the number of postadmission complications was found in bothgroups. Interestingly, the presence of severe hypokalaemia (<3.5mmmol/l) and metabolic alkalosis (plasma HCO₃>30 mmol/l)was associated with a very high mortality of 73% and 86% respectivelyin the elderly patients. Complete or incomplete recovery ofrenal function was the same in both age groups. It is concludedthat age alone should not be used as a discriminating factorin therapeutic decisions concerning acute renal failure in anolder patient.     

Alterations in the RB1 pathway in low-grade diffuse gliomas lacking common genetic alterations

We recently reported that the vast majority (>90%) of low‐grade diffuse gliomas (diffuse astrocytoma, oligoastrocytoma and oligodendroglioma) carry at least one of the following genetic alterations: IDH1/2 mutation, TP53 mutation or 1p/19q loss. Only 7% of cases were triple‐negative (ie, lacking any of these alterations). In the present study, array comparative genomic hybridization (CGH) in 15 triple‐negative WHO grade II gliomas (eight diffuse astrocytomas and seven oligodendrogliomas) showed loss at 9p21 (p14^ARF, p15^INK4b, p16^INK4a loci) and 13q14–13q32 (containing the RB1 locus) in three and two cases, respectively. Further analyses in 31 triple‐negative cases as well as a total of 160 non‐triple‐negative cases revealed that alterations in the RB1 pathway (homozygous deletion and promoter methylation of the p15^INK4b, p16^INK4a and RB1 genes) were significantly more frequent in triple‐negative (26%) than in non‐triple‐negative cases (11%; P = 0.0371). Multivariate analysis after adjustment for age, histology and treatment showed that RB1 pathway alterations were significantly associated with unfavorable outcome for patients with low‐grade diffuse glioma [hazard ratio, 3.024 (1.279–6.631); P = 0.0057]. These results suggest that a fraction of low‐grade diffuse gliomas lacking common genetic alterations may develop through a distinct genetic pathway, which may include loss of cell‐cycle control regulated by the RB1 pathway.     

大肠腺癌中HIF—1α和P14^ARF的表达及意义

目的 探讨大肠腺癌组织中HIF-1α和P14ARF的表达及其意义.方法 采用免疫组织化学技术检测62例大肠腺癌标本HIF-1α和P14ARF蛋白的表达.结果 HIF-1α阳性表达率为43.5%(27/62),P14ARF阳性率为71%(44/62).HIF-1α阳性表达率与癌组织分化程度无关 (P>0.05),但随Duke's分期的不同有增高的趋势,即Duke's D期>Dukes' C期>Duke's B期>Duke's A期.HIF-1α阳性表达与癌组织Duke's分期呈显著相关(χ2=15.651,P<0.001).P14ARF表达与大肠腺癌分化程度和Duke's分期均相关(χ2＝11.113,P<0.01;χ2＝16.642,P<0.01).大肠腺癌组织中HIF-1α与 P14ARF表达显著相关(τ= -0.392,P<0.01).结论 HIF-1α可能参与了大肠腺癌的浸润和转移;P14ARF表达与癌组织分化程度和转移状况相关,P14ARF可能通过抑制HIF-1α表达的途径抑制大肠腺癌的发生发展.     

Crystalglobulin-Induced Nephropathy

Crystalline nephropathy refers to renal parenchymal deposition of crystals leading to kidney damage. The most common forms of crystalline nephropathy encountered in renal pathology are nephrocalcinosis and oxalate nephropathy. Less frequent types include urate nephropathy, cystinosis, dihydroxyadeninuria, and drug-induced crystalline nephropathy (e.g., caused by indinavir or triamterene). Monoclonal proteins can also deposit in the kidney as crystals and cause tissue damage. This occurs in conditions such as light chain proximal tubulopathy, crystal-storing histiocytosis, and crystalglobulinemia. The latter is a rare complication of multiple myeloma that results from crystallization of monoclonal proteins in the systemic vasculature, leading to vascular injury, thrombosis, and occlusion. In this report, we describe a case of crystalglobulin-induced nephropathy and discuss its pathophysiology and the differential diagnosis of paraprotein-induced crystalline nephropathy.