综合性营养评估法在维持性血液透析患者中的应用分析

目的 对血液透析患者的几项营养指标进行评估。方法 依据SGA评分对142例维持性血液透析患者进行主观综合性营养评估（SGA）、膳食调查、生化参数的测量。结果 平均每日每公斤体重能量和蛋白质摄入（DEI、DPI）、血白蛋白，均有显著性差异（P〈0．001—0．05）。但营养良好组的DPI和DEI异常率高达49．0％、46．0％，重度营养不良组中各指标异常率均在80％以上。血前白蛋白与白蛋白有显著相关（P〈0．01），与DPI、DEI均无相关。结论 SGA是评价血透患者营养状况的简便方法，但还需其它反映营养状况不同侧面的指标的补充，如DEI、DPI、血白蛋白。前白蛋白作为血透患者营养监测的常规指标有待进一步证实。     

Risk groups for clinical complications of norovirus infections: an outbreak investigation

Norovirus infections have been described as self-limiting diseases of short duration. An investigation of a norovirus outbreak in a university hospital provided evidence for severe clinical features in patients with several underlying diseases. Clinical outcomes of norovirus infection were defined. Risk-factor analysis targeting underlying diseases and medication was performed using multivariate analyses. In five outbreak wards, 84 patients and 60 nurses were infected (an overall attack rate of 32% in patients, and 76% in nurses). The causative agent was the new variant Grimsby virus. Severe clinical features, including acute renal failure, arrhythmia and signs of acute graft organ rejection in renal transplant patients, were observed in seven (8.3%) patients. In multivariate analyses, cardiovascular disease (OR 17.1, 95% CI 2.17-403) and renal transplant (OR 13.0, 95% CI 1.63-281) were risk-factors for a potassium decrease of >20%. Age >65 years (OR 11.6, 95% CI 1.89-224) was a risk-factor for diarrhoea lasting >2 days. Immunosuppression (OR 5.7, 95% CI 1.78-20.1) was a risk-factor for a creatinine increase of >10%. Norovirus infections in patients with underlying conditions such as cardiovascular disease, renal transplant and immunosuppressive therapy may lead to severe consequences typified by decreased potassium levels, increased levels of C-reactive protein and creatine phosphokinase. In the elderly, norovirus infection may lead to an increased duration of diarrhoea. Therefore patients at risk should be hospitalised early and monitored frequently. Strict preventional measures should be implemented as early as possible to minimise the risk of nosocomial outbreaks.     

中药醇提物对血液透析效果的影响

①目的　观察中药醇提物 (HD组方 )对血液透析效果的影响。②方法　选择我院终末期肾衰竭 (ES RD)病人 6 6例 ,已行维持性血液透析治疗 1年以上 ,随机分为常规组 32例 ,中药组 34例。常规组继续进行常规血液透析 ,中药组在常规透析的基础上 ,将透析液中加入HD组方 ,疗程均为 6个月。定期观察各组病人透析前、后血清尿素氮 (BUN)、肌酐 (Cr)、平均时间尿素氮浓度 (TACurea)、蛋白分解率 (PR)及G S指数 (KT/V值 )。③结果　中药组治疗后BUN、Cr水平与常规组同期比较明显降低 ,差别具有显著性 (t=2 .5 6 1、2 .4 98,P <0 .0 5 )。中药组治疗后TACurea较治疗前明显降低 ,差别具有极显著性 (t=2 .797,P <0 .0 1 ) ;而PR、KT/V值较治疗前明显升高 ,差别具有显著性 (t=2 .36 1、2 .4 98,P <0 .0 5 )。④结论　中药HD组方在透析液中的应用可提高ESRD病人透析效果及生活质量     

“分步给药”在低氧易感患者无痛苦胃镜检查中安全性的探讨

目的 探讨在低氧易感患者无痛苦胃镜检查中采用分步给药的安全性和镇静/镇痛效果.方法 接受胃镜检查的180例患者,其中有鼾症、或咳嗽、咳痰症状的患者120例单双号随机入选Ⅰ组(分步给药组)和Ⅱ组(普通组),60例无鼾症、咳嗽、咳痰症状的患者为Ⅲ组(常规给药组),Ⅰ组采用分步给药法,Ⅲ组采用常规给药法对患者实施胃镜检查前的镇静/镇痛术,Ⅱ组则进行普通胃镜检查,分析2种镇静法对SBP、DBP、SpO2、HR、清醒时间、患者反应、患者对检查过程的感受以及是否愿意再次接受检查的影响,评价分步给药法在低氧易感患者无痛苦胃镜检查中的安全性和镇静/镇痛效果.结果 Ⅰ组、Ⅲ组检查中SBP、DBP变化无明显差异(均P＞0.05),Ⅰ组检查前、中SpO2的变化小于Ⅲ组(均P＜0.01);Ⅰ组进镜时咽部受刺激产生的恶心咽吐、流涎、咳嗽、躁动反应多于Ⅲ组(均P＜0.01),但较Ⅱ组少(均P＜0.01);Ⅰ组对胃镜检查的评价与Ⅲ组无明显差异(P＞0.05),与Ⅱ组相比有明显差异(P＜0.01).结论 分步给药法是一种适用于低氧易感患者无痛胃镜检查的安全、有效的镇静/镇痛方法.     

Similarities in Skeletal Muscle Strength and Exercise Capacity Between Renal Transplant and Hemodialysis Patients

Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients. Aim of the study was to assess to what extent exercise capacity and skeletal muscle strength of RTx patients differ from HD patients and healthy controls and to elucidate potential determinants of exercise capacity in RTx patients. Exercise capacity, muscle strength, lean body mass (LBM) and physical activity level (PAL) were measured by cycle-ergometry, isokinetic dynamometry, DEXA and Baecke Questionnaire, respectively, in 35 RTx, 16 HD and 21 controls. VO2peak and muscle strength of the RTx patients were significantly lower compared to controls (p<0.01), but not different compared to HD patients. In RTx patients, strength (p<0.001), PAL (p=0.001) and age (p=0.045) were significant predictors of VO2peak. Muscle strength was related to LBM (p=0.001) and age (p=0.001), whereas gender (p<0.001) and renal function (p=0.01) turned out to be significant predictors of LBM. No effects of corticosteroids were observed. Exercise capacity and muscle strength seem equally reduced in RTx and HD patients compared to controls. In RTx patients, muscle strength and PAL are highly related to exercise capacity. Renal function appears to be a significant predictor of LBM, and through the LBM, of muscle strength and exercise capacity.     

心理干预对社区老年抑郁病人的影响

[目的 ]探讨心理干预对社区老年抑郁病人的影响。 [方法 ]采用对照研究的方法 ,按区域用老年抑郁量表(GDS)将筛选出的符合标准的老年抑郁病人分为干预组及对照组 ,对干预组病人进行 3个月的心理干预 ,3个月后两组进行GDS评分及抑郁障碍缓解率的比较分析。 [结果 ]干预前两组GDS分数比较无统计学意义 ,3个月后干预组GDS得分显著低于对照组 ;干预后干预组的抑郁障碍缓解率显著高于对照组。 [结论 ]心理干预可以显著减轻老年抑郁病人的抑郁症状 ,提高抑郁病人的缓解率。     

Complications Related to Dapsone Use for Pneumocystis Jirovecii Pneumonia Prophylaxis in Solid Organ Transplant Recipients

Dapsone, used for prevention of Pneumocystis jirovecii infections, has been reported to cause hemolytic anemia and methemoglobinemia; its tolerability in solid organ transplant recipients is not well described. We investigated dapsone-related adverse events in patients undergoing solid organ transplantation from 1999 to 2004. Transplant providers identified patients for the investigators who then reviewed the patients' hospital and outpatient records. Sixteen solid organ transplant recipients fit case definitions for dapsone-related hemolytic anemia (n = 11) or methemoglobinemia (n = 5). Median time from event to dapsone discontinuation was 15 days; all patients improved after drug discontinuation. G6PD enzyme activity was normal in all patients whose test results were available. Dapsone may be associated with hemolytic anemia or methemoglobinemia, even with normal G6PD levels. These events are often not promptly recognized, and drug discontinuation is delayed. Dapsone-related hemolytic anemia or methemoglobinemia should be considered in solid organ transplant recipients with unexplained anemia or hypoxia.     

Excessive daytime somnolence in Japanese patients with Parkinson''s disease

To investigate the prevalence and severity of excessive daytime somnolence (EDS) in Japanese patients with Parkinson's disease (PD) and to examine the main cause of EDS. Fifty-three Japanese patients with PD (PDs: 32 females and 21 males) and 17 controls (10 females and seven males) were evaluated using the Epworth Sleepiness Scale (ESS). The severity of the disease was evaluated by Unified Parkinson's disease Rating Scale (UPDRS), and information about quality and quantity of medications was collected. The correlations amongst EDS and age, severity of PD, duration of illness and medications were analyzed. The mean ESS score was significantly higher in advanced PDs than in controls, and correlated with the UPDRS score (r(s) = 0.743, P < 0.0001). Age, duration of illness and the dose of levodopa weakly correlated with ESS score. The intake of dopamine agonists did not affect the severity of EDS. The mean ESS score in PDs was lower than that reported in PD in European and American studies. EDS in Japanese patients with PD was milder compared with Caucasian patients, which might be due to the lower doses of the medications used in Japan. The results suggest that EDS in PD is mainly because of neuropathological changes of the disease itself.     

Diagnostic value of serum prostate-specific antigen in hemodialysis patients

BACKGROUND: The value of serum prostate-specific antigen (PSA) screening was examined to detect prostate cancer in men receiving hemodialysis. METHODS: Forty-one male patients age 60-95 (median age, 70 years) receiving hemodialysis were investigated for PSA levels. We set the cut-off point at 4 ng/mL (the usual reference range). Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) of the prostate were performed in patients whose PSA was more than 4 ng/mL and/or who expected further examination of the prostate. When prostate cancer was suspected, biopsy of the prostate was performed. In patients with prostate cancer, magnetic resonance imaging, computed tomography and bone scintigraphy were performed to diagnose the clinical stage. RESULTS: The mean serum level of PSA was 2.10 +/- 0.49 ng/mL. In this screening study, four of 41 men required further examinations for prostate cancer. Two of four refused further examinations. The other two were diagnosed with prostate cancer. The incidence of prostate cancer was at least 5% in our hemodialysis patients. One man, whose clinical stage was T2aN0M0, was treated with radical retropubic prostatectomy. Another man, whose clinical stage was T2bN0M0, was treated with luteinizing hormone-releasing hormone analogue. CONCLUSION: In our preliminary study, prostate cancer screening with PSA was useful for the early detection of prostate cancer in hemodialysis patients. If possible, DRE and TRUS should be performed in conjunction with PSA tests.     

Dynamic observations on NK cell activity and IL-2 and IFNγ productionin vitro in patients on maintenance hemodialysis

Summary In order to study the immune function of patients on maintenance hemodialysis (MHD), we assayed NK cell cytotoxicity against K⁵⁶² targets in 40 patients on MHD, and the production of IL-2 and IFN in peripheral blood mononuclear cells (PBMC) after PHA stimulation, in contrast to those in normal controls. The results showed that NK cell activity and IL-2 and IFN levels were markedly lower in the patients than in the controls. Afeter a single dialysis, NK cell activity as well as IL-2 and IFN levels were elevated to different extent. But there was no significant change in patients after long-term dialysis. There was a positive correlation between the NK cell activity and IL-2 and IFN activity in the controls, but no such correlation was found in the patients on MHD. There was a positive correlation between the NK cell activity and IL-2 activity in patients after dialysis, suggesting that immune function were impaired in the patients on MHD, with a decline in the activity of NK cell and IL-2 and IFN, and a disorder of immune regulation cycle. These abnormal immune impairments in the patients could be partly corrected by hemodialysis. However, long-term hemodialysis is not much helpful in the improvement of patient’s immune function.