尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检测的临床意义

目的：探讨尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检验的临床价值。方法：用AVE-763尿沉渣分析仪观察尿毒症组、肾小球肾炎血尿组和非肾小球血尿组患者的尿红细胞形态并计算畸形率,再用XT-2000i全自动血细胞分析仪检测尿红细胞及外周血红细胞MCV。结果：尿毒症组尿红细胞畸形率、MCV及血MCV／尿MCV与肾小球肾炎血尿组比较差异有统计学意义（P〈0．01）,与非肾小球血尿组比较差异无统计学意义（P〉0．05）。结论：尿毒症患者尿红细胞形态、MCV与非肾小球性血尿接近,临床医生诊断和观察病情变化时必须重视。     

尿毒症患者淋巴细胞亚群改变的研究

目的了解尿毒症患者淋巴细胞亚群的改变。方法采用血液细胞计数仪对血液细胞进行分类与计数;使用单激光三色流式细胞仪,分析带荧光标记单克隆抗体染色的淋巴细胞及其亚群。结果①血常规计数表明:尿毒症患者存在淋巴细胞减少症(P<0.005),中性粒细胞百分比高于正常对照组(P<0.005);②淋巴细胞亚群分析提示:尿毒症患者CD3 、CD4 、CD8 细胞百分数以及CD4/CD8比值,与正常对照组相比差异无显著性(P>0.05);NK细胞百分数明显增高(P<0.005),透析组CD8 细胞数较未透析组增加[(27.45±7.26)%Vs(20.33±7.01)%,P=0.042],单核细胞数高于正常对照组[(75.6±9.68)%Vs(63.98±12.82)%P=0.039];B淋巴细胞数低于正常对照组[(4.33±1.69)%Vs(9.49±3.30)%P=0.001];③尿毒症患者表现为Th2细胞优势(P<0.05),Th1/Th2比值显著降低(P<0.05),长期透析后上述表现无改善。结论尿毒症患者T细胞亚群表现为Th2优势,透析患者存在B淋巴细胞减少,淋巴细胞亚群的这些改变可能参与了血液透析患者免疫功能下降的发病机理。     

TRPC6基因变异致儿童激素耐药型肾病综合征四例并文献复习

目的:探讨TRPC6基因变异致儿童激素耐药型肾病综合征(SRNS)的特征、治疗及预后。方法:回顾性分析2017年1月至2019年12月在上海市儿童医院肾脏风湿科住院的4例(SRNS)且经基因检测为TRPC6变异患儿的临床资料。以“肾病综合征”“TRPC6”“儿童”“nephrotic syndrome”“TRPC6 variation”“child”为检索词,检索建库至2020年8月中国知网数据库、万方数据库、维普数据库及PubMed数据库并进行文献复习。结果:4例SRNS患儿中,男1例、女3例,起病年龄4岁1月龄至12岁2月龄。临床均以浮肿、大量蛋白尿、低蛋白血症起病,4例出现贫血,2例出现继发性甲状旁腺功能亢进,1例肾萎缩。肾脏病理结果示1例为免疫复合物相关性肾炎,3例为局灶节段肾小球硬化。4例患儿病初予足量糖皮质激素治疗4周以上,均为激素耐药,后予糖皮质激素联合免疫抑制剂(如环磷酰胺、钙调神经磷酸酶抑制剂、霉酚酸酯)治疗,症状没有改善。4例患儿2~6个月进展为终末期肾病。全外显子测序显示4例患儿TRPC6基因变异类型分别为c.2684G>T、c.523C>T、c.2678G>A、c.2683C>T,均为新发变异。文献检索纳入中文文献1篇,外文文献9篇,共27例。汇总分析31例(包括本组)病例资料,其中18例错义变异,移码变异、同义变异、剪切变异各1例。起病年龄4月龄至14岁,18例患儿临床表现为大量蛋白尿、低蛋白血症,6例仅表现为蛋白尿,19例患儿病理类型为局灶节段肾小球硬化,IgA肾病、微小病变各2例,塌陷性肾小球病、C1q肾病、免疫复合物相关性肾小球肾炎各1例。18例患儿激素治疗无效,11例钙调神经磷酸酶抑制剂类药物无效。该疾病预后不佳,12例患儿出现肾衰竭,进展至终末期肾病时间为4个月至13.8年。结论:TRPC6基因变异致SRNS的患儿起病年龄较小,病理特征多为局灶节段肾小球硬化,激素及免疫抑制剂治疗多无效,进展迅速预后差。     

组织多普勒Tei指数评价尿毒症患者心肌损害程度的的价值

目的:探讨组织多普勒(TDI)综合射血等容期指数[Tei,(二尖瓣关闭~开放时间-主动脉射血时间/主动脉射血时间)]评价尿毒症心肌损害程度的价值。方法:85例尿毒症患者根据二维超声心动图(2D)心肌回声强度等指标分为心肌损害逐渐加重之Ⅰ、Ⅱ、Ⅲ组(n=30,32,23),分别进行2D各项参数及左室射血分数(LVEF)、短轴缩短率(FS)、心搏指数(SI)测定,并利用脉冲多普勒(PWD)测定二尖瓣血流频谱E峰、A峰、E/A比值,同时利用TDI技术检测二尖瓣瓣环运动频谱,获取TDI-Tei,并与30例正常人(正常对照组)进行比较,分析不同组间各项指标差异。结果:与正常对照组比较,尿毒症Ⅱ、Ⅲ组的LVEF[(65.30±7.42)%∶(54.01±10.63)%、(47.35±10.67)%],FS[(32.86±6.31)%∶(26.78±6.03)%、(23.29±6.08)%]显著下降(P0.01),SI[(41.75±8.61)ml/m2∶(50.73±10.86)ml/m2、(52.09±9.53)ml/m2]显著升高(P0.01),Ⅰ组与正常对照组比较则无显著性差异。与正常对照组比较,尿毒症3组TDI-Tei均显著升高,且Ⅰ、Ⅱ、Ⅲ组的水平依次显著升高[(0.36±0.13)、(0.57±0.29)、(0.74±0.36)、(0.87±0.26)]P0.01。结论:TDI-Tei是较传统超声心动图指标更为敏感的,评价尿毒症心功能损害程度无创指标。     

肾性甲状旁腺功能亢进症甲状旁腺全切加前臂移植31例临床分析

目的总结31例尿毒症继发性甲状旁腺功能亢进症(以下简称甲旁亢)行甲状旁腺全切加前臂移植的临床经验。方法回顾性分析1996-2005年我院肾科行甲状旁腺全切加前臂移植者31例的临床特点、相关内科处理及疗效。结果 31例患者为长期血液透析者(平均透析9.2年),26例有骨痛,11例有骨折,25例有皮肤瘙痒,14例有转移性钙化。(2)31例患者血甲状旁腺激素(iPTH)平均为(1811±879)ng/L;颈部 B 超及发射型计算机体层摄影术均证实有增生肿大的甲状旁腺2～4枚,内科治疗均失败。(3)31例患者均做甲状旁腺全切加前臂移植术,术后症状明显改善。iPTH 快速下降至200 ng/L 以下。高钙、高磷恢复至正常水平,碱性磷酸酶逐步下降。随访最长时间9年,目前 iPTH、钙、磷正常。结论严重肾性甲旁亢对内科治疗失败者应及时行甲状旁腺全切加前臂移植治疗,疗效可靠。     

使用不同透析膜时IL-8表达的改变

目的 了解不同透析膜对血液透析患者IL-8表达的影响。方法 采用酶联免疫吸附试验(ELISA)测定IL-8血浆水平及外周血单个核细胞(PBMC)培养上清液IL-8水平,逆转录多聚酶链反应(RT-PCR)检测基因表达。结果 聚砜膜组的IL-8血浆水平及mRNA表达低于铜仿膜组及铜氨膜组,而铜仿膜组及铜氨膜组之间无显著差异。各组透析后的IL-8血浆水平及mRNA表达均较透析前升高。铜仿膜组透析前PBMC受LPS刺激后产生的IL-8多于聚砜膜组,血透后聚砜膜组产生的IL-8较透析前升高,而铜仿膜组较透析前无明显改变。结论 再生纤维素膜(尤其是铜仿膜)导致IL-8表达改变的能力强于聚砜膜,测量IL-8表达有助于评价不同透析膜的生物相容性。     

Dendritic cell co-stimulatory and co-inhibitory markers in chronic HCV: An Egyptian study

AIM:To assess co-stimulatory and co-inhibitory markers of dendritic cells(DCs)in hepatitis C virus(HCV)infected subjects with and without uremia.METHODS:Three subject groups were included in the study:group 1 involved 50 control subjects,group2 involved 50 patients with chronic HCV infection and group 3 involved 50 HCV uremic subjects undergoing hemodialysis.CD83,CD86 and CD40 as co-stimulatory markers and PD-L1 as a co-inhibitory marker were assessed in peripheral blood mononuclear cells by realtime polymerase chain reaction.Interleukin-10(IL-10)and hyaluronic acid(HA)levels were also assessed.All findings were correlated with disease activity,viral load and fibrogenesis.RESULTS:There was a significant decrease in costimulatory markers;CD83,CD86 and CD40 in groups2 and 3 vs the control group.Co-stimulatory markers were significantly higher in group 3 vs group 2.There was a significant elevation in PD-L1 in both HCV groups vs the control group.PD-L1 was significantly lower in group 3 vs group 2.There was a significant elevation in IL-10 and HA levels in groups 2 and 3,where IL-10was higher in group 3 and HA was lower in group 3 vs group 2.HA level was significantly correlated with disease activity and fibrosis grade in group 2.IL-10 was significantly correlated with fibrosis grade in group 2.There were significant negative correlations between co-stimulatory markers and viral load in groups 2 and3,except CD83 in dialysis patients.There was a significant positive correlation between PD-L1 and viral load in both HCV groups.CONCLUSION:A significant decrease in DC co-stimulatory markers and a significant increase in a DC coinhibitory marker were observed in HCV subjects and to a lesser extent in dialysis patients.     

老年血液透析患者的临床特征分析

目的探讨老年维持性血液透析患者的临床特征。方法选择1993年3月～2010年5月间在杭州市中医院肾内科进行维持性血液透析治疗的167例老年血液透析患者（≥60岁）和同期140例非老年维持性血液透析患者,对比分析两组的病因、营养指标、透析效果、临床转归等。结果继发性肾脏疾病在老年组发病率增加。两组患者间总胆固醇（TC）、甘油三酯（TG）、钙（Ca）、甲状旁腺激素（PTH）、铁蛋白（Fer）及每月促红素用量无统计学差异（P〉0．05）。老年组透析前血浆白蛋白（Alb）、尿素氮（BUN）、血清肌酐（Cr）、磷（P）、舒张压、透析间期增重均低于非老年组,hsCRP水平高于非老年组P〈0．01）。两组间尿素氮清除效率（Kt／v）比无统计学差异。随访1年,老年组死亡16例,其中脑血管意外8例（50％）,感染5例（31．2％）,肿瘤1例（6．3％）,心肌梗死1例（6．3％）,高钾血症1例（6．3％）;非老年组死亡6例,其中脑出血2例（33％）,感染1例（16．6％）,肾癌1例（16．6％）,心肌梗死1例（16．6％）,高钾血症1例（16．6％）。非老年组另有5例改行肾移植,1例改行腹透。结论随着透析技术不断进步,老年透析患者透析质量改善,生存期延长,脑血管并发症和感染是主要死亡原因。     

老年尿毒症患者血液透析滤过临床疗效

目的探讨老年尿毒症患者对血液透析滤过（ＨＤＦ）的耐受性及临床疗效。方法回顾性分析２０例老年尿毒症患者１６６例次ＨＤＦ，并与其常规血液透析（ＨＤ）治疗进行比较。结果患者对ＨＤＦ治疗的耐受性显著优于ＨＤ，且ＨＤＦ对小分子及中分子尿毒性物质的清除显著优于ＨＤ，ＨＤＦ治疗前血β２微球蛋白（β２－ＭＧ）值６０．７±１２．９ｍｇ／Ｌ、甲状旁腺素（ＰＴＨ）２．０±１．３ｐｇ／Ｌ，治疗后分别为４９．９±１１．０ｍｇ／Ｌ，及１．１±０．９ｐｇ／Ｌ，治疗前、后差异均有非常显著性（Ｐ＜０．０１及＜０．００１）；而ＨＤ治疗前后β２－ＭＧ分别为５２．８±１２．７及５１．７±１１．９ｍｇ／Ｌ（Ｐ＞０．０５），ＰＴＨ１．９±１．６及１．９±１．８ｐｇ／Ｌ（Ｐ＞０．０５）。结论老年尿毒症患者ＨＤＦ未发生ＨＤ时发生的顽固性高血压、严重的低血压、心律失常、心绞痛、心力衰竭、体腔积液等，提高了对透析治疗的耐受性，透析效果显著提高     

Effects of Peripheral Blood Mononuclear Cells Morphology on Vascular Calcification in Uremic Patients on Maintenance Hemodialysis

We used high‐resolution atomic force microscopy (AFM) to examine possible changes in the morphology of peripheral blood mononuclear cells (PBMCs), and to investigate their influence on vascular calcification in uremic patients on maintenance hemodialysis (MHD). 36 uremic patients had cardiovascular diseases after MHD (MHD group1) and 30 uremic patients did not (MHD group 2), and 20 healthy volunteers were the control group. The extent of coronary artery calcification was assessed with coronary artery calcification score (CACS). AFM was used to analyze PBMCs nuances. Concentrations of bone morphogenetic protein‐2 (BMP‐2) in PBMC supernatants were detected by ELISA. Protein expressions of BMP‐2 were measured by Western blot. No significant differences in PBMC morphology were observed among groups by light microscopy. AFM images revealed that uremic patients exhibited significant differences of PBMC morphology and vascular calcification when compared with healthy volunteers. The PBMCs in uremic patients were larger in volume, mean height, half‐maximum amplitude, average roughness and higher concentrations and expression of BMP‐2 and CACS (P < 0.05), with granular processes or caveolae of uneven size distributed over cell surfaces. These differences were also significant between MHD group 1 and group 2 (P < 0.05). PBMC volume, mean height, half‐maximum amplitude, and average roughness were positively correlated with BMP‐2 and CACS. Moreover, the correlation PBMC with BMP‐2 was higher than with CACS. PBMC morphology in MHD patients was related to the degree of vascular calcification. The larger mean height, half‐maximum amplitude, average roughness and cell volume were, the higher degree of vascular calcification was.