益肾解毒方配合血液透析治疗尿毒症28例临床观察

目的:进一步提高终末期尿毒症维持性血液透析(血透)患者的透析效果及生活质量。方法:采用益肾解毒方配合血透治疗终末期尿毒症患者28例,并设对照组28例,仅予常规血透。两组疗程均为1个月,连续观察3个月。结果:治疗组28例中所测得的平均时间尿素氮浓度(TACurea)、蛋白质分解率(PCR)及G—S指数(KT/V值)均明显优于对照组(P<0.05)。结论:益肾解毒方配合血透在提高透析充分性及患者生活质量方面优于单纯的血透。     

血液灌流联合血液透析治疗尿毒症皮肤瘙痒临床观察

目的：探讨血液灌流联合血液透析治疗尿毒症的临床疗效。方法：维持性血液透析患者24例,随机分为两组,治疗组12例,采用血液灌流联合透析治疗;对照组12例,单纯透析治疗。两组均采用肝素抗凝,血流量200～250ml/min,透析液流量500ml/min。检测治疗前后血肌酐、尿素氮、甲状旁腺激素、β2微球蛋白、血压及临床症状。结果：治疗组皮肤瘙痒减轻及甲状旁腺激素、β2微球蛋白清除显著高于对照组（P〈0.05）。结论：血液灌流联合血液透析治疗尿毒症病人,可清除中分子物质,可有效减轻皮肤瘙痒。     

左旋卡尼汀对尿毒症腹透患者心功能不全的治疗作用

目的探讨左旋卡尼汀对尿毒症腹透患者心功能不全的治疗作用。方法选择维持性腹膜透析患者30例，分为对照组15例和治疗组15例，对照组给予维持性的腹膜透析，治疗组在维持性腹膜透析同时予左旋卡尼汀治疗．疗程均为30d。分别于治疗后评价疗效。结果治疗组心功能改善有效率为93．7％，明显高于对照组的73．3％（P〈0．01）。治疗前后心率、血压、心输出量及左室射血分数均有显著改善（P〈0．05）。治疗组与对照组比较差异有统计学意义（P〈0．05）。结论维持性腹膜透析的尿毒症患者同时使用左旋卡尼汀，心功能明显改善。     

Roentgenological signs in the skeleton of uremic children

The roentgenological signs encountered in the skeleton of uremic children, some treated by hemodialysis and others untreated, are described and related to histological studies. There is a discrepancy in behaviour between cortical and cancellous bone. Under the influence of parathormone cortical bone is eroded from the periosteal, endosteal and Haversian system surfaces. In contrast, cancellous bone is dense (osteosclerosis). The epiphyseal growth plate is narrow in end-stage renal failure; the histological equivalent of the radiolucent area in the growing zone is primary spongiosa consisting of undermineralised woven bone devoid of chondroid.     

Effects of hemodialytic treatment on uremic polyneuropathy

Summary The involvement of the peripheral motor and sensory nerve, at least on a subclinical level, is a nearly constant event with chronic renal failure. The study of the motor and sensory propagation velocity indicates that a widespread functional lesion of the axon with a peripheral point of attack and secondary demyelination, may be the basic pathogenetic event of uremic polyneuropathy. Prolonged hemodialytic treatment is substantially unable to influence the evolution of uremic polyneuropathy. The electrophysiological follow-up study of the peripheral nerve does not seem to be an index of adequate dialysis.

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Zusammenfassung Die Beteiligung des peripheren motorischen und sensiblen Nerven, zumindest subklinisch, ist bei chronischer Niereninsuffizienz Regel. Die Untersuchung der motorischen und sensorischen Erregungsleitungsgeschwindigkeit spricht dafür, daß bei der urämischen Polyneuropathie als wesentliches pathologisches Geschehen das Axon besonders distal ausgedehnt betroffen ist mit einer sekundären Demyelinisation. Auch langdauernde Hämodialyse scheint nicht in der Lage zu sein, die Entwicklung der urämischen Polyneuropathie zu beeinflussen. Die elektrophysiologische fortlaufende Kontrolle des peripheren Nerven scheint nicht ein brauchbarer Parameter für eine wirksame Dialyse zu sein.

     

联机血液透析滤过治疗尿毒症的临床应用研究

目的：探讨联机血液透析滤过（On-line hemodiafiltration,On-line HDF)对尿毒症患不同分子量物质的清除率、患耐受性及临床疗效。方法：回顾性分析18例伴有血透并发症及不适症状的尿毒症患行后稀释法On-line HDF 231例次，并与23例仍行常规血液透析（HD）治疗的患（887例次）进行比较，观察Kt/V，血清肌酐（Scr)、尿素氮（BUN）、血磷（SP）、β2－微球蛋白（β2－M）下降率及治疗中患血透常见并发症和不良反应发生率。结果：患对联机HDF治疗效果和耐受性显优于HD，透析并发症和不适症状发生率显低于HD（P＜0．01），联机HDF治疗后血清Scr、BUN、SP、β2－M水平显降低，KT／V明显增高。结论：后稀释法联机HDF能有效清除尿毒症患血中大、中、小分子物质，透析效果显提高，患对该法治疗的耐受性明显提高，适用于易出现血透并发症及不适症状的尿毒症患。     

炎症在尿毒症血管病变中的作用及其机制

目的探讨炎症在尿毒症血管病变中的作用及其相关机制.方法21例尿毒症透析前患者在行动静脉内瘘术中取部分桡动脉,同时选择10例胸外科良性肿瘤患者,在术中选取同级别的部分胸廓内动脉作对照,分别用ELISA和免疫组织化学方法检测所有患者血浆C反应蛋白(CRP)及血管壁上巨噬细胞表面抗原CD68、单核细胞趋化因子(MCP-1)、氧化低密度脂蛋白(ox-LDL)、内皮素1(ET1)、内皮性一氧化氮合成酶(eNOS)、增殖细胞核抗原(PCNA)、纤连蛋白(FN)的表达,并根据血浆CRP水平将尿毒症患者分为A组(CRP≥10 mg/L)和B组(CRP＜10 mg/L).结果常规HE染色A组4例尿毒症患者桡A存在明显的粥样斑块.尿毒症患者血管壁中层明显增厚,壁厚/外径(T/D)比值A组明显高于B组和对照组(0.54±0 10对0.37±0 07、0.24±0.07,P＜0.01).A组患者血浆CRP水平及血管壁上CD68、MCP-1、ox-LDL、ET1、PCNA、FN的表达均显著高于B组和对照组(P＜0.01),且CRP水平与上述指标在血管壁上的表达呈明显正相关(P＜0.01).血浆白蛋白(Alb)和eNOS在血管壁上的表达,A组却低于B组和对照组(P＜0.01).结论炎症加重了营养不良、氧化应激及血管内皮功能的紊乱,是尿毒症血管病变的重要因素.     

高通透性滤过器血液透析尿毒症32例临床观察

目的观察高通透性滤过器血液透析对尿毒症病人的治疗效果。方法选择32例尿毒症病人并进行高通透性滤过器血液透析。结果血尿素氮,肌酐,磷及β_2微球蛋白均明显下降。结论高通透性滤过器血液透析能有效清除血液中代谢废物成份,能大大提高病人的生活质量,能减少由于长期透析所产生的并发症。     

血、尿β_2微球蛋白在小儿常见肾脏疾病中的意义

本文测定了健康儿童血和尿β_2微球蛋白(β_2m)正常值,观察了几种儿科常见肾脏病血和尿β_2m变化。在急性肾炎早期血β_2m可有轻度增高。肾病综合征和IgA肾病有少数病例血和/或尿β_2m增高。狼疮肾炎和过敏性紫癜肾炎部分病例血β_2m增高,而尿β_2m增高更显著。尿毒症病例血β_2m与血肌酐(SCr)、血尿素氮(BUN)呈正相关,与肌酐清除率(Ccr)呈负相关。尿β_2m测定肾小管功能较酚红排泄试验和莫氏试验敏感,并能反映出肾小管病理改变。     

Effect of growth hormone on kidney growth and glomerular structure

The effect of growth hormones (GH) on renal growth was measured in growing uremic rats using a five-sixths nephrectomy model and GH, 5 mg/kg per day. At the end of 8 weeks, somatic size was significantly smaller in the untreated uremic rats. The uremic rats given GH were the same size as the non-uremic control animals. Organ size (heart, liver and kidney) differed in that only untreated uremic animals had a significantly smaller kidney weight. Despite a five-sixths nephrectomy, the uremic animals receiving GH had kidneys the same size as shamoperated control animals. Renal function was not changed by GH therapy in either control or uremic animals. DNA content expressed as milligrams per kilogram kidney tissue was low only in the untreated uremic rats. Glomerular volume and proximal tubular area were elevated in both groups of uremic animals but were elevated to a significantly greater degree in those receiving GH. GH given in large doses to growing animals appears to induce both somatic and renal growth.