老年人群慢性肾脏疾病流行病学研究

目的 了解我国老年人群慢性肾脏疾病(CKD)的患病率及其影响因素.方法 对2004年1月至2007年1月长期在北京医院老年病房进行健康查体及疾病治疗、病历资料完整的老年人进行回顾性调查.分别记录受检者年龄、身高、体质量、血压、血尿、蛋白尿、血红蛋白、血肌酐、血尿素、血脂、血尿酸、乙肝表面抗原、影像学检查结果 以及既往诊断疾病情况,采用公式法估算肾小球滤过率,并对影响蛋白尿及CKD的危险因素进行二分类Logistic回归分析.结果 1082例老年人中,蛋白尿检出率为4.9%,肾功能下降为47.2%,CKD检出率为48.4%;多因素Logistic回归分析表明,糖尿病(OR=2.257)和镜下血尿(OR=5.324)是老年人发生蛋白尿的危险因素(P<0.05),高血压(OR=1.459)、冠心病(OR=3.290)、慢性阻塞性肺病(OR=2.094)、恶性肿瘤(OR=2.072)、高尿酸血症(OR=1.928)、贫血(OR=8.122)、血尿(OR=1.604)是发生CKD的危险因素(P<0.05).结论 初步估计我国特殊老年人群的CKD患病率为48.4%,相关危险因素有糖尿病、高血压、高尿酸血症、贫血等,与发达国家水平相似.     

壮肾固精方联合黄芪注射液足三里穴位注射对脾肾气虚型蛋白尿患者的影响

目的：探讨壮肾固精方联合黄芪注射液足三里穴位注射对脾肾气虚型蛋白尿患者的影响。方法45例蛋白尿患者随机分为观察组和对照组,对照组予常规治疗,观察组在对照组基础上予口服壮肾固精方及黄芪注射液足三里穴位注射,观察两组治疗前后24 h尿蛋白定量（24H-UPRO）,、尿微量白蛋白（MAU）、血浆白蛋白（ALB）变化。结果观察组与对照组治疗前年龄、24 h尿蛋白定量、尿微量白蛋白无显著性差异,治疗后观察组24 h尿蛋白定量（977.9±795.4） mg/24 h、尿微量白蛋白（144.6±128.4） mg/L 显著低于对照组（1619.8±1135.4） mg/24 h、（250.0±197.9） mg/L。观察组治疗后的24 h 尿蛋白定量（977.9±795.4） mg/24 h、尿微量白蛋白（144.6±128.4） mg/L较治疗前（1757.8±1113.5） mg/24 h、（369.1±395.5） mg/L）显著降低,而治疗后血浆白蛋白（42.2±5.1） mg/24 h则较治疗前（40.7±6.3） g/L有所升高。结论壮肾固精方联合黄芪注射液足三里穴位注射可有效减少脾肾气虚型蛋白尿患者的蛋白尿。     

Expression of nephrin,podocin, α-actinin,and WT1 in children with nephrotic syndrome

Recently, nephrin, podocin, -actinin, and WT1, which are located at the slit diaphragm and expressed by the podocyte, were found to be causative in congenital/familial nephrotic syndrome (NS), but their role in acquired NS remains unclear. We studied their expression in NS with the aim of disclosing their possible role in the development of proteinuria. Immunofluorescence, confocal microscopy, and image analysis were used to study the expression and the distribution in 19 children with primary NS, 9 with isolated hematuria, and 9 controls. All the children with NS presented with heavy proteinuria and foot process effacement was identified by electron microscopy. No proteinuria and foot process effacement was seen in the group with hematuria. A dramatic decrease of podocin expression was found in NS (86.66±22.74) compared with control groups (P=0.014). Furthermore, we also found the pattern of distribution of nephrin, podocin, and -actinin changed in children with NS. In conclusion, a dramatic decrease of podocin expression and abnormal distribution of nephrin, podocin, and -actinin were found in children with NS. No differences were found in children with isolated hematuria, suggesting involvement of these molecules in the development of proteinuria in primary NS.     

醛固酮灌注诱导大鼠肾小球损伤

目的:研究醛固酮(Ald)灌注对大鼠肾小球损伤及依普利酮的干预作用。方法:18只雄性Sprague-Dawley大鼠随机分为Ald灌注组(A)、依普利酮治疗组(E)、空白对照组(C)3组,分别皮下埋置渗透性微泵,A、E组均以1.5μg/h的浓度持续灌注Ald,E组以100 mg/(kg.d)依普利酮灌胃,C组由DMSO代替Ald,测定28 d内大鼠血压及蛋白尿,于第28天处死动物,测定血浆Ald水平,取肾脏观察病理改变。结果:A和E组血浆Ald水平均显著升高。A组血压和尿微量白蛋白排泄率(UAER)从第7天起均较同期C组增高(P<0.05),E组血压和UAER均较同期A组显著降低(P<0.05)。A组肾小球系膜细胞轻度增殖,系膜外基质轻度增宽,少数肾小球出现段性硬化;足突节段性融合,部分足细胞和系膜细胞有凋亡小体形成,E组病变较A组减轻。结论:血浆Ald水平持续增高有致肾小球损伤作用。     

Glomerular and tubular function in glycogen storage disease

Urinary protein and calcium excretion were assessed in 77 patients with the hepatic glycogen storage diseases (GSD): 30 with GSD-I (median age 12.4 years, range 3.2–32.9 years), 25 with GSD-III (median age 10.5 years, range 4.2–31.3 years) and 22 with GSD-IX (median age 11.8 years, range 1.2–35.4 years). Inulin (C _inulin) and para-aminohippuric acid (C _PAH) clearances were also measured in 33 of these patients. Those with GSD-I had significantly greater albumin (F=15.07,P<0.001), retinolbinding protein (RBP) (F=14.66,P<0.001),N-acetyl--d glucosaminidase (NAG) (F=9.41,P<0.001) and calcium (F=7.41,P=0.001) excretion than those with GSD-III and GSD-IX. GSD-I patients (n=18) also had significantly higherC _inulin (F=5.57,P=0.009), butC _PAH did not differ (F=0.77, NS). Renal function was normal in GSD-III and GSD-IX patients. In GSD-I,C _inulin (r=–0.51,P=0.03) and NAG excretion (r=–0.40,P=0.03) were inversely correlated with age, whereas albumin excretion was positively correlated with age (r=+0.41,P=0.03). RBP and calcium excretion were generally high throughout all age groups. Hyperfiltration in GSD-I is associated with renal tubular proteinuria that occurs before the onset of significant albuminuria. Deficiency of glucose-6-phosphatase within the proximal renal tubule may primarily cause tubular dysfunction, glomerular hyperfiltration being a secondary phenomenon.     

Effects of Eicosapentaenoic Acid Supplementation on Immunoglobulin A Nephropathy

Eicosapentaenoic acid (EPA), which is purified from fish oil, attenuates inflammatory responses by decreasing eicosanoid and cytokine production. EPA reportedly improves renal survival in patients with immunoglobulin (Ig)A nephropathy; however, this is unconfirmed. We studied the effects of EPA on IgA nephropathy patients. Eighteen biopsy-confirmed IgA nephropathy patients (aged 31 ± 3 years) were enrolled. The prognoses based on glomerular findings were good (N = 5), relatively poor (N = 12), and poor (N = 1). EPA was administered at 1.8 g/day for 12 months. Five biopsy-confirmed IgA nephropathy patients were enrolled as control subjects. Administration of other drugs used to treat IgA nephropathy was not changed. The estimated creatinine clearance (eCCr), serum creatinine (Cr) concentration, urinary protein creatinine ratio (U/P), and other clinical parameters were checked. In the EPA group, the Cr went from 0.8 ± 0.2 mg/dL to 0.7 ± 0.2 mg/dL after 12 months of EPA treatment, and the U/P went from 550 ± 580 mg/g Cr to 330 ± 920 mg/g Cr. The values did not differ significantly; however, Cr and U/P tended to improve, with no adverse effects from the EPA. The eCCr improved significantly (99 ± 7–110 ± 8 mL/min, P = 0.001) in the EPA group, but not in the control group (126 ± 12–120 ± 13, P > 0.05). The effect of EPA in patients with IgA nephropathy is not pronounced, but these results suggest that EPA is a safe and worthwhile supplement to the drugs used to treat this disease.     

流行性出血热470例次肝功能分析

通过对流行性出血热227例470例次肝功能分析发现:肝脏损害不但与本病的病型、病程、肾功能有一定的关系,而且与患者的性别、年龄也有一定的关系。因此,在临床上应引起重视。     

Proteinuria prevalence in insulin-treated patients: prediction of need for end-stage renal failure treatment

In the Dundee Diabetic clinic area (population circa 250,000), a population-based survey of the prevalence of proteinuria in diabetic patients treated with insulin showed that 9.4% of such patients had persistent proteinuria. The percentage of males with proteinuria was 11.4%, against 7.2% of females. An additional 5.2% of patients had proteinuria observed once, but did not meet the criteria for persistent proteinuria. No result was available in 10% of patients for a variety of reasons. Not every patient with diabetes and persistent proteinuria will progress to end-stage renal failure, but consideration of the group as a whole allows predictions based on published reports, to be made of the likely future incidence of renal failure, and hence future need for renal replacement services. We estimate that over the next decade two patients per 125,000 total population will develop renal failure each year. If survival is unchanged, there could be two or three times that number on treatment at any time.     

缬沙坦联合福辛普利治疗IgA肾病蛋白尿的疗效观察

目的 观察缬沙坦联合福辛普利治疗IgA肾病蛋白尿的疗效及安全性.方法 选择IgA肾病患者60例,随机分成治疗组32例和对照组28例.治疗组给予缬沙坦联合福辛普利治疗;对照组单用福辛普利治疗.疗程为6个月,观察治疗前后24 h尿蛋白定量及药物不良反应情况.结果 治疗后治疗组24 h蛋白尿改善显著优于对照组（P＜0.01）;治疗组总有效率显著高于对照组（P＜0.01）;两组患者用药后不良反应发生率无显著差异（P＞0.05）.结论 缬沙坦联合福辛普利治疗IgA肾病蛋白尿疗效显著优于单用福辛普利,且不良反应并无增加.