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81.
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.
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.相似文献
82.
联机血液透析滤过治疗尿毒症的临床应用研究 总被引:4,自引:0,他引:4
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。 相似文献
83.
炎症在尿毒症血管病变中的作用及其机制 总被引:17,自引:3,他引:14
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. 相似文献
84.
高海琳!北京 《中国现代医药杂志》1999,(2)
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。 相似文献
85.
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。 相似文献
86.
W. C. Arnold Belinda Shirkey Paul Frindik Eileen Ellis 《Pediatric nephrology (Berlin, Germany)》1991,5(4):529-532
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. 相似文献
87.
血液透析和尿毒症对血清肿瘤标志物的影响 总被引:1,自引:0,他引:1
摘要 目的:了解血液透析和尿毒症对肿瘤标志物水平的影响。方法:采用病例对照的方法,选择67例维持性血液透析患者作为透析组、67例未行血液透析的尿毒症患者(CKD5期)作为非透析组,并选择419例健康人作为对照组。测定血清肿瘤标志物进行比较,并将血透组按血透维持时间分为两个亚组比较。结果:两组肿瘤标志物水平无统计学差异,2组肿瘤标志物CA153、CA125、CA242、AFP、Ferritin、β-HCG、HGH、NSE与正常对照比,差异有统计学意义;血清CA19-9、PSA、fPSA、CEA的差异无统计学意义。2个亚组肿瘤标志物水平差异无统计学意义。结论:尿毒症患者部分肿瘤标志物有不同程度的升高,血透不能清除肿瘤标志物。 相似文献
88.
Jolanta Malyszko Maria Mazerska Jacek Malyszko Krystyna Pawlak Arsalan Azzadin Michal Mysliwiec Wlodzimierz Buczko 《International Journal of Clinical & Laboratory Research》1993,23(1-4):42-44
Summary Recombinant human erythropoietin was administered to 12 patients with end-stage renal failure on long-term hemodialysis. They
responded to the therapy with a shortening of the prolonged bleeding time, starting from the 1st week of therapy, before a
significant increase in hemoglobin concentration was achieved. We also observed an increase in the activity of tissue plasminogen
activator and a decrease in the activity of its inhibitor. There were no changes in platelet count but a significant increase
in blood and platelet serotonin concentration was found. The shortening of the prolonged bleeding time before the correction
of the anemia correlated with the rise in blood and platelet serotomin concentration during erythropoietin therapy. We suggest
the possible involvement of an serotonergic mechanism in the hemostatic action of recombinant human erythropoietin. 相似文献
89.
Wang Mengjing Huang Bihong Tao Ye Zhang Weichen Chen Weisheng Huang Junwen Wang Hongying Zhang Minmin Chen Jing. 《中华肾脏病杂志》2018,34(12):909-916
Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P<0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P<0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P<0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO. 相似文献
90.
尿毒症患者淋巴细胞亚群改变的研究 总被引:3,自引:0,他引:3
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。 相似文献