血清iPTH、Ca、P和血液透析患者死亡率之间的关系

目的 探讨长沙市第一医院血透患者CKD-MBD标志物的达标率,以及它们和血液透析患者死亡率之间的关系.方法 对2014年1月至2016年12月期间,在本院进行血液透析的177例患者的病史、实验室检查结果进行了回顾性分析.以2009年KDIGO指南为标准,了解177例患者CKD-MBD标志物的达标率.根据临床结局将患者分为死亡组35例,存活组142例.使用广义估计方程比较死亡组和存活组患者的iPTH、钙、磷.再用Logistic回归模型评估血透患者血清磷、钙和甲状旁腺素与全因死亡率之间的关系.结果 本院177例血透患者中,有102例(57.6％)血清钙浓度、51例(28.8％)血清磷浓度、81例(45.8％) iPTH达到指南标准.死亡组和存活组患者的钙、iPTH有差异,而磷无差异.在本次研究中,钙和磷与血透患者的全因死亡率相关,而iPTH与全因死亡率无关.结论 本研究所显示的结果要不同于之前欧美国家观察性研究的结果,KDIGO指南的建议是否适合中国血透人群仍需要进一步的证明.     

La prise en charge des troubles du métabolisme minéral et osseux avant le stade de la dialyse reste encore perfectible. À partir des données de l’Observatoire national du métabolisme minéral et osseux Photo-Graphe

Only limited data is available on the management of the chronic kidney disease-associated bone and mineral metabolism disorder (CKD-MBD) in the pre-dialysis stages of CKD in France. A better knowledge of current management habits could lead to an improvement in the implementation of international recommendations (KDIGO). The 3rd version of the French Phosphorus and Calcium Survey Photo-Graphe (Sanofi) included a cohort of CKD stages 4 and 5 patients, whose aim was to examine the prevalence of CKD-MBD and the quality of its management in patients under the care of 62 nephrologists from over 20 geographical regions in France. The study started in October 2011, i.e. one year after patient enrollment. We examined in particular the percentage of patients presenting with laboratory parameter abnormalities indicative of CKD-MBD who were not receiving adequate treatment. A total of 456 patients with CKD stage 4 and 154 with CKD stage 5 were studied. Their mean age was 72.9 ± 14.2 years, and male/female ratio was 58/42. KDIGO targets of serum PTH for CKD stages 4 and 5 were not achieved in respectively 80 and 84% of the patients, for serum calcium in 8 and 22% and for serum phosphate in 12 and 46%. As a potential explanation, insufficient therapy was estimated to account for respectively 45 and 60% of insufficiently controlled secondary hyperparathyroidism, and for 36% of persistent hyperphosphatemia in stage 5. It should be noted that 55.5 and 57.5% of patients were receiving native vitamin D. In this national observatory, the management of CKD-MBD stages 4 and 5 appears suboptimal, especially as regards the control of secondary hyperparathyroidism, which remained untreated in nearly 50% of the patients. Hyperphosphatemia was also common and inadequately controlled in CKD stage 5. To improve the management of CKD-MBD, nephrologists need to be more aware of the importance of aiming for recommended laboratory targets and how this can be achieved.     

全段甲状旁腺激素联合钙磷测定在慢性肾脏病患者中的应用价值

目的 探讨全段甲状旁腺激素(iPTH)联合钙磷测定在慢性肾脏病(CKD)患者中的应用价值.方法 选择2015年1月至2016年6月期间我院肾内科收治的CKD3~5期患者92例为研究对象,将52例CKD3~4期患者纳入慢性肾功能衰竭(CRF)早期组,40例CKD5期患者纳入终末期肾病组,并选择40例健康体检者纳入对照组,检测并比较三组受检者的血清钙磷及iPTH水平.结果 CRF早期组与对照组比较,血钙、血磷水平差异均无统计学意义(P>0.05),但CRF早期组患者血清iPTH为(105.54±31.45)pg/mL,明显高于对照组的(30.23±11.62)pg/mL,差异有统计学意义(P<0.05);终末期肾病组患者血钙为(2.02±0.24)mmol/L,明显低于CRF早期组的(2.23±0.48)mmol/L及对照组的(2.34±0.32)mmol/L,血磷及iPTH水平分别为(1.91±0.77)mmol/L、(413.53±114.75)pg/mL,均明显高于CRF早期组[(1.34±0.46)mmol/L、(105.54±31.45)pg/mL]及对照组[(1.17±0.43)mmol/L、(30.23±11.62)pg/mL],差异均有统计学意义(P<0.05).结论 血清iPTH测定可用于反映CKD患者的肾功能进展程度,进一步联合钙磷测定对CKD的早期诊断和治疗具有的指导意义.     

32P 韧致辐射显像在甲状腺结节核素介入治疗中的应用

目的 探讨应用韧致辐射监测介入核素在人体甲状腺及其它部位的分布及其可行性。方法 ①以２个相同规格分别装有约１４．８ＭＢｑ的＾３２Ｐ胶体及＾９９ｍＴｃ的玻璃瓶为模型,进行＾３２Ｐ能谱、窗宽实验。②对介入治疗后甲状腺进行＾３２Ｐ显像,并与＾９９ｍＴｃ甲扫图比较。结果 ①＾３２Ｐ模型韧致辐射能谱为一连续曲线,其顶峰能量约为８３ｋｅＶ,最佳窗宽为６０％。②用实验的能量参数在人体可得到理想的３２Ｐ韧致辐射图     

不同血液净化方法对患者钙、磷、甲状旁腺激素、营养状态及生活质量的影响

目的 探究不同血液净化方法对血液透析患者钙、磷、甲状旁腺激素(iPTH)、营养状态及生活质量的影响.方法 前瞻性选取2019年6月至2021年1月汕头市中心医院血液净化中心收治的60例血液净化患者作为研究对象,按随机数表法将患者分为普通血液透析(HD)、透析+血液透析滤过(HD+HDF)、透析+血液灌流(HD+HP),...     

二维黑磷及其在口腔医学领域的研究应用进展

二维黑磷具备独特的层状结构和出色的光学性能、良好的生物相容性和高生物降解性。近年研究显示,二维黑磷在生物医学领域具有稳定的载药和光控调节缓释药物功能、优异的抗菌活性和促血管和神经再生能力,因此在口腔医学中具有广阔的应用前景。本文就二维黑磷的生物学特性及其在口腔医学领域的研究应用进展进行综述,以期为二维黑磷的进一步研究和...     

Short-term effectiveness of radiochemoembolization for selected hepatic metastases with a combination protocol

AIM:To introduce the combination method of radio-chemoembolization for the treatment of selected hepatic metastases. METHODS:Twenty patients with biopsy proven hepatic metastases were selected from those who underwent transarterial radiochemoembolization, a novel combination protocol, between January 2009 and July 2010. Patients had different sources of liver metastasis. The treatment included transarterial administration of three chemotherapeutic drugs (mitomycin, doxorubicin and cisplatin), followed by embolization with large (50-150 μm) radioisotope particles of chromic 32P. Multiphasiccomputer tomography or computer tomography studies, with and without contrast medium injections, were performed for all patients for a short-term period before and after the treatment sessions. The short-term effec-tiveness of this procedure was evaluated by modified response evaluation criteria in solid tumors (mRECIST), which also takes necrosis into account. The subjective percentage of necrosis was also assessed. The response evaluation methods were based on the changes in size, number, and the enhancement patterns of the lesions between the pre-and post-treatment imaging studies. RESULTS:Patients had liver metastasis from colorectal carcinomas, breast cancer, lung cancer and carcinoid tumors. The response rate based on the mRECIST criteria was 5% for complete response, 60% for partial response, 10% for stable disease, and 25% for progressive disease. Regarding the subjective necrosis percentage, 5% of patients had complete response, 50% had partial response, 25% had stable disease, and 20% had progressive disease. Based on traditional RECIST criteria, 3 patients (15%) had partial response, 13 patients (65%) had stable disease, and 4 patients (20%) had disease progression. In most patients, colorectal carcinoma was the source of metastasis (13 patients). Based on the mRECIST criteria, 8 out of these 13 patients had partial responses, while one remained stable, and 5 showed progressive disease. We also had 5 cases of breast cancer metastasis which mostly remained stable (4 cases), with only one partial response after the procedure. Six patients had bilobar involvement; three of them received two courses of radiochemoembolization. The follow up imaging study of these patients was performed after the second ses-sion. In the studied patients there was no evidence of extrahepatic occurrence, including pulmonary radioac-tive deposition, which was proven by Bremsstrahlung scintigraphy performed after the treatment sessions. For the short-term follow-ups for the 2 mo after the therapy, no treatment related death was reported. The mostly common side effect was post-embolizationsyndrome, presented as vomiting, abdominal pain, and fever. Nineteen (95%) patients experienced this syndrome in different severities. Two patient had ascites (with pleural effusion in one patient) not related to hepatic failure. Moreover, no cases of acute liver failure, hepatic infarction, hepatic abscess, biliary necrosis, tumor rupture, surgical cholecystitis, or non-targeted gut embolization were reported. Systemic toxicities such as alopecia, marrow suppression, renal toxicity, or cardiac failure did not occur in our study group. CONCLUSION:Radiochemoembolization is safe and effective for selected hepatic metastases in a short-term follow-up. Further studies are required to show the long-term effects and possible complications of this approach.     

More than skin deep? Potential nicotinamide treatment applications in chronic kidney transplant recipients

Non-melanoma cutaneous carcinomas, or skin cancers, predominantly squamous cell carcinomas (SCCs), are the most common malignancies occurring in kidney transplant recipients (KTRs). Squamous cell carcinoma risk is dramatically elevated in KTRs, occurring at rates of up 45-250 times those reported in general populations. New non-melanoma skin cancers in KTRs with a prior non-melanoma skin cancer also develop at 3-times the rate reported in non-KTRs with the same clinical history. The unique aggressiveness of SCCs in KTRs increases patient morbidity, due to the high rate of new lesions requiring treatment, frequently surgical excision. Oral nicotinamide shows promise in the chemoprevention of the especially aggressive non-melanoma skin cancers which occur in KTRs. This benefit might be conferred via its inhibition of sirtuin enzymatic pathways. Nicotinamide’s concurrent hypophosphatemic effect may also partially ameliorate the disturbed calcium-phosphorus homeostasis in these patients-a putative risk factor for mortality, and graft failure. Conceivably, a phase 3 trial of nicotinamide for the prevention of non-melanoma skin cancers in KTRs, lasting at least 12-mo, could also incorporate imaging and laboratory measures which assess nicotinamide’s impact on subclinical cardiovascular and chronic kidney disease risk, and progression.     

不同年龄组和病损牙氟磷含量比的变化

随机采集口腔科门诊拔牙患者的离体牙７０个，按年龄分３组（儿童组、中青年组、老年组）；按病变分３组（正常组、龋齿组、氟斑牙组）。各组牙齿均经１０％甲醛浸泡。清除结石，用优级纯硝酸冷消化处理后，分别采用电化学分析法和分光光度法测定离体牙氟和磷的含量并计算氟磷含量比（Ｆ／Ｐ）。结果表明，中青年组Ｆ／Ｐ值是儿童组的１１８倍，是老年组的１．８倍；而正常组牙齿Ｆ／Ｐ值则是龋齿组的１．６倍，氟斑牙组的１．１倍。     

密封微波溶样联合测定堆肥样品中全量氮,磷,钾

采用密封微波溶样技术一次消化堆肥样品，同时测定全量氮，磷，钾，样品处理时间由１０个小时缩短为现在的十几分钟，测定的精密度得到改善，回收率在９７．３％～１０１．５％。