血液透析患者甲状旁腺全切除加上臂移植术后低钙血症的防治

目的 观察因继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）进行甲状旁腺全切除加上臂移植术（total parathyroidectomy with upper arm autograft,TPTX＋AT）的血液透析患者,术后使用不同钙离子浓度的透析液行透析治疗低钙血症的效果,探讨如何更有效防治术后低钙血症.方法 选择2011年3月至2013年6月在我院接受TPTX＋AT的血液透析患者29例,按照手术时间的先后顺序进行编号,随机将偶数分在A组14例,奇数分在B组15例.术前B组补钙及骨化三醇;术后2组均予补钙及骨化三醇.A组使用钙浓度1.50 mmol/L透析液,B组使用钙浓度1.75 mmol/L高钙透析液.观察术后8 h、24 h、48 h、1周、2周及4周的血钙、血磷及甲状旁腺素（intact parathyroid hormone,iPTH）的变化,记录低钙血症的临床症状,术后达到治疗目标所需要的时间及静脉补钙量.结果 术后血钙、血磷、iPTH均明显下降.术后低钙血症主要表现四肢末端发麻,全身无力,焦虑、烦躁;少数患者表现为心悸、多汗、肌肉痉挛、四肢抽搐,血压低、腹痛或腹泻.A组低钙血症发生率为 85.7%（12/14）、B组为 73.3%（11/15）.术后1周B组血钙水平[（1.95±0.18）mmol/L]明显高于A组[（1.76±0.21）mmol/L].B组术后达到治疗目标所需要的时间为[（7.56±2.25）d],少于A组[（10.54±3.12）d];而B组所需静脉补钙量[（6.86±2.13）g]少于A组[（9.28±2.81）g],差异均有统计学意义（P＜0.05）.结论 并发SHPT的血液透析患者在TPTX＋AT术后常会出现低钙血症,术前、术后足量补充钙剂和骨化三醇,术后使用高钙透析液透析能更加有效防治低钙血症.     

Body composition measurements using bioimpedance analysis in peritoneal dialysis patients are affected by the presence of dialysate

The presence of peritoneal dialysate when performing bioimpedance analysis may affect body composition measurements. The aim of this study was to evaluate the impact of dialysate on body composition measurements in Asians. Forty‐one patients undergoing maintenance peritoneal dialysis in our hospital peritoneal dialysis unit were included in this study. Dialysate was drained from the abdomen prior to measurement, and bioimpedance analysis was performed using multi‐frequency bioimpedance analysis, with each subject in a standing position (D‐). Dialysate was then administered and the measurement was repeated (D+). The presence of peritoneal dialysate led to an increase in intracellular water (ICW), extracellular water (ECW), and total body water (D‐: 20.33 ± 3.72 L for ICW and 13.53 ± 2.54 L for ECW; D+: 20.96 ± 3.78 L for ICW and 14.10 ± 2.59 L for ECW; P < 0.001 for both variables). Total and trunk oedema indices were higher in the presence of peritoneal dialysate. In addition, the presence of peritoneal dialysate led to an overestimation of mineral content and free fat mass (FFM) for the total body; but led to an underestimation of body fat (D‐: 45.80 ± 8.26 kg for FFM and 19.30 ± 6.27 kg for body fat; D+: 47.51 ± 8.38 kg for FFM and 17.59 ± 6.47 kg for body fat; P < 0.001 for both variables). Our results demonstrate that the presence of peritoneal dialysate leads to an overestimation of FFM and an underestimation of fat mass. An empty abdomen is recommended when evaluating body composition using bioimpedance analysis.     

低钙透析对血液透析患者血管结构和心脏功能的影响

目的观察低钙透析对维持性血液透析患者血管结构和心脏功能的影响。方法测定2007年6月至12月在安徽医科大学第三附属医院肾内科血液透析中心30例维持性血液透析（maintenance hemodialysis,MHD）患者,所有患者入组前均使用标准钙1．5mmol／L（dCa^2＋1．5）透析,透析过程平稳。入组后改用低钙1．25mmol／L（dCa^2＋1．25）透析液,余治疗方案不变。入组前及改用低钙透析液6个月后行血生化检查。采用GE ViVid 7型彩色多普勒超声诊断仪检测颈总动脉内膜-中层厚度（intima medial thickness,IMT）、左心室射血分数（left ventricular ejectian fraction,LVEF）,测量舒张早期和舒张晚期最大血流速度。并根据公式计算心脏输出指数,舒张早期和舒张晚期最大血流速度的比值（E／A）等指标。结果在使用dCa^2＋1．25透析液6个月后,患者血清钙值和钙磷乘积与使用dCa^2＋1．5透析液相比明显下降,甲状旁腺激素（parathyroid hormone,PTH）水平明显上升（P〈0．05）,有统计学差异,而其它的血清生化指标的变化无统计学差异。使用低钙透析6个月后,患者颈动脉IMT较使用dCa^2＋1．5透析液相比明显下降,（E／A）比值水平明显上升（P〈0．05）,而左心室射血分数及心脏输出指数在使用dCa^2＋1．25透析液6个月后变化无统计学差异（P〉0．05）。结论低钙透析可改善维持性血液透析患者动脉粥样硬化和动脉顺应性的下降,促进左室舒张功能,并推测其作用可能与纠正钙磷代谢紊乱有关。     

HT-ED联合UPLC-MS/MS技术分析白头翁皂苷B4的大鼠血浆蛋白结合率

目的:建立血浆中白头翁皂苷B4的分析方法,测定白头翁皂苷B4大鼠血浆蛋白结合率。方法:采用96通道高通量平衡透析系统(HTD 96b)进行透析,利用UPLC-MS/MS测定透析内外液中白头翁皂苷B4的浓度,研究白头翁皂苷B4在大鼠血浆中的血浆蛋白结合率,使用Waters XTerra MS C18色谱柱(2.1 mm×50 mm,5μm),流动相0.1%甲酸水溶液-乙腈梯度洗脱,流速0.7 m L·min~(-1),柱温40℃,进样量5μL。结果:白头翁皂苷B4在5~2 000 ng·L-1线性关系良好,其精密度RSD及准确度均8.0%,重复性RSD9.0%,稳定性的RSD均15%;提取回收率和基质效应均在80%~115%。白头翁皂苷B4在低、中、高(6,12,24 mg·L-1)3个质量浓度下大鼠血浆蛋白结合率分别为(95.32±0.37)%,(94.32±0.63)%,(88.64±0.37)%。结论:白头翁皂苷B4与大鼠血浆具有较强的蛋白结合率,且结合率不具有质量浓度依赖性。     

Modulatory effects of plasma and colonic milieu of patients with ulcerative colitis on neutrophil reactive oxygen species production in presence of a novel antioxidant,rebamipide

Rebamipide protects gastrouintestinal mucosal integrity against reactive oxygen species (ROS). The effect of rebamipide on the capability of PMNs to produce ROS in the presence of plasma and rectal dialysates (RD) of control and ulcerative colitis (UC) subjects was evaluated. We recruited six healthy volunteers for obtaining PMNs, control plasma, and control RD and six patients with inactive UC for obtaining plasma and RD. PMNs were activated using fMLP, and ROS was measured by fluorescent microplate assay (DCFD). Rebamipide significantly inhibited the neutrophil respiratory burst by 45%. Plasma from both control subjects and UC patients significantly blunted the fMLP-induced respiratory burst. However, the plasma of the UC patients was significantly less inhibitory than the plasma of control subjects. RD from control subjects significantly blunted the fMLP-induced respiratory burst while, RD from patients with UC did not. Rebamipide maintained its antioxidant effects in the presence of plasma or RD obtained from both controls and UC patients. In conclusion, partial loss of the inhibitory effects of plasma and RD in patients with UC may contribute to oxidative-induced tissue damage in UC and rebamipide antioxidant properties were not hampered by the biological milieu of patients with UC.     

离子色谱法测定血液透析液中乳酸根的含量

目的：建立离子色谱法测定血液透析液中乳酸根的含量测定方法并进行方法验证,为乳酸盐透析液的质量控制和市场监管提供重要的技术参考。方法用DIONX ICS?1100离子色谱仪进行检测,色谱柱为AS9?HC柱（4 mm×250 mm）,淋洗液为9 mmol／L碳酸钠,流速1 mL／min,电导检测器,外标法定量。结果乳酸根的线性范围为5?03～80?54μg／mL（ r＝0?9999）,定量限为0?1007μg／mL,平均加样回收率为101?4％。结论该方法准确,分析时间短,样品无需前处理,不受样品中其他组分的干扰,可用于血液透析液中乳酸根的含量测定。     

High Glucose Concentrations in Peritoneal Dialysate Are Associated with All-Cause and Cardiovascular Disease Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

♦ Background: The effect of high peritoneal dialysate glucose concentration (PDGC) on all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is unclear.♦ Objective: Our study aimed to investigate the effect of high PDGC on all-cause and CVD mortality in continuous ambulatory PD (CAPD) patients.♦ Methods: The study enrolled 716 patients newly initiated on CAPD therapy between January 2006 and December 2010. We allocated the patients to low (<1.56%), medium (≥1.56% to <1.74%), and high (≥1.74%) average PDGC groups according to the tertile of average PDGC in the first 6 months after PD initiation. Cox regression and ordinal logistic regression were used to analyze determinants of mortality and of PDGC use respectively.♦ Results: Mean follow-up in the study cohort was 31 ± 15 months. The all-cause mortality was 4.7 events per 100 patient-years, and the leading cause of death was CVD. Patients with a higher PDGC had significantly higher cumulative rates of all-cause (log-rank p < 0.001) and CVD mortality (log-rank p < 0.001). In Cox regression analysis, high PDGC independently predicted higher all-cause (hazard ratio: 2.63; p = 0.004) and CVD mortality (hazard ratio: 2.78; p = 0.01). Compared with a lower PDGC, a higher PDGC was significantly associated with older age [odds ratio (OR): 1.02; p < 0.001], low residual renal function (OR: 0.91; p < 0.001), and high dialysate-to-plasma ratio of creatinine (OR: 28.61; p < 0.001) in ordinal logistic regression.♦ Conclusions: Higher PDGC is associated with higher allcause and CVD mortality in CAPD patients.     

Does a reduction in dialysate sodium improve blood pressure control in haemodialysis patients?

Introduction: There has been debate as to the value of lower sodium dialysates to control blood pressure in haemodialysis patients, as sodium is predominantly removed by ultrafiltration. Methods: Re‐audit of clinical practice following reduction in dialysate sodium concentration. Results: Overall dialysate sodium concentration decreased from 138.9 ± 1.7 to 137.8 ± 1.7 mmol/L (mean ± standard deviation), resulting in a reduction in pre‐ and post‐dialysis mean arterial pressure (MAP) of 4 mmHg (from 100.6 ± 15.6 to 97.1 ± 15.6, P < 0.01 and from 91.7 ± 15.6 to 87.1 ± 14.6, P < 0.001 respectively), yet fewer patients were prescribed antihypertensives (49.6 vs 60.6%), and less antihypertensive medications/patient (mean 0.86 vs 1.05), ultrafiltration requirements (2.8% vs 3.2% body weight, P < 0.001), and symptomatic intradialytic hypotension (0.19 vs 0.28 episodes per week, P < 0.001). A multivariable model showed that for a dialysate sodium of 136 mmol/L, younger patients had higher MAP than older patients (0.35 mmHg lower MAP/year older; but with a dialysate sodium of 140 mmol/L, there was minimal association of MAP with age (0.07 mmHg higher MAP/year older). Conclusion: Change in clinical practice, amounting to a modest reduction in dialysate sodium was associated with a reduction not only in pre‐ and post‐dialysis blood pressures, but also ultrafiltration requirements and symptomatic intradialytic hypotension. However, this effect on blood pressure was most marked for older patients and women, within minimal effects for younger patients, and lesser effects for men, suggesting that dialysate sodium reduction alone may help improve blood pressure control, but requires additional factors such as dietary sodium restriction to be effective in younger male patients.     

益气固肾透析液对维持性血液透析患者血清补体功能的影响

目的:观察益气固肾透析液对维持性血液透析患者血清补体功能的影响。方法:将益气固肾液加入常规透析液中配制成益气固肾透析液,治疗15例维持性血透患者3月,并与15例采用常规透析液治疗的患者进行对照,观察2组治疗前后C3、C4、CH50的改变及治疗期间各种感染发生的情况。结果:益气固肾透析液组治疗后的C3、C4、CH50均较疗前有显著增高,与常规透析液组比较,P<0.01;且前者人均感染次数为(0.53±0.64)次;后者人均感染次数为(1.13±0.92)次,2组比较,P<0.05。结论:益气固肾透析液可使维持性血液透析患者卫表固,营血和,推测其一方面可增加患者补体的生成,一方面可改善透析膜的生物相容性,减少补体的损耗。     

低钙透析液对腹膜透析患者动力缺失性骨病的治疗

目的通过观察动力缺失性骨病的腹膜透析患者使用低钙透析液提高全段甲状旁腺激素(iPTH)治疗动力缺失性骨病的有效性和安全性以及对钙磷代谢的影响。方法选取动力缺失性骨病患者(iPTH<100ng/L)22例,改用百特(Baxter)PD4(Ca1.25mmol/L)透析液治疗,回顾分析9个月血iPTH、血钙、血磷、血钙磷乘积及血白蛋白等指标。结果使用低钙透析液治疗后,第一个月血iPTH水平明显上升[治疗前vs1月(52.34±33.49)ng/Lvs.(117.66±63.16)ng/L,P<0.05],第3、6、9月逐步上升,并保持在安全范围内。iPTH水平上升至100~300ng/L的患者所占比例在第1、3、6、9个月分别为50%、62.5%、63.5%、63.5%。治疗后第一个月血钙水平由治疗前(2.56±0.23)mmol/L下降至(2.25±0.20)mmol/L(P=0.01);血磷水平由治疗前的(1.66±0.48)mmol/L降至(1.47±0.41)mmol/L(P<0.05);血钙磷乘积值由治疗前的52.20±14.29下降至40.79±11.38(P<0.01)。平均血钙、血磷、血钙磷乘积值在后8个月中均保持稳定。血钙磷乘积值在第1、3、6、9个月达到目标值(<55)的比例分别为73.33%,77.78%,82.35%,85%,与治疗前(50%)比较,P值均<0.05。治疗前后血清白蛋白无明显差异。治疗中没有明显低钙抽搐、低血压等情况发生。结论对动力缺失性骨病的腹膜透析患者使用低钙透析液能有效地调整其iPTH水平以治疗动力缺失性骨病,并且安全性好,同时能有效地控制血钙、血磷及钙磷乘积水平。