肾缺血预处理对未成熟心肌凋亡蛋白表达的影响

目的 :探讨肾缺血预处理 （RIP）对未成熟心肌细胞凋亡相关蛋白表达的影响。方法 :采用兔Langendorff模型 ,幼兔 2 4只随机分为 3组 ,对照组 （C ,n =8） :仅灌注KH液 180min ,然后取标本 ;缺血 /再灌组 （I/R ,n =8） :灌注 2 0min后 ,停灌 4 5min ,再灌 12 0min ;肾缺血预处理组 （RIP ,n =8） ,反复 2次阻断肾血流 5min/放开 5min ,建立Langendorff模型 ,然后重复I/R组缺血 /再灌方法。以凋亡细胞原位标记与半定量分析、琼脂糖凝胶电泳检测DNA片段梯及Bcl 2、Bax、Fas基因蛋白的表达作为观察指标。结果 :凋亡细胞原位标记与半定量分析 :RIP组与I/R组比较 ,心肌细胞凋亡率显著减少 ;琼脂糖凝胶电泳检测DNA片段梯 :RIP组与I/R组比较 ,光密度显著降低 ;RIP组与I/R组比较 ,Bcl 2表达明显增多 ,Bax、Fas表达显著减少。结论 :RIP可能通过调节Bcl 2、Bax、Fas蛋白的不同表达影响心肌细胞的凋亡。     

连续性不卧床腹膜透析治疗艾滋病并发终末期肾脏病(附一例报道)

目的：观察连续性不卧床腹膜透析（CAPD）对艾滋病（acquired immunodeficiency syndrome,AIDS）并发终末期肾脏病（ESRD）的疗效。方法：一例确诊为艾滋病的男性患者,合并慢性丙型肝炎、血友病甲（Ⅷ因子缺乏）和糖尿病,高效抗逆转录病毒治疗（HAART）1年后出现蛋白尿及肾功能不全,进展至ESRD后行CAPD治疗,观察CAPD前后残余肾功能、贫血、钙磷代谢、心功能、营养状况等变化,并进行透析充分性及并发症评估。结果：患者行CAPD治疗后高血压、贫血、氮质血症、酸中毒及心功能均明显改善,体重稳定,无水肿,Kt/V2.01/周,nPCR1.133g/（kg.d）。存在营养不良-炎症-心血管疾病综合征及代谢紊乱。结论：AIDS并发ESRD行CAPD作为肾脏替代治疗可取得满意疗效。     

Dobutamine stress echocardiography and cardiac troponin T for the detection of significant coronary artery disease and predicting outcome in renal transplant candidates.

AIMS: Ischaemic heart disease is the leading cause of mortality and morbidity in patients with end-stage renal disease (ESRD) and after renal transplantation. However, the optimal non-invasive test for coronary artery disease (CAD) diagnosis in this population has yet to be established. The aim of this study was to assess the diagnostic accuracy of dobutamine stress echocardiography (DSE) and baseline plasma cardiac troponin T (cTnT) for detecting significant CAD and predicting adverse cardiac events in patients referred for renal transplantation. METHODS: Coronary angiography, DSE, and baseline cTnT measurements were performed in 118 consecutive patients (mean age 52+/-12 years, 75 male) with ESRD (mean creatinine 608+/-272 micromol/L) referred for renal transplantation. The mean follow-up period was 1.32+/-0.48 years. Significant CAD was defined as a reduction in luminal diameter >70% by visual estimation in at least one major epicardial vessel. An abnormal DSE result defined as the development of a new regional wall motion abnormality in one or more normal resting segments or a deterioration of wall motion in one or more resting hypokinetic segments. A baseline cTnT>0.1 microg/L was taken as positive. RESULTS: Significant CAD in at least one vessel was present in 35 patients (30%). The number of patients with significant 3 vessel and 2 vessel disease was 6 and 7, respectively. An abnormal DSE result was present in 36 (31%) patients. Thirty-one (26%) had cTnT>0.1 microg/L. Sixty-four (54%) patients were on dialysis and 46 (39%) were diabetic. The sensitivity, specificity, positive and negative predictive values for DSE in detecting significant coronary artery disease were 88%, 94%, 86% and 95%, respectively. The same values for a raised cTnT were 54%, 62%, 40% and 74%, respectively. The combination of an abnormal DSE result and raised cTnT gave values of 61%, 91%, 76%, and 80%, respectively. Over the follow-up period, mortality was significantly higher in those with a raised baseline cTnT but not those with an abnormal DSE result or significant CAD. CONCLUSION: DSE is an accurate technique for the detection of significant CAD in renal transplant candidates. An elevated cTnT does not predict significant CAD in this population and when used in conjunction with DSE, reduces the sensitivity of the combined tests. cTnT is an important marker of prognosis in renal transplant candidates.     

Transradial bilateral cardiac catheterization and endomyocardial bioposy: a feasibility study.

A case series and technique of transradial cardiac catheterization with cardiac biospy are described. Transradial cardiac catheterization is perceived to be limited to arterial procedures. Using the veins of the forearm, we have converted many previous femoral arterial/venous cardiac procedures to a transradial/forearm approach. Retrospective review of patients undergoing transradial procedures with concurrent cardiac biopsies was undertaken. A convenience sample of transfemoral procedures with biopsies performed by the same operator was identified for comparison. Coronary angiography/left heart catheterization was performed using standard transradial/femoral approaches. A 7 Fr introducer sheath was placed via a large median forearm or femoral vein. Right heart catheterization was done using a 120 cm balloon-tipped catheter and endomyocardial biopsy was performed with a 7 Fr biotome. Both groups were then compared for baseline characteristics and procedural events. Transradial (n = 8) and transfemoral (n = 12) procedures were all done for postcardiac transplantation management. There was no crossover between groups. Durations of the radial procedures (median, 73 min; range, 40-95) were similar to transfemoral procedures (median, 68 min; range, 45-105). No procedural complications were reported. Endomyocardial biopsy plays an important role in the diagnosis of transplant rejection and identification of pathological processes that cause myocardial dysfunction. Transradial cardiac catheterization has some clear advantages over a transfemoral approach. Bilateral cardiac catheterization with concurrent cardiac biopsy is technically feasible using a transradial/forearm approach. This approach offers an alternative approach for selected patients in need of cardiac biopsy.     

老年人院内急性肾功能衰竭的临床特点及急诊腹膜透析疗效分析

目的　分析老年人院内急性肾功能衰竭 (ARF)的常见原因及床旁插管进行连续性腹膜透析 (CCPD)的临床效果。方法　老年ARF 2 8例 ,年龄 6 0～ 84 (6 8 2± 9 6 )岁。青壮年ARF 13例 (男 7例 ,女 6例 ) ,年龄 19～ 4 5(39 5± 9 1)岁。分析两组病人的ARF致病因素 ,观察和对比 32例床旁插管进行腹膜透析 (PD)的临床效果。结果　在导致ARF的各种原因中 ,肾前性因素占的 32 1% ,感染及创伤控制欠佳共占 39 3%以及肾毒性药物的不当使用占 14 3% ,合计占 85 7%。 2 1例老年ARF患者 (76 % )接受腹膜透析治疗 ,11例 (5 2 4 % )获得完全缓解、5例 (2 3 8% )转为慢性维持腹膜透析 ,抢救成功率达到 81 0 % ,病死率仅为 19 1%。结论　肾前性因素 ,感染及创伤的控制欠佳以及肾毒性药物的不当使用是老年人院内ARF的常见原因 ,床旁插管进行腹膜透析是一种安全、简单、有效的治疗方法。     

Percutaneous high-speed rotational atherectomy (Rotablator™) of a restenosed ostial renal artery: A case report

This case report describes the feasibility and potential benefit of the use of a high-speed rotational atherectomy device (the Rotablator?) in the treatment of renovascular hypertension in a patient with a recorded restenosis of an ostial renal artery lesion following standard balloon angioplasty.     

Paradoxical emboli through the patent foramen ovale as the suspected cause of myocardial and renal infarction in a 48-year-old woman.

We review the case of a 48-year-old woman who underwent elective percutaneous patent foramen ovale closure following successive renal and myocardial infarction with normal renal and coronary arteries, probably as a consequence of paradoxical emboli.     

福建省闽西地区维持性血液透析患者病因及贫血状况的多中心调查

目的 了解福建省闽西地区终末期肾病(ESRD)患者的病因构成及其贫血状况。 方法 回顾性分析闽西地区11家医院2014年1-12月因ESRD行维持性血液透析的858例患者的临床资料,比较患者的血红蛋白水平与铁缺乏、营养状况、甲状旁腺激素、透析充分性、促红细胞生成素(EPO)治疗之间的关系。 结果 ESRD的病因中,前3位分别为慢性肾小球肾炎(458例,52.79%)、糖尿病肾病(143例,16.67%)和高血压肾病(128例,14.92%)。使用EPO治疗775例,治疗率90.33%,贫血治疗达标率42.87%。血红蛋白越低,EPO治疗的比例越高,用量也越大。与贫血治疗达标患者比较,贫血治疗不达标患者血清铁蛋白、转铁蛋白饱和度、血清白蛋白水平明显低下(均为P<0.05),血甲状旁腺素、肌酐、尿素氮水平明显升高(均为P<0.05),每周3次透析的患者所占比例明显下降(P<0.05)。 结论 闽西地区ESRD的病因主要是原发性肾小球肾炎、糖尿病肾病和高血压肾损害; 维持性血液透析患者贫血治疗率高,但达标率仍偏低,主要影响因素是铁缺乏、营养不良、继发性甲状旁腺功能亢进和透析不充分。