血卟啉衍生物(HpD)—激光对缺血小鼠肾脏的影响—光镜、组化和电镜观察

经尾静脉给雄性昆明小鼠注入HpD(10mg/kg体重),48小时后阻断肾动脉,造成缺血、缺氧的肾脏模型。然后用250—300J/cm~2剂量的630nm波长激光照射小鼠肾脏。最早出现的形态学改变是间质水肿和毛细血管破坏。近端小管上皮细胞在光照后6小时出现形态学改变,其它结构均在光照后24小时发生坏死。超微结构主要是线粒体、内质网和细胞核的破坏。肾酶的损伤程度为Cytox>AKP>ACP>SDH。实验结果表明,断血肾脏对血卟啉光动力学作用敏感性降低,但血管损伤加重。因此,血管损伤不是造成实质细胞损伤的始动因素,氧在血卟啉光动力学作用中是必需的。     

高血糖导致肾脏高灌注的机制研究

探讨了高血糖对整体大鼠和离体灌注鼠肾（ＩＰＲＫ）血流动力学的影响及其机制。结果显示：高血糖在整体大鼠和ＩＰＲＫ均可引起肾血浆流量（ＲＰＦ）、肾小球滤过率（ＧＦＲ）的增加；在ＩＲＰＫ阻断管－球反馈后，高血糖不再能诱发上述改变；结构和葡萄糖相似的Ｄ－α－甲基－葡萄糖苷在ＩＰＲＫ可引起与相同渗透浓度的葡萄糖相似的ＲＰＦ，ＧＦＲ增加；血红蛋白不改变高血糖对肾血流动力学的影响。提示：高血糖可支接引起肾脏高灌注、高滤过，其机制主要是对管一球反馈的抑制，此抑制效应可能与葡萄糖的结构相关。内皮由来性舒张因子（ＥＤＲＦ）在高血糖导致的ＩＰＲＫ高灌注中不起主要作用。     

微嵌合体表达与移植肾免疫耐受的实验研究

目的探讨肾移植术后受者微嵌合体表达与免疫耐受的相关性。方法采集接受男性供体肾脏移植术后女性受者不同生存期外周血及尿沉渣标本,采用Y染色体三对引物SRY1、DYZ11st和DYZ12nd,应用PCR和RT-PCR方法检测标本中微嵌合体特异性代表Y染色体DNA和mRNA的表达,同时测定移植肾功能。结果在130例供者为男性的女性肾移植受者检测到嵌合阳性者98例,占75.39%(n=130),嵌合阴性者32例,占24.61%。嵌合阳性与阴性两组比较,移植肾平均存活时间分别为(8.7±3.5)年和(5.4±3.3)年,P<0.05;嵌合阳性者发生过排斥反应的有11例,占11.22%,而嵌合阴性者为9例,占28.13%,P<0.05;血清肌酐在嵌合阳性者(74.3±32.5)mol/L,而嵌合阴性者为(113.6±37.8)mol/L,P<0.05。结论受者体内嵌合阳性与阴性者相比具有更好的移植肾功能和低排斥率,肾移植术后受者生存期愈长嵌合阳性率愈高,提示肾移植术后受者体内的嵌合状态与免疫耐受具有相关性。     

诱导型一氧化氮合酶在单侧输尿管梗阻大鼠肾脏的表达

目的:探讨诱导型一氧化氮合酶(iNOS)在单侧输尿管梗阻(UUO)大鼠术侧肾脏的表达.方法:建立左侧输尿管梗阻模型(UUO组),设假手术组为对照.3 d后应用逆转录-聚合酶链反应(RT-PCR)检测iNOS的mRNA水平.结果:与对照组相比,UUO组大鼠肾脏出现明显病理变化,并且其iNOS mRNA表达明显增加.结论:iNOS参与UUO的发生和发展的病理过程.     

Kidney transplant monitoring by anti donor specific antibodies

Donor-specific anti-HLA antibodies were studied by cytotoxicity crossmatching (CTXM) and flow cytometry crossmatching (FCXM) in 117 kidney transplant candidates; the same study was carried out in 33 cadaver-donor kidney recipients, during the first 3 post-transplant months, for which donor cells were available. Pre-transport evaluation showed that 82.9 % of subjects were CTXM negative/FCXM negative, 6.8 % of patients were positive in both tests, and 10.3 % were CTXM negative/FCCM positive. Post-transplant monitoring for donor-specific antibodies (Abs-DS) showed that nine recipients (27.3 %) were FCXM positive; six of them were IgG + and three IgM +. In comparing these results with the clinical course, a significant association between FCXM IgG + and rejection episodes was observed (P < 0.01).     

肾虚型牙周炎患者血清锌水平的变化

应用原子吸收光谱分析法检测了４０例牙周炎患者和１９例健康人血清锌水平，结果表明：牙周炎患者血清锌水平呈降低趋势，但差异无显著性；根据患者病情的轻重程度和中医辨证分析显示：牙周炎患者血清锌水平的降低不仅与其病情的严重程度呈负相关，而且肾虚型牙周炎患者的血清锌水平明显低于健康人和无肾虚型牙周炎组（Ｐ〈０．０５），无肾虚型牙周炎组与健康人之间血清锌水平无显著差异（Ｐ〉０．０５），提示：血清锌水平的降低…     

免疫性血小板减少性紫癜辨证分型与血小板表面相关抗体及T淋巴细胞亚群的关系

为探讨免疫性血小板减少性紫癜（ITP）中医辨证分型与免疫机理的关系,将ITP患者中医辨证分型结合血小板相关抗体（PAIg）及T淋巴细胞亚群进行分析。发现作为本病主要抗体的PAIgG脾肾阴亏型明显高于脾虚失统型（P<0.01）;OKT₈⁺值亦显著高于脾虚失统型（P<0.05）,OKT₄⁺/OKT₈⁺比值则明显低于脾虚失统型（P<0.05）。提示脾肾阴亏型的免疫损伤程度较脾虚失统型严重。     

Impact of Dialysis and Older Age on Survival after Liver Transplantation

Because creatinine is heavily weighed in the MELD (model for end-stage liver disease) score, we sought to determine the impact of MELD-based organ allocation on outcomes after transplantation in the pre- and post-MELD eras, focusing on recipients over age 65 on dialysis prior to transplant. A total of 20 196 patients from the UNOS database were analyzed. Comparing the pre-MELD to MELD era, there was a 41% increase in patients on dialysis (p<0.0001), and a 117% increase in combined liver/kidney transplants (p<0.0001). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who received liver transplant alone was 56.8% and 76.4%, respectively (p=0.13). In the MELD era these rates were 50.7% and 77.8% (p=0.04). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who underwent combined liver/kidney transplantation was 25.0% and 83.2%, respectively (p=0.0002). In the MELD era, these rates were 67.0% and 82.5% (p=0.18). In conclusion, a greater proportion of patients in the MELD era are on dialysis prior to transplant, and more receive combined liver/kidney transplants compared with the pre-MELD era. Candidates over age 65 who are on dialysis at the time of transplant have decreased survival after isolated liver transplantation.     

碎石术对肾结石患者肾功能损害的观察

目的 探讨肿瘤坏死因子-α（TNF-α）和表皮生长因子（EGF）在经尿道体外冲击波碎石术（ESWL）的变化和规律。方法采用放射免疫分析法，选择性地对50例肾单发结石患者ESWL前后TNF-α和EGF含量进行测定。结果碎石后尿中TNF-α含量在1～4d与术前比较总体水平明显升高（t=2．22，P〈0．05），术后2d TNF-α含量明显高于术后4d（t=2．82，P〈0.01），第5天水平回落，与术前比较差异无统计学意义（P〈0．05）；EGF的含量术后明显高于术前（t=2．28，P〈0．05）。结论TNF-α和EGF水平可能提示肾小管细胞的自身炎症过程及与肾损害的发生机制密切相关。     

肾移植术后并发大腿感觉功能障碍(附28例报告)

目的 提高对肾移植术后并发大腿感觉功能障碍的认识水平。方法 对179例肾移植术后患者进行问诊和大腿皮肤针刺检查。结果 179例中发现28例存在手术侧大腿感觉功能障碍。其中78例移植肾动脉与髂内动脉吻合的患者中有11例，分别为大腿前面7例、外侧面2例、前面和外侧面2例：101例移植肾动脉与髂外动脉吻合的患者中有17例，分别为大腿前面13例、外侧面1例、前面和外侧面3例。除1例为持续性感觉功能障碍外，其余27例均在术后半年内自愈。结论 肾移植术后出现手术侧大腿皮肤感觉功能障碍是较常见的并发症。肾移植术前应告知患者可能出现这种并发症。