一氧化氮合酶在肾脏缺血预处理中的表达

目的 :检测一氧化氮合酶 (NOS :eNOS ,iNOS ,nNOS)在肾脏缺血预处理动物模型肾组织中的表达 ,探讨NOS在肾脏缺血预处理中的可能作用机制。方法 :将 36只小白兔随机分为四组即对照组、缺血预处理组(IP)、缺血再灌注组 (I/R)和缺血预处理后再灌注组 (IP +I/R)。分别检测各组肾组织中NOS的表达及组织学变化。结果 :在急性肾缺血 6 0min再灌注 6 0min时 ,eNOS阳性表达在IP组和IP +I/R组明显高于I/R组和对照组 (P <0 .0 1) ,iNOS和nNOS在组织肾中未见明显表达。组织学变化发现I/R组肾组织中肾细胞发生明显变性坏死 ,而IP组和对照组未见明显改变。结论 :肾脏缺血预处理在肾脏缺血再灌注中具有保护作用 ,而NOS参与该作用机制。     

Assessment of split renal function with99mTc-aprotinin

The aim of this work is to correlate the net kidney uptake of^99mTc-aprotinin (TcA) in 103 subjects with separate effective renal plasma flow (ERPF) and some blood chemistry parameters at 90, 180, and 360 min postinjection both in the normal and diseased kidney. Correlations found with separate ERPFs are highly significant at any time (P < 0.001). However, although the slope of the regression line is steeper at 180 min,r tends to deteriorate slightly with time postinjection and a higher intercept on they axis: this pattern is more pronounced if diseased kidneys are considered separately. The following are probably related to the renal handling of TcA: (1) Early scans better reflect blood flow to the kidney, while later scans are more related to the metabolism/excretion tubular mechanisms; (2) correlations found with urea, creatinine, urea clearance, and creatinine clearance are highly significant at any time; (3) in 20 additional patients with diseased kidneys, renal uptake measurements done 360 min postinjection first with TcA and then with DMSA showed better correlations with ERPF employing TcA. Our results indicate that TcA is a feasible indicator of split renal function even at 90 min postinjection when a scan is easily carried out on an outpatient basis.This paper was in part presented at the European Nuclear Medicine Congress, August 14–17, 1984, Helsinki, Finland     

肾移植术后早期国产环孢素药动学的临床研究

目的:探讨肾移植受者术后早期服用国产环孢素的药动学变化特点。明确环孢素各时点血药浓度与时间曲线下面积(AUC)的相关关系。方法48例肾移植受者始服环孢素6mg/kg·d~(-1)1周后,按不同品种分环孢素组24例,赛斯平组14例及田可组10例,分别于服药即刻,服药后1、2、3、4、5、6、8、10、12h抽血查环孢素浓度(以C_0、C_1、C_2……C_(12)表示),比较不同品种药动学的变化特点。然后用逐步回归分析法计算环孢素的总体C_0、C_2、峰浓度C_(max),达峰时间(T_(max)),AUC以及各种指标的变异系数,并计算各浓度值与AUC的相关关系。结果三种国产环孢素在使用相同剂量时,C_0、C_2、C_(max)T_(max)及AUC差异均不显著,具有同质性。合并分析后,总体值C_0为(214.2±113.0)μg/L,总体C_(max)=C_2为(1048.0±378.7)μg/L,达峰时间(2.0±0.9)h,平均2h,AUC为(5106.4±1471.8)μg/(h·L)。抽血检测的10个时点浓度中,C_1、C_2、C_3、C_4、C_6、C_7与AUC的相关性有显著意义,其中C_2偏相关系数0.96最大,而变异系数(34.9％)相对较小。C_0不仅变异系数(52.8％)较大,且与AUC的相关性亦不显著。结论 国产环孢素总体峰浓度为C_2,与AUC具有较好的相关性,对AUC的变化影响大。可以将C_2作为临床一个常规的环孢素浓度监测指标。     

DTPA renal scan assessment of renal allograft dysfunction in rats

The precise cause of allograft dysfunction after renal transplantation often cannot be established by non-invasive means. In clinical practice, radionuclide scans form an integral part of the clinician's armamentarium in the assessment of these patients [1, 2]. Unfortunately, in the clinical setting more than one pathological process may be responsible for the impaired function, making it difficult to correlate the scan appearances with the pathology. In this study in rats we compared the renal DTPA scan appearances of the various pathological processes which may cause renal allograft dysfunction in the immediate post-transplant period.     

IL-2R 在急性细胞性排异反应的同种异体尸体移植肾组织中的检测及意义

为探讨白介素－２受体（ＩＬ－２Ｒ，即ＣＤ２５）在同种异体肾移植急性细胞性排异（ＡＣＲ）临床诊断的作用，着重观察移植肾发生（ＡＣＲ）和无ＡＣＲ时，其间质浸润细胞中ＩＬ－２Ｒ阳性细胞数的变化，及其与间质浸润的淋巴细胞的关系。作者选择同期行异体肾移植，且无并发症患者１７例，采用ＰＡＰ四层免疫酶标法，检测移植肾组织中间质浸润细胞中ＩＬ－２Ｒ阳性细胞数的变化。结果显示：无ＡＣＲ的肾组织中，ＩＬ－２Ｒ阳性细胞仅轻度增加，当移植肾出现ＡＣＲ时，ＩＬ－２Ｒ阳性细胞数的增加十分显著，并与间质浸润的ＣＤ８密切相关。作者认为ＩＬ－２Ｒ对于ＡＣＲ的诊断及鉴别诊断具有一定的临床应用价值。     

Human chronic kidney allograft rejection is accompanied by increased intraglomerular cathepsin B and L activity

Abstract The major reason for late graft losses is chronic rejection. Recently, a large number of studies have indicated that proteolytic enzymes play an important role as mediators of glomerular injury. The cysteine proteinases cathepsins B and L degrade structural matrix proteins such as type I collagen and laminin. We investigated intraglomerular protease activities in 12 patients after kidney graftectomy because of end-tage renal disease following chronic rejection. A group of 12 patients undergoing nephrectomy because of cancer served as controls using only non-involved parts of the kidney. The activities of cathepsins B and L in homogenates of isolated glomeruli were measured fluorometrically methylcoumarylamidc substrates and related to DNA content. In rejected kidney allografts we observed significantly enhanced intraglomerular cathepsin B activity and cathepsin B + L activity.     

Nephrectomy during operative management of retroperitoneal sarcoma

Background: Complete resection of a retroperitoneal sarcoma often requires removal of adjacent organs. In this study we evaluated the role of nephrectomy during operation for retroperitoneal sarcoma. Methods: Between July 1982 and July 1995, 75 of the 371 (20%) patients who underwent resection of retroperitoneal sarcoma at MSKCC underwent concommitant nephrectomy. Data concerning the reasons for nephrectomy, degree of sarcomatous renal involvement, and survival were retrospectively analyzed. Results: Fifty-four patients (72%) underwent nephrectomy during the initial resection, and 21 (28%) during a resection of a recurrent or persistent tumor. The most common reason for nephrectomy was total encasement by sarcoma (n=40; 53%), followed by dense adherence of the tumor to the kidney (n=21; 28%), and the direct invasion of the kidney by tumor (n=2; 3%). Pathology demonstrated an absence of kidney invasion in the majority of cases (55 of 75; 73%). Renal capsular invasion was present in 11 of 75 (15%), renal parenchymal invasion in 7 of 75 (9%), and renal vein invasion in 2 of 75 (3%) of cases. There were no significant differences in survival based on degree of sarcoma involvement of the kidney, tumor grade, or whether the resection was for primary or recurrent disease. The 53 patients who underwent a complete gross resection of all tumor had a significantly improved long-term survival compared to the 20 patients who did not (50% versus 20% DFS at 5 years, respectively; p<0.001). Conclusions: Decisions for concomitant nephrectomy during resection of retroperitoneal sarcoma should be based on whether this maneuver will provide a complete resection of all gross tumor, in which case the long-term disease-free survival of 50% is comparable to the reported 5-year survival of all patients with retroperitoneal sarcoma who are completely resected. Presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

手辅助腹腔镜取肾的实验研究

目的　探索和运用手辅助腹腔镜技术切除供肾并行肾移植术 ,了解该方法的优缺点及临床应用的可行性。方法　用成年狗作动物实验进行手辅助腹腔镜供肾切除术并移植 ,观察并记录手术时间 ,供肾热缺血时间 ,移植肾功能恢复情况及供者的康复情况等。结果　实验狗术后均存活 ,供肾切除手术时间平均 13 2min ;肾热缺血时间平均 83s ,移植肾再灌注后排尿时间平均 74s。结论　手辅助腹腔镜活体供肾切除术易于掌握 ;手术时间短 ;供肾热缺血时间短 ,质量好 ;供肾者手术创伤小 ,术后恢复快 ;是临床值得推广应用的一种活体供肾切除方法     

Vasopressin stimulation of NaCl transport in the medullary thick ascending limb of Henle's loop is decreased in aging mice

The maximal urinary osmolality that can be reached by the kidney is reduced with age. This may be due to impaired NaCl transport by the medullary thick ascending limb of Henle's loop, which is part of the renal concentrating mechanism and is modulated by antidiuretic hormone (ADH). We therefore tested in vitro a possible age-related change in the transport capacity and in the response of this nephron segment to ADH in young (1–2 months) and old (20–24 months) mice. The transepithelial potential difference (V _te) was significantly higher in young mice (+8.5±0.4 mV, n=13) than in old ones (+6.6±0.5 mV, n=17). Addition of 0.1 nmol.l^–1 ADH to the bath solution significantly increased V _te by 5.2±0.5 mV in the young and by 3.1±0.6 mV in the old animals. Application of dibutyryl-cAMP (0.1 mmol.1^–1) did not further increase the hormonal response in both groups. The ADH-mediated increase in the corresponding equivalent short-circuit current (I _SC = V _te/R_te) was twice as great in young mice as in old, indicating that the stimulation of NaCl transport by ADH across the medullary thick ascending limb is significantly reduced with age. These results suggest that the previously reported age-related defect in the urinary concentrating ability of the kidney is partly due to a decreased response of the medullary thick ascending limb to ADH.     

尿流式细胞学在诊断移植肾急性排斥反应中的应用价值

目的：探讨尿流式细胞学在诊断移植肾急性排斥反应中的临床应用价值。方法：对43例肾移植受者的116份尿样本进行尿流式细胞学分析，并将急性排斥组和肾功能稳定组的分析结果进行比较。结果：急性排斥反应组尿淋巴细胞总数以及HLA－DR^ 淋巴细胞数显著增多，与肾功能稳定组比较，P＜0．01，CD8^ 细胞亦增多（P＜0．05），而CD3^ ,CD4^ ,CD19^ 细胞数变化两组差异不显著（P＞0．05），在诊断移植肾急性排斥反应上，HLA－DR阳性样本和淋巴细胞数阳性样本的诊断敏感性和特异性分别达95．2％，90．5％，和92．6％，87．4％，结论：尿流式细胞学分析可反映移植肾内的免疫状态，尿淋巴细胞数的显著增多和尿HLA－DR^ 淋巴细胞增多可以作为诊断急性排斥反应的有意义指标。