阿托伐他汀联合卡维地洛治疗慢性心力衰竭的效果分析

目的 探讨阿托伐他汀联合卡维地洛治疗对心力衰竭患者血清TNF-α、IL-1β、SCr、BUN的影响。方法选取2018年9月—2020年9月本院收治的心力衰竭患者104例,分为两组(随机数字表法),对照组采用卡维地洛治疗,研究组采用阿托伐他汀联合卡维地洛治疗。结果 研究组有效率为92.3%,大于对照组的84.6%,差异有统计学意义(χ²=5.333,P=0.036)。治疗后,研究组SCr、BUN小于对照组(t=15.218、P=0.036,t=12.255、P=0.047),研究组TNF-α、IL-1β小于对照组(t=13.475、P=0.036、t=15.170、P=0.034)。研究组安全性大于对照组(5.8%vs 23.1%,χ²=6.023,P=0.037)。结论 在心力衰竭治疗中,阿托伐他汀联合卡维地洛治疗效果明显,值得应用。     

The efficacy of biomarkers in the diagnosis of acute kidney injury secondary to liver cirrhosis

This study is to investigate the role of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine in the diagnosis of acute kidney injury (AKI) secondary to liver cirrhosis.A total of 825 patients (including 540 liver cirrhosis patients and 285 healthy controls) were enrolled. Liver cirrhosis patients were further subdivided into AKI secondary to liver cirrhosis group (AKI group, 210 patients) and simple liver cirrhosis group (LC group, 330 patients). Serum NGAL/urine NGAL (sNGAL/uNGAL), and serum creatinine (sCr) levels as well as estimated glomerular filtration rates were measured. The diagnostic performances of these indicators in AKI secondary to liver cirrhosis were evaluated.The levels of sNGAL, uNGAL, CysC and sCr in the AKI group were significantly higher than those of LC and healthy control groups. However, the eGFR and c-aGFR of AKI group were significantly lower. With the progression of AKI (AKI-S1→AKI-S2→AKI-S3), the levels of sNGAL, uNGAL, CysC and sCr increased gradually, while the levels of c-aGFR and eGFR decreased gradually. The sNGAL, uNGAL and CysC were positively correlated with sCr (r = 0.638, 0.635, and 0.650), but negatively correlated with c-aGFR (r = -0.617, -0.606 and -0.655). However, eGFR had a negative correlation with sCr (r = -0.711), but a positive correlation with c-aGFR (r = 0.736). ROC curve analysis showed that the area under the curve for uNGAL was the largest (0.976), followed by sNGAL (0.967). The diagnostic efficacy of uNGAL and sNGAL in AKI group were 0.907 and 0.870, and the risk degrees were OR = 54.524 and 5.115, respectively.NGAL might perform better than sCr and CysC in the diagnosis of AKI secondary to liver cirrhosis, while uNGAL might be a better indicator than sNGAL in AKI diagnosis.     

肾脏生化检验中分级式检验的应用研究

目的分析肾脏生化检验中分级式检验的应用效果。方法于2017年1月—2019年1月在医院行肾脏生化检验患者94例,按数字随机表法分为两组,即对照组(n=47)及观察组(n=47),对照组采取常规检验,观察组采取分级式检验;比较两组肾脏生化指标检验结果。结果观察组标本检出阳性率97.87%高于对照组的76.60%,差异有统计学意义(P<0.05);观察组BUN检出阳性率65.96%高于对照组的29.79%,Scr检出阳性率63.83%高于对照组的29.79%;差异有统计学意义(P<0.05);两组患者Cys C检出阳性率比较,差异无统计学意义(P>0.05)。结论肾脏生化检验采取分级式检验,具较高的检出率,临床价值高。     

Preoperative prognostic factors in vitrectomy for severe proliferative diabetic retinopathy

PurposeTo investigate the preoperative prognostic factors contributing to extremely poor visual outcome in cases of proliferative diabetic retinopathy after a successful vitrectomy and an uneventful postoperative course.MethodsWe enrolled 28 consecutive eyes of 28 patients with poor preoperative visual acuity (VA), who underwent primary diabetic vitrectomy. The postoperative course was uneventful, and retinal attachment was achieved for at least 6 months in all cases. The cases were separated into the study group (postoperative VA < preoperative VA) and control group (postoperative VA ≥ preoperative VA). Preoperative factors including systemic diseases, demographic data, proliferative diabetic retinopathy severity, and neovascularization status were compared between the two groups. Significant risk factors for poor visual results were determined by logistic regression analysis.ResultsThe creatinine level was significantly higher in the study group (4.07 ± 4.15 mg/dL) than in the control group (1.23 ± 0.46 mg/dL; p = 0.003). Chronic macular detachment was noted in 7/10 eyes (70%) in the study group and in 1/18 eyes (5.6%) in the control group (p = 0.001). Broad fibrovascular proliferation extending to the periphery for more than two quadrants was found in 4/10 eyes (40%) in the study group and in none of the eyes in the control group (p = 0.016). Chronic macular detachment and broad fibrovascular proliferation were significantly associated with poor visual outcome in multiple logistic regression analysis.ConclusionPreoperative chronic macular detachment, broad fibrovascular proliferation, and poor renal function may indicate worse visual results after successful diabetic vitrectomy for cases with severe diabetic retinopathy.