2型糖尿病肾病病理分型特点与尿蛋白的关系

目的 探讨2型糖尿病肾病患者各个分型的病理特征与尿蛋白的关系.方法 将确诊为2型糖尿病肾病(2TDN)的患者根据24小时尿蛋白分为A、B、C、D四组,分别为A蛋白尿组(尿蛋白/24h＜2000mg)、B蛋白尿组(尿蛋白/24h2000～＜4000mg)、C蛋白尿组(尿蛋白/24h 4000～6000mg)、D蛋白尿组(尿蛋白/24h＞ 6000mg).对四组患者分别检测尿素氮(BUN)、血肌酐(Scr)、白蛋白(Alb),光镜下分别观察各组患者肾组织HE、PAS、PASM、Masson染色结果变化,电镜下观察各组患者肾组织超微结构的改变以及测量各组肾小球基底膜厚度.结果 各组DN患者经病理分型后,A组Ⅰ型6例(20％),Ⅱa型7例(23％),Ⅱb型6例(20％),Ⅲ型10例(33％),Ⅳ型1例(3％);B组Ⅰ型2例(7％),Ⅱa型3例(10％),Ⅱb型10例(33％),Ⅲ型14例(47％),Ⅳ型1例(3％);C组Ⅰ型1例(3％),Ⅱa型3例(10％),Ⅱb型5例(17％),Ⅲ型20例(67％),Ⅳ型1例(3％);D组Ⅰ型0例(0％),Ⅱa型1例(3％),Ⅱb型3例(10％),Ⅲ型17例(57％),Ⅳ型9例(30％).B、C、D组与A组相比较,血清Alb皆降低,差异有统计学意义(P＜0.05);D组与A组相比较,血清BUN、Scr升高,差异有统计学意义(P＜0.05);D组与B、C组相比较,血清Alb皆降低,差异有统计学意义(P＜0.05),Scr升高,差异有统计学意义(P＜0.05).随着蛋白尿的升高,各组DN患者的基底膜厚度相应增加,病理分型也相应严重.结论 DN患者肾脏的病理变化与蛋白尿的进展有一定的内在联系,对DN患者进行病理分型,有助于深入了解患者病情,为早期诊断和治疗提供依据.     

食物不耐受与慢性肾脏疾病及风湿性疾病的关系

食物不耐受是国内外研究的热点,其发生率在逐年上升,但目前在许多方面尚存在争议.研究食物不耐受的概念界定、发病机制、诊断、治疗及与肾病综合征、IgA肾病、类风湿性关节炎等常见肾脏疾病及风湿性疾病相关性具有重要意义.     

IgA肾病中IgA1异常糖基化的致病机制

IgA肾病是最常见的原发性肾小球疾病,是发展为终末期肾病的主要病因,其病理机制复杂,临床表现多样化,组织形态学改变轻重不一。IgA肾病以肾小球系膜区IgA1沉积为病理特征,肾脏沉积的IgA1分子铰链区O-糖链半乳糖基减少,致使IgA1分子易于自身聚集并沉积在肾小球。糖基化酶缺乏、基因突变、免疫紊乱都可能导致IgA1异常糖基化的发生。IgA1分子的异常糖基化是IgA肾病发病的关键因素,但其具体产生原因和致病机制仍未明确,对IgA1异常糖基化的深入研究有助于了解IgA肾病的发病机制并提供新的治疗方向。     

Fate of full‐house immunofluorescence staining in renal allograft: A case report

Here, we report the case of a patient with renal allograft with full‐house immunofluorescence staining in the zero‐hour biopsy. Full‐house immunofluorescence staining is a well‐known characteristic of lupus nephritis. Previous studies have reported patients with full‐house immunofluorescence staining, but without other symptoms or serological findings; this condition is referred to as full‐house nephropathy. We identified only one case out of 2203 zero‐hour biopsies over 13 years. Zero‐hour biopsy presented no glomerular changes but showed full‐house immunofluorescence staining. Electron microscopy revealed a nonorganized electron‐dense deposit mainly in the mesangial lesion. Systemic lupus erythematosus (SLE)‐associated antibodies were negative, and complement deficiency was not observed in the donor patients. Deposition of immunoglobulin and complement levels markedly decreased within 1–3 years post transplantation. Neither donor nor recipient developed clinical or biological features of SLE; they showed good renal prognosis.     

成人IgA肾病中CD20的表达及意义

目的探讨CD20在不同肾功能状态的成人IgA肾病(IgA nephropathy,IgAN)患者肾组织中的表达及其与肾脏临床病理特征、预后的关系。方法将47例IgAN依据改良MDRD公式评估肾小球滤过率(estimated glomerular filtration rate,eGFR),将入选患者分为三组:A组(肾功能正常或轻度受损):eGFR60 ml/min;B组(肾功能中度受损):eGFR 30~60 ml/min;C组(肾功能重度受损,不含尿毒症):eGFR 10~30 ml/min。按Katafuchi评分标准进行肾活检病理评分,应用免疫组化法检测三组肾穿刺标本中CD20的表达,并对所有患者进行随访,复查相关临床指标。结果 CD20主要表达于IgAN患者肾组织皮质区肾小管管周间质B淋巴细胞胞膜。与eGFR60 ml/min组相比,eGFR 30~60 ml/min组、eGFR 10~30 ml/min组CD20表达量明显升高,差异有统计学意义(P值分别为0.002,0.001);肾组织中CD20表达量与eGFR呈负相关(r=-0.697,P0.001),与24 h尿蛋白定量、血清肌酐、肾小管间质积分呈正相关(r值分别为0.524、0.647、0.769;P均0.001)。结论肾组织中CD20的表达量与IgAN患者肾脏病理损伤指数、24 h尿蛋白定量、肾功能状态均密切相关,提示检测IgAN患者肾组织中CD20表达对了解肾脏病变程度、评估患者预后有一定临床价值。     

Sequential therapy with cyclophosphamide and mycophenolic acid in patients with progressive immunoglobulin A nephropathy: a long‐term follow‐up

In progressive immunoglobulin (Ig)A nephropathy (IgAN), cyclophosphamide pulse therapy (CyP), high‐dose intravenous immunoglobulins (IVIg) and mycophenolic acid (MPA) have been used to stop progressive loss of renal function, but disease progression may occur after the end of the initial treatment. Here, we report the long‐term follow‐up of patients with progressive IgAN with MPA as maintenance therapy after CyP (CyP‐MPA). In a median observation time of 6·2 years, we analysed the slopes of the loss of renal function of 47 patients with biopsy‐proven IgAN and treated with CyP. Thirty‐one patients with further progression were treated with MPA maintenance for a median time of 5·2 years. Follow‐up was compared with symptomatic therapy and IVIg as historically matched control groups. Median loss of renal function was reduced significantly from 0·9 ml/min to 0·1 ml/min per month with CyP (P < 0·05), and with MPA in patients with a relapse from ?0·4 ml/min to ?0·1 ml/min per month (P < 0·05) until the end of the study. Proteinuria decreased significantly from 1·6 g/l to 1·0 g/l after CyP, and during MPA treatment to 0·6 g/l (P = 0·001 Friedman test). Median renal survival time was in patients with CyP 10·5 years (range = 3·2–17·8), with CyP‐MPA 10·7 years (range = 8·3–13·1), with IVIg 4·7 years (range = 2·6–6·6), and in untreated patients 1·2 years (range = 0·8–1·6; log‐rank test P < 0·01). In patients with progressive IgAN, our long‐term follow‐up observation indicates that sequential CyP‐MPA therapy maintains renal survival significantly.     

红景天苷上调HIF-1α减轻高糖诱导的大鼠肾小球内皮细胞损伤

目的:观察体外不同浓度葡萄糖对大鼠肾小球内皮细胞(rRGECs)表达低氧诱导因子1α(HIF-1α)、血管内皮生长因子A(VEGFA)及血管内皮钙黏素(VE-cadherin)的影响,探讨红景天苷减轻高糖诱导rRGECs损伤的作用及可能相关机制。方法:体外培养rRGECs,分为正常糖组、高糖(20、30和50 mmol/L)组、高渗组及红景天苷+高糖组。采用MTT法检测rRGECs的活力;RT-qPCR法检测rRGECs内HIF-1α、VEGFA及VE-cadherin的mRNA表达;Western blot法检测rRGECs内HIF-1α蛋白的表达。结果:与正常糖组相比,培养24 h后,高糖(20mmol/L)组rRGECs HIF-1α的mRNA及蛋白表达均上调(P 0.05);培养120 h后,高糖组HIF-1αmRNA表达下调(P 0.05)。与正常糖组相比,培养24 h和120 h后,高糖组rRGECs内VE-cadherin的mRNA表达下调(P 0.05)。与正常糖组相比,培养24 h后,高糖组rRGECs内VEGFA的mRNA表达上调(P 0.05);培养120 h后,高糖组rRGECs内VEGFA的mRNA表达下调(P 0.05)。与正常糖组相比,培养24 h和120 h后,高渗组rRGECs内HIF-1α、VE-cadherin及VEGFA的mRNA表达无变化。与高糖组相比,培养24 h后,红景天苷(50μmol/L)组rRGECs的活力增加(P 0.01),且细胞内HIF-1α和VE-cadherin的mRNA及HIF-1α蛋白表达均上调(P 0.05)。结论:体外高糖培养能影响rRGECs表达HIF-1α,可能与细胞活力、葡萄糖的浓度、作用时间及HIF/VEGF通路有关。红景天苷能减轻高糖诱导的rRGECs损伤,其机制可能与增加rRGECs内HIF-1α的表达有关。     

一种新型多普勒血流仪的研制

目的 研制一种具有数据采集、存储、传输、显示及声音辅助诊断功能,可以面向社区和家庭应用的便携式多普勒血流仪.方法 基于多普勒测量血流原理,以STM32微处理器为核心,采用定向型正交相位解调法获取多普勒频移信号,通过电源模块、数据采集模块、USB模块、按键模块、数据存储模块、音频处理模块、液晶显示模块、网络收发模块等外围电路,结合PC构成一个完整的血流检测系统.结果 该血流仪能够实现对患者血流数据的采集、处理、存储、传输,可实时显示脉率、诊听血流声音及输出双向血流频移波形和血流速度波形,可用于糖尿病足的诊断.结论 该血流仪使用方便,通过血流声音、血流速度波形、频移波形和脉率等反映血流特征的信息,进行糖尿病足等与血流相关慢性病的早期检测.