含α－酮酸的复方氨基酸治疗慢性肾功能不全

慢性肾功能不全病人１５例（男性９例，女性６例；年龄４６±ｓ１３ａ）；在低蛋白饮食的基础上（摄入蛋白质３０ｇ／ｄ），加用含α－酮酸的复方氨基酸片０．９ｇ，ｐｏ，ｔｉｄ治疗３０－４５ｄ后，观察治疗前后的有关肾功能及氮平衡的相应参数的变化。治疗前氮平衡为０．６±０．５ｇ，治疗末是１．４±０．５ｇ，两者相比，有明显的改善，（Ｐ＜０．０５）。     

营养治疗在血液透析中应用

16例尿毒症血透患者分成三组。第一组6例常规维持血透,自由进食;第二组5例低蛋白饮食,蛋白量为0.6g·kg~(-1)/a,第三组5例极低蛋白饮食,蛋白量为0.3～0.4g·kg~(-1)/d,供给必需氨基酸或酮酸。二、三组每周血透1次,所有患者均观察6个月。结果示三组患者营养状态相似,氮平衡、总体氮流量、蛋白合成速度均有改善,二和三组患者血磷明显降低,血钙明显升高,其Ccr下降率明显慢于一组,提示血透联合低蛋白饮食或(和)加必需氨基酸可以减少血透次数,能保护残存肾单位功能。     

33例复发性胰腺炎患者胰腺内外分泌功能的观察

急性胰腺炎患者(主要是水肿型)经内科保守治疗后大多能获痊愈;但部分病例,尤其是病因不明或病因未能及时解除者,往往反复发作,最后导致胰腺组织破坏,纤维组织增生,钙化和萎缩,表现为胰腺内外分泌功能不全,严重影响患者的健康。目前对胰腺内外分泌功能的检查尚缺乏实用和简便的方法。本组应用口服葡萄糖-胰岛素释放试验和口服N-苯甲酰-L、-酪氨酰对氨基苯甲酰酸(N-benzoyl-L-tyrosyl-p-aminobenzoic acid,BT-PABA)胰腺功能试验(OPFT),分别测定33例复发性胰腺炎患者的内外分泌功能,结果报道如下。     

ALTERATION OF ZINC, COPPER AND MAGNESIUM IN SERUM OF UREMIC PATIENTS AND PERITONEAL DIALYSATE

In 11 uremic patients serum zinc, copper and magnesium were determined prior to and 3—6 months after starting intermittent peritoneal dialysis (IPD). The trace elements were measured by atomic absorption spectrophotometry. The concentrations of serum zinc and copper were raised significantly from the initial mean values of 9.36±2.498 μmol/L and 15.875±4.223 μmol/L prior to IPD to 12.102±2.514 μmol/L and 22.127 ±3.530 μmol/L respectively after IPD. While in normal controls serum zinc was 13.571±1.665 μmol/L and copper 15.830±4.113 μmol/L. Serum magnesium dropped from 2.127±0. 712 mmol/L to 1.921±0.378 mmol/L、but the change was not significant statistically; the value in normal controls was 1.300±0.128 mmol/L. When IPD had been well established and there was no sign of peritonitis, serum zinc, copper and magnesium were tested before and after the procedure of IPD in a single day at random, and at the same time the concentrations of these elements in the drained dialysate were also determined. The result showed that serum levels of zine, copper and magnesium remained unchanged before and after dialysis in a single day, however, those in the drained dialysate were raised from the initial values of 1.301±0.522 μmol/L, 0.9635±0.335 μmol/L and 1.168±0.411 mmol/L to 8.478±5.324 μmol/L, 5.715±1.868 μmol/L and 1.098±0.494 mmol/L.     

原发性慢性肾炎中T淋巴细胞及其亚群的改变

本文对50例原发性慢性肾炎T淋巴细胞及其亚群进行了初步研究。慢性肾炎的诊断根据1977年北戴河肾炎座谈会提出的“关于原发性肾小球疾病的临床分类初步方案。”属慢性肾炎肾病型27例,男性16例,女性11例,平均年龄29.9±12.1岁。属慢性肾炎普通型23例,男性11例,女性12例,平均年龄36.3±15.3岁。全组50例平均年龄32.8±13.9岁。多系住院病人,在未服皮质激素或用其他     

EFFECT OF LOW PROTEIN DIE'T ON WHOLE BODY NITROGEN METABOLISM IN PATIENTS WITH CHRONIC RENAL FAILURE

isN-glycine was administered orally as a tracer t0 3 patients with chronic renal failure (CRF) in the study of total body protein metabolism during the course of diet therapy. Five healthy subjects with matched age and sex served as controls. Patients on a diet providing l.2 g protein/kg/day had significantly low total nitrogen flux (Q), rates of total body pro- tein synthesis (S), catabolism (C) and S/Q, as com' pared with the controls. A reduction in daily protein intake t0 0.6 g/kg/day resulted in marked increase in all these parameters, approaching those of the con- trols. In normal subjects, low protein intake did not affect the total body protein turnover signfiicantly. The results suggest that the adaptive response to res- triction of protein intake is an efficient utilization of nitrogen entering the metabolic pool for anabolic purposes. This response becomes manifest and essen- tialin patients with CRF and forms the basis for low protein diet therapy.     

骨髓瘤肾病

骨髓瘤肾病是多发性骨髓瘤的严重并发症之一,其死亡率仅次于感染。多发性骨髓瘤中肾病发生率约66%,男略多于女,年龄多在50岁以上。骨髓瘤肾病可在确诊骨髓瘤前一段时间发生,因而易误诊为原发性肾病,应引起注意。一、骨髓瘤肾病的发生与下列因素有关:1.轻链的肾毒作用:骨髓瘤细胞可产生大量免疫球蛋白,其中轻链分子量小,能经肾小球滤过,进入肾小管内形成管型,阻塞管腔,从而降低GFR。此外轻链可直接损害肾脏,高等电点轻链易引起肾脏损害;轻链糖化作用和聚合作用也可损害肾脏;轻链还可促进Tamm-Horsfall 蛋白(THP)沉淀形成管型,且THP 外渗至肾间质与钙及其他蛋白形成钙蛋白复合物,直接损害肾实质。2.骨髓瘤细胞直接损害肾实质。3.骨髓瘤引起电解质代谢紊乱:     

PATTERN OF SERUM TRYPTOPHAN IN CHRONIC RENAL FAILURE

Data on serum total (Trp) and free (fTrp) and bound (bTrp) tryptophan concentrations in patients with chronic renal failure were analysed. The results revealed marked decrease of serum Trp and bTrp, increase of fTrp concentrations and negative correlation between serum creatinine and bTrp/albumin ratio. The mechanism leading to these alterations is not clear. Increased serum fTrp concentration may play a role in causing uremic syndrome.     

慢性肾脏疾病蛋白C含量测定

本文用放射免疫法测定39例正常人及58例慢性肾脏疾病患者的血浆PC含量。1.慢性肾炎普通型7例,PC平均值为2.657±0.44 mg/L,与正常对照3.24±0.4 mg/L比明显降低(P<0.05);2.肾病综合征6例,PC含量为6.446±2.504 mg/L,与对照组比明显升高(P<0.05);3.氮质血症组8例,PC平均值为3.424±0.363 mg/L,与正常对照比无明显差异(P>0.05);4.尿毒症非透析组26例,PC平均值为4.902±2.035 mg/L与正常比明显升高(P<0.001);5.尿毒症透析组,其中血透6例PC平均值为2.63±0.547 mg/L,与正常对照比明显下降(P<0.05),腹透组5例PC值为5.56±1.952 mg/L,与正常对照比明显升高(P<0.05),在慢性肾脏疾病中PC降低可有血栓形成促使肾病恶化,PC增高可有抗凝作用引起出血倾向,在肾病综合征中PC增高有助于对抗高凝状态。     

46例正常老年人脑电图的初步观察

作为反映老年人脑功能的一个客观指标——老年人脑电图变化,国内报道不多。本文通过观察正常老年人脑电图变化的一般规律,探讨脑电图在判断脑老化过程的价值。