泌尿系统含钙结石的实验室检查进展

含钙结石约占泌尿系结石的80%,发病率高、复发率高,反复发作增加高血压、慢性肾脏病的风险。全面的代谢评估对含钙结石的预防非常重要。随着对结石发生机制研究的不断深入,发现结石抑制物、炎症和氧化应激分子在结石形成过程中发挥重要作用,单基因突变位点也不断被发现。这些可能作为新型诊断标志物用于泌尿系结石的预防和评估。肾结石复发...     

引起甲状腺功能异常的常见药物对血清生物标志物检测的影响

药物治疗过程中出现的甲状腺功能指标的异常已经受到人们日益的关注,包括传统的药物,例如：糖皮质激素、非甾体类抗炎药、碘剂等,也包括新型药物如免疫检查点抑制剂等。甲状腺功能指标的异常可源于药源性甲状腺疾病、药物相互作用影响外源性甲状腺素治疗,也可源于药物对体外检测的干扰。本文重点阐述了几种药物在甲状腺激素调节、合成与释放、...     

尿液10项肾损伤标志物检测试剂的性能评价

目的 对尿液10项肾损伤标志物检测试剂进行性能评价,并评估其临床适用性。方法 对北京利德曼公司尿液α₁微球蛋白(u-α₁MG)、总蛋白(u-TP)、免疫球蛋白G(u-IgG)、微量清蛋白(u-Alb)、中性粒细胞明胶酶相关脂质运载蛋白(u-NGAL)、半胱氨酸蛋白酶抑制剂C(u-CysC)、视黄醇结合蛋白(u-RBP)、β₂微球蛋白(u-β₂MG)、N-乙酰-β-D-氨基葡萄糖苷酶(u-NAG)、转铁蛋白(u-Trf)检测试剂盒进行性能评价。正确度和精密度验证参考美国临床和实验室标准协会(CLSI) EP15-A3,验证物质采用ERM-DA470k、ERM-DA471、B2M-NIBSC等参考物质及纯度物质;线性验证参考CLSI EP06;抗干扰能力参考CLSI EP07;不同检测系统间比对参考CLSI EP09。结果 正确度方面,10项标志物检测试剂测定标准物质在低值、中值、高值的偏倚分别为-2.69%～4.67%、-3.60%～3.33%、-2.38%～3.02%;不精密度方面,重复性以不精密度...     

尿Ⅳ型胶原测定的方法学评价及分析前因素对于测定的影响

目的对一步法酶联免疫吸附测定（ELISA）试剂盒进行功能评价,建立参考范围并对分析前和可能影响测定的一些因素进行研究。方法采用ELISA对尿液中的Ⅳ型胶原进行测定。对试剂盒的敏感性,测量线性,精密度,特异性,回收率进行了测定和评价,并进行干扰试验和初步建立参考范围。同时评价分析前因素,包括采样、离心、保存条件和时间,以及冻融和昼夜节律对于测定的影响。结果该方法具有令人满意的敏感性（0．2ng／m1）,测量线性（0．8～50ng／m1）,精密度（CV〈7％）,特异性和回收率（82．84％～97．45％）。精液的污染对于Ⅳ型胶原的测定没有显著影响。尿内Ⅳ型胶原的量呈明显的昼夜节律,晨尿内含量最低,白天含量达到最高,睡前再次下降。Ⅳ型胶原在尿液内比较稳定,但长时间室温保存也可被各种蛋白酶的降解。冻融对于Ⅳ型胶原的影响不大,但离心可以造成测量值下降。将尿液与一定量的缓冲液（pH7．5的TRIS-HCI）混合（10：1）可以得到一个满意的回收率,避免Ⅳ型胶原被降解。结论该试剂盒具有良好的性能;Ⅳ型胶原在尿液内比较稳定,但如需长期保存,应加入缓冲液并在-80℃保存。     

青春期进行性乳房增大:巨大肿物的切除与美学重建

正1病历简介患者女性,16岁,主诉"右侧乳房进行性增大4年,迅速增大6个月",于2018年7月4日收住北京协和医院整形美容外科。1. 1现病史患者4年前开始双侧乳房发育,左侧乳房体积形态无明显异常,右侧乳房进行性增大,体积逐渐大于左侧。近6个月以来,右侧乳房迅速肥大,伴有皮肤     

充填式无张力疝修补术后复发的预防

目的　探讨充填式无张力疝修补术后复发的原因及对策。方法　通过对 1 0例腹股沟斜疝病人经疝环充填式无张力疝修补术后复发情况的研究。结果　网塞和补片的放置缝合欠佳及术后存在腹内压增高因素是引起复发的主要原因。结论　减少疝环充填式无张力疝修补术后复发应改进网塞和补片的固定方法及控制腹内压增高因素     

超敏C-反应蛋白水平与慢性肾功能衰竭和透析治疗病人的关系

目的探讨慢性肾功能衰竭、血液透析和腹膜透析患者血浆超敏C-反应蛋白(hs-CRP)的变化规律及其临床意义.方法用胶乳增强散射浊度法测定122例患者(慢性肾衰未透析45例、血液透析32例和腹膜透析45例)的血浆hs-CRP,同时检测了总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、白蛋白和前白蛋白,并与42名健康人比较.结果三组患者hs-CRP平均水平分别为慢性肾衰未透析组4.82(6.86 mg/L、血液透析3.58(4.28 mg/L、腹膜透析6.89(7.54 mg/L,均明显高于对照组1.78(2.26mg/L,统计学分析有显著性差异(P＜0.01、P＜0.05和P＜0.001).各组hs-CRP＞升高的比率分别为:慢性肾衰组44.44%、血液透析组40.63%、腹膜透析组62.22%,对照组14.28%.慢性肾衰未透析组hs-CRP水平的变化与肌酐水平有正相关关系(r=0.35,P＜0.05);与白蛋白和前白蛋白有负相关关系(r=-0.34和r=-0.43,P＜0.05).在血脂测定中,慢性肾衰未透析组和腹膜透析组的水平显著高于正常对照组,而血液透析组与正常对照组无显著性差异.结论慢性肾衰、血液透析和腹膜透析患者血浆hs-CRP平均水平都升高;检测hs-CRP水平对肾脏病患者心血管并发症的预防和治疗有一定临床意义.     

内蒙古呼伦贝尔地区成人慢性肾脏病流行病学调查

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in the general adult population in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region where many minorities of north China live. Methods Sampling surveywas performed in the residents aged 20 years and older in the Hulunbeir Prefecture. All the investigated subjects were tested for urinary albumin to creatinine ratio (ACR); hematuria by microscopy of urinary sediment; and GFR estimated by modified MDRD equation for Chinese adults (eGFR). The related risk factors of CKD were also investigated. Results A total of 4522 subjects were enrolled in the study. The prevalence of albuminuria was 7.11％, hematuria was 2.64％ and reduced eGFR [60 ml-min-1·(1.73 m2)-1] was 2.75％. The prevalence of hypertension was 38.90％; hyperglycemia 6.61％; hyperlipidemia 2.72％; increased waist 24.79％ and metabolic syndrome 15.02％. After the subjects with combined microalbuminuria, hematuria and reduced eGFR were excluded, the prevalence of CKD was 12.95％. Logistic regression analysis and stratified analysis showed increased age, increased waist, elevated systolic pressure, hyperglycemia,hypertriglyceridemia and metabolic syndrome were independently associated with albuminuria;increased age, elevated systolic pressure and hyperglycemia were independently associated with reduced eGFR; increased age was independently associated with hematuria. Conclusions The prevalence of adult CKD is 12.95％ in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region. Independent risk factors of CKD include increased age, increased waist, hypertension,abnormal blood glucose or lipid, and metabolic syndrome.     

内蒙古呼伦贝尔地区成人慢性肾脏病流行病学调查

目的 探讨我国内蒙古自治区呼伦贝尔少数民族聚居区成年人群中慢性肾脏病（CKD）患病率及其危险因素。 方法 对该地区20岁以上常住居民进行CKD抽样调查,被调查者均检测了尿白蛋白/肌酐比率、血尿（离心后尿沉渣显微镜检查）及估计肾小球滤过率（eGFR,检验血清肌酐后用国人校正的简化MDRD公式计算）;并同时调查了CKD的相关危险因素。 结果 符合入选条件的被调查者共4522例,白蛋白尿阳性率为7.11%;血尿阳性率为2.64%;eGFR低于60 ml•min-1•(1.73 m2)-1者为2.75%;去除白蛋白尿、血尿及eGFR下降共同存在造成的重复,该地区CKD患病率为12.95%。高血压患病率38.90%,糖代谢异常6.61%,脂代谢异常34.60%,腰围增大24.79%,代谢综合征15.02%。多因素Logistic回归分析及分层分析显示,年龄增加、腰围增大、收缩压升高、空腹血糖升高、血清三酰甘油增高及患代谢综合征与白蛋白尿发生相关;年龄增加、收缩压升高及空腹血糖升高与肾功能下降相关;年龄增加与血尿发生相关。 结论 内蒙古自治区呼伦贝尔地区CKD患病率为12.95%。相关危险因素包括年龄增加、腰围增大、高血压、血糖或血脂异常、及代谢综合征。     

内蒙古呼伦贝尔地区成人慢性肾脏病流行病学调查

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in the general adult population in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region where many minorities of north China live. Methods Sampling surveywas performed in the residents aged 20 years and older in the Hulunbeir Prefecture. All the investigated subjects were tested for urinary albumin to creatinine ratio (ACR); hematuria by microscopy of urinary sediment; and GFR estimated by modified MDRD equation for Chinese adults (eGFR). The related risk factors of CKD were also investigated. Results A total of 4522 subjects were enrolled in the study. The prevalence of albuminuria was 7.11％, hematuria was 2.64％ and reduced eGFR [60 ml-min-1·(1.73 m2)-1] was 2.75％. The prevalence of hypertension was 38.90％; hyperglycemia 6.61％; hyperlipidemia 2.72％; increased waist 24.79％ and metabolic syndrome 15.02％. After the subjects with combined microalbuminuria, hematuria and reduced eGFR were excluded, the prevalence of CKD was 12.95％. Logistic regression analysis and stratified analysis showed increased age, increased waist, elevated systolic pressure, hyperglycemia,hypertriglyceridemia and metabolic syndrome were independently associated with albuminuria;increased age, elevated systolic pressure and hyperglycemia were independently associated with reduced eGFR; increased age was independently associated with hematuria. Conclusions The prevalence of adult CKD is 12.95％ in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region. Independent risk factors of CKD include increased age, increased waist, hypertension,abnormal blood glucose or lipid, and metabolic syndrome.