Chinese Journal of Integrated Traditional and Western Nephrology

目前全国部分医学院校与当地综合大学进行合并调整后,不少作者在投稿时,对所在单位的中、英文名称的书写不够规范,不少单位在开具推荐信（即介绍信）时,使用的公章与文稿中所书写的不一致。单位名称书写不规范,将影响读者与作者之间的联系及文稿发表后文献计量学的统计等工作。为此,本刊就作者单位名称的书写要求如下:（1）作者在投稿时,首先应列出单位名称的全称,如已归属于综合大学的单位,应先列出大学名

1.数值范围号的使用应统一,一般使用浪纹连接号" ～ " . 例如:5 至10 可写成5 ～10;但5 万至10 万应写成5 万～10 万. 2.幂次相同的参数范围:前一个参数的幂次不能省略. 例如3 ×109 ～5 ×109 不能写成3 ～5 ×109,但可以写成(3 ～5) ×109. 3.百分数范围:前一个参数的百分号不能省略. 例如:20％ ～30％不能写成20 ～30％.

Objective:By observing the clinical characteristics of patients with diabetic kidney disease(DKD)with subclin-ical hypothyroidism(SCH),the clinical characteristics and distribution differences of TCM syndrome of DKD patients with SCH are discussed and analyzed,which provides certain value to the syndrome differentiation treatment of such patients.Methods:Through retrospective analysis,484 DKD patients were hospitalized in the Department of Nephrology and Endocrinology of Dongzhimen Hospital of Beijing University of Chinese Medicine for recent 5 years,among which 186 patients with SCH were in the DKD +SCH group(The 49 cases where TSH≥10.0 mIu/L was severe and 137 cases were 4.0 mIu/L TSH 10 mIu/L was mild),A total of 298 DKD patients without SCH were included in the DKD alone group and 246 patients in the type 2 diabetes group.The differences in gender,age,disease duration,thyroid function index and antibody level,renal function,HbA1c,24 h urinary protein quantification,and blood lipid were compared,and the proportion and distribution characteristics of TCM syndrome in DKD + SCH group were analyzed,and the relevant risk factors of different TCM syndrome were explored.Results:The levels of Scr,BUN,24 Upr,HbA1c,LDL-C,com-bined DL-C,TC,TC,TG,and HDL-C were all higher than patients with DKD alone or type 2 diabetes,with a statistically signifi-cant difference(P<0.05);The DKD patients with SCH had mostly lower spleen and kidney Yang deficiency syndrome,and the sig-nificantly lower FT4 level and significantly higher TSH level were observed,with a statistically significant difference(P<0.05);Risk factor analysis of DKD patients complicated with SCH found that sex,BMI,SBP,TSH,FT4,and Scr were independent risk fac-tors for progression to spleen and kidney Yang deficiency(P<0.05).Conclusion:DKD patients have different degrees of thyroid dysfunction;The renal function,blood lipid and saccharification indexes of SCH patients are different compared with simple DKD pa-tients or type 2 diabetes patients.Their TCM syndrome is mainly spleen and kidney Yang deficiency syndrome,and their thyroid func-tion is different among different TCM syndrome types,and the spleen and kidney Yang deficiency syndrome,qi stagnation and blood stasis syndrome are closely related to the progression of disease and SCH formation in DKD patients;In clinical practice,it is necessa-ry to correctly manage lifestyle,pay attention to timely changes of thyroid function,and adopt symptomatic treatment of spleen invigor-ating kidney and promoting blood circulation and removing blood stasis as soon as possible,which can provide important reference val-ue for delaying the progression of DKD and preventing the occurrence and development of hypothyroidism.

Objective:To systematically evaluate the clinical effect and safety of Shenkang Injection with Alprostadil(exper-imental group)versus Alprostadil alone(control group)on chronic renal failure(CRF),and to provide reference for clinical use.Methods:RevMan 5.4 provided by the Cochran collaboration was applied to risk assessment and meta-analysis of the included RCTs.Results:A total of 9 studies involving 691 patients were included.Meta analysis indicated that the experimental group had ad-vantages in total clinical effective rate(RR =1.24,95%CI[1.16,1.33],P<0.000 01),BUN(MD =-4.28,95%CI[-6.10,-2.46],P<0.000 01),Scr(MD =-51.91,95%CI[-68.11,-35.70],P<0.000 01),Ccr(MD = 5.78,95%CI[2.15,9.41],P =0.002),24 h Upro(MD =-0.56,95%CI[-0.66,-0.46],P<0.000 01)compared with the control group.But there were no significant difference in incidence of adverse reactions between two groups.Serious adverse reactions were not found.Conclu-sion:Compared with Alprostadil alone,Shenkang Injection with Alprostadil has better efficiancy,and deserved to be promoted for clinical use.However,due to the low quality of evidence,more rigorous,multicenter,randomized double-blind,large sample ran-domized controlled trials are needed for further exploration.

慢性肾脏病(CKD)因其高患病率、高致残率、高医疗花费和低知晓率——"三高一低"的特征,已成为全球范围内危害人类健康的重要公共卫生问题[1] .全球疾病负担研究显示,2017 年全球CKD患病率为9.1％,CKD 1 ～ 2 期为 5.

Objective:Investigate the changes and relationship between Klotho and autophagy in immortalized proximal tu-bular epithelial human cell line HK-2 cells which were induced by lipopolysaccharide(LPS).Methods:Cell model of sepsis-in-duced AKI was established by HK-2 cells that were exposed to LPS.HK-2 cells were incubated with0,1,5,10,50,or100 μg/ml LPS for 3,6,12,or 24 hours to determin the best LPS incubation concentration and time.The protein of Klotho,LC3 and P62 were detected by Westernblot,and autophagosomes were observed by electron microscope and fluorescence microscope.Statistical an-alyses were performed using Student's t-test by SPSS 23.0.Results:Cell model of sepsis-induced AKI was successfully estab-lished by HK-2 cells that were exposed to LPS.The activation of autophagy was indicated by the expression of LC3-Ⅱ/L3-Ⅰand p62.Klotho reduction and autophagy activation reached the maximum in HK-2 cells 24 hours after LPS incubation on the concentra-tion of 10 μg/ml.Also autophagosomes could be seen by electron microscope and fluorescence microscope on this concentration and time.Conclusion:It was a process of Klotho protein reduction and autophagy protein intension in HK-2 cells induced by LPS,the expression of Klotho and autophagy behaved dose and time dependence in septic AKI cell models,particularly 24 hours after LPS in-cubation on the concentration of 10 μg/ml.

胡桃夹综合征(nutcracker syndrome,NCS),又称左肾静脉压迫综合征,是指左肾静脉受到压迫(依据左肾静脉走行,可分为前位和后位)而出现的血尿、腰疼等一系列临床症状.NCS合并肾脏疾病也有较多文献,但后位NCS少见尤其是合并IgA肾病者,目前笔者尚未见有报道,现将我科发现的 1 例患者报告如下.

IgA肾病与糖尿病肾脏疾病均为常见的慢性肾脏病,二者病理类型及发病机制不同,但均可出现不同程度的血尿、蛋白尿或肾功能损害等表现. 从中医的角度审证求因,IgA肾病与糖尿病肾脏疾病在病程发生发展过程中存在相同病因,即风热邪气扰动肾脏,二邪相引相煽使邪势加剧、病情进展,故此两种疾病均可运用清热祛风法治疗.

目的:分析肾衰宁治疗慢性肾衰竭的有效性与安全性.方法:检索知网、万方、维普、中国生物医学数据库、PubMed、EMbase、the Cochrane Library数据库中关于肾衰宁治疗慢性肾衰竭的随机对照试验,筛选结果并提取信息,采用Rev-man5.3 软件进行Meta分析,TSA软件进行试验序贯分析.结果:共纳入25 项研究,合计1 997 例慢性肾衰竭患者.Meta分析结果显示,试验组可提高慢性肾衰竭患者治疗有效率[OR =5.15,95%CI(3.91,6.79),P<0.01],改善估算肾小球滤过率[MD =7.49,95%CI(5.59,9.39),P<0.01]、肌酐清除率[MD =-50.84,95%(-56.45,-45.23),P<0.01],降低血肌酐[MD =-67.91,95%(-79.01,-56.80),P<0.01]、血尿素氮[MD =-3.40,95%(-4.18,-2.62),P<0.01]、24 h尿蛋白定量[MD =-0.58,95%(-0.61,-0.56),P<0.01],升高血浆白蛋白[MD =2.85,95%CI(2.48,3.23),P<0.01],疗效优于对照组,差异均具有统计学意义.无严重不良事件或不良反应报告.试验序贯分析结果显示,传统界值和TSA界值被传统Z值穿过.结论:肾衰宁可提高慢性肾衰竭的临床疗效,安全性良好.

目的:探究益肾化湿颗粒(YSHSG)对老年慢性肾脏病(CKD)3～4 期患者治疗效果和作用机制.方法:收集2020 年12 月—2021 年11 月上海市第六人民医院肾病科门诊老年CKD3～4 期患者,筛选并纳入 63 例受试者,随机分成两组,对照组(32 例),常规药物治疗;治疗组(31 例),常规治疗加YSHSG治疗.治疗12 个月,观察两组患者湿热、风湿证改善情况,对比两组肾功能、尿微量白蛋白、尿白蛋白肌酐比值(ACR),用网络药理学分析该方干预的信号通路,用ELISA方法检测血液中VEGF、AKT、TNF-α等蛋白的表达情况.结果:治疗组中血肌酐、eGFR、ACR、VEGF、AKT、TNF-α表达量明显低于对照组,治疗组中患者湿热、风湿证表现明显改善,优于对照组.结论:YSHSG可以有效改善患者风湿证,抑制 VEGF、AKT、TNF-α的表达,有效保护肾功能,延缓肾病发展.

Objective:Traditional follow-up management can improve the prognosis.The aim of this study was to investi-gate the additional influence of mobile health(mHealth)management combined with traditional follow-up management on self-care behavior and clinical outcomes compared to only traditional follow-up management in patients with IgA nephropathy.Methods:We conducted a prospective cohort study with patients with IgA nephropathy who received mhealth management and traditional follow-up management as the experimental group and patients who received only traditional follow-up management as the control group.The patients were followed up for 3 months,and the score of self-management ability,blood pressure,urinary protein quantification and other clinical indicators were compared between the two groups.Results:(1)Compared with the control group,the self-care behav-ior score of the patients who received mHealth management increased by(12.6±8.1)points,systolic blood pressure decreased by(7.2±17.1)mmHg and total cholesterol decreased by(0.4±1.2)mmol/L.(2)For diastolic blood pressure,urinary PCR,albu-min,serum creatinine,serum potassium,serum uric acid,triglyceride and hemoglobin,there was no significant difference between the two groups.Conclusion:Compared with traditional follow-up,mobile health management improved the self-management ability of patients with nephropathy.

慢性肾脏病(chronic kidney disease,CKD)及其所导致的终末期肾病(end-stage renal disease,ESRD)患病率逐年升高,在世界人群中的患病率约为9. 1％ [1]. 临床中治疗ESRD的主要方法为肾脏替代疗法,但其治疗花费大、病死率高,难以真正改变患者生存质量[2] . 肾纤维化是CKD进展至ESRD的最主要的病理改变. 因此,有效治疗肾纤维化将有助于延缓CKD进展. 微小RNA(micro-RNA,miRNA)是内源性产生的短链非编码RNA,长度为22 ～25 个核苷酸. miRNA通过抑制翻译或诱导靶mRNA降解在哺乳动物转录后基因表达中发挥关键作用[3] . 其靶向多个 mRNA的独特性表明,靶向特定的 mRNA进行治疗可能会对疾病进程产生显著影响. 越来越多的研究发现miRNA在肾纤维化的发生发展中起着关键作用. 因此深入研究miRNA及其靶基因在肾纤维化中的作用将有助于发现识别肾纤维化预后的生物标志物和治疗肾纤维化的新型靶向药物[4] . 本文将综述近年来国内外有关miRNA在肾脏纤维化中作用机制及临床应用的研究进展,为肾纤维化疾病的治疗提供新的见解.

慢性肾炎是由多种原因、多种病理类型组成的原发于肾小球的一组免疫性疾病.其起病隐匿,病程长,最终进入慢性肾衰竭阶段,需维持肾脏替代治疗.若不重视保护,透析患者可短期内肾衰竭进展,出现高容量负荷、毒素蓄积等情况,严重影响预后.结合了几十年的临床工作经验,杨霓芝教授形成了益气活血法治疗慢性肾炎并腹膜透析的理论,并取得了很好的临床疗效.

Objective:To determine the effect of the changes of serum uric acid(UA)on estimated glomerular filtration rate(eGFR)in a healthy population.Methods:We conducted a retrospective study of a health examination center database in China.Subjects who had at least 3 visits from 2011 to 2018 were enrolled.A linear mixed-effects regression model was used to calculate the association between UA levels and eGFR.A logistic regression model was used to test the relationship between the slope of the chan-ges in UA levels and rapid eGFR decline and the risk of rapid eGFR decline in different trajectories.Results:In total,10470 study participants were included in this analysis.In a linear mixed model,after adjusting for confounders,UA was independently inversely associated with eGFR(P<0.001)in the HUA and non-HUA groups.We observed a nonlinear relationship(P for nonlinear associ-ation<0.001 in the HUAandnon-HUAgroups)betweenthe UAslopeandrapideGFRdecline(P<0.001 in the non-HUA and HUA groups).Compared with the low-stable group,low-increasing(adjusted OR[95%CI]=2.884[2.217,3.752])andhigh-increasing(3.701[2.680,5.110])had higher risk of faster decrease in eGFR in men and low-increasing(2.325[1.810,2.986]),high-decreasing(1.737[1.009,2.990]),high-stable(2.051[1.425,2.951])and high-increasing(3.982[2.643,5.999])had higher risk of faster decrease in eGFR in women.Conclusion:Our study found that UA was independently in-versely associated with eGFR in individuals in healthy participants.The distinct changes of UA are differently associated with faster decrease of eGFR.

糖尿病肾病(diabetic kidney disease,DKD)是严重的糖尿病(diabetes mellitus,DM)微血管并发症之一[1]. DKD发病机制复杂,遗传和表观遗传因素、氧化应激、炎症和血流动力学等多种因素[2,3] . DKD 患者往往最终会进入终末期肾病(end stage kidney disease,ESKD),不仅严重影响患者的健康,而且给家庭及社会带来沉重的经济负担. 钠-葡萄糖协同转运体 2抑制剂(sodium-glucose cotransporter 2,SGLT2i,又称SLC5A2)是一种钠-葡萄糖共转运蛋白,主要位于肾脏近曲小管S1 段,少量分布在S2 段.

终末期肾脏病(ESRD)患者心血管疾病死亡风险是普通人群 15 ～30 倍.>70％ESRD患者存在左室肥厚(LVH),而LVH是尿毒症心肌病的重要特征.透析患者猝死占全因死亡40％,猝死多提示存在心肌病变.

铁死亡是铁依赖性的脂质过氧化引发的新型细胞死亡方式,不同于细胞凋亡、坏死和自噬,它具有独特的细胞形态和生化特征.其主要的发生机制包括: SystemXc- - GPX4 - GSH轴、脂代谢、铁代谢及氧化应激等.急性肾损伤(acute kidney injury,AKI)是临床上常见的肾脏疾病,在我国,AKI的发病率达到 11.6％ [1],每年至少约 70 万例成年 AKI 住院患者死亡[2].除了透析和肾移植,目前尚无有效的治疗方法[3].近年来有研究表明,铁死亡参与AKI的发生发展,深入了解铁死亡的相关机制可为AKI的治疗提供新的方向[4].现就铁死亡在AKI中的作用机制、研究现状与治疗潜力进行总结.

特发性膜性肾病是成人原发性肾病综合征的主要病因之一[1,2],据统计我国特发性膜性肾病患者约占原发性肾小球疾病的9.9％ ～13.3％ [3].近年来,膜性肾病的发病率逐年升高,并且发病年龄越来越趋于年轻化.在特发性膜性肾病的自然病程中,约30％的患者有自发缓解倾向,约30％的患者部分缓解,但仍有 30％ ～40％的患者蛋白尿持续不缓解,最终进展至终末期肾病[4,5].因此,选择行之有效的治疗方法,是特发性膜性肾病治疗过程中亟待解决的问题.

Objective:To investigate the microbial spectrum and antibiotic resistance of continuous ambulatory peritoneal di-alysis(CAPD)associated peritonitis(PDAP)in our centre and guide the clinical rational use of antimicrobial agents.Methods:The etiological culture results of peritoneal peritonitis in patients with CAPD from January 2010 to December 2019 in our center were re-viewed,and the pathogenic bacteria spectrum and drug resistance to common antibiotics were analyzed.Results:In 331 cases of PD-Associated peritonitis,193 cases were positive for pathogen culture,with a positive rate of 58.51％ Among them,136 strains(70.47％)of gram-positive bacteria were mainly Staphylococcus epidermidis,Staphylococcus haemolyticus and Staphylococcus au-reus.There were 42 gram-negative strains(21.76％),mainly escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoni-ae.There were 15 strains of fungi(7.77％).The resistance rates of gram-positive bacteria to penicillin,cefazolin sodium and levo-floxacin were 70.16％,62.50％ and 38.28％,respectively,and the sensitivity rates to vancomycin,linezolid and teicoranin were 99.22％,99.15％and 98.65％,respectively.The drug resistance rates of gram-negative bacteria to ceftriaxone,piperacillin and cefotaximewere 28.57％,29.03％ and 25.00％,respectively.The sensitivity rates of moxifloxacin,piperacillin tazobactam and meropenem were 100％,100％ and 96.93％,respectively.Among 331 cases of PDAP,262 cases(79.15％)were cured after treat-ment,64 cases were extubated and transferred to hemodialysis,5 case died.Conclusion:Peritonitis is one of the common causes of PD withdrawal.The pathogenic bacteria were mainly Gram-positive bacteria.Vancomycin is the first choice.The third generation cephalosporins,piperacillin/tazobactam or carbapenem antibiotics can be selected for treatment of gram-positive bacteria.Periodic analysis of the distribution of pathogenic bacteria,drug resistance rate and sensitivity rate can guide the selection of clinical drugs.

腹膜透析(peritoneal dialysis,PD)是终末期肾病(ESRD)替代治疗方式之一,相对于血液透析(HD),PD有利于残余肾保护,对于建立血管通路困难或患有心血管疾病的患者有优势,与HD比较所占用的医疗资源少,治疗花费低,已成为重要肾脏替代治疗手段之一.随着PD患者的增加,其相关性并发症也逐渐增多.腹膜透析相关性胸腹瘘是持续不卧床腹膜透析(CAPD)患者相对少见的并发症之一,发生率为 1.6％ ～ 1.9％ [1].一旦发生,会影响到患者的透析效果,严重时会影响呼吸循环功能,甚至危及患者生命.本文对山西医科大学第二医院腹膜透析中心近14 年诊断的PD合并胸腹瘘患者的临床表现、诊断方法及治疗与转归进行分析总结,并文献复习,指导临床工作.