BACKGROUND:The aim was to investigate the clinical characteristics of lipid metabolism and the effect of apolipoprotein E (ApoE) gene polymorphism on lipid metabolism in hemodialysis patients.METHODS:The serum levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), ApoA1, ApoB, ApoE and lipoprotein Lp(a) were detected by polymerase chain reaction-restriction fragment length (PCR-RFLP).RESULTS:The level of serum TG was significantly increased and the level of HDLC was significantly decreased in hemodialysis patients. Serum TG level was 33% higher than normal, and HDLC was 10.4% less than normal. The correlation analysis showed that TG level was significantly correlated with serum albumin level and extracorporeal circulation blood flow during dialysis. HDLC was significantly correlated with KT/V. The incidence of hypertension in hemodialysis patients was 73.6% and cardiovascular disease was 25%. The level of TG in the cardiovascular disease group was significantly higher than that in the non-cardiovascular disease group, and there was no significant difference between the hypertensive group and the non-hypertensive group. ApoE gene polymorphism test showed that the frequency of ApoE genotype ε3/3 and allele ε3 was the highest in hemodialysis patients, and the levels of TC, TG and LDLC were higher in ApoE genotype ε3/4 + ε4/4.CONCLUSION:The levels of serum TG and ApoB were significantly increased in patients with hemodialysis, and HDLC and other indexes were significantly decreased. The level of TG in patients with cardiovascular complications was significantly higher than in patients without complications. TG level was significantly correlated with serum albumin level and extracorporeal circulation blood flow during dialysis. HDLC was significantly correlated with KT/V. Hemodialysis patients who had ApoE allele ε4 are prone to lipid metabolism disorders.

Objectives To investigate the characteristics of dislipidemia and influence by low density lipoprotein receptor related protein (LRP) exon 3 Rsa Ⅰ gene polymorphism in hemodialysis patients.Methods serum total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDLC),high density lipoprotein cholesterol ( HDLC),apolipoproteins ( Apo A1,B,E) and lipoprotein (a) [Lp (a)] were measured,polymerase chain reaction - restriction fragment length polymophism ( PCR - RFLP) was used to detect LRP gene polymorphism in hemodialysis patients.Results The serum levels of TG and ApoB were higher significantly in the hemodialysis patients compared to contrals,and the levels of TC,LDLC,HDLC were lower compared to controls.Patients with cardiovascular disorder had higher TG level compared to patients without the disorder.The data of LRP polymorphism detected by PCR - RFLP showed that the allele frequency and the distribution of the LRP genotype of tetranucleotide reapeat sequence and exon 3 did not differ significantly between controls and hemodialysis patients.There was no statistic difference in serum lipid level between hemodialysis patients with different genotype of LRP exon 3.Conclusions Hemodialysis patients were liable to develop hypertrglyeridemia and hypocholesteroldemia.TG level might related to the development of cardiovascular disorder in hemodialysis patients.There is different influence of LRP Rsa Ⅰ gene polymorphism on lipid levels between controls and hemodialysis patients.

Objective To investigate characteristics of dislipidemia and the effect of gene polymorphism of low density lipoprotein receptor related protein (LRP) tetranucleotide on hemodialysis patients. Methods Serum total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDLC),high density lipoprotein cholesterol (HDLC),apolipoproteins (Apo A1,B,E) and lipoprotein(a) [Lp(a)] were measured;polymerase chain reaction-restriction fragment length polymophism (PCR-RFLP) was used to detect LRP gene polymorphism in hemodialysis patients. Results Serum levels of TG and ApoB were significantly higher in the hemodialysis patients than those in contrals,and the levels of TC,LDLC,HDLC were lower compare to those in contrals. Patients with cardiovascular disease had higher TG level comparing to the patients without cardiovascular disease. The data of LRP polymorphism detected by PCR-RFLP showed that the allele frequency and the distribution of the LRP genotype of tetranucleotide reapeat sequence did not differ significantly between controls and hemodialysis patients. There was no statistic difference of serum lipid levels among hemodialysis patients with different genotype of LRP tetranucleotide.Conclusions Hemodialysis patients can develop hypertrglyeridemia and hypocholesteroldemia. TG level might be related to the development of cardiovascular disease in hemodialysis patients. The gene polymorphisms of LRP tetranucleotide dose not affect the lipid levels significantly in hemodialysis patients.

BACKGROUND Use of conventional dialysate (CD) (powdered sodium bicarbonate dissolved manually with reverse osmosis water before dialysis) is common in Chinese haemodialysis (HD) centres. However, this preparation carries the risk of degradation and contamination, potentially negatively impacting host defense. Commercially available high-purity dialysate (HPD) may decrease inflammation and improve nutritional status in HD patients. However, whether HPD affects immune cells is unclear. The purpose of this study was to investigate the in vitro effect of these dialysates on apoptosis in U937 monocytes and its possible mechanism. METHODS Following incubation with two different types of dialysate, U937 cell apoptosis was measured by flow cytometry. Cell morphological changes were observed by Hoechst 33258 fluorescence staining. The expression of protein kinase C-δ (PKC-δ) was assayed by RT-polymerase chain reaction and western blot. Cytokine levels in U937 cells after exposure to CD or HPD for an indicated time were assayed by commercial enzyme-linked immunosorbent assay. RESULTS CD contained more bacteria (66 ± 6 CFU/mL) than HPD (7 ± 3 CFU/mL) while there was no difference in endotoxin levels. Compared with cells exposed to HPD and phosphate-buffered saline (PBS), U937 monocytes experienced more apoptosis when exposed to CD for 24 and 48 h, while there was no significant difference between HPD and PBS. Expressions of PKC-δ mRNA and protein in U937 cells were enhanced following exposure to CD for 24 and 48 h, with increased proteolytic cleavage of PKC-δ which could be inhibited by rottlerin, a specific inhibitor of PKC-δ. Moreover, the cultured supernatant in CD-exposed cells contained significantly higher levels of interleukin-6 (4.09 ± 0.36 vs 2.73 ± 0.38 pg/mL, P < 0.01, 24 h; 4.28 ± 0.32 vs 2.83 ± 0.32 pg/mL, P < 0.01, 48 h) and tumour necrosis factor α (3.45 ± 0.79 vs 2.44 ± 0.39 pg/mL, P < 0.05, 24 h; 4.60 ± 0.57 vs 2.50 ± 0.37 pg/mL, P < 0.01, 48 h) than those of HPD. CONCLUSION CD, but not HPD, contained more bacterial contamination, increased monocyte apoptosis in a PKC-δ-dependent manner and induced more cell inflammation. These findings suggest that impurity of dialysis fluid may be an important determinant of the elevated inflammation seen in CD-treated patients.

Objective To investigate the effects of different dialysates on expression of protein kinase C-δ (PKCδ) and apoptosis of U937 cell line. Methods Different dialysates were added into culture fluid with U937 cell line at exponential phase of growth, and groups were divided: fluid A+fluid B group (dialysate A+dialysate B), fluid A+fluid B+rottlerin (PKCδ specific inhibitor)group, fluid A+powder B group (dialysate A+powder B) and fluid A+powder B + rottlerin group. Besides, blank control group and normal control group were established. Cells were harvested 24 h and 48 h after treatment, morphological changes were observed by Hoechst33258 fluorescence staining, cell apoptosis was measured by Annexin-V-FITC/PI double staining, and expression of PKCδ mRNA and protein was detected by RT-PCR and Western blotting, respectively. Results Cell apoptosis significantly increased in fluid A+powder B group, with typical morphology of apoptosis. After treatment for 24 h and 48 h, cell apoptosis rates in fluid A+powder B group were significantly higher than those at corresponding time points in blank control group, normal control group and fluid A+powder B+rottlerin group (P0.05). Compared with normal control group, blank control group and fluid A+powder B+rottlerin group, the expression of PKCδ mRNA and protein of U937 cells in fluid A+powder B group were significantly increased (P0.05). There was no significant difference in cell apoptosis rates and expression of PKCδ mRNA and protein between fluid A+fluid B group and blank control group, normal control group and fluid A+fluid B+rottlerin group (P0.05). Conclusion Fluid A+powder B can significantly increase apoptosis of U937 cell line, the mechanism of which may be associated with the up-regulation of expression of PKCδ. Compared with fluid A+powder B, fluid A+fluid B is superior in reducing apoptosis of peripheral blood monouclear cells.

Objectives: To evaluate the images acquired with a clinical 3.0-T magnetic resonance imaging machine as the quantification of transplanted and surviving islets in vivo. Methods: Polyethyleneimine (PEI) was introduced to increase the labeling efficiency of Feridex, a dextran-coated superparamagnetic iron oxide. Allogeneic (Lewis-to-Wistar) and syngeneic (Wistar-to-Wistar) intraheptatic islet transplantations were performed to study the relationship among magnetic resonance imaging, metabolic monitoring, and pathological examination. Results: After receiving Feridex-PEI-labeled islets, dark voids could be observed in the livers of both groups, accompanied with a significant decrease in liver/muscle intensity ratio from 1.25 ± 0.03 to 1.09 ± 0.05 (P < 0.01). One week after transplantation, islet grafts were rejected in the allogeneic group. Rapid disappearance of dark voids and a significant increase of liver/muscle ratio were observed. No islet grafts could be found in the paraffin sections of livers by that time. Meanwhile, in the syngeneic group, islet grafts survived indefinitely. Dark voids persisted and low liver/muscle ratios retained. The fact that the dark voids represented the labeled islets was confirmed by combined staining of insulin activity and Prussian blue. Conclusions: Either spot counting or signal intensity measurement provides a perfect quantification of transplanted and surviving islets in vivo. Feridex-PEI provides an effective and safe way to label islets.

Objective To investigate the possibility of monitoring superparamagnetic iron oxide (SPIO) labeled islet grafts in vivo by magnetic resonance imaging (MRI). Methods Islet grafts were labeled with SPIO in vitro and transplanted into the liver of streptomycin-induced diabetic rats. There were 4 groups, including 2 syngeneic groups (Wistar to Wistar transplantation, one group receiving SPIO labeled islets,and the other group unlabeled islets as control) and 2 allogeneic groups (Lewis to Wistar transplantation, one group receiving SPIO labeled islets, and the other group unlabeled islets as control). Poly-L-Lysine (PLL) was used to increase the labeling efficiency of SPIO. After transplantation, MRI was performed regularly, fed glucose level was monitored, and animals were sampled for pathological examination. Results Only SPIO labeled islets could be detected by MRI. The relative number of islets detected by MRI in syngeneic group receiving labeled islets at week 1,2 and 3 following transplantation was (89.6±2.2)%, (87.5±14.4)% and (74.5±19.5)% respectively, and the relative number in allogeneic groups receiving labeled islets at these time points were (43.2±17.2)%, (36.5±13.0)% and (26.5±17.4)% respectively. Statistical significance was observed as the result of a paired student's t test (P<0.05). In the syngeneic groups, hyperglycemia was under well control, and co-localization of insulin activity and Prussian blue staining was observed in the liver sections of the animals receiving labeled islets. Meanwhile, in the allogeneic groups, loss function of islet grafts was determined by fed glucose level > 16.8 mmol/L at first week following transplantation,and no intact islets could be found in liver sections since that time. Conclusion Results of MRI correlate to fed glucose level monitoring and pathological examination. Application of this elegant imaging technique provides a direct, noninvasive and continuous way to monitor the distribution and survival of islet grafts in vivo.

Objective To investigate the causes of acute renal failure(ARF)after orthtopic liver transplantation(OLT)in patients of acute liver failure(ALF)and the effects of systemic therapy based on continuous renal replacement(CRRT).Methods Clinical data of 412 patients who underwent liver transplantations between January 2001 and June 2006 were analyzed retrospectively (all the cases were followed up to June 2007).According to UNOS grading scale,54 patients were of acute liver failure(UNOS 1 and 2A).Posttransplant ARF developing in 17 cases underwent a systemic therapy based on CRRT as well as anti-rejection,anti-infection and nutrition support.The perioperative courses,complications,causes of death and follow up results were analyzed.Results There were no severe complications during CRRT.Perioperative mortality was 5.4%and 58.8%in patients without ARF and those with ARF respectively.the rate of complications was 35.1%vs 100%.1 year survival rate Was 89.2% vs 41.2%.3 year survival rate was 81.1% vs 41.2%.Condusions The effect of surgery mainly depends on the function of liver and other vital organs.The ALF recipients suffered from a high perioperative mortality,especially those with posttransplant ARL.The systemic therapy based on CRRT benefits patients with postoperative ARF.

<正>血液透析时血管通路再循环(dialysis access recirculation,R)是部分已透析过的血液不经过体循环直接从静脉端向动脉端的回流,它降低了血液中溶质的量,使血液中可透析的溶质浓度低于全身血液该物质的浓度,削弱了透析效率[1,2],影响了

目前,克隆氏病的病因尚不明确,可能与免疫反应有关,糖皮质激素及免疫抑制剂是主要治疗方法之一.本院1例患者于肾移植术11年后并发克隆氏病,给予病变肠段切除治疗,但最终因全身多脏器功能衰竭死亡.报道如下:

Objective To observe the effect of uremic serum on the production of reactive oxygen species (ROS) and interleukin-6 (IL-6) in human umbilical vein endothelial cells (HUVEC),and its intervention by L-car-nitine (L-CN). Methods Uremic sera mixed with various concentrations of L-CN (0,25,250,1000 and 2500μM) were added to the culture medium. Semi-quantitative RT-PCR and ELISA were applied to evaluate the expression of IL-6. Cells labeled with oxidation-susceptible fluorescent probe 2,7-dichorofluoresin diacetate (DCFH) and mea-sured by spectrofluorophotometer were used for ROS assay. Results IL-6 and ROS were increased in HUVEC in the presence of uremic serum. With the addition of L-CN (250μM～2500μM) in culture medium,the production of ROS and IL-6 in HUVEC was inhibited,and the inhibition was L-CN concentration dependent. Conclusion Uremic serum induces the micro-inflammation processes of blood vessel endothelia. L-CN inhibits the production of ROS and IL-6 in HUVEC and thus the microinflammation and atherosclerosis processes in uremic patients.

目的 探讨血液净化在肝移植围手术期患者中的应用价值.方法 回顾性分析42例肝移植围手术期患者进行血液净化包括血浆置换(plasma exchange,PE)和持续肾脏替代治疗(continuous renal replacement therapy,CRRT)的结果.结果 29例肝移植患者移植前后行PE治疗(其中5例联合血液灌流),25例患者顺利过渡到肝移植,移植后的25例患者1年存活率为68%.PE治疗前后CD3+分别为70.5%±9.3%及53.9%±6.4%,CD8+(29.7%±8.1%,18.9%±7.3%)和CD25+(12.3%±6.4%,9.6%±5.9%)下降,CD20+(10.9%±6.9%,22.0%±8.6%)上升,IgG[(16.9±2.4)g/L,(12.2±1.5)g/L]和IgA[(6.4±1.5)g/L,(3.6±0.8)g/L)]下降,补体C3[(0.35±0.17)g/L,(0.60±0.19)g/L)]和CH50[(9.6±3.0)×104U/L,(15.7±1.3)×104U/L]增高.19例患者移植前后进行CRRT治疗,9例肾功能恢复,移植后存活7例.移植后需要CRRT支持的17例患者1年存活率为41.2%.7例患者既行PE又行CRRT治疗,移植后4例存活.治疗期间无严重并发症发生.结论 血浆置换可以改善患者凝血功能及一般情况;肝移植加人工肝支持系统是治疗肝衰竭的有效方法;以CRRT为基础的综合疗法能有效治疗肝移植术后急性肾衰竭的患者。

Background: Inflammation is involved in the pathogenesis of chronic allograft nephropathy (CAN) and cardiovascular disease (CVD) in post-kidney transplantation.Methods: Sixty patients, selected from 167 renal transplant patients, were divided into 2 groups: Group A (normal lipidemia group, n=30) and Group B (hyperlipidemia group, n = 30). In addition, Control Group came from 30 healthy volunteers. In Group B, the patients were treated with simvastatin for 3 months. The mRNA expressions of MCP-1 and CCR2 were detected with reverse transcription-polymerase chain reaction (RT-PCR).Results: The mRNA expressions of MCP-1 and CCR2 of all post-kidney transplant patients were significantly higher than controls. Compare Group A with Group B and the mRNA expressions of MCP-1 and CCR2 in Group B were much higher than Group A. After simvastatin treatment, the mRNA expressions of MCP-1 and CCR2 were significantly reduced in one and a half months and decreased to the lowest levels in three months.Conclusions: Simvastatin decreased the expressions of MCPA and CCR2 in post-kidney transplant patients with hyperlipidemia. (c) 2006 Elsevier B.V. All rights reserved.

Objective To investigate the prevalence of vitamin D receptor(VDR) gene polymophism in renal allograft recipients in Shanghai, and to study the relationship with bone mineral density (BMD). Methods The VDR genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR- RFLP) showing fine stable transplanted renal function (serum creatinine＜176μmol/L) together with periodic fol- low up of blood chemistry. BMD was measured by dual-energy X-ray absorptionmetry. Results The distribution frequencies of Aap I and Taq I alleles in this cohort were all in accordance with the Hardy-Weinberg equilibrium. BMD of lumbae vertebral and femoral trochanter in renal allograft recipients with“Aa”genotype were higher than those with“aa”genotype [(1.03±0.05, 0. 64±0. 02) g/cm~2 vs (0.83±0.05, 0. 55±0. 03) g/cm~2 (P＜0.05)]. No significant difference was found between Taq I genotypes and BMD in renal transplantation patients. Conclusion In the renal allograft recipients, Apa I polymorphism of VDR gene is associated with BMD. VDR gene Taq I has no effect on BMD in the renal allograft recipients.

1 病例介绍 患者女性,66岁,慢性肾衰竭,透析前血压130/80mm Hg(1mm Hg=0.133kpa),血管通路为动静脉内瘘,血液透析机为Baxter1550型(该机使用年份为3年).重碳酸盐透析,电导度设置为14.4mS/cm(钠浓度为138mmol/L).机器自检通过后预充透析器透析管开始透析.治疗处方:肝素钠抗凝,透析4h,目标超滤量2 900ml,血流量200ml/min.

Objective To investigate the mRAN expressions of PDGF-AA and PDGFα in peripheral blood monocyte cells of renal transplant recipients and the influence by Simvastatin treatment.Methods Sixty recipients were selected from 167 renal transplant recipients,and were divided into A,B groups..The patients in group B were treated with Simvastatin for 3 months.The mRNA expressions of PDGF-AA and PDGFα were detected with RT-PCR.Results The mRNA expressions of PDGF-AA and PDGFα in post transplant recipients were significantly higher compared to normal controls,which were more evident in group B than those in group A.Serum lipid levels in patients of group B decreased significantly after Simvastatin treatment.Meanwhile,the mRNA expressions of PDGF-AA and PDGFα reduced significantly at th 1.5th month of Simvastatin treatment,and reduced to a evidence even significantly lower than those in group A at the 3th month.Conclusion It is suggested that up-regulated expressions of PDGF-AA and PDGFα mRNA may be involved in the pathogenesis of CAN and CVD in renal transplant recipients with hyperlipidemia.Simvastatin might be used to reduce the mRAN expressions of PDGF-AA and PDGFαin renal recipients with hyperlipidemia

目的探讨血液透析患者脂代谢紊乱的临床特征及原因.方法检测106例维持性血液透析患者空腹血脂,并对影响血脂水平及有关因素进行分析.结果血液透析患者脂代谢紊乱主要表现为血清甘油三酯(TG)、载脂蛋白B(Apo-LB)水平显著增高,高密度脂蛋白胆固醇(HDLC)显著降低.TG与血清白蛋白(Alb)、透析时体外循环血流量显著负相关(r=-0.398,r=-0.219);HDLC水平与Kt/V显著相关(r=-0.305).血液透析患者高血压的发生率为73.6%,心血管病变为25%.伴心血管疾病的血液透析患者TG水平显著高于无心血管疾病者.结论血液透析患者脂代谢紊乱主要表现为TG、Apo-LB水平增高,HDLC水平降低.透析充分及透析时体外循环血流量及血清白蛋白水平影响血脂水平.

肾移植受者的多瘤病毒感染越来越受到人们的重视.本文主要综述肾移植术后多瘤病毒感染的表现、诊断及防治.

目的研究肾脏移植术后高脂血症同转化生长因子β及其受体 mRNA表达之间的关系,探讨其导致慢性移植肾病的可能机制与防治措施.方法肾移植术血脂正常组、血脂增高组及正常对照组各30例,血脂增高组应用辛伐他汀20 mg/d进行降脂治疗,于服药后1.5及3个月复查血脂;同时于不同时段应用逆转录聚合酶链反应检测外周血单个核细胞转化生长因子β及其受体mRNA表达.结果血脂增高组患者血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均显著高于血脂正常组及正常对照组(P＝0.000),辛伐他汀降脂治疗1.5及3个月后血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平呈递减趋势,且有显著差异(P值分别为0.000、0.000、0.027);外周血单个核细胞转化生长因子β及其受体 mRNA表达水平按正常对照组、血脂正常组、血脂增高组的顺序递增,血脂增高组患者于辛伐他汀治疗后随血脂的下降呈逐步下降趋势.结论肾移植患者高脂血症可导致转化生长因子β及其受体mRNA表达水平上调,可能是高脂血症引起动脉硬化、慢性移植肾病的机制之一;辛伐他汀降脂治疗可使转化生长因子β及其受体的表达下调,有助于减少肾移植患者动脉硬化及慢性移植肾病的发生.

骨质丢失是肾移植后的重要并发症,不论是近期移植还是长期移植的存活患者均持续存在骨质丢失,激素的使用是其主要原因之一[1,2].