Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis (MHD) patients. This is a pilot trial evaluates short-term near-infrared (NIR) therapy for AVF in MHD patients. Between July and September 2023, 60 MHD patients at Peking University Third Hospital were screened. Of these, 44 were enrolled and randomized, and 42 completed the study. The JLP-800 infrared therapy device (Input voltage 220 V, oscillation mode, wavelength 600–3400 nm, 0–21 W output, the output power is 70%, and the energy density is 31.8 J/cm2) was used to illuminate AVF for 30-min. The safety index was the skin temperature of the AVF. Hemodynamic alterations and regional biomarker profiles were assessed via intention-to-treat analysis with longitudinal pre-/post-NIR exposure comparisons. The results demonstrated the safety of NIR for AVFs. The Interleukin‑6 (IL‑6) on AVF and systemic level of NIR group decreased significantly compared to controls [ -0.46 pg/mL (IQR: -1.84 to 0.19) versus + 0.23 pg/mL (IQR: -0.23 to 0.79); -0.53 pg/mL (IQR: -2.05 to 0.07) versus + 0.86 pg/mL (IQR: -0.37 to 4.27)]. After 30-min, theinterleukin‑10 (IL‑10) on the AVF in the NIR group increased significantly. Compared with the control group, the rise in interleukin‑8 (IL‑8)on the AVF of NIR was more modest. The CD4+/CD8 + on the AVF and systemic increased significantly in NIR group [1.48(0.00,2.84) vs. 2.07(0.55,3.48), P < 0.05; 1.66(0.00, 2.71) vs. 1.94(0.60, 3.80), P < 0.05]. This pilot study suggests that short-term NIR irradiation of the AVF in hemodialysis patients appears to be safe and may potentially attenuate the inflammatory response to some extent.Clinical trial registration number: ChiCTR2300071305 (05/10/2023).

Rituximab is recommended as the first-line treatment for moderate- to high-risk primary membranous nephropathy (PMN). Obinutuzumab, a highly humanized anti-CD20 monoclonal antibody, has been shown to exhibit enhanced efficacy in laboratory studies. This study aimed to investigate the efficacy, side effects, and potential remission predictors of obinutuzumab in PMN treatment. This retrospective cohort study included PMN patients who presented with nephrotic syndrome and who were treated with obinutuzumab (1 g on day 1 and day 28 in the majority of patients) between March 2022 and December 2023. Logistic regression, Kaplan–Meier curve analysis, and the log-rank test were used to assess treatment effectiveness and predictors of remission. Safety profiles were also recorded and analyzed. A total of 66 PMN patients, with a mean age of 50 ± 13 years, were enrolled, and 48 (72.7

Introduction: Enarodustat is an oral HIF-PHI for the treatment of chronic kidney disease anemia. Methods: This phase 3, multicenter, randomized 24-week study assessed enarodustat's noninferiority to rHuEPO for treating hemodialysis-dependent CKD (HD-CKD) anemia. Overall, 100 ESAs-treated patients were randomized 1:1 to enarodustat or rHuEPO for a 24-week treatment with dose adjustment every 4 weeks to maintain hemoglobin (Hb) within target range 100-120 g/L. The primary efficacy endpoint was the between-group difference in mean Hb over weeks 20-24 (evaluation period [noninferiority margin: -10 g/L]). Safety was assessed by treatment-emergent adverse events (TEAEs). Results: Of the 100 patients treated (enarodustat: 50; rHuEPO: 50), 93 completed the study. Demographic and baseline characteristics were comparable. During the evaluation period, the mean Hb level was 106.81 g/L in the enarodustat group and 99.68 g/L in the rHuEPO group. Enarodustat was noninferior to rHuEPO (least squares mean difference: 7.47 g/L [95% confidence interval: 4.17, 10.78]; p < 0.001). The mean Hb level in the enarodustat group remained within the target range throughout the treatment period, with a maintenance rate of 79.6% during weeks 20-24 versus 51.0% for rHuEPO. After switching from ESAs, the enarodustat group showed increased total iron-binding capacity, transferrin, and serum iron, decreased hepcidin by week 4, and increased RET% by week 2. TEAEs incidences were comparable (enarodustat: 90.0%, rHuEPO: 90.0%), with no additional safety concerns for enarodustat. Conclusions: Enarodustat was noninferior to rHuEPO for the treatment of anemia in HD-CKD patients, with good safety and tolerability over 24 weeks.

INTRODUCTION:PLA2R-associated primary membranous nephropathy (PMN) was classified as IgG4-associated autoimmune disease, in which anti-PLA2R antibody is predominantly IgG4 subclass. Our objective was to explore the capability of anti-PLA2R IgG4-to-IgG ratio for predicting remission in PLA2R-associated PMN patients. METHODS:A total of 143 patients with anti-PLA2R IgG ≥14 RU/mL were biopsy-confirmed as PLA2R-associated PMN. Serum samples collected at the time of renal biopsy were tested for anti-PLA2R IgG and anti-PLA2R IgG4 using time-resolved fluoroimmunoassay. The anti-PLA2R IgG4-to-IgG ratio was calculated as anti-PLA2R IgG4 (ng/mL) divided by anti-PLA2R IgG (RU/mL). Patients were divided into high-ratio and low-ratio groups by cutoff value of 31.5 ng/RU determined by the maximally selected log-rank statistic. The relationship between anti-PLA2R IgG4-to-IgG ratio and remission was analyzed using Cox proportional hazard regression. RESULTS:Compared to the low-ratio group, patients in the high-ratio group were significantly younger (52 [40-60] vs. 58 [51-61] years, p = 0.035), had higher estimated glomerular filtration rate (102 [88-111] vs. 94 [72-100] mL/min/1.73 m2, p = 0.004), and obtained higher 6-month partial remission rates (64.6% vs. 30.0%, p = 0.001) and 1-year complete remission rates (38.3% vs. 7.7%, p = 0.003). The higher remission rates with high ratio remained in both moderate-low-risk and high-risk subgroups categorized according to KDIGO 2021 guidelines. The anti-PLA2R IgG4-to-IgG ratio had a significant positive relation with partial remission (hazard ratio [95% confidence interval] = 2.09 [1.27-3.46], p = 0.004), which also persisted across both risk subgroups. Kaplan-Meier survival curves confirmed the significantly higher possibility of partial remission in the high-ratio group. CONCLUSION:An elevated anti-PLA2R IgG4-to-IgG ratio may be a supplementary predictor for remission in PLA2R-associated PMN.

To explore the efficacy of erythropoietin (EPO) combined with low-dose roxadustat in the treatment of hemodialysis patients with renal anemia whose hemoglobin (Hb) levels did not reach the guideline-recommended targets with EPO alone. This retrospective study included patients undergoing hemodialysis from January 2020 to December 2023 at three general hospitals in Beijing. Patients included were those whose Hb levels could not be maintained within the guideline-recommended range with EPO alone, for whom increasing EPO doses posed risks, or who had already reached the maximum EPO dose per the drug label, and those who could not afford full conversion to roxadustat. Changes in Hb levels and influencing factors before and after combination therapy were analyzed. A total of 125 patients were included (74 males, 50 females, mean age 61 ± 14 years, range 29–89 years). The median dialysis vintage was 55 ± 67 months (range 5–370 months). Primary diseases included diabetic nephropathy (48 cases), glomerulonephritis (42 cases), hypertensive nephropathy (10 cases), ADPKD (9 cases), tubulointerstitial nephropathy (3 cases), and unknown etiology (13 cases). Hb levels were persistently <110 g/L for 3 months before adding roxadustat. At the start of combination therapy, Hb was 96.66 ± 15.86 g/L, which increased to 102.64 ± 20.48 g/L (P = 0.001) at 1 month and 110.70 ± 16.07 g/L (P < 0.001) at 3 months. The average roxadustat dose was 197 ± 92 mg/week, approximately two-thirds of the recommended dose per the label. No significant changes were observed in EPO dose (P > 0.05), intravenous iron dose, transferrin saturation (TSAT), ferritin (SF), dialysis parameters, adequacy (KT/V), us-CRP, or iPTH levels (all P > 0.05). No significant adverse events were reported. Low-dose roxadustat combined with EPO is safe and effective for hemodialysis patients with renal anemia whose Hb levels cannot be maintained within target ranges with EPO alone.

Obinutuzumab is a more humanized and more potent efficacy in basic research, and it has a different epitope anti-CD20 monoclonal antibody compared with rituximab. We conducted an exploration to investigate its effectiveness in primary membranous nephropathy (PMN) and present the results here. A total of 66 PMN patients who received obinutuzumab from March 2022 to December 2023 were retrospectively enrolled. The patients had an age of 50 ± 13 years, among whom 48 were male (72.7%). They were grouped into the clinical remission group and the non-clinical remission group. Data was expressed by median (25%, 75%) or mean ± SD. One month after the first administration of obinutuzumab, the anti-phospholipase A2 receptor (PLA2R) antibody decreased by 84.7% (64.9%, 94.0%), urinary protein decreased by 37.4% (7.3%, 57.9%), and serum albumin increased by 13.8% (8.1%, 22.5%) (all P < 0.05) (Fig. 1A). The anti-PLA2R antibody and urinary protein continued to decrease, and serum albumin continued to increase (all P < 0.001 from the second month, not shown in Fig. 1A). During the follow-up period (with an average of 15.1 ± 6.5 months), 58 cases (87.9%) achieved clinical remission, among which 29 cases (43.9%) achieved complete remission (CR). The median time to the first (recorded) response was 4 (2, 7) months for partial remission (PR) and 11 (8, 15) months for CR (Fig. 1B). After the first administration of obinutuzumab, the serum anti-PLA2R antibody and proteinuria decreased significantly and maintained a downward trend. The serum albumin level increased significantly and continued to rise to the normal level, and the estimated glomerular filtration rate (eGFR) remained stable (Fig. 1 C–F). The decrease rate of the anti-PLA2R antibody one month after obinutuzumab was higher in the remission group than in the non-remission group [88.2 (72.0, 94.3)% vs 62.5 (14.2, 82.9)%, P = 0.063]. Multivariate logistic analysis showed that the decrease rate of the anti-PLA2R antibody was associated with clinical remission (OR = 1.058, 95% CI 1.012–1.105, P = 0.012). The receiver operating characteristic (ROC) curve indicated that it had a predictive value for complete remission (AUC = 0.796, 95% CI 0.685–0.908, P < 0.001), and patients were more likely to achieve complete remission when the decrease rate was >85%. Obinutuzumab showed a rapid and long-acting effect in reducing the serum anti-PLA2R antibody levels in PMN patients, and finally led to good clinical remission. The decrease rate of the anti-PLA2R antibody one month after administration has a predictive value for the clinical remission of PMN.

Background: Maintenance hemodialysis (MHD) can lead to hypertrophy of myocardial cells and interstitial fibrosis in patients, which can ultimately culminate in left ventricular hypertrophy (LVH). The objective of this study is to examine the expression of miR-107 in patients undergoing MHD who also present with LVH and to evaluate its predictive value. Methods: A total of 135 patients with end-stage renal disease who were undergoing MHD were included as the research subjects. Patients were grouped based on left ventricular mass index. Real-time quantitative polymerase chain reaction was used to detect the expression of miR-107 in the serum of the patients. The receiver operating characteristic curve was used to evaluate the diagnostic value of miR-107 in MHD with LVH patients. The Pearson's method was used for correlation analysis. Logistic regression model was used to analyze the risk factors for cardiac hypertrophy in MHD patients. Results: Serum miR-107 is highly expressed in patients with MHD and LVH, and it may be a potential diagnostic biomarker. miR-107 has relatively high sensitivity and specificity in predicting LVH in patients with MHD. Serum miR-107 is closely related to the serum highsensitivity C-reactive protein level and echocardiographic characteristics of patients with MHD combined with LVH. MiR-107 correlates with echocardiographic characteristics of MHD patients with LVH. Finally, logistic regression analysis indicated that miR-107 was a risk factor for LVH in MHD patients. Conclusion: Serum miR-107 may have significant potential in diagnosing cardiac hypertrophy in MHD patients and is a potential biological indicator for cardiac hypertrophy in MHD patients.

OBJECTIVE:To analyze the clinical characteristics of hemodialysis patients with corona virus disease 2019 (COVID-19) in a single-center from Beijing.METHODS:Patients with COVID-19 who received regular hemodialysis at Peking University Third Hospital from November 30, 2022 to January 4, 2023 were selected as the study objects. Clinical symptoms, severity and duration of symptoms during the period of virus positive were investigated in the form of questionnaires, and the basic information of the patients, as well as the results of blood tests (routine blood and blood biochemistry, etc.) before and after infection, dialysis treatment and the outcome of the disease were collected by consulting medical records.RESULTS:A total of 203 subjects were included in this study, including 148 mild cases (72.91%), 23 medium cases (11.33%), 32 severe and critical cases (15.76%), and 16 (7.88%) deaths occured during the follow-up. Clinical symptoms mainly included respiratory symptoms (among which 81.77% had cough, 68.97% had expectoration), fever (81.28%) and fatigue (65.52%), and fatigue and weakness had the longest duration [9 (5, 15) days] among all symptoms. Twenty-six patients (12.8%) reduced the dialysis sessions [1 (1, 2) times], 25 patients (12.32%) had the behavior of early finishing dialysis (27 times), reducing the dialysis time by 30.0 (20.0, 30.5) minutes. Univa-riate analysis showed that the hemoglobin, creatinine, urea nitrogen and ultrafiltration decreased signi-ficantly after infection (P < 0.05). There were significant differences in age, albumin, hemoglobin, creatinine levels and vascular access types among the patients with different clinical subtypes, and the changes of dialysis sessions, fever, expectoration and fatigue degree were also different among the patients with different clinical subtypes (P < 0.05). Multivariate Logistic regression analysis showed that age (OR=1.051, 95%CI: 1.017-1.086, P=0.003) and albumin levels (OR=0.905, 95%CI: 0.803-1.019, P=0.098) corrected by fever, expectoration and fatigue levels were still associated with the occurrence of pneumonia.CONCLUSION:The morbidity of pneumonia and the proportion of deaths in hemodialysis patients with COVID-19 were higher, and some clinical symptoms lasted for a longer time than the general population. During the infection period, the incidence of dialysis-related complications increased, hemoglobin and nutritional status decreased. Elderly patients and patients with low albumin level had a higher risk of developing pneumonia after infection.

Abstract Background and Aims We reported that rituximab 100 mg monthly showed an effective regimen for low anti-phospholipase A2 receptor (anti-PLA2R) primary membranous nephropathy (PMN), especially for those elderly and susceptible PMN. Here we attempted to compare effect of the rituximab (RTX) 100 mg monthly vs traditional corticosteroid-cyclophosphamide (GC-Cy) for the treatment of PLA2R-associated PMN in our hospital. Method All the included PMN patients were treated in our hospital between June 2017 and June 2022 and were retrospectively analyzed. The inclusion criteria:(1) age >18 years old, (2) biopsy-proven PMN, (3) anti-PLA2R titers >20 RU/ml, (4) nephrotic syndrome (NS, both proteinuria >3.5 g/24 and serum albumin <30 g/L), (5) eGFR >30 ml/ min. 1.73 m2, (6) followed up at least 12 months. Patients were stratified into the RTX and GC-Cy groups according to their received treatment. In the RTX group, patients received RTX 100 mg monthly until the NS was remission or at least serum anti-PLA2R less than 2 RU/ml. In the GC-Cy group, patients received prednisolone (0.5-1.0 mg/kg/day) or methylprednisolone (similar dose) orally for 1-2 months, then dosage was reduced gradually, and the total duration about one year; meanwhile received intravenous cyclophosphamide (0.6-1.0 g every month), total doses 6-12 g. Results The baseline parameters (included age, gender, anti-PLA2R antibody, urinary protein, serum albumin, and eGFR) did not differ significantly between the two groups (see Table 1). Total RTX dosed were 819 ± 240 (400-1200 mg) in the RTX group. After different treatment, anti-PLA2R antibody was significantly higher in rituximab group than in the GC-Cy group at 3 months (P < 0.05), but were not significantly different between the two groups at 6, 9, and 12 months (P > 0.05, see Fig. 1A); urinary proteins were significantly higher in RTX group than in the GC-Cy group at 3, 6, and 9 months (P < 0.001), but were not significantly different between the two groups at 12 months (P > 0.05, see Fig. 1B); serum albumin were significantly lower in RTX group than in the GC-Cy group at 3, 6, 9 and 12 months (P < 0.01, see Fig. 1C). The total remission rate was not significantly different between the two groups at 12 months (P > 0.05, see Fig. 1D). Conclusion Compared to traditional GC-Cy treatment, RTX 100 mg monthly appeared as a weak but lasting effective regimen for anti-PLA2R-associated PMN.

Abstract Objective: The infection rate and mortality of COVID-19 in hemodialysis patients are extremely high. In this study, we analyzed the risk prediction of pneumonia in Chinese’s hemodialysis patients with COVID-19. Method: We conducted a retrospective analysis of maintenance hemodialysis patients with COVID-19 admitted to Peking University Third Hospital from December 1, 2022 to January 31, 2023. We collected demographic data, underlying diseases, dialysis treatment data, and laboratory test results of these patients; logistic regression and ROC curve were used to analyze the risk factors of pneumonia. Results: A total of 209 hemodialysis patients with COVID-19 were enrolled in this study, of whom 80(38.3%) had pneumonia and 129(61.7%) normal. Multivariate logistic analysis revealed that older age (OR=1.030, 95%CI 1.002~1.059, p=0.036), lower hemoglobin (OR=0.968, 95%CI 0.942~0.995, p=0.019), lower albumin (OR=0.834, 95%CI 0.738-0.943, p=0.004) were risk factors for pneumonia. Patients with age >65 years old, hemoglobin <115g/L or albumin <36.8g/L had a higher risk of pneumonia, and we combined the three indexes to predict the risk of pneumonia (P= elogit(P) / 1+ elogit(P) , logit(P)=9.593 +0.031×Age (years old) -0.038×Hemoglobin (g/L) -0.210×Albumin (g/L)), drew the ROC curve with the risk P value (AUC=0.756, 95% CI 0.687~0.825, p<0.001), when P=0.575 was selected as the cut-off value, the sensitivity and specificity of the three indexes combined to predict pneumonia were 44.0% and 94.5% respectively. Conclusion: Older age, anemia and hypoalbuminemia were risk factors for pneumonia in MHD patients. We could reduce the incidence of pneumonia and improve the prognosis of MHD patients by correcting anemia and hypoalbuminemia.

纯红细胞再生障碍性贫血(pure red cell aplasia,PRCA)是一种以正细胞正色素贫血、网织红细胞减低和骨髓中红系前体细胞显著减低或缺如为特征的综合征[1].慢性肾脏病(chronic kidney disease,CKD)透析患者合并PRCA的病例临床较少见,以重组人促红细胞生成素(recombinant hu-man erythropoietin,rhEPO)引起的获得性PRCA为主,非促红细胞生成素(erythropoietin,EPO)抗体相关的PRCA报道少之又少[2-3].近期出现的罗沙司他是一种脯氨酰羟化酶抑制剂,为CKD贫血的治疗带来了新思路[4-6].本文报道罗沙司他应用于透析合并非EPO抗体相关原发性获得性PRCA患者1例.

目的 比较S.T.O.N.E.评分、Guy's分级、CROES图表计数3种评分系统预测经皮肾镜碎石取石术后结石清除率的准确性.方法 因肾结石行经皮肾镜碎石取石术病人133例,比较S.T.O.N.E.评分、Guy's分级、CROES图表计数预测术后结石残留的准确性及与手术时间、术后住院时间、术中出血量等临床资料的关系.结果 133例病人术后结石残留有53例.Guy's、S.T.O.N.E.评分系统随评分的增加,结石清除率逐渐降低;而CROES分级评分则相反.CROES图表计数评分方案对结石残留预测的准确性优于S.T.O.N.E.评分和Guy's分级方案.结论 与S.T.O.N.E.评分和Guy's分级比较,CROES图表计数对经皮肾镜取石术后结石残留的预测准确性更高.

1病历摘要 患者,31岁,因剖宫产术后7小时,子宫切除术后6小时,于2020年9月29日急诊转至北京大学第三医院重症监护室.患者孕期于某二甲医院规律产前检查,孕24周时,诊断妊娠期糖尿病,饮食运动控制血糖正常.2020年9月27日因宫内孕40周,妊娠期糖尿病入院引产,分娩前实验室指标大致正常,纤维蛋白原(FIB)2.35 g/L.9月28～ 29日予米索前列醇25 μg促子宫颈成熟,9月29日下午自然破膜,破膜后30分钟孕妇出现烦躁、紫绀,胎心出现延长减速,考虑胎儿窘迫,立即行子宫下段剖宫产术.术中出血多,血不凝,予按摩子宫、宫腔纱条填塞后出血未见减少,并出现酱油色尿.

Abstract Objective Maintaining a low-protein diet (LPD) is important for patients with chronic kidney disease (CKD) to delay renal degradation and alleviate clinical symptoms. For most patients with CKD, it is difficult to maintain the necessary low level of dietary protein intake (DPI). To improve the current dietary management of CKD, we conducted an intervention study by administering low-protein staple foods (LPSF). Design and methods We conducted a prospective case-crossover study among 25 patients with stage 3–4 CKD. During the initial 12 weeks of the study, we instructed the patients regarding a standard LPD according to the recommendations of a renal dietitian. In the second stage of the study, we requested the patients taking low-protein rice or low-protein flour (250 g/d) as an LPSF diet instead of regular staple food daily, and followed these patients up for 12 weeks. We compared the DPI, dietary energy intake (DEI), normalized protein equivalent of total nitrogen appearance (nPNA), serum creatinine levels, and nutritional index between baseline and the end of the study. Results We found no change in dietary variables among the patients during the first 12 weeks of the LPD. After subjecting them to an LPSF diet, the corresponding variables showed a pronounced change. The patients’ DPI decreased from 0.88 ± 0.20 to 0.68 ± 0.14 g/kg/d (P < 0.01) and the nPNA value decreased from 0.99 ± 0.18 to 0.87 ± 0.19 g/kg/d (P < 0.01). The high biological value protein intake proportion increased from 42% (baseline) to 57% (P < 0.01) during the 24 weeks. No variation was found in the measured DEI (28.0 ± 5.8 vs 28.6 ± 5.4 kcal/kg/d), nutrition assessment, or renal function and serum creatinine levels. Conclusion Our prospective case-crossover study demonstrated that an LPSF diet can help patients with stage 3–4 CKD reduce DPI and nPNA values, improve the proportion of highly bioavailable proteins, ensure adequate calorie intake, and avoid malnutrition. An LPSF diet is an effective and simple therapy for patients with stage 3–4 CKD.

Background Direct and indirect effects of radiofrequency ablation (RFA) on tumor microenvironment of the liver tumor have been noted, which was reported to be related to a variety of tyrosine protein kinase or cytokinetic pathway, but have not been thoroughly investigated and conclusive. Purpose To elucidate direct and indirect effects of RFA on tumor microenvironment in the liver tumor model, and to explore the role of the specific inhibitor in tumor growth by targeting the key pathway of RFA. Materials and methods One hundred and ten mice with H22 liver tumor were used in animal experiments. Eighty-four mice were randomized into three groups: control, direct RFA and indirect RFA (a block slide was inside the middle of the tumor). The growth rate of the residual tumor after RFA was calculated ( n = 8 each group) and the pathologic changes at different time points (6 h, 24 h, 72 h and 7d after RFA) were evaluated ( n = 5 in each subgroup). After semi-quantitative analysis of the pathological staining, the most significant marker after RFA was selected. Then, the specific inhibitor (PHA) was applied with RFA and the tumor growth and pathological changes were evaluated and compared with RFA alone. The Kruskal-Wallis test was used for evaluating the significance of different treatments in the pathological positive rate of specific markers in tumor. The two-way analysis of variance was used to determine the significance of treatment in tumor growth or body weight. Results The growth rate of the residual tumor in the direct RFA group was faster than the indirect RFA group ( P = 0.026). The pathological analysis showed the expression of HSP70 (73 ± 13% vs 27 ± 9% at 24 h, P < 0.001), SMA (70 ± 18% vs 18 ± 7% at 6 h, P < 0.001) and Ki-67 (51 ± 11% vs 33 ± 14% at 7d, P < 0.001) in the direct RFA group was higher than those in the indirect RFA group after RFA. On the other hand, the expression of c-Met (38 ± 11% vs 28 ± 9% at 24 h, P = 0.01), IL-6 (41 ± 10% vs 25 ± 9% at 24 h, P < 0.001) and HIF-α (48 ± 10% vs 28 ± 8% at 24 h, P < 0.001) in the indirect RFA group was higher than those in the direct RFA group. And the expression of c-Met increased mostly in both direct and indirect RFA group compared to the baseline (53 and 65% at 72 h). Then the specific inhibitor of c-Met-PHA was applied with RFA. The growth rate of the tumor was significantly slower in the RFA + PHA group than the RFA alone group (1112.9 ± 465.6 mm 3 vs 2162.7 ± 911.1 mm 3 at day 16, P = 0.02). Conclusion Direct and indirect effects of RFA on tumor microenvironment changed at different time points and resulted in increased residual tumor growth in the animal model. It can be potentially neutralized with specific inhibitor of related pathways, such as tyrosine-protein kinase c-Met.

目的 探讨红细胞生成素(erythropoietin,EPO)联合低剂量罗沙司他治疗单用EPO血红蛋白(Hb)未能维持靶目标的血液透析患者肾性贫血的效果.方法 纳入2020年1月～2021年9月北京大学第三医院血液透析患者中,单用EPO不能维持Hb在靶目标范围、增加EPO剂量存在风险或EPO已经超剂量、全部改用罗沙司他费用承担困难者,分析联合治疗前、后各6个月Hb水平的变化,罗沙司他和EPO剂量、透析方案、铁剂补充以及超敏C反应蛋白(us-CRP)、甲状旁腺激素(iPTH)、酸中毒程度(C02CP)的变化.结果 共38例患者接受了联合治疗,加用罗沙司他之前6月较前3月、前3月较0月,Hb逐渐降低(t=6.689、4.910,均P＜0.001),EPO剂量无显著变化(t=-1.686、-1.937,P=0.102、0.088),转铁蛋白饱和度(TSAT)、铁蛋白(SF)处于目标范围;联合低剂量罗沙司他[(211.9±12.5)mg/w]后1月、3月、6月分别较0月时,EPO剂量较联合治疗前无显著性改变(t=0.583、-1.303、-1.402,P=0.563、0.201、0.180),联合治疗后1、3、6个月Hb分别较0月时逐渐提高(t=-4.788、-5.162、-5.910,均P＜0.001),TSAT出现下降但未达到统计学差异(t=1.967,P=0.064),铁蛋白显著性降低(t=2.259,P=0.037);联合治疗前后,透析方案、静脉铁剂的剂量无变化,us-CRP、iPTH、C02CP 无显著差异(t=-1.989、-1.743、0.946,P=0.427、0.464、0.352),未见明显不良事件.结论 对于单用EPO不能维持Hb靶目标的血液透析患者,联合使用低剂量罗沙司他安全有效.