新型冠状病毒感染（coronavirus disease 2019, COVID-19）是一种新发急性感染性疾病，人群普遍易感，以发热、乏力、干咳为主要表现，重症/危重症患者在发病早期即可出现呼吸困难和（或）低氧血症，快速进展为急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）、脓毒症休克、难以纠正的代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等。高龄（>60岁）及合并基础疾病是造成重型/危重型新冠病毒感染患者高病死率的重要原因[1]。如何降低重型/危重型患者的病死率，是其救治的重点和难点。我们对1例老年重型COVID-19患者进行血浆吸附治疗，在阻止ARDS进展方面取得良好的效果，现将诊治过程和体会报道如下。

Objective:To investigate the comorbidities and treatment of super-aged inpatients in South China.Methods:Super-aged inpatients in the Department of Geriatrics of Guangzhou First People's Hospital were cross-sectional selected as the research subject, the disease of these patients and their treatment plans were described and analyzed to explore the characteristics of comorbidities.Results:A total of 262 patients with an age of (88.0±5.5) years old were included in this study, including 173 men and 89 women. According to the prevalence rate, the most common chronic diseases were peripheral arteriosclerosis occlusion [87.50% (231/262)], and then, lacunar cerebral infarction [82.06% (215/262)], hypertension [73.48% (214/262)], osteoporosis [69.32% (183/262)], dementia [56.82% (150/262)], coronary heart disease [43.56% (115/262)], type 2 diabetes mellitus [37.12% (98/262)], chronic kidney disease [27.27% (72/262)], stroke [23.48% (61/262)], and chronic obstructive pulmonary disease [21.21% (56/262)], respectively. The incidence of comorbidities increased to the top in patients with 5 comorbidities, and then decreased gradually, presenting a normal distribution. Comorbidities were common in these people, 59.92% (157/262) of them had at least 5 kinds of chronic diseases, and 91.22% (237/262) had at least 3 kinds of chronic diseases. The age of patients increased with the increase of comorbidities, and this trend was more obvious in patients with 1-4 comorbidities, while the age fluctuated laterally in patients with 4-9 comorbidities. There were many kinds of medications used in these people and the proportion was high, as we found that the usage rate of statins was 73.86% (195/262), 11.74% (31/262) of rivaroxaban, 13.26% (35/262) of clopidogrel, and 6.06% (16/262) of aspirin, respectively.Conclusions:There are more comorbidities in the super-aged patients in South China, which increase with age, and the consumption of health resources and the proportion of drug use are high.

目的 探讨中国南方老年患者肾功能不全(Renal insufficiency,RI)尤其是慢性肾脏病(Chronic kidney disease,CKD)和痴呆(Dementia)的关系,为CKD患者中痴呆的预防和治疗提供借鉴.方法 横断面选取老年科患者262例为研究对象.将研究对象按照肾功能情况分为CKD组和non-CKD组.分析两组患者的相关并发症、实验室数据、生化指标及人口统计学等资料.结果 纳入的262例老年患者中CKD的患者有72例(27.5％),non-CKD组共有190例,两组患者在病史方面如年龄、性别、抽烟、饮酒、冠心病、房颤、脑卒中、糖尿病、骨质疏松、肿瘤等方面比较均无统计学差异;主要指标痴呆的患病率在CKD组中(28例,占38.9％)明显高于non-CKD组(49例,占25.8％),两组比较有统计学差异(P<0.05);其他指标如血尿酸白蛋白、甘油三酯、血氯等在CKD组中明显升高,而血小板在CKD组明显低于non-CKD组.结论 CKD患者中痴呆的患病率明显升高,CKD和痴呆的发生相关.

目的 探讨中国南方超高龄老年患者血清尿酸(Serum uric acid,SUA)和慢性肾脏病(Chronic kidney dis-ease,CKD)的关系,为超高龄CKD患者高尿酸血症患者的治疗提供借鉴.方法 横断面选取我院老年科超高龄患者为研究对象.将研究对象按照eGFR的大小分为CKD分期1～5期,探索各CKD分期血尿酸的分布及其与肾功能的关系.结果 本研究共纳入262例患者,平均年龄为88±5.5岁.按照eGFR将CKD分为5期,CKD1-5期的患者的例数和比例分别为:88例(33.6％),102例(38.9％)、59例(22.5％)、6例(2.3％)和7例(2.7％).相应的血尿酸水平分别为:259±93μmol/L,314±84μmol/L、446±162μmol/L、369±114μmol/L和408±191μmol/L.组间对比中,CKD1期2期,CKD1期3期,CKD2期3期之间均有统计学差异,提示肾功能和血尿酸相关.CKD1-3期血尿酸呈递增趋势,至CKD4和5不在上升且和CKD1-3期比较无统计学意义,提示血尿酸并非随着肾功能的下降而线性上升.另外,CKD的重要风险指标尿白蛋白肌酐比值(Albumin creatinine ratio,ACR)分为三个组:①<30 mg/g,②介于30～300 mg/g之间,③>300 mg/g.分别提示为正常或低风险、中风险、高风险.ACR和血尿酸的关系呈相反的趋势,组间对比提示仅有②组和①组有统计学差异,其余对比无统计学差异,提示ACR和血尿酸可能反向相关.结论 在中国南方的超高龄患者中肾功能和血尿酸呈非线性相关.

AIM:MicroRNAs (miRs) are endogenous substances that act as important diagnostic and treatment targets in renal diseases. miR-146 plays an important role in the development of endotoxin tolerance through NF-κB pathway, but the underlying mechanism is not clearly understood. The aim of this study was to determine the molecular regulation and function of miR-146 and also the expression of miR-146 in an experimental model of renal ischemia reperfusion injury (IRI). METHODS:IRI was induced in mouse by bilateral IRI for 45 min followed by reperfusion. The male mice were randomized as: sham, I/R, I/R+miR-146, and I/R+antago-miR-146 groups. Renal function, histological damage, and cell apoptosis were evaluated at 24 h after reperfusion. RESULTS:Overexpression of miR-146 protected renal function. Renal cells with upregulated miR-146 had lower plasma levels of blood urea nitrogen (BUN) and creatinine, decreased apoptosis and active caspase-3 protein expressions. miR-146 was shown to have a role in renal IR injury. miR-146 has a protective effect on renal function and plays a significant role in apoptosis. IGSF1 acts as a target of miR-146. IGSF1 rescued the effects of miR-146 on renal IRI. miR-146 protected renal function by activation of PI3K/AKT. CONCLUSION:These findings suggest that miR-146 might regulate apoptosis and can cause injury in I/R via targeting IGSF1 and also exert renal protection property.

目的:分析标准吞咽功能评估、预见性护理对老年脑卒中吞咽障碍患者康复的影响.方法:选2015年1月-2017年1月本院接收的89例老年脑卒中吞咽障碍患者,根据不同护理方法为依据分组:观察组(45例予以标准吞咽功能评估联合预见性护理),参照组(44例予以单一康复训练),对两组护理效果作比对.结果:观察组吸入性肺炎发生率8.89％、治疗有效率95.56％,均优于参照组的26.67％、77.27％,P＜0.05.结论:临床予以老年脑卒中吞咽障碍患者标准吞咽功能评估联合预见性护理,临床康复效果比单一康复训练更显著,可在提升临床治疗有效率、改善其吞咽能力的同时,有效降低吸入性肺炎发生率,可推荐.

目的:探讨高龄住院患者血尿酸水平与慢性肾脏病相关因素.方法:选取2016年3月至2017年3月我院老年病科住院的119例80岁以上患者资料进行回顾性分析.抽取空腹血检测血尿酸、血脂、肾功能等指标.结果:高尿酸血症组的eGFR、SCr、Cys-c、TC、TG、LDL-C明显高于尿酸正常组(P<0.05),高尿酸血症组的年龄、HDL-C、FBG低于尿酸正常组(P<0.05).年龄、HDL-C、FBG与eGFR呈正相关,UA、SCr、Cys-c、TC、TG、LDL-C、MAP与eGFR呈负相关.结论:高尿酸血症组的eGFR、SCr、Cys-c、TC、TG、LDL-C明显高于尿酸正常组(P<0.05),高龄、高尿酸血症、高血脂、空腹血糖是eGFR独立危险因素.

目的 探讨靶向流量计控制枸橼酸钠抗凝体系在多器官功能障碍(multiple organ dysfunction,MODS)患者连续肾脏替代治疗(continuous renal replacement therapy,CRRT)中的应用.方法 选择2011年1月~2014年6月在我院住院治疗MODS患者40例,随机分为2组:枸橼酸钠抗凝组、肝素抗凝组,每组各20例;其中,枸橼酸钠抗凝组给予靶向流量计控制枸橼酸钠抗凝、肝素抗凝组给予肝素抗凝.观察凝血功能指标PT、APTT、INR、CRP以及出血事件等变化.采用APACHE II评分和MODS评分,以评估血液净化对病情的总体影响.结果 枸橼酸钠抗凝组较肝素抗凝组的PT、APTT、INR以及出血事件显著降低(P<0.05);在外周血CRP表达方面,枸橼酸钠抗凝组与肝素抗凝组相比无明显差异.经治疗后枸橼酸钠抗凝组较肝素抗凝组的APACHEⅡ及MODS评分降低(P<0.05).结论 靶向流量计控制枸橼酸钠抗凝体系能够改善MODS患者CRRT治疗过程凝血功能预后、降低出血事件.

Objective to observe the clinical effect of extended release nifedipine tablets combined with benazepril in treating hypertension patients complicated with chronic kidney disease,to investigate the impact on pharmacokinetics of extended release nifedipine tablets. Methods A total of 100 hypertension patients complicated with chronic kidney disease were selected in the First People′s Hospital of Guangzhou from December 2012 to December 2014,and they were randomly divided into control group and study group,each of 50 cases. Patients of control group received extended release nifedipine tablets,while patients of study group received extended release nifedipine tablets combined with benazepril. Blood pressure,serum creatinine level,24 -hour urinary protein excretion before and after treatment,and pharmacokinetic index〔including time to peak(tmax ),half - life period(t1 / 2 ),area under the curve for drug concentration - time curve(AUC) and maximum plasma concentration(Cmax )〕were compared between the two groups,and the incidence of adverse reactions was observed. Results No statistically significant differences of SBP,SDP,serum creatinine level or 24 - hour urinary protein excretion was found between the two groups before treatment(P > 0. 05),while SBP,SDP,serum creatinine level and 24 - hour urinary protein excretion of study group were statistically significantly lower than those of control group after treatment( P < 0. 5). No statistically significant differences of tmax ,t1 / 2 ,AUC or Cmax was found between the two groups(P > 0. 05). the incidence of adverse reactions of study group was 10. 0& ,that of control group was 8. 0& ,the difference was not statistically significantly different( P > 0. 05). Conclusion Extended release nifedipine tablets combined with benazepril has certain clinical effect in treating hypertension patients complicated with chronic kidney disease,can effectively reduce the blood pressure and 24 - hour urinary protein excretion,protect the renal function,and combination of benazepril has no obvious impact on pharmacokinetics of extended release nifedipine tablets.

Objective To investigate the expression of plasma proteins in patients with diabetic nephropathy (DN),to provide a scientific basis for searching for sensitive plasma protein markers in DN.Methods 6 patients with DN and 6 normal subjects were observed by two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) in plasma to study disease protein markers.Selected protein spots with differential expression was greater than 1.5 fold to give mass spectrometry analysis.Results A two-dimensional gel electrophoresis profile of diabetic nephropathy and normal plasma was successfully established.11 different proteins were identified by analysis,including C3,C4,Apolipoprotein E,etc.Conclusion 2D-DIGE can objectively show the difference of protein expression between DN patients and normal blood plasma.11 proteins identified in this study may be molecular markers for DN,can provide the basis for the early diagnosis of DN.

目的：分析他汀类药物对老年急性肾损伤患者治疗效果的影响。方法选取我院2013年6月1日～2014年6月1日期间收治的老年急性肾损伤患者346例，分为3组，给予20mg他汀组、20mg阿托伐他汀治疗，给予40mg他汀组、40mg阿托伐他汀治疗，非他汀组采用常规治疗，分析3组治疗效果。结果治疗后，3组BUN水平比较无明显差异（ P＞0．05）；治疗后，40mg他汀组Scr、TC、TG、IL－7及MMP－8水平下降程度，与其他两组比较有统计学意义（ P＜0．05）。结论应用大剂量他汀类药物治疗老年急性肾损伤，对于调脂、逆转斑块、减少炎症反应具有积极意义。

目的：对老年急性药物性小管间性肾炎疾病的临床特点进行分析和探讨，总结其病理特点。方法选择2010年1月1日至2014年1月1日某院的64例老年急性药物性小管间质性肾炎患者作为研究对象，其中男性患者36例，女性患者28例，对他们的临床资料进行回顾性系统性分析，分析该疾病的临床与病理特点。结果老年急性药物性小管间质性肾炎的临床表现较多，病因较复杂，主要的临床表现为水肿、高血压、尿蛋白定量不正常并出现血尿、尿糖阳性、血尿酸增高等现象。结论老年急性药物性小管间质性肾炎需要早诊断早治疗，在治疗过程中合理使用治疗肾功能急性小管间质性肾炎的药物，注意用药安全。

Objective:To observe the elderly patients with chronic renal failure in h. pylori infection therapy before and after the change of blood ammonia and characteristics.Methods: choose me institutes were elderly, 84 cases of patients with chronic renal failure and helicobacter pylori positive as observation group, the negative and helicobacter pylori detected 84 cases as control group. On two groups of patients with bl ood ammonia detection value of comprehensive comparison and analysis.Results:The observation group of patients before treatment, blood ammonia detection averages(27.±2.3)umol/L, significantly higher than the control group(P<0.05); Observation group of patients after treatment, blood ammonia detection averages(11.2±1.5)umol/L, significantly lower than before treatment(P<0.05), with statistical significance. Conclusion:Elderly patients with chronic renal failure disease symptoms of helicobacter pylori infection can cause the body's blood ammonia increased significantly after helicobacter pylori anti-infection treatment to have a positive effect, can reduce blood ammonia readings, have significant meaning to delay progression of renal failure, is worthy of clinical attention and research further.

目的通过与灭吐灵止呕效果的对比,探讨盐酸苯海拉明与654-2联用止呕的有效性。方法两组共80例病例,随机分为实验组以及对照组,结果盐酸苯海拉明与654-2联用止呕效果与灭吐灵单用止呕比较,两组有显著性差异。结论盐酸苯海拉明与654-2联用止呕效果好,副作用小,实用方便。