目的 观察维持性血液透析(hemodialysis,HD)患者肾性贫血治疗达标后,不同补铁方式对血红蛋白变异度(hemoglobin variation,Hb-Var)的影响.方法 选择2015年1-12月厦门大学附属中山医院行HD的患者160例,按照随机数字表法分入静脉补铁组(蔗糖铁注射液100 mg,每周1次,静脉滴注)与口服补铁组(多糖铁复合物100 mg,每天1次,口服)并随访1年,观察2种维持性补铁方式对Hb-Var的影响.结果 采用4种方法对Hb-Vat进行评估:①静脉组患者剩余标准差明显低于口服组[(8.04 ±4.58)g/L vs.(12.25±6.85) g/L,P=0.042].②静脉组患者血红蛋白(hemoglobin,Hb)振幅低于口服组[(15.88±8.07) g/L vs.(27.00±15.88) g/L,P=0.015].③连续测量相邻时间点Hb变化绝对值,静脉组患者Hb的个体变化值及其标准差均较口服组明显降低[分别为(8.64±4.91)g/Lvs.(13.69±7.60) g/L及(6.25±3.76) g/L vs.(11.23±8.49) g/L,均P＜0.05].④观察期内4次检测血红蛋白高于、处于及低于靶目标(Hb:110 ～ 130 g/L)的比例分别为:静脉组12.85％、71.14％及16.01％;口服组6.90％、55.17％及37.93％(x2=7.164,P=0.028).静脉组转铁蛋白饱和度及铁蛋白在治疗后均增高[分别为(29.29±11.80)％vs.(39.36±12.32)％,P=0.025;(375.39±223.77) ng/ml vs.(463.05±303.26)ng/ml,P=0.005].结论 不同的维持性补铁方式对Hb-Var的影响程度不同,静脉补铁较口服补铁更有助于血液透析患者Hb的持续达标,其原因可能与铁储备的稳定性及铁离子利用率的提高有关.

目的 观察补铁治疗对维持性血液透析患者贫血指标和促红细胞生成素类药物(ESAs)用量的影响.方法 前瞻性入组2015年1-7月我科维持性血液透析患者169例,根据患者铁指标情况采用静脉补充铁剂或口服补充铁剂治疗,比较患者治疗前后的血红蛋白(Hb)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)和ESAs治疗剂量.结果 与治疗前相比,静脉补充铁剂治疗后患者的Hb、SF和TSAT水平均显著增加(P＜0.05),ESAs使用剂量明显下降(P＜0.01).口服补充铁剂治疗后患者的Hb、SF、TSAT和ESAs使用剂量与治疗前相比,差异均不具有统计学意义(P＞0.05).结论 针对铁储备明显低下的透析患者,通过静脉补充铁剂后可提高血透患者贫血指标,减少ESAs使用剂量;铁储备在理想范围的透析患者通过补充口服铁剂可稳定患者的Hb和铁指标,为患者的后续治疗提供了指导和帮助.

ABSTRACT To delay the progression of chronic kidney disease and prevent the occurrence of end stage renal disease are a research focus in the field of nephrology. Blocking the renin-angiotensin system can effectively lower the blood pressure and reduce the output of urine protein so as to attain the target of protecting the kidney and preventing kidney disease chronic progress. This paper introduces the protective effects of kidney, applications and the common adverse drug reactions of several commonly used rennin-angiontensin system blockers in the treatment of chronic kidney disease.

Objective To evaluate the value of serum total cholesterol for prediction of 90-day mortality acute kidney injury (AKI) patients. Methods In a prospective cohort study, 176 hospital-acquired AKI patients were enrolled into low cholesterol group (<2.8 mmol/L) and high cholesterol group (≥2.8 mmol/L) when they were diagnosed as AKI. All patients were followed up for 90 days. Results The mean serum total cholesterol was (3.61±1.49) mmol/L. There were 48 patients (27.3%) with hypocholesterolemia (<2.8 mmol/L). The case fatality rate in low cholesterol group and high cholesterol group were 54.2% (26/48) and 32.8% (42/128), respectively. Kaplan-Meier survival analysis showed that there was significant difference in survival curve between the two groups (P=0.006). Cox risk regression model showed that hypocholesterolemia was one of the independent predictors for death in 90 days after AKI. Logistic regression model receptor oriented curve showed that area under curve (AUC) was 0.588 (95%CI: 0.489-0.687) for total cholesterol. Conclusion Serum total cholesterol can be taken as a 90-day mortality predictor in hospital-acquired acute kidney injury.

Objective This study was designed to establish a clinical prediction score for the prognosis of acute kidney injury(AKI) in hospitalized patients.Methods A total of 363 hospitalized AKI patients in Huashan Hospital from January 2011 to March 2012 were enrolled.In this prospective cohort study,the 261 AKI patients were assigned as the test group,and the 102 AKI patients as the validation group.Multivariate logistic regression analysis was applied to identify the risk factors for AKI.Based on the odds ratios,we derived a new prediction score system,from which the prediction curve for AKI mortality within 90 days was established.The ROC curve and Hosmer-Lemeshow goodness-of-fit chi-squared test were used to assess the accuracy and efficacy of the scoring system.Results ①Five variables were identified as the independent risk factors for AKI,including total number of complications,vasopressor(dopamine) support,mechanical ventilation,blood urea nitrogen(BUN),and serum prealbumin.②The overall risk score was calculated from the scores of risk factors for each patient in the test group.The incidence of AKI was 16.8% in the low-risk subgroup(=4 points),48.0% in the moderate-risk subgroups(5～10 points),76.0% in the high-risk subgroup(11～16 points) and 100% in the very-high-risk subgroup(17～30 points).The area under the ROC curve was 0.801(P<0.001).③Good discriminative power was found in the validation group,and the risk score was strongly correlated with AKI mortality(?=4.149,P=0.657).Conclusion This scoring system can accurately predict the mortality of AKI patients developed during hospitalization.Clinical application of this score may be useful for the decision of kidney protection interventions and the improvement of prognosis in AKI patients developed in hospital.

Objective To investigate the risk factors for contrast-induced nephropathy (CIN) after endovascular therapy in patients with peripheral arterial diseases and to evaluate the conformance of serum cystatin C (Cys C) and serum creatinine in diagnosis of CIN. Methods In this prospective,single center study,in-hospital patients with peripheral arterial diseases undergoing non-emergency endovascular therapy from July 2010 to April 2011 in our hospital were enrolled.CIN was defined as Scr increase ≥25％ after angiography.General clinical characteristics and blood biochemical parameters were compared between the non-CIN and CIN groups.Logistic regression analysis was performed to determine risk factors.Changes compared to baseline level in serum creatinine and Cys C at predefined time-points were evaluated. Results A total of 367 patients were enrolled in the study.The proportions of patients with diabetes mellims and treatment with diuretics before angiography,contrast-media dosage were significantly higher in the CIN group than those in non-CIN group (P＜0.05,＜0.01,＜0.01).Logistic regression analysis indicated that diabetes mellitus,contrast-media dosage were risk factors for CIN.Several serum Cys C increase criteria at 24 hours after contrast media exposure all had low sensitivity for predicting a Scr increase ≥25％.Only small overlapped regions were found in Venn diagram between several increasing criteria according to serum Cys C and serum creatinine criterion. Conclusions Diabetes mellitus,contrast-media dosage are independent risk factors for CIN.The results of several increasing criteria according to serum Cys C in evaluating contrast-induced AKI are not coincident well with that of serum creatinine criterion.