目的 探讨糖尿病肾病(DN)患者尿液基质金属蛋白酶组织抑制剂2(TIMP-2)、胰岛素样生长因子结合蛋白7(IGFBP7)水平及其临床意义.方法 选取254例DN患者为研究组,另选取同期230例单纯2型糖尿病患者为对照组,比较2组患者临床资料.根据估算肾小球滤过率(eGFR)将DN患者分为Ⅰ期组32例,Ⅱ期组84例,Ⅲ期组90例,Ⅳ期组48例;根据血清肌酐及尿量将DN患者分为AKI组19例和非AKI组235例;比较血清肌酐、尿液TIMP-2、IGFBP7水平在不同组别患者中的差异.采用酶联免疫吸附法检测尿液TIMP-2、IGFBP7水平及尿肌酐水平;采用Pearson检验分析尿液TIMP-2、IGFBP7与相关指标的关系;采用受试者工作特征(ROC)曲线评价尿液TIMP-2、IGFBP7及血清肌酐诊断DN患者发生AKI的效能.结果 研究组血清肌酐、糖化血红蛋白(HbA1c)、血尿酸、尿素氮、尿微量白蛋白、24 h尿蛋白定量、尿β2-微球蛋白水平均高于对照组,血清白蛋白、eGFR水平均低于对照组,差异有统计学意义(P＜0.05).Ⅲ期、Ⅳ期DN患者血清肌酐、尿TIMP-2与尿肌酐的比值(TIMP-2/尿肌酐)、尿IGFBP7与尿肌酐的比值(IGFBP7/尿肌酐)均高于Ⅰ期、Ⅱ期患者,差异有统计学意义(P＜0.05);与非AKI组相比,AKI组患者血清肌酐、尿TIMP-2/尿肌酐、尿IGFBP7/尿肌酐均升高,差异有统计学意义(P＜0.05).尿液TIMP-2、IGFBP7与血清肌酐、HbA1c、血尿酸、尿素氮、尿微量白蛋白、24 h尿蛋白定量、尿β2-微球蛋白均呈正相关(P＜0.05),与血清白蛋白、eGFR均呈负相关(P＜0.05).ROC曲线显示,尿液TIMP-2、IGFBP7、血清肌酐预测DN患者发生 AKI 的曲线下面积(AUC)分别为 0.676(95％CI:0.587～0.756)、0.864(95％CI:0.792～0.918)、0.618(95％CI:0.528～0.703),尿液TIMP-2联合IGFBP7预测DN患者发生AKI的AUC为0.926(95％CI:0.866～0.965).结论 DN 患者尿液TIMP-2、IGFBP7水平随病情加重而呈上升趋势,对DN患者发生AKI有一定的预测价值.

The grey predictive mathematical model based on big data was used for analysis on the effect of Escherichia coli infection on patients with lupus nephritis (LN) in this study. Then, 156 patients diagnosed with LN infections by Wuzhong People’s Hospital’s information system (HIS) from October 30, 2017 to October 30, 2019 were selected as the experimental group, and 89 patients without LN infections were selected as the control group. Besides, the grey theory mathematical model was applied to process the integrated data, and feature analysis was employed to screen out disease-related bio-markers for the diagnosis of LN. The two groups were compared for affected organs, treatment, laboratory indicators, pathogenic bacteria, and recovery status. Multivariate logistic regression was used to analyze the related factors of patients with infections. The results showed that the specificity, sensitivity, and accuracy of the big data diagnosis based on the grey theory mathematical model were 78.9%, 87.6%, and 92.1, respectively; hormones, c-reactive protein, procalcitonin, and the daily antibiotic dose were positively correlated with concurrent infections (P < 0.05); 38 cases of Gram-negative bacteria were screened out, accounting for the largest proportion (37.18%); the effective rate of the experimental group was obviously lower than that of the control group (P < 0.05), suggesting that C-reactive protein (CRP), procalcitonin (PCT), antibiotics, daily dose of hormones, and serum albumin were independent risk factors for LN infection. In conclusion, the grey predictive mathematical model based on big data had high specificity, sensitivity, and accuracy in diagnosing the occurrence of infection in patients with LN; LN infection was mainly respiratory infection, and gram-negative bacteria were the main pathogen. Patients with LN infections showed higher serum creatinine, 24-hour urine protein quantification, CRP, and PCT, and lower serum albumin and recovery effect versus those without LN infections.

Objective:To investigate the clinical effect of far-infrared therapy combined with clopidogrel on thrombosis of autogenous arteriovenous fistula (AVF).Methods:A total of 66 patients who underwent hemodialysis in the hemodialysis center of our hospital from June 2017 to December 2017 were selected and divided into combined group, clopidogrel group and control group according to random number table method, with 22 patients in each group. Patients in the combined group were given the therapy of far-infrared and clopidogrel, while in the clopidogrel group were only treated with clopidogrel. The control group was not treated with far infrared or clopidogrel. After 6 months follow-up, blood flow changes and the incidence of fistula thrombosis were compared in two groups.Results:At the end of follow-up, the patency rate of fistula in the combined group, clopidogrel group and control group were 90.91%(20/22), 77.27%(17/22) and 59.09%(13/22), respectively ( P<0.05). The blood flow of patients in combined group and clopidogrel group after treatment were respectively significantly higher than that before treatment ( P< 0.05). In the control group, there was no significant difference in blood flow before and after treatment ( P>0.05). The index of Hb, plasma albumin and Kt/V in the combined group was significantly higher than that before treatment, while hs-CRP was significantly lower ( P<0.05). The plasma albumin was significantly lower in clopidogrel group after treatment ( P<0.05). The index of serum albumin and Kt/V in the control group were lower than that before treatment ( P<0.05). Conclusions:Therapy of far-infrared combined with clopidogrel may protect AVF via reducing thrombosis.

Renal fibrosis is a critical process underlying the development progression of chronic kidney disease to end-stage renal disease, which has intrigued much attention. This study aimed to investigate the role of Sphingosine kinase 1 (SphK1) on epithelial-mesenchymal transition (EMT) in renal fibrosis and the potential regulatory mechanisms. In the present study, unilateral ureteral obstruction (UUO)-induced mouse renal fibrosis model was established. HE and Masson staining were employed to detect the pathological change and fibrous deposition in renal tissues respectively. Moreover, the expression of SphK1, EMT relative proteins including E-cadherin (E-cad), N-cadherin (N-cad) and vimentin as well as fibrosis marker protein α-smooth muscle actin (α-SMA) were measured by immunohistochemistry and Western blot, respectively. In vitro, SphK1 silencing was generated in TGF-β induced human renal tubular epithelial HK-2 cells. Immunofluorescence staining was applied to examine the expression of α-SMA, then the levels of EMT relative proteins and NF-κB signaling were measured using Western blot. The results revealed that notably tubulointerstitial damage and fibrous deposition were detected in the UUO mouse renal tissues. The expression level of E-cad and SphK1 were decreased coupled with an increase of N-cad, vimentin and α-SMA expression. Furthermore, after knockdown of SphK1 in TGF-β induced HK-2 cells, the E-cad expression was up-regulated while N-cad, vimentin and α-SMA expression were down-regulated remarkably. In addition, the expression levels of phospho-NF-κB p65 (p-NF-κB p65) and p-IκB-α were lowered significantly following SphK1 silencing. These findings indicated that the inhibition of SphK1 protected renal tubular epithelial cells against renal fibrosis, by contribution to decrease the EMT via blocking the NF-κB signaling. Therefore, SphK1 may serve as a therapeutic target in the future.

移动医疗服务机构由于便捷、及时等优势得到快速发展,但运营过程中也面临许多问题.文章通过实地访谈具有代表性的移动医疗公司,详细了解其运营状况,分析普遍存在的问题,以期为移动医疗企业公司未来的发展提供合理可行的建议.

目的 探讨采用丹参酮ⅡA磺酸钠注射液治疗过敏性紫癜对患者紫癜消退及肾受累的影响.方法 选取2013年8月至2014年10月已确诊为过敏性紫癜的患者68例,每组34例.采用随机数字表将患者分为实验组和对照组,每组34例.对照组给予常规治疗,实验组在常规治疗的基础上加静脉滴注丹参酮ⅡA磺酸钠注射液.观察两组过敏性紫癜患者紫癜消退情况及肾脏受累情况.结果 入院时两组各有6例为肾型紫癜,基础肾受累率相当(P＞0.05);入院后新发肾脏受累实验组2例(5.88％),对照组9例(26.47％),新发肾脏受累率实验组明显低于对照组,差异有统计学意义(P＜0.05).且治疗后实验组原6例肾型紫癜患者肾脏损害减轻,逐渐转为镜下血尿;而对照组原6例肾型紫癜的肾脏损害几乎无改善.结论 在常规治疗基础上加用丹参酮ⅡA磺酸钠注射液治疗过敏性紫癜,可降低患者的肾脏受累率,改善肾脏损害程度.

当前我国互联网产业进入快速发展时期，互联网+概念正在加速我国产业结构升级，传统医疗模式由于我国人口快速老龄化及制度问题无以承担人民群众日益增加的医疗需求，而互联网浪潮蔓延至医疗领域产生的新兴移动医疗产业成为当前医疗体制改革前沿，因此，重视并研究目前正处于朝阳产业的移动医疗有着很强的必要性、前瞻性与研究价值，而苏南作为经济发达与互联网产业蓬勃发展的地区，有着极强的代表性。该文通过对苏南地区医生与消费者关于移动医疗需求的调查进行原因分析。

目的:探讨血清胱抑素C水平与脑梗死的关系。方法:以100例住院非脑血管病患者为对照组,104例脑梗死患者为观察组,测定血清胱抑素C水平。结果:观察组和对照组血清胱抑素C水平分别为(1.38±0.47)mg/L和(1.10±0.26)mg/L,两组比较差异有统计学意义(P<0.05)。结论:血清胱抑素C水平升高是脑梗死的危险因素之一。

目的 探讨慢性肾脏病(CKD)3～5期患者血清酶的变化及其临床意义.方法 273例CKD患者根据肾小球滤过率分为三组,检测其血清酶指标,包括天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、肌酸激酶(creatine kinase,CK)、乳酸脱氢酶(lactate dehydrogenase,LDH)、碱性磷酸酶(alkaline phosphatase,ALP),各组间进行比较,并分别与70例健康体检者(健康对照组)进行比较.结果CKD 5期患者的CK、LDH水平高于健康对照组及CKD 3、4期;CKD 3～5期患者血清ALP水平高于健康对照组,AST水平低于健康对照组;ALT在本研究中各组间差异无统计学意义.结论 CKD患者部分血清酶水平不同于健康对照组,这种变化可能与慢性肾脏病患者肾性骨病、贫血、感染等有关,可对疾病临床诊断产生一定的影响.