患者男，47岁，因尿毒症接受维持性血液透析6年余，软组织多发脓肿，脓液标本培养为金黄色葡萄球菌阳性，血磷升高入院。CT及核素显相检查提示全身肌肉、血管广泛钙化。硫代硫酸钠及综合治疗效果欠佳，于入院后3个月死亡。本病例提示钙化防御表现具有多样性，早期积极控制钙磷代谢紊乱具有重要意义。

目的 探讨维持性血液透析患者不同的铁代谢水平对患者射血分数长期影响.方法 选取我院血液透析中心行维持性血液透析(MHD)治疗的352例患者.根据铁代谢水平将患者分为低铁代谢组、高铁代谢组与正常铁代谢组.常规治疗的同时观察随访2年后心脏功能的变化.通过Kaplan-Meier法比较3组患者2年后心脏功能的差异.利用多因素Cox比例回归模型分析影响行MHD治疗患者心功能降低的危险因素.结果 入组时3组患者资料仅Hb(P=0.037)、SF(P =0.005)、TSAT(P =0.017)存在统计学差异,2年后正常铁代谢组发生射血分数下降显著少于低铁代谢组和高铁代谢组(x2=37.775,P＜0.001).2年时患者预后良好229例,预后不良组94例.多因素Cox分析显示,透析时间长(RR=1.335,P=0.012)、高铁蛋白(RR=2.337,P=0.026)、低Hb(RR =0.918,P=0.031)、低血钙(RR=0.492,P=0.008)、铁代谢分组(RR=2.714,P=0.006)是MHD患者心功能降低的独立危险因素.结论 低铁代谢水平或高铁代谢水平均可影响MHD患者长期心脏射血功能,其中铁代谢水平、高SF、低Hb、透析时间长、低血钙是造成患者左室射血分数降低的危险因素.

目的 探讨使用血清 β-微量蛋白(β-TP)和 β2-微球蛋白(β2-M)预测方程估算血液透析(HD)患者的残肾功能,检出其残尿素清除率(KRU)值>2.00 ml/(min·1.73 m2)的患者.方法 用新KRU方程和尿常规方法估算42例HD的终末期肾病新患者残肾功能.结果 KRU常规方法测量值和方程估算值之间的中位数偏离为0.30 ml/(min·1.73 m2).用KRU估算值>2.00 ml/(min·1.73 m2)作为截断值检出实测KRU值>2.00 ml/(min·1.73 m2)患者的受者工作特征曲线(ROC)下面积为0.91,其敏感性为71％、特异性为96％.结论 无需采集尿液,该方程即可检出KRU值>2.00 ml/(min·1.73 m2)的HD患者.

目的:研究比较不同剂量的四氧嘧啶(alloxan,ALX)诱导1型糖尿病(type 1 diabetes mellitus,T1DM)兔模型效果的差异,探求四氧嘧啶的最佳使用剂量.方法:将90只成年雄性新西兰兔随机分为5组,实验组每组20只,对照组10只.分别为一次给药组:A组(80 mg/kg)、B组(100 mg/kg)、C组(150 mg/kg);两次给药组D组,第1次给药50 mg/kg,第2次给药100mg/kg;及空白对照组E组.对比四组的成模率,死亡率,恢复率.结果:B组成模率明显高于其他三组(P＜0.05),A组建模存活率较其他三组更高(P＜0.05),C组死亡率最高(P＜0.05),D组恢复率最高(P＜0.05),差异具有统计学意义.结论:一次性静脉给予100 mg/kg的四氧嘧啶,可建立高成模率,低死亡率,低恢复率的1型糖尿病兔动物模型.

目的 探讨甘露聚糖结合凝集素(MBL)途径激活对糖尿病肾病(DN)合并高血压的影响,并探讨左旋氨氯地平对DN合并高血压患者的保护作用.方法 选择2012年9月至12月泸州医学院附属医院肾内科就诊的DN合并高血压患者40例,按机数字表法分为试验组30例,对照组10例.两组均给予DN的常规治疗,试验组在常规治疗基础上口服左旋氨氯地平2.5mg,每日1次,如果2周后血压仍未降至正常(＞140/90mmHg,1mmHg=0.133kPa)则增加左旋氨氯地平用量至5mg,并联合应用降压药物;两组均连续用药90d.观察两组患者治疗前和治疗后30d和90d血压的变化及治疗前后血脂、肝肾功指标、外周血尿白蛋白排泄率(UAER)、MBL、糖化血红蛋白(HbA1c)、膜攻击复合物(MAC)的变化,并评价MBL与DN的相关性.结果 试验组治疗后30d、60d血压均较治疗前下降[收缩压(mmHg):157.4±8.6、145.6±7.5比167.6±11.4,舒张压(mmHg):90.6±6.9、83.9±5.8比98.6±7.9,均P＜0.05].两组治疗前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白-C(HDL-C)、低密度脂蛋白-C(LDL-C)、糖化血红蛋白(HbA1c)、血肌酐(SCr)水平比较差异均无统计学意义(均P＞0.05).两组治疗后UAER、MBL和MAC均较治疗前明显下降,且试验组的下降程度较对照组更显著[UAER(mg/24h)为200.3±69.8比467.2±87.3,MBL(μg/L)为410±120比519±98,MAC(pg/L)为60±20比80±18,均P＜0.05].相关性分析显示,血清MBL及尿MAC水平均与UAER呈正相关(rMBL/UAER=0.894,P=0.041;rMAC/UAER=0.908,P=0.032).结论 左旋氨氯地平对DN合并高血压患者具有保护作用,其机制与MBL途径相关.

Objective To investigate the protective effect and mechanism of MST1 inhibition on kidney tissue in diabetic rats,and to find a new therapeutic target for diabetic nephropathy.Methods Total of 54 male SD rats enrolled in this study were divided into 3 groups including normal control (group A,n=18),MST1 inhibition group (Group B,n=18) and diabetes group (group C,n=18).Diabetes was induced by a single streptozotocin (STZ,50 mg/kg) injection in group B and group C.rats in group B received lentiviral vector contain Mst1 interference RNA (shRNA) and the rats in group C received empty vector.The end of 4th,8th and 12th week after modeling were considered as time points in this study.At each time point,the level of 24 hours urine protein (24-HUP),blood glucose and serum creatinine were examined.Pathological changes were observed with HE stain; Injury of podocyte and glomerular basement membrane (GBM) were examined with transmission electron microscope (TEM).The intensity and location of MST1 in kidney tissue were detected by immunohistochemistry.The level of MST1,Phosphorylated-MST1,nephrin,Caspase-3 and FasL were detected by western bloting.Results (1) At the starting point,there were no significant differences among groups in terms of weight,activity,eating and drinking.Since the end of 72nd hour after modeling,the levels of glucose in both group B and group C,compared to those in group A,significantly increased (P ＜ 0.05).There was no significant difference between group B and group C for glucose level at each time point (P ＞ 0.05); the level of 24-HUP increased significantly since the end of 4th week after modeling,and the level in group C was higher than its counterpart in group B at the same point (P ＜ 0.05); (2) There was no significant pathological lesion observed in group A.Without obvious K-W nodular changes,mesangial proliferation was observed in group B and group C.It was shown by TEM that podocyte fusion and thickening of the GBM could be found in group B and group C.The pathological change in group B was better than that in group C; (3) Compared to group A,it was shown by western blot that the levels of MST1,Phosphorylated-MST1,Caspase-3 and FasL in group B and group C were significantly higher (P ＜ 0.05),and the levels of nephrin in group B and group C were significantly lower (P ＜ 0.05) since the end of 4th week after modeling.Meanwhile,the levels of MST1,Phosphorylated-MST1,Caspase-3 and FasL in group B were significantly lower than that in group C at each time point (P ＜ 0.05),the level of nephrin in group B was significantly higher than the one in group C; (4) It was shown by immunohistochemistry that there was low MST1 expression in normal condition,especially in cytoplasm of tubular epithelial cells.The level of MST1 in group B and group C significantly increased after modeling,and the change could be the same as Western blot shown.Conclusions MST1 pathway could be involved in kidney injury induced by diabetes.MST1 inhibition could alleviate the kidney injury in STZ-induced diabetes animal model.

Objective To investigate the effect of high glucose on MST1 (mammalian sterile 20-like kinase 1)expression in primary glomerular podocytes.Methods Primary podocytes cultured from healthy SD rat kidneys after gradient centrifugation were divided into normal group (cultured with glucose of 5 mmol/L)and high glucose group (cultured with glucose of 25 mmol/L).The cell properties were verified with flow cytometry and immunofluorescence.The time points for observation were after 12,24,48,and 72 hours of cell culture.And immunofluorescence and Western blotting method were used for detecting MST1 and caspase-3 expression.Multiple-group comparison was performed with single factor analysis of variance, while two groups were compared with Q test.Results (1)It was shown by flow cytometry that 93.18% of the podocytes cultured expressed nephrin protein,suggesting that stable culture of primary podocytes was successful.Besides,indirect immunofluorescence staining showed that the podocytes stably expressed nephrin and WT-1 proteins.(2)Immunofluorescence staining showed a small amount of MST1 expression in podocytes of the normal group mainly locating in the cytoplasm,while the expression of MST1 increased in the high glucose group,and more nuclear expression began to appear after 48 h of treatment.(3)Western blotting showed that the levels of caspase-3 and MST1 were significantly higher in the high glucose group than in the normal group (F =84.989,312.407,P <0.001 ).Furthermore,after 48 h of treatment, cleaved form of MST1 was observed in the high glucose group,which also increased with the time of treatment.Conclusions The dysfunction of MST1 pathway may be involved in the pathogenesis of diabetic nephropathy.

目的 观察阿魏酸哌嗪片治疗狼疮肾炎的临床疗效.方法 将80例狼疮肾炎患者随机分为两组.对照组给予激素加免疫抑制剂常规治疗.治疗组在对照组基础上加用阿魏酸哌嗪片治疗.观察并比较两组的临床疗效及血肌酐、尿素氮、血浆白蛋白、血红蛋白、尿蛋白定量、补体C3、抗核抗体、抗双链DNA抗体等指标的改变情况.结果 治疗组在治疗后血尿素氮、血肌酐、尿蛋白定量均明显下降,血浆白蛋白、血红蛋白较治疗前明显上升,且与对照组比较有统计学差异.结论 阿魏酸哌嗪联合激素加免疫抑制剂治疗狼疮肾炎疗效优于常规治疗,对狼疮肾炎患者纠正贫血、改善肾功能、降低尿蛋白有一定疗效.

Objective To explore the change of S-adenosylhomocysteine(SAH),the precursor of homocysteine(Hcy),in patients with chronic kidney disease(CKD) and the relationship between serum SAH level and cardiovascular complications(CVD).Methods Fifty-five CKD patients and 32 healthy volunteers were included in this study.Serum SAH level was measured by continuous cycle enzyme colorimetric method.Serum Hcy level was measured by ELISA.Serum folate and Vitamin B12 levels were measured by automatic immunity analyzer.Results The mean levels of serum Hcy and SAH in CKD patients were significantly higher than that in the healthy controls,especially SAH.The mean level of serum SAH in CKD patients with CVD was significantly higher than that of patients without CVD.Logistic regression analysis indicated SAH was an independent risk factor for cardiovascular disease in patients with CKD.Levels of folate and vitamin B12 do not differ significantly between groups.Conclusion Serum SAH appears to be a much more sensitive indicator of the cardiovascular complications in patients with CKD than Hcy.Serum SAH and Hcy level are significantly correlated with serum creatinine level in patients.

目的 观察舒洛地特治疗非糖尿病性慢性肾脏病(CKD) 2～3期的临床疗效及安全性.方法 将40例非糖尿病性CKD 2～3期患者随机分为对照组和治疗组,每组20例.对照组进行常规治疗(包括降压、肠道排毒及纠正贫血等处理)；治疗组在对照组治疗的基础上加服舒洛地特胶囊25 mg/次,2次/d,共50 d.比较2组治疗后血肌酐、24 h尿蛋白定量及纤维蛋白原含量.结果 治疗组血肌酐、24 h尿蛋白定量及纤维蛋白原含量明显低于对照组(P＜0.05).结论 舒洛地特治疗非糖尿病性CKD 2～3期效果好,具有临床应用价值.

Objective:To provide evidence for clinical practice by assessing the effectiveness and safety of panax notoginosedes for primary nephrotic syndrome.Methods:We searched CBM,Chinese Evidence-Based Medicine/Cochrane Centre Database,Cochrane Library for the randomized controlled trials (RCTs).Jadad score was used to assessthe quality of RCTs.The total clinical efficiency and short term effectiveness,and adverse effect of the treatment were analyzed by RevMan4.2.7.Results:Eight RCTs involving 352 patients met inclusion criteria1.Meta-analysis showed that panax notoginosedes lowered 24 h urine protein [OR6.80,95%CI(1.88,12.35)],improved hypercoagulation condition.Whether panax notoginosedes had long term side effect was not confirmed.No adequate evidence showed that panax notoginosedes could reduce the relapse rate of primary nephrotic syndrome.Conclusions:Meta-analysis of low quality RCTs suggest that panax notoginosedes does work in primary nephritic syndrome in short term observation.No adequate evidence shows that panax notoginosedes has severe side effect or can reduce the relapse rate of primary nephrotic syndrome.A rigorously designed,randomized,double blind,placebo controlled trial are required.

Objective:To observe the expression of monocyte chemotactic protein-1(MCP-1)and intercellular cell adhesion molecule-1(ICAM-1) in renal arteriole.Methods:Forty adult Sprague-Dawley male rats were randomly devided to two group:control group and DM group.High fat and high glucose diet was used to establish a DM rat mode1.Paraffin sections of renal tissue of rats were stained by routine methods and immunohistochemistry.Results:The levels of serum lipid,creatine and urine protein were markedly higher than that of control group.MCP-1 and ICAM-1 have expressed in renal arteriole when the formation of atherosclerosis in aorta.The expression of MCP-1and ICAM-1 related to serum creatine,urine protein positively.Conclusion:MCP-1 and ICAM-1 have expressed in renal arteriole when the formation of atherosclerosis in aorta of diabetes mellitus rats.It may indicate that they participate in the development of diabetic nephropathy.

Objective Profound venous catheters insertion is an effective method to build temporary dialysis access.We analyzed commplications of profound venous catheters insertion in different sites to seek the best method.Methods The cases of profound vein catheter were retrospectively analyzed in 219 hemodialysis patients.Catheter locations were internal jugular and femoral vein.Pure hepatin was used for sealing catheters.Results 219 cases received profound venous catheterization.The average period of maintaining catheters were 72.5 days and the total incidence of complications was 20.5%.The average period of maintaining catheters for internal jugular vein was longer than that of femoral vein(72.33±23.56) days,(28.3±13.56) days,P<0.05.The incidence of catheter-related complications of internal jugular vein(18.2%) was lower than that of femoral(30%,P<0.05).Conclusions Internal jugular vein catheterization is the first choice of temporary access.

系统性红斑狼疮(systemic lupus eryhematosis,SLE)是一种系统性自身免疫性疾病.SLE患者细胞免疫功能低下,且因长期应用激素和(或)免疫抑制剂治疗,增加了肿瘤发生的几率.而SLE可累及全身各器官系统,临床表现为发热、关节疼痛、贫血、腹痛等多种症状,合并白血病的SLE患者早期往往缺乏典型症状,较难与活跃期SLE鉴别,易造成误诊和漏诊.现将我院收治的1例SLE并白血病漏诊患者的病例进行分析,以期望引起临床医师对同类病例的重视.

免疫球蛋白A(IgA)肾病是以IgA或IgA为主的免疫球蛋白在肾小球系膜弥漫沉积为特征的肾小球肾炎.原发性IgA肾病是我国最常见的肾小球疾病之一,是导致终末期肾功能衰竭的一个主要原因[1].

目的:采用基因重组技术,将结核杆菌Ag85A与协同刺激信号CD80基因融合,构建成融合结核DNA疫苗,旨在提高结核DNA疫苗的免疫效果,可望通过基因免疫,获得免疫原性强,以低剂量即可有效刺激机体产生T细胞和B细胞应答,安全可靠的新型结核病疫苗.方法①pcDNA3-tPA-Ag85A质粒的构建和鉴定以V1Jns-tPA-Ag85A质粒为模板,PCR扩增tPA-Ag85A,(不含终止密码),定向插入pcDNA3载体的BamHⅠ和EcoRⅠ位点之间,构建成pcDNA3-tPA-Ag85A质粒.②pcDNA3-tPA-Ag85A/CD80质粒的构建与鉴定以pcDNA3CD80质粒为模板,扩增CD80(含终止密码)定向插入pcDNA3-tPA-Ag85A质粒的EcoR Ⅰ和XbaⅠ位点之间,构建成pcDNA-tPA-Ag85A/CD80融合DNA真核表达质粒.结果:重组质粒pcDNA3-tPA-Ag85A和pcDNA3-tPA-Ag85A/CD80经酶切鉴定和测序鉴定均构建正确.结论:结核杆菌Ag85A与协同刺激分子CD80融合DNA真核表达质粒构建成功,为进一步研究比较其免疫保护效果,研制结核杆菌Ag85A与协同刺激分子CD80融合DNA疫苗打下基础.

转化生长因子β1(transforming growth factor-β1,TGFβ1)是一种在人体内广泛存在具有多种生物学功能的细胞因子,可促进细胞肥大和细胞外基质合成[1].近年大量研究表明TGFβ1的过度表达构成了组织纤维化的基础,在肾脏疾病进展中可能起着十分重要的作用[2],肾脏细胞是尿中TGFβ1丰富来源,也是TGFβ1作用的目标.因此探讨尿中TGFβ1的含量,无疑对肾脏疾病进展的研究具有重要的临床意义.为此,我们对25例原发性肾病综合征患者和15例健康者尿中TGFβ1的含量进行测定,并探讨其临床意义.

目的:构建结核分枝杆菌Ag85A重组真核表达质粒,为DNA疫苗的研究提供靶基因.方法:采用聚合酶链反应(PCR)方法从结核分枝杆菌H37Rv基因组DNA中扩增出结核杆菌Ag85A分泌性蛋白的基因,应用T-A克隆技术,直接与pUCm-T载体连接,转化大肠杆菌JM109(E.coli JM109),蓝白筛选,阳性克隆经酶切鉴定和DNA测序证实基因碱基无误后,用NheⅠ和XbaⅠ双酶消化,回收的小片段与用NheⅠ和XbaⅠ消化的真核表达质粒pCI-neo连接,转化E.coli JM109,筛选阳性克隆酶切鉴定.结果:经酶切鉴定,证实结核分枝杆菌重组真核表达质粒pCI-Ag85A构建正确.结论:结核分枝杆菌真核表达质粒pCI-Ag85A构建成功,为进一步研究其作为一种结核病DNA疫苗在预防和治疗结核病中的作用奠定了基础.

目的:观察银杏叶提取物对肾病综合征高凝状态的调节作用.方法:对64例原发性肾病综合征患者,随机分为治疗组和对照组各32例,两组同服强的松1mg/d/kg,治疗组加服银杏叶提取物80mg tid×30天.结果:治疗组血清胆固醇、甘油三脂、及血液流变学等指标均得到明显改善,与对照组比较,差异有统计学意义(P<0.05,或P<0.01).结论:银杏叶提取物能明显改善肾病综合征高凝状态,降低血脂、血粘度,保护肾脏.