目的 探讨肾小球疾病患者随机尿免疫球蛋白G/尿肌酐(IgG/Cr)比值与24 h尿IgG的相关性,评估IgG/Cr对肾小球疾病的病情监测能力.方法 选取2021年4月至6月中国医科大学附属盛京医院肾内科收治的肾病综合征及肾小球肾炎患者,留取随机尿液检测尿IgG、尿肌酐,留取24 h尿液检测24 h尿IgG含量,将尿IgG/Cr与24 h尿IgG进行相关性分析及logistic回归分析.绘制受试者操作特征(ROC)曲线,计算曲线下面积,确定尿IgG/Cr对于大量24 h尿IgG判断界值.结果 肾小球疾病患者随机尿IgG/Cr同24 h尿IgG正相关(r=0.786,P<0.001).随机尿IgG/Cr的ROC曲线下面积为0.863,临界值为133.5 mg/g,灵敏度为0.848,特异度为0.754.结论 肾小球疾病患者随机尿IgG/Cr同24 h尿IgG呈正相关,对24 h尿IgG有较好的判断能力,有望成为肾小球疾病诊断指标.

目的 了解医院小儿重症监护病房医院感染现状和变化趋势,为制订医院感染防控措施提供依据.方法 采用横断面调查方法,连续3年对某院小儿重症监护病房医院感染现患率进行调查分析.结果 该院2017—2019年小儿重症监护病房医院感染现患率分别为3.21％、3.95％和5.03％,呈上升趋势;感染部位以上呼吸道感染、下呼吸道感染、泌尿道感染和胃肠道感染为主;医院感染病原菌主要为鲍曼不动杆菌,并呈现上升趋势;抗菌药物使用率呈下降趋势,治疗用药病原微生物送检率在不断提高.结论 该院2017—2019年小儿重症监护病房医院感染呈上升趋势,抗菌药物的使用日趋规范、合理,但还需要继续加强医院感染管理工作,以减少医院感染的发生.

目的 探讨血清抗M型磷脂酶A2受体(PLA2R)抗体阳性的肿瘤合并膜性肾病(M-MN)患者的临床特点、治疗方法及预后.方法 回顾分析中国医科大学附属盛京医院2016年6月至2019年6月期间诊断的6例M-MN患者的临床资料及治疗方法,并随访患者预后.结果 PLA2R阳性的M-MN患者的肿瘤病理类型与既往研究中出现的肿瘤类型基本符合,4例经肾穿刺活检的患者肾脏病理表现为基底膜不均匀增厚,免疫荧光染色IgG4为阳性,其中1例患者表现为蛋白尿及白蛋白水平表现不一致,2例肿瘤患者存在镜下血尿.6例患者均经手术切除肿瘤,并治疗MN后4例完全缓解,2例未缓解.结论 M-MN肾病有PLA2R相关检测阳性的病例存在,同时临床要重视PLA2R阳性的膜性肾病中有M-MN的可能,以免漏诊误诊,并及时针对性治疗.

目的 预测我国百日咳发病趋势,为相关部门制定百日咳防治策略提供参考依据.方法 收集1990-2018年我国百日咳发病率数据,通过SPSS 23.0进行建立数据库,采用指数平滑法进行预测.结果 指数平滑拟合的简单模型、Holt线性趋势、Brown线性趋势、阻尼趋势4个模型中,Holt线性趋势为最优模型,平稳R2值为0.650、R2值为0.782、标准化的BIC为-2.690;RMSE、MAPE、MAE分别为0.232、27.388、0.154;2019-2021年百日咳发病预测呈上升趋势.结论 指数平滑的Holt线性趋势模型能够较好的预测肺结核的发病情况,未来几年百日咳发病仍呈上升趋势,应继续加强百日咳防治工作.

目的 比较槐杞黄颗粒与百令胶囊治疗特发性膜性肾病(IMN)中肾病综合征(NS)的效果.方法 选择2016年12月至2018年6月于我院就诊并接受治疗的40例IMN中NS患者,随机分为槐杞黄颗粒组(16例)和百令胶囊组(24例).两组在性别、年龄、痰病严重程度等方面比较差异无统计学意义.两组患者均给予低盐低脂饮食,预防感染、避免劳累,给予激素、环磷酰胺控制病情,应用ACEI/ARB类药物控制血压.在此基础上,槐杞黄颗粒组应用槐杞黄颗粒,百令胶囊组应用百令胶囊.所有入组病例均需随访12周.记录治疗前及治疗后第4、8、12周的24h尿蛋白定量、尿红细胞计数、血清白蛋白、肝功能、血常规、CRP、CD4/CD8、胱抑素C、血清肌酐等指标,观察药物不良反应及感染情况.结果 治疗后,两组24h尿蛋白均降低(P＜0.05);两组24h尿蛋白、血尿(RBC/HP)、CD4/CD8、肝功能、肾功能、CRP、血红细胞及血小板等方面比较差异无统计学意义(P＞0.05).槐杞黄组治疗前后白细胞计数比较差异无统计学意义(P＞0.05).百令组、槐杞黄组总有效率比较差异无统计学意义(79.17％ vs.81.25％,P=0.68).两组感染次数比较差异无统计学意义(P＞0.05).结论 在IMN中NS患者的辅助治疗中,槐杞黄颗粒与百令胶囊的疗效无明显差别.

艾滋病即获得性免疫缺陷综合征(acquired immune deftciency syndrome,AIDS)是由HIV引起的,以机会性感染和恶性肿瘤为其主要特征的慢性传染病[1].AIDS患者的肾损害发生率约为20％～50％[2].HIV感染患者肾脏损害的病理类型多样,可以分为三大类:(1)HIV特异性肾小球疾病:包括HIV相关性肾病(HIV-associated nephropathy,HIVAN)、HIV免疫复合物性肾病(HIV-associated immune complex kidney disease,HIVICK)、血栓栓塞性微血管病(thrombotic microangiopathy,TMA);(2)HIV非特异性肾小球疾病:包括HCV相关的膜增生性肾小球肾炎或冷球蛋白血症相关肾炎、糖尿病肾病、肾小球硬化、膜性肾病、微小病变疾病、IgA肾病、感染后肾小球肾炎;(3)抗逆转录病毒治疗(antiretroviral therapy,ART)相关性肾小管疾病:包括急性小管坏死、结晶性肾病、急性或慢性间质性肾炎[3].其中最具特点的是HIVAN,也被称为艾滋病相关性肾病(AIDS associated nephropathy,AIDSAN),病理表现为塌陷型局灶节段性肾小球硬化.1984年,Sehaffer等[4]首次报道HIVAN获得极大关注.本文对两例收治的HIV感染患者相关肾病进行报道,以期更好地认识该类疾病.

目的 探讨乙型肝炎病毒X蛋白(HBx)诱导大鼠肾小管上皮细胞凋亡及其可能的机制.方法 以HBx的表达载体转染体外培养的大鼠肾小管上皮细胞(NRK-52E)建立HBx过表达模型.分别转染空质粒pc-DNA3.1(+)24 h(空质粒转染组),以及转染pc-DNA3.1(+)HBx质粒24 h(HBx24h组)、48 h(HBx48 h组)和72 h(HBx72 h组),并设对照组(未做转染).应用流式细胞仪测定细胞凋亡率.分别采用Western印迹法检测Fas、Fas配体(FasL)、Bcl-2、Bax的蛋白质表达水平,分光光度测定法测定半胱氨酸天冬氨酸蛋白酶(Caspase)8活性.结果 HBx24 h组、HBx48 h组、HBx72 h组的HBx、Fas、FasL、Bax的蛋白质相对表达量,以及Caspase8的相对活性逐渐增加,且组间差异均有统计学意义(P值分别＜0.05、0.01);Bcl-2的蛋白质相对表达量逐渐降低,组间差异亦有统计学意义(P值分别＜0.05、0.01).对照组与空质粒转染组间细胞凋亡率的差异无统计学意义(P＞0.05);HBx24 h组、HBx48 h组和HBx72 h组的细胞凋亡率逐渐升高,组间差异有统计学意义(P值均＜0.05),且均显著高于对照组和空质粒转染组(P值均＜0.05).结论 HBx基因通过Fas/FasL死亡受体途径促进NRK-52E细胞凋亡,Caspase8的活化可能参与其中.

Objective To investigate the joint value of early peak temperature and 48 h-△sequential organ failure assessment (SOFA) score in predicting the prognosis for patients with sepsis in emergency department.Methods Two hundred and thirty-one patients with sepsis admitted from January 2013 to January 2015 in Emergency Intensive Care Unit of the First Affiliated Hospital of China Medical University were enrolled.Clinical features,early peak temperature,SOFA scores,the length of stay in EICU and the mortality in 28 days were studied.The patients were divided into two groups according to the 48 h-△SOFA.Each group were divided into three subgroups according to the early peak temperature.For example,hypothermia subgroup had temperature below 36 ℃,normothermia subgroup had temperature between 36 ℃ and 38 ℃,and hyperthermia subgroup had temperature above 38 ℃.The relationship between peak temperature plus 48 h-△SOFA and the length of stay in EICU as well as mortality were analyzed.Results Of 231 patients,in 48 h-△SOFA＞0 group (n =142) 27 (19.0％) patients died,and in 48 h-△SOFA≤0 group (n =89) 33 (37.1％) patients died (P ＜ 0.05).Hypothermia subgroup had a higher odds ratio value in predicting nonsurvival in 48 h-△SOFA≤0 group (OR =4.51,95％CI:1.33-2.17,P =0.01).Hyperthermia subgroup had a longer stay in EICU than hypothermia subgroup and normothermia subgroup (P ＜ 0.05).Conclusion The combination of the early peak temperature and 48h-△SOFA score is an effective indicator to evaluate the prognosis and to stratify patients with sepsis in emergency department.More attention should be paid to the patients with an early peak temperature ＜ 36 ℃ and 48 h-△SOFA ≤0 because of higher mortality.The condition of patients should be reassessed and try to make a more rational treatment for the patients with an early peak temperature ＞38 ℃ and 48 h-△SOFA ＞0 because of its longer stay in EICU.

Objective To compare the effects of losartan potassium,valsartan and telmisartan on uric acid of patients with chronic glomerulonephritis. Methods One hundred and forty-eight patients with primary chronic glomer-ulonephritis from May 2013 to May 2014 in our hospital were retrospectively analyzed. The patients were divided into 3 groups according to the different treatment. Patients in group L,group V and group T received losartan potassium ta-bles,valsartan tablets and telmisartan tablets respectively for 3 months. The changes of uric acid,blood pressure,24 h u-rine protein,albumin and renal function of the patients in 3 groups were compared. Results After 3 months of treat-ment,the uric acid of group L decreased from (378. 18 ± 108. 58)to (325. 91 ± 99. 04),there was significant difference (P<0. 01),but no significant difference was found in group V and group T. There was no significant difference in 24 h urine protein,blood pressure,albumin and renal function among the 3 groups (P>0. 05). Conclusion Losartan po-tassium can not only reduce urine protein and blood pressure,but also have good effect on reducing uric acid.

Objective To investigate the prognosis and risk factors in Chinese patients with indiopathic membranous nephropathy(IMN).Methods One hundred and thirty-seven patients with IMN were selected in this study,who were admitted to Shengjing Hospital Affiliated to China medical university from January 2006 to December 2011 with biopsy proven.They were performed 12 months follow-up.The patients' clinical features and pathological stage were collected.Results All patients' age was ranged from 16 to 73 years old and male accounted for 57.66％.At the end of following up,18 patients(13.14％) were with glomerular filtration rate (eGFR) less than 30 ml/min.Survival analysis showed that patients with hypertension,age≥60 years old,elevated serum creatinine (SCr ≥ 133 μmol/L),and proteinuria no remission were with poor prognosis.Cox univafiate analysis showed that hypertension(HR =5.709,95％ CI 2.173-14.998),age≥60 years old (HR =18.200,95％ CI 3.904-84.869),elevated serum creatinine(HR =22.235,95％ CI 5.586-89.304),and proteinuria no remission(HR =4.681,95％ CI 1.168-13.060) were risk factors(P ＜0.05).Cox multivariate analysis showed that age≥60 years old(HR =12.280,95％ CI 1.945-77.540) and elevated serum creatinine (HR =11.45,95％ CI 2.230-58.783) were independent risk factors (P =0.008,0.030 respectively) Conclusion IMN patients have relatively good prognosis.Age ≥ 60 years old and higher serum creatinine at biopsy were independent risk factors of IMN patients with eGFR ＜ 30 ml/min.

在诊断学实践教学中引入问诊教学,采用模拟教学法,对学生进行问诊能力的培训,通过学生和教师反馈及期末诊断学理论成绩的分析,对教学效果进行评价.结果显示模拟教学法应用于问诊实践能调动学生的学习积极性,是培养学生问诊技巧的好方法.

过氧化物酶体增殖物激活受体(PPARs)有3种异构体:PPARα、PPARδ和PPARγ.作为转录因子的PPARs,通过调节特定的目的基因的表达,影响脂代谢、糖代谢稳态、细胞分化、免疫反应、炎性反应和肿瘤等[1-2].PPARα激动剂(贝特类)和PPARγ激动剂(噻唑烷二酮)作为降脂药物和胰岛素增敏剂已经在临床上广泛应用,而且被证明具有肾脏保护作用[3-4].而PPARδ激动剂对肾脏作用的研究才刚刚起步,我们拟研究PPARδ激动剂L165041在肾小管上皮细胞炎性反应中的作用,为PPARδ激动剂在肾脏疾病中的应用提供理论基础.

探讨重建百草枯肺损伤的3D图像并计算损伤肺组织的体积对急性百草枯中毒患者预后的预测价值。重建百草枯肺损伤的3D图像能在断层CT的基础上定量地动态监测百草枯所致急性肺损伤的病情进展,评估患者的预后。

Objective To investigate the effects of cyclic mechanical stretch on the expression of monocyte chemoattractant protein-1(MCP-1) mRNA in the rats vascular smooth muscle cells(VSMCs) and the role of NADPH oxidase in the process.Methods VSMCs were cultured on flexible silicone membranes and exposed to cyclic mechanical stretch and cyclic mechanical stretch plus DPI(inhibitor of NADPH oxidase) respectively.MCP-1 mRNA,superoxide ion and P47phox membrane translocation were detected.Results Cyclic mechanical stretch enhanced the expression of MCP-1 mRNA and production of superoxide ion and membrane translocation of P47phox,DPI down-regulated the expression of MCP-1 mRNA and production of superoxide ion via inhibition of P47phox membrane translocation.Conclusion Cyclic mechanical stretch can activate NADPH oxidase and augment production of superoxide ion,and further promote the production of MCP-1 mRNA in VSMCs.

<正>成人斯蒂尔病(adult onset Still's disease,AOSD)是一组病因及发病机制不明,临床表现多样的全身综合征〔1〕,过去称"变应性亚败血症",1987年起统一称AOSD。主要以高热、一过性皮疹、关节炎或关节痛为特点〔2〕,可伴淋巴结肿大、白细胞、中性粒细胞增多和血小板增多,严重者可伴多系统损害。由于无特异性的诊断方法和标准,诊断

Objective To investigate the effect of iron sucrose injection on the anemia and its influence to the microinflammation state in the patients undergoing maintenance hemodialysis.Methods The levels of haematocrit(HCT),hemoglobin(Hb),serum ferrintin(SF),transferrin saturation(TSAT) and biomarkers of inflammation as serum C-reactive protein(CRP),interleukin-1β and interleukin-6 in 36 maintenance hemodialysis patients were measured at the beginning and the end of the testment,and the adverse reactions were observed.Results The levels of hemoglobin,haematocrit,serum ferrihtin and transferrin saturation in both groups increased compared with before administration,then the range of the levels in intravenous group higher than in oral group(P0.01).C-reactive protein,interleukin-1β and interleukin-6 were increased significantly compared with that before treatment of intravenous group(P0.05).Conclusion The intravenous iron can improve effectively than the oral for the anemia,but the intravenous iron supplementation aggravates the status of microinflammation.

Objective To study the effect of pioglitazone on the oxidative stress of kidney in adriamycin induced glomerulosclerosis rats.Methods Glomerulosclerosis rat model was established by uninephrectomy(left kidney) and injecting adriamycin twice through vena caudalis.Thirty-two Wistar rats were randomly divided into three groups: sham operated control group,glomerulosclerosis model group,pioglitazone-treated group.After the first injection of adriamycin,the rats in pioglitazone-treated group were administered orally by pioglitazone(10 mg·kg-1·d-1).After 12 weeks,24 h urinary excretion of protein,urine creatinine,serum creatinine(SCr) and blood urea nitrogen(BUN) were measured.The renal tissue was observed by light microscopy to calculate glomerulosclerosis index(GSI).The levels of maleic dialdehyde(MDA) in urine and renal tissue as well as the activities of antioxidant enzymes including superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px) in renal tissue were determined.Results Pioglitazone-treated group showed an improvement in 24 h urinary excretion of protein,SCr,BUN,Ccr and glomerulosclerosis index(GSI) compared with the glomerulosclerosis model group(P0.05).The levels of MDA in urine and renal tissue were significantly lower than those in the model group, while the activities of SOD and GSH-Px in renal tissue were markedly higher than those in the modle group(P0.05).Conclusion Pioglitazone protects the structural and functional changes of kidney in adriamycin induced glomerulosclerosis rats through the reduction of oxidative stress.

Objective To observe the clinical features of IgM nephropathy.Methods Retrospective analysis of the clinical manifestations,pathologic features,characteristic of urinary podocyte excretion,treatment method and therapeutic reaction were carried out in 10 patients with IgM nephrology.Results Of the 10 patients(6 males and 4 females),9 were with nephrotic syndrome and one was with glomerulonephritis.Microscopic hematuria was noted in 3 cases and no gross hematuria was noted at all.Pathologic changes were mesangial proliferation of mild to moderate degrees with granular IgM deposit seen in the mesangial areas in all cases.No podocyte excretion was found in 9 out of the 10 cases and minimal excretion was noted in 1 case(2/20HP).Satisfiable treating response was achieved with complete remission occurred in 9 cases,effectiveness in 1 case,and relapse in 3 cases.Treatment with steroids and Lefloumint(alone or combined) were all effective.Conclusion Clinical features of IgM nephropathy primarily represent nephrotic syndrome.Pathologic changes are mild to moderate degrees of mesangial proliferation.Granular IgM deposit is seen in mesangial areas in all cases.No podocyte excretion is found in the urine.Satisfiable responses to steroids and immunosuppressants are noted.

Objective The aim of this study was to investigate the relationship between urinary podocyte excretion and severity of renal pathological injury in IgA nephropathy.Methods We selected 36 cases of patients with IgA nephropathy and divided into 4 groups according to Lee histopathological classification.Urinary podocytes were examined by immunocytochemistry methods and maked by mouse anti-human podocalyxin monoclonal antibody.We counted the podocytes and examined the laboratory index.We analyzed relationship between urinary podocytes,clinical laboratory index and renal pathological injury of IgA nephropathy.Results Urinary protein quantitation,cholesterol,urea nitrogen and serum creatinine in group 4 of IgA nephropathy were apparently more than that in group 1,and plasma albumin were apparently lower.Urinary protein quantitation and urea nitrogen were statistically difference between group 1 and group 3.However,only urea nitrogen in group 2 was statistically different from that in group 1(P 0.05).The number of podocytes in the urine of patients with in group 4 of IgA nephropathy were apparently more than that in group 1 and group 2(P 0.05).There was obvious correlation of urinary podocyte with Lee histopathological classification of IgA nephropathy(r=0.432,P=0.01).Conclusion The mean level of podocytes in urinary excretion increased with pathological changes of IgA nephropathy aggravated,and there was obviousiy relative.

Objective To research the effects of hemoperfusion (HD) on serum leptin and nutritional status in maintenance hemodialysis (MH) patients.Methods Forty-eight MH patients were divided randomly into groups HP and HP+HD,24 in each.Serum leptin,pre-albumin(PA),transferrin(TRF),albumin(Alb) and haemoglobin (Hb) were detected in 2 groups before treatment and after 3 months of treatment.The results were determined to analyze the correlation between the indexes.Results There was not significant difference in Leptin,PA,TRF,Alb between 2 groups before treatment (P0.05).Leptin level decreased remarkably and the nutrition indicators improved in HP+HD group,the difference was significant between 2 groups (P0.05).Leptin was negatively correlated with PA and Alb (P0.05).Conclusion HP can remove effectively Leptin and improve patients' nutritional status.PA may be one of the indicators reflecting the nutritional status in early CRF patients.