目的:调查厦门医学院附属第二医院维持性血液透析患者6 年的临床资料,为改善患者预后及提高血透中心管理水平提供理论依据.方法:回顾性分析2015 年～2020 年于厦门医学院附属第二医院透析时间超过3 个月的维持性血液透析患者的临床资料.结果:2020 年维持性血液透析患者262 例,男154 例,女108 例,二者比例为1.43∶1.年龄以40～59 岁居多,占47.71%.排名前3 位的原发病病因分别是糖尿病肾病84 例,占32.06%、慢性肾小球肾炎67 例,占25.57%、高血压肾病59 例,占22.52%.自体内瘘 212 例,占 80.92%,隧道式带涤纶套透析导管 49 例,占 18.70%,移植物内瘘 1 例,占0.38%.每周透析3 次者仅249 例,占95.04%.乙型肝炎抗原标志物阳性率 14.51%,丙型肝炎抗体的阳性率 0.2020 年血透机数量78 台,较2015 年增涨1.36 倍.近6 年血透人数逐年增加,2020 年较 2015 年增加 40.1%.2020 年血红蛋白、铁蛋白、转铁蛋白饱和度达标率分别为62.64%、40.83%及44.35%,血红蛋白及铁蛋白达标率较2015 年提高,转铁蛋白饱和度达标率较2015 年下降,2020 年本中心血白蛋白达标率62.64%,较2015 年明显上升,差异均有统计学意义(均P＜0.05).2020年本中心血磷、血钙、甲状旁腺激素达标率分别为29.22%、52.24%、37.89%,同2015 年相比,血磷及甲状旁腺激素达标率比较,差异无统计学意义(P＞0.05),血钙达标率较2015 年下降,差异有统计学意义(P＜0.05).结论:近 6 年来,厦门医学 院附属第二医院血透中心2020 年贫血指标达标率及营养指标达标率较 2015 年明显上升,慢性肾脏病-骨代谢异常指标达标率较2015 年无明显改善.不断提高血液透析中心管理水平,对改善维持性血液透析患者的预后有着重要的意义.

1 病例资料 患者男,77岁,主因"上腹痛、呕吐1h"于2020年12 月10日收入ICU.患者50余年前因尿中泡沫增多就诊,诊断为"慢性肾小球肾炎".10年前因血肌酐升高,诊断为"尿毒症",规律血液透析10年,透析方案为3 次/周,4h/次,患者日常收缩压波动在136～150mmHg(1mmHg=0. 133kPa).

目的 探讨回授法在血液透析患者限磷饮食健康教育中的应用效果.方法 选取2020年8月至2021年8月在厦门医学院附属第二医院收治的维持性血液透析患者100例,按照随机数表法分为对照组(n=50)和观察组(n=50).对照组患者运用常规性健康教育模式,观察组患者在此基础上运用回授法开展健康教育.分析两组患者低磷饮食相关知识、低磷饮食健康信念、低磷饮食依从性、血磷值、血磷达标率.结果 干预前两组患者低磷饮食相关知识、低磷饮食健康信念、低磷饮食依从性、血磷值、血磷达标率比较,差异均无统计学意义(P>0.05);干预3个月后,观察组患者低磷饮食相关知识、低磷饮食健康信念、低磷饮食依从性及血磷达标率高于对照组(P<0.05),血磷值低于对照组(P<0.05).结论 运用回授法对接受血液透析患者实施限磷饮食健康教育,可以提升患者低磷饮食相关知识水平、低磷饮食健康信念水平及低磷饮食依从性,改善患者的血磷水平,值得临床推广应用.

目的 探讨老年2型糖尿病(T2DM)患者与正常健康人群血清鸢尾素(Irisin)水平差异及Irisin与血压等临床指标的关联性,分析血清Irisin对T2DM的影响.方法 基于该课题组建立的老年居民研究队列,根据纳入排除标准,按照年龄、性别等因素进行匹配,共入选T2DM组和对照组各90例.研究对象均接受问卷调查(包括一般人口学资料、疾病史、服药史等),体格检查(包括身高、体重、收缩压、舒张压等)并进行血常规和生化检测(包括血红蛋白、白蛋白、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、肌酐、尿素氮、空腹血糖、总胆固醇、三酰甘油等),采用酶联免疫吸附试验(ELISA)检测血清Irisin水平.结果 T2DM组血清Irisin水平明显低于对照组(P<0.05);T2DM组体重指数、收缩压、舒张压、三酰甘油、空腹血糖均显著高于对照组(P<0.05).血清Irisin水平与收缩压、舒张压、空腹血糖、总胆固醇、三酰甘油、丙氨酸氨基转移酶呈负相关;Logistic回归分析显示Irisin水平越高,糖尿病患病风险越低,血清Irisin水平是糖尿病的保护因素.结论 老年T2DM人群血清Irisin水平低于健康人群,血清Irisin水平是糖尿病的保护因素,可能是由于Irisin参与改善了糖代谢降低糖尿病的患病风险.

目的:探讨运用FOCUS-PDCA程序提高血液透析患者透析间期水分增长达标率的效果.方法:运用FOCUS-PDCA程序的发现、组织、选择、计划、实施、检查和执行等9个步骤分析透析患者透析间期水分增长过多的原因.制定改进措施.结果:实施FOCUS-PDCA程序干预后,血液透析患者透析间期水分增长达标率较干预前下降,差异有统计学意义(P<0.01).结论:运用FOCUS-PDCA程序可有效提高血液透析患者透析间期水分增长达标率,减少透析间期并发症的发生.

目的 分析血管内皮生长因子(VEGF)在缺血再灌注致急性肾损伤(AKI)大鼠肾脏中的表达及舒洛地特对其的干预作用.方法 将雄性SD大鼠22只随机分为空白对照组7只、缺血再灌注组(IRI组)7只、舒洛地特组8只,造模后24 h测定3组大鼠血尿素氮和肌酐水平;行RT-PCR检测各组VEGF的mRNA表达情况.结果 与空白对照组比较,IRI组大鼠血尿素氮、肌酐水平均明显升高,VEGF mRNA表达降低(P<0.05);与IRI组比较,舒洛地特组大鼠血尿素氮、肌酐水平均明显下降,VEGF mRNA表达增强(P<0.05).结论 舒洛地特能促进缺血再灌注致AKI大鼠肾间质血管内皮细胞损伤的修复,通过抗炎、改善血管内皮功能等机制途径保护肾脏,有效改善肾脏缺血再灌注损伤.

Objective To study the NLRP3 inflammatory corpuscle in ischemia-reperfusion expression in acute kidney injury in the rat kidney. Method 14 only selection methods: SD male rats, divided into ischemia reperfusion group (group A) and control group (group B), the contrast between the two groups of changes in serum creatinine, blood urea nitrogen and NLRP3 expression differences. Results The group A rat serum creatinine, blood urea nitrogen level obviously were higher than that of group B in the rat, there difference was statistically significant (P<0. 05); Immunohistochemical display of ischemia reperfusion group with the acute kidney injury rat renal tubular epithelial cells the expression of NLRP3 significantly enhanced; Pathological examination showed ischemia reperfusion group rat renal tubular interstitial damage more serious. Conclusion Ischemia reperfusion of acute kidney injury is associated with elevated serum creatinine levels and renal tissue NLRP3 expression enhancement.

目的 研究缺血-再灌注急性肾损伤(AKI)大鼠肾组织中Nod样受体蛋白3(NLRP3)炎性体的表达以及地塞米松干预对其影响.方法 选取发育正常的SD雄性大鼠21只,将实验大鼠平均分为三组并进行大鼠模型构造,分别为缺血-再灌注组(A组)、假手术组(B组)及地塞米松+缺血-再灌注组(C组),对比各组之间血肌酐、尿素氮变化及NLRP3表达的差异情况,分析地塞米松干预治疗对大鼠体内NLRP3炎性体含量的影响.采用Western blot检测大鼠肾组织NLRP3蛋白的表达情况,应用ELISA检测大鼠肾组织中白细胞介素-1β(IL-1β)以及白细胞介素-18(IL-18)的水平,采取免疫组化检测各组间肾脏NLRP3表达情况,病理学检查各组大鼠的肾小管间质损伤情况.结果 A组大鼠血肌酐、尿素氮水平、NLRP3炎性体蛋白表达以及IL-1β、IL-18水平明显高于B组大鼠[分别为(89.5±10.8) μmol/L vs.(22.3±3.1) μmol/L,(23.1±5.3)mmol/Lvs.(4.8±0.7) mmol/L,(0.39±0.11) vs.(0.08±0.01),(21.7±5.6)pg/mL vs.(5.7±1.9)pg/mL,(42.5±6.7)pg/mLvs.(11.4±2.3)pg/mL],差异均有统计学意义(P＜0.05);C组大鼠血肌酐、尿素氮水平及肾组织NLRP3表达明显低于A组大鼠[(53.4±8.3) μmol/L vs.(89.5±10.8) μmol/L,(9.6±2.9) mmol/L vs.(23.1±5.3)mmol/L,(0.21±0.07)vs.(0.39±0.11),P＜0.05];免疫组化显示,缺血-再灌注组大鼠肾小管上皮细胞NLRP3的表达显著升高;病理学检查显示,缺血-再灌注组大鼠肾小管间质损伤较重.结论 缺血-再灌注AKI会伴随血肌酐水平及NLRP3炎性体、IL-1β、IL-18的快速增高以及肾组织NLRP3表达增强,地塞米松干预能够减少肾组织NLRP3炎性体含量,减轻肾组织的损伤程度.

目的:探讨EPCs移植对缺血再灌注肾损伤大鼠血管内皮生长因子(VEGF)表达的影响.方法:雄性SD大鼠22头,随机分为3组:对照组、I/R组、EPCs组,术后1d处死各组大鼠,抽取外周血培养及鉴定内皮祖细胞,抽血检测大鼠的生化指标,采用RT-PCR技术测定三组大鼠VEGF mRNA的表达情况,行病理染色观察各组大鼠肾间质血管CD34的表达情况.结果:EPCs移植上调缺血再灌注大鼠VEGF mRNA的表达并改善了该组大鼠的肾功能,减轻了肾间质血管内皮细胞的损伤.结论:EPCs移植减轻大鼠缺血再灌注肾损伤可能与上调VEGF的表达有关.

目的 探讨血液透析联合血液灌流对维持性血液透析患者钙磷代谢的影响.方法 60例尿毒症维持性血液透析患者随机分成观察组和对照组各30例.对照组采用血液透析治疗,3次/周;观察组除3次/周血液透析治疗外,每2周1次血液灌流.治疗疗程为3个月.观察两组患者治疗前及治疗3个月后的血钙、血磷、钙磷乘积、血清甲状旁腺激素的变化及皮肤瘙痒症状的改善程度.结果 治疗前两组患者血肌酐、钙磷、甲状旁腺激素等基线资料比较,差异无统计学意义;经3个月的治疗后,观察组血磷[(2.20±0.75) mmol/Lvs(1.73±0.50) mmol/L,P＜0.01]、钙磷乘积[(5.11±1.71) mmol2/L2 vs (4.12±1.21) mmol2 /L2,P＜0.01]及甲状旁腺激素水平[(435±393) pg/mL vs (289±273) pg/mL,P＜0.05]均显著低于治疗前;对照组与治疗前比较,差异无统计学意义(P＞0.05);观察组患者皮肤瘙痒症状的缓解率(86.7％)显著高于对照组(50％),差异有统计学意义(P＜0.05).结论 血液透析联合血液灌流可有效降低血液透析患者血磷、钙磷乘积及iPTH水平,纠正钙磷代谢紊乱,还可有效改善患者皮肤瘙痒症状.

目的:探讨厦门市集美区中老年人群肥胖及KDHC疾病分布情况,为当地政府制定中老年卫生保障政策提供依据.方法:随机抽取2013-2014年集美区7个社区的1563例中老年人群,采集数据,通过Excel2007、SPSS16.0等软件统计分析中老年人群KDHC疾病分布情况.结果:厦门市集美区中老年居民超重及肥胖、高血糖及糖尿病、高血压、高血脂、慢性肾损伤等疾病患病率分别是57.4%、32.6%、41.7%、38.6%、11.7%.结论:肥胖和"三高"占厦门市集美区中老年居民的1/3甚至1/2以上,严重危害居民健康,当地政府和社会医疗机构及时制定慢性疾病的社会卫生保障体系,加强社区健康教育和定期进行慢性疾病的筛查工作对于提高社区居民健康意识、改善居民慢性病状况具有重要意义.

目的 观察血液灌流对维持性血液透析患者睡眠障碍的疗效.方法 选择2014年1～6月我科维持性血液透析伴有睡眠障碍患者40例,加用血液灌流治疗,每周1次,治疗3个月.采用自身对照的方法,观察血液灌流前后患者睡眠质量评分(匹兹堡睡眠质量指数量表,PSQI)、血红蛋白、血小板、钙、磷、甲状旁腺激素(iPTH)、β2-微球蛋白水平的变化.结果 血液灌流治疗后患者睡眠质量明显改善.除催眠药物外,PSQI各因子及总分明显降低(P＜0.05).血清磷、甲状旁腺激素(iPTH)、β2-微球蛋白水平也较治疗前下降(P＜0.01).结论 血液灌流可改善透析患者的睡眠质量,提高血透患者的生活质量.

Objective To investigate the expression and significance of transforming growth factor-β1 (TGF-β1)and dexamethasone intervening in ischemia/reperfusion(I/R) rat kidney.Methods Sprague-Dawley(SD) rats were randomly assigned to the following groups,sham + saline group (n =6),I/R + saline group (n =6) and I/R + dexamethasone group (n =6).Right kidney of rats in I/R group was removed,left renal artery was clamped until 45 min to restore blood supply.Only removed right renal and didn't clamp the renal artery in sham group.Dexamethasone treatment group (I/R + Dex) were intraperitoneally injected dexamethasone (4 mg/kg) before 30 min ischemia.All the animals were sacrificed to obtain blood samples and kidney tissue after 24 hours reperfusion.Serum urea nitrogen,creatinine and renal pathology were evaluated.TGF-β1 expression was determined by Western Blot and immunohistochemistry.Results Urea nitrogen and serum creatinine levels,TGF-β1 expression were significantly increased in I/R group as compared with sham group.However,they were significantly reduced after application of dexamethasone in I/R + dexamethasone group.The damage of kidney and score of tubular injury was the highest in I/R group,followed in I/R + dexamethasone group and the damage was the lightest in sham group.Conclusions TGF-β1 expression is up-regulated after ischemia reperfusion kidney injury.It is suggested the increase of TGF-β1 involved in renal injury.Dexamethasone can alleviate kidney injury by inhibiting the inflammatory and reducing the increase of TGF-β1.

目的 探讨终末期肾病维持血液透析患者使用头孢菌素导致抗生素脑病的临床表现及预防、治疗方法,指导合理用药.方法 我院2005年7月～2016年7月16例终末期肾病维持血液透析患者使用头孢菌素后出现抗生素脑病,回顾性总结分析上述患者的临床资料.结果 16例维持性血液透析患者因感染住院治疗,使用头孢菌素后出现抗生素脑病,患者平均年龄(69.3±13.7)岁,发病前后无神经系统定位体征,查血常规、肝肾功能、血糖、电解质等指标无明显变化(P＞0.05),头颅CT检查未见急性脑梗死或脑出血病变.患者临床表现多种多样:嗜睡、昏睡、头痛、幻觉、定向力障碍、癫痫样发作等.经停药、对症治疗及加强血液透析、联合血液滤过、CRRT、血液灌流后患者症状消失.结论 尿毒症血液透析患者,特别是老年患者,使用头孢菌素可能会导致抗生素脑病.减小剂量或延长给药间隔是防范发生脑病的关键.一旦发现需及时停药,并加强血液净化,患者大多预后良好.

慢性肾脏病(CKD)是临床常见的疾病,肾性贫血是CKD最常见的并发症之一,也是影响CKD患者预后的重要危险因素.关于肾性贫血的治疗一直都是全球关注的焦点.本文简要阐述CKD患者肾性贫血治疗的目标值及研究进展.

ObjectiveTo explore the risk factors of cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD).MethodsOne hundred and fifty-eight ESRD patients staying on HD for at least 6 months in our hospital were involved in this study. The clinical data were collected retrospectively, the levels of hemoglobin, serum albumin, serum lipids, serum creatinine, serum uric acid, Kt/V, serum calcium, serum phosphate, iTPH, CRP, BNP and blood pressure were measured. According to the recognition criteria of cardiovascular disease, maintenance hemodialysis patients were divided into CVD group and non-CVD group, and the risk factors for CVD were analyzed in hemodialysis patients.Results The incidence of cardiovascular disease in hemodialysis patients was 70.9 percent (112/158). Age, dialysis time, the levels of blood pressure, serum creatinine before dialysis, serum uric acid, serum phosphate, serum triglyceride, CRP, BNP in hemodialysis patients with CVD were higher significantly than those in the patients without CVD. The levels of hemoglobin, Kt/V were lower significantly in the former than those in the latter, the differences had statistical significance (P<0.05). Logistic regressive analysis showed that age, hypertension, the level of hemoglobin, serum triglyceride, serum phosphate, serum uric acid and CRP were the important risk factors of cardiovascular disease in hemodialysis patients.Conclusion Cardiovascular disease was the most frequent complication in maintenance hemodialysis patients. Age, hypertension, anemia, the levels of serum triglyceride, uric acid, phosphate and CRP were the important risk factors of cardiovascular disease in hemodialysis patients.

Objectives To investigate the role of phosphatidyl-inositol 3-kinase-Akt signal pathway in attenuation of ischemia-reperfusion injury by transplanting EPCs in I/R rat.Methods 22 Sprague-Dawley rats were divided in 3 groups ,in which 16 rats were randomized to receive epcs (5 ×106/2 mL) or solvent after Acute is-chemic kidney injury while the rest 6 rats just received a sham operation.Peripheral blood CD34+EPCs were coun-ted, serum creatinine and urea nitrogen were tested, p-AKT expression was determined.Results Serum creati-nine and urea nitrogen were significantly reduced, pAKT expression was upregulated in I/R rats,Epcs treatment largely prevented changes in I/R rats.Conclusions Activation of PI3K-Akt signal pathway is involved in the attenuation of I/R injury by transplanting Epcs.

Objectives To explore the plasma level and role of oxidized low density lipoprotein (ox-LDL) in maintenance hemodialysis patients.Methods Plasma ox-LDL was measured by sandwich ELISA and the serum total cholesterol,triglyceride,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,serum creatinine,blood albumin of 66 hemodialysis patients in our hospital were determined and compared with those of 22 healthy controls.Results The plasma levels of ox-LDL was obviously elevated in hemodialysis patients (4176.9μg/L ±2038.6μg/L) compared with control subjects(326.9μg/L ± 173.8μg/L),the differences had statistical significance(P =0.003).And it was higher in hemodialysis patients with coronary heart disease (5021.3μg/L ±2873.9μg/L) than that in hemodialysis patients without coronary heart disease (3163.7μg/L ± 1430.2μg/L) (P =0.018).Conclusions Ox-LDL level in maintenance hemodialysis patients was higher than control subjects and it was even higher in hemodialysis patients with coronary heart disease.It indicated that the increase of ox-LDL may be concerned with renal failure and an important risk factor of coronary heart disease.

BACKGROUND:Endothelial progenitor cells are recruited into local vascular injury under the injury-induced stimulation, and then differentiate into mature endothelial cells that are thereby involved in angiogenesis and endothelial repair. OBJECTIVE:To investigate whether endothelial progenitor cells can al eviate renal injury and improve renal function of ischemia/reperfusion injury (I/R) rats. METHODS:Peripheral blood samples extracted from Sprague-Dawley rats were used to isolate and culture endothelial progenitor cells using density gradient centrifugation. Twenty-two male Sprague-Dawley rats were randomized to three groups:I/R group, normal control group, and endothelial progenitor cells group. In the I/R and endothelial progenitor cells groups, the right kidney was removed and the renal artery and vein of the left kidney were occluded for 40 minutes to establish I/R models in the rats, and then endothelial progenitor cells (5×109/L, total y 1 mL) or solvent was transplanted via the artery of the left kidney into the left kidney. In the normal control group, the experimental procedure was same as that in the I/R group except for occlusion of the&nbsp;artery and vein of the left kidney. Renal and blood samples from three groups were col ected at day 1 after operation. Peripheral blood CD34 and vascular endoethelial growth factor receptor 2 expressions were determined using flow cytometry and immunofluorescence methods, serum creatinine and urea nitrogen were tested, and immunohistochemistry observation was used for CD34 observation. RESULTS AND CONCLUSION:Compared with the normal control group, serum creatinine and urea nitrogen levels were significantly increased, and tubulointerstitial CD34 expression was decreased in the I/R group (P<0.05). Endothelial progenitor cells treatment largely decreased the levels of serum creatinine and urea nitrogen, and increased CD34 expression (P<0.05). These findings indicate that transplantation of endothelial progenitor cells contributes to renal protection in I/R rats.

Objectives To investigate the mRAN expressions level of EP2 receptor in the peripheral blood mononuclear cells of patients with diabetic nephropathy (DN) and the influence by PGE1 treatment.Methods Sixty patients were treated with PGE1 for 2 weeks.The mRNA expressions of EP2 receptor were detected with RTPCR.Results Meanwhile,we observed the changes of blood pressure,24h urinary protein output,serum creatinine level.The mRNA expression of EP2 receptor was elevated after treatment in patients with diabetic nephropathy,The treatment effect of PGE1 in patients with higher EP2 mRNA expression was better.Conclusions It is suggested that EP2 receptor might be involved in the pathogenesis of diabetic nephropathy.The treatment effect of DN by PGE1 may be related with expressions of EP2 mRNA.