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:总结应用前臂肘正中静脉穿通支重新建立自体动静脉内瘘的手术体会,探讨该手术在自体动静脉内瘘再造对透析患者的临床意义.方法:对本院2014年4月-2017年7月6例自体动静脉内瘘闭塞的透析患者再造内瘘时采取肘正中静脉穿通支重新建立自体动静脉内瘘.结果:6例接受该手术的患者手术均一次性成功,术后内瘘通畅良好,术后即时穿刺使用率为100%,透析血流量在200~250ml/min.在应用观察中未发生窃血综合征、肿胀手综合征及术侧肢体缺血等严重并发症,且在应用中对患者心功能未造成不良影响.结论:对于自体动静脉内瘘闭塞的透析患者重新再造内瘘时,尤其是血管条件差、静脉资源少的患者,经前臂肘正中静脉穿通支重建自体动静脉内瘘是种值得考虑的术式选择.

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 探讨非常规自体动静脉内瘘建立困难下经前臂贵要静脉转位术内瘘的建立意义.方法 对本院2014年2月~2016年8月常规内瘘建立困难患者14例采用前臂贵要静脉转位建立非常规自体动静脉内瘘,与行高位瘘对比,可明显增加可利用血管长度,总结接受这一手术患者节约静脉资源情况的临床资料.结果 14例接受该手术方式的患者手术均一次性成功,术后通畅良好,术后6~8周穿刺使用率为100%,透析血流量在180~250 mL/min.观察内瘘应用中均未发生窃血综合征、肿胀手综合征及肢体缺血等严重并发症,对患者的心功能未造成不良影响.结论 大多数的常规内瘘建立困难患者利用前臂贵要静脉进行转位建立自体动静内瘘在技术上是可行的,有效利用了前臂的血管资源,是对上臂静脉宝贵资源的开发与利用,不失为良好的优先于高位内瘘和血管移植内瘘选择.

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.

Objective To investigate the therapeutic effects of Shenyankangfu tablet combined with valsartan capsule on proteinuria in patients with stage Ⅳ diabetic nephropathy and normal renal function.Methods 120 patients with stage Ⅳ diabetic nephropathy and normal renal function were randomly divided into two groups:valsartan group(n =60,valsartan 160 mg qd) and valsartan combined with Shenyankangfu tablets group (n =60,Shenyankangfu tablet 5 tablets tid combined with Valsartan 160 mg qd),and were treated for 16 weeks.Both groups were treated with the same basic diet control and routine treatment.After 16-week course of treatment,24 hours urinary protein,serum creatinine,blood glucose and blood lipids were determined and compared.Results Mter 16-week treatment,the total efficiency of the experiment group and the control group was 66.7％ and 46.7％ respectively,there was a significant difference between the two groups (P ＜ 0.05).The 24 hours urinary protein of both groups after treatment were significantly decreased,but in valsartan combined with Shenyankangfu tablets group,the 24 hours urinary protein decreased greatly [(1.77 ± 0.79) g vs.(2.29 ± 1.36) g,t =2.617,P ＜ 0.05].The levels of serum creatinine and blood glucose of both groups had no significant differences before and after treatment(P ＞ 0.05).Conclusion Shenyankangfu tablet combined with Valsartan capsule can decrease the urinary protein in patients with stage Ⅳ diabetic nephropathy,the therapeutic effect is better than valsartan alone.

> 患者男,33岁;主述"腰痛3d,血肌酐升高1d"。入院3d前饮用杨桃浸泡高粱酒(约5kg杨桃切片浸泡于5kg60°高粱酒中)约500ml后,出现腰部酸痛,无明显尿量减少,无发热、皮疹,无关节疼痛,未予诊治。入院前1天来我院就诊。生化检查:血尿素氮14.63mmol/L,肌酐411.7μmol/L,胱抑素C1.72 mg/L,钾4.6mmol/L,钙2.49mmol/L,磷1.56mmol/L,血糖5.58mmol/L,尿酸680μmol/L。既往体健,查肝肾功能、尿常规无明显异常。入院

人工自体动静脉内瘘(artetiovenous fistula,AVF)是维持性血液透析患者中较为理想、被广泛使用的血管通路,被视为透析患者的生命线[1].因此,切实有效地保护好AVF,才能保证透析治疗的顺利进行.应用尿激酶局部注射治疗动静脉内瘘血栓形成,疗效较为肯定且费用、创伤亦较低,不失为AVF血栓形成后的较佳选择.

我院收治1例Laurence-Moon-Biedl综合征病例,男性,16岁,出生时即多指（趾）畸形,高度近视,食欲大,体型肥胖,智力水平较同龄儿童差,经多项检查确诊。本病分五型:完全型、不完全型、顿挫型、非典型型、扩大进展型,诊断中应注意与Astrom综合征、Froehtich综合征、Klinefetter综合征、Prader-willi综合征、皮质醇增多症等相鉴别,无特效治疗方法。死因主要有肾脏疾病和心血管疾病等。