Background: The associations between triglyceride glucose (TyG), triglyceride glucose-body mass index (TyG-BMI), and non-alcoholic fatty liver disease (NAFLD) in high-altitude regions remain unclear. Methods: This is a cross-sectional, population-based study comprising 1384 adults living in Jianchuan county, China, which has an average altitude of over 2200 m. Logistic regressions were used to examine the associations between TyG, TyG-BMI, and NAFLD. Receiver operating characteristic (ROC) curves were utilized to compare the predictive ability of TyG, TyG-BMI, hepatic steatosis index (HSI), and triglyceride glucose-alanine aminotransferase (TyG-ALT). Results: In total, 307 (35.7%) male and 81 (15.4%) female participants were diagnosed with NAFLD. Individuals with NAFLD had higher BMI, blood pressure, and TyG indices. The adjusted odds ratios (95% confidence intervals) for the highest quartile of TyG and TyG-BMI were 16.04 (8.51-30.25) and 48.55 (25.12-93.81), respectively. The areas under the ROC curve were 0.811 (95% CI: 0.787-0.836) for TyG, 0.883 (95% CI: 0.864-0.902) for TyG-BMI, 0.839 (95% CI: 0.817-0.863) for HSI, and 0.831 (95% CI: 0.801-0.855) for TyG-ALT. Tyg-BMI had the highest sensitivity (0.832) and specificity (0.780) compared to the other indices. Conclusions: Both TyG and TyG-BMI were associated with higher NAFLD risk in people living in high-altitude regions, while TyG-BMI had greater predictive capabilities.

ObjectiveTo examine the validity of the 5-component SARC-F questionnaire for screening sarcopenia among patients with chronic kidney disease (CKD).MethodsEligible participants were enrolled from the Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from March 2019 to November 2019. Evaluations were performed using the self-administered SARC-F questionnaire. Sarcopenia was diagnosed by grip strength, the chair stand test and appendicular skeletal muscle mass. The severity of sarcopenia was evaluated by gait speed. We calculated the sensitivity and specificity of the SARC-F to evaluate construct validity. Moreover, receiver operating characteristic (ROC) curve analysis was performed to identify the cutoff value for nondialysis-dependent (NDD) CKD patients’ and maintenance hemodialysis (MHD) patients’ scores.ResultsA total of 105 NDD-CKD patients and 125 MHD patients were included, and the prevalence of sarcopenia was 5.7 and 31.2%, respectively. Among them, there were 21 (16.8%) MHD patients with severe sarcopenia but no NDD-CKD patients with severe sarcopenia. The sensitivity and specificity of the SARC-F were 16.7 and 98.0% for NDD-CKD patients, and 48.7 and 89.5% for MHD patients, respectively. For NDD-CKD patients, the area under the receiver operating characteristic curve (AUROC) of the total SARC-F score was 0.978 (95% confidence interval (CI): 0.929–0.997, p < 0.001), and the cutoff value of 1 reached the highest Youden index of 0.950 and max ROC curve area of 0.974. For MHD patients, the AUROC of the total SARC-F score was 0.730 (95% CI: 0.644–0.806, p < 0.001), and the cutoff value of 4 reached the highest Youden index of 0.383 and max ROC curve area of 0.691.ConclusionCKD patients, especially MHD patients, were at high risk of suffering sarcopenia. The SARC-F had low-to-moderate sensitivity but high specificity for screening sarcopenia among patients with CKD. The best cutoff values of the SARC-F score were different for screening sarcopenia among NDD-CKD and MHD patients.

Objective:To investigate the clinical characteristics and vaccination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in maintenance hemodialysis (MHD) patients.Methods:It was a cross-sectional survey. Through wechat questionnaire star mode, the status of SARS-CoV-2 infection, clinical manifestation after infection and vaccination of MHD patients in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between December 8, 2022 and January 12, 2023 were retrospectively collected during the period that SARS-CoV-2 infection was managed with measures against class B infectious diseases. The patients were grouped according to whether they were infected with SARS-CoV-2 and whether they were complicated with pneumonia after infection during the study period. Logistic regression analysis was used to analyze the risk factors of SARS-CoV-2 infection combined with pneumonia or persistent symptoms after SARS-CoV-2 turning negative.Results:A total of 241 questionnaires were issued, and 223 valid questionnaires were returned, of which 175 patients (78.5%) were infected with SARS-CoV-2 during the study period. The time of negative conversion of antigen or nucleic acid after SARS-CoV-2 infection was 10 (7,14) days. Asymptomatic infections accounted for 10.3% (18/175). Symptomatic infections accounted for 89.7% (157/175), and the top five most frequent symptoms were cough (70.1%, 110/157), fever (64.3%, 101/157), pharyngeal pain (35.0%, 55/157), muscle pain (28.7%, 45/157), and nasal obstruction (21.0%, 33/157). Pneumonia was reported in 54.3% (95/175) of infected patients. There were no statistically significant differences in age, gender distribution, proportion of diabetes mellitus, and proportion of history of tumors between SARS-CoV-2-infected and uninfected patients (all P>0.05). Compared with the non-pneumonia group, the proportions of dyspnea (12.6% vs. 1.3%, χ2=8.181, P=0.004) and chest tightness (23.2% vs. 10.0%, χ2=5.293, P=0.021) in the pneumonia group were both higher. There were no significant differences in age, gender distribution, time of negative SARS-CoV-2 transition, number of symptoms and SARS-CoV-2 vaccination rate,and proportions of diabetes mellitus and tumors between the pneumonia group and the non-pneumonia group (all P>0.05). There were 48.6% (85/175) infected patients having long-lasting clinical symptoms after SARS-CoV-2 turning negative. Logistic regression analysis results showed that diarrhea was an independent influencing factor of pneumonia in MHD patients infected with SARS-CoV-2 [ OR (95% CI)=6.323 (1.061-37.682), P=0.043]. The number of symptoms at onset [ OR (95% CI)=1.571 (1.318-1.873), P<0.001] and history of tumors [ OR (95% CI)=0.206 (0.054-0.777), P=0.020] were independent influencing factors of long-lasting clinical symptoms. The SARS-CoV-2 vaccination rate was 7.2% (16/223) in MHD patients due to safety concerns (81.2%, 164/202). Conclusions:MHD patients are SARS-CoV-2-susceptible population. The clinical symptoms after infection are diverse, heterogeneous, and the proportion of complicated pneumonia is high. Diarrhea is an independent influencing factor of pneumonia in SARS-CoV-2-infected MHD patients. Nearly half of patients experience long-lasting clinical symptoms after SARS-CoV-2 turning negative. The low rate of vaccination in the MHD population necessitates increased awareness about the safety and efficacy of SARS-CoV-2 vaccine.

Objective:To investigate the Influence of different anastomotic methods and checkpoints on ultrasonographic flow assessment after autogenous arteriovenous fistula.Methods:Thirty patients who underwent the first autologous arteriovenous fistula surgery in our hospital from December 1, 2017 to June 1, 2018 were selected and divided into end-to-end anastomosis group (10 cases) and end-to-end anastomosis group (20 cases) according to different anastomosis methods. General data of the patients were collected, and color Doppler ultrasound was used to measure and calculate the blood flow and related blood flow parameters of the brachial artery, radial artery and autologous fistula before the first internal fistula puncture.Results:There was no significantly difference of age, primary disease, rate of diabetes and time to maturity between the two groups( P>0.05). No postoperative complications such as stenosis and embolism occurred in all patients. The postoperative evaluation time of the two groups was (7.9±2.4) and (7.2±2.0) months, respectively, with no statistical significance ( P>0.05). In end-to-end group, the diameter of anastomotic stoma and the blood flow of cephalic vein were (3.8±1.1)mm and (524.7±116.1)mL/min. Those in end-to-side group were (7.9±2.1)mm and (877.2±442.3)mL/min with the statistical difference( P<0.05). There was no significant difference in the diameter of internal fistula ( P>0.05). There was no statistical significance in blood flow of cephalic vein and radial artery between the two groups ( P>0.05), but there was statistical significance in blood flow of brachial-cephalic vein and brachial-radial artery between the two groups ( P<0.05). There was a linear correlation between venous blood flow of brachial artery, radial artery and head ( P<0.05). Conclusions:There is no significant difference in maturation time and diameter of internal fistula between the two anastomoses of autogenous arteriovenous fistula. The blood flow is better after end-to-side anastomosis. Considering the influence of blood flow after autologous arteriovenous fistula on cardiac function, the size of anastomosis should be appropriately limited. In this case, end-to-end anastomosis can be the first choice. It is suggested that direct measurement of cephalic vein flow by Doppler ultrasound can be used to evaluate the maturity of internal fistula, and brachial artery flow can be used as an indicator of internal fistula function monitoring.

2022年3月～5月期间,上海交通大学医学院附属瑞金医院援老年医学中心医疗队(以下简称"援老年医疗队")以整建制形式参与抗击新型冠状病毒肺炎(以下简称"新冠肺炎")的一线救治工作.援老年医疗队充分发挥主观能动性,克服诸多困难,坚持"医-护-院感"三方联动协作机制,合理安排医护人力资源,健全应急管理制度与优化医院感染防控(感控)流程,从而有效保障各项医疗工作保质保量且高效运行.在总计71 d的工作时间里,医疗队共计收治患者880例,其中病情复杂及高龄重症患者48余例,累计出院800例,无危重症及死亡病例.

Acute kidney injury (AKI) is a critical clinical syndrome characterised by a rapid decrease in renal filtration, with the accumulation of products of metabolism such as creatinine and urea. In recent years, the incidence of AKI has increased not only in critically ill hospitalised patients but also in community patients. Also, the prognosis of AKI is poor and treatment is limited in these populations. The increasing incidence and poor prognosis may be the reasons why more investigators are involved in epidemiological and risk factor analysis of AKI.

目的:探讨Adimea系统在评价维持性血液透析患者透析充分性的应用价值. 方法:检测上海交通大学医学院附属瑞金医院血液净化中心167例维持性血液透析患者通过采血法及Adimea系统监测获得的单室尿素清除指数(spKt/V),通过线性相关分析了解两者的相关性,通过多元线性回归分析了解Adimea系统监测尿素清除率的临床影响因素,并比较spKt/V值达标与未达标患者的临床资料. 结果:(1)Adimea系统监测spKt/V(1.47+0.27),采血法spKt/V(1.47±0.26),直线相关分析显示,两者具有良好的相关性(r=0.697,P＜0.001).(2)干体重、前白蛋白、体重增长率、尿酸、透析前尿素氮是Adimea测定spKt/V值的独立影响因素,其中干体重(OR=0.587,P＜0.001)、透前尿素氮(OR=0.855,P=0.015)为负相关,前白蛋白(OR=1.300,P＜0.001)、体重增长率(OR=1.240,P=0.001)、尿酸(OR=1.206,P=0.003)为正相关.(3)spKt/V-Adimea达标组和未达标组在性别、尿素下降率(URR)、透前体重、干体重等方面存在显著差异,实验室指标无明显差异. 结论:Adimea系统监测spKt/V值与采血法spKt/V值具有显著相关性,可应用于实时在线监测尿素清除指数,是临床评价透析充分性的可靠指标.

Background Both soluble suppression of tumorigenicity 2 (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are promising biomarkers associated with the adverse clinical outcomes of dialysis patients. Our research aims at exploring and comparing the roles of sST2 and NT-proBNP in predicting the short-term and long-term mortality of maintenance hemodialysis (MHD) patients. Methods A prospective cohort study was performed. Patients undergoing hemodialysis in July 2014 were enrolled from the Blood Purification Center of Ruijin Hospital. MHD patients were followed up for 3 years. The primary outcome was all-cause mortality at the 1-year and 3-year follow-up, while the secondary outcome was cardiovascular mortality. Serum sST2 level was detected by quantified ELISA kits. Clinical data were analyzed by SPSS 23.0 version. Results 205 patients were recruited. The median sST2 level was 15.99 (11.60, 20.49) ng/ml. After 3 years of follow-up, both all-cause and cardiovascular mortality in 1 year and all-cause and cardiovascular mortality in 3 years increased significantly with serum sST2. For short-term mortality, no significant difference was observed in patients with increasing NT-proBNP levels. Cox regression analysis indicated that only sST2 was independent in predicting the risk of short-term outcomes. For long-term mortality, both sST2 and NT-proBNP were independent risk factors, while a higher hazard ratio was observed for NT-proBNP. Conclusions Serum sST2 is a novel biomarker associated with adverse clinical outcomes in MHD patients. It was significant for both all-cause and cardiovascular mortality in MHD patients and may provide better prognostic value in short-term prognosis than the classic biomarker NT-proBNP.

Introduction: Heterotopic vascular calcification is a common complication of maintenance hemodialysis (MHD) patients. Galectin 3 (Gal-3) has been reported to be associated with cardiovascular calcification. The current study aims to explore the potential predictive value of serum Gal-3 for severe abdominal aortic calcification (AAC) and AAC progression in MHD patients. Methods: A prospective cohort who underwent hemodialysis during July 2014 at the Blood Purification Center of Ruijin Hospital were followed up for 3 years. Two AAC assessments were performed: one at baseline and one after the 3-year follow-up period. Serum Gal-3 was detected with quantitative ELISA kits. SPSS 23.0 and MedCalc 11.4.2.0 were used to analyze the data. Findings: One hundred and fifty-two patients were recruited. Approximately 59.9% were male, the median age was 60 (50-67) years. Logistic regression analysis indicated that serum Gal-3 was an independent risk factor for both follow-up severe AAC and AAC progression. Receiver operating characteristic (ROC) curve analysis revealed significant prognostic value of serum Gal-3 for predicting severe AAC and AAC progression within 3 years. Discussion: We found serum Gal-3 is correlated to vascular calcification in ESRD patients. Gal-3 may be a potential biomarker of vascular calcification for MHD patients.

Hyperuricemia (HUA) is a risk factor for chronic kidney disease (CKD). The relationship between HUA and white blood cell (WBC) count remains unknown. A sampling survey for CKD was conducted in Sanlin community in 2012 and 2014. CKD was defined as proteinuria in at least the microalbuminuric stage or an estimated GFR of 60 mL/(min∙1.73 m2). HUA was defined as serum uric acid > 420 μmol/L in men and > 360 μmol/L in women. This study included 1024 participants. The prevalence of HUAwas 17.77%. Patients with HUA were more likely to have higher levels of WBC count, which was positively associated with HUA prevalence. This association was also observed in participants without CKD, diabetes mellitus, hyperlipidemia, or obesity. Multivariate logistic regression analysis showed that WBC count was independently associated with the risk for HUA in male and female participants. Compared with participants without HUA, inflammatory factors such as high-sensitivity C-reactive protein, tumor necrosis factor-α, and interleukin 6 increased in participants with HUA. Hence, WBC count is positively associated with HUA, and this association is independent of conventional risk factors for CKD.

目的:探讨1例家族性高胆固醇血症(familial hypercholesterolemia,FH)的致病基因及其突变,进行系谱调查,分析长期疗效.方法:根据荷兰临床脂质网络(Dutch Lipid Clinic Network,DLCN)指南诊断标准,确立1例临床型FH患者,收集患者及其家系的临床相关数据及DNA,对95个疑似基因进行外显子区突变检测,并对患者家系进行系谱分析.治疗上在强化调脂治疗(阿托伐他汀40 mg每日睡前口服,联用依折麦布10 mg 1次/d)的基础上,经左前臂动静脉内瘘路径,采用双重滤过血浆置换(double filtration plasmapheresis,DFPP)行血脂吸附治疗,每2～3个月1次,总计7年28次.观察血液净化治疗前后患者血脂水平的变化.结果:患者血清总胆固醇(total cholesterol,TC)>16.0 mmol/L,同时合并有黄色瘤、 主动脉瓣狭窄特征,其亲属无黄色瘤.患者存在低密度脂蛋白受体(low-density lipopretein receptor,LDLR)基因杂合突变(c.1129T>G)及胆固醇酯转移蛋白(cholesterol ester transfer protein,CETP)基因杂合突变(c.833T>G),可确诊为复合杂合型FH.检查患者4代18人,根据血脂水平、临床表现及基因筛查确诊2例杂合型FH,系谱分析该家系遗传方式符合常染色体显性遗传规律.患者治疗前TC和低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)的平均水平分别为(12.18±0.84)mmol/L和(9.58±0.89)mmol/L,血液净化治疗后平均水平TC(4.93±0.45)mmol/L和LDL-C(3.71±0.49)mmol/L,较治疗前均显著降低(P<0.01);同时患者黄色瘤着色减退.结论:杂合型FH是一种以高胆固醇血症为特征的常染色体显性遗传性疾病,可伴有黄色瘤及多种早发性心血管疾病.此FH家系中LDLR是主要致病基因.血液净化技术可明显降低FH患者的TC及LDL-C水平,提高患者耐受性.

Objective· To observe the progression of left ventricular hypertrophy (LVH) in maintenance hemodialysis (MHD) patients,and to analyse risk factors of the progression of LVH.Methods· Stable MHD patients of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were enrolled in July 2012.These patients were followed for 1 year.Clinical characteristics and laboratory indices were collected at baseline and 1-year followup.Left ventricular mass (LVM) was evaluated by ultrasonic cardiogram.Left ventricular mass index (LVMI) increased more than 5％ was defined as LVH progression.Results · Totally 71 MHD patients were enrolled in this study.44 patients were males,with median age 55.9 years old,median dialysis vintage 152.1 months.22 (30.99％) patients had LVH at enrollment.A significant higher percentage of MHD patients used calcium-channel binder (CCB) and angiotensin-converting-enzyme inhibitor (ACEI) in LVH group,while a significant higher NT-proBNP level was also showed in LVH group.31 patients had LVH progression while 40 patients didn't after 1 year.Patients in progression group had significant higher levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C).In univariable and multivariable Logistic regression,total cholesterol and LDL-C were independent risk factors of LVH progression (OR=2.515,95％ CI 1.219-5.910,P=0.013;OR=1.950,95％ CI 1.127-3.375,P=0.017).Conclusion · LVH is one of the common cardiovascular complications in MHD patients.The proportion of use of antihypertensive drugs is higher in the patients with LVH.Higher LDL-C and total cholesterol levels are risk factors for the progression of LVH.

Objective:To investigate the Prevalence of hyperuricemia and the relationships between hyperuricemia and the chronic kidney disease in adult residents of Pudong New Area,Shanghai.Methods:1 024 residents were randomly selected from a community of Pudong district.Questionnaires and laboratory test were taken.Risk factors for hyperuricemia was analyzed by multivariate logistic.Hyperuricemia was defined by gender-specific criteria of serum UA ＞ 420 μmol/L in males and ＞ 360 μmol/L in females.Results:We included 1 024 residents.The average age was 56 ± 14 years old.The male to female ratio was 1∶ 1.53.The overall prevalence of hyperuricemia was 17.77％ and CKD was 81.42％.Participants with HUA typically had higher age [(60 ± 15)vs (55 ±13) years old,P＜0.01],higher SBP[(135 ±13)vs (128 ±15) mmHg,P＜0.01],DBP[(85.55 ±8.31) vs (82.99±8.55) mmHg,P＜0.01],BMI[(26.26 ±3.47) vs (23.91 ±3.64) kg/m2,P＜0.01],WHR[(0.88 ±0.05) vs (0.86 ±0.06),P＜0.01],BUN[(5.41 ±1.50) vs (4.87±1.27) μmol/L,P＜0.01],Scr[(127.83 ±36.56) vs (143.17 ±38.46)μ mol/L,P ＜ 0.01],lower eGFR [(127.83 ± 36.56) vs (143.17 ± 38.46) ml · min-1 · 1.73 m-2,p ＜ 0.01].Also,they had higher percentage of hypertension(P ＜ 0.01),hyperlipidemia(P =0.04) and cardiovascular diseases(P ＜ 0.01).Univariate analysis showed that HUA was associated with age,SBP,DBP,BMI,WHR,BUN,Scr,Hb and eGFR.Multivariate logistic regression analysis showed that gender,SBP,BMI and Scr were independent factors for HUA.Conclusion:The prevalence of HUA in community of Shanghai was 17.77％.With the CKD progression,the prevalence of HUA increased.The risk factor for HUA included gender,SBP,BMI,WHR and Scr.

目的 研究维持性血液透析患者超声评估甲状旁腺增生的患病率,并结合临床资料分析甲状旁腺增生的影响因素,探讨甲状旁腺激素水平对甲状旁腺增生的预测价值.方法 选取2015年7月～2015年12月上海交通大学医学院附属瑞金医院血液净化中心维持性血液透析(maintenance hemodialysis,MHD)患者,收集患者基线时性别、年龄、透析龄、原发疾病、用药情况和血生化指标.使用Philips iE33彩色多普勒超声诊断仪评估甲状旁腺增生,探头频率llMHz.结果 2011年7～12月期间,共有96例MHD患者进入本研究,其中56例(58.3％)原发疾病为慢性肾小球肾炎,60例(62.5％)为男性,年龄(56.2±13.3)岁,透析龄(75.8±55.6)月.96例MHD患者中,54例(57.3％)患者B超可见甲状旁腺增生,其中41例(42.7％)为左侧甲状旁腺增生,44例(45.8％)为右侧甲状旁腺增生,29例(30.2％)为双侧甲状旁腺增生.透析龄＜36个月、36～72个月和≥72个月的患者超声诊断甲状旁腺增生的患病率分别为34.6％、54.5％和68.8％,3组间有统计学差异(x2=0.018,P=0.018).比较甲状旁腺增生组(n=54)和无甲状旁腺增生组(n=42)两组间患者临床资料、生化指标和药物治疗情况,发现甲状旁腺增生组透析龄更长(t=-3.507,P=0.001)、血磷(t=-2.591,P=0.011)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平更高(Z=-4.328,P＜0.001),以及维生素D制剂使用率(x2=11.197,P=0.001)更高.受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)显示iPTH水平能有效预测甲状旁腺增生(AUC=0.758,P＜0.001,95％ CI0.661～0.855).当iPTH为456.9pg/ml时,其对甲状旁腺增生预测的敏感性为57.4％,特异性为88.1％.结论 甲状旁腺增生是尿毒症患者常见的并发症之一,超声检查是评估尿毒症患者甲状旁腺增生的有效手段.较长的透析龄、高甲状旁腺激素水平、高磷血症和活性维生素D制剂的应用与甲状旁腺增生相关.当iPTH＞400pg/ml时,建议常规行甲状旁腺超声评估甲状旁腺增生情况.

Objective:To investigate the changes of Klotho expression in rat vascular smooth muscle cells (VSMCs)calcification induced by high phosphate.Methods:Rat VSMCs was cultured in vitro,the proliferation of VSMCs induced by different concentrations of phosphate was detected by cell counting kit-8 (CCK-8).VSMCs were treated with high phosphate (3 mmol/L) for 3 days or 6 days,and the calcification of VSMCs was evaluated by alizarin red staining.The activity of alkaline phosphatase (ALP) and calcium content in VSMCs were detected by ALP assay kit and calcium colorimetric assay kit,respectively.The expression of mRNA and protein of bone morphogenetic protein 2 (BMP-2),Runt related transcription factor 2 (Runx2) and Klotho were detected by quantitative real-time polymerase chain reaction (qrt-PCR) and Western blotting (WB).Results:Higher-phosphate media inhibited the proliferation of VSMCs.After being incubated in high-phosphate media for 6 days,calcified nodules were observed with alizarin red staining and calcium content was significantly increased;qrt-PCR demonstrated that levels of BMP-2 and Runx2 mRNA and protein were increased and the expressions of Klotho mRNA and protein levels were decreased.Conclusions:Klotho might be involved in the hyperphosphate-induced calcification and phenotype changes in VSMCs.

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清骨源性碱性磷酸酶(bone alkaline phosphatase,BAP)水平及其可能影响BAP水平的因素.方法 入选2012年7月于上海交通大学医学院附属瑞金医院血液透析中心的MHD患者,年龄超过18周岁,透析龄在3个月以上.结果 共入选的226例MHD患者,男性144例,中位年龄58.00岁(48.00～68.00岁),中位透析龄41.00(21.00～72.25)月.中位BAP浓度为19.71(14.85～26.72) U/L和健康志愿者21.32(19.13～28.84)U/L无统计学差异(P＞0.05).其中MHD患者中,女性平均BAP浓度22.41 (16.37～32.01) U/L显著高于男性平均BAP浓度18.65 (13.81～24.25)U/L(Z=-3.199,P=0.001).相关分析结果显示甲状旁激腺素(r=0.569,P＜0.001)、碱性磷酸酶(r=0.687,P＜0.001)、尿酸(r=0.133,P=0.045)、血磷(r=0.145,P=0.029)与BAP正相关,身高(r=0.173,P=0.010)、血碳酸氢盐水平(r=-0.158,P=0.017)、透析后平均动脉压(r=-0.135,P=0.043)与BAP负相关.多因素Logistic回归结果显示服用β-受体阻滞剂(OR 2.600,95％ CI1.253～5.395,P=0.010)、女性(0R2.693,95％ CI 1.336～5.312,P=0.004)、甲状旁腺激素(OR 1.005,95％ CI 1.003～1.007,P＜0.001)是BAP水平的独立影响因素(Forward Stepwise,P=0.458,Nagelkerke R Square 0.339).结论 BAP是反应MHD患者骨代谢的一个灵敏指标,女性、服用β-受体阻滞剂、高甲状旁腺激素水平的透析患者血清BAP水平较高.

中国成人慢性肾脏病（chronic kidney disease,CKD）发病率高达10.8% [1] ,以2016年中国大陆13.8亿人口计算,CKD患者多达1.49亿。部分CKD患者不可避免的会进展至终末期肾病（end-stage renal disease,ESRD）。2014年上海透析登记报告显示,上海地区ESRD患病率呈逐年上升趋势。血液透析目前仍是世界范围内ESRD患者的首要治疗方

目的 检测维持性血液透析(maintenance hemodialysis,MHD)患者血浆铁调素(hepcidin)水平,分析其与贫血相关指标和血管钙化的相关性,探讨其在MHD患者中的应用价值.方法 纳入2011年1月至2011年12月期间于上海交通大学医学院附属瑞金医院血液透析中心长期MHD患者,记录患者入组时一般资料及生化指标.收集患者透析前血浆标本,应用酶联免疫吸附法测定血浆hepcidin水平,分析hepcidin与贫血相关指标、红细胞生成刺激剂(erythropoiesis stimulating agent,ESA)、铁代谢指标、C反应蛋白(C-reactive protein,CRP)之间的相关性,探讨hepcidin的危险因素及其与血管钙化之间的关系.结果 216例MHD患者中位hepcidin水平2952.66(1131.38,6076.72)pg/ml.Hepcidin水平与红细胞计数(r=-0.203,P=0.003)、血红蛋白(r=-0.165,P=0.015)、红细胞比容(r=0.182,P=0.007)、总铁结合力(r=-0.467,P＜0.001)、转铁蛋白(r=-0.362,P＜0.001)呈显著负相关,与平均血红蛋白量(r=0.163,P=0.017)、平均血红蛋白浓度(r=0.156,P=0.022)、转铁蛋白饱和度(r=0.193,P=0.004)、铁蛋白(r=0.681,P＜0.001)、CRP(r=0.301,P＜0.001)、每周ESA剂量(r=0.146,P=0.032)呈显著正相关;逐步多元线性回归显示体质量指数(body mass index,BMI)(β=1.360,95％CI0.437～2.283,P=0.004)、铁蛋白(,β=0.061,95％ CI 0.046～0.077,P＜0.001)、CRP(β=3.532,95％ CI 0.887～6.177,P=0.009)是影响hepcidin水平的独立危险因素,总铁结合力(β=0.729,95％ CI 1.170～-0.288,P=0.001)是保护因素.Hepcidin水平与腹主动脉钙化(aorta abdominalis calcification,AAC)受累节段(r=0.189,P=0.028)、腹主动脉钙评分(r=0.178,P=0.039)显著正相关.结论 MHD患者hepcidin水平与贫血、铁代谢指标显著相关,且与炎症指标、AAC也显著相关,提示hepcidin可能参与了MHD患者微炎症状态和血管钙化的病理学机制.

analysis was performed by using polymerase chain reaction.Retrospective analysis included data, collected from the patients history regarding cardiovascular morbidity.Collected data were correlated with genetic polymorphism for MMP3.Seven years after the analysis were done, all-cause and cardiovascular mortality was analysed regarding MMP3 gene polymorphisms.RESULTS: The results have shown higher risk for developing myocardial infarction and cerebrovascular accident in 5A allele carriers of MMP3 gene, while this allele showed protective effect on development of hyperlipoproteinaemia and left ventricular hypertrophy.During the 7 years follow-up, 5A/5A homozygots showed the lowest all cause and cardiovascular survival, while 6A homozygots showed the highest cardiovascular survival.CONCLUSIONS: Apart from different risk factors, genetic milleu may influence cardiovascular morbidity and mortality of hemodialysis patients.Still, we need longer follow-up in a larger group of patients, in order to make a definitive conclusion about the importance of MMP3 polymorphism in daily clinical practice.