Objective: To evaluate the safety and immunogenicity of hepatitis E vaccine(HEV)in Maintenance hemodialysis(MHD)patients. Methods: Based on an open-labeled controlled trial, from May 2016 to March 2018, 35 eligible MHD patients were recruited in the Hemodialysis Center of Zhongshan Hospital Affiliated to Xiamen University as the experimental group, and 70 MHD patients with matched age, gender and underlying diseases as the control group. The experimental group received HEV at 0, 1 and 6 months according to the standard vaccination procedures, while the control group received routine diagnosis and treatment without vaccine and placebo injection to observe the safety and immunogenicity of the vaccine. The safety of vaccine in MHD population was evaluated by the incidence of adverse reactions/events in the experimental and control groups. The immunogenicity of HEV in MHD patients was evaluated by comparing the data from the phase Ⅲ clinical trial. Results: The overall incidence of adverse reactions/events was 17.1% (18/105), and there were no grade 3-4 adverse reactions/events related to vaccination. In the experimental group, the incidence of local adverse reactions/events was 20.0% (7/35), and the incidence of systemic adverse reactions/events was 17.1% (6/35).There was no significant difference in the incidence of systemic adverse reactions/events between the experimental group and the control group (P>0.05). There were 23 patients receiving 3 doses with the standard schedule. The positive rate of HEV-IgG antibody was 100% and the GMC was 14.47(95%CI:13.14-15.80) WU/ml, which showed no significant difference compared with the 46 patients in Phase Ⅲ clinical trial (t=-1.04, P>0.05). Conclusion: Recombinant HEV has good safety and immunogenicity in MHD patients.

Chronic kidney diseases (CKD) with complication of sepsis brings great clinical burden worldwide. Regulatory T cells (Tregs) can regulate key immune response during the progression of the diseases. The present study aims to investigate the role of HMGB1 in the regulation of Tregs and find out the potential mechanism. Jurkat cells were stimulated with 0.5 ng/ml TGF-β1 for 24 h to induce phenotypic alternation into Tregs, followed by stimulation with indoxyl sulfate (IS) and lipopolysac-charide (LPS) for 24 h. Then, Tregs were treated with recombinant human HMBG1 (rHMGB1) at different concentrations (10, 100 and 1000 ng/ml). Cell viability of Tregs was assayed by CCK-8. The gene expressions related to proliferation and autophagy were determined using RT-qPCR and western blotting. RAGE was inhibited by transfection with shRNA-RAGE in Tregs. The results showed that HMGB1 and RAGE were upregulated upon IS and LPS induction in Tregs. rHMGB1 significantly promoted the viability, proliferation and function of Tregs at a concentration-dependent way, which was partly reversed by RAGE knockdown. Besides, HMGB1-RAGE could regulate autophagy activity and AMPK-mTOR signaling pathway. In summary, our study concluded that the active autophagy mediated by enhanced HMGB1-RAGE axis through AMPK-mTOR signaling pathway was a potential mechanism to enhance Tregs viability and function in chronic kidney diseases with complication of sepsis.

Abstract Background and Aims Chronic kidney disease (CKD) is a major public health issue worldwide including in China. One of the most common complication in advanced Chronic kidney disease (CKD) is secondary hyperparathyroidism (SHPT). Reports show higher risk of bone fracture, cardiovascular events and all-cause mortality is associated with uncontrolled SHPT in patients with CKD. Cinacalcet, a calcimimetic agent was reported to reduce iPTH levels without Ca increase in patients with SHPT previously. However there has been no large-cohort study and stratified analysis of cinacalcet based on the level of iPTH in China. Moreover, the optimal therapeutic doses of cinacalcet with mild-to-severe SHPT is remaining unknown. ACTIVE study is an IV, open-label, multicenter clinical trial aimed to: (1) evaluate the efficacy and safety of cinacalcet in maintenance hemodialysis patients with mild-to-severe SHPT; (2) explore optimal combinations therapy with cinacalcet and other agents for treating patients with CKD-mineral and bone disorder. (3) investigate the benefit of long-term, continuous medication with cinacalcet in the real-world setting. Method The study design was reported on 2019 ASN. Key inclusion criteria were a baseline iPTH ≥300 pg/mL with life expectancy of ≥2 years, and ≥12 weeks of maintenance dialysis (three dialysis sessions per week) prior to enrollment. The enrollments were grouped based on their iPTH level as having mild (300-600 pg/mL), moderate (600-900 pg/mL) or severe (≥900 pg/mL). Patients initiated treatment with cinacalcet orally at a starting dose of 25 mg once daily (qd). The primary efficacy endpoint is the proportion of patients achieving iPTH targets (iPTH between 150-300pg/mL) at 20 and 32 weeks after the initiation of cinacalcet treatment. Adverse events and serious adverse events were recorded. An interim analysis was scheduled as 375 patients completed 32 weeks visit. Results 911 patients were recruited and of 750 eligible patients, 275 were identified as mild, 224 were considered as moderate and left 251 were grouped as severe SHPT. The study flowchart of 375 patients including mild(127), moderate(106) and severe(142) SHPT for interim analysis was shown in Fig 1. The baseline results including demographic and biomarkers level were reported on 2019 ASN. After 4 weeks’ cinacalcet treatment, serum PTH decreased in all three group, while extremely remarkable in the severe SHPT group. Interim analysis results revealed that the proportion of patients achieving iPTH target (150-300 pg/mL) at 20 wk visit among mild, moderate and severe groups were 38.61% (39/101), 30.11% (28/93) and 10.91% (12/110) respectively. The proportion of patients achieving iPTH target at 32 wk visit in 3 groups increased to 44.68% (42/94), 27.27% (24/88) and 14.56% (15/103) respectively (Table.1). The trends of the proportion of patients achieving iPTH target increased in all 3 different groups (Fig.2). The safety analysis showed the most common treatment-related AE in top 3 including hypocalcemia, hyperlipidemia, and loss of appetite. In vital signs, electrocardiogram (ECG) and laboratory examination of descriptive analysis, found no obvious safety tips. This study is sponsored by Kyowa Hakko Kirin (China) Pharmaceutical Co., Ltd. The analysis is still ongoing and results will be released at EDTA meeting this year. Conclusion Oral cinacalcet HCl was effective and safe in reducing iPTH in patients receiving HD with mild-to-severe SHPT.

目的 观察维持性血液透析(hemodialysis,HD)患者肾性贫血治疗达标后,不同补铁方式对血红蛋白变异度(hemoglobin variation,Hb-Var)的影响.方法 选择2015年1-12月厦门大学附属中山医院行HD的患者160例,按照随机数字表法分入静脉补铁组(蔗糖铁注射液100 mg,每周1次,静脉滴注)与口服补铁组(多糖铁复合物100 mg,每天1次,口服)并随访1年,观察2种维持性补铁方式对Hb-Var的影响.结果 采用4种方法对Hb-Vat进行评估:①静脉组患者剩余标准差明显低于口服组[(8.04 ±4.58)g/L vs.(12.25±6.85) g/L,P=0.042].②静脉组患者血红蛋白(hemoglobin,Hb)振幅低于口服组[(15.88±8.07) g/L vs.(27.00±15.88) g/L,P=0.015].③连续测量相邻时间点Hb变化绝对值,静脉组患者Hb的个体变化值及其标准差均较口服组明显降低[分别为(8.64±4.91)g/Lvs.(13.69±7.60) g/L及(6.25±3.76) g/L vs.(11.23±8.49) g/L,均P＜0.05].④观察期内4次检测血红蛋白高于、处于及低于靶目标(Hb:110 ～ 130 g/L)的比例分别为:静脉组12.85％、71.14％及16.01％;口服组6.90％、55.17％及37.93％(x2=7.164,P=0.028).静脉组转铁蛋白饱和度及铁蛋白在治疗后均增高[分别为(29.29±11.80)％vs.(39.36±12.32)％,P=0.025;(375.39±223.77) ng/ml vs.(463.05±303.26)ng/ml,P=0.005].结论 不同的维持性补铁方式对Hb-Var的影响程度不同,静脉补铁较口服补铁更有助于血液透析患者Hb的持续达标,其原因可能与铁储备的稳定性及铁离子利用率的提高有关.

Background: This study investigated the therapeutic effect of intensive phosphorus-lowering therapy on intact-parathyroid hormone (iPTH) levels in hemodialysis patients. Methods: Ninety-five hemodialysis patients with serum phosphorus ≥1.78 mmol/L and iPTH ≥300 pg/dL were apportioned to either the treatment or control group (n = 43 and 52, respectively) based on patient commitment to treatment. The treatment group was given phosphorus-lowering therapies with phosphate binders (lanthanum, sevelamer or/and calcium reagent) combined with dietary phosphate restriction and intensified hemodialysis. The control individuals were given low doses of calcium agents, if serum calcium was <2.54 mmol/L. Percent changes in serum phosphorus and iPTH levels were compared between the two groups. In addition, based on the time required to achieve >20% decrease in serum phosphorus, the patients in the treatment group were further stratified as rapid responders (≤2 months; 27 patients) or slow responders (>2 months; 16 patients) and percent changes in iPTH were compared. Results: Serum phosphorus and iPTH levels decreased from baseline in the treatment group (−24.08 ± 1.93% and −9.92 ± 3.70%, respectively) but increased in the control group (22.00 ± 3.63% and 104.21 ± 23.89%; both p < .001). In the rapid responders subgroup, the iPTH decreased (−16.93 ± 3.49%), but in the slow responders subgroup the iPTH increased slightly (0.68 ± 7.37%, p < .05). Conclusions: For these patients on maintenance hemodialysis, intensive treatment of hyperphosphatemia was associated with a decrease in iPTH levels, especially for those who had achieved substantial reduction in serum phosphorus within 2 months.

Background: Serum N-terminal probrain natriuretic peptide (NT-proBNP) level is known to be strongly associated with fluid overload, and serves as a guide for fluid management in patients on hemodialysis (HD). This study aimed at investigating the relationship between NT-proBNP level and blood pressure (BP), ultrafiltration/dry weight ratio as well as hemoglobin, and to explore the optimal cutoff point of NT-proBNP level in Chinese patients on HD.Methods: A total of 306 patients on maintained HD for stage 5 chronic kidney disease (CKD) were included in this prospective study. Their average ultrafiltration/dry weight ratio and BP before dialysis were recorded. The serum NT-proBNP, hemoglobin, serum calcium, and phosphorus were detected. The cutoff value for NT-proBNP level was calculated using receiver operating characteristic (ROC) analysis.Results: The high NT-proBNP level was associated with high BP and ultrafiltration/dry weight ratio, and low hemoglobin level. The optimal cutoff point of NT-proBNP level for patients on maintained HD was 5666 pg/mL, with a sensitivity of 78.5%, specificity of 43.9%, and area under the curve (AUC) of 0.703 (<0.001).Conclusions: NT-proBNP level ≤5666 pg/mL was recommended to achieve the target BP, hemoglobin level, and ultrafiltration/dry weight ratio in patients on maintained HD with an ejection fraction (EF) >50%.

Objective To investigate the clinicopathological characteristics of IgA nephropathy combined with hyperuricemia in order to reveal the clinical significance of IgA nephropathy associated with hyperuricemia.Methods We retrospectively reviewed the clinical data of 270 patients with IgA nephropathy diagnosed by renal biopsy from June 2006 to December 2012.The patients were divided into the two groups:IgA nephropathy patients with or without hyperuricemia.The sex,age,systolic blood pressure,24-h urine protein,serum uric acid,and serum creatinine were measured.All patients underwent renal pathological examination and Lee’s classification.A comparative analysis of clinical manifestations and renal pathological injuries was performed between the two groups,and the pathological parameters of patients with normal renal function were further analyzed.Results The prevalence of hyperuricemia in patients with IgA nephropathy was 25.19%.The systolic blood pressure,24-h urine protein and serum creatinine level were higher in the hyperuricemia group than in the normal group.The renal pathological changes in the hyperuricemia group were more severe than those in the normal uric acid group.The proportion of renal tubular interstitial lesions and renal artery lesions in the hyperuricemia group was higher than in the normal renal function group.The proportion of renal artery stenosis and renal tubular interstitial chronic lesions in the patients with hyperuricemia group was higher than in normal serum uric acid group.Conclusions The clinical manifestations and renal pathological changes of patients with IgA nephropathy combined with hyperuricemia are more serious than those with normal serum uric acid level,in particular,the effects of renal tubular interstitial lesions and renal vascular lesions were more obvious,and the clinical prognosis is not good.Timely and effective treatments are needed.

目的 观察补铁治疗对维持性血液透析患者贫血指标和促红细胞生成素类药物(ESAs)用量的影响.方法 前瞻性入组2015年1-7月我科维持性血液透析患者169例,根据患者铁指标情况采用静脉补充铁剂或口服补充铁剂治疗,比较患者治疗前后的血红蛋白(Hb)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)和ESAs治疗剂量.结果 与治疗前相比,静脉补充铁剂治疗后患者的Hb、SF和TSAT水平均显著增加(P＜0.05),ESAs使用剂量明显下降(P＜0.01).口服补充铁剂治疗后患者的Hb、SF、TSAT和ESAs使用剂量与治疗前相比,差异均不具有统计学意义(P＞0.05).结论 针对铁储备明显低下的透析患者,通过静脉补充铁剂后可提高血透患者贫血指标,减少ESAs使用剂量;铁储备在理想范围的透析患者通过补充口服铁剂可稳定患者的Hb和铁指标,为患者的后续治疗提供了指导和帮助.

Objective Although idiopathic membranous nephropathy（IMN） is a common cause of adult-onset nephrotic syndrome,its treatment remains controversial.Recent studies show tacrolimus is effective in the treatment of IMN.This study was performed to evaluate the efficacy and safety of tacrolimus（TAC） combined with glucocorticoids in patients with IMN.Methods Twenty patients with biopsy-proven IMN were collected in this retrospective study.TAC was given at 0.05-0.1 mg·kg-1·day-1 initially,in combination with oral administration of glucocorticoids(prednisone 0.5 mg·kg-1·day-1 or methylprednisolone 0.4 mg·kg-1·day-1).The primary outcome was the remission rate,whereas the secondary outcomes included the changes in serum albumin levels and daily urinary protein levels,and adverse events.Results After treatment with TAC combined with glucocorticoids for 3 months,the albumin levels had a significant improvement[（23.57 ± 4.51） g/L vs.（33.16 ±6.87） g/L,P<0.05],and the proteinuria had a significant decrease[（6.74 ± 3.08）g vs.（3.69 ±2.65） g,P<0.05].At the 6th month post-therapy,the albumin levels were significantly improved[（23.57 ± 4.51） g/L vs.（36.96 ± 6.63） g/L,P<0.05],and the proteinuria was significantly decreased[（6.74 ± 3.08） g vs.（2.48 ± 2.21） g,P<0.05].At the 12 th month post-therapy,the albumin levels were significantly improved[（23.57 ± 4.51） g/L vs.（37.30 ± 7.62） g/L,P<0.05],and the proteinuria was significantly decreased[（6.74 ± 3.08） g vs.（2.19 ± 2.10） g,P<0.05].At the end of the 18-month therapy,the albumin levels were significantly improved[（23.57 ± 4.51） g/L vs.（39.84 ± 4.31） g/L,P<0.05],and the proteinuria was significantly decreased[（6.74 ± 3.08） g vs.（1.26± 1.42） g,P<0.05].After treatment for 18 months,complete remission（CR） was achieved in 45%（9/20） of the patients and partial remission（PR） in 40%（8/20）,yielding a final response rate of 85%（17/20）.Two patients experienced relapses during the follow-up period of 12 month.There were no significant changes in creatinine,transaminase and glucose in blood.The patients had no serious adverse reactions during the treatment Conclusions In this study,treatment with tacrolimus showed a good efficacy with mild adverse reactions in patients with IMN.

Objective Anemia and secondary hyperparathyroidism are the two most common complications associated with chronic kidney disease. Erythropoiesis-stimulating agents (ESAs) are widely used in the management of anemia in hemodialysis patients. A reverse correlation has been established between hyperparathyroidism and hemoglobin levels. The aim of this retrospective study is to evaluate the relationship of high-dose ESAs and hyperparathyroidism in hemodialysis patients with anemia. Methods A total of 240 uremic patients maintained on regular hemodialysis were enrolled in this study. Among them, 142 patients were treated with Epiao® (epoetin-alfa) and 98 patients were treated with Recormon® (epoetin-beta). The target hemoglobin concentration was 110–130 g/L. Laboratory measurements including hemoglobin, calcium, phosphorus, albumin, intact-parathyroid hormone (iPTH), serum ferritin, and transferrin saturation were collected. Results Hemoglobin concentration increased as iPTH level decreased by stratification. However, no significant association between anemia and calcium or phosphorus level was found. Patients with iPTH levels within 150–300 pg/mL had the highest levels of hemoglobin, serum ferritin, and transferrin saturation. Patients treated with Recormon and Epiao had similar hemoglobin concentrations. However, the dose of Recormon for anemia treatment was significantly less than that the dose of Epiao (P < 0.05). The level of iPTH in the Recormon group was significantly lower than in the Epiao group. In patients with hemoglobin levels between 110 and 130 g/L (P < 0.05), iPTH level was found to be significantly lower in patients treated with lower doses of ESAs than in patients treated with higher doses of ESAs, no matter which ESA was used (Recormon or Epiao, P < 0.05). Conclusion The dose of ESAs might be positively associated with iPTH level, suggesting that a reasonable hemoglobin target can be achieved by using the lowest possible ESA dose.

To elucidate the incidence of renal impairment in chronic hepatitis B (CHB) patients on adefovir dipivoxil (ADV). We retrospectively enrolled 127 CHB patients on ADV alone (38.6%) or in combination with lamivudine (61.4%) for over 12 months.Renal function was measured by estimated glomerular filtration rate (eGFR). And renal dysfunction was defined as mild ( 50%). During a treatment duration of 12 months, 2 patients (1.6%) developed mild renal impairment.At Month 36, there were 13 patients with renal damage (10.4%) and one case of hypertension with severe renal impairment plus bone pain.The characteristic of renal pathology was tubule injury.Modification of dosing interval or discontinuation of ADV may arrest a further decline of eGFR in CHB patients. Key words: Nucleotides; Nephrosis

The greatest threat of arteriovenous fistula (AVF) is early thrombosis. There remains limited evidence for the use of agents for the prevention of AVF thrombosis. A total of 180 patients with stage 4 or 5 chronic kidney disease were enrolled in the present study. They were expected to have hemodialysis (HD) within the next six months and a planned lower arm AVF is expected to be the primary HD access. They were randomly divided into a control group with 60 patients, a heparin (H) treatment group with 60 patients and a heparin/anisodamine (H/A)-treatment group with 60 patients. The H/A-treatment group was given 50 IU/kg of heparin and 10 mg of anisodamine for seven days after the AVF was generated. The H-treatment group was given 50 IU/kg of heparin for seven days whereas the control group was given no treatment. The diameter and blood flow rate of the AVF were evaluated by color Doppler ultrasound at the fourth week after the operation. Patency rates of AVF were 96.7% in the H/A-treatment group, 86.7% in the H-treatment group (P < 0.05) and 83.3% in the control group (P < 0.05). The present research indicates that combined application of heparin and anisodamine can effectively relieve the vessel spasm that often occurs after establishment of an AVF and reduce the risk of early thrombosis. However, further evidence is required to validate the maintenance of long-term patency of AVF.

目的 观察尿毒症患者血清晚期氧化蛋白产物水平,对比不同血液净化方式对其清除效果,探讨其与心血管疾病的关系。方法 将60例维持性血液透析患者随机分为单纯血液透析(HD)组、血液透析联合血液透析滤过(HD+HDF)组和血液透析联合血液灌流(HD+HP)组,每组20例;另设健康对照及尿毒症未透析组,观察12个月。结果 尿毒症未透析组血清晚期氧化蛋白产物明显高于健康对照组(P<0.01),透析后进一步升高(P<0.05);12个月后,HD+HDF组及HD+HP组血清晚期氧化蛋白产物水平及心血管并发症发生率低于HD组(P<0.05)。结论 ①尿毒症患者HD后血清晚期氧化蛋白产物水平升高;②HD+HDF或HD+HP血液灌流能降低尿毒症患者血清晚期氧化蛋白产物水平,改善维持性血液透析患者心血管预后。

Microporous anodic aluminum oxide (AAO) membranes were modified by 3-glycidoxypropyltrimethoxysilane to produce terminal epoxy groups. These were used to covalently link hydroxyethyl celluloses (HEC) to amplify reactive groups of AAO membrane. The hydroxyl groups of HEC-AAO composite membrane were further modified with 1,4-butanediol diglycidyl ether to link arginine as an affinity ligand. The contents of HEC and arginine of arginine-immobilized HEC-AAO membrane were 52.1 and 19.7mg/g membrane, respectively. As biomedical adsorbents, the arginine-immobilized HEC-AAO membranes were tested for bilirubin removal. The non-specific bilirubin adsorption on the unmodified HEC-AAO composite membranes was 0.8mg/g membrane. Higher bilirubin adsorption values, up to 52.6mg/g membrane, were obtained with the arginine-immobilized HEC-AAO membranes. Elution of bilirubin showed desorption ratio was up to 85% using 0.3M NaSCN solution as the desorption agent. Comparisons equilibrium and dynamic capacities showed that dynamic capacities were lower than the equilibrium capacities. In addition, the adsorption mechanism of bilirubin and the effects of temperature, initial concentration of bilirubin, albumin concentration and ionic strength on adsorption were also investigated.

目的 分析乙肝病毒相关性肾炎的临床、实验室指标、病理特点及抗病毒治疗的疗效.方法 对53例乙肝病毒相关性肾炎患者临床表现、肝功能、肾功能、乙肝病毒血清标志物、乙肝病毒DNA以及病理分型进行分析,观察乙肝病毒DNA与临床表现之间的相关性,并根据乙肝病毒复制情况和蛋白尿的水平进行分组,给予核苷类似物抗病毒治疗,观察治疗效果.结果 肾病综合征21例,肾炎综合征32例,48例患者合并血尿,合并肾功能不全患者3例.肾活检病理结果显示膜性肾病占49.06％,膜增生性肾小球肾炎占30.19％,继发性IgA肾病占20.75％.乙肝病毒DNA载量与24 h尿蛋白定量呈正相关.19例患者使用核苷(酸)类似物拉米夫定和恩替卡韦抗病毒治疗6个月,乙肝病毒DNA载量显著下降,乙肝病毒相关性肾炎完全缓解2例,部分缓解6例.结论 乙肝病毒相关性肾炎具有特殊临床表现与肾脏病理特征,乙肝病毒DNA载量与蛋白尿水平呈正相关.抗病毒治疗可在部分患者中获得完全和部分缓解.

AIM To explore the effects of all-trans retinoic acid(atRA) on the expression of bone morphogenetic protein-7(BMP-7),transforming growth factor-β1(TGF-β1) and the metabolism of collagen Ⅳ,collagen Ⅲ in kidney tissues of streptozotocin(STZ)-induced diabetic rats.METHODS Rats injected with STZ were randomly divided into model group(DM)and therapy group(DM+atRA).Other 12 normal rats were used as control group(NC).The treatment was lasted for 8 weeks or 12 weeks,and renal pathological change was evaluated by light and electron microscopy.The expression of BMP-7,TGF-β1 and collagen Ⅳ,collagen Ⅲ in kidney tissues were tested by immunohistochemistry technique.The mRNA expression of BMP-7 and TGF-β1 in kidney tissues was quantitatively determined through real time reverse transcription polymerase chain reaction(real time RT-PCR).RESULTS The expression of BMP-7 in kidney in DM+atRA group was significantly higher than that in DM group(P0.01),but the expression of TGF-β1,collagen Ⅲ and Ⅳ of kidney in DM+atRA group was significantly lower than that in DM group(P0.01).And the levels of protein exprssion of BMP-7 were negatively correlated with the levels of TGF-β1(r=-0.86,P0.01),collagen Ⅳ(r=-0.75,P0.01)and collagen Ⅲ(r=-0.71,P0.01),respectively.The levels of mRNA exprssion of BMP-7 in kidney in DM+atRA group were higher than those in DM group(P0.01),but the levels of TGF-β1 lower than those in DM group(P0.01).Also the levels of mRNA exprssion of BMP-7 were negatively correlated with the levels of TGF-β1(r=-0.83,P0.01).CONCLUSION The atRA can relieve renal injury and inhibit renal fibrosis in rats with diabetic nephropathy induced by STZ,which might be related to the up-regulating of the expression of BMP-7 and the down-regulating the expression of TGF-β1 expression in kidney tissues.

目的对比老年糖尿病肾病尿毒症透析患者选择长期导管或自体动静脉内瘘的使用情况。方法回顾性队列研究,92例老年糖尿病肾病透析患者分两组,分别采用长期导管(n=40)与自体动静脉内瘘(n=52)作为血管通路。观察1年内两组患者的血管通路的通畅率情况、营养、贫血纠正情况、并发症发生率、住院次数及住院时间,比较两组差异。结果 (1)两组人血白蛋白、血脂、贫血纠正情况无统计学差异;(2)长期导管组导管的1年通畅率高达95%,内瘘组为78.8%,两组有统计学差异(χ2=4.862,P<0.05);(3)导管组总住院日平均(14.2±5.3)d,明显短于内瘘组总住院日平均(30.0±4.4)d,有统计学差异(t=10.953,P<0.01);(4)超敏C反应蛋白水平导管组为(7.07±8.02)mg/ml,内瘘组为(2.45±2.17)mg/ml,两组差异有统计学意义(t=2.384,P<0.05)。结论老年糖尿病肾病透析患者选择使用长期导管作为血管通路,短期内在住院时间、血管通路的通畅率方面优于使用内瘘患者。

Objective To evaluate the efficacy of combined heparin and anisodamine to protect from early thrombosis in patients with chronic kidney disease(CKD) who underwent arteriovenous fistula(AVF).Methods A total of 210 patients with stage 4 or 5 CKD were enrolled in the presented study from January 2008 to December 2009.They were having hemodialysis(HD) at this period or expected to have HD within the next 6 months.They were randomly divided into two groups,treated by 10 mg of heparin and 10 mg of anisodamine for 3 to 5 days(trial group) or without treatment(control group).Vessel murmur and thrill were evaluated at the fourth week after the operation.Results In the trial group,potent risk of early thrombosis in AVF reduced by combined use of heparin and anisodamine.AVFs were maintained in 94.5% in trial group whereas the ratio was 80% in the control group(P0.05).Conclusion The presented research indicates that combined use of heparin and anisodamine could effectively relieve the spasm of the vessels underwent AVF and reduce the risk of early thrombosis.

1 病历简介 患者男性,33岁,因肾衰竭1年,咳嗽10 d,伴发热、气促1 d入院.发病前有疑似甲型H1N1流感(甲流)患者接触史.患者1年前诊断为恶性高血压、慢性肾衰竭(尿毒症期)、乙型肝炎(乙肝)病毒携带者,行维持性血液透析治疗.

Objective:To explore the effect and mechanism of all-trans retinoic acid(atRA) on the fibrosis of kidney in STZ-induced diabetic rats.Methods:38 rats injected with streptozotocin(STZ) were randomly divided into model group(DM)and therapy group(DM+atRA).Other 12 normal rats were used as control group(NC).The rats in DM+atRA group were administrated atRA at a dosage of 20 mg·kg-1·d-1,and other rats were treated with normal saline.24 h urinary protein(Ualb),blood urea nitrogen(BUN),creatinine clearance(Ccr),the ratio of renal weight/body weight(KW/BW)and renal pathological changes was evaluated.The expression of collagen were tested by immunohistochemisty technique 8 and 12 weeks after treated.Results:24h Ualb、BUN、Ccr,the ratio of left renal weight/body weight were significantly lower in DM+atRA group than in DM group(P<0.05).The expressions of collagen Ⅲ and Ⅳ of kidney in DM+atRA group were significantly lower than those in DM group(P<0.01).AtRA improved obviously the renal pathological changes in rats with diabetic nephropathy.Conclusion:AtRA can relieve renal injury and inhibit renal fibrosis in rats with diabetic nephropathy induced by STZ,which might be related to the down-regulation of the expression of collagen Ⅲ and Ⅳ in kidney.