Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.

目的 探讨腹膜透析患者基线红细胞分布宽度(red blood cell distribution width,RDW)、时间平均RDW及RDW动态变化趋势与全因死亡的关系.方法 回顾性分析2005年7月1日～2017年6月30日北京医院腹膜透析中心规律透析3个月以上共89例患者的临床资料,随访至2018年12月31日.分析基线RDW、时间平均RDW与腹膜透析患者死亡的相关性;根据受试者工作特征曲线(receiver operating characteristic curve,ROC)确定时间平均RDW最佳截断值,以基线RDW是否大于正常值和时间平均RDW是否大于最佳预测截断值分为低基线RDW并低时间平均RDW组、低基线RDW并高时间平均RDW组、高基线RDW并低时间平均RDW组、高基线RDW并高时间平均RDW组,观察4组患者的预后差异. 结果 患者平均年龄(62.6±13.1)岁,中位透析龄48.0(32.0,66.0)个月.随访期内死亡33例(37.1％).相关性分析显示基线RDW、时间平均RDW均和死亡相关(r=0.365,P＜0.001;r=0.520,P＜0.001);COX多因素回归分析提示时间平均RDW和腹膜透析患者的全因死亡独立相关(HR=1.833,95％CI:1.158～2.899,P=0.010);时间平均RDW的ROC面积为0.881 (95％CI:0.686～0.808,P＜0.001),最佳预测截断值为14.1％;较基线及随访期RDW均较低的“双低”组,基线及随访期RDW均较高的“双高”组或“基线低随访期高”组患者的累积生存率更低(x2=17.172,P＜0.001;x2=11.232,P=-0.001).结论 时间平均RDW水平可独立预测腹膜透析患者的全因死亡;RDW处于持续高水平或基线正常而随访期升高患者的生存预后较差.

Objective To examine the clinical characteristics and red cell distribution width (RDW) changes and to investigate the prognostic value of RDW in elderly patients undergoing peritoneal dialysis(PD). Methods We retrospectively analyzed the data of 59 elderly patients aged 60 or over who had undergone regular PD for over three months at Beijing Hospital from July 1 ,2005 to June 30 ,2017.All patients were followed up until the occurrence of a composite event or until December 31 ,2017. General characteristics ,baseline laboratory data ,RDW at baseline ,and time-average RDW during the follow-up were compared between the non-survival group and the survival group.Cox regression analysis was performed to determine whether RDW was an independent risk factor of all-cause mortality. Results Fifty-nine elderly PD patients with a mean age of (70.5 ± 6.6) years were included.The median follow-up duration was 40(25 ,56)months and the median survival duration was 57(36.6 ,74.4)months. The 1-,3-,and 5-year survival rates of all patients were 98.3%(n＝58) ,72.9%(n＝ 43) ,and 52.5%(n＝ 31) ,respectively.Twenty-eight patients died during the follow-up ,of whom 15 died of infection ,8 of cardio-cerebrovascular disease and 5 of other causes.Non-survivors had higher Charlson Comorbidity Index (CCI)scores ,higher levels of RDW at baseline ,higher time-average RDW ,lower initial total KT/V ,and lower initial total CCr (all P＜0.01).In univariate analysis ,high CCI ,high basic RDW ,high time-average RDW ,low serum albumin ,low serum ferrum , and low serum cholesterol were associated with all-cause mortality (all P＜ 0.05).In multivariate- adjusted Cox analysis ,high CCI(HR＝1.679 ,95% CI :1.238-2.236 ,P＝0.001)and high time-average RDW(HR ＝ 1.889 ,95% CI :1.195-2.987 ,P ＝ 0.007)were independent predictors for all-cause mortality in elderly PD patients. Conclusions Time-average RDW may independently predict the mortality of elderly PD patients. The prognostic value of dynamic RDW may be similar to that of CCI.

Objective To explore the clinical value of the contrast-enhanced ultrasound（CEUS）in the diagnosis of renal artery stenosis（RAS）.Methods A total of 20 patients（12 males and 8 females）including 40 renal arteries,who were suspected to have RAS were enrolled in Department of Renal,Beijing Hospital.All patients were

Objective To investigate the clinical characteristics and laboratory examinations in incident dialysis effect on the prognosis of elderly patients undergoing hemodialysis.Methods Ninety-three patients aged 65 years or older initiating hemodialysis were enrolled from Hemadialysis Center of Beijing Hospital from January lst,2007 to June 30th,2016.The duration time of HD of all patients was more than three months.Patients were divided into death group and non-death group.The clinical characteristics and laboratory examinations were compared between the two groups.Cox proportional hazards regression was used for the multivariate analysis to determine independent prognosis factors.Results The average year of patients was 74.2±6.5 years old with 43 months of median time of follow-up.The first two causes of death were infection (n =25,49.0％) and cardiovascular and cerebrovascular diseases (n =16,31.4％).Cox single factor regression analysis showed that the older ages,diabetic nephropathy being the cause of end-stage renal disease (ESRD),complicating with diabetes mellitus or congestive heart failure,the higher Charlson cardiovascular diseases score,ALB being under 35 g/L were correlated with poor outcome respectively(P＜0.05).Cox multivariate regression analysis indicated that older ages (HR =1.056,P =0.021),diabetic nephropathy being the cause of ESRD (HR =2.661,P =0.001),the higher Charlson cardiovascular diseases score (HR =1.675,P =0.010),central venous catheters being vascular access(HR=1.167,P=0.048) on incident dialysis were the main risk factors for mortality in elderly patients.Conclusion The older ages,diabetic nephropathy being the cause of ESRD,the higher Charlson cardiovascular diseases score,central venous catheters being vascular access on incident dialysis are independent risk factors influencing survival of elderly patients.

目的 本研究旨在探讨应用多频生物电阻抗法评估腹膜透析(peritoneal dialysis,PD)患者容量负荷的临床价值.方法 横断面研究.选择2014年1月～2016年1月稳定规律腹膜透析患者61例,记录临床资料,检测血清氨基末端前体脑钠肽(N-terminal pro brain natrinuretic peptide,NT-proBNP)水平,透析充分性及相应的生化参数,同时应用Inbody 720行人体成分检测,记录细胞外液量(extracel lular water,ECW)与身体总水量(total body water,TBW)的比值即浮肿指数(edema index),同时根据公式获得腹膜透析患者理想干体质量,并推算水过多(Overyhydration,OH)值.结果 本组患者浮肿指数为(0.402±0.010),浮肿指数达标率为34.4％(21/61),公式法计算理想干体质量的达标率为77.05％(47/61).浮肿指数与年龄呈正相关(r=0.514,P=0.000)关系,与白蛋白水平呈负相关(r=-0.483,P=0.000)关系,年龄(β=0.426,P＜0.001)和白蛋白水平(β=-0.386,P＜0.001)是腹膜透析患者浮肿指数的独立影响因素(R2=0.385).合并糖尿病(t--3.488,P=0.001)、合并心血管疾病(t=-2.176,P=0.034),存在显性水肿(t=-2.546,P=0.014)的腹膜透析患者的浮肿指数明显高于对照组.浮肿指数与NT-proBNP水平(r=0.397,P=0.002)密切正相关,两者对显性水肿和水过多诊断的ROC曲线下面积分别为(0.740比0.665)和(0.818比0.630). 结论 腹膜透析患者浮肿指数诊断正常值受年龄、白蛋白水平及合并疾病影响而有所不同.浮肿指数与NT-proBNP密切相关,浮肿指数对于诊断容量超负荷的敏感性特异性更高.多频生物电阻抗法评估腹膜透析患者容量负荷简便易行,具有一定的临床应用价值.

目的 分析本中心2011～2013年腹膜透析相关性腹膜炎发生率的变化原因,探讨降低腹膜炎发生的改进措施.方法 以持续质量改进(continous quality improvement,CQI)模式回顾性分析比较2011～2013年腹膜透析相关性腹膜炎患者的一般情况、腹膜炎发生率及转归、病原菌分布、病因评估、患者培训频次.结果 2011～2013年腹膜透析相关性腹膜炎的发生率类似“V”型曲线变化,分别为48.8次/患者月,91.8次/患者月,27.9次/患者月,(P＜0.001).G+球菌发生率(P =0.030)、除肠球菌外的G+球菌发生率(P=0.04)均呈“V”型曲线变化.肠源性腹膜炎呈逐年上升趋势(P =0.050).2013年长透析龄患者中65岁以上患者比例升高(P-0.010).2012年、2013年老患者年度培训率、患者总体培训率较2011年比明显降低(P＜0.001). 结论 长透析龄中65岁以上老年患者比例增加,肠源性腹膜炎相关教育缺失,年度腹膜透析相关性腹膜炎培训频次不足是本中心2013年腹膜炎发生率增高的主要原因.

目的 比较应用血清白蛋白、改良SGA法(MQSGA)和MIS评分预测腹膜透析(PD)患者住院风险的差异.方法 横断面及回顾性研究.选择符合纳入标准的57例病情稳定的腹膜透析患者,对其进行改良SGA和MIS评分,以及血清白蛋白等各项临床指标检测,记录患者1年内住院情况,分析不同评估方法对患者营养状态的判定及其与住院风险相关性的差异. 结果 ①3种营养评估方法对腹膜透析患者诊断营养不良的发生率由低到高分别为:血清白蛋白(57.9％);MQSGA评分(70.2％);MIS评分(100％).②3种营养评估方法之间的相关性显著(P＜0.01);MQSGA和MIS评分与住院频次和各项临床营养指标的相关性显著(P＜0.01).③以PEW为标准,血清ALB、MQSGA和MIS评分对营养不良诊断的ROC曲线下面积分别为0.028、0.966、0.961.④住院组患者的血清白蛋白、前白蛋白水平低于非住院组(P＜0.05),住院组患者的Hs-CRP水平以及MQSGA和MIS评分均显著高于非住院组(P=0.000).⑤非条件Lo-gistic多元回归分析显示MQSGA与腹膜透析患者住院的相对危险度最高[RR=2.559,95％ CI (1.498～4.372),P=0.001].结论 MIS评分诊断腹膜透析患者营养不良的发生率最高,MQSGA与MIS评分具有相似的营养评估效果,MQSGA与MIS评分都具有预测腹膜透析患者住院风险的价值,MQSGA对住院风险的预测价值相对更高.

目的 探讨腹膜透析(PD)患者血清N末端前体脑钠肽(NT-proBNP)水平的变化及相关的影响因素.方法 横断面研究.选择2011年4月至2012年5月北京医院肾内科57例腹膜透析患者,进行血清NT-proBNP水平检测,同时评估患者的血压、透析充分性、营养、残余肾功能、心功能指标及相应的生化参数,对数据进行相关分析及分层分析. 结果 PD患者血清lnNT-proBNP水平与血磷(p=0.020)、MQSGA评分(P＜0.001)、肌钙蛋白T(P=0.002)、收缩压(P=0.010)、平均血压(P=0.013)、收缩压指数(P＜0.001)、左心房内径(P=0.001)、左心室重量指数(P=0.001)呈明显正相关;与白蛋白(P=0.008)、24h尿量(P=0.005)、残肾Kt/V (P=0.001)、残肾Ccr (P=0.010)、残余肾小球滤过率rGFR(P=0.001)、心脏射血分数(P＜0.001)、上臂围(P=0.031)、三头肌皮褶厚度(P=0.037)呈明显负相关.多元逐步回归法分析结果显示与lnNT-proBNP相关的因素依次为:MQSGA评分(β=0.470,P＜0.001)、残余肾小球滤过率rGFR(β=-0.389,P＜0.001)、收缩压指数(β=0.287,P＜0.001)、左心房内径LAD(β=0.236,P=0.006),这些指标是PD患者的血清NT-proBNP水平的独立影响因素(R2=0.722,F=37.342,P＜0.001).PD患者血清NT-proBNP中位数为5240.00 pg/ml (699.90～35000pg/ml),以中位数为截点将本组患者分为A组(NT-proBNP水平较低组)和B组(NT-proBNP水平较高组).B组在收缩压(P=0.010)、平均血压(P=0.009)、收缩压指数(P=0.001)、MQSGA评分(P＜0.001)、血磷(P=0.022)、肌钙蛋白T(P=0.037)、左心房内径(P=0.002)、左心室重量指数(P=0.003)方面均显著高于A组;在白蛋白(P=0.010)、三酰甘油(P=0.029)心脏射血分数(P＜0.001)方面明显低于A组.分层分析显示:总Kt/V≥2.0患者的lnNT-proBNP水平明显低于Kt/V＜2.0的患者(P=0.030);总Ccr≥60L/周患者的lnNT-proBNP水平明显低于总Ccr＜60L/周的患者(P=0.002);MQSGA≥8.0组患者的]nNT-proBNP水平较MQSGA＜8.0组明显升高(P＜0.001); PEW组患者的lnNT-proB-NP水平较非PEW组明显升高(P＜0.001);有左心室肥厚的患者lnNT-proBNP水平明显高于没有左心室肥厚的患者(P=0.02);有心血管疾病史患者的lnNT-proBNP水平明显高于没有心血管疾病史的患者(P＜0.001). 结论 PD患者血清NT-proBNP水平与血压、营养状况、残余肾功能、透析充分性和心功能情况均有相关性;高MQSGA评分、低残余肾小球滤过率、高收缩压指数、高左心房内径是血清NT-proBNP升高的独立影响因素.

Objective To analyze the characteristics of the maintenance hemodialysis(MHD) patients died in this hospital from January 2005 to December 2011,and to investigate the risk factors relating to the death in elderly MHD patients.Methods Retrospective study on MHD patients in the period from January 2005 to December 2011 found 83 death cases that had treated with MHD for more than 3 months.The annual number of death cases and mortality rate were then calculated.These cases were divided into 3 groups:middle age group(<60 years of age),elderly group(60 to 79 years of age),and very elderly group(>80 years of age).Demographic features,diabetes,dialysis age and cause of death were analyzed among the three groups.Results The annual mortality rate in MHD patients from 2005 to 2011 was 11.00%,10.90%,8.30%,8.10%,10.10%,8.70% and 6.34%,respectively.Of the 83 death cases,49 cases were males and 34 cases were females,with the mean age of 71.8?2.0 years(42～94 years).Fourteen cases were in middle age group,46 cases in elderly group,and 23 cases in very elderly group.Sex difference was insignificant among the three groups.Dialysis age was longer in middle age group,and was shorter in elderly group.Diabetic nephropathy was frequently found in elderly group.The causes of death were different.In middle age group,50% cases died of cerebral vascular disease,especially cerebral hemorrhage.In very elderly group,56% cases died of septic shock.In elderly group,death was resulted from various causes,including septic shock,cardiac infarction or heart failure,tumor,malnutrition-inflammation-atherosclerosis syndrome(MIA syndrome) and sudden death(in order of the prevalence rate).Conclusions Most of the death cases in this dialysis center were older than 60 years of age.Diabetes played a role more important than age on the prognosis of MHD patients.Cerebral vascular disease was the major cause of death in middle age patients,and septic shock is the main cause in very elderly patients.The causes leading to death in elderly patients were various,including cardiovascular disease,infection,tumor and MIA syndrome.

Objective To investigate the protective effect and mechanism of taurine on the cytotoxicity of iohexol on HK-2 cells. Methods HK-2 cells were exposed to iohexol at different dosage (25, 50, 100, 125 gI/L) for 6 h and at the dose of 100 gl/L for different time(2 h, 4 h, 6 h). Then taurine (3,12,24 mmol/L) was coincubated with iohexol (100 gI/L) for 6 h.Cell viability was assessed by CCK-8 assay. Cell apoptosis was determined by Hoechest 33342 flurescence stains,flow cytometry with Annexin V-FITC/PI double stains and caspase-3 activity by colorimetric assay. Bcl-2 and Bax expression were examined by Western blot. Intracellular ROS was detected by flow cytometry with fluorescent probe DCFH-DA. Results Iohexol decreased HK-2 cell viability and induced apoptosis in concentration-dependant and time-dependant manner (all P＜0.05). ROS was increased following iohexol (100 gI/L for 6 h) treatment (P＜0.05). Taurine increased cell viability and attenuated apoptosis in dose-dependant manner. The cell viability levels in taurine intervention (3,12,24 mmol/L) group were significantly increased compared with that in iohexol treated group respectively [(88.00±1.00)%, (91.33±0.58)%, (95.67±1.52) % vs (76.67±1.53)%, all P＜0.05]. Apoptosis rate by flow cytometry were decreased respectively [(8.84±1.75)%,(7.86±1.82)%, (6.30±1.50)% vs (11.98±0.39)%, all P＜0.05]. Caspase-3 activities were decreased respectively [(1.33±0.10), (1.27±0.06), (1.10±0.04) vs (1.42±0.13), all P＜0.05].Taurine up-regulated the expression of Bcl-2, and decreased the intracellular ROS (all P＜0.05).Conclusions Iohexol induces cell apoptosis and oxidative stress. Taurine attenuates direct cytotoxic effect induced by iohexol. The anti-oxidative stress effect and up-regulated Bcl-2 expression may partly account for the protection of taurine.

Objective To investigate the role of oxidative stress on apoptosis induced by iohexol in human renal tubular epithelial cells(HK-2 cells).Methods The incubated HK-2 cells were divided into four groups:①control group;②iohexol treated group(100mgI/ml);③NAC treated group(10mmol/L);④pre-incubated with NAC and then co-incubated with iohexol group.The cell viability was tested by CCK-8 assay;cell apoptosis was determined by flow cytometry with AnnexinⅤ-FITC/PI double staining.Intracelluar ROS was detected by flow cytometry with DCFH-DA fluorescence staining.The signaling transduction pathways were tested by western blot and immunofluorescence staining.Results Iohexol decreased cell viability to(63±5)%(vs.control group,P<0.01),and increased cell apoptosis to(24.41±0.23)% [vs.control group(0.97±0.28)%,P<0.05].ROS was increased to 1.30-fold compared with control(P<0.05).In NAC and iohexol co-incubated groups,the cell viability was increased to 118 %(vs.iohexol treated group,P<0.05).Apoptosis rate was decreased to 13.46%(vs.iohexol treated group,P<0.05).ROS was decreased 0.93-fold(vs.iohexol treated group,P<0.05).Iohexol induced an increasing of p53 phosphorylation and activity,then an up-regulation of Bax and down-regulation of Bcl-2 protein expression.Iohexol induced a releasing of cytochrome C from mitochondria to cytoplasm,all of which caused a final activation of caspase-3.The expression levels of p53,Bax and caspase-3 were decreased,while Bcl-2 protein expression level was increased by NAC.Conclusions Oxidative stress may play an important role in iohexol-induced apoptosis in HK-2 cells.

Antibacterial doses for critically ill patients receiving continuous renal replacement therapy(CRRT) are complicated,and failure to correctly choose a dose may result in either drug toxicity or treatment failure,and development of antibiotic resistance.In general,the initial dose depends on the volume of distribution,and maintenance doses depend on clearance.The volume of distribution of some antibacterials is altered by critical illness or acute kidney injure,or both.Clearance of drugs in CRRT depends on the dose and mode of CRRT,and the sieving or saturation coefficient of the drug.Both sieving and saturation coefficient relate to the plasma protein binding.

Objective To explore the protective effect and mechanism of antioxidant N-acetyl-L-cysteine (NAC)on the cytotoxicity induced by iohexol in HK-2 cells. Methods The incubated HK-2 cells were divided into four groups:control group,iohexol group,NAC group,and NAC+iohexol group(pre-incubated with NAC and then co-incubated with iohexol).The cell viability was tested by CCK-8 assay;cell apoptosis was determined by Hoechst 33342 fluorescence staining and flow cytometry with Annexin V-FITC/PI double staining.Intracelluar ROS waft detected by flow cytometry with DCFH-DA fluorescence staining.The signaling transduction pathways were investigated by Western blotting and immunofluorescence staining. Results Iohexol decreased cell viability,and increased apoptosis in a dose-and time-dependent manner.In iohexol(100 gl/L,6 h)group,ROS was increased by 1.30-fold of control(P＜0.05).In NAC(5,10,15 mmol/L)+iohexol groups,the cell viability was increased by 104%,118%,130%respectively,and iohexol group was 63% (P＜0.05, respectively); apoptosis rate was decreased by 13.51%, 13.46%, 12.23% respectively, and iohexol group was 24.41% (P＜0.05, respectively); ROS was decreased by 1.05-fold, 0.93-fold, 0.86-fold respectively, and iohexol group was 1.3-fold (P＜0.05, respectively).Iohexol induced the increase of p53 phosphorylatian and activity, then up-regulation of Bax and down-regulation of Bcl-2 protein expression. Iohexol induced the release of cytochrome C from mitochondria to cytoplasm, all of which caused final activation of caspase-3. The expression levels of p53, Bax and caspase-3 were decreased, while Bcl-2 protein expression level was increased by NAC. Conclusions Iohexol induces the increase of apeptosis rate and ROS generation in HK-2 cells. NAC attenuates this iohexol-induced cytotoxicity by decreasing intracelluar ROS, which is mairdy through the intrinsic pathway.

Objectives To observe the changes of renal function and blood pressure in the patients with atherosclerotic renal artery stenosis(ARAS) undergoing percutaneous transluminal renal artery stenting(PTRAS),and to explore the prognostic result of baseline renal function.Methods Twenty-three patients were divided into two groups:group A(14 case) and group B(9 case),according to an initial GFR≥50 ml·min-1·1.73 mm-2 or 50 ml·min-1·1.73 mm-2 respectively.The changes of blood pressure and renal function were compared between before and after PTRAS and between the two groups after PTRAS.Results For the entire group,SBP and DBP decreased by 19 mm Hg and 6 mm Hg(1 mm Hg =0.133 kPa,P=0.000,P=0.051) respectively,while serum Cr increased by 4.4%(P=0.594) and GFR decreased by 4.4%(P=0.462) after PTRAS.In group A,BP decreased by 26/8 mm Hg(P=0.000,P=0.033),Cr increased by 21.8%(P=0.137) and GFR decreased by 12.9%(P=0.066);while in group B,BP decreased by 8/1 mm Hg(P=0.292,P=0.773),Cr decreased by 12.6%(P=0.126)and GFR increased by 16.8%(P=0.090).Conclusions PTRAS could obviously improve blood pressure in ARAS patients.There seems to be no significance in renal function improvement.

目的 探讨老年人大肠息肉的诊治及其临床特点.方法回顾性分析167例老年大肠息肉患者的临床资料,分析其就诊原因、息肉的大小、部位、形态、病理学特点及内镜治疗情况,并与同期81例中、青年人大肠息肉患者资料进行对比分析.结果便血、腹痛、腹泻及便秘是老年人结肠息肉常见的就诊原因;直肠、乙状结肠是息肉的好发部位,但老年人右半结肠息肉明显增多,横结肠、升结肠检出率为17.7%和11.4%,中青年组为9.3%和7.9%(P 1 cm、分叶状息肉及腺瘤性息肉的比例相对增高.结论老年人结肠镜的适应证应适当放宽,并尽量行全结肠检查;内镜下摘除老年人大肠息肉是安全、简单、痛苦小、有效的治疗方法。

Objective To investigate the effect and adverse reaction of active vitamin D and low calcium dialysate on secondary hyperparathyroidism in 13 new hemodialysis patients. Methods Hemodialysis with low calcium dialysate(1.25mmol/L) was applied for 13 patients first. As to calcium-phosphorus product less than 55mg2/dl2, therapy of active vitamin D was begun according to the severities of hyperparathyroidism. Serum calcium, phosphorus, calcium-phosphorus product, iPTH and other side effects were observed. Results After 2 months of treatment, serum calcium markedly elevated from (8.37±0.82)mg/dl to (9.24±0.97)mg/dl(P 0.05). There was no significant difference in the change of serum phosphorus and calcium-phosphorus product.The iPTH significantly declined from (590.8±274.0)pg/ml to(305.3±227.9) pg/ml(P0.05). Following 5-16 months,serum phosphorus (5.54±1.06)mg/dl and calcium-phos-phorus product (51.43±11.4)mg2/dl2were apparently higher than pre-therapy(P0.05). The lever of serum calcium, phosphorus and calcium-phosphorus product were somewhat higher than those after 2 months of treatment. The iPIH of 11 patients fluctuated between 150～320 pg/ml, 2 patients did not achieve fine effect, 13 patients endured well to low calcium dialysate, there were no adverse reaction including muscle spasm, hypotension or arrhythmia. Conclusions Therapy of active vitamin D and low calcium dialysate on secondary hyperparathyroidism in new hemo-dialysis patients is effective. It is recommended to use low calcium dialysorus for those patients whose serum phosphorus is high and calcium is not too low.Using of available calcium-containing phosphorus binders witch could increase to patients calcium load and low calcium dialysate may reduce calcium-phosphorus product without enhancing the risk of cardiovascular calcification.

患者男,54岁.2002年11月查体发现脾肿大达肋下11cm,血常规检查白细胞及血小板明显减低,骨髓穿刺符合脾功能亢进,腹部CT见脾脏多个低密度灶(图1).

介入治疗是动脉粥样硬化性肾动脉狭窄的重要治疗方法之一,但并非所有经介入 治疗的患者均能从中获益。本文将对动脉粥样硬化性肾动脉狭窄患者经介入治疗能否获益的临床 预测指标进行综述。