Low-molecular-weight heparin (LMWH) is an anticoagulant used to prevent clotting during blood purification treatments. This study aimed to evaluate the clinical use of the anti-factor Xa level (anti-Xa) for monitoring LMWH anticoagulant levels during intermittent venovenous hemofiltration (IVVHF). This prospective observational study enrolled patients who required IVVHF for renal failure in Beijing Hospital between May 2019 and February 2021. The LMWH anticoagulation was assessed by the coagulation grade of the filter and line. One hundred and ten participants were included. There were 90 patients with a filter and line coagulation grade of ≤ 1 and 20 patients with grade > 1. The anti-Xa level of 0.2 IU/mL was a critical value. The multivariable logistic regression analysis showed that anti-Xa level > 0.2 IU/mL (odd ratio [OR] = 2.263; 95% CI: 1.290–4.871, P = 0.034) and cardiovascular disease (OR = 10.028; 95% CI: 1.204–83.488; P = 0.033) were independently associated with the coagulation grade of the filter and line. Anti-Xa level could monitor LMWH anticoagulation during IVVHF.

Background:Free light chains κ and λ (FLC κ, FLC λ) are of great significance in diagnostic and monitoring monoclonal gammopathy. Freelite and N-Latex methods are two common monitoring methods at present. But the two meanings are not completely equivalent, especially for patients with renal insufficiency. We analyzed the changes of serum and urine FLC in renal insufficiency patients without monoclonal gammopathy and the clinical significance of these changes.Methods:This study is an observational study. Patients ≥ 18 years old, who met the diagnostic criteria of chronic kidney disease (CKD), excluding monoclonal gammopathy, were selected. Fasting serum and 24-hour urine were taken to detect serum FLC κ, serum FLC λ, SCr, serum β 2-microglobulin, urinary FLC κ, urinary FLC λ, urinary α 1-microglobulin, and urinary β 2-microglobulin.Results:There was a good correlation between the two methods for determining serum/urinary FLC. No matter serum or urine, FLC showed a good correlation with renal function by the N-Latex method, but not by the Freelite method. Under the N-Latex method, FLC κ/λ remained stable, which was basically within the reference range of healthy people and was not affected by renal function. There was a good correlation between FLC detected by N-Latex and microglobulin in serum and urine.Conclusion:When the concentration of FLC is low, the N-Latex method is more recommended to monitor FLC. The FLC measured by the N-Latex method is more closely related to renal function. The ratio of FLC κ/λ determined by the N-Latex method remained stable within the recommended range.

目的 分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案.方法 根据北京医院血液透析中心不同时期MBD相关药物使用情况,纳入相应时间段的MHD患者.选取2017年1月1-31日151例患者为传统药物按需治疗组,2019年1月1-31日151例患者为新型药物受限治疗组,2020年1月1-31日153例患者为新型药物按需治疗组.3组患者均随访1年,比较3组生化指标、骨痛、临床事件和药品使用费用的情况.结果 传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组患者性别、年龄、透析龄和合并糖尿病的比例比较,差异均无统计学意义(P＞0.05).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组血钙水平[2.30(2.15,2.43) mmol/L、2.20(2.11,2.34) mmol/L和2.21(2.12,2.30) mmol/L]比较,差异有统计学意义(P＜ 0.001),按照K/DOQI标准的达标率分别为49.0％、57.6％和65.4％,组间比较差异有统计学意义(P=0.016);血磷水平[(1.74±0.51)mmol/L、(1.76±0.50)mmol/L和(1.65±0.44)mmol/L]比较,差异无统计学意义(P=0.081),按照K/DOQI标准的达标率分别为45.0％、43.7％和58.8％,差异有统计学意义(P=0.014);钙磷乘积[49.25(40.13,58.46)、47.42(38.59,55.95)和43.44(35.41,52.62)]比较,差异有统计学意义(P=0.024).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺激素(parathyroid hormone,PTH)水平比较,差异无统计学意义(P=0.465),按照K/DOQI标准PTH达标率分别为24.5％、35.8％和36.6％,按照KDIGO标准PTH达标率分别为51.0％、60.3％和66.0％,组间比较差异均有统计学意义(P=0.042和P=0.048).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组分别有109例(72.2％)、101例(66.9％)和87例(56.9％)患者使用含钙的磷结合剂,有0例(0.0％)、76例(50.3％)和87例(56.9％)患者使用不含钙的磷结合剂,有0例(0.0％)、35例(23.2％)和47例(30.7％)患者使用拟钙剂,差异均有统计学意义(P＜0.05).随访期内3组骨折和心脑血管事件发生率比较,差异均无统计学意义(P=0.703和P=0.889),传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺切除手术分别有2、0和0例次.传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组CKD-MBD治疗相关药物月均费用分别为100.2(11.1,322.9)元、361.6(50.1,866.9)元和633.3(121.5,1323.4)元,组间比较差异有统计学意义(P＜ 0.001).结论 新型药物按需治疗模式能明显提高MHD患者MBD生化指标的达标率,减少甲状旁腺切除手术需求,但增加了MBD相关治疗药物的费用.

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.

目的 探讨肾移植患者病原菌分布及临床主要病原菌对常用抗感染药物的敏感性和耐药性.方法 选取北京医院/国家老年医学中心/中国医学科学院老年医学研究院2020年1月1日至2020年12月31日收治的46例肾移植患者,记录患者标本送检结果;分析患者病原菌分布情况;分析患者对常用抗感染药物的敏感性和耐药性.结果 共送检各类标本1013份,主要为引流液、尿液、血液.共检出病原菌204株,分离率为20.1％.共分离出非重复菌株82株,其中细菌(革兰氏阳性菌和革兰氏阴性菌)74株(90.2％)、真菌8株(9.8％).尿液标本中革兰氏阳性菌和革兰氏阴性菌的检出比例相同,均为44.8％,真菌占10.4％,最常见的菌种为屎肠球菌(27.6％);引流液标本中革兰氏阳性菌和革兰氏阴性菌及真菌检出率分别为62.8％、25.8％和11.4％,最常见的菌种为凝固酶阴性葡萄球菌(45.6％);血液标本中革兰氏阳性菌和革兰氏阴性菌及真菌的检出率分别为76.9％、15.4％和7.7％,最常见的菌种为凝固酶阴性葡萄球菌(53.8％).肠杆菌科中肺炎克雷伯菌和大肠埃希菌超广谱β-内酰胺酶的检出率分别为77.3％和76.1％.检出耐碳青霉烯类(厄他培南、亚胺培南、美罗培南)肠杆菌2株,包括阴沟肠杆菌及肺炎克雷伯菌各1株.屎肠球菌对青霉素、左氧氟沙星、环丙沙星和红霉素耐药率均为100.0％;对氨苄西林和呋喃妥因耐药率分别为92.3％和58.3％;检出耐万古霉素屎肠球菌1株.粪肠球菌对多数测试抗感染药物的耐药率低于屎肠球菌,未检出万古霉素耐药菌株.表皮葡萄球菌对青霉素、苯唑西林、氨苄西林、左氧氟沙星、环丙沙星和莫西沙星耐药率分别为100.0％、85.7％、80.0％、100.0％、100.0％和100.0％,未检出万古霉素耐药菌株.结论 肾移植患者标来源以引流液、尿液和血液为主,所有送检标本的分离菌中细菌和真菌占比分别为90.2％和9.8％,且不同标本类型的分离菌分布有差异,严重多重耐药菌检出率较高.

诺如病毒肠炎是急性腹泻的常见原因，大多呈自限性，于24～48 h内好转。然而，在器官移植术后长期服用免疫抑制剂的患者中，诺如病毒肠炎会表现为慢性感染，引起持续、严重的腹泻。该例患者在肾移植术后出现慢性、进行性加重的腹泻，因出现脱水、代谢性酸中毒、电解质紊乱、营养不良和肾功能损伤等并发症转诊至北京医院，经多学科讨论、诊断和治疗，病情明显缓解。

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.

Background: The current study investigated the clinical application of the T-SPOT.TB assay for detecting tuberculosis (TB) infection in chronic kidney disease patients treated with immunosuppressive therapy.Methods: Clinical data from 91 patients were retrospectively analyzed. The rate of positive T-SPOT.TB results and spot numbers were compared before and after treatment. Clinical characteristics that may affect the test results were also investigated.Results: Two active TB cases were observed after immunosuppressive treatment, and eight patients with negative T-SPOT.TB results at baseline had positive results after treatment. No significant changes in spot numbers were observed for patients who were positive at baseline. Compared with pretreatment baseline, patients who received medium/high doses of corticosteroids had a greater number of T-SPOT.TB positive results (p = 0.016) and CFP-10 spots (p = 0.041) after treatment. For patients who received combination therapy with medium/high doses of corticosteroids, the T-SPOT.TB positive rate (p = 0.046) and CFP-10 spot number (p = 0.041) were increased after treatment, with no significant changes in the total number of spots or ESAT-6 spots. For those who received combination therapy with low doses of corticosteroids and those who received single immunosuppressive medication, there were no significant differences in the T-SPOT.TB positive rate, total spot number, or numbers of ESAT-6 and CFP-10 spots.Conclusion: The increase in positive T-SPOT.TB results was mainly associated with medium/high doses of glucocorticoids. The active TB cases might represent new infections. Regular monitoring using the T-SPOT.TB assay will help in the early detection of active TB.

目的 探讨北京医院肾脏专科医联体工作模式对下级医联体单位(北京东城区第一人民医院)血液净化中心医疗质量及费用的影响.方法 选取东城区第一人民医院血液净化中心2016年1月1日～2016年10月31日前在透199例维持性血液透析(maintenance hemodialysis,MHD)患者作为医联体前组,选取2016年11月1日～2017年8月31日在透181例MHD患者作为医联体后组.分析肾脏专科医联体工作模式运行前后10个月下级医联体单位MHD患者透析相关管理指标,不良事件发生率及同期住院医疗费用的变化. 结果 肾脏专科医联体成立后东城区第一人民医院MHD患者血红蛋白达标率明显提高(51.3％比70.2％,x2=3,P＜0.001)、血清铁蛋白达标率明显提高(25.1％比43.1％,x2=14.153,P＜0.001)、血钾达标率明显提高(79.4％比87.3％,x2=4.219,P=0.040)、全段甲状旁腺素达标率明显提高(25.6％比43.6％,x2=13.673,P＜0.001);不良事件发生率明显下降(37.2％比26.5％,x2=4.948,P=0.026);不良事件导致总住院费用明显下降(2 000 357元比958 053元). 结论 肾脏专科医联体工作模式能够明显提高下级医联体单位MHD患者血液透析医疗质量控制指标,明显降低MHD患者不良事件发生率,明显减少不良事件住院费用,全面节省医疗保险费用,充分证明肾脏专科医联体工作模式的可行性和有效性.

1960年Scrihner等首先提出连续性血液净化治疗的概念,1977年Kramer等首次成功地将连续性肾脏替代治疗(CRRT)用于重症患者,并得到广泛应用.CRRT是所有缓慢连续清除水和溶质的一组治疗方式的总称,在调节体液平衡的同时,清除各种代谢产物、毒物、药物和机体产生的各种致病性因子.CRRT具有血流动力学稳定、能持续稳定地清除水分和体内毒素及炎症因子、保证营养补充等优点,不仅能改善肾功能,而且对多器官功能的恢复提供支持,使其临床应用不局限于肾脏相关疾病领域,已经扩展至重症感染、创伤、急性坏死性胰腺炎、肝性脑病、心力衰竭、药物及毒物中毒、急性呼吸窘迫综合征至全身炎症反应综合征(SIRS)、多器官功能障碍综合征(MODS)等危重病症的救治.

Multiple myeloma (MM) refers to a malignant proliferative disorder caused by abnormal proliferation of plasma cells in the bone marrow, which is characterized by the production of monoclonal immunoglobulins or their fragments that subsequently lead to damage to the relevant organs or tissues. Renal damage is a common complication of MM, and is one of the main causes of death. There are various mechanisms of renal damage in MM, among which tubular nephropathy and hypercalcaemia are most important. Timely and effective diagnosis and appropriate treatment plans can improve the overall prognosis of such patients. This article focused on the diagnosis and treatment of myeloma-related renal damage. Key words: Multiple myeloma; Renal impairment; Serum free light chain; High cut-off hemodialysis

目的 了解间断静静脉血液滤过(intermittent venovenous hemofiltation,IVVH)预防老年慢性肾衰竭患者对比剂所致急性肾损伤(contrast-induced acute kidney injury,CI-AKI)的应用现状,探讨IVVH对老年慢性肾衰竭患者CI-AKI的预防作用.方法 回顾性分析2014年6月～2015年12月于北京医院心内科行冠状动脉造影检查和/或经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的39例老年(≥60岁)慢性肾衰竭患者相关临床资料.按照PCI术后是否行预防性血液净化措施,将患者分为IVVH组和非IVVH组,比较组间对比剂所致急性肾损伤发生率及相关临床资料.结果39例老年慢性肾衰竭患者,年龄(74.03±7.65)岁;IVVH组18例,非IVVH组21例.18例PCI术后行IVVH慢性肾衰竭患者:高血压肾病8例、糖尿病肾病3例、缺血性肾病2例、其他肾脏病5例;术前血肌酐(188.83±76.68)μmol/L,术前肾小球滤过率评估(estimated glomerular filtration rate,eGFR)(30.89±12.38)ml/(min·1.73d),含碘对比剂用量(176.67±69.11)ml;IVVH参数:血流速(155.56±9.84)ml/min,血滤置换液流速(29.73±6.42)ml/(kg·h),每次超滤量386.72±265.75ml.IVVH组和非IVVH组CI-AKI发生率分别为5.56％、42.86％,组间存在统计学差异(x2=5.252,P=0.022,).结论PCI术后行IVVH可能是降低老年慢性肾衰竭患者CI-AKI发生的有效措施.

BACKGROUND:Kimura disease is a rare chronic inflammatory disorder with peripheral eosinophilia and elevated serum IgE and is also frequently complicated by nephropathy.METHODS:We report a rare case of Kimura disease concomitant with lupus nephritis in a 72-year old male patient with recurrent unexplained lymphadenopathy, renal lesions, and immunologic abnormalities.RESULTS:The patient was successfully managed with gamma immunoglobulin, intravenous pulse methylprednisolone therapy, hydroxychloroquine, and prednisone.CONCLUSION:This is the first report of a case of Kimura disease concomitant with lupus nephritis and highlights the importance of considering lupus nephritis as a possible concurrent disease in patients with Kimura disease that have immunologic abnormalities.

Background: Kimura disease is a rare chronic inflammatory disorder with peripheral eosinophilia and elevated serum IgE and is also frequently complicated by nephropathy. Methods: We report a rare case of Kimura disease concomitant with lupus nephritis in a 72-year old male patient with recurrent unexplained lymphadenopathy, renal lesions, and immunologic abnormalities. Results: The patient was successfully managed with gamma immunoglobulin, intravenous pulse methylprednisolone therapy, hydroxychloroquine, and prednisone. Conclusion: This is the first report of a case of Kimura disease concomitant with lupus nephritis and highlights the importance of considering lupus nephritis as a possible concurrent disease in patients with Kimura disease that have immunologic abnormalities.

OBJECTIVE:To study the baseline distribution of polymorphisms in the promoter of peroxisome proliferators activated receptor co-activator 1 (PPARGC1A) gene in ethnic Hans from Beijing, and to assess their association with type 2 diabetes (T2DM).METHODS:A 2-stage study was designed. Firstly, the promoter region of PPAGC1A gene was screened with PCRRFLP in a small population (n=216, T2DM/control: 104/112), which was followed by a replication study of a larger group (n=1546, T2DM/control: 732/814). Fasting plasma glucose, insulin, blood lipid, height, weight, waist circumference, and blood pressure were measured in all subjects. Potential association was assessed by logistic regression. Linkage disequilibrium and haplotype analysis were conducted with Haploview software.RESULTS:Five polymorphisms were identified with Sanger sequencing, among which T-2120C (rs3755857), -1999C/G (rs2946386) and -1437T/C (rs2970870) were included for genotypic analysis based on their moderate levels of heterozygosity. No significant difference was found between the two groups. When adjusted for age and gender confounding, we have combined the OR values from population 1 and population 2 based on Mantel-Haenszel fixed model, and recognized a mild contribution of C allele of -1999C/G (rs2946386) to the 1.18-fold risk of T2DM (P=0.03, OR=118). No haplotype was associated with T2DM after permutation correction.CONCLUSION:The C allele of -1999C/G ( rs2946386) in the promoter region of the PPARGC1A gene is mildly associated with T2DM. Variations in the promoter region of the PPARGC1A gene seem not to confer the risk of T2DM in our population.

目的:探讨解耦联蛋白2基因(UCP2)启动子变异-866G/A及载脂蛋白E与北京人群糖尿病肾病(DN)的发生关联和协同效应.方法:基于聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术,对228例DN患者,243例非DN的2型糖尿病患者及78例正常对照进行基因分型,同时进行体格检查和生化指标测定,数据处理使用SPSS(version16.0)完成,用Hardy-Weinberg平衡检验评价人群代表性,按照加性模型分析基因型的整体分布规律,隐性模型和显性模型分析风险等位基因与疾病的关联,通过Logistic回归分析基因变异间的交互作用,分层分析评估其相互作用对DN的贡献.结果:加性模型分析提示UCP2基因-866G/A在DN组和DM组间的分布差异达到统计学显著性(P＜0.001),进一步通过显性模型发现-866A同DN存在正关联,调整年龄和性别混杂后,正关联仍然存在(OR=1.814,95％CI:1.148-2.867).UCP2×APOE交互项和DN存在独立于年龄、性别、体质指数、血糖、甘油三酯等血脂指标的正关联,二者存在效应的协同作用.分层分析表明UCP2基因-866A是独立APOEε4的DN的危险因素,且APOEε4对UCP2基因-866A存在异位显性(epistasis)关系.结论:UCP2基因启动子-866A等位基因和APOEε4等位基因是北京汉族人群DN的风险等位基因,APOEε4存在异位显性,二者效应存在叠加.

目的 探讨APOE和MTHFR基因C677T变异在北京汉族人群2型糖尿病(T2DM)和糖尿病肾病(DN)发生中的关联和交互作用.方法 基于聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术,对228例DN患者,243例非DN的T2DM患者及78例正常对照进行APOE和MTHFR的基因分型,分析基因型的整体分布规律及风险等位基因APOE ε4和MTHFR 677T与DN的关联,通过Logistic回归分析基因变异间的交互作用.结果对照组中APOE和MTHFR基因C677T各基因型均满足Hardy-Weinberg平衡,加性模型(additive model)发现 MTHFR和APOE基因的基因型的整体分布,在DM和NGT组间无差异,而在DN和DM组间存在显著性差异(CETP基因:P=0.023;APOE基因:P=0.003);MTHFR基因C677T等位基因T在显性模型(dominant model)和隐性模型(recessive model)中均与DN正关联;MTHFR基因C677T和APOEε4间交互效应同DN存在正关联(P<0.001,OR=12.121),APOEε4存在异位显性效应,二者效应存在叠加.结论 APOE和MTHFR基因C677T存在基因-基因交互作用和协同效应,与北京汉族DN正关联,二者对于DN易感性存在累积效应.

<正>尿路感染(本文简称尿感)是指病原体侵犯尿路黏膜或组织引起的尿路炎症。多种病原体如细菌、真菌、支原体、衣原体、病毒、寄生虫等均可以引起尿路感染。尿感是临床常见病和多发病,是所有微生物感染中最常见的临床类型之一。根据流行病学资料显示女性人群发生率2.05%,生育期女性可达5%以上,妊娠

Objective To evaluate the association between methylenetetrahydrofolate reductase gene (MTHFR) C677T polymorphism and diabetic kidney disease in Chinese population.Methods After searching the related literatures from PubMed,Medline,EMBASE databases and common Chinese journal literature databases,meta-analysis was performed to assess the association of MTHFR C677T polymorphism with diabetic kidney disease according to the principles of systematic review based on the recessive model and dominant model respectively.Fixed effect model (M-H) was used to pool odd ratio (OR) after heterogeneity test.The Begg and Egger analysis were conducted to evaluate the publication bias.Results 10 literatures including a total of 2018 cases were included in the metaanalysis.No significant heterogeneity was detected.Data were pooled by fixed effect model.The total OR was 2.41 (95％CI=1.85～3.13) and 2.33 (95％CI=1.82～2.98) in recessive and dominant models respectively.No obvious publication bias was observed by Begg and Egger analysis.Conclusions The T allele of C677T polymorphism in MTHFR gene is positively associated with diabetic kidney disease in Chinese population.

Objective: To study the association between the methylene tetrahydrofolate reductase(MTHFR) gene C677T polymorphism and levels of serum creatinine(Scr) and blood urea nitrogen(BUN) in diabetic nephropathy patients.Methods: Based on the polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) method,the C677T polymorphism in 102 DN cases and 104 controls was analyzed and the distribution of C677T alleles and genotypes were compared,and further stratified analysis with Scr and BUN was carried out in DN group by carriers of the C677T risk allele T.Results: MTHFR gene C677T were consistent with Hardy-weinberg equilibrium in both DN group and control group,but no significant association has been found between the DN and distribution of genotype(df=2,P=0.296) and alleles(df=1,P=0.184).In DN group,the Scr level in those carrying the risk allele T(TT+CT genotype) was significantly higher than those without risk allele T(P=0.032).Conclusion: C677T variation in MTHFR seemed not to be a main effect factor to DN,but the T allele might be a predictive marker for early assessment of Scr and the progress of renal dysfunction.