目的 生物电阻抗分析法(bioelectrical impedance analysis,BIA)可用来评估营养状况[相位角(phase angle,PA)]及容量状态[人体多余水分(over-hydration,OH)],本研究通过BIA评估持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者的营养状况与容量状态,探讨CAPD患者PA的影响因素及预估营养不良.方法 纳入2017年10月～2020年10月于吉林大学第二医院腹膜透析中心行CAPD的门诊患者200例,入选患者开始腹膜透析(peritoneal dialysis,PD)3个月后行BIA检测,根据PA的参考值,分为营养不良组(PA＜4.5°)和营养正常组(PA≥4.5°),回顾性分析患者的临床和实验室资料,探讨影响CAPD患者PA的相关因素,并预测营养不良的最佳临界值.结果 200例患者中营养不良的患病率为55.50％,营养不良组的患者较营养正常组OH升高(Z=-5.984,P＜0.001),而白蛋白、肌肉组织指数(lean tissue index,LTI)均下降(t为3.823和6.719,P均＜0.001),相关分析结果显示PA与白蛋白(F0.232,P=0.003)和LTI (r=0.556,P＜0.001)呈正相关,与OH呈负相关(r=-0.583,P＜0.001).根据ROC曲线结果,当OH大于2.85L或LTI小于12.85kg/m2或白蛋白低于35.05g/L时,CAPD患者出现营养不良的可能性大,此时的特异性(分别为67.50％、74.70％、40.30％)及敏感性(分别为71.40％、67.10％、86.30％)都相对较高.结论 在CAPD患者中营养不良的现象普遍存在,可结合OH、LTI及白蛋白水平预估患者的营养状况.纠正CAPD患者的营养不良,不仅要对患者予以营养支持,同时要积极纠正患者的容量超负荷状态.

目的 通过护理管理实现新型冠状病毒肺炎疫情期间血液透析室零感染.方法 疫情期间血液透析室施行三级防控,更改患者就诊通道,调整人力资源,组织透析室医护人员学习新型冠状病毒诊疗方案、消毒防护流程并全员考核,成立管理小组包括:成立NCP预检分诊转运小组、透析室新冠感染防控小组、透析室新型冠状病毒应急预案组以加强管理执行力,应对突发状况,同时对透析室环境实施严格感控等管理措施.结果 从2020年1月23日至2020年3月18日,透析室医护人员55人,透析患者11944人次,均未发生疑似或确诊感染新型冠状病毒肺炎病例.结论 通过在疫情期间的一系列护理管理措施,避免血液透析室在新型冠状病毒肺炎疫情期间感染暴发.

IgA肾病(IgAN)是常见的原发性肾小球疾病,约30％的患者进展为终末期肾脏病,IgAN也是维持性血液透析最主要的原发病之一[1,2].影响IgAN预后因素诸多,如年龄、高血压、吸烟、高甘油三酯、感染等[3],国外文献报道血尿酸水平也与IgAN预后相关[4],高血尿酸与IgAN相关性研究引起国内外广泛关注.

IgA肾病(IgAN)是导致终末期肾脏病的常见原发性肾小球疾病之一,其病理特点是肾小球系膜区以免疫球蛋白 IgA 沉积为主[1,2].IgAN 临床表现多样,如血尿、蛋白尿、高血压等,以上临床表现与IgAN预后密切相关[3].在临床工作中发现原发性IgAN患者临床表现、病理特点与性别差异具有相关性,但是此观点仍存在一定的争议[4].本研究回顾232 例原发性 IgAN 患者的相关资料,旨在探索原发性IgAN临床表现、病理特点与性别关系,为临床诊疗提供依据.

肾穿刺活检术是获取肾脏组织标本最有效的方法,肾穿刺活检病理是诊断肾脏疾病的金标准[1]。正确的肾穿刺活检病理诊断对临床医生及时为病患做出正确的诊断、指导治疗及评估预后具有至关重要的作用[2,3]。本文将我院自2007年10月-2011年10月间收住院行肾穿刺活检的1600例患者分4个组:小儿组,青中年组,老年前期组,老年组,对其病理资料进行回顾性研究,以期待更进一步了解肾脏疾病的构成及各个病理类型之间的关系。

肾活检穿刺术是在彩超引导下经皮肾脏组织穿刺,以了解肾脏组织形态学改变,为临床医生判断病情、治疗疾病和估计预后方面提供了重要的依据,肾脏病理检查结果已经成为肾脏疾病诊断的重要方法之一。过碘酸-雪夫氏（Periodic Acid-Schiff stain,PAS）染色是肾穿刺活检术中重要的染色方法之一,主要检测肾脏组织中糖元和其它多糖物质,显示肾小球系膜区的范围和基膜的厚度、肾小球内某些渗出性

随着2型糖尿病发病率的不断增加,糖尿病肾病（DN）已成为我国最常见的继发性肾脏疾病之一[1]。同时,DN也逐渐成为终末期肾病的主要原因,但并非所有糖尿病患者的肾损伤都为糖尿病肾病[2]。本文就疑似合并非糖尿病肾病的185例2型糖尿病患者的临床及病理做一下回顾性分析。

Objective To investigate the effect of Salvia miltiorrhiza on the connective tissue growth factor(CTGF) and the cell circle related kinase inhibitor(p27)in kidney tissue of renal interstitial fibrosis rats.Methods Forty-eight Wistar male rats of clean level were randomly divided into four groups:normal group,sham operation group,model group and Salvia miltiorrhiza group treated with Salvia miltiorrhiza at a singgle dose of 30mg/kg.daydiluted in 2 ml phuysical saline after establishment of rat RIF model.The the left renal tissues of these four groups were obtained and the expression of CTGF and p27 in kidney tissues was detected by immunohistochemical method.Results Salvia miltiorrhiza could reduce the expression of CTGF and p27 levels in kidney tissue,inhibit renal cell abnormal hypertrophy and it could also reduce the extracellular matrixIn synthesis.Conclusions CTGF and p27 play an important role in the occurrence and development of obstructive RIF.

目的探讨复用透析器在血液透析中的应用。方法选择68例采用复用血液透析器行血液透析的患者,通过透析器复用机对透析器的血室容积(Tcv)进行检测。同时检测患者在使用百特CAHP-150醋酸纤维膜透析器第1次及第5、7、9次透析前、透析后的尿素氮(BUN)及尿素清除指数(Kt/V)。结果 68例使用百特CAHP-150醋酸纤维膜透析器的患者在第1次及其使用第5、7、9次的透析前后BUN、Kt/V相互比较无统计学差异(P>0.05);使用第9次有大部分的透析器Tcv下降≥20%(P<0.05)。结论透析器复用能减少透析时补体激活,改善生物相容性,而且还能降低患者透析费用;但透析器复用不能超过9次。

Objective In order to explore the role of amylin in the progess of obesity related glomerulopathy.Methods 14 biopsy-proved ORG patients in observed group and 14 biopsy-proved mesangial proliferative glomerulonephritis patients in control group were studied.20 Wistar rats were induced by high fat diet to establish obesity related glomerulopathy model,and randomized into 2 equal groups with 10 rats in each group:model control group and Amylin group.Serum Amylin level was determined by ELISA.The serum insulin were detected by radioimmunoassay.The serum glucose and lipid was determined with automatic biochemical analyzer,The 24-hour urine protein was detected with Coomassie brilliant blue method.Amylin expressed in kidney of rat by immunochemistry.Results The levels of serum Amylin in patients of group ORG was high than in group NC.As well as the deposition of amylin in kidney was obvious.The levels of Amylin,insulin and lipid in serum,and proteinuria in group Amylin were high than in group ORG.Conclusion Amylin takes part in the occurrence and development of ORG,and has played apositive role.

Aim To observe physiological and pathological changes of compensatory renal side in normal rats after unilateral nephrectomy. Methods Urine creatinine was detected by urinary creatinine detection kit; the urine protein was determined by coomassie brilliant blue; the renal function was assayed by the automatic biochemical analyzer; the pathological changes in compensatory renal side was observed by the special staining of PAS. Results Compared with the normal group,the protein-creatinine ratio in the nephrectomized (NX) group aged 2 -3 months,7 -9 months,10 -12 months,was significantly increased after one month,then decreased to normal at the second month for the male NX group aged 2-3 months ,and decreased to normal for the female NX group in the third month,while droped to normal in the third month for the NX group aged 10 -12 months. The protein-creatinine ratio in the NX group aged 4 -6 months was not significantly different compared with normal group. Conclusion The first 1-2 months is the critical period of unilateral nephrectomy,which is directly related to the short-term and long-term safety of the rats. There is a great risk for the younger rats and the older ones to suffer renal injury after unilateral nephrectomy. The compensatory function of male rats after unilateral nephrectomy is better than that of the female rats.

目的 减少上臂动-静脉内瘘伤口的感染,促进愈合,减少病人痛苦,提高伤口护理质量,为获得高质量的血液透析而建立理想的血管通路.方法 对120例上臂动-静脉内瘘伤口随机分成两组,观察组60例伤口采用美皮康有边型敷料,对照组60例伤口采用纱布绷带包扎.对两组进行比较.结果 观察组病人在舒适度、伤口敷料浸渍情况、防水性、伤口愈合时间、感染率等方面优于对照组.结论 美皮康有边型是上臂动静脉内瘘伤口理想的敷料,具有纱布绷带敷料无法比拟的优点,值得临床推广应用.