随着糖尿病发病率的升高,糖尿病肾病( diabet-ic nephropathy,DN)成为继发性肾小球疾病的重要组成部分,临床上遇到糖尿病伴随肾脏损害的患者时,肾穿刺活检则起了重要的作用.笔者对2010-07至2019-06吉林大学第二医院、武警吉林总队医院及大连市友谊医院住院行肾穿刺的4756 例中的560例糖尿病患者肾脏病理诊断进行分析,探讨糖尿病患者的肾脏病理类型分布特点、病理类型组成及肾活检对临床诊断的修正率.

系统性红斑狼疮（ SLE）病变可累及多个器官和组织，肾脏是最常受累的器官，狼疮性肾炎（ LN）是我国最常见的继发性肾小球肾炎。在我国，乙型肝炎病毒（ HBV ）感染已超过1亿人，不乏出现合并HBV感染的LN患者，研究显示大剂量激素和免疫抑制剂的应用可以引起HBV的激活复制，导致肝脏损害加重。本文回顾性分析10例LN合并HBV感染患者给予小剂量甲泼尼龙、咪唑立宾、他克莫司及阿德福韦酯联合治疗，取得较好的疗效，避免出现严重毒副反应。

Objective To determine the relationship between primary hypertension and obesity in 3-18-years-old children and adolescents of Changchun City so as to provide scientific basis for early prevention of hypertension.Methods Children aged from 3 to 18 years were sampled by random-cluster.Height, weight, waist circumference and blood pressure were measured.Questionnaire survey, t-test, and Chi-squared test were conducted.Pearson correlation analysis and multivariate Logistic regression analysis of the data were used.Results (1)The prevalence of hypertension was 8.9%.The prevalence of overweight and obesity was 20.9%.The peak of obesi-ty was found at the age of 9 to 11 years.( 2 ) The incidencies of hypertension in overweight and obesity groups were 13.17% and 32.85%,respectively significantly higher than in the normal weight group(5.3%).The influence of BMI on systolic blood pressure was greater than its influence on diastolic blood pressure.(3)BMI, waist circumference, waist height ratio (WHtR) were positively correlated with systolic blood pressure and diastolic blood pressure.The correlation between waist circumference and BMI with blood pressure was greater than WHtR;there was no significant gender differences.(4) The incidence of overweight and obesity was 56.3%in adolescents with overweight family history, and it was 18.7%in adolescents without overweight history (P<0.05).(5)Children with high blood pressure were more likely to be inflicted with hyperglycemia and lipid metabolism disorder.BMI, waist circumference and serum lipids were the main factors influencing the blood pressure.BMI significantly influenced systolic blood pressure whereas waist circumference sig-nificantly influenced diastolic blood pressure(P<0.05).Conclusions Hypertension in children and adolescents can be predicted sensi-tively by BMI.At present, incidence of overweight and obesity has increased significantly in China.The intervention against overweight, obesity and hypertension among children and adolescents should be concerned with by local government, schools and parents.

本研究选择2005年1月-2012年12月在我院住院并进行肾活检的486例继发性肾小球疾病患者,探讨继发性肾小球疾病性别、病理类型分布特征、病理类型与临床表现的关系,旨在为临床肾脏疾病的诊断、治疗及预后判断提供有价值的资料。1资料与方法1.1一般资料选择2005年1月-2012年12月于我院肾病内科住院行肾穿刺活检486例继发性肾小球疾病患者,患者的临床及病理资料均完整、属实,

目的:探讨狼疮性肾炎的病理类型、免疫学异常和临床特点之间的关系.方法:2005年1月～ 2012年12月在我院住院并进行肾活检的260例LN患者,肾活检病理类型按照2003年ISN/RDS分型方案,临床资料来自病史记载,实验室指标取自首次肾活检的检查结果.回顾性分析患者一般资料、病理类型分布、各病理类型的临床和免疫学特征.结果:260例LN患者肾外脏器损害临床表现中,发热症状最常见,共157例；合并高血压者63例,血肌酐升高者75例.病理类型以Ⅳ型最常见,96例,Ⅰ型9例,Ⅱ型81例,Ⅲ型21例,Ⅴ型21例,Ⅴ+Ⅳ型12例,Ⅴ+Ⅲ型20例.高血压主要出现在Ⅳ型(P＜0.05),水肿主要出现在Ⅳ型、Ⅴ+Ⅳ型、Ⅴ型,Ⅳ型浆膜炎发生率高于其他病理类型(P＜0.05).Ⅱ型、Ⅲ型AI、CI、TL评分低,Ⅳ型、Ⅴ+ⅣAI、CI、TL评分高,此二型是活动性、慢性化程度最高、临床表现最突出,预后最差.患者SLEDAI评分＞9分,各病理类型之间SLEDAI评分差异无统计学意义.结论:LN病理类型以Ⅳ型为主,Ⅱ型肾外表现较为突出,以发热、关节刚、皮肤损害多见,LN不同病理类型具有一定的临床和免疫学特征,反映了不同的免疫发病机制.

我国是乙型肝炎病毒（HBV）感染的高发区,临床上原发性肾病综合征患者同时携带HBV亦较多见。原发性肾病综合征的治疗大多数需要糖皮质激素联合免疫抑制剂,免疫抑制治疗可能使病毒复制增加,使肝病加重。本文探讨21例原发性肾病综合征合并HBV感染患者,通过血清学和肾脏病理排除乙肝相关性肾小球肾炎,根据病理类型给予不同的治疗方案,通过对治疗前后生化指标的检测为合并HBV感染的肾病综合征患者的诊断和预后提供了经验和依据。

Objective To evaluate the effect and safety of prolonged use of tacrolimus combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN).Methods Twentysix consecutive IMN patients (male 18,female 8,age 18-72 years old,mean age (52± 18) years old) who were diagnosed in our department during March 2004 and June 2008 were recruited in this prospective observation.Tacrolimus in combination with corticosteroids were used for 24 months.Remission,relapse as well as the trough level of tacrolimus were observed.Student's t test or Chi-square test was used for data analysis.Results After treatment for 24 months,18 and 4 patients achieved complete or partial remission,respectively,and another 4 patients was ineffective.During the first 6 month,the trough level of tacrolimus in most patients fell into the range of 5-7 μg/L.During the second 6 months,the trough level of tacrolimus ranged between 2.1 and 4.1 μg/L.After withdrawal of corticosteroids and tacrolimus,only 1 part remission patient relapsed.Two patients received repeat renal biopsy,which suggested improvement in renal histology,and renal interstitial fibrosis was not observed.Conclusions Prolonged use (up to 24 months) of corticosteroids in combination with tacrolimus,even at a low dose,could effectively and safely induce remission,and thereafter reduce relapses of IMN.This regimen might even improve the lesion in renal histology.

<正>尿毒症患者机体免疫功能低下,是细菌感染的高发人群;而尿毒症患者由于肾功能障碍,影响抗生素的代谢和清除,在应用抗生素的过程中更容易出现严重的不良后果。CRRT即连续性肾脏替代治疗(continuous renal replacement therapy,

视神经损伤是在颅脑损伤中虽不多见但较为严重的并发症之一,手术治疗效果较好。闭合性颅脑损伤合并视神经损伤患者多数为单侧视神经损伤,发病率约为0.5%-4.0%[1],损伤程度较轻者可出现视力下降,视神经萎缩,损伤程度重者甚至可出现

近年来,糖尿病肾病的发病率逐年升高,此类患者后期大多伴严重水肿,且水肿一般比较顽固,常规内科扩容利尿治疗效果差.笔者在2008年1月～2009年5月对重度水肿而常规利尿无效的糖尿病肾病患者,采用序贯透析结合药物治疗,取得了较满意的疗效. 1 临床资料 1.1 一般资料 27例均符合糖尿病肾病的诊断标准[1].男16例,女11例,年龄57～76 (65.13±8.91)岁.

6 min步行试验(6 minute walking test,6 MWT)目前已经被公认为评估慢性充血性心力衰竭(CHF)患者运动能力和生活质量最主要的研究方法之一.2005年9月-2006年8月我们采用6 MWT对28例慢性CHF患者加用葛根素治疗前后心功能变化进行疗效评估.

IgA肾病是一组肾脏免疫病理相同但临床表现、病理改变和预后变异甚大的原发性肾小球疾病.临床应用糖皮质激素治疗,由于使用激素剂量大,而且疗程长,多数患者出现明显不良反应.来氟米特是一种新型免疫抑制剂,临床上已广泛应用于类风湿性关节炎的治疗,近期也在狼疮性肾炎及肾移植的治疗中.我院自2003年1月至今应用来氟米特治疗IgA肾病,取得较好疗效.