Objective To evaluate the clinical significance of the changes in mean platelet volume（MPV）,platelet-large cell ratio（P-LCR）,platelet distribution width（PDW）,neutrophil-lymphocyte ratio（NLR）,platelet-lymphocyte ratio（PLR）and monocyte-lymphocyte ratio（MLR）in early diabetic nephropathy（DN）.Methods Complete blood count（CBC）of 117 DN patients and 87 healthy controls（HC）were measured.Also PLR,NLR and MLR were compared among two groups.Results MPV,P-LCR,NLR,PLR and MLR were significantly higher in DN patients than those in HC group.Conclusion The levels of MPV,P-LCR,PDW,NLR,PLR and MLR become elevated in early DN patients.All these parameters have certain clinical reference values.

近年来,局部枸橼酸抗凝(regional citrate anticoagulation,RCA)在间歇性血液透析(in-termittent hemodialysis,IHD)中使用逐步增多,对于存在出血高危风险及活动性出血的患者有其独特优势,本文回顾分析近年来国内外RCA在IHD中的应用,为其推广提供参考.

近年来，局部枸橼酸抗凝（regional citrate anticoagulation，RCA）在血液净化领域得到广泛应用，对于存在出血高危风险及活动性出血的患者有其独特优势。本文回顾分析近年来国内外RCA在临床血液净化领域中的应用，其抗凝安全、有效，与全身性抗凝相比RCA可以延长滤器寿命、减少出血并发症，适宜在临床广泛开展。

目的 分析连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)在蜂蜇伤致横纹肌溶解症合并急性肾损伤(acute kidney injury,AKI)中的应用.方法 前瞻性分析简阳市人民医院、四川大学华西医院及安岳县人民医院2013年1月-2016年12月收治的132例蜂蜇伤致横纹肌溶解症患者,其中62例合并AKI,均接受CRRT治疗,采用连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)的模式.CVVH机型为金宝Prismaflex,滤器选择M100-AN69,血流量180～ 200mL/min,置换液速度2 000～2 500mL/h[30～ 35 mL/(kg.h)],应用普通肝素或低分子肝素抗凝,碳酸氢盐置换液采用前稀释方法输入,治疗时间至少48 h;患者病情稳定后使用间断血液透析.对比患者治疗前后生化指标变化、住院时间、生存率及肾功能恢复情况,使用SPSS 19.0软件进行统计学分析.结果 51例患者符合入选标准,其中4例(7.8％)在住院期间死亡,其余47例完成治疗及随访.经治疗3、7、14d后患者肌酸激酶、肌红蛋白、乳酸脱氢酶均明显下降,并逐渐恢复至正常水平.45例(95.7％)患者肾脏功能在3个月内恢复,2例患者发展为慢性肾脏病.患者血红蛋白于(30.5±11.3)d后恢复至正常水平.结论 蜂蜇伤致横纹肌溶解合并AKI是蜂蜇伤的严重并发症,早期积极的CRRT干预能获得满意疗效.

ObjectiveTo explore the clinical significance of serum brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) in elderly peritoneal dialysis patients.Method60 elderly patients who underwent peritoneal dialysis in Jianyang People's Hospital from April 2009 to April 2012 were selected as observation group and 30 healthy elderly people were selected as control goup. The levels of serum BNP and NT-proBNP were determined by enzyme-linked immunosorbent assay (ELISA). The relationship of BNP and NT-proBNP levels with the prognosis of observation group patients were detected. All the patients were followed up to April 2015.ResultThe average follow-up time of 60 patients was (41.5±7.8) months, 12 cases (20%) died during the follow-up period. The NT-proBNP and BNP levels in observation group were significantly higher than control group (P<0.05). Compared to patients with lower BNP and NT-proBNP levels, the age, dialysis age, systolic blood pressure, hyperlipidemia, incidence of cardiovascular disease and mortality were significantly higer than patients with high BNP and NT-proBNP levels (P<0.05). NT-proBNP level was an independent risk factor for predicting the death of peritoneal dialysis patients (HR=2.35,P<0.05). ConclusionThe levels of NT-proBNP and BNP are significantly higher in elderly peritoneal dialysis patients than in healthy people, and high NT-proBNP level is an independent risk factor for mortality.

Objective To observe the clinical efficacy of double filtration plasmapheresis in treatment of patients with lupus nephritis com-plicated by thrombotic microangiopathy. Methods 60 patients with LN - TMA were randomly divided into 2 groups,patients in control group( n=30)were treated by hormone combined immunosuppressive therapy,patients in observation group(n=30)were treated by joint DFPP on the basis of the treatment in control group,patients in these two groups were treated with renal replacement therapy( RRT)for 3 months and serum level of creatinine( Scr)fell by 50%,the serum level of autoantibodies and rate of 2 years renal survival were observed. Results The proportion (72. 2%)of patients in observation group got rid of renal replacement therapy(RRT)is higher than that of patients in control group(43. 8%), and the difference was significant( P ﹤0. 05). The serum level of creatinine in proportion(73. 3%)of patients in observation group fell by 50% was higher than that of patients in control group(33. 3%),and the difference was significant( P ﹤0. 05). The turn rate(56. 7%)of an-tiphospholipid(APL)antibodies and the increase rate of activity(46.7%)of von Willebrandˊs factor lyase(ADAMTS13)in observation group was significantly higher than those of control group(13. 3%,13. 3%),with significant difference( P ﹤0. 05),but the difference in turn rate (73. 3%)of anti-dsDNA antibodies in observation group and control group(63. 3%)was not significant( P ﹥0. 05). The 2 years human re-nal survival rate(93. 3%)in patients of observation group in comparison with that of patients of control group(73. 3%),the difference was sig-nificant( P ﹤0. 05). Conclusion On the basis of hormone combined with immunosuppressant therapy plus DFPP treatment,it can reduce the ratio of renal replacement in patients with lupus nephritis associated thrombotic microangiopathy,and raise the ratio of Scr fell by 50% and the o-vercast rate of APL antibodies,and turn rate of anti dsDNA antibodies,and increase the ratio of ADAMTS13 activity,and raise the long-term survival rate of kidney.

Objective To investigate the curative effect of different mode of blood puriifcation on acute kidney injury following multiple bee stings. Method 287 patients with bee stings injury from June 2009 to December 2014, were retrospective analysised, in which 135 cases (47%) suffered acute kidney injury (AKI), 117 cases with AKI were administered blood puriifcation. The 117 patients were divided into three groups: ①CVVH+HP/IHD group:intervention of HA330 hemoperfusion after hospitalized, 2 hours later, continuous veno-venous hemoifltration (CVVH) during 24 ~ 72 hours was performed, and then intermitent hemodialysis (IHD) was administered when conditions of patients were stable; ②IHD+HP group:IHD was performed 3~5 times per week, intervention of HA330 hemoperfusion was performed in the ifrst three hemodialysis; ③IHD group:IHD was performed 3~5 times per week. Compared the prognosis, biochemical indicator and length of stay. Result ①CVVH+HP/IHD group:43 cases (91.5%) improved and discharged, while 4 cases (8.5%) died;②IHD+HP group:41 cases (78.8%) improved but 7 cases (13.5%) died, and 4 cases (7.7%) were automatic discharged; ③IHD group:10 cases (55.5%) improved but 5 cases (27.8%) died, and 3 cases (16.7%) were automatic discharged. There were no signiifcant differences of survival and clinical improvement rates between CVVH+HP/IHD and IHD+HP groups, but there was statistical signiifcance when comparing CVVH+HP/IHD and IHD+HP with IHD groups. The rate of improvement in CVVH+HP/IHD was faster than IHD+HP group, and the length of stay was shorter. Conclusion CVVH + HP/IHD and IHD + HP are useful for curing the patient with acute kidney injury following multiple bee stings, but CVVH+HP/IHD controlled the disease more rapidly, which is the preferred way. However, where the continuous blood puriifcation machine is shortage, the primary health care units can get achieve effective treatment through IHD+HP.

Objective To study the successional vein dialysis on acute renal injury with multiple organ dysfunction syndrome.Methods The APACHEII score and renal function of 45 patients with renal injury with multiple organ dysfunction syndrome treated with successional vein dialysis were analyzed.Results The fatality rate was 24.4%,which was related to the age,APACHEII score,urea nitrogen and serum creatinine.Conclusion Renal injury with multiple organ dysfunction syndrome has high fatality rate,whose key of treatment is complex therapy with early successional vein dialysis.

<正>地震导致的挤压综合征,常并发多脏器功能障碍综合征(MODS),尤其是急性肾功能衰竭(ARF),是导致患者死亡的常见原因,连续性血液透析滤过(CVVHDF)能有效地清除尿毒毒素、炎症介质和代谢废物,已广泛应用于急性肾衰竭(ARF)及危重患者(如MODS、脓毒症等)的抢救。现将CVVHDF成功救治重症儿童地震后挤压综合征致ARF并MODS 1例报告如下。

Objective To summarize the clinical characteristics of elder patients with acute kidney injury(AKI)and explore the effect and prognosis of continuous venovenous hemodialysis filtration(CVVHDF)treatments for them.Methods Twenty elder patients with AKI were enrolled in this study,five patients in AKI stage 2 and fifteen patients in AKI stage 3,respectively.All of them were treated with CVVHDF and synthetic therapies,and we compared the different therapeutic effects of CVVHDF between the two groups.Results The main clinical manifestations of elder patients with AKI were proteinuria,oliguria and edema.95% patients were complicated with serious cardiac events including hypertension,shock,hypotension and arrhythmia.More than 50% patients had nausea,vomiting,myocardial ischemia and etc.Treatment with CVVHDF resulted in an excellent response,without any obvious toxic and side effects.Patients with AKI in stage 2 had a high cure rate.Results shown that the chance of recovery renal function in patients with AKI in stage 2 were superior to patients in stage 3(P0.05).Furthermore,compared with patients in AKI stage 3,patients in AKI stage 2 had a shorter-time of oliguria period(P0.05).Conclusion CVVHDF treatment strategy for elder patients with AKI can get a high survive rate.Early treatment should be performed in patients with severe conditions,existing high risk factors,aged,especially complicated with multiple organ dysfunction syndromes.At the same time,we should be emphasized the synthetic therapies:treatment of basic disease,nutritional support,anti-infection and so on.

<正>目的回顾性分析老年人ARF时的肾脏替代疗法及预后。方法17例急性肾功能衰竭(ARF)患者均采用Prisma连续性肾替代治疗机治疗,选择前稀释法CVVHDF模式,血流量50～180mL/min,透析液量1000～1500