Abstract Objective To investigate the risk factors of left ventricular diastolic dysfunction in maintenance hemodialysis (MHD) patients. Method We retrospectively collected data from 363 hemodialysis patients who were on dialysis for at least 3 months at January 1, 2020. According to the echocardiogram results, these patients were divided into left ventricular diastolic dysfunction (LVDD) group and non-LVDD group. The differences in basic data, cardiac structure and functiona between the two groups were analyzed. Logistic regression analysis was used to analyze the risk factors of cardiac diastolic dysfunction in MHD patients. Results Compared with the non-LVDD group, patients in the LVDD group were older, with an increased proportion of coronary heart disease, more prone to chest tightness, shortness of breath. Simultaneously, they had a significantly increased (p < 0.05) proportion of cardiac structural abnormalities such as left ventricular hypertrophy, left heart enlargement and systolic dysfunction. Multivariate logistic regression analysis showed that the risk of LVDD was significantly increased in elderly MHD patients older than 60 years (OR = 3.86, 95%CI 1.429–10.429), and left ventricular hypertrophy was also significantly associated with LVDD (OR = 2.227, 95% CI 1.383–3.586). Conclusion According to research, both age and left ventricular hypertrophy are risk factors for LVDD in MHD patients. It is recommended that early intervention for LVDD should be implemented to improve the quality of dialysis and reduce the incidence of cardiovascular events in MHD patients.

结节病是一种病因未明的多系统肉芽肿性疾病，以非干酪样坏死性上皮细胞肉芽肿为特征，可累及全身多个系统和器官 [1,2,3,4,5,6,7,8,9]。结节病的发病机制目前尚不明确，现有的资料认为具有遗传易感性的个体在环境因素影响下引起免疫功能失调，从而发生肉芽肿性反应 [1,8,10,11,12,13]。而根据所累及的器官不同，其临床表现亦不相同，以肺部和胸腔内淋巴结受累最为常见，通常表现为双侧肺门淋巴结肿大，肾损害较为少见，且常因缺少典型的临床表现而被忽略 [9,14]。本文作者报告一例病理表现为膜性肾病的肺、肾同时受累的结节病临床病例，并结合相关文献复习，对结节病肾脏损害的临床表现特点、病理特点及治疗转归进行总结，供临床参考。

Objective:To investigate the characteristics of cardiac structure and function changes in maintenance hemodialysis (MHD) patients.Methods:The information of 363 MHD patients with dialysis age ≥3 months who were registered in Huadu District People′s Hospital of Guangzhou City before January 2020 was collected, and the echocardiographic screening was performed to analyze the changes in cardiac structure and function.Results:The most common abnormal changes of heart structure and function in MHD patients were valve regentation (69.7%), left ventricular hypertrophy (LVH) (51.8%), left ventricular diastolic dysfunction (29.8%), valve calcification (11.6%), and left ventricular systolic dysfunction (10.2%). With the increase of age, the left ventricular ejection fraction of MHD patients decreased, and the proportion of left ventricular diastolic dysfunction, left atrial enlargement and pulmonary hypertension increased (all P<0.05). Among 363 MHD patients, 188(51.8%) had LVH. It was found that LVH patients had higher average single ultrafiltration volume, higher brain natriuretic peptide (BNP) level, more type 2 diabetes, lower left ventricular ejection fraction (all P<0.05), and were more prone to chest tightness, chest pain, post activity shortness of breath, heart failure and other symptoms compared with the non-LVH patients (all P<0.05). Conclusions:Most MHD patients have different degrees of cardiac structural changes. Early intervention, reduction of single ultrafiltration volume and control of blood glucose are beneficial to improve the dialysis quality of MHD patients and reduce the occurrence of cardiovascular events.

Objective:To report a case of acute kidney injury caused by rhabdomyolysis and summarize its etiology, pathogenesis, and treatment strategy.Methods:The clinical data of a case of rhabdomyolysis complicated by acute kidney injury admitted to Affiliated Huadu Hospital of Southern Medical University on August 30, 2020, were collected, including clinical manifestation, auxiliary examination, and disease outcome. Referring to the previous literature reports of rhabdomyolysis complicated by acute kidney injury, this paper discusses its etiology, monitors and analyzes some indicators such as serum creatinine, blood urea nitrogen, creatine kinase, myoglobin, and 24-hour urine volume during the treatment, and summarizes the clinical diagnosis and treatment ideas of the disease.Results:This case developed an intestinal infection after an unclean diet, which induced rhabdomyolysis and acute kidney injury. Renal pathology after renal biopsy showed that renal biopsy result was consistent with an acute tubulointerstitial injury caused by myoglobin tubular nephropathy. The biochemical indexes such as creatine kinase and myoglobin decreased rapidly after ordinary hemodialysis, but the levels of serum creatinine and blood urea nitrogen did not decrease markedly, and there was continuous oliguria. After switching to hemodialysis filtration and continuous intensive dialysis treatment, the levels of serum creatinine and blood urea nitrogen decreased rapidly, the amount of urine increased gradually, and finally, the renal function recovered.Conclusion:For acute kidney injury caused by rhabdomyolysis, early sufficient blood purification can accelerate the clearance of myoglobin, promote the recovery of the injured kidney, and improve the prognosis of the disease.

Objective:To explore the molecular mechanism of dynamin-related protein 1 (Drp1) -mediated mitochondrial energy metabolism involved in renal ischemia-reperfusion injury.Methods:The experiment was conducted on October 14, 2020. Male Wistar rats aged 8-10 weeks were randomly divided into a normal control group, a sham operation group, a model group, and a Drp1 inhibitor group, with 5 rats in each group and weight of 0.25-0.30 kg for each rat. The rat model of acute renal injury induced by renal ischemia-reperfusion was established. The rats in the Drp1 inhibitor group were intraperitoneally injected with mitochondrial division inhibitor 1 (Mdivi-1) of 20 mg/kg body weight, and the other groups were injected with normal saline of the same volume. Serum and kidney tissue were retained 24 hours after the model was made. The serum creatinine level, pathological change of renal tissue, apoptosis of renal tissue cells, mitochondrial ultrastructure, and mitochondrial ATPase activity were compared between the groups. The HK-2 cell hypoxia and reoxygenation models were established in vitro. The changes of mitochondrial membrane potential were detected by JC-1 staining after treatment. Analysis of variance was used.Results:Compared with those in the sham operation group, the serum creatinine in the model group was significantly increased [(41.12±1.895) μmol/L vs. (48.68±2.065) μmol/L], the renal tubule injury score was increased [(1.29±0.426) points vs. (6.50±0.577) points], the number of apoptosis in renal tissue was increased [(2.40±0.547) vs. (10.20±1.095)], the mitochondrial damage was more obvious under electron microscope, and the activity of mitochondrial ATPase was decreased [(6.38±0.321) U/mg prot vs. (4.18±0.198) U/mg prot]; in the HK-2 cell hypoxia and reoxygenation models, the proportion of cells with decreased mitochondrial membrane potential increased in the model group compared with that in the sham operation group [(9.81±0.251)% vs. (4.24±0.598)%], with statistically significant differences (all P<0.05). Compared with those in the model group, the serum creatinine in the Drp1 inhibitor group was decreased [(48.68±2.065) μmol/L vs. (43.28±0.895) μmol/L], the renal tubule injury score was decreased [(6.50±0.577) points vs. (4.50±0.578) points], the number of apoptosis of renal tissue cells was decreased [(10.20±1.095) vs. (6.60±1.140)], the mitochondrial structure damage was reduced, and the activity of mitochondrial ATPase was increased [(4.18±0.198) U/mg prot vs. (5.16±0.628) U/mg prot]; in the HK-2 cell hypoxia and reoxygenation models, the proportion of cells with decreased mitochondrial membrane potential decreased in the Drp1 inhibitor group compared with that in model group [(5.90±0.360)% vs. (9.81±0.251)%], with statistically significant differences (all P<0.05). Conclusion:Selective inhibition of Drp1 can effectively improve the energy metabolism disorder, reduce the cell apoptosis, and alleviate the renal ischemia-reperfusion injury by inhibiting the mitochondrial division.

This paper mainly analyzed the clinical process of a patient with acute renal failure after surgery for aortic dissection treated in Guangzhou First People's Hospital in October 2021, aiming at strengthening the medical staff's knowledge of patients with acute renal failure after surgery for aortic dissection, increasing related nursing experiences, and achieving better nursing effect. Nursing points included closely observing the changes of the disease, carrying out hemodialysis treatment, postoperative nursing, dialysis nursing, medication nursing, and prevention of complications. Through the implementation of the above nursing measures, the patient's residual kidney function and quality of life had been improved, and the patient had safely survived the perioperative period.

Objective:To investigate the prevalence of chronic constipation in maintenance hemodialysis (MHD) patients and analyze the risk factors of chronic constipation.Methods:Using the cross-sectional survey method, patients who received MHD in Huadu District People′s Hospital of Guangzhou from September 1, 2021 to September 30, 2021 were enrolled as the research objects. The patient′s demographic, general data and laboratory results were collected. The anxiety level and quality of life were assessed by questionnaires. The patients were divided into constipation group and non-constipation group according to whether they had chronic constipation. The Rome Ⅳ criteria was used to diagnose chronic constipation, and the differences of clinical data between the constipation group and the non-constipation group were compared. The risk factors of chronic constipation in MHD patients were analyzed by logistic regression analysis method.Results:A total of 321 MHD patients were enrolled in this study, with 168 males, 153 females and age of (59.5±13.4) years old (ranged from 29 to 87 years old). There were 160 patients (49.8%) with chronic constipation. The proportions of males, long dialysis age, taking sevelamer and lanthanum carbonate, diabetic nephropathy, and diabetes in the constipation group were higher than those in the non-constipation group, and the differences between the two groups were statistically significant (all P<0.05). The serum calcium, serum phosphorus, calcium-phosphorus product, anxiety scores, average weekly ultrafiltration volume/dry weight in the constipation group were significantly higher than those in the non-constipation group (all P<0.05), and the serum albumin, serum magnesium, urea clearance index (Kt/V) and geriatric nutritional risk index were significantly lower than those in the non-constipation group (all P<0.05). The results of logistic regression analysis showed that moderate to severe anxiety (moderate, OR=3.233, 95% CI 1.339-7.805, P=0.009; severe, OR=5.103, 95% CI 1.906-13.663, P=0.001), existed risk of nutrition (low risk, OR=3.705, 95% CI 1.440-9.533, P=0.007; moderate risk, OR=5.638, 95% CI 2.557-12.430, P<0.001; severe risk, OR=15.097, 95% CI 4.112-55.436, P<0.001), >60 years old (≤40 years old as a reference, OR=4.050, 95% CI 1.366-12.006, P=0.012), diabetes history ( OR=2.224, 95% CI 1.253-3.946, P=0.006), taking sevelamer ( OR=2.290, 95% CI 1.207-4.346, P=0.011), and calcium-phosphorus product ( OR=1.704, 95% CI 1.329-2.186, P<0.001), intact parathyroid hormone ( OR=1.013, 95% CI 1.003-1.022, P=0.007), blood urea nitrogen ( OR=1.092, 95% CI 1.002-1.189, P=0.045) and serum magnesium ( OR=0.042, 95% CI 0.006-0.294, P=0.001) were the independent influencing factors for chronic constipation in MHD patients. Conclusions:The prevalence of chronic constipation in MHD patients is 49.8%. Adequate dialysis, improving calcium and phosphorus metabolism, improving nutritional status, relieving anxiety, and increasing serum magnesium level may help to reduce the risk of chronic constipation in MHD patients.

Objective:To investigate the perioperative nursing effect of percutaneous transluminal angioplasty (PTA) for hemodialysis patients with arteriovenous fistula (AVF) stenosis.Methods:Sixty-four maintenance hemodialysis patients taking PTA for AVF stenosis in Huadu District People's Hospital from March 2019 to October 2021 were selected. The 32 patients treated from March 2019 to March 2020 were set as a control group, and the 32 ones from April 2020 to April 2021 as an experimental group. There were 21 males and 11 females in the control group, and they were (59.72±13.22) years old. There were 23 males and 9 females in the experimental group, and they were (58.41±14.16) years old. The control group were routinely cared; in addition, the experimental group took comprehensive perioperative nursing. Both groups were followed up for 6 months. The internal fistula vessel diameters, internal fistula natural blood flow volumes, puncture needle blood flow volumes, and clinical detection results before and after PTA were observed in both groups. The incidences of complications and the recurrence rates of AVF stenosis in both groups were calculated. The independent-sample t test, paired t test, and χ2 test were applied. Results:After PTA, the vascular diameter, intravascular natural blood flow volume, puncture needle blood flow volume, hemoglobin (Hb), blood albumin (ALB), urea clearance rate (URR), and blood phosphorus (P) were better than those before PTA, and were significantly better in the experimental group than in the control group, with statistical differences (all P<0.05). The incidence of complications and recurrence rate of AVF stenosis in the experimental group were significantly lower than those in the control group [12.5% (4/32) vs. 37.5% (12/32) and 0 vs. 18.75% (6/32) ], with statistical differences ( χ2=5.333, P=0.021 and 0.024). Conclusion:Perioperative nursing intervention for hemodialysis patients with AVF stenosis treated by PTA has significant clinical effect and is worth being generalized.

Background:This study sought to investigate the protective effects of Astragaloside IV (AS-IV) on ischemia-reperfusion (I/R) renal injury based on the keap1-Nrf2/ARE signaling pathway.Methods:A total of 36 male Sprague-Dawley rats (aged: 8 weeks; weighing: 200-220 g) were randomly divided into the following 6 groups (n=6 per group): (I) the control group; (II) the sham operation group; (III) the kidney I/R injury group (the I/R group); (IV) the kidney I/R injury group treated with 2 mg/kg of AS-IV (the low-dose group); (V) the kidney I/R injury group treated with 5 mg/kg of AS-IV (the mid-dose group); and (VI) the kidney I/R injury group treated with 10 mg/kg of AS-IV (the high-dose group). Serum creatinine (CRE), serum urea, malondialdehyde (MDA), and superoxide dismutase (SOD) were examined using enzyme-linked immunoassay kits. Cell apoptosis and the pathological damage to the renal tissue were determined by terminal deoxynucleotidyl transferase dUTP nick end labeling, hematoxylin and eosin, and periodic acid-Schiff (PAS) staining. The immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR), and western blot methods were used to determine the expression of Nrf2, HO-1, Bcl-2 and Bax in the kidney tissue.Results:In the I/R rat model, the serum CRE level was increased. In the acute kidney injury (AKI) and chronic kidney disease (CKD) models, AS-IV treatment significantly decreased serum CRE levels in a dose-dependent manner. AS-IV treatment also reduced the injury of renal tubular epithelial cells, increased the expression levels of Nrf2 and HO-1, decreased the rate of apoptosis, downregulated the level of MDA, and elevated the activity of SOD. In the CKD rat model, the AS-IV treatment groups had reduced renal tubular epithelial cell injury, increased expression levels of Nrf2 and HO-1, decreased MDA levels, and increased SOD activity compared to the I/R group.Conclusions:AS-IV induced the expression of Nrf2, enhanced the activity of antioxidant enzymes, reduced apoptosis, protected against renal I/R injury, and prevented AKI from transforming into CKD. These findings suggest that AS-IV is a promising drug for treating kidney injury.

Objective:To investigate the correlation between parathyroid hormone (PTH) and high-sensitivity troponin I (hs-cTnI) in patients undergoing maintenance hemodialysis.Methods:A retrospective study was conducted on 290 patients with chronic kidney disease (CKD) at stage 5 undergoing maintenance hemodialysis in Huadu Hospital of Southern Medical University from January to June 2020. The patients were divided into 3 groups according to the PTH level, and the correlation between PTH level and hs-cTnI positive rate was analyzed. The data were statistically analyzed by independent sample t test, univariate analysis of variance, rank-sum test, χ2 test, and logistic regression equation. Results:A total of 290 eligible maintenance hemodialysis patients were included, aged (58.94±14.16) years, with male patients of 57.59% (167/290), a median dialysis age of 31 months, PTH of (52.23±46.97) pmol/L, and a positive rate of hs-cTnI of 5.86% (17/290). Univariate analysis showed that the proportion of males and the levels of B-type natriuretic peptide, urea nitrogen, myoglobin, serum calcium, and PTH before dialysis in the hs-cTnI positive (>0.1 μg/L) patients were significantly higher than those in the hs-cTnI negative patients, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that every 10.00 pmol/L increase of PTH increased the hs-cTnI positive effect value in hemodialysis patients by 14% ( OR=1.14, 95% CI: 1.01-1.27, P=0.029). Conclusion:The PTH level is associated with myocardial injury in maintenance hemodialysis patients.

Objective:To analyze the incidence of malignant tumors and its risk factors in patients on maintenance hemodialysis.Methods:Clinical data of 627 hemodialysis patients in Huadu District People′s Hospital of Guangzhou who met the inclusion criteria and exclusion criteria from January 2015 to December 2020 were retrospectively collected. Clinical characteristic of patients with malignant tumors was summarized. Multivariate logistics regression analysis was performed to explore the related factors of malignant tumors.Results:Among the 627 patients, 19(3.03%) developed malignant tumors. There were 14 males and 5 females with a mean age of (65.7±13.7)years. Their mean dialysis duration was (45.16±38.18)months. Gastrointestinal tumor was the most common tumor type (9/19). Univariate analysis showed that the age of the patients combined with malignant tumors was significantly higher, and the serum prealbumin was significantly lower than those patients without malignant tumors (all P<0.05). Logistic regression analysis showed that age was the independent risk factor of developing cancers after adjusting dialysis age, hemoglobin, albumin and parathyroid hormone ( P<0.05). Conclusions:The incidence of malignant tumor is significantly higher in maintenance hemodialysis patients than that in the general population. Age is the risk independent risk factor. Therefore, we should strengthen the monitoring of elderly hemodialysis patients, discover the disease in time, and take measures to improve the prognosis.

Objective:To observe the effect of fine nursing intervention on weight control of maintenance hemodialysis patients during the interdialytic period.Methods:A total of 92 patients receiving maintenance hemodialysis in People's Hospital of Huadu District from October 2019 to April 2021 were selected as the research objects, and they were divided into two groups by the random draw method. There were 27 males and 19 females in the research group, aged (59.72±12.24) years; there were 24 males and 22 females in the control group, aged (58.02±12.48) years. The control group received routine nursing methods, and the research group received fine nursing intervention on the basis of routine nursing for 6 months. The body weight control, complication rate, and nursing satisfaction were compared between the two groups. Independent sample t test and χ2 test were used for statistical analysis. Results:Before nursing intervention, there was no statistically significant difference in the body weight control between the two groups ( P>0.05). After nursing intervention, the body weight control of the control group was less than 3% in 5 cases and >5% in 10 cases, the body weight control of the research group was less than 3% in 19 cases and >5% in 1 case, and those in the research group were significantly better than those in the control group, with statistically significant differences (both P<0.05). The incidences of complications during dialysis treatment in the research group were significantly lower than those in the control group (all P<0.05). The nursing satisfaction in the research group was significantly higher than that in the control group [97.82% (45/46) vs. 76.09% (34/46)], with a statistically significant difference between the two groups ( χ2=6.907, P=0.009). Conclusion:Fine nursing intervention can effectively control the weight gain of maintenance hemodialysis patients during the interdialytic period, improve their quality of dialysis, and reduce the incidence of hemodialysis related complications, worthy of promotion.

Objective:To analyze the correlation between peritoneal fluid micro Albumin/creatinine(mALB/Cr) and peritoneal dialysis (PD) dysfunction, and to explore new evaluation indicators for PD dysfunction.Methods:The baseline value of dialysate mALB/Cr in peritoneal dialysis patients was detected and compared between patients in poor dialysis status and fully dialyzed patients to analyze the effect of different levels of dialysate mALB / Cr baseline value on the risk of poor PD dialysis.Results:An interaction between the baseline value of mALB/Cr in peritoneal dialysis fluid and the levels of estimated glomerular filtration rate(eGFR) in the risk on PD dysfunction was found in 89 PD patients cross-sectionally study. In the high eGFR group, higher baseline mALB/Cr was independently associated with the risk of poor PD results.Conclusion:The baseline value of mALB/Cr in peritoneal dialysis fluid was significantly correlated with inadequate dialysis and/or hypoproteinemia in PD, which could be a predictive indicator of PD dysfunction.

目的:了解覆膜支架腔内隔绝术对假性动脉瘤并动静脉瘘的治疗效果。方法:报道1例覆膜支架腔内隔绝成功治疗深静脉穿刺并发假性动脉瘤伴动静脉瘘患者的临床资料，并针对病因和治疗方法进行文献复习。结果:深静脉穿刺致假性动脉瘤伴动静脉瘘少见，保守治疗适合于瘤体小、瘘口较小者；外科血管修补术和带膜支架介入适用于压迫法无效或瘘口较大者。本例采取覆膜支架腔内隔绝治疗成功。结论:覆膜支架腔内隔绝术治疗假性动脉瘤并动静脉瘘效果明显。

Renal fibrosis commonly leads to glomerulosclerosis and renal interstitial fibrosis and the main pathological basis involves tubular atrophy and the abnormal increase and excessive deposition of extracellular matrix (ECM). Renal fibrosis can progress to chronic kidney disease. Stem cells have multilineage differentiation potential under appropriate conditions and are easy to obtain. At present, there have been some studies showing that stem cells can alleviate the accumulation of ECM and renal fibrosis. However, the sources of stem cells and the types of renal fibrosis or renal fibrosis models used in these studies have differed. In this review, we summarize the pathogenesis (including signaling pathways) of renal fibrosis, and the effect of stem cell therapy on renal fibrosis as described in preclinical and clinical studies. We found that stem cells from various sources have certain effects on improving renal function and alleviating renal fibrosis. However, additional clinical studies should be conducted to confirm this conclusion in the future.

目的:探讨协同护理干预在预防血液透析患者院外跌倒中的应用效果。方法:选取2019年4月至2019年10月在我院血液净化中心接受维持性血液透析治疗的98例患者作为研究对象，采用便利抽样法将其分为对照组和观察组，对照组46例，观察组52例。对照组给予常规血液透析宣教，观察组给予协同护理干预，干预半年。比较对照组及观察组干预期间院外跌倒发生率。结果:干预后观察组院外跌倒发生率低于对照组(7.69% vs 26.08%)，步态平衡评分(27.54±1.63 vs 16.41±7.19)和跌倒风险评分(133.48±8.92 vs 74.72±27.54)高于对照组，差异均具有统计学意义( P<0.05)。 结论:协同护理干预使维持性血液透析患者对跌倒有更清楚、更全面的认识，可有效预防院外跌倒的发生。

In the present study, we examined the molecular mechanism of astragaloside IV (AS-IV) in high glucose (HG)-induced epithelial-to-mesenchymal transition (EMT) in renal proximal tubular epithelial cells (PTCs). NRK-52E cell viability and apoptosis were determined by the cell counting kit-8 (CCK-8) assay and flow cytometric analysis, respectively. Expressions of E-cadherin, N-cadherin, vimentin, and occludin were measured by Western blot, and those of E-cadherin and N-cadherin were additionally measured by immunofluorescence analysis. Transforming growth factor-β1 (TGF-β1) and α-smooth muscle actin (α-SMA) expressions were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. The expressions of Smad2, Smad3, phosphorylated-Smad2 (p-Smad2), and p-Smad3 were measured using Western blot. We found that AS-IV could recover NRK-52E cell viability and inhibit HG-induced cell apoptosis. TGF-β1, α-SMA, Smad2, Smad3, p-Smad2, and p-Smad3 expressions were decreased in the AS-IV-treated groups compared with the HG group. Moreover, the expressions of E-cadherin and occludin were remarkably up-regulated and those of N-cadherin and vimentin were down-regulated in the AS-IV-treated groups compared with the HG group. Interestingly, the TGF-β1 activator SRI-011381 hydrochloride had an antagonistic effect to AS-IV on HG-induced EMT behavior. In conclusion, AS-IV attenuates HG-induced EMT by inhibiting the TGF-β/Smad pathway in renal PTCs.

目的:探究梓醇对急性肾损伤大鼠TLR4/NF-κB通路及肾小球内皮损伤的影响.方法:采用腹腔注射脂多糖的方法建立急性肾损伤大鼠模型,随机分为模型组、梓醇低(25 mg/kg)、中(50 mg/kg)、高(100 mg/kg)剂量组、地塞米松(5 mg/kg)组,每组12只,另取12只作为对照组,分组处理后,测定大鼠肾功能指标血清肌酐(Scr)、血尿素氮(BUN)水平;苏木精-伊红(HE)染色检测大鼠肾组织病理形态;以试剂盒检测大鼠血清TNF-α,IL-6水平及肾组织内皮细胞功能指标NO、内皮素1(ET-1)水平;蛋白免疫印迹法检测肾组织TLR4/NF-κB通路相关蛋白表达.结果:与对照组相比,模型组大鼠肾组织明显水肿,可见炎症细胞浸润,肾小球严重皱缩,肾小管管腔变窄闭塞,细胞肿胀、空泡变性等病理损伤,血清Scr、BUN、TNF-α、IL-6水平、肾组织ET-1水平及TLR4、MyD88、核内NF-κB p65蛋白表达明显升高(P<0.05),肾组织NO水平明显降低(P<0.05);与模型组相比,梓醇各剂量组及地塞米松组大鼠肾组织病理损伤减轻,血清Scr、BUN、TNF-α、IL-6水平、肾组织ET-1水平及TLR4、MyD88、核内NF-κB p65蛋白表达降低,肾组织NO水平升高,且梓醇各组之间呈剂量依赖性(P<0.05);梓醇高剂量组与地塞米松组相比,各指标差异无统计学意义(P>0.05).结论:梓醇可能通过抑制TLR4/NF-κB通路,抑制炎症反应,进而减轻肾组织及肾小球内皮损伤,改善急性肾损伤大鼠肾功能.

Objective To investigate the death related information and causes of death of the hemodialysis patients in our hospital, improve the prognosis and survival rate of hemodialysis patients, and provide a basis for the clinical diagnosis and treatment of hemodialysis patients in the future. Methods All the informations of the hemodialysis death patients in our dialysis center from January 2012 to December 2017 were collected, and the numbers of death, death age, dialysis age, primary kidney disease type and cause of death were analyzed. Results A total of 113 death patients were in-cluded. The median dialysis age was 11. 7 months. The causes of death were cardiovascular and cere-brovascular diseases (46 cases), infection(13 cases),advanced carcinoma (4 cases), and other cau-ses (7 cases). Among the death patients of different dialysis age, those with shorter dialysis age had more serious anemia and lower albumin. Conclusions The life time of the hemodialysis death pa-tients in our hospital is short, among the dead patients,the proportion of hemodialysis patients less than 1 year is the highest. The main causes of death are cardiovascular and cerebrovascular diseases and in-fection. The treatment of anemia timely and improvement of nutritional status may help improve early survival rate.

本研究回顾性收集2012年1月1日至2017年12月1日在广州市花都区人民医院透析中心登记的436例血液透析（HD）患者的信息，男265例（60.8%），共113例（25.9%）死亡，根据患者透析龄分为短期（小于1年）、中期（1~3年）、长期（大于3年）组，Cox回归分析提示，在短期透析患者中急性左心衰（HR=2.5，95%CI 1.3~4.7，P=0.005）和使用临时导管进行透析（HR=53.5，95%CI 7.2~399.5，P<0.001）是死亡的独立危险因素；在中期透析患者中，年龄大于80岁（HR=34.8，95%CI 5.8~209.0，P<0.001）和肿瘤（HR=31.7，95%CI 4.4~226.7，P=0.001）是死亡的独立危险因素；而在长期透析患者中急性左心衰（HR=9.0，95%CI 3.1~26.2，P<0.001）和年龄60~79岁（HR=5.7，95%CI 1.8~18.3，P=0.004）是死亡的独立危险因素。本研究提示，不同透析龄患者的死亡危险因素不同，关注年长透析患者、防治心血管疾病、提前造瘘可能会改善血透患者的预后。