目的 探讨终末期肾病血液透析患者应用β-内酰胺类抗菌药物后癫发作的发病机制、临床表现、治疗方法及预后,以指导临床合理用药.方法 安徽医科大学第三附属医院2016年3月—2018年5月终末期肾病血液透析患者使用β-内酰胺类抗菌药物后出现癫发作11例,对其临床资料进行总结分析.结果 11例患者平均年龄(83.6±6.7)岁,发病前后无神经系统定位体征,无新发脑卒中,肾功能、血红蛋白、血糖、电解质等无明显变化(P>0.05),经停药、对症治疗后,6例患者在24～72 h内症状消失,1例患者15 d后症状消失,4例患者因为其他疾病死亡.结论 终末期肾病血液透析患者,尤其老年患者,使用β-内酰胺类抗菌药物后可能出现癫发作,一旦出现需及时停药,一般预后较好.

氯氮平中毒引起多种并发症已有较多报道,但同时致横纹肌溶解、急性肾损伤、深静脉血栓及麻痹性肠梗阻极罕见.现将我院收治1例报告如下.

Objective To investigate the serum level of TGF-β, Th1 cytokine IFN-y and Th2 cytokine IL-10 in patients with systemic lupus erythematosus (SLE) and to explore their role in the pathogenesis of SLE. Methods 54 patients with SEE were divided into ones with active SEE and ones with inactive SLE according to their SLEDAI score. ELISA was employed for the levels of TGF-β, IFN-γ and IL-10 in serum of 54 patients with SEE and 20 health volunteers. Results The level of serum TGF-β in patients with SEE was significantly lower than that normal controls (P＜0.01). The levels of serum IFN-γ and IL-10 were significantly increased compared with those in normal controls (P＜0.01). serum TGF-β level was positively correlated with Hb, PLT numbers and RBC numbers. IFN-γ was negtively correlated with complement C3 and C4 and positively correlated with anti-C1q, anti-nucleosome and immunoglobulin (IgG). IL-10 was positively correlated’ with anti-nucleosome and immunoglobulin (IgG). Conclusion Both Th1 and Th2 might participate in the pathogenesis of SLE. The combined detection of serum TGF-β、IFN-γ and IL-l0of patients with SEE may have some practical significance for the guidance of clinical treatment and the evaluation of the disease activity.

Objective To discuss the significance of high-flux hemodialysis combined ultra-pure dialysate in uremic renal anemia treatment.Methods First select 50 cases uremic patients in stable condition with renal anemia and the experience of more than six months'hemodialysis therapy.Then treat them with high-flux dialysis combined ultra-pure dialysate from 2008.12.1 to 2010.2.1.Give their blood test,blood biochemistry,renal function after dialysis,parathyroid hormone,etc.regular monthly before their hemodialysis.Finally evaluate the method according to long-term observing the large samples and the comparing previous and latter prospective cohort study,using non-parametric test and Bivariate Correlation analysis.Results At the end of experiement after using high-flux hemodialysis combined ultra-pure dialysate in uremic renal anemia treatment,we observe a significance increase in hemoglobin,hematocrit and plasma protein,respectively P<0.001,P<0.001 and P<0.05,comparing with little increase in EPO and KT/V.Conclusion High-flux hemodialysis combined ultra-pure dialysate can have the positive impact in uremic renal anemia treatment.Long-term therapy can improve renal anemia,increase plasma protein.High-fiux hemodialysis might have low effect with eliminating parathyroid hormone.

Objective To investigate the serum level of TGF-β,Th1 cytokine IFN-γ and Th2 cytokine IL-10 in patients with systemic lupus erythematosus(SLE) and to explore their role in the pathogenesis of SLE.Methods 54 patients with SLE were divided into ones with active SLE and ones with inactive SLE according to their SLEDAI score.ELISA was employed for the levels of TGF-β,IFN-γ and IL-10 in serum of 54 patients with SLE and 20 health volunteers.Results The level of serum TGF-β in patients with SLE was significantly lower than that normal controls(P<0.01).The levels of serum IFN-γ and IL-10 were significantly increased compared with those in normal controls(P<0.01).serum TGF-β level was positively correlated with Hb,PLT numbers and RBC numbers.IFN-γ was negtively correlated with complement C3 and C4 and positively correlated with anti-C1q,anti-nucleosome and immunoglobulin(IgG).IL-10 was positively correlated with anti-nucleosome and immunoglobulin(IgG).Conclusion Both Th1 and Th2 might participate in the pathogenesis of SLE.The combined detection of serum TGF-β、IFN-γ and IL-10of patients with SLE may have some practical significance for the guidance of clinical treatment and the evaluation of the disease activity.

Objective To evaluate the correlation between homocysteine(Hcy),hypersensitivity C-reactive protein(hsCRP),tumor necrosis factor-α(TNF-α)and atherosclerosis(AS)in the maintenance hemodialysis patients(MHD).Methods The level of Hcy,hs-CRP,TNF-α,serum creatinine,serum uric acid,glucose,albumin,triglyceride(TG)and total cholesterol(TC)were measured from 40 patients who had more than 1 years maintenance hemodialysis history.Intima-medial thickness of carotid arteries and the presence of atherosclerotic plaque were measured by ultrasonography.Results In MHD with AS group the level of serum Hcy,hsCRP and TNF-α was significantly higher than that without AS.The difference between the two groups was statistically significance(P<0.05).Meanwhile,there was no significant differences on serum TC,TG,blood pressure,pulse pressure,glucose,albumin and uric acid between two groups.Conclusion The increased level of serum Hcy,hsCRP and TNF-α could be used as independent dangerous factors for AS in MHD patients.

目的:探讨CT定位与B超定位方法对肾活检应用的精确性,以提高诊断性穿刺的成功率.方法:24例肾活检患者分成二组:18例CT定位(CT组),6例采用B超定位(B超组).结果:18例采用CT组均成功;6例B超组3例成功.CT、B超导引者均无一例肉眼血尿.结论:CT导引肾穿定位准确,操作安全,并发症少,成功率高于B超导引肾穿.