Objective To explore the application value of urinary calprotectin in adult acute kidney injury（AKI） by observing urinary calprotectin concentration in adult AKI patients and healthy people. Methods Fifty patients with AKI（AKI group） and 30 healthy people（healthy control group） were selected to determine the indexes of urinary calprotectin, serum creatinine, blood urea nitrogen, urinary kidney injury molecule-1（KIM-1）, blood albumin and hemoglobin. General clinical data and laboratory indexes were compared between the two groups. ROC curve was used to analyze the predictive value of urinary calprotectin for adult AKI. Results Urinary calprotectin, urinary KIM-1, serum creatinine and blood urea nitrogen were higher in AKI group than in healthy control group（t=10.113, 9.152, 11.119 and 9.049 respectively; P＜0.001）. Urinary calprotectin was positively correlated with serum creatinine（r=0.794, P＜0.001）, urea nitrogen（r=0.462, P=0.001） and urinary KIM-1（r=0.409, P=0.003）, and was negatively correlated with serum albumin（r=-0.620,P=0.042） and hemoglobin（r=-0.289, P＜0.001） in AKI group. When the diagnostic limit of urinary calprotectin for adult AKI was set at 55.17ng/ml, the area under the ROC curve was 0.747（95% CI: 0. 641～0.853）,with the sensitivity of 62.0% and specificity of 90.0%. Conclusion Urinary calprotectin concentration was significantly increased, and was positively correlated with serum creatinine, blood urea nitrogen and urinary KIM-1 levels in adult AKI patients. The sensitivity and specificity of urinary calprotectin for the diagnosis of adult AKI are higher. Therefore, urinary calprotectin has an important clinical value in the prediction and evaluation of therapeutic effect and recovery process in adult AKI patients.

目的 通过观察成人急性肾损伤(acute?kidney?injury,AKI)患者和健康人群中尿钙卫蛋白(calprotectin,CLP)浓度水平,来探究尿CLP对成人AKI的预后评估价值.方法 选择潍坊市人民医院自2020年12月至2021年11月确诊为AKI的患者50例(AKI组)和健康体检中心的健康人群30名(健康对照组),检测两组研究对象的尿CLP、血肌酐、血尿素氮、尿肾损伤因子1(kid-ney?injury?molecule-1,KIM-1)、血白蛋白和血红蛋白等指标,同时收集一般资料,比较两组间上述检测指标的差异性.然后对上述AKI组患者随访90?d后进行分组,行肾脏替代治疗(renal?replace-ment?therapy,RRT)治疗的患者归为透析组,未行RRT治疗的患者归为非透析组;90?d后死亡的患者归为死亡组,未死亡的患者归为存活组,进行相关指标的比较,绘制受试者工作特征曲线(receiv-er?operating?characteristic?curve,ROC)曲线和AKI患者的生存曲线(乘积极限法),评价尿CLP在成人AKI预后中的价值.结果 AKI组患者尿CLP[(65.02?±?33.75)?μg/L比(37.85?±?17.33)?μg/L]、尿KIM-1[(52.21?±?30.91)ng/L比(30.86?±?15.38)ng/L]、血肌酐[(538.62?±?233.91)?μmol/L比(62.03?±14.27)?μmol/L]、血尿素氮[(20.85?±?9.38)?mmol/L比(5.26?±?1.02)?mmol/L]浓度较健康对照组增高.透析组患者的血肌酐[(654.53?±?218.68)?μmol/L比(478.91?±?221.49)?μmol/L]、尿CLP[(92.26?±?29.26)μg/L比(50.99?±?26.82)?μg/L]和尿KIM-1[(65.69?±?40.76)ng/L比(45.27?±?22.04)ng/L]水平较非透析组高,尿CLP预测成人AKI患者进行RRT治疗的诊断界值在76.92?μg/L时,ROC曲线下面积为0.850,敏感度和特异度分别为76.5％和87.9％.死亡组和存活组的尿CLP、血红蛋白、尿KIM-1、血尿素氮、收缩压和舒张压水平比较差异均无统计学意义.尿CLP预测成人AKI患者90?d病死率的曲线下面积为0.564,敏感度和特异度分别为76.5％和87.9％.透析组和非透析组90?d病死率差异无统计学意义(P>0.05).结论 成人AKI患者尿CLP水平较健康对照人群显著升高,尿CLP在预测AKI患者RRT需求方面显示出了一定程度的准确性,但是在预测AKI患者90?d病死率方面表现不佳.

目的:探讨血清syndecan-1在成人急性肾损伤(acute kidney injury,AKI)诊断中的临床价值.方法:选取47例AKI患者(AKI组)和30例健康志愿者(对照组),检测两组血清syndecan-1、血清肌酐、血尿素氮、血清肾损伤因子-1(kidney injury molecule-1,KIM-1)、血白蛋白和血红蛋白等指标,同时收集人口统计学资料,比较两组指标的差异.采用ROC曲线分析血清syndecan-1对成人AKI的预测价值.结果:AKI组血清syndecan-1、KIM-1、血肌酐、尿素氮的水平明显高于对照组.AKI组血清syndecan-1和血清肌酐、血尿素氮、血KIM-1水平呈正相关,与血白蛋白、血红蛋白水平呈负相关.校正性别、年龄、血肌酐、尿素氮、收缩压、舒张压等因素后,血清syndecan-1仍与血清KIM-1和血肌酐水平呈正相关.血清syndecan-1诊断急性肾损伤的ROC曲线下面积为0.872,敏感度和特异度分别为78.7％和90％.结论:血清syn-decan-1浓度在成人AKI患者中明显升高,其诊断AKI的灵敏度和特异度较高,提示syndecan-1在诊断成人AKI中具有重要临床价值,可作为诊断早期AKI的敏感指标.

目的 探讨血清和透出液可溶性细胞间黏附分子-1(sICAM-1)、降钙素原(PCT)、糖类抗原125(CA125)与腹膜透析相关细菌性腹膜炎的关系,以及其预测腹膜透析相关细菌性腹膜炎的价值.方法 选取辽宁省人民医院肾病学科2017年1月—2019年6月疑似腹膜透析相关细菌性腹膜炎119例患者作为研究对象.根据临床诊断结果分为研究组(有细菌性腹膜炎者66例)与对照组(无细菌性腹膜炎者53例).比较两组血清和透出液sICAM-1、PCT、CA125水平,并探究各指标对腹膜透析相关细菌性腹膜炎的预测价值.研究组给予抗感染治疗,比较治疗后感染控制者与未控制者血清、透出液sICAM-1、PCT、CA125水平.结果 研究组血清和透出液sICAM-1、PCT、CA125水平高于对照组(P<0.05);血清sICAM-1水平[O(R)=1.123(95％CI:1.051,1.200)]、透出液sICAM-1水平[O(R)=2.006(95％CI:1.352,2.975)]、血清PCT水平[O(R)=2.134(95％CI:1.292,3.525)]、透出液PCT水平[O(R)=3.025(95％CI:1.628,5.621)]及透出液CA125水平[O(R)=1.227(95％CI:1.065,1.414)]均是腹膜透析细菌性腹膜炎的危险因素(P<0.05);血清sICAM-1、PCT联合预测腹膜透析细菌性腹膜炎的曲线下面积(AUC)为0.898(95％CI:0.829,0.946),大于血清sICAM-1单独预测的AUC 0.750(95％CI:0.662,0.824)和血清PCT单独预测的AUC 0.810(95％CI:0.728,0.876),联合预测的敏感性为84.85％(95％CI:0.734,0.921)、特异性为84.91％(95％CI:0.719,0.928);透出液sICAM-1、PCT、CA125联合预测腹膜透析细菌性腹膜炎的AUC为0.926(95％CI:0.863,0.966),大于透出液sICAM-1单独预测的AUC 0.798(95％CI:0.714,0.866)、透出液PCT单独预测的AUC 0.819(95％CI:0.738,0.884)及透出液CA125单独预测的AUC 0.794(95％CI:0.711,0.863),联合预测的敏感性为86.36％(95％CI:0.752,0.932)、特异性为88.68％(95％CI:0.763,0.953);感染控制者血清和透出液sICAM-1、PCT及透出液CA125水平均低于感染未控制者(P<0.05).结论 随着血清和透出液sICAM-1、PCT及透出液CA125水平的升高,腹膜透析相关细菌性腹膜炎的发生风险增加,各指标对腹膜透析细菌性腹膜炎具有预测价值,且能辅助临床评估感染控制情况.

目的:探讨miR-15b-5p是否调控磷脂酰肌醇-3-羟激酶(PI3K)/蛋白激酶B(AKT)/mTOR信号通路影响肾癌细胞(A-498)凋亡和氧化应激反应.方法:运用实时定量PCR分析肾癌组织中miR-15b-5p表达水平.流式细胞术分析抑制或过表达miR-15b-5p对A-498细胞凋亡的影响.试剂盒分析丙二醛(MDA)含量以及超氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平.免疫印迹法分析磷脂酰肌醇-3-羟激酶(PI3K)/蛋白激酶B(AKT)/雷帕霉素靶蛋白(mTOR)相关蛋白表达水平.结果:肾癌组织中miR-15b-5p表达水平显著升高(P<0.05).抑制miR-15b-5p表达显著促进A-498细胞凋亡,增加MDA含量,降低SOD和CAT水平,并下调p-p85、p-Akt和p-p70S6K1蛋白表达水平(P<0.05),而过表达miR-15b-5p具有相反作用(P<0.05).PI3K/AKT/mTOR信号通路抑制剂GNE-477显著促进A-498细胞凋亡,增加MDA含量,降低SOD和CAT水平(P<0.05).GNE-477还可减弱miR-15b-5p过表达对A-498细胞凋亡和氧化应激反应的影响(P<0.05).结论:肾癌中miR-15b-5p表达显著增加.抑制miR-15b-5p表达通过抑制PI3K/AKT/mTOR信号通路可促进肾癌细胞凋亡和氧化应激损伤.

目的 探讨前列地尔联合缬沙坦治疗慢性肾小球肾炎的临床效果.方法 96例慢性肾小球肾炎患者,以入院顺序分为对照组和观察组,各48例.对照组采用缬沙坦治疗,观察组采用前列地尔联合缬沙坦联合治疗.比较两组治疗效果、生活质量及治疗前后肾功能指标.结果 治疗后,观察组血肌酐、尿素氮和血尿酸水平均低于对照组,差异有统计学意义(P<0.05).观察组物质生活、躯体功能、社会功能、心理功能及总分分别为(55.28±1.12)、(55.68±2.36)、(55.16±1.48)、(54.72±0.80)、(223.72±2.88)分,均明显高于对照组的(48.32±1.64)、(49.18±2.60)、(48.56±1.42)、(48.10±0.96)、(197.47±3.31)分,差异有统计学意义(P<0.05).结论 予以慢性肾小球肾炎患者前列地尔联合缬沙坦治疗,可明显提高治疗效果,对患者肾功能和生活质量有明显的改善作用,推广应用价值高.

目的:探讨自动化腹膜透析治疗复方感冒制剂引起药物性脑病的疗效.方法:回顾性分析2017年11月～2019年12月本院8例腹膜透析患者在家自服复方感冒制剂后出现药物性脑病的临床资料.结果:8例腹膜透析患者使用复方感冒制剂后出现药物性脑病,入院后均采用自动化腹膜透析机进行连续循环24h腹膜透析,精神症状消失.结论:腹膜透析患者服用复方感冒制剂易出现药物性脑病,自动化腹膜透析治疗药物性脑病有效.

目的 观察梗阻性急性肾损伤(AKI)患者血清血红素加氧酶1(HO-1)的水平变化,并探讨其临床意义.方法 选取33例梗阻性AKI患者(AKI组)及30例健康体检者(健康对照组),采用酶联免疫吸附法检测两组血清HO-1、肾损伤因子(KIM-1)等指标.采用Spearman相关分析血清HO-1、KIM-1水平的相关性;绘制受试者工作特征(ROC)曲线评价HO-1对梗阻性AKI的诊断价值;用二分类Logistic回归分析梗阻性AKI发病的影响因素.结果 AKI组血清HO-1、KIM-1水平高于健康对照组(P均＜0.01).AKI组血清HO-1水平与血清KIM-1水平呈正相关(r=0.596,P＜0.01).HO-1对AKI的诊断界值为0.60 pg/mL,其ROC曲线下面积为0.869,敏感度和特异度分别为81.8％、77.8％.血清HO-1、KIM-1水平升高是梗阻性AKI发生的危险因素.结论 梗阻性AKI患者血清HO-1水平升高,其诊断梗阻性AKI的灵敏度和特异度较高,HO-1水平升高的患者易发生梗阻性AKI.

目的:评估尿血红素加氧酶-1(heme oxygenase-1,HO-1)和尿肾损伤分子-1(kidney Injury molecule-1,KIM-1)水平对急性肾损伤的预测价值.方法:筛选2017年08月～2018年08月期间于潍坊市人民医院住院的确诊急性肾损伤(acute kidney injury,AKI)患者38例及慢性肾脏病组30例,健康对照组30例,采用受试者工作特征曲线(ROC曲线)评价观察指标的预测价值.结果:急性肾损伤组在确诊急性肾损伤后6h的尿HO-1、尿KIM-1、血清尿素氮、血清肌酐、血清尿酸均高于健康对照组,差异均有统计学意义(P＜0.05).确诊急性肾损伤后6h的尿HO-1高于慢性肾脏病组,差异有统计学意义(P＜0.05).而慢性肾脏病组的尿HO-1水平与健康对照组相比较,差异无统计学意义(P＞0.05).确诊急性肾损伤组6h内的尿HO-1和尿KIM-1ROC曲线下面积分别为0.804和0.802.当急性肾损伤组6h内尿HO-1为0.885 pg/ml时,敏感度和特异度分别为71.1％和86.7％;当急性肾损伤组6h内尿KIM-1为0.8 ng/ml时,敏感度和特异度分别为65.8％和86.7％.结论:尿HO-1及尿KIM-1均是预测AKI的良好指标.

目的 探讨成人尿蛋白聚糖-1(syndecan-1)和急性肾损伤(AKI)的关系.方法 选取47例成人AKI患者(AKI组)及30例健康体检者(对照组),检测两组患者的尿syndecan-1、血肌酐、尿素氮、血红蛋白、血白蛋白等指标,同时收集人口统计学资料,比较两组各指标的差异.绘制ROC曲线,探讨尿syndecan-1对成人AKI的预测价值.结果 AKI组患者尿syndecan-1水平(1264.32±683.68)μg/L明显高于对照组(807.43±285.71)μg/L(P=0.001).AKI组患者尿syndecan-1和血肌酐水平呈正相关(Pearson r=0.476,P＜0.01),与血白蛋白、血红蛋白水平呈负相关(分别为Pearson r=-0.322,P=0.004;Pearson r=-0.300,P=0.008).尿syndecan-1诊断AKI的ROC曲线下面积为0.707,敏感度和特异度分别为63.8％和73.3％.结论 成人AKI患者尿syndecan-1明显升高,提示其对成人AKI可能具有诊断价值.

Objectjve To analyse the clinical and pathological classification of patients who underwent percutaneous renal biopsy in Liaoning. Methods 1 562 patients who underwent percutaneous renal biopsy in Department of Nephrology of Shengjing Hospital Affiliated to China Medical University from 2006 to 2012,were selected as study subjects,their clinical and pathological informations were analyzed retrospectively. Results Among 1 562 patients who underwent percutaneous renal biopsy, 1 222 cases(78. 23% )had primary glomerular disease( PGN),277 cases(17. 73% )had secondary glomerular disease (SGN),44 cases(2. 82% )had renal tubular interstitial disease(TID),11 cases(0. 71% )had hereditary kidney disease, and 8 cases( 0. 51% ) had unclassified kidney disease. IgA nephropathy ( 475 cases,38. 87% ) was the most common pathological type of primary glomerular disease,followed by membranous nephropathy( 311 cases,25. 45% ),mesangial proliferative glomerulonephritis ( 243 cases,19. 89% ) . Purpura nephritis ( 68 cases,24. 55% ) was the most common pathological type of SGN,followed by lupus nephritis(45 cases,16. 25% ),diabetic nephropathy(44 cases,15. 88% ). There was significant difference in constituent of renal pathological type in different ages(P < 0. 05). There was no significant difference in constituent of renal pathological type between male and female and in different years(P > 0. 05). The most common&nbsp;clinical indication of renal biopsy was nephrotic syndrome(662 cases,42. 38% ),followed by nephritis syndrome(448 cases, 28. 68% ),asymptomatic urinary abnormalities( 223 cases,14. 28% ),acute renal insufficiency( 105 cases,6. 72% ), macroscopic haematuria(59 cases,3. 78% ),chronic renal insufficiency(53 cases,3. 39% ),and other abnormalities(12 case,0. 77% ). There was no significant difference in constituent of renal biopsy indication between male and female( P >0. 05). There were significant difference in constituent of renal biopsy indication in different ages and types( P < 0. 05). Conclusjon PGN is the most common disease among patients who undergo percutaneous renal biopsy in Liaoning. IgA nephropathy is the most common pathological type,followed by membranous nephropathy. Purpura nephritis and lupus nephritis are the most common types of SGN. The most common clinical indications of renal biopsy in PGN and SGN are nephrotic syndrome and nephritis syndrome,patients with the same pathological type can have different clinical features.

Objective To investigate the prognosis and risk factors in Chinese patients with indiopathic membranous nephropathy(IMN).Methods One hundred and thirty-seven patients with IMN were selected in this study,who were admitted to Shengjing Hospital Affiliated to China medical university from January 2006 to December 2011 with biopsy proven.They were performed 12 months follow-up.The patients' clinical features and pathological stage were collected.Results All patients' age was ranged from 16 to 73 years old and male accounted for 57.66％.At the end of following up,18 patients(13.14％) were with glomerular filtration rate (eGFR) less than 30 ml/min.Survival analysis showed that patients with hypertension,age≥60 years old,elevated serum creatinine (SCr ≥ 133 μmol/L),and proteinuria no remission were with poor prognosis.Cox univafiate analysis showed that hypertension(HR =5.709,95％ CI 2.173-14.998),age≥60 years old (HR =18.200,95％ CI 3.904-84.869),elevated serum creatinine(HR =22.235,95％ CI 5.586-89.304),and proteinuria no remission(HR =4.681,95％ CI 1.168-13.060) were risk factors(P ＜0.05).Cox multivariate analysis showed that age≥60 years old(HR =12.280,95％ CI 1.945-77.540) and elevated serum creatinine (HR =11.45,95％ CI 2.230-58.783) were independent risk factors (P =0.008,0.030 respectively) Conclusion IMN patients have relatively good prognosis.Age ≥ 60 years old and higher serum creatinine at biopsy were independent risk factors of IMN patients with eGFR ＜ 30 ml/min.

s Objective:To observe the effect of Shuxuetong injection on hemorheology and therapeutic effect in patients with primary nephrotic syndrome. Methods:120 patients of primary nephrotic syndrome were divided into the treatment group (n=60) and the control group (n=60) randomly. The treatment group were injected shuxuetong injection and conventional therapy while the control group were injected salvia miltiorrhiza compound injection and conventional therapy. Before and after 3 days of treatment course, hemorrheology, blood routine, urine routine, 24 hours urine protein quantity, liver function, renal function and serum lipid were detected in all patients. Results: All patients had hyperviscousemia before treatment. There was no-singificant difference between two groups. After 4 weeks treatment, seven indexes of the treatment groups degraded markedly beside hematocrit and erythrocyte aggregation exponent (P<0.01). Beside the erythrocyte sedimentation rate and the erythrocyte sedimentation rate equation K value, other seven indexes of the control group had no-statistics difference before and after treatment (P>0.05). Compared with the control group after treatment, the whole blood viscosity (high, middle and low cuts), the erythrocyte sedimentation rate, the erythrocyte sedimentation rate equation K value, the fibrin of the treatment group had significant deviation (P<0.01). The plasma viscosity difference was also significant (P<0.05). Total effective rate of the treatment group was 86.7%, and the control group was 63. 3%. The treatment group is higher than the control group obviously (X2 =4.36, P<0.01). Conclusion: The study shows Shuxuetong injection can obviously improve blood hyperviscous and hypercoagulabale state, which can elevate remission rate of the primary nephrotic syndrome patients.