INTRODUCTION:Sacubitril/valsartan is increasingly used in hemodialysis patients due to its cardioprotective benefits. However, its impact on serum potassium levels in anuric patients undergoing hemodialysis remains controversial. METHODS:We conducted a retrospective data from patients undergoing hemodialysis at two dialysis centers. A total of 71 out of 332 patients receiving hemodialysis treatment were enrolled. Mean serum potassium (mean value of 6-8 determinations), peak serum potassium (maximum K value observed during follow-up observations), and other biochemical parameters were recorded at baseline and during the follow-up period. FINDINGS:After 6 months of follow-up, mean serum potassium increased from 4.84 ± 0.45 mmol/L at baseline to 5.07 ± 0.46 mmol/L at 3 months and 5.04 ± 0.46 mmol/L at 6 months (p < 0.001). Notably, no significant group differences were found in peak serum potassium concentrations between baseline and 6 months after sacubitril/valsartan therapy (5.69 ± 0.56 vs. 5.75 ± 0.41, p = 0.419). Prior to starting sacubitril/valsartan treatment, none of the patients had severe hyperkalemia; however, after 3 and 6 months of sacubitril/valsartan therapy, two (2.80%) and three (4.20%) patients experienced severe hyperkalemia, respectively; however, this difference was not statistically significant. Additionally, there was a significant reduction in blood pressure; however, serum sodium, bicarbonate, and Kt/V values did not change significantly during either period. DISCUSSION:Sacubitril/valsartan therapy is associated with an increase in serum potassium levels in anuric hemodialysis patients. Nevertheless, the proportion of patients with severe hyperkalemia did not increase significantly. This suggests that the use of sacubitril/valsartan in anuric patients on hemodialysis is relatively safe.

The aim of the study was to analyze the change trend of serum ALP over time and identify factors influencing its levels in peritoneal dialysis patients. Then to investigate the impact of serum ALP changes on calcium and phosphorus metabolism in single peritoneal dialysis center utilizing repeated measurement data. A retrospective cohort study was conducted with a total follow-up duration of 30 months. Serum ALP and other biomarkers, including calcium (Ca), phosphorus (P), 25(OH)D, intact parathyroid hormone (iPTH), albumin(ALB), and hemoglobin(Hb) were measured every 3 months. The generalized estimation equation (GEE) was utilized to analyze the change trend of serum ALP over time, and to assess whether there were differences in changes over time between different genders and different primary disease groups. Additionally, factors influencing serum ALP levels were analyzed, and the impact of serum ALP changes on calcium and phosphorus metabolism was also explored. A total of 34 patients were included in the study. Serum ALP and other indicators were measured repeatedly, with a maximum of 8 times and a minimum of 4 times. The median of serum ALP values at all measurement times for all selected patients was 89 U/L. The GEE analysis revealed that serum ALP gradually increased with time, and patients in diabetes group increased faster than those in non-diabetes group. A positive correlation was observed between serum ALP and dialysis duration, also between serum ALP and hemoglobin. However, variations in serum ALP did not significantly affect serum corrected calcium, phosphorus, or iPTH concentrations. The serum ALP levels of peritoneal dialysis patients increase gradually over time, and the concentrations are influenced by dialysis duration. The changes in serum ALP values do not have a significant impact on serum calcium, phosphorus, and iPTH levels.

The highly prevalent cognitive impairment in hemodialysis patients is associated with all-cause mortality; however, the role of different cognitive domain impairments in this association is still not clarified. Our objective was to determine the association between cognitive domain impairment and all-cause mortality in elderly adult patients undergoing hemodialysis. We conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. Baseline data were collected, and a series of neuropsychological batteries covering 5 domains of cognitive function were included for the assessment of cognitive function. According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V), the patients were classified as normal, mild, and major cognitive impairment for global and domain cognitive function, then followed up for 1 year. Kaplan–Meier survival analysis was used to compare the difference in the cumulative survival rate in different cognitive domains. A multivariate Cox proportional hazards regression analysis was used to determine the association between global or domain cognitive impairment and all-cause mortality. A total of 613 patients were enrolled, the mean age was 63.82 ± 7.14 years old, and 42.1% were women. After 49.53 ± 8.42 weeks of follow-up, 69 deaths occurred. Kaplan–Meier plots demonstrated a significant association of cognitive impairment in memory, executive function, attention, and language domains with all-cause death. Multivariate Cox regression analysis showed that mild and major impairment of global cognition (HR = 2.89 (95% CI, 1.01–8.34), p = 0.049 and HR = 4.35 (95% CI, 1.55–12.16), p = 0.005, respectively), executive cognitive domain (HR = 2.51 (95% CI, 1.20–5.24), p = 0.014; HR = 3.91 (95% CI, 1.70–9.03), p = 0.001, respectively), and memory cognitive domain (HR = 2.13 (95% CI, 1.07–4.24), p = 0.031; HR = 3.67 (95% CI, 1.71–7.92), p = 0.001, respectively) were associated with all-cause mortality. Combined impairment of 3, 4, and 5 cognitive domains was associated with all-cause mortality [HR = 5.75 (95% CI, 1.88–17.57), p = 0.002; HR = 12.42 (95% CI, 3.69–41.80), p < 0.001; HR = 13.48 (95% CI, 3.38–53.73), p < 0.001, respectively]. We demonstrate an association between the executive and memory cognitive domain impairment and all-cause mortality in hemodialysis patients. Our data suggest that the impairments in these cognitive domains might help in the early identification of hemodialysis patients at risk of death.

Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.

Objective:To investigate the association between cognitive impairment and all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis (HD).Methods:A prospective cohort study was conducted. Patients from 11 HD centers in Beijing between April and June 2017 were enrolled. Baseline data were collected, and a series of neuropsychological batteries covered 5 domains of cognitive function were applied for the assessment of cognitive function. The patients were then classified as normal and cognitive impairment groups according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V) and followed-up until June 2018. The clinical characteristics of the two groups of patients were compared. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the independent influencing factors of all-cause mortality, to determine the relationship between cognitive impairment and different cognitive domain impairments and all-cause death.Results:A total of 613 patients were enrolled, of which 496(80.91%) patients had cognitive impairment. Compared with the normal cognitive function group, the patients in the cognitive impairment group tended to be older, longer dialysis vintage, a higher proportion of diabetes, hypertension, and stroke, increased serum iPTH level, and lower education level and urea clearance index (Kt/V) (all P<0.05). After (49.53±8.42) weeks of follow-up, Kaplan-Meier survival analysis showed that the cumulative survival rate of cognitive impairment group was significantly lower than that of cognitive normal group (Log-rank χ2=8.610, P=0.003). Multivariate Cox regression analysis showed that history of diabetes ( HR=2.742, 95% CI 1.598-4.723, P<0.001), coronary heart disease ( HR=1.906, 95% CI 1.169-3.108, P=0.010), dialysis vintage (every increase of 1 month, HR=1.007, 95% CI 1.003-1.011, P=0.001), serum level of albumin (every increase of 1 g/L, HR=0.859, 95% CI 0.809-0.912, P<0.001), cognitive impairment ( HR=2.719, 95% CI 1.088-6.194, P=0.032) were independently associated with all-cause mortality. Multivariate Cox regression analysis on different cognitive domains also indicated that memory impairment ( HR=2.571, 95% CI 1.442-4.584, P<0.001), executive function impairment ( HR=3.311, 95% CI 1.843-5.949, P=0.001) and three, four, five domains combined impairment ( HR=5.746, 95% CI 1.880-17.565, P=0.002; HR=12.420, 95% CI 3.690-41.802, P<0.001; HR=13.478, 95% CI 3.381-53.728, P<0.001) were independently related to all-cause mortality. Conclusions:Cognitive impairment is an independent risk factor of all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis, and the risk is significantly increased in patients with the impairment of the domains of memory, executive function, or in the combination of three to five cognitive domains.

The clinical epidemiological features of cognitive impairment in Chinese older adult patients undergoing hemodialysis are not clear, we aimed to identify the extent and patterns of cognitive impairment among those patients. We conducted a cross-sectional study of 613 hemodialysis patients aged 50 to 80 from 11 centers in Beijing. A neuropsychological battery of 11 tests covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied, patients were classified as none, mild, or major cognitive impairment according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria for cognitive impairment. Compared with Chinese population norms, 37.2% of the participants had mild cognitive impairment, 43.7% had major cognitive impairment. Memory and language were the most severe impaired domains in the mild cognitive impairment group, attention and visuospatial function domains were the most serious impaired domains in the major cognitive impairment group. Concomitant impairment across multiple cognitive domains was common. Factors associated with major cognitive impairment included age, education level, history of stroke and hypertension, dialysis vintage, and single-pool Kt/V. There is a high frequency of cognitive impairment in Chinese older adult hemodialysis patients, with varying severity and concomitant impairment across multiple domains.

背景 高血压是终末期肾病维持性血液透析患者常见并发症之一,研究表明降低血液透析液钠浓度可改善终末期肾病维持性血液透析伴高血压患者水钠负荷并降低其血压,但多数研究样本量较小,降低血液透析液钠浓度的临床意义尚存在争议.目的 通过扩大样本量而进一步证实降低血液透析液钠浓度对处于干体重的行维持性血液透析的终末期肾病伴高血压患者血压、血钠的影响,并验证其安全性.方法 本研究为多中心、自身对照研究,共选取2018年9—11月在北京市7家血液净化中心行维持性血液透析的终末期肾病伴高血压患者154例,2018年12月开始将其血液透析液钠浓度调整至138 mmol/L并维持1个月(干预前),2019年1月开始下调其血液透析液钠浓度至136 mmol/L并维持4个月(干预后).比较所有患者干预前1个月最后1周、干预后1周血液透析前血红蛋白、血白蛋白、血钙、血磷、甲状旁腺激素、收缩压、舒张压及血液透析前后血钠、血液透析间期干体重增长数,记录所有患者使用降压药物种数及血液透析过程中不良事件发生情况.结果 154例患者干预后血液透析前平均血红蛋白、血白蛋白、血钙、血磷、甲状旁腺激素与干预前比较,差异无统计学意义(P>0.05),干预后血液透析前后平均血钠、血液透析间期干体重增长数、血液透析前收缩压及舒张压、使用降压药物种数较干预前降低(P<0.05).154例患者干预前后血液透析过程中低血压、肌肉痉挛发生率比较,差异无统计学意义(P>0.05).结论 轻度下调血液透析液钠浓度可有效降低处于干体重的行维持性血液透析的终末期肾病伴高血压患者血压、血钠,且安全性较高,宜于在基层血液透析机构推广应用.

目的 探讨血液透析患者低三碘甲状腺原氨酸(T3)综合征与代谢性酸中毒的相关性.方法 选取2017年9月至2018年9月北京大学首钢医院长期维持性血液透析的患者151例,根据T3水平将其分为正常T3组(77例)和低T3综合征组[74例,血清游离T3(FT3)＜3.5 pmol/L,游离甲状腺素正常且血清促甲状腺激素＜4.5 mIU/L],比较2组患者的血清碳酸氢根水平及其他生化指标,分析血液透析患者低T3综合征与代谢性酸中毒的相关性.结果 低T3综合征组患者的血红蛋白、血清白蛋白、二氧化碳结合力(CO2CP)均低于正常T3组[(93±9) g/L比(110±9)g/L、(32±3) g/L比(39±4)g/L,(15.6±2.5) mmol/L比(21.2±5.8) mmol/L],差异均有统计学意义(均P＜0.01).低T3综合征组的总胆固醇明显高于正常T3组,差异有统计学意义[(5.1±0.9) mmol/L比(4.0±0.8)mmol/L,P＜0.01].Pearson相关分析结果显示,CO2CP与FT3水平呈正相关(r=0.495,P＜0.001),与总胆固醇、C反应蛋白以及校正血钙、血磷水平无明显相关性(r=-0.091、0.202、0.048、0.200,P=0.831、0.373、0.673、0.343).结论 在维持性血液透析的患者中,CO2 CP与FT3呈正相关,血清碳酸氢根水平越低,FT3水平越低.

目的 探讨原发性肾病综合征(PNS)患者血清脂蛋白a[Lp(a)]、骨形态发生蛋白-7(BMP-7)水平变化及其与预后的相关性.方法 选取2015年2月—2018年6月我院收治的PNS患者76例作为PNS组,选择同期健康体检者50例作为对照组.PNS组患者均接受糖皮质激素联合环磷酰胺治疗,并于入院时和治疗6个月后检测24 h尿蛋白、肾功能指标、Lp(a)和BMP-7水平.比较PNS患者不同临床效果及不同复发情况患者的Lp(a)和BMP-7水平.结果 PNS组24 h尿蛋白、血肌酐(Scr)、尿素(BUN)及Lp(a)水平显著高于对照组,BMP-7水平显著低于对照组(P<0.05).Lp(a)分别与PNS患者的24 h尿蛋白、SCr、BUN呈现正相关,BMP-7分别与PNS患者的24 h尿蛋白、SCr、BUN呈现负相关(P<0.01).完全缓解PNS患者的Lp(a)水平显著低于部分缓解和未缓解患者,BMP-7水平显著高于部分缓解和未缓解患者(P<0.05).治疗前和治疗后未复发PNS患者的Lp(a)水平显著低于复发患者,BMP-7水平显著高于复发患者(P<0.05).结论 在PNS患者中Lp(a)水平升高而BMP-7降低,高水平的Lp(a)和低水平的BMP-7与PNS更差的预后有关.

Background Vascular calcification is common in maintenance hemodialysis (HD) patients. Recent studies showed that cartilage oligomeric matrix protein (COMP) could protect blood vessels from calcification, but the role of ADAMTS7 was opposite. We aimed to investigate the relationship between serum COMP, ADAMTS7 levels and vascular calcification scores in HD patients. Methods Serum COMP and ADAMTS7 levels were tested by ELISA and we compared calcification scores between high and low COMP groups, also between high and low ADAMTS7 groups. We also investigated the differences of serum COMP and ADAMTS7 levels between mild and severe vascular calcification groups. The relationship between serum COMP and ADAMTS7 levels was analyzed in the end. Results Serum COMP and ADAMTS7 levels were both higher in HD patients than in control (29.63 vs 14.23 ng/mL, P = .002, 11.12 vs 2.40 ng/mL, P = .005). Serum COMP levels in severe vascular calcification (VC) group were higher than in mild VC (43.13 +/- 28.77 vs 26.75 +/- 18.22 ng/mL, P = .010). Serum ADAMTS7 levels were positively correlated with radial and digital arteries (small arteries) calcification scores (r = .249, P = .033). And serum COMP and ADAMTS7 levels were positively correlated (r = .348, P = .026). Conclusions Serum COMP and ADAMTS7 levels were probably associated with vascular calcification scores in HD respectively.

Objective To study the relationship between average serum uric acid level and all-cause mortality in maintenance hemodialysis patients at a single center at the beginning of dialysis and 1 year after dialysis.Methods A retrospective cohort study was conducted to observe 122 patients with end-stage kidney disease.The observation period was 5 years.The data of average serum uric acid,albumin,serum calcium,serum phosphorus,hemoglobin and so on were collected at the beginning of dialysis and 3 months,6 months,9 months and 1 year after dialysis.The change trend of serum uric acid was analyzed.According to the levels of uric acid in different periods,the patients were divided into hyperuricemia group(male> 420 μmol/L,female>360 μmol/L)and normal uric acid group(male≤420 μmol/L,female≤360 μmol/L).Kaplan-Meier was used to analyze the difference of all-cause mortality between the high and normal uric acid groups in different periods,and COX regression analysis was used to analyze whether uric acid level is an independent risk factor for all-cause death.Results During the 5-year observation 35 of 122 patients died,with a mortality rate of 28.7%.The average serum uric acid level at the beginning of hemodialysis was(456±121)μmol/L,and the average serum uric acid level one year after dialysis was(409±76)μmol/L,with statistically significant difference(P<0.05).According to the level of uric acid at the beginning of dialysis,there was no difference in all-cause mortality between high uric acid group and normal uric acid group(P=0.125).According to the mean uric acid level one year after hemodialysis,the all-cause mortality of the high uric acid levelgroup was lower than the normal uric acid levelgroup(P=0.004).Multivariate COX regression analysis suggested that after rectifying for age,sex,albumin,creatinine and Kt/V,hyperuricemia was an independent protective factor for all-cause death,and its odd ratio was 0.320 times the normal uric acid.At the same time,the patients in the high uric acid group are younger and the serum creatinine level is higher than that in normal uric acid group,with rectifying differences.Conclusions Patients with end-stage renal disease usually have a high level of uric acid at the beginning of hemodialysis and can reach a stable level one year after hemodialysis.Patients with high and normal uric acid levels have no difference in mortality at the beginning of dialysis.Patients with high uric acid have a higher survival rate when they are grouped by uric acid levels one year after hemodialysis.

Objective To compare the clinical effects of ciclosporin A ( CsA) with CsA combined with low?dose prednisolone for idiopathic membranous nephropathy ( IMN) in the elderly patients. Methods Twenty?seven elderly patients with IMN, with pathologic stage ofⅠ?Ⅱmembranous nephropathy( MN) were enrolled in this study. The patients were divided into two groups. Group A received low?dose CsA ( 2 mg/kg/d);Group B received small dose of prednisolone ( 0?5 mg/kg/d) in combination with low?dose CsA ( 2 mg/kg/d) . The treatment course was more than 6 months, and the follow?up period was more than six months. The clinical efficacy and the incidence of side effects and complications were recorded and compared between two groups. Results There was no significant difference in gender, age, pre?treatment serum creatinine, eGFR, and 24 h urinary protein excretion between the two groups ( P>0?05); The rate of complete remission and the rate of partial remission showed no significant difference between the two groups. The dropout rate of group B was 30?8%, compared with 14?3% in group A, with no significant difference ( P=0?385) . The incidence rate of complication in group B was 84?6%, compared with 35?7% in group A (P=0?018). The patients achieving remission showed significant differences in gender, age and eGFR before treatment, 24 h urinary protein excretion and pathological staging with the patients achieving non?remission ( P<0?05) . Conclusions Low?dose CsA shows similar effects on IMN with low?dose CsA combined with low?dose hormone therapy, with less side effects and complications. Low?dose CsA program could be used in the elderly patients with IMN.

Honokiol is the predominant active ingredient in the commonly used traditional Chinese medicine, Magnolia, which has been confirmed in previous studies to exhibit anti-oxidation, antimicrobial, antitumor and other pharmacological effects. However, its effects on renal ischemia/reperfusion injury (IRI) remain to be elucidated. The present study aimed to examine the effects of honokiol on renal IRI, and to investigate its potential protective mechanisms in the heart. Male adult Wistar albino rats were induced into a renal IRI model. Subsequently, the levels of serum creatinine, blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), and the levels of serum nitrite and the kidney nitrite were examined in the IRI group. The levels of oxidative stress, inducible nitric oxide synthase (iNOS), inflammatory factors and caspase-3 were evaluated using a series of commercially available kits. The levels of phosphorylated signal transducer and activator of transcription 3 (p-STAT3) and the protein expression levels of STAT3 were determined using western blotting. Pretreatment with honokiol significantly reduced the levels of serum creatinine, BUN, ALT, AST and ALP, and the level of nitrite in the kidney of the IRI group, compared with the control group. The levels of malondialdehyde, the activity of myeloperoxidase, and the gene expression and activity of iNOS were reduced in the IRI rats, compared with the sham-operated rats, whereas the levels of superoxide dismutase and catalase were increased following treatment with honokiol in the IRI rats. In addition, the expression levels of tumor necrosis factor-α and interleukin-6 in the IRI rats were increased by honokiol. Treatment with honokiol suppressed the protein expression levels of p-STAT3 and caspase-3 in the IRI rats. These findings indicated that honokiol protects against renal IRI via the suppression of oxidative stress, iNOS, inflammation and STAT3 in the rat.

目的:分析维持性血液透析(MHD)患者透析时血压变异性(BPV)等因素同心血管事件的关系.方法:回顾性分析接受MHD 6个月以上发生心血管事件的32例终末期肾病(ESRD)伴高血压患者,对照组为同期接受MHD但未发生心血管事件的40例ESRD伴高血压患者.分析各组患者年龄、性别、糖尿病患者率、体质指数、血压参数、KT/V、透析间期体重增长率等临床资料.结果:单因素分析表明,两组患者糖尿病患病率、透析间期体重增长率,透析时BPV及低血压发生率比较差异有显著性,可能为影响心血管事件因素;多因素Logistic回归分析表明,较高的SBP-SD(B=0.414,OR=1.512,P=0.000)和DBP-SD(B=0.606,OR=1.833,P=0.000)为本组患者预后不良的主要危险因素.结论:MHD患者心血管事件同多因素相关,其中透析时高SBP-BPV和DBP-BPV作为发生心血管事件的主要危险因素应引起重视.

Clinical cases show that zirconia restoration could happen fracture by accident under overloading after using a period of time. The purpose of this study is to research mechanical behavior and predict lifetime of dental zirconia ceramics under cyclic normal contact loading with experiments. Cyclic normal contact loading test and three point bending test are carried on specimens made of two brands of dental zirconia ceramic to obtain flexure strength and damage degree after different number of loading cycles. By means of damage mechanics model, damage degree under different number of contact loading cycles are calculated according to flexure strength, and verified by SEM photographs of cross section morphology of zirconia ceramics specimen phenomenologically. Relation curve of damage degree and number of cycles is fitted by polynomial fitting, then the number of loading cycles can be concluded when the specimen is complete damage. Strength degradation of two brands dental zirconia ceramics are researched in vitro, and prediction method of contact fatigue lifetime is established.

目的 24 h动态分析慢性肾脏疾病(1～3期)合并高血压(HCKD)患者的血压变化,并与原发性高血压(PH)患者的血压进行比较.方法 选择2013年1月至2014年1月海军总医院肾内科收治的HCKD患者52例作为HCKD组,另外选取47例PH患者作为PH组,对两组患者行24 h动态血压以及血压变异性检测,对两组患者的24 h舒张压(24 h-SBP)、24 h收缩压(24 h-DBP)、日间和夜间血压平均值以及收缩压和舒张压变异性进行统计分析.结果 ①血压比较:HCKD组24-DBP、夜间收缩压、夜间舒张压分别为(81.5±13.2) mmHg、(162.0±17.2)mmHg、(82.4±16.5) mmHg,均高于PH组(71.8±12.0) mmHg、(140.3±25.6) mmHg、(66.8±20.1) mmHg,差异均有统计学意义(P＜0.01).②血压变异性比较:HCKD组24 h收缩压变异性和舒张压变异性分别为(14.4±3.5)mmHg、(9.5±1.2)mmHg,均高于PH组(11.3±2.6)mmHg、(7.8±1.3)mmHg(P＜0.05);HCKD组夜间收缩压变异性和夜间舒张压变异性分别为(9.4±2.5)mmHg、(9.4±2.5)mmHg,均高于PH组(7.7±2.2)mmHg、(9.1±2.4)mmHg,差异均有统计学意义(P＜0.01).结论 肾性因素参与的高血压患者血压趋势紊乱,夜间血压及变异性明显增加,是肾功能继续恶化的重要因素.

近年来,随着对心血管病和肾脏病认识的不断深入,人们逐渐认识到心肾疾病之间双向作用的复杂性.肾脏病与心血管病的病死率、再入院率以及治疗费用密切相关,两者互为因果,形成恶性循环,导致心肾功能进行性恶化,即称为心肾综合征(cardio-renal syndrome,CRS).随着人口老龄化和寿命的延长,心血管疾病和肾脏疾病的发病率同步升高,CRS的患病率、死亡率均明显增高[1],越来越引起临床医生的高度重视。

Mesangial proliferative glomerulonephritis (MsPGN) is characterized by widespread mesangial cell proliferation and an accumulation of extracellular matrix (ECM) in the mesangial area. In a previous study we developed a polycystin‑1 N‑terminal fragment (PC‑1 NF) fusion protein that inhibits the proliferation of cyst‑lining epithelial cells in autosomal dominant polycystic kidney disease. In addition, the PC‑1 NF fusion protein arrests the cell cycle of cancer cells at the G0/G1 phase, inhibiting their proliferation. In the present study, the effect of the PC‑1 NF fusion protein on MsPGN was investigated. It was found that the PC‑1 NF fusion protein inhibited the proliferation of rat mesangial cells and induced G0/G1 phase arrest and apoptosis in vitro. PC‑1 NF fusion protein treatment also resulted in a decrease in mRNA expression levels of proliferating cell nuclear antigen, cyclin D1 and B‑cell lymphoma‑2 (Bcl‑2) and an increase in mRNA expression levels of Bcl‑2‑associated X protein (Bax) and p21Waf1. Furthermore, a decrease in Bcl‑2, c‑fos, c‑jun and protein kinase C‑α protein levels was observed, whereas Bax protein levels increased. Additionally, PC‑1 NF fusion protein induced ECM degradation and inhibited ECM expansion. The results also demonstrated that PC‑1 NF fusion protein treatment resulted in a decrease in type IV collagen and tissue inhibitor of metalloproteinase mRNA levels but an increase in matrix metalloproteinase 2 mRNA levels. In combination, these results suggest that the PC‑1 NF fusion protein inhibits proliferation, promotes apoptosis and induces ECM degradation in MsPGN rats. This study offers novel perspectives for the treatment of MsPGN.

目的 探讨影响临床期2型糖尿病肾病(DN)并高血压患者病情转归的危险因素.方法 跟踪随访50例临床期2型DN合并高血压患者,所有患者均经积极降压、降糖、降脂等对症治疗,3年后将肾功能显著恶化[肾小球滤过率估算值(eGFR)较基线值下降30％]或发生心脑血管并发症列为观察终点事件并定义为预后不良.按有无终点事件(包括复合终点事件)分为两组,分析其体质量指数、糖化血红蛋白、血脂、尿蛋白排泄率、血压及血压变异性(BPV)等临床资料.结果 单因素分析表明,两组患者3年前的年龄、性别、血压、尿蛋白排泄率、糖化血红蛋白、血脂、eGFR等基线资料无统计学差异(P＞0.05).但3年后,其体质量指数、收缩压变异系数(SBP-BPV)、尿蛋白排泄率、血胆固醇、血尿酸的检测指标比较均有统计学差异(P＜0.05),且可能为影响预后的因素,经多因素logistic回归分析,SBP-BPV为本组病人预后不良的主要危险因素(B=0.969,OR=2.637,P=0.001).结论 临床期DN的预后同多种因素有关,其中SBP-BPV为预后不良的主要危险因素,应引起重视并进行积极干预.