目的 探讨糖尿病肾病(DN)患者尿液基质金属蛋白酶组织抑制剂2(TIMP-2)、胰岛素样生长因子结合蛋白7(IGFBP7)水平及其临床意义.方法 选取254例DN患者为研究组,另选取同期230例单纯2型糖尿病患者为对照组,比较2组患者临床资料.根据估算肾小球滤过率(eGFR)将DN患者分为Ⅰ期组32例,Ⅱ期组84例,Ⅲ期组90例,Ⅳ期组48例;根据血清肌酐及尿量将DN患者分为AKI组19例和非AKI组235例;比较血清肌酐、尿液TIMP-2、IGFBP7水平在不同组别患者中的差异.采用酶联免疫吸附法检测尿液TIMP-2、IGFBP7水平及尿肌酐水平;采用Pearson检验分析尿液TIMP-2、IGFBP7与相关指标的关系;采用受试者工作特征(ROC)曲线评价尿液TIMP-2、IGFBP7及血清肌酐诊断DN患者发生AKI的效能.结果 研究组血清肌酐、糖化血红蛋白(HbA1c)、血尿酸、尿素氮、尿微量白蛋白、24 h尿蛋白定量、尿β2-微球蛋白水平均高于对照组,血清白蛋白、eGFR水平均低于对照组,差异有统计学意义(P＜0.05).Ⅲ期、Ⅳ期DN患者血清肌酐、尿TIMP-2与尿肌酐的比值(TIMP-2/尿肌酐)、尿IGFBP7与尿肌酐的比值(IGFBP7/尿肌酐)均高于Ⅰ期、Ⅱ期患者,差异有统计学意义(P＜0.05);与非AKI组相比,AKI组患者血清肌酐、尿TIMP-2/尿肌酐、尿IGFBP7/尿肌酐均升高,差异有统计学意义(P＜0.05).尿液TIMP-2、IGFBP7与血清肌酐、HbA1c、血尿酸、尿素氮、尿微量白蛋白、24 h尿蛋白定量、尿β2-微球蛋白均呈正相关(P＜0.05),与血清白蛋白、eGFR均呈负相关(P＜0.05).ROC曲线显示,尿液TIMP-2、IGFBP7、血清肌酐预测DN患者发生 AKI 的曲线下面积(AUC)分别为 0.676(95％CI:0.587～0.756)、0.864(95％CI:0.792～0.918)、0.618(95％CI:0.528～0.703),尿液TIMP-2联合IGFBP7预测DN患者发生AKI的AUC为0.926(95％CI:0.866～0.965).结论 DN 患者尿液TIMP-2、IGFBP7水平随病情加重而呈上升趋势,对DN患者发生AKI有一定的预测价值.

目的:探讨维持性血液透析对患者微炎症状态的影响.方法:选取82例维持性血液透析患者,随机分为两组,对照组使用低通量血液透析治疗,研究组使用高通量血液透析治疗.并选取同期健康体检健康人员41名作为健康组,比较三组营养状况,比较两组微炎症状态.结果:研究组治疗后ALB、TP、BMI指标均高于对照组(P＜0.05);研究组治疗后TNF-α、IL-6、hs-CRP水平均低于治疗前、对照组(P＜0.05).结论:维持性血液透析患者采用高通量血液透析,相较于低通量血液透析,一定程度上可对患者的营养状态起到改善作用,使

Objective:To investigate the clinical effect of far-infrared therapy combined with clopidogrel on thrombosis of autogenous arteriovenous fistula (AVF).Methods:A total of 66 patients who underwent hemodialysis in the hemodialysis center of our hospital from June 2017 to December 2017 were selected and divided into combined group, clopidogrel group and control group according to random number table method, with 22 patients in each group. Patients in the combined group were given the therapy of far-infrared and clopidogrel, while in the clopidogrel group were only treated with clopidogrel. The control group was not treated with far infrared or clopidogrel. After 6 months follow-up, blood flow changes and the incidence of fistula thrombosis were compared in two groups.Results:At the end of follow-up, the patency rate of fistula in the combined group, clopidogrel group and control group were 90.91%(20/22), 77.27%(17/22) and 59.09%(13/22), respectively ( P<0.05). The blood flow of patients in combined group and clopidogrel group after treatment were respectively significantly higher than that before treatment ( P< 0.05). In the control group, there was no significant difference in blood flow before and after treatment ( P>0.05). The index of Hb, plasma albumin and Kt/V in the combined group was significantly higher than that before treatment, while hs-CRP was significantly lower ( P<0.05). The plasma albumin was significantly lower in clopidogrel group after treatment ( P<0.05). The index of serum albumin and Kt/V in the control group were lower than that before treatment ( P<0.05). Conclusions:Therapy of far-infrared combined with clopidogrel may protect AVF via reducing thrombosis.

目的:采用乙二醇加氯化铵法制作大鼠肾结石模型,观察肾复康的防治作用.方法:大鼠连续5 w喂饲乙二醇加氯化铵复制肾结石模型,用肾复康按2.8、1.4、0.7g生药/kg的剂量同步灌胃给药5周,观察肾复康对模型动物尿量、血清生化和肾组织病理学的影响;结果:连续给药5 w后,与模型对照组比较,各给药组大鼠精神、饮食活动等好于对照组,肾复康大、中、小剂量组大鼠的血清肌酐水平明显降低(P＜0.05),肾组织钙含量显著减少(P＜0.01).结论:肾复康对由乙二醇引起的大鼠肾结石形成有一定的治疗作用,通过增加尿钙和肾组织钙的排泄,增强细胞抗氧化能力,减少氧自由基生成,抑制脂质过氧化反应,起到抑制草酸钙结晶形成、保护肾小管上皮细胞的作用.

目的 探讨采用丹参酮ⅡA磺酸钠注射液治疗过敏性紫癜对患者紫癜消退及肾受累的影响.方法 选取2013年8月至2014年10月已确诊为过敏性紫癜的患者68例,每组34例.采用随机数字表将患者分为实验组和对照组,每组34例.对照组给予常规治疗,实验组在常规治疗的基础上加静脉滴注丹参酮ⅡA磺酸钠注射液.观察两组过敏性紫癜患者紫癜消退情况及肾脏受累情况.结果 入院时两组各有6例为肾型紫癜,基础肾受累率相当(P＞0.05);入院后新发肾脏受累实验组2例(5.88％),对照组9例(26.47％),新发肾脏受累率实验组明显低于对照组,差异有统计学意义(P＜0.05).且治疗后实验组原6例肾型紫癜患者肾脏损害减轻,逐渐转为镜下血尿;而对照组原6例肾型紫癜的肾脏损害几乎无改善.结论 在常规治疗基础上加用丹参酮ⅡA磺酸钠注射液治疗过敏性紫癜,可降低患者的肾脏受累率,改善肾脏损害程度.