目的 探讨容量状态及其他冈素对腹膜透析患者残余肾功能(residual kidney function,RKF)下降的影响.方法 分析复旦大学附属华山医院腹膜透析中心白2010年6月至2017年8月期间进行腹膜透析(peritoneal dialysis,PD)并且规律随访患者的临床资料,筛除有腹膜炎病史、临床资料不全、中途由外院转入的患者.以患者开始规律PD第3个月的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)作为基础值,记录腹膜透析患者在≤36个月间内所有基本临床特征、透析相关变量和主要生化指标.终点事件定义为在开始PD 24个月内的eGFR下降为0.采用单因素及多因素线性回归和Cox回归模型法分析影响PD患者eGFR下降的影响因素.结果 本研究纳入96名患者,基线eGFR为(4.20±3.00) mL·min-1·1.73 m-2,单因素和多因素线性回归结果显示体重指数(body mass index,BMI)和时间平均后的终末段脑钠肽前体(NT-proB-type natriuretic peptide,BNP)为共同影响PD患者RKF下降的危险因素.单因素Cox回归分析结果显示BMI、标准化蛋白分解率(normalized protein catabolic rate,nPCR)、平均动脉压(mean arterial pressure,MAP)和时间平均后的BNP为影响PD患者进入终点事件的共同危险因素.多因素Cox回归分析结果显示时问平均后的BNP为影响PD患者进入终点事件的独立影响因素.结论 容量过剩与新开始PD患者RKF下降可能相关.

Objective To analyze the clinical characteristics,pathological classification and therapy strategy of rectal carcinoid and its prognostic factors.Methods Forty four patients with rectal carcinoid were diagnosed and treated in Ruijin Hospital Shanghai Jiaotong University from January 2006 to November 2013,among whom 21 patients (19 males and 2 females) were followed-up for 1-7.5 years.The clinical data of these cases were retrospectively analyzed.Results The patients underwent colonoscopy because of changed bowel habits and/or abnormal digital rectal examination,none of them had carcinoid syndrome.Colonoscopy showed that most lesions presented yellowish in color and smooth in surface; the diameter of the tumor was ≤ 1.0 cm in 12 cases (57％) ; the tumors were located at the rectum within 8 cm from anal rim in 17cases (76％); most of them were well differentiated.Immunohistochemistry demonstrated that NSE expression was highly positive.The 1 year-and 3year-survival rate were both 100％.Among 8 cases who were followed up for over 5 year,2 relapsed.Conclusions The digital rectal examination plays a key role in detecting rectal carcinoid.Though prognosis is relatively good,we should keep close following-up to detect the recurrence.The main risk factors influencing the prognosis are tumor size,depth of invasion and clinical stage.The combination measurement of CEA,TSGF,CA19-9 and NSE will either increase the sensitivity or the specificity of early detection.