Background:Free light chains κ and λ (FLC κ, FLC λ) are of great significance in diagnostic and monitoring monoclonal gammopathy. Freelite and N-Latex methods are two common monitoring methods at present. But the two meanings are not completely equivalent, especially for patients with renal insufficiency. We analyzed the changes of serum and urine FLC in renal insufficiency patients without monoclonal gammopathy and the clinical significance of these changes.Methods:This study is an observational study. Patients ≥ 18 years old, who met the diagnostic criteria of chronic kidney disease (CKD), excluding monoclonal gammopathy, were selected. Fasting serum and 24-hour urine were taken to detect serum FLC κ, serum FLC λ, SCr, serum β 2-microglobulin, urinary FLC κ, urinary FLC λ, urinary α 1-microglobulin, and urinary β 2-microglobulin.Results:There was a good correlation between the two methods for determining serum/urinary FLC. No matter serum or urine, FLC showed a good correlation with renal function by the N-Latex method, but not by the Freelite method. Under the N-Latex method, FLC κ/λ remained stable, which was basically within the reference range of healthy people and was not affected by renal function. There was a good correlation between FLC detected by N-Latex and microglobulin in serum and urine.Conclusion:When the concentration of FLC is low, the N-Latex method is more recommended to monitor FLC. The FLC measured by the N-Latex method is more closely related to renal function. The ratio of FLC κ/λ determined by the N-Latex method remained stable within the recommended range.

目的 分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案.方法 根据北京医院血液透析中心不同时期MBD相关药物使用情况,纳入相应时间段的MHD患者.选取2017年1月1-31日151例患者为传统药物按需治疗组,2019年1月1-31日151例患者为新型药物受限治疗组,2020年1月1-31日153例患者为新型药物按需治疗组.3组患者均随访1年,比较3组生化指标、骨痛、临床事件和药品使用费用的情况.结果 传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组患者性别、年龄、透析龄和合并糖尿病的比例比较,差异均无统计学意义(P＞0.05).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组血钙水平[2.30(2.15,2.43) mmol/L、2.20(2.11,2.34) mmol/L和2.21(2.12,2.30) mmol/L]比较,差异有统计学意义(P＜ 0.001),按照K/DOQI标准的达标率分别为49.0％、57.6％和65.4％,组间比较差异有统计学意义(P=0.016);血磷水平[(1.74±0.51)mmol/L、(1.76±0.50)mmol/L和(1.65±0.44)mmol/L]比较,差异无统计学意义(P=0.081),按照K/DOQI标准的达标率分别为45.0％、43.7％和58.8％,差异有统计学意义(P=0.014);钙磷乘积[49.25(40.13,58.46)、47.42(38.59,55.95)和43.44(35.41,52.62)]比较,差异有统计学意义(P=0.024).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺激素(parathyroid hormone,PTH)水平比较,差异无统计学意义(P=0.465),按照K/DOQI标准PTH达标率分别为24.5％、35.8％和36.6％,按照KDIGO标准PTH达标率分别为51.0％、60.3％和66.0％,组间比较差异均有统计学意义(P=0.042和P=0.048).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组分别有109例(72.2％)、101例(66.9％)和87例(56.9％)患者使用含钙的磷结合剂,有0例(0.0％)、76例(50.3％)和87例(56.9％)患者使用不含钙的磷结合剂,有0例(0.0％)、35例(23.2％)和47例(30.7％)患者使用拟钙剂,差异均有统计学意义(P＜0.05).随访期内3组骨折和心脑血管事件发生率比较,差异均无统计学意义(P=0.703和P=0.889),传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺切除手术分别有2、0和0例次.传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组CKD-MBD治疗相关药物月均费用分别为100.2(11.1,322.9)元、361.6(50.1,866.9)元和633.3(121.5,1323.4)元,组间比较差异有统计学意义(P＜ 0.001).结论 新型药物按需治疗模式能明显提高MHD患者MBD生化指标的达标率,减少甲状旁腺切除手术需求,但增加了MBD相关治疗药物的费用.

目的 探索慢性肾脏病维持性血液透析患者的有效管理模式.方法 采取自身前后对照研究,筛选血磷≥1.78 mmol/L的规律透析患者入组,组建医护患质量改善团队,采取责任护士分组管理,运用五"E"模式通过鼓励、教育、运动、工作、评价5项措施干预18个月,并评价患者自我管理能力和血磷水平改善情况.结果 五"E"模式干预18个月后,患者自我管理各维度及总分较干预前明显提高,血磷平均值由(2.15±0.32)mmol/L下降至(1.78±0.42)mmol/L(t=6.249,P<0.01),血磷<1.78 mmol/L的比例提升60.32％;NT-proBNP平均值下降幅度43.24％.结论 运用五"E"模式对透析患者进行全程管理,形成以护士为主导的医护患多团队协作一体化闭环管理架构,可以提高患者自我管理能力,有利于患者的预后及提高生活质量.

Objective:We aimed to compare the characteristics between elderly and non-elderly corona virus disease 2019(COVID-19)patients, especially patients with different severity, in order to achieve a good understanding of elderly patients' clinical presentations.Methods:Records of patients diagnosed with COVID-19 and hospitalized at Tongji Hospital from February 9, 2020 to February 29, 2020 were retrospectively reviewed.They were divided into the elderly(≥65 years old)and non-elderly(<65 years old)groups according to age.Data on morbidity, underlying diseases, clinical symptoms, laboratory test results, imaging characteristics and hospitalization outcomes were collected retrospectively and analyzed statistically.Results:A total of 51 patients were enrolled with 21 in the elderly group(41.2%), with an average age of(71.9±6.4)years, and 30 non-elderly patients(58.8%). There were 13 elderly patients(61.9%)exhibiting fever, representing a lower rate than in the non-elderly patients(27 or 90%)( χ2=5.764, P=0.016). Bilateral pneumonia was present on chest CT scans in all of the elderly patients, while it was seen in 83.3% of the non-elderly patients( χ2=3.880, P=0.049). The proportion of elderly patients with coronary heart disease(61.9%)or hypertension(26.8%)was higher than that of non-elderly patients.The usage rates of antiviral drugs, systemic hormones and antibiotics were all higher and the causes of death were all due to multiple organ failure in elderly patients. Conclusions:Elderly patients with COVID-19 possess special characteristics, showing atypical symptoms, and multiple concomitant diseases may be the reason for their poor clinical prognosis.More rigorous monitoring and careful treatment should be conducted for elderly COVID-19 patients.

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘近吻合口狭窄,数字减影血管造影(digital subtraction angiography,DSA)下经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)与内瘘血管狭窄段近端重建手术的效果比较.方法 搜集2017年6月至2019年6月在北京医院接受治疗的MHD患者自体动静脉内瘘近吻合口狭窄71例,根据手术方式分为PTA(扩张组)37例及内瘘血管狭窄段近端重建术(手术组)34例.比较两种治疗方法成功率,3个月、6个月及12个月的内瘘通畅率及对血管资源的保护情况.结果 两组性别、年龄、透析龄、内瘘使用时间和糖尿病所占比例比较差异无显著性.扩张组手术成功率100％,其中,3个月内瘘通畅率为97.30％、6个月内瘘通畅率为78.38％,12个月内瘘通畅率为51.35％,所有病例在围术期没有留置中心静脉导管作为透析通路,没有血管的损失.手术组手术成功率100％,其中3个月内瘘通畅率94.12％(χ2=0.443,P=0.506),6个月内瘘通畅率82.35％(χ2=0.177,P=0.674),12个月内瘘通畅率64.71％(χ2=1.295,P=0.255),与扩张组比较差异无显著性.手术组围术期有5例患者留置中心静脉导管作为血液透析通路,血管损失(2.43±0.93)cm.结论 PTA治疗自体动静脉内瘘近吻合口狭窄是有效安全的治疗手段,和同期内瘘重建术相比效果相当.PTA治疗可以减少中心静脉插管率,减轻患者痛苦,更能充分保护血管资源.

目的 探讨动态脑CT灌注成像对缺血性脑血管病的临床应用价值.方法 选取2017年7月～2019年6月在汕头市龙湖人民医院接受诊治的50例缺血性脑血管病患者,根据脑血管减影造影显示的动脉狭窄率分为健侧、患侧,均进行动态脑CT灌注成像,得到动态脑CT灌注图像,参数包括达峰时间图(TTP)、脑血容量图(CBV)、脑血流量图(CBF).比较患者两侧大脑中动脉供血区的脑CT灌注参数指标变化,观察患者发病不同病程大脑中动脉供血区动态脑CT灌注成像参数指标的变化.结果 患者健侧大脑中动脉供血区的TTP、CBV、CBF等灌注参数指标高于患侧,差异有统计学意义(P<0.05);同一患者患侧比较,发病12～30 h大脑中动脉供血区的TTP、CBV、CBF等灌注参数指标高于发病<12h,差异有统计学意义(P<0.05).结论 缺血性脑血管病患者脑灌注CT中的TTP、CBV、CBF等灌注参数指标与脑梗死的风险因素密切相关,可用于指导临床治疗方案的制订.

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.

Objective: We aimed to compare the characteristics of elderly and nonelderly COVID-19 pneumonia patients by describing their epidemiological, clinical, laboratory, and imaging characteristics Methods: It was a retrospective study of patients diagnosed COVID-19 pneumonia who were hospitalized in Tongji Hospital from February 9, 2020 to February 29, 2020 The patients were divided to elderly (≥65 years old) and non-elderly group (&lt;65 years old) Results: A total of 51 patients were enrolled with 21 in elderly group (42 18%) and 31 in non-elderly group (58 82%) There was a higher proportion of severe and critically ill patients in elderly group Bilateral pneumonia in the chest CT was present in all of the elderly patients, while in 83 33% of the non-elderly patients (P = 0 049) The severe/critically ill elderly patients had lowest proportion of respiratory symptoms, but the highest proportion of diabetes, hypertension and chronic respiratory diseases Half of the elderly patients who were severe/critically ill had lymphocytopenia IL-6 level was the highest among the four groups, and more intensive oxygen or respiratory support, corticosteroid and antibiotics usage were received in severe/critically ill elderly patients Conclusions: The study showed that the clinical symptoms of elderly COVID-19 patients were more insidious, but the clinical conditions were more severe COVID-19 pneumonia cases in elderly people require more precise attention due to its particular characteristics

Objective To investigate the management of maintenance hemodialysis(MHD)anemia and the role of reticulocyte hemoglobin content(CHr)in its treatment.Methods Data of the patients,who underwent MHD from October 1,2019 to January 31,2020 at Beijing Hospital’s Blood Purification Center,were collected:demographic data,hemoglobin(Hb),serum ferritin(SF),transferrin saturation(TSAT),CHr,etc.;application of erythropoietin(EPO)and iron preparations.Results A total of 148 people were enrolled.Patients with Hb compliance with the reference range accounted for 35.14%.SF,TSAT and CHr were all within the target range.SF was significantly correlated with C-reactive protein(CRP)(r=0.175,P=0.037),while CHr was not(P=0.054).After excluding patients with elevated CRP,SF and CHr changed from non-correlation to significant correlation between them(r=0.272,P=0.004).By simply adjusting the dosage of EPO based on Hb,the rate of Hb compliance was not ideal.Patients with CHr decreased continually and the iron preparation was not adjusted;even if the dosage of EPO was increased,Hb could not meet the standard.CHr increased to the normal range,while the iron preparation dose was increased,and the Hb also reached the standard without increasing the EPO.Conclusions CHr is a more stable indicator that can reflect the recent iron reserve.Supplementing Iron preparation combined with CHr can better improve the situation of anemia.

Our previous study indicated that microRNA 145 (miR-145) and its predicated target, erythropoietin-producing hepatoma (EPH) receptor A4 (EPHA4), was closely associated with ischemic stroke. In this study, we aimed to further explore their function in a model of oxygen-glucose deprivation (OGD). The expression of miR-145 in the blood of 44 patients with ischemic stroke and 37 normal controls was detected by qRT-PCR. After transfection with either the wild- or mutant-type pGL3-promoter EPHA4 3'UTR into the miR-145 mimic and miR-145 inhibitor, a dual-luciferase reporter assay was performed to explore the interaction between miR-145 and EPHA4. qRT-PCR and Western blot were performed to further explore the effects of miR-145 on EPHA4 expression after an miR-145 mimic, an miR-145 inhibitor or LV-sh-EPHA4 was transfected into cerebral cortical neurons. The expression of miR-145 was significantly upregulated in the blood of patients with ischemic stroke compared to that of normal controls. Dual-luciferase reporter assay, qRT-PCR and Western blot results indicated that miR-145 indeed targets EPHA4 through its 3'-UTR and regulates the expression level of EPHA4 at both the mRNA and protein levels. Moreover, the OGD model was successfully constructed, and miR-145 exerted a protective effects in cell viability in the OGD model by downregulating EPHA4. The expression of LOC105376244 could be regulated by the miR-145-EPHA4 interaction. MiR-145 exerted a protective effects in cell viability in the OGD model by downregulating EPHA4, which suggested their potential roles in ischemic stroke and requires further research.

Previous clinical studies found inconsistent relationship between circulating sclerostin levels and treatment outcome in patients undergoing maintenance hemodialysis (MHD). Therefore, this study aimed to assess the associations of sclerostin with carotid artery atherosclerosis and all-cause mortality in Chinese patients undergoing MHD.

目的 探讨北京医院肾脏专科医联体工作模式对下级医联体单位(北京东城区第一人民医院)血液净化中心医疗质量及费用的影响.方法 选取东城区第一人民医院血液净化中心2016年1月1日～2016年10月31日前在透199例维持性血液透析(maintenance hemodialysis,MHD)患者作为医联体前组,选取2016年11月1日～2017年8月31日在透181例MHD患者作为医联体后组.分析肾脏专科医联体工作模式运行前后10个月下级医联体单位MHD患者透析相关管理指标,不良事件发生率及同期住院医疗费用的变化. 结果 肾脏专科医联体成立后东城区第一人民医院MHD患者血红蛋白达标率明显提高(51.3％比70.2％,x2=3,P＜0.001)、血清铁蛋白达标率明显提高(25.1％比43.1％,x2=14.153,P＜0.001)、血钾达标率明显提高(79.4％比87.3％,x2=4.219,P=0.040)、全段甲状旁腺素达标率明显提高(25.6％比43.6％,x2=13.673,P＜0.001);不良事件发生率明显下降(37.2％比26.5％,x2=4.948,P=0.026);不良事件导致总住院费用明显下降(2 000 357元比958 053元). 结论 肾脏专科医联体工作模式能够明显提高下级医联体单位MHD患者血液透析医疗质量控制指标,明显降低MHD患者不良事件发生率,明显减少不良事件住院费用,全面节省医疗保险费用,充分证明肾脏专科医联体工作模式的可行性和有效性.

Background: Investigate into the medical expenditures of chronic kidney disease (CKD) patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups (DRGs) grouping of the diagnosis, and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments. Methods: Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014–2016 within the hospital were selected as the sample of the study, multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process. Results: The maximum proportion of the medical costs within CKD patients was the costs on treatment, with the highest of 35.3% on the year 2014, the second was the costs on drug, which accounted for <30% during consecutive years, and the third was the costs on examination, which accounted for about 20% on average. The main influencing factors of medical expenditures included the type of dialysis, length of hospitalization, the admission of Intensive Care Unit (ICU), and so on. The coefficients toward the effect for total costs were 0.416, 0.376, and 0.094, respectively. Conclusions: It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients, and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.

Objective To analyze the primary disease,the difference in clinical manifestation and the reason for initiating dialysis between diabetic nephropathy (DN) group and non-DN group,and the vascular access in the hemodialysis patients in our center in the recent 20 years.Methods We recruited the patients initiating the maintenance hemodialysis (MHD) during 1994 to 2015.Their primary disease,the direct cause leading to dialysis initiation,vascular access and laboratory tests were recorded.The differences in these parameters in DN and non-DN patients between the first 10-year period and the second 10-year period in 1994-2015 were compared.Results A total of 289 patients were recruited.The leading primary disease was glomerulonephritis,followed by DN and hypertension.The proportion of DN patients increased significantly (16.000％ to 21.296％) in the second 10-year period.At the initiating dialysis in DN patients,serum creatinine level was relatively low (659.036±350.533 μmol/L vs.877.452±386.593μmol/L,t=3.789,P＜0.001),anemia was relatively severe (86.839 ± 18.890 g/L vs.93.092 ± 22.795 g/L,t=2.064,P=0.041),serum phosphorus (1.648±0.481 mmol/L vs.2.006±0.753 mmol/L,t=3.865,P＜0.001) and iPTH (236.150±203.332 pg/ml vs.460.647±480.166 pg/ml,t=2.766,P=0.007) were relatively low,and metabolic acidosis was not very heavy (t=-2.483,P=0.014).The direct cause to initiate hemodialysis was mainly heart failure/edema in DN group and uremic symptoms in non-DN group.In the second 10-year period,blood urea nitrogen (30.427±14.519 mmol/L vs.24.865±7.517 mmol/L,t=-1.312,P=0.036) increased significantly in all patients,but serum potassium (4.676±0.945 mmol/L vs.5.200±0.745 mmol/L,t=1.880,P=0.037),calcium (2.154±0.369 mmol/L vs.2.395±0.270 mmol/L,t=2.033,P=0.037),and iPTH (399.920±435.836 pg/ml vs.968.000±705.377 pg/ml,t=2.399,P=0.020) were controlled better than those in the first 10year period.Most patients initiated hemodialysis with central venous catheterization as the blood access.The proportion of arteriovenous fistula (AVF) for blood access had no significant change.Conclusions The leading primary disease of MHD was glomerulonephritis in our center,but the proportion of DN as the primary disease increased significantly in recent 10 years.DN patients initiated MHD earlier and often due to the refractory heart failure/edema.Controlling of chronic kidney disease complications became better in the recent 10 years.We should carefully take account of the appropriate time to create and the use of AVF in CKD patients.

Objective To investigate the clinical characteristics and laboratory examinations in incident dialysis effect on the prognosis of elderly patients undergoing hemodialysis.Methods Ninety-three patients aged 65 years or older initiating hemodialysis were enrolled from Hemadialysis Center of Beijing Hospital from January lst,2007 to June 30th,2016.The duration time of HD of all patients was more than three months.Patients were divided into death group and non-death group.The clinical characteristics and laboratory examinations were compared between the two groups.Cox proportional hazards regression was used for the multivariate analysis to determine independent prognosis factors.Results The average year of patients was 74.2±6.5 years old with 43 months of median time of follow-up.The first two causes of death were infection (n =25,49.0％) and cardiovascular and cerebrovascular diseases (n =16,31.4％).Cox single factor regression analysis showed that the older ages,diabetic nephropathy being the cause of end-stage renal disease (ESRD),complicating with diabetes mellitus or congestive heart failure,the higher Charlson cardiovascular diseases score,ALB being under 35 g/L were correlated with poor outcome respectively(P＜0.05).Cox multivariate regression analysis indicated that older ages (HR =1.056,P =0.021),diabetic nephropathy being the cause of ESRD (HR =2.661,P =0.001),the higher Charlson cardiovascular diseases score (HR =1.675,P =0.010),central venous catheters being vascular access(HR=1.167,P=0.048) on incident dialysis were the main risk factors for mortality in elderly patients.Conclusion The older ages,diabetic nephropathy being the cause of ESRD,the higher Charlson cardiovascular diseases score,central venous catheters being vascular access on incident dialysis are independent risk factors influencing survival of elderly patients.

Background: MicroRNAs (miRNAs) are part of the brain's response to ischemia. This study aimed to screen potential miRNAs for the prediction and novel treatments of ischemic stroke. Methods: Two mRNA and 1 miRNA microarray expression profile data were downloaded from the Gene Expression Omnibus database. Then, differentially expressed mRNAs and miRNAs were identified. Based on the miRNA-target pairs predicted, an miRNA-target interaction network was established. Bioinformatics analysis (Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment) was applied to interpret the function of the miRNA targets. Results: In total, 16 differentially expressed miRNAs and 1345 differentially expressed genes were identified in ischemic stroke, respectively. Importantly, 445 miRNA-target pairs with an inverse correlation of expression were obtained, and the miRNA functional synergistic network was generated. Two miRNAs (miR145 and miR-122) may represent potential biomarkers in ischemic stroke by being involved in the process of postischemic neuronal damage and thrombosis, respectively. Three novel miRNAs (miR-99b, miR-542-3p, and miR-455-5p) were deregulated, suggesting their roles in the pathological processes of ischemic stroke. Functional annotation indicated that apoptotic signaling cascades play an important role in patients with ischemic stroke. Conclusion: miR-145 and miR-122 represent new biomarkers and underlying targets for the prevention and treatment of ischemic stroke. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

BACKGROUND To identify the relationship between predialysis pulse wave velocity (PWV), postdialysis PWV during 1 hemodialysis (HD) session, and deaths in maintenance HD patients. METHODS 43 patients were recruited. PWV was measured before and after one HD session and dialysis- related data were recorded. Clinical data such as blood pressure, blood lipids, and blood glucose, were carefully observed and managed in a 5-year follow-up. The association between all-cause death, predialysis PWV, postdialysis PWV, change of PWV (ΔPWV), and other related variables were analyzed. RESULTS After 5 years, 17 patients (39.5%) died. Univariate Cox regression analysis showed that all-cause death of the patients significantly correlated with age, postdialysis PWV, and ΔPWV. Multivariate Cox regression analysis revealed that postdialysis PWV was an independent predictor for all-cause death in these patients (HR: 1.377, 95% CI: 1.146 - 1.656, p = 0.001). CONCLUSION Elevated postdialysis PWV significantly correlated with and was an independent predictor for all-cause death in maintenance HD patients.

目的 探索适合血液透析患者的系统饮食教育,改善透析患者的钙磷水平,提高患者的营养状况.方法 组建健康饮食教育团队,筛选40例高磷血症维持性血液透析患者,采取责任护士分组管理,通过集体教育、个体化教育的系统饮食教育,干预3个月后,采取自身前后对照研究的方法评估患者营养状况及钙磷代谢变化.结果 3个月后,患者血磷由(2.12±0.31) mmol/L下降到(1.68 ±0.49) mmol/L(P＜0.01),全段甲状旁腺激素由(824.52±588.07) ng/ml下降到(567.61±526.59) ng/ml(P＜0.05).结论 通过集体教育、个体化教育的系统饮食教育,可以提高患者健康饮食知识水平和依从性,改善饮食习惯,减少磷的摄入,血磷水平下降,改善患者的钙磷代谢.

Objective To investigate the association between the type of vascular access and erythropoietin(EPO)dose in maintenance hemodialysis(MHD)patients with targeted hemoglobin level. Methods We selected 115 patients on MHD met inclusion and exclusion criteria retrospectively during the period from January 2014 to June 2014 from three hospitals in Beijing and compared the difference of EPO dose between arteriovenous fistula(AVF)and central venous(CVC)group.Univariable analysis followed by multiple liner regression analysis was performed to identify the independent risk factors for EPO dose.Results There were similar serum ferritin,albumin,iPTH level between AVF and CVC patients.However,EPO dose were significant higher in CVC patients compared with AVF patients (P <0.05).It had been associated with increase in total weekly EPO dose by 27.5% in CVC patients. Conclusion The type of vascular access is an independent factor influencing EPO dose in MHD patients with targeted serum hemoglobin level.

目的 通过多频生物电阻抗法(multifrequency bioelectrical impedance analysis,MBIA)评估临床干体质量达标的维持性血液透析(maintenance hemodialysis,MHD)患者理想干体质量达标情况,明确氨基末端前体脑钠肽(N-terminal pro brain natrinuretic peptide,NT-proBNP)对本组患者容量超负荷的诊断价值.方法 选取血液净化中心临床干体质量达标的MHD患者共105例,采用MBIA法完成人体体液成分测定,得到细胞外液量(extracellular Water,ECW)与身体总水量(total body water,TBW)的比值(ECW％),确定理想干体质量是否达标,同时检测透前NT-proBNP,分析ECW％的相关影响因素,通过ROC曲线确定NT-proBNP定性诊断容量超负荷的最佳诊断临界值. 结果 应用MBIA法测定本组患者ECW％,平均值为0.39±0.01,以校正的ECW％应用公式确定本组患者理想干体质量,结果显示在本组患者中仍有51.4％(54/105例)的患者未达到理想干体质量.年龄与ECW％呈正相关关系(r=0.578,P=0.000);性别(r=-0.251,P=0.010)、脱水量(r=-0.226,P=0.020)、各点舒张压(r值分别为0.336、-0.374、-0.281,P值分别为0.000、0.000、0.004)与ECW％呈负相关关系;多元线性回归分析显示年龄是ECW％的独立影响因素(β=0.451,t=4.892,P=0.000).血清NT-proBNP水平与ECW％呈正相关关系(r=0.340,P=0.000).理想干体质量达标组与未达标组的NT-proBNP中位数分别为3321pg/ml和5407pg/ml,差别有显著统计学意义(z=-3.802,P=0.000),经ROC曲线分析显示NT proBNP诊断理想干体质量不达标的曲线下面积为0.715(P=0.000),NT-proBNP浓度在3937pg/ml时具有最高灵敏度(0.704)和特异度(0.627),此截点值可作为理想干体质量定性评定的参考临界值. 结论 年龄及NT-proBNP水平与MHD患者ECW％密切相关,NT-proBNP可以作为定性评价MHD患者容量状态的临床标志物,NT-proBNP截点浓度3937pg/ml可作为临床定性判断是否干体质量达标的参考临界值.