血管钙化是慢性肾脏病患者常见的并发症之一,是导致其心血管事件发生和猝死的重要原因.在慢性肾脏病病因中,高血压肾病已成为第三位,而高血压可以导致动脉血管硬化,引起心血管事件发生,有研究表明动脉血管硬化是机体异位钙化的最常见部位[1,2].因此,研究高血压肾病患者中血管钙化具有重要意义.血管钙化是由多因素参与的主动调节过程,调节机制比较复杂,主要调节机制为钙化激活和钙化抑制,分别由相应的因子参与.胎球蛋白A就是钙化抑制因子之一,对异位钙化具有抑制作用.高血压肾病患者的血管钙化是否与血清胎球蛋白A水平有关,目前尚缺乏相应的临床证据.本实验通过对高血压肾病患者血清胎球蛋白A水平及相关项目的检测,探讨它与血管钙化的关系.

Objective To investigate the incidence of restless legs syndrome (RLS) in hemodialysis patients and to analyze the related risk factors. Methods There were 220 cases of hemodialysis as hemodialysis group and 40 cases of chronic nephrosis as control group. The severity of RLS was measured by International Restless Legs Syndrome Study Group Rating Scale (IRLS). Beck Depression Inventory (BDI) was used to evaluate the status of depression, Epworth Sleepiness Scale (ESS) was used to evaluate excessive daytime sleepiness (EDS), and Insomnia Severity Index (ISI) was used to evaluate the status of insomnia. Univariate and multivariate forward Logistic regression analysis was used to analyze the related risk factors for RLS in hemodialysis patients. Results In hemodialysis group duration ( Z =-9.837, P = 0.000), serum ferritin ( t = 2.847, P = 0.005), incidence rate of RLS ( χ 2 = 10.918, P = 0.001), the proportion of using hypnotic drugs ( χ 2 = 7.669, P = 0.006), IRLS ( t = 2.322, P = 0.020) and ISI ( Z = 4.117, P = 0.001) were significantly higher than control group. Univariate and multivariate forward Logistic regression analysis showed diabetes ( OR = 3.387, 95% CI: 1.538-7.461; P = 0.002), BDI > 9 score ( OR = 2.643, 95% CI: 1.457-4.795; P = 0.001) and ISI > 7 score ( OR = 3.542, 95%CI: 1.939-6.468; P = 0.000) were independent risk factors for RLS in hemodialysis patients. Conclusions Hemodialysis patients have a high incidence of RLS and insomnia. RLS is closely related with insomnia. Depression plays an important role therein. DOI: 10.3969/j.issn.1672-6731.2018.01.009

Objective To compare the effect of one-step and two-step approach in establishing 5/6 nephrectomy model of renal failure.Methods One-step and two-step approach were used to establish the model of 5/6 nephrectomy, and the mortality rate and the levels of creatinine and urea nitrogen were recorded in the two groups at the end of week 4, week 8 and week 12 after the operation.Results The mortality rate was 17.65% in the one-step group at the end of the 4th week, compared with 29.41% in the two-step group at the same time after the operation. The renal failure models were successfully established in the two groups, and there was no significant difference in the levels of creatinine and urea nitrogen between the two groups at the end of the 8th week.Conclusion One-step and two-step approach can successfully establish 5/6 nephrectomy model of renal failure, and the one-step approach may produce lower mortality.

Objective To observe the clinical effect and adverse reactions of low dose of cyclosporine A combined with small dose of hormone in the treatment of idiopathic membranous nephropathy,and to explore the safe and effective treatment strategy.Methods Thirty-seven cases of idiopathic membranous nephropathy admitted at the Department of Nephrology,the First Affiliated Hosital of PLA General Hospital were given low-dose cyclosporine A (1.5～3.0 mg/kg every day) combined with small dose of glucocorticoid (prednisone 0.2～0.4 mg/kg every day).The treatment course was 12～24 months,and the follow-up period was 12-24 months.The clinical efficacy,adverse reactions and complications were observed.At 12th month during the follow-up period,the patients were divided into effective group (complete or partial remission) and ineffective group (no remission).The single factor analysis was used to analyze the prognostic factors.Results In 37 cases,23 cases (62％) achieved complete remission,10 cases (27％) partial remission,and 4 cases (11％) no remission.Eight cases had the effect of cyclosporine A within 4 weeks,and 4 cases relapsed in stopping drug or reducing process.Univariate analysis showed no statistically significant difference in gender between the effective and ineffective groups (P＞0.05).The proportion of the patients in the ineffective group in age,and pathological stage Ⅲ and Ⅳ was significantly higher than that in the effective group,and the proportion of hypertension and microscopic hematuria before treatment in the ineffective group was significantly higher than that in the effective group (P＜0.05).Conclusions Low dose of cyclosporine A combined with low dose of prednisone in the treatment of idiopathic membranous nephropathy is effective.But even such a low dose,after treatment the uric acid level is still significantly increased,because of renal tubular injury caused by cyclosporine A.The patient's age,pathological stage,hypertension and microscopic hematuria all affect the effectiveness of treatment.

糖尿病视网膜病变是糖尿病最严重的微血管并发症之一,防止其发生和发展成为迫切需要.本文综述糖尿病视网膜病变的发病机制及其主要药物治疗研究进展.

目的 研究内皮素受体拮抗剂波生坦对糖尿病小鼠血管病变的保护作用及其机制.方法 60只雄性C57BL/6小鼠随机分为正常对照组、糖尿病对照组、糖尿病药物干预组.链脲佐菌素(streptozotocin,STZ)(70mg/kg)腹腔注射建立糖尿病模型,尾静脉空腹血糖测定检测建模是否成功.模型建立后,糖尿病药物干预组给予波生坦(100 mg/kg)灌胃,1次/d,连续8周;正常对照组、糖尿病对照组给予同等剂量0.9％氯化钠注射液灌胃8周.8周后观察各组主动脉HE染色情况、主动脉实时定量PCR检测血管内皮生长因子(vascular endothelial growth factor,VEGF)、内皮素1(endothelin-1,ET-1)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、基质金属蛋白酶2(matrix metalloproteinases 2,MMP-2)、基质金属蛋白酶9(matrixmetalloproteinases 9,MMP-9)的mRNA表达水平.结果 主动脉HE染色示对照组大致正常;糖尿病组主动脉斑块形成明显,大量炎症细胞浸润;糖尿病药物干预组斑块负荷明显减轻,炎症细胞浸润减少.主动脉实时定量PCR检测结果示糖尿病组与糖尿病药物干预组VEGF mRNA表达低于正常对照组(P＜0.05),ET-1、TNF-α、MMP-2、MMP-9 mRNA表达高于正常对照组(P＜0.05);糖尿病药物干预组VEGF mRNA表达较糖尿病组升高(P＜0.05);糖尿病药物干预组ET-1、TNF-α、MMP-2、MMP-9 mRNA表达较糖尿病组降低(P＜0.05).结论 内皮素受体拮抗剂波生坦对糖尿病小鼠主动脉病变有保护作用.

<正>1临床资料患者男性,24岁,主诉乏力、纳差2月,胸闷、憋气2周于2011年6月12日收入我科,患者2011年6月于当地医院测血压249/149mmHg(1mmHg=0.133KPa),查血尿素氮(BUN)21.8mmol/L,血肌酐(Cr)758umol/L,予以置中心静脉导管,开始血液透析治疗。诊断急性肾损伤3期、恶性高血压、恶性高血压肾损害。入院后查血:血浆凝血酶原

患者女,16岁,因发现"血小板减低10年,尿检异常3个月"于2011年1月17日入解放军总医院第一附属医院.患者5岁时因磕碰后皮下淤斑至当地医院检查示血小板39×109/L,抗血小板抗体阴性,抗核抗体(ANA)及抗ds-DNA抗体阴性,骨髓穿刺未见异常,符合1986年中华血液学会及全国血栓与止血学术会议关于特发性血小板减少性紫癜(ITP)的诊断标准及关于自体免疫特发性血小板减少性紫癜(AI-TP)的诊断标准,诊断为ITP,予甲泼尼龙及丙种球蛋白静脉冲击治疗好转,后予口服泼尼松50 mg/d,但泼尼松减量后复发,再次予泼尼松龙及丙种球蛋白静脉冲击仍可好转,反复发作4次,近6个月口服甲泼尼龙片8 mg/d治疗.