Objective:To systematically evaluate and quantitatively analyze the incidence of AKI in patients with SARS-CoV-2 infection and the relationship between the AKI and clinical prognosis.Methods:After retrieving databases of CNKI, Weipu, Wanfang, China Biomedical Literature Database (CBM), PubMed, and Embase, the literature quality evaluation was carried out according to the the Newcastle-Ottawa scale (NOS) quality evaluation table. The data was extracted by 2 researchers independently, and the Review Manager 5.3 software was used for the meta-analysis of the obtained data.Results:A total of 17 studies were included. The meta-analysis results showed that if the patients with SARS-CoV-2 infection had new-onset AKI, they had significantly increased risks of progression to severe cases (OR=10.25, 95%CI: 7.79-13.49, P<0.01) or death (OR=24.38, 95%CI: 4.87-122.04, P<0.01).Conclusion:The overall incidence of AKI in patients with SARS-CoV-2 infection was not high, but the AKI increased their probability of progressing to severe cases or death. Therefore, once AKI appeared, attention should be paid immediately and corresponding treatment should be given to the patients.

目的:利用系统评价和荟萃分析的方法探究利妥昔单抗对比一线类免疫抑制剂在特发性膜性肾病中治疗的有效性及安全性.方法:以Rituximab、Glomerulonephritis、Membranous、Clinical Trial为检索词,检索PubMed、Medline和Co-chrane Library数据库,以利妥昔单抗/CD20单抗/美罗华、膜性肾病等关键词检索Sinomed、万方和中国知网数据库,检索年限从建库至2020年3月,对符合标准和排除标准的筛选文献进行质量评价和数据提取,采用RevMan5.2软件进行统计分析,主要对比治疗效果(缓解率、尿蛋白、血清白蛋白和肾功能水平)及安全性.结果:共检索145文献,纳入7篇临床试验研究,且纳入研究的整体质量偏高.Meta分析结果提示,利妥昔单抗组同对照组相比在完全缓解率[OR=1.83,95％CI=(0.61,5.50),P>0.05]和部分缓解率上差异无统计学意义[OR=0.78,95％CI=(0.32,1.88),P=0.58],但利妥昔单抗组能更好降低尿蛋白水平[均值差异-1.27,95％CI=(-1.86,-0.67),P<0.0001]并提高血清白蛋白水平[均值差异7.62,95％CI=(0.44,14.79),P=0.04],且两组在治疗后血肌酐水平差异无统计学意义[均值差异-0.04,95％CI=(-0.11,0.04),P=0.35];利妥昔单抗治疗组具有更少的严重不良反应[OR=0.35,95％CI=(0.24,0.35),P<0.0001].结论:利妥昔单抗治疗后的缓解率和血肌酐变化同传统的一线免疫抑制剂相比差异并无统计学意义,但在降低尿蛋白水平及提高血清白蛋白水平具有优势,且利妥昔单抗安全性更好,因此是治疗特发性膜性肾病的重要策略.

单克隆免疫球蛋白沉积病(monoclonal immunoglobulin deposition disease,MIDD)是以单克隆免疫球蛋白及其游离片段轻链和(或)重链沉积于全身组织和器官并引起功能障碍为特征,其中肾脏是最常累及的器官之一.MIDD分为轻链沉积病(light chain deposition disease,LCDD)、轻重链沉积病(light-heavy chain deposition disease,LHCDD)和重链沉积病(heavy chain deposition disease,HCDD)3种类型.其中,LCDD较为多见,而LHCDD和HCDD罕见[1-3].1993年,HCDD才在国际上首次被报道.迄今为止,HCDD的发病机制尚不十分清楚,可能是B细胞无法分泌与轻链结合的单克隆截断重链引起,其中以γ型重链为多[1-3].

目前我国全科医师的规培单位多数为各地区三级甲等医院.全科医师的培养需要面面俱到,覆盖知识广泛,使其对于各系统疾病有一定充分的认识,同时针对疾病的早期发现、诊疗提出了更高的要求.然而,由于血液透析属于专科性质较强的亚专科,全科医师在血液净化中心的学习培训具有更强的专业性,且全科医师与血液透析专科医师培养模式、培养时间大不相同,且目前无相关文章作过对应的探讨.本文主要探讨全科医师如何在较短的轮转时间内掌握血液透析相关知识为主要目的,进而为相关带教提供借鉴.