Objective To explore the application value of urinary calprotectin in adult acute kidney injury（AKI） by observing urinary calprotectin concentration in adult AKI patients and healthy people. Methods Fifty patients with AKI（AKI group） and 30 healthy people（healthy control group） were selected to determine the indexes of urinary calprotectin, serum creatinine, blood urea nitrogen, urinary kidney injury molecule-1（KIM-1）, blood albumin and hemoglobin. General clinical data and laboratory indexes were compared between the two groups. ROC curve was used to analyze the predictive value of urinary calprotectin for adult AKI. Results Urinary calprotectin, urinary KIM-1, serum creatinine and blood urea nitrogen were higher in AKI group than in healthy control group（t=10.113, 9.152, 11.119 and 9.049 respectively; P＜0.001）. Urinary calprotectin was positively correlated with serum creatinine（r=0.794, P＜0.001）, urea nitrogen（r=0.462, P=0.001） and urinary KIM-1（r=0.409, P=0.003）, and was negatively correlated with serum albumin（r=-0.620,P=0.042） and hemoglobin（r=-0.289, P＜0.001） in AKI group. When the diagnostic limit of urinary calprotectin for adult AKI was set at 55.17ng/ml, the area under the ROC curve was 0.747（95% CI: 0. 641～0.853）,with the sensitivity of 62.0% and specificity of 90.0%. Conclusion Urinary calprotectin concentration was significantly increased, and was positively correlated with serum creatinine, blood urea nitrogen and urinary KIM-1 levels in adult AKI patients. The sensitivity and specificity of urinary calprotectin for the diagnosis of adult AKI are higher. Therefore, urinary calprotectin has an important clinical value in the prediction and evaluation of therapeutic effect and recovery process in adult AKI patients.

目的 通过观察成人急性肾损伤(acute?kidney?injury,AKI)患者和健康人群中尿钙卫蛋白(calprotectin,CLP)浓度水平,来探究尿CLP对成人AKI的预后评估价值.方法 选择潍坊市人民医院自2020年12月至2021年11月确诊为AKI的患者50例(AKI组)和健康体检中心的健康人群30名(健康对照组),检测两组研究对象的尿CLP、血肌酐、血尿素氮、尿肾损伤因子1(kid-ney?injury?molecule-1,KIM-1)、血白蛋白和血红蛋白等指标,同时收集一般资料,比较两组间上述检测指标的差异性.然后对上述AKI组患者随访90?d后进行分组,行肾脏替代治疗(renal?replace-ment?therapy,RRT)治疗的患者归为透析组,未行RRT治疗的患者归为非透析组;90?d后死亡的患者归为死亡组,未死亡的患者归为存活组,进行相关指标的比较,绘制受试者工作特征曲线(receiv-er?operating?characteristic?curve,ROC)曲线和AKI患者的生存曲线(乘积极限法),评价尿CLP在成人AKI预后中的价值.结果 AKI组患者尿CLP[(65.02?±?33.75)?μg/L比(37.85?±?17.33)?μg/L]、尿KIM-1[(52.21?±?30.91)ng/L比(30.86?±?15.38)ng/L]、血肌酐[(538.62?±?233.91)?μmol/L比(62.03?±14.27)?μmol/L]、血尿素氮[(20.85?±?9.38)?mmol/L比(5.26?±?1.02)?mmol/L]浓度较健康对照组增高.透析组患者的血肌酐[(654.53?±?218.68)?μmol/L比(478.91?±?221.49)?μmol/L]、尿CLP[(92.26?±?29.26)μg/L比(50.99?±?26.82)?μg/L]和尿KIM-1[(65.69?±?40.76)ng/L比(45.27?±?22.04)ng/L]水平较非透析组高,尿CLP预测成人AKI患者进行RRT治疗的诊断界值在76.92?μg/L时,ROC曲线下面积为0.850,敏感度和特异度分别为76.5％和87.9％.死亡组和存活组的尿CLP、血红蛋白、尿KIM-1、血尿素氮、收缩压和舒张压水平比较差异均无统计学意义.尿CLP预测成人AKI患者90?d病死率的曲线下面积为0.564,敏感度和特异度分别为76.5％和87.9％.透析组和非透析组90?d病死率差异无统计学意义(P>0.05).结论 成人AKI患者尿CLP水平较健康对照人群显著升高,尿CLP在预测AKI患者RRT需求方面显示出了一定程度的准确性,但是在预测AKI患者90?d病死率方面表现不佳.

目的:探讨血清syndecan-1在成人急性肾损伤(acute kidney injury,AKI)诊断中的临床价值.方法:选取47例AKI患者(AKI组)和30例健康志愿者(对照组),检测两组血清syndecan-1、血清肌酐、血尿素氮、血清肾损伤因子-1(kidney injury molecule-1,KIM-1)、血白蛋白和血红蛋白等指标,同时收集人口统计学资料,比较两组指标的差异.采用ROC曲线分析血清syndecan-1对成人AKI的预测价值.结果:AKI组血清syndecan-1、KIM-1、血肌酐、尿素氮的水平明显高于对照组.AKI组血清syndecan-1和血清肌酐、血尿素氮、血KIM-1水平呈正相关,与血白蛋白、血红蛋白水平呈负相关.校正性别、年龄、血肌酐、尿素氮、收缩压、舒张压等因素后,血清syndecan-1仍与血清KIM-1和血肌酐水平呈正相关.血清syndecan-1诊断急性肾损伤的ROC曲线下面积为0.872,敏感度和特异度分别为78.7％和90％.结论:血清syn-decan-1浓度在成人AKI患者中明显升高,其诊断AKI的灵敏度和特异度较高,提示syndecan-1在诊断成人AKI中具有重要临床价值,可作为诊断早期AKI的敏感指标.

左乙拉西坦是一种广谱抗癫痫药物，主要用于部分性癫痫和全面性癫痫的单药治疗或辅助治疗。报道左乙拉西坦导致低钾血症1例，旨在提供低钾血症的病因分析、诊断、治疗经验，为临床用药安全提供参考。

维持性血液透析(maintenance hemodialysis,MHD)患者由于体内毒素蓄积、氧化应激和一些透析相关的因素,体内的单核巨噬细胞持续活化,机体存在低水平、持续的炎症状态,外周血清炎症因子水平升高,这种没有全身或局部显性的临床感染的状态称为微炎症状态.微炎症状态已被证实与MHD患者预后不良密切相关,C反应蛋白水平升高是其预后不良的独立危险因素.目前应用于改善微炎症状态的治疗方案较多,如他汀类药物、维生素C[1]、血管紧张素转化酶抑制剂(angiotensin-convert ing en-zyme inhibitor,ACEI)和血管紧张素受体拮抗剂(angiotensin receptor antagonist,ARB)类药物、抗抑郁药物、中药治疗、紫外线照射、抗氧化应激、营养干预、改善透析膜生物相容性等,但其疗效评估仍缺少大量临床数据的支持,行之有效的微炎症状态的治疗方案尚在不断探索中.

在局部解剖教学上肢解剖操作中发现,1成年男尸左侧肱二头肌为4个头(图1).该类变异中国人体发生率为2.25％[1,2],比较少见,现报道如下. 左上肢肱二头肌呈现4个头,长头、短头的起止、行程、神经支配及血液供应未见变异.在短头内后方,见一索状肌束,长21.50 cm,宽1.05 cm,厚0.82 cm,起于喙肱肌止点上方的肱骨内侧面,穿喙肱肌肌腹的中下部,在肱骨中下部肘窝上方9.44 cm处与短头会合.在肱骨体下半前内侧面肱二头肌短头内后方,见一扁薄肌束,长15.32 cm,宽2.03 cm,厚0.71 cm,起于肱骨干,向下在肘窝上方1.12 cm处附着于肱二头肌肌腱.