目的：：结合生物电阻抗( bioimpedence analysis,BIA)及颈动脉超声对透析病人营养不良状态与动脉硬化相关性进行早期评估。方法：随机选择我院维持性血液透析病人(maintenance hemodialysis,MHD)46例,透析时间均大于3个月,根据颈动脉彩超有无颈动脉粥样斑块形成分为两组,颈动脉斑块形成31例,无颈动脉粥样斑块形成15例,分别测定两组患者的超敏C反应蛋白( hs-CRP)、血清前白蛋白( PA)、白蛋白( Alb)、血红蛋白( Hb)、颈动脉中层厚度( IMT)。生物电阻抗测定体质指数( BMI)、去脂体重( FFM)、体脂百分比( Fat%)、体脂肪量。结果：两组患者的体脂百分比差异存在统计学意义(P<0.01),两组患者的体重指数、去脂体重、白蛋白、前白蛋白、H-CRP、Hb、iPTH、收缩压及透析龄亦差异存在统计学意义(P<0.05)。结论：BIA可以反应病人营养状况,尤其是肌肉含量减少,脂类含量异常,与hs-CRP升高及动脉硬化正相关性,与血清白蛋白、血红蛋白呈负相关,可较好预测营养状态及动脉硬化风险。

Objective To evaluate the fluid distribution in patients on maintenance hemodialysis(MHD)by the whole-body bioimpedanc spectroscopy and investigate its effect on blood pressure in MHD patients. Methods A total of 64 patients with stable MHD for more than 3 months were enrolled in this study. Based on inter-dialysis blood pressure control,they were divided into ideal blood pressure group(41 cases)and refractory hypertension group(23 cases). Preand post-dialysis intracellular water(ICW)and extracellular water(ECW)were measured by whole-body multifrequency bioimpedance spectroscopy,and standardized by body weight to produce ICW% and ECW% . 64 normal individuals of matched sex,age and body weight were used as controls. Results The pre-HD ECW% was significantly higher than those of normal controls(P < 0. 01). Patients with MHD had higher pre- and post-dialysis ECW% values than those without hypertension. Conclusion MHD patients have higher pre-dialysis ECW% . MHD patients with hypertension are significantly higher than the ideal blood pressure control group.

目的 调查泌尿道感染的细菌分布及主要致病菌大肠埃希菌对临床常用20种药物的耐药性,为临床合理选用抗菌药物提供依据.方法 按全国临床检验操作规程鉴定菌种,用K-B纸片法进行药敏试验,结果 依据CLSI标准判断,分析尿路感染患者清洁中段尿培养的结果 以及泌尿系统感染的主要致病菌大肠埃希菌对抗生素的耐药性.结果 泌尿系感染检出大肠埃希菌占检出细菌总数的36.29%,其次为葡萄球菌属.大肠埃希菌对亚胺培南、哌拉西林/三唑巴坦、阿米卡星、替卡西林/棒酸、阿莫西林/棒酸和头孢西丁耐药率较低,分别为0.9%、5.4%、7.1%、9.8%、10.7%和14.3%,而其他常用抗生素的耐药率均＞50%.大肠埃希菌ESBILs(+)细菌的检出率较高,ESBLs(+)菌对头孢菌素的耐药率普遍高于ESBLs(-)菌(P＜0.05).结论 尿路感染的主要致病菌为大肠埃希菌,其对临床常用20种药物的耐药性率较高,临床医生应当根据药敏试验来选择抗生素,指导临床抗感染治疗.

Objective To detect the methylation levels of genomic DNA in patients with systemic lupus erythematosus (SLE). Methods DNA was extracted from SLE patients and healthy controls. DNA methylation levels were detected by high-performance capillary electrophoresis. Results The levels of DNA methylation was lower in the SLE patients than in the controls (P < 0.05). DNA methylation levels differed significantly between the patients with active SLE or with stable SLE and the controls (P = 0.012 and P = 0.008,respectively),but no significant difference was found between active SLE and stable SLE. DNA methylation levels were not associated with SLE disease activity index (SLEDAI),anti-nucleosome antibodies,anti-C1q antibodies,ANA,anti-dsDNA antibodies,immunoglobulin,and complements C3 and C4. Conclusions The methylation levels of genomic DNA are decreased in patients with SLE.

Objective To investigate the effect of ultraviolet ray on DNA methylation in systemic lupus erythematosus (SLE) and its role in the pathogenesis of SLE.Methods Peripheral blood mononuclear cells (PBMC) were isolated from 45 SLE patients and 20 healthy controls and were cultured in vitro.Then they were irradiated with 311 nm narrow band-ultraviolet my (NB-UVB) in various dosages.DNA methylation was,detected by high-performance capillary electrophoresis and DNA methyltransferase 1 (DNMT1) mRNA expression was measured by real-time quantitative PCR.Results The level of DNA methylation in SLE pafients was lower than that in the control group (P=0.014).DNA methylation was,decreased after UVB exposure with the dosage of 50,100 mJ/cm2 (P＜0.01),but no significant difference could be found in the DNMT1 mRNA expression.No significant correlation was found between the level of DNA methylation and systemic lupus erythematosus activity index (SLEDAI).Conclusion Changes take palce in DNA methylation after UVB exposure,and UVB may affect the pathogenesis of SLE by changing DNA methylation.

Aim To probe the influence of variablesodium dialysis on the changes in blood pressure of patients with maintenance hemodialysis.Methods The patients in our hospital were diviged into groups in terms of their blood pressure.Hypertensive patients are in group-A,optimal blood pressures patients are in group-B.The therapeutic schemes on the patients of the two groups were both based on the original therapy,they would receive variablesodium dialysis(VSD)for 3 months after their receiving standardsodium dialysis(SSD)for 3 months,for the purpose of investigating the influence of serum sodium concentration and blood pressure with different therapeutic schemes on patients in the two groups.Results Blood pressure was changed after different therapeutic schemes.The blood pressure of patients with hypertension(Group A)was obviously improved 3 months after VSD treatment,while that of patients with optimal blood pressures(Group B)was recognizably increased 3 months after SSD treatment.There was statistical significance in the data on the two groups,(P0.05),however after patients with hypertension(Group A)was received SSD for 3 months,there was no statistical significance in the changes of blood pressure.The two therapeutic schemes had no notable effect on the sodium serum concentration.Conclusions Variablesodium dialysis(VSD)had a favorable effect on the blood pressure of patients with maintenance hemodialysis and no notable changes on the concentration of their serum sodium concentration,however when it came to the patients in different subgroups,there was a different effect on their blood pressure.

Objective To monitor the real-time blood volume of the patients with maintenance hemodialysis via online blood volume monitoring and variablesodium dialysis(VSD),and work out individualized dialysis plan.Methods 40 patients with treatment of maintenance standardsodium dialysis(SSD)were divided into groups in terms of the fact whether they occurred iteratively the hypotensive reaction or not during treatment.Simultaneously the blood volume of patients in each group was real-time monitored.Based on real-time monitoring patients of the above two group,to observing the record threshold of average △BV in the process of ultrafiltration by applying VSD,meanwhile,observing the △BV between the two treetment.Results The patients who were prone to iteratively occur the hypotension in the process of ultrafiltration showed the statistical differences(P>0.05)in many aspect,such as age,the age of dialysis,single total ultrafiltration,plasma albumin,hemoglobin,etc.Such uncomfortable reaction as hypotension was reduced after VSD base on this,as well as there was statistical significance.There was a different threshold of volume with statistical significance compared to SSD.After 3 month VSD treatment,we also found that the blood pressure of patients with hypertension was obviously improved compared with patients without treatment.Conclusion Our study shows that the factors that can put impact on the threshold change of blood volume of patients with hemodialysis are primary disease,age,age of dialysis,increasing degree of weight in the process of dialysis and the nutrition status.VSD can improve the hypotensive reaction;and the threshold of blood volume has a remarkable change.VSD has a favorable control on the blood pressure of patients with hypertension compared to SSD.

Objective To evaluate the correlation between homocysteine(Hcy),hypersensitivity C-reactive protein(hsCRP),tumor necrosis factor-α(TNF-α)and atherosclerosis(AS)in the maintenance hemodialysis patients(MHD).Methods The level of Hcy,hs-CRP,TNF-α,serum creatinine,serum uric acid,glucose,albumin,triglyceride(TG)and total cholesterol(TC)were measured from 40 patients who had more than 1 years maintenance hemodialysis history.Intima-medial thickness of carotid arteries and the presence of atherosclerotic plaque were measured by ultrasonography.Results In MHD with AS group the level of serum Hcy,hsCRP and TNF-α was significantly higher than that without AS.The difference between the two groups was statistically significance(P<0.05).Meanwhile,there was no significant differences on serum TC,TG,blood pressure,pulse pressure,glucose,albumin and uric acid between two groups.Conclusion The increased level of serum Hcy,hsCRP and TNF-α could be used as independent dangerous factors for AS in MHD patients.

目的观察可调钠透析对预防血透中低血压的作用.方法对维持血液透析病人进行标准钠透析(透析液Na+浓度138 mmol·L-1和可调钠透析(Na+mmol·L-1由148阶梯下降至135 mmol·L-1),治疗前后自身对照透析中血压的变化.结果标准钠透析与可调钠透析在透析中低血压的发生率分别为28.5%和6.1%,两者比较差异有显著性(P＜0.01).结论可调钠透析可减少血液透析中低血压的发生,且不增加病人钠负荷、不引起病人口渴以及透析间期体重增加过多.

OBJECTIVE To discuss the clinical application of clearance monitor by no heparin hemodialysis. METHODS First, filled the line with physiological saline contained heparin. Then connected the line and emptied the physiological saline. Washed the dialyzer and line with 150～200 ml PS per 15～30 minutes during the course of hemodialysis. Observed the effect to the patient of hemorrhage, coagulation and the level of Kt/V. RESULTS There were 58 cases of the 12 patients who were acute or chronic renal failure with serious danger of hemorrhage. We did not find more serious hemorrhage. But some patients' time of hemodialysis was shorter and the effect of hemodialysis was declined because of coagulation. CONCLUSIONS Hemodialysis without heparin was safe and easy for the patients with serious danger of hemorrhage. But some patients whose effect of hemodialysis was declined need increase the times of hemodialysis.

目的对比观察常规减量法和隔日减量法对原发性肾病综合征(PNS)复发率的影响,探讨何种方法更为合理.方法取88例PNS患者经足量强的松治疗8周、完全缓解者62例为研究对象,随机分为两组:常规减量组(n=30)和隔日减量组(n=32).两组减至维持量均治疗12个月,随访2年.结果常规减量组和隔日减量组一年内复发率分别为33.3%和12.5%,有显著性差异(P＜0.05);第二年复发率分别为20.0%和15.6%,无显著性差异(P＞0.05);两年累计复发率分别为53.3%和28.1%,有显著性差异(P＜0.05);两组并发症无显著性差异.结论使用激素治疗PNS,首次大剂量治疗8周获临床缓解后,采用隔日减量法较常规减量法明显降低PNS的复发率,同时副作用无差异.