镇痛剂肾病( analgesic nephropathy,AN)指应用非甾体类抗炎药( NSAIDs)及其复方制剂造成的慢性肾小管间质性损伤、肾乳头坏死及肾衰竭[1].与镇痛性肾病相关的常用药物包括非处方止痛药,如阿司匹林、扑热息痛/对乙酰氨基酚和布洛芬,为了减少这种并发症,开发了新的镇痛/抗炎药物,如COX-2抑制剂.长期过度使用这些药物,可能会发展为慢性肾病和终末期肾病[2].

肾病综合征是儿童时期最常见的肾小球疾病,也是导致儿童暴露于全身性糖皮质激素的主要病因之一.儿童肾病综合征是一种具有挑战性且经常持续存在的肾脏疾病,其发病率在不同种族和地区之间存在差异.皮质类固醇几十年来一直是主要的治疗方法,对大多数患有特发性肾病综合征的儿童有效,但仍有10％ ～15％的儿童对类固醇产生了耐药性.利妥昔单抗,是一种针对B淋巴细胞CD20标记的单克隆抗体,可导致B细胞凋亡,并在儿童肾病综合征的治疗中显示良好的治疗效果.本综述中,我们总结利妥昔单抗在不同类型的儿童肾病综合征中的疗效,已知的和潜在的作用机制,治疗剂量下存在的不良反应和安全性,影响利妥昔单抗治疗的因素,以及利妥昔单抗的活性生物标志物.

目的 观察组织蛋白酶L(Cat L)对糖尿病大鼠肾脏炎症及氧化应激指标的影响,探索Cat L在糖尿病肾病发生发展中的作用.方法 将30只SD雄性大鼠采用随机数字表法分为对照组和糖尿病组,分别为10只和20只.腹腔注射链脲佐菌素建立糖尿病大鼠模型,建立成功后从糖尿病组取10只大鼠每天腹腔注射10 mg/kg Cat L抑制剂Z-FY-CHO,作为抑制剂组.之后4周、8周分别收集三组各5只大鼠24 h尿,采血并处死大鼠取肾组织.全自动生化分析仪检测各组大鼠的尿蛋白、血尿素氮和血肌酐含量,实时荧光定量逆转录聚合酶链反应(qRT-PCR)检测Cat L的mRNA表达,试剂盒测定Cat L活性、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、丙二醛、超氧化物歧化酶(SOD)、谷胱甘肽过氧化酶(GSH-Px)和谷胱甘肽水平并比较.结果 与对照组相比,糖尿病大鼠血糖持续较高、体质量减轻,而肾脏组织中Cat L mRNA表达增加[4周(0.79±0.06)比(1.02±0.14),8周(0.54±0.10)比(0.93±0.19)],且活性增强[4周(218.90±23.35)％比(404.00±94.46)％,8周(283.10±29.99)％比(463.80±85.32)％].与正常大鼠比,糖尿病大鼠尿蛋白增加[8周(52.06±7.75)mg/24 h]、血尿素氮[8周(342.2±54.9)mg/L]和血肌酐[8周(282±68)μmol/L]水平升高;与糖尿病组相比,Cat L拮抗剂处理组大鼠尿蛋白减少[8周(38.12±5.98)mg/24 h]、血尿素氮[8周(228.4±32.3)mg/L]和血肌酐[8周(157±51)μmol/L]水平降低.与正常大鼠比,糖尿病大鼠肾组织中炎性因子IL-1[8周(58.94±27.52)ng/L]、IL-6[8周(39.25±3.47)ng/L]和TNF-α[8周(257.73±78.88)ng/L]水平增加、氧化应激相关指标丙二醛表达增加[8周(0.97±0.14)nmol/mg],SOD、GSH-Px和谷胱甘肽水平降低[8周(25.86±3.62)U/mg、8周(13.03±1.76)U/mg、8周(3.00±0.61)μmol/g],而Cat L拮抗剂抑制了这一改变[8周IL-1(27.84±2.81)ng/L、IL-6(33.41±4.72)ng/L、TNF-α(150.78±56.07)ng/L、丙二醛(0.52±0.18)nmol/mg、SOD(36.55±4.35)U/mg、GSH-Px(18.54±2.26)U/mg、谷胱甘肽(5.93± 1.65)μmol/g].结论 Cat L促进糖尿病大鼠肾脏炎症反应和氧化应激的发生,抑制Cat L可减轻糖尿病肾损伤.

Objective:To research the clinical effects of ulinastatin in the treatment of sepsis induced acute renal injury and its possible mechanisms.Methods:114 cases of patients with sepsis induced acute kidney injury from 2014.02 ～ 2016.08 were selected and randomly divided into the control group (n=57) and experimental group (n=57) according to the draw method,the control group was given conventional treatment,while the experimental group was treated by ulinastatin based on the control group,the urine urinary injury molecule-1 (KIM-1),atrialnatriuretic peptide (ANP),cyscatin-c (CYS-C),interleukin l,6 (IL-1,IL-6),c-reactive protein (CRP),tumor necrosis factor-α(TNF-α),nitric oxide (NO),endothelin 1 (ET-1),immunoglobulin A,G,M (IgA,IgG,IgM) levels,APACHE-Ⅱ score were compared between two groups before and after the treatment.Results:After treatmented,the urine of KIM-1,ANP,serum of CYS-C,IL-l,IL-6,CRP,TNF-α,ET-1 levels and APACHE-Ⅱ score of experimental group were significantly lower than those of the control group (P＜0.05).The serum NO,IgA,IgG,IgM levels of experimental group were significantly higher than those of the control group (P＜0.05).Conclusion:Ulinastatin could significantly relieve sepsis induced acute renal injury,which might be related to the inhibition of inflammatory response,improvement of the renal blood flow and immune function.

Objective To discuss the clinical effect of tacrolimus combined with glucocorticoid in the treatment of adult patients with refractory nephrotic syndrome. Method 80 adult patients with refractory nephrotic syndrome treated in our hospital from January 2013 to January 2015 were selected as object of study, according to the order of admission, they were divided into tacrolimus group (40 cases) and cyclophosphamide group (40 cases) according to the time of admission. Tacrolimus group patients were treated with tacrolimus combined with glucocorticoid, cyclophosphamide group patients were treated with cyclophosphamide combined with glucocorticoid. Before and after treatment, the levels of blood urea nitrogen (BUN), serum creatinine (SCr), total cholesterol (TC), triglycerides (TG), 24 hours urine protein and serum albumin and adverse reactions of the two groups were compared. Result After treatment, the total effective rate of tacrolimus group was 95%, which was significantly higher than that of cyclophosphamide group (82.5%) and the difference was significant (P < 0.05). After treatment, the levels of BUN, TC, TG, SCr and 24 hours urinary protein of the two groups were lower than those before treatment (P < 0.05), serum albumin levels were higher than those before treatment (P < 0.05). There was no significant difference in the incidence of adverse reactions (12.5% vs 5.0%) between the two groups (P > 0.05). Conclusion In the treatment of adult refractory nephrotic syndrome, the e?cacy of tacrolimus combined with glucocorticoid is better than that of cyclophosphamide combined with glucocorticoid and the safety is better.

目的:探讨前列地尔联合参芪扶正注射液治疗IgA肾病的临床疗效.方法:选取2011年3月～2015年7月于我院就诊的IgA肾病患者60例,按照随机数字表法将所有患者分为2组,每组各30例.对照组患者给予前列地尔,实验组患者在对照组的基础上联合使用参芪注射液.比较治疗前后两组患者血清胱抑素C、血肌酐、血尿素氮、血浆白蛋白及24小时尿蛋白水平,同时比较治疗结束后两组患者的临床总有效率.结果:治疗前相比,两组患者治疗后的血清胱抑素C、血肌酐、24小时尿蛋白水平均降低(P＜0.05);血浆白蛋白水平均升高(P＜0.05),且实验组患者血清胱抑素C、血肌酐、血尿素氮及24小时尿蛋白水平较对照组更低(P＜0.05),血浆白蛋白水平更高(P＜0.05).与对照组相比,实验组患者临床总有效率较高(P＜0.05).结论:前列地尔联合参芪扶正注射液能够提高IgA肾病患者的临床总有效率,可能与升高血浆白蛋白水平有关.

目的比较抗角蛋白（antikeratin antibody，AKA）抗体与抗环瓜氨酸肽（cyclic citrullinated peptides， CCP）抗体在早期类风湿关节炎诊断中的意义。方法对40例类风湿关节炎（rheumatoid arthritis，RA）患者、40例非RA患者和40例健康人采用酶联免疫吸附法（ELISA）检测抗CCP抗体，用免疫比浊法检测类风湿因子（rheumatoid factor，RF），用间接免疫荧光法检测抗AKA抗体，并作比较。结果 RA患者抗CCP抗体、抗AKA抗体、RF阳性率分别为82.5%、67.5%、90%，敏感性分别为82.5%、67.5%、90%，特异性分别为97.2%、95%、80%；非RA患者抗CCP抗体、AKA、RF的阳性率为分别2.5%、5%、32.5%；正常对照组1例抗CCP抗体弱阳性，2例AKA低滴度阳性。结论抗CCP抗体及AKA均为早期类风湿关节炎特异性诊断指标，但抗CCP抗体敏感性及特异性高于AKA，联合检测抗CCP抗体、AKA、RF有利于RA的早期诊断。

目的:探讨显微镜下多血管炎肾损害的临床特点,分析误诊的原因。方法:收治显微镜下多血管炎(MPA)患者20例,对临床资料及误诊原因进行分析。结果:20例患者均有肾脏受累表现,肺脏是继肾脏之后最常受累的脏器,确诊前被误诊为系统性红斑狼疮、肺部感染等。结论:肾脏是MPA最常见的受累部位,其次是肺脏,本病临床表现复杂多样,误诊原因主要是对本病认识不足,抗中性粒细胞胞浆抗体(ANCA)检测可提高诊断率。

目的探讨结节性红斑的临床特点及发病原因。方法对28例结节性红斑患者的一般资料、临床特点、辅助检查、治疗及预后进行分析。结果结节性红斑多发生于中青年女性,病因复杂,28例患者中链球菌感染8例,结核杆菌感染8例,系统性红斑狼疮2例,原发干燥综合征2例,白塞病3例,病因不明5例。结论链球菌及结核杆菌感染是结节性红斑的主要病因,其次是结缔组织病,应根据不同病因进行针对性治疗。

目的 观察慢性肾脏病患者血清同型半胱氨酸(Hcy)和B型钠尿肽(BNP)水平的变化情况,及与心脏并发症的关系.方法 将72例慢性肾脏病患者按照美国K/DOQI指南提出的慢性肾脏病分期分为3期组(18例)、4期组(25例)、5期组(29例),采用快速免疫荧光测定法及酶循环法检测血清BNP、Hcy水平,与30例健康正常人(对照组)进行比较.结果 3期组、4期组、5期组血清BNP水平均高于对照组[(110.32±2.35)、(326.41±8.79)、(845.15±5.58) ng/L比(22.52±0.56)ng/L,P＜0.05].5期组血清Hcy水平明显高于对照组[(25.34±10.54) μmol/L比(10.42±3.95)μmol/L,P＜ 0.05].结论 随着患者肾小球滤过率的下降,患者的血清Hcy、BNP水平进行性升高.血清BNP、Hcy水平过高预示患者生存期短。

特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)是一种免疫介导的以血小板减少为主要临床表现的自身免疫性疾病,是临床最为常见的出血性疾病之一.本病多发于儿童和育龄期妇女,近年来,作者在临床工作中观察到老年ITP患者并不少见,且老年ITP患者因其基础病较多,因而在临床表现、治疗效果等方面与年轻患者有所不同.作者自2000年1月至2010年1月对68例老年(≥60岁)ITP患者的临床特点、治疗方案、治疗反应进行分析,对处理老年ITP的经验进行报道.

Objective To analyze the clinical features of the adults allergic purpura.Methods The clinical and laboratorial data of 32 in-patients with adults allergic purpura in the third people's Hosptial Yunnan Province,between Jan 1990 and Jan 2010,were retrospectively collected and analyzed respectively.Results Most patients with adults allergic purpura in this group were male and young adult.Adults allergic purpura occurred more commonly in the winter and the spring.The important predisposing factors were upper respiratory tract infection and having specific seafood.The most common presenting signs were purpuric lesions.Purpura was present in all case,lower extremities were more commonly involved.Joint involvement was observed in 13 cases(40.6%),abdominal involvement in 16 cases(50.0%),renal involvement in 23 cases(71.9%),multiple organ involvement in 16(50.0%).Conclusion The patients with adults allergic purpura have more tendenecy to have severe renal damage and multiple organ involvement.

Objective To investigate the prevalence of anemia in the patients with chronic kidney disease(CKD)and the related factors.Method The data of 465 in-patients with CKD in our hospital from January 2007 to January 2010 were collected and retrospectively analyzed.Results In the 465 patients with CKD,the prevalence of anemia was 72.04%,the prevalence of anemia in patients 30 years,30～50 years,50～70 years,and70 years was 47.06%,60.94%,74.45% and 86.26%,respectively.The prevalence of anemia in patients with CKD in stageⅠ～Ⅴwas 24.19%,43.84%,63.22%,88.61% and 99.39%,respectively.The prevalence of anemia in patients with CKD corrected by GFR was associated with varied underling diseases,and the sequence from high to low was diabetic nephropathy(78.78%),hypertensive nephropathy(66.00%),chronic glomerulonephritis(65.61%)and ploycystic renal disease(60.00%).The prevalence of anemia in dialysis patients and non-dialysis patients was 97.79% and 53.45%(P0.01).Age,kidney function and dialysis were correlated to anemia significantly by monofactor analysis.Conclusions The prevalence of anemia in patients with chronic kidney diease is high.The kidney function and age are identified as independent risk factors of anemia.

目的探讨多发性骨髓瘤肾脏损害的临床特征及其发生的相关因素.方法 对多发性骨髓瘤患者肾脏损害的临床表现及实验室检查进行回顾性分析.结果 肾脏损害发生率42.2%,以慢性肾功能不全最常见.骨髓浆细胞数量、β2微球蛋白(β2-MG)及尿游离轻链与肾功能损害之间有显著相关性(P<0.01);贫血及多发性骨损害与肾功能损害之间有相关性(P<0.05).结论 骨髓浆细胞增殖、β2-MG及尿游离轻链可能是多发性骨髓瘤肾脏损害的主要原因.

目的 总结以血小板减少为首发症状的结缔组织病患者的临床特点,以减少误诊.方法 回顾性分析36例以血小板减少为首发症状的结缔组织病患者的临床资料及治疗效果.结果 36例患者均有不同程度的皮肤、黏膜出血及内脏出血症状,初诊时考虑为原发性血液系统疾病24例,就诊至确诊时间7天～34个月.36例患者经激素治疗后显效23例,良效8例,进步5例,有效率为100%.结论 结缔组织病并发血小板减少较常见,对反复出现血小板减少的患者,应动态监测自身抗体.

目的 分析类风湿性关节炎(rheumatoid arthritis,RA)患者肺部损害的病变特征.方法 对93例RA中有肺部表现的46例患者的临床表现、呼吸系统症状和体征、胸部X线检查和肺功能检查进行回顾性分析.结果 本组RA患者肺部损害发生率为49.5%;呼吸系统表现主要为慢性咳嗽及进行性呼吸困难;体征主要有爆裂音;胸部X线检查表现为肺间质纤维化、胸膜增厚、胸腔积液、肺结节、肺纹理增多和肺部渗出性病变.肺功能损害为限制性通气功能障碍、弥散功能障碍和小气道通气障碍.结论 RA对呼吸系统的损害较常见,应加以重视,RA患者应定期行胸部X线片及肺功能检查.

临床上已有很多证据证明开始血液透析后尿量对患者的重要性,它不仅在一定程度上能有效清除尿毒症的毒素,而且对水盐代谢、高血压、调节钙磷代谢、清除β2-微球蛋白,避免淀粉样物质沉积起重要作用[1].由于致肾功能衰竭的原发病、肾性高血压、药物等因素的影响,导致透析患者的残余肾功能仍以一定的速率进行性丧失[2].在临床上表现为患者尿量减少.影响因素较多,既往研究多关注腹膜透析(CAPD)患者的尿量,作者通过观察2年以内行维持性血液透析(HD)患者超滤量与尿量的变化情况,以提高临床认识并延缓尿量的丧失.

<正>百草枯是近几年国内流行的除草剂。百草枯对人有很强的毒性,目前尚无特效解毒剂[1-3]。国内所有报道都为口服中毒,中毒后病死率极高。我院于2006年7月23-27日收治10例吸入百草枯后出现不良反应的病人,现报告如下。