目的 研究血液透析(HD)患者中心静脉导管相关性感染(CRI)发生与人白细胞抗原(HLA) DQA1基因多态性的关系和Cox回归模型对发病风险预测价值.方法 选取2019年1-12月山东省烟台毓璜顶医院置人中心静脉导管(CVC)进行HD治疗的398例患者为研究对象,患者首次CVC置管时采集患者基本资料,同时完善实验室检查并检测HLA-DQA1基因多态性,随访透析期间CRI发生情况,根据结果将患者分为CRI组和未感染组,比较两组临床资料和检测结果,分析影响CRI发生的影响因素及其预测价值.结果 398例HD患者中发生CRI者67例,占16.83％,CRI组年龄、糖尿病占比、白细胞计数(WBC)、中性粒细胞占比(N％)、C-反应蛋白(CRP)、降钙素原(PCT)、股静脉置管比例和HLA-DQA1* 0102等位基因分布频率高于未感染组,血清白蛋白(ALB)水平低于未感染组(P＜0.05);Cox回归分析显示,年龄、股静脉置管和HLA-DQA1* 0102等位基因是CRI发生的影响因素(P＜0.05),血清ALB水平为保护因素(P＜0.05);年龄、ALB、股静脉置管、HLA-DQA1*0102以及各因素联合诊断预测HD患者CRI发生风险的AUC分别为0.583、0.622、0.556、0.562和0.662,灵敏度分别为92.54％、50.75％、43.28％、28.36％和80.60％,特异度分别为24.77％、69.18％、69.18％、82.78％和47.43％.结论 HD患者CRI发生与HLA-DQA1基因多态性关系密切,同时还受年龄、ALB和股静脉置管等因素影响,综合评估各种因素可为预测CRI发生风险提供参考信息.

Objective To observe the effect of levocarnitine combined with hemodialysis in the treatment of patients with uremic peripheral neuropathy.Methods Eighty-four patients with uremic peripheral neuropathy were randomly assigned to hemodialysis group(HD,n=30),hemodiafiltration group(HDF,n=27),or levocarnitine combined with hemodialysis group(LCN + HD,n=27).Patients in HD group received regular hemodialysis thrice a week.Patients in HDF group received regular hemodialysis twice a week and hemodiafiltration once a week.Patients in L-CN+HD group were given levocarnitine 2.0g dripped and intravenously thrice a week.Clinical symptoms and the sensory conduction velocity(SCV)of median nerve,tibial nerve and lateral popliteal nerve were observed in the three groups at baseline and after the treatment for 8 weeks.Results In HDF and L-CN+HD groups after the treatment for 8 weeks,peripheral neuropathy symptoms of Pain in the extremities、Sensory disturbances、 Numbness、Restless Legs Syndrom improved,as compared with HD group(χ 2 =13.87,17.52,25.37,9.20;P0.05),and SCV of L-CN+HD and HDF groups after the treatment became faster than that before treatment(t=L-CN+HD/ HDF=10.1/12.3,12.7/13.4,16.8/18.1;P0.05),with wider range of SCV change in treatment group than in HD group(F=25.63,32.83,22.5;P0.01).While the changes of SCV before and after the treatment for 8 weeks were statistically indifferent between HDF group and L-CN+HD group(F=0.613,P0.05).Conclusions Both levocarnitine combined with hemodialysis and hemodiafiltration are effective for the treatment of patients with uremic peripheral neuropathy.

Histone deacetylase inhibitors (HDACis) have shown significant antiproliferative and apoptotic properties in various types of cancer cells, including prostate cancer cells, and are therefore being evaluated as a treatment modality. However, the mechanism by which sodium butyrate (SB) induces apoptosis is not completely understood. We focused on SB which exists in the intestine and is therefore expected to have less adverse effects. In this study, three prostate cancer cell lines (LNCaP, DU145 and PC-3) were treated in vitro with different concentrations of SB. Cell proliferation was studied by the XTT assay; cell cycle analysis and induction of apoptosis were studied by laser scanning cytometry. Western blot analysis was used to study p21, p27, CDK2, CDK4, CDK6, caspase-3, caspase-7, Fas, FADD, TRADD, Bcl-2 and Bax protein expression. SB inhibited cell growth and induced apoptosis in a concentration-dependent manner in human prostate cancer cells (LNCaP, DU145 and PC-3). Western blot analysis showed dose-dependent increases of p21 levels in DU145 and PC-3 cells, and dose-dependent decreases of CDK2, CDK4, CDK6 and procaspase-3 protein levels in all three prostate cancer cell lines. Bcl-xL was significantly down-regulated in DU145 cells, and Bcl-2 was significantly down-regulated in PC-3 and LNCaP cells. No significant changes were observed in procaspase-7, TRADD and Bax expression, although slight decreases in Fas and FADD expression were seen in all three prostate cancer cell lines. Analysis of cell morphology using laser scanning microscopy detected condensed and fragmented nuclei. In conclusion, SB induces G1 and G2 arrest by increasing p21 expression resulting in CDK2, CDK4 and CDK6 down-regulation. SB potently induced apoptosis, which was accompanied by DNA fragmentation, down-regulated Bcl-2 in LNCaP and PC-3 cells, Bcl-xL in DU145 cells, and down-regulated procaspase-3, but not procaspase-7, in these human prostate cancer cell lines. These results suggest that SB may serve as a new modality for the treatment of hormone refractory prostate cancer.