狼疮肾炎42例临床与病理分析

目的 探讨狼疮肾炎(LN)的临床表现与病理类型之间的关系.方法 对近3年来收治的42例狼疮肾炎(LN)的病例临床特征和病理进行回顾性分析,肾活检病理按照2003年ISN/RPS分型方案.结果 42 例中,男4例,女38例,男女比例为1:9;临床类型:单纯血尿或蛋白尿4例占9.5%,肾炎综合征10例占23.8%,肾病综合征22例占52.4%,急进性肾炎综合征4例占9.5%,慢性肾炎2例占4.8%;病理类型中Ⅱ型2例占7.1%,Ⅲ型3例占10.7%,Ⅳ型16例占57.1%,Ⅴ型7例占25.0%.结论 狼疮性肾炎的病理类型与临床表现、实验室检查有一定联系;肾活检对判断疾病活动性,指导治疗与估计预后有重要意义.     

回顾性分析狼疮肾炎终末期肾病危险因素

目的 研究与狼疮肾炎发展至终末期肾病需透析有关的临床和免疫学高危因素,及其与狼疮肾炎病理分型的相关性.方法 收集60例确诊狼疮肾炎患者,其中21例发展为终末期肾病需要透析治疗.采用单因素分析和多因素方法分析狼疮肾炎发展至终末期肾病需透析与狼疮肾炎临床表现和实验室检查相关性,以及与狼疮肾炎病理分型的相关性.结果 单因素分析年龄、性别、高血压病史、GFR降低和抗ds-DNA抗体等暴露因素在两组间存在差异,多因素分析高血压病史、GFR降低在两组间存在差异(P＜0.05).肾活检病理分型Ⅳ型和Ⅴ型狼疮肾炎与狼疮肾炎发展为终末期肾病有相关性(P＜0.05).结论 高血压病史、GFR降低为狼疮肾炎的主要危险因子.Ⅳ型和Ⅴ型狼疮肾炎预后不良.     

GMP-140水平与狼疮肾炎肾损害的相关性

【目的】了解血浆GMP 140水平与狼疮肾活动、肾病理及肾功能损害的关系。【方法】采用酶联免疫吸附法测定40例血浆GMP 140水平 ,并研究其与狼疮肾组织活动指数、肾组织病理及肾功能损害的关系。【结果】狼疮性肾炎病人血GMP 140水平升高 ,其中WHOⅣ型病人较Ⅲ型、Ⅱ型者明显升高 ;血浆GMP 140水平与狼疮肾活动指数明显正相关 ,与肾病理和功能损害有一定正相关关系。【结论】GMP 140在介导狼疮肾炎中起重要作用 ,其水平可作为反映狼疮肾活动和进行性肾损害的指标。     

抗核抗体荧光核型与狼疮肾炎病理类型的相关性分析

目的 探讨抗核抗体(ANA)荧光核型与狼疮肾炎病理类型的相关性。方法 采用间接免疫荧光法测定75例行肾活检LN患者的ANA荧光核型, 并与56例无狼疮肾炎的系统性红斑狼疮患者对照, 分析ANA荧光核型与狼疮肾炎病理改变的关系。结果 75例狼疮肾炎患者病理类型分属Ⅰ~Ⅵ型者有12例(16.0%)、38例(50.7%)、3例(4.0%)、9例(12.0%)、12例(16.0%)和1例(1.3%)。75例狼疮肾炎患者ANA均为阳性, 56例无狼疮肾炎患者中54例(96%)ANA阳性。在38例Ⅱ型狼疮肾炎患者中均质型ANA占16(42.1%), 明显高于无狼疮肾炎患者的23.2%(P<0.05)。而在12例Ⅴ型狼疮肾炎中, 11例(91.7%)ANA荧光核型为颗粒型或颗粒型/均质型, 明显高于无狼疮肾炎患者的51.8% (P<0.05) 。结论 均质型ANA与Ⅱ型LN发病有关, 而颗粒型或颗粒型+均质型ANA则可能在Ⅴ型LN病变中发挥作用。     

尿液NAG变化对狼疮性肾炎活动性评价意义

目的 :观察狼疮性肾炎患者尿液N -乙酰 - β -D -氨基葡萄糖苷酶 (N -acetal- β -D -glucosaminidase,NAG)的变化 ,探讨其与狼疮活动度的关系。方法 :回顾性分析 5 6例狼疮性肾炎的临床资料。结果 :其中 5 2例狼疮性肾炎患者尿液NAG增高 ,敏感度 92 .8% ,行肾组织病理检查 38例中有 2 6例为Ⅳ型狼疮性肾炎患者 ,其尿液NAG均见明显增高 ,治疗后随着狼疮活动的控制 ,尿液NAG明显下降 (P <0 .0 1)。而活动度相对较低的Ⅱ型狼疮性肾炎 ,尿液NAG仅增高程度显著低于Ⅳ型狼疮性肾炎患者 (P <0 .0 1)。结论 :尿液NAG的变化可以作为评价狼疮活动程度及治疗效果的一个指标。     

狼疮肾炎患者发展为尿毒症的影响因素分析

目的探讨狼疮肾炎患者发展为尿毒症的影响因素。方法收集85例确诊狼疮肾炎患者,其中29例发展为尿毒症需要进行透析治疗。采用单因素方差分析和多因素Logistic回归分析方法分析狼疮肾炎发展至尿毒症与各种临床指标的相关性,以及与狼疮肾炎的病理分型之间的相关性。结果单因素方差分析显示,年龄、性别、GFR降低、高血压病史及抗dsDNA抗体在两组之间的差异均具有统计学意义（P〈0．05）;多因素Logistic回归分析显示,GFR降低、高血压病史、血肌酐升高为狼疮肾炎发展为尿毒症的主要危险因素（P〈0．05）;经肾穿刺活检的病理分型,Ⅳ型和V型的狼疮肾炎肾穿刺病理分型和狼疮肾炎发展到尿毒症需透析具有相关性（P〈0．05）。结论GFR降低、高血压病史和血肌酐升高为狼疮肾炎的主要危险因素,Ⅳ型和V型的狼疮肾炎患者的预后不良。     

霉酚酸酯和环磷酰胺治疗30例Ⅳ型狼疮肾炎疗效对比观察

目的:探讨霉酚酸酯对比环磷酰胺治疗Ⅳ型狼疮性肾炎临床特点及疗效观察。方法:对30例确诊为Ⅳ型狼疮性肾炎患者随机分为治疗组与对照组各15例,两组分别采用霉酚酸酯和环磷酰胺治疗,对比观察症状改善情况。结果:经霉酚酸酯治疗总有效率和缓解率明显高于环磷酰胺,能有效控制狼疮肾炎患者的病情。结论:霉酚酸酯能有效控制Ⅳ狼疮肾炎,并且不良反应少,提高治疗效果,值得临床应用。     

叶任高"狼疮方"治疗狼疮性肾炎19例

笔者在广州有幸跟随中国中西医结合肾病专家叶志高教授坐诊,叶师用自创"狼疮方"配合激素或免疫抑制剂治疗狼疮性肾炎19例,疗效卓著,现报道如下.     

儿童狼疮性肾炎合并神经精神性狼疮的危险因素

目的探讨儿童狼疮性肾炎合并神经精神性狼疮的危险因素。方法随机选取该院2009年7月-2013年2月收治的15例狼疮性肾炎合并神经精神性狼疮患儿及同期的20例无神经系统病变患儿作为研究对象,先对变量进行单因素分析,对比两组患儿的临床资料、实验室资料及治疗情况,再对有意义的变量进行多因素非条件Logistic回归分析。结果在单因素分析与多因素非条件分析及Logistic回归分析中,发热、激素使用不规范、C3〈0．4及CTX治疗不规范为有统计学意义的危险因素。结论狼疮性肾炎患儿发生神经精神性狼疮的主要因素是发热、激素使用不规范、C3〈0．4及CTX治疗不规范。     

血清抗核小体抗体水平与狼疮肾炎病理分型及其活动性的相关性研究

目的研究血清抗核小体抗体（AnuA）水平与狼疮肾炎（LN）病理类型及其活动性的相关性。方法选取110例系统性红斑狼疮（SLE）患者（狼疮肾炎34例进行肾脏病理,非狼疮肾炎76例）作为研究对象,同时选取健康体检者30例作为正常对照组,用酶联免疫吸附法（ELISA）检测血清中的AnuA水平,并与LN病理类型及活动性指标进行相关性分析。结果 SLE组中血清AnuA水平（107.2±86.5）RU·mL-1显著高于正常对照组（17.4±14.0）RU·mL-1（t=8.37,P〈0.05）;狼疮肾炎组血清AnuA水平（115.0±87.0）RU·mL-1明显高于非狼疮肾炎组（68.1±49.3）RU·mL-1（t=4.28,P〈0.05）;各肾脏病理类型的血清AnuA水平差异有统计学意义,IV型III型LN患者血清AnuA水平高于V型II型,V型又高于II型（P〈0.05）。血清AnuA与活动指数（AI）呈正相关（r=0.69,P〈0.05）,与慢性指数（CI）无显著相关性。血清AnuA水平与肾脏病变临床活动度的关系表现为：血清AnuA水平由高向低依次为肾炎复发组、尿蛋白复发组、部分缓解组、持续活动组和完全缓解组;肾炎复发组和尿蛋白复发组显著高于其它活动度组（P〈0.05）,肾炎复发组又显著高于尿蛋白复发组（P〈0.05）。结论 AnuA水平与SLE患者肾脏损害显著相关,不同肾脏病理类型的血清AnuA水平表达有差异,可用于评估临床治疗及预后。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.