恶性贫血的免疫和遗传研究进展

恶性贫血患者存在着免疫和遗传方面的改变。患者血清中存在多种自身抗体;患者T淋巴细胞亚群失衡,尤其是T抑制细胞的缺陷使机体免疫耐受性降低而引起自身免疫反应。恶性贫血有明显的家族发病倾向,患者的细胞有丝分裂,核酸合成以及HLA抗原的表达均有异常。恶性贫血遗传因子对该病的支配方式、恶性贫血时淋巴细胞亚群的变化以及与HLA抗原的确切关系等值得进一步研究。     

老年人心肾贫血综合征研究进展

心肾贫血综合征是Silverberg提出的一个新概念,其基本病理生理学机制是充血性心力衰竭、慢性肾功能不全和贫血之间存在恶性循环。值得重视的是Silverberg等对心肾贫血综合征患者采取皮下注射红细胞生成素和静脉注射铁剂并用的方法,显著地提高了患者的心功能,明显地降低了患者的死亡率。本文就其研究进展作一综述。     

血常规检测结果对鉴别诊断缺铁性贫血、地中海贫血价值观察

目的对缺铁性贫血、地中海贫血两种贫血类型利用血常规检测结果鉴别诊断,并分析其临床价值。方法选取2018年9月-2019年7月在我院治疗的108例贫血患者,根据其贫血类型,将其分为缺铁性贫血组、地中海贫血组。同时,选取同期健康体检者54例作为健康对照组。所有受检者均进行血常规检测。结果与健康对照组相比,贫血组患者的Hb、RBC、MCV、MCH、MCHC更低,RDW更高,差异明显(P<0.05)。贫血组间对比,地中海贫血组患者的Hb、MCHC明显高于缺铁性贫血组,RDW、RBC、MCV、MCH明显低于缺铁性贫血组(P<0.05)。结论缺铁性贫血、地中海贫血患者的血常规检测结果差异明显,可作为临床诊断、鉴别的重要依据,具有推广价值。     

糖尿病肾病患者贫血的特点及其相关因素分析

目的：分析糖尿病肾病患者贫血的特点及其影响因素。方法：临床和肾活检明确诊断为2型糖尿病肾病患者235例,分析贫血的发生率、贫血的性质及其与肾小管功能、血清肌酐（SCr）和胱抑素C（cystatinC,Cys-C）水平以及代谢指标及其他血管并发症的关系。结果：235例糖尿病肾病患者总的贫血发生率为43.8%,SCr正常患者即已出现相当比例的贫血;患者大部分为正细胞正色素性贫血;血红蛋白（Hb）与RBP、NAG水平成负相关（r=-0.310,-0.353,P〈0.01）,贫血组肾小球滤过率（eGFR）正常者大部分已存在肾小管功能损害;SCr在正常情况下贫血组肾小管病变较非贫血组更重;Hb与eGFR、Cys-C成正相关（r=0.365,0.578,P〈0.01）,在eGFR下降前即出现贫血;Cys-C升高者小管病变更重;非贫血组胰岛素及C肽水平明显高于贫血组;非贫血者三酰甘油水平较高,贫血者高密度脂蛋白胆固醇更高;Hb与血清白蛋白及前白蛋白水平成正相关（r=0.504,0.282,P〈0.05）,非贫血组患者体重指数高于贫血组;贫血组视网膜病变及心脏病变发生率明显高于非贫血组（P〈0.01）。结论：糖尿病肾病患者贫血的发生率高,并且出现时间早,它与患者的肾小管间质病变密切相关,在GFR下降前即可出现贫血。糖尿病肾病的贫血除与患者的肾功能有关外,还与体内存在的代谢异常及患者的营养状态相关。贫血是糖尿病肾病患者出现其他血管并发症的高危因素。因此,认识糖尿病肾病患者贫血的特点,早期纠正贫血对改善患者症状,减少并发症的发生,提高患者生活质量具有重要意义。     

老年慢性心力衰竭患者贫血与肾功能障碍的关系

目的探讨贫血对老年慢性心力衰竭（CHF）病情及预后的影响。方法老年CHF患者118例,按血红蛋白水平将其分为轻度贫血组、中度贫血组和重度贫血组,采用前瞻性队列研究的方法,在常规控制心力衰竭治疗情况下,分析贫血对其心功能分级和肾功能的影响。结果随着贫血程度增加,心脏射血分数下降（P〈0.05）;CHF时肾功能障碍发生率为35.6%;随着心脏射血分数的下降,肾功能障碍亦逐渐增加且程度加重（P〈0.05）。反映肾功能的各项指标随贫血严重程度的加剧,恶化更加明显（均P〈0.05）。结论老年CHF合并贫血的患者心功能和肾功能障碍恶化明显,且贫血的程度越重,其病情也越严重,预后越差。     

骨髓细胞学对老年人贫血病因诊断的临床价值

目的　总结老年贫血骨髓像的特点 ,明确老年贫血的病因。方法　 1 2 0 0例贫血患者分为老年组 (≥ 60岁 )和对照组 (<60岁 ) ,每组各 60 0例。行骨髓穿刺术进行骨髓细胞学检查 ,同时做外周血细胞形态学检查。结果　 (1 )红细胞减少时其减少幅度老年贫血组与对照组比较无明显差异 (P>0 .0 5) ,红细胞在正常范围时老年贫血组明显低于对照组 (P<0 .0 1 )。 (2 )老年贫血患者 ,轻度贫血时血红蛋白量减少程度明显小于对照组 (P<0 .0 1 ) ,在中度与重度贫血时两组比较无明显差异 (P>0 .0 5)。 (3)老年人贫血伴有外周血细胞形态改变者占 65.0 % ,对照组占 59.3% (P<0 .0 1 )。结论　 (1 )老年人贫血骨髓增生以减低为多见。 (2 )贫血病因以巨幼细胞贫血和缺铁性贫血为主。 (3)病因为急、慢性白血病时 ,常为少见类型的低增生性白血病。 (4)临床表现虽为贫血 ,但真正的病因可能是恶性肿瘤。 (5)骨髓细胞学是老年人贫血有意义的检查项目 ,能够对 96.3%的老年人贫血的病因作出诊断和鉴别诊断     

博乐市区0～6岁儿童营养性贫血调查分析

目的调查了解博乐市区托幼机构儿童营养性贫血发病情况,并针对存在的问题制定防治措施。方法2009年6月3~12日,全市区四所托幼机构1673名儿童进行调查,对资料完整的1501名儿童资料进行了统计分析。结果哈萨克族儿童贫血患病率高于其他民族儿童（16.7%）,汉族儿童（8.4%）,其次是蒙古族（7.6%）和回族（7.5%）,维吾尔族（7.1%）;3岁组以下儿童贫血患病率（21.8%）明显高于4岁组以上儿童组;州直机关托儿所儿童贫血患病率为10.2%,其他三所私立幼儿园儿童贫血患病率为7.8%。结论营养性贫血的发生发展与社会经济水平、健康教育的普及程度以及个人饮食生活习惯、营养状况等有关。     

巨幼细胞贫血与难治性贫血患者血清LDH检测结果分析

目的通过测定比较巨幼细胞贫血与难治性贫血患者血清乳酸脱氢酶（LDH）活性,探讨利用其进行鉴别诊断的价值。方法对49例巨幼细胞贫血和19例难治性贫患者的血清LDH活性进行测定分析。结果巨幼细胞贫血患者血清中LDH活性明显高于难治性贫血患者（P〈0．01）。结论测定患者血清LDH活性对鉴剐巨幼细胞贫血和难治性贫血有一定的指导意义。     

白血病贫血

贫血是白血病最常见的临床表现.大多数急性白血病患者诊断时存在贫血.纠正贫血是白血病治疗的重要内容,与患者生存质量和化疗的耐受性密切相关.白血病贫血的发病涉及多重机制,其治疗方法仍以成分输血为主.临床实践中还应注意某些特殊的白血病贫血类型,以期正确处理.本文对白血病贫血做一综述.     

2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)与贫血之间的关系

目的研究并探讨2型糖尿病(T2DM)患者的糖尿病视网膜病变(DR)与贫血之间的关系。方法于2011年1月—2015年12月,在该院住院部收治的2型糖尿病患者中,随机选取200例2型糖尿病患者作为此次研究的对象,根据贫血的诊断标准将这200例患者分为贫血组和非贫血组,比较两组患者病情改善情况。结果 200例2型糖尿病患者中,共有42例贫血患者,贫血发生率为21%。贫血组患者的视网膜病变发生率为47.62%(20/42),明显高于非贫血组的21.52%(34/158)(P0.05)。与非贫血组相比,贫血组患者的年龄、C反应蛋白均明显更高(P0.05),其糖化血红蛋白、总胆固醇、甘油三酯均明显更低(P0.05)。结论 2型糖尿病患者发生视网膜病变与贫血密切相关,贫血患者更容易出现视网膜病变,临床治疗2型糖尿病患者时,应注意对患者的贫血进行纠正。     

Anaemia in diabetic renal failure: is there a role for early erythropoietin treatment in preventing cardiovascular mortality?

The mortality rate in diabetics with chronic kidney disease (CKD) is seven times higher than end-stage renal disease mainly because of cardiac causes. Anaemia may have a relevant role in the pathogenesis of cardiovascular (CV) disease in CKD. Anaemia occurs at an earlier stage of CKD in diabetic individuals than in those with other causes of CKD. Observational findings support the unfavourable influence of anaemia on mortality in CKD patients, and the combination of anaemia and CKD in diabetics identifies a group with a particularly high mortality risk. While the effect of erythropoietin on these patients' quality of life is known, its impact on mortality and CV risk is uncertain. The recent Anaemia Correction in Diabetes (ACORD) trial in diabetic CKD patients, which targeted haemoglobin levels of 13-15 mg/dl, disclosed no statistically significant favourable or adverse effects on mortality or morbidity over the 2-year follow-up, while other studies endeavouring to nearly normalize haemoglobin have reportedly proved risky. Even if anaemia is causally involved, the pathogenesis of CV disease in diabetics with CKD is so complex that addressing just one factor (anaemia) may not suffice to prevent CV risk, and normalizing haemoglobin levels may even be harmful.     

Anaemia in diabetes

Anaemia is a common complication of chronic kidney disease (CKD). It is often more severe and occurs at an earlier stage in patients with diabetic nephropathy than in patients with CKD of other causes. This anaemia results from erythropoietin deficiency, which seems to develop in patients with type 1 diabetes even at relatively "normal" levels of serum creatinine. Early erythropoietin- deficiency anaemia occurs in both type 1 and type 2 diabetes, although the prevalence may be higher in type 1 diabetes. However, numerically most patients with erythropoietin-deficiency anaemia have type 2 diabetes as it is a much more common disease. There is also a greater prevalence in women than men but this is not related to iron stores. In addition, erythropoietin-deficiency anaemia is associated with the presence of autonomic neuropathy in patients with diabetes. Small studies have suggested that recombinant human erythropoietin (rhEPO; epoetin) treatment is effective in correcting erythropoietin-deficiency anaemia in patients with diabetes. Additionally, rhEPO therapy improves quality of life and well-being in these patients. Studies also suggest that treatment with rhEPO to restore a normal haematocrit ameliorates orthostatic hypotension. Given the high cardiovascular risk in patients with diabetic nephropathy, it is important to determine in prospective clinical trials whether early anaemia correction can also improve cardiovascular outcomes.     

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

Chronic kidney disease (CKD) is now a recognized global public health problem. It is highly prevalent and strongly associated with hypertension and cardiovascular disease (CVD); far more patients with a glomerular filtration rate below 60?ml?min(-1) per 1.73?m(2) will die from cardiovascular causes than progress to end-stage renal disease. A better understanding of the complex mechanisms underlying the development of CVD among CKD patients is required if we are to begin devising therapy to prevent or reverse this process. Observational studies of CVD in CKD are difficult to interpret because renal impairment is almost always accompanied by confounding factors. These include the underlying disease process itself (for example, diabetes mellitus and systemic vasculitis) and the complications of CKD, such as hypertension, anaemia and inflammation. Kidney donors provide an ideal opportunity to study healthy subjects without manifest vascular disease who experience an acute change from having normal to modestly impaired renal function at the time of uninephrectomy. Prospectively examining the cardiovascular consequences of uninephrectomy using donors as a model of CKD may provide useful insight into the pathophysiology of CVD in CKD and, therefore, into how the CVD risk associated with renal impairment might eventually be reduced.     

A review of the updated European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure

The management of anaemia of Chronic Kidney Disease (CKD) has progressed significantly during the last decade. Research studies show that effective treatment of anaemia in adult patients with CKD can reduce cardiovascular complications slow progression of renal failure, and improve quality of life. To ensure adult patients receive optimum care, evidence-based practice and recognised guidelines and management strategies are needed to help reduce variations in clinical practice. In 1999 a working party of European Nephrologists developed the European Best Practice Guidelines (EBPG) for Management of Anaemia in Patients with Chronic Renal Failure to address this issue. Since the publication of the guidelines in 1999, over 3,000 papers relating to anaemia in CKD, have been published, many of which have significant implications for the practice of anaemia management. To ensure that the most up to date scientific evidence is available to those who manage anaemia in CKD the guidelines were revised in 2004. These guidelines, look at the anaemia management of adults with CKD and do not include guidelines for children.     

CE: Continuing Education Article MANAGEMENT OF CO‐MORBID DISEASES IN A PATIENT WITH ESTABLISHED RENAL FAILURE

This follows on from an article relating to chronic kidney disease (CKD) and co‐morbidities. Not only do these co‐morbid diseases cause problems to patients with CKD, they continue to impact upon them when they develop established renal failure (ERF). Various co‐morbid conditions can affect the patient including diabetes, hypertension, anaemia and cardiovascular issues. As nephrology nurses we play a fundamental role in patient education, monitoring and management of these factors.     

The Role of Novel Biomarkers of Cardiovascular Disease in Chronic Kidney Disease: Focus on Adiponectin and Leptin

Cardiovascular disease (CVD) remains a major cause of premature death in patients with chronic kidney disease (CKD), including renal transplant recipients. Both interplay of traditional cardiovascular and renal specific risk factors have been shown to be associated with an increased risk of cardiovascular death in patients with CKD. Recently, there has been great interest in the role of novel biomarkers, in particular adiponectin and leptin, and its association with CVD in the CKD population. Adiponectin is a multifunctional adipocyte-derived protein with anti-inflammatory, antiatherogenic and insulin sensitizing activity. Recent observational studies have shown adiponectin to be a novel risk marker of CVD in patients with stages 1 to 5 CKD. Leptin is an adipocyte-derived hormone that promotes weight loss by decreasing food intake. Similarly, there are observational studies to support an association between leptin and CVD, including patients with CKD. In the CKD population, leptin may be associated with uremic cachexia and subsequent increased mortality. This review aims to summarize the pathophysiological and potential clinical roles of these cardiovascular biomarkers in patients with CKD.Key Words: Biomarker, cardiovascular disease, adiponectin, leptin, kidney disease.     

Atherosclerosis in CKD: differences from the general population

The prevalence of cardiovascular morbidity and mortality is higher in patients with chronic kidney disease (CKD)-especially those with end-stage renal disease-than in the general population. The contribution of atherosclerosis to cardiovascular disease in patients with CKD remains unclear. Researchers in the 1970s proposed that atherosclerosis was the main cause of cardiovascular disease in patients with CKD and that its progression, based on observations of patients on long-term dialysis, was accelerated by the uremic state. Subsequent reports, however, favor the involvement of other mechanisms, such as arteriosclerosis (characterized by vascular stiffening), vascular calcification, 'myocyte/capillary mismatch', congestive cardiomyopathy, and sudden cardiac death. Imaging and morphological studies have contributed to our understanding of the pathogenesis and progression of cardiovascular disease associated with CKD. Based on clinical and experimental findings, we hypothesize the following: the initial cardiovascular abnormalities in the CKD setting include arteriosclerosis, left ventricular diastolic dysfunction, and left ventricular hypertrophy, abnormalities which, in adult patients, are often accompanied by atherosclerosis. The prevalence of atherosclerosis increases with age and is aggravated, but not specifically induced, by CKD. The cardiovascular events associated with atherosclerosis are more often fatal in patients with CKD than in individuals without CKD.     

Stroke and renal dysfunction

Stroke is the most frequent neurological disease and represents a continuously evolving medical and social problem. Chronic kidney disease (CKD) is also an important worldwide public health problem. Renal dysfunction carries a substantial risk of cardiovascular morbidity and mortality and an independent, graded association between renal function and cardiovascular events was found. In the last 15 years the link between CKD and cerebrovascular disease has become more apparent. Patients with end stage renal disease treated with maintenance hemodialysis have a much higher incidence of stroke than the general population and stroke is one of the major causes of death in these patients. Nowadays ischemic subtype of stroke is present in approximately 70% of dialysis patients. In population based studies conflicting results have been reported about the association between stroke and CKD before replacement therapy. However, in high risk patients, defined by the presence of either cardiovascular disease or cardiovascular risk factors, different stages of CKD are clearly associated with subsequent stroke.In patients with stroke the exact prevalence of renal dysfunction is not known. Reported prevalence from a few published studies is up to 38% and it is higher than that in age-matched control groups. Furthermore, in patients suffering from stroke renal dysfunction is associated with short and long term mortality.The most effective treatment of stroke in patients with CKD is not known and further studies are needed.     

RENAL ANAEMIA: RECENT DEVELOPMENTS AND FUTURE DIRECTIONS FOR IMPROVED MANAGEMENT

The global burden of chronic kidney disease (CKD) and associated anaemia is substantial. With the increasing numbers of patients that are likely to be affected in the future, approaches are required to improve anaemia management without increasing the workload of renal units. Advocating early treatment may improve patient outcomes and nurses are in an ideal position to identify and manage anaemia at an early stage in patients with CKD. In addition, adopting a multidisciplinary approach, alongside nephrologists, diabetologists, cardiologists, social workers, nutritionists and pharmacists, may allow nurses to detect and treat anaemia earlier in patients with CKD. Maintaining awareness of factors associated with decreased erythropoiesis‐stimulating agents (ESAs) efficacy (e.g. iron deficiency or poor nutritional status) is also important. To reduce the burden on healthcare providers, anaemia management could be simplified by extending the administration interval of ESAs. Recent studies have explored the clinical efficacy of administration of currently available agents at intervals of up to once monthly in highly selected, stable patients. The use of an ESA that can control anaemia while maintaining haemoglobin levels within guideline ranges with extended administration intervals in all patients without the need for additional screening or stepwise dose adjustments with attendant monitoring may help improve patient care while reducing the workload of healthcare providers.     

Cardiovascular disease and chronic kidney disease: insights and an update

Despite the high prevalence and significant morbidity and mortality rates of chronic kidney disease (CKD) related to cardiovascular disease, it remains vastly understudied. Most of the current practice recommendations come from small under-powered prospective studies, retrospective reviews, and assuming patients with CKD will similarly benefit from medications and treatments as patients with normal renal function. In addition, because of the previous lack of a consistent definition of CKD and how to measure renal function, definitions of the degree of renal dysfunction have varied widely and compounded the confusion of these data. Remarkably, despite patients with CKD representing the group at highest risk from cardiovascular complications, even greater than patients with diabetes mellitus, there has been a systematic exclusion of patients with CKD from therapeutic trials. This review outlines our current understanding of CKD as a cardiovascular risk factor, treatment options, and the future directions that are needed to treat cardiovascular disease in patients with CKD.