活性维生素D_3治疗对维持性血透患者左心室肥厚的影响

目的 :研究活性维生素D3 制剂罗钙全治疗对维持性血透 (MHD)患者左心室肥厚 (LVH)的影响。方法 :伴继发性甲状旁腺功能亢进的MHD患者 30例随机分成两组 ,治疗组 16例接受罗钙全治疗 (口服 ,2 μg/次 ,2～ 3次 /周 )共 12周 ,余 14例作为对照组。其它治疗两组均相同。期间观察血甲状旁腺素 (iPTH)水平及左室舒张末期内径 (LVDd)、左室收缩末期内径 (LVDs)、左房内径 (LAD)、室间隔厚度 (IVST)和左室后壁厚度 (PWT)变化。结果 :(1)治疗前两组血iPTH水平明显高于正常 ,存在继发性甲状旁腺功能亢进 ,但两组间无差异 :两组间LVDd、LVDs、LAD、IVST、PWT值均无差异 ,但均明显高于正常值或处于正常值高限 ;(2 )治疗组 12周后血iPTH水平和LVDd、LVDs、LAD、IVST、PWT值均较治疗前明显降低 ,而对照组 12周后上述参数均无明显改变。结论 :活性维生素D3 治疗可明显改善维持性血透患者的左心室肥厚 ,此作用与其改变继发性甲状旁腺功能亢进有关。     

维生素D与血液透析患者左心室肥厚的相关性研究

目的研究维持性血液透析患者维生素D[25(OH)D_3]水平变化及其与左心室肥厚的关系。方法对80例维持性血液透析患者的临床及实验室结果作回顾性分析。采用放射免疫分析法测定25(OH)D_3水平。采用Pearson相关分析25(OH)D_3与左心室结构指标的相关性;用二分类Logistic回归方法分析左心室肥厚(left ventricular hypertrophy,LVH)的危险因素。ROC曲线分析25(OH)D_3预测LVH的最佳截值。结果 80例维持性血液透析患者25(OH)D_3水平为(15.2±3.6)ng/mL;LVH组患者25(OH)D_3水平显著低于非LVH组患者[(13.5±2.8)vs(17.8±3.2)ng/mL,P0.05];25(OH)D_3水平与左心室舒张末内径(left ventricular end diastolic diameter,LVDd)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、室间隔厚度(interventricular septum thickness,IVST)、左心室心肌质量指数(left ventricular mass index,LVMI)呈负相关,与左心室射血分数(left ventricular ejection fraction,LVEF)呈正相关(r=-0.582,P=0.032;r=-0.562,P=0.038;r=-0.498,P=0.046;r=-0.641,P=0.024;r=0.726,P=0.018),二分类Logistic回归分析显示,低25(OH)D_3、C反应蛋白(CRP)、胆固醇(total cholesterol,TC)、贫血、高血压是维持性血液透析患者LVH的危险因素。ROC曲线分析结果显示,维生素D缺乏预测LVH发生的曲线下面积为0.842,最佳诊断截值为14.28 ng/mL,敏感度为68.8%,特异度为81.2%。结论维持性血液透析患者25(OH)D_3水平显著降低,维生素D缺乏是维持性血液透析患者LVH的独立危险因素。维生素D可能参与血液透析患者心血管疾病的发生、发展。     

维生素D受体ApaⅠ基因多态性和维持性血透患者左心室肥厚的关系

左心室肥厚（LVH）是维持性血透患者心血管并发症发病率和死亡率的危险因素之一,维生素D通过与其受体结合形成激素-受体复合物可影响血透患者LVH的发生。本研究通过检测维持性血透患者VDRApaⅠ基因型,旨在探讨VDR ApaⅠ基因多态性和血透患者LVH及其相关危险因素的关系。     

维持性血液透析患者甲状旁腺素水平与左心室肥厚关系的研究

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺素(parathyroid hormone,PTH)水平与左心室肥厚(1eft ventrieular hypertrophy,LVH)的关系。方法选择同济大学附属同济医院血液透析中心MHD患者50例,根据患者PTH水平分成L-PTH组(PTH300 ng/L)、H-PTH组(PTH300 ng/L)。通过对2组患者进行心脏超声及临床生化检测,比较2组患者的心脏超声结构及LVH发生率,并作相关性分析。结果 2组患者的性别构成、年龄、血压、脑钠肽、血红蛋白、血钙和血白蛋白均无统计学差异(P0,05)。H-PTH组的透析时间、血磷均明显高于L-PTH组[(8,66±4,91)年比(5.4±5.73)年、(1.81±0.37)mmol/L比(1.51±0.32)mmol/L,P0.05]。H-PTH组的左室舒张末内径、左室收缩末内径、室间隔厚度与左室心肌质量指数均明显高于L-PTH组[(49.56±4.59)rmm比(45.84±5.65)mm、(32.44±4.26)mm比(29.6±5.00)mm、(11.12±1.45)mm比(10.16±1.41)mm、(144.29±31.82)g/m~3比(122.83±38.34)g/m~3,P0.05];2组的左房内径、左室后壁厚度及射血分数均无统计学差异[(43.96±3.98)mm比(42.52±5.86)mm、(9.56±1.58)mm比(9.08±1.29)mm、(63.16±6.97)%比(65.72±6.67)%,P0.05]。H-PTH组的LVH发生率明显高于L-PTH组(72%比40%,P0.05)。Spearman相关性分析表明,PTH水平与左室心肌质量指数、左室舒张末内径、左室收缩末内径、室间隔厚度呈正相关(r=0.325,0.330,0.348,0.310,P0.05),而与左房内径、左室后壁厚度、射血分数相关性无统计学意义(r=0.088,0.115,-0.210,P0.05)。结论MHD患者PTH水平增高可能是导致左心室肥厚的重要因素之一。     

低钙透析联合1,25(OH)2D3及碳酸钙治疗维持性血液透析患者继发性甲状旁腺功能亢进

本文主要研究低钙透析联合1，25（OH）2D3及碳酸钙治疗维持性血液透析（MHD）患者继发性甲状旁腺功能亢进（SHPT）的有效性和安全性。本文主要研究低钙透析联合1，25（OH）2D3及碳酸钙治疗维持性血液透析（MHD）患者继发性甲状旁腺功能亢进（SHPT）的有效性和安全性。     

维持性血液透析患者中性粒细胞/淋巴细胞比值与左心室肥厚的关系

目的检测维持性血液透析(maintenance hemodialysis,MHD)患者中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)水平,探讨其与左心室肥厚(left ventricular hypertrophy,LVH)相关性。方法选择2018年1月至2019年8月于凉山州第一人民医院肾脏内科行MHD患者96例,获取所有患者NLR中位数并将其分为高NLR组(NLR3.31,n=47)和低NLR组(NLR≤3.31,n=49),比较2组基线资料、心脏超声指标[左房舒张末内径(LAEDd)、左室收缩末内径(LVEDs)、射血分数(EF)、左心室质量指数(LVMI)]、实验室检测指标[NLR、脑钠肽、Hb、白蛋白(Alb)、血钙]、血脂水平,统计LVH发生率;根据是否发生LVH分为LVH组和非LVH组,多因素分析LVH发生高危因素,ROC曲线分析NLR对LVH发生的预测价值。结果 NLR与SBP、LAEDd、LVEDs、LVMI、NLR、BNP、Alb、LDL-C、胆固醇、非高密度脂蛋白胆固醇、Cr均呈正相关(P0.05),与DBP呈负相关(P0.05)。经彩色多普勒超声检查结果确定高NLR组LVH发生率高于低NLR组LVH发生率;年龄、SBP、LAEDd、LVEDs、LVMI、NLR、脑钠肽、Alb、LDL-C、胆固醇、非高密度脂蛋白胆固醇、Cr是LVH发生高危因素(P0.05),且NLR相对危险比(OR)最大。NLR是预测LVH发生的预测因子(P0.05)。结论 NLR值与MHD患者LVH的发生和发展密切相关,关注NLR变化对防治LVH具有较高价值。     

甲状旁腺切除术对维持性血液透析患者骨代谢的影响

目的:观察甲状旁腺全切加自体前臂移植术(total parathyroidectomy with forearm autograft,PTX+AT)对维持性血液透析(maintenance hemodialysis,MHD)合并难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,S...     

心悦胶囊治疗血液透析患者左心室肥厚的临床研究

目的:探讨心悦胶囊治疗维持性血液透析(MHD)患者左心室肥厚(LVH)的临床研究。方法:选择2019年01月—2020年01月于济宁医学院附属医院行MHD伴有LVH患者120例,按照随机数字表法分为观察组和对照组各60例,对照组给予常规治疗;观察组在对照组基础上加用心悦胶囊0.6 g/次,每日3次,疗程6个月。检测中医症候评分、心脏左心室的前后径(LVDd)、室间隔舒张末期厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、左室射血分数(LVEF),计算左心室质量指数(LVMI),测定B型钠尿肽(BNP)及常规生化指标的变化。结果:治疗后,两组中医症候评分、LVDd、LVMI、IVST和LVPWT降低(P<0.05),LVEF升高(P<0.05),BNP降低(P<0.05),以观察组更明显(P<0.05)。观察组治疗后三酰甘油、胆固醇降低(P<0.05)。两组均未发现明显不良反应。结论:心悦胶囊能改善MHD患者LVH。     

参麦注射液对血液透析患者微炎症状态及左心室肥厚的影响

目的：研究参麦注射液对维持性血液透析（maintenance hemodialysis,MHD）患者微炎症状态及左心室肥厚（left ventricular hypertrophy,LVH）的影响。方法：MHD患者40例,随机分为参麦组和对照组,每组20例,治疗3个月,观察治疗前后血hs-CRP、IL-6、IL-1β水平,测定心超指标。结果：治疗后,参麦组的hs-CRP、IL-6、IL-1β水平明显降低（P〈0.05）,与对照组比较,hs-CRP、IL-6的降低差异有统计学意义（P〈0.05）;治疗后,参麦组LVM、LVMI、IVST降低,与治疗前相比差异有统计学意义（P〈0.01）;与对照组相比LVM、LVMI、IVST的降低差异均有统计学意义（P〈0.01和P〈0.05）。结论：参麦注射液可以改善MHD患者微炎症状态,逆转LVH。     

Cardiac Valve Calcifications and Left Ventricular Hypertrophy in Hemodialysis Patients

Cardiac valve calcification (VC) is a common finding in end-stage renal disease patients. It was shown recently that VC is an independent predictor for all-cause and cardiovascular mortality in peritoneal dialysis patients. In hemodialysis (HD) patients, VC was associated with all-cause and cardiovascular mortality, but after adjusting for other cardiovascular risk factors and complications, as well as left ventricular mass index (LVMI), it lost significance. The aim of the study was to assess the relationship between VC and left ventricular hypertrophy in hemodialysis patients. Echocardiographic examination with mitral and aortic valves assessment and LVMI calculation was performed in 65 HD patients ages 49 ± 12, with duration of HD therapy 38 ± 32 months. VC were found in 32 of 65 patients (49%)—Group VC(+), mitral valve calcifications (MVC) in 10, aortic valve calcifications (AVC) in 9, and both valves calcifications (MVC + AVC) in 13 patients. Patients with VC were older, on HD therapy were longer, had higher systolic and pulse pressure, and had higher LVMI. Patients with both VCs had the highest LVMI. No significant differences were found with respect to Ca, P, PTH, and mean Ca × P product, but the incidence of Ca × P product above 4.43 mmol²/L² was higher in VC(+) compared with those without VCs. VC coexists with left ventricular hypertrophy, particularly when both valves are calcified. Even short-lasting incidents of increased Ca × P product may lead to cardiac VC.     

Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D3

BACKGROUND: Antimicrobial peptides (AMPs) such as cathelicidins contribute to initial defense of the airway against inhaled pathogens. Recent studies have shown that the hormonally active form of vitamin D(3), 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) up-regulates AMP gene expression in several established cell lines. Furthermore, serum levels of vitamin D are often deficient in cystic fibrosis (CF) patients. METHODS: We investigated the effect of 1,25(OH)(2)D(3) on AMP mRNA levels in primary cultures of normal human bronchial epithelial (NHBE) cells by real-time PCR, and protein levels by Western blot. Antimicrobial activity of airway surface fluid from these cells was measured by in vitro assay against laboratory strains of bacteria. RESULTS: Treatment of NHBE cells with 1,25(OH)(2)D(3) (10(-8)M), resulted in a 10-fold up-regulation of cathelicidin mRNA levels after 12 h, which was augmented 2-fold with co-incubation of 1 mM Calcium. Moreover, 1,25(OH)(2)D(3) induced antimicrobial activity against the airway pathogens Bordetella bronchiseptica and Pseudomonas aeruginosa. 1,25(OH)(2)D(3) induced cathelicidin mRNA expression equally in both normal and CF bronchial epithelial cells. CONCLUSIONS: Elucidation of the effect of 1,25(OH)(2)D(3) on cathelicidin expression in NHBE cells and CF bronchial epithelial cells will aid in the development of novel therapeutic agents for treatment of airway infections in CF.     

进展期右半结肠癌D3术式与D2术式的比较

目的 探讨应用D3廓清术治疗进展期右半结肠癌（ARCC）的安全性、合理性和可行性。方法 97例ARCC患者随机分组为D2廓清术组（55例）和D3廓清术组（42例）,比较两组的相关临床资料。结果 D3廓清术较D2廓清术的手术创伤程度增加,但并发症未有明显增多,且治愈性根治或非治愈性根治切除比例有明显提高,术后3,5年生存率亦有明显提高（88.1%和73．8％：72．8％和52．7％）（P＜0．05）。结论 对于ARCC,D3术式较D2术式能明显提高患者的5年生存率。D3廓清术是安全、合理和可行的,应予开展,推广。     

An Association Between Inflammatory State and Left Ventricular Hypertrophy in Hemodialysis Patients

This study was performed to investigate the potential relationship between left ventricular hypertrophy (LVH) and proinflammatory cytokines in hemodialysis (HD) patients and the effect of HD on cytokine production. Serum interleukin 1 beta (IL-1 β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) measurements and echocardiographic studies were performed in 35 stable HD patients. A variety of probable risk factors for LVH including age, HD duration, blood pressure (BP), body mass index, lipid profile, hemoglobin, albumin, parathormone and homocysteine levels were also investigated. Additionally, the effect of HD procedure on cytokine levels was evaluated. Predialysis serum levels of IL-1β, IL-6, TNF-α, and homocysteine in HD patients were compared with 12 healthy subjects. Left ventricular hypertrophy was demonstrated in 20 (57%) of HD patients by echocardiography. Left ventricular mass index (LVMI) was correlated positively with systolic BP (r = 0.556, p = 0.001), diastolic BP (r = 0.474, p = 0.004), and serum levels of TNF-α (r = 0.446, p = 0.009).Multiple regression analysis showed that systolic BP and TNF-α levels were significant independent predictors of LVH. No relationship was observed between LVH and other parameters. The mean predialysis serum level of IL-6 was significantly higher in HD patients compared to healthy controls (15.7 ± 8.7 vs. 7.3 ± 0.7 pg/mL, p = 0.001). Predialysis serum levels of TNF-α in HD patients were higher when compared to healthy subjects, but the difference was not statistically significant (8.3 ± 3 vs. 7 ± 1.45 pg/mL, respectively, p > 0.05). However, serum levels of IL-6 and TNF-α significantly elevated after HD, when compared to predialysis levels (from 15.7 ± 8.7 to 17.8 ± 9.5 pg/mL, p = 0.001 and from 8.3 ± 3.0 to 9.9 ± 3.5 pg/mL p = 0.004, respectively). As a conclusion, in addition to BP, proinflammatory cytokines, TNF-α in particular, seem to be associated with LVH in ESRD patients.