血清抗磷脂酶A2受体抗体对2型糖尿病合并蛋白尿患者病理诊断的预测价值研究

目的 探讨血清抗磷脂酶A2受体（PLA2R）抗体对T2DM合并蛋白尿患者病理诊断的预测价值。方法 选取2017年1月至2019年12月于河北省人民医院肾内科住院治疗的T2DM合并蛋白尿并行肾活检的患者87例,根据肾活检病理结果分为T2DM合并特发性膜性肾病（IMN）组（IMN,n=46,包括IMN合并DKD患者3例）、DKD组（n=25）及T2DM合并其他类型肾病组（其他组,n=16）。ELISA法检测患者血清抗PLA2R抗体。结果 DKD、其他组血清抗PLA2R抗体阳性率及抗体水平低于IMN组（P<0.05）。受试者工作特征（ROC）曲线分析显示,血清抗PLA2R抗体预测IMN的ROC曲线下面积为0.904(P<0.05),最佳截断值为13.80 RU/ml,灵敏度0.804,特异度0.951。Logistic回归分析显示,DM病程、eGFR、血清抗PLA2R抗体是IMN的影响因素,DR、SBP、血清抗PLA2R抗体是DKD的影响因素。结论 血清抗PLA2R抗体阳性的T2MD合并蛋白尿患者,病理诊断为IMN可能性较大,可用于鉴别诊断。     

血清抗M型磷脂酶A2受体抗体阳性肿瘤合并膜性肾病6例临床分析

目的 探讨血清抗M型磷脂酶A2受体(PLA2R)抗体阳性的肿瘤合并膜性肾病(M-MN)患者的临床特点、治疗方法及预后.方法 回顾分析中国医科大学附属盛京医院2016年6月至2019年6月期间诊断的6例M-MN患者的临床资料及治疗方法,并随访患者预后.结果 PLA2R阳性的M-MN患者的肿瘤病理类型与既往研究中出现的肿瘤...     

老年肾病综合征患者血清抗磷脂酶A2受体抗体水平与肾功能的相关性

目的探讨老年肾病综合征患者血清抗磷脂酶(PL)A2受体(PLA2R)抗体水平与肾功能的相关性。方法选择老年肾病综合征患者81例作为观察组;同期健康体检者52例作为对照组。所有入组研究对象于清晨抽取静脉血,分离血清,采用酶联免疫吸附法(ELISA)测定抗PLA2R抗体含量,采用酶法测定血尿素氮(BUN)、尿酸(UA)、肌酐(Cr)含量。比较两组血清PLA2R抗体含量、血BUN、UA及血Cr含量变化及PLA2R抗体与BUN、UA和Cr相关性。结果观察组血清PLA2R抗体明显高于对照组(P0.05);观察组BUN、UA和Cr含量明显高于对照组(P0.05);观察组PLA2R抗体与BUN、UA和Cr呈正相关。结论老年肾病综合征患者血清PLA2R抗体表达异常升高,且PLA2R抗体与BUN、UA和Cr呈正相关。     

老年肾病综合征的临床表现和病理类型分析

目的：进一步了解老年肾病综合征的临床表现和病理特点。方法：对北京协和医院1980－1999年底住院老年肾病综合征病人进行临床表现和病理类型分析。结果：住院成人肾病综合征病人共513例,其中老年肾病综合征61例,占11．9％,原发病为原发性肾小球肾炎者49例,占80．3％,糖尿病肾病者7例,占11．5％。临床表现以浮肿、血尿为主,贫血的发生率为54．1％,慢性肾功能不全（CRF）为32．8％。肾活检发现,在非糖尿病肾病综合征病人用激素或激素加免疫抑制剂治疗的缓解率为47．85,有效率为30．4％,未缓解率为21．7％,一般激素或激素加免疫抑制剂效果较好,其临床表现与年轻人的肾病综合征相似,但合并贫血、急性肾功能不全（ARF）、CRF和感染的比例较高,最常见的病因是慢性肾小球肾炎,其病理类型以系膜增殖型肾小球肾炎最常见,其次是局灶增殖型肾小球肾炎,老年肾病综合征患者对激素或激素加免疫抑制剂治疗的反应尚可。     

老年肾病综合征的临床、病理及转归

报道３４例肾病综合征的病因、治疗和转归。原发性肾病综合征１４例（４１．１％）,以膜性肾病（６例）为最常见的病理类型,继发性２０例,以淀粉样变多见（１７．６％）。临床表现为镜下血尿、持续性非选择蛋白尿、高血压和肾功能损害。经激素和免疫抑制剂治疗,１２例完全缓解,８例部分缓解,总有效率达５９％,提示老年肾病综合征经积极治疗可取得较好的疗效。     

老年糖尿病患者血清可溶性白血胞介素—2受体水平变化及其临床意义

为探讨可溶性白细胞介素Ⅱ受体（ｓＩＬ－２Ｒ）在老年糖尿病患者不同病程血清中含量变化的临床意义，我们用双抗体夹心酶联免疫吸附试验检测了５５例不同病程老年糖尿病患者血清ｓＩＬ－２Ｒ水平，其结果示老年糖悄病患者血清ｓＩＬ－２Ｒ可作为该病病情进展及转归的辅助监测指标。     

老年肾病综合征的临床特点及病理类型分析

目的探讨老年肾病综合征的临床表现和病理特点。方法收集60岁以上老年肾病综合征患者41例,对其临床表现及肾活检病理进行分析。结果 41例患者中,原发性肾小球疾病28例(68.29%),病理类型以膜性肾病最常见,其次为局灶节段性肾小球硬化、微小病变性肾病;继发性肾病综合征13例(31.71%)。除肾病综合征表现外,伴血尿25例(60.98%),高血压24例(58.54%),肾功能异常20例(48.78%)。病程中出现感染11例(26.83%)。肾活检后无严重并发症。结论老年肾病综合征最常见的病因为原发性肾小球疾病,病理类型以膜性肾病最常见。主要临床表现为浮肿、血尿、高血压、肾功能减退,并发症主要为感染。行肾活检对老年患者是安全的。     

老年肾病综合征临床及病理特点

<正>肾病综合征(NS)是临床常见的肾脏疾病之一,对其临床及病理特点报道较多〔1,2〕。老年NS在临床上也并不少见,但对其报道较少。本研究通过对101例老年NS(≥60岁)患者的一般资料、实验室检查、原发病及肾穿刺活检(老年组71例,非老年组134例)病理资料进行回顾性分析,并与同期174例非老年NS(<60岁)患者进行对比,拟探讨老年NS临床及病理特点。1资料与方法1.1一般资料2009年2月至2013年4月我院收住院诊断为NS的患者275例,均符合NS的临床诊断标准〔3〕,分为老年组     

原发性肾病综合征43例临床及病理分析

对４３例原发性肾病综合征（ＰＮＳ）的临床及病理进行分析，结果表明：本组ＰＮＳ的主要病理类型为系膜增殖性肾炎；肾小管萎缩与肾间质纤维化病变越重，血肌酐（Ｓｃｒ）异常的发生率越高；肾间质病变越重，血尿、高血压，Ｓｃｒ异常及尿溶菌酶升高的并存率越高。提示ＰＮＳ患者肾小球病变合并肾间质损害时，间质病变的程度更能准确反映患者病情的轻重，并指导治疗，判断预后。     

糖尿病肾病大鼠肾脏磷脂酶A2活性变化及Ⅱ型磷脂酶A2 mRNA的表达

糖尿病肾病 (ｄｉａｂｅｔｉｃｎｅｐｈｒｏｐａｔｈｙ ,ＤＮ)的发病原因较复杂 ,花生四烯酸及其代谢产物前列腺素、血小板活化因子等参与了ＤＮ的发生、发展过程 ,而有关这些物质的合成前体磷脂酶Ａ2 (ｐｈｏｓｐｈｏｌｉｐａｓｅＡ2 ,ＰＬＡ2 )与ＤＮ关系的研究报道较少 ,尤其是参与ＤＮ病理过程的ＰＬＡ2 类型还不清楚。本文初步探讨了肾脏ＰＬＡ2 活性及Ⅱ型ＰＬＡ2 ｍＲＮＡ表达在ＤＮ时的改变 ,及其在ＤＮ发生机制中的可能作用 ,以进一步了解ＤＮ发生的病理机制。1　材料和方法1.1　实验动物模型　雄性Ｗｉｓｔａｒ大鼠 ,体重 150～2 …     

血、尿 RBP 水平判断原发性肾病综合征肾脏损伤程度和预后的价值

目的：检测原发性肾病综合征（PNS）患者血清、尿视黄醇结合蛋白（RBP）水平,探讨其对患者肾脏损伤程度和预后判断的价值。方法收集50例PNS患者,行肾穿刺病理检查,根据小管间质损伤（ TID）程度将患者分为两组,A组TID≤2分、B组TID＞2分。另设正常对照组,检测三组的血清、尿RBP,24 h尿蛋白总量及肾功能。对PNS患者给予强的松及相应的降压抗凝等治疗,2个月后复查血清、尿RBP,肌酐及尿常规。根据疗效分为激素敏感（尿蛋白转阴）、激素部分敏感（尿蛋白＋～＋＋）、激素不敏感（尿蛋白＞＋＋＋）三组。比较三组的血清、尿RBP变化及与激素敏感性的相关性。结果与正常对照组相比,A、B两组血清、尿RBP,血肌酐、尿素氮均升高（ P均＜0．05）,B组较A组变化更显著（P均＜0．05）。与激素敏感组相比,部分敏感组和不敏感组治疗前血清、尿RBP均有升高,部分敏感组较不敏感组变化更显著（P均＜0．05）。 Spearman 相关分析显示,治疗前血清RBP、尿RBP与激素敏感性呈正相关（P均＜0．05）。结论血、尿RBP可以反映PNS患者的肾小管间质病变的严重程度,并且可以作为判断预后的指标。     

Circadian blood pressure abnormalities in patients with primary nephrotic syndrome

Background: Only a few studies have evaluated the abnormalities of ambulatory blood pressure (ABP) in patients with nephrotic syndrome (NS). Methods: The 24-h ABPs were measured in primary NS patients with acute onset of disease and analyzed in relation to the clinical variables. Results: Our subjects comprised 21 patients: 17 with minimal change disease and 4 with focal segmental glomerulosclerosis. Of these patients, 8 (38%) had daytime hypertension, 13 (62%) had nighttime hypertension, and 13 (62%) were non-dippers (nighttime-to-daytime ratio of ABP: NDR > 0.9). The serum sodium level was correlated with the average 24-h ABP and NDR, after adjustment for other clinical variables, such as the increase in body weight, serum albumin level, and urinary protein excretion. The data from repeated ABP measurements, before and after the achievement of remission, showed a marked decrease in the average 24-h ABP after remission. Furthermore, change in the serum sodium level was significantly correlated with the change in NDR. Conclusion: These results suggest that alteration in renal handling of sodium and water, which might be reflected in serum sodium level, is involved in the abnormality of circadian blood pressure in primary NS patients.     

肾病综合征合并急性肾衰诱因分析及治疗体会

报告１２例原发性肾病综合征合并急性肾功能衰竭的病例，经大剂量激素冲击疗法，环磷酰胺及血透、血滤等治疗后，９例肾功能恢复，尿蛋白消失或减少。文章分析了ＮＳ引起ＡＲＦ的肾外及肾内病因，指出要高度警惕以ＡＲＦ为首发症状的ＮＳ患者，对治疗及相关因素进行了讨论。     

免疫抑制剂治疗原发性肾病综合征伴慢性肾功能不全的疗效观察

目的：探讨原发性肾病综合征（PNS）合并慢性肾功能不全患者应用糖皮质激素联合免疫抑制剂等药物的疗效及副作用,以期为临床上治疗此类疾病提供安全、有效的治疗方法。方法对2007年12月至2012年6月在解放军第148医院肾内科住院、诊断明确、临床资料完整、入院前未经系统、正规治疗的PNS伴肾功能不全患者50例进行回顾性分析。将患者分为免疫抑制治疗组及常规对症治疗组,观察两组治疗前及治疗后1,3,6,12个月时24h尿蛋白定量、血清白蛋白和血清肌酐等指标变化,并进行对比分析。结果免疫抑制治疗组的24h尿蛋白定量在治疗1,3,6及12个月时均显著减少;估算肾小球滤过率（eGFR）在治疗后3,6,12个月时均显著升高;而常规对症治疗组的上述两项指标在治疗12个月时变化仍不明显。免疫抑制治疗组与常规对症治疗组在药物副作用的观察方面有差异,但无统计学意义。结论对伴有一定程度慢性肾功能不全PNS患者,糖皮质激素和免疫抑制剂治疗可明显减少尿蛋白,改善eGFR,延缓肾功能恶化。     

东北地区147例成人原发性肾病综合征的临床病理研究

本文报告了东北地区147例成人原发性NS的临床病理观察。主要病理类型为MCNS(31.3％)和MsPGN(30.6％)。主要发病诱因是上呼吸道感染,这可能与气候、环境影响有关。91.2％病例血清α_2球蛋白增高,81％病例血IgG降低,75.5％病例血沉增快。作者认为此三项指标对NS有诊断意义。全部病例中完全缓解和部分缓解率分别为46.3％和31.3％,其中MCNS为67.4％和28.3％,MsPGN为55.6％和33.3％,FSGS为23.5％和52.9％.113例经过4.57±2.14年随访,未见有恶性疾病发生。本文结果显示,血栓栓塞性疾病可能成为NS患者的主要死亡原因.     

血清糖化血红蛋白及总胆红素水平与老年2型糖尿病患者早期肾损伤的相关性分析

目的 探讨血清糖化血红蛋白（glycosylated hemoglobin,HbA1c）和总胆红素（total bilirubin,TBIL）水平与老年2型糖尿病（type2diabetes mellitus,T2DM）患者早期肾损伤的相关性,为诊治该病提供参考。方法 选取2018年5月—2021年5月于西部战区总医院诊治的92例老年T2DM患者作为观察组,根据尿微量蛋白排泄率（urinary albumin ejection rate,UAER）分为3个亚组：正常蛋白尿（NA）组（UAER<20μg/min,n=26）、微量蛋白尿（MA）组（UAER20～200μg/min,n=31）和大量蛋白尿（CA）组（UAER> 200μg/min,n=35）;另取同期40例体检健康者作为对照组。检测并比较所有受试者血清HbA1c值、TBIL水平及肾损伤指标值,采用ROC曲线分析血清HbA1c值和TBIL水平对老年T2DM患者早期肾损伤的诊断价值,采用Pearson相关系数分析血清HbA1c值和TBIL水平与老年T2DM患者早期肾损伤的相关性。结果 观察组血清HbA1c值高于对照组...     

The effectiveness of cyclosporine A for patients with steroid-resistant nephrotic syndrome: A protocol for systematic review and meta-analysis

Background:The purpose of this study is to determine the efficacy and safety of Cyclosporine A (CsA) for patients with steroid-resistant nephrotic syndrome (SRNS).Methods:This study will be designed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement guidelines. Studies are identified through systematic searches in November 2021 with no restrictions on date and time, and publication status using the following bibliographic databases: Embase, Medline, PubMed, Web of Science, Science Direct, and the Cochrane Library. The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting, and other bias by Cochrane Collaboration''s tool. Data synthesis and analyses are performed using Stata version 10.0 software.Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:CsA may be an effective and safe therapy for SRNS. However, additional randomized controlled studies are needed to thoroughly assess the role of CsA in the treatment of SRNS.Open Science Framework registration number:10.17605/OSF.IO/P6YB9     

Elevated SCF levels in the serum of patients with chronic renal failure

Serum stem cell factor (SCF) and soluble KIT (sKIT) levels were estimated in patients with chronic renal failure (CRF) and anaemia, and compared with clinical parameters of blood cells and renal function. Serum SCF levels in CRF patients were 5-fold higher than those in healthy controls. However, serum sKIT levels in haemodialysis (HD)-CRF patients were only slightly higher than those of healthy controls. In untreated CRF patients and healthy controls, serum SCF levels were significantly correlated with blood urea nitrogen (BUN), creatinine, haemoglobin, red blood cell (RBC) count and sKIT. In untreated CRF patients, serum SCF levels were significantly correlated with BUN, creatinine, and sKIT. These results suggest that serum SCF levels increased with the deterioration of renal function and might be related to erythropoiesis.     

M-type Phospholipase A2 Receptor Autoantibodies and Renal Function in Patients with Primary Membranous Nephropathy

Background and objectives

Loss of renal function in patients with primary membranous nephropathy cannot be reliably predicted by laboratory or clinical markers at the time of diagnosis. M-type phospholipase A₂ receptor autoantibodies have been shown to be associated with changes in proteinuria. Their eventual effect on renal function, however, is unclear.

Design, setting, participants, & measurements

In this prospective, open, multicenter study, the potential role of M-type phospholipase A₂ receptor autoantibodies levels on the increase of serum creatinine in 118 consecutive patients with membranous nephropathy and positivity for serum M-type phospholipase A₂ receptor autoantibodies was analyzed. Patients were included in the study between April of 2010 and December of 2012 and observed until December of 2013. The clinical end point was defined as an increase of serum creatinine by ≥25% and serum creatinine reaching ≥1.3 mg/dl.

Results

Patients were divided into tertiles according to their M-type phospholipase A₂ receptor autoantibody levels at the time of inclusion in the study: tertile 1 levels=20–86 units/ml (low), tertile 2 levels=87–201 units/ml (medium), and tertile 3 levels ≥202 units/ml (high). The median follow-up time of all patients in the study was 27 months (interquartile range=18–33 months). The clinical end point was reached in 69% of patients with high M-type phospholipase A₂ receptor autoantibodies levels (tertile 3) but only 25% of patients with low M-type phospholipase A₂ receptor autoantibodies levels. The average time to reach the study end point was 17.7 months in patients with high M-type phospholipase A₂ receptor autoantibodies levels and 30.9 months in patients with low M-type phospholipase A₂ receptor autoantibodies levels. A multivariate Cox regression analysis showed that high M-type phospholipase A₂ receptor autoantibodies levels—in addition to men and older age—are an independent predictor for progressive loss of renal function.

Conclusions

High M-type phospholipase A₂ receptor autoantibodies levels were associated with more rapid loss of renal function in this cohort of patients with primary membranous nephropathy and therefore, could be helpful for treatment decisions.     

肾综合征出血热患者血清铁蛋白水平变化研究

目的 观察不同分型及不同分期肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者血清铁蛋白(ferritin,FRT)水平变化,探讨其在重症HFRS早期预警及预后(死亡)评估中的作用.方法 以空军军医大学第二附属医院传染科2011年10月—2013年12月收治的符合...