肾病综合征血清铁与3种蛋白质及白球比值的关系分析

[目的]探讨肾病综合症（NS）患者血清铁（SI）与血清总蛋白（TP）、白蛋白（Alb）、球蛋白（Glb）以及白蛋白／球蛋白比值（A／G）之间的关系。[方法]对正常对照组和肾病综合征组中的SI、TP和Alb分别用比色法、双缩脲法和溴甲酚紫法进行检测,Glb=TP—Alb,A／G=Alb／Glb。[结果]NS组中血清铁与TP（r=0．439,P〈0．001）、Alb（r=0．448,P〈0．001）以及A／G（r=0．372,P〈0．001）具有相关性,差异具有显著性、具有明显的统计学意义,而与Glb则无相关性,差异无显著性（P〉0．05）;正常对照组中,血清铁与血清TP、Alb、Glb、A／G间均不存在相关关系,差异均不具显著性（P〉0．05）。[结论]NS患者中血清铁的水平与TP和Alb之间具有紧密的关系。     

原发性肾病综合征患者血清前白蛋白和白蛋白水平的变化

前白蛋白（ｐｒｅａｌｂｕｍｉｎ,ＰＡ）虽然主要由肝脏合成,但在胰腺、肾近曲小管和视网膜及脉络丛组织内亦有分布。血清ＰＡ水平在肝病、肿瘤及营养状态方面的变化多有报道,但在肾病中的报道甚少。本文对２２例原发性肾综合征（简称肾综）病人和正常人血清ＰＡ和白蛋白含量进行了测定。材料和方法一、检测对象　正常对照组５７人均为健康体检者,男３５,女２２,１８～５５岁,Ｂ超及肝、肾功能各项指标均无异常发现。肾病组２２人均为本院内肾科明确诊断的原发性肾综病人,男１４,女８,２８～６７岁。二、方法１．试剂　ＰＡ试剂由…     

肾病综合征血清铁与血清白蛋白的关系分析

目的探讨肾病综合征(NS)患者血清铁(Fe)与血清白蛋白(ALB)之间的关系。方法分别对65例NS病人和正常对照组人员的血清铁和血清白蛋白进行测定。结果 NS组中的血清铁与血清白蛋白(r=0.439,P<0.001)具有相关性,差异有统计学意义;正常对照组中,血清铁与血清白蛋白间不存在相关关系,差异无统计学意义(P>0.05)。结论 NS患者中血清铁的水平与血清白蛋白之间具有紧密的关系。     

肾病综合征治疗前后血清CAl25水平变化及其影响因素分析

肾病综合征（NS）是一种常见的泌尿系疾病，严重危害人体健康。其临床特点为“三高一低”，即高脂血症、高蛋白尿、水肿和低血浆蛋白。病情严重者可出现胸腹腔积液及无尿等症状。     

儿童肾病综合征血清钠与白蛋白相关因素分析(附107例报告)

肾病综合征合并低钠血症临床较常见。为探讨血清钠与血浆白蛋白之间的关系 ,了解血浆白蛋白是否有助于纠正低钠血症 ,为此我们回顾分析 10 7例原发性肾病综合征的临床资料 ,报告如下。1　资料与方法1.1　一般资料　 10 7例肾病综合征患儿均符合 1981年全国小儿肾脏疾病科研协作组制定的标准 ,均为初发病例。男 72例 ,女 35例 ;年龄≤ 6岁 5 3例 ,>6岁 5 4例。其中单纯型 82例 ,肾炎型 2 5例。按住院第 1次血清钠情况 ,血钠 <135mm ol/ L 为低钠组 ,共 5 1例 ;血钠正常 5 6例为对照组。观察两组血浆白蛋白变化以及在纠正低钠血症中补充血浆…     

原发性肾病综合征患儿血清白介素-8的变化

目的 探讨原发性肾病综合征患儿血清白介素-8（IL-8）的变化以及IL-8在肾病综合征发病中的作用及意义。方法 采用酶联免疫吸附（ELISA）法,检测肾病综合征急性期和缓解期惠儿血清IL-8的水平,同时检测血清白蛋白,作统计分析。结果 肾病综合征患儿急性期IL-8水平显著高于正常对照组及缓解期患儿组;缓解期患儿血清IL-8水平高于正常对照组,但无显著性差异。急性期和缓解期惠儿血清白蛋白显著低于正常对照组;急性期患儿血清白蛋白显著低于缓解期．患儿急性期血清IL-8和血清白蛋白水平存在明显的负相关。结论 IL-8在血清中的含量与肾小球病理损伤密切相关,因此对肾病综合征患儿IL-8水平进行监测对判断肾病综合征损伤、预后等可能具有一定的临床意义。     

儿童肾病综合征血清钠与白蛋白相关

作者分析了107例原发性肾病综合征患儿低钠血症与血蛋白的关系,现报告如下.1临床资料     

236例肾病综合征患者发生院内感染的临床研究

肾病综合征（nephritic syndrome,NS）由于大量蛋白的丢失、营养不良及自身免疫功能低下,加之治疗中应用大量糖皮质激素和细胞毒性药物,造成全身和局部抵抗力下降,常易合并感染,尤其是在医院这种环境中,感染的发生率更高。医院感染不仅加重病情,增加治疗的难度,而且影响患者的预后。因此,对NS患者医院感染发生特点的分析研究,进一步早期预防和早期治疗具有重要的意义。我们对近6年来我院收治的236例NS患者发生医院感染的情况进行分析研究,现报告如下。     

血清视黄醇结合蛋白、胆碱脂酶、白蛋白水平联合检测对肾病综合征患者的诊断价值

目的探讨视黄醇结合蛋白(RBP)、胆碱酯酶(CHE)、白蛋白(ALB)水平联合检测对肾病综合征患者的诊断价值。方法选取2018年4月～2019年4月我院肾病综合征患者83例作为观察组,另选取同期健康体检者80例作为对照组,均进行RBP、CHE、ALB水平检测。比较两组RBP、CHE、ALB、CHE/ALB水平,同时对比观察组中RBP、CHE/ALB单独与联合诊断肾病综合征的阳性检出率。结果观察组RBP、CHE、CHE/ALB水平高于对照组,ALB水平低于对照组,差异有统计学意义(P0.05);RBP水平检测诊断肾病综合征阳性检出率为65.06%,CHE/ALB阳性检出率为81.93%,联合诊断为97.59%,联合诊断肾病综合征阳性检出率高于单独诊断(P0.05)。结论 RBP、CHE/ALB联合检测可提高肾病综合征患者阳性检出率,具有较高诊断效能,且操作简便,适合临床推广使用。     

Relationship among the concentrations of serum lipoproteins and changes in their chemical composition in patients with untreated nephrotic syndrome

Abstract. The quantitative and qualitative changes of serum lipoproteins have been studied in twelve patients with untreated uncomplicated nephrotic syndrome. The lipoprotein disorders found in these patients were characterized by an elevation of VLDL (d < 1.006 g ml^-1), LDL (d 1.006–1.019 g ml^-1) and LDL₂ (d 1.019–1.063 g ml^-1) and a diminution of HDL₂ (d 1.063–1.125 g ml^-1). These changes were strictly correlated with the concentration of serum albumin and were more pronounced in the patients with serum albumin < 20 g l^-1. The study of the relationship among the concentrations of the various lipoprotein classes indicated that (i) the levels of VLDL and LDL₁ were reciprocally related to that of the high density lipoproteins and (ii) the level of LDL₂ rose with the moderately increased VLDL and LDL₁ but at the high concentrations of VLDL and LDL₁ observed in the severe nephrotic syndrome it did not show any further increase, suggesting a defect in the conversion of VLDL to LDL₂. The nephrotic syndrome was associated with marked changes in the composition of all lipoprotein fractions which were found to contain more phospholipid but less protein than normal. Major changes in composition were observed in VLDL and LDL₁ which were rich in esterified cholesterol and phopholipids and had an esterified cholesterol: triglyceride molar ratio (CE/TG) higher than the corresponding fractions of the control subjects. Furthermore, CE/TG ratio in these fractions increased as their serum concentration increased. These observations indicate that in severe, untreated uncomplicated nephrotic syndrome there is a progressive accumulation of d < 1.019 g ml^-1 lipoproteins rich in esterified cholesterol. Chemically these resemble VLDL and chylomicron remnants and are possibly related to some defect in the conversion of VLDL to LDL₂.     

儿童原发性肾病综合征患者小而密低密度脂蛋白胆固醇水平变化及其临床价值

目的分析肾病综合征(NS)患儿血清小而密低密度脂蛋白胆固醇(sdLDL-C)水平,探讨治疗前后NS患儿sdLDL-C水平的变化,评估其临床价值。方法收集2018年6—9月在南京大学医学院附属金陵医院肾内科住院并确诊的NS患儿50例(NS组)和同期健康对照儿童40例(对照组)。分别检测NS患儿治疗前后和对照组儿童的血清sdLDL-C水平,同时测定其总蛋白(TP)、清蛋白(ALB)、血脂[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]及肾功能指标[尿素(UREA)、肌酐(Cr)、尿酸(UA)]水平,并进行统计学分析。结果治疗前NS组患儿血清sdLDL-C水平中位数(四分位数)[M(P 25,P 75)]为[47.61(29.41,99.54)]mg/dL,治疗后NS组血清sdLDL-C水平为[29.13(17.72,43.90)]mg/dL,均明显高于对照组[15.88(13.66,20.08)]mg/dL,差异有统计学意义(均P<0.001);且治疗后NS患儿血清sdLDL-C水平明显低于治疗前患儿(P<0.001)。Spearman相关性分析显示,NS患儿血清sdLDL-C水平与TC(r=0.949,P<0.001)、TG(r=0.597,P<0.001)和LDL-C(r=0.874,P<0.001)水平均呈显著正相关,与TP(r=-0.692,P<0.001)、ALB(r=-0.765,P<0.001)均呈显著负相关。逐步多元线性回归分析显示,在校正其他相关因素的影响后,NS患儿血清sdLDL-C水平与ALB水平仍独立相关(β=-0.780,P<0.001,校正R 2=0.604)。结论NS患儿血清sdLDL-C水平明显升高,治疗后明显下降;且NS患儿血清sdLDL-C水平有望作为其病情评估的新指标。     

骨髓增生异常综合征患者血清细胞因子表达及相关性研究

目的探讨血清肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)和IL-12水平与骨髓增生异常综合征(MDS)的关系及临床意义,进而研究其在MDS发病中的作用,为临床防治MDS提供理论依据。方法采用酶联免疫吸附试验(ELISA)检测40例MDS患者及40例健康人血清中TNF-α、IL-10和IL-12水平。结果与健康对照组比较,MDS患者血清TNF-α、IL-10和IL-12水平明显升高,差异有统计学意义(P<0.01);观察MDS不同分型间血清TNF-α、IL-10和IL-12水平发现,MDS早期组和进展组患者血清TNF-α、IL-10和IL-12水平均高于健康对照组,差异有统计学意义(P<0.01),且进展组血清IL-10水平显著高于早期组,差异有统计学意义(P<0.01),但进展组血清TNF-α和IL-12水平低于早期组,差异有统计学意义(P<0.01)。结论 TNF-α、IL-10和IL-12参与MDS发病及病情演变,检测TNF-α、IL-10和IL-12有助于指导MDS分型和判断预后,并为治疗MDS提供新思路。     

原发性肾病综合征高脂血症与肾功能的相关性研究

目的研究原发性肾病综合征(PNS)患者高脂血症与肾功能评价指标间的关系,并分析其尿液形态学特点。方法收集2018年1-12月解放军第970医院威海院区肾内科经临床和病理穿刺明确确诊为PNS病例59例作为PNS组,并选取同期就诊于该院肾内科的其他肾病病例57例作为疾病对照组,另选取同期体检中心进行查体健康且检测指标与疾病对照组均匹配的体检人群52例作为健康对照组。比较PNS组与疾病对照组、健康对照组的血脂水平,主要评价指标包括三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)等。Spearman相关分析和Logistic线性回归分析研究PNS组内各项血脂指标与肾功能指标,清蛋白(ALB)、肾小球滤过率(eGFR)、血肌酐(Scr)、血清尿素氮(BUN)和24 h尿蛋白定量(24 hPro)等之间的相关性,并对PNS患者尿液进行镜检,观察尿液形态学特征改变。结果PNS组各项血脂指标明显高于疾病对照组和健康对照组,差异有统计学意义(P<0.05);Spearman相关分析发现ALB、eGFR、SCr与血脂指标存在相关性;Logistic线性回归分析显示低ALB水平和LDL、eGFR和HDL互为水平变化的危险因素,同时低ALB水平还可促进TC、ApoB升高,eGFR还可促进ApoA1升高,低HDL水平促进SCr升高,而血脂升高的PNS患者镜下可见脂肪变性的肾上皮细胞或脂肪管型。结论PNS患者血脂指标明显升高,且存在血脂指标与肾功能指标相互促进关系。PNS尿液有形成分出现脂肪变性,可作为肾脏脂质沉积和肾功能损伤的表现。     

原发性肾病综合征胰岛素抵抗与炎症因子的相关性

目的:探讨原发性肾病综合征(PNS)是否存在胰岛素抵抗及其与炎症因子TNF-α、IL-6的相关性.方法:收集73例PNS患者和69例健康对照者血脂、血肌酐、空腹血糖、胰岛素,计算胰岛素敏感指教,并用ELIASA法检测TNF-α、IL-6,两组对照比较,判断PNS有无胰岛素抵抗,分析胰岛素敏感指数与TNF-α、IL-6的关系.结果:PNS患者总胆固醇、甘油三酯、低密度脂蛋白胆固醇、胰岛素、TNF-α、IL-6显著高于对照组(r=-0.45,r=-0.62,P<0.05),胰岛素敏感指数显著低于对照组(P<0.05).胰岛素敏感指数与TNF-α、IL-6呈显著负相关(P<0.05).结论:PNS存在胰岛素抵抗,可能与炎症因子TNF-α、IL-6升高有关.     

血清NT-proBNP水平与代谢综合征相关性研究

目的探讨血清N末端B型钠尿肽原(NT-proBNP)与代谢综合征(MS)的相关性。方法选取该院内分泌科门诊符合MS诊断标准的患者61例为MS组,同时选取同期该院门诊查体健康人群50例为健康对照组。采用电化学发光法测定血清NT-proBNP水平。结果 MS组血清NT-proBNP水平为(112.6±18.6)pg/mL,显著高于健康对照组的(80.3±5.7)pg/mL,差异有统计学意义(P0.05)。血清NT-proBNP与静脉空腹血糖水平(FPG)、腰臀比(WHR)、收缩压(SBP)和三酰甘油(TG)呈正相关(r分别为0.710、0.626、0.595、0.595,P0.05);血清NT-proBNP与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.745,P0.05)。结论血清NT-proBNP与MS密切相关,血清NT-proBNP水平可作为评估MS患者早期预防高危因素的标志物之一。     

老年类风湿关节炎肺功能变化及其相关性

目的研究老年类风湿关节炎(PA)患者肺功能变化及与其他指标的相关性。方法将66例RA患者按年龄分为中青年类风湿关节炎(YMRA)、老年类风湿关节炎(ERA)两组,采用肺功能仪检测两组RA患者的肺功能变化,并与健康对照组(NC)进行比较;观察两组RA患者的生活质量、焦虑(SAS)和抑郁(SDS)、社会支持评定(SSRS)量表、健康指数(HAQ)、疾病活动度评分(DAS-28)及临床症状、体征及实验室指标的变化。结果(1)在66例RA患者中,YMRA占71.2%,ERA占28.8%;与健康对照组比较可知,RA患者肺功能异常率最高的为FEF75(66.7%),其次为FEF50、MVV、FEF25;ERA组FEF75异常率达74.4%,PEF、MVV异常率分别为73.4%、57.9%。(2)与NC组比较,YMRA组、ERA组VC、FEV1、FVC、MVV、FEF25、FEF50、FEF75、PEF明显降低(P<0.01)。与YMRA组相比,ERA组SSRS、双手握力数、ASO、CD4+CD25+CD127-Treg降低(P<0.05);生理功能积分、社会功能积分、心理功能积分、健康认识积分、生活质量总积分、SAS、SDS、HAQ、关节肿胀、关节压痛、中医症候总积分、血清铁、X胸片分级显著升高(P<0.05或P<0.01)。(3)Spearman相关分析结果显示,ERA组患者肺功能参数FEV1与晨僵呈正相关,FEF25与关节压痛呈正相关(P<0.05);VC、FVC与15 m步行时间呈负相关,FEV1、PEF与关节压痛呈负相关,MVV与DAS-28呈负相关,FEF50与关节压痛、15 m步行时间呈负相关,FEF75与补体C3呈负相关(P<0.05或P<0.01)。结论类风湿关节炎患者随着年龄的增长,其肺功能水平显著下降,表现为小气道功能的严重损伤,并伴有混合性通气功能障碍。     

冠心病与C反应蛋白的相关性研究

目的探讨冠心病患者血清C反应蛋白(CRP)水平对冠心病发病的临床意义及对病情预测的价值。方法选取90例冠心病患者和同期体检的知情同意的健康体检人25例分别作为实验组和对照组,其中实验组中稳定型心绞痛(SAP组)30例,不稳定型心绞痛患者(UAP组)30例,急性心肌梗死(AMI组)30例。分别在其入院或体检时抽取空腹静脉血,测定血清CRP含量,观察其CRP的变化。结果实验组中UAP、AMI患者CRP含量高于对照组(P<0.05),SAP、UAP及UAP患者CRP水平依次升高且UAP和AMI两组间有显著性差异(P<0.05)。结论CRP水平与冠心病的病变程度有明显的相关性,早期检测CRP水平对于冠心病的早期评估和控制有重要作用,并可减少心血管病患者急性事件的发生。     

Effect of changes in posture on circulatory homeostasis in patients with the nephrotic syndrome

Summary. To assess whether the upright posture causes circulatory hypovolaemia in patients with the nephrotic syndrome (NS), we studied 12 subjects with NS and 12 healthy subjects during recumbency, 110 min of standing, followed again by recumbency. Control blood-pressure was 134/88±4/3 mmHg in the patients and 113/75±2/3 mmHg in the normal subjects (P<0.01), and remained higher in the patients throughout the procedure. Heart rate was continuously higher in the patients (P<0.05), but acceleration on standing was normal. The blood volume, which was not different during recumbency, had fallen below that in normal subjects after 25 min of standing (P<0.05), due to excessive plasma volume reduction (-16.8±0–8% in the patients against -11.7±1.2% in the normals, P<0.02). Plasma renin activity (PRA) was higher in the patients while recumbent (P<0.001) but not during standing, due to a blunted response in some. No significant differences in plasma noradrenaline were found, but four patients reacted with an excessive rise in plasma noradrenaline and heart rate. This subset, which had high PRA levels as well, comprised the only subject who experienced orthostatic hypotension. It is concluded that during standing an excessive drop in plasma volume leads to a lowered blood volume in NS patients. This forms a paradox with the heart rate acceleration and noradrenaline levels, which were mostly normal, and with the blood-pressure, which remained slightly elevated. Even in a few patients with enhanced stimulation of heart rate and noradrenaline, blood-pressure was found to be high in the majority of cases. PRA was usually found to be increased but, in part, independent of posture.     

LDL-apheresis in patients with nephrotic syndrome: effects on serum albumin and urinary albumin excretion

BACKGROUND: Hyperlipidemia is a common feature of the nephrotic syndrome (NS). From retrospective studies, it has been suggested that aggressive lipid-lowering with low-density lipoprotein apheresis (LDL-A) may not only improve dyslipidemia but also decrease urinary albumin excretion and increase serum levels of albumin in patients with focal segmental sclerosis. METHODS: Seven patients (6 males) aged 44 +/-7 years (SEM) with NS (duration 29+/-11 months) of diverse etiologies were investigated in a prospective study. A fixed protocol of LDL-A was designed for treatment twice-a-week for 3 weeks and then once a week for 7 weeks. The effects of LDL-A on lipid parameters (cholesterol, triglycerides, HDL, Lp(a), apo A-I, apo B) and renal parameters (iohexol clearance, serum albumin and 24-h urinary albumin excretion) were evaluated. RESULTS: Following treatment by LDL-A a remission in the severity of the NS was observed in two patients whereas a clear improvement was observed in four of the patients. A small, but significant (P<0.05), increase in serum albumin levels from 20+/-2 to 24+/-2 g L(-1) was noted after LDL-A. As expected, serum lipid parameters improved during LDL-A, and significant decreases in serum cholesterol, apo B and plasma Lp(a) were observed at different time-points of LDL-A. Conversely, no significant changes in either triglyceride, HDL or apo A-I levels were observed during LDL-A. CONCLUSIONS: The present uncontrolled prospective study shows that LDL-A causes a rapid 30-40% decrease in serum cholesterol and plasma Lp(a) levels in patients with NS. The present prospective study also suggests that short-term LDL-A treatment may increase serum albumin levels in nephrotic patients.