要重视肾小管间质性疾病的早期诊治

１引言肾小管间质性疾病（nephrotictublointerstitialdiseases，NTID）是由多种病因引起、发病机制各异、以肾小管间质病变为主的一组疾病。NTID是病理学诊断，按其肾脏病理变化的特点分为：以肾间质水肿、炎性细胞浸润为主的急性肾小管间质性疾病（ANTID）和以肾间质纤维化、肾小管萎缩为主的慢性肾小管间质性疾病（CNTID）。NTID在临床上的重要性在于：①NTID是引起肾衰竭的主要疾病之一，NTID引起的肾衰竭占急性肾衰竭的１０％，占慢性肾衰竭的２０％；②国外和我们的研究资料均表明，在原发性或继发性肾小球疾病中，肾小管…     

肾动态显像与IgA肾病病理学改变相关性研究

目的:研究肾动态显像与IgA肾病(IgAN)病理学改变的关系。方法:选择经病理学证实为IgAN患者67例,对其肾小球、肾小管间质和血管损害程度进行Katafuchi’s积分和Lee氏分级。全部患者均接受99mTc-DTPA肾动态显像,计算出灌注指数(PI)、肾小球滤过率(GFR)和20min清除率(C20)。分析不同病理分级之间显像指标与病理积分间的关系。结果:PI与血管损害积分正相关(P<0.01),GFR与肾小球损害(P<0.01)及肾小管间质损害积分(P<0.05)负相关,C20与肾小管间质损害积分(P<0.05)负相关。随着病理分级增高,GFR和C20值逐渐降低,PI值逐渐增高,且各级之间显像参数均有显著性差异(P<0.05)。结论:肾动态显像结果与肾脏组织病理学改变明显相关,能较好地反映病理损伤的进程,对IgAN病情评价及预后判断具有实用价值。     

缺氧在慢性肾脏疾病进程中的不良作用机制及其干预

各种类型的慢性肾脏疾病(CKD)虽有不同的病理学特征,但也存在一些共性,即其晚期均出现肾小球硬化和肾小管间质纤维化。CKD大多始于肾     

肾活检患者病理及临床资料分析

目的：探讨肾穿刺活检术（简称肾活检）患者病理分型与临床表现的关系,为肾脏疾病的诊断和治疗提供参考。方法回顾性分析2009年1月至2013年1月接受肾活检的270例患者的临床资料。结果270例患者中,原发性肾小球疾病190例,占70．37％;继发性肾小球疾病50例,占18．52％;遗传性肾脏疾病5例,占1．85％;肾小管间质性疾病25例,占9．26％。临床分类以肾病综合征（NS ）最为多见,共有117例,占43．33％,其中以系膜增生肾小球肾炎为主,共61例,占22．59％。未检出存在4级肾小球硬化和肾间质纤维化病变的患者,检出3级肾小球硬化100例、3级肾间质纤维化14例,且其血清纤维化指标水平高于1级和2级病变患者。结论由于肾脏疾病的临床表现与病变程度往往不一致,因此肾活检对于肾脏疾病的诊断和治疗方案的制订有着非常重要的意义。     

海军水面舰艇官兵高尿酸血症患病情况调查及相关因素分析

目的 调查海军某部水面舰艇官兵高尿酸血症(HUA)患病情况,并对相关因素进行研究探讨,旨在找出HUA的危险因素为防治提供依据。方法 选取2021年1月至2023年3月到某院疗养的水面舰艇官兵368例,进行健康状况调查、常规体检,并抽血化验血尿酸及其他生化指标进行分析。结果 368例疗养员中,检出HUA 92例,检出率25.00%;在对一般情况进行亚组分析时发现超重肥胖组发病率明显高于体质指数(BMI)正常人员(P<0.05)。相关因素Logisitic回归分析表明,BMI、尿素氮、脂肪肝均为HUA的危险因素(P<0.05)。结论 HUA在海军水面舰艇官兵呈现稳定的高患病率状态,且与超重肥胖、肾功能下降和脂肪肝呈正相关。     

133例老年肾穿刺活检患者临床及病理特征

目的探讨年龄65岁老年肾穿刺活检患者的临床及病理特征。方法回顾性分析133例年龄65岁老年肾脏病患者的临床资料及肾穿刺活检组织病理结果。结果 133例老年肾穿刺活检患者收缩压(140.21±22.42)mm Hg,舒张压(81.67±11.57)mm Hg,血清白蛋白(27.28±8.48)g/L,肌酐101(41,445)μmol/L,估算肾小球滤过率(62.8±41.9)mL/(min·1.73m~2),24h尿蛋白定量2.44(0.20,4.28)g;临床诊断为原发性肾小球疾病84例,继发性肾小球疾病23例,肾小管-间质疾病20例,其他6例;原发性肾小球疾病的临床表现以肾病综合征最为多见(77例),其次为慢性肾功能不全(5例)、肾炎综合征(2例),病理类型以膜性肾病最多见(50例),其次为肾小球微小病变(18例);继发性肾小球疾病以抗中性粒细胞胞浆抗体相关性血管炎多见(7例),其次为淀粉样变性和乙肝病毒相关性肾炎(各6例);77例肾病综合征患者中膜性肾病42例。结论年龄65岁肾脏病患者原发性肾小球疾病多见,临床主要表现为肾病综合征,病理类型以膜性肾病为主,抗中性粒细胞胞浆抗体相关性血管炎是继发性肾小球疾病最常见的病理类型。     

老年高血压与高尿酸血症

高尿酸血症(HUA)定义为血尿酸(UA)水平大于428μmol/L。UA是人类嘌呤代谢的产物,2／3以上经肾脏排泄,游离尿酸盐可自由从肾小球滤过,但98％被肾小管重吸收。UA的生成增加或排泄不足,可导致高UA血症,而超饱和状态的UA可以在滑膜囊、皮下肾小管甚至间质内释出沉积,发生肾结石、间质性     

p16^INK4a在原发性系膜增生性肾小球肾炎的表达及意义

目的：探讨原发性系膜增生性肾小球肾炎（MsPGN）细胞周期素依赖蛋白激酶抑制剂p16^INK4a在肾小球和肾小管间质的表达分布及意义。方法：采用非生物素免疫组化二步法检测36例MsPGN患者活检肾组织肾小球和肾小管间质p16^INK4a的表达水平。结果：正常对照组肾小球见极少p16^INK4a表达,肾小管间质少许表达,MsPGN组肾小球和小管间质p16^INK4a表达升高,两组比较,具有显著统计学差异（P〈0.01）。36例病例中15例硬化、新月体形成组肾小球上高表达,而非硬化、非新月体形成组肾小球部分表达,组间相比具有显著差异（P〈0.01）,而小管间质表达无统计学差异（P〉0.05）。结论：MsPGN组p16^INK4a高表达,主要表达于硬化肾小球、新月体形成肾小球,p16^INK4a参与了MsPGN的细胞周期调控。     

循证医学对肾脏疾病诊疗的影响

半个多世纪以来,临床上对大部分原发性肾小球疾病的有效治疗仍没有令人满意的突破.多种肾小球及肾小管间质疾病病情演变为慢性肾功能衰竭(CRF)的趋势并未能有效遏制,CRF患者发病率仍不断增加.临床研究原发性肾小球疾病的有效治疗是个战略任务.     

p16^INK4a在原发性系膜增生性肾小球肾炎的表达及意义

目的：探讨原发性系膜增生性肾小球肾炎（MsPGN）细胞周期素依赖蛋白激酶抑制剂p16^INK4a在肾小球和肾小管间质的表达分布及意义。方法：采用非生物素免疫组化二步法检测36例MsPGN患者活检肾组织肾小球和肾小管间质p16^INK4a的表达水平。结果：正常对照组肾小球见极少p16^INK4a表达,肾小管间质少许表达,MsPGN组肾小球和小管间质p16^INK4a表达升高,两组比较,具有显著统计学差异（P〈0.01）。36例病例中15例硬化、新月体形成组肾小球上高表达,而非硬化、非新月体形成组肾小球部分表达,组间相比具有显著差异（P〈0.01）,而小管间质表达无统计学差异（P〉0.05）。结论：MsPGN组p16^INK4a高表达,主要表达于硬化肾小球、新月体形成肾小球,p16^INK4a参与了MsPGN的细胞周期调控。     

Glucocerebrosidase mutations and the pathogenesis of Parkinson disease

Abstract

Parkinson disease (PD) is the second most common neurodegenerative disease after Alzheimer disease with a lifetime risk in the UK population of almost 5%. An association between PD and Gaucher disease (GD) derived from the observation that GD patients and their heterozygous carrier relatives were at increased risk of PD. GD is an autosomal recessive lysosomal storage disorder caused by homozygous mutations in the gene encoding glucocerebrosidase (GBA). Approximately 5%–10% of PD patients have GBA mutations, making these mutations numerically the most important genetic predisposing risk factor for the development of PD identified to date. GBA mutations result in a phenotype that is virtually indistinguishable clinically, pharmacologically, and pathologically from sporadic PD, except GBA mutations result in a slightly earlier age of onset and more frequent cognitive impairment among PD patients. The mechanisms by which GBA mutations result in PD are not yet understood. Both reduced glucocerebrosidase enzyme (GCase) activity with lysosomal dysfunction, and unfolded protein response (UPR) with endoplasmic reticulum-associated degradation (ERAD) and stress are considered contributory.     

脑部退行性变疾病与高脂血症和颈部硬化关系的探讨——附21例临床观察

目的通过21例病例的治疗和研究，说明高脂血症性动脉粥样硬化伴颈椎和颈部软组织的硬化、增生、钙化是脑部退行性疾病的主要原因。方法针刺疏通督脉经，足太阳膀胱经和颈部夹脊穴，外用荀萝颈椎病按摩液和内服荀萝三降（降血脂、降血压、降肥胖）浓缩免煎颗粒治疗脑部退行性疾病，如帕金森氏综合征、老年性痴呆、脑萎缩、脑梗塞、高脂血症、高血压、糖尿病、单纯性甲状腺肿等21例。结果20例脑部退行性疾痫自身前后对照全部显效，1例因经济问题而放弃。结论高血脂性动脉粥样硬化和颈部软组织硬化形成的脑部供血不足、无菌性炎症、出血、水肿、纤维化、机化等慢性的反复的恶性循环，是造成脑部退行性疾病的重要原因。     

Distribution of tick-borne diseases in Japan: Past patterns and implications for the future

The rapid geographical spread of tick-borne diseases (TBDs) worldwide has recently provoked significant concerns amongst public health authorities. Tick-borne pathogens are maintained in enzootic cycles involving ticks and wild animal hosts, with epizootic spread to other mammals, including livestock and humans. Despite the increasing public health concern, current TBD diagnostic tests and treatments are inadequate, and predictive models of future risks posed by TBDs are limited by the heterogeneity of environmental, vector, and host factors, even in neighboring regions. In recent years, infections resulting in severe fever with thrombocytopenia syndrome (SFTS), Japanese spotted fever, and the scrub typhus pathogens have been reported frequently in addition to traditional TBDs in Japan. The Japanese archipelago is extremely elongated from north to south and its climate varies considerably, creating remarkable regional differences in tick species. The importance of continuous surveillance of TBDs has been growing in terms of geopathology – studies dealing with the relationships between geographic factors and the causes of specific diseases – in Japan and neighboring areas among eastern Asian countries, including China and Korea. In this review, we summarize detailed information regarding the history and epidemic status of human TBDs in Japan.     

累及肺脏的克罗恩病一例并文献复习

目的 探讨累及肺脏克罗恩病的临床表现.方法 对我院收治1例临床确诊累及肺脏克罗恩病患者的临床资料进行分析,并结合文献进行复习.结果 患者临床表现为咳嗽、咳痰、发热,胸部CT示双肺斑片状阴影,病原学检查阴性,抗菌治疗2个月双肺阴影无明显变化,纤维支气管镜示气管及右上叶开口处结节状新生物,病理示肉芽组织息肉状增生,给予泼尼松和柳氮磺胺吡啶治疗半个月后双肺阴影明显消散,气管内结节消失,右上叶开口处结节明显缩小.检测到以英文发表的相关文献,病理确诊的克罗恩病累及肺脏或合并肺部并发症病例共34例.克罗恩病累及肺脏罕见,以咳嗽、咳痰、发热为常见临床表现,肺脏和肠道常有相同病变理变化,即肉芽肿性炎症.对糖皮质激素反应良好,可应用糖皮质激素加柳氮磺胺吡啶治疗.结论 克罗恩病出现呼吸道症状时应考虑累及肺脏的可能,结合临床和病理可以确诊.

Abstract：

Objective To describe the characteristics of pulmonary involvement in Crohn was described and relevant literature were reviewed. Results The patient showed chief complaints of cough,expectoration and fever. The chest CT scan revealed bilateral lung opacity shadows ,Ziehl-Neelsen acid-fast stain examination in sputum and cultures got negative results for many times. Chest CT scan revealed no dissipation after different antimicrobials treatment for 2 months. The fiberoptic bronchoscopy was performed, which showed nodular lesions in the trachea and beside the opening of right upper lobe. Histopathology showed polypoid hyperplasia of granulation tissue. The bilateral patchy opacity dissipated, the nodes in the trachea disappeared and the nodes beside the opening of right upper lobe diminished obviously after the patient was treated with oral prednisone and salicylazosulfapyridine (SASP). Pulmonary involvement in Crohn disease is very rare and it can involve any part of the lungs. The most common manifestations are cough, expectoration and fever. The lung and gastrointestinal system often share similar pathogenetic changes: granulomatous inflammation. These patients responded well to combination use of glucocorticoid and SASP. Conclusion Pulmonary involvement should be considered when patients with Crohn disease manifested with respiratory symptoms, which can be definitely diagnosed by clinical features and histopathological examintation.     

Chronic Lyme disease: the controversies and the science

The diagnosis of chronic Lyme disease has been embroiled in controversy for many years. This is exacerbated by the lack of a clinical or microbiologic definition, and the commonality of chronic symptoms in the general population. An accumulating body of evidence suggests that Lyme disease is the appropriate diagnosis for only a minority of patients in whom it is suspected. In prospective studies of Lyme disease, very few patients go on to have a chronic syndrome dominated by subjective complaints. There is no systematic evidence that Borrelia burgdorferi, the etiology of Lyme disease, can be identified in patients with chronic symptoms following treated Lyme disease. Multiple prospective trials have revealed that prolonged courses of antibiotics neither prevent nor alleviate such post-Lyme syndromes. Extended courses of intravenous antibiotics have resulted in severe adverse events, which in light of their lack of efficacy, make them contraindicated.     

治疗性超声在心脑血管疾病中的应用进展

治疗性超声以其无创、安全、操作简单等特点得以重视。其中,超声波在心脑血管疾病中的应用也受到了关注,在一些领域如超声辅助血栓溶解研究也取得了值得关注的进展,显示了良好的前景。     

急性冠脉综合征患者炎性因子的表达与室性心律失常的关系

[目的]探讨急性冠脉综合征(ACS)患者的炎性因子的表达与室性心律失常的关系.[方法]本院115名确诊为ACS的患者其中,ST段抬高型心肌梗死(STEMI)54例,非ST段抬高型心肌梗死(NSTEMI)22例,不稳定型心绞痛(UA)39例.分别在入院时、7 d、14 d抽静脉血测定CD40配体(CD40L)、肿瘤坏死因...     

对冠心病患者实施疾病管理的实践与效果

目的探讨对冠心病患者进行疾病管理的效果。方法对305例冠心病患者进行生活方式问卷调查,综合评估危险因素后建立健康档案,制订相应的疾病管理计划,有针对性地实施健康教育和随访,并进行个体化的健康指导,观察并分析疾病管理效果。结果患者的不良生活方式较管理前有明显改善(P0.05或P0.01)。其中患者戒烟率达92.57%,戒酒率达90.10%,能够坚持低盐低脂饮食的患者达64.85%,能够坚持运动锻炼的患者达89.60%。结论对冠心病患者实施疾病管理,患者不良生活方式有明显改善,可有效提高患者的自我防护意识,对预防不良心脏事件的发生有重要作用。     

儿童睾丸疾病的声像图表现及鉴别诊断

目的 分析儿童睾丸疾病的声像图特征,探讨其诊断及鉴别诊断。方法 应用二维及彩色多普勒观察52例病变的形态、结构、内部回声及血供情况,并经手术、病理及临床证实。结果 急性睾丸炎26例;睾丸扭转8例;睾丸肿瘤9例;睾丸血肿6例;睾丸微小结石症2例;多睾症1例。本文分析了各例的声像图特征。结论 超声在儿童睾丸疾病的诊断中具有较高的敏感性和特异性,无创伤,简便易行,可为临床诊断、治疗提供可靠依据。     

肾上腺占位性病变超声显像诊断及临床意义

目的　探讨不同病理性质肾上腺占位性病变的声像图特征,为临床提供诊断依据。方法　报告７９ 例肾上腺占位性病变的声像图表现,并对照手术和病理结果进行分析。结果　肾上腺占位性病变种类较多,声像图虽有雷同之处,但也不乏各自的特点,本组超声诊断符合率达８９－９％ 。结论　肾上腺占位性病变的超声显像诊断符合率较高,具有重要的临床意义。