血液透析联合血液灌流对维持性血液透析患者肿瘤坏死因子-α及白介素-10的影响

目的:探讨血液透析联合血液灌流对维持性血液透析患者肿瘤坏死因子-α(TNF-α)及白介素-10(IL-10)的影响.方法:广东省佛山市顺德第一人民医院透析中心行血液透析患者25例,10例行单纯血液透析治疗,15例行血液透析联合血液灌流治疗,选择10例健康人作为对照组.观察单纯血液透析,血液透析串连血液灌流治疗4次后患者血清TNF-α及IL-10的改变.结果:单纯血液透析治疗前后患者血清TNF-α及IL-10分别为82.47±21.66、80.57±17.18和54.11±22.93、56.87±9.27:血液透析联合血液灌流治疗前后患者血清TNF-α及IL-10分别为86.35±19.25、40.07±21.40和57.64±14.10、30.21±10.54,与单纯血液透析治疗比较,血液透析联合血液灌流治疗能降低患者血清TNF-α及IL-10水平.结论:血液透析联合血液灌流对促炎因子及抗炎因子都有明显清除作用,可改善维持性血液透析患者的微炎症状态.     

不同剂量脂多糖对大鼠腹膜形态和转运功能的影响

[目的]探讨不同剂量的脂多糖（LPS）对大鼠腹膜形态和功能的影响。[方法]42只SD雄性大鼠按不同的LPS剂量随机分为四组,即A组（6只）：正常对照组。B组（12只）：LPS 0.3 mg/kg组;C组（12只）：LPS 0.6 mg/kg组;D组（12只）：LPS 1.2 mg/kg组。B、C、D组在d1、d3、d5、d7腹腔注射不同剂量LPS。于2、4周每组分别取6只,10%水合氯醛麻醉后行腹膜转运功能实验,术后采集壁层腹膜标本作光镜检查。[结果]不同剂量的LPS组2周时腹膜结构和功能均有明显受损,LPS的剂量与厚度呈显著正相关（r=0.628,P=0.005）,与超滤量显著负相关（r=-0.587,P=0.03）,各组葡萄糖转运量与对照组相比均有显著增加。停止LPS刺激3周后腹膜厚度及超率量与2周相比无明显改变,间皮细胞损伤有所减轻,葡萄糖转运恢复正常。[结论]不同剂量的LPS对大鼠腹膜形态结构和功能均有明显影响,腹膜厚度和超滤量与LPS剂量相关。停止LPS刺激3周后间皮细胞结构和小分子物质转运功能有所恢复。     

312例急性肾功能衰竭患者的临床特征与预后的关系

[目的]探讨急性肾功能衰竭(acute renal failure,ARF)的病因特点、治疗情况及其与预后的关系,为临床治疗ARF 提供依据.[方法]回顾性分析312例ARF的临床资料,采用逻辑斯蒂回归分析方法分析各种因素与患者预后的关系.[结果]312例ARF中内科病因引起的占55.4%,其次为外科病因,占29.8%,肿瘤病因占10.9%,儿科和妇产科病因所占的比例较低.老、少患者的病死及未愈率之和均高于青壮年(P＜0.05);少尿型、非少尿型ARF死亡及未愈率合计分别为60.1%和34.7% ,两者相比差异有显著性(P＜0.01);无并发症与合并多脏器功能衰竭的ARF病死及未愈率合计分别为43.9%和90.2% ,两者相比差异有显著性(P＜0.01).[结论]内科病因引起的ARF居首位,其次为外科病因和肿瘤;老、少患者,少尿型患者,合并多脏器功能衰竭患者病死率较高;透析可降低ARF患者的病死率.     

大鼠急性腹膜炎模型的建立及其对腹膜功能的影响

目的建立稳定的大肠杆菌诱导的大鼠急性腹膜炎模型,并观察急性细菌性腹膜炎对腹膜功能的影响.方法雄性SD大鼠60只,体重180～230 g,随机分为6组,每组10只,对照组给予腹腔注射50 ml/kg磷酸盐缓冲液(PBS),其余5组分别按体重给予大肠杆菌ATCC25922 3.3×106、3.3×107、3.3×108、3.3×109、3.3×1010cfu/kg腹腔注射,观察大鼠一般情况及死亡率,并在72h杀检,做腹水白细胞计数及腹膜HE染色.另取SD雄性大鼠130只,体重180～230 g,随机分为两组,对照组63只,灭菌PBS腹腔注射;腹膜炎组63只,腹腔注射大肠杆菌ATCC25922 3.3×108cfu/kg体重,分别于0 h、3 h、6 h、12 h、24 h、48 h、72 h、7 d、21 d各杀检7只大鼠,24 h、48 h、72 h、7 d、21 d在杀检前4小时做腹膜平衡试验,并留取腹膜组织做Masson染色及泛白细胞抗原CD45免疫荧光检查.结果(1)随着腹腔注射大肠杆菌剂量的增高,注射后模型组的死亡率逐渐增高(0、10%、10%、50%、100%),其中3.3×108组腹膜炎症状较重,但死亡率较低(10%).(2)模型组外周血白细胞3 h即降低,72 h后回升到正常水平,粒细胞在3 h显著下降,12 h显著回升,之后再次下降,并在24 h、48 h、72 h持续处于较低水平,7 d回复正常;腹水白细胞总数3h开始升高,24 h达高峰,7 d回复正常,腹水中性粒细胞在48 h达到高峰,7d回复到对照组水平;腹水单核细胞在24 h显著增高,72 h回复到对照组水平;腹膜组织炎症细胞呈弥漫性分布,72 h最为显著,7 d回复正常.(3)模型组净超滤量显著下降,D/D0葡萄糖显著降低,D/P总蛋白显著增高.结论大肠杆菌ATCC25922在3.3×108cfu/kg体重是诱导大鼠急性腹膜炎模型的较佳剂量.急性腹膜炎对腹膜的超滤功能及蛋白和葡萄糖的转运功能影响显著.     

蔗糖铁对中度贫血的透析患者的治疗作用

目的(1)了解口服铁剂时肾脏替代治疗患者贫血情况;(2)静脉蔗糖铁治疗对中度贫血患者的治疗效果及副作用观察。方法我院透析中心规律透析的尿毒症患者134例,血液透析患者104例,腹膜透析30例。患者均常规叶酸及正规促红细胞生成素使用,统计口服铁剂时患者贫血情况。将中度贫血的部分患者行蔗糖铁静脉注射治疗,观察治疗前后患者血清铁、铁蛋白、血红蛋白、红细胞压积、肝功能等指标并观察蔗糖铁的临床副作用。结果134例肾脏替代治疗患者中经口服铁剂HB达110g以上者占18%,轻度贫血占17%,中度贫血占44%。重度贫血占21%。中度贫血患者经静脉注射蔗糖铁治疗后血清铁、铁蛋白、血红蛋白(HB)、红细胞压积(HCT)较口服时均有明显升高。总有效率达88%。患者使用蔗糖铁过程中血压脉搏呼吸体温等生命体征无明显变化,肝功能无明显改变,无一例出现过敏反应等严重副作用。结论(1)肾脏替代治疗患者口服铁剂以中重度贫血为主,患者血红蛋白达标率低;(2)静脉用蔗糖铁治疗中度肾性贫血安全有效。     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

AGEs对肾小管上皮细胞转分化、1型胶原合成及smad信号通路的影响

目的:观察终末期糖基化终产物(AGEs)对正常大鼠近端肾小管上皮细胞（NRK52E ）转分化、collagenⅠ合成及Smads信号通路的影响。 方法:应用自制的AGEs（AGE-BSA）刺激NRK52E细胞，采用免疫细胞化学方法检测pmad2/3核表达情况；ELISA方法检测细胞培养上清TGF-β₁的浓度；RT-PCR检测TGF-β₁、Smad2、Smad3和Smad7 mRNA的表达；Western印迹检测α-平滑肌肌动蛋白（SMA）、E-钙粘着糖蛋白（cadherin）和1型胶原（collagenⅠ）蛋白的表达。 结果: AGE-BSA刺激15 min后pSmad2/3核表达明显增加，于30 min（68%）和24 h（76%）出现两个高峰，与刺激前及时间匹配的BSA对照组比较均有显著差异（P<0.05）；AGE-BSA以时间依赖方式上调TGF-β₁、Smad2、Smad3和Smad7 mRNA的表达；NRK52E细胞α-SMA和collagenⅠ蛋白表达高于对照组（P<0.01），E-cadherin蛋白表达低于对照组（P<0.01），细胞上清液TGF-β₁的浓度高于对照组（P<0.01）。 结论:AGEs可诱导肾小管上皮细胞Smads信号通路活化，促进肾小管上皮细胞转分化和细胞外基质collagenⅠ的合成。     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.