轻度认知功能障碍中医证候特点及与血清BDNF水平的初步研究

为探究轻度认知功能障碍(MCI)患者中医证候的特点以及与血清脑源性神经营养因子(BDNF)水平的关系。本研究根据轻度认知障碍的诊断标准,在社区中随机筛选出MCI患者120例,正常对照组60例,比较两组人群的中医证候,并采用双抗体夹心ABC-ELISA法检测MCI患者血清BDNF水平。结果显示,MCI患者中医体质平和质34例(28.33%),偏颇体质中以阳虚质及气虚质为主。在中医辨证分型中,以脾肾亏虚证52例(43.33%)、气血不足证18例(15.00%)为主。MCI患者的血清BDNF水平较正常对照组显著升高(p0.05),MCI患者中脾肾亏虚证血清BDNF水平显著低于非脾肾亏虚证血清BDNF水平(p0.05)。本研究表明MCI在肾、脾、心三脏虚损的基础上,兼有痰、淤等邪,提示MCI为本虚标实之证。MCI患者的血清BDNF水平较正常对照组显著降低,且脾肾亏虚证血清BDNF水平显著低于非脾肾亏虚证血清BDNF水平,提示血清中BDNF水平与轻度认知功能障碍疾病的发生、发展密切相关,脾肾亏虚证患者能够通过温阳益气、健脾补肾来改善脑内BDNF水平,从而改善认知功能,符合中医治未病思路。     

犬、猫肾功能衰竭的中西医结合疗法

本文介绍了中医的肾脏生理功能理论、阐述了目前西兽医及中兽医对犬猫急性肾功能衰竭、慢性肾功能衰竭发病原因的认识,分析了肾功能衰竭的中医辨证分型和急性肾功能衰竭、慢性肾功能衰竭的治疗原则。     

养肺保元汤治疗慢性肺系疾病临床应用举隅

总结刘良丽教授使用"养肺保元汤"治疗慢性肺系疾病的临床经验。刘教授认为慢性肺系疾病主要累及肺脾肾三脏,"本虚标实、下虚上实",治疗应扶正固本,减少急性发作,延缓疾病进展。     

老年脑卒中并发多器官衰竭32例分析

总结了32例老年脑卒中合并多器官衰竭临床特点.认为脑卒中合并多器官衰竭是患者死亡的另一个重要原因.特点:1.病前患多种慢性疾病.脑卒中发作导致或加重器官功能减退;2.各器官衰竭发生率依次是心、肺、肾、胃肠道.3个脏器以上衰竭死亡率较高,尤其肾功能衰竭可作为预后不良指标;3.病情进展较缓慢,且老年多器官衰竭发生率与其原患疾病相关,所以具有一定可测性,提出前瞻性评价各脏器功能.加强监测各重要器官功能变化,早期识别多器官衰竭,加强重要器官保护和支持,减少医源性损伤等防治措施.     

高血压病中医证型与心血管危险因素的相关性研究

目的:分析高血压病中医证型与心血管危险因素的相关性研究,探讨证型形成、发展,为疾病防治、证型管理提供借鉴。方法:对350例高血压患者行问卷调查,中医辩证分型,行相关性分析。结果:肝火亢盛29.14%、阴虚阳亢型26.00%、痰湿壅盛型17.43%、阴阳两虚型13.43%、痰淤阻络型11.43%,合并心血管病比重排序与发生比重排序具有一致性,肝火亢盛病发心血管病风险最高20.59%,差异具有统计学意义(P0.05);吸烟22.29%、缺少运动16.86%、高胆固醇16.00%、肥胖14.86%以及糖尿病6.00%,糖尿病多见于阴阳两虚16.67%,肥胖多见于瘀血阻络27.50%,吸烟多见于肝火亢盛30.39%、阴虚阳亢27.47%,高胆固醇多见于痰湿壅盛24.59%、阴阳两虚20.83%,缺少运动多见于痰湿壅盛24.59%、阴阳两虚22.92%、瘀血阻络22.50%,差异具有统计学意义(P0.05)。结论:证型比重与心血管发生率排序相一致,即比重越高证型心血管病发生率越高;不同高血压证型伴有心血管危险因素具有显著差异,提示证型形成可能与风险因素有关,但后者并不能起决定性作用,证型偏向于反映机体总体状态,辩证治疗注重综合调理。     

化癥扶正汤治疗肺癌的经验

国医大师刘尚义教授认为肺癌病机为正虚邪实,主因疾病本身消耗,加之放化疗之毒、残余癌毒及坏死组织蓄于体内所致;经过多年临床实践,总结出了"化癥扶正汤";该方可以改善肺癌患者症状,提高其生活质量,延长患者生存期。     

慢性肾功能衰竭病人红细胞变形能力的改变

慢性肾功能衰竭(CRF)是发生在各种慢性肾脏疾病后期的一种临床症状,以肾功能减退,代谢产物潴留,水、电解质及酸碱平衡失调为主要表现。为了解CRF时红细胞变形能力的改变情况,我们对CRF病人及正常人的红细胞变形能力进行了测定。     

探讨肾功能衰竭患者血清VE-Cad、Ang-2及尿KIM-1表达情况及与病情严重程度的相关性

摘要 目的：探讨肾功能衰竭患者血清血管内皮钙黏蛋白（VE-Cad）、血管生成素2（Ang-2）及尿肾损伤分子1（KIM-1）表达情况及与病情严重程度的相关性。方法：选取我院2018年2月到2021年2月收治的76例慢性肾功能衰竭患者作为研究对象,依照其病情严重程度进行分组,分为肾功能代偿组（n=25）,氮质血症组（n=18）,肾功能衰竭组（n=21）和尿毒症组（n=12）,对比四组患者VE-Cad、Ang-2、KIM-1表达情况,并分析VE-Cad、Ang-2、KIM-1与慢性肾功能衰竭病情严重程度的相关性。对所有患者进行电话随访或复查随访,将76例慢性肾功能衰竭患者依照预后情况分为两个亚组,存活组（n=56）和死亡组（n=20）,对比两组患者临床情况和各指标水平,并应用Logistic回归分析分析VE-Cad、Ang-2、KIM-1对慢性肾功能衰竭预后预测价值。结果：四组患者VE-Cad、Ang-2、KIM-1表达水平差异显著,尿毒症组明显高于肾功能衰竭组、氮质血症组和肾功能代偿组（P＜0.05）;Spearman相关分析结果显示：VE-Cad、Ang-2、KIM-1与慢性肾功能衰竭病情严重程度呈正相关（P＜0.05）;存活组与死亡组患者性别、年龄、BMI、器官衰竭≥2个、少尿、VE-Cad水平对比无差异（P＞0.05）,存活组与死亡组患者APACHEⅡ评分、CysC、Ang-2、KIM-1水平对比差异显著（P＜0.05）;logistic回归分析结果表明,APACHEⅡ评分、CysC、KIM-1为影响慢性肾功能衰竭预后的独立危险因素（P＜0.05）。结论：VE-Cad、Ang-2、KIM-1与慢性肾衰竭患者病情严重程度呈正相关,临床可以考虑参考三者水平来评价慢性肾衰竭患者的病情严重程度。而三者中仅有KIM-1与肾功能衰竭患者的预后情况具有一定关系,因此临床可以考虑在APACHEⅡ评分与CysC预测预后的基础上增加KIM-1指标进行判断,进而提升预后预测准确性。     

铜蓝蛋白、鳞状细胞癌相关抗原与慢性肾功能衰竭的关系及对病情进展的预测价值研究

摘要 目的：分析铜蓝蛋白（CER）、鳞状细胞癌相关抗原（SCCA）与慢性肾功能衰竭的关系及对病情进展的预测价值。方法：选择我院自2019年4月至2021年4月接诊的169例慢性肾功能衰竭患者作为研究对象,根据24 h尿白蛋白定量分为微量白蛋白尿组（＜200 mg/24 h,102例）和大量白蛋白尿组（＞200 mg/24 h,67例）。比较两组各项实验室指标及血清CER、SCCA水平,分析CER、SCCA与慢性肾功能衰竭患者肾功能指标的关系。随访12个月,观察病情进展,使用受试者工作特征曲线（ROC）评价血清CER联合SCCA对病情进展的预测效能。结果：大量白蛋白尿组血清肌酐（Scr）、血尿素氮（BUN）水平均明显高于微量白蛋白尿组,肾小球滤过率（GFR）低于微量白蛋白尿组（P＜0.05）;大量白蛋白尿组血清CER、SCCA水平均高于微量白蛋白尿组（P＜0.05）;经Pearson相关性分析,慢性肾功能衰竭患者血清CER、SCCA水平均与Scr、BUN呈正相关,与GFR呈负相关（P＜0.05）;经多因素Logistic回归分析,GFR、CER、SCCA均是慢性肾功能衰竭患者病情进展的独立预测因素（P＜0.05）;经ROC曲线分析,血清CER联合SCCA预测慢性肾功能衰竭患者病情进展的AUC为0.925,明显大于GFR的0.620（P＜0.05）。结论：血清CER、SCCA水平与慢性肾功能衰竭患者肾功能呈负相关,联合预测病情进展效能较好,值得临床予以重视应用。     

从"补脾强肾"小儿推拿手法论治小儿脑瘫

目的:从中医的角度,探究"补脾强肾"小儿推拿手法论治小儿脑瘫的作用机制。方法:采用回顾性的分析,收集中西医治疗小儿脑瘫的相关文章,分析小儿脑瘫的原因、治疗方法及作用机制。结果:在中医中脑瘫病位在脑、脾、肾,脑瘫患儿普遍存在脾肾亏虚,表现为肌肉瘦削,筋骨痿软,故属于"五迟"、"五软"范畴。这与现代医学所观察到的脑瘫患儿肢体运动障碍和营养吸收障碍相符。因此该病除了应用现代康复技术手段外,还应从补益脾肾的角度开展相应的中医治疗。临床中不能接受内服药物治疗的患儿,可以采用小儿推拿治疗,治疗效果显著。结论:在脑瘫康复训练中配合补脾强肾小儿推拿手法,同补先后天之本,可提高营养生长水平,缩短康复疗程,提升康复疗效,最终达到全面促进脑瘫患儿康复的目的。     

Inflammatory response and matrix metalloproteinases in chronic kidney failure: Modulation by adropin and spexin

Chronic kidney disease is a major global public health problem. The peptide hormones adropin and spexin modulate many physiological functions such as energy balance and glucose, lipid and protein metabolism. However, it is unclear whether these peptides may exert effects on renal damage, tissue remodeling, and inflammatory conditions. In view of the limited information, we aimed to investigate the effect of adropin and spexin on matrix metalloproteinase and inflammatory response genes a rat model of adenine-induced chronic kidney failure. Chronic kidney failure was induced in rats by administering adenine hemisulfate. Renal function was determined in an autoanalyzer. Histopathological modifications were assessed by H&E staining. mRNA expression levels of ALOX 15, COX 1, COX 2, IL-1β, IL-10, IL-17A, IL-18 IL-21, IL-33, KIM-1, MMP-1, MMP-2, MMP-3, MMP-7, MMP-9, MMP-13, NGAL, TGFβ1, TIMP-1, and TNFα in kidney tissue were measured by qPCR. Our results showed an increase of 24-h urine volume, serum creatinine, BUN, and urine protein levels in group with adenine-induced CKF. Adropin and spexin treatments decreased urine protein and 24-h urine volume. Renal damage, TIMP-1, IL-33, and MMP-2 increased after CKF induction, while COX 1, MMP-9, and MMP-13 levels were significantly reduced. Furthermore, KIM-1, TIMP-1, IL-33, and MMP-2 were downregulated by spexin treatment. Renal damage, NGAL, TIMP-1 IL-17A, IL-33, MMP-2, and MMP-3 decreased after adropin treatment, while MMP-13 levels were upregulated. Treatment with adropin+spexin decreased KIM-1, NGAL, TIMP-1, IL-1β, IL-17A, IL-18, IL-33, ALOX 15, COX 1, COX 2, TGFβ1, TNFα, MMP-2, MMP-3, and MMP-7, but increased MMP-13 levels. Our findings revealed that inflammatory response and MMP genes were modulated by adropin and spexin. These peptides may have protective effects on inflammation and chronic kidney damage progression.     

Alport 综合征1 例报道及文献复习

目的:探讨Alport综合征的临床表现,病理学特征及研究进展。方法:分析1例此病患者的临床资料。结果:本例患者临床表现为慢性视力下降。尿常规检查提示蛋白尿,血尿。肾肾穿刺活检的光镜、电镜检查均支持诊断。结论:Alport综合征患者中眼部异常的表现有独特性;了解眼部病变特征并结合全身病史,病理学检查有助于疾病的诊断和随诊。     

肥大细胞增生症研究进展

肥大细胞增生症(mastocytosis)是由多种临床表现组成的一组疾病谱,其特征表现以肥大细胞在一个或多个器官异常浸润和积聚为主,常累及皮肤、消化道、骨髓、肝脾以及淋巴结,临床表现为皮肤瘙痒、潮红、恶心、呕吐、腹泻、腹痛等改变。针对存在以下情况需考虑本病:不明原因的溃疡或吸收不良;影像学检查发现骨骼扫描异常、肝脾肿大、淋巴结肿大;外周血异常;速发型过敏反应;或原因不明的低血压;一旦确定为肥大细胞增生症引起,应对疾病活动性、亚型和预后进行评估,并进行适当治疗;肥大细胞增多症根据临床表现、病理改变和预后分为7种不同类型,皮肤性及惰性系统性肥大细胞增多症预后较好,肥大细胞肉瘤预后最差。本文对肥大细胞增生症发病机制、临床特征、诊断、治疗及预后等方面的研究现状进行综述。     

青少年慢性粒细胞白血病急变临床分析

目的:分析青少年慢性粒细胞白血病(CGL)急变患者临床表现及实验检查特点,以提高对青少年CGL急变临床特点的认识。方法:将CGL急变患者按年龄分组,将青少年组和中老年组患者的急变时间、确诊时和急变时的脾脏大小、白细胞和血小板数目、急变时骨髓幼稚细胞的比例,以及患者的总生存时间、急变后生存时间进行对比分析。结果:青少年组和中老年组的脾脏大小、确诊时血小板数目、急变时的白细胞数目、急变时间、以及总生存时间无显著性差异;青少年组确诊时的白细胞数目较中老年组高,青少年组的急变后生存时间较长。结论:青少年CGL患者的临床表现及实验室检查结果具有CGL的普遍特征,但其确诊时白细胞数目较高,急变后生存时间较长。     

THE HEART AND ALCOHOL

The cardiovascular effects of the ingestion of ethyl alcohol are determined by the amount consumed and time factors as well as the nutritional status of the individual.Acute alcoholism produces various cardiac manifestations that are related primarily to the concentration of alcohol in the blood.Chronic alcoholism is associated with three identifiable cardiovascular syndromes that have been designated alcoholic myocardosis, nutritional heart disease and beriberi heart disease. Differentiation is indicated because of their respective distinguishing diagnostic features and prognostic implications.The therapeutic effects of alcohol in coronary artery disease are apparently attributable to cerebral responses rather than demonstrable increase in coronary blood flow.     

The heart and alcohol

The cardiovascular effects of the ingestion of ethyl alcohol are determined by the amount consumed and time factors as well as the nutritional status of the individual. Acute alcoholism produces various cardiac manifestations that are related primarily to the concentration of alcohol in the blood. Chronic alcoholism is associated with three identifiable cardiovascular syndromes that have been designated alcoholic myocardosis, nutritional heart disease and beriberi heart disease. Differentiation is indicated because of their respective distinguishing diagnostic features and prognostic implications. The therapeutic effects of alcohol in coronary artery disease are apparently attributable to cerebral responses rather than demonstrable increase in coronary blood flow.     

Contribution of renal innervation to hypertension in rat autosomal dominant polycystic kidney disease

The kidney has both afferent (sensory) and efferent (sympathetic) nerves that can influence renal function. Renal innervation has been shown to play a role in the pathogenesis of many forms of hypertension. Hypertension and flank pain are common clinical manifestations of autosomal dominant (AD) polycystic kidney disease (PKD). We hypothesize that renal innervation contributes to the hypertension and progression of cystic change in rodent PKD. In the present study, the contribution of renal innervation to hypertension and progression of renal histopathology and dysfunction was assessed in male Han:SPRD-Cy/+ rats with ADPKD. At 4 weeks of age, male offspring from crosses of heterozygotes (Cy/+) were randomized into either 1) bilateral surgical renal denervation, 2) surgical sham denervation control, or 3) nonoperated control groups. A midline laparotomy was performed to allow the renal denervation (i.e., physical stripping of the nerves and painting the artery with phenol/alcohol). Blood pressure (tail cuff method), renal function (BUN) and histology were assessed at 8 weeks of age. Bilateral renal denervation reduced the cystic kidney size, cyst volume density, systolic blood pressure, and improved renal function (BUN) as compared with nonoperated controls. Operated control cystic rats had kidney weights, cyst volume densities, systolic blood pressures, and plasma BUN levels that were intermediate between those in the denervated animals and the nonoperated controls. The denervated group had a reduced systolic blood pressure compared with the operated control animals, indicating that the renal innervations was a major contributor to the hypertension in this model of ADPKD. Renal denervation was efficacious in reducing some pathology, including hypertension, renal enlargement, and cystic pathology. However, sham operation also affected the cystic disease but to a lesser extent. We hypothesize that the amelioration of hypertension in Cy/+ rats was due to the effects of renal denervation on the renin angiotensin system.     

Clinical importance of acquired cystic disease of the kidney in patients undergoing dialysis.

From 1976 to 1982 five patients undergoing haemodialysis at Oxford Renal Unit suffered serious complications from acquired cystic disease of the kidney and two died as a direct result. Clinical features seen were pain, haematuria, palpable renal enlargement, massive haemorrhage, resolution of anaemia, and metastatic malignancy. The clinical histories emphasise the features of a disease that is likely to assume increasing importance in patients undergoing haemodialysis.     

The importance of body composition and dry weight assessments in patients with chronic kidney disease

Chronic volume overload is the major cause of hypertension and other cardiovascular morbidity in dialysis patients. One of the most important goals of physicians who take care of patients with chronic renal failure is to obtain near euvolemia or "dry body weight" in order to maintain or normalize blood pressure and prevent further cardiovascular events. In clinical practice, exact estimation of dry weight in hemodialysis patients remains a major challenge. Alterations in body composition, particularly malnutrition, are common in patients receiving long-term hemodialysis and contribute to a high mortality rate. In contrast, obesity - a known risk factor for cardiovascular morbidity and mortality - is prevalent amongst kidney allograft recipients in - long term after renal transplantation. Several technological tools and biochemical markers for estimation of plasma volume and body composition are available for clinical use. Our aim was to highlight the importance of control of body fluid volume and body composition in patients with chronic kidney disease and to describe the different methods available for such measurements.