慢性肾脏病患者心脏结构与功能变化的超声心动图研究

目的:研究慢性肾脏病(CKD)患者心脏结构及功能的变化.方法:选择我院肾内科175例慢性肾脏病未透析患者,按照2003年美国国家肾脏基金会-肾脏病转归质量(NKF-K/DOQI)指南的标准进行分期,观察所有患者心脏结构及功能在超声中的变化.结果:慢性肾脏病患者随着肾功能的恶化,各组之间比较,室间隔厚度(IVST)、左心室后壁厚度(LVPW)、左心室心肌重量指数(LVMI)、左心室舒张末期内径(LVDd)、左心房内径(LAD)具有升高的趋势(P＜0.05,P＜0.01);但E/A比值未出现伴随着肾功能恶化而逐渐减低的趋势(P＞0.05);射血分数(EF)、短轴缩短卒(FS)在各期之间无明显变化(P＞0.05);而TVI技术测定的Em、Em/Am具有显著减低的趋势(P＜0.05,P＜0.01);瓣膜返流以二尖瓣返流为主.结论:慢性肾脏病患者心脏结构与功能随肾功能减退而加重,超声心动图检查结合组织速度显像(TVI)技术能更好地检测心脏结构和功能变化,尤其是检测左心室舒张功能障碍.     

慢性肾脏病患者心脏结构与功能变化的超声心动图研究(英文)

目的:研究慢性肾脏病(CKD)患者心脏结构及功能的变化。方法:选择我院肾内科175例慢性肾脏病未透析患者,按照2003年美国国家肾脏基金会-肾脏病转归质量(NKF-K/DOQI)指南的标准进行分期,观察所有患者心脏结构及功能在超声中的变化。结果:慢性肾脏病患者随着肾功能的恶化,各组之间比较,室间隔厚度(IVST)、左心室后壁厚度(LVPW)、左心室心肌重量指数(LVMI)、左心室舒张末期内径(LVDd)、左心房内径(LAD)具有升高的趋势(P<0.05,P<0.01);但E/A比值未出现伴随着肾功能恶化而逐渐减低的趋势(P>0.05);射血分数(EF)、短轴缩短率(FS)在各期之间无明显变化(P>0.05);而TVI技术测定的Em、Em/Am具有显著减低的趋势(P<0.05,P<0.01);瓣膜返流以二尖瓣返流为主。结论:慢性肾脏病患者心脏结构与功能随肾功能减退而加重,超声心动图检查结合组织速度显像(TVI)技术能更好地检测心脏结构和功能变化,尤其是检测左心室舒张功能障碍。     

慢性肾脏病继发性甲状旁腺功能亢进的发病机制研究进展

继发性甲状旁腺功能亢进是慢性肾脏病的常见并发症,严重影响患者的生活质量和生存率。其发病机制主要包括低钙血症、高磷血症、活性维生素D缺乏、维生素D受体及钙敏感受体表达下调等。近年来,成纤维细胞生长因子23在继发性甲状旁腺功能亢进发病机制中的作用,也越来越受到重视。上述机制均可导致慢性肾脏病患者的甲状旁腺细胞增生,由多克隆增生逐渐发展为单克隆增生、腺瘤等,甲状旁腺功能亢进也逐渐加重。现就慢性肾脏病继发性甲状旁腺功能亢进的发病机制的进展做一综述。     

慢性肾脏病肾小管损伤诊断标志物的研究进展

肾小管萎缩和肾小管间质纤维化是慢性肾脏疾病(chronic kidney disease,CKD)常见的病理表现,肾小管损伤的生物标志物通常可反映肾小管间质中直接组织损伤和修复的过程,其严重程度一直被证明是预测疾病进展的可靠指征。目前大部分研究常利用肾小球滤过率和尿白蛋白/肌酐比作为评估CKD的主要指标,而肾小管损伤诊断标志物在慢性肾脏病中的研究较少。因此,本文就肾小管损伤诊断标志物在CKD中的研究进展作一综述,以期最大限度地诊断、治疗和预防CKD,对肾脏健康进行更加全面的评估。     

多发性硬化生物标记物的研究进展

多发性硬化(MS)是主要以中枢神经系统(CNS)白质脱髓鞘病变为主要特点的自身免疫性疾病。生物标记物是中枢神经系统自身免疫性疾病病因、诊断和预后的重要参考因素,因为他们可能反映遗传以及环境变化所引起的某些免疫反应的存在,性质和强度。因此生物标记有助于MS的早期诊断和鉴别诊断,指导治疗方案,推断MS疾病活动性,以及判断疗效。本文概述了多发性硬化领域当前的生物标记物研究状况及其相关的临床实践,并通过对三种具有较大潜力的生物标记物与病理的特异性、灵敏度、可靠性和临床实用工具进行分析,以确定最优化的治疗以防止致残,同时还可以对疾病修饰药物的有效性进行测试。     

血浆代谢轮廓分析在慢性肾脏病早期诊断中的应用价值

摘要 目的：探究血浆代谢轮廓分析在慢性肾脏病早期诊断中的应用价值。方法：选取我院在2019-2021收治的120例慢性肾病（CKD）患者,运用相色谱-四级杆飞行时间质谱（liquid chromatography quadrupole time-of-flight mass spectrometry,LC-QTOF/MS）联用技术对参与本次研究的患者的血浆样品进行非靶向代谢组学分析,判断不同时期慢性肾病患者与健康对照者的血浆代谢轮廓谱,同时利用多变量结合单变量统计分析方法筛选差异代谢物。结果：慢性肾脏病（CKD）肌酐、尿酸、尿素、血红蛋白等检测物质多项生化指标异常,且据统计分析可知,在不同阶段CKD患者的血浆中找到了多种差异化合物,其中磺基丙氨鞘酸、氨醇-１-磷酸、醛固酮差异显著。结论：研究证明血浆代谢轮廓分析可以增进对慢性肾病发病机制的了解,为之后早期诊断慢性肾病具有重大意义,值得推广与应用。     

急性肺损伤的生物标记物

急性呼吸窘迫综合征(ARDS)和急性肺损伤(ALI)多由低氧性呼吸衰竭引起,导致高通透性肺水肿,临床上有较高的发病率与死亡率。近十年来,针对血浆和支气管肺泡灌洗液中相关生物标记物的研究为探索急性肺损伤的病理生理机制指明了新的方向。个别生物标记物已在一些大型、多中心ARDS试验中得到证实。但迄今仍没有一个或一组生物标记物常规应用于临床。随着人类对ALI发病机制理解的进一步深入,或许不久的将来,生物标记物会真正应用于评估疾病的严重程度和预后。本文将概述近年来ALI相关生物标记物的研究进展。     

生物标记物对脑损伤患儿早期诊断及监测价值的研究进展

脑损伤是新生儿期危害严重的疾病之一,可导致脑瘫、运动发育迟缓、认知功能障碍及学习困难等后遗症,严重影响了新生儿的健康发育及生活质量的提高。新生儿脑损伤(NBI)是一种由多种原因导致的范围很广的疾病,其临床表现缺乏特异性,临床上在判断其损伤严重程度、持续时间及产前损伤时间等存在较大的困难,受到广大科研者及临床医师的重视。目前,影像学方法是NBI确诊的主要手段,但影像学检查通常存在滞后性和一定的局限性。体液生物标记物水平在脑损伤后会较早发生变化,通过检测其水平变化可早期预测脑损伤情况。近年来,新生儿各种体液中已检测出多种具有敏感性的脑损伤生物标记物,主要包括神经元特异性烯醇化酶(NSE)、泛素羟基末端水解酶L-1(UCH-L1)、S100B蛋白、Tau蛋白、髓鞘碱性蛋白(MBP)、胶质纤维酸性蛋白(GFAP)、激活素A等,本研究对上述常用生物标记物在NBI中的应用情况以及研究进展进行综述,探讨其临床应用前景。     

卡维地洛对慢性心力衰竭患者神经内分泌及心功能的影响

目的:观察卡维地洛对慢性心力衰竭患者神经内分泌及心功能的影响.方法:60例慢性心力衰竭患者随机分为对照组(n=30)和卡维地洛组(n=30).对照组给予洋地黄、利尿剂、血管紧张素转化酶抑制剂等常规治疗;卡维地洛组在给予常规治疗的基础上加用卡维地洛,从小剂量(3.125mg,1次/天)逐渐加至靶剂量(12.5mg,2次/天或3次/天)治疗6个月.治疗前及治疗6个月后放射免疫法测定血浆血管紧张素Ⅱ(Ang Ⅱ)及内皮素-1(ET-1)水平,超声心动图检测心功能.结果:两组治疗后较治疗前Ang Ⅱ及ET-1水平显著降低,卡维地洛组改善更明显(P＜0.01);两组左房内径、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)明显缩短(P＜0.01),左室射血分数(LVEF)显著增高(P＜0.01).结论:卡维地洛抑制心衰患者的神经内分泌激活,逆转心室重塑,改善心功能.     

Comparison of Ambulatory Blood Pressure Parameters of Hypertensive Patients With and Without Chronic Kidney Disease

There is strong association between chronic kidney disease (CKD) and increased prevalence of hypertension, risk of end-organ damage, and cardiovascular disease (CVD). Non-dipping, as determined by ambulatory blood pressure (BP) monitoring (ABPM), is frequent in CKD and has also been consistently associated with increased CVD risk. The reported prevalence of non-dipping in CKD is highly variable, probably due to relatively small sample sizes, reliance only on a single, low-reproducibility, 24-h ABPM evaluation per participant, and definition of daytime and nighttime periods by arbitrary fixed clock-hour spans. Accordingly, we assessed the circadian BP pattern of patients with and without CKD by 48-h ABPM to increase reproducibility of the results. This cross-sectional study involved 10 271 hypertensive patients (5506 men/4765 women), 58.0?±?14.2 (mean?±?SD) yrs of age, enrolled in the Hygia Project. Among the participants, 3227 (1925 men/1302 women) had CKD. At the time of recruitment, 568/2234 patients with/without CKD were untreated for hypertension. Patients with than without CKD were more likely to be men and of older age, have diagnoses of obstructive sleep apnea, metabolic syndrome, diabetes, and/or obesity, plus have higher glucose, creatinine, uric acid, and triglyceride, but lower cholesterol, concentrations. In patients with CKD, ambulatory systolic BP (SBP) was significantly elevated (p?<?.001), mainly during the hours of nighttime sleep, independent of presence/absence of BP-lowering treatment. In patients without CKD, ambulatory diastolic BP (DBP), however, was significantly higher (p?<?.001), mainly during the daytime. Differing trends for SBP and DBP between groups resulted in large differences in ambulatory pulse pressure (PP), it being significantly greater (p?<?.001) for the entire 24?h in patients with CKD. Prevalence of non-dipping was significantly higher in patients with than without CKD (60.6% vs. 43.2%; p?<?.001). The largest difference between groups was in the prevalence of the riser BP pattern, i.e., asleep SBP mean?>?awake SBP mean (17.6% vs. 7.1% in patients with and without CKD, respectively; p?<?.001). The riser BP pattern significantly and progressively increased from 8.1% among those with stage 1 CKD to a very high 34.9% of those with stage 5 CKD. Elevated asleep SBP mean was the major basis for the diagnosis of hypertension and/or inadequate BP control among patients with CKD; thus, among the uncontrolled hypertensive patients with CKD, 90.7% had nocturnal hypertension. Our findings document significantly elevated prevalence of a blunted nocturnal BP decline in hypertensive patients with CKD. Most important, prevalence of the riser BP pattern, associated with highest CVD risk among all possible BP patterns, was 2.5-fold more prevalent in CKD, and up to 5-fold more prevalent in end-stage renal disease. Patients with CKD also presented significantly elevated ambulatory PP, reflecting increased arterial stiffness and enhanced CVD risk. Collectively, these findings indicate that CKD should be included among the clinical conditions for which ABPM is mandatory for proper diagnosis and CVD risk assessment, as well as a means to establish the best therapeutic scheme to increase CVD event-free survival. (Author correspondence: rhermida@uvigo.es)     

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMD_BA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMD_BA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMD_BA, aPWV, and vascular endothelial cell protein expression.     

Efficacy of Benzbromarone in Hyperuricemic Patients Associated with Chronic Kidney Disease

We have retrospectively evaluated the uric acid control status and renal function changes over a period of up to 7 years in 35 patients with renal impairment who had stage 3 or higher chronic kidney disease (CKD; stage 3 in 32 patients, stage 4 in 2 patients, and stage 5 in 1 patient) associated with hyperuricemia and were receiving monotherapy with benzbromarone as an antihyperuricemic drug. Serum uric acid levels significantly decreased from 8.5 ± 0.9 to 6.1 ± 0.8 mg/dL at 6 months and were subsequently controlled at less than 7.0 mg/dL in most patients. Most patients received benzbromarone at a dose of 25–50 mg/day, whereas 150–200 mg/day was used in some patients with stage 4 or 5 CKD. No significant changes in estimated glomerular filtration rate (eGFR) from the baseline value of 46.2 ± 11.5 mL/minute/1.73 m² were found after benzbromarone therapy. Although the renal function impairment did not improve by reducing the serum uric acid levels with benzbromarone, the renal function did not deteriorate further on the therapy. These results suggest that benzbromarone is applicable to the management of hyperuricemia associated with renal impairment.     

慢性肾脏病伴发高尿酸血症预后的回顾性研究

摘要 目的：本研究对慢性肾脏病伴发高尿酸血症的情况进行现状分析及随访,观察我院住院患者中符合该条件的人群,并对该人群是否较早进入以透析为主要方式的肾脏替代治疗阶段或是以死亡为主要表现的终点事件进行评估,以期降低肾脏病致死致残风险。方法：收集2013.1-2018.1在哈尔滨医科大学第一临床医院肾内科住院确诊为慢性肾脏病CKD1-5期患者的临床资料,进行回顾性分析。用SAS9.4软件统计数据,所得的数据以均值±标准差或者例数（百分比）的方式进行描述;方差齐时t检验应用于定量资料组间比较;方差不齐时应用Satterthwaite t''检验;完全随机设计的方差分析体现在多组间比较的应用。卡方检验是组间比较定性资料的一种选择。Pearson分析用来挖掘尿酸与本实验中其他指标的相关可能。采用单、多因素logistic回归分析汇总探讨慢性肾脏病的可能危险因素。结果：1）高尿酸血症组患者以24.93%的比例进入透析阶段,比非高尿酸组高了12.04%。死亡结果对两组之间的差异不构成影响。2）尿酸和胆固醇及血糖具有正相关关系,相关系数分别为0.12637 和0.11639。与eGFR具有负相关性,相关系数为-0.326。3) 单因素logistic回归分析CKD的危险因素结果表明年龄、尿酸、胱抑素C、尿素氮、血肌酐、尿蛋白、尿潜血、收缩压是CKD的危险因素。以CKD分期为应变量,单因素logistic 回归分析中有意义的变量为自变量,包括尿酸、尿蛋白、尿潜血、年龄、BUN、CysC、收缩压、血肌酐、吸烟、饮酒、BMI、甘油三酯、胆固醇、血红蛋白（Hemoglobin, Hb）进行多因素回归分析,变量筛选法采用向后法,结果显示,尿蛋白、尿素氮、尿酸是CKD独立危险因素。结论：1）与慢性肾脏病非高尿酸血症组相比,伴有高尿酸血症的慢性肾脏病患者进入透析阶段的比例更大。2）本研究可以得出尿蛋白、血尿素氮、尿酸是CKD的独立危险因素。     

两种心衰模型大鼠心功能的比较

目的　比较两种心衰模型大鼠心功能的特点。方法　用腹主动脉、下腔静脉穿刺造瘘法及冠脉结扎法建立不同的心衰模型 ,用Doppler超声心动图及心脏称重的方法比较其心功能的各项参数。结果　两组大鼠的相对心脏重量均有所增高。造瘘组射血分数有所下降 ,但心输出量、血压维持正常 ,而冠脉结扎组术后 3周射血分散、心输出量和平均动脉压均明显下降 ,等容舒张期延长。结论　腹主动脉、下腔静脉穿刺造瘘所造成的是高输出量心衰 ,而冠脉结扎法所造成的是低输出量心衰 ,其心衰程度更为严重。Doppler超声心动图为大鼠心功能的检测提供了一种简单、可靠、可随访的无创伤性检查方法。     

不同类型慢性心力衰竭患者临床特征及心功能危险因素、预后影响因素分析

摘要 目的：分析不同类型慢性心力衰竭患者临床特征及心功能危险因素、预后影响因素。方法：回顾性分析2020年1月-2022年1月我院收治的慢性心力衰竭患者80例,根据左室射血分数（LVEF）分为A组（n=25,LVEF<30%）、B组（n=25,LVEF 40%~50%）、C组（n=25,LVEF≥50%）三组,另根据随访1年后是否存活分为生存组（n=51）和死亡组（n=29）。比较不同组别临床相关指标,采用Pearson检验分析患者临床特征与慢性心力衰竭患者心功能、预后之间的相关性,采用多因素Logistic回归分析影响慢性心力衰竭患者心功能、预后的独立危险因素。结果：A组的心率及患有冠心病、心律失常1年以上、合并非心血管疾病人数占比、LAD、RAD、Scr、Hcy水平高于B组和C组（P<0.05）。死亡组的心率及患有冠心病、心律失常1年以上、LAD、RAD、Scr水平明显高于生存组（P<0.05）。Pearson相关性检验显示,心率、冠心病、心律失常、合并非心血管疾病、LAD、RAD、Scr、Hcy水平与慢性心力衰竭患者心功能之间呈正相关（P<0.05）;心率、冠心病、心律失常、LAD、RAD、Scr水平与慢性心力衰竭患者预后之间呈正相关（P<0.05）。多因素Logistic回归分析结果显示,心率、冠心病、心律失常、合并非心血管疾病、LAD、RAD、Scr、Hcy水平是影响慢性心力衰竭患者心功能的独立危险因素（P<0.05）;心率、冠心病、心律失常、LAD、RAD、Scr水平是影响慢性心力衰竭患者预后的独立危险因素（P<0.05）。结论：心率、冠心病、心律失常、LAD、RAD、Scr水平与慢性心力衰竭患者心功能、预后之间均呈正相关,是影响慢性心力衰竭患者心功能、预后的独立危险因素,可用来预测慢性心力衰竭的发生。     

慢性肾脏病患者胰岛素抵抗的发生情况及其影响因素分析

目的:探究慢性肾脏病(chronic kidney disease,CKD),尤其是非肥胖CKD患者,胰岛素抵抗(insulin resistance,IR)的发生情况,并分析其影响因素。方法:按照纳排标准,选择2016年1月至2017年11月在解放军总医院肾病科就诊的CKD患者共573例,其中非肥胖CKD患者510例,检测患者的身高、体重、空腹胰岛素、血肌酐、血尿素氮等临床指标,计算患者身高体重指数(body mass index,BMI),以BMI≥28 kg/m~2定义为肥胖,按照e GFR水平将CKD分期,建立HOMA指数(HOMA-IR)稳态模型评价IR情况,对CKD患者及非肥胖CKD患者各期IR的发生率进行比较,应用单因素相关性分析和多元逐步回归分析进行HOMA-IR指数相关因素的研究。结果:随着CKD患者肾脏功能的逐渐恶化,IR的发生率逐渐升高。各期CKD患者及非肥胖CKD患者IR的发生率比较差异均具有统计学意义(P=0.019,P=0.000)。在单因素相关性分析结果显示CKD患者的HOMA-IR指数与BMI、血尿素氮、甘油三酯、甲状旁腺激素、CKD分期呈正相关,与总蛋白、白蛋白、高密度脂蛋白、e GFR呈负相关。非肥胖CKD患者的HOMA-IR指数与年龄、尿素氮、甘油三酯、甲状旁腺激素、CKD分期呈正相关,与总蛋白、白蛋白、高密度脂蛋白、e GFR呈负相关。多元回归分析显示CKD患者的BMI、血尿素氮、甘油三酯、CKD分期进入最终回归方程,HOMA-IR与BMI、血尿素氮、甘油三酯、CKD分期呈正相关(P0.05)。非肥胖CKD患者的尿素氮、甲状旁腺激素、CKD分期进入最终回归方程,HOMA-IR与尿素氮、甲状旁腺激素、CKD分期呈正相关(P0.05)。结论:IR的发生率随CKD的进展逐渐升高,肥胖、血尿素氮升高、甘油三酯升高、肾功能降低是CKD患者发生IR的相关危险因素,血尿素氮升高、甲状旁腺激素升高、肾功能降低是非肥胖CKD患者IR发生的相关危险因素。