维持性血液透析患者睡眠质量的影响因素及与氧化应激水平、生活质量和疲乏状况的关系研究

摘要 目的：分析调查维持性血液透析（MHD）患者睡眠质量的影响因素,并分析其与生活质量、氧化应激水平和疲乏状况的关系。方法：研究对象选取自2019年8月~2021年5月在首都医科大学附属北京朝阳医院血液透析室长期规律行MHD治疗的终末期肾脏病患者150例,收集患者的临床资料,采用匹兹堡睡眠指数（PSQI）量表评定睡眠质量。采用修订版Pieper疲劳量表（RPFS）评估所有患者的疲乏程度。采用肾脏病生活质量量表（KDQOL-SF）评估患者生活质量。分析MHD患者睡眠质量的影响因素,并分析其与氧化应激水平、生活质量和疲乏状况的关系。结果：150例MHD患者中有114例PSQI评分>5分,本血液透析室MHD患者睡眠障碍发生率为76.00% (114/150)。根据是否发生睡眠障碍将患者分为睡眠障碍组（n=114）和无睡眠障碍组（n=36）。单因素分析结果显示睡眠障碍组、无睡眠障碍在年龄、透析时间、血红蛋白（Hb）、血清甲状旁腺激素（iPTH）、透析治疗效率标准（Kt/V）、血钙方面组间对比有差异（P<0.05）。透析时间、年龄、Hb、iPTH、Kt/V均是MHD患者睡眠质量的影响因素（P<0.05）。睡眠障碍组的一般健康状况、肾病相关、总分均低于无睡眠障碍组（P<0.05）。睡眠障碍组的疲乏评分高于无睡眠障碍组（P<0.05）。睡眠障碍组的丙二醛（MDA）高于无睡眠障碍组,超氧物歧化酶（SOD）、人谷胱甘肽-过氧化物酶（GSH-Px）低于无睡眠障碍组（P<0.05）。结论：透析时间、年龄、Hb、iPTH、Kt/V均是MHD患者睡眠质量的影响因素,且睡眠质量变差会加重MHD患者疲乏程度,加重氧化应激反应,降低患者的生活质量。     

Use of body composition measurements to guide the assessment of dry weight in anuric dialysis patients: improvements in blood pressure control

PurposeFluid management using a body composition monitor (BCM) based on bioimpedance spectroscopy has been found to be beneficial for maintenance hemodialysis (MHD) patients. Our purpose was to provide a management procedure for the adjustment of post-dialysis overhydration (OH_post) and to evaluate whether this approach could improve blood pressure.MethodsPost-dialysis fluid status was assessed weekly using the BCM. The reference value of OH_post and the flow procedure for post-dialysis target weight (PDTW) adjustment were established via measurements of OH_post in 60 normotensive MHD patients. In the interventional study, we adjusted the PDTW of hypertensive patients to the optimal OH_post range, with a 0.2–0.5 kg change in PDTW per week.ResultsThis observational study included 130 anuric MHD patients, of whom 60 were in the pre-dialysis systolic blood pressure (sBP_pre) < 140 mmHg group. On multivariate logistic regression analysis, we found that only OH_post was significantly associated with sBP_pre ≥ 140 mmHg (odds ratio = 2.293, p = 0.000). Patients in the OH_post < ?1.8 L group were mainly male and younger, and had higher post-dialysis diastolic blood pressure, ultrafiltration volume, levels of nutrition markers (serum albumin and creatinine), body mass index, and lean tissue index (LTI). On multiple stepwise regression analysis, only the change in LTI was found to be an independent predictor of OH_post [R² 0.208, β = ?0.196, 95% CI (?0.296, ?0.095), p < 0.001]. The reference value of OH_post was found to deviate by ? 2.5–0.5 L from that of normotensive patients. At the end of the study, the systolic blood pressure of 38 patients was less than 140 mmHg after PDTW adjustment. The changes in OH_post from the initial to last adjustment were significant (t = 5.431, p < 0.001), with a substantial decrease in the sBP_pre (t = 11.208, p < 0.001).ConclusionsAssessment of OH_post and LTI using a BCM with a patient-specific optimal PDTW adjustment flow can lead to significantly better control of hypertension in anuric MHD patients.     

低频电刺激联合间歇导尿及Motomed运动训练对脊髓损伤致神经源性膀胱患者膀胱内压力及膀胱容量的影响

目的:探讨低频电刺激联合间歇导尿及Motomed运动训练对脊髓损伤致神经源性膀胱患者膀胱内压力及膀胱容量的影响。方法:选取我院2015年12月～2018年2月收治的脊髓损伤致神经源性膀胱患者92例,根据随机数字表法将其分为对照组(n=46)与研究组(n=46)。两组均给予间歇性导尿、盆底肌训练、膀胱功能训练等常规干预,对照组在此基础上采取低频电刺激,研究组于对照组基础上采取Motomed运动训练,两组均干预2个月。比较两组的临床疗效、治疗前及治疗2个月后的排尿情况(日均单次排尿量、日单次最大排尿量、日均排尿次数)、尿动力学情况(最大尿流率、膀胱容量、残余尿量、膀胱内压力)、LUTS(国际下尿路症状评分)及USDS(泌尿症状困扰评分)。结果:治疗后,研究组总有效率(93.48%)显著高于对照组(78.26%)(P0.05);治疗2个月后,两组日均单次排尿量、日单次最大排尿量、日均排尿次数、最大尿流率、膀胱容量、膀胱内压力均较治疗前显著增多,且研究组以上指标均明显高于对照组(P0.05);两组LUTS及USDS分值均较治疗前显著降低,且研究组以上指标均显著低于对照组(P0.05)。结论:间歇导尿联合低频电刺激与Motomed运动训练可有效改善脊髓损伤致神经源性膀胱患者尿动力学状态及排尿情况,增大膀胱容量及膀胱内压力等,缓解下尿路症状及泌尿症状困扰程度,提高治疗效果。     

高通量血液透析联合草酸艾司西酞普兰对尿毒症伴焦虑抑郁患者临床应用研究

目的:探讨高通量血液透析联合草酸艾司西酞普兰对尿毒症伴焦虑抑郁患者血清钙磷代谢、营养状态和不良心理状态的影响。方法:选取2016年2月～2018年8月期间保定市第一中心医院收治的尿毒症伴焦虑抑郁患者113例,根据数字表法将患者随机分为对照组(n=56)和研究组(n=57),对照组给予心理治疗和常规血液透析治疗,研究组给予高通量血液透析联合草酸艾司西酞普兰治疗。比较两组患者钙、磷水平、营养状态、焦虑抑郁评分,记录两组不良反应发生情况。结果:两组患者治疗3个月后磷下降,且研究组低于对照组(P0.05),研究组磷水平达标率均高于对照组(P0.05)。研究组治疗3个月后白蛋白(Alb)、血红蛋白(Hb)、总蛋白(TP)、转铁蛋白(TRF)较治疗前升高,且研究组高于对照组同时间点(P0.05)。两组治疗3个月后汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分较治疗前下降,且研究组低于对照组(P0.05)。两组患者不良反应发生率比较无差异(P0.05)。结论:高通量血液透析联合草酸艾司西酞普兰治疗尿毒症伴焦虑抑郁患者,可有效降低血清磷水平,改善机体营养状态,缓解焦虑抑郁情绪,同时不增加不良反应发生率,临床应用价值较高。     

Specific growth rate of Chlamydomonas reinhardtii and Chlorella sorokiniana under medium duration light/dark cycles: 13–87 s

The specific growth rate of Chlamydomonas reinhardtii and Chlorella sorokiniana decreased under square-wave light/dark cycles of medium duration, 13–87 s, in comparison to continuous illumination. Three experiments were done in three different turbidostats at saturating and sub-saturating light intensities during the light period, 240–630 μmol m⁻² s⁻¹. Within each experiment the light intensity during the light periods of the intermittent light regimes was equal and this intensity was also applied under continuous illumination. The specific growth rate decreased proportional or more than proportional to the fraction of time the algae were exposed to light; this light fraction ranged from 0.32 to 0.88. We conclude that under these light regimes the chlorophyta C. reinhardtii and C. sorokiniana are not able to store light energy in the light period to sustain growth in the dark period at the same rate as under continuous illumination. C. reinhardtii increased its specific light absorbing surface by increasing its chloropyll-a content under light/dark cycles of 13 s duration and a light fraction of 0.67 at 240 μmol m⁻² s⁻¹; the chloropyll-a content was twice as high under intermittent illumination in comparison to continuous illumination. The combination of a higher specific light absorption together with a lower specific growth rate led to a decrease of the yield of biomass on light energy under intermittent illumination.     

Inflammatory cytokines and metabolic responses to high-intensity intermittent training: effect of the exercise intensity

To examine the effects of two high-intensity intermittent training (HIIT) programs of varying intensities (100% vs. 110% of maximal aerobic velocity [MAV]) on metabolic, hormonal and inflammatory markers in young men. Thirty-seven active male volunteers were randomly assigned into: HIIT experimental groups (100% MAV [EG₁₀₀, n = 9] and 110% MAV [EG₁₁₀, n = 9]) and a control groups (CG₁₀₀, n = 9 and CG₁₁₀, n = 9). Particpants performed high intesity intermittent exercise test (HIIE) at 100% or 110% MAV. Venous blood samples were obtained before, at the end of HIIE and at 15 min of recovery, and before and after 8 weeks of HIIT programs. After training, Glucose was lower (p < 0.01) in EG₁₀₀ (d = 0.72) and EG₁₁₀ (d = 1.20) at the end of HIIE, and at 15 min recovery only in EG₁₁₀ (d = 0.95). After training, Insulin and Cortisol were lower than before training in EG₁₀₀ and EG₁₁₀ at the end of HIIE (p < 0.001). After HIIT, IL-6 deceased (p < 0.001) in EG₁₀₀ (d = 1.43) and EG₁₁₀ (d = 1.56) at rest, at the end of HIIE (d = 1.03; d = 1.75, respectively) and at 15 min of recovery (d = 0.88;d = 1.7, respectively). This decrease was more robust (p < 0.05) in EG₁₁₀ compared to EG₁₀₀. After HIIT, TNF-α deceased (p < 0.001) in EG₁₀₀ (d = 1.43) and EG₁₁₀ (d = 0.60) at rest, at the end of HIIE (0.71 < d < 0.98) and at 15 min of recovery (0.70 < d < 2.78). HIIT with 110% MAV is more effective in young males on the improvements of some metabolic (Glucose), hormonal (Cortisol) and inflammatory (IL-6) markers at rest, at the end of HIIE and 15 min of recovery than training at 100 % MAV.     

Creatol,an oxidative product of creatinine in hemodialysis patients

Creatol (CTL) is a product resulting from the reaction of creatinine (Cr) with the hydroxyl radical and is identified as a precursor of methylguanidine (MG), a uremic toxin. In this study, we investigated serum CTL levels together with those of Cr and MG in 66 patients who were on maintenance hemodialysis (HD). Prior to dialysis, the mean serum levels of Cr, CTL and MG were 967 (=11.1 mg/dl) ±267 μM, 11.1 ± 4.8μM and 5.8±2.9 μM, respectively. The mean CTL level was about 1.1% that of Cr, and the CTL plus MG level was about 1.4% that of the Cr level. The reduction rates of Cr, CTL and MG by a single HD were 62.6±6.1%, 71.0±10.3% and 51.9±11.6%, respectively. The CTL level at 0.5, 1 and 6h after HD increased rapidly by 20.7±8.7%, 31.7±14.7% and 80.1±27.3%, respectively. There was a significant correlation between CTL or CTL/Cr and parathyroid hormone in patients who had just undergone parathyroidectomy. No significant correlation was found between CTL or CTL/Cr and those factors which seems to be related to the predialysis levels of reactive oxygen. Therefore, because of the good clearance of CTL and its rapid conversion to MG, its usefulness for the estimation of hydroxyl radical generation in HD patients is limited.     

The response of interleukin-6 and soluble interleukin-6 receptor isoforms following intermittent high intensity and continuous moderate intensity cycling

As interleukin-6 (IL-6), its soluble receptor (sIL-6R), and the IL-6/sIL-6R complex is transiently elevated in response to prolonged moderate-intensity exercise, this study investigated how these levels would be modulated by an acute bout of high-intensity intermittent (HIIT) exercise in comparison to continuous moderate-intensity exercise (MOD). This study also investigated the expression of the differentially spliced sIL-6R (DS-sIL-6R) in response to exercise. Eleven healthy males completed two exercise trials matched for external work done (582 ± 82 kJ). During MOD, participants cycled at 61.8 (2.6)% VO_2peak for 58.7 (1.9) min, while HIIT consisted of ten 4-min intervals cycling at 87.5 (3.4)% [(V)\dot]O_2peak \dot{V}{{\hbox{O}}_{2{\rm{peak}}}} separated by 2-min rest. Blood samples were collected pre-exercise, post-exercise, and 1.5, 6, and 23 h post-exercise. Plasma IL-6, sIL-6R, IL-6/sIL-6R complex, and DS-sIL-6R levels were measured by enzyme-linked immunosorbent assay. HIIT caused a significantly greater increase in IL-6 than MOD (P = 0.018). Both MOD and HIIT resulted in an increase in sIL-6R and IL-6/sIL-6R complex (P < 0.001), however, this was not significantly different between trials. Soluble IL-6R peaked at 6 h post-exercise in both trials. DS-sIL-6R increased significantly with exercise (P = 0.02), representing 0.49% of the total sIL-6R increase. This investigation has demonstrated that the IL-6 response is greater after intermittent high-intensity exercise than comparable moderate-intensity exercise; however, increased IL-6/sIL-6R complex nor sIL-6R was different between HIIT and MOD. The current study has shown for the first time that elevated sIL-6R after HIIT exercise is derived from both proteolytic cleavage and differential splicing.     

Do intermittent and ephemeral Mediterranean rivers belong to the same river type?

The benthic macroinvertebrate communities and ecological quality of eleven temporary rivers (seven intermittent and four ephemeral) in Dadia National Park, north-eastern Greece, were examined with respect to the degree of flow temporality. Sampling took place during the high flow season at both ephemeral and intermittent sites and during the low flow season only at the intermittent ones, which receded to pools. Despite the remarkable seasonal variation in both the hydrology and ecology of the intermittent rivers, the various metrics and indices as well as the multivariate analyses confirmed the clear distinction between the two river types (ephemeral and intermittent). Existing European quality indices do not sufficiently differentiate between ephemeral and intermittent river types, and thus cannot reliably discriminate the degree of natural variability from human induced stressors in temporary rivers.     

Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers

A 6-mo longitudinal study of 48 hemodialysis patients (HPs) with chronic renal failure was performed. Three blood samplings were done. Samples of whole blood from each patient were collected during hemodialysis sessions after passing through the artificial kidney. Zinc and copper levels were measured by atomic absorption spectrometry. Additionally, 36 biochemical indexes were evaluated during the study. Fifty-two healthy matched controls were also considered. Mean serum zinc and copper concentrations in HPs were significantly decreased (Zn) and increased (Cu), when compared with healthy controls (p<0.01). Zinc concentrations found in the first and second blood samplings from patients were significantly lower than those measured for the third sampling (p<0.01). The etiology of chronic renal failure influenced the statistically serum Zn levels of patients (p<0.05). Serum copper levels of HPs were significantly diminished by the existence of secondary associated diseases (p<0.01). Uric acid and parathyroid hormone, and total-cholesterol and glutamic-pyruvic-transaminase levels were significantly (p<0.05) and linearly related with serum zinc and copper concentrations, respectively. From all of indexes, creatinine, direct bilirubin, magnesium, calcium, parathyroid hormone, transferrin, and albumin were statistically modified along the longitudinal study (p<0.05). Transferrin serum levels were significantly diminished in the third blood sampling, indicating the tendency toward anemia in the patients. This result is reinforced by low levels of biochemical and hematological indexes related with iron body staus.