维持性血液透析患者血管钙化和血清骨硬化蛋白的相关因素

目的探讨维持性血液透析(MHD)患者血清骨硬化蛋白与慢性肾脏病矿物质和骨异常(CKD-MBD)相关指标尤其是血管钙化的关系。方法筛选暨南大学附属第一医院MHD患者72例,收集一般资料,检测血钙、磷、甲状旁腺激素(IPTH)等矿物质代谢指标,透析前后肌酐、尿素,计算Kt/V。用酶联免疫吸附法检测血清骨硬化蛋白水平。行腰椎侧位片进行腹主动脉钙化评分(Kauppila半定量法)。按血清骨硬化蛋白水平(≤125 pg/mL和> 125 pg/mL)分为2组,比较分析CKD-MBD相关指标与骨硬化蛋白的关系,并对其进行多因素Logistic回归分析。结果低血清骨硬化蛋白组和高血清骨硬化蛋白组比较发现,MHD患者IPTH差异统计学意义(P <0.05)。将CKD-MBD等相关指标引入Logistic回归模型发现,透析龄、男性和无尿是MHD患者血清骨硬化蛋白的独立危险因素,IPTH和Kt/V是其保护因素。结论透析龄、男性和无尿是MHD患者血清骨硬化蛋白的独立危险因素,IPTH和Kt/V是其保护因素。腹主动脉钙化与血清骨硬化蛋白无关。

足细胞损伤在糖尿病肾病中作用机制的研究进展

糖尿病肾病是糖尿病患者最主要的微血管并发症之一,患病率可达到20%~40%,是导致终末期肾病的最主要原因之一。糖尿病肾病主要是由于肾小球高滤过、系膜细胞增生、基底膜增厚、肾小球肥大、细胞基质积累等原因所致,进一步导致肾小管的纤维化和肾小球的硬化。近年来,关于DN患者尿蛋白与足细胞的功能和形态改变有着密切联系的研究越来越多。在DN早期,由于足细胞的足突消失和融合,且随着病情进展,足细胞损伤积累可导致凋亡与脱落的发生、肾小球基底膜受到破坏、大量蛋白尿产生,促进DN进展为ESRD。因此,研究清楚足细胞的损伤机制将有助于为糖尿病肾病患者的治疗提供新策略。

Efficacy and Safety of Febuxost at in the Treatment of Chronic Kidney Disease with Hyperuricemia: A Meta- Analysis

Background Febuxostat and allopurinol have different pharmacological mechanisms,the efficacy of febuxostat in chronic kidney disease complicated with hyperuricemia remains controversial.A meta-analysis and systemic review was conducted to investigate the efficacy and safety of febuxostat in CKD populations complicated with hyperuricemia.Methods A comprehensive search was conducted in multiple electronic databases based on the inclusion and exclusion criteria,before December 2016,searching for the published studies,including Chinese and English,relating to the use of febuxostat in CKD populations complicated with hyperuricemia,and manual retrieval of the inclusion literature.Literature evaluation and data extraction were performed by two reviewers,Rev Man 5.3 was used to perform the meta-analysis.Results Seven studies with 482 CKD patients were included in the meta-analysis.We found that febuxostat can significantly slow the decreasing speed of e GFR[RR=4.90,95%CI(1.95,7.84),P=0.001],and reduce serum uric acid[RR=-99.30,95%CI(-172.24,-26.37),P=0.008]levels in CKD patients complicated with hyperuricemia when compairing with control group.There was no significant difference in the levels of systolic blood pressure[RR=-2.19,95%CI(-9.99,5.61),P=0.58],diastolic blood pressure[RR=-2.30,95%CI(-7.33,2.73),P=0.10],low density lipoprotein[RR=-0.47,95%CI(-7.64,6.69),P=0.90]between the two groups.Compared with the control group,the use of febuxostat increase the incidence of adverse reaction[RR=4.73,95%CI(1.04,21.43),P=0.04]in patients.Conclusions Febuxostat can significantly lower serum uric acid level and effectively delay the process of chronic renal failure in CKD patients complicated with hyperuricemic,increases the incidence of adverse reaction,no significant difference in SBP,DBP,LDL,when compared with control group.

Correlation between Vascular Calcification and Serum Sclerostin in MHD Patients

Objective Investigate the correlation between serum sclerostinlevel and chronic kidney disease-mineral and bone disorder(CKD-MBD),especially vascular calcification,in maintenance hemodialysis(MHD)patients.Methods This is across-sectional study,a total of 72 MHD patients were included from the first affiliated hospital of Jinan university.Measure the biochemical indicators of mineral metabolism,renal function,and serum sclerostin level by ELISA.The abdominal aorta calcification score(AACS)was assessed according to Kauppila method on lateral spine imaging using DEXA.Patients were distributed into two groups according to the level of serum sclerostin:low sclerostingroup(≤125 pg/ml)and high sclerostingroup(>125 pg/ml).Analyze the association of serum sclerostin level with the indicators of CKD-MBD.Results There was significant difference in i PTH level between high sclerost in group and low sclerost in group.Multivariate Logistic regression analysis demonstrated that dialysis duration,male and anuria were independent risk factor of high sclerostin level,and i PTH and Kt/V were protective factors.Conclusion Dialysis duration,man,anuria was independent risk factors and i PTH,Kt/V were protective factors of high serum sclerostin level in MHD patients.There was no correlation between abdominal aorta calcification and serum sclerostin level.

Application Status and Prospect of Bio-artificial Liver

Liver failure which can be caused by viral hepatitis,alcohol,drugs,metabolic diseases,autoimmune processes or other fac tors is the end stage of chronic liver disease.Although liver transplantation is currently considered to be the primary treatment measures of chronic liver disease.Due to donor shortages,surgical complications and immune rejection,cell therapy has been extensively studied.?Hepa tocyte transplantation and artificial liver have evolved into a simpler alternative to liver failure treatment.Artificial liver can be used as Liver replacement therapy in patients who were waiting for the liver transplantation with chronic liver disease.The ideal biological artificial liver must have the liver material metabolism,detoxification,synthesis and secretion and other functions.Nowadays bio-artificial liver has carried out a large number of clinical trials and get some progress.?This article is now discuss the status of bio-artificial liver and its re placement therapy prospects.

Advances in Diagnosis and Treatment of Neuropsychiatric Systemic Lupus Erythematosus

1 Introduction Neuropsychiatric systemic lupus erythematosus(NPSLE)is a serious complication of systemic lupus erythematosus(SLE),with an incidence of about 30%to 40%[1].No matter early or late SLE patients are prone to concurrent,so early diagnosis and treatment of NPSLE is extremely important.