Effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function in patients with chronic renal failure

Objective:To explore the effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function indexes in patients with chronic renal failure, and to provide help for clinical treatment of patients with chronic renal failure. Methods:80 cases of chronic renal failure patients in our hospital were selected as the study group, given peritoneal dialysis treatment;80 healthy people during the same period in our hospital selected as the normal group. The inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and IL-8], renal function indices [BUN (Urea nitrogen) and SCR (serum creatinine)] and nutritional index [PA (prealbumin), Hb (hemoglobin), ALB (albumin) and TF (Transferrin)] levels were detected in healthy population and patients with chronic renal failure patients before and after treatment of 1 and 30 d, and the relative significance was analyzed. Results:Compared with the normal group, the inflammatory factors (CRP, IL-6, TNF-αand IL-8) and renal function indices (BUN and SCR) of patients with chronic renal failure in study group increased significantly and nutritional indexes (TF, PA and ALB) decreased significantly (P<0.05). The inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) of patients with chronic renal failure by peritoneal dialysis in the treatment of 1 d in research group were significantly lower than the level before treatment, and Hb was significantly higher than that before treatment (P<0.05). After 30 d of dialysis, inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) decreased further and Hb increased further (P<0.05). Conclusions:Peritoneal dialysis can improve the inflammatory factors levels of patients with chronic renal failure, reduce the renal function index, and can affect the nutritional index of patients, and has important significance in clinical treatment of patients with chronic renal failure.

Kidney transplantation in older recipients:Preemptive high KDPI kidney vs lower KDPI kidney after varying dialysis vintage

AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing database from 2001-2015, we identified deceased donor kidney(DDK) transplant recipients > 60 years of age who either underwent preemptive transplantation of kidneys with kidney donor profile index(KDPI) ≥ 85%(marginal kidneys) or received kidneys with KDPI of 35%-84%(better quality kidneys that older wait-listed patients would likely receive if waited longer) after being on dialysis for either 1-4 or 4-8 years. Using a multivariate Cox model adjusting for donor, recipient and transplant related factors-overall and death-censored graft failure risks along with patient death risk of preemptive transplant recipients were compared to transplant recipients in the 1-4 and 4-8 year dialysis vintage groups.RESUTLS The median follow up for the whole group was 37 mo(interquartile range of 57 mo). A total of 6110 DDK transplant recipients above the age of 60 years identified during the study period were found to be eligible to be included in the analysis. Among these patients350 received preemptive transplantation of kidneys with KDPI ≥ 85. The remaining patients underwent transplantation of better quality kidneys with KDPI 35-84% after being on maintenance dialysis for either 1-4 years(n = 3300) or 4-8 years(n = 2460). Adjusted overall graft failure risk and death-censored graft failure risk in preemptive high KDPI kidney recipients were similar when compared to group that received lower KDPI kidney after being on maintenance dialysis for either 1-4 years(HR 1.01, 95%CI: 0.90-1.14, P = 0.84 and HR 0.96, 95%CI: 0.79-1.16, P = 0.66 respectively) or 4-8 years(HR 0.82, 95%CI: 0.63-1.07, P = 0.15 and HR 0.81, 95%CI: 0.52-1.25, P = 0.33 respectively). Adjusted patient death risk in preemptive high KDPI kidney recipients were similar when compared to groups that received lower KDPI kidney after being on maintenance dialysis for 1-4 years(HR 0.99, 95%CI: 0.87-1.12, P = 0.89) but lower compared to patients who were on dialysis for 4-8 years(HR 0.74, 95%CI: 0.56-0.98, P = 0.037).CONCLUSION In summary, our study supports accepting a "marginal" quality high KDPI kidney preemptively in older waitlisted patients thus avoiding dialysis exposure.

8种寄主植物对朝鲜球坚蚧(Didesmococcus koreanus Broch)的适合度及自然种群增长的影响

在室外对8种寄主植物上朝鲜球坚蚧的刺吸、产卵以及种群动态进行了系统调查,并运用选择性指数(SI)、嗜食性指数(PI)、危害指数(DI)和种群趋势指数(I)等4种指数系统定量评价了8种寄主对朝鲜球坚蚧的适合度以及自然种群增长等的影响。结果表明,好、中、弱3种生长势的寄主对朝鲜球坚蚧的适合度由高至低的顺序均是桃、梅、李、杏、苹果、梨、樱和山楂;在一个生长季节内,8种寄主适合度总体变化均表现为正态分布形,呈弱-强-弱态势,都以6月份的8种寄主适合度表现最高,且以生长势好的寄主最高,中等的次之,弱的最差。朝鲜球坚蚧更趋向于梅、桃、李和杏寄主上刺吸取食和产卵,且若蚧存活率、卵的孵化率以及羽化率均较高,自然种群增长最快,4种指数均较大(SI>0.875、PI>5.469、I>5.75、DI>1.049)。桃、梅、李和杏寄主是该蚧的最适宜类寄主;苹果、梨和樱寄主植物是适宜类寄主;山楂为次适宜类寄主。PI与DI间回归方程为:PI=0.3389+DI(r0.01=0.937)。8种寄主表皮毛密度、长度、皮层厚度和枝条直径等物理结构与适合度的强弱均呈负相关(r0.01=-0.976),其对该蚧刺吸取食和产卵等行为起到抑制作用。山楂表皮毛密度、长度、皮层厚度和枝条直径分别是最适宜类寄主枝条4种物理结构指标平均值的2.73、3.27、2.77倍和3.47倍。这些对抗蚧育种、预测测报以及优化防治策略等具有一定的指导意义。

预后营养指数对腹膜透析患者心血管疾病死亡的影响:一项多中心回顾性队列研究

背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。

基于MODIS数据的西藏荒漠化遥感监测研究

基于MODIS卫星NDVI产品构建了西藏荒漠化监测模型,利用该模型分析了2000-2017年全区荒漠化时空分布特征和趋势变化,并利用实地调查的植被覆盖度及影像资料进行模型验证。结果表明:近18年来西藏主要以中度荒漠化土地为主,占全区面积的37.68%,非荒漠化区域面积占28.65%,轻度和重度荒漠区面积分别占全区面积的13.20%和12.64%。全区荒漠化总体趋势属微弱改善状态,继续退化区域主要集中在西藏中部,包括那曲地区东南部,拉萨市大部,日喀则市东部和山南市北部。阿里地区大部和那曲地区北部属改善区。整体上全区荒漠化态势以稳定为主,占45.79%。改善和退化区域面积分别占23.58%和22.52%。构建的荒漠化指数与实测植被覆盖度呈负相关关系,判定系数R^2=0.52(P<0.05),表明实测样本与模型结果总体上趋于一致,反演模型可以作为研究区土地荒漠化监测方法。

Mapping and Assessing Typhoon-induced Forest Disturbance in Changbai Mountain National Nature Reserve Using Time Series Landsat Imagery

Monitoring forest disturbances is important for understanding changes in ecosystems. The 1986 Typhoon Vera was a serious disturbance that severely impacted the forest ecosystems of Changbai Mountain National Nature Reserve. Although the typhoon disturbance occurred more than two decades ago, the effects of the typhoon still remain within the study area. Few studies have focused on mapping and assessing disturbances across broad spatial and temporal scales. For this study, we first generated a map of forest composition prior to the typhoon disturbance, which served as a baseline data for the extraction of disturbed area. Then, the Disturbance Index(DI) method was tested for mapping the extent and magnitude of disturbance in the study area by applying a Tasseled Cap transformation to the Landsat imagery. The Landsatbased DI method estimated that an area of 13,764.78 ha of forest was disturbed by the typhoon. Based on visual assessments, these results correspond closely with the reference map derived from ground surveys. These results also revealed the influence of local topographic features on the distribution of windthrow areas. Windthrow areas were more pronounced inareas with elevations ranging from 1,000 to 2,000 m, slopes of less than 10 degrees, and southwestern to northwestern aspects. In addition, the relatively long(25 years) post-typhoon recovery period assessed by this study provided a more comprehensive analysis of the dynamics of forest recovery processes over time. Windthrow areas did not recover immediately after the typhoon, likely due to forest management practices enacted at the time. So far, forest recovery has proceeded more rapidly at elevations below 1,400 m, particularly on western slopes within the study area. Finally, a time series of DI values within the study period suggests a secondary disturbance may have occurred between 2000 and 2001.

Study on evaluation of cities' ability reducing earthquake disasters

Cities ability reducing earthquake disasters is a complex system involving numerous factors, moreover the re-search on evaluating cities ability reducing earthquake disasters relates to multi-subject, such as earthquake sci-ence, social science, economical science and so on. In this paper, firstly, the conception of cities ability reducing earthquake disasters is presented, and the ability could be evaluated with three basic elements the possible seis-mic casualty and economic loss during the future earthquakes that are likely to occur in the city and its surround-ings and time required for recovery after earthquake; based upon these three basic elements, a framework, which consists of six main components, for evaluating citys ability reducing earthquake disasters is proposed; then the statistical relations between the index system and the ratio of seismic casualty, the ratio of economic loss and re-covery time are gained utilizing the cities prediction results of earthquake disasters which were made during the ninth five-year plan; at last, the method defining the comprehensive index of cities ability reducing earthquake disasters is presented. Thus the relatively comprehensive theory frame is set up. The frame can evaluate cities ability reducing earthquake disasters absolutely and quantitatively and consequently instruct the decision-making on reducing cities earthquake disasters loss.

Vertical variations and composition of dissolved free amino acid in the seawater of the Yap Trench in the western Pacific Ocean

The composition and concentration of dissolved free amino acid(DFAA)of seawater samples collected in May 2016 from the surface to the hadal zone of the northern region of the Yap Trench were analyzed by pre-column derivatization of o-phthalaldehyde.Results show that the average concentration of DFAA in the study area was 0.47±0.36μmol/L.In different sampling stations,the concentrations of DFAA with water depth showed complex variation patterns.At the sediment-seawater interface,the concentrations of DFAA in the western side of the trench were obviously higher than that in its eastern side.In the study area,there were no significant correlations between the concentrations of DFAA and the environmental parameters such as concentrations of chlorophyll a(Chl a),dissolved oxygen(DO),pH,and dissolved inorganic nitrogen(DIN),indicating that the concentrations of DFAA in seawater of the trench are affected by many factors,such as photosynthesis,respiration,temperature,pressure,illumination,and circulation.The dominant DFAA are similar in different water layers of sampling stations,including aspartic acid(Asp),glutamic acid(Glu),glycine(Gly),and serine(Ser).The composition of different amino acids,and the relative abundance of acidic,basic,and neutral amino acids might be related to the sources and consumption of various amino acids.Nine pairs of amino acids in the DFAA showed significantly positive relationship by correlation matrix analysis,suggesting that they might share similar biogeochemical processes.The degradation index(DI)of the DFAA in seawater of the Yap Trench could reflect the degradation,source,and freshness of DFAA in the trench to some extents.This is a preliminary study of amino acids from sea surface to hadal zone in the ocean,more works shall be done in different trenches to reveal their biogeochemical characte ristics in extreme marine environme nts.

Sources and implications of particulate organic matter from a small tropical river——Zuari River, India

Transitional ecosystems,estuaries and the coastal seas,are distinctively affected by natural and anthropogenic factors.Organic matter(OM)originating from terrestrial sources is exported by rivers and forms a key component of the global biogeochemical cycles.Most previous studies focused on the bulk biochemical and anthropogenic aspects affecting these ecosystems.In the present study,we examined the sources and fate of OM entrained within suspended particulate matter(SPM)of the Zuari River and its estuary,west coast of India.Besides using amino acid(AA)enantiomers(L-and D-forms)as biomarkers,other bulk biochemical parameters viz.particulate organic carbon(POC),δ13C,particulate nitrogen(PN),δ15N and chlorophyll a were analyzed.Surprisingly no significant temporal variations were observed in the parameters analyzed;nonetheless,salinity,POC,δ13C,PN,δ15N,glutamic acid,serine,alanine,tyrosine,leucine and D-aspartic acid exhibited significant spatial variability suggesting source differentiation.The POC content displayed weak temporal variability with low values observed during the post-monsoon season attributed to inputs from mixed sources.Estuarine samples were less depleted than the riverine samples suggesting contributions from marine plankton in addition to contributions from river plankton and terrestrial C3 plants detritus.Labile OM was observed during the monsoon and post-monsoon seasons in the estuarine region.More degraded OM was noticed during the pre-monsoon season.Principal component analysis was used to ascertain the sources and factors influencing OM.Principally five factors were extracted explaining 84.52%of the total variance.The first component accounted for 27.10%of the variance suggesting the dominance of tidal influence whereas,the second component accounted for heterotrophic bacteria and their remnants associated with the particulate matter,contributing primarily to the AA pool.Based on this study we ascertained the role of the estuarine turbidity maximum(ETM)controlling the sources of POM and its implications to small tropical rivers.Thus,changes in temporal and regional settings are more likely to affect the natural biogeochemical cycles of small tropical rivers.

老年营养风险指数对腹膜透析相关性腹膜炎患者治疗效果的评估价值

目的探讨老年营养风险指数(geriatric nutritional risk index,GNRI)对腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)患者治疗效果的评估价值。方法选取2020年1月—2023年1月于青岛市市立医院就诊的PDAP患者147例作为研究对象,根据患者治疗效果分为治愈组和治疗失败组,比较2组间GNRI分值及临床特征差异,分析GNRI分值与PDAP患者治疗效果的关系。结果治愈组患者102例,治疗失败组患者45例,其中患者死亡25例、拔管10例、转院治疗10例。与治愈组相比,治疗失败组患者GNRI分值、体质量指数、血红蛋白、白蛋白(ALB)降低(t=5.134、7.517、2.336、3.259,P<0.001、<0.001、0.021、0.001),透析龄高于治愈组(t=10.924,P<0.001)。Logistic多因素回归分析显示GNRI分值下降(OR=0.541,95%CI:0.335~0.872,P<0.001)、ALB下降(OR=0.638,95%CI:0.494~0.825,P<0.001)和透析龄延长(OR=1.674,95%CI:1.081~2.591,P<0.001)是PDAP患者治疗失败的独立危险预测因素。ROC曲线分析显示GNRI分值预测PDAP患者治疗失败的ROC曲线下面积为0.735,敏感度为89.55%,特异度为75.43%,约登指数为0.649,最佳预测值为90.53分。结论GNRI分值下降是PDAP患者治疗失败的独立危险预测因素,且对PDAP患者治疗失败具有较高的预测效能,及早纠正患者营养状态可改善患者治疗效果。

CTCA定量参数对冠心病患者短期病死预测价值

目的探讨CT冠状动脉造影(CTCA)定量参数对冠心病患者短期病死预测价值。方法选取2021年3月—2023年3月收治的冠心病200例,比较不同冠状动脉病变程度冠心病患者CTCA定量参数(动脉阻力指数、总斑块负荷和斑块最小密度CT值),分析CTCA定量参数与冠心病患者冠状动脉病变程度相关性,探讨术后1年冠心病患者病死情况,分析CTCA定量参数与冠心病患者短期病死风险关联性,评价CTCA定量参数对冠心病患者短期病死预测价值。结果不同冠状动脉病变程度冠心病患者动脉阻力指数、总斑块负荷逐渐升高,斑块最小密度CT值逐渐降低(P<0.05)。冠心病患者动脉阻力指数、总斑块负荷与疾病类型、病变支数及狭窄程度呈正相关,斑块最小密度CT值与疾病类型、病变支数及狭窄程度呈负相关(P<0.05)。冠心病200例中39例(19.50%)术后1年病死。动脉阻力指数、总斑块负荷和斑块最小密度CT值与冠心病患者短期病死有关(P<0.01)。对冠心病患者短期病死预测的受试者工作特征曲线下面积动脉阻力指数、总斑块负荷和斑块最小密度CT值三者联合明显高于单独预测(P<0.05)。结论CTCA定量参数与冠心病患者冠状动脉病变程度密切相关,且联合各参数预测冠心病患者短期病死价值较高。

百令胶囊治疗早期腹膜透析患者的疗效分析

目的:研究百令胶囊治疗早期腹膜透析(EPD)患者的疗效。方法:选取2019年1月—2020年12月就诊于宜昌市中心人民医院的100例EPD患者,采用随机数字表法将其分成两组,对照组患者接受EPD治疗(n=50),观察组患者行EPD治疗的同时加服百令胶囊(n=50)。对比研究两组患者治疗三个月后的肾功能、营养状况、微炎症因子及氧化应激指标。结果:在改善肾功能方面,观察组患者残余肾功能(RRF)、24 h尿量及24 h超滤量均显著高于对照组(均P<0.05);在营养状态方面,观察组患者血清白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TRF)及血红蛋白(Hb)明显高于对照组(均P<0.05),且观察组患者的改进主观全面营养评定量表(MQSGA)明显降低(10.02±1.05分vs 12.54±2.20分,P<0.05);在微炎症指标方面,观察组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)水平均明显低于对照组(均P<0.05);在氧化应激方面,观察组患者血清中丙二醛(MDA)、同型半胱氨酸(Hcy)含量较对照组均显著降低,超氧化物歧化酶(SOD)活力明显高于对照组(均P<0.05);两组患者不良反应无明显差异(P>0.05)。结论:百令胶囊可有效缓解EPD患者氧化应激反应、减轻微炎症状态,改善营养不良,提高患者的肾功能。

灭活植物乳杆菌对仔猪生长性能、血液生化指标及腹泻率的影响

试验主要研究灭活植物乳杆菌对仔猪生长性能、血液生化指标及腹泻率的影响。选用45头28日龄的健康杜×长×大三元杂交断奶仔猪,对照组饲喂基础饲粮,试验Ⅰ组在基础饲粮中添加0.3 g/kg天蚕素抗菌肽,试验Ⅱ组在基础饲粮中添加0.3 g/kg灭活植物乳杆菌。结果表明,试验Ⅰ组与对照组相比平均日增重(ADG)提高了15.56%(P<0.05),腹泻率降低了7.3%(P>0.05);试验Ⅱ组与对照组相比ADG提高了26.67%(P<0.05),料重比(F/G)降低了13.73%(P<0.05),腹泻率降低了56.92%(P<0.05)。试验Ⅰ组与对照组相比大肠杆菌数量降低了37.25%(P<0.05),沙门氏菌的数量降低了75.07%(P<0.05);试验Ⅱ组与对照组相比大肠杆菌数量降低了40.43%(P<0.05),沙门氏菌的数量降低了90.03%(P<0.05),乳酸菌数量提高了74.59%(P<0.05)。与对照组相比,试验Ⅰ组和试验Ⅱ组免疫球蛋白G含量均显著提高(P<0.05),分别提高了34.35%和60.31%;与对照组相比,试验Ⅰ组和试验Ⅱ组的血样中免疫球蛋白A、免疫球蛋白M、总蛋白、白蛋白含量都略有所提高的趋势,但差异不显著(P>0.05);与对照组相比,试验Ⅱ组与对照组相比血样中葡萄糖含量提高了15.70%(P<0.05),尿素氮含量降低了42.70%(P<0.05)。由此可见,在基础日粮中添加灭活植物乳杆菌,对于仔猪具有良好的饲喂效果,可改善仔猪生长性能,降低仔猪腹泻率,改善仔猪健康。

基于VSURF-CA的小麦条锈病高光谱病情指数估测模型

【目的】条锈病对小麦生长和产量造成严重威胁,为确保有效防控,精准监测尤为关键。利用遥感技术构建小麦条锈病估测模型,能快速、准确地估测病情指数(DI),为精准防控提供技术支持。【方法】利用ASD光谱仪获取小麦不同生育期(抽穗期、灌浆期和成熟期)高光谱数据,采用随机森林变量选择(VSURF)方法结合相关性分析(CA)对原始光谱(OR)和一阶微分光谱(FD)进行特征波段筛选。使用随机森林(RF)对比不同数据集的特征波段建模结果,确定模型效果最佳的特征集。随后借助偏最小二乘回归(PLSR)、极致梯度提升(XGBoost)以及反向传播神经网络(BPNN),对比特征集在不同算法中的建模效果。通过对比建模效果,确定针对全生育期小麦条锈病病情指数的最佳估测模型。为了验证特征集在不同生育期中的效果,利用特征集在3个生育期重新构建模型,并对比模型效果。【结果】对不同数据集进行特征筛选,并使用RF构建条锈病DI估测模型,通过比较模型效果,确定VSURF-CA-FD特征集(绿光范围的537 nm以及近红外范围的821和846nm)在RF模型中的估测效果最好。采用RF算法构建的模型表现出优异的精度,R^(2)为0.89,RMSE为12.34。这些特征波段在其他算法构建的模型中也展现出良好的精度:XGBoost模型的R^(2)为0.87,RMSE为13.15;BPNN模型的R^(2)为0.84,RMSE为15.19;PLSR模型的R^(2)为0.69,RMSE为20.92。使用不同生育期的冠层微分高光谱数据进行验证,利用VSURF-CA-FD特征集构建RF模型,对比模型发现在小麦生长的早期(抽穗期)R^(2)为0.54,RMSE为1.29,NRMSE为0.21,能满足估测病害的要求;小麦生长的中期(灌浆期),模型的R^(2)表现较好,R^(2)为0.66,RMSE为12.24,NRMSE为0.21;小麦生长晚期(成熟期),模型效果好于前两个时期,R^(2)为0.75,RMSE为10.77,NRMSE为0.15。【结论】使用VSURF-CA方法筛选出的特征波段,能构建出对小麦条锈病病情指数具有出色估测效果的RF模型。研究结果可为预测早期和中期条锈病病情指数提供有价值的思路和方法。

全身免疫炎症指数在慢性肾脏病患者中的研究进展

慢性肾脏病(chronic kidney disease,CKD)是一种全球性的健康问题,其发病机制错综复杂,持续的低度炎症状态是其本质特征。近年来,全身免疫炎症指数(systemic immune inflammation index,SII)作为评估炎症状态的新工具能更好的反映患者全身炎症水平,受到了广泛关注,它的计算公式为血小板计数×中性粒细胞计数/淋巴细胞计数,因为容易获取、价格低廉、易于计算等优势,成为一个“热点问题”被广泛应用于临床。本文旨在综述SII在CKD患者中的研究进展,探讨其与CKD发生、发展的关系,以及该指数在疾病监测和预后评估中的应用价值,以期为后续相关研究提供有价值的参考。

基线全身炎症反应指数对腹膜透析相关性腹膜炎发生和预后的预测价值

目的 探讨基线全身炎症反应指数(systemic inflammatory response index,SIRI)对腹膜透析(peritoneal dialysis,PD)患者腹膜透析相关性腹膜炎(peritoneal dialysis-related peritonitis,PDAP)发生和预后的预测价值。方法 回顾性分析2014年1月—2020年12月于安徽医科大学第二附属医院行PD置管的140例患者为研究对象,根据是否发生PDAP分为腹膜炎组和非腹膜炎组,比较2组患者一般临床资料及实验室指标。采用二分类Logistic回归分析PDAP发生的危险因素,采用受试者工作特征(ROC)曲线评估基线SIRI对PDAP发生的预测价值。根据腹膜炎组的预后情况将其进一步分为治疗成功组与治疗失败组,分析腹膜炎治疗失败的危险因素。结果 腹膜炎组的SIRI(Z=-4.347,P<0.001)、白细胞计数(Z=-3.590,P<0.001)、血磷(Z=-5.499,P<0.001)、血清碱性磷酸酶(Z=-2.452,P=0.014)、总胆固醇(Z=-2.195,P=0.028)水平高于非腹膜炎组,差异有统计学意义。多因素Logistic回归分析显示:基线高SIRI(OR=2.084,95%CI:1.054~4.121,P=0.035)、高血磷(OR=11.826,95%CI:4.204~33.262,P<0.001)及高血清碱性磷酸酶(OR=1.010,95%CI:1.002~1.019,P=0.022)是PDAP发生的危险因素。ROC曲线结果显示SIRI的曲线下面积为0.720(95%CI:0.633~0.808,P<0.001),灵敏度和特异度分别为69.2%和67.0%。高基线SIRI水平(OR=0.446,96%CI:0.208~0.959,P=0.039)是PDAP治疗失败的危险因素。结论 基线全身炎症反应指数与维持性腹膜透析患者发生腹膜透析相关性腹膜炎发生风险相关,对腹膜透析相关性腹膜炎的发生和预后有较好的预测价值。

高甘油三酯葡萄糖乘积指数与腹膜透析患者病死率增加相关的队列研究

目的 探讨高甘油三酯葡萄糖乘积(TyG)指数与腹膜透析(PD)患者病死率增加是否相关。方法 本研究为单中心、回顾性队列研究。自2007年1月1日至2018年12月31日止,共有519例PD患者被纳入研究。采用了Kaplan-Meier方法和Cox回归模型,对TyG指数水平与PD患者全因死亡率和CVD死亡率之间的相关性进行分析。结果 本研究中位随访时间为35.4(8,101)月,有104例(20.0%)PD患者在研究结束时死亡,其中55例(52.9%)死于心血管疾病(CVD)。基线时中位血清TyG指数为8.44(6.48,11.94)。在Cox回归分析中,对患者的性别、年龄、BMI、有无CVD、高血压等因素进行调整,发现高TyG指数组全因死亡的风险显著升高(HR=2.22,95%CI:1.43~3.44,P <0.001),同时CVD死亡风险也有所上升(HR=2.50,95%CI:1.34~4.65,P=0.004)。此外,对于高时间平均的TyG指数(TA-TyG指数)而言,它同样与全因死亡和CVD死亡风险呈现出了相似的关系(分别为HR=1.90,95%CI:1.25~2.90,P=0.003和HR=2.05,95%CI:1.14~3.70,P=0.017)。结论 高TyG指数的PD患者出现全因死亡和CVD死亡的风险较高。

汉江生态经济带土地利用格局的地形梯度效应特征

[目的]探究汉江生态经济带土地利用的地形梯度效应,为区域土地利用格局的调整和优化提供科学借鉴。[方法]基于1990—2022年土地利用和DEM数据,选取高程、坡度、地形起伏度和地形位4个地形指标,借助分布指数、信息图谱等分析方法,探讨了汉江生态经济带土地利用格局的地形梯度效应。[结果](1)汉江生态经济带土地利用结构以林地(面积占比在54.59%以上)和耕地(35.20%以上)为主,呈现“东耕西林”空间格局。1990—2022年林地、建设用地和水域面积有所增加,耕地和草地面积减少明显。(2)随各地形梯度等级增加,耕地、水域和建设用地的面积和分布指数逐渐减少,草地均呈先增后减趋势,林地分别呈先增后减、持续增加态势。(3)研究时期内,耕地、林地的分布优势分别在各地形因子的中低(Ⅰ—Ⅲ)和中高(Ⅲ—Ⅴ)等级上有所扩大,其分布指数增幅介于0.041~0.117,0.005~0.076;除Ⅰ级梯度上的分布指数一致呈减少外,其他梯度上草地和水域的分布优势以扩大为主,其指数增加最明显的分别为地形起伏度Ⅲ级(0.317)、地形位Ⅲ级(0.299);建设用地分布优势在Ⅰ级梯度上皆呈扩大态势,其指数增加了0.056~0.689。(4)研究区土地利用信息图谱以稳定型(81.39%)为主,其他图谱类型受地形梯度影响存在显著差异。[结论]受自然、政策等因素的共同影响,汉江生态经济带土地利用格局具有显著的地形梯度效应,分布优势在地形梯度上的变化相对复杂。因此,未来国土空间开发需秉承因地制宜原则,促进土地资源的可持续发展。

腰方肌阻滞麻醉对女性尿毒症患者腹膜透析置管术中血气指标及术后恢复的影响

目的观察腰方肌阻滞(QLB)麻醉对女性尿毒症患者腹膜透析置管术中血气指标及术后恢复的影响.方法选取2021年1月至2023年12月廊坊市人民医院收治的70例行腹膜透析置管术女性尿毒症患者作为研究对象.按随机数字表法将患者分为对照组和研究组,每组35例.对照组给予常规局部浸润麻醉方案,研究组采用QLB麻醉方案.观察两组患者不同间点平均动脉压(MAP)、心率(HR)、血气指标[脉搏血氧饱和度(SpO_(2))、动脉血二氧化碳分压(PaCO_(2))]、数字评分量表(NRS)评分、术前和术后24h疼痛因子[5-羟色胺(5-HT)、P物质(SP)、去甲肾上腺素(NE)]水平的变化、术后恢复指标(首次下床时间、首次排气时间、住院时间)及不良反应发生情况.结果两组入室时MAP、HR、血气指标及NRS评分比较差异均无统计学意义.研究组切皮时、腹直肌分离时、置管时、缝合时、出室时MAP、HR、PaCO_(2)均明显低于对照组,SpO_(2)均明显高于对照组,切皮时、腹直肌分离时、置管时、缝合时NRS评分均明显低于对照组(均P<0.05).两组术前5-HT、SP、NE水平比较差异无统计学意义,术后24h均较术前明显升高,但研究组5-HT、SP、NE水平均低于对照组(均P<0.05).研究组首次下床时间、首次排气时间、住院时间均较对照组明显缩短,不良反应发生率也明显低于对照组(均P<0.05).结论QLB能减少女性尿毒症患者腹膜透析置管术中MAP、HR及血气指标波动,缓解患者术后疼痛,降低疼痛因子水平,并减少不良反应发生,对促进患者术后恢复有较好的效果.

基层医院终末期肾病患者不同透析方式的临床疗效研究

目的 探讨基层医院终末期肾病(End-stage Renal Disease,ESRD)患者应用不同透析方式的治疗效果。方法 目的选取织金县人民医院于2023年1—12月收治的137例ESRD患者为研究对象,按不同透析方式分成A组(n=39)、B组(n=45)、C组(n=53)。A组每周透析两次,4.5 h/次;B组每周透析两次,4 h/次;C组每周透析3次,4 h/次。对比3组营养指标、炎症指标及并发症发生情况。结果 治疗后,3组营养指标水平较治疗前提高,A组营养指标水平高于B组,差异有统计学意义(P均<0.05),而A组与C组比较,差异无统计学意义(P>0.05)。治疗后,3组炎症指标水平均低于治疗前,A组项炎症指标水平优于B组,差异有统计学意义(P均<0.05),而A组与C组比较,差异无统计学意义(P>0.05)。A组并发症总发生率(10.26%)低于B组(28.89%)、C组(30.19%),差异有统计学意义(χ^(2)=5.241,P<0.05)。结论 对于基层医院ESRD患者,选择每周透析两次,4.5 h/次的透析方式,总体效果优于每周2次、4 h/次的透析患者,而与每周3次,4 h/次的透析患者的治疗效果相当,但每周透析两次,4.5 h/次的透析方式可降低透析并发症的发生率。