Clinical Application of Monitoring Glomerular Filtration Rate and Effective Renal Plasma Flow

Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured by SPECT in 172 patients (192 times) with renal impairment due to various diseases and also in 18 normal controls. The results suggest that GFR and ERPF are sensitive and efficient renal function indicators in monitoring the change of the disease and assessing therapeutic effect. However, they should be checked carefully because of many factors affect the resutls of the measurement.

Effect of medical ozone therapy on renal blood flow and renal function of patients with chronic severe hepatitis

Background Medical ozone therapy system was reported to have certain effects on the treatment of severe hepatitis, but its mechanism is not very clear. One of the causes of death of severe hepatitis is complication of renal damage or hepatorenal syndrome. The present study aimed to observe effects of medical ozone therapy system on plasma renin activity （PRA）, angiotensin II （All）, aldosterone （ALD）, renal blood flow and renal function of patients with chronic severe hepatitis and explore mechanisms of medical ozone therapy in the treatment of severe hepatitis. Methods Eighty-five cases with chronic severe hepatitis were randomly divided into ozone therapy group （43 cases） and control group （42 cases）. The patients in the ozone therapy group were treated with basic treatments plus ozone therapy system. Basic autohemotherapy was used. One hundred milliliter venous blood was drawn from each patient, and was mixed with 100 ml （35 pg/ml） medical ozone and then was returned the blood to the patient intravenously, once every other day for 20 days. Only the basic treatments were given to the control group. PRA, All, ALD, renal blood flow and damage to renal function of the two groups before treatment and 20 days after treatment were compared. Survival rates were also compared. Results Twenty days after the treatment, in ozone therapy group, PRA was （1.31±0.12） ng.m^-1.h^1, All （111.25±17.35） pg/ml, ALD （251.31±22.60） pg/ml, which decreased significantly compared with those before treatment （PRA （2.23±0.13） ng.ml^-1.h^-1, All （155.18±19.13） pg/ml, ALD （405.31±29.88） pg/ml, t=4.67-14.23, P 〈0.01 ）, also lower than those of control group 20 days after the treatment （PRA （2.02±0.11） ng.ml^-1.h^-1, All （162.21±15.32） pg/ml, ALD （401.20±35.02） pg/ml, t=4.97-15.61, P 〈0.01）; renal blood flow was （175.15±28.20） ml/min, which increased compared with that before the treatment （（125.68±21.25） ml/min） and was higher than that of control group 20 days after the treatment （（128.59±23.15） ml/min, t=4.78, 4.61, P 〈0.01）. Renal damage occurred in 2 cases （5%） in ozone therapy group, less than that in control group （9 cases, 21%） （X^2=5.295, P 〈0.05）. Thirty-three cases （77%） in ozone therapy group vs. 16 cases （38%） in control group survived （X^2=12.993, P 〈0.01 ）. Conclusions Basic treatment plus medical ozone therapy for patients with chronic severe hepatitis could decrease PRA, All and ALD levels significantly increase renal blood flow, prevent renal damage to certain extent and improve survival rate of the patients.

Effects of Norepinephrine on Renal Cortical and Medullary Blood Flow in Atherosclerotic Rabbits

Objective The aim of this study was to explore the effect of norepinephrine(NE)on renal cortical and medullary blood flow in atherosclerotic rabbits without renal artery stenosis.Methods Atherosclerosis was induced in 21 New Zealand white rabbits by feeding them a cholesterol-rich diet for 16 weeks.Thirteen healthy New Zealand white rabbits were randomly selected as controls.After atherosclerosis induction,standard ultrasonography was performed to confirm that there was no plaque or accelerated flow at the origin of the renal artery.Contrast-enhanced ultrasound(CEUS)was performed at baseline and during intravenous injection of NE.The degree of contrast enhancement of renal cortex and medulla after the injection of contrast agents was quantified by calculating the enhanced intensity.Results The serum nitric oxide(NO)level in atherosclerotic rabbits was higher than that in healthy rabbits(299.6±152 vs.136.5±49.5,P<0.001).The infusion of NE induced a significant increase in the systolic blood pressure(112±14 mmHg vs.84±9 mmHg,P=0.016)and a significant decrease in the enhanced intensity in renal cortex(17.78±2.07 dB vs.21.19±2.03 dB,P<0.001)and renal medulla(14.87±1.82 dB vs.17.14±1.89 dB,P<0.001)during CEUS.However,the enhanced intensity in the cortex and medulla of healthy rabbits after NE infusion showed no significant difference from that at baseline.Conclusion NE may reduce renal cortical and medullary blood flow in atherosclerotic rabbits without renal artery stenosis,partly by reducing the serum NO level.

Correlation of effective hepatic blood flow with liver pathology in patients with hepatitis B virus

Background and aims:Effective hepatic blood flow(EHBF)decreases with liver disease progression,and identifying liver pathology is critical for patients with liver disease.This study was designed to elucidate the correlation between EHBF and liver pathology and explore the potential of EHBF for predicting the degree of liver pathology.Methods:In this study,207 patients with hepatitis B virus(HBV)who underwent liver biopsy and indocyanine green(ICG)clearance tests were enrolled.EHBF was measured using the ICG clearance test,and liver tissue was histologically analyzed to determine the pathological stage according to the Scheuer scoring system.Demographic data,biochemical indexes,and FibroScan data were collected for statistical analysis.Results:EHBF levels decreased as the liver histological stages of inflammation and fibrosis increased(P<0.01).EHBF was significantly negatively associated with the levels of alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,alkaline phosphatase,aspartate aminotransferase-to-platelet ratio index,fibrosis index based on the four factors,and liver stiffness measurement(P<0.05).The EHBF levels of patients without liver inflammation(G0)were significantly higher than those of patients with liver inflammation(G1e4)(P<0.001).The area under the receiver operating characteristic curve(AUROC)value for discriminating patients without liver inflammation was 0.827,and the optimal cutoff value was 0.936 L/min.The EHBF levels of patients with severe liver inflammation(G4)were significantly lower than those of patients with G0e3 liver inflammation(P<0.001).The AUROC value for discriminating patients with severe liver inflammation was 0.792,and the optimal cutoff value was 0.552 L/min.The EHBF levels of patients without liver fibrosis(S0)were significantly higher than those of patients with liver fibrosis(S1e4)(P<0.001).The AUROC value for discriminating patients without liver fibrosis was 0.633,and the optimal cutoff value was 1.173 L/min.The EHBF levels of patients with liver cirrhosis(S4)were significantly lower than those of patients with S0e3 liver fibrosis(P<0.001).The AUROC value for discriminating patients with liver cirrhosis(S4)was 0.630,and the optimal cutoff value was 0.562 L/min.Conclusions:EHBF levels and liver pathology are significantly correlated.EHBF could effectively reflect liver inflammation and fibrosis in patients infected with HBV,especially for patients without liver inflammation or liver fibrosis.

Electroosmotic oscillatory flow of micropolar fluid in microchannels:application to dynamics of blood flow in microfluidic devices

The electroosmotic flow of a micropolar fluid in a microchannel bounded by two parallel porous plates undergoing periodic vibration is studied. The equations for conservation of linear and angular momentums and Gauss＇s law of charge distribution are solved within the framework of the Debye-Hückel approximation. The fluid velocity and microrotation are assumed to depend linearly on the Reynolds number. The study shows that the amplitude of microrotation is highly sensitive to the changes in the magnitude of the suction velocity and the width of the microchannel. An increase in the micropolar parameter gives rise to a decrease in the amplitude of microrotation. Numerical estimates reveal that the microrotation of the suspended microelements in blood also plays an important role in controlling the electro-osmotically actuated flow dynamics in microbio-fluidic devices.

Assessment of Biological Reaction to Whole Body Vibration Training by Evaluating Changes in Salivary Components and Cutaneous Blood Flow

Aim: Whole body vibration (WBV) is thought to improve blood flow and autonomic balance and thereby induce a relaxation effect, which suggests its use for stress management. However, the relaxation effect of WBV training has not been objectively evaluated thus far. The purpose of this study was to determine the biological response to WBV training by measuring peripheral blood flow and salivary components using non-invasive techniques. Methods: Participants included 10 healthy volunteers (7 men, 3 women;mean age 33.8 ± 2.3) who provided oral consent and served as their own control. Each participant performed 15 types of stretching exercises for 10.5 min on the Power Plate? and cutaneous blood flow and salivary components were measured before and after the exercise. One week later, all participants performed the same exercise regimen for 10.5 min on a non-vibratory plate, and blood flow measurement and salivary tests were performed in a similar manner. Cutaneous blood flow was measured in the 4th digit for 1 min using the laser speckle flowgraphy. Saliva samples were evaluated for cortisol levels and α-amylase activity. To determine the effects of stretching exercises on the Power Plate? vs a non-vibratory plate, the differences in pre- and post-exercise peripheral blood flow, salivary cortisol levels, and salivary α-amylase activity were statistically evaluated by the t-test. Results: Mean blood flow before and after the exercise on the Power Plate? was 122.0 ± 54.2 and 156.7 ± 51.2, respectively;on a non-vibratory plate, blood flow was 136.6 ± 47.9 and 146.3 ± 38.3, respectively. The differences in pre-exercise and post-exercise values of the two training methods were not significant (p = 0.215). Mean cortisol levels before and after the exercise on the Power Plate? were 266.6 ± 125 and 204.9 ± 61.6, respectively;on a non-vibratory plate, the levels were 439.0 ± 121.7 and 425.8 ± 118.8, respectively. The differences in pre-exercise and post-exercise values of the two training methods were not significant (p = 0.384). Mean α-amylase activity before and after the exercise on the Power Plate? was 3.74 ± 2.89 and 5.40 ± 3.76, respectively;on a non-vibratory plate, the activity was 3.95 ± 2.23 and 3.28 ± 1.73. The differences in pre-exercise and post-exercise values of the two training methods were not significant (p = 0.115). Conclusion: Our results showed that a brief WBV training increased peripheral blood flow, reduced cortisol levels, and increased α-amylase activity. WBV appears to regulate autonomic activity, in particular, suppress sympathetic activity and improve bodily functions. Thus WBV exercise may be conductive for stress management, but further investigation is warranted to determine the optimal duration of WBV training for stress relief.

Acute Effects of Tolvaptan on Renal Hemodynamics in Autosomal Dominant Polycystic Kidney Disease —A Randomized, Cross-Over, Double Blind, Placebo-Controlled Study of Renal Plasma Flow and Glomerular Filtration Rate

Background: Previous studies have shown that reduced renal plasma flow (RPF) may play a role in progression of renal disease in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan, a vasopressin 2 antagonist, reduces growth of total kidney volume and slows the decrease in estimated glomerular filtration rate (eGFR) in ADPKD. The purpose of this randomized, cross-over, double-blind, placebo-controlled study was to investigate if acute tolvaptan treatment increases RPF in ADPKD patients. Methods: Eighteen ADPKD patients (chronic kidney disease stages I-III) were investigated twice (min. 10 days apart) after acute treatment with either tolvaptan 60 mg or placebo. Two hours after treatment RPF and GFR were estimated by Technetium-99m diethylenetriamine penta-acetic acid (99-mTc-DTPA) renography. During the examination day, central and brachial blood pressures (BP) were measured using Mobil-O-Graph? PWA. We also measured plasma concentrations of vasopressin (p-AVP), renin (PRC), angiotensin II (p-AngII) and aldosterone (p-Aldo), urine excretion of aquaporin 2 (u-AQP2), urine output (OU), urine osmolality (u-Osm) and fractional excretion of sodium (FENa). Results: 99-mTc-DTPA renography showed a similar RPF (673 ± 262 ml/min after tolvaptan vs. 650 ± 209 ml/min after placebo, p = 0.571) and GFR (78 ± 26 ml/min after tolvaptan vs. 79 ± 21 ml/min after placebo p = 0.774) after tolvaptan and placebo treatment. P-AVP and UO increased and u-Osm decreased after tolvaptan and remained unchanged during placebo. Systolic BP tended to decrease during renography during tolvaptan. Very small or insignificant changes were seen in PRC, p-AngII and p-Aldo. Conclusions: Acute tolvaptan treatment did not change renal hemodynamics in ADPKD.

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

肾小管及肾小球标志物在2型糖尿病患者不同肾损伤阶段诊断价值的研究

目的探讨肾小管及肾小球相关标志物在2型糖尿病(type 2 diabetes mellitus,T2DM)患者不同肾损伤阶段的诊断价值。方法选取于2018年4月1日至2019年10月31日入住首都医科大学附属北京同仁医院内分泌科的T2DM患者272例,完善临床生化指标及尿蛋白四项:尿微量白蛋白/肌酐(urinary albumin to creatinine ratio,ACR)、α1-微球蛋白/肌酐(urinary α1-microglobulin to creatinine ratio,UA1CR)、免疫球蛋白G/肌酐(urinary immunoglobulin G to creatinine ratio,UIGG)、转铁蛋白/肌酐(urinary transferrin to creatinine ratio,UTRF);进行眼底照相、核医学99mTc-EC检测肾有效血浆流量(effective renal plasma flow,ERPF)和99mTc-DTPA检测肾小球滤过率(glomerular filtration rate,GFR)。根据ACR和眼底检查结果分为4组:正常蛋白尿无糖尿病视网膜病变(diabetic retinopathy,DR)132例,即对照组(ACR≤30 mg/g);正常蛋白尿合并DR 32例,为糖尿病肾病(diabetic kidney disease,DKD)前期组;微量蛋白尿组78例(30<ACR≤300 mg/g)和大量蛋白尿组30例(ACR>300 mg/g)。比较四组间尿蛋白四项和ERPF、GFR的水平,通过受试者工作特征(receiver operating characteristic,ROC)曲线评价上述各指标在不同肾损伤阶段的诊断价值。结果尿蛋白四项和ERPF、GFR的水平在不同组间差异有统计学意义(P<0.05)。在尿蛋白正常组中,DR组中肾小管功能标志物UA1CR较对照组明显升高(P<0.01);肾小球功能标志物ACR、UTRF和GFR在两组间差异无统计学意义(P>0.05),DR组UIGG较对照组升高(P<0.01)。在微量蛋白尿组和大量蛋白尿组,尿蛋白四项随肾损伤程度增加而增加,而ERPF和GFR随肾损伤程度增加而降低。ROC曲线分析显示,在尿蛋白排出正常的T2DM患者中合并DR组中肾小管功能标志物UA1CR和ERPF的曲线下面积(area under the curve,AUC)分别为68.2%(P<0.01)和60.5%(P<0.05),而肾小球功能标志物ACR和GFR的AUC均小于60%,差异无统计学意义(P>0.05)。尿蛋白四项及GFR在微量和大量蛋白尿组的AUC均大于60%(P<0.05),ERPF在大量蛋白尿组AUC为67.2%(P<0.05)。结论T2DM极早期微血管改变即ACR正常仅有DR时,肾小管标志物UA1CR先于肾小球标志物ACR和GFR发生变化。肾损伤早期,肾小管标志物诊断效能优于肾小球;肾损伤后期,肾小球标志物诊断效能优于肾小管。提示DKD肾小管功能的改变可能早于肾小球。

肝癌TACE前后癌灶及癌旁CT灌注成像血流定量变化及指导疗效评估的价值

目的探讨肝癌肝动脉化疗栓塞术(TACE)前后癌灶及癌旁计算机断层扫描灌注成像(CTPI)血流定量变化及指导疗效评估的价值。方法回顾性选取2022年8月至2024年3月在本院行TACE治疗的肝癌患者63例,均分别于TACE术前1~3d及术后7d进行CTPI检查,对比肿瘤组织与癌旁1cm组织手术前后肝血流量(BF)、肝血容量(BV)、平均通过时间(MTT)、肝动脉灌注指数(HPI)、肝动脉灌注量(HAP)、门静脉灌注量(PVP)变化情况。根据术后7d肝癌患者疗效情况分为有效组和无效组,对比两组手术前后上述血流灌注参数变化,绘制受试者工作曲线(ROC)分析CTPI血流参数对肝癌患者疗效的评估价值。结果术前、术后肿瘤组织BF、BV、HPI、HAP均高于癌旁1cm组织,PVP、MTT均低于癌旁1cm组织(P<0.05);术后,肿瘤组织BF、BV、HPI、HAP水平较术前均降低(P<0.05),PVP、MTT均升高但与术前比较无差异(P>0.05);术后癌旁1cm组织上述参数水平较术前无变化(P>0.05)。TACE后7d肝癌患者有效率为65.07%(41/63),无效34.92%(22/63)。有效组手术前后△BF、△BV、△HPI、△HAP、△PVP、△MTT与无效组比较差异均有统计学意义(P<0.05)。ROC结果显示,△BF、△BV、△HPI、△HAP、△PVP、△MTT及其联合检测评估肝癌患者TACE疗效的曲线下面积(AUC)分别为0.703、0.751、0.737、0.746、0.770、0.732、0.928(P均<0.05)。结论TACE后肝癌患者肿瘤组织的BF、BV、HPI、HAP均下降,PVP、MTT均升高,但癌旁组织上述指标无变化,临床可通过CTPI血流定量变化对肝癌患者早期疗效予以准确评估。

金水宝联合胰高血糖素样肽-1受体激动剂治疗对糖尿病肾病患者肾功能、肾脏血流及血管内皮功能的影响

目的 探究金水宝联合胰高血糖素样肽-1受体激动剂(glucagon-likepeptide-1,LP-1)治疗对糖尿病肾病患者肾功能、肾脏血流及血管内皮功能的影响。方法 采用随机数字表法将2020年3月—2022年8月收治的96例糖尿病肾病患者分为观察组(n=48)与对照组(n=48)。对照组采用GLP-1受体激动剂,观察组在此基础上联合使用金水宝治疗。观察两组患者治疗前后中医证候积分、肾功能、肾脏血、氧化应激指标及血管内皮功能水平。观察两组患者临床疗效和不良反应发生率。结果 两组患者治疗前尿频、精神萎靡、口渴喜饮和易饥多食中医证候积分差异无统计学意义(P>0.05)。治疗后,观察组尿频、精神萎靡、口渴喜饮和易饥多食中医证候积分显著低于对照组(P<0.05)。两组患者治疗前24 h尿蛋白定量、同型半胱氨酸(homocysteine, Hcy)、尿白蛋白排泄率(urinary albumin excretion, UAER)、血清肌酐(serum creatinine, Scr)水平差异无统计学意义(P>0.05)。治疗后,观察组24 h尿蛋白定量、Hcy、UAER和Scr水平显著低于对照组(P<0.05)。两组患者治疗前段间动脉血流灌注指数(Perfusion Index, PI)、段间动脉胰岛素(Regular Insulin, RI)和叶间动脉RI水平差异无统计学意义(P>0.05)。治疗后,观察组段间动脉PI、段间动脉RI和叶间动脉RI水平显著低于对照组(P<0.05)。两组患者治疗前丙二醛(malondialdehyde;malonic dialdehyde, MDA)、脂质过氧化氢(lipid peroxidation, LPO)、谷胱甘肽过氧化物酶(glutathione Peroxidase, GPX)、总抗氧化能力(total antioxidative capability, T-AOC)水平差异无统计学意义(P>0.05)。治疗后,观察组MDA、LPO水平显著低于对照组,且GPX和T-AOC水平显著高于对照组(P<0.05)。观察组总有效率为89.58%(43/48)显著高于对照组72.92%(35/48)(χ^(2)=4.376,P=0.036)。观察组总不良反应发生率为8.32%(4/48),略低于对照组的10.42%(5/48),但差异无统计学意义(χ^(2)=0.123,P=0.726)。结论 金水宝联合GLP-1受体激动剂能有效提高临床疗效,改善肾功能和肾脏血流,促进血管内皮功能恢复。

维持性血液透析患者脑血流灌注改变与脑网络有效连接变化研究

目的采用脑血流灌注(CBF)和格兰杰因果分析(GCA)方法研究终末期肾病(ESRD)维持性血液透析(MHD)患者脑血流灌注改变及与全脑连接效应特点,揭示这些脑血流灌注变化与MHD患者认知功能障碍之间的潜在联系。方法本研究纳入29例MHD患者和29例对照组(HC组)。所有受试者行功能磁共振检查,获得的两组间血流灌注的差异脑区作为种子点,并基于格兰杰因果分析观察静息态功能磁共振成像所示种子点与全脑效应连接异常脑区,并将MHD患者异常脑区与临床数据资料和神经心理学测试结果进行相关分析。结果MHD组双侧海马、右侧脑岛的CBF值较HC组减低(P<0.05,FDR校正)。MHD组右侧脑岛CBF值与肌酐(Cr)呈负相关(P<0.05)。MHD组右侧海马到右侧三角部额下回连接效应增加。MHD组左侧海马到右侧距状裂周围皮层、右侧豆状壳核、右侧前扣带和旁扣带脑回、右侧脑岛连接效应增加,左侧海马到左侧丘脑连接效应减低(P<0.05,FDR校正)。MHD组右侧海马至右侧三角部额下回连接效应与血尿素氮(BUN)呈正相关(P<0.05),MHD组左侧海马至右侧前扣带和旁扣带脑回连接效应与命名评分呈正相关(P<0.05),左侧海马至右侧豆状壳核连接效应与抽象评分、透析时间呈负相关,左侧海马至左侧丘脑连接效应与命名评分呈负相关(P<0.05)。结论终末期肾病维持性血液透析患者存在脑血流灌注异常及双侧海马与全脑效应连接异常,并参与认知功能调节。

针药并用对缺血性脑卒中患者血流与神经损伤的影响

目的研究针灸和药物治疗对急性缺血性脑卒中患者大脑中动脉血流量的即刻效应及神经损害程度的影响。方法选取福建医科大学附属泉州第一医院2021年6月至2023年6月收治入院的100例急性缺血性脑卒中患者,采用随机数字表法分为针刺治疗组(35例)、非穴针刺组(32例)、常规药物治疗组(33例)。所有缺血性脑卒中患者入院后均予西医常规治疗,在此基础上,针刺治疗组与非穴针刺组均在入组的第1天未使用药物改善循环的情况下进行首次针灸治疗。三组患者连续治疗14d,观察患者治疗前后的大脑血流动力学指标:大脑中动脉的收缩期峰速(systolic peak velocity,Vs)、舒张期峰速(diastolic peak velocity,Vd)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)及平均血流速度(mean blood flow velocity,MFV);检测患者治疗前后的脑神经损伤标志物水平,并通过美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评估患者的神经功能损伤程度。结果与治疗前比较,治疗后常规药物治疗组和非穴针刺组患者的Vs、MFV水平提高(P<0.05),PI较治疗前显降低(P<0.05);针刺治疗组患者的Vs、Vd、MFV水平均提高(P<0.05);PI、RI较治疗前降低(P<0.05)。三组治疗后比较,针刺治疗组患者的Vs、Vd、PI、RI、MFV改善情况优于非穴针刺组与常规药物治疗组(P<0.05)。针刺治疗组患者首次针刺后的Vs、Vd、PI、RI、MFV均有改善,其改善程度优于非穴针刺组(P<0.05)。三组治疗后,患者的血清S-100β蛋白、心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)、神经元特异性烯醇化酶(neuron specific enolase,NSE)水平显著降低(P<0.05),其中针刺治疗组指标低于非穴针刺组和常规药物治疗组(P<0.05)。与非穴针刺组和常规药物治疗组比较,针刺治疗组在治疗2周后、随访30d后,患者的NIHSS评分更低,差异有统计学意义(P<0.05)。结论早期针刺治疗可改善急性缺血性脑卒中患者的大脑中动脉的血流情况,减轻患者神经损伤的程度。

尤瑞克林治疗脑梗死患者的效果及对脑血流、神经损伤的影响

目的:探究尤瑞克林在脑梗死患者中的应用效果及对脑血流、神经损伤的影响。方法:选择2020年1月—2022年1月三明市中西医结合医院收治的80例脑梗死患者作为研究对象,依据随机数表法分为两组,各40例。对照组进行常规脑梗死治疗,观察组则在对照组治疗措施的基础上加用尤瑞克林进行治疗。比较两组的临床总有效率、治疗前后的神经功能缺损程度[改良爱丁堡-斯堪的纳维亚(MESSS)评分]、脑血流指标(大脑前动脉、中动脉及后动脉血流速)及神经损伤相关血液指标[中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)及一氧化氮(NO)]。结果:观察组临床总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组MESSS评分、脑血流指标及神经损伤相关血液指标比较,差异无统计学意义(P>0.05);治疗1周及2周后,观察组MESSS评分优于对照组,差异有统计学意义(P<0.05);治疗1周及2周后,两组的脑血流指标、神经损伤相关血液指标显著低于治疗前,且观察组显著低于对照组,差异有统计学意义(P<0.05)。结论:尤瑞克林在脑梗死患者中的应用效果较好,且可显著改善患者的脑血流及控制神经损伤。

一种基于线性零磁场的动脉血管扫描成像方法仿真

基于磁电耦合效应的血流检测及血管成像是实现心血管疾病早期诊疗的有效方法之一。该文基于磁场与血流耦合电效应,设计一种用于动脉血管扫描成像的组合线圈结构,产生带有零磁场线(FFL)区域的线性梯度磁场;在此结构的基础上,通过控制激励电流驱动FFL实现成像区域双向扫描;结合卷积神经网络(CNN)实现磁电耦合信号与血管信息的非线性映射,进而提出一种基于线性零磁场的动脉血管扫描成像新方法。采用多物理场仿真软件COMSOL对基于线性零磁场的血管扫描成像方法进行建模,求解磁电耦合信号,验证了所提出方法的合理性和有效性。结果表明,线性梯度磁场模式下的磁电耦合信号含有血管位置、半径等信息;CNN重建血管位置误差平均值为1.5694 mm,重建血管半径的方均误差(MSE)和相关系数(CC)平均值分别为0.0548和0.9870。研究结果可用于血管成像装置设计及后续相关临床应用提供研究支撑。

肾衰Ⅱ号方颗粒联合西医一体化方案治疗慢性肾脏病3~4期脾肾气虚证患者临床疗效及对肾脏微循环的影响

目的观察肾衰Ⅱ号方颗粒对原发性肾小球肾炎(PGN)引起的慢性肾脏病(CKD)3~4期脾肾气虚证患者的临床疗效及肾脏微循环(RMC)的影响。方法采用随机、双盲的临床试验设计,将70例CKD 3~4期患者分为治疗组和对照组各35例。对照组予CKD一体化治疗联合安慰剂颗粒,治疗组予CKD一体化治疗联合肾衰Ⅱ号方颗粒。观察2组临床疗效,比较2组治疗前后中医症状总分、肾功能指标、RMC指标。监测2组安全性指标。结果治疗组总有效率为82.86%(29/35),对照组为54.29%(19/35),2组比较差异有统计学意义(P<0.05)。与本组治疗前比较,2组治疗后各项中医症状评分均降低(P<0.05,P<0.01);2组治疗后比较,治疗组5项脾肾气虚证症状评分及总分均低于对照组(P<0.05)。与本组治疗前比较,治疗组治疗后肾皮质、肾髓质血流均值均升高(P<0.05,P<0.01);2组治疗后比较,治疗组肾皮质、肾髓质血流均值均高于对照组(P<0.05,P<0.01)。与本组治疗前比较,治疗组治疗后血清一氧化氮(NO)含量升高(P<0.01),内皮素-1(ET-1)、血管内皮生长因子(VEGF)含量下降(P<0.01);2组治疗后比较,治疗组NO含量高于对照组(P<0.05),ET-1、VEGF含量低于对照组(P<0.01)。与本组治疗前比较,治疗组治疗后血肌酐(SCr)、血尿素氮(BUN)、24 h尿蛋白定量(24 hUP)下降,估算肾小球滤过率(e GFR)上升(P<0.05,P<0.01);2组治疗后比较,治疗组SCr、BUN、24 hUP低于对照组,eGFR高于对照组(P<0.01)。与本组治疗前比较及治疗后组间比较,2组血清尿酸比较差异无统计学意义(P>0.05)。2组安全性指标无异常变化(P>0.05)。结论肾衰Ⅱ号方颗粒联合西医一体化治疗可有效改善CKD 3~4期脾肾气虚证患者临床症状及肾功能相关指标,增加肾血流量、改善RMC障碍,提高临床疗效。

腺苷负荷与ATP负荷评估冠状动脉微血管疾病中的不良反应分析

背景 冠状动脉微血管疾病(CMVD)的诊疗一直是非冠状动脉阻塞性缺血性心脏病的重点。腺苷注射液和ATP注射液是目前测定冠状动脉血流储备(CFR)评估CMVD的临床常用负荷药物,两者有所关联,但具有显著区别。ATP是腺苷的前体,其价格低廉且血管扩张机制与腺苷类似,临床上常代替腺苷,但忽视了其潜在的不良反应。目的 比较腺苷负荷与ATP负荷在评估CMVD过程中的不良反应发生率。方法 选取2019年6月—2020年7月因典型心绞痛就诊于陕西省人民医院心内科行冠状动脉造影术/冠状动脉CT血管造影术(CTA)明确各支冠状动脉残余狭窄直径<50%的患者170例,依据随机数字表法分为腺苷组和ATP组,腺苷组88例,ATP组82例。腺苷组给予腺苷注射液负荷测定CFR,ATP组采用ATP负荷测定CFR,检测过程中记录患者的血压、心率、扫描时间及不良反应发生情况。结果 与腺苷组相比,ATP组患者胸闷[61.0%(50/82)和20.4%(18/88)]、头晕[72.0%(59/82)和31.8%(28/88)]、头痛[68.3%(56/82)和11.4%(10/88)]、胃肠道不适[13.4%(11/82)和4.5%(4/88)]、心悸[69.5%(57/82)和5.7%(5/88)]、气促[40.2%(33/82)和2.3%(2/88)]、大汗[28.0%(23/82)和3.4%(3/88)]、潮热[19.5%(16/82)和2.3%(2/88)]、颜面潮红[13.4%(11/82)和4.5%(4/88)]的发生率均较高(P<0.05);两组患者神经过敏、耳鸣、咽干、颈部不适的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 与ATP负荷相比,腺苷负荷测定CFR的不良反应发生率更低。

Acute renal dysfunction in liver diseases

Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indicator.Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction.Obstructive or post renal dysfunction only rarely complicates liver disease.Hepatorenal syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal histology.Irrespective of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular resistance.Volume expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment.Splanchnic vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in HRS.Continuous renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.

VEGF基因修饰大鼠羊膜间充质干细胞对肾病综合征大鼠血液生化指标的影响

目的:探究血管内皮生长因子(VEGF)基因修饰大鼠羊膜间充质干细胞对肾病综合征大鼠血液生化指标的影响。方法:选取60只雄性大鼠,随机分为4组,各15例,分别为对照组(健康)、模型组(肾病综合征)、治疗1组(羊膜间充质干细胞悬液)、治疗2组(VEGF基因修饰羊膜间充质干细胞悬液)。观察4组肾组织病理形态学及羊膜间充质干细胞存活、分布情况,并比较尿肌酐(SCr)、血尿素(BU)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、24 h尿蛋白定量(24 h UTP)、阻力指数(RI)、舒张期末期流速(EDV)、收缩期峰值流速(PSV)及肾组织VEGF相关表达。结果:对照组大鼠肾组织具有完整清晰结构,模型组大鼠肾组肾小球表现为肿胀,肾小球内存在较多细胞,系膜区明显增宽,系膜细胞及基质中到重度增生;相较于模型组,各治疗组病理改变均较轻,各治疗组病理改变程度均较模型组轻,其中治疗1组病理改变较治疗2组病理改变明显;对照组及模型组大鼠肾组织均未见荧光细胞;治疗1组、治疗2组大鼠肾组织均可见红色荧光的阳性细胞,且仅可见于肾间质及小管内,在肾小球中未见其表达。与治疗1组比较,治疗2组阳性细胞较多;与对照组比较,模型组SCr、BU、24 h UTP、TC、TG、LDL、IL-1β、TNF-α水平均明显升高(P<0.05),治疗1组、治疗2组SCr、BU、24 h UTP、TC、TG、LDL、IL-1β、TNF-α水平均较模型组明显降低,且治疗2组最低(P<0.05);与对照组比较,模型组RI明显升高,PSV、EDV明显下降(P<0.05),治疗1组、治疗2组PSV、EDV均较模型组显著升高,RI水平较模型组显著降低,且治疗2组RI最低,PSV、EDV最高(P<0.05);与对照组比较,模型组肾组织中VEGF蛋白及mRNA表达均明显下降(P<0.05),治疗1组、治疗2组肾组织中VEGF蛋白及mRNA表达均较模型组显著升高,且治疗2组最高(P<0.05)。结论:经VEGF基因修饰的羊膜间充质干细胞移植治疗,可显著改善肾病综合征大鼠血脂水平、微炎症状态、肾功能及肾动脉血流,效果更为显著,可为肾病综合征细胞移植治疗提供有力依据。