中西医结合联合系统护理干预治疗高血压性肾损伤的临床疗效

目的探讨中西医联合系统护理干预治疗高血压性肾损伤的临床疗效。方法选取广西中医药大学第一附属医院仁爱分院2014年1月—2015年1月收治的高血压性肾损伤患者160例,根据入院时间分为对照组和试验组,各80例。对照组患者给予常规西药治疗及护理,试验组患者在对照组基础上给中药治疗,并结合系统护理干预。比较两组患者的临床疗效及治疗前后实验室检查指标[24 h尿蛋白定量、丝氨酸(Ser)、尿素氮(BUN)、三酰甘油(TG)、总胆固醇(TC)、血糖]。结果试验组患者临床疗效优于对照组(P<0.05)。治疗前,两组患者24h尿蛋白定量、Ser、BUN、TG、TC、血糖水平比较,差异无统计学意义(P>0.05);治疗后,试验组患者24 h尿蛋白定量、Ser、BUN、TG、TC、血糖水平低于对照组(P<0.05)。结论中西医结合联合系统护理干预治疗高血压性肾损伤临床疗效确切,可有效改善患者临床症状。

肾脏表面结节定量分级与高血压性肾损伤相关性研究

目的 探索基于CT成像的肾脏表面结节定量分级与高血压性肾损伤的相关性。方法 回顾性纳入458例原发性高血压合并或不合并高血压性肾脏损伤患者,同时采集年龄、性别、高血压分级等临床信息,以及实验室检查和肾脏表面结节定量分级。根据实验室检查,分为肾损伤组(n=109)及对照组(n=344)。通过性别、年龄进行1∶1病例对照匹配,然后采用单因素分析及多因素Logistic回归方法分析肾脏表面结节定量分级与高血压性肾损伤的相关征象。结果 肾损伤组和对照组各入组109例。单因素分析提示:高血压控制情况、高血压分级、肾脏表面结节定量分级可能与高血压性肾损伤相关(P<0.2)。多因素Logistic回归分析显示:未联合肾脏表面结节定量分级的Logistic回归分析示高血压控制不良是高血压性肾损伤的独立危险因子(OR=1.805;95%CI:1.042~3.129,P=0.035);联合肾脏表面结节定量分级后,仅有肾脏表面结节定量分级与高血压肾损伤的独立相关(OR=7.534;95%CI:1.005~56.494,P=0.049)。结论 基于CT成像的肾脏表面结节定量分级与高血压性肾损伤存在关联性,其有潜力成为评价高血压性肾损伤的影像学临床标志物之一。

瑞舒伐他汀联合缬沙坦对老年原发性高血压早期肾损伤患者肾功能及凝血功能的影响

目的探讨瑞舒伐他汀、缬沙坦对老年原发性高血压早期肾损伤患者肾功能及凝血功能的影响。方法以100例老年原发性高血压早期肾损伤患者为对象,分为对照组与观察组。两组均给予参芪补肾汤治疗,对照组采用缬沙坦治疗,观察组加用瑞舒伐他汀钙,比较两组肾功能及凝血功能指标。结果观察组总有效率为94.00%(47/50),高于对照组(80.00%(40/50),P<0.05)。两组治疗后尿-N-乙酰-β-D氨基葡萄糖肝酶(NAG)、α1-微球蛋白(α1-MG)、胱抑素C(CysC)、β2-微球蛋白(β2-MG)水平均降低,观察组低于对照组(P<0.05)。两组治疗后纤维蛋白原(Fbg)、D二聚体(D-D)、平均血小板体积(MPV)水平均降低,活化部分凝血酶原时间(aPTT)水平升高,观察组变化幅度高于对照组(P<0.05)。结论缬沙坦、瑞舒伐他汀联合治疗老年原发性高血压早期肾损伤的疗效理想,可改善患者的凝血状态,保护患者肾脏功能。

非洛地平与缬沙坦对原发性高血压肾脏保护效果对比

目的比较非洛地平与缬沙坦对原发性高血压的肾脏保护作用。方法 45例原发性高血压Ⅰ级伴蛋白尿患者分为2组,分别使用非洛地平和缬沙坦进行治疗,观察两种药物在高血压肾损伤早期对肾脏保护方面的差异。结果两种药物在降压及肾脏保护作用间无明显差异。结论非洛地平以价格优势更适合基层医院的患者,对高血压肾损伤早期具有保护作用。

原发性高血压患者NGAL表达水平及临床意义分析

目的分析原发性高血压患者血清及尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)表达水平及其临床意义。方法对107例原发性高血压患者和100例健康者进行血清、尿NGAL检测和尿微量清蛋白检测。对检测结果进行统计学分析。结果原发性高血压患者血清、尿NGAL浓度分别为(1.98±1.49)、(1.29±0.54)μg/L,健康者血清、尿NGAL浓度分别为(0.69±1.02)、(0.55±0.35)μg/L,前者血清、尿NGAL水平均高于后者(P<0.05)。原发性高血压患者尿微量清蛋白水平高于健康者(P<0.05)。结论原发性高血压患者血清及尿液NGAL水平明显升高,为早期干预高血压性肾损伤提供了新的研究方向。

尿微量白蛋白联合FNDC5/Irisin对原发性高血压肾损伤的诊断价值

目的探究尿微量白蛋白联合前体纤维连接蛋白Ⅲ型域包含蛋白5(fibronectin typeⅢdomain-containing protein 5,FNDC5)/鸢尾素(Irisin)对原发性高血压肾损伤的诊断价值。方法选取作者医院2018-06/2021-06月收治的144例原发性高血压患者临床资料,分为原发性高血压组(n=72)和原发性高血压肾损伤组(n=72);同时选取60例临床基本资料相匹配的健康志愿者作为对照组。采用生化法测定尿微量白蛋白、血清FNDC5/Irisin水平。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估尿微量白蛋白及FNDC5/Irisin联合检测对原发性高血压肾损伤的诊断价值。结果原发性高血压肾损伤组患者肾功能血清尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)及尿微量白蛋白水平均显著高于对照组(P均<0.05);其中β_(2)-MG及尿微量白蛋白水平明显高于原发性高血压组(P均<0.05)。原发性高血压肾损伤组患者血清Irisin、FNDC5含量均显著低于对照组和原发性高血压组(P均<0.05);且FNDC5 mRNA水平明显低于对照组和原发性高血压组(P均<0.05)。ROC曲线分析显示,尿微量白蛋白、FNDC5 mRNA和Irisin的曲线下面积(area under the curve,AUC)为0.927、0.831及0.855,联合检测的AUC为0.945,敏感度94.70%,特异度81.10%,对原发性高血压肾损伤的诊断价值优于尿微量白蛋白、FNDC5及Irisin单独检测。结论对于原发性高血压肾损伤的诊断,尿微量白蛋白、FNDC5 mRNA表达和Irisin水平较原发性高血压患者及对照组患者差异显著,具有一定诊断意义,且三者联合诊断优于单一指标检测。

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

AIM To study the clinico-pathological spectrum of snake bite-induced acute kidney injury(AKI).METHODS A retrospective study of patients admitted at Indira Gandhi Medical College Hospital,Shimla with snake bite-induced AKI from July 2003 to June 2016.Medical records were evaluated for patient's information on demographic,clinical characteristics,complications and outcome.Outcomes of duration of hospital stay,requirement for intensive care unit support,treatment with dialysis,survival and mortality were analyzed.The survival and non survival groups were compared to see the difference in the demographic factors,clinical characteristics,laboratory results,and complications.In patients subjected to kidney biopsy,the findings of histopathological examination of the kidney biopsies were also analyzed.RESULTS One hundred and twenty-one patients were diagnosed with snake bite-induced AKI.Mean age was 42.2 ± 15.1 years and majority(58%) were women.Clinical details were available in 88 patients.The mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to30 d.Eighty percent had oliguria and 55% had history of having passed red or brown colored urine.Coagulation defect was seen in 89% patients.The hematological and biochemical laboratory abnormalities were:Anemia(80.7%),leukocytosis(75%),thrombocytopenia(47.7%),hyperkalemia(25%),severe metabolic acidosis(39.8%),hepatic dysfunction(40.9%),hemolysis(85.2%) and rhabdomyolysis(68.2%).Main complications were:Gastrointestinal bleed(12.5%),seizure/encephalopathy(10.2%),hypertension,pneumonia/acute respiratory distress syndrome(ARDS) and disseminated intravascular coagulation(9.1% each),hypotension and multi organ failure(MOF)(4.5% each).Eighty-two percent patients required renal replacement therapy.One hundred and ten(90.9%) patient survived and 11(9.1%) patients died.As compared to the survival group,the white blood cell count(P = 0.023) and bilirubin levels(P = 0.006) were significant higher and albumin levels were significantly lower(0.005) in patients who died.The proportion of patients with pneumonia/ARDS(P = 0.001),seizure/encephalopathy(P = 0.005),MOF(P = 0.05) and need for intensive care unit support(0.001) was significantly higher and duration of hospital stay was significantly shorter(P = 0.012) in patients who died.Kidney biopsy was done in total of 22 patients.Predominant lesion on kidney biopsy was acute tubular necrosis(ATN) in 20(91%) cases.In 11 cases had severe ATN and in other nine(41%) cases kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis(AIN).One patient only had moderate AIN and one had patchy renal cortical necrosis(RCN).CONCLUSION AKI due to snake bite is severe and a high proportion requires renal replacement therapy.On renal histology ATN and AIN are common,RCN is rare.