急性肾功能不全伴糖尿病、高血压1例的药学监护

目的：探讨临床药师在肾内科治疗方案的制订与用药监护中的工作要点。方法：参与1例急性肾功能不全伴糖尿病、高血压的药学监护和治疗用药方案的制订。结果：通过对症治疗和对因治疗后，患者病情好转：确定符合患者特点的抗感染方案．避免不良反应发生的策略，达到了理想的预后情况结论：个体化用药方案的设计与分析及用药监护是临床药师开展“以患者为中心“药学服务工作的切入点。

甲状旁腺全切加前臂移植治疗继发性甲状旁腺功能亢进的疗效分析

目的探讨甲状旁腺全切加前臂移植对慢性肾功能不全长期血透患者继发性甲状旁腺功能亢进(SHPT)的疗效。方法回顾性分析16例接受甲状旁腺全切加前臂移植的慢性肾功能不全长期血透患者术前后临床症状,全段甲状旁腺素(iPTH)、血钙、磷等变化,总结手术并发症、病理结果、复发及预后等。结果患者术后临床症状明显缓解,术后iPTH、血钙、磷均较术前低,术后低血钙发生率较高,术后2周内需静脉、口服补钙和高钙透析液纠正,有1例发生术后SHPT复发。结论甲状旁腺全切加前臂移植治疗慢性肾功能不全SHPT安全、有效。

单次快速静脉滴注科莫非对肾性贫血患者凝血功能的影响

目的探讨单次快速静脉滴注科莫非对肾性贫血患者凝血功能的影响,为该改进方案的安全性提供依据。方法回顾分析本院采用静脉滴注科莫非治疗肾性贫血的96例慢性肾脏病患者的凝血功能情况,依据用药方案将患者分为传统方案和改良方案(单次快速静脉注射)。分析治疗前、治疗后30min和24h的凝血四项(凝血酶时间TT、凝血酶原时间PT、活化部分凝血活酶时间APTT、纤维蛋白原FIB)、血小板参数(血小板计数PLT、血小板比积PCT、平均血小板体积MPV、血小板体积分布宽度PDW)和D-二聚体水平及用药1周内的不良反应情况。结果传统方案和改进方案在静脉注射后30min、24h的凝血四项、血小板参数和D-二聚体水平与治疗前比较,差异无统计学意义(P>0.05);用药1周内,除改进方案组有2例首次用药疼痛外,且疼痛均发生静脉注射位置,未有其他不良反应报道。结论快速静脉注射科莫非可有效的节省时间和医疗资源,同时对患者凝血功能的影响较小,患者耐受好,安全性高。

急性有机磷农药中毒致肾损害临床分析

目的探讨急性有机磷农药中毒致肾损害患者的发病机制、临床表现和治疗方法,提高抢救成功率。方法收集我院1999年1月～2010年12月收治的急性有机磷农药中毒致肾损害患者的临床资料。回顾患者临床表现特点、综合性治疗措施以及预后。结果共收集急性有机磷农药中毒患者456例,其致肾损害105例,发病率23%,临床表现以蛋白尿(100%)、镜下血尿(93%)为突出表现,部分患者可出现急性肾功能不全(39%),中毒程度较重的患者可出现1个或多个重要脏器并发症。105例患者治愈97例,治愈率达92.4%,死亡8例,病死率7.6%,死亡的主要原因为多脏器功能衰竭。结论急性有机磷农药中毒致肾损害的预后不仅仅是由肾功能损害程度决定的,它合并其他重要脏器衰竭或严重感染,是导致患者死亡的重要因素,所以,治疗上除尽早、足量使用抗胆碱能药和胆碱脂酶复能剂外,积极采取综合性措施预防和治疗并发症,是提高急性有机磷农药中毒致肾损害患者抢救成功率的重要环节。

Real-time shear wave elastography combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease

Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with CKD(CKD group)and 64 healthy subjects(control group)were retrospectively enrolled.Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages.SWE parameters of liver and kidney,including mean value,the maximum value and the median value of Young's modulus(EQI mean,EQI max and EQI med)were compared between CKD subgroups and control group.Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage,as well as of liver SWE parameters with biochemical indicators.Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients.Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group(all P≤0.001).Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQI max in CKD4 subgroup were all higher than those in control group(all P<0.003).Kidney SWE parameters in CKD3 subgroup were all higher than those in control group,while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup(all P<0.003).Kidney EQI mean and EQI med in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup,while kidney EQI max in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup(all P<0.003).Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages(r=0.364—0.665,all P<0.001).Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase(ALP)(r=0.229—0.248,all P<0.01).Theγ-glutamyl transferase,ALP and liver EQI max were all independent predictors of liver injury in CKD patients(all P<0.01),with AUC for evaluating liver injury in CKD patients alone of 0.645,0.756 and 0.741,respectively,lower than that of their combination(0.851,all P<0.01).Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages.

Clinical Features of Renal Insufficiency due to Multiple Myeloma and Related Risk Factors

Objective: To study clinical features of the patients with multiple myeloma(MM) accompanied by renal insufficiency and investigate the related risk factors of renalimpairment. Methods: A control study of clinical characteristics was performed between 91 patientswith renal insufficiency due to MM and 165 patients with normal renal function in MM during the sameperiod. The data were statistically analyzed by chi-square test and logistic regression analysis.Results: Renal insufficiency was the initial presentation in 48 (52.7%) of the 91 patients, and 30(62.5%) of the 48 patients were misdiagnosed. The prognosis of group with renal insufficiency wassignificantly poorer than that of group with normal renal function: mortality in 3 months, 3months-1 year was 26/91 vs 14/165 (P 【 0.0001), 14/91 vs 12/165 (P 【 0.05) respectively, andpatients survived 】 1 year was 18/91 vs 95/165 (P 【 0.0001). The incidence of hypercalcemia,hyperuricemic, severe anemia, high serum M-protein concentration and lytic bone lesions weresignificantly higher in renal insufficiency group than those in control group (P 【 0.05). Logisticregression analysis identified 5 risk factors of renal impairment, including, severe anemia(Exp(β)=13.819, P 【 0.0001), use of nephrotoxic drugs (Exp(β)=6.217, P = 0.001), high serumM-protein concentration (Exp(β) = 5.026, P = 0.001), male (Exp(β)=3.745, P=0.006), andhypercalcemia (Exp(β)=3A72, P=0.006), but age, serum density of uric acid, type of serum M-protein,and Bence Jones proteinuria were not significantly associated with renal insufficiency. Conclusion:Renal insufficiency was a common early complication of MM, which often resulted in misdiagnosis.The status of these patients tended to be very bad, with many other complications, when MM wasdiagnosed, so their prognosis was poor. The occurrence of renal insufficiency in patients with MMand hypercalcemia, severe anemia, high serum M-protein concentration, especially use of nephrotoxicdrugs should be alert.

Spontaneous bacterial peritonitis

Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit with steady prevalence and a high recurrencerate. Bacterial translocation,the key mechanism in thepathogenesis of SBP,is only possible because of theconcurrent failure of defensive mechanisms in cirrhosis.Variants of SBP should be treated. Leucocyte esterasereagent strips have managed to shorten the 'tap-to-shot' time,while future studies should look into theircombined use with ascitic fluid pH. Third generationcephalosporins are the antibiotic of choice becausethey have a number of advantages. Renal dysfunctionhas been shown to be an independent predictor ofmortality in patients with SBP. Albumin is felt to reducethe risk of renal impairment by improving effectiveintravascular volume,and by helping to bind pro-inflammatory molecules. Following a single episodeof SBP,patients should have long-term antibioticprophylaxis and be considered for liver transplantation.

Diffusion-weighted imaging of biliopancreatic disorders:Correlation with conventional magnetic resonance imaging

Diffusion-weighted magnetic resonance imaging(DWI)is a well established method for the evaluation of intracranial diseases,such as acute stroke.DWI for extracranial application is more difficult due to physiological motion artifacts and the heterogeneous composition of the organs.However,thanks to the newer technical development of DWI,DWI has become increasingly used over the past few years in extracranial organs including the abdomen and pelvis.Most previous studies of DWI have been limited to the evaluation of diffuse parenchymal abnormalities and focal lesions in abdominal organs,whereas there are few studies about DWI for the evaluation of the biliopancreatic tract.Although further studies are needed to determine its performance in evaluating bile duct,gallbladder and pancreas diseases,DWI has potential in the assessment of the functional information on the biliopancreatic tract concerning the status of tissue cellularity,because increased cellularity is associated with impeded diffusion,as indicated by a reduction in the apparent diffusion coefficient.The detection of malignant lesions and their differentiation from benign tumor-like lesions in the biliopancreatic tract could be improved using DWI in conjunction with findings obtained with conventional magnetic resonance cholagiopancreatography.Additionally,DWI can be useful for the assessment of the biliopancreatic tract in patients with renal impairment because contrast-enhanced computed tomography or magnetic resonance scans should be avoided in these patients.

Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

AIM： To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy （PEG）. METHODS： We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008 after PEG were defined as： Enteral nutrition problems （1） patients who required ≥ 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or （2） patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients＇ backgrounds and the specific causes that led to their problems. RESULTS： Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients （17.5%） were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis （often Clostridium difficile-related）, paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases： （1） enteral nutrition before gastrectomy （a risk reduction factor）; （2） presence of esophageal hiatal hernia; （3） past history of paralytic ileus; and （4） presence of chronic renal dysfunction. CONCLUSION： Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.

Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

AIM:To evaluate the incidence of contrast-induced nephropathy(CIN)in cirrhotic patients and to identify risk factors for the development of CIN.METHODS:We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography(CT)with intravenous contrast at the University of Rochester between the years 2000-2005.We retrospectively examined factors associated with a high risk for CIN,defined as a decrease in creatinine clearance of 25%or greater within one week after receiving contrast.RESULTS:Twenty-five percent of our patients developed CIN,and 74%of these patients had ascites seen on CT.Of the 75%of patients who did not develop CIN,only 46%had ascites.The presence of ascites was a significant risk factor for the development of CIN(P=0.0009,OR 3.38,95%CI 1.55-7.34)in multivariate analysis.Patient age,serum sodium,Model for End-stage Liver Disease score,diuretic use,and the presence of diabetes were not found to be significant risk factors for the development of CIN.Of the patients who developed CIN,11%developed chronic renal insufficiency,defined as a creatinine clearance less than baseline for 6 wk.CONCLUSION:Our results suggest that in hospitalized cirrhotic patients,especially those with ascites,the risk of CIN is substantial.

Self-care actions for the maintenance of the arteriovenous fistula:An integrative review

Objective:To identify self-care actions for the maintenance of arteriovenous fistula of renal patients.Method:An integrative review study was conducted and literature were searched in Medline/PubMed,Scopus,CINAHL LILACS,BDENF and SciELO Library databases using the descriptors chronic renal insufficiency,arteriovenous fistula,self-care,and knowledge.The inclusion criteria were that the documents be written in Portuguese,English,and Spanish,full text available,published in the last five years,and that they address the research question.Reflection articles,theses,dissertations,editorials of nonscientific journals,and research studies that did not follow the necessary methodological rigor were excluded.Data were analyzed with the IRAMUJTEQ software.Results:Fifteen articles were selected and comprised the final sample.Seven classes of self-care actions emerged from the text segments analysis and grouped into three categories:(1)Self-care actions that maintain the arteriovenous fistula;(2)Self-care actions for the prevention and the monitoring of complications with arteriovenous fistula;(3)Self-care actions directed at the perioperative period of arteriovenous fistula preparation.Conclusion:The results allowed us to identify important care for the maintenance of arteriovenous fistula functionality.The self-care actions identified in this study can guide a nursing care policy for implementation with protocols that help identify problems related to self-care actions and,thus,subsidize the development of actions aimed at the renal patient.However,more studies with high levels of evidence that identify self-care actions with arteriovenous fistula and the factors involved in its implementation are needed.

Heart valve disease in elderly Chinese population： effect of advanced age and comorbidities on treatment decision-making and outcomes

Background A considerable proportion of elderly patients with symptomatic severe heart valve disease are treated conservatively de- spite clear indications for surgical intervention. However, little is known about how advanced age and comorbidities affect treatment deci-sion-making and therapeutic outcomes. Methods Patients （n = 234, mean age： 78.5 ± 3.7 years） with symptomatic severe heart valve dis- ease hospitalized in our center were included. One hundred and fifty-one patients （65%） were treated surgically （surgical group） and 83 （35%） were treated conservatively （conservative group）. Factors that affected therapeutic decision-making and treatment outcomes were investi- gated and long-term survival was explored. Results Isolated aortic valve disease, female sex, chronic renal insufficiency, aged _〉 80 years, pneumonia, and emergent status were independent factors associated with therapeutic decision-making. In-hospital mortality for the surgical group was 5.3% （8/151）. Three patients （3.6%） in the conservative group died during initial hospitalization. Low cardiac output syndrome and chronic renal insufficiency were identified as predictors of in-hospital mortality in the surgical group. Conservative treatment was identi- fied as the single risk factor for late death in the entire study population. The surgical group had better 5-year （77.2% vs. 45.4%, P 〈 0.0001） and 10-year （34.5% vs. 8.9%, P 〈 0.0001） survival rates than the conservative group, even when adjusted by propensity score-matched analysis. Conclusions Advanced age and geriatric comorbidities profoundly affect treatment decision-making for severe heart valve disease. Valve surgery in the elderly was not only safe but was also associated with good long-term survival while conservative treatment was unfavorable for patients with symptomatic severe valve disease.

Major influence of renal function on hyperlipidemia after living donor liver transplantation

AIM:To investigate the impact of renal and graft function on post-transplant hyperlipidemia(PTHL) in living donor liver transplantation(LDLT).METHODS:A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled.Data were collected and analyzed by the China Liver Transplant Registry retrospectively.PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT.Early renal dysfunction(ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.RESULTS:In 115 eligible patients,the incidence of PTHL was 24.3%.Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL(17.9% vs 4.6%,P = 0.037).Serum creatinine showed significant positive correlations with total serum triglycerides,both at posttransplant month 1 and 3(P < 0.01).Patients with ERD had much higher pre-transplant serum creatinine levels(P < 0.001) and longer duration of pre-transplant renal insufficiency(P < 0.001) than those without ERD.Pretransplant serum creatinine,graft-to-recipient weight ratio,graft volume/standard liver volume ratio,body mass index(BMI) and ERD were identified as risk factors for PTHL by univariate analysis.Furthermore,ERD [odds ratio(OR) = 9.593,P < 0.001] and BMI(OR = 6.358,P = 0.002) were identified as independent risk factors for PTHL by multivariate analysis.CONCLUSION:Renal function is closely associated with the development of PTHL in LDLT.Post-transplant renal dysfunction,which mainly results from pre-transplant renal insufficiency,contributes to PTHL.

Acute coronary syndromes： an old age problem

The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes （ACS）. This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological tiailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

Synchronous bilateral multiple chromophobe cell renal carcinoma complicated with right kidney cyst: a case report

Synchronous bilateral multiple chromophobe cell renal carcinoma is rare; here we report a case diagnosed with bilateral renal multiple tumors complicated with a cyst in the right kidney. Retroperitoneal laparoscopic bilateral nephron sparing surgery was performed and there was no serious postoperative renal dysfunction. Pathological and immunohistochemical diagnoses of both tumors were chromophobe cell renal carcinoma. The patient has been doing well without any evidence of recurrence or metastasis for 6 months.

Measurement of serum cystatin C,creatinine clearance and urea micro-albumin as renal function evaluation indicators in cancer patients during chemotherapy with platinum

Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.

The treatment strategies of breast cancer in patients with renal dysfunction

Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug concentrations to determine its safety and effectiveness.Results:Chemotherapy assessment efficiency:SD(better),hemodialysis did not affect THP treatment,their safety was guaranteed.Conclusion:The chemotherapy of renal dysfunction is not an absolute contraindication to fully assess the patient's adverse effects and tolerability,the reasonable arrangements for hemodialysis and the timing of administration can be safe and effective chemotherapy.

Renal impairment in multiple myelomas

Objective: The aim of the study was to investigate the clinic manifestation, diagnosis and treatment on multiple myeloma (MM) with the onset of renal impairment. Methods: The 27 cases of multiple myeloma with the onset of renal impair-ment were collected in Department of Nephrology, Wuhan General Hospital of Guangzhou Command, China, from January 2007 to January 2011. All cases were divided into the groups with renal dysfunction (n = 16) and normal renal function (n = 11). The clinic manifestations, treatments and prognosis of all patients were analyzed. Results: Of all the patients in normal renal function group, 5 suffered nephrotic syndrome, 4 had abnormal results of routine urinalysis (hematuria or proteinuria) which were not caused by nephrotic syndrome, and 1 suffered urinary tract infection. Five pathological specimens of renal biopsy revealed that light chain protein, immunoglobulin and complement C3 were deposited mainly in the glomerular base-ment membrane and mesangia, tubular basement membrane and arteriolar walls. Two pathological specimens were proved to be renal amyloidosis. Patients with renal dysfunction had poorer prognosis, severer anemia, higher values of serum lactate dehydrogenase (LDH) and β2-microglobulin (β2-MG), worse responses to chemotherapy. Of 16 patients with renal dysfunc-tion, 14 (87.5%) were stage III, which were significantly higher than that in the group of normal renal function [63.6% (7/11)]. Of 16 cases with renal dysfunction, 9 were treated with blood purification, and 5 of 9 cases were treated with plasma exchange. Conclusion: Multiple myeloma with the onset of renal impairment was easily misdiagnosed. Hemodialysis concomitant with chemotherapy could contribute to recovery of renal function.

不同水化方案预防造影剂肾病临床研究

目的比较应用质量分数0.45%及0.9%氯化钠注射液、质量分数1.25%碳酸氢钠注射液3种水化治疗方案,预防伴肾功能不全急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneouscoronary intervention,PCI)术后造影剂肾病的效果。方法血肌酐>97μmol/L并行PCI术ACS患者300例随机分为A、B、C 3组各100例,分别应用质量分数0.45%、0.9%氯化钠注射液及质量分数1.25%碳酸氢钠注射液3种水化治疗方案,测定3组血肌酐、血尿酸及半胱氨酸蛋白酶抑制剂C水平,比较3组造影剂肾病(contrast induced nephropathy,CIN)发生率,Kaplan-Meier(K-M)生存曲线预测发生CIN对患者远期预后的影响。结果 A、B、C组术后48h血肌酐分别为(116.91±20.47)、(113.39±12.08)、(110.61±12.55)μmol/L,A组高于B、C组(P<0.05),B组与C组比较差异无统计学意义(P>0.05);A、B、C组CIN发生率分别为12%、4%、3%,3组比较差异有统计学意义(P<0.05);K-M生存曲线显示,PCI术后发生CIN者再次发生心绞痛或心肌梗死等终点事件的风险明显高于未发生CIN者(P<0.05)。结论伴有肾功能不全ACS患者行PCI术前、术后应用质量分数1.25%碳酸氢钠注射液进行水化治疗,可有效预防CIN发生,改善患者远期预后。

Effect of Zibu Shenjing Fang(滋补肾精方) on Growth and Development of the Mouse with Kidney-essence Insufficiency and Study on the Mechanism

Objective:To investigate effects of Zibu Shenjing Fang(滋补肾精方) on growth and development of the mouse with insufficiency of kidney-essence and the mechanism.Methods:Total 50 mice were randomly divided into a normal group,a model group,a Jingui Shenqi Wan(金匮肾气丸) group,a Zibu Shenjing Fang high dose group and a Zibu Shenjing Fang low dose group,10 mice in each group.The kidney-essence insufficiency mouse model was established by use of threat-injuring the kidney combined with over-fatigue.At the same time of modeling,the mice in the model group were intragastrically administrated with saline 20 mL·kg-1·d-1,in the Jingui Shenqi Wan group with suspension of the Jingui Shenqi Wan 2.7 g·kg-1·d-1,in the Zibu Shenjing Fang high dose group with Zibu Shenjing Fang 20 g·kg-1·d-1 and in the Zibu Shenjing Fang low dose group with Zibu Shenjing Fang 10 g·kg-1·d-1,for 21 consecutive days.The general state was observed,the body weight was weighted,and serum growth hormone(GH) and insulin-like growth factor-1(IGF-1) contents were detected.Results:Compared with model group,Zibu Shenjing Fang groups and Jingui Shenqi Wan group could improve manifestation of the mouse with kidney-essence insufficiency,increase body weight of the mouse and serum GH and IGF-1 contents,especially in the high dose group.Conclusion:Zibu Shenjing Fang gives play to the function of tonifying the kidney and replenishing essence through regulating GH and IGF-1 levels,so as to influence growth and development of the mouse.