Comparative efficacy of traditional Chinese herbal injection for chronic renal failure:A systematic review and network meta-analysis of randomized controlled trials

Objective: To conduct a systematic review and network meta-analysis(NMA) for the comparison of the efficacy and safety of Chinese herbal injection(CHI) combined with Western medicine(WM) and WM monotherapy for chronic renal failure(CRF).Methods: Eight databases were searched from inception to August 30, 2022. Randomized controlled trials(RCTs) regarding the comparison of CHI-WM combination therapy and WM monotherapy were included. Literature search, risk-of-bias assessment, and data extraction were conducted by 2 reviewers independently. NMA was performed by Stata 14.0, R 4.0.4 software, and the latest risk of bias assessment tool 2(RoB 2).Results: A total of 53 RCTs were finally included, involving 4445 participants and 16 CHIs. RoB 2 showed that 2 of these studies had a high risk of bias. Tianqi injection(TQ) + WM was the most effective in reducing serum creatinine(Scr) level. Xingding injection(XD) + WM was the most effective in reducing blood urea nitrogen(BUN) and cystatin C(Cys C) levels. Guhong injection(GH) + WM had the highest endogenous creatinine clearance rate(Ccr). Shuxuetong injection(SXT) + WM was the most effective in improving the clinical effective rate. Danhong injection(DH) + WM resulted in the lowest 24-h urinary protein quantity(24 h-UPQ), while Danshen injection(DS) + WM led to the lowest blood uric acid(UA)level. Shenfu injection(SF) + WM was the most effective in increasing hemoglobin(Hb) level.Conclusion: CHIs-WM combination therapy is more effective than WM monotherapy in treating CRF.Considering all of the indicators, SK + WM may be the optimal treatment option for improving renal function in patients with CRF.

Beta-blocker therapy in elderly patients with renal dysfunction and heart failure

OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.

Effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as CTGF and TGF-β1 content in patients with chronic renal failure

Objective:To analyze the effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 content in patients with chronic renal failure.Methods:80 patients with chronic renal insufficiency treated in our hospital between March 2013 and March 2016 were selected for study and randomly divided into observation group (n=40) and control group (n=40). Control group received conventional therapy and observation group received conventional + adjuvant salvia miltiorrhiza and ligustrazine therapy. After 3 months of treatment, differences in renal function indexes, illness-related indexes, renal blood perfusion, CTGF and TGF-β1 content, and so on of two groups of patients were determined. Results: After 3 months of treatment, serum urea nitrogen (BUN), serum creatinine (Scr),β2 microglobulin (β2-MG), intermedin (IMD), fibroblast growth factor 23 (FGF23), cystatin C (CysC), CTGF and TGF-β1 content as well as 24 h urine albumin excretion rate (UAER) level in urine of observation group were significantly lower than those of control group (P<0.05) while glomerular filtration rate (GFR) level and serum adiponectin (APN) content were significantly higher than those of control group (P<0.05);renal perfusion parameters renal cortex Tmax (ATc) and medulla Tmax (ATm) levels of observation group were significantly lower than those of control group while cortex peak intensity change (ΔAc), medulla peak intensity change (ΔAm) and peak intensity (PI) levels were significantly higher than those of control group.Conclusions:Adjuvant salvia miltiorrhiza and ligustrazine therapy can effectively control the overall condition of patients with chronic renal failure, and plays a positive role in improving renal function and increasing renal blood perfusion.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

One Case of Diabetes Nephropathy Stage V, Combined Valvular Disease, Total Heart Failure with Diabetes Foot Gangrene

The patient was found to have 4+urine sugar by physical examination 14 years ago and was treated with oral hypoglycemic drugs. Insulin was injected intramuscularly nine years ago. Two and a half years ago, it was found that the color of the thumb, index and middle toe of the left foot became black. He went to a third-class hospital in Beijing and was diagnosed as “diabetes foot”. He was treated with “balloon dilation of lower limb blood vessels of diabetes foot”. Half a year ago, the third toe on the right side was broken and treated in the hospital again. “Popliteal artery stent implantation” was given for the diagnosis of “double kidney insufficiency, diabetes foot, left heart failure, combined heart valve disease”, “Hemofiltration therapy” and anti-inflammatory, amino acid supplementation, kidney function protection, anticoagulation, anemia correction and other treatments. Later, he went to our hospital and was diagnosed by the TCM diagnosis: category of consumptive disease, toe or finger gangrene (syndrome/pattern of qi and yin deficiency). Western medicine diagnosed: stage V of diabetes nephropathy, type II diabetes foot gangrene, combined with heart valve disease, hypoalbuminemia, double kidney cyst, moderate anemia, pleural effusion, hyperkalemia, pulmonary infection, and total heart failure. The patient was treated by the Qi-acupuncture therapy of TCM in combination with Chinese and Western medicine Medical treatment made the patient significantly better and discharged.

Fetal kidney stem cells ameliorate cisplatin induced acute renal failure and promote renal angiogenesis

AIM: To investigate whether fetal kidney stem cells(f KSC) ameliorate cisplatin induced acute renal failure(ARF) in rats and promote renal angiogenesis.METHODS: The f KSC were isolated from rat fetuses of gestation day 16 and expanded in vitro up to 3rd passage. They were characterized for the expression of mesenchymal and renal progenitor markers by flow cytometry and immunocytochemistry, respectively. The in vitro differentiation of f KSC towards epithelial lineage was evaluated by the treatment with specific induction medium and their angiogenic potential by matrigel induced tube formation assay. To study the effect of f KSC in ARF, f KSC labeled with PKH26 were infused in rats with cisplatin induced ARF and, the blood and renal tissues of the rats were collected at different time points. Blood biochemical parameters were studied to evaluate renal function. Renal tissues were evaluated for renal architecture, renal cell proliferation and angiogenesis by immunohistochemistry, renal cell apoptosis by terminal deoxynucleotidyl transferase nickend labeling assay and early expression of angiogenic molecules viz. vascular endothelial growth factor(VEGF), hypoxia-inducible factor(HIF)-1α and endothelial nitric oxide synthase(eN OS) by western blot.RESULTS: The fK SC expressed mesenchymal markers viz. CD29, CD44, CD73, CD90 and CD105 as well asrenal progenitor markers viz. Wt1, Pax2 and Six2. They exhibited a potential to form CD31 and Von Willebrand factor expressing capillary-like structures and could be differentiated into cytokeratin(CK)18 and CK19 positive epithelial cells. Administration of fK SC in rats with ARF as compared to administration of saline alone, resulted in a significant improvement in renal function and histology on day 3(2.33 ± 0.33 vs 3.50 ± 0.34, P < 0.05) and on day 7(0.83 ± 0.16 vs 2.00 ± 0.25, P < 0.05). The infused PKH26 labeled fK SC were observed to engraft in damaged renal tubules and showed increased proliferation and reduced apoptosis(P < 0.05) of renal cells. The kidneys of fK SC as compared to saline treated rats had a higher capillary density on day 3 [13.30 ± 1.54 vs 7.10 ± 1.29, capillaries/high-power fields(HPF), P < 0.05], and on day 7(21.10 ± 1.46 vs 15.00 ± 1.30, capillaries/HPF, P < 0.05). In addition, kidneys of fK SC treated rats had an upregulation of angiogenic proteins hypoxia-inducible factor-1α, VEGF and eN OS on day 3(P < 0.05).CONCLUSION: Our study shows that fK SC ameliorate cisplatin induced ARF in rats and promote renal angiogenesis, which may be an important therapeutic mechanism of these stem cells in the disease.

Early plasma exchange and continuous renal replacement therapy improve puerperal prognosis in hepatitis B virus-related acute-on-chronic liver failure in pregnancy

Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF.Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE.Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006).Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.

Echocardiographic Evaluation of Qiangxin Decoction Combined with Cardiac Resynchronization Therapy for Patients with Chronic Heart Failure

OBJECTIVE: To explore the echocardiographic evaluation of patients with chronic heart failure (CHF) after Qiangxin Decoction combined with cardiac resynchronization therapy. METHODS: A total of 140 CHF patients admitted to our hospital were randomly divided into combined group (Qiangxin Decoction and cardiac resynchronization, n = 70) and routine group (cardiac resynchronization, n = 70), and they were treated for 2 courses (16 weeks), with 8 weeks as a course. The improvement of heart function classification (HYHA) was observed before and after treatment, and the therapeutic effects were evaluated according to the improvement of heart function classification (markedly effective, effective, invalid, and worsening). The traditional Chinese medicine (TCM) diagnostic criteria was the main symptoms (0 to 6 points), secondary symptoms (0 to 3 points), tongue picture (0 to 1 point) and pulse condition (0 to 1 point), and the higher the score was, the more obvious the symptoms were. The left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and cardiac output (CO) were observed and recorded according to the heart color ultrasound before and after treatment. And the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to evaluate the life quality before and after treatment, and the highest score of the scale was 105 points. The higher the score was, the obvious the symptoms were, and the worse the life quality was. And the adverse reactions were recorded in the 2 groups. RESULTS: After the treatment, the total effective rate in the routine group was significantly lower than that in the combined group (75.71% vs . 94.30%), and there was statistically significant difference (P < 0.05). After the treatment, the TCM syndrome score in the routine group was higher than that in the combined group ((14.37±3.59) points vs.(10.53±3.11) points), and there was statistically significant difference (P < 0.05). After the treatment, the levels of LVEDD and LVESD in the routine group were higher than those in the combined group, and there were statistically significant differences (P < 0.05). The levels of LVEF and CO in the routine group were lower than those in the combined group, and there were statistically significant differences (P < 0.05). After the treatment, the score of MLHFQ scale in the routine group was higher than that in the combined group ((57.38±8.53) points vs.(46.39±7.14) points), and there was statistically significant difference (P < 0.05). CONCLUSION: Qiangxin Decoction combined with cardiac resynchronization therapy has good echocardiographic evaluation in patients with chronic heart failure.

Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy

BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.

Treatment of Chronic Heart Failure Complicated with Anxiety and Depression Using Traditional Chinese and Western Medicine

Chronic heart failure(CHF)is the terminal stage of various heart diseases,and is the main cause of death from cardiovascular disease.In recent years,the prevalence of CHF combined with anxiety and depressive state has shown an upward trend,and this paper was aimed to provide a reference for the diagnosis and treatment of CHF combined with anxiety and depression using Traditional Chinese medicine(TCM)and Western medicine.

影响慢性肾衰竭CRRT患者细菌感染发生的独立危险因素分析

目的 探讨影响慢性肾衰竭连续肾脏替代疗法(CRRT)患者发生细菌感染的独立危险因素。方法 回顾性分析2019年12月~2022年12月在运城市中心医院进行CRRT治疗的1 000例慢性肾衰竭患者。记录发生细菌感染的患者例数,分析细菌感染病原菌分布状况。将细菌感染患者267例设为观察组,余下未感染患者733例设为对照组,比较两组基线资料,并将有差异的指标纳入二元logistic回归分析,得到影响慢性肾衰竭CRRT患者出现细菌感染的独立危险因素。结果 1 000例慢性肾衰竭CRRT治疗患者,共发生细菌感染267例(观察组),发生率为26.70%;未发生细菌感染733例(对照组)。两组患者年龄、治疗时间、体质量指数(BMI)、合并糖尿病、糖尿病肾病、合并心力衰竭、留置静脉导管、血红蛋白(Hb)及血清白蛋白差异比较具有统计学意义(χ^(2)=8.123、5.463、8.631、5.043、8.898、8.052、4.861、8.658、4.803,P<0.05)。多因素logistic回归分析结果显示,≥65岁、≥1年治疗时间、BMI <20 kg/m2、合并糖尿病、合并心力衰竭、留置静脉导管、糖尿病肾病、Hb <70 g/L及血清白蛋白<30 g/L为影响慢性肾衰竭患者CRRT治疗过程中出现细菌感染的独立危险因素(P<0.05)。结论 慢性肾衰竭CRRT患者年龄、治疗时间、BMI、合并糖尿病与心力衰竭、留置静脉导管、糖尿病肾病、Hb及血清白蛋白均可影响细菌感染的发生,临床应针对上述危险因素构建干预方案,预防细菌感染。

高通量血液透析联合血液透析滤过序贯治疗慢性肾衰竭的临床效果及对钙磷代谢、预后的影响

目的分析高通量血液透析(HFHD)联合血液透析滤过(HDF)序贯治疗慢性肾衰竭(CRF)的临床效果。方法选取2020年1月至12月我院接收的90例CRF患者为研究对象,随机将其分为常规组(45例,常规HFHD治疗)和联合组(45例,HFHD联合HDF序贯治疗)。比较两组的治疗效果。结果联合组的治疗总有效率高于常规组(P<0.05)。治疗后,联合组的血尿素氮(BUN)、血肌酐(Scr)、甲状旁腺素(PTH)及β2-微球蛋白(β2-MG)水平低于常规组,内生肌酐清除率(Ccr)显著高于常规组(P<0.05)。治疗后,联合组的钙(Ca)水平高于常规组,磷(P)、成纤维细胞生长因子-23(FGF-23)、镁(Mg)、降钙素(CT)及碱性磷酸酶(ALP)水平低于常规组,差异具有统计学意义(P<0.05)。治疗后,联合组的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及白细胞介素-8(IL-8)水平低于常规组,白细胞介素-10(IL-10)水平高于常规组,差异具有统计学意义(P<0.05)。联合组的不良反应总发生率低于常规组,差异具有统计学意义(P<0.05)。结论HFHD联合HDF序贯治疗CRF可取得理想的效果。

中药内服方联合肾脏替代疗法治疗脓毒症急性肾损伤临床疗效和安全性的系统评价及Meta分析

目的对中药内服方联合肾脏替代疗法(RRT)治疗脓毒症急性肾损伤的临床疗效以及安全性进行系统性评价及Meta分析。方法检索建库至2023年6月17日,中国知网、万方数据库、中文科技期刊数据库、中国生物医学文献数据库、Web of Science、PubMed、Embase、Cochrane Library中收录的文献,纳入符合标准的中药内服方联合RRT治疗脓毒症急性肾损伤患者的随机对照试验(RCT)。文献质量评价采用Cochrane风险偏倚评估工具进行,并运用RevMan 5.4.1软件进行最终数据分析。结果9篇RCT共包括681例脓毒症急性肾损伤患者最终被纳入。与单纯运用RRT相比较,中药内服方联合RRT清除TNF-α作用更强[MD=-29.48,95%CI(-44.81,-14.15),P=0.0002]、IL-6水平[MD=-28.83,95%CI(-38.84,-18.82),P<0.0001]、Scr水平[MD=-21.86,95%CI(-44.10,0.38),P=0.05]、NGAL水平[MD=-12.25,95%CI(-16.90,-7.60),P<0.0001]、Cys C水平[MD=-0.45,95%CI(-0.49,-0.42),P<0.0001]、APACHEⅡ评分[MD=-3.20,95%CI(-3.89,-2.50),P<0.0001]、SOFA评分[MD=-1.78,95%CI(-2.19,-1.37),P<0.0001]及病死率[RR=0.42,95%CI(0.26,0.68),P=0.0004]均更低。仅1篇文献报道了不良反应,未有文献报道安全性指标。结论中药内服方联合RRT可以缓解脓毒症急性肾损伤患者炎症反应,保护肾功能,减低患者死亡率,但上述结论仍需多中心、大样本的RCT研究进一步验证。

金宝Prismaflex连续性肾脏替代治疗设备运行原理与故障案例分析

分析金宝Prismaflex连续性肾脏替代治疗(CRRT)机的设计原理和治疗模式,基于设备的基本结构与治疗流程解析CRRT设备出现的压力接头和秤归零测试失败的典型故障案例,提出针对性解决方案及维护保养策略,保障CRRT机稳定高效运行。

采用自配碳酸氢盐置换液行CRRT治疗流行性出血热合并急性肾功能衰竭1例回顾性分析

目的总结1例流行性出血热(EHF)合并急性肾功能衰竭(ARF)患者采用自配碳酸氢盐置换液行连续性肾脏替代治疗(CRRT)的经验,以期为同类病例的治疗提供参考。方法对2021年4月兰州大学第一医院东岗院区综合内科收治的1例EHF合并ARF患者行内科综合治疗,同时采用自配碳酸氢盐置换液行CRRT,依据动态监测血气分析、电解质、肾功能及凝血指标水平调整自配置换液配方及抗凝剂剂量。结果患者住院治疗14 d出院,出院后30 d复查随访,各项指标均恢复正常。结论在内科综合治疗的同时及时采用自配碳酸氢盐置换液行CRRT是治疗EHF合并ARF的有效方法。

2002-2022年中医药治疗慢性肾衰竭研究热点及趋势可视化分析

目的分析近年中医药治疗慢性肾衰竭研究现状、热点及趋势,为相关研究提供参考。方法检索中国知识资源总库(CNKI)2002-2022年收录的中医药治疗慢性肾衰竭期刊文献。采用NoteExpress3.5软件进行文件管理,采用Excel2020分析发文趋势,采用CiteSpace6.1.R6软件分析作者、机构、关键词并绘制知识图谱。结果共纳入894篇文献。发文量基本稳定,近年略有下降趋势。涉及331位作者,发文较多的有何立群、魏连波、邓聪、金华,形成王亿平、魏连波、何泽云等研究团队。涉及222个研究机构,发文较多的有上海中医药大学附属曙光医院、广东省中医院、上海中医药大学及北京中医药大学,未形成明显跨区域合作。涉及341个关键词,高频关键词包括肾功能衰竭、临床经验、动物模型等,高中心性关键词有临床研究、中西医结合治疗、中药灌肠等。结论中医药治疗慢性肾衰竭研究方法多样,涉及基础实验研究、临床研究、名医经验、药物开发等,研究热点主要为延缓慢性肾衰竭发生发展、相关并发症的治疗、中医药及其制剂研发、发病机制及分子机制等方面。

双罐串联连续血液净化对慢性肾衰竭尿毒症患者血清可溶性转铁蛋白受体和人巨噬细胞趋化蛋白-1水平及生存质量的影响

目的:探讨双罐串联连续血液净化(CRRT)对慢性肾衰竭尿毒症患者血清可溶性转铁蛋白受体(sTfR)和人巨噬细胞趋化蛋白-1(MCP-1)水平及生存质量的影响。方法:选择2022年4月至2023年4月新疆医科大学第一附属医院行血液透析治疗的96例慢性肾衰竭尿毒症患者,随机分为单罐组(CRRT连续血液净化单个灌流器)和双罐串联组(CRRT连续血液净化2个灌流器串联),每组48例。分别于治疗前,治疗后2个月、半年及1年时检测两组患者血清sTfR和MCP-1水平,判断其治疗后皮肤瘙痒缓解程度;分别于治疗前及治疗后72h记录两组白细胞水平、急性生理与慢性健康量表(APACHEⅡ)评分情况。采用中文版欧洲五维量表(CEQ-5D-3L)、视觉模拟量表(VAS)评分,评估两组患者治疗前后生命质量。结果:两组治疗前血清sTfR水平比较差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组血清sTfR水平均低于单罐组,差异有统计学意义(t=5.089、18.410、41.306,P<0.05);两组治疗前血清MCP-1水平比较,差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组血清MCP-1水平均低于单罐组,差异有统计学意义(t=8.554、8.019、10.744,P<0.05);两组治疗后原有皮肤瘙痒程度均有所改善,但单罐组缓解程度明显低于双罐串联组,差异有统计学意义(x^(2)=8.540,P<0.05);两组治疗前白细胞、APACHEⅡ评分比较,差异无统计学意义(P>0.05),治疗后72h白细胞、APACHEⅡ评分均降低,且双罐串联组改善程度均优于单罐组,差异有统计学意义(t=5.549、14.781,P<0.05);两组治疗前血清CEQ-5D-3L评分比较,差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组健康描述系统标准总分均低于单罐组,VAS评分高于单罐组,差异有统计学意义(t健康描述系统标准总分=4.744、5.103、9.418,tVAS评分=3.375、2.866、3.126,P<0.05)。结论:双罐串联连续血液净化可有效降低慢性肾衰竭尿毒症患者血清sTfR,MCP-1水平,缓解皮肤瘙痒程度,提高生存质量,同时还能有效降低白细胞水平,改善APACHEⅡ评分和血常规。

中医药协同CIK细胞治疗肾细胞癌研究进展

细胞因子诱导的杀伤(CIK)细胞是一种新型的免疫活性细胞,目前,细胞免疫治疗已成为一种新型的肿瘤治疗方法。尤其对晚期癌症患者有一定优势。CIK细胞在肿瘤治疗中具有重要作用,具有增殖速度快、杀瘤活性强、杀瘤谱广、非主要组织相容性复合体限制性杀瘤等特点。中医治疗是治疗肾癌的重要方法,可以改善晚期肾癌患者的肾功能,降低生物抑制剂和靶向治疗的毒副作用、延长生命周期。文章就中医药协同CIK免疫治疗用于晚期肾癌治疗的最新进展进行综述。

益气护肾方佐治慢性肾衰竭3~5期肾气虚夹瘀临床研究

目的:观察益气护肾方佐治慢性肾衰竭(CRF)3~5期肾气虚夹瘀患者的临床疗效。方法:选取106例肾气虚夹瘀CRF 3~5期患者作为研究对象,按照随机数字表法分为常规组(予以常规治疗及穴位贴敷和中药直肠滴入治疗)和益气护肾组(在常规组基础上联合使用益气护肾方治疗),每组53例。比较两组临床疗效、中医症状积分、治疗前后肾功能[肾小球滤过率(eGFR)、血肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白定量(24 h-UPRO)]、炎性因子[粒细胞-巨噬细胞集落刺激因子(GM-CSF)、白细胞诱素-1(LKN-1)、肿瘤坏死因子-α(TNF-α)]、氧化应激指标[晚期糖基化终产物(AGEs)、丙二醛(MDA)、活性氧(ROS)]。结果:益气护肾组总有效率高于常规组(P<0.05)。治疗后,两组中医症状评分下降,且益气护肾组低于常规组(均P<0.05)。治疗后,两组Scr、BUN、24 h-UPRO下降,eGFR升高(均P<0.05),且组间比较差异具有统计学意义(均P<0.05)。治疗后,两组GM-CSF、LKN-1、TNF-α水平下降,且益气护肾组低于常规组(均P<0.05)。治疗后,两组AGEs、MDA、ROS水平下降,且益气护肾组低于常规组(均P<0.05)。结论:益气护肾方佐治CRF 3~5期肾气虚夹瘀患者可调节其炎症因子水平,减轻氧化应激反应和肾损伤,从而改善患者症状和提高疗效。

甲磺酸萘莫司他与枸橼酸抗凝在慢性肾衰竭伴高危出血患者连续性肾替代治疗中的疗效评估

目的评价在慢性肾衰竭伴高危出血患者中行连续性肾替代治疗(CRRT)应用甲磺酸萘莫司他(NM)与局部枸橼酸(CA)抗凝的安全性和有效性。方法回顾性研究2021年1月至2023年9月在本中心接受NM或CA抗凝的慢性肾衰竭伴高危出血患者,评估滤器寿命或出血及其他并发症,采用多因素Cox回归分析确定滤器衰竭相关危险因素。结果共纳入125例患者,其中59例接受CA抗凝,66例接受NM抗凝。与CA组相比,NM组高血压、冠心病比例较高,两组在其他基线特征上无显著性差异。CA组滤器寿命长于NM组[12(8~24)h vs.8(8~13.13)h,P=0.003],NM组滤器衰竭的风险显著增高(HR=22.886,95%CI:3.935~133.12,P<0.001),但在8 h以内,两种抗凝滤器凝血率相当。CA组新发出血6例(10.17%),与NM组9例(13.64%)相当(P=0.552)。两组输血浆、红细胞、血小板均无差异。CA组代谢性碱中毒(5.08%)发生率略高于NM组(4.55%)(P=0.042)。结论在慢性肾衰竭伴高危出血患者CRRT中,使用NM与局部CA相比出血风险相当,抗凝效果稍差,但可满足8 h内的治疗需要。