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陣發性睡眠性血紅蛋白尿繼發霜樣樹枝狀視網膜血管炎1例

Clinical Significance of the Detection of CD55, CD59 Expression Deletion in Patients with Cytopenia

目的　檢測血細胞減少患者外周血紅細胞和中性粒細胞細胞膜糖基磷脂酰肌醇（GPI）連接的補體調節蛋白衰變加速因子（CD55)和膜反應性溶血抑制物（CD59）表達情況，并探討其臨床意義。 方法　2006年7月－2011年3月，采用直接免疫熒光標記法流式細胞儀檢測182例血細胞減少患者外周血CD55及CD59表達情況，其中陣發性睡眠性血紅蛋白尿（PNH）9例，再生障礙性貧血（AA）-PNH綜合征8例，AA 83例，骨髓增生異常綜合征51例，自身免疫性溶血性貧血11例，造血功能停滯6例，缺鐵性貧血7例，巨幼細胞性貧血4例，脾功能亢進3例。 結果　PNH及AA-PNH患者CD55、CD59抗原缺失率均較其他血細胞減少者明顯增高。 結論　流式細胞儀檢測外周血中紅細胞和中性粒細胞膜CD55和CD59抗原表達缺失率是目前診斷PNH可靠和敏感的方法，也是對PNH、AA-PNH早期診斷敏感指標，并且PNH克隆檢測還能為診斷疾病提供鑒別診斷依據。

Renal toxicity of intravitreal injection of anti-vascular endothelial growth factor drugs in the treatment of retinopathy

Anti-vascular endothelial growth factor (VEGF) drugs have been widely used in clinic by inhibiting angiogenesis to treat ocular diseases such as malignant tumors and diabetic retinopathy. However, recent studies have shown that intravitreal injection of anti-VEGF drugs may have significant systemic absorption, leading to a series of renal damages such as worsening hypertension, proteinuria, new glomerular disease, and thrombotic microangiopathy. This article reviews the renal toxicity of intravitreal injection of anti-VEGF drugs in the treatment of diabetic retinopathy and other ocular diseases, aiming to provide recommendations for clinicians.

微量白蛋白尿在原發性高血壓患者中的臨床意義

微量白蛋白尿是指尿中白蛋白排泄率超過正常范圍，受血壓水平、血糖、血脂、體重等諸多因素的影響，是高血壓早期腎臟損害的標志，也是全身血管內皮細胞受損的重要標志之一。微量白蛋白尿具有重要意義，是高血壓患者心血管疾病的獨立危險因子。原發性高血壓患者應進行微量白蛋白尿篩查。

Effect of Proteinuria on Residual Renal Function in Peritoneal Dialysis Patients

ObjectiveTo observe whether proteinuria is relate to the decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. MethodsThis is a prospective cohort study including 45 PD patients (underwent PD between January 2011 and January 2013) with a 12-month follow-up. All the patients were divided into 2 groups with respect to the initial proteinuria level: massive proteinuria group A (n=20) and non-massive proteinuria group B (n=25) at baseline. We established regression models to do univariate analysis and multivariate analysis of the relationship between the decline of RRF≥50% of baseline and the indices of age, sex, PD-associated peritonitis, baseliner residual glomerular filtration rate (rGFR), initial proteinuria, and use of ACEI/ARB. ResultsThe primary outcome (RRF>50% of baseline) at 12 months was 65% in group A, and 80% in group B (P<0.05). Based both on the results of univariate and multivariate Cox regression analysis, non-massive proteinuria and higher rGFR at baseline were factors to protect RRF from decline (P<0.05). ConclusionThe study demonstrates that massive proteinuria and lower rGFR at baseline may be associated with a rapid decline of RRF in PD patients. Treatment aimed at reducing albuminuria may lead to protect RRF and improve life quality of patients.

The Relationship between Antioxidant Activity of Hyper Density Lipoprotein and Microalbuminuria in Patients with Hypertension

ObjectiveTo discuss the relationship between microalbuminuria (MAU) and antioxidant activity of plasma hyper density lipoprotein (HDL) in hypertensive patients, and investigate whether MAU could be a predictor of HDL antioxidant activity. MethodFrom December 2007 to March 2009, sixty consecutive primary hypertensive patients from the inpatient and outpatient departments of West China Hospital and Sichuan Electric Power Central Hospital were included in the study, and 30 healthy volunteers served as controls. MAU, plasma HDL and paraoxonase (PON1) activity were tested. ResultsPON1 activity was lower in hypertensive patients than the controls (P<0.05), and this degree of decline was positively related to MAU (P<0.05). ConclusionMAU reflects PON1 activity in hypertensive patients and can be a predictor to judge plasma HDL function in patients with hypertension.

陣發性睡眠性血紅蛋白尿癥的靶向治療

陣發性睡眠性血紅蛋白尿癥（PNH）是一種罕見的造血干細胞克隆性的溶血性疾病，目前治療困難。重組人源型抗補體蛋白C5單克隆抗體（eculizumab）的出現及臨床應用開啟了PNH靶向治療的新篇章。eculizumab通過與補體C5結合，防止C5裂解形成C5b及膜攻擊復合物，減少溶血，降低輸血需求，提高患者生活質量。2007年，eculizumab分別被美國食品和藥物管理局、歐盟委員會通過用于治療PNH血管內溶血。現對PNH患者使用eculizumab靶向治療作一綜述。

2型糖尿病并發視網膜病變患者血清人類軟骨糖蛋白39及其與尿白蛋白排泄率的關系

Evidence-based Prevention and Treatment of Microalbuminuria in Patient with Type 2 Diabetes

Objective　To search evidence of angiotensin-converting-enzyme inhibitors for microalbumin-uria in type 2 diabetes for guiding clinical practice. Methods　We searched MEDLINE （ 1970 -Jun. 2005 ） to identify randomized controlled trials （RCT）of the effect on angiotensin-converting-enzyme inhibitors to prevent microalbuminuria in type 2 diabetes. Results　One RCT （n =1 204）was identified. The result showed that angiotensin-converting-enzyme inhibitors were significantly more effective in prevention of microalbuminuria than other medicines in type 2 diabetes. However, angiotensin-converting-enzyme inhibitors may increase the risk of cardiac mortality. We explained the evidence to patients and they were satisfied with our explanation. Conclusions　Angiotensin-converting-enzyme inhibitors can decrease the incidence of microalbuminuria in patients with type 2 diabetes and hypertension.

The Clinical Analysis of 48 Cases of Psoriasis with Proteinuria

目的：探討銀屑病合并蛋白尿患者的臨床特點。方法：回顧性分析1996年1月～2005年8月收治的銀屑病合并蛋白尿者臨床資料，并與銀屑病非蛋白尿者的臨床特點比較。結果：銀屑病合并不明原因蛋白尿48例，皮膚受累面積與蛋白尿程度無相關關系（P＞0.05），但銀屑病合并蛋白尿組的銀屑病病程更短,腎臟病理熒光表現為IgA沉積為主。蛋白尿組皮膚受累面積與非蛋白尿組皮膚受累面積比較，無統計學意義（P＞0.05），蛋白尿組和非蛋白尿組的病程也無統計學差異（P＞0.05）。結論：銀屑病合并不明原因蛋白尿值得重視，有必要對其發病機制、臨床特點、病理特征進行深入的研究。