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Clinical Analysis on 180 Children with Henoch-Schnlein Purpura Nephritis

目的：分析小兒紫癜性腎炎的臨床特點。方法：回顧分析兩院兒科最近8年收治的小兒紫癜性腎炎180例的臨床表現、實驗室檢查結果，治療和預后等方面的資料。結果(1)臨床以血尿蛋白尿型最多見(61/180)，其次為急性腎炎型(36/180)、腎病綜合征型(31/180)和單純血尿或蛋白尿型(25/180)。(2)重癥病兒短期使用激素可改善腎臟損害。(3)所有病例均有必要長期隨訪。結論：小兒紫癜性腎炎絕大多數預后良好，但病情反復不愈者可發展為終末期腎臟損害，故需要長期隨訪。

乙酰肝素酶與糖尿病腎病

【摘要】　乙酰肝素酶（heparanase，HPA）是目前發現的哺乳動物細胞中唯一能切割細胞外基質中硫酸肝素蛋白多糖側鏈的內源性糖苷酶。因其可促進腫瘤細胞的浸潤和轉移，還可以促進腫瘤細胞生長和微血管形成，而被視為是抗腫瘤、抗炎癥的理想靶點。研究表明HPA可以降解腎小球基底膜硫酸乙酰肝素多糖側鏈，造成腎小球基底膜選擇性濾過蛋白質功能下降，與糖尿病腎病（diabetic nephropathy，DN）蛋白尿的產生密切相關。HPA活性的高低對糖尿病腎病的研究有著重要的意義。現將HPA與DN之間的研究進展作一綜述。

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.

血管緊張素Ⅱ1型受體及血管緊張素Ⅰ轉化酶 基因多態與 2型糖尿病視網膜病變的關系

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.

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 Microalbuminuria and Atherosclerosis in Aged Patients with Essential Hypertension

目的:探討老年原發性高血壓(EH)患者早期腎損害指標微量白蛋白尿(MAU)和動脈粥樣硬化的早期征象頸動脈內中膜厚度(C-IMT)之間的關系。方法:99名老年EH患者按尿白蛋白/肌酐比值(ACR)分為異常ACR組和正常ACR組,對兩組的C-IMT、斑塊發生率、ACR水平及血中尿素氮(Bun)、肌酐(Cr)、總膽固醇(TC)、甘油三酯(TG)、血糖(Glu)、體重指數(BMI)等進行分析和比較。結果:異常ACR組的年齡、尿酸、ACR、C-IMT、24小時平均收縮壓,平均動脈壓及脈壓均高于正常ACR組(Plt;0.05);且C-IMT與ACR水平呈正相關(Plt;0.05)。結論:微量白蛋白尿和頸動脈IMT密切相關,提示微量白蛋白尿不僅和老年高血壓腎臟病變有關,也是亞臨床期動脈粥樣硬化的早期標志.

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

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。