慢性肾衰竭（CRF）核心病机为脾肾两虚、湿浊瘀毒互结，形成“精亏-络损-浊毒”的恶性循环。文章基于“肾藏精泄浊”理论，系统阐释固肾泄浊法论治CRF的理论依据及临床实践经验。固肾泄浊法以“固肾培本，分消浊毒”为纲，通过填精固摄恢复脾肾气化枢纽，通络活血改善肾络瘀阻，并分消三焦湿浊、瘀浊、毒浊，打破“精微漏泄－浊毒蓄积—络脉损伤”病理过程。唐阁主任基于此创立固肾泄浊方，临床观察表明该方治疗CRF患者疗效确切。固肾泄浊方组方注重脾肾互根、寒温相济、升降相因，动态调整固肾与泄浊权重，契合CRF不同分期病机演变。固肾泄浊法融合藏象学说、络病理论及三焦气化论，以“补泻兼施、藏泄并调”实现标本同治，为CRF中医药治疗提供新思路。

       The core pathological mechanism of chronic renal failure（CRF）involves deficiency of the spleen and kidney，intertwined with dampness，turbidity，blood stasis and toxins，forming a vicious cycle of “essence deficiency-collateral damage-turbid toxin accumulation” Based on the theory of “The kidney stores essence and reduces turbidity”，this article systematically elucidates the theoretical foundation and clinical application of  reinforcing the kidney and  reducing turbidity method for treating CRF．This method，guided by the principles of “securing the kidney to strengthen the root，and resolving turbid toxins”，aims to replenish essence and consolidate the kidney to restore the pivotal qi transformation functions of the spleen and kidney，to unblock collaterals and circulate blood to ameliorate renal collateral stasis，to resolve damp-turbidity，stasis-turbidity，and toxin-turbidity from the Sanjiao．This strategy breaks the pathological progression of “leakage of essence-accumulation of turbid toxins-damage to collaterals”．Professor Tang Ge formulate this Reinforcing the Kidney and Reducing Turbidity Formula（固肾泄浊方，Gushen Xiezhuo Fang）based on this approach．Clinical observations confirmed its significant efficacy in CRF patients．The formula focuses on the interdependence of the spleen and kidney，balance of warm and cool properties，and harmony of ascending and descending actions．It dynamically adjusts the therapeutic focus between kidney-securing and turbidity-reducing to align with the evolving pathogenesis across different CRF stages．Integrating theories of visceral manifestation（Zangxiang），collateral disease，and Sanjiao qi transformation，reinforcing the kidney and  reducing turbidity method achieves simultaneous treatment of  root and branch through “simultaneous supplementation and drainage，concurrent storing and discharging”．This approach offers a novel perspective for the traditional Chinese medicine treatment of CRF．

       目的   探讨溶酶体相关膜蛋白3（LAMP3）与肾癌发病风险之间的因果关系，为肾癌的分子致病机制提供新的理论依据。方法   基于全基因组关联研究（GWAS）数据，采用孟德尔随机化分析方法，评估LAMP3基因表达与肾癌的因果关系。并通过GEPIA2分析LAMP3表达对肾癌总体生存期（OS）及无病生存期（DFS）的关系。结果  LAMP3基因变异与肾癌风险呈正相关，提示LAMP3的表达可能增加肾癌的发病风险。此外，GEPIA2分析进一步显示，LAMP3的高表达与肾癌患者的低总体生存期（OS）及无病生存期（DFS）显著相关。结论   本研究通过孟德尔随机化分析探讨了LAMP3基因表达与肾癌的因果关系，结果表明LAMP3可能是肾癌的潜在致病因子，并与肾癌预后相关。这为肾癌的分子致病机制研究提供了重要的理论依据，并为未来的生物标志物和靶向治疗策略的开发提供了新的思路。

        Objective  To investigate the causal  relationship  between LAMP3 expression and  renal cancer  risk  using Mendelian randomization analysis，providing a theoretical basis for understanding the molecular mechanisms underlying renal cancer．Methods  This study utilized data from genome-wide association studies（GWAS）and employed Mendelian randomization analysis to assess the causal relationship between LAMP3 gene expression and renal cancer．Additionally，GEPIA2 was used to examine the association between LAMP3 expression and overall survival（OS）and disease-free survival（DFS）in renal cancer patients．Results  Variants in the LAMP3 gene were positively correlated with renal cancer risk，suggesting that LAMP3 expression may increase the likelihood of developing renal cancer．Furthermore，GEPIA2 analysis  revealed that high expression of LAMP3 was significantly associated with lower OS and DFS in renal cancer patients．Conclusions  This study explored the causal  relationship between LAMP3 gene expression and renal cancer through Mendelian randomization analysis．The results indicate that LAMP3 may be a potential pathogenic factor in renal cancer and is associated with poor prognosis．These findings provide important theoretical insights into the molecular mechanisms of  renal cancer and offer new perspectives for the development of biomarkers and targeted therapeutic strategies in the future．

       目的   探讨基于手术风险模型（RoSCo）评分系统的早期下床活动时机在肾肿瘤患者术后的应用效果。方法   选取2021年6月—2024年6月天津市人民医院收治的80例肾肿瘤患者，应用随机数字表法将其分为观察组与对照组，各40例。80例患者均实施腹腔镜肾部分切除术，对照组实施常规干预与术后早期下床活动干预，观察组实施常规干预与基于RoSCo评分系统的早期下床活动时机干预。对比两组术后康复水平，疼痛程度与睡眠质量，并发症发生率及生活质量。结果   观察组首次下床活动（19.30±4.17）h、排气（22.03±4.15）h、排便时间（29.93±5.58）h及术后住院时间（5.35±1.33）h短于对照组［（25.08±5.11）、（29.38±5.75）（34.20±5.98）（7.35±2.38）］h，对比差异有统计学意义（t=-5.540、-6.557、-3.308、-4.637，P＜0.05）；手术后，观察组视觉模拟量表（VAS）评分（3.93±0.92）分、PSQI评分（9.13±1.64）分高于对照组［（5.38±1.25）、（12.23±2.40）］分，对比差异有统计学意义（t=-5.902、-6.747，P＜0.05）；观察组并发症发生率7.50%低于对照组27.50%（χ ² =5.541，P=0.019）；手术后观察组SF-36评分相关维度［生理职能（84.45±9.74）、总体健康（60.75±10.65）、躯体疼痛（65.65±8.60）、生理功能（72.98±9.22）、活力（71.95±6.93）、社会功能（75.38±8.33）、精神健康（75.63±8.02）、情感职能（65.43±9.70）］分值高于对照组［生理职能（69.98±10.09）、总体健康（53.58±7.96）、躯体疼痛（58.83±9.35）、生理功能（65.68±7.58）、活力（62.83±12.80）、社会功能（68.98±10.99）、精神健康（71.58±9.69）、情感职能（57.90±6.86）］分值，对比差异有统计学意义（t=6.530、3.414、3.398、3.870、3.966、2.936、2.037、4.004，P＜0.05）。结论   针对肾肿瘤患者术后应用基于RoSCo评分系统的早期下床活动时机干预可促进其术后康复，辅助减轻术后疼痛程度，提升睡眠质量，降低并发症发生率，进一步提升患者生活质量。

      Objective  To explore the application effect of early mobilization timing  based on the Risk of  Surgical Complication（RoSCo）scoring system in renal tumor patients after surgery．Methods  From June 2021 to June 2024，80 patients with renal tumors admitted to the hospital were selected as the research subjects．They were  randomly divided into an observation group and a control group using a random number table method，with 40 patients in each group．All patients underwent laparoscopic partial nephrectomy．The control group received routine care and early postoperative mobilization intervention，while the observation group received routine care and early mobilization intervention based on the RoSCo scoring system．The postoperative rehabilitation level，pain level and sleep quality，incidence of complications，and quality of life between two groups were compared．Results  The first time getting out of bed，exhaust，defecation and postoperative hospitalization time in observation group（［19.30±4.17］h，［22.03±4.15］h，［29.93±5.58］h，［5.35±1.33］h） were shorter than those in control group（［25.08±5.11］h，［29.38±5.75］h，［34.20±5.98］h，［7.35±2.38］h），the  differences  were  statistically significant（t=-5.540，-6.557，-3.308，-4.637，all P＜0.05）．After operation，VAS score（3.93±0.92）and PSQI score（9.13±1.64）in the observation group were higher than those in the control group（［5.38±1.25］and［12.23±2.40］），and the differences were statistically significant（t=-5.902，-6.747，both P＜0.05）．The complication  rate of the observation group （7.50%） was lower than that of the control group（χ ² =5.541，P=0.019）．After operation，SF-36 scores in the observation group were physiological function（84.45±9.74），general health（60.75±10.65），physical pain（65.65±8.60），physiological function（72.98±9.22），vitality（71.95±6.93），social function（75.38±8.33），spiritual health（75.63±8.02）and emotional function（65.43±9.70），which were higher than those of the control group（physiological function［69.98±10.09］，general health［53.58±7.96］，physical pain［58.83±9.35］，physiological function［65.68±7.58］and vitality［62.83±12.80］，social function［68.98±10.99］，mental health［71.58±9.69］，emotional function［57.90±6.86］），and the differences were statistically significant（t=6.530，3.414，3.398，3.870，3.966，2.936，2.037，4.004，all P＜0.05）．Conclusions  Early mobilization intervention based on the RoSCo scoring system can promote postoperative recovery，assist in reducing postoperative pain，improve sleep quality，reduce the incidence of complications，and further enhance the quality of life of patients with renal tumors．

目的 探讨血清胱抑素C（SCys-C）、同型半胱氨酸（Hcy）及尿微量白蛋白（UmAlb）在高血压患者肾损害早期评估中的应用价值。方法 选择2022年9月—2023年9月期间福建中医药大学附属第三人民医院接收的150例高血压患者作为观察组,另选择健康体检者150例为对照组,测定肾小球滤过率（GFR）、SCys-C、Hcy、UmAlb,比较不同血压程度及对照组的各指标水平,比较观察组各指标检测阳性率及诊断符合率,依据GFR值评估肾损害程度,比较不同肾损害程度患者的SCys-C、Hcy、UmAlb水平。结果 高血压2级、高血压3级患者SCys-C、Hcy、UmAlb水平高于高血压1级患者（t=5.255、10.976、21.578,P<0.05;t=7.378、18.012、23.708,P<0.05）及对照组患者（t=8.308、19.675、31.891,P<0.05;t=10.661、31.511、21.578,P<0.05）,高血压3级患者高于高血压2级患者（t=2.776、12.725、7.779,P<0.05）。观察组肾损害患者SCys-C、Hcy、UmAlb的阳性率79.41%、73.53%、83.82%高于无肾损害患者的阳性率6.10%、4.88%、6.10%（χ²=83.733、76.040、92.613,P<0.05）。观察组中重度肾损害、轻度肾损害患者的SCys-C、Hcy、UmAlb水平高于无损害患者（t=7.567、24.214、30.836,P<0.05;t=5.783、16.054、25.164,P<0.05）,中重度肾损害高于轻度肾损害患者（t=2.685、7.179、9.561,P<0.05）。结论 高血压分级越高患者的SCys-C、Hcy、UmAlb水平越高,各指标联合检测的阳性率高,而且SCys-C、Hcy、UmAlb水平越高,肾损害程度越严重。

Objective To explore the application value of serum cystatin C（SCys-C）,homocysteine（Hcy） and urinary microalbumin（UmAlb）in early assessment of renal damage in hypertensive patients．Methods A total of 150 hypertensive patients admitted to the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from September 2022 to September 2023 were selected as the observation group,and 150 healthy individuals were selected as the control group．Glomerular filtration rate（GFR）,serum cystatin C（SCys-C）,homocysteine（Hcy）,and UmAlb were measured,and the levels of various indicators in different blood pressure levels and the control group were compared．The positive rate and diagnostic accuracy of each indicator in the observation group were compared,and the degree of renal damage was evaluated based on GFR values．The levels of SCys-C,Hcy and UmAlb in patients with different degrees of renal damage were compared．Results The levels of SCys-C,Hcy and UmAlb in patients with grade 2 and grade 3 hypertension were significantly higher than those in patients with grade 1 hypertension（t=5.255,10.976,21.578,P<0.05;t=7.378,18.012,23.708,P<0.05）,as well as in the control group（t=8.308,19.675,31.891,P<0.05;t=10.661,31.511,21.578,P<0.05）,patients with grade 3 hypertension were significantly higher than those with grade 2 hypertension（t=2.776,12.725,7.779,P<0.05）．The positive rates of SCys-C,Hcy and UmAlb in patients with renal injury in the observation group were 79.41%,73.53% and 83.82%,which were significantly higher than the positive rates of 6.10%,4.88% and 6.10% in patients without renal injury（χ²=83.733,76.040,92.613,P<0.05）．The levels of SCys-C,Hcy and UmAlb in patients with severe and mild kidney damage in the observation group were significantly higher than those in patients without damage（t=7.567,24.214,30.836,P<0.05;t=5.783,16.054,25.164,P<0.05）,patients with moderate to severe kidney damage were significantly higher than those with mild kidney damage（t=2.685,7.179,9.561,P<0.05）．Conclusions The higher the grading of hypertension,the higher the levels of SCys-C,Hcy and UmAlb in patients,and the higher the positive rate of combined detection of various indicators．Moreover,the higher the levels of SCys-C,Hcy and UmAlb,the more severe the renal damage．

目的 探讨宣清导浊汤加减方联合血液透析治疗对老年慢性肾衰竭（CRF）患者肾功能、微炎症状态和毒素清除率的影响。方法 回顾性选取2019年10月—2022年10月我院收治的82例老年CRF患者,将其根据治疗方法分为联合组与单一组,每组41例。单一组仅采取血液透析治疗,联合组联合宣清导浊汤加减方治疗,对比两组患者治疗前后中医证候积分、毒素清除率、炎症因子变化。结果 治疗后,两组患者口淡不渴、肢体麻木、腰膝酸软、倦怠乏力、食少纳呆以及面色晦暗相关中医证候积分均降低,且联合组低于单一组（P<0.05）;治疗后两组患者血肌酐、尿素氮、血β₂-微球蛋白均降低,联合组低于单一组（P<0.05）;治疗后两组患者白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α炎性因子水平明显降低,且联合组更低（P<0.05）。两组在治疗期间均无不良反应。结论 宣清导浊汤加减方联合血液透析治疗老年CRF患者效果较佳,可通过降低机体炎症因子表达水平、提高毒素清除率来改善患者临床症状,且不会增加不良反应。

Objective To explore the effect of Xuanqing Daozhuo Decoction modified formula combined with hemodialysis treatment on renal function,micro inflammatory status,and toxin clearance rate in elderly patients with chronic renal failure（CRF）．Methods Retrospectively,82 elderly CRF patients admitted to our hospital from October 2019 to October 2022 were selected and divided into a combination group and a single group according to the treatment methods,with 41 cases in each group． The single group was treated with hemodialysis only,and the combined group was treated with Xuanqing Daozhuo Decoction modified formula additionally．The changes of TCM syndrome scores,toxin clearance rate and inflammatory factors before and after treatment were compared between the two groups．Results After treatment,the scores of TCM syndroms including tasteless mouth and no thirst,numbness of limbs,soreness and weakness of waist and knee,fatigue,poor appetite and sluggish stomach were all decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,serum creatinine,blood urea nitrogen and β₂-microglobulin were decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,the levels of interleukin-6,C-reactive protein and tumor necrosis factor-α inflammatory factors were significantly decreased in 2 groups,which were lower in combination group（P<0.05）．The two groups had no adverse effects during the treatment period．Conclusions Xuanqing Daozhuo Decoction modified formula and hemodialysis can improve the clinical symptoms of elderly patients with CRF,reduce the expression level of inflammatory factors in patients,and increase the clearance rate of toxins in patients,and does not increase the adverse effects．

目的 分析恩格列净对2型心肾综合征（CRS）患者的治疗效果。方法 研究于2021年10月—2023年10月进行,随机抽取88例2型CRS患者,经计算机程序随机分成对照组（44例,给予常规治疗）、实验组（44例,在常规治疗的同时加用恩格列净）,通过对比两组患者心、肾功能指标来评估疗效,并记录两组患者治疗过程中发生的不良反应。结果 治疗后,实验组LAD、LVED低于对照组,而LVEF高于对照组;实验组血清肌酐、尿酸等肾功能指标水平均低于对照组（均P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 对于2型CRS患者,恩格列净可促进其心、肾功能的改善,且无过多不良反应,安全性理想,治疗效果可观,值得推广。

Objective To analyze the therapeutic effect of empagliflozin on patients with type 2 cardiorenal syndrome（CRS）．Methods The study was conducted from October 2021 to October 2023,and 88 patients with type 2 CRS were randomly selected and divided into control group（44 cases,receiving conventional treatment）and experimental group（44 cases,receiving conventional treatment combined with englaglitzin）by computer program．The efficacy was evaluated by comparing cardiac and renal function indexes and adverse reactions．Results After treatment,the LAD and LVED of the experimental group were lower than those of the control group,while LVEF was higher than that of the control group．The levels of serum creatinine,uric acid and other renal function indexes in the experimental group were lower than those in the control group after treatment（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions For patients with type 2 CRS,empagliflozin can promote the improvement of cardiac and renal function without many side effects,with ideal safety and considerable therapeutic effect,which is worthy of promotion．

目的 探讨福辛普利钠与多沙唑嗪联合对肾性高血压的治疗效果,并分析治疗后患者血压控制情况及相关活性因子变化。方法 前瞻性选取天津市北辰区北辰医院2020年10月—2023年10月收治的98例肾性高血压患者,以随机数字表法作为分组方式,分为观察组（n=49）与对照组（n=49）。对照组患者采取福辛普利钠治疗,观察组在对照组基础上增加多沙唑嗪治疗。对比两组的血压控制效果,治疗前后一氧化氮（NO）、内皮素（ET）、血管紧张素Ⅱ（AngⅡ）相关生物活性因子水平变化,肾功能变化,不良反应发生情况。结果 观察组总有效率89.79%,高于对照组的73.47%（χ²=4.356,P=0.037）;治疗后两组AngⅡ、ET水平均降低,且观察组[（13.62±2.24）ng/mL、（68.62±6.66）ng/L]低于对照组[（16.25±4.32）ng/mL、（74.26±9.35）ng/L],对比差异有统计学意义（t₁=3.783,t₂=3.439,P<0.001）;NO水平升高,观察组[（54.26±3.42）μmol/L]高于对照组[（50.51±2.37）μmol/L],对比差异有统计学意义（t=6.309,P<0.001）;治疗后两组血肌酐（Scr）、尿素氮（BUN）、胱抑素C（CysC）水平均降低,且观察组[（404.36±92.12）μmoI/ L、（13.34±4.31）mmol / L、（2.19±0.24）mg / L]低于对照组[（443.49±80.19）μmoI / L、（15.07±4.23）mmol / L、（2.87±0.38）mg / L],对比有统计学意义（t₁=2.243,P₁=0.027;t₂=2.005,P₂=0.048;t₃=10.591,P₃<0.001）;两组不良反应发生率对比差异无统计学意义（10.20% vs 8.16%,P>0.05）。结论 对肾性高血压患者,采取福辛普利钠与多沙唑嗪联合治疗可提升其血压控制效果,改善血管内皮功能,降低血管紧张素Ⅱ表达水平,改善肾功能,且不增加不良反应。

Objective To explore the therapeutic effect of the combination of fosinopril sodium and doxazosin on renal hypertension,and to analyze the blood pressure control and changes in related active factors in patients after treatment．Methods A prospective study was conducted on 98 patients with renal hypertension admitted to Beichen Hospital from October 2020 to October 2023．Random number table method was used as the grouping method,and they were divided into an observation group（n=49）and a control group（n=49）．The control group patients were treated with fosinopril sodium,while the observation group was treated with doxazosin additionally．The blood pressure control effect,changes in levels of NO,ET,Ang II related bioactive factors,renal function changes before and after treatment,and their adverse reactions were compared．Results The total response rate in the observation group was 89.79%,which was higher than 73.47% in the control group（χ²=4.356,P=0.037）．Ang Ⅱ and ET levels in both groups decreased after treatment,the observation group[（13.62±2.24）ng/mL,（68.62±6.66）ng/L] was lower than the control group[（16.25±4.32）ng/mL,（74.26±9.35）ng/L],the difference was statistically significant（t₁=3.783,t₂=3.439,P<0.001）．Elevated NO levels in the observation group[（54.26±3.42）μmol/L] was higher than the control group[（50.51±2.37）μmol/L],the difference was statistically significant（t=6.309,P<0.001）．Blood Scr,BUN,and CysC levels were decreased in both treatment groups,and those in observation group[（404.36±92.12）μmoI/L,（13.34±4.31）mmol/L,（2.19±0.24）mg/L] were lower than the control group[（443.49±80.19）μmoI/L,（15.07±4.23）mmol/L,（2.87±0.38）mg/L],the differences were statistically significant（t₁=2.243,P₁=0.027;t₂=2.005,P₂=0.048;t₃=10.591,P₃<0.001;P<0.05）．There was no difference in the incidence of adverse effects between the two groups（10.20% vs 8.16%,P>0.05）．Conclusions The combination treatment of fosinopril sodium and doxazosin can improve the blood pressure control effect,improve endothelial function,reduce the expression level of angiotensin II,and improve renal function in patients with renal hypertension,with high safety．

目的 探讨终末期肾病患者血液透析中实施基于依从性曲线变化规律的阶段性护理的效果。方法 选择2022年1月—2023年10月濮阳市人民医院收治的接受血液透析治疗的86例终末期肾病患者,将其通过单双号抽签的方式分组,即对照组与观察组,各43例,前者实施常规护理,后者在此基础上实施基于依从性曲线变化规律的阶段性护理,对比两组患者护理前后心理状态评分情况、生活质量评分情况及治疗依从性。结果 两组患者护理前后正性负性情绪量表（PANAS评分有一定差距,其中负性情绪显著降低,正性情绪显著提升,而护理后观察组负性情绪评分为（11.67±2.55）分,低于对照组的（16.11±3.02）分,正性情绪为（25.07±5.28）,高于对照组的（20.11±5.23）分（t=7.366、4.376,P<0.05）;护理后观察组生活质量综合评定量表（GQOLI-74）躯体、心理、社会及物质生活等维度评分分别为（82.17±7.11）分、（82.02±7.45）分、（81.11±7.78）分及（81.11±7.42）分,高于对照组的（71.22±7.23）分、（72.12±7.56）分、（71.23±7.45）分及（70.23±7.33）分（t=7.081、6.116、6.015、6.840,P<0.05）;观察组（95.35%）与对照组（76.74%）的治疗依从性比较,前者更高（χ²=6.198,P<0.05）。结论 基于依从性曲线变化规律的阶段性护理对于接受血液透析治疗的终末期肾病患者,不仅有助于调整其心理状态,还有助于提高其治疗依从性,使其生活质量也得以全面提高。

Objective To explore the effect of implementing phased nursing based on compliance curve changes in hemodialysis for end-stage renal disease patients. Methods The research deadline was from January,2022 to October,2023．The research object was 86 patients with end-stage renal disease who received hemodialysis treatment in Puyang People's Hospital,and they were divided into control group and observation group with 43 patients in each group by odd and even numbers．The former was given routine care,while the latter was given stage nursing based on the change of compliance curve．The psychological state score,quality of life score and treatment compliance of the two groups were compared before and after care. Results There was a certain difference in the Positive and Negative Affect Scale（PANAS）scores between the two groups before and after nursing,in which the negative emotion was significantly reduced and the positive emotion was significantly improved．After nursing,the negative emotion score of the observation group was（11.67±2.55）,which was significantly lower than that of the control group（16.11±3.02）,and the positive emotion score was（25.07±5.28）,which was significantly higher than that of the control group（20.11±5.23）（t=7.366,4.376,P<0.05）．After nursing,the scores of Generic Quality of Life Inventory-74（GQOLI-74）in the observation group were（82.17±7.11）,（82.02±7.45）,（81.11±7.78）and（81.11±7.42）,which were significantly higher than those in the control group（71.22±7.23）,（72.12±7.56）,（71.23±7.45）and（70.23±7.33）（t=7.081,6.116,6.015,6.840,P<0.05）．The treatment compliance of the observation group（95.35%）was higher than that of the control group（76.74%）（χ²=6.198,P<0.05）. Conclusions Choosing stage nursing based on the variation pattern of compliance curve for end-stage renal disease patients undergoing hemodialysis not only helps to adjust their psychological state,but also improves their treatment compliance,leading to a comprehensive improvement in their quality of life．

目的 探讨术前血清肌酐（sCr）、估测肾小球滤过率（eGFR）对急性A型夹层术后急性肾损伤3级（AKI 3级）及连续性肾脏替代治疗（CRRT）的影响。方法 回顾性分析广州市第一人民医院2017年1月—2022年12月6年间收治的143例行Bentall或升主动脉置换+Sun’s手术的急性Stanford A型夹层患者术前sCr及eGFR、术后24 h及48 h sCr、尿量、术后AKI及CRRT情况。应用ROC曲线（受试者特征曲线）分析术前sCr、eGFR对术后AKI 3级及CRRT的影响。结果 术后AKI 3级27例（18.9%）,CRRT 14例（9.8%）。发生AKI 3级及CRRT的患者术前sCr水平升高（AKI3级与AKI0-2级组间比较t’=-2.722,P=0.011,CRRT与非CRRT组间比较t’=-2.184,P=0.048）、eGFR降低（AKI3级与AKI0-2级组间比较t=4.585,P<0.001,CRRT与非CRRT组间比较t=4.932,P<0.001）。ROC曲线分析提示术前sCr可有效预测术后AKI 3级（AUC 0.768,临界点123 μmol/L,灵敏度67%,特异度85%）及CRRT（AUC 0.848,临界点137.5 μmol/L,灵敏度71%,特异度88%）。eGFR可预测AKI 3级[AUC 0.761,临界点56.25 mL/（min·1.73 m²）,灵敏度67%,特异度83%]及CRRT[AUC 0.855,临界点47.6 mL/（min·1.73 m²）,灵敏度71%,特异度87%]。手术合并低心排血量等肾灌注不良时,eGFR低于75.9 mL/（min·1.73 m²）,术后CRRT发生率增加。结论 急性A型夹层术前sCr及eGFR影响术后AKI 3级及CRRT的发生。sCr>123 μmol/L、eGFR低于58.25 mL/（min·1.73 m²）的患者术后AKI 3级发生率增加。sCr>137.5 μmol/L、eGFR低于47.6 mL/（min·1.73 m²）,或合并肾灌注不良的患者术后CRRT发生率增加。

Objective To explore the influences of preoperative serum creatinine（sCr）and estimated glomerular filtration rate（eGFR）on postoperative stage 3 acute kidney injury（AKI）or continuous renal replacement treatment（CRRT）in patients with acute Stanford type A aortic dissection（ATAAD）．Methods From July 2017 to December 2022,143 ATAAD patients who underwent Bentall or ascending aortic replacement and total arch replacement and stented elephant trunk were retrospective analyzed．Data included preoperative sCr and eGFR,postoperative sCr,eGFR,urine volume,AKI and CRRT at 24 h and 48 h．Receiver operating characteristic（ROC）curve were used to analyze the influences of preoperative sCr and eGFR on stage 3 AKI and CRRT．Results Stage 3 AKI occurred in 27（18.9%）patients,including 14 patients who required CRRT．sCr was significantly higher in stage 3 AKI or CRRT group（AKI 3 vs AKI 0-2 group：t’=-2.722,P=0.011,CRRT vs non-CRRT group：t’=-2.184,P=0.048）,and eGFR was significantly lower（AKI 3 vs AKI 0-2 group：t=4.585,P<0.001,CRRT vs non-CRRT group：t=4.932,P<0.001）．Preoperative sCr could effectively predict postoperative stage 3 AKI（AUC 0.768,the best cut-off value was 123 μmol/L,sensitivity 67%,specificity 85%）and CRRT（AUC 0.848,the best cut-off value was 137.5 μmol/L,sensitivity 71%,specificity 88%）．Preoperative eGFR could predict postoperative stage 3 AKI（AUC 0.761,the best cut-off value was 56.25mL/（min·1.73 m²）,sensitivity 67%,specificity 83%）and CRRT（AUC 0.855,the best cut-off value was 47.6 mL/（min·1.73 m²）,sensitivity 71%,specificity 87%）．CRRT requirement significantly increased in patients with eGFR lower than 75.9 mL/（min·1.73 m²） who complicated with peripheral malperfusion．Conclusion sPreoperative sCr and eGFR have significant influences on incidence of postoperative stage 3 AKI and CRRT．Postoperative stage 3 AKI significantly increase in patients with sCr more than 123 μmol/L or eGFR lower than 56.25mL/（min·1.73 m²）．Postoperative CRRT significantly increase in patients with sCr more than 137.5 μmol/L,eGFR lower than 47.6mL/（min·1.73 m²）,or peripheral malperfusion．

目的 观察百令胶囊辅助缬沙坦治疗IgA肾病效果及对患者肾功能、细胞免疫调节、尿足细胞标志蛋白的影响。方法 选取2019年5月—2021年5月西部战区总医院肾内科收治经肾活检确诊为IgA肾病,筛选治疗方案中尚未使用激素及免疫抑制剂的80例患者,按住院先后顺序随机分为观察组和对照组,每组各40例。对照组给予缬沙坦治疗,观察组给予百令胶囊辅助缬沙坦治疗,治疗12周后,比较2组的疗效、治疗前后肾功能指标[24 h蛋白尿(24 h Upro)、尿素氮(BUN)、血肌酐(SCr)、尿红细胞(RBC)计数]、1型/2型辅助性T细胞(Th1/Th2)代表细胞因子[γ-干扰素(IFN-γ)、白介素-4(IL-4)]、尿足细胞标志蛋白[尿足萼糖蛋白(PCX)、尿足细胞B7-1分子(B7-1)]水平。结果 治疗12周后,观察组的治疗总有效率为95.0%,高于对照组的82.5%;观察组的24 h Upro、BUN、SCr、尿RBC计数低于对照组,IFN-γ、Th1/Th2低于对照组、IL-4高于对照组,尿PCX、B7-1水平低于对照组;差异均有统计学意义(P<0.05)。结论 百令胶囊辅助缬沙坦治疗IgA肾病患者,可以提高临床疗效,有效保护患者肾功能,调节其免疫状态,减轻肾损伤。

Objective To observe the effects of Bailing capsules assisting valsartan in the treatment of IgA nephropathy and its influence on renal function, cellular immune regulation and urine prodocytes marker protein. Methods From May 2019 to May 2021, 80 patients with IgA nephropathy confirmed by renal biopsy in the Nephrology Department of Western Theatre Command General Hospital, who had not used hormones or immunosuppressants in the treatment were selected.Patients were divided into observation group and control group according to the order of hospitalization, 40 cases in each group.The control group was given valsartan, and the observation group was given Bailing capsules and valsartan.After 12 weeks of treatment, the efficacy, the levels of renal function indexes [24 h proteinuria (24 h Upro), urea nitrogen (BUN), serum creatinine (SCr), urinary red blood cell (RBC) count], type 1/type 2 helper T cells (Th1/Th2) represent cytokines [interferon-γ (IFN-γ), interleukin-4 (IL-4)], urine prodocytes marker protein [urine podocalyxin (PCX), urinary podocyte B7-1 molecule (B7-1)] before and after treatment were compared between the two groups. Results After treatment, the total effective rate in observation group was higher than that in control group (95.0% vs 82.5%).The 24 h Upro, BUN, SCr levels and urine RBC count in observation group were lower than those in control group, IFN-γ and Th1/Th2 levels were lower than those in control group, the IL-4 level was higher than that in control group, and the levels of urine PCX and B7-1 were lower than those in control group.Those differences were statistically significant (P<0.05). Conclusions Bailing capsules assisting valsartan in the treatment of IgA nephropathy can improve clinical efficacy, effectively protect the renal function of patients, regulate the immune status, and alleviate renal injury.