目的 本研究旨在探讨压迫止血法在减少实时超声引导经皮肾穿刺术后并发症中的价值。方法 选取2011年9月1日—2016年12月31日于我院行超声引导下经皮肾穿刺术患者405例。按肾穿刺后是否行立即行压迫止血法分2组,非压迫止血法为对照组(A组),压迫止血法为研究组(B组)。记录患者术前血压、凝血四项、血红蛋白、血小板等指标。记录穿刺次数及每次穿刺所取标本长度。术后24 h复查穿刺点出血情况及肾周血肿情况。穿刺术后24 h内监测血尿情况。结果 与非采用压迫止血法超声定位经皮肾穿刺术后(A组)相比,压迫止血法术后(B组)并发症发生率较低, A组肉眼血尿发生率为8.8 %,B组为4 %,差异有统计学意义(P=0.048);A组24 h肾周血肿发生率为 62.1%,B组为49.8%,差异有统计学意义(P=0.042)。结论 实时超声引导下经皮肾穿刺后立即行压迫止血法,可有效减少术后肾周血肿和血尿。

Objective To discuss how to reduce the post-biopsy complications of real-time ultrasound-guided percutaneous renal biopsy by manual compression. Methods A total of 405 ultrasound-guided biopsies were performed in 404 patients in our hospital, between September 2011 and January 2017, were recruited to this study. They were divided into 2 groups, group A biopsy without manual compression, and group B biopsy with manual compression. All patients' records were retrospectively reviewed and both pre and post biopsy information, as well as complications were collected. Results The gross hematuria rate is 8.8 % (16 patients) in group A, but in group B, the rate is 4 %. The perirenal hematoma rate at 24 h after biopsy in group A detected by ultrasound is 62.1% (113 patients), and 49.8% (116 patients, P vs group A=0.042) in group B. Conclusion Manual compression to the puncture site reduced complications like perirenal hematoma and gross hematuria after real-time ultrasound-guided renal biopsy.

目的 分析超声引导下经皮肾穿刺活检术对弥漫性肾病进行病理诊断的临床应用价值。方法 回顾性分析我院275例弥漫性肾病患者经超声引导下行经皮肾穿刺活检术进行诊断的情况,针对上述患者的穿刺活检情况、穿刺满意度、取材成功率、并发症发生状况、弥漫性肾病病理分型结果以及术后诊断更正的情况进行分析。结果 275例患者穿刺满意度、取材成功率、并发症总发生率分别为94.91%,100%、10.91%。275例患者术后并发症的发生与年龄、穿刺次数、肾实质厚度、术前血肌酐水平有关。275例患者以膜性肾病、IgA肾病居多,分别占比23.27%、18.55%。275例患者术后诊断更正率为19.79%。结论 超声引导下经皮肾穿刺活检术是一种安全有效的弥漫性肾病诊断方法,其术后并发症发生率较低且较轻。在弥漫性肾病病理分型诊断中以膜性肾病、IgA肾病的发病率较高。超声引导下经皮肾穿刺活检术可早期诊断弥漫性肾病的病理类型,为确定治疗方案提供可靠依据,改善肾脏疾病的预后。

Objective To analyze the clinical value of ultrasound-guided percutaneous renal biopsy for pathological diagnosis of diffuse renal disease. Methods Retrospective analysis of 275 patients with diffuse renal disease in our hospital underwent ultrasound-guided percutaneous renal biopsy for diagnosis. According to the above-mentioned patients' biopsy status,puncture satisfaction,success rate of material extraction,complications,and diffuse results of pathological typing of nephropathy and correction of postoperative diagnosis were analyzed. Results The satisfaction rate of puncture,the success rate of material extraction and the total incidence of complications were 94%,100%,and 10.91%,respectively. The incidence of postoperative complications in 275 patients was related to age,number of punctures,thickness of renal parenchyma,and preoperative serum creatinine levels. Membrane nephropathy and IgA nephropathy were the most common in 275 patients,accounting for 23.27% and 18.55% respectively. The correction rate of postoperative diagnosis in 275 patients was 19.79%. Conclusion Ultrasound-guided percutaneous renal biopsy is a safe and effective method for diagnosing diffuse nephropathy,and the incidence of postoperative complications is low and mild. Membrane nephropathy and IgA nephropathy have a higher incidence in the diagnosis of diffuse nephropathy. Ultrasound-guided percutaneous renal biopsy may early diagnose the pathological type of diffuse renal disease,provide a reliable basis for determining the treatment plan,and improve the prognosis of renal disease.

目的 探讨四金石灵膏联合间苯三酚治疗输尿管结石伴肾绞痛的应用价值。方法 随机将76例输尿管结石伴肾绞痛患者分为两组,以接受中药安慰剂联合间苯三酚治疗者为对照组,以接受四金石灵膏联合间苯三酚治疗者为观察组,每组38例。对比两组临床治疗效果,并分析尿液相关指标的变化情况。结果 两组7 d治疗过程中VAS评分及尿Ga水平呈降低趋势、WHOQL-BREF评分及尿OPN水平呈升高趋势(P<0.05),而治疗3 d及7 d后,治疗组VAS评分及尿Ga水平低于对照组、WHOQL-BREF评分及尿OPN水平高于对照组(P<0.05)。同时,治疗7 d后,观察组排石率高于对照组(P<0.05),而观察组排石时间及止痛时间短于对照组(P<0.05)。此外,治疗7 d后,治疗组治疗总有效率高于对照组(P<0.05),而两组间治疗不良反应发生率比较未见差异有统计学意义(P>0.05)。结论 四金石灵膏联合间苯三酚可有效的提高输尿管结石伴肾绞痛的临床治疗效果,具有较为理想的应用价值。

Objective To explore the application value of four-gold-stone-ling confection and phloroglucinol in the treatment of ureteral calculus with renal colic. Methods 76 patients with ureteral calculus with renal colic were randomly divided into two groups, with those receiving traditional Chinese medicine placebo combined with phloroglucinol as the control group, and those receiving four-gold-stone-ling confection combined with phloroglucinol as the observation group,38 cases in each group. The clinical treatment effects of the two groups were compared, and the changes of urine-related indicators were analyzed. Results The VAS score and urine Ga level of the two groups showed a decreasing trend during 7d treatment, and the WHOQL-BREF score and urine OPN level showed an increasing trend(P<0.05). After 3d and 7d treatment, the VAS score and urine Ga level of the treatment group were lower than that of control group, the WHOQL-BREF score and urine OPN level were higher than that of control group(P<0.05). Meanwhile, After 7d of treatment, the rate of stone drainage in the observation group was higher than that of control group(P<0.05), while the time of stone drainage and pain relief in the observation group was shorter than control group(P<0.05). In addition, after 7d treatment, the total effective rate of the treatment group was higher than control group (P<0.05), while the difference of incidence of adverse reactions between the two groups was not significant(P>0.05). Conclusion Four-gold-stone-ling confection combined with phloroglucinol may effectively improve the clinical effect of ureteral calculi with renal colic, and have ideal application value.

目的 探讨钙调磷酸酶结合蛋白1(calcineurin binding protein 1, Cabin1)在肾小管上皮细胞(renal tubular epithelial cells,RTECs)线粒体损伤中的作用机制。方法 采用siRNA干预体外培养RTECs,敲低Cabin1的表达,继而以电镜观察其对RTECs线粒体形态的影响。结果 在对照组和阴性对照组中Cabin1蛋白在RTECs中有高表达,采用siRNA干预RTECs后,Cabin1蛋白的表达量较对照组和阴性对照组降低50%以上(P＜0.05)。对照组与阴性对照组中,线粒体形态规则,呈圆形或椭圆形,线粒体膜完整,线粒体嵴清晰可见。敲低组中,线粒体肿胀,呈长条形或不规则形,线粒体膜、线粒体嵴结构模糊甚至消失。结论 敲低Cabin1引起RTECs的线粒体形态学异常,提示Cabin1是维持RTECs线粒体正常功能的重要分子。

Objective To investigate the role of calcineurin binding protein 1 (Cabin1) in renal tubular epithelial cells (RTECs) mitochondrial dysfunction. Methods Knocked down Cabin1 in RTECs with siRNA, Western bolt was applied to detect the level of Cabin1 protein. The morphology of mitochondria in RTECs were observed under microscopy. Results In control and negative control groups, Cabin1 protein was obviously expressed in RTECs. After knocked down by siRNA, Cabin1 protein expression was decreased (P＜0.05). In Cabin1 knocked down group, mitochondria changed from large and ellipsoid shape to the small, long and irregulars. Morover, mitochondria were swollen and cristae were remarkably dissolved. Conclusion Knocked down Cabin1 induced RTECs mitochondrial dysfunction, which indicates Cabin1 is a crucial factor regulating mitochondrial function.

瘦素(leptin)是由控制各种生理过程的脂肪组织合成和分泌的一类激素,通过作用于靶细胞膜上的瘦素受体并经信号传导在各器官和系统中发挥一系列生物学效应。肾脏是高血压常见的靶器官之一。相关研究表明,瘦素在高血压肾损害中发挥作用,其机制可能与氧化应激及其炎症反应有关。本文以瘦素对高血压肾损害及其相关机制作一综述,并探讨瘦素对高血压肾损害发病机制研究进展。

Leptin which is a kind of synthesis and secretion of hormone that participates in various physiological processes is the role of the leptin receptor on the target cell membrane and the signal transduction through a series of biological effects in different organs and systems. Kidney is one of the common target organs of hypertension, and related research shows that leptin plays a role in hypertensive kidney damage, whose mechanism may be related to oxidative stress and its inflammatory reaction. The paper reviewed leptin on renal damage in hypertension and its related mechanisms, to explore the leptin on renal pathogenesis of hypertension research progress.

目的 探讨声触诊组织定量(virtual touch tissue quantification,VTQ)技术在肾上腺肿瘤诊断中的应用价值。方法 对50例患者共50个肾上腺肿瘤及同侧肾皮质进行VTQ检查,获取肾上腺肿瘤及同侧肾皮质剪切波速度(shear wave velocity,SWV)值,比较肾上腺肿瘤与同侧肾皮质及肾上腺肿瘤各类型之间SWV值,全部病例均经手术后病理证实。结果 病理证实恶性肿瘤5个,良性肿瘤45个。良、恶性肿瘤之间SWV值的差异无统计学意义。肿瘤与同侧肾皮质之间SWV值的差异有统计学意义。髓样脂肪瘤、神经鞘瘤、皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间,除皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间SWV值的差异无统计学意义外,其余任两组之间SWV值的差异有统计学意义。结论 VTQ技术可以提供肾上腺肿瘤的硬度及弹性信息,在肾上腺肿瘤的诊断中具有一定应用价值。

Objective To evaluate the application value of virtual touch tissue quantification (VTQ) technique in the diagnosis of adrenal tumors.Methods VTQ was performed in 50 patients with 50 adrenal tumors and ipsilateral renal cortex, to obtain the shear wave velocity(SWV) of adrenal tumors and ipsilateral renal cortex, the comparison between adrenal tumor and ipsilateral renal cortex and adrenal tumors of various types of SWV. All cases were pathologically confirmed after operation.Results 5 malignant tumors and 45 benign tumors were confirmed by pathology. The difference of SWV between benign and malignant tumors was not statistically significant. The difference of SWV between tumor and ipsilateral renal cortex was statistically significant. Among myelolipoma, schwannoma, adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma in addition to differences in adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma, SWV value was not statistically significant; it was statistically significant difference between the two groups in any other SWV.Conclusion VTQ technology may provide hardness and elasticity of the adrenal tumors; it has certain application value in the diagnosis of adrenal tumors.

目的 不同通道下的经皮肾镜取石术肾盂压力监测治疗鹿角形肾结石的临床分析。方法 选取我院2016年1月–2017年12月收治的鹿角形肾结石患者120例,通过随机分组,分别采用16F、18F、20F、22F、24F 作为手术通道,在气管插管全麻下置入8/9.8F 输尿管镜行经皮肾镜气压弹道碎石取石术,行经皮肾镜取石术,术中通过监测输尿管导管的压力,即肾盂内压并记录。测压系统每秒钟采集一次数据并录入数据库。观察不同通道下肾盂内压力以及取石速度。结果 在24F通道下肾盂内压力最低,与其他通道组进行比较,差异有统计学意义（P<0.05）;肾盂内压力大于40 cmH₂O时在24F通道下取石速度最短,与其他通道组进行比较,差异有统计学意义（P<0.05）;24F通道与22F通道下取石速度最快,与其他通道组进行比较,差异有统计学意义（P<0.05）。结论 肾盂内压监测使经皮肾镜取石术更加安全和精确,值得临床进一步推广应用。

Objective To investigate the pyelolithic pressure monitoring in percutaneous nephrolithotomy of different channel in treatment of renal staghorn calculi. Methods 120 patients of staghorn renal calculi in our hospital were selected from January 2016 to December 2017. These patients were randomly divided into 5 groups according to the operation channel（16F,18F,20f,22F,24F）. During operation,renal pelvis,ureter catheter pressure and operation time were recorded. Results The lowest renal pelvis pressure could be found in the 24F channel and the difference was statistically significant（P<0.05）. The lowest operation time could be found in the condition of the renal pelvis pressure of more than 40cmH₂O and 24F channel（P<0.05）. Beside of this, the fastest stone-free rate could be found in 22F and 24F channel（P<0.05）. Conclusion Monitoring of renal pelvic pressure makes percutaneous nephroscopic surgery more accurate and safety. It is worthy of clinical application.

目的 探讨醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效。方法 选取我院2014年6月—2016年6月收治的76例脓毒症相关性脑病患者作为研究对象,按照随机数字表法将其分成两组,每组38例。观察组给予醒脑静联合连续肾脏替代疗法治疗,对照组给予连续肾脏替代疗法治疗,比较两组患者的临床疗效,治疗前后格拉斯哥昏迷(Glasgow coma scale,GCS)评分、神经元特异性烯醇化酶(neuron-specifie enolase,NSE)含量、C-反应蛋白(C-reactive protein,CRP)含量及治疗后退热时间、恢复意识时间的长短。结果 观察组总有效率为89.47%,相对于对照组明显上升(P<0.05);观察组治疗后GCS评分较对照组明显升高,NSE含量、CRP含量较对照组明显降低,差异均有统计学意义(P<0.01);观察组治疗后的退热时间、恢复意识时间较对照组明显降低(P<0.01)。结论 醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效显著,可有效缩短退热及恢复意识时间,降低患者痛苦,值得临床推广应用。

Objective To investigate the curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy. Methods 76 cases of sepsis associated encephalopathy in our hospital from June 2014 to June 2016 were selected as the research objects, and they were divided into two groups according to the random number table method, 38 cases in each group. The observation group were treated with Xingnaojing combined with continuous renal replacement therapy. The control group was given continuous renal replacement therapy. The clinical efficacy of two groups were compared before and after treatment about the Glasgow coma (Glasgow coma scale, GCS) score, neuron specific enolase (neuron-specifie enolase, NSE) content, C- reactive protein (C-reactive protein, CRP)content, and the length of the consciousness recovery time and pyretolysis time. Results In the observation group, the total effective rate was 89.47%. Compared with the control group. it increased significantly (P<0.05); After treatment the GCS score in the observation group was significantly higher than the control group, the content of NSE and CRP were significantly lower than the control group, the differences were statistically significant (P<0.01); In the observation group, after treatment the pyretolysis time, consciousness recovery time was significantly lower than the control group(P<0.01). Conclusion The curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy is significant and may effectively shorten the pyretolysis and the recovery of consciousness time, which is worthy of clinical application.

目的 本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法 选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果 本研究患者的平均年龄(84.23±4.92)a,按eGFR<60 mL·min^-1·1.73 m^-2定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 ①肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。②年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people's hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of (84.23±4.92),had being divided into two groups according to eGFR< 60 ml·min^-1·1.73 m^-2:renal insufficiency group (n=52) and normal renal function group (n=51).There were statistical significance in the number of lacunar lesions,score of white-matter hyperintensity,mixed lesions between groups(P<0.05). Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is positively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI,and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.

目的 探讨山莨菪碱联合黄体酮治疗高原地区急性肾绞痛的临床疗效。方法 将2016年9月—2017年6月收治的60例急性肾绞痛患者随机分成2组,试验组和对照组各30人,试验组应用黄体酮注射液40 mg肌肉注射,山莨菪碱10 mg加入质量浓度为50 g/L的葡萄糖注射液250 mL静脉滴注;对照组仅用山莨菪碱10 mg加入质量浓度为50 g/L的葡萄糖注射液250 mL静脉滴注。给药前、后15min、30min、1 h及4 h对患者疼痛采用视觉模拟评分(VAS)评价其疗效,并观察其起效时间和不良反应。结果 治疗组和对照组总有效率分别为 93.3%和70.0%,2组比较差异有统计学意义( P<0.05);2组药物起效时间比较有差异(P<0.05);给药后15min至4 h,试验组VAS评分均低于对照组(P<0.05)。结论 山莨菪碱联合黄体酮治疗高原急性肾绞痛安全有效,联用明显优于只采用山莨菪碱。

Objective To study the effect and efficacy of Anisodamine combined with Progesterone in the treatment of acute renal colic in plateau area. Methods From September 2016 to June 2017, 60 cases of acute renal colic patients were randomly divided into experimental group or control group. Both groups are 30 cases. The test group applied the injection of progesterone injection 40 mg by muscle injection and Anisodamine 10mg to the concentration of 5% of glucose injection in 250 mL by intravenous drip. In the control group, only using 10 mg of Anisodamine was added to the 250 mL intravenous drip of 5% glucose injection. The visual Analogue Scale/Score(VAS) was used to evaluate the efficacy of the patients before dosing, after dosing of 15min, 30min, 1 h and 4 h, and we observed their effective time and adverse reactions. Results The total effective rate of treatment group and control group was 93.3 % and 70.0 % respectively. There was a statistically significant difference between the two groups (P<0.05). The VAS score of the experimental group was lower than that in the control group (P<0.05). Conclusion Anisodamine combined with Progesterone is safe and effective in the treatment of plateau acute renal coli, and is obviously better than only using Anisodamine.