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The Relationship between Serum Uric Acid and Insulin Release and Sensitivity

目的　探討血尿酸與胰島素分泌和敏感性的關系。 方法　對成都市龍泉驛區2007年6月－7月間20～75歲常住自然人群565人進行人口學、腰圍、臀圍、血壓、75 g葡萄糖耐量及胰島素測定（0、30、120 min），血脂、血肌酐及血尿酸檢測。以早期胰島素分泌功能指數（△I30/△G30）和葡萄糖處置指數（DIo）代表胰島素分泌功能，以Matsuda 指數代表胰島素敏感性，分別與血尿酸進行相關性研究。 結果　男性的血尿酸與年齡呈負相關，與舒張壓、葡萄糖負荷后120 min胰島素和甘油三酯呈正相關。女性的血尿酸與甘油三酯、低密度脂蛋白、血肌酐呈正相關，與高密度脂蛋白、Matsuda指數呈負相關。無論男性和女性，均未發現血尿酸與△I30/△G30、DIo相關。 結論　女性的胰島素敏感性下降與血尿酸升高有關。未發現血尿酸與胰島素分泌有相關關系。

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。

高血壓患者全血低切變黏度和血尿酸水平及頸動脈內-中膜厚度與心肌梗死的相關性

目的　分析原發性高血壓（EH）患者頸動脈內-中膜厚度（IMT）與全血低切變黏度及血尿酸水平的關系，以探討心肌梗死和頸動脈斑塊之間的相關性。 方法　2010年3月－2011年5月113例EH患者通過頸動脈超聲檢查分為IMT正常組（n=47）、增厚組（n=37）和斑塊組（n=292），各組同時檢測全血低切變黏度和血尿酸。 結果　正常組、增厚組和斑塊組全血低切變黏度分別為（8.19 ± 2.31）、（14.88 ± 2.34）、（19.96 ± 3.81）mPa·s，各組兩兩比較，差異均有統計學意義（P＜0.01）。正常組、增厚組和斑塊組血尿酸分別為（303.26 ± 91.42）、（371.33 ± 92.12）、（416.54 ± 96.02）μmol/L，各組兩兩比較，差異均有統計學意義（P＜0.01）。 結論　EH患者IMT隨全血低切變黏度和血尿酸水平升高而增厚，通過以上的檢查和檢測從而達到對心肌梗死的早發現早治療。

The Clinical Treatment and Diagnosis Analysis of 21 Cases of Nutcracker Syndrome in Adult Patients

摘要:目的:探討胡桃夾綜合征(NCS)在成年患者中的臨床表現、診斷及治療特點。方法:回顧性分析四川大學華西醫院泌尿外科2001年2月至2008年11月期間收治入院的21例胡桃夾綜合征患者的臨床病歷資料。結果:21例患者男性15例,女性6例。以血尿為最主要的癥狀,其中19例(9048%)為肉眼血尿,2例(952%)為顯微鏡下血尿。17例(8095%)患者尿中正常形態紅細胞≥85%,11例(5238%)患者尿蛋白呈陽性,9例(4286%)患者彩超發現平臥位左腎靜脈最寬處內徑(a)與最窄處內徑(b)比值均數為45±24,直立位a/b均數為81±26。15例(7143%)患者CT呈現左腎靜脈受壓表現,8例(3809%)患者膀胱鏡檢見左側輸尿管口噴血。7例(3333%)行左腎靜脈下移—下腔靜脈端側吻合術,平均血管阻斷時間23±554min,血尿、蛋白尿在術后消失,其余14例(6667%)行保守治療,獲得隨訪的5例患者中有3例血尿消失,2例患者仍有無癥狀性血尿和蛋白尿。結論:尿紅細胞形態、腎血管彩色超聲、增強CT、核磁共振(MRI)及膀胱鏡檢查對胡桃夾綜合征的診斷具有重要價值,左腎靜脈下移—下腔靜脈端側吻合術治療胡桃夾綜合征效果明確,術后并發癥少。 關鍵詞:胡桃夾綜合征;左腎靜脈;血尿

Prognostic value of blood urea nitrogen and high-density lipoprotein cholesterol combined with the quick Sequential Organ Failure Assessment for in-hospital mortality prediction in sepsis

Objective To identify independent risk factors for in-hospital all-cause mortality in patients with sepsis and to integrate them into the quick Sequential Organ Failure Assessment (qSOFA) score to construct modified models, thereby improving the ability of the original qSOFA to predict mortality risk. Methods This retrospective study included adult patients who met the Sepsis-3 criteria for sepsis and were admitted to the Intensive Care Unit or Emergency Intensive Care Unit of Zigong Fourth People’ s Hospital between January 2018 and December 2023. Demographic characteristics, vital signs, comorbidities, and laboratory parameters were collected, and the Sequential Organ Failure Assessment (SOFA) and qSOFA scores were calculated. Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality. Independent predictors were dichotomized according to cut-off values derived from receiver operating characteristic (ROC) curves and combined with qSOFA to construct new models. The ROC analysis with bootstrap validation was used to assess predictive performance, and comparative performance was further evaluated using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results A total of 218 patients were included. Multivariable logistic regression analysis identified blood urea nitrogen (BUN) [odds ratio (OR)=1.100, 95% confidence interval (CI) (1.040, 1.170)] and qSOFA [OR=2.610, 95%CI (1.450, 4.920)] as independent risk factors for in-hospital mortality, whereas high-density lipoprotein cholesterol (HDL-C) was an independent protective factor [OR=0.250, 95%CI (0.065, 0.841)]. After dichotomization by ROC-derived cut-off values, BUN and HDL-C were incorporated into qSOFA to generate B-qSOFA, H-qSOFA, and BH-qSOFA. Bootstrap ROC analysis showed that BH-qSOFA exhibited the highest discriminatory ability compared with all combined models as well as the conventional SOFA and qSOFA scores [area under the curve=0.803, 95%CI (0.735, 0.863)]. NRI and IDI analyses demonstrated that BH-qSOFA provided incremental prognostic improvement over qSOFA (NRI=0.969, IDI=0.165), B-qSOFA (NRI=0.644, IDI=0.054), and H-qSOFA (NRI=0.804, IDI=0.091) (all P<0.05). Conclusions Elevated BUN and qSOFA and decreased HDL-C are independent predictors of in-hospital mortality in sepsis. The BH-qSOFA model is simple and clinically practical, exhibits superior predictive performance over the original qSOFA. It may serve as a useful early instrument for prognostic risk stratification in patients with sepsis.

Analysis of the effect of asymptomatic hyperuricemia on the effectiveness after arthroscopic rotator cuff repair

ObjectiveTo investigate the effect of asymptomatic hyperuricemia on the effectiveness of arthroscopic rotator cuff repair.MethodsThe clinical data of 80 patients who underwent arthroscopic rotator cuff repair and met the selection criteria between March 2018 and December 2019 were retrospectively analyzed. According to the serum uric acid level, the patients were divided into hyperuric acid group (46 cases, the serum uric acid level was more than 417 μmol/L in males and was more than 357 μmol/L in females) and normal group (34 cases, serum uric acid level was lower than the above standard). There was no significant difference in gender, age, side, body mass index, blood glucose level, total cholesterol level, rotator cuff tear size, and preoperative shoulder motion, visual analogue scale (VAS) score, University of California-Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and other general data between the two groups (P>0.05). The range of motion of abduction, forward flexion, and external rotation at 90° abduction were recorded and compared between the two groups before operation and at last follow-up; the improvement of shoulder pain was evaluated by VAS score; the improvement of shoulder function was evaluated by UCLA score, Constant score, and ASES score; and the shoulder joint MRI grade was evaluated according to Sugaya evaluation criteria.ResultsAll patients were followed up 9-16 months, with an average of 11.9 months; there was no significant difference in the follow-up time between the two groups (t=0.968, P=0.336). There were 2 cases of retear in the hyperuric acid group (including 1 case of severe tear) and 1 case of light retear in the normal group. The remaining patients in the two groups had no early-related complications. At last follow-up, the range of motion of the shoulder joints (abduction, forward flexion, external rotation at 90° abduction), VAS score, UCLA score, Constant score, and ASES score of the two groups were significantly improved when compared with preoperative ones (P<0.05); the above indicators in the normal group were significantly better than those in the hyperuric acid group (P<0.05). The MRI grade of the shoulder joint in the normal group was significantly better than that in the hyperuric acid group (Z=–2.000, P=0.045).ConclusionCompared with patients with normal serum uric acid level, asymptomatic hyperuricemia can lead to worse recovery after arthroscopic rotator cuff repair in patients with rotator cuff tears.

158例2型糖尿病患者血脂與血尿酸代謝異常關系分析

目的:探討2型糖尿病患者血脂與血尿酸代謝的關系;方法:對158 例2型糖尿病患者(觀察組及101 例正常對照組)進行血清總膽固醇(TC)、甘油三脂(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、載脂蛋白A(APoA)、載脂蛋白B(APoB)、血尿酸(UA)測定;結果:觀察組TG、APoB、UA明顯高于對照組,觀察組HDL-C、APoA明顯低于對照組。結論:2型糖尿病患者易發生脂代謝異常,而血脂、血糖、血尿酸異常的共存是該病發生的危險因素,也是心腦血管疾病的危險因素。因此,及時糾正血脂、血尿酸代謝異常對2型糖尿病的治療就顯得十分重要。

多囊腎病患者維持性血液透析應用甲磺酸萘莫司他的預見性護理一例

Association Between Sreum Uric Acid Concentration and Blood Pressure, Triglycerides in Old People with MS

目的:探討老年代謝綜合征者血清尿酸與血壓、甘油三脂的關系。方法:163例入選者,MS組96例,對照組67例,對二組的SUA、BMI、WC 、SBP、DBP及TG進行分析。結果:MS組SUA較對照組高。MS組男性SUA與BMI正相關、女性與WC正相關;男女性MS組及對照組SUA與SBP及TG不相關。對照組女性SUA與DBP正相關。結論:SUA對老年女性DBP的維持可能有一定作用。TG對老年人SUA的影響有限;體重及脂肪聚集部位對SUA的影響,存在性別差異。

Evidence-Based Diagnosis for an Elderly Patient with Hematuria

ObjectiveTo determine the diagnosis method for an elderly male patient with hematuria by means of evidence-based practice, so as to provide references for clinical diagnosis. MethodWe searched databases including PubMed, EMbase, and The Cochrane Library up to Nov. 2014, to collect relevant diagnostic evidence for elderly patients with hematuria. ResultsCompared with MRI, CT had higher sensitivity and specificity in determination of lesion location in where the hematuria was caused by tumor. ConclusionsCT scan may be better for patients with hematuria to determine the location of lesion.