目的：分析白塞氏病合并結核感染的臨床特點及相關因素。方法：回顧分析2002年至今四川大學華西醫院臨床免疫科收治的初診為白塞氏病且合并結核感染的病歷資料，并結合相關文獻分析可能的相關因素。結果：37例首診為白塞氏病的患者中有10例（29.7%）合并結核感染，4例（10.8%）既往有結核病史，經抗結核或/和抗白塞氏病治療后好轉。結論：應警惕白塞氏病與結核感染并存，結核感染的臨床表現可能和白塞氏病相混淆，需做好鑒別診斷并合理治療。
Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
【摘要】 目的 分析2型糖尿病患者合并不同類型腎臟損傷的臨床表現、腎臟病理分型,探討臨床特點和病理類型之間的關系,以指導臨床診治。方法 分析1998年12月—2008年12月53例接受腎活檢的2型糖尿病患者,其中男38例,女15例,平均52歲,糖尿病病程0~22年,平均5年。分析納入患者的臨床表現、腎臟病理特點和腎臟損傷程度。結果 2型糖尿病合并腎臟損傷以中老年多見,年齡50～74歲,其中糖尿病腎病(DN) 34例,44.1%的患者腎臟損害出現在發現糖尿病5年后；非糖尿病腎病(DM+NDRD)16例,81.3%的患者腎臟損害出現在發現糖尿病5年內；糖尿病腎病合并非糖尿病腎病(DN+NDRD)3例,平均糖尿病病程均lt;5年。2型糖尿病合并腎臟損傷的腎臟病理類型多樣,除DN(占64.2%)外,17.0%的患者為膜性腎病，7.5%的患者為系膜增生性腎病。結論 2型糖尿病合并腎損傷以DN為多,亦可出現DM+NDRD或DN +NDRD,通過腎活檢明確腎臟病理類型對臨床治療及判斷預后有指導意義。
目的 分析朱砂蓮中毒導致急性腎功能衰竭臨床表現、腎臟病理學及相關文獻復習。 方法 2007年3月－9月收治朱砂蓮中毒急性腎功能衰竭2例，分析臨床表現及腎臟病理損害。 結果 朱砂蓮急性中毒易致急性腎功能衰竭，危及生命；其主要損害腎小管間質，表現為急性腎小管重度損傷，無炎性細胞浸潤，而腎小球幾乎無病變。 結論 朱砂蓮為我國常使用中藥，主要成分為馬兜鈴酸，易致馬兜鈴酸腎病，須提高對該病認識，規范使用中草藥，避免藥物性所致腎損害。Objective To analyze the clinical and pathological manifestations of kidney in patients with ciliatenerve knotweed root-induced acute renal failure. Methods Two patients who were admitted into our hospital for acute renal failure caused by over-dose ciliatenerve knotweed root from March to September in 2007 were included in this study. We analyzed the clinical and pathological manifestations of their kidneys. Results Over-dose ciliatenerve knotweed root could induce acute renal failure, even threaten life. The pathology of kidney is characterized by severe tubular injury,rather than glomerulus damage, without cell infiltration. Conclusions Ciliatenerve knotweed root is one of the frequently-used traditional Chinese medicines in our country, which can easily result in aristolochinc acid nephropathy. We should recognize the importance of this disease and avoid using nephrotoxic drugs.
【摘要】 目的 分析乳酸性酸中毒發生的危險因素，警示臨床工作。 方法 回顧性分析2008年5月—2010年12月收治的32例乳酸性酸中毒患者的臨床資料。 結果 32例患者均合并2型糖尿病，其中老年患者27例（占84.6%）；20例有服用雙胍類降糖藥物史（占62.5%）；12例合并肺部疾病（占37.5%）；9例合并心臟疾病（占28.1%）；15例合并腎功能不全（占46.9%）；8例合并肝功能異常（占25.0%）。 結論 糖尿病、老年、使用雙胍類藥物、合并心肺疾病及肝腎功能不全都是發生乳酸性酸中毒的危險因素。在臨床工作中，對高危患者需提高警惕，盡量避免危險因素疊加以減少乳酸性酸中毒的發生。【Abstract】 Objective To analyze the risk factors of lactic acidosis. Methods The clinical data of 32 patients with lactic acidosis admitted to our hospital from May 2008 to December 2010 were studied retrospectively. Results All patients had type 2 diabetes mellitus. Among them, 27 (84.6%) were older than 60, 20 (62.5%) had ingested antidiabetic drugs of biguanides, 12 (37.5%) were complicated by pulmonary diseases, 9 (28.1%) by heart diseases, 15 (46.9%) by renal dysfunction, and 8 (25.0%) by liver dysfunction. Conclusions Diabetes mellitus, old age, ingesting of biguanides, cardiopulmonary diseases, renal and hepatic dysfunction all contribute to the occurrence of lactic acidosis. During clinical work, we should try to avoid the above-mentioned risk factors.