目的 研究温肾利水汤联合贝前列素钠对老年原发性肾病综合征（PNS）患者T淋巴细胞亚群及肾功能的影响。方法 回顾性收集我院106例老年PNS患者临床资料（2024年4月-2026年1月），按照不同治疗方法分为研究组（n=55，温肾利水汤联合贝前列素钠）、对照组（n=51，贝前列素钠治疗）。比较两组治疗效果、中医证候积分、治疗前后肾功能[血尿素氮（BUN）、白蛋白（ABL）、血肌酐（SCR）]、T淋巴细胞亚群[CD4+、辅助性T细胞17（Th17）、CD3+]、不良反应。结果 治疗3个月后，研究组总有效率（92.73%）高于对照组（P<0.05）；治疗3个月后，研究组主证积分、次证积分均低于对照组（P<0.05）；治疗3个月后，研究组血清BUN、SCR水平低于对照组，ABL水平高于对照组（P<0.05）；治疗3个月后，研究组CD4+、CD3+高于对照组，Th17低于对照组（P<0.05）；两组不良反应发生率（5.45% VS 9.80%）相比，差异无统计学意义（P>0.05）。结论 温肾利水汤联合贝前列素钠治疗老年PNS患者能提高治疗效果，改善T淋巴细胞亚群水平，促进肾功能恢复。

目的 血清同型半胱氨酸（Hcy）水平与慢性肾脏病（CKD）的进展相关,但中年人群的非线性关联研究较少,本研究旨在寻找慢性肾脏病危险因素。方法 本研究基于NHANES 1996—2006年数据,纳入5 361例45~65岁参与者,以估算肾小球滤过率（eGFR）<60 mL/（min·1.73 m²）和尿白蛋白/肌酐比值（uACR）≥30 mg/g评估肾功能下降。结果 通过逻辑回归及平滑曲线拟合分析发现,Hcy每升高1 µmol/L,eGFR降低的风险增加8%（OR=1.08,95%CI：1.06~1.10）,uACR升高的风险增加2%（OR=1.02,95%CI：1.00~1.04）。非线性分析显示,Hcy对eGFR的阈值效应拐点为13.4 µmol/L（拐点左侧OR=1.59,95%CI：1.49~1.70;右侧无显著关联）。亚组分析表明,性别、高血压、糖尿病等协变量无交互作用,然而,在敏感性分析中,糖尿病患者中Hcy与eGFR降低的关联更强（交互P=0.015 8）。结论 本研究提示,控制Hcy水平或可延缓美国中年人群（尤其是糖尿病患者）的肾功能衰退。

Objective Elevated serum homocysteine（Hcy）levels are linked to chronic kidney disease（CKD）progression,yet the nonlinear relationship in middle-aged populations remains underexplored．Methods This study analyzed data from 5 361 participants aged 45-65 years in the NHANES 1996-2006 cohort．Renal dysfunction was defined as an estimated glomerular filtration rate（eGFR）<60 mL/min/1.73 m² and urinary albumin-to-creatinine ratio（uACR）≥30 mg/g．Results Logistic regression and smoothed curve fitting revealed that each 1 µmol/L increase in Hcy elevated the risk of reduced eGFR by 8%（OR=1.08,95% CI：1.06-1.10）and uACR by 2%（OR=1.02,95% CI：1.00-1.04）．A nonlinear threshold effect was identified at 13.4 µmol/L,with a stronger association below this threshold（OR=1.59,95% CI：1.49-1.70）and no significant effect above it．Subgroup analyses showed no interactions with gender or hypertension,but a stronger Hcy-eGFR association was observed in diabetics（interaction P=0.0158）．Conclusions These findings suggest that controlling Hcy levels may mitigate renal decline,particularly in diabetic populations,warranting further causal investigations．

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.

目的 分析精神分裂症患者体内的肌酸激酶（CK）、肌红蛋白（MYO）、β₂微球蛋白（β₂-MG）、细胞间黏附分子（ICAM）水平随患者精神状态及肾功能损害程度的变化,探讨其对患者早期急性肾损伤（AKI）可能的作用机制。方法 根据肾功能水平将 80例精神分裂症患者分为4组,并设立健康对照组（同期我院门诊健康体检者）20例。采用酶联免疫吸附法检测血清CK、MYO 、ICAM,采用放射免疫法检测β₂-MG水平,分析其与患者精神状态变化及肾功能损害程度的关联。结果 精神分裂症患者中肾功能损害组的血清CK、MYO、ICAM、β₂-MG值高于健康对照组及肾功能正常组,差异具有统计学意义（F=623.534,30.437,636.776,88.283,P<0.05）,精神分裂症AKI 1期组到AKI 3期组CK、MYO、β₂-MG、ICAM数值均比对照组升高（P<0.05）,3组之间如上指标的比较差异有统计学意义（P<0.05）。结论 精神分裂症肾功能损害患者的血清CK、MYO、ICAM、β₂-MG的异常升高能反映出患者的精神状态及肾功能损害程度,提示临床可通过检测如上血清指标来监测患者的精神状态及肾功能。

Objective To study the changes of serum creatine kinase（CK）,myoglobin（MYO）,β₂ microglobulin（β₂-MG）,intercellular adhersion molecule（ICAM）with the mental state and the degree of renal function damage of patients,to explore the possible mechanism of their effects on early acute kidney injury（AKI）in patients with schizophrenia．Methods A total of 80 schizophrenic patients were divided into 4 groups according to their renal function level,and 20 healthy controls（who underwent physical examination during the same period）were included．At the same time,enzyme linked apta-sorbent assay was used to detect serum CK,MYO and ICAM levels in each group,and radioimmunoassay was used to detect serum β₂-MG level in each group．The correlation between the above indexes and the changes of mental state and the degree of renal function damage was analyzed．Results The serum CK,MYO,ICAM and β₂-MG values in schizophrenia renal impairment groups were higher than those in healthy control group,and the differences were statistically significant（F=623.534,30.437,636.776,88.283,P<0.05）,and the comparison of the above indexes among the three groups was statistically significant（P<0.05）．Conclusions The abnormal increase of serum CK,MYO,ICAM and β₂-MG can reflect the patient's mental state and the degree of renal function damage,it suggesting that the clinical staff can monitor the patient's mental state and renal function through daily serum collection and analysis．

目的 探究连续性静脉-静脉血液滤过（CVVH）联合HA330血液灌流在改善创伤脓毒症急性肾损伤患者肾功能及炎症反应中的应用效果。方法 选择我院2021年1月—2023年1月期间接诊的98例创伤脓毒症急性肾损伤患者开展研究,随机抽签法分为观察组（联合CVVH、HA330血液灌流治疗）、对照组（予以CVVH治疗）,各49例,对比临床疗效,包括肾功能、炎症反应、不良反应、预后情况。结果 治疗5 d后,观察组临床总有效率为93.84%,高于对照组73.47%（P<0.05）;观察组血清肌酐、尿素氮较对照组明显改善（P<0.05）;观察组IL-6、hs-CRP水平低于对照组（P<0.05）;观察组不良反应总发生率低于对照组（P<0.05）;观察组序贯器官衰竭估计评分、急性生理与慢性健康评分系统评分较对照组低（P<0.05）。结论 CVVH联合HA330血液灌流在改善创伤脓毒症急性肾损伤患者肾功能及炎症反应中的疗效良好,且安全性高,有利于减轻患者炎症反应,控制病情进展,从而改善肾功能及预后。

目的 探究百令胶囊联合前列地尔对早期糖尿病肾病患者血液流变学及肾功能影响。方法 选我院2020年1月—2021年1月期间100例糖尿病肾病患者为研究对象,将其以随机数字表法分为对照组、观察组,各50例,分别应用前列地尔治疗、前列地尔+百令胶囊治疗,比较2组治疗前后血液流变学指标、肾功能指标。结果 治疗前2组血浆粘度、全血粘度、红细胞聚集指数水平相近,差异无统计学意义(P＞0.05);治疗后观察组血浆粘度、全血粘度、红细胞聚集指数水平较对照组低,差异有统计学意义(P＜0.05);治疗前2组微量蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(Scr)水平相近,差异无统计学意义(P＞0.05);治疗后观察组UAER、BUN、Scr水平较对照组低,差异有统计学意义(P＜0.05);2组治疗期间均未见严重不良反应。结论 对早期糖尿病肾病患者应用百令胶囊+前列地尔治疗,可改善其血液流变学指标及肾功能指标,降低炎症反应程度,治疗安全且疗效理想。

Objective To explore the effect of Bailing capsule combined with alprostadil on hemorheology and renal function in patients with early diabetic nephropathy. Methods A total of 100 patients with diabetic nephropathy in our hospital from January 2020 to January 2021 were randomly divided into control group and observation group, 50 cases in each group.They were treated with alprostadil and alprostadil with Bailing capsule respectively.The indexes of hemorheology and renal function before and after treatment were compared between the two groups. Results Before treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). Before treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). There was no serious adverse reaction in the two groups during the treatment. Conclusion Bailing capsule combined with alprostadil in the treatment of early diabetic nephropathy can improve the indexes of hemorheology and renal function, lower the inflammatory reaction, and the treatment is safe and effective.

目的 探讨在慢性肾炎中采用厄贝沙坦＋肾炎康复片对肾功能的影响。方法 在我院肾内科2018年3月—2020年8月收治的慢性肾炎患者中随机选取80例,按照抽签法分为2组,对照组(40例)采用厄贝沙坦,研究组在其基础上加用肾炎康复片,对比2组肾功能指标、临床疗效及不良反应。结果 治疗后2组肾功能指标均好转,且研究组血肌酐、尿素氮、24 h尿蛋白量均低于对照组,肾小球滤过率高于对照组(P＜0.05)。2组治疗总有效率对比差异显著(P＜0.05),不良反应对比无差异。结论 在对慢性肾炎的治疗中联用厄贝沙坦及肾炎康复片可有效提高肾功能,疗效显著。

Objective To investigate the effect of irbesartan and Shenyan Kangfu Tablet on renal function in chronic nephritis. Methods A total of 80 patients of chronic nephritis admitted in our hospital from March 2018 to August 2020 were randomly selected and divided into two groups by drawing lots. The control group (40 cases) received irberartan, while the research group added Shenyan Kangfu Tablet on the basis of irberartan. The renal function indexes, clinical efficacy and adverse reactions of the two groups were compared. Results After treatment, renal function indexes in both groups were improved, and serum creatinine, urea nitrogen and 24 h urinary protein levels in the research group were lower than those in the control group, and glomerular filtration rate was higher than that in the control group (P<0.05). The total effective rate was significantly different between the two groups (P<0.05), but there was no difference in adverse reaction rate. Conclusions In the treatment of chronic nephritis, irbesartan combined with Shenyan Kangfu Tablets could effectively improve renal function, and the effect is significant.

目的 分析慢性肾衰竭患者接受肾衰康方治疗对其血清微炎症状态的影响及肾功能的保护作用。方法 将2020年1月—2020年12月作为研究时间段,选取期间广东祈福医院接诊的50例慢性肾衰竭患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入25例)、观察组(加用肾衰康方治疗,纳入25例),对组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标展开分析。结果 组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗前无明显差异,P>0.05;观察组中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗后优于对照组,P<0.05。结论 肾衰康方对改善慢性肾衰竭患者血清微炎症状态、氧化应激水平、临床症状均有较好效果,且能保护肾功能,值得推广。

Objective To analyze the effect of Shenshuaikang decoction on serum microinflammation and renal function in patients with chronic renal failure. Methods From January 2020 to December 2020, 50 patients with chronic renal failure treated by Clifford Hospital were selected, and the random number table method was used for grouping. All cases were divided into control group (n=25) and observation group (n=25). The TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index were analyzed. Results There were no significant differences in TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index between the two groups before treatment, P>0.05; the TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index of the observation group were better than those of the control group after treatment, P<0.05. Conclusion Shenshuaikang decoction has good effect on improving serum microinflammation, oxidative stress level and clinical symptoms of patients with chronic renal failure, and also can protect renal function, which is worthy of promotion.

目的 探讨糖尿病肾病患者肾功能恶化的危险因素。 方法 采用回顾性队列研究分析山东省立第三医院2017年1月—2020年5月108例患者的临床数据。将病人分为糖尿病肾病肌酐翻倍组和不翻倍组,比较两组间临床数据的变化。结果 糖尿病肾病肌酐翻倍组的BUN、胱抑素C和ACR水平均高于肌酐不翻倍组;eGFR、CO₂、ALB、HGB均低于肌酐不翻倍组,差异有统计学意义(P<0.05)。而UA、GLU、血脂、糖化血红蛋白,糖尿病和高血压病史差异无统计学意义(P>0.05)。相关分析表明血肌酐与BUN、eGFR、胱抑素C、ACR呈正相关;与ALB,HGB和CO₂呈负相关。多元线性回归分析结果显示,eGFR,胱抑素C,ACR, ALB和HGB是糖尿病肾病肾功能恶化的影响因素(P<0.05)。结论 糖尿病肾病除检测肾功能的常规指标外,还可观察ACR、ALB和HGB水平的变化,对判断患者肾功能是否恶化有一定价值。

Objective To investigate the risk factors of renal function deterioration in patients with diabetic nephropathy. Methods Retrospective cohort study was used to analyze the clinical data of 108 patients from January 2017 to May 2020 in the Third Hospital of Shandong Province. Patients were divided into diabetic nephropathy creatinine doubling group and non-doubling group. The changes of clinical data in two groups were compared and the risk factors of renal function deterioration were analyzed. Results The levels of BUN、cystatin C and ACR in the creatinine doubling group were higher than those in the creatinine non-doubling group, and the levels of eGFR、CO₂、ALB、 HGB were lower than those in the creatinine non-doubling group, the differences were statistically significant (P<0.05). However, there were no significant differences in the levels of UA, blood glucose, blood lipid, glycosylated hemoglobin, the history of diabetes and hypertension (P>0.05). The correlation analysis showed that serum creatinine was positively correlated with BUN、 eGFR、cystatin C and ACR and negatively correlated with CO₂、ALB and HGB. The results of multiple regression analysis showed that eGFR、cystatin C、ACR、ALB and HGB were independent influencing factors of renal function deterioration(all P<0.05). Conclusion Diabetic nephropathy can not only notice the routine indexes of renal function, but also observe the changes of ACR、ALB and HGB levels, which has certain value for awareing the renal function deterioration in patients.