虽然血液透析(hemodialysis,HD)治疗可以提高终末期肾病(end stage renal disease,ESRD)患者的预期寿命,但是与普通人群相比,透析患者死亡风险仍然显著增加。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice ...虽然血液透析(hemodialysis,HD)治疗可以提高终末期肾病(end stage renal disease,ESRD)患者的预期寿命,但是与普通人群相比,透析患者死亡风险仍然显著增加。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study,DOPPS)中HD患者死亡原因及死亡特点。方法DOPPS是1项国际性的前瞻性观察研究,中国参加了DOPPS 5期研究(2012~2015年),并完成了队列的随访。中国DOPPS 5中纳入了1427名患者。以这些患者为研究对象,收集人口统计学、实验室检查、死亡日期、死亡原因等指标。明确患者死亡原因及死亡时间、地点等特点。结果DOPPS 5期研究中共纳入1427名HD患者,其中北京473例,广州454例,上海500例。患者平均年龄为(59.4±14.9)岁,男性占55.0%,糖尿病患者占25.1%。平均随访时间为1.9(1.1,2.1)年。在随访期间共205名患者发生死亡,患者总体死亡率为14.4%,年平均死亡率为8.8%。死亡患者的中位年龄为70(59,79)岁;男性比例为56.1%,中位透析龄为2.5(1.0~5.0)年。北京、广州、上海死亡患者数分别为67,67,71例,年平均死亡率分别为7.9%,10.0%以及8.6%。导致HD患者死亡的前3位病因分别为:脑血管意外(含缺血性卒中,19.3%)、充血性心力衰竭(18.2%)和肺部感染(11.6%)。心血管死亡总计为105例,占51.2%。主要死亡原因排序有性别差异。血液透析死亡患者中70.8%于医院死亡,27.0%患者在家中发生死亡;79.8%患者没有停止血液透析,20.2%患者死亡前停止了HD治疗。死亡患者中高达62.9%患者在死亡前接受了临终关怀治疗。1天中10pm~6am时段患者死亡风险最高。结论在中国DOPPS 5期研究中,患者年平均死亡率为8.8%,其中心血管死亡是最主要的原因。在单项死亡原因中脑血管意外(含缺血性卒中)、充血性心力衰竭和肺部感染为最常见的3种病因,且死亡的病因似乎具有性别差异。大部分患者为可预见的临终状态,1/4的患者在家中死亡,在无医疗干预情况下,患者夜间凌晨死亡风险最高。展开更多
目的高钾血症是终末期肾病患者的常见合并症之一,严重高钾血症可引起致死性心律失常而危及生命。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study,DOPPS)中血液透析(hemodialysis,HD)患者合...目的高钾血症是终末期肾病患者的常见合并症之一,严重高钾血症可引起致死性心律失常而危及生命。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study,DOPPS)中血液透析(hemodialysis,HD)患者合并高钾血症的情况,并探究血液透析患者合并高钾血症的独立相关因素。方法DOPPS是1项国际性的前瞻性观察研究,中国参加了DOPPS5(2012~2015),并完成了队列的随访。中国DOPPS5中纳入了1427名患者。以这些患者为研究对象,收集实验检查中透析前血钾的值,分为正常血钾组(血钾<5.5mmol/L)和高钾血症组(血钾≥5.5mmol/L)。根据严重程度进一步将高钾血症分为轻度(5.5~5.9mmol/L)、中度(6.0~6.4mmol/L)或重度(≥6.5 mmol/L)。比较2组间的一般资料、实验室检查及透析处方间的差异,并用多因素Logistic回归分析探究高钾血症的独立相关因素。结果本研究共纳入了1339名HD患者,平均年龄为(59.4±14.9)岁,中位透析龄为2.6(0.9,5.3)年,男性占54.4%。合并高钾血症的患者为345人(25.8%),其中轻度高钾血症占13.3%,中度高钾血症占7.6%,重度高钾血症占4.9%。3个城市中,北京的HD患者合并高钾血症的比例最高(31.8%),其次是广州(26.0%),上海的患者中合并高钾血症的比例最低(19.3%)(χ^(2)=18.580,P<0.001)。血钾正常和高钾血症的2组患者在年龄(t=2.610,P=0.009)、性别比例(χ^(2)=4.059,P=0.007)、BMI(t=-2.680,P=0.008)、透析充分性(t=4.280,P<0.001)、透析频次(χ^(2)=21.548,P<0.001)、血白蛋白(t=6.071,P<0.001)、血磷(t=7.083,P<0.001)等方面均有显著差异。多因素Logistic回归分析示,较高的BMI(OR:1.040,95%CI:1.004~1.077,P=0.027)、女性(OR:1.201,95%CI:1.023~2.547,P=0.026)、透析液钾浓度≥2.5mEq/L(相比于<2.5mEq/L)(OR:1.194,95%CI:1.028~1.386,P=0.020)、透析充分性不达标(stdKt/V<2)(OR:1.336,95%CI:1.170~1.527,P<0.001)、透析频次低于每周3次(OR:1.332,95%CI:1.150~1.544,P<0.001)、血白蛋白水平高(OR:1.815,95%CI:1.294~2.547,P<0.001)、血磷水平高(OR:1.231,95%CI:1.153~1.316,P<0.001)是与HD患者合并高钾血症的独立相关因素。结论在中国DOPPS5研究中,25.8%的HD患者合并高钾血症。纳入的3个城市中,北京患者中合并高钾血症的比例最高,其次是广州,上海最低。较高的BMI、女性、透析液钾浓度≥2.5mEq/L(相比于<2.5mEq/L)、透析充分性不达标(stdKt/V<2)、透析频次低于每周3次、血白蛋白水平高、血磷水平高是HD患者合并高钾血症的独立相关因素。展开更多
体外用次氯酸氧化牛血清白蛋白(BSA)制备晚期氧化蛋白产物(AOPP)-BSA。将人脐静脉内皮细胞(HUVEC s)与不同浓度的AOPP-BSA共同培养,用W estern b lotting及免疫荧光化学染色法检测血管细胞黏附分子-1(VCAM-1)蛋白表达,用RT-PCR法检测VCA...体外用次氯酸氧化牛血清白蛋白(BSA)制备晚期氧化蛋白产物(AOPP)-BSA。将人脐静脉内皮细胞(HUVEC s)与不同浓度的AOPP-BSA共同培养,用W estern b lotting及免疫荧光化学染色法检测血管细胞黏附分子-1(VCAM-1)蛋白表达,用RT-PCR法检测VCAM-1 mRNA表达。结果AOPP-BSA诱导VCAM-1 mRNA表达呈时间依赖性,同时以时间和剂量依赖的方式上调HUVEC s VCAM-1蛋白的表达;未经氧化修饰的BSA对HUVEC s VCAM-1表达无明显作用。认为AOPP可诱导内皮细胞VCAM-1表达,此可能是动脉粥样硬化发生和发展的机制之一。展开更多
Objective: To compare the protective effects of removingcirculatory TNF by specific immunoadsorption and by nonspeciflc Amberlite XAD-7 adsorption on experimental endotoxin shock. Methods: New Zealand white rabbits re...Objective: To compare the protective effects of removingcirculatory TNF by specific immunoadsorption and by nonspeciflc Amberlite XAD-7 adsorption on experimental endotoxin shock. Methods: New Zealand white rabbits receiving a lethal dose of endotoxin underwent hemoperfusion through immunoadsorbent or Amberlite BAD-7. Plasma TNF levels. efficiency of the adsorbents and the survival rate were observed. Results: After 2 h of hemopcrfusion through immunoadsorhent or Amberlite XAD-7. plasma TNF levels were significantly lower than those in the control group(P<0.01). and the best result was shown by immunoadsorption (P<0. 01). The 12 h and 18 h survival rates were 70% and 30% in the immunoadsorption group, and 30% and 5% in the Amberlite XAD-7 group respectively (P<0. 05). Conclusion: Compared with the nonspecific Amberlite XAD-7 adsorption,the specific imrnunoadsorption might be a more effective method of removing circulatory TNF and improve the survival rate in endotoxin shock.展开更多
In order to evaluate the feasibility of specific removal of circulating TNF by imrnunoadsorption,the efficacy and safety of the anti-TNF monoclonal antibody immobilized immunosorbent were studied fromdifferent points ...In order to evaluate the feasibility of specific removal of circulating TNF by imrnunoadsorption,the efficacy and safety of the anti-TNF monoclonal antibody immobilized immunosorbent were studied fromdifferent points of view. The results showed: (l ) The physical characteristics of the immunosorbent wereperfect; (2) The maximum of antibody 1 ml was about 8. 12 mg; (3) Leakage of the antibody from the immunosorbent was not detectable; (4 ) The immunosorbent could remove circulating TNF effectively; (5 )Small amounts of Plasma proteins were adhered nonspecifically, but most of them could be washed out easily;(6 ) The sorbent capacity was not affected obviously when it was disinfected with ethanol; (7 ) The immunosorbent was of good biocompatibility. These findings suggest that the immunosorbent might be used forremoving circulatory TNF in endotoxic shock in the展开更多
文摘目的高钾血症是终末期肾病患者的常见合并症之一,严重高钾血症可引起致死性心律失常而危及生命。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study,DOPPS)中血液透析(hemodialysis,HD)患者合并高钾血症的情况,并探究血液透析患者合并高钾血症的独立相关因素。方法DOPPS是1项国际性的前瞻性观察研究,中国参加了DOPPS5(2012~2015),并完成了队列的随访。中国DOPPS5中纳入了1427名患者。以这些患者为研究对象,收集实验检查中透析前血钾的值,分为正常血钾组(血钾<5.5mmol/L)和高钾血症组(血钾≥5.5mmol/L)。根据严重程度进一步将高钾血症分为轻度(5.5~5.9mmol/L)、中度(6.0~6.4mmol/L)或重度(≥6.5 mmol/L)。比较2组间的一般资料、实验室检查及透析处方间的差异,并用多因素Logistic回归分析探究高钾血症的独立相关因素。结果本研究共纳入了1339名HD患者,平均年龄为(59.4±14.9)岁,中位透析龄为2.6(0.9,5.3)年,男性占54.4%。合并高钾血症的患者为345人(25.8%),其中轻度高钾血症占13.3%,中度高钾血症占7.6%,重度高钾血症占4.9%。3个城市中,北京的HD患者合并高钾血症的比例最高(31.8%),其次是广州(26.0%),上海的患者中合并高钾血症的比例最低(19.3%)(χ^(2)=18.580,P<0.001)。血钾正常和高钾血症的2组患者在年龄(t=2.610,P=0.009)、性别比例(χ^(2)=4.059,P=0.007)、BMI(t=-2.680,P=0.008)、透析充分性(t=4.280,P<0.001)、透析频次(χ^(2)=21.548,P<0.001)、血白蛋白(t=6.071,P<0.001)、血磷(t=7.083,P<0.001)等方面均有显著差异。多因素Logistic回归分析示,较高的BMI(OR:1.040,95%CI:1.004~1.077,P=0.027)、女性(OR:1.201,95%CI:1.023~2.547,P=0.026)、透析液钾浓度≥2.5mEq/L(相比于<2.5mEq/L)(OR:1.194,95%CI:1.028~1.386,P=0.020)、透析充分性不达标(stdKt/V<2)(OR:1.336,95%CI:1.170~1.527,P<0.001)、透析频次低于每周3次(OR:1.332,95%CI:1.150~1.544,P<0.001)、血白蛋白水平高(OR:1.815,95%CI:1.294~2.547,P<0.001)、血磷水平高(OR:1.231,95%CI:1.153~1.316,P<0.001)是与HD患者合并高钾血症的独立相关因素。结论在中国DOPPS5研究中,25.8%的HD患者合并高钾血症。纳入的3个城市中,北京患者中合并高钾血症的比例最高,其次是广州,上海最低。较高的BMI、女性、透析液钾浓度≥2.5mEq/L(相比于<2.5mEq/L)、透析充分性不达标(stdKt/V<2)、透析频次低于每周3次、血白蛋白水平高、血磷水平高是HD患者合并高钾血症的独立相关因素。
文摘体外用次氯酸氧化牛血清白蛋白(BSA)制备晚期氧化蛋白产物(AOPP)-BSA。将人脐静脉内皮细胞(HUVEC s)与不同浓度的AOPP-BSA共同培养,用W estern b lotting及免疫荧光化学染色法检测血管细胞黏附分子-1(VCAM-1)蛋白表达,用RT-PCR法检测VCAM-1 mRNA表达。结果AOPP-BSA诱导VCAM-1 mRNA表达呈时间依赖性,同时以时间和剂量依赖的方式上调HUVEC s VCAM-1蛋白的表达;未经氧化修饰的BSA对HUVEC s VCAM-1表达无明显作用。认为AOPP可诱导内皮细胞VCAM-1表达,此可能是动脉粥样硬化发生和发展的机制之一。
文摘Objective: To compare the protective effects of removingcirculatory TNF by specific immunoadsorption and by nonspeciflc Amberlite XAD-7 adsorption on experimental endotoxin shock. Methods: New Zealand white rabbits receiving a lethal dose of endotoxin underwent hemoperfusion through immunoadsorbent or Amberlite BAD-7. Plasma TNF levels. efficiency of the adsorbents and the survival rate were observed. Results: After 2 h of hemopcrfusion through immunoadsorhent or Amberlite XAD-7. plasma TNF levels were significantly lower than those in the control group(P<0.01). and the best result was shown by immunoadsorption (P<0. 01). The 12 h and 18 h survival rates were 70% and 30% in the immunoadsorption group, and 30% and 5% in the Amberlite XAD-7 group respectively (P<0. 05). Conclusion: Compared with the nonspecific Amberlite XAD-7 adsorption,the specific imrnunoadsorption might be a more effective method of removing circulatory TNF and improve the survival rate in endotoxin shock.
文摘In order to evaluate the feasibility of specific removal of circulating TNF by imrnunoadsorption,the efficacy and safety of the anti-TNF monoclonal antibody immobilized immunosorbent were studied fromdifferent points of view. The results showed: (l ) The physical characteristics of the immunosorbent wereperfect; (2) The maximum of antibody 1 ml was about 8. 12 mg; (3) Leakage of the antibody from the immunosorbent was not detectable; (4 ) The immunosorbent could remove circulating TNF effectively; (5 )Small amounts of Plasma proteins were adhered nonspecifically, but most of them could be washed out easily;(6 ) The sorbent capacity was not affected obviously when it was disinfected with ethanol; (7 ) The immunosorbent was of good biocompatibility. These findings suggest that the immunosorbent might be used forremoving circulatory TNF in endotoxic shock in the
