目的：分析白塞氏病合并结核感染的临床特点及相关因素。方法：回顾分析2002年至今四川大学华西医院临床免疫科收治的初诊为白塞氏病且合并结核感染的病历资料，并结合相关文献分析可能的相关因素。结果：37例首诊为白塞氏病的患者中有10例（29.7%）合并结核感染，4例（10.8%）既往有结核病史，经抗结核或/和抗白塞氏病治疗后好转。结论：应警惕白塞氏病与结核感染并存，结核感染的临床表现可能和白塞氏病相混淆，需做好鉴别诊断并合理治疗。
目的 分析朱砂莲中毒导致急性肾功能衰竭临床表现、肾脏病理学及相关文献复习。 方法 2007年3月－9月收治朱砂莲中毒急性肾功能衰竭2例，分析临床表现及肾脏病理损害。 结果 朱砂莲急性中毒易致急性肾功能衰竭，危及生命；其主要损害肾小管间质，表现为急性肾小管重度损伤，无炎性细胞浸润，而肾小球几乎无病变。 结论 朱砂莲为我国常使用中药，主要成分为马兜铃酸，易致马兜铃酸肾病，须提高对该病认识，规范使用中草药，避免药物性所致肾损害。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2型糖尿病患者合并不同类型肾脏损伤的临床表现、肾脏病理分型,探讨临床特点和病理类型之间的关系,以指导临床诊治。方法 分析1998年12月—2008年12月53例接受肾活检的2型糖尿病患者,其中男38例,女15例,平均52岁,糖尿病病程0~22年,平均5年。分析纳入患者的临床表现、肾脏病理特点和肾脏损伤程度。结果 2型糖尿病合并肾脏损伤以中老年多见,年龄50～74岁,其中糖尿病肾病(DN) 34例,44.1%的患者肾脏损害出现在发现糖尿病5年后；非糖尿病肾病(DM+NDRD)16例,81.3%的患者肾脏损害出现在发现糖尿病5年内；糖尿病肾病合并非糖尿病肾病(DN+NDRD)3例,平均糖尿病病程均lt;5年。2型糖尿病合并肾脏损伤的肾脏病理类型多样,除DN(占64.2%)外,17.0%的患者为膜性肾病，7.5%的患者为系膜增生性肾病。结论 2型糖尿病合并肾损伤以DN为多,亦可出现DM+NDRD或DN +NDRD,通过肾活检明确肾脏病理类型对临床治疗及判断预后有指导意义。
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 分析乳酸性酸中毒发生的危险因素，警示临床工作。 方法 回顾性分析2008年5月—2010年12月收治的32例乳酸性酸中毒患者的临床资料。 结果 32例患者均合并2型糖尿病，其中老年患者27例（占84.6%）；20例有服用双胍类降糖药物史（占62.5%）；12例合并肺部疾病（占37.5%）；9例合并心脏疾病（占28.1%）；15例合并肾功能不全（占46.9%）；8例合并肝功能异常（占25.0%）。 结论 糖尿病、老年、使用双胍类药物、合并心肺疾病及肝肾功能不全都是发生乳酸性酸中毒的危险因素。在临床工作中，对高危患者需提高警惕，尽量避免危险因素叠加以减少乳酸性酸中毒的发生。【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.