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对高尿酸血症危害的认识与患者健康管理的思考

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中华健康管理学杂志 2023年第4期17卷 241-244页

作者：肖湘成中南大学湘雅医院肾内科长沙410008

高尿酸血症是嘌呤代谢紊乱引起的代谢异常综合征。近年来,中国高尿酸血症患病率急剧增加,已成为我国重要的公共卫生问题。高尿酸血症可累及全身多系统,与痛风、代谢综合征、心脑血管疾病及慢性肾脏病等疾病的发生发展有关。高尿酸血症... 详细信息

高尿酸血症是嘌呤代谢紊乱引起的代谢异常综合征。近年来,中国高尿酸血症患病率急剧增加,已成为我国重要的公共卫生问题。高尿酸血症可累及全身多系统,与痛风、代谢综合征、心脑血管疾病及慢性肾脏病等疾病的发生发展有关。高尿酸血症患者的良好自我管理、多学科及全病程管理、中西医结合管理和互联网及远程医疗的运用对提高高尿酸血症的健康管理水平,改善患者生活质量和预后具有重要作用。

关键词：高尿酸血症危害健康管理

Clinico-biological characteristics and treatment of hepatitis B virus-related mixed cryoglobulinemia

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Chinese Medical Journal 2022年第3期135卷 371-373页

作者： Xiufen Wang xiangcheng xiao Huipeng Ge Tianci Deng Qiaoling Zhou Jianping Ning xiaoying Wu Hongling Yin Wei Lin Wenbin Tang Department of Nephrology Xiangya HospitalCentral South UniversityChangshaHunan 410008China Department of Pathology Xiangya HospitalCentral South UniversityChangshaHunan 410008China Health Management Center Xiangya HospitalCentral South UniversityChangshaHunan 410008China

To the Editor:Cryoglobulinemia is a disease characterized by cryoglobulins in serum that precipitate under in vitro conditions<37°C and redissolve on *** is divided into three types:Type I,where the cryoglobulin is composed of monoclonal IgG or IgM,and rarely IgA or free immunoglobulin(Ig)light chains;Type II,where the cryoglobulin is made of monoclonal IgM with rheumatoid factor(RF)activity and polyclonal IgG;and Type III,where the cryoglobulin is composed of polyclonal IgM with RF activity and polyclonal IgG.[1]Types II and III are mixed cryoglobulinemia(MC).MC could be related to several infectious diseases,like hepatitis C and *** mainly presents as cryoglobulinemic vasculitis,[2]including fatigue,purpura,arthralgia,myalgia,peripheral neuropathy,and even severe organ damage,like ***,cryoglobulinemic vasculitis involving the gastrointestinal tract and heart is ***,neurological,ocular,and rhino-otological symptoms of hyperviscosity syndrome are also hardly seen in ***,we report one hepatitis B virus(HBV)-related MC case and analyze 41 cases in *** have analyzed these 42 HBV-related MC cases to clarify their clinico-biological characteristics and treatment.

关键词： globulin hepatitis mixed

Single-cell RNA sequencing reveals the transcriptomic landscape of kidneys in patients with ischemic acute kidney injury

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Chinese Medical Journal 2023年第10期136卷 1177-1187页

作者： Rong Tang Peng Jin Chanjuan Shen Wei Lin Leilin Yu Xueling Hu Ting Meng Linlin Zhang Ling Peng xiangcheng xiao Peter Eggenhuizen Joshua DOoi Xueqin Wu Xiang Ding Yong Zhong Department of Nephrology Xiangya HospitalCentral South UniversityChangshaHunan 410008China Key Laboratory of Biological Nanotechnology of National Health Commission Xiangya HospitalCentral South UniversityChangshaHunan 410008China Department of Organ Transplantation Xiangya HospitalCentral South UniversityChangshaHunan 410008China Department of Hematology The Affiliated Zhuzhou Hospital Xiangya Medical CollegeCentral South UniversityZhuzhouHunan 412007China Department of Pathology Xiangya HospitalCentral South UniversityChangshaHunan 410008China Department of Nephrology Jiujiang Hospital of Traditional Chinese MedicineJiujiangJiangxi 332099China Department of Medicine Centre for Inflammatory DiseasesMonash Medical CentreMonash UniversityClaytonVIC 3168Australia Department of Nephrology The Third Xiangya HospitalCentral South UniversityChangshaHunan 410013China National Clinical Research Center for Geriatric Disorders Xiangya HospitalCentral South UniversityChangshaHunan 410008China

Background:Ischemic acute kidney injury(AKI)is a common syndrome associated with considerable mortality and healthcare *** to now,the underlying pathogenesis of ischemic AKI remains incompletely understood,and specific strategies for early diagnosis and treatment of ischemic AKI are still ***,this study aimed to define the transcriptomic landscape of AKI patients through single-cell RNA sequencing(scRNA-seq)analysis in ***:In this study,scRNA-seq technology was applied to kidneys from two ischemic AKI patients,and three human public scRNA-seq datasets were collected as *** expressed genes(DEGs)and cell clusters of kidneys were *** ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis,as well as the ligand-receptor interaction between cells,were *** also validated several DEGs expression in kidneys from human ischemic AKI and ischemia/reperfusion(I/R)injury induced AKI mice through immunohistochemistry ***:15 distinct cell clusters were determined in kidney from subjects of ischemic AKI and *** injured proximal tubules(PT)displayed a proapoptotic and proinflammatory *** cells of ischemic AKI had up-regulation of novel pro-apoptotic genes including USP47,RASSF4,EBAG9,IER3,SASH1,SEPTIN7,and NUB1,which have not been reported in ischemic AKI *** hub genes were validated in kidneys from human AKI and renal I/R injury mice,***,PT highly expressed DEGs enriched in endoplasmic reticulum stress,autophagy,and retinoic acid-inducible gene I(RIG-I)*** overexpressed in other tubular cells were primarily enriched in nucleotide-binding and oligomerization domain(NOD)-like receptor signaling,estrogen signaling,interleukin(IL)-12 signaling,and IL-17 *** genes in kidney-resident immune cells including macrophages,natural killer T(NKT)cells,monocytes,and dendritic cells were associated with

关键词： Ischemic acute kidney injury Single-cell RNA sequencing Proximal tubule cells Apoptosis Inflammation Cell-cell crosstalk

社区2型糖尿病患者的自我管理行为与其血糖控制的相关性研究

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中南大学学报（医学版） 2013年第4期38卷 425-431页

作者：于平平肖湘成王琳云王磊中南大学湘雅医院老干科长沙410008 中南大学湘雅医院肾内科长沙410008

目的:调查社区2型糖尿病患者的自我管理行为水平,并探讨其与血糖控制之间的关系。方法:采用整群分层随机抽样的方法,抽取社区2型糖尿病患者211名调查其自我管理行为水平。同时现场检测研究对象的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖... 详细信息

目的:调查社区2型糖尿病患者的自我管理行为水平,并探讨其与血糖控制之间的关系。方法:采用整群分层随机抽样的方法,抽取社区2型糖尿病患者211名调查其自我管理行为水平。同时现场检测研究对象的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1C),比较不同组间血糖水平的差异,并分析患者自我管理行为与其血糖水平的关系。结果:调查对象中自我管理行为总体水平不高;2hPG,HbA1C受不同自我管理行为水平的影响较大(P<0.05);自我管理行为与FPG(r=–0.277,P=0.015),2hPG(r=–0.453,P<0.001),HbA1C(r=–0.435,P=0.001)呈负相关;病程≥5年时患者的血糖控制因自我管理行为的不同而呈现明显的不同;患者的FPG与饮食控制的管理最相关,2hPG与饮食控制、坚持用药、血糖自我监测3个管理维度密切相关,HbA1C与饮食控制、坚持用药相关;患者参加糖尿病教育的次数、使用胰岛素治疗的方式以及病程是影响社区2型糖尿病患者自我管理行为的重要因素。结论:社区2型糖尿病患者自我管理行为水平不佳,良好的自我管理行为有助于患者的血糖控制,特别是2hPG和HbA1C的控制;在提高社区2型糖尿病患者自我管理行为时要关注患者的病程、治疗的方式以及接受糖尿病健康教育的内容与效果。

关键词： 2型糖尿病社区自我管理行为血糖控制

Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis:a prospective multicenter randomized controlled trial

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2022年第11期23卷 931-942页

作者： xiaoyan TANG Dezheng CHEN Ling ZHANG Ping FU Yanxia CHEN Zhou xiao xiangcheng xiao Weisheng PENG Li CHENG Yanmin ZHANG Hongbo LI Kehui LI Bizhen GOU Xin WU Qian YU Lijun JIAN Zaizhi ZHU Yu WEN Cheng LIU Hen XUE Hongyu ZHANG Xin HE Bin YAN Liping ZHONG Bin HUANG Mingying MAO Division of Nephrology Kidney Research InstituteWest China Hospital of Sichuan UniversityChengdu 610041China Department of Nephrology People's Hospital of Jianyang CityChengdu64140China Department of Nephrology the Second Afiliated Hospital of Nanchang UniversityNanchang 330006China Department of Nephrology Xiangya Hospital of Central SouthUniversityChangsha 410008China Department of Nephrology Wuhan No.1HospitalWuhan 430022China Department of Blood Purification the First Affliated Hospital of Guangxi Medical UniversityNanning 530021China Department of Nephrology GuiyangFirst People's HospitalGuiyang550002China Department of Nephrology West China Hospital Sichuan University Jintang HospitalJintang 610400China Department of Nephrology Meishan People's HospitalMeishan 620020China Department of Nephrology Ziyang People's Hospital.Ziyang 641300China Department of Nephrology Ya'an People's HospitalYan 625000China Department of Nephrology Chengdu Kangfu Kidney Disease HospitalChengdu 610047China Department of Nephrology the First People's Hospital of Liangshan Yi Autonomous PrefectureXichang 615000China

Objective:Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of *** purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation(RCA)combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis(IHD)***:Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments,and were randomly divided into RCA group and saline flushing *** the RCA group,0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion *** sodium citrate was stopped after 3 h of dialysis,which was changed to sequential dialysis without *** hazard ratios for coagulation were according to ***:A total of 159 patients and 208 sessions were enrolled,including RCA group(80 patients,110 sessions)and saline flushing group(79 patients,98 sessions).The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group(3.64%vs.20.41%,P<0.001).The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group((238.34±9.33)min vs.(221.73±34.10)min,P<0.001).The urea clearance index(Kt/V)in the RCA group was similar to that in the saline flushing group with no statistically significant difference(1.12±0.34 vs.1.08±0.34,P=0.41).Conclusions:Compared with saline flushing,the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.

关键词： Regional citrate anticoagulation Intermittent hemodialysis Calcium-containing dialysate Saline flushing Anticoagulation

血液透析并肠系膜动脉钙化狭窄及肠系膜缺血一例

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中国医师杂志 2023年第3期25卷 370-373页

作者：张琳琳唐荣肖宫葛辉鹏肖湘成中南大学湘雅医院肾内科长沙410008

目的结合病例资料分析及相关文献回顾,提高对血液透析合并肠系膜动脉钙化狭窄及肠系膜缺血相关病例的认识。方法报道1例以顽固性腹痛为主要表现的血液透析病例,总结其临床特征及诊治要点。结果该病例为维持性血液透析患者,腹痛表现为脐... 详细信息

目的结合病例资料分析及相关文献回顾,提高对血液透析合并肠系膜动脉钙化狭窄及肠系膜缺血相关病例的认识。方法报道1例以顽固性腹痛为主要表现的血液透析病例,总结其临床特征及诊治要点。结果该病例为维持性血液透析患者,腹痛表现为脐周持续性隐痛,餐后及血透下机后疼痛加重,检查结果提示全身多发血管钙化、肠系膜上动脉狭窄,诊断为慢性肠系膜缺血。拟在介入下行肠系膜血运重建,但术中导丝未能进入肠系膜上动脉,建议予外科手术治疗,患者及家属拒绝手术、自动出院。结论透析患者合并顽固性腹痛,应仔细鉴别,警惕有无肠系膜动脉病变及肠系膜缺血。

关键词：血管钙化肠系膜上动脉肠系膜缺血血液透析

LRG-1在高血压肾损害小鼠中的表达及其意义

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中南大学学报（医学版） 2023年第6期48卷 837-845页

作者：张琳琳肖湘成胡雪玲王维彭玲唐荣中南大学湘雅医院肾内科长沙410008

目的:长期的血压升高可能导致肾损伤,而高血压肾损害的发病机制尚不清楚。本研究通过检测高血压肾损害小鼠血清及肾组织中富含亮氨酸α-2糖蛋白-1(leucine-rich alpha-2-glycoprotein-1,LRG-1)的表达,分析其与相关指标的关系,探讨其在... 详细信息

目的:长期的血压升高可能导致肾损伤,而高血压肾损害的发病机制尚不清楚。本研究通过检测高血压肾损害小鼠血清及肾组织中富含亮氨酸α-2糖蛋白-1(leucine-rich alpha-2-glycoprotein-1,LRG-1)的表达,分析其与相关指标的关系,探讨其在高血压肾损害中的作用及意义。方法:以C57BL/6小鼠为研究对象,将其随机分为对照组、血管紧张素Ⅱ(angiotensin Ⅱ,Ang Ⅱ)组和Ang Ⅱ+厄贝沙坦组(n=5)。对照组用生理盐水灌胃;Ang Ⅱ组用Ang Ⅱ以1.5 mg/(kg·d)的速度持续皮下泵入28 d构建高血压肾损害小鼠模型,再用等量生理盐水灌胃;Ang Ⅱ+厄贝沙坦组用相同方法构建高血压肾损害小鼠模型,再用厄贝沙坦灌胃。运用免疫组织化学法及蛋白质印迹法检测肾组织中LRG-1及纤维化相关指标(Ⅰ型胶原和纤维连接蛋白)的表达,酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测各组小鼠血清LRG-1及相关炎症因子水平,检测小鼠的尿蛋白-肌酐比值及肾功能,并进行相关性分析。结果:与对照组相比,Ang Ⅱ组小鼠血清LRG-1水平升高,肾组织LRG-1蛋白、Ⅰ型胶原及纤维连接蛋白表达增加(均P<0.01)。经过厄贝沙坦治疗后,高血压小鼠肾损害减轻,血清及肾组织LRG-1水平降低,肾组织Ⅰ型胶原及纤维连接蛋白表达下调(均P<0.01)。直线相关分析显示:高血压肾损害小鼠血清LRG-1水平与尿蛋白-肌酐比值、血尿素氮及血肌酐水平呈正相关;血清LRG-1水平与血清炎症因子TNF-α、IL-1β及IL-6呈正相关。结论:高血压肾损害小鼠血清及肾组织LRG-1表达增加,厄贝沙坦在减轻肾损害的同时可以降低LRG-1的表达;血清LRG-1水平与高血压肾损害程度及炎症反应呈正相关,提示其可能参与高血压肾损害的发生、发展。

关键词：高血压肾损害富含亮氨酸α-2糖蛋白-1 肾纤维化炎症

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他克莫司治疗特发性膜性肾病研究进展

中国临床药理学与治疗学 2019年第2期24卷 228-234页

作者：方茜屈强肖湘成中南大学湘雅医院肾内科中南大学湘雅医院药学部

他克莫司是一种钙调磷酸酶抑制剂,发挥免疫抑制作用。特发性膜性肾病是原发性肾病综合征最常见的病理类型。他克莫司的不良反应较其他免疫抑制剂小,疗效肯定,在特发性膜性肾病中的应用越来越广泛。近年来,关于他克莫司在特发性膜性肾病... 详细信息

他克莫司是一种钙调磷酸酶抑制剂,发挥免疫抑制作用。特发性膜性肾病是原发性肾病综合征最常见的病理类型。他克莫司的不良反应较其他免疫抑制剂小,疗效肯定,在特发性膜性肾病中的应用越来越广泛。近年来,关于他克莫司在特发性膜性肾病中的应用有较多研究及探索。本文总结了他克莫司在特发性膜性肾病中的治疗进展及个体化用药。

关键词：他克莫司膜性肾病免疫抑制个体化用药

269例抗中性粒细胞胞浆抗体相关性血管炎患者的临床病理特征及预后

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中南大学学报（医学版） 2020年第8期45卷 916-922页

作者：伍婷钟永周亚欧陈金彪杨映强唐荣孟婷肖舟肖湘成周巧玲肖平中南大学湘雅医院肾内科长沙410008 中南大学湘雅医院风湿免疫科长沙410008 中南大学湘雅医院病案信息科长沙410008

目的:了解抗中性粒细胞胞浆抗体(antineutrophil cytoplasimc antibody,ANCA)相关性血管炎(ANCAassociated vasculitis,AAV)的临床病理特征、预后及其影响因素。方法:回顾性分析中南大学湘雅医院2010年1月至2018年1月新诊断为AAV的269例住院患者的基本资料、临床病理数据,定期随访肾存活及患者存活情况,并对其临床病理及预后数据进行统计学分析及预后因素分析。结果:在269例AAV患者中,显微镜下多血管炎(microscopic polyangiitis,MPA)225例,占83.64%;肉芽肿性多血管炎(granulomatosis with polyangiitis,GPA)33例,占12.27%;嗜酸性肉芽肿性多血管炎(eosinophilic granulomatosis with polyangiitis,EGPA)11例,占4.09%。在MPA患者中,男女比例约为1:1,而GPA和EGPA患者中男性明显多于女性。从发病到确诊的中位时间为64.0 d,30 d内确诊65例,占24.16%。94.67%的MPA患者肾受累,显著高于GPA患者(63.63%),GPA累及耳鼻喉系统更常见(42.42%)。肾1年生存率在GPA和MPA患者中分别为75%和59.3%,1年病死率分别为16.7%和16.9%。多因素logistic回归分析显示:低血小板、低球蛋白血症、低免疫球蛋白G及血清肌酐升高是AAV患者1年肾生存率的危险因素,而血清肌酐升高是AAV患者全因死亡的独立危险因素。结论:AAV患者以MPA为主,患者进展为终末期肾病比例和病死率仍较高。早期诊断和及时治疗对改善AAV患者预后至关重要。

关键词：血管炎抗中性粒细胞胞浆抗体临床特征预后