【摘要】 目的 血管緊張素受體拮抗劑（angiotension Ⅱ receptor blockers，ARB）是血液透析患者常用的降壓藥物之一，可對腎臟的排鉀功能產生影響。研究通過對血液透析患者高鉀血癥的發生情況進行調查，了解并分析相關影響因素，探討ARB類藥物在血液透析患者中應用的安全性。 方法 2010年1月－2010年7月對95例維持性血液透析患者的臨床資料進行調查，比較ARB組和非ARB組高鉀血癥的發生率，并將可能的危險因素和高鉀血癥的發生率進行相關性分析。 結果 納入患者中使用ARB類降壓藥47例，未使用ARB類降壓藥48例。ARB組高鉀血癥15例（31.9%），非ARB組高鉀血癥14例（29.2%），發生率無統計學意義（Pgt;0.05）。將高鉀患者和血鉀正常患者做對比，高鉀血癥組年齡較輕[（47.69±13.64）歲，（54.50±13.54）歲；Plt;0.05]，尿量lt;400 mL者所占比例更大（89.7%，57.6%；Plt;0.05）。logistic回歸分析結果顯示，高鉀血癥的發生與年齡、透析次數、尿量相關，而與ARB藥物的使用無關。 結論 血液透析患者高鉀血癥的發生與患者的透析次數、尿量、年齡相關，ARB類藥物的使用未增加高鉀血癥的發生率。【Abstract】 Objective To analyze the risk factors for hyperkalemia and evaluate the security of ARBs application in hemodialysis patients, as angiotensin Ⅱ receptor blockers (ARBs) are commonly used anti-hypertensive drugs in hemodialysis patients, and they may affect the renal excretion of potassium. Methods The clinical data of 95 hemodialysis patients were investigated from January 2010 to July 2010. We compared the incidence of hyperkalemia in ARBs group and non-ARBs group, and also analyzed the correlation between the possible risk factors and hyperkalemia incidence. Results There were 47 patients in the ARBs group and 48 patients in the non-ARBs group. Fifteen patients (31.9%) in the ARBs group and 14 (29.2%) in the non-ARBs group had hyperkalemia, and there was no significant difference in the proportion of patients who had hyperkalemia between the two groups (Pgt;0.05). Compared with patients without hyperkalemia, patients with hyperkalemia were younger [(47.69±13.64) vs. (54.50±13.54) years, Plt;0.05], and more often had urine volume less than 400 mL (89.7% vs. 57.6%, Plt;0.05). Logistic regression analysis showed that the incidence of hyperkalemia was related to age, frequency of dialysis, and urine volume, not to ARBs. Conclusion The incidence of hyperkalemia in hemodialysis patients is related to the frequency of dialysis, urine volume and age; ARBs do not increase the incidence of hyperkalemia.
ObjectiveTo systematically review the renal adverse reactions of tyrosine kinase inhibitors (TKI). MethodsPubMed, EMbase, Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the incidence of renal adverse reactions of TKI from inception to March 30, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 19 RCTs involving 10 141 patients were included. The results of meta-analysis showed that compared with placebo or blank control, gefitinib, ranvartinib, cabotinib, vandetanib, pazopanib, arotinib, apatinib, and acitinib could lead to an increased risk of proteinuria events, while sildenib did not increase the risk of proteinuria in patients. Anlotinib could increase the risk of hematuria. Vandetanil increased the risk of acute kidney injury. Gefitinib, ranvartinib and apatinib could increase the risk of grade 3-4 renal adverse reactions. ConclusionCurrent evidence shows that TKI drugs may cause renal damage in patients, and proteinuria is the most common. Vandetanil can cause acute kidney injury, gefitinib, ranvartinib and apatinib are more nephrotoxic. The renal adverse reactions of neratinib, ibutinib and sildenib are relatively few.
Objective To explore the medical insurance quota payment of dialysis treatment for outpatients with end-stage renal disease in Chengdu from following aspects, evaluation indexes and reasonable amount, so as to provide scientific basis for the payment of single disease. Methods A questionnaire survey was conducted to collect the cost information of patients, and to formulate the assignment of evaluation indexes according to the therapeutic principles and statistical results; Delphi method was adopted to determine the assignment and the standard of quota payment. Results A total of 17 dialysis organizations approved by Chengdu municipal medical insurance were involved in this study. Of 700 questionnaires distributed, 686 were retrieved. After excluding 26 questionnaires for incomplete filling and incorrect treatment information, a total of 660 questionnaires were included actually, accounted for 94.28% of all informants. The results of survey showed that, the hemodialysis treatment rate accounted for 84% (555/660) of all informants, while the peritoneal dialysis treatment rate accounted for 16% (105/660). By assessing the project assignment of outpatient dialysis treatment, the minimum annual payment of hemodialysis was RMB 118 242.75 yuan, while that of peritoneal dialysis was RMB 96 498.00 yuan. Conclusion The quota payment of outpatient dialysis shows b evidence after adopting the treatment project assignment. The grading quota payment of outpatient dialysis enables the medical insurance fund to be more reasonably used.
Objective To review the research progress on the application of three-dimensional (3D) bioprinting technology in auricle repair and reconstruction. Methods The recent domestic and international research literature on 3D printing and auricle repair and reconstruction was extensively reviewed, and the concept of 3D bioprinting technology and research progress in auricle repair and reconstruction were summarized. Results The auricle possesses intricate anatomical structure and functionality, necessitating precise tissue reconstruction and morphological replication. Hence, 3D printing technology holds immense potential in auricle reconstruction. In contrast to conventional 3D printing technology, 3D bioprinting technology not only enables the simulation of auricular outer shape but also facilitates the precise distribution of cells within the scaffold during fabrication by incorporating cells into bioink. This approach mimics the composition and structure of natural tissues, thereby favoring the construction of biologically active auricular tissues and enhancing tissue repair outcomes. Conclusion 3D bioprinting technology enables the reconstruction of auricular tissues, avoiding potential complications associated with traditional autologous cartilage grafting. The primary challenge in current research lies in identifying bioinks that meet both the mechanical requirements of complex tissues and biological criteria.