Objective We searched for evidence on mycophenolate mofetil(MMF) as a treatment for patients with diffuse proliferative lupus nephritis. Methods We attempted to find the current best evidence by searching The Cochrane Library(Issue 4, 2005), MEDLINE(1990 to June 2007), CMB(1980 to December 2006), CNKI(1979 to October 2007). We critically appraised the available evidence. Results Four systematic reviews and 6 randomized controlled trials of high quality were available. MMF and prednisolone were found to be an effective continuous induction-maintenance treatment for diffuse proliferative lupus nephritis. MMF was associated with less drug toxicity. Conclusion Given the current evidence and our clinical experience, and considering the patient and the values and preferences of his family,MMF was given at 1 g daily in combination with steroids at the beginning. No obvious adverse effects occurred during 3 months of follow-up.
ObjectiveTo investigate the diagnosis, clinical features, treatment and outcome of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPV-B19) infection in kidney recipients. Method The clinical courses of six patients with PRCA caused by HPV-B19 infection after renal transplantation in West China Hospital between May 2018 and April 2019 were retrospectively investigated. Results The six patients showed obvious anemia symptoms, lacking rash, joint pain and other clinical symptoms of viral infection. The hemoglobin level of five patients got totally remission from a course of intravenous immunoglobulin (IVIG) treatment, and anemia symptoms like fatigue, weakness got notable improvement. One patient had no improvement after two courses of IVIG treatment, and his anemia was significantly improved after the third IVIG course combined with immunosuppressant conversion(from tacrolimus to cyclosporine), and one patient with recurrence accepted a repeated course of IVIG treatment and obtained remission of severe anemia again. The median time of reticulocyte firstly rose to above 0.084×1012/L from the day of IVIG treatment ended was 3.50 (1.25, 5.00) days, and the median time required for a 30 g/L increase in hemoglobin to the end of IVIG treatment was 16.00 (9.25, 31.25) days. No serious adverse reactions occurred and all patients had stable graft function. Conclusions The main clinical manifestations of PRCA caused by HPV-B19 infection after kidney transplantation are anemia symptoms, lacking other clinical symptoms of viral infection. HPV-B19 DNA detection combined with blood routine examination, reticulocyte count and bone marrow cytology (or none) can diagnose HPV-B19 infection. High dose of IVIG is effective and safe, and a repeated course is still effective when the infection recurs. For refractory PRCA that IVIG monotherapy fail, a combination with conversion from tacrolimus to cyclosporine can effectively improve the anemia without graft dysfunction.
目的 總結腎移植術后肺部感染的臨床表現、病原學及救治措施，以提高其治愈率。 方法 對四川大學華西醫院50例次腎移植術后肺部感染住院患者的病歷資料進行回顧性分析。 結果 共收集42例（50例）次腎移植肺部感染患者，痰培養檢出病原體38例次（76%），未檢出12例次，其中細菌感染17例次（44.7%），真菌感染7例次（18.4%），巨細胞病毒感染19例次（38%），支原體感染6例次（12%），混合感染10例次（20%）。肺部感染發生在腎移植術后1個月以內者3例（7%），1～6個月者16例（38%），6個月以后者23例（55%）。50例次感染患者中48例次經積極治療搶救后好轉出院，有2例患者死亡。 結論 腎移植術后肺部感染患者的病原體與腎移植術后時間有一定的規律性。對于腎移植術后肺部感染，救治成功的關鍵是早期病原體及CT檢查，及時給予綜合治療措施，包括經驗性抗生素治療措施，及時調整免疫抑制劑方案，加強全身支持。
目的 回顧性觀察糖皮質激素聯合小劑量嗎替麥考酚酯（MMF）對IgA腎病的臨床療效及安全性。 方法 2010年9月－2012年9月在我科門診就診的28例IgA腎病患者接受了小劑量MMF聯合激素治療。醋酸潑尼松起始劑量為0.6 mg/（kg·d），MMF起始劑量為0.5～1.0 g/d，2～4周內調節藥物劑量使血藥濃度（MPA-AUC）維持在30～60 mg·h/L。治療前及治療后每月隨訪觀察血清肌酐、血清白蛋白、尿蛋白定性、24 h尿蛋白定量及藥物不良反應等指標。誘導期初定為6個月，若6個月未完全緩解（CR）則延長至9個月，總療程至少12個月，主要評價指標為誘導治療期的完全緩解率。 結果 全部患者均完成了12個月的隨訪觀察，全組28例中CR 8例（28.6%），部分緩解（PR）14例（50.0%），未緩解（NR）6例（21.4%），總有效率78.6%。隨訪過程中，3例患者出現呼吸道感染，其中2例住院治療；2例患者出現尿路感染，1例患者出現腹瀉。 結論 小劑量MMF治療IgA腎病安全、有效且能在一定程度上節省患者費用，可作為其他免疫抑制方案治療無效或復發時的一種治療選擇。
Objective To investigate the efficacy and safety of polyethersulfone highflux dialyzer for uremic patients. Methods Forty eligible uremic patients were randomized into two groups, i.e. polyethersulfone (PES) group and polysulfone(PSF) group, according to a random number table. The PES group received hemodialysis for 4 hours with polyethersulfone highflux dialyzer (Chengdu OCI Medical Device Co., Ltd), and the PSF group with polysulfone highflux dialyzers (Fresenius Polysulfones, Fresenius Medical Care, Bad Homburg, Germany). Changes in serum creatinine, urea, β2-microglobulin, hemoglobin and albumin levels were determined for efficacy and safety evaluation. Results All the 40 patients completed the trial. The serum creatinine, urea, β2-microglobulin levels of all the patients in the two groups decreased (gt;30%) after the hemodialysis with different highflux dialyzers, and no significant difference was observed between the two groups (Pgt;0.05). Changes in solute clearance index (KT/V) value, hemoglobin and albumin levels were also comparable between the two groups (Pgt;0.05). Conclusions The efficacy and safety of the PES hollow fiber membrane hemodialyzer is equivalent to that of the PSF hemodialyzer in hemodialysis for uremic patients.
Objective To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.
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 understand the preventive effect of pneumatic compression therapy on deep vein thrombosis (DVT) in lower limbs of patients with spinal cord injury. Methods Patients with spinal cord injury who transferred from Orthopedics Department to Rehabilitation Department undergoing rehabilitation in the First Affiliated Hospital of University of Science and Technology of China and discharged from April 2017 to December 2020 were retrospectively included. According to the contents of the medical order of the case data, the patients were divided into treatment group and control group. The intervention method of the treatment group was pneumatic compression therapy and conventional rehabilitation treatment, and the control group was conventional rehabilitation treatment. Multivariate logistic regression was used for statistical analysis to explore the association of pneumatic compression therapy and the risk of DVT in patients with spinal cord injury. Results Finally, 153 patients were enrolled, including 71 cases in the treatment group and 82 cases in the control group. After rehabilitation therapy, DVT occurred in 10 cases (14.1%) in the treatment group and 21 cases (25.6%) in the control group. There was no significant difference in incidence of DVT between the two groups (χ2=3.129, P=0.077). After six months of follow-up, DVT occurred in 11 cases (15.5%) in the treatment group and 12 cases (14.6%) in the control group. There was no significant difference in incidence of DVT between the two groups (χ2=0.022, P=0.822). D-dimer [odds ratio (OR) =1.104, 95% confidence interval (CI) (1.036, 1.175), P=0.002] and age [OR=1.081, 95%CI (1.040, 1.124), P<0.001] were independent risk factors for the risk of DVT after treatment. Pneumatic compression therapy was a protective factor for the risk of DVT [OR=0.210, 95%CI (0.075, 0.591), P=0.003]. Age [OR=1.057, 95%CI (1.008, 1.108), P=0.023] was an independent risk factor for the risk of DVT after six months. The effect of pneumatic compression therapy was not statistically significant (P=0.393). Conclusions After spinal cord injury, it is necessary to strengthen the management of high serum D-dimer state, especially the risk of DVT in elderly patients. Pneumatic compression therapy could be used as a treatment measure to reduce risk of DVT in patients with spinal cord injury during hospitalization, however, the preventive effect after half a year needs to be further studied.
【摘要】 目的 觀察激素加霉酚酸酯（mycophenolate mofetil，MMF）和他克莫司（tacrolimus，FK506）的多靶點方案治療難治性腎小球疾病的療效及安全性。 方法 2008年5月-2010年3月收治的15例狼瘡性腎炎（lupus nephritis，LN）、3例膜增生性腎小球腎炎（membranoproliferative glomerulonephritis，MPGN）及3例膜性腎病（membranous nephropathy，MN）患者，因多種免疫抑制劑治療無效或復發而改用多靶點療法。潑尼松以30~40 mg/d起始，逐漸減量。MMF 和FK506起始劑量分別為0.5 g/d或1 mg/d，目標血藥濃度分別為20~40 mg/（h·L）或5~8 ng/mL。定期隨訪觀察肝腎功能、尿蛋白定量、不良反應等指標。 結果 治療6個月時15例LN中7例（46.7%）完全緩解（complete remission，CR），5例（33.3%）部分緩解（partial remission，PR），3例（20%）無效（no response，NR）。3例MPGN均表現為NR。3例MN中2例（66.7%）PR，1例（33.3%）NR。治療過程中呼吸道感染及脫發各1例，胃腸不適2例，肌酐逐步升高3例，無死亡或退出者。 結論 多靶點療法對難治性LN安全、有效，可作為其他免疫抑制劑治療無效或復發時的選擇方案，但對MPGN和MN療效欠佳，需進一步研究。【Abstract】 Objective To investigate the efficacy and safety of multitarget therapy with steroid, mycophenolate mofetil (MMF) and tacrolimus (FK506) in the treatment of refractory glomerular diseases. Methods Fifteen patients with lupus nephritis (LN), 3 patients with membranoproliferative glomerulonephritis (MPGN) and 3 patients with membranous nephropathy (MN) who failed the previous immunosuppressive therapy from May 2008 to March 2010 in our hospital were treated with multitarget therapy. The initial dose of prednisone was 30-40 mg/d and then tapered gradually. MMF and FK506 were started at 0.5 g/d or 1 mg/d, and the target blood concentration of the two drugs was 20-40 mg/(h·L) and 5-8 ng/mL respectively. Clinical parameters such as liver and renal function, urine protein, and side effects were recorded and analyzed in the regular follow-up. Results After 6 months of treatment, 7 (46.7%) of the 15 LN patients achieved complete remission (CR), 5 (33.3%) achieved partial remission (PR), while 3 (20%) failed this treatment and had no response (NR). All of the three MPGN patents had NR to this combined therapy. Two (66.7%) of the 3 MN patents achieved PR while 1 (33.3%) had NR. No patient withdrew or died because of side effects. One patient developed upper respiratory infection, one experienced alopecia, two developed gastrointestinal syndrome and three experienced gradual increasing in the serum creatinine. Conclusion Multitarget therapy with FK506, MMF and steroid is an effective and safe therapy for refractory lupus nephritis and it can be used in patients who are resistant to the conventional immunosuppressive therapy. However, this combined therapy does not meet a satisfactory result in patients with MN and MPGN, which entails further study.
Objective To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA). Methods Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram. Results The operation time of the resurfacing group was significantly longer than that of the control group (P<0.05), and there was no significant difference in intraoperative blood loss between the two groups (P>0.05). All patients’ incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, etc.), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, etc. No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee activity difficulty, and the composition ratio of anterior knee pain localization between the two groups (P>0.05). The KSS clinical scores, functional scores, and VAS scores of both groups significantly improved compared to preoperative ones (P<0.05); there was no significant difference in the comparison between the two groups at the two time points postoperatively (P>0.05). At 2 years postoperatively and at last follow-up, there was no significant difference in FJS scores between the two groups (P>0.05). ConclusionPatellar resurfacing or not has similar mid- and long-term effectiveness in primary TKA.