目的 总结反复黏膜感染的IgA肾病的临床病理特点。 方法 采用单中心流行病学调查及回顾性研究，收集2006年1月－2009年12月253例经肾活检确诊为IgA肾病的住院患者的临床病理资料，对114例反复黏膜感染的IgA肾病患者（A组）及139例偶发或从未发生黏膜感染的IgA肾病患者（B组）的临床病理指标进行比较。 结果 A组患者年龄较B组小（t=2.913，P=0.004），临床表现无明显症状者比例较B组多，临床分型以反复发作肉眼血尿型为多，病理分级较B组轻（Z=?2.042，P=0.041），IgA+IgM+C3沉积率高（P＜0.001）；B组IgA+IgG+C3沉积率高（P＜0.001），纤维连接蛋白沉积率高（P＜0.001）。 结论 反复黏膜感染的IgA肾病组患者年龄小，反复发作肉眼血尿型多，临床表现及病理分级较轻；两组FN沉积及免疫球蛋白沉积的主要类型不同，提示两组发病机制可能有所不同。
目的 探讨不同性别IgA肾病患者合并高尿酸血症的临床及肾脏病理特点。 方法 采用回顾性研究方法，将2008年1月－2010年12月收治的226例经肾活检确诊的原发性IgA肾病患者分为男性高尿酸血症组、男性尿酸正常组、女性高尿酸血症组及女性尿酸正常组4组，统计分析4组的临床指标及病理指标。 结果 高尿酸血症患病率男性（21.7%）高于女性（11.9%），差异有统计学意义（P＜0.01），尿检异常型患病率男性（14.6%）高于女性（4.0%），差异有统计学意义（P＜0.01），女性LeeⅢ级的患病率（7.1%）高于男性（5.8%），差异有统计学意义（P＜0.01）；男性高尿酸血症组的尿素氮高于尿酸正常组（P＜0.05），女性高尿酸血症组的血尿素氮、血肌酐、胱抑素C、舒张压、甘油三酯比尿酸正常者明显增高（P＜0.01），女性高尿酸血症组的高密度脂蛋白明显高于男性组（P ＜0.01）。 结论 高尿酸血症是IgA肾病的危险因素，可导致更严重的肾功能损害及肾脏病理损害，这种影响在不同性别中存在差异。
Objective To systematically review the efficacy of total glycosides extracted from Rehmannia glutinosa Libosch leaf in the treatment of diabetic nephropathy. Methods Databases including PubMed, EMbase, MEDLINE, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP were electronically searched to collect randomized controlled trials of total glycosides from Rehmannia glutinosa Libosch for diabetic nephropathy from inception to May 30th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.4 software was then used to perform meta-analysis. Results A total of 7 RCTs involving 504 patients were included. The results of meta-analysis showed that there were no significant differences in creatinine levels (MD=−1.71, 95%CI −3.97 to 0.56, P=0.14) and urea (MD=−0.18, 95%CI −0.44 to 0.08, P=0.19) between the two groups. In terms of regulating proteinuria, the urinary albumin excretion rate (MD=−39.41, 95%CI −48.46 to −30.36, P<0.000 01), urinary microalbumin (MD＝−9.94, 95%CI −12.16 to −7.73, P<0.000 01), and 24-hour urinary protein (MD=−0.67, 95%CI −0.85 to −0.49, P<0.000 01) were all lower in the treatment group compared with control group. However, there were no differences between groups in terms of blood glucose metabolism as indicated by changes in levels of the long-term blood glucose metabolism indicator (HbA1c: MD=−0.16, 95%CI −0.67 to 0.35, P=0.53). Only one study suggested that short-term blood glucose metabolism indicators, fasting blood glucose and postprandial blood glucose levels were not different between groups. In terms of blood lipid metabolism, only one study suggested glycoside treatment produced lower serum levels of cholesterol and triglycerides compared with control group. Conclusions Current evidence suggests that adjunctive therapy with total Rehmannia glutinosa Libosch glycosides can benefit diabetic nephropathy patients more than angiotensin II receptor inhibitor or pancreatic kininogen by alleviating proteinuria and likely improving lipid metabolism. However, no benefit is observed in terms of renal function improvement or blood glucose metabolism. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.
Objective To provide evidence for clinical practice by assessing the effectiveness and safety of Ligustrazine for primary nephrotic syndrome. Methods We searched MEDLINE (1966.1-2002.12), EMBASE (1975-2002.12), CBM (1979.1-2002.12), Chinese Evidence-Based Medicine/Cochrane Centre Database (CEBM/CCD, Issue 4, 2002) , Cochrane Library, and SCI (1985-2002.12) and handsearched 15 kinds of journals (including Journal of Nephrology et al) (1980-2003.2) for the randomized controlled trials (RCTs).Jadad score was used to assess the quality of RCTs. The outcomes of short term and long term effectiveness, and adverse effect of the treatment were analyzed by RevMan 4.1. Results Thirteen RCTs involving 675 patients met inclusion criteria. Jadad scores of each trial was 1 point. Meta-analysis of 4 studies showed that Ligustrazine had significant better short term effect [OR 4.24, 95% confidence interval (CI) 1.76 to 10.19], lowered 24 h urine protein (OR -0.36, 95% CI -0.71 to -0.02), improved renal function [ creatinine level in children group: (OR -3.34, 95% CI -5.25 to -1.43), creatinine level in adult group: (OR -48.29, 95% CI -68.24 to -28.35)], and increased serum albumin level (OR 3.61, 95% CI 2.61 to 4.61). Whether Ligustrazine had long term side effect was not confirmed. No adequate evidence showed that Ligustrazine could reduce the relapse rate of primary nephrotic syndrome. Conclusions Meta-analysis of low quality RCTs suggest that Ligustrazine does work in primary nephritic syndrome in short term observation. No adequate evidence shows that Ligustrazine has severe side effect or can reduce the relapse rate of primary nephrotic syndrome. We can’t draw a conclusion that Ligustrazine is safe in primary nephrotic syndrome treatment.A rigorously designed, randomized, double blind, placebo controlled trial are required.
Objective To assess the effectiveness and safety of Shenling granule for lower urinary tract infection （damp-heat in lower-Jiao ） in comparison with Niaoganling Chongji. Methods A double-bhnd, double-dummy, randomized controlled trial was conducted. A total of 96 patients （damp-heat in lower-Jiao） were randomized to the treatment group （n =72, Shenling granule, 1 bag, rid） and the control group （n =24, Niaoganling Chongji, 1 bag, tid）. The therapeutic course for both groups was 1 week. Results ITT （intention-to-treatment） analysis showed that the total effective rates of the treatment group and the controlled group were 92.43% and 91.31% , respectively （P 〉0.05）. PP （perprotocol-population） analysis showed that they were 92.31% and 90.91% , respectively （ P 〉0.05 ）. The effective rates on Chinese medicine symptom of the treatment group and the controlled group were 93.43% and 95, 65% respectively by ITT analysis （ P 〉0.05 ） , 95.38% and 94.45% respectively by PP analysis （ P 〉0.05 ）, No significant difference between the two groups was detected. No adverse effect was found. Conclusions There is no significant difference between Shenling granule and Niaoganling Chongji in the treatment of patients with lower urinary tract infection. No adverse effect was found.
Objective To assess the efficacy and safety of okra capsule for IgA nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of okra capsule for IgA nephropathy were collected from CENTRAL, MEDLINE, EMbase, PubMed, WanFang Data, CNKI and CBM. Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross-checked then. Then RevMan 5.07 software was used for meta-analysis. Results Five RCTs were included. The results of meta-analyses showed that: compared with the control group, okra capsule was more effective in decreasing urinary protein (P≥0.05), but had no significant difference in improving renal function, reducing urine red blood cells and blood lipid (Plt;0.05). No research reported the adverse effects of okra capsule. Conclusion Current evidence reveals that okra capsule can reduce urinary protein and improving therapeutic effect for IgA nephropathy. However, further studies are needed to test its safety. Because of the small sample size and low methodological quality of the included studies, these results require more high-quality RCTs for further verification.
Objective To assess the efficacy and safety of Rhubarb and adjunvent drugs for chronic renal failure. Methods Electronic database searching including Medline, Cochrane Library and CBM from 1980 to Dec., 2000 was performed. Handsearching was applied to 15 kinds of nephrological and traditional Chinese medicine journals such as Chinese Journal of Nephology. Randomised and quasi-randomised trials concerning Rhubarb treatment for CRF were selected. The selected studies were assessed for their methodological quality and the data were extracted to perform the Meta-analysis. Results Eighteen randomised and quasi-randomised trials including 1 322 patients met the inclusion criteria, but their methodological quality was low. Compared to non-specific treatment, Rhubarb showed significant positive effects on relieving symptoms, lowering serum creatinine, improving HGB and adjusting disturbance of lipid metabolism. The effect of Rhubarb on reducing the number of death [OR 0.15, 95%CI (0.06 to 0.36), P=0.000] and the number of progressing into end-stage renal disease [OR 0.38, 95%CI (0.09 to1.64), P=0.19] was not confirmed because of the small sample size. Conclusions Rhubarb may have the same effect on CRF in the short-term observation. But its long-term effect of delaying the progression of CRF is still unclear. Well designed, randomised, double-blinded, placebo-controlled trials with long-term follow up and clinical related outcomes are warranted.
To diagnose and treat a patient with rare lupus erythematosus-like syndrome and antineutrophil cytoplasmic antibodies (ANCA) positive vasculitis with graves’ disease by applying the approach of evidence-based medicine. Clinical problems were raised based on the patient condition and PubMed (1966-2003), CBM (1978-2003), EMBASE (1974-2003) were searched for the related information. We found that the best explaination for this case was antithyroid drugs’ side effect, and the patient was obvious better after treatment.
目的 探讨抗核抗体（ANA）在IgA肾病中的阳性率及其对临床的意义。 方法 回顾性分析2007年1月－2009年12月间进行ANA检测的115例IgA肾病患者及59例非IgA肾病慢性肾炎患者的临床资料。统计分析ANA阳性与阴性的临床指标。 结果 IgA肾病患者中有12例（10.4%）存在ANA阳性，与非IgA肾病慢性肾炎中的阳性率比较差异无统计学意义（P＞0.05），ANA阳性的IgA肾病血浆IgG水平较高，病理改变较轻。 结论 IgA肾病ANA阳性的机体免疫有增强，肾功、尿蛋白及病理损害较轻，其对IgA肾病预后的影响仍需进一步研究。
【摘要】为顺应留学生教育规模的扩大和教学质量的稳步提升，通过几年的留学生教学实践和探索，立足留学生临床专业教育培养目标，强化课程设置、师资培养、教材建设、教学手段、教学管理等多个教学环节的建设和推进，确保留学生临床医学课程教学质量的提高和可持续发展。【Abstract】To explore a better way to improve the quality of the clinical medical teaching for foreign students in China along with the expansion of the enrollment of international medical students, some experience are summarized, which include the establishment of the international education aim, the organization of courses, training of the teachers, the selection and reinforcement of teaching material, the enrichment of teaching methods and the strengthening of teaching management.