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阵发性睡眠性血红蛋白尿继发霜样树枝状视网膜血管炎1例

Clinical Significance of the Detection of CD55, CD59 Expression Deletion in Patients with Cytopenia

目的　检测血细胞减少患者外周血红细胞和中性粒细胞细胞膜糖基磷脂酰肌醇（GPI）连接的补体调节蛋白衰变加速因子（CD55)和膜反应性溶血抑制物（CD59）表达情况，并探讨其临床意义。 方法　2006年7月－2011年3月，采用直接免疫荧光标记法流式细胞仪检测182例血细胞减少患者外周血CD55及CD59表达情况，其中阵发性睡眠性血红蛋白尿（PNH）9例，再生障碍性贫血（AA）-PNH综合征8例，AA 83例，骨髓增生异常综合征51例，自身免疫性溶血性贫血11例，造血功能停滞6例，缺铁性贫血7例，巨幼细胞性贫血4例，脾功能亢进3例。 结果　PNH及AA-PNH患者CD55、CD59抗原缺失率均较其他血细胞减少者明显增高。 结论　流式细胞仪检测外周血中红细胞和中性粒细胞膜CD55和CD59抗原表达缺失率是目前诊断PNH可靠和敏感的方法，也是对PNH、AA-PNH早期诊断敏感指标，并且PNH克隆检测还能为诊断疾病提供鉴别诊断依据。

Renal toxicity of intravitreal injection of anti-vascular endothelial growth factor drugs in the treatment of retinopathy

Anti-vascular endothelial growth factor (VEGF) drugs have been widely used in clinic by inhibiting angiogenesis to treat ocular diseases such as malignant tumors and diabetic retinopathy. However, recent studies have shown that intravitreal injection of anti-VEGF drugs may have significant systemic absorption, leading to a series of renal damages such as worsening hypertension, proteinuria, new glomerular disease, and thrombotic microangiopathy. This article reviews the renal toxicity of intravitreal injection of anti-VEGF drugs in the treatment of diabetic retinopathy and other ocular diseases, aiming to provide recommendations for clinicians.

微量白蛋白尿在原发性高血压患者中的临床意义

微量白蛋白尿是指尿中白蛋白排泄率超过正常范围，受血压水平、血糖、血脂、体重等诸多因素的影响，是高血压早期肾脏损害的标志，也是全身血管内皮细胞受损的重要标志之一。微量白蛋白尿具有重要意义，是高血压患者心血管疾病的独立危险因子。原发性高血压患者应进行微量白蛋白尿筛查。

Effect of Proteinuria on Residual Renal Function in Peritoneal Dialysis Patients

ObjectiveTo observe whether proteinuria is relate to the decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. MethodsThis is a prospective cohort study including 45 PD patients (underwent PD between January 2011 and January 2013) with a 12-month follow-up. All the patients were divided into 2 groups with respect to the initial proteinuria level: massive proteinuria group A (n=20) and non-massive proteinuria group B (n=25) at baseline. We established regression models to do univariate analysis and multivariate analysis of the relationship between the decline of RRF≥50% of baseline and the indices of age, sex, PD-associated peritonitis, baseliner residual glomerular filtration rate (rGFR), initial proteinuria, and use of ACEI/ARB. ResultsThe primary outcome (RRF>50% of baseline) at 12 months was 65% in group A, and 80% in group B (P<0.05). Based both on the results of univariate and multivariate Cox regression analysis, non-massive proteinuria and higher rGFR at baseline were factors to protect RRF from decline (P<0.05). ConclusionThe study demonstrates that massive proteinuria and lower rGFR at baseline may be associated with a rapid decline of RRF in PD patients. Treatment aimed at reducing albuminuria may lead to protect RRF and improve life quality of patients.

The Relationship between Antioxidant Activity of Hyper Density Lipoprotein and Microalbuminuria in Patients with Hypertension

ObjectiveTo discuss the relationship between microalbuminuria (MAU) and antioxidant activity of plasma hyper density lipoprotein (HDL) in hypertensive patients, and investigate whether MAU could be a predictor of HDL antioxidant activity. MethodFrom December 2007 to March 2009, sixty consecutive primary hypertensive patients from the inpatient and outpatient departments of West China Hospital and Sichuan Electric Power Central Hospital were included in the study, and 30 healthy volunteers served as controls. MAU, plasma HDL and paraoxonase (PON1) activity were tested. ResultsPON1 activity was lower in hypertensive patients than the controls (P<0.05), and this degree of decline was positively related to MAU (P<0.05). ConclusionMAU reflects PON1 activity in hypertensive patients and can be a predictor to judge plasma HDL function in patients with hypertension.

阵发性睡眠性血红蛋白尿症的靶向治疗

阵发性睡眠性血红蛋白尿症（PNH）是一种罕见的造血干细胞克隆性的溶血性疾病，目前治疗困难。重组人源型抗补体蛋白C5单克隆抗体（eculizumab）的出现及临床应用开启了PNH靶向治疗的新篇章。eculizumab通过与补体C5结合，防止C5裂解形成C5b及膜攻击复合物，减少溶血，降低输血需求，提高患者生活质量。2007年，eculizumab分别被美国食品和药物管理局、欧盟委员会通过用于治疗PNH血管内溶血。现对PNH患者使用eculizumab靶向治疗作一综述。

2型糖尿病并发视网膜病变患者血清人类软骨糖蛋白39及其与尿白蛋白排泄率的关系

Evidence-based Prevention and Treatment of Microalbuminuria in Patient with Type 2 Diabetes

Objective　To search evidence of angiotensin-converting-enzyme inhibitors for microalbumin-uria in type 2 diabetes for guiding clinical practice. Methods　We searched MEDLINE （ 1970 -Jun. 2005 ） to identify randomized controlled trials （RCT）of the effect on angiotensin-converting-enzyme inhibitors to prevent microalbuminuria in type 2 diabetes. Results　One RCT （n =1 204）was identified. The result showed that angiotensin-converting-enzyme inhibitors were significantly more effective in prevention of microalbuminuria than other medicines in type 2 diabetes. However, angiotensin-converting-enzyme inhibitors may increase the risk of cardiac mortality. We explained the evidence to patients and they were satisfied with our explanation. Conclusions　Angiotensin-converting-enzyme inhibitors can decrease the incidence of microalbuminuria in patients with type 2 diabetes and hypertension.

乙酰肝素酶与糖尿病肾病

【摘要】　乙酰肝素酶（heparanase，HPA）是目前发现的哺乳动物细胞中唯一能切割细胞外基质中硫酸肝素蛋白多糖侧链的内源性糖苷酶。因其可促进肿瘤细胞的浸润和转移，还可以促进肿瘤细胞生长和微血管形成，而被视为是抗肿瘤、抗炎症的理想靶点。研究表明HPA可以降解肾小球基底膜硫酸乙酰肝素多糖侧链，造成肾小球基底膜选择性滤过蛋白质功能下降，与糖尿病肾病（diabetic nephropathy，DN）蛋白尿的产生密切相关。HPA活性的高低对糖尿病肾病的研究有着重要的意义。现将HPA与DN之间的研究进展作一综述。