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Objectives The relationship between homocysteine ( Hcy ) and lipid levels in renal transplant patients was analyzed to investigate the effect of hyperlipidemia on renal function and the importance of lipid monitoring in renal function after renal transplantation.Methods 492 patients outpatient follow-up of renal transplants from November 2014 to April 2015 in the Department of Urology and 221 healthy subjects from Shanghai First People′s Hospital were enrolled and their serum Hcy, Total cholesterol( TC) ,triglycerides( TG) , High density lipoprotein cholesterol( HDL-C) , Low density lipoprotein cholesterol( LDL-C ) were tested.All the subjects were divided into normal group and abnormal group according to the serum Hcy levels.At the same time serum cysteine protease inhibitor C(CysC) level was tested to estimate glomerular filtration rate(eGFR),grouping according to the principle of Chronic Kidney Disease( CKD)《Kidney Disease Outcomes Quality Initiative》( KDOQI) staging criteria.The co-relationship between serum TC, HDL-C, TG, LDL-C levels and the possibilities of high cardiovascular risk factors, and the relationship between of serum Hcy and lipid levers, kidney function were analyzed based on the standard of“2007 China Adult dyslipidemia prevention and treatment guidelines”.Statistical methods using U test、chi square analysis, correlation and multiple regression analysis.Results The serum TC(4.48 -5.85),TG (1.05-1.91),HDL-C(1.33-2.01),LDL-C(2.53-3.72) and Hcy(11.99-20.23) levels in the renal transplantation group were higher than the control group′s TC ( 4.02-5.33 ) , TG ( 0.81-1.74 ) , HDL-C (1.11-1.58),LDL-C(2.21-3.32), Hcy(8.9-12.4) levels.(P=0.00,0.00,0.00,0.00,P<0.01) In the renal transplantation group,serum Hcy levels was negatively correlated with eGFR and HDL-C levels (r=-0.565, -0.197, P<0.01), and was positively correlated with TG levels.(r=0.107, P<0.05) In renal transplantation group ,the serum levels of HDL-C was significant lower in Hcy-abnormal group(1.15-1.77)than the normal group(1.35 -1.97) (P=0.001,P<0.01),while the serum levels of LDL-C (2.51-3.93) was higher than the normal group(2.44 -3.69) (P=0.023,P<0.05).In the renal transplantation group,the count ratio of lipid risk factors in the Hcy-abnormal group (0 item 55.4%,1 item 23.5%,2 items 14.2%,3 items 6.5%,4 items 0.4%)was higher than normal group(0 item 69.8%,1 item 17.2%,2 items 9.1%,3 items 3.9%,4 items 0.0%) ( P=0.019,P<0.05).Ranked serum Hcy levels with cardiovascular risk factors, high-risk factors count ratio of eGFR 45-60 ml/min/1.73 m2 group was significant higher than eGFR 60-89 ml/min/1.73 m2 group in each level(P=0.018,P<0.05).Logistic regression analysis was carried out on the risk factors of serum TG, LDL-C, Hcy levels respectively, the results show that serum TG,LDL-C,Hcy levels and differences in renal function have statistical significance (P=0.00,0.00,0.00,P<0.01).Conclusions The serum TG,LDL-C and Hcy levels in the renal transplantation group were consistent increase and associated with kidney injury.The differences in TG, LDL-C, Hcy levels of renal transplant patients may cause differences in renal function after transplantation.Monitoring of serum lipids and Hcy levels is helpful for forecast the possibility of kidney injury.
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Objective To investigate the significance of testing serum homocysteine for renal transplant patients .Methods 445 renal transplant patients from outpatient follow‐up(renal transplant group) and 100 healthy subjects(control group) were enrolled in the study ,whose serum homocysteine(Hcy) ,Cystatin C(CysC) ,creatinine(Cr) were tested .Then according to the eGFR(refered to the principle of NKF‐K/DOQI) patients of renal transplant group were divided into six subgroups .Serum levels of Hcy and Cr were compared among different groups ,and the relationship between serum Hcy concentration and anti‐rejection drugs were ana‐lyzed .Results In the transplant group ,concentrations of Hcy were obviously higher than that in control group(P0 .05) . Concentrations of CysC and Cr were significantly associated with Hcy in renal transplant group(r=0 .481 ,0 .456 ,P<0 .05) .There was significant difference between eGFR≥90 subgroup and control group in CysC concentration(P<0 .05) .Conclusion Concen‐tration of Hcy in renal transplant group was obviously higher than that in control group .With the eGFR decreased ,Hcy increased gradually ,and in transplant group was associated with the concentration of CysC and Cr .There was significant difference between eGFR≥90 subgroup and control group in Hcy and CysC concentrations(P<0 .05) .The different anti‐rejection drugs had no effect on serum Hcy levels .
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Objective To investigate the level and value of serum IgE, anti-IgE, FcεRⅠα, anti-FcεRⅠin autoimmune liver disease ( AILD) .Methods In this case-control study, the serum samples and clinical data of 77 patients with hepatosis were collected between May and November 2014 from the department of gastroenterology of Shanghai First People′s Hospital.These patients had positive results about the liver-related autoimmune antibodies, including 33 cases of AILD, 44 cases of other chronic liver disease. 64 healthy persons were collected as control group.Serum mast cell-associated anti-IgE, FcεRⅠα, anti-FcεRⅠwere detected by Enzyme-linked Immuno sorbent Assay ( ELISA) .Serum IgE, IgM and IgG were detected by rate scatter nephelometry.Differences among AILD, other chronic liver disease and healthy control were assessed.Results were compared using Mann-Whitney U test.Results Mast cell-associated anti-IgE, FcεRⅠα, anti-FcεRⅠin liver-related autoimmune antibodies positive patients were significantly higher than healthy control [1.74(1.16 -2.88)mg/L, 14.86(4.39 -26.23)mg/L, 47.22(36.89 -55.29)mg/L and 1.23(0.95-1.58)mg/L, 1.87(1.52-2.33)mg/L, 35.40(24.74-44.89)mg/L, respectively;U=1614,556.5,1319.5, P<0.01].FcεRⅠαwas significantly higher in other chronic liver disease patients than AILD patients [18.40(7.35-30.64)mg/L and 6.25(2.49-22.29), respectively;U=445, P<0.01] .Conclusion Mast cell-associated anti-IgE, FcεRⅠα, anti-FcεRⅠwere increased in liver-related autoimmune antibodies positive hepatosis patients.However, FcεRⅠαwas lower in AILD than other chronic liver disease.Mast cell-associated anti-IgE、FcεRⅠαand anti-FcεRⅠ molecules involved in the inflammatory lesion of liver disease.
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Objective To explore the influence between perioperative nutritional support and outcome of refractory constipation patients complicated with megacolon.Methods Seventy-three patients with refractory constipation complicated with megacolon receiving surgical interventions were enrolled,both by gastrointestinal decompression and total parenteral nutrition support treatment.Thirty-seven cases who could not recover intestinal tract unobstructed,did not receive enteral nutrition support treatment and surgery as control group; 36 cases of patients with intestinal recovery unobstructed,after 2 weeks of total enteral nutrition support undergoing elective surgery as observation group.The nutrition indicators,surgery and postoperative complications between two groups were compared.Results The operation time and intraoperative blood loss compared between two groups had no significant difference (P ＞0.05).The operation method between two groups was statistically significants (P ＜ 0.05).The incidence of anastomotic bleeding,anastomotic fistula and pneumonia in observation group were lower than those in control group [2.8％ (1/36) vs.21.6％ (8/37),0 vs.13.5％ (5/37) and 0 vs.13.5％ (5/37)],there were significant differences (P ＜ 0.05).The hospitalization time,incidence of incision infection,urinary retention,intestinal obstruction between two groups had no significant difference (P ＞ 0.05).The postoperative hospital stay in observation group was shorter than that in control group [(12 ± 3) d vs.(25 ± 6) d],there was significant difference (P ＜ 0.05).The index comparison on admission similar between two groups had no statistical significance (P ＞0.05).The preoperative fat weight,fat mass and serum albumin,transferrin and prealbumin in observation group were higher than those in control group [(41.9 ± 7.6) kg vs.(38.7 ± 3.0) kg,(13.2 ± 4.0) kg vs.(7.8 ± 2.7) kg,(37.9 ± 2.6) g/L vs.(31.3 ± 2.5) g/L,(2.9 ± 0.6) μ g/L vs.(2.0 ± 0.6) μ g/L,(243.7 ± 25.2) mg/L vs.(141.2 ± 11.9) mg/L],there were significant differences (P ＜ 0.05).After 1 month,the weight,fat weight,protein quality,fluid in cells and extracellular fluid,body mass index,albumin,transferrin in observation group were better than those in control group [(55.1 ± 6.4) kg vs.(50.9±4.7) kg,(42.9 ± 3.2) kgvs.(39.1 ± 1.3) kg,(12.2 ± 1.4) kg vs.(9.7 ± 3.2) kg,(23.7 ± 5.0) Lvs.(18.8 ± 5.5) L,(10.9 ± 4.5) L vs.(7.7 ± 0.8) L,(22.3 ± 1.9) kg/m2 vs.(17.5 ± 3.6) kg/m2,(41.9 ± 4.7) g/L vs.(33.1 ± 2.9) g/L and (3.5 ± 0.7) μg/L vs.(2.7 ± 0.5) μg/L],there were significant differences (P ＜0.05).Conclusion Refractory constipation complicated with megacolon requires surgical intervention,should as far as possible to restore the intestinal function preoperatively,enteral nutrition support treatment,can significantly reduce the incidence of perioperative complications.