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Objective To analyze the pathological characteristics and prognostic factors of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods A retrospective analysis of AAV patients with renal biopsy results admitted to Kidney Disease Center of the First Affiliated Hospital from January 2004 to February 2017 was performed.The patients were divided into 4 types according to Berden classification,and their clinical,pathological characteristics and prognosis were compared.The survival curves of each type of patients were plotted by Kaplan-Meier method,and the difference of survival curves was compared using Log-rank test.With entering the maintenance dialysis as the endpoint,Cox regression was used to analyze the prognostic factors.Results A total of 175 patients with AAV,including 59 cases (33.7％) of focal type,39 cases (22.3％) of crescent type,32 cases (18.3％) of sclerosis type,45 cases (25.7％) of mixed type.The basal serum creatinine levels in crescent type group and sclerosis type group were significantly higher than those in the focal type group or mixed type group (all P ＜ 0.05),and loop necrosis rate in sclerosis type group was significantly lower than chat in the focal type group or crescent type group (both P ＜ 0.05).The median follow-up period was 11.8 (0.5-86.7) months.The event-free survival rates were 83.1％,77.8％,64.1％ and 50.0％ in the focal type,mixed type,crescent type and sclerotic type groups (Log-rank x2=11.537,P=0.009).Cox regression analysis showed higher parathyroid hormone (HR=1.013,95％ CI 1.007-1.019,P ＜ 0.001),glomerular sclerosis ≥50％ (HR=10.532,95％CI 2.903-38.203,P ＜ 0.001) were independent risk factors for AAV patients entering maintenance dialysis,and higher estimated glomerular filtration rate (HR=0.943,95％ CI 0.896-0.993,P=0.025) was protective factor.Conclusion The prognosis of AAV renal damage is worsened according to focal,mixed,crescent and sclerosis types.Lower estimated glomerular filtration rate,higher parathyroid hormone and glomerular sclerosis ≥ 50％ are independent risk factors for AAV patients entering maintenance dialysis.
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Objective To compare the effects of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of elderly patients with end-stage renal disease.Methods The clinical data of 100 elderly patients with end-stage renal disease who were treated in the People's Hospital of Beilun District from March 2013 to April 2015 were retrospectively analyzed.The patients were divided into HD group and PD group according to the treatment methods,with 50cases in each group.The 2-year survival rate of the patients in the two groups was observed,and the differences of renal function,nutritional index and lipid metabolism were compared between the two groups before and after treatment.Results Before treatment,there were no statistically significant differences between the two groups in the levels of proinflammatory cytokines.After treatment,the levels of IL-18 [(56.22 ± 7.32) mg/L],IL-6 [(12.18 ± 2.03)mg/L] and hs-CRP[(8.54 ± 1.12)mg/L] in the HD group were lower than those in the PD group [(78.46 ± 7.28) mg/L,(15.23 ± 2.25) mg/L,(10.23 ± 1.67) mg/L] (t =15.233,7.117,5.943,all P ＜ 0.001).After treatment,the levels of BUN [(6.22 ± 1.05) mmol/L],SCr[(115.44 ± 10.84) μmol/L] in the HD group were lower than those in the PD group [(8.87 ± 1.22) mmol/L,(134.52 ± 15.23) μmol/L] (t =5.943,7.217,all P ＜ 0.001),the GFR[(8.15 ± 13.35)mL/min] of the HD group was higher than that of the PD group [(9.26 ± 12.58) mL/min] (t =-4.969,P ＜ 0.001).Before treatment,the nutrition indicators between two groups had no statistically significant difference.After treatment,the levels of ALB [(53.62 ± 4.13)g/L],PA[(342.15 ± 15.02) mg/L] and Hb [(115.86 ± 10.02)g/L] in the HD group were higher than those in the PD group [(45.95 ± 5.57) g/L,(228.36 ± 12.23) mg/L,(98.02 ± 7.12) g/L] (t =-7.821,-41.541,-10.263,all P ＜ 0.001).Before treatment,the lipid metabolism indicators between the two groups had no statistically significant differences(all P＞0.05).After treatment,the levels of TC[(4.78 ±0.98) mmol/L],LDL[(2.51 ±0.97) mmol/L] in the HD group were lower than those in the PD group [(5.53 ± 1.02) mmol/L,(2.89 ± 1.03) mmol/L] (t =3.749,1.899,all P ＜ 0.05),the level of HDL [(1.39 ± 0.46) mmol/L] of the HD group was higher than that of the PD group [(1.22 ± 0.34) mmol/L] (t =-2.101,P ＜ 0.001).The 2-year survival rate in the HD group was 96.00％,and that in the PD group was 86.00％.There was no statistically significant difference between the two groups in the 2-year survival rate (P ＞ 0.05).Conclusion HD has better therapeutic effect on elderly patients with end-stage renal disease,it can significantly improve the metabolic level of patients and improve the survival rate of patients.
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Objective To investigate the clinical efficacy of alprostadil in the treatment of diabetic nephropathy,and its effect on serum bone morphogenetic protein 7(BMP-7)and transforming growth factor-β1(TGF-β1)levels in patients.Methods From January 2014 to January 2016,120 cases of diabetic nephropathy in the People's Hospital of Beilun District were selected in the study.According to different treatment methods,the patients were divided into study group and control group,with 60 cases in each group.The two groups were treated with basic treatment,the study group was treated with alprostadil for 8 weeks.The clinical efficacy and serum levels of BMP-7 and TGF-β1 were compared between the two groups.Results There were no significant differences in serum BMP-7 and TGF-β1 between the two groups before treatment(P>0.05).After treatment,the serum BMP-7[(17.54 ±3.90)pg/mL]in the study group was higher than that in the control group [(15.20 ±2.96)pg/mL](t=3.607,P<0.05),the level of TGF-β1[(7786.3 ±1951.2)pg/mL]was lower than that of the control group [(10021.5 ±2109.7)pg/mL](t=6.025,P<0.05).There were no significant differences in the levels of fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG)and glycosylated hemoglobin(HbA1c)between the two groups(all P >0.05).After treatment,the levels of UAER,Hcy,Scr,BUN in the study group were(89.62 ±17.74)g/min,(23.55 ±4.17)mol/L,(64.2 ±8.5)mol/L,(6.70 ±0.96)mmol/L,which were significantly lower than those in the control group [(118.50 ± 21.18)g/min,(29.69 ±4.82)mol/L,(74.7 ±9)mol/L,(7.52 ±0.89)mmol/L](t=8.097,7.462,6.57,4.852,all P<0.05).Conclusion Alprostadil has better clinical effect on diabetic nephropathy,and can significantly improve serum BMP-7 and TGF-β1 levels.