Chronic Disease Control among Rural Residents in Beijing Pinggu District / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the composition and control status of chronic diseases among rural residents in a Beijing suburb district.</p><p><b>METHODS</b>Rural residents aged 35 years or older were investigated by stratified random sampling in Pinggu District, Beijing. Each participant received questionnaire-based survey,physical examination,and laboratory tests including routine blood test,urine albumin creatinine ratio (ACR), liver and renal function,serum lipid, fasting blood glucose, and glycosylated hemoglobin.</p><p><b>RESULTS</b>A total of 10 385 residents completed all items. Cerebrovascular disease was leading cause of hospitalization (accounting for 14.4%) and its incidence in the population was 9.6%. The incidences of hypertension,hyperlipidemia,diabetes mellitus,and gout/hyperuricemia,which were the main compositions related with metabolic diseases,were up to 64.4%,42.5%,24.4%, and 9.0%, respectively. The disease onset was significantly related with the age. The incidence of hypertension was gradually elevated with the increasing of age,while the peak age was 55-64 years for diabetes and 35-44 years for gout/hyperuricemia. The awareness rate of hypertension,diabetes,and chronic kidney disease was 60.2%, 55.1%,and 6.0%,respectively. The control rate of chronic disease was 19.2% and 28.8% in hypertensive and diabetic patients, respectively.</p><p><b>CONCLUSIONS</b>Cerebrovascular diseases and metabolic-associated diseases are the main chronic diseases affecting rural residents in Pinggu district, Beijing. The awareness rate and control rate of chronic diseases needs to be further enhanced by strengthening health education and improving the community medical service.</p>

Long-term effects of arteriovenous fistula on cardiac structure and function in non-diabetic hemodialysis patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the long-term effects of arteriovenous fistula (AVF) on heamodynamic changes and cardiac structure and function in non-diabetic hemodialysis patients.</p><p><b>METHODS</b>Data were collected from 50 non-diabetic hemodialysis patients (aged 18 to 60 years) who had used AVF as the vascular access. AVF flow (Qa), stoke volume (SV), cardiac output (CO), cardiac index (CI), central blood volume (CBV) and peripheral vascular resistance (PR) were measured using the ultrasound dilution technique. Echocardiography was performed in the second day after hemodialysis sessions to evaluate the influence of AVF on the cardiac structure and function.</p><p><b>RESULTS</b>The cubic polynomial regression model best fit the relationships of Qa with SV, CO, and CI. CO and CI significantly increased and PR reduced when the Qa of AVF was more than 2.0 L/min(all P<0.05), and no statistical difference of CO, CI and PR in groups of Qa between 0.6-2.0 L/min and less than 0.6 L/min(all P>0.05). In different Qa groups, the grades of cardiac function (based on New York Heart Association classification) showed significant difference, among which the cardiac failure was significantly common when Qa >2.0 L/min(both P<0.05). Echocardiography showed the left atrium dimension, thickness of posterior wall and interventricular seprum of left ventricle, left ventricular end-systolic dimension (LVESD) and end-diastolic dimension (LVEDD), venae cava inferior, and pulmonary artery systolic pressure gradually increased when Qa increased, while the ejection fraction and fractional shortening reduced(all P<0.05). Notably, the changes of LVESD, LVEDD, and venae cava inferior with different Qa were statistically significant(all P<0.05).</p><p><b>CONCLUSIONS</b>Long-term AVF remarkably affects the cardiovascular dynamics of non-diabetic hemodialysis patients. A cubic polynomial regression model best fits the relationship of AVF Qa with SV, CO, and CI. The cardiac adaptic changes after long-term AVF include the enlargement of left ventricle and the thickening of ventricular wall. The risk of cardiac failure significantly increases when the Qa of AVF is more than 2.0 L/min with much higher CO and lower PR.</p>

Association between cardiac function and intradialytic hypotension / 中国医学科学院学报

<p><b>OBJECTIVE</b>To prospectively determinate the association of left ventricular systolic and diastolic function with intradialytic hypotension (IDH) in patients on maintenance hemodialysis.</p><p><b>METHODS</b>Totally 115 patients with sinus rhythm were included in this study and divided into IDH group (n=29) and control group (n=86). The cardiac function was assessed by New York Heart Association (NYHA) classification before hemodialysis. Echocardiograms were performed in the next day after hemodialysis and the software of GE EchoPAC was used to estimate parameters of cardiac systolic and diastolic functions including ejection fraction, fractional shortening of left ventricular diameter, stroke volume (SV), cardiac output (CO), left ventricular mass index, Tei index, isovolumetric relaxation time, E-deceleration time, mitral inflow peak early diastolic velocity (E) to late diastolic velocities (A) ratio, and E to peak mitral annulus velocity (E/Em) ratio.</p><p><b>RESULTS</b>The mean age (p=0.045) and the ratio of heart failure evaluated by the NYHA classification (p<0.01) were significantly higher in IDH group than those in control group. No difference was noted for gender, body mass index, duration of dialysis, body weight elevated rate and blood pressure between these two groups (all p>0.05). Left ventricular diameters at the end of diastolic phase, SV, and CO in IDH group were significantly lower than those in control group (all P<0.05), whereas no significant difference was found for EF, FS, Tei index, IVRT, EDT, E/A and E/Em ratio (all p>0.05). Multivariate logistic regression analysis showed that NYHA cardiac function was an independent predictor of IDH, and the risk of IDH increased by 1.134 times with incremental one grade of NYHA classification.</p><p><b>CONCLUSIONS</b>IDH is a common complication of hemodialysis. Neither systolic dysfunction nor diastolic dysfunction of left ventricle evaluated in second day after hemodialysis affects its frequency, whereas the clinical cardiac function is an independent predictor of IDH.</p>

Clinical analysis of anti glomerular basement membrane disease with normal renal function / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical and pathologic characteristics of anti-glomerular basement membrane(GBM) disease with normal renal function.</p><p><b>METHODS</b>The clinical and pathologic data of 6 patients with anti-GBM disease and normal renal function in Peking Union Medical College Hospital were reviewed retrospectively. Furthermore, 29 patients with anti-GBM disease and impaired renal function in the same period in the same hospital were enrolled as the control group. Factors that may influence the prognosis were analyzed.</p><p><b>RESULTS</b>Six (17.1%) of all 35 patients maintained normal renal function for 12-133 months during follow-up. Five patients had microhematuria and proteinuria, one had pulmonary hemorrhage only, and three manifested as Goodpasture syndrome. Renal biopsies from 4 patients revealed linear deposition of IgG 2+-3+ along the glomerular capillary walls by immunofluorescence. As shown by normal light microscopy, mild mesangial proliferation and crescentic glomerulonephritis with a large amount of fibrinoid necrosis of glomerular capillary walls were observed in different patients; however, most pathological changes were mild. Five of these six patients were treated with immunosuppressive drugs and/or plasma exchange. Compared with the control group, the 6 patients with normal renal function had significantly higher hemoglobin[(77.97±20.62 vs.(99.67±19.80 g/L P=0.024], lower titers of anti-GBM antibody[(224.34 ± 145.79 vs.(80.23 ± 85.73 EU/ml P=0.027], and lower ratio of glomeruli with crescents[(0.58±0.29 vs.(0.17±0.27 ,P=0.005]. These 6 patients with normal renal function were followed up for 12-133 months, among whom 4 patients achieved complete remission and 2 had mild proteinuria and microhematuria.</p><p><b>CONCLUSION</b>Anti-GBM disease with normal renal function is not uncommon. Most patients have mild pathologic changes and good prognosis.</p>

Glomerular disease associated with Takayasu arteritis: 6 cases analysis and review of the literature / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical features, renal histopathology and therapeutic response to glucocorticoid and immunosuppressive agents in patients with glomerular disease associated with Takayasu arteritis (TA).</p><p><b>METHODS</b>Patients with TA and renal biopsy-confirmed glomerular disease were investigated retrospectively. None of them had renal artery stenosis or occlusive changes.</p><p><b>RESULTS</b>Six patients with glomerulopathy, accounting for 3.75% of the 160 TA patients admitted to our hospital at the same period, were analyzed. All of them were females with a mean age of 35.5 +/- 10.0 years. Four cases presented with lower extremity edema. Laboratory tests showed that one was nephrotic syndrome, three were nephrotic range proteinuria, and two of them had mild renal dysfunction. The other two patients were asymptomatic microscopic hematuria and proteinuria. Renal pathology revealed mild immunoglobulin A nephropathy in two cases, mild mesangial proliferative glomerulonephritis (GN), membranoproliferative GN, minimal change disease, and fibrillary GN in one case respectively. Five cases received glucocorticoids and cyclophosphamide therapy. Proteinuria and microscopic hematuria disappeared in 2 to 4 weeks after the initiation of therapy in three cases. The patient with membranoproliferative GN also reached complete remission of proteinuria and recovered renal function 6 months after the treatment.</p><p><b>CONCLUSIONS</b>TA may induce glomerular disease as a part of its histological spectrum. Apart from ischemic glomerular disease, glomerular disease should be suspected when TA patients have microscopic hematuria or proteinuria, that may be therapeutically responsive to glucocorticoids and immunosuppressive agent in relative early phase.</p>

Risk factors of post-renal biopsy bleeding / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the risk factors of post-renal biopsy bleeding (PBB).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 1 262 patients who received ultrasound-guided biopsy of native kidney at our hospital from January 2005 to December 2006.</p><p><b>RESULTS</b>The overall incidence of PBB was 30.3% (383/1,262), among which the incidence of hematoma was 29.4% (371/1,262) (the percentages of less and more than 5cm were 73.9% and 26.1%, respectively) while that of gross hematuria was only 1.3% (17/1,262). The incidences of minor, intermediate, and major bleeding complications were 21.4% (270/1,262), 8.4% (106/1,262), and 0.6% (7/1,262), respectively. In seven patients with major bleeding complications, six had renal disease secondary to rheumatic disease (lupus nephritis, n = 5; scleroderma crisis, n = 1), while the other one had IgA nephropathy (Lee's classification V). The risk of PBB was relatively higher in women and younger patients.</p><p><b>CONCLUSIONS</b>Patients with chronic connective tissue diseases are vulnerable to severe PBB complications. A close monitoring of these patients is necessary.</p>

Effects of oxidized low-density lipoprotein on expression of type A scavenger receptor in human mesangial cells / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the regulational effect of oxidized low-density lipoprotein (Ox-LDL) on expression of type A scavenger receptor (SR-A) in human mesangial cells (HMC).</p><p><b>METHODS</b>HMC line (HMCL) with high expression of SR-A (HMCL-SRA) was established after stable transfection of expressive vector with cDNA encoding SR-A. Uptake of Ox-LDL by HMCL was evaluated using Oil Red "O" staining. SR-A mRNA expression was examined using reverse transcription-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>More uptake of Ox-LDL was observed in the HMCL-SRA than that in the untransfected HMCL. Ox-LDL could induce SR-A mRNA expression in HMC in a dose-dependent manner, and reached a peak level after 24 h of stimulation. After 24 h of stimulation with Ox-LDL at the dose of 10, 50 and 100 micrograms/ml, SR-A mRNA expression was up-regulated to 1.35, 1.83 and 2.30-fold of controls, respectively. However, LDL had no effect on the expression of SR-A.</p><p><b>CONCLUSIONS</b>It suggests that SR-A be a major binding receptor to uptake Ox-LDL in HMC. Ox-LDL may promote the progression of chronic renal diseases through up-regulation of SR-A.</p>

Non-diabetic renal disease in type II diabetes mellitus / 中国医学科学院学报

<p><b>OBJECTIVE</b>Several studies have suggested that non-diabetic renal disease (NDRD) was common among non-insulin dependent diabetes mellitus (NIDDM) patients with renal involvement.</p><p><b>METHODS</b>The prevalence of NDRD among Chinese NIDDM population in PUMC hospital center was retrospectively studied. Renal biopsy specimens were evaluated with light-, immunofluorescence- and electron-microscopy. The cohort consisted of 33 NIDDM patients who received renal biopsy.</p><p><b>RESULTS</b>Patients with both isolated diabetic nephropathy (DN, n = 7) and NDRD (n = 22) had comparable duration of DM, creatinine clearance, serum creatinine, albumin and 24 hours proteinuria, as well as incidences of retinopathy, neuropathy and hypertension. Significantly more patients with NDRD had haematuria (P = 0.030) or non-nephrotic proteinuria (P = 0.016). IgA nephropathy accounted for 40.9% of the NDRD identified.</p><p><b>CONCLUSIONS</b>In this study, haematuria and non-nephrotic proteinuria predicted the presence of NDRD among NIDDM patients complicated with renal disease. IgA nephropathy is the most frequent type of NDRD in Chinese.</p>