目的：探讨长期动静脉内瘘对非糖尿病肾病血液透析患者血液动力学及心脏结构和功能的影响。方法将2011-2013年肾内科收治的非糖尿病肾病血液透析患者100例，按动静脉内瘘流量（Qa）分为三组。对其进行回顾性分析研究，采用超声稀释法检...目的：探讨长期动静脉内瘘对非糖尿病肾病血液透析患者血液动力学及心脏结构和功能的影响。方法将2011-2013年肾内科收治的非糖尿病肾病血液透析患者100例，按动静脉内瘘流量（Qa）分为三组。对其进行回顾性分析研究，采用超声稀释法检测心脏搏出量、心输出量（CO）、外周血管阻力等血液动力学指标，并与血液透析次日行心脏彩色超声心动图检测，分析动静脉 Qa 对血液动力学及心脏结构和功能的影响。结果 Qa 〉2.0 L/ min 组在内瘘流量、Qa/CO、搏出量、心脏输出量、心脏指数、中心血容量方面明显高于其他两组，外周血管阻力明显低于其他两组，差异均有统计学意义（ P 均〈0.05）；Qa 0.6-2.0 L/ min 组内瘘流量、Qa/ CO、搏出量均高于 Qa 〈0.6 L/ min 组，差异有统计学意义（ P 〈0.05），而在心脏指数、中心血容量、外周血管阻力方面差异无统计学意义（ P 〉0.05）；左房直径、右房面积、右房直径、右房面积、左室后壁厚度、室间隔厚度、LEVSD、LEVDD 的指标随着 Qa 的增加而增大，且右房面积、LEVSD、LEVDD 指标在 Qa 〉2.0 L/ min 组和 Qa 〈0.6 L/ min 组间差异有统计学意义（ P 〈0.05）；心脏功能方面 Qa 〉2.0 L/ min 组明显低于 Qa 〈0.6 L/min 组、Qa 0.6-2.0 L/ min 组，差异有统计学意义（ P 〈0.05）。结论长期 AVF 对血液动力学及心脏结构和功能与 Qa 有关，当流量控制在一定范围内时心脏变化以代偿性改变为主，当 Qa 〉2.0 L/ min 出现心腔明显扩大的可能性比较大，易出现心衰并发症，因此临床上应根据患者病情选择合适的流量。展开更多
Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the us...Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a NDN. Predictive factors of NDN diagnosis were展开更多
文摘目的：探讨长期动静脉内瘘对非糖尿病肾病血液透析患者血液动力学及心脏结构和功能的影响。方法将2011-2013年肾内科收治的非糖尿病肾病血液透析患者100例，按动静脉内瘘流量（Qa）分为三组。对其进行回顾性分析研究，采用超声稀释法检测心脏搏出量、心输出量（CO）、外周血管阻力等血液动力学指标，并与血液透析次日行心脏彩色超声心动图检测，分析动静脉 Qa 对血液动力学及心脏结构和功能的影响。结果 Qa 〉2.0 L/ min 组在内瘘流量、Qa/CO、搏出量、心脏输出量、心脏指数、中心血容量方面明显高于其他两组，外周血管阻力明显低于其他两组，差异均有统计学意义（ P 均〈0.05）；Qa 0.6-2.0 L/ min 组内瘘流量、Qa/ CO、搏出量均高于 Qa 〈0.6 L/ min 组，差异有统计学意义（ P 〈0.05），而在心脏指数、中心血容量、外周血管阻力方面差异无统计学意义（ P 〉0.05）；左房直径、右房面积、右房直径、右房面积、左室后壁厚度、室间隔厚度、LEVSD、LEVDD 的指标随着 Qa 的增加而增大，且右房面积、LEVSD、LEVDD 指标在 Qa 〉2.0 L/ min 组和 Qa 〈0.6 L/ min 组间差异有统计学意义（ P 〈0.05）；心脏功能方面 Qa 〉2.0 L/ min 组明显低于 Qa 〈0.6 L/min 组、Qa 0.6-2.0 L/ min 组，差异有统计学意义（ P 〈0.05）。结论长期 AVF 对血液动力学及心脏结构和功能与 Qa 有关，当流量控制在一定范围内时心脏变化以代偿性改变为主，当 Qa 〉2.0 L/ min 出现心腔明显扩大的可能性比较大，易出现心衰并发症，因此临床上应根据患者病情选择合适的流量。
文摘Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a NDN. Predictive factors of NDN diagnosis were
