Chinese Journal of Blood Purification

12 October 2017, Volume 16 Issue 10 Previous Issue    Next Issue

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Diagnosis, treatment and prevention of HIV infection 2017, 16 (10):  651-653.  doi: 10.3969/j.issn.1671-4091.2017.010.002 Abstract ( 336 )   PDF (419KB) ( 587 )   Acquired immunodeficiency syndrome (AIDS) caused by chronic infection with human immunodeficiency virus-1 (HIV-1) is one of the most devastating pandemics ever recorded in human history, and has been widely concerned around the world. The purpose of this review is to discuss four aspects of HIV infection: screening of HIV infection, diagnosis and prevention of HIV infection and treatment of HIV-infection patients. Metrics

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Judgment, prevention and control of active tuberculosis 2017, 16 (10):  654-656.  doi: 10.3969/j.issn.1671-4091.2017.010.003 Abstract ( 466 )   PDF (366KB) ( 455 )   The judgment of tuberculosis (TB) activity is based on clinical manifestation, sputum bacteria, blood test, tuberculin skin test and imaging examination, and the judgment of communicable TB is based on quantity of discharged bacteria, lesion and symptom, size of discharge droplets, level of contact with the patients and environmental factors. Isolating contagious patients as soon as possible, cutting off transmission routes and protecting susceptible population are the basic requirements in controlling TB. Metrics

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Who is the origin of hepatitis C virus infection? 2017, 16 (10):  657-660.  doi: 10.3969/j.issn.1671-4091.2017.010.004 Abstract ( 302 )   PDF (405KB) ( 424 )   Hepatitis C virus (HCV) infection represents an important public health problem worldwide. The prevalence of HCV-related disease is increasing, and no vaccine is yet available. The presence of anti-HCV antibody is an indicator of HCV blood screening, but not a protective parameter. HCV RNA is a diagnostic marker for HCV infection. The highly sensitive assay increases the accuracy of detection and is critical for the diagnosis and treatment of HCV infection. When HCV RNA is not detected by high sensitivity assay, the patients are recovered from the disease and are not contagious anymore. However, anti-HCV antibody can be positive lifelong. Direct-acting antiviral agents (DAA) are safe and effective for the treatment of HCV infection. HCV genotyping is highly valuable in guiding individualized antiviral therapy. Metrics

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Syphilis Laboratory Tests and Interpretation of Results 2017, 16 (10):  661-663.  doi: 10.3969/j.issn.1671-4091.2017.010.005 Abstract ( 363 )   PDF (298KB) ( 1089 )   The incidence of syphilis has gradually increased in recent years, laboratory test is important for the correct diagnosis of syphilis .This paper has reviewed the clinical characteristics and laboratory test progress in syphilis diagnosis, especially in Nontreponemal tests and treponemal tests for syphilis infection diagnosis and laboratory test results interpretation for clinical use. Metrics

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The relationship between hepatitis B virus markers and infectivity of the patients with chronic hepatitis B virus infection 2017, 16 (10):  664-666.  doi: 10.3969/j.issn.1671-4091.2017.010.006 Abstract ( 348 )   PDF (358KB) ( 415 )   Hepatitis B virus infection is a global public problem. Because of the lack of typical clinical manifestation, occult hepatitis B infection is often unaware by the majority of infected people, leading to spread of the infection. Serological markers of HBV and quantification of HBV DNA can virtually reflect status of hepatitis B virus infection. This article aims to discuss HBsAg and anti-HBs antibody, HBeAg and anti- HBe antibody, anti-HBc antibody, HBV DNA, and newly discovered biological markers for HBV replication in vivo. Metrics

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Quantitative ultrasound applied to differentiate bone turnover in dialysis patients 2017, 16 (10):  667-671.  doi: 10.3969/j.issn.1671-4091.2017.010.007 Abstract ( 293 )   PDF (1039KB) ( 433 )   Objective To evaluate whether quantitative ultrasound (QUS) can determine the bone status and differentiate bone turnover type in dialysis patients. Methods We recruited 42 dialysis patients and 119 healthy volunteers as the study objects and attributed the dialysis patients into high serum parathyroid hormone(PTH) group and low PTH group according to the mean PTH value in the last year. They accepted QUS and dual-energy X-ray absorptiometry (DXA) examinations. QUS parameters included calcaneus bone mineral density (BMD), T value, speed of sound (SOS) and broadband ultrasound attenuation (BUA). DXA parameters included BMD and T value of hip and lumbar spine. Results There were moderate correlations between calcaneus BMD by QUS and hip and lumbar spine BMD by DXA in study objects (r=0.461, P<0.001 and r=0.438, P<0.001, respectively) and in high PTH group (r=0.714, P=0.002 and r=0.616, P=0.011, respectively), but not in low PTH group. SOS and BUA by QUS were significantly lower in high PTH group than in low PTH group[ (1521.345±24.004) m/s vs. (1539.168±26.267) m/s, t=-2.270, P=0.029 for SOS and (70.582±12.504) dB/MHz vs. (82.511±12.276) dB/MHz, t=-3.072, P=0.004 for BUA]. The parameters measured by DXA had no differences between the two groups. Conclusions Calcaneus QUS examination may be a useful technique for bone assessment, and more importantly QUS may be helpful to differentiate high turnover bone disease from low turnover bone disease in dialysis patients. Metrics

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The relationship between serum ferritin and compliance rate of hemoglobin level in maintenance hemodialysis patients 2017, 16 (10):  672-675.  doi: 10.3969/j.issn.1671-4091.2017.010.008 Abstract ( 577 )   PDF (397KB) ( 446 )   Objective To investigate the relationship between serum ferritin and compliance rate of hemoglobin (HGB) level in maintenance hemodialysis (MHD) patients. Methods Clinical data of MHD patients treated in this center between Jan. 2012 to Dec. 2016 were recruited. We defined serum ferritin 13-500μg/L as normal level and that >500μg/L as high serum ferritin. MHD patients were divided into normal ferritin group and high ferritin group. The target HGB level is 110～130g/L. Demographic characteristics, HGB level and HGB compliance rate were compared between the two groups. Results A total of 110 MHD patients were enrolled in this study. (a) Dialysis age was longer in high ferritin group than in normal ferritin group(120.960 ± 68.148 vs. 73.920 ± 61.104, t=3.780, P<0.001), while patients’age was younger in high ferritin group than in normal ferrtin group (54.300±13.421 years vs. 62.180 ± 12.110 years, t=3.204, P =0.002). (b) There were no significant differences in HGB level (110.300 ± 14.575g/L in high ferritin group, 107.060 ±18.323g/L in normal ferritin group, t=1.033, P=0.304), and HGB compliance rate (76.667% in high ferritin group and 70.000% in normal ferritin group, c2=0.624, P=0.429) between the two groups. Conclusion Serum ferritin more than 500μg/L could not improve HGB level and its compliance rate. Clinically, rational use of iron supplement for anemia not leading to high serum ferritin should be emphasized. Metrics

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Long-term outcome and risk factors in patients with end stage renal disease on peritoneal dialysis 2017, 16 (10):  676-680.  doi: 10.3969/j.issn.1671-4091.2017.010.009 Abstract ( 328 )   PDF (516KB) ( 398 )   Objective To investigate long- term outcome and the risk factors influencing the long- term prognosis in patients with end stage renal disease (ESRD) on peritoneal dialysis (PD). Methods The ESRD patients treated with PD as the initial renal replacement therapy in Anhui Provincial Hospital from Jan. 2011 to Dec. 2013 were enrolled in this study. They were followed up for 3 years and their outcomes were recorded. Kaplan-Meier survival curve was used to calculate cumulative survival rate and technique survival rate. Cox regression models were used to analyze the risk factors for mortality and PD technical failure, and to calculate their relative risk (RR) and 95% confidence interval (CI). Results A total of 100 patients were recruited. The cumulative survival rates after 1, 2 and 3 years were 95.8%, 87.4% and 76.7%, respectively. Cox regression showed that age (RR 1.042, 95% CI 1.012～1.073, P=0.006), lower serum albumin (RR 0.872, 95% CI 0.800～0.950, P=0.002) and chronic heart failure (RR 3.545, 95% CI 1.336～9.409, P=0.011) at the beginning of PD were the risk factors for survival in PD patients. The cumulative technical survival rates after 1, 2 and 3 years were 90.8%, 82.5% and 65.5%, respectively. Cox regression revealed that lower serum albumin level at the beginning of PD (RR 0.932, 95% CI 0.870～0.998, P=0.042) was the risk factor for dropout of the treatment in PD patients. Conclusions The PD patients treated in this department had better survival rate and technical survival rate. The factors at the beginning of PD that affected survival rate included age, lower serum albumin and chronic heart failure, and the factor at the beginning of PD that affected technical survival rate was lower serum albumin. The PD patients with hypoalbuminemia had poor long-term prognosis. Correction of low serum albumin before PD may improve the long-term prognosis. Metrics

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Clinical application of immunoadsorption therapy for the treatment of refractory rheumatoid arthritis 2017, 16 (10):  681-683.  doi: 10.3969/j.issn.1671-4091.2017.010.010 Abstract ( 702 )   PDF (442KB) ( 553 )   Objective To evaluate the therapeutic effect of immunoadsorption therapy for refractory rheumatoid arthritis. Methods Clinical data of 120 patients with refractory rheumatoid arthritis and treated with immunoadsorption therapy in the Department of Rheumatology, Shanghai Guanghua Chinese and Western Medicine Hospital from Oct. 2014 to Dec. 2016 were retrospectively analyzed. Results In the 120 patients, the inflammation indicator erythrocyte sedimentation rate (ESR) decreased from (78.23±50.65)mm/h before treatment to (3.03±2.06) mm/h after treatment and (12.01±9.12) mm/h after the treatment for 3 months (t=0.394, P= 0.002, comparison of ESR values before treatment and after treatment). C reaction protein (CRP) decreased from (58.93±45.21)mg/l before treatment to (8.20± 3.04)mg/l after treatment and (18.01±12.11)mg/l after the treatment for 3 months (t=0.067, P=0.003, comparison of CRP values before treatment and after treatment). Rheumatoid factor decreased from (350.07±177.28) IU/ml before treatment to (103.22±82.06)IU/ml after treatment and (230.12±145.52) IU/ml after the treatment for 3 months (t=0.033, P=0.048, comparison of rheumatoid factor values before treatment and after treatment). All the 120 patients achieved ACR50 or ACR 70 after immunoadsorption therapy for 2 weeks. One of the 120 patients experienced pancreatitis, 5 had acute episode of chronic cholecystitis, and 10 had hypoalbuminemia; all of these adverse reactions improved after treatment and no serious adverse reactions happened in the observation period. Conclusion Immunoadsorption therapy provides a new and effective therapeutic approach with quite better safety for refractory rheumatoid arthritis patients. Metrics

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Constipation and its influence factors in peritoneal dialysis patients: a single center study 2017, 16 (10):  684-687.  doi: 10.3969/j.issn.1671-4091.2017.010.011 Abstract ( 551 )   PDF (466KB) ( 632 )   Objectives To investigate the prevalence of constipation and its related risk factors in peritoneal dialysis (PD) patients through a cross-section study in order to guide the prevention, treatment and education of constipation and to reduce constipation-related complications in PD patients. Methods Stable maintenance PD patients who received regular follow-up in PD center of Peking University People's Hospital from Jun. 2015 to Dec. 2015 were enrolled in this study. A questionnaire survey for constipation was used. Constipation was diagnosed by using the international standard of Rome III. General information, drug usage and laboratory tests in these patients were collected. Related risk factors for constipation were analyzed by logistic regression analysis. Results ①A total of 143 PD patients (73 males; average age 59.15±13.03 years) were enrolled in this study. Their PD duration was 37.14±27.79 months. ② Among the 143 patients, 50 patients (35%) had constipation and 61 patients (42.65%) took or used 1.69±0.92 types of laxatives. ③ Logistic regression analyses showed that oral dose of atorvastatin (OR=1.807, 95% CI: 1.021～1.157, P=0.009), Karnofsky score (OR=1.606, 95% CI: 1.704～2.401, P=0.021) and age (OR=1.856, 95% CI: 1.088～3.168, P=0.023) were independent risk factors for constipation in PD patients. Conclusions The prevalence of constipation in maintenance PD patients was high. Constipation was more likely to occur in patients who were elderly, had less activity, and took higher dose of atorvastatin. In addition to conventional education about the importance of constipation prevention, specific preventive and standardized treatment for constipation should be given for PD patients. Metrics

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The prognosis of patients with hyperlipidemic acute pancreatitis in pregnancy treated by continuous veno-venous hemofiltration and plasma exchange 2017, 16 (10):  688-691.  doi: 10.3969/j.issn.1671-4091.2017.010.012 Abstract ( 349 )   PDF (352KB) ( 449 )   Objective To study the prognosis of hyperlipidemic acute pancreatitis in pregnancy (HLAPIP) patients treated by continuous veno- venous hemofiltration (CVVH) or CVVH plus plasma exchange (PE). Methods We recruited 30 patients diagnosed with HLAPIP in Luoyang Central Hospital, Zhengzhou University and randomly divided them into 2 groups. The CVVH group received CVVH for 5 days, and the CVVH+PE group received plasma exchange 3 times in addition to CVVH5 for 5 days. We then compared treatment efficiency, symptom alleviating time, fasting time, hospitalization days and laboratory blood indices between the two groups. Results The treatment efficiency is 93.33% in CVVH + PE group, higher than 53.33% (P=0.035) in CVVH group. The symptom alleviating time (t =3.850, P＜0.001), fasting time (t =5.290, P＜0.001), hospitalization days (t =4.890, P＜0.001) are shorter in CVVH+PE group than in CVVH group. After the treatment, white blood cell (t =4.870, P＜0.001), C response protein (t=10.390, P＜0.001), triglyceride (t =5.230, P＜0.001) and total cholesterol (t =5.370, P＜0.001) are lower in CVVH+PE group than in CVVH group; while amylase and lipase have no significant differences between the two groups. Metrics

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The prognosis of patients with hyperlipidemic acute pancreatitis in pregnancy treated by continuous veno-venous hemofiltration and plasma exchange 2017, 16 (10):  692-695.  doi: 10.3969/j.issn.1671-4091.2017.010.012 Abstract ( 195 )   PDF (397KB) ( 196 )   Objective To study the prognosis of hyperlipidemic acute pancreatitis in pregnancy (HLAPIP) patients treated by continuous veno- venous hemofiltration (CVVH) or CVVH plus plasma exchange (PE). Methods We recruited 30 patients diagnosed with HLAPIP in Luoyang Central Hospital, Zhengzhou University and randomly divided them into 2 groups. The CVVH group received CVVH for 5 days, and the CVVH+PE group received plasma exchange 3 times in addition to CVVH5 for 5 days. We then compared treatment efficiency, symptom alleviating time, fasting time, hospitalization days and laboratory blood indices between the two groups. Results The treatment efficiency is 93.33% in CVVH + PE group, higher than 53.33% (P=0.035) in CVVH group. The symptom alleviating time (t =3.850, P＜0.001), fasting time (t =5.290, P＜0.001), hospitalization days (t =4.890, P＜0.001) are shorter in CVVH+PE group than in CVVH group. After the treatment, white blood cell (t =4.870, P＜0.001), C response protein (t=10.390, P＜0.001), triglyceride (t =5.230, P＜0.001) and total cholesterol (t =5.370, P＜0.001) are lower in CVVH+PE group than in CVVH group; while amylase and lipase have no significant differences between the two groups. Metrics

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Clinical benefit and research progress of online hemodiafiltration 2017, 16 (10):  696-698.  doi: 10.3969/j.issn.1671-4091.2017.010.014 Abstract ( 368 )   PDF (279KB) ( 419 )   On- line hemodiafiltration（OL-HDF）is an important method of renal replacement therapy, which combines hemodialysis and hemofiltration characteristics. The ultra-net replacement fluid is generated on line and it greatly improved the ability to remove toxins in the body. Meanwhile, it is conducive to maintaining the stability of hemodynamics during dialysis and has a protective effect on the cardiovascular system of dialysis patients. In this review, we summarize the clinical benefit and research progress of OL-HDF. Metrics

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Multicenter study of the knowledge about arteriovenous fistula and its related factors in hemodialysis patients in Shanghai 2017, 16 (10):  702-705.  doi: 10.3969/j.issn.1671-4091.2017.010.016 Abstract ( 380 )   PDF (452KB) ( 557 )   Objective To investigate the knowledge about arteriovenous fistula (AVF) and its influencing factors in hemodialysis patients. Methods A total of 430 hemodialysis patients with AVF in the 8 hospitals in Shanghai were selected by the convenience sampling method. They were investigated by self- designed questionnaire. Descriptive analysis was completed by using SPSS 22.0 software. Results The knowledge about AVF was at a low level in most hemodialysis patients. Educational level (β=1.758, P＜0.001), revascularization of AVF (β=1.289, P＜0.001), age (β=-0.494, P=0.005) and marital status (β=-1.146, P=0.007) were the predictors for knowledge score. Conclusions In order to improve the knowledge about AVF in hemodialysis patients, medical personnel should reinforce education on AVF knowledge and training on AVF protection in hemodialysis patients, and develop individualized programs to enhance their knowledge level. Metrics

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The effect of limb behavioral norms on complications of internal fistula in maintenance hemodialysis patients 2017, 16 (10):  706-710.  doi: 10.3969/j.issn.1671-4091.2017.010.017 Abstract ( 263 )   PDF (498KB) ( 644 )   Objective To investigate the influence of limb behavioral norms on the complications of internal fistula in maintenance hemodialysis (MHD) patients Methods Thirty-one MHD patients who received arteriovenous fistula (AVF) for the first time in our hospital from Jun. 2014 to Dec. 2014 were selected as the control group, and 33 MHD patients who received AVF for the first time in our hospital from Jan. 2015 to Jun. 2015 as observation group. The control group adopted the traditional health education, and the observation group established more detailed norms of physical behavior. The fistula complications were compared between the two groups after one year. Results After one year, the incidence of thrombosis (χ2=4.399, P=0.036), stenosis and occlusion (χ2=4.373, P=0.037), decreased blood flow in AVF (χ2=4.510, P=0.034) were significantly lower in observation group than in control group, and the differences were statistically significant. Fistula infection was not statistically significant (χ2=1.081, P=0.298) between the two groups. Conclusion The establishment of limb behavioral norms can reduce the incidence of fistula thrombosis, occlusion and fistula blood flow reduction in MHD patients. Metrics

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Observational study on clinical effects of blunt buttonhole technique in hemodialysis 2017, 16 (10):  711-714.  doi: 10.3969/j.issn.1671-4091.2017.010.018 Abstract ( 474 )   PDF (447KB) ( 645 )   Objective To compare the clinical effects between buttonhole (BH) puncture by blunt needle and rope ladder (RL) puncture by sharp needle in maintenance hemodialysis (MHD) patients. Methods Patients with native arteriovenous fistula (AVF) for MHD treated in our blood purification center from Feb. 2016 to Feb. 2017 (13 months) were followed up. There were 11 patients punctured by BH technique (group BH) and 15 patients punctured by RL technique (group RL) during hemodialysis. The ratio of infection, success of puncture, bleeding of puncture point, average effective blood flow volume, and urea clearance index (Kt/V) were compared between the two groups. Results No infection events happened in both groups. There were 2,073 times puncture in group BH and 2,392 times puncture in group RL. The successful puncture rate in group BH was significantly higher than that in group RL (99.5% vs. 96.0%, χ2=57.591, P＜0.001). The incidence of bleeding in group BH was significantly less than that in group RL (2.9% vs. 4.1%, χ2=5.008, P=0.029). There were no significant differences in average effective blood flow volume (285.2±21.1 ml/min vs.300.2±24.6 ml/min, t=-1.673, P=0.107) and Kt/V (1.4±0.2 vs. 1.5±0.2, t=-0.256, P=0.800). Conclusion BH technique using blunt needle for AVF puncture shows the benefits in terms of higher puncture success rate, less bleeding rate and lower risk of infection. Metrics

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Effect of quality control circles on intradialytic exercise participation rate in young and middle-aged hemodialysis patients 2017, 16 (10):  715-718.  doi: 10.3969/j.issn.1671-4091.2017.010.019 Abstract ( 249 )   PDF (843KB) ( 379 )   Objective To explore the effectiveness of quality control circles on intradialytic exercise participation rate in young and middle- aged hemodialysis patients. Methods A quality control circles group was established before carrying out a quality control circles activity using the methods and steps of quality control circles and selecting a theme of“ promotion of intradialytic exercise participation rate of young and middle- aged hemodialysis patients”. Results The intradialytic exercise participation rate after the implementation of quality control circles increased from 19.23% to 89.74%, and the difference was statistically significant (χ2=55, P＜0.05). Conclusion The quality control circles activity carrying out in young and middle-aged hemodialysis patients can improve exercise participation rate in the process of dialysis. Metrics