Studies on serum and urinary alpha 1-microglobulin levels as parameter of the renal function--renal function observed after CDDP administration

To evaluate the clinical usefulness of alpha 1-microglobulin (alpha 1-MG) as parameter of renal function, we determined the levels of alpha 1-MG in the serum and urine of patients who had no malignant tumors, and compared them with the levels of beta 2-microglobulin (beta 2-MG), serum creatinine, urinary N-acetyl-beta-glucosaminidase (NAG) and 24-hour creatinine clearance (24 Ccr). There were significant positive correlations between alpha 1-MG in the serum and urine, and those of beta 2-MG levels. Serum alpha 1-MG and 24 Ccr were inversely correlated. Combined measurements of alpha 1-MG in the serum and urine seemed to be useful to estimate glomerular and tubular renal functions. The renal function in 8 patients with advanced urogenital cancers treated with cis-diammine-dichloroplatinum (CDDP) was examined by measuring 24 Ccr, alpha 1-MG, and beta 2-MG in serum and urine and urinary NAG. Determination of urinary alpha 1-MG was useful for early detection of tubular damage after CDDP administration.     

Creatinine clearance prediction in spinal cord injury patients: comparison of 6 prediction equations

The renal function of spinal cord injury patients frequently is overestimated by 3 commonly used equations to predict creatinine clearance. Overestimation of creatinine clearance may result in aminoglycoside overdosage and resultant nephrotoxicity. Three newer prediction equations have been developed from creatinine clearances measured in neurologically abnormal patients. These 6 equations were tested in 77 male and 9 female spinal cord injury patients (48 quadriplegics and 38 paraplegics, including 38 with acute and 48 with chronic injuries). The equation developed by Sawyer and Hutchins was superior to 2 other equations developed in spinal cord injury patients and 3 equations developed in neurologically normal patients. However, creatinine clearances predicted by this equation were within 30 ml. per minute of measured creatinine clearances in only two-thirds of the spinal cord injury patients. Errors ranged from overestimation by 95 ml. per minute (151 per cent) to underestimation by 106 ml. per minute (45 per cent). The potential for large errors in creatinine clearance prediction necessitates measurement of creatinine clearance as soon as possible when renal excreted and toxic pharmaceuticals are administered to spinal cord injury patients.     

The evaluation of creatinine clearance in spinal cord injury patients

The parameters of age, height, weight, serum creatinine and 24-hour urinary creatinine production were measured in 101 consecutive spinal cord injury patients (79 men and 22 women, 43 quadriplegics and 58 paraplegics) admitted to a rehabilitation hospital. Creatinine production was significantly lower than that of age and sex-matched hospitalized controls, upon whom commonly used nomograms for evaluation of endogenous creatinine clearance are based. Therefore, these nomograms grossly overestimate the creatinine clearance in paralyzed patients, which often results in aminoglycoside overdosage. Regression analysis identified the interval since injury and age as important determinants of creatinine production. We propose 2 simple equations and nomograms that should allow more accurate prediction of creatinine clearance in spinal cord injury patients.     

Serum beta 2-microglobulin as a index of the initiation of dialysis therapy for diabetic patients with chronic renal failure]

This study was designed whether serum beta 2-microglobulin is good index for the initiation of dialysis therapy in diabetic patients with chronic renal failure. Serum creatinine (S. Cr), beta 2-microglobulin (S. beta 2-MG) and guanidinoacetic acid (S. GAA) were measured in dialyzed or undialyzed diabetic patients with chronic renal failure in comparison with non diabetic patients. 28.6% of diabetic patients showed S. Cr below 8.0 mg/dl at the initiation of dialysis therapy although all of non diabetic patients showed it over 8.0 mg/dl. On the other hand, there was no significant difference in S. beta 2-MG between diabetic and non diabetic patients, and all patients of the two groups showed S. beta 2-MG over 12.0 mg/l. In non diabetic patients whose S. Cr was below 8.0 mg/dl, undialyzed patients had a significant correlation between S. Cr and S. beta 2-MG (r = 0.840, P less than 0.01), and all non diabetic patients showed relatively high value of S. Cr as compared with that of beta 2-MG at the initiation of dialysis therapy. Undialyzed diabetic patients whose S. Cr was below 8.0 mg/dl also revealed a close correlation between serum creatinine and beta 2-MG (r = 0.864, P less than 0.01), but dialyzed diabetic patients showed different correlation between S. Cr and S. beta 2-MG from it of non diabetic patients and S. Cr was underestimated as compared with S. beta 2-MG. Undialyzed diabetic patients showed significant lower values of S. Cr and S. GAA of non diabetic patients whose S. beta 2-MG were almost same as diabetics.(ABSTRACT TRUNCATED AT 250 WORDS)     

Monitoring of renal function in patients with spinal cord injury

OBJECTIVE: To assess the sensitivity of serum creatinine level in detecting clinically important and early deterioration of renal function in patients with spinal cord injury (SCI), and to evaluate the optimal method of determining creatinine clearance in these patients. PATIENTS AND METHODS: The serum creatinine level of 36 patients (25 paraplegics and 11 quadriplegics) was evaluated and compared with the corresponding measured creatinine clearance rate. Correlations were also assessed between the creatinine clearance measured by 24-h endogenous clearance, single-shot 99mTc-labelled diethylenetriamine pentaacetic acid (99mTc-DTPA) clearance technique, and the Cockcroft-Gault formula, to test their validity. RESULTS: Of the 36 patients 11 (31%) had a measured creatinine clearance of < 100 mL/min (mean 84.8) and a corresponding normal serum creatinine level. Creatinine clearance calculated by the Cockcroft-Gault formula did not correlate well with that measured by the 24-h endogenous clearance (r = 0.426) and 99mTc-DTPA clearance (r = 0. 366), overestimating creatinine clearance in all but three patients. The mean (SD) difference between the creatinine clearance measured by the 24-h and DTPA clearance technique was 17.7 (16.5)% and the correlation between these techniques was good (r = 0.71). CONCLUSION: Serum creatinine level is not sensitive in detecting early deterioration of renal function in patients with SCI. The Cockcroft-Gault formula generally significantly overestimates the true creatinine clearance and is not recommended. The 24-h endogenous creatinine clearance measured on appropriately collected urine samples is an acceptable accurate and practical method of determining glomerular filtration rate in patients with SCI.     

Dosage of once-daily gentamicin in spinal cord injury patients

INTRODUCTION: In patients with spinal cord injury (SCI), serum creatinine does not accurately reflect the level of renal function. Therefore, in SCI patients, the dose of potentially nephrotoxic drugs should be adjusted on an individual basis from the estimated creatinine clearance. CASE REPORT: A 41-year-old male with tetraplegia due to cervical spinal cord injury underwent extended pyelolithotomy for staghorn calculus in the right kidney. The blood urea level was 9.9 mmol/l; creatinine was 112 umol/l (reference range: 0-135). We were conscious of this patient's renal disease, and therefore, administered only 3 mg/kg of gentamicin (240 mg) instead of the standard dose of 5 mg/kg body weight. Despite taking this precaution, the gentamicin level measured 22.5 h after the initial dose, was in the potentially toxic range 3.3 mg/l. CONCLUSION: We recommend that even the first dose of gentamicin in the once-daily regimen, which is 5 mg/kg, should be individualised in SCI patients based on age, sex, weight, height, level of spinal cord injury, and renal function.     

Assessment and predictability of renal function in spinal cord injury patients

Creatinine clearance values were determined by duplicate urine collections in 18 patients with spinal cord injury, cerebrovascular accident, or multiple sclerosis. Measured creatinine clearance values were compared with estimates predicted by a urine free mathematical method for estimation of renal function. Measured creatinine clearance values were considerably lower than would be ordinarily expected on the basis of patient body size, age, sex, and serum creatinine. In addition, creatinine clearances calculated using the urine free method were considerably higher than measured values, suggesting that techniques for the prediction of creatinine clearance may not be routinely applicable in patients with these conditions.     

Estimating the glomerular filtration rate using serum cystatin C levels in patients with spinal cord injuries

Study design:Prospective cohort study.Objectives:To investigate the relationship between (51)chromium-ethylene-diamine-tetra-acetate ((51)Cr-EDTA) clearance, serum cystatin C (CysC), serum creatinine, creatinine clearance and estimated glomerular filtration rate (eGFR(MDRD), MDRD stands for modification of diet in renal disease) based on the serum creatinine in patients with complete or incomplete spinal cord injury (SCI) and to develop and evaluate a GFR-estimating equation using serum CysC.Settings:Spinal Cord Injury Unit, Viborg Regional Hospital, Viborg, Denmark.Methods:Ninety-eight men and 47 women with SCI were included in the study. Serum CysC levels were measured by an automated particle-enhanced nephelometric immunoassay, serum and urine creatinine levels were measured by an enzymatic method traceable to the IDMS creatinine reference method, and (51)Cr-EDTA clearance was measured by a multiple plasma sample method.Results:The area under the curves (AUCs) in the non-parametric receiver operating characteristics (ROC) plots for serum CysC were compared with serum creatinine and to eGFR(MDRD) and revealed a significant difference (P-value<0.05) for all SCI patients. There was no significant difference between the AUC for serum CysC compared with the AUC for creatinine clearance. GFR (ml?min(-1) per 1.73?m(2)) can be calculated from serum CysC values (mg?l(-1)) using the equation eGFR(CysC)=212·exp(0.914·CysC). The model accurately predicted the GFR of 88% of patients within ±30% of the measured GFR, and it was able to predict the GFR of 50% of patients within ±10% of the measured GFR.Conclusion:In patients with SCI, GFR can be estimated independent of age, sex and muscle mass by a newly developed equation based on a single serum CysC value.     

Vancomycin Pharmacokinetics in Spinal Cord Injured Patients: A Comparison with Age-matched,Able-bodied Controls

Abstract

To compare the pharmacokinetics of vancomycin in chronic spinal cord injured patients and hospitalized, age-matched, able-bodied controls, we evaluated 14 spinal cord injured patients and 14 controls. Pharmacokinetic parameters of total body clearance (CL), distribution volume (V), elimination rate constant (k) and elimination half-life (ti/2) were calculated from two steady-state vancomycin serum concentrations by the method of Sawchuk and Zaske. Demographic data such as age, ideal body weight (IBW), total body weight (TBW) and serum creatinine at start of therapy (SCr), pharmacokinetic parameters and predicted dosages to achieve specific peak (30 mcg/ml) and trough concentrations (5–10 mcg/ml) were calculated for both groups. Statistical comparisons were made using a two sample, Student’s t-test. Demographic data between groups differed only in mean serum creatinine (p=0.04). There were no statistically significant differences in mean pharmacokinetic parameters of CL and V or mean predicted dosages. Mean elimination rate constant was significantly smaller and mean elimination half-life was significantly longer in spinal cord injured patients (p=0.02 and p=0.04, respectively). The longer dosing interval predicted in spinal cord injured patients trended toward statistical significance (p=0.10). We conclude that with chronic spinal cord injury, 1) the elimination half-life of vancomycin is increased and these patients may require longer dosing intervals and 2) distribution volume and predicted vancomycin doses are unaltered compared with controls. (J Spinal Cord Med;) 8:233–235)     

Serum cystatin C as a marker of the renal function in patients with spinal cord injury

OBJECTIVE: To investigate the relationship between serum cystatin C, serum creatinine, and (51)Cr-EDTA-clearance in patients with spinal cord injury. SETTING: The Spinal Cord Unit, Viborg-Kjellerup County Hospital. METHODS: Twenty-four men and seven women aged 20.3 to 68.0 years with motor complete spinal cord injury (ASIA A or B) were included. Serum cystatin C was measured by an automated particle-enhanced nephelometric immunoassay (Dade Behring), serum creatinine by an enzymatic method (Vitros 950), and (51)Cr-EDTA-clearance by a multiple plasma sample method. RESULTS: A linear relationship was found between (51)Cr-EDTA-clearance and the reciprocal values of cystatin C and creatinine. The correlation coefficient between (51)Cr-EDTA-clearance and 1/cystatin C was 0.72 compared to the correlation coefficient between (51)Cr-EDTA-clearance and 1/creatinine being 0.26. Comparison of the area under the curves in the non-parametric receiver operating characteristics (ROC) plots for serum cystatin C (area under the curve (AUC)=0.912; SE=0.065), and serum creatinine (AUC=0.507; SE=0.115) revealed significant differences (P-values=0.0005). CONCLUSION: In patients with spinal cord injury serum cystatin C is a better marker of the renal function compared to serum creatinine.     

Salt wasting, hypotension, polydipsia, and hyponatremia and the level of spinal cord injury

STUDY DESIGN: Case control.Objective:To test the reported correlation of hypotension, polydipsia, and hyponatremia with higher levels of spinal cord injury (SCI). SETTING: A Veterans Administration Hospital, USA. METHODS: The records of men who were paralyzed owing to trauma at any spinal cord level with motor complete lesions (ASIA A or B) and who received an annual physical and laboratory examination were reviewed for age, duration of paralysis, level of paralysis, blood pressure (BP), serum sodium, and 24 h urinary volume, creatinine, and sodium. Creatinine clearance and fractional excretion of sodium (FcNa) were calculated. Spearman rank-order correlations (r (s)) were carried out. RESULTS: Patients were aged 25 to 88 years, median 56 years, paralyzed 2-61 years, median 26 years, with levels of paralysis ranging from C2 to L4, median T4, n=111. From lower to higher levels of paralysis FcNa increased (0.4-7.3%), mean BP diminished (132-66 mmHg), urine volume increased (600-5400 ml), and serum sodium was reduced (148-129 mEq/l) - r (s)=0.29, 0.49, -0.22, and 0.23, respectively. Increasing 24 h urinary volumes correlated with lower serum sodium concentrations but higher creatinine clearance, r (s)=-0.28, 0.24. Increasing 24 h urinary sodium improved creatinine clearance, r (s)=0.37. P-values ranged from <0.05 to <0.001. CONCLUSION: Higher levels of SCI correlate with reduced sodium conservation, hypotension, polydipsia, and hyponatremia. Greater water intake raises creatinine clearance but lowers serum sodium. Greater salt intake increases creatinine clearance.     

Serum cystatin C and beta2-microglobulin as markers of glomerular filtration rate

Continuous efforts have been made to find out precise and simple method for determination of glomerular filtration rate (GFR). Cystatin C (cysteine proteinase inhibitor = CyC) is a low molecular weight (LMW) protein which is produced constantly by all nucleated cells independently of different pathological conditions and eliminated from the blood exclusively by glomeruli. So, CyC closely reflects the GFR. In the present study 75 patients aged between 18 and 74 (44.3 +/- 12.2) years were analyzed, with the aim to compare the reciprocal values of serum level of LMW proteins CyC and beta2-microglobulin (beta2-MG) with creatinine clearance (Ccr) as a measure of GFR. Patients were divided into groups according to sex, age (<60; >60 years) and renal diseases: patients with glomerulonephritis (GN) with and without nephrotic proteinuria, pyelonephritis (PyN), and renal transplant (Tx). High correlation between Ccr and 1/CyC (r = 0.81; p < 0.01) and Ccr and 1/beta2-MG (r = 0.80; p < 0.01) in all examined patients was found. There was significant correlation between Ccr and 1/CyC (0.82 vs. 0.79) and Ccr and 1/beta2-MG (0.85 vs. 0.76) in men as well in women, and also in two groups of patients formed according to the age (0.82 vs. 0.77; p < 0.01; 0.80 vs. 0.81; p < 0.01), without any statistical significant difference between the groups. In studied groups with different renal diseases, there were no differences in correlation coefficients between Ccr and 1/CyC and Ccr and 1/beta2-MG (p1 = 0.29; p2 = 0.21; p3 = 0.79; p4 = 0.43), without statistical differences between the groups, except significant difference in correlation coefficients for Ccr and 1/beta2-MG between patients with GN with and without nephrotic proteinuria (p < 0.032). LMW proteins, serum CyC and beta2-MG, are as good markers of GFR as Ccr, regardless sex and age. Both of these LMW proteins are good markers of GFR in patients with GN without nephrotic proteinuria, PyN and Tx patients. In patients with GN and nephrotic proteinuria serum CyC is a better marker of GFR than beta2-MG.     

Glomerular proteinuria as an early sign of renal-transplant rejection

The introduction of cyclosporin gave rise to an additional problem in the surveillance of renal transplant patients, namely the differentiation between cyclosporin toxicity and acute transplant rejection. The development of assays for specific proteins in urine has produced a non-invasive solution to this problem. In 55 renal transplant patients the following proteins were determined daily in 24 h-urine samples: IgG, transferrin (TF), albumin, beta 2-microglobulin (beta 2-MG), retinol binding protein (RBP), alpha 1-microglobulin (alpha 1-MG) and alpha 1-antitrypsin (alpha 1-AT). All proteins were determined quantitatively using immunoluminometric assays and 10 microliters urine in dilutions from 1:1-1:100. The urinary protein excretion was related to the actual creatinine clearance as this index gave the best differentiation between normal and abnormal status. In 24 h-urine, intraindividual peaks of IgG, TF and albumin were seen regularly in acute rejection episodes. However, a peak in the "tubular" proteins (RBP, beta 2-MG, alpha 1-MG) could not be detected. After effective treatment of the rejection episode, the renal function improved and the protein excretion returned to prerejection episode levels. In bacterial infection of the urogenital tract, urinary alpha1-AT levels rose. They returned to normal after successful antibiotic treatment. In two cases of cyclosporin toxicity neither glomerular nor tubular proteins were excreted in abnormal amounts when compared with transplant patients without complications, the only changes being an increase in serum creatinine as a result of reduced renal function.     

Influences on renal function in chronic spinal cord injured patients

PURPOSE: The optimal method of bladder management in the spinal cord injured population remains controversial. We determined the significance of bladder management and other factors on renal function in this population. MATERIALS AND METHODS: We retrospectively reviewed the medical records and upper tract imaging studies of 308 patients with a mean followup of 18.7 years since injury. Renal function was assessed by serum creatinine, creatinine clearance and proteinuria measurement, and by upper tract abnormalities on renal ultrasound and nuclear medicine renal scan. Independent variables evaluated for an influence on renal function included patient age, interval since injury, injury level and completeness, vesicoureteral reflux, history of diabetes mellitus and bladder management method. RESULTS: Mean serum creatinine plus or minus standard deviation in patients on chronic Foley catheterization, clean intermittent catheterization and spontaneous voiding was 1.08 +/- 0.99, 0.84 +/- 0.23 and 0.97 +/- 0.45 mg./dl. (analysis of variance p = 0.05, Student's t test p = 0.10), and mean creatinine clearance was 91.1 +/- 46.5, 113.4 +/- 39.8 and 115 +/- 49 ml. per minute, respectively (analysis of variance and Student's t test p <0.01), respectively. Proteinuria was present in 19 patients (6.2%) in the Foley catheterization, 3 (1%) in the clean intermittent catheterization and 4 (1.3%) in the spontaneous voiding group (chi-square test p <0.01), while there were upper tract abnormalities in 56 (18.2%), 20 (6.5%) and 24 (7.8%) patients, respectively (chi-square test p <0.01). Multiple regression analyses revealed no significant predictors of serum creatinine, although older patient age and Foley catheterization significantly predicted low creatinine clearance. Additional logistic regression analyses showed that Foley catheterization was associated with proteinuria and vesicoureteral reflux was associated with upper tract abnormalities. CONCLUSIONS: While renal function may be preserved by all forms of bladder management, chronic indwelling catheters may contribute to renal deterioration.     

Estimation of glomerular filtration rate by serum creatinine and serum beta 2-microglobulin

51Cr-EDTA clearance, serum beta 2-microglobulin and serum creatinine were measured simultaneously on 271 occasions in 114 patients. Serum beta 2-microglobulin was more sensitive than serum creatinine for detection of changes of glomerular filtration rate (GFR) and for detection of a moderately reduced GFR. However, serum beta 2-microglobulin also had severe limitations when used to estimate GFR. The serum levels of the protein varied considerably in patients with similar GFR, probably due to different rates of synthesis of beta 2-microglobulin.     

Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C.

BACKGROUND: Assessment of renal function in patients with renal transplants is of great importance. Various studies have reported cystatin C as an easily and rapidly assessable marker that can be used for accurate information on renal function impairment. To date, no study is available to define the role of cystatin C in patients with renal transplants. METHODS: Thirty steady-state patients (50% male/50% female) with status post-kidney transplantation were studied. To assess renal function, cystatin C, creatinine clearance, serum creatinine, beta2-microglobulin (beta2M), and [125I]iothalamate clearance were determined. Correlations and non-parametric ROC curves for accuracy, using a cut-off glomerular filtration rate (GFR) of 60 ml/min, were obtained for the different markers allowing for calculations of positive predictive values (PPV), positive likelihood ratios (PLR), specificity and sensitivity, respectively. Further, to evaluate the usefulness of these markers for monitoring, intraindividual coefficients of variation (CVs) for cystatin C and creatinine measurements were compared in 85 renal transplant patients. Measurements consisted of at least six pairs of results, which were obtained at different time points during routine follow-up. RESULTS: Cystatin C correlated best with GFR (r=0.83), whereas serum creatinine (r=0.67), creatinine clearance (r=0.57) and beta2M (r=0.58) all had lower correlation coefficients. The diagnostic accuracy of cystatin C was significantly better than serum creatinine (P=0.025), but did not differ significantly from creatinine clearance (P=0.76) and beta2M (P=0.43). At a cut-off of 1.64 mg/l, cystatin C has a PPV of 93%, PLR of 6.4, specificity 89% and sensitivity 70%, respectively. For beta2M, PPV 83%, PLR 1.7, specificity 67% and sensitivity 75% was seen at a cut-off of 3.57 mg/l. Accordingly, at a cut-off of 125 micromol/l for serum creatinine, a PPV 76%, PLR 1.4, specificity 44% and sensitivity 80% was revealed. Finally, at a cut-off of 66 ml/min/1.73 m2 for creatinine clearance, the following characteristics were found: PPV 94%, PLR 7.7, specificity 89% and sensitivity 85%. The intraindividual variation of creatinine was significantly lower than that of cystatin C (P<0.001). With increasing concentrations, their ratios of CV tended towards a value of 1, demonstrating identical variability at low GFR. CONCLUSION: Together, our data show that in patients with renal transplants, cystatin C, in terms of PPV and PLR, has a similar diagnostic value as creatinine clearance. However, it is superior to serum determinations of creatinine and beta2M. The intraindividual variation of cystatin C is greater than that of creatinine. This might be due to the better ability of cystatin C to reflect temporary changes especially in mildly impaired GFR, most critical for early detection of rejection and other function impairment. Thus, cystatin C allows for rapid and accurate assessment of renal function (GFR) in renal transplants and is clearly superior to the commonly used serum creatinine.     

Study on urinary low molecular protein and enzyme in primary vesico-ureteral reflux patients

Urinary beta-2-microglobulin (beta 2-MG), urinary N-acetyl-beta-D-glucosaminidase (NAG), urinary creatinine (Cr) and serum creatinine level were measured in 79 patients with primary vesico-ureteral reflux. Comparing the data between conservatively treated group and operated group, between pre and post operation, we obtained the following conclusions: 1. From urinary beta 2-MG and NAG, renal tubular damage tended to increase in both conservatively treated group and operated group in proportion to the grade of reflux. But the degree of tubular damage was more severe in the conservatively treated group than in the operated group. 2. Tubular reabsorption ability was lower in the operated group than in the conservatively treated group. 3. In patients with severe tubular damage, improvement of tubular function was seen at the early stage after operation. 4. Anti-reflux operation was shown to be effective even in improving glomerular function.     

The effect of high-flux hemodialysis on dialysis-associated amyloidosis

Amyloidosis is an important cause of mortality and morbidity in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). In this study, depending on the idea that the clearance of middle and high molecular weight toxins could be improved, we aimed to investigate the effect of high-flux dialyzer on clearance of beta-2 microglobulin (beta2-MG) and calcium (Ca) phosphorus (P) metabolism in patients under HD treatment. Forty-eight patients with ESRD under chronic HD treatment were included in the study. All patients were randomized into two groups, and HD was performed with low-flux or high-flux dialyzer for 6 months. In the high-flux group, the reduction of beta2-MG and P levels during dialysis was significantly higher when compared with the low-flux group (p<0.001). During the follow-up period, while beta2-MG levels decreased significantly in the high-flux group (p<0.05), there was an increase in the low-flux group (p<0.05). As a result, our findings suggest that use of high-flux dialyzer can be an efficient alternative in terms of controlling the clearance of beta2-MG and impaired Ca and P metabolism. These beneficial effects of high-flux dialyzers are probably mediated by the improved clearance of middle and high molecular weight toxins.     

急性脊髓损伤患者血清中单核趋化蛋白-1的表达

目的:观察急性不完全性脊髓损伤患者血清中单核细胞趋化蛋白-1(MCP-1)的表达,探讨继发性脊髓损伤的可能机制。方法:收集急性不完全性脊髓损伤患者和单纯脊柱压缩骨折患者及正常对照者的血清,ELISA方法检测其中MCP-1的水平。结果:与健康对照组相比,急性不完全性脊髓损伤患者血清中MCP-1的浓度明显增高(P<0.01)。结论:MCP-1可能通过向脊髓损伤部位募集炎症细胞而参与脊髓损伤部位的继发性炎症反应。     

脊髓损伤患者血清及脑脊液中髓鞘碱性蛋白的动态变化及意义

目的：研究急性脊髓损伤后血清、脑脊液髓鞘碱性蛋白（MBP）的动态变化与脊髓损伤程度、预后情况之间的关系。方法：ELISA法检测47例不同程度脊髓损伤患者伤后不同时间血清和脑脊液MBP含量,结合预后程度进行分析。结果：脊髓完全性损伤组病人伤后12h内即出现脑脊液MBP显著增高,伤后3d达高峰,并持续至伤后第14d,脊髓不完全性损伤组伤后,12h内也出现脑脊液MBP增高,高峰亦为伤后第3d,但各时间点增高幅度较完全性损伤组小,且伤后第14d时即恢复正常;脊髓震荡组不出现脑脊液MBP增高;各组血清检测结果与脑脊液结果平行。结论：血清和脑脊液MBP检测对于判断脊髓损伤程度、估计预后特别是骨髓损伤休克期选择正确的治疗方法具有积极的意义。