术前NLR、PLR、RDW与喉癌患者临床特征的关系

目的分析中性粒细胞与淋巴细胞比值(NLR)、血小板计数(PLT)与淋巴细胞比值(PLR)、红细胞分布宽度(RDW)与喉鳞状细胞癌间的关系。方法回顾性分析2012年12月至2017年12月该院头颈外科收治的经手术治疗的患者60例,临床病理被确诊为喉鳞状细胞癌。分别检测患者术前最近一次全血细胞分析的参数,包括血红蛋白(Hb)、白细胞计数(WBC)、中性粒细胞绝对值(NEU)、淋巴细胞绝对值(LYMPH)、PLT、平均血小板体积(MPV)、红细胞平均体积(MCV)、血小板分布宽度(PDW)和RDW,计算NLR和PLR值。根据ROC曲线,同时兼顾敏感性和特异性,分为低NLR组(NLR2.04)和高NLR组(NLR≥2.04);高PLR组(PLR≥120.32)和低PLR组(PLR120.32);高RDW组(RDW≥14.05fL)和低RDW组(RDW14.05fL)。比较各组术前比值在喉鳞状细胞癌中的变化及意义。结果各组患者年龄、性别、淋巴结转移方面比较,差异无统计学意义(P0.05),而在肿瘤分期方面比较,高NLR组T3和T4期比率高于低NLR组T3和T4期比率(74.3% vs.44.0%),差异有统计学意义(P=0.017)。结论术前NLR2.04提示喉癌患者分期较晚,预后不良。喉鳞状细胞癌的分期越高,PLR值越大。     

中性粒细胞/淋巴细胞比率联合血小板/淋巴细胞比率检测对于重症急性胰腺炎早期预测价值

目的:评估中性粒细胞／淋巴细胞比率（Neutrophil to lymphocyte ratio,NLR）联合血小板/淋巴细胞比率（platelet to lymphocyteratio,PLR）检测(NLR-PLR)对于重症急性胰腺炎(severe acute pancreatitis,SAP)早期预测价值。方法:连续性收集2019年1月至2019年12月北京大学人民医院急诊科符合急性胰腺炎（acute pancreatitis, AP）诊断标准的216例患者。按病情严重程度分为轻症急性胰腺炎组（mild acute pancreatitis,MAP）(86例)、中度重症急性胰腺炎组（moderately severe acute pancreatitis,MSAP）(40例)及SAP组(90例)三组。所有患者均于发病48 h内采集外周血样进行分析,检测白细胞计数（WBC）、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)、血红蛋白(HGB)、血小板计数(PLT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血清肌酐(CR)、血糖(GLU)等实验室指标,同时完善CT影像学等检查,分别计算NLR和PLR,比较NLR和PLR在三组中是否具有统计学意义。比较NLR、PLR和APACHEⅡ评分及Ranson评分的相关性。同时绘制受试者工作特征曲线(ROC曲线)计算NLR和PLR的最佳阈值,分别依据NLR和PLR的最佳阈值,计算NLR-PLR,同时绘制ROC曲线研究NLR-PLR对于SAP的预测价值。结果:NLR [OR=1.071,95% CI（1.025,1.120）, P=0.002]和PLR[OR=1.003,95% CI（1.000,1.244）, P=0.044]是早期重症胰腺炎的危险因素。NLR与Ranson评分呈正相关（r=0.0342, P<0.05）;NLR与APACHEⅡ评分呈正相关（r=0.0210, P=0.003）;PLR与Ranson评分呈正相关（r=0.0218, P=0.002）;PLR与APACHEⅡ评分呈无相关性（ P=0.157）。NLR和PLR的ROC曲线下面积（AUC）分别为0.894和0.728。NLR的最佳阈值为6.105,敏感度为92.9%,特异度为76.1%,PLR的最佳阈值为154.358,敏感度为78.2%,特异度为73.2%。依据最佳阈值,计算NLR-PLR(NLR≥6.105且PLR≥154.358）,比较NLR-PLR、NLR(≥6.105)和PLR（≥154.358）的ROC曲线下面积,其中NLR-PLR曲线下面积最大,为0.864。 结论:NLR和PLR在AP发病48 h内对SAP患者病情的具有预测价值,NLR-PLR联合检测对于SAP具有早期预测价值。     

外周血NLR、MLR、PLR和SII在宫颈癌中的临床意义分析

目的探讨中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)、血小板与淋巴细胞比值(PLR)及系统性免疫性炎症指数(SII)在宫颈癌中的变化及临床意义。方法以67例宫颈癌患者(宫颈癌组)、169例宫颈癌前病变患者(宫颈癌前病变组)、42例体检健康女性(对照组)作为研究对象,根据检测的血常规结果分别计算NLR、MLR、PLR和SII,比较NLR、MLR、PLR和SII在宫颈癌组、宫颈癌前病变组和对照组中的变化,并分析其鉴别诊断宫颈癌和宫颈癌前病变的价值,以及与年龄、临床病理特征的关系。结果NLR、MLR、PLR和SII在对照组、宫颈癌前病变组和宫颈癌组中依次升高,两两比较,差异有统计学意义(P0.05)。NLR、MLR、PLR和SII随着上皮内瘤变级别的升高逐渐升高,差异有统计学意义(P0.05)。NLR、MLR、PLR和SII鉴别诊断宫颈癌和宫颈癌前病变的受试者工作特征(ROC)曲线下面积分别为0.724、0.700、0.646和0.733,最佳诊断截断值分别为2.11、0.20、120.81、662.29。SII的诊断效能最好,其灵敏度、特异度、阳性预测值、阴性预测值、符合率和Youden指数分别为55.22%、81.07%、53.62%、82.04%、73.73%和0.36。以最佳诊断截断值对宫颈癌患者进行分层后发现,NLR≥2.11或MLR≥0.20或SII≥662.29的宫颈癌患者中肿瘤浸润深度≥深肌层、FIGO分期为Ⅲ～Ⅳ期和有淋巴结转移的例数明显多于NLR2.11或MLR0.20或SII662.29患者数,PLR≥120.81患者中肿瘤分期为Ⅲ～Ⅳ期和有淋巴结转移的例数明显多于PLR120.81患者,差异有统计学意义(P0.05)。结论外周血NLR、MLR、PLR和SII可鉴别诊断宫颈癌和宫颈癌前病变,SII诊断的特异度最高。NLR、MLR和SII对肿瘤的浸润程度、FIGO分期和淋巴结转移具有一定的预测价值,PLR对FIGO分期和淋巴结转移具有一定的预测价值。     

肿瘤4项联合NLR、CEA在结肠癌中的诊断价值及与临床分期的相关性

目的探讨血清肿瘤4项[细胞角蛋白19片段(CYFRA21-1)、糖类抗原125(CA125)、糖类抗原15-3(CA15-3)、糖类抗原19-9(CA19-9)]联合中性粒细胞计数/淋巴细胞计数比率(NLR)、癌胚抗原(CEA)在结肠癌中的诊断价值,并分析血清肿瘤4项和NLR、CEA与结肠癌临床分期的相关性。方法选取进行结肠组织活检的284例患者为研究对象,根据病理诊断结果,其中良性病变203例(良性病变组),结肠癌81例(病例组)。比较两组患者CYFRA21-1、CA125、CA15-3、CA19-9、NLR、CEA的水平。采用受试者工作特征曲线(ROC曲线)分析血清肿瘤4项(CYFRA21-1、CA125、CA15-3、CA19-9)联合NLR、CEA在结肠癌诊断中的价值;采用Spearman相关分析血清肿瘤4项和NLR、CEA表达与结肠癌临床分期的相关性。结果病例组CYFRA21-1、CA125、CA15-3、CA19-9和NLR、CEA均高于良性病变组(P<0.05)。NLR、CEA联合血清肿瘤4项(CYFRA21-1、CA125、CA15-3、CA19-9)诊断结肠癌的灵敏度(89.71%)、特异度(90.08%)、准确率(92.31%)均高于各项指标单独检测。NLR(r=0.813,P=0.016)、CEA(r=0.881,P=0.013)、CYFRA21-1(r=0.853,P=0.014)、CA125(r=0.857,P=0.014)、CA15-3(r=0.851,P=0.014)、CA19-9(r=0.829,P=0.015)与临床分期呈正相关(P<0.05)。结论血清肿瘤4项和NLR、CEA与结肠癌临床分期密切相关,且血清肿瘤4项和NLR、CEA联合检测在结肠癌早期诊断中具有较高价值,值得临床推广使用。     

NLR联合MLR在非ST段抬高型心肌梗死危险分层中的预测价值

目的探讨中性粒细胞/淋巴细胞比率(NLR)联合单核细胞/淋巴细胞比率(MLR)在非ST段抬高型心肌梗死(NSTEMI)危险分层中的价值。方法纳入2013年6月至2014年12月于第三军医大学附属新桥医院行冠状动脉照影的患者288例,分为对照组(110例),稳定性心绞痛(SAP)组(66例)和NSTEMI组(112例),对NSTEMI组患者计算GRACE评分,并根据GRACE评分分为低危组和中高危组。收集所有受试者的血常规指标并计算NLR、MLR。结果 NSTEMI组的NLR、MLR明显高于对照组和SAP组(P0.01)。Spearman相关分析表明NLR、MLR与GRACE评分呈正相关(r=0.342,P0.01;r=0.398,P0.01);中高危组比低危组的NLR(P0.01)、MLR(P0.01)高。通过受试者工作曲线(ROC)分析,预测NSTEMI危险分层的ROC曲线下面积(AUC)分别是NLR的AUC为0.747(95%CI:0.656~0.837,P0.01);MLR的AUC为0.765(95%CI:0.677~0.852,P0.01);NLR联合MLR的AUC为0.778(95%CI:0.693~0.863,P0.01)。结论NLR、MLR与GRACE评分呈正相关,NLR联合MLR对NSTEMI患者的危险分层有一定的预测价值。     

精神分裂症与双相障碍患者血液学炎症标志物及脑源性神经营养因子的比较

目的 比较精神分裂症患者与双相障碍患者的中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、全血细胞计数和脑源性神经营养因子(BDNF)水平差异.方法 选取急性期住院的80例精神分裂症患者和70例双相障碍躁狂发作患者为研究对象,分别纳入精神分裂症组和双相障碍组,同时选取77名健康志愿者纳入对照组.检测3组受试者BDNF水平和全血细胞计数,记录白细胞、中性粒细胞、淋巴细胞、血小板和单核细胞数,并计算NLR、PLR和MLR.结果 双相障碍组患者PLR、MLR水平高于对照组,淋巴细胞、BDNF水平低于对照组,差异有统计学意义(P＜0.05).精神分裂症组患者白细胞、单核细胞、NLR、MLR和PLR水平高于对照组,BDNF、淋巴细胞水平低于对照组,差异有统计学意义(P＜0.05).精神分裂症组患者淋巴细胞水平低于双相障碍组,单核细胞、NLR、PLR、MLR水平高于双相障碍组,差异有统计学意义(P＜0.05),但2组BDNF水平比较,差异无统计学意义(P＞0.05).精神分裂症患者BDNF与中性粒细胞呈显著负相关(r=-0.223,P=0.047).结论 精神分裂症患者和双相障碍患者存在炎症和神经营养缺陷,其中精神分裂症患者血液学炎症标志物、BDNF水平异常更明显,且精神分裂症患者BDNF与中性粒细胞具有显著相关性.     

淋巴细胞相关炎性反应指标联合CA153在乳腺癌辅助诊断中的应用价值*

摘要:目的探讨 中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值( LMR)、血小板和淋巴细胞比值(PLR)、系统免疫炎症指标(SII)联合CA153在辅助诊断乳腺良恶性肿瘤中的临床应用价值。方法收集 2015年至2019年南通大学附属 医院就诊的440例初诊乳腺癌女性患者与544例乳腺良性疾病女性患者的外周血标本,比较两组上述各项炎症指标,并分析其与患者临床病理参数之间的关系;采用ROC曲线分析各项指标对乳腺良恶性肿瘤的鉴别诊断效能。结果乳腺 癌组NLR、LMR、PLR及SII的表达水平分别为1.79(1.43,2.31) ,5. 12( 4.08 ,6. 36), 119.70(97.42, 149.80)和367.30( 286.20 ,506.30) ,乳腺良性疾病组的表达水平分别为1.44( 1.14,1.76) ,5.21(4.24, 6.38) , 109.00( 87.02, 132.40)和300.40( 224.00, 390.10),乳腺癌组NLR、PLR及SII的表达水平均显著高于乳腺良性疾病组(P均<0.001)。此外,NLR与乳腺癌患者年龄(P=0.004)、淋巴结转移(P=0.035) .TNM分期相关(P=0.047);LMR和PLR仅与乳腺癌患者年龄相关(P=0.008 ,P=0.024);SII与乳腺癌患者年龄(P=0.000 2)和TNM分期相关(P=0.041);上述炎症指标与CA153之间均无相关性(P均>0.05)。NLR对乳腺癌鉴别诊断的ROC曲线下面积(AUCHOC)为0.716,显著高于其他指标;NLR、LMR、PLR和SII分别与CA153联合检测鉴别诊断乳腺癌的AUCROC均高于四者单独检测。结论乳腺癌患者 NLR、PLR .SII水平均显著高于乳腺良性疾病患者,NLR与CA153联合检测可提高乳腺癌辅助诊断效能。     

孕妇血清学指标监测对子痫前期的诊断价值

目的探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及血小板计数(PLT)对子痫前期(PE)的诊断价值。方法回顾性分析在医院正规建卡并于孕晚期确诊为PE的137例孕妇(实验组)以及同期正规建卡的130例健康孕妇(对照组)的临床资料,比较2组孕妇的PLR、NLR及PLT。结果实验组NLR水平高于对照组,PLR水平低于对照组,差异有统计学意义(P 0. 05);重度PE组PLT及PLR水平低于轻度PE组,NLR水平高于轻度PE组,差异均有统计学意义(P 0. 05)。Logistic回归分析显示,PLR及NLR是PE发生的独立预测因素(P 0. 001); NLR与发现血压升高至终止妊娠时间呈负相关(r=-0. 173,P=0. 043),PLT与发现血压升高至终止妊娠时间呈正相关(r=0. 241,P=0. 005)。结论监测孕期NLR、PLR及PLT水平变化可预测PE的发生和进展。     

ST段抬高型心肌梗死患者PLR和NLR与梗死相关冠状动脉血流通畅状况的关系

目的研究ST段抬高型心肌梗死(STEMI)患者血小板淋巴细胞比率(PLR)和中性粒细胞淋巴细胞比率(NLR)与梗死相关动脉(IRA)血流状况的关系。方法选取2013年1月至2016年8月我院心内科收治的STEMI患者214例,根据血常规数据计算血小板淋巴细胞比率,根据冠脉造影检查的梗死相关动脉心肌梗死溶栓治疗(TIMI)血流分级,将TIMI 0-2级的患者定为IRA梗阻组,TIMI 3级的患者定为IRA通畅组。统计学分析两组患者之间临床病理学资料之间的关系。结果IRA梗阻组患者PLR显著高于IRA通畅组(143.8±49.2 vs. 93.7±51.6,P0.0001); IRA梗阻组患者血糖及cTnI水平、中性粒细胞计数、中性粒细胞淋巴细胞比率(NLR)和PLR均高于IRA通畅组患者(P0.05),而淋巴细胞计数低于IRA通畅组患者(P0.05)。多因素逻辑回归分析显示入院时PLR [Odds Ratio (OR):0.977, 95%confidence interval (95%CI):0.955～1.012, P=0.007]和NLR(OR:0.906, 95%CI:0.879～0.983, P=0.027)是IRA血流梗阻的独立预测因子。结论 STEMI患者入院高PLR值和高NLR值是直接经皮冠状动脉介入治疗术前梗死相关动脉血流梗阻的独立预测因子。     

NLR和PLR与婴幼儿轮状病毒性肠炎相关性研究

目的通过分析和比较轮状病毒感染婴幼儿与健康婴幼儿的中性粒细胞/淋巴细胞比率(NLR)和血小板/淋巴细胞比率(PLR),探讨NLR和PLR对婴幼儿轮状病毒性肠炎的指示情况。方法选取轮状病毒检测阳性的患儿手指血标本53例(阳性组),健康体检幼儿手指血标本68例(健康组),使用希森美康xs1000i全自动血细胞分析仪对2组标本进行血常规检测,使用SPSS19.0统计软件对2组的NLR和PLR进行分析。结果比较2组检验结果发现,2组的NLR和PLR比较,阳性组比率高于健康组,差异有统计学意义(P0.05)。结论婴儿感染轮状病毒后,严重腹泻和粪便隐血阳性可导致患儿NLR和PLR升高,提示患儿处于炎性应急状态;随着比值下降,可提示患儿疾病好转。     

Origin, structure, and activity in vitro and in vivo of dalbavancin

Dalbavancin is a novel semi-synthetic lipoglycopeptide that was designed to improve upon the natural glycopeptides currently available, vancomycin and teicoplanin. Chemical modification of natural glycopeptides has produced compounds with more potent antimicrobial activity and longer t(1/2), while maintaining an excellent safety profile. Dalbavancin, prepared from a teicoplanin-like glycopeptide, has better activity, in vitro and in animal infection models, than vancomycin and teicoplanin. In particular, dalbavancin has excellent activity against staphylococci, including coagulase-negatives. A unique feature of dalbavancin is its pharmacokinetics, characterized by a long elimination t(1/2) in humans which makes a once-weekly dosing regimen feasible. Dalbavancin recently completed Phase 3 clinical trials in skin and skin structure infection.     

Absorption, distribution, metabolic fate, and elimination of pefloxacin mesylate in mice, rats, dogs, monkeys, and humans

Pefloxacin mesylate is well absorbed by the oral route. The antimicrobial activity in dog, cynomolgus monkey, and human plasma was essentially due to unchanged drug which respectively accounted for 64, 94, and 84% of the total activity (ratios derived from relative area under the curve [AUC] values). Half-lives ranged from 1.9 h in mice to 8.6 h in humans. Protein binding was weak, about 20% in plasma. Except in brain, concentrations in most of the organs and tissues tested in rats and dogs were higher than the plasma levels. Microbiological activity in urine was mainly due to pefloxacin and norfloxacin, the N-desmethyl metabolite. The norfloxacin/pefloxacin ratios were 0 in mice, ca. 1 in rats and dogs, 1.6 in cynomolgus monkeys, and 2.3 in humans. The principal urinary compounds were unchanged drug in mice, pefloxacin glucuronide and pefloxacin N-oxide in rats and dogs, norfloxacin and pefloxacin in monkeys, and pefloxacin N-oxide and norfloxacin in humans. The urinary recovery of identified metabolites was 29.5% of the dose in mice, 37.8% in rats, 36.3% in dogs, 26.5% in monkeys, and 58.9% in humans. Biliary excretion occurred and was extensive in rats and dogs, mainly as a glucuronide conjugate of the drug. In rat and human bile, the main active compound was unchanged pefloxacin.     

Comparison of Tobramycin, Gentamicin, Colistin, and Carbenicillin in Pseudomonas Sepsis in Monkeys

Intravenous inoculation of 3.4 x 10(10) to 7.4 x 10(10)Pseudomonas aeruginosa organisms into rhesus monkeys 4 days after intravenous or intratracheal inoculation of 2.0 to 2.5 mg of vincristine sulfate resulted in fatal sepsis in eight of nine monkeys. After intramuscular administration, in two equal doses, of 5 mg of tobramycin, gentamicin, and colistin per kg per day beginning 16 hr after challenge, 4 of 11, 4 of 11, and 3 of 10 monkeys died, respectively. Administration of daily doses of 100 to 400 mg of carbenicillin per kg was followed by death in 5 of 12. Duration of illness in the surviving monkeys in each therapy group was similar. Under the conditions of this study, prior administration of vincristine sulfate resulted in a decrease in leukocytes and enhanced susceptibility to Pseudomonas infection. Using this model for studies of comparative efficacy of antibiotics, we observed comparable results after treatment with tobramycin, gentamicin, colistin, and carbenicillin.     

Use of Primary Health Care in Spili,Crete, and in Dalby,Sweden

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC).

In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%), but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%).

There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.     

Antimicrosporidial activities of fumagillin, TNP-470, ovalicin, and ovalicin derivatives in vitro and in vivo

Therapies for microsporidiosis in humans are limited, and fumagillin, which appears to be the most broadly effective antimicrosporidial drug, is considered to be moderately toxic. The purpose of this study was to apply an in vitro drug screening assay for Encephalitozoon intestinalis and Vittaforma corneae and an in vivo athymic mouse model of V. corneae infection to assess the efficacy of TNP-470 (a semisynthetic analogue of fumagillin), ovalicin, and eight ovalicin derivatives. TNP-470, ovalicin, and three of the ovalicin derivatives inhibited both E. intestinalis and V. corneae replication by more than 70% in vitro. Another three of the ovalicin derivatives inhibited one of the two microsporidian species by more than 70%. None of the treated athymic mice survived the V. corneae infection, but they did survive statistically significantly longer than the untreated controls after daily treatment with fumagillin administered at 5, 10, and 20 mg/kg of body weight subcutaneously (s.c.), TNP-470 administered at 20 mg/kg intraperitoneally (i.p.), or ovalicin administered at 5 mg/kg s.c. Of two ovalicin derivatives that were assessed in vivo, NSC 9665 given at 10 mg/kg i.p. daily also statistically significantly prolonged survival of the mice. No lesions associated with drug toxicity were observed in the kidneys or livers of uninfected mice treated with these drugs at the highest dose of 20 mg/kg daily. These results thus support continued studies to identify more effective fumagillin-related drugs for treating microsporidiosis.     

Levels of Carbenicillin, Ticarcillin, Cephalothin, Cefazolin, Cefamandole, Gentamicin, Tobramycin, and Amikacin in Human Serum and Interstitial Fluid

The ability of eight antibiotics (carbenicillin, ticarcillin, cefamandole, cephalothin, cefazolin, gentamicin, tobramycin, and amikacin) to enter human interstitial fluid was evaluated by the skin window technique. All of the antibiotics tested, except cefazolin, which has the highest percentage of protein binding, diffused into the interstitial fluid quite well. This study confirms our previous observation on the effect of high-percentage protein binding on diffusion of a drug into the minimally inflamed extravascular space.