2型糖尿病患者血管并发症与ET、NO、CRP的关系及贝那普利的治疗效果

[目的]探讨2型糖尿病患者血管并发症与血清内皮素(ET)、一氧化氮(NO)和C反应蛋白(CRP)的相关性及贝那普利干预治疗对其的影响.[方法]130例2型糖尿病患者分为无血管并发症组(A组66例)和有血管并发症组(B组64例),以55例正常人为对照(C组),放射免疫分析测定(RIA)、酶联免疫吸附测定(ELISA)及免疫比浊法检测血清ET、NO、CRP水平和贝那普利干预治疗12周后各指标的变化.[结果]2型糖尿病患者血清ET和CRP显著高于正常对照组(P＜0.05～0.01),而NO显著低于正常对照组(P＜0.05～0.01).伴血管并发症患者较单纯2型糖尿病患者血清ET和CRP显著增高(P＜0.05),而NO明显降低(P＜0.05).2型糖尿病患者经贝那普利干预治疗12周后,血清ET和CRP水平均显著下降(P＜0.05),NO水平显著升高(P＜0.05).[结论]2型糖尿病患者存在着血管内皮功能受损和动脉内膜的慢性炎症反应,贝那普利干预治疗可以改善2型糖尿病慢性并发症血管病变的发生与发展.     

社区护理干预对缺血性脑卒中病人血脂水平和卒中复发的影响

[目的]探讨社区护理干预对伴高脂血症的缺血性脑卒中病人血脂水平的影响.[方法]将社区65例伴高脂血症的缺血性脑卒中病人随机分为干预组和对照组,干预组病人由经过培训的社区护士结合病人病情,定期给予健康指导,如饮食指导、调整药物;对照组采用传统的出院指导.于干预前及干预3个月、6个月和12个月时评价干预效果.[结果]干预组病人总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)水平明显下降,与对照组比较均有统计学意义(P<0.001);高密度脂蛋白胆固醇(HDL-C)水平升高,在6个月和12个月时与对照组比较差异有统计学意义(P<0.05).且干预组脑卒中复发率明显低于对照组(P<0.05).[结论]社区护理干预能有效降低伴高脂血症的缺血性脑卒中病人的血脂水平,减少脑卒中的复发.     

连续护理干预对脑卒中偏瘫病人健康指导依从性的影响

[目的]探讨连续护理对脑卒中偏瘫病人健康指导依从性的影响.[方法]采用随机分组的方法将2007年6月-2007年12月在天津市环湖医院神经内科住院的85例脑卒中偏瘫病人分为干预组和对照组,两组病人均给予常规护理,在常规护理的基础上干预组实施连续护理干预,分别在干预前和干预后3个月收集脑卒中偏瘫病人健康指导依从性资料.[结果]干预组病人对脑卒中相关危险因素、康复护理、饮食和药物知识的理解水平显著增高(P<0.001);饮食和药物依从性显著高于对照组(P<0.05).[结论]连续护理干预能够有效地提高脑卒中偏瘫病人对脑卒中相关知识的理解和依从性水平.     

缺血性脑卒中患者hs-CRP和LDL-C的变化及相关性分析

目的 观察缺血性脑卒中患者血清超敏C-反应蛋白与低密度脂蛋白水平及相关性,探讨两指标在缺血性脑卒中发生、发展中的作用及之间的相互关系.方法 分别用免疫比浊法和ELISA法测定54例缺血性脑卒中患者及38名健康对照组血清hs-CRP、LDL-C水平,进行对照比较及相关性分析.结果 缺血性脑卒中血清hs-CRP、LDL-C 水平分别高于正常对照组(均P<0.05),且缺血性脑卒中组hs-CRP与LDL-L呈正相关(r=0.46437,P<0.05).结论 脂质过氧化和炎症反应可能参与缺血性脑卒中的发生、发展,联合检测LDL-C和hs-CRP的水平,对缺血性脑卒中的诊断和治疗有指导意义.     

血液透析对终末期肾脏病患者脂蛋白相关磷脂酶A2的影响

目的 通过观察终末期肾脏病(end-stage renal disease,ESRD)患者血液透析前、后脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,LpPLA2)的活性变化及血清C反应蛋白(C-reactive protein,CRP)的浓度水平,探讨血液透析对ESRD患者此炎症指标表达的影响.方法 收集20例ESRD进行血液透析患者透析前、透析中2 h及透析完毕后外周血8 ml,年龄、性别相匹配的健康体检者20例作为正常对照组.利用免疫比浊法检测血清中CRP的浓度水平;酶联免疫吸附法测定LpPLA 2的活性变化.结果 在透析前,ESRD患者血清CRP的浓度水平均较正常对照组高( P＜0.01);而LpPLA2的活性在ESRD患者和正常对照组之间差异无统计学意义( P＞0.05).透析完毕后,血清CRP浓度水平与透析前、透析中差异均无统计学意义(均P＞0.05);而LpPLA2 的活性在透析中及透析完毕后均较透析前明显提高(P ＜0.01).结论 血液透析对ESRD患者会产生微炎症状态,此炎症反应状态或许部分是通过提高LpPLA 2的活性来介导的.     

贝那普利对冠心病心绞痛患者炎症因子的影响

目的:观察贝那普利对冠心病心绞痛患者炎症因子的影响.方法:将60例患者随机分为治疗组(30例)与对照组(30例).治疗组给予西医常规治疗的基础上加服盐酸贝那普利片;对照组给予西医常规治疗.观察两组患者治疗前后心绞痛疗效、心电图疗效及炎症因子TNF-α和IL-6的水平.结果:治疗后治疗组心绞痛疗效、心电图疗效均优于对照组,差异有统计学意义(P<0.05);治疗组TNF-α和IL-6水平均显著降低,与对照组比较,差异有统计学意义(P<0.05).结论:贝那普利能降低冠心病心绞痛患者炎症因子TNF-α和IL-6的水平,抑制炎症反应.     

消栓肠溶胶囊联合丁苯酞治疗老年急性缺血性脑卒中患者临床疗效观察

目的 探讨消栓肠溶胶囊联合丁苯酞治疗老年急性缺血性脑卒中患者的临床疗效.方法 选取自2016年1月至2018年1月收治的180例老年(年龄≥60岁)急性缺血性脑卒中患者为研究对象,采用随机数字表法分为A组(n=90)与B组(n=90).A组患者给予丁苯酞治疗,B组患者给予消栓肠溶胶囊联合丁苯酞治疗.记录并比较两组患者治疗前、后脑血流灌注指标[平均流速(TMV)、收缩期峰值流速(PSV)、阻力指数(RI)]、炎症因子[血清C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、同型半胱氨酸酶(Hcy)]水平、临床疗效及不良反应发生情况.结果 B组患者治疗有效率为86.7％(78/90),显著高于A组的68.9％(62/90),差异有统计学意义(P<0.05).治疗前,两组患者PSV、TMV、RI比较,差异无统计学意义(P>0.05).治疗后,两组患者TMV、PSV高于治疗前,且B组高于A组;两组患者RI低于治疗前,且B组低于A组,差异均有统计学意义(P<0.05).治疗前,两组患者CRP、TNF-α、Hcy水平比较,差异无统计学意义(P>0.05).治疗后,两组患者CRP、TNF-α、Hcy水平均低于治疗前,且B组低于A组,差异均有统计学意义(P<0.05).两组患者治疗期间均未出现明显不良反应.结论 消栓肠溶胶囊联合丁苯酞可明显改善老年急性缺血性脑卒中患者临床症状,提高脑血流灌注状况,临床疗效较好.     

血清球蛋白对神经介入术后急性缺血性脑卒中患者炎症因子和神经激素的影响

目的 探讨血清球蛋白水平对神经介入术后急性缺血性脑卒中患者炎症因子和神经激素水平的影响.方法 选取2018年1月至2020年12月在该院就诊的急性缺血性脑卒中患者236例.按治疗方案的不同分为对照组(120例)和观察组(116例).根据术后7 d是否出血将观察组进一步分为出血组(23例)和未出血组(93例),出血组以治疗后γ球蛋白占比18.8％为临界值分为低值组(12例)和高值组(11例).比较各组治疗前后血清蛋白水平,以及炎症因子、神经激素水平等.结果 治疗后,出血组γ球蛋白、α1球蛋白和α2球蛋白明显高于对照组和未出血组,差异有统计学意义(P<0.05);高值组白细胞介素(IL)-2、IL-6、γ干扰素(INF-γ)、丙二醛(MDA)和活性氧(ROS)水平明显高于低值组和未出血组,高值组超氧化物歧化酶(SOD)水平低于低值组,差异有统计学意义(P<0.05);高值组血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)和心钠素(ANP)水平明显高于低值组和未出血组,差异有统计学意义(P<0.05).结论 神经介入术后出血急性缺血性脑卒中患者血清球蛋白水平升高,且会影响炎症因子水平,进而可能影响患者的病情转归.     

C反应蛋白与缺血性脑卒中的相关性研究

目的:探讨C反应蛋白(CRP)是否是缺血性脑卒中的始动因子之一及其与急性缺血性脑卒中患者病情的严重程度、预后、复发率、死亡率的关系.方法:采用胶体金双抗体夹心法测定60例急性缺血性脑卒中患者发病后6 h内及1、4周CRP的水平.结果:大面积组发病后6 h内、1、4周CRP水平高于中等、小面积组(P＜0.01);中、重型组发病后4周CRP水平均高于轻型组(P均＜0.01);复发、死亡组CRP平均值均高于预后良好组(P均＜0.01).结论:CRP是脑梗死的始动因子之一,并可了解缺血性脑卒中病情的严重程度,是预测急性缺血性脑卒中预后、复发率、死亡率的一个重要指标.     

血清C反应蛋白水平与脑卒中的病情及预后的关系

目的:探讨急性脑卒中患者发病早期血液中C反应蛋白(CRP)含量高低与病情严重程度及预后的影响.方法:对155例患者血清CRP含量进行测定.其中脑梗死41例(脑梗死组),脑出血40例(脑出血组),腔隙性梗死33例(脑隙性梗死组)及非脑卒中41例(对照组).结果:(1)脑卒中患者CRP阳性率明显较对照组升高(P<0.01);其中脑出血组较脑梗死组CRP水平高(P<0.05),脑梗死组较腔隙性梗死组水平高(P<0.05),而腔隙性梗死组与对照组比较无明显升高(P>0.05).结论:急性脑卒中患者早期血清CRP升高提示病情严重且预后不良.     

血液透析治疗对终末期肾病患者血清降钙素原的影响和意义

【目的】探讨终末期肾病患者进行血液透析后血清降钙素原（PcT）和C-反应蛋白（CRP）的变化。【方法]43例无全身感染的终末期肾病患者,分别在透析前和4h后测量血清PCT和cRP,并与40例健康志愿者进行比较。【结果】终末期肾病患者透析前PCT（2．13±0．7ng／mL）和CRP（14．3±2．9mg／L）,均高于健康对照组（PCT：0．18±0．03ng／mL,CRP：4．5±2．2mg／L）且差异有显著性（P〈0．01）。且在透析前,PCT与CRP呈弱的正相关。而透析4h后,PCT则显著降低,CRP无明显变化,且PCT与CRP无相关性。【结论】在终末期肾病不存在感染征象的患者中,其PCT及CRP水平显著增高,说明终末期肾病患者中存在慢性系统性炎症。虽然透析可降低血清PCT水平,但其对CRP则无影响。     

脑梗死患者血清C-反应蛋白水平与病情及预后的关系

目的 研究脑梗死患者血清C-反应蛋白（CRP）水平与病情的严重性及预后的量化关系。方法 对病程在2周以内的90例脑梗死患者在入院时进行血清CRP水平的测定,应用美国国立卫生研究院卒中量表及Barthel指数记分对入选患者在入院时及3个月后的神经功能缺损程度进行评分。结果 血清CRP水平与当时及病后3个月神经功能缺损的严重程度显著相关（P〈0．01）,且这种相关性存在着量化的关系。结论 根据脑梗死患者病后2周内的CRP水平可以对病情的严重性及预后进行量化的判定。     

急性心肌梗死与缺血性脑卒中发病危险因素分析

[目的]探讨急性心肌梗死(AMI)与缺血性脑卒中危险因素的异同.[方法]分析137例AMI患者和132例急性缺血性脑卒中患者的疾病史、家族疾病史、生活方式因素以及入院后血糖、血脂、血纤维蛋白原等生化检测资料.[结果]AMI患者的吸烟率、吸烟>20支/日比例、高血压家族史、阳性心血管病家族史、既往高脂血症患病率均显著高于...     

血液透析对尿毒症患者血清中炎症及氧化应激指标的影响

目的：探讨尿毒症患者血液透析前后C反应蛋白（cRP）、白细胞介素-6（IL-6）、脂质过氧化物丙二醛（MDA）、同型半胱氨酸（Hcy）等指标的水平变化及相互之间的关系。方法：选取26例透析时间在3个月以上的尿毒症患者为血透组，24例健康者为对照组，分别抽血检查CRP、IL-6、MDA、Hcy。结果：尿毒症患者透析前CRP、IL-6、MDA、Hcy水平明显升高，与对照组相比差别显著；血液透析治疗前后上述指标均有明显改变，血清CRP水平较透前升高，IL-6、MDA、Hcy水平明显下降。结论：尿毒症患者体内炎症及氧化应激水平增高，血液透析能够提高终末期肾衰患者血清中CRP水平，同时血液透析能够清除一定的IL-6、MDA及Hcy。     

Biomarkers for the prediction of mortality and morbidity in patients with renal replacement therapy

The mortality of end-stage renal disease (ESRD) patients on dialysis remains high despite great improvement of dialysis technologies in the past decades. These patients die due to infectious diseases (mainly sepsis), cardiovascular diseases such as myocardial infarction, heart failure, stroke, and, in particular, sudden cardiac death. End stage renal disease is a complex condition, where the failure of kidney function is accompanied by numerous metabolic changes affecting almost all organ systems of the human body. Many of the biomarker characteristics of the individually affected organ systems have been associated with adverse outcomes. These biomarkers are different in patients with ESRD compared to the general population in the prediction of morbidity and mortality. Biomarker research in this field should aim to identify patients at risk for the different disease entities. Traditional biomarkers such as CRP, BNP, and troponins as well as new biomarkers such as fetuin, CD154, and relaxin were analyzed in patients on dialysis. We will include observational as well as prospective clinical trials in this review. Furthermore, we will also discuss proteomics biomarker studies. The article assess the potential diagnostic value of different biomarkers in daily clinical practice as well as their usefulness for clinical drug development in end stage renal disease patients.     

Discriminative Capacity of Biomarkers for Acute Stroke in the Emergency Department

Background: Acute ischemic stroke remains largely a clinical diagnosis. Objective: To assess the potential of several biomarkers to distinguish acute ischemic stroke from mimics in the emergency department (ED). Methods: In this prospective study, 63 patients with suspected acute stroke were enrolled. Blood samples were collected at ED presentation and assayed for B-type natriuretic peptide, C-reactive protein (CRP), matrix metalloproteinase 9 (MMP-9), D-dimer, and protein S100B. Final diagnosis of stroke was rendered by blinded independent stroke experts after review of all clinical, imaging, and conventional laboratory data during admission. Logistic regression and bootstrapping models were used to evaluate the association between biomarker values and acute stroke. Results: Thirty-four patients had a final diagnosis of stroke and 29 with mimics. The initial ED values of CRP, MMP-9, and S100B (C-indices of 0.808, 0.811, and 0.719, respectively) and the National Institutes of Health Stroke Scale (NIHSS) (C-index 0.887) predicted acute cerebral ischemia. CRP levels added discriminative value over clinical variables alone in the diagnosis of stroke. When the levels of CRP were added to the NIHSS, the combination was highly predictive of stroke (bootstrap mean C-index 0.951, 90% Confidence Interval 0.903–0.991, likelihood test p = 0.004). Conclusions: Biomarker testing with CRP and potentially MMP-9 and S100B, may add valuable and time-sensitive diagnostic information in the early evaluation of patients with suspected stroke in the ED. Future prospective evaluations are necessary to validate the diagnostic capability of these biomarkers for acute ischemic stroke in the ED before they should be considered for use in clinical practice.     

C-反应蛋白与脑梗死TOAST亚型梗死灶大小神经功能损害程度的关系

目的 观察急性脑梗死（ACI）患者发病早期血清C-反应蛋白（CRP）的水平变化及其与TOAST亚型、梗死灶大小、神经功能损害程度的关系。方法 采用免疫比浊法对136例ACI患者发病72h内的血清CRP水平进行测定，按照TOAST标准对患者进行病因分型，记录梗死灶大小，采用NIHSS评分及Barthel指数记分法进行临床神经功能损害程度评价，并与对照组比较分析。结果 ACI患者血清CRP水平与对照组比较显著升高（P〈0．01）。心源性栓塞脑梗死CRP水平最高，其余依次为大动脉粥样硬化脑梗死、其他明确病因性脑梗死、不明原因性脑梗死，而小动脉闭塞脑梗死最低。血清CRP水平升高程度与梗死灶大小及神经功能损害程度密切相关。CRP与NIHSS评分呈正相关（rs=0．53，P〈0．01），与Barthel指数呈负相关（rs=-0．41，P〈0．01）。结论 血清CRP水平在TOAST各型中的不同，说明不同的ACI亚型在病因及病理生理学机制方面存在着一定的差异。CRP测定对ACI病因学分型有一定的参考价值，CRP可作为ACI患者病情评估的重要指标。     

Arginine, citrulline, and nitric oxide metabolism in end-stage renal disease patients

The kidneys are thought to be a major site of net de novo arginine synthesis, but the quantitative status of arginine metabolism and its substrate precursor relationship to nitric oxide (NO) synthesis in end stage renal disease (ESRD) patients have not been characterized. We have investigated kinetic aspects of whole body arginine metabolism in six patients with ESRD. They received two pre- and two post-hemodialysis intravenous tracer infusion studies with L-[guanidino-(15)N(2)]arginine and L-[(13)C]leucine during the first study, and L-[5-(13)C]arginine and L-[5-(13)C-ureido,5,5, (2)H(2)]citrulline during the second study. Arginine homeostasis in ESRD patients was found to be associated with a lower rate of arginine oxidation, and despite the decrease in renal function, the rate of de novo arginine synthesis appeared to be preserved. Plasma citrulline concentrations and flux were also elevated in these subjects compared with healthy adults. The rate of whole body NO synthesis was increased in the ESRD patients, but apparently not different pre- and post-hemodialysis therapy. The anatomic site(s) responsible for the maintenance of net de novo arginine synthesis and for the elevated NO synthesis and its pathophysiological importance in ESRD remain to be established.     

血浆游离脂肪酸与缺血性心源性卒中的关系

【目的】探讨血浆游离脂肪酸（free fatty acids,FFA）与缺血性卒中亚型之间的关系【方法】收集湖南省人民医院2010年7月至2013年12月间收治的715例急性缺血性卒中患者入院时的一般临床资料,回顾性分析患者 FFA浓度与缺血性卒中各个亚型之间的关系。【结果】715例患者中,血清 FFA浓度在心源性（cardioembolic ,CE）卒中（1194．68±806．45 Eq/L）和非CE卒中组（793．73±611．87 Eq/L）之间相比较差异有显著性（P＜0．001）。所有合并心房颤动（AF）的卒中患者 FFA浓度（1297．48±818．48 Eq/L）明显高于无AF卒中患者（776．50±596．00 Eq/L）,且两组相比较差异具有显著性（P＜0．01）;合并 AF 的 CE卒中患者的FFA浓度（1311．53±830．61 Eq/L）明显高于合并AF的非CE卒中患者（894．77±663．20 Eq/L）,且差异亦具有显著性（P＜0．01）。【结论】急性缺血性卒中患者空腹血浆 FFA浓度与 CE卒中相关,FFA浓度升高,合并 AF可作为CE卒中的预测指标。     

Polymorphism in the human C-reactive protein (CRP) gene, serum concentrations of CRP, and the difference between intracranial and extracranial atherosclerosis

BACKGROUND: C-reactive protein, a proinflammatory factor, is involved in the development of atherosclerosis. The CRP 1059G>C polymorphism appeared to be a susceptive marker for atherosclerosis. We investigated the relationship of the distribution of cerebral atherosclerosis with triggered serum CRP concentrations following acute ischemic stroke/transient ischemic attack (IS/TIA) and CRP 1059G>C polymorphism. METHODS: We recruited 222 IS/TIA patients (122 with only intracranial atherosclerotic lesions and 100 with isolated extracranial atherosclerotic lesions) and 227 controls. Intra- and extracranial atherosclerotic lesions were determined by digital subtraction angiography. Serum CRP concentrations were measured by particle-enhanced immunonephelometry assay. CRP 1059G>C genotypes were obtained through PCR amplification and restriction enzyme digestion. RESULTS: CRP concentrations were significantly higher in intra- and extracranial groups than in controls. No significant difference was found in CRP concentrations between intra- and extracranial groups. The CRP 1059G>C single-nucleotide polymorphism did not influence CRP serum concentrations. CRP genotype and allele frequencies did not differ significantly between patients and controls. However, the frequencies of GC genotype and C allele were significantly higher in extracranial group than that in intracranial group. The GC individuals showed a higher risk of extracranial atherosclerosis compared with GG individuals (OR 3.41; 95%CI, 1.124-10.347; P=0.030). CONCLUSIONS: Serum CRP is associated with cerebral atherosclerotic disease. CRP 1059G>C polymorphism is one possible genetic determinant for the difference between intra- and extracranial atherosclerosis.