多种炎性因子在脓毒血症中的诊断和预后价值比较

目的探讨多种炎性因子在脓毒血症中的诊断和预后评估价值。方法回顾性分析235例脓毒血症患者和251例非脓毒症患者的白细胞计数(WBC)、中性粒细胞比率(NEU%)、C反应蛋白(CRP)水平、降钙素原(PCT)水平、脑钠肽(BNP)水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,采用ROC曲线、方差分析、Jonckheere-Terpstra检验、U检验进行分析。结果 ROC曲线分析结果显示,PCT、CRP和BNP诊断脓毒血症的的AUC分别为0.792、0.638、0.626,其诊断脓毒血症的灵敏度和特异度分别为82.90%和52.30%、80.50%和31.20%、86.60%和35.20%;方差分析显示PCT、CRP、BNP和APACHEⅡ评分水平在感染性休克组、严重脓毒血症组、一般脓毒血症组与非脓毒血症组之间的差异有统计学意义(P 0.01); Jonckheere-Terpstra Test分析显示PCT、CRP和BNP在四组间有量效关系,PCT的J-T值最大,为9.658,CRP和BNP分别为3.734、3.328,提示PCT评估感染严重程度的能力最强。脓毒血症死亡组和存活组对比分析结果显示,年龄和APACHEⅡ评分在两组间差异有统计学意义(P 0.05),但性别、WBC、NEU%、CRP、PCT和BNP水平在两组间差异无统计学意义(P 0.05)。结论 PCT、CRP和BNP水平有助于早期脓毒血症诊断并对其严重程度进行评价,其中PCT的诊断和疾病分程价值最优,年龄和APACHEⅡ评分是脓毒血症患者发生死亡的影响因素。     

降钙素原、C-反应蛋白检测在感染性疾病诊断和病情评估中的应用价值

目的探讨血清降钙素原(PCT)与C-反应蛋白(CRP)检测在感染性疾病诊断和病情评估中的临床应用价值。方法选取65例感染性疾病患者,根据感染类型分为细菌感染组(细菌组,45例)和病毒感染组(病毒组,20例),检测比较两组患者CRP、PCT水平。结果细菌组患者的CRP、PCT水平均高于病毒组,差异有统计学意义(P0.05);细菌组患者CRP与PCT呈正相关(r=0.754,P0.05),病毒组患者CRP与PCT无相关性;细菌组中败血症患者的CRP、PCT血清水平高于局部细菌感染患者,差异有统计学意义(P0.05)。结论 CRP、PCT可以作为细菌性感染和病毒感染鉴别诊断的辅助指标,同时可用于评估患者病情的严重程度。     

联合检测C反应蛋白和降钙素原在急性胰腺炎中的应用价值分析

[目的]探讨联合检测血清中C反应蛋白(CRP)和降钙素原(PCT)在急性胰腺炎(AP)中的临床诊断价值。[方法]选择我院2012年2月~2015年2月符合入选标准的101例AP患者作为研究对象。根据病情将患者分为感染组25例和非感染组76例。动态观察患者第1、3、7、14天血清中CRP和PCT的变化趋势,并统计CRP和PCT联合检测及单独检测对AP诊断的敏感性和特异性。[结果]感染组患者第1、3、7、14天的血清中CRP和PCT水平均明显高于非感染组患者,差异有统计学意义(P0.05);联合检测CRP和PCT对AP早期诊断的敏感性为90.1%,特异性为90.8%,比CRP、PCT单独检测的敏感性(80.5%、77.9%)和特异性(84.9%、83.4%)明显增高(P0.05)。[结论]联合检测血清中CRP和PCT的变化有助于早期诊断AP并发的感染,为其诊断、分类以及早期治疗提供有效的依据。     

血清PCT、CRP联合检测对老年肺炎病情诊疗及预后的价值探究

目的观察并探讨联合检测血清降钙素原(Procalcitonin,PCT)和C反应蛋白(C-reactive protein,CRP)对老年肺炎患者诊断及预后评价探究。方法选择自2013年2月至2015年4月在本院接受诊断和治疗的老年肺炎患者56例,作为观察组;选取同期入院并排除细菌感染的健康老年人56例,作为对照组。利用化学发光法检测两组的PCT和CRP水平。观察组患者接受治疗后1周,根据病情好转分为改善组32例和未改善组24例,比较两组PCT、CRP水平。结果观察组PCT、CRP水平分别为(2.62±0.34)ng/ml和(34.24±4.82)mg/ml,对照组为(0.05±0.01)ng/ml和(4.71±0.18)mg/ml,观察组PCT、CRP水平明显高于对照组(P0.05);CRP诊断老年肺炎的敏感性和特异性分别为96.4%(54/56)和67.8%(38/56),PCT的敏感性和特异性分别为92.9%(52/56)和76.8%(43/56),而两者联合的敏感性和特异性分别为94.6%(53/56)和89.2%(50/56),联合诊断特异性明显更高(P0.05);改善组与未改善组相比,PCT、CRP水平及急性生理与慢性健康评分(APACHE II)明显更低(P0.05)。结论老年肺炎患者的PCT和CRP水平均显著上升,PCT和CRP可作为老年肺炎诊断的灵敏指标,对于PCT和CRP的动态监测有助于老年肺炎预后判断。     

血清降钙素原及C反应蛋白在老年慢性心力衰竭合并肺部感染患者中的应用价值

目的探讨血清降钙素原(PCT)及C反应蛋白(CRP)在老年慢性心力衰竭(心衰)合并肺部感染中的应用价值。方法入选我院住院患者126例,分为心衰合并肺部感染组(观察组)30例、心衰组39例和肺部感染组57例,健康体检者23例为对照组。检测各组血清PCT、CRP水平;采用ROC曲线分析血清PCT、CRP及联合检测的诊断价值。结果各组PCT及CRP水平比较,差异有统计学意义(P0.01)。肺部感染组、观察组、心衰组及对照组PCT及CRP水平呈明显降低趋势(P0.05)。心衰组心功能(NYHA)Ⅱ级、Ⅲ级、Ⅳ级患者PCT水平分别为(0.03±0.01)μg/L、(0.06±0.04)μg/L、(0.11±0.07)μg/L,差异有统计学意义(F=6.61,P0.01)。心衰组心功能分级与PCT呈正相关(rs=0.61,P0.05)。ROC曲线显示,血清PCT、CRP水平检测截点值分别为0.13μg/L、12.15mg/L,PCT+CRP联合检测的ROC曲线下面积明显高于PCT、CRP[0.864(95%CI:0.721～0.927)vs 0.813(95%CI:0.728～0.932)和0.754(95%CI:0.635～0.873),P0.05]。结论心衰患者血清PCT明显升高,且能反映心功能;血清PCT、CRP水平对心衰合并肺部感染具有良好的诊断价值,联合检测更优。     

血清CRP、PCT及ANA对白血病化疗所致败血症的诊断效能分析

目的:探究血清C反应蛋白(CRP)、降钙素原(PCT)和抗核抗体(ANA)检测对白血病化疗所致败血症的诊断效能。方法:选取2019年2月—2020年2月接受化疗的白血病患者124例,根据是否并发败血症将患者分为感染组(并发败血症)41例和非感染组(未并发败血症)83例。比较2组患者不同时间点的血清CRP、PCT水平和ANA阳性率,采用受试者工作特征曲线(ROC)分析CRP、PCT、ANA及联合检测对白血病化疗所致败血症的诊断效能。结果:化疗时,2组患者的血清CRP、PCT水平和ANA阳性率比较差异无统计学意义(P0.05);感染组患者感染后和感染控制后的血清CRP、PCT水平和ANA阳性率均高于化疗时(P0.05);非感染组患者化疗时的血清CRP、PCT水平和ANA阳性率均明显低于感染组感染后和感染控制后(P0.05);ROC曲线分析结果显示,CRP、PCT、ANA及联合检测的曲线下面积(AUC)分别为0.786、0.780、0.797和0.874,对白血病化疗所致败血症的诊断均差异有统计学意义(P0.05),且联合检测的AUC大于各单项检测(P0.05),联合检测的敏感度和特异度均高于单独检测。结论:白血病化疗后并发败血症患者,其血清CRP、PCT水平和ANA阳性率均高于非感染患者,血清CRP、PCT及ANA对白血病化疗所致败血症有良好的诊断效能,三者联合检测可进一步提高诊断敏感性和特异性。     

联合PCT、D-D、CRP及IL-6检测在急性胰腺炎早期的临床价值

目的探讨急性胰腺炎(acute pancreatitis,AP)患者降钙素原(procalcitonin,PCT)、D-二聚体(D-dimer,D-D)、C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)与病情严重程度的相关性,评价联合四项实验室指标早期评估AP病情的临床价值。方法回顾性分析2015年3月至2017年5月徐州医科大学附属医院收治的146例AP患者的临床资料。依据病情严重程度分为轻症急性胰腺炎组(MAP) 85例、中度重症急性胰腺炎组(MSAP) 34例、重症急性胰腺炎组(SAP) 27例,统计入院24 h PCT、D-D、CRP、IL-6水平。采用Spearman相关分析病情严重程度与PCT、D-D、CRP、IL-6的相关性。采用曲线下面积(area under the receiver operating characteristic curve,AUC)评价PCT、D-D、CRP、IL-6及联合四项实验室指标对SAP的预测价值。结果入院24 h内SAP患者PCT、D-D、CRP和IL-6水平显著高于MAP、MSAP组(P 0. 05); MSAP组D-D、CRP和PCT水平显著高于MAP组(P 0. 05);而MAP与MSAP组IL-6水平比较,差异无统计学意义(P 0. 05)。Spearman相关分析提示,PCT、D-D、CRP、IL-6与病情严重程度呈正相关(r值分别为0. 63、0. 57、0. 53、0. 46,P 0. 05)。受试者工作特征曲线(receiver operating characteristic curves,ROC)分析示,PCT、D-D、CRP、IL-6及联合四项实验室指标的AUC分别为0. 90、0. 85、0. 85、0. 83、0. 95;对应灵敏度分别为88. 89%、88. 89%、96. 30%、70. 37%、92. 59%;特异度分别为83. 19%、70. 59%、59. 66%、89. 92%、88. 24%; PCT、D-D、CRP、IL-6对应临界值分别为1. 40 ng/ml、1. 65μg/ml、118 mg/L、221 pg/ml。结论 PCT、D-D、CRP、IL-6可有效评估AP患者病情严重程度,PCT是SAP的最佳预测因子,联合四项实验室指标可进一步预测SAP。     

可溶性髓系细胞触发受体-1、降钙素原及超敏反应蛋白在脓毒血症诊断中的价值*

【】 目的 探究可溶性髓系细胞触发受体-1(Soluble triggering recepter expression on myeloid cell-1, sTREM-1)、降钙素原(Procalcitonin, PCT)及超敏反应蛋白(C-reactive protein, CRP)在脓毒血症诊断中的价值。 方法 选取84例于2013年2月至2016年5月入我院诊治的脓毒血症患者作为脓毒血症组,另选同期36例非脓毒血症患者作为对照组,运用ELISA法检测所有患者血浆sTREM-1和PCT水平,运用免疫比浊法检测所有患者血浆CRP水平,运用序贯器官衰竭估计评分(Sequential Organ Failure Assessment Score,SOFA)对患者进行评分,并比较组间差异。 结果 脓毒血症组患者的血浆sTREM-1、PCT、CRP以及SOFA评分均显著高于对照组,差异具有统计学意义(t=8.81、6.92、9.32、22.50,P＜0.01);脓毒血症患者各亚组间的血浆sTREM-1、PCT水平差异显著(F=16.79、30.89,P＜0.01),而组间CRP水平无显著差异(F=1.23,P=0.30);sTREM-1、PCT、SOFA评分和CRP诊断脓毒血症的曲线下面积(AUC)由高到低分别为0.92、0.85、0.67、0.55,CRP诊断脓毒血症价值不高;死亡组患者的血浆sTREM-1、PCT水平随时间推移,变化不大(P＞0.05),生存组患者血浆sTREM-1、PCT水平随时间推移逐渐降低(P＜0.05),其第4、7天的血浆sTREM-1、PCT水平显著低于死亡组(P＜0.05),而CRP水平两组间无显著差异(P＞0.05);脓毒血症组的sTREM-1、PCT和SOFA评分两两之间呈正相关关系(P＜0.05),而CRP与上述指标无显著相关性(P＞0.05)。 结论 相比于传统的PCT,血浆sTREM-1、PCT水平在脓毒血症患者的早期诊断方面具有更高的临床意义。     

PCT、CRP和CPIS评分对呼吸机相关肺炎的临床诊断价值研究

目的研究PCT、CRP以及简化CPIS评分对VAP临床诊断的价值。方法将2014年11月至2015年11月入住广州医科大学附属第一医院急诊监护病房且疑诊为VAP的成人患者纳入此项研究,检测患者机械通气当日的血清PCT、CRP值,评估并记录简化CPIS评分值,培养支气管灌洗物,此后每48 h重复以上检测,进行数据记录直至试验结束。以病原学结果为标准,分析所得PCT、CRP、简化CPIS评分值,绘制上述指标诊断VAP的患者工作曲线(ROC),以此为基础,计算敏感性、特异性的最佳比值并确定诊断的最佳阈值,计算曲线下面积(AUC)。结果 AUC值分别为0.719(PCT),0.557(CRP)以及0.789(CPIS)。PCT和CPIS无相关性(r=0.301,P=0.068),但有很好的相关趋势,PCT0.615ng/m L,结合简化积分≥6分诊断VAP,敏感性和特异性分别为74%和99%。结论单独采用PCT、简化CPIS检测对VAP初期诊断具备一定参考价值,并且简化CPIS评分值略优于PCT;而CRP检测对VAP早期诊断价值最低,无明显临床应用意义;简化CPIS评分结合PCT检测可在敏感性未降低的情况下大大提高VAP初期诊断特异性。     

C反应蛋白和降钙素原在肝硬化腹水自发性细菌性腹膜炎中的诊断价值

目的观察C反应蛋白(CRP)与降钙素原(PCT)对肝硬化腹水自发性细菌性腹膜炎(SBP)的诊断价值。方法选取我院2016年1月-2018年10月收治的肝硬化腹水患者60例,根据患者是否发生SBP分成两组,分别为SBP组(n=14)与非SBP组(n=46),检测各自的血清CRP、PCT水平。比较两组血清指标检测结果,并绘制受试者工作特征曲线(ROC),分析血清CRP、PCT水平对肝硬化腹水并SBP的预测价值。以临床诊断结果为金标准,采用一致性Kappa检验分析血清CRP联合PCT诊断肝硬化腹水并SBP与临床诊断的一致性。结果 SBP组血清CRP、PCT水平均显著高于非SBP组,差异有统计学意义(P0.05)。血清CRP、PCT水平预测肝硬化腹水并SBP的曲线下面积分别为0.646、0.639,当血清CRP30.427 mg/L、血清PCT0.497 ng/m L时,肝硬化腹水患者发生SBP危险性越高。血清CRP联合PCT诊断肝硬化腹水并SBP的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为71.43%、95.65%、90.00%、83.33%、91.67%,与临床诊断一致性Kappa检验值为0.706(P=0.000)。结论临床可以通过测定血清CRP、PCT水平对肝硬化腹水并SBP进行诊断,便于尽早确诊病情,及时采取干预措施。     

The history of the (Young) AEMI(E) and the EFIM

The European Federation of Internal Medicine (EFIM) was formed in 1996 through a merger between the Association Européenne de Médicine Interne (d' Ensemble) (AEMI(E)) and the Forum of Presidents of National Societies of Internal Medicine (IM). It arose as a result of ideas from Carcassi (Rome/Cagliari) and Merino (Alicante) to transform the largely French-speaking and rather elitist AEMI into a more easily accessible and English-speaking federation of national societies. The founding meeting of the General Assembly of the EFIM took place in May 1996 in Paris. Since then, the EFIM has initiated many activities, some of them originating from the time of the AEMI(E).     

Central bisectionectomy (bisegmentectomy) of the liver (with video)

Surgical techniques and indications for central bisectionectomy (bisegmentectomy) of the liver, i.e., resection of Couinaud's segments 4, 5 and 8, are described. Parenchymal dissection between the left medial and lateral sections is performed by dividing Glisson's branches arising from the right side of the umbilical portion towards the confluence between the middle and left hepatic veins. Parenchymal dissection between the right anterior and posterior sections is performed along the demarcation line created by obliterating the Glisson's pedicle of the right anterior section (Couinaud's segments 5 and 8), and then along the left side of the right hepatic vein. The root of the middle hepatic vein is divided at the bottom of the right and left plane of the parenchymal division. The indications for central bisectionectomy include benign and malignant tumors occupying both the left medial and right anterior sections, i.e., Couinaud's segments 4, 5 and 8, while sparing the left lateral and right posterior sections, i.e., Couinaud's segments 2, 3, 6 and 7. This technique is advocated especially for liver tumors arising in chronic liver diseases such as hepatocellular carcinoma complicating viral hepatitis and metastatic liver tumor with concomitant steatosis of the non-cancerous liver parenchyma, for which right or left trisectionectomy could result in less than optimal remnant liver volume and function.     

Diffusivity of Methane in a Mixture of CCl(4) and c-C(6)F(11)C(2)F(5) of the Critical Composition in the Region above the Temperature of Separation

The diffusivity of CH₄ in a mixture of CCl₄ and c-C₆F₁₁C₂F₅ of the critical composition in the region of temperature close to that of unmixing, decreases as in a homogeneous liquid from 36° to about 32°. It then passes through a minimum of 10⁵D ≈ 4.15 cm²/sec at about 27.5°, then rises to 10⁵D = 4.61 at 25.00°, then steeply to 6.36 cm²/sec in the further drop of only 0.3° to 24.71°.     

Human immunodeficiency virus (HIV) antigenemia (p24) in the acquired immunodeficiency syndrome (AIDS) and the effect of treatment with zidovudine (AZT)

Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level could be categorized as high (greater than 100 pg/mL) or low (15 to 65 pg/mL). Three patients with anti-p24 antibody had no antigenemia. Zidovudine (AZT), 200 or 250 mg every 4 hours, reduced antigenemia by about 90%; other regimens were less effective. Leukocyte cultures were positive for HIV from patients with antigenemia, and in one third of samples in the absence of antigenemia. High levels of antigenemia correlated with symptoms, CD4 cell count, and prognosis. Drug toxicity requiring a lower dose was followed by increased antigenemia, recurrent symptoms, and decreased CD4 cells, suggesting lymphocyte toxicity. Monitoring antigenemia can be useful in evaluating patients with HIV infection and in evaluating the effect of antiviral chemotherapy.     

Variations of the pre-coronary times (1973-1977) (author's transl)

A comparison has been made between the pre-coronary times of IMA patients in the UCIC of the S. Camillo Hospital in Rome between 1973 and 1977, and the pre-coronary times of patients in another UCIC in the same city, in order to record possible modifications. From 1973 to 1977 there has been a decrease in the pre-coronary times: this is the result of a better hospitalization policy and more frequent admission directly to the UCIC. The mortality rate according to the data in question, has also decreased from 21% in 1973 to 10% in 1977, with a marked reduction for patients with a pre-coronary time superior to 12 hours. This is also connected to the fact that there is a considerable reduction in the number of patients, generally suffering from serious complications, transferred to UCIC from other wards. From an analysis of the data we infer that there has been an improvement in the policy governing the admission of patients to UCIC, a policy which could be improved further by a more adequate training both for doctors and the population in general.