直肠癌前切除术后吻合口漏的早期诊断研究

目的筛选直肠癌前切除术后吻合口漏早期诊断的实验室指标。方法回顾性分析2017年9月—2019年1月在解放军联勤保障部队第940医院结直肠肛门外科因直肠癌行直肠前切除手术128例患者的临床资料。结果 128例患者中16例发生吻合口漏, 发生率为12.5%。确诊吻合口漏的时间自术后第2～9天, 平均为(6.13±2.00)d。肿瘤下缘距肛缘的距离是吻合口漏发生的危险因素, 距离>7 cm的患者吻合口漏发生率明显低于距离≤7 cm患者(χ2=6.022, P=0.014)。手术后第3～5天患者的外周血白细胞、中性粒细胞百分比及血清白细胞介素-6、C-反应蛋白、降钙素原升高均与吻合口漏的发生密切相关(均P<0.05)。受试者工作特征曲线分析显示, 术后第3～5天血清C-反应蛋白、降钙素原、白细胞介素-6、外周血白细胞总数及中性粒细胞百分比的曲线下面积均>0.5。结论术后血清C-反应蛋白、降钙素原、白细胞介素-6、外周血白细胞总数及中性粒细胞百分比对早期诊断直肠癌前切除术后吻合口漏有一定的价值。     

C-反应蛋白及临床肺部感染评分在老年社区获得性肺炎预后评估中价值的分析

目的:探讨C-反应蛋白和临床肺部感染评分对老年社区获得性肺炎患者预后评估的价值作用。方法:对80例老年社区获得性肺炎患者资料进行分析,记录其入院第1天、第8天的C-反应蛋白、临床肺部感染评分以及白细胞计数。按预后把患者分成存活组、死亡组,比较两组C-反应蛋白、临床肺部感染评分和白细胞的差别。结果:治疗8天后,存活组的C-反应蛋白、、白细胞、临床肺部感染评分比刚入院时明显下降(P<0.05),但是死亡组和入院时的结果没有差异(P>0.05),死亡组C-反应蛋白和临床肺部感染评分都明显比存活组高(P<0.01)。结论:动态监测C-反应蛋白和临床肺部感染评分对评价老年社区获得性肺炎的预后在临床上有着重要的价值。尤其是对临床的表现很不典型的老年C-反应蛋白患者,同时动态监测具有更大的价值。     

急性颅脑损伤不同GCS评分患者手术前后炎症因子水平变化及临床意义

目的研究急性颅脑损伤不同GCS评分患者手术前后炎症因子水平变化及临床意义。方法选取本院2018年1月至2020年3月期间接诊的62例急性颅脑损伤患者作为研究对象。根据格拉斯哥昏迷量表评分(GCS)标准将其分为两组,GCS≤8分为A组(31例),GCS评分在9～12分为B组(31例)。在术前、术后7天、术后14天记录两组患者炎症因子肿瘤坏死因子-α(TNF-ɑ)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C-反应蛋白(CRP)、红细胞沉降率(ESR)水平。结果两组患者的TNF-ɑ、IL-6、IL-8、CRP表达水平均呈现先上升后下降的趋势,术后7天左右达到峰值,ESR水平呈现下降趋势,差异有统计学意义(P0.05),B组患者不同时间点的TNF-ɑ、IL-6、IL-8、CRP、ESR水平均明显低于A组,差异有统计学意义(P0.05)。结论血清CRP、ESR、TNF-ɑ、IL-6、IL-8炎症因子水平变化可反应急性颅脑损伤患者病情严重程度,可作为治疗和预后的重要参考指标,具有临床研究价值。     

腹腔镜结直肠癌手术对应激细胞因子ET、IL-6及CRP的影响

目的:探讨腹腔镜结直肠癌手术对机体应激反应的影响。方法:选择2006年6月~2007年3月结直肠癌患者35例,分为腹腔镜组15例,开腹组20例。比较两组围手术期内皮素(ET)、白细胞介素-6(IL-6)、C-反应蛋白质(CRP)及相关临床指标的变化。结果:两组患者的性别、年龄、身高、体重、术后病理分期及手术方式差异无统计学意义(P>0.05),平均手术时间腹腔镜组长于开腹组(P<0.05);术中平均出血量开腹组多于腹腔镜组(P<0.05)。腹腔镜组术后第1天ET显著下降(P<0.05),术后第3天恢复至术前水平;开腹组手术前后ET无显著变化。两组术后未出现显著差异。两组患者术后IL-6和CRP均明显升高(P<0.01),且开腹组明显高于腹腔镜组(P<0.01),术后第5天腹腔镜组IL-6恢复至术前水平,但开腹组仍明显高于腹腔镜组(P<0.05)。术后第5天两组CRP仍显著高于术前水平(P<0.05;P<0.01),且开腹组高于腹腔镜组(P<0.05)。结论:腹腔镜结直肠癌手术对ET、IL-6和CRP的影响小,应激反应比开腹手术轻、强度低、持续时间短。     

胰十二指肠切除术后并发症患者中血清降钙素原、C-反应蛋白及乳酸脱氢酶的变化

目的:探讨血清降钙素原、C-反应蛋白及乳酸脱氢酶在胰头癌行胰十二指肠切除术后并发症患者中的变化及临床意义。方法:前瞻性选择2016年10月—2019年5月行胰十二指肠切除术治疗的胰头癌患者236例。在患者入院后、术后第1、4、7天分别检测患者血清降钙素原、C-反应蛋白及乳酸脱氢酶水平,并评估患者的急性生理与慢性健康状况评分(APACHE)-II评分,根据是否发生并发症分为并发症组和无并发症组,并对各项指标行组间比较。结果:并发症组患者住院天数显著长于无并发症组(P0.05)。术后第1、4、7天两组血清降钙素原、C-反应蛋白及乳酸脱氢酶水平及APACHE-II评分较术前均明显升高(P0.05),且并发症组升高较无并发症组更明显(P0.05)。血清降钙素原、C-反应蛋白及乳酸脱氢酶水平均与APACHE-II评分呈正相关(r=0.712、0.635、0.816,P0.05)。结论:对胰头癌行胰十二指肠切除术的患者,术后动态监测血清降钙素原、C-反应蛋白及乳酸脱氢酶及APACHE-II评分有助于判断并发症发生情况及病情改善状况,便于及时采取治疗措施,改善预后。     

腹腔镜经后腹膜途径治疗感染期急性重症胰腺炎

目的研究腹腔镜经后腹膜途径治疗感染期急性重症胰腺炎(SAP)的效果。方法4例感染期SAP采用腹腔镜经后腹膜途径对胰腺坏死及脓肿进行清创并引流,比较术前1 d与术后第1、3、7天白细胞计数、C-反应蛋白、降钙素原、体温及膀胱压的变化。结果患者术后体温有明显下降,术后白细胞计数、C-反应蛋白、降钙素原水平指标较术前均有明显下降(P0.05);术后腹胀明显减轻,膀胱压测定较术前明显下降(P0.05)。结论腹腔镜经后腹膜途径对感染期SAP进行清创引流可取得满意效果。     

手助腹腔镜与开腹巨脾切除术对机体应激反应的影响

目的:总结手助腹腔镜与开腹巨脾切除术对患者术后机体应激反应的影响。方法:随机选取2006年8月至2011年10月40例巨脾患者,根据其经济状况及意愿分为两组,每组20例,分别行手助腹腔镜脾切除术(hand-assisted laparo-scopic splenectomy,HALS)及传统开腹脾切除术(open splenectomy,OS),对比分析两组患者术前、术后皮质醇(cortisol,COR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)水平。结果:术后1天HALS组COR、TNF-α、IL-6、CRP水平均低于OS组(P<0.05),术后3天TNF-α、CRP水平低于OS组(P<0.05),术后5天CRP低于OS组(P<0.01)。结论:相对开腹手术而言,手助腹腔镜巨脾切除术对患者术后机体应激反应的影响较小,充分显示了其微创的优越性。     

肾移植后血清白细胞介素2,可溶性白细胞介素2受体和白细胞介…

动态监测６０例肾移植患者术后２个月内血清白细胞介素，可溶性ＩＬ－２受体和白细胞的变化。结果发现发生急性排斥反应时，上述细胞因子的升高较临床诊断提早数天，并且显著高于环孢素Ａ肾中毒组；对泼尼龙第三的排斥反应，抗排斥治疗数天后上述因子下降到排斥前水平。     

腹腔镜直肠癌Miles手术对机体应激反应和内脏蛋白的影响

目的:探讨腹腔镜直肠癌Miles手术对机体应激反应和内脏蛋白的影响。方法:将60例行直肠癌Miles手术的患者按其意愿分为腹腔镜组和开腹组,每组30例,于术前、术后第1、2、3天晨检测血C反应蛋白(CRP),IL-6及内脏蛋白,包括白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)的变化。结果:两组CRP、IL-6术后1~3d较术前均明显升高(P<0.01),腹腔镜组术后CRP、IL-6明显低于开腹组(P<0.01)。两组术后ALB、PRE、TRF、RBP较术前明显下降(P<0.01)。术后第2天腹腔镜组PRE高于开腹组(P<0.01),术后第3天腹腔镜组ALB、PRE、TRF、RBP均明显高于开腹组(P<0.01)。结论:腹腔镜直肠癌Miles手术较开腹手术机体创伤及应激反应小,有利于机体内脏蛋白的恢复。     

高龄患者腹腔镜结直肠癌根治术对机体应激及内脏蛋白的影响

目的:研究高龄患者腹腔镜与开腹结直肠癌根治术围手术期IL-6、IL-10和C反应蛋白(C-reactive protein,CRP)及内脏蛋白的差异。方法:按患者意愿将41例行结直肠癌根治术的高龄患者分为腹腔镜组(n=20)和开腹组(n=21),两组患者的年龄、性别、体重指数(BMI)等差异无统计学意义,具有可比性,检测两组患者术前、术后的应激指标:血清IL-6、IL-10、CRP及内脏蛋白:前白蛋白(prealbumin,PRE)、转铁蛋白(transferrin,TRF)、视黄醇结合蛋白(retinal-binding protein,RbP)的变化。结果:两组患者CRP在术后1、2、3d均较术前明显升高(P0.01),术后第2天达峰值,腹腔镜组术后CRP明显低于开腹组(P0.01);两组患者血清IL-6、IL-10术后明显升高,腹腔镜组明显低于开腹组(P0.01),IL-10升高持续时间短。术后两组PRE、TRF、RbP均较术前明显下降(P0.01),术后1、2d两组各项指标差异无统计学意义(P0.05),术后第3天腹腔镜组4种蛋白指标均明显高于开腹组(P0.01)。结论:本组高龄患者术后应激水平及内脏蛋白指标的结果显示,腹腔镜结直肠癌根治术较开腹手术创伤小,应激水平低,有利于机体内脏蛋白的恢复,这对实施微创外科是有力的支持。     

肠道手术和骨科手术围术期白介素-6及相关因素的变化

目的 观察围术期血清ＩＬ－６、Ｃ－反应蛋白和皮质醇等指标的变化,以探讨手术对机体造成的损伤程度。方法 随机选择全麻下行推管手术（组１）和直肠、结肠癌根治术（组２）的病人各１０例,分别于术前、手术开始、切皮后２、４、６ｈ及术后第１ｄ抽取周围静脉血测定血清ＩＬ－６、Ｃ－反应蛋白和皮质醇浓度。结果 ＩＬ－６于手术开始后逐渐升高,并在切皮后６ｈ达到最高点,组２升高幅度在手术开始后４及６ｈ均明显大于组１：Ｃ     

老年颈动脉硬化患者血清C反应蛋白测定及意义

目的:探讨 C 反应蛋白(C-reactive protein,CRP)作为系统性炎症因子在老年人颈动脉硬化中的改变及其意义。方法:选取经超声多普勒确诊的颈动脉硬化病人共130例,根据狭窄程度分为重组54例,轻组76例,对照组为经超声多普勒证实无颈动脉硬化病变的健康人,共45例。采用放射比浊法测定血清 CRP、放射免疫法测定血清白细胞介素-6(IL-6)浓度。结果:颈动脉硬化组血清 CRP 水平显著高于对照组(P<0.01);在颈动脉硬化患者中,重组血清 CRP 水平显著高于轻组(P<0.01),但两组间 IL-6浓度无显著差异(P>0.05)。结论:血清 CRP、IL-6水平在颈动脉硬化患者中明显升高,CRP 浓度与颈动脉狭窄程度密切相关。     

Minimal access surgery for cholelithiasis induces an attenuated acute phase response.

BACKGROUND: Some benefits of laparoscopic (LC) and minilaparotomy (MC) cholecystectomy may reflect attenuation of the acute phase response. The authors examined components of this response. METHODS: Patients were randomized to LC (n = 11) or MC (n = 11). C-reactive protein (CRP), alpha-1-antitrypsin (AAT), retinol-binding protein (RBP), transferrin, and albumin were measured preoperatively and on postoperative days 1, 2, 4, and 7. Interleukin-1 receptor antagonist (IL-1ra), IL-6, and tumor necrosis factor (TNF-alpha) were measured more frequently perioperatively. Peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity were measured daily. RESULTS: The IL-6 increase was more persistent and marked in the MC patients from hour 8 to day 7 postoperatively (P < 0.05). Alterations in CRP, AAT, and albumin were similar. Postoperative deficits of respiratory function correlated with the magnitude of acute phase protein alteration. CONCLUSIONS: Minimal access surgery induces an acute phase response that is less prominent after a laparoscopic technique.     

术前应激反应对关节置换手术患者术后疼痛的影响

目的分析术前应激反应对关节置换手术患者术后疼痛的影响，以期能为后期治疗护理提供指导。 方法采用前瞻性分析的研究方法，依据纳入标准和排除标准筛选后共纳入2019年8月至2020年8月期间来广州医科大学附属第一医院进行治疗的102例关节置换手术患者为研究对象。对术前及术后6个月患者血清内氧化应激指标含量进行t检验比较，术后使用视觉模拟评分(VAS)量表评估疼痛情况，并以Pearson相关性分析患者关节置换手术前后的应激情况与术后疼痛的相关性。 结果与术前比较，术后患者的血清氧化指标丙二醛(MDA)、髓过氧化物酶(MPO)和晚期蛋白氧化产物(AOPPs)含量均显著降低；血清抗氧化指标，如超氧化物歧化酶(SOD)、总抗氧化能力(T-AOC)、谷胱甘肽过氧化物酶(GSH-Px)含量均升高(t＝2.365、3.929、2.175、2.419、2.319、2.263，均为P<0.05)。与术前比较，术后患者的血清炎症因子白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)含量均显著降低(t＝4.137、2.421、4.763、3.827、2.274，均为P<0.05)。术前第3天疼痛VAS评分为(4.1±1.1)分。术前血清MDA、MPO、AOPPs含量与术后疼痛呈现正相关(r＝0.421、0.371、0.486，均为P<0.05)；SOD、T-AOC、GSH-Px含量与术后疼痛呈现负相关(r＝-0.135、-0.176、-0.332，均为P<0.05)；术前血清IL-2、IL-6、IL-8、TNF-α和CRP含量与术后疼痛呈现正相关(r＝0.426、0.411、0.548、0.223、0.302，均为P<0.05)。 结论术前应激反应和炎症反应与关节置换手术患者术后疼痛存在密切相关性，术前应激反应和炎症反应越重的患者术后疼痛越明显。     

Objective assessment of reduced invasiveness in MED

Microendoscopic discectomy (MED) has been accepted as a minimally invasive procedure for lumbar discectomy because of the small skin incision and short hospital stay required for this surgery. However, there are few objective laboratory data to confirm the reduced systemic responses in the early phase after this procedure. In order to substantiate the reduced invasiveness of MED compared to microdiscectomy (MD) or procedures involved in one-level unilateral laminotomy, the invasiveness of each surgical procedure was evaluated by measuring serum levels of biochemical parameters reflective of a post-operative inflammatory reaction and damage to the paravertebral muscles. Thirty-three patients who underwent lumbar discectomy or one-level unilateral laminotomy (MED in 15 cases, MD in 11 cases and one-level unilateral laminotomy in 7 cases with lumbar spinal canal stenosis) were included in this study. The serum levels of C-reactive protein (CRP) and creatine phosphokinase (CPK) were measured at 24 h after operation. Interleukin-6 (IL-6) and Interleukin-10 (IL-10) were measured at 2, 4, 8 and –24 h following the surgery to monitor the inflammatory response to the respective surgery. The post-operative serum CRP levels from both the MD and MED groups were significantly lower than those from the open laminotomy group. However, there was no significant difference in these serum levels between the MED and MD groups. The levels of IL-6 and IL-10 in the MED group during0 the first post-operative day were also significantly lower than those in the laminotomy group. When the MED and MD groups were compared, the IL-6 levels in the MED group were lower than in MD group at 2, 4 and 8 h after surgery, but the differences were not statistically significant. However, the level was significantly lower in the MED group at 24 h after surgery. In terms of IL-10, no significant difference was noted between the MED and MD groups over the study period. The changes in serum levels of post-operative inflammatory: markers (CRP, IL-6 and IL-10) in the early phase indicated reduced inflammatory reactions in MED as well as in MD when compared with classical open unilateral laminotomy. These data draw a direct link between the lower level of the inflammatory response and reduced invasiveness of MED. However, an indicator for muscle damage (CPK) appeared not to be affected by the type of surgical procedure used to correct disc herniation.     

Circulating serum levels of interleukin 6 and C-reactive protein after liver transplantation.

The study objectives were to investigate serum levels of interleukin-6 and C-reactive protein (CRP) after liver transplantation to correlated measurements with various clinical parameters. Twenty-three patients were studied after orthotopic liver transplantation. Serum IL-6 activity was evaluated by testing its capacity to induce proliferation of the IL-6-dependent hybridoma cell line B9. CRP was assessed by a nephelometric method. Only two of seven patients with acute cellular rejection developed an increase of serum IL-6 and CRP. In contrast to this rejection group, elevated IL-6 levels were observed in 7/9 patients with bacterial infections. Peak values for IL-6 were observed one day and for CRP two days after clinical diagnosis of infection. CMV disease was also associated with markedly increased IL-6 and CRP levels in 5/7 patients. Surprisingly, levels in this condition were approximately in the same range as in bacterial infection. IL-6 and CRP serum levels seen in bacterial infection and CMV disease were significantly higher than those in rejection (P less than 0.001). Serum IL-6 activity was neutralized by an antiserum directed against recombinant human IL-6. Preferential elevations of IL-6 and CRP represent one feature of bacterial and viral infections. Elevation of TNF during rejection as described earlier is only rarely accompanied by increased serum IL-6 levels.     

强直性脊柱炎患者血清DKK-1、VEGF-A、IL-17水平变化及其临床意义

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)患者血清Dickkopf-1蛋白(DKK-1)、血管内皮细胞生长因子-A(VEGF-A)、白细胞介素-17的变化及与患者病情的关系。方法选取我院2016年2月至2017年9月收治的AS患者40例(AS组)、健康体检对象40例(健康组),检测两组的血清DKK-1、VEGF-A、IL-17、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)水平,并分析血清DKK-1、VEGF-A、IL-17与AS患者ESR、CRP、强直性脊柱炎疾病活动指数(BASDAI)、巴氏强直性脊柱炎功能指数(BASFI)的关系。结果 AS组患者的血清DKK-1、VEGF-A、IL-17水平显著高于健康组,差异具有统计学意义(P0. 05); AS组患者的ESR、血清CRP水平显著高于健康组,差异具有统计学意义(P0. 05); AS组患者的BASDAI评估值为(52. 91±10. 62)分、BASFI评估值为(55. 81±9. 70)分; AS患者血清DKK-1、IL-17水平与ESR、血清CRP水平BASDAI评分、BASFI评分呈显著正相关关系(P0. 05); AS患者血清VEGF-A水平与ESR、血清CRP水平BASDAI评分、BASFI评分无显著相关性(P0. 05)。结论 AS患者血清DKK-1、VEGF-A、IL-17水平较健康人群显著升高,其中血清DKK-1、IL-17水平还能在一定程度上反映患者的疾病活动程度。