肾综合征出血热患者血清铁蛋白水平变化研究

目的观察不同分型及不同分期肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者血清铁蛋白(ferritin,FRT)水平变化,探讨其在重症HFRS早期预警及预后(死亡)评估中的作用。方法以空军军医大学第二附属医院传染科2011年10月—2013年12月收治的符合纳排标准的102例HFRS患者为研究对象,根据HFRS临床分型标准分为轻型、中型、重型和危重型4组,以28例健康志愿者为对照组。应用ELISA检测纳入患者急性期、恢复期及健康对照者的血清FRT水平。比较FRT在不同分型患者病程中的表达变化以及与对照组的差异;分析急性期FRT与常规实验室指标的相关性,评估其在反映HFRS疾病严重程度中的作用;采用Logistic回归分析构建基于急性期FRT和常规实验室指标的HFRS预后(死亡)风险模型,并应用ROC曲线评估模型及FRT对预后(死亡)的预测效力。结果纳入患者中,轻型17例、中型19例、重型27例、危重型39例。各组之间基线资料(年龄、性别、急性期采血时间)对比,差异无统计学意义(P>0.05)。各型HFRS患者急性期血清FRT水平均高于同型恢复期和对照组(P均<0.05),且随着病情加重逐渐增高,在危重型患者中表达最高(P<0.05)。HFRS患者急性期血清FRT水平与WBC、PLT、AST、APTT等常规实验室指标具有相关性,其中与PLT相关性最强(rs=-0.792,P=0.000)。应用Logistic回归分析构建HFRS预后(死亡)风险模型,最终进入模型的指标为WBC、AST和APTT。ROC曲线分析结果显示,急性期FRT对HFRS预后(死亡)的预测价值与WBC、PLT、AST、APTT等常规实验室指标相当,联合多个指标所构建的模型的预测价值高于单个指标。结论FRT在重症HFRS早期预警及预后(死亡)评估中具有重要价值,值得在临床推广应用。     

肾综合征出血热患者血浆MCP-1水平及其临床意义

目的　分析肾综合征出血热（hemorrhagic fever with renal syndrome, HFRS）患者不同病期及不同临床型血浆单核细胞趋化蛋白-1（monocyte chemotactic protein-1, MCP-1）浓度变化与疾病相关性,为HFRS临床诊治提供参考依据。方法　以2012年10月—2014年1月期间在空军军医大学唐都医院住院就诊的81例HFRS患者及15例健康志愿者（正常对照组）作为研究对象,用酶联免疫吸附法分别检测其血浆中MCP-1水平,同步检测血常规、肾功能等指标,并分析MCP-1与临床常规检测指标的相关性。结果　在急性期,所有患者血浆MCP-1水平均明显升高,其中重型/危重型患者血浆MCP-1水平升高比轻型/中型更为显著;中型、重型、危重型患者血浆MCP-1水平急性期均高于恢复期及正常对照组（P均＜0.05）,恢复期与正常对照组比较差异无统计学意义（P＞0.05）。Spearman相关分析显示血浆MCP-1水平与白细胞、尿素氮、肌酐水平呈正相关,与血小板水平呈负相关。结论　HFRS患者血浆MCP-1水平与疾病严重程度及疾病进程密切相关。     

血清PTX-3、OSM水平对老年脓毒症患者预后的评估价值

目的 探讨血清穿透素(PTX)-3、抑瘤素(OS)M对老年脓毒症患者预后的评估价值。方法 收集脓毒症老年患者136例,根据28 d预后分为存活组(n=98)与死亡组(n=38)。比较不同预后组血清PTX-3、OSM水平等临床资料差异,分析PTX-3、OSM水平与脓毒症病情严重程度的关系,并绘制受试者工作特征(ROC)曲线评价各指标对预后的评估能力。结果 死亡组入院时血清PTX-3、OSM水平显著高于存活组(P<0.05)。Pearson相关分析显示,脓毒症患者血清PTX-3水平与急性生理学与慢性健康评估(APACHE)Ⅱ、序贯器官衰竭评估(SOFA)评分呈正相关(r=0.341、0.326,P均<0.05),OSM水平与APACHEⅡ、SOFA评分呈正相关(r=0.338、0.331,P均<0.05)。Logistic回归分析得出,脓毒性休克(OR=5.703)、SOFA评分(OR=2.212)、血清PTX-3水平(OR=1.451)和OSM水平(OR=1.531)均是老年脓毒症患者28 d预后的危险因素(P<0.05)。ROC曲线分析显示,血清PTX-3水平、...     

肾综合征出血热患者外周血循环内皮细胞的检测及临床意义

目的 探讨肾综合征出血热(HFRS)患者循环内皮细胞(CEC)数量变化的临床意义.方法 共纳入72例HFRS患者及30例健康对照者,利用Percoll密度梯度离心法分离外周血CEC进行检测.数据行t检验.结果 HFRS患者发热期CEC数量(单位为细胞数/0.9 μL)为23.36±11.53,低血压休克期为48.25±18.40,少尿期为17.38±7.38,多尿期为4.56±1.58,恢复期为4.02±1.39,对照组为3.33±2.06,发热期、低血压休克期、少尿期明显高于多尿期、恢复期和健康对照组,差异有统计学意义(P＜0.01);HFRS发热期各型(轻型、中型、重型和危重型)患者CEC数量与健康对照组比较,差异均有统计学意义(P＜0.01),发热期各型之间CEC数量随着病情加重逐渐增多,各型之间比较差异均有统计学意义(P＜0.01).结论 HFRS患者外周血CEC数量呈动态变化,与病情发展及轻重相关,HFRS患者外周血CEC的早期检测可作为早期诊断、早期预测病情轻重的可靠指标.     

血浆N末端B型钠尿肽原水平对ACS患者近期预后判断的价值

目的 探讨血浆N末端B型钠尿肽原(NT-proBNP)水平对急性冠脉综合征(ACS)患者近期预后判断的价值.方法 选择ACS患者90例,其中不稳定型心绞痛29例(UAP组)、非ST段抬高型心肌梗死30例(NSTEMI组)、ST段抬高型心肌梗死31例(STEMI组),同期选择健康体检者30例作为对照组,比较各组血浆NT-proBNP水平,随访观察ACS患者3个月内主要不良心脏事件(MACE)发生情况,并分析血浆NT-proBNP水平对MACE的预测价值.结果 ACS患者血浆NT-proBNP水平显著高于对照组(P均＜0.05).STEMI组MACE的发生率(48.39％)显著高于UAP组(10.34％)、NSTEMI组(13.33％)(P均＜0.05).血浆NT-proBNP水平预测3个月内MACE发生的ROC曲线下面积为0.85(95％ CI为0.75 ～0.91,P＜0.01).当血浆NT-proBNP＞ 385 pg/mL时,其预测ACS患者3个月内MACE发生的敏感性为67.5％、特异性为92.8％.结论 血浆NT-proBNP水平可作为ACS近期预后评估的重要指标.     

血清半乳糖凝集素-3、正五聚体蛋白-3水平与慢性心力衰竭患者心室重构及预后的关系

目的探讨血清半乳糖凝集素(Gal)-3、正五聚体蛋白(PTX)-3水平与慢性心力衰竭(CHF)患者心室重构及预后的关系。方法选择88例CHF患者作为研究组,选择同期进行体检的88例健康对象作为对照组。两组均进行血清Gal-3、PTX-3水平检测和彩色多普勒超声检查,对比两组左心室射血分数(LVEF)、左心室质量指数(LVMI)、Gal-3、PTX-3水平,随访6个月,根据患者是否发生心血管不良事件分为预后不良组及预后良好组。结果研究组LVEF水平明显低于对照组,Gal-3、PTX-3与LVMI水平明显高于对照组,差异均有统计学意义(均P0.05)。随美国纽约心脏病协会(NYNA)心功能分级升高,研究组Gal-3、PTX-3与LVMI水平逐渐升高,LVEF水平逐渐降低,差异有统计学意义(均P0.05)。预后不良组Gal-3、PTX-3与LVMI水平明显高于预后良好组,LVEF水平明显低于预后良好组,差异有统计学意义(均P0.05)。Pearson相关分析显示,研究组血清Gal-3、PTX-3水平与LVMI、心功能分级呈正相关(P0.05),与LVEF呈负相关(P0.05)。结论 Gal-3与PTX-3水平能够有效反映出CHF患者心室重构及预后情况。     

血浆骨桥蛋白、纤维蛋白原水平与急性脑梗死患者神经功能缺损程度及预后相关性的前瞻性研究

目的探讨血浆骨桥蛋白(OPN)、纤维蛋白原(FIB)水平与急性脑梗死患者神经功能缺损程度及预后的相关性。方法连续选取2017年8月—2018年3月承德医学院附属医院神经内科收治的急性脑梗死患者150例作为脑梗死组,根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻型脑梗死组(NIHSS评分5分,n=87)和中重型脑梗死组(NIHSS评分≥5分,n=63),根据治疗后90 d改良Rankin量表(mRS)评分分为预后良好组(m RS评分≤2分,n=104)和预后不良组(mRS评分2分,n=46);另选取同期体检健康志愿者100例作为对照组。分别比较对照组与脑梗死组、轻型脑梗死组与中重型脑梗死组、预后良好组与预后不良组血浆OPN、FIB水平;血浆OPN、FIB水平与急性脑梗死患者NIHSS评分和mRS评分的相关性分析采用Spearman秩相关分析;绘制ROC曲线以评价血浆OPN、FIB水平对急性脑梗死患者神经功能缺损程度和预后的预测价值。结果脑梗死组患者血浆OPN、FIB水平高于对照组(P0.05)。中重型脑梗死组患者血浆OPN、FIB水平高于轻型脑梗死组(P0.05)。预后不良组患者血浆OPN、FIB水平高于预后良好组(P0.05)。Spearman秩相关分析结果显示,血浆OPN、FIB水平与急性脑梗死患者NIHSS评分(r_s分别为0.480、0.497)、mRS评分(r_s分别为0.387、0.352)呈正相关(P0.05)。ROC曲线显示,血浆OPN水平预测急性脑梗死患者神经功能缺损程度和预后的曲线下面积(AUC)分别为0.724、0.726,血浆FIB水平预测急性脑梗死患者神经功能缺损程度和预后的AUC分别为0.714、0.711。结论血浆OPN、FIB水平与急性脑梗死患者神经功能缺损程度及预后呈正相关,并可在一定程度上预测患者神经功能缺损程度及预后。     

急性冠脉综合征患者血清正五聚蛋白和超敏C反应蛋白水平变化与预后的关联

目的探讨急性冠脉综合征(ACS)患者血清正五聚蛋白(PTX-3)和高敏C反应蛋白(hsCRP)水平变化及其与预后的关联。方法选自2012年4月至2013年4月吴忠市新区医院心内科临床诊断为冠状动脉粥样硬化性心脏病(冠心病)的患者132例,男性81例,女性51例,年龄范围40~75岁,分为稳定型心绞痛35例(SAP组),不稳定型心绞痛患者36例(UAP组),非ST段抬高型心肌梗死患者共32例(NSTEMI组),急性ST段抬高型心肌梗死患者29例(STEMI组)。另选同期年龄、性别相匹的正常体检者共35例(正常对照组)。检测PTX-3、hs-CRP水平,并随访1年主要心血管事件(MACE)的发生情况。结果与对照组比较,UAP组、NSTEMI组和STEMI组患者PTX-3、hs-CRP水平升高,差异具有统计学意义(P均0.05)。对97例ACS患者随访1年MACE的发生情况,33例发生MACE。通过ROC曲线计算血浆PTX-3、hs-CRP预测ACS患者发生MACE的最佳界值(cut off value)分别为PTX-3=6.05μg/L,hsCRP=8.21 mg/L,ROC曲线下面积为0.78、0.58。结论 PTX-3水平能够预测ACS患者MACE发生情况。     

血浆受体相互作用蛋白激酶-3水平与非ST段抬高型急性冠状动脉综合征患者近期预后的相关性研究

目的:探讨血浆受体相互作用蛋白激酶-3(RIP3)对非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者近期预后的预测价值。方法:选择2018年1月至2019年12月,在铜川市妇幼保健院住院治疗的205例NSTE-ACS患者纳入研究,包括不稳定性心绞痛(UAP)患者143例和非ST段抬高型心肌梗死(NSTEMI)患者62例。另选取60例稳定性心绞痛(SAP)患者作为SAP组,60例非冠心病患者作为对照组。采用ELISA法检测血浆RIP3水平,采用GRACE评分系统对NSTE-ACS患者进行评分。并对NSTE-ACS患者在出院后随访6个月,观察主要不良心脏事件发生情况。结果:UAP组、NSTEMI组血浆RIP3水平均高于SAP组和对照组,且NSTEMI组血浆RIP3水平高于UAP组,差异均有统计学意义(均P0.01)。Pearson直线相关分析结果示血浆RIP3水平与GRACE评分呈正相关关系(r=0.527,P0.001)。校正年龄、性别等参数,多元线性回归分析结果示NSTE-ACS患者血浆RIP3水平与GRACE评分相关(Beta=0.454,P0.001)。二分类Logistic回归分析结果示血浆RIP3水平是NSTE-ACS患者近期预后的影响因素(OR=1.014,95%CI:1.001～1.028,P=0.034)。ROC曲线分析结果示血浆RIP3和GRACE评分预测出院6个月发生MACE的AUC分别为0.840(0.718,0.961)和0.890(0.827,0.953),差异无统计学意义(P0.05)。结论:NSTE-ACS患者血浆RIP3水平显著升高,并与GRACE评分呈正相关关系,对患者近期预后具有较高的预测价值。     

缺血性心脑血管疾病患者血浆纤溶酶原激活物及纤溶酶原激活物抑制剂1的测定及临床意义

目的研究缺血性心脑血管疾病患者血浆尿激酶型纤溶酶原激活物及其受体、组织型纤溶酶原激活物及其抑制剂1的水平及意义。方法应用酶联免疫吸附试验测定急性脑梗死、急性心肌梗死及不稳定型心绞痛患者血浆尿激酶型纤溶酶原激活物及其受体、组织型纤溶酶原激活物及其抑制剂1的水平。结果(1)脑梗死患者急性期血浆尿激酶型纤溶酶原激活物轻度升高(P>0.05),恢复期明显回落(P<0.05),尿激酶型纤溶酶原激活物受体水平在急性期明显升高(P<0.01),恢复期进一步升高;血浆中组织型纤溶酶原激活物含量在急性期明显低于对照组(P<0.01),而纤溶酶原激活物抑制剂1含量则明显高于对照组(P<0.01),恢复期纤溶酶原激活物抑制剂1水平趋于正常,而血浆中组织型纤溶酶原激活物水平与对照组比较仍存在一定差异(P<0.05)。(2)急性心肌梗塞患者血浆尿激酶型纤溶酶原激活物受体水平急性期明显升高(P<0.05),恢复期进一步升高(P<0.01),尿激酶型纤溶酶原激活物水平均大致正常;急性期血浆中血浆中组织型纤溶酶原激活物及纤溶酶原激活物抑制剂1含量均明显高于对照组(P<0.01),恢复期明显回落,纤溶酶原激活物抑制剂1趋于正常,血浆中组织型纤溶酶原激活物水平仍高于对照组(P<0.05)。(3)不稳定型心绞痛患者急性期(入院时)血浆尿激酶型纤溶酶原激活物受体水平明显升高(P<0.01),恢复期(入院后二周)回落,但仍明显高于对照组(P<0.05),尿激酶型纤溶酶原激活物水平与对照组比较均未见明显差异(P>0.05);急性期血浆中组织型纤溶酶原激活物含量明显低于正常组(P<0.01),而纤溶酶原激活物抑制剂1含量略高于对照组(P>0.05),恢复期两者含量均趋于正常(P>0.05)。结论缺血性心脑血管疾病患者存在不同程度的凝血纤溶系统失平衡,对疾病的发生发展起重要作用。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.