血清可溶性人白细胞抗原G测定在诊断亚临床绒毛膜羊膜炎中的意义

目的探讨孕妇血清可溶性人白细胞抗原G（sHLA-G）测定在诊断妊娠合并亚临床绒毛膜羊膜炎中的意义。方法选取早产及胎膜早破孕产妇115例及正常足月分娩孕产妇40例,通过运用双抗体夹心酶联免疫吸附（ELISA）法检测上述研究对象血清中sHLA-G的水平,同时用散射比浊法测定其中C反应蛋白（CRP）含量,最后对所有产后胎膜进行病理检查,判断有无绒毛膜羊膜炎。结果①通过对产后胎膜组织进行病理检查,共检测出绒毛膜羊膜炎患者70例,作为研究组,另外85例无绒毛膜羊膜炎患者作为对照组;②研究组血清中sHLA-G的水平平均为（46.52±13.75）U/ml,显著高于对照组（28.48±10.76U/ml）,差异有统计学意义（P〈0.001）;③研究组血清中CRP的水平平均为（13.39±12.48）mg/L,显著高于对照组（5.49±5.45mg/L）,差异有统计学意义（P〈0.001）;④用ROC曲线分析：血清sHLA-G检测绒毛膜羊膜炎的最佳临界值为36.09U/ml,诊断敏感性77.1%,特异性75.3%,曲线下面积0.847,明显优于CRP（敏感性68.6%,特异性68.2%,曲线下面积0.739,最佳临界值为7.5mg/L）。结论发生绒毛膜羊膜炎时,母血中sHLA-G的水平升高,与CRP相比,有更高的敏感性和特异性,提示sHLA-G是诊断亚临床绒毛膜羊膜炎的较理想的血清学指标。     

C反应蛋白和白细胞介素-6与胎膜早破绒毛膜羊膜炎的关系

目的探讨胎膜早破孕妇血清及羊水中白细胞介素-6（IL-6）和血清中C反应蛋白（CRP）含量与绒毛膜羊膜炎的关系。方法胎膜早破孕妇40例（胎膜早破组）及正常孕妇40例（对照组）各取羊水及肘静脉血5ml,经离心处理后取上清液及血清,检测其血清IL-6和CRP含量,以及羊水中IL-6含量,同时2组均取胎膜行病理检查。结果胎膜早破孕妇血清IL-6和母血CRP含量水平均较对照组高,尤其是以羊水中IL6水平升高更为敏感（P〈0.05）。绒毛膜羊膜炎患者18例,其血清、羊水中IL-6和血清CRP含量水平均明显高于非绒毛膜羊膜炎患者（P〈0.05或P〈0.01）。结论胎膜早破孕妇血清、羊水中IL-6和血CRP水平对诊断绒毛膜羊膜炎有临床应用价值。     

母血C反应蛋白水平对胎膜早破孕妇绒毛膜羊膜炎的诊断意义

目的了解胎膜早破孕妇母血中C反应蛋白(CRP)白细胞计数及宫颈细菌培养对绒毛膜羊膜炎的诊断意义。方法测定200例胎膜早破孕妇CRP水平、白细胞计数,部分进行颈管壁细菌培养;每例组织绒毛膜羊膜炎通过产后胎盘病理证实,按病理结果分为绒毛膜羊膜炎组(n=28)及非绒毛膜羊膜炎组(n=172)。结果绒毛膜羊膜炎组和非绒毛膜羊膜炎组比较,CRP有统计学意义(P<0.01),白细胞计数的差异无统计学意义,WBC、CRP、宫颈细菌培养对预测绒毛膜羊膜炎的灵敏度和特异度分别为67.857%、55.233%、85.710%、77.326%和79.167%、44.318%。结论胎膜早破孕妇母血中的CRP及宫颈管细菌培养较WBC对诊断绒毛膜羊膜炎灵敏,而CRP较宫颈细菌培养早期发现组织绒毛膜羊膜炎。     

CRP预测早期宫内感染的临床意义

目的探讨C-反应蛋白（CRP）诊断胎膜早破急性绒毛膜羊膜炎的临床价值。方法收集200例胎膜早破病例血清测定CRP水平及白细胞计数。每例组织绒毛膜羊膜炎通过产后胎盘病理证实,按病理结果分为绒毛膜羊膜炎组（n=35）及非绒毛膜羊膜炎组（n=165）。结果 （1）绒毛膜羊膜炎组和非绒毛膜羊膜炎组比较,CRP有统计学意义（P〈0.01）,白细胞计数的差异无统计学意义,WBC、CRP对预测绒毛膜羊膜炎的灵敏度和特异度分别为59.86%、85.73%和48.35%、76.08%。结论胎膜早破孕妇母血中的CRP较WBC对诊断绒毛膜羊膜炎灵敏,胎膜早破时测定CRP对预测宫内感染有很好的临床价值。     

血清降钙素原与胎膜早破的关系研究

目的检测未足月胎膜早破(PPROM)与足月胎膜早破(足月PROM)孕妇血清降钙素原(PCT)的浓度,探讨其与胎膜早破的关系及对PPROM患者绒毛膜羊膜炎的预测价值。方法选取PPROM患者55例,相同孕周健康孕妇40例;足月PROM患者40例,相同孕周健康孕妇40例,进行血清PCT检测,孕足月PROM及PPROM患者分娩后胎盘胎膜病理检查。结果孕足月PROM及PPROM组孕妇血清中PCT阳性率均高于相应对照组(P<0.05);但足月PROM及PPROM组孕妇血清中PCT比较,差异无统计学意义(P>0.05)。且PPROM组中存在组织学绒毛膜羊膜炎者与无绒毛膜羊膜炎者血清PCT差异无统计学意义(P>0.05);PCT诊断PPROM患者组织学绒毛膜羊膜炎的敏感性、特异性分别为60.00%、35.00%(PCT>0.5μg/L);37.00%、60.00%(PCT>2μg/L)。结论PCT在PPROM及孕足月PROM孕妇血清中浓度升高,但其对PPROM患者绒毛膜羊膜炎的预测价值尚待进一步研究。     

血清降钙素原及白细胞介素-6与胎膜早破患者并发绒毛膜羊膜炎的相关性研究

目的探讨降钙素原及白细胞介素-6与胎膜早破的关系以及对绒毛膜羊膜炎的诊断意义。方法选取足月胎膜早破患者73例,未足月胎膜早破患者54例,足月及未足月健康孕妇各50例,检测血清PCT及IL-6。所有孕妇分娩后对胎盘、胎膜进行病理检查。结果足月PROM组与PPROM组的PCT、IL-6阳性率均高于对照组,差异有统计学意义(P<0.05)。胎膜早破患者中有组织学绒毛膜羊膜炎与无组织学绒毛膜羊膜炎血清PCT及IL-6比较,差异有统计学意义(P<0.05)。有组织学绒毛膜羊膜炎患者血清PCT及IL-6均阳性的比例高于无组织学绒毛膜羊膜炎组,其差异有统计学意义(P<0.05)。PCT对诊断组织学绒毛膜羊膜炎的敏感性、特异性、阳性预测值、阴性预测值分别为72.88%、70.59%、68.25%、75%,IL-6对诊断组织学绒毛膜羊膜炎的敏感性、特异性、阳性预测值、阴性预测值分别为83.05%、67.65%、69.01%、82.14%。联合检测PCT和IL-6对诊断组织学绒毛膜羊膜炎的敏感性、特异性、阳性预测值、阴性预测值分别为67.80%、82.35%、76.92%、78.67%。结论 PCT及IL-6都是胎膜早破并发绒毛膜羊膜炎较好的诊断指标,联合二者检测比单独检测无明显优势。     

可溶性细胞间黏附分子-1、白介素-1β与绒毛膜羊膜炎的关系

目的探讨可溶性细胞间黏附分子-1（sICAM-1）、白细胞介素-1β（IL-1β）与绒毛膜羊膜炎的关系。方法采用双抗体夹心酶联免疫吸附法检测未足月胎膜早破组56例、足月胎膜早破组38例孕妇的血清中sICAM-1、IL-1β、C反应蛋白（CRP）、白细胞（WBC）的水平,并进行胎膜的病理检查。结果未足月胎膜早破组的绒毛膜羊膜炎的发生率明显高于足月胎膜早破组（P〈0．05）;发生绒毛膜羊膜炎的胎膜早破孕妇的血清中sICAM-1、IL-1β、CRP、WBC水平明显高于非绒毛膜羊膜炎的胎膜早破孕妇（P〈0．05）;血清sICAM-1比CRP、WBC指标有更高的敏感性、特异性,血清IL-1β比CRP、WBC指标亦有更高的敏感性,特异度类似。结论检测孕妇血清的sICAM-1、IL-1β水平是早期诊断绒毛膜羊膜炎的良好指标。     

联合检测PPROM孕妇PCT及CRP对预诊绒毛膜羊膜炎的意义

目的探讨联合检测未足月胎膜早破(PPROM)孕妇血清降钙素原(PCT)及C反应蛋白(CRP)水平对绒毛膜羊膜炎的预测价值。方法选取我院产科2012年1月至2013年1月孕28³7周孕妇分为胎膜早破100例,另选择同期孕周健康孕妇100例,入院后行PCT、CRP及宫颈细菌涂冀检查,分娩后行胎盘病理检查。结果观察组100例患者经病理检查,结果64.00%(64/100)为绒毛膜羊膜炎。观察组中PCT、CRP阳性率分别为66.0%(66/100)、60.00%(60/100),而对照组中PCT、CRP阳性率分别为3.00%、4.00%,差异有显著性(P<0.05)。观察组中PCT、CRP同时阳性者为38例,占38.00%。联合检测结果明显优于PCT、CRP单独检测,且差异有统计学意义(P<0.05)。结论同时检测血清中PCT、CRP浓度,可大大提高对PPROM孕妇合并绒毛膜羊膜炎诊断的特异性和阳性预测价值并可预测潜伏期的长短。     

MIF和IL-6与胎膜早破关系的研究

目的探讨胎膜早破时巨噬细胞移动抑制因子(MIF)在胎膜的表达和母血中白细胞介素-6(IL-6)的水平及其二者与绒毛膜羊膜炎之间的关系。方法采用免疫组化SP法检测60例足月胎膜早破(PROM)分娩组和40例足月非PROM分娩组胎膜中MIF的分布和表达,采用ELISA法检测两组孕妇血清IL-6含量,采用HE染色的方法确诊绒毛膜羊膜炎。结果 PROM组胎膜MIF表达和母血IL-6含量明显高于对照组。PROM组胎膜MIF表达和母血IL-6含量随着破膜时间延长升高。PROM绒毛膜羊膜炎组胎膜MIF表达和母血IL-6含量明显高于PROM非绒毛膜羊膜炎组。结论 MIF和IL-6在胎膜早破的发病机制中起着重要的作用,MIF及IL-6与绒毛膜羊膜炎关系密切。     

MMP-9、TIMP-1及FFN与胎膜早破绒毛膜羊膜炎的关系

目的：探讨MMP-9、TIMP-1和FFN同胎膜早破绒毛膜羊膜炎的关系。方法选择2012年5月～2013年10月在本院产科住院的足月胎膜早破孕妇80例（观察组）,随机选取同期因社会因素行剖宫产的正常妊娠妇女40例（对照组）,检测两组血清、羊水和脐血中基质金属蛋白酶-9（MMP-9）、组织金属蛋白酶抑制物-1（TIMP-1）,检测两组孕妇阴道液中胎儿纤维粘连蛋白（FFN）水平,分析三者同胎膜早破绒毛膜羊膜炎的关系。结果观察组血清、羊水和脐血中MMP-9、TIMP-1水平同对照组比较差异有统计学意义,观察组的FFN阳性率93.48%,对照组的阳性率为2.5%,差异均有统计学意义（P＜0.05）;病理检查证实观察组中46例为绒毛膜羊膜炎,FFN的阳性预测值和阴性预测值分别为95.56%和91.18%。结论MMP-9、TIM-1和FFN同胎膜早破关系密切,对绒毛膜羊膜炎的诊断具有重要的指导价值。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。