不同剂量阿托伐他汀对急性冠脉综合征患者血清高敏C-反应蛋白的影响

目的　探讨不同剂量的阿托伐他汀对急性冠脉综合征 (ACS)患者血清高敏C -反应蛋白 (hs-CRP)和血脂水平的影响。方法　 78例ACS患者随机分为两组 ,分别应用 10mg和 4 0mg阿托伐他汀治疗 8周 ,于治疗前后分别检测血清hs-CRP和血脂水平 ,做治疗前后对比及组间对比。结果　ACS患者血清hs -CRP水平较健康对照组明显升高 (P <0 0 1) ,治疗 8周后 ,两组患者hs -CRP、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL -C)、甘油三酯 (TG)和载脂蛋白B(apoB)均有明显下降 (P <0 0 5、0 0 1) ,高密度脂蛋白胆固醇 (HDL -C)明显升高 (P <0 0 5 ) ,大剂量组效果更好 ,与小剂量组比较有显著差别 (P <0 0 5、0 0 1)。结论　阿托伐他汀不仅能有效降低ACS患者血脂水平 ,而且可明显降低血清hs-CRP水平 ,抑制斑块内炎症反应。     

原发性肾病综合征患儿脂代谢紊乱及意义

目的：探讨原发性肾病综合征脂质代谢的紊乱及意义。方法：对34例肾病综合征患儿在不同病期血清脂质、脂蛋白及载脂蛋白进行检测。结果：活动期肾病血清胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL－C）、载脂蛋白B100（apoB100)、脂蛋白a[LP(a)]均较缓解期及正常儿童升高（P＜0．01或＜0．05）,高密度脂蛋白胆固醇（HDL－C）、载脂蛋白A1（apoA1)与正常组无差别（P＞0．05）。缓解期TC,TG,LDL－C恢复正常,但HDL－C,apoA1,ApoB100高于正常组（P＜0．05）。LP(a）含量与24h尿蛋白量呈正相关（r＝0．712,P＜0．01）。结论：肾病活动期脂代谢紊乱,载脂蛋白水平对揭示疾病的严重程度十分重要。     

血液光量子疗法对脑梗塞病人血清LP(a)及apoB基因多态性的影响

目的:探讨血液光量子疗法(UBIO)对血清脂蛋白(a)[LP(a)]、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL -C)及其载脂蛋白B(apoB)基因多态分布的影响。方法 :将脑梗塞高血脂病人随机分为两组 ,常规组30例 ,UBIO组36例 ,一疗程前后采外周静脉血检测上述指标。结果 :UBIO疗法降低LP(a)、TC、LDL -C和TG有效率为79.2 %、77 %、68 %、50 % ;UBIO疗法降低LP(a)明显优于常规(P<0.001) ;UBIO治疗前后apoB基因多态分布无改变。结论 :UBIO疗法是降低LP(a)的一种有效、安全方法     

急性脑梗死患者24h内超敏-C反应蛋白水平及相关研究

目的　观察急性脑梗死患者 (ACI)超敏 C反应蛋白 (hs CRP) ,并探讨hs CRP与其他危险因子的关系。方法　选择 93例ACI患者 ,测定血清hs CRP水平 ,同时测血压 (BP)、血糖 (BS)、血小板计数 (PTL)、纤维蛋白原 (FIB)和血脂参数 ,并观察患者神经系统缺损程度 ,并进行相关性分析。结果　hs CRP与BS、FIB、SBP、TG显著正相关 (P <0 0 5 )。hs CRP水平与ACI患者神经系统缺损程度相关 (P <0 0 1)。结论　BS、FIB、SBP、TG是CRP升高的相关因素。hs -CRP水平升高可能可作为病情评估的指标之一     

糖尿病患者尿GPDA与血清脂质变化的关系

目的　探讨糖尿病患者尿甘氨酰脯氨酸二肽氨基肽酶 (GPDA)与血清脂质变化的关系。方法　选择糖尿病患者 2 1 1例 ,正常对照组 98名 ,检测尿GPDA和血清脂质的水平 ,对其相互关系进行分析。结果　糖尿病患者组尿GPDA水平显著高于正常对照组 (t=4 .2 5 5 5 ,P <0 .0 0 1 ) ,血清胆固醇 (TC)、三酰甘油 (TG)、低密度脂蛋白胆固醇 (LDL C)、TC/高密度脂蛋白胆固醇比值 (TC/HDL C)、LDL C/HDL C比值、载脂蛋白B(ApoB)、脂蛋白 (a) [Lp(a) ]水平均高于正常对照组 (P <0 .0 0 1 ) ,而HDL C、载脂蛋白Al(ApoAl)、ApoAl/ApoB比值则明显低于正常对照组 (P <0 .0 1 )。糖尿病患者分组比较 ,血清TC、TG、LDL C、TC/HDL C、LDL C/HDL C、ApoB、Lp(a)随尿GPDA排泄量增多呈增高趋势 ,而HDL C、ApoAl、ApoAl/ApoB比值呈下降趋势。 结论　糖尿病患者伴有脂代谢紊乱 ,并与尿GPDA的升高、肾功能的损害相平行     

肝癌患者血脂及总胆汁酸检测的临床意义

目的 :探讨肝癌患者血脂及总胆汁酸水平的变化及其临床意义。方法 :测定 40例肝癌患者总胆固醇 (TC)、甘油三脂(TG)、高密度脂蛋白 (HDL -C)、低密度脂蛋白 (LDL -C)、载脂蛋白A1(APOA1)、载脂蛋白B(APOB)、脂蛋白a[LP(a) ]及总胆汁酸 (TBA)水平 ,并以 90例健康人作为对照。结果 :肝癌患者各项指标水平 ( x±s)分别为TC 3 .85± 1.16,TG 1.0 5± 0 .63 ,HDL -C 0 .91± 0 .5 1,LDL -C 2 .74± 0 .88,APOA10 .73± 0 .3 5 ,APOB 0 .87± 0 .3 4,LP(a) 78.2 6± 5 5 .48,TBA 2 9.3 2± 10 .17,对照组各项指标为TC 4.2 8± 0 .72 ,TG1.98± 1.5 8,HDL -C 1.3 1± 0 .2 8,LDL -C2 .96± 0 .67,APOA11.3 5± 0 .2 0 ,APOB 0 .91±0 .2 9,LP(a) 15 3 .63± 112 .65 ,TBA 8.0 2± 2 .15 ,经统计学处理表明TC、TG、APOA1、HDL -C、LP(a)均低于对照组 ,TBA高于对照组 ,而LDL -C、APOB与对照组比较无显著性差异。结论 :肝癌患者存在血脂水平的代谢紊乱 ;检测肝癌患者的血脂及总胆汁酸水平 ,对于观察病情具有实用的临床意义。     

应用高敏C-反应蛋白研究他汀类药物对急性冠状动脉综合征的干预作用

目的　探讨洛伐他汀和氟伐他汀对急性冠脉综合征患者血清高敏C 反应蛋白 (hs CRP)及血脂水平的影响。方法　 78例急性冠脉综合征患者随机单盲分为 3组 ,其中对照组 (A组 ) 18例 ;洛伐他汀组(B组 ) 30例 ,2 0mg/d ;氟伐他汀组 (C组 ) 30例 ,2 0mg/d ;随访 30天 ,检测患者治疗前后 30天血清的hs CRP浓度和血脂浓度变化。结果　治疗 30天后 ,B、C组能显著降低血总胆固醇 (TC)、甘油三酯 (TG)及低密度脂蛋白 (LDL)水平、升高血高密度脂蛋白 (HDL) ;两组间疗效无明显差异。B、C组能显著降低hs CRP的浓度 ,两组间疗效无明显差异。B、C组患者的血清hs CRP水平降低与血清TC、TG、LDL的水平降低、HDL的水平升高不相关。结论　洛伐他汀和氟伐他汀治疗急性冠脉综合征患者 30天就可明显改善血脂 ,降低hs CRP水平 ,并且具有抗炎症和稳定冠状动脉斑块的作用     

慢性肾脏疾病患者肾功能水平与血脂代谢的关系

目的探讨慢性肾脏疾病患者肾功能与血脂代谢的关系。方法慢性肾脏衰竭(CRF)组29例,慢性肾炎(CN)组21例,糖尿病肾脏疾病(DN)组14例,肾脏疾病综合征(NS)组,12例。以健康体检者65例纳入对照组,检测肾功能、血脂、超敏C反应蛋白(hs-CRP)、24h尿蛋白排泄量各指标的关系。结果 CN组尿素氮(Urea)、血清胱抑素C(CysC)、肌肝(Cr)、尿酸(UA)、β2-微球蛋白(β2-MG)、hs-CRP、低密度脂蛋白(LDL-C)、脂蛋白a[LP(a)]、24h尿蛋白有明显升高;DN组Urea、肌酐(Cr)、β2-MG、CysC、hs-CRP、载脂蛋白A1(ApoA1)、LP(a)、24h尿蛋白有明显升高;NS组Urea、hs-CRP、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、LDL-C、载脂蛋白B(ApoB)、LP(a)、24h尿蛋白有升高;CRF组Urea、Cr、UA、β2-MG、CysC、hs-CRP、TG、LDL-C、ApoB、LP(a)、24h尿蛋白均有明显升高。结论肾脏疾病患者在肾功能指标发生改变的同时,伴随有血脂及hs-CRP的改变。     

LP（a）、hs—CRP和LDL—C检测在冠心病诊断中的意义

[目的]探讨脂蛋白（a）、高敏C反应蛋白（hs—CRP）和低密度脂蛋白胆固醇（LDL—C）检测在冠心病诊断中的意义。[方法]采用免疫比浊法检测LP（a）、酶联免疫吸附法检测125例CHD患者的hs—CRP，常规生化分析仪测定LDL—C。CHD患者中急性心肌梗死（AMI）41例，不稳定型心绞痛（UAP）42例，稳定型心绞痛（SAP）42例，35例健康体检者作为对照组。[结果]（1）CHD血清LP（a）、LDL—C、hs—CRP浓度显著高于正常对照组（P〈0．01）；（2）急性心肌梗死的患者和不稳定型心绞痛患者LDL—C、hs—CRP水平较稳定型心绞痛组升高（P〈0．01）。[结论]LP（a）、hs—CRP和LDL—C参与CHD的发病过程，三者联合检测有助于了解CHD患者的病情变化和判断预后。     

高血压病人血脂和脂蛋白水平变化与肾损害关系

目的　探讨高血压病人血脂、脂蛋白水平变化与肾脏损害的关系。方法　随机取 94例高血压住院病人 ,分为高血压未发生肾损害组 (n =40 )、高血压早期肾损害组 (n =3 6)、高血压临床肾损害组 (n =18) ,以 98例血压正常者作为对照 ,检测血清总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、载脂蛋白A1及B(apoA1、apoB)、脂蛋白 (a) [Lp(a) ] ,进行比较分析。 结果　高血压病人血清TC、TG、LDL C、apoB、Lp(a)水平明显高于正常对照组 ,差异有显著性意义 (P均 <0 .0 1) ;HDL C水平明显低于正常人对照组 (P <0 .0 5 )。TC、LDL C、apoB水平随高血压肾功能损害的加重呈现升高的趋势 ,高血压临床肾损害组病人血清Lp(a)水平及异常率明显高于高血压早期肾损害和未发生肾损害患者组 ,差异有显著性意义 (P <0 .0 5 ,P <0 .0 1) ,其余各指标异常率三组间差异均无显著性意义。结论　高血压病人存在着明显的脂质异常 ,高血压肾损害与脂质代谢紊乱相关联 ,肾损害可加重脂质代谢紊乱。     

The clearance of Procalcitonin (PCT) during continuous veno-venous hemodiafiltration (CVVHD)

Objective. To evaluate the Procalcitonin (PCT) clearance during continuous veno-venous hemodiafiltration (CVVHD).?Design. Case report?Setting. Surgical intensive care unit?Patient. 51-year-old man, who had undergone total thyroidectomy about ten years before owing to multiple endocrine neoplasia 2 (MEN 2), suffering from multiple organ dysfunction syndrome (MODS) with acute renal failure after severe trauma caused by a traffic accident.?Measurements and main result. The samplings of prefilter (afferent) and post-filter (efferent) blood and of ultradiafiltrate were 6 times performed during 24 h of CVVHD to calculate the PCT clearance of hemdiafiltration.?During the first half period of CVVHD the serum PCT concentration did not decrease, though PCT had been eliminated from serum. On the other hand during the latter half period of it the serum PCT value decreased (from 46.8 ng/ml to 29.4 ng/ml) and the amount of the eliminated PCT from serum was about 100 ng per minute and its clearance was 2.3 ∼ 3.4 ml/min.?Conclusion. The CVVHD could eliminate PCT from serum. First it was brought about by the adsorption by the filter menbrane and then by ultradiafiltration. Received: 25 February 1999/Final revision received: 31 May 1999/Accepted: 9 June 1999     

Quality management of potential chemotherapy-induced neutropenic complications: evaluation of practice in an academic medical center

Goals

Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guidelines?

Materials and methods

This retrospective chart review study included a random sample of 305 cancer patients receiving care at a single US academic medical center. Abstracted data included demographics, risk factors, and outcome variables (e.g., development of FN/SN, administration of myeloid growth factors). To evaluate quality of care, we assessed conformance between actual practice and established clinical practice guidelines for the use of myeloid growth factors from the National Comprehensive Cancer Network (NCCN).

Main results

Of the 305 cases reviewed, 8% were classified as low risk (<10%), 48% as intermediate risk (10–20%), and 44% as high risk (>20%), using the risk classifications in the NCCN guidelines modified to accommodate illness and other risk factors. Thirty-four percent received prophylactic administration of myeloid growth factors. Half of the cases had adequate documentation of mid-cycle absolute neutrophil count to determine whether FN/SN developed. Among these cases with adequate documentation, 21% developed FN/SN. Use of growth factors did not conform to established quality guidelines. Overall, 77 of 133 (58%) high-risk cases received myeloid growth factors, whereas six of 25 (24%) low-risk cases received myeloid growth factors.

Conclusions

Routine clinical practice in this academic oncology setting was poorly aligned with established guidelines; there is substantial opportunity to standardize clinical strategies and increase conformance with evidence-based guidelines.     

Ultrasonic study of venous patterns in the right hypochondrium: An anatomical approach to differential diagnosis of obstructive jaundice

Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused portal hypertension, systemic venous enlargement caused cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.     

新生儿缺氧缺血性脑病NO、GSH—PX和TNF的含量测定及其临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)血浆和脑脊液(CSF)中的一氧化氮(NO)和谷胱甘肽过氧化物酶(GSH-PX)和肿瘤坏死因子(TNF)含量变化及其与HIE不同时期和不同程度间的相关关系.方法对HIE患儿第3天的CSF和出生初入院(HIE2h内)、第1天、第2天、恢复期的血浆中NO、SOD进行检测,并与正常对照组比较;分析NO、GSH-PX、TNF的变化原因和意义.结果HIE患儿血浆中第1天的NO含量最高,而GSH-PX相反;初入院、第1天、第3天的血浆中NO、GSH-PX含量与正常对照组对比均有显著性差异(P＜0.01),而恢复期中NO、GSH-PX含量与正常对照组对比无显著性差异(P＞0.05),血浆和HIE第3天的CSF中NO和GSH-PX水平均呈负相关;病情越重NO浓度越高,GSH-PX越低.急性期血浆TNF显著高于对照组(P＜0.01),恢复期两组无显著性差异(P＞0.05).结论NO、GSH-PX和TNF参与HIE的发病过程,在HIE的发病过程中起着重要作用;检测血浆和CSF中NO、GSH-PX、TNF含量有助于判断HIE患儿病变程度和病情进展.     

Comparison of two methods based on photoplethysmography for the diagnosis of peripheral arterial disease

Aim. To examine the interchangeability of two methods for distal pressure measurement based on photoplethysmography using a truncated or full display of the arterial inflow curve, respectively. Methods. Toe and ankle pressures were obtained from 69 patients suspected of peripheral arterial disease (PAD). Observer reproducibility of the curve readings was examined by blinded reassessment of the pressure curves in a randomly selected subgroup (60 limbs). Results. There were no significant differences in mean pressures between the two methods (p for all >?.455). The limits of agreement for the differences were ?15.0–15.4?mmHg for right toe pressures, ?16.3–16.2?mmHg for left toe pressures, ?14.2–15.7?mmHg for right ankle pressures, and ?18.3–17.7?mmHg for left ankle pressures. Correlation analysis revealed intraclass correlation coefficients ≥0.960 for all measuring sites. Cohen’s Kappa showed excellent agreement in diagnostic classification, with κ?=?0.930 for the diagnosis of PAD and perfect agreement in the diagnosis of critical limb ischemia (κ?=?1.000). The analysis of intra-observer variation for curve reading showed limits of agreement of ?3.9–4.0 for toe pressures and ?7.6–7.7 for ankle pressures for the method involving truncated display and ?3.1–3.2 for toe pressures and ?6.3–8.6 for ankle pressures for the method involving full display of the signal. Conclusion. The present study shows minimal differences in diagnostic classification, as well as in ankle and toe pressures, between the full display and the truncated display of the photoplethysmographic pulse signal. Furthermore, the inter-observer variation was low for both of the photoplethysmographic methods investigated.     

动脉瘤性蛛网膜下腔出血病人血清FSH LH PRL GH的浓度变化

目的　研究动脉瘤性蛛网膜下腔出血 (SAH)病人血清卵泡刺激素 (FSH)、黄体生成素 (LH)、泌乳素 (PRL)、生长激素 (GH)的浓度变化规律。方法　对 35例动脉瘤性SAH病人发病后 1～ 3、7～ 9、13～ 15d血清FSH、LH、PRL、GH的浓度进行动态观察 ,用TCD检测大脑中动脉血流速度 (VMCA)。结果　动脉瘤性SAH病人血清FSH、LH、PRL、GH浓度在发病后 1～3、7～ 9d各均值明显高于对照组 ,尤以发病后 7～ 9d变化最明显 ;术前、术后有脑血管痉挛 (CVS)组和非CVS组也有明显差异。结论　动脉瘤性SAH病人血清FSH、LH、GH、PRL含量与SAH的病情演变、CVS程度有关 ,并可判断预后。     

健康国人年龄性别对主要脑底动脉血流速度的影响及其检测方法的探讨

应用多普勒技术探测颅外脑血管血流速度,1965年由Miyazaki等首先报告,然而,由于骨骼严重衰减超声波,故使用5～10MHz探测频率难以记录颅内血管的血流速度。1982年Aaslid报告了应用脉冲多普勒技术,通过调整取样深度,观察了颅内脑动脉的血流速度,此后,颅内主要脑底动脉的血液动力学变化,以及无创手段对频内脑血管血流速度的监测得到了广泛的研究和深入的开展。我们心功能科自1988年12月引进美国Meda Sonics经颅超声多普勒(TCD)诊断仪以来     

Individual patient diagnosis of AD and FTD via high-dimensional pattern classification of MRI

The purpose of this study is to determine the diagnostic accuracy of MRI-based high-dimensional pattern classification in differentiating between patients with Alzheimer's disease (AD), Frontotemporal Dementia (FTD), and healthy controls, on an individual patient basis. MRI scans of 37 patients with AD and 37 age-matched cognitively normal elderly individuals, as well as 12 patients with FTD and 12 age-matched cognitively normal elderly individuals, were analyzed using voxel-based analysis and high-dimensional pattern classification. Diagnostic sensitivity and specificity of spatial patterns of regional brain atrophy found to be characteristic of AD and FTD were determined via cross-validation and via split-sample methods. Complex spatial patterns of relatively reduced brain volumes were identified, including temporal, orbitofrontal, parietal and cingulate regions, which were predominantly characteristic of either AD or FTD. These patterns provided 100% diagnostic accuracy, when used to separate AD or FTD from healthy controls. The ability to correctly distinguish AD from FTD averaged 84.3%. All estimates of diagnostic accuracy were determined via cross-validation. In conclusion, AD- and FTD-specific patterns of brain atrophy can be detected with high accuracy using high-dimensional pattern classification of MRI scans obtained in a typical clinical setting.     

电磁脉冲照射对小鼠脑组织氧化状态的影响及姜黄素的治疗作用

目的观察电磁脉冲（EMR）照射后小鼠脑组织超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）的变化及姜黄素的防护作用。方法40只小鼠随机分为空白对照组、单纯EMR组、EMR＋姜黄素低剂量（20mg／kg／d）组、中剂量（40mg／kg／d）组、高剂量（80mg／kg／d）组，每组8只。EMR组和EMR＋姜黄素组小鼠接受200kV／m的EMR照射，EMR＋姜黄素组小鼠同时每日给予不同剂量的姜黄素，5d后停止照射及给药，测定小鼠脑组织中SOD、GSH-Px、MDA的变化。结果与空白对照组比较，EMR照射组小鼠脑组织SOD与GSH-Px活性及MDA含量上升（均P〈0．05）；与单纯EMR组比较，EMR＋姜黄素中、高剂量组小鼠脑组织SOD与GSH-Px活性及MDA含量下降（均P〈0.05）。结论200kV／m的EMR照射可导致小鼠脑组织过氧化，姜黄素可通过其抗氧化作用有效治疗这种损伤，且效应呈一定的剂量依赖关系。     

载酯蛋白A-I与急性呼吸道感染的关系

目的 探讨急性呼吸道感染患者血清载酯蛋白A-I(ApoA-I)变化及临床意义.方法 2006年12月至2007年7月入住上海交通大学附属第一人民医院急诊ICU及急诊观察室急性呼吸道感染患者为试验组(44例),根据降钙素原(PCT)的质量浓度进行分组,分为PCT＜0.5 ng/ml组,0.5ng/ml∧≤PCT＜2 ng/ml组,PCT≥2 ng/ml组.41例健康体检者为对照组.试验组和对照组均在入院24h内测定静脉血中ApoA-I、PCT、C反应蛋白(CRP)和白蛋白水平.统计学方法计量资料用均数±标准差(x±s)表示,应用SPSS 12.0软件进行统计学分析,计量资料的比较采用t检验及方差分析,相关性分析采用直线相关分析,P＜0.05为差异具有统计学意义.结果 随着PCT质量浓度增加,ApoA-I和血清白蛋白值越低而CRP值越高(P＜0.05).结论 ApoA-I与呼吸道感染的严重程度呈正相关,在较严重的呼吸道感染ApoA-I具有一定的诊断价值,表明这类患者存在脂质代谢紊乱.