高通量血液透析和持续不卧床腹膜透析对钙磷代谢的影响

目的 探讨高通量血液透析(HFHD)和持续不卧床腹膜透析(CAPD)对钙磷代谢的影响.方法 40例慢性肾脏病第5期患者按随机数字表法分为HFHD组和CAPD组,每组20例,HFHD组给予HFHD治疗,CAPD组给予CAPD治疗,测定两组患者在治疗前及治疗第1、3、6个月末的钙磷代谢指标,并进行比较.结果 治疗第1个月末,CAPD组血钙低于HFHD组[(1.98±0.12)mmol/L比(2.21±0.19) mmol/L],1,25二羟基胆骨化醇低于HFHD组[(13.65±3.61) ng/L比(19.89±7.78) ng/L],血磷高于HFHD组[(1.75±0.39) mmol/L比(1.55±0.25) mmol/L],全段甲状旁腺激素(iPTH)高于HFHD组[(298.38±64.04) ng/L比(226.76±43.21) ng/L],差异均有统计学意义(P＜0.05).治疗第3个月末,CAPD组血磷低于HFHD组[(1.23±0.60) mmol/L比(1.61±0.40)mmol/L],iPTH低于HFHD组[(176.30±33.98) ng/L比(237.83±32.93) ng/L],1,25二羟基胆骨化醇高于HFHD组[(37.85±9.38) ng/L比(21.38±8.72) ng/L],差异均有统计学意义(P＜0.05或＜0.01).治疗第6个月末,CAPD组血磷低于HFHD组[(1.07±0.15) mmol/L比(1.56±0.23) mmol/L],iPTH低于HFHD组[(121.56±23.29) ng/L比(174.49±25.02) ng/L],1,25二羟基胆骨化醇高于HFHD组[(65.74±9.46) ng/L比(43.09±9.88) ng/L],差异均有统计学意义(P＜ O.01或＜0.05).结论 HFHD和CAPD均有改善钙磷代谢的作用.治疗第1个月末,HFHD对血钙、1,25二羟基胆骨化醇显著升高,对血磷、iPTH显著清除,优于CAPD.治疗第3、6个月末,CAPD对血钙、1,25二羟基胆骨化醇显著升高,对血磷、iPTH显著清除,均优于HFHD.     

危重病患者早期血浆N末端B型钠尿肽前体水平与疾病严重程度及炎性因子相关性研究

目的 探讨危重病患者早期血浆N末端B型钠尿肽前体(NT-proBNP)表达对炎性因子及预后的影响.方法 46例危重病患者治疗前检测血浆NT-proBNP、白细胞介素(IL)-6、IL-10,并行急性生理学和慢性健康状况(APACHE)Ⅱ评分,记录28 d存活情况,分为生存组和死亡组,每组23例.根据不同APACHEⅡ评分分为＜15分组(20例)、15～25分组(18例)、＞25分组(8例).结果 生存组血浆NT-proBNP、IL-6、APACHEⅡ评分均显著低于死亡组[(1073.30±677.38) ng/L比(1529.87±721.22) ng/L、(33.31±14.03) ng/L比(65.03±36.12) ng/L、(14.96±6.19)分比(19.21±7.16)分,P＜ 0.05].15～ 25分组血浆NT-proBNP、IL-6显著高于＜15分组[(1352.28±581.19) ng/L比(911.30±412.35) ng/L、(56.02±33.28) ng/L比(31.49 ±20.39) ng/L,P＜0.05],＞25分组血浆NT-proBNP[(2163.25±920.39) ng/L]显著高于15～25分组(P＜0.05).NT-proBNP与APACHEⅡ评分、IL-6呈正相关(r=0.6586,P＜0.01;r=0.3634,P＜ 0.05),与IL-10无相关性(r=0.0458,P＞0.05).结论 早期血浆NT-proBNP水平升高,可反映疾病严重程度及炎性状态,对判断预后有指导意义.     

颅脑创伤患者早期动态监测血碱剩余水平对判断预后的价值

目的 动态监测颅脑创伤患者入院后3d内血碱剩余(BE)水平的变化,评估血BE水平对预后的影响.方法 选取颅脑创伤患者56例,监测入院后3d内动脉血BE水平,按入院即刻格拉斯哥昏迷量表(GCS)评分将患者分为轻型(13 ～ 15分)组15例、中型(9～ 12分)组22例、重型(3～8分)组19例,按预后分为死亡组14例与存活组42例,以入院后3d内血BE水平分为高BE(≥-8 mmol/L)组35例和低BE(＜-8 mmol/L)组21例,比较评估血BE水平与患者病情严重程度、预后的关系.结果 轻、中、重型组患者入院后1、2、3d血BE水平较入院即刻出现不同程度的升高,轻型组[(-3.02±0.21)mmol/L]、重型组[(-9.64±1.19)mmol/L]分别与中型组[(-8.49±1.44)mmol/L]比较差异有统计学意义(P＜0.01);死亡组患者入院即刻、入院后1、2、3d血BE水平均显著低于存活组[(-11.97±2.13)mmol/L比(-6.29±1.16) mmol/L,(-9.84±1.33)mmol/L比(-4.89±1.78) mmol/L,(-8.78±2.01)mmol/L比(-3.61±1.43)mmol/L,(-7.84±1.42)mmol/L比(-3.10±0.98) mmol/L](P＜ 0.01);低BE组入院即刻急性生理和慢性健康状况Ⅱ评分、病死率均高于高BE组[(24.84±3.68)分比(16.27±2.21)分;52.4％(11/21)比8.6％(3/35)] (P＜ 0.01),入院即刻GCS评分低于高BE组[(7.56±3.09)分比(1 0.51±2.43)分](P＜0.01).结论 早期动态监测血BE水平是评价颅脑创伤患者治疗效果及预测预后的简单而有效的指标,值得临床推广应用.     

N末端B型利钠肽原对急性脑梗死病情和预后的意义研究

目的 探讨急性脑梗死患者血清N末端B型利钠肽原(NT-proBNP)对病情和预后的评估价值.方法 选择132例急性脑梗死患者作为观察组,64例健康体检者作为对照组.观察组中小面积梗死5例,中等面积梗死50例,大面积梗死31例;临床神经功能损害程度,轻型50例,中型45例,重型37例.测定并比较两组血清NT-proBNP水平,并分析观察组患者血清NT-proBNP水平与梗死面积、神经功能损害程度及梗死部位的关系.结果 观察组血清NT-proBNP水平为(616.76±424.82) ng/L,显著高于对照组的(68.16±38.52) ng/L,差异有统计学意义(P＜0.01).血清NT-proBNP水平大面积梗死患者[(842.22±328.54) ng/L]和中等面积梗死患者[(290.26±204.16) ng/L]均高于小面积梗死患者[(137.38±89.62) ng/L],差异均有统计学意义(P＜0.01);大面积梗死患者血清NT-proBNP水平高于中等面积梗死患者,差异有统计学意义(P＜0.01).不同梗死部位患者血清NT-proBNP水平比较差异无统计学意义(P＞0.05).血清NT-proBNP水平临床神经功能损害重型患者[(1184.82±262.58) ng/L]明显高于中型患者[(542.82±228.84) ng/L]和轻型患者[(356.62±204.38) ng/L],差异均有统计学意义(P＜0.01);中型患者高于轻型患者,差异有统计学意义(P＜0.01).血清NT-proBNP水平与美国国立卫生院卒中量表(NIHSS)评分呈正相关(r=0.57,P＜0.01).结论 急性脑梗死患者血清NT-proBNP水平明显升高,并且与神经功能损害程度、梗死面积呈正相关,NT-proBNP可作为急性脑梗死判断病情和预后的指标.     

儿科重症监护病房患儿动态监测血乳酸与小儿危重病例评分相关性研究

目的　探讨动态监测血乳酸与小儿危重病例评分(PCIS)的相关性及临床意义.方法对77例患儿入住儿科重症监护病房(PICU)时立即进行PCIS,根据PCIS分为极危重组(23例)、危重组(32例)、非危重组(22例),以患儿住院28　d是否存活分为死亡组(22例)和存活组(55例),并检测其动脉血乳酸.比较各组间的乳酸监测指标、PCIS,进行相关性分析,及其与患儿预后的关系.结果极危重组入PICU时血乳酸[(5.28±3.69)mmol/L]、乳酸峰值[(8.54±4.32)　mmol/L]明显高于危重组和非危重组(P＜0.05),而PCIS[　(65.79±2.34)分]明显低于其他两组(P＜0.05);死亡组PCIS低于存活组(P＜0.05),而入PICU时血乳酸水平和乳酸峰值高于存活组(P＜0.05或＜0.01);PCIS与血乳酸水平呈负相关(P＜0.01).结论血乳酸水平升高的危重症患儿,病情更重、预后更差,PCIS与血乳酸水平存在明显负相关,动态监测血乳酸水平是反映危重症患儿病情严重程度和预测患儿转归的较好指标.     

成纤维细胞生长因子-23和慢性心力衰竭的相关性研究

目的 通过慢性心力衰竭与成纤维细胞生长因子（FGF）-23水平的相关性研究,探索心力衰竭的发病机制,为慢性心力衰竭诊断提供新的方法.方法 选择128例慢性心力衰竭患者（慢性心力衰竭组）,按左室射血分数（LVEF）水平分为LVEF轻度减低组（LVEF 40％～50％,50例）、LVEF中度减低组（LVEF30％ ～ 39％,35例）、LVEF重度减低组（LVEF＜ 30％,43例）.另选择同期健康体检者50例作为对照组.检测各组FGF-23、甲状旁腺激素（PTH）及肌酐（Cr）、尿素氮（BUN）、血钙、血磷、N末端B型钠尿肽前体（NT-proBNP）水平,并进行心脏彩色超声检查.结果 慢性心力衰竭组FGF-23、血磷、PTH、左室质量指数（LV MI）、NT-proBNP显著高于对照组[68.44（55.85～ 94.73）ngL比34.18 （30.57～38.87） ng/L、（1.13±0.13） mmol/L比（1.02±0.12） mmol/L、（15.51±3.99） ng/L比（9.97±0.89） ng/L、（112.27±52.02） g/m2比（71.37±12.95） g/m2、（6 265.3±15 991.6） ng/L比（76.12±51.80） ng/L],血钙、GFR低于对照组[（2.28±0.16） mmol/L比（2.48±0.13） mmol/L、（78.28±14.20） ml/（min· 1.73 m2）比（85.03±14.44） ml/（min·1.73 m2）],差异均有统计学意义（P＜0.01）.Spearman相关分析显示,FGF-23与年龄（r=0.256,P＜0.01）、血磷（r=0.326,P＜0.01）、PTH （r=0.584,P＜0.01）、NT-proBNP（r=0.799,P＜0.01）、LVMI（r=0.540,P＜ 0.01）呈正相关,与血钙（r=-0.308,P＜0.01）、GFR（r=-0.527,P＜0.01）呈负相关.FGF-23水平随着LVEF水平的降低而升高.结论 FGF-23水平与慢性心力衰竭严重程度密切相关,提示其可作为评价心肌收缩功能标志物之一.     

血浆氨基末端B型钠尿肽前体及组织多普勒成像评价左室舒张功能不全价值的研究

目的 探讨血浆氨基末端B型钠尿肽前体(NT-proBNP)及组织多普勒成像评价左室舒张功能不全的价值.方法 选择舒张性心力衰竭患者43例,根据舒张早期二尖瓣口血流速度(E)与舒张早期二尖瓣环运动速度(Em)的比值将患者分为三组:E/Em＜8为Ⅰ组,E/Em 8～15为Ⅱ组,E/Em＞15为Ⅲ组.测定三组患者血浆NT-proBNP水平,并进行比较.结果 Ⅲ组NT-proBNP水平[(1119±3123)ng/L]显著高于Ⅱ组[(684±1742)ng/L]和Ⅰ组[(276±438)ng/L](P＜0.01),Ⅱ组NT-proBNP水平显著高于Ⅰ组(P＜0.01).相关性分析表明E/Em与NT-proBNP具有相关性(r=0.438,P＜0.01).结论 血浆NT-proBNP水平及组织多普勒成像可用于评价左室舒张功能不全.     

脓毒症休克患者心肌损伤程度及预后判断的研究

目的 探讨心肌肌钙蛋白Ⅰ（cTnI）、脑钠尿肽（BNP）、血乳酸、急性生理和慢性健康评估（APACHE）Ⅱ评分在脓毒症休克患者中判断心肌损伤程度及预后的价值.方法 确诊脓毒症休克患者61例,入院后即刻,治疗后6,24h检测血乳酸、BNP、cTnI水平,并进行APACHEⅡ评分,观察存活组和死亡组上述指标差异.结果 61例患者中35例存活（存活组）,26例死亡（死亡组）.死亡组入院后即刻BNP、cTnI、血乳酸、APACHEⅡ评分均明显高于存活组,差异有统计学意义（P＜0.05）.死亡组治疗后6h上述指标与入院后即刻比较差异无统计学意义（P＞0.05）,治疗后24 h上述指标显著高于入院后即刻,差异有统计学意义（P＜0.05）.存活组治疗后6,24h上述指标均较入院后即刻明显降低,且治疗后24 h上述指标均较治疗后6h也明显降低[BNP：（478.1±95.3） ng/L比（1025.2±263.3） ng/L;cTnI：（0.9±0.1） μg/L比（2.5±0.4）μg/L;血乳酸：（2.4±0.3） mmol/L比（5.4±2.1） mmol/L; APACHEⅡ评分：（11.4±1.8）分比（15.6±2.9）分],差异均有统计学意义（P＜0.05）.结论 BNP、cTnI、血乳酸、APACHEⅡ评分可反映脓毒症休克患者心肌损伤的严重程度,预测患者预后.     

血乳酸水平与重症肺炎预后关系的研究

目的探讨血乳酸水平与重症肺炎预后的关系。方法依据重症肺炎患者入院28 d生存状况分为存活组及死亡组,回顾性分析两组入院后48 h动态血乳酸变化。结果重症肺炎患者入院48 h血乳酸水平,死亡组(2.91±1.54)mmol/L,存活组(1.73±1.05)mmol/L,死亡组高于存活组,差异有统计学意义(P<0.05);6 h血乳酸清除率死亡组(6.87±3.89)%,存活组(18.88±9.24)%,死亡组明显低于存活组,差异有统计学意义(P<0.01),提示动态血乳酸测定较单次血乳酸测定对重症肺炎患者预后更具有价值。结论动态监测血乳酸水平,尤其是6 h血乳酸清除率对判断重症肺炎预后具有较高的价值。     

尿磷排泄率对继发性甲状旁腺功能亢进症早期诊断意义的探讨

目的 探讨尿磷排泄率对继发性甲状旁腺功能亢进症(SHPT)早期诊断的意义.方法 选择未接受透析的慢性肾脏病(CKD)5期患者50例,另选取100例肾功能正常的健康人,分别测定尿磷排泄率和血浆全段甲状旁腺激素(iPTH)水平,并对所得结果进行统计学分析.结果 与肾功能正常的健康人比较,CKD5期患者血钙水平和尿磷排泄率明显降低[(2.05±0.72) mmol/L比(2.41±0.33) mmol/L和2.86±1.52比7.24±3.16],血磷水平和血浆iPTH水平明显升高[(1.92±0.93) mmol/L比(1.14±0.11) mmol/L和(392.34±93.12) ng/L比(32.34±9.17) ng/L],差异有统计学意义(P＜0.01)；CKD5期患者中,随着尿磷排泄率的降低,血浆iPTH水平逐渐增高,二者呈明显负相关(Kendall秩相关:r=-0.543,P＜ 0.01；Spearman秩相关:r=-0.686,P＜ 0.01).结论 尿磷排泄率对早期诊断SHPT具有一定的意义.     

医疗服务操作分类与编码的设计与应用简

医疗服务操作分类与编码是医学信息标准化的重要组成部分,是临床数据提取、分析和应用的基础。世界卫生组织及世界多国一直致力于开发、更新和维护此分类与编码。我国此前一直沿袭美国准备在2014年停止使用的ICD-9-CM-3（卷3）,中国需要结合国际主流设计思路,根据国情开发出适宜的多轴、一体化的医疗服务操作分类与编码体系。     

环境中双酚A的污染及降解去除的研究进展

近10年来随着科学与社会的发展，环境雌激素污染日益引起人们的关注。双酚A是环境雌激素的一种，用途广泛，但具有多方面的毒性。对其毒理、污染及降解去除的研究已经成为国际上的研究热点。该文拟对上述几方面的研究进展情况作一简要介绍。     

黄体功能不健的调控机理

主要就引起卵巢黄体功能不健的因素 ,分别从激素调节、细胞因子 (VEGF、TNF α、BFGF、IFN γ、IGF)、C myc、Fas、SGP 2基因调控以及细胞连接、细胞粘附分子、NO等对卵巢功能的调节及对黄体细胞的凋亡影响进行阐述 ,认为卵泡发育不良、颗粒细胞、黄体细胞的凋亡与黄体功能不足有密切的关系。且多种细胞因子、基因表达产物参与此过程的调控。深入的研究这一调控机制 ,对于进一步了解卵巢卵泡生长发育、卵泡闭锁及黄体细胞凋亡的内在机制有重要意义     

HIS与PACS软件融合方案的设计与实现

目的：实现PACS与HIS的系统集成。方法：使用Powerbuilder设计电子申请系统，利用Oracle存储过程实现不同系统间的数据同步。结果：完成了第四军医大学西京医院的PACS／HIS软件融合，经临床应用，反应良好。结论：系统集成应根据医院需求，由信息科牵头，多方论证，遵循高可用性、低耦合度的原则，在保证软件实用、流程合理的前提下，应最大限度地压缩新旧流程的共存时间。     

Intake of dietary phytoestrogen and indices of antioxidant and bone metabolism of pre- and post-menopausal Korean women

A group of 101 women, aged 40-65 years consisted of 48 premenopausal subjects and 53 postmenopausal ones living in Daegu and Gyeongbuk area in Korea were evaluated with their general characteristics, lifestyle factors, nutrient and phytoestrogen intakes, blood and urinary indices concerning antioxidant status and bone metabolism. Body mass index (BMI), waist hip ratio (WHR) and systolic blood pressure (SBP) of the postmenopausal women were significantly higher (23.8, 0.86, and 126.9 mmHg, respectively) than those of the premenopausal women (22.6, 0.82, and 115.9 mmHg; respectively). Nutrient intakes of the postmenopausal and premenopausal groups were not different except lower fat intake and higher dietary fiber and iron intakes in the postmenopausal group. Daily total phytoestrogen intake was significantly higher in the postmenopausal group (48.54 mg) than the premenopausal (31.41 mg) and was resulted mostly from higher intakes of daidzein and genistein from soy and soy products (45.42 mg vs 28.91 mg). Serum genistein level and excretion of enterolactone, major lignan metabolite, were not very different between the two groups. Serum retinal and α- tocopherol levels were higher in the postmenopausal group but TBARS levels were not different between the two groups. Serum osteocalcin (7.18 ng/mL) and urinary deoxypyridinoline (7.15 nmol/mmol creatinine), in the postmenopausal group were significantly higher than those in the premenopausal group (4.80 ng/mL, 5.95 nmol/mmol creatinine). Urinary excretion of enterolactone was positively correlated with serum osetocalcin in premenopausal women and serum genistein negatively correlated with the urinary DPD in postmenopausal women. Dietary phytoestrogen intake was negatively correlated with serum level of TBARS in all subjects. It is concluded that the effect of total phytoestrogen intake is beneficial on body antioxidant status in all middle-aged women regardless of menopause but the effect on bone metabolism appears different by the type of the phytoestrogen and the menopausal state.     

Reliability and validity of indices of hand-grip strength and endurance

Background/aim: Grip strength is useful in clinical practice for the assessment of disease and/or rehabilitation progression. Brief maximal gripping is seldom required in everyday occupations, with repeated or sustained gripping at sub‐maximal power more commonly involved. It has been proposed that assessment of both maximal hand‐grip force and endurance is utilised. While the suitability of maximal contraction measures has been clearly established, the reliability and validity of other hand‐grip indices have not been investigated. This study examined the reliability of various hand‐grip indices and their validity in relation to distance walked during the six‐minute walk test, a standardised exercise capacity test. Methods: Subjects undertook static sub‐maximal (50%) and maximal force contraction hand‐grip testing from which various indices were derived, and six‐minute walk testing from which distance walked was determined. Testing was repeated on three separate occasions for determination of test–retest reliability. Results: Pre‐ and post‐fatigue maximal contraction measurements demonstrated excellent test–retest reliability and validity. Conversely, other hand‐grip indices were shown to be unreliable and exhibited no relationship with distance walked and hence concurrent validity could not be established. Conclusions: Based on the results of this study, it is recommended that pre‐ and post‐fatigue maximal contraction may be utilised for the assessment of client ability and progression due to their established validity and test–retest reliability. However, previously proposed measures of fatigue such as endurance (duration of sustained contraction), Strength Decrement Index and work performed (function of endurance and force of contraction) are unreliable and invalid and may have limited use in clinical practice.     

Evaluation of impact of temperature and pH alterations on the size and antigenicity of meningococcal serogroup A and X polysaccharides and conjugates

The changes in the recommended storage conditions of the glycoconjugate vaccines against Neisseria meningitidis (Men) serogroup A and serogroup X can affect its activity or potency. Elevated temperature and the change in pH may result in the physical instability leading to the size degradation of the polysaccharide (PS) and subsequent loss of PS epitopes. Moreover, high temperature may also result in protein aggregation and altered tertiary structure of the protein in the conjugate. Consequently, the construction of a potent glycoconjugate is dependent on optimal temperature and pH. The changes in both these conditions can also affect the production of a capsular polysaccharide (PS) and its conjugation to a protein carrier and may also affect the integrity of the vaccine molecule including the maintenance of the protective epitopes. In our study we have used inhibition ELISA as a tool to assess the impact of temperature and pH alterations on the antigenicity of N. meningitidis serogroup A and X, PS and conjugates and their correlation with the size distribution analysis using high pressure size exclusion chromatography. The studies on pH alterations from 5 to 9 led to minimal impact on size and antigenicity of all antigens, however, an elevated temperature adversely impacted the antigen size as well as antigenicity to varying extent. Results indicate the higher stability of MenX PS and conjugate as compared to that for MenA counterparts at elevated temperatures. Furthermore, both the MenA and MenX conjugates appears to be more stable as compared to the corresponding PSs.     

Adenocarcinoma of the stomach and esophagus and drinking water and dietary sources of nitrate and nitrite

We conducted a population-based case-control study of adenocarcinoma of the stomach and esophagus in Nebraska, U.S.A. Nitrate concentrations in public drinking water supplies were linked to residential water source histories. Among those using private wells at the time of the interview, we measured nitrate levels in water samples from wells. Dietary nitrate and nitrite were estimated from a food-frequency questionnaire. Among those who primarily used public water supplies (79 distal stomach, 84 esophagus, 321 controls), average nitrate levels were not associated with risk (highest versus lowest quartile: stomach OR=1.2, 95% CI [0.5-2.7]; esophagus OR=1.3, 95% CI [0.6-3.1]). We observed the highest ORs for distal stomach cancer among those with higher water nitrate ingestion and higher intake of processed meat compared with low intakes of both; however, the test for positive interaction was not significant (p=0.213). We did not observe this pattern for esophagus cancer. Increasing intake of nitrate and nitrite from animal sources was associated with elevated ORs for stomach cancer and with a significant positive trend in risk of esophagus cancer (P-trend=0.325 and 0.015, respectively). Larger studies with higher exposures to drinking water sources of nitrate are warranted to further evaluate N-nitroso compound precursors as risk factors for these cancers.