肺部疾病引发全身炎症反应综合征的老年患者死亡因素分析

目的分析肺部疾病引发全身炎症反应综合征（SIRS）的老年患者病情死亡因素。方法选择2009年9月至2010年12月入住浙江大学医学院附属第一医院中心重症监护病房因肺部疾病引发SIRS的老年患者50例,根据预后情况分为存活组（18例）和死亡组（32例）。检测所有入院患者24h内的血清胆碱酯酶（ChE）、白蛋白（ALB）、D-二聚体、乳酸及C反应蛋白（CRP）水平,并进行急性病生理学和长期健康评价（APACHE）Ⅱ评分。结果存活组和死亡组之间比较,肺部疾病引发SIRS患者的血乳酸、ALB及APACHEⅡ评分差异无统计学意义（P均〉0.05）,而年龄、血浆D-二聚体、CRP及ChE方面,差异均具有统计学意义（P均〈0.05）。Logistic回归结果表明,影响肺部疾病引起SIRS的老年患者预后的独立危险因素仅有ChE一项（β=-0.016,P=0.040）。受试者工作特征曲线（ROC）分析显示,以ChE预测SIRS的老年患者预后的ROC曲线下面积为0.839,S.E.=0.057,P=0.000;当ChE=98.5U/L时,敏感度为88.9;1-特异度为0.25,以此切点对患者的预后具有较好的预测价值。结论 ChE可能参与了老年SIRS的发生和发展过程,对这类患者的病情发展转归有一定的预测作用,指标稳定,受干扰因素少。     

血清胆碱酯酶活性对慢性乙型肝炎肝组织病理分级分期的预测价值

目的探讨血清胆碱酯酶活性对慢性乙型肝炎肝组织病理学分级和分期的预测价值。方法 419例慢性乙型肝炎患者行肝穿活检;采用Roche全自动生化分析仪检测血清胆碱酯酶活性。结果血清胆碱酯酶活性在G1与G2、G2与G3、G3与G4之间均有显著性差异（P=0.000、0.000、0.014）,在S0与S1、S1与S2之间无显著性差异（P=0.309、0.370）,在S2与S3、S3与S4之间有显著性差异（P=0.000、0.000）;基于血清胆碱酯酶活性的判别函数预测G1、G2、G3、G4的正确率分别为55.65%、28.25%、27.83%、66.67%,预测S0、S1、S2、S3、S4的正确率分别为43.33%、6.49%、19.01%、31.11%、71.29%;血清胆碱酯酶活性预测G4和S4的ROC曲线下面积分别为0.868和0.831（P=0.000和0.000）,以血清胆碱酯酶活性≤5.235×103u/L和≤5.535×103u/L为标准,其预测G4和S4的灵敏度、特异度、准确度分别为1.000和0.822、0.678和0.758、0.687和0.771。结论血清胆碱酯酶活性对预测慢性乙型肝炎肝组织G4和S4有一定的参考价值。     

急性有机磷杀虫药中毒中间综合征的临床分析

目的探讨急性有机磷杀虫药中毒中间综合征（intermediate syndrome,IMS）的诊断治疗。方法回顾性分析10例IMS患者临床表现和治疗方法。结果有机磷中毒中间综合征的10例患者均出现不同程度呼吸肌麻痹症,及时建立人工气道及机械通气和乙酰胆碱酯酶（AchE）复能剂应用,治愈8例,死亡2例。结论 IMS应早期识别,建立人工气道与机械通气是抢救成功的重要方法。     

血清TBA、CHE及PA联合检测在不同类型肝病诊断中的应用

目的探讨血清总胆汁酸(TBA)、胆碱酯酶(CHE)及前白蛋白(PA)在不同类型肝病诊断中的应用。方法检测25例健康对照者和134例不同类型肝病患者的血清TBA、CHE及PAB等指标,并对结果进行分析。结果与对照组相比,除慢性肝炎轻度组外,其他各组血清TBA水平均显著高于正常对照(P<0.01),且以急性肝炎最高;与对照组相比,急性肝炎组、慢性肝炎轻度组和肝癌组的血清CHE水平差异无统计学意义(P>0.05);慢性肝炎中、重度组以及肝硬化组血清CHE水平明显降低(P<0.01);与对照组比较,除急性肝炎和慢性肝炎轻度组,其他各组血清PA水平差异均有统计学意义(P<0.01)。结论 TBA、CHE和PA在不同类型肝病诊断中具有一定的实用价值。     

Evaluation of Different Laboratory Tests and Activity Indices Reflecting the Inflammatory Activity of Crohn's Disease

In a prospective study we compared the usefulness of various laboratory tests (albumin, alpha-1-proteinase inhibitor (A1PI), cholinesterase (CHE), C-reactive protein, erythrocyte sedimentation rate, hematocrit) and activity indices (CDAI, VHAI) in relation to the disease activity by endoscopic criteria. Except for hematocrit highly significant differences (p < 0.0005) of the mean values of all test results were found for patients without or with slight mucosal lesions compared with patients with severe inflammation of the mucosa. Further analysis of the data indicates the highest test efficiency (84%), sensitivity (80%), and specificity (88.6%) for CHE. CHE showed good correlations to all other tests; the highest correlation was found between CHE and VHAI (r = -0.78). We suggest that a suppression of CHE synthesis mediated by endotoxins and cytokines rather than an increased intestinal loss explains the decreased CHE in severe Crohn's disease. It is concluded from the data that CHE is a useful test to assess the inflammatory activity of Crohn's disease.     

高氟饮水对小鼠脑功能的影响

目的 探讨高氟饮水对小鼠脑功能的影响。方法 对饮加氟离子浓度１００、５０、１０ｍｇ／Ｌ水６个月的小鼠,通过行为毒理学实验（穿梭箱试验）判断其学习和记忆功能,并对其脑组织胆碱酯酶（ＣｈＥ）活力进行测定。结果 饮高氟水的小鼠学习和记忆能力显著落后于对照组;高氟组小鼠脑组织ＣｈＦ活力显著高于对照组。结论 高氟饮水对小鼠脑功能有显著的影响,氟对中枢神经系统具有毒性作用。     

Erhebung des Ernährungszustandes — ein Bestandteil der klinischen Routine-Diagnostik: Cholinesterase-Aktivität als Ernährungsindikator

Summary Nutritional assessment has not yet been established as integral part of basic clinical diagnostic procedures everywhere, eventhough the prognostic relevance of malnutrition is well known. One of the reasons is the the lack of nutritional indicators, which are specific of and sensitive for changes of the nutritional status on the one hand, and routinely analyzed on the other. We report on the utility of serum cholinesterase, which has the shortest half-life of all plasma proteins, to identify malnourished patients. 54 internal inpatients with malignant diseases or in septic state were followed up prospectively with respect to courses of cholinesterase (CHE), albumin (ALB), transferrin (TRA), and body weight over periods of 4 weeks. A correct correlation to malnutrition was defined as plasma concentrations < reference ranges or continuous concentr. fall >10%. Based on 132 observations (65 with continuous weight loss, mean: –5.5% of original w.; 54 w. gain, mean +4,6%, 13 constant w.), changes of CHE had the highest correlation to weight changes (r=0.79,p<0.001), compared to the courses of TRA-or ALB-levels (r=0.65/0.68). Incorrect positive results (conc. fall or conc. < ref. range without weight loss): absolute levels — CHE 4%, ALB 4%, TRA 22%; conc. courses — CHE 0%, ALB 0%, TRA 6%. Incorrect negative: absolute c. — CHE 63%, ALB 30%, TRA 28%; courses — CHE 15%, ALB 19%, TRA 17%. The common determination of CHE and ALB-courses allowed a correct identification of malnutrition in 96% of all observations, with the same result as the courses of ALB + TRA. Because of its wide ref. ranges, the absolute CHE activity is useless for nutritional screening in contrast to ALB and TRA, but the follow-up of CHE-levels allows an excellent discrimination between good and bad nutritional status. The use of the CHE-course can be recommended as nutritional indicator, if TRA-analysis is not available.

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Abkürzungen ALB Albumin - CHE Cholinesterase - GEW Körpergewicht - OKG Optimales Körpergewicht - TRA Transferrin - MW Mittelwert - SD Standardabweichung - m männlich - w weiblich Herrn Prof. Dr. W. Kaufmann zur Vollendung des 65. Lebensjahres gewidmet.     

卡巴拉汀治疗血管性痴呆的开放性多中心随机对照研究

目的评价重酒石酸卡巴拉汀治疗血管性痴呆(VD)的疗效和安全性。方法多中心、随机、开放、对照试验。5个城市7家医院共98例VD患者[简易精神状态检查(MMSE)10～26分],随机进入对照组(n=48)和卡巴拉汀治疗组(n=50),为期12周,受严重急性呼吸综合征(SARS)影响,13例脱落,最终对照组37例,治疗组48例。对照组应用改善血液循环的药物,治疗组在应用改善血液循环的药物的同时服用卡巴拉汀4.5～6.0mg/d。在患者入组时(基线期)和12周末进行疗效评价,采用MMSE、血管性痴呆评估量表认知分量表(VaDAScog)、日常生活能力量表(ADL)及阿尔茨海默病评估量表非认知分量表(ADASnoncog),评估患者在认知功能、日常生活能力及精神行为症状三方面的变化;以总体印象变化量表(ADCSCGIC)评估总体疗效。安全性检查包括每2～4周评估生命体征和在基线及研究终点进行实验室检查。结果治疗组在记忆力、定向力、注意力、结构运用能力等认知领域的测验分数有所改善,与对照组相比,治疗组的MMSE总分(12周末20.2±4.8,基线18.9±4.8,P=0.003)和数字倒背成绩(12周末3.5±1.5,基线4.2±1.8,P=0.01)提高;两组的日常生活能力较基线均无明显变化(P>0.05);治疗组妄想症状减轻(P=0.03),爱流泪现象减少(P=0.06)。总体印象评估治疗组65.1%的患者有改善,多于对照组(40.1%),两组差异接近统计学显著水平(P=0.06)。对照组和治疗组的总不良事件概率分别为8.1%～10.4%,两组差异无统计学意义。药物对患者生命体征及实验室指标无影响。结论卡巴拉汀可以改善VD患者的认知功能和行为症状,且安全性和耐受性良好,可作为VD治疗的候选药物。     

Interactions of morphine and nalorphine with physostigmine on operant behavior in the rat

Morphine and nalorphine were tested alone and in combination with physostigmine (0.0625 mg/kg) in rats trained under a continuous avoidance schedule with an escape contingency. When tested alone, nalorphine increased avoidance rate in doses up to 32 mg/kg but exerted no other effects. Morphine, 1 mg/kg, increased avoidance response rate while higher doses produced a graded depression of all behavior. In the presence of physostigmine, nalorphine produced a well-defined graded depression of avoidance responding and increased the number of shocks received by the animals over a 16-fold dose range. Physostigmine failed to potentiate the prominent depressant effects of morphine in the same test situation. The finding that in the presence of cholinesterase inhibition nalorphine acts as a depressant of operant behavior in the rat supports existing evidence that cholinergic mediation should be considered as a factor in some of the actions of strong analgesics.Publication No. 1028 of the Division of Basic Health Sciences of Emory University. This investigation was supported by USPHS Grants SO-1-FR05364 and MH12870-04.A preliminary report of this investigation appeared in Fed. Proc, 30, 390 (1971).Postdoctoral trainee of NIH Graduate Pharmacology Training Grant GM-179 during part of this work.     

Regional pre- and postganglionic sympathetic activity during experimental paraoxon poisoning

The effects of 0.4 or 0.8 mg paraoxon/kg i.v. on circulation and regional pre- and postganglionic sympathetic activity were studied in anaesthetized rabbits. At both doses, the discharges of the preganglionic efferents increased slowly, whereas the changes in activity of postganglionic efferents differed. Concomitantly with a transient initial rise in blood pressure a temporary increase of discharges to the skeletal muscles and to the intestine was observed which is attributed to spontaneous firing of the regional ganglionic cells. After injection of 0.4 mg/kg there occasionally occurred a second pressor reaction conditioned by enhancement of preganglionic activity and facilitated transmission in certain sympathetic ganglia.After injection of the higher dose, postganglionic activity generally decreased except for the discharges of gastrointestinal efferents, which increased. Arterial blood pressure, cardiac output and total peripheral resistance fell markedly. A shock syndrome occurred which could be controlled by atropine injection if timely. From the results it was concluded that the higher dose of paraoxon blocked synaptic transmission in the paravertebral ganglia of the sympathetic trunk, and facilitated impulse transmission in the prevertebral abdominal ganglia.The authors dedicate this work in gratitude to Professor Dr. R. Domenjoz, on the occasion of his seventieth birthday