头部亚低温治疗新生儿缺氧缺血性脑病的疗效及其对脑脊液中肌酸激酶脑型同工酶的影响

目的:探讨头部亚低温治疗对新生儿缺氧缺血性脑病(HIE)脑脊液中肌酸激酶脑型同工酶(CK鄄BB)的影响及临床治疗效果。 方法:选择 2014 年 3 月至 2016 年 3 月在我院治疗的 HIE 患儿 84 例,随机分为亚低温组 39 例和常规治疗组 45 例,亚低温组在常规治疗基础上给予头部亚低温治疗,常规治疗组给予 HIE 常规治疗,检测两组患儿脑脊液中 CK鄄BB 变化,同时进行新生儿神经行为(NBNA)评分和婴幼儿期智能发育评估。 结果:亚低温组和常规治疗组患儿治疗 72 h 后脑脊液中 CK鄄BB 较治疗前降低(P<0.05);亚低温组治疗72 h 后脑脊液中 CK-BB 为(13.10±1.57)U/ L,明显低于常规治疗组(P<0.05);两组出生14 d、28 d 时 NBNA 评分均较出生 7 d 时明显升高(P<0.05);亚低温组出生14 d 和28 d 时 NBNA 评分为(37.10±1.32)分和(38.10±1.30)分,均明显高于常规治疗组(P<0.05);亚低温组出生后 3 个月和 6 个月智力发育指数(MDI)分别为(91.02±9.80)分和(99.10±7.53)分,明显高于常规治疗组(P<0.05);亚低温组出生后 3 个月和 6 个月心理运动发育指数(PDI)分别为(87.22±6.72)分和(95.10±5.52)分,明显高于常规治疗组(P<0.05)。 结论:头部亚低温治疗 HIE 有较好的效果,能明显降低患儿脑脊液中 CK-BB 水平,值得临床推广。     

新生儿窒息后血清CK-MB、CT-1及H-FABP判断心肌损伤的价值

目的 探讨新生儿窒息后血清肌酸激酶同工酶（CK-MB）、心肌营养素-1（CT-1）及心性脂肪酸结合蛋白（H-FABP）判断心肌损伤的价值。方法 选取2018年1月～2019年12月我院收治的窒息新生儿98例为观察组,其中有心肌损伤者31例,同时选取健康新生儿50例为对照组,比较两组患儿血清CK-MB、CT-1及H-FABP水平。结果 两组性别、胎龄、体质量及身长比较差异无统计学意义（P＞0.05）;观察组出生后5 min Apgar评分（5.30±0.82）明显低于对照组（9.40±0.32）（P＜0.05）。观察组血清CK-MB、CT-1及H-FABP分别为（6.62±1.31）ng/mL、（68.46±18.84）ng/L和（21.03±8.11）ng/mL,明显高于对照组（P＜0.05）;观察组有心肌损伤患儿血清CK-MB、CT-1及H-FABP分别为（7.01±1.22）ng/mL、（78.11±12.03）ng/L和（30.45±9.54）ng/mL,明显高于无心肌损伤患儿（P＜0.05）;血清CK-MB、CT-1及H-FABP判断心肌损伤的ROC曲线下面积分别为0.629、0.815和0.862,其中CT-1及H-FABP的ROC曲线下面积高于CK-MB（均P＜0.05）。结论 CK-MB、CF-1及H-FABP在判断新生儿窒息后心肌损伤中有一定应用价值,其中CF1及HFABP价值较高。     

Increased CKMB (mass concentration) in patients without traditional evidence of acute myocardial infarction. A risk indicator of coronary death.

A study of 102 patients consecutively admitted to a coronary care unit (CCU) investigated the clinical usefulness of three different immunoenzymometrical CKMB methods: NovoClone CK-MB, ICON QSR CKMB and IMx CK-MB. Blood samples were drawn on admission and then every 6 h for 48 h. The three different methods correlated very well (r = 0.93-0.96). With discrimination levels of 10 micrograms.l-1 for NovoClone CK-MB and 5 micrograms.l-1 for the other two methods, a sensitivity of 1.0 and a still acceptable specificity (> 0.81) were achieved. In the group of patients (n = 53) with suspicion of acute myocardial infarction (AMI) but with no standard criteria for AMI, 14 patients were identified with small but significant increase of serum CKMB (mass concentration) and an increased CKMB (mass concentration)/CK ratio. During a 4 year follow-up nine out of these 14 patients died within 2 years, the majority being coronary deaths, as compared to only two out of the remaining 39 non-AMI patients with suspicion of AMI but with normal CKMB values (chi 2 = 18.47, P < 0.001). The finding of such a high mortality rate among patients with increased CKMB (mass concentration) has an important prognostic value even in patients without standard criteria for AMI.     

不同地域阴道毛滴虫品系的同工酶电泳分析

目的研究中国大陆不同地域(北京、河北唐山、河北承德、江西九江)阴道毛滴虫7个分离株的生物学类型。方法用聚丙烯酸胺凝胶电泳(PAGE)、同工酶染色、聚类分析方法进行分析。结果检测MDH、LDH、G-6-PD、PGI、PGM等5种酶的同工酶。在G-6-PD、PGI酶谱中,7株完全相同。在MDH、LDH酶谱中,北京1株、北京2株、九江3株完全相同,而与承德株、唐山株、九江1株、九江2株不同。在PGM酶谱中,北京1株、北京2株完全相同,而与承德株、唐山株、九江1株、九江2株、九江3株不同。并依酶谱绘制系统进化树。承德株、唐山株、九江1株、九江2株与北京1株、北京2株、九江3株大多数同工酶谱存在显著差异,九江3株与北京1株、北京2株在5个同工酶谱中存在微小差异。结论我国阴道毛滴虫虫株可能至少存在3种不同的生物学类型。     

M2型丙酮酸激酶在肿瘤代谢和发展中的作用

肿瘤细胞不同于正常细胞,即使在氧气充足的条件下,主要依赖糖酵解代谢,称为有氧糖酵解.丙酮酸激酶(PK)是糖酵解最后一个限速酶,催化磷酸烯醇式丙酮酸产生丙酮酸和ATP.M2型丙酮酸激酶(PKM2),丙酮酸激酶同工酶之一,在肿瘤细胞中高表达.PKM2不仅在肿瘤代谢中,而且在基因表达的调控及细胞增殖中都具有重要作用.     

爱维治对烧伤患者心肌组织缺血缺氧的保护作用

目的:研究爱维治对烧伤患者心肌组织缺血缺氧的影响。方法:本研究为随机、开放、对照性多中心研究。选择烧伤总面积在30%~70%总体表面积(TBSA)且血清乳酸值异常的患者作为研究对象,将70例患者随机分为两组:试验组(n=36)给予爱维治30 mL 生理氯化钠溶液250 mL,静脉滴注,qd,给药7 d;对照组(n=34)仅给予生理氯化钠溶液250 mL,静脉滴注,qd,共7 d。取患者用药前、用药后48 h,72 h和7 d的血样,以血清乳酸值、心肌型肌酸激酶同工酶和肌钙蛋白作为主要监测指标,评价爱维治对烧伤后患者心肌组织的影响。结果:两组血清乳酸值、心肌型肌酸激酶同工酶、肌钙蛋白阳性率在观测期内均有下降,但试验组下降的时间早且幅度大,有统计学意义。结论:爱维治能够有效而且快速改善大面积烧伤患者心肌组织缺血缺氧状况。     

3种心肌损伤标记物在急性心肌梗死早期诊断中的价值

目的 探讨血清心肌钙蛋白Ⅰ(cTnI),肌红蛋白(Mb)和肌酸激酶同工酶(CK-MB)在早期诊断急性心肌梗死(AMI)中的价值.方法 对40例急性心肌梗死患者及40例健康老年人(对照组)进行cTnI、Mb和CK-MB检测.结果 急性心肌梗死组血清cTnI、Mb和CK-MB含量显著高于对照组(P＜0.01).结论 急性心肌梗死患者cTnI、Mb和CK-MB的联合检测有助于早期诊断急性心肌梗死和病情分析.     

围产期窒息后血浆cTnI、CK-MBmass的影响因素及临床应用价值

为探讨围产期窒息后血浆心肌肌钙蛋白I（cTnI）、肌酸激酶心型同工酶质量（CK-MBmass）的影响因素及临床应用价值。对71例围产期窒息新生儿及27例对照组新生儿生后6小时－48时血浆cTnI、CK-MBmass水平进行测定，运用逐步回归等方法进行分析。结果显示：（1）血浆cTnI水平的变化与胎龄、5分钟Apgar评分有关。（2）围产期窒息组足月儿（59例）cTnI明显高于对照组足月儿（19）；重度窒息组（17例）与轻度窒息组（16例）比较，cTnI差异无显著性，而CK-MBmass差异有非常显著性；围产期窒息组的重度心脏损害患儿（8例）cTnI、CK-MBmass水平明显高于无重心脏损害患儿（63例）。表明围产期窒息持续时间越长cTnI的水平越高。相对于CK-MBmass而言，cTnI对心肌损伤的敏感性可能稍差，而且由于cTnI的水平随着胎龄的增加而增加，因此这一指标在判断早产儿心肌损伤时有一定的局限性。     

Potential diagnostic value of pancreatic isoamylases for pancreaticobiliary maljunction with mild biliary dilatation in patients and a porcine model

Purpose

The aim of this study was to evaluate the diagnostic value of serum pancreatic isoamylases for pancreaticobiliary maljunction (PBM) with mild biliary dilatation.

Methods

Serum and bile from 8 children with PBM and mild biliary dilatation (6 to 11 mm in diameter) and 4 young pigs with an anastomosis constructed between an isolated pancreas-duodenal segment and the gallbladder were studied for pancreatic isoamylases. Using an electrophoretic technique, the assay of pancreatic isoamylases was expressed by peak appearance rate (PAR). Serum from 20 healthy children served as normal controls.

Results

In the serum of the patients, preoperatively there were 5 pancreatic peaks with PAR as follows: P1, 100%; P2, 100%; P3, 100%; P4, 100%; and P5, 66.7%. These abnormal pancreatic isoamylases disappeared 2 weeks after operative treatment. In normal controls, there were only P1 (PAR, 40%) and P2 (PAR, 100%). Mild cylindrical dilatation (6 to 8 mm in diameter) of the common bile duct developed in the porcine PBM model. There were P1 (PAR, 100%) and P2 (PAR, 100%) in the porcine serum preoperatively. Thirty days and 60 days after establishing the model, there appeared in the serum 6 pancreatic peaks with PAR as follows: P1, 100%; P2, 100%; P3, 75%; P4, 100%; P5, 100%, and P6; 75%. The bile patterns of pancreatic isoenzymes in the patients and pigs were similar to those in serum.

Conclusions

Abnormal pancreatic isoamylases are characteristically present in the serum from both children and a porcine model of PBM and mild biliary dilatation. Assay for these abnormalities is promising to recognize this subset of patients in whom diagnosis remains a challenge.     

肺炎支原体肺炎患儿心肌损伤标志物的变化及结果分析

目的观察肺炎支原体肺炎(MPP)患儿心肌酶谱、肌红蛋白(Mb)、肌钙蛋白I(cTnI)、糖原磷酸化酶同工酶BB(GPBB)的变化,以探讨其在肺炎支原体肺炎诊治中的意义。方法对56例支原体肺炎急性期患儿和50例正常对照组儿童,采用全自动生化分析仪检测血清心肌酶谱变化,选用电化学发光方法检测血清Mb和cTnI含量,采用ELISA方法检测血清GPBB的变化。结果MPP患儿组血清AST、LDH、α-HBDH、CK与正常对照组比较,增高极为显著(p<0.01),CK-MB增高显著(p<0.05);MPP患儿组血清Mb含量比正常对照组显著增高,二者相差极为显著(p<0.01),而cTnI、GPBB与正常对照组比较,增高没有Mb程度大(p<0.05)。结论观察MPP急性期患儿心肌损伤标志物的变化情况对于疾病的诊治非常重要,而且对于研究MPP的发病机理也有帮助。