血浆N端脑钠肽前体浓度变化与脑出血患者预后的相关分析

目的：探讨血浆N端脑钠肽前体浓度变化与脑出血患者预后的关系。方法选择我院2011-02-2013-02收治的52例脑出血患者的临床资料,并选择本院同期38例健康的体检人员作为对照组,探讨血浆N端脑钠肽前体浓度变化与脑出血患者预后的关系。结果脑出血患者组的NT-proBNP水平均明显高于对照组,且组间差异具有统计学意义（P＜0.05）,且大量出血组患者的血浆 NT-proBNP水平明显高于中量和少量出血组,死亡患者的血浆 NT-proBNP水平达（1688.32±234.98）pg/mL ,明显高于好转组,且组间差异具有统计学意义（P＜0.05）;而在好转的45例患者中,NIHSS评分＞6分的患者其血浆NT-proBNP水平达（677.09±102.34）pg/mL ,明显高于 NIHSS评分≤6分的患者,且差异具有统计学意义（P＜0.05）。结论脑出血患者的血浆NT-proBNP水平明显增高对判断脑出血患者的预后恢复具有十分重要的意义,可作为临床脑出血诊断和治疗的重要参考指标。     

危重患者毛细血管渗漏综合征

目的探讨代血浆与血制品对毛细血管渗漏综合征(Capillary leak syndrome,CLS)患者中心静脉压(CVP)和平均动脉压(MAP)的影响.方法依据单纯输入706代血浆、单纯输入新鲜冰冻血浆(FFP)和二者兼输,将临床诊断为CLS的48例患者分3组,监测治疗前后CVP与MAP的变化.结果总体分析,48例患者治疗前后的CVP与MAP的变化有显著性.分组比较,706代血浆输入组的CVP变化与非706代血浆输入组比较有显著性差异,而三组中任何两组间的MAP变化均无显著性.结论706代血浆对CLS患者的血容量恢复效果优于FFP.     

失血性休克大鼠血浆S100B蛋白的动态测定

目的探讨失血性休克大鼠血浆S100B蛋白动态变化及其临床价值。方法选择无特定病原体级成年大鼠10只,通过急性失血损伤方式建立收缩压下降曲线,形成失血性休克动物模型,测定大鼠收缩压基础值（T1）,记录收缩压降至基础值3／4（T2）、基础值2,3（T3）、基础值1／2（T4）、基础值2,5（T5）、30mmHg（T6）、基础值1／5（B）、10mmHg（T8）失血量,采用酶联免疫吸附分析检测各个时间点血浆S100B蛋白含量。结果T2和B、T5和T6、T7和T8间失血量有统计学意义（P〈0．05）,而其它相邻时间点之间无显著差异（P〉0．05）;T3和T4、T4和T5之间血浆S100B蛋白含量差异显著（P〈0．05）,而其它相邻时间点之间无显著差异（P〉0．05）;不同时间点失血量和S100B蛋白含量无显著相关性（P〉0．05）。结论建立收缩压下降曲线的失血性休克大鼠模型,可评估失血量变化,结合S100B蛋白水平动态监测,可对脑组织细胞损伤发展程度进行有效评估。     

颅脑损伤患者血浆硫化氢含量的变化及其意义

目的探讨颅脑损伤后血浆硫化氢（H2S）含量的变化及其意义。方法2011年9月~2012年6月收治颅脑损伤144例,其中重型48例,中型46例,轻型50例;另选同期健康体检者52例作为对照。采用改良亚甲基蓝分光光度法测定患者血浆H2S含量,分析其与颅脑损伤严重程度的关系。结果重、中、轻型颅脑损伤患者及对照组血浆H2S含量分别为（27．92±7．25）umol,L、（36．15±4．80）umol／L、（45．16±3．72）umol／L和（48．79±6．28）umol／L,两两相较均相差非常显著（P〈0．01）。结论本研究表明颅脑损伤的严重程度与患者血浆中H2S含量呈负相关,提示颅脑损伤后H2S血浆含量降低可能参与颅脑损伤后继发性脑损伤的发生和发展。     

TST联合等离子治疗混合痔的临床观察

为探讨选择性痔上黏膜切除术（TST）联合等离子治疗混合痔的临床疗效,将160例混合痔患者随机分为两组,治疗组80例采用TST联合等离子治疗,对照组80例采用内痔套扎术联合等离子治疗,比较两组患者的疗效、手术时间、住院时间、住院费用以及术后并发症如疼痛、出血、水肿、尿潴留、肛门狭窄、肛门坠胀等。结果显示,两组临床治愈率均为100％,两组住院时间、手术时间、住院费用以及肛门疼痛、出血、尿潴留、肛门狭窄、肛门坠胀感差异有统计学意义（P〈0．05或P〈0．01）。结果表明,TST联合等离子是一种疗效确切、疗程短、术后并发症少的微创技术,治疗混合痔临床疗效显著。     

不同妊娠期孕妇及妊高征患者凝血四项指标变化的意义

目的探讨正常妊娠妇女和妊高征患者凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶凝固时间(TT)及血浆纤维蛋白原(Fbg)等反映凝血功能4项指标的检测及临床意义。方法厌PT、APTT、TT测定为凝固法,Fbg测定为发色底物法,均在CulterACL-200全自动血凝仪上进行,试剂及定标血浆均为IL公司产品。结果妊娠中、晚期妇女与正常对照组或早期妊娠者比较,PT、APTT、TT时间明显缩短、Fbg含量明显增高,差异有显著性(P<0.05或P<0.01);妊高征组与晚期妊娠组比较,PT、APTT、TT时间进一步缩短,差异有显著性(P<0.05或P<0.01);Fbg水平明显增高,其中65例中、晚孕妇女中39例大于4g/L,占60%;58例中、重度妊高征组中有46例Fbg>4g/L,占80%,某妊高征患者最高Fbg达7.5g/L。结论妊娠各期及妊高征患者由于凝血功能增强、抗凝及纤溶功能减弱,出现所谓妊娠期高凝状态。这一妊娠期生理变化为产后快速有效止血提供了物质基础,但也是导致妊娠期血栓病形成的重要原因,并可能与多种产科疾患有关。妊娠期间检测凝血4项指标的变化对预防血栓形成并及时进行抗凝治疗有着关键的作用。     

高脂血症对血液流变学血浆粘度影响的探讨

目的探讨高脂血症的四种类型对血液流变学血浆粘度的影响。方法测定各型的高脂血症患者和正常对照者的血浆粘度和血脂指标(各50例),并对结果进行统计学分析。结果各型高脂血症患者之间以及与正常对照组的血浆粘度的两两比较均有显著性差异(P<0．01)。结论各类型高脂血症患者的血浆粘度有不同程度的改变,其中以混合型的影响尤为明显,其次为高甘油三酯血症、高胆固醇血症。     

Attributional styles and stress-related atherogenic plasma lipid reactivity in essential hypertension

Objective

Hypertension and an atherogenic lipid profile are known risk factors for coronary heart disease (CHD). Hypertensives show greater changes in atherogenic plasma lipids to acute stress than normotensives. In this study, we investigated whether attribution of failure is associated with lipid stress reactivity in hypertensive compared with normotensive men.

Methods

18 normotensive and 17 hypertensive men (mean ± SEM; 45 ± 2.2 years) underwent an acute standardized psychosocial stress task that can be viewed as a situation of experimentally induced failure. We assessed external-stable (ES), external-variable (EV), internal-stable (IS), and internal-variable (IV) attribution of failure and psychological control variables (i.e. extent of depression and neuroticism). Moreover, total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and norepinephrine were measured immediately before and several times after stress.

Results

ES moderated TC- and LDL-C-stress reactivity in hypertensives as compared to normotensives (interaction mean arterial pressure [MAP]-by-ES for TC: F = 3.71, p = .015; for LDL-C: F = 3.61, p = .016). TC and LDL-C levels were highest in hypertensives with low ES immediately after stress (p ≤ .039). In contrast, hypertensives with high ES did not differ from normotensives in TC and LDL-C immediately after stress (p's > .28). Controlling for norepinephrine, depression, and neuroticism in addition to age and BMI did not significantly change results. There were no significant associations between lipid baseline levels or aggregated lipid secretion and IS, IV, or EV (p's > .23).

Conclusion

Our data suggest that ES may independently protect from elevated lipid stress reactivity in hypertensive individuals. ES thus might be a protective factor against CHD in hypertension.     

Vasopressin and oxytocin in CSF and plasma of patients with aneurysmal subarachnoid haemorrhage

Objective

Clinicopathological studies on patients succumbing to subarachnoid haemorrhage (SAH) demonstrated hypothalamic lesions. The implication of the hypothalamic neuropeptides arginine-vasopressin (AVP) and oxytocin (OXT) has not been linked to aneurysmal SAH yet. This study investigates AVP and OXT in CSF and plasma of patients with spontaneous aneurysmal SAH and their association with outcome.

Methods

CSF and plasma samples of 12 patients with aneurysmal SAH were prospectively studied for 2 weeks. AVP and OXT were measured by radioimmunoassay. Outcome was assessed on Glasgow-Outcome-Scale. Twenty-nine patients without neuropsychiatric disturbances served as controls. Differences in neuropeptide concentration time courses were assessed by regression models. Group comparisons were performed by Kruskal–Wallis and correlations by Spearman tests.

Results

Regression of CSF levels between patients with poor and good outcome revealed significantly lower levels of AVP in patients with poor outcome (p = 0.012) while OXT showed a trend towards lower levels (p = 0.063). In plasma, no significant differences between outcome groups were found. Group comparisons between poor outcome patients and controls revealed significant differences in CSF for AVP (p = 0.001) and OXT (p = 0.015). In plasma, AVP yielded significantly different results while OXT did not. No differences were found between the good outcome group and controls. Plasma and CSF concentrations showed no significant correlation.

Conclusion

Patients with poor outcome after aneurysmal SAH have lower AVP and OXT levels in CSF than patients with good outcome while neuropeptide levels in plasma failed to reflect differences in outcome. The data indicate hypothalamic damage as an aetiologic factor for outcome after aneurysmal SAH.     

Mechanized assay of plasma prekallikrein by activation with Pseudomonas aeruginosa elastase and amidolysis of chromogenic substrate.

An automated assay of plasma prekallikrein is described. Prekallikrein was converted to kallikrein with Pseudomonas aeruginosa elastase, and the hydrolytic activity of kallikrein to H-D-Pro-Phe-Arg-paranitroanilide subsequently measured.

The conversion was complete within 8 minutes and the amidolytic activity remained stable at least another 10 min at 37 ° C. This method worked in plasma deficient in Hageman factor (blood coagulation factor XII). Using anti-prekallikrein antibody and plasma deficient in prekallikrein, the amidolytic activity generated in normal plasma was identified as due to kallikrein. With plasma samples, the coefficients of variation (CV) for multiple measurements within run (n = 10) and between run (n = 10) were as low as 5.0% and 6.6%, respectively, and the minimum measurable concentration of prekallikrein in plasma was 10% of the normal level.