创伤性癫痫患者血浆前清蛋白水平检测与患者自我效能、生活质量及预后的关系

目的探讨创伤性癫痫患者血浆前清蛋白水平与患者自我效能、生活质量及临床预后的关系。方法选取2015年8月至2016年4月在该院治疗的颅脑外伤患者120例作为研究对象,根据患者是否发生癫痫,分为对照组和观察组,对比两组患者血浆前清蛋白、自我效能、生活质量评分,采用相关性分析探讨血浆前清蛋白水平与患者自我效能、生活质量及临床预后的关系,采用Logisitic回归分析探讨创伤性癫痫患者预后不良的风险因素。结果观察组创伤(CRAMS)评分、血浆前清蛋白、自我效能、生活能力低于对照组患者,差异有统计学意义(P0.05)。Pearson相关性分析发现,血浆前清蛋白与CRAMS评分、自我效能、生活能力呈正相关(r=0.78、0.65、0.89,P0.05)。Logistic回归分析结果提示CRAMS下降0.2分(P=0.015)、血浆前清蛋白下降5μg/L(P=0.032)均是脑创伤性癫痫患者预后的独立风险因素。结论血浆前清蛋白水平和CRAMS评分是创伤性癫痫患者死亡的独立风险因素,对于颅脑损伤的患者应注意检测血浆前清蛋白水平。     

肝硬化患者联合检测血清视黄醇结合蛋白、前白蛋白、白蛋白、胆碱酯酶的临床意义

目的：探讨肝硬化患者联合检测血清视黄醇结合蛋白（RBP）、前白蛋白（PA）、白蛋白（ALB）、胆碱酯酶（CHE）的临床意义.方法：分别采用免疫透射比浊法、终点法、溴甲酚绿法、丁酰硫代胆碱/铁氰化钾法检测81例不同程度（按Child-Pugh分级）肝硬化患者（肝硬化组）和35名正常人（对照组）的RBP、PA、ALB、CHE水平.结果：肝硬化组血清RBP、PA、ALB和CHE水平均明显低于对照组（P〈0.01）.肝硬化程度由轻到重患者血清RBP、PA、ALB和CHE均依次降低（P〈0.01）.结论：联合检测血清RBP、PA、ALB和CHE能更好地反映肝功能损害的严重程度,肝硬化患者病情变化、疗效评价和预后判断具有良好的参考价值.     

上消化道出血患者检测血清前白蛋白的临床意义

目的:探讨血清前白蛋白在上消化道出血中的意义。方法:对32例肝硬化并发上消化道出血患者及30例胃十二指肠疾病并发上消化道出血患者进行血清前白蛋白(PA)测定,并与34例正常对照相比较。结果:肝硬化并发上消化道出血患者血清PA低于胃十二指肠疾病并发上消化道出血者及正常对照组,且肝硬化组PA分布与后两者无重迭;Child分级间PA有显著差异。结论:上消化道出血患者检测血清PA有助于肝硬化并发出血的诊断,并可帮助判断病情及估计预后。     

In vitro biosynthesis of plasma proteins under ischemic conditions of closed-circuit perfusion of healthy and intoxicated rabbit liver

We are elaborating on the kinetics and mechanisms of septic rabbit liver to de novo biosynthesize acute-phase response (APR) proteins under in vitro conditions of deepening ischemia in reference to their in vivo prevalence in serum and cerebrospinal fluids (CSF) collected at predetermined times. The significance of the data is interpreted as relevant to grafting cadaveric liver into end-stage liver diseased patients and APR-induced ischemic heart diseases (IHD). Hepatic APR was induced by CCl(4)-intubation, and the administration of cholera toxin (CT) or scorpion venom (SV), or both, to rabbits. Hepatic functional efficiency, in terms of biosynthesis of APR proteins in closed circuit perfusion of the isolated intoxicated liver with oxygenated saline or L-15 media paralleled the two-dimensional immunoelectrophoresis (2D-IEP) spectrum of APR serum proteins at time of liver isolation. We are suggesting: (a) in vitro biosynthesis of plasma proteins by isolated perfused liver is the result of in vivo decoded and retained APR inflammatory signals; and (b) decoded inflammatory signals are expressed not withstanding the perfusate's organic composition. Furthermore, 90 min of ischemic perfusion in saline or L-15 medium precipitated mitochondrial aberrations which resulted in further deterioration of de novo biosynthesis of APR plasma proteins. Regardless of the nature of the inflammatory stimuli, mitochondrial aberrations rendered the perfused organ a biologically inert tissue mass that was incapable of resuming biological function upon perfusion with oxygenated L-15 medium. This is most likely due to ischemia-induced irreversible hepatic necrosis. Thus, in vitro aberrations of mitochondrial function(s) critically limit the capability of the isolated liver to resume its organic function to sustain biosynthesis of de novo plasma proteins. Extrapolation of these results to the surgical management of end-stage liver diseases points to the importance of the status and the handling protocol(s) of the cadaver donor liver prior to successful grafting. We conclude that although histology of a cadaver liver may reveal well-preserved hepatic cellular organelles with at least minimal intra- and intercellular communication required for viable hepatic function, we deem it essential to further define acceptable minimal capabilities to de novo biosynthesize plasma proteins by a cadaver liver as a measure of its functional viability and suitability for transplantation. Ultimately, this measure may improve the success of liver transplants with minimal surgical and drug interventions.     

术前血清前白蛋白水平在评价膀胱尿路上皮癌患者预后中的价值

目的 探讨术前血清前白蛋白水平在评价膀胱尿路上皮癌患者预后中的价值。方法 回顾性分析2006年1月至2014年12月在海军军医大学（第二军医大学）长海医院行根治性膀胱切除术的320例膀胱尿路上皮癌患者的临床病理资料。绘制受试者工作特征（ROC）曲线,确定术前血清前白蛋白的最佳截断值。采用χ²检验分析术前血清前白蛋白水平与患者临床病理特征的关系,采用log-rank检验和Kaplan-Meier法分析术前血清前白蛋白水平与患者总生存和无复发生存的关系,再利用Cox回归模型分析影响患者预后的危险因素。结果 根据术前血清前白蛋白最佳截断值249.5 mg/L,将患者分为高前白蛋白（≥249.5 mg/L）组（162例）和低前白蛋白（<249.5 mg/L）组（158例）。与高前白蛋白组患者相比,低前白蛋白组患者年龄更大,术前肾积水、高病理T分期、高病理分级、远处转移和术中输血的患者比例均较高（P均<0.05）,总生存情况和无复发生存情况均较差（P均<0.05）。Cox回归模型分析结果显示,高病理T分期、淋巴结侵犯、远处转移、术中输血和术前血清前白蛋白水平降低是患者术后总生存的独立危险因素（P均<0.05）,高病理T分期、淋巴结侵犯、远处转移和术前血清前白蛋白水平降低是患者术后无复发生存的独立危险因素（P均<0.05）。结论 术前血清前白蛋白水平降低是膀胱尿路上皮癌患者预后不良的独立危险因素,术前血清前白蛋白可作为监测膀胱尿路上皮癌预后的常用指标。     

The Relationship between QTc Changes and Nutrition during Weight Loss after Gastroplasty

ABSTRACT Electrocardiograms, serum electrolytes, plasma concentrations of pre-albumin and retinol-binding globulin, and dietary intakes were analyzed in 22 women during weight loss after gastroplasty surgery for morbid obesity. QT interval corrected for heart rate (QT_c) was prolonged (>0.44 sec) in 32% (95% confidence limits 14–55%) on one or more occasions. No clinical or electrocardiographic complications were seen. Occurrence of QT_c prolongation was significantly (p<0.05) associated with protein intake below recommendation and with low plasma pre-albumin concentrations. QT_c prolongation was not associated with mineral intake and occurred in spite of normal serum levels of calcium (uncorrected and albumin-corrected), magnesium, potassium and sodium. Because QT_c prolongation may precede fatal arrhythmias, adequate protein intake is mandatory during weight reduction.     

Risk factors for higher mortality at the highest levels of spKt/V in haemodialysis patients.

BACKGROUND: The survival of patients on haemodialysis improves as the delivered doses of dialysis attain a Kt/V of 1.2 or more. However, a consistent yet paradoxical finding in the Kt/V survival relationship is that the mortality tends to increase at the higher ends of Kt/V. METHOD: To determine the relationship of Kt/V with survival at a time when increasing doses of dialysis are being delivered and to examine the effect of body mass and nutritional markers including serum pre-albumin on the paradoxical relationship, we analysed relative mortality risk (RR) as a function of single-pool Kt/V (spKt/V) in the Cox proportional hazard model. We used body mass index (BMI), dry body weight and nutritional parameters including serum pre-albumin obtained in 1151 patients on chronic haemodialysis as covariates. RESULTS: The mean spKt/V for February and March of 1997 was 1.46+/-0.28 (+/-SD). A spKt/V of >1.2 was achieved in 82.5% of patients and 20% of patients received a spKt/V of >1.68. Using spKt/V in deciles and assigning the third decile (spKt/V 1.2-1.3) as the reference group with an RR of 1, the extreme first and the tenth deciles displayed a higher RR imparting a U-shaped configuration to the curve. In this unadjusted analysis, there was no dependency between delivered dose of spKt/V and RR values. spKt/V values were re-analysed in quintiles. The U-shaped relationship persisted between spKt/V and RR, and an unadjusted analysis again exhibited no clear dependency between spKt/V and RR. The patients in the highest fifth spKt/V quintile, who received the highest dose of dialysis and had the paradoxical increase in RR, had the lowest body weight, BMI, serum pre-albumin and creatinine. Adjustments for case-mix characteristics (age, gender, race and diabetes) in the Cox multivariate model did not reduce the paradoxical increase in RR. However, introduction of BMI or dry body weight along with serum creatinine and pre-albumin to the above case-mix covariates for the first time produced a dose-dependent inverse relationship between the first four quintiles of the spKt/V and their respective RR. With the above variables adjusted, the fifth quintile RR of 1.6 (0.9, 3.1) was reduced to 0.9 (0.4, 2.0), but was not corrected to the lowest RR of 0.6 (0.2, 1.2) noted in the fifth spKt/V quintile. This difference between the adjusted RR of fifth and fourth quintile was not statistically significant, but persisted after adjusting for any clustering variation. CONCLUSIONS: Our analysis, which is the first to include serum pre-albumin in the Kt/V survival analysis, demonstrates a steeper rise in the unadjusted RR at the highest end of spKt/V levels than reported previously and suggests that patients with lower weight and nutritional parameters may mostly account for the spKt/V and RR paradox. As we find a worsening in the spKt/V-RR paradox at a time when higher doses of dialysis are being delivered, we speculate that factors other than underweight and malnutrition such as 'toxicity' of rapid dialysis, especially in sick and underweight patients, may contribute to the paradox. If future studies were to verify this possibility, sick and underweight patients could benefit from less vigorous but frequent sessions of haemodialysis.     

Prognostic Indicators of Surgery for Esophageal Cancer: A 5 Year Experience

Background/Aim:

To assess the prognostic indicators preoperatively presenting and influencing the mortality rate following esophagectomy for esophageal cancer.

Materials and Methods:

This study was a retrospective cohort study, conducted at the Department of Surgery, Lady Reading Hospital, Peshawar, from 1 January 2003 till 31 December 2008. Group 1 included patients who had undergone sub-total esophagectomy and were alive at completion of 12 months; whereas Group 2 included those patients who died by the completion of 12 months. Data were recollected from the Data Bank. A list of variables common to all patients from both groups was categorized and subsequently all data related to each individual patient were placed and analyzed on the version 13.0 of SPSS^R for Windows.

Results:

Significant findings of a lower mean level of serum albumin from Group 2 were observed, whereas serum transferrin levels, also found lower in Group 2, were not statistically significant. Findings of serum pre-albumin, with a mean value of 16.12 mg/dl (P<0.05) and Geansler’s index for the evaluation of the presence of obstructive pulmonary disease prior to surgery showed a lower reading of mean ratio in Group 2. Anastamotic leak was not a common finding in the entire study. In most cases, the choice of conduit was the remodeled stomach. Nine patients from Group 2 were observed with evident leak on the fifth to seventh post-operative day following contrast swallow studies. This was statistically insignificant (P = 0.051) on multivariate analysis.

Conclusion:

Pre-operative variables including weight loss, low serum albumin and pre-albumin, Geansler’s index, postoperative chylothorax, pleural effusion, and hospital stay, are predictive of mortality in patients who undergo esophagectomy for esophageal cancer.     

检测CysC,hs-CRP和前白蛋白对老年AECOPD的临床意义

目的检测AECOPD患者CysC,hs-CRP和前白蛋白(PA)的变化,探讨其相关临床意义。方法选取2013年4月至2014年4月我院呼吸内科的老年AECOPD患者106例为观察组,经规范治疗1周,分别比较治疗前后血气分析,CysC,hs-CRP和前白蛋白水平。并选取同期稳定期COPD患者102例对照组。结果观察组治疗前与治疗后CysC,hs-CRP水平均显著高于对照组,而PA水平显著低于对照组(P0.05);观察组治疗前CysC,hs-CRP水平均显著高于治疗后,而PA水平显著低于治疗后(P0.05)。结论检测CysC,hs-CRP和前白蛋白的指标有利于临床上老年AECOPD的诊断和疗效观察。     

术前白蛋白与碱性磷酸酶比值作为食管癌患者诊断指标的临床价值

目的探讨术前白蛋白与碱性磷酸酶比值(albumin-to-alkaline phosphatase ratio,AAPR)对食管癌的诊断价值。方法选取2018年1月至2020年10月于我院胸外科行食管癌根治术的患者202例,同时期于我院消化内科住院治疗的食管良性疾病患者215例和胃镜检查未见明显异常的体检者214名,比较三组患者的AAPR、纤维蛋白原与前白蛋白比值(fibrinogen to pre-albumin ratio,FPR)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)的水平,利用ROC曲线评价AAPR、FPR、NLR、CEA、CA19-9对食管癌患者的诊断及良恶性患者的鉴别诊断;利用Logistic回归分析食管癌良恶性鉴别诊断的危险因素。通过Kruskal-Wallis H检验、Mann-Whitney U检验AAPR、FPR、NLR与食管癌患者临床病理特征的相关性。结果食管癌组患者术前AAPR显著低于食管良性疾病组、健康对照组(P<0.001),FPR、NLR、CEA、CA19-9均显著高于食管良性疾病组、健康对照组(P<0.001);FPR、NLR、CEA、CA19-9在食管良性疾病组与健康对照组中比较,差异无统计学意义(P>0.05);而AAPR在这两组患者中比较,差异有统计学意义(P<0.05);通过Kruskal-Wallis H检验、Mann-Whitney U检验对食管癌患者临床病理特征分析显示,随着淋巴结转移、浸润深度加深、肿瘤直径增加、临床分期增加,食管癌患者的AAPR的中位数显著降低,FPR的中位数显著升高,而与肿瘤部位无相关性。ROC曲线分析结果显示,AAPR对食管癌的诊断效能显著高于其他指标。Logistic回归显示,AAPR、NLR、CEA均与食管癌和食管良性疾病的鉴别诊断显著相关。在食管癌与食管良性疾病的鉴别诊断上,AAPR与其他指标联合可提高诊断效能,其中AAPR、FPR、NLR、CEA、CA19-9联合,ROC曲线下面积最大,有最大的诊断效能(AUC=0.830,灵敏度为79.2%,特异度为71.4%)。结论AAPR可能是诊断食管癌有价值的生物标志物,其与FPR、NLR、CEA、CA19-9联合可显著提高食管癌和食管良性疾病的鉴别诊断效率。