脂联素、直接胆红素及甘油三酯对2型糖尿病患者大血管病变的诊断价值

目的 探讨脂联素（APN）、直接胆红素（DB）、甘油三酯（TG）及三者联合对 2 型糖尿病（T2DM）患者大血管病变的诊断价值。方法 选取120例T2DM患者,根据是否合并大血管病变将其分为T2DM组（62 例）和 T2DM+大血管病变组（58 例）。比较两组的临床资料;采用非条件多因素逐步Logistic回归分析T2DM患者合并大血管病变的风险因素;绘制受试者工作特征（ROC）曲线评估APN、DB、TG及三者联合对T2DM患者合并大血管病变的诊断效能。结果 非条件多因素逐步Logistic回归分析结果显示,■是T2DM患者合并大血管病变的危险因素（P <0.05);■是T2DM患者合并大血管病变的保护因素（P <0.05）。ROC曲线分析结果显示,当APN ≤ 5.870 nmol/mL时,诊断T2DM患者合并大血管病变的曲线下面积（AUC）为0.718,敏感性为70.7%(95% CI:0.571,0.815）,特异性为61.3%(95% CI:0.480,0.713）;当DB ≤ 14.205 mol/L 时,AUC 为 0.772,敏感性为 74.1% (95% C...     

2016—2019年河北省儿童血培养检出病原菌及其耐药性变迁

 目的 了解河北省细菌耐药监测网74所医院2016—2019年儿童患者血培养病原菌的分布及耐药性变迁。方法 应用WHONET软件回顾性分析45所三级医院、29所二级医院儿童患者血培养病原菌分布及药敏特点;应用SPSS 19.0软件进行统计分析。结果 剔除重复菌株后,2016—2019年儿童住院患者血培养分离菌株共7 591株,革兰阳性菌占71.7%,革兰阴性菌占28.3%。在本研究定义的4个年龄段内,金黄色葡萄球菌、嗜麦芽窄食单胞菌所占比率随年龄增加而增多。肺炎克雷伯菌对亚胺培南、美罗培南的耐药率为7.8%~35.5%。4年间,耐碳青霉烯类肺炎克雷伯菌（CRKP）检出率呈上升趋势（由12.9%上升至30.1%）,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率呈下降趋势（由81.7%下降至75.2%）。结论 河北省儿童住院患者血培养病原菌以革兰阳性菌为主,与成人血培养病原菌分布不同,病原菌存在年龄分布差异,临床经验性治疗儿童血流感染时应注意儿童血培养的特点。     

超声清创联合重组人表皮生长因子治疗肛周脓肿合并感染的效果

目的探讨超声清创联合重组人表皮生长因子对肛周脓肿合并感染患者表皮细胞生长因子(Epidermal growth factor,EGF)、激活素A(Activin A,ACTA)水平及创面血流量的影响。方法选取2018年2月-2020年1月承德医学院附属医院肛周脓肿合并感染患者117例,依据随机数字表法分为对照A组(n=39)、对照B组(n=39)、联合组(n=39)。常规干预基础上对照A组采取超声清创,对照B组采取重组人表皮生长因子,联合组采取超声清创及重组人表皮生长因子。统计三组治疗情况、治疗前后疼痛程度评分、创面血流量及经皮氧分压、EGF、转化生长因子-β(Transforming growth factor-β,TGF-β)、ACTA、C-反应蛋白(C-reactive protein,CRP)水平及临床疗效。结果联合组创面愈合时间、感染控制时间、住院时间分别为(12.39±2.01)d、(5.22±1.56)d、(13.91±2.51)d短于对照A组、对照B组,创面细菌清除率为(89.13±4.64)%高于对照A组、对照B组(P<0.001);治疗后1 d、3 d、7 d、14 d三组VAS评分较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);治疗后1 d联合组创面血流量及经皮氧分压分别为(0.92±0.25)PU、(35.69±3.20)mmHg大于对照A组、对照B组(P<0.05);治疗后1 d联合组血清EGF、TGF-β分别为(0.70±0.11)μg/L、(0.68±0.12)μg/L高于对照A组、对照B组(P<0.05);治疗后1 d联合组血清ACTA、CRP分别为(9.45±3.58)μg/L、(5.71±2.68)mg/L低于对照A组、对照B组(P<0.05);联合组疗效优于A组和B组(P<0.05)。结论联合采取超声清创及重组人表皮生长因子治疗肛周脓肿合并感染,可改善创面愈合及感染控制情况,缓解疼痛程度,增加创面血流量及经皮氧分压,调节EGF、ACTA等水平,提高整体治疗效果。     

Hyperglycemia is associated with lower levels of urokinase-type plasminogen activator and urokinase-type plasminogen activator receptor in wound fluid

AimsWounds in patients with hyperglycemia show impaired healing. Plasminogen activation is crucial in several overlapping phases of wound healing process. In this study, we aimed i) to compare acute wound fluid in patients with hyperglycemia and normoglycemia, ii) to focus on the elements of plasminogen activation in the wound fluid, and iii) to determine if the acute wound fluid characteristics are associated with surgical site infections.MethodsIn a cohort of 54 patients, a closed suction drain was placed in the wound above the anterior abdominal wall fascia under the skin in order to collect postoperative acute wound fluid samples for 3 following days after colorectal surgery. Patients were classified as normoglycemic (n = 25) or hyperglycemic (n = 29; 17 with type 2 diabetes and 12 with stress induced hyperglycemia). Surgical site infection was defined according to the Centers for Disease Control criteria. The levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAr), plasminogen activator inhibitor-1 (PAI-1), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and fibroblast growth factor-1 (FGF-1) were measured in the wound fluid.ResultsCompared to normoglycemic subjects, patients with hyperglycemia had significantly lower levels of uPA and uPAr in the wound fluid despite similar or even higher circulating levels. There was no significant difference in IL-1β, TNF-α, PAI-1 and FGF-1 levels. In the whole study population, the wound fluid levels of uPA and uPAr were negatively correlated with circulating glucose levels. No difference was detected in the wound fluid characteristics of patients with and without surgical site infection.ConclusionPatients with hyperglycemia exhibit decreased levels of uPA and uPAr in the wound fluid, suggesting a local failure in plasminogen activation at the wound site.     

Morphological and serum hyaluronic acid, laminin and type Ⅳ collagen changes in dimethylnitrosamine-induced hepatic fibrosis of rats

AIM: To study the morphological and serum hyaluronic acid (HA), laminin (LN), and type Ⅳ collagen changes in hepatic fibrosis of rats induced by dimethylnitrosamine (DMN).METHODS: The rat model of liver fibrosis was induced by DMN. Serum HA, type Ⅳ collagen, and LN were measured by ELISA. The liver/weight index and morphological changes were examined under electron microscope on d 7, 14, 21, and 28 by immunohistochemical alpha smooth muscle actin α-SMA staining as well as Sirius-red and HE staining.RESUJLTS: The levels of serum HA, type Ⅳ collagen and LN significantly increased from d 7 to d 28 (P = 0.043).The liver/weight index increased on d 7 and decreased on d 28. In the model group, the rat liver stained with HE and Sirius-red showed evident hemorrhage and necrosis in the central vein of hepatic 10 lobules on d 7. Thin fibrotic septa were formed joining central areas of the liver on d 14. The number of α-SMA positive cells was markedly increased in the model group. Transitional hepatic stellate cells were observed under electron microscope.All rats in the model group showed micronodular fibrosis in the hepatic parenchyma and a network of α-SMA positive cells. Typical myofibroblasts were embedded in the core of a fibrous septum. Compared to the control group, the area-density percentage of collagen fibrosis and pathologic grading were significantly different in the model group (P＜0.05) on different d (7, 14, and 28). The area-density percentage of collagen fibrosis in hepatic tissue had a positive correlation with the levels of serum HA, LN, and type Ⅳ collagen.CONCLUSION: The morphological and serum HA, type Ⅳ collagen, and LN are changed in DMN-induced liver fibrosis in rats.     

血清CTRP13和UACR与不稳定型心绞痛合并2型糖尿病的相关性研究

目的 探讨血清补体C1q/肿瘤坏死因子相关蛋白13(CTRP13)及尿微量白蛋白/肌酐比值(UACR)与不稳定型心绞痛(UAP)合并2型糖尿病(T2DM)的关系。方法 选取2019年10月—2020年10月在承德医学院附属医院心内科和内分泌科住院的150例患者,根据是否诊断UAP和T2DM分为UAP+T2DM组(n＝50)、UAP组(n＝50)和T2DM组(n＝50),选取同期体检的健康人为对照组(n＝50)。分别测定四组患者的血清CTRP13浓度和晨尿UACR水平。比较各组间的一般资料及CTRP13和UACR水平的差异,分析UAP+T2DM组CTRP13和UACR与各指标的相关性;使用倒数f[CTRP13(ng/L)]＝1/[CTRP13(ng/L)]转换CTRP13(ng/L),用ROC曲线分析f(CTRP13)和UACR单独检测及联合检测对UAP+T2DM的预测效能。结果 血清CTRP13水平在UAP+T2DM组最低,T2DM组和UAP组次之,对照组水平最高(P＜0.05);UACR水平在UAP+T2DM组最高,UAP组和T2DM组次之,对照组最低(P＜0.05)。UAP+T2DM组Gensini评分高于UAP组(P＜0.05)。相关性分析显示,在UAP+T2DM组,血清CTRP13水平与空腹血糖(FPG)、高敏C反应蛋白(hs-CRP)及Gensini评分呈负相关,与高密度脂蛋白胆固醇(HDLC)呈正相关(均P＜0.05);UACR与腰围、低密度脂蛋白胆固醇(LDLC)、hs-CRP及Gensini评分呈正相关(均P＜0.05)。ROC曲线显示,f(CTRP13)、UACR单独检测及联合检测预测UAP合并T2DM的曲线下面积(AUC)分别为0.820(95%CI:0.759～0.882)、0.846(95%CI:0.786～0.905)和0.876(95%CI:0.820～0.931),其灵敏度分别为88%、82%和86%,其特异度分别为64%、80%和77.3%。结论 CTRP13和UACR不仅可作为UAP合并T2DM患者临床诊断的辅助指标,还可用于评估冠状动脉病变的严重程度;二者联合检测对UAP合并T2DM的诊断价值更高。     

冠心病患者小而密低密度脂蛋白胆固醇与血浆致动脉硬化指数的相关性

目的 探讨冠心病(CHD)患者小而密低密度脂蛋白胆固醇(sdLDLC)与血浆致动脉硬化指数(AIP)的关系。方法 回顾性收集本院2019年9月—2020年6月因胸痛、胸闷入院,疑似CHD行冠状动脉造影检查的525例患者为研究对象,根据冠状动脉造影结果分为CHD组(n＝422)和非CHD组(n＝103)。同时又按照AIP三分位数分为3组:AIP≤－0.056组(n＝176),－0.056＜AIP＜0.208组(n＝175),AIP≥0.208组(n＝174)。测定各血脂指标并计算AIP。比较CHD组和非CHD组的sdLDLC和AIP水平。分析AIP的影响因素和CHD的危险因素。结果 CHD组sdLDLC、AIP、低密度脂蛋白(LDL)亚型LDL3、LDL4显著高于非CHD组,LDL1、高密度脂蛋白胆固醇显著低于非CHD组(P＜0.05)。随着AIP增加,sdLDLC、LDL4显著升高,LDL1、LDL2显著降低(P＜0.001)。多元线性回归分析显示,sdLDLC、高血压史是AIP的独立影响因素(P＜0.05)。多因素Logistic回归分析显示,sdLDLC、AIP是CHD的独立危险因素(P＜0.05)。结论 CHD患者sdLDLC与AIP呈显著正相关,sdLDLC、AIP是CHD发生的独立危险因素。     

人早孕绒毛细胞滋养层细胞培养方法的改良

目的 探索一种简便高纯度的早孕滋养细胞的体外培养方法。方法 采用完整早孕绒毛通过胰蛋白酶联合胶原酶消化法分离,Percoll梯度分离法提纯体外培养,应用光镜HE染色和免疫细胞化学法检测细胞纯度。 结果 CK-7表达阳性细胞数可以达到90%以上。结论 完整绒毛消化和Percoll纯化联合可在短期内获得高纯度、高产量的滋养细胞以供后期试验,方法更加简便。     

ROS对糖尿病大鼠血脂代谢及肾脏组织中VEGF的影响

目的探讨地黄寡糖(ROS)对糖尿病大鼠血脂代谢及肾脏组织中血管内皮生长因子(VEGF)的影响。方法将40只SPF级大鼠按照随机数字表法分为健康组、DM组、ROS组及药物对照组,每组10只。DM组、ROS组及药物对照组大鼠均建立糖尿病模型。ROS组及药物对照组分别采用200 mg/(kg·d)的ROS及二甲双胍灌胃,剩余两组灌胃等体积生理盐水,治疗22 d。治疗结束后,检测血脂代谢指标、肾脏重量、肾脏病理组织切片、肾脏组织中VEGF阳性率及蛋白。结果与健康组比较,DM组、ROS组、药物对照组总胆固醇(TC)、三酰甘油(TG)升高,高密度脂蛋白胆固醇(HDL-C)降低,经药物干预后,ROS组、药物对照组TC、TG明显低于DM组,HDL-C明显高于DM组,且ROS组TG明显低于药物对照组,差异有统计学意义(P<0.05)。与健康组比较,ROS组、药物对照组大鼠肾脏重量及肾脏指数均明显增加,药物干预后,与DM组比较,ROS组及药物对照组肾脏重量及肾脏指数明显降低,差异有统计学意义(P<0.05)。健康组大鼠肾脏结构完整,肾小球基质分布清晰,未见增生及肥大;DM组大鼠肾小球基质模糊,毛细血管增厚,炎性反应浸润严重,肾小球出现肥大;经药物干预的ROS组及药物对照组上述病理情况均好转,症状减轻。健康组、DM组、ROS组及药物对照组大鼠肾脏组织中VEGF蛋白相对表达量分别为1.00±0.15、3.03±0.33、1.45±0.27、1.50±0.30,组间比较,差异有统计学意义(F=109.100,P<0.001)。DM组VEGF蛋白相对表达量明显高于健康组,差异有统计学意义(t=17.880,P<0.001)。ROS组及药物对照组VEGF蛋白相对表达量明显低于DM组,差异有统计学意义(t=11.870、10.990,P<0.001)。结论灌胃ROS能够改善糖尿病大鼠血脂代谢指标,降低肾脏重量,这与抑制VEGF表达具有相关性。