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1.
氨基末端B型利钠肽在心功能分级中的应用   总被引:1,自引:1,他引:2  
目的:研究氨基末端B型利钠肽(NT-proBNP)水平在心功能分级中的应用。方法:选取2007年11月-2008年4月,复旦大学附属中山医院心血管疾病患者204例(年龄12~90岁),健康人群(对照组)40例(年龄25~65岁)。按照纽约心脏病协会心功能分级(NYHA)将患者分为4组,其中NYHA Ⅰ级33例,NYHA Ⅱ级45例,NYHA Ⅲ级90例,NYHA Ⅳ级36例。测定患者血清NT-proBNP水平,同时进行超声心动图检查,记录患者左心射血分数(LVEF)。分析血清NT-proBNP水平与NYHA分级和LVEF的关系。结果:区分健康人群组和NYHA Ⅰ级疾病组NT-proBNP水平的截点值为136.8ng·L^-1,敏感度和特异性分别为88.1%和90.9%;区分NYHA Ⅰ~Ⅱ级和NYHA Ⅲ~Ⅳ级疾病组NT-proBNP水平的截点值为768.8ng·L^-1,敏感度和特异性分别为93.4%和87.2%。将对照组和疾病组分别按性别和年龄进行分组统计,结果显示各年龄组别区分健康人群组和NYHA分级疾病组NT-proBNP水平的截点值有所变化,65岁以上各组NT-proBNP水平的截点值显著高于65岁以下同组水平。疾病组LVEF值和血清NT-proBNP水平存在一定的相关性(r=0.699,P〈0.01)。结论:血清NT-proBNP可用于NYHA分级。在不同年龄段使用相应的cut-off值,可提高NYHA分级的敏感度和特异性。联合使用NT-proBNP和LVEF值对于NYHA分级有一定的辅助诊断作用。  相似文献
2.
目的评价临床上最为常用的3种胆红素检测方法。方法使用罗氏、强生、和光3种胆红素试剂对58份新鲜患者血清做相关性分析。使用3种试剂分别检测梗阻性黄疸患者术前及术后的血清样本,并比较检测结果。结果3种试剂对总胆红素(TBil)检测的结果相关性较好,强生、和光与罗氏试剂的相关系数(r)分别为0.99、0.98,和光与罗氏试剂对直接胆红素(DBil)检测结果的r为0.99;强生试剂检测结合胆红素(Bc)/TBil比值在梗阻性黄疸成功解除梗阻后迅速下降,下降趋势较罗氏、和光试剂检测结果更为明显。结论罗氏、强生、和光3种胆红素试剂由于方法不同,其对胆红素的检测结果有一定的差异。强生试剂测定Bc更能准确反映梗阻性黄疸的疗效观察。  相似文献
3.
目的 研究糖尿病患者不同时段尿白蛋白(urinary albumin)的排泌情况及尿白蛋白在诊断早期糖尿病肾脏损伤中的应用.方法 收集中山医院门诊及住院糖尿病患者及健康对照组3 d内不同时间段的尿液,分析尿白蛋白天内、天间的排泌变化情况;以24 h尿白蛋白为标准判断肾脏早期损伤情况,比较不同时段尿及时间点尿与24 h尿白蛋白的相关性、诊断特异度及敏感度;评估随机尿的诊断特异度及敏感度,推导随机尿最佳诊断水平.结果尿白蛋白天间变异较大,以尿Cr和尿量分别校正后可降低变异.糖尿病组中尿白蛋白使用尿Cr校正后变异系数(CV)小于尿量校正(CV分别为49%±23%vs 64%±30%).尿白蛋白天内排泌呈节律性变化.不同尿液留取方式中夜间尿尿白蛋白/尿Cr(ratio of urinary concentrations of albumin and creatinine,ACR)与24 h尿白蛋白定量相关性最好(R~2=0.976),优于晨尿ACR(R~2=0.900)、午间餐后尿ACR(R~2=0.584)和随机尿ACR(R2=0.791).以24 h尿白蛋白总量作为判断标准进行受试者操作特性曲线(ROC曲线)分析显示,随机尿ACR的判断值为27.7 μg/mg尿Cr(存在男女性别差异:男性12.8μg/mg尿Cr vs性27.0μg/mg尿Cr).最小阴性似然比0.011时推导随机尿ACR的排除判断值为13.0 μg/mg尿Cr;最大阳性似然比481.000时推导随机尿ACR的确诊判断值为87.4 μg/mg尿Cr.结论 尿Cr较尿量能更好地降低尿白蛋白天内变异,但仍无法完全消除变异.夜尿ACR与24 h尿白蛋白定量相关性最好,可替代24 h尿白蛋白定量.随机尿ACR作为最方便留取的尿液标本亦可以较好地替代24 h尿白蛋白定量,但应考虑引入尿Cr后带来的性别间差异.以13.0 μg/mg及87.4 μg/mg作为随机尿ACR的排除判断值及确诊判断值可以便于临床医师基本排除或确定白蛋白尿的出现.  相似文献
4.
目的 建立本实验室电化学发光法检测血清骨钙素(osteocalein,OCN)、Ⅰ型胶原羧基端肽β特殊序列(β-crossLaps,β-CTX)和总Ⅰ型前胶原氨基端肽(total procollagen type 1 amino-terminal propeptide,tP1NP)的参考区间.方法 根据临床和实验室标准化协会(CLSI)C48-A文件要求筛选出合适人群,按性别和绝经期前后分为男性、绝经前女性、绝经后女性3组.收集窄腹血清,使用Roche Modular E170电化学全自动免疫分析仪检测OCN、β-CTX、tP1NP.结果 393例合适人群中男性112名(年龄29~69岁)、绝经前女性148名(年龄28~54岁)、绝经后女性133名(年龄44~68岁),各组血清OCN、β-CTx、tP1NP的检测结果为男性[(15.33±4.76)μg/L、(413±189)ng/L、(42.15±17.14)μg/L];绝经前女性[(12.99±4.53)μg/L、265(30~820)ng/L、(36.43±14.23)μg/L];绝经后女性[(18.96±5.15)μg/L、(513±195)ns/L、51.40(8.98~118.6)μg/L].除血清β-CTx(绝经前女性)和tP1NP(绝经后女性)各组数据经Log转换均为正态分布.各组的95%参考区间分别为:男性(6.00~24.66μg/L、43~783 ns/L、9.06~76.24μg/L);绝经前女性(4.11~21.87μg/L、68~680 ns/L、8.53~64.32μg/L);绝经后女性(8.87~29.05μg/L、131~900 ns/L、21.32~112.8μg/L).结论 本实验室建立的3项血清骨转换标志物的参考区间与厂商提供的有差异,各实验室在引用时应加以注意.  相似文献
5.
Objective To investigate the urinary albumin excretion of the diabetes patients and application value in the monitoring of early impairment in kidney. Methods The random urine samples from diabetes patients and controls within three days were collectod. The changes of urinary albumin excretion within day and between days were analyzed. 24-hour urine albumin was used as a standard to evaluate early kidney damage. The correlations between results of random urine albumin at the different time points and different periods were comparod. The sensitivity and specificity of random urine albumin at the different time points and different periods was evaluated and compared to deduce the best diagnostic porformance of the random urine albumin. Results There are greater variations of the levels of urinary albumin of patients with diabetes and control. After the correction with urine creatinine and urine volume the variations can be reduced (CV:49%±23% and 64%±30%). Urinary albumin excretion rate change rhythmically within the 24 h in healthy and diabetes patients. We found the best correlation between overnight ratio of urinary concentrations of albumin and creatinine (ACR) and 24-hour urinary albumin (R2 = 0.976). It was superior to urina sanguinis (R2 = 0.900), postprandial urine (R2 = 0.584) and random urine (R2 =0.791). When 24 h urinary albumin was taken as the standard, receiver operating characteristic (ROC) curve analysis showed there was significant difference between male and female(male 12.8 μg/mg urine creatinine vs female 27.0 μg/mg urine creatinine),and the the cut-off value of ACR was 27.7μg/mg urine creatinine. When the smallest available negative likelihood ratio (0.011) and the greatest positive likelihood ratio (481.000) were obtained,the concentration of 13.0 μg/mg creatinine and 87.4 μg/mg creatinine were set as the cut-off value of ACR. Conclusions The correction with urinary creatinine can reduce the variation between-days compared with urine volume, but still can not completely eliminate the variability. The ACR of overnight urine has the best correlation with the 24 h urinary albumin and can replace 24 h urinary albumin. Random urine as the most convenient collecting urine samples can also replace 24-hour urinary albumin, but the gender discrepancy need to be considered. When the concentration of 13.0 μg/mg and 87.4 μg/mg was set as a random ACR exclusion value and the confirmative value, it can basically rule out and confirm the existence of microalbuminuria.  相似文献
6.
Objective To establish the reference intervals of serum osteocalcin (OCN), C-terminal cross-linking telopeptide of type Ⅰ collagen (β-CTx) and total type Ⅰ procollagen N-terminal peptide (P1NP) by electrochemiluminescence assay. Methods According to the Clinical and Laboratory Standards Institute (CLSI) "CA8-A" document the appropriately healthy people, who were divided into three groups (men, premenopausal women, and postmenopausal women) by sex and pre- or postmenopausal status were screened. The levels of fasting serum of OCN,β-CTx, tPINP were detected by Roche Modular E170 electrochemical immunoassay. Results 393 appropriately healthy people consists of 112 men between the ages of 29 and 69 years, 148 premenopausal women between the ages of 29 and 69 years, 133 postmenopausal women between the ages of 29 and 69 years. The levels of serum OCN, β-CTx, tP1NP in men group were (15.33±4.76) μg/L, (413±189) ng/L, (42.15±17.14) μg/L, respectively. The levels of serum OCN, β-CTx, tP1NP in premenopausal women group were (12.99±4.53) μg/L, 265(30-820) ng/L, (36.43±14.23) μg/L, respectively. The levels of serum OCN, β-CTx, tP1NP in postmenopausal women group were (18.96±5.15) μg/L, (513±195) ng/L, 51.40 (8.98 -118.6)μg/L, respectively. Logarithmic transformation produced normal distributions for all markers but serum β-CTx of premenopausal women group and serum tPINP of postmenopausal women group. The 95% of the distribution intervals for serum OCN, β-CTx, tP1NP in men group was 6.00-24.66 μg/L, 43-783 ng/L, 9.06-76.24 μg/L, respectively. The 95% of the distribution intervals for serum OCN, β-CTx, tP1NP in premenopausal women group was 4.11-21.87 μg/L, 68-680 ng/L, 8.53-64.32 μg/L respectively. The 95% of the distribution intervals for serum OCN, β-CTx, tPl NP in postmenopausal women group were 8.87-29.05 βg/L, 131-900 ng/L, 21.32-112. 80 μg/L, respectively. Conclusions Compared with the reference intervals provided by manufacture, the reference intervals of three serum bone turnover markers established by our laboratory have great difference. Laboratory should pay attention to the reference intervals was cited.  相似文献
7.
目的评价临床上最为常用的3种胆红素检测方法。方法使用罗氏、强生、和光3种胆红素试剂对58份新鲜患者血清做相关性分析。使用3种试剂分别检测梗阻性黄疸患者术前及术后的血清样本,并比较检测结果。结果3种试剂对总胆红素(TBil)检测的结果相关性较好,强生、和光与罗氏试剂的相关系数(r)分别为0.99、0.98,和光与罗氏试剂对直接胆红素(DBil)检测结果的r为0.99;强生试剂检测结合胆红素(Bc)/TBil比值在梗阻性黄疸成功解除梗阻后迅速下降,下降趋势较罗氏、和光试剂检测结果更为明显。结论罗氏、强生、和光3种胆红素试剂由于方法不同,其对胆红素的检测结果有一定的差异。强生试剂测定Bc更能准确反映梗阻性黄疸的疗效观察。  相似文献
8.
目的评价流程优化在标本前处理过程中的作用。方法应用“精益思想”分析中山医院检验科生化组目前的标本前处理流程并进行优化,评价流程优化前、后标本前处理的改善情况。结果在标本前处理流程中应用真空管和条形码,对离心起始位置的设置、离心步骤的顺序以及标本前处理的批次进行优化。通过以上改进措施,使中山医院检验科生化组完成100个血清标本的前处理时间由过去的56.0mn缩短为现在的21.5min,工作效率提高了61.6%。结论运用流程优化对实验室检验流程进行必要的改进,可以大大缩短标本的前处理时间,提高工作效率。  相似文献
9.
目的:探讨五脂氧化酶激活蛋白基因(-5lipoxygenase activating protein gene,ALOX5AP)突变与冠心病的关系。方法:采用高分辨率溶解曲线法(high resolution melting,HRM)分析150例冠心病患者和280例健康对照者ALOX5AP基因的单核苷酸多态性(SNPs)。结果:ALOX5AP的A22879C位点的CC基因型增加了冠心病3.691倍患病风险;T8733A位点的AA基因型增加了冠心病2.718倍患病风险;T8733A位点的TA杂合基因型增加了冠心病2.962倍患病风险。结论:ALOX5AP的A22879C位点和T8733A位点多态性是冠心病的易患风险因素。  相似文献
10.
目的 探索上海地区血清Cr临床检测结果的一致性,进行表面健康人群的分布调查,并通过改良的适用于中国人群的MDRD公式计算eGFR,了解其分布情况,进一步评估eGFR的临床适用性.方法 每次实验前将自动化分析系统校准品(c.f.a.s.)中含有的根据IFCC推荐方法测得的Cr值传递到1份新鲜人混合血清,以此校准各参加医院检验科的Cr检测系统.14家医院检验科先后进行6次试验,并在检测结果基本一致后进行6 837名(男3 289名,女2 132名,儿童及青少年1 416名)、年龄段为0~99岁的表面健康人群Cr值测定及调查,并依据文献发表的适用于上海人群的GFR估算公式[eGFR=175×(血清Cr)-1.154×(年龄)-0.203×0.742(女性)×0.827]估算表面健康人群的eGFR值.结果 校准前各参加医院检验科之间的Cr检测值CV为3.1%~9.1%,校准后各医院之间检测值具有良好的一致性,CV降至5%以下.Cr人群分布调查后,得到结果为:成年男性63.0~102.8 μmol/L、成年女性:45.0~76.0 μmol/L;儿童及青少年:0~1岁11.0~77.0 μmol/L,>1~<3岁15.5~33.3 μmol/L,3~5岁19.0~42.0 μmol/L,6~19岁41.4~62.0μmol/L.成年男女间Cr存在差异,男性为(82.1±10.9)μmol/L、女性为(59.4±8.4)μmol/L,差异有统计学意义(t=94.3,P<0.01);eGFR值可减小性别间的差异[男性为(79.1±13.5)ml·(min·1.73 m2)-1;女性为(79.2±13.6)ml·(min·1.73 m2)-1,差异无统计学意义,t=0.266,P>0.05].成年人按年龄每10岁分组,统计显示Cr及eGFR年龄组间均存在差异(x2值分别为2601、1105,P均<0.01).结论 采用新鲜人混合血清,可以使不同医院(不同检测系统)之间的Cr检测值差异明显减小;Cr人群分布应按性别、年龄加以区分;使用eGFR可减小性别差异,但无法消除年龄间差异.  相似文献
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