ABO-HDN“二孩”患儿多项指标的联合检测分析

目的对确诊为ABO新生儿溶血病(ABO-HDN)的"二孩"患儿,对产前与产后多项相关检测指标进行综合分析,做到早预防、早诊断、早治疗。方法选取2013-2016年在该院检查并确诊为ABO-HDN患儿92例,产前微柱凝集法检测父亲、母亲血型及母亲不规则抗体筛选,母亲血清IgG抗A(B)抗体效价,产后微柱凝集法进行新生儿溶血3项试验,根据新生儿溶血3项试验结果,分成5组。A组:直抗试验(+)、游离试验(+)、释放试验(+);B组:直抗试验(-)、游离试验(+)、释放试验(+);C组:直抗试验(+)、游离试验(-)、释放试验(+);D组:直抗试验(-)、游离试验(-)、释放试验(+);E组:直抗试验(+)、游离试验(-)、释放试验(-);全自动分析仪检测患儿总胆红素、非结合胆红素、血红蛋白、网织红细胞百分比、乳酸脱氢酶水平。结果92例ABO-HDN患儿经溶血3项试验,发现5组母亲IgG抗A(B)抗体效价越高,患儿病情越严重,差异具有统计学意义(P0.05);网织红细胞百分比与乳酸脱氢酶在5组间比较,差异具有统计学意义(P0.05)。结论产前产后多项实验室指标联合检测,对诊断"二孩"ABO-HDN更为准确,同时有助于掌握患儿病情发展状态,降低并发症和后遗症的出现。     

孕妇血浆中sCD40及其配体与子痫前期发病及肾功能损害的关系

目的 探讨孕妇血浆中可溶性白细胞分化抗原(sCD40)和sCD40配体(sCD40L)水平变化与子痫前期发病及肾功能损害的关系.方法 选择2008年8月-2010年6月在青岛大学医学院附属医院产科分娩的轻度子痫前期孕妇28例(轻度子痫前期组),重度子痫前期孕妇35例(重度子痫前期组);另选同期妊娠结局良好的健康孕妇30例为对照组.比较3组孕妇分娩孕周及血压变化、血小板计数并检测其血常规、C反应蛋白(CRP)、尿常规、24h尿蛋白定量,以及血清尿酸(UA)、肌酐(Cr)、尿素氮(BUN)等生化指标.采用ELISA法检测3组孕妇血浆中sCD40和sCD40L的水平,并对血浆sCD40和sCD40L的水平与各临床指标的相关性进行分析.结果 (1)血常规及l临床指标:重度子痫前期组和轻度子痫前期组孕妇血浆CRP水平(分别为10.8及7.1 mg/L)均明显高于对照组(3.3 mg/L),前后两者分别比较,差异均有统计学意义(P＜0.05);重度子痫前期组高于轻度子痫前期组,两组比较,差异也有统计学意义(P＜0.05).重度子痫前期组孕妇分娩孕周(32.5周)明显低于轻度子痫前期组(37.2周)和对照组(38.6周),分别与对照组比较,差异均有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).重度子痫前期组孕妇血小板计数(132×109/L)明显低于轻度子痫前期组(212×109/L)和对照组(216×109/L),分别比较,差异有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).3组孕妇之间血红蛋白水平及白细胞数分别比较,差异均无统计学意义(P＞0.05).(2)血浆sCD40及sCD40L水平:重度子痫前期组、轻度子痫前期组和对照组孕妇血浆sCD40水平分别为133.6、126.5和90.7 ng/L,sCD40L水平分别为12.5、10.4和4.4 ng/L,24h尿蛋白定量分别为4.5、0.8 g和0,UA水平分别为486、289和162 μmol/L,重度子痫前期组以上各指标均明显高于轻度子痫前期组和对照组,差异均有统计学意义(P＜0.01);轻度子痫前期组也明显高于对照组,差异也有统计学意义(P＜0.01).重度子痫前期组孕妇血浆Cr(89 μmol/L)、BUN(5.32 mmol/L)水平高于轻度子痫前期组(分别为66μmol/L及4.49mmol/L)和对照组(分别为57 μmol/L及3.32 mmol/L),分别比较,差异均有统计学意义(P＜0.05);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).(3)相关性分析:轻、重度子痫前期组孕妇血浆sCD40水平与24 h尿蛋白定量呈正相关(r=0.434,P＜0.05),与UA、CRP呈明显正相关(r=0.536、0.528,P＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.135、0.183、-0.133、0.190、0.167、-0.221,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与24 h尿蛋白定量、UA、CRP均呈明显正相关(r分别为0.591、0.445、0.539,P均＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.178、0.212、-0.292、0.144、0.135、-0.273,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与sCD40呈明显正相关(r均为0.707,P＜0.01).对照组孕妇血浆sCD40、sCD40L水平与各项临床指标均无相关性(P＞0.05).结论 子痫前期孕妇血浆中sCD40和sCD40L水平明显升高,可能参与了子痫前期的发病,并导致肾功能损害.sCD40和sCD40L水平变化也与子痫前期的严重程度相关.

Abstract：

Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.     

多功能输液治疗车设计与应用

集体静脉输液是临床最常见的护理技术操作,治疗车是重要的辅助工具,但临床使用时发现因置物空间小,废弃物处置不方便等问题,给护理工作带来不便,也增加护士职业性损伤和环境污染的机会,根据临床实际使用需求,设计了新型多功能输液治疗车。现介绍如下。     

多功能输液治疗车设计与应用

<正>集体静脉输液是临床最常见的护理技术操作,治疗车是重要的辅助工具,但临床使用时发现因置物空间小,废弃物处置不方便等问题,给护理工作带来不便,也增加护士职业性损伤和环境污染的机会,根据临床实际使用需求,设计了新型多功能输液治疗车。现介绍如下。1设计背景目前使用的治疗车存在以下弊端及安全隐患:①用物无法分类放置,一般配有1个或2个抽屉,取用不方便;②物品堆放     

多重位点特异性PCR鉴别海龙及其混伪品

目的:建立一种高效、准确的中药材海龙及其常见混伪品的特异性聚合酶链式反应(polymerase chain reaction,PCR)鉴别方法。方法:通过比较海龙及其混伪品的细胞色素C氧化酶亚基Ⅰ基因(cytochrome C oxidase subunitⅠ,COⅠ)基因序列差异,根据变异位点设计刁海龙、尖海龙及拟海龙的特异性鉴别引物,优化反应体系,并对此方法进行耐受性和适用性的考察和验证。在此基础上,将3对特异性引物组合,构建多重PCR体系。结果:在多重PCR体系中,刁海龙能扩增出485 bp片段,尖海龙可扩增出120 bp片段,拟海龙可以扩增出240 bp片段,其他混伪品均无条带。所设计的特异性鉴别引物具有高度的特异性。结论:该文所建立的位点特异性PCR鉴别方法可实现海龙的准确鉴别。     

红外光谱在药物定量分析上的应用

与可见紫外分光光度法及色谱法相比,红外光谱法(IR)灵敏度低、仪器操作要求严格,在定量分析中的应用不如前二者广泛。但是,由于IR 具有特征吸收峰较多、便于选择测定波长的特点,对于那些理化性质相近、用其它方法定量存在困难的样品,可不经分离就能达到快速定量的目的。故目前无论是在工业分析还是在     

高效液相色谱法测定不同产地夏枯草中咖啡酸和迷迭香酸的含量

目的比较不同产地夏枯草中咖啡酸和迷迭香酸的含量。方法采用高效液相色谱法，Waters SunFire C18色谱柱（4．6mm×150mm，5μm），甲醇-0．1％甲酸梯度洗脱，流速1．0mL／min，检测波长330nm。结果咖啡酸在0．0992～0．4960gg范围内与峰面积呈良好的线性关系（r=0．9999），平均回收率为99．75％，RSD=2．27％（n=5）；迷迭香酸在0．8288～4．1440gg范围内与峰面积呈良好的线性关系（r=0．9998），平均回收率为101．37％，RSD=1．19％（n=5）；不同产地夏枯草中咖啡酸与迷迭香酸的含量分别在0．02％-0．05％，0．09％-0．20％之间。结论不同产地夏枯草中咖啡酸和迷迭香酸含量差异很大，使用夏枯草时要注意产地差异。     

面向临床的病理实习课教学改革意义与方法

针对目前病理学教学中存在的问题,介绍了从提高医学生临床思维能力、适应临床医学新发展、提高学生主动学习兴趣等三方面,进行病理实习课改革的一些方法。     

自拟麻桔前贝紫菀汤治疗咳嗽86例

笔者自2000年以来应用自拟麻桔前贝紫菀汤治疗咳嗽86例,疗效满意,现报告如下。1临床资料1·1一般资料:本组86例均为门诊患者,男49例,女37例,年龄最大78岁,最小8个月,平均38岁,病程最短3天,最长15年,以咳嗽、咯痰为主要症状,西医诊断多属呼吸系统疾病,如上呼吸道感染,急慢性支气管炎等。1·2治疗方法:以麻桔前贝紫菀汤治疗。药物组成:麻黄、桔梗、前胡、浙贝母、紫菀。风寒加苏子;风热加黄芩、桑叶、菊花;肺虚燥咳加知母、天冬、麦冬;湿痰加陈皮、法夏;虚喘加补骨脂、胡桃仁;脾胃虚弱加党参、白术;久咳入络者加茜草、丹参。上药冷水浸泡30min…