急性心肌梗死溶栓治疗对血浆C—反应蛋白（CRP）水平的影响

目的：研究溶栓治疗对急性心肌梗死（AMI）患者血浆C－反应蛋白（CRP）水平的影响,方法：42例确诊的AMI患者,经静脉溶栓或一般治疗,测定入院时即刻和胸痛发作后2,4,6,10,14,24小时及第2至第9天的血浆CRP,CK－MB浓度。结果：（1）AMI患者血浆CRP与CK－MB水平呈正相关,（2）溶栓治疗成功者血浆CRP峰值水平明显下降（P＜0．05）。结论：溶栓治疗可明显降低AMI患者血浆CRP水平,这种降低可能与溶栓治疗减轻了急性炎症反应有关。     

糖尿病患者超敏C反应蛋白和白细胞介素6的应用研究

目的 探讨血清超敏C反应蛋白(hs-CRP)和血清白细胞介素6(IL-6)在糖尿病并发动脉粥样硬化的临床价值。方法 用岛津7200生化分析仪胶乳增强免疫比浊法检测血清hs-CRP,一步法检测低密度脂蛋白胆固醇(LDL-C);采用ELISA双抗体夹心法测定血清IL-6。结果 糖尿病患者LDL-C升高组,血清hs-CRP浓度为(6.81±3.32)mg/L,IL-6为(17.2±5.6)ng/L,两者呈显著正相关,r=0.61;P<0.01。糖尿病患者LDL-C正常组hs-CRP为(3.81±1.86)mg/L,IL-6为(9.2±3.9)ng/L,呈明显正相关,r=0.46,P<0.01。健康组血清hs-CRP为(0.76±0.65)mg/L,血清IL-6为(5.8±2.1)ng/L,r=0.136,两者无明显相关性(P>0.05)。结论 糖尿病患者血清IL-6参与诱导肝急性时相蛋白(CRP)的合成,并共同参与糖尿病动脉粥样硬化的病理过程。     

2型糖尿病患者大血管病变与C反应蛋白的相关性研究

目的　探讨C反应蛋白 (CRP)与 2型糖尿病 (T2DM)患者大血管病变的关系。方法　 90例T2DM患者按有无大血管病变分为大血管病变组 4 4例、单纯DM组 4 6例 ,另设 5 0例正常对照组 ,均检测血清CRP值及糖化血红蛋白、空腹血糖、空腹胰岛素 ,空腹C肽值等 ,并计算胰岛素敏感指数 (IAI)和胰岛素分泌功能指数 (IS) ,做相关性分析。结果　单纯T2DM患者CRP值比较正常对照组明显升高 (P <0 .0 5 ) ;而大血管病变组CRP值比较单纯DM组升高更明显 (P <0 .0 1)。相关分析中 ,CRP的升高与IS和IAI呈显著负相关 (前者r =- 7.2 3,P <0 .0 1,后者r =- 6 .6 87,P <0 .0 1)。结论　CRP增高与T2DM大血管病变发生明显相关 ,CRP可能参与糖尿病患者胰岛素抵抗和胰岛功能的损害。     

血清高敏C反应蛋白及S100B蛋白与脑出血关系的研究

目的 探讨血清高敏C反应蛋白(hs-CRP)及S100B蛋白水平与脑出血病情、出血量及预后的关系.方法 对脑出血患者155例分型,用免疫透射比浊法测定hs-CRP含量,用双抗体夹心ELISA法测S100B蛋白含量,观察二者水平与脑出血病情、出血量及预后的关系.结果 ①腩出血病情愈重,血清hs-CRP及S100B蛋白含量愈高(P<0.01);②脑出血患者出血量愈多,ks-CRP及S100B蛋白含量愈高(P<0.01);③hs-CRP及S100B过高者,脑出血预后不良.④hs-CRP及S100B水平呈正相关(r=0.7,P=0.001).结论hs-CRP及S100B水平是判断脑出血患者病情和预后的良好监测指标.     

Robotic surgery for the upper gastrointestinal tract: Current status and future perspectives

More than 4000 da Vinci Surgical Systems have been installed worldwide. Robotic surgery using the da Vinci Surgical System has been increasingly performed in the last decade, especially in urology and gynecology. The da Vinci Surgical System has not become standard in surgery of the upper gastrointestinal tract because of a lack of clear benefits in comparison with conventional minimally invasive surgery. We initiated robotic gastrectomy and esophagectomy for patients with upper gastrointestinal cancer in 2009, and we have demonstrated the potential advantages of the da Vinci Surgical System in reducing postoperative local complications after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. However, robotic surgery has the disadvantages of a longer operative time and higher costs than the conventional approach. In this review article, we present the current status of robotic surgery for gastric and esophageal cancer, as well as future perspectives on this approach, based on our experience and a review of the literature.     

中西医结合治疗创伤性血气胸对血清C反应蛋白的影响

目的:观察中西医结合治疗创伤性血气胸对患者血清C反应蛋白的影响,并对临床疗效进行评价。方法:选取2013年10月~2014年10月陕西中医药大学附属医院收治的40例单纯性创伤性血气胸患者作为观察组,进行中西医结合治疗,监测动态C反应蛋白(CRP),并选择前期患者进行对照,对比分析两组的治疗效果。结果:观察组的胸引管留置时间、住院时间均显著低于对照组,P0.05;观察组第3、5天血清CRP水平均显著低于对照组(P0.05)。结论:中西医结合治疗创伤性血气胸可显著减少胸引管留置时间和住院时间,加快CRP水平的恢复,并提高临床治疗效果。     

内毒素及血清C反应蛋白联合测定在肺部革兰阴性菌感染中的临床意义

目的评价内毒素、血清C反应蛋白(CRP)联合测定在肺部革兰阴性菌感染诊疗中的临床意义。方法 48例确诊为肺部革兰阴性菌感染的患者抽取血液标本进行内毒素及CRP测定,并与正常健康组比较。结果肺部革兰阴性菌感染患者的内毒素水平及CRP均明显高于正常对照组,中重度感染组患者的内毒素高于轻度感染组患者,而CRP则无明显差异,感染组抗感染治疗前后两项指标均有显著差异。结论内毒素、CRP联合检测可提高肺部革兰阴性菌感染诊断可靠性,对感染的严重程度做出较为客观地评估,指导临床及时合理地应用抗生素,防治延误病情或过度用药。     

Phage therapy: Current status and perspectives

The spread of antimicrobial resistant bacterial pathogens combined with the lack of new drug classes in the antibiotic pipeline causes a resurgence of the use of bacterial viruses (phages) to treat bacterial infections (phage therapy [PT]). There has been a substantial increase in patients subjected to this experimental therapy and emergence of new PT centers in Europe and the United States paralleled by one clinical trial completed in accord with good medical practice (GMP) requirements and a few others underway. What is more, evidence has been accumulating to suggest that phages can also exert anti-inflammatory and immunomodulatory action which opens new pathways for the development of novel targets for PT. Here we present the status quo of the PT, recent regulatory, and clinical developments as well as new perspectives for its wider application in clinical medicine.     

Assay of ischemia-modified albumin and C-reactive protein for early diagnosis of acute coronary syndromes

Diagnosis of cardiac ischemia in patients coming to emergency departments (ED) with symptoms of acute chest pain is often difficult. Many markers are sensitive and specific for the detection of myocardial necrosis but may not rise during reversible myocardial ischemia. Ischemia-modified albumin (IMA) has recently been shown to be a sensitive and early biochemical marker of ischemia. The variation laws were observed by measuring IMA and C-reactive protein (CRP) of 113 patients in ED within 12 hr after onset of chest pain. In the observation, blood was taken for IMA and CRP. Patients underwent standardized triage, diagnostic procedures, and treatment. Results of IMA and CRP were correlated with final diagnoses of nonischemic chest pain (NICP) and acute coronary syndrome (ACS). There were obvious distinction of IMA and CRP levels between the NICP and ACS groups. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cutoff of this assay for identifying individuals with ACS patients from NICP. The area under the curves of IMA is 0.948. The sensitivity and specificity of albumin cobalt binding (ACB) at a cutoff value of 70.0 units/mL were 94.4% and 82.6%, respectively. The area under the curves of CRP is 0.746. Sensitivity and specificity of CRP at a cutoff value of 3.16 mg/L were 70.0% and 73.9%, respectively. Negative predictive value (NPV) of IMA and CRP for ischemia origin was 79.2% and 38.6%, respectively. IMA may make an early diagnosis of acute coronary ischemia, and will improve the early diagnostic sensitivity and specificity of ACS.     

糖尿病患者的C反应蛋白与细胞外基质变化

目的观察 2型糖尿病( T2DM)患者 C反应蛋白( CRP)与细胞外基质( ECM)的变化,并探讨其对 DM慢性并发症的影响.方法测定 64例 2型 DM者和 30例健康对照组的 CRP、透明质酸( HA)、Ⅳ型胶原( CⅣ)、Ⅲ型前胶原( PCⅢ)水平,并根据有无慢性并发症存在,把 2型 DM者分成 A、B两组,对各组间进行比较分析.结果① DM组的 CRP、HA、CⅣ水平均较正常对照组有显著意义的升高( P<0.05).而有慢性并发症的 A组较无并发症的 B组 CRP、CⅣ水平有显著意义的升高( P<0.05);②在合并有慢性并发症的 A组中, CRP与 CⅣ水平有正相关( r=0.3714, P<0.05),而在未分组的 DM组中,二者无相关性.结论 CRP与糖尿病慢性并发症有关,而 ECM特别是功能相关蛋白如 CⅣ增加,可能是 CRP与慢性并发症之间的介导因素.     

参附注射液对多发伤合并休克患者凝血功能及C-反应蛋白的影响

目的研究早期使用参附注射液(Shenfu injection,SFI)对多发伤合并休克患者凝血功能及C-反应蛋白(CRP)的影响。方法回顾性分析2017年11月至2020年5月入住于南昌大学第二附属医院急诊重症监护室(EICU)120例多发伤患者的临床资料,根据治疗方法的不同分为对照组和试验组各60例,试验组在对照组治疗基础上加用参附注射液治疗,收集并分析两组患者的一般资料、临床预后及治疗前后的尿量、心率(HR)、血乳酸(Lac)、血红蛋白(HGB)、中心静脉压(CVP)、平均动脉压(MAP)、静脉血氧饱和度(SpO₂)、凝血功能、血白细胞计数(WBC)、降钙素原(PCT)及C-反应蛋白(CRP)。结果两组患者入院时均有不同程度的凝血功能紊乱及血WBC、PCT、CRP升高;治疗3 d试验组尿量、血Lac较前明显改善,与对照组比较差异有统计学意义(P<0.05);治疗3 d试验组D-二聚体(D-D)较入院时明显下降(mg/L:23.51±7.66vs.29.09±7.06),与对照组比较差异有统计学意义(P<0.05);治疗3 d两组患者CRP均较前升高(试验组与对照组比较,mg/L:126.27±50.24 vs.133.35±67.01),对照组升高明显(P<0.05);治疗5 d两组患者凝血酶原时间(PT)、凝血酶时间(TT)、D-D、CRP均较前下降,血小板计数(PLT)均较前升高[试验组与对照组比较,PT(s):11.75±1.22 vs.13.34±1.79;TT(s):15.25±2.74 vs.17.11±3.17;D-D(g/L):12.42±3.83 vs.22.02±5.73;CRP(mg/L):88.84±40.98 vs.108.41±59.97;PLT(×109/L):186.35±31.4 vs.151.12±33.6],试验组变化更明显(P<0.05)。结论早期给予多发伤合并休克患者参附注射液治疗可能改善其凝血功能和全身炎性反应,加快机体的康复进程。     

Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: A cohort study

Introduction

The purpose of the study is to evaluate the impact of daily consecutive measurements of C-reactive protein (CRP) in the initial 2 days of hospitalization on the 30-day all-cause mortality in patients with severe community-acquired pneumonia (CAP).

Methods

We used 4 different thresholds of fractional decrease (FD) in CRP at the second day of admission (CRP2) of 25%, 30%, 40%, and 60%. In addition, we studied the association of each of these thresholds with the 30-day all-cause mortality.

Results

The mean age was 64 ± 20; males, 59%. The 30-day mortality rate was 18% (20/111). The mean serum CRP levels at the first day of all study group and CRP2 were 203 ± 98 vs 146 ± 92 mg/L, respectively, P = .05. The mean FD in CRP2 levels among the survivors was 33 %, whereas among the nonsurvivors, was 7%, P < .001. Multiple regression analysis revealed that FD less than 25% in CRP2 was associated with 30-day all-cause mortality, odds ratio of 3.07 (95% confidence interval, 2.84-5.03), P = .002, compared with those with FD more than 25% in CRP2.

Conclusions

Fractional decrease less than 25% in CRP levels at the second day was significantly associated with 30-day all-cause mortality in hospitalized patients with severe CAP.     

Chemopreventive herbal anti-oxidants: current status and future perspectives

Cancer chemoprevention is fast becoming a lucrative approach for controlling cancer. Carcinogenesis being a complex multi-step, multi-factorial process, a number of chemopreventive interventions can be employed. These strategies are generally directed against two broad events of carcinogenesis viz., initiation and promotion/progression. Anti-initiation interventions principally involve inhibition of carcinogen activation, scavenging of free radicals and reactive carcinogen metabolites along with enhanced detoxification of carcinogens by modulating cellular metabolism. Anti-promotion strategies involve attenuation of enhanced cellular proliferation along with induction of cellular apoptosis and differentiation. Dietary agents or herbal anti-oxidants due to low toxicity and relative safety are promising chemopreventive agents. These agents after emerging successful through a series of in vitro and in vivo assays enter clinical trials. Many dietary compounds have emerged as promising chemopreventive agents in empirical experiments. However, in clinical trials these compounds have met with limited success. This emphasizes the need for further detailed research on the mechanisms of observed chemoprevention and choice, dose, duration and bioavailability of chemopreventive agent used. Complex issues such as choice and nutritional status of target population, genetic variation, gene-environment interactions and relevance of biomarkers analyzed also warrant further research and analyses.     

Biosimilars: current status and future directions

Importance of the field: Expiration of patents covering biopharmaceuticals, has provided opportunities for pharmaceutical companies to develop, produce and market biosimilars or follow-on biologicals. However, there have been concerns over the degree of similarity of these complex drugs in addition to the hope that their introduction may lower the cost of such expensive medicinal products.

Areas covered in this review: The introduction/manufacturing considerations, immunogenicity and regulatory approaches to biosimilars around the world. In addition, arguments and techniques employed by pharmaceutical companies to advance or discredit biosimilar drugs will be outlined. Issues with post-marketing surveillance programmes and their limitations are described.

What the reader will gain: This evaluation outlines the controversial issues associated with introduction of biosimilar medicines across a range of pharmacological indications. Also the differences between regulatory approved medicines and biopharmaceutical products not subjected to regulatory approval (‘B-NSRA’) are highlighted. The review is limited by the rapid changes in regulatory approval and licencing of biosimilars.

Take home message: Hopefully biosimilar medicines will allow more widespread availability of expensive biopharmaceutical products. Clinicians need to be wary of non-transparent promotion of innovator/biosimilar products.     

Asthma and metabolic syndrome: Current knowledge and future perspectives

Asthma and obesity are epidemiologically linked; however, similar relationships are also observed with other markers of the metabolic syndrome, such as insulin resistance and dyslipidemia, which cannot be accounted for by increased body mass alone. Obesity appears to be a predisposing factor for the asthma onset, both in adults and in children. In addition, obesity could make asthma more difficult to control and to treat. Although obesity may predispose to increased Th2 inflammation or tendency to atopy, othermechanisms need to be considered, such as those mediated by hyperglycaemia, hyperinsulinemia and dyslipidemia in the context of metabolic syndrome. The mechanisms underlying the association between asthma and metabolic syndrome are yet to be determined. In the past, these two conditions were believed to occur in the same individual without any pathogenetic link. However, the improvement in asthma symptoms following weight reduction indicates a causal relationship. The interplay between these two diseases is probably due to a bidirectional interaction. The purpose of this review is to describe the current knowledge about the possible link between metabolic syndrome and asthma, and explore potential application for future studies and strategic approaches.     

急性有机磷农药中毒患者血细胞数Hb和CRP浓度的变化及意义

目的　探讨急性有机磷农药中毒患者血细胞数、血红蛋白和C -反应蛋白浓度的变化及临床意义。方法　把35例中毒患者分为轻、中和重度中毒 3组 ,在入院 1、3、7d分别采集静脉血 4mL ,作红细胞 (RBC)、血红蛋白 (Hb)、白细胞(WBC)、中性粒细胞 (N)、血小板 (PLT)及C -反应蛋白 (CRP)浓度检测。并与对照组进行对比分析。结果　各中毒组第 1日检测上述各项指标均有不同程度的升高 ,且中毒越重 ,升高越显著 ;中毒第 3日 ,各中毒组RBC数和Hb浓度均明显下降 ,随中毒的严重程度而下降更显著。PLT数则随中毒程度而明显升高 ,中、重度中毒组与对照组比较差异显著 (P <0 .0 1或P <0 .0 0 1) ;WBC、N和CRP浓度随中毒的程度而显示不同的变化 ,中度中毒组较中毒第 1日有所下降 ,而重度中毒组则呈现出上升趋势 ;中毒第 7日 ,中度中毒组除PLT和N仍显示升高外 ,其余各项均基本恢复正常 ;重度中毒组除RBC和Hb较第 3日更进一步降低外 ,其余各项呈上升趋势 ,与对照组比较差异显著 (P <0 .0 1或P <0 .0 0 1)。结论　对急性有机磷农药中毒患者动态观察血细胞数、Hb和CRP浓度的变化 ,对判定中毒程度和了解病情变化有重要临床意义。     

Elevated procalcitonin and C‐reactive protein as potential biomarkers of sepsis in a subpopulation of thrombotic microangiopathy patients

Thrombotic microangiopathy (TMA) comprises a group of microvascular thrombosis syndromes associated with multiple pathogenic factors. Deficient activity of ADAMTS13 is a pathogenic factor in a subset of TMA patients that provides a strong rationale for plasma exchange treatment. However, the subset of TMA patients with normal ADAMTS13 activity remains a heterogeneous group of patients in which the appropriate treatment is not well understood. In addition to the common forms of TMA thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome, the differential diagnosis of TMA may include sepsis, autoimmune disorders, and disseminated intravascular coagulation. Optimal treatment of TMA depends on timely recognition of treatable pathogenic factors. We hypothesized that sepsis is a rapidly identifiable pathogenic factor in a subset of TMA patients. To test this hypothesis, we retrospectively measured the rapid biomarkers of sepsis C‐reactive protein (CRP) and procalcitonin (PCT), in a repository of pretreatment plasma samples from 61 TMA patients treated with plasma exchange. Levels were analyzed in 31 severely ADAMTS13‐deficient and 30 ADAMTS13‐normal patients. None of the 31 patients with severe deficiency of ADAMTS13 had elevated PCT. However, 11 of 30 (37%) non‐ADAMTS13‐deficient patient samples were strongly positive for PCT. These patient samples also had a >10‐fold higher median CRP level than patients with normal PCT. We conclude that rapid assays may help identify sepsis in a subset of TMA patients. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.     

Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis

Purpose

To prospectively evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) as percentage of baseline (POB) in predicting hospital survival, we studied 64 consecutive, postoperative patients with severe sepsis.

Materials and Methods

Plasma PCT, IL-6, and CRP were serially measured from day 1 (onset of sepsis) to day 14 in parallel with clinical data until day 28. Multivariate logistic regression and univariate analysis of predictive accuracy of PCT-, IL-6-, and CRP-POB were performed. Newly derived binary prediction rules were evaluated by calculating sensitivity, specificity, positive predictive value, and negative predictive value.

Results

In survivors, PCT and IL-6 significantly decreased from days 1 to 14, whereas CRP did not. In nonsurvivors, the inflammation markers mostly increased within the second week. At day 7, logistic regression analysis revealed PCT-POB as an independent determinant for survival. Especially, PCT-POB not exceeding 50% and PCT-POB not exceeding 25% with CRP-POB not exceeding 75% on day 7 indicated a favorable outcome with a positive predictive value/sensitivity of 75%/97% and 92%/67%, respectively. In comparison, pretest likelihood to survive by day 28 and observed survival rate were 60% and 67%, respectively.

Conclusions

Prediction rules of decrease in PCT-POB on day 7 in combination with CRP-POB may serve to monitor efficacy and guide duration of therapy in critically ill patients.     

C-反应蛋白与脑梗死TOAST亚型梗死灶大小神经功能损害程度的关系

目的 观察急性脑梗死（ACI）患者发病早期血清C-反应蛋白（CRP）的水平变化及其与TOAST亚型、梗死灶大小、神经功能损害程度的关系。方法 采用免疫比浊法对136例ACI患者发病72h内的血清CRP水平进行测定，按照TOAST标准对患者进行病因分型，记录梗死灶大小，采用NIHSS评分及Barthel指数记分法进行临床神经功能损害程度评价，并与对照组比较分析。结果 ACI患者血清CRP水平与对照组比较显著升高（P〈0．01）。心源性栓塞脑梗死CRP水平最高，其余依次为大动脉粥样硬化脑梗死、其他明确病因性脑梗死、不明原因性脑梗死，而小动脉闭塞脑梗死最低。血清CRP水平升高程度与梗死灶大小及神经功能损害程度密切相关。CRP与NIHSS评分呈正相关（rs=0．53，P〈0．01），与Barthel指数呈负相关（rs=-0．41，P〈0．01）。结论 血清CRP水平在TOAST各型中的不同，说明不同的ACI亚型在病因及病理生理学机制方面存在着一定的差异。CRP测定对ACI病因学分型有一定的参考价值，CRP可作为ACI患者病情评估的重要指标。