T3水平对慢性阻塞性肺疾病营养状况的影响

目的：探讨慢性阻塞性疾病（COPD）营养状况与甲状腺激素水平的关系，以进一步阐明COPD并发营养不良的机制。方法：对53例COPD患者进行系统的身体测量和内脏蛋白测定，同时检测其血清甲状腺素（T3、T4）和促甲状腺激素（TSH）水平。结果：发现COPD混合型营养不良组T3、T4水平显著下降（P＜0．05－0．01），而单纯消瘦组甲状腺激素水平与营养正常组无显著差异（P＞0．05）。T3与所有营养参数均呈显著相关性（P＜05－0．001），T4仅与白蛋白相关（P＜0．05），TSH与各营养参数均无相关性（P＞0．05）。结论：甲状腺激素T3水平与COPD营养状况密切相关，COPD低蛋白血症与患者甲状腺激素水平下降而影响其蛋白质合成有关。     

肾移植术后甲状腺功能监测及其意义

目的 监测肾移植患者手术前后血清甲状腺激素水平,以了解甲状腺激素水平与肾功能间的关系.方法 以30例健康者作为正常对照组,对50例肾移植成功受者术前及术后不同时间的血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺激素(TSH)、血肌酐(SCr)进行监测,对术后第10天甲状腺激素水平与SCr水平进行相关性分析.结果 肾移植组术前血清T3、T4水平显著低于正常对照组(P＜0.01),TSH与对照组比较差异无统计学意义(P＞0.05).术后,甲状腺激素水平皆呈下降趋势,T3于术后第1天下降达30%,下降幅度大于其他指标,术后1周开始上升,3周显著高于术前(P＜0.01).T4术后下降于第14天开始上升,术后3周恢复到术前水平.TSH第7天上升,各时间段与术前比较差异均无统计学意义.SCr术后一直呈下降趋势,于术后2周,水平恢复正常.SCr与T3、T4、呈负相关(r=-0.546、-0.423,均P＜0.01).结论 甲状腺激素水平(T3、T4)与移植后肾功能呈显著负相关.术后监测甲状腺激素水平,尤其是T3水平,可以了解肾功能发展情况.对于肾移植成功者早期甲状腺激素减低给予适当的甲状腺激素治疗是必要的.     

血清瘦素、肿瘤坏死因子和甲状腺激素在慢性阻塞性肺疾病患者营养不良发生中的意义

目的:探讨血清瘦素、甲状腺激素及肿瘤坏死因子α(TNF-α)在慢性阻塞性肺疾病(COPD)患者营养不良发生中的意义.方法:用放射免疫法测定68例COPD患者(分为营养不良组,即COPD Ⅰ组35例;非营养不良组,即COPDⅡ组33例)及30例健康人对照组的血清瘦素、甲状腺激素和TNF-α浓度,并测定体重指数(BMI)、理想体重百分比(NW%)、肱三头肌皮皱厚度(TSF)、臂中部臂圉(MAC),血清白蛋白(ALB),总淋巴细胞计数(LYM)等指标.分析瘦素与各项营养参数、TNF-α及甲状腺激素的相关性.结果:(1)COPD患者血清瘦素浓度均明显低于对照组;其中,Ⅰ组血清瘦素浓度低于Ⅱ组.(2)COPD患者血清TNF-α水平明显高于对照组.且Ⅰ组高于Ⅱ组.(3)COPD Ⅰ组血清T3浓度和T4浓度低于Ⅱ组和对照组(P<0.05),而Ⅱ组的T3、T4水平与对照组无显著差异.(4)COPD组及对照组的血清疫素均和BMI、NM%、TSF等营养状况指标呈正相关,还与促甲状腺素呈正相关,而与TNF-α浓度之间无显著相关性.(5)COPD组内女性患者血清瘦素浓度高于男性,有显著差异,而对照组内则无显著差异.结论:血清瘦素浓度与COPD患者的营养参数、性别有关.瘦素的调节不受TNF-α系统的控制,瘦素和甲状腺激素之间相互调节共同维持机体能量平衡,瘦素可能参与了COPD时营养不良的发生.     

慢性阻塞性肺疾病血清甲状腺素水平变化与疾病严重程度的相关性

目的 探讨慢性阻塞性肺疾病急性发作期(AECOPD)血清中甲状腺激素水平的改变与疾病的严重程度的关系.方法 选取48例AECOPD患者,根据动脉氧分压(PaO2)水平分为轻度或无缺氧组(A组)、中度缺氧组(B组)、重度缺氧组(C组),入院时在未吸氧状态下检测动脉血气,治疗前后分别检测血清甲状腺素三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)及促甲状腺激素(TSH)的水平,各组之间分别进行比较.结果 B组及C组与A组血清中T3、FT3、T4、FT4及TSH相比下降显著(P＜0.05).检测上述指标,A组血清甲状腺素水平变化不大,其余两组血清中甲状腺素均明显改变(P＜0.05).血清中T3、FT3的变化与PaO2呈正相关,T4、FT4、TSH各组变化不大,差异未见统计学意义(P＞0.05).结论 AECOPD患者血清中甲状腺激素水平的变化与PaO2、疾病的严重程度呈正相关,对AECOPD患者的病情判断具有一定的临床意义.     

阿尔茨海默病患者甲状腺激素水平与抑郁症状及生活能力相关性研究

目的 探讨阿尔茨海默病患者甲状腺素水平与抑郁症状、生活能力、认知功能的相关性.方法 将32例伴有抑郁症状的阿尔茨海默病患者设为研究组,将27例无抑郁症状的阿尔茨海默病患者设为对照组,两组均予以阿尔茨海默病常规治疗,研究组在此基础上联合抗抑郁剂治疗,观察8周.于治疗前后采用汉密顿抑郁量表、日常生活能力量表、简易精神状态量表、长谷川痴呆量表评定患者疾病状况,同时测定甲状腺激素水平.结果 治疗前后两组甲状腺激素T4水平均在正常范围内,FT3水平均低于正常范围;研究组治疗后T4水平较治疗前有显著下降(P＜0.01),但治疗前后均显著高于对照组(P＜0.01),FT3水平治疗前后无显著变化,但显著低于对照组(P＜0.05).研究组汉密顿抑郁量表评分治疗前显著高于对照组(P＜0.01),治疗后较治疗前显著下降(P＜0.01),且与对照组差异无显著性(P＞0.05);日常生活能力量表评分治疗后较治疗前显著下降,但治疗前后均显著高于对照组(P＜0.01);简易精神状态量表及长谷川痴呆量表评分治疗前后无显著变化(P＞0.05),且与对照组差异无显著性(P＞0.05).结论阿尔茨海默病患者的甲状腺激素T4水平与抑郁症状、日常生活能力有关,FT3水平与认知功能衰退有关;抗抑郁治疗能有效降低T4水平,提高患者日常生活能力.     

心力衰竭患者血清甲状腺激素水平变化的临床意义

目的:观察心力衰竭患者血清甲状腺激素水平的改变.方法:将80例心力衰竭患者按心功能不同分为三组:心功能Ⅱ级组,心功能Ⅲ级组,心功能Ⅳ级组;选择同期我院体检健康者作为正常对照组.检测各组甲状腺激素水平.结果:与正常对照组比,心力衰竭组TT4、FT4、TSH有轻度下降(P＜0.05),TT3、FT3明显下降(P＜0.01);与心功能Ⅱ级组比,心功能Ⅲ级组TT3、FT3下降(P＜0.05),心功能Ⅳ级组TT3、FT3下降更明显(P＜0.01);与心功能Ⅱ级组比,心功能Ⅳ级组TT4、FT4、TSH也下降(P＜0.01),与心功能Ⅲ级组比,TT3、FT3、TT4、FT4、TSH均明显降低(P＜0.05).结论:甲状腺激素水平可能与心功能有密切的关系,心功能越差,甲状腺激素下降幅度越大.     

高龄男性慢性阻塞性肺疾病患者甲状腺激素的临床观察

目的 观察高龄男性慢性阻塞性肺疾病(COPD)患者甲状腺激素水平与肺功能减低的关系.方法 纳入我院干部病房2006年1月至2010年2月收治的高龄男性COPD患者195例,常规检查甲状腺功能、肺功能[第1秒用力呼气量(FEV1)、FEV1/FVC(用力肺活量)],比较甲状腺功能正常患者(正常组)与异常患者(减低组)的肺功能,比较肺功能不同分级程度患者(轻、中、重、极重组)的甲状腺功能.结果 195例高龄男性COPD患者甲状腺激素浓度减低组与正常组相比FEV1、FEV1/FVC降低明显[(53.67±5.36)％与(57.49±6.09)％、(59.31±6.36)％与(62.05±4.77)％;t值分别为3.582、2.981,P均＜0.01)].肺功能分级各组三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)比较差异均有统计学意义(F值分别为1.959、1.873,P均＜0.05),其中轻度组与重度组T3、FT3比较差异均有统计学意义(P均＜0.05),但在其他各组间比较差异均无统计学意义(P均＞0.05);而甲状腺素(T4)、游离甲状腺素(FT4)、促甲状腺素(TSH)肺功能分级各组比较差异均无统计学意义(P均＞0.05).结论 合并甲状腺激素浓度减低的高龄男性COPD患者与无甲状腺功能障碍者相比肺功能下降明显,且甲状腺激素水平越低,肺功能越差.     

122例窒息新生儿甲状腺功能测定与意义

目的探讨窒息新生儿甲状腺功能的变化和意义.方法对122例窒息新生儿(窒息组)及60例同期出生的正常新生儿(对照组)于出生第1天及第8天取静脉血检测T3、T4和TSH.结果窒息新生儿T3、T4均显著低于对照组(分别为P＜0.05,P＜0.01),重度窒息新生儿T3、T4均显著低于轻度窒息新生儿(P＜0.01),TSH无显著性差异(P＞0.05),第8天复查T3、T4和TSH窒息组与对照组无显著性差异(P＞0.05).结论窒息新生儿甲状腺功能损害严重,且与窒息程度呈正相关,恢复后甲状腺功能自行恢复,无需甲状腺素治疗.     

慢性乙型病毒性肝炎患者甲状腺功能及类风湿因子检测的临床意义

目的:探讨慢性乙型病毒性肝炎患者的血清甲状腺激素水平与类风湿因子(RF)水平的变化及临床意义.方法:测定150例慢性乙型病毒性肝炎患者和30例正常对照组血清总T3 (TT3)、总T4 (TT4)、游离T3 (FT3)、游离T4 (FT4)、促甲状腺激素(TSH)及RF.并采用统计学方法分析不同病情各组患者与对照组之间的差异.结果:与对照组比较,慢性乙型病毒性肝炎轻度组FT4升高(P ＜ 0.01),中度组TT3、FT4升高(P ＜ 0.01,P ＜ 0.05),重度组TT3、FT3、TSH降低(P ＜ 0.01),重型组TT3、TT4、FT3、TSH降低(P ＜ 0.01),肝硬化组TT3、TT4、FT3降低(P ＜ 0.01);与对照组比较,慢性乙型病毒性肝炎各分组血清RF水平都增高(P ＜ 0.01).结论:随着病情变化,慢性乙型病毒性肝炎的甲状腺功能及血清RF水平受到不同程度影响,联合检测甲状腺激素水平与RF对评估病情发展及预后具有一定的价值.     

腹腔镜结肠癌手术对机体应激反应及能量代谢的影响

目的 探讨腹腔镜辅助和开腹结肠癌根治术对患者机体应激反应及能量代谢的影响.方法 选择沈阳军区总医院普通外科2005年1月-2007年5月收治的结肠癌患者40例.20例行腹腔镜辅助根治术(腹腔镜组):20例行开腹根治术(开腹组).比较分析两组患者术前及术后第1天至第3天外周静脉血血糖(BG)、胰岛素(Ins)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素刺激激素(TSH)、皮质醇(CS)及静息能量消耗(REE)的变化.结果 两组患者性别、年龄、身高、体重、术后病理分期等方面差异无统计学意义(P＞0.05).术前两组BG、Ins、T3、T4、TSH及CS无差异.两种术式术后第1天BG及CS均升高.腹腔镜组BG及CS至术后第2夭恢复至术前水平(P＞0.05).开腹组BG及CS至术后第3天恢复互术前水平(P＞0.05).两组相比,开腹组术后第2天BG及CS水平明显高于腹腔镜组(P＜0.05).两种术式术后第1天Ins、T3及T4均降低,腹腔镜组Ins、T3及T4至术后第2天恢复至术前水平(P＞0.05).开腹组Ins、T3及T4至术后第3天恢复至术前水平(P＞0.05).两组相比,开腹组术后第2天Ins、T3及T4水平明显低于腹腔镜组(P＜0.05).腹腔镜组与开腹组TSH术后与术前差异无统计学意义(P＞0.05).两组术后第1、2、3天KEE较术前明显升高(P＜O.05),术后第1天两组升高幅度差异无统计学意义(P＞0.05),术后第2天腹腔镜组明显低于开腹组(P＜0.05).结论 腹腔镜结肠癌手术者机体应激反应持续时间短,反应强度低.同传统开腹手术一样,均可导致术后早期高代谢状态的发生.但腹腔镜手术更有利于患者机体高能量代谢的恢复.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.