氨基末端B型钠尿肽前体及肌钙蛋白I对脓毒症预后的预测价值

目的 评价氨基末端B型钠尿肽前体（NT-pro-BNP）及肌钙蛋白I（cTnI）对脓毒症预后判断的作用.方法 人选住院的脓毒症患者66例,按病情严重程度,分为一般脓毒症组（24例）、严重脓毒症组（22例）及脓毒症休克组（20例）;根据患者的28天生存率,分为死亡组（20例）和存活组（46例）.在入院24小时内检测血清cTnI、NT-pro-BNP及降钙素原（PCT）水平,并进行急性生理和慢性健康状况评分Ⅱ（APACHEⅡ评分）,比较各组血清cTnI、NT-pro-BNP、PCT水平及APACHEⅡ评分,分析NT-pro-BNP、cTnI水平与PCT水平、APACHEⅡ评分的相关性.结果 脓毒症休克组的血清NT-pro-BNP、cTnI、PCT水平及APACHEⅡ评分明显高于严重脓毒症组及一般脓毒症组,差异具有统计学意义（P＜0.05）.严重脓毒症组的血清NT-pro-BNP、cTnI、PCT水平及APACHEⅡ评分高于一般脓毒症组,差异具有统计学意义（P＜0.05）.死亡组的血清cTnI、NT-pro-BNP、PCT水平及APACHEⅡ评分明显高于生存组（P＜0.05）.血清NT-pro-BNP、cTnI水平与PCT呈正相关（r分别=0.901,0.866,P＜0.05）,血清NT-pro-BNP、cTnI水平与APACHEⅡ评分呈正相关（r=0.602、0.521,P＜0.05）.结论 血清cTnI与NT-pro-BNP联合检测可以作为常规临床检测指标来判断脓毒症患者的预后.     

动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值研究

目的 探讨动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值.方法 选择脓毒性休克患者40例,采用早期目标指导治疗(EGDT),将其中死亡患者15例作为死亡组,其余25例作为存活组,比较其在入院时、入院6h和入院24h动脉血乳酸水平及乳酸清除率.结果 存活组入院时、入院6h、入院24h血乳酸浓度均低于死亡组,差异有统计学意义(P<0.01).存活组6h乳酸清除率和24h乳酸清除率均高于死亡组,差异有统计学意义(P<0.05).结论 动脉血乳酸浓度持续增高或6h乳酸清除率低的脓毒性休克患者预后差,6h乳酸清除率较24h乳酸清除率具有良好的早期预后评估作用.     

1-磷酸鞘氨醇在脓毒性休克患者表达及其与预后关系的研究

目的分析1-磷酸鞘氨醇(Sphingosine-1-phosphate,S1P)在脓毒性休克患者表达及其与预后的关系。方法选择136例脓毒症患者作为研究对象,分为单纯脓毒症、重度脓毒症和脓毒性休克3个亚组;比较各组血清S1P、降钙素原(Procalcitonin,PCT)表达水平、急性生理和慢性健康状况评分Ⅱ(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)、死亡率;根据脓毒性休克患者的APACHEⅡ,分为<15分、15~20分、>20分3个分段,比较不同分段的血清S1P、PCT表达水平、死亡率;根据脓毒性休克患者的预后情况,分为死亡组和存活组,比较两组患者的血清S1P、PCT表达水平、APACHEⅡ评分;采用Spearman相关分析脓毒性休克患者血清S1P表达水平与PCT、APACHEⅡ评分、死亡率的相关性。结果脓毒性休克组血清S1P、PCT表达水平、APACHEⅡ评分、死亡率均高于单纯脓毒症组、重度脓毒症组(P<0.05);而单纯脓毒症组与重度脓毒症组的血清S1P、PCT表达水平、APACHEⅡ评分、死亡率比较差异无统计学意义(P>0.05);APACHEⅡ<15分、15~20分、>20分脓毒性休克患者的血清S1P、PCT表达水平、死亡率比较差异有统计学意义(P<0.05);脓毒性休克患者血清S1P、PCT表达水平、死亡率随着APACHEⅡ评分提高而提高,各APACHEⅡ分段间差异有统计学意义(P<0.05);死亡组血清S1P、PCT表达水平、APACHEⅡ评分均高于存活组(P<0.05);经Spearman相关分析,脓毒性休克患者血清S1P与PCT表达水平、APACHEⅡ评分、死亡率均呈明显正相关(r=0.381、0.358、0.463,P<0.01)。结论 S1P在脓毒性休克患者血清中表达水平显著提高,且与患者预后呈负相关,通过监测血清S1P表达水平,可评估病情严重程度和预后。     

降钙素原联合APACHE Ⅱ评分对脓毒症病情及预后判断的指导价值

目的探讨血清降钙素原(PCT)检测联合APACHE Ⅱ评分对脓毒症病情及预后的价值。方法对长沙市第四医院重症医学科68例脓毒症患者按疾病的严重程度分为脓毒症组、严重脓毒症组、脓毒性休克组,分别检测各组血清PCT,并同时进行APACHE Ⅱ评分,对PCT与APACHE Ⅱ进行相关性分析。然后再根据患者转归不同分为生存组和死亡组,评价PCT、APACHE Ⅱ评分对脓毒症预后的判断的指导价值。结果脓毒症组PCT低于严重脓毒症组,严重脓毒症组PCT低于脓毒性休克组,其差异均具有统计学意义(P<0.05),死亡组PCT及APACHE Ⅱ评分明显高于生存组,差异具有统计学意义(P<0.05)。结论脓毒症患者PCT水平与APACHE Ⅱ评分具有相关性;检测PCT水平联合APACHE Ⅱ评分对脓毒症病情及预后判断具有指导价值。     

血乳酸清除率在腹腔感染性休克治疗中的预测价值

目的：回顾性分析动脉血乳酸清除率在腹腔感染性休克治疗中的预测价值。方法选择本院急诊科31例感染性休克患者,根据14 d 病程转归分为存活组和死亡组,定时监测动脉血乳酸并进行计算血乳酸清除率,比较两组间乳酸清除率差异。结果①存活组初始动脉血乳酸水平与死亡组相比差异无统计学意义（P〉0.05）;②存活组动脉血乳酸清除率明显高于死亡组,差异均有统计学意义（P〈0.05）。结论动脉血乳酸清除率可作为评价腹腔感染性休克疗效和预后的指标。     

动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值研究

目的探讨动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值。方法选择脓毒性休克患者40例,采用早期目标指导治疗(EGDT),将其中死亡患者15例作为死亡组,其余25例作为存活组,比较其在入院时、入院6h和入院24h动脉血乳酸水平及乳酸清除率。结果存活组入院时、入院6h、入院24h血乳酸浓度均低于死亡组,差异有统计学意义(P<0.01)。存活组6h乳酸清除率和24h乳酸清除率均高于死亡组,差异有统计学意义(P<0.05)。结论动脉血乳酸浓度持续增高或6h乳酸清除率低的脓毒性休克患者预后差,6h乳酸清除率较24h乳酸清除率具有良好的早期预后评估作用。     

降钙素原在脓毒症病情评估和预后判断中的应用价值

目的探讨降钙素原在脓毒症病情评估和预后判断中的应用价值。方法选取2009年8月~2014年6月本院重症监护病房收住的感染危重患者200例,其中脓毒症组140例,局部感染组60例,脓毒症患者根据病情轻重分为休克组和非休克组,根据预后分为生存组和死亡组,入科后进行APACHEⅡ评分,监测患者血清PCT水平及动态变化,并进行比较分析。结果脓毒症组和局部感染组首次PCT水平比较差异有统计学意义(P<0.01);非休克组和休克组首次PCT水平、APACHEⅡ评分比较差异有统计学意义(P<0.01)。生存组PCT水平呈下降趋势,死亡组PCT水平呈缓慢上升趋势,并维持较高水平。结论血清PCT水平对脓毒症的早期诊断、严重程度及预后评估具有较高的灵敏度和特异度,PCT水平的动态变化可作为评估病情、判断预后及调整治疗方案的依据,在脓毒症诊疗过程中有重要价值。     

血清降钙素原水平检测在脓毒症患者中的临床意义

目的探讨脓毒症患者检测血清降钙素原水平的临床意义。方法收集脓毒症患者100例入脓毒症组及健康体检成年人80例为对照组,检测脓毒症组和对照组血清降钙素原水平。脓毒症患者予以Sepsis集束化治疗及乌司他丁治疗。检测治疗前及治疗后PCT、CRP水平,及APACHEⅡ评分,探讨PCT水平变化及其与APACHEⅡ评分的关系,探讨不同预后患者PCT水平的差异。结果脓毒症患者血清PCT水平明显高于对照组(P<0.01),且随着治疗进展血浆PCT水平逐渐降低(P<0.01)。死亡患者PCT水平明显高于存活患者(P<0.05)且PCT与APACHEⅡ评分呈正相关(P<0.05)。结论血浆PCT水平对脓毒症患者的诊断及严重程度评价有重要价值。     

血乳酸及6h乳酸清除率在ICU重症患者中的应用研究

目的研究血乳酸、6h乳酸清除率在评估重症患者病情及预后中的临床价值。方法收集在ICU住院的重症患者115例,入科时测定动脉血乳酸,6h后再测定动脉血乳酸,计算6h乳酸清除率,并行APACHEⅡ评分,按APACHEⅡ评分分值分为三组,分值20分的为A组,21～30分为B组,30分为C组;按预后分为存活组及死亡组,分析不同分组之间动脉血乳酸、6h乳酸清除率的差异,研究其与患者预后相关性。结果 B组及C组的动脉血乳酸明显高于A组,6h乳酸清除率低于A组,C组的动脉血乳酸高于B组,6h乳酸清除率低于B组,B组的动脉血乳酸高于A组,6h乳酸清除率低于A组。动脉血乳酸及6h乳酸清除率与APACHEⅡ评分相关。死亡组动脉血乳酸水平明显高于存活组,6h乳酸清除率低于存活组。结论动脉血乳酸水平随着APACHEⅡ评分增高而增高,与疾病严重程度呈正相关;乳酸清除率动态反应病情变化,是评价病情及预后的早期、有效指标。     

血乳酸监测对感染性休克预后判断的意义

目的探讨动态监测血乳酸浓度对感染性休克预后评价的意义。方法收集我院重症医学科诊治的50例感染性休克患者,分为存活组28例,死亡组22例。测定患者入院时、经积极液体复苏后6 h、24 h、48 h血乳酸值并计算血乳酸清除率,24 h进行急性生理与慢性健康评分Ⅱ(APACHEⅡ)。分析2组血乳酸浓度、6 h乳酸清除率、APACHEⅡ评分的差异及APACHEⅡ评分与血乳酸相关性。结果死亡组入院0 h、6 h、24 h、48 h血乳酸浓度及APACHEⅡ评分高于存活组,差异有统计学意义(P<0.05,P<0.01),6 h乳酸清除率低于存活组(P<0.05)。APACHEⅡ评分与血乳酸呈正相关(r=0.621,P<0.01)。结论血乳酸浓度持续增高或6 h乳酸清除率低的感染性休克患者预后差,动态监测血乳酸浓度及早期乳酸清除率能很好判断感染性休克预后。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.