反应性淋巴细胞、白细胞分类及EB病毒与儿童传染性单核细胞增多症的关系

目的探讨儿童传染性单核细胞增多症反应性淋巴细胞增高(10%)与EB病毒衣壳蛋白Ig M(EBVCA-Ig M)抗体阳性率、白细胞(WBC)分类的关系,为临床诊断传染性单核细胞增多症提供实验室依据。方法采用双盲法分别镜检,判断反应性淋巴细胞。选取反应性淋巴细胞增高(10%)的患儿80例,采用酶联免疫吸附试验(ELISA)检测EBV-CA-Ig M抗体,采用XE-2100全自动血液分析仪进行WBC分类。采用受试者工作特征(ROC)曲线评价各项指标诊断传染性单核细胞增多症的效能。结果反应性淋巴细胞10%的患儿中传染性单核细胞增多症占81.3%、细菌感染占18.7%;反应性淋巴细胞20%的患儿中传染性单核细胞增多症占100.0%。传染性单核细胞增多症患儿淋巴细胞百分比[(65.76±12.39)%]明显高于细菌感染患儿[(41.57±18.79)%](P0.05)。EBV-CA-Ig M抗体、反应性淋巴细胞、WBC总数、淋巴细胞百分比及单核细胞百分比诊断传染性单核细胞增多症的曲线下面积(AUC)分别为0.854、0.688、0.658、0.848、0.482。结论 EB病毒是引起传染性单核细胞增多症的病因,但部分患儿可出现EBV-CA-Ig M抗体阴性。传染性单核细胞增多症患儿淋巴细胞百分比明显增高。反应性淋巴细胞增高(20%)可用于筛查儿童传染性单核细胞增多症。     

应用VCA-IgM诊断传染性单核细胞增多症体会

应用ＶＣＡ－ＩｇＭ诊断传染性单核细胞增多症体会刘慧清杨雪秋胡伶俐田军旗传染性单核细胞增多症（ＩＭ），既往诊断主要依靠典型的临床表现、末梢血异型淋巴细胞＞１０％及嗜异凝集试验阳性，但对表现不典型、异型淋巴细胞不高、嗜异凝集试验阴性者常误诊或漏诊。自１９...     

EB病毒血清学及DNA联合检测在婴幼儿传染性单核细胞增多症临床应用研究

目的探讨实时定量PCR技术对传染性单核细胞增多症婴儿的诊断价值。方法选取临床表现为发热的婴儿442例,其中48例传染性单核细胞增多症患儿为观察组,另选择50例健康儿童为对照组,应用实时定量PCR技术(RT-qPCR)检测外周血EB病毒DNA载体,对患儿进行外周血异型淋巴细胞及血清嗜异凝集反应,并对单个细胞EBV-DNA载量进行检测,全面对比分析EBV-DNA诊断的诊断效果。结果 1EBV-DNA阳性患儿中异型淋巴细胞10%患儿39例,占69.6%,血清嗜异凝集反应阳性患儿37例,占66.1%;EBV-DNA阴性患儿中异型淋巴细胞10%患者9例,占2.3%,血清嗜异凝集反应阳性患者7例,占1.8%,两组患者异型淋巴细胞10%患者及血清嗜异凝集反应阳性患者占比例差异有统计学意义(P0.01);2VCA-IgM阳性率最高,阳性率为87.5%(43/48),明显高于对照组(P0.01)。结论 VCA-IgM与DNA联合检测能提高婴幼儿传染性单核细胞增多症诊断准确性。     

儿童传染性单核细胞增多症49例临床分析

目的:分析儿童传染性单核细胞增多症(简称传单)的临床特点。方法:回顾性分析本院儿科2004年6月至2006年5月诊治的儿童传单49例的临床资料。结果:传单临床表现多样,除发热,咽峡炎,颈淋巴结肿大常见外,肝肿大(82%),鼻塞(49%)和双眼睑水肿(29%)较多见;传单肝功改变以酶学改变为主,其中以乳酸脱氢酶升高最常见,各年龄组传单患儿外周血异型淋巴细胞均明显升高;早期检测EBV-IgM总体阳性率为86%,发生EBV相关性噬血细胞综合征1例。结论:传染性单核细胞增多症是累及多系统的全身性疾病,临床表现多样,易误诊,需提高对本病的认识以早期诊断。     

194例小儿传染性单核细胞增多症实验室分析

目的 探讨传染性单核细胞增多症(IM)的实验室检查.方法 回顾性分析194例小儿传染性单核细胞增多症实验室的检查及临床表现.结果 外周血异型淋巴细胞大于10%者125例(64.4%),贫血32例(16.5%),粒细胞减少症31例(16%),血小板减少20例(10.3%),溶血性贫血2例(1%).EB病毒(EBV)IgM抗体78例,EBV-DNA阳性30例,总阳性率75%.查天冬氨酸氨基转移酶90例中异常46例,查丙氨酸氨基转移酶85例,异常49例,骨髓检查较外周血异型淋巴细胞少.结论 传染性单核细胞增多症可引起血液等方面的疾病,临床应重视实验室的检验,尤其是异型淋巴细胞涂片的形态学检查.     

837例住院患儿EB病毒感染特点及临床分析

目的探讨住院患儿EB病毒(EBV)感染特点及临床分析。方法回顾性分析2017年1月至2018年3月该院837例住院患儿EBV感染概况、临床表现、常规检查结果及免疫功能的变化。结果 EBV-Ab阳性率为64.63%,共有25种不同模式抗体阳性谱;EBV-DNA阳性率为41.12%,传染性单核细胞增多症和急性扁桃体炎为其主要临床表现。WBC减少者25例(14.30%),淋巴细胞百分比升高者145例(82.40%);丙氨酸氨基转移酶(ALT)升高者65例(36.80%),天门冬氨酸氨基转移酶(AST)升高者70例(39.50%),总胆汁酸(TBA)升高者35例(19.70%),γ-谷氨酰转肽酶(GGT)升高者14例(8.20%);羟丁酸脱氢酶(HBDH)升高者143例(81.50%),乳酸脱氢酶(LDH)升高者131例(74.30%),肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)正常;肌酐(Cr)降低者有156例(88.60%),尿素氮(BUN)降低者110例(62.50%),胱抑素C(CysC)正常。IgG及IgM水平:EBV-DNA阳性组EBV-DNA阴性组,差异有统计学意义(P0.05);EBV-DNA阳性组:CD3~+、CD8~+显著升高,而CD4~+、CD19~+、CD56~+降低;EBV-DNA阴性组:CD19~+升高,CD3~+、CD4~+、CD8~+、CD56~+降低。结论住院患儿EBV感染率较高,临床表现多样,实验室指标变化明显,提示感染可累及多个系统,在临床诊疗中应高度重视。     

小儿传染性单核细胞增多症70例临床特点分析

收集我院2007～2012年收治的70例传染性单核细胞增多症患儿的临床资料,分析患者的发病原因、临床表现、并发症及预后。结果在本组资料中,传染性单核细胞增多症患儿以发热、咽峡炎、颈淋巴结肿大、肝脾肿大等临床表现最为多见,患儿发病多与EB病毒感染有关,变异淋巴细胞增高是诊断传染性单核细胞增多症简便有效的筛查手段,但与患者病情、预后无明显相关性,EBV-VCA-IgM的阳性率与病程、预后等因素有关。传染性单核细胞增多症具有典型的临床表现,能累及多种器官、系统,提高本病实验室检查特点的认识有助于减少误诊及判断患者的预后。     

儿童传染性单核细胞增多症并发心肌炎的临床分析

目的探讨儿童传染性单核细胞增多症并发心肌炎的临床特点。方法回顾分析56例儿童传染性单核细胞增多症的临床表现、实验室检查及预后转归。结果并发心肌炎者达7.14%,临床上除有发热、咽峡炎等外,尚出现精神萎靡、心慌、心累、面色苍白、心音低钝等临床表现;3种心肌细胞损伤标志物及心肌酶谱升高;心电图异常等临床特点。结论儿童传染性单核细胞增多症是全身性疾病,绝大多数患儿预后良好,但重症病例预后差。对于起病急,进展快,多系统损害者,应积极排除并发心肌炎的可能。     

儿童传染性单核细胞增多症的临床分析

目的 探讨儿童传染性单核细胞增多症的临床特征.方法 对我院2002年4月至2006年3月共收治的传染性单核细胞增多症28例患儿的临床资料进行回顾性分析.结果 发病年龄2个月至10岁,以学龄前及学龄儿童多见.28例患者以发热、咽峡炎、肝脾肿大、淋巴结肿大、皮疹、外周血中淋巴细胞增高及出现异型淋巴细胞为主要表现,另外双眼睑浮肿6例,占21.4%;心脏损害3例,占10.7%.结论 儿童传染性单核细胞增多症是由EB病毒感染所致且累及多系统的全身性疾病,提示:双眼睑浮肿及心脏损害均为传染性单核细胞增多症不可忽视的体征之一,大多数传染性单核细胞增多症呈良性临床经过,预后良好.对于起病急,进展快,肝功能损害严重,多系统损害者,应注意EB病毒相关性嗜血细胞综合征的可能.     

更昔洛韦治疗儿童传染性单核细胞增多症的临床疗效

目的探讨更昔洛韦治疗儿童传染性单核细胞增多症的临床效果。方法选取80例传染性单核细胞增多症患儿随机分为2组,更昔洛韦组给予更昔洛韦治疗,干扰素组则给予干扰素雾化治疗,比较2组患儿各临床症状缓解时间、总体治疗效果、实验室指标、不良反应与随访结果。结果更昔洛韦组患儿各临床症状缓解时间显著早于干扰素组,总有效率显著高于干扰素组(P 0. 05);治疗后,更昔洛韦组异型淋巴细胞比例(ALY%)、谷丙转氨酶(ALT)与CD8+水平均显著低于干扰素组,CD4+与CD4+/CD8+水平显著高于干扰素组(P 0. 05);更昔洛韦组治疗后复查白细胞(WBC) 20×109/L与ALY% 10%者占比均显著低于干扰素组(P 0. 05); 2组患儿治疗期间药物不良反应发生率无显著差异(P 0. 05)。结论相较于干扰素雾化治疗方式,更昔洛韦治疗儿童传染性单核细胞增多症的临床疗效更优。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.