2型糖尿病肾病血清蛋白质谱图人工神经网络诊断模型研究

目的通过比较2型糖尿病肾病和对照人群血清蛋白指纹图谱的差异,建立2型糖尿病肾病诊断模型,并探讨其在该病诊断中的应用价值。方法采用表面增强激光解析电离飞行时间质谱(SELDI-TOF-MS)技术检测51例2型糖尿病肾病患者和66例对照人群血清,获得蛋白指纹图谱。结合人工神经网络软件建立诊断模型并进行验证。结果在相对分子质量2 000～30 000共检测到175个蛋白峰,其中有17个明显表达差异的蛋白峰(P<0.01)。筛选其中质荷比(m/z)分别为5 420、5 782、6 472、6 666、10 277和11 770的6个蛋白峰作为标志蛋白建立人工神经网络诊断模型。利用该模型对2型糖尿病肾病进行盲法预测,结果表明其对该病的诊断灵敏性和特异性分别为81.0%和96.2%。结论利用SELDI-TOF-MS和生物信息学技术建立了敏感性和特异性均较高的2型糖尿病肾病诊断模型,为该病诊断提供了新途径。     

动态磁敏感对比增强MRI和动态对比增强MRI鉴别诊断胶质瘤复发和放射性脑损伤

目的 探讨动态磁敏感对比增强MRI（DSC-MRI）及动态对比增强MRI（DCE-MRI）在鉴别脑胶质瘤术后放化疗后复发和放射性脑损伤中的临床应用价值。方法 对19例经临床病理确诊为脑胶质瘤患者在术后、放化疗前、放化疗后定期行DSC及DCE检查,得到相关的血流动力学参数值并将灌注成像影像诊断结果与临床最终诊断结果对照,分析各灌注参数在鉴别诊断中的价值。结果 11例为胶质瘤复发,8例为放射性脑损伤。胶质瘤复发患者的rCBF、rCBV、K_trans、V_e及riAUC值均明显高于放射性脑损伤患者（P均<0.05）;而K_ep、V_p值在胶质瘤复发或放射性脑损伤患者差异无统计学意义（P=0.37、0.22）。K_trans联合rCBV共同诊断,并、串联试验中鉴别诊断的敏感度分别为90.9%、72.7%;特异度分别为62.5%、100%。结论 DCE及DSC均可鉴别肿瘤复发或放射性脑损伤。K_trans、riAUC及rCBV诊断效能略高于V_e及rCBF,联合应用rCBV及K_trans可提高诊断正确率。     

应用计算机人工神经网络系统结合CT与PET鉴别良、恶性肺结节

目的 利用肺结节CT、PET特征,开发计算机人工神经网络(ANN)辅助诊断系统,评价其对肺结节良恶性的鉴别能力。方法 连续收集112例肺内单发小结节(<3.0 cm)患者,均接受PET/CT及胸部CT检查,二者间隔小于1个月。112例患者中恶性肺结节52例,良性60例,均经组织学或临床随诊证实。利用结节的CT特征及PET特征开发计算机ANN辅助诊断系统。计算机ANN的训练及测试采用Round-Robin方法。采用ROC方法评价计算机ANN输出结果并进行统计学分析。结果 CT计算机ANN程序采用20个输入单元,包括4个临床特征及16个CT特征,ROC曲线下面积(Az)为0.83;PET计算机ANN程序采用4个临床特征及1个PET特征作为5个输入单元,Az值为0.91;CT+PET计算机ANN程序采用临床特征CT及PET所有21个输入单元,Az值为0.95。与CT计算机ANN程序、PET计算机ANN程序相比,CT+PET计算机ANN程序输出结果明显提高(P＝0.015、0.037)。 结论 CT+PET ANN计算机辅助诊断程序输出结果优于单纯PET或CT计算机ANN结果。当PET对肺结节诊断有困难时,结节的CT特征有助于鉴别诊断。     

DWI以及ADC值测量鉴别脑脓肿与坏死囊变性胶质瘤

目的评价弥散加权成像(DWI)以及表观弥散系数(ADC)值测量在脑脓肿与坏死囊变性胶质瘤鉴别诊断中的作用.方法 12例经手术病理(10例)或临床随访(2例)证实的脑脓肿和20例经手术病理证实的坏死囊变性胶质瘤,在术前或治疗前接受了常规MRI检查及DWI(弥散敏感系数即b值采用:b=0 s/mm2及b=1000 s/mm2),测量了脑脓肿、胶质瘤坏死囊变区、对侧相应正常白质区以及脑脊液的ADC值,并计算其平均值.结果脓腔于DWI上表现为明显的高信号,而胶质瘤坏死囊变区表现为低信号.脑脓肿、胶质瘤坏死囊变区、对侧相应正常白质区以及脑脊液的ADC平均值分别为(0.53±0.15)×10-3mm2/s、(2.92±0.22)×10-3mm2/s、(0.75±0.05)×10-3mm2/s以及(3.16±0.30)×10-3mm2/s,脑脓肿与胶质瘤坏死囊变区之间ADC值存在显著差异(T=78.0,P<0.001).结论 DWI以及 ADC值测量在脑脓肿与坏死囊变性胶质瘤的鉴别诊断中具有重要作用,可作为常规MR序列的重要补充.     

DWI联合1H-MRS多参数分析鉴别胶质瘤术后复发与放射性脑损伤

目的 探讨DWI联合¹H-MRS鉴别脑胶质瘤术后复发与放射性脑损伤的价值。 方法 对22例脑胶质瘤术后放疗后出现异常强化区的患者进行DWI、¹H-MRS检查。分析复发和放射性脑损伤的DWI与¹H-MRS表现,对复发、损伤、正常脑白质的ADC值及复发、损伤病灶的Cho、Cr、NAA峰高与Cho/Cr、Cho/NAA值进行统计学分析,并根据ROC曲线确定比值参数(rADC、Cho/Cr、Cho/NAA)的最佳诊断阈值及诊断准确率。 结果 损伤灶ADC值[(1476.40±453.74)mm²/s]高于复发灶[(987.62±309.93)mm²/s],差异有统计学意义(P＜0.05)。复发灶Cho/Cr(1.74±0.53)、Cho/NAA(2.39±1.21)高于损伤灶Cho/Cr(1.30±0.19)、Cho/NAA(1.16±0.41),差异有统计学意义(P均＜0.05)。最佳诊断阈值分别为:rADC(1.40)、Cho/Cr(1.51)和Cho/NAA(1.42),诊断准确率分别为:rADC(72.73%)、Cho/Cr(72.73%)、Cho/NAA(86.36%)、多参数评分系统(86.36%)。 结论 DWI联合¹H-MRS多参数分析可明显提高复发与损伤的鉴别诊断准确率,对放射性脑损伤的早期确诊具有重要应用价值。     

Faecal and serum levels of eosinophil cationic protein in a healthy paediatric population

Background. Eosinophil cationic protein (ECP) has been regarded as an excellent marker of eosinophil activation in various diseases where eosinophil‐mediated inflammation plays a role. Recently, it has been suggested as a faecal marker of intestinal inflammation in several immune‐mediated diseases with gastrointestinal expression. Owing to the scarcity of information at paediatric age, the establishment of reference values is necessary before further clinical studies. Objective. To determine faecal and serum ECP levels in healthy children and their association with other biological parameters, thereby providing background additional validation data for this age group. Methods. Faecal and serum ECP levels were available from healthy Caucasian children recruited at a regular outpatient clinic. Exclusion criteria were: chronic illnesses, acute illness, mucosal bleeding and recent pharmacological medication. Faecal and serum ECP levels and faecal α1AT were determined by commercial radioimmunoassay and serum IgE by fluoroenzyme immunoassay Uni‐CAP. Results. Mean and median faecal ECP levels were 1.93?µg/g and 1.20?µg/g, respectively (range 0.41–22.20), while the corresponding serum ECP levels were 13.50?µg/L and 9.54?µg/L, respectively (range 0.20–74.8). The cut‐offs found were 2.80?µg/g and 16.89?µg/L for faecal and serum ECP, respectively. A significant (p = 0.001) increase in serum, but not in faecal, ECP levels was found among patients with high peripheral eosinophil blood count. Neither faecal nor serum ECP levels were influenced by serum IgE levels. Conclusions. Faecal and serum ECP levels, as determined in the present study, add background information concerning reference levels at paediatric age for further studies in different clinical settings.     

Serum S-100B protein monitoring in patients with severe traumatic brain injury

Objective S-100B protein is a promising marker of injury severity and outcome after head injury. We examined the relationship between serum S-100B concentrations and injury severity, clinical course, survival, and treatment efficacy after severe traumatic brain injury (TBI). Design and setting Prospective observational study in a neurosurgical intensive care unit. Patients and participants 102 adult patients with severe TBI, admitted between June 2001 and November 2003 (30 months). Interventions Serum S-100B levels were measured by immunoluminometric technique on admission and every 24 h thereafter for a maximum of 7 days. Measurements and results Initial S-100B levels were significantly related to pupillary status, computed tomography severity1, and 1-month survival. Cox's proportional hazard regression analysis showed that initial S-100B was an independent predictor of 1-month survival, in the presence of dilated pupils, and with increased age. Subjects with initial levels above 1 μg/l had a nearly threefold increased probability of death within 1 month. Serum S-100B alteration indicated neurological improvement or deterioration. Finally, surgical treatment reduced S-100B levels. Conclusions Serum S-100B protein reflects injury severity and improves prediction of outcome after severe TBI. S-100B may also have a role in assessing the efficacy of treatment after severe TBI.     

老年糖尿病患者血清胱抑素C与血脂及高敏C反应蛋白的关系

目的探讨老年糖尿病患者血清胱抑素C与血脂及高敏C反应蛋白的关系。方法 2008年5月-2009年10月糖尿病患者共141例,其中糖尿病合并症组68例,单纯糖尿病组73例;另选取对照组51例。对入选者的血清胱抑素C、血脂及高敏C反应蛋白进行分析。结果老年男女糖尿病合并症组血清胱抑素C、高敏C反应蛋白、总胆固醇、甘油三酯及低密度脂蛋白胆固醇最高、高密度脂蛋白胆固醇最低,与对照组比较有统计学意义（P〈0.05）、与单纯糖尿病组比较,无统计学意义（P〉0.05）。老年男女单纯糖尿病组高敏C反应蛋白、总胆固醇、甘油三酯高于对照组,组间比较,有统计学意义（P〈0.05）。老年男女单纯糖尿病组血清胱抑素C与对照组比较,无统率学意义（P〉0.05）。老年女性单纯糖尿病组低密度脂蛋白胆固醇与对照组比较,有统计学意义（P〈0.05）。老年男性糖尿病二组与对照组血清胱抑素C低于老年女性糖尿病二组与对照组,组间比较,无统计学意义（P〉0.05）。老年男性糖尿病患者血清胱抑素C与高敏C反应蛋白及血脂不相关。老年女性糖尿病合并症组血清胱抑素C与空腹血糖正相关;单纯糖尿病组血清胱抑素C与高密度脂蛋白胆固醇负相关、与低密度脂蛋白胆固醇正相关、与高敏C反应蛋白不相关。结论老年糖尿病患者高脂、高糖及低度炎症状态下,血清胱抑素C水平较高。血脂对血清胱抑素C的影响可能存在性别差异。随着动脉粥样硬化的加重,血清胱抑素C有升高趋势。     

肝硬化并发严重感染患者C反应蛋白、前降钙素测定的临床意义

目的:分析肝硬化并发严重感染时血清前降钙素、C反应蛋白的变化及其临床意义。方法:对25例肝硬化并发自发性细菌性腹膜炎和败血症的患者,测定其血清和腹水的前降钙素(PCT)和反应蛋白(CRP)。结果:合并严重感染时,PCT明显增高,增高幅度与感染程度呈正比,且与未合并感染者的差异有显著性(P<0.05);同时还发现PCT的增高与CRP的升高呈正相关。结论:PCT是诊断肝硬化并发严重感染的一个新型、敏感的实验室指标,对于鉴别感染与否,是否为细菌性感染具有较好的特异性。