血小板相关参数检测在脑梗死发病中的意义

目的探讨血小板相关参数的检测在脑梗死患者中的变化规律。方法利用流式细胞仪,Advance血凝仪,CoulterSTKS血球仪对60例脑梗死患者治疗前同时进行血小板计数(PLT),血小板平均体积(MPV),血小板分布宽度(PDW),血小板膜糖蛋白(CD62P、CD63),血小板压积(PCT),纤维蛋白原(Fg)检测,并与同年龄段60例正常体检血标本血小板相关参数作为对照组,与脑梗死组进行比较。结果脑梗死患者的PLT、MPV、PDW、CD62P、CD63、PCT、Fg分别是155.73±62.49,9.78±1.56,17.09±0.76,6.24±6.08,6.78±6.17,0.15±0.05,408.20±133.50。MPV、PDW、CD62P、CD63、PCT、Fg较对照组有显著差异(p<0.05)。结论血小板相关参数的检测结果与对照组在统计学上具有显著差异,提示对脑梗死的发病具有一定的相关性。     

血小板及CD62P在Ⅱ型糖尿病患者中的变化

目的 探讨血小板、平均血小板容积、血小板体积分布宽度、大血小板比率及血小板a颗粒膜糖蛋白(CD62P)在Ⅱ型糖尿病患者中的变化.方法 使用血细胞分析仪对40例Ⅱ型糖尿病患者及40例健康体检者进行血小板及其参数的测量,用流式细胞仪法观察血小板CD62P的变化.结果 与对照组相比,Ⅱ型糖尿病患者中血小板、平均血小板容积、血小板体积分布宽度及大血小板比率均有显著性变化(MPV分别为12.13±1.18 fl和10.98±1.07fl,PLT分别为188±65 × 109/L和223±55×109/L,P-LCR分别为41.04±10.04%和32.11±8.17%,PDW分别为17.01±3.47 fl和14.10±2.53 fl,P均<0.01),血小板CD62P阳性程度显著高于对照组(18.8±9.4%和3.1±5.3%,P<0.01),血小板CD62P表达与MPV为正相关关系(r=0.57,P<0.01).结论 血小板的各项参数在Ⅱ型糖尿病患者中有显著性改变,提示糖尿病患者存在着血小板活化及凝血活性增高的现象,血小板活性改变在糖尿病患者的病情发展及血栓性并发症的发生中起着一定的作用.     

胃癌患者血小板参数对肿瘤转移的预测价值初探

目的探讨胃癌患者血小板参数对肿瘤转移的预测价值。方法回顾性分析2008年7月至2011年12月就诊于在邯郸市第一医院经病理组织学检查证实的原发胃癌患者。将入选患者分为转移组(n=86)和非转移组(n=131)。分析两组患者基本临床资料、病理分型和肿瘤胃壁浸润情况,记录两组患者外周静脉血血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)以及血小板压积(PCT)等血小板参数。结果两组患者性别、年龄以及病理分型相似。与非转移组比较,转移组患者PLT、MPV、PDW、PCT均较高,PLT(301.38±64.30)×109/L vs(262.48±53.59)×109/L;MPV(12.24±1.15)fl vs(10.17±0.82)fl;PDW(23.26±3.19)%vs(21.95±2.70)%;PCT(0.38±0.07)%vs(0.31±0.06)%(P<0.01)。将应变量肿瘤转移和自变量PLT、MPV、PDW和PCT进行赋值,逐步前进法进行logistic回归,建立肿瘤转移预报概率模型Log(P)=4.340-0.818PLT-4.478MPV-0.581PDW-3.015PCT,敏感度和特异度分别为0.840和0.942。结论在检测血小板参数基础上建立预测模型,对胃癌患者肿瘤转移具有良好预测价值。     

肝硬化患者凝血酶原时间和血小板参数检测的临床意义

目的探讨凝血酶原时间(PT)和血小板参数检测对肝硬化患者的临床意义。方法选择2016年1月15日—2017年3月15日在青岛市第六人民医院就诊的60例肝硬化患者作为研究对象,根据有无出血现象分为出血肝硬化组(32例)和无出血肝硬化组(28例),另选择同期进行体检的60例健康体检者作为健康对照组。采用全自动血细胞分析仪检测所有受检者的PT和血小板参数[血小板压积(PCT)、血小板计数(PLT)、平均血小板体积(MPV)和血小板分布宽度(PDW)],分析上述检测数据对肝硬化患者病情判断的意义。结果与健康对照组比较,肝硬化患者的PCT、PLT均明显降低[PCT:(0.18±0.05)%比(0.42±0.03)%,PLT(×109/L):68.35±14.57比199.63±37.15],MPV、PDW均明显升高[MPV(fl):15.36±1.87比10.32±1.26,PDW(fl):20.20±2.00比12.20±1.62],PT明显延长(s:20.16±2.45比11.93±1.89),差异均有统计学意义(均P0.05)。与无出血肝硬化组比较,出血肝硬化组的PCT、PLT均明显降低[PCT:(0.21±0.10)%比(0.36±0.05)%,PLT(×10~9/L):54.21±14.20比87.23±26.89],MPV、PDW均明显升高[MPV(fl):16.23±1.03比14.12±0.78,PDW(fl):20.02±2.09比16.33±1.52],PT明显延长(s:20.91±3.36比17.13±2.06),差异均有统计学意义(均P0.05)。结论临床上对PT、血小板参数进行检测,便于分析肝硬化患者的肝功能损伤情况和出血情况,辅助疾病的诊断和治疗。     

PLT、MPV、PCT与PDW在特发性血小板减少性紫癜诊断中的应用价值

目的探讨PLT、MPV、PCT与PDW在特发性血小板减少性紫癜诊断中的应用价值。方法选取我院2014年5月至2015年5月收治的特发性血小板减少性紫癜(ITP)患者40例为ITP组,另选取同期来我院进行体检的40名健康人员为对照组,应用深圳Mindray BC-5200全自动血细胞分析仪对PLT、MPV、PCT与PDW其进行自动检测,并给予其相应治疗,然后对两组人员的PLT、MPV、PCT与PDW、ITP组初诊时不同PLT患者的临床疗效进行统计分析。结果 ITP组患者治疗后的PLT、MPV、PCT与PDW均显著高于治疗前(P0.05);治疗前后的PLT均显著低于对照组(P0.05),MPV、PCT与PDW均显著高于对照组(P0.05),初诊时PLT≤10×109/L、(10-60)×109/L、(≥60-100)×109/L患者治疗的总有效率87.5%(7/8)、72.7%(16/22)、80.0%(8/10)之间的差异均不显著(P0.05)。结论 PLT、MPV、PCT与PDW在特发性血小板减少性紫癜诊断中具有较高的应用价值。     

冠心病合并糖耐量减低患者血小板参数与超敏C 反应蛋白的相关性研究

【目的】探讨冠心病(CHD)合并糖耐量减低(IGT)患者血小板参数与超敏 C 反应蛋白(hs-CRP)的相关性。【方法】选取本院收治的CHD合并 IGT患者49例作为 A 组,单纯 CHD患者52例作为 B组,同期入院体检正常者55例作为对照组(C组),入院后均检测 hs-CRP及血小板计数(PLT)、血小板压积(PCT)、血小板分布宽度(PDW)、平均血小板体积(MPV)、大血小板比率(P-LCR)5项血小板参数水平,并了解其相关性。【结果】A 组 hs-CRP、PCT、PDW、MPV、P-LCR 分别为(7.94±0.51)mg/L、(0.24±0.04)%、(22.86±3.05)%、(16.04±3.97)fl、(59.68±8.24)%均显著高于B,C组,PLT为(148.37±29.79)×109/L显著低于 B, C组,B组和C组之间相比较差异亦具有显著性(P <0.05);Pearson相关分析显示hs-CRP与PLT呈负相关关系,与PCT、PDW、MPV、P-LCR呈正相关关系。【结论】CHD合并 IGT 患者血小板参数与 hs-CRP 具有显著相关性。     

选择性5-羟色胺再摄取抑制剂艾司西肽普兰对血小板功能的影响

目的 观察选择性5-羟色胺再摄取抑制剂艾司西肽普兰对血小板功能的影响。方法 选取抑郁症患者61例,随机分为治疗组(艾司西酞普兰10 mg/日)和安慰剂对照组,测定治疗前后的血小板计数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板聚集率(PAR)、血小板膜糖蛋白CD62P和CD63表达。结果 治疗组在治疗前后的PLT(10⁹/L),MPV(fl),PDW(fl),PAR(%),CD62P(%)和CD63(%)分别为175.8±59.1 vs 169.1±60.5,11.8±1.2 vs 10.3±0.9,15.6±2.1 vs 16.7±1.9,60.1±11.5 vs 59.3±14.9,23.8±5.6 vs25.1±3.7,20.6±7.2 vs 22.4±4.7,对照组在治疗前后的PLT(10⁹/L),MPV(fl),PDW(fl),PAR(%),CD62P(%)和CD63(%)分别为198.6±76.5 vs 203.2±49.8,9.4±1.1 vs 10.2±0.8,12.5±1.8 vs 13.3±2.9,62.7±13.6 vs 66.4±10.7,27.9±7.1 vs 24.8±4.9,26.9±8.1 vs 24.1±6.4,差异均无统计学意义(均P>0.05)。结论 艾司西肽普兰对血小板功能无明显影响。     

SIRS患者血小板4项参数变化及临床意义

目的:观察血小板4项参数(BPC血小板计数、MPV血小板平均体积、PCT血小板比积、PDW血小板分布宽度)在SIRS(全身炎症反应综合征)发展过程中的变化趋势及其临床意义.方法:对正常对照组、SIRS组(未达MODS)和MODS(多器官功能障碍综合征)组进行PLT、MPV、PCT、PDW记录与统计分析;同时也记录S组(由非SIRS发展到SIRS的病人但未达到MODS者)、M组(由SIRS发展到MODS者)的病人4项参数变化,进行自身对照,统计分析.结果:对照组BPC(×109/L)为200.72±52.09,MPV(fl)为10.03±1.83,PCT(%)为0.1991±0.0564,PDW(%SD)为17.59±0.94;SIRS组分别为121.94±44.46、10.98±2.34、0.1263±0.0396、17.57±1.64;MODS组分别为51.74±24.55、10.75±2.54、0.0674±0.0454、18.77±2.45;其中BPC和PCT三组对比均有显著性差异(P＜0.05).SIRS组和对照组MPV比较有显著性差异(P＜0.05).MODS组和对照组、SIRS组的PDW比较均有显著性差异(P＜0.05).S组4项参数前后差值为-125.55±60.66(P＜0.001)、1.116±1.944(P=0.000)、-0.0953 ±0.0696(P＜0.000)、0.2370±1.3767(P=0.249);M组4项参数前后差值为-67.54±42.23(P＜0.000)、0.7629±1.9071(P＜0.05)、-0.0453±-0.0392(P＜0.001)、1.886±1.912(P＜0.001).结论:在SIRS发展过程中,PLT、PCT进行性下降,MPV、PDW逐渐上升,SIRS病人上述变化趋势提示病情加重.     

血小板参数在3种疾病诊断中的临床价值

目的探讨血小板参数在肝硬化、脑梗死、尿毒症3种疾病中的变化情况。方法对238例不同疾病患者进行血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)4项参数测定,并与96例健康对照组比较。结果肝硬化组PLT、PCT明显低于健康对照组(P0.01),MPV、PDW高于健康对照组(P0.05)。肝硬化出血组PLT、MPV、PCT低于无出血组(P0.05),PDW无明显变化。脑梗死组PLT低于健康对照组,而MPV高于健康对照组,差异均有统计学意义(P0.05),PCT、PDW无明显变化。脑梗死组治疗后MPV比治疗前降低(P0.05)。尿毒症组PLT低于健康对照组(P0.05),PDW、MPV高于健康对照组(P0.05),PCT变化不明显。结论血小板参数的联合监测对3种疾病的诊断、治疗、预后观察有重要临床价值。     

脑梗死患者C反应蛋白 同型半胱氨酸及血小板检测意义

目的研究脑梗死患者超敏C反应蛋白(hs-CRP)、血清同型半胱氨酸(Hcy)、血小板(PLT)及其参数在疾病诊断治疗中的变化及其临床意义。方法对急性脑梗死患者治疗前后组和健康对照组进行hs-CRP、Hcy及血小板参数检测,并对检测结果做统计学分析。结果急性脑梗死组治疗前PLT为(173.1±84.2)×109/L、平均血小板体积(MPV)为(10.93±1.36)fL、血小板分布宽度(PDW)为17.34%±0.86%、Hcy为(17.49±4.10)μmol/L、hs-CRP为(10.91±4.86)mg/L,与健康对照组比较,急性脑梗死组治疗前PLT减少明显(P<0.05),MPV、PDW、Hcy及hs-CRP明显升高;治疗后PLT升高,MPV、PDW、Hcy及hs-CRP下降,与健康对照组比较,差异无统计意义(P>0.05)。结论测定血清Hcy、hs-CRP水平及监测PLT和MPV、PDW,是了解脑梗死病情严重程度及预后的重要指标,有显著的临床应用价值。     

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.