中枢神经系统能量代谢与脑细胞外液及血液中葡萄糖和乳酸含量差异的关系

观察兔脑细胞外液与血液中葡萄糖(Glu)及乳酸(Lac)的差异，分析乳酸在中枢神经系统中的作用。方法：实验于2002-10／2003-05在解放军第二军医大学神经生物实验室进行。取纯系新西兰兔7只，采用微透析技术，每10min收集脑细胞外液并静脉采血1次，观察正常状态下，以及静注质量浓度200g／L葡萄糖0～60min、胰岛素0～70min期间血液及脑细胞外液中葡萄糖及乳酸的动态变化。结果：正常状态下，脑细胞外液中葡萄糖明显低于血液，仅为血糖的30％，而乳酸却显高于血液，为血糖的165％；在高血糖及低血糖期间，脑细胞外液中葡萄糖随着血糖浓度的改变而变化，但时间较血糖延迟30min左右；脑细胞外液中葡萄糖波动期间，乳酸水平无明显变化。结论：血液中葡萄糖在通过血脑屏障时具有代谢改变，乳酸可能是神经细胞的重要燃料来源。     

脑性瘫痪患儿脑细胞葡萄糖代谢与发育商关系的研究

目的：探讨脑瘫患儿脑细胞葡萄糖代谢与发育商（DQ）的关系。方法：符合脑瘫诊断标准的脑瘫患儿33例（脑瘫组），均采用Gesell发育量表（GDS）进行测试，同时进行18F-FDG脑显像检查（简称PET），并与健康自愿体检正常儿童（正常组）进行比较。结果：与正常组比较，脑瘫组中PET脑显像异常30例，正常3例；PET脑显像异常与动作能、应物能、应人能和言语能均有明显相关性；单灶低代谢灶其4个能区表现为轻度异常，多灶和弥漫低代谢灶则分别为中度和重度异常，且脑细胞葡萄糖代谢异常程度越重，DQ分值越低（P〈0．05或0．01）。结论：脑细胞葡萄糖代谢异常可影响小儿的DQ状况。GDS结合PET脑显像检查可了解患者脑葡萄糖代谢功能和细胞活动功能，客观反映脑细胞损伤部位及程度，对于脑瘫患儿DQ状况的评估以及指导临床治疗具有重要意义。     

乳酸脱氢酶对葡萄糖检测结果的干扰研究

目的探讨乳酸脱氢酶(LDH)对己糖激酶(HK)法和葡萄糖氧化酶(GOD)法检测葡萄糖(GLU)的干扰效应,评估3种GLU检测试剂的抗干扰能力。方法在全自动生化仪上,采用3个厂家2个不同批次的HK法和GOD法试剂检测高浓度LDH(1 000μmol/L)条件下磷酸盐缓冲液中固定浓度(15mmol/L)的GLU含量。结果 (1)LDH干预导致3种HK法试剂中1种试剂的GLU检测结果显著低于真值,偏差达到66%以上;(2)LDH干预对GOD法检测GLU无明显影响。结论 GLU检测试剂质量仍存在参差不齐的现象,临床实验室在选购试剂前应全面评价试剂质量。     

滑膜液中葡萄糖的含量高低与关节炎活动期关系的临床研究

目的探讨风湿性关节炎患者关节滑膜液中葡萄糖含量的高低与关节炎活动期症状的相关性,并研究滑膜液生态平衡对关节炎的重要性。方法对80倒风湿性关节炎患者进行入院时、用药后、出院时滑膜炎成分检测,并对患者症状进行疼痛、关节肿胀程度、表面温度分级,观察与葡糖糖含量的关系。结果70例患者的疼痛、关节肿胀程度、表面温度分级与葡萄糖含量成正相关,9例患者因中途出院未配合检测,1例患者确诊为系统性红斑狼疮。结论滑膜液检测葡萄糖含量的高低可作为关节炎活动期的参考指标。     

全血及血浆标本钾、葡萄糖、乳酸检测结果的比较

目的:通过方法对比和系统偏差评估,了解同一实验室中血气分析仪检测全血标本和全自动生化分析仪检测血浆标本的钾(K)、葡萄糖(GLU)、乳酸(LAC)结果是否具有可比性或实验结果的偏差程度.方法:按照EP9-A文件要求[1],用全血标本在IL GEM3000血气分析仪、血浆标本在贝克曼DXC800全自动生化分析仪上进行K、GLU、LAC测定,计算相关系数和直线回归方程,对系统误差(systematic error,SE)进行评估,以美国临床实验室修正法规(CLIA'88)规定的室间质量评价允许误差范围为临床接受范围.结果:SEK在正常参考范围上、下限水平均小于1/2 CuA'88.SEGLU在正常参考范围上限小于1/2 CLIA'88、下限大于1/2但小于CLIA'88.SELAC在正常参考范围上、下限水平都大于15%.结论:全血/血浆标本检测K、GLU差异在临床可接受范围内.     

肝移植术后早期肝组织葡萄糖及乳酸代谢的相关性研究

目的 利用微透析技术观察移植肝早期肝组织代谢(葡萄糖、乳酸、乳酸/丙酮酸)的变化和它们之间的相关性.方法 收集我院2007-03~2009-12肝移植患者20例,在新肝镰状韧带植入微透析导管进行透析,每隔1 h,测定透析液中葡萄糖、乳酸、乳酸/丙酮酸的浓度,常规监测5~7 d.结果 原位肝移植患者术后,葡萄糖和乳酸在第...     

妊高症孕妇乳酸及乳酸脱氢酶含量的变化

目的 探讨妊娠期高血压患者体内乳酸及乳酸脱氢酶含量的变化.方法 取被确诊为妊娠期高血压病的住院产妇60例作为研究组.取同期住院年龄和孕周有可比性的正常待产妇40例作为对照组,早晨空腹采血测定乳酸、乳酸脱氢酶及相关生化指标的含量.结果 重度妊高症其乳酸和乳酸脱氢酶的检测结果均明显高于对照组(P<0.05).重度妊高症组与轻度妊高症组相比较差异有统计学显著性意义(P<0.05),含量的多少与妊高症的严重程度呈相关性.结论 乳酸可作为妊高症生化监测指标,尤其是与乳酸脱氢酶的联合检测对临床治疗和预后有指导意义.     

老年痴呆患者血脂与脑脊液乳酸含量关系的研究

目的：了解老年性痴呆患者血脂与脑脊液（ＣＳＦ）中乳酸含量变化的关系。方法：痴呆组和对照组各１４例,分别检测每组患者ＣＳＦ乳酸含量及血清中血脂水平。结果：脂蛋ａ（Ｌｐａ）,甘油三酯（ＴＧ）,载脂蛋白Ｂ（ａｐｏＢ）,高密度脂蛋白（ＨＤＬ）,ＣＳＦ乳酸含量痴呆组与对照组比较差异有显著意义。     

血浆葡萄糖和血清葡萄糖测定结果的差异评估

目的评价血浆葡萄糖和血清葡萄糖测定结果的差异,并探讨血浆葡萄糖测定结果是否优于血清葡萄糖测定结果。方法对该市某小区健康查体人员200例,同时抽取2份血样,一份用氟化钠抗凝管分离血浆;另一份用含分离胶的促凝管分离血清。2份血样同时测定葡萄糖水平,用Excel软件分析2组数据的相关性,并用SPSS 13.0软件对测定结果进行处理,分析2组数据的差异性。结果血浆葡萄糖和血清葡萄糖测定结果相关性好,回归方程:Y=0.926 2X-0.434 4;r2=0.973 1。血浆葡萄糖平均值5.72 mmol/L;标准差1.22。血清葡萄糖平均值4.86 mmol/L;标准差1.14。两种方法的检测结果差异有统计学意义(P<0.01)。结论血浆葡萄糖和血清葡萄糖测定结果相关性好,但2组结果间存在较大差异。     

犬心肺复苏后血中游离脂肪酸,丙二醛和葡萄糖含量变化对脑复？…

目的 犬循环呼吸骤停１８ｍｉｎ复苏后观测８ｈ血中游离脂及脂肪酸,丙二醛和葡萄糖含量变化,同时观察神经机能恢复情况和骨骼肌症状。实验分３组即假手术组,常规复苏组和强力宁复苏组。结果 （１）常规复苏组复苏期间ＦＦＱ和ＭＤＡ含量显著升高。强力宁复苏组则无明显升高;（２）两个复苏组血糖均于复苏后３０ｍｉｎ显著升高并达高峰,但于复苏２ｈ后均迅速下降;（３）常规复苏组神经机级恢复明显慢于强力宁复苏组,而且震颤     

The 75-gram glucose load in pregnancy: relation between glucose levels and anthropometric characteristics of infants born to women with normal glucose metabolism

OBJECTIVE: To investigate, in pregnant women without gestational diabetes mellitus (GDM), the relation among obstetric/demographic characteristics; fasting, 1-h, and 2-h plasma glucose values resulting from a 75-g glucose load; and the risk of abnormal neonatal anthropometric features and then to verify the presence of a threshold glucose value for a 75-g glucose load above which there is an increased risk for abnormal neonatal anthropometric characteristics. RESEARCH DESIGN AND METHODS: The study group consisted of 829 Caucasian pregnant women with singleton pregnancy who had no history of pregestational diabetes or GDM, who were tested for GDM with a 75-g, 2-h glucose load, used as a glucose challenge test, in two periods of pregnancy (early, 16-20 weeks; late, 26-30 weeks), and who did not meet the criteria for a GDM diagnosis. In the newborns, the following abnormal anthropometric characteristics were considered as outcome measures: cranial/thoracic circumference (CC/TC) ratio /=90th percentile for GA, and macrosomia (birth weight >/=90th percentile for GA), on the basis of growth standard development for our population. For the first part of the objective, logistic regression models were used to identify 75-g glucose load values as well as obstetric and demographic variables as markers for abnormal neonatal anthropometric characteristics. For the second part, the receiver operating characteristic (ROC) curve was performed for the 75-g glucose load values to determine the plasma glucose threshold value that yielded the highest combined sensitivity and specificity for the prediction of abnormal neonatal anthropometric characteristics. RESULTS: In both early and late periods, maternal age >35 years was a predictor of neonatal CC/TC ratio 35 years being an independent predictor for macrosomia. The 2-h, 75-g glucose load values were significantly associated in both periods with neonatal CC/TC ratio /=90th percentile, whereas maternal age >35 years was an independent predictor of both neonatal CC/TC ratio 相似文献   

Lactic dehydrogenase in cerebrospinal fluid may differentiate between structural and non-structural central nervous system lesions in patients with diminished levels of consciousness

Background: Impaired consciousness without a history of trauma is a common reason for emergency department (ED) visits. Among critically ill patients with a history and physical findings suggestive of a cerebrovascular accident (CVA), it may be difficult to differentiate between a structural and a non-structural cause for their condition. Objectives: This study was conducted to determine if lactic dehydrogenase (LDH) levels in the cerebrospinal fluid (CSF) of patients with acute non-traumatic neurological disorders could distinguish between structural and non-structural etiologies. Material and Methods: Over a 6-month period, CSF specimens were collected from 54 critically ill patients admitted to the ED with impaired consciousness and findings consistent with a CVA. The patients had moderate to severe impairment of consciousness, had a new motor or sensory deficit, or had meningeal signs of recent onset. CSF-LDH levels were analyzed because CSF levels of the enzyme are typically elevated in meningitis, metastatic cancer, and disorders resulting in ischemic necroses. Patients were excluded if a computed tomography scan showed contraindications to performing a lumbar puncture, if they had a coagulopathy, or if the CSF was xanthochromic or produced visible blood sediment after centrifuging. The data were analyzed according to the patients' admission diagnoses—structural vs. non-structural lesion. Results: Of the samples collected from 54 patients, eight were excluded. Among the 46 patients included in the study, the mean age was 56.1 ± 2.75 years, mean APACHE II score was 20.93 ± 0.98, Glasgow Coma Scale (GCS) score was 7.15 ± 0.49, and mortality was 55% (22 patients). The 30 patients with a structural abnormality had a mean age of 56.7 ± 3.55 years, GCS score of 7.3 ± 0.61, APACHE II score of 20.2 ± 1.1, mortality of 43% (13 patients), and CSF-LDH level of 128.8 ± 24.8 IU/L (95% confidence interval [CI] 78.1–179.6). The 16 patients with a non-structural (metabolic) disturbance had: a mean age of 55.0 ± 4.42 years, GCS score of 6.87 ± 0.86, APACHE II score of 22.2 ± 1.94, mortality of 56% (9 patients), and CSF-LDH level of 29.8 ± 2.9 IU/L (95% CI 23.6–36.1). Analysis by Student's t-test was p < 0.05. When the diagnostic value of CSF-LDH level was evaluated using a cutoff point of 40 IU/L, the following results were obtained: sensitivity: 86.7%, specificity: 81.3%, pretest likelihood: 65%, positive predictive value: 90%, negative predictive value: 76%, Likelihood Ratio (LR)+: 4.62, LR−: 0.16 (6.25-fold increase). Conclusions: In critically ill patients with acutely altered levels of consciousness but without a history of trauma, a CSF-LDH value ≤ 40 IU/L is associated with non-structural pathology.     

骨髓基质细胞与中枢神经系统损伤和修复

目的:探讨骨髓基质细胞生物学特性、增殖分化能力和在中枢神经系统的多潜能应用及其作用机制。资料来源:应用计算机检索Medline1994-01/2004-12与骨髓基质细胞和中枢神经系统损伤和修复相关的文章,检索词“bonemarrowstemcells,centralnervoussystem,并限定文章语言种类为English,同时计算机检索万方数据库2000-01/2004-12相关的文章,限定文章语言种类为中文,检索词为“骨髓基质细胞,中枢神经系统”。资料选择:就检索到的200余篇文献进行筛选,选择以骨髓基质细胞用于中枢神经系统损伤和修复的基础研究为主要内容的文献60多篇,其中研究内容相似的,以近5年且发表在较权威杂志者优先,排除综述类文献和Meta分析。资料提炼:将筛选的22篇文献进行分类,7篇研究骨髓基质细胞的生物学特性,5篇与骨髓基质细胞增殖分化能力相关,10篇与骨髓基质细胞在中枢神经系统的应用及其作用机制相关。资料综合:骨髓基质细胞修复中枢神经系统损伤有巨大潜力。通过局部、脑室系统及动脉、静脉植入骨髓基质细胞均发现其在中枢神经系统内长时间存活并集中于损伤区,且有着向神经细胞分化的表现。脑内特殊微环境对其迁移、分化起着重要的诱导作用,同时通过移植骨髓基质细胞可改善损伤的神经功能,此外,骨髓基质细胞对中枢神经系统的神经干细胞也有积极的影响作用,可促进神经再生及可塑性的增强。但目前在骨髓基质细胞的分离、鉴别等方面还存在一些问题有待解决。结论:骨髓基质细胞具有多向分化潜能,在适宜条件下可分化为神经元和星形胶质细胞,能在人类中枢神经系统疾病中起到修正和更改的潜在作用,但其对神经功能损伤恢复的具体机制仍不是十分明确。     

重视脑脊液检验在中枢神经系统疾病诊治中的应用

脑脊液（CSF）是充满脑室系统、蛛网膜下隙和脊髓中央管内的无色透明液体,能直接反映人体中枢神经系统（CNS）的疾病状态。随着新技术用于CSF检验,为中枢神经系统疾病的诊断、预后判断和治疗监测提供了全新的视角。当前主要的挑战是克服生物标志物变异、选择适宜的技术以及检测标准化。