ROC曲线评价缺血修饰白蛋白、高敏肌钙蛋白Ⅰ联合检测在急性冠脉综合征早期诊断中的应用

目的运用ROC曲线分析缺血修饰白蛋白(IMA)、高敏肌钙蛋白I(hs-TnI)联合检测在急性冠脉综合征早期诊断中的应用价值。方法选择我院经冠状动脉造影确诊的、发病至采血时间间隔在3 h以内的急性冠脉综合征(ACS)患者31例,分别检测血清IMA和hs-TnI水平。另选择31例同期经冠状动脉造影排除急性冠脉综合征胸痛患者作为非缺血性胸痛(NICP)患者组,31名外表健康的体检人员作为对照组。应用Logistic回归模型,绘制"IMA+hs-TnI"联合检测诊断急性冠脉综合征的ROC曲线,获得相应诊断效能参数,并与肌红蛋白等其它心肌标志物对比,评价IMA和hs-TnI用于急性冠脉综合征早期诊断的临床价值。结果发病3 h内,IMA诊断ACS的曲线下面积为0.840,hs-TnI为0.945。"IMA+hs-TnI"联合检测的曲线下面积为0.967,敏感性为90.3%,特异性为93.5%,高于IMA或hs-TnI单独检测及"TnI+Myo+CKMB"联合检测。结论 IMA和hs-TnI联合检测时可以发挥较好的互补作用,对发病3 h内ACS的诊断具有较高的特异性和敏感性,且高于"TnI+Myo+CKMB"联合检测。     

血清肌钙蛋白I和缺血修饰白蛋白在急性冠状动脉综合征早期诊断及预后评估中的价值

目的 探讨血清肌钙蛋白I(TnI)和缺血修饰白蛋白(IMA)在急性冠状动脉综合征(ACS)早期诊断及预后评估中的价值,为临床的诊断治疗及预后提供更准确的实验室依据,以便及时进行临床干预.方法 收集543例ACS患者发病3小时内的血清样本,其中不稳定心绞痛(UA)180例、非ST段抬高心肌梗死(NSTEMI) 100例、ST段抬高心肌梗死(STEMI) 173例,以同期400例体检健康者作为对照组.全自动生化仪检测IMA、血糖(GLU)、血脂(TG、CHO、HDL、LDL),全自动化学发光仪检测TnI.各组间TnI、IMA比较采用非参数Mann-Whitney U检验,利用受试者工作特征(ROC)曲线分析抗TnI及IMA对ACS的早期诊断价值,采用二分类Logistic回归分析对ACS的预后因素进行评估.结果 UA组、NSTEMI组及STEMI组IMA水平分别为79.30 (77.50～ 86.00)、81.40(78.25～89.70)、83.46(80.01～90.04),均显著高于对照组[71.28(66.44 ～75.55)],而NSTEMI组和STEMI组TnI水平[0.65(0.173 ～3.523)、0.74(0.29～22.51)]也显著高于对照组[0.03(0.018～0.6)],TnI、IMA及联合诊断的ROC曲线下面积(AUC)分别为0.842、0.868、0.904.ACS患者30天内发生主要心脏不良事件(MACEs)的几率为16.70％ (88/527),发生MACEs组的血清TnI及IMA水平[0.41(0.11～16.43),89.10(84.20～93.89)]均高于未发生MACEs组[0.11(0.05 ～1.78),81.80(77.70～85.60)],多因素Logistic回归分析显示血清IMA水平是30天内MACEs发生的独立危险因素.结论 血清TnI、IMA均可作为ACS早期诊断的生物学标志,两者联合检测具有高敏感度和特异度,具有更强的诊断价值,血清IMA是ACS近期预后不良的独立危险因素,还可对ACS患者近期预后进行评估.     

Logistic回归和ROC曲线综合评价四种指标对原发性肝癌的诊断价值

目的 运用logistic回归与受试者工作特征曲线(ROC曲线)评价甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、胸苷激酶(TK1)、分泌型蛋白Dickkopf-1(DKK1)对原发性肝癌(PHC)的诊断价值.方法 选择76例原发性肝癌患者作为PHC组、42例良性肝脏疾病患者作为良性肝病组、32健康体检人员作为对照组,采用电化学发光法检测血清AFP水平;采用亲和吸附层析法检测AFP-L3水平,计算AFP-L3在AFP中比例;采用免疫印迹增强化学发光法检测血清TK1水平:采用ELISA试剂盒检测血清标本中DKKI水平.通过ROC曲线分析和Logistic回归结果的ROC曲线下面积(AUC),对4个指标单独及联合检测的临床性能行比较分析.结果 PHC组4个血清指标的含量明显高于良性肝病组及健康对照组,差异有统计学意义(P＜0.05),AFP、AFP-L3、TK1和DKK1诊断PHC的敏感性分别为68.4％、76.3％、77.6％和80.3％,特异性分别为90.5％、91.9％、95.9％和94.6％.四项联合检测的敏感性和特异性为93.4％和89.2％;AFP、AFP-L3、TK1和DKK1的ROC曲线下面积(AUC)分别为0.755、0.808、0.913、0.814,联合检测的AUC为0.941,与AFP、AFP-L3、TK1和DKK1比较,差异均有统计学意义(P＜0.05).结论 AFP-L3、TK1和DKK1可以作为诊断PHC血清标志物,与AFP联合检测可提高诊断效能;Logistic回归结合ROC曲线可用于PHC多指标联合诊断的分析评价.     

妊娠相关性蛋白A、超敏C反应蛋白及D-二聚体用于早期诊断急性冠脉综合征

目的:分析血浆妊娠相关性蛋白A(PAPP-A)、超敏C反应蛋白(hs-CRP)及D-二聚体(D-D)水平变化及对急性冠脉综合征(ACS)的早期诊断价值。方法:选择本院急诊内科及心血管内科收治的56例ACS患者为ACS组,同期另选50例健康体检者作为对照组,分别检测ACS组胸痛发生2h内和对照组静脉血血浆PAPP-A、hs-CRP及D-D浓度,并比较组间差异,同时绘制受试者工作特征(ROC)曲线,评价以上各项指标对ACS患者的诊断效能。结果:ACS组血浆PAPP-A、hs-CRP及D-D水平明显高于对照组(P0.01)。血浆PAPP-A、hs-CRP及D-D诊断ACS的ROC曲线下面积(AUC)分别为0.910、0.871和0.845,三者联合检测ACS的AUC为0.955,大于单独检测。PAPP-A诊断ACS的敏感度为82.10%,特异度为98.00%。hs-CRP诊断ACS的敏感度为91.10%,特异度为74.00%。D-D诊断ACS的敏感度为75.00%,特异度为86.00%。结论:血浆PAPP-A、hs-CRP及D-D水平与ACS发病相关,可作为ACS早期诊断指标,联合检测可提高对ACS的诊断效能。     

1, 3-β-D葡聚糖、甘露聚糖IgM/IgG抗体对侵袭性念珠菌病早期诊断的临床价值

目的评估1, 3-β-D葡聚糖(BDG)、甘露聚糖IgM抗体(Mn-IgM)、甘露聚糖IgG抗体(Mn-IgG)对侵袭性念珠菌病的诊断价值, 对比分析血清学标志物独立及联合检测在诊断性能上的差异。方法收集126例侵袭性念珠菌病患者和104例同期健康体检者的血清作为研究对象。采用动态显色法检测BDG, ELISA法检测Mn-IgM、Mn-IgG。比较分析3项血清学标志物独立及联合检测的敏感性、特异性、阳性预测值、阴性预测值、约登指数、符合率、Kappa值, 绘制受试者工作特征(ROC)曲线并计算ROC曲线下面积(AUC)。结果 BDG、Mn-IgM、Mn-IgG在侵袭性念珠菌病患者中明显高于健康体检人群(P<0.01)。BDG的敏感性和特异性分别为48.41%、92.31%, Kappa值为0.389, AUC为0.842;Mn-IgM的敏感性和特异性分别为64.29%、91.35%, Kappa值为0.540, AUC为0.829;Mn-IgG的敏感性和特异性分别为27.78%、95.19%, Kappa值为0.214, AUC为0.737。BDG+Mn-IgM的敏感性和特异性分...     

ACS患者冠状动脉旁路移植术后血清sST2、H-FABP和hsTnT水平及意义

目的探讨冠状动脉旁路移植术后血清可溶性生长刺激表达基因2(sST2)、心脏型脂肪酸结合蛋白(H-FABP)和超敏肌钙蛋白(hsTnT)水平变化及与预后的关系。方法选取2015年2月至2018年2月我院收治的169例急性冠脉综合征(ACS)患者为研究对象。选取同期80例健康体检者为对照组。检测并比较两组受试者血清sST2、H-FABP及hsTnT水平。采用Logistic回归分析影响冠状动脉旁路移植术后ACS患者预后的相关因素。采用受试者工作特征曲线(ROC)分析sST2、H-FABP、hsTnT及联合检测诊断ACS患者不良预后的价值。结果ACS组患者血清sST2、H-FABP及hsTnT水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后,ACS组患者血清sST2、H-FABP和hsTnT水平明显降低(P<0.05)。单因素及多因素Logistic回归分析显示,高血压、手术时间、TC、TG、sST2、H-FABP及hsTnT与ACS患者不良预后密切相关。单指标检测时,hsTnT诊断ACS患者不良预后的AUC为0.820,高于sST2的0.815及H-FABP的0.742,三者联合检测诊断患者不良预后的AUC为0.940,明显高于单独指标检测(P<0.05)。结论血清sST2、H-FABP及hsTnT与ACS患者冠状动脉旁路移植术后不良预后密切相关,三者联合检测有助于诊断ACS患者不良预后。     

指南推荐的肿瘤标志物单独或联合应用对原发性肺癌诊断和分型的应用价值

目的 研究指南推荐的肿瘤标志物癌胚抗原(CEA)、鳞状细胞癌抗原(SCC)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)以及胃泌素释放肽前体(ProGRP)单独或联合应用在原发性肺癌诊断和病理分型中的应用价值。方法 通过医院信息系统纳入130例肺癌患者(病例组)和50例肺良性结节患者(对照组),收集每组患者的数据包括CEA、SCC、CYFRA21-1、NSE以及ProGRP,以病理诊断为金标准分析病例组与对照组的肿瘤标志物的差异，应用受试者工作特征(ROC)曲线统计单独或联合应用肿瘤标志物的诊断价值。结果 各项肿瘤标志物在病例组中的水平均高于对照组，肿瘤标志物单项或联合应用的阳性率病例组显著高于对照组，差异有统计学意义(P<0.05);联合应用的灵敏度和阴性预测值均高于单项的检测；联合应用诊断肺癌的AUC为0.931,CYFRA21-1和SCC诊断鳞癌的AUC为0.986和0.959,两项联合诊断的AUC为0.997,NSE和ProGRP对小细胞肺癌诊断的AUC为0.945和0.932,两项联合诊断的AUC为0.969,CEA对腺癌诊断的AUC为0.7...     

血清CXCL9和TIMP-1水平对脑胶质瘤诊断价值的评价

目的 探讨血清中CXC趋化因子家族9(Chemokine C-X-C motif ligand 9,CXCL9)和组织金属蛋白酶抑制剂-1(Tissue inhibitor of metalloproteinases-1,TIMP-1)对脑胶质瘤恶性程度的鉴别价值.方法 使用ELISA法检测低级别和高级别脑胶质瘤组中CXCL9和TIMP-1的含量.结果 与低级别脑胶质瘤组相比较,高级别脑胶质瘤组血清CXCL9和TIMP-1含量均显著升高,且差异具有统计学差异(P＜0.05).CXCL9区分两组的受试者工作特征曲线(Receiver operator characteristic curve,ROC)下面积为0.758(0.723,0.793),对于高级别脑胶质瘤的诊断敏感性和特异性分别为72.7％和67.9％.TIMP-1的ROC曲线下面积为0.722(0.694,0.751),敏感性和特异性分别为70.5％和62.5％.利用二元Logistic回归分析评价血清CXCL9和TIMP-1联合检测的诊断价值,其曲线下面积为0.855(0.792,0.917),敏感性和特异性分别为80.4％和76.1％.CXCL9和TIMP-1的联合诊断与CXCL9和TIMP-1单独检测的诊断价值相比,其曲线下面积有显著提高(P =0.014,P=0.007).结论 CXCL9和TIMP-1的联合诊断是脑胶质瘤患者鉴别诊断的一种潜在的辅助诊断方法.     

IL-6、TNF-α、D- D、NT- BNP在重症肺炎心肌损害患者中的检测及临床意义分析

目的 探讨外周血白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、D-二聚体(D-D)及氨基末端脑钠肽前体(NT-BNP)在重症肺炎心肌损害患者中的水平及临床检测意义。方法 选取2019年1月至2020年12月我院收治的143例重症肺炎患者作为观察对象，按照是否合并心肌损害将其分为心肌损害组(97例)与非心肌损害组(46例)。所有患者均于入院时检测IL-6、TNF-α、D-D、NT-BNP、肌酸激酶MB同工酶(CKMB)和肌钙蛋白I(cTnI)等实验室指标，经ROC曲线分析IL-6、TNF-α、D-D、NT-BNP表达水平对重症肺炎患者心肌损害的预测效能；采用Pearson相关性分析IL-6、TNF-α、D-D、NT-BNP与CKMB和cTnI表达水平的相关性。结果 心肌损害组患者IL-6、TNF-α、D-D、NT-BNP表达水平均高于非心肌损害组患者(P<0.05)。ROC曲线结果显示，IL-6、TNF-α、D-D、NT-BNP水平诊断重症肺炎心肌损害的AUC分别为0.793、0.848、0.835、0.859,均具有较高的灵敏度和特异性。重症肺炎心肌损害组CKMB、cTnI...     

超敏C反应蛋白水平与急性冠脉综合征危险分层的相关性分析

目的 探讨血清超敏C反应蛋白(hs-CRP)水平与急性冠脉综合征(ACS)危险分层的相关性.方法 选取2014年6月至2015年6月军事医学科学院附属医院收治的ACS患者.入院后测定血清hs-CRP水平,采用GRACE评分对ACS进行危险分层,分析两者间的相关性,评估hs-CRP预测ACS高危患者的敏感性与特异性.结果 共入组112例ACS患者.人组患者血清hs-CRP水平与GRACE危险评分呈正相关(r=0.519,P＜0.001).根据ROC曲线结果,hs-CRP诊断ACS高危患者的AUC为0.789(95％ CI:0.701～0.878,P＜0.001).设血清hs-CRP水平为3.5mg/L为预测ACS患者GRACE高危组的临界点,其诊断ACS高危患者的敏感性和特异性分别为81.0％、58.4％.结论 本研究结果证实入院早期的血清hs-CRP水平与GRACE评分呈显著的相关性,其可以有效反映ACS患者的危险程度.     

Modes of reinforcement and gender and culture of experimenter and subject: effects of "alien" and external reinforcement for Japanese and American men and women

In this study, we examined external and "alien" reinforcement (ER and AR. respectively) as a factor in social learning, and studied the combined effects of culture and reinforcement mode. A female (Experiment 1) and a male (Experiment 2) experimenters conducted experimental sessions. Both men and women, who grew up in the same culture as the experimenter, participated and performed the experimental task. A three-way interaction effect of experimenter gender, culture, and reinforcement mode was found on task performance. And the effect was more pronounced for a Japanese experimenter. A female and a male experimenters conducted Experiments 3 and 4, respectively; however participants this time were men and women who grew up in different cultures than the experimenter. Results indicated that the pattern of the subject gender and reinforcement mode interaction effect, when the experimenter was Japanese with American subjects, was exactly opposite to that when the experimenter was American. These experiments showed that AR was as effective for social learning as ER, and that the cultural backgrounds of experimenter and subject influenced AR and ER effectiveness.     

Rates of oxygen consumption and of anaerobic glycolysis in renal cortex and medulla of adult and new-born rats and guinea-pigs

1. Rates of oxygen uptake and of anaerobic glycolysis were estimated in slices from the renal cortex and medulla (a) of adult rats and guinea-pigs, (b) of new-born (1-, 5- and 21-day-old) rats and of guinea-pigs of 1, 12, 21, 24 and 120 hr age.2. In the adult rat, Q(O2) values for the cortex were 12.55 +/- 0.20 (22) and for the medulla: 8.56 +/- 0.17 (22) mul./hr.mg dry weight, while in the new-born rat (24 hr old) they were 10.99 +/- 0.46 (12) and 9.33 +/- 0.18 (9) mul./hr.mg dry weight respectively.3. Values for Q(CO2) (N2) (anaerobic glycolysis) in the 14 hr old new-born rat were in the renal cortex 9.65 +/- 0.35 (5) and in the medulla 7.39 +/- 0.43 (5) mul./hr.mg dry weight; while in the adult they were 2.25 +/- 0.08 (16) and 5.76 +/- 0.14 (16) mul./hr.mg dry weight, respectively.4. In the adult guinea-pig values for Q(CO2) (N2) were of the same order as in the adult rat, though the rate of O(2) uptake was for the cortex 8.12 +/- 0.22 (12) and for the medulla 5.02 +/- 0.23 (11) mul./hr.mg dry weight.5. Though the Q(O2) values in the renal cortex and medulla were smaller in the 1 hr old new-born guinea-pig, they were already increasing in the 12 hr old neonate.6. The results are discussed in the light of enzyme changes occurring during the process of maturation of the nephron as indicated by histochemical observations.     

Timing and intensity of early fevers and the development of allergies and asthma

BACKGROUND: Early childhood fevers appear to protect against later allergies and asthma. What is not known is the time in which fevers exert this effect and whether the degree of temperature increase is important. OBJECTIVE: We sought to examine the relationship between the time and degree of early fevers and later allergies and asthma. METHODS: Eight hundred thirty-five children from southeast Michigan were enrolled at birth. Clinic records from their first 2 years were abstracted for episodes of fever. At age 6 to 7 years, children underwent allergy testing. We examined fevers occurring within 6-month intervals in the first 2 years of life and outcomes at age 6 to 7 years. The primary outcome measures were allergic sensitization, asthma, asthma with allergic sensitization, and asthma without allergic sensitization. RESULTS: In the unadjusted analysis each episode of fever between 7 and 12 months of age was associated with a lower odds of allergic sensitization (odds ratio [OR], 0.71; 95% CI, 0.54-0.93) and asthma with allergic sensitization (OR, 0.43; 95% CI, 0.21-0.90) at age 6 to 7 years. Likewise, every 1 degrees C increase in the maximum temperature between 7 and 12 months was associated with a lower odds of allergic sensitization (OR, 0.77; 95% CI, 0.61-0.96) and asthma with allergic sensitization (OR, 0.62; 95% CI, 0.40-0.94). After adjusting for potential confounders, each episode of fever between 7 and 12 months was associated with a lower likelihood of asthma with allergic sensitization (adjusted OR, 0.33; 95% CI, 0.11-0.94) at age 6 to 7 years. CONCLUSIONS: Both the timing and intensity of childhood fevers appear to be important factors in the development of allergies and asthma.     

纳米水平分子成像与诊疗一体化研究进展与挑战

分子成像能以非侵入性的方式重现活体细胞的生理功能和生物学过程,提高疾病的早期和特异性诊断水平。纳米颗粒/材料具有物理性质可控性高、易于表面修饰、血液循环时间长和可功能化等优点,在疾病诊断与治疗中显示出巨大潜力。但如何阐明纳米材料多功能间的内在联系、解决其代谢及安全性等关键机制难题、实现纳米颗粒/材料多功能性到临床多功能...