尿微量蛋白对判断过敏性紫癜肾脏损害预后的价值

目的探讨尿微量蛋白检测对判断过敏性紫癜患者肾损伤预后价值。方法检测过敏性紫癜患者尿白蛋白(A1b)、尿免疫球蛋白G(IgG)、尿α1微球蛋白(α1-MG),β2微球蛋白(β2-MG)。结果三组不同肾损害的过敏性紫癜患者α1-MG,β2-MG差异有显著性(P<0.05)。结论α1-MG,β2-MG可成为判断过敏性紫癜肾损害预后的有效指标。     

纳络酮抢救新生儿窒息疗效分析

新生儿窒息为新生儿最常见的症状,可导致多器官功能损害,是围产儿死亡和致残的重要原因,故新生儿窒息的抢救意义重大。乐清市妇幼保健院在常规复苏方案的基础上,早期应用纳络酮抢救新生儿窒息效果满意,现报告如下。     

尿微量蛋白诊断系统性红斑狼疮肾脏早期损伤

目的探讨早期诊断系统性红斑狼疮(SLE)肾脏损伤的方法.方法采用速率散射比浊法测定18例尿蛋白定性阴性和42例尿蛋白定性阳性SLE患者晨尿转铁蛋白(TF)、尿微量白蛋白(UMA)和免疫球蛋白G(IgG).结果正常对照组(n=45)晨尿TF为0.48±0.46mg/L,UMA为7.1±6.4mg/L和IgG为3.3±2.2mg/L.尿蛋白定性阴性SLE组(n=18)晨尿TF为2.6±3.2mg/L,UMA为50±64mg/L和IgG为15.2±10mg/L,该组患者TF、UMA和IgG均显著高于对照组(P＜0.01),三项指标联合检测在该组SLE中阳性率达89%.尿蛋白定性阳性组三项指标均极显著高于对照组,各项检出率均达100%.结论联合检测晨尿TF、UMA和IgG是诊断SLE肾脏早期损伤灵敏、可靠的实验指标.     

荧光PCR和蛋白免疫印迹技术在诊断新生儿先天梅毒中的意义

目的:探讨荧光PCR和蛋白免疫印迹技术在诊断新生儿先天梅毒中的运用。方法:对我院收治的50例先天梅毒患儿以及40例正常新生儿进行荧光PCR和蛋白免疫印迹技术在诊断新生儿先天梅毒的敏感度以及特异性研究。结果:荧光PCR其敏感度为98%,特异性为100%,明显高于蛋白免疫印迹的84%以及85%。两种方法比较具有统计学差异性(P<0.05)。结论:荧光PCR在诊断新生儿先天梅毒中较蛋白免疫印迹技术具有更好的敏感性以及特异性,值得在临床中推广。     

尿液相关细胞因子在系统性红斑狼疮肾脏病情评估中的意义

目的 明确尿液细胞因子TNF-α、IL-6水平在系统性红斑狼疮(SLE)肾脏病情评估中的临床意义.方法 选取2018年2月至2019年2月在昆明医科大学附属第二医院住院的SLE患者30例,同期纳入性别、年龄相匹配的非红斑狼疮者30例作为对照.采用酶联免疫吸附试验(ELISA)测定患者和对照组的尿TNF-α、IL-6表达...     

尿动力学检测在前列腺增生患者中的意义

目的：分析前列腺增生症患者的尿动力学参数,为个性化治疗前列腺增生症提供依据。方法：2011年1月至2013年1月我科收治800名前列腺增生症患者,经直肠指诊、泌尿系彩超,膀胱镜等初步诊断为前列腺增生,对所有患者进一步行尿动力学检查。结果：本组800例患者中,无梗阻8例;可疑梗阻89例,其中逼尿肌收缩无力23例,逼尿肌收缩乏力66例;膀胱出口明显梗阻（BOO）703例,患者中伴不稳定膀胱132例,低顺应性膀胱486例,不稳定膀胱合并低顺应性膀胱18例。平均最大尿流率（8.2±1.5〕mL/s,平均残余尿量（82.6±75.6）mL,急迫尿意时膀胱容量（280.6±171.3）mL,与同期体检中心健康者正常值比较有差异（P〈0.05）。顺应性（24.4±16.5）mL/cmH2O,与同期体检中心健康者正常值比较无差异（P〉0.05）。结论：尿流动力学检测对前列腺增生症患者具有重要意义。     

PGL—1抗原和S—100蛋白检测在早期麻风病诊断中的意义

目的：为提高病理检查对早期麻风病的确诊率,从病原学,组织学及免疫学三方面了解麻风病早期皮损特征。方法：对45例临床诊断和疑似的麻风皮损,彩常规病理和免疫组化法进行了抗麻风菌特异性PGL－1单克隆抗体,S－100蛋白染色,结果：（1）连续切片的抗酸染色和PGL抗原检测可提高对早期皮损内抗酸菌（AFB）及PGL抗原的发现率。AFB及PGL抗原多分布在真皮浅层,神经内／或神经束膜及周围血管浸润的组织细胞中,（1）10例PGL抗原阳性的单个皮损麻风,7例AFB阳性,其中5例神经内有AFB,6例神经内有PGL抗原,4例神经内AFB及PGL抗原均阳性;（3）经S－100蛋白染色显示,未定类皮损组织学的非特异性炎性浸润,多是以淋巴细胞为主,有选择性的皮神经分支的炎性浸润,60％具有特异性神经病变;（4）除皮损数不清的3例外,单个皮损的确诊率为41．6％（10／24）。随着皮损数的增加,病理确诊率也增高,两块皮损和3块以上的确诊率分别为66．6％（6／9）和88．8％（8／9）。结论：PGL－1,S－100蛋白免疫染色,可提高早期麻风病的确诊率。     

系统性红斑狼疮患者4种尿微量蛋白检测结果分析

目的探讨尿微量白蛋白、转铁蛋白、α1-微球蛋白、β2-微球蛋白在SLE患者早期肾损害监测中的意义。方法 SLE患者108例,依据是否有肾脏的临床表现分为两组:有肾脏表现组和无肾脏表现组。65名健康献血者为正常对照组。收集受检者晨起第2次尿液,采用免疫散射比浊法定量检测尿微量白蛋白、转铁蛋白、α1-微球蛋白、β2-微球蛋白。血清尿素氮、肌酐的检测采用全自动生化仪(东芝120)检测。结果有肾脏表现组4种微量蛋白均高于无肾脏表现组和对照组(P<0.05),无肾脏表现组4种微量蛋白均高于对照组(P<0.05)。4项指标单独检测的阳性率在无肾脏表现组、有肾脏表现组组内比较,差异均无统计学意义(P>0.05)。而分析4种微量蛋白联合检测阳性率的结果,发现在无肾脏表现组1项指标阳性率与2项指标阳性率比较,3项指标阳性率与4项指标阳性率比较,差异无统计学意义(P1,2;P3,4>0.05)。而1项指标阳性率与3项指标阳性率比较,与4项指标阳性率比较;2项指标阳性率与3项指标阳性率比较,与4项指标阳性率比较,差异有统计学意义(P1,3;P1,4;P2,3;P2,4<0.05)。在有肾脏表现组结果与无肾脏表现组结果相同。有肾脏表现患者的尿中微量白蛋白、转铁蛋白、α1-微球蛋白、β2-微球蛋白与血清尿素氮之间无统计学相关性;尿中转铁蛋白、α1-微球蛋白、β2-微球蛋白与血清肌酐之间无统计学相关性,P>0.05;而尿微量白蛋白与血清肌酐之间呈正相关,r=0.737,P<0.05。结论 4种指标联合检测可以大大提高阳性检出率,提示系统性红斑狼疮患者早期动态观察监测尿微量蛋白的类型与含量,对患者肾早期损伤的诊断具有非常重要的临床价值。     

系统性红斑狼疮患者外周血及尿视黄醇结合蛋白的测定

目的　探讨系统性红斑狼疮 (SLE)患者血、尿视黄醇结合蛋白的关系及其临床意义。方法　采用双抗体酶联免疫法检测 3 7例患者血清及 2 4h尿视黄醇结合蛋白含量。并设 3 5例健康者为对照组。结果　系统性红斑狼疮患者外周血中视黄醇结合蛋白水平较正常对照低 (t =4.13 1,P <0 .0 0 1) ,但患者的血、尿视黄醇结合蛋白水平没有相关性(P >0 .0 5 )。结论　视黄醇结合蛋白可能参与SLE的发病。     

梅毒螺旋体IgM抗体蛋白印迹试验诊断新生儿胎传梅毒的探讨

目的探讨梅毒螺旋体IgM抗体蛋白印迹试验(Treponema pallidum IgM Western blot，TP-IgM-WB)在新生儿胎传梅毒早期诊断中的价值。方法对8例胎传梅毒新生儿(其母亲均为梅毒)进行TRUST、TPPA，FTA-ABS-19S-IgM和TP-IgM-WB 4种梅毒血清学检查，并结合临床对结果进行比较。结果8例中3例出现胎传梅毒的典型临床表现，包括典型皮肤损害，梅毒新生儿肺炎，伴发心、脑、肝、肾多脏器衰竭；另外5例无胎传梅毒的临床表现。梅毒血清学试验结果：所有8例TP-IgM-WB均为阳性；除1例外，7例FTA-ABS-19S-IgM试验为阳性；3例有症状的胎传梅毒及3例胎传潜伏梅毒中4种梅毒血清学试验均为阳性；1例TRUST和TPPA均阴性，但FTA-ABS-19S-IgM和TP-IgM-WB均阳性；1例FTA-ABS-19S-IgM阴性，但TRUST滴度是母亲的4倍，TPPA和TP-IgM-WB均阳性。结论梅毒螺旋体IgM抗体蛋白印迹试验可作为一种确诊试验应用于新生儿胎传梅毒，尤其是胎传潜伏梅毒的早期诊断。     

某些儿童发疹性疾病与早期肾小管损伤的相关性研究

本文采用双抗体夹心酶免疫测定法测定了８５例皮疹伴发热患儿及对照组８０例无皮疹发热上感患儿尿液的视黄醇结合蛋白（Ｒｅｔｉｎｏｌ ｂｉｎｄｉｎｇ ｐｒｏｔｅｉｎ,ＲＢＰ）含量,皮疹组患儿尿ＢＰ含量全部高于正常值,而对照组患儿尿ＲＢＰ含量全部在政党范围内,二组间经ｔ检验,Ｐ〈０．０１,有显著性意义。因为尿ＲＢＰ是早期肾功能损害最第三而可靠的检测指标,所以本资料结果提示皮疹患儿可能有肾损伤。     

新生儿先天性梅毒多系统损害的临床诊断及治疗

目的:分析先天性梅毒的新生儿患者的临床特征,探讨诊断和治疗该疾病的方法,以期提高治愈率。方法:回顾性分析2010年2月至2013年2月我院接受的TPPA试验且结果显阳性的110例新生儿患者作为研究对象,根据患者的母亲接受治疗的情况分成两组,即治疗组65例和非治疗组45例,分析各组中新生儿先天性梅毒的发生率、确诊为新生儿先天性梅毒多系统损害的临床特征和治疗情况。结果:治疗组中确诊为先天性梅毒发生率为9.23%,非治疗组中发生率为35.56%;治疗组中疑诊为先天性梅毒发生率为4.56%,非治疗组中疑诊发生率为11.11%;治疗组中单纯TPPA阳性发生率为86.15%,非治疗组发生率为53.33%。非治疗组的确诊比例明显高于治疗组,治疗组中单纯TPPA阳性所占的比例明显高于非治疗组,且差异均显著,具有统计学意义(P<0.05);确诊为新生儿先天性梅毒患者中,脏器损害比例排在前三位的是皮肤、血液系统和肝脏;24例确诊和疑诊患儿中22例患者经治疗后2年无复发。结论:母亲在孕期积极治疗对新生儿出生后的先天性梅毒的症状影响较大,先天性梅毒易导致多脏器损害,儿科医生应加强对该类疾病的了解,提高治愈率。     

Role for urinary biomarkers in diagnosis of acute rejection in the transplanted kidney

Despite the introduction of potent immunosuppressive medications within recent decades, acute rejection still accounts for up to 12% of all graft losses, and is generally associated with an increased risk of late graft failure. Current detection of acute rejection relies on frequent monitoring of the serum creatinine followed by a diagnostic renal biopsy. This strategy is flawed since an alteration in the serum creatinine is a late clinical event and significant irreversible histologic damage has often already occurred. Furthermore, biopsies are invasive procedures that carry their own inherent risk. The discovery of non-invasive urinary biomarkers to help diagnose acute rejection has been the subject of a significant amount of investigation. We review the literature on urinary biomarkers here, focusing on specific markers perforin and granzyme B m RNAs, FOXP3 m RNA, CXCL9/CXCL10 and mi RNAs. These and other biomarkers are not yet widely used in clinical settings, but our review of the literature suggests that biomarkers may correlate with biopsy findings and provide an important early indicator of rejection, allowing more rapid treatment and better graft survival.     

银屑病患者尿中四种多胺的检测

采用反向高效液相色谱分析法检测了60例银屑病患者的晨尿,正常人42例晨尿和40例24小时尿中多胺含量.结果发现正常人24小时尿与晨尿中多胺含量无显著性差异,患者晨尿中四种多胺均较对照组显著性上升.不同病期的腐胺.尸胺、精脒以及精脒/精胺比值有显著性差异;治疗后腐胺、尸胺,精眯显著性下降;地图状皮损尿腐胺显著性升高,炎症重者腐胺、精眯上升更明显.晨尿中多胺含量可作为银屑病病情判断和疗效观察的生化指标.     

Biomarkers in chronic kidney disease,from kidney function to kidney damage

Chronic kidney disease(CKD) typically evolves over many years, with a long latent period when the disease is clinically silent and therefore diagnosis, evaluation and treatment is based mainly on biomarkers that assess kidney function. Glomerular filtration rate(GFR) remains the ideal marker of kidney function. Unfortunately measuring GFR is time consuming and therefore GFR is usually estimated from equations that take into account endogenous filtration markers like serum creatinine(SCr) and cystatin C(Cys C). Other biomarkers such as albuminuria may precede kidney function decline and have demonstrated to have strong associationswith disease progression and outcomes. New potential biomarkers have arisen with the promise of detecting kidney damage prior to the currently used markers. The aim of this review is to discuss the utility of the GFR estimating equations and biomarkers in CKD and the different clinical settings where these should be applied. The CKD-Epidemiology Collaboration equation performs better than the modification of diet in renal disease equation, especially at GFR above 60 m L/min per 1.73 m2. Equations combining Cys C and SCr perform better than the equations using either Cys C or SCr alone and are recommended in situations where CKD needs to be confirmed. Combining creatinine, Cys C and urine albumin to creatinine ratio improves risk stratification for kidney disease progression and mortality. Kidney injury molecule and neutrophil gelatinase-associated lipocalin are considered reasonable biomarkers in urine and plasma to determine severity and prognosis of CKD.     

The level of urinary epidermal growth factor is not influenced by the extent of psoriatic lesions

Summary Epidermal growth factor (EGF) levels in the urine of 31 normal individuals and 33 psoriatic patients were measured. The amounts of urinary EGF secreted in a day by normal and psoriatic individuals were not significantly different nor were the levels of EGF in random urine specimens corrected for creatinine values. It is known that the urinary EGF content corrected for the creatinine value correlates very well with the EGF level in blood as well as in 24-h urine specimens. Our data indicate that EGF circulating in the blood may not be correlated with the extent of psoriatic lesions.     

尿KIM-1、L-FABP联合检测在重症肺炎并发急性肾损伤早期诊断中的意义

目的探讨尿肾损伤分子1(KIM-1)和肝型脂肪酸结合蛋白(IL-FABP)在重症肺炎急性肾损伤(AKI)中的水平变化及其对早期诊断的意义。方法选择入住南翔医院ICU及急诊内科的重症肺炎患者87例,留取血液、尿液标本,并记录尿量。采用酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测尿KIM-1和L-FABP,运用受试者工作特征(ROC)曲线及曲线下面积(AUC)进行分析。结果共入组的87例患者,年龄(66.53±17.77)岁,其中重症肺炎非AKI者58例,重症肺炎AKI者29例。其中AKI组年龄更大,合并COPD比例更高,入院时CRP及PCT更高,但是两组患者其基线肌酐数值无明显差异。AKI组在入院时危重病评分及死亡率更高。应用常用炎症指标C和危重病评分对重症肺炎患者发生AKI进行预测,结果发现AUC依次为.CURB-65>PCT>SOFA评分>APACHEII评分>CRP。两组患者尿L-FABP水平在AKI发生前48h即有差异,尿KIM-1水平在发生AKI前24h有差异。尿KIM-1(-24 h)、L-FABP(-24 h)及其联合使用,其AUC分别为0.791、0.784和0.823。KIM-1(-24 h)、L-FABP(-24 h)、CURB-65三者联合预测AKI,当cut-off>0.6092时,敏感性为0.690,特异性为0.983。结论重症肺炎患者在AKI发生前24~48h其尿KIM-1、L-FABP即出现升高,具有早期诊断AKI的价值。KIM-1(-24 h)、L-FABP(-24 h)、CURB-65三者联合预测AKI,其价值更高。     

Macromelanosomes in the early diagnosis of neurofibromatosis

Skin biopsies of café-au-lait macules from 34 patients with a clinical diagnosis of classical neurofibromatosis were examined histologically and ultrastructurally to determine the presence or absence of macromelanosomes in the epidermal melanocytes and keratinocytes. Sixteen of the 34 patients had macromelanosomes. The presence of macromelanosomes varied with age and ethnic background; they were detected in nine of 12 Whites, six of 10 persons of mixed ancestry, and one of two Blacks. In these populations skin biopsy is useful in early diagnosis of neurofibromatosis. However, none of 10 persons of Indian stock had macromelanosomes. Their total absence in this group may be indicative of genetic heterogeneity.