网织红细胞多参数分析在地中海贫血患者中测定的意义

目的调查健康中国成人的网织红细胞多参数分析的参考值范围;并进一步观察在地中海贫血时网织红细胞各参数改变情况及临床意义。方法应用Coulter-GENS.system2型全自动血液分析仪检测了66例健康成人和33例地中海贫血患者7项网织红细胞细胞参数。结果①网织红细胞细胞多参数的正常参考值范围(男女混合)为:RET%1.34±0.48(0.86%~1.82%);RET#0.059±0.023(0.036~0.082);IRF0.3±0.04(0.26~0.34);HLR%0.38±0.14(0.24%~0.52%);HLR#0.017±0.007(0.01~0.024);MRV113±7(106~120);MSCV91±6(85~97)。②地贫患者的7项网织红细胞参数中有多项与正常人有相比有显著性差异,其中RET%、RET#、HLR%和HLR#明显增高(P<0.01),MRV、MSCV明显下降(P<0.01),且变化程度病情的严重程度有一定的关联性。贫血程度较轻的血红蛋白病,网织红细胞各参数变化不大。结论网织红细胞细胞多参数测定提示,地中海贫血时患者网织红细胞细胞中未成熟细胞占的比例增加可能是导致“无效造血”的主要原因之一;网织红细胞细胞多参数分析能在一定程度上提示地中海贫血严重程度;在经典网织红细胞指标RET%,RET#基础上,应用HLR%、HLR#和IRF可以更细微、全面地描述网织红细胞的成熟度,从而更好的评价骨髓造血的功能。     

网织红细胞多参数参考值调查及临床意义

目的调查网织红细胞(网红)七项参数的参考值及临床意义。方法COULTER-GENS.SYSTEM2五分类血细胞仪对200例健康体检者网织红细胞七项参数进行测定,并将所得结果用SPSS11.0forwindows软件作t检验。结果网织红细胞绝对值(RET#)(X±1.96S):男性0.0179～0.1379,女性0.0191～0.1137;网织红细胞百分比(RET%):男性0.0042～0.0286,女性0.0198～0.0252;高荧光强度网织红细胞绝对值(HLR#):男性0.0001～0.0572,女性0.0001～0.0484;高荧光强度网织红细胞百分比(HLR%):男性0.0001～0.0380,女性0.0001～0.0108;未成熟网织红细胞比例(IRF):男性0.22～0.48,女性0.27～0.48;平均网织红细胞体积(MRV):男性103.7～121.3,女性98.0～126.0;平均球状网织红细胞体积(MSCV):男性81.5～98.5,女性77.9～104.0;其中RET#、HLR#男女两组均有显著性差异(t=2.406P<0.05)而RET%、HLR%、IRF、MRV、MSCV男女两组均无显著性差异(P>0.05)。结论不同年龄、性别、不同实验室结果有差异,各实验室应建立相应的网织红细胞各参数参考值,从而为临床提供有价值的数据。     

网织红细胞多参数参考值调查及临床意义

目的调查网织红细胞(网红)七项参数的参考值及临床意义.方法 COULTER-GENS.SYSTEM 2五分类血细胞仪对200例健康体检者网织红细胞七项参数进行测定,并将所得结果用SPSS 11.0 for windows软件作t检验.结果网织红细胞绝对值(RET#)(X±1.96S):男性0.0179～0.1379,女性0.0191～0.1137;网织红细胞百分比(RET%):男性0.0042～0.0286,女性0.0198～0.0252;高荧光强度网织红细胞绝对值(HLR#):男性0.0001～0.0572,女性0.0001～0.0484;高荧光强度网织红细胞百分比(HLR%):男性0.0001～0.0380,女性0.0001～0.0108;未成熟网织红细胞比例(IRF):男性0.22～0.48,女性0.27～0.48;平均网织红细胞体积(MRV):男性103.7～121.3,女性98.0～126.0;平均球状网织红细胞体积(MSCV):男性81.5～98.5,女性77.9～104.0;其中RET#、HLR#男女两组均有显著性差异(t=2.406 P＜0.05)而RET%、HLR%、IRF、MRV、MSCV男女两组均无显著性差异(P＞0.05).结论不同年龄、性别、不同实验室结果有差异,各实验室应建立相应的网织红细胞各参数参考值,从而为临床提供有价值的数据.     

网织红细胞多参数分析在轻型地中海贫血患者的变化及意义

目的探讨轻型地中海贫血患者网织红细胞参数的变化及临床意义。方法应用Beckman-Coulter公司的LH-750型全自动血细胞分析仪检测50例轻型地中海贫血患者和60例健康成年人的红细胞和网织红细胞参数,对所得数据进行统计学分析。结果网织红细胞百分数（RET％）和绝对值（RET#）在男女之间存在着显著性差异（P〈0．05）。轻型地中海贫血患者RET％、RET#、高光散网织红细胞百分数（HLR％）、高光散网织红细胞绝对值（HLR#）显著增高,平均网织红细胞体积（MRV）、平均球形红细胞体积（MSCV）显著减低,未成熟网织红细胞指数（IRF）变化不大。结论网织红细胞多参数分析对轻型地中海贫血患者有重要的参考价值,可以更细微、全面地评价骨髓造血功能。     

妊娠β地中海贫血患者红细胞及网织红细胞观察

摘要 目的 探讨妊娠的β地中海贫血(β地贫)妇女红细胞参数：平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)、红细胞体积分布宽度(RDW)，网织红细胞参数：网织红细胞百分率(RET%)、网织红细胞绝对值(RET#)、未成熟网织红细胞指数(IRF)、低荧光强度网织红细胞 (LFR)、中荧光强度网织红细胞 (MFR)、高荧光强度网织红细胞 (HFR)在妊娠后的变化情况。方法 用Sysmex XE-2100全自动血液分析仪测定β地贫妊娠妇女红细胞及网织红细胞，将各项测定结果与正常妊娠妇女、非妊娠β地贫妇女进行比较。结果 β地贫妊娠妇女的MCV、MCH低于正常妊娠妇女，RDW高于正常妊娠妇女；β地贫妊娠妇女RET%、RET#、IRF、MFR、HFR高于正常妊娠女妇女，LFR低于正常妊娠妇女。β地贫妊娠妇女的MCV、MCH高于β地贫非妊娠妇女，IRF、MFR、HFR高于β地贫非妊娠妇女，LFR低于β地贫非妊娠妇女。结论 β地贫妇女在妊娠后造血功能会更旺盛，红细胞、网织红细胞参数变化更明显，MCV、MCH、RDW、RET%、RET#、IRF、LFR、MFR、HFR可作为产前地中海贫血筛查的参考指标。     

儿童贫血网织红细胞各参数的应用评价

目的探讨LH750血细胞分析仪检测患儿网织红细胞（Ret）各参数的临床意义。方法用LH750血细胞分析仪测定120例健康体检儿童及118例贫血患儿的网织红细胞参数。结果不同病因的贫血中,网织红细胞百分比（RET%）、网织红细胞绝对值（RET#）、未成熟网织红细胞指数（IRF）、强光散射网织红细胞百分比（HLR%）、强光散射网织红细胞绝对值（HLR#）均具有统计学意义（P〈0.05）。其中溶血性贫血、失血性贫血、肾性贫血、缺铁性贫血、白血病和再生障碍性贫血的HLR%分别为4.02±1.46、2.29±0.87、0.46±0.22、0.50±0.23、0.49±0.25、0.38±0.18;IRF分别为0.56±0.11、0.44±0.13、0.25±0.06、0.26±0.06、0.25±0.05、0.18±0.04。结论网织红细胞各参数在儿童贫血疾病的诊断及疗效观察中具有较高的应用价值。     

网织红细胞分群检测在儿科的临床运用

摘要：目的 探讨网织红细胞分群参数RET%、RET#、IRF、LFR、MFR、HFR在儿科中的临床运用。方法：用sysmex XT2000i全自动血细胞分析仪检测我院2005年2006年295例患者网织红细胞绝对值RET#，网织红细胞白分比RET%，未成熟网织红细胞比率IRF，低荧光强度网织红细胞LFR，中荧光强度网织红细胞MFR，高荧光强度网织红细胞HFR。结果：缺铁性贫血患者RET%为4.35±1.11，IRF%为11.9±3.11，蚕豆黄患者RET%为7.56±0.35，IRF%为10.25±0.45，白血病患者RET%为1.02±0.35，IRF%为0.58±0.56，再生障碍性贫血患者RET%为0.54+0.21，IRF%为0.25±0.12，新生儿和恶性肿瘤患者的网织红细胞各项参数基本正常。白血病患者在化疗过程中第二至三天HFR%降至1.05±1.35，MFR降至2.15±1.69，HFR%和MFR%早于中性粒细胞绝对值与血小板计数的降低。结论：测定网织红细胞的各项参数有助于判断骨髓红系增生活跃程度，也是监测白血病患者在化疗过程中骨髓受抑制程度早期指标。     

网织红细胞参数在贫血性疾病临床诊断中的应用研究

目的探讨网织红细胞参数在贫血性疾病鉴别诊断中的临床意义。方法采用日本希森美康公司XN-2000全自动血细胞分析仪对133例各类贫血患者和60例健康体检者网织红细胞绝对值(RET#)、网织红细胞百分率(RET%)、未成熟网织红细胞比率(IRF%)、低荧光强度网织红细胞百分率(LFR%)、中荧光强度网织红细胞百分率(MFR%)和高荧光强度网织红细胞百分率(HFR%)进行检测。结果各类贫血患者RET#、RET%、IRF%、LFR%、MFR%、HFR%水平与健康者相比呈不同程度升高或降低。溶血性贫血患者RET#、RET%、IRF、MFR%、HFR%显著升高,LFR%显著降低(P0.05);缺铁性贫血患者RET#、RET%、IRF、MFR%、HFR%轻度升高,LFR%轻度降低(P0.05);再生障碍性贫血患者RET#、RET%显著降低,IRF、MFR%、HFR%显著升高(P0.05),而LFR%轻度降低(P0.05)。结论网织红细胞参数,特别是IRF%、LFR%、MFR%、HFR%检测在贫血性疾病鉴别诊断和疗效评价方面具有重要价值。     

地中海贫血孕晚期妇女网织红细胞参数及网织血小板的变化分析

目的探讨网织红细胞6项参数及网织血小板在地中海贫血（简称地贫）孕晚期妇女中的变化及意义。方法对经基因确诊的39例地贫孕晚期妇女、30例正常孕晚期妇女和30例正常非孕妇女,应用SysmexXE-5000全自动血细胞分析仪测定网织红细胞绝对值（RET#）、网织红细胞百分率（RET%）、未成熟网织红细胞比率（IRF%）、低荧光强度网织红细胞百分率（LFR%）、中荧光强度网织红细胞百分率（MFR%）、高荧光强度网织红细胞百分率（HFR%）6项网织红细胞参数及网织血小板百分率（IPF%）。结果地贫孕晚期妇女、正常孕晚期妇女、正常非孕妇女的六项网织红细胞参数及网织血小板比较,差异有统计学意义（P〈0.05或P〈0.01）,其中地贫孕晚期妇女RET#、RET%、IRF%、MFR%、HFR%、IPF%明显增高,LFR%明显下降。结论地贫孕晚期妇女在生理和病理的双重刺激下骨髓的造血功能更旺盛,检测妊娠妇女的网织红细胞参数及网织血小板,有助于发现地贫患者,减少及控制危重地贫患儿的出生。     

探讨网织红细胞相关参数在贫血性疾病中的临床意义

目的探讨网织红细胞(RET)相关参数在贫血性疾病中的临床意义。方法用全自动血液分析仪对153例贫血患者和30例健康体检者的网织红细胞绝对值(RET#)、网织红细胞百分比(RET%)、高荧光强度网织红细胞(HFR)、中荧光强度网织红细胞(MFR)、低荧光强度网织红细胞(LFR)、未成熟网织红细胞比率(IRF)、网织红细胞血红蛋白含量(RET-He)进行检测及分析。结果巨幼细胞性贫血患者和白血病(化疗后)患者的RET%、HFR、MFR、LFR、IRF、RET-He与健康对照组比较,差异有统计学意义(P0.05);肿瘤性贫血患者(化疗后)和肾性贫血(治疗后)患者的RET%、MFR、LFR、IRF、RET-He与健康对照组比较,差异有统计学意义(P0.05);缺铁性贫血(治疗前)患者和失血性贫血患者的RET#、RET%、HFR、MFR、LFR、IRF、RET-He与健康对照组相比,差异有统计学意义(P0.05)。结论 RET相关参数的检测可以反映RET的成熟状态,对不同类型的贫血性疾病的诊断及鉴别诊断具有重要的临床意义及参考价值。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.