循环酶法检测抑郁症患者血清同型半胱氨酸水平分析

目的观测抑郁症患者血清同型半胱氨酸(HCY)水平,探讨其与抑郁症的关系。方法采用病例对照研究,用循环酶法检测100例抑郁症患者(患者组)和100例健康者(对照组)的血清HCY水平。并比较两组间的差异。结果患者组血清HCY水平为(16.3±6.9)μmol/L,高于对照组(10.2+3.6)μmol/L。其高同型半胱氨酸血症[(HCY(16.3±6.9)μmol/L]的发生率明显高于对照组[(10.2+3.6)μmol/L]。结论抑郁症患者血清HCY水平轻度升高,并与抑郁症病理症状有关。     

血清同型半胱氨酸水平与脑梗死相关分析

目的探讨血清同型半胱氨酸在脑梗死疾病中的研究。方法应用美国BECKMAN公司DXC-800型全自动生化分析仪检测468例住院脑梗死患者和100例健康对照者的血清同型半胱氨酸(homocysteine,Hcy)含量。结果脑梗死患者的Hcy均值为(26.0±8.0)μmol/L,健康对照者的均值为(10.2±4.0)μmol/L,两组的Hcy值差异有统计学意义(P<0.05)。结论 Hcy是脑梗死疾病的一个独立致病因素。     

血清同型半胱氨酸和高敏C反应蛋白与心血管疾病的相关性探讨

目的 探讨血清同型半胱氨酸(HCY)和高敏C反应蛋白(hs-CRP)在心血管疾病(CVD)诊疗中的临床价值.方法 通过临床试验,检测210例CVD患者和190名健康人群中血清HCY浓度,同时检测hs-CRP,进行对比分析.结果 CVD患者组(试验组)的血清HCY浓度主要集中在10～20 μ mol/L,而健康体检者(对照组)则为0～5μmol/L;试验组的血清hs-CRP浓度主要集中在2～15 mg/L,而对照组则为0～8 mg/L;试验组HCY浓度平均值为19.6μmol/L,明显高于对照组的9.4μmol/L,而试验组hs-CRP浓度平均值为8.4 mg/L,也明显高于对照组的1.3 mg/L,两组在血清HCY和hs-CRP这两项指标上存在高度一致性,且数据集中趋势比较明显.结论 综合监测血清中HCY和hs-CRP浓度的变化,对心血管疾病诊疗有十分重要的临床价值.     

血清同型半胱氨酸水平与脑梗塞关系的临床研究

目的探讨血清同型半胱氨酸(HCY)水平与脑梗死之间的关系。方法检测140例脑梗死患者血清HCY、叶酸(FA)、维生素B12(VitB12)及血脂等指标,并与80例健康对照者相比较。结果脑梗死组血清HCY及甘油三脂(TG)水平高于健康对照组[(16.67±9.06)μmol/L vs.(10.51±2.33)μmol/L,和(1.63±1.12)mmol/L vs.(1.34±0.43)mmol/L,P均<0.001],而FA及VitB12水平则低于健康对照组[(4.62±2.37)g/L vs.(8.47±1.56)g/L,和(255.32±83.43)ng/L vs.(334.6±53.88)ng/L,P值均<0.001],两对照组间总胆固醇(TCHO)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)比较差异没有统计学意义(P>0.05)。结论血清HCY升高可能是脑梗死的危险因素,导致HCY升高的原因可能与血清内叶酸和维生素B12的降低有关。     

血浆hs-CRP和血清HCY水平检测对缺血性眼病的诊断价值

目的探讨血浆超敏C-反应蛋白(hs-CRP)和血清同型半胱氨酸(HCY)水平在缺血性眼病(IOP)中的临床诊断价值。方法已确诊为IOP的175例患者作为试验组,以年龄、性别与试验组患者一比一配对,选取175例健康体检者作为对照组。采用全自动特定蛋白分析系统及配套试剂,以散射免疫比浊法对血浆hs-CRP水平进行测定;采用全自动生化分析仪及HCY检测试剂盒,以速率法对血清HCY水平进行测定。高水平半胱氨酸血症定义为总HCY浓度15.0μmol/L;高水平hs-CRP定义为血浆hs-CRP浓度0.5mmol/L。对血浆hs-CRP和血清HCY检测数据进行回顾性分析。结果IOP组患者中血浆hs-CRP(3.65±3.60mmol/L)和血清HCY水平(49.45±31.04μmol/L)明显高于健康对照组(0.66±0.30mmol/L和12.69±5.23μmol/L),差异均有统计学意义(t=2.623,3.557,均P0.05);IOP组患者中高同型半胱氨酸血症的发病率为82.9%,高水平hs-CRP的发病率为72.6%,明显高于健康对照组,差异均有统计学意义(χ~2=117.978,56.149,均P=0.000)。结论血浆hs-CRP和血清HCY可作为诊断IOP的标志分子,有助于IOP患者的诊断。     

血清同型半胱氨酸检测在中老年急性脑梗死中的应用

目的：研究血清同型半胱氨酸（HCY）在中老年急性脑梗死中的应用。方法收集132例急性脑梗死患者和120名健康体检者（对照组）血液标本,按年龄分中年组（45～59岁）和老年组（≥60岁）。采用循环酶法检测血清HCY水平。结果急性脑梗死患者血清HCY水平中年组、老年组分别为21.50±4.55μmol/L、22.72±6.45μmol/L,差异无统计学意义（P＞0.05）,但均明显高于中年对照组、老年对照组的11.78±1.38μmol/L、16.63±2.17μmol/L,差异有统计学意义（P＜0.05）。老年对照组HCY水平高于中年对照组,差异有统计学意义（P＜0.05）。中年急性脑梗死患者93.55%HCY升高,但老年急性脑梗死患者仅67.14%升高,灵敏度差异有统计学意义（P＜0.05）,HCY对老年急性脑梗死诊断的Kappa指数＜0.60,对中年急性脑梗死诊断的灵敏度、特异度、准确度均＞90%,Kappa指数0.86。结论急性脑梗死患者血清HCY水平明显升高,HCY对中年脑梗死的诊断和警示价值高。     

老年冠心病患者同型半胱氨酸测定的应用

目的 分析不同类型老年冠心病患者同型半胱氨酸(HCY)水平变化.方法 51例确诊冠心病患者,分为不稳定型心绞痛组26例,稳定型心绞痛组25例,对照组为32名健康体检者,循环酶法测定血清HCY.结果 不稳定型心绞痛组HCY为21.5±5.7μmol/L,稳定型心绞痛组15.5±5.2μmol/L,对照组12.9±4.2μmol/L.方差分析3组问有非常显著差异(P＜0.01);各组两两比较表明不稳定型心绞痛组HCY水平最高,较对照组有非常显著差异(P＜0.01);稳定型心绞痛组次之.较对照组有显著差异(P＜0.05).36例冠心病患者HCY＞15μmol/L,高同型半胱氨酸血症(HHCY)发生率70.6%,对照组18.8%,X2检验有非常显著差异(P＜0.01);不稳定性心绞痛组HHCY发生率92.3%,稳定性心绞痛组48.0%,分别与对照组X2检验,前者有非常显著差异(P＜0.01),后者有显著差异(P＜0.05).冠心病两组间X2检验有非常显著差异(P＜0.01).结论 老年冠心病患者血清HCY水平较高,HHCY与病情严重程度相关.     

血清HCY,CysC和NT-proBNP检测在急性脑梗死诊断及预后中的应用研究

目的 探讨血清HCY,CysC和NT-proBNP改变在急性脑梗死(acute cerebra infarction,ACI)患者诊断及预后中的价值及临床意义。方法测定300例患者(急性脑梗死组)及50例健康者(健康对照组)血清HCY,CysC和NT-proBNP水平进行t检验分析,同时测定50例急性脑梗死患者发病时、治疗期及愈后一年血清HCY和NT-proBNP水平,进行ANOVA方差分析,评估HCY,CysC和NT-proBNP对急性脑梗死的诊疗价值。结果 急性脑梗死组男性患者血清HCY值与女性患者(22.65±16.98 μmol/L vs 17.66±15.43 μmol/L)比较,差异有统计学意义(t=2.659,P<0.05); 健康对照组年龄<60岁纳入者其血清HCY和CysC值与年龄≥60岁纳入者相比(14.33±4.12 μmol/L vs 18.18±4.94 μmol/L,2.85±1.01 mg/L vs 1.16±0.79 mg/L),差异均有统计学意义(t=2.066,1.81,均P<0.05); 急性脑梗死组血清HCY,CysC和NT-proBNP值与健康对照组比较(20.23±16.40 μmol/L vs 17.56±4.93 μmol/L,1.88±1.22 mg/L vs 1.14±0.83 mg/L和189.6±92.4 pg/ml vs 88.8±66.7 pg/ml,差异均有统计学意义(t=2.267～7.39,均P<0.05); 急性脑梗死患者血清HCY和NT-proBNP测定结果显示发病组血清HCY和NT-proBNP值与治疗组比较,差异有统计学意义(t=2.27,5.52,均P<0.05); 发病组血清NT-ProBNP与愈后组比较差异亦有统计学意义(t=3.78,P<0.05)。结论 血清HCY,CysC和NT-proBNP测定可作为急性脑梗死患者疾病诊断及愈后效果判断的有效指标,其检测简便,成本低廉,有望用于普通人群急性脑梗死疾病的筛查。     

Ⅱ型糖尿病病人高浓度血清IgA与其慢性并发症的相关性

目的：对Ⅱ型糖尿病及糖尿病并发症患者的血清免疫球蛋白调查，并研究其相关性。方法：分别测定糖尿病、糖尿病并发症患者、健康对照者各组各自的免疫球蛋白，进行统计分析。结果：三组中IgG、IgM无统计学意义。糖尿病并发症组血清IgA浓度最高（x=2.40μmol/L）与对照组差异极显著（P＜0．01），糖尿病组次之（x=1.85μmol/L）与对照组（x=1.54μmol/L)有显著差异。进一步分析发现糖尿病并发心血管病患者血清IgA(x=2.71μmol/L)与并发高血压患者（z=1.96μmol/L)有显著差异，与并发肾病（x=2.34μmol/L）无显著差异。结论：糖尿病人血清IgA浓度高在Ⅱ型糖尿病人中是普通现象，其增高是由于特定的FFI在糖尿病的平均效价明显高于正常人。     

同型半胱氨酸检测参考值范围的探讨

目的确立同型半胱氨酸(HCY)检测的参考值范围。方法通过Olympus AU2700全自动生化分析仪,对2 033例标本进行分析,检测HCY,以确定HCY的参考值范围。结果 HCY≤10μmol/L的检测值人数为1 520例,占检测人数的74.76%;10.1～14.9μmol/L的检测值人数为296例,占检测人数的14.55%;≥15μmol/L的检测值人数为217例,占检测人数的10.67%。结论 HCY≤10μmol/L为正常参考值,>10～<15μmol/L为临界参考值,在此水平的HCY,可根据患者的病理情况做进一步分析认证;HCY≥15μmol/L为异常参考值。高HCY血症的男性人数明显多于女性。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.