心肌损伤标志物CK—MB质量在急性心肌梗死时的诊断临界值探讨

[目的]了解急性心肌梗死(AMI)时肌酸激酶同工酶质量(CK—MB mass)在不同时间内的临床诊断价值。[方法]测定非AMI患者和AMI患者入院后2h内、24h内、48h内的血浆或血清CK—MB mass浓度，通过ROC曲线特性分析CK—MB mass在AMI不同时间内的诊断临界值。[结果]非AMI患者CK—MB mass的浓度不随时间发生变化，而AMI患者的CK-MB mass浓度随时间呈动态变化，且不同时间内的诊断临界值不同，即入院2h内、24h内和48h内其初筛临界值分别为3．02μg／L。、3．3μg／L和2．95μg／L；最佳临界值分别为3．80μg／L、3．47μg／L和3．26μg／L；确诊临界值分别为4．16μg／L，L、4．35μg／L和4.02μg／L；其AUC面积分别为0.898,0.974和0.864。[结论]AMI患者的CK—MB mass浓度随时间呈动态变化，不同时间内CK—MB mass的临床诊断临界值不同。     

应用ROC曲线评价心肌钙蛋白T在急性心肌梗死诊断中的临床准确性

目的 应用临床诊断性能(ROC)曲线评价心肌钙蛋白T(cTnT)在急性心肌梗死(AMI)诊断中的临床准确性。方法 电化学发光免疫分析法测定病例组及健康对照组的血清cTnT，所得数据用ROC曲线统计软件进行分析。结果 cTnT在AMI诊断中的ROC曲线图左上方最高点为0．04μg／L，其诊断敏感度91％，特异度92％。结论 cTnT在AMI诊断中的最佳临界值为0．04μg／L，比生产厂商提供的诊断临界值0．1μg／L低，故生产厂商提供的诊断临界值只能作为参考，各临床实验室应根据各自的方法学，应用ROC曲线确立诊断AMI适当的临界值。     

心肌标志物在急性心肌梗死诊断时的临界值分析

目的了解急性心肌梗死(AMI)时各心肌标志物的临界值.方法测定AMI患者入院后5 d内不同时间血清心肌肌钙蛋白T(cTnT)、肌红蛋白(Myo)、肌酸激酶MB同工酶(CK-MB)活性、CK-MB蛋白量等心肌标志物浓度,通过ROC曲线特性分析心肌标志物在AMI诊断时的临界值.结果 AMI发病后不同时间各心肌标志物测定值都出现不同程度变化.ROC曲线特性分析显示,AMI发病后不同时间除cTnT外各心肌标志物的诊断临界值都呈动态变化.结论 AMI患者入院后不同时间的各心肌标志物临界值随时间不同而有所变化.相比而言,cTnT的诊断窗口期明显更长,临床应用价值更高.     

心肌标志物在急性心肌梗死诊断时的临界值分析

目的　了解急性心肌梗死 (AMI)时各心肌标志物的临界值。方法　测定AMI患者入院后 5d内不同时间血清心肌肌钙蛋白T(cTnT)、肌红蛋白 (Myo)、肌酸激酶MB同工酶 (CK MB)活性、CK MB蛋白量等心肌标志物浓度 ,通过ROC曲线特性分析心肌标志物在AMI诊断时的临界值。结果　AMI发病后不同时间各心肌标志物测定值都出现不同程度变化。ROC曲线特性分析显示 ,AMI发病后不同时间除cTnT外各心肌标志物的诊断临界值都呈动态变化。结论　AMI患者入院后不同时间的各心肌标志物临界值随时间不同而有所变化。相比而言 ,cTnT的诊断窗口期明显更长 ,临床应用价值更高     

心肌标志物在急性心肌梗死诊断中的临床应用研究

目的应用临床诊断性能曲线(ROC)评价心肌肌钙蛋白T(cTnT)、肌红蛋白(Myo)和肌酸激酶同工酶质量(CK—MB mass)在急性心肌梗死诊断中的临床决定限。方法电化学发光免疫分析法测定病例组及对照组的血清cTnT、Myo和CK—MB mass，所得数据用ROC曲线统计软件进行分析。结果入院即刻血清cTnT诊断急性心肌梗死(AMI)的最佳临界值为0．042μg／L，诊断特异性93％、敏感性92％；CK—MB mass的临界值为5.37μg／L．诊断特异性88％；Myo的临界值为62.8μg／L，诊断特异性为74％、敏感性为72％。急性心肌梗死(AMI)患者胸痛发作6h内Myo的诊断敏感性较高(90．0％)。cTnT其次(76.7％)，CK—MB mass最低(73．3％)；6h后Myo诊断敏感性仅为58．3％；cTnT上升为91．7％，CK—MB mass仍为75．0％。结论cTnT不论是曲线下面积、诊断敏感性、特异性及准确性等方面都明显优于CK—MB mass和Myo．是诊断急性心肌损伤的“金标准”。     

应用ROC曲线评价心肌钙蛋白T在急性心肌梗死诊断中的临床准确性

目的　应用临床诊断性能 (ROC)曲线评价心肌钙蛋白T(cTnT)在急性心肌梗死 (AMI)诊断中的临床准确性。方法　电化学发光免疫分析法测定病例组及健康对照组的血清cTnT ,所得数据用ROC曲线统计软件进行分析。结果　cTnT在AMI诊断中的ROC曲线图左上方最高点为 0 .0 4 μg/L ,其诊断敏感度 91% ,特异度92 %。结论　cTnT在AMI诊断中的最佳临界值为 0 .0 4 μg/L ,比生产厂商提供的诊断临界值 0 .1μg/L低 ,故生产厂商提供的诊断临界值只能作为参考 ,各临床实验室应根据各自的方法学 ,应用ROC曲线确立诊断AMI适当的临界值     

cTnT及hs-cTnT检测在急性心肌梗死早期诊断中的临床价值评价

目的 探讨心肌肌钙蛋白T(cTnT)及高敏cTnT(hs-cTnT)检测在急性心肌梗死(AMI)早期诊断中的临床价值.方法 采集90例AMI患者入院0、3、6 h血清hs-cTnT和cTnT水平,以hs-cTnT 0.014 μg/L和cTnT 0.030 μg/L作为临界值计算阳性率;以受试者工作特征曲线(ROC曲线)分析入院0 h血清hs-cTnT及cTnT水平对AMI的诊断性能.结果 患者入院0、3、6 h血清hs-cTnT阳性率分别为88.75%、97.50%和100.00%,与cTnT各时间点阳性率(61.25%、85.00%、92.50%)比较差异有统计学意义(P＜0.05).患者入院0 h血清hs-cTnT、cTnT水平诊断AMI的ROC曲线下面积分别为0.892、0.790,二者比较差异有统计学意义(P＜0.05).结论 hs-cTnT检测比cTnT具有更高的AMI早期诊断性能,值得推广使用.     

心肌标志物临界值在急性心肌梗死诊断中的应用

目的了解急性心肌梗死(AMI)时心肌标志物的临界值。方法测定AMI患者入院6天内不同时间血清心肌肌钙蛋白T(cTnT)、肌红蛋白(Mayo)、肌酸激酶MB同工酶(CK-MB)活性、CK-MB蛋白量等心肌标志物浓度,通过ROC曲线特性分析显示特性分析心肌标志物在AMI诊断时的临界值。结果AMI患者发病后不同时间各心肌标志物测定值都出现不同程度变化。ROC曲线显示,AMI患者发病后不同时间除cTnT外各心肌标志物的诊断临界值都呈不同程度变化。结论AMI患者入院后不同时间各心肌标志物测随时间不同而有变化。比较而言,cTnT的诊断窗口其明显更长,临床应用价值更高。     

心肌标志物在急性心肌梗死诊断中的临床应用研究

目的应用临床诊断性能曲线(ROC)评价心肌肌钙蛋白T(cTnT)、肌红蛋白(Myo)和肌酸激酶同工酶质量(CK MBmass)在急性心肌梗死诊断中的临床决定限。方法电化学发光免疫分析法测定病例组及对照组的血清cTnT、Myo和CK MBmass,所得数据用ROC曲线统计软件进行分析。结果入院即刻血清cTnT诊断急性心肌梗死(AMI)的最佳临界值为0.042μg/L,诊断特异性93%、敏感性92%;CK MBmass的临界值为5.37μg/L,诊断特异性88%;Myo的临界值为62.8μg/L,诊断特异性为74%、敏感性为72%。急性心肌梗死(AMI)患者胸痛发作6h内Myo的诊断敏感性较高(90.0%),cTnT其次(76.7%),CK MBmass最低(73.3%);6h后Myo诊断敏感性仅为58.3%;cTnT上升为91.7%,CK MBmass仍为75.0%。结论cTnT不论是曲线下面积、诊断敏感性、特异性及准确性等方面都明显优于CK MBmass和Myo,是诊断急性心肌损伤的“金标准”。     

急性心肌梗死诊断中多个时段心肌肌钙蛋白Ⅰ临界值的比较

目的通过动态监测急性心肌梗死(AMI)患者胸痛后3个时段(4、6和10 h)心肌肌钙蛋白Ⅰ(cTnI)含量,设置3个不同临界值,为诊断AMI提供准确的标准。方法用化学发光法测定AMI组及非AMI组血液中cTnI含量,用统计软件绘制受试者工作特征曲线(ROC曲线)。结果根据ROC曲线,4 h cTnI用于诊断AMI的临界值为0.383μg/L,敏感度为88%,特异性为75%;6 h cTnI临界值为0.815μg/L,敏感度为95%,特异性为95%;10 h cTnI临界值为2.065μg/L,敏感度为98%,特异性为100%。结论针对不同时段的cTnI测定值应分别选择各自时段的临界值,可提高其用于临床诊断AMI的实用性及敏感性。     

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.