红细胞比容和血肌酐测定对胰腺坏死早期预测的价值

目的探讨检测红细胞比容（HCT）和血肌酐（Scr）对急性胰腺炎（AP）患者发生胰腺坏死（PN）早期预测的价值。方法采用回顾性分析的方法,比较胰腺坏死组和非胰腺坏死组患者人院时HCT值和48小时内Scr峰值的差异,以及高、低HCT组,高、低Scr组的胰腺坏死发生率、CTSI评分、APACHEⅡ评分之间的差异。并对HCT和Scr这两项指标判断胰腺坏死的灵敏度、特异度、阳性预测值和阴性预测值进行计算。结果低HCT组胰腺坏死发生率低于高HCT组（P〈0．01）,高Scr组胰腺坏死发生率高于低Scr组（P〈0．01）,HCT值判断胰腺坏死的的敏感度、特异度分别为68．8％和82．8％,阳性预测值、刚忡颅洲位分别为52．4％和90．6％,Scr值判断胰腺坏死的敏感性、特异性分别为37．5％和99．1％,阳性预测值、阴性预测值分别为92．3％和85．2％。结论HCT和Scr有助于胰腺坏死的早期预测。     

红细胞比容对老年女性心力衰竭患者3年不良结局事件的预测意义

目的 探讨不同红细胞比容(HCT)水平对老年女性心力衰竭(心衰)患者3年不良结局的影响。方法 选择2014～2016年在天津医科大学总医院及天津市胸科医院这两家医院门诊就诊的症状性老年女性心衰患者561例,排除了91例缺少实验室检查指标的患者、7例患有严重血液病或恶性肿瘤的患者及99例失访患者,最终纳入364例症状性老年女性心衰的患者,根据HCT水平不同分为3组,HCT<37%(HCT低水平组)124例,HCT 37%～45%(HCT正常水平组)123例,HCT>45%(HCT高水平组)117例。通过门诊或电话进行为期3年的随访,采用logistic回归分析不同HCT水平对老年女性心衰患者3年不良结局的影响。结果 与HCT低水平组比较,HCT正常水平组血钠、血红蛋白、红细胞计数及左心室内径显著升高,HCT高水平组血管紧张素转换酶抑制剂比例显著降低(P<0.05)。随访结束88例患者出现心衰再住院,93例患者出现心因死亡,109例患者出现全因死亡;与HCT低水平组比较,HCT高水平组心衰再住院、心因死亡、全因死亡显著增高,差异有统计学意义(P<0.05)。单因素l...     

血液透析患者血容量监测的意义

目的了解血容量监测对评价透析患者干体重和防治透析患者难治性高血压、透析中低血压中的作用.万法38例规律性血液透析患者,其中男8例,女30例,患者平均年龄(54.2±11.5)岁,其中2例为糖尿病肾病.根据患者临床表现分为病情稳定组(A)、低血压倾向组(B)和难治性高血压组(C).对所有患者进行血红蛋白、血清白蛋白、超声心动图和透析充分性检查,观察透析前后血压、心率及体重,透析中监测超滤量、血压、心率、临床症状和血容量变化.结果A组27例,一次透析血容量下降(△BV)5.1%～26.1%之间,其中△BV＜15%者和△BV＞15%者临床指标无明显差异;B组9例,△△BV在12.5%～22.6%之间,和A组患者相比,年龄偏大(P=0.03)和脱水量过多(P=0.006),两组之间的其他因素无显著性差异.对其中3例透析中发生低血压患者在血容量监测的指导下上调干体重,透析结束时血容量下降程度明显好转(21.03%±1.99%vs16.06%±2.03%,P=0.04),未再发生低血压.C组2例,△BV＜5%,在连续血容量监测下,下调干体重后,血压得到有效控制.结论在透析过程中,患者所能耐受的血容量下降程度存在着明显的个体差异.根据患者临床表现结合血容量监测有助于确定合适的超滤量、调整干体重、防治透析过程中低血压和指导治疗透析患者难治性高血压.     

血液透析滤过与常规血液透析对慢性肾衰患者溶质清除的效果比较

对慢性肾功能衰竭（肾衰）患者行维持性血液透析时,其溶质（包括尿素、肌酐、β－微球蛋白、甲状旁腺激素等）清除的充分与否,直接影响其生存率和生活质量。近来,我们对２０例慢性肾衰患者分别采用血液透析滤过（ＨＤＦ）与常规血液透析治疗,现将结果报告如下。１资料...     

非瓣膜性心房颤动患者血尿酸、红细胞比容水平与缺血性脑卒中的相关性分析

目的:探讨血尿酸(SUA)和红细胞比容(Hct)水平与非瓣膜性心房颤动(房颤)患者脑卒中的关系.方法:连续入选2018年1月-2019年6月于华中阜外医院拟行心脏射频消融术并符合标准的845例非瓣膜性房颤患者,记录所有患者病史资料、SUA以及Hct等化验指标和经胸超声心动图参数,并进行CHA2DS2-VASc评分.对H...     

慢性肾衰血液透析病人的高血压

众所周知,高血压是慢性肾衰患者的常见并发症,也是促使肾功能进行性恶化的重要因素。终末期肾衰病人约80%以上合并高血压,血液净化疗法可在数周及数月内使多数尿毒症患者的血压降为正常.10～20%的透析患者虽经有效透析仍存在高血压。长期高血压所致的心脑血管疾病就成为维持性血透病人最重要的危险因素和主要伤亡原因。因此研究慢性透析患者高血压的发生机理和治疗措施对透析病人的长期存活是十分重要的. 终末期肾衰(ESRD)高血压发生机理一、容量机制:即容量依赖性高血压.许多肾衰病人,高血压与细胞外液容量和总体可交换钠(NaE)增高有关,血压与容量及总体可交换钠成正相关.体钠成为主要的血压调节因子.但钠潴留与容量扩张引起高血压的机理尚不十分清楚。二、肾素血管紧张素和水钠平衡之间相互作用的异常。尿毒症病人,即使摄入中等量的钠盐(100     

促红细胞生成素改善慢性肾功能衰竭血透患者红细胞质量

目的：探讨重组促红细胞生成素（ｒＨｕＥＰＯ）替代治疗慢性肾功能衰竭（ＣＲＦ）贫血患者的红细胞质量改变。方法：选择４３例ＣＲＦ维持性血透贫血患者，２４例应用ｒＨｕＥＰＯ治疗，１９例应用输血治疗，分别观察两组治疗前、后，血红蛋白（Ｈｂ）、血球压积（Ｈｃｔ）、脂质过氧化物（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）和Ｎａ＾＋－Ｋ＾＋－ＡＴＰａｓｅ活性变化以及分析Ｎａ＾＋－Ｋ＾＋ＴＡＰａｓｅ活性与ＬＰＯ，ＳＯＤ之     

慢性肾衰患者红细胞变形能力及其影响因素

农垦５８ｓ与一对感光性不同的等基因系杂交，观察了Ｆ１～Ｆ５的代的生育期和育性的变化，生育期从Ｆ２代起出现连续变异，并有超亲类型，Ｆ１代结实率为５４．８％～７５．１％，可以认为不育性是隐性性状，Ｆ２～Ｆ５代的育性呈连续分离，在Ｆ２代没有３：１或１５：１的分离比例，到Ｆ５代不育性还不能稳定，不育株的抽穗期连续分布于整个杂种群体的抽穗期间，而不局限于某一抽穗期间，表明感光性和光敏性是基本独立遗传的，但不     

红细胞生成素皮下和静脉注射对慢性血液透析患者贫血的疗效比较

应用基因重组人红细胞生成素（ｒＨｕＥＰＯ）治疗４０例慢性血液透析（ＣＨＤ）患者的贫血。在起始治疗阶段分为皮下注射和静脉注射两组，皮下注射的平均剂量为每周１７５Ｕｋｇ－１，静脉注射的平均剂量为每周２８２Ｕｋｇ－１。治疗前两组之间的血红蛋白（Ｈｂ）和血细胞比容（ＨＣｔ）值近似，治疗８周后两组病人的Ｈｂ和Ｈｃｔ都有显著上升，静脉注射组上升幅度更大，但两组之间差异无统计学意义。皮下注射的副作用仅为静脉注射的１６．７％，且程度较轻。结果提示，皮下注射ｒＨｕＥＰＯ治疗ＣＨＤ贫血与静脉注射同样有效，而且更加经济安全。     

肾综合征出血热患者血液透析前后红细胞免疫功能的检测及临床意义

自1981年美国生殖免疫学家Siegel提出“红细胞免疫系统”（The red cell immune system）的新概念后,引起国内外学者的极大关注,开拓了机体免疫系统新领域,许多学者对其表达、机制、调节因子等进行了大量研究.但是,在肾综合征出血热（HFRS）患者进行血液透析过程中红细胞免疫功能如何变化却研究较少.因此,对我院HFRS患者血液透析前后的红细胞免疫功能进行了检测和分析,现报告如下.     

SysmexXE-2100血细胞分析仪有核红细胞提示的可靠性分析

目的：评价Sysmex XE-2100血细胞分析仪检测外周血标本时有核红细胞（NRBC）异常提示Q-flag值的可靠性,并探讨其临床应用价值以及影响因素。方法：将NRBC提示阳性（Q-flag值100-300）的血标本100例及无NRBC提示异常（Q-flag值100以下）的血标本100例进行手工涂片瑞特染色镜检,以显微镜检结果为金标准,判断Q-flag值提示的可靠性。结果：SysmexXE-2100测定NRBC提示的灵敏度、特异性分别为98．7％、80．5％。结论：Q-flag值在有核红细胞的检测中有一定的应用意义。     

Quantification of red blood cell fragmentation by the automated hematology analyzer XE-2100 in patients with living donor liver transplantation

The fragmented red cell (FRC) is a useful index for diagnosing and determining the severity of thrombotic thrombocytopenic purpura (TTP), thrombotic microangiopathy (TMA) and other similar conditions, as it is found in peripheral blood in patients with these diseases. The FRC expression rate has conventionally been determined by manual methods using smear samples. However, it is difficult to attain accurate quantification by such methods as they are time consuming and prone to a great margin of error. With cases of living donor liver transplantation, the current study examined the possibility of using a multi-parameter automated hematology analyzer, the XE-2100 (Sysmex Corporation) for FRC quantification. While there was a notable correlation between the manual and automated measurements, the manual measurement resulted in higher values. This suggested remarkable variations in judgment by individuals. The FRC values had a significant correlation with the reticulocyte count, red blood cell distribution width (RDW), fibrin/fibrinogen degradation products (P-FDP) and lactate dehydrogenase (LDH) among the test parameters, and this finding was consistent with the clinical progression in patients. The automated method can offer precise measurements in a short time without inter-observer differences, meeting the requirement for standardization. The determination of FRC count (%) by the XE-2100 that enables early diagnoses and monitoring of TTP or TMA will be useful in the clinical field.     

Pseudoeosinophilia associated with malaria infection determined in the Sysmex XE-2100 hematology analyzer

Hemozoin is known to be an end product of hemoglobin digestion by the malaria parasite. Hemozoin is a birefringent crystal, and thus hemozoin-containing white blood cells (WBCs) may show the atypical light scattering pattern. The purpose of this study was to investigate pseudoeosinophilia associated with malaria infection using a Sysmex XE-2100 hematology analyzer (Sysmex Corporation, Kobe, Japan). The study group included 16 patients with malaria infection. Of these, 38% showed erroneously high eosinophil counts and atypical eosinophil distributions in the WBCs scattergram, which was due to the presence of hemozoin-containing neutrophils. In two patients, their erroneously high eosinophil counts declined as the parasitemia decreased with treatment. In conclusion, hematologists should consider the possibility of pseudoeosinophilia as a result of hemozoin-containing WBCs and confirm the WBC differential count by microscopy in cases of malaria infection.     

Development and clinical application of nucleated red blood cell counting and staging on the automated haematology analyser XE-2100

We initially developed a new flow cytometric (FCM) reference method for the enumeration and staging of nucleated red blood cells (NRBC) in 1997 [Wang et al., 1998 (XIth International Symposium on Technological Innovations in Laboratory Haematology, Banff, Canada, 1998); Tsuji et al., 1999 (Cytometry, 1999)]. The method used CD45 antibody and propidium iodide staining to separate NRBCs from other cells. Accuracy and precision were enhanced because larger numbers of cells were counted than was possible with the manual method. We also developed a method for automated NRBC counting on a haematology analyser, the XE-2100 (Wang, 1988). NRBC were separated from other cells using a special lysing buffer and a fluorescent dye. The XE-2100 was found to detect peripheral and cord blood NRBC accurately and precisely when compared with cell morphology or FCM control methods. The FCM NRBC staging method was established through the identification of different NRBC populations following the novel staining and lysing method. To evaluate the method further, we sorted samples containing NRBCs using a FACSort and investigated NRBC staging on the Sysmex XE-2100 based on the cell sorting results. Data were analysed using special software (ida). First, we used the data in various parameter combinations. We then established gates to classify the NRBC populations. Finally, we analysed blood specimens from patients with different types of diseases to explore possible clinical applications.     

血液透析患者死亡原因分析

目的：分析血液透析(hemodialysis,HD)患者的死亡原因,探讨影响生存的相关危险因素,为提高HD患者生存率提供依据。方法：分析1998-01-01～2008-12-31HD死亡患者的临床资料,分析其死亡原因。结果：同期HD患者共811例,死亡237例,死亡患者透始中位年龄岁67(19～87岁),男性占60.8％,中位生存时间9.6月(0.1～96.6月)。主要死因为心血管疾病(20.3％)、脑血管疾病(16.5％)、感染(24.9％)[与非心脑血管疾病死因患者相比,死于心脑血管疾病的HD患者女性比例(43.7％vs36.7％,P＜0.05)、糖尿病肾病的比例(25.0％vs11.1％,P＜0.05)、HD前有左室肥厚史的比例(9.6％vs4.7％,P＜0.05)、充血性心衰病史的比例(23.3％vs13.4％,P＜0.05)较高,体质量指数(BMI)(21.1 kg/m2vs23.6 kg/m2,P＜0.05)、eGFR(7.6 ml/min·1.72 m2vs10.0 ml/min·1.72m2,P＜0.05)较低]。Logistic回归分析提示BMI较低、透析前有充血性心衰史和左室肥厚史是HD患者死于心血管疾病的危险因素。与非感染死因患者相比,死于感染的HD患者透始年龄较大(66岁vs62岁,P＜0.05)、透析前血白蛋白较低(30.2g/Lvs33.1g/L,P＜0.05)。Logistic回归分析提示透始年龄大、透析前低白蛋白是HD患者死于感染的危险因素。33.3％患者于HD开始3月内死亡,其主要死亡原因为感染(38.0％)、心血管疾病(22.8％)、脑血管疾病(11.4％)。HD开始3月内死亡患者的慢性肾小球肾炎比例(20.6％vs36.2％,P＜0.05)、透析前血钙(1.91 mmol/Lvs2.18 mmol/L,P＜0.05)、血白蛋白(29.2g/Lvs34.7g/L,P＜0.05)、CO2-CP(18.52 mmol/Lvs22.15 mmol/L,P＜0.05)、eGFR(7.55 ml/min·1.72m2vs10.29ml/min·1.72m2,P＜0.05)均显著较低,HD前有充血性心力衰竭病史的比例(19.4％vs16.3％,P＜0.05)、Charlson并发症指数(CCI)=5～10的比例(25.4％vs13.5％,P＜0.05)显著较高。Logistic回归分析提示透析前低白蛋白血症、eGFR较低、充血性心力衰竭史、CCI≥5是HD 3个月内死亡的危险因素。结论：HD患者主要死亡原因为心、脑血管疾病和感染。在HD开始3月内死亡风险较高,尤其是透析前血白蛋白较低、有充血性心力衰竭病史、CCI≥5和开始透析时机较晚的患者。积极改善患者的营养状况、防治心脑血管疾病、感染等并发症、适时开始HD可能有助于提高患者的早期生存率。     

Malaria detection with the Sysmex XE-2100 hematology analyzer using pseudoeosinophilia and abnormal WBC scattergram

Recent investigation using the Sysmex XE-2100 hematology analyzer (Sysmex Corporation, Japan) has demonstrated erroneously high eosinophil counts and abnormal white blood cell (WBC) scattergrams in malaria cases. This study was conducted to assess the diagnostic efficiency of the Sysmex XE-2100 analyzer for malaria. One hundred forty-four patients initially diagnosed with Plasmodium vivax infection, 319 patients with febrile illness, and 24 patients who underwent malaria treatment were analyzed. Atypical features on Sysmex XE-2100 analyzer were categorized as pseudoeosinophilia (a gap of more than 5% in eosinophil counts between the Sysmex XE-2100 analyzer and microscopic examination) and abnormal WBC scattergram. Pseudoeosinophilia or abnormal WBC scattergram were detected in 100 of 144 malaria-positive samples (sensitivity 69.4%, specificity 100%). The samples with pseudoeosinophilia or abnormal WBC scattergrams showed significantly higher parasite counts than the samples without pseudoeosinophilia or an abnormal WBC scattergram (P<0.05). All 24 samples from patients for whom the malaria smear was repeated after malaria treatment was initiated showed a normalized eosinophil count and a normal WBC histogram. In conclusion, attention to differential count and WBC scattergrams provided by the Sysmex XE-2100 would be a valuable tool in malaria detection.     

Erroneously elevated immature reticulocyte counts in leukemic patients determined using a Sysmex XE-2100 hematology analyzer

The immature reticulocyte fraction (IRF) in peripheral blood, as determined by automated reticulocyte analysis, is calculated using the sum of medium and highly fluorescent reticulocyte numbers and provides information about erythropoietic activity in bone marrow. The purpose of this study was to investigate erroneously elevated IRF in leukemic patients, as determined using a Sysmex XE-2100 hematology analyzer (Sysmex, Kobe, Japan). Normal reticulocyte scattergram patterns show regions corresponding to reticulocytes located between matured RBCs and an upper particle (UPP) region, which show a continuum of non-separated fraction. The UPP represents erythroblasts and some immature reticulocytes. As a control group, peripheral blood was taken from patients with benign hematologic diseases, and their reticulocyte scattergrams all showed a normal pattern; UPP values were all less than 100. However, the reticulocyte scattergrams of 5 of 11 leukemia patients showed abnormal patterns and displayed a gap between RBC and reticulocyte regions. Three patients showed a flag with a message such as “RET Abn Scattergram”. IRF results were elevated in these five patients, and their UPP values were above 100. For the remaining six leukemia patients with a normal reticulocyte scattergram pattern, immature reticulocytes were not markedly increased, and UPP values were less than 100. The findings of the present study demonstrate that IRF results may be erroneously elevated in leukemia patients and indicate that hematologists should examine reticulocyte scattergrams and UPP values carefully.     

Quantification of red blood cell fragmentation by automated haematology analyser XE‐2100

The extent of red blood cell fragmentation in peripheral blood is useful for diagnosis and follow‐up in many diseases, e.g. haemolytic uremic syndrome, transplantation‐associated thrombotic microangiopathy (BMT‐TMA). However, this quantification still relies on manual counting of fragmented red cells on blood smears. We have developed a quantification system by gating a fixed area of fragmented red blood cells (Gate 1) on an automated haematology analyser (XE‐2100, Sysmex Co., Kobe, Japan). The fragmented red cell percentage (FRC%) calculated with this system, from 100 samples, was highly correlated with the manual count (r=0.902, P < 0.0001). Because microcytic anaemia specimens usually occupy a lower position on the XE‐2100 scattergram, with microcytic cells overlapping Gate 1 and causing a spuriously high FRC% calculation, a supplementary gate (Gate 2) was added. Using the particle number in this gate as well as in Gate 1, a revised method for such samples was developed and its validity confirmed (revised FRC% correlated with a manual count for 10 subjects (P < 0.001). Because this gating system can be programmed on any XE‐2100, it is likely to prove useful for accurate quantification of red blood cell fragmentation and for the monitoring of the development of BMT‐TMA.