血清人附睾蛋白4联合糖类抗原125检测对浆液性卵巢癌的诊断价值

目的 探讨血清人附睾蛋白(HE)4联合糖类抗原(CA)125检测对浆液性卵巢癌的诊断价值。方法选择浆液性卵巢癌患者87例(浆液性卵巢癌组)、卵巢良性肿瘤患者77例(阴性对照组)及健康查体妇女52例(正常对照组),采用化学发光法分别检测血清HE4、CA125水平,用受试者工作特征(ROC)曲线分析血清HE4联合CA125检测诊断浆液性卵巢癌的效能。结果 浆液性卵巢癌组血清HE4、CA125水平明显高于阴性对照组及正常对照组(P均<0.05);晚期浆液性卵巢癌组患者血清HE4水平高于早期患者(P<0.05);HE4、CA125联合检测ROC曲线下面积大于二者单独检测(P均<0.05)。结论 HE4、CA125联合检测比单独检测对早期浆液性卵巢癌的诊断价值更高。     

HE4、CA125及ROMA指数在盆腔包块诊断中的应用价值

目的探讨血清人附睾上皮分泌蛋白(HE) 4、糖类抗原(CA) 125及卵巢癌风险预测指数(ROMA)在盆腔包块诊断中的应用。方法盆腔包块病例89例,其中原发性卵巢癌36例(卵巢癌组)、卵巢良性疾病53例(卵巢良性疾病组);另外选取同期的体检健康者90例(对照组),用罗氏E411全自动电化学发光仪检测卵巢癌组、卵巢良性疾病组、对照组血清HE4及CA125水平,并根据卵巢癌风险性评估软件计算出ROMA指数。以卵巢良性疾病组及对照组作对照,绘出受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),比较CA125、HE4及ROMA指数在盆腔包块诊断中的应用价值。结果卵巢癌组的血清HE4、CA125和ROMA指数均高于对照组及卵巢良性疾病组差异有统计学意义(均P0. 05)。卵巢良性疾病组的血清HE4和ROMA指数的中位数水平与对照组相比差异无统计学意义(均P0. 05); CA125中位数水平高于对照组,差异有统计学意义(P0. 05)。HE4的敏感性、特异性、阳性预测值和阴性预测值最高,分别达到86. 11%、90. 57%、86. 11%和90. 57%。以卵巢良性疾病患者和体检健康者为参照人群,HE4、CA125和ROMA指数的ROC-AUC分别为0. 912、0. 907、0. 931。结论血清HE4、CA125和ROMA指数均有助于评估盆腔包块的性质。对卵巢癌诊断的应用价值大小依次为ROMA指数HE4CA125。     

血清人附睾蛋白4、CA125在卵巢癌诊断中的价值

目的：探讨血清人附睾蛋白4（ HE4）、CA125对卵巢癌的诊断及鉴别诊断的价值。方法采用电化学发光免疫法对49例卵巢癌患者（卵巢癌组）、55例卵巢良性肿瘤患者（卵巢良性病变组）及60例健康体检者（对照组）血清HE4、CA125进行检测,同时绘制HE4、CA125受试者工作曲线（ ROC曲线）。结果卵巢癌组血清HE4及CA125水平显著高于卵巢良性病变组及对照组（P 均＜0．01）。 HE4的 ROC 曲线下面积（0．935）大于 CA125（0．913）;根据ROC曲线确定最佳诊断界值,HE4诊断卵巢癌的灵敏度（89．8％）及特异度（89．9％）均高于CA125（85．7％,86．2％）;HE4联合CA125诊断卵巢癌的灵敏度及特异度分别为95．2％和84．6％,联合检测的灵敏度要高于单一检测的灵敏度（ P均＜0．05）。结论 HE4可作为诊断卵巢癌的血清特异标志物,其对卵巢癌的诊断价值高于CA125;两者联合检测对卵巢癌的诊断效果更好。     

血清糖类抗原125和人附睾蛋白4联合检测在卵巢癌诊断中的价值

目的探讨人血清糖类抗原(CA)125和人附睾蛋白(HE)4联合检测对诊断卵巢癌的价值。方法选取该院收治的卵巢癌患者82例(卵巢癌组)和卵巢良性肿瘤患者85例(卵巢良性病度组)。用电化学发光法及酶联免疫法检测两组患者血清CA125和HE4浓度差别,结果以中位数表示,分析两种肿瘤标志物联合检测对卵巢癌诊断的价值。结果卵巢癌组血清CA125和HE4浓度水平呈高表达,且明显高于卵巢良性病变组(P0.05);卵巢癌组的CA125、HE4阳性检出率明显高于卵巢良性病变组(P0.05),在卵巢癌组中,CA125的阳性检出率高于HE4。从诊断卵巢癌的灵敏度方面比较,患者血清CA125+HE4联合检测的敏感度优于CA125和HE4中任何一项的单项检测,但特异性有所降低。结论血清CA125和HE4的联合检测具有较高的灵敏度,可提高卵巢癌的阳性检出率,是一种有效的组合检测方法。     

建立卵巢肿瘤风险预测模型在卵巢肿瘤诊断中的应用

目的:探讨卵巢肿瘤风险预测模型(ROMA)在卵巢肿瘤诊断中的应用价值。方法:回顾性分析因卵巢肿瘤住院接受手术的良性肿瘤患者41例,恶性肿瘤患者42例及正常受试者40例,用ELISA法检测血清中HE4与CA125水平,计算ROMA值以评估患卵巢肿瘤的风险性。结果:卵巢肿瘤组患者血清HE4、CA125水平及ROMA值高于对照组和良性肿瘤组,差异有统计学意义(P0.01)。良性肿瘤组CA125水平值高于对照组值,差异有统计学意义(P0.01);而HE4水平及ROMA与对照组比较差异无统计学意义(P0.05)。以HE4≥150pmol/L,CA125≥35U/ml作为阳性界限,则HE4、CA125及ROMA值敏感度分别为83.33%,69.04%85.71%;特异度分别为95.12%,78.0%,95.12%。CA125ROC曲线下面积(AUC)为0.676;HE4ROC曲线下面积(AUC)为0.749;ROMA ROC曲线下面积(AUC)为0.814,与CA125、HE4比较差异有统计学意义(P0.05)。结论:在卵巢肿瘤诊断中,单项检测HE4的临床价值优于CA125。对于单项HE4、CA125检测而言,HE4、CA125联合应用计算ROMA值具有更好的诊断卵巢恶性肿瘤的临床价值。     

HE4联合CA72-4、CA19-9血清糖类抗原检测对卵巢癌患者的临床意义

目的:探讨人附睾蛋白4(HE4)联合糖链抗原72-4(CA72-4)、糖链抗原19-9(CA19-9)血清糖类抗原检测对卵巢癌(OC)患者的临床价值。方法:随机选取妇科就诊的57例OC患者及80例卵巢良性疾病患者为研究对象,另外设置80例健康对照组。所有研究对象均抽取静脉血4mL作为血液标本,经离心分离血清后参照试剂盒说明书进行HE4、CA72-4以及CA19-9水平检测,比较各组间检测结果并分析。结果:OC组患者HE4、CA72-4以及CA19-9血清浓度和阳性率分别为(102.1±14.6pmol/L,77.19%)、(43.1±15.9 U/mL,47.37%)及(132.1±53.7 U/mL,49.12%)均显著高于卵巢良性疾病组(56.7±9.3pmol/L,6.25%)、(10.3±5.8U/mL,15.00%)及(15.4±9.7 U/mL,21.25%),健康对照组(37.1±8.4pmol/L,2.50%)、(9.4±3.2 U/mL,3.75%)及(13.1±4.5U/mL,6.25%),P0.05;OC组3项指标联合检测的敏感度(84.21%)显著高于各单项指标(77.19%、47.37%、49.12%),P0.05。结论:HE4、CA72-4以及CA19-9血清浓度均与OC的发生有关,具有一定临床诊断价值,3项指标联合检测的敏感度更高,具有很好的临床价值。     

Finkler超声评分联合血流阻力指数和HE4对老年卵巢癌患者诊断和化疗疗效评估

目的 探讨Finkler超声评分联合血流阻力指数(RI)和人附睾蛋白(HE)4在老年卵巢癌患者诊断和化疗疗效评估中的意义。方法 纳入103例老年卵巢上皮源性恶性肿瘤患者为研究组，选取同期31例年龄匹配的卵巢良性肿瘤为对照组。检测患者血清HE4水平。根据患者首次化疗结束后的无瘤生存期长短分为化疗反应组和无反应组。收集患者临床、超声资料，并通过受试者工作特征曲线明确各指标鉴别卵巢良恶性肿瘤的效能。使用单因素和多因素二元Logistic回归明确影响卵巢癌化疗反应的危险因素。结果 Finkler超声评分、RI和HE4鉴别卵巢肿块良恶性的曲线下面积(AUC)分别为0.67、0.72和0.87,联合3个指标后AUC升高至0.91。HE4<188 pmol/L组中位无瘤生存期明显长于HE4≥188 pmol/L组(15 vs 12个月，P=0.03),而Finkler超声评分和RI对无瘤生存期无明显影响。单因素和多因素Logistic回归分析表明，肿瘤国际妇产科学联合会(FIGO)分期高与HE4≥188 pmol/L是老年卵巢癌患者化疗无反应的危险因素。结论 Finkler超声评分联合RI和H...     

血清附睾蛋白4、糖类抗原125及19-9水平在老年卵巢癌诊断及病理类型鉴别中的临床价值

目的研究肿瘤标志物人附睾蛋白(HE)4、糖类抗原(CA)125、CA19-9在老年卵巢癌诊断及病理类型鉴别的临床应用价值。方法 100例老年卵巢癌设为恶性组,74例卵巢良性病变设为良性组,32例健康体检人员设为对照组,观察三组HE4、CA125及CA19-9平均血清水平及异常率,对其单独检测及并联检测进行方法学评价,并对不同病理类型卵巢癌血清HE4、CA125及CA19-9进行比较。结果恶性组HE4、CA125及CA19-9平均血清水平及异常率均与其他各组有统计学差异(P0.05),灵敏度以三种肿瘤标志物联合检测最高,达83.0%;特异度以HE4最高,达92.5%;约登指数与符合率均以三种肿瘤标志物联合检测最高;HE4、CA125在浆液性癌以及子宫内膜样癌升高较为显著,CA19-9在黏液性卵巢癌升高较为显著。结论 HE4、CA125及CA19-9的联合检测对卵巢癌的早期诊断具有重要的临床应用价值。     

联合检测血清人附睾分泌蛋白4和癌抗原125对卵巢癌的诊断价值

目的：探讨血清人附睾上皮分泌蛋白4（HE4）和癌抗原（CA125）单独或联合检测对卵巢癌的诊断价值。方法：分别应用酶联免疫吸附试验和电化学发光技术测定经病理确诊的卵巢癌患者112例、盆腔良性疾病患者68例及健康对照者80例血清肿瘤标志物HE4、CA125的含量水平,并计算各项目的灵敏性、特异性、准确性、阳性及阴性预测值等诊断性能指标。结果：①卵巢癌组HE4和CA125水平明显高于其他2组,差异有统计学意义（P〈0.01）;健康对照组和良性疾病组比较HE4差异无统计学意义（P〉0.05）;CA1252组差异有统计学意义（P〈0.01）。②以卵巢良性疾病作参照,单独检测血清HE4水平对卵巢癌诊断的敏感性为57.8%,低于单独检测CA125的75.3%;但其特异性为97.0%,高于CA125的85.5%。以二者其中之一高于参考值即视为阳性时,联合检测HE4和CA125对卵巢癌诊断的敏感性为94.6%,特异性可达85.0%。结论：HE4单项检测诊断卵巢癌的特异性优于CA125单项检测,两者联合检测可以提高诊断。     

血清指标结合彩色多普勒超声在早期诊断老年卵巢癌中的临床意义

目的探讨血清指标结合彩色多普勒超声在早期诊断老年卵巢癌中的临床意义。方法回顾性分析115例老年卵巢肿瘤患者的临床资料,均经术后病理检查确诊。按照手术病理结果分为卵巢癌50例(卵巢癌组),卵巢良性肿瘤65例(良性肿瘤组)。所有患者术前分别检测血清糖类抗原(CA)125、CA199、人附睾蛋白(HE)4,并行彩色多普勒超声检查。以手术病理结果为金标准,判断CA125、CA199、HE4、彩色多普勒超声四项联合及单独检测对早期诊断老年卵巢癌的价值。结果卵巢癌组血清CA125、CA199、HE4水平及阳性率均明显高于良性肿瘤组(P0.05);卵巢癌组彩色多普勒超声检测阳性率明显高于良性肿瘤组(P0.05);卵巢癌组卵巢动脉舒张期流速(EDV)、收缩期峰值流速(PSV)明显高于良性肿瘤组,血流阻力指数(RI)明显低于良性肿瘤组(P0.05);以手术病理结果为金标准,血清CA125、CA199、HE4、彩色多普勒超声四项联合检测诊断敏感度、特异度、准确度、阳性预测值、阴性预测值均明显高于各项单独检测(P0.05)。结论老年卵巢癌早期诊断中联用血清CA125、CA199、HE4与彩色多普勒超声检测可提升诊断效能。     

不同病因对老年心力衰竭患者血清CA125水平的影响

目的 研究不同病因所致老年心力衰竭患者CA125的变化情况,探讨与血B型脑钠肽(BNP)间的关系.方法 155例确诊的慢性心力衰竭患者,按照纽约心脏学会(NYHA)心功能分级Ⅲ级或Ⅳ级的老年患者作为研究对象,根据患者病因分为高血压组、冠心病组、心肌病组及其他病因组,选取25例健康体检老年人为对照组;采用化学免疫发光法定量测定血清CA 125值,采用微粒子酶联免疫检测法定量测定血浆BNP水平,将各组间的CA 125值进行比较,并对CA 125与BNP间的相关性进行分析.结果 高血压组、冠心病组、心肌病组及其他病因组血清CA125值分别为(83.4±6.6)U/L、(36.8±1.4) U/L、(38.1±1.6)U/L及(38.4±1.4)U/L,高于对照组(14.3±1.15)U/L,差异有统计学意义(均P＜0.05);其中高血压组CA125值高于其他各组(P＜0.05),且与BNP呈正相关(r=0.67,P＜0.05).结论 CA 125值可作为诊断心力衰竭的筛选指标,且对评价引起心力衰竭的病因有一定的预测价值.

Abstract：

Objective To investigate the effect of different etiology on the serum level of carbohydrate antigen 125 (CA125) in elderly patients with chronic congestive heart failure (CHF), and to assess any correlation of CA125 with serum level of B-type natriuretic peptide (BNP). Methods The 155 aged patients with New York Heart Association (NYHA) class Ⅲ or Ⅳ were enrolled and grouped into four reasons of hypertension, coronary heart disease (CHD), cardiomyopathy and other reasons, and 25 healthy old persons as control.CA125 and BNP levels were measured by automatic chemiluminescent immunoassay and enzyme immunoradiometric assay, respectively. Results CA125 level in patients with CHF was (83.4±6.6)U/L for hypertension, (36.8±1.4)U/L for CHD, (38.1±1.6)U/L for cardiomyopathy and (38.4±1.4)U/L for other reasons, which significantly higher than for healthy controls [(14.3±1.15) U/L, P＜0.05].Especially, CA125 level in hypertension group was notable higher than in other reasons of group (P＜0.05), and was positively related to BNP level (r=0.67,P＜0.05). Conclusions Serum CA125 level is a predictor for clinical pathogen of CHF.Therefore, it may be a useful additional marker for the evaluation of clinical treatment of these patients     

血清和肽素水平与急性缺血性卒中患者转归的相关性

目的 探讨血清和肽素水平与急性缺血性卒中患者转归的关系.方法 纳入发病24 h内的首次缺血性卒中患者,应用酶联免疫吸附法检测血清和肽素水平,应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估基线卒中严重程度.在发病后90 d时应用改良Rankin量表(modified Rankin Scale,mRS)评分评价转归,0～2分定义为转归良好.年龄和性别相匹配的健康体检者作为对照者.结果 共纳入连续86例发病24 h内首次缺血性卒中患者和50名年龄和性别相匹配的健康体检者作为对照者.急性缺血性卒中患者发病24 h、7d和14 d血清和肽素水平分别为(7.81±0.66) pmol/L、(4.78±1.76) pmol/L和(2.82±1.42) pmol/L,均显著高于对照组[(1.67±0.56) pmol/L;P均＜0.05].86例患者中,74例(86.05％)转归良好,12例(13.95％)转归不良.转归不良组年龄[(67.64 ±9.62)岁对(61.12±7.31)岁;t=-3.420,P=0.020]、NIHSS评分[(14.16±4.22)分对(6.96±2.04)分;t=-8.26 3,P＜ 0.001]、基线收缩压[(166.06±13.42)mmHg对(154.12±11.69)mmHg;t=5.216,P=0.037;1mmHg=0.133 kPa]、空腹血糖[(8.79±2.98) mmol/L对(6.92±2.24) mmol/L;t=2.076,P=0.041]、C反应蛋白[(7.02±1.72) mg/L对(4.07±1.58) mg/L;t=-1.724,P=0.019]、24 h时和肽素水平[(9.67±2.28)p mol/L对(6.88±2.82)pmol/L;t=13.962,P＜ 0.001]、7d时和肽素水平[(8.22±2.14) pmol/L对(2.97±2.04)pmol/L;t=20.564,P＜0.001]、14 d时和肽素水平[(4.77±1.86)p mol/L对(2.02±0.76) pmol/L;t=8.428,P=0.032]以及心房颤动(33.33％对8.11％;x2=4.986,P=0.036)、大动脉粥样硬化性卒中(41.67％对21.62％;x2 =6.729,P=0.038)、心源性栓塞(33.33％对8.11％;x2=4.986,P=0.036)的患者构成比均显著高于转归良好组,小动脉闭塞性卒中的患者构成比显著低于转归良好组(16.67％对70.27％;x2=16.972,P=0.041).多变量logistic回归分析显示,血清24 h(优势比2.424,95％可信区间1.920 ～ 3.562;P＜0.001)和7d(优势比2.326,95％可信区间1.768 ～3.482;P＜0.001)时和肽素水平以及基线NIHSS评分(优势比2.146,95％可信区间1.616～3.268;P＜0.001)是转归不良的独立危险因素.结论 基线血清和肽素水平增高是急性缺血性卒中患者90 d时转归不良的独立预测因素.     

多发性骨髓瘤骨病患者骨代谢及调节因子水平及其意义

目的 研究多发性骨髓瘤(MM)患者血清Dickkopf-1(DKK-1)、可溶性核因子κB配体受体激活剂(sRANKL)、护骨素(OPG)和骨代谢因子[碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶(TRACP-5b)]水平及其与MM分期、溶骨性病变的关系,探讨骨代谢及调节因子DKK-1和sRANKL在MM骨病中的临床意义.方法 采用双抗体夹心ELISA检测30例初诊MM患者和20例健康人血清DKK-1、sRANKL、OPG、ALP、TRACP-5b等骨代谢因子及调节因子的水平.结果 MM患者血清DKK-1、sRANKL、OPG和TRACP水平均显著高于健康人,分别为42.96μg/L比5.33 μg/L,1.83pmol/L比0.79 pmol/L,1799.30 pmol/L比822.40 pmol/L,5.81 U/L比0.28 U/L,P值均＜0.05.国际分期系统(ISS)分期Ⅲ期患者血清DKK-1水平(46.33 μg/L)和sRANKL(2.26 pmol/L)水平显著高于Ⅰ/Ⅱ期患者(37.91μgL和1.19 pmol/L,P值均＜0.05).3处以上与1～3处溶骨病变患者相比,血清DKK-1、sRANKL和TRACP-5b水平显著升高(46.30μg/L比31.98μg/L,2.18 pmol/L比0.69 pmol/L,6.02 U/L比5.13 U/L,P值均＜0.05).结论 MM患者血清DKK-1、sRANKL、OPG和TRACP-5b水平均显著高于健康人;血清DKK-1、sRANKL水平与MM分期及溶骨病变程度相关.

Abstract：

Objective To detect serum concentrations of Dickkopf-1(DKK-1) and soluble receptor activator of nuclear factor-κB ligand (sRANKL) in patients with multiple myeloma (MM) and to investigate its clinical significance. Methods Serum DKK-1, sRANKL, osteoporotegerin(OPG) and tartrate-resistant acid phosphatase 5b (TRACP-5b) levels were quantified in 30 newly diagnosed MM patients and 20 healthy control subjects by using sandwich ELISA. Results The serum DKK-1, sRANKL,OPG and TRACP-5b levels were significantly higher than those in the healthy controls (42.96 μg/L vs 5.33 μg/L, 1.83 pmol/Lvs 0. 79 pmol/L, 1799. 30 pmol/L vs 822.40 pmol/L, 5.81 U/L vs 0. 28 U/L, respectively; all P＜0. 05). Serum levels of DKK-1 were positively correlated with sRANKL and TRACP-5b, respectively.Serum concentrations of DKK-1 and sRANKL were significantly elevated in stage Ⅲvs stages Ⅰ and Ⅱaccording to International Staging System (ISS) (46. 33 μg/L vs 37.91 μg/L, 2.26 pmol/L vs 1.19pmol/L, respectively, all P ＜0.05). Serum concentrations of DKK-1 , sRANKL and TRACP-5b were significantly higher in patients with more than 3 lytic bone lesions than those with only 1-3 lytic bone lesions (46. 30 μg/L vs 31.98 μg/L, 2. 18 pmol/L vs 0. 69 pmol/L, 6.02 U/L vs 5. 13 U/L, all P ＜ 0.05).Conclusions MM patients have increased serum DKK-1, sRANKL, OPG and TRACP-5b levels as compared with the healthy controls. Serum concentrations of DKK-1 and sRANKL have close relationship with MM stage and lytic bone disease.     

老年肿瘤患者血清促红细胞生成素变化及其与化疗的关系

目的 分析老年肿瘤患者血清促红细胞生成素(Epo)水平及其与血红蛋白(Hb)的关系,以及化疗对其的影响. 方法 应用ELISA方法 检测老年肿瘤患者血清Epo,并观察化疗后Epo变化. 结果 (1)老年组Epo为(22.0±15.1)U/L,与对照组(30.4±21.8)U/L比较,差异无统计学意义(t=1.2988,P＞0.05);Epo水平与Hb水平存在负相关关系(r=0.3700,P＜0.01);(2)55例Hb正常者Epo为(14.7±10.6)U/L,22例轻度贫血者(20.2±9.O)U/L,23例中重度贫血者(42.3±24.8)U/L,差异有统计学意义(F=11.6886,P＜0.01);(3)化疗4周期和2周期后,贫血组Epo分别为(45.2±39.1)U/L和(25.8±15.9)U/L,与治疗前的(20.2±10.8)U/L比较,差异有统计学意义(F=4.5477,PG0.01);Hb分别为(96.8±16.6)g/L和(102.1±19.3)g/L,与治疗前的(111.0±20.5)g/L比较,差异有统计学意义(F=4.0071,PG0.01). 结论 老年肿瘤患者与非老年肿瘤患者比较,Epo水平差异无统计学意义;贫血患者Epo水平明显高于无贫血患者;Epo水平与Hb值呈负相关关系;化疗可以引起部分患者发生贫血,并且随着化疗周期的增加,Hb值下降而Epo水平升高.     

老年帕金森病患者血尿酸水平及其与认知功能的关系

目的 探讨老年帕金森病(PD)患者血尿酸水平与认知功能的关系,并对相关因素进行分析.方法 回顾性分析60例老年PD患者的病历资料,选择性别、年龄相匹配的60例健康体检者作为对照,记录性别、年龄、病程、Hoehn&Yahr分期(H-Y分期)、尿酸、简易智能量表(MMSE)评分,并进行比较和相关性分析.结果 老年PD组血浆尿酸水平[(262±53)μmol/L]明显低于对照组[(332±45)μmol/L],差异有统计学意义(t=-6.724,P＜0.001).PD组男性血浆尿酸水平[(271±48)μmol/L]均值略高于女性水平[(254±39)μmol/L],但差异无统计学意义(t=3.282,P=0.058).PD组男性血浆尿酸水平明显低于对照组男性尿酸水平[(353±62)μmol/L],差异有统计学意义(t=-5.625,P＜0.001).PD组女性血浆尿酸水平低于对照组女性尿酸水平[(294±59)/μmol/L],差异有统计学意义(t=-4.721,P=0.012).老年PD各亚组间血尿酸水平无显著差异,但与对照组比较差异均有统计学意义(F=22,039,P＜0,01).老年PD组血尿酸水平与病程长短无明显相关性(r=0.961,P＞0,05).老年PD患者存在认知功能障碍,其MMSE评分与H-Y分期(r=-0.577,P=0.019)、年龄(r=-0.333,P=0.034)呈负相关,与血尿酸水平呈正相关(r=0.789,P=0.000),与病程(r=-0.333,P=0.027)、体质指数(BMI)(t=-0.410,P=0.115)无相关性.结论 老年PD患者血尿酸水平降低,低尿酸水平可能与老年PD患者的认知功能障碍有关.

Abstract：

Objective To explore the relationship between uric acid (UA) level and cognitive function in elderly patients with Parkinson,s disease (PD) and analyze the cognition related factors.Methods The clinical data of 60 elderly PD cases in our hospital from 2001 to 2009 were retrospectively analyzed. The 60 healthy people receiving medical examination in our hospital and matched by gender and age, were as control group. The information including gender, age, illness duration, Hoehn & Yahr stage (H-Y stage), serum UA level and Mini-Mental State Examination (MMSE) scale were recorded. Results The serum UA level was significantly lower in PD group than in control group [(262±53) μmol/L vs. (332±45) μmol/L, t=-6.724, P＜0.001]. In PD group, the serum UA level was slightly higher in males than in females [(271 ±48) μmol/L vs.(254±39) μmol/L, t=3. 282, P=0. 058]. The serum UA level was significantly lower in male PD patients than in male controls [(353± 62) μmol/L, t=- 5. 625, P＜0. 001], and was lower in female PD patients than in female controls [( 294 ± 59) μmol/L, t = - 4. 721, P = 0. 012]. There were no significant differences in serum UA level among different H-Y stage subgroups (P＞0. 05), but the serum UA level was lower in different H-Y stage subgroups than in control group (F=22. 039, P＜0. 01 ). There was no correlation between the UA level and the illness duration (r=0. 961, P＞0.05).The MMSE score had significant difference between elderly PD group and control group (t= -3. 168,P＜0. 001). In PD patients, the MMSE score was positively correlated with serum UA level (r=0. 789, P= 0. 000), and was negatively correlated with H-Y stage (r= - 0. 577, P = 0. 019 ), age (r= -0. 333, P=0. 034), but was not correlated with illness duration (r= -0. 333, P=0. 207) and BMI (t=- 0. 410, P= 0. 115). Conclusions The level of serum UA is lower in elderly patients with PD than in normal controls. There is correlation between the serum UA level and cognitive impairment. Lower serum UA level predicts worse cognitive scores.     

CA 125 and its relation to cardiac function.

BACKGROUND: CA 125, known as a marker for ovarian cancer with hypothetical but hitherto uncharacterized biologic functions, was reported to be elevated in some not-well-defined benign conditions. There are no reports on fluctuations of CA 125 related to cardiac function, especially the failing heart and neurohumoral factors such as norepinephrine or atrial natriuretic peptid/e. METHODS AND RESULTS: CA 125 blood levels were determined in patients with heart failure before and after heart transplantation (HTx). In 71 patients, parallel determinations of norepinephrine, atrial natriuretic peptide, pulmonary capillary wedge pressure, and right atrial filling pressure were done. CA 125 levels also were prospectively studied in patients with heart failure with stabilization (n = 25) or worsening of the clinical status (n = 9) and after HTx (n = 25). Parallel determinations of the tumor markers CEA, CA 199, CA 153, TPS, and TPA were also done. The results were grouped according to the clinical status (New York Heart Association class) of the patients. CA 125 was significantly correlated with neurohormones and filling pressures. Follow-up investigations revealed a decrease of CA 125 levels after HTx (401 +/- 259 U/L vs 33 +/- 22 U/L, P <.001, n = 25) or stabilization (429 +/- 188 U/L vs 78 +/- 35 U/L, P <.001, n = 25) and an increase during worsening of heart failure (42 +/- 25 U/L vs 89 +/- 32 U/L, P <.01, n = 9). In 4 patients after HTx, unexpected death was preceded by rising CA 125 levels. CEA, CA 199, CA 153, TPS, or TPA did not correlate with heart failure status or clinical events. CONCLUSIONS: CA 125 is a marker of the clinical and hemodynamic status and the course of patients with heart failure before and after heart transplantation. The determination of CA 125 serum levels may be an additional tool in the management of these patients. In patients with cancer, these "nonspecific" changes must be considered when CA 125 levels are determined. Whether CA 125 has a specific biologic role in heart failure deserves further studies.     

N末端B型利钠肽原在陈旧性心肌梗死患者中诊断心力衰竭的价值

目的 评价血浆N末端B型利钠肽原(NT-proBNP)在陈旧性心肌梗死(OMI)患者中诊断失代偿性心力衰竭(心衰)的价值.方法 连续检测586例OMI患者入院时的血浆NT-proBNP浓度.依据NYHA心功能分级标准评价患者的心功能.心衰组为NYHA心功能Ⅱ级、Ⅲ级和Ⅳ级的患者,非心衰组为NYHA心功能I级的患者.通过ROC曲线下面积评价血浆NT-proBNP浓度诊断失代偿性心衰、左心室收缩功能不全和左心室扩大的价值,并找出其诊断失代偿性心衰的切点.结果586例 OMI患者中,男性占80％,年龄25～83岁,平均(58±11)岁.NYHA Ⅰ级374例、Ⅱ级99例、Ⅲ级82例、Ⅳ级31例,其血浆NT-proBNP浓度[中位数(第25百分位数,第75百分位数)]分别为[484.7(381.6,647.8)pmol/L、907.6(516.6,1290.3)pmol/L、1420.2(879.5,2336.2)pmol/L2442.6(1695.4,3670.7)pmol/L,P＜0.01].心衰组(212例)血浆NT-proBNP浓度显著高于非心衰组(374例)[分别为1148.2(707.9,2145.3)pmol/L和484.7(381.6,647.8)pmol/L,P＜0.01].60岁以上的OMI患者的血浆NT-proBNP显著高于＜60岁的患者[分别为702.3(472.4,1208.5)pmol/L和526.6(392.1,855.6)pmol/L,P＜0.01].男女性别间比较差异无统计学意义.血浆NT-proBNP诊断失代偿性心衰的ROC曲线下面积是0.844(95％ CI:0.809～0.880,P＜0.01).根据ROC曲线,将NT-proBNP诊断失代偿性心衰的切点值定为700 pmol/L,大于或等于此值时诊断心衰的敏感性、特异性和准确性分别是75.9％、79.9％和78.3％,阳性预测值和阴性预测值分别为67.9％和85.3％.对于＜60岁患者,该切点值以600 pmol/L最佳,对于≥60岁患者,该切点值以800pmol/L为最佳.结论 血浆NT-proBNP是OMI患者中诊断失代偿性心衰的可靠指标.对≥60岁和＜60岁的患者应采取不同的诊断切点.     

卵巢癌患者血清SMRP和HE4的表达及其临床意义

目的 探讨血清可溶性间皮素相关蛋白(SMRP)和人附睾蛋白-4(HE4)在卵巢癌早期诊断及病情监测中的临床意义.方法 血清标本取自44例卵巢癌、56例良性肿瘤及40例健康志愿者.ELISA试剂盒测定血清HE4和SMRP,化学发光法测定CA125.结果 卵巢癌组血清CA125、HE4和SMRP高于其他两组.经过理想肿瘤减灭术的卵巢癌术后1 w血清CA125、HE4和SMRP水平明显减低.在诊断效能上,单独检测HE4特异度为100.00%,灵敏度86.36%;SMRP灵敏度77.27%,特异度97.92%;二者与CA125联合检测均可提高灵敏度或特异度.结论 HE4和SMRP补充完善了CA125用于卵巢癌的早期诊断和病情监测,具有较高的临床应用价值.     

Myxedema ascites with an extremely elevated CA125 Level: a case report

Carbohydrate antigen 125 (CA125) is a tumor-marker frequently associated with ovarian malignancies; however, benign gynecologic conditions (e.g. ovarian cysts) commonly cause a smaller increase in CA125 levels. This report describes an elderly Japanese woman with high CA125 levels and massive ascites caused by hypothyroidism. A 67-year-old woman presented herself with a weight gain of about 12 kg and abdominal distension. Her serum CA125 level was markedly elevated (822 U/ml) and abdominal CT revealed a right ovarian cyst and massive ascites. Hormonal laboratory data showed severe primary hypothyroidism with a serum TSH of 594 IU/L and a free thyroxin level of 0.05 ng/dl. Ascitic fluid was found to be exudate with a high protein content of 42 g/L. Cytological analysis and FDG-PET showed no evidence of malignancy. The ascites completely disappeared and serum CA125 normalized after adequate hormonal replacement therapy. These data suggest that hypothyroidism should be considered in patients with ascites and elevated serum CA125.