乌司他丁对脓毒症患者抗炎作用观察

目的观察乌司他丁对脓毒症患者的抗炎作用。方法将80例脓毒症患者随机分为治疗组与对照组,两组给予综合常规治疗,治疗组在综合治疗的基础上给予乌司他丁,观察两组治疗前后外周血降钙素原(PCT)、C-反应蛋白(CRP)和WBC水平变化及并发症的发生情况。结果治疗组治疗后外周血PCT、CRP和WBC水平明显下降,而对照组则变化不大;治疗组并发症发生率明显低于对照组。结论乌司他丁对脓毒症患者炎症因子具有拮抗作用,可阻断全身炎症反应综合征的病理反应过程,改善脓毒症患者的预后。     

乌司他丁对严重烧伤患者血清C反应蛋白、降钙素原及脓毒症发生的影响

[目的]观察乌司他丁对严重烧伤患者血清C反应蛋白(C-reactive protein CRP)、降钙素原(Procalci-tonin,PCT)及脓毒症发生的影响。[方法]将严重程度相当的重度以上烧伤住院患者156例随机分为治疗组(n=90)和对照组(n=66)。对照组按烧伤常规治疗,治疗组在对照组治疗的基础上加用乌司他丁,观察2组患者治疗前及治疗后3、7、14d血清CRP、PCT变化,并统计2组脓毒症发病率。[结果]治疗7d后,治疗组患者CRP、PCT较对照组显著下降(P﹤0.01);脓毒症发病率显著低于对照组(P﹤0.05)。[结论]乌司他丁能够降低患者体内炎症反应,降低脓毒症的发病率,可能是通过降低严重烧伤患者血清CRP、PCT的水平来实现的。     

乌司他丁治疗新生儿脓毒症的疗效观察

目的：观察乌司他丁治疗新生儿脓毒症的临床效果。方法：将48例新生儿脓毒症患儿按随机数字表法分为治疗组（n=25）和对照组（n=23）。对照组给予常规治疗,治疗组在常规治疗的基础上加用乌司他丁,比较两组治疗前后的体温（T）、呼吸（RR）、心率（HR）、白细胞计数（WBC）、肝肾功能等指标的变化,同时比较两组治疗有效率及病死率的变化。结果：两组治疗后T、R、HR、WBC均较治疗前明显改善（P〈0.05）;两组的血浆CRP、PCT、ALT、TBIL、DBIL、Cr、BUN、LDH、CK-MB、PT、APTT、D-D、IL-6、TNF-α、NSE较前均明显下降（P〈0.05）,FIB、IL-10较前明显升高（P〈0.05）,且乌司他丁组除Cr、BUN外,上述其余指标较对照组改变更明显（P〈0.05）。两组的有效率比较差异有统计学意义（P〈0.05）;两组的病死率比较差异无统计学意义（P〉0.05）。结论：乌司他丁治疗新生儿脓毒症具有良好的临床疗效,值得临床推广应用。     

乌司他丁联合胸腺肽治疗重症肺炎疗效观察

目的：探讨乌司他丁联合胸腺肽α1治疗重症肺炎的疗效。方法：90例符合纳入标准的重症肺炎患者随机分为2组,每组各45例。对照组给予乌司他丁察组总治疗有效率为83.3%,明显高于对照组66.7%的总治疗有效率,比较有统计学意义（p〈0.05）。治疗后,观察组炎性细胞因子CRP和PCT的水平明显低于对照组,比较都有统计学差异（p均〈0.05）。结论：乌司他丁联合胸腺肽α1是治疗重症肺炎的一种有效治疗方案,可以提高治疗有效率,降低炎性细胞因子水平,减轻炎症反应,值得临床推广。     

乌司他丁治疗儿科重症肺炎的临床研究

目的通过对乌司他丁治疗的重症肺炎患儿的各项生理指标及实验室检验结果的监测,探讨其在重症肺炎患儿中的临床应用价值。方法 60例重症肺炎合并脓毒症患儿,随机分为对照组（C组）和乌司他丁治疗组（U组）,在相同的常规治疗基础上,U组给予乌司他丁（UTI）静脉滴注,2万U/kg/d,Q8h,疗程共5d。分别在用药前、后测定各项生理指标及感染指标：心率（HR）、呼吸（RR）、体温（T）、白细胞（WBC）、C反应蛋白（CRP）、降钙素原（PCT）、氧和指数,胸片变化。并比较两组病人入住ICU时间、机械通气时间及病情改善情况。结果治疗组HR、RR、WBC、CRP、PCT、氧和指数、胸片变化、机械通气时间经治疗后与对照组相比差异有统计学意义（P〈0.05）,病情改善优于对照组。结论乌司他丁可有效改善重症肺炎合并脓毒症患儿的病情,改善预后、降低病死率,可规范用于临床。     

乌司他丁治疗儿科重症肺炎的临床研究

目的通过对乌司他丁治疗的重症肺炎患儿的各项生理指标及实验室检验结果的监测,探讨其在重症肺炎患儿中的临床应用价值。方法 60例重症肺炎合并脓毒症患儿,随机分为对照组（C组）和乌司他丁治疗组（U组）,在相同的常规治疗基础上,U组给予乌司他丁（UTI）静脉滴注,2万U/kg/d,Q8h,疗程共5d。分别在用药前、后测定各项生理指标及感染指标：心率（HR）、呼吸（RR）、体温（T）、白细胞（WBC）、C反应蛋白（CRP）、降钙素原（PCT）、氧和指数,胸片变化。并比较两组病人入住ICU时间、机械通气时间及病情改善情况。结果治疗组HR、RR、WBC、CRP、PCT、氧和指数、胸片变化、机械通气时间经治疗后与对照组相比差异有统计学意义（P〈0.05）,病情改善优于对照组。结论乌司他丁可有效改善重症肺炎合并脓毒症患儿的病情,改善预后、降低病死率,可规范用于临床。     

炎性指标对住院严重感染患者病情的评估效果研究

目的探究前降钙素(PCT)、C-反应蛋白(CRP)、白细胞计数等炎性指标对于加强医疗科(ICU)脓毒症患者感染严重程度以及预后效果的诊断评估价值。方法选取2016年1月-2017年1月转入ICU进行治疗的174例患者为研究对象,根据脓毒症诊断标准将患者分为非脓毒症组和脓毒症组,其中非脓毒症组96例,脓毒症组78例。转入ICU第一天时检测患者PCT、CRP、外周血白细胞计数(WBC)、白细胞介素-6(IL-6)、乳酸浓度(Lac)等炎性指标水平,记录患者急性生理与慢性健康评分Ⅱ(APACHEⅡ)以及序贯器官衰竭评分(SOFA)。结果转入ICU时脓毒症组患者PCT、CRP、WBC、IL-6、Lac水平均显著高于非脓毒症组患者,差异具有统计学意义(P0.05)。脓毒症根据严重程度分组比较发现,一般脓毒症组、严重脓毒症组以及MODS组间PCT、CRP、WBC、APACHEⅡ以及SOFA比较差异均具有统计学意义(P0.05)。ROC曲线显示PCT、Lac、APACHEⅡ评分以及SOFA评分与感染严重程度呈正相关关系,且PCT对于早期诊断脓毒症的特异度最高,优于其他指标。结论炎性指标与感染患者病情严重程度存在明显的相关性,其中PCT对于由感染引起的全身炎症反应综合征具有良好的诊断预测价值,其浓度越高提示患者感染程度越重,临床可对其进行观察以控制患者病情。     

血清降钙素原在不同种类细菌脓毒症的早期鉴别诊断价值

目的 探讨血清降钙素原(PCT)对不同种类医院获得性细菌脓毒症的早期鉴别诊断价值.方法 以医院获得性革兰阴性菌脓毒症、革兰阳性菌脓毒症、全身炎症反应综合征(SIRS)患者及健康人群(对照组)各50例为研究对象,于入院第1天晨时采集血清观察PCT、C-反应蛋白(CRP)、白细胞(WBC)、中性粒细胞(PMN)、中性粒细胞比例(N)等指标变化,同时记录当日最高体温.结果 患者入院第1天PCT水平革兰阴性菌脓毒症组为9.56 μg/L、革兰阳性菌脓毒症组为4.64 μg/L、SIRS组为0.36 μg/L及对照组为0.08 μg/L,革兰阴性细菌脓毒症组PCT水平显著高于革兰阳性细菌脓毒症组(P＜0.01),革兰阴性菌脓毒症组CRP、WBC、PMN、N水平与革兰阳性细菌脓毒症组相近,PCT受试者特征操作曲线面积(AUC)为0.926,高于CRP的0.747 mg/L、WBC的0.807×109/L、N的0.771,革兰阴性组PCT受试者特征操作AUC 0.926,明显高于革兰阳性菌脓毒症组患者的0.807,差异有统计学意义(P＜0.05).结论 PCT是细菌性脓毒症诊断的一个较好指标,其灵敏度和特异度均高于其他炎性指标,对革兰阴性菌、革兰阳性菌脓毒症的鉴别有一定的作用.     

血清降钙素原水平在尿路感染中的定位作用研究

目的探讨血清降钙素原（PCT）在尿路感染中的定位作用。方法选取尿路感染患者106例，同期健康体检者100例，用化学发光免疫法测定血清中的PCT和C-反应蛋白（CRP）水平，同时检测患者外周血白细胞计数（WBC）。结果上尿路感染组患者血清PCT水平明显高于下尿路感染患者组（P〈0．01），PCT对上尿路感染诊断的敏感性为81．1％，特异性为85．5％，阳性预测值为80．3％，阴性预测值为92．5％，均高于CRP和WBC。结论血清PCT水平的测定对尿路感染有定位作用。     

纤维蛋白原降解产物对重症监护室患者炎症指标的影响

目的 分析纤维蛋白原降解产物（FDP）对重症监护室（ICU）患者炎症指标的影响。方法 选取2022年1月至2023年3月医院ICU收治的98例感染患者为试验组，另选取同期医院50名健康体检者为对照组，检测两组血浆中FDP、降钙素原（PCT）、C-反应蛋白（CRP）、白细胞计数（WBC）以及中性粒细胞比值，比较两组各项指标水平差异，比较试验组中重症和轻症感染患者各项指标水平，并分析FDP与PCT、CRP、WBC及中性粒细胞比值的相关性。结果 试验组FDP、PCT、CRP、WBC及中性粒细胞比值均高于对照组，差异有统计学意义（P<0.05）。试验组中重症感染患者的FDP、PCT、CRP、WBC及中性粒细胞比值均高于轻症感染患者，差异有统计学意义（P<0.05）。相关性分析显示，FDP与PCT、CRP、WBC及中性粒细胞比值间均呈正相关（r=0.664、0.785、0.692、0.710,P <0.05）。结论 FDP可用于ICU患者的炎症反应评估，其与PCT、CRP、WBC及中性粒细胞比值等炎症指标均存在相关性，是评估ICU患者感染严重程度和预后判断的重要参考指标。     

Primary hyperaldosteronism. A study of 18 cases

Primary aldosteronism (PA) is defined as an autonomous over-production of aldosterone by the zona glomerulosa of the adrenal glands. It is classically considered as a rare cause of hypertension. Aldosterone producing adenoma (APA) and idiopatic hyperoldosteronism (IHA) represent the most frequent subtypes of PA. The authors report 18 cases of PA (14 women an 4 men) with a mean age of 42 +/- 13.5 years. All patients have hypertension and hypokaliemia (K < 3.5 mmol/l). Eleven patients have an APA, one patient has an adrenal carcinoma and three patients have IHA. The subtype of PA has not been established in three patients. We discuss in this article the clinical, biological, radiological and evolutif characteristics of our cases, and we insist on the necessity of making a precise etiologic diagnosis to propose the most adequate treatment.     

Primary hyperaldosteronism

Primary hyperaldosteronism (PHA), autonomic secretion of aldosterone by the adrenal gland, is rare. PHA usually results in therapy-resistant hypertension and is often but not always accompanied by hypokalaemia. Common causes of PHA are an aldosterone-producing adenoma, idiopathic aldosterone hypersecretion, unilateral hyperplasia or a genetic variant: glucocorticoid-remediable aldosteronism (GRA). The diagnosis should be phased and first of all requires a biochemical confirmation of the presence of PHA. In PHA patients, plasma renin is invariably suppressed. Blood should be collected under standardised conditions while the patient is not using beta-blockers or centrally-acting antihypertensive medication. Patients with a suppressed plasma renin and an elevated plasma aldosterone concentration have PHA. In patients with a suppressed plasma renin and a high-normal plasma aldosterone concentration a confirming test should be performed in which PHA is diagnosed if aldosterone is not suppressed following volume expansion with sodium chloride. The cause of PHA is determined by means of a CT scan or MRI of the adrenal glands to find a unilateral adenoma. If the CT scan or MRI is normal, adrenal vein aldosterone sampling may be considered as a next step in order to demonstrate lateralisation of aldosterone production. The hypertension and hypokalaemia of all forms of PHA respond well to spironolactone therapy. In the case of a unilateral adenoma or unilateral hyperplasia, adrenalectomy is the treatment of choice. For GRA, dexamethasone in doses that reduce the corticotropin (ACTH) level is indicated.     

Determining aldosterone in the adrenal veins in order to establish uni- or bilateral aldosterone production in patients with primary hyperaldosteronism

In 3 patients, men aged 60, 55 and 60, respectively, with hypertension due to primary hyperaldosteronism, the aldosterone level in the adrenal veins was determined for the purpose of further diagnosis. In two patients, unilateral adrenal enlargement on the CT-scan was accompanied by overproduction ofaldosterone, in one case in a non-enlarged adrenal gland and in the other case in both adrenals. The first patient underwent adrenalectomy of the non-enlarged adrenal gland, while in the second patient surgery was decided against. The third patient had bilateral adrenal gland enlargement on the CT-scan with a surgically treatable, unilateral overproduction ofaldosterone. Now that determination ofthe aldosterone:renin ratio in plasma as a screening method in selected patients with hypertension is being used more often, primary hyperaldosteronism turns out to be more common than was previously thought. For differentiation between unilateral and bilateral overproduction of aldosterone, imaging of the adrenals, for example with CT, is insufficiently accurate. Aldosterone determination in the adrenal veins can distinguish between unilateral and bilateral overproduction of aldosterone with great accuracy, which has important therapeutic consequences.     

Diagnosis and treatment outcome in primary aldosteronism based on a retrospective analysis of 187 cases

INTRODUCTION: Primary aldosteronism is the most common form of mineralocorticoid hypertension. The disease has been described by Jerome W. Conn in 1955; since that time there has been a great progress in the knowledge concerning the prevalence, diagnostics and treatment of the disease. AIMS: The authors retrospectively analyzed the efficacy of diagnostic procedures and the outcome of treatment by the analysis of data of 187 patients with primary aldosteronism examined between 1958 and 2004 at the 2nd Department of Medicine of Semmelweis University. METHODS: The efficacy of different methods used for the diagnosis, the frequency of the different subtypes of primary aldosteronism, as well as the surgical outcomes in patients with surgically treated subtypes of primary aldosteronism were studied. RESULTS: Aldosterone-producing adenoma was detected in more than two thirds of patients (n = 135), whereas idiopathic hyperaldosteronism was found in 46 patients. Other subtypes of primary hyperaldosteronism occurred less frequently (unilateral primary adrenocortical hyperplasia in 5 patients and adrenocortical carcinoma in one patient). For the diagnosis of familial hyperaldosteronism type I, molecular biological studies of the aldosterone-synthase/11beta-hydroxylase gene chimera were carried out in 30 patients but none of them showed the presence of the chimeric gene. When comparing the clinical parameters of patients with aldosterone-producing adenoma and idiopathic hyperaldosteronism, no significant differences were found in the time period between the diagnosis of hypertension and the diagnosis of primary aldosteronism, or in the systolic and diastolic blood pressure values. The mean of the lowest documented serum potassium concentration was slightly lower in patients with aldosterone-producing adenoma (2.8 +/- 0.1 mmol/l) compared to those with idiopathic hyperaldosteronism (3.1 +/- 0.2 mmol/l), but the difference was not significant. Normokalemic primary hyperaldosteronism was found in 7 cases. The ratio of plasma aldosterone concentration (ng/dl) to plasma renin activity (ng/ml/h) was above 20 in all patients with aldosterone-producing adenoma and in all but 5 cases with idiopathic hyperaldosteronism. To confirm the diagnosis and to differentiate the subtypes of primary aldosteronism, the postural test combined with furosemide administration was performed in the majority of patients. When cases showing an elevation of plasma cortisol level during the test were excluded, this test differentiated patients with aldosterone-producing adenoma from those with idiopathic hyperaldosteronism with a sensitivity of 69% and a specificity of 92%. In cases of adrenocortical adenomas not or not clearly detectable by radiological imaging techniques, as well as in cases with bilateral adrenocortical adenomas, selective adrenal vein sampling was performed (n = 55). All but 4 patients with aldosterone-producing adenoma underwent adrenalectomy. Histology and postoperative hormone results confirmed the preoperative diagnosis in all operated patients. After surgery serum potassium concentration returned to normal in all patients showing low serum potassium levels before surgery. Also, the moderate to severe preoperative hypertension disappeared or improved after surgery. CONCLUSIONS: These observations are in contrast with the results of international studies which showed a high frequency of normokalemic primary aldosteronism and a more frequent occurrence of idiopathic hyperaldosteronism well treatable with aldosterone-antagonists. Therefore, it can be presumed that a significant number of primary aldosteronism cases that are not accompanied with severe hypokalemia remain undetected in Hungary.     

A unique case of a benign adrenocortical tumor with triple secretion of cortisol, androgens, and aldosterone: development of multiple sclerosis after surgical removal of the tumor

We present a 39-year old female with a benign adrenal tumor characterized by autonomous secretion of cortisol, androgens, and aldosterone. The patient presented with a 4-year history of hypertension and severe hirsutism. Baseline investigations revealed elevated testosterone, androstendione, and 17OH progesterone with normal levels of dehydroepi androsterone sulfate. CT of the adrenals revealed a 2.5 x 3.0 cm tumor with characteristics of an adenoma on the left adrenal gland. Pelvic ultrasound was normal. Further investigations revealed suppressed basal ACTH levels, loss of diurnal rhythm of cortisol, and failure to suppress on low dose dexamethasone suppression test, suggesting autonomous cortisol secretion by the tumor. She had an exaggerated response of 17OH progesterone to ACTH, implying reduced 21-hydroxylase activity. An elevated plasma aldosterone concentration to plasma renin activity ratio was suggestive of hyperaldosteronism, which was confirmed by failure of aldosterone to suppress to a formal saline infusion test. Complete clinical and biochemical remission of the disease was observed after left adrenalectomy. Histology confirmed the presence of an adrenocortical adenoma. The patient developed multiple sclerosis 6 months after the operation. The flare-up of an autoimmune disease (multiple sclerosis) postoperatively could be coincidental or possibly related to the high normalization of the high cortisol levels acting as a precipitating factor.     

Profibrotic effects of aldosterone

Animal studies have shown that during high sodium intake aldosterone induces cardiac fibrosis and renal nephrosclerosis through activation of mineralocorticoid receptors. In the human heart mineralocorticoid receptors and activity of the enzyme 11beta-hydroxysteroid-dehydrogenase type 2, which is required for the activation of mineralocorticoid receptors by aldosterone, are both present. In clinical medicine the profibrotic effect of aldosterone has been related to diastolic dysfunction, arrhythmia and progression of cardiac and renal failure. The addition of an aldosterone receptor antagonist to optimal treatment in patients with heart failure causes a decrease in serum markers of collagen turnover and a decline in cardiac morbidity and mortality. These findings are a strong indication of a profibrotic effect of aldosterone in cardiac failure. Studies concerning the profibrotic effect of aldosterone in patients with primary hyperaldosteronism are contradictory and at the moment no data are available about a potential antifibrotic effect of aldosterone receptor antagonists in patients with impaired renal function.     

Regression of a pituitary tumor, associated with primary hyperthyroidism, under the effect of 1-thyroxine

The authors report on a successful medical treatment of a 36-year-old woman who had hypothyroidism and pituitary adenoma. Primary hypothyroidism was evidenced by decreased serum thyroxine (23 nmol/l; 1,77 micrograms/dl) and increased plasma thyroid-stimulating hormone (TSH) levels (108 mU/l). Pituitary mass with suprasellar expansion (1 cm in diameter) was proven by computed tomography (CT). The patient had been treated conventionally with 1-thyroxine and this medication was continued during a 1-year follow-up. Not only did she become symptom-free but control CT scanning revealed a large reduction of tumor size and the disappearance of suprasellar expansion.     

Transtubular potassium gradient in the diagnosis of potassium metabolism disorders

The transtubular potassium gradient (TTKG) is a simple physiologically based clinical test to study the renal excretion of potassium. This article reviews the most important physiological changes influencing TTKG, the hypokalaemia and hyperkalaemia, the effect of mineralocorticoids, alkalosis, action of diuretics among other drugs etc. The authors studied the abnormalities of TTKG occurring in clinical conditions (renal patients with nephrotic edema, "dry" patients with renal diseases, liver cirrhosis associated with ascites, and primary hyperaldosteronism) and compare them to the results obtained in healthy people. They consider the test to be useful in the recognition of conditions with hypoaldosteronism (including the various types of pseudohypoaldosteronisms and aldosterone resistance) and hyperaldosteronism as well as renal diseases, in accordance with the data published in the literature. On the basis of their own results, they found the method of determination of TTKG informative and helpful also when investigating the site of actions and the effect mechanisms of the diuretics.     

分析西门子64排螺旋CT对冠状动脉狭窄病变的诊断价值

目的：研究西门子64排螺旋CT(Siemens 64 row screw CT,S64CT)对冠状动脉狭窄病变的诊断价值。方法：选取2019年2月～2020年3月本院收治的106例冠状动脉狭窄病变患者,先对所有患者进行施行S64CT检测,再施行传统冠状动脉造影（coronary arteriography,CAG）检测,比较两种方式检测的准确率及精密度。结果：106例冠状动脉狭窄病变患者中,S64CT检查吻合率为91.50%;CAG检查吻合率为87.74%,S64CT检测吻合率高于CAG检测,但是结果差异不大,不具有统计学意义（P>0.05）。S64CT检测的敏感度、阳性率均高于CAG检测,两组数据结果差异具有统计学意义（P<0.05)。结论：S64CT对冠状动脉狭窄患者的临床诊断水平更强,而且具有准确率更高、定位更加准确、创伤微小等优势,诊断价值更高更为理想。