PLR与NLR对急性脑梗死患者预后的预测价值

目的 血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）对急性脑梗死患者预后的预测价值。方法 回顾性连续纳入2016年1月~2016年12月于笔者医院神经内科住院的急性脑梗死患者507例,依照改良Rankin量表（mRS）对所有患者进行神经功能评分并分为预后良好组318例（≤ 2分）,预后不良组189例（>2分）。比较两组基线资料,根据入院时血小板计数、中性粒细胞计数与淋巴细胞计数计算NLR、PLR值。采用多因素Logistic回归分析急性脑梗死患者预后不良影响因素,采用ROC曲线评价入院时PLR、NLR水平对急性脑梗死患者预后的预测作用。结果 预后不良组年龄、空腹血糖、NEUT计数、PLT计数、入院时NLR水平、入院时PLR水平、入院NIHSS评分、脑梗死病史率均显著高于预后良好组,组间比较差异有统计学意义（P<0.05）;预后不良组尿酸、LYM计数均显著低于预后良好组,组间比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示,尿酸水平升高是AIS患者预后良好的独立保护因素;年龄、NEUT计数、PLT计数、入院NIHSS评分、入院时高水平NLR和PLR是AIS患者发生预后不良的独立危险因素。入院时PLR、NLR水平对急性脑梗死患者预后不良的诊断界值分别为137.47、3.92,敏感度分别为69.8%、64%,特异性分别为70.8%、82.7%,PLR和NLR联合预测敏感度为74.1%,特异性为75.2%。结论 入院时PLR、NLR水平对急性脑梗死患者预后有良好的预测价值,高PLR、NLR水平提示预后不良。     

Impact on the survival of neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,and monocyte-lymphocyte ratio on prognosis in children with Hodgkin lymphoma

Objectives:To evaluate the clinical utility of the recently described absolute neutrophil counts to absolute lymphocyte counts ratio (NLR), absolute platelet counts to absolute lymphocyte counts ratio (PLR), and absolute monocyte counts to absolute lymphocyte counts ratio (MLR) on prognosis in children with Hodgkin lymphoma (HL).Methods:We retrospectively evaluated the clinical characteristics, laboratory features (lymphocyte counts, NLR, PLR, and MLR), treatment, and results of 52 children with HL in the Department of Pediatric Hematology and Oncology, Selcuk University, konya, Turkey, from January 2006 until December 2021.Results:The patients included 27 (51.9%) females and 25 (48.1%) males. The age of the patients ranged between 3-17.5 years old (median: 9 years). There were 22 patients in stage II, 24 in stage III, and 6 in stage IV. The most prevalent histopathological subgroup was the nodular sclerosing type (53.8%). The 5-year overall survival rate was 93.7%. The overall survival rate differed based on lymphocyte counts (p<0.0001), NLR (p=0.018), and PLR (p=0.009). However, none of the prognostic factors in the univariate analysis were not prognostic risk factors (p>0.05) in the multivariate analysis.Conclusion:Lymphocyte counts, NLR, and PLR may be useful markers for determining the outcomes in children with HL.     

血管迷走性晕厥儿童血浆NO、5-HT及指端SpO_2的变化

目的探讨迷走神经晕厥（VVS）患儿血浆NO浓度、血小板5-HT含量以及血氧饱和度的动态变化,为临床诊治提供帮助。方法经HUTT确诊为VVS患儿20例作为研究组,20例健康儿童作为对照组。在HUTT前后分别测定两组血浆NO浓度、单位血小板5-HT含量以及SpO2的变化。结果研究组出现阳性表现时血浆NO浓度、SpO2与试验前平卧位相比较明显降低（P〈0.01）,对照组试验结束后血浆NO浓度、SpO2与试验前平卧位比较无明显差异（P〉0.05）,研究组处理恢复后SpO2与开始平卧位比较无明显差异（P〉0.05）;研究组在出现阳性表现时血小板5-HT含量与试验前平卧位相比较明显升高（P〈0.01）,对照组试验结束后血小板5-HT含量与试验前平卧位比较无明显差异（P〉0.05）。结论血浆NO浓度升高可能是触发VVS发病的机制之一;中枢5-HT系统可能参与了VVS的发病过程;VVS儿童血氧饱和度的降低可能是导致晕厥及晕厥先兆的主要原因,并可能成为临床诊断VVS的新依据。     

血小板数量对严重急性呼吸综合征患者预后的影响

为探讨严重急性呼吸综合征(SARS)患者血小板数量与病情严重程度和预后的关系,对我院2003年5至6月收治的133例临床确诊的SARS患者的一般情况进行回顾性调查研究,比较血小板下降组与血小板正常组2组之间在病情轻重、年龄、最重胸片病变面积、出院时胸片正常率、感染、入住ICU、死亡、白细胞、淋巴细胞数量异常的发生率及继发肝功能异常、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CPK)、血糖异常等的发生率之间的差异。结果血小板下降组(<100×109/L)重症患者和年龄>50岁患者所占的比例、总的病程、平均年龄明显高于血小板正常组(P<0.01);血小板下降组患者胸片严重程度、感染的发生率、入住ICU和死亡患者所占比例、病程中出现WBC>10×109/L或并发肝功能异常、LDH、CPK、电解质异常和高血糖的发生率明显高于血小板正常组(P<0.01)。血小板正常组出院时胸片正常的比例明显大于血小板下降组(P<0.01)。以血小板<150×109/L为标准再次进行分组,在血小板下降组和非下降组之间上述指标仍有显著差异(P<0.01)。提示血小板数量低的患者病情严重程度和生化指标异常等的发生率明显高于血小板正常组,预后差,病死率高。血小板的数量及其动态变化对SARS患者的病情严重程度、预后及转归有很好的提示作用。     

血小板聚集率及血小板平均体积预测急性冠脉综合征术后主要心血管事件的价值

目的评价血小板聚集率(PAR)、血小板平均体积(MPV)对急性冠脉综合征(ACS)患者支架术后在院期间发生主要心血管事件(MACE)的预测价值。方法选取2016年1月至2018年12月在南京市高淳人民医院行经皮冠状动脉介入治疗(PCI)的206例ACS患者,根据PCI术后是否发生MACE,分为MACE组(n=31)与非MACE组(n=175),分析MPV、PAR与MACE的关系。采用受试者工作特征曲线(ROC)法评价二者作为MACE预测指标的价值,应用logistic回归分析ACS发生MACE的影响因素。结果 MACE组患者MPV为(13. 14±1. 73) fl,PAR为(55. 49±7. 21)%,高于非MACE组,差异有统计学意义(P <0. 05)。MPV和PAR可作为预测ACS支架术后在院期间MACE的指标,其曲线下面积(AUC)分别为0. 883(0. 814～0. 953)和0. 842(0. 761～0. 932),其最佳诊断界值为11. 53 fl和50. 67%,并且MPV、PAR是发生MACE的危险因素。结论 MPV与PAR可作为预测ACS患者支架术后在院期间发生MACE的指标。     

壁细胞抗体阳性的脊髓亚急性联合变性临床特征分析

目的 探讨壁细胞抗体(PCA)阳性的脊髓亚急性联合变性(SCD)临床特征,为SCD早期诊断提供参考。方法 回顾性分析2020年12月至2022年2月安徽医科大学第一附属医院神经内科收治的13例SCD患者临床资料。结果 13例患者均以麻木无力症状起病,查体可见周围神经和脊髓受累的阳性体征,其中10例存在巨幼细胞贫血,8例维生素B₁₂水平降低,11例同型半胱氨酸(Hcy)水平升高,13例PCA阳性,8例内因子抗体(IFA)阳性,10例脊髓核磁共振(MRI)见脊髓异常病灶,9例脑MRI见白质异常信号,11例神经电生理检查见多发周围神经损害,2例胃镜见萎缩性胃炎。给予患者维生素B₁和维生素B₁₂肌肉注射,3个月后随访,病程6个月以内的9例患者无神经系统遗留症状,其余患者仍有麻木和/或无力。结论 SCD诊断不能仅依靠维生素B₁₂水平、脊髓MRI和神经电生理检查,结合PCA、IFA和Hcy有助于提高SCD的诊断率。     

反复呼吸道感染患儿血清维生素A E水平的临床研究

目的 研究反复呼吸道感染(RRTI)患儿血清维生素A、E的水平。方法 选取2017年2～12月在安徽省妇幼保健院就诊的120例呼吸道感染患儿作为研究对象,其中反复呼吸道感染患儿60例作为RRTI组,非反复呼吸道感染患儿60例作为非RRTI组,选取同期体检的健康儿童42例作为对照组。比较3组对象血清维生素A、E水平及白细胞计数(WBC)、C反应蛋白(CRP)、血红蛋白(Hb)水平;分析血清维生素A、E水平与血清WBC、CRP、Hb水平的相关性。结果 3组对象维生素A、Hb水平进行比较,差异有统计学意义(P<0.05),RRTI组患儿血清维生素A、Hb水平均低于非RRTI组和对照组,差异有统计学意义(P<0.05)。维生素A检测水平分型比较,差异有统计学意义(P<0.05),RRTI组、非RRTI组和对照组血清维生素A缺乏率分别为85.00%、78.33%和40.48%。120例患儿血清维生素A水平与血清Hb水平呈正相关(r=0.186,P=0.018),与血清CRP水平呈负相关(r=-0.205,P=0.009)。结论 呼吸道感染儿童存在维生素A缺乏,以RRTI儿童维生素A缺乏最为明显。     

内皮损伤引起血小板沉积测定方法的建立与应用

目的：研究建立血小板沉积模型的方法。方法：采用⁹⁹锝体外血小板标记与光化学血管内膜损伤法建立模型,通过血小板沉积数测定研究模型的应用性。结果：实验结果表明,⁹⁹锝体外血小板标记率受标记时间影响,最佳时间为30 min;洗涤2次可将未标记同位素基本分离掉;血小板沉积数表示法较直接CPM计数法优越;阳性对照欣维宁可减少血小板在内膜损伤动脉血管壁上的沉积。结论：通过⁹⁹锝体外血小板标记与光化学血管内膜损伤建立的血小板沉积方法,科学、可靠,有一定实用性。     

冠状动脉介入治疗对急性冠状动脉综合征白细胞介素-37、超敏C反应蛋白、单核细胞及中性粒细胞与淋巴细胞比值的影响

目的  探讨经皮冠状动脉介入治疗（PCI）对急性冠状动脉综合征（ACS）患者血浆白细胞介素-37（IL-37）水平、超敏C反应蛋白（hs-CRP）水平、单核细胞计数、中性粒细胞与淋巴细胞比值（NLR）的影响,评估上述炎症指标与ACS类别、Gensini评分、心脏重构和功能关系。方法  检测58例ACS患者PCI术前及术后24 h血浆IL-37、hs-CRP水平、单核细胞（M）计数及NLR,常规检测血脂、血浆N端脑钠肽前体（NT-proBNP）水平、左室舒张末期内径（LVEDD）和左室射血分数（LVEF）。另选同期因胸痛入院且排除冠状动脉粥样硬化性心脏病（冠心病）患者30例为对照组。结果  与对照组比较,ACS患者PCI术前血浆hs-CRP水平、M计数及NLR均显著增高,血浆IL-37水平显著降低（P均<0.05）;与PCI术前比较,ACS患者术后血浆hs-CRP水平、M计数及NLR增高,血浆IL-37水平降低（P均<0.05）。ACS患者PCI术前血浆IL-37水平与Gensini评分呈负相关;hs-CRP水平、M计数、NLR与Gensini评分、LVEDD和NT-proBNP水平呈正相关,NLR与LVEF呈负相关。结论  PCI导致体内抗炎/促炎反应失衡加重;PCI术前炎症指标一定程度上反映ACS患者冠状动脉病变严重程度、心室重构和心功能损伤状况。

     

ACS合并低氧血症患者NIMV治疗的应用时机

［摘要］ 目的　探讨急性冠脉综合征合并低氧血症的患者应用无创机械通气治疗进行干预的时机．方法　2014年7月至2015年7月在昆明医科大学附属延安医院诊断为急性冠脉综合征合并低氧血症的患者46例,使用面罩供氧后,脉搏血氧饱和度仍然持续下降至≤90%时,给予经口鼻面罩进行双水平气道正压通气（BiLevel）治疗,观察机械通气前和通气2 h后呼吸频率、脉搏血氧饱和度、动脉血气分析等指标的变化．结果　46例急性冠脉综合征合并低氧血症的患者,给予无创机械通气治疗2 h后,呼吸频率、脉搏血氧饱和度、动脉血氧分压均有明显改善,临床症状缓解明显．结论　急性冠脉综合征合并低氧血症的患者,在使用面罩供氧后,脉搏血氧饱和度仍然持续下降至≤90%,出现呼吸衰竭时,开始应用无创机械通气治疗,能够安全、迅速地纠正低氧血症和呼吸衰竭．     

Factors relating to bone mineral density in young and middle-aged patients with ankylosing spondylitis

Background:Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.Methods:From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.Results:There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.Conclusions:The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.     

败血症患者血小板计数与预后关系

目的了解败血症患者血小板水平与预后关系。方法对54例败血症患者进行回顾性分析,观察菌落归属、初次血培养阳性时血小板水平及病程严重程度(APACHEⅡ)对预后的影响,并分析不同菌落归属患者血小板水平、APACHEⅡ及其预后间的关系。结果初次血培养阳性时血小板计数和APACHEⅡ与预后密切相关,而与菌落归属无相关性。血小板计数<100×109/L者APACHEⅡ评分明显升高(P<0.05),不同菌落属感染患者血小板水平、APACHEⅡ与预后间差异无统计学意义。结论败血症患者血小板水平与APACHEⅡ评分及预后密切相关,血小板水平能较好的反映败血症患者病情及预后。     

Pulmonary function indices in children with sickle cell anemia in Enugu,south-east Nigeria

Objectives:

To determine the pulmonary function indices of children with sickle cell anemia (SCA) attending the pediatric sickle cell clinic at the University of Nigeria Teaching Hospital, Enugu, south-east Nigeria and to compare these indices with the results obtained from other regions.

Methods:

A case control study of lung function in children with SCA aged 6-20 years. The study was carried out in the University of Nigeria/University of Nigeria Teaching Hospital, Enugu State, Nigeria between October 2014 and January 2015. Measurements of the peak expiratory flow rate, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were evaluated.

Results:

A total of 80 subjects were recruited into the study, comprising 40 homozygous HbSS (hemoglobin SS) patients and an equal number of controls. Children with SCA had statistically lower values of FEV1 (1.6±0.52), FVC (1.76±0.95), and peak expiratory flow rate (PEFR) (309.00±82.64) when compared with normal hemoglobin genotype FEV1 (12.01±0.53), FVC (2.12±0.54), and PEFR (364.10±87.85). The mean FVC, FEV1/FVC, and PEFR were also higher in the male control group compared with the HbSS male group, but these differences were not statistically significant. Female controls had significantly larger FEV1, FVC, and PEFR values compared with the HbSS females.

Conclusion:

The lung function indices were significantly lower in children and adolescents with SCA compared with the matched controls with a hemoglobin genotype AA.Sickle cell anemia (SCA) is a genetic hematological disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape.1 This hereditary disorder contributes the equivalent of 3.4% mortality in children aged <5 years worldwide or 6.4% in Africa.2 The prevalence of SCA in Nigeria ranges from 0.4-3%.3 Approximately 85% of sickle cell disorders and >70% of all affected births occur in Africa.4 It is worth noting that at least 5.2% of the world population carry a significant trait. The clinical consequence of SCA results from obstruction of the microvasculature by the sickle cells and red blood cell hemolysis, which causes multi-systemic manifestation. The lungs are affected in a variety of ways by these pulmonary insults, and recurrence overtime may leave the lungs with chronic interstitial, parenchymal, or vascular damage that compromises pulmonary function.5,6 It has been documented that the prevalence of hypoxemia among SCA children was 13%.4 This prevalence was attributable to the chronic anemic state, micro vascular occlusion of the circulation by sickle hemoglobin, and constant pertubation of the endothelial membrane, and consequent elaboration of endothelial molecules, which are commonly seen among SCA children, especially those with various types of vaso-occlusive episodes.7 This is defined as bone and joint pain or multiple sites of pain needing analgesics or hospitalization.8 Acute and chronic pulmonary complications occur frequently in patients with SCA, and contribute to morbidity and mortality later in life. Although the pathogenesis of chronic pulmonary disease in sickle cell disease (SCD) has not been clearly defined, recurrent microvascular obstruction resulting in the development of pulmonary hypertension, endothelial dysfunction, and parenchymal fibrosis are probably the primary mechanisms.6 There is increasing evidence that repeated episodes of acute chest syndrome (ACS) may cause permanent damage to the pulmonary parenchyma and vasculature. Repeated attacks of ACS are a major risk factor for the development of sickle cell chronic lung disease. Studies of lung function in SCD have also demonstrated a restrictive defect,8,9 while a reduction in the total lung capacity (TLC) of 50% has been reported in advanced forms. Acute chest syndrome refers to a spectrum of pulmonary pathology having in common, chest pain, fever, dyspnea with abnormal clinical, and radiologic chest signs as well as leucocytosis.10,11 It is the most common cause of death in children with sickle cell anemia over 10 years of age.12 The etiology of ACS is not clear, lung and bone infarction, infection, and acute pulmonary sequestration, among other possible causes have been proposed.10 In children with sickle anemia in steady state, the major abnormality in pulmonary function is a restrictive pathology, characterized by a slight decrease in total lung capacity, with attendant ventilation perfusion mismatch.10 This can cause a defect in diffusion capacity for carbon monoxide.10 These abnormalities worsen with age and are associated with increases in pulmonary-artery pressures.11 Whereas some studies have documented impaired lung function in SCA (hemoglobin SS) patients,8-10 previous studies8-10 reported what appears to be contrasting findings when the lung function in children with SCA and those of healthy controls with normal hemoglobin genotype were compared. It is therefore necessary that ventilatory function studies be undertaken in this parts of the world to see if there is any difference with known values in other part of the world. In this study, we determine the impact of SCA on the pulmonary function indices in patients attending the pediatric sickle cell clinic at the University of Nigeria Teaching Hospital (UNTH) Enugu, south-east Nigeria and compare it with matched controls and other studies. Many studies have described and assessed the pattern of pulmonary function in SCD from childhood to adulthood, but much is not known on this topic in South Eastern Nigeria. Most of the original studies are from western Nigeria.13,14 This study could therefore corroborate or refute regional or ethnic differences in lung function in children with SCD. The study hypothesis seeks to answer the following questions? Do children with SCA attending UNTH Enugu present with any alteration in lung function? If they do, is there any gender and age difference? Are these lung volume findings similar to that obtained from other region?     

急性冠脉综合征患者心率减速力变化特点及其与心率变异性的相关性分析

目的 分析急性冠脉综合征患者（ACS）心率减速力（DC）指标变化特点及其与心率变异性（HRV）的相关性。方法 选取2016年9月至2017年7月期间在安徽医科大学第三附属医院心内科确诊为ACS的119例患者（ACS组）,为研究对象,将ACS组分为不稳定型心绞痛（UAP）组和急性心肌梗死（AMI）组,选择同期本院门诊体检者中年龄、性别相仿并接受动态心电图检查的52例健康者（健康对照组）为对照组,检测两组患者24 h动态心电图,并应用美国DMS公司动态心电图Net版分析系统对两组研究对象24 h动态心电图检查结果进行分析,包括DC指标和HRV时域指标[24 h正常RR间期标准差（SDNN）、全程相邻窦性R-R间期之差的均方根值（rMSSD）、相邻正常RR间期差值>50 ms的心搏数占总RR间期数的百分比（PNN50）]。比较3组患者DC、HRV各指标的差异,探讨ACS患者DC和HRV指标相关性。结果 与健康对照组比较,UAP组及AMI组DC值降低,差异有统计学意义（P均<0.05）;UAP组及AMI组DC值差异无统计学意义（P>0.05）。UAP组及AMI组SDNN、rMSSD、PNN50较对照组降低,差异具有统计学意义（P均<0.05）,AMI组SDNN较UAP组降低,差异具有统计学意义（P<0.05）, rMSSD、PNN50差异无统计学意义（P>0.05）。ACS组患者的DC值与SDNN、PNN50、rMSSD的相关系数分别为0.329、0.201、0.187（P均<0.05）,均为正相关。结论 DC可作为定量反映ACS患者迷走神经受损程度的可靠心电学指标。     

关于小儿急性呼吸窘迫综合征的临床研究

目的总结无创持续气道正压通气治疗小儿急性呼吸窘迫综合征的效果。方法 25例患儿皆选择持续无创持续气道正压通气（CPAP）治疗,所选择为Bubble CPAP婴儿呼吸机。连接方式主要为鼻塞,同时需调整相关的参数,其中,流量可调节（4~15LPM）,一般选择6~8LPM,不超过10LPM,,氧浓度可调（21%~100%）,一般〈45%,不超过60%,CPAP压力靠刻度管调节（3~10cmH2O）,一般在4~8cmH2O,气体可以选择进行温化与湿化,湿度0.8~1.0,温度30~35℃,严格监测患儿的血压、意识状态、末梢循环情况、呼吸、经皮血氧饱和度以及心率等。对比患儿治疗前与治疗后2h、24h的氧合指数PaO2/FiO2,血氧饱和度、呼吸频率以及心率等。结果 25例患儿在给予无创持续气道正压通气（CPAP）治疗后,其相关症状均出现明显的改善,其中,与治疗前相比,治疗后2h及治疗后24h患儿氧合指数PaO2/FiO2〉200,血氧饱和度明显上升,治疗前、后差异有统计学意义（P〈0.01）;与治疗前相比,治疗后2h及治疗后24h患儿呼吸频率与心率明显下降,治疗前、后差异有统计学意义（P〈0.01）。结论无创气道正压通气治疗小儿急性呼吸窘迫综合征,可以有效地改善相关的症状,使氧合指数PaO2/FiO计上升,患儿的经皮血氧饱和度逐渐上升,同时可以降低患者的呼吸频率与心率,对患儿疾病治疗有着至关重要的作用,值得在临床医学中推广使用。     

不同病原菌新生儿败血症患儿血糖异常、血小板计数、白细胞计数及C反应蛋白的变化研究

［摘要］ 目的 探讨不同病原菌新生儿败血症患儿血糖异常、血小板计数、白细胞计数、Ｃ反应蛋白的变化。 方法 选取新生儿败血症患儿108例,按照血培养病原菌种类,将患儿分成革兰阳性菌组46例、革兰阴性菌组43例及真菌组19例,分析3组患儿的一般资料与临床表现情况,比较3组患儿的血糖异常、血小板计数、白细胞计数、Ｃ反应蛋白的变化。 结果 在108例新生儿败血症患儿中,感染革兰阳性菌46例（42.59%）,其中以凝固酶阴性葡萄球菌（24.07%）、屎肠球菌（9.26%）为主;感染革兰阴性菌43例（39.81%）,其中以大肠埃希菌（21.30%）、肺炎克雷伯杆菌（14.81%）为主;感染真菌19例（17.60%）,其中以白色假丝酵母菌（9.26%）为主。 革兰阳性菌组的胎龄和出生体重显著优于革兰阴性菌组和真菌组,3组患儿在胎龄及出生体重差异有统计学意义（P＜0.05）;真菌组的发病日龄显著大于革兰阳性菌组和革兰阴性菌组,且革兰阴性菌组的发病日龄显著大于革兰阳性菌组（P＜0.05）。革兰阴性菌组、真菌组的血糖异常比例（34.88%、31.58%）显著高于革兰阳性菌组（13.04%）（P＜0.05）;真菌组的白细胞计数异常、C反应蛋白水平升高的比例显著低于革兰阳性菌组和革兰阴性菌组,且革兰阴性菌组的C反应蛋白水平升高的比例显著高于革兰阳性菌组（P＜0.05）;革兰阴性菌组、真菌组的血小板计数降低的比例显著高于革兰阳性菌组（P＜0.05）。 结论 当新生儿败血症患儿白细胞计数明显异常和C反应蛋白水平明显上升时,细菌感染的概率较大;当血小板计数明显下降时,感染革兰阴性菌和真菌概率较大。且革兰阴性菌组、真菌组的血糖异常比例显著高于革兰阳性菌组。     

促血小板生成素和平均血小板体积在2型糖尿病合并心血管疾病中的意义

目的 观察2型糖尿病（DM2）患者促血小板生成素（TPO）及平均血小板体积（MPV）水平,探讨其在DM2合并冠心病（CHD）和合并急性冠脉综合征（ACS）中的应用价值。方法 检测134例2型糖尿病患者（DM2组）以及39例健康志愿者（对照组）TPO、MPV以及心肌肌钙蛋白I（cTnI）水平,分析ACS患者TPO和MPV与cTnI的相关性,运用ROC曲线评价TPO和MPV对DM2合并CHD和合并ACS的预测价值。结果 DM2组TPO和MPV水平均显著高于对照组,合并CHD组TPO和MPV水平均显著高于单纯DM2组（P=0.000）;合并ACS组TPO和MPV水平均显著高于合并稳定型心绞痛组（P<0.01）。合并ACS的患者中,合并ST段抬高性心肌梗死（STEMI）组TPO水平显著高于非ST段抬高性心肌梗死（NSTEMI）组,NSTEMI组其水平也显著高于不稳定型心绞痛（UA）组（P<0.01）。合并ACS的患者TPO水平与cTnI水平呈高度正相关（r=0.906,P=0.000）。TPO和MPV预测DM2合并CHD的ROC曲线下面积分别为0.911（95% CI：0.862~0.960）和0.835（95%CI：0.760~0.909）,其cutoff值为83.2pg/ml和11.5fl,敏感度为88.8%和78.7%,特异性为83.3%和85.7%;TPO和MPV预测DM2合并ACS的ROC曲线下面积为0.876（95%CI：0.820~0.932）和0.761（95%CI：0.68~0.842）,cutoff值为97.3pg/ml和12.3fl,敏感度为91.0%和83.1%,特异性为81.0%和88.1%。结论 TPO和MPV可用于预测DM2合并CHD和ACS发生,TPO有助于合并ACS患者的病情判断。     

七氟醚和异丙酚复合氯胺酮用于小儿短小手术的临床观察

目的 评价七氟醚和异丙酚复和氯胺酮在小儿短小手术的临床效果。方法 选取笔者医院择期小儿手术70例,随机分为两组(S组:七氟醚复合氯胺酮;P组:异丙酚复合氯胺酮),每组35例。比较两组患儿麻醉过程中平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)等生命体征变化情况,比较两组患儿麻醉诱导时间、苏醒时间、苏醒质量等麻醉效果及术中、术后不良反应发生情况。结果 两组患儿麻醉过程中生命体征差异无统计学意义(P>0.05);S组的麻醉诱导时间、苏醒时间均明显短于P组(P<0.05),苏醒质量S组明显高于P组(P<0.05);两组的不良反应差异无统计学意义(P>0.05)。结论 两种方法均可以很好地用于小儿短小手术的麻醉,但七氟醚复合氯胺酮麻醉是更为有效的麻醉方式。     

急性冠脉综合征发生与外周血红细胞源微粒致血栓活性的关系研究

目的 通过评估红细胞源微粒（RMPs）和急性冠脉综合征（ACS）发病之间的关联,描述RMPs在急性冠状动脉血栓形成过程中发挥的作用。方法 研究对象分ACS组（n=200）,其分为急性心肌梗死（AMI,n=100）和不稳定型心绞痛组（UAP,n=100）,对照组为非冠心病组（n=100）。获得患者知情同意后,收集ACS组以及对照组的外周血,离心后加入钙离子载体A23187,得到MPs。用特异性红细胞微粒抗体（glycophorine A）标记RMPs,后经流式细胞仪定量分析。在体外,将ACS患者血浆中提取的RMPs加入对照组血浆中,在荧光标记的血栓底物作用下诱导血栓形成并用荧光光度仪检测RMPs的致血栓活性。结果 RMPs水平在ACS的AMI亚组（163×10²）和UAP亚组（96×10²）都明显高于对照组（12×10²,P<0.05）。ACS患者在每一个时间段相对荧光单位较对照组显著提高（P<0.05）。研究结果显示,高浓度的MPs更易导致血栓形成且所需时间较短,差异有统计学意义（P<0.05）。结论 ACS组的外周血中RMPs水平明显升高,提示RMPs参与了ACS的发生、发展过程。MPs诱导的血栓形成峰值前移,提示RMPs可能诱导凝血酶形成,揭示ACS发生急性血栓与RMPs有关。     

急性脑梗死患者外周血平均血小板体积与颈动脉粥样硬化的相关性研究

目的 探讨急性脑梗死患者外周血平均血小板体积（mean platelet volume,MPV）水平与颈动脉粥样硬化的相关性。方法 纳入99例发病1周内的急性脑梗死患者为观察组,30例同期无心脑血管疾病,并经多普勒彩色超声检查无颈动脉内膜增厚的健康体检者为对照组。检测所有纳入者的外周血MPV水平,采用多普勒彩色超声检查颈动脉内膜中层厚度（intima media thickness,IMT）,按病变程度将观察组分为IMT正常组、IMT轻度狭窄组、IMT中重度狭窄组;根据头颅CT或MRI提示的梗死面积大小将观察组分为小面积、中等面积、大面积脑梗死组。分析比较观察组与对照组以及观察组各亚组间MPV水平的差异,并分析MPV与IMT及梗死面积的相关性。结果 脑梗死组外周血MPV水平较对照组升高,差异有统计学意义（P<0.05）;观察组不同颈动脉狭窄程度组外周血MPV比较差异有统计学意义（P=0.000）;Pearson相关性分析表明,MPV与IMT值呈正相关（r=0.331,P=0.000）,MPV与脑梗死面积呈正相关（r=0.386,P=0.000）;ROC曲线显示MPV对急性脑梗死的预测曲线下面积为0.682,最佳界值是11.45,敏感度为41.4%,特异性为86.7%。结论 急性脑梗死患者外周血MPV水平与颈动脉粥样硬化狭窄程度密切相关,且对急性脑梗死有一定的预测价值。