IL-18在几种风湿免疫病患者血清中的变化及意义

目的 检测多发性肌炎(PM)和皮肌炎(DM)、狼疮肾炎(LN)、类风湿关节炎(RA)患者血清中IL-18水平,比较活动期和非活动期IL-18水平,以探讨IL-18与疾病活动相关性.方法 采用酶联免疫吸附法(ELISA)测定.研究对象包括PM/DM、LN和RA患者各30例,正常对照者30例.结果 PM/DM、LN、RA患者血清IL-18水平比正常对照组明显升高,三种不同疾病活动期血清中IL-18水平明显高于各自非活动期.绪论 IL-18在PM/DM、LN、RA患者血清中明显升高,浓度与疾病活动性呈正相关.     

狼疮性肾炎患者血清生长激素检测的意义

目的:探讨生长激素(GH)与狼疮性肾炎(LN)的关系。方法:采用放射免疫分析法(RIA)检测52例LN患者和30例健康体检者血清GH水平。结果:LN组血清GH水平明显高于正常对照组(P<0.05);活动期LN组GH水平显著高于静止期LN组(P<0.05);52例LN患者血清GH水平与抗ds-DNA水平呈正相关(r=0.713,P<0.05)。结论:LN患者血清GH水平与病情活动有关,可将GH作为判断LN病情活动性的指标之一;GH在LN发病中可能起一定的作用。     

狼疮性肾炎患者外周血sIL-2R、IL-6、IL-18检测及其临床意义

目的 探讨狼疮性肾炎(LN)患者外周血可溶性白细胞介素2受体(sIL-2R)、白细胞介素(IL)-6、IL-18水平变化及临床意义.方法 按LN病情活动程度将54例LN患者分为活动期组、缓解期组和稳定期组.采集患者及健康者(对照组)空腹静脉血5 mL,采用ELISA法检测血清sIL-2R、IL-6、IL-18水平.结果 各组患者3项指标水平均明显高于对照组,差异有统计学意义(P<0.05),活动期组和缓解期组患者3项指标水平均高于稳定期组,差异有统计学意义(P<0.05).结论 LN患者外周血sIL-2R、IL-6、IL-18水平变化与LN发病进程及早期诊治有密切联系.     

狼疮性肾炎患者血清miR-2861和miR-4532水平检测及临床意义

目的研究狼疮性肾炎患者血清miR-2861和miR-4532表达水平及临床意义。方法回顾性分析2015年7月至2017年12月住院的89例狼疮性肾炎(LN)患者血常规等临床资料,其中活动期48例,稳定期41例,另选同时期体检健康者45例作为对照组。检测受试者血清miR-2861、miR-4532、白介素6(IL-6)、白介素10(IL-10)水平及肾小球滤过率,分析血清miR-2861、miR-4532水平与LN患者临床参数的关系,与血清IL-6、IL-10水平及肾小球滤过率的相关关系。结果活动期组和稳定期组血清miR-2861、miR-4532相对表达量显著低于对照组(P0.05),血清IL-6、IL-18水平显著高于对照组(P0.05);活动期组血清miR-2861、miR-4532相对表达量显著低于稳定期组(P0.05),血清IL-6、IL-18水平显著高于稳定期组(P0.05);血清miR-2861、miR-4532与LN患者24 h尿蛋白量和SLEDAI评分有关,而与血清补体C3、C4等其他临床参数无关;血清miR-2861、miR-4532分别于肾小球滤过率呈强正相关关系(r=0.842,P=0.000;r=0.878,P=0.000),与IL-6呈中等负相关关系(r=-0.600,P=0.000;r=-0.740,P=0.000),与IL-18呈中等负相关关系(r=-0.636,P=0.000;r=-0.692,P=0.000);血清miR-2861、miR-4532诊断LN的ROC曲线下面积(AUC)分别为0.742、0.714。结论 LN患者血清miR-2861和miR-4532表达下调,与24 h尿蛋白量、SLEDAI评分及肾小球滤过率降低和炎症水平升高有关,可能在LN发病及肾功能损伤过程中发挥重要作用,且对LN具有一定临床诊断价值。     

血清IL-6水平在原发性高血压患者中的变化及其临床意义

目的:探讨原发性高血压患者血清IL-6水平的变化及其与靶器官损伤的相关性。方法:98例原发性高血压患者,年龄(58±9)岁,对照组85例健康体检者,用放射免疫分析法测定其血清IL-6水平,应用超声心动图及头颅CT或磁共振诊断左室肥厚及缺血性脑卒中,观察IL-6与靶器官损伤的关系。结果:高血压患者血清IL-6水平显著高于正常对照组(P<0.01),高血压合并左室肥厚及缺血性脑卒中者血清IL-6显著高于正常对照组及无靶器官损伤组(P<0.01)。结论:IL-6介导的炎症反应在高血压病的发生发展及其靶器官损伤中可能起到重要的作用。     

狼疮性肾炎患者血清和尿液中IL-18和KIM-1的表达水平及临床意义

目的探讨狼疮性肾炎(LN)患者血清和尿液中白细胞介素-18(IL-18)和肾损伤分子-1(KIM-1)的水平变化及其临床意义。方法选取该院2016年10月至2017年9月收治的LN患者60例作为LN组,LN患者根据系统性红斑狼疮疾病活动指数2000(SLEDAI-2000)评分系统分为LN活动组(SLEDAI评分≥10分)35例和非活动组(SLEDAI评分10分)25例;再按照ds-DNA抗体是否阳性分为抗ds-DNA抗体阳性组35例,抗ds-DNA抗体阴性组25例,另选取该院体检健康者60例作为对照组。比较两组患者临床资料,并采用酶联免疫吸附试验法(ELISA)测定血清及尿液中IL-18和KIM-1的表达水平。结果 3组血清和尿液IL-18和KIM-1水平比较差异均有统计学意义(P0.05);其中LN活动组血清和尿液IL-18和KIM-1水平明显高于非活动组与对照组,非活动组血清和尿液IL-18和KIM-1水平明显高于对照组,差异均有统计学意义(P0.05);LN患者血清和尿液中IL-18和KIM-1水平在抗ds-DNA抗体阳性组与抗体阴性组之间比较差异无统计学意义(P0.05);根据相关性结果显示:LN患者血清中的IL-18和KIM-1水平与白细胞计数、C反应蛋白、尿蛋白定量之间均呈负相关(P0.05),且补体C3、补体C4、红细胞沉降率及SLEDAI评分之间均呈正相关;LN患者尿液中的IL-18和KIM-1水平与白细胞计数、补体C3、补体C4之间呈负相关,且C反应蛋白、尿蛋白定量、红细胞沉降率及SLEDAI评分之间均呈正相关(P0.05)。结论 LN患者血清和尿液中IL-18和KIM-1的水平均增高,说明IL-18和KIM-1在LN发病机制中起着一定的作用,且二者联合检测可作为评估LN严重程度及监测病情的活动性指标。     

过敏性紫癜患儿部分白介素血清水平的研究

目的:检测过敏性紫癜(HSP)患儿血清白介素IL-2、IL-6、IL-12水平的变化,以探讨其发病机理。方法:采用ELISA法对HSP患儿组和正常对照组儿童组各33例进行血清IL-2、IL-6、IL-12水平进行测定。结果:HSP患儿的血清IL-6水平明显高于正常对照组,而血清IL-2和IL-12水平较正常对照组为低。结论:HSP患者血清白介素水平出现异常,机体存在免疫功能紊乱。     

脑梗死患者血清IL-6和IL-8水平及其与认知功能障碍的关系研究

目的研究脑梗死患者血清脑梗死患者白介素-6(IL-6)和白介素-8(IL-8)水平及其与认知功能障碍的关系。方法选取本院2014年1月~2016年2月收治的60例脑梗死患者作为和同期门诊体检的60例居民作为对照组,采用酶联免疫法检测两组研究对象血清中IL-6和IL-8水平,采用蒙特利尔认知评估量表(Mo CA)评定两组研究对象认知功能情况。结果观察组血清IL-6和IL-8水平明显高于对照组(P0.05);观察组Mo CA评分高于对照组(P0.05);认知功能障碍组Mo CA评分结果高于认知功能正常组(P0.05);认知功能障碍组血清IL-6和IL-8水平高于认知功能正常组(P0.05);血清IL-6与Mo CA评分呈负相关(r=-0.426,P=0.009),血清IL-8水平与Mo CA评分呈负相关(r=-0.315,P=0.010)。结论血清IL-6和IL-8水平在急性脑梗死患者体内均升高,可能与认知功能障碍的发生有关。     

IL-1Ra/IL-1β及IL-10/IL-6比值在冠心病的作用及其意义

目的:探讨IL-1β、IL-1受体拮抗剂(IL-1Ra)、IL-10、IL-6水平及IL-1Ra/IL-1β、IL-10/IL-6比值在冠状动脉粥样硬化性心脏病(冠心病)患者血清中的变化以及临床意义。方法:选择稳定型心绞痛(SAP)患者26例,不稳定型心绞痛(UAP)患者27例,AMI患者27例,健康体检者30名,分为SAP组、UAP组、AMI组及正常对照组,采用ELISA法检测四组患者血清IL-1β、IL-1Ra、IL-10、IL-6水平,计算IL-1Ra/IL-1β、IL-10/IL-6比值,并进行比较。结果:UAP组、AMI组患者的血清IL-1Ra水平均明显低于正常对照组(P<0.05),IL-1β高于对照组(P<0.05);三组冠心病患者的IL-1Ra/IL-1β比值均低于正常对照组(P<0.05)。三组冠心病患者的血清IL-10、IL-6水平均高于正常对照组(P均<0.05),而IL-10/IL-6比值低于正常对照组(P均<0.05)。结论:IL-1β、IL-1Ra、IL-10、IL-6可能参与了冠心病的炎症反应过程,IL-1Ra/IL-1β及IL-10/IL-6比值反映了冠心病患者的免疫调节状况,其比值高低及动态变化对冠心病患者的病情监测有重要参考价值。     

伴冠状动脉病变川崎病患儿体内血清白细胞介素-6的水平及意义

目的:探讨川崎病尤其是伴冠状动脉病变患儿体内血清IL-6水平及意义。方法:选择165例川崎病患儿,根据UCG诊断结果分为冠状动脉病变组63例和无冠状动脉病变组102例,另选择同期在我院门诊体检且与川畸病患儿年龄、性别、BMI相匹配的185名健康儿童为正常对照组。采用ELISA法分别测定正常对照组与川崎病患儿治疗前、治疗后血清IL-6水平,观察川崎病冠状动脉病变组与冠状动脉正常组川崎病患儿IL-6水平的差异。结果:治疗前、后川崎病患儿血清IL-6水平分别为(196±97)、(99±44)ng/L,正常对照组则为(91±47)ng/L。治疗前川崎病患儿血清IL-6水平明显高于对照组(P<0.01),治疗后川崎病患儿血清IL-6水平较治疗前明显下降(P<0.01),与正常对照组比较差异无统计学意义(P>0.05)。冠状动脉病变组IL-6水平为(254±121)ng/L,明显高于冠状动脉正常组的(168.72±87.63)ng/L,P<0.01。结论:川崎病尤其是伴冠状动脉病变患儿体内血清IL-6水平较高,动态监测IL-6水平有助于了解川崎病的病情发展和转归。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.