检测原发性肝癌血清促吞噬肽水平的临床意义

目的 检测原发性肝癌切除前、后血清促吞噬肽(tuftsin)水平,探讨肝癌患者免疫功能的变化,确立其在肿瘤免疫中的地位和作用.方法用放射免疫分析方法检测12例原发性肝癌患者术前及术后血清促吞噬肽水平,以20例肝硬变患者和20例正常人作对照. 结果受检者血清促吞噬肽水平 肝癌组术前为(449±106) ng/ml,明显低于肝硬变组的(580±187) ng/ml、正常对照组的(703±128) ng/ml和肝癌组术后的(588±129) ng/ml (P＜0.01); 且肝癌组术后水平亦低于对照组(P＜0.01).结论对肝癌患者应最大限度地切除肿瘤,以增加机体内血清促吞噬肽的含量,有利于激活患者NK细胞、T细胞等免疫活性细胞功能.     

结直肠癌患者手术前后血清中IL-6和NO水平的临床意义

目的探讨结直肠癌患者手术治疗前后血清中IL-6和NO水平变化及其临床意义。方法对40例结直肠癌患者分别采用酶联免疫分析法和化学比色法测定手术前后血清中的IL-6和NO水平,并与10名正常健康人作比较。结果结直肠癌患者手术前血清中IL-6水平高于正常人（P〈0.05）,NO水平明显低于正常人（P〈0.01）;经手术治疗2周后,患者血清IL-6水平较治疗前降低（P〈0.05）,而NO水平明显升高（P〈0.05）。结论结直肠癌患者血清中IL-6和NO水平的变化,对病情和预后判断具有重要的临床意义。     

慢性重症肝炎低钾血症大剂量补钾的护理

对13例慢性重症肝炎合并低钾血症患者采用微量泵大剂量高浓度补钾，结果3～14d血钾均达到正常水平，无严重不良反应出现。提示利用微量泵补钾安全有效，但应注意高浓度钾对血管的刺激以及注意观察患者症状和心电图变化。     

慢性重症肝炎低钾血症大剂量补钾的护理

对13例慢性重症肝炎合并低钾血症患者采用微量泵大剂量高浓度补钾,结果 3～14 d血钾均达到正常水平,无严重不良反应出现.提示利用微量泵补钾安全有效,但应注意高浓度钾时血管的刺激以及注意观察患者症状和心电图变化.     

Significance of Serum Type IV Collagen Level of Hepatectomized Patients with Chronic Liver Damage

Type IV collagen, one of the serum markers for hepatic fibrosis, was measured perioperatively in patients with and without chronic liver damage to investigate whether this parameter changes in response to acute stress to the liver and can predict the surgical risk of hepatic resection. The serum type IV collagen level was significantly elevated in patients with liver cirrhosis. There were significant correlations between serum type IV collagen levels and the indocyanine green clearance test and cholinesterase activity, although the correlation coefficients were not high. The size of the resected hepatic mass was not the primary factor to influence the postoperative serum type IV collagen level. In patients with liver cirrhosis, the postoperative serum type IV collagen level increased significantly compared to that in patients with normal liver or chronic hepatitis. Postoperative liver failure occurred in 0%, 11.6%, and 44.4% of patients with preoperative serum type IV collagen levels of <150, < or = 150 to 300, and > or = 300 ng/ml, respectively. In those with postoperative liver failure, the serum type IV collagen levels were significantly higher both pre- and postoperatively compared to those in patients with uneventful courses. Several preoperative liver function tests indicated that type IV collagen is an independent risk factor for postoperative liver failure. Thus perioperative measurement of the serum type IV collagen levels seemed to be useful for predicting the risk of hepatic resection in patients with chronic liver damage.     

乳腺癌患者血清VEGF—C水平与癌组织C—erbB-2蛋白的表达及临床意义

目的 探讨乳腺癌患者血清血管内皮生长因子C (VEGF-C)水平及癌组织中C-erbB-2蛋白表达及其临床意义.方法 选取女性乳腺浸润性导管癌患者和乳腺良性病变患者各62例,采用ELISA法检测患者术前和术后1个月血清VEGF-C水平,免疫组织化学法检测乳腺癌组织C-erbB-2蛋白表达,分析VEGF-C与乳腺癌临床病理特征及C-erbB-2蛋白表达的关系.结果 乳腺癌患者术前血清VEGF-C水平为(279.65±17.34) pg/ml,乳腺良性病变患者为(167.26±12.15) pg/ml,两者比较差异有统计学意义(P＜0.01).乳腺癌患者术后1个月血清VEGF-C水平为(209.45±15.23) pg/ml,与其术前比较差异有统计学意义(P＜0.01).VEGF-C水平与原发肿瘤分期有关(P＜0.05),与患者年龄、肿瘤大小、有无淋巴结转移、绝经情况及ER和PR的表达无关(P>0.05).C-erbB-2蛋白在乳腺癌中的表达阳性率为54.84%(34/62),明显高于乳腺良性病变的11.29%(7/62),P＜0.01.乳腺癌腋窝淋巴结转移患者的C-erbB-2蛋白表达阳性率(69.44%)明显高于腋窝淋巴结无转移患者(34.62%,P＜0.05).血清VEGF-C水平随癌组织中C-erbB-2阳性表达强度增强而增高,两者呈正相关(r=0.813,P＜0.05).结论 乳腺疾病患者血清中VEGF-C水平可能成为鉴别乳腺良、恶性病变的辅助指标之一; C-erbB-2与乳腺癌淋巴结转移有关; 在乳腺癌的淋巴转移途径中VEGF-C可能与C-erbB-2存在着协同作用.     

Serum Carcinoembryonic Antigen Monitoring After Curative Resection for Colorectal Cancer: Clinical Significance of the Preoperative Level

Aim  

We evaluated preoperative serum carcinoembryonic antigen (CEA) as a prognostic factor for colorectal cancer and determined when surveillance of this marker was useful.     

血液透析患者血清尿酸与C反应蛋白水平的相关研究

目的：验证血清尿酸（SUA）与C反应蛋白（CRP）的关系及两者在血液透析患者心血管事件发生中是否存在协同作用。方法：本研究入组的67例患者均为在我院血净中心进行常规血液透析（透析龄≥3个月）的患者。所有患者均无明显感染和传染性疾病病史。检测患者的基线SUA、CRP、KT/V及其他临床指标。并对患者进行了6个月的随访,以观察高尿酸血症合并CRP升高对血液透析患者心血管并发症的影响。结果：67例患者均完成了6个月的随访,未出现死亡病例。入组时平均SUA水平为（459.6±128.9）μmol/L,其中高尿酸血症患者38例（56.7%）;CRP升高者35例（52.2%）。高尿酸血症伴CRP升高者24例（35.8%）。多元回归分析显示,在进行年龄、性别、体重、Kt/V、三酰甘油、吸烟史、糖尿病病史、高血压等校正后,血清尿酸仍与CRP-log明显相关关系（OR：2.24,Z=2.24,P=0.001）。随访6个月,67例血液透析患者中共有26例（38.8%）患者发生心血管事件,其中高尿酸血症伴CRP升高组心血管事件发生率70.8%（17/24）;单纯高尿酸血症组27.3%（3/11）;单纯CRP升高组28.6%（4/14）血清尿酸及CRP水平均正常组11.1%（2/18）。结论：血液透析患者的血清尿酸水平与C反应蛋白水平可能相关。高尿酸血症与CRP共同作用可增加血液透析患者心血管事件的发生率。     

维持性血透患者长期生存率与血清脂联素的关系

目的：探讨维持性血透患者长期生存率与血清脂联素的关系。方法：选择血液净化中心规律血液透析超过6个月的患者81例,随访16个月。分析其长期存活率,改良定量SGA评估法评估血透患者营养状况,测定体重指数、血红蛋白、胆固醇、三酰甘油、透析充分性,采用ELISA法测定血清脂联素水平,评估血清脂联素与血透患者长期生存率之间的关系。结果：维持性血透患者1年、2年、3年、5年、10年存活率分别为100%、90.12%、75.31%、38.27%、6.17%。Cox回归模型发现,年龄（r=1.088,P〈0.05）、ADPN（r=1.671,P〈0.01）是导致患者死亡的危险因素。透析开始年龄≤60岁组生存率高于〉60岁组（P〈0.05）。结论：血透开始年龄、血清脂联素水平是影响维持性血透患者生存率的危险因素。     

Serum Potassium during Regional Anaesthesia with special reference to the effects of adrenaline

Abstract: Hypokalaemia may occur in connection with regional anaesthesia. The main purpose of this thesis was to: (1) Evaluate the effect of some major forms of regional anaesthesia on the serum potassium (S–K) level. (2) Determine whether the response to adrenaline with regard to the S–K level is different during and after surgery compared to a plain experimental situation and, if so, decide if this can be explained by an altered responsiveness in the β–adrenoceptors. (3) Study ECG disturbances attributable to adrenaline and to hypokalaemia caused by the local anaesthesia. (4) Find out whether differences in health status and medication constitute risk factors in developing marked preoperative changes in the S–K level. Ninety–seven patients and 10 volunteers participated in the studies. Local anaesthetics with and without adrenaline were used. Epidural anaesthesia using mepivacaine or bupivacaine and field block for inguinal hernia surgery with prilocaine were studied in relation to surgery. Intercostal nerve block with bupivacaine or prilocaine for postoperative pain relief after cholecystectomy and in volunteers were also studied. Data from 150 other patients were collected to evaluate S–K changes in the preoperative period. Local anaesthetics with adrenaline caused hypokalaemia, but it was not possible to predict the hypokalemic effect from one type of nerve block to another. During surgery under local anaesthesia, surgical stress aggravated the hypokalaemia from exogenous adrenaline. The hypokalemic effect of marcaine–adrenaline was nearly abolished during intra–abdominal surgery under general anaesthesia, but it was intensified during recovery after cholecystectomy. No major arrthythmias were caused by the local anaesthetics with or without adrenaline. Preoperative S–K changes, with increases occurring as frequently as decreases, of 0.4 mmol/1 occurred in one third of the patients. It is concluded that local anaesthetics with adrenaline cause a decrease in the S–K concentration and minor ECG disturbances. The hypokalemic effect of local anaesthesia might be intensified during postoperative recovery but reduced during surgery under general anaesthesia. The intra–operative lack of a hypokalemic effect caused by adrenaline could partly be explained by a reduced responsiveness in the β₂–adrenoceptors. The preoperative changes in S–K can be explained only to a minor extent by the health status and medication of the patients.     

胃癌患者血清白细胞介素-6的测定及临床意义

目的探讨血清白细胞介素-6与胃癌生物学特性的关系。方法采用ELISA法(双抗体夹心酶联免疫吸附试验)检测28例胃癌患者和32例胃溃疡患者手术前后血清IL-6含量,并进行相关分析。结果胃癌患者血清IL-6水平明显高于正常人及胃溃疡患者(P<0.01),且与手术效果、临床分期和癌细胞分化程度有关(P<0.01)。结论胃癌患者血清IL-6水平在一定程度上可反映胃癌发生、发展和预后,可作为预测胃癌预后及疗效的有效指标。     

肺癌病人血清铜、锌水平的研究

本研究应用原子吸收分光光度法，检测186例肺癌病人血清铜，锌水平，并以150例正常人和64例良性胸部疾患病人作对照，结果显示：肺癌病人血清铜水平明显高于良性胸部疾患病人和正常人，血清锌水平明显低于良性胸部疾患病人和正常人，铜，锌水平的改变与肺癌的病期有明显的关系（P＜0．04），而与组织学类型无关，本研究结果表明：检测肺癌病人血清铜，锌水平可用于肺癌的辅助诊断和判别肺癌的 病期。     

膀胱肿瘤患者血清胰岛素样生长因子及血管内皮生长因子的测定及临床意义

目的：探讨膀胱肿瘤患者术前、术后m清中胰岛素样生长因子（IGF—J）及血管内皮生长因子（VEGF）的水平及意义。方法：采用双抗体夹心EI。ISA法对48例膀胱肿瘤患者及50例正常人lIn清中IGF一1、VEGF的检测,了解膀胱肿瘤患者在术前、术后血清中IGF一1、VEGF的水平变化。以及不同病理分级和不同浸润深度膀胱肿瘤患者血清中IGF一1、VEGF水平的异同。结果：术前、术后第7天,膀胱肿瘤患者血清中IGF-l、VEGF值明显高于正常人;术后膀胱肿瘤患者血清中的IGF-1、VEGF的水平明显低于术前水平;随着病理分级的升高或浸润深度的增加,膀胱肿瘤患者血清中IGF一1、VEGF的水平也升高;同时膀胱肿瘤患者血清中的IGF1和VEGF水平均升高,且存在一定的正相关。结论：监测膀胱肿瘤患者妞清中的IGF一1,VEGF的水平的变化,对预测肿瘤恶性潜能和肿瘤的发展情况,以及了解肿瘤的治疗效果具有重要的临床意义。     

血浆置换对抗中性粒细胞胞质抗体相关性血管炎患者外周血高迁移率族蛋白-1水平的影响

目的：观察血浆置换对抗中性粒细胞胞质抗体相关性血管炎（ANCA-associated vasculitis,AAV）外周血高迁移率族蛋白-1（highmobility group box chromosomal protein 1,HMGB1）的影响。方法：13例活动期AAV患者,男10例,女3例,年龄41岁~76岁,BVAS评分（21.8±4.9）分,其中11例p/MPO-ANCA阳性,2例c/PR3-ANCA阳性,ANCA水平（295.78±52.76）RU/m L。均给予糖皮质激素及其冲击疗法等治疗基础上,辅以血浆置换。分别留取血浆置换治疗前空腹（TO）、治疗开始后2 h（T1）、血浆置换停止后12 h（T2）患者静脉血标本,分离血清后采用ELISA法检测其中的HMGB1。结果：本组患者行血浆置换后2 h血清HMGB1水平（3.67±0.93）ng/ml,较血浆置换前血清HMGB1水平（7.8±1.26）ng/ml显著下降,血浆置换后12 h血清HMGB1水平（5.18±0.93）ng/ml稍有回升,但仍低于血浆置换前浓度（P〈0.05）;血管炎活动指标（ESR、CRP、BVAS评分）较血浆置换前均降低。结论：血浆置换能有效清除AASV患者外周血清HMGB1,可明显降低疾病活动度。     

急性肠系膜上动脉栓塞病程中的甲状腺激素水平

目的：探讨急性肠系膜上动脉栓塞患者血清甲状腺素水平及治疗后的变化规律。方法：选择42例急性肠系膜上动脉栓塞患者,于治疗前和治疗后1、3、7、14、30 d抽取空腹静脉血,利用放射免疫测定方法检测血清FT3、FT4、T3、T4、TSH水平;选择同龄同性别健康查体人员作为对照组。结果：治疗组血清FT3、FT4、T3、T4均明显低于正常对照组,且以肠坏死组最明显（P＜0.05）;治疗后血清甲状腺素降低,30 d后接近正常水平。结论：急性肠系膜上动脉栓塞患者存在低甲状腺素血症,且以肠坏死患者最明显,治疗后随病情逐渐恢复。     

骨折延迟愈合患者血转化生长因子-β1的改变

目的 研究骨折延迟愈合患者外周血中转化生长因子（transforming growth factor，TGF）-β1表达水平的变化趋势，并与正常愈合患者进行对比。方法 共60例骨折延迟愈合患者，取其在骨折后1年内不同时间的外周血标本作为实验组；另取60例骨折后正常愈合的患者作为对照组。通过免疫酶标法分别检测骨折后1、2、4、8、12、24、36、48、60周，各组患者外周血中TGF-β1表达水平的变化趋势，并比较实验组与对照组之间的差异。另检测30例骨不连患者在手术前后及最终愈合时，外周血中TGF-β1的水平。结果 骨折2周后，各组患者的外周血TGF-β1水平都有显著升高（P〈0．01）。在2～4周间，实验组患者的TGF-β1水平急剧下降，又回到正常水平；而对照组患者的外周血TGF-β1仍维持在较高的水平，是实验组的1．2倍（P〈0．01）。对照组TGF-β1水平直至骨折后8周时，才回落至正常水平。术前骨不连患者外周血TGF-β1水平与正常人无差异，术后2周TGF-β1水平迅速上升（P〈0．01），维持到4周时逐步下降，直到最终愈合时又回落到正常值。结论 骨折患者外周血TGF-β1水平于较早期下降是骨折延迟愈合的一个重要指标。TGF-β1在骨折愈合过程中起关键作用，骨不连患者术后愈合与外周血TGF-β1也有密切联系。     

Significance of Mycophenolate Monitoring in Liver Transplant Recipients: Toward the Cut-off Level

Mycophenolate mofetil blocks the "de novo" -purine synthesis to reduce the incidence and severity of acute rejection episodes. There has been an increased interest in utility of monitoring mycophenolic acid (MPA) levels, however currently the MPA monitoring is not part of the protocol following liver transplantation. We assessed whether trough MPA monitoring could be advisable in liver transplant patients or not. For this reason MPA levels of 56 liver transplants were measured on 3, 5, 10, 14, 21, 30, 60, and 180 posttransplant days. The optimal cut-off of MPA level (≥1.73 mg/L) for all (56) and ≥1.34 mg/L for ciclosporin-treated- and ≥1.98 mg/L for the tacrolimus-treated transplants were calculated by statistical analysis to reduce the incidence of acute rejection. MPA concentrations of 3 days period before the day of clinical diagnosis acute rejection were well below the cut-off value. Only 3 (16%) out 19 patients with acute rejection had higher MPA levels than the cut-off value on the day of diagnosis of acute rejection. In conclusion, our data suggests that MPA predose level monitoring, especially in the early "filling phase" after transplantation, is applicable in liver allograft recipients given adjunctive MMF, protecting them from the ineffective immunosuppression.     

急诊人院患者低钾血症的原因分析及护理

对132例急诊入院患者发生低钾血症的原因及护理措施进行回顾性分析。提出低钾血症主要是由原发疾病及呕吐、未进食等原因所致。提出严格遵循补钾原则，根据缺钾程度及时有效补钾的同时，积极治疗原发病，密切观察病情变化，以促进患者早日康复。