血清低密度脂蛋白胆固醇直接测定与Friedewald公式计算结果比较

总结了应用聚乙烯硫酸（ＰＶＳ）沉淀法测定１２３１例标本的低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）值并与Ｆｒｉｄｅｗａｌｄ公式计算的结果比较，按甘油三酯（ＴＧ）浓度分组，对比两法ＬＤＬ－Ｃ值的差异及影响ＬＤＬ－Ｃ值的因素。结果显示在低密度ＴＧ时两法基本一致，高ＴＧ时两法差别较大。ＴＧ＞４．５２ｍｍｏｌ／Ｌ（４００ｍｇ／ｄｌ）时Ｆｒｉｅｄｅｗａｌｄ公式计算结果偏低。以直接测定ＬＤＬ－Ｃ值计算ＶＬＤＬ－Ｃ／ＴＧ     

Friedewald公式在法定单位中计算系数的修正

Ｆｒｉｅｄｅｗａｌｄ公式在法定单位中计算系数的修正徐州矿务局张集矿医院检验科（２２１１４７）胡成友目前基层医院做血脂测定，通常测定血中的甘油三酯（ＴＧ）、ＴＣ、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）三项，ＬＤＬ－Ｃ是根据Ｆｒｉｅｄｅｗａｌｄ公式（简称下公式...     

LDL—C直接测定法与Friedewald计算结果的比较

用ＤＡ－６１０１ＬＤＬ－Ｃ试剂盒及日立７１７０Ａ生化自动分析仪直接测定血清ＬＤＬ－Ｃ含量。方法批内变异ＣＶ在０．５％～１．４７％，批间变异ＣＶ在２．６０％～３．７３％。平均回收率为１０２．１％，在６．６０ｍｍｏｌ／Ｌ浓度内呈良好的线性关系。ＬＤＬ－Ｃ＜４．５２ｍｍｏｌ／Ｌ时与Ｆｒｉｅｄｅｗａｌｄ公式计算的结果相关良好。方法简单，勿需沉淀分离和其他处理，适宜自动分析。     

3－磷酸甘油脱氢酶偶联法测定血清醛缩酶活性

探讨用３－磷酸甘油脱氢酶偶联法测定血清中醛缩酶（ＡＬＤ）活性的最佳反应条件。反应体系的终末浓度：ＴＥＡ１００ｍｍｏｌ／Ｌ，ＦＤＰ４ｍｍｏｌ／Ｌ，碘乙酸０．２２ｍｍｏｌ／Ｌ，ＮＡＤＨ０．２６ｍｍｏｌ／Ｌ，ＧＤＨ≥１０００Ｕ／Ｌ，ＴＰＩ≥１５００Ｕ／Ｌ，ＬＤ≥１０００Ｕ／Ｌ。最适ｐＨ在７．８～８．０，Ｋｍ为７．２×１０－３ｍｍｏｌ／Ｌ。批内ＣＶ：酶活性在７．３４Ｕ／Ｌ和６５．０６Ｕ／Ｌ时，ＣＶ分别为５．７％和１．４％；批间ＣＶ：酶活性在１１．８９Ｕ／Ｌ和１００．０８Ｕ／Ｌ时，ＣＶ分别为６．０％和３．３％，酶活性线性范围至少可达１８０Ｕ／Ｌ。健康人６０名，ＡＬＤ活性为４．５３±１．１７（ｘ±ｓ）Ｕ／Ｌ，男女两组均值无显著性差异。本文对ＴＥＡ－ＨＣｌ（ｐＨ８．０）、Ｔｒｉｓ－ＨＣｌ（ｐＨ８．０）和Ｃｏｌｉｄｉｎｅ－ＨＣｌ（ｐＨ７．５）三种缓冲液用于ＡＬＤ活性测定效果进行了评价，结果表明在ＴＥＡ缓冲液中所测ＡＬＤ活性最高；ＴＥＡ和Ｃｏｌｉｄｉｎｅ两种缓冲液的浓度在２５～１５０ｍｍｏｌ／Ｌ范围内对ＡＬＤ活性无影响，Ｔｒｉｓ缓冲液在５０ｍｍｏｌ／Ｌ时测得酶活性较高，缓冲液浓度过高或过低，酶活性均有所下降     

糖尿病患者血清维生素C浓度改变与血脂的关系

本文采用２，４－二硝基苯肼法测定５２例糖尿病患者的血清ＶｉｔＣ浓度，并同时测定其血脂及血糖水平。与正常组比较后表明，糖尿病患者血清ＶｉｔＣ浓度明显降低（２７±１２μｍｏｌ／Ｌ与３７±１４μｍｏｌ／Ｌ，Ｐ＜０．０５），其中１２例ＩＤＤＭ患者降低更显著（２３±９μｍｏｌ／Ｌ，Ｐ＜０．０１），４０例ＮＩＤＤＭ患者亦明显降低（３０±１２μｍｏｌ／Ｌ，Ｐ＜０．０５）。糖尿病患者血清ＶｉｔＣ浓度与ＴＣ和ＴＧ呈负相关，与ＨＤＬ－Ｃ呈正相关。对１３例ＴＣ、ＴＧ及ＨＤＬ－Ｃ有明显改变的糖尿病患者在降糖治疗及饮食控制不变的情况下，口服ＶｉｔＣ１．８ｇ／ｄ６周，前后的血脂及血糖结果对比表明，ＶｉｔＣ具有降低ＴＣ、ＴＧ及血糖作用，同时也有升高ＨＤＬ－Ｃ的功用。     

血清低密度脂蛋白胆固醇匀相测定法试剂的研制

目的 研制低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）直接法测定的试剂,方法 低密度脂蛋白（ＬＤＬ）与聚阴离子和表面活性剂Ⅰ形成稳定复合物,而非ＬＤＬ则在缺乏偶联剂条件下被胆固醇试剂消除,在表面活性剂Ⅱ和色原作用下,ＬＤＬ释放胆固醇并显色。结果 本室研制的试剂（Ｙ）与聚丙烯硫酸盐（ＰＶＳ）沉淀法（Ｘ１）、Ｆｒｉｅｄｅｗａｌｄ公式计算（Ｘ２）和日本第一化学试剂（Ｘ３）相关良好,分别为Ｙ＝１．０８４８Ｘ１－０．２     

血清LP（a）浓度对用Friedewald公式计算LDL－C的影响

血清ＬＰ（ａ）浓度对用Ｆｒｉｅｄｅｗａｌｄ公式计算ＬＤＬ－Ｃ的影响黄全跃，赵水平，罗琳，王钟林（湖南医科大学附二医院心内科，长沙４１００１１）直接测定ＬＤＬ－胆固醇（ＬＤＬ－Ｃ）水平通常需要超速离心技术，而该方法耗资费时颇多，显然难以在常规实验室推广...     

66例老年冠心病患者脂蛋白分析

目的 探讨老年冠心病（ＣＨＤ）患者的脂蛋白特点。方法 取健康老年组与ＣＨＤ组做对照，分别做血清十项指标检测。包括ＴＣ，ＴＧ用酶法测定，ＨＤＬ－Ｃ．ａｐｏＡ．Ｂ．ＣⅡＣⅢ．Ｅ及Ｌｐ（ａ）用免疫比浊法测定。ＬＤＬ－Ｃ依据公式计算。结果 健康老年组与ＣＨＤ组比较，ＴＣ．ＴＧ．ＨＤＬ－Ｃ．ＬＤＬ－Ｃ．ａｐｏＡ，ａｐｏＢ，Ｐ〈０．００１；ａｐｏＣⅡ，Ｐ〈０．０１。ＴＧ．ＴＣ分别与ａｐｏＣⅡ．ａｐｏＣⅢ极相关     

多指标联合检测原发性肝癌的意义探讨

对原发性肝癌（ＰＨＣ）、肝硬化和其他消化道恶性肿瘤以及健康人进行了ＡＦＰ、ＡＦＵ、ＧＰＤＡ、ＬＤＬ－ＶＬＤＬ－ＧＧＴ、和ＴＢＡ等六项指标的检测。结果表明，嘲笑因清多指标含量与健康对照组和良性肝病组相比，均有显著性差异（Ｐ〈０．０５），与其他消化道恶性肿瘤相比，ＡＦＰ、ＡＦＵ、ＬＤＬ－ＶＬＤＬ－ＧＧＴ和ＴＢＡ亦有显著性差异（Ｐ〈０．０５）。各指标的灵敏度、特异性、阳性预期值、阴性预期值和实验总有效率     

急性出血性脑血管病并发多脏器功能失常综合征患者血浆内皮素-1及降钙素基因相关肽水平的观察

目的：探讨血浆内皮素１（ＥＴ１）和降钙素基因相关肽（ＣＧＲＰ）在急性出血性脑血管病（ＡＨＣＶＤ）并发多脏器功能失常综合征（ＭＯＤＳ）发病中的作用。方法：采用放射免疫法分别测定２１例ＡＨＣＶＤ合并ＭＯＤＳ患者（ＭＯＤＳ组）、２０例ＡＨＣＶＤ患者（ＡＨＣＶＤ组）及３０例正常人（正常对照组）血浆中ＥＴ１和ＣＧＲＰ水平。结果：ＭＯＤＳ组及ＡＨＣＶＤ组血浆ＥＴ１水平明显高于正常对照组（Ｐ均＜０．０１），ＭＯＤＳ组ＥＴ１水平又明显高于ＡＨＣＶＤ组（Ｐ＜０．０１）。ＡＨＣＶＤ组血浆ＣＧＲＰ水平高于正常对照组，但无显著性差异（Ｐ＞０．０５）。而ＭＯＤＳ组血浆ＣＧＲＰ水平明显低于正常对照组，ＥＴ１／ＣＧＲＰ（Ｅ／Ｃ）比值明显高于ＡＨＣＶＤ组及正常对照组（Ｐ均＜０．０１）。结论：血浆ＥＴ１水平升高、ＣＧＲＰ水平降低、Ｅ／Ｃ比值严重失衡与ＭＯＤＳ的发生相关；检测血浆ＥＴ１和ＣＧＲＰ水平对评估ＡＨＣＶＤ患者预后有一定意义     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.