微量元素铁、铜、锌与胃癌关系的研究

目的 通过对胃癌患者血清中微量元素铁、铜、锌的检测,探讨微量元素与胃癌发病的关系。方法采用分光光度法检测50例胃癌患者和50例健康对照者血清中Cu、Zn和Fe离子浓度,分析胃癌患者与健康对照者之间血清铜、锌和铁离子含量及铜／锌比值的差异,分析血清铜、锌和铁离子含量及铜／锌比值与胃癌临床病理参数之间的关系。结果 （1）胃癌患者组血清铜、铜／锌比值均高于健康对照组（P〈0．05或P〈0．01）;血清锌含量低于对照组（P〈0．01）,血清铁含量与对照组无统计学差异（P〉0．05）。（2）初治胃癌患者血清铁含量高于非初治胃癌患者（P〈0．01）;血清锌、铜、铜／锌比2组相比无统计学差异（P〉0．05）。（3）初治胃癌患者中低分化和未分化患者组血清锌含量低于高分化和中分化患者组（P〈0．05）,铜／锌比高于高分化和中分化患者组（P〈0．05）,而血清铜含量2组相比无统计学差异（P〉0．05）;浸润程度T3和T4患者组血清锌含量低于浸润程度T1和T2患者组（P〈0．05）,铜／锌比高于浸润程度T1和T2患者组（P〈0．001）,血清铜含量高于浸润程度T1和T2患者组（P〈0．05）;血清锌、铜、铜／锌比与病人的年龄、性别、肿瘤的大小、定位、淋巴结转移以及远处转移无关。结论 （1）铜、锌等微量元素的含量异常与胃癌的发病存在内在的联系。（2）胃癌的病程发展也影响了铜、锌、铁等微量元素的含量异常。     

慢性阻塞性肺疾病急性加重期患者血清B型利钠肽浓度与CAT评分的相关性研究

目的:探讨慢性阻塞性肺疾病(COPD)急性加重期患者血清B型利钠肽(BNP)浓度与COPD症状评估测试(CAT)评分的相关性,分析其临床意义。方法:选取COPD急性加重期患者45例,健康对照者23例,分别测定COPD患者急性加重期、稳定期及健康对照者血清BNP浓度与CAT评分及作相关分析。结果:COPD组患者急性加重期及稳定期血清BNP浓度与CAT评分均明显高于健康对照组(P均<0.01);COPD组患者急性加重期血清BNP浓度与CAT评分呈正相关(r=0.918,P<0.001)。结论:COPD急性加重期患者血清BNP浓度与CAT评分有显著相关性,两者结合对判定COPD急性加重期患者病情严重程度有一定的临床意义。     

慢性阻塞性肺疾病急性加重时血清和痰液中SP-D的变化和临床意义

目的通过测定慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)、稳定期患者的血清和诱导痰中肺表面活性蛋白D(SP-D)的变化,探讨痰和血清SP-D在AECOPD中的临床意义。方法随机选择我院呼吸内科住院及门诊COPD患者共50例,其中24例AECOPD患者、26例COPD稳定期患者。同时随机抽送14例吸烟非COPD和16例不吸烟者作为对照。收集患者及对照组临床资料、血清和诱导痰标本,用ELISA法测定血清及诱导痰中肺表面活性蛋白D(SP-D)水平。结果 AECOPD患者血清SP-D水平显著高于稳定期COPD和非COPD对照组(P<0.05),而痰SP-D水平则与血清水平相反,AECOPD组显著低于稳定期及对照组(P<0.05),AECOPD组血清SP-D水平与痰SP-D水平呈显著负相关性(R=-0.705,P<0.001)。结论痰SP-D水平与血清水平有较好的相关性,监测痰SP-D水平可替代血清监测作为COPD的参考生物学标志物。     

慢性阻塞性肺病患者血清TNF-α、MMP-9的表达及相关性

目的 探讨肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)在慢性阻塞性肺病(COPD)不同时期表达的相关性.方法 分别测定28例健康人群(对照组)和28例稳定期患者(稳定期组)和28例急性加重期患者(加重期组)血清TNF-α、MMP-9水平.结果 对照组TNF-α、MMP-9的血清浓度值明显低于COPD加重期和稳定期组的血清水平(P<0.05),加重期组TNF-α、MMP-9的血清浓度值高于稳定期组的血清水平(P<0.01).加重期组和稳定期组的血清TNF-α、MMP-9二者之间存在明显相关性.结论 TNF-α、MMP-9在COPD患者血清中明显增高且存在明显相关.提示二者可能参与了COPD的发病过程,并在COPD的诊断和预后预测中具有潜在的临床价值.     

慢性阻塞性肺病稳定期患者血清C反应蛋白、白细胞介素-6与BODE指数相关性

目的分析慢性阻塞性肺病(COPD)稳定期患者血清C反应蛋白(CRP)和白细胞介素-6(IL-6)水平与BODE指数相关性。方法收集COPD稳定期患者49例,健康体检者30例为对照组,测定其血清CRP及IL-6水平。COPD患者通过计算体重指数(BMI),测定肺功能、6 min步行距离、评估呼吸困难程度获得BODE指数。比较不同级别BODE指数患者CRP和IL-6水平,及BODE指数与CRP、IL-6之间的相关性。结果COPD稳定期血清CRP、IL-6,水平高于对照组(P<0.05)。不同BODE指数级别COPD患者血清CRP及IL-6存在差异(P<0.05)。COPD稳定期患者血清CRP、IL-6与BODE指数呈正相关(r=0.589,r=0.668,P<0.05)。结论 COPD稳定期患者血清CRP和IL-6水平增高,且与BODE指数正相关,检测血清CRP、IL-6有助于评估稳定期COPD患者病情的严重程度及预后。     

老年COPD患者血清PCT、hs-CRP的表达与肺功能指标、生活质量的相关性

目的探讨老年慢性阻塞性肺疾病(COPD)患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)的表达与肺功能指标、生活质量的相关性。方法老年COPD急性加重期(AECOPD)患者42例为AECOPD组,老年COPD稳定期患者38例为稳定期COPD组,另选取同期体检健康者30例作为对照组,分别检测三组受试者血清PCT、hs-CRP水平,检测AECOPD组和稳定期COPD组的第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)、FEV1占预计值的百分比(FEV1%),同时用圣乔治呼吸问卷(SGRQ)评估两组患者的生活质量,分析PCT、hs-CRP与FEV1/FVC、FEV1%、SGRQ评分的相关性。结果 AECOPD组患者血清PCT、hs-CRP水平均高于稳定期COPD组和对照组,稳定期COPD组上述指标高于对照组(P0.05)。AECOPD组FEV1/FVC及FEV1%均低于稳定期COPD组,而SGRQ评分高于稳定期COPD组(P0.05)。相关性分析显示血清PCT、hs-CRP水平与FEV1/FVC和FEV1%呈负相关,与SGRQ评分正相关(均P0.05)。结论 COPD患者血清PCT、hs-CRP呈现高表达,且肺功能和生活质量均下降。COPD患者血清PCT、hs-CRP水平与FEV1/FVC、FEV1%和生活质量呈负相关。     

血清和胸水铜、锌、铁检测对结核性和癌性胸水的鉴别诊断价值

目的通过检测结核性和癌性胸水患者血清及胸水中铜、锌、铁水平,探讨其对鉴别良恶性胸水的意义。方法采用火焰原子吸收分光光度法(FAA S)检测32例结核性胸水和32例癌性胸水患者血清及胸水铜、锌、铁水平。结果癌性胸水组血清和胸水铜含量及铜/锌比值显著高于结核性胸水组,而血清和胸水锌含量显著降低(P<0.01)。癌性胸水组血清铁含量显著降低,而胸水铁含量显著高于结核性胸水组(P<0.01)。结论同时检测血清及胸水中铜、锌、铁水平对鉴别良恶性胸水有重要价值。     

COPD急性发作期超敏C-反应蛋白与降钙素原水平变化及相关性研究

目的探讨COPD急性期超敏C-反应蛋白(hs-CRP)与降钙素原(PCT)水平的变化及相关性。方法选取50例COPD急性期患者为观察组,同时选取稳定期患者40例为对照组,治疗前后检测血清hs-CRP与PCT水平。结果急性期COPD患者治疗前hs-CRP及PCT血清水平明显高于稳定期COPD患者;急性期患者治疗后hs-CRP及PCT血清水平显著下降,与治疗前相比有差异,但与稳定期COPD患者相比无差异;hs-CRP及PCT血清水平下降与治疗后患者病情的好转有明显的相关性,相关性系数分别为0.92、0.90。结论血清hs-CRP及PCT水平参与了急性期COPD的发病过程。     

ICU呼吸机相关性肺炎患者微量元素、维生素D水平含量及临床意义

目的探讨重症医学科ICU呼吸机相关性肺炎(VAP)患者的微量元素、维生素D水平含量及临床意义。方法选取2019年6月至2020年3月在我院ICU病房收治的200例行呼吸机辅助呼吸超过2d的患者作为研究对象。以是否发生VAP作为分组依据,将发生VAP的52例患者纳入发生组,根据患者发生VAP情况分为3个亚组,低危组19例、中危组17例、高危组16例;未发生VAP的148例患者纳入未发生组。比较各组的血清微量元素钙、铁、锌、铜、维生素D水平差异。结果VAP发生组的血清钙、铁、锌、铜、维生素D水平均低于未发生组,差异有统计学意义(P<0.05)。低危组、中危组、高危组VAP患者的血清钙、铁、锌、铜、维生素D水平依次降低,差异有统计学意义(P<0.05);且组间两两比较,差异有统计学意义(P<0.05)。VAP病情严重程度与血清钙、铁、锌、铜、维生素D均呈负相关(r值分别为:-0.405、-0.392、-0.373、-0.278、-0.537,P<0.05)。结论大部分ICU病房患者在行呼吸机辅助呼吸时发生VAP与自身的微量元素钙、铁、锌、铜、维生素D水平含量低下有关。纠正患者的微量元素、维生素D水平,有助于降低VAP发生率。     

慢性阻塞性肺疾病患者血清白介素6、肿瘤坏死因子α水平与肺功能的相关性研究

目的 探讨慢性阻塞性肺疾病(COPD)患者血清白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平与肺功能相关性的临床意义.方法 选取我院收治的COPD患者84例和健康体检者45例.血常规检测外周血中性粒细胞占白细胞总数百分比(Neu/Leu％),采用ELISA方法测定COPD患者和健康体检者血清IL-6和TNF-α浓度,同时计算第1秒用力呼气容积占预计值百分比(FEV1 ％pred)检测肺功能指标.结果 COPD稳定期组、急性加重期组的外周血Neu/Leu％,血清IL-6、TNF-α水平均高于对照组,急性加重期组较稳定期组进一步升高,差异均有统计学意义(P＜0.05).FEV1％ pred值在正常对照组以及COPD稳定期组、急性加重期组则呈递减趋势,组间两两比较差异均有统计学意义(P＜0.05).血清IL-6、TNF-α水平与FEV1％ pred均呈负相关(P＜0.05),与Neu/Leu％均呈正相关(P＜0.05).结论 IL-6、TNF-α、中性粒细胞密切参与了COPD的炎症反应过程,与肺功能密切相关,可作为评估病情严重程度的辅助指标.     

Trace elements as a component of oxidative stress in COPD

OBJECTIVE: The purpose of this study was to assess the serum concentrations of those trace elements that act as a component of oxidative stress in COPD patients. Clinically stable COPD outpatients (n = 26) and healthy controls (n = 24) were studied. METHODOLOGY: Serum concentrations of copper (Cu) and zinc (Zn) were determined using a Varian Spectra AA220 flame atomic absorption spectrophotometer. Serum concentration of iron (Fe) was measured by the ferene assay, using a commercially available kit (IL Test Iron) with the ILAb 900 autoanalyser. The lipid peroxidation product malondialdehyde (MDA) in serum samples was measured spectrophotometrically in terms of TBARS (thiobarbituric acid reactive substances). RESULTS: The serum MDA concentration in COPD patients was found to be similar to the control group (0.68 +/- 0.15 nmol/mL vs 0.62 +/- 0.13 nmol/mL, respectively; P= 0.163). The serum concentrations of the trace elements in both study groups were in the normal reference range. There was no difference in Fe concentration between COPD patients and the control group (0.81 +/- 0.38 micro g/mL vs 0.92 +/- 0.41 micro g/mL; P= 0.360). Copper concentrations were higher (1.06 +/- 0.26 microg/mL vs 0.92 +/- 0.19 microg/mL; P <0.040); while zinc was lower in the COPD group compared to the controls (0.83 +/- 0.25 microg/mL vs 1.03 +/- 0.23 microg/mL; P= 0.006). Serum Zn concentrations were lower in the severe COPD patients compared to mild-moderate COPD patients (P = 0.038). CONCLUSION: The results of this study indicate that there are alterations in serum concentrations of trace elements in COPD patients, suggesting that they may play a role in the pathophysiology of this disease by virtue of their role in oxidative stress. We recommend further studies on the role of trace elements in the pathophysiology of COPD, their association with markers of oxidant/antioxidant status and on the clinical significance of their deficiency.     

肺炎患儿血清中微量元素含量的临床探讨

目的研究肺炎患儿血清中铜、锌、铁、镁、钙等微量元素的含量的变化情况。方法选择50例肺炎的患儿作为观察组,随机选择同期在我院门诊健康体检的50例健康儿童作为对照组,分别测定两组患儿血清中微量元素铜、锌、铁、镁、钙的含量。结果观察组中患有肺炎的患儿血清中的铜、锌、钙的含量明显低于对照组,具有统计学意义(P<0.01);观察组中患有重症肺炎的患儿血清中钙。镁、铁、锌、铜的含量都比轻症肺炎患儿显著降低,具有显著差异性(P<0.01)。结论肺炎患儿血清中钙、铁、锌、铜、镁等微量元素的代谢紊乱,故应对肺炎患儿进行血微量元素的检测,并对缺乏者给予合理的补充治疗,以助疾病的迅速恢复。     

63例慢活肝严重胆汁郁积患者血清微量元素与黄疸、病理和证型关系的研究

对63例乙型慢活肝重度郁胆病人的血清微量元素与胆红素(BIL)、肝脏病理、中医证型之间的关系及治疗前后含量变化进行了临床研究。结果表明:本组病例血清锌基本正常,铁、锰、铜明显高于正常。其中 BIL>342μmol/L 组血清铜明显高于 BIL>171μmol/L 组,兼证组血清铁显著高于淤热组;四种元素含量与肝脏病理分型无明显关系;治疗前后亦无明显差异。对于血清铜与 BIL的关系及兼证组血清铁升高的原因进行了探讨。     

Serum zinc, copper, and selenium levels in inflammatory bowel disease: effect of total enteral nutrition on trace element status

Serum levels of zinc, copper, and selenium, and alkaline phosphatase activity were prospectively studied in 29 patients with inflammatory bowel disease. Fifteen patients had extensive active colitis (active colitis group). Seven patients had active, and seven cases inactive small bowel or ileocecal Crohn's disease (small bowel disease group). Ninety-three healthy subjects acted as controls. Serum trace element levels were considered in relation to vitamin A and E levels, nutritional parameters, the activity of the disease, and the recent intake of steroids. The effect of total enteral nutrition on serum trace elements was studied in seven cases. Serum zinc levels were lower and serum copper levels higher in the active colitis group than in controls (p = 0.0007, and p = 0.02, respectively). More than 50% of patients with active colonic or small bowel disease showed zinc levels below the 15th percentile of the control group. Serum zinc levels correlated with plasma vitamin A in acute colitis (r = 0.67; p = 0.006), and with both serum albumin concentration (r = 0.76; p = 0.002) and disease activity score (r = -0.67, p = 0.009) in patients with small bowel disease. The copper:zinc ratio was higher in the active colitis group than in controls (p = 0.002). In spite of the increase in serum albumin levels and the decrease in disease activity, serum zinc levels remained low after total enteral nutrition. The implications of the abnormal trace element status in patients with inflammatory bowel disease are discussed.     

Zinc therapy increases duodenal concentrations of metallothionein and iron in Wilson's disease patients

OBJECTIVE: Wilson's disease is effectively treated by zinc administration which, in vitro, increases metallothionein concentrations. To ascertain whether the latter also occurs in humans we measured metallothionein and trace element concentrations in the duodenal mucosa of 15 Wilson's disease patients: 12 treated with zinc sulphate, two treated with penicillamine, and one not yet on treatment. The control group consisted of 17 patients with dyspepsia, who underwent the same study protocol. METHODS: Metallothionein and trace element concentrations were measured in duodenal mucosa biopsies according to the silver-saturation hemolysate method and atomic absorption spectrophotometry. RESULTS: Metallothionein concentrations increased by 1500% after zinc and 150% after penicillamine in Wilson's disease patients, with respect to controls who had negative endoscopy and Wilson's disease patients who were not treated. A significant correlation was found between metallothionein and duodenal zinc concentrations. Mucosal iron concentration increased in Wilson's disease patients whether they were treated with zinc or penicillamine. Duodenum with duodenitis also had significantly increased iron levels compared with normal duodenum. CONCLUSIONS: Zinc administration increases intestinal metallothionein in Wilson's disease patients. The blockade of copper absorption and its elimination in the stools on desquamation of the intestinal cells probably explains one of the mechanisms underlying the effect of zinc treatment. Despite normal endoscopy, Wilson's disease patients present increased mucosal iron concentrations similar to those in controls with duodenitis. Metallothionein may therefore prevent oxidative damage caused by metal toxicity.     

This month in the Scandinavian Journal of Gastroenterology

Background: The production of free radicals is increased in inflammatory bowel disease, and trace elements are crucial components of several antioxidants. Trace elements deficiency may therefore compromise the defense against oxidative damage. The aims of this study were to measure plasma and tissue concentration of trace elements and antioxidants and to relate this to disease activity. Methods: A 10-ml blood sample and six colonic biopsy specimens were obtained from 24 patients with either active ulcerative colitis or in remission and 10 patients with irritable bowel syndrome for measurement of trace elements and trace element-dependent enzymes. Results: Patients with moderately active disease had significantly lower plasma iron, selenium, and glutathione peroxidase levels than patients in remission and controls, whereas no significant differences were found between the zinc and copper values of patients and controls. Mucosal concentrations of zinc and metallothionein were reduced, whereas iron and glutathione peroxidase concentrations were increased in patients with endoscopically active disease as compared with controls and patients in remission. Conclusions: Patients with ulcerative colitis have altered plasma and tissue levels of trace elements and antioxidant-related enzymes. The resulting reduced protection against free radicals may contribute to the inflammatory process.     

Determination of selected trace elements in patients affected by dementia

The relationship between dementia and trace elements is widely debated. Neurotoxicity of aluminium is well recognized. The purpose of the study was to evaluate serum levels of a few trace elements and a few serum proteins in demented subjects. The study was carried out on 452 women, age range 73-88 years. Thirty one of them were affected by dementia of Alzheimer type in early or middle stages. The diagnosis had been performed by history, physical and instrumental examinations, as well as by psychometric tests. The following parameters were determined: iron, zinc, copper, serum albumin, transferrin, ceruloplasmin. Iron, copper and zinc are somewhat lower in demented subjects than in controls, but the differences are statistically not significant. The slightly diminished levels of serum albumin and transferrin in the study group may be related to a mild malnutrition. The reduction of the proteins binding trace elements, particularly of transferrin, could cause a higher bioavailability of neurotoxic trace elements such as aluminium.     

Serum copper and zinc concentrations in patients with chronic hepatitis C

The aim of this study was to measure the alterations in serum trace elements, including zinc and copper in patients with chronic hepatitis C and to compare them with the results of healthy individuals. Seventeen patients with chronic hepatitis C and 17 healthy individuals were included in this study. Serum zinc and cooper concentrations were measured by using atomic absorption spectrophotometer of patients with chronic hepatitis C and the results were statistically compared with those of healthy individuals. Serum zinc concentrations were 105.6+/-22.8 microg/dl in patients with chronic hepatitis C and 94.41+/-19 microg/dl in healthy controls, respectively. Serum copper concentrations were 103.17+/-20.8 microg/dl in patients with chronic hepatitis C and 90.8+/-14.3 microg/dl in healthy subjects, respectively. Serum zinc and copper concentrations were not found statistically different in patients with chronic hepatitis C compared with those of healthy individuals (p>0.05). In conclusion, serum trace element concentrations did not show statistical alterations in patients with chronic hepatitis C compared to healthy subjects.     

Assay of trace elements in the serum by the PIXE method in patients with Crohn's disease

Concentrations of trace elements were determined by the PIXE method (particle induced X-ray emission) in 43 serum samples from 29 Crohn's disease patients and compared with the results obtained from a control group of 100 healthy subjects. Most of the patients were outpatients whose disease was quiescent or moderately active. Half of them had a good nutritional state. Mean serum selenium level was significantly higher in the Crohn's disease group than in the control group. A negative correlation was found between serum selenium and C-reactive protein levels. Mean serum bromine was normal in the Crohn's disease group, but there was a positive correlation between serum bromine and fibrinogen and C-reactive protein levels and leucocytosis. Mean serum copper concentration was higher in women than in men in both groups. In Crohn's disease patients, copper serum concentration was increased and correlated positively to fibrinogen and C-reactive protein concentrations, erythrocyte sedimentation rate and thrombocytosis, and negatively to hematocrit. Copper serum level could be used as a marker of Crohn's disease activity. Mean serum zinc level was decreased in the Crohn's disease group. There was a positive correlation between serum zinc level and erythrocyte sedimentation rate and fibrinogen concentration.