中性粒细胞/淋巴细胞比值对血流感染的诊断价值

目的探讨5项感染标志物对血流感染的诊断价值。方法随机选取望京医院血培养阳性的血流感染患者110例为研究组,血培养阴性的细菌感染患者30例为对照组。在血培养的同1天抽取静脉血,检测全血细胞计数和C反应蛋白(CRP)。比较两组白细胞(WBC)、中性粒细胞(NEU)、淋巴细胞(LYM)、中性粒细胞/淋巴细胞比值(NLCR)和CRP的差异。结果血流感染组WBC、NEU、NLCR、CRP均显著高于对照组(P0.05),而LYM显著低于对照组(P0.05)。5项感染标志物中,NLCR和LYM诊断血流感染的受试者工作特征曲线下面积(ROC-AUC)分别为0.808和0.756。当NLCR取临界值为9.33时,敏感性为63.6%,特异性为93.3%;LYM小于等于0.97为临界值时,敏感性为58.2%,特异性为86.7%。进一步,在血培养阳性患者中,革兰氏阴性菌所致的血流感染组的NLCR高于革兰氏阳性菌血流感染组,NLCR在区分血流感染的类型中具有重要的临床意义。结论 NLCR优于其他常规感染指标,有助于血流感染的诊断。     

细胞因子IL-2、IL-6、IL-8和TNF-α与危重症患者血流感染的相关性研究

为探讨血清IL-2、IL-6、IL-8和TNF-α对危重症患者早期血流感染的诊断意义,收集重症监护病房(ICU)收治的血流感染患者77例,同时设对照组22例,空腹采集静脉血,采用ELISA方法检测血清IL-2、IL-6、IL-8和TNF-α的水平,同时进行血液培养明确病原菌,评价细胞因子与危重症患者血流感染的关系。结果显示血流感染组血清中的4种细胞因子显著高于健康对照组(P0.01);不同病原菌感染组血清中的4种细胞因子水平均具有一定的差异性(P0.001),其中真菌感染组细胞因子水平最高,依次是革兰阴性菌感染组,最低的是革兰阳性菌感染组;IL-2、IL-6、IL-8和TNF-α的ROC曲线下面积分别为0.993、0.994、0.997和0.905。由此,IL-2、IL-6、IL-8和TNF-α在危重症患者血流感染早期诊断中具有较高的敏感性和特异性,可作为早期诊断的检测指标。     

降钙素原对ICU血流感染患者中脓毒血症的诊断价值

目的 评估血清降钙素原(PCT)对重症监护室(ICU)血流感染患者中脓毒血症的诊断价值.方法 利用回顾性分析方法,针对2016年1月至2018年6月期间于中山市小榄人民医院ICU的血培养阳性结果119例患者,采用SPSS 22.0软件比较PCT值在革兰氏阳性菌与革兰氏阴性菌的差异.根据其有无脓毒血症分组,并建立受试者工作曲线(ROC)评价PCT对脓毒血症的诊断价值.结果 对于ICU血培养阳性患者,PCT值在脓毒血症组与非脓毒血症组的差异有统计学意义(P=0.001).PCT值在革兰氏阳性菌与革兰氏阴性菌的差异有统计学意义(P=0.006).PCT对ICU血培养阳性患者脓毒血症的诊断特异性为0.754,曲线下面积为0.680,cut-off值为4.95ng/mL.PCT区分革兰氏阳性菌与革兰氏阴性菌的特异性为0.733,曲线下面积为0.614,cut-off值为3.94ng/mL.结论 PCT对ICU血流感染患者诊断脓毒血症及区分血流感染不同菌属有一定价值.     

高龄患者血培养实验室污染菌群分布与降钙素原鉴别血流感染和污染的价值

目的分析高龄患者血培养标本中污染菌的菌种与分布,并对降钙素原(PCT)鉴别患者血流感染和血培养污染的诊断价值进行评价。方法前瞻性分析2016年9月至2017年12月入住北京市第二医院的高龄患者630例。所有患者抽取血培养,同时检测静脉血中PCT水平。依据实验室对血培养的判定原则并结合临床表现进行综合分析,判断血培养污染并分析其分布。以受试者工作特征曲线(ROC曲线)评价降钙素原鉴别高龄患者血流感染和血培养污染的诊断价值。结果血培养总计1322瓶,全部成套送检,成套率100%。血培养阳性率为13.9%,污染率为9.8%。污染菌以凝固酶阴性葡萄球菌和棒状杆菌较为多见。PCT鉴别高龄患者血流感染及污染的灵敏度为60.9%、特异性为83.1%、最佳阈值为0.659 ng/mL ,ROC曲线下面积(AUC)为0.740,准确性为中等。结论本院高龄患者血培养污染率高于国内相关文献报道,凝固酶阴性葡萄球菌是最常见的污染菌;PCT检测能够为临床鉴别高龄患者血流感染和血培养污染提供一定诊断价值。     

血清GDF-15及临床常用炎症指标在诊断血液恶性肿瘤患者血流感染中的应用价值

目的 探索血清GDF-15及临床常用炎症指标hs-CRP、PCT、SAA和AGP在诊断血液系统肿瘤患者发生血流感染中的应用价值，为血流感染患者诊断筛选新的标志物。方法 纳入2021年3月至2022年10月在航天中心医院血液科收治的疑似血流感染的患者标本，根据血培养结果分为血流感染组(51例)和非血流感染组(81例),检测两组患者血清GDF-15、hs-CRP、PCT、SAA和AGP的水平。采用Mann-Whitney U检验和ROC曲线分析来确定各个指标对于血流感染诊断的灵敏度和特异性，通过约登指数确定诊断界值。结果 血流感染组患者的GDF-15、hs-CRP、PCT和SAA水平均显著高于非血流感染组(P值分别为0.018、0.007、<0.001和0.009),但两组间AGP水平差异无统计学意义(P=0.056)。ROC曲线分析发现血清GDF-15、hs-CRP、PCT和SAA用于诊断血液肿瘤患者是否发生血流感染的曲线下面积分别0.623、0.639、0.690和0.635(P<0.05),各指标的AUC差异无统计学意义(P>0.05)。另外，血清GDF-15、hs...     

血清白细胞介素-6检测对血流感染诊断价值的探讨

目的探讨血清白细胞介素-6（IL-6）水平对鉴别革兰阴性菌（G-）、革兰阳性菌（G＋）及真菌血流感染在临床中的诊断价值。方法收集从2015年1月至2016年3月入院血流感染患者的资料,所有患者血培养为单一菌株并于采血当天检测血清IL-6水平,同时选取血培养阴性的局部感染患者30例作为对照组,比较IL-6水平在G-菌、G＋菌及真菌血流感染患者之间的差异,并根据受试者工作特征（ROC）曲线判断IL-6诊断效能。结果 170例血流感染患者中,G-菌感染75例（占44%）、G＋菌感染67例（占40%）及真菌感染28例（占16%）;G-菌组、G＋菌组、真菌组及对照组IL-6水平中位数分别为221.3pg/m L、37.4 pg/m L、111.0 pg/m L和3.87 pg/m L,各组间IL-6水平差异有统计学意义（P57.585pg/m L时,G-菌感染可能性大;IL-6对鉴别真菌所致血流感染患者无临床参考价值,有待相关新指标的发现及评估。     

重庆地区670例呼吸道感染患者呼吸道病原体谱IgM的检测和分析

目的了解重庆地区呼吸道感染患者病原体流行及分布情况。方法收集我院自2015年1月至2016年3月期间所有呼吸道感染的住院和门诊患者670例,采用间接免疫荧光法检测患者血清中11种呼吸道病原体的Ig M抗体,根据不同性别、不同年龄和不同季节的病原体抗体阳性率以及合并感染情况进行统计分析。结果 1)670例患者中检出病原体抗体290例(290/670,43.28%),其中乙型流感病毒阳性率最高,其他依次为:嗜肺军团菌、肺炎衣原体、肺炎支原体、甲型流感病毒、呼吸道合胞病毒、副流感病毒、腺病毒、柯萨奇病毒A和埃可病毒;检出的病原体抗体阳性290例中,单项感染的224例(224/290,77.24%),双重感染的51例(51/290,17.59%),三重及以上感染15例(15/290,5.17%)。2)所有患者中女性病原体抗体阳性率高于男性(P0.05);不同年龄组呼吸道病原体感染阳性率有明显差异(P0.05)。3)不同季节病原体抗体的阳性率有差异,春冬季的病原体抗体阳性率显著高于夏秋季(P0.05)。结论该地区呼吸道感染患者检出的呼吸道病原体抗体以乙型流感病毒和嗜肺军团菌为主,感染类型以单项病原体感染为主,且可根据不同的流行病学差异进行有效的病原体预防和控制,尤其对在易感人群中注射疫苗有重要意义。     

血流感染中耐碳青霉烯类肺炎克雷伯菌的临床感染流行特征、耐药性调查

目的:探究血流感染中耐碳青霉烯类肺炎克雷伯菌的临床感染流行特征及耐药性.方法:回顾分析在我院因肺炎克雷伯菌引起的血流感染患者69例.根据患者对耐碳青霉烯类药物的敏感性将其分为碳青霉烯类敏感肺炎克雷伯菌感染组(CSKP)32例和碳青霉烯耐药肺炎克雷伯菌感染组(CRKP)37例.比较两组的一般资料,并进行耐药性分析,对CRKP组进行耐药基因检测.结果:本研究最常见的感染部位为胆道(27.54％)、腹腔内(26.09％)、泌尿系统(18.84％)、肺部(13.04％)以及肝脓肿(5.80％),4.34％患者存在多部位感染.两组在性别、年龄上无明显差异(P>0.05),在科室分布、手术、留置导管、免疫抑制剂应用、机械通气及临床结局上两组比较有显著差异(P<0.05).CSKP组对临床常用抗菌药物高度敏感,1～3代头孢菌素、喹诺酮类药物、氨基甙类药物、β-内酰胺/抑制剂复合制剂均具有较高的敏感性;而CRKP组对亚胺培南完全耐药,对其他类型的抗菌药物也有较高的耐药性.CRKP组中菌株均检测携带耐药基因blaKPC-2,均未检测到blaNDM-1、blaVIM、blaIMP、blaOXA-48-like.结论:血流感染多发于膈下部位,CSKP组及CRKP组患者具有不同的临床特征及结局,有创操作及免疫抑制剂的使用是CRKP组血流感染的危险因素.     

特重度烧伤合并吸入性损伤患者血流感染的临床特征及其主要风险因素分析

目的通过研究特重度烧伤合并吸入性损伤患者临床特征和风险因素,为未来构建特重度烧伤合并吸入性损伤患者血流感染风险模型提供依据。方法回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2010年1月1日至2019年12月31日收治的符合入选标准的185例患者的病历资料。分析其基本特征、烧伤情况、转运情况、血流感染的特点、治疗及结局。根据其是否发生血流感染将患者分为感染组62例(33.51%)和未感染组123例(66.49%),分析该类患者血流感染的临床特征及发生血流感染的危险因素,并行单因素分析和Logistic回归分析。结果 185例特重度烧伤合并吸入性损伤患者中有62例发生血流感染。检出阳性率从高到低的前3位细菌分别是肺炎克雷伯菌(36.25%),铜绿假单胞菌(28.75%),鲍曼不动杆菌(13.75%)。感染组烧伤总面积、Ⅲ度烧伤面积均显著高于非感染组,差异均有统计学意义(Z=4.361、4.652,P0.05);感染组ICU住院时间、住院时间显著长于非感染组,差异均有统计学意义(Z=4.297、 2.769,P0.05)。感染组和非感染组男女构成比差异有统计学意义(χ~2=4.237,P0.05)。感染组和非感染组接受机械通气的患者构成比差异有统计学意义(χ~2=13.788,P0.05)。最终Logistic回归结果显示ICU住院时间为独立危险因素(OR=1.035,95%CI=1.014～1.057,P0.05)。结论特重度烧伤合并吸入性损伤患者具有血流感染高风险,其中肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌等革兰氏阴性菌为主要致病菌,ICU住院时间为特重度烧伤合并吸入性损伤患者发生血流感染的独立危险因素。     

血清HA、LN、Ⅳ-C和PCⅢ检测在慢性肝病中的临床意义

血清透明质酸(HA)、层黏蛋白(LN)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)在一定程度上反映肝内的纤维化状况[1-2〗。本文对290例慢性肝病患者进行HA、LN、Ⅳ-C、PCⅢ测定,现将结果报告如下。1资料和方法.1.1资料290例(男195,女95)慢性肝病患者均为我院2009.7～2011.7门诊和住院治疗的患者,年龄(20～65)岁,平均42.6岁。其中慢性肝炎轻度患者59例(男40,女19),年龄(21～63)岁,平均41.3岁;慢性肝炎中度患者90例(男     

Effects of Leukotrienes on Neutrophil Migration, and on Production and Action of Lymphokines

The effect of the leukotrienes LTB4, LTC4 and LTD4 on the production of the lymphokine leukocyte migration inhibitory factor (LIF) from human peripheral blood mononuclear cells was tested. LTC4 and LTD4 failed to influence LIF production by cells stimulated by antigen or the polyclonal T cell activator, phytohemagglutinin (PHA). LTB4, at concentrations 10(-7) to 10(-6) M, showed significant inhibition of antigen-induced LIF production but was without effect when cells were stimulated by PHA. The cell levels of cyclic adenosine monophosphate (cAMP) were unaffected by 2.5 X 10(-7) M LTB4 in the absence or presence of theophylline. These results indicate that LTB4 acts on the early effector stage of the immune response without affecting the cellular cAMP content.     

Effects of sex steroids and related compounds on pregnancy and on development of the young

Extensive animal research has shown that endogenous estrogens and progestins play a vital role in controlling the course of normal pregnancy and fetal development. The balance of the 2 types of hormones must be maintained, a relative excess of deficiency of either being detrimental to the offspring. Information on this topic is presented from a review of the animal study literature. The effect of sex steroids in the following areas of pregnancy and fetal development is discussed: 1) interruption of gestation; 2) antifertility effects; 3) prolonged gestation; 4) maintenance of pregnancy; 5) fetal masculinization; 6) fetal feminization; 7) teratogenic effects; 8) postnatal effects of steroids on males and females; 9) steroid transfer through milk; and 10) female sterility induction through early postnatal administration of steroids.     

Effect of hypertonicity on augmentation and potentiation and on corresponding quantal parameters of transmitter release

Augmentation and (posttetanic) potentiation are two of the four components comprising the enhanced release of transmitter following repetitive nerve stimulation. To examine the quantal basis of these components under isotonic and hypertonic conditions, we recorded miniature endplate potentials (MEPPs) from isolated frog (Rana pipiens) cutaneous pectoris muscles, before and after repetitive nerve stimulation (40 s at 80 Hz). Continuous recordings were made in low Ca2+ high Mg2+ isotonic Ringer solution, in Ringer that was made hypertonic with 100 mM sucrose, and in wash solution. Estimates were obtained of m (no. of quanta released), n (no. of functional release sites), p (mean probability of release), and vars p (spatial variance in p), using a method that employed MEPP counts. Hypertonicity abolished augmentation without affecting potentiation. There were prolonged poststimulation increases in m, n, and p and a marked but transient increase in vars p in the hypertonic solution. All effects were completely reversed with wash. The time constants of decay for potentiation and for vars p were virtually identical. The results are consistent with the notion that augmentation is caused by Ca2+ influx through voltage-gated calcium channels and that potentiation is due to Na+-induced Ca2+ release from mitochondria. The results also demonstrate the utility of this approach for analyzing the dynamics of quantal transmitter release.     

Age and sex influence on pulmonary hypertension of chronic hypoxia and on recovery

To study the influence of age and sex on the hemodynamic and structural response of the pulmonary vascular bed to chronic hypobaric hypoxia, "infant" Sprague-Dawley rats from 8 days old and "adult" rats from 9 wk old, each group including both sexes, were exposed to half atmospheric pressure for 1 mo and then allowed to recover in room air for up to 3 mo. During hypoxic exposure, pulmonary artery hypertension (Ppa) developed in all groups. The level of Ppa was similar in both male and female infant and in male adult rats but was significantly lower (P < 0.01) in the female adult rats. After recovery in room air, only partial regression of Ppa had occurred in all groups (P < 0.001). In male and female adult rats, recovery values were similar but infant rats had more residual Ppa than adults (P < 0.001). The structural changes that developed during hypoxia, especially the abnormal presence of muscle in small and peripheral intra-acinar arteries, were more severe in male adult rats compared with female adults (P < 0.01) and in infants of both sexes compared with male adults (P < 0.01). After recovery, residual structural changes were present in all rat groups but were most severe in the infants (P < 0.01).     

Effects of alcohols and volatile anesthetics on S-potential producing cells and on neurons

Summary Comparative studies were carried out regarding the effects of alcohols (ethyl- and methyl-alcohols) and of volatile anesthetics (ethyl-ether, Fluothane and chloroform) on the plasma membrane potential recorded from controller cells (S-potential producing cells, isolated fish retina) and from conductor cells (spike producing neurons, isolated frog dorsal root ganglion). The results clearly demonstrate that alcohols and volatile anesthetics in low concentrations suppress controller cell function, whereas the photoreceptor, conductor cells and synaptic transmission have a great resistance to these agents. The depolarizing component of the C-type S-potentials was selectively depressed by ethanol. A fundamental difference was found between the effects of ethanol and of ether on the controller cell membrane behavior.     

The effect of coimmobilizing heparin and fibronectin on titanium on hemocompatibility and endothelialization

Currently available cardiovascular implants, such as heart valves and stents, exhibit suboptimal biocompatibility because of the incomplete endothelialization and sequential thrombosis formation especially after a long-term implantation. To improve the blood compatibility and endothelialization simultaneously and ensure the long-term effect of the cardiovascular implants, a technique of combining electrostatic interaction and coimmobilization was developed to form heparin and fibronectin (Hep/Fn) films on aminosilanized titanium (Ti) surfaces. The Hep/Fn coimmobilized films were stable after immersion in PBS for five days, probed by wettability studies and by the release kinetics of heparin and fibronectin. Blood compatibility tests showed that the coimmobilized Hep/Fn films displayed lower hemolysis rate, prolonged blood coagulation time, higher AT III binding density, less platelets activation and aggregation, and less fibrinogen conformational change compared with Ti surface. Endothelial cells (ECs) seeding and fibronectin bioactivity results showed more attached and proliferated ECs and exposed cell-binding sites on the Hep/Fn immobilized samples than that on Ti surfaces. Thus, the Hep/Fn coimmobilized films kept excellent bioactivity even after immersion in PBS for five days. Systemic evaluation suggests that the coimmobilization of Hep/Fn complex improves the blood compatibility and promotes the endothelialization simultaneously. We envisage that this method will provide a potential and effective selection for biomaterials surface modification of cardiovascular implants.     

运动和呼吸对心率及心音幅值影响的探讨

目的用数字心音图探索运动和呼吸对心率及心音幅值的影响.方法运动前后分别同时记录心力和心动周期信号,用相继各心动周期的标准差(SDNN)作为心率变异性的一个指标,用相继各第一心音幅值的标准差(SDS1)作为心力变异性的一个指标;记录呼吸和屏气状态下的心率变化.结果 34名受试者运动前的SDNN为±18ms,SDS1为±1.63,运动后的SDNN为±10ms,SDS1为±10.61,运动前后心率变异性和心力变异性的差异非常显著(P<0.01);屏气状态下心率变化小于呼吸周期内的心率变化.结论运动后心率变异性减小,而心力变异性增高;屏气状态下仍然存在心率变化.     

儿童烧伤治疗及瘢痕防治策略的探讨

本文结合儿童生理特点,从儿童烧伤休克复苏补液的液体选择、晶体配方、输注方式;创面修复中敷料的选择、新型敷料的应用;深度烧伤创面手术时机和处理方法以及覆盖物的选择,多方位对儿童烧伤治疗进行阐述。同时,对烧伤瘢痕的预防措施,如压力疗法、激光治疗、支具应用;瘢痕的手术和非手术治疗的新进展;儿童瘢痕整形手术方法的选择;烧伤治疗全程康复措施和经验等作了分享和探讨,旨在为临床一线工作的医护人员提供参考依据。