缺血修饰白蛋白、肌钙蛋白、肌红蛋白、肌酸激酶同工酶检测在急性冠状动脉综合征早期发现中的应用

目的 探讨缺血修饰白蛋白（IMA）、肌钙蛋白（cTnⅠ）、肌红蛋白（MYO）、肌酸激酶同工酶（CK-MB）检测在急性冠状动脉综合征的早期发现中的应用价值.方法 选择100例急性冠状动脉综合征（ACS）患者,在胸痛发作后3小时内检测缺血修饰白蛋白（IMA）、肌钙蛋白（cTnl）、肌红蛋白（MYO）,肌酸激酶同工酶（CK-MB）,同时选择100例健康查体者为对照组,做相同检测,观察各种心肌标志物的变化.结果 ACS组与对照组的检测结果进行对比,4项指标的差异均具有统计学意义（P＜0.05）.ROC下曲线面积显示,IMA仅次于cTnⅠ,高于MYO和CK-MB.结论 IMA、MYO、cTnⅠ、CK-MB联合检测在急性冠脉综合征（ACS）早期诊断中具有重要的临床意义.     

IMA、Hcy和hs-CRP在ACS患者的诊断价值

目的：探讨急性冠脉综合征（acute coronary syndrome,ACS）患者缺血修饰性白蛋白（ischemia modified albumin,IMA）、同型半胱氨酸（homocysteine,Hcy）和高敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）在ACS患者的诊断价值。方法：随机选择73例在胸痛3h内就诊的ACS患者,即时抽血检测IMA、Hcy和hs-CRP,与40例体检健康者进行对照比较,计算单项或联检的敏感性和特异性,绘制ROC曲线,计算ROC曲线下面积。结果：单指标检测,IMA对ACS的敏感性为87.67%,特异性为100%,高于Hcy和hs-CRP。IMA的ROC曲线下面积最大（面积：0.985;95%可信区间0.969~1.001）,临床诊断效能高于Hcy和hs-CRP。多指标联检,三指标联检敏感性可提高至97.26%,且敏感性和特异性之和最大。结论：IMA为一高度敏感的ACS诊断血清学标志物,其与Hcy和hs-CRP联检,有助于ACS的风险评估及早期诊断。     

急性颅脑损伤病人血清CRP动态监测及临床意义

颅脑损伤病人急性期血清C-反应蛋白（CRP）升高与病情的严重程度及预后直接相关。本文对2008年1月-2010年6月期间收住的92例颅脑损伤病人入院时进行CRP监测，现将结果报告如下。     

急性缺血性脑卒中患者血清超敏C反应蛋白和炎性细胞因子水平变化及临床意义

急性缺血性脑卒中发病率、致残率高,恢复困难,早期及时、恰当的治疗至关重要。脑缺血的损伤机制十分复杂,其中缺血后一系列炎症级联反应可能是导致进一步脑损伤的主要因素之一。本文报道急性缺血性脑卒中患者血清超敏C-反应蛋白（hs—CRP）和炎性细胞因子如肿瘤坏死因子-α（TNF-α）、     

晋城地区健康人群缺血修饰白蛋白的参考区间

目的应用全自动生化分析仪建立缺血修饰白蛋白(ischemia modified albumin,IMA)的生物学参考区间。方法应用日立7600全自动分析仪,采用白蛋白-钴结合法测定786例健康人群的血清IMA水平,建立晋城地区健康人群IMA参考区间。结果晋城地区健康人群不同性别组IMA水平差异有统计学意义,女性各年龄组段IMA水平差异无统计学意义,参考区间IMA< 75.78U/mL ,男性各年龄组段IMA水平差异无统计学意义,参考区间是IMA<73.11U/mL。结论由于各实验室的检测系统不一致,检测对象也有一定的区域性,因此建立本地区IMA的参考区间十分重要,有利于临床及时诊断急性心肌缺血,也是急性冠状动脉综合症(ACS)早期辅助诊断指标。     

心肌标志物联合检测对川崎病早期诊断的临床意义

目的 探讨心肌标志物联合检测对川崎病患儿早期心肌损伤的诊断价值。方法　选取2016年1月~2018年12月本院收治的93例川崎病患儿,根据 cTnⅠ是否阳性分为心肌损伤组41例,无心肌损伤组52例,另选取同期来院体检的健康儿童45例设为健康对照组。采用白蛋白钴结合试验分别测定两组血清缺铁修饰白蛋白（IMA）、化学发光法检测肌钙蛋白Ⅰ（cTnⅠ）、免疫抑制法测定肌酸激酶同工酶（CK-MB）。结果 ①心肌损伤组的IMA、cTnⅠ、CK-MB 水平高于健康对照组和无心肌损伤组（P＜0.05）,而无心肌损伤组的心电图、IMA、cTnⅠ、CK-MB和健康对照组比较,差异无统计学意义（P＞0.05）;②心肌损伤组的IMA、cTnⅠ、CK-MB 的阳性率高于健康对照组和无心肌损伤组（P＜0.05）,而无心肌损伤组和健康对照组比较,差异无统计学意义（P＞0.05）;心肌损伤组阳性率从高到低依次为IMA 、cTnⅠ、CK-MB,IMA阳性率高于cTnⅠ和CKMB阳性率,统计学意义显著（P＜0.01）,cTnⅠ阳性率高于CKMB,统计学意义显著（P＜0.01）;③三种指标联合检测的阳性率高于单个指标,差异有统计学意义（P＜0.05）。结论 IMA 、cTnⅠ和CK-MB联合检测,有助于早期诊断川崎病的心肌损伤。     

C-反应蛋白在动脉粥样硬化中的作用

C-反应蛋白（C-reactive protein,CRP）是反映炎症的敏感指标。近年的研究揭示超敏C-反应蛋白（high-sensitive CRP,hs-CRP）是心血管疾病的危险标志之一。同时还发现CRP自身可能直接参与了动脉继样硬化的过程,CRP可增加单核细胞向血管壁黏附、促进巨噬细胞摄取LDL,促使内皮细胞功能失调及促进平常细胞迁移和增生;CRP还与血栓形成和斑块的破裂有关。     

2型糖尿病患者超敏C反应蛋白与微量白蛋白尿的关系研究

目的探讨2型糖尿病患者超敏C反应蛋白（hs—CRP）的变化及微量白蛋白尿（MAU）与hs—CRP的关系。方法对160例2型糖尿病患者根据尿白蛋白排泄率（UAER）分为正常白蛋白尿组、微量白蛋白尿组，分别进行空腹血糖和hs—CRP测定，并与100例正常对照组比较。结果2型糖尿病患者hs—CRP明显高于正常对照组（P〈0．01），而微量白蛋白尿组hs—CRP值明显高于正常白蛋白尿组（P〈0．05）。结论hs—CRP与糖尿病及其血管并发症有关。微量白蛋白尿是心血管病的预测指标．慢性炎症可能起媒介作用。     

生脉散对应激小鼠组织氧化损伤的影响研究

目的: 研究生脉散对应激小鼠组织氧化损伤的预防作用。方法: 通过剪除小鼠胡须的方式造成氧化应激模型, 以羰基蛋白（carbonyl protein）、硫代巴比妥酸反应物(thiobarbituric acid reactive substance,TBARS)作为衡量氧化损伤的指标对生脉散的抗氧化能力进行评价。结果: 应激小鼠自主活动次数显著增高,预先灌服生脉散可抑制这种增高。应激小鼠脑、心、肝、肾组织中的羰基蛋白量的升高和心、肝组织中的TBARS增高,可以被生脉散抑制。结论: 生脉散对应激小鼠组织氧化损伤有防治作用。     

过氧化物还原酶I-硫氧还蛋白、超氧化物歧化酶及过氧化氢酶在大鼠肝脏缺血再灌注损伤中的表达变化

目的 观察过氧化物还原酶I-硫氧还蛋白(PrxI-Trx)、超氧化物歧化酶(SOD)及过氧化氢酶(CAT)抗氧化体系在大鼠肝脏缺血再灌注损伤模型中的表达变化,探讨其在抗氧化应激反应中的作用。方法 通过无损伤血管夹钳夹通往大鼠肝左叶、肝中叶的血管和胆管蒂,30 min后松
开血管夹,制造大鼠70%肝脏缺血再灌注损伤模型。损伤再灌注6h后取血和肝脏。全自动生化分析仪测丙氨酸氨基转移酶（ALT）含量。HE法观察大鼠肝脏形态学改变。采用RT-PCR的方法观察在肝脏缺血再灌注损伤中PrxI-Trx、SOD、CAT氧化还原体系mRNA水平的表达变化。采用Western
blotting测定PrxI、SOD和CAT的蛋白表达水平。结果 与对照组相比,血清中ALT水平和HE结果均显示肝脏缺血再灌注损伤组大鼠肝细胞明显受损。PrxI-Trx、SOD和CAT的mRNA水平明显升高。同时,PrxI、SOD和CAT的蛋白表达水平也明显升高。结论 PrxI-Trx、SOD和CAT在肝脏缺血再灌
注损伤中均发挥了抗氧化应激作用,对肝细胞具有保护作用。     

Total antioxidant capacity of cerebrospinal fluid is decreased in patients with motor neuron disease

Oxidative stress has been associated with motor neuron disease (MND). The human body has several antioxidant defense systems to repair the damage caused by oxidative stress. The activity of these systems is thought to be reduced in neurodegenerative diseases, which may increase the level of oxidative damage and be a contributing factor to motor neuron death. In the present study, we compared the total antioxidant capacity (TAC) of human serum and cerebrospinal fluid (CSF) of MND patients with that of a control group including patients with migraine, tension headache and psychiatric disorders. Within-subject serum and CSF TAC were strongly correlated (r=0.639; p=0.000), and CSF TAC was significantly lower in MND patients as compared to controls after adjustment for known influencing factors (112.7 micromol Fe/L+/-11.7 versus 135.2 micromol Fe/L+/-19.7; p=0.012). No differences in serum or CSF TAC were observed among the clinical forms of MND considered in this work. In conclusion, the CSF TAC was strongly correlated with serum TAC, and a decrease in CSF TAC was demonstrated in MND patients compared to controls that was not independent from serum antioxidants, this translating in a systemic (but prevailing in the CNS) oxidative damage in this pathology.     

Necessity of clinical decision support system created by medical staff

To support patient safety, we have established a new system that collates medical facility clinical records, examination results and orders, and implementation information comprehensively in real time, checks for consistency and validity, and sends warnings to the appropriate people at the appropriate time. Because our system actually corrects inaccurate operation information, it is different from most existing facilities for patient safety in that it reconstructs information independently from the HIS (Hospital Information System). We were permitted to send warning messages not only to the doctor who entered the orders, but also to the chief of medical staff and team members. For the warning method, we tried screen flashes and chimes, mobile phone messages, and high quality interactive voice responses. We also investigated the degree of message usefulness. Therein, by not relying on "authenticity" and "readability," but by exhaustively collecting and appropriately revising in alignment with the use of information, we have created an original system that collects accurate information. This original system was established by medical staff members. The appropriate revisions mentioned herein are items which meticulously reflect the medical professional's comments and selected operation and signify why a "Clinical Decision Support System created by medical staff" is necessary.     

家属的护理干预对脑胶质瘤患者围手术期应激状态的影响

目的本研究旨在研究家属的焦虑状态是否对脑胶质瘤患者围手术期的应激状态有影响,手术前对家属进行心理干预后,对患者围手术期应激状态的影响。方法本研究共纳入112例需手术治疗的脑胶质瘤患者,入院后对这些患者随机分为对照组,家属护理干预组,患者护理干预组和家属患者护理干预组,每组28例。对于需要护理干预的家属或患者实行标准,系统化的护理干预。并于患者手术前一天（T1）,麻醉诱导前（T2）,手术结束（T3）,术后24小时（T4）测量患者血压,心率。并且测定血清中皮质醇（Cor）和C反应蛋白（CRP）的浓度。结果在T1时间点,四组患者的心率、血压、血清Cor和CRP水平均没有显著性差异（P〉0.05）。而在T2,T3时间点,家属病人护理干预组的心率、血压、血清Cor和CRP水平均低于其他三组,差异有统计学意义（P〈0.01）。而在T4时间点,四组患者的心率、血压、血清Cor和CRP水平两两之间差异有统计学意义。结论对家属和病人同时护理干预比仅对患者或仅对家属护理干预更能降低患者围手术期的应激水平。     

Defective endovascular trophoblast invasion in the first trimester is associated with increased maternal serum ischemia-modified albumin

BACKGROUND: Ischemia-modified albumin (IMA), a protein elevated in cardiac ischemia, is also increased to supra-physiological levels in early normal pregnancy. This finding supports the hypothesis that normal trophoblast development is stimulated by a hypoxic intrauterine environment. The aim of this study was to examine whether first trimester IMA levels are further elevated with defective trophoblast development. METHODS: Prospective study of healthy women with singleton pregnancies undergoing nuchal translucency assessment at 11-14 weeks. First trimester maternal serum IMA concentrations in those subsequently developing pre-term pre-eclampsia (n = 19) were compared to randomly chosen controls with normal pregnancy outcome (n = 69). RESULTS: Median first trimester serum IMA concentrations were significantly higher in women who subsequently developed pre-eclampsia (median 126.5 kU/L, interquartile range (IQR) 114.33-134.36 kU/L) when compared to those with normal pregnancy outcome (median 115.01 kU/L, IQR 102.29-124.81 kU/L, P = 0.02). CONCLUSIONS: Maternal serum IMA levels are elevated in the first trimester in women with pre-eclampsia, a clinical manifestation of defective endovascular trophoblast development. This suggests that abnormally high intrauterine hypoxia and subsequent reperfusion oxidative damage may be associated with defective trophoblast development. First trimester serum IMA may be a potential biomarker for abnormal placental development.     

湖北地区健康人群缺血修饰白蛋白血清水平参考区间的建立及临床应用

目的:应用美国临床实验室标准化委员会颁布的CLSIC28-A3文件建立湖北地区健康人群缺血修饰白蛋白(IMA)的参考区间,并采用急性冠状动脉综合征(ACS)心肌缺血患者和健康人群验证此参考区间的可靠性。方法:按要求选择健康人群血清标本,采用白蛋白钴结合试验测定血清IMA,经统计分析后确定IMA参考区间。选择ACS心肌缺血患者和一批健康人群,同法测定其血清IMA,并与肌钙蛋白I(cTnI)平行检测比较,验证新建立参考区间的可靠性。结果:IMA的参考值为>65.20U/ml。ACS心肌缺血患者的IMA水平为46.00U/ml(95%CI:45.10～47.10),阳性率为98.90%;cTnI的血清水平为3.31ng/ml(95%CI:2.53～4.51),阳性率为93.40%。健康人群的IMA水平为70.20U/ml(95%CI:67.20～73.10);cTnI的血清水平为0.23ng/ml(95%CI:0.21～0.54)。结论:利用CLSIC28-A3文件建立IMA参考区间简便可行,能较客观反映临床症状,有助于缺血性心肌损伤的诊断。     

地震受灾人群创伤后应激障碍危险因素的病例对照研究

目的:探讨地震3年后受灾人群中创伤后应激障碍(PTSD))的危险因素。方法:采用病例对照研究的方法,分析地震3年后云南省鲁甸县龙头山镇重灾区受灾群众155人的调查资料,以PTSD筛查阳性人群为病例组,阴性人群为对照组,对自编人口学基本信息调查表、创伤后应激障碍自评量表(PCL-C)的问卷数据进行单因素分析,采用非条件logistic回归分析探讨年龄、性别等人口学资料及灾难暴露程度、参与现场救援、地震中失去亲人与否等对创伤后应激障碍的影响。结果:病例组与对照组单因素分析比较显示,性别(χ²=4.65,P<0.05)、受教育程度(χ²=9.63,P<0.01)、灾难暴露程度(χ²=7.15,P<0.01)有统计学意义。非条件logistic回归分析显示女性(OR=4.89,P<0.01)、非文盲(OR=6.30,P<0.01)、高暴露者(OR=17.44,P<0.05)是发生PTSD的危险因素。结论:地震三年后重灾区受灾人群中女性、非文盲、高暴露者发生PTSD的危险性大,提示应当重点对这类...     

Impaired oxidative status as a potential predictor in clinical manifestations of herpes zoster

Oxidative stress, caused by an imbalance between reactive oxygen species and antioxidants, is related to many dermatologic diseases. Increased reactive oxygen species is also associated with various decreased T‐cell immune responses. The incidence and severity of herpes zoster (HZ), which is caused by the reactivation of varicella ‐ zoster virus, increase with age because of declining cell‐mediated immunity. The main purpose of this study was to assess the levels of oxidative stress biomarkers in patients with HZ compared with control subjects. In this case‐control study, the serum levels of total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index, glutathione, superoxide dismutase, and total polyphenol content (TPC) in 43 patients with HZ and 47 age‐matched controls were determined, and their biomarker patterns were compared. TAC and TPC levels were significantly lower in patients with HZ; however, TOS and oxidative stress index levels were significantly higher in comparison with the control (P < .001). In addition, a signi?cantly strong negative correlation was found between TAC and TPC with TOS levels in patients with HZ (r = ?.79, P < .001; r = ?.81, P < .001, respectively). Our findings showed an oxidative stress imbalance in HZ. Whether this change correlates with HZ pathogenesis or is a consequence of the inflammatory response to HZ needs more investigation.     

Comparative morphological study of the structure of the normal and arteriosclerotic internal mammary, coronary, and renal artery wall]

Morphological comparative study of the normal anatomy of the internal mammary artery, coronary artery and renal artery, and their atherosclerotic alterations. We report in this paper the comparative results of a morphological and morphometrical study of the normal anatomy of the Left Coronary Artery (interventricular descending branch) (LCA), Internal Mammary Artery (IMA) and Renal Artery (RA) and their atherosclerotic alterations in 27 unselected people of both sexes aging from 19 to 76 years (average 59 +/- 14.3). Sections from three different segments of each vessel were examined by measuring the thickness of the intima and media calculated at the maximum intimal thickening. The lumen was also measured at the level of its highest pathological reduction; the same measurements were carried out on sections free from atherosclerotic damage. Then the intima to media ratio was assumed as major indicator of atherosclerosis involvement according to the literature. All these parameters were statistically analysed. With these procedures we found that LCA displayed more severely atherosclerotic changes than IMA. The degree of damage in RA fell in between when compared to the other arteries. The intima to media ratio average was 0.061 mm. (+/- 0.084) in I.M.A.; 0.882 mm. (+/- 0.753) in L.C.A. and 0.272 (+/- 0.315) in RA with statistically significant differences between IMA and LCA (p less than 0.001) and between IMA and RA (p less than 0.001). In the lesion free sections intima to media ratios were 0.178 (+/- 0.90) in LCA, 0.053 (+/- 0.28) in IMA and 0.082 (+/- 0.127) in RA. The difference was statistically significative between LCA and IMA, but not between RA and IMA.(ABSTRACT TRUNCATED AT 250 WORDS)     

The activity of Krebs cycle enzymes in the visual analyzer of rats in the norm and under stress

Higher activity of the NAD-dependant dehydrogenases of the tricarboxylic acid cycle (TAC) is observed in the optic retina, and of FAD-dependant dehydrogenases in the occipital lobes of the brain, in the visual analyzer of intact rats. The influence of stress using Desiderato's method induces a compensatory increase in the activity of succinate dehydrogenase. Acute stress induces a change in the regulation of the activity of the TAC dehydrogenases, assessed on the basis of the reaction to functional load. The animals' remaining in the dark following stress promotes the restoration of the activity of the TAC cycle to the normal level.Translated from Zhurnal Vysshei Nervnoi Deyatel'nosti imeni I. P. Pavlova, Vol. 42, No. 2, pp. 357–362, March–April, 1992.