血液透析过程中患者血清一氧化氮及内皮素水平的变化

目的：了解血液透析（血透）患者血清一氧化氮（ＮＯ）及内皮素（ＥＴ）在血透过程中的变化。方法：２０例维持性血透患者分别进行醋酸盐透析（ＡＨＤ）、重碳酸盐透析（ＢＨＤ）和无醋酸盐透析（ＡＦＨＤ），分别于各种方式透析时抽取透析开始时及透析１５分钟、３０分钟、６０分钟、１２０分钟和２４０分钟时的管路动脉端血标本，用比色法测定ＮＯ水平，用放射免疫法测定ＥＴ水平。结果：ＡＨＤ６０分钟时ＮＯ呈一过性增高（ｔ＝６．２６，Ｐ＜０．００１），而后降到透析开始时水平；ＢＨＤ前１２０分钟ＮＯ水平无明显变化，２４０分钟时下降（ｔ＝２．５３，Ｐ＜０．０５）；ＡＦＨＤ时ＮＯ逐渐下降，至６０分钟时达最低水平（ｔ＝４．７６，Ｐ＜０．００１），而后稳定不变。ＡＨＤ２４０分钟时ＥＴ达最高值（ｔ＝８．４６，Ｐ＜０．００１）；ＢＨＤ２４０分钟时ＥＴ水平增高（ｔ＝２．７０，Ｐ＜０．０５）；ＡＦＨＤ时ＥＴ水平变化无显著性差异（Ｆ＝１．４３，Ｐ＞０．０５）。结论：醋酸盐尤其高浓度时能促进血透患者ＮＯ及ＥＴ的上升；ＮＯ能被透析清除；ＡＦＨＤ对ＮＯ及ＥＴ的影响优于ＢＨＤ，ＢＨＤ优于ＡＨＤ。     

血清酮体比值判断感染性多脏器功能失常综合征病情严重程度及预后的意义

目的：探讨血清酮体比值（ＡＫＢＲ）对判断感染性多脏器功能失常综合征病情轻重程度和预后的意义。方法：测定正常对照组、肝硬化组、急性感染组（又分Ａ、Ｂ、Ｃ３组）患者乙酰乙酸（ＡｃＡｃ）、β羟丁酸（３ＨＢ）及ＡＫＢＲ等指标水平。结果：肝硬化组ＡｃＡｃ〔（０．４２±０．１５）ｍｍｏｌ／Ｌ〕和３ＨＢ〔（０．８２±０．１８）ｍｍｏｌ／Ｌ〕明显低于正常对照组〔（０．９９±０．２０）ｍｍｏｌ／Ｌ和（１．４０±０．２５）ｍｍｏｌ／Ｌ〕，Ｐ均＜０．０１；急性感染Ａ、Ｂ、Ｃ３组的ＰａＯ２、乳酸、阴离子间隙具有显著性差异（Ｐ均＜０．０１）；ＡＫＢＲ与ＡＰＡＣＨＥⅢ评分呈明显负相关（ｒ＝－０．８１２，Ｐ＜０．００１）；血清酮体水平与ＡＰＡＣＨＥⅢ评分间无明显直线相关关系（ｒ＝０．１６３，Ｐ＞０．０５）；ＡＫＢＲ和ＰａＯ２与ＡＰＡＣＨＥⅢ评分间有明显相关性（ｒ＝０．７２２，Ｐ＜０．０１）。结论：ＡＫＢＲ能更早期、直接、准确地反映肝细胞线粒体的受损程度和能量代谢状态，可以作为评估感染性ＭＯＤＳ病情严重程度及预后的重要指标。     

碳酸氢盐血液透析的临床应用

本文对２４例尿毒症患者血透治疗２９６例次，其中醋酸盐透析（ＡＣ－ＨＤ）治疗２０５例次，碳酸氢盐血透（Ｂｉ－ＨＤ）治疗９１例次，比较两者在透析过程中的临床并发症，提示：Ｂｉ－ＨＤ临床并发症频率明显低于ＡＣ－ＨＤ，并对其原因作了分析。     

紫热线照射充氧自血中输对冠心病患者血清脂蛋白及载体蛋白的 …

目的：探讨紫外线照射充氧自血回输（ＵＢＩＯ）对血清总胆固醇（Ｔｃｈ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）及其亚组分Ⅱ（ＨＤＬ２－Ｃ）、亚组分Ⅲ（ＨＤＬ３－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载体蛋白（Ａｐｏ）Ａ１、Ａ２、ｂ１００、Ｃ２、Ｃ３的影响．方法：将冠心病高血脂患者分成两组，对照且２７例，给予硝酸酯类和维生素类药物，ＵＢＩＯ组３２中用光量子疗法。两组患者治疗期间停用其他影     

甲状旁腺素对红细胞生成素疗效的影响

目的：观察尿毒症贫血患者，甲状旁腺素（ＰＴＨ） 水平对红细胞生成素（ｒ － ＨｕＥＰＯ） 疗效的影响。方法：根据血红蛋白水平分为两组：Ａ 组为Ｈｂ ＜ ９０ｇ／Ｌ，Ｂ 组为Ｈｂ ≥９０ｇ／Ｌ。测定两组ＰＴＨ 水平，观察ｒＨｕＥＰＯ，１－２５（ＯＨ）２Ｄ３ 治疗前后血Ｈｂ 、ＨＣＴ，ＰＴＨ 变化。结果：（１）Ａ 组ＰＴＨ 明显高于Ｂ 组（ Ｐ＜ ０－０１） 。（２）ｒＨｕＥＰＯ 治疗３ 个月后，两组Ｈｂ 、ＨＣＴ 均有提高，Ａ 组上升幅度（ Ｐ＜ ０－０５） 低于Ｂ 组（ Ｐ＜ ０－０１） 。（３）１－２５（ＯＨ）２Ｄ３ 治疗后，血ＰＴＨ 有所下降（ Ｐ＜ ０－０５） 。结论：高ＰＴＨ 可加重贫血，降低ｒＨｕＥＰＯ 疗效，１－２５（ ＯＨ）２Ｄ３ 治疗可降低ＰＴＨ 水平。     

人体血液流变特性正常范围及其机理的初探

本文对１０３例不同年龄组和性别的正常人２５项血液流变学参数研究结果发现：ＷＢＶ、ＣＷＢＶ、ＲＷＢＶ、ＨＣＴ、Ｆｉｂ、ＴＫ值、ＭＣＨＣ、ＯＤ和血沉方程Ｋ值具有明显的性别差异（Ｐ＜０．０５～０．００１）；Ｔｃｈ、血沉方程Ｋ值、ＷＢＶ、ＣＷＢＶ、ＲＷＢＶ、ＴＧ、ＨＣＴ、Ｆｉｂ、ＷＭＦＰ、ＲＡＩ、ＥＳＲ、Ｈｂ、ＲＢＣ、ＭＣＨＣ和ＯＤ与年龄的增长呈趋势性变化（Ｐ＜０.０５～０.００１）．并对血液流变学参数的性别和年龄组间的差异机理予以初步探讨。     

同源盒（HOX）基因对造血的调控作用

同源盒（ＨＯＸ）基因，不仅在胚胎发育中起作用，而且在造血发育和分化以种系特异性和阶段特异性的方式起调控作用，研究表明，ＨＯＸＢ（Ｂ２，Ｂ４，Ｂ６～９），ＨＯＸＣ（Ｃ６，Ｃ８）和ＨＯＸＡ（Ａ５）基因与红系造血有关；ＨＯＸＡ，ＨＯＸＢ，ＨＯＸＣ的部分基因在淋巴系分化中起重要作用，Ａ９，Ａ１０，Ｂ３，Ｂ７和Ｂ８调节粒单核系的发育。而且，ＨＯＸ基因在琐发育阶段有不同的表达模式，位于３’端的基因在ＣＤ３４＾     

一种新高频通气方法对实验性急性呼吸窘迫综合征的疗效观察

在高频喷射通气（ＨＦＪＶ）治疗犬实验性急性呼吸窘迫综合征（ＡＲＤＳ）时，采用连续ＨＦＪＶ基础上间歇叠加深吸气（ＨＦＪＶ＋ＤＩ）的新通气方法，以期为ＡＲＤＳ的治疗寻找一种新途径。用油酸复制犬ＡＲＤＳ模型，并随机分为３组。ＨＦＪＶ＋ＤＩ组（ｎ＝１０）：在连续ＨＦＪＶ基础上每隔１０分钟加入１次深吸气；常规机械通气组（ＣＭＶ，ｎ＝１０），给予０．７８５ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ）呼气末正压（ＰＥＥＰ）治疗；对照组（ｎ＝１０），未予通气治疗。每隔１小时测定１次氧合及血流动力学指标，共观察５小时。注射油酸后，动脉氧分压（ＰａＯ２）由１２．４００ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至６．５６０ｋＰａ（Ｐ＜０．０１），动脉二氧化碳分压（Ｐａ－ＣＯ２）未见明显变化。通气治疗后，ＣＭＶ和ＨＦＪＶ＋ＤＩ均使ＰａＯ２明显升高，ＰａＣＯ２无明显变化（Ｐ＞０．０５），ＨＦＪＶ＋ＤＩ的氧释放指数（ＤＯ２Ｉ）明显高于ＣＭＶ组（Ｐ＞０．０５），心脏指数（ＣＩ）在ＣＭＶ组及ＨＦＪＶ＋ＤＩ组均明显减低（Ｐ＜０．０５）。提示：ＨＦＪＶ＋ＤＩ时ＰａＯ２的提高大于ＣＩ下降所致的不利影响，在改善组织缺氧方面明显优于ＣＭＶ时加用ＰＥＥＰ     

肾移植患者相关低氧血症的临床研究

目的：探讨肾移植患者相关低氧血症的发病机制及防治措施。方法：对３０例肾移植患者进行肾移植前后动脉血氧分压（ＰａＯ２）、红细胞（ＲＢＣ）和血红蛋白（Ｈｂ）测定，并与２０名正常人作对照。结果：患者肾移植前ＰａＯ２明显低于肾移植后及正常对照组（Ｐ＜０．０１和Ｐ＜０．００１）；ＲＢＣ和Ｈｂ值肾移植前均显著低于肾移植后及正常对照组（Ｐ均＜０．００１）；肾移植前后Ｈｂ与ＲＢＣ呈正相关，而Ｈｂ与ＰａＯ２之间无显著相关。结论：肾移植前部分患者即有低氧血症存在，肾移植后低氧血症得到纠正。低氧血症的发生原因可能与ＲＢＣ、Ｈｂ的减少和血氧含量下降有关；如能提高Ｈｂ的数量和质量，可能对肾移植前低氧血症的预防和治疗起到一定的作用。     

2型糖尿病患者外周血细胞凋亡与一氧化氮、血糖的关系

目的：探讨２型糖尿病（Ｔ２ＤＭ）２外周血淋巴细胞（ＰＢＬ）凋亡与一氧化氮（ＮＯ）、血糖浓度的关系。方法：用琼脂糖凝胶电泳测定５３例Ｔ２ＤＭ「ＤＭ组,其中无血管并发症（ＤＭＩ）组２６５例,伴血管并发症（ＤＭ２组２７例」,患者及队列３空（ＮＣ组）ＰＢＬ在体外培养２４小时的凋亡发生率,同时因清ＮＯ葡萄糖浓度及糖化血红蛋白的变化。结果：ＤＭ组细胞凋亡、ＮＯ、葡萄糖、ＨｂＡ１ｃ镁明显高于ＮＣ组,此现象ＳＤＭ     

Haematological and hormonal responses to dynamic exercise in patients with chronic airway obstruction

The influence of exercise on hormonal and total white blood cells (WBC), lymphocytes (L). Granulocytes (GR), and platelet (P) count responses was studied in: twenty-five patients with chronic airway obstruction (CAO, 47 +/- 1.8 years, mean +/- SEM) and thirteen normal subjects (N, 36 +/- 2.6 years). They performed a submaximal (40 W) and a maximal exercise (VO2max). Arterial blood samples were taken at rest, 40 W, and VO2max. [H+], PaCO2, PaO2 haematocrit (Hct), [Hb], P, total platelet volume (TPV), WBC, GR, L, and total red blood cells (RBC) were measured. At rest, WBC, GR, P and TPV were higher in CAO patients, whilst PaO2 and cortisol were lower. At 40 W, when compared to values obtained at rest, WBC, GR, L, P and TPV were increased in both groups; WBC, GR, P and TPV were higher in CAO patients. VO2max of CAO patients represented 54% of that of controls. At VO2max, Hct, [Hb] and RBC were approximately 10% higher than at rest in both groups, whilst changes were more significant in normals for WBC (CAO = 55%, N = 76%), lymphocytes (CAO = 83%, N = 105%), GR, (CAO = 37%; N = 51%), platelets (CAO = 23%, N = 29%), TPV (CAO = 25.4%, N = 35%), [H+] (CAO = 43%, N = 38%) and ACTH (CAO = 82%, N = 139%). PaO2 and cortisol did not differ between groups. PaCO2 and platelets however, were higher in the CAO group.(ABSTRACT TRUNCATED AT 250 WORDS)     

尿毒症患者肾性贫血对氧化应激的影响

目的通过测定不同贫血程度尿毒症患者外周血脂质过氧化物(LPO)和红细胞中超氧化物歧化酶(SOD)的活性变化,来检测尿毒症患者氧化应激情况及探讨肾性贫血对氧化应激的影响.方法将血液透析患者分为2组,组Ⅰ患者未经正规红细胞生成素(rHuEPO)治疗血红蛋白(Hb)浓度＜10g/L,组Ⅱ患者经正规rHuEPO治疗6个月后Hb＞10g/L.应用硫代巴比妥酸比色法(TBAR)分别检测2组患者血液透析前血浆LPO浓度,及应用邻苯三酚法检测2组患者红细胞SOD值,同时检测血生化指标:尿素氮,肌酐,白蛋白,胆固醇,低密度脂蛋白等.结果组Ⅰ Hb浓度与组Ⅱ Hb有显著差异(P＜0.001),而血生化指标无明显差异(P＞0.05).治疗后两组血LPO浓度有显著性差异(P＜0.001),且均明显大于健康对照组(P＜0.001),两组红细胞SOD浓度有显著性差异(P=0.002),且均明显低于对照组(P=0.005).LPO值与Hb浓度呈反相关(r=-0.680,P＜0.001).红细胞SOD浓度与Hb浓度呈正相关(r=0.449,P=0.01).结论尿毒症患者脂质过氧化物较正常人增高,而抗氧化物较正常人减少,证明尿毒症患者氧化应激增加.组Ⅰ患者血红蛋白明显低于组Ⅱ患者,证明贫血越严重,氧化应激越增强,氧化应激与贫血成正相关,提示贫血会加重氧化应激,积极纠正贫血可改善尿毒症患者的氧化应激状态.     

The Complete Blood Count and Reticulocyte Count–Are They Necessary in the Evaluation of Acute Vasoocclusive Sickle-cell Crisis?

Objective : To assess the usefulness of the complete blood count (CBC) and the reticulocyte count in the evaluation of adult patients with acute vasoocclusive sickle-cell crisis (SCC) presenting to the ED.
Methods : A 2-part study was performed. Part 1 was a retrospective chart review of patients with a sole ED diagnosis of acute SCC. Part 2 was a prospective evaluation of consecutive patients presenting in SCC. In both parts of the study, patients with coexisting acute disease were excluded. The remaining patients were divided into 2 groups: admitted and released. The mean values for white blood cell (WBC) count, hemoglobin (Hb) level, and reticulocyte count were compared. In Part 2. the change (Δ) from the patient's baseline in WBC count, Hb level, and reticulocyte count also was determined. Data were analyzed by 2-tailed Student's t-test.
Results : Part 1: There was no difference between the admitted ( n = 33) and the released ( n = 86) groups in mean WBC count (p = 0.10), Hb level (p = 0.25), or reticulocyte count (p = 0.08). Part 2: There was no difference between the admitted ( n = 44) and the released ( n = 160) groups in mean Hb level (p = 0.88). reticulocyte count (p = 0.47). AHb level (p = 0.88). and Areticulocyte count (p = 0.76). There was a difference in mean WBC counts (15.8 ± 4.9 × 10⁹/L admitted vs 12.8 ± 4.9 × 10⁹/L released, p = 0.003) and ΔWBC counts (5.1 ± 4.6 × 10⁹/L admitted vs 1.8 ± 4.6 × 10⁹/L released, p < 0.002).
Conclusion : Determination of the Hb level and the reticulocyte count do not appear useful in the evaluation of acute SCC in the ED. Admission decisions appear associated with elevations in the WBC count. Further study is required to determine the true value of the WBC count in such decisions.     

Mechanisms producing hypoxemia during hemodialysis

Arterial hypoxemia occurs frequently during hemodialysis. Proposed mechanisms for this phenomenon have included hypoventilation and embolism of granulocyte aggregates. We studied 18 patients with endstage renal failure who required chronic hemodialysis, and measured arterial blood gases, pulmonary gas exchange, and dialyzer gas exchange. During use of acetate as a dialysate buffer, PaO2 decreased to 80 +/- 6.8 torr, whereas during use of the bicarbonate buffer oxygen tension remained at 92 +/- 4.9 torr or greater. Hypoventilation and microembolism were not sufficient to explain the degree of hypoxemia during acetate dialysis. Hypoxemia occurred only after the 1st exposure to acetate; neither an instantaneous change to bicarbonate nor stopping dialysis restored oxygen tension to normal. We conclude that a pharmacologic action of acetate adversely affects lung function, aggravating the decreased alveolar oxygen tension (PAO2) due to hypoventilation. Hypoxemia was not present when bicarbonate was used. Acetate buffer should not be used for dialysis in patients with unstable cardiovascular or respiratory systems.     

ANA、抗SSA抗体、抗SSB抗体阳性患者血细胞分析参数的变化

目的探讨抗核抗体(ANA)、抗干燥综合征A抗体(抗SSA抗体)、抗干燥综合征B抗体(抗SSB抗体)均阳性患者血细胞分析参数的变化。方法采用间接免疫荧光法(IIF)检测ANA,采用免疫印迹法检测抗SSB抗体和抗SSA抗体,以日本希森美康XE-2100全自动仪检测血红蛋白(Hb)、白细胞(WBC)、血小板(PLT)、中性粒细胞百分比(NE%)、淋巴细胞百分比(LY%)。结果与ANA荧光、抗SSA抗体、抗SSB抗体均阴性对照组相比,ANA、抗SSA抗体、抗SSB抗体均阳性组中,血细胞分析参数Hb、WBC、PLT明显减少,差异有统计学意义(P<0.05),其中仅Hb减少53例占29.94%;仅WBC减少59例占33.33%;仅PLT减少24例占13.56%;Hb和WBC同时减少46例占10.50%;WBC和PLT同时减少12例占6.78%,Hb和PLT同时减少26例占14.59%;Hb、WBC、PLT三者同时减少12例占6.78%。结论血液系统自身抗体阳性患者的异常损伤造成的血细胞分析参数变化对临床自身免疫病的诊断治疗具有一定意义。     

肺癌患者血清VEGF与临床病理及PaO2和Hb关系的研究

摘 要 目的：探讨血清血管内皮生长因子（VEGF）在肺癌中的表达及与临床病理和PaO2及Hb的关系。方法：肺癌患者及健康对照组血清血管内皮生长因子采用双抗体夹心ABC-ELISA法测定。结果：肺癌组血清VEGF测定值高于正常对照组（P<0.001）。血清VEGF测定值与患者年龄、性别、病理分型、PaO2及Hb含量无关（P>0.05），与肿瘤直径及远处转移有关（P<0.01）。肿瘤直径与血清VEGF测定值呈正相关（P<0.001）。结论：血管内皮生长因子的检测对肺癌的诊断和判断有无远处转移具有一定的临床指导意义。     

维持性腹膜透析与血液透析患者血红蛋白变异性的对比研究

目的回顾性分析比较维持性腹膜透析(简称腹透)患者及血液透析(简称血透)患者血红蛋白(Hb)水平及血红蛋白变异性(Hb-Var)的差异,探讨影响Hb-Var的可能因素。方法选取成都市第三人民医院2011年1月至2013年4月终末期肾病进行维持性透析(包括血透及腹透)患者90例,观察9个月内患者的Hb、铁指标水平及重组人红细胞生成素(EPO)用量。进行Hb围绕目标值的分组及计算Hb余标准差(Res-SD)来表示Hb-Var,观察维持性腹透患者及血透患者Hb-Var,并分析9个月期间患者使用EPO剂量的变化以及透析前后C-反应蛋白(CRP)指标的变化,使用二分类Logstic回归分析方法分析Hb-Var与性别、年龄、透析方式、基线Hb、EPO剂量、EPO剂量波动、铁蛋白水平及血清白蛋白之间的关系。结果血透患者透析后CRP较透析前明显升高(P<0.001),而腹透前后的CRP无明显变化。同期比较血透组使用的EPO剂量明显高于腹透组。围绕Hb目标值两组分布结果相似,血透腹透均围绕目标值下限波动最多,两组无统计学差异(P>0.05),血透患者的Res-SD显著高于腹透患者(P=0.014),影响Hb-Var的相关因素有EPO剂量的波动和血透方式。结论血透患者较腹透患者的EPO使用量更大、血红蛋白变异性更为显著,EPO剂量的波动及透析方式是影响Hb-Var的独立危险因素。     

Bicarbonate hemodialysis of patients with acute renal failure and severe sepsis

During hemodialysis (HD), septic patients with acute renal failure (ARF) often exhibit severe hemodynamic instability, with a fall in BP that requires a large-volume infusion or even cessation of dialysis. To investigate the hypothesis that acetate transfer plays a role in the BP decrease, we compared acetate (Ac) and bicarbonate (Bi) HD in ten septic ARF patients. Patients were dialyzed daily for 4 h with a single-pass system and 1.1 m2 cuprophan dialyzers, alternately using Ac and Bi as the dialysate buffer. Heart rate and systemic arterial resistance did not change significantly during use of either buffer, and changes in pulmonary wedge pressure were similar. However, decreases in cardiac output and mean arterial pressure were more pronounced during Ac-HD than during Bi-HD. Rapid correction of metabolic acidosis and a larger decrease of plasma potassium concentration occurred during Bi-HD. These results suggest that Bi-HD was better tolerated than Ac-HD because of changes in myocardial contractility that may be related to different effects on acid-base status and plasma potassium concentrations.     

胆红素对血常规各项参数检测的影响论著

目的探讨胆红素对血常规各参数的影响。方法选择门诊生化检测胆红素异常患者(实验组)56例,检测血常规;另选同期健康志愿者(对照组)血常规结果 65例。比较分析两组白细胞计数(WBC)、血红蛋白(HGB)、血小板(PLT)等参数的变化。将实验组标本分别放置0.5 h,1 h,2 h、4 h检测血常规,进一步分析胆红素作用时间对血常规的影响。结果胆红素对血细胞计数的影响表现为:实验组WBC、HGB均明显高于对照组,差异有统计学意义(P<0.05,P<0.05),PLT计数明显下降,差异有统计学意义(P<0.05)。血细胞比容(HCT)、平均血红蛋白浓度(MCHC)、红细胞体积分布宽度(RDW)、血小板体积分布宽度(PDW)、血小板压积(PCT)、平均血小板体积(MPV)两组比较差异无统计学意义(P>0.05)。胆红素作用时间对血常规检测结果的影响各时间段无明显差异(P>0.05)。结论样本中胆红素异常增高会使血常规WBC、HGB假性增高,PLT计数假性减少,胆红素作用时间对血常规检测结果没有进一步的影响。