HBV携带产妇血清与乳汁中HBV-DNA相关性分析

目的分析HBV携带产妇血清与乳汁中HBV-DNA的相关性,为安全母乳喂养提供科学依据。方法收集我院2013年至2015年共68例HBV携带产妇的血清及乳汁,采用实时荧光定量PCR(FQ-PCR)方法分别检测其HBV-DNA载量,并按产妇血清HBV载量分为四组。比较产妇血清HBV-DNA与乳汁HBV-DNA阳性率以及各组间乳汁的阳性率,分析血清HBV-DNA载量与乳汁HBV-DNA载量的相关性。结果 68例HBV携带产妇血清HBV-DNA阳性率为63.2%(43/68),乳汁HBV-DNA阳性率为29.4%(20/68),两者比较差异有统计学意义(χ~2=14.309,P0.05);HBV携带产妇血清HBV-DNA载量在500IU/ml、500~10~4IU/ml、10~5~10~6IU/ml、107~108IU/ml区间时,对应乳汁中HBV-DNA检出率分别为0%(0/25)、11.1%(2/18)、63.6%(7/11)、78.6%(11/14),各组间阳性率比较差异具有统计学意义(χ~2=40.756,P0.05);当HBV携带产妇血清和乳汁中HBVDNA同时阳性时,乳汁中HBV-DNA的载量随血清HBV-DNA载量增高而增高,二者中度相关(r=0.574)。结论 HBV携带产妇随着血清HBV-DNA载量的升高,产妇乳汁中HBV-DNA检出率以及HBV-DNA载量有增高趋势,HBV携带产妇在进行母乳喂养时应结合血清HBV-DNA和乳汁HBV-DNA来正确指导母乳喂养。     

不同HBV感染模式产妇乳汁中HBV-DNA载量及肝功能分析

目的研究乙型肝炎阳性产妇感染模式,以及血清中乙型肝炎病毒(HBV)-DNA载量与乳汁中HBV-DNA载量的关系,乳汁中HBV-DNA载量与产妇肝功能的关系,评价母乳喂养的安全性。方法对267例HBV携带产妇,用酶联免疫吸附试验(ELISA)法检测乙型肝炎表面抗原(HBsAg)和乙型肝炎e抗原(HBeAg),用荧光定量PCR技术检测血清中和乳汁中HBVDNA载量,采用速率法检测丙氨酸氨基转移酶(ALT)。结果 109例HBsAg和HBeAg双阳性的产妇,其乳汁HBV-DNA阳性率为76.1%,158例HBsAg阳性而HBeAg阴性产妇乳汁HBV-DNA阳性率为3.2%,差异有统计学意义(P0.05)。观察产妇其血清中携带不同载量的HBV-DNA,分别为HBV-DNA500、500~1.0×10~5、1.0×10~5 copies/mL 3组,其两两比较乳汁中HBV-DNA载量差异有统计学意义(P0.05),且血清中HBV-DNA载量与乳汁中HBV-DNA载量呈正相关关系;乳汁中HBVDNA阳性与乳汁中HBV-DNA阴性产妇血清ALT进行比较,差异有统计学意义(P0.05)。结论 HBsAg和HBeAg双阳性和血清中HBV-DNA1.0×10~5 copies/mL的产妇不宜母乳喂养,同时乳汁中HBV-DNA载量较高的产妇应同时密切监测肝功能,以防发生肝损伤。     

乙型肝炎产妇血清与乳汁HBV标志物检测意义

目的调查乙型肝炎(下称乙肝)病毒携带产妇血清乙肝病毒DNA(HBV-DNA)含量、乙肝血清免疫学指标与乳汁中HBV-DNA含量及阳性率的关系,以指导母乳喂养。方法选择血清乙肝表面抗原(HBsAg)为阳性的乙肝携带者的产妇116例,采用酶联免疫吸附试验(ELISA)检测血清及乳汁中免疫血清学标志物;荧光定量聚合酶链反应(FQ-PCR)技术测定血清与乳汁与中HBV-DNA含量,并对所有检测指标进行相关性分析。结果在ELISA检测中HBsAg乳汁中阳性率为62.1%,低于血清结果差异有统计学意义(P0.01);其他免疫学标志物乙肝e抗原(HBeAg)、乙肝病毒表面抗体(HBsAb)、乙肝病毒e抗体(HBeAb)、前S1抗原差异无统计学意义(P0.05)。HBV-DNA检测结果中HBeAg阳性组血清HBV-DNA阳性率97.6%,乳汁HBV-DNA阳性率85.7%,二者差异无统计学意义(P0.05);HBeAb阳性组血清HBV-DNA阳性率12.1%,乳汁HBV-DNA检2例,阳性率2.7%,二者差异有统计学意义(P0.05)。乳汁HBV-DNA的含量随血清HBV-DNA含量的升高而增大,二者呈正相关(r=0.864,P0.05)。结论乙肝产妇免疫学标志物不只是能决定进行母乳喂养的指标,同时还应检测血清HBV-DNA与乳汁HBV-DNA,两者均为阴性才能进行哺乳。     

不同稀释液在乙型肝炎病毒DNA稀释检测中的应用研究

目的分析和评价使用不同稀释液对高载量标本进行乙型肝炎病毒(HBV)-DNA稀释检测的结果,评估临床常用稀释液在高载量标本HBV-DNA稀释检测中的应用价值。方法收集初次检测HBV-DNA载量超出线性范围的标本30份,比较使用阴性质控品、阴性血清、生理盐水、蒸馏水作为稀释液进行稀释检测结果的差异。结果高载量标本进行稀释检测时,使用阴性血清、生理盐水、蒸馏水进行稀释,其检测结果与使用阴性质控品作为稀释液时的结果比较,差异无统计学意义(F=1.198,P=0.314);偏差均在允许总误差范围内,但偏差之间的差异有统计学意义(F=16.945,P0.05)。使用蒸馏水作为稀释液时偏差最小,且该结果与使用阴性质控品进行稀释检测的结果呈良好的线性关系,回归方程为Y=0.970 X+0.255(Y=阴性质控品稀释检测结果,X=蒸馏水稀释检测结果),R~2=0.959。结论当试剂盒自带阴性质控品不能满足高载量标本HBV-DNA稀释检测需要时,使用蒸馏水作为稀释液进行稀释检测能取得较满意的结果。     

慢性乙型肝炎患者血清中HBeAg、HBsAg与HBV-DNA的关系

目的探讨慢性乙型肝炎患者血清中HBeAg、HBsAg与乙肝病毒HBV-DNA之间的关系。方法选取655例HBsAg阳性的慢性乙型肝炎患者血清标本,用微粒子酶免疫分析法(MEIA)检测HBeAg、HBsAg,用荧光定量聚合酶链反应(FQ-PCR)检测HBV-DNA。结果在HBeAg阳性标本中,HBV-DNA阳性率为64.64%;HBeAg阴性标本中,HBV-DNA阳性率为36.61%,二者差异有统计学意义(P0.01)。不同浓度组HBeAg和HBV-DNA检测结果比较,差异有统计学意义(P0.01)。不同载量HBV-DNA组,HBeAg差异有统计学意义(P0.01),且随HBV-DNA含量增加而增加;HBsAg差异也有统计学意义(P0.01),但随HBV-DNA含量增加而降低。结论同时检测HBV-DNA与HBeAg能更好地用于临床诊断与疗效观察,HBeAg随着HBV-DNA拷贝数的增加而增加,而HBsAg却呈下降趋势。     

乙型肝炎“大三阳”与“小三阳”患者血清中HBV-DNA定量、肝功能检测结果分析

目的分析乙型肝炎(乙肝)"大三阳"与"小三阳"患者血清中的HBV-DNA定量与肝功能指标。方法选取325例乙肝患者作为研究对象,根据生化指标和血清学指标检测结果分为两组:小三阳组(210例)、大三阳组(115例),对两组患者的血清HBV-DNA定量、肝功能指标检测结果进行分析。结果大三阳组的HBV-DNA、AST、ALT水平均明显高于小三阳组,差异有统计学意义(P0.05);大三阳组各年龄段的ALT、AST水平均明显高于小三阳组(P0.05);大三阳组的ALT、AST水平均随年龄的升高而显著升高,随着HBV-DNA载量的增加,两组患者的ALT、AST水平均逐渐升高,但相同的HBV-DNA载量下,两组患者的ALT、AST水平比较差异无统计学意义(P0.05)。大三阳组的HBV-DNA阳性率为90.43%,明显高于小三阳组的35.24%,差异有统计学意义(P0.05)。结论乙型肝炎"大三阳"患者的血清HBV-DNA载量、肝功能损伤程度比"小三阳"明显增高。     

乙型肝炎病毒外膜大蛋白的检测及其临床意义

目的探讨乙型肝炎病毒外膜大蛋白(HBV-LP)与乙型肝炎病毒脱氧核糖核酸(HBV-DNA)的相关性,及其检测对诊断乙型肝炎病毒复制的临床意义。方法采用酶联免疫吸附试验(ELISA)和实时荧光定量聚合酶链反应(FQ-PCR)技术对180例HBsAg阳性血清标本进行HBV-LP和HBV-DNA的平行检测。结果在乙型肝炎病毒感染者血清中,HBV LP含量与HBV-DNA拷贝数间具有良好的正相关性(r=0.85,P0.001);不同HBV-DNA拷贝数组别间HBV-LP含量差异具有统计学意义(P0.01);在180例HBeAg阳性标本中,HBV-DNA阳性率为79.4%,HBV-LP的阳性率为83.9%,二者差异无统计学意义(P0.05);在90例HBeAg阳性标本中,HBV-DNA、HBV-LP阳性率分别为94.4%(85/90)、95.6%(86/90),二者差异无统计学意义(P0.05);在90例HBeAg阴性标本中,HBV-DNA与HBV-LP的阳性检出率分别为41.1%(37/90)、77.8%(70/90),差异具有统计学意义(P0.01)。结论 HBV-LP是判断乙型肝炎病毒感染者体内病毒复制程度的可靠指标,尤其是HBeAg阴性患者体内病毒复制及预后判断良好的血清学检测指标。     

慢性乙肝患者HBeAg和HBV-DNA载量与ALT水平相关性探讨

目的探讨慢性乙肝患者血清中乙型肝炎e抗原(HBeAg)和乙型肝炎病毒DNA(HBV-DNA)载量与丙氨酸氨基转移酶(ALT)水平之间的关系,为临床诊治提供参考。方法收集380例慢性乙肝患者标本采用ELISA法进行HBeAg检测,血清HBV-DNA定量采用实时荧光定量PCR法,ALT采用全自动生化法。结果Ⅰ组与Ⅱ组HBeAg阳性率差异无统计学意义(P=0.052)。Ⅰ、Ⅱ组分别与Ⅲ组比较,HBeAg阳性率差异均有统计学意义(P<0.01)。HBV-DNA载量与ALT水平存在一定的关联(P=0.000),等级相关系数为0.398。结论慢性乙肝患者不能单靠某项检验指标来判断是否进行抗病毒治疗,在决定是否需抗病毒治疗时,需联合、动态检测这些指标。     

乙型病毒性肝炎5项检测结果与HBV-DNA的关系及临床意义

目的通过对乙型病毒性肝炎(以下简称乙肝)5项检测结果的不同模式与乙型肝炎病毒(HBV)-DNA定量检测的比较分析,探索两者之间的关系及临床意义,为临床早期诊断乙肝提供依据。方法采用酶联免疫吸附法(ELISA)和荧光定量聚合酶链反应法(FQ-PCR),将本院744例乙肝患者血液标本按不同的乙肝5项检测结果分为Ⅰ~Ⅶ7组,并对各组间的HBVDNA结果进行比较分析;同时对744例标本中HBeAg阳性患者的HBV-DNA与HBeAg阴性患者的HBV-DNA检测结果进行比较。结果Ⅰ组HBV-DNA阳性率明显高于Ⅱ、Ⅲ、Ⅳ组,比较差异均有统计学意义(χ2=104.769、103.056、4.047,P<0.05);其余各组结果比较差异无统计学意义(P>0.05);HBeAg阳性标本中HBV-DNA阳性率为78.5%(128/158),明显高于HBeAg阴性标本的HBV-DNA阳性率25.8%(151/586),比较差异有统计学意义(χ2=148.409,P<0.05)。结论同时进行乙肝5项与HBV-DNA定量检测对临床判断乙肝的感染、复制及传染性具有重要意义。     

HBV-DNA定量与HBV模式及肝功能损害指标定量的相关性探讨

目的探讨HBV-DNA定量与不同的HBV模式及肝功能损害指标定量的相关关系。方法收集治疗的235例乙肝阳性患者的血清标本,采用ELISA方法检测HBV标志物及肝功测定。结果 HBV-DNA定量测定显示HBcAg+HBcAb组与小三阳组显著低于大三阳组(P均0.05),前两者之间差异无统计学意义(P0.05);HBV-DNA定量在各年龄之间的差异均无统计学意义(P均0.05),各性别间差异无统计学意义(P0.05),HBsAg、HBcAg、HBeAg与HBV-DNA呈正相关;HBV-DNA与肝功损害指标PT、AST、ALB、ALT、PAB、TBIL等有一定的相关性。结论 HBV-DNA定量测定结果与HBV模式存在一定的相关性,而HBcAg、HBeAg、HBsAg是乙肝病毒标志物,与其相应的抗体作用,是判断肝功损害的指标之一,HBV-DNA与肝功损害指标有一定相关性,但与年龄、性别无关,针对乙肝患者,应全面检测肝功损害指标以达到诊断和治疗的效用。     

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.     

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.     

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.     

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.