肝癌患者呼气中挥发性标志物的筛选与定量分析

目的 筛选肝癌患者呼气中的挥发性标志物,并评估它们用于临床肝癌诊断的可行性.方法 用Tedlar 采样袋收集30份肝癌患者呼气样品,收集27份肝硬化患者和36份健康人的样品作为对照,同时收集周围空气作为参照.经固相微萃取浓缩,用气相色谱/质谱检测呼气中的挥发性有机化合物(VOCs),筛选肝癌患者呼气中的挥发性标志物,标准曲线法定量,Mann-Whitney U检验进行组间比较,通过ROC曲线评估它们用于临床肝癌诊断的可行性.结果 筛选出3个组间存在明显差异的VOCs:3-羟基-2-丁酮、苯乙烯和癸烷,它们在肝癌患者呼气中的中位浓度均高于健康人或肝硬化患者.3-羟基-2-丁酮用于肝癌的诊断效果较好,在健康人与肝癌中,诊断肝癌的灵敏度与特异度可达到83.3%与91.7%;在肝硬化与肝癌人群中,诊断肝癌的灵敏度与特异度可达到70.0%与70.4%.肝癌患者中,AFP>400μg/L与AFP<400μg/L两组患者呼气中,这3种VOCs的浓度差异无显著性(P>0.05),在Ⅰ～Ⅱ期与Ⅲ～Ⅳ期肝癌患者呼气中,它们的浓度差异亦无显著性(P>0.05).结论 3-羟基-2-丁酮,苯乙烯和癸烷这3种VOCs可能作为肝癌患者呼气中的标志物,这些标志物与肝癌患者的AFP水平和临床分期无关联.     

卵巢癌患者呼气中挥发性标志物的筛查

目的应用固相微萃取联合气相色谱/质谱技术筛查卵巢癌患者呼气中挥发性标志物。方法收集40例卵巢癌患者呼气样本(卵巢癌组),49例健康女性呼气样本(对照组),同时收集周围空气作为参考。利用固相微萃取联用气相色谱/质普检测筛查卵巢癌患者呼气中的挥发性有机化合物。通过t检验分析卵巢癌患者呼气中的特异性挥发性标志物。结果筛选出苯乙烯和壬醛两种特异性挥发性标志物。卵巢癌组苯乙烯的浓度为(268.854±96.660)ng/L,壬醛的浓度为(388.631±122.660)ng/L。两种物质的浓度在卵巢癌组和对照组之间差异有统计学意义(P<0.05)。结论苯乙烯和壬醛可能是卵巢癌患者呼气中潜在挥发性标志物。     

正己烷接触工人的早期生物标志物含量变化

目的探讨正己烷接触工人的早期生物标志物。方法分别检测正己烷接触工人63名及对照组50名工人的尿2,5-己二酮、血清神经元特异烯醇化酶(NSE)及髓鞘碱性蛋白(MBP)水平。结果接触组工人尿2,5-己二酮含量为0.31～10.38mg/gCr,对照组未检出;接触组血清NSE和MBP含量分别为(9.02±3.87)μg/L和(1.47±0.41)μg/L,均显著高于对照组(P<0.05)。结论正己烷接触可导致血清NSE及MBP水平的升高,尿2,5-己二酮、血清NSE和MBP水平可作为正己烷接触的早期生物标志物。     

血管内皮细胞生长因子水平对肺癌预后的影响

目的探讨血管内皮细胞生长因子(VEGF)水平对肺癌预后的作用.方法采用ELISA方法对肺癌组(112例)、对照组(48例)、健康组(31例)的血清、尿液及恶性胸腔积液(46例)和结核性胸腔积液(31例)中VEGF水平进行检测,并对其进行分析.结果肺癌组血清VEGF含量[(506.22±365.06)μg/ml]明显高于对照组[(237.16±168.09)μg/ml]和健康组[(131.32±99.76)μg/ml](P＜0.001);血清VEGF的水平与病变侵袭程度、淋巴结转移、远处转移、生存时间密切相关;而与性别、组织学类型无关;恶性胸腔积液中VEGF含量[(937.23±400.92)μg/ml]明显高于结核性胸腔积液组[(257.41±361.47)μg/ml](P＜0.001);肺癌组尿液VEGF水平也明显增高[(167.40±186.89)μg/ml].结论血清VEGF检测可作为临床预测肺癌患者预后的重要指标之一.     

外周血CEA、CA19-9、CA72-4的表达水平与晚期胃癌化疗疗效及预后的关系

目的:探讨外周血癌胚抗原(CEA)及糖类相关抗原(CA19-9、CA72-4)的表达水平与晚期胃癌化疗疗效及预后的关系.方法:搜集在我院进行体检的30名人员、30例晓期胃癌患者、35例胃炎患者、40例其他癌肿疾病患者的资料.采用电化学发光法对这些患者以及晚期胃癌患者化疗前与化疗后3个月的血清标本进行3种标志物的检测.结果:晚期胃癌化疗前患者结果为CEA:(4.7±7.3)μg/L,CA72-4:(3.2±1.9)μg/ml,CA19-9:(11.3±7.4)μg/ml,和胃炎组、健康体检组、其他癌肿疾病组进行对比发现有不同程度的升高.对比晚期胃癌组化疗前与化疗后3个月3种肿瘤标志物的含量变化.化疗后明显降低.结论:CEA、CA19-9和CA72-4进行联合检测能够有效的辅助诊断晚期胃癌;观察晚期胃癌患者血清标志物的含量变化,可促进晚期胃癌的辅助诊断的精准性以及疗效评估有重要价值.     

乳腺癌患者呼气中挥发性标志物的筛选与定量分析

目的 探讨乳腺癌患者呼出气体中挥发性有机化合物成分在临床诊断中的价值.方法 用Tedlar袋收集36例正常人、27例乳腺腺病及33例乳腺癌术前患者的呼气样本,经固相微萃取浓缩后经气相色谱/质谱对呼气中的挥发性有机化合物(VOCs)进行检测,筛选出乳腺癌的挥发性标志物,以标准曲线法定量,并通过受试者工作曲线(ROC)评估它们用于乳腺癌诊断的价值.结果 在乳腺癌患者呼气标本中筛选出两种挥发性标志物,分别为苯乙酮和十六烷.在健康人与乳腺癌患者中,苯乙酮和十六烷浓度差异均有统计学意义(P<0.05),苯乙酮用于乳腺癌的诊断敏感性和特异性分别为97.0%和50.0%,十六烷为75.8%和61.1%;在乳腺腺病和乳腺癌患者中,两种VOCs差异无统计学意义(P>0.05);在乳腺腺病患者和健康人中,苯乙酮浓度差异有统计学意义(P<0.05),十六烷浓度差异无统计学意义(P>0.05).结论 苯乙酮和十六烷可能作为乳腺癌患者呼气中的标志物,两者都不能正确区分乳腺癌和乳腺腺病,但苯乙酮可能对鉴别健康人与乳腺腺病有帮助.     

高效液相色谱法测定草酸钙结石大鼠尿中草酸含量

目的建立高效液相色谱法(HPLC)检测大鼠尿液中草酸含量。方法将SPF级雄性健康Wistar大鼠24只采用随机数字表法分为空白对照组(n=12)和乙二醇组(n=12)。空白对照组给予去离子水喂养,每天以1 ml生理盐水灌胃;乙二醇组给予1%乙二醇自由饮水喂养,每天2%氯化铵2 ml灌胃。造模28 d后收集两组大鼠24 h尿液,采用HPLC法测定尿中草酸含量,并与铬酸钾氧化甲基红催化光度法的结果进行比较。HPLC法采用色谱柱Aglient 5TC-C18(250×4.6 mm,5μm),以甲醇(0.1 mol/L)、醋酸铵水溶液(15∶85)为流动相,流速为1.2 ml/min,紫外检测波长为314 nm,柱温20℃。结果大鼠尿液中高、低浓度草酸标准曲线分别为y=5909.1x+378730,R2=0.9984和y=7810.5x-16635,R2=0.9967;最低检测浓度为5μg/ml,大鼠尿液中草酸高浓度线性范围为62.50~2000.00μg/ml,低浓度线性范围为6.25~100.00μg/ml。平均回收率为95.1%,日内及日间精密度分别为3.4%~10.8%和3.8%~9.4%。HPLC法和铬酸钾氧化甲基红催化光度法均显示乙二醇组大鼠尿草酸浓度和24 h尿草酸含量显著高于空白对照组[尿草酸浓度:(736.35±254.52)μg/ml比(51.56±36.34)μg/ml,(687.35±234.53)μg/ml比(50.24±42.34)μg/ml;24 h尿草酸含量:(11.23±4.12)mg比(0.87±0.45)mg,(9.89±3.55)mg比(0.77±0.65)mg;P均<0.01];两种方法检测出的尿草酸浓度和24 h尿草酸含量差异无统计学意义(P均>0.05)。结论 HPLC法简单快速、回收率高、精密度好,与铬酸钾氧化甲基红催化光度法检测结果一致,适用于大鼠尿中草酸含量的测定。     

尿液脱落细胞膜N-乙酰基神经氨酸/蛋白检测临床意义初探

目的:探讨检测尿液脱落细胞膜N-乙酰基神经氨酸/蛋白水平作为临床辅助诊断膀胱肿瘤及监控肿瘤复发的临床应用价值。方法:采用快速高效液相色谱-荧光法检测临床患者尿液中脱落细胞N-乙酰基神经氨酸/蛋白水平,确诊为膀胱肿瘤术前组22例;术后组20例;泌尿系结石组20例;健康对照组30例。数据以x±s表示,采用t检验进行比较。结果:以N-乙酰基神经氨酸/蛋白浓度超过0.02μg/μg为阳性,膀胱肿瘤术前组(0.123 4±0.119 9)μg/μg显著高于正常对照组(0.008 4±0.007 8)μg/μg(P<0.01),临床诊断阳性率为81.82%,膀胱肿瘤术前组与术后组(0.015 5±0.010 6)μg/μg比较,术前组显著高于术后组(P<0.01),术后组与正常对照组比较则差异无统计学意义(P>0.05)。结论:检测尿液脱落细胞膜N-乙酰基神经氨酸/蛋白水平可为膀胱肿瘤早期辅助诊断及肿瘤复发监控提供重要的参考指标。     

血清葡萄糖6-磷酸异构酶在类风湿关节炎诊断中的意义

目的 探讨葡萄糖6-磷酸异构酶(gheose-6-phosphate isomerase,GPI)在类风湿关节炎(rheumatoid arthritis,RA)诊断中的意义.方法 用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)双抗体夹心法检测108例RA患者、42例系统性红斑狼疮(systemic lupus erythematosus,SLE)患者、50例其他风湿病患者及112例健康体检者血清GPI浓度,RA患者同时检测了抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide antibody,anti-CCP)、类风湿因子(rheuma-toid factor,RF).结果 GPI浓度:RA患者为(1.840±2.821)μg/ml, SLE患者为(0.143±0.426)μg/ml,其他风湿病患者为(0.074±0.279)μg/ml,健康体检者为(0.092±0.232)μg/ml.RA患者血清中GPI浓度显著高于SLE、其他风湿病患者和健康体检者(P＜0.01).Spearman等级相关分析显示RA患者GPI浓度与类风湿因子(RF)浓度呈显著正相关(r=0.622,P＜0.01),与其他检测指标无相关性.结论 GPI浓度大于0.209μg/ml时对RA的诊断有较高的特异性, 其特异性可达93.7%,敏感性为56.5%.表明GPI的变化在RA诊断有较重要的意义.     

血栓相关凝血标志物在诊断深静脉血栓患者中的应用

目的评估凝血标志物凝血酶-抗凝血酶复合物(TAT)、凝血酶调制蛋白(TM)、纤溶酶-抗纤溶酶复合物(PIC)、组织型纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(t PAI-C)、D二聚体(D-D)、纤维蛋白降解产物(FDP)在深静脉血栓患者中的应用。方法利用仁济医院收集的深静脉血栓(DVT)患者样本66例,32例为慢性期DVT,34例为急性期DVT检测凝血标志物。使用SYSMEX CS5100血凝分析仪测定D-D和FDP,使用SYSMEX HISCL5000化学发光免疫分析仪测定TAT、TM、PIC、t PAI-C,均为配套试剂。同时选取40例健康体检样本作为正常对照。数据用SPSS11.0软件分析。结果慢性期DVT患者,D-D、FDP、TAT、TM、PIC、t PAI-C均值分别为(0.079±0.093)μg/ml、(1.60±2.41)μg/ml、(3.36±3.73) ng/ml、(9.89±2.13) TU/ml、(1.008±1.096) ug/ml、(9.83±3.84) ng/ml;急性期DVT患者,D-D、FDP、TAT、TM、PIC、t PAI-C均值分别为(2.47±2.80)μg/ml、(32.6±42.11)μg/ml、(17.64±18.35) ng/ml、(9.74±3.01) TU/ml、(5.658±6.974) ug/ml、(11.58±6.52) ng/ml;正常对照组,D-D、FDP、TAT、TM、PIC、t PAI-C均值分别为(0.073±0.088)μg/ml、(1.62±2.49)μg/ml、(2.60±1.13) ng/ml、(8.08±1.49) TU/ml、(0.459±0.105) ug/ml、(5.59±2.25) ng/ml。组间比较显示,急性和慢性期DVT间有统计学差异(P 0.05水平)的指标为D-D、FDP、TAT、PIC。正常组和急性期DVT间有统计学差异(P 0.05水平)的指标为D-D、FDP、TAT、TM、PIC、t PAI-C;正常组和慢性期DVT间有统计学差异(P 0.05水平)的指标为TM、t PAI-C。结论对于诊断急性DVT来说,D-D、FDP、TAT、TM、PIC、t PAI-C这6项指标均有良好的诊断价值;慢性DVT患者相对于正常人群而言,TM、t PAI-C表现增高,说明血栓后血管修复是一个漫长持续的过程,而对于急性期DVT而言,D-D、FDP、TAT、PIC下降明显,对于DVT的诊断和治疗有良好的指导意义。     

Determination of drug concentration in aqueous humor of cataract patients administered gatifloxacin ophthalmic gel

Background Ophthalmic gel has been developed to increase the drug concentration in aqueous humor and to retard the loss of drug from the conjunctival sac.The research was to compare the drug concentration in aqueous humor of cataract patients administered 0.3% gatifloxacin ophthalmic gel with that in patients administered 0.3% gatifloxacin ophthalmic solution.Methods Ninety-six patients with cataract （96 eyes） were randomly assigned to 8 groups.The patients in groups 1-4received topical gatifloxacin 0.3% ophthalmic gel and those in groups 5-8 received gatifloxacin 0.3% ophthalmic solution.The dose regimen was 1 drop, 4 times a day for 3 consecutive days prior to cataract surgery.On the day of surgery, 1drop was applied at 15, 30, 60 or 120 minutes before commencement of cataract surgery in groups 1 and 5, groups 2 and 6, goups 3 and 7, and groups 4 and 8, respectively.Aqueous humor was extracted during the cataract surgery for the analysis of gatifloxacin concentration..Results The concentrations of gatifloxacin in aqueous humor were （0.24±0.25） μg/ml, （1.11±0.74） μg/ml, （2.32±2.01）μg/ml and （1.85±1.14） μg/ml in groups 1 to 4, and （0.16±0.25） μg/ml, （0.31±0.24） μg/ml, （0.75±0.28） μg/ml and （0.33±0.22） μg/ml in groups 5 to 8, respectively.Patients receiving gatifloxacin ophthalmic gel showed greater mean values of gatifloxacin concentration in aqueous humor than those receiving gatifloxacin solution, and such differences were significant with P 〈0.05 for all comparisons except that between groups 1 and 5.Conclusion Topical gatifloxacin ophthalmic gel can attain significantly greater drug concentrations in human aqueous humor than gatifloxacin ophthalmic solution.     

Relationship between depth of anesthesia and effect-site concentration of propofol during induction with the target-controlled infusion technique in elderly patients

Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （r=-0.580, P 〈0.01）. Systolic blood pressure （SBP） before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with （1.9±0.3） pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with （2.8±0.3） pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.     

胃癌患者呼气中挥发性标志物的筛选分析

目的应用固相微萃取-气相色谱/质谱技术筛选胃癌患者呼气中挥发性标记物。方法用Tedlar采样袋收集37例胃癌患者呼气样本,32例正常人的呼气标本作为对照,同时收集周围空气作为参照。经固相微萃取浓缩,通过气相色谱/质谱检测呼气中的挥发性有机化合物,通过Wilcoxon非参数检验筛选胃癌患者呼气中的特征性挥发性标志物。结果在胃癌呼气标本中筛选出丙烯腈和甲基环己烷两种挥发性标志物。丙烯腈的浓度范围为14.72～594.29 ng/L,甲基环己烷的浓度范围为9.20～970.89 ng/L。比较胃癌患者和正常对照呼气中两种物质浓度,差异均有统计学意义(P<0.05)。结论丙烯腈和甲基环己烷可作为胃癌潜在的挥发性标志物辅助胃癌诊断。     

Effects of activated protein C on coagulation and fibrinolysis in rabbits with endotoxin induced acute lung injury

Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI. Methods Twenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups （n=7 in each group）. After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coil endotoxin 100 μg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC （25 μg·kg^-1·h^-1） was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer＇s lactate solution. Results In comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level （TM; control group was （0.68±0.06） ng/ml, vs APC group of （0.62±0.07） ng/ml at 6 hours, P 〈0.05）, and significantly attenuated the fall in protein S （PS; control group was （2.32±0.03） μg/ml at 2 hours, （2.24±0.06） μg/ml at 4 hours and （2.21±0.09）μg/ml at 6 hours, vs APC group （2.46±0.04） μg/ml at 2 hours, （2.40±0.05） μg/ml at 4 hours and （2.39±0.07） μg/ml at 6 hours, P 〈0.01）. In addition, APC limited the increase in plasminogen activator inhibitor-1 （PAI-1） both in plasma （control group was （0.68±0.12） ng/ml at 1 hour, （0.84±0.06） ng/ml at 2 hours, （0.87±0.08） ng/ml at 4 hours and （0.91±0.05） ng/ml at 6 hours, vs APC group （0.42±0.16） ng/ml at 1 hour, （0.43±0.04） ng/ml at 2 hours, （0.45±0.09） ng/ml at 4 hours and （0.45±0.14） ng/ml at 6 hours, P 〈0.01） and in bronchoalveolar lavage fluid （at 6 hour     

临床控制的哮喘患者小气道功能和诱导痰炎性标志物测定的临床意义

目的 检测临床控制的哮喘患者小气道功能和诱导痰嗜酸细胞（Eos）、嗜酸细胞阳离子蛋白（ECP）和IL-5水平,探讨其临床意义.方法 对62例临床控制的哮喘患者做肺功能测定,并分别采用瑞氏染色、荧光免疫法和ELISA检测诱导痰Eos数量、ECP和IL-5水平.选择30例急性发作期哮喘患者和20例健康者作为对照组.结果 62例临床控制哮喘患者中,小气道功能异常43例（69.4%）,正常19例（30.6%）,诱导痰Eos数量（5.6±2.9）%、ECP（129±100）μg/L、IL-5（21±12）μg/L,显著低于急性发作期哮喘组（P＜0.01）,但显著高于健康对照组（P＜0.01）.小气道功能异常哮喘患者诱导痰Eos数量（6.9±3.1）%、ECP（148±90）μg/L、IL-5（24±12）μg/L,显著高于小气道功能正常患者[痰Eos（2.0 ±1.1）%,ECP（54 ±29）μg/L、IL-5（13 ±5）μg/L,P＜0.01].结论 临床控制的哮喘患者小气道功能异常和气道炎症持续存在,测定患者小气道功能和诱导痰炎性标志物有助于指导哮喘治疗.     

血清基质金属蛋白酶3水平与早期类风湿关节炎病情评估

目的: 研究血清基质金属蛋白酶3(matrix metalloproteinase 3,MMP3)在C-反应蛋白(C-reaction protein,CRP)和/或红细胞沉降率(erythrocyte sedimentation rate,ESR)正常的早期类风湿关节炎(early rheumatoid arthritis,ERA)患者中的表达及在病情评估中的意义。方法: 选择北京大学人民医院2011年至2015年确诊的早期RA患者133例,骨关节炎(osteoarthritis,OA)患者25例,健康对照组60例,其中早期RA患者根据CRP、ESR水平分为4组,CRP升高ESR升高组88例,CRP正常ESR正常组15例,CRP正常ESR升高组17例,CRP升高ESR正常组13例,回顾患者临床资料,并采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)法测定患者及健康对照血清中MMP3水平。结果: CRP正常和/或 ESR正常患者血清MMP3水平[(72.89±6.34) μg/L]明显高于OA组MMP3[(42.87±4.14) μg/L](P=0.002)和健康对照组MMP3水平[(31.62±2.88) μg/L](P<0.001), 其中,CRP正常ESR正常患者血清MMP3水平[(47.04±9.64) μg/L]高于健康对照组,差异具有统计学意义(P<0.05), CRP升高ESR正常患者血清MMP3水平[(94.18±9.11) μg/L]和CRP正常ESR升高患者血清MMP3水平[(79.42±10.60) μg/L]均高于OA组和健康对照组,差异有统计学意义(P<0.05)。在CRP正常和/或ESR正常的早期RA患者中,血清MMP3水平与CRP水平呈正相关(r=0.336,P=0.024)。CRP正常和/或 ESR正常患者MMP3阳性率为44.44%,高于CRP阳性率(28.89%)和ESR阳性率(37.78%), 其中CRP正常ESR升高组阳性率52.94%,CRP升高ESR正常组阳性率53.85%。结论: 血清MMP3水平的测定对于CRP和/或ESR正常的病程小于2年的早期类风湿关节炎患者具有辅助评估价值。     

结核性胸膜炎患者异烟肼胸腔积液浓度测定及胸膜透过性

目的采用高效液相色谱法(HPLC)测量结核性胸膜炎患者胸腔积液和血浆中异烟肼浓度,并评价异烟肼从血液经胸膜的透过性。方法收集15名结核性胸膜炎患者第1天晨服300 mg异烟肼后2 h的胸腔积液,并采集第3天服药后2 h的血样和胸腔积液,建立HPLC方法进行样品检测,并计算异烟肼的胸膜透过率。结果第1天异烟肼在胸腔积液中的平均浓度是(1.156±1.190)μg/ml;第3天异烟肼在胸腔积液中的平均浓度是(1.920±1.294)μg/ml,在血浆中的平均浓度是(2.445±1.463)μg/ml;异烟肼从血浆进入胸腔积液的平均透过率是86.0%。结论大多数初治患者异烟肼的胸腔积液透过性较高,连续口服异烟肼可以达到有效治疗浓度,对于非耐药结核性胸膜炎不需要胸腔内单独注射异烟肼。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

血友病患者抗凝物质及纤溶抑制物质的改变及其在血友病出血机制中的意义

目的探讨抗凝物质及纤溶抑制物质在血友病中的改变及其在血友病出血机制中的作用。方法分别对近期未治疗的血友病患者65例(A型54例,B型11例),58例(A型48例,B型10例)及20例(A型15例,B型5例)以ELISA法检测组织因子途径抑制物(TFPI)、蛋白C(PC)、游离蛋白S(FPS),以速率散射比浊法检测抗凝血酶(AT)以及以生色法检测凝血酶激活的纤溶抑制物活性(TAFIa)。其中TFPI、PC、FPS、AT正常健康对照20例,TAFIa正常健康对照组15例。采用SPSS统计软件包进行统计学分析,结果采用t检验。以实验结果为依据对血友病出血机制中抗凝物质及纤溶抑制物质的作用进行探讨。结果血友病患者与正常健康对照血浆抗凝物质及纤溶抑制物质TFPI、PC、FPS、AT及TAFIa值分别为:TFPI96.90±24.06ng/mlvs85.17±12.62ng/ml,P0.05;PC5.02±1.37μg/mlvs5.34±0.86μg/ml,P0.05;FPS8.99±3.44μg/mlvs9.17±2.32μg/ml,P0.05;AT308.27±64.68μg/mlvs236.85±21.73μg/ml,P0.05;TAFIa86.00±15.67%vs107.00±9.63%,P0.001。结果显示血友病患者血浆TFPI、AT水平明显高于正常对照,P0.05;血浆TAFIa水平明显低于正常对照,P0.001。结论导致血友病出血的凝血酶生成障碍不仅由于FⅧ或FⅨ缺乏,而且与血浆TFPI及AT水平升高,凝血酶生成负调节增强密切相关。提示以抑制TFPI或AT为靶点,有可能为制止血友病出血开辟新途径。血友病患者血浆TAFIa水平降低,下调纤溶机制减弱导致血友病纤溶活性增强,表明抗纤溶措施是血友病治疗的重要环节。     

重组海葵溶细胞素及平颏海蛇磷脂酶A2对血管外膜成纤维细胞增殖的影响

目的 观察重组海葵溶细胞素(rSrc)及平颏海蛇磷脂酶A₂(rPLA₂)对成纤维细胞增殖的影响。方法 体外培养成纤维细胞,应用不同浓度的rSrc和rPLA₂分别进行作用并设立对照进行比较,采用非放射性的MTS/PES法确定成纤维细胞的增殖状态。结果 各组细胞增殖率分别为:对照组0.840±0.061、rSrc 100 μg/ml组0.263±0.044、rSrc 10 μg/ml组0.418±0.054、rSrc 1 μg/ml组0.605±0.063、rSrc 100 ng/ml组0.772±0.054、rSrc 10 ng/ml组0.906±0.072、rPLA₂ 100 μg/ml组0.498±0.076、rPLA₂ 10 μg/ml组0.937±0.112、rPLA₂ 1 μg/ml组0.978±0.145。统计分析显示,低至1 μg/ml的rSrc仍能明显抑制大鼠成纤维细胞的增殖(P<0.01),并呈现剂量依赖性(P<0.05)。rPLA₂ 100 μg/ml组与对照组相比细胞增殖率有显著差异(P<0.05);rPLA₂ 10 μg/ml和rPLA₂ 1 μg/ml组与对照组相比均无显著差异(P>0.05)。结论 rSrc和rPLA₂分别对血管外膜成纤维细胞增殖有一定的抑制作用。