梅毒螺旋体检测方法的临床评价

目的 探讨三种血清梅毒螺旋体检测方法的应用价值.方法 应用快速血浆反应素试验(RPR)、酶联免疫吸附试验(ELISA)、梅毒螺旋体明胶凝集试验(TPPA)分别检测602份标本,其中61例确诊为梅毒感染.荧光定量PCR(FQ-PCR)方法对RPR阳性标本进行检测.结果 ELISA法与TPPA法检测结果之间无显著性差异(P＞0.05),二者敏感性和特异性分别为95.1%、97.8%和91.8%、96.9%;RPR与ELISA法、TPPA法之间有显著性差异(P＜0.05);FQ-PCR法检测结果均为阴性.结论 ELISA法和TPPA法是较好的血清梅毒螺旋体的检测方法.FQ-PCR法检测的阳性率低.     

梅毒螺旋体抗体酶联免疫吸附试验和快速血浆反应素环状卡片试验对梅毒螺旋体检测结果比较

目的比较梅毒螺旋体抗体酶联免疫吸附（TP—ELISA）法和快速血浆反应素环状卡片试验（RPR）对血清梅毒螺旋体检测的准确性及特异性。方法分别使用TP—ELISA法和RPR试验对5135例住院患者进行梅毒抗体筛查试验,并对检测结果进行比较分析。结果5135例患者中RPR检测阳性45例（0．88％）;ELISA法检测阳性62例（1．21％）。62例ELISA阳性标本经TPPA确认60例阳性,相符率96．8％;45例RPR检测阳性标本经梅毒螺旋体明胶颗粒凝集试验（TPPA）确认36例阳性,相符率80．0％,假阳性率20．0％;RPR法漏检率20．0％。ELISA检测法敏感性及特异性均高于RPR检测法（P〈0．05）,与TPPA法接近。结论ELISA法检测梅毒螺旋体灵敏度和特异性均优于RPR检测法,结果客观可靠,便于保存,且检测费用相对较低,可作为目前临床检测梅毒螺旋体疑似标本和筛选献血员的首选方法。     

四法筛查手术前或输血前病人梅毒螺旋体抗体的比较

目的　探讨TP ELISA、RPR、胶体金试纸和TPPA等四种方法在筛查手术前或输血前病人梅毒螺旋体抗体中的实用性和可行性。方法　用TP -ELISA、RPR、胶体金试纸和TPPA分别检测 5 0份阳性标本及 5 0份阴性标本。结果　RPR与TPPA阳性符合率为 82 % ,假阴性率为 18% ,假阳性率为 4% ;胶体金试纸与TPPA阳性符合率为 90 % ,假阴性率为 10 % ,阴性符合率10 0 % ;TP ELISA与TPPA阳性符合率为 10 0 % ,阴性符合率为 10 0 %。结论　TP ELISA是目前较为合适的筛查手术前或输血前病人梅毒螺旋体抗体的方法。     

四种梅毒血清学检验方法的比较

目的了解梅毒快速血浆反应素试验(RPR)、梅毒甲苯胺红不加热血清试验(TRUST)、酶联免疫吸附试验(ELISA)和梅毒螺旋体抗体被动颗粒凝集试验(TPPA)的敏感性和特异性.方法采用RPR、TRUST、ELISA和TPPA同时对202份梅毒患者血清标本进行检测,以TPPA作为参考标准,分别统计RPR、TRUST和ELISA的敏感性和特异性.结果 RPR、TRUST、ELISA诊断梅毒的敏感性分别为84.16%、88.12%、98.51%;特异性均为96.67%;ELISA与TPPA检测阳性率差异无统计学意义,RPR、TRUST与TPPA法检测阳性率差异有统计学意义.结论 ELISA法具有较高的敏感性和特异性法,可用于临床筛查和梅毒感染的确证试验.     

探讨梅毒特异性抗体检测方法

目的 比较两种血清梅毒抗体检测方法的性能.方法 采用酶联免疫吸附试验(ELISA)和梅毒螺旋体特异性抗体明胶凝集试验(TPPA)对110份梅毒患者血清和890份健康人血清进行检测比较.结果 TP-ELISA共检出梅毒螺旋体抗体阳性109份、TPPA共检出108份阳性,两法的阳性检出率分别为99.1%和98.2%.TP-ELISA从890份健康体检者中检出2份阳性,TPPA未检出阳性,后经确认2例为假阳性,TP-ELISA的假阳性率为0.22%.结论 ELISA和TPPA都具有较高的敏感性和特异性,两法结果差异无统计学方法(P>0.05).     

3种方法梅毒诊断的应用分析

目的:比较临床常用的3种梅毒血清学检测方法,选择最合适的筛查方法.方法:采用目前临床实验室检测梅毒最常用的梅毒螺旋体梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)、明胶颗粒凝集试验(TPPA)、梅毒血浆快速反应素试验(RPR)3种方法对门诊和住院患者标本共4876例进行检测.结果:ELISA、TPPA和RPR检测梅毒患者的灵敏度分别为96.1%、88.3%和80.5%.3种方法阳性率中TP-ELISA法与TPPA法检测结果差异无统计学意义,而与RPR法检测结果比较差异均有统计学意义(P＜0.01).结论:ELISA、TPPA两种检测方法有较高的灵敏度,RPR的灵敏度比ELISA、TPPT差.ELISA是目前梅毒血清学检测的首选方法.     

三种临床常用的梅毒螺旋体抗体检测方法的比较和评价

目的:比较和评价3种临床常用的梅毒螺旋体(TP)抗体检测方法,并重点关注酶联免疫吸附试验(ELISA)检测抗TP抗体时存在假阳性的问题.方法:收集赤峰市第二医院5 227名门诊及住院患者血清,用ELISA法进行检测得到抗TP抗体阳性患者的血清,再用微粒子化学发光免疫分析法(CLIA)和梅毒螺旋体明胶颗粒凝集试验(TPPA)对ELISA法梅毒螺旋体抗体阳性标本进行检测,对结果进行统计分析.结果:3种方法中,ELISA法检出121例阳性结果,CLIA法和TPPA法分别检出98例和96例阳性结果.以TPPA法为确证方法,ELISA法假阳性率最高,CLIA和TPPA两种方法比较无统计学意义(P＞0.05);ELISA方法中,老年组的假阳性率明显高于中青年组(假阳性率分别为0.75％和0.33％).结论:CLIA法与TPPA法均可作为梅毒抗体的确证试验;用ELISA法检测梅毒抗体时,老年人假阳性率较高,在临床工作中应慎重对待.     

2450例梅毒血清学结果分析

目的:比较快速血浆反应素环状卡片试验(RPR)、酶联免疫吸附试验(ELISA)和梅毒螺旋体明胶颗粒凝集试验(TPPA)的检出效果。方法:用三种试验对我院2450例住院患者血清进行检测,不同方法之间比较采用2χ检验。结果:RPR阳性检出率为2.16%,ELISA阳性检出率为2.65%,TPPA阳性检出率为2.61%。RPR与TPPA法比较,差异具有统计学意义。ELISA与TPPA法比较,差异无统计学意义。结论:临床上可采用RPR与ELISA法作为梅毒血清学的过筛试验,对于梅毒的确诊需采用TPPA法。     

早期梅毒实验室检测方法的评价

目的:评价在梅毒早期诊断中,四种梅毒血清学检测方法的比较及在临床诊断中应用价值。方法:应用快速血浆反应素试验(RPR)、梅毒螺旋体血球凝集试验(TPHA)、梅毒螺旋体明胶凝集试验(TPPA)、酶联免疫吸附试验(ELISA)检测182例血清标本。结果:RPR、TPHA、TPPA、ELISA的敏感性分别为88.3%、92.2%、94.8%、98.7%,特异性分别为85.7%、94.3%、96.2%、98.1%,其中RPR、TPHA、TPPA与灵敏性、特异性较好的ELISA比较,RPR、TPHA、TPPA的敏感性较低,差异有显著性(P<0.05),特异性方面,除TPHA、TPPA差异无显著性(P>0.05),RPR低于ELISA,差异有显著性(P<0.05);RPR滴度随治疗时间的增加而逐渐下降。结论:ELISA方法操作简单,结果判断可标准化,特异性高,敏感性高,可作为早期梅毒检测较理想的方法,RPR试验可用于梅毒治疗期间的疗效判定。     

常用梅毒抗体检测方法的比较

目的探讨不同梅毒抗体检测方学的敏感性和特异性。方法利用梅毒螺旋体胶凝试验(TPPA)、梅毒酶联免疫吸附试验(TP-ELISA)和梅毒螺旋体抗体快速血浆反应素试验(RPR)三种不同方法,对68份阳性标本及80份阴性标本分别进行检测,比较其敏感性和特异性。结果 TPPA、TP-ELISA和RPR三法的灵敏度分别为97.1%、94.1%、80.9%,特异性分别为97.5%、91.3%、88.8%,阳性预期值分别为97.1%、90.1%、85.9%,阴性预期值分别为97.5%、94.8%、84.5%。与灵敏度和特异性均较好的TPPA比较,RPR敏感性和特异性较低,敏感性差异有统计学意义(P<0.01),特异性间差异有统计学意义(P<0.05)。结论 TPPA不适合大规模的血液筛查,适用于对筛查后的阳性标本进行梅毒抗体的确证试验;TP-ELISA是目前筛查梅毒的理想方法;RPR检测梅毒非特异性抗体,用于疗效观察及过筛试验。     

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.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.