血液透析患者营养状况与瘦素水平

目的 研究慢性终末期肾衰竭血液透析患者血清瘦素(Leptin)水平与营养相关指标的关系。方法①慢性终末期肾衰竭维持性血液透析患者31例,男16例,女15例,平均年龄(54.0±11.0)岁;②采用放射免疫分析法测定血清Leptin浓度;③采用生物电阻抗技术(BLA)测量患者的体重指数(BMI)、脂肪百分比(％Fat)和瘦体重(LBM),检测患者血清白蛋白、血红蛋白、胆固醇等浓度。结果 ①慢性肾衰竭血液透析患者血清Leptin水平与体重指数(BMI)、脂肪百分比(％Fat)呈正相关(分别为r=0.605、P<0.001;r=0.779、P<0.001);与瘦体重呈负相关(r=-0.731,P<0.001);②慢性肾衰竭血液透析患者血清Leptin水平与血清白蛋白、胆固醇、血红蛋白等无相关性(P>0.05)。结论①慢性肾衰竭血液透析患者血清Leptin水平与患者的脂肪含量呈正相关,Leptin可作为评价机体脂肪含量的营养指标;②慢性肾衰竭血液透析患者血清Leptin水平与患者的瘦体重呈负相关,高Leptin血症可造成血液透析患者瘦体重丢失;③Leptin没有在慢性终末期肾衰竭血液透析患者蛋白质营养不良中发挥显著作用。     

瘦素水平与性别及残余肾功能关系的对照研究

目的:研究维持性血液透析患者血清瘦素水平与性别、残余肾功能的关系。方法:慢性肾功能衰竭维持性血液透析患者31例(患者组),男16例,女15例;门诊体检健康志愿者38例(对照组),男18例,女20例。采用放射免疫分析法测定所有研究对象的血清瘦素水平,测定血液透析患者的体质量指数(bodymassindex,BMI)、血肌酐、尿素氮、内生肌酐清除率。结果:①慢性肾功能衰竭血液透析患者血清瘦素水平犤(11.820±5.507)μg/L犦显著高于健康对照组犤(6.163±3.230)μg/L犦,差异有非常显著性意义(P<0.001)。②慢性肾功能衰竭血液透析患者女性血瘦素水平犤(15.710±4.969)μg/L犦高于男性犤(8.173±2.879)μg/L犦,差异有非常显著性意义(P<0.001)。③慢性肾功能衰竭血液透析患者血清瘦素水平与内生肌酐清除率、血肌酐、尿素氮无相关性(P>0.05)。结论:①慢性肾功能衰竭血液透析患者存在高瘦素血症。②女性患者血瘦素水平高于男性,性别是影响血瘦素水平的一个独立因素。③慢性终末期肾功能衰竭血液透析患者血瘦素水平与患者的残余肾功能无关。     

尿毒症透析及非透析患者血清瘦素水平及临床意义

目的 观察慢性肾小球肾炎肾功能正常、肾功能衰竭非透析、肾功能衰竭透析患者血清瘦素水平及临床意义。方法 以放射免疫法测定正常对照组及观察组患者血清瘦素浓度,生物化学方法测定血肌酐、血红蛋白、血浆白蛋白、血脂。结果 肾功能衰竭非透析组与慢性肾小球肾炎肾功能正常组比较血清瘦素浓度升高具有显著性差异P<0.05,肾功能衰竭非透析组与肾功能衰竭透析组比较血清瘦素浓度升高无显著性差异P>0.05,肾功能衰竭透析组与慢性肾小球肾炎肾功能正常组比较血清瘦素浓度升高具有显著性差异P<0.05;慢性肾功能衰竭患者血清瘦素与血红蛋白呈负相关(P<0.05),而血清瘦素与血浆白蛋白、血脂之间无相关性。结论 慢性肾功能衰竭患者血清瘦素浓度增加,与肾功能关系密切,可能是造成尿毒症患者营养不良的因素之一。     

慢性肾衰竭维持性血液透析患者血清瘦素水平及其意义

目的：探讨慢性肾衰竭维持性血液透析患者的血清瘦素水平及其与残余肾功能、人体构成和营养状况的关系.方法：分别采用放射免疫分析技术、生物电阻抗技术和常规生化方法测定68例慢性肾衰竭维持性血透患者的血清瘦素水平、残余肾功能、人体构成和营养相关指标.结果：慢性肾衰竭维持性血透患者血清瘦素水平显著高于对照组（P〈0.01）;瘦素水平与体重指数和脂肪百分比呈正相关,与去脂体重呈负相关（P均〈0.01）,与内生肌酐清除率、血清肌酐、尿素氮、白蛋白、胆固醇、血红蛋白相关性无统计学意义（P均〉0.05）.结论：慢性肾衰竭维持性血透患者存在高瘦素血症, 血清瘦素水平可以作为评价机体脂肪含量的营养指标,其在终末期慢性肾衰竭血透患者蛋白质营养不良中未发挥显著作用.     

瘦素水平与性别及残余肾功能关系的对照研究

目的：研究维持性血液透析患者血清瘦素水平与性别、残余肾功能的关系。方法：慢性肾功能衰竭维持性血液透析患者31例(患者组)，男16例，女15例；门诊体检健康志愿者38例(对照组)，男18例，女20例。采用放射免疫分析法测定所有研究对象的血清瘦素水平，测定血液透析患者的体质量指数(body mass index，BMI)、血肌酐、尿素氮、内生肌酐清除率。结果：①慢性肾功能衰竭血液透析患者血清瘦素水平[(11．820&;#177;5．507)μg／L]显著高于健康对照组[(6．163&;#177;3．230)μg／L]，差异有非常显著性意义(P&;lt;0．001)。②慢性肾功能衰竭血液透析患者女性血瘦素水平[(15．710&;#177;4．969)μg／L]高于男性[(8．173&;#177;2．879)μg／L]，差异有非常显著性意义(P&;lt;0．001)。③慢性肾功能衰竭血液透析患者血清瘦素水平与内生肌酐清除率、血肌酐、尿素氮无相关性(P&;gt;0．05)。结论：①慢性肾功能衰竭血液透析患者存在高瘦素血症。②女性患者血瘦素水平高于男性，性别是影响血瘦素水平的一个独立因素。③慢性终末期肾功能衰竭血液透析患者血瘦素水平与患者的残余肾功能无关。     

慢性肾功能衰竭患者血清瘦素及IL-6、IL-8变化的相关性研究

目的通过对134例慢性肾功能衰竭患者血清瘦素(leptin)及白细胞介素6(interleukine-6;IL-6)、IL-8(interleukine-8;IL-8)水平的检测,探讨慢性肾功能衰竭与瘦素、IL-6、IL-8的关系及发生机制。方法患者134例(男73、女61),年龄36~80 y,均经确诊。入院后第2 d抽取空腹静脉血,用酶联免疫分析法(ELISA)检测IL-6及IL-8;用放射免疫分析法(RIA)检测血清瘦素,同时检测40例健康成人作对照组。结果慢性肾功能衰竭组瘦素水平显著高于对照组(t=2.39,P<0.01)。慢性肾功能衰竭早期、肾衰竭期、尿毒症期患者瘦素无差异,而细胞介素6、8随病情的加重而升高,差异显著。结论慢性肾功能衰竭患者存在高瘦素血症和瘦素抵抗,瘦素参与了能量平衡的调节,瘦素水平增高是慢性肾功能衰竭的危险标志物。其发生机理有待深入研究。     

慢性肾功能衰竭时瘦素与肿瘤坏死因子及内皮素的关系

目的 观察慢性肾功能衰竭患者血清瘦素(Leptin)水平及其与肿瘤坏死因子(TNF)及内皮素(ET)的关系。方法 应用放射免疫方法检测40例慢性肾功能衰竭患者及20例健康志愿者血清Leptin、TNF及ET水平,并对血清Leptin水平与TNF及ET之间的关系进行相关性分析。结果 慢性肾功能衰竭患者血清Leptin水平显著高于正常对照组[(19.25±4.89)μg／L比(5.57±1.69)μg／L,P<0.01],并与TNF及ET水平呈显著正相关(rTNF=0.829,rET=0.605;P均<0.01);而肾功能和血中总蛋白的含量与Leptin之间无相关性(P均>0.05)。结论 慢性肾功能衰竭患者血清TNF及ET水平异常升高和高瘦素血症明显相关。     

血清瘦素水平及体质指数与乳腺癌发生的相关性研究

目的探讨血清瘦素水平及体质指数与乳腺癌发生的相关性。方法采用酶联免疫吸附试验法检测50例乳腺癌患者(观察1组)、50例乳腺良性疾病患者(观察2组)和50例健康体检者(对照组)血清瘦素的水平,并计算体质指数,对3组血清瘦素水平与体质指数进行相关性分析。结果观察2组体质指数值、血清瘦素水平与对照组比较差异无统计学意义(P>0.05)。观察1组体质指数值、血清瘦素水平均明显高于观察2组和对照组(均P<0.05)。相关性分析结果显示,3组血清瘦素水平与体质指数均呈正相关(r=0.328、0.423、0.527,均P<0.05)。多因素Logistic回归分析结果显示,血清瘦素水平升高是乳腺癌发生的危险因素,OR为1.132(95%CI 1.073~1.206),P<0.01。结论血清瘦素水平、体质指数的升高可能与乳腺癌发生有关,在临床上应引起高度重视。 更多还原     

老年慢性阻塞性肺疾病患者营养状态与血清瘦素、生长激素的相关性

目的探讨老年慢性阻塞性肺疾病(COPD)患者血清瘦素、生长激素的变化及意义。方法采用放射免疫法测定32例老年COPD患者及15例健康老年人的血清瘦素、生长激素,同时进行营养状况评价。结果COPD组患者各营养指标均明显低于健康对照组(P<0.05),血清瘦素(3.2±2.1)μg/L、生长激素(4.1±1.5)μg/L亦低于健康对照组(P<0.05),瘦素水平与各营养指标犤体重指数(BMI)(r=0.75,P<0.001),理想体质量百分比(IBW%)(r=0.66,P<0.001),三头肌皮褶厚度(TSF)(r=0.57,P<0.01),上臂中部臂围(MAC)(r=0.54,P<0.01)犦呈显著正相关。结论COPD患者存在营养不良,血清瘦素、生长激素水平低于健康老年人,瘦素对COPD营养不良患者有调节意义。     

慢性肾功能衰竭患者高同型半胱氨酸血症与血清维生素B12、叶酸、脂蛋白(α)水平的关系

目的 探讨慢性肾功能衰竭(CRF)患者血清同型半胱氨酸(HCY)水平与其代谢因子叶酸、维生素B_(12)水平、血肌酐(SCr)及有关生化指标之间的关系。方法 本研究分为两组:正常对照组47例,慢性肾功能衰竭组46例。应用荧光偏振免疫分析(FPIA)方法测定血清HCY浓度,同时测定血清叶酸、维生素B_(12)、SCr、ALB、血脂、脂蛋白及瘦素(Leptin)浓度。结果 CRF患者血清HCY浓度(24.6±8.1)μmol/L比正常对照组(10.7±3.8)μmol/L,显著升高(P<0.001);CRF患者叶酸水平(14.5±8.8)ng/ml比正常人(5.5±2.5)ng/ml显著升高(P<0.001),血清维生素B_(12)(456±309)pg/ml比正常人(346±117)pg/ml明显升高(P<0.05);血清HCY浓度与叶酸、维生素B_(12)浓度呈明显负相关(分别为r=-0.586,P<0.01;r=-0.442,P<0.05);血清HCY浓度与SCr、Lp(a)浓度呈明显正相关,与瘦素及其它血脂水平无明显相关;血液透析患者透析后血清HCY水平(17.6±6.2)μmol/L比透析前(25.4±8.2)μmol/L明显下降(P<0.001)。结论CRF患者血清HCY水平比正常人明显升高;CRF患者肾功能、血清叶酸、维生素B_(12)水平是影响HCY水平的重要因素;血清脂蛋白(a)增高与高HCY血症密切相关;口服叶酸治疗不能满意纠正高HCY血症;血液透析可清除体内部分HCY。如何完全纠正CRF患者高HCY血症尚     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.