妊高症孕妇乳酸及乳酸脱氢酶含量的变化

目的 探讨妊娠期高血压患者体内乳酸及乳酸脱氢酶含量的变化.方法 取被确诊为妊娠期高血压病的住院产妇60例作为研究组.取同期住院年龄和孕周有可比性的正常待产妇40例作为对照组,早晨空腹采血测定乳酸、乳酸脱氢酶及相关生化指标的含量.结果 重度妊高症其乳酸和乳酸脱氢酶的检测结果均明显高于对照组(P<0.05).重度妊高症组与轻度妊高症组相比较差异有统计学显著性意义(P<0.05),含量的多少与妊高症的严重程度呈相关性.结论 乳酸可作为妊高症生化监测指标,尤其是与乳酸脱氢酶的联合检测对临床治疗和预后有指导意义.     

An Automated Colorimetric Method for the Estimation of Lactate Dehydrogenase Activity in Serum

An automated method for estimating lactate dehydrogenase (LDH) in serum is presented. Fe³⁺ is reduced to Fe²⁺ by NADH formed when lactate is oxidized to pyruvate. Fe²⁺ complexed with 2,2-bipyridyl is measured colorimetrically. Solutions of Fe²⁺ salt are used as standards. Nicotinamide is used to stabilize NAD+ in solution and is shown to enhance enzyme activity. The method is less expensive than most automated methods published and reagents are stable for at least 4 weeks. Results correlate well with a kinetic spectro-photometric method.     

胸腔积液和乳酸脱氢酶对急性胰腺炎严重度评估的价值

目的 探讨胸腔积液和乳酸脱氢酶在急性胰腺炎严重度评估中的价值.方法 对2009年7月1日～2010年6月30日123例急性胰腺炎病例资料作回顾性分析.按照中国急性胰腺炎诊治指南（草案）分为轻症急性胰腺炎组（76例）和重症急性胰腺炎组（47例）,采用Logistic多因素回归及ROC曲线分析入院后24h内乳酸脱氢酶和C-反应蛋白、72h内胸腔积液与急性胰腺炎严重度的相关性.结果 胆道疾病是急性胰腺炎最常见的原因（55.28%）,胸腔积液、乳酸脱氢酶和C-反应蛋白在急性胰腺炎轻症组和重症组间差异均有显著性（P〈0.01）,三者ROC曲线下面积分别为0.748、0.875、0.873;经Z检验,胸腔积液与乳酸脱氢酶、C-反应蛋白两指标ROC曲线下面积的分别比较均有统计学意义（P=0.012,P=0.013）,乳酸脱氢酶、C-反应蛋白两指标ROC曲线下面积的比较无统计学意义（P=0.976）;胸腔积液和乳酸脱氢酶联合应用其平行试验的敏感度、特异度分别为0.973、0.548,其序列试验的灵敏度、特异度分别为0.623、0.939.结论 胸腔积液、乳酸脱氢酶对急性胰腺炎严重度评估具有一定的临床价值.     

血清乳酸脱氢酶及β2-微球蛋白在慢性淋巴细胞白血病中的预后意义

为了研究血清乳酸脱氢酶（LDH）和132-微球蛋白（β2-MG）在慢性淋巴细胞白血病（CLL）中的预后价值，回顾性分析了141倒CLL患者的LDHI、β2-MG水平以及其他临床及实验室检查资料，采用Kaplan—Meier法及Cox回归模型进行生存分析。进行多因素分析时，将LDH和β2-MG表达水平分为3个组，即：①LDH和β2-MG水平均升高；②LDH和β2-MG水平中一个升高；③LDH和β2-MG两者水平均正常。结果表明：BinetC期患者的LDH和β2-MG水平较BinetA期患者明显升高（P=0．034和P=0．036）。β2-MG水平与淋巴细胞计数无明显相关（P=0．756）。经Cox回归分析．BinetC期（P=0．015）和LDH水平升高（P=0．035）与总体生存时间短显著相关，β2-MG水平与总体生存时间无显著相关性（P=0．384）。LDH和β2-MG水平均升高组较均正常组生存期短（P=0．04）。结论：Binet分期及血清LDH水平是影响CLL预后的重要因素。     

血小板参数联合乳酸脱氢酶在血小板增多症鉴别诊断中的价值

本研究探讨血小板参数联合乳酸脱氢酶在血小板增多症鉴别诊断中的价值。常规检测骨髓增殖性疾病组（CMPD组）[包括慢性髓系白血病（CML）、真性红细胞增多症（PV）、原发性血小板增多症（ET）]和反应性血小板增多症组（RT组）血小板计数（Plt）、平均血小板体积（MPV）、血小板体积分布宽度（PDW）、大血小板比率（P—LCR）和血清乳酸脱氢酶酶（LDH）水平,应用非参数检验进行统计学分析,绘制ROC曲线,判断各个指标在血小板增多症患者鉴别诊断中的价值,并确定最佳截断值。结果表明,CMPD组血小板参数MPV、PDW、P-LCR和LDH各项指标均明显高于RT组（P〈0．05）,可以鉴别CMPD和RT,尤以PDW、P—LCR预测CMPD的诊断效能最高,ROC曲线下面积分别为0．96、0．89,最佳截断值分别为11．95％、23．05％;鉴别3种CMPD的方法如下：如LDH、P—LCR明显升高,应考虑CML,其最佳预测截断值分别为424U／L、26．10％;如LDH中度升高,同时Pit明显升高,应考虑ET,Plt最佳预测截断值为939×10^9／L。结论：血小板参数联合LDH有助于血小板增多症的鉴别诊断．它是一种简单、快速、初步的鉴别方法,尤其适合基层医院推广应用。     

Multiplex Fluorescent Immunoassay for Detection of Mice Infected with Lactate Dehydrogenase Elevating Virus

Commercially available diagnostic tools for the detection of lactate dehydrogenase elevating virus (LDV) infection have been restricted to measurement of serum lactate dehydrogenase (LDH) activity levels and detection of the viral genome by RT-PCR assays. Serologic diagnosis of LDV infection has not been widely adopted due to the belief that the formation of antigen–antibody complexes and B-cell polyclonal activation may confound interpretation of results. In the current study, we inoculated BALB/c, C57BL/6, and Swiss Webster mice with LDV to compare the diagnostic reliability of a commercially available multiplex fluorescent immunoassay for the detection of antiLDV antibodies with that of the LDH enzyme assay. The serologic assay was vastly more sensitive and specific than was the LDH enzyme assay. Moreover, the serologic assay detected antiviral antibodies throughout the 3-mo time course of this study. These results suggest that antigen–antibody complex formation and polyclonal B-cell activation had little effect on assay performance.Abbreviation: LDV, lactate dehydrogenase elevating virus; MFI, multiplex fluorescent immunoassayLactate dehydrogenase elevating virus (LDV) is an RNA virus within the family Arteriviridae that initially was identified as a transmissible contaminant of tumors in laboratory mice.⁴¹ Previous reports have demonstrated that after experimental infection, circulating virus levels peak by 12 to 24 h, stabilize by 1 to 2 wk after infection, and persist for the lifetime of the mouse.^36,38-40 Although clinical disease is rare and only seen in immunocompromised strains, viral infection has many implications for biomedical research, including changes in tumor growth rate,^3,26,31,49 differences in immunologic function,^{21,29,32,33,35,44,45} polyclonal B-cell activation,¹² and altered serum enzyme levels.^34,39Laboratory mouse colonies are commonly screened for viral pathogens by serology, but commercial diagnostic methods for LDV have been limited to RT-PCR assays^10,20,47,48 and measurement of serum lactate dehydrogenase (LDH) activity. Although RT-PCR assays are a very reliable diagnostic method, it is costly and time intensive. Historically, measurement of serum or plasma LDH activity has been used to detect infection, but at least one study has determined that this assay has poor sensitivity and specificity.⁴⁸ LDV infection causes a 5- to 10-fold elevation of LDH within 3 d of exposure, and, due to decreased clearance rates, LDH levels can remain elevated for as long as 10 mo after exposure.¹ Enzyme activity is assayed by the coupled reaction catalyzed by lactate dehydrogenase:LDH activity (in units) is quantified as the change in optical density due to the oxidation of NADH or reduction of NAD⁺.¹⁸ When using LDH activity levels for diagnostic purposes, false positives may result from cellular damage and leakage of LDH due to repeated venipuncture¹⁶ or hemolysis.⁵⁰ Differences in baseline plasma levels of LDH between sexes and ages of inbred mice may confound the interpretation of results also.¹⁹ One published diagnostic method, not currently commercially available, is the detection of viral particles in plasma by using a latex agglutination assay.²⁹ However, this assay was used to detect acute LDV infection, and its utility for detecting chronic infection is unknown. In light of the weaknesses of the RT-PCR and LDH activity assays and the unavailability of the latex agglutination assay, we reexamined the suitability of a serologic assay for the detection of LDV.Serologic diagnosis of LDV infection has not received wide acceptance due to potentially confounding polyclonal B-cell activation and antigen–antibody complex formation.^17,37 Although polyclonal B-cell activation and antigen–antibody complex formation in LDV-infected mice are well described in the literature,^12,13,35 their effect on antiLDV antibody detection is unclear. Immunocompetent mice mount a robust immune response, but only a small fraction of the antibodies formed are specific for LDV proteins.¹⁵ AntiLDV antibodies are directed toward 2 of the 3 structural proteins: the 14-kDa nucleocapsid protein and the 24- to 42-kDa glycosylated envelope protein.^5,14 Questions about the sensitivity and specificity of antiLDV antibody detection arose when multiple studies demonstrated the presence of low-molecular–weight complexes in LDV immune serum that bound to ELISA plates not coated with antigen.^6,25 These complexes are believed to comprise auto-antibodies and cellular proteins rather than antiLDV antibodies and LDV viral proteins.^25,43 Application of a blocking agent to ELISA plates not coated with antigen reduced, but did not completely prevent, the binding of nonspecific antibodies to uncoated wells.²⁵ This result suggests that nonspecific antibodies may interfere with the detection and quantification of antiLDV antibodies. However, to our knowledge, there have been no controlled studies to show that these nonspecific antibodies compromise the sensitivity or specificity of antiLDV antibody detection in murine serum samples. Contrary to the suggested interference of these low-molecular–weight complexes, many reports have shown that LDV-infected mice mount a demonstrable antibody response, as detected by ELISA and immunofluorescent assays, as early as 1 wk after infection and which remains elevated for at least 1 y.^5,7,14,30,40 These methods are not routinely used in high-throughput screening laboratories because of the relative inefficiency of cultivating LDV: this virus does not replicate well in cell culture.⁴⁶The objective of the current study was to compare the diagnostic reliability of a commercially available multiplex fluorescent immunoassay (MFI) for the detection of antiLDV antibodies with that of the LDH activity assay in laboratory mice experimentally infected with LDV. To this end, we inoculated 2 inbred strains and a single outbred stock of laboratory mice with LDV or a sham inoculum and evaluated serum longitudinally over a 3-mo period for LDH enzyme activity, antiLDV antibodies by MFI, and LDV genomic DNA by RT-PCR assay. To confirm the presence or absence of viral genome in each mouse, spleen samples were evaluated by using an RT-PCR assay, the ‘gold standard.’ Our results demonstrate that the serologic diagnosis of LDV infection by using MFI was more sensitive and specific than was the LDH activity assay in female Swiss Webster, C57BL/6, and BALB/c mice at 2, 4, 8, and 12 wk after infection.     

血清乳酸脱氢酶及其同工酶检测在卵巢癌诊治中的初步应用

目的:探讨血清乳酸脱氢酶(LDH)及其同工酶检测在卵巢癌诊治中的意义。方法:检测72例卵巢癌、22例子宫恶性肿瘤、33例卵巢良性肿瘤患者术前和30名健康成年女性(对照组)血清LDH及其同工酶水平,治疗后测定卵巢癌患者血清LDH的变化。结果:卵巢癌患者术前血清LDH含量为(405.9±331.5)u/L,明显高于子宫恶性肿瘤(198.2±60.1)U/L、卵巢良性肿瘤(205.0±70.5)U/L和对照组(168.6±69.3)U/L(P<0.001),晚期患者高于早期患者(P<0.05),各病理类型之间无明显差异。卵巢癌治疗有效患者血清LDH下降明显,与治疗无效或稳定患者相比差异亦有显著性(P<0.01)。血清LDH同工酶检测显示卵巢癌患者LDH1、LDH2明显低于对照组(P<0.05),LDH5水平高于对照组(P<0.001)。结论:测定卵巢癌患者血清LDH及其同工酶水平对卵巢癌的诊断、鉴别诊断以及随访具有一定的临床意义。     

Specific Inhibition of Hepatic Lactate Dehydrogenase Reduces Oxalate Production in Mouse Models of Primary Hyperoxaluria

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连续动态观察乳酸脱氢酶对MDS预后判定的意义

本研究旨在动态观察MDS患者的乳酰脱氢酶(LDH)的表达水平,初步探讨LDH对MDS患者预后判定的意义。回顾分析我院2001-2009年确诊的163例MDS患者,诊断时的LDH的表达水平,随访患者的LDH的变化情况及其与MDS的预后、生存期和疾病进展的关系;监测血细胞、骨髓原始细胞比例和核型,并分析其与LDH水平的关系。结果表明:163例患者在诊断时LDH表达值为214U/L(102-865U/L),LDH升高组MDS患者的中位生存期为25.6月,LDH正常组MDS患者的中位生存期为56.8月,两组比较差异显著(p<0.05)。按照IPSS预后积分系统分类,LDH升高多在中危-2和高危组,与低危和中危-1比较差异显著(p<0.05)。有疾病进展的MDS患者的LDH值比诊断初期和进展前明显升高,而无疾病进展的MDS患者的LDH水平基本保持稳定范围,无明显升高,两组比较差异显著(p<0.05)。与其他预后指标比较,LDH是一个独立的预后指标。结论:LDH值可作为MDS患者的预后判断指标,有助于早期识别MDS进展和白血病的发生,从而选择合理的治疗方案。     

创伤性失血性休克大鼠血浆乳酸脱氢酶的动态测定及价值

目的探讨创伤性失血性休克(traumatic hemorrhagic shock,THS)中血浆乳酸脱氢酶(lactate dehydrogenase,LDH)动态变化及其临床价值。方法选择无特定病原体成年大鼠19只,通过急性失血方式建立收缩压下降曲线,形成THS动物模型,测定收缩压基础值(T1),记录收缩压降至基础值3/4(T2),基础值1/2(T3),基础值2/5(T4),基础值1/5(T5),10 mmHg(T6)时失血量,采用酶联免疫吸附分析检测各时间点血浆LDH含量水平。结果T2～T3及T4～T5时间段组内差异有统计学意义(P<0.05),T3～T4及T5～T6时间段组内差异无统计学意义(P>0.05),T2～T3时间段组内LDH含量水平显著性升高,T4～T5时间段组内LDH含量水平显著性下降。结论选择收缩压下降曲线建立THS模型评估失血量变化,结合血浆LDH含量水平动态监测,可对THS过程中组织细胞损伤程度进行有效评估,LDH含量水平可作为判断组织细胞损伤反应的血清学指标。     

妊娠肝内胆汁淤积症患者血清心肌酶检测及其临床价值

【目的】研究妊娠肝内胆汁淤积症（ICP）患者心肌酶水平及其临床价值。【方法】选取30例妊娠肝内胆汁淤积症患者及20例正常孕妇,比较血清中乳酸脱氢酶（LDH）、肌酸肌酶（CK）和γ谷氨酰转移酶（γ-GT）水平。【结果】ICP组总胆汁酸（TBA）、总胆红素（TB）、直接胆红素（DB）,谷丙转氨酶,谷草转氨酶、乳酸脱氢酶和γ谷氨酰转移酶（-γGT）均高于正常对照组（P〈0.05）;ICP组间接胆红素（IB）和肌酸肌酶（CK）高于正常对照组,但差异无显著性（P〉0.05）。在ICP组患者乳酸脱氢酶和γ-GT与TBA存在正相关（r=3.54,P〈0.05）,与TB、DBI、B、谷丙转氨酶及谷草转氨酶间不存在相关（P〉0.05）;CK与TB、DBI、B、胆汁酸、谷丙转氨酶及谷草转氨酶间不存在相关（P〉0.05）。【结论】LDH和γ-GT增高可以提示诊断和预后,而CK没有诊断价值。     

ACD中添加丙氨酰谷氨酰胺对储存红细胞乳酸脱氢酶活性的影响

目的探讨添加丙氨酰谷氨酰胺的血液保存液对储存血液乳酸脱氢酶活性的影响。方法选取血标本分为实验组A和对照组B,每组均为相对应的1-10管,A组抗凝剂为ACD配方血液保存液和丙氨酰谷氨酰胺注射液,B组抗凝剂为ACD配方血液保存液,比较两组采血后第6、15、21、28天血液乳酸脱氢酶活性检测结果,并予以统计分析。结果采血后第6、15、21、28天测定两组标本乳酸脱氢酶活性,组内比较分析,A组：F=60.16,P〈0.001,B组：F=18.17,P〈0.001;A、B两组组间比较分析,6、15、21d的差异有统计学意义（P〈0.05）。结论 ACD配方血液保存液添加丙氨酰谷氨酰胺制成血液保存液,相比ACD配方血液保存液,对储存血液乳酸脱氢酶活性有影响,其对血液有形成分具有保护作用。     

A Study on the Effects of Severe Repetitive Exercise on Serum Myoglobin, Creatine Kinase, Transaminases and Lactate Dehydrogenase

Two groups of young men taking part in a 24-day training courseinvolving increasingly severe exercise were studied. Serum myoglobin,creatine kinase, creatine kinase-MB, transaminases, lactatedehydrogenase, urea, creatinine, calcium and uric acid wereestimated at intervals. During the first few days, increasesin myoglobin and muscle enzymes correlated with the severityof the preceding exercise. Increases in myoglobin and muscleenzymes after the final most severe exercising were less thanwith the initial exercising, demonstrating the effect of physicaltraining. The changes in myoglobin and the muscle enzymes correlatedclosely. Elevated myoglobin levels persisted for over 24 hours.There was no consistent correlation between changes in myoglobinand uric acid, both of which have been considered responsiblefor the renal failure which may occur with rhabdomyolysis.     

以LDH为例来探讨具有溯源性和互换性的校准品在临床生化应用中的重要性

目的通过在临床实验室使用具有溯源性和互换性的校准品,寻求血清酶测定标准化的新途径。方法以乳酸脱氢酶(LDH)为例,收集混合血清,由4家酶学参考实验室联合赋值,制备具有溯源性和互换性的参考物质。参加试验的8个实验室先使用自己的校准品,在校准通过后,将高中低3个水平的血清样本和参考物质各测定3次,记录检验结果;再使用具有溯源性和互换性的参考物质作为校准品校准后,重复测定高中低3个水平的血清样本和参考物质各3次,记录检验结果。计算8家实验室在使用具有溯源性和互换性的参考物质作为校准品校准前后,参考物质检测结果与靶值的偏倚和高中低3个水平的血清样本LDH检测结果的变异系数(CV%)。结果使用具有溯源性和互换性的参考物质参后,参考物质检测结果与靶值的偏倚由6.80%降到1.40%;高中低3个水平的血清样本LDH检测结果的变异系数CV由11.41%,9.93%和9.87%降到了4.13%,3.55%和3.80%。结论在临床实验室使用具有溯源性和互换性的参考物质作校准品,能大大降低实验室间结果的正确度和精密度,提高检测结果的准确性,有利于各个实验室各设备间结果的标准化和一致性。     

Lactate metabolism

Lactate is the end product of the anaerobic metabolism of glucose, and its accumulation in the blood signals an increase in production or a decrease in utilization, or both. The most common etiology of lactic acidosis is hypoperfusion, which represents an imbalance between systemic oxygen demand and oxygen availability with resultant tissue hypoxia. A wide variety of other etiologies of hyperlactatemia have been identified or implicated. However, most of these are uncommon causes, and many actually represent an associated perfusion failure. Clinical recognition of hyperlactatemia is facilitated by an awareness of the clinical settings in which it is likely to occur. Serum electrolyte and arterial blood gas studies are helpful to recognize lactic acidosis, but direct assay of blood lactate is necessary to identify milder degrees of lactate elevation, to confirm and quantitate the severity of more severe degrees, and to monitor the progress of therapy. Therapy should be directed toward measures to ensure adequate systemic oxygen delivery and specific treatment of the underlying causes.     

腺苷脱氨酶(ADA)同工酶的诊断与生物作用

腺苷脱氢酶（Ａｄｅｎｏｓｉｎｅｉｓｏｅｎｚｙｍｅ,ＡＤＡ）是一种巯基酶,属细胞免疫功能有关的核酸代谢酶类,它广泛分布于人体各组织中,以盲肠、肠系膜、脾中含量最多。在纤维细胞、羊水细胞、肝、肾、肺、骨骼肌中也有发现。血液ＡＤＡ主要存在于红、白细胞（淋巴...     

自制超薄型琼脂糖凝胶板电泳分离检测血清LDH同工酶及成年人参考范围的建立

目的 自制超薄型琼脂糖凝胶板,建立电泳分离检测血清乳酸脱氢酶(LDH)同工酶的方法并建立成人血清的参考区间。方法 用自制琼脂糖凝胶板分离检测LDH同工酶,对方法学性能包括精密度、正确度、线性范围、参考区间进行确认和建立。结果 5种LDH同工酶图谱分离清晰,批内CV值均小于8.77%,批间CV值均小于13.12%,胶板间CV值均小于7.89%。LDH1在13.48～287.65U/L,LDH2在18.19～575.67U/L,LDH3在19.42～504.62U/L,LDH4在8.00～342.27U/L和LDH5在13.88～199.79U/L的范围内呈线性,斜率趋近于1。与Sebia配套电泳试剂盒的结果比较,5种同工酶在两方法间的差异无统计学意义(t=0.028 1～0.567 4,均P>0.05),相关系数r=0.949 4～0.985 5。建立的成人参考区间为LDH1:15.7%～34.3%,LDH2:26.8%～38.9%,LDH3:18.8%～28.1%,LDH4:5.7%～13.7%和LDH5:2.7%～15.3%。结论 自制超薄型琼脂糖凝胶板电泳分离检测血清LDH同工酶的方法性能良好,可用于临床检测。     

Alkaline Phosphatase: Diagnostic Value of Isoenzyme Determination

Abstract. The isoenzyme pattern of the alkaline phosphatases was determined in the sera of 51 normal subjects, 28 patients with hepatobiliary diseases and 17 patients with bone diseases. Two quick and technically simple methods of differentiation were used for a semiquantitative determination: stereospecific sensitivity to L-phenylalanine, especially of the small intestine phosphatase, and the separation of the bone and liver/biliary tract phosphatases by a combination of heat inactivation and stereo-specific inhibition. The basic principles of these methods are described. The results, statistically evaluated, are discussed. The alkaline phosphatase activity in the serum of healthy adults stems from isoenzymes of the small intestine (about 20%), of bone and of hepatobiliary origin. In hepatobiliary diseases the proportion of bone to liver/biliary tract phosphatases changes significantly in favour of the latter. In diseases of the skeleton, however, which are accompanied by increased activity of serum alkaline phosphatase, there is a significant increase in the absolute fraction of bone phosphatase in the total activity. In addition to the demonstration of these qualitative and quantitative changes in the isoenzyme distribution patterns, limiting values were determined for a normal group; values outside these can be considered as pathognomonic for diseases of the liver and biliary tract and the skeleton respectively. Of particular importance for early diagnosis is the fact that changes in the isoenzyme distribution pattern are demonstrable not only when the total activity is increased, but at a time when the serum activity lies still within normal limits. The methods used are suitable for a rapid and reproducible semiquantitative determination of the isoenzymes of alkaline phosphatase, and for early differential diagnosis of diseases of the skeleton (especially metastatic tumours), the liver and biliary tract.