胸腹水中C反应蛋白等免疫化学指标测定的临床意义

The levels of C-reactive protein(CRP),adenosine deaminase(ADA),total cholesterol (TC),lactate dehydrogenase(LDH),carcinoembryonic antigen(CEA),ferritin(Fer),β2-microglobulin (β2-MG),alpha-fetoprotdn(AFP),carbohydrate anfigen12-5(CA125),carbohydrate antigen19-9(CAl99),carbohydrate antigen15-3(CA153),eyfra211(CY211)and neuron specific enolase(NSE)were detected by automatic chemistry analyzer or electrogenerated chemiluminescence analyzer in pleural and peritoneal exudates from 48 cases oftuberculosis and 82 cases of malignant tumors.The levels of CRP,ADA and β2-MG in tuberculotic exudates were higher than those in malignant exudates(P<0.01).However,the levels of TC,LDH,CEA,Fer,CA153,CY211,NSE,AFP,CA125 and CA199 in malignant exudates were higher than those in tuberculotic exudates(P<0.01).Combined determination of CRP,ADA,TC,LDH,CEA,Fer,and β2-MG in pleural and peritoneal exudates are of value in differentiation of tuberculosis from malignant exudates.Combined determination of CA153.CY211 and NSE in pleural effusions and AFP,CA125 and CA199 in peritoneal effusions can improve the semitivity and specificity of diagnosis for malignant exudates.     

Clinical Value of Vascular Endothelial Growth Factor Combined with Interferon-γ in Diagnosing Malignant Pleural Effusion and Tuberculous Pleural Effusion

In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.     

胸水四项肿瘤标志物联检对恶性胸腔积液的诊断价值

目的 探讨联合检测胸水中的肿瘤标志物糖链抗原125(CA125)、糖链抗原19-9(CA199)、癌胚抗原(CEA)、肿瘤特异性生长因子(TSGF)对良、恶性胸腔积液的诊断价值.方法 采用酶联免疫吸附法(ELISA)和化学比色法检测胸水中的CA125、CA199、CEA、TSGF水平,并单项及联合计算四项肿瘤标志物的敏感性和特异性,并分析其在恶性胸腔积液诊断中的价值.结果 恶性组胸水中的CA125、CA199、CEA、TSGF的值均显著高于良性组(P<0.01),胸水四项联合检测可使恶性胸腔积液组的敏感性提高到95.8%,与胸水中单项肿瘤标志物的敏感性相比较,P<0.01,差异有统计学意义.特异性为82.3%,与单项检测的各组特异性相比,无明显下降,P＞0.05,差异无统计学意义.结论 联合检测胸水中的四项肿瘤标志物CA125、CA199、CEA、TSGF可提高对恶性胸腔积液诊断的敏感性,而特异性无明显下降.上述四项肿瘤标志物可作为良、恶性胸腔积液鉴别诊断的辅助指标. Abstract： Objective To study the role of co-detections of four tumor markers CA125,CA199,CEA and TSGF in differential diagnosis of benign and malignant pleural effusion.Methods The levels of CA125, CA199, CEA and TSGF in pleural effusion were detected by ELISA and colorimetry,the sensitivity and the specifity of the the single tumor marker and tumor markers combined assay were counted. Tle diagnostic value of combined assay of these four tumor markers was evaluated. Results Pleural fluid levels of CA125 ,CA199 ,CEA and TSGF in patients with malignant effusion were significantly higher than those patients in benign pleural effusions(P<0.01). Four tumor markers in pleural effusion increased the diagnostic sensitivity to 95.8% ,contrast with the sensitivity of the single tumor marker(P<0.01). While the specifity of those was 82.3%, not declining significantly (P＞0.05), compared with the specifity of the single tumor marker. Conclusions The combined assay of four tumor markers CA125, CA199, CEA and TSGF in pleural effusion increased the diagnostic sensitivity, while the specifity of those have no decrease significantly. The co-detections of four tumor markers in pleural effusion show great values in diagnosis and differential diagnosis for malignant and benign pleural effusion.     

各类胸腹水中淋巴细胞亚群分布水平的研究

Objective To determine counts of T lymphocyte sub-populations in malignant and tuberculous pleural effusion or ascites and evaluate its significance in difierential diagnosis.Methods T lymphocyte sub-populations in pleural effusion or ascites and peripheral blood were determined in 30 patients with tuberculosis and 31 patients with cancer by flow cytometry.Concentrations of cytokines Th1 and Th2,γ-interferon(IFN-γ),interleukin-12(IL-12)and IL-4 in pleural effusion or ascites were measured by enzyme-linked immunosorbent assay(ELISA).Results Compared to that in peripheral blood,percentage of CD3+ and CD4+ T-celI counts were all higher in both malignant and tuberculous pleural effusion or ascites [(73±6)%and(67±20)%vs.(51±19)%and(48±14)%,P＜0.05].Although CD3+T-cells count was higher in tuberculous pleural effusions or ascites,no difference in ratio of CD3+ and CD4+/CD3+ and CD8+ T-cell counts was found between malignant and tuberculous pleural effusions or ascites.However,ratios of IFN-γ and IL-12 to IL-4 were higher in tuberculous pleural effusion or ascites(54±24 and 82±19vs.8±6 and 19±10,t=10.34 and 16.28,respectively,P＜0.01).Conclusions CD3+ and CD4+ Tcells can be aggregated in both malignant and tuberculous pleural effusions or ascites,80 nature (tuberculosis or malignancy)of pleural effusion or ascites can not be differentiated by CD4+ and/or CD8+ T-cell counts only,and determination of cytokines Th1 and Th2 can help their differentiation.     

各类胸腹水中淋巴细胞亚群分布水平的研究

Objective To determine counts of T lymphocyte sub-populations in malignant and tuberculous pleural effusion or ascites and evaluate its significance in difierential diagnosis.Methods T lymphocyte sub-populations in pleural effusion or ascites and peripheral blood were determined in 30 patients with tuberculosis and 31 patients with cancer by flow cytometry.Concentrations of cytokines Th1 and Th2,γ-interferon(IFN-γ),interleukin-12(IL-12)and IL-4 in pleural effusion or ascites were measured by enzyme-linked immunosorbent assay(ELISA).Results Compared to that in peripheral blood,percentage of CD3+ and CD4+ T-celI counts were all higher in both malignant and tuberculous pleural effusion or ascites [(73±6)%and(67±20)%vs.(51±19)%and(48±14)%,P＜0.05].Although CD3+T-cells count was higher in tuberculous pleural effusions or ascites,no difference in ratio of CD3+ and CD4+/CD3+ and CD8+ T-cell counts was found between malignant and tuberculous pleural effusions or ascites.However,ratios of IFN-γ and IL-12 to IL-4 were higher in tuberculous pleural effusion or ascites(54±24 and 82±19vs.8±6 and 19±10,t=10.34 and 16.28,respectively,P＜0.01).Conclusions CD3+ and CD4+ Tcells can be aggregated in both malignant and tuberculous pleural effusions or ascites,80 nature (tuberculosis or malignancy)of pleural effusion or ascites can not be differentiated by CD4+ and/or CD8+ T-cell counts only,and determination of cytokines Th1 and Th2 can help their differentiation.     

Diagnostic and therapeutic value of thoracoscopy for pleural effusions: experience from 628 consecutive cases in China

Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis, pneumonia, etc. This means that both malignant and benign diseases can cause pleural effusions. Therefore, it is essential for clinicians to determine the etiology prior to the treatment of patients with pleural effusions.     

An evaluation of the diagnostic value of CA19-9 and CEA levels in patients with pancreatic cancer

Objective:The use of a combination of tumor markers may be an important tool in the early diagnosis of pancreatic cancer, which is the key to improving prognosis. The study aim was to investigate the diagnostic value of carbohydrate antigen 19-9(CA 19-9) and carcinoembryonic antigen(CEA) levels in patients with pancreatic cancer. Methods:An immunoradiometric assay was used to homochronously measure the serum CA19-9 and CEA levels in 78 pancreatic cancer cases and 64 healthy examinees in hospital. The normal reference values were CA19-9(0-39 U/ml) and CEA(0-3.4 ng/ml). Results: Mean serum CA 19-9 and CEA levels in patients with pancreatic cancer(406.55±60.18 U/ml, 12.43±1.25 ng/ml) were significantly higher(P＜0.01) than those in healthy examinees(16.54 ± 1.95 U/ml, 2.37 ± 0.17 ng/ml).The sensitivity of the combined detection of CA19-9 and CEA (92.31%) was significantly higher(P ＜ 0.05) than that of either marker alone (79.49%, 71.79%, respectively). In addition, the sensitivity to diagnose pancreatic cancer by detecting the serum CA19-9 and CEA levels was higher(P ＜ 0.05) in stage Ⅱ B +Ⅲ + Ⅳ(87.04%, 79.23%) than stage Ⅰ + Ⅱ A(62.50%, 54.17%). Conclusion: The combined detection of CA19-9 and CEA could overcome the deficiency of using single marker detection by improving the sensitivity to diagnose pancreatic cancer. At the same time, CA19-9 and CEA detection could be used to assess mesenteric artery invasion and the metastasis of lymphatics and distant organs in pancreatic cancer.     

Expression of soluble Toll-like receptors in pleural effusions

Background The Toll-like receptors （TLRs） represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.Methods Pleural effusion and serum samples were collected from 102 patients （36 with malignant pleural effusion, 36with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion）.The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay.Four classical parameters （protein, lactate dehydrogenase, glucose and C-reactive protein （CRP）） in the pleural fluid were also assessed.Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.Results The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively.Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843,0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion.Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters （protein, lactate dehydrogenase, glucose and CRP）.Conclusions The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions.Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.     

Expression of soluble triggering receptor expression on myeloid cells-1 in pleural effusion

Background Triggering receptors expressed on myeloid cells （TREM） proteins are a family of cell surface receptors expressed broadly by cells of the myeloid lineage. The aim of this study was to investigate the clinical significance of soluble TREM-1 （sTREM-1） in pleural effusions, and to determine the effects of pneumonia on pleural sTREM-1 concentrations. Methods Pleural fluid was collected from 109 patients who presented to the respiratory institute （35 with malignant pleural effusion, 31 with tuberculous pleural effusion, 21 with bacterial pleural effusion, and 22 with transudate）. The concentrations of sTREM-1, tumor necrosis factor-a （TNF-a） and interleukin-113 （IL-113） were determined in effusion and serum samples by enzyme linked immunosorbent assay （ELISA）. Results The concentrations of sTREM-1 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups （all P 〈0.001）. An sTREM-1 cutoff value of 768.1 ng/L had a sensitivity of 86% and a specificity of 93%. Pleural sTREM-1 levels were positively correlated with levels of TNF-a and IL-113. Patients with complicating bacterial pneumonia did not have elevated concentration of sTREM-1 in pleural effusion when compared with patients without pneumonia. Conclusions Determination of pleural sTREM-1 may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies. The occurrence of bacterial pneumonia did not affect pleural sTREM-1 concentrations.     

DIAGNOSTIC VALUE OF DENSITY GRADIENT CENTRIFUGATION FOR EXFOLIATIVE TUMOR CELLS IN MALIGNANT PLEURAL EFFUSIONS

To find out a specific method for diagnosis of malignant pleural effusions ( MPEs )with higher sensitivity and practicality. Methods The diagnosis of MPEs were made using density gradient centrifugation( DGC ) , smear cytologic examination( SCE) and pleural needle biopsy(PNB). Comparisons between these results and those of benign pleural effusions were also made. Results The positive rates of DGC, SCE and PNB for diagnosing MPEs were 94. 3 %, 62. 9% and 44.6%, respectively, and the positive rate of SCE combined with PNB for diagnosing MPEs was 73.2%. The positive rate of the exfoliative tumor cells ( ETCs ) by DGC was much higher than that of SCE or~and PNB with no false-positive. Conclusion The ETCs isolated by DGC from the MPEs is quite specific for the diagnosis of malignant tumors with higher sensitivity and practicality in clinico-patho-logical practice.     

麻疹的双相移位研究进展

近年新生儿、婴儿、成人麻疹患者逐年增加,临床表现一般仍较典型,成年人麻疹患者全身中毒症状较重。麻疹抗体检测结果阳性是主要的诊断依据。麻疹发病的双相移位的机理可能是,免疫保护力不足,婴儿出生时麻疹抗体力低。孕期母传胎的麻疹抗体减弱,母经乳汁传给婴儿的抗体减弱,成人麻疹抗体水平逐年下降。预防措施是怀孕前给予育龄妇女麻疹疫苗接种,鼓励母乳喂养,麻疹疫苗计划免疫适当提前,在成人追加麻疹疫苗的免疫,加强病毒变异的研究等。     

正常增殖期子宫内膜细胞增生状态的定量观察

以＾３氢－胸腺嘧啶核苷放射自显影法及ＨＥ染色，观察并分别测定了１８例正常子宫内膜增殖中期，１５例增殖晚期的腺上皮细胞或间质细胞的标记指数、分裂指数。结果显示：子宫内膜增殖晚期腺上皮细胞或间质细胞之ＬＩ均明显高于增殖中期。同时，增殖晚间质细胞之ＭＩ也明显高于增殖中期，即此两种细胞在增殖晚期中增生明显，其增生状态初步获得了定位定量测定的正常值。     

尿微量白蛋白检测在继发性肾脏疾病中的临床意义

目的探讨尿微量白蛋白（m-Alb）检测在继发性肾脏疾病中的临床意义。方法采用Beckman Immage全自动特种蛋白分析仪对糖尿病组、高血压组、心脏病组患者进行了m-Alb测定,同时与健康组结果作对比。结果m-Alb检测糖尿病组为3.7±5.26mg/dl,高血压组为7.5±8.18mg/dl,心脏病组为7.8±3.76mg/dl,健康组为0.66±0.48mg/dl,各试验组m-Alb增高百分率为糖尿病组48.9%,高血压组37.5%,心脏病组26.9%。结论尿蛋白阴性的糖尿病、高血压、心脏病患者进行m-Alb检测,可以监测病程的进展。     

人工全髋关节置换术的手术配合

目的：介绍人工全髋关节置换术的手术配合做法;方法：主要在手术配合的六个方面,解决防感染、防栓塞等问题。结果：30例人工全髋关节置换术均获成功,结论：手术配合是护士责任心和基本功的全面体现,对提高手术效果有至关重要的影响。     

80例局限性银屑病误诊原因分析

本文报告80例局限于小腿或手或足的银屑病。均经皮肤组织病理检查确诊。因部位比较特殊。受多种理化因素影响,使皮疹形态发生轻重程度不同的变化,常看不到典型损害,因而误诊为神经性皮炎,湿疹,慢性皮炎及癣等。作者对误诊原因进行了分析后,提出了鉴别诊断方法。     

腰椎间盘突出症再次手术的原因分析

目的解决腰椎间盘突出症手术中神经压迫。方法对1980～1998年再手术资料进行统计分析,讨论分析再手术原因,再次手术前影像学检查,观察病理变化以确定再手术方法。结果对11例随访6个月～1年,优7例(68．4％),良3例(36．8％),差1例(2．8％)。结论初次手术前详细查体和分析X线片,术中用导尿管和神经剥离探查,尽量避免髓核遗留,手术范围不宜太大,尽量减少对软组织和脊柱结构的破坏,避免形成硬膜囊与神经根粘连而致单纯形疤痕。     

妊娠晚期重度妊高征的监测

重度妊高征表现为高血压、蛋白尿、浮肿等症状 ,严重可以导致母婴死亡。对妊娠足月的重度妊高征 ,可以根据其临产与否及宫颈条件 ,立即决定其为阴道分娩或是剖宫产术。对于妊娠晚期的重度妊高征 ,因其胎龄不足月 ,胎儿生长发育及胎肺成熟度情况需通过一定时间的治疗 ,根据其病情变化来决定其治疗方案或终止妊娠的时机[1,2 ] 。这就需要我们对这一阶段的治疗进行监测 ,防止母儿并发症的发生。现将 2 0 0 0年至今我院收治妊娠晚期重度妊高征 30例的监测结果回顾分析如下。1　资料和方法1.1　研究对象　选择孕 31～ 36周重度妊高征 30例 ,其中 …