Plasma adenosine deaminase activity among HIV1 Clade C seropositives: relation to CD4 T cell population and antiretroviral therapy

BACKGROUND: Plasma adenosine deaminase and its isoenzymes(s) activities have been used as diagnostic marker for intracellular parasitism, including HIV infection, and malignancy of immune cells. HIV infection being primarily targeted against CD4 cells, it would be of interest to relate the activity of total plasma ADA and isoenzymes fractions to immune status and antiretroviral therapy. METHODS: In the present study, plasma total ADA activity (ADAT) including ADA1 and ADA2 isoenzyme(s) were assayed among HIV seropositive Clade C (n=90) comprising both asymptomatic (n=71) and symptomatic (n=19) and compared with that of HIV seronegatives (n=35). RESULTS: A significant increase in the activity of ADAT (16.30+/-0.80 v/s 6.18+/-0.30) as well as ADA1 (6.50+/-0.42 v/s 2.34+/-0.16) and ADA2 (9.79+/-0.53 v/s 3.85+/-0.23) isoenzyme(s) among the asymptomatic as well as the symptomatic subjects as compared to respective controls was noted. Increase in plasma ADAT activity, including ADA1 and ADA2 isoenzyme(s), were found to have negative correlation with CD4 counts (r, -0.273; p<0.05). The increased plasma ADAT activity among the asymptomatic HIV seropositive with CD4 counts>500 (13.2+/-1.65; p<0.01) as well as those who were on antiretroviral therapy (19.31+/-1.36; p<0.001) was evident. CONCLUSIONS: These findings suggest that plasma ADA can be a sensitive marker of an ongoing biological insult to host tissues either because of infection and/or side effects of medication. Measurement of plasma ADA activity, along with serological evidence for HIV infection may provide an alternate laboratory tool to monitor intracellular parasitism including secondary infection vis a vis the after effects of therapeutic outcome.     

Evaluation of hypoxic brain injury with spinal fluid enzymes, lactate, and pyruvate.

OBJECTIVE: To investigate the prognostic importance in neurologic recovery of the lumbar cerebrospinal fluid (CSF) variables creatine kinase (CK) and brain-type creatine kinase isoenzyme (CK-BB), lactate dehydrogenase (LDH) and its isoenzymes (LDH 1-5), CSF acid phosphatase, beta-D-N-acetylglucosaminidase activity, and CSF lactate, pyruvate, sodium, potassium, and calcium concentrations in patients who experienced cardiac arrest. DESIGN: Prospective clinical study with blood and CSF samples collected 4, 28, 76, and 172 hrs after resuscitation. SETTING: Medical ICU in a university hospital. PATIENTS: Twenty consecutive victims of out-of-hospital cardiac arrest. Eight patients recovered neurologically and 12 patients remained comatose or neurologically disabled until death. MEASUREMENTS AND MAIN RESULTS: CSF CK, CK-BB, LDH, and LDH isoenzyme 1-3 concentrations in all disabled patients were markedly increased at 76 hrs after the resuscitation. However, these variables were not changed in the recovered subjects. Patients (n = 7) with a mean CSF CK level of 25 +/- 33 (SD) U/L, CK-BB 23 +/- 33 U/L, and CSF lactate 3.8 +/- 0.9 mmol/L at 28 hrs after cardiac arrest remained unconscious and died. In the recovered patients, the mean CSF CK concentration was 2.0 +/- 1.5 U/L (p less than .001) and CSF lactate concentration 2.5 +/- 0.5 mmol/L (p less than .002). The lactate concentration was highest at 4 hrs after resuscitation, declining thereafter. Patients with a mean CSF total LDH level of 609 +/- 515 U/L and acid phosphatase 2.4 +/- 1.2 U/L 76 hrs after resuscitation died without regaining consciousness. In the recovered patients, the mean total CSF LDH activity was 82 +/- 58 U/L (p = .003) and CSF acid phosphatase was 0.8 +/- 0.5 U/L (p = .01) 76 hrs after resuscitation. CONCLUSIONS: CSF CK, CK-BB, and CSF lactate concentrations reflect a patient's outcome most reliably when measured within 28 to 76 hrs of the cardiac arrest. Similarly, CSF LDH, its isoenzymes 1-3, and CSF acid phosphatase concentrations, when measured at 76 hrs, can be used to monitor the patient's outcome after cardiac arrest. When correlated with Glasgow Coma Scale scores, the closest negative correlation was again seen in CSF CK and CK-BB at 28 and 76 hrs, as well as in LDH, LDH1-3, and acid phosphatase values at 76 hrs. The negative correlation between CSF lactate and Glasgow Coma Scale scores was most distinct at 28 hrs.     

Significance of cerebrospinal fluid adenosine deaminase isoenzymes in tuberculous (TB) meningitis

Adenosine deaminase (ADA) exists as two isoenzymes, ADA(1) and ADA(2). It appears that the ADA(2) isoenzyme originates mainly from monocytes and macrophages. In tuberculous pleural effusions most of the ADA activity consists of ADA(2). The aim of this prospective study was to analyse ADA isoenzymes in the CSF of patients with meningitis to investigate whether the expected rise of the ADA(2) isoenzyme would occur in tuberculous meningitis. ADA isoenzyme analysis was performed on the CSF of 15 patients with tuberculous and 11 patients with bacterial meningitis by an automated kinetic enzyme coupled assay in the presence and absence of a specific ADA inhibitor. The ratio of ADA(2)/ADA(Total) was > 0.8 in 14/15 patients with tuberculous meningitis. In bacterial meningitis the ratio was > or =0.8 in 10/11 patients. The ADA(2) isoenzyme is the major contributor to increased ADA activity in the CSF of patients with tuberculous meningitis, probably reflecting the monocyte-macrophage origin of the ADA.     

Diagnostic scoring system for tuberculous meningitis among adult patients with non-suppurative and non-bacterial meningitis

Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis. The definite diagnosis of this disease is difficult and can result in delayed treatment. Conventional culture yields low sensitivity while high-sensitivity diagnostic techniques are costly and unpractical. Adenosine deaminase (ADA) is used to diagnose several settings of extra-pulmonary tuberculosis but it is limited in TBM especially among HIV-infected patients. We retrospectively reviewed the data of patients with non-suppurative meningitis and compared the patient data with TBM and other causes including carcinomatous, lymphomatous, lymphocytic and fungal meningitis. We found that HIV infection, diabetes mellitus, duration of symptoms <14 days, radiologic findings of hydrocephalus, and CSF ADA level >10 IU were associated with TBM. The scoring system based on these parameters and their coefficients in the final model achieved an area under the receiver operating characteristic curve of 0.95,625. The indices were HIV infection = 5, diabetes mellitus = 3, duration of symptoms <14 days = 5, hydrocephalus = 4, and ADA in CSF >10 IU = 5. Based on the assumed costs of the patients with false negative and false positive, an appropriate cut off value of 10 was selected and the sensitivity was 92% and specificity was 89%.     

Analysis of serum adenosine deaminase (ADA) and ADA1 and ADA2 isoenzyme activities in HIV positive and HIV-HBV co-infected patients

Objectives

To determine adenosine deaminase (ADA) activity as a possible diagnostic marker in HIV and HIV–HBV co-infected patients.

Design and methods

Blood samples were collected from 72 healthy, 33 HIV positive and 30 HIV–HBV co-infected subjects. Blood CD4+ cell count was recorded and serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total ADA, and ADA1 and ADA2 isoenzyme activities were determined.

Results

Serum ALT, AST, total ADA and ADA2 isoenzyme activities were significantly higher in HIV positive and HIV–HBV co-infected groups compare to the control (p < 0.05), whereas serum ALP showed no differences between groups. CD4+ cell counts markedly decreased in all patients and showed a significant inverse correlation with ADA activities (R² = 0.589, p < 0.001).

Conclusions

Serum ADA was significantly increased in HIV and HIV–HBV co-infections. Therefore, because of its low cost and simplicity to perform, ADA activity might be considered as a useful diagnostic tool among the other markers in these diseases.     

脑脊液MRD联合乳酸脱氢酶检测在中枢神经系统白血病诊断中的应用价值

目的探讨急性白血病脑脊液微小残留白血病细胞(MRD)联合乳酸脱氢酶(LDH)检测在中枢神经系统白血病(CNSL)早期诊断中的应用价值,为临床诊断和病情发展及治疗效果评价提供实验室诊断依据。方法选择该院住院患者无血液病及中枢神经系统器质性病变、脑脊液常规和生化检验各项指标均为正常者30例作为对照组,骨髓穿剌FAB形态学和流式细胞免疫分型确诊的急性白血病(AL)96例作为疾病组。用流式细胞术法检测对照组和疾病组脑脊液中的MRD,用速率法检测对照组和疾病组脑脊液中LDH的活性,并对检测结果进行比较分析。结果 96例急性白血病患者中,30例伴中枢神经系统白血病脑脊液MRD检测阳性者13例,阳性率为43.33%。66例无CNSL组未检出MRD。96例急性白血病患者中30例伴中枢神经系统白血病(CNSL)组脑脊液LDH水平为(30.54±10.29)U/L,显著高于无CNSL组(16.16±7.12)U/L,两者比较差异具有统计学意义(P0.05)。结论急性白血病脑脊液中MRD、LDH检测可作为早期诊断CNSL的实验室诊断指标,MRD联合LDH检测可提高CNSL阳性诊断率。     

Sepsis alerts in EMS and the results of pre-hospital ETCO2

BackgroundField sepsis alerts have the ability to expedite initial ED sepsis treatment. Our hypothesis is that in patients that meet EMS sepsis alert criteria there is a strong relationship between prehospital end-tidal carbon dioxide (ETCO2) readings and the outcome of diagnosed infection.MethodsIn 2014, our EMS service initiated a protocol requiring hospitals to receive notification of a “sepsis alert” on all suspected sepsis patients. The EMS service transports 70,000 patients/year to a number of urban centers. All patients transported to our major urban teaching hospital by our EMS service in one year in which a sepsis alert was announced were included in this study. The primary outcome variable was diagnosed infection and secondary outcomes were hospital admission, ICU admission and mortality. Positive lactate was defined as >4.0 mmol/L. ROC curve analysis was used to define the best cutoff for ETCO2.Results351 patients were announced as EMS sepsis alert patients and transported to our center over a one year period. Positive outcomes were as follows: diagnosed infection in 28% of patients, hospital admission in 63% and ICU admission in 11%. The correlation between lactate and ETCO2 was −0.45. A ROC curve analysis of ETCO2 vs. lactate >4 found that the best cutoff to predict a high lactate was an ETCO2 of 25 or less, which was considered a positive ETCO2 (AUC = 0.73). 27% of patients had a positive ETCO2 and 24% had a positive lactate. A positive ETCO2 predicted a positive lactate with 76% accuracy, 63% sensitivity and 80% specificity. 27% of those with a positive ETCO2 and 44% of those with a positive lactate had a diagnosed infection. 59% of those with a positive ETCO2 and 89% of those with a positive lactate had admission to the hospital. 15% of those with a positive ETCO2 and 18% of those with a positive lactate had admission to the ICU. Neither lactate nor ETCO2 were predictive of an increased risk for diagnosed infection, hospital admission or ICU admission in this patient population.ConclusionWhile ETCO2 predicted the initial ED lactate levels it did not predict diagnosed infection, admission to the hospital or ICU admission in our patient population but did predict mortality.     

联合检测ADA、LDH和CRP对结核性与恶性胸腔积液的诊断价值

目的探讨联合测定胸腔积液中的腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)和C反应蛋白(CRP)在结核性与恶性胸腔积液上鉴别诊断的价值。方法酶法和免疫比浊法检测59例结核性胸腔积液和17例恶性肿瘤积液中ADA、LDH和CRP的含量,并进行统计学分析。结果结核性胸腔积液中ADA和CRP水平显著高于恶性积液的值,具有统计学意义,P<0.01。但是,结核性胸腔积液中LDH含量低于恶性积液的LDH值,有显著性差异,P<0.01。结论胸腔积液中ADA、LDH和CRP的联合检测,对鉴别结核性与恶性胸腔积液有重要价值。     

脑脊液热休克蛋白70水平对小儿中枢神经系统感染的鉴别诊断价值

目的 探讨脑脊液(CSF)中热休克蛋白70(HSP70)的变化及其在小儿中枢神经系统感染中的诊断价值.方法 采用蛋白质免疫印迹技术检测13例化脓性脑膜炎(化脑组)、38例病毒性脑膜炎(病脑组)、7例结核性脑膜炎(结脑组)及46例非中枢神经系统感染患儿(对照组)CSF中HSP70水平.常规生化检测CSF的细胞总数、白细胞数、乳酸脱氢酶(LDH)、蛋白定量、腺苷脱氨酶、葡萄糖、压力及氯(Cl-) 水平.结果 化脑组(76.61±27.69)、病脑组(33.65±16.93)及结脑组(65.85±33.16)的HSP70水平均高于对照组(23.28±19.77),差异有显著性(P＜0.05或P＜0.01);化脑组及结脑组HSP70水平均高于病脑组(P均＜0.01);化脑组与结脑组之间HSP70水平差异无显著性(P＞0.05).相关性分析显示:HSP70水平增高程度与CSF的细胞总数(r=0.298,P=0.002)、白细胞数(r=0.274,P=0.005)、LDH(r=0.322,P=0.001)、蛋白定量(r=0.629,P＜0.001)、腺苷脱氨酶水平(r=0.363,P=0.001)均呈显著正相关,与CSF中葡萄糖水平呈显著负相关(r=-0.443,P＜0.001),与CSF压力(r=0.001,P=0.993)及Cl-水平(r=0.148,P=0.133)无相关性.结论 小儿中枢神经系统感染时,CSF中HSP70增高;检测CSF中HSP70水平有助于化脑、结脑与病脑的鉴别诊断.     

Role of biochemical tests in the diagnosis of exudative pleural effusions

OBJECTIVES: To examine the diagnostic utility of pleural adenosine deaminase (PADA), pleural lactate dehydrogenase (PLDH), and several other biochemical tests in bronchogenic carcinoma and malignant mesothelioma, and to compare biochemical characteristics of their fluid with nonmalignant pleural effusions. DESIGN AND METHODS: This study consisted of 226 patients diagnosed with malignant (75), tuberculous (65), and parapneumonic pleural effusions (86). We examined the following biochemical parameters in the pleural fluid and serum: adenosine deaminase, lactate dehydrogenase, glucose level, protein level, pleural fluid/serum ADA ratio (P/S ADA), P/S LDH ratio, and P/S protein ratio. RESULTS: Parapneumonic pleural effusions had a significantly higher level of PLDH and of P/S LDH than malignant and tuberculous pleural effusions (P = 0.000), and malignant pleural effusions had a higher level of PLDH than tuberculous pleural effusions. Tuberculous and parapneumonic effusions had significantly higher levels of PADA than those of malignant effusions (P = 0.000). When the 54 patients having bronchogenic carcinoma were compared to the remaining 21 mesothelioma patients, the former had a lower median level of PADA (P = 0.001) with a higher level of PLDH (P = 0.05). CONCLUSION: Our results show that high pleural LDH and low PADA levels are suggestive of pleural effusion due to bronchogenic carcinoma, whereas high levels of PADA alone can be indicative of tuberculous pleural effusion and high levels of both markers can show complicated parapneumonic effusions or empyema.     

Chemical analyses for early differential diagnosis between bacterial and viral meningitis

The present study was undertaken to evaluate the benefit of measuring different chemical parameters in the cerebrospinal fluid (CSF), at the time of admittance to hospital, for rapid differentiation between bacterial and viral meningitis. In addition to the leucocyte count, the CSF concentration of total protein, glucose (together with blood glucose), lactate, lactate dehydrogenase and creatine kinase was determined. The results revealed that the CSF lactate and the CSF:blood glucose ratio were the two best parameters for this purpose. When the information from these analyses was combined a complete separation between the two kinds of meningitis could be obtained.     

Adenylate kinase activity in the cerebrospinal fluid of hypoxic newborns

Adenylate kinase (AK) activity in the cerebrospinal fluid (CSF), described as a marker of brain edema and lesions in adults, was studied in 79 newborns with severe respiratory distress within 24 h after admission to the Intensive Care Unit (ICU). The CSF-AK activity was compared with CSF lactate concentration, CSF lactate dehydrogenase activity (LDH), and CSF and serum creatine kinase isoenzyme BB (CK-BB) activity. Newborns were divided into Group I with moderate to severe brain dysfunction and Group II with mild or no detectable brain dysfunction on discharge from the ICU. Mean CSF-AK activity (11.31 U/L) in Group I was significantly (p less than 0.001) higher than in Group II (2.82 U/L). Correlation between CSF-AK and CSF lactate was r = 0.714, p less than 0.01 and between CSF-AK activity and CSF-LDH activity was r = 0.550, p less than 0.01 in Group I. Preliminary data indicate that CSF-AK activity within 24 h after ischaemia is an indicator of hypoxic brain lesions in newborns. Its prognostic value for the infant's development remains to be determined by further study.     

结核性脑膜炎患者脑脊液中腺苷脱氨酶的动态观察

目的　动态观察结核性脑膜炎患者脑脊液中腺苷脱氨酶的变化 ,以期对结核性脑膜炎的早期诊断和预后判断提供依据。方法　采用比色法动态检测 4 3例结核性脑膜炎患者脑脊液中腺苷脱氨酶活力的变化 ,并以 2 2例病毒性脑膜炎患者作为对照组。结果　 4 3例结核性脑膜炎患者酶活性较对照组明显升高 ,差异有统计学意义 (P <0 .0 5 ) ,治疗后 2周内结核性脑膜炎患者腺苷脱氨酶活力较其他时间明显增高 ,此后腺苷脱氨酶活力随治疗时间的延长呈进行性下降趋势。另外 8例有不同程度的神经系统并发症结核性脑膜炎患者呈现持续高水平。结论　检测脑脊液中腺苷脱氨酶是早期诊断结核性脑膜炎的一个简单而可靠的方法 ;动态观察腺苷脱氨酶还能对疾病的预后判断提供依据。     

成年人脑脊液CK,AST,LDH和GPx活性检测对脑血管病的鉴别诊断价值

目的 研究脑脊液(CSF)肌酸激酶(CK)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)和谷胱甘肽过氧化物酶(GPx)四种酶的活性水平变化对脑血管病的鉴别诊断价值。方法 利用日立7600全自动生化分析仪检测脑血管病患者、疾病对照组(颅脑损伤、脑出血和颅内感染)及健康对照组CSF上述四种酶的活性水平。结果 脑血管病、颅脑损伤、脑出血、颅内感染的CK,AST和LDH酶活性均有不同程度升高,其中LDH在脑血管病患者CSF中升高最为显著(P<0.05),其诊断界值为79.37 U/L(P<0.05),约登指数为0.673; GPx仅在脑血管病患者CSF中出现显著降低(P<0.05),其诊断界值为13.56 U/L(P<0.05),约登指数为0.648; CK和AST在脑血管病患者鉴别诊断中无显著性诊断价值(P>0.05)。结论 CSF中LDH和GPx在脑血管病的诊断与鉴别诊断及评估损伤和氧化应激状态中具备潜在价值,值得进行更大标本量和更多疾病种类的研究。     

血清腺苷脱氨酶测定在涂阴肺结核诊疗中的应用价值

目的：探讨血清腺苷脱氨酶(adenosine deaminase,ADA)在涂阴肺结核诊断及治疗中的应用价值。方法对152例涂阴肺结核、80例涂阳肺结核、63例非结核性肺部疾病及227例健康志愿者进行血清 ADA 测定,并对测定结果进行比较,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算敏感性和特异性。所有活动性肺结核患者给予标准方案的抗结核治疗,于治疗的1月末、2月末、6月末测定血清 ADA,与治疗前结果进行比较。结果治疗前涂阴肺结核组 ADA(10.795±4.164)U/L 高于非结核肺部疾病组(9.354±2.401)U/L 和健康对照组(5.971±1.734)U/L,涂阳肺结核组(14.441±6.267)U/L 高于涂阴肺结核组(10.795±4.164)U/L,差异有统计学意义。共有57例涂阴肺结核患者和45例涂阳肺结核患者于抗结核治疗1月末、2月末、6月末 进 行 了 血 清ADA 测定,两组患者治疗2月末、6月末的血清 ADA 值与疗前相比均有下降,差异有统计学意义(P <0.05)。ROC曲线分析显示以血清 ADA=6.95 U/L 为临界值鉴别涂阴肺结核和健康对照的曲线下面积(Area Under Curve, AUC)为0.921(95% CI =0.894~0.947),敏感性为94.0%,特异性为70.7%。以 ADA=18 U/L 为临界值鉴别涂阴肺结核与非结核性肺部疾病的特异性为100%,敏感性为5.9%。结论涂阴肺结核患者的血清 ADA 水平高于健康人群和非结核性肺部疾病患者,血清 ADA 可以在一定程度上协助诊断涂阴肺结核,适时检测可以反映肺结核的治疗疗效。     

Adenosine deaminase activity in chronic lymphocytic leukemia. Relationship to B- and T-cell subpopulations.

The level, phenotypes, and isozyme distribution of adenosine deaminase (ADA) were determined in lymphocytes from patients with chronic lymphocytic leukemia (CLL). The ADA level in lymphocytes from patients with untreated CLL was consistently lower than in lymphocytes from normal subjects. No significant differences were found in the phenotype or isozyme distribution. In untreated patients, the ADA level was inversely correlated with the lymphocyte count and the percentage of bursa-equivalent (B) cells. After therapy, a diminution in the lymphocyte count was associated with an increase of ADA activity towards normal levels. The ADA levels were slightly higher in the thymus-derived (T) than in the B lymphocytes from normal subjects. The B cells had lower activity than T cells in patients with CLL. They also had a lower activity than the B cells from normal subjects. The ADA level was 2.3-fold higher in T cells from patients with CLL than in normal T cells. The decrease in ADA levels is an anomaly that is reversible and appears to be a reflection of the proliferation of abnormal B cells in this disorder.     

非人类免疫缺陷病毒感染的肺孢子菌肺炎患者的临床特征

[目的]探讨非人类免疫缺陷病毒(HIV)感染的肺孢子菌肺炎(PCP)患者的临床特征.[方法]收集2018年10月至2019年9月在本院呼吸与危重症医学科诊治的非HIV感染的PCP患者的临床资料,分析其临床特征.[结果]研究纳入45例患者,19例(42.2％)死亡.基础疾病中最常见的为自身免疫性疾病,其次为恶性肿瘤、实体...     

Beta-site amyloid precursor protein cleaving enzyme 1 (BACE1) as a biological candidate marker of Alzheimer's disease

Alzheimer's disease (AD) is characterized by the progressive formation of insoluble amyloid plaques and vascular deposits consisting of the amyloid beta-peptide (Abeta) in the brain. Pathological mechanisms are already active early in the presymptomatic stage of AD. BACE1, beta-secretase, is one of the two key enzymes in amyloid precursor protein (APP) processing; the other being gamma-secretase. The Abeta peptide results from cleavage of APP initially by BACE1 to produce the C99 fragment and releases soluble APPbeta (sAPPbeta); C99 is then further cleaved by gamma-secretase leading to the Abeta peptide. Increased BACE1 activity and elevated levels of insoluble Abeta peptide have been shown in brain tissue of patients with sporadic AD. Since the CSF is in direct contact with the extracellular space of the central nervous system, biochemical changes in the brain can potentially be reflected in CSF. Therefore, CSF-based detection of BACE1 levels and activity might be valuable in aiding early detection and prediction, particularly in preclinical or even presymptomatic subjects who are at risk of AD. Recently, we were among the first groups to quantitatively analyse the enzymatic activities and protein levels of BACE1 in the CSF. Preliminary research using recently developed BACE1 ELISAs, BACE1 enzymatic activity, sAPPbeta and total Abeta1-x ELISAs were used by examining these hypothesis driven functional candidate markers in subjects with clinically diagnosed AD and amnestic MCI. Two sandwich ELISAs were used and BACE1 enzymatic activities were seen by synthetic fluorescence substrate and total Abeta levels by sandwich-ELISA. Moreover, elevated CSF levels of BACE1 protein were associated with an increased risk ratio in MCI. Interestingly, amnestic MCI subjects showed increased levels of BACE1 activity compared to HC and AD patients. For total Abeta and tau, increased CSF levels were associated with a higher risk of MCI compared to HC as well. BACE1 activity was significantly correlated with BACE1 protein concentration and total Abeta levels, with Abeta being itself correlated with the BACE1 protein level. Currently, independent studies are ongoing to validate BACE1 and functionally associated proteins as candidate biomarkers for early detection, prediction, progression as well as for biological activity in AD.     

Zidovudine-associated type B lactic acidosis and hepatic steatosis in an HIV-infected patient

A 34-year-old obese woman with human immunodeficiency virus (HIV) infection diagnosed a year earlier was seen because of nausea, vomiting, and intermittent diarrhea for 3 weeks. Her current medications included zidovudine. Physical examination revealed tachypnea and tender hepatomegaly. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration. Liver enzymes were within normal range except for elevated lactate dehydrogenase (LDH). The serum bicarbonate value was low, with a lactate level three times normal. The tachypnea and dyspnea worsened as lactate concentrations rapidly increased to 15 times normal. Although her Po2 and cardiac index were initially adequate, the patient had acute respiratory failure. She died with multiorgan dysfunction, including hepatic failure, severe lactic acidemia, disseminated intravascular coagulation, and renal failure. Autopsy revealed hepatomegaly and massive steatosis. Physicians should consider lactic acidosis in patients taking zidovudine and having unexplained tachypnea, dyspnea, and low serum bicarbonate concentrations.     

肌酐、乳酸脱氢酶、D－二聚体与急性缺血性脑卒中后患者日常生活活动能力缺陷严重程度的相关性分析雒晓甜1,刘邦忠1,戚少华1,张键1*

目的：分析急性缺血性脑卒中后患者日常生活活动能力缺陷严重程度的可能危险因素,探讨尿酸(UA)、肌酐(CREA)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血糖（GLU）、乳酸脱氢酶（LDH）、前白蛋白(PA)、D-二聚体（D-Dimer）与急性急性缺血性脑卒中后日常生活活动能力缺陷的相关性。方法：筛选2019年8月到2020年5月复旦大学附属中山医院康复医学科住院病房的急性缺血性脑卒中患者,观察急性缺血性脑卒中后日常生活活动能力缺陷严重程度及相关血清生化指标的变化。按照入组标准和排除标准分为4组:轻度、中度、严重及极严重日常生活活动能力缺陷组。结果：根据单因素方差分析发现,急性缺血性脑卒中患者日常生活活动能力缺陷严重程度和患者入院时的CREA、TC、LDL-C、LDH、D-Dimer有相关关系。根据二者之间的Spearman 相关性分析,可以得出,急性缺血性脑卒中患者日常生活活动能力缺陷严重程度与CREA、LDH、D-Dimer有显著性的关系,CREA相关系数为-0.312,说明急性缺血性脑卒中患者日常生活活动能力缺陷严重程度与肌酐呈负相关;LDH相关系数为0.353,说明急性缺血性脑卒中患者日常生活活动能力缺陷严重程度与乳酸脱氧酶呈正相关;D-Dimer相关系数为0.503,说明急性缺血性脑卒中患者日常生活活动能力缺陷严重程度与D－二聚体呈正相关。结论：在脑卒中的急性期,应早期检测患者血清中肌酐、乳酸脱氢酶、D-二聚体含量,早期干预,对脑卒中后引发肾功能、心肌功能、凝血功能损伤的改善具有积极意义。