C反应蛋白、降钙素原和血小板计数联合检测对细菌性肝脓肿预后的预测价值

目的 探讨C反应蛋白(CRP)、降钙素原(PCT)和血小板计数(PLT)联合检测对细菌性肝脓肿(PLA)预后的预测价值。方法 选择2019年6月至2021年12月在南京市中医院接受治疗的98例PLA患者为研究对象。根据临床症状、血清学、影像学等结果将患者分为轻症组(n=29)和中重症组(n=69),根据患者的预后分为预后良好组(n=67)和预后不良组(n=31)。另选择40名同期在本院体检健康者为对照组。采集所有受试者空腹静脉血10 mL,采用全自动免疫发光分析仪检测血清CRP、PLT水平，采用双抗夹心免疫化学发光法检测血清PCT水平。收集所有患者的临床资料，采用单因素和多因素logistic回归分析影响PLA患者预后的危险因素，绘制受试者操作特征(ROC)曲线分析血清CRP、PCT、PLT对PLA患者预后的预测价值。结果 轻症组、中重症组患者血清CRP、PCT、PLT水平显著高于对照组(P<0.05);中重症组患者血清CRP、PCT、PLT水平显著高于轻症组(P<0.05)。单因素分析结果显示，预后良好组与预后不良组患者的性别、最高体温、脓肿位置、腹部手术史、合并高血压比...     

肿瘤手术患者大量输血之后部分血液检验指标变化情况分析

目的分析肿瘤手术患者大量输血之后部分血液检验指标变化情况。方法选取我院2017年6月至2018年9月的60例接受大量输血的肿瘤手术患者进行研究,经过大量输血后对患者的血小板计数、凝血四项、血清电解质、肝功能和肾功能等血液检验指标进行分析。结果大量输血后,血小板计数(PLT),国际标准化比值(INR),纤维蛋白原(FIB)含量与输血前比较明显减少,凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)与输血前相比时间明显延长,差异显著(P0.05);血清Na+与Cl~-差异不明显(P 0.05),血清K~+、Ca~(2+)、Mg~(2+)的浓度与输血前相比明显下降,组间差距较大,有统计学意义(P0.05);大量输血后血清总蛋白(TP)较输血前明显减少,丙氨酸氨基转移酶(ALT)、冬氨酸氨基转移酶(AST)有明显升高,差异显著(P0.05),但血清总胆红素(TBIL)无显著差异(P 0.05);大量输血后尿酸(UA)、尿素氮(BUN)、肌酐(Cr)等指标无明显差异(P 0.05)。结论大量输血对肿瘤手术患者非常重要,临床医师要及时检测并观察大量输血后患者的血小板计数、凝血四项、血清电解质、肝功能和肾功能等血液检验指标,帮助患者预防并发症的发生。     

ITP患者血小板计数与PDW、MPV的相关性分析

目的探讨原发性血小板减少性紫癜(ITP)患者血小板计数(PLT)与血小板分布宽度(PDW)及血小板平均体积(MPV)的相关性。方法 2010年6月～2011年6月收集本院168例ITP患者全血标本,统计其血小板计数情况,将168例患者按照PLT<30×109,PLT:(30～60)×109,PLT:(60～100)×109,PLT>100×109分为4组,按照配伍组设计的方差分析的统计学方法分析所得结果,探讨ITP患者PLT与PDW及MPV的相关性。结果 ITP患者的PLT越少,MPV越大,PDW越高;随着患者的治疗,当PLT计数升高时,PDW和MPV都趋于减小。结论 ITP患者PLA与PDW及MPV有一定相关性。     

红细胞体积分布宽度与冠心病的关系研究

目的探讨红细胞分布宽度(RDW)与冠心病(CHD)的关系。方法选取冠状动脉造影确诊的152例CHD患者为CHD组,67例健康体检人群为对照组。对比分析两组人群的RDW、红细胞计数(RBC)、血红蛋白(HGB)、红细胞平均体积(MCV)、血细胞比容(Hct)、白细胞计数(WBC)、血小板计数(PLT)、平均血小板体积(MPV)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌肝(Cr)、尿素氮(BUN);采用改良Gensini积分法评价冠状动脉病变的严重程度。结果与对照组比较,CHD组RDW明显升高(P<0.05)。结论 RDW与CHD及冠状动脉病变严重程度存在一定关系,可以预测其严重程度。     

侵袭性肺炎克雷伯菌肝脓肿综合征12例临床特征分析

目的总结分析侵袭性肺炎克雷伯菌肝脓肿综合征(IKLAS)患者的临床特征, 以提高对该病的认识。方法回顾性分析株洲市中心医院2020年1月至2023年1月确诊为IKLAS的12例患者的临床资料。结果 12例患者中男性6例, 女性6例, 年龄49～90(65.3±12.2)岁, 9例合并糖尿病。主要临床表现为发热(9例), 畏寒(6例), 寒战(4例), 恶心、呕吐(2例), 上腹痛(2例), 乏力、纳差(2例), 咳嗽、咳痰(1例), 意识障碍(1例), 咯血(1例)。8例患者白细胞计数水平升高, 10例淋巴细胞计数减少, 3例血小板计数减少。所有患者C反应蛋白、降钙素原水平均升高。所有患者血清白蛋白水平均降低。7例患者丙氨酸氨基转移酶水平升高, 7例门冬氨酸氨基转移酶水平升高。8例患者肝脓肿位于肝右叶, 1例位于肝左叶, 3例发生于双侧;7例为单发脓肿, 5例为多发脓肿。病原学标本主要来源于肝脓液和血液培养, 分别有10例和5例阳性。侵袭部位或系统主要为肺和血液系统, 分别为10例和5例。12例患者培养鉴定的肺炎克雷伯菌多为敏感菌株, 总体耐药率低。所有患者经抗感染治疗, 其中10例患...     

血小板的变化对急性有机磷中毒患者预后的影响

目的:探讨血小板的变化对有机磷中毒患者预后的影响。方法:将167例有机磷中毒患者按血小板(PLT)是否减少分为PLT减少组和PLT非减少组,按随访结果再分为存活组和死亡组,所有患者入院后行中毒程度评估;记录血小板在1、3、5、7、10 d血小板计数,观察多器官功能障碍(MODS)发生率。结果:PLT减少组住院死亡率及多器官功能衰竭发生率明显高于PLT非减少组(P0.05),但有机磷中毒初期病情程度分布无差异性(P0.05);死亡组与生存组相比血小板计数多在第5天后进行性下降(P0.05);结论:有机磷中毒患者血小板的进行性下降能在一定程度上反应患者预后不良。     

APRI联合血小板计数短期变化率对脓毒症相关肝损伤的预测价值

目的 探讨天冬氨酸转移酶与血小板比值指数(aspartate transaminase to platelet ratio index,APRI)联合血小板计数短期变化率预测脓毒症相关肝损伤(sepsis-related liver injury,SRLI)发生的临床价值。方法 回顾性选择2018年8月~2021年1月徐州医科大学附属医院重症医学科(intensive care unit,ICU)收治的脓毒症患者。收集患者的临床资料,根据入住ICU28天内是否发生肝损伤分为SRLI组和脓毒症非肝损伤组,比较两组患者各指标的差异。采用多因素Logistic回归分析筛选发生SRLI的危险因素;采用受试者工作特征(ROC)曲线评估APRI联合血小板计数短期变化率对SRLI发生的预测效能。结果 共入组222例脓毒症患者,其中SRLI组102例,脓毒症非肝损伤组120例;SRLI组男性患者更多、体重指数更大,急性生理与慢性健康状况评分Ⅱ及序贯器官衰竭评分更高,ICU住院时长、机械通气时间更长,行气管切开术的患者更多,28天病死率更高;SRLI组患者在天冬氨酸氨基转移酶、谷氨酸氨基转移酶、谷氨酰转移酶、直接胆红素、总胆红素、乳酸水平上明显高于脓毒症非肝损伤组,SRLI组患者血小板计数较脓毒症非肝损伤组更低(P均＜0.05),SRLI组患者的APRI及血小板计数短期变化率较脓毒症非肝损伤组患者更大(P＜0.001);多因素Logistic回归分析显示,谷氨酸氨基转移酶、总胆红素、APRI、血小板计数短期变化率为预测SRLI发生的独立危险因素。ROC曲线结果显示,APRI预测SRLI发生的ROC曲线下面积(AUC)为0.841(95% CI:0.788～0.894),血小板计数短期变化率的AUC为0.787(95% CI:0.728～0.847);而 APRI联合血小板计数短期变化率预测SRLI发生的AUC为0.905,当取最佳截断值0.44时,敏感度为82.4%,特异性为88.2%,优于单一指标对SRLI的诊断预测价值。结论APRI及血小板计数短期变化率可很好的预测SRLI的发生,当两者联合时,对SRLI发生的预测价值更高。     

腹腔镜胃癌根治术中应用雷替曲塞腹腔灌注化疗的安全性研究

目的 评估腹腔镜胃癌根治术中使用雷替曲塞腹腔灌注化疗的安全性指标及不良反应发生情况。方法选取我院2018年5月至2019年5月内62例行腹腔镜胃癌根治术的进展期胃癌患者,随机分为两组,每组各31例。对照组患者采用常规腹腔镜胃癌根治手术,观察组患者在常规腹腔镜胃癌根治术基础上联合雷替曲塞腹腔灌注化疗。观察并评估两组患者的相关毒性指标和不良反应发生情况。结果 两组术前术后血常规指标包括白细胞计数(WBC)、血小板计数(PLT)、红细胞计数(RBC)和肝肾功能指标血肌酐(Cr)、血尿素(BUN)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)比较,差异无统计学意义(P0.05);观察组与对照组不良反应发生率分别为32.26%和38.71%,两组比较,差异无统计学意义(P0.05)。结论 进展期胃癌患者术中采用雷替曲塞腹腔灌注化疗相对安全可靠,并没有增加患者的相关毒性指标与不良反应。     

肝衰竭患者人工肝治疗前后疗效分析

目的探析肝衰竭患者采用人工肝治疗前后效果,以及不同方式人工肝对治疗的影响。方法针对本院2014年1月至2016年9月收治的116例肝衰竭患者采用人工肝治疗,对比治疗前效果差异。结果针对本组研究患者采用人工肝治疗,检测人工肝治疗前后患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、谷氨酰转肽酶(GGT)、尿素氮(Bun)、血钾(K+)、红细胞(WBC)、血红蛋白(Hb)、血小板(PLT)、凝血酶原时间(PT)等数值均有明显下降趋势,但是患者白蛋白(ALB)、血钠(Na+)、对苯二甲酸(PTA)、中性粒细胞率等有上升。结论针对肝衰竭患者使用不同人工肝治疗能不同程度改善患者的肝功能、凝血功能,但是也可导致血钠上升、血钾下降、血小板计数和血红蛋白下降,中性粒细胞上升等情况。因此,应针对患者具体病情情况,适当选择人工肝治疗方式,以利于疾病治疗。     

干扰素α-2b联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化及其临床意义

目的:探讨干扰素α-2b(INF-α2b)联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化,阐明影响外周血细胞数量的相关因素。方法:选择343例慢性丙型肝炎患者(有慢性肝炎的症状且抗-HCV和HCV-RNA阳性),均给予药物INF-α 2b 500 万U、隔日1次、皮下注射,利巴韦林 15 mg·kg^-1·d^-1 口服,疗程48周;在基线、2周、12周、24周、36周和48周对患者进行血常规、HCV RNA定量等检测,治疗后60、72和96周进行随访。出现中性粒细胞绝对值数减少、贫血及血小板计数减少的患者依据《2010丙型肝炎防治指南》进行相应治疗或随访观察。结果:治疗过程中中性粒细胞减少症发病率为40.5%(139例),贫血发病率为48.4%(166例),血小板减少症发病率为39.9%(137例)。治疗结束后仍有个别患者出现外周血细胞数量改变。抗病毒治疗过程中,外周血细胞数量减少多出现在治疗开始至12周内。治疗2周内中性粒细胞、血红蛋白和血小板计数即有明显下降,至第12周时同时降到最低值,12周后出现缓慢上升,治疗结束时(48周)虽较12周恢复明显,但仍未达到治疗前水平,60~72周时趋于平稳且恢复到治疗前水平。基线中性粒细胞绝对值、血小板计数、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肝纤维化程度与中性粒细胞减少症的发生及严重程度有关联(P<0.05)。性别与贫血的发生有关联,基线血红蛋白水平与贫血的发生及严重程度均有关联(P<0.05)。性别、基线中性粒细胞绝对值、血小板计数、AST、ALT、γ-谷氨酰转肽酶(γ-GT)、肝纤维化程度与血小板减少症的发生有关联(P<0.05)。结论:抗病毒治疗2周内慢性丙型肝炎患者外周血细胞数量即有明显下降,12周时降至最低,临床医生应及时对患者进行随访及干预,避免严重不良事件的发生。根据基线性别、外周血细胞水平、肝功能和肝纤维化程度可评估抗病毒过程中患者外周细胞数量是否减少及严重程度。     

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.