血清游离脂肪酸和同型半胱氨酸检测对诊断急性脑梗死的临床意义

目的 探讨血清游离脂肪酸(FFA)、同型半胱氨酸(Hcy)检测对诊断急性脑梗死(ACI)的临床意义.方法 选取2010年6月至2014年7月期间我院确诊治疗的ACI患者71例作为ACI组,同期选取体检中心健康人员10例作为健康组,统计采用酶联免疫吸附法检测所有受试者血清FFA、Hcy水平,应用ROC曲线分析其对ACI的诊断价值. 结果 ACI组FFA、Hcy水平明显高于健康组,差异有统计学意义(P＜0.05);ROC曲线分析结果显示,FFA对AMI诊断敏感度为79.56％,特异度为84.27％,准确度为89.04％,Hcy诊断敏感度为76.16％,特异度为79.34％,准确度为84.15％,联合诊断敏感度为83.48％,特异度为86.31％,准确度为93.73％. 结论 FFA、Hcy均可作为诊断ACI的重要指标,联合检测具有更高的诊断价值.     

小儿先天性心脏病术前血浆氨基末端B型利钠肽前体检测及慢性心力衰竭诊断截断点探讨

目的:通过检测小儿先天性心脏病患儿行心脏手术前血浆生物学标志物氨基末端B型利钠肽前体(NT-proBNP),绘制ROC曲线,分析其特异度和敏感度,探讨NT-proBNP慢性心力衰竭诊断指标截断点.方法:测定2010年9月～2012年9月佛山市顺德区妇幼保健院收治的100例小儿先天性心脏病术前患儿和100例健康儿童的血浆NT-proBNP实验室指标,以改良Ross评分为标准诊断的心力衰竭患儿为心力衰竭组,无心力衰竭的患儿为无心力衰竭组,健康儿童为对照组,通过绘制ROC曲线分析其特异度和敏感度,探讨NT-proBNP小儿先天性心脏病心力衰竭诊断指标截断点.其结果进行统计学分析比较.结果:100例小儿先天性心脏病患儿中32例NT-proBNP指标异常升高,心力衰竭组与无心力衰竭组、正常组3组血浆NT-proBNP比较及轻、中、重度心力衰竭3组血浆NT-proBNP比较差异均有统计学意义(P均＜0.001).NT-ProBNP与改良Ross标准的相关性比较差异有统计学意义(r=0.592,P＜0.001).NT-proBNP诊断心力衰竭的ROC曲线下面积为0.983(95％可信区间:0.965～0.996),按照ROC曲线选取的诊断截断点为≥547 ng/L,此数值可作为小儿先天性心脏病NT-proBNP心力衰竭诊断参考指标.结论:小儿先天性心脏病术前心力衰竭患儿血浆NT-proBNP心力衰竭诊断截断点为≥547 ng/L,其特异度和敏感度之和最高,此数值可作为小儿先天性心脏病术前NT-proBNP心力衰竭诊断参考指标.     

同型半胱氨酸联合胱抑素C对早期糖尿病肾病的诊断价值分析

目的探讨联合检测同型半胱氨酸(Hcy)与血清胱抑素C(Cys-C)在早期糖尿病肾病诊断中的临床价值。方法选择2型糖尿病患者94例,依据尿微量白蛋白排泄率(UAER),分为单纯糖尿病组(SDM组)62例:UAER30 mg/24 h;早期糖尿病肾病组(EDN组)32例:UAER 30 mg/24 h~300 mg/24 h。另选取同期体检的健康志愿者40例。比较各组实验室指标,受试者工作曲线(ROC)计算Hcy、Cys-C诊断早期糖尿病肾病的临界值。结果 EDN组Hcy、Cys-C水平高于SDM组、NC组,差异有统计学意义(P0.05)。在Hcy临界值取13.55μmol/L时,诊断早期糖尿病肾病的敏感度为87.5%、特异度为77.42%、诊断指数达到最大值为0.649 2,AUC为0.872。在Cys-C临界值取1.3 mg/L时,诊断早期糖尿病肾病的敏感度为84.38%,特异度为75.81%,诊断指数达到最大值为0.601 8,AUC为0.878。当Hcy临界值取13.55μmol/L、Cys-C临界值取1.3 mg/L时,联合诊断早期糖尿病肾病的敏感度为93.75%、特异度为88.71%,诊断指数达到最大值为0.824 6,AUC为0.957。结论联合检测Hcy及Cys-C,对诊断早期糖尿病肾病具有重要的临床价值。     

冠心病患者血清脂蛋白a、同型半胱氨酸、胱抑素C水平变化及临床价值研究

目的:探讨冠心病患者血清脂蛋白a[Lp(a)]、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)水平变化及临床价值.方法:选取2014年1月-2017年1月在我院心内科住院治疗的冠心病患者145例,纳入观察组,同时选取健康体检者85例,作为对照组进行对比研究.对所有入选者进行Lp(a)、Hcy、Cys-C测定,探讨上述指标在冠心病患者中的表达水平及临床意义.同时描绘ROC曲线,观察上述指标联合诊断在冠心病中的价值.结果:血清Lp(a)、Hcy、Cys-C在冠心病组患者高于对照组,两组分别比较,差异有统计学意义(P＜0.05);对上述指标进行ROC曲线比较,发现联合检测的敏感度、特异性高于单项检测.结论:血清Lp(a)、Hcy、Cys-C表达水平在冠心病患者中明显升高,临床上可通过对上述指标的联合检测,评估冠心病合的严重程度,指导预后及治疗.     

血清肌酐、胱抑素C、NGAL检测对妊娠相关急性肾损伤诊断及预后评估的价值

目的:探讨血清肌酐(SCr)、胱抑素C(Cys-C)、中性粒细胞明胶酶相关载脂蛋白(NGAL)检测对妊娠相关急性肾损伤(RP-AKI)诊断及预后评估的价值。方法:将RP-AKI患者93例按照产后随访结果分为预后不佳组27例和预后良好组66例,另选择100例正常分娩的产妇作为对照组,采用肌氨酸氧化酶法检测SCr水平,乳胶增强免疫透射比浊法检测血清Cys-C水平,双抗夹心酶联免疫吸附实验检测血清NGAL水平,logistic多元回归分析RP-AKI或预后不佳的危险因素,利用受试者工作曲线(ROC)预测SCr、Cys-C、NGAL对RP-AKI或预后不佳的诊断价值。结果:RP-AKI组SCr、Cys-C、NGAL水平均高于对照组(P<0.05)。产后3个月、6个月、12个月,预后不佳组SCr、Cys-C、NGAL水平均高于预后良好组(P<0.05)。相关性分析显示,RP-AKI组血清SCr水平与Cys-C和NGAL均呈正相关(均P<0.05),Cys-C与NGAL呈正相关(P<0.05)。logistic回归分析显示,SCr、Cys-C、NGAL是RP-AKI预后不佳的独立危险因素(均P<0.05)。NGAL诊断RP-AKI的最佳临界值为17.98μg/L,敏感度为82.7%,特异度为87.9%,ROC曲线下面积(AUC)为0.946(P<0.05),NGAL诊断RP-AKI的AUC高于SCr(AUC 0.851)和Cys-C(AUC 0.817)(均P<0.05)。SCr预测RP-AKI预后不佳的最佳临界值为127.63μmoI/L,敏感度为79.4%,特异度为83.1%,ROC曲线下面积为0.893(P<0.05),SCr预测RP-AKI预后不佳的AUC高于Cys-C(AUC0.754)、NGAL(AUC0.803)(P<0.05)。结论:NGAL对RP-AKI的诊断价值高于SCr和Cys-C,SCr对RP-AKI预后的预测价值高于Cys-C和NGAL。     

多指标联合检测在急性心肌梗死早期诊断的应用评价

目的探讨联合检测肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)和N末端脑钠素原(NT-proBNP)早期诊断急性心肌梗死(AMI)的价值。方法回顾性选取已确诊的急性心肌梗死患者78例(AMI组)和随机选取的医院体检正常的健康人80例(对照组)作为研究对象。对158例观察对象在不同时间点采集静脉血,定量检测cTnI、CK-MB、Myo、NT-proBNP的结果进行统计学分析。结果和对照组相比,AMI组cTnI、CKMB、Myo、NT-proBNP各时间点的含量均高于对照组,差异有统计学意义(P<0.05);单独检测cTnI、CK-MB、Myo、NT-proBNP的敏感度和特异度分别是87.17%和81.25%、84.62%和78.75%、89.74%和72.50%、76.90%和76.25%,联合检测时灵敏度和特异度达到了93.58%和91.25%,高于单项检测,差异有统计学意义(P<0.05)。结论 cTnI、CK-MB、Myo、NT-proBNP四项联合检测可提高AMI早期检测的敏感度和特异度。     

联合检测血清相关因子在诊断2型糖尿病患者早期肾功能损伤的价值

目的探讨检测血清胱抑素(Cys-C)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(Hs-CRP)及尿微量清蛋白(U-mALB)在2型糖尿病早期肾损伤中的诊断价值。方法选取复旦大学附属中山医院青浦分院2016年1月—2017年12月94例疑似2型糖尿病早期肾损伤患者作为本次研究对象,根据CT等检查结果将患者分为对照组(2型糖尿病30例)与观察组(2型糖尿病早期肾损伤64例)。分别检测两组血清(Cys-C)、HbA1c、Hs-CRP和U-mALB,并比较各指标单独检测、联合检测敏感度、准确度及特异度。结果观察组患者血清(Cys-C)、Hs-CRP及U-mALB水平明显高于对照组,差异有统计学意义(P0.05);两组血清HbA1c水平比较,差异无统计学意义(P0.05)。单纯检测各指标时,其中检测U-mALB阳性率最高,而检测Hs-CRP的阳性率最低,联合检测血清(Cys-C)、HbA1c、Hs-CRP及U-mALB阳性率明显高于单纯检测单一指标检测阳性率。联合检测血清(Cys-C)、HbA1c、Hs-CRP及U-mALB敏感度、准确度及特异度明显高于单纯检测单一指标。结论 2型糖尿病早期肾损伤患者血清(Cys-C)、Hs-CRP及U-mALB明显升高,且联合检测(Cys-C)、HbA1c、Hs-CRP及U-mALB可提高检测准确度,为临床疾病诊断和治疗方案的制定提供有力依据。     

联合检测血清因子在诊断2型 糖尿病患者早期肾功能损伤的价值

目的探讨检测血清胱抑素(Cys-C)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(Hs-CRP)及尿微量清蛋白(U-mALB)在2型糖尿病早期肾损伤中的诊断价值。方法选取复旦大学附属中山医院青浦分院2016年1月—2017年12月94例疑似2型糖尿病早期肾损伤患者作为本次研究对象,根据CT等检查结果将患者分为对照组(2型糖尿病30例)与观察组(2型糖尿病早期肾损伤64例)。分别检测两组血清(Cys-C)、HbA1c、Hs-CRP和U-mALB,并比较各指标单独检测、联合检测敏感度、准确度及特异度。结果观察组患者血清(Cys-C)、Hs-CRP及U-mALB水平明显高于对照组,差异有统计学意义(P0.05);两组血清HbA1c水平比较,差异无统计学意义(P0.05)。单纯检测各指标时,其中检测U-mALB阳性率最高,而检测Hs-CRP的阳性率最低,联合检测血清(Cys-C)、HbA1c、Hs-CRP及U-mALB阳性率明显高于单纯检测单一指标检测阳性率。联合检测血清(Cys-C)、HbA1c、Hs-CRP及U-mALB敏感度、准确度及特异度明显高于单纯检测单一指标。结论 2型糖尿病早期肾损伤患者血清(Cys-C)、Hs-CRP及U-mALB明显升高,且联合检测(Cys-C)、HbA1c、Hs-CRP及U-mALB可提高检测准确度,为临床疾病诊断和治疗方案的制定提供有力依据。     

降钙素原与脑钠肽在心衰诊断预后价值

目的:探究降钙素原(PCT)与N端钠尿肽前体(NT-proBNP)在心衰诊断及预后判断的价值.方法:选取2015年10月~2017年5月就诊于我院的260例心力衰竭患者,根据是否合并感染分为单纯心衰组(150例)与心衰感染组(110例),根据发病14d内临床结局分为生存组(173例)与病死组(87例).对所有患者的PCT、NT-proBNP水平进行检测.比较入院第1、2、3、5、7d的PCT和NT-proBNP水平,并比较生存、病死组的PCT和NT-proBNP水平,分析PCT与NT-proBNP之间相关性,并用受试者工作特征曲线(ROC)分析PCT与NT-proBNP检测对心衰患者预后判断价值.结果:心衰感染组入院第1、2、3、5、7d的PCT、NT-proBNP高于单纯心衰组,病死组的PCT和NT-proBNP水平高于生存组,差异有统计学意义(P<0.05).经Spearman相关性分析,心衰患者PCT与NT-proBNP呈正相关(r>0,P<0.05).PCT预测心衰预后最佳截断值为2.50ug/L时,曲线下面积(AUC)最大为0.764,对应的敏感度、特异度为88.50%、65.30%;NT-proBNP检测最佳截断值为4653.85ng/L时,AUC最大为0.949,对应的敏感度、特异度为98.9%、94.8%.结论:血清PCT、NT-proBNP与心衰合并感染密切相关,可通过PCT、NT-proBNP检测来预测心衰患者预后.     

联合检测腺苷脱氨酶、干扰素-γ、可溶性白细胞介素-2受体对结核性与恶性胸腔积液鉴别诊断的价值

目的 探讨腺苷脱氨酶(ADA)、干扰素-γ(IFN-γ)、可溶性白细胞介素-2受体(sIL-2R)在结核性与恶性胸腔积液鉴别诊断中的应用价值.方法 对48例结核性胸腔积液(结核组)及32例恶性胸腔积液患者(恶性肿瘤组)的胸腔积液标本行酶比色法检测ADA活性,ELISA法检测IFN-γ、sIL-2R浓度.结果 结核组的ADA活性及IFN-γ、sIL-2R浓度均明显高于恶性肿瘤组,差异有统计学意义(P<0.05).根据受试者工作特征(ROC)曲线结果判断,以45 U/L几为临界值,ADA对结核性胸腔积液诊断的敏感度、特异度及准确度分别为82%、91%、86%;以100 ng/L为临界值,IFN-γ对结核性胸腔积液诊断的敏感度、特异度及准确度分别为85%、94%、89%;以450μg/L为临界值,sIL-2R对结核性胸腔积液诊断的敏感度、特异度及准确度分别为84%、81%、83%.三项指标联合检测,其敏感度、特异度及准确度分别达到88%、100%、94%.结论 联合检测ADA、IFN-γ及sIL-2R可以提高结核性胸膜炎诊断的敏感度、特异度及准确度.     

Survey of ethylenethiourea (ETU) in ethylenebis(dithiocarbamate) (EBDC) fungicides

Ethylenethiourea (ETU) has been recognized as a compound with adverse toxicological properties. It may occur in ethylenebis(dithiocarbamate) (EBDC) fungicides as a by-product and/or a degradation product. Restrictions have been issued by the Italian Health Authority to keep the level of ETU in EBDC formulations under 0.5% (on an EBDC technical product basis). A survey was carried out on 85 samples of commercial formulations from the Italian market to verify compliance with the above limitation. ETU was extracted by methanol and determined by gas chromatography with a flame ionization detector. Three of the 85 samples (3.5%) exceeded the limit of 0.5% established by the Italian legislation for ETU.     

Diagnostic image (5) (Ileum pathology)

In a 28-year-old woman Crohn's disease was diagnosed. She had drug treatment but the situation deteriorated and ileocoecal resection was carried out. In the surgical specimen the diagnosis was confirmed.     

Sorption of Phosphate and Cr(VI) by Fe(III) and Cr(III) Hydroxides

Understanding the chemical behavior and interactions of Cr(VI) (e.g., HCrO₄ ⁻) and other anions, such as orthophosphate (P) with insoluble metal hydroxides (i.e., Cr[III] and Fe[III]) in disposal landfills or in chromite ore processing residue (CORP)–enriched soil is very important in predicting the movement and the fate of Cr(VI). This study evaluates the sorption behavior of P and Cr(VI) by Fe(III) (i.e., ferrihydrite), Cr(III) (i.e., Cr[OH]₃), and coprecipitated Fe(III)/Cr(III) hydroxides. These metal hydroxide sorbents were synthesized, and sorption of P and Cr(VI) were conducted at different pH using a batch technology. Our results show that P and Cr(VI) sorption by metal hydroxides decreased with increasing suspension pH. Greater decrease in P sorption was observed when Cr(III) was present in the structures of hydroxides. Following the sorption of low concentration of P (i.e., 0.5 mM), the sorption of subsequently added Cr(VI) by hydroxides was less influenced. However, Cr(VI) sorption was greatly inhibited when high concentration of P (i.e., 10 mM) prereacted with hydroxides, particularly in Fe(III) hydroxide system. Results also indicated that high concentration of Cr(VI) (10 mM) could dissolve Cr(III) hydroxide at pH 3 and reprecipitate as an amorphous form of Cr(VI) and Cr(III) compound at pH about 6.5. Although coprecipitation of Cr(VI) with Cr(III) can inhibit Cr(VI) movement through soil profiles, the inhibition seems to be low due to the gradual release of Cr(VI) with increasing pH. Received: 16 April 2002/Accepted: 29 October 2002     

Crusted (Norwegian) scabies in Dakar (Senegal)

Between January 1993 and June 1997, 30 patients with crusted scabies were seen at the dermatological clinic in Dakar (Senegal). Seventeen of these patients were male and 13 were female. Six were children aged 5 to 15 years and 24 were adults aged 18 to 70 years. Diagnosis of crusted scabies was straightforward because this condition, which was rare in Dakar before 1990, has become much more common and is now familiar to Senegalese dermatologists. The infection presented as an extensive scaly or crusted eruption with symmetrical lesions affecting the hands, feet, knees, elbows and ears in particular. Scalp involvement was reported in 25 patients. Erythrodermia was present in 4 cases and pachyonychia in 4 cases. Twenty-seven of the 30 patients had moderate or severe pruritus, whereas an absence of pruritus is regarded as a classical characteristic of crusted scabies. Diagnosis was readily confirmed by examination of hyperkeratotic material under the microscope: numerous mites and eggs were present. The two most common etiological factors were auto-immune diseases (6 cases, 4 of whom were receiving no steroid or other immunosuppressive treatment at the time of onset of crusted scabies) and malnutrition (5 of the 6 children in the study). The other associated conditions identified were: physical debilitation (4 cases), HIV infection (3), mental disability-Down's syndrome (3) and long term use of topical steroids for artificial depigmentation (2). Two patients were immunocompetent and 5 patients died shortly after diagnosis, before any underlying conditions could be identified. Seven patients were cured with benzyl benzoate. Seven others, all adults, received a single oral dose of ivermectin (200 mg/kg) and topical kerolytic drugs. Ivermectin was ineffective in 1 case, and an improvement was observed in another case, although a complete cure was achieved only after a second dose. The other patients were all cured and showed no signs of scabies one month after ivermectin treatment. A recurrence was observed in 3 patients a few months later however, suggesting that these patients were reinfected. No side effects were reported in any of the patients treated with ivermectin.