降钙素原、C反应蛋白及白细胞计数在慢性阻塞性肺疾病急性加重期患者的临床价值

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白细胞(WBC)计数的检测在诊断和治疗慢性阻塞性肺疾病急性加重期(AECOPD)中的临床价值。方法选择42例AECOPD和39例COPD稳定期(对照组)患者,检测血清PCT、CRP及WBC计数、中性粒细胞比例,并比较以上各指标在AECOPD患者治疗前后的变化。结果 AECOPD组治疗前血清PCT、CRP及WBC计数、中性粒细胞比例与AECOPD组治疗后和对照组比较,差异有统计学意义(P0.05)。结论血清PCT、CRP及WBC计数、中性粒细胞比例在AECOPD患者在细菌感染后明显升高,经有效抗感染治疗后可明显下降,检测血清PCT、CRP及WBC有助于AECOPD的早期诊断及疗效的观察。     

降钙素原在早期诊断新生儿败血症的价值

目的:探讨降钙素原在新生儿败血症早期诊断的价值。方法:将患儿根据诊断随机分为败血症组(n=56)和非感染组(n=50),比较血清降钙素原、超敏C反应蛋白、白细胞计数、血小板计数、网织红细胞计数、未成熟中性粒细胞/中性粒细胞、血糖的差异。结果:败血症组与非感染组降钙素原、超敏C反应蛋白比较差异有统计学意义(P<0.05);降钙素原其敏感性、特异性均高于超敏C反应蛋白;败血症组恢复期降钙素原、超敏C反应蛋白均较初期明显下降,比较有统计学意义(P<0.05)。结论:血清降钙素原有利于新生儿败血症诊断和疗效观察,可作为新生儿败血症的早期诊断指标。     

白细胞介素6、C反应蛋白和降钙素原等感染指标在链球菌感染暴发中的早期诊断价值

目的 明确白细胞介素6（interleukin-6,IL-6）、C反应蛋白、降钙素原等在链球菌暴发感染早期诊断中的价值.方法 收集2010年10月某单位员工集体宿舍暴发链球菌感染所有患者就诊时及治疗后两次IL-6、血白细胞计数、血中性粒细胞百分数、C反应蛋白、降钙素原等数值,比较患者就诊时和治疗2d后的IL-6、血白细胞计数、血中性粒细胞百分数、C反应蛋白、降钙素原变化,分析炎性因子变化的意义及原因.结果 白细胞、中性粒细胞百分比、IL-6水平就诊时升高明显,治疗2d后白细胞、中性粒细胞百分比、IL-6均明显低于就诊时,分别为（6.5±1.9）×10^9 vs （11.6±3.2）×10^9、（61％±8％）vs（79％±10％）、25.1（16.9,39.2） ng/Lvs1.5（1.5,1.5） ng/L,P=0.000;C反应蛋白水平高于就诊时[0.7（0.3,1.6） mg/Lvs2.7（0.9,4.7） mg/L,P=0.000];降钙素原阳性率治疗前后差异无统计学意义（P=0.317）.结论 IL-6在细菌感染早期反应迅速,与白细胞、中性粒细胞百分比升高趋势一致,C反应蛋白升高相对滞后,降钙素原在急性局部细菌感染时无明显升高;IL-6、白细胞、中性粒细胞百分比为此次溶血性链球菌感染的早期诊断提供了依据.     

AECOPD患者血气分析、肺功能与血浆纤维蛋白原相关性研究

目的探讨AECOPD患者血气分析、肺功能与血浆纤维蛋白原的相关性。方法选择57例AECOPD患者,监测患者治疗前后肺功能(FEV1%、FEV1/FVC)、血气分析、纤维蛋白原(FB)等指标。结果纤维蛋白原治疗前高于治疗后(P0.01);一秒钟用力呼气容积(FEV1)治疗前低于治疗后(P0.01);FB与FEV1呈显著负相关(P0.01);治疗前FB与动脉氧分压呈显著负相关,与二氧化碳分压呈显著正相关(P0.01)。结论纤维蛋白原与AECOPD严重程度具有相关性。     

老年2型糖尿病C反应蛋白与其他炎性指标相关性分析

目的探讨老年2型糖尿病患者血清C反应蛋白(CRP)与红细胞沉降率、纤维蛋白原、中性粒细胞的关系及意义。方法 66例老年2型糖尿病患者采用免疫比浊法测定C反应蛋白、纤维蛋白原,魏氏法测定红细胞沉降率,电阻抗法测定中性粒细胞。结果老年糖尿病患者C反应蛋白与红细胞沉降率、纤维蛋白原等炎性指标具有明显正相关且敏感度明显优于其他炎性指标。结论血清C反应蛋白是反映炎症发生极敏感的指标。     

降钙素原及C-反应蛋白在肺结核治疗中的意义

目的:探讨肺结核患者治疗前后血清降钙素原及C反应蛋白的变化及其临床意义。方法:应用化学发光法及免疫比浊方法检测30例活动性肺结核患者(实验组)治疗前后和24例非活动性肺结核患者(对照组)降钙素原及C反应蛋白的含量。结果:治疗前实验组血清中降钙素原及C反应蛋白的含量高于对照组(P<0.05);治疗后实验组血清中降钙素原的含量显著低于治疗前(P<0.05)。结论:联合检测肺结核患者血清中降钙素原及C反应蛋白的含量可以用于评价活动性肺结核的治疗效果。     

血清降钙素原检测对呼吸系统感染疾病的诊断价值分析

目的：分析血清降钙素原检验对呼吸系统感染疾病的诊断价值。方法：选取2020年1月-2021年12月上海交通大学医学院苏州九龙医院收治的100例呼吸系统感染疾病患者作为研究对象,将其设为试验组;另选取同期接受体检的100例健康者设为对照组。两组均进行血清降钙素原、白细胞计数及C反应蛋白检查,比较试验组轻症与重症患者血清降钙素原水平,分析两组间、试验组患者治疗前后血清降钙素原、白细胞计数及C反应蛋白水平。结果：重症患者血清降钙素原水平高于轻症患者,差异有统计学意义(P<0.05)。试验组血清降钙素原、白细胞计数以及C反应蛋白水平均高于对照组,差异有统计学意义(P<0.05)。治疗后,试验组患者血清降钙素原、白细胞计数及C反应蛋白水平均低于治疗前,差异有统计学意义(P<0.05)。结论：血清降钙素原检验对呼吸系统感染疾病患者的诊断价值较高,不仅能够对其进行确诊,还能够判断病情的严重程度,分析其治疗效果,值得推广。     

脓毒血症临床诊断及治疗探讨

目的:分析脓毒血症临床诊断及治疗方法。方法:选取我院2012年10月-2013年10月间收治的42名脓毒血症患者作为研究对象,采用回顾性的方式分析患者的临床资料,总结临床诊断及治疗方法。结果:本组患者均经血常规、炎症标志物(降钙素原、C反应蛋白、中性粒细胞VCS参数检查确诊,检查结果显示,患者的白细胞、C反应蛋白、降钙素原、平均中性粒细胞体积、中性粒细胞体积分布宽度指标值均显著高于正常水平。通过血液净化治疗后有40名患者痊愈出院,1名患者因家庭原因及个人原因放弃治疗,另外1名患者因继发多器官功能衰竭而死亡,抢治疗有效率为95.24%。结论:血常规、炎症标志物(降钙素原、C反应蛋白)、中性粒细胞VCS参数可作为脓毒血症的早期诊断及鉴别肺感染的依据,采用血液净化的方式可提高脓毒血症的临床治疗效果。     

AECOPD患者血嗜酸性粒细胞百分比与呼出气一氧化氮及气道细菌感染的关系

目的 探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者血嗜酸性粒细胞百分比(percentage of eosinophils,EOS%)与呼出气一氧化氮(fractional exhaled nitric,FeNO)及气道细菌感染的关系。方法 选取2020年3月~2021年5月甘肃省人民医院呼吸与危重症医学科收治的116例AECOPD患者,收集患者病史、一般资料(性别、年龄、吸烟指数、体重指数)并检测血EOS%、中性粒细胞百分比、降钙素原、白细胞介素-6、白细胞计数、C反应蛋白及FeNO。以EOS%≥2%为界值,将血EOS%≥2%的患者设为A组(嗜酸型AECOPD),血EOS%＜2%的患者设为B组(非嗜酸型AECOPD)。首先用t检验、χ²检验、Mann-Whitney U非参数检验比较A组与B组患者一般资料、FeNO、中性粒细胞百分比、降钙素原、白细胞介素-6、白细胞计数、C反应蛋白水平,根据差异是否有统计学意义,进一步用Pearson或Spearman相关性分析描述上述差异有统计学意义的指标与血EOS%的关系。结果 A组与B组一般资料比较,差异均无统计学意义(P均＞0.05);中性粒细胞百分比、白细胞介素-6、降钙素原、FeNO水平比较,差异均有统计学意义(P均＜0.05);白细胞计数、C反应蛋白水平比较,差异均无统计学意义(P均＞0.05)。相关性分析结果显示,血EOS％与中性粒细胞百分比、白细胞介素-6、降钙素原水平呈负相关(r=－0.425、r_s=－0.376、r_s=－0.342,P均<0.001);血EOS％与FeNO水平呈正相关 (r_s=0.399, P<0.001)。结论 AECOPD患者血EOS%与 FeNO呈正相关,EOS%升高可能会导致气道嗜酸性炎性反应增强,使得FeNO水平也显著升高;血EOS%与中性粒细胞百分比、白细胞介素-6、降钙素原呈负相关,血EOS%与气道细菌感染呈负相关。     

急性心肌梗死血瘀证患者纤维蛋白原、超敏C反应蛋白与补体系统表达变化

[目的]探讨急性心肌梗死(AMI)血瘀证患者纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)及补体系统表达变化。[方法]检测72例AMI患者血瘀证、非血瘀证及33例健康对照者的血清样本中hs-CRP、FIB及补体C3、C4、C5b-9的表达变化,并比较以上指标之间及其与血瘀证的相关性。[结果]AMI患者的血清FIB、C3、C4、C5b-9及hs-CRP表达均较对照组显著升高,且血瘀证组高于非血瘀证组;血瘀证与hs-CRP、FIB、D-2聚体水平呈正相关(r=0.239、r=0.402、r=0.199,P0.05);GRACE评分与血瘀证、hs-CRP水平呈正相关(r=0.309、r=0.376,P0.05)。[结论]AMI患者具有一定程度炎性反应和补体激活,而在血瘀证中表达更为明显;血瘀证为AMI患者中的较高危者,早期辨证治疗可降低急性心血管事件的发生风险。     

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.