不同类型骨科疾患患者D-二聚体与纤维蛋白原检测

目的分析不同类型骨科疾患患者血浆中D-二聚体与纤维蛋白原的水平,探讨不同类型骨科疾患患者并发血栓性疾病倾向性。方法对患有不同类型骨科疾患的患者血浆D-二聚体、纤维蛋白原（FIB）及其他凝血指标凝血酶原时间、部分活化凝血活酶时间、凝血酶时间和白细胞、血小板的检测结果进行统计分析。结果所有病例组D-二聚体升高程度和异常率最高,其次为FIB,其值在各组中从高到低依次为股骨骨折组、胸椎腰椎骨折组、其他骨折组、椎间盘突出组、关节病组,各病例组与健康对照组比较差异有统计学意义（P<0.05）;D-二聚体异常率股骨骨折组为100%,胸腰椎骨折组94%,其他骨折组88.23%,关节病组64.56%,椎间盘突出组62.63%。结论除了骨折和手术患者D-二聚体升高明显之外,其他各类骨科疾患患者血浆D-二聚体水平和FIB也都普遍升高,提示不同骨科疾患患者都有并发血栓性疾病的倾向,密切观察D-二聚体和FIB水平,警惕深静脉血栓的发生。     

血乳酸和D-二聚体测定在全身炎症反应综合征中的意义

目的　探讨血乳酸 (LA)和D -二聚体 (D -dimer)在全身炎症反应综合征 (SIRS)时的变化、相关性及与预后的关系。方法　满足SIRS诊断标准的住院病人 10 0例为SIRS组 ,并按满足 2项、3项、4项标准分为S1、S2 、S3 亚组 ,按照预后分为生存组和死亡组 ;不满足SIRS诊断标准的急诊病人 5 0例为非SIRS组 ;健康正常人 5 0例为对照组。分别测定LA和D -dimer。结果　SIRS组LA和D -dimer均高于非SIRS组及对照组 (P <0 .0 1) ,SIRS组LA和D -dimer在S3 亚组高于S1亚组 (P <0 .0 5 ) ,死亡组高于生存组 (P <0 .0 5 ) ,SIRS组LA与D -dimer呈明显正相关 (P <0 .0 1) ,LA和D -dimer均与预后呈负相关 ,经检验 ,D -dimer与预后呈明显负相关 (r=- 0 .2 90 3,P<0 .0 1)。结论　LA、D -dimer在SIRS病人明显升高 ,二者呈正相关 ,D -dimer可能是SIRS预后的标记物。     

Elevated exhalation of hydrogen peroxide in patients with systemic sclerosis

BACKGROUND: Systemic sclerosis is accompanied by an influx of activated phagocytes into distal airways. These cells release H2O2, which may evaporate from the airways surface and be detected in expired breath condensate. We tested whether patients with systemic sclerosis exhale more H2O2 than healthy subjects and whether breath condensate H2O2 levels correlate with some clinical parameters. MATERIAL AND METHODS: H2O2 was measured fluorimetrically in the expired breath condensate of 27 patients (22 women, five men, mean age 49 +/- 13.1 years) with systemic sclerosis and 27 age- and sex- matched healthy controls. RESULTS: Exhaled H2O2 levels were 3.5-fold higher (0.88 +/- 0.62 microM vs. 0.25 +/- 0.17 microM, P < 0.001) in the patients with systemic sclerosis than in the controls. Treatment with cyclophosphamide and/or prednisone (29 +/- 50 months, range 3-168 months) did not significantly decrease H2O2 exhalation (0.78 +/- 0.50 microM, n= 10 vs. 0.94 +/- 0.67 microM, n= 17, P > 0.05). No significant difference was found between patients with limited and diffuse scleroderma (1.03 +/- 0.69 microM, n= 17 vs. 0.63 +/- 0.41 microM, n= 10, P > 0.05). H2O2 levels correlated with disease duration (r = 0.38, P < 0.05) and time from the first Raynaud's episode (r = 0.44, P < 0.05). CONCLUSIONS: Patients with systemic sclerosis exhale more H2O2 than healthy controls, suggesting involvement of reactive oxygen species in disease processes. Lack of significant intergroups differences in H2O2 levels may have resulted from the small number of patients analyzed.     

Clinical significance of serum ferritin in patients with systemic sclerosis

ObjectiveThe purpose of this study was to explore the clinical significance of serum ferritin (SF) in patients with systemic sclerosis (SSc).MethodsThe levels of SF were measured in 115 patients with SSc and 117 healthy controls (HCs). Clinical characteristics and laboratory indexes between the high ferritin SSc group and the normal ferritin SSc group were analyzed.ResultsThe level of SF in SSc patients was significantly higher than that in HCs (319.78 [179, 554.33] ng/ml vs. 99 [49.03, 164.29] ng/ml, p < 0.01). Compared with the normal ferritin SSc group, the high ferritin SSc group was more likely to develop skin diffuse cutaneous SSc, fingertip arthralgia, and cardiac involvement. In addition, the levels of glutamine transaminase (GGT), alanine aminotransferase (ALT), creatine kinase (CK), creatine kinase isoenzyme‐MB (CK‐MB), lactate dehydrogenase (LD), immunoglobulin G (IgG), immunoglobulin A (IgA), C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the positive rate of anti‐Scl70 antibody in the high ferritin SSc group were significantly higher (each p < 0.05). SF was positively correlated with GGT, ALT, CK, CK‐MB, LD, IgA, CRP, and ESR (each p < 0.05). Multiple linear regression analysis showed that cardiac involvement, ALT, and ESR were independent influencing factors of SF in SSc.ConclusionOur study shows that the level of SF in patients with SSc is increased, and the elevated SF is related to abnormal liver function, myocardial involvement, inflammatory status, and production of autoantibodies in SSc. Cardiac involvement, ALT, and ESR are independent factors affecting SF in SSc.     

Evaluation of cardiac laboratory markers in patients with systemic sclerosis

OBJECTIVES: Myocardial involvement is frequent in systemic sclerosis, but symptoms are usually delayed and non-specific, thus often misrecognized. The aim of this study was the evaluation of the early subclinical cardiac involvement in patients with systemic sclerosis by means of non-invasive laboratory cardiac markers. DESIGN AND METHODS: Cardiac troponin T (cTnT), ischemia modified albumin (IMA) and NT-prohormone-brain natriuretic peptide (NT-proBNP) were measured in 40 female patients with systemic sclerosis and in 40 matched healthy controls. RESULTS: Patients with systemic sclerosis displayed significantly increased concentrations of serum IMA (106 versus 93.5 kunits/l, P < 0.0001) and NT-proBNP (89 versus 37 pg/ml, P < 0.0001), whereas no significant differences could be observed in both IMA and NT-proBNP values in limited versus diffuse pattern of disease. CONCLUSIONS: The increased levels of NT-proBNP and IMA could be considered a sign of early myocardial involvement, warranting further heart examination and a regular follow-up.     

Evaluation of paraffin bath treatment in patients with systemic sclerosis

Objective: To investigate the effects of treatment with paraffin bath in patients with systemic sclerosis (scleroderma).

Methods: In 17 patients with scleroderma one hand was treated daily with paraffin bath in combination with hand exercise. The other hand was treated with exercise only and was considered a control. Hand function was estimated before treatment and after 1 month of treatment, concerning hand mobility and grip force, and perceived pain, stiffness and skin elasticity.

Results: At the follow-up, finger flexion and extension, thumb abduction, volar flexion in the wrist, and perceived stiffness and skin elasticity had improved significantly in the paraffin-treated hand compared with the baseline values. The improved hand function was independent of skin score and disease duration. Improvements in function were significantly greater in the hand which was treated with paraffin bath and exercise than in the hand treated with exercise only concerning extension deficit, perceived stiffness and skin elasticity.

Conclusions: In this pilot study hand exercise in combination with paraffin bath seemed to improve mobility, perceived stiffness and skin elasticity. However, further studies with larger sample size are needed to attain more reliable results of the effect of paraffin bath treatment in patients with scleroderma.     

系统性硬化症患者营养不良原因及干预策略的研究进展

系统性硬化症（SSc）病程长且逐年进展,易发生胃肠道受累,导致营养不良。SSc合并营养不良可显著降低患者生活质量,加速病程发展,缩短患者寿命,合理的营养支持对患者而言至关重要。本文对SSc合并营养不良的相关原因和营养支持进行综述,旨在为临床医护人员及时发现和尽早干预SSc合并营养不良提供参考和依据,以改善患者的生活质量和预后。     

Evaluation of paraffin bath treatment in patients with systemic sclerosis

Objective:?To investigate the effects of treatment with paraffin bath in patients with systemic sclerosis (scleroderma).

Methods:?In 17 patients with scleroderma one hand was treated daily with paraffin bath in combination with hand exercise. The other hand was treated with exercise only and was considered a control. Hand function was estimated before treatment and after 1 month of treatment, concerning hand mobility and grip force, and perceived pain, stiffness and skin elasticity.

Results:?At the follow-up, finger flexion and extension, thumb abduction, volar flexion in the wrist, and perceived stiffness and skin elasticity had improved significantly in the paraffin-treated hand compared with the baseline values. The improved hand function was independent of skin score and disease duration. Improvements in function were significantly greater in the hand which was treated with paraffin bath and exercise than in the hand treated with exercise only concerning extension deficit, perceived stiffness and skin elasticity.

Conclusions:?In this pilot study hand exercise in combination with paraffin bath seemed to improve mobility, perceived stiffness and skin elasticity. However, further studies with larger sample size are needed to attain more reliable results of the effect of paraffin bath treatment in patients with scleroderma.     

Plasma concentration of micafungin in patients with hematologic malignancies

In 20 patients with hematologic malignancies, we measured the plasma concentration of micafungin (MCFG) by high-performance liquid chromatography after drip infusion of MCFG, at 150 mg/day over a 1-h period, and we analyzed the results in relation to the patients’ laboratory parameters of liver and kidney function. Measurement of the plasma concentration was performed at the end of the initial administration of MCFG, 5 to 6 h after the start of the initial administration, immediately before the second dosing, immediately before the fourth dosing, and at the end of the fourth dosing. The plasma concentration of MCFG was correlated with the doses of MCFG per kilogram body weight (P = 0.0008–0.0036). The peak after the initial administration was 2.6 times higher than the trough value after the initial administration. The steady-state trough value was 1.2 times higher than the trough value after the initial administration. There was no correlation between the liver/kidney function parameters and the plasma concentration of MCFG. These results suggest that there was a good correlation between the plasma concentration of MCFG and the dose of MCFG per kilogram body weight, and that MCFG can be administered safely to patients with liver or kidney dysfunction without adjusting the dose.     

Ophthalmic timolol: Plasma concentration and systemic cardiopulmonary effects

Timolol maleate is a non‐selective β‐adrenoceptor antagonist currently used mainly as an ocular preparation for the treatment of glaucoma and ocular hypertension. Despite the topical administration, ophthalmic timolol causes systemic adrenergic β‐blocking because of absorption from the eye into the systemic circulation. Gel formulations of ophthalmic timolol have been developed to reduce systemic absorption and adverse effects in comparison with conventional aqueous solution formulations. Timolol is metabolized by the polymorphic cytochrome P450 2D6 enzyme (CYP2D6). The changes in heart rate (HR) are the most striking effects of the systematically absorbed fraction of ophthalmic timolol, with 0.5?% aqueous formulations presenting larger effects than 0.1?% hydrogel formulations, especially during exercise. Plasma levels of ophthalmic timolol correlate with the changes in HR. Neither 0.5?% aqueous nor 0.1?% hydrogel formulations of timolol have exerted noteworthy effects on systolic (SAP) or diastolic (DAP) arterial pressures, probably because of a compensatory increase in systemic vascular resistance due to the attenuation of HR. Ophthalmic timolol does not exert remarkable effects on pulmonary parameter peak expiratory flow (PEF) and forced expiratory volume in 1?s (FEV1) in non‐asthmatic patients. CYP2D6 activity is clearly associated with the pharmacokinetic parameters, particularly when 0.5?% aqueous solution of timolol is used: peak plasma concentration, elimination half‐life and area‐under‐the‐curve are highest in CYP2D6 poor metabolizers. Finally, since there is a correlation between the plasma level of timolol and several haemodynamic effects – especially HR in the state of elevated β‐adrenergic tonus – the CYP2D6 poor metabolizers may be more prone to bradycardia during treatment with (aqueous) ophthalmic timolol.     

Plasma exchange in the treatment of nonadvanced stages of progressive systemic sclerosis

Ten patients suffering from progressive systemic sclerosis, who responded poorly to conventional therapy, underwent plasma exchange (PE) therapy in conjunction with drug therapy. The frequency of PE was twice weekly for 4-6 weeks, two or three times per year, with a summer interruption, when in our own experience a spontaneous relief of symptoms occurs. To judge the efficacy of our therapeutic device, we assessed several laboratory and clinical parameters before and after therapy. The changes in circulating immune complexes, in IgG and IgA, and in some functional indices were significant (P less than 0.001). Eight of 10 patients improved satisfactorily. The remaining two did not improve sufficiently to continue the apheretic treatment. In conclusion, our study suggests that the PE, together with conventional therapy, can be an effective therapeutic device in the treatment of progressive systemic sclerosis.     

Prolactin synthesis by lymphocytes from patients with systemic sclerosis.

Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of the skin and internal organs. It has been demonstrated that serum prolactin levels are increased in patients with various connective tissue diseases. The aim of this study was to investigate the possible source of excessive prolactin synthesis in SSc and its effects on immune cells. The study group consisted of 52 patients with diffuse SSc (44 women and eight men) and 52 age and sex matched healthy controls. The methods used were: ELISA and indirect immunofluorescence. Our results show significantly elevated level of prolactin in male and female patients with SSc and increased prolactin production by SSc lymphocytes as compared to healthy donors X lymphocytes (25.4+/-11.0 vs. 13.4+/-5.0 absorbance units). Patients X and healthy controls X lymphocytes, showed equal presence of prolactin receptors. Soluble interleukin 2 receptor (CD25) concentration, was significantly higher in supernatants of prolactin stimulated lymphocytes, as compared to non-stimulated lymphocytes. We conclude that lymphocytes might contribute to elevated prolactin levels in patients with SSc and that these cells themselves may be sensitive to prolactin stimulation. Therefore, a pharmacologic attempt to lower prolactin levels in patients with SSc could proof beneficial.     

老年全身炎症反应综合征患者血清D-二聚体和C反应蛋白检测的意义

目的 研究D-二聚体、C反应蛋白（CRP）检测在老年全身炎症反应综合征（SIRS）向多器官功能障碍综合征（MODS）转化中的临床意义。方法 老年患者240例分为SIRS组和非SIRS组，SIRS组190例再分为MODS组与非MODS组，常规测定各组患者APACHEⅡ评分，分别用ELISA法测定血清D-二聚体水平，全自动生化分析仪免疫比浊法测定CRP水平。结果 发病后24h内SIRS组D-二聚体和CRP水平明显高于非SIRS组（P〈0．01）。MODS组患者血D-二聚体和CRP水平明显高于非MODS组（P〈0．05）。D-二聚体与预后呈负相关（r=-0．2879，P〈0．01）。结论 检测SIRS患者血清CRP和D-二聚体水平有助于早期诊断MODS并判断预后。     

首发精神分裂症患者血浆D-二聚体和纤维蛋白原水平的临床研究

目的研究首发精神分裂症患者急性期D-二聚体(D-D)和纤维蛋白原(Fib)水平及其临床意义。方法选择2014年3月至2016年12月该院收治的首发精神分裂症患者83例为研究组,另选择同期无精神疾病和重大躯体疾病的健康体检者58例为对照组。空腹采集两组研究对象的枸橼酸钠抗凝血浆,检测D-D和Fib水平。结果首发精神分裂症组血浆D-D水平为(240.42±245.78)μg/L,显著高于对照组(76.53±71.25)μg/L,且差异具有统计学意义(P0.05),而血浆Fib水平(2.62±0.49)g/L显著低于对照组(2.87±0.65)g/L,且差异具有统计学意义(P0.05)。精神分裂症患者D-D水平的增高和Fib水平的降低与性别无关。结论首发精神分裂症患者发病急性期可能存在高凝状态和继发性纤溶功能亢进。     

系统性硬化症肺损害52例临床分析

分析52例系统性硬化症患者肺部病变,包括4例尸检,42例(80.8%)有不同程度的胸部X线异常,32例(61.5%)有明显肺纤维化征象,5例无肺间质纤维化而以肺动脉高压和(或)心衰为突出表现.死亡14例均有明显的心、肺受累,死亡大多与肺部感染有关.52例中有6例伴发恶性肿瘤.