高敏C反应蛋白水平对急性心肌梗塞并发心衰死亡率的预测价值

目的：探讨高敏C反应蛋白（CRP）预测急性心肌梗塞（AMI）并发心力衰竭（HF）死亡率的价值。方法：采用免疫比浊法测定51例AMI组,40例冠心病对照组患者入院第1d（1d）、第3d（3d）、第7d（7d）的高敏CRP（hs—CRP）水平。结果：AMI组的hs—CRP水平（3d,60mg／L）显著高于冠心病对照组（3d,13mg／L）,P〈0．001。AMI并发HF患者（31例）的hs—CRP水平[1d,（30±4）mg／L]显著高于未并发HF患者（20例）的[1d,（15士3）mg／L],P〈0．01。AMI者在1年内的总死亡率：第3dhs—CRP峰值≥85mg／L者为47％,hs-CRP峰值〈85mg／L者为8．8％,P〈0．001;HF的死亡率：第3dhs-CRP峰值≥85mg／L者为23．5％,hs-CRP峰值〈85mg／L者为2．9％,P〈0．001。说明第3d的hs-CRP水平峰值与1年内的死亡率有关。结论：hs—CRP水平可做为预测AMI1年内总死亡率和HF死亡率的一项重要指标。     

超敏C反应蛋白与老年冠心病严重程度相关性的探讨

目的：研究血清超敏C反应蛋白（hsCRP）与老年冠心病严重程度的关系。方法：测定经冠脉造影确诊的110例老年冠心病患者的血清hs—CRP浓度,其中稳定型心绞痛（SAP）患者40例,不稳定型心绞痛（UAP）患者58例,急性心肌梗塞（AMI）患者12例。以经冠脉造影排除冠心病的18例患者为正常对照组,比较各组间hs—CRP的浓度。结果：冠心病患者各亚组hs—CRP浓度均较正常对照组[（0．58±0．27）mg／L]显著升高;冠心病患者各亚组中,UAP组血清hs—CRP浓度[（7．78±5．93）mg／L]显著高于SAP组的[（5．46±10．7）mg／L],P〈0．001;AMI组血清hs—CRP浓度[（32．75±22．12）mg／L]又分别显著高于UAP组及SAP组的,P〈0．001。结论：血清hs—CRP的浓度与冠心病患者病情的严重程度有关,可作为其严重程度的参考指标。     

超敏C-反应蛋白对急性冠状动脉综合征的近期预后意义

目的探讨急性冠状动脉综合征（ACS）患者超敏C-反应蛋白（hs—CRP）的表达及其近期预后意义。方法分别测定30例ACS患者入院时hs—CRP水平，并与30例稳定型心绞痛及30例健康成人hs—CRP作对照。以hs—CRP〉5mg／L为界，比较ACS患者阳性组及阴性组心脏事件发生率。血浆hs—CRP的测定采用微粒增强免疫透射比浊法。结果ACS组的hs—CRP水平（6．05±2．08）mg／L，较正常对照组（3．16±0.96）mg／L高（P〈0．01），也较稳定型心绞痛组（3．24±0．94）mg／L高（P〈0．01）。后两组hs—CRP无差异无统计学意义（P〉0．05）。hs-CRP水平高的ACS患者较hs—CRP水平低者预后更差。结论hs—CRP与ACS发生有关，可作为危险分层的指标之一。     

冠心病血清C反应蛋白、纤维蛋白原、尿酸的变化及意义

目的：探讨冠心病（CHD）与血清C反应蛋白（CRP）、纤维蛋白原（FBG）及尿酸（UA）的关系。方法：分别采用终点法、比浊法检测170例不同类型的CHD患者以及58例正常人血清CRP、FBG及UA含量。结果：CHD组CRP[（15．38±4．15）mg／L]、FBG[（4．69±0．91）g／L]和UA[（478．16±98．75）μmol／L]含量明显高于正常对照组（均P〈0．01）;CHD患者中三者的浓度均以急性心肌梗塞（AMI）组增高最明显;CRP同FBG呈正相关（r=0．793,P〈0．01）。结论：尿酸、C反应蛋白和纤维蛋白原同冠心病关系密切,C反应蛋白同纤维蛋白原呈正相关。     

血浆同型半胱氨酸和氧化低密度脂蛋白与急性冠状动脉综合征关系的探讨

目的 观察急性心肌梗死（AMI）患者血C-反应蛋白（CRP）、同型半胱氨酸（Hcy）和氧化低密度脂蛋白（OX—LDL）的水平及其与预后的关系。方法 2003年4月至2004年8月对中国医科大学附属第二医院的92例发病24h之内入院的AMI患者为观察组，同期健康成人52例为对照组，患者入院后立即采肘静脉血，测定血清CRP，并将上述患者分为CRP正常组（〈10mg／L）36例，CRP上升组（≥10mg／L）56例。入选患者在服用调血脂药之前及出院时（3—4周），空腹状态下采静脉血测定Hcy和ox—LDL。其中58例患者出院后追踪观察6个月，统计其心脏事件的发生与Hcy及ox—LDL的关系。结果 患者出院时血浆Hcy较急性期时明显下降（P〈0．05），两者均高于正常对照组（P〈0．05，P〈0．01）。患者出院时血浆ox—LDL较急性期时明显下降（P〈0．05），两者亦均高于正常对照组（P〈0．05，P〈0．01）。CRP升高组血浆Hcy值与CRP正常组比较差异无显著性（P〉0．05）；CRP升高组血浆ox—LDL比CRP正常组明显升高（P〈0．01）。追踪观察6个月，发生心脏事件者出院时血浆Hcy、ox—LDL水平均明显高于非发生组（P〈0．05）。结论 Hcy、ox—LDL与CRP不仅共同参与了动脉粥样硬化的形成，而且可能在导致粥样斑块的不稳定性和促进血栓形成过程中起重要的协同作用.     

132例老年冠心病患者C-反应蛋白检测在诊断中的意义

目的探讨老年冠心病患者C-反应蛋白检验在诊断中的意义。方法对132例老年CHD患者进行了CRP含量检测。结果老年CHD组中稳定型心绞痛（UA）、不稳定型心绞痛、AMI患者CRP含量分别为（258．3±22．8）mg／L、（314．1±29．6）mg／L、（227．1±23．5）mg／L,正常对照组为（3．56±1．28）mg／L。老年CHD组CRP浓度比对照组明显升高（P〈0．05）。其中不稳定型心绞痛患者CRP水平比UA患者显著增高（P〈0．05）,而UA患者与AMI患者比较亦显著增高（P〈0．05）。本研究结果表明,老年CHD患者CRP浓度较对照组显著增高（P〈0．05）;而不稳定型心绞痛患者CRP浓度较稳定型心绞痛患者显著增高（P〈0．05）。结论可见老年冠心病与炎症有密切的联系。因此,动态检查血中CRP的含量不但有利于协助诊断老年冠心病,并且有助于老年不稳定型心绞痛与急性心肌梗死的鉴别。     

血浆N末端B型利钠肽原与超敏C反应蛋白联合检测对评估冠脉病变的临床价值

目的研究血浆N末端B型利钠肽原（NT—proBNP）与超敏C反应蛋白（hs—CRP）联合检测对冠脉病变的临床评估价值。方法选取我院148例冠脉病变患者,按照确诊分为：AMI组,诊断为急性心肌梗死,共51例;UAP组,诊断为不稳定型心绞痛,共48例;NSTEMI组,诊断为非ST段抬高心肌梗死,共49例。以正常体检患者50名为对照组。比较各组静脉血NT—proBNP、hs—CRP、肌酸肌酶同工酶（CK—MB）及肌钙蛋白I（cTnI）的差异。随访3个月,观察主要心脏事件（MACE）发生率与上述指标的相关性。结果AMI组的NT—proBNP[（162．3±27．6）mg／L]和hs—CRP[（17．2±3．5）mg／L]值最大,对照组最小,分别为NT—proBNP（44．1±6．8）mg／L,hs—CRP（3．9±0．8）mg／L（P〈0．05）,UAP组的NT—proBNP和hs—CRP与NSTEMI组比较[NT—proBNP[（85．5±11．8）mg／L比（101．7±32．2）mg／L,hs—CRP（8．4±1．5）mg／L比（14．3±2．3）mg／L],差异无统计学意义（P〉0．05）。NT—proBNP与hs—CRP浓度与3个月内的MACE有相关性,P值分别为0．023和0．036。结论NT—proBNP与hs—CRP联合检测能有效评估冠脉病变情况,有利于临床诊断。     

急诊介入治疗对急性心肌梗死患者血清VEGF、Fg及hsCRP的影响

目的：探讨急诊介入治疗对急性心肌梗死（AMI）患者血管内皮生长因子（VEGF）、纤维蛋白原（Fg）及超敏c-反应蛋白（hsCRP）的影响。方法：采用酶联免疫吸附法（EI。ISA）检测60例行急诊经皮冠状动脉介入（PCI）治疗的AMI患者术前及术后血清VEGF、Fg及hsCRP的含量。结果：与治疗前相比,AMI患者急诊介入治疗后VEGF[（134．5±30．1）pg／ml比（101．5±25．4）pg／m1]水平明显降低（P〈0．05）、Fg[（4．76±0．24）mg／L比（5．40±0．26）]mg／L]及hsCRP[（2．93±0．38）mg／I。比（5．06±0．60）mg／L]水平明显升高（P均〈0．05）。结论：血管内皮生长因子、超敏C-反应蛋白、纤维蛋白原水平与急性心肌梗死PCI相关,对上述指标进行联合检测,对评定AMI患者PCI病情、判断预后可能有重要价值。     

B-型钠尿肽系列测定判定急性冠脉综合征患者预后的价值

目的探索对急性冠脉综合征（ACS）患者，B-型钠尿肽（BNP）系列测定联合TnT、CRP与不良心脏事件发生率的关系。方法对83例ACS患者分别在入院时、48h、72h测定其BNP、TnT、CRP值，以死亡、心肌梗死、症状性心衰为随访终点，平均随访12个月，对BNP等生化指标与心脏事件发生率的相关性进行统计学分析。结果随访中发现，BNP〉250ng／L的患者与BNP≤250ng／L的患者相比，心脏事件的发生率显著升高，为9％和27％（OR3．7，95％CI：2．3-5．7，P〈0．01）。在TnT阴性的患者，高BNP组与低BNP组相比，其危险比为5．9（95％CI2．6-13.3，P〈0．01）。在临床稳定、没有难治性心肌缺血的患者，BNP值快速下降，基线、48h、72h时的BNP值分别为248．6±10、188．9±8（-24％）、126．8±11（-49％），与基线相比，48h、72h差异均有统计学意义（P〈0．01）。BNP在基线时水平较低，而在72h显著升高的患者，预后较差，OR值为24．0（95％CI：8．4-32．5，P〈0．01）。而在基线时BNP值较高，72h时明显下降者，MACE发生率显著降低，与持续升高者相比，为16％vs38％（OR18．5，95％CI：7．6-21-3，P〈0．01）。结论对ACS患者，BNP是一个强有力的预后判断指标，并且BNP的系列测定与单一基线水平测定相比，其预后判断价值显著增加。     

冠心病血清超敏C-反应蛋白和血清淀粉样蛋白A，脂联素的关系

摘要：目的：探讨冠心病（CHD）患者血清超敏C-反应蛋白（hs-CRP）、血清淀粉样蛋白A（SAA）和血清脂联素（APN）的关系。方法：人选确诊冠心病的患者66例（CHD组）,正常者20例（正常对照组）。分别测定其血清hs—CRP、SAA、APN水平,并进行比较。结果：CHD组hs—CRP、SAA水平分别为（2．88±0．61）mg／L和（9．89±5．23）mg／L,明显高于正常对照组的（0．67±0．17）mg／L和（1．27±1．11）mg／L,P均〈0．01;CHD组APN水平为（3．38±0．26）μg／L,显著低于正常对照组的（3．91±0．34）／Lg／L,P〈0．05。hs—CRP水平与SAA水平呈正相关（r=0．835,P〈0．05）,与APN水平呈负相关（r=-0．285,P〈0．05）。结论：CHD患者血清hs—CRP、血清淀粉样蛋白A水平明显升高,血清脂联素水平明显降低,血清hs—CRP水平与淀粉样蛋白A水平呈正相关,与脂联素水平呈负相关,可作为临床诊断和预后判断的依据。     

A novel digital method to assess air space loss associated with acute lung injury in experimental acute pancreatitis

Background/Objectives

Respiratory dysfunction and/or failure from acute lung injury (ALI) are common in acute pancreatitis (AP), but assessment of ALI in experimental AP has lacked standardisation.

超声心动图在与急性心肌梗死混淆的急性肺栓塞患者诊断中的价值

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急性粒单和急性单核细胞性白血病的临床和细胞表面标记分析

目的：分析ＡＭＬ－Ｍ４、Ｍ５患者的临床和免疫学特征。方法：总结了７５例患者的血液学和临床特征，并用活细胞间接免疫荧光法检测了其中３９例患者的细胞免疫表型，着重分析了ＣＤ７＾＋ＡＭＬ在这二类ＡＭＬ中的发生率、临床特征及预后。结果：这两类白血病的ＨＬＡ－ＤＲ、ＣＤ３８、ＣＤ３４阳性率很高，分别为９１．４３％，８５．１９％和６５．６３％；结论：Ｍ４、Ｍ５这二种亚型有不同于其它ＡＭＬ亚型的临床，血液学和生     

58例急性粒-单核细胞和急性单核细胞白血病的临床及治疗疗效的比较

本文总结了24例 M_4和34例 M_5患者的临床和治疗疗效观察。研究结果表明,M_4好发于女性而 M_5多见于男性,在>60岁老人中 M_5较 M_4多见.M_4患者出血和贫血较明显,M_5以高热、肝脾浸润多见,在治疗反应上,无论 HOAP 或其它化疗方案组,M_5的 CR 率低于 M_4患者。     

Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in acute pancreatitis still represents a substantial problem,with a mortality rate in the range of 30%-40%.The present review evaluates underlying pathophysiological mechanisms in both ALI and ARDS and potential clinical implications.Several mediators and pathophysiological pathways are involved during the different phases of ALI and ARDS.The initial exudative phase is characterized by diffuse alveolar damage,microvascular injury and inf...     

Protective effects of erythropoietin against acute lung injury in a rat model of acute necrotizing pancreatitis

AIM： TO investigate the effect of exogenous erythro- poietin （EPO） administration on acute lung injury （ALI） in an experimental model of sodium taurodeoxycholate- induced acute necrotizing pancreatitis （ANP）. METHODS： Forty-seven male Wistar albino rats were randomly divided into 7 groups： sham group （n = 5）, 3 ANP groups （n = 7 each） and 3 EPO groups （n = 7 each）. ANP was induced by retrograde infusion of 5% sodium taurodeoxycholate into the common bile duct. Rats in EPO groups received 1000 U/kg intramuscular EPO immediately after induction of ANP. Rats in ANP groups were given 1 mL normal saline instead. All animals were sacrificed at postoperative 24 h, 48 h and 72 h. Serum arnilase, IL-2, IL-6 and lung tissue malondialdehyde （MDA） were measured. Pleural effusion volume and lung/body weight （LW/BW） ratios were calculated. Tissue levels of TNF-a, IL-2 and IL-6 were screened immunohistochemically. Additionally, ox-LDL accumulation was assessed with immune-fluorescent staining. Histopathological alterations in the lungs were also scored.RESULTS： The mean pleural effusion volume, calculated LW/BW ratio, serum IL-6 and lung tissue MDA levels were significantly lower in EPO groups than in ANP groups. No statistically significant difference was observed in either serum or tissue values of IL-2 among the groups. The level of tumor necrosis factor-（~ （TNF-（~） and IL-6 and accumulation of ox-LDL were evident in the lung tissues of ANP groups when compared to EPO groups, particularly at 72 h. Histopathological evaluation confirmed the improvement in lung injury parameters a~er exogenous EPO administration, particularly at 48 h and 72 h. CONCLUSION： EPO administration leads to a significant decrease in ALI parameters by inhibiting polymorphonuclear leukocyte （PMNL） accumulation, decreasing the levels of proinflammatory cytokines in circulation, preserving microvascular endothelial cell integrity and reducing oxidative stress-associated lipid peroxidation and therefore     

Acute pancreatitis complicated by acute myocardial infarction – A rare association

Acute pancreatitis complicated by acute myocardial infarction has been reported very rarely. The exact mechanism of the cause of myocardial injury is not known. We report a case of 36 year old male presenting with acute pancreatitis complicated by ST elevation acute myocardial infarction (AMI). The administration of thrombolytic therapy in such patients can have deleterious effects. We report successful performance of primary angioplasty in this complicated patient.     

Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

AIM: To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy (SILC) for acute inflamed gallbladder (AIG).METHODS: One hundred and ten consecutive patients underwent original SILC for gallbladder disease without any selection criteria and 15 and 11 of these were diagnosed with acute cholecystitis and acute gallstone cholangitis, respectively. A retrospective review was performed not only between SILC for AIG and non-AIG, but also between SILC for AIG and traditional laparoscopic cholecystectomy (TLC) for AIG in the same period.RESULTS: Comparison between SILC for AIG and non-AIG revealed that the operative time was longer in SILC for AIG (97.5 min vs 85.0 min, P = 0.03). The open conversion rate (2/26 vs 2/84, P = 0.24) and complication rate (1/26 vs 3/84, P = 1.00) showed no differences, but a need for additional trocars was more frequent in SILC for AIG (5/24 vs 3/82, P = 0.01). Comparison between SILC for AIG and TLC for AIG revealed no differences based on statistical analysis.CONCLUSION: Our original SILC technique was adequately safe and feasible for the treatment of acute cholecystitis and acute gallstone cholangitis.     

Use of the FAB Crriteria for the Diagnosis of Acute Erythroleukaemia (AEL)

Abstract: Use of the FA6 criteria for the diagnosis of acute erythroleukaemia (AEL). R. K. Woodruff, I. H. Bunce, S. Johnson, A. in. Paxton and J. S. malpas, Aust. N.Z. J. med ., 1981, 11, pp. 1–7.
The criteria proposed by the French-American-British (FAB) Group for the diagnosis of acute erythroleukaemia (AEL), including the requirement for ≥ 30% marrow myeloblasts, were used in a review of patients with erythroleukaemia. Ten patients with AEL were identified, and a further twelve patients with marrows suggestive of AEL but having <30% myeloblasts were classified as having refractory anemia with excess of blasts (RAEB). The AEL patients had a poor prognosis, poor response to chemotherapy, and none showed evolution to myeloblastic or monoblastic leukaemia. In contrast, the patients with RAEB appeared to survive longer, respond better to chemotherapy, and several evolved into typical myelogenous leukaemia
The FAB criteria subdivides patients with erythroleukaemia into groups with apparent clinic pathological and prognostic differences. Further studies using these or equally strict criteria are required