流式细胞术检测体液T淋巴细胞亚群的临床应用

目的探讨胸水、腹水、肺泡灌洗液T淋巴细胞亚群的检测方法及临床价值。方法采用流式细胞术检测良、恶性疾病患者的50例胸水、46例腹水、47例肺泡灌洗液(BALF)中T淋巴细胞亚群的水平并分组进行比较。结果 1)胸水:结核性胸膜炎组胸水Ts细胞占T淋巴细胞的(27.36±6.41)%、Th细胞占T淋巴细胞的(67.98±7.41)%、Th/Ts比值为2.60±0.64,肺部恶性肿瘤组胸水Ts细胞占T淋巴细胞的(67.97±4.20)%、Th细胞占T淋巴细胞的(37.61±4.80)%、Th/Ts比值为0.47±0.10,与结核性胸膜炎组比较,恶性组Th、Th/Ts比值显著下降(P0.01)而Ts显著升高(P0.01);2)肺泡灌洗液:肺良性疾病组肺泡灌洗液Ts细胞占T淋巴细胞的(44.54±9.56)%、Th细胞占T淋巴细胞的(49.28±12.88)%、Th/Ts比值为1.13±0.29,肺部恶性肿瘤组肺泡灌洗液Ts细胞占T淋巴细胞的(65.11±7.77)%、Th细胞占T淋巴细胞的(34.57±6.65)%、Th/Ts比值为0.54±0.19,与良性病变组比较,恶性组Th下降(P0.05),Th/Ts比值显著下降(P0.01),而Ts显著升高(P0.01)。3)腹水:结核性腹膜炎组腹水Ts细胞占T淋巴细胞的(33.11±3.34)%、Th细胞占T淋巴细胞的(66.69±3.78)%、Th/Ts比值为2.03±0.28,恶性组腹水Ts细胞占T淋巴细胞的(56.64±9.34)%、Th细胞占T淋巴细胞的(35.86±3.30)%、Th/Ts比值为0.65±0.10,与结核性腹膜炎组比较,恶性组Th、Th/Ts比值显著下降(P0.01),而Ts显著升高(P0.01)。结论胸腹水、肺泡灌洗液T淋巴细胞亚群检测可用于分析性质并有助于评估患者局部免疫功能状态。     

支气管肺泡灌洗液中T淋巴细胞亚群检测在肺癌诊断中的价值

目的探讨流式细胞仪结合免疫荧光技术检测肺泡灌洗液中T淋巴细胞亚群在肺癌诊断中的价值.方法支气管镜检查36例,其中肺癌18例,肺部良性病变18例,均行支气管肺泡灌洗,收集支气管肺泡灌洗液(bronchoalveolar lavagenuid,BALF)检测T淋巴细胞亚群(T lymphocyte subsets).结果肺部良性病变组CD8+占T淋巴细胞的(32.1±1.21)%,CD4+占T淋巴细的(42.3±1.92)%,CD4+/CD8+比值为(1.30±0.05),肺癌组CD8+占T淋巴细胞的(45.11±9.62)%,CD4+占T淋巴细胞的(24.3±5.24)%,CD4+/CD8+比值为(0.53±0.13).与良性病变组比较,肺癌组CD4+明显下降,CD8+明显升高,CD4+/CD8+比值明显下降(P<0.01).结论肺癌患者免疫功能低下,是肿瘤发生发展的原因之一,流式细胞仪结合免疫荧光技术检测肺泡灌洗液中T淋巴细胞亚群,可作为诊断肺癌有效的辅助方法及了解患者的免疫功能.     

支气管肺泡灌洗液T淋巴细胞亚群对肺部病变的诊断价值

目的:探讨支气管肺泡灌洗液T淋巴细胞亚群对肺部病变的诊断价值。方法:用流式细胞仪对31例肺癌和22例肺良性病变的患者支气管肺泡灌洗液(BALF)及外周血作T淋巴细胞亚群分析。结果:中央型肺癌组BALFCD3+CD4+(46.19±12.70)%、CD3+CD8+(53.40±12.20)%和CD4+/CD8+(0.97±0.48);周围型肺癌组BALFCD3+CD4+(41.58±10.39)%、CD3+CD8+(58.16±10.46)%和CD4+/CD8+(0.77±0.33);肺良性病变组BALFCD3+CD4+(63.50±7.56)%、CD3+CD8+(32.78±7.07)%和CD4+/CD8+(2.15±0.64)。前两组比较P>0.05,差异无统计学意义,前两组与肺良性病变组比较P<0.05,差异有统计学意义;肺癌组患者外周血T淋巴细胞各亚群与肺良性病变组比较P>0.05,差异无统计学意义。结论:支气管肺泡灌洗液T淋巴细胞亚群的改变对肺部疾病的鉴别诊断有重要意义,是诊断肺部良恶性病变有效辅助方法。     

探讨肺部感染患者肺泡灌洗液中T淋巴细胞亚群的临床意义

目的 探讨肺部染患者外周血及肺泡灌洗液中T淋巴细胞亚群的变化特点及其临床意义.方法 采用流式细胞术同时检测22例ICU肺部感染患者和22例志愿者的肺泡灌洗液及外周血中T淋巴细胞亚群.结果 感肺组泡灌洗液中CD3+比例(61.69%±18.69%),较正常对照(57.64%±13.84%)变化不明显,CD4+比例(25.04%±14.24%),较正常对照(33.0I%±11.94%)显著降低,CD8+比例(40.40%±13.53%),较正常对照(30.63%±12.32%)显著增高,CD4+/CD8+比值(0.69%±0.34%),较正常对照显著降低.而感染组外周血中CD3+、CD4+、CD8+均下降.CD4+/CD8+比值无明显变化.结论 肺泡灌洗液中淋巴细胞的检测能更好地反映患者肺部感染的情况,对临床诊断及治疗有较大帮助.     

结节病支气管肺泡灌洗液细胞学与影像学关系分析

目的:探讨结节病患者支气管肺泡灌洗液中中性粒细胞、淋巴细胞及T淋巴细胞亚群CD4+T淋巴细胞、CD8+T淋巴细胞、CD4/CD8比值与CT影像之间的相关性。方法:行纤维支气管镜下支气管肺泡灌洗及肺CT检查的结节病患者59例,按照CT表现分为无肺内病变组(23例),有肺内病变组(36例),比较2组患者支气管肺泡灌洗液中中性粒细胞、淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞及CD4/CD8比值的水平。结果:有肺内病变组较无肺内病变组支气管肺泡灌洗液中中性粒细胞升高(P<0.05),CD8+T淋巴细胞增高(P<0.05),CD4/CD8比值下降(P<0.05),淋巴细胞和CD4+T淋巴细胞差异无统计学意义(P>0.05)。结论:结节病患者可根据肺CT影像评估支气管肺泡灌洗液中各种淋巴细胞亚型变化的趋势。     

T-SPOT及肺泡灌洗液T细胞亚群检测在肺结核及肺结节病鉴别诊断中的意义

目的探讨结核分枝杆菌T细胞斑点试验(T-SPOT)及肺泡灌洗液T细胞亚群检测在肺结节病和肺结核鉴别诊断中的作用。方法选择2010年1月至2015年9月该院确诊的50例肺结节病和123例肺结核患者进行T-SPOT和肺泡灌洗液T细胞亚群检测,并对结果进行统计和分析。结果肺结节病患者中T-SPOT阳性率为4.0%,肺泡灌洗液CD3~+、CD4~+、CD8~+ T细胞百分比分别为(88.79±5.34)、(63.58±20.56)、(27.42±6.76)%,CD4~+/CD8~+比值为2.32±2.0;肺结核患者中T-SPOT阳性率为90.2%,肺泡灌洗液CD3~+、CD4~+、CD8~+T细胞百分比分别为(75.10±11.20)、(44.52±7.30)、(32.10±12.30)%,CD4~+/CD8~+比值为1.30±1.20。肺结节病患者较肺结核患者CD3~+和CD4~+T细胞明显增多,CD4/CD8比值升高,差异均有统计学意义(P0.05),CD8~+T细胞有所下降,但差异无统计学意义(P0.05);肺结核患者T-SPOT阳性率明显高于肺结节病患者,差异均有统计学意义(P0.05)。结论 T-SPOT以及肺泡灌洗液T细胞检测适用于快速鉴别诊断肺结节病与肺结核。     

乳腺癌患者外周血T淋巴细胞及调节性T细胞的检测意义

目的 探讨乳腺癌患者外周血中T淋巴细胞亚群及调节性T细胞的变化和临床意义.方法 采用流式细胞技术检测30例乳腺癌患者外周血中T淋巴细胞亚群及调节性T细胞的变化,并与健康对照组进行比较.结果 乳腺癌患者外周血CD4+CD25+及CD4+CD25+high调节性T细胞占CD3+CD4+T细胞的比率为(15.52±1.54)%及(3.49±0.54)%,高于健康对照组(6.11±0.72)%及(1.42±0.61)%,差异有统计学意义(P<0.05);乳腺癌患者CD3+T淋巴细胞比率为(50.98±6.79)%、CD4+Th细胞比率为(28.37±7.58)%和Th/Ts比值为(1.05±0.38),显著低于健康对照组(67.55±5.98)%、(40.12±5.27)%和(1.59±0.65),差异有统计学意义(均P<0.05),而CD8+Ts细胞比率为(30.05±7.79)%,与健康对照组(29.97±7.14)%比较,差异无统计学意义(P>0.05).结论 乳腺癌患者外周血调节性T细胞水平升高,T淋巴细胞及Th细胞降低可能是乳腺癌患者细胞免疫功能受损的重要原因之一.     

麻醉及手术对糖尿病合并肿瘤患者肺泡灌洗液T细胞亚群的临床研究

目的探讨麻醉及手术对糖尿病合并肿瘤患者的肺泡灌洗液中T细胞亚群的影响,以了解肺局部免疫功能的变化。方法 2012年7月至2013年12月该院根据美国麻醉师协会(ASA)Ⅰ~Ⅱ级的肝癌、胃癌、结肠癌、乳腺癌以及妇科恶性肿瘤合并糖尿病患者30例。分别于气管插管后、麻醉后2h、手术结束患者清醒拔除气管导管前获取肺泡灌洗液标本,应用流式细胞仪进行T细胞亚群检测(CD3、CD4、CD8、CD4/CD8比值)。结果患者麻醉后的T细胞亚群较麻醉前数值降低,术后较术前也有所降低,差异均有统计学意义(P0.05);而CD4/CD8比值在此期间一直处于降低趋势。结论肿瘤患者在术后更容易发生肺部感染,甚至发生肿瘤转移。     

骨髓增生异常综合征患者细胞及体液免疫功能分析

目的 探讨骨髓增生异常综合征( myelodysplastic syndrome,MDS)患者细胞免疫和体液免疫水平的变化及意义.方法 采用流式细胞术(FCM)检测30例健康志愿者(健康对照组)及31例确诊但未治疗的MDS患者(低危、中危和高危)外周血淋巴细胞亚群,包括CD3+T淋巴细胞及其亚群、CD3 CD19+B淋巴细胞和CD3(CDI6CD56)+自然杀伤(NK)细胞比例.结果 与健康对照组比较,MDS患者的T淋巴细胞、B淋巴细胞和NK细胞总数均明显减低.另外,在T淋巴细胞亚群中,CD3+ CD4+的辅助性T细胞(Th)表达降低,CD3+ CD8+的抑制性T细胞(Ts)表达增高,Th/Ts比值倒置,比例失衡;且随着MDS疾病的进展,Ts细胞的表达逐渐增加,但低危、中危和高危3组间的差异无统计学意义,NK细胞的表达逐渐降低,但差异无统计学意义(P＞0.05),MDS 3组间T淋巴细胞和Th/Ts比值差异无统计学意义.结论 MDS患者的细胞和体液免疫功能均降低,淋巴细胞亚群检测可用来评估MDS患者免疫功能状态.     

反复呼吸道感染儿童T淋巴细胞亚群的变化

目的研究儿童反复呼吸道感染(RRTI)时T淋巴细胞亚群的变化。方法采用流式细胞术检测RRTI患儿(观察组)和健康儿童(对照组)外周血T淋巴细胞亚群的表达水平。结果观察组CD3+、CD4+与CD8+T细胞百分率分别为(61.82±7.25)%、(32.87±6.73)%及(20.39±3.72)%,均明显低于对照组(P<0.01);CD4+/CD8+比值(1.65±0.42)显著高于对照组,差异有统计学意义(P<0.05)。结论 RRTI患儿存在细胞免疫功能紊乱,表现为CD3+、CD4+/CD8+T细胞比例下降和CD4+、CD8+上升。流式细胞术检测T淋巴细胞亚群可用于快速、简便、准确评估患儿的免疫功能状况。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.