血清肌钙蛋白T危急值临床意义

目的探讨血清肌钙蛋白T（cTnT）危急值与临床的关系。方法统计2009年1月至2011年1月期间医学检验部检测到的危急值,分析血清cTnT危急值特点及其分布规律。结果共报告危急值检验报告2865个,其中血清cTnT164例,占所有报告危急值的5．72％;检测血清cTnT3417人次,报告率为4．80％。其中28例危急值结果〉10ng／ml,占血清cTnT报告危急值的17．07％,均为心脑血管病患者。危急值病例主要以急性心肌梗死（AMI）和急性冠状动脉综合征（ACS）患者为主,其次为脑梗死、肺栓塞、严重肾功能不全及消化系统疾病患者。结论血清cTnT危急值的限值范围较宽,应根据具体情况科学合理的设置危急值范围。     

中山市流浪精神病患者救治现状调查

目的：了解中山市流浪精神病患者的救治现状,为进一步完善流浪精神病患者救治体制提供依据。方法对中山市114例流浪精神病患者的临床资料进行回顾性分析。结果本组患者98．2％由110及120送入院,79．8％来自广东省外,婚姻状况以未婚为主（62．3％）,文化程度较低;流浪原因以受精神病性症状影响为主（85．1％）,救治原因以言语紊乱为主（76．3％）,诊断以精神分裂症（40．4％）、精神活性物质所致精神障碍（21．1％）居多,多应用第一代抗精神病药物治疗（69．3％）,部分患者合并有躯体疾病或传染病。结论中山市流浪精神病患者来源地域分布广,文化程度较低,未婚者居多,多由公安机关及医疗机构联合送治,部分患者合并传染病或躯体疾病,救治任务复杂且繁重。     

血清肿瘤标志物联合检测在胃癌诊断中的临床价值

[目的]评价联合检测血清肿瘤标志物CA19—9、CA242、CA125及癌胚抗原CEA四项指标对胃癌的诊断价值。[方法]选取65例胃癌患者作为病患组（A组）,70例同期住院的良性胃疾病患者作为良性胃疾病组（B组）,70例同期体检合格的健康成人作为正常对照组（c组）。采用化学发光免疫分析法检测三组人选对象的CA19—9、CA125、CA242、CEA血清水平并进行对比。[结果]胃癌患者血清CA19—9、CA125、CA242、CEA值均明显高于正常对照组及良性胃疾病组,差异均有统计学意义（P〈0．05）;CA19—9、CA125、CA242、CEA四项指标联合检测的敏感性（75．84％）和特异性（59．71％）较单测任何一项（CA19—9：23．12％、83．91％,CA125：38．45％、90．41％、CA242：21．33％、85．30％,CEA：35．11％、92．30％。）敏感性均有提高,差异均有统计学意义（P〈0．05）。[结论]联合检测血清CA19—9、CA125、CA242及CEA能提高对胃癌的阳性检出率,具有临床诊断价值。     

住院精神病患者并发内科重症80例临床资料分析

目的：探究住院精神病患者并发内科重症的原因及临床治疗效果。方法对80例并发内科重症住院精神病患者的临床资料进行回顾性分析。结果本组41．3％的患者伴有躯体性疾病,伴发的躯体疾病以呼吸系统、消化系统疾病为主;30．0％的患者应用抗精神病药物出现严重不良反应;87．5％的患者经治疗后获得痊愈或好转,12．5％的患者治疗无效死亡。结论住院精神病患者伴发躯体疾病发生率高,及时予以对症治疗效果显著。     

H—FABP与多项心肌标志物在AMI早期检测中的比较

[目的]研究心型脂肪酸结合蛋白（H—FABP）检测在急性心肌梗死（AMl）中的临床应用价值，并与常规的检测项目肌酸激酶MB同功酶（CK—MB）、肌钙蛋白I（cTnI）、肌红蛋白（MYO）进行同步比较，为AMI的诊断提供更好的指标。[方法]对临床可疑的81例AMI患者测定全血eTnI、MYO、CK—MB质量，并同时对血清中H—FABP进行定性分析，所得数据进行统计学分析。[结果]在入院后24h内CKMB、cTnI、和H—FABP对AMI的敏感性分别为：80．5％、77．8％、91．6％、83．3％；特异性分别为：77．8％、77．8％、66．7％、100％。急性心肌梗死（AMI）患者胸痛发作6小时内MYO诊断敏感性较高（95．45％），其次H—FABP（77．27％），CKMB（72．73％），cTnI（68．18％）。[结论]H—FABP较cTnI，CKMB，MYO对早期AMI具有更好的诊断价值有望成为新的AMI早期诊断标志物。     

2015年某院血液室危急值情况分析

目的：分析广东药科大学附属第一医院2015年血液室危急值项目,以便进一步完善危急值制度。方法通过实验室信息系统收集该院2015年血液室危急值项目,统计危急值发生率、科室分布及来源。结果广东药科大学附属第一医院血液室危急值项目包括红细胞（RBC）、白细胞（WBC）、血小板（PLT）等8项,全年共发送危急值报告9235例,危急值报告的发生率为1．74％;危急值比例最高为PLT（30．62％）,其次为PT（22．27％）;危急值发生率最高为PT（7．27％）,其次为PLT（2．67％）;危急值发生频率最高的科室是血液内科,其次是肿瘤科。结论血液学危急项目的设定和阈值设定上存在一定问题,各实验室应在参考国内外文献的基础上,与临床积极协商,制定出适合所在医院的危急值界限。     

心肌标志物检测在早期诊断急性心肌梗死中的价值

目的探讨胶体金免疫层析法检测血清肌钙蛋白Ⅰ、肌酸激酶同工酶（CK-MB）、肌红蛋白在急性心肌梗死（AMI）患者早期不同时间段的诊断价值。方法收集该院2011年1月至2012年12月收治的89例AMI病例,根据发病时间分为两组,2～〈6h组42例,6～12h组为47例,非心肌梗死对照组70例。采用血清肌钙蛋白Ⅰ、CK-MB、肌红蛋白三合一诊断试剂对选取的病例进行测定。结果AMI患者肌钙蛋白Ⅰ、CK-MB、肌红蛋白的阳性率均高于对照组（P〈0．05）,在2～〈6h时间段内三者的敏感度分别为35．7％、64．3％、52．4％,均低于6～12h时间段的48．9％、85．1％、76．6％,结果差异有统计学意义（P〈0．05）。CK-MB用于诊断的敏感度在两个时间段内分别为：64．3％、85．1％,较肌钙蛋白I（35．7％、48．9％）、肌红蛋白（52．4％、76．6％）高,差异有统计学意义（P〈0．05）,而肌红蛋白敏感度较肌钙蛋白Ⅰ高（P〈0．05）。将三者联合测定时,阳性率高于单独测定时的阳性率,2～6h组阳性率为69．0％,6～12h组阳性率为89．4％。结论在AMI早期,肌钙蛋白Ⅰ、CK-MB、肌红蛋白单独测定阳性率较低,不能满足临床需要,而采用胶体金法心肌三合一诊断试剂盒,对肌钙蛋白Ⅰ、CKMB、肌红蛋白进行联合测定能提高AM1的早期诊断阳性率,以便为临床提供可靠的实验信息,及时采取有效的治疗措施,从而降低患者的病死率。     

长期住院精神病患者躯体疾病调查

目的调查我院长期住院精神病患者躯体疾病情况.方法以2005年3月8日为时点,对连续住院2年以上的350例精神病患者的精神科诊断及躯体疾病分项进行临床调查和统计分析.结果住院患者中精神科疾病诊断排在前3位的是：精神分裂症（61.32%）、阿尔采默病（15.26%）、心境障碍（4.74%）;躯体疾病前3位是：心脏病（8.68%）、糖尿病（8.42%）、高血压（4.47%）.结论长期住院精神病患者中老年患者越来越多,合并躯体疾病的发生率随之增高,在临床工作中应引起足够的重视.     

肇事精神病患者304例的临床特征调查

目的 调查分析肇事精神病患者的临床特征。方法 采用自编的个人资料调查表调查2003年1月至2007年12月间浦东新区精神卫生中心收治的304例肇事精神病患者临床资料,并将所得数据输入统计软件SPSS10．0进行统计。结果 5年收治的304例肇事精神病患者年龄15～65岁,平均（31．54±10．38）岁;18例（5．9％）存在躯体疾病;诊断精神分裂症或分裂样精神病者277例（91．3％）;给予氯丙嗪治疗者246例,平均治疗剂量为（335．80±128．71）mg／d;痊愈者2例（0．7％）、显进者9例（2．9%）、好转或进步者265例（87．2％）,未愈或恶化者28例（9．2％）。结论 “肇事精神病患者”多为中青年,生活压力大,又缺乏社会支持及家庭的关心,因此,应关注精神卫生知识的普及,多关爱此类患者,以促进患者的疾病预后。     

城市流浪精神病患者入院原因及躯体合并症状及其治疗效果：配对分析

目的：了解深圳市住院流浪精神病患者特点。方法：选择2003-06／2004-06在深圳市康宁医院住院的流浪精神病患者96例（观察组）；同期入院的其他精神病患者中随机选取96例作为对照组，对两组患者进行一般资料和临床资料的调查统计，用大体评定量表、躯体生活自理量表、阳性与阴性症状量表评定入院时的精神状况。结果：192例患者全部进入结果分析。①两组入院原因、合并躯体疾病、精神科诊断比较：观察组中，男性患者占62％（59／96），因伤人毁物肇事行为入院者占68％（65／96），合并的躯体疾病者占76％（73／96），诊断精神分裂症者占81％（78／96），既往有精神病史者占46％（44／96），均高于对照组[45％（43／96），29％（28／96），27％（26／96），55％（53／96），27％（26／961，P〈0．01-0．05]。②两组患者大体评定量表、躯体生活自理量表、阳性与阴性症状量表评分比较：观察组人院时大体评定量表评分低于对照组（15．6&;#177;6．2，28．2&;#177;7．9，P〈0．05）；躯体生活自理量表评分，阳性与阴性症状量表评分，其中阴性症状分，一般病理症状分均高于对照组[18．5&;#177;4．4，12．1&;#177;3．1；99．6&;#177;14．8，77。3&;#177;13．5；39．7&;#177;7．4，22．3&;#177;5．7；41．2&;#177;7．9；34．9&;#177;6．8，P〈0．05或P〈0．01]。③两组患者住院时间、自动出院率、欠费率及出院时疗效转归比较：观察组住院时间明显低于对照组[（14．8&;#177;8．3）d，（28．5&;#177;12．9）d，P〈0．05]。观察组自动出院者占60％（58／96），最终欠费者占85％（82／96），均高于对照组[9％（9／96），2％（2／96），P〈0．01-0．05]。出院时疗效显著好转以上者（阳性与阴性症状量表评分的减分率50％以上者为显著好转）占9％（9／96），低于对照组[59％（57／96），P〈0．01]。结论：流浪精神病患者精神症状较严重，多伴发躯体疾病。住院时间短，自动出院率高，出院时欠费率高。阴性症状突出，生活自理能力低，疗效较差。     

Circadian rhythm in serum parathyroid hormone concentration in human subjects: correlation with serum calcium, phosphate, albumin, and growth hormone levels

A circadian variation in serum calcium, albumin and PTH concentration in normal subjects has been demonstrated. The levels of the three blood constituents were remarkably constant during the day, but striking night and early morning changes occurred. Serum calcium levels were highest at 8:00 p.m. and reached a nadir between 2:00 and 4:00 a.m. Serum albumin levels were parallel to those of serum calcium. PTH levels began to rise after 8:00 p.m., reached the highest levels between 2:00 and 4:00 a.m., and fell to baseline values by 8:00 a.m. The nocturnal fall in serum calcium levels appears to be secondary to dilution of serum proteins by increasing blood volume. The nocturnal rise in PTH levels appears to be independent of serum calcium levels within the normal range but it can be abolished by induced hypercalcemia.     

不同类型标本血电解质及葡萄糖测定结果的比较分析

目的探讨动脉血浆、静脉血浆、动脉血清、静脉血清之间电解质、葡萄糖结果的差异及其原因。方法采集54例患者动静脉抗凝血、动静脉凝集血各1管,分离出相应的血浆和血清,用强生VITROS 5600自动干式生化分析仪对K~+、Na~+、Cl~-、血糖的浓度进行测定,并应用统计学方法对检测结果进行比较分析。结果当标本类型为血清时,动脉血与静脉血之间Na~+、Cl~-、血糖和血清K~+浓度的测定值差异有统计学意义(P0.05);当标本类型为血浆时,动脉血与静脉血之间Na~+、Cl~-、血糖浓度的测定值差异有统计学意义(P0.05),但K~+浓度差异无统计学意义(P0.05)。另外,动脉的血浆和血清之间血糖和血K~+的测定值差异有统计学意义(P0.05),而Na~+、Cl~-测定值的差异无统计学意义(P0.05);同样的,静脉的血浆和血清之间血糖和血K~+的测定值差异有统计学意义(P0.05),而Na~+、Cl~-测定值的差异无统计学意义(P0.05)。结论同一检测系统检测电解质、葡萄糖,动脉血浆、静脉血浆、动脉血清、静脉血清之间测定值存在一定差异,临床上应注意区别对待不同类型标本的测定值,建立、选择合适的参考范围。     

Oxygen effects on glucose meter measurements with glucose dehydrogenase- and oxidase-based test strips for point-of-care testing

OBJECTIVES: To determine the effects of different oxygen tensions (Po2) on glucose measurements with glucose dehydrogenase (GD)-based and glucose oxidase (GO)-based test strips, to quantitate changes in glucose measurements observed with different Po2 levels, and to discuss the potential risks of oxygen-derived glucose errors in critical care. DESIGN: Venous blood from healthy volunteers was tonometered to create different oxygen tensions simulating patient arterial Po2 levels. Venous blood from diabetic patients was exposed to air to alter oxygen tensions simulating changes in Po2 during sample handling. Whole-blood glucose measurements obtained from these samples with six glucose meters were compared with reference analyzer plasma glucose measurements. Glucose differences were plotted vs. different Po2 levels to identify error trends. Error tolerances were as follows: a) within +/-15 mg/dL of the reference measurement for glucose levels 100 mg/dL. SETTING AND SUBJECTS: Five healthy volunteers in the bench study and 11 diabetic patients in the clinical study. RESULTS: In the bench study, increases in Po2 levels decreased glucose measured with GO-based amperometric test strips, mainly at Po2 levels >100 torr. At nearly constant glucose concentrations, glucose meter systems showed large variations at low (39 torr) vs. high (396 torr) Po2 levels. Glucose measured with GD-based amperometric and GO-based photometric test strips generally were within error tolerances. In the clinical study, 31.6% (Precision PCx), 20.2% (Precision QID), and 23.0% (Glucometer Elite) of glucose measurements with GO-based amperometric test strips, 14.3% (SureStep) of glucose measurements with GO-based photometric test strips, and 4.6% (Accu-Chek Advantage H) and 5.9% (Accu-Chek Comfort Curve) of glucose measurements with GD-based amperometric test strips were out of the error tolerances. CONCLUSIONS: Different oxygen tensions do not significantly affect glucose measured with the GD-based amperometric test strips, and have minimal effect on GO-based photometric test strips. Increases in oxygen tension lowered glucose measured with GO-based amperometric test strips. We recommend that the effects of different oxygen tensions in blood samples on glucose measurements be minimized by using oxygen-independent test strips for point-of-care glucose testing in critically ill and other patients with high or unpredictable blood Po2 levels.     

检验危急值在急诊科应用效果的分析

目的对急诊科检验危急值项目的历史数据进行分析,评价危急值在急诊科应用的效果。方法制定危急值报告处理流程,对急诊科2011年的135例危急值项目经数据预处理、变换后,计算出危急值项目的发生率、天内分布和周转时间,分析处置结果。结果危急值的发生率是0．14％,主要集中在晚上10：00-凌晨1：00,危急值项目总体周转时间控制在70min,急救效率达到100％。结论检验危急值在急诊科运用成功,可以提高实验室及急诊的工作效率和质量,满足患者的安全要求。     

Semi-quantitative estimation of serum myoglobin by a rapid latex agglutination method: an emergency screening test for acute myocardial infarction

The present study reports the evaluation of a new latex agglutination test for serum myoglobin (SMb). The time of agglutination of the latex particles coated with antibodies to myoglobin was measured in 172 serum specimens with known concentration of myoglobin quantitated by a radioimmunoassay (RIA), collected from myocardial infarction (MI) patients, subjects suffering from various diseases, and normal controls. Myoglobin levels in the samples were found to decrease exponentially with time of agglutination. Agglutination occurring within 1 min (result coded as + + + +) corresponded to 761 +/- 366 micrograms/l of myoglobin; between 1 and 2 min (+ + +), to 285 +/- 101 micrograms/l; between 2 and 3 min (+ +), to 85 +/- 47 micrograms/l; between 3 and 4 min (+), to 51 +/- 38 micrograms/l; and after more than 4 min (-), to 31 +/- 16 micrograms/l. Blood samples were serially drawn from 24 MI patients with short hospitalization delays; the rapid agglutination which was obtained in the specimens taken upon admission (20 results coded as + + + + and four as + + +) actually corresponded to markedly increased SMb levels. In contrast, serum creatine kinase (CK) activities were still less than 150 U/l in four patients (16.6%); CK-MB was less than 5 U/l in five cases (20.8%). Positive agglutinations for SMb were also obtained 4 and 8 h following admission in all subjects, confirming that the latex test is an early and very sensitive indicator for MI.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of methods for calculating serum osmolality: multivariate linear regression analysis.

BACKGROUND: There are several methods for calculating serum osmolality, and their accordance with measured osmolality is the subject of controversy. METHODS: The concentrations of sodium, potassium, glucose, blood urea nitrogen (BUN) and osmolalities of 210 serum samples were measured. Two empirical equations were deduced for the calculation of serum osmolality by regression analysis of the data. To choose the best equation, chemical concentrations were also used to calculate osmolalities according to our formulas and 16 different equations were taken from the literature and compared with the measured osmolalities. Correlation and linear regression analyses were performed using Excel and SPSS software. RESULTS: Multiple linear regression analysis showed that serum concentrations of sodium (beta = 0.778, p< or = 0.000), BUN (beta = 0.315, p < or = 0.000), glucose (beta = 0.0.089, p < or = 0.007) and potassium (beta = 0.109, p < or = 0.008) are strong predictors of serum osmolality. The data were also analyzed by manual linear regression to yield the equations: osmolality = 1.897[Na + ]+glucose+BUN+13.5, and osmolality = 1.90[Na+ + K+]+glucose+BUN+5.0. The osmotic coefficient for sodium and potassium solutes was deduced to be 0.949 from the slope of the curves of measured osmolality vs. [Na+] and [Na+ + K+], respectively. The inclusion of a BUN value in the equation for osmolality increased the correlation coefficient by approximately 450% and decreased the SD of difference by approximately 35% (p < or = 0.002). Inclusion of the osmotic coefficient for sodium solutes caused an underestimation of measured osmolality and positive osmolal gap unless an appropriate coefficient, constant value and/or the potassium value were included in the equation. The agreement was not improved when molal chemical concentrations were used instead of molar values. The formula presented by Dorwart and Chalmers gave inferior results to those obtained with our formulas. CONCLUSIONS: Our data suggest use of the Worthley et al. formula Osm = 2[Na +]+glucose+BUN for rapid mental calculation and the formulas of Bhagat et al. or ours for calculation of serum osmolality by equipment linked to a computer.     

危急值电子报告系统的临床应用分析

目的探讨危急值电子报告系统的临床应用价值。方法通过医院信息管理系统(eHIS)查询2015年8月1日至2016年1月31日的危急值数据,分析危急值的发生率、项目分布和科室分布。结果共报告危急值3 405项,危急值发生率为0.45%;危急值报告数量排前5位的分别是血氯(25.76%)、磷酸肌酸激酶同工酶(19.97%)、血钠(9.43%)、血小板计数(9.05%)和二氧化碳分压(6.40%);危急值报告数量前5位的科室分别是心血管内科病区(18.94%)、神经重症医学科病区(12.04%)、重症医学科(9.52%)、神经外科二病区(5.11%)和血管神经病区(5.02%);危急值报告的中位数时间降低了33.33%,四分位间距时间降低了40.00%。结论危急值电子报告系统的使用,降低了危急值报告所用时间,提高了危急值报告的及时性和准确性,对于保障医疗质量具有重要意义。     

776例孕早期妇女甲状腺功能筛查结果分析

目的探索甲状腺疾病在妊娠早期的发生率和特点,为优生优育提供科学依据。方法运用化学发光免疫分析法检测776例妊娠早期(12~(+6)周)妇女(试验组)和100例非妊娠育龄妇女(对照组)血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)和甲状腺过氧化物酶抗体(TPO-Ab)的浓度,根据妊娠早期与非妊娠育龄妇女的不同诊断标准分析检测结果。结果试验组的TSH、FT4和TPO-Ab血清浓度与对照组的差异均有统计学意义(P0.05)。妊娠早期妇女的甲状腺疾病总发生率达35.05%,明显高于非妊娠育龄妇女(15.00%),差异有统计学意义(P0.05)。试验组的孕妇所患甲状腺疾病主要为甲状腺功能减退(9.28%)和亚临床甲状腺功能减退(22.94%),与对照组妇女比较差异有统计学意义(P0.05)。结论妊娠早期甲状腺疾病的发生率高,可导致出生缺陷;因此,要重视对妊娠早期甲状腺疾病的筛查,提供优生优育理论依据。     

Analytical performance of time-resolved fluorometry-based Innotrac Aio! cardiac marker immunoassays

The results of an evaluation of the Innotrac Aio! cardiac markers are presented. This system is based on dry-chemistry, time-resolved fluorometry. All assay-specific reagents are dry-coated into assay-specific cups, and only the generic assay buffer is required. The levels of precision attained with pooled serum samples and control materials were acceptable for cTnI and CK-MB. Myoglobin assay showed higher CV, 5.6-9.5%. The linearity studies were performed in concentration ranges of 0.1-76 microg/L for cTnI, 0.7-450 microg/L for CK-MB and 0.6-1500 microg/L for myoglobin. The markers were found to be linear within the ranges tested. The correlation coefficient between the Aio! and AxSYM cTnI assays was 0.960, and the slope was 0.07. The correlation coefficients between the Aio! and AxSYM CK-MB and myoglobin assays were 0.995 and 0.971, respectively. They involved some differences in the measured concentrations (Aio! CK-MB was about 9% higher than AxSYM CK-MB, and Aio! myoglobin was 19% higher than AxSYM). Comparative studies with all the markers, using EDTA whole blood and lithium heparin plasma specimens and lithium heparin whole blood and plasma, yielded the following results: the slopes were close to 1.0 for all correlations, with the exception of that between CK-MB EDTA whole blood and lithium heparin (0.83). High correlation coefficients were obtained (> or = 0.97). The carryover results for all the cardiac markers were good, 0.0%, 0.0%, and 0.3% for cTnI, CK-MB, and myoglobin, respectively. The analytical detection limits were 0.01 microg/L for cTnI, 0.8 microg/L for CK-MB and 0.5 microg/L for myoglobin. The stability of the analytes in the lithium heparin samples at room temperature was also studied and was found to be decreased by from 10% (myoglobin and CK-MB) to 17% (cTnI) in 8 h. Innotrac Aio! provides a rapid and easy quantitative measurement of cardiac TnI, CK-MB, and myoglobin within < 18 min. This system is therefore suitable for use in emergency departments, coronary care units or central laboratory settings.     

医学检验危急值管理评估分析

目的 分析医学检验危急值管理现状,提出相应的对策。方法 采用回顾性分析法,对内江市第二人民医院2014年9月506例医学危急值报告,利用软件统计出危急值项目构成比以及不同时间段危急值发生频率,危急值发生周期,不同临床科室危急值报告量等。结果 检验医学危急值出现率最高的项目是血小板(PLT),占危急值总数的16.80%,其次:白细胞(WBC)13.24%、血肌酐(Cr)12.25%; 危急值报告量集中在9:00～11:00,占全天的34%左右; 周二和周四危急值报告量较多,周日较少; 危急值报告量最多的是:重症监护病房(ICU)占危急值总数的24.70%,其次是肾内科21.15%,血液科19.57%。结论 检验科室人员必须认真执行检验医学危急值报告制度,各临床科室认真执行危急值报告登记制度。每年根据情况对医学检验危急值进行评估,确保医疗质量安全。