冠心病患者IL-6及CRP血清水平检测的临床意义

目的 探讨白细胞介素-6(IL-6)血清水平和C-反应蛋白(CRP)在监测冠心病病情及与冠状动脉病变程度的关系.方法 142例冠心病患者,按临床诊断分为急性心肌梗死(AMI)组48例、不稳定性心绞痛(UAP)组45例、稳定性心绞痛(SAP)组49例,对照组50例.采用免疫透射比浊测定CRP,用酶联免疫吸附实验检测血清IL-6的水平.比较各组间的差异.结果 AMI组、UAP组及SAP组的CRP及IL-6水平均比对照组高(P<0.05);AMI组、UAP组ClIP及IL-6水平和SAP组相比,其值增加明显;AMI组和UAP组结果相似;IL-6水平与CRP变化呈正相关.结论 血清CRP及IL-6可能是冠状动脉粥样硬化的标志,参与了冠心病的发病过程,其值与冠状动脉病变程度密切相关.     

冠心病患者血清IL-6和IL-10水平检测的临床意义

目的探讨血清可溶性白细胞介素-6（IL-6）和白细胞介素-10（IL-10）水平与冠心病（CHD）病情及与冠状动脉病变程度的关系。方法将165例冠心病患者按临床诊断分为3组：急性心肌梗死（AMI）组60例、不稳定性心绞痛（UAP）组50例、稳定性心绞痛（SAP）组55例;健康对照组55例。用酶联免疫吸附试验检测各组血清可溶性IL-6和IL—10的水平,并比较各组间的差异。结果AM／组、UAP组及SAP组的血清可溶性IL-6和IL-10水平比对照组高（P〈0．05）,AMI组、UAP组血清IL-6水平高于SAP组（P〈0．05）;AMI组和UAP组血清IL-10水平低于SAP组（P〈0．05）;AMI组和UAP组血清IL-10的水平相似（P〉0．05）;结论冠心病患者血清可溶性IL-6及IL-10明显升高,且在一定程度上反映了病情、病变的严重程度,可作为CHD危险分层及病变程度评估的参考指标。     

急性冠状动脉综合征患者血清炎性细胞因子水平及临床意义

目的通过对急性冠状动脉综合征患者血清炎性细胞因子水平的测定及比较,分析炎症及细胞因子在急性冠状动脉综合征发生发展过程中的作用及临床意义。方法选择急性心肌梗死(AMI)患者44例(AMI组),不稳定性心绞痛(UAP)患者44例(UAP组),稳定性心绞痛(SAP)患者43例(SAP组),无冠心病患者35例(对照组),分别检测各组患者血清白细胞介素6(IL-6)、白细胞介素8(IL-8)、白细胞介素10(IL-10)、TNF-α、C反应蛋白(CRP)和基质金属蛋白酶9(MMP-9)浓度并进行比较。结果 AMI组患者血清IL-6、IL-8、IL-10、TNF-α、CRP和MMP-9水平均明显高于SAP组和对照组(P<0.01);AMI组患者血清IL-10、TNF-α、CRP、MMP-9水平明显高于UAP组(P<0.05);UAP组患者血清IL-6、IL-8、IL-10水平明显高于SAP组和对照组;MMP-9和CRP与IL-6呈正相关(r=0.308,r=0.384,P<0.01)。结论冠心痛与炎性反应密切相关,多种细胞因子参与了动脉粥样硬化斑块的形成和进程,血清炎性细胞因子水平的升高是冠状动脉粥样硬化斑块不稳定的标志。     

血清白细胞介素-34水平与冠心病严重程度的关系

目的:通过检测不同类型冠心病患者血清中白细胞介素(IL)-34水平,探讨IL-34表达水平与临床严重程度及冠状动脉病变严重程度之间的关系。方法:通过ELISA检测各组[对照组42例,稳定型心绞痛(SAP)组30例,不稳定型心绞痛(UAP)组36例和急性心肌梗死(AMI)组24例]血清IL-34水平。比较不同Gensini评分组患者血清IL-34水平。结果:血清IL-34水平UAP组(143.06±34.57)pg/ml和AMI组(151.32±37.08)pg/ml显著高于SAP组(32.31±6.23)pg/ml和对照组(15.21±3.32)pg/ml(均P0.05),而UAP组和AMI组、SAP组和对照组之间无显著差异。在不同Gensini评分组患者血清IL-34水平无显著差异;对血清IL-34水平与Gensini评分进行Pearson相关分析,同样发现二者之间无显著的相关性(r=0.193,P=0.114)。结论:血清IL-34水平与冠心病临床严重程度相关,而与冠状动脉病变严重程度无相关性,提示IL-34可能参与了急性冠状动脉综合征的发病过程。     

Npt、IL-8和HCY与冠心病的关系

目的 研究新蝶呤(Npt)、白细胞介素8(IL-8)和同型半胱氨酸(HCY)与冠心病患者冠状动脉病变稳定性及病变狭窄程度的关系.方法 选取不稳定型心绞痛(UAP)和稳定型心绞痛(SAP)患者各30例,另20例冠脉造影正常者为正常对照组,ELISA法测定Npt、IL-8、HCY水平,均接受冠状动脉造影,根据冠状动脉狭窄程度及部位进行记分.结果 心绞痛患者Npt、IL-8、HCY均较正常对照组增高(P均<0.05),且UAP较SAP的Npt、IL-8、HCY升高更明显(P均<0.05).冠状动脉三支病变组Npt、IL-8、HCY的水平高于双支病变组和单支病变组,且3组均高于对照组.Npt、IL-8、HCY是UAP和冠状动脉狭窄程度的独立危险因素.结论 Npt、IL-8、HCY可作为判定冠心病患者冠状动脉病变稳定性和狭窄程度的指标.     

不同类型老年冠心病患者外周血单核细胞程序性死亡因子配体2的表达及与血清超敏C反应蛋白、白细胞介素6的相关性

目的探讨不同类型老年冠心病(CHD)患者外周血单核细胞程序性死亡因子配体(PD-L)2的表达情况及其与血清高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6等炎性因子的联系。方法老年CHD患者112例,其中急性心肌梗死(AMI)患者34例,不稳定型心绞痛(UAP)患者41例,稳定型心绞痛(SAP)患者37例,同时选取体检的健康人33名作为对照组,检测各组PD-L2、hs-CRP、IL-6以及IL-8表达水平。结果 AMI组PD-L2蛋白表达水平明显高于其他组,而对照组最低;AMI组血清hs-CRP、IL-6和IL-8水平明显高于其他组(P0.05);SAP组和对照组血清hsCRP、IL-6和IL-8差异无统计学意义(P0.05);PD-L2表达水平与hs-CRP、IL-6表达水平呈正相关(P0.05),而与IL-8表达水平无相关性(P0.05)。结论老年CHD患者外周血单核细胞PD-L2表达水平明显升高,可能促进了血清hs-CRP、IL-6的分泌。     

老年冠心病患者血清hs-CRP、IL-6水平与不同性质斑块的关系

目的探讨老年冠心病患者血清hs-CRP、IL-6水平与不同性质斑块的关系。方法 146例冠心病患者根据临床表现分为不稳定型心绞痛(UAP)组78例、稳定型心绞痛(SAP)组68例;另取健康志愿者62例作为对照组。检测各组血清hs-CRP和IL-6水平,冠脉内超声检查患者冠脉斑块情况。结果 SAP组和UAP组血清hs-CRP、IL-6水平均明显高于对照组(P均<0.05);UAP组血清hs-CRP、IL-6水平均高于SAP组(P均<0.05);UAP组发生易损斑块比例高于SAP组(P<0.01);IL-6与脂质斑块呈正相关(r=0.238,P<0.05)。结论老年冠心病患者血清IL-6水平与脂质斑块密切相关,可作为脂质斑块的临床预测指标。     

不同类型冠心病患者血清炎症细胞因子水平比较

目的:分析炎症细胞因子在不同类型冠心病发生、发展过程中的作用并探讨其临床意义.方法:检测急性心肌梗死(AMI)组44例,不稳定型心绞痛(UAP)组44例,稳定型心绞痛(SAP)组43例及非冠心病患者(对照组)35例的血清白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子-α(TNF-α)浓度并进行比较.结果:与SAP组及对照组比较,AMI组和UAP组血清IL-6、IL-8、IL-10 、TNF-α水平均明显升高(P<0.01);AMI组血清IL-10、TNF-α水平高于UAP组(P<0.05),组间血清IL-6、IL-8水平差异无统计学意义(P>0.05);SAP组和对照组之间比较,血清IL-6、IL-8、IL-10、TNF-α水平均差异无统计学意义(P>0.05).结论:IL-6、IL-8、IL-10、TNF-α均参与了动脉粥样硬化斑块的形成和进展,血清细胞因子水平与冠心病病情严重程度密切相关.     

不同类型的老年冠心病病人血清CRP与TNF-α、IL-6相关性研究

目的观察老年冠心病不同类型病人中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平变化及其与C反应蛋白(CRP)之间的关系,进一步探讨老年急性冠状动脉综合征的临床预测的炎症指标.方法分别检测27例急性心肌梗死(AMI)病人(AMI组)、26例不稳定型心绞痛病人(UAP组)、52例稳定型心绞痛病人(SAP组),50名正常者(对照组).采用ELASA法测定血清TNF-α、IL-6浓度,免疫浊度分析法测定CRP的浓度.对比分析CRP与TNF-α、IL-6的相关性及各组间的差异.结果 AMI组及UAP组病人CRP、TNF-α和IL-6水平均显著高于对照组(P＜0.05)和SAP组(P＜0.05).AMI组与UAP组间血清CRP、TNF-α和IL-6比较均无统计学意义(P＞0.05),CRP水平与TNF-α、IL-6呈显著正相关(r=0.547,r=0.448,P＜0.01).结论细胞因子TNF-α、IL-6表达异常是促使急性冠状动脉综合征发生的主要机制之一.老年冠心病病人炎性标志物CRP与TNF-α、IL-6表达异常密切相关,可能是动脉粥样硬化斑块不稳定的标志.     

血清基质金属蛋白酶3水平与冠心病及冠状动脉病变程度的关系研究

目的探讨血清基质金属蛋白酶3(MMP-3)水平与冠心病及冠状动脉病变程度的关系。方法选择2010年6月—2012年6月江苏大学附属武进人民医院心内科收治的冠心病患者127例,其中急性心肌梗死(AMI)患者50例(AMI组)、不稳定型心绞痛(UAP)患者37例(UAP组)、稳定型心绞痛(SAP)患者40例(SAP组)。另外选择同期在我院体检健康者50例作为对照组。采用ELISA法测定各组受检者血清MMP-3水平,比较各组受检者及不同冠状动脉病变支数患者血清MMP-3水平。结果对照组受检者血清MMP-3水平为(1.85±0.86)μg/L,SAP组为(1.77±0.96)μg/L,UAP组为(4.22±2.81)μg/L,AMI组为(6.37±1.68)μg/L。AMI组患者血清MMP-3水平UAP组SAP组和对照组(P0.05)。冠状动脉单支病变患者血清MMP-3为(3.72±1.88)μg/L,双支病变患者为(4.22±1.92)μg/L,三支病变患者为(4.86±2.24)μg/L,不同冠状动脉病变支数患者血清MMP-3水平比较,差异无统计学意义(F=0.438,P0.05)。结论血清MMP-3水平与冠心病患者冠状动脉病变程度无明显关系,但与动脉粥样硬化斑块的不稳定性有关,是急性冠脉综合征(ACS)的重要血清标志物。     

Acceptability of blood and blood substitutes

Alternatives to donor blood have been developed in part to meet increasing demand. However, new biotechnologies are often associated with increased perceptions of risk and low acceptance. This paper reviews developments of alternatives and presents data, from a field-based experiment in the UK and Holland, on the risks and acceptance of donor blood and alternatives (chemical, genetically modified and bovine). UK groups perceived all substitutes as riskier than the Dutch. There is a negative association between perceived risk and acceptability. Solutions to increasing acceptance are discussed in terms of implicit attitudes, product naming and emotional responses.     

Capillary blood sampling for self-monitoring of blood glucose

New and emerging capillary blood sampling technologies for self-monitoring of blood glucose (SMBG) are reviewed for their impact on factors pertaining to users such as pain, and from the standpoint of skin physiology and technical feasibility. Innovative blood sampling techniques based on lancets for skin penetration on nonfinger (alternate) sites such as the forearm seem to be virtually painless, convenient and cost effective as compared to other methods such as laser-based perforation of fingertips. Alternate site blood sampling with new lancet devices appears not only medically sound but also technically practical and user-friendly. It is anticipated that alternate site blood sampling techniques would improve compliance rate and, consequently, outcome of treatment for patients with diabetes.     

献血者ABO血型正反定型不符情况分析

目的：通过对河北省血液中心献血者ABO血型正反定型不符的回顾性分析,了解ABO血型正反不符引起的报废血状况,探索对ABO血型正反不符献血者血液的处理对策。方法：对河北省血液中心检验科送检的ABO血型正反定型不符的献血者样本进行ABO血型鉴定,不规则抗体筛查等试验,记录结果,以查找AB0血型正反定型不符的原因。结果：在241例ABO正反不符的样本中,ABO亚型69例,占标本总数的28．63％;假凝集（冷凝集）27例,占标本总数的11．20％;抗体筛查阳性48例,占标本总数的19．92％;抗体减弱或缺失78例,占标本总数的32．37％;正常血型19例,占标本总数的7．88％。结论：引起ABO正反不符的原因主要是ABO亚型,血样中存在假凝集或冷凝集,ABO以外抗体影响,抗A或抗B抗体弱4种情况。对于这些ABO正反不符的献血者血液如何处理国家没有统一的标准,一般将血液报废,献血者淘汰。其中,部分血液能否经过处理后用于临床,希望与大家共同探讨。     

Rheological properties and function of blood cells in stored bank blood and salvaged blood

The technique involving filtration of diluted blood enables the separate analysis of the flow properties of different cell subpopulations. This study was designed to assess the changes occurring in the flow properties and function of blood cells in stored bank blood and salvaged blood compared to patient blood in a given clinical situation. We measured hydrogen peroxide production by neutrophils and the filterability, through 5 μm Nucleopore filters, of isolated red blood cells and of diluted blood. Samples were obtained from patients undergoing aortic surgery and blood intended for transfusion: either salvaged during surgery or stored bank blood. Both salvaged and bank blood were much less filterable than patient blood, with reduced deformability of both red and white blood cells. However, salvaged blood contained highly activated neutrophils with a prolonged transit time of the 'fast-flowing' cells in the analysis compared to bank blood. Bank blood contained significantly more particles which acted as pore-blockers. Cells in bank and salvaged blood therefore have markedly abnormal flow and biochemical properties compared to patient blood.     

Blood transfusion: old blood, new blood or no blood

Vigorous blood transfusion has long been regarded as having an essential role in the management of acute gastrointestinal haemorrhage. Two new studies, one a nationwide audit of acute gastrointestinal haemorrhage in the UK and another, a complex physiological study of stored blood from the USA, offer new insights.     

Correlation of blood temperature fluctuations with blood pressure waves

Summary Constant blood temperature in the pulmonary artery is assumed when the thermal dilution method is used for cardiac output determination. In some cases, however, slow temperature fluctuations (2–6 cycles per min.) occur in arterial and venous blood and interfere in the measurement. Those thermal fluctuations were investigated in the pulmonary artery and venae cavae of dogs. The temperature variations were found to be correlated with blood pressure waves: an increase of blood pressure was accompanied by an increase in the blood temperature in the pulmonary artery and a decrease in the blood temperature in the venae cavae. Therefore, measurement of the temperature of the pulmonary artery relative to that of the venae cavae does not rule out those fluctuations, and will not improve the thermal dilution method.

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Zusammenfassung Bei Bestimmung des Herzminutenvolumens nach der Kälteverdünnungsmethode wird eine konstante Bluttemperatur in der Pulmonalarterie unterstellt. Jedoch treten in einigen Fällen langsame Temperaturfluktuationen (2–6 Zykl. pro Minute) im arteriellen und venösen Blut auf, die mit der Messung interferieren. Diese Temperaturfluktuationen wurden in der Pulmonalarterie und V. cava des Hundes untersucht. Es zeigte sich, daß die Änderung der Temperatur mit den Blutdruckwellen korreliert sind: Ein Anstieg des Blutdrucks war von einem Anstieg der Bluttemperatur in der Pulmonalarterie und einem Rückgang der Temperatur in der V. cava begleitet. Die Meßprozedur läßt sich nicht dadurch verbessern, daß die Temperatur in der Pulmonalarterie auf die der Hohlvenen bezogen wird.

     

The safety of blood donation by elderly blood donors

Background Due to the ageing population, blood donation by the elderly is necessary to maintain blood supply. We initiated a prospective study, to assess whether there is an increased risk of donor reactions in elderly donors. Study Design and Methods In this prospective study, regular donors aged from 66 to 68 and 69 to 71 years were invited to continue blood donation on mobile collection sites of the German Red Cross Blood Service West. A control group (50–52 years) was established. Admission of donors in all groups followed the German national guidelines for blood donation. Donor deferrals and all kinds of donor reactions during donation (on‐site) and in the 48 h following donation (off‐site) were monitored. Results A total of 64 260 valid cases were entered in the study. Donor deferrals increased with age from 1·12% in the control group up to 8·74 in female donors aged 69–71 years. Adverse reactions to blood donation were rare with an overall reaction rate of 0·63% (0·05% on‐site; 0·58% off‐site). Off‐site reactions significantly decreased with increasing age. The relative risk (RR) for adverse reactions in elderly donors compared to the control group (50–52 years) was slightly increased for on‐site reactions in the 69‐ to 71‐year‐old donors (RR 1·0309; 95% CI 1·0292–1·0325). In all other comparisons, the RR for adverse reactions was distinctively lower in elderly donors (RR 0·3785 – 0·7778). Conclusions Our data confirm that elderly regular blood donors may safely continue blood donation at least to the age of 71. Based on these data, we increased the upper age limit.     

全自动血型配血仪在血型检测中的应用

目的：比较强生、达亚美全自动血型分析系统与试管法在血型鉴定中的符合率,并对三者操作程序进行比较。方法：将标本分别用2种全自动仪器和试管法进行检测以测定符合率;不同数量分组的标本,计算3种方法的操作时间并统计操作程序。结果：2种全自动仪器符合率100%,试管法反定型与全自动仪器符合率为99.9%;2种全自动仪器检测时间差别较小,比试管法用时长,但操作程序简单。结论：2种全自动血型仪符合率为100%,反定型较试管法敏感,并且操作程序更简单,错误率低。     

Storage of whole blood overnight in different blood bags preceding preparation of blood components: in vitro effects on red blood cells

Background

Routines for the storage of whole blood (WB) overnight for the preparation of blood components on the following day are of increasing interest primarily for logistic reasons. The present study focuses on in vitro effects during storage for 6 weeks on red blood cells (RBC) prepared in different blood containers after being held overnight.

Study design and methods

Five different blood collection systems were used with either inline leucocyte reduction red cell filters for the preparation of RBC, buffy coat (BC) and plasma or WB filters for the preparation of RBC and plasma. A new container with an integrated WB filter removing leucocytes but not platelets was also included for the preparation of leucocyte-reduced RBC, BC and plasma units. Standard CPD solution (63 or 70 mL) and SAG-M solution (100 or 110 mL) were used for the collection of either 450 or 500 mL blood. All WB units were stored at room temperature, either overnight for 18–24 hours (test groups, n=104) or for up to 8 hours (reference groups, n=20). In addition, five test units were stored overnight under refrigeration.

Results

In test groups (overnight storage at room temperature) we found significantly lower levels of extracellular potassium, 2,3-DPG and pH (up to day 28). During storage, higher levels of ATP (Terumo, CaridianBCT until day 35, Fresenius until day 14, Fenwal throughout storage) were seen in test groups than in reference groups. When WB was stored overnight at 2–6°C before WB filtration, the levels of ATP and haemolysis were higher than in the corresponding reference.

Conclusion

Significant differences in in vitro parameters were observed between RBC prepared within 8 hours and 18–24 hours after blood collection. The results were consistent irrespective of the blood container used. New alkaline solutions may decrease the differences.