降钙素原、C-反应蛋白检测在感染性疾病诊断和病情评估中的应用价值

目的探讨血清降钙素原(PCT)与C-反应蛋白(CRP)检测在感染性疾病诊断和病情评估中的临床应用价值。方法选取65例感染性疾病患者,根据感染类型分为细菌感染组(细菌组,45例)和病毒感染组(病毒组,20例),检测比较两组患者CRP、PCT水平。结果细菌组患者的CRP、PCT水平均高于病毒组,差异有统计学意义(P0.05);细菌组患者CRP与PCT呈正相关(r=0.754,P0.05),病毒组患者CRP与PCT无相关性;细菌组中败血症患者的CRP、PCT血清水平高于局部细菌感染患者,差异有统计学意义(P0.05)。结论 CRP、PCT可以作为细菌性感染和病毒感染鉴别诊断的辅助指标,同时可用于评估患者病情的严重程度。     

白细胞联合C反应蛋白检测在小儿支气管哮喘合并感染中的应用价值探讨

目的对小儿支气管哮喘合并感染患者进行WBC及CRP的检测,分析其应用价值。方法选择在我院住院治疗的支气管哮喘患者90例作为实验组,分单纯哮喘组、哮喘合并细菌感染组、哮喘合并肺炎支原体组,对照组取健康查体者。检测其血清CRP、WBC水平,并进行比较分析。结果哮喘合并细菌感染者WBC、CRP均明显高于对照组、单纯哮喘组、哮喘合并肺炎支原体组,差异有统计学意义(P0.05);哮喘合并肺炎支原体组与单纯哮喘组、对照组比较,WBC、CRP水平升高,差异有统计学意义(P0.05);单纯哮喘组与对照组比较,WBC无明显改变(P0.05),CRP水平升高(P0.05);三组哮喘患者血清CRP及WBC均较治疗前明显下降,差异有统计学意义(P0.05);哮喘合并细菌感染组治疗后仍高于哮喘合并肺炎支原体组及单纯哮喘组,且高于正常值,差异有统计学意义(P0.05)。结论对小儿支气管哮喘合并感染者联合检测WBC与CRP,有助于鉴别感染种类,及时判断预后,值得临床广泛推广应用。     

重症慢性阻塞性肺疾病急性发作期患者血清D-二聚体、超敏C反应蛋白及降钙素原表达及其临床意义

目的探讨重症慢性阻塞性肺疾病(COPD)急性发作期患者血清C反应蛋白(CRP)、D-二聚体(D-D)和降钙素原(PCT)的表达及其临床价值。方法 146例重症COPD急性发作期患者为急性组,146例COPD缓解期患者为缓解组和80名健康者为对照组。用全自动荧光免疫分析仪检测血清D-D及PCT表达水平、全自动生化仪检测血清超敏(hs)-CRP表达水平,比较3组血清D-D、hs-CRP及PCT表达水平,同时对比急性组有无细菌感染、不同肺功能分级患者血清D-D、hs-CRP及PCT表达差异。结果急性组血清D-D、hs-CRP及PCT表达水平较缓解组明显升高,缓解组亦较对照组明显升高(P<0. 05)。合并细菌感染的急性组血清hs-CRP及PCT表达水平均显著高于无细菌感染组(P<0. 05),但D-D表达水平差异无统计学意义(P>0. 05)。不同肺功能分级患者间的血清D-D、hs-CRP及PCT表达水平差异有统计学意义(P<0. 05),且肺功能分级越高,血清D-D、hs-CRP及PCT表达水平越高(P<0. 05)。结论重症COPD急性发作期患者血清CRP、D-D及PCT水平均明显升高,合并细菌感染者升高更明显,其表达水平与肺功能分级呈正相关,可作为临床对该病诊治的参考。     

血清中性粒细胞载脂蛋白检测对急性细菌感染性疾病的诊断价值

目的 探讨血清中性粒细胞载脂蛋白(HNL)检测对急性细菌感染性疾病诊断的价值。方法 选取急性细菌感染患者79例为细菌感染组(脓毒血症组24例、局部细菌感染组55例)、病毒感染患者39例(病毒感染组)、健康体检者45例(对照组),分别采用酶联免疫法、化学发光法、免疫比浊法检测抗生素使用前和使用后血清HNL、降钙素原(PCT)及C反应蛋白(CRP),采用受试者工作特征(ROC)曲线评价HNL、PCT、CRP水平变化对急性细菌感染性疾病的诊断效能。结果 治疗前,血清HNL、PCT、CRP水平脓毒血症组>局部细菌感染组>病毒感染组>对照组(P均<0.05);随着治疗时间增加,局部细菌感染组HNL和PCT检测值在诊断界值以上患者的比例显著降低。分析ROC曲线,血清HNL诊断急性细菌感染性疾病的效能与PCT相仿(P>0.05),优于CRP(P<0.05);其cut-off值为141.43μg/L时,灵敏度、特异度最高。结论 血清HNL(141.43μg/L)可作为急性细菌感染早期诊断的指标,且其水平变化能反映患者细菌感染控制情况。     

血浆Presepsin水平的检测在骨髓移植早期并发感染诊断中的意义

目的:观察白血病骨髓移植患者血浆可溶性白细胞分化抗原14(Presepsin)水平与早期感染致病菌类型的关系,评价其临床应用价值。方法:对57例早期感染的骨髓移植患者在不同时点进行血浆Presepsin检测,根据病原学检测结果分为细菌感染组34例,真菌感染组8例,非典型感染组4例及混合感染组11例。观察细菌感染组Presepsin水平与APACHEⅡ评分相关性。结果:细菌感染组血浆Presepsin水平高于真菌感染、非典型感染及混合感染组(均P0.05)。在细菌感染组中,血浆Presepsin水平在革兰阳性菌感染中最高,厌氧菌感染中最低(均P0.05)。混合型感染组血浆Presepsin水平高于真菌及非典型感染(均P0.05)。细菌感染组患者血浆Presepsin水平与其APACHEⅡ评分呈正相关(r=0.439,P0.05)。在细菌感染组出现感染症状前3天血浆Presepsin水平出现升高,出现症状后第3天达峰值,然后逐渐下降。结论:根据血浆Presepsin水平可初步判断骨髓移植患者早期致病菌类型,对临床病情评估有一定的应用价值。     

肺结核患者血清前蛋白、降钙素原、C反应蛋白检测的临床意义

正研究表明,肺结核(TB)患者血清中的降钙素原(PCT)水平明显升高,且与疾病进展密切相关。血清PCT与C反应蛋白(CRP)是筛查、评估细菌感染的重要指标,敏感性较好。本研究通过测定血清前蛋白(PA)、PCT、CRP水平,探讨其在肺结核合并细菌感染诊断中的临床意义。1资料与方法1.1一般资料研究对象为2014年6月至2015年6月本院收治的120例肺结核患者,痰液结核杆菌培养     

CRP对溃疡性结肠炎患者的疗效评价

检测溃疡性结肠炎(UC)患者治疗前后血清C反应蛋白(CRP)水平变化,评估其与其他临床指标之间的相关性和对临床疗效的诊断价值.发现活动期UC患者血清CRP水平比缓解期患者和健康者明显升高,且活动期UC患者的血清CRP水平与临床严重程度呈正相关;活动性UC患者经激素和美沙拉嗪治疗后,病情得到缓解,血清CRP水平明显下降.认为CRP水平可以反映UC患者的临床严重程度,为临床治疗和预后判断提供了一个重要指标.     

白细胞、C反应蛋白和免疫球蛋白检测在小儿肺炎中的运用

目的探讨C反应蛋白（CRP）、白细胞及免疫球蛋白（Ig）检测对小儿肺炎的诊断价值。方法将83例小儿肺炎急性期患儿分为细菌感染组和病毒感染组,分别进行白细胞计数和分类、CRP和Ig水平检测,并与正常对照组进行比较。结果细菌感染组治疗前后CRP比较有统计学意义（P〈0．01）;细菌感染组CRP升高阳性率与白细胞升高阳性率比较有统计学意义（P〈0．01）;细菌感染组和病毒感染组Ig均明显下降（P〈0．05或〈0．01）。结论小儿肺炎急性期CRP明显升高,可用于鉴别细菌和病毒感染;增强患儿免疫功能、加强肺炎期间的护理可防治院内感染、减少医疗纠纷。     

降钙素原、C反应蛋白在细菌性肺炎诊断价值研究

目的 研究降钙素原(PCT)、C反应蛋白(CRP)在细菌性肺炎临床诊断价值.方法 比较病毒、细菌、支原体引起的肺炎患者PCT、CRP血清浓度的变化情况及不同严重程度细菌性肺炎患者PCT、CRP的血清水平.结果 三组CRP、PCT、WBC、NEUT经方差分析比较,差异有统计学意义(P＜0.05).CRP以细菌组升高幅度最大,支原体组次之;PCT以细菌组升高幅度最大,病毒组与支原体组升高不明显;细菌组中病情不同严重程度组别CRP、PCT、WBC经方差分析比较,差异有统计学意义(P＜0.05),CRP、PCT、WBC随病情严重程度依次升高.结论 PCT、CRP在细菌性肺炎的病原诊断、病情评估、预后判断上有重要临床应用价值.     

C反应蛋白在心血管急性事件中意义

C反应蛋白（C-reactiveprotein CRP）是由肝脏合成的敏感性的急性时相反应蛋白,以往作为细菌感染的灵敏指标,CRP在病毒感染时不会升高,是鉴别细菌感染还是病毒感染常用指标[1]。在正常情况下,少量存在于人体体液中。CRP持续增高,提示机体存在慢性炎症反应,CRP变化不受患者的个体差异、     

Allogeneic Marrow Transplantation for the Treatment of Leukaemia

22 HL-A antigen and mixed leukocyte culture-matched sibling bone marrow transplants were attempted in patients with acute leukaemia (at the National Cancer Institute) to define the toxicities of four different immunosuppressive regimens, the complications associated with warrow engraftment and antileukaemic effect. 73% (16/22) were engrafted as indicated by a change to donor red blood cells (RBC) type, leukocyte, immunoglobulin allotype or by the speed of marrow repopulation and the occurrence of the Graft Versus Host Disease (GVHD). 12 of 16 (75%) successful engrafted patients developed GVHD. The current published results of clinical bone marrow transplantation from major centers has been reviewed and will be discussed in relationship to current clinical complications associated with bone marrow transplantation.     

Allogeneic marrow transplantation for the treatment of leukaemia. A review.

22 HL-A antigen and mixed leukocyte culture-matched sibling bone marrow transplants were attempted in patients with acute leukaemia (at the National Cancer Institute) to define the toxicities of four different immunosuppressive regimens, the complications associated with warrow engraftment and antileukaemic effect. 73% (16/22) were engrafted as indicated by a change to donor red blood cells (RBC) type, leukocyte, immunoglobulin allotype or by the speed of morrow repopulation and the occurrence of the Graft Versus Host Disease (GVHD). 12 of 16 (75%) successful engrafted patients developed GVHD. The current published results of clinical bone marrow transplantation from major centers has been reviewed and will be discussed in relationship to current clinical complications associated with bone marrow transplantation.     

Allogeneic bone marrow transplantation for severe aplastic anaemia-the London experience

Using the Seattle protocol with minor modifications, 23 patients with severe aplastic anaemia received allogeneic bone marrow transplants from HLA/ mixed leucocyte culture matched sibs in three London centres between 1973 and 1977. Ten patients (43.5%) are alive 6 months to 5 years after transplantation, and are well with full haemopoietic reconstitution, two with autologous bone marrow recovery following the graft procedure. A failure of the marrow graft to take, or take followed by rejection occurred in 12 patients (52%). Failure of marrow recovery was associated with a high early mortality from bacterial or fungal infection. The only survivors amongst those who rejected the first graft were four patients in whom a subsequent graft from the same donor was successful, and two in whom autologous recovery occurred. Graft versus host disease (GVHD) occurred in seven patients, and was fatal in one case. The most frequent complication after successful engraftment was varicella-zoster infection which occurred in five patients and was fatal in one patient. The overall results compare favourably with those from other transplant centres, but the high rate of graft rejection and low incidence of GVHD differ from other series. The results should encourage further referral of patients with severe AA for bone marrow transplantation.     

The effects of pretransplant conditioning, graft-versus-host disease and sepsis on the CRP levels in bone marrow transplantation

Summary To evaluate the diagnostic utility of C-reactive protein (CRP) for the detection of sepsis in bone marrow transplantation, CRP levels were analyzed after pretransplant conditioning and variably combined in septic, focal or viral infections with graft-versus-host disease (GvHD) in 64 bone marrow recipients. The CRP levels after pretransplant conditioning were low. The peak levels of CRP were influenced independently by the type of infection (p=0.016; septic and viral infections were significantly different) and GvHD (p=0.003). The area under the receiver-operator characteristic (ROC) curve for peak CRP in sepsis was 0.653 and 0.618 with and without GvHD, respectively. It was concluded that GvHD and the type of infection were independent determinants of the CRP responses. GvHD did not affect the extent of the CRP response. Therefore, although not highly specific for sepsis, CRP remains a useful detector of sepsis in bone marrow transplantation.     

骨髓移植术后非感染性肺部并发症的诊断与治疗进展

骨髓移植是当今治疗血液系统肿瘤、实体肿瘤、代谢和遗传性疾病的重要手段，骨髓移植术后多达一半的病人会出现肺部并发症，其中由于大量免疫抑制剂的应用、移植物抗宿主病（graft versus host disease，GVHD）等因素造成的非感染肺部并发症给l临床诊治工作带来极大困难，往往是骨髓移植病人术后发病和死亡的重要因素。根据发病时间早晚，可分为早期并发症（例如特发性肺炎综合征、骨髓植入综合征、弥漫性肺泡出血等）；晚期并发症（例如闭塞性细支气管炎、淋巴细胞增生性疾病等）。本文即对骨髓移植后相关并发症的诊断和治疗进展作一综述。     

Similarity Between Hepatic Graft-versus-host Disease and Primary Biliary Cirrhosis

Similarities between hepatic graft-versus-host disease (GVHD) and primary biliary cirrhosis (PBC) have been reported recently. To examine this association, we studied 60 patients who underwent allogeneic bone marrow transplantation (BMT) consecutively at a single medical institution.

Among the 60 patients, 12 developed hepatic GVHD after BMT and 48 did not. These two groups were compared with respect to various characteristics seen in PBC, such as autoantibodies, human leukocyte antigen (HLA) status, infection and inflammatory cytokines.

The two groups showed a significant difference in HLA DR status. There was also a significant difference in the febrile period and in cytokine levels between the patients with hepatic GVHD and 12 other patients who had no complications after transplantation.

These findings suggest that hepatic GVHD resembles PBC and that HLA DR features of PBC may also be risk factors for the onset of hepatic GVHD.     

Avascular necrosis in the femoral head secondary to bone marrow infarction in a patient with graft-versus-host disease after unrelated bone marrow transplantation

We previously reported a case of bone marrow infarction attributable to acute graft-versus-host disease (GVHD) in a patient with acute lymphoblastic leukemia after unrelated bone marrow transplantation (BMT). Although the bone marrow infarction-induced arthralgia in this patient improved, severe arthralgia appeared again with exacerbation of chronic GVHD, and the arthralgia was strongly correlated with the clinical course of chronic GVHD, i.e., the course of symptoms such as dermal and hepatic GVHD and ocular dryness. Finally, the patient developed avascular necrosis (AVN) in the right femoral head. Serum interleukin (IL)-6 and IL-10 levels were high at the onset of arthralgia but low during remission, and levels of interferon-gamma were undetectable throughout the period of arthralgia. Based on the clinical course and these data, chronic GVHD was thought to have been the major cause of the AVN. Since IL-10 antagonizes various other cytokines that induce GVHD, the increase in IL-10 might have inhibited the development of GVHD.     

Markedly elevated serum IgE levels following allogeneic and syngeneic bone marrow transplantation

Serum IgE levels were studied in 25 bone marrow transplant recipients (in 12 patients twice weekly and in 13 patients, at random). A 2-748- fold increase in serum IgE was recorded in 20 of the 25 patients after transplantation, the highest IgE value observed being 8,000 kU/liter. The IgE elevation appeared concomitantly with acute graft-versus-host disease (GVHD) in 14 patients. Both events occurred on day 24 +/- 2 (mean +/- SE). When the acute GVHD was diagnosed, there was a significant increase in serum IgE as compared to the first posttransplantation value. In one patient in whom GVHD recurred, a second IgE peak was seen, and in another patient with flaring GVHD, IgE levels increased on several occasions. In 6 patients without clinical signs of GVHD, a rise in IgE occurred on day 35 +/- 12. One of these patients was grafted with marrow from her identical twin. The rise in IgE did not correlate with an elevated proportion of eosinophil granulocytes. In the majority of the patients, no correspondent increases in serum IgG, IgA, or IgM were seen during the period with increased IgE after transplantation.     

自体混合HLA半相合异基因骨髓移植后的移植物抗宿主病

作者在动物实验的基础上,成功地用自体骨髓混合HLA半相合异基因骨髓移植治疗了16例恶性血液病患者。本文报告这些患者混合移植后GVHD的发生情况及其对疗效的影响。结果证实移植过程是安全的,16例中无1例发生aGVHD。但在ABMT后2h内输入异基因骨髓的8例皆有不同程度的cGVHD,主要表现在皮肤、粘膜炎,全血细胞减少,肝功异常,发热、体重减轻及易感冒等,中位随访13.5个月无1例复发,除2例在移植后3和8月分别因爆发肝炎和急性阑尾炎穿孔死亡外,余6例皆存活,最长1例已无病存活19月余,其中供受者性别不同的6例移植后性染色体观察3例皆形成嵌合体,最长者12月余。而ABMT移植后6h输异基因骨髓的8例,未观察到急慢性GVHD,其中5例4～7月后复发,仅1例仍持续缓解,其中5例染色体检查未形成嵌合体,提示ABMT后2h内输入异基因骨髓的混合移植,可诱发早发的cGVHD,部分受体内可形成嵌合体,减少白血病的复发,并发症较少而较轻,可望成为恶性血液病治疗的新的更有效的途径。     

DNA synthesis in human blood mononuclear cells correlates with severity of acute graft-versus-host disease

'Spontaneous' blood mononuclear cell DNA synthesis was studied in 83 bone marrow transplantation (BMT) recipients and 58 controls. Prior to BMT, patients with chronic myeloid leukemia had increased DNA synthesis, which decreased dramatically after conditioning and transplantation. After engraftment, patients with syngeneic marrow or allogeneic marrow without graft-versus-host disease (GVHD) had increased DNA synthesis compared to healthy controls. However, patients with acute GVHD (AGVHD) had a significantly increased DNA synthesis compared to patients without GVHD (p less than 0.001). DNA synthesis increased with increasing grade of AGVHD. Among patients with severe AGVHD, recipients of HLA-mismatched marrow had higher lymphocyte DNA synthesis at diagnosis of GVHD and maximum values compared to HLA-matched siblings (p less than 0.05). At diagnosis of GVHD, patients who developed grades II-IV GVHD with progressive disease had higher DNA synthesis, 23.9 +/- 4.0 x 10(3) c.p.m. (mean +/- SE) compared to 11.1 +/- 2.7 x 10(3) c.p.m. in patients in whom GVHD resolved (p less than 0.02). DNA synthesis during GVHD was lower in sheep erythrocyte rosette-forming cells (E-RFC) compared to enriched non-E-RFC. Herpes simplex virus, cytomegalovirus, bacterial septicemia and chronic GVHD had no major effect on lymphocyte DNA synthesis in these patients.