急性心肌梗死患者黏附分子及相关因素的研究

目的探讨急性心肌梗死(AMI)患者发病早期至1周内血清可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)、D-二聚体(D-D)、血小板第4因子(PF4)的动态变化及其相互关系.方法测定40例AMI患者发病24小时和1周时的血清sICAM-1、sVCAM-1、D-D、PF4并与健康对照组30例比较.结果AMI患者于发病24小时及1周时sICAM-1、sVCAM-1、DD、PF4[发病24小时分别(420.97±128.83)μg/L,(51.44±14.83)μg/L,(357.93±147.09)μg/L和(6.10±1.54)mg/L;发病1周时分别为(404.96±115.22)μg/L,(48.01±17.24)μg/L,(381.12±163.00)μg/L和(6.33±2.19)mg/L]均明显高于对照组[分别为(180.70±32.07)μg/L,(13.31±12.81)μg/L,(84.00±26.99)μg/L和(3.07±1.34)mg/L,P均<0.01].AMI组于发病24小时及1周时sICAM1与sVCAM-1均具有正相关性(P均<0.01),PF4与sICAM1、sVCAM-1、D-D间亦具有正相关性(P均<0.01),而D-D与sICAM-1、sVCAM-1间均无相关性(P均>0.05).结论AMI从发病早期至1周内sICAM-1、sVCAM-1持续升高,表明炎症参与心肌细胞损伤过程,早期应用抗黏附分子抗体和药物可防止AMI病情进展.     

冠心病患者血清可溶性细胞间粘附分子-1和血管细胞粘附分子-1的变化

目的:检测各型冠心病患者循环中可溶性细胞间粘附分子-1(sICAM-1)和血管细胞粘附分子-1(sVCAM-1)水平并分析它们与冠心病活动性之间的关系.方法:用ELISA法测定稳定型心绞痛患者(SAP组),不稳定型心绞痛患者(UAP组),急性心肌梗塞患者(AMI组)和健康体检者(对照组)血清sICAM-1和sVCAM-1浓度.结果:SAP组、UAP组和AMI组血清sICAM-1浓度高于对照组(SAP组与对照组比较P＜0.05;UAP组及AMI组与对照组比较P＜0.001).相关分析表明,sICAM-1水平与冠心病的活动性显著相关(r=0.665,P＜0.001).四组间血清sVCAM-1浓度差异无显著意义.结论:冠心病患者循环中sICAM-1水平升高,并与疾病的活动性相关,而sVCAM-1水平无明显变化.     

冠心病患者细胞粘附分子的水平变化和临床意义

目的：探讨冠心病患者外周血白细胞粘附分子β2整合素(β2-intergrin，CD18)和血清可溶性细胞间粘附分子-1(soluble intercellulal adhesion molecule-1，sICAM-1，CD54)、血管细胞粘附分子-1(soluble vascular cell adhesion molecule-1，sVCAM-1，CD106)变化及其意义。方法：采用流式细胞仪技术检测45例冠心病患者外周血白细胞CD18以及血清sICAM-1和sVCAM-1的表达。结果：冠心病患者外周血白细胞CD18以及血清sICAM-1和sVCAM-1表达显著增加。结论：冠心病患者外周血白细胞CD18以及血清sICAM-1和sVCAM-1的水平对冠心病的早期诊断具有一定的临床意义。     

妊娠晚期妊高征患者血清sVCAM-1和sICAM-1水平检测及临床意义

目的 探讨妊娠晚期妊高征(PIH)患者血清可溶性血管细胞粘附分子-1(soluble vascular cell adhesion molecule-1,sVCAM-1)和可溶性细胞间粘附分子-1(soluble intercelluar adhcsion molecule-1,sICAM-1)检测的意义。方法 用ELISA法检测37例PIH患者及14例正常妊娠妇女血清sVCAM-1和sICAM-1的含量。结果 svcam-1在中重度妊高征组明显高于正常对照组和轻度妊高征组(P<0.05),轻度妊高征组与正常对照组无明显差异。(P>0.05);sICAM-1在各组间无明显差异(P>0.05)。结论 妊娠晚期血清sVCAM-1 水平明显升高,sICAM-1变化不明显。     

甲状腺相关眼病血清sICAM-1、sVCAM-1水平变化及与病情关系分析

目的观察甲状腺相关眼病(TAO)患者血清可溶性细胞间黏附分子1(sICAM-1)及可溶性血管细胞黏附分子1(sVCAM-1)表达情况,并与病情进行相关性分析。方法将该院2016年8月至2018年3月收治的150例TAO患者纳入研究,依据临床活动性评分(CAS)分为活动期组、非活动期组,按病情严重程度分为轻度组、中重度组、极重度组,并选取同期80例健康体检者作为对照组,比较各组一般资料及血清sICAM-1、sVCAM-1水平;分析sICAM-1、sVCAM-1水平与TAO病情严重程度的相关性。结果活动期组血清sICAM-1与sVCAM-1显著高于非活动期组及对照组,对照组与非活动期组比较差异无统计学意义(P0.05)。不同病情严重程度组的活动期患者血清sICAM-1与sVCAM-1显著高于组内活动期患者与对照组(P0.05),极重度组、中重度组、轻度组的水平依次降低,差异有统计学意义(P0.05)。非活动期患者病情程度与血清sICAM-1、sVCAM-1无显著相关性(P0.05);活动期患者病情程度与血清sICAM-1、sVCAM-1呈正相关(P0.05)。结论活动期患者病情越严重,血清sICAM-1、sVCAM-1表达水平越高,而非活动期患者无此特点,可指导TAO临床诊治。     

颅内动脉瘤术后脑血管痉挛与血清可溶性血管细胞粘附分子-1、可溶性细胞间粘附分子-1及丙二醛的关系

目的 探讨颅内动脉瘤(IA)显微外科夹闭术后脑血管痉挛(CVS)的相关因素及与血清可溶性血管细胞粘附分子-1(sVCAM-1)、可溶性细胞间粘附分子-1(sICAM-1)及丙二醛(MDA)水平的关系。方法 2019年2月至2022年10月在我院接受IA显微外科夹闭术的147例患者,依照术后情况分为CVS组(n=45)和非CVS组(n=102),多因素Logistic回归分析术后CVS发生的危险因素;依照脑血管直径将CVS患者分类,并对血清sVCAM-1、sICAM-1以及MDA水平进行检测,分析上述血清指标与CVS疾病严重程度的关系。结果 多因素Logistic回归分析显示Hunt-Hess分级Ⅲ～Ⅳ级、高动脉瘤直径以及血清sVCAM-1、sICAM-1和MDA的高表达均是导致CVS发生的独立危险因素(P<0.05);以上血清指标在严重CVS组中显著高于轻度和中度组(P<0.05);以上血清指标均与CVS疾病严重程度呈正相关(P<0.05)。结论 血清sVCAM-1、sICAM-1及MDA水平是IA显微外科夹闭术后CVS独立危险因素,且与其形成密切相关,可作为CVS严...     

膀胱癌患者细胞粘附分子水平的变化及其意义

目的：探讨膀胱癌患者外周血白细胞粘附分子β2（整合素（β2－integrin,CD18)和血清可溶性细胞间粘附分子－1（soluble intercellular adhesion molecule-1 sICAM-1,CD54),血管细胞粘附分子（soluble vascular cell adhesion molecule-1,sVCAM-1 CD106)变化及其意义。方法：采用流式细胞技术检测30例膀胱癌患者外周血白细胞CD18以及血清sICAM-1和sVCAM-1的表达，结果：膀胱癌患者外周血白细胞CD18以及血清sICAM-1和sVCAM-1表达显著增加。结论：膀胱癌患者外周血白细胞CD18和血清sICAM-1和sVCAM-1的水平对膀胱癌的早期诊断病理分级、临床分期具有明确的预示作用。     

原发性肝细胞癌可溶性粘附分子-1和甲胎蛋白的表达及其临床意义

目的探讨血清细胞间粘附分子-1(sICAM-1)水平和甲胎蛋白浓度在原发性肝细胞癌中的表达及临床意义。方法应用酶联免疫吸附分析法测定266例门诊及病区就诊患者sICAM-1的血清含量(其中原发性肝细胞癌71例,慢性肝炎68例,肝硬化67例,健康人群60例),同时测定原发性肝细胞癌组的血清甲胎蛋白(AFP)浓度,并与sICAM-1水平进行对比分析。结果71例原发性肝癌(PHC)患者血清sICAM-1水平为(1694.41±664.58)ng/ml,明显高于慢性肝炎(CH)组〔(526.21±233.94)ng/ml〕、肝硬化(LC)组〔(685.50±298.16)ng/ml〕及正常对照组〔(324.19±105.71)ng/ml〕。其中58例AFP阳性和13例AFP阴性HCC患者血清sICAM-1水平分别为(2219.81±621.72)ng/ml和(1498.12±273.99)ng/ml。结论原发性肝细胞癌存在与sICAM-1相关的抗肿瘤细胞免疫应答异常,血清sICAM-1检测可以反映肿瘤细胞逃逸机体免疫监视的能力,可作为判断原发性肝细胞癌发展程度及疗效评价和随访监测病情变化的一项血清学指标。     

肝癌患者粘附分子和细胞因子的变化及其意义

目的：观察肝癌患者外周血清可溶性P-选择素(soluble P-selectin，CD62P)，细胞间粘附分子-1(soluble intercellular adhesion molecule-1，sICAM-1，CD54)，血管细胞粘附分子(soluble vascular cell adhesion molecule-1，sVCAM-1，CD106)和白细胞粘附分子β2整合素(β2-integrin，CD18)的变化，并探讨其临床意义。方法：采用流式细胞仪技术检测了48例不同期肝癌患者外周血清sP-selectin，sICAM-1 sVCAM-1水平和白细胞CD18的表达。结果：与正常对照组相比，血清sP-selectin，sICAM-1 sVCAM-1水平和白细胞CD18的表达显著增加。结论：肝癌患者外周血清sP-selectin，sICAM-1 sVCAM11水平和白细胞CD18的表达对肝癌的早期临床分期具有一定的参考价值。     

2型糖尿病血清粘附分子水平变化与尿微量白蛋白关系的探讨

近年来不少研究表明粘附分子(AMS)在糖尿病慢性并发症的发生、发展中起重要作用.可溶性细胞间粘附分子-1(sICAM-1)和可溶性血管细胞粘附分子-1(sVCAM-1)在糖尿病等疾病时表达增加,并具有一定的临床意义[1,2,3].本文对45例2型糖尿病(DM)患者血清sICAM-1、sVCAM-1同时作了检测.以探讨其与尿白蛋白的关系及临床意义.     

Neighborhood Poverty and 9-1-1 Ambulance Contacts

Background: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. Methods: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories. For each model, we estimated the incident rate ratios for 10 percentage point increases in tract-level poverty while controlling for geographic patterns in race, citizenship, gender, age, emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, tract-level poverty was positively associated with ambulance contacts (incident rate ratio [IRR] 1.45; 95% confidence interval [CI] 1.34 to 1.57). Second, poverty was positively associated with low severity contacts (IRR 1.48; 95% CI 1.35 to 1.61), medium severity contacts (IRR 1.38; 95% CI 1.28 to 1.49), and high severity contacts (IRR 1.40; 95% CI 1.30 to 1.51). Third, poverty was positively associated with 12 primary impression categories: abdominal (IRR 1.48; 95% CI 1.36 to 1.61), altered level of consciousness (IRR 1.37; 95% CI 1.25 to 1.50), cardiac (IRR 1.28; 95% CI 1.14 to 1.42), overdose/intoxication (IRR 1.59; 95% CI 1.40 to 1.81), pain (IRR 1.56; 95% CI 1.41 to 1.73), psych/behavioral (IRR 1.50; 95% CI 1.34 to 1.67), respiratory (IRR 1.42; 95% CI 1.29 to 1.56) seizure (IRR 1.52; 95% CI 1.38 to 1.68), stroke (IRR 1.14; 95% CI 1.01 to 1.28), syncope/near syncope (IRR 1.23; 95% CI 1.12 to 1.36), trauma (IRR 1.44; 95% CI 1.31 to 1.58), and general weakness (IRR 1.31; 95% CI 1.20 to 1.42). Conclusion: Our study suggests poverty is a positive, strong, and enduring predictor of ambulance contacts at the neighborhood level. The relationship between neighborhood poverty and ambulance utilization should be considered at multiple levels of EMS decision making     

Neighborhood Poverty and 9-1-1 Ambulance Response Time

Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. Methods: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24 s decrease in MART (?23.55 s, 95% confidence interval [CI] ?33.13 to ?13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full minute per estimated 10 percentage point increase in poverty concentration. Conclusion: Our study challenges the commonly held assumption that ambulances are later to poor neighborhoods. We scrutinize our findings before cautiously considering their relevance for ambulance response time research and for ongoing conversations on the relationship between neighborhood poverty and prehospital care.     

9-1-1: Rapid identification and treatment of acute myocardial infarction

The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards. Currently, approximately 78% of the United States population, mainly in urban areas, has access to a 9-1-1 system. Approximately 195 United States cities with a population of greater than 100,000 people have access to enhanced 9-1-1. It is the contention of the NHAAP that 9-1-1 services should be universally available to all Americans to ensure seamless access to EMS and, potentially, early detection, evaluation, and treatment for AMI. This article reports several key recommendations for achieving this goal.