APACHEⅡ、ISS、SOFA评分对创伤继发ARDS严重程度及预后的预测价值比较

目的比较APACHEⅡ、ISS、SOFA评分对创伤继发ARDS严重程度及预后的预测价值。方法回顾性分析168例创伤继发ARDS患者的临床资料,根据ARDS柏林定义按病情严重程度对患者进行分组:轻度组86例,中度组43例,重度组39例;根据患者受伤后28天内是否死亡对患者进行分组:死亡组65例,生存组103例。计算患者入院24小时内APACHEⅡ、ISS、SOFA评分,比较三种评分预测重度ARDS及死亡的受试工作者特征曲线(ROC)的曲线下面积(AUC),及其灵敏度和特异度。结果中度ARDS组患者APACHEⅡ、ISS、SOFA评分均高于轻度ARDS组(P=0. 011、0. 040、0. 006),重度ARDS组患者APACHEⅡ、ISS、SOFA评分均高于中度ARDS组(P=0. 045、0. 023、0. 001)。死亡组APACHEⅡ、ISS、SOFA评分均高于存活组(P=0. 000、0. 000、0. 000)。APACHEⅡ、ISS、SOFA评分预测重度ARDS的AUC分别为0. 759、0. 757、0. 836(P 0. 001),APACHEⅡ、ISS、SOFA评分预测死亡的AUC分别为0. 778、0. 823、0. 777(P 0. 001)。结论SOFA评分预测创伤继发ARDS严重性的效果较好,ISS评分预测创伤继发ARDS患者预后的效果较好。     

血皮质醇浓度、APACHEⅡ评分的变化与老年重症创伤患者预后的相关性

目的分析血皮质醇浓度、急性生理和慢性健康评估评分系统(APACHE)Ⅱ评分的变化与老年重症创伤患者预后的相关性。方法老年重症创伤患者共90例为老年组,选取同期入院的非老年重症创伤患者85例作为非老年组。将老年患者按照死亡与否分为存活组和死亡组,对比两组血皮质醇浓度、APACHEⅡ评分、血糖、促肾上腺皮质激素(ACTH)水平。分析老年患者的血皮质醇水平与APACHEⅡ评分、血糖相关性及老年重症创伤患者预后的影响因素。结果老年组血皮质醇浓度、APACHEⅡ评分、血糖水平显著高于非老年组(P0.01);老年组和非老年组血ACTH水平无显著差异(P0.05)。存活组的血皮质醇浓度、APACHEⅡ评分和血糖显著低于死亡组(P0.05);存活组和死亡组血ACTH水平无显著差异(P0.05)。血皮质醇水平和APACHEⅡ评分呈正相关(r=0.364,P0.05);血皮质醇水平和血糖水平呈正相关(r=0.512,P0.05)。血皮质醇水平和APACHEⅡ评分与老年重症创伤患者预后有回归关系(P0.05)。结论血皮质醇浓度和APACHEⅡ评分可作为评价老年重症创伤患者预后的重要指标。     

ICU危重患者APACHEⅡ评分变化率和临床预后的关系

目的:分析ICU危重症患者APACHEⅡ评分变化率(简称APACHEⅡ变化率)和临床预后的关系。方法:选取ICU危重症患者94例并跟踪28 d,根据28 d生存情况分为生存组(66例)和死亡组(28例),收集第1天APACHEⅡ评分(APACHEⅡ1)、第2天APACHEⅡ评分(APACHEⅡ2)资料,计算APACHEⅡ变化率;比较2组患者APACHEⅡ1、APACHEⅡ2和APACHEⅡ变化率;采用ROC曲线比较APACHEⅡ1和APACHEⅡ变化率预测临床预后的差异。结果:死亡组患者APACHEⅡ1、APACHEⅡ2高于生存组,而APACHEⅡ变化率低于生存组(P0.05);APACHEⅡ变化率与预后呈负相关性(P0.05);ROC曲线结果显示APACHEⅡ变化率预测总体预后的曲线下面积(AUC)为0.880,高于APACHEⅡ1的曲线下面积0.775(P0.05)。APACHEⅡ变化率的最佳界值为0.21(敏感性60.7%,特异性95.5%)。结论:APACHEⅡ变化率对ICU危重症患者临床预后的评估意义高于单纯APACHEⅡ评分。     

APACHEⅡ评分及血清C反应蛋白对成人社区获得性肺炎患者的近期预后评估

目的探讨APACHEⅡ评分和血清CRP在成人社区获得性肺炎(CAP)患者近期预后评估中的价值。方法回顾性分析淮南市第一人民医院呼吸内科和ICU 2015年1月至2016年12月收治的125例成人CAP患者的APACHEⅡ评分和血清CRP,根据30天生存情况和PSI评分、CURB-65评分将CAP患者分为生存组、死亡组、低风险组、中风险组和高风险组,观察其在不同预后组和风险组间的差异。结果死亡组CAP患者APACHEⅡ评分、CRP均高于存活组(P0.001)。APACHEⅡ评分和CRP在不同风险组间比较,差异有统计学意义(APACHEⅡ评分,P0.001;CRP,P=0.001),两者均随风险增加而增加。APACHEⅡ评分、CRP与PSI评分、CURB-65评分间存在正相关性(r_s分别为0.885、0.835、0.358、0.345,P0.001)。使用ROC曲线分析APACHEⅡ评分、PSI评分和CURB-65评分预测CAP患者30天病死率的曲线下面积(AUC)均大于CRP,APACHEⅡ评分的AUC大于CURB-65评分(P0.05)。结论 APACHEⅡ评分和血清CRP与成人CAP患者病情严重程度和近期病死率呈正相关,使用APACHEⅡ评分和血清CRP检测对成人CAP患者近期预后评估具有重要的临床价值和指导意义。     

降钙素原在重症监护患者细菌感染的预后价值

目的探讨血清降钙素原(PCT)对重症患者细菌感染性疾病预后评估和病情严重程度判断的价值。方法选取116例细菌感染性疾病患者,采用免疫色谱法检测入院后24 h内的血清PCT水平,记录患者24 h急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分。根据28 d临床结局,分为死亡组(36例)和存活组(80例),比较两组间PCT、APACHEⅡ评分的差异,分析血清PCT水平与APACHEⅡ评分的相关性,用受试者工作特征曲线(ROC)下面积(AUC)评估PCT单独应用及联合PCT和APACHEⅡ评分预测28 d生存情况的效能。对PCT和APACHEⅡ评分预测28 d生存情况的效能进行比较。结果死亡组PCT水平明显高于存活组(Z=5.598,P0.001),死亡组APACHEⅡ评分亦显著高于存活组(t=6.148,P0.01)。PCT与APACHEⅡ评分存在显著正相关(r=0.388,P0.001),PCT和APACHEⅡ评分预测重症患者细菌感染性疾病28 d生存情况的AUC分别为0.804和0.792,PCT的AUC值高于APACHEⅡ评分,但差异无统计学意义(U=0.2073,P=0.802)。联合PCT和APACHEⅡ评分预测28 d生存情况的ACU较单一指标高,为0.817,敏感度90.7%,特异度75.2%,均优于单一指标的预测效能。结论血清PCT能反映重症患者细菌感染性疾病病情严重程度及预后,是预测28 d生存情况的有效指标,联合PCT检测和APACHEⅡ评分可提高预测效能。     

APACHEⅡ和LIPS在急性呼吸窘迫综合征病情评估及预后判断中的价值

目的 探讨急性生理与慢性健康评估(APACHE)Ⅱ和肺损伤预测评分(LIPS)在急性呼吸窘迫综合征(ARDS)病情评估及预后判断中的价值.方法 108例ARDS患者根据氧合指数分为轻(n=43)、中(n=35)、重度(n=30)3组,比较各组入院时基本资料.按照治疗28 d后的预后转归再分为死亡组(n=41)和存活组(...     

C反应蛋白、白蛋白比值与多评分系统对脓毒症严重程度和预后的评估价值比较

目的:分析C反应蛋白(CRP)、白蛋白(ALB)比值与多评分系统对脓毒症严重程度和预后的评估价值。方法:选取脓毒症患者117例,根据脓毒症严重程度分为脓毒症组与重脓毒症组,均在入院后24h内检测CRP、ALB水平,计算CRP/ALB比值,并进行序贯器官衰竭评分(SOFA)、急性生理与慢性健康状况评估(APACHEⅡ)评分、急诊脓毒症死亡风险评分(MEDS)、简化急性生理学评分(SAPSⅡ)、快速急诊内科评分(REMS)、改良早期预警评分(MEWS),分析CRP/ALB值与各评分系统对脓毒症严重程度和预后的评估价值,采用Pearson多重线性分析计算CRP/ALB值与脓毒症严重程度和预后的相关性。结果:存活患者入院24h CRP/ALB比值低于死亡患者,脓毒症组入院24h CRP/ALB比值低于重脓毒症组(均P 0.05)。存活患者SOFA评分、APACHEⅡ评分、MEDS评分、SAPSⅡ评分、REMS评分、MEWS评分均低于死亡组,脓毒症组SOFA评分、APACHEⅡ评分、MEDS评分、SAPSⅡ评分、MEWS评分均低于重脓毒症组(均P 0.05)。死亡患者患糖尿病的构成比高于存活组(18.8%vs 5.9%,P 0.05)。CRP/ALB值与脓毒症患者严重程度呈正相关(r=0.672),与预后呈正相关(r=0.596)。结论:CRP/ALB值对脓毒症病情和预后有较高的评估价值,而各项评分在一定程度上均可反映脓毒症患者病情,部分指标对预后有一定的预测价值。     

可溶型Fms样酪氨酸激酶1在重症肺炎预后中的应用价值

目的:分析可溶型Fms样酪氨酸激酶1(sFLT-1)在重症肺炎中的预测价值及其与急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分的相关性。方法:回顾性分析2017-01—2019-01收治的76例重症肺炎患者(Ⅰ组),另选择同期65例普通肺炎患者(Ⅱ组),非肺炎住院患者52例(ⅡI组)。比较3组患者临床基本资料和入院后不同时间血浆sFLT-1含量的差异,并比较Ⅰ组入院后4周存活(存活组,64例)与死亡患者(死亡组,12例)入院1 d内APACHEⅡ评分、血浆sFLT-1含量的差异。通过绘制受试者工作特征(ROC)曲线评价血浆sFLT-1在评估重症肺炎诊断与预后中的预测价值,采用Pearson相关性分析血浆sFLT-1含量与Ⅰ组患者APACHEⅡ评分的相关性。结果:3组患者入院1 d内APACHEⅡ评分的比较,差异有统计学意义(P0.05)。入院后不同时间血浆sFLT-1含量的比较,差异有统计学意义(P0.05)。Ⅰ组死亡患者入院1 d内APACHEⅡ评分和血浆sFLT-1含量较存活患者均显著升高(P0.05)。sFLT-1诊断重症肺炎的敏感度和特异度分别为85.53%、77.50%,sFLT-1预测重症肺炎预后评估(入院后4周死亡)的敏感度和特异度分别为75.00%、82.81%,ROC曲线下面积分别为0.84(95%CI:0.75～0.95,P0.05)、0.79(95%CI:0.68～0.91,P0.05。Pearson相关性分析发现,Ⅰ组患者血浆sFLT-1含量与APACHEⅡ评分存在正相关关系(r=0.72,P0.05)。结论:血浆sFLT-1含量与APACHEⅡ评分密切相关,通过监测血浆sFLT-1含量可用于诊断重症肺炎和评估患者的预后状况,有良好的预测价值。     

血小板平均体积联合APACHE Ⅱ评分对肺栓塞病情及预后的评估价值

目的探讨血小板平均体积联合APACHEⅡ评分对肺栓塞病情及预后的评估价值。方法采用回顾性研究方法,选取2010年7月至2017年11月于哈尔滨医科大学附属第一医院确诊为肺栓塞并住院的患者共171例,其中高危组(50例)、中危组(59例)和低危组(62例),根据预后情况分为存活组(147例)与死亡组(24例)。收集患者的基本资料、MPV值,计算患者APACHEⅡ评分的得分。比较不同组间血MPV值和APACHEⅡ评分之间的差异,评价MPV水平和APACHEⅡ评分用于肺栓塞患者病情严程度及预后的临床价值。结果随着肺栓塞患者病情严重程度的增加,APACHEⅡ评分指标水平逐渐升高(P<0.05);对于患者预后而言,死亡组患者有着更高的APACHEⅡ得分(P<0.05)。ROC曲线分析显示,当APACHEⅡ评分=22分为最佳临界值,其曲线下面积为0.8715(95%CI 0.814~0.928),预测患者不良预后的敏感度和特异度分别为100.0%和67.0%。相关性分析显示,血MPV值与APACHEⅡ评分并无相关性。血MPV值与肺栓塞患者病情严重程度及预后无统计学关系(P=0.6547 vs P=0.3279)。结论APACHEⅡ评分可以用于肺栓塞患者病情严重程度及预后的评估,而血MPV值与肺栓塞患者的病情无明确相关性,两者联合并不能提高对肺栓塞病情及预后的评估效能。     

CRP、PCT与APACHEⅡ评分判断ICU老年重症感染患者预后的价值

目的探讨C反应蛋白(CRP)、降钙素原(PCT)及急性生理和慢性健康状况评分(APACHE)Ⅱ对重症监护病房(ICU)老年重症感染患者预后的判断价值。方法回顾性分析老年脓毒症患者175例临床资料,按照患者病情严重程度将其分为脓毒症组70例、严重脓毒症组59例、脓毒症休克组46例,根据患者临床预后分为存活组133例、死亡组42例,比较分析各组CRP、PCT及APACHEⅡ评分,并采用受试者工作特征(ROC)曲线分析各指标对患者临床预后判断价值。结果不同病情严重程度患者CRP、PCT及APACHEⅡ评分差异有统计学意义(P0.05),随着患者病情严重程度增加,CRP、PCT及APACHEⅡ评分明显升高(P0.05)。死亡组CRP、PCT及APACHEⅡ评分均显著高于存活组(P0.05)。PCT、CRP及APACHEⅡ评分两两互呈显著正相关(P0.05)。采用ROC曲线分析CRP、PCT、APACHEⅡ评分及三者联合对患者预后的预测价值,CRP曲线下面积为0.817,PCT曲线下面积为0.798,APACHEⅡ评分曲线下面积为0.809,三项指标联合曲线下面积为0.893。结论联合运用CRP、PCT及APACHEⅡ评分对ICU老年重症感染患者临床预后具有较高的评估价值。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.