血清高敏C反应蛋白与冠心病斑块稳定性的相关性研究

目的　研究血清高敏C反应蛋白 (hs CRP)水平与冠心病斑块稳定程度的相关性。方法　用酶联免疫吸附法 (ELISA)检测了 138例冠心病患者 (2 8例急性心肌梗死 ,6 6例不稳定型心绞痛 ,4 4例稳定型心绞痛 )及 2 8例非冠心病对照组的hs CRP的水平 ,并对冠心病患者进行冠状动脉造影病变形态学分析 ,比较不同类型的冠心病及不同形态斑块的hs CRP水平。结果　血清hs CRP在急性心肌梗死组 (16 .2 5± 1.2 7)mg/L和不稳定型心绞痛组 (11.4 1±4 .89)mg/L明显高于稳定型心绞痛组 (4 .82± 3.94 )mg/L和非冠心病组 (2 .70± 1.95 )mg/L(P均 <0 .0 5 )。血清hs CRP在Ⅱ型斑块组中的水平 (14 .5 0± 4 .6 6 )mg/L明显高于其他型斑块组 (6 .82± 5 .6 3)mg/L及非冠心病组 (2 .70± 1.95 )mg/L(P <0 .0 1)。结论　血清hs CRP水平与冠心病斑块稳定性有关。冠状动脉造影斑块分型结合hs CRP水平 ,可较好地估价斑块的稳定性     

血清高敏C-反应蛋白在心血管病变中的表达特性

目的　探讨心血管病变血清高敏C 反应蛋白 (hs CRP)的表达特性。方法　采用胶乳增强免疫 (超敏 )比浊法 ,定量检测健康对照组 340名、冠脉造影患者 341例、心肌梗死患者 86例血清hs CRP。结果　 (1 )健康对照组hs CRP呈明显的偏态分布 ,hs CRP中位数 :0 45mg/L ,95 %位数 :3 0 7mg/L ,经对数转换hs CRP均数为 (0 76± 1 2 9)mg/L ,存在性别和年龄差别。 (2 )冠脉造影阳性组 (2 1 4例 )hs CRP :(2 1 8± 2 71 )mg/L ,冠脉造影阴性组 (1 2 7例 )hs CRP :(1 46± 1 66)mg/L ,差异有显著意义(t=2 638,P <0 0 1 )。急性心肌梗死组hs CRP :(6 0 8± 4 55)mg/L。脉造影阳性组hs CRP随阳性支数增加而增高。hs CRP对冠心病的临床评价ROC曲线下面积为 0 81 0。结论　hs CRP对健康人心血管病变的存在和发生心血管意外预测和预防具有重要意义。     

糖尿病血浆超敏C反应蛋白及胆固醇变化的研究

目的 :研究超敏C 反应蛋白 (hs CRP)对糖尿病患者并发冠心病的预示作用。方法 :收集 85例糖尿病患者及 35例体检正常者的血浆 ,用HITACHI71 70A全自动生化分析仪检测hs CRP、胆固醇和高密度脂蛋白胆固醇(HDL C)。结果 :hs CRP在正常对照组为 (0 68± 0 70 )mg/L ,胆固醇正常的糖尿病组为 (1 98± 1 2 4 )mg/L ,高胆固醇的糖尿病组为 (3 65± 1 76)mg/L。胆固醇正常组、高胆固醇组明显高于正常对照组 (分别为P <0 0 5 ,P <0 0 1 )。hs CRP和胆固醇在胆固醇正常组与高胆固醇组之间差异也有非常显著意义 (P <0 0 1 )。同时 ,hs CRP浓度与胆固醇浓度呈正相关 (r=0 43 ,P <0 0 1 ) ;hs CRP浓度与HDL C浓度没有相关性。结论 :hs CRP作为一个炎症因子 ,在预测糖尿病患者并发动脉粥样硬化性心血管疾病中具有重要的临床意义 ,对于冠心病的发病机制也有一定的揭示作用     

急性冠脉综合征患者血清C-反应蛋白浓度的变化及意义

目的　研究急性冠脉综合征 (ACS)患者血清C -反应蛋白 (CRP)浓度水平并与对照组比较 ,探讨CRP是否为ACS的一种危险因子。方法　测定ACS患者和对照组血清CRP浓度 ,同时检测冠心病的常见危险因子并与CRP一起做Logis tic回归分析。结果　①ACS患者血清CRP浓度〔(18.5 0± 2 3.98)mg/L(SE 2 .5 1,n =91)〕显著高于对照组〔(3.89± 7.14 )mg/L(SE 0 .5 1,n =194 )〕 (P <0 .0 1)。②急性心肌梗死 (AMI)急性期患者CRP浓度〔(18.6 5± 2 4 .12 )mg/L〕和不稳定型心绞痛(UAP)CRP浓度〔(17.95± 2 4 .10 )mg/L〕显著高于正常对照组、稳定型心绞痛 (SAP)CRP浓度〔(3.94± 7.5 0 )mg/L〕、AMI患者恢复期〔(5 .93± 13.0 7)mg/L〕和陈旧性心肌梗死 (OMI)患者〔(4 .5 7± 8.2 7)mg/L〕(均P <0 .0 1) ;SAP患者、AMI患者恢复期和OMI患者之间CRP浓度无差别 (P >0 .0 5 ) ,并与正常人群比较无显著性差别 (P >0 .0 5 )。③每增加CRP 5mg/L ,ACS发生危险增加到近 2倍 (用Logistic回归 ,OR =1.6 5 ) ,故CRP是ACS一种潜在决定因子。结论　血清CRP浓度升高与ACS有极大的相关性 ,并提出CRP是ACS的一种新的危险因子。     

弓形虫感染与脑出血相关性的研究

目的　探讨弓形虫感染与脑出血的相关性。方法　采用ELISA方法 ,对 4 3例急性脑出血患者 (脑出血组 )和5 1例非神经系统疾病患者 (对照组 )于起病 1周内静脉采血 3mL ,取血清进行弓形虫循环抗原 (CAg)及弓形虫抗体IgM、IgG的定性检测 ,统计阳性例数 ,进行统计分析 ,做脑出血组与对照组、健康人群的比较。结果　脑出血组弓形虫CAg阳性率为2 3 2 6 % (10 / 4 3) ,对照组弓形虫CAg阳性率为 7 84 % (4/ 5 1) ,两组间有显著差异 (χ2 =4 39,P <0 0 5 )。脑出血组弓形虫抗体IgM阳性率为 18 6 0 % (8/ 4 3) ,对照组弓形虫抗体阳性率为 5 88% (3/ 5 1) ,两组间有显著差异 (χ2 =3 86 ,P <0 0 5 )。脑出血组弓形虫抗体IgG阳性率为 34 88% (15 / 4 3) ,对照组弓形虫抗体阳性率为 15 6 9% (8/ 5 1) ,两组间有显著差异 (χ2 =4 6 4 ,P <0 0 5 )。脑出血组男女患者间弓形虫CAg、IgM、IgG阳性率无显著差异。中青年脑出血患者弓形虫CAg、IgM阳性率明显高于老年患者。结论　弓形虫感染与脑出血存在相关性 ,弓形虫感染可能是脑出血的病因之一。     

SARS患者和普通肺炎患者体液免疫调查

目的 :调查SARS患者和普通肺炎患者体液免疫的差别。方法 :采用速率散射免疫比浊法检测 5 2例SARS患者 (抗SARS病毒抗体阳性 3 4例 ,阴性 18例 )和 2 6例普通肺炎患者血清免疫球蛋白IgG、IgM、IgA ,补体C3、C4和C反应蛋白 (CRP)的含量。结果 :SARS患者的血清免疫球蛋白IgG、IgM、IgA、补体C3、C4和CRP的含量都高于普通肺炎患者 ,P >0 0 5。抗SARS病毒抗体阳性组的血清免疫球蛋白IgG、IgM含量显著高于普通肺炎患者(P <0 0 1) ;IgA、补体C4和CRP含量也显著高于普通肺炎患者 (P <0 0 5 ) ;C3含量略高于普通肺炎患者 (P >0 0 5 )。抗SARS病毒抗体阴性组血清免疫球蛋白IgG、IgM、IgA、补体C3、C4和CRP含量与普通肺炎患者组差异无显著性。结论 :抗SARS病毒抗体阳性患者组与普通肺炎患者组非特异性体液免疫反应存在显著差别     

心房颤动患者血清CRP测定及意义

目的　探讨C反应蛋白 (CRP)作为系统性炎症因子在心房颤动的发生与持续中的变化及意义。方法　选取2 0 0 1年 8～ 12月入我院心内科的心房颤动患者共 5 3例 ,其中阵发性房颤 (<30d) 19例 ,持续性房颤 (>30d) 34例 ,同时选取同期入院的房性早搏及房性心动过速患者 18例作为对照 ,应用免疫比浊法测定血清CRP浓度 ,正常参考值 0 0 1～ 2mg/L。同时应用ELISA法及放免法检测血浆IL - 1β及IL - 6、TNF -α浓度。结果　心房颤动组血清CRP浓度 (1 87± 0 4 6 )mg/L显著高于对照组 (0 4 3± 0 15 )mg/L ,P <0 0 1;而血浆IL - 1β及IL - 6、TNF -α浓度在心房颤动组及对照组间无显著性差异 ,P >0 0 5。在心房颤动患者中 ,持续性房颤组血清CRP浓度 (2 0 4± 0 5 6 )mg/L显著高于阵发性房颤组 (1 5 7± 0 4 2 )mg/L ,P <0 0 1。结论　血清CRP在心房颤动患者中明显升高 ,其代表的全身炎症状态与心房颤动的发生与持续密切相关。     

抗磷脂抗体综合征误诊一例

【病例】　女 ,49岁。因间断性全身肌肉及双膝关节疼痛伴皮肤网状青斑 6年 ,加重 10天入院。患者 6年前出现全身肌肉及双膝关节疼痛伴发热 ,渐出现手背皮肤网状青斑及轻度水肿。曾在外院就诊 ,查血白细胞 4 5× 10 9/L ,血红蛋白 69g/L ,血涂片中红细胞呈缗钱状 ,红细胞沉降率 (ESR) 15 0mm/h,碱性磷酸酶 196U/L γ 谷氨酰转移酶 76U /L ,C反应蛋白 3 7 8mg/L ,IgG 3 3 8g/L ,IgA695 0mg/L,IgM 65 3 0mg/L。骨髓象 :浆细胞 0 13 5 ,幼稚浆细胞 0 0 15。考虑为多发性骨髓瘤 ,转我院。查体 :体温 3 6 5℃ ,呼吸 2 0 /min ,脉搏 84/…     

冠心病高血压糖尿病和单纯性肥胖病人血清adiponectin水平研究

目的　研究adiponectin在冠心病、高血压、糖尿病和单纯性肥胖病人血清中的水平。方法　采用双抗夹心酶联免疫试验测定血清中adiponectin水平。结果　共测定 6 0名正常人 ,30例冠心病患者 ,2 2例高血压患者 ,32例糖尿病患者和 47例单纯性肥胖病人。adiponectin水平分别为 :冠心病组 ( 3 90± 1 36 )mg/L、高血压组 ( 3 6 1± 3 0 0 )mg/L、糖尿病组 ( 4 14± 2 19)mg/L、单纯性肥胖组( 4 0 2± 2 5 2 )mg/L与正常对照组 ( 9 82± 2 99)mg/L之间的差异均具有统计学意义 (P <0 0 1)。结论　adiponectin在冠心病组、高血压组、糖尿病组和单纯性肥胖组中的水平下降 ;低adiponectin水平可能是肥胖致相关疾病的分子生物学基础之一。     

预防ERCP术后胰腺炎的临床研究

目的探讨内镜逆行胰胆管造影(ERCP)术后胰腺炎的预防措施。方法行ERCP患者164例,随机分为2组预防组82例,分别于术前3 0min皮下注射善宁0 1mg ,术后2 4h连续静脉滴注善宁针0 4mg ;对照组82例,ERCP术前术后不用善宁。2组患者术前、术后均不用其他任何抑制胰腺分泌及预防胰腺炎药物,并分别于术前、术后3、2 4h作血清淀粉酶测定,术前、术后2 4h作血清C反应蛋白(CRP)测定,同时观察胰腺炎的发生情况。结果预防组ERCP术后3、2 4h血淀粉酶分别为( 164±12 5 )U/L和( 2 0 4±195 )U/L ,明显低于对照组的( 2 79±2 0 1)U/L和( 4 98±3 82 )U/L(P <0 0 5 ) ;预防组血CRP明显低于对照组,预防组胰腺炎发生5例( 6 1% )明显低于对照组11例( 13 4% ) (P <0 0 5 )。结论ERCP术前及术后2 4h持续应用善宁有助于预防ERCP术后胰腺炎、减少组织损伤。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.