BNP在舒张性心衰诊断中的应用价值

对17例左室功能正常、28例舒张性心衰及28例舒张性并收缩性心衰患者进行血浆B型钠利尿肽(BNP)及心功能检测,结果显示,左室功能正常组血浆BNP(17.1±9.9)pg/ml,舒张性心衰组(99.5±66.7)pg/ml,舒张性并收缩性心衰组(511.4±422.5)pg/ml,三组两两比较均有显著性差异(P<0.01)。以血浆BNP31pg/ml作为诊断舒张性心衰的分界值,其特异性为96%。认为根据血浆BNP变化诊断舒张性左室功能不全简单快速,其准确性与心脏超声心动图有同等重要的价值。     

快速血浆B型钠尿肽测定鉴别心源性和肺源性急性呼吸困难

目的　探讨床边快速血浆B型钠尿肽 (B -typenatriureticpeptide,BNP)浓度检测对心源性和肺源性急性呼吸困难的鉴别诊断价值和最适诊断分界点。方法　前瞻性对急性呼吸困难急诊入院的 131名患者行床边快速血浆BNP浓度检测 ,两名心脏专家在不知其结果的情况下 ,根据患者的所有临床资料 ,独立作出病因诊断。一致性诊断作为确定诊断。结果　心源性急性呼吸困难组 54人 ,血浆BNP浓度为 880 78± 4 0 2 86pg/ml,肺源性急性呼吸困难组 6 2人 ,血浆BNP浓度为 192 86± 174 0 1pg/ml,两组比较P <0 0 1,具有显著性差异。血浆BNP浓度诊断心源性急性呼吸困难的接受者工作特征 (receiveroperatingcharacteristic,ROC)曲线下面积为 0 94 1。最适诊断分界点为 370pg/ml,诊断准确率为86 2 %。结论　床边快速血浆BNP浓度检测有助于心源性和肺源性急性呼吸困难的鉴别诊断     

糖代谢异常对急性心肌梗死患者血浆B型利钠肽和心功能的影响

【】目的：评价不同糖尿病状态对急性心肌梗死患者血浆B型利钠肽(BNP)和心功能的影响。方法：105例急性心肌梗死患者根据糖尿病史和OGTT检测结果将其分为糖耐量正常(NGT)、糖耐量异常(IGT)和糖尿病(DM)三组。应用美国博适Triage干式快速定量心肌梗死/心力衰竭诊断仪和 BNP检测板,测定三组患者入院时和发病第7天血浆BNP水平,同时对患者的心功能进行评价。结果：AMI＋DM 组患者入院时和发病第 7 天血浆 BNP水平分别为(347.78±122.02)pg/ml和(331.53±108.53)pg/ml,均明显高于AMI NGT组[(158.57±75.32)pg/ml和(102.85±60.52)pg/ml]和AMI IGT组[(167.86±72.56)pg/ml和(145.21±80.61)pg/ml],P＜0.05。AMI＋IGT组患者的BNP 水平亦高于AMI＋NGT 组,但差异无统计学意义,P＞0.05。三组患者发病第7 天血浆 BNP水平较入院时均有下降,但仅有AMI＋NGT组[(158.57±75.32)pg/ml比(102.85±60.52)pg/ml]BNP下降程度有统计学差异, P＜0.05。AMI DM组患者心功能Ⅲ-Ⅳ级比例(29.7%)明显高于其他两组(8.9%和8.7%),P＜0.05。结论：糖代谢异常影响急性心肌梗死患者血浆BNP的分泌,合并糖尿病的急性心肌梗死患者血浆BNP水平明显升高,心功能较差。     

心衰患者伴肝脏肿大时血浆内皮素水平的变化

检测24例重度心衰(NYHAⅢ～Ⅳ)患者和20例健康对照者的血浆内皮素(ET)浓度,发现前者明显高于后者(102.4±26.3pg/ml,55.5±17.4pg/ml,P<0.001)。心衰病人伴肝大者(n=11)较无肝大者(n=13)血浆ET浓度显著降低(82.8±13.6pg/ml,121.5±21.1pg/ml,P<0.001)。其机制可能是钠水潴留致ET浓度稀释。     

老年人舒张性心力衰竭与血浆B型尿钠肽水平

目的　观察老年舒张性心功能衰竭 (DHF)患者血浆B型尿钠肽 (BNP)水平关系。方法　选患临床充血性心功能衰竭 (CHF)症状而左室射血指数 (LVEF)≥ 5 0 %的 30例老年病人作为老年DHF组 ,选 30例有同样基础疾病但无临床CHF症状的老年病人作为对照组 ,分别测定和比较两组病人血浆BNP值。结果　心衰组血BNP水平非常显著高于对照组 (心衰组 6 81± 5 11pg/ml,对照组 33± 16pg/ml,P <0 0 1)。结论　老年人DHF患者血BNP显著升高。     

高血压病人不同左室功能与血浆B型钠尿肽及Ⅲ型前胶原的关系

目的探讨原发性高血压患者不同左心室功能状态与血浆B型钠尿肽(BNP)及血清Ⅲ型前胶原(PCⅢ)的相互关系。方法入选原发性高血压患者190例,根据心功能情况分为心功能正常、左室舒张功能不全、左室收缩功能不全三组,另设正常对照组40例,所有患者均行超声心动图检查。用放免法测定血清PCⅢ浓度,干式快速免疫荧光法定量测定血浆BNP浓度。结果(1)高血压患者心功能正常、左室舒张功能不全、左室收缩功能不全三组的BNP与PCⅢ水平分别为:49±18pg/ml,135±31pg/ml,283±96pg/ml;82.3±33.7ug/L,119.4±38.5ug/L,147.4±51.6ug/L;血压正常对照组BNP与PCⅢ水平分别为43±16pg/ml,77.5±23.1ug/L。BNP与PCⅢ水平在高血压患者三组间逐步增高(P<0.05),且以左室收缩功能不全组增高最显著(P<0.05);(2)血浆BNP水平与LVMI、血清PCⅢ水平均呈显著正相关(P<0.05)。结论血浆BNP及组织纤维化血清指标PCⅢ可客观反映高血压患者不同左心室功能状态。     

B型脑钠肽在高危人群中早期诊断孤立性左心室舒张功能障碍的价值

目的评估血浆BNP水平在高危人群中早期诊断孤立性左室舒张功能障碍的价值。方法纳入72例高血压、糖尿病、高血脂以及缺血性心脏病患者。脉冲多普勒(PW)获取二尖瓣口血流速率E/A、E峰下降时间(DT)与等容舒张时间(IVRT)。并检测所有患者的血浆BNP水平。根据E/A、DT、IVRT值分为两组:左心室舒张功能正常组和孤立性舒张功能障碍组。结果左心室舒张功能正常组的血浆BNP值为(42.1±7.6)pg/ml,而舒张功能不全组为(185.5±26.5)pg/ml,两组间有明显差异(P<0.01)。BNP检测孤立性左心室舒张功能障碍ROC曲线下面积0.93(95%CI,0.86 to 0.99;P<0.01)。BNP值为63pg/ml,其特异性为90.5%,敏感性91.3%,准确率为90.3%。结论血浆BNP水平检测有助于早期诊断孤立性左心室舒张功能障碍。     

冠心病合并糖尿病慢性心衰患者HbA1c与脑钠肽的相关性

目的:探讨冠心病(CHD)合并糖尿病(DM)慢性心衰患者的糖化血红蛋白(HbA1c)与血浆脑钠肽(BNP)水平的相关性。方法:选择2013年2月~2014年10月在我科住院的CHD慢性心衰患者100例,其中CHD合并DM患者50例(CHD+DM组),单纯CHD患者50例(单纯CHD组),检测比较两组患者的HbA1c及血浆BNP水平,分析两者的相关性。结果:与单纯CHD组比较,CHD+DM组HbA1c[(5.43±0.49)%比(8.02±0.96)%]和血浆BNP水平[(659.32±138.38)pg/ml比(1271.58±274.97)pg/ml]均显著升高,P均0.01。Pearson相关分析显示CHD+DM患者的HbA1c与血浆BNP水平呈显著正相关(r=0.81,P0.05)。结论:糖化血红蛋白水平与糖尿病慢性心衰患者的BNP呈显著正相关,检测糖化血红蛋白水平对其防治有重要指导价值。     

充血性心衰患者血浆内皮素含量变化以及苯那普利对其影响

目的:探讨充血性心衰患者血浆内皮素(ET)的浓度和苯那普利对ET的影响。方法:用放免法测定79例心衰患者血浆ET含量并用苯那普利10mg/d,连服2周观察疗效。结果:心衰患者的血浆ET浓度较对照组明显升高,NYHA心功能Ⅳ级者的ET水平(94.7±20.0)pg/ml较NYHA心功能Ⅱ级(69.5±19.0)pg/ml和NYHA心功能Ⅲ级者(79.2±14.3)pg/ml明显升高(P均<0.01)。左室射血分数(EF)减低者的血浆ET浓度明显升高,经相关分析后,血浆ET浓度与EF呈显著的负相关(r=-0.35,P=0.02)。其中29例患者经苯那普利治疗后,血浆ET浓度由治疗前的(113.7±36.6)pg/ml下降至(81.1±43.1)pg/ml(P<0.001)。结论:ET参与了心衰的发病和病理过程,苯那普利可明显降低心衰患者的血浆ET浓度。     

B型利钠肽对心源性和非心源性呼吸困难鉴别诊断界值标准研究

目的 探讨心源性与非心源性呼吸困难患者B型利钠肽(BNP)诊断界值水平。 方法采用美国博适-Triage干式快速定量心力衰竭/心肌梗死诊断仪对351例急性呼吸困难患者床旁BNP测定。 结果 BNP水平小于60pg/ml患者基本可诊断为非心源性呼吸困难;BNP水平大于100pg/ml但小于500pg/ml患者需考虑心源性呼吸困难可能;大于500pg/ml患者基本可诊断为心源性呼吸困难。 结论 BNP水平高低是鉴别心源性和非心源性呼吸困难可靠的指标。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.