储存式单采自体红细胞在腹膜后肿瘤择期手术中的应用

目的 探讨普外科腹膜后肿瘤择期手术患者术后输注单采自体红细胞的疗效.方法 回顾性分析本院2014年1月1日至2014年11月30日20例腹膜后肿瘤择期手术患者自体输血对患者血液指标的影响及术后自体红细胞回输的疗效.结果 20例自体储血患者血常规指标单采后与单采前相比有所下降,但PLT、HCT、Hb均维持在较高水平(PLT＞ 150×109/L、HCT＞ 30％ 、Hb＞1 l0g/L),因此自体储血不会造成凝血功能障碍和组织缺氧.回输自体血后患者的血液指标与术后相比有所回升,防止了术后失血性贫血的发生.结论 普外科择期手术术后输注单采自体红细胞是一种安全有效的输血方案,不仅可以解决择期大手术的输血需求,而且能减少输血不良反应.     

补达秀治疗慢性肝病伴低钾血症的依从性

本文观察补达秀(氯化钾控释片)对慢性肝病伴低钾血症的治疗作用及依从性,并与10％氯化钾溶液进行比较。住院治疗的慢性肝病伴低血钾(<3.5mmol/L)患者40例,男34例,女6例,年龄29～59岁。随机分为2组:补达秀组20例,10％氯化钾组20例,两组年龄、病情及病程具可比性。服药前测血钾,然后分别口服补达秀1g,bid,或10％氯化钾溶液10ml,bid,均进餐时服用。用药后5天及10天复查血钾。进入研究期间其它治疗维持不变。研究期间详细询问记录不良反应及服药依从情况。结果:服药前2组血钾均明显低于正常(2.72±0.6mmol/L vs 2.73±0.5mmol/L),患者有低钾症状,如肌肉软弱无力、厌食、恶心、倦怠及心电图低钾表现。服药     

椎基底动脉供血不足和脑干梗死患者的瞬目反射检测

目的：探讨瞬目反射(BR)对椎基底动脉供血不足(VBI)及脑干梗死的临床应用价值。方法：用表面电极刺激三叉神经眶上支，在双侧眼轮匝肌进行记录。对BR异常者治疗1、3、6个月后复查。结果：VBI组80例治疗前BR异常者58例(72．5％)，治疗一个月后复查BR恢复正常者39例，BR正常或治疗后恢复正常者近期都能获得基本痊愈，而BR持续异常者则预后较差。脑干梗死组26例，：BR全部异常且异常程度重于VBI组。结论：在对VBI及脑干梗死诊断、疗效观察及预后评价中，BR是一项极为客观有用的指标。     

枸橼酸钠置换液在血液滤过中的抗凝效果评估

目的评估枸橼酸钠置换液在血液滤过中的抗凝效果。方法随机对照的实验研究,每组健康犬6只。枸橼酸钠组：配制含1．5mmol／L枸橼酸钠抗凝剂的置换液,在血滤管路静脉端持续补钙对抗枸椽酸根;肝素组：使用低分子肝素（20U／kg·h）持续泵入的抗凝方法。分别对急性肾功能衰竭的动物行血液滤过治疗,血流量为50ml／min,置换液速度为500ml／h。观察使用枸橼酸钠置换液后及补钙后血滤管道的凝血功能（PT、PT％、PT／R、PTINR、AFTT、AT3％及Fbg等）的变化,记录血滤管路使用时间,以及血液滤过结束时的血清肌酐、尿素、电解质、酸碱平衡,血滤器前、以及体内凝血功能指标的变化。结果血液滤过治疗过程中,使用枸橼酸钠置换液后血滤管道中血液的凝血指标（PT、PT％、PT INR、APTT）延长,补钙后恢复正常水平,体内静脉血的凝血指标均恢复正常范围内;两组均未有血滤管路和血滤器堵塞现象,实验犬的血浆电解质、酸碱平衡、肌酐、尿素等结果两组无明显差异（P〈0．01）,肝素组动物体内的部分凝血指标（跗、PT INR、APTT）延长（P〈0．01）。结论经研究配制后的枸橼酸钠置换液应用血液滤过治疗时,通过血滤器时有良好的抗凝效果．而且对体内凝血功能及内环境无不良影响。     

肝病患者血清AFP含量变化的观察

本文收集681例肝病患者血清,作AFP放射免疫分析,对其含量的变化进行了观察,现报告如下。 对象和方法 一、对象:681例肝病患者均系我院1995年3月～1995年12月门诊和住院病人。肝癌46例,余635例中甲肝122例;乙肝473例;丙肝40例。 二、方法:采用放射免疫分析法,试剂盒由上海科苑生物工程技术中心提供,操作按说明书。 结果 甲型肝炎122例,其中38例血清AFP含量增高,占31.14％,结果平均值为97.39μg/L。乙型肝炎473例,其中269例血清AFP含量增高,占56.87％。乙肝急性期(黄疸指数12u以上、高麝浊>10u、ALT>100u)结果平均值为203.18μg/L,乙肝恢复期(黄疸指数12u以下,麝浊<10u,ALT正常或稍偏高)结果平均值为64.80μg/L。丙型肝炎40例,其中11例血清AFP含量增高,占27.5％,结果平均值为76.23μg/L。原发性肝癌患者46例,血清AFP含量均>400μg/L,结果平均值为809.4μg/L,最高为4200μg/L。73例肝炎好转期,但黄疸指数仍升高者占12.26％,AFP结果平均值为102.61μg/L。 讨论 一、AFP在正常人血清中含量<20μg/L,当肝脏发生病变时含量升高,检测血清中AFP的含量是原发性肝癌的早期特异性诊断指标,当血清AFP含量持续升高,且>400μg/L时,基本可确诊原发性肝癌。本文结果原发性肝癌AFP结果平均值为809.4μg/L,最高     

19例慢性肾功能衰竭患者透析前后的脑电图分析

我院于1997年1月至1998年1月对19例慢性肾功能衰竭患者进行血液透析治疗，并于透析疗程结束后复查了脑电图。现报告如下。1 临床资料本组19例患者中，男16例，女3例，年龄38～64岁。所有患者均有贫血、恶心、呕吐等全身中毒症状，以及水中毒、高钾血症等。实验室检查：19例的血肌酐均＞442 μmol/L(正常值：45～135 μmol/L)，血尿素氮均＞214 mmol/L(正常值18～830 mmol/L)，16例中血钾＞53 mmol/L(正常值：35～55 mmol/L)。2 脑电图资料透析前脑电图结果：19例患者中，轻度异常者9例，脑电图改变为基本节律变慢，约75～8…     

循证晚期妊娠母血及脐血铁蛋白水平的相关性

目的　研究晚期妊娠妇女血清及胎儿脐血中铁蛋白水平的变化并探讨其相关性。方法　根据血红蛋白 (Hb)水平的不同各选取 2 5例孕足月妇女定为A组 (10 0 g/L～ 10 5g/L)、B组 (10 5 g/L～ 110 g/L)、C组 (Hb≥ 110g/L)。分别测定母血、脐血铁蛋白水平。结果　C组母血、脐血铁蛋白水平分别为 (19.0 9± 4 .0 8) μg/L和 (199.6 0± 6 1.0 4 ) μg/L ,高于A、B组 ,差异有显著性 (P <0 .0 5 ) ;Hb在 10 0g/L～ 110 g/L范围内母血与脐血的铁蛋白水平呈正相关 (P <0 .0 1)。结论　通过对母血铁蛋白的测定可以了解胎儿体内的贮铁水平 ;将正常孕妇血红蛋白值评判标准以往的 >10 0 g/L提高为 >110g/L ,有利于及时发现和治疗铁缺乏期的孕妇。     

伴急性肾功能衰竭横纹肌溶解综合征临床分析

目的探讨横纹肌溶解综合征伴急性肾功能衰竭（ARF）的临床特点、治疗及预后。方法对20例横纹肌溶解综合征伴ARF患者进行回顾性分析。结果20例伴ARF的横纹肌溶解综合征患者中，14例无尿。4例少尿；20例尿蛋白、隐血均阳性；血肌红蛋白（2961．2±285.3）mg／L，血肌酐（823．7±184．1）μmol／L，谷草转氨酶（712．3±82．6）U／L、谷丙转氨酶（978．4±71．9）IU／L、肌酸磷酸激酶（12753．5±18．2）U／L、CPK—MB（138．4±25．8）U／L；15例（75％）为高钾血症。给予补充液体、血液透析滤过等治疗后，18例（90％）存活，2例（10．0％）死于多器官功能障碍综合征；存活者出院时均脱离透析，14例血肌酐恢复正常，血清酶均恢复正常。结论横纹肌溶解综合征伴ARF时常表现为少尿型，高钾血症常见，血清酶学和血肌红蛋白明显升高有助于诊断，血液透析滤过治疗效果良好，存活者肾功能多可恢复。     

移行带前列腺特异性抗原密度在前列腺特异性抗原4.0～10.0和10.1～20.0μg/L时诊断前列腺癌的作用

目的 探讨移行带前列腺特异性抗原密度(TZPSAD)在前列腺特异性抗原(PSA)4.0～10.0 μg/L 和 10.1～20.0 μg/L时诊断前列腺癌的意义.方法 回顾性分析1999年11月至2009年8月在本院行前列腺穿刺活检的患者资料,以PSA 4.0～20.0 μg/L且有经直肠B超测量前列腺移行带资料的1 89例患者为研究对象,用接受者操作特性(ROC)曲线计算评估PSA和TZPSAD诊断前列腺癌的意义.分析PSA和TZ PSAD不同临界点在PSA 4.0～10.0 μg/L和10.1～20.0 μg/L范围内对前列腺癌的诊断效力.结果 40例(21.2％)诊断为前列腺癌,PSA 4.0～10.0μ/L时前列腺癌的阳性率为20.5％(16/78),PSA 10.1～20.0 μg/L时前列腺癌的阳性率为21.6％(24/111),两者差异无统计学意义(P=0.854).PSA4.0～10.0 μg/L时,PSA和TZPSAD预测前列腺癌ROC曲线下面积(AUC)分别为0.569和0.702;PSA10.1～20.0 μgL时,PSA和TZ PSAD预测前列腺癌AUC分别为0.463和0.730.TZPSAD 0.370和0.500 ng·ml-1·ml-1分别在PSA4.0～10.0和10.1～20.0 μg/L的诊断效力最大,其敏感性分别为68.8％和70.8％,特异性分别为72.6％和70.1％,结论 TZPSAD在PSA 4.0～ 10.0和10.1～20.0μg/L时诊断前列腺癌的效力均明显优于PSA,可明显提高PSA诊断前列腺癌的阳性率,减少不必要的前列腺穿刺活检.     

β—HCG测定对异位妊娠的诊断价值

采用放射免疫分析测定76例异位妊娠患者血清和（或）腹腔（后穹窿）穿刺血标本的β-HCG，来研究其对异位妊娠的诊断价值。结果是：47例中单独检测静脉血清的43例（91．49％）均为阳性（＞5μg/L）；单独检测腹腔血的3例均为阳性；有26例同时检测静脉血清和腹腔血，检测静脉血清的21例（80．77％）为阳性，检测腹腔血的25例（96．15％）为阳性。结果提示腹腔血β-HCG含量高于静脉血清β-HCG含量，测定β-HCG对异位妊娠的诊断是一项有价值的实验方法，但有时仍有假阴性结果出现。     

Positive direct antiglobulin test and high serum immunoglobulin G values

To investigate the association between the positive direct antiglobulin test (DAT) and hypergammaglobulinemia, the authors prospectively studied 154 patients, classified into three groups: Group 1, 52 patients with a positive DAT result in pretransfusion samples; Group 2, 52 patients with a negative DAT result; and Group 3, 50 patients initially found to have an elevated serum immunoglobulin G (IgG) level. Serum protein electrophoreses and IgG quantifications were performed for all three groups. Serum haptoglobin and lactate dehydrogenase (LD) isoenzyme electrophoreses were also assayed for Group 1. Of 52 patients in Group 1, 17 (33%) had an elevated serum IgG level and nonreactive eluates. Clinical history, haptoglobin, and LD isoenzyme studies did not suggest increased red blood cell destruction. Only 2 (4%) of 52 patients in Group 2 had an elevated serum IgG level. Of 50 in Group 3, 25 (50%) had a positive DAT result with nonreactive eluates and did not have hemolytic diseases. Two of 10 patients (20%) with serum IgG levels ranging from 18 to 20 g/L (1.8-2.0 g/dL), 13 of 29 (45%) with serum IgG levels from 20 to 40 g/L (2.0-4.0 g/dL), 4 of 6 (67%) with serum IgG levels from 40 to 60 g/L (4.0-6.0 g/dL), and 6 of 6 (100%) with serum IgG levels from 60 to 80 g/L (6.0-8.0 g/dL) had a positive DAT result. The authors concluded there is a significant correlation between a positive DAT result and serum IgG concentrations and that the higher the elevated serum IgG, the more frequently the positive DAT result is observed. Elevated serum IgG levels may explain many positive DAT results in pretransfusion blood samples.     

Serum erythropoietin and interleukin-6 levels in hemodialysis patients with hepatitis virus infection.

The influence of hepatitis B (HBV) and hepatitis C virus (HCV) infection on blood hemoglobin (Hb) and serum erythropoietin (Epo) and interleukin-6 (IL-6) concentrations was studied in 48 anemic patients on regular hemodialysis. They were grouped as follows: (I) 19 patients whose Hb values improved after infection (Hb > 85 g/L), (II) 10 patients with persisting anemia after infection (Hb < 75 g/L), and, without hepatitis virus markers (III) 8 patients with Hb > 85 g/L and (IV) 11 patients with Hb < 75 g/L. Serum immunoreactive Epo levels were significantly higher in group I (34.4+/-47.1 U/L) than in the other groups (II, 10.8+/-6.0; III, 7.9+/-3.2; IV, 8.4+/-4.3). Serum IL-6 was higher in group I than group III (7.7+/-7.8 pg/ml vs. 3.6+/-2.4; p = 0.05) but similar to the other groups. Hb levels in group I were maximal at the time of serum alanine aminotransferase normalization. Red cell production increases as a result of elevated circulating Epo during hepatic regeneration after HBV or HCV infection.     

Recurrences of viral hepatitis A

The aim of the study was to examine the frequency, severity, persistence and etiology of relapses occurring during the hepatitis A viral infection. Therefore, a prospective study of 910 patients suffering from hepatitis A (HA) was carried out. The clinical examination and determination of glutamyl pyruvic transaminase (GPT) in the serum every 7-14 days till recovery (usually during 6--8 months) were performed. HAV infection was confirmed by detecting anti-HAV IgM in the blood of all the examined by radioimmunoassay. In 876 (93.3%) patients HA had typical clinical features and a monophasic course. All cases made a rapid clinical recovery and liver function tests improved strikingly between 1 and 4 months after the onset of illness. However, in 34 (3.7%) of 910 patients, after an asymptomatic interval of 4--8 weeks, relapsing hepatitis occurred. Mild clinical symptoms: fatigue, myalgia, nausea, epigastric discomfort accompanied by the elevated levels of GPT in the serum were noticed in 11 patients, while 3 of them redeveloped jaundice. In 23 remaining patients relapses of hepatitis were asymptomatic, except for the reappearance of icterus in six cases. The only way to establish the exacerbation of the disease was through the pathological findings of GPT in the serum, which increased 10--60 times above the upper limit of the normal value. While 25 patients had one relapse, in 9 there were two or more relapses, so that hepatitis had a biphasic or polyphasic course. The second relapse was registered 3--6 weeks after the first one disappeared. Through biochemical tests the average values of the GPT were established: 1566 U/L in the acute stage, 107 U/L during the early stage of convalescence and 1016 U/L during the first relapse of hepatitis. After the first relapse and during remission, in 9 patients the average values of GPT in the serum were 84 U/L, while during the second relapse 518 U/L. Clinical signs of relapsing hepatitis disappeared approximately in 4 days, but liver function tests decreased slowly and persisted elevated between 5 and 12 months. A possibility of establishing the etiology of relapsing hepatitis, which has yet remained unknown, is discussed. Anti-HAV IgM were present in all 34 patients during the initial and relapsing phase of hepatitis and in 26 cases in the latter phase of convalescence between 9 and 11 months after the beginning of the disease. Serological tests excluded infection with hepatitis B, cytomegalovirus and Epstein-Barr virus. With a great probability other infections and toxic agents damaging the liver could have been excluded.(ABSTRACT TRUNCATED AT 400 WORDS)     

α干扰素、利巴韦林联合治疗难治性小儿丙型肝炎前瞻性研究

目的 寻找难治性小儿丙型肝炎的有效治疗方法。方法 采用基因工程α干扰素联合利巴韦林（病毒唑,维克拉,Ribavirin)治疗15例经α干扰素治疗无效或复发、病程长者达5－9年的难治性小儿丙型肝炎。采用年龄分组的方法,经病毒血清及肝脏组织病理学检查确诊。结果 本组平均年龄6－8岁,最大10岁,最小6个月,平均病程4．5年,男12例,女3例,14例有输注血制品史。经联合治疗后,血清HCV RNA阴转率为12／15,平均阴转时间为3个月,最短1．5个月,最长为5个月。本组无一例出现严重不良反应。一过性发热和感冒样症状与单独应用α干扰素无差别。个别（2例）病例有一性轻度纳差、恶心,部分病例（9例）有一过性血色素轻度下降,降幅平均值为5g/L,最多者降幅为20g／L,网织红细胞均有一过性轻度升高。均不影响治疗,可自行恢复。未见皮疹,白细胞和血小板减少及肾功异常改变。结论 α干扰素联合利巴韦林治疗难治性小儿丙型肝炎是有效的、安全、可靠的,值得进一步推广应用。     

透明质酸放免分析方法的改进及临床应用

本文制备了与透明质酸（ｈｙａｌｕｒｏｎｉｃ ａｃｉｄ ， Ｈ Ａ） 呈高度特异亲和的结合蛋白， 用氯胺 Ｔ 法碘化标记 Ｈ Ａ 衍生物。采用平衡加样程序， 固相第二抗体作分离剂建立了 Ｈ Ａ 放射免疫分析方法， 其最低检测限为８μｇ／ Ｌ， 最大结合率达９１２ ％ ， 且加样步骤少， 检测时间２ｈ ， 有效期达２ 个月。应用此方法检测１３２ 例肝炎患者血清 Ｈ Ａ 水平， 慢性迁延性肝炎（ Ｃ Ｐ Ｈ） 、慢性活动性肝炎（ Ｃ Ａ Ｈ） 及肝硬化（ Ｌ Ｃ） 平均分别为１９７７ 、４３３５ 和６８５２μｇ／ Ｌ。 Ｈ Ａ 对 Ｃ Ｐ Ｈ 与 Ｃ Ａ Ｈ 有鉴别诊断价值。应用 Ｒ Ｏ Ｃ曲线确定 Ｌ Ｃ 的诊断限为４５０μｇ／ Ｌ， 其灵敏度为９５７ ％ 、特异性７８５ ％ 。说明本方法稳定可靠， 对肝纤维化有诊断作用。     

Elevated fibrinogen in an acute phase reaction prolongs the reptilase time but typically not the thrombin time

The effects of elevated fibrinogen on thrombin and reptilase times have not been well documented. High fibrinogen levels are common (38% of specimens submitted to our coagulation laboratory). Among 102 patients in the present study, an endogenously elevated fibrinogen level was significantly associated, as follows, with prolonged reptilase times: 1 (4%) of 28 with normal fibrinogen levels, 6 (20%) of 30 with levels in the 400 to 700 mg/dL (4.0-7.0 g/L) range, 10 (34%) of 29 with levels in the 700 to 1,000 mg/dL (7.0-10.0 g/L) range, and 7 (47%) of 15 with fibrinogen levels greater than 1,000 mg/dL (10.0 g/L). This association was independent of patient age and fibrin degradation product titer. In contrast, thrombin time was not altered notably by elevated fibrinogen levels. In 4 patients studied further, the prolonged clotting times could be corrected or nearly corrected by adding calcium chloride or albumin, whereas no such corrections were demonstrable in samples from several hereditary dysfibrinogenemia control subjects. An elevated fibrinogen level is common and is associated with reptilase time prolongations. For patients with prolonged reptilase times, a fibrinogen assay is suggested before establishing a diagnosis of dysfibrinogenemia.     

血清免疫球蛋白、轻链测定对多发性骨髓瘤诊断的临床价值

目的:探讨血清免疫球蛋白(Ig)、轻链(κ、λ)的含量测定对多发性骨髓瘤(MM)诊断的临床价值.方法:速率散射比浊法.结果:39例MM的初诊患者,Ig测定结果显示,IgG型27例,占69.2%,IgG含量(60.19±29.80)g/L;IgA型7例,占17.9%,IgA含量(38.10±20.72)g/L;IgM型1...     

Prevalence of hepatitis G virus in Pakistani children with transfusion dependent beta- thalassemia major

We ought to obtain data on the prevalence of the newly discovered tranfusion transmittable hepatitis G virus in polytransfused b- thalassemia major children. Each individual had received multiple blood transfusions, from 12 to 36 per year. No documentation of prior hepatic infection was available. Serum samples were collected prospectively from the randomly selected subjects and were analyzed for HGV RNA by polymerase chain reaction using primer specific for two different regions of the HGV genome. Among the 100 individuals examined 21 were positive for HGV RNA. Four patients had evidence of dual infection, both HGV RNA and HCV RNA were isolated from their sera. While in one sample presence of both HGV RNA and HBV DNA was established. Only one child was positive for hepatitis E antibodies. The sera of 10 children were reactive for hepatitis B surface antigen whereas 35 individuals were positive for hepatitis C virus antibody. The ALT levels were variable in HGV infected children. Four out of 16 (25%) showed peak ALT levels of 218 IU/I, 8/16 (50%) children demonstrated slightly elevated ALT levels whereas 25% individuals showed normal ALT levels. Alkaline Phosphatase levels were elevated in 90% of the children and 20% patients of this series also had higher GGT levels. The observed AP levels were not statistically different among HGV, HGV/HCV or HGV/HBV groups. Even though the ALT levels were deranged in the children with HGV alone but none of the children had demonstrated symptoms of liver disease, their direct and total bilirubin levels were normal and no complain of jaundice was recorded. In conclusion, our findings suggested that like other blood borne hepatic viruses, HGV is also prevalent in the high risk group of multiple transfused patients in Pakistan but our results support the absence of any causal relationship between HGV and hepatitis.     

Serum levels of soluble Tac peptide in acute and chronic hepatitis B virus infection

Serum-soluble Tac peptide was measured by an enzyme-linked immunosorbent assay in 12 patients with acute type B hepatitis, 33 patients with chronic type B hepatitis, and 15 age- and sex-matched controls. All 12 patients with acute type B hepatitis had elevated levels of soluble Tac peptide with a mean (+/- SD) of 1527 +/- 432 U/ml, significantly higher than that of normal controls (264 +/- 74 U/ml) or patients with chronic type B hepatitis (646 +/- 399 U/ml). Serial follow-up showed that serum levels of soluble Tac peptide tended to return to normal 2-4 months after onset of acute hepatitis along with the normalization of alanine aminotransferase and seroconversion of hepatitis B surface antigen (HBsAg) to anti-HBs. Patients with chronic type B hepatitis also had significantly higher levels of soluble Tac peptide than normal controls, although only 63.6% (21/33) of them had a level greater than the upper limit of normal. Serum levels of soluble Tac peptide in patients with chronic type B hepatitis varied considerably with the inflammatity in liver. The hepatitis B e antigen (HBeAg)-positive patients with chronic active liver disease had significantly higher levels of soluble Tac peptide (928 +/- 424 U/ml) than HBeAg-positive (412 +/- 146 U/ml) or anti-HBe-positive (424 +/- 175 U/ml) patients with chronic persistent hepatitis or minimal histological change. In addition, there was a significant positive correlation between serum levels of soluble Tac peptide and alanine aminotransferase. These findings suggested that activation of T cells might play an important role in the pathogenesis of acute and chronic type B hepatitis. Assay of serum-soluble Tac peptide might provide a simple and useful means to better understand the immune mechanisms of acute and chronic hepatitis B virus infection.