急性胰腺炎患者血清粘附分子水平变化的临床意义

目的探讨细胞间粘附分子-1(sICAM-1)在急性胰腺炎(AP)发病中的作用,并研究ICAM-1的连续监测在AP的分类诊断中的意义。方法对于60例AP患者,其中急性水肿性胰腺炎(AEP)组36例和急性出血坏死性胰腺炎(AHNP)组24例,连续7天采用ELISA法测定其血清sI-CAM-1水平变化。结果AEP组和AHNP组患者血清sICAM-1差异有统计学意义(P<0.01),且两组患者血清sICAM-1均明显高于健康对照组(P<0.01):AEP患者sICAM-I浓度-时间曲线呈下降型,AHNP患者sICAM-1浓度-时间曲线呈递增型或复发型。结论sICAM-1在AP的发生、发展过程中发挥重要作用,sICAM-1升高的程度及方式与AP严重程度密切相关,对AP的分类诊断具有重要价值。     

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。     

母血清白细胞介素6、C-反应蛋白与早产亚临床绒毛膜羊膜炎的关系

目的探讨母血清白细胞介素 6 (IL 6 )、C 反应蛋白 (CRP)与早产亚临床绒毛膜羊膜炎的关系。方法用酶联免疫吸附实验测定6 7例早产孕妇及 32例相同孕周正常孕妇血IL 6 ,同时测定血CPR、白细胞计数 (WBC)。结果早产组血IL 6WBC明显高于对照组(P <0 .0 5 ) ,但两组间CRP浓度无显著性差异 (P >0 .0 5 )。胎膜早破早产与胎膜完整早产血IL 6、CPR无显著性差异 (P >0 .0 5 )。组织学绒毛膜羊膜炎阳性组血清IL 6、CRP均明显高于组织学绒毛膜羊膜炎阴性组 (P<0 .0 1) ,IL 6≥ 10pg/ml、CPR >8.2 0mg/l对预测亚临床绒毛膜羊膜炎的敏感性和准确性分别为 88.89%、80 .6 0 %和 5 2 .78%、6 4.18%。结论母血IL 6CRP均是预测早产亚临床绒毛膜羊膜炎较有用的指标 ,但IL 6比CRP具有更高的敏感性和准确性。     

急性胰腺炎早期患者IL-10、IL-6变化的临床意义

【目的】了解急性胰腺炎 (AP)早期患者IL 10、IL 6的变化及临床意义。【方法】分别在AP病人入院后d1和d3 采血 ,回顾性分析其IL 6、IL 10的早期变化并与健康献血人群比较。【结果】AP患者血浆IL 10阳性检测率在入院d1为 4 4 .6 %、d3 为 2 4 .4 % ,正常人群无阳性结果 (P <0 .0 5 )。血浆IL 6入院d1SAP组血浆IL 6浓度明显高于MAP组及正常对照组 (P <0 .0 1) ,MAP组与正常组IL 6浓度也有显著差异 (P <0 .0 1) ,最佳截断值为 10 5 pg/ml,预测SAP的敏感性 84 .6 2 % ,特异性 94 .12 % ,阳性预断值 93.5 2 % ,阴性预断值 85 .95 % ,可用度为 78.73% ;入院d3 SAP组血浆IL 6浓度仍明显高于MAP组和正常组 (P <0 .0 1) ,MAP组与正常组相比差异无显著性 (P >0 .0 5 )。【结论】IL 10在正常人中一般不能检测出 ,在AP时升高 ;SAP早期IL 6浓度明显升高 ,检测IL 6可能对于早期鉴诊有一定的意义 ,其监测SAP的敏感性、特异性较高 ,且稳定性较好 ,可作为其临床诊断参考指标之一     

急性胰腺炎病人血清G-CSF和CRP的变化

目的　测定急性胰腺炎 (AP)病人血清粒细胞集落刺激因子 (G -CSF)和C -反应蛋白 (CRP)水平 ,并探讨其临床意义。方法　对 41例AP病人和 40例正常对照组利用双抗体夹心ELISA法测定血清G -CSF ,快速免疫消浊比浊法测定CRP。结果　AP病人血清G -CSF和CRP水平较正常对照组明显增高 ,其中重症急性胰腺炎 (SAP)又较轻症急性胰腺炎 (MAP)病人血清G -CSF和CRP水平增高 (P <0 0 5 )。血清G -CSF和CRP的变化和病情变化一致。结论　血清中G -CSF可能与AP的严重程度有关 ,在临床上检测血清G -CSF和CRP有助于AP病情的了解和疗效的观察     

TNF-α、IL-6、TAP与急性胰腺炎严重程度的相关性研究

目的:探讨血浆肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及血清、尿液中胰蛋白酶原激活肽(TAP)与急性胰腺炎(AP)严重程度的相关性,为早期预测重症胰腺炎提供有临床价值的指标。方法:61例AP患者分为重症AP(30例)和轻症AP(38例)两组,另选择30例健康正常人作为对照组,比较各组血浆TNF-α、IL-6及血清、尿液TAP水平。结果:入院时AP患者血浆TNF-α、IL-6及血清、尿液TAP水平均明显高于正常对照组(P均<0.01);重症AP组患者TNF-α、IL-6及血清、尿液TAP水平均明显高于轻症AP组(P均<0.05)。结论:TNF-α、IL-6及血清、尿液TAP水平变化与AP病情变化密切相关,病程早期检测TNF-α、IL-6及血清、尿液TAP水平有助于重症急性胰腺炎的预测。     

急性呼吸窘迫综合征患者血清和支气管肺泡灌洗液中白介素-1β的变化

目的 :探讨白细胞介素 1β(IL 1β)在急性呼吸窘迫综合征 (ARDS)发病中的作用。方法 :用酶联免疫吸附试验检测了 13例 ARDS患者和 9例健康者支气管肺泡灌洗液 (BAL F)和血清中 IL 1β含量。结果 :ARDS患者 BAL F及血清中 IL 1β含量〔分别为 (14 4 .6 7± 80 .79) ng/ L 和 (4 5 .71± 7.0 9) ng/ L〕明显高于对照组〔分别为 (2 0 .39± 1.87) ng/ L 和 (35 .0 6± 5 .4 6 ) ng/ L,P=0 .0 0 0和 P=0 .0 0 1〕,且 ARDS患者 BAL F中IL 1β含量也明显高于血清 (P=0 .0 0 0 )。结论 :IL 1β参与了 ARDS的发病过程 ,早期测定 ARDS患者肺内细胞因子可能比血液或血浆中更有价值。     

血清淀粉酶、C反应蛋白、白细胞联合检测对急性胰腺炎鉴别的价值研究

目的探讨血清淀粉酶(S-Amy)、C反应蛋白(CRP)、白细胞(WBC)联合检测在急性胰腺炎(AP)鉴别中的临床价值。方法选取2017年1―12月该院接受治疗的急腹症患者380例,其中AP组患者200例,非AP组患者180例。AP组包含急性轻症胰腺炎(MAP)组患者136例,急性重症胰腺炎(SAP)组患者64例,选择同期门诊的健康体检者74例作为健康对照组。比较各组研究对象的血清学指标并分析其特异度和灵敏度。结果 AP组S-Amy水平明显高于非AP组和健康对照组(P0.05);AP组患者CRP、WBC水平明显高于健康对照组(P0.05);MAP组S-Amy水平与SAP组比较,差异无统计学意义(P0.05),MAP组CRP、WBC水平明显低于SAP组(P0.05);3项血清指标联合检测的特异度和灵敏度均显著高于单项检测(P0.05)。结论 AP患者S-Amy、CRP、WBC水平均有所增高,且3项血清指标联合检测,能反映AP的严重程度,值得临床推广应用。     

血清C反应蛋白、白介素-6、白介素-8与尿胰蛋白酶原活性肽联合检测在急性胰腺炎早期病情判断中的意义

目的探讨血清C反应蛋白(CRP)、白介素-6(IL-6)、白介素-8(IL-8)与尿胰蛋白酶原活性肽(TAP)联合检测在急性胰腺炎(AP)早期病情判断中的意义。方法分别检测健康对照组(26例)、轻型AP组(24例)和重型AP组(21例)血清CRP、IL-6、IL-8和尿TAP水平。结果重型AP组血清CRP、IL-6、IL-8和尿TAP水平高于轻型AP组和健康对照组(P<0.05)。结论血清CRP、IL-6、IL-8与尿TAP水平随AP病情严重程度的升高而增高,四者联合检测对于AP早期病情判断具有重要应用价值。     

C-反应蛋白与冠心病严重程度的临床研究

目的:探讨C-反应蛋白(CRP)在动脉粥样硬化形成和发展中的作用以及与冠心病严重程度之间的关系。方法:入选126例患者均进行了冠状动脉造影,其中急性心肌梗死(AMI)组26例,不稳定心绞痛(UAP)组30例,稳定性心绞痛(SAP)组30例,对照组40例。又将冠状动脉造影异常者分为单支血管病变(SVL)组46例和多支血管病变(MVL)组40例。结果:冠心病各亚组血清CRP含量均较对照组升高(P0.05),其中UAP组和AMI组CRP升高明显(P0.01);UAP组血清CRP浓度高于SAP组(P0.01);AMI组血清CRP浓度高于SAP组(P0.01)和UAP组(P0.01)。MVL组血清CRP浓度高于SVL组(P0.01)。结论:CRP在冠心病患者中有不同程度升高,且与冠心病严重程度相关,临床上检测外周血CRP浓度,在诊断冠心病和预测冠心病严重程度方面有较高的临床应用价值。     

Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin.

OBJECTIVE: To test the sepsis marker procalcitonin (PCT) for its applicability to discriminate between septic and nonseptic causes of acute respiratory distress syndrome (ARDS). DESIGN: Prospective study, assessing the course of PCT serum levels in early (within 72 hrs after onset) ARDS. The three other inflammation markers neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) were tested in parallel. SETTING: Twenty-four-bed medical intensive care unit of a 1,990-bed primary hospital, providing health care for an estimated 39,000 patients. PATIENTS: Twenty-seven patients, 18 male and nine female, aged 16-85 yrs, with early ARDS of known cause (17 with septic and ten with nonseptic ARDS) were enrolled in a prospective study between May 1994 and May 1995. INTERVENTIONS: Serum samples were drawn every 4-6 hrs for measurement of PCT, neopterin, IL-6, and CRP concentrations. Blood cultures, tracheal aspirates, and urine samples were obtained every 12-24 hrs. In 24 of 27 patients, bronchoscopic cultures were also obtained. Clinical sepsis criteria as defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference were checked daily. MEASUREMENTS AND MAIN RESULTS: Assessment of inflammation marker serum levels in septic vs. nonseptic ARDS. PCT serum levels were significantly higher (p < .0005) in the patients with septic ARDS than in patients with nonseptic ARDS within 72 hrs after onset of ARDS. There was no overlap between the two groups. Also, neopterin allowed a differentiation (p < .005), although a substantial overlap between serum levels of septic and nonseptic patients was observed. No discrimination could be achieved by determination of CRP and IL-6 levels. CONCLUSION: PCT determination in early ARDS could help to discriminate between septic and nonseptic underlying disease.     

急性胰腺炎患者血清TNF-a和CRP水平的测定及其临床意义

目的探讨TNF-a、CRP变化在急性胰腺炎的临床意义。方法测定轻症急性胰腺炎和重型急性胰腺炎患者入院第1、4、7、14天时血清TNF-a和CRP水平，并与健康人对照。结果入院时和入院后重症急性胰腺炎血清TNF-a和CRP水平均高于轻症急性胰腺炎，而后者又均高于健康组（P＜0．05），且血清TNF-a含量和CRP含量变化呈正相关（r=0.7124,P＜0．05）。结论血清TNF-a和CRP水平变化与AP病情变化密切相关，联合检测有助于了解病情发展。     

Circulating cytokines in predicting development of severe acute pancreatitis

Introduction

Severe acute pancreatitis (AP) is associated with high morbidity and mortality. Early prediction of severe AP is needed to improve patient outcomes. The aim of the present study was to find novel cytokines or combinations of cytokines that can be used for the early identification of patients with AP at risk for severe disease.

Methods

We performed a prospective study of 163 nonconsecutive patients with AP, of whom 25 had severe AP according to the revised Atlanta criteria. Admission serum levels of 48 cytokines and growth factors were determined using Bio-Plex Pro Human Cytokine Assay 21-plex and 27-plex magnetic bead suspension panels. Admission plasma levels of C-reactive protein (CRP), creatinine and calcium were measured for comparison. In subgroup analyses, we assessed the cytokine profiles of patients with severe AP (n = 14) who did not have organ dysfunction (OD) upon admission (modified Marshall score <2).

Results

Of 14 cytokines elevated in the severe AP group, interleukin 6 (IL-6) and hepatocyte growth factor (HGF) levels were independent prognostic markers of severe AP. IL-6, HGF and a combination of them predicted severe AP with sensitivities of 56.0%, 60.0% and 72.0%, respectively, and specificities of 90.6%, 92.8% and 89.9%, respectively. The corresponding positive likelihood ratio (LR+) values were 5.9, 8.3 and 7.1, respectively. The predictive values of CRP, creatinine and calcium were comparable to those of the cytokines. In subgroup analyses of patients with severe AP and without OD upon admission, we found that IL-8, HGF and granulocyte colony-stimulating factor (G-CSF) levels predicted the development of severe AP, with G-CSF being the most accurate cytokine at a sensitivity of 35.7%, a specificity of 96.1% and a LR+ of 9.1.

Conclusions

IL-6 and HGF levels upon admission have prognostic value for severe AP which is similar to levels of CRP, creatinine and calcium. Although IL-6 and HGF, as either single or combined markers, were not perfect in identifying patients at risk for severe AP, the possibility that combining them with novel prognostic markers other than cytokines might improve prognostic accuracy needs to be studied. The accuracy of IL-8, HGF and G-CSF levels in predicting severe AP in patients without clinical signs of OD upon admission warrants larger studies.     

Procalcitonin for discrimination between activity of systemic autoimmune disease and systemic bacterial infection

Objective To investigate whether serum procalcitonin (PCT) levels could be useful to differentiate between systemic infection and the activity of the underlying disease in autoimmune disease. Methods In 18 patients with systemic lupus erythematodes (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibody-associated vasculitis (AAV) clinical disease activity was assessed by score systems. Infection was defined by clinical and microbiological means. PCT was determined in parallel with concentrations of neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) in 397 serum samples. Results Only in 3 of the 324 samples taken from patients with autoimmune disease but without concomitant infection, serum PCT levels were above the normal range (>0.5 ng/ml), whereas neopterin, CRP and IL-6 were elevated in patients with active underlying disease. All systemic infections (N=16 in AAV-patients) were associated with markedly elevated PCT-levels (mean±SD:1.93±1.19 ng/ml). Conclusion PCT may serve as a useful marker for the detection of systemic bacterial infection in patients with autoimmune disease.     

TIA患者血清IL-6、IL-18水平与颈动脉内中膜厚度的关系

目的 通过分析颈动脉内中膜厚度(IMT)与血清细胞因子白介素-6(IL-6)、白介素-18(IL-18)水平的关系,探讨IMT增厚的发生机制.方法 选择66例短暂性脑缺血发作(TIA)患者(TIA组)作为研究对象,另选择40名健康者作为正常对照组.分别测量其颈动脉IMT值,并分为IMT＜1.0mm亚组和IMT≥1.0mm亚组.利用液相平衡竞争放射免疫分析法(RIA)和酶联免疫吸附法(ELISA)分别测定了2组的血清IL-6和IL-18水平,并对IMT与IL-6,IL-18的关系进行分析.结果 TIA组所有IMT≥1.0mm患者血清IL-6、IL-18含量均比正常对照组升高,差异有统计学意义(P＜0.05,P＜0.01); TIA组IMT≥1.0mm亚组患者血清IL-6、IL-18含量比IMT＜1.0 mm亚组患者升高,差异有统计学意义(P＜0.05).经Pearson相关分析,TIA组IMT≥1.0mm亚组患者IMT与血清IL-18含量呈明显正相关(r=0.551,P＜0.01);TIA组、脑梗塞组IMT≥1.0mm亚组患者IMT与血清IL-6含量无相关性(r=0.303,P=0.058).结论 TIA组IMT增厚的患者血清IL-6、IL-18的水平是升高的.IMT的增厚与血清IL-18含量呈明显正相关,与血清IL-6含量无相关性.IL-6、IL-18可能参与了AS的形成过程.     

Procalcitonin for discrimination between activity of systemic autoimmune disease and systemic bacterial infection

Objective: To investigate whether serum procalcitonin (PCT) levels could be useful to differentiate between systemic infection and the activity of the underlying disease in autoimmune disease.¶Methods: In 18 patients with systemic lupus erythematodes (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibody-associated vasculitis (AAV) clinical disease activity was assessed by score systems. Infection was defined by clinical and microbiological means. PCT was determined in parallel with concentrations of neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) in 397 serum samples.¶Results: Only in 3 of the 324 samples taken from patients with autoimmune disease but without concomitant infection, serum PCT levels were above the normal range ( > 0.5 ng/ml), whereas neopterin, CRP and IL-6 were elevated in patients with active underlying disease.¶All systemic infections (N = 16 in AAV-patients) were associated with markedly elevated PCT-levels (mean - SD:1.93 - 1.19 ng/ml).¶Conclusion: PCT may serve as a useful marker for the detection of systemic bacterial infection in patients with autoimmune disease.     

血清IL-6、IL-18及CRP水平在新生儿缺氧缺血性脑病中变化及意义

目的探讨血清白细胞介素(IL)-6、IL-18及C反应蛋白(CRP)水平在新生儿缺氧缺血性脑病(HIE)中的变化及其临床意义。方法分别应用酶联免疫吸附法和免疫透射比浊法检测100例HIE新生儿血清IL-6、IL-18及CRP水平,并与100例健康新生儿(对照组)进行比较。结果 HIE组与对照组相比较,血清IL-6、IL-18及CRP水平均明显升高(P0.01),且随临床分级程度加重逐渐升高;血清CRP水平与血清IL-6、IL-18水平均呈正相关(r=0.663、0.725,均P0.01),IL-6与IL-18水平呈正相关(r=0.783,P0.01)。结论 IL-6、IL-18及CRP在HIE发生发展过程中可能起重要作用,且与HIE病变严重程度和临床变化有较密切的关系,对病情和预后判断有重要价值。     

4种血清标志物联合检测对急性胰腺炎的诊断和预后判断的价值

目的探讨血液淀粉酶(AMY)、脂肪酶(LPS)、C-反应蛋白(CRP)和白细胞介素6(IL-6)联合检测对急性胰腺炎(AP)的诊断和预后判断的价值。方法检测50例急性胰腺炎患者,包括28例轻型急性胰腺炎(MAP)患者和22例重型急性胰腺炎(SAP)患者入院时以及50例非胰腺炎急腹症(NAA)患者入院时和50例健康者的血清AMY、LPS、CRP和IL-6的水平,并检测50例AP患者入院后第3、5、7天血清CRP和IL-6的水平。结果入院时AP患者AMY、LPS和CRP水平明显高于NAA患者和健康对照组,差异有统计学意义(P<0.01),SAP患者IL-6水平明显高于健康组,差异有统计学意义(P<0.01),NAA患者AMY、CRP和IL-6水平明显高于健康对照组(P<0.01),但NAA患者LPS水平和健康组差异无统计学意义(P>0.05)。SAP患者CRP和IL-6水平明显高于MAP患者,差异有统计学意义(P<0.01),但SAP患者AMY和LPS水平和MAP患者差异无统计学意义(P>0.05)。入院后SAP组CRP和IL-6水平最高值均出现于第3天,SAP患者CRP和IL-6水平均明显高于同期MAP患者,差异有统计学意义(P<0.01),SAP患者和MAP患者治疗后第7天CRP和IL-6水平均明显低于同组入院时水平,差异有统计学意义(P<0.01)。联合检测AMY、LPS、CRP和IL-6敏感性、特异性和诊断符合率均明显高于单项检测,差异有统计学意义(P<0.01)。结论 AMY、LPS、CRP和IL-6联合检测有助于AP的早期诊断、病变程度的判断、治疗效果的观察及预后判断。     

6项检测指标在急性胰腺炎诊断中的价值探讨

目的探讨血淀粉酶（S-Amy）、胰脂肪酶（LPS）、蛋白酶原激活肽（TAP）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）和尿胰蛋白酶原-2（Tgb-2）对急性胰腺炎（AP）早期诊断和病情评估的价值。方法检测100例急性胰腺炎患者（包括60例轻型胰腺炎,40例重型胰腺炎）,100例非胰腺炎急腹症患者,50例健康者的S-Amy、LPS、TAP、CRP、IL-6和Tgb-2,并对检测结果进行比较分析。结果 AP患者S-Amy、Tgb-2,TAP水平均高于非AP组,非AP组高于健康组,各组间差异均有统计学意义（P〈0.01）;AP组LPS水平明显高于非AP组和健康对照组,差异有统计学意义（P〈0.01）,而非AP组和健康对照组间的差异无统计学意义（P〉0.05）;AP组和非AP组之间CRP、IL-6水平差异无统计学意义（P〉0.05）,但均高于健康对照组（P〈0.01）。SAP组TAP、CRP及IL-6水平明显高于MAP组,差异有统计学意义（P〈0.01）,而S-Amy、LPS、Tgb-2水平2组间无差异（P〉0.05）。在AP的诊断中,Tgb-2特异性和敏感性最高,其次是LPS。结论在AP的诊断中,Tgb-2敏感性和特异性高于S-Amy和LPS,Tgb-2是鉴别AP的最好标志物,联合S-Amy和LPS检测有助于提高诊断的准确性,而TAP、CRP、IL-6则有助于病情评估和疗效观察。