肝移植术前测定氧自由基相关指标在预后判别中的价值

目的 :研究肝移植患者术前体内氧自由基的相关指标及与预后的关系。方法 :测定了 18例肝移植患者术前血浆中脂质过氧化物 (LPO)、总抗氧化能力 (TAC)、一氧化氮 (NO)、总胆红素 (T BIL ) ,分析其与预后的关系。结果 :死亡组血浆 L PO(17.13± 4.16)μmol/ L ,明显高于存活组 (7.97± 3 .5 2 )μmol/ L (P<0 .0 5 ) ,存活组血浆 TAC(3 8.0 5± 19.13 ) k U / L ,高于死亡组 (3 2 .5 4± 3 .0 7) k U/ L,但无显著性差异 (P>0 .0 5 ) ;存活组血浆NO (5 0 .46± 19.5 4)μmol/ L,死亡组 (5 0 .80± 14 .80 )μmol/ L ,无显著性差异 (P>0 .0 5 ) ;死亡组血 T BIL(4 2 5 .98± 2 14 .18) μmol/ L,明显高于存活组 (172 .10± 14 4.3 2 ) μmol/ L(P<0 .0 5 )。从结果筛选出对判断预后有意义的指标为血浆 LPO和血浆 TAC,建立根据术前检验指标预测术后死亡与存活的判别函数式分别为 :Y1 =0 .3 2 90 X1 + 0 .0 998X2 ,3 .90 40 ,Y2 =1.3 5 2 0 X2 -0 .0 5 0 0 X2 -11.464 0 (其中 X1 为血浆 LPO,X2 为血浆 TAC) ;判别方程对存活组判别正确率为 10 0 .0 % ,对死亡组判别正确率为 83 .3 % ,总的判别正确率为94.4%。结论 :术前检测血浆 LPO和 TAC能较正确判断患者的死亡危险程度 ,可作为术前常规检查。判别方程判别     

慢性充血性心力衰竭患者血浆游离肉碱浓度的测定及临床意义

目的探讨测定慢性充血性心力衰竭 (CHF)患者血浆游离肉碱浓度的临床意义。方法用放射性同位素酶化学法测定 40例 CHF患者和 3 0例正常人的血浆游离肉碱浓度。结果 CHF患者血浆游离肉碱浓度 [(4 6.48± 1.3 3 ) μmol/L]明显低于正常人血浆游离肉碱水平 [(5 5 .3± 11.19) μmol/L,P<0 .0 5 ]。心功能 级组比心功能 、 级组的血浆游离肉碱浓度更低 ,前者为 (3 5 .76± 5 .61)μmol/L,后者分别为 (5 0 .2 4± 9.3 2 ) μmol/L 和 (4 9.81± 12 .2 3 ) μmol/L;左室射血分数 (L VEF)≤ 40 %组血浆游离肉碱浓度较L VEF>40 %组低 ,分别为 (3 8.96± 9.0 6) μmol/L和 (4 9.71± 10 .77) μmol/L,两组比较有显著性差异 (P<0 .0 1)。经 L-肉碱 3 g/d静脉滴注治疗 10天后 ,伴随 CHF患者心功能改善 1～ 2级后 ,血浆游离肉碱浓度显著升高至 (10 0 .2 7± 5 6.2 3 )μmol/L (P<0 .0 1)。结论放射性同位素酶化学法测定血浆游离肉碱浓度灵敏、精确、可靠且重复性好。 CHF患者血浆游离肉碱浓度随心衰程度的加重而降低 ,提示 CHF患者存在能量代谢的紊乱 ,可能与体内肉碱缺乏有关 ,补充外源性 L -肉碱后 CHF患者心功能得以明显改善 ,血浆游离肉碱浓度亦随之升高 ,CHF患者补充适量的外源性肉碱是有效的代谢治疗方法之一     

老年糖尿病患者血浆一氧化氮、内皮素水平变化及意义

目的 :探讨老年糖尿病患者血浆 ET- 1、NO水平变化及其临床意义。方法 :采用放免分析法、硝酸还原酶法分别测定 38例老年糖尿病患者和 30例正常老年人的血浆 ET- 1、NO水平。结果 :无血管并发症老年糖尿病患者的血浆ET- 1水平 (5 7.2 1± 2 9.5 4) ng/ L较正常老年人 (4 1.71± 11.33) ng/ L显著升高 ,有血管并发症 (137.70± 5 3.72 ) ng/ L 较无并发症者显著升高 (P均 <0 .0 0 1)。无血管并发症的老年糖尿病患者血浆 NO水平 (12 4.18± 5 1.15 ) μmol/ L较正常老年人 (6 9.36± 2 5 .44 ) μmol/ L 显著升高 ,有血管并发症的老年糖尿病患者血浆 NO水平 (4 7.19± 16 .93) μmol/ L较无并发症者和正常人显著降低 (P<0 .0 0 1)。结论 :ET与 NO在老年糖尿病血管并发症的发生、发展中起了重要作用     

血浆置换治疗高胆红素血症患者的护理

目的　探讨血浆置换治疗高胆红素血症的疗效。方法　采用免疫吸附系统 (KM - 890 0系统 )对 5例高胆红素血症患者进行血浆置换 ,血浆交换速度 30ml/min ,以等量的同型血浆或 4 %白蛋白稀释液为置换液 ,每次血浆交换量 2 5 0 0～ 30 0 0ml,每例血浆置换次数为 1～ 3次。结果　血浆置换前直接胆红素 (2 78.3± 74 .2 ) μmol/L ,间接胆红素为 (6 37.4± 1 2 2 ) μmol/L ,总胆红素 (91 5 .8±1 82 .8) μmol/L ,血浆置换后直接胆红素 (2 2 8.4± 78.3) μmol/L ,间接胆红素 (4 2 8.4± 1 75 .8) μmol/L ,总胆红素 (6 5 6 .8± 1 78.2 ) μmol/L ,治疗后明显低于治疗前(P <0 .0 5 )。结论　血浆置换可有效治疗高胆红素血症。     

重型颅脑损伤患者血浆S-100B蛋白测定的临床意义

目的　探讨血浆 S 10 0 B蛋白作为一种生物学指标在重型颅脑损伤诊断及预后判断中的应用价值。方法　重型颅脑损伤患者 6 6例 ,伤后早期 (2～ 6 h)抽取血浆标本 ,并从伤后 2 4 h起连续 3～ 7d检测血浆 S 10 0 B蛋白含量 ,将其结果与患者伤后 6个月格拉斯哥预后评分 (GOS)进行比较。结果　 6 6例患者中死亡 2 5例 ,致残 2 2例 ,良好 19例。死亡组 S 10 0 B平均 2 .6 0 μg/ L,明显高于存活组 (0 .5 5 μg/ L,P<0 .0 0 1) ;死亡组中有 14例 S 10 0 B峰值超过 2 .0 0 μg/ L,而存活组中只有 4例峰值超过 2 .0 0 μg/ L(P<0 .0 0 5 )。结论　血浆 S 10 0 B蛋白在重型颅脑损伤的诊断及预后判断中具有可靠的应用价值。     

谷氨酸脱氢酶监测在肝移植中的应用

目的　探讨谷氨酸脱氢酶(GLD)在肝移植术中及术后早期对供肝冷、热缺血及再灌注损伤程度的判断价值以及对肝移植预后的评估作用。方法　对 18例原位肝移植患者及 18例腹腔其他器官移植患者从下腔静脉阻断至术毕每 0. 5h一次,术后每日晨一次连续 30d测定患者血清GLD、ALT、AST、LDH、γGT、ALP的活性。结果　在新肝移植后 (下腔静脉开放 ) 20min~3h内,GLD、AST、ALT、LDH都出现一明显上升又回落过程,其相互间的相关性良好,而与γGT、ALP不相关。其中以GLD上升幅度最大,且峰值出现较早,GLD的上升幅度变化率与ALT、AST、LDH变化率有显著性差别(P<0. 001)。GLD的平均变化率是LDH的 6. 7倍。肝移植术后预后良好组GLD的升高平均值为 169. 6U/L,预后不良组为 1 719. 6U/L。术后GLD>800U/L的 4例肝移植患者,平均生存期为 19. 5d。结论　血清GLD可作为肝移植早期判断供肝损伤程度的有效指标,其敏感性、特异性显著高于ALT、AST、LDH。肝移植术后患者血清GLD水平剧增示预后不良。     

血清肌钙蛋白T及血浆同型半胱氨酸在急性冠脉综合征中的作用

目的　探讨急性冠脉综合征时高同型半胱氨酸血症和心脏肌钙蛋白T的关系 ,评价高同型半胱氨酸血症是否能导致心肌损伤程度加重。方法　AMI 5 3例 ,UAP 5 5例 ,采用荧光标记免疫检测法测定血浆同型半胱氨酸 (Hcy) ,酶联免疫法 (ELISA)测定肌钙蛋白T(cTnT)。结果　AMI组Hcy明显升高时cTnT也明显升高 ,Hcy大于 16 0 μmol/L时cTnT明显高于Hcy小于 7 7μmol/L(P <0 0 1) ,Hcy分别为 7 7、9 0、11 3、14 3、16 0 μmol/L时cTnT分别为 4 6 3、4 6、4 8、6 2、7 8μg/L ;UAP组同样 ,Hcy分别为 9 8、11 0、12 1、12 8、15 4 μmol/L时cTnT分别为 0 0 3、0 0 3、0 0 2、0 0 4、0 15 μg/L ,最高浓度组与最低浓度组方差分析显示P <0 0 1。UAP组cTnT阳性者血浆Hcy浓度比阴性者显著升高 (P <0 0 0 1)。结论　血浆同型半胱氨酸浓度升高与ACS时心肌损伤有关。     

游离PSA／PSA和PSA动态变化在前列腺癌诊断中的应用

目的　评价游离前列腺抗原 (FPSA) /前列腺抗原 (PSA)比值和PSA动态变化 (年变化率 )在前列腺癌诊断中的应用价值。方法　应用ELISA追踪检测PSA在 4～ 10 μg/L范围患者在不同时段内PSA水平 ,并与正常人进行对照 ,利用ROC曲线 ,评价了FPSA/PSA比值和PSA年变化率 2项指标在前列腺癌诊断时的预示价值。结果　前列腺癌患者的FPSA/PSA比值和PSA年变化率与非前列腺癌组之间差异具有显著性 (P <0 .0 0 1) ,当FPSA/PSA比值的临床判断限为 0 .2 1时 ,诊断灵敏度为 93.5 % ,特异性为 91.4 % ;当PSA年变化率的临床判断限为 0 .85 μg·L-1·年 -1时 ,诊断灵敏度为 82 .6 % ,诊断特异性为 97.9%。前列腺增生患者的FPSA/PSA比值与正常人之间差异无显著性 (P >0 .0 5 ) ,而PSA年变化率与正常人比较差异具有显著性 (P <0 .0 0 1)。结论　FPSA/PSA比值和PSA年变化率有助于PSA在 4～ 10 μg/L范围的患者前列腺癌的诊断。     

脑梗死患者血浆胆红素和氧化低密度脂蛋白水平变化及意义

目的　探讨脑梗死患者血浆胆红素浓度和氧化低密度脂蛋白 (ox-LDL)含量的变化以及它们在脑梗死中的作用。方法　用钒酸盐氧化法和酶联免疫吸附法 (ELISA)分别测定 75例急性期脑梗死患者血浆胆红素浓度和ox -LDL水平 ,并与 30例其他疾病对照组及 4 6例正常对照组进行比较。结果　 (1)脑梗死患者血浆胆红素浓度为 (11 8± 4 3) μmol L ,咀显低于其他疾病对照组 (14 9± 4 7) μmol L及正常对照组 (15 5± 5 5 ) μmol L ,差异有显著性 (P <0 0 1) ;脑梗死患者血浆ox -LDL水平为 (6 2 5 3± 2 5 7 2 )μg L ,明显高于其他疾病对照组 (4 71 9± 195 0 ) μg L及正常对照组 (4 32 7± 184 4 ) μg L ,差异有显著性(P <0 0 1)。 (2 )大梗死灶组血浆胆红素浓度 (9 5± 3 1)mol L明显低于中梗死灶组 (10 3± 4 4 ) μmol L和小梗死灶组 (12 7± 5 0 ) μmol/L ,P <0 0 1。而大梗死灶组血浆ox -LDL水平 (6 80 4± 2 4 7 1) μg L明显高于中梗死灶组 (5 81 5± 2 6 3 5 ) μg L和小梗死灶组 (5 0 4 2± 2 2 5 7) μg L ,P <0 0 1。 (3)胆红素降低程度和ox -LDL增高程度与神经功能缺损程度密切相关。 (4 )经相关分析 :脑梗死时总胆红素与血浆ox -LDL水平呈负相关 (r=- 0 5 93,P <0 0 1) ,总     

亚甲基四氢叶酸还原酶基因多态性与深静脉血栓形成

目的　研究血浆同型半胱氨酸 (Hcy)水平及亚甲基四氢叶酸还原酶 (MTHFR)基因多态性与深静脉血栓形成 (DVT)的关系。方法　采用聚合酶链反应 限制性片段长度多态性法检测 10 1名健康对照者和 6 9名DVT患者的MTHFRC6 6 7T基因型 ,采用荧光偏振免疫法 (FPIA)测定血浆Hcy水平。结果　DVT组MTHFRC6 77T的TT基因型频率 (2 0 3% )高于对照组 (11 9% ) ,但两者差异无显著意义 (P >0 0 5 ) ,TT基因型不增加DVT患病的危险性 [比数比 (OR) =0 5 3,95 %可信限 (CI) 0 2 2 8～1 2 2 8]。DVT组的血浆Hcy水平为 (12 2± 8 7) μmol/L明显高于对照组的 (10 4± 4 8) μmol/L(P <0 0 5 ) ,轻度升高的同型半胱氨酸水平增加了DVT患病的危险性 (OR =2 5 3,95 %CI 1 0 4 9～ 6 0 5 )。两组人群MTHFRC6 77T的TT型血浆Hcy水平分别为 (19 7± 15 3) μmol/L和 (17 2± 7 8) μmol/L均明显高于同组CC型和CT型的血浆Hcy水平 (P <0 0 5 )。结论　轻度升高的同型半胱氨酸水平是我国北方地区汉族人DVT发病的独立危险因子 ,MTHFR基因C6 6 7T多态性可能与DVT无关联     

不同营养支持对危重病患者炎症介质及死亡率的影响

摘 要 目的 探讨不同营养支持方式对危重病患者炎症介质及死亡率的影响。方法 60例危重病患者分为试验组及对照组，每组各30例。30名健康体检者为正常组。试验组接受肠内营养(enteral nutrition, EN)+肠外营养（parenteral nutrition，PN）支持。对照组接受全肠外营养支持(total parenteral nutrition, TPN)，2组等氮等热量供给。营养支持前1天及营养支持后第10天检测血浆TNF-α及IL-10水平。并随访28天，观察两组死亡率。结果 试验组死亡率为26.7％，对照组死亡率为36.7％，两者相比无明显差异（P>0.05）。危重病患者血浆TNF-α及IL-10水平明显高于正常组(P< 0.05)；对照组及试验组治疗前的血浆TNF-α及IL-10水平比较，无明显差异（P>0.05）。营养支持后第10天，对照组及试验组的TNF-α及IL-10水平明显低于治疗前水平(P< 0.05)；试验组的TNF-α及IL-10水平明显低于对照组(P< 0.05)。结论 危重病患者存在炎症反应紊乱。PN+EN较TPN更能降低危重病人的炎症介质，减轻炎症反应，但不能降低死亡率。     

Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: a randomized, controlled trial

OBJECTIVE: To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate for stress ulcer prophylaxis. DESIGN: Randomized, controlled study. SETTING: Cardiothoracic intensive care unit. PATIENTS: Twenty postoperative cardiac surgical patients INTERVENTIONS: Twenty patients requiring CVVH support for acute renal failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline and on days 1, 4, 8, and 14. MEASUREMENTS AND MAIN RESULTS: In both the sucralfate and ranitidine groups, clinical characteristics, number of days the patients were on CVVH support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] micromol/L, vs. median, 0.32 [range, 0.11-1.0] micromol/L; p =.79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] micromol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] micromol/L) with seven of the ten patients exhibiting levels of >2 micromol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis of the two groups at the four time points revealed that aluminum levels in the sucralfate group were up to 14 times higher, with the confidence intervals suggesting that the true value may be 2-27 times higher (p <.0001). On cessation of CVVH, a rapid decline in aluminum levels was observed. No clinical manifestations of these potentially toxic levels were observed. CONCLUSIONS: The use of sucralfate for stress ulcer prophylaxis in patients requiring CVVH results in toxic elevations in plasma aluminum levels. Alternative agents should be considered for prophylaxis in these patients.     

Erythrocyte zinc content in critically ill patients.

Abnormalities in thyroid hormone metabolism are common in critically ill patients. However, it is not known if these patients are truly hypothyroid at tissue level. Erythrocyte zinc has been shown to be a tissue marker of thyroid hormone status. In this study we have measured the erythrocyte zinc in critically ill patients. In this observational study we measured the zinc content of young erythrocytes in blood samples from 33 healthy subjects, 26 hypothyroid patients, four hyperthyroid patients, and 44 patients in the intensive care unit--22 of these were admitted after a major surgical procedure (surgical group) and the other 22 patients had a variety of conditions (non-surgical group). Erythrocytes were separated according to age by centrifugation. Plasma thyroid hormone concentrations were abnormal in 70% of the critically ill group. Erythrocyte zinc was significantly lower in hyperthyroid patients and higher in hypothyroid patients. In the non-surgical patients, erythrocyte zinc of young cells (median 256 micromol/L of cells) was significantly higher than (p<0.01) the corresponding cells in the healthy controls (202 micromol/L of cells), whereas in the surgical group it was not different (197 micromol/L of cells). We conclude that in non-surgical critically ill patients, erythrocyte zinc content is higher, suggesting that these patients may be hypothyroid at tissue level.     

血浆N末端B型钠尿肽前体对重症患者预后的预测价值研究

目的 探讨入重症监护病房(ICU)时血浆N末端B型钠尿肽前体(NT-pro-BNP)水平是否是预测重症患者预后的独立因子.方法 采用前瞻性、单中心、观察性研究方法.选择6个月内入本院ICU＞18岁的120例患者,最终有88例患者符合试验要求.血浆NT-pro-BNP样本在进入ICU时收集;计算进入ICU后24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)的最差值;入ICU后28 d患者生存状态为预测终点.结果 入ICU 28 d死亡35例,病死率为39.8%.88例患者血浆NT-pro-BNP水平(ng/L)为1221.7(78.7～5 500.0),生存组明显低于死亡组[781.8(78.7～5 066.6)比2 774.5(166.8～5 500.0),P＜0.01].男性NT-pro-BNP水平(ng/L)高于女性[1 585.5(103.7～5 100.0)比794.5(78.7～5 500.0),P＜0.05];性别与NT-pro-BNP水平有相关性(r=-0.224,P＜0.05).进入ICU时重度感染患者NT-pro-BNP水平(ng/L)较其他患者更高[3 416.1(103.7～5 100.0)比883.4(78.7～5 500.0),P＜0.01];入ICU时是否存在重度感染与NT-pro-BNP水平有相关性(r=0.285,P＜0.01).NT-pro-BNP和APACHE Ⅱ评分的受试者工作特征曲线(ROC曲线)下面积分别为0.734[95%可信区间(95%CI)0.628～0.840]和0.747(95%CI0.637～0.858).Logistic回归分析显示:入ICU时NT-pro-BNP水平＞1 418 ng/L和APACHE Ⅱ评分均可作为28 d生存状态预测的独立因子[相对比值比(OR)5.235,95%CI 1.819～15.071;OR 1.105,95%CI1.819～15.071].以入ICU时NT-pro-BNP最佳临界值1 418 ng/L为分界点进行生存分析,高于此值者生存率比低于此值者低(x2=16.9,P＜0.01).结论 入ICU时血浆NT-pro-BNP＞1 418 ng/L和APACHE Ⅱ评分可作为重症患者短期生存状态的预测因子;NT-pro-BNP值可能用来诊断或者鉴别重度感染患者.

Abstract：

Objective To investigate whether plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP)as measured at admission to intensive care unit(ICU)is an independent predictor of mortality in critically ill patients. Methods A prospective observational study of patients in ICU was conducted. One hundred and twenty patients aged＞18 years were included during a 6-month period. Among them 88 patients were enrolled for the study. Plasma NT-pro-BNP samples were obtained at admission to ICU. The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score was calculated within 24hours after admission based on the worst values up to that point. The final evaluation was 28-day mortality.Results Thirty-five patients died within 28 days of ICU admission, the mortality was 39. 8%. In 88 patients, the mean plasma NT-pro-BNP levels(ng/L)were 1 221.7(78.7- 5 500.0), and that in survivor group was significantly lower than non-survivor group[781.8(78. 7 - 5 066. 6)vs. 2 774. 5(166.8 - 5 500.0), P＜0.01]. The mean NT-pro-BNP level(ng/L)in male patients was higher than that in females[1 585. 5(103.7 - 5 100. 0)vs. 794. 5(78. 7 - 5 500. 0), P＜0. 05]. There was correlation between gender and NT-pro-BNP levels(r=-0. 224, P＜0. 05). Patients admitted to the ICU because of a severe infection had higher levels of NT-pro-BNP(ng/L)compared with the rest of the cohorts[3 416.1(103. 7 -5 100.0)vs. 883. 4(78. 7 - 5 500. 0), P＜0.01]. There was correlation between severe infection at admission to ICU and NT-pro-BNP levels(r=0. 285, P＜0. 01). Areas under the receiver operating characteristic curves(ROC curves)of NT-pro-BNP and APACHE I score were 0. 734[95% confidence interval(95%CI)0. 628 - 0. 840]and 0. 747(95%CI 0. 637 - 0. 858), respectively. Logistic regression analysis showed that the NT-pro-BNP level ＞ 1 418 ng/L and the APACHE I score were independently associated with 28-day mortality[odds ratio(OR)5.235, 95%CI 1.819- 15.071; OR 1.105, 95%CI 1.819- 15.071]. WithI 418 ng/L of NT-pro-BNP as the cutoff value, survival rate was significantly lower in the patients with higher NT-pro-BNP level as compared with those with lower values at admission(x2= 16.9, P＜0. 01).Conclusion The ICU NT-pro-BNP level higher than 1 418 ng/L and APACHE Ⅱ score at admission are independent prognosis markers of early mortality. NT-pro-BNP might serve as a potent early diagnostic and prognostic marker in critically ill patients.     

Prognostic value of homocysteinemia in patients with congestive heart failure.

BACKGROUND: Elevated plasma homocysteine levels are associated with increased risk of vascular disease and of congestive heart failure (CHF), with a relationship between homocysteine values and disease severity. Hyperhomocysteinemia is a risk factor for cardiac dysfunction. In this study, the predictive value of elevated homocysteine levels was investigated in the prognosis of ischemic and non-ischemic CHF. METHODS: A total of 159 patients with CHF, 89 with non-ischemic and 70 with ischemic CHF (83% males, mean age 62 years, mean ejection fraction 27%), and 119 controls (79% males, mean age 59.8 years) had fasting blood samples taken to measure plasma homocysteine, vitamin B(12) and folate levels. Coronary angiography was performed for all patients. The mean duration of follow-up was 49.6+/-36.7 months. RESULTS: As in other studies, the mean level of homocysteinemia was significantly higher in the CHF group (15.80 micromol/L) than in the control group (10.90 micromol/L) (p=0.001) whatever the etiology (non-ischemic, 16.11+/-6.84 micromol/L; ischemic, 15.41+/-6.45 micromol/L). This result was observed without vitamin deficiency, but in patients, the mean creatinine value was moderately higher than in controls. We found a positive correlation between plasma homocysteine levels and New York Heart Association (NYHA) classification, creatinine and age. Moreover, hyperhomocysteinemia appears to be a powerful predictive factor of mortality in CHF patients (relative risk of death, 4.23; p=0.0003). In the follow-up of this study, 41.5% of patients with homocysteinemia >17 micromol/L died vs. 21.3% of patients with levels <17 micromol/L. In multivariate analysis, when homocysteine levels were adjusted for a second parameter (age, NYHA, creatinine, diabetes), the risk of death remained significant after each adjustment. CONCLUSIONS: Elevated homocysteine levels observed in CHF patients, whatever the etiology of their heart disease (ischemic or non-ischemic), were correlated with the severity of the disease. Hyperhomocysteinemia appears to be a predictive factor of mortality in CHF patients.     

Protein turnover, lipolysis, and endogenous hormonal secretion in critically ill children

OBJECTIVES: The catabolic state is a major contributor to morbidity and mortality of critical illness and may be related to endocrine changes. We studied whether protein and lipid turnover correlate with insulin and growth and thyroid hormone plasma levels in critically ill infants. DESIGN: Prospective clinical study. SETTING: Pediatric intensive care unit. PATIENTS: Twelve critically ill children and ten age-matched controls. MEASUREMENTS: We measured lipolysis and protein turnover by infusing albumin-bound uniformly 13C palmitic acid and 2H3-leucine for 3 hrs and 2H5-glycerol for 5 hrs to critically ill infants. Simultaneously, we measured serum growth hormones, insulin, C-peptide, thyroid-stimulating hormone, T4, T3, albumin, retinol binding protein (RBP), and prealbumin. Hormone and serum protein levels were also measured in six children when recovered from critical illness. Ten healthy age-matched children served as controls for hormone serum levels comparison. RESULTS: Palmitic acid and glycerol turnover were 5.6 +/- 2.2 micromol/kg/min and 12.2 +/- 7.3 micromol/kg/min, respectively, whereas alpha-ketoisocaproic turnover was 4.9 +/- 2.8 micromol/kg/min. Alpha-ketoisocaproic turnover positively correlated (R = 0.7, p = .03) with duration of pediatric intensive care unit admission and with prealbumin and RBP serum levels (R = 0.9, p = .001). Insulin-like growth factor binding protein (IGFBP)-2 was significantly higher and IGFBP-3 was significantly lower in critically ill children (p = .03 and p = .04 vs. recovery phase, respectively). No other hormonal differences were found. Serum albumin was significantly lower in sick children. We found a significant correlation between prealbumin and RBP and IGFBP-3 (R = 0.6, p = 0.03 and R = 0.6, p = .04, respectively). Alpha-ketoisocaproic turnover positively correlated with IGFBP-1 (R = 0.79, p = .01) and did not correlate with insulin-like growth factor I (R = -0.5, p = .15 [not significant]) No other correlations were found. Lipid turnover measurements did not correlate with any endogenous hormone levels or with duration of critical illness. CONCLUSION: Protein turnover but not lipolysis correlated with a persisting critically ill condition, serum prealbumin, RBP, and plasma IGFBP-1.     

Elevated levels of plasma homocysteine in postmenopausal women in Burkina Faso.

BACKGROUND: Low levels of plasma homocysteine have been found in children and adult populations living in Burkina Faso in association with a low prevalence of coronary heart disease. METHODS: Based on this finding, the levels of plasma homocysteine and other thiols (cysteine, cysteinylglycine, glutathione) in postmenopausal women living in Burkina Faso were evaluated with the aim of investigating whether age and life conditions influence plasma homocysteine and other thiol levels. RESULTS: It was found that in older postmenopausal women the mean level of homocysteine was higher (16.4+/-6.6 micromol/L) than in fertile women (6.8+/-1.2 micromol/L) and that this increase was correlated with cysteine levels (166.6+/-44.6 micromol/L). While the glutathione level in postmenopausal women was lower (3.6+/-2.3 micromol/L) compared with fertile women (7.0+/-1.7 micromol/L), cysteinylglycine levels were within the normal range (29.9+/-9.3 micromol/L). No correlation was found between homocysteine levels and serum folate, vitamin B(12), vitamin B(6), cystatin C and serum creatinine levels. The older the women were, the higher were their plasma homocysteine levels: levels up to 20.2+/-9.1 micromol/L were found in those >70 years old. CONCLUSIONS: The elevated levels of homocysteine in the postmenopausal women of Burkina Faso must be viewed as a characteristic of older age and its metabolic consequences.     

Pharmacokinetics and dosing regimen of meropenem in critically ill patients receiving continuous venovenous hemofiltration

OBJECTIVE: To study the pharmacokinetics of meropenem in critically ill patients with acute renal failure receiving continuous venovenous hemofiltration (CWHF). DESIGN: Prospective, open-labeled study. SETTING: Medical intensive care unit of the University Medical Center Utrecht. PATIENTS: Five critically ill patients receiving CWHF for acute renal failure treated with meropenem for documented or suspected bacterial infection. INTERVENTION: All patients received meropenem (500 mg) administered intravenously every 12 hrs. Plasma samples and ultrafiltrate aliquots were collected during one dosing interval. MEASUREMENTS AND RESULTS: Mean age and body weight of the patients studied were 46.6 yrs (range, 28-61 yrs) and 85.8 kg (range, 70-100 kg), respectively. The following pharmacokinetic variables for meropenem were obtained: mean peak plasma concentration was 24.5 +/- 7.2 mg/L, mean trough plasma concentration was 3.0 +/- 0.9 mg/L, mean terminal elimination half-life was 6.37 +/- 1.96 hrs, mean total plasma clearance was 4.57 +/- 0.89 L/hr, mean CWHF clearance was 1.03 +/- 0.42 L/hr, mean nonrenal clearance was 3.54 +/- 1.06 L/hr, and mean volume of distribution was 0.37 +/- 0.15 L/kg. CONCLUSION: In critically ill patients with acute renal failure, nonrenal clearance became the main elimination route. CWHF substantially contributed to the clearance of meropenem (23% of mean total plasma clearance). We recommend meropenem to be dosed at 500 mg intravenously every 12 hrs in patients receiving CWHF, according to our operational characteristics. This dosing regimen resulted in adequate trough plasma levels for susceptible microorganisms.