血清钠浓度评估肠瘘合并腹腔感染病人预后研究

目的 评价血清钠浓度对肠瘘合并腹腔感染病人死亡情况的预测价值。方法 选择2012年1月至2013年1月南京军区南京总医院普通外科收治的162例肠瘘合并腹腔感染病人作为推导队列,根据28 d死亡情况将病人分为生存组（119例）和死亡组（43例）。监测病人入院当天及入院第3、7天的各项生化指标［血清钠浓度（［Na+］）、血清降钙素原（PCT）］。以［Na+］为例：［Na+］0、［Na+］3、［Na+］7分别为入院当天和入院后第3、7天的［Na+］;Δ［Na+］3 = ［Na+］3-［Na+］0;Δ［Na+］7= ［Na+］7-［Na+］0;Δ［Na+］7-3= ［Na+］7-［Na+］3。其余指标以此类推。使用ROC曲线分析各指标对预后的影响。同时,选择2013年1-10月的116例相关病人作为验证队列,对各指标的预测价值进行验证。结果 ROC曲线分析表明,［Na+］7>147.5 mmol/L和Δ［Na+］7>5.2 mmol/L可准确地预测病人的死亡情况。［Na+］7：敏感度81.2%,特异度87.7%,AUC=0.872（P<0.001）;Δ［Na+］7：敏感度81.3%,特异度83.6%,AUC=0.836（P<0.001）。联合多个指标预测的准确度最高：［Na+］7>147.5 mmol/L+Δ［Na+］7>5.2 mmol/L+ΔPCT7<5.3 ng/mL（AUC=0.899,P<0.001）。结论 动态监测血清钠浓度可预测肠瘘合并腹腔感染病人的28 d死亡情况,高钠血症和血钠波动幅度过大是敏感的预警指标,应该在危重症病人的临床监护中加以重视。     

血清钠浓度与结直肠癌术后吻合口漏的相关性研究

目的探讨血清钠浓度在结直肠癌手术后吻合口漏发生的预测价值。方法回顾性分析2013年1月至2015年3月北京大学深圳医院胃肠外科行结直肠癌手术的546例病人的临床资料,将病人分为吻合口漏组(16例)和对照组(530例)。检测病人术前及术后第1、3、5、7天的钠离子([Na~+])、钙离子浓度([Ca~(2+)])和白蛋白(ALB)水平。先进行两组间单因素分析,而后进行多因素非条件Logistic逐步回归分析,筛选出有统计学意义的指标,并使用ROC曲线分析其预测病人吻合口漏发生的甄别阈值。结果吻合口漏组[Na~+]_3、[Na~+]_5、[Na~+]_7、[Ca~(2+)]_7、ALB_5、ALB_7的浓度低于对照组(P0.05),差异有统计学意义。二项Logistic回归分析示,[Na~+]_3、[Na~+]_5和ALB_7入选回归方程。ROC曲线分析显示,[Na~+]_5≤135 mmol/L对结直肠癌术后发生吻合口漏有显著的诊断价值(AUC=0.901,P0.001,灵敏度为93.75%,特异度为74.34%)。结论 [Na~+]_5浓度≤135mmol/L是敏感的预警指标,应该警惕吻合口漏发生的可能性,结合临床表现必要时行CT等检查明确诊断。     

降钙素原与C反应蛋白早期预测腹腔镜结直肠癌术后吻合口漏的临床价值

目的探讨降钙素原(PCT)及C反应蛋白(CRP)早期预测腹腔镜结直肠癌术后吻合口漏的临床价值。方法前瞻性入组2019年3月至2019年10月间华中科技大学同济医学院附属协和医院胃肠外科收治的行腹腔镜结直肠癌手术的病人。分别于术前及术后第1、3、5、7天检测病人血清PCT、CRP、白细胞计数(WBC)、中性粒细胞计数(NEUT)水平,根据术后是否发生吻合口漏分为吻合口漏组与非吻合口漏组。比较两组不同时间点血清PCT、CRP、WBC、NEUT水平的差异,根据受试者工作特征曲线(ROC)评价和比较PCT、CRP、WBC对吻合口漏预测的准确性,并计算其敏感度、特异度及最佳临界值。采用DeLong测试计算两条ROC曲线下面积(AUC)之差,并进行AUC间的比较。结果共入选112例行腹腔镜结直肠癌手术病人,术后8例(7.14%)发生吻合口漏,吻合口漏组术后血清PCT、CRP水平显著高于非吻合口漏组。PCT、CRP预测术后吻合口漏的准确性均优于WBC;CRP在各时间点中术后第3天预测吻合口漏准确性最高;PCT在术后第3、5天预测吻合口漏准确性均优于术后第3天CRP预测吻合口漏准确性;术后第3、5天PCT预测吻合口漏的AUC比较,两者差异无统计学意义(P=0.664)。术后第3天PCT预测吻合口漏敏感度为87.5%,特异性为86.5%,阳性预测值为31.8%,最佳临界值为1.26μg/L;术后第5天PCT预测吻合口漏敏感度为87.5%,特异性为76.9%,阳性预测值为22.6%;术后第3天PCT预测吻合口漏的特异性与阳性预测值优于术后第5天。术后第3、5天PCT联合CRP预测吻合口漏的AUC分别为0.903、0.888,术后第3天单独PCT预测吻合口漏的AUC与术后第3天PCT联合CRP预测吻合口漏的AUC相比,两者差异无统计学意义(P=0.135)。结论动态监测术后血清PCT和CRP水平可有效预测腹腔镜结直肠癌手术后吻合口漏的发生。术后第3天血清PCT水平对早期预测吻合口漏有很高的临床价值,当术后第3天血清PCT>1.26μg/L时,应高度警惕吻合口漏发生的可能。     

雄激素对前列腺癌细胞内游离钙离子浓度的影响

目的 探讨5α-双氢睾酮(DHT)对前列腺癌LNCaP细胞内游离钙离子浓度([Ca2+]i)的影响及其机制.方法 应用Fura-2/乙酸甲酯(Fura-2/AM)Ca2+荧光探针法结合MiraCal荧光成像系统实时检测不同浓度的DHT刺激以及Ca2+通道阻滞剂干预后LNCaP细胞[Ca2+]i的变化.结果 DHT能快速诱导[Ca2+]i升高,在20 s～3 min升至峰值.DHT浓度为1、10、100和1000nmol/L时能诱导[Ca2+]i分别从基础值(28±5)、(29±5)、(28±4)和(28±9)nmol/L上升至峰值31±3(P＞0.05)、65±9(P＜0.01)、193±33(P＜0.001)和(208±42)nmol/L(P＜0.001).DHT浓度为100和1000 mol/L时,[Ca2+]i峰值间差异无统计学意义(P＞0.05).细胞外液无Ca2+时,1000 nmol/L DHT未能诱导[Ca2+]i升高.细胞膜L-型电压门控Ca2+通道阻滞剂维拉帕米(50μmol/L)、地尔硫卓(100 μmol/L)或硝苯地平(5 mmol/L)37℃孵育细胞5 min后,能完全抑制1000nmol/L DHT诱导的[Ca2+]i升高.磷脂酶C抑制剂新霉素(1 mmol/L)37 ℃孵育细胞5 min或兰尼定受体阻滞剂普鲁卡因(50 mmol/L)37℃孵育细胞3 min后,对1000 nmol/L DHT诱导的[Ca2+]i升高没有影响.结论 DHT可快速、剂量依赖性诱导LNCaP细胞[Ca2+]i升高;DHT诱导LN-CaP细胞[Ca2+]i的升高是细胞外Ca2+经细胞膜L-型电压门控Ca2+通道流入细胞内实现的,细胞内贮钙库未释放Ca2+.     

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

高脂血症相关性急性胰腺炎的治疗

目前已明确,高脂血症是胰腺炎的病因之一[1 ] ,其发生与血清胆固醇无关,而与血清高甘油三脂密切相关,有学者[2 ] 将甘油三酯>1 1 .30mmol/L或甘油三酯值为5 .6 5～1 1 .3mmol/L ,且血清呈乳状的胰腺炎病人称为“高甘油三脂血症性胰腺炎”,将甘油三酯为1 .7～5 .6 5mmol/L的称为“伴高甘油三脂血症的胰腺炎”。笔者探讨了该类病人的治疗特点,报告如下。1　资料和方法1 .1　一般资料　筛选1 998年1月至2 0 0 2年1 2月期间收治胰腺炎病例共5 0例,入院时空腹血清甘油三酯>1 .7mmol/L且排除胆道疾病的胰腺炎病例。其中治疗组2 5例,年龄2 0～6 9…     

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood [K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The [K+]in the prime solution was significantly higher [(9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate [(9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P相似文献   

公民逝世后器官捐献供肝保护及功能评估临床分析

目的总结公民逝世后器官捐献供肝保护及功能评估的初步经验。方法回顾性分析35例公民逝世后器官捐献供者和33例受者的临床资料。总结供肝获取情况和受者预后情况;根据供者器官获取前的血清钠离子水平(血清钠),将相应受者分为血清钠155 mmol/L组、血清钠155~160 mmol/L组和血清钠161~180 mmol/L组,比较3组受者术后早期移植肝功能不全的发生率。结果 35例供者中,中国标准二类27例,中国标准三类8例,实施肝移植33例,余2例肝脏有淤血性肝硬化改变,弃用。33例肝移植受者中,30例恢复顺利,术后7~14 d肝功能逐渐恢复正常,长期门诊随访移植肝功能基本正常;3例受者死亡,其中2例死于门静脉血栓形成,1例死于肺部感染合并多器官功能衰竭。血清钠155 mmol/L组、血清钠155~160 mmol/L组和血清钠161~180 mmol/L组受者术后早期移植肝功能不全的发生率依次为18%、23%和4/5,其中,血清钠161~180 mmol/L组明显高于血清钠155 mmol/L组(P0.05)。结论对公民逝世后器官捐献供肝功能进行及时、准确的评估和维护是提高供肝利用率、保证供肝功能和取得较好移植效果的关键因素。     

PCT在重症急性胰腺炎的临床应用初探

目的通过监测重症急性胰腺炎(severe acute pancreatitis,SAP)患者血清降钙素原(procalcitonin,PCT)水平的变化及术后相关并发症的发生率,探讨PCT在SAP手术时机选择及术后并发症评估中的应用。方法研究对象选自四川大学华西医院2009年9月至2011年12月期间因SAP合并不同程度胰腺坏死及感染行手术治疗的SAP患者93例。根据术前1 d血清PCT值,将93例患者分为了低水平组(PCT2 ng/m L)、中水平组(PCT2~10 ng/m L)和高水平组(PCT10 ng/m L)3组。同时记录术后患者发生的相关并发症。结果 93例患者中出现至少1种术后相关并发症的发生率为19.4%(18/93);并发症包括术后腹腔出血13例,肠瘘14例,胰瘘18例,肺部感染4例,残余脓肿10例;行再次手术15例,死亡8例(死亡率为8.6%)。除肺部感染、A级胰瘘及C级胰瘘外,中水平组及高水平组的各项并发症发生率均高于低水平组(P0.05);与入院当天比较,发病1周时发生并发症的患者PCT值明显增高(P0.05);在出现术后肠瘘和残余脓肿患者中,血清PCT水平在术后1 d较术前1 d升高(P0.05);与术后1 d比较,术后1周时发生残余脓肿及死亡的患者其PCT值明显增高(P0.05)。在死亡患者中,术后血清PCT持续处于高水平。结论术前PCT水平越高,术后发生并发症以及死亡的风险越高。通过动态监测术前血清PCT值的变化,可用于指导SAP手术时机的选择及术后肠瘘、肺部感染和死亡风险的评估,对于改善SAP患者的预后具有重要作用。     

血清炎症介质对重症急性胰腺炎患者后期感染性胰腺坏死的预估价值

目的:探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和白细胞介素-8(IL-8)对重症急性胰腺炎患者后期感染性胰腺坏死的预估价值。方法:回顾性分析96例重症急性胰腺炎患者的临床资料,分为感染组和非感染组,比较和评估两组后期发生感染性胰腺坏死的有统计学意义的检测指标的预估价值。进一步构建和绘制相关指标的ROC曲线,计算ROC曲线下面积(AUC),评价其敏感度和特异度。结果:96例经入院后7 d上腹部CT检查确诊,发生感染性胰腺坏死27例(28.1%),感染组PCT、hs-CRP及IL-8水平分别为(7.2±2.3)μg/L、(23.6±3.9)mg/L和(185.8±25.5)pg/m L,均明显高于非感染组的(2.5±0.5)μg/L、(13.1±1.9)mg/L和(80.2±7.9)pg/m L(均P0.05);PCT的AUC为0.849,诊断界值为6.1μg/L;hs-CRP的AUC为0.861,诊断界值为18.5 mg/L;IL-8的AUC为0.785,诊断界值为138.9 pg/m L;进一步以感染性胰腺坏死诊断结果为金标准,上述指标的敏感度分别为88.9%、85.2%和77.8%,特异度分别为85.5%、82.6%和78.3%。结论:早期观察重症急性胰腺炎患者血清PCT、hs-CRP和IL-8,对后期感染性胰腺坏死的诊断具有较好的预估价值。     

血糖变异性指标预测急性胰腺炎持续性器官功能衰竭的价值研究

目的 探讨血糖变异性指标与急性胰腺炎（acute pancreatitis,AP）发生持续性器官功能衰竭（persistent organ failure,POF）的关系。方法 前瞻性纳入2019年7月至2021年11月期间在四川大学华西医院中西医结合中心住院的AP伴高血糖患者,每日监测血糖≥4次,连续监测血糖至少3 d,分析血糖变异性指标对AP患者发生POF的预测价值。结果 纳入559例AP患者,其中发生POF 95例。POF患者的入院时血糖值（11.0 mmol/L vs. 9.6 mmol/L）、血糖最小值（6.8 mmol/L vs. 5.8 mmol/L）和平均血糖浓度（9.6 mmol/L vs. 8.7 mmol/L）高于未发生POF的患者,而血糖变异系数（16.6%vs. 19.0%）低于未发生POF的患者（P<0.05）。校正混杂因素后,logistic回归分析结果显示,随入院时血糖值[OR=1.11,95%CI(1.04,1.19),P=0.002]、血糖最小值[OR=1.28,95%CI(1.10,1.48),P=0.001]、平均血糖浓度[OR=1.18,...     

新型生物标志物可溶性髓样细胞触发受体-1在重症肺炎早期诊断中的应用价值

目的探究血清可溶性髓样细胞触发受体-1(sTREM-1)在重症肺炎早期诊断中的应用价值。方法2021年6月到2021年12月于吉林大学第二医院就诊的60例肺炎患者纳入研究组,其中重症40例(重症肺炎组)和轻症20例(普通肺炎组)。以及同期门诊体检者15例纳入健康对照组。研究组患者均于入院24 h内使用肺炎严重程度指数(PSI)评分进行评估;分别采用电化学发光法、散射比浊法、酶联免疫吸附实验(ELISA)检测血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和sTREM-1水平。比较重症肺炎组、普通肺炎组及健康对照组研究对象入组24 h内血清sTREM-1水平,并比较重症肺炎组和普通肺炎组研究对象入组24 h内血清PCT、hs-CRP水平及PSI评分。采用Pearson相关性分析探讨血清sTREM-1和hs-CRP水平与PSI评分的相关性;采用Spearson相关性探讨血清PCT水平与PSI评分的相关性。绘制受试者工作特征曲线(ROC)及应用MedCalc软件比较曲线下面积(AUC)比较血清sTREM-1、PCT和hs-CRP对重症肺炎早期诊断的价值。结果重症肺炎组、普通肺炎组以及健康对照组血清sTREM-1表达水平(4864.81±1314.53 pg/ml、1144.58±571.01 pg/ml、509.11±43.70 pg/ml)差异有统计学意义(F=109.292、P<0.001),其中重症肺炎组较普通肺炎组和健康对照组显著升高(t=10.981、P<0.001,t=9.264、P<0.001)。重症肺炎组患者血清PCT、hs-CRP水平以及PSI评分均高于普通肺炎组,差异有统计学意义(Z=-3.360、P=0.001,t=2.047、P=0.048,t=4.878、P<0.001)。血清sTREM-1、PCT和hs-CRP诊断重症肺炎的AUC分别为1.00、0.86和0.68(95%CI:1.00~1.00、0.73~0.98、0.51~0.86);分别以2916.92 pg/ml、0.31 ng/ml和32.14 mg/L为截断值时约登指数最大,对应的敏感性分别为100%、85%和85%,特异性分别为100%、81%和50%。sTREM-1诊断重症肺炎的AUC与hs-CRP、PCT差异均有统计学意义(Z=3.463、P<0.001,Z=2.220、P=0.026);hs-CRP与PCT差异无统计学意义(Z=1.454、P=0.146)。PSI评分与血清sTREM-1(r=0.641、P<0.001)、PCT(r=0.540、P=0.001)呈正相关,与血清hs-CRP无相关性(r=0.269、P=0.124)。结论肺炎患者血清sTREM-1升高,以重症患者升高更为显著,且其与PSI评分呈正相关;检测血清sTREM-1水平有助于早期诊断重症肺炎,且其特异性及敏感性高,均优于PCT和hs-CRP,有望成为新的早期诊断重症肺炎的生物标志物。