两种血小板抗体检测技术的方法学比较

目的 采用简易致敏红细胞血小板血清学试验(SEPSA)和微柱凝胶免疫分析技术(MGIA)检测血小板抗体,并对两种方法的结果进行比较.方法 选择100例血小板减少症患者及20例健康体检者(正常对照组),采用SEPSA法和MGIA法分别检测血小板抗体.结果 采用SEPSA法在100例血液病患者中共检出血小板抗体阳性8例,阳性率为8.0％;MGIA共检出血小板抗体阳性9例,阳性率为9.0％.两种方法结果的差异无统计学意义(x2=0.02,P＞0.05).两种方法检测结果均显示,血小板抗体阳性率与血小板输注次数有关(SEPSA:x2=23.66,P＜0.01;x2=20.02,P＜0.01).结论 SEPSA法血小板抗体检出率与MGIA法基本一致,但MGIA法具有简便、快速、易于标准化等特点,更适合于批量标本的临床初筛试验.     

原发性血小板减少性紫癜两种血小板相关抗体检测方法的比较

目的运用流式细胞术(FCM)和酶联免疫竞争抑制法(ELISA)检测血小板相关抗体(PAIgG、PAIgA、PAIg M),研究其在原发性血小板减少性紫癜(ITP)诊断中的应用价值。方法应用FCM和ELISA检测19例ITP患者血小板膜表面(直接法)及血浆中(间接法)的血小板相关抗体及17例健康自愿者血小板膜表面的相关抗体,比较各指标与正常对照组之间的表达差异,并对结果进行诊断价值的评价。结果FCM和ELISA检测ITP患者血小板相关抗体的结果均明显高于正常对照组(P<0.01),其中ITP组PAIgG较对照组明显升高;FCM测得的阳性率(84%)比ELISA法(79%)稍高,两种方法差异无统计学意义(P>0.05);直接法和间接法差异也无统计学意义(P>0.05)。结论血小板相关抗体(尤其是PAIgG)有助于诊断ITP;其中FCM是血小板相关抗体检测的一项快速、灵敏、简便的方法,而ELISA是最常用的定量试验方法,可动态观察病情变化;两种方法同时应用具有较大的临床推广价值。     

血小板抗体检测与患者血小板输注效果的分析

目的分析血小板抗体检测与患者血小板输注效果的关系。方法用固相红细胞吸附试验(sPRA)对348名反复多次输注血小板的患者,进行了血小板抗-HLA和抗-HPA的检测,分析抗体产生规律,并观察抗体阳性患者的血小板输注效果。结果 348名反复输血小板患者检测出血小板抗体阳性率63.79%,其中抗-HLA阳性107例,阳性率30.75%;抗-HPA 24例,阳性率6.89%;其中抗-HLA合并抗-HPA 91例,阳性率26.15%。抗体阳性率与血小板输注次数成正比(P<0.05),且与输注效果间的差异有统计学意义(P<0.05)。结论血小板输注次数越多,血小板抗体的产生几率越大;血小板抗体的产生直接影响血小板输注效果。     

原发免疫性血小板减少症患者ANA及ANAs筛查结果分析

目的 探讨间接免疫荧光法检测的抗核抗体(ANA)及免疫印迹法检测的抗核抗体谱(ANAs)在原发免疫性血小板减少症(ITP)患者中的特点。方法 对123例初诊ITP的患者采用间接免疫荧光法检测ANA,免疫印迹法检测ANAs,并对结果进行回顾性分析。结果 123例ITP患者中ANAs阳性率高于ANA,差异有统计学意义(P<0.05);ANAs 15种抗体中抗干燥综合征抗原A抗体(SSA)的阳性率最高,其次为Ro52,差异有统计学意义(P<0.05),抗Scl-70、PM-Sc及Jo-1均为阴性,其余10种抗体阳性率不一,但是相互之间对比差异无统计学意义(P>0.05);抗体联合表达阳性率高于单项表达,差异有统计学意义(P<0.01)。结论在ITP患者ANA及ANAs阳性率不同,ANAs表达主要以单项及联合抗体表达为主,但是联合表达高于单项表达。     

母婴血小板血型不合致新生儿血小板减少症的试验诊断

目的探讨新生儿同种免疫性血小板减少症(NAIT,Neonatal Allo-immune Thrombocytopenic)的试验诊断方法。方法采用常规凝集试验进行红细胞血型系统相关检测,采用MASPAT试剂盒单克隆抗体固相血小板抗体实验进行血小板特异性抗体鉴定,采用酶联免疫(ELISA)方法进行HLA-Ⅰ类抗体检测,同时用PCR-SSP方法进行被检者HPA基因分型。结果虽然母亲为RhD(-)且既往有多次妊娠史,但无Rh系新生儿溶血病血清学表现,母亲HPA基因型为HPA15a/15a,父亲和患儿基因型均为HPA15a/15b。相关试验证实既有HLA-Ⅰ类抗体,也有血小板特异性体抗HPA-15b。结论按照本系列试验方案进行检测,能够对引致NAIT的血小板抗体进行筛查分类,并为NAIT的科学准确诊断及治疗提供依据。     

抗血小板生成素抗体与系统性红斑狼疮伴血小板减少的相关性探讨

目的分析抗血小板生成素(thrompoietin,TPO)抗体在系统性红斑狼疮(systemic lupus erytematosus,SLE)血小板减少中的作用,初步探讨该抗体的致病机制及临床价值。方法应用间接ELISA法检测24例SLE伴有血小板减少、27例SLE曾有血小板减少已恢复正常、18例SLE无血小板减少患者及18例正常对照者血清中抗TPO抗体及TPO水平,并分析其与临床表现及SLEDAI评分之间的关系。结果血清抗TPO抗体在SLE总的阳性率为29.1%,抗TPO抗体在SLE血小板减少组、SLE曾有血小板减少现已恢复正常组、SLE血小板从未减少组中的阳性率无统计学差异(P=0.843);抗TPO抗体阳性组血清TPO水平低于抗TPO抗体阴性组(P=0.038),两组血小板计数,C3、C4、ESR、CRP水平,ANA、dsDNA、ANCA阳性率和SLE-DAI评分无统计学差异(P>0.05)。结论抗TPO抗体可能与SLE血小板减少相关。     

流式细胞仪法用于血小板相关抗体检测和血小板交叉试验

目的 应用流式细胞仪(FCM)进行血小板相关抗体检测和血小板交叉试验。方法 利用血小板抗体阳性、阴性血清探寻FCM法实验条件,血小板经血清致敏,洗涤后,加入荧光标记鼠抗人IgG反应,由FCM获取和分析。52人次正常人血清经FCM法检测后,统计界定正常值范围。1份阳性血清经9个稀释度倍比稀释,分别用FCM法和固相ELISA抗体筛选法检测。31名临床血小板输注无效患者分别用FCM法和抗原捕获酶免分析法(MACE)进行102人次血小板交叉配合试验。结果 FCM法检测正常值为荧光强度比值R<1.156,9个稀释度的阳性血清检测表明,FCM法最高可检稀释度为86.67,固相ELISA法最高可检稀释度为56.34(抗-HPA)和67.25(抗-HLA)。102人次血小板交叉结果显示,FCM法和MACE法无显著性差异(P>0.05)。结论 FCM法可用于血小板相关抗体检测和血小板交叉配血,是一种快速、灵敏的新方法。     

应用流式细胞术检测血小板抗体的临床研究

目的观察血小板自身抗体(PAIgG)在特发性血小板减少性紫癜(ITP)疾病中的变化,探讨其在ITP诊断和治疗的意义。方法应用流式细胞术(FCM)以及酶联免疫吸附试验(ELISA)同时检测52例原发性血小板减少性紫癜(ITP)患者,20例健康志愿者并对结果进行比较。结果在ITP患者中,FCM检测阳性率为87.5%,ELISA检测阳性率为74%。同时检测12例ITP患者在通过3个月的激素治疗,FCM检测其平均荧光强度由65.23±18.12降低至31.25±12.23,血小板计数均升高。结论FCM检测血小板自身抗体较ELISA方法更具有灵敏度高、简单、快捷的优点。应用FCM对ITP进行疗效评估,对提高ITP诊断水平及指导临床治疗有一定的意义。     

自身免疫性血小板减少性紫癜相关抗体的研究

目的　探索对自身免疫性血小板减少性紫癜 (AITP)诊断特异和敏感的实验方法。方法　采用单克隆抗体特异性俘获血小板抗原技术 (MAIPA技术 )并加以改进 ,对比检测血小板洗脱液和血浆中血小板膜糖蛋白特异性抗体。结果　AITP患者血浆游离抗血小板膜糖蛋白 (GPⅡb Ⅲa、GPⅠb Ⅸ )抗体总阳性率为 38.89%(5 4例中 2 1例 ) ,洗脱血小板表面抗血小板膜糖蛋白 (GPⅡb Ⅲa、GPⅠb Ⅸ )抗体总阳性率为 6 8.5 2 %(5 4例中 37例 ) ,两者差异有显著性 (校正 χ2 =19.39,P <0 .0 0 5 )。原发AITP组血浆游离及洗脱血小板表面抗血小板糖蛋白 (GPⅡb Ⅲa、GPⅠb Ⅸ )特异性抗体总阳性率与继发性AITP组比较差异无显著性。AITP患者血小板数量与自身抗体滴度呈明显负相关。结论　MAIPA法检测血小板洗脱液中抗血小板糖蛋白抗体在AITP的诊断和治疗中具有高度特异性 ,且敏感性较血浆抗体检测显著提高。     

血小板抗体与不良妊娠及妊娠次数的关联性分析

目的分析266例孕妇外周血血小板抗体检测结果,探讨血小板抗体与不良妊娠及妊娠次数的关系。方法选取陕西省人民医院266例孕妇,进行血小板抗体检测,根据有无不良妊娠分为2组,比较其血小板抗体阳性率;同时,根据妊娠次数分为A组(1次)、B组(2次)、C组(≥3次),比较其血小板抗体阳性率。结果有不良妊娠组与无不良妊娠组血小板抗体阳性率(31.81%vs 14.86%)比较差异有统计学意义(P<0.05),妊娠次数不同的3组间血小板抗体阳性率(A组:9.09%;B组:21.62%;C组:23.65%)比较差异有统计学意义(P<0.05),组间的趋势χ2检验统计学分析显示,妊娠次数和血小板抗体有线性趋势(P<0.05)。结论血小板抗体与不良妊娠有关,有不良妊娠组血小板抗体阳性率高于无不良妊娠组;血小板抗体与妊娠次数有线性趋势,妊娠次数越多,抗体阳性率越高。将血小板抗体检测作为妊娠期常规检测项目,有利于临床对不良妊娠孕妇的早发现,以及对胎儿/新生儿同族免疫性血小板减少性紫癜等疾病的早预防、早发现、早干预。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.