降钙素原和血乳酸对脓毒症合并弥散性血管内凝血的诊断价值

目的:初步分析降钙素原(PCT)和血乳酸(Lac)水平测定对脓毒症患者发生弥散性血管内凝血(DIC)的诊断价值。方法:选取2012-08-01至2015-12-30本院重症监护室(ICU)收治脓毒症患者70例,根据是否合并DIC分为DIC组(n=34)和非DIC组(n=36)。两组患者入ICU 24h内检测PCT和Lac浓度,同时测定血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)水平,并进行急性生理与慢性健康评分(APACHEⅡ),比较上述指标组间差异;建立ROC曲线,计算PCT、Lac曲线下面积(AUC)及其诊断DIC的敏感度和特异度。结果:DIC组PCT和Lac水平明显高于非DIC组(P均0.01);其它检测指标和APACHEⅡ评分组间差异亦有统计学意义(P0.01);PCT和Lac的AUC分别为0.871和0.790;PCT和Lac的敏感度分别为91.20%和79.40%。结论:PCT与Lac可作为脓毒症合并DIC早期诊断的敏感指标。     

脓毒症患者血清超敏肌钙蛋白水平与其预后的关系

目的:探讨血清超敏肌钙蛋白(hs-TnI)水平与脓毒症患者预后的关系。方法:脓毒症患者112例,入院1h内检测hs-TnI水平,并将其分为hs-TnI正常组和hs-TnI升高组;入院24h内进行APACHEⅡ评分。分析hs-TnI升高组hs-TnI水平与APACHEⅡ评分的相关性;比较两组患者基础疾病和并发症急性肾损伤(AKI)分布;比较两组患者升压药、机械通气及针对AKI的连续性肾脏替代治疗(CRRT)的使用率和使用时间;比较两组总住院时间、住ICU时间和住院死亡率、ICU死亡率。结果:hs-TnI升高组基础疾病比例和AKI发生率显著高于hs-TnI正常组(P<0.01)。hs-TnI水平升高患者APACHEⅡ评分也升高,两者呈显著正相关(r2=0.5958,P<0.01)。两组机械通气和升压药使用率无显著性差异(P>0.05),hs-TnI升高组机械通气和升压药治疗时间显著长于hs-TnI正常组(P<0.05或P<0.01),针对AKI的CRRT使用率高于hs-TnI正常组(P<0.05);hs-TnI升高组患者的总住院时间、住ICU时间、住院死亡率和ICU死亡率显著高于hs-TnI正常组(P<0.05)。结论:hs-TnI升高有助于判断脓毒症患者预后,hs-TnI水平越高,预后越差。     

血清PCT、IL-6、NT-proBNP、CTnI和D-D测定水平在急诊脓毒症患者早期诊断中的临床研究

目的 为了探讨急诊脓毒症患者早期诊断中测定血清降钙素原(procalcitonin,PCT)、白介素-6(interleukin-6,IL-6)、N端脑利钠肽前体(n-terminal pro B-type netriuretic peptide,NT-proBNP)、肌钙蛋白Ⅰ(cardiac troponin Ⅰ,CTnI)和D-二聚体(D-dimer,D-D)水平的临床意义.方法 采用化学发光免疫分析、超敏酶免疫分析和荧光免疫分析测定了急诊就诊患者439例,其中307例诊断为急诊脓毒症患者(包括236例严重脓毒症和71例脓毒症休克)和普通感染患者132例,以及86例正常对照组血清生物标志物(PCT、IL-6、NT-proBNP、CTnI和D-D)水平,并进行了对比性分析.采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析PCT、IL-6、NT-proBNP、CTnI和D-D评估急诊脓毒症患者早期诊断的临床价值.结果 307例急诊脓毒症患者血清PCT、IL-6、NT-proBNP、CTnI和D-D水平较之86例正常对照组明显增高(P分别为＜0.001,＜0.001,＜0.01,＜0.001和＜0.001),并且随疾病严重程度而增高.132例普通感染患者血清PCT、NT-proBNP、CTnI和D-D水平正常(P均＞0.05),仅血清IL-6水平轻度增高(P＜0.05).ROC曲线对急诊脓毒症早期诊断预测的价值评估表明:五种生物标志物均具有急诊脓毒症早期诊断的价值,以PCT为最佳,其后依次为IL-6、NT-proBNP、CTnI和D-D.结论 生物标志物(PCT、IL-6、NT-proBNP、CTnI和D-D)是急诊脓毒症早期诊断和病情严重程度评估的有价值指标.     

脂多糖结合蛋白在脓毒症患者诊断和预后预测中的作用

目的:探讨脂多糖结合蛋白(LBP)在脓毒症患者诊断和预后预测中的作用。方法:挑选ICU的患者共80名,患者分为全身炎症反应综合征(SIRS)组(阴性对照组)、脓毒症存活组和脓毒症死亡组;所有患者均于进入ICU后24 h内采集血清样本并进行APACHEⅡ评分分析;另挑选10名健康志愿者血清作为正常对照组;ELISA检测各组样本血清LBP、C反应蛋白(CRP)和降钙素原(PCT)浓度;并以APACHEⅡ评分、血清LBP、CRP和PCT浓度对脓毒症诊断和预后预测做ROC曲线,评价LBP在脓毒症患者诊断和预后预测中的作用。结果:与SIRS组相比,脓毒症组的APACHEⅡ评分、血清LBP、CRP、PCT浓度均升高(P0.05);与脓毒症存活组相比,死亡组的APACHEⅡ评分和血清LBP浓度升高(P0.05),而血清CRP和PCT浓度在脓毒症存活组与死亡组之间的差异无统计学意义;LBP血清浓度高于26.84 mg/L时诊断脓毒症的敏感性和特异性分别为97.1%和95.9%;LBP血清浓度高于54.16 mg/L时预测脓毒症预后的敏感性和特异性分别为85.2%和80.0%。结论:与传统的脓毒症生物标志物CRP、PCT相比,LBP在脓毒症的诊断和预测方面都具有更好的效果。     

脓毒症继发急性肾损伤过程中的凝血变化

目的 脓毒症继发急性损伤是脓毒症患者死亡的重要原因之一,凝血变化是急性肾损伤重要因素。本研究旨在筛选脓毒症过程中同急性肾损伤相关的凝血指标。方法 本研究收集外科、急诊及呼吸重症监护室的脓毒症患者,纳入132例脓毒症患者,其中合并急性肾损伤64例,非急性肾损伤68例。收集各组患者一般资料及入ICU第1个24h内各项实验室指标,利用Logistic回归分析及Cox回归分析进行统计学分析。结果 AKI组与非AKI组相比,抗凝血酶Ⅲ(P=0.007)显著降低,D-二聚体则显著升高(P=0.006)。二分类变量Logistic回归显示,D-二聚体与抗凝血酶Ⅲ为脓毒症继发AKI的危险因素,OR值分别为3.018(95%CI:1.127～8.083)和2.89(95%CI:1.181～7.070),P<0.05。利用Cox回归分析显示仅有D-二聚体同病死率相关,HR值1.347(95%CI:1.081～1.677),P=0.008。结论 D-二聚体和抗凝血酶Ⅲ是脓毒症继发AKI发生的独立危险因素。D-二聚体升高同脓毒症继发AKI的28d病死率高相关。     

PCT及CRP在社区获得性肺炎中的临床价值研究

目的：探讨PCT及CRP与社区获得性肺炎(CAP)患者的诊断,病情严重程度和预后的关系。方法本文选取180例社区获得性肺炎患者,对其临床资料进行回顾性分析。结果①根据是否合并脓毒症分为非脓毒症组和脓毒症组,脓毒症组CAP患者PCT、CRP水平高于非脓毒症组(<0.05);②根据患者好转情况分病情改善组及病情无改善组,CAP患者病情改善组治疗后PCT、CRP、APACHEⅡ评分低于治疗前水平(<0.01);CAP患者病情无改善组治疗前后PCT、CRP、APACHEⅡ差异无显著性。(>0.05)。结论①PCT、CRP对判断肺炎合并脓毒症有一定应用价值,其中PCT优于CRP。②动态监测PCT水平变化有助于判断肺炎,尤其肺炎伴脓毒症患者预后,其水平越高,预后越差,与APACHEII等危重系统评分联用具有更高的预测价值。     

血清铁蛋白、D-二聚体、降钙素原联合SOFA评分对评估脓毒症预后的临床价值

目的 探讨血清铁蛋白联合降钙素原(procalcitonin, PCT)、D-二聚体(D-dimer,D-D)、序贯器官衰竭评分(sequential organ failure assessment, SOFA评分)对评估脓毒症患者短期预后的临床价值。方法 回顾性分析2020年12月至2021年11月在首都医科大学附属北京世纪坛医院重症医学科治疗的346例脓毒症患者的相关临床数据,按28d预后将脓毒症患者分为生存组和死亡组,比较两组患者的血清铁蛋白、PCT、D-二聚体及SOFA评分差异,通过Logistic回归分析确认影响脓毒症患者短期预后的独立危险因素,建立血清铁蛋白、PCT、D-二聚体和SOFA评分的组合,通过绘制受试者工作特征(ROC)曲线,分析上述指标单独和联合检测对评估脓毒症患者入院后28d死亡的预测价值。结果 (1)死亡组的血清铁蛋白、PCT、D-二聚体和SOFA评分均明显高于生存组,差异有统计学意义(P<0.05)。(2)Logistic回归分析显示血清铁蛋白、PCT、D-二聚体和SOFA评分是影响脓毒症患者28d预后的独立危险因素(P<0.05)。(3)血...     

PCT、CRP动力学评估脓毒血症预后及诊断意义的研究

目的 观察血清降钙素原(PCT)、C反应蛋白(CRP)及其动力学变化,评估其在严重脓毒症/感染性休克患者的诊断及预后价值.方法 本研究采用回顾性分析方法,2014年9月1日至2016年4月30日选择184例ICU中被诊断为严重脓毒症/感染性休克疾病患者,检测入院时血清PCT、CRP水平和治疗后第2,第3和第5天的PCT、CRP水平.结果 通过△PCT、△CRP评估PCT、CRP的动力学在存活者与死亡组中有显著性统计学意(△PCT2/0,P=0.0001;△PCT3/0,P=0.0001;△PCT5/0,P=0.0001;△CRP2/0,P=0.0069;△CRP3/0,P=0.0001;△CRP5/0,P=0.0001),在严重脓毒症和感染性休克组中也存在显著差异(PCT5,P=0.007;△PCT5/0,P=0.007).受试者工作特征曲线(ROC)模型显示,△PCT3/0(AUC=0.721)、△PCT5/0(AUC=0.77)、△CRP5/0(AUC=0.766)水平判断严重脓毒症/感染性休克患者预后有较好的临床意义.△PCT5/0 (0.619)对严重脓毒症或感染性休克有一定的辅助诊断效果,其在ROC曲线上灵敏度、特异性均较高的临界点为0.624,所以,以第5天的血清△PCT5/0水平＞0.624可作为预测感染性休克的临界点.结论 血清中PCT、CRP对严重脓毒症/感染性休克早期有较好的临床诊断及预后价值,其动力学研究可以提高对严重脓毒症/感染性休克诊断及预后评估的敏感性及准确性.     

降钙素原、乳酸及C反应蛋白在重症肺炎中的变化及意义

目的 分析不同时间重症肺炎（SP）患者降钙素原（PCT）、乳酸（Lac）和C-反应蛋白（CRP）水平的变化及其意义。方法 选择2016年1月~2018年12月我院收治的67例SP患者,分别在患者入院后的第1、3、7天以及好转出科或死亡前检测PCT、Lac及CRP水平,同时行APACHE-Ⅱ评分。根据患者预后情况分为存活组（48例）和死亡组（19例）。比较两组不同时间血清PCT、Lac、CRP水平及其与APACHE-Ⅱ评分的相关性。结果 存活组第3、7天以及好转出科前PCT、Lac、CRP、APACHE-Ⅱ评分均低于第1天（P＜0.05）;死亡组第3、7天以及死亡前PCT、Lac、CRP、APACHE-Ⅱ评分均高于第1天（P＜0.05）;死亡组不同时间PCT、Lac、CRP、APACHE-Ⅱ评分均高于存活组（P＜0.05）。重症肺炎患者血清PCT、Lac、CRP与APACHE-Ⅱ评分呈正相关（r＝0.721、0.613、0.814,P＜0.05）。结论 PCT、Lac、CRP与SP的病情程度有关,病情越严重,血清水平越高;动态监测PCT、Lac、CRP及APACHE-Ⅱ评分有助于病情和预后的判断。     

重症肺炎合并脓毒症患儿血清PCT、PLT、内毒素水平与危重症评分相关性分析

目的研究重症肺炎合并脓毒症患儿血清降钙素原(PCT)、血小板计数(PLT)、内毒素(ET)水平与危重症评分(PCIS)的相关性。方法收集2018年1月至2019年5月入住我院儿科重症监护病房(PICU)24h以上的98例重症肺炎合并脓毒症患儿的临床资料,按入院24 h PCIS评分分为极危重组(0~70分,n=34)、危重组(71~80分,n=36)与非危重组(>80分,n=28),并选取同期收治单纯重症肺炎患儿30例作为对照组,均采血测定PCT、PLT、ET、白细胞计数(WBC)、C反应蛋白(CRP)水平,并按28d预后分为存活组(n=56)与死亡组(n=42),比较不同结局患儿血清学指标及PCIS评分的差异,Pearson相关分析法分析重症肺炎合并脓毒症PCT、PLT、ET水平与CRP、WBC及PCIS评分的关系,受试者工作曲线(ROC)分析三者单独及联合预测重症肺炎合并脓毒症的价值。结果PCT、ET、CRP、WBC比较:极危重组>危重组>非危重组>对照组,PLT比较:极危重组<危重组<非危重组<对照组(P<0.05);98例重症肺炎合并脓毒症患儿28 d死亡率为42.86%,极危重组死亡20例(58.82%),危重组死亡13例(36.11%),非危重组死亡9例(32.14%),死亡率极危重组>危重组>非危重组,但比较差异无统计学意义(P>0.05),生存组PCT、ET、CRP、WBC低于死亡组(P<0.05),PCIS评分、PLT高于死亡组(P<0.05);PCT与PLT、PCIS评分呈负相关(r=-0.799、-0.606,P<0.05),与ET呈正相关(r=0.793,P<0.05);PLT与ET呈负相关(r=-0.660,P<0.05),与PCIS呈正相关(r=0.568,P<0.05);ET与PCIS呈负相关(r=-0.578,P<0.05);CRP与PCT、ET、WBC呈正相关(r=0628、0.567、0.635,P<0.05),与PLT、PCIS呈负相关(r=-0.438、-0.497,P<0.05);WBC与PCT、ET呈正相关(r=0.879、0.702,P<0.05),与PLT、PCIS呈负相关(r=-0.613、-0.557,P<0.05);PCT>4.04 ng/mL时预测重症肺炎合并脓毒症灵敏度、特异性分别为94.90%、100.00%;PLT<215.28×10^9/L时预测重症肺炎合并脓毒症灵敏度、特异性分别为95.92%、93.10%;ET>0.88×10^3EU/L时预测重症肺炎合并脓毒症灵敏度、特异性分别为78.57%、100.00%;联合诊断以PCT+PLT+ET预测重症肺炎合并脓毒症效能最高,灵敏度、特异性分别为95.90%、100.00%。结论重症肺炎合并脓毒症患儿血清PCT、ET、CRP、WBC水平较高,PLT水平降低,随PCIS评分的降低,PLT减少,PCT、ET、WBC、CRP升高;PCT、ET、PLT三者均可作为预测重症肺炎合并脓毒症发病的依据。     

Depersonalization,adversity, emotionality,and coping with stressful situations

Depersonalization is defined as persistent or recurrent episodes of feeling detached or estranged from a sense of self and the world. This study addressed the primary question: Do nonclinical individuals who endorse high symptomatic depersonalization have inherently more intense emotional responses, along with more childhood adversity and past trauma? In this IRB approved study, participants who met clinical levels of depersonalization (n = 43, 16.3%) were compared to a group without clinical levels of depersonalization (n = 221, 83.7%). Adverse childhood experiences, adult traumatic events, emotional overexcitability, coping strategies under stress, and anxiety were examined in both groups. The variables to assess depersonalization severity included the Dissociative Experience Scale-II, Cambridge Depersonalization Scale, and Multiscale Dissociation Inventory. The results indicated that clinical levels of depersonalization were identified in 16.3% of the sample. The high depersonalization group had significantly more adverse childhood experiences, in particular, emotional abuse and neglect. They also experienced more adult traumatic events, higher levels of anxiety, more emotional overexcitability, and they employed a less adaptive emotion-oriented coping strategy under stress. It is recommended that treating depersonalization symptoms should include examining childhood adversity, especially emotional abuse and neglect. Based on study findings, emotion regulation skills should be promoted to help individuals with elevated depersonalization manage their emotion-oriented coping strategies, anxiety, and emotional overexcitability.     

Facts, fallacies, fears, and frustrations with human pheromones

Among primates in general, pheromones are of variable importance to social communication. Data on humans have generated the greatest controversy regarding the existence of pheromonal communication. In this review, the likelihood of pheromonal communication in humans is assessed with a discussion of chemical compounds produced by the axilla that may function as pheromones; the likelihood that the vomeronasal organ (VNO), a putative pheromone receptor organ in many other mammals, is functional in humans; and the possible ways pheromones operate in humans. In the human axilla, the interactions between the cutaneous microflora and axillary secretions render this region analogous to scent glands found in other primates. Both the chemistry of axillary secretions and their effects on conspecifics in humans appear to be analogous to other mammalian pheromone systems. Whichever chemical compounds serve a pheromonal function in humans, another unknown is the receptor. Although the VNO has been implicated in the reception of pheromones in many vertebrates, it is not the only pathway through which such information has access to the central nervous system; there is ample evidence to support the view that the olfactory epithelium can respond to pheromones. Furthermore, if a chemical activates receptors within the VNO, this does not necessarily mean that the compound is a pheromone. An important caveat for humans is that critical components typically found within the functioning VNO of other, nonprimate, mammals are lacking, suggesting that the human VNO does not function in the way that has been described for other mammals. In a broader perspective, pheromones can be classified as primers, signalers, modulators, and releasers. There is good evidence to support the presence of the former three in humans. Examples include affects on the menstrual cycle (primer effects); olfactory recognition of newborn by its mother (signaler); individuals may exude different odors based on mood (suggestive of modulator effects). However, there is no good evidence for releaser effects in adult humans. It is emphasized that no bioassay-guided study has led to the isolation of true human pheromones, a step that will elucidate specific functions to human chemical signals.     

Osteochondrodysplasia with rhizomelia, platyspondyly, callosal agenesis, thrombocytopenia, hydrocephalus, and hypertension

A female infant born at term to phenotypically normal nonconsanguinous parents had hypertension, thrombocytopenia, hydrocephalus, callosal agenesis, and nonlethal rhizomelic osteochondrodysplasia. Her osteochondrodysplasia was characterized roentgenographically by shortening and metaphyseal broadening of long bones, without bowing, and by platyspondyly, with deficient ossification of dorsal and central portions of vertebral bodies. By light microscopy, the iliac crest growth plate showed expansion of the zone of chondrocyte hypertrophy and degeneration, with faulty columnar alignment, sparse vascular ingrowth, and irregular mineralization at the zone of chondroosseous transformation. These findings appear to define a novel osteochondrodysplasia, which in association with hypertension, thrombocytopenia, hydrocephalus, and callosal agenesis may constitute a new syndrome.     

Sibs with growth deficiency, delayed bone age, congenital hip dislocation, and iridocorneal abnormalities with glaucoma

We report on a brother and sister with short stature, delayed bone age, developmental delay, congenital hip dislocation, and iridocorneal abnormalities with onset of glaucoma at or soon after birth. Results of endocrine evaluation were normal. To our knowledge, no similar pattern of defects has been reported previously.     

Comparison of CLA with BPT, SPT, and RAST in children with asthma

Bronchial provocation tests (BPT) with allergen extracts were performed in 82 children with asthma, and the results were compared with the chemiluminescent assay (CLA), the radio-allergo-sorbent-test (RAST) and skin prick test (SPT). It was found that CLA matched BPT with a concordance of 87% (77-93%), RAST with a concordance of 74% (64-83%) and SPT with 80% (70-88%). Most often, CLA and RAST gave similar results, although their classes did not match precisely.