CysC、α1-MG和β2-MG在糖尿病早期肾损伤诊断中的价值

目的 探讨血清胱抑素C（CysC）、α1微球蛋白（α1-MG）和β2微球蛋白（β2-MG）多指标检测在糖尿病早期肾损伤中的诊断价值.方法 选取糖尿病（DM）患者188例和健康对照者90例,检测各组血CysC、α1-MG、β2-MG、BUN和Cr的含量并作统计分析.结果 单纯DM组血清CysC、α1-MG水平较健康对照组明显升高（P〈0.05）,但两组β2-MG、BUN和Cr水平无明显差异;早期DN组血清CysC、α1-MG和β2-MG水平较单纯DM组显著升高（P〈0.01）,但两组血清BUN、Cr水平无明显差异;188例糖尿病患者血清 CysC、α1-MG和β2-MG均与BUN、Cr水平呈正相关;早期DN组中3个指标的异常率较单纯DM组显著升高;3个指标联合检测早期肾损伤的异常率较单指标检测明显升高;用ROC曲线进行诊断效能评价,以CysC最优.结论 血清CysC、α1-MG和β2-MG联合检测可发现糖尿病病程中的早期肾损伤,有重要的临床应用价值.     

小于胎龄儿尿微量蛋白检测和临床意义

目的 通过检测小于胎龄儿尿微量蛋白（SGA）和血BUN、Cr的变化探讨尿微量蛋白在宫内发育迟缓新生儿肾脏损害早期诊断的意义.方法 小于胎龄儿组新生儿40例（足月小样儿组20例,早产小样儿组20例）,对照组分别为40例足月适于胎龄儿、30例早产适于胎龄儿,于生后48h内留取新鲜尿液检测尿微量蛋白：尿α1微球蛋白（α1-MG）、β2微球蛋白（β2-MG）、N-乙酰-β- D-氨基葡萄糖苷酸酶（NAG）、转铁蛋白（TRF）、免疫球蛋白（IgG）;采静脉血检测血BUN、Cr.结果 足月小样儿组与足月适于胎龄儿组比较：尿α1-MG、β2-MG、NAG水平升高,差异有统计学意义（P〈 0.01）;尿TRF、IgG 、血BUN、Cr水平无明显统计学差异（P〉0.05）.早产小样儿组与早产适于胎龄儿组比较：尿α1-MG、β2-MG、NAG、TRF、IgG 、血BUN、Cr水平均显著升高（P〈 0.01）.足月小样儿组与早产小样儿组比较：尿α1-MG、β2-MG、NAG水平均无明显统计学差异（P〉0.05）,尿TRF、IgG和血BUN、Cr水平显著升高（P〈0.01）.结论 小于胎龄儿尿微量蛋白水平有明显变化,可以作为新生儿宫内发育不良肾脏损害早期的判断指标.     

血清胱抑素C测定在窒息新生儿肾损伤中的诊断价值

目的：探讨血清胱抑素C（Cys-C）在窒息新生儿肾损伤中的诊断价值。方法：对90例窒息新生儿和40例健康新生儿测定血清Cys-C、β2-微球蛋白（β2-MG）、BUN、Cr并进行比较。结果：窒息组患者Cys-C与β2-MG、BUN和Cr水平之间呈正相关（r分别为0.937、0.530、0.513;P〈0.01）;以Cys-C为标准,血清β2-MG、BUN、Scr水平升高的相对敏感性分别为89.7%、42.3%、34.6%。结论：血清Cys-C检测有助于新生儿窒息后肾损伤的早期诊断。     

血清胱抑素C检测对肝硬化患者肾功能损害的诊断价值

目的探讨血清Cys C在肝硬化患者早期肾功能损害中的诊断价值及意义。方法采用免疫比浊法检测118例肝硬化、48例CHB患者及30例健康对照组血清Cys C、β2微球蛋白（β2-MG）水平,同时采用酶法测定血清肌酐（Scr）、尿素（Urea）水平。对各组血清Cys C、Scr、Urea及β2-MG水平差异、相关性及异常率进行比较分析。结果肝硬化组、CHB组和对照组的血清Cys C水平分别为（1.29±0.33）mg/L、（0.98±0.21）mg/L和（0.92±0.15）mg/L,肝硬化组显著高于CHB组（P〈0.05）和对照组（P〈0.05）。肝硬化组Scr、Urea和β2-MG水平分别为（69.22±21.21）μmol/L、（5.47±2.16）mmol/L和（2.58±0.88）mg/L,均显著高于对照组（P〈0.05）。各组血清Cys C与Scr均呈正相关,肝硬化组（r=0.502,P〈0.01）,CHB组（r=0.485,P〈0.01）,对照组（r=0.494,P〈0.01）。肝硬化组血清Cys C异常率（75.4%）显著高于Scr（5.9%）、Urea（17.8%）和β2-MG（22%）,差异有统计学意义（P〈0.01）。结论血清Cys C可以作为评价肝硬化早期肾功能损害的标志物,为临床相关疾病的诊断提供参考依据。     

尿NAG、β2-MG变化与儿童过敏性紫癜肾炎肾功能损害的关系

目的探讨过敏性紫癜性肾炎患儿尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、β2微球蛋白(β2-MG)的水平变化及其意义。方法选取我院2016年3月-2017年10月收治的160例过敏性紫癜性肾炎患儿,根据尿蛋白水平分为A组(孤立性血尿)56例、B组(轻度蛋白尿)43例、C组(中度蛋白尿)32例、D组(肾病水平蛋白尿)29例。对比四组患儿尿NAG、β2-MG水平,分析过敏性紫癜性肾炎患儿尿NAG、β2-MG水平与血清尿素氮(BUN)、肌酐(Cr)的关系。结果(1)4组研究对象尿NAG、β2-MG水平比较差异有统计学意义(P0.01),D组尿NAG、β2-MG水平显著高于A组、B组、C组(P0.05),C组尿NAG、β2-MG水平显著高于A组、B组(P0.05),B组尿NAG、β2-MG水平显著高于A组(P0.05)。(2)4组研究对象血清BUN、Cr水平比较差异有统计学意义(P0.01),D组血清BUN、Cr水平显著高于A、B、C三组,差异均具有统计学意义(P0.05)。(3)过敏性紫癜性肾炎患儿尿NAG、β2-MG水平与血清BUN、Cr水平呈显著正相关系(P0.01)。结论过敏性紫癜性肾炎患儿尿NAG、β2-MG水平与肾功能损害程度具有一定的相关性。     

多发性骨髓瘤病人血清sgp130与IL-6变化及意义

目的探讨多发性骨髓瘤（MM）病人血清可溶性糖蛋白130（sgp130）和白细胞介素6（IL-6）的动态变化及临床意义。方法采用双抗体夹心酶联免疫吸附（ELISA）法,检测60例MM病人和20例健康体检者（对照组）血清sgp130及IL-6的水平,并观察二者与血清β2-微球蛋白（β2-MG）水平的相关性。结果 MM病人血清sgp130、IL-6水平均明显升高,与对照组比较差异有显著性（t=5.51、8.29,P〈0.01）,并随MM临床分期增加、病情加重而逐渐升高（F=23.21、21.86,P〈0.05）,但不同免疫亚型间差异无显著性（F=7.37、4.12,P〉0.05）。血清sgp130、IL-6水平的变化与化疗效果有关,化疗有效病人血清sgp130、IL-6水平均明显下降,其中BD组（硼替佐米＋地塞米松）下降程度明显大于VAD组（长春地辛＋表柔比星＋地塞米松）,差异有显著性（t=11.77、5.31,P〈0.05）。血清sgp130、IL-6水平与血清β2-MG水平呈正相关（r=0.683、0.549,P〈0.01）。结论血清sgp130及IL-6水平变化与MM的肿瘤负荷和化疗效果有关,可作为评估病情变化和治疗效果的有效指标。     

β2-微球蛋白在诊断早期肾功能损害中的临床意义

目的探讨高血压、糖尿病患者血清及尿液中的β2-微球蛋白（β2-MG）含量,对诊断其早期肾功能损害的价值。方法测定75例高血压患者（高血压组）和72例糖尿病患者（糖尿病组）血清、尿β2-MG,血肌酐（Cr）和尿素氮（BUN）含量,并与68例正常人（对照组）进行比较。结果高血压、糖尿病2组患者血清、尿β2-MG含量明显高于对照组（P〈0.01）,而Cr、BUN含量与对照组比较差异无统计学意义（P〉0.05）。结论动态监测血清、尿β2-MG对于发现高血压、糖尿病患者早期肾功能损害有重要的临床意义。     

血清胱抑素C与尿α_1-微球蛋白对糖尿病肾病的早期诊断价值

目的探讨血清胱抑素C（CysC）和尿α1-微球蛋白（α1-MG）在糖尿病肾病（DN）早期诊断中的价值。方法将524例2型糖尿病患者按尿微量清蛋白（mAlb）水平分为3组,mAlb正常组0～30mg/L,mAlb 31～100mg/L组和mAlb〉100mg/L组。定量测定各组患者血清中CysC、肌酐（Cr）、尿素氮（BUN）、α1-MG的浓度。结果 mAlb正常组与健康对照组比较,BUN、Cr差异无统计学意义（P〉0.05）;3组糖尿病患者的血CysC和尿α1-MG水平较健康对照组均显著升高（P〈0.05）,并随着mAlb的上升而升高。血CysC和尿α1-MG的阳性检出率在3组糖尿病患者中均高于BUN和Cr（P〈0.05）。血CysC和尿α1-MG联合检测,其阳性检出率在mAlb正常组中明显高于单项指标检出率,差异有统计学意义（P〈0.05）。在肾功能早期病变（患者mAlb〈100mg/L）的糖尿病患者中,各指标的阳性检出率由高到低为血CysC联合尿α1-MG〉尿α1-MG〉血CysC〉BUN〉Cr。结论血CysC和尿α1-MG对糖尿病肾病的早期诊断较Cr和BUN更有意义,联合检测血CysC和尿α1-MG可显著提高糖尿病早期肾损害的阳性检出率。     

血清肌红蛋白和β2-微球蛋白测定对原发性高血压患者肾功能损害的评价

肌红蛋白（Myoglobin，Mb）是肾功能损害、心肌损伤的一个较为敏感的指标，β2-微球蛋白（beta-2-microglobulin，β2-MG）是肾小球滤过率下降，肾功能损害的重要指标之一。作者于2000年1月至2005年12月测定了160例原发性高血压（EH）患者和60例对照组血清Mb和β2-MG水平，血肌酐（Cr）和尿素氮（BUN）水平，以期对血清Mb和β2-MG在原发性高血压患者肾功能损害的临床意义作一评价。     

血胱抑素C对窒息新生儿肾损伤的早期诊断价值

目的探讨血胱抑素C（cys C）水平对窒息新生儿肾功能损伤的诊断价值。方法对重度窒息20例,轻度窒息25例和对照组22例无窒息新生儿做血cys C、尿素氮（BUN）和肌酐（Cr）的检测,并比较分析。结果轻度窒息组和重度窒息组血清cys C均较对照组有显著升高（P〈0.01）;重度窒息组血清cys C较轻度窒息组显著升高（P〈0.01）。轻度窒息组血清cys C的异常率显著高于BUN和Cr的异常率（均P〈0.01）;重度窒息组血清cys C的异常率显著高于BUN和Cr的异常率（均P〈0.05）。结论血清cys C可作为窒息新生儿肾功能损伤的早期诊断指标,而且敏感性高于血BUN和Cr。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.