急性脑梗塞患者血清及脑脊液游离氨基酸递质水平的变化及临床意义

应用日立８３５－５０型氨基酸自动分析仪,对３０例发病１２小时至３天急性脑梗塞患者的血清氨基酸中兴奋在酸递质谷氨酸和天门冬氨酸水平明显升高;牛黄酸、甘氨酸递质水平下降,但差异不显著,血清中Ｇｌｕ和Ａｓｐ水平变化与脑梗塞直径呈显著正相关,与神经功能评分呈正相关。提示Ｇｌｕ和Ａｓｐ参与脑梗塞的病理过程,血清Ｇｌｕ和Ａｓｐ水平可作为临床观察其病情严重程度、梗塞面积的客观指标。     

Cerebrospinal Fluid Glucose Levels and Sensorineural Hearing Loss in Bacterial Meningitis

Background: Low cerebrospinal fluid (CSF) glucose levels have been associated with sensorineural hearing loss (SNHL) in bacterial meningitis but systematic investigations are lacking.Patients and Methods: A retrospective case control study was conducted comparing CSF glucose levels in 47 cases with and 145 controls without SNHL following bacterial meningitis.Results: The mean CSF glucose level (standard deviation [SD]) was 1.3 mmol/l (1.2) in cases and 2.5 mmol/l (1.6) in controls (p < 0.001). The difference between the groups was significant for Streptococcus pneumoniae and Haemophilus influenzae but not for Neisseria meningitidis infection. It was independent of the delay of treatment if this was greater than 12 h. This delay was significantly longer in cases compared to controls.Conclusion: In bacterial meningitis other than that caused by N. meningitidis and independent of the duration of symptoms prior to diagnosis, CSF glucose levels were significantly lower in patients developing a SNHL compared to controls.     

结核性脑膜炎脑脊液中粒细胞集落刺激因子的测定

本文采用ＥＬＩＳＡ法检测２３例结核性脑膜炎及２１例非结核性脑膜炎脑脊液中的Ｇ－ＣＳＦ。结脑组（０．６５＋０．３２ＯＤ）明显高于非结脑组（０．１５±０．１１ＯＤ）（Ｐ＜０．０１）。诊断结脑的敏感性为９１．３％，特异性为９０．５％。Ｇ－ＣＳＦ在抗感染的非特异性细胞免疫中起重要作用，细菌及其产物是刺激和调节Ｇ－ＣＳＦ产生的主要物质。     

脑梗死患者脑脊液及血清中载脂蛋白的变化

目的 观察脑梗死患者脑脊液与血清中血脂及载脂蛋白的变化。方法 脑梗死患者110名，对照组60名，收集脑脊液及血清。总胆固醇及甘油三酯用酶法测定；载脂蛋白AⅠ及载脂蛋白B用单向免疫扩散法测定。高密度脂蛋白胆固醇及低密度脂蛋白胆固醇用氧化酶法测定，载脂蛋白E及脂蛋白（a）用酶联免疫法测定。结果 脑梗死组脑脊液中脂蛋白（a）、载脂蛋白AⅠ及载脂蛋白E明显高于对照组（P〈0．01及〈0．05），总胆固醇及甘油三酯两组间无明显差异（P〉0．05）。脑梗死组血清中总胆固醇、甘油三酯、载脂蛋白B、载脂蛋白E、低密度脂蛋白胆固醇、脂蛋白（a）明显高于对照组（P〈0．05）；载脂蛋白AⅠ、高密度脂蛋白胆固醇明显低于对照组（P〈0．05）。脑脊液与血清中，各项指标间未发现相关关系（P〉0．05）。结论 脑梗死组脑脊液中脂蛋白（a）、载脂蛋白AⅠ、载脂蛋白E明显高于对照组，TC、TG两组间无明显差异；血清中总胆固醇、甘油三酯、载脂蛋白B、载脂蛋白E、低密度脂蛋白胆固醇、脂蛋白（a）明显高于对照组，载脂蛋白AⅠ、高密度脂蛋白胆固醇明显低于对照组。脑脊液及血清中脂类无相关关系。     

FilmArray Meningitis/Encephalitis (ME) panel in the diagnosis of bacterial meningitis

The precise diagnosis of bacterial meningitis is essential. Cytological and biochemical examination of cerebrospinal fluid (CSF) are not specific. Conventional methods for bacterial meningitis lack sensitivity or take too long for a final result. Therefore, other methods for rapid and accurate diagnosis of central nervous system infections are required. FilmArray meningitis/encephalitis (ME) panel is a PCR multiplex for simultaneous and rapid identification of 14 pathogens, including 6 bacteria, 7 viruses, and Cryptococcus. We evaluated 436 CSF samples submitted to FilmArray ME Panel. Among them, 25 cases were positive for bacteria, being Streptococcus pneumonia the most frequent (48 %). Among positive cases for bacteria, 60 % were positive only with FilmArray. All the bacterial meningitis cases in which the only positive test was FilmArray had CSF findings suggestive of bacterial meningitis, including neutrophilic pleocytosis, increased CSF protein and lactate, and decreased CSF glucose. These findings suggest that FilmArray may increase the diagnostic sensitivity for bacterial meningitis.     

脑脊液置换术治疗蛛网膜下腔出血临床研究

目的探讨脑脊液置换术治疗蛛网膜下腔出血的临床效果。方法将80例蛛网膜下腔出血患者随机分治疗组及对照组,各40例,治疗组在常规治疗的基础上进行脑脊液置换术治疗,对照组使用单纯的常规治疗。结果治疗组治疗的有效例数与对照组比较差异有统计学意义。治疗组中有头痛颈强者21例,持续时间6～12.5d,对照组头痛颈强持续时间14～21d,两组比较差异有统计学意义。治疗组中表现不同意识障碍者6例,经置换2～3次最短在4d内意识恢复正常,对照组意识障碍11例,意识障碍恢复时间6～14d,两组比较有显著差异。蛛网膜下腔出血3大并发症脑血管痉挛、脑积水、脑梗死,治疗组与对照组比较,均有显著差异。结论脑脊液置换术治疗蛛网膜下腔出血,能减少脑血管痉挛、脑积水、脑梗死等并发症,有利于患者恢复,操作简单易行、安全,疗效显著,值得临床推广应用。     

脑梗死患者脑脊液和血清中脂蛋白(a)的变化

为观察脑梗死患者脑脊液和血清中脂蛋白 (a)含量的变化 ,选择 80例脑梗死患者和 40例对照者 ,用酶联免疫法测定脂蛋白 (a)在脑脊液及血清中的含量。结果发现 ,脑梗死患者与对照者脑脊液中脂蛋白 (a)含量分别为 2 34± 2 9μg/L及 2 11± 2 1μg/L ,血清中脂蛋白 (a)含量分别为 0 .2 99± 0 .0 2 8g/L及 0 .2 71± 0 .0 2 5g/L ,脑梗死组脑脊液及血清中脂蛋白 (a)含量明显高于对照组 (P <0 .0 1)。脑梗死患者和对照者脑脊液与血清中脂蛋白 (a)水平间均无相关关系 (P >0 .0 5 )。结果提示 ,脑梗死患者脑脊液及血清中脂蛋白 (a)水平明显高于对照者。     

血清降钙素原检测对院内深部真菌感染诊断价值的探讨

目的 :探讨血清降钙素原 (PCT)检测诊断危重病患者院内深部真菌感染 (IMI)的价值。方法 :回顾性分析重症监护病房内 5 6例临床资料 ,并与健康组 15例对照。结果 :IMI组较健康对照组血清PCT水平明显升高 (P <0 .0 1)。不同感染部位 ,以血液真菌感染者PCT水平最高 (P <0 .0 1)。但PCT不能鉴别不同真菌菌株。结论 :PCT可作为危重病患者院内IMI有价值的诊断指标。     

Association between Multiple Sclerosis and Cystic Structures in Cerebrospinal Fluid

Background: The aim of the study was to search for infectious agents in the cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS). Patients and Methods: CSF from ten patients with the diagnosis relapsing remitting MS and from five controls without MS were examinated by transmission electron microscopy (TEM), dark field microscopy (DF), interference contrast microscopy (ICM) and UV-microscopic examination of acridine orange staining (AO). All CSF samples from patients and controls were cultured. Results: Cystic structures were observed in CSF of all ten patients by AO and TEM. DF revealed eight cyst-positive patients out of nine. One of five control persons had such structures in the CSF; this person had suffered from erythema migrans. Spirochete or rod-like structures emerged after culturing two of the MS patient CSF samples and these structures could be propagated. Conclusion: A significant association of CSF cysts and MS was identified in this small study among residents in a coastal area of southern Norway. The cysts could be of spirochetal origin. Our study may encourage other researchers to study larger patient groups. Received: November 30, 1999 · Revision accepted: August 28, 2001     

血清C肽和糖化血红蛋白联合检测对糖尿病诊断的临床价值研究

目的探究血清C肽、糖化血红蛋白二者联合检测在糖尿病临床诊断中的临床价值。方法整理2018年1月—2019年2月期间该院内二科收治的56例糖尿病患者设为观察组,同期选择56名身体健康的老年人设为对照组。对两组进行血清C肽检测与糖化血红蛋白检测,分析两种检测方法的检测结果及临床检测价值。结果观察组的糖化血红蛋白、空腹血糖水高于对照组,观察组的血清C肽水平低于对照组。合并并发症患者的糖化血红蛋白、空腹血糖水高于无并发症患者,而合并并发症患者的血清C肽低于无并发症的患者。以上差异有统计学意义(P<0.05)。结论在糖尿病临床诊断中进行血清C肽、糖化血红蛋白检测,可显著提高诊断效果,有利于临床医师有效判断患者的病情严重程度,了解其血糖水平变化,为临床诊治提供有价值的依据。     

急性胰腺炎患者血浆降钙素原的变化及其意义

目的探讨血浆降钙素原（PCT）水平对急性胰腺炎（AP）患者预后的预测价值。方法将入选的122例急性胰腺炎患者,根据Ranson评分标准分为轻型胰腺炎组（68例）和重型胰腺炎组（54例）,比较两组患者白细胞计数、中性粒细胞比值、血浆淀粉酶、脂肪酶、C反应蛋白（CRP）以及PCT水平。腹部CT检查评估两组患者CT严重指数（C鸭I）,评估CTSI和血浆PCT水平的相关性。结果（1）与轻型急性胰腺炎患者相比,重型组患者白细胞总数、中性粒细胞比值、血浆淀粉酶、脂肪酶、CRP以及PCT均明显升高,差异具有统计学意义（P〈0．05）;（2）Spearman相关分析提示CTSl分级与血浆PCT水平呈正相关（r=0．886,P〈0．05）。结论检测急性胰腺炎患者血浆PCT水平有利于对患者预后的评估。     

开博通介入肾显像对肾动脉再血管化治疗疗效的预测价值

目的 :评价开博通介入肾显像对肾动脉再血管化治疗疗效的预测价值。方法 :3 1例患者经肾动脉造影证实有肾动脉狭窄并行肾动脉再血管化治疗 ,并在行肾动脉再血管化治疗前行基础肾显像 +开博通肾显像。全部患者术后随访时间为 2～ 2 4( 12 5± 9 4)个月。结果 :各种指标对再血管化治疗患者的疗效预测价值不同。从准确性方面看 :开博通肾显像对再血管化治疗疗效的预测准确性为 87 0 % ,高于其他几种指标的预测准确性。阳性预测值为 89 0 % ,高于其他几种指标的预测值。阴性预测值为 83 3 %。结论 :开博通肾显像对肾动脉的再血管化治疗具有重要的预测价值     

颅脑手术后并发脑膜炎危险因素分析

目的　探讨颅脑手术后并发脑膜炎的危险因素及预防措施。方法　回顾性分析 1994年 1月至2 0 0 2年 12月收治的 4 877例施行颅脑手术患者的临床资料。结果　术后并发脑膜炎 14 1例 (占 2 .89% ) ,其中无菌性脑膜炎 12 0例 ,细菌性脑膜炎 2 1例。术后脑脊液漏、刀口皮下积液及因急症再次手术者 ,脑膜炎的发生率分别为 35 .34%、2 4 .6 0 %及 15 .78% ,明显高于总病例脑膜炎发生率 (2 .89% ) ,P<0 .0 5 ;有颅脑手术史者术后脑膜炎发生率为 5 .10 % ,幕下手术后为 6 .4 0 % ;手术时间 4～ 8小时者为 4 .4 0 % ,8小时以上者为 7.0 9% ;术前使用糖皮质激素者为 4 .80 % ;术后未用激素者细菌性脑膜炎发生率为 0 .1% ,应用激素者发生率为 0 .5 2 %。结论　术后脑脊液漏、刀口皮下积液及因急症再次手术是颅脑手术后并发脑膜炎的危险因素 ,手术后应用糖皮质激素是并发细菌性脑膜炎的危险因素     

Evaluation of Cerebrospinal Fluid for the Presence of Anticardiolipin Antibodies (aCL) in NP-SLE Patients

Many neurological or psychiatric manifestations of SLE (NP-SLE) are related to the presence of anticardiolipin antibodies (aCL) in the patient’s sera. The aim of this study was to evaluate the presence of aCL in cerebrospinal fluid (CSF) in SLE patients with NP features. Fifteen SLE patients were studied, all with NP features. CSF was evaluated for intrathecal IgG synthesis, oligoclonal IgG, and blood–brain barrier impairment. Sera and CSF were tested by ELISA for the presence of aCL-IgG and aCL-IgM with and without β₂ glycoprotein (β₂ GPI) cofactor. CSF and sera of 50 low back pain patients served as controls. Six patients were aCL(+) and nine aCL(–). In all patients the general CSF examination was normal. In all patients the value of indices of intrathecal IgG synthesis were normal but oligoclonal protein was present in the CSF of three patients. In none of the patients was the blood–brain barrier impaired. Neither aCL-IgG nor aCL-IgM was detected in the CSF of any NP-SLE patient. Mean levels of aCL in patients without cofactor β₂ GPI and with cofactor were as follows: for IgG class 0.005 and 0.057 OD (negative); for IgM class 0.004 and 0.024 OD (negative). We could not detect aCL in the CSF of patients with NP-SLE, even if sera were positive for aCL. Received: 6 July 1999 / Accepted: 18 January 2000     

老年肥厚型心肌病患者并发肺高血压的影响因素及其预测模型的预测价值研究

背景老年肥厚型心肌病(HCM)并肺高血压患者的病死率高,预后差,而目前有关老年HCM患者并发肺高血压的影响因素报道较少。目的分析老年HCM患者并发肺高血压的影响因素及其预测模型的预测价值。方法选取2016年6月-2018年12月于青海省人民医院收治的老年HCM患者80例,根据是否并发肺高血压分为观察组(HCM并肺高血压患者,n=22)和对照组(单纯性HCM患者,n=58)。比较两组患者一般资料{包括性别、年龄、体质指数、病程、收缩压(SBP)、舒张压(DBP)、基础疾病〔包括慢性阻塞性肺疾病(COPD)、高血压、糖尿病〕}、心功能指标〔包括左心室舒张末期内径(LVEDD)、左心房内径(LAD)、左心室收缩末期内径(LVEDS)、左心室射血分数(LVEF)、纽约心脏病协会(NYHA)分级〕、实验室检查指标〔包括总胆固醇(TC)、白蛋白(Alb)、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)、胱抑素C(Cyc-C)〕。老年HCM患者并发肺高血压的影响因素分析采用多因素Logistic回归分析;绘制受试者特征工作曲线(ROC曲线)以分析预测模型对老年HCM并发肺高血压的预测价值。结果两组患者性别、体质指数、病程、SBP、DBP、基础疾病、LVEDS、TC比较,差异无统计学意义(P>0.05);观察组患者年龄、hs-CRP、NT-proBNP、Cyc-C高于对照组,LVEDD、LAD长于对照组,LVEF、Alb低于对照组,NYHA分级劣于对照组(P<0.05)。多因素Logistic回归分析结果显示,LVEDD〔OR=1.773,95%CI(1.205,2.609)〕、LVEF〔OR=0.716,95%CI(0.585,0.876)〕、NYHA分级〔OR=1.907,95%CI(1.354,2.686)〕、NT-proBNP〔OR=3.117,95%CI(1.329,7.311)〕是老年HCM患者并发肺高血压的影响因素(P<0.05)。根据多因素Logistic回归分析结果建立预测模型:P=1/〔1+e(7.041-0.573X2+0.334X4-0.646X5-1.137X9)〕,e为自然对数,X2为LVEDD,X4为LVEF,X5为NYHA分级,X9为NT-proBNP。预测模型预测老年HCM患者并发肺高血压的ROC曲线下面积(AUC)为0.755〔95%CI(0.645,0.866)〕,灵敏度为0.727,特异度为0.603。结论LVEDD、LVEF、NYHA分级、NT-proBNP是老年HCM患者并发肺高血压的影响因素,且预测模型对患者具有一定预测价值。     

Filtration of Cerebrospinal Fluid for Acute Demyelinating Neuropathy in Systemic Lupus Erythematosus

We report a patient with systemic lupus erythematosus complicated by an acute demyelinating neuropathy. Conventional therapy with intravenous immunoglobulins and immunoadsorption complemented by pulse methylprednisolone and cyclophosphamide failed. Institution of filtration of the cerebrospinal fluid was followed by a rapid improvement of the paresis. Received: 12 February 1999 / Accepted: 18 June 1999     

ELISA检测脑囊虫病患者脑脊液中囊尾蚴抗原

应用酶联免疫吸附实验(ELISA),以38例脑囊虫病人脑脊液(CSF)和26例脑部其它疾患的CSF为对照,用兔抗囊尾蚴抗血清进行了囊尾蚴抗原检测,28例呈阳性反应,阳性率73.68％;对照组26例全部为阴性。本方法特异性强,重复性和敏感性较好,简单迅速,有希望用于脑囊虫病的临床诊断。     

缺氧缺血性脑病患儿其血浆和脑脊液中NO及SOD的含量及意义

目的探讨新生儿缺氧缺血性脑病(HIE)血浆和脑脊液(CSF)中的一氧化氮(NO)和超氧化物歧化酶(SOD)含量变化及其HIE不同时期和不同程度间的相关关系.方法对HIE患儿第3天的CSF和初入院(HIE 2 h内)、第1天、第3天、恢复期的血浆中NO、SOD进行检测,并与正常对照组比较;分析NO和SOD的变化原因和意义.结果HIE患儿血浆中第1天的NO含量最高,而SOD相反;初入院、第1天、第3天的血浆中NO和SOD含量与正常对照组对比均有统计学意义(P＜0.01),而恢复期中NO和SOD含量与正常对照组对比无统计学意义(P＞0.05),血浆和HIE第3天的CSF中NO和SOD水平均呈负相关;病情越重NO浓度越高,SOD越低.结论NO,SOD参与HIE的发病过程,在HIE的发病过程中起着重要作用.