王家岭3·28透水事故获救矿工消化功能的分析

目的分析长期饥饿应激条件对消化系统的影响。方法2010年3月28日王家岭煤矿透水事故中153名矿工,被困井下,处于断食、应激状态。8d后115例矿工获救并住院,均男性,年龄（38．7±7．6）岁（19。54岁）。观察其消化系统症状,入院后连续7～10d检测转氨酶、胆红索、脂肪酶、淀粉酶、电解质等生化指标。结果115例矿工中,21例矿工表现腹部不适和腹痛,有2例矿工表现恶心,但未有呕吐等症状;49．6％的矿工有低白蛋白血症;33．3％的矿工丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）增高;40．3％的矿工总胆红素增高;74．5％的矿工有电解质异常,表现为低钠血症、低钾血症和,或低钙血症。结论长时间的饥饿应激可致低白蛋白血症及血生化紊乱,循序渐进的进食方案及补液治疗有助于恢复。     

Two rare cases of benign hyperlipasemia in children

Gullo’s syndrome is a newly identified condition characterized by a chronic elevation of pancreatic amylase and/or lipase in the absence of pancreatic disease. Until now, only one case of benign isolated hyperlipasemia in children has been recorded. We describe two children with benign and not familial increase of serum lipase. Case 1: a six year old girl presented with occasional discovery of serum lipase elevation. Medical history was silent for pancreatic hyperenzymemia. The screening for possible causes for elevated lipase (genetic, autoimmune and infectious diseases) was normal. The serum lipase increased three fold over the upper limit (193 U/L; reference range 0-60 U/L), with daily fluctuation of values. Both ultrasound scan and magnetic resonance imaging were normal. The genetic mutation associated with chronic pancreatitis was negative. We followed up this patient for two years with blood tests every six months and she did not show any signs or symptoms of pancreatic disease, except for the high level of lipase serum. Case 2: an eight year old girl complained of nausea, vomiting and severe abdominal pain in the epigastric region after eating for the last two weeks. Full blood count, electrolytes, C-reactive protein, liver and renal function were normal. Serum lipase was 96 U/L (reference range 0-60 U/L). The screening for the possible causes of pancreatic disease was negative. Endoscopy of the upper gastrointestinal tract, ultrasound, computed tomography scan and magnetic resonance imaging were normal. One year after the presentation of the symptoms, the patient became asymptomatic although the level of serum lipase continued to be high.     

Stability of human α-salivary amylase in aged forensic samples

The unequivocal tissue identification in forensic casework samples is a key step for crime scene reconstruction. Just knowing the origin of a fluid can sometimes be enough to either prove or disprove a fact in court. Despite the importance of this test, very few data are available in literature concerning human saliva identification in old forensic caseworks. In this work the stability of human α-amylase activity in aged samples is described by using three different methods integrated with DNA profiling techniques. This analytical protocol was successfully applied on 26-years old samples coming from anonymous threat letters sent to prosecutors who were working on “the Monster of Florence”, a case of serial murders happened around Florence (Italy) between 1968 and 1985.     

血清淀粉酶同工酶谱诊断胰胆管连接异常的初步临床应用

目的 通过血清淀粉酶同工酶谱检测诊断伴有胆管轻度扩张的胰胆管连接异常。方法 采仪式 8例胆管轻度扩张并经术中造影证实PBM的患儿术前、术后血清,另取8例正常儿童血清作对照,应用不连续缓冲系统苤膜电泳法行酶谱分析。结果 政党组仅存在P1和P2,PBM患儿术前血清淀粉酶同工酶波峰除有P1和P2外,还出现P3,P4、P5等异常波峰,无优势波峰,该血清酶学异常在胰胆分流术后基本消失,结论 PBM患儿即使仅伴有胆管轻度扩张。其血清淀粉酶同工酶谱仍存在异常,具一定特异性,有助于PBM的临床诊断。     

脂肪酶抑制剂产生菌筛选

为了开发减肥用品的微生物菌种 ,用脂肪酶活性为筛选模型分别以肉汤培养基和马铃薯培养基培养土壤分离获得 1 1个菌株LA、LB、LC、LD、LE、LF、LG、MA、MB、MC和MD ,且同时考察了各菌株发酵液对淀粉酶、蛋白酶的抑制效果 ,结果表明LC、LE、LF、LG、MC和MD对淀粉酶有抑制作用 ,其抑制率分别为3 7%、5 8%、32 %、3 2 %、70 2 %和 73 5 % ;LA、LB、LC、MB对蛋白酶有抑制效果 ,抑制率分别为 55 %、31 2 5 %、37 5 %和 2 7 3 % ;LA、LB、LC、LD、LE、LF、MC和MD对脂肪酶有抑制效果 ,抑制率分别为 79%、54 8%、2 0 9%、1 2 9%、61 3 %、80 6 %、2 4 7%和 35 1 %。菌种LF对脂肪酶有较强的抑制作用 ,对淀粉酶抑制作用较小 ,对蛋白酶没有抑制作用。初步鉴定该菌属于芽孢杆菌属 ,命名为BacillusspLF。     

柴芩承气汤对急性重症胰腺炎的疗效观察及部分机制

目的:探究柴芩承气汤加减联合西医治疗急性重症胰腺炎的临床效果,并对其作用机制进行研究,以期丰富治疗方法,降低急性重症胰腺炎并发症,提高疗效。方法:选取2017年1月至2018年2月绵阳市中心医院收治的急性重症胰腺炎患者62例作为研究对象,按照就诊顺序编号,采用数字随机表法分为对照组和观察组,每组31例。对照组给予心电监护、禁食禁饮、胃肠减压、抑酸、维持内环境稳定、抗菌、抑制胰腺分泌和胰腺活性、止痛等治疗,观察组在对照组基础上加用柴芩承气汤加减治疗,且经胃管给药,均同时治疗2周。观察2组治疗前、治疗后血清淀粉酶、脂肪酶变化并比较;观察治疗前、治疗后在白细胞(WBC)、超敏C反应蛋白(hs-CRP)、内毒素、白细胞介素-6(IL-6)变化并比较;观察治疗前、治疗后在免疫功能指标CD4~+、CD8~+、CD4~+/CD8~+情况并比较;治疗过程中进行不良反应观察并比较;治疗后进行疗效比较。结果:1)2组患者治疗前血淀粉酶、尿淀粉酶、脂肪酶比较,差异无统计学意义(P0.05),治疗后2组以上指标较治疗前显著下降,差异有统计学意义(P0.05),治疗后观察组患者以上指标显著低于对照组,差异有统计学意义(P0.05);2)2组患者治疗前WBC、CRP、内毒素、IL-6指标比较,差异无统计学意义(P0.05),治疗后以上指标2组较治疗前均显著下降,差异有统计学意义(P0.05),治疗后观察组患者以上指标显著低于对照组,差异有统计学意义(P0.05)。3)2组患者治疗前CD4~+、CD8~+、CD4~+/CD8~+比较,差异无统计学意义(P0.05),治疗后CD4~+、CD8~+、CD4~+/CD8~+2组较治疗前显著升高,CD8~+则显著下降,差异有统计学意义(P0.05),治疗后观察组患者以上指标显著优于对照组,差异有统计学意义(P0.05)。4)完成治疗后观察组患者治愈率、总有效率明显高于对照组,差异有统计学意义(P0.05)。5)2组恶心呕吐、腹痛腹泻、头晕不良反应发生率比较,差异无统计学意义(P0.05)。结论:柴芩承气汤能抑制急性重症胰腺炎血清淀粉酶和脂肪酶,抑制炎性反应,改善免疫力,提高疗效。     

联合检测血清PCT、IL-6、CRP、AMY 及LPS对急性胰腺炎的诊断价值

目的 通过检测急性胰腺炎（AP）患者外周血清降钙素原（PCT）、白细胞介素6（IL-6）、C反应蛋白（CRP）、淀粉酶（AMY）和脂肪酶（LPS）的水平,分析这5种血清指标联合检测在AP临床诊断中的价值。 方法 选取2015年1月～2017年1月在成都上锦南府医院确诊为急性胰腺炎患者117例为观察组,其中重症急性胰腺炎患者（SAP）62例,轻症急性胰腺炎患者（MAP）55例。另选取同期体检健康者110例为对照组。检测SAP者、MAP者和对照组血清中PCT、IL-6、CRP、AMY和LPS的浓度,并比较水平差异。 结果 SAP者及MAP者的PCT、IL-6、CRP、AMY和LPS水平均显著高于对照组（均P＜0.05）。SAP者的PCT、IL-6、CRP水平均高于MAP者（P＜0.05）,而AMY、LPS水平比较,差异无统计学意义（P＞0.05）。PCT、IL-6、CRP、AMY和LPS的ROC曲线面积分为0.72、0.87、0.84、0.88、0.86,灵敏度分别为为60.40%、71.80%、67.50%、70.90%、78.60%,特异度分别为82.70%、86.40%、90.90%、88.20%、85.50%。多种血清指标联合检测对AP诊断的曲线面积为0.97,灵敏度为86.80%,特异度为99.10%。 结论 血清PCT、IL-6、CRP、AMY及LPS指标联合检测对AP的诊断具有较高的敏感性和特异性,可有效提升AP患者的临床诊断准确率,可在临床推广、应用。     

Extrinsic compression of pancreactic duct by intragastric balloon treatment and its potential to cause acute pancreatitis: two case reports and clinical discussion

We describe two cases of increased pancreatic enzyme levels after intragastric balloon (IGB) placement possibly related to extrinsic pancreatic duct compression, followed by a short review of the literature.Case 1 is the first, to our knowledge, of a patient with asymptomatic increase of pancreatic enzymes due to pancreatic duct compression, with unknown clinical significance. We hypothesize that this finding maybe can be relatively common in IGB users and almost certainly an important risk factor for the development of acute pancreatitis (AP). On the other hand, case 2 reports an AP that occurred one day after IGB placement, presented with nausea and vomiting, making AP a differential diagnosis of initial IGB intolerance.     

肾综合征出血热患者胰腺功能变化的临床研究

将６５例确诊为肾综合征出血热（ＨＦＲＳ）的住院患者列为观察组，选１０例正常者为对照组，监测ＨＦＲＳ患者各期的空腹血糖、血淀粉酶，脂肪酶及胰岛素含量并随机选出３０例ＨＦＲＳ患者，于发热末期或少尿期行口服葡萄糖耐量试验及胰岛素释放试验（口服７５ｇ糖）。发现ＨＦＲＳ患者在发热期即出现血糖、血淀粉酶，脂肪酶及胰岛素水平升高，服糖后胰岛素释放减少，糖耐量减低。此变化在少尿期最显著，多尿期次灾，恢复期渐正常，