成人体外循环心脏手术后急性肾损伤发生的危险因素及其早期预测价值

目的探讨成人体外循环(CPB)心脏术后急性肾损伤(AKI)发生的危险因素及其预测价值。方法回顾性分析2019年6月至2020年4月西南医科大学附属医院心脏大血管外科收治的170例行CPB心脏手术患者资料,根据术后是否发生AKI分为AKI组和非AKI组。对患者临床资料进行单因素分析筛选后将有意义的变量进行多因素Logistic回归分析,采用受试者工作特征(ROC)曲线分析危险因素对成人CPB心脏手术术后发生AKI的预测价值。结果共入选170例患者,其中47例患者发生AKI(27.6%)。AKI组和非AKI组间性别构成、ICU住院时间、高血压比例和冠心病比例差异有统计学意义(P<0.05);术前血肌酐(sCr)、血尿酸、血白细胞(WBC)、淋巴细胞和心功能分级差异有统计学意义(P<0.05),术后WBC、C-反应蛋白(CRP)、降钙素原(PCT)、sCr、尿酸、淋巴细胞和中性粒细胞差异均有统计学意义(P<0.01)。拟合多因素Logistic回归模型分析发现,术前s Cr、术后CRP、术后PCT和高血压是术后发生AKI的独立危险因子;ROC多因素联合分析发现,患者术前sCr、术后PCT截断值同时分别达到>71.6μmol/L、>4.83 ng/m L时,预测成人CPB心脏术后发生AKI的特异度为91.1%,而两者中任意一项达到截断值时,预测发生AKI的敏感度为93.2%。结论术前s Cr、术后PCT对成人CPB心脏手术AKI发生有预测价值,两者联合可提高预测的敏感度和特异度。     

PCT、Fb和CRP检测在感染性疾病诊断中的应用

目的：探讨降钙素原（PCT）、纤维蛋白原（n）、C反应蛋白（CRP）检测在早期细菌性感染的诊断价值。方法：采用半定量的胶体金免疫结合法检测血清PCT,磁珠凝固法检测血浆Fb,免疫荧光比色法测定全血CRP水平。分别对细菌感染组91例,非细菌感染组108例,非感染组40例（对照组）进行PCT、Fb和CRP的测定。并同时检测白细胞计数和分类。结果：以血清PCT〉10．5ng／ml、Fb〉4．Og／L、CRP〉8．0mg／L为阳性阈值,细菌感染组PCT的阳性率为98．9％、浓度分别为（O．5～〈2．0）、（2．0～〈10）ng／ml、≥10ng／ml三个级别间;Fb的阳性率为93．4％,浓度为（6．19±1．44）g／L;CRP的阳性率为100％,浓度为（150．5±56．6）mg／L。非细菌感染组PCT的阳性率为18．5％,浓度为（0．5-〈2．0）ng／ml;Fb的阳性率为48．1％,浓度为（4．01±1．18）g／L;CRP的阳性率为47．2％,浓度为（48．9±5．61）mg／L。细菌感染组PCT阳性率明显高于非细菌感染组（P〈0．01）;n、CRP水平明显高于非细菌感染组（P〈0．01,P〈0．01）。非细菌感染组Fb、CRP水平明显高于非感染组（2．58±0．32）g／L（P〈0．01）,Cae（14．5±0．3）mg／L（P〈0．01）。结论：PCT、Fb、CRP联检可作为早期细菌性感染的敏感诊断指标,指导临床合理用药和治疗。     

sTREM-1、IL-17、PCT及PA联合检测在重症肺炎中的诊断价值

目的探讨可溶性髓系细胞表达的触发受体-1(s TREM-1)、白介素17(IL-17)、降钙素原(PCT)、前白蛋白(PA)联合检测在重症肺炎(SP)中的诊断价值。方法采用双抗体夹心酶联免疫法(ELISA)、免疫比浊法检测120例SP患者(SP组)、50例健康体检者(对照组)血清中s TREM-1、IL-17、PCT及PA水平,比较不同预后患者上述生物标志物水平的变化,分析其与SP的相关性。测定并比较不同检测方法的敏感性、特异性、准确率、阳性预测值、阴性预测值等指标。结果 SP组s TREM-1、IL-17、PCT水平明显高于对照组,而PA水平则明显降低(P0.05);治疗后,存活亚组第3天、第7天及出院当天s TREM-1水平均较第1天明显降低,且均明显低于同时期死亡亚组(P0.05);死亡亚组第1天、第3天、第7天s TREM-1水平无明显差异(P0.05),死亡当天水平明显升高(P0.05);联合检测的敏感性、特异性、准确率、阴性预测值分别为84.2%、94.0%、87.1%、71.2%,明显高于s TREM-1、IL-17、PCT及PA任一单项检测的敏感性、特异性、准确率及阴性预测值(P0.05)。结论 SP患者血清s TREM-1、IL-17、PCT水平明显升高,PA水平明显降低,与SP及其病情严重程度密切相关。联合检测可提高SP的早期诊断率并指导疗效评估。     

降钙素原在慢性阻塞性肺疾病急性加重期诊治中的应用

目的探讨降钙素原（PCT）在慢性阻塞性肺疾病（COPD）急性加重期诊治中的应用价值。方法将本院2011年5月～2012年7月的COPD急性加重期患者65例,分有细菌感染组（A组,33例）、无细菌感染组（B组,32例）。治疗前及治疗病情稳定后分别检测血清PCT水平测定并进行痰培养观察分析。结果A组患者急性加重期的降钙素原水平明显高于稳定期（P〈0．05）,B组患者两个阶段降钙素原水平无统计学差异（P〉0．05）。A组患者急性加重期PCT平均水平明显高于稳定期（P〈0．05）;B组患者两阶段平均水平无统计学差异（P〉0．05）。A组患者急性加重期PCT水平明显高于B组（P〈0．05）,稳定期无明显差异（P〉0．05）。65例患者急性加重期内痰培养显示31例PPM,其中19例细菌载量≥10^7CFU／mL;稳定期痰培养显示20例PPM,其中8例细菌载量≥10^7CFU／nlL,细菌浓度为2．3×10^6CFu／mL,明显低于急性加重期（P〈0．05）。结论血清降钙素原水平在慢性阻塞性肺疾病急性加重期升高可能与细菌感染有关。     

N-乙酰半胱氨酸雾化吸入治疗对重度AECOPD患者血液中CRP和PCT水平的临床观察

目的探讨急性加重期慢性阻塞性肺疾病(AECOPD)使用N-乙酰半胱氨酸(NAC)雾化吸入治疗的临床效果。方法 120例IV级AECOPD患者随机分为干预组和对照组各60例,治疗0天和10天后观察比较两组的生活质量评分、血气指标及第1s用力呼气容积(FEV1)占预计值%以及血中CRP和PCT水平。结果治疗10天后,两组患者生活质量评分、血气分析各指标及FEV1占预计值%均有明显好转(均P<0.05),且干预组较对照组改善更加明显,差异有统计学意义(均P<0.05)。同时还发现,治疗后AECOPD患者血中CRP和PCT水平较治疗前下降(均P<0.05),且干预组下降更明显,差异有统计学意义(均P<0.05)。结论 N-乙酰半胱氨酸雾化吸入可辅助改善AECOPD患者的临床症状和肺功能,并能减轻炎症,且不良反应较轻,可用于AECOPD的临床治疗。     

Kawasaki disease is associated with sensorineural hearing loss: A systematic review

Context

Kawasaki Disease (KD), a systemic vasculitis of unknown etiology, has been associated with the development of sensorineural hearing loss (SNHL). KD is primarily a disease of young children, who are the most susceptible to complications from even minimal hearing loss. If there is a connection between KD and the development of SNHL, a better understanding of this relationship may improve our management of this disease and its complications.

Objective

To perform a systematic review according to a standardized guideline to evaluate the possible association between KD and SNHL.

Data sources

Medline and PubMed online databases were reviewed for appropriate articles.

Study selection

All studies available in English discussing KD and SNHL were included.

Data extraction

Studies were assessed primarily for the incidence of SNHL. Where possible, they were assessed for the degree and laterality of the loss, length of follow up and change in hearing over time.

Results

8 studies meeting the criteria were assessed. 3 were case reports, 1 was a case series and the remaining 4 were prospective control trials. 8 patients have been reported as cases, and 240 assessed in PCT. 36% of patients assessed had some degree of SNHL, and overall 14% had evidence of persistent SNHL at follow up.

Conclusions

This systematic review would suggest there is an association between KD and SNHL. It is important for physicians caring for patients with KD to be aware of this complication and consider screening these patients given possible complications of hearing loss in this age group.     

Can we predict pneumococcal bacteremia in patients with severe community-acquired pneumonia?

Purpose

This study aimed to evaluate the role of biomarkers as markers of pneumococcal bacteremia in severe community-acquired pneumonia (SCAP).

Materials and Methods

A prospective, single-center, observational cohort study of 108 patients with SCAP admitted to the intensive care department of a university hospital in Portugal was conducted. Leucocytes, C-reactive protein (CRP), lactate, procalcitonin (PCT), d-dimer, brain natriuretic peptide (BNP), and cortisol were measured within 12 hours after the first antibiotic dose.

Results

Fifteen patients (14%) had bacteremic pneumococcal pneumonia (BPP). They had significantly higher levels of median CRP (301 [interquartile range, or IQR], 230-350] mg/L vs 201 [IQR, 103-299] mg/L; P = .023), PCT (40 [IQR, 25-102] ng/mL vs 8 [IQR, 2-26] ng/mL; P < .001), BNP (568 [IQR, 478-2841] pg/mL vs 407 [IQR, 175-989] pg/mL; P = .027), and lactate (5.5 [IQR, 4.5-9.8] mmol/L vs 3.1 [IQR, 1.9-6.2] mmol/L; P = .009) than did patients without BPP. The discriminatory power evaluated by the area under the receiver operating characteristic curve (aROC) for PCT (aROC, 0.79) was superior to lactate (aROC, 0.71), BNP (aROC, 0.67), and CRP (aROC, 0.70). At a cutoff point of 17 ng/mL, PCT showed a sensitivity of 87%, a specificity of 67%, a positive predictive value of 30% and a negative predictive value of 97%, as a marker of pneumococcal bacteremia.

Conclusions

In this cohort, significantly higher PCT, BNP, lactate, and CRP levels were found in BPP, and PCT presented the best ability to identify pneumococcal bacteremia. A PCT serum level lower than 17 ng/mL could identify patients with SCAP unlikely to have pneumococcal bacteremia.     

Serum concentrations of A Proliferation-Inducing Ligand (APRIL) are elevated in sepsis and predict mortality in critically ill patients

Introduction

Inflammatory and autoimmune diseases have been associated with the tumor necrosis factor superfamily member “A PRoliferation Inducing Ligand” (APRIL). However, up to now, APRIL has not been investigated in critical illness or sepsis. We therefore analyzed APRIL serum concentrations in a large cohort of well-characterized intensive care unit patients.

Methods

Serum concentrations of APRIL were measured in 246 critically ill patients, of which 157 fulfilled sepsis criteria in comparison with 81 healthy controls. Clinical data were recorded and correlated with APRIL serum levels.

Results

We detected strongly elevated serum levels of APRIL in critically ill patients compared with healthy controls. Levels of APRIL were further elevated in sepsis and significantly correlated with classical markers of inflammation, bacterial infection, or multiorgan failure. Consequently, high APRIL levels were associated with an unfavorable prognosis and predicted mortality with higher diagnostic accuracy than established prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II score.

Conclusion

Serum levels of APRIL were significantly elevated in intensive care unit patients, with the highest concentrations in septic patients, and associated with unfavorable outcome. Besides being used as a single marker, APRIL may be implemented into established scoring systems to further improve their sensitivity and specificity in predicting patient's prognosis.     

血清PCT、sTREM-1及乳酸测定在重症肺炎中的临床意义

目的探讨血清降钙素原（PCT）、人可溶性髓系细胞触发受体-1（sTREM-1）和乳酸水平在重症肺炎中的临床测定意义,为重症肺炎的诊断和判断预后提供参考。方法选取2012年4月至2013年1月年本院收治的88例重症肺炎患者,在入院后的第1、4、7天分别进行PCT、sTREM-1和乳酸水平的检测,根据预后将88例重症患者分为死亡组和存活组来进行比较和分析。结果 88例患者中死亡25例,存活63例。死亡组第4、7天的PCT值、sTREM-1值和乳酸值分别为明显高于存活组,差异具有统计学意义（P〈0.05）。结论动态监测血清中的PCT、sTREM-1和乳酸的水平有助于判定重症肺炎的病情程度和预后,可应用于临床。     

浅谈PCT在少数民族院校口腔科学教学中的应用

口腔科学教学通常以向学生讲授为主，影响教学效果，而CT教学方法可发挥学生的主动性，教学方法灵活。本阐述了PCT教学在少数民族院校口腔科学教学中应用及以取得的良好教学效果。