血清降钙素原测定在慢性阻塞性肺疾病急性加重期治疗中的意义

目的 研究血清降钙素原(PCT)检测在慢性阻塞性肺疾病急性加重(AECOPD)患者治疗时抗生索使用中的临床意义.方法 选取2004年5月至2006年12月间收治入院的AECOPD患者235例,随机分配为常规治疗组117例(A组)和PCT指导治疗组118例(B组),入院后即用荧光增强发射法检测血清PCT水平.在相同常规治疗基础上,A组由经治医师按照抗生素使用指南决定抗生素治疗方案,B组按照血清PCT水平决定是否使用抗生素,在血清PCT≥0.25 mg/ml时,进行抗生素治疗,PCT＜0.25 ng/ml时,不予抗生素治疗.观察两组患者的住院时间、临床有效率、住院费用及抗生素费用、抗生素使用率、住院病死率、1年随访期间AECOPD发生率及住院率.采用:检验、Mann-Whitney U检验及X2检验进行统计学分析.结果 两组患者在临床有效率、住院病死率、住院时间及1年随访期间AECOPD发生率及住院率方面差异无统计学意义(P分别为0.635、0.768、0.884、0.747和0.727),PCT指导治疗组的抗生素费用、住院费用及抗生素使用率均低于常规治疗组(P分别为0.029,0.036和0.014).结论 AECOPD患者入院之初可以进行PCT水平检测以指导抗生素使用,能够降低抗生素使用率,减少用于抗生素使用的费用和总的住院费用.     

Adjusted Intensive Care Infection Score (ICISΔ)—A new approach for prediction of ascitic fluid infection in patients with cirrhosis

Background

Early and accurate diagnosis is the key to improving survival in cirrhotic patients with ascitic fluid infection.

Anti-HCV-core specific IgM in porphyria cutanea tarda

Aim Analysis of the prevalence of scrum IgM antibodies directed against the HCV-core antigen (HCV-IgM) in patients with Porphyria cutanea tarda (PCT), taking into account the hepatic histological picture, liver biochemical markers and the PCI biochemical indices. Background Hepatic damage, especially that due to HCV infection, has been previously reported as a PCT trigger. HCV-IgM reactivity, a marker of chronic HCV hepatitis, suggested to be related to active virus replication could also be related to the PCT clinical course. Methods Blood samples of 97 patients, previously analyzed for a panel of clinical, histological and laboratory variables, followed in our Centre for Porphyria. stored at - 80°C, were available to be retrospectively assayed for anti-HCV-core IgM (HCV-IgM. ELISA). Results 61% HCV-IgM positivity was found, with no apparent significant relationship with the respective histological hepatitis classification. PCT remission phase, and PCT familiarity, when evaluated on overall patients. The levels of HCV-IgM presented u peculiar behaviour when correlated to the serum AST values. In fact, there was a significant positive correlation in those with HCV-IgM < 4 and a not significant, inverse correlation in the remaining group. These two groups showed other differences: the HCV-IgM levels were correlated to histology, PCT remission and to the markers of liver disease (such as AST and ALT) only in the first group. Conclusion a relationship between IgM response, PCT activity and the underlying liver disease is suggested.     

胃疡宁丸联合瑞巴派特片治疗胃溃疡活动期的临床研究

目的探讨胃疡宁丸联合瑞巴派特片治疗胃溃疡活动期患者的临床疗效。方法选取2018年1月—2018年12月在中国人民解放军联勤保障部队第九八九医院治疗的胃溃疡活动期患者124例,随机分为对照组和治疗组,每组各62例。对照组口服瑞巴派特片,0.1 g/次,3次/d。治疗组在对照组基础上口服胃疡宁丸,3.0 g/次,3次/d。两组患者均治疗8周。观察两组患者临床疗效,同时比较治疗前后两组患者幽门螺杆菌(Hp)根除率及血清C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-8(IL-8)、胃泌素(GAS)、生长抑素(SS)、血管内皮生长因子(VEGF)和前列腺素E2(PGE2)水平。结果治疗后,对照组和治疗组临床有效率分别为79.03%和93.55%,两组比较差异有统计学意义(P0.05)。治疗后,对照组Hp根除率为77.42%,显著低于治疗组的91.94%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者血清CRP、PCT、IL-8、GAS、SS水平均显著降低(P0.05),而VEGF和PGE2水平显著升高(P0.05),且治疗组这些血清指标明显好于对照组,两组比较差异具有统计学意义(P0.05)。结论胃疡宁丸联合瑞巴派特片治疗胃溃疡活动期有更高的溃疡愈合率及幽门螺杆菌根除率,能有效的降低血清炎症因子。     

黄栀花口服液联合阿莫西林克拉维酸钾治疗小儿急性上呼吸道感染的临床研究

目的 探讨黄栀花口服液联合阿莫西林克拉维酸钾干混悬剂医治小儿急性上呼吸道感染的临床效果.方法 选取2017年1月—2018年1月在南阳市中心医院就诊的150例急性上呼吸道感染患儿,根据用药的差别分为治疗组、对照组(每组75名).对照组患儿口服阿莫西林克拉维酸钾干混悬剂,7～12岁儿童1袋半/次,2～7岁1袋/次,9个月...     

A diagnostic test: combined detection of heparin-binding protein,procalcitonin, and C-reactive protein to improve the diagnostic accuracy of bacterial respiratory tract infections

BackgroundRespiratory tract infection (RTI) is one of the most common diseases worldwide, and its incidence is rising year by year due to environmental pollution. Sputum culture remains the gold standard for RTI diagnosis, but its performance is limited by difficulties related to the sampling and testing of the sputum specimens. Heparin-binding protein (HBP), procalcitonin (PCT), and C-reaction protein (CRP) are Inflammatory markers. They have the advantage of being fast, accurate and reproducible, but limited by their sensitivity and specificity. We explored the clinical value of the combined detection of them in the diagnosis of bacterial RTIs.MethodsPatients who fulfilled the inclusion criteria were selected as the case group, healthy age- and sex-matched subjects were enrolled as a control group. The subjects’ HBP, PCT, and CRP levels were detected. The case group was further divided into two groups according to the bacterial culture results, and the differences in the markers were statistically analyzed. The receiver operating characteristic (ROC) curves were drawn, and the areas under the ROC curve (AUCs) were calculated to analyze the diagnostic values of each marker and their combination in parallel for bacterial RTIs.ResultsThe plasma HBP, PCT, and CRP levels of patients in the bacterial and non-bacterial infection groups were significantly higher than those of patients in the healthy control group, and were positively correlated to the severity of the disease. for HBP with an AUC of 0.785 [95% confidence interval (CI): 0.686–0.884], a sensitivity of 0.821, a specificity of 0.771; PCT with an AUC of 0.767 (95% CI: 0.664–0.870), a sensitivity of 0.773, a specificity of 0.791, and CRP with an AUC of 0.748 (95% CI: 0.642–0.854), a sensitivity of 0.839, a specificity of 0.696 in the bacterial and non-bacterial infection groups. The combined detection of HBP + CRP had the optimal diagnostic performance, with an AUC of 0.797 (95% CI: 0.698–0.895; P<0.001), a sensitivity of 0.809, a specificity of 0.800.ConclusionsThe combined detection of HBP and CRP is valuable for diagnosing bacterial RTIs and may guide the development of reasonable treatment protocols in clinical settings.     

支气管扩张合并感染患者血清suPAR、PCT和CRP水平及其临床意义

目的分析支气管扩张合并感染患者血清可溶性尿激酶型纤溶酶原激活物受体(soluble urokinase-type plasminogen activator receptor,suPAR)、降钙素原(procalcitonin,PCT)和C反应蛋白(C-reactive protein,CRP)水平的检测意义。方法收集2016年5月—2019年5月在广安市人民医院就诊的100例支气管扩张合并感染患者(研究组),根据病情严重程度将其分为轻度(n=23)、中度(n=56)、重度(n=21)3个亚组;将同期30例健康体检者纳入对照组。比较研究组各亚组间及研究组与对照组受试者血清suPAR、PCT、CRP水平差异,应用受试者工作特征曲线(receiver operating characteristic curve,ROC)及曲线下面积（area under curve,AUC）评价suPAR、PCT、CRP及三者联合对支气管扩张合并感染的诊断价值。结果研究组血清suPAR、PCT、CRP水平高于对照组(P<0.05);研究组各亚组间血清suPAR、PCT、CRP水平差异有统计学意义(P<0.05),各指标水平轻度组低于中、重度组,中度组低于重度组(P<0.05);血清suPAR、PCT、CRP水平与受试者是否患支气管扩张合并感染密切相关(P<0.05)。suPAR AUC为0.951(P<0.05),临界值为5.88 ng/mL,敏感性、特异性分别为0.850、1.000;PCT AUC为0.943(P<0.05),临界值为0.13 ng/mL,敏感性、特异性分别为0.860、0.967;CRP AUC为0.921(P<0.05),临界值为5.16 mg/L,敏感性、特异性分别为0.830、0.933;三者联合预测AUC为0.989,敏感度、特异度分别为0.950、1.000,优于各自单独预测(P<0.05)。结论血清suPAR、PCT、CRP水平升高与支气管扩张合并感染发生、发展密切相关,联合检测对支气管扩张合并感染诊断有一定价值。     

清胰承气汤保留灌肠治疗急性胰腺炎临床研究

目的:观察清胰承气汤保留灌肠治疗急性胰腺炎的临床疗效。方法:选取急性胰腺炎患者80例,按随机数字表法分为对照组和观察组各40例。对照组行西医常规入院治疗,观察组在对照组基础上给予清胰承气汤保留灌肠治疗。比较2组治疗前、治疗后第1、4、7天患者血清肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-2(IL-2)、白细胞介素-10(IL-10)、淀粉酶水平,评价临床疗效。结果:观察组总有效率为92.50%,高于对照组75.00%(P<0.05)。治疗前,2组血清各项指标比较,差异无统计学意义(P>0.05)。治疗后第1、4、7天,2组TNF-α、CRP、IL-6、PCT和淀粉酶水平较治疗前降低,IL-10水平较治疗前升高;且观察组TNF-α、CRP、IL-6、PCT和淀粉酶水平低于同时间点对照组,IL-10水平高于同时间点对照组;差异均有统计学意义(P<0.05)。观察组腹痛消失时间、腹胀消失时间、肠鸣音恢复时间、肛门首次排气时间和住院时间均小于对照组(P<0.05)。结论:清胰承气汤保留灌肠辅助治疗急性胰腺炎,能够显著促进患者恢复,提高疗效,治疗机制与抑制体内炎症反应有关。     

柴胡桂枝汤在小儿肠系膜淋巴结炎(脾胃湿热证)的临床研究影响

目的:探讨柴胡桂枝汤对肠系膜淋巴结炎患者疼痛及血清降钙原素(PCT)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平的影响。方法:选取2018年7月至2019年11月沧州中西医结合医院收治的肠系膜淋巴结炎(脾胃湿热证)患儿90例作为研究对象,按照随机数字表法随机分为对照组(n=40)和观察组(n=50)。对照组给予头孢克洛混悬剂治疗,观察组在对照组的基础上加用柴胡桂枝汤治疗,比较2组临床疗效。结果:观察组总有效率(90.00%)显著高于对照组(77.50%)(P0.05);与治疗前比,2组中医证候积分各积分及血清PCT、IL-6、IL-8水平均降低,且观察组显著低于对照组(P0.05);观察组各主次症消失时间均显著短于对照组(P0.05);与治疗前比,治疗后2组肠系膜淋巴结纵横径均缩短,且观察组显著短于对照组(P0.05);观察组不良反应总发生率(6.00%)显著低于对照组(20.00%)(P0.05)。结论:柴胡桂枝汤可有效治疗小儿肠系膜淋巴结炎,改善中医证候积分,加快症状消失时间,缓解疼痛,缩短患儿腹部肠系膜淋巴结纵横径大小,疗效显著。