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.     

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。     

血清cTnI、HCY、PCT在多发性创伤患者病情严重程度中的诊断价值及与预后的关系

目的探讨血清中肌钙蛋白I(cTnI)、同型半胱氨酸(HCY)、降钙素原(PCT)水平与患者病情及预后的关系。方法选取我院于2015年11月-2018年11月收治的多发性创伤患者126例作为研究对象,并依据创伤严重程度评分量表(ISS)分为重症组(ISS评分>25分)60例,轻症组(ISS评分≤25分)66例;选择同期于我院进行健康体检者58例作为对照组。分别于治疗前和治疗后6个月,采用化学发光免疫分析法测定两组患者血清中cT-nI、HCY及PCT的水平,采用急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ)和简化急性生理学Ⅱ评分(SAPSⅡ)对患者进行评分。根据随访6个月期间的存活情况将重症组患者分为死亡组25例和存活组35柄,分析两组血清cTnI、HCY及PCT水平。采用Spearman分析患者血清cTnI、HCY及PCT水平与APACHEⅡ、SAPSⅡ评分的相关性;Logistic回归分析多发性创伤患者预后的影响因素;ROC曲线分析cTnI、HCY及PCT用于预测多发性创伤患者的预后情况。结果多发性创伤轻症组和重症组患者血清cTnI、HCY及PCT水平均高于健康对照组,重症组高于轻症组,差异均有统计学意义(P<0.05)。治疗后轻症组和重症组cTnI、HCY及PCT水平均显著低于各自治疗前(P<0.05),而治疗后轻症组与健康对照组差异无统计学意义(P>0.05)。死亡组患者血清cTnI、HCY及PCT水平显著高于存活组(P<0.05)。各时间点轻症组APACHEⅡ评分和SAPSⅡ评分均显著低于重症组,差异有统计学意义(P><0.05);治疗后轻症组和重症组两种评分均显著降低(P<0.05)。患者血清cT-nI、HCY及PCT水平分别与APACHEⅡ评分和SAPSⅡ评分均呈显著性正相关(均P<0.0001)。多因素Logistic回归分析结果显示,cTnI(OR=2.356,95%CI:1.769-2.841)、HCY(OR=3.480,95%CI:2.043-4.125)以及.PCT(OR=2.207,95%CI:1.612~3.536)均为影响多发性创伤患者预后的独立危险因素。ROC曲线分析显示,血清cTnI、HCY及PCT最佳临界值分别为0.036 ng/mL、21.37μmol/L和0.81 ng/mL,曲线下面积分别为0.865、0.840和0.803,对预测多发性创伤预后不良均有较高的灵敏度和特异性;cTnI+HCY+PCT三者联合AUC为0.904,灵敏度为93.1%,特异度为88.1%。结论血清cTnI、HCY及PCT水平三者联合可作为早期判断多发性创伤患者损伤程度及预后评估的重要临床指标。     

乌司他丁对泌尿系脓毒性休克患者血清PCT及 IL-6水平的影响

目的 :探讨乌司他丁对泌尿系脓毒性休克患者血清中前降钙素(procalcitonin,PCT)及白细胞介素-6(interleukin-6,IL-6)水平的影响。 方法 :选取30例泌尿系脓毒性休克患者,随机分为两组,每组15例,均给予常规抗休克和病因治疗。在此基础上,治疗组加用乌司他丁20万U溶于20 mL生理盐水中静脉注射,每天1次,连续3 d;对照组予以等量生理盐水作为安慰剂对照。另设正常对照组30例。应用双抗体夹心免疫发光法及双抗体夹心酶联免疫吸附法分别测定三组血清PCT及IL-6的含量。 结果 :PCT和IL-6水平在泌尿系脓毒性休克患者组显著高于正常对照组,且急性期显著高于恢复期,死亡组高于存活组。与安慰剂对照组相比,治疗组应用乌司他丁后,不同时相点的PCT、IL-6均明显降低(P<0.05,P<0.01)。 结论 :PCT和IL-6在泌尿系脓毒症发病机制中起预警作用,对该疾病的早期诊断及预后判断有重要应用价值。乌司他丁可降低泌尿系脓毒性休克患者血清PCT、IL-6水平,可改善泌尿系脓毒性休克患者的病情