创伤患者血浆降钙素原与创伤严重程度全身性感染器官衰竭及死亡率之间关系的研究

目的分析比较创伤患者血浆降钙素原(PCT)水平和全身炎症反应综合征(SIRS)、感染、多器官功能障碍综合征(MODS)的发生率和严重程度,并评估PCT对这些创伤后并发症的预测价值.方法对急诊抢救和入住重症监护病房(ICU)的机械性创伤患者在创伤严重程度、感染性并发症的发生、器官功能不全及死亡率等方面进行回顾性分析,在入院当天和第1、3、5、7、10、14和21天分别采集血标本,采用免疫发光法检测血浆PCT.结果机械性创伤导致的血浆PCT升高与创伤严重程度相关,在第1～3天达到峰值,并在21 d内逐渐下降.与没有发生SIRS的患者相比,发生SIRS患者的血浆PCT水平升高显著(P＜0.05).在创伤后第1天,创伤后病情平稳的患者血浆PCT水平为1.0±0.3μg/L,而伴有全身性感染、多器官功能不全患者的血浆PCT水平分别为7.0±3.2、5.5±2.6μg/L,且其在创伤早期血浆PCT浓度最高,并维持在高水平约10～14 d.创伤后3 d内血浆PCT水平升高预示严重的SIRS、全身性感染和MODS的发生(P＜0.0001).结论PCT水平升高可以作为一项对创伤患者发生全身性感染和MODS敏感的和有预测意义的指标,常规监测血浆PCT有助于早期认识创伤后并发症.因此,PCT可以作为一个有价值的指标来监测高危创伤患者的炎症状态.     

The pathogenesis of renal cortical tumours in rats fed 2% trisodium nitrilotriacetate monohydrate

To help assess the relationship between the renal toxicity and tumorigenicity associated with the administration of high doses of nitrilotriacetate (NTA) we have reviewed slides of sections from the kidneys of rats used in the National Cancer Institute bioassay of NTA. Trisodium NTA fed to Fischer 344 rats at 2% in the diet for 2 yr exerts a persistent toxic effect on the renal cortex which is manifested morphologically as vacuolation of proximal convoluted tubular epithelium and exacerbation of age-related nephrosis. Additionally, two pathogenic pathways leading to tumour formation in NTA-treated rats are suggested. A specific pathway initiated by vacuolation of proximal convoluted tubular epithelium leads to hyperplasia; reasons are advanced for the view that hyperplasia progresses to neoplasia. A possible concomitant pathway, which we suggest is nonspecific, is associated with regenerative proliferation in kidneys affected by severe age-related nephrosis. These data support the concept that there is a causal relationship between NTA-associated tubular toxicity and tumorigenicity. Doses of NTA that do not induce toxicity do not induce tubular tumours as demonstrated in this and in two other major long-term studies. Hence studies to investigate the pathogenesis of the toxic response provide an insight that suggests the basis for the development of NTA-associated tumours.     

降钙素原--细菌感染全身反应的新指标

细菌感染的常用监测指标缺乏特异性和敏感性。本文就降钙素原(procalcitonin,PCT)的生化特点、临床应用及 其与CRP、细胞因子的比较展开讨论,为推广PCT在临床的应用提供参考。     

Should the post-coital test (PCT) be part of the routine fertility work-up?

BACKGROUND: This study aimed to determine whether medical history and semen analysis can predict the result of the post-coital test (PCT). METHODS: A previously reported data set of Dutch patients collected between 1985 and 1993 was used. Our study was limited to just patients with an ovulatory cycle. Data were complete for medical history, semen analysis and PCT. We performed logistic regression analysis to evaluate whether these factors could predict the result of the PCT (PCT model). Furthermore, we evaluated the additional contribution of the PCT in the prediction of treatment-independent pregnancy (pregnancy model). RESULTS: Thirty-four percent (179 out of 522) had an abnormal PCT. The PCT model contained previous pregnancy [odds ratio (OR) 2.1; 95% confidence interval (CI) 1.3-3.5], semen volume (OR 0.88; 95% CI 0.77-0.99), sperm concentration (OR 0.96; 95% CI 0.94-0.97), sperm motility (OR 0.97; 95% CI 0.96-0.98) and sperm morphology (OR 2.7; 95% CI 1.2-6.8). The area under the ROC curve of the model was 0.81. In the pregnancy model, the result of the actual PCT could be replaced by the predicted result of the PCT model in about half of the couples, without compromising its predictive capacity. CONCLUSION: The medical history and semen analysis can predict the result of the PCT in approximately 50% of the subfertile couples with a regular cycle, without compromising its potential to predict pregnancy.     

联合丙氨酰谷氨酰胺的营养制剂对伴有降钙素原升高的闭合性颅脑损伤患者治疗的临床意义

目的 探讨联合丙氨酰谷氨酰胺的营养制剂对伴有降钙素原(PCT)升高的重度颅脑损伤患者后续治疗中PCT及内毒素的影响。方法 入选60例伴有PCT升高的重度颅脑损伤患者,随机分为两组,其中实验组给予联合丙氨酰谷氨酰胺的肠外营养制剂,对照组给予不联合丙氨酰谷氨酰胺的常规治疗。连续监测1-7天PCT及血清内毒素水平的变化。结果 给予联合丙氨酰谷氨酰胺的营养制剂的实验组患者在后续治疗中PCT、内毒素水平明显低于对照组(P<0.05)。结论 闭合性颅脑损伤等“非感染”创伤患者PCT升高来源于肠源性感染;联合丙氨酰谷氨酰胺的肠外营养制剂可改善肠屏障功能从而减少PCT及内毒素的水平,从而在一定程度上减少了内毒素血症乃至脓毒症的发生。     

慢性阻塞性肺疾病急性加重期患者血清PCT、CRP动态变化及回归分析

目的探讨慢性阻塞性肺疾病急性加重期患者(AECOPD)血清降钙素原(Procalcitonin,PCT)和C反应蛋白(c-reactive protein,CRP)的动态变化,并分析其临床意义。方法选择我院收治的82例AECOPD患者,在入院第1、3、5、7、9天抽取静脉血,动态检测所有患者的血清CRP及PCT水平,并对结果取对数(LN)后进行线性回归分析。同时根据是否合并肺炎,进行多元线性回归的亚组分析。结果患者LN(PCT)的值与时间相关,有统计学意义(P值0.05),并得到回归方程:LN(PCT)=2.37-0.46 day。同时LN(CRP)的值与时间相关,有统计学意义(P值0.05),并得到回归方程:LN(CRP)=5.01-0.30day。方程代入正常值可知,AECOPD患者PCT恢复至正常值较CRP恢复至正常值早3.11天。同时对是否合并肺炎进行亚组分析,统计得出LN(PCT)及LN(CRP)的数值分别与天数(day)以及合并肺炎与否(pneu)两个变量相关(P0.05)。PCT的方程为:LN(PCT)=1.91-0.46day+0.68pneu,CRP的方程为:LN(CRP)=4.66-0.30day+0.53pneu。将正常值带入方程可知合并肺炎组(A组)比不合并肺炎组(B组)患者PCT指标恢复到正常值早1.48天,CRP指标恢复到正常值早1.77天。结论合并肺炎的AECOPD患者,血清PCT、CRP恢复时间更长。同时,血清PCT在AECOPD患者的恢复过程中,较CRP更为灵敏,动态监测PCT能有助于确定抗生素的停药时间,减少抗生素的滥用。     

血清PCT、sTREM-1对肺癌术后并发肺部细菌感染诊断及疗效评估的价值

目的 探讨血清PCT、sTREM-1对肺癌术后并发肺部细菌感染诊断及疗效评估的价值.方法 选择行手术治疗的肺癌患者216例的临床资料进行回顾性分析,其中23例发生术后肺部感染.比较感染患者与未感染患者、治疗好转组与未好转组、好转组治疗前后血清PCT、sTREM-1水平以及CRP水平、乳酸水平等.结果 感染组在术后24 h以及48 h后CRP、乳酸、PCT以及sTREM-1均显著高于未感染组,差异有统计学意义(P＜0.05).治疗未好转亚组在术后24 h、术后48 h、感染时、感染后24 h以及感染后48 h CRP、乳酸、PCT以及sTREM-1均显著高于治疗好转亚组,差异有统计学意义(P＜0.05).治疗后,治疗好转组CRP、乳酸、PCT以及sTREM-1显著低于治疗前,差异有统计学意义(P＜0.05).结论 动态监测患者PCT、sTREM-1能够及时评估肺癌患者术后发生肺部细菌感染的风险,及时诊断肺部细菌感染,并评估治疗效果.     

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures

BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity.AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery.Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4).ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM.ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.