血清降钙素原水平检测在脓毒症患者中的临床意义

目的探讨脓毒症患者检测血清降钙素原水平的临床意义。方法收集脓毒症患者100例入脓毒症组及健康体检成年人80例为对照组,检测脓毒症组和对照组血清降钙素原水平。脓毒症患者予以Sepsis集束化治疗及乌司他丁治疗。检测治疗前及治疗后PCT、CRP水平,及APACHEⅡ评分,探讨PCT水平变化及其与APACHEⅡ评分的关系,探讨不同预后患者PCT水平的差异。结果脓毒症患者血清PCT水平明显高于对照组(P<0.01),且随着治疗进展血浆PCT水平逐渐降低(P<0.01)。死亡患者PCT水平明显高于存活患者(P<0.05)且PCT与APACHEⅡ评分呈正相关(P<0.05)。结论血浆PCT水平对脓毒症患者的诊断及严重程度评价有重要价值。     

降钙素原检测对新生儿败血症早期诊断治疗及病情评估的临床意义

目的：探讨降钙素原（PCT）对新生儿败血症的早期诊断及病情评估的价值。方法：将2008年7月～2010年7月我院收治的新生儿败血症55例作为研究对象,其中合并休克的20例作为重症组,其余35例作为轻症组,将同期住院非败血症新生儿40例作为对照组,用免疫色谱法对比检测新生儿败血症与其他新生儿患者在入院时及住院抗生素治疗1周后血浆PCT及C反应蛋白（CRP）浓度的变化。结果：新生儿败血症患者入院时（急性期）PCT较对照组明显升高[（15.6±7.1）μg/L vs（0.8±0.4）μg/L]（P〈0.01）],经抗生素治疗1周后下降接近正常[（1.2±1.0）μg/L],与对照组比较差异无统计学意义（P〉0.05）;PCT的敏感性、特异性（89.0%、82.4%）均高于CRP（78.2%、69.6%）;新生儿败血症PCT重症较轻症患者明显增高（P〈0.01）。结论：PCT的检测对新生儿败血症的早期诊断、病情及治疗效果的评估有一定价值。     

血小板4项参数对慢性乙型肝炎预后的影响

目的:探讨血小板参数在慢性乙型肝炎患者预后中的意义.方法:收集我院2003年1月～2005年4月诊治的124例肝炎患者,分为3组,慢性乙型肝炎患者45例为甲组,重型肝炎早期患者42例为乙组,重型肝炎晚期患者37例为丙组.选取我院同时间段68例健康体检者为对照组.比较4组血小板4项参数血小板计数(PLT)、平均血小板体积...     

亚甲蓝衍生物光化学反应对人成骨肉瘤细胞细胞株灭活作用的实验研究

目的探讨光化学反应中不同浓度亚甲蓝衍生物(M007)对人成骨肉瘤细胞(MG-63)的灭活作用,提供将M007应用于肿瘤手术血液回收的前期研究基础。方法实验设空白(C)对照组、单纯光照(P)对照组、不作红光光照的M007对照组及实验组(M007-PCT)。将106个/ml的MG-63单细胞悬液与不同浓度的M007混匀反应,经震荡暗反应及可见红外光照射(M007-PCT)后,采用台盼蓝染色检测肿瘤细胞死亡率。结果 M007-PCT组,M007为(2~4)μmol/L时,MG-63细胞株死亡率随光敏剂浓度增加而增大(P<0.05);M007在(4~32)μmol/L内,MG-63细胞的死亡率达到较高水平(>93%),且不再随M007浓度增加而增大(P>0.05)。M007对照组的MG-63细胞株死亡率随M007浓度增加有增加的趋势,但明显低于相同光敏剂浓度M007-PCT组肿瘤细胞死亡率(P<0.05)。结论新型光敏剂M007对MG-63细胞具有有效的灭活作用,是肿瘤手术术中血液回收方面极具应用前景的光敏剂。     

Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis

Purpose

To prospectively evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) as percentage of baseline (POB) in predicting hospital survival, we studied 64 consecutive, postoperative patients with severe sepsis.

Materials and Methods

Plasma PCT, IL-6, and CRP were serially measured from day 1 (onset of sepsis) to day 14 in parallel with clinical data until day 28. Multivariate logistic regression and univariate analysis of predictive accuracy of PCT-, IL-6-, and CRP-POB were performed. Newly derived binary prediction rules were evaluated by calculating sensitivity, specificity, positive predictive value, and negative predictive value.

Results

In survivors, PCT and IL-6 significantly decreased from days 1 to 14, whereas CRP did not. In nonsurvivors, the inflammation markers mostly increased within the second week. At day 7, logistic regression analysis revealed PCT-POB as an independent determinant for survival. Especially, PCT-POB not exceeding 50% and PCT-POB not exceeding 25% with CRP-POB not exceeding 75% on day 7 indicated a favorable outcome with a positive predictive value/sensitivity of 75%/97% and 92%/67%, respectively. In comparison, pretest likelihood to survive by day 28 and observed survival rate were 60% and 67%, respectively.

Conclusions

Prediction rules of decrease in PCT-POB on day 7 in combination with CRP-POB may serve to monitor efficacy and guide duration of therapy in critically ill patients.     

Dynamic perfusion CT: optimizing the temporal resolution for the calculation of perfusion CT parameters in stroke patients

PURPOSE: To assess the influence of different temporal sampling rates on the accuracy of the results from cerebral perfusion CTs in patients with an acute ischemic stroke. MATERIAL AND METHODS: Thirty consecutive patients with acute stroke symptoms received a dynamic perfusion CT (LightSpeed 16, GE). Forty millilitres of iomeprol (Imeron 400) were administered at an injection rate of 4 ml/s. After a scan delay of 7s, two adjacent 10mm slices at 80 kV and 190 mA were acquired in a cine mode technique with a cine duration of 49 s. Parametric maps for the blood flow (BF), blood volume (BV) and mean transit time (MTT) were calculated for temporal sampling intervals of 0.5, 1, 2, 3 and 4s using GE's Perfusion 3 software package. In addition to the quantitative ROI data analysis, a visual perfusion map analysis was performed. RESULTS: The perfusion analysis proved to be technically feasible with all patients. The calculated perfusion values revealed significant differences with regard to the BF, BV and MTT, depending on the employed temporal resolution. The perfusion contrast between ischemic lesions and healthy brain tissue decreased continuously at the lower temporal resolutions. The visual analysis revealed that ischemic lesions were best depicted with sampling intervals of 0.5 and 1s. CONCLUSION: We recommend a temporal scan resolution of two images per second for the best detection and depiction of ischemic areas.     

95例脑梗死患者血小板参数检测的临床意义

目的:探讨血小板参数与脑梗死患者发病的关系。方法:Sysmex XE-2100血细胞计数仪检测PLT、PCT、MPV、PDW。结果:脑梗死组PLT减少、MPV增高,有显著差异(P<0.05或P<0.01);PCT及PDW则无显著差异(P>0.05)。经有效治疗后MPV治疗后减小(P<0.05)。结论:MPV增高是脑梗死的独立危险因素,动态观察MPV对脑梗死的疗效观察有一定的临床意义。     

早期诊断严重脓毒症脓毒性休克研究进展

脓毒症(sepsis)可发展成严重脓毒症(severe sepsis)甚至脓毒性休克(septic shock),其发展转归有众多复杂的机制参与,包括宿主对感染的反应以及氧的传输和利用障碍等。早期诊断和积极干预脓毒症,有利于改善脓毒症的预后。早期诊断的生物学指标包括降钙素原(procal-citonin,PCT)、前肾上腺髓质素(proadrenom edullin,proADM)及前心房尿钠肽(pro-atrial natriuretic peptide,proANP)等。     

CRP、PCT、PA及IL-6联合检测在患儿呼吸道感染诊断及预后中的价值研究

目的 监测C反应蛋白（CRP）、降钙素原（PCT）、前白蛋白（PA）和白细胞介素-6（IL-6）,计算C反应蛋白与前白蛋白比值(CRP/PA)、白细胞介素-6与前白蛋白比值(IL-6/PA),评估其对小儿呼吸道感染诊断及评估疗效的价值。方法 分析2020年1月-2020年6月在杭州市儿童医院接受住院治疗的150例呼吸道感染患儿临床资料,根据患儿病原感染类型的不同分为细菌感染组（n = 90）和非细菌感染组（n = 60）,分别检测其入院时和治疗后CRP、PCT、PA及IL-6检测水平,并选取正常体检儿童55名作为对照组,比较感染组与对照组、细菌感染组与非细菌感染组CRP、PCT 、PA、IL-6、CRP/PA、IL-6/PA水平差异;比较细菌感染组治疗前和治疗后CRP、PCT 、PA、IL-6、CRP/PA、IL-6/PA水平差异;用受试者工作特征（ROC）曲线分析诊断效能。结果 感染组患儿CRP、PCT、IL-6、CRP/PA、IL-6/PA水平均高于对照组,PA水平低于对照组,差异有统计学意义（P <0. 05）,细菌感染组CRP、PCT、IL-6、CRP/PA、IL-6/PA水平高于非细菌感染组,差异有统计学意义（P <0.05）。治疗后, 细菌感染组患儿CRP、PCT、IL-6、CRP/PA、IL-6/PA水平较治疗前明显下降,PA水平明显升高,差异均有统计学意义（P< 0.05）。ROC曲线显示,IL-6/PA曲线下面积最大,为0.963,其诊断灵敏度为86.7%,特异度为90.9%。结论 CRP、PCT、PA、IL-6联合检测可作为诊断小儿急性呼吸道感染的有效指标,IL-6/PA有助于提高诊断效能,可以为早期鉴别感染类型、指导临床治疗和评估疗效提供参考依据。     

肠道去污剂对肝硬化患者肝功能、血浆内毒素、肿坏死因子-α及降钙素原水平的影响

目的 探讨肠道去污剂对肝硬化患者肝功能、血浆内毒素、肿瘤坏死因子-α（TNF-α）及降钙素原（PCT）水平的影响.方法 将84例肝硬化患者随机分为对照组和观察组.两组均予以低盐饮食、补充白蛋白及保肝利尿等对症治疗.观察组加用口服肠道去污剂10 mL/次,3次/d,连用14 d.观察并比较两组治疗前和治疗14 d后肝功能、血浆内毒素、TNF-α及PCT水平的变化.结果 治疗14 d后,两组ALT、AST和TBIL均明显下降（P＜0.05或P＜0.01）,且观察组下降更明显（P＜0.05）;同时两组血浆内毒素、TNF-α及PCT水平均明显下降（P＜0.05或P＜0.01）,且观察组下降更明显（P＜0.05）.结论 采用肠道去污剂治疗肝硬化能明显改善肝功能指标,并能降低血浆内毒素、TNF-α及PCT水平,从而减轻肠源性内毒素血症,保护及改善患者的肠道屏障功能.