血清前清蛋白水平与脓毒症的早期诊断

目的探讨血清前清蛋白（PA）在鉴别诊断全身性炎性反应综合征（SIRS）与脓毒症（sepsis）中的价值,研究血清PA能否对脓毒症的早期诊断提供帮助。方法共有48例SIRS患者及36例sepsis患者入选。在患者入选后的第2天进行PA测定,并进行急性生理和慢性健康状况评分。结果sepsis组PA水平明显低于SIRS组,差异有统计学意义（P〈0．01）,若以PA〈170mg／L作为诊断sepsis的阳性标准,PA的敏感性和特异性分别为80．55％和87．50％。结论血清PA有助于早期诊断sepsis。     

术前纤维蛋白原与前白蛋白比值在膀胱癌预后中的应用价值

目的探讨术前纤维蛋白原/前白蛋白(FPR)与膀胱癌术后患者预后的关系。方法回顾性分析锦州医科大学附属第一医院泌尿外科2009年12月～2016年8月收治的200例膀胱癌手术患者的临床资料。采用ROC曲线确定FPR的最佳临界值为0.0977,以术前FPR是否大于0.0977分为低FPR组、高FPR组。术后随访3年,观察生存情况,同时对于患者的临床病理相关性数据进行统计学分析,单因素生存分析采用Kaplan-Meier法和log rank检验,多因素采用Cox回归分析。结果低FPR组和高FPR组在TNM分期、分级、淋巴结转移、糖尿病病史方面比较差异有统计学意义(P0.05)。所有患者均行3年随访,共有139例生存,生存率为69.5%,61例患者死亡,死亡率为30.5%。低FPR组和高FPR组的肿瘤进展率分别为22.7%(20/88),39.3%(44/112),中位PFS分别为62.5个月、32.5个月,两组比较差异有统计学意义(P0.05)。单因素分析显示:年龄、分级、淋巴结转移、手术方式、高血压病史、糖尿病病史、其他手术史、FPR≤0.0977是影响患者OS的因素(P0.05)。行Cox多因素分析结果显示:术前FPR≤0.0977是影响肿瘤进展的独立危险因素(P=0.001)。FPR的升高可显著降低膀胱癌患者的OS和PFS。结论术前FPR是膀胱癌患者术后预后的独立影响因素,且与临床病理特征相关,其用于评估膀胱癌患者术后的预后具有一定的价值。     

大鼠实验性急性肝损伤血清前白蛋白和转氨酶测定的比较

通过用D—氨基半乳糖(D—GalN)造成SD大鼠不同程度的急性肝损伤,测定损伤后24小时、48小时血清前白蛋白水平的变化,并与白蛋白、谷丙转氨酶、谷草转氨酶相比较。结果表明,对于急性发生的肝细胞损伤,前白蛋白的测定不仅远较白蛋白敏感,在反映肝细胞损伤程度上还优于转氨酶的测定。该项指标如应用于临床,则具有重要价值。     

血浆纤维粘连蛋白和前白蛋白测定在白血病临床上的意义

本文用火箭电泳法测定了94例健康人和20例住院白血病患者血浆纤维粘连蛋白(Fn)和前白蛋白(PA)浓度,并对7例白血病患者经治疗后达到缓解和部分缓解者,进行了动态观测,结果表明 Fn 和 PA 浓度与其病情相关。本文对其临床价值进行了讨论。     

前白蛋白在病毒性肝炎检测中的意义

目的探讨前白蛋白在病毒性肝炎患者中检测的意义。方法对172例各型病毒性肝炎患者及41例健康体检对照组进行血清前白蛋白（S－pA）的比较检测。结果发现各型肝炎在急性期（或活动期）S－pA水平与对照组相比均有下降,且病情越重．S－pA水平下降越明显,其中以重症肝炎S－pA水平下降最为明显;随病情好转,S－pA逐渐上升。结论S－pA水平是反映肝功能急性损害与肝功能恢复的一项灵敏指标;在肝硬变患者S－pA可反映肝脏最大储备功能;在重症肝炎,通过对S－pA的动态观察,可判断其预后。     

慢性乙肝患者血清前白蛋白及铁蛋白检测的临床意义

目的：探讨血清前白蛋白（PA）、铁蛋白（SF）对慢性乙肝患者病情评估的临床价值。方法：选择106例慢性乙肝患者为研究组,按肝脏损害程度分为轻度组（24例）、中度组（46例）、重度组（40例）,另选择76例健康人为对照组,分别检测血清前白蛋白及铁蛋白,并进行比较分析。结果：研究组PA、SF水平明显高于健康组,差异具有统计学意义（P＜0．001）;随着肝脏损害程度的加重,PA水平逐级下降,而SF水平逐级升高,各组治疗前后PA、SF水平比较,差异具有统计学意义（P＜0．001）。结论：对慢性乙肝患者进行血清前白蛋白及铁蛋白的检测,有利于早期判断肝脏损害的程度,以及更好的评价疗效、评估预后。     

前白蛋白对急性心肌梗死的早期预警价值

目的 探讨前白蛋白对12 h内就诊的缺血性胸痛患者急性心肌梗死(acute myocardial infarction,AMI)的早期预警价值.方法 选取以胸痛为主诉的12h内发病的疑诊急性心肌梗死180例为研究对象,其中确诊AMI 103例.根据发病时间不同,将AMI患者分为0～3h、4～6h和7～12 h组,检测其前白蛋白、高敏肌钙蛋白T(hs-cTnT)、肌酸激酶同工酶(CK-MB)水平,比较前白蛋白及肌钙蛋白T、肌酸激酶同工酶诊断AMI的敏感性、特异性、阳性预测值、阴性预测值.结果 发病0～3h,前白蛋白诊断AMI的敏感性为23.70％[95％可信区间(CI):17.00％～ 31.94％]、特异性73.33％ (95％CI:57.79％～84.90％)、阳性预测值0.89、阴性预测值1.04;随发病时间延长,前白蛋白诊断AMI的敏感性增加,发病7～12 h PA诊断敏感性、特异性分别为53.33％(95％CI:44.58％～61.90％)、57.78％(95％CI:42.24％ ～ 72.01％),同期hs-cTnT及CK-MB诊断AMI的敏感性、特异性分别为95.56％ (95％ CI:90.16％ ～ 98.18％)、80％(95％ CI:64.95％～89.91％)、78.52％(95％ CI:70.45％～84.92％)、73.33％ (95％CI:57.79％ ～ 84.90％),与hs-cTnT及CK-MB相比,发病7～12h前白蛋白诊断AMI的准确性低于hs-cTnT及CK-MB.结论 前白蛋白在早期对急性心肌梗死具有一定预警价值,但诊断急性心肌梗死敏感性、特异性较低.     

Hereditary amyloidosis: detection of variant prealbumin genes by restriction enzyme analysis of amplified genomic DNA sequences

The autosomal dominant prealbumin amyloidoses are late-onset disorders characterized by varying degrees of peripheral neuropathy, nephropathy and cardiomyopathy. To date, seven different single amino acid mutations in the plasma protein prealbumin (transthyretin) have been found to be associated with amyloidosis and each is the result of a single nucleotide change in the prealbumin gene. By virtue of the restriction endonuclease sites created by the point mutations which give rise to the protein variants, direct DNA tests using Southern analysis have already been developed for detection of the Met-30, Ile-33, Ala-60, Tyr-77 and Ser-84 prealbumin genes. As an alternative to Southern analysis, we have amplified discrete regions of the prealbumin gene using polymerase chain reaction (PCR) and used restriction enzyme analysis of the PCR products to detect the Met-30, Ala-60, Tyr-77 and Ser-84 prealbumin genes after agarose gel electrophoresis and staining with ethidium bromide. In comparison to Southern analysis these alternative tests yield results much more quickly and avoid the use and handling of radioactively labeled probes.     

Changes in Serum Prealbumin and Incision Complications Following Spinal Tuberculosis Surgery: A Preliminary Study

ObjectivesTo explore the trend of changes in the serum prealbumin (PA) level in patients with spinal tuberculosis during the perioperative period and its relationship with postoperative incision complications.MethodsA retrospective study was performed by enrolling 162 patients (82 men and 80 women) with spinal tuberculosis who had been admitted to the Tianjin Haihe Hospital from June 2013 to June 2017. The included patients were then assigned to the elderly group (≥65 years of age, n = 35) and the non‐elderly group (<65 years of age, n = 127). The chemotherapy regimen was 3HREZ/9HRE, in combination with nutritional support for 3–4 weeks, as well as one‐stage debridement and (or) bone graft fusion and internal fixation. The serum PA levels of patients with spinal tuberculosis at admission, prior to surgery, and at 2 and 4 weeks after surgery were collected, and incision healing and sinus formation were observed for 3 months. Changes in serum PA levels of all patients at different time points were observed using one‐way analysis of variance. Pairwise comparison at different time points was performed using the least significant difference method and comparison of serum PA levels between different groups at the same time points was subjected to t‐test. The χ²‐test was used for comparison of the incidence of incision complications between different groups and between different subgroups based on different PA levels.ResultsThere was a gradual increased trend in the PA level from admission to 4 weeks after surgery in all patients [(0.14 ± 0.03) g/L < (0.16 ± 0.04)g/L < (0.22 ± 0.04) g/L < (0.25 ± 0.04) g/L]. The increase in the non‐elderly group was higher than that in the elderly group (P < 0.01). Furthermore, the incidence of incision complications in the elderly group was higher than in the non‐elderly group (14.29% > 1.78%, P < 0.01). The serum PA level was graded in accordance with NRS2002. There were 88 patients with preoperative grade 0–1 serum PA level (≥0.16g/L) who had no incision complications. The incidence of incision complications in patients with grade 3 serum PA level (<0.10 g/L, 9 patients) was higher than in patients with grade 2 (0.100–0.159 g/L, 66 patients) (44.44% > 6.06%, P < 0.01).ConclusionChanges in serum PA level in patients with spinal tuberculosis during the perioperative period are consistent with the trend of inflammation control and nutrition improvement, and are correlated with the incidence of incision complications after surgery. The relationship between the changes and the timing of surgery is worthy of future research.