不同随访模式早产儿生后6至12月营养相关指标的对比研究

目的 监测规律随访与未规律随访模式早产儿生后6~12月间(矫正月龄)血清25-羟维生素D₃[25-(OH)D₃]、钙(Ca)、磷(P)、碱性磷酸酶(ALP)、尿素(UREA)、前白蛋白(PA)的水平,探讨两种随访模式对早产儿营养状况的影响及其安全性。方法 回顾性分析2015年1月-2017年12月在陆军军医大学第二附属医院院门诊就诊的143例早产儿资料,其中定期规律随访者79例设为A组,另外因各种原因未能定期规律随访者64例设为B组,同时将同期在本院儿保门诊随访的足月健康婴儿253例设为C组。婴儿于出生第6月至第12月(早产儿为矫正月龄)间抽血查血清25-(OH)D₃、Ca、ALP、P、UREA、PA水平。结果 1)A组及C组的血清25-(OH)D₃、Ca、PA均显著高于B组(P<0.05)。A组的血清25-(OH)D₃高于C组,差异具有统计学意义(P<0.05)。A、B、C三组间血清ALP、P、UREA差异无统计学意义(P>0.05)。2)A、B、C三组25-(OH)D₃测值评价结果比较:三组均无中毒病例,评价为25-(OH)D₃值适宜的例数A组最多,B组最少。结论 1)定期规律随访并按儿保建议喂养的早产儿,其生后6至12月血清25-(OH)D₃缺乏及低前白蛋白血症发生率低。2)早产儿喂养方案需个体化。3)部分早产儿营养评价指标(如:ALP)缺乏参考标准,仍需完善。     

Model for end-stage liver disease combined with serum prealbumin to predict the prognosis of patients with decompensated liver cirrhosis

OBJECTIVE: To evaluate the prognostic value of model for end-stage liver disease (MELD) combined with serum prealbumin (PA) in patients with decompensated liver cirrhosis. METHODS: A total of 252 patients were enrolled in the study and followed 1 year. PA was measured and MELD score was calculated on the first day of admission. Analysis of variance (anova ) was used to assess correlation between PA level and MELD score. Multivariable Cox proportional hazards model was used to screen the prognosis related factors. Kaplan–Meier survival curves were drawn. RESULTS: Of the 252 patients, 28 died within 3 months, 58 within 6 months and 91 within 1 year. Serum PA level in dead patients was significantly lower than that in survival patients (P < 0.005) and decreasing with increasing of MELD score. Cox analysis showed that MELD score > 18 (RR = 2.749) and PA < 70 mg/L (RR = 2.412) were independent prognosis risk factors. The risk ratio of MELD score combined with PA level (1.854, P < 0.01) was higher than that of MELD score alone (1.054, P < 0.05). Kaplan–Meier survival curve analysis showed that MELD score ≤ 18 combined with PA ≥ 70 mg/L could clearly discriminate patients who would survive or die within 6 month and 1 year follow up. CONCLUSION: MELD score ≤ 18 combined with PA ≥ 70 mg/L could predict the 6-month and 1-year prognosis of patients with decompensated liver cirrhosis, and was superior to that of MELD score alone.     

肺癌患者术后肠内营养支持的探讨

目的研究肺癌手术后早期应用肠内营养（EN）支持对患者营养状况的影响。方法60例肺癌术后患者随机分为EN组和肠外营养（PN）组,观察营养支持前后营养状况变化。结果经过10天营养支持,PNA患者的上臂肌围（MAMC）和血清总蛋白（TP）显著低于术前（P〈0．05）;EN组患者的前白蛋白（PA）显著高于术前（P〈0．05）,TP、PA、白蛋白（Alb）显著高于同期DN组（P〈0.05）。结论早期EN可改善患者蛋白质代谢和患者营养状况,疗效优于PN。     

血清前白蛋白对老年病人营养状况的评价及意义

目的：为了解老年病人营养状况与血清前白蛋白（PAB）关系。方法：对住院病人采用免疫透射比浊法测定PAB,同时将健康体检者作为对照组。结果：对照组健康体检者50例血清前白蛋白平均含量为315±45．3mg／L,老年病人963例血清PAB平均含量为116±40．3mg／L,明显低于对照组（P〈0．01）。结论：老年病人血清PAB含量明显低于正常人,血清PAB含量可作为判断老年病人的营养状况的依据之一。     

慢性阻塞性肺疾病急性加重期C反应蛋白与前白蛋白检测的临床意义

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）是一种常见的呼吸系统疾病,其本质特征是气道的慢性炎症。众多临床资料显示反复细菌感染是造成COPD急性加重的重要原因。CRP及PA是急性时相反应的一个极敏感指标,与白细胞总数及中性粒细胞百分比等反应感染情况的实验指标相比,CRP、PA具有辅助诊断和检测快速的特点。     

CHANGES IN SERUM CONCENTRATIONS OF THYROID HORMONES AND THYROID HORMONE-BINDING PROTEINS DURING EARLY INFANCY Studies in Healthy Fullterm, Small-for-gestational Age and Preterm Infants Aged 7 to 240 Days

Abstract. Serum concentrations of thyrotropin (TSH), thyroxine (T₄), triiodothyronine (T₃), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were determined in 492 blood samples from 127 fullterm (FT), 91 small-for-gestational age (SGA) and 88 preterm (PT) healthy infants aged 7 to 240 days. Serum T ₄ decreased about 20% during the first month of life. In infants aged 7–49 days, serum T₄ concentrations were significantly lower in SGA than in FT infants, and even lower values were found in PT infants. Serum T ₃ increased 50–70% reaching maximal values by 50–79 days of life. Serum T₃ levels were higher in FT than in SGA infants throughout the observation period. In PT infants serum T₃ increased from low values to levels which exceeded those of SGA and FT infants by 120–240 days of life. Serum TSH level did not change with age and was 5 mU/1 in all infants. Serum TBG values were high compared to normal adult values and did not change significantly with age. Comparable serum TBG values were found in FT, SGA and PT infants. Serum TBPA increased with age. Serum TBPA increased gradually in FT infants. In SGA infants serum TBPA increased from low values to levels which by 120–240 days of life exceeded those of PT and FT infants. In PT infants a decrease in serum TBPA appeared before the rise commenced. Serum Alb increased gradually in FT, SGA and PT infants during the observation period. Serum Alb in PT infants aged 30–119 days was lower than those in FT infants with similar ages. These physiological changes in serum concentrations of thyroid hormones and hormone-binding proteins during early infancy should be considered when interpreting thyroid function tests in infants with various maturity.     

Sites of prealbumin production in the human fetus using the indirect immunoperoxidase technique

Summary An indirect immunoperoxidase technique was used to investigate the site of prealbumin synthesis in the human fetus from between 8 and 43 weeks. Prealbumin staining was noted in the A cells of the fetal pancreas, both in the primary and secondary generations of the islets of Langerhans, from as early as 12 weeks gestation. Electron microscopy localized the staining to the cytoplasmic secretory granules. Prealbumin was also present in the gastrointestinal mucosa in cells which had a distribution similar to that of argentaffin cells. Positive staining was noted in the lining epithelium of the renal proximal convoluted tubules, but ultrastructural studies indicated that this was probably related to reabsorption, and not to synthesis.     

丁酰胆碱酯酶、前白蛋白和白蛋白在肝硬化诊断和治疗中的价值

目的：评估血清BuChE活性和PA、Alb浓度在肝硬化诊断和治疗中的价值.方法：测定197例肝硬化患者血清BuChE活性和PA、Alb浓度,计算出BuChE、PA和Alb诊断肝硬化的各项性能指标.结果：肝硬化患者血清BuChE活性、PA和Alb浓度明显低于对照组（P＜0.01）,并且在Child-Pough各级之间及各级和对照组之间的差异有显著性意义（P＜0.01）,肝硬化患者总体血清BuChE活性和PA浓度与血清Alb浓度呈显著正相关.结论：血清BuChE和PA在肝硬化的诊断和疗效观察方面比Alb具有更多的优点.     

自体骨髓干细胞移植治疗失代偿肝硬化血小板参数和血清前清蛋白、胆碱酯酶的变化分析

目的:分析失代偿肝硬化患者自体骨髓干细胞移植治疗前后血小板计数(PLT)、血小板比积(PCT)、血小板分布宽度(PDW)、血小板平均体积(MPV)和血清前清蛋白(PA)、胆碱酯酶(CHE)的改变及临床意义。方法:使用仪器法对99例肝硬化患者的PLT、PCT、PDW、MPV及PA、CHE进行自体骨髓干细胞移植治疗前后的结果检测。结果:与术前比较,术后第2周CHE增高明显(P0.05),术后第4周除PDW外,所有检测结果均有不同程度增高(P0.05,P0.01),术后第6周,所有检测结果均有明显增高(P0.01,P0.05)。结论:常规检测血小板参数及PA、CHE可作为自体骨髓干细胞移植治疗失代偿肝硬化患者病情监测和预后判断的重要依据。     

Automated immunoturbidimetric methods for the determination of retinol binding protein, prealbumin and transferrin in urine

We describe the development of rapid and simple automated methods for the estimation of retinol binding protein (RBP), prealbumin (PA) and transferrin (TRF) in urine. These methods measure the turbidity formed as a result of reaction between the protein and a specific antibody in a phosphate buffer containing 70 g/L polyethyleneglycol as accelerator for the antigen antibody reaction. The method for retinol binding protein (RBP) correlated well when compared with a method based on enzyme-linked immunosorbent assay (ELISA) (r = 0.978). The recoveries were 93-104%, 84-95% and 84-100% for RBP, PA and TRF respectively. The between-batch coefficients of variation were 2.6-10.6, 2.8-12.6 and 4.2-8.7% respectively. The analytical range of the method was 0.0625 to 40 mg/L for RBP, 0.28 to 45 mg/L for PA and 0.14 to 70 mg/L for TRF. The methods can be performed manually using a simple spectrophotometer or can be easily automated.