孕妇血浆中sCD40及其配体与子痫前期发病及肾功能损害的关系

目的 探讨孕妇血浆中可溶性白细胞分化抗原(sCD40)和sCD40配体(sCD40L)水平变化与子痫前期发病及肾功能损害的关系.方法 选择2008年8月-2010年6月在青岛大学医学院附属医院产科分娩的轻度子痫前期孕妇28例(轻度子痫前期组),重度子痫前期孕妇35例(重度子痫前期组);另选同期妊娠结局良好的健康孕妇30例为对照组.比较3组孕妇分娩孕周及血压变化、血小板计数并检测其血常规、C反应蛋白(CRP)、尿常规、24h尿蛋白定量,以及血清尿酸(UA)、肌酐(Cr)、尿素氮(BUN)等生化指标.采用ELISA法检测3组孕妇血浆中sCD40和sCD40L的水平,并对血浆sCD40和sCD40L的水平与各临床指标的相关性进行分析.结果 (1)血常规及l临床指标:重度子痫前期组和轻度子痫前期组孕妇血浆CRP水平(分别为10.8及7.1 mg/L)均明显高于对照组(3.3 mg/L),前后两者分别比较,差异均有统计学意义(P＜0.05);重度子痫前期组高于轻度子痫前期组,两组比较,差异也有统计学意义(P＜0.05).重度子痫前期组孕妇分娩孕周(32.5周)明显低于轻度子痫前期组(37.2周)和对照组(38.6周),分别与对照组比较,差异均有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).重度子痫前期组孕妇血小板计数(132×109/L)明显低于轻度子痫前期组(212×109/L)和对照组(216×109/L),分别比较,差异有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).3组孕妇之间血红蛋白水平及白细胞数分别比较,差异均无统计学意义(P＞0.05).(2)血浆sCD40及sCD40L水平:重度子痫前期组、轻度子痫前期组和对照组孕妇血浆sCD40水平分别为133.6、126.5和90.7 ng/L,sCD40L水平分别为12.5、10.4和4.4 ng/L,24h尿蛋白定量分别为4.5、0.8 g和0,UA水平分别为486、289和162 μmol/L,重度子痫前期组以上各指标均明显高于轻度子痫前期组和对照组,差异均有统计学意义(P＜0.01);轻度子痫前期组也明显高于对照组,差异也有统计学意义(P＜0.01).重度子痫前期组孕妇血浆Cr(89 μmol/L)、BUN(5.32 mmol/L)水平高于轻度子痫前期组(分别为66μmol/L及4.49mmol/L)和对照组(分别为57 μmol/L及3.32 mmol/L),分别比较,差异均有统计学意义(P＜0.05);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).(3)相关性分析:轻、重度子痫前期组孕妇血浆sCD40水平与24 h尿蛋白定量呈正相关(r=0.434,P＜0.05),与UA、CRP呈明显正相关(r=0.536、0.528,P＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.135、0.183、-0.133、0.190、0.167、-0.221,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与24 h尿蛋白定量、UA、CRP均呈明显正相关(r分别为0.591、0.445、0.539,P均＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.178、0.212、-0.292、0.144、0.135、-0.273,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与sCD40呈明显正相关(r均为0.707,P＜0.01).对照组孕妇血浆sCD40、sCD40L水平与各项临床指标均无相关性(P＞0.05).结论 子痫前期孕妇血浆中sCD40和sCD40L水平明显升高,可能参与了子痫前期的发病,并导致肾功能损害.sCD40和sCD40L水平变化也与子痫前期的严重程度相关.

Abstract：

Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.     

改良式双通路超声骨刀在椎管肿瘤手术中预防热损伤的效果分析

目的:探讨改良式双通路超声骨刀在椎管肿瘤切除术中截骨时刀头温度对周围神经组织的热损伤的影响。方法:选取2020年12月至2021年8月在我院行手术治疗的腰椎管肿瘤患者62例为研究对象。采用随机信封法将患者分为试验组和对照组,每组31例。试验组选用改良式双通路超声骨刀,对照组选用单通路超声骨刀;两组使用冷灌液均为常温0.9%氯化钠溶液。分别测量超声骨刀切骨时10 s、30 s、1 min、2 min、3 min骨及周围组织温度,观察并记录术中相应电生理监测结果。结果:与对照组相比,试验组测得的骨及其周围组织温度较低,热损伤率较低,两组间差异存在统计学意义(P<0.05)。结论:改良式双通路超声骨刀在椎管肿瘤术中截骨时能够有效降低骨及周围组织温度,还可以通过术中电生理监测波形观察来预防周围神经及组织热损伤的发生,提高手术的安全性。     

高效液相色谱法测定不同产地夏枯草中咖啡酸和迷迭香酸的含量

目的比较不同产地夏枯草中咖啡酸和迷迭香酸的含量。方法采用高效液相色谱法,Waters SunFire C18色谱柱（4．6mm×150mm,5μm）,甲醇-0．1％甲酸梯度洗脱,流速1．0mL／min,检测波长330nm。结果咖啡酸在0．0992～0．4960gg范围内与峰面积呈良好的线性关系（r=0．9999）,平均回收率为99．75％,RSD=2．27％（n=5）;迷迭香酸在0．8288～4．1440gg范围内与峰面积呈良好的线性关系（r=0．9998）,平均回收率为101．37％,RSD=1．19％（n=5）;不同产地夏枯草中咖啡酸与迷迭香酸的含量分别在0．02％-0．05％,0．09％-0．20％之间。结论不同产地夏枯草中咖啡酸和迷迭香酸含量差异很大,使用夏枯草时要注意产地差异。     

心血管中枢与心血管功能的同步记录技术

目的:建立心血管中枢与心血管功能的同步记录技术,用于观察心血管中枢活动和外周自主神经功能活动,研究心血管中枢对心血管活动的调节。方法:取成年SD大鼠,用混合麻药腹腔麻醉后,同步记录延髓头端腹外侧区(rostral ventrolateral medulla,RVLM)神经元单位放电活动、心电图、血压、呼吸肌肌电、体温,并进行相关参数的分析。结果:可记录到明确稳定的神经元单位放电活动等各项指标,在12只大鼠的RVLM中一共记录了18个自发单位放电,其中连续放电有12个,周期性簇状放电有6个。另外,两种类型放电分别对应的同步记录指标进行组间比较,仅呼吸肌肌电幅值差异有统计学意义(P<0.05)。在记录各项指标时观察到RVLM神经元自发放电与血压之间有相互影响。结论:同步记录心血管中枢与心血管活动是一种实时可靠的在体动物实验技术,为研究心血管各级中枢之间的相互作用提供了一种有效的方法。     

中国古代护理思想发展浅述

在漫长的历史进程中，勤劳智慧的华夏子孙创造了丰富的文化，其中也包括历史悠久的中医护理思想。巴浦洛夫说过，有了人类，就有医疗活动。同样道理，自从有了人类，就有了护理活动。医起源于护，而护理又起源于生活实践。医护同源，护理思想的发展一直与人类的进步息息相关，并生共存。中医学强凋“三分治，七分养”，其中“七分养”的实践就是指护理，中医护理学的实质就是研究“养”的科学。可以说，在医疗技术与知识萌芽之前，对疾病的简易护理措施就已经出现了，护理学正是在人类祖先自我防护本能的基础上，通过长期的抗病害斗争和劳动实践而逐渐发展起来的。古代中医护理学的形成大至经历了以下八个时期：     

心理干预在中医护理中的作用浅探

情绪是人们的一种心理活动，正常的情绪是有益的，但急剧、突然、或持续的情绪波动却可导致或加重疾病的发展。早在公元前5～3世纪，我国最早的经典医著《内经》中就有大量关于心理学方面的阐述。它认为“七情郁结”可引起“气血凝滞”，强调“喜怒不节，则伤脏，脏伤则病起”，又称“怒则气上，喜则气缓，悲则气消，恐则气下，惊则气乱，思则气结”，     

ABO-HDN“二孩”患儿多项指标的联合检测分析

目的对确诊为ABO新生儿溶血病(ABO-HDN)的"二孩"患儿,对产前与产后多项相关检测指标进行综合分析,做到早预防、早诊断、早治疗。方法选取2013-2016年在该院检查并确诊为ABO-HDN患儿92例,产前微柱凝集法检测父亲、母亲血型及母亲不规则抗体筛选,母亲血清IgG抗A(B)抗体效价,产后微柱凝集法进行新生儿溶血3项试验,根据新生儿溶血3项试验结果,分成5组。A组:直抗试验(+)、游离试验(+)、释放试验(+);B组:直抗试验(-)、游离试验(+)、释放试验(+);C组:直抗试验(+)、游离试验(-)、释放试验(+);D组:直抗试验(-)、游离试验(-)、释放试验(+);E组:直抗试验(+)、游离试验(-)、释放试验(-);全自动分析仪检测患儿总胆红素、非结合胆红素、血红蛋白、网织红细胞百分比、乳酸脱氢酶水平。结果92例ABO-HDN患儿经溶血3项试验,发现5组母亲IgG抗A(B)抗体效价越高,患儿病情越严重,差异具有统计学意义(P0.05);网织红细胞百分比与乳酸脱氢酶在5组间比较,差异具有统计学意义(P0.05)。结论产前产后多项实验室指标联合检测,对诊断"二孩"ABO-HDN更为准确,同时有助于掌握患儿病情发展状态,降低并发症和后遗症的出现。     

红外光谱在药物定量分析上的应用

与可见紫外分光光度法及色谱法相比,红外光谱法(IR)灵敏度低、仪器操作要求严格,在定量分析中的应用不如前二者广泛。但是,由于IR 具有特征吸收峰较多、便于选择测定波长的特点,对于那些理化性质相近、用其它方法定量存在困难的样品,可不经分离就能达到快速定量的目的。故目前无论是在工业分析还是在     

自拟麻桔前贝紫菀汤治疗咳嗽86例

笔者自2000年以来应用自拟麻桔前贝紫菀汤治疗咳嗽86例,疗效满意,现报告如下。1临床资料1·1一般资料:本组86例均为门诊患者,男49例,女37例,年龄最大78岁,最小8个月,平均38岁,病程最短3天,最长15年,以咳嗽、咯痰为主要症状,西医诊断多属呼吸系统疾病,如上呼吸道感染,急慢性支气管炎等。1·2治疗方法:以麻桔前贝紫菀汤治疗。药物组成:麻黄、桔梗、前胡、浙贝母、紫菀。风寒加苏子;风热加黄芩、桑叶、菊花;肺虚燥咳加知母、天冬、麦冬;湿痰加陈皮、法夏;虚喘加补骨脂、胡桃仁;脾胃虚弱加党参、白术;久咳入络者加茜草、丹参。上药冷水浸泡30min…