中性粒细胞与淋巴细胞比值和胆红素与2型糖尿病周围血管病变的相关性研究

目的探讨中性粒细胞与淋巴细胞比值(NLR)、胆红素与2型糖尿病周围血管病变的相关性。方法回顾性分析安徽省第二人民医院2018年3月至2019年12月在内分泌科就诊的205例2型糖尿病患者,按有无周围血管并发症分为无血管病变组(DM组,n=102)、周围血管病变组(PV组,n=103)。观察2组临床指标及生化指标的差异,分析2型糖尿病周围血管病变的危险因素。采用受试者工作特征(ROC)曲线评估NLR与胆红素对2型糖尿病周围血管病变的诊断效能。结果与DM组相比,PV组患者年龄、病程、NLR水平升高,淋巴细胞(L)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆红素(TBIL)下降,差异有统计学意义(P<0.05)。Pearson相关分析显示NLR与血小板(PLT)、空腹血糖(FPG)、病程呈正相关(P<0.05),与IBIL、总胆固醇(TC)呈负相关(P<0.05)。IBIL与TC、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)呈正相关(P<0.05),与白细胞(WBC)、中性粒细胞(N)、NLR、病程呈负相关(P<0.05)。Logistic回归分析结果显示,病程长(OR=1.081,95%CI:1.016~1.150,P<0.05)、高NLR(OR=1.086,95%CI:1.055~1.119,P<0.05)、低IBIL(OR=-0.925,95%CI:0.863~0.991,P<0.05)是2型糖尿病周围血管病变的独立危险因素。ROC曲线显示NLR诊断2型糖尿病周围血管病变的曲线下面积为0.707(95%CI:0.648~0.766),当NLR截点为2.66,诊断敏感度为83.7%,特异度为48.4%;IBIL的曲线下面积为0.439(95%CI:0.375~0.503)。结论高NLR、低IBIL与2型糖尿病周围血管病变相关,NLR对2型糖尿病周围血管病变有一定的预测价值。     

中性粒细胞与淋巴细胞比值联合脉压对冠心病诊断价值及冠心病发生影响因素分析

目的探讨中性粒细胞与淋巴细胞比值(NLR)联合脉压对冠心病诊断价值及冠心病发生影响因素分析。方法选取2018年1—12月就诊疑诊冠心病并行冠状动脉造影检查748例,根据冠状动脉造影检查结果将其分为冠心病组(553例)和非冠心病组(195例)两组。比较两组临床资料,应用Spearman相关性分析对冠心病患者NLR、脉压和中性粒细胞、淋巴细胞、Gensini评分的相关性进行分析,应用受试者工作特征(ROC)曲线探讨NLR、脉压和NLR联合脉压对冠心病的诊断价值,应用多因素Logistic回归分析探讨冠心病发生影响因素。结果冠心病组男性和有吸烟史、大量饮酒史、高血压病病史、糖尿病病史所占比例,以及年龄、收缩压、脉压、心率、白细胞、中性粒细胞、NLR、空腹血糖、尿酸和Gensini评分高于非冠心病组,有血脂异常史所占比例、淋巴细胞和高密度脂蛋白胆固醇低于非冠心病组,差异有统计学意义(P0.05或P0.01)。Spearman相关性分析结果显示,冠心病患者NLR与脉压、中性粒细胞和Gensini评分呈正相关,与淋巴细胞呈负相关;脉压与NLR、中性粒细胞和Gensini评分呈正相关,与淋巴细胞呈负相关(P0.01)。ROC曲线分析结果显示,对冠心病诊断的曲线下面积NLR联合脉压大于NLR和脉压,差异有统计学意义(P0.01)。多因素Logistic回归分析结果显示,有吸烟史、高血压病病史、糖尿病病史和脉压≥55 mmHg、白细胞≥10×10~9/L、NLR≥3.39为冠心病发生的独立危险因素(P0.05或P0.01)。结论 NLR联合脉压对冠心病的诊断价值较高,有吸烟史、高血压病病史、糖尿病病史和脉压≥55 mmHg、白细胞≥10×10~9/L、NLR≥3.39为冠心病发生的独立危险因素。     

中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与2型糖尿病合并冠心病患者动脉粥样硬化程度的相关性

目的探讨2型糖尿病合并冠心病患者中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)与冠状动脉病变程度的关系。方法选取2015年6月至2016年7月于扬州大学附属医院心内科就诊的144例2型糖尿病合并冠心病患者,冠脉病变程度根据Gensini积分将患者分为高危组(Gensini积分≥64分)75例、中低危组(Gensini积分<64分)69例。比较不同组别患者一般资料、实验室检查指标;采用多因素Logistic回归方法分析患者冠状动脉病变程度的影响因素;PLR、NLR与患者Gensini积分的相关性分析采用Pearson相关分析;绘制ROC曲线以评价PLR、NLR对患者高危冠状动脉复杂病变的预测价值。结果不同程度的冠状动脉病变组体质量指数(BMI)、收缩压(SBP)、糖化血红蛋白(HbA1c)、NLR、PLR之间差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,脂蛋白a、NLR、PLR为冠状动脉病变程度的独立危险因素(P<0.05)。相关性分析显示,冠状动脉病变程度与NLR、PLR呈正相关关系(r=0.386,P<0.001;r=0.487,P<0.001)。NLR预测2型糖尿病合并冠心病患者高危冠状动脉复杂病变的曲线下面积为0.843,95%CI 0.78～0.907,最佳截断值为2.566,敏感度为82.6%,特异度为73.3%;PLR曲线下面积为0.72,95%CI0.778～0.909,最佳截断值为107.054,敏感度为84.1%,特异度为78.7%。结论 NLR、PLR是2型糖尿病合并冠心病患者的独立危险因素,与患者的Gensini积分呈正相关。NLR、PLR可作为预测2型糖尿病合并冠心病患者冠状动脉病变严重程度的经济且易测的实验室指标。     

冠心病患者外周血中性粒细胞 / 淋巴细胞比值与冠脉狭窄程度的相关性研究

目的　分析冠心病（coronary artery disease，CAD）患者外周血中性粒细胞 / 淋巴细胞比值（neutrophil/lymphocyte ratio，NLR）与冠脉狭窄程度的相关性，探讨 NLR 的临床应用价值。方法　收集 2016 年 7 月～ 2018 年 9月东部战区总医院心血管内科收治的 278 例 CAD 患者和同期来院体检的 117 例健康对照者的临床资料、血细胞检测及血生化指标，根据病情将 CAD 患者分为稳定型冠心病（stable coronary artery disease，SCAD）和急性冠脉综合征（acute coronary syndrome，ACS）两组，同时根据冠状动脉造影结果又将 CAD 患者分为观察组、单支病变组、双支病变组和三支病变组，统计各组患者 Gensini 积分。比较各组间外周血 WBC，NLR 及 CRP 水平差异，并分析 NLR 与心肌肌钙蛋白 I （cTnI）水平和 Gensini 积分的相关性，ROC 曲线分析 NLR 对 CAD 病情的辅助诊断价值。结果　外周血WBC，NLR 及 CRP 在各组中差异有统计学意义 (χ 2 =29.962，31.045，F=17.656，均 P<0.05)，且 NLR 与 CAD 患者 cTnI水平和 Gensini 积分呈正相关 (r =0.381，P=0.000；r =0.217，P=0.000)；NLR 用于诊断 CAD,SCAD 及 ACS 患者的 ROC曲线下面积分别为0.720(95%CI: 0.671~0.770，P=0.000)，0.643(95%CI: 0.582~0.704，P=0.000)，0.835(95%CI: 0.787~0.884，P=0.000)。结论　NLR 水平可作为冠脉狭窄程度的辅助评估指标。     

血小板相关指数与溶栓后急性脑卒中患者预后的关系

目的?研究血小板体积相关指数(platelet volume indices, PVIs)、中性粒细胞/淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)以及这些参数的组合与接受静脉溶栓后的急性缺血性脑卒中(acute ischemic stroke,AIS)患者神经功能预后的关系。方法?回顾性研究2016年1月至2019年1月北京大学人民医院急诊科符合AIS诊断标准的147例静脉溶栓患者。根据3个月后随访结果,将研究人群依据MRS评分(modified rank in scale,MRS),分为MRS≤2和MRS≥3两组,比较两组患者的一般资料、既往病史、实验室检查结果等。采用Logistic回归分析溶栓后AIS患者神经功能预后不良的危险因素。结果?NLR(OR=1.045, 95%CI:1.032~2.350, P=0.032),平均血小板体积(mean platelet volume, MPV)(OR=4.212, 95%CI:1.074~16.513, P=0.039),MPV×NLR/血小板计数(PLT)(OR=5.711,95%CI:1.342~24.298, P=0.018),血小板分布宽度(platelet distribution width, PDW)(OR=1.015, 95%CI:1.001~2.372, P=0.032),美国国立卫生研究院中风量表(NIHSS)评分(OR=1.266, 95%CI:1.111~1.443, P<0.01)是接受静脉溶栓治疗后AIS患者神经功能预后不良的影响因素。结论?NLR、MPV、MPV×NLR/PLT、PDW、NIHSS评分是溶栓后急性缺血性脑卒中神经功能预后不良的危险因素。MPV×NLR/PLT可以较好地预测3个月后AIS神经功能严重程度。     

中性粒细胞/淋巴细胞与急性冠状动脉综合征及其预后的关系

目的探讨中性粒细胞/淋巴细胞(NLR)与急性冠状动脉综合征(ACS)及其预后的关系。方法入选我院经冠状动脉造影检查的160例可疑冠心病患者,其中不稳定型心绞痛组(UA组)50例,急性心肌梗死(AMI)组60例,正常对照组50例,对照组为冠状动脉造影阴性的非冠心病患者。检测各组的白细胞计数(WBCC)、中性粒细胞计数(NC)、淋巴细胞计数(LC)、超敏C反应蛋白(hs-CRP),并计算NLR。比较各组之间各项指标水平的差异,并进行Logistic回归分析。另对行PCI术的48例AMI患者按NLR大小均分为两组,分别进行为期一年的随访,记录或计算各组的死亡率、死亡原因、再住院率及左心室重构率。结果 (1)随着病情严重程度的升高WBCC、NC、hs-CRP、NLR水平逐渐升高(P<0.05或P<0.01),AMI组的LC水平较对照组明显升高[(1.7±0.7)×109/Lvs.(1.2±0.4)×109/L,P<0.05]。(2)多因素Logistic回归分析WBCC(OR5.960,95%CI5.278～6.729,P<0.01),hs-CRP(OR10.827,95%CI7.498～15.632,P<0.001)、NLR(OR9.915,95%CI7.958～12.351,P<0.001)均为ACS的独立危险因素,NLR与hs-CRP预测ACS的价值相当。(3)随访结果:NLR较高组的PCI术患者一年全因死亡率(25.0%vs.4.2%,P<0.05)、左心室重构率(37.5%vs.12.5%,P<0.05)较低NLR组明显偏高。结论 NLR是ACS的独立危险因素,其预测价值较WBCC高,与hs-CRP相当。NLR与PCI术患者术后一年全因死亡率、左心室重构率密切相关。     

下肢深静脉血栓形成的危险因素分析

目的研究下肢深静脉血栓形成(deep venous thrombosis,DVT)的危险因素。方法对新疆维吾尔自治区人民医院血管外科收治的下肢深静脉血栓患者及同时期体检的健康人群行病例对照实验,通过问卷调查、实验室检查等,研究该疾病的危险因素,并使用logistics回归模型对危险因素进行综合分析。结果两组间水果摄入(P<0.01)、妊娠/产褥期(P<0.05)、血浆抗凝血酶Ⅲ(AT-Ⅲ)浓度(P<0.05)、蛋白C(PC)浓度(P<0.05)、同型半胱氨酸(Hcy)浓度(P<0.05)及叶酸浓度(P<0.05)差异统计学意义。使用多因素logistic回归对筛选后的因素进行分析后发现,体重指数(BMI)(OR=1.082,95%CI=1.014~1.154)、妊娠/产褥期(OR=5.038,95%CI=1.752~14.490)、血浆AT-Ⅲ浓度降低(OR=0.937,95%CI=0.920~0.953)及Hcy浓度增高(OR=1.084,95%CI=1.047~1.122)可能是DVT的独立危险因素。结论血浆AT-Ⅲ浓度及Hcy浓度与DVT密切相关,前者的浓度降低及后者的浓度增高可能增加DVT患病的风险;妊娠/产褥期及血清叶酸浓度降低是DVT的危险因素。     

肝硬化腹水并发肝肾综合征的危险因素分析

目的探讨肝硬化腹水并发肝肾综合征的危险因素。方法以67例肝硬化腹水并发肝肾综合征患者(研究组)和82例单纯肝硬化患者(对照组)作为研究对象。收集2组性别、年龄、体质量、既往史、出入院诊断、并发症和预后等资料,并对2组相关指标(血白细胞计数、凝血酶原时间和血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、白蛋白、肌酐、钾、钠、肾小球滤过率)及肝硬化腹水并发肝肾综合征的相关危险因素进行统计学分析。结果与对照组比较,研究组血白细胞计数、凝血酶原时间和血清天冬氨酸氨基转移酶、总胆红素、肌酐水平,自发性腹膜炎、肝性脑病、消化道出血、肺部感染发生率及病死率均显著升高,血清白蛋白、钠、肾小球滤过率水平均显著下降(均P<0.05)。自发性腹膜炎(OR=2.264,95%CI 1.386~5.288,P<0.01)、消化道出血(OR=1.636,95%CI1.036~3.587,P<0.05)、低钠血症(OR=4.503,95%CI 4.172~18.793,P<0.01)、低蛋白血症(OR=1.508,95%CI1.316~1.717,P<0.05)及肾小球滤过率(OR=6.182,95%CI 6.070~26.087,P<0.01)均为肝硬化腹水并发肝肾综合征的独立危险因素。结论自发性腹膜炎、上消化道出血、低钠血症、低蛋白血症及肾小球滤过率均为肝硬化腹水并发肝肾综合征的危险因素,应及早采取干预措施,预防肝肾综合征的发生。     

中性粒细胞/淋巴细胞比率联合血小板/淋巴细胞比率检测对于重症急性胰腺炎早期预测价值

目的:评估中性粒细胞／淋巴细胞比率（Neutrophil to lymphocyte ratio,NLR）联合血小板/淋巴细胞比率（platelet to lymphocyteratio,PLR）检测(NLR-PLR)对于重症急性胰腺炎(severe acute pancreatitis,SAP)早期预测价值。方法:连续性收集2019年1月至2019年12月北京大学人民医院急诊科符合急性胰腺炎（acute pancreatitis, AP）诊断标准的216例患者。按病情严重程度分为轻症急性胰腺炎组（mild acute pancreatitis,MAP）(86例)、中度重症急性胰腺炎组（moderately severe acute pancreatitis,MSAP）(40例)及SAP组(90例)三组。所有患者均于发病48 h内采集外周血样进行分析,检测白细胞计数（WBC）、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)、血红蛋白(HGB)、血小板计数(PLT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血清肌酐(CR)、血糖(GLU)等实验室指标,同时完善CT影像学等检查,分别计算NLR和PLR,比较NLR和PLR在三组中是否具有统计学意义。比较NLR、PLR和APACHEⅡ评分及Ranson评分的相关性。同时绘制受试者工作特征曲线(ROC曲线)计算NLR和PLR的最佳阈值,分别依据NLR和PLR的最佳阈值,计算NLR-PLR,同时绘制ROC曲线研究NLR-PLR对于SAP的预测价值。结果:NLR [OR=1.071,95% CI（1.025,1.120）, P=0.002]和PLR[OR=1.003,95% CI（1.000,1.244）, P=0.044]是早期重症胰腺炎的危险因素。NLR与Ranson评分呈正相关（r=0.0342, P<0.05）;NLR与APACHEⅡ评分呈正相关（r=0.0210, P=0.003）;PLR与Ranson评分呈正相关（r=0.0218, P=0.002）;PLR与APACHEⅡ评分呈无相关性（ P=0.157）。NLR和PLR的ROC曲线下面积（AUC）分别为0.894和0.728。NLR的最佳阈值为6.105,敏感度为92.9%,特异度为76.1%,PLR的最佳阈值为154.358,敏感度为78.2%,特异度为73.2%。依据最佳阈值,计算NLR-PLR(NLR≥6.105且PLR≥154.358）,比较NLR-PLR、NLR(≥6.105)和PLR（≥154.358）的ROC曲线下面积,其中NLR-PLR曲线下面积最大,为0.864。 结论:NLR和PLR在AP发病48 h内对SAP患者病情的具有预测价值,NLR-PLR联合检测对于SAP具有早期预测价值。     

慢性肾脏病3~5期患者冠状动脉钙化危险因素分析及其与铁代谢指标的相关性

目的探讨慢性肾脏病(chronic kidney diseases,CKD)3~5期患者冠状动脉钙化(coronary artery calcification,CAC)的危险因素以及铁代谢指标与CAC相关性。方法纳入安徽医科大学第二附属医院CKD 3~5期患者162例,收集临床资料及实验室指标,检测血清铁、铁蛋白、转铁蛋白、总铁结合力(total iron-binding capacity,TIBC),计算转铁蛋白饱和度(transferrin saturation,TSAT),铁蛋白>800μg/L和(或)TSAT>50%定义为铁超载。采用多层螺旋计算机断层扫描测定冠状动脉钙化积分(coronary artery calcification score,CACs),CACs>10为钙化组。分析CAC危险因素及其与铁代谢指标的相关性,探讨危险因素对CAC的预测价值。结果合并CAC的患者92例,占56.8%。转铁蛋白、TIBC与CACs负相关(r值分别为-0.293、-0.253,P值分别为<0.001、0.001)。二元Logistic回归分析显示高龄(OR=1.050,95%CI:1.013~1.088,P=0.007)、糖尿病(OR=4.712,95%:CI:1.445~15.371,P=0.010)、高中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte,NLR)(OR=1.253,95%CI:1.025~1.533,P=0.028)、高血磷(OR=3.981,95%CI:1.791~8.849,P=0.001)以及转铁蛋白水平降低(OR=0.130,95%CI:0.044~0.378,P<0.001)是CAC的独立危险因素。ROC曲线显示,年龄、糖尿病、NLR、血磷、转铁蛋白联合预测CAC的曲线下面积为0.828(95%CI 0.766~0.891,P<0.001),灵敏度为79.3%,特异度为75.7%。结论CKD3~5期患者CAC发生率较高,高龄、糖尿病、高磷血症、高NLR和血转铁蛋白水平减低是CAC的独立危险因素,以上危险因素的联合指标对CAC的发生有较好的预测价值。     

Is the L/S ratio really a lecithin/sphingomyelin ratio?

Fetal lung maturity is commonly assessed by determining the ratio of lecithin/sphingomyelin in centrifuged amniotic fluid. In a variety of chromatographic systems currently used for the routine determination of the lecithin/sphingomyelin ratio, including the systems recommended in the original procedure, at least one and frequently two additional phospholipids, normally present in amniotic fluid, tend to chromatograph between or overlapping with lecithin and/or sphingomyelin. These phospholipids have been tentatively identified as phosphatidylserine and phosphatidylinositol. The extra phospholipids contribute significantly to the routine lecithin/sphingomyelin ratio with considerable variation between individual cases. Treatment of dried lipid extracts with cold acetone before chromatography, as suggested in the original lecithin/sphingomyelin ratio procedure, does not remove the interfering phospholipids.     

Comparison of IVC diameter ratio,BUN/creatinine ratio and BUN/albumin ratio for risk prediction in emergency department patients

IntroductionEarly prediction of patients' prognosis in the emergency department (ED) is important. Patients' conditions such as dehydration help predict prognosis. The ratio of serum blood urea nitrogen to creatinine (BUN/Cr ratio) and inferior vena cava (IVC) diameter is often used to determine dehydration. Also, serum albumin levels reflect nutritional conditions such as dehydration. In this study, we evaluated the performance of BUN/Cr ratio, IVC diameter ratio, and BUN/Albumin ratio as predictive markers for in-hospital mortality and ICU admission among various diseases in ED.Material and methodsThis retrospective cohort study utilized data from patients who had abdominal and pelvic computed tomography (APCT) performed at our institution from 2015 to 2018. The measurement of IVC diameter from computed tomography, the BUN/Cr ratio, and the BUN/Albumin ratio were calculated. Differences in the performance among the BUN/Cr ratio, the IVC diameter ratio, and the BUN/Albumin ratio for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve.ResultsA total of 914 patients were enrolled and 78 patients (8.5%) were admitted to the ICU, and 71 patients (7.8%) died during the clinical process. Multivariate logistic regression showed that only the BUN/Albumin ratio was a significant predictor of inhospital mortality and ICU admission.ConclusionAmong dehydration markers the BUN/Albumin ratio is a simple and useful tool for predicting the outcomes of patients visiting the ED.     

中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值对溃疡性结肠炎的诊断价值

目的探讨中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)在溃疡性结肠炎(UC)患者外周血中的水平,评估两者对UC的诊断效能。方法收集87例UC患者纳入UC组,收集65例肠易激综合征(IBS)患者纳入对照组。分析患者临床资料,比较两组NLR和PLR水平差异;采用Pearson相关分析NLR、PLR与临床常用指标白细胞计数(WBC)、血小板计数(PLT)、C反应蛋白(CRP)、红细胞沉降率(ESR)的相关性;采用受试者工作特征(ROC)曲线计算NLR和PLR最佳临界值及曲线下面积(AUC),并与常用炎性指标进行比较。结果UC组患者外周血NLR和PLR均明显高于对照组(P<0.05)。相关性分析发现,NLR、PLR均与WBC、CRP和ESR呈正相关(P<0.05)。NLR用于诊断UC的最佳临界值为2.64,灵敏度和特异度分别为81.9%和62.6%,AUC为0.758,PLR用于诊断UC的最佳临界值为163.40,灵敏度和特异度分别为75.0%和60.6%,AUC为0.759,两者均优于WBC(AUC:0.687)和PLT(AUC:0.745),稍逊于ESR(AUC:0.783)和CRP(AUC:0.830)。NLR联合CRP、PLR联合CRP对UC的诊断价值均优于CRP单独检测。结论NLR和PLR在UC患者外周血中的水平升高。NLR、PLR诊断UC的效能优于常用指标WBC和PLT,其与CRP联合应用可提高UC的诊断效能。     

Anterior interosseous/median nerve latency ratio

This report describes a new diagnostic technique for evaluating anterior interosseous nerve injuries (Kiloh Nevin syndrome). The resultant "AIM" (anterior interosseous/median nerve) score establishes a normal ratio of the pronator quadratus latency to the abductor pollicis brevis latency after one stimulus to the proximal median nerve and simultaneous recordings of the evoked response at the respective muscles. One hundred normal nerves were tested in 61 patients. The result was an AIM score of 0.60 (SD = 0.06). Five patients with Kiloh Nevin syndrome were evaluated. The average AIM score was 0.76 (SD = 0.04). Five patients with severe carpal tunnel syndrome were evaluated. The average AIM score was 0.38 (SD = 0.06). Ten patients with borderline carpal tunnel syndrome were evaluated. The average AIM score was 0.48 (SD = 0.06). Anterior interosseous nerve entrapment or compression injury remains a difficult clinical diagnosis because it is mainly a motor nerve and the syndrome is often mistaken for finger ligamentous injury. We describe an easily performed electrodiagnostic latency ratio technique to diagnose this injury. This technique may also be helpful as a screen for carpal tunnel syndrome when it is difficult to control for systemic illness.     

Serum pepsinogen I/II ratio test

Serum pepsinogen levels were measured in 137 stomach cancer patients and compared with those of 288 normal cancer-free subjects. The serum pepsinogen levels of stomach cancer patients, especially pepsinogen I and the pepsinogen I/pepsinogen II ratio were significantly lower than those of normal controls and correlated well with the extent of chronic gastritis associated with the cancerous stomach. These results were in good accordance with the results of previous studies indicating that the cancer derived from the stomach where chronic gastritis/intestinal metaplasia is extensive. The initial step of the screening procedure can be completed rapidly. Our results indicate that serum pepsinogen screening(pepsinogen test method) is a valuable method to detect gastric cancers in the Japanese population.     

Serum cortisol/cortisone ratio after Synacthen stimulation

OBJECTIVES: 11beta-Hydroxysteroid dehydrogenase (11beta-HSD) enzymes interconvert active cortisol and inactive cortisone. There is growing evidence that local tissue concentrations of cortisol are generally modulated by site specific different 11beta-HSD actions. While 11beta-HSD type 2 unidirectionally inactivates cortisol, type 1 isoform acts bidirectionally. 11beta-HSD type 1 is mainly localized in the liver and may thus restore circulating biologically inactive cortisone to active cortisol thereby modulating systemic glucocorticoid action; such a mechanism might be of importance in stressful situations. To study this hypothesis we investigated the influence of exogenous ACTH on serum cortisol/cortisone ratio. DESIGN AND METHODS: Paired serum samples that were submitted for routine analysis of cortisol before and 1 h after stimulation with 250 microg ACTH (1-24) (Synacthen) were collected prospectively if the routine tests indicated normal adrenal function; 40 patients were included in the study, 29 patients were female, 11 male, median age was 31 yr (range 14-70). Serum cortisol and cortisone were determined using LC-ESI/MS/MS with an online sample extraction system and tri-deuterated cortisol as the internal standard. RESULTS: While mean serum cortisol increased by 109% (mean basal concentration 373 nmol/L (SD 151 nmol/L), stimulated 781 nmol/L (SD 194 nmol/L)), mean serum cortisone significantly decreased after ACTH administration by 31% (p < 0.001, paired t-test for differences). Mean serum cortisone was 70 nmol/L (SD 16 nmol/L) before and 48 nmol (SD 16 nmol/L) after ACTH administration; decrease in serum cortisone was observed in 34 (85%) of the patients. The ratio of serum cortisol/cortisone increased in all subjects (mean 5.4 (SD 1.9) before ACTH, and 16.2 (SD 6.2) after ACTH; p < 0.001). CONCLUSIONS: The data of our observational study suggest a modulation of peripheral metabolism of cortisol by ACTH with a stimulation of systemic 11beta-HSD type 1 activity, leading to restoration of inactive cortisone to biologically active cortisol.