应用GGT方法及对GGT活性检测结果58例的临床观察与探讨

2005～2007年我院检验科对住院病人进行肝功能检测时，发现γ-谷氨酰移换酶（CGT）活性显著增高的病人58例：其值为986-1260U／L，平均值为1123U／L。男53例，女5例，年龄29～68岁，平均48．5岁。我院检验科对GGT活性测定设定的正常值为：男性〈50U／L，女性〈30U／L。     

γ-谷氨酰转移酶参考品赋值方法的初步研究

目的 :研究γ 谷氨酰转移酶 (GGT)参考品活性的赋值。　方法 :用临床化学国际联盟 (IFCC)推荐方法测定该酶的活性 ,选择 5种厂家生产的试剂盒 ,首先进行实际K值的测定 ,然后对该酶参考品赋值。　结果 :瓶间变异系数 (CV) <1.0 %。GGT催化浓度以 95 %可信限赋值 ,复溶的冻干参考品为 (138± 8)U/L。　结论 :该赋值对于本品的试用和认证是有价值的。     

进口质控物酶活力的靶值探讨

目的 比较了进口质控物中8种酶的靶值与常规方法的实测值，并探讨其在常规工作中的应用价值。方法 在常规条件下，测定了5种进口质控物（正常和异常水平）的8种酶（ALT、AST、ALP、GGT、LDH、CK、HBDH、ASM）的活力，并计算其与靶值的相对偏差和VIS。结果 ALT、AST、GGT均为负偏差（－13．9％、－12．4％、－8．27％）；ALP、CK、LDH的偏差无规律性；HBD、AMS以正偏差居多。结论 不同厂家的质控品的靶值与实测值之间存在较大的偏差，而且差别无一致性。因此，其靶值的应用须根据特定的分析系统来决定，而不能盲目地作为校准值使用。     

1例糖尿病肝细胞脂肪变性坏死的超声表现

患者男，68岁。主诉黄染，乏力7d就诊。既往史：糖尿病病史15年，无上腹不适及肝病史。查体：消瘦不明显，精神差，全身皮肤及巩膜黄染，肝脾未触及，腹水征( )。实验室检查：血糖16．2mmoL／L．尿糖卅。血ALT186U／L，AST185U／L，ALP683U/L。GGT126GU／L。TP59g／L。ALB34．6g／L，A/G1．4，TBL98mmol／L。DBL46．8mmol／L，ICDH95．6U／L，LAP170U／L．PAB632mg／L，TBA104mmol／L，     

57例股骨骨折的ALP和GGT分析

目的 碱性磷酸酶ALP和γ-谷氨酰氨基转移酶GGT在肝胆等大部分疾病中其升高和降低两者多数一致,通过探索骨疾病时患者血清中碱性磷酸酶ALP和γ-谷氨酰氨基转移酶GGT检测,了解骨疾病时ALP和GGT两者的变化关系来推断其临床价值和意义.方法 采用Beckkman DXC800生化分析仪进行同时检测股骨骨折患者血清中ALP和GGT检测值,并进行分析比较.结果 碱性磷酸酶ALP检测结果异常(ALP>150 U/L)为73.7%,而γ-谷氨酰氨基转移酶GGT异常(GGT>50 U/L)为28.1%,两组数据比较差异具有统计学意义(P<0.05).结论 股骨骨折血清中ALP明显升高,与骨疾病骨形成的标志物吻合,在代谢性骨病骨形成增加时增加.而γ-谷氨酰氨基转移酶GGT却增高不明显,两者呈显著性差异,可以得出通过血清ALP和GGT同时检测结果ALP升高,GGT不升高来推断出骨疾病.     

阻塞性睡眠呼吸暂停低通气综合征患者血清胱蛋白酶抑制剂C水平及尿系列酶活性的变化

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清胱蛋白酶抑制剂C(CystatinC)水平及尿系列酶活性的变化。方法选择OSAHS患者30例(OSAHS组)和健康成人30例(对照组),所有受试者均接受多导睡眠仪监测,采用ELISA法测定血清CystatinC水平,底物速率法检测尿系列酶N-乙酰-β-D氨基葡萄糖苷酶(NAG)、β-半乳糖苷酶(GAL)、γ-谷氨酰转移酶(GGT)和碱性磷酸酶(ALP)的活性。结果OSAHS组血清CystatinC水平显著高于对照组[(1.69±0.46)mg/L比(1.03±0.28)mg/L,P<0.01],尿系列酶NAG、GAL、GGT和ALP活性较对照组显著升高[分别为(5.02±2.11)U/(mmolCr)比(2.25±1.12)U/(mmolCr)、(1.42±0.57)U/(mmolCr)比(0.65±0.32)U/(mmolCr)、(3.78±0.70)U/(mmolCr)比(3.38±0.45)U/(mmolCr)、(0.81±0.28)U/(mmolCr)比(0.61±0.16)U/(mmolCr),P<0.01或P<0.05]。OSAHS组血清CystatinC水平与呼吸暂停低通气指数(AHI)呈正相关(r=0.538,P<0.01),与最低血氧饱和度(LSaO2)呈负相关(r=-0.515,P<0.01);尿系列酶NAG、GGT与AHI呈正相关(r=0.477,r=0.435,P<0.01或P<0.05),尿系列酶NAG、GGT与LSaO2负相关(r=-0.431,r=-0.510,P<0.05或P<0.01)。结论OSAHS患者血清CystatinC水平及尿系列酶活性显著升高,提示OSAHS患者存在肾功能损害。     

ALP、GGT及LDH联合检测评价原发性肝癌患者治疗效果

原发性肝癌是我国常见的恶性肿瘤之一，死亡率极高。碱性磷酸酶(ALP)及γ-谷氨酰转肽酶(GGT)是广泛分布于人体肝脏、骨骼、肠及肾等组织的酶。但血清中的ALP及GGT主要来自肝脏，因此具有较强的特异性，自1955年Hill等报告恶性肿瘤患者血清乳酸脱氢酶(LDH)活力增高以来，大量资料证明，血清LDH测定对心脏疾病、肝脏疾病和恶性肿瘤的诊断都有一定意义。利用三者联合检测评价原发性肝癌患者治疗效果具有一定的临床意义。     

初查乙肝病毒大三阳半年内转阴分析

患者男，47岁。因乏力、腹胀、恶心、呕吐、右上腹肝区不适四天，全身皮肤黄染、巩膜黄染一天，于2005年6月5日入院。入院经查：肝功：丙氨酸氨基转移酶ALT1340U／L，门冬氨酸氨基转移酶AS1060U／L，Y-谷氨酰转肽酶GGT1040U／L，总蛋白TPS0．0g／L，白蛋白ALB44G／L，球蛋白GL036．0G／L，A：G1．22：1，总胆红素TBIL261UmoFL，直接胆红素DBIL170umol／L，间接胆红素TBIL91Umol/L，碱性磷酸酶ALP200u／L。病原学检测：HBSAg＋HBSAb-HbeAg＋HSeAb—HBcAb＋。自诉以往健康，无乙肝病史。给予入院治疗，嘱患者卧术休息、清淡饮食，给予保肝、降酶、补液治疗，26天后患者症状好转，复查肝功恢复正常。     

迈克酶学试剂体系溯源性初步研究

目的初步建立迈克酶学体外诊断试剂的溯源性。方法用日本临床化学学（JSCC）提供的酶学参考品（ERM）及迈克自产较准品同时校准迈克试剂,并测定新鲜临床标本及交叉测定校准品或参考品。结果ALT、AST、GGT、CK、LDH-L、AMS项目用参考品和校准品校准后测定临床标本的结果相关性良好。结论迈克ALT、AST、GGT、CK、LDH—L、AMS项目基本可溯源至JSCC-ERM,ALP则由于测量体系差异太大而不能进行溯源到该参考品。     

血清酶校准品在室内质控血清中溯源性研究

目的　探讨血清酶校准品在室内质量控质中溯源性 ,建立实验室血清酶测定的标准化方法。方法　在日立737全自动生化分析仪上用酶校准品以单点定标方式设定仪器测得校准参数KT值 ,与理论校准参数KS值两种方法分别测定室内质控血清中的丙氨酸氨基转移酶 (ALT) ,天门冬氨酸氨基转移酶 (AST) ,碱性磷酸酶 (ALP) ,肌酸激酶 (CK) ,γ 谷氨酰转移酶 (GGT) ,乳酸脱氢酶 (LD)等 6种酶的活性。同一份标本进行校准前和校准后双份测定 ,比较其均值 ( x)、标准差(s)、相对偏奇 (D % )。结果　两种方法的测定结果存在一定差异 ,用KT值测定 6种酶的s均 <3.0 ,D % <4 .0 %比用KS值的测定结果明显减小。结论　用酶校准品进行室内质控血清中酶的测定方法具有较好的溯源性     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.