慢性肝炎血液学检查与肝脏病理对照分析

目的 :提高慢性肝炎临床诊断的正确性。方法 :按 2 0 0 0年“病毒性肝炎防治方案”(简称“2 0 0 0年肝炎方案”) ,对 774例不同病理分级、分度、分期慢性肝炎患者 7项血液学指标 ,血清丙氨酸转氨酶 (ALT)、血清门冬氨酸转氨酶(AST)、血清总胆红素 (TBIL)、白蛋白 (ALB)、白蛋白 /球蛋白 (A/G)、γ -球蛋白 (γ G)、凝血酶原活动度 (PTA)进行比较。结果 :随着肝组织炎症活动及纤维化程度的加重 ,ALT、AST、TBIL、γ G逐渐上升 ,PTA、ALB、A/G逐渐下降。轻度慢性肝炎ALB、γ G、PTA、TBIL、AST与病理诊断符合率较高 ,分别为 86 .9%、82 .3%、80 .0 %、74.0 %、70 .6 % ;而中度肝炎 7项指标中以ALT和A/G诊断符合率较高 ,分别为 78.2 %和 5 1.9% ;重度肝炎 7项指标中只有ALT有 81.3%的患者与病理相符。病理为轻度慢性肝炎患者 ,其ALT、TBIL已达到中度慢性肝炎范围 ;病理为中度及重度慢性肝炎 ,其PTA、ALB、A/G、γ G均数均轻于“2 0 0 0年肝炎方案”中相应界定标准。ALT、TBIL、PTA、ALB、A/G能较好反映肝组织炎症活动程度 ,PTA、ALB、γ G、A/G能较好反映肝纤维化进程。PTA、ALB、γ G、A/G在S0、S1、S2、S3期均在正常或大致正常范围 ,进入S4期PTA、ALB、γ G、A/G变化显著 ,均达到异常范围 ,分别为 6 5 .0     

HBeAg阴性慢性乙型肝炎患者血清学指标临床意义的探讨

目的 探讨乙型肝炎e抗原(HBeAg)、阴性慢性乙型肝炎患者血清学指标的临床意义.方法 检测HBeAg阴性的慢性乙型肝炎的HBV DNA、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBIL)、铁蛋白、透明质酸酶(HA)和IV型胶原肽含量,并与对照组进行分析.结果 HBeAg阳性组HBV DNA 含量、ALT明显高于HBeAg阴性组(P<0.01),而HBeAg阳性组的AST、TBIL、ALB、SF、HA、IV型胶原肽水平与HBeAg阴性组无明显差异(P>0.05).结论 HBeAg阴性的慢性乙型肝炎患者肝纤维化指标与HBeAg阳性的患者无明显差异,应定期加强监测.     

乙肝合并肺结核患者血清生化指标与肝组织病理学的相关性研究

目的探讨乙肝合并肺结核患者血清生化指标与肝组织病理学的相关性。方法回顾性选择接受肝组织活检的乙肝合并肺结核患者100例作为研究对象,根据肝组织炎症活动度和纤维化程度分组。检测患者血清生化指标谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)、白蛋白(ALB)、总胆红素(TBil)、凝血酶原活动度(PTA)、胆碱酯酶(CHE)。采用Sperman相关分析各血清生化指标与肝组织炎症活动度、纤维化程度的相关性。应用单因素、多因素非条件Logistic回归分析影响乙肝合并肺结核患者中重度炎症和纤维化的危险性因素。结果 100例乙肝合并肺结核患者中,中重度炎症38例,中重度纤维化35例。乙肝合并肺结核患者肝组织炎症活动度、肝组织纤维化程度与AST、ALP、TBil呈正相关(P 0. 05),与PTA、CHE呈负相关(P 0. 05),与ALT、GGT、ALB无相关性(P 0. 05)。多因素Logistic回归分析结果显示,AST、PTA是影响乙肝合并肺结核患者中重度炎症的危险性因素(P 0. 05),AST是影响乙肝合并肺结核患者中重度纤维化的危险性因素(P 0. 05)。结论乙肝合并肺结核患者肝组织炎症活动度、纤维化程度与血清生化指标AST、ALP、TBil、PTA、CHE密切相关。AST、PTA是影响中重度炎症的危险性因素,AST是影响中重度纤维化的危险性因素。     

人工肝血浆置换治疗重型肝炎效果及其预后影响因素分析

目的探讨人工肝血浆置换治疗重型肝炎效果及其预后影响因素。方法选取2017年10月—2020年10月收治的重型肝炎102例,按照治疗方法不同将其分为研究组(70例)和对照组(32例)两组。比较两组治疗3个月后临床效果、治疗前和治疗3个月后肝功能指标,观察两组治疗期间不良反应发生情况,并采用单因素和多因素Logistic回归分析探讨影响重型肝炎预后的相关因素。结果治疗3个月后,临床有效率研究组为95.71%高于对照组68.75%,差异有统计学意义(P0.01)。治疗3个月后,两组总胆红素(TBIL)和结合胆红素(DBIL)均较治疗前降低,白蛋白(ALB)和凝血酶原活动度(PTA)均较治疗前升高;研究组TBIL和DBIL低于对照组,ALB和PTA高于对照组,差异有统计学意义(P0.01)。治疗期间,研究组发生低血压、发热反应和四肢麻木各1例,对照组发生恶心和呕吐1例。单因素分析结果显示,预后良好组和预后不良组临床分期、治疗方法,TBIL、DBIL、ALB、PTA、血白细胞、血肌酐水平,以及是否并发感染、肝性脑病比较差异有统计学意义(P0.01)。多因素Logistic回归分析结果显示,内科常规治疗、PTA60%、血肌酐≥120μmol/L和并发肝性脑病为影响重型肝炎预后的独立危险因素(P0.01)。结论人工肝血浆置换治疗重型肝炎患者临床效果好,可改善肝功能,且安全性佳。内科常规治疗、PTA60%、血肌酐≥120μmol/L和并发肝性脑病为影响重型肝炎预后的独立危险因素。     

72例肝炎患者TT病毒DNA检测及部分基因序列分析

目的 了解肝炎患者中的TTV的感染情况并对部分分离株进行基因分型。方法 设计通用引物，采用半套式聚酶链反应检测肝炎患者血清标本中TTVDNA，并对部分PCR产物进行直接测序和序列分析。结果 在72例不同肝炎患者血清中，共检出TTVDNA阳性血清39份，总检出率为54.16%.其中,在非甲-非庚型肝炎患者中,TTVDNA阳性率为87.5%;在甲-庚型肝炎患者TTVDNA的阳性率(50.0%).对4株TTV序列分析结果显示,它们与日本分离株TA278、NA004、TKB555、PT3最高的同源性分别为97.7%、99.1%、96.8%、91%。经系统发育分析。其中有1株属G1型，有3株属G2型。结论 本次研究的肝炎人群中，TTV感染率较高，。感染的TTV颁发于G1及G2两个不同的基因型，TTV可能是非甲-非庚肝炎致病因素之一。     

护理干预对提高人工肝支持系统治疗重型肝炎疗效的影响

目的探讨护理干预对提高人工肝支持系统(MARS)治疗重型肝炎成功率的影响。方法将100例行MARS治疗的重型肝炎患者按随机数字表法分为观察组与对照组,每组各50例。对照组给予一般性的护理;观察组在一般性护理的基础上加强健康教育指导,做好心理护理。MARS治疗1周后,对2组谷丙转氨酶(ALT)、总胆红素(TBIL)、谷草转氨酶(AST)水平的变化进行比较。结果观察组ALT、TBIL、AST均较对照组明显降低(均P<0.05)。结论护理干预对MARS治疗重型肝炎效果有着积极的影响。     

HBeAg阴性慢性乙型肝炎患者肝组织学与血清学指标改变相关性研究

目的：探讨 HBeAg 阴性慢性乙型肝炎（CHB）患者肝组织学与血清学指标改变相关性。方法对135例确诊的HBeAg 阴性 CHB 患者分别进行肝活检和 HBV-DNA 拷贝、血清丙氨酸氨基转移酶（ALT）、总胆红素（TBiL）、天冬氨酸氨基转移酶（AST）、血清清蛋白（ALB）、凝血酶原活动度（PTA）、透明质酸（HA）、层粘连蛋白（LN）检测,并分析组织学检查结果和血清学检查结果相关性。结果血清 HBV-DNA 拷贝水平和各级肝组织炎症分级之间的差异具有统计学意义（χ2＝23.64,P ＜0.05）;高炎症等级血清 ALT、TBiL、AST、ALB、PTA 和 HA 浓度高于低炎症等级,差异具有统计学意义（P ＜0.05）;其中 ALT、TBiL、AST 和 HA 与炎症等级成正相关（P ＜0.05）;ALB 和 PTA 和 HA 与炎症等级成负相关（P ＜0.05）。结论 HBeAg 阴性 CHB 患者 HBV-DNA 拷贝水平、血清 TBiL、ALT、AST、ALB、PTA 浓度和患者的肝组织炎症分级相关,血清 HA 水平和肝组织纤维化水平相关。上述指标能够为 HBeAg 阴性 CHB 患者病情和预后判断提供参考价值。     

老年戊型肝炎患者肝功能分析

目的探讨戊型肝炎对老年人肝功能的损害。方法收集戊型肝炎患者208例,根据年龄、性别分组,检测肝功能相关指标:谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、总胆汁酸(TBA)、前白蛋白(PA)、白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL),并与100例健康人检测结果进行比较。结果戊肝患者的AST、ALT、GGT、TBA、TBIL、DBIL检测均值明显高于健康人,PA、ALB低于健康人;50岁以上戊型肝炎患者AST、ALT、PA、ALB检测均值明显低于50岁以下戊肝患者,TBIL、DBIL检测均值明显高于50岁以下戊肝患者,且P0.05,GGT、TBA的差异无统计学意义:老年男性戊肝患者的AST、ALT、GGT、PA、TBIL、DBIL检测均值明显高于老年女性戊肝患者,TBA、ALB的差异无统计学意义。结论戊型肝炎病毒感染对肝功能的损害严重,老年人比青壮年肝损害严重、黄疸程度重且易发生瘀胆,老年男性患者相对较多且对肝脏损害比老年女性严重。     

慢性乙型肝炎常见血液指标与肝脏纤维化状态相关性分析

目的探讨慢性乙型肝炎患者常见血液检验指标与肝组织纤维化状态相关性,遴选肝纤维化的相关性血液指标。方法回顾性调查230例肝活检慢性乙型肝炎患者资料,对患者血液常规、生化指标、乙型肝炎脱氧核糖核酸(HBV DNA)定量、血清甲胎蛋白进行等级相关、等级回归及Logistic回归等统计学分析。结果γ-谷氨酰转肽酶(GGT)、甲胎蛋白(AFP)、天冬氨酸转氨酶(AST)、凝血酶原时间(PT)、白蛋白(ALB)、血小板(Plt)、总胆红素(TB)、丙氨酸转氨酶(ALT)与炎症程度相关;Plt、ALB、PT、GGT水平显著影响炎症分级,预测准确率60.0%;AFP、PT、GGT、Plt、ALB、TB、AST与肝纤维化相关,其中Plt、ALB、AST及GGT显著影响肝纤维化分期,预测准确率62.0%;Plt、GGT参与代偿性肝硬化诊断敏感度27.0%,特异度96.7%,准确率83.2%,阳性预告值66.7%,阴性预告值84.6%;Plt 100×109/L单一指标诊断代偿性肝硬化ROC下面积0.793,特异度98.4%,敏感度23.1%,准确率85.6%,阳性预告值75.0%、阴性预告值86.2%。结论在慢性乙型肝炎常见血液检验指标中,血清GGT、AFP、AST、PT、ALB、Plt、TB与肝脏炎症、纤维化有相关性,Plt、ALB、AST及GGT显著影响肝纤维化分期,Plt、GGT预测肝硬化准确率83.2%。     

人工肝支持系统治疗重症黄疸型肝炎的临床观察

目的　探讨应用人工肝支持系统对 (ALSS)黄疸型肝炎的临床疗效及安全性。方法　治疗组 72例共行人工肝治疗 2 2 1次 ,平均 3 .2次 ,比较治疗前后临床表现。主要实验室检查指标及人工肝的不良反应。设同期住院病情相似的病例 56例为对照组。结果　治疗组症状明显好转 ;血TBIL、ALT、AST、NH3 、TBA、GGT明显下降 ,PTA、ALB升高 ;治愈好转率 88.89% ,不良反应率 16.7%。对照组治愈好转率 60 .71%。治愈好转病例住院时间 :治疗组 (2 7.16± 2 0 .3 6)天 ,对照组 (58.15± 2 5.49)天 ,两组比较有显著差异。结论　ALSS为黄疸型肝炎患者提供了较为安全有效的治疗手段     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。