儿童急性呼吸窘迫综合征预后危险因素分析

目的:分析影响儿童急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)预后的危险因素,探讨干预策略。方法:回顾我院2012年2月—2016年7月151例ARDS患儿情况,按照患儿预后情况分为存活组和死亡组,对比两组患儿年龄、原发病、小儿危重病评分(PCIS)、实验室检查结果等基线资料间差异,运用Logistic多因素回归分析,总结影响ARDS患儿预后的相关危险因素。结果:151例患儿死亡92例,死亡率为60.93%,其中57例于确诊后3 d内死亡,占61.96%;存活组基线PCIS评分、氧合指数、WBC高于死亡组,其机械通气时间、受累器官数量低于死亡组,差异有统计学意义(P<0.05);死亡组年龄<28 d、肺源性疾病及新生儿透明膜肺病构成比高于存活组,差异有统计学意义(P<0.05)。PCIS评分≥70分、年龄≥28 d为儿童ARDS预后的保护因素,受累器官数量≥2个、肺源性疾病、新生儿透明膜肺病为影响儿童ARDS预后的独立危险因素(P<0.05)。结论:儿童ARDS的预后危险因素包括受累器官数量、肺源性疾病及新生儿透明膜肺病,根据患儿年龄及PCIS评分综合评估其预后,有望为治疗策略调整提供一定参考。     

急性白血病染色体异常与预后关系

目的:分析急性白血病(Acute leukemia,AL)染色体异常与预后的关系。方法:回顾279例AL患者临床资料。按照患者AL类型,分为急性髓细胞白血病(AML)组、急性淋巴细胞白血病(ALL)组,并按照其染色体核型检测结果,将患者分别纳入正常核型组、异常核型组,比较各组患者临床疗效及生存时间,分析AL染色体异常与预后的关系。结果:279例AL患者染色体核型异常率为75.99%,AML组与ALL组染色体核型异常率比较,差异无统计学意义(P>0.05)。染色体核型异常组1疗程CR率、总CR率均低于染色体核型正常组,差异有统计学意义(P<0.05);染色体核型异常组OS均低于染色体核型正常组,差异有统计学意义(P<0.05)。结论:染色体异常在AL患者中普遍存在,且异常染色体核型可对患者预后造成明显影响,据此开展个体化治疗有望提高化疗效果、延长患者生存时间。     

慢性阻塞性肺疾病急性加重期合并肺栓塞原因分析

目的:明确慢性阻塞性肺疾病急性加重期(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并肺栓塞(Pulmonary embolism,PE)的原因,为AECOPD患者合并PE的早期风险评估提供参考。方法:选取374例AECOPD患者,将合并PE患者纳入PE组,将未合并PE患者纳入对照组,比较2组患者一般资料、临床特征及辅助检查结果,运用Logistic多因素回归分析明确AECOPD合并PE的危险因素。结果:374例患者中,81例(21.66%)合并PE,其余293例(78.34%)未合并PE。PE组卧床≥7 d、合并糖尿病、合并静脉血栓患者比例显著高于对照组,胸痛、咯血、发热、胸腔积液、不对称下肢水肿发生率显著高于对照组,动脉血氧分压、动脉血二氧化碳分压显著低于对照组,D-二聚体、内皮素-1、血红蛋白、白细胞、肺动脉压显著高于对照组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析,卧床时间≥7 d、合并静脉血栓、PaO_2<60 mm Hg、PaCO_2<39 mm Hg、D-D升高、肺动脉压升高是影响AECOPD合并PE的独立危险因素。结论:根据AECOPD患者一般资料、临床特征及辅助检查结果能够评估其PE发生风险,根据患者PE发生的高危信号实施早期合理诊治有望降低其PE发病率、改善预后。     

血浆金属蛋白酶-9对急性脑梗死后自发性出血转化的预测价值分析

目的:分析血浆金属蛋白酶-9(MMP-9)对急性脑梗死后自发性出血转化(HT)的预测价值。方法:我院2014年7月至2016年7月收治的159例急性脑梗死患者纳入观察组,并选取同期80名健康体检者,纳入对照组。检测两组受试者基线血浆MMP-9浓度,而后按照观察组患者自发性HT发生情况,将其分为HT组、非HT组两个亚组,比较其基线血浆MMP-9浓度差异,运用Logistic多因素回归分析、ROC曲线,总结MMP-9对急性脑梗死后自发性HT的预测价值。结果:观察组血浆MMP-9浓度为(1095.36±214.27)μg/L,高于对照组的(915.28±107.43)μg/L,差异有统计学意义(P<0.05)。观察组25例(15.72%)于入院后7~10 d内发生自发性HT,HT组基线MMP-9浓度为(1368.85±371.09)μg/L,高于非HT组的(1013.26±179.08)μg/L,差异有统计学意义(P<0.05)。Logistic多因素回归分析示,血浆MMP-9升高以及合并房颤是影响急性脑梗死后自发性HT的独立危险因素(P<0.05)。ROC曲线示,以血浆MMP-9浓度=1225.81μg/L为界值,预测急性脑梗死后自发性HT的AUC为0.768,灵敏度为72.6%、特异性为70.1%,预测价值良好。结论:血浆MMP-9浓度是急性脑梗死后自发性HT的独立危险因素,可根据患者血浆MMP-9浓度选择溶栓治疗方案,从而降低溶栓后HT发生风险,改善患者预后质量。     

不同危重评分对急性肾功能衰竭预后判断价值

目的 :分析不同危重评分对急性肾功能衰竭(Acute renal failure,ARF)预后判断价值,为ARF患者预后判断提供参考依据。方法 :选取我院2013年5月—2015年5月收治的129例ARF患者,均于其确诊后24 h内行急性生理学和慢性健康状况评分(APACHE II)、简化急性生理评分(SAPS II)及序贯器官衰竭估计评分(SOFA),并按照其预后情况分为存活组与病死组,比较2组患者各项评分差异,并以受试者工作特征曲线(ROC)分析不同危重评分判断患者预后价值。观察APACHE II评分与病死率、死亡风险的关系。结果 :129例患者病死86例,病死率66.7%。存活组APACHE II、SAPS II评分显著低于病死组,差异有统计学意义(P<0.05),2组患者SOFA评分比较,差异无统计学意义(P>0.05)。APACHE II评分的ROC曲线下面积显著高于SAPS II评分、SOFA评分,差异有统计学意义(P<0.05),SAPS II评分与SOFA评分的ROC曲线下面积比较,差异无统计学意义(P>0.05)。随着患者APACHE II评分的增加,其病死率、R值均呈上升趋势。结论 :APACHE II对ARF患者预后的判断价值最高,建议作为临床预测患者预后的首选评分手段。     

急性冠状动脉综合征患者治疗后合并出血的相关因素分析

目的:分析急性冠状动脉综合征(Acute coronary syndrome,ACS)患者治疗后合并出血的相关因素。方法:以我院2010年5月~2016年5月收治的接受经皮冠脉介入治疗(PCI)的1109例ACS患者为研究对象,进行回顾性分析。参照GUSTO出血分级标准,按照患者治疗后出血事件发生情况,将发生出血事件者纳入出血组,将未发生出血事件者纳入未出血组,计算患者治疗后合并出血发生率,并比较两组患者基线临床资料,将存在统计学差异的因素纳入Logistic多因素回归分析,总结影响ACS患者治疗后合并出血的相关因素。结果:1109例患者中,共有52例治疗后发生出血,发生率为4.69%,其中大出血18例,中度出血15例,小出血19例,分别占34.62%、28.85%、36.53%。多因素分析示,年龄≥60岁、女性、NYHA心功能分级Ⅲ~Ⅳ级、消瘦、肌酐清除率<30 m L/min、血红蛋白<110 g/L(女)或<120 g/L(男)、合并糖尿病、既往消化道溃疡史、既往粘膜/腔道出血史及使用GPⅡb/Ⅲa受体拮抗剂,均为影响ACS患者治疗后合并出血的独立危险因素(P<0.05)。结论:ACS患者治疗后合并出血的相关因素包括年龄、性别、疾病状态、治疗方案等,应早期评估患者出血风险并调整治疗策略,尽可能降低出血事件发生风险。     

不同急性肾损伤标准评估急性肾损伤患者短期预后比较

目的:比较不同急性肾损伤(Acute kidney injury,AKI)标准对AKI患者短期预后的预测价值。方法:以我院2014年1月至2016年1月救治的276例AKI患者为研究对象,进行前瞻性对照分析。分别使用RIFLE、AKIN、KDIGO及传统标准,根据患者血清肌酐(SCr)水平变化判断其肾损伤程度分级,并比较不同肾损伤程度患者30d死亡率,运用受试者工作特征曲线(ROC),评估4种AKI标准预测患者30d死亡率的灵敏度与特异性。结果:276例患者中,69例于入院30d内病死,死亡率为25.00%。达到传统标准者,其死亡率高于未达到传统标准者,差异有统计学意义(P<0.05);随着患者RIFLE、AKIN、KDIGO分期的增加,其死亡率逐渐上升,差异有统计学意义(P<0.05)。4种AKI标准评估患者死亡率的ROC曲线下面积均>0.680(P<0.05),传统标准的ROC曲线下面积、特异性均最高,AKIN、KDIGO的灵敏度均为72.31%,高于其他2个标准。结论:传统标准预测AKI患者病死风险的特异性最高,AKIN、KDIGO对患者病死风险的预测最为灵敏,综合多种AKI标准评估患者病死风险对于指导临床诊治具有重要参考意义。     

急性心肌梗死患者急诊行介入治疗后预后影响因素分析

目的 :分析急性心肌梗死(Acute myocardial infarction,AMI)患者急诊行经皮冠脉介入治疗(Percutaneous coronary intervention,PCI)后预后影响因素,为患者PCI术后心血管事件防治提供参考依据。方法:以我院2010年3月-2014年3月收治的271例行急诊PCI治疗AMI患者为研究对象,进行回顾性分析。观察患者随访期间心血管事件发生情况,并分析年龄、性别等对患者预后影响。结果:共有93例患者于随访期间发生心血管事件,占34.3%,心血管事件以复发心绞痛为主,占21.0%,其次为再次血运重建,占15.5%。多因素分析结果示,年龄、发病至PCI时间、纤维蛋白原(Fibrinogen,FIB)、冠脉病变支数≥1支、梗死相关动脉(Infarct related artery,IRA)为左前降支(Left anterior descending branch,LAD)是影响AMI患者急诊行PCI预后的独立危险因素。结论 :影响急诊行PCI介入治疗后AMI患者预后的危险因素繁杂,应选择合理有效治疗方案控制或逆转危险因素,降低患者术后心血管事件发生率,改善预后质量。     

肾功能不全的特发性膜性肾病患者预后危险因素分析

目的:分析肾功能不全的特发性膜性肾病(Idiopathic membranous nephropathy,IMN)患者预后危险因素,探讨患者预后质量的改善策略。方法:对209例表现为肾功能不全的IMN患者进行分析。按照患者随访结果,将肾小球滤过率(e GFR)<30 m L/(min·1.73m~2)、发生终末期肾病(ESRD)或死亡者纳入预后不良组,将e GFR未降至终点事件范围者纳入肾功能稳定组。比较两组患者年龄、性别、合并症、尿蛋白等基线资料差异,运用多因素Logistic回归分析,总结影响肾功能不全的IMN患者预后的危险因素。结果:209例患者中,共计53例患者发生终点事件,占25.36%。年龄≥60岁、肾小管间质损害≥25%、尿β2-微球蛋白≥1.17mg/L、尿免疫球蛋白G≥24.98 mg/L是影响肾功能不全的IMN患者预后的独立危险因素,血清白蛋白≥25 g/L为保护因素(P<0.05)。结论:多数肾功能不全的IMN患者可自发缓解,但仍有部分高龄、营养不良及肾小管变严重患者预后质量不佳,应予以积极救治。     

急性脑梗死患者微量白蛋白尿对病情预后评估价值

目的 :探讨微量白蛋白尿(MAU)对于急性脑梗死患者临床意义。方法 :对60例急性脑梗死患者(脑梗死组)和60例非急性脑卒中患者(对照组)进行MAU测定,比较两组患者MAU检测阳性率,并比较脑梗死组MAU阳性和阴性患者NIHSS、GCS及mRS评分,对脑梗死组患者随访24个月,比较比较脑梗死组MAU阳性和阴性患者复发率。结果 :脑梗死组MAU检测阳性率高于对照组(χ2=5.168,P=0.023);脑梗死组60例患者中MAU检测阳性28例,阴性32例,MAU阳性组NIHSS评分高于MAU阴性组(P<0.01),GCS评分低于MAU阴性组(P<0.01),入院时及出院后3个月、12个月MAU阳性组mRS评分均高于MAU阴性组,(P<0.05,P<0.01);对急性脑梗死患者随访24个月,MAU阳性亚组复发率高于阴性组(χ2=4.436,P=0.035),差异均有统计学意义。结论 :MAU不仅是急性脑梗死发病的危险因素,还可作为病情判断、预后评估重要指标。     

Adrenocorticotropin regulation of steroidogenic acute regulatory protein

We studied the effect of the adrenocorticotropin hormone (ACTH) on the expression of the steroidogenic acute regulatory protein (StAR) in vivo in rat and hamster adrenals and also in transfection experiments using COS-1 cells. In vivo, ACTH increased the level of StAR mRNA within 30-60 minutes and also increased the quantity of StAR, but with a 2-3-hour delay. ACTH induced the formation of many acidic StAR species as analyzed by two-dimensional gel electrophoresis and immunoblotting. In the transfection experiments, (Bu)(2)-cAMP also induced the formation of many acidic species for the hamster StAR; in COS-1 cells, StAR is phosphorylated mainly on serine (S) residue(s). When alanine (A) was substituted for serine, S13A, S185A, and S194A mutants had decreased StAR activity compared to wildtype, thus determining the importance of these amino acid residues in StAR action. The full-length WT, N46-truncated StAR lacking its mitochondrial import sequence, and N46-S194A had similar activities, whereas N46-S185A had completely lost its activity. Our results suggest that S194, but not S185, functions in association with the mitochondrial import sequence for the initiation of StAR activation. Further studies showed that S185 is implicated in salt bridge stability, not in StAR phosphorylation, suggesting its importance for StAR folding. Thermodynamic calculations of the hamster StAR homology model based on MLN64 show that StAR can partially unfold to bind cholesterol and serve as a rapid transfer mechanism for eventual translocation into mitochondria. This is supportive of a StAR functioning either outside the mitochondria or in the mitochondrial intermembrane space.     

Protein-mediated interactions in the dynamic regulation of acute inflammation

Protein-mediated interactions are the fundamental mechanism through which cells regulate health and disease. These interactions require physical contact between proteins and their respective targets of interest. These targets include not only other proteins but also nucleic acids and other important molecules as well. These proteins are often involved in multibody complexes that work dynamically to regulate cellular health and function. Various techniques have been adapted to study these important interactions, such as affinity-based assays, mass spectrometry, and fluorescent detection. The application of these techniques has led to a greater understanding of how protein interactions are responsible for both the instigation and resolution of acute inflammatory diseases. These pursuits aim to provide opportunities to target specific protein interactions to alleviate acute inflammation.     

主动脉内球囊反搏在急性心肌梗死致心源性休克中应用

目的:观察主动脉球囊反搏在急性心肌梗死致心源性休克治疗中应用效果。方法:回顾性分析2010年3月²013年9月由我中心出诊治且转送至同一家医院收治的急性心肌梗死导致的心源性休克患者资料,主动脉球囊反搏组患者在主动脉球囊反搏(IAPB)辅助下予以急诊PCI治疗,未行IAPB组患者予以常规药物治疗行急诊经皮冠状动脉介入(PCI)治疗。结果:IAPB组行IAPB术后心率血压均显著改善,患者左心室射血分数增加、心功能改善均优于未行IABP组,组间差异有统计学意义;IAPB组术后死亡率较未行IAPB组明显低(P<0.05)。结论:IABP治疗可明显改善患者心功能,能降低急性心梗行PCI术患者的死亡率。     

心电图变化在急性胰腺炎患者诊断中的应用

目的评价急性胰腺炎患者的心电图变化对其预后及诊疗的价值。方法收集2001年1月—2006年1月在天津市南开医院确诊的新发急性胰腺炎患者(230例)的心电图,并进行回顾性分析,综合评价。结果230例急性胰腺炎患者,95例出现心电图异常(41.31%),其中:急性水肿性胰腺炎(MAP)174例,出现心电图异常为61例(35.06%);出血坏死性胰腺炎(SAP)56例,出现心电图异常为34例(60.71%)。结论心电图的变化对急性胰腺炎预后及诊疗均具有一定的临床意义。     

Short term protective effect of digitoxin in sepsis-induced acute lung injury

Purpose: Digitoxin is a cardiac glycoside used in the treatment of heart failure. Inspired by its known anti-inflammatory effect, this study aims to investigate the effect of digoxin in a sepsis model and to bring to light its effect and underlying mechanism in acute lung injury (ALI). Method: 28 wistar albino rats were divided into 4 groups. Sepsis model is performed by the feces intraperitoneal-injection procedure (FIP). Results: TNF-a, CRP, IL-6, IL 1-Beta, lactic acid, and MDA values were significantly decreased in the FIP+digitoxin group compared to the FIP+Saline group. When the same groups were examined, histological improvements such as decrease in alveolar inflammation and decrease in septal thickening in the digitoxin group and thorax CT were found to be significantly higher in the Hounsfield unit digitoxin group compared to the Saline group. Conclusion: Digitoxin has shown biochemical improvement in sepsis with all known mechanisms of action, and healing effects in both computerized tomography and histology in the lung.     

Overview of transcutaneous electrical nerve stimulation for treatment of acute postoperative pain

The Office of Health Technology Assessment of the Public Health Service recently reviewed primary evidence presented by investigators who conducted clinical trials of transcutaneous electrical nerve stimulation (TENS). The therapeutic use of TENS involves placing electrodes at various locations on the body and then applying electrical impulses to the patient through the electrodes. OHTA's assessment concludes that, in instances in which specific indications are met, TENS for treatment of acute postsurgical incision pain has become an accepted alternative to conventional methods of treatment.     

慢阻肺急性加重期无创机械通气失败的危险因素

目的 :分析慢阻肺急性加重期无创机械通气失败的危险因素。方法 :回顾性分析我院2015年2月至2018年5月治疗的388例慢性阻塞性肺疾病急性加重期患者临床资料,按无创机械通气结局进行分组,最终成功组纳入病例305例,失败组纳入病例83例,采用统计学方法处理两组患者临床资料,分析无创机械通气失败的危险因素。结果 :成功组降钙素原、C反应蛋白(C-reactionprotein,CRP)及二氧化碳分压(partial pressure of carbon dioxide,PaCO_2)表达水平均低于失败组,而pH值高于失败组,差异均有统计学意义(P <0.05)。以降钙素原、PaCO_2、CRP及pH值为自变量,无创机械通气结局为因变量,采用多因素回归分析对以上因素进行分析,结果发现降钙素原> 0.72 ng/mL、PaCO_2> 74.38mmHg、CRP> 16.75 mg/mL及pH值≤7.23均是慢阻肺急性加重期无创机械通气失败的独立危险因素(P <0.05)。结论 :慢阻肺急性加重期行无创机械通气时应密切观察CRP、pH值、PaCO_2及降钙素原变化情况,及时给予针对性干预。     

尿胰蛋白酶原激活肽测定对急性重症胰腺炎诊断价值

目的探讨尿胰蛋白酶原激活肽测定对急性重症胰腺炎的诊断价值。方法选择51例急性胰腺炎患者,按Atlanta标准分为轻型（MAP）28例,重型（SAP）23例,比较轻型和重型患者发病后、24h、48h、72h血CRP、ESR、血淀粉酶和尿TAP水平,并以尿TAP诊断试验与同期APACHEⅡ评分系统比较,确定尿TAP对SAP诊断的灵敏度、特异性、准确率,并观察TAP与SAP合并症的关系。结果SAP患者尿TAP水平在入院时、24h、48h均高于MAP组（P〈0.05）,TAP测定结果法与APACHⅡ系统法对急性胰腺炎轻、重型的评估,差异无统计学意义（P〉0.05）,小于、大于临界值35 nmol/L时,尿TAP预测SAP的敏感性、特异性和准确性分别为86.9%、67.8%、76.5%和78.3%、75.0%、80.4%。有无腹水及是否合并MODS,TAP的检测结果差异有统计学意义（P〈0.05）。结论尿TAP水平与急性胰腺炎患者病情的严重程度有关,在发病24h内对早期SAP具有一定预测价值,与APACHEⅡ评分系统效果相当。     

Accurate automatic detection of acute lymphatic leukemia using a refined simple classification

An improved classification technique is presented to identify automatically the acute lymphatic leukemia (ALL) subtypes. An adaptive segmentation procedure is performed on peripheral blood smear images to extract the main features (10 geometric features) from the segmented images of white blood cell (WBC), nucleus, and cytoplasm. To show the importance of the different extracted features for the diagnostic accuracy, a comprehensive study is made on all the possible permutation cases of the features using powerful classifiers which are K‐nearest neighbor (KNN) at different metric functions, support vector machine (SVM) with different kernels, and artificial neural network (ANN). This procedure enables us to construct a feature map depending only on least number of features which lead to the highest diagnostic accuracy. It is found that the features map regarding the vacuoles in the cytoplasm and the regularity of the nucleus membrane gives the highest accurate results. The automatic classification for ALL subtypes based only on these two effective features is assessed using the receiver operating characteristic (ROC) curve and F ₁ ‐score measures. It is confirmed that the present technique is highly accurate, and saves the effort and time of training.     

肺保护性通气策略在急性呼吸衰竭治疗中应用

目的:探讨肺保护性通气在急性呼吸衰竭患者治疗中的应用及其效果。方法:选取急性呼吸衰竭且具备机械通气指征患者80例,随机分为观察组与对照组,每组各40例。观察组采用肺保护性通气策略,对照组采取序贯性机械通气。比较两组治疗前及治疗后血气指标、机械通气总时间、呼吸机相关肺炎(VAP)发生率及死亡率。结果:治疗前,两组pH、PaO2、PaCO2比较,差异均无统计学意义。治疗后,两组pH、PaO2均升高(t=3.26⁶.23,P<0.05或P<0.01),PaCO2(t=5.36、3.64,P<0.05或P<0.01);除观察组PaCO2高于对照组(t=3.47,P<0.05)、VAP发生率低于对照组(χ2=5.12,P<0.05)外,治疗后两组pH、PaO2、机械通气总时间及死亡率比较,两组差异均无统计学意义(t=0.006.23,P<0.05或P<0.01),PaCO2(t=5.36、3.64,P<0.05或P<0.01);除观察组PaCO2高于对照组(t=3.47,P<0.05)、VAP发生率低于对照组(χ2=5.12,P<0.05)外,治疗后两组pH、PaO2、机械通气总时间及死亡率比较,两组差异均无统计学意义(t=0.00¹.36,P>0.05)。结论 :肺保护性通气与序贯通气治疗急性呼吸衰竭均能有效改善患者氧合能力,减轻呼吸肌疲劳,纠正低氧血症,均具有较好效果。区别在于肺保护性通气低潮气量可减少肺部损伤、序贯通气减少了有创通气时间。