Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.

The Association between Hemoglobin Value and Estimation of Amount of Intraoperative Blood Loss

Introduction: The estimation of blood loss rate during surgery for prediction of transfusion of blood or blood products requirement is important for surgeon and anesthesiologist. In regard to various results and lack of definite index for start of transfusion in operating rooms, the assessment of blood loss reduction is necessary. The aim of study was evaluation of hemoglobin (Hb) value and hemorrhage estimation rate. Methods and materials: 48 cases underwent major orthopedic surgery with high probability of intraoperative blood loss rate was included in study. Hb, hematocrit (Hct) and basic vital signs were measured preoperatively and blood loss rate was estimated by using of blood volume in suction, bloody gases and blood loss in operation field and recorded. The blood sample per 100 mL blood loss was sent to laboratory. For transfusion deciding based on Hb, we did not any intervention. Results: 26 males and 22 females were included in study. Our results showed that Hb value of males was higher significantly of females in preoperative period. After beginning of blood loss, Hb and Hct values declined with fixed slope and there was high negative correlation between them. First, intraoperative systolic and diastolic pressures declined with high slope and then reduced with mild slope. Hb value reduced significantly per 100 mL blood loss. During survey, no alteration in urine output did not be observed. Conclusion: Present study showed that much more intraoperative blood loss could reduce Hb with high correlation coefficient and measurement of it is efficient on transfusion.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

Contribution to the Improvement of Transfusion Safety: Assessment of the Pre-Donation Hemoglobin Level at the Yamoussoukro Blood Transfusion Center in Cote d’Ivoire

Introduction: Despite the progress recorded at the level of transfusion safety in Côte d’Ivoire, much remains to be done, particularly at the level of the medical selection of blood donors. The objective of the study was to make an assessment of the pre-donation capillary hemoglobin dosage for the year 2020 of the fixed collection, of the Blood Transfusion Center of Yamoussoukro. Method: This is a retrospective study that took place at the Yamoussoukro Blood Transfusion Center. The data collection related to all old and new blood donors were deemed suitable for the fixed collection of the year 2020. The method chosen for the pre-donation control is that of the portable hemoglobinometer of the HémoCue® type, more precisely 201+. Results: Of the 1160 blood donors in the study, the pre-donation hemoglobin level was not measured in 787 (67.8%) subjects of either sex. Of the subjects who had a pre-donation hemoglobin level performed, 97 (26%) blood donors had a sub-standard hemoglobin level, including 15 females and 82 males. Conclusion: Pre-donation hemoglobin testing of blood donors is effective in Yamoussoukro. However, efforts must still be made to improve the quality of the blood collected and to protect blood donors.

Detection of <i>β</i>-Hemoglobin Gene and Sickle Cell Disorder from Umbilical Cord Blood

Sickle cell disease (SCD) is one of the most common hemoglobinopathies, which is caused by the replacement of glutamic acid with valine at the sixth position of the beta-globin amino acid chain which sickling of the entire red blood cells in the homozygous (Hb S/S) condition. There are many analyses and screening procedures were developed to detect sickle cell anemia in the early age of birth, especially from heel prick blood, but in case of developing countries, it would be more acceptable to detect sickle cell disorder using umbilical cord blood just after birth rather than using heel prick blood. In this study, umbilical cord blood (UCB) was used to detect β-hemoglobin gene and sickle cell disorder. Polymerase chain reaction (PCR) based analysis was done using two primers (wild-type and mutant type) to detect this disorder. A total number of 22 samples were enrolled in this experiment for PCR amplification among which nineteen samples were identified by amplification of both 267 bp and 517 bp fragments revealing heterozygous sickle cell trait (Hb A/S), whereas three samples were found to amplify of 517 bp only revealing healthy individuals. The result from PCR analysis was then collaborated with the information of the mothers of each sample to analyze the result more conveniently and found that the mothers of all individuals except the three samples had anemia or mild form of anemia, thus it was expected that the newborn might have anemia trait (Hb A/S) the exception was found in case of sample No. 9 and sample No. 15. Both samples showed the bands on 267 bp and 517 bp thus expressed the sickle cell disease trait although the mothers of these samples were not anemic. However, no samples were recorded having sickle cell anemia (9 Hb S/S). The inherent simplicity and low cost of this PCR based analysis with umbilical cord blood will be considered as an effective tool in future newborn screening in Bangladesh.

血红蛋白/红细胞分布宽度比值与肺栓塞患者预后的相关性

目的探讨血红蛋白/红细胞分布宽度比值(hemoglobin/red blood cell distribution width ratio,HRR)与肺栓塞患者病死率的相关性及预后预测价值。方法本研究对MIMIC-Ⅳ(v2.2)中的肺栓塞患者进行回顾性研究。主要结局为院内死亡,次要结局为出ICU 7天、30天病死率。采用逻辑回归和限制性立方样条(RCS)探讨HRR与肺栓塞患者病死率的相关性;应用受试者工作特征(ROC)曲线分析HRR对肺栓塞患者的预后预测价值;通过亚组分析和似然比检验的交互作用检验来评估研究结果的稳健性。收集2021年1月1日至2023年12月31日入住山东中医药大学附属医院周围血管病科及重症医学科肺栓塞患者的临床数据,对肺栓塞与HRR预后相关性进行验证。结果本研究共纳入2282例肺栓塞患者,根据HRR的三分位数分成Q1组(<0.81)、Q2组(0.81~0.99)、Q3组(>0.99)。逻辑回归模型分析院内病死率时,在校正模型3中,HRR与院内病死率呈负相关(OR=0.202,95%CI 0.063~0.654)。RCS曲线进一步验证其具有线性相关性。ROC曲线分析院内死亡风险时,曲线下面积(AUC)为0.6424(95%CI 0.5863~0.6985),HRR具有显著预测优势。在亚组分析中,除婚姻-其他组(P=0.068)、种族-黑人组(P=0.497)、连续性肾脏替代治疗(CRRT)-是组(P=0.522)外,肺栓塞患者院内病死率的相关性稳定(P<0.05)。除下肢深静脉血栓形成组(交互作用P=0.019)、糖尿病组(交互作用P=0.019)外,HRR与其他各组无显著交互作用(交互作用P=0.152~0.821)。收集国内肺栓塞患者临床数据应用ROC曲线加以验证,AUC为0.8515(95%CI 0.7455~0.9575)。结论HRR与肺栓塞患者病死率具有显著的线性负相关性,且HRR是相对独立的预测因子。

德谷门冬双胰岛素治疗2型糖尿病有效性和安全性Meta分析

目的系统评价德谷门冬双胰岛素治疗2型糖尿病(T2DM)的有效性与安全性。方法采用计算机检索PubMed,Embase,The Cochrane Library,Clinicaltrials及中国知网(CNKI)、万方(WanFang)数据库中自建库起至2024年3月关于比较德谷门冬双胰岛素(试验组)与基础胰岛素或预混胰岛素(对照组)治疗T2DM的随机对照试验(RCT)。采用Cochrane偏倚风险评估量表对纳入文献进行质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入15项RCT,涉及患者4484例。Meta分析结果显示,与基础胰岛素比较,德谷门冬双胰岛素降低糖化血红蛋白(HbA1C)和空腹血糖(FBG)水平,增加体质量,降低低血糖事件、不良事件和严重不良事件的发生风险均无显著差异(P=0.86,0.89,0.08,0.13,0.81,0.07);与预混胰岛素比较,德谷门冬双胰岛素能显著降低FBG水平[MD=-1.42,95%CI(-1.44,-1.40),P<0.00001]和低血糖事件发生风险[RR=0.92,95%CI(0.86,0.98),P=0.010],但降低HbA1C水平、增加体质量、降低不良事件和严重不良事件的发生风险均无显著差异(P=0.19,0.69,0.58,0.09)。结论德谷门冬双胰岛素治疗T2DM的疗效显著,且安全性高。

白细胞介素18在低氧暴露大鼠骨髓及外周血中表达的意义

背景:低氧暴露下大鼠外周血红细胞水平明显升高,而骨髓有核红细胞增殖可能是导致外周血红细胞增加的直接原因之一,既往研究着重于促红细胞生成素、低氧诱导因子等因素的影响,对炎症、免疫等相关因素的研究甚少。目的:研究低氧暴露后大鼠骨髓有核红细胞、骨髓上清液及外周血中白细胞介素18的表达,探讨白细胞介素18在慢性高原病发病过程中可能发挥的作用。方法:16只健康雄性SD大鼠随机分为2组:实验组在模拟海拔5000 m低压氧舱中饲养28 d,对照组在海拔2260 m的实验室内饲养28 d,检测两组大鼠血常规,流式测定两组大鼠骨髓CD71^(+)有核红细胞比例,RT-qPCR、Western blot测定两组大鼠骨髓CD71^(+)有核红细胞中白细胞介素18 mRNA和蛋白表达,免疫荧光测定两组大鼠胸骨中白细胞介素18蛋白表达,ELISA测定两组大鼠外周血、骨髓上清液中白细胞介素18水平。结果与结论:①实验组大鼠外周血红细胞计数、血红蛋白、红细胞压积、平均血红蛋白含量等指标均较对照组增高(P<0.05);②实验组大鼠骨髓CD71^(+)有核红细胞比例较对照组显著增高(P<0.05);③RT-qPCR结果显示,实验组大鼠骨髓CD71^(+)有核红细胞中白细胞介素18 mRNA表达较对照组显著增高(P<0.05);④Western blot结果显示,实验组大鼠骨髓CD71^(+)有核红细胞中白细胞介素18蛋白表达较对照组显著增高(P<0.05);⑤免疫荧光结果显示,实验组大鼠胸骨中白细胞介素18蛋白表达较对照组显著增高(P<0.05);⑥ELISA结果显示,实验组大鼠血清中白细胞介素18水平较对照组增高(P<0.05),但实验组大鼠骨髓上清液中白细胞介素18水平较对照组下降(P<0.05)。结果表明低氧暴露后大鼠骨髓CD71^(+)有核红细胞、外周血中白细胞介素18表达增高可能参与骨髓有核红细胞的增殖过程。

T2DM患者红细胞体积、血红蛋白变化及其临床意义探讨

目的探讨2型糖尿病(T2DM)患者平均红细胞体积(MCV)、血红蛋白(Hb)变化及其临床意义。方法选择2021年1月—2023年1月本院收治的240例2型糖尿病(T2DM)患者(T2DM组)及本院同期健康体检者240名(健康对照组)作为研究对象,空腹采血,应用全自动血液分析仪检测其MCV、Hb和糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)]。比较T2DM组、健康对照组的MCV、Hb水平;Pearson分析T2DM组MCV、Hb与糖代谢指标的相关性;随访1年统计T2DM组微血管并发症发生率,并分为发生组、未发生组,Logistic回归分析T2DM微血管并发症的影响因素。结果与健康对照组比较,T2DM组MCV水平较高(P<0.05),Hb水平较低(P<0.05);T2DM组MCV与FBG、2 h BG、HbA1c呈正相关(P<0.05),Hb与FBG、2 h BG、HbA1c呈负相关(P<0.05);T2DM微血管并发症发生率为32.88%(72/219);体质量指数(BMI)(OR=1.370,95%CI:1.129~1.664)、高血压(OR=1.342,95%CI:1.116~1.613)、高脂血症(OR=1.302,95%CI:1.085~1.562)、MCV(OR=1.373,95%CI:1.126~1.674)、T2DM病程(OR=1.380,95%CI:1.121~1.699)、Hb(OR=0.734,95%CI:0.594~0.907)和血糖控制不达标(OR=1.365,95%CI:1.126~1.654)为T2DM微血管并发症发生的影响因素(P<0.05)。结论T2DM患者MCV异常升高,Hb异常降低,与糖代谢指标存在相关性,与BMI、高血压、高脂血症、T2DM病程和血糖控制不达标共为T2DM微血管并发症发生的影响因素。

新型凝血检测技术在评估创伤失血性休克合并凝血功能障碍患者早期病情中的应用

目的分析新型凝血检测技术(Sonoclot分析仪)在创伤失血性休克(THS)合并凝血功能障碍(ATC)早期预警中的临床价值。方法采用巢式病例对照研究:第一阶段开展回顾性病例对照研究,分析THS患者早期死亡的危险因素,重点关注凝血功能指标;第二阶段开展前瞻性研究,探究Sonoclot分析仪早期预警THS患者ATC的效能。结果回顾性研究纳入215例THS患者,随访至伤后30 d,死亡34例(15.81%);多因素logistic回归分析发现动脉血乳酸、血红蛋白、凝血酶原时间为THS患者早期死亡的高危因素。THS合并ATC患者(ATC组)病死率较无ATC组明显升高,ATC组患者凝血酶原时间较无ATC组显著延长(P<0.01)。Sonoclot分析仪检测凝血功能的指标包括活化凝血时间、凝血速率、血小板功能,与现用凝血指标联合检测能进一步提升对THS患者发生ATC预测效能(P<0.05)。结论高乳酸血症和凝血功能障碍是THS患者死亡的高危因素,Sonoclot分析仪可早期预警THS患者发生ATC,且联合现用凝血指标可进一步提升诊断效率。

Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding

AIM: To examine characteristics of patients with blood urea nitrogen(BUN) levels higher and lower than the normal limit.METHODS: Patient records between April 2011 and March 2014 were analyzed retrospectively. During this time, 3296 patients underwent upper endoscopy. In total, 50 male(69.2 ± 13.2 years) and 26 female(72.3 ± 10.2 years) patients were assessed. Patients were divided into two groups based on BUN levels: higher than the normal limit(21.0 mg/d L)(H) and lower thanthe normal limit(L). One-way analysis of variance was performed to reveal differences in the variables between the H and L groups. Fisher's exact test was used to compare the percentage of patients with gastric ulcer or gastric cancer in the H and L groups.RESULTS: White blood cell count was higher in the H group than in the L group(P = 0.0047). Hemoglobin level was lower in the H group than in the L group(P = 0.0307). Glycated hemoglobin was higher in the H group than in the L group(P = 0.0264). The percentage of patients with gastric ulcer was higher in the H group(P = 0.0002). The H group contained no patients with gastric cancer.CONCLUSION: Patients with BUN ≥ 21 mg/d L might have more severe upper gastrointestinal bleeding.

社区老年2型糖尿病患者血糖控制现状与自我管理行为、家庭关怀度的关系

目的调查社区老年2型糖尿病(T2DM)患者的血糖控制水平、自我管理行为与家庭关怀度现状,探讨自我管理行为与家庭关怀度对血糖控制的影响。方法选取2022年1—12月梧州市某社区卫生服务中心辖区内的160例老年2型糖尿病患者为调查对象,采用自行设计的一般情况调查表、家庭关怀度指数问卷(APGAR)和糖尿病患者自我管理行为量表(SDSCA)对患者进行问卷调查,分析社区老年2型糖尿病患者自我管理行为水平、家庭关怀度和血糖控制之间的关系。以糖化血红蛋白(HbA1c)作为血糖控制指标,SDSCA得分和APGAR得分作为自我管理行为和家庭关怀指标。结果社区老年2型糖尿病患者的SDSCA得分为38.14±9.24分,APGAR得分为4.40±2.12分。Pearson相关性分析显示,自我管理行为与糖化血红蛋白呈负相关(r=-0.384,P=0.000),其中普通饮食、运动、血糖监测、足部护理、遵医用药5个维度与糖化血红蛋白呈负相关;家庭关怀度与糖化血红蛋白亦呈负相关(r=-0.387,P=0.000),其中适应度、合作度、成长度、亲密度4个维度与糖化血红蛋白呈负相关。Logistic回归分析的结果显示,糖尿病患者自我管理行为中普通饮食、运动、足部护理和家庭关怀度中的亲密度是影响糖化血红蛋白的重要因素。结论社区老年T2DM患者HbA1c控制水平不佳,自我管理行为及家庭关怀度总体情况较差。提高患者自我管理水平和家庭关怀度,是有效控制HbA1c水平的方法。

2型糖尿病患者血清TRAF3表达水平与胰岛功能和胰岛素抵抗的相关性研究

目的分析2型糖尿病患者血清肿瘤坏死因子受体相关因子3(TRAF3)的表达水平与胰岛功能和胰岛素抵抗(IR)的相关性。方法选取2022年8月至2023年12月收治的148例2型糖尿病患者,根据胰岛素抵抗指数(HOMA-IR)值分为无IR组75例和IR组73例;另选80例同期体检健康者作为对照组。酶联免疫吸附法测定血清TRAF3的表达水平;Pearson和Spearman法分析血清TRAF3表达水平与空腹胰岛素(FINS)、餐后2 h血糖(2 h PG)、胰岛β细胞功能指数(HOMA-β)、胰岛素敏感指数(ISI)相关性;多元线性回归分析2型糖尿病患者发生IR的影响因素;受试者工作特征(ROC)曲线分析血清TRAF3表达水平对2型糖尿病患者IR的预测价值。结果2型糖尿病患者血清TRAF3水平高于体检健康者,无IR组患者血清TRAF3水平低于IR组(P<0.01)。2型糖尿病患者无IR组和IR组FINS、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、2 h PG、HOMA-IR、HOMA-β、ISI比较差异有统计学意义(P<0.05,P<0.01);2型糖尿病患者血清TRAF3水平与FINS、2 h PG、HOMA-β、FPG呈显著正相关(P<0.05);多元线性回归分析结果显示,TRAF3、FINS、FPG、2 h PG、LDL-C、HbA1c均为2型糖尿病患者IR的影响因素(P<0.05,P<0.01);ROC曲线分析结果显示,血清TRAF3表达水平评估2型糖尿病患者IR的曲线下面积为0.818,敏感度和特异度分别为78.08%和73.00%。结论血清TRAF3表达水平与2型糖尿病患者胰岛功能和IR密切相关。

2型糖尿病合并冠心病患者血清Hcy、HbAlc和血尿酸水平变化的临床意义

目的探讨2型糖尿病合并冠心病患者血清同型半胱氨酸(Hcy)、糖化血红蛋白(HbAlc)和血尿酸水平变化的临床意义。方法选取2型糖尿病合并冠心病患者60例为合并冠心病组,单纯2型糖尿病患者45例为单纯糖尿病组,健康志愿者30名为健康对照组。采集空腹外周静脉血,检测血清Hcy、HbAlc及血尿酸水平;行冠状动脉造影检查,记录冠脉狭窄程度50%及以上的病变累及左前降支、回旋支或右冠脉的支数(单支病变、双支病变、多支病变)。收集2型糖尿病合并冠心病患者的年龄、性别、身高、体质量、吸烟情况及低密度脂蛋白、总胆固醇、甘油三酯、空腹血糖、维生素B12、叶酸水平。进行3 a随访,记录患者病情加重再入院、死亡情况。结果合并冠心病组血清Hcy、HbAlc及血尿酸水平明显高于单纯糖尿病组和健康对照组(P<0.05);多支病变患者血清Hcy、HbAlc及血尿酸水平明显高于双支病变和单支病变患者(P<0.05);预后不良组患者血清Hcy、HbAlc及血尿酸水平明显高于预后良好组患者(P<0.05);预后不良组患者中吸烟比例、空腹血糖水平明显高于预后良好组(P<0.05)。Hcy、HbAlc、血尿酸是2型糖尿病合并冠心病患者预后的独立影响因素。ROC曲线分析显示,血清Hcy、HbAlc及血尿酸水平对2型糖尿病合并冠心病患者预后具有较高的预测价值(P<0.05),联合检测的预测价值最高(AUC=0.947)。结论2型糖尿病合并冠心病患者血清Hcy、HbAlc及血尿酸水平升高,且与冠脉病变程度密切相关,联合检测可用于患者预后评估。

延长氨甲环酸使用时间有助于减少老年股骨转子间骨折围术期隐性失血

背景:股骨转子间骨折好发于老年人,手术后会出现大量的隐性失血,减少隐性失血可以降低并发症和住院时间。目的:评估延长氨甲环酸的使用时间对股骨近端防旋髓内钉治疗转子间骨折围术期隐性失血的影响。方法:选择2022年1月至2023年5月自贡市第四人民医院经急诊收治入院的老年股骨转子间骨折患者共62例,均在牵引床上闭合牵引复位后置入股骨近端防旋髓内钉治疗。根据氨甲环酸的使用时间分为2组,对照组38例在切开皮肤前15-30 min给予氨甲环酸1 g静脉滴注,3 h后追加1 g;试验组24例在对照组的基础上,术后第1天再追加氨甲环酸1 g静脉滴注每12 h一次。术前、术后当天、术后第1,3,5天均复查血常规,统计血红蛋白量和红细胞压积,理论总失血量采用Gross方程计算,同时记录两组患者并发症发生情况。结果与结论:①通过统计学分析,两组患者术中显性出血量相差较小,差异无显著性意义(P>0.05);②试验组围术期血红蛋白下降量、总失血量、隐性失血量低于对照组,差异有显著性意义(P<0.05);③试验组术后第3天的血红蛋白值、术后第1,3天的红细胞压积值高于对照组,差异有显著性意义(P<0.05);④两组术后血红蛋白和血小板计数呈下降趋势,第3天的血红蛋白值为最低值,术后第1天的血小板值为最低值,然后开始回升;⑤两组患者术后并发症发生率相比差异无显著性意义(P>0.05);⑥结果表明,术后延迟氨甲环酸的使用时间,可能有助于减少股骨近端防旋髓内钉治疗股骨转子间骨折的隐性失血量,并不会增加并发症风险。

Correlation between GEM Premier 3000 and Vitros5.1+5600, SYSMEX XN-9000 in Detecting Electrolytes and Red Blood Cell Volume

Objective: To explore the consistency and relevance of the results of the bedside rapid blood gas analyzer GEM premier 3000, the Vitros5.1+5600 biochemical immunoassay analyzer and the SYSMEX XN-9000 automatic blood cell analyzer in the central laboratory detecting serum potassium (K+), serumsodium (Na+), blood glucose (Glu), hemoglobin (Hb) and red blood cell volume (Hct). And to provide a reference for the accurate interpretation of the bedside blood gas analysis report. Method: Usually, ICU patients will be taken arterial blood gas, biochemical and blood samples through the arterial indwelling needle;at the same time patients’ potassium, serum sodium, blood glucose, hemoglobin and red blood cell volume will be detected. This study implemented paired t-test and correlation regression analysis on each group of data, and used the analysis quality requirements (allowable total error) of CLIA’88 proficiency testing program as the criteria for clinical acceptance. Results: The paired t-test showed that the serum potassium, serum sodium and blood glucose detected by GEM premier 3000 and Vitros5.1+5600 were significantly different;and the hemoglobin and red blood cell volume detected by GEM premier 3000 and SYSMEX XN-9000 were significantly different (P < 0.05). The Pearson correlation coefficients (r) of hemoglobin, red blood cell volume and red blood cell volume were 0.860, 0.886, 0.924, 0.841 and 0.856, respectively, and the above test items all had good correlations (P < 0.05). The average (SE) of the paired differences of K+, Na+, Glu, Hb and Hct detected by the two sets of instruments is less than the allowable error of CLIA’88, and the SE of blood Na+ and Hb is less than half of the allowable error of CLIA’88. Conclusion: The test results of GEM premier 3000, the central laboratory Vitros5.1+5600 and SYSMEX XN-9000 have good correlation, but the consistency is not good. The test results of GEM premier 3000 cannot replace the central laboratory.

血糖和糖化血红蛋白水平与糖尿病视网膜病变患者病变分级及视力损伤的关系

目的 探讨血糖和糖化血红蛋白(Hb A1c)水平与糖尿病视网膜病变(DR)患者病变分级及视力损伤的关系。方法 选取江苏省淮安市第一人民医院分院2019年1月至2022年12月确诊为糖尿病的患者100例,其中DR患者60例(DR组)、糖尿病非视网膜病变(NDR)患者40例(NDR组)。根据DR分期标准将DR组分为35例非增殖型DR患者(NPDR组)和25例增殖型DR患者(PDR组)。比较DR组与NDR组患者、NPDR组与PDR组患者血糖和Hb A1c水平,比较不同空腹血糖(FPG)、餐后2 h血糖(2hPG)、Hb A1c水平患者的视力损伤程度,分析FPG、2hPG、Hb A1c与视力损伤及病变分级的相关性。结果 NDR组FPG、2hPG、睡前血糖、Hb A1c水平低于DR组(P<0.05);NPDR组FPG、2hPG、睡前血糖、Hb A1c水平低于PDR组(P<0.05);不同FPG、2hPG、Hb A1c水平患者视力损伤程度比较,差异有统计学意义(P<0.05);FPG、2hPG、Hb A1c与视力、病变分级呈正相关(r>0,P<0.05)。结论 血糖及Hb A1c水平与DR的发生、病变分级、视力损伤具有相关性,随着血糖及Hb A1c水平的升高,DR患者视力损伤程度增加。

西地那非对脑出血所致病理损伤和神经功能缺损的影响

目的 探讨血管活性药物西地那非(SDNF)对脑出血小鼠脑影像、病理损伤及神经功能的影响。方法 24只2~3月龄C57Bl/6小鼠,采用脑立体注射胶原酶法构建脑出血(ICH)模型,随机分为溶剂组、SDNF组,分别给予生理盐水或等体积0.5 mg/kg的SDNF连续灌胃7 d,之后分别在第3、7、14天进行mNSS神经功能评分,第7天采用脑磁共振检查脑血肿体积,激光散斑脑血流仪检测脑血流。造模后第14天处死小鼠,采用血红蛋白检测试剂盒检测脑内血红蛋白含量,采用免疫荧光法检测血肿周围血管内皮细胞标记CD31的表达量。结果 SDNF组小鼠mNSS评分在第7、14天的评分(分别为6.17±1.19、2.75±1.21)较溶剂组(分别为8.50±1.12、4.83±0.93)显著减小(F_(交互)=6.49,P<0.001)。SDNF组小鼠脑内血肿体积、校正脑组织水肿率在第7天(分别为2.94±1.05、5.37±1.26)较溶剂组(分别为6.03±1.23、8.01±1.75)显著减小(t值分别为4.66、2.99,均P<0.05),相对脑血流量(82.50±5.17)显著高于溶剂组(73.50±7.56,P<0.05)。SDNF治疗组小鼠脑内血红蛋白含量在第14天(36.98±12.31)显著小于溶剂组(66.00±17.21,P<0.05),病理结果显示SDNF治疗组小鼠脑内血管内皮标记物CD31的表达量(34.72±8.22)显著高于溶剂组(23.00±8.60,P<0.05)。结论 SDNF可减轻小鼠脑出血后神经功能缺损症状,改善脑血流,促进血肿吸收,降低脑内血红蛋白的含量,促进血管内皮细胞再生,在脑出血治疗中具有潜在的临床应用价值。

药学服务对终末期肾脏病透析患者治疗效果影响的Meta分析

目的:通过Meta分析探讨药学服务对终末期肾脏病透析患者治疗效果的影响。方法:通过中国知网、万方、维普、PubMed和Web of Science等数据库收集有关药学服务对终末期肾脏病透析患者的治疗效果研究,使用RevMan5.3软件进行数据处理分析。结果:Meta分析最终纳入12篇文献,终末期肾脏病透析患者1614人,分析结果显示,药学服务组患者服药依从性较对照组明显提高(OR=8.37,95%CI[2.13,32.89],P=0.002);药学服务组患者血压(OR=4.77,95%CI[2.48,9.18],P<0.001)、血钙(OR=3.33,95%CI[1.77,6.30],P=0.0002)和血红蛋白(OR=4.39,95%CI[2.51,7.68],P<0.001)的达标率均显著大于对照组。结论:药学服务可提高终末期肾脏病透析患者服药依从性,并对血压、血钙和血红蛋白的改善起到积极作用。