Significance of functional hepatic resection rate calculated using 3D CT/^(99m)Tc-galactosyl human serum albumin singlephoton emission computed tomography fusion imaging

AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/99mTc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and 99mTc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/99mTc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.

Indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography evaluated preoperative remnant liver

BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.

The correlation of urinary albumin excretion rate with renal function, inflammatory response and oxidative stress response in patients with diabetic nephropathy

Objective:To study the correlation of urinary albumin excretion rate with renal function, inflammatory response and oxidative stress response in patients with diabetic nephropathy (DN).Methods: A total of 78 patients with DN treated in our hospital December 2012 and March 2016 were collected and divided into early diabetic nephropathy group (n=51) and middle-advanced diabetic nephropathy group (n=27) according to the DN grading standard;60 subjects with normal renal function who receiving physical examination in our hospital during the same period were selected as normal control group. Immediately after admission, the urinary albumin excretion rate (UAER) of all groups were determined;automatic biochemical analyzer was used to determine renal function index levels, ELISA method was used to determine inflammatory factor levels, and RIA method was used to determine the oxidative stress index levels;Pearson test was used to analyze the correlation of UAER value with renal function, inflammatory response and oxidative stress response in patients with DN.Results:Differences in UAER value as well as renal function index, inflammatory response index and oxidative stress index levels were statistically significant among three groups of subjects. UAER value as well as BUN, Scr, CysC,β2-MG, IL-6, hs-CRP, TNF- , MDA and AOPP levels of early DN group and middle-advanced DN group were higher than those of normal control group while T-AOC and SOD levels were lower than those of normal control group;UAER value as well as BUN, Scr, CysC,β2-MG, IL-6, hs-CRP, TNF- , MDA and AOPP levels of middle-advanced DN group was higher than those of early DN group while T-AOC and SOD levels were lower than those of early DN group;UAER value in patients with DN was correlated with renal function, inflammatory response and oxidative stress.Conclusion:UAER value can directly reflect the renal injury, inflammation and oxidative stress in patients with DN, and be the reliable means for early disease diagnosis and treatment guidance.

Bovine Serum Albumin-Conjugated Ferrimagnetic Iron Oxide Nanoparticles to Enhance the Biocompatibility and Magnetic Hyperthermia Performance

Magnetic hyperthermia is a fast emerging, non-invasive cancer treatment method which is used synergistically with the existing cancer therapeutics. We have attempted to address the current challenges in clinical magnetic hyperthermia-improved biocompatibility and enhanced heating characteristics, through a single combinatorial approach. Both superparamagnetic iron oxide nanoparticles(SPIONs) of size 10 nm and ferrimagnetic iron oxide nanoparticles(FIONs) of size 30 nm were synthesized by thermal decomposition method for comparison studies. Two different surface modifying agents, viz, Cetyl Trimethyl Ammonium Bromide and 3-Aminopropyltrimethoxysilane, were used to conjugate Bovine Serum Albumin(BSA) over the iron oxide nanoparticles via two different methods—surface charge adsorption and covalent amide bonding, respectively. The preliminary haemolysis and cell viability experiments show that BSA conjugation mitigates the haemolytic effect of the iron oxide nanoparticles on erythrocytes and is non-cytotoxic to the healthy Baby Hamster Kidney cells. It was observed from the results that due to better colloidal stability, the SAR value of the BSA-iron oxide nanoparticles is higher than the iron oxide nanoparticles without BSA, irrespective of the size of the iron oxide nanoparticles and method of conjugation. The BSA-FIONs seem to show improved biocompatibility, as the haemolytic index is less than 2 % and cell viability is up to 120 %, when normalized with the control. The SAR value of BSAFIONs is 2300 Wg^(-1) when compared to 1700 Wg^(-1) of FIONs without BSA conjugation. Thus, we report here that BSA conjugation over FIONs(with a high saturation magnetization of 87 emug^(-1)) provide a single combinatorial approach to improve the biocompatibility and enhance the SAR value for magnetic hyperthermia, thus addressing both the current challenges of the same.

Microalbuminuria in White and Black Hypertensive Nondiabetic Brazilian Patients

Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 μg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe’s reaction. ACR (μg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African ancestry, as estimated by molecular markers.

蛋白尿与估算肾小球滤过率联合对糖尿病患者新发心血管疾病的影响

目的 观察估算肾小球滤过率(estimated glomerular filtration rate, eGFR)和尿微量白蛋白与肌酐比值(urine albumin-to-creatinine ratio, uACR)评估肾功能的一致性,探讨二者联合对糖尿病患者新发心脑血管疾病(cardia-cerebrovascular disease, CVD)(包括心力衰竭、心肌梗死、脑卒中)的影响。方法 选择参加开滦第5次或第6次健康体检且进行尿微量白蛋白及尿肌酐、血肌酐检测的8 791例2型糖尿病(type 2 diabetes mellitus, T2DM)患者为研究对象。依据基线uACR和eGFR水平分组:正常组(uACR<3 mg/mmol且eGFR≥90 mL·min^(-1)·1.73 m^(-2))、单纯eGFR下降组(uACR<3 mg/mmol且eGFR<90 mL·min^(-1)·1.73 m^(-2))、单纯uACR升高组(uACR≥3 mg/mmol且eGFR≥90 mL·min^(-1)·1.73 m^(-2))和uACR升高合并eGFR下降组(uACR≥3 mg/mmol且eGFR<90 mL·min^(-1)·1.73 m^(-2))。观察eGFR和uACR评估的肾功能是否一致。采用多因素Cox回归模型分析uACR和eGFR联合分组对CVD发病风险的影响。结果 (1)研究对象基线年龄为(60.97±9.99)岁,男性占79.05%,中位uACR为1.68(0.81,4.60)mg/mmol,平均eGFR为(92.14±16.52) mL·min^(-1)·1.73 m^(-2),uACR升高与eGFR下降不一致者占43.59%。(2)中位随访时间为3.83年,共发生CVD事件694例(7.89%),4组总CVD事件的发病密度分别为12.96/1 000人年、19.04/1 000人年、25.65/1 000人年和46.87/1 000人年。(3)与正常组相比,单纯eGFR下降组、单纯uACR升高组和uACR升高合并eGFR下降组新发总CVD事件的风险分别升高1.06(95%CI 0.73~1.55)倍、1.99(95%CI 1.41~2.80)倍和3.00(95%CI 2.12~4.25)倍。结论 eGFR下降和uACR升高所评估的肾功能不一致现象较为常见,二者对CVD发病的影响存在联合作用。

高血压早期肾损害诊断指标的筛选

目的:筛选高血压早期肾损害的诊断指标。方法:搜集2020年1月至2023年2月河南省人民医院内科病房收治的高血压患者,选取高血压早期肾损害[30 mg/24 h≤尿白蛋白排泄率(uAER)<300 mg/24 h]患者51例(肾损害组),以及单纯高血压患者51例(对照组)。比较两组患者血清尿素氮(BUN)、肌酐(SCr)、同型半胱氨酸(HCY)、视黄醇结合蛋白(RBP)、胱抑素C(CysC)、尿微量白蛋白(umALB)、微量白蛋白/肌酐比值(uACR)、α1微球蛋白(uα1MG)、β2微球蛋白(uβ2MG)、N-乙酰-β-D氨基葡萄糖苷酶(uNAG)及转铁蛋白(uTF)水平的差异。绘制ROC曲线,比较上述指标对高血压早期肾损害的诊断效能。结果:肾损害组患者血清BUN、SCr、HCY、RBP、CysC水平及umALB、uAER、uACR、uα1MG、uβ2MG、uNAG、uTF水平均高于对照组(P均<0.05)。ROC曲线AUC>0.9的指标从高到低分别为uACR>CysC>uα1MG>uβ2MG>umALB>RBP,其中CysC+uACR联合诊断的效能和敏感度最高[AUC(95%CI)为0.994(0.954~1.000),敏感度为1.000]。结论:CysC+uACR为高血压患者早期肾损害的高效诊断指标。

早期慢性肾脏病患者体内血清白蛋白水平对冠脉钙化的预测价值

【目的】探讨早期慢性肾脏病(CKD)患者的血清白蛋白水平与冠脉钙化(CAC)的相关性,以及对CAC发生及严重程度的预测价值。【方法】筛选2019年1月至2022年12月于中山大学孙逸仙纪念医院住院行冠状动脉CTA检查的早期CKD患者391例,收集一般临床资料、血清学检查结果、冠脉CTA检查结果。根据冠脉钙化积分(CACS)将患者分为非冠脉钙化组(CACS=0分)184例,冠脉钙化组(CACS>0分)207例;根据血清白蛋白水平分为三组,即白蛋白<35 g/L组(30例)、35 g/L≤白蛋白<40 g/L组(198例)、白蛋白≥40 g/L组(163例)。首先利用单因素及多因素回归方法分析血清白蛋白对早期CKD患者CAC的影响,其次对不同CAC程度患者中进行组内差异性分析、组间多重比较、logistics回归模型分析。【结果】冠脉钙化组患者的血清白蛋白水平显著低于非冠脉钙化组(P<0.05)。在早期CKD患者中血清白蛋白水平与CACS呈负相关(P<0.01),即血清白蛋白水平越低,CAC程度越严重。【结论】在早期CKD患者中,血清白蛋白水平越低,CAC发生率越高。并且低血清白蛋白水平是CAC进展的独立危险因素。

白蛋白结合型紫杉醇联合替吉奥一线治疗晚期胃癌的效果

目的探讨白蛋白结合型紫杉醇联合替吉奥一线治疗晚期胃癌的效果。方法回顾性选取2022年1月—2023年6月赤峰市医院收治的100例晚期胃癌一线治疗患者的临床资料,按治疗方案不同分为观察组(50例,白蛋白结合型紫杉醇联合替吉奥治疗)与对照组(50例,奥沙利铂联合替吉奥治疗)。对比两组临床疗效、不良反应发生率、血清肿瘤标志物。结果观察组治疗有效率为64.00%(32/50)、疾病控制率88.00%(44/50)均较对照组的42.00%(21/50)、70.00%(35/50)更高,差异有统计学意义(χ^(2)=4.858、4.883,P均<0.05)。观察组不良反应的总发生率为36.00%(18/50)低于对照组的40.00%(20/50),差异无统计学意义(χ^(2)=0.170,P>0.05)。治疗4周期后,观察组的血清肿瘤标志物均低于对照组,差异有统计学意义(P均<0.05)。结论晚期胃癌一线治疗联用白蛋白结合型紫杉醇、替吉奥,可提高治疗效果,保障治疗安全,降低血清肿瘤标志物水平,值得临床借鉴。

入院检查指标与骨质疏松椎体压缩性骨折患者术后死亡率的相关性分析

目的:探讨入院实验室检查各指标与骨质疏松椎体压缩性骨折(OVCF)患者行经皮球囊扩张椎体后凸成形术(PKP)治疗后死亡率的相关性。方法:选取2018年6月至2022年6月在包头市第三医院经同一手术小组诊断为OVCF并行PKP手术治疗的患者,收集患者入院时血常规、血生化指标及基本信息,随访患者术后生存情况及Oswestry功能障碍指数问卷(ODI)。根据随访期间患者是否存活将患者分为生存组及死亡组两组。对两组患者入院时相关检查指标进行比较,分析患者死亡结局的影响因素。结果:176例OVCF的患者术后一年死亡率为6.81%(12/176),随访观察期间患者总死亡率为18.75%(33/176)。骨密度(BMD)预测患者死亡的AUC为0.797(95%CI:0.699-0.895,P<0.05),当敏感性为66.7%、特异性为85.3%时诊断指数最大为0.520,诊断截点为-3.430。白蛋白(ALB)预测患者死亡的AUC为0.676(95%CI:0.572-0.780,P<0.05),当敏感性为63.6%、特异性为70.6%时诊断指数最大为0.342,诊断截点为39.450 g/L。中性粒细胞与淋巴细胞比率(NLR)预测患者死亡的AUC为0.786(95%CI:0.693-0.879,P<0.05),当敏感性为81.8%、特异性为65.0%时诊断指数最大为0.468,诊断截点为3.120。BMD、ALB、NLR三个指标联合后预测患者死亡的AUC为0.871(95%CI:0.798-0.945,P<0.05),当敏感性为75.8%、特异性为86.7%时诊断指数最大为0.625,诊断截点为4.945,高于NLR、BMD及ALB单个指标的曲线下面积。结论:BMD、ALB、NLR三个指标联合后(联合指标Y=0.528×NLR-3.526×BMD-0.227×ALB)可以更好预测患者死亡率。

ESR与白蛋白比值水平与强直性脊柱炎疾病活动度的关系研究

目的探讨ESR与白蛋白(ALB)比值(EAR)水平与强直性脊柱炎(AS)疾病活动度的关系。方法选择2016年1月至2021年9月广东省第二人民医院风湿免疫科住院的AS患者298例为观察组,将观察组中Bath AS活动性指数(BASDAI)≥4的111例患者分为活动亚组,BASDAI<4的187例为非活动亚组。另择同期本院健康体检者85名为对照组。收集两组对象的实验室检查指标,采用Bath AS功能指数(BASFI)和BASDAI测定AS的疾病活动度。采用Spearman秩相关分析观察组患者实验室检查指标与疾病活动度的相关性。采用logistic回归分析评价AS患者疾病活动度的危险因素,ROC曲线评估这些诊断AS疾病活动度的效能。结果活动亚组患者中性粒细胞与ALB比值(NAR)、PLT与ALB比值(PAR)、CRP、ESR、EAR、BASFI高于非活动亚组,ALB低于非活动亚组,差异均有统计学意义(均P<0.05)。EAR与BASDAI、BASFI呈正相关(rs=0.213、0.329,均P<0.001)。logistic回归分析提示,EAR是AS患者疾病活动度的独立危险因素[OR=1.018(95%CI:1.001~1.034),P=0.035]。EAR的AUC=0.613(95%CI:0.548~0.678)高于PLT与淋巴细胞比值、单核细胞与淋巴细胞比值、NAR和PAR。EAR诊断AS疾病活动度的最佳截断值为0.85,灵敏度和特异度分别为0.568和0.652。结论活动性AS患者EAR水平较高,且与AS疾病活动度呈正相关。EAR对诊断AS疾病活动度有效好的效能。

益气养阴法联合西药治疗肾病综合征的疗效及安全性的Meta分析

【目的】系统评价益气养阴法联合西药治疗肾病综合征的有效性及安全性。【方法】检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方(Wangfang)、维普(VIP)、PubMed、Web of Science、Cochrane Library、Embase等国内外主要文献数据库,筛选其中有关益气养阴法联合西药(试验组)对比单纯西药(对照组)治疗肾病综合征的临床随机对照试验(RCTs),采用Cochrane手册中的偏倚风险工具进行文献的质量评价,运用RevMan 5.3软件进行Meta分析。【结果】共纳入18个RCTs,包含1334例患者。Meta分析结果显示,益气养阴法联合西药在提高临床有效率(RR=1.24,95%CI[1.16,1.32],P<0.00001),改善24 h尿蛋白定量(24hUPRO)(MD=-0.92,95%CI[-1.09,-0.75],P<0.00001)、血清白蛋白(ALB)(MD=7.06,95%CI[4.73,9.39],P<0.00001)、尿素氮(BUN)(MD=-1.57,95%CI[-2.01,-1.13],P<0.00001)、血肌酐(SCr)(MD=-12.23,95%CI[-16.58,-7.88],P<0.00001)、总胆固醇(TC)(MD=-1.06,95%CI[-1.69,-0.43],P=0.0009)、甘油三酯(TG)(MD=-0.58,95%CI[-0.94,-0.21],P=0.002)水平,以及降低不良反应发生率(RR=0.50,95%CI[0.40,0.64],P<0.00001)方面优于单纯西药治疗。【结论】益气养阴法联合西药治疗肾病综合征在提高临床疗效及改善24hUPRO、ALB、BUN、SCr、TC、TG方面优于单纯西药治疗,且能降低激素产生的不良反应。因纳入文献较少,文献质量较低,潜在疗效需更多的高质量研究进行验证。

腹膜透析患者治疗后腹膜溶质转运速率升高危险因素分析

目的:探究影响腹膜透析治疗后腹膜溶质转运速率(PSTR)升高的危险因素。方法:回顾性纳入接受腹膜透析治疗的终末期肾病患者209例,随访观察腹膜透析治疗1年后腹膜转运特征分布;复查腹膜平衡实验,观察4 h腹膜透析液与2 h血肌酐比值(D/Pcr)相比基线的变化情况,分为PSTR升高组和降低组。基于人口学特征和实验室指标,通过Logistic回归分析影响PSTR升高的危险因素。结果:入组209例腹膜透析患者,基线腹膜转运特征以低平均转运和高平均转运为主,基线D/Pcr为0.64±0.15。腹膜透析治疗1年时,约64.1%患者PSTR升高,D/Pcr值为0.73±0.12,明显高于基线D/Pcr值,差异有统计学意义(t=-6.773,P<0.05)。PSTR升高组D/Pcr、糖尿病肾病比例及透析时间大于PSTR降低组,基线D/Pcr值及基线血清白蛋白和血镁水平低于PSTR降低组,差异具有统计学意义(均P<0.05)。Logistic回归分析,基线D/Pcr值、糖尿病肾病、透析时间越长及基线血清白蛋白水平是影响PSTR升高的独立危险因素(均P<0.05)。结论:随着腹膜透析治疗时间延长,D/Pcr值逐渐升高,患者腹膜溶质转运速率呈增高趋势;基线低D/Pcr、透析时间越长、糖尿病肾病及基线血清白蛋白水平降低是影响腹膜透析治疗后腹膜溶质转运速率升高的独立危险因素。

血清白蛋白减低对急性淋巴细胞白血病患儿感染的影响及预后分析

目的 本研究旨在探讨急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患儿初次诱导治疗期血清白蛋白(albumin,ALB)减低对发生严重感染及预后的影响。方法 回顾分析自2018年1月—2021年10月于安徽省儿童医院初诊并接受治疗的202例ALL患儿,收集其基线资料,化疗过程中体质指标及ALB变化和感染发生情况,总体生存(overall survival,OS)情况等。采用SPSS26.0软件进行相关因素分析,P<0.05为有统计学意义。结果 202例患儿发生严重感染51例(25.24%),多因素分析显示诱导化疗第15天血清ALB降低及初诊时外周血白细胞(white blood cell,WBC)≥50×10~9/L是发生严重感染的独立危险因素(P<0.05),第15天血清ALB水平及多因素联合作用预测发生严重感染效能高,死亡病例中大多数(55.55%)死于初次诱导缓解期严重感染,诱导化疗第33天白血病微小残留病(minimal residual disease,MRD)未转阴是影响OS的独立危险因素(P<0.05)。结论 儿童ALL在初次诱导缓解期易发生严重感染,化疗第15天ALB水平是严重感染的危险因素及预测因素,严重感染是早期化疗相关死亡的重要原因,诱导治疗33天MRD未转阴是影响OS的独立危险因素。在临床实践中应加强支持尤其是ALB供给,以提高疗效。

测试条件对超滤膜截留率和通量的影响

以50kD和100kD超滤膜为研究对象,牛血清白蛋白为测试的标准物质,测试不同的过滤方式、运行时间、测试压力和料液浓度对超滤膜截留率和通量的影响。结果表明:50kD超滤膜的截留率,不同测试条件对其影响小,偏离值<±10%;100kD超滤膜的截留率,不同测试条件对其影响较大,偏离值可以达到50%。50kD和100kD超滤膜的通量受测试条件影响都较大,实验表明截留物质相对分子质量与超滤膜截留相对分子质量之间的相对大小对通量有较大的影响;长时间的过滤(>20 min),超滤膜采用错流过滤的方式比死端过滤更有优势,通量衰减慢且更稳定。

糖尿病肾病患者开展血糖与糖化血红蛋白、白蛋白/肌酐比值、肾小球滤过率检验的诊断价值探讨

目的探究糖尿病肾病患者开展生化检验的的诊断价值。方法选取2022年4月—2024年3月泰州市中西医结合医院收治的68例疑似糖尿病肾病患者为研究对象,所有患者均进行血糖与糖化血红蛋白、白蛋白/肌酐比值、肾小球滤过率检测,以肾脏活检为金标准,比较不同指标联合方案(A联合方案:血糖与糖化血红蛋白联合白蛋白/肌酐比值;B联合方案:血糖与糖化血红蛋白联合肾小球滤过率;C联合方案:4项指标联合)的诊断效能(准确度、灵敏度、特异度、阳性预测值、阴性预测值)。结果C联合方案诊断出阳性60例,阴性8例。C联合方案诊断的灵敏度、准确度、阴性预测值均高于A联合方案和B联合方案,差异有统计学意义(P均<0.05)。结论血糖与糖化血红蛋白、白蛋白/肌酐比值、肾小球滤过率联合检测可有效检出糖尿病肾病,为后续治疗提供科学依据。

脓毒性休克合并弥散性血管内凝血患者血小板最大聚集率及乳酸/白蛋白比值的变化及意义

目的探究脓毒性休克合并弥散性血管内凝血(DIC)患者血小板最大聚集率、乳酸/白蛋白比值的变化及意义。方法选取安阳市人民医院2021年10月至2022年10月收治的102例脓毒性休克合并DIC患者作为研究组。另选取同期106例为脓毒性休克患者作为对照组。受试者均行血小板最大聚集率、乳酸/白蛋白比值检测并进行对比。评估血小板最大聚集率、乳酸/白蛋白比值联合检测对脓毒性休克患者合并DIC的诊断价值。同时分析影响脓毒性休克患者合并DIC的影响因素。结果研究组乳酸/白蛋白比值(0.50±0.05)高于对照组(0.15±0.02),差异具有统计学意义(P<0.05),研究组血小板最大聚集率[(57.97±8.18)%]低于[(73.40±10.96)%],差异具有统计学意义(P<0.05)。两组患者性别、年龄、吸烟史、饮酒史、血钠、血钾、血小板计数、血液净化情况、纤维蛋白原降解产物(FDP)、血小板计数、肝功能损伤、肾功能损伤、气管切开、血钠紊乱、平均动脉压、白细胞计数对比差异无统计学意义(P>0.05)。以脓毒性休克患者合并DIC为因变量,血小板最大聚集率、乳酸/白蛋白比值为自变量,二元Logistic多因素分析结果显示,乳酸/白蛋白比值为脓毒性休克患者合并DIC的危险因素,血小板最大聚集率为脓毒性休克患者合并DIC的保护因素,差异具有统计学意义(P<0.05)。结论血小板最大聚集率、乳酸/白蛋白比值与脓毒性休克患者合并DIC相关,可加强检测脓毒性休克合并DIC患者血小板最大聚集率、乳酸/白蛋白比值。

以白蛋白结合型紫杉醇为基础的方案治疗晚期肺癌的临床疗效及安全性观察

背景与目的白蛋白结合型紫杉醇是通过将人血白蛋白与紫杉醇相结合的无需助溶剂的新型紫杉醇制剂,本研究旨在观察白蛋白结合型紫杉醇治疗晚期肺癌的临床疗效及其安全性。方法选取2011年11月-2014年12月收治的进展期/不可手术的晚期肺癌患者共50例。给予白蛋白结合型紫杉醇130 mg/m2,第1天、第8天单药方案或者联合方案治疗,21 d为1个周期,观察每个周期不良反应,每2个周期按实体瘤疗效评价标准(Response Evaluation Criteria in Solid Tumors,RECIST)1.1进行影像学疗效评价。结果白蛋白结合型紫杉醇治疗总体客观有效率(overall response rate,ORR)为20%,疾病控制率(disease control rate,DCR)为68%。在亚组分析中,鳞癌ORR为26.7%,DCR为80%,明显优于其他病理类型,但是尚未达到统计学差异。以白蛋白结合型紫杉醇单药或者两药联合的基础上联合抗血管生成治疗可以提高ORR(36.4%vs 15.4%)。四线及以上治疗患者DCR仍可达到69.2%。主要不良反应为血液学毒性但是可控制,无超敏反应及4级不良反应发生。结论白蛋白结合型紫杉醇为基础的治疗方案治疗晚期肺癌无论其病理类型及治疗线数均有一定疗效,对于鳞癌及与抗血管靶向治疗联合时更有优势,即使对于老年及多线治疗后的患者耐受性较好。

大豆球蛋白和清蛋白水法提取工艺研究

采用水法从低温豆粕和高温豆粕中提取球蛋白和清蛋白,通过单因素实验和正交实验对提取工艺进行优化,并研究了pH对蛋白质提取率的影响。结果表明：低温豆粕和高温豆粕清蛋白水法提取的最佳工艺条件为料液比1∶12、提取时间2.0 h、提取温度45℃,此时清蛋白提取率分别为66.41%、24.89%;低温豆粕球蛋白水法提取的最佳工艺条件为料液比1∶8、提取时间3.0 h、提取温度50℃、Na Cl溶液质量分数4%,此时球蛋白提取率为21.86%;高温豆粕球蛋白水法提取的最佳工艺条件为料液比1∶14、提取时间2.0 h、提取温度50℃、Na Cl溶液质量分数4%,此时球蛋白提取率为16.98%。在最佳工艺条件下,pH在7~11时低温豆粕清蛋白提取率分别提高了0.65、4.99、10.59、8.91、10.99个百分点,pH在8~11时高温豆粕清蛋白提取率分别提高了2.46、10.29、26.24、37.86个百分点,pH在4~6时低温豆粕和高温豆粕球蛋白提取率分别提高了7.74、13.30、2.94个百分点和4.45、5.13、3.27个百分点。

糖尿病肾病患者尿白蛋白排泄率与肾功能、炎症反应、氧化应激反应的相关性

目的:探讨糖尿病肾病(DN)患者尿白蛋白排泄率与肾功能、炎症反应、氧化应激反应的相关性。方法:收集本院收治的DN患者78例,根据DN分级标准分为早期糖尿病肾病组51例、中晚期糖尿病肾病组27例;另取同期在本院进行体检的肾功能正常者60例作为正常对照组。入院即刻,测定各组研究对象的尿白蛋白排泄率(UAER);采用全自动生化分析仪测定肾功能指标含量,采用ELISA法测定炎症因子含量,采用放射免疫法测定氧化应激指标含量;采用Pearson检验分析DN患者UAER值与肾功能、炎症反应、氧化应激反应的相关性。结果:三组研究对象的UAER值,肾功能指标、炎症反应指标、氧化应激指标含量差异有统计学意义。早期DN组、中晚期DN组的UAER值以及BUN、Scr、CysC、β2-MG、IL-6、hs-CRP、TNF-α、MDA、AOPP含量高于正常对照组,T-AOC、SOD含量低于正常对照组;中晚期DN组的UAER值以及BUN、Scr、CysC、β2-MG、IL-6、hs-CRP、TNF-α、MDA、AOPP含量高于早期DN组,T-AOC、SOD含量低于早期DN组;DN患者的UAER值与肾功能、炎症反应、氧化应激呈相关关系(P<0.05)。结论:UAER值可直观反映DN患者的肾功能损伤、炎症反应及氧化应激程度,作为疾病早期诊断、治疗指导的可靠手段。