Hemoglobin, albumin, lymphocyte, and platelet score as a predictor of prognosis in metastatic gastric cancer

BACKGROUND The hemoglobin,albumin,lymphocyte,and platelet(HALP)score,derived from a composite evaluation of markers reflecting the tumor-inflammation relationship and nutritional status,has been substantiated as a noteworthy prognostic determinant for diverse malignancies.AIM To investigate how the HALP score relates to prognosis in patients with metastatic gastric cancer.METHODS The cutoff values for the HALP score,neutrophil/lymphocyte ratio,and platelet/lymphocyte ratio were determined using receiver operating characteristic analysis.Low HALP scores were defined as those less than 24.79 and high HALP scores as those greater than 24.79.RESULTS The study cohort comprised 147 patients and 110 of them(74.8%)were male.The patients'median age was 63(22-89)years.The median overall survival was significantly superior in the patients with high HALP scores than in those with low HALP scores(10.4 mo vs 7.5 mo,respectively;P<0.001)CONCLUSION The HALP score was found to be a prognostic factor in patients with metastatic gastric cancer.

Preoperative maximal voluntary ventilation,hemoglobin,albumin,lymphocytes and platelets predict postoperative survival in esophageal squamous cell carcinoma

BACKGROUND Preoperative pulmonary function plays an important role in selecting surgical candidates and assessing postoperative complications.Reduced pulmonary function is associated with poor survival in several cancers,but the prognostic value of preoperative pulmonary function in esophageal squamous cell carcinoma(ESCC)is unclear.Nutritional and systemic inflammation parameters are vital to cancer survival,and the combination of these parameters improves the prognostic value.The hemoglobin,albumin,lymphocytes and platelets(HALP)score is a novel prognostic indicator to reflect the nutritional and inflammation status,but the clinical effects of the HALP score combined with maximal voluntary ventilation(MVV),an important parameter of pulmonary function,have not been well studied in ESCC.AIM To investigate the prognostic value of MVV and HALP score for assessing postoperative survival of ESCC patients.METHODS Data form 834 ESCC patients who underwent radical esophagectomy with R0 resection were collected and retrospectively analyzed.Preoperative MVV and HALP data were retrieved from medical archives.The HALP score was calculated by the formula:Hemoglobin(g/L)×albumin(g/L)×lymphocytes(/L)/platelets(/L).The optimal cut-off values of MVV and HALP score were calculated by the receiver operating characteristic curve analysis.The Kaplan-Meier method with log-rank test was used to draw the survival curves for the variables tested.Multivariate Cox proportional hazard regression models were used to analyze the independent prognostic factors for overall survival.RESULTS MVV was significantly associated with gender(P<0.001),age at diagnosis(P<0.001),smoking history(P<0.001),drinking history(P<0.001),tumor length(P=0.013),tumor location(P=0.037)and treatment type(P=0.001).The HALP score was notably associated with gender(P<0.001),age at diagnosis(P=0.035),tumor length(P<0.001)and invasion depth(P=0.001).Univariate Cox regression analysis showed that low MVV and low HALP score were associated with worse overall survival(all P<0.001).Multivariate analysis showed that low MVV and the HALP score were both independent risk factors for overall survival(all P<0.001).The combination of MVV and HALP score improved the prediction performance for overall survival than tumor-node-metastasis.Also,low combination of MVV and HALP score was an independent risk factor for poor overall survival(P<0.001).CONCLUSION MVV,HALP score and their combination are simple and promising clinical markers to predict overall survival of ESCC patients.

Binding mechanism of halide ions to bovine serum albumin and hemoglobin: investigated by ion selective-electrode

The binding mechanism of the interactions of halide ions (F–, Br– and I–) with bovine serum albumin (BSA) and hemoglobin (Hb) were studied at different temperatures, by using ion-selective electrodes. The experimental data were treated according to Klotz equation, and the number of binding sites and the binding constants were determined. The results show that the binding sites of F– on protein molecules are more than those of Br– and I–. Additionally, the number of the binding sites for halide ions on protein molecules increases with increasing temperature. This study also indicates that the binding constants for the interactions of halide ions with proteins gradually decrease as the size of halide ions and temperature increases. These behaviors were reasonably interpreted with the structural and thermodynamic factors. The thermodynamic functions at different temperatures were calculated with thermodynamic equations, and the enthalpy change for the interactions were also determined by isothermal titration calorimetry (ITC) at 298.15 K, which indicate that the interactions of halide ions with proteins are mainly electrostatic interaction.

Elevation of the glycated albumin to glycated hemoglobin ratio during the progression of hepatitis C virus related liver fibrosis

AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant dif- ference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/ HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3% and 70.4%, respectively and its sensitivity and specificity for the detection of severe liver fibrosis (F3-F4) were 50.0% and 74.4%,respectively. With regard to the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its specificity was 77.0%. Although even the excellent marker APRI shows low sensitivity (25.9%) for distinguishing patients with or without significant fibrosis, the combination of the APRI and GA/HbA1c ratio increased the sensitivity up to 42.0%, with only a modest decrease in the specificity (from 90.2% to 83.6%). CONCLUSION: The GA/HbA1c ratio increased in line with the histological severity of liver fibrosis, thus suggesting that this ratio is useful as a supportive index of liver fibrosis.

Prognostic significance of the preoperative hemoglobin to albumin ratio for the short-term survival of gastric cancer patients

BACKGROUND Hemoglobin and albumin are associated with the prognosis of gastric cancer(GC)patients. However, the prognostic value of the hemoglobin to albumin ratio(HAR) for the short-term survival of GC patients with D2 radical resection has not been studied.AIM To investigate the significance of the HAR in evaluating the short-term survival of GC patients after D2 radical resection and to construct a nomogram to predict the prognosis in GC patients after surgery, thus providing a reference for the development of postoperative individualized treatment and follow-up plans.METHODS Cox regression and Kaplan-Meier analysis was used for prognostic analysis.Logistic regression was used to analyze the relationships between HAR and the clinicopathological characteristics of the GC patients. A prognostic nomogram model for the short-term survival of GC patients was constructed by R software.RESULTS HAR was an independent risk factor for the short-term survival of GC patients.GC patients with a low HAR had a poor prognosis(P < 0.001). Low HAR was markedly related to high stage [odds ratio(OR) = 0.45 for Ⅱ vs Ⅰ;OR = 0.48 for Ⅲ vs Ⅰ], T classification(OR = 0.52 for T4 vs T1) and large tumor size(OR = 0.51 for ≥4 cm vs < 4 cm)(all P < 0.05). The nomogram model was based on HAR, age,CA19-9, CA125 and stage, and the C-index was 0.820.CONCLUSION Preoperative low HAR was associated with short-term survival in GC patients.The prognostic nomogram model can accurately predict the short-term survival of GC patients with D2 radical resection.

Use of glycated albumin for the identification of diabetes in subjects from northeast China

BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage,and in maintaining blood glucose concentrations within the normal range.The clinical diagnosis of diabetes mellitus is currently made using fasting plasma glucose,2 h-plasma glucose(2h-PG)during a 75 g oral glucose tolerance test,and hemoglobin A1c(HbA1c)level.However,the fasting plasma glucose test requires fasting,which is a barrier to screening,and reproducibility of the 2h-PG level is poor.HbA1c is affected by a shortened red blood cell lifespan.In patients with anemia and hemoglobinopathies,the measured HbA1c levels may be inaccurate.Compared with HbA1c,glycated albumin(GA)is characterized by more rapid and greater changes,and can be used to diagnose new-onset diabetes especially if urgent early treatment is required,for example in gestational diabetes.In this study,we provided cutoff values for GA and evaluated its utility as a screening and diagnostic tool for diabetes in a large high-risk group study.AIM To evaluate the utility of GA in identifying subjects with diabetes in northeast China,and to assess the diagnostic accuracy of the proposed GA cutoff in the diagnosis of diabetes mellitus.METHODS This cross-sectional study included 1935 subjects,with suspected diabetes or in high-risk groups,from 2014 to 2015 in the Second Affiliated Hospital of Harbin Medical University(Harbin,China).The use of GA to identify diabetes was investigated using the area under the receiver operating characteristic curve(AUC).The GA cutoffs were derived from different 2h-PG values with hemoglobin A1c cutoffs used as a calibration curve.RESULTS The GA cutoff for the diagnosis of diabetes mellitus was 15.15%from the receiver operating characteristic(ROC)curve.ROC analysis demonstrated that GA was an efficient marker for detecting diabetes,with an AUC of 90.3%.CONCLUSION Our study supports the use of GA as a biomarker for the diagnosis of diabetes.

Spectroscopic studies on interaction of hemoglobin and serum albumin with nicotine

The interactions of nicotine and Hb/SA were studied in vitro by UV/Vis, fluorescence, 1H NMR and FT-IR spectroscopies. The UV/Vis absorbance of Hb/SA (200nm) shifted to red and decreased gradually with the addition of nicotine, indicating that the protein conformational change resulted from the chemical interaction. With increasing nicotine concentration, incubation of SA with nicotine caused the quenching of fluorescence typical of protein tryptophan residues, which meant that the vicinity of the tryptophan residues of SA was changed because of nicotine. FT-IR spectra showed that α-helix component of Hb/SA decreased, turn and β-structure components of Hb/SA increased in the presence of nicotine. In the 1H NMR spectra of nicotine, all proton peaks on pyrrolidinyl ring moved to downfield and the resonance emanating from nicotine was preferentially broadened while the concentration of Hb/SA increased. All these results indicate that nicotine and Hb/SA in vitro interact on each other, forming a new

Glycated albumin may be a choice, but not an alternative marker of glycated hemoglobin for glycemic control assessment in diabetic patients undergoing maintenance hemodialysis

Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; however, glycemic evaluating performance of HbAlc may be still better than that of GA. Therefore, HbAlc should not be replaced completely although GA can be used as a choice to monitor glycemic level.

Biomedical studies on lipid peroxidation and erythrocyte fragility during the process of aging

Objective:To investigate oxidative stress,hemoglobin percentage and erythrocyte osmotic fragility in various aging groups.Methods:A total of 200 healthy volunteers of hoth genders between age group 20-65 years were selected by random method.Determination of hemoglobin percentage was done employing modified cyanide method of Dacie and Lewis.The erythrocyte lysis was observed in hypotonic solution of buffered saline at varying concentrations and optical density was measured at 540 nm.The extent of lipid peroxidation in form of malondialdehyde was measured by thiobarbituric acid method.Results:The study found a significant decrease in hemoglobin percentage,increase in erythrocyte osmotic fragility and increased lipid peroxidation in form of malondialdehyde with increasing age.Conclusions:Supplementation of antioxidants may prevent the oxidative injury in elderly group of subjects.

Erythrocyte and erythrocyte function

950362 Combination therapy for 18 adult aplasticanemia patients with cyclosporin A and SLL regimen.SHAO Jinzhang(邵景章),et al.1st Teach Hosp,Suzhou Med Coll,Suzhou,215006.Chin J Hematol1995;188-189.Combination of SLL regimen and cyclosporin A wasused in the treatment of 18 patients with aplastic ane-mia (AA).Out of the 18 cases,11 were severe and 7chronic AA.A control group of 19 patients (7

代谢相关标志物用于良性前列腺增生的临床价值研究

目的通过检测老年良性前列腺增生(BPH)患者的糖脂代谢相关指标,评价其与BPH的相关性,探讨将糖脂代谢相关指标纳入BPH常规检测的可能性,进一步对老年BPH患者治疗提出指导性建议。方法选取2021年7月至2022年6月于枣庄市立医院就诊的85例BPH患者设为BPH组,同期于本院体检的54例健康人员设为健康对照组。检测两组研究对象的糖化白蛋白(GA)、血清白蛋白(ALB)、总胆汁酸(TBA)、1,5-脱水-D-山梨醇(1,5-AG)以及丙酮酸(PYR)和糖化血红蛋白(HbA1c)水平。采用Pearson分析探讨BPH与各指标间的相关性,绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评价相关指标对BPH的诊断价值。结果BPH组的BMI显著高于健康对照组(P<0.001)。BPH组的ALB、1,5-AG水平显著低于健康对照组,HbA1c显著高于健康对照组(P<0.01)。BMI、HbA1c与BPH发生呈正相关,ALB和1,5-AG与BPH发生呈负相关(P<0.05)。ALB、1,5-AG和HbA1c诊断BPH的AUC分别为0.796、0.701和0.656。结论ALB、1,5-AG水平降低以及HbA1c升高是BPH患者疾病进展的危险因素,建议将糖脂代谢相关指标ALB、1,5-AG和HbA1c纳入BPH常规检测。

Prognostic value of a nomogram model for postoperative liver metastasis of colon cancer

BACKGROUND Colon cancer is one of the most common malignant tumors of the digestive system.Liver metastasis after colon cancer surgery is the primary cause of death in patients with colon cancer.AIM To construct a novel nomogram model including various factors to predict liver metastasis after colon cancer surgery.METHODS We retrospectively analyzed 242 patients with colon cancer who were admitted and underwent radical resection for colon cancer in Zhejiang Provincial People’s Hospital from December 2019 to December 2022.Patients were divided into liver metastasis and non-liver metastasis groups.Sex,age,and other general and clinicopathological data(preoperative blood routine and biochemical test indexes)were compared.The risk factors for liver metastasis were analyzed using singlefactor and multifactorial logistic regression.A predictive model was then constructed and evaluated for efficacy.RESULTS Systemic inflammatory index(SII),C-reactive protein/albumin ratio(CAR),red blood cell distribution width(RDW),alanine aminotransferase,preoperative carcinoembryonic antigen level,and lymphatic metastasis were different between groups(P<0.05).SII,CAR,and RDW were risk factors for liver metastasis after colon cancer surgery(P<0.05).The area under the curve was 0.93 for the column-line diagram prediction model constructed based on these risk factors to distinguish whether liver metastasis occurred postoperatively.The actual curve of the column-line diagram predicting the risk of postoperative liver metastasis was close to the ideal curve,with good agreement.The prediction model curves in the decision curve analysis showed higher net benefits for a larger threshold range than those in extreme cases,indicating that the model is safer.CONCLUSION Liver metastases after colorectal cancer surgery could be well predicted by a nomogram based on the SII,CAR,and RDW.

入院时血红蛋白、白蛋白水平对股骨粗隆间骨折患者预后的预测价值

目的探讨入院时血红蛋白(HGB)、白蛋白(ALB)水平对股骨粗隆间骨折(ITF)患者术后预后的预测价值。方法回顾性收集北京京煤集团总医院骨科2019年5月至2022年5月收治的接受手术治疗的92例ITF患者进行研究,依据ITF患者术后6个月返院复诊时髋关节功能Harris评分将患者分为预后良好组(n=72)和预后不良组(n=18)。比较2组基线资料及HGB、ALB等实验室指标,通过受试者工作曲线(ROC)探讨入院时HGB、ALB对ITF患者术后预后的预测价值。结果预后不良组年龄、术后并发症个数显著大于预后良好组,ALB、HGB水平显著低于预后良好组,差异有统计学意义(P<0.05)。经Pearson相关性分析显示,ALB、HGB、年龄、术后并发症个数与ITF患者术后髋关节功能Harris评分间有关(P<0.05)。绘制ROC曲线显示,ALB、HGB单独、二者联合及所有指标总联合预测ITF患者术后预后的曲线下面积(AUC)值分别为0.810、0.855、0.924、0.958,其中总联合预测与ALB、HGB联合预测的AUC值比较,差异无统计学意义(Z=0.908,P=0.364)。结论入院时HGB、ALB可较好预测ITF患者术后预后情况,两者值越低,ITF患者术后预后不良发生可能性越大。

足月分娩妊娠期糖尿病母亲新生儿脐血糖化血红蛋白 糖化白蛋白和胰岛素样生长因子-1水平变化及意义

目的 分析足月分娩妊娠期糖尿病(GDM)母亲新生儿脐血糖化血红蛋白(HbA1c)、糖化白蛋白(GA)和胰岛素样生长因子-1(IGF-1)水平与新生儿不良妊娠结局的相关性。方法 选取2019年2月至2022年2月收治的220例足月分娩GDM母亲新生儿为观察对象,根据妊娠结局分为妊娠结局良好组159例、妊娠结局不良组61例。比较妊娠结局良好组和妊娠结局不良组的临床资料,检测妊娠结局良好组和妊娠结局不良组新生儿的脐血HbA1c、GA、IGF-1水平,采用Spearman相关分析法分析脐血HbA1c、GA和IGF-1水平与新生儿不良妊娠结局的关系,采用受试者工作曲线(ROC)分析脐血HbA1c、GA和IGF-1水平预测新生儿不良妊娠结局的价值。结果 妊娠结局不良组母亲空腹血糖[(6.68±0.61)mmol/L]、母亲口服葡萄糖耐量试验(OGTT)后1 h血糖[(12.54±1.12)mmol/L]、2 h血糖[(10.35±0.91)mmol/L]均高于妊娠结局良好组[(5.43±0.26)mmol/L、(11.38±1.03)mmol/L、(9.26±0.64)mmol/L](t=21.330、7.297、9.991,均P<0.05)。妊娠结局不良组新生儿的脐血HbA1c[(7.07±0.56)%]、GA[(18.19±0.76)%]和IGF-1[(77.56±7.37)ng/ml]水平均高于妊娠结局良好组(5.25±0.32)%、(12.27±0.52)%、(59.13±5.04)ng/ml (t=30.161、65.977、21.187,均P<0.05)。脐血HbA1c、GA和IGF-1水平与新生儿低血糖、新生儿窒息、胎儿窘迫、羊水过多、巨大儿呈正相关(均P<0.05)。受试者工作特征(ROC)曲线分析结果显示,HbA1c、GA、IGF-1单独预测新生儿不良妊娠结局的曲线下面积(AUC)分别为0.832、0.806、0.812,对新生儿不良妊娠结局均有一定预测价值(均P<0.05),且以3项联合检测(AUC=0.935)的预测价值优于单一指标(P<0.05)。结论 足月分娩GDM母亲新生儿脐血HbA1c、GA、IGF-1水平与新生儿不良妊娠结局存在相关性,其水平升高时更易出现新生儿不良妊娠结局,检测脐血HbA1c、GA、IGF-1水平对预测新生儿不良妊娠结局具有一定的价值。

昆明市2社区2型糖尿病慢病管理患者服药依从性对病情控制的影响

目的分析昆明市2社区2型糖尿病(type 2 diabetes,T2DM)慢病管理患者服药依从性对病情控制的影响。方法选取2021年12月至2022年7月昆明市官渡、小板桥2个社区纳入慢病管理的2型糖尿病患者138例,完善基本信息采集、糖化血红蛋白(HbAlc)等相关检查,进行Morisliy服药依从性量表(8-item Morisky medication adherence scale,MMAS-8)问卷调查,分析服药依从性高(A组)、中(B组)、低(C组)3组的HbAlc等指标水平,并进行统计学分析。结果A组病例数占22.5%,B组占44.9%,C组占32.6%。2组间的尿白蛋白肌酐比(UACR)、HbA1c、血肌酐差异有统计学意义(P<0.05)。A组患者UACR、HbAlc、血肌酐水平低于B组、C组患者,UACR、HbAlc、血肌酐与用药依从率存在相关性,呈负相关(P<0.05)。结论昆明市官渡社区、小板桥2社区2型糖尿病慢病管理患者服药依从性高的患者比例仅为22.5%。依从性越高,患者UACR、HbAlc、血肌酐水平越低,两者之间存在相关性,提示应将服药的依从性作为社区糖尿病慢病管理中重点之一,并应加强对患者服药依从性的干预。

人造血液的研究进展

人造血液是一类具有载氧能力、可暂时替代血液部分功能的液体制剂。目前已研制出的人造血液可分为人工合成的血红蛋白、天然血红蛋白制成的人工红细胞、全氟碳化合物和干细胞分化红细胞4大类。本文重点对近年人造血液的国内外研发进展进行总结,并对人造血液在临床上的应用价值、发展趋势及未来研发方向进行初步探讨,以期对该领域的发展提供新思路,推进人造血液产品的临床应用。

平鼾祛湿汤联合持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征疗效观察

目的观察平鼾祛湿汤联合持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAS)的临床疗效。方法选择2021年1月—2022年3月河北省沧州中西医结合医院诊治的80例OSAS患者为研究对象,随机分为2组各40例,对照组给予CPAP治疗,观察组在对照组基础上加用平鼾祛湿汤治疗,2组均治疗12周。比较2组治疗前后中医证候积分,呼吸睡眠相关指标[Epworth嗜睡量表评分(ESS评分)、睡眠呼吸暂停低通气指数(AHI)、呼吸紊乱时最低氧饱和度(LSaO 2)、压力滴定值]、体质指数(BMI)、红细胞相关指标[红细胞分布宽度(RDW)、红细胞计数(RBC)、血红蛋白(Hb)、促红细胞生成素(EPO)]及临床治疗效果与不良反应发生情况。结果2组治疗12周后的单项中医症状(形体肥胖、胸脘痞闷、呕恶纳呆、嗜睡、倦怠乏力、大便溏滞不爽、身体困重、痰多色白、头晕健忘)积分与总积分均较治疗前显著降低(P均<0.05),且观察组治疗后的上述积分均显著低于对照组(P均<0.05)。2组治疗12周后的ESS评分、AHI、BMI及RDW、RBC、Hb、EPO水平均显著低于治疗前(P均<0.05),压力滴定值、LSaO 2均显著高于治疗前(P均<0.05),且观察组治疗后的上述指标改善情况均显著优于对照组(P均<0.05)。观察组治疗总有效率为92.5%(37/40),明显高于对照组的70.0%(28/40)(P<0.05)。观察组不良反应发生率为7.5%(3/40),明显低于对照组的22.5%(9/40)(P<0.05)。结论在CPAP基础上加用平鼾祛湿汤治疗OSAS可明显改善患者临床症状和呼吸睡眠情况,且不良反应少,其机制可能与改善红细胞相关指标,降低微循环血液黏稠度,从而改善机体缺氧状况有关。

血脂和糖化血红蛋白与腹膜透析患者认知功能关系的研究

目的 探究影响持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者认知功能的影响因素,评估血脂和糖化血红蛋白(glycosylated hemoglobin,HbA1c)与CAPD患者认知功能之间的关系。方法 纳入2021年1月至2022年12月于河北医科大学第二医院规律腹膜透析3个月以上的患者312例,收集患者的临床资料,采用蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评估患者的整体认知功能,连线测试A(trail making test,TMTA)评估患者的执行功能,探讨血脂、HbA1c等因素与认知功能的关系。结果 (1)我院腹膜透析中心CAPD患者认知障碍(cognitive impairment,CI)的发病率为36.9%。CI组患者的年龄[(56.99±9.80)岁比(44.93±11.64)岁)]、HbA1c[5.50(5.20,6.08)%比5.10(4.80,5.60)%)]、血清钾[4.2(3.9,4.6)mmol/L比4.1(3.8,4.4)mmol/L)]和低密度脂蛋白胆固醇[2.55(2.13,3.04)mmol/L比2.43(2.01,2.70)mmol/L]水平高于非CI组(P<0.05),受教育程度、总铁结合力[50.4(45.0,55.6)μmol/L比52.4(47.2, 59.1)μmol/L]、血清白蛋白[(36.0±3.9)g/L比(37.1±3.8)g/L)]水平均低于非CI组(P<0.05)。(2)血清白蛋白、受教育程度与MoCA评分呈正相关(r=0.126,P=0.025;r=0.216,P<0.001),年龄、HbA1c与MoCA评分呈负相关(r=-0.547,P<0.001;r=-0.264,P<0.001);年龄与TMT-A时间呈正相关(r=0.126,P<0.001),血清钠、受教育程度与TMT-A时间呈负相关(r=-0.157,P=0.046;r=-0.244,P=0.002)。血脂与MoCA评分及TMT-A时间无相关(P>0.05),进一步分析在老年腹膜透析患者中两组间高密度脂蛋白胆固醇差异有统计学意义(P<0.05),而相关分析显示高密度脂蛋白胆固醇与CI无相关(r=0.156,P>0.05)。(3)年龄、受教育程度、血清白蛋白、HbA1c为认知功能的影响因素,血清白蛋白是CAPD患者认知功能的保护因素(OR=0.978,95%CI:0.917~1.040);年龄、受教育程度、HbA1c(OR=1.203,95%CI:1.176~1.230;OR=5.565,95%CI:1.962~15.789;OR=1.694,95%CI:1.348~2.040)是CAPD患者认知功能的危险因素。(4)HbA1c和血清白蛋白的受试者工作特征曲线显示曲线下面积分别为0.651(95%CI:0.570~0.732),0.583(95%CI:0.518~0.648),对CAPD患者发生CI具有预测价值,当HbA1c界定值为5.15%时,约登指数最大(0.315)。血清白蛋白界定值为35.6 g/L时,约登指数最大(0.149)。结论 对于CAPD患者,血脂不是其CI的相关危险因素。HbA1c是影响CAPD患者认知功能的危险因素,监测并控制HbA1c水平可有助于降低CAPD患者发生CI的风险。

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。

Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus

Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternalinfant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus(GDM) have been changed. Therefore, in patients with GDM and pregnant women with diabetes mellitus, even stricter glycemic control than before is required to reduce the incidence of perinatal maternal-infant complications. Strict glycemic control cannot be attained without an indicator of glycemic control; this review proposes a reliable indicator. The gold standard indicator of glycemic control in patients with diabetes mellitus is hemoglobin A1c(Hb A1c); however, we have demonstrated that Hb A1 c does not reflect glycemic control accurately during pregnancy because of iron deficiency. It has also become clear that glycated albumin, another indicator of glycemic control, is not influenced by iron deficiency and therefore might be a better indicator of glycemic control in patients with GDM and pregnant women with diabetes mellitus. However, largepopulation epidemiological studies are necessary in order to confirm our proposal. Here, we outline the most recent findings about the indicators of glycemic control during pregnancy including fructosamine and 1,5-anhydroglucitol.