Combined APACH Ⅱ score and arterial blood lactate clearance rate to predict the prognosis of ARDS patients

Objective:To explore the easily applicable indicators of practical value to evaluate the prognosis of acute respiratory distress syndrome（ARDS）.Methods:Blood and biochemical tests and bloodgas analyses were performed upon entry into the ICUs,12 h,24 h,48 h and 72 h after that in 72 ARDS patients（who were admitted to the ICUs of our hospital from January 2000 to December 2009）.Then APACHEⅡscores were achieved by combining relevant physiological parameters and laboratory results.Results:There was a statistical difference between the death group and survival group at different time points upon entering the ICUs in terms of APACHEⅡscore, alveolar-arterial oxygen difference and arterial blood lactate clearance rate.PaO2/FiO2 values were recorded to be statistically different between the death group and survival group 24 h,48 h and 72 h,respectively after entry into the ICUs.In addition,registered linear regression existed between APACHEⅡscore,alveolar-arterial oxygen difference or PaO2/FiO2 value and time. APACHEⅡscore 24 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve（AUC） standing respectively at 0.919 and 0.9SS.Arterial blood lactate clearance rate 12 h, 24 h,48 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve （AUC） at 0.918,0.918,0.909 and 0.991,respectively.Conclusions:APACHEⅡscore applied in combination with arterial blood lactate clearance rate is of clinical significance in assessing the prognosis of ARDS patients.

Acu-TENS lowers blood lactate levels and enhances heart rate recovery after exercise

Objective:The primary aim of this study is to investigate the effect of application of transcutaneous electrical nerve stimulation over acupuncture points(Acu-TENS)on postexercise blood lactate level.The secondary aim is to explore the effect of Acu-TENS on heart rate recovery and its association with autonomic nervous system.Methods:Twenty healthy subjects(mean age 26.9
1.3)acting as their own controls,were randomized to receive either Acu-TENS or Placebo-TENS as the first of two intervention protocols,implemented one week apart.During Acu-TENS,subjects received 45 min TENS bilaterally over the acupoints Neiguan(PC6).Subjects receiving Placebo-TENS had identical electrode placement but with no electrical output from the TENS unit despite an active output light.Interventions were followed by a 10-min ergometer exercise at 70%age-predicted maximal heart rate.Oxygen consumption and heart rate(HR)were recorded continuously throughout exercise.Blood lactate and blood pressure were taken at 4 time points:prior to,immediately after,at 15-min after exercise,and when HR had returned to baseline values.Results:The post-exercise blood lactate level in the Acu-TENS group was lower than that of the placebo group by 1.12
0.39 mmol/L(p Z 0.01).The Acu-TENS group also had a faster return of HR to pre-exercise level compared to placebo(9.98
4.54 min,p Z 0.047).Heart rate variability analysis inferred reduced sympathetic modulation during exercise after Acu-TENS.There was no between-group difference in post-exercise oxygen consumption.Conclusion:Acu-TENS lowered post-exercise blood lactate level and enhanced heart rate recovery after moderate exercise.The role of Acu-TENS in exercise performance and energy metabolism warrants further investigation.(ClinicalTrails.gov Identifier:NCT01102634)a 2014 Beijing University of Chinese Medicine.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/3.0/).

Trend of blood lactate level in acute aluminum phosphide poisoning

BACKGROUND: Aluminum phosphide(Al P) poisoning is common in the developing countries. There is no specifi c antidote for the treatment of acute Al P poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute Al P poisoning to evaluate its role as a prognostic factor.METHODS: This was a prospective study on acute Al P intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a selfmade questionnaire. Blood lactate levels were analyzed every two hours for 24 hours.RESULTS: Thirty-nine(27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood p H and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was signifi cantly higher in the non-survivors group during 8 to 16 hours post ingestion.CONCLUSION: Blood lactate level could be used as an index of severity of acute Al P poisoning.

Amperometric Enzyme Biosensor for the Determination of High Concentration Lactate in Whole Blood of Athletes

<正>Amperometric biosensor applied to the determination of high concentration lactate in serum and whole blood was described.The biosensor was constructed by gold electrode modified with nanoplatinum particles.Lactate oxidase (E.C.1.1.3.2) was immobilized at platinized activated gold electrode which was used for the determination of high concentration lactate at low potential (+0.2 V).The linear calibration graphs were obtained from 1 to 21 mmol·L~ (-1) lactate in serum and from 0.9 to 13.2 mmol.L~ (-1) lactate in whole blood.The correlation coefficients were 0.99 and 0.97,respectively at a steady-state response time of 50 s.

Accuracy of a hand-held lactate meter in measuring umbilical cord blood lactate at all lactate levels

Objective: Fetal scalp lactate has largely replaced pH analysis to assess intrapartum hypoxia. Many obstetrics units use hand-held lactate meters to measure umbilical blood because of its affordability and ease of use. We sought to investigate the agreement of Lactate ProTM with a reference method blood gas analyser and to determine its usefulness with a recommended cutoff value of 4.8 mmol/L. Methods: Prospective study carried out at a tertiary institution where 237 arterial and 233 venous samples from umbilical cords of 16 elective caesarean and 285 emergency deliveries were measured using Lactate ProTM and ABL735 Sesries Acid-Base analyser. Limits of agreement were analysed using Bland-Altman plots. Results: Lactate ProTM differentiated fewer deliveries as “high risk” (≥4.8 mmol/L) and more as “low risk” (<2.2 mmol/L). Limits of agreement for lactate values (as measured by Lactate ProTM) were –1.46 - 0.97 mmol/L for arterial lactate levels <4.8 mmol/L and –3.21 - 0.88 mmol/L for arterial lactate levels ≥ 4.8 mmol/L. Conclusion: There was a poorer agreement between the two devices at higher lactate values. Lactate ProTM underestimates by up to 3.2 mmol/L;a 4.8 mmol/L reading may actually signify a lactate level of 8.0 mmol/L, indicating severe metabolic acidosis. We caution the use of this device in assessing fetal lactate levels.

Recovery Capacity, Haemodynamic and Blood Lactate Changes during Training and Competition in Elite Congolese Karate Athletes

Background: Rare are the studies which treated the effect of training and successive fights of karate on haemodynamic and blood lactate concentrations responses. Objectives: To evaluate and analyze the aerobic capacity of elite Congolese karate athletes, as well as their haemodynamic and blood lactate concentrations responses changes during Ruffier test and stimulated competition. Methods: Twelve karate athletes (6 seniors and 6 juniors) took part in the study. These karate athletes were selected within the national karate teams (senior and junior) of Congo-Brazzaville. Anthropometric, bioenergetic and haemodynamic (HR, SBP, DBP) parameters and blood lactate [La] concentrations were measured at rest, immediately after the end of Ruffier test and each fight (n = 3). Results: Peak aerobic power (PAP) and maximum oxygen uptake (VO2 max) values averaged 437 ± 23 watts and 57.61 ± 2.2 ml/kg/mn, values varying as function as age division (senior vs junior). The recovery index was 5.4 ± 3.4 for juniors and 6.8 ± 3.2 for seniors. SBP, HR and [La] concentrations increased significantly during fights, compared to the resting values. HRmax was 182.3 ± 1.6 bpm (89% theoretical HRmax) for seniors and 182.0 ± 13.5 bpm (86% theoretical HRmax) for juniors. Peak [La] concentrations were 10.3 ± 1.5 mmol/l for seniors and 10.8 ± 1.2 mmol/l for juniors. Conclusion: Congolese karate athletes call upon high levels of the anaerobic and aerobic capacities. The karate training program in Congo should emphasize more gold improvising lower body anaerobic power and endurance.

Blood Chemistry, Acid-Base, Electrolyte, Blood Lactate Metabolism and Sleep at 3480 m in Mountain Marathon Runners

Altered blood chemistry, acid-base and electrolyte are suggested determinants of sleep disturbance, with frequent arousal at high altitude even in well and long-trained altitude marathon runners. In this sample of experienced altitude marathon runners with maximal aerobic power at sea level of 61.4 ± 2.7 ml/kg-1·min-1 we found that pO2 and percent of oxygen saturation (%SO2) were lower at2050 mand3480 mthan at sea level;pO2 was higher after 38 - 41 hours than after 30 - 31 hours of acclimatization at3480 m(P 2 decreased (P 2 and (P 2 at a sleeping altitude of3480 mwas lower (P Simple regression analysis disclosed a significant correlation between the changes in TST and the percent of REM sleep and the changes in %SpaO2 recorded during sleep (P 2 at higher altitude and the percent of W and of TST (P 2, tCO2 and [HCO3-] correlated negatively and significantly with the percent of REM sleep changes at high altitude (P 2 and pH and correlated negatively with the changes in %SO2, pCO2, tCO2, and [HCO3-] (P ++] and [BE] and negatively with the changes in buffered bases [BB] and [BEeffective] (P 2 and significantly and negatively with the changes in [K+] (P 2, tCO2, [HCO3-] and [K+]

Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.

Value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure

Objective:To explore the value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure.Methods:A total of 78 patients with COPD merged with respiratory failure were included in the study. The arterial blood lactate level 1 d before treatment and 6 h after treatment was detected. The early lactate clearance was evaluated. The patients were divided into the severe elevation group, mild elevation group, and normal control group according to the blood lactate level. APACHEⅡ score, 28 d death rate, and other clinical related indicators in the three groups were compared. According to the early lactate clearance, the patients were divided into the high lactate clearance group and low lactate clearance group. The arterial blood lactate level, APACHEⅡ score, death rate, and arterial blood gas indicators in the two groups were compared. The multiple-factor analysis of prognosis was performed.Results:With the increasing of blood lactate concentration before treatment, APACHEⅡ score, mechanical ventilation time, ventilation rate, hospitalization time, and death rate were gradually elevated, and the comparison among the three groups was not statistically significant. When compared with before treatment, the arterial blood lactate level, APACHEⅡ score, and PaCO2 in the high lactate clearance group were significantly reduced, but PaO2 and pH were significantly elevated, while PaO2 in the low lactate clearance group was significantly elevated. The death rate in the high lactate clearance group was significantly lower than that in the low lactate clearance group. The early lactate clearance was a factor in protecting the prognosis in patients with COPD merged with respiratory failure.Conclusions:The arterial blood lactate level and early lactate clearance can affect the prognosis in patients with COPD merged with respiratory failure. Dynamic monitoring of early blood lactate level can better evaluate the disease severity degree and prognosis.

活性酵母对冷季泌乳牦牛产奶量、乳成分及血液指标的影响

为探讨活性酵母对冷季泌乳牦牛产奶量、乳成分及血液指标的影响,试验将16头泌乳牦牛随机分为两组,分别为对照组和活性酵母组(80 g/头·d),试验期为6周。结果显示:(1)与对照组相比,活性酵母组第18天产奶量提高了0.45 kg(P <0.05);35天乳蛋白率、乳脂肪率及乳糖率分别提高了0.68、0.49、0.11个百分点(P <0.05)。(2)与对照组相比,活性酵母组第18天血液葡萄糖(GLU)含量提高了0.26 mmol/L(P <0.01);第35天白蛋白(ALB)和甘油三酯(TG)含量分别提高了4.34 g/L(P <0.01)和0.08 mmol/L(P <0.05),尿素氮(UN)含量降低了0.55 mmol/L(P <0.01)。(3)与对照组相比,活性酵母组第18天免疫球蛋白G(Ig G)、第35天免疫球蛋白A(Ig A)和试验全程免疫球蛋白M(IgM)含量分别提高了1.26 pg/mL(P <0.05)、0.04 g/L(P <0.05)和0.23 g/L(P <0.01)。结果表明,活性酵母可通过调控瘤胃内环境和微生物区系结构,提高饲粮能量、蛋白质等营养物质消化率及利用率,进而提高机体免疫力并改善泌乳性能及乳成分。

H型高血压合并冠心病患者24h动态血压变异系数及乳酸脱氢酶水平与冠状动脉粥样硬化病变程度的相关性

目的 探究H型高血压合并冠心病患者24 h动态血压变异系数及乳酸脱氢酶(LDH)水平与冠状动脉粥样硬化病变程度的相关性。方法 对40例H型高血压合并冠心病患者进行冠状动脉造影检查,以Gensini积分表示冠状动脉粥样硬化病变严重程度,以酶联免疫吸附法检测患者LDH水平,监测患者24 h动态血压,计算24 h动态血压变异系数。比较不同冠状动脉病变程度患者24 h动态血压变异系数及LDH水平。24 h动态血压变异系数及LDH水平与动脉粥样硬化病变程度的相关性采用Pearson相关分析,对重度冠状动脉粥样硬化的影响因素行多因素Logistic回归分析。结果 入组冠状动脉粥样硬化轻度病变患者12例,中度和重度病变患者各14例。重度及中度病变患者血清同型半胱氨酸(Hcy)、LDH水平及24 h血压变异系数均高于轻度病变患者(P<0.01),重度病变患者血清Hcy、LDH水平及24 h血压变异系数均高于中度病变患者(P<0.01)。Pearson相关分析显示,血压变异系数、LDH水平与Gensini积分均呈正相关(P<0.05或0.01)。多因素Logistic回归分析显示,24h血压变异系数(OR=1.326,95%CI为1.040~1.691,P<0.05)及LDH水平(OR=1.311,95%CI为1.048~1.639,P<0.05)为重度冠状动脉粥样硬化发生的危险因素。结论 H型高血压合并冠心病患者24 h动态血压变异系数及LDH水平较高,且可能与冠状动脉粥样硬化病变程度加重有关。

放牧条件下泌乳母马补喂氨基酸对哺乳马驹生长发育及血液生化指标的影响

【目的】放牧条件下为泌乳母马补喂氨基酸,分析补喂对哺乳马驹生长发育及血液生化指标的影响,为哺乳马驹在母马挤乳条件下健康生长提供参考依据。【方法】选择产驹日期相近(5月),泌乳30 d的伊犁马母马24匹,年龄7~9岁,胎次4~5胎,产驹至30 d日均8 h挤奶量为(2.79±0.02)kg。24匹马驹平均体重为(71.36±14.3)kg,8母16公。结合马驹性别将24匹马驹随机分为4个组,每组6匹(2母,4公),分别为对照组、试验Ⅰ组、试验Ⅱ组和试验Ⅲ组,马驹分组与母马相对应。在相同放牧条件下(放牧时间、饮水时间、挤奶时间和放牧草场完全相同),对照组不进行任何氨基酸补喂,试验Ⅰ组补喂赖氨酸40 g/(d·匹)+苏氨酸20 g/(d·匹),试验Ⅱ组补喂赖氨酸60 g/(d·匹)+苏氨酸40 g/(d·匹),试验Ⅲ组补喂赖氨酸80 g/(d·匹)+苏氨酸60 g/(d·匹)。进行为期为120 d的补饲试验。【结果】(1)试验Ⅰ组和试验Ⅱ组与对照组相比能够极显著提高哺乳马驹的60 d体重、60 d体高、90 d体高、总增高、30 d体斜长和120 d体斜长,分别提高了8.37%、4.44%、4.27%、24.22%、5.31%、5.20%和6.25%、4.05%、4.09%、22.14%、5.55%、6.22%(P<0.01)。试验Ⅰ组能够显著提高哺乳马驹60 d胸围、90 d胸围、120 d胸围和胸围总增长,分别提高了6.34%、9.38%、9.52%和33.83%(P<0.05);试验Ⅲ组仅能够显著提高哺乳马驹60 d的体高、61~90 d和91~120 d胸围增长,分别提高3.53%(P<0.01)、25.17%(P<0.05)和21.26%(P<0.05),另外,各试验组在管围相关指标与对照组均无显著差异(P>0.05)。(2)各试验组哺乳马驹血液中Glu、ALT、AST和ALP的含量与对照组相比分别极显著提高了13.08%、33.91%、26.93%、6.19%、17.08%、38.18%、26.69%、9.43%和12.02%、38.14%、18.38%、6.35%(P<0.01),同时,试验Ⅰ组和试验Ⅱ组哺乳马驹血液中TP、UA、T-Bil、γ-GT和Ca^(2+)的含量分别极显著提高了6.19%、23.44%、29.89%、15.47%、15.02%和6.67%、31.18%、30.07%、20.02%、14.00%(P<0.01)。【结论】在放牧条件下为泌乳母马补喂赖氨酸和苏氨酸,能够显著促进哺乳马驹体重、体尺的增长,同时提高马驹血液中TP、ALB、GLB、Glu和Ca^(2+)的含量,增加ALT、AST和ALP的活力,进而促进马驹的生长发育,补喂泌乳母马40~60 g/(d·匹)赖氨酸和20~40 g/(d·匹)苏氨酸,能够促进马驹的生长发育和机体健康。

穴位灸法对运动时机体血清CK、BLA及运动能力的影响

通过对运动员进行穴位施灸处理 ,并以西洋参作为对照 ,观察定量运动时血清CK(肌酸激酶 )及BLA(血乳酸 )含量的变化以及台阶指数的变化 .经过 2个月的施灸处理 ,结果表明艾灸可以明显降低运动时机体血清肌酸激酶 (CK)的活性及血乳酸的含量 ,能明显提高机体的台阶指数 .本研究提示 :灸法可以减轻运动性疲劳 ,提高机体的运动能力 .

血乳酸FGF21在儿童线粒体脑肌病诊断与疗效监测中作用及意义

目的:分析血乳酸、纤维母细胞生长因子21(FGF21)在儿童线粒体脑肌病(ME)诊断与疗效监测中作用及意义。方法:按照1∶1∶1选取2020年8月至2023年2月昆明市儿童医院收治的47例儿童ME患儿(ME组)、47例非线粒体病的肌肉病患儿(肌肉病组)及47例健康儿童(对照组)。给予ME患儿饮食和运动指导、左乙拉西坦、艾地苯醌、维生素C、叶酸、辅酶Q10等对症治疗,治疗后3个月评估疗效,根据疗效将ME患儿分为控制与未控制亚组。治疗前、治疗后1个月和3个月留取空腹血标本,以美国YSI 1500 SPORT型血乳酸分析仪及配套试剂盒检测血乳酸水平,以酶联免疫吸附法及酶标仪检测血清FGF21水平。比较3组治疗前血乳酸、FGF21,使用交互作用系数γ与OR值分析血乳酸、FGF21对儿童ME易感性影响的交互作用,受试者工作特征曲线(ROC)分析血乳酸、FGF21诊断儿童ME的价值,并比较ME不同疗效患儿治疗前、治疗后1个月和3个月血乳酸、FGF21、Newcastle线粒体病评分量表(NMDAS)评分变化,Pearson分析治疗后1个月和3个月血乳酸、FGF21降低值与NMDAS评分降低值相关性。结果:与对照组相比,ME组血乳酸、FGF21升高(t=13.901、38.082,P<0.05);与肌肉病组相比,ME组血乳酸、FGF21升高(t=12.734、35.696,P<0.05);对照组、肌肉病组血乳酸、FGF21相比,无明显差异(t=0.821、1.326,均P>0.05);交互作用分析显示,血乳酸、FGF21共存所致OR值为1350.500,回归系数为7.208,交互作用OR值<两单独因素OR值的乘积,为次相乘模型,γ=1.535>1,血乳酸对FGF21的效应具有正向交互作用;ROC曲线显示,血乳酸+FGF21诊断儿童ME的AUC为0.904,高于血乳酸的0.839及FGF21的0.719,其诊断敏感度为78.72%,特异度为87.23%;病情获得控制患儿治疗后1个月、治疗后3个月血乳酸、FGF21、NMDAS评分低于未控制患儿(P<0.05);相关性分析显示,血乳酸、FGF21治疗后1个月降低值、治疗后3个月降低值与NMDAS评分治疗后1个月降低值、治疗后3个月降低值呈正相关(P<0.05)。结论:ME患儿血乳酸、FGF21升高,两者具有正向交互作用,并与患儿病情、疗效密切相关。

中国母乳寡糖构成特征分析

为了分析中国代表性地区健康乳母的母乳寡糖因地区、泌乳时间和血型基因型受到的影响,探究中国母乳寡糖的构成特征,采用纵向队列研究方法采集我国东西南北6个城市、109名健康母亲、3个泌乳阶段的母乳样本,利用超高效液相色谱-串联三重四极杆质谱分析23种母乳寡糖的质量浓度,并对母乳血型基因型归属状态进行分析。结果表明,昆明、济南和深圳的总母乳寡糖质量浓度和总岩藻糖基中性寡糖质量浓度显著高于北京、包头和西宁,其中包头地区母乳的3-岩藻糖基乳糖(3-fucosyllactose,3-FL)、二岩藻糖基乳糖(lactodifucotetraose,LDFT)和乳糖-N-二岩藻糖基新六糖II(lacto-N-neodifucohexaose II,LNn DFH-II)质量浓度分别显著低于深圳、济南和北京;8种中性寡糖和4种酸性寡糖随泌乳时间延长呈现显著降低趋势;3-FL含量随泌乳时间延长呈现显著上升,LDFT和LNn DFH-II也随泌乳时间延长呈上升趋势,但差异不显著;2种单岩藻糖基六糖在1月龄成熟乳时质量浓度达到最高,之后持平或者略降低;以寡糖类型推测的血型基因型分型发现,各城市乳母均以Se+Le+为主,但该类型母乳中除了乳糖-N-二岩藻糖基六糖II(lacto-N-difucohexaose II,LNDFH-II)、LNDFH-I&LNn DFH-I、6’-唾液酸化乳糖和唾液酸化-乳糖-四糖c质量浓度比其他血型基因型高以外,其他18种寡糖质量浓度均低于其他血型基因型。本研究揭示了地区、泌乳阶段和乳母血型基因型造成了母乳寡糖组成和含量的差异,可为生命早期婴幼儿营养摄入中母乳寡糖的精准化提供科学理论指导。

深化对血乳酸在脓毒症中作用与意义的新认识

作为反映组织低灌注的重要指标,早期血乳酸水平及其变化趋势与脓毒症患者预后关系密切。新近研究证实,乳酸可参与机体天然和获得性免疫调控,并且具有转录后修饰功能,直接影响脓毒症发展。非缺氧型乳酸增多、有氧糖酵解、主要能量底物等重要科学问题不断赋予乳酸新的角色和功能,很有必要深刻认识乳酸的作用与意义。

血乳酸、IL-6联合SOFA评分对脓毒症患者28 d死亡风险的预测价值

目的:探讨血乳酸、IL-6联合序贯器官衰竭评估(SOFA)对脓毒症患者28 d死亡风险的预测价值。方法:回顾性分析2015年7月至2023年7月新疆医科大学第二附属医院重症医学科收治的145例脓毒症患者的临床资料,所有患者入院后完善血气分析及血常规等实验室检查,并进行SOFA评分。所有患者随访28 d,根据患者是否存活分为生存组46例和死亡组99例,比较两组血乳酸、IL-6及SOFA评分的区别,单因素和多因素Logistic回归分析临床基本资料,确定脓毒症患者死亡的独立影响因素,Spearman相关性分析血乳酸、IL-6及SOFA评分与脓毒症患者死亡的相关性,利用受试者工作特征(ROC)曲线评估血乳酸、IL-6、SOFA评分及三者联合检测对脓毒症患者死亡风险的预测价值。最后,基于R语言采用Bootstrap法对模型重抽样500次后,绘制校准曲线及临床决策曲线。结果:脓毒症死亡组患者血乳酸水平、IL-6及SOFA评分均明显高于生存组,差异均具有统计学意义(P<0.05)。脓毒症患者病死率为68%(99/145)。单因素Logistic回归分析显示,糖尿病、血乳酸、IL-6、SOFA评分是导致脓毒症患者死亡的相关因素。多因素Logistic回归分析显示,高SOFA评分、有糖尿病、高血乳酸、高IL-6是导致脓毒症患者死亡的独立危险因素。血乳酸、IL-6、SOFA评分与脓毒症患者死亡呈正相关,ROC曲线分析结果表明,血乳酸、IL-6、SOFA评分及三者联合检测预测脓毒症患者死亡的AUC依次为0.863、0.850、0.897、0.949。血乳酸最佳截断值为2.950 mmol/L时,诊断敏感度为77.800%,特异度为89.100%;IL-6最佳截断值为100.970 pg/mL时,诊断敏感度为70.700%,特异度91.300%;SOFA评分最佳截断值为7.500分时,诊断敏感度为93.900%,特异度为80.400%;三者联合检测的敏感度为90.900%,特异度为89.100%。结论:血乳酸、IL-6、SOFA评分升高是脓毒症患者死亡的独立危险因素,此次构建的临床预测模型的准确度及临床适用度较高,三者联合检测对脓毒症患者的预后分析具有良好的预测价值。

外周血LDH、24-hUPro水平和脐动脉血流相关参数检测与子痫前期及新生儿预后的关系

目的:乳酸脱氢酶(lactate dehydrogenase,LDH)是生物体内重要的氧化还原酶,主要在糖酵解过程中将丙酮酸转化为乳酸的胞内酶,异常表达于缺氧和氧化应激环境;24 h尿蛋白(24-hour urinary protein,24-hUPro)水平检测可以反映子痫前期进展过程中肾损伤、肾微血管细胞损伤情况,以及肾小球滤过能力;全身小动脉痉挛是子痫前期特征性的临床表现,发生后会导致子宫螺旋小动脉重铸不足,进而影响局部灌注不足,而呈现脐动脉血流相关参数变化,是孕晚期产检评估胎儿在母体内发育的重要手段。子痫前期作为产妇最严重的并发症之一,严重威胁产妇安全和新生儿预后。本研究旨在分析外周血LDH、24-hUPro水平和脐动脉血流相关参数检测与子痫前期及新生儿预后的关系。方法:选取2019年1月至2023年1月在黄山市人民医院建卡并于孕晚期诊断为子痫前期的72例产妇为研究对象,另纳入同期正常建卡的72例健康产妇为对照。收集入组对象一般资料,比较子痫前期组与健康组外周血LDH、24-hUPro水平、脐动脉血流相关参数[收缩期峰值血流速度/舒张末期血流速度(systolic blood flow velocity/enddiastolic blood flow velocity,S/D)、阻力指数(resistance index,RI)、搏动指数(pulsatility index,PI)]和母婴结局,绘制受试者操作特征(receiver operator characteristic,ROC)曲线,分析上述指标检测对子痫前期的预测效能,相关性分析子痫前期组外周血LDH、24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)与终止妊娠时间、新生儿体重和Apgar评分的关系。结果:子痫前期组与健康组产妇年龄、孕前BMI、初产妇情况、流产史和血红蛋白比较,差异均无统计学意义(均P>0.05)。子痫前期组收缩压、舒张压、外周血LDH、24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)均高于健康组(均P<0.05)。外周血LDH、24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)及联合检测预测子痫前期的曲线下面积(area under the curve,AUC)均>0.70,预测效能较好,且以联合最佳。根据ROC曲线获得外周血LDH,24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)的截断值分别为239.16 U/L、0.26 g、2.04、0.49和0.67。子痫前期组不良母婴结局发生率高于健康组(P<0.05)。子痫前期组终止妊娠时间早于健康组,新生儿体重、Apgar评分低于健康组(均P<0.05)。子痫前期组外周血LDH、24-hUPro水平和脐动脉血流相关参数与新生儿体重和Apgar评分均呈负相关关系(均P<0.05),与终止妊娠时间均无明显相关性(均P>0.05)。结论:子痫前期产妇外周血LDH、尿蛋白水平和脐动脉血流相关参数均有异常升高,临床可通过对其联合检测预测子痫前期的发生风险,且与母婴结局具有一定的相关性。此外,扩大样本量、延长观察时间继续观察新生儿后生长发育情况,进一步验证上述指标对新生儿远期生长发育的影响将会成为下一步的研究重点和方向。

快速Pitt菌血症评分联合乳酸预测急性下呼吸道感染患者的死亡风险

目的分析快速皮特菌血症(qPitt)评分联合急诊常用指标是否可作为急性下呼吸道感染患者28 d死亡风险的预测因素。方法以2018年7月1日至2023年12月31日收治于首都医科大学附属北京朝阳医院急诊科的急性下呼吸道感染患者为研究对象,以入院后28 d死亡为终点,将研究对象分为存活组和死亡组。使用单因素分析比较两组qPitt评分和临床指标的差异,并通过Logistic回归筛选影响急性下呼吸道感染患者28 d死亡的独立相关因素,建立联合预测模型,使用受试者工作特征(ROC)曲线评价独立相关因素及联合变量预测模型对急性下呼吸道感染患者28 d死亡的预测价值。结果共纳入患者696例,其中28 d存活组445例(63.9%)和28 d死亡组251例(36.1%)。死亡组年龄、降钙素原、D-二聚体、血乳酸(lactate,LAC)、血肌酐(SCr)及qPitt评分均高于存活组(均P<0.05),淋巴细胞计数和血小板计数均低于存活组(均P<0.05)。Logistic回归分析得出LAC(OR=1.258,95%CI 1.143~1.384,P<0.001)、年龄(OR=1.021,95%CI 1.008~1.034,P=0.001)及qPitt评分(OR=1.923,95%CI 1.597~2.317,P<0.001)是预测急性下呼吸道感染患者28 d死亡风险的独立因素。年龄、LAC与qPitt评分联合变量预测模型的ROC曲线下面积(area under curve,AUC)为0.746(95%CI 0.708~0.784),高于LAC(AUC=0.692,95%CI 0.650~0.733)和qPitt评分(AUC=0.702,95%CI 0.660~0.743),且其预测效能优于单独应用LAC(Z=2.888,P=0.004)和qPitt评分(Z=3.850,P<0.001)。结论qPitt评分和LAC是急性下呼吸道感染患者死亡的独立危险因素,二者与年龄构建的联合变量预测模型可有效预测28 d死亡风险。

补喂赖氨酸和苏氨酸对放牧条件下泌乳母马血液生化指标的影响

通过给放牧条件下泌乳母马补饲赖氨酸和苏氨酸,探究其对泌乳母马血液生化指标的影响,为氨基酸调控泌乳期母马的健康提供参考依据。选择产驹日期相近(5月份),年龄7~9岁,胎次4~5胎,平均体重(428.00±33.42)kg,泌乳30 d的伊犁马母马24匹,随机分为4个组,每组6匹,分别为对照组、试验Ⅰ组、试验Ⅱ组和试验Ⅲ组。在相同的放牧条件下(放牧时间、饮水时间、挤奶时间和放牧草场完全相同),对照组不进行任何氨基酸补喂,试验Ⅰ组每匹马补饲赖氨酸40 g/d+苏氨酸20 g/d,试验Ⅱ组每匹马补饲赖氨酸60 g/d+苏氨酸40 g/d,试验Ⅲ组每匹马补饲赖氨酸80 g/d+苏氨酸60 g/d。整个补饲期为120 d,定期采集母马血液,测定相关生化指标。结果:在蛋白质代谢方面,试验Ⅰ~Ⅲ组母马血液中总蛋白和白蛋白含量均显著低于对照组(P<0.05),尿酸含量分别比对照组提高16.33%、37.20%和17.58%;在糖脂代谢方面,试验Ⅰ~Ⅲ组的总胆红素均极显著高于对照组(P<0.01),葡萄糖和甘油三酯含量均低于对照组;在酶活力方面,试验Ⅰ~Ⅲ组的谷丙转氨酶和谷草转氨酶活力均极显著低于对照组(P<0.01),碱性磷酸酶和肌酸激酶的活力随着赖氨酸和苏氨酸剂量的增加而呈上升趋势;在矿物质方面,Ca^(2+)、无机磷和Mg^(2+)的含量各组之间均无显著差异(P>0.05),但试验Ⅱ组Fe^(2+)含量最高,与其他3组有显著或极显著差异。综上,在放牧条件下给泌乳母马补饲赖氨酸和苏氨酸可降低其血液中葡萄糖、甘油三酯含量以及谷草转氨酶和谷丙转氨酶的活力,提高总胆红素、无机磷、Mg^(2+)和Fe^(2+)的含量,促进泌乳母马的健康,以每匹泌乳母马摄入60 g/d的赖氨酸和40 g/d的苏氨酸效果最佳。