单克隆抗人血红蛋白抗体法检测尿中血红蛋白

单克隆抗人血红蛋白抗体法检测尿中血红蛋白岳秀玲（首都医科大学附属天坛医院检验科，北京１０００５０）周建山丛玉隆（解放军总医院检验科）关键词尿血红蛋白单克隆抗体尿液分析目前检测尿血红蛋白多采用化学法和干化学法。化学法的敏感性较低，而干化学法又存在一些干...

糖化血红蛋白检测在糖尿病中的诊断价值

目的探讨糖尿病(DM)应用糖尿血红蛋白(HbA1c)进行诊断的临床价值。方法回顾性分析总参军训部二管处门诊部2010年5月至2012年5月门诊进行体检的糖尿病80例患者与同期进行体检的92例健康人的空腹血糖、餐后2h血糖、HbA1c。结果经检测观察组患者空腹血糖为(10.18±3.87)mmoL/L、餐后2h血糖为(16.23±8.92)mmoL/L、HbA1c为9.03%±2.26%,明显高于健康对照组[空腹血糖为(4.67±0.49)mmoL/L、餐后2h血糖为(6.17±2.04)mmoL/L、HbA1c为4.75%±0.68%]。且当HbA1c值6.15%时,特异性及灵敏性均较高,是最佳的DM诊断界点,此时的诊断准确性最好,漏诊及误诊率均较低。结论 HbA1c对DM患者的早期诊断和疗效评估起着重要的作用,值得临床广泛推广和应用。

游离血红蛋白检测的临床应用及现状

血红蛋白是人体红细胞膜的主要成分。红细胞被破坏溶血后,血红蛋白呈游离状态释放到血浆中,称为游离血红蛋白。医学实验室采用隐血试验（或潜血试验）对临床标本中微量的游离血红蛋白进行检测以用于出血性或溶血性疾病的诊断与鉴别。当机体发生出血性或溶血性疾病时,血管内的红细胞可发生异常分布或溶血,通过对相关标本内游离血红蛋白的水平进行检测,可以判断疾病的发生及发展。

尿干化学分析仪测定与显微镜镜检结果分析

目的:通过比较尿液干化学分析与显微镜镜检两种方法的检测结果,联系临床合理解析实验结果。方法:运用干化学分析法和沉渣镜检测定患者尿液白细胞、尿血红蛋白、红细胞,对两种方法的检测结果进行分析比较。结果:实验数据显示化学法分析结果与镜检结果有不相符的情形存在,两者阴、阳性结果间有交叉现象。结论:尿干化学法检查与沉渣镜检法的联合使用能提高临床应用价值。

急性有机磷农药中毒罕见并发症——附7例报告

急性有机磷农药中毒并发血红蛋白尿、帕金森氏综合征、吞咽肌麻痹、呼吸肌麻痹、急性坏死性胰腺炎、急性肾衰等,较为罕见,特报告如下。 例1,男,20岁,HBsAg阳性。口服“1605”150ml,经治疗后,中毒症状缓解。于病程第6天,突然出现酱油样小便。尿血红蛋白试验强阳性,血红蛋白由2.09mmol/L降至1.24mmol/L,网织红细胞由0.5％上升到2.9％;经用激素、硷性药物等治疗,4天后尿液正常。

Attainment of multifactorial treatment targets among the elderly in a lipid clinic

Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old （n = 465） with a follow-up 〉 3 years. Low-density lipoprotein cholesterol （LDL-C）, blood pressure （BP） and glycated hemoglobin （HbAlc） goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society （ESC/EAS）, European Society of Hypertension （ESH）/ESC and European Association for the Study of Diabetes （EASD） guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin ＋ ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy （48% vs. 33%, P 〈 0.05）. Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals （86%） had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% （88% and 47%, respectively）. Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.

Utility of a hemoglobin A1C obtained at the first prenatal visit

AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% （group one） were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% （group two） were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C 〈 5.7% （group three） were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL （5.3 mmol/L） and 2 h postprandial ≤ 120 mg/dL （6.7 mmol/L）.RESULTS： In group one （n = 16）, 15/16 （95%） re-quired medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients （87%） remained diabetic. Group two contained 82 patients. Sixty-sixpatients （80%） were given a diagnosis of GDM and 52 patients （64%） required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients （8.7%） were diagnosed with GDM and 13 patients （6%） required medication. In comparison to group three, patients in group one were 220 times more likely to require medication （95%CI： 26.9- 〉 999, P 〈 0.0001）. Patients in group two were 26 times more likely to require medication （95%CI： 12.5-54.3, P 〈 0.0001）.

Analysis on blood glucose excursions in well-controlled patients with type 2 diabetes mellitus

Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tolerance(NGT) from December 2005 to December 2007 in our department were subjected prospectively.Continuous glucose monitoring system(CGMS) was employed to record their continuous blood glucose level for 3 d.The blood glucose profiles including the mean blood glucose(MBG),standard differentiation(SD),mean amplitude of glycemic excursions(MAGE) and absolute means of daily differences(MODD) were analyzed.Results:T2DM group had obviously postprandial hyperglycemia,in about 2 h after meal,especially after breakfast.Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups,of which 73.1%(38 episodes) were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L.And 20 episodes took place during the day hours,while 32 episodes observed during the night hours.Compared with NGT groups,SD,MAGE and MODD were all significantly higher in T2DM groups.MBG was significantly correlated with HbA1c in T2DM groups,but SD,MAGE,NGE and MODD were all independent of HbA1c.MAGE was independent of MODD.Conclusion:The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups.Thus ideally glycemic control is not only to make HbA1c reach standard,but also to lessen glycemic excursions and reduce hypoglycemia episodes.

Analysis of γ-Hydroxybutyrate in Human Urine by LC-MSIMS Method and Its Forensic Application

GHB （γ-hydroxybutyrate） is becoming popular recreational drugs. As a result of its strong sedative and amnesiac effects, GHB has been implicated in a number of DFSA cases. The natural presence of GHB in the human body and its rapid elimination after ingestion make it difficult to detect and to evaluate its roles in suspected GHB-facilitated assaults. The paper describes an analytical method for the determination of GHB in urine using LC-MS/MS. Samples were acidified by ammonium chloride solution and extracted with ethyl acetate, and then the extracts were analysed by LC-MS/MS. The limit of detection was 0.05 p.g/mL （S/N = 3）. The intra- and inter-day precision was within 10.0% at three concentrations. The methods were found to be sensitive, accurate, rapid and suitable for the forensic toxicology to test GHB in real cases.

RhD血型中不同型血浆和血小板输注临床分析

目的:探讨RhD血型中不同型血浆和血小板临床应用的可行性。方法:对40例RhD阴性者于输注RhD阳性血浆和血小板前、后跟踪检测抗D效价,对32例RhD阳性者于输注RhD阴性血浆前、后进行总胆红素、间接胆红素定量和尿血红蛋白定性试验的检测比较。结果:输注过程中患者均未出现不良反应;40例RhD阴性患者输注RhD阳性血浆和血小板后3个月,抗D效价阳性者由输注前2例增加为3例;32例RhD阳性患者输注RhD阴性血浆前、后总胆红素、间接胆红素和尿血红蛋白定性试验比较差异无统计学意义(P>0.05)。结论:尽可能减少RhD不同血型血浆和血小板输注,在无RhD同型血浆或血小板时,RhD不同型的输注也可以进行。

Clinical analysis of 78 cases of paroxysmal nocturnal hemoglobinuria diagnosed in the past ten years

OBJECTIVE: To learn more about the clinical and laboratory features of patients with paroxysmal nocturnal hemoglobinuria (PNH) diagnosed in the past ten years. METHODS: Clinical and laboratory data for 78 cases of PNH diagnosed from January 1990 to November 1999 in our hospital were analyzed retrospectively. RESULTS: In comparison with PNH cases reported in the 1980s, the newly diagnosed PNH cases showed the following features: (1) older age of disease onset (from 27 to 34 years); more female cases (from 18.5% to 38.5%); more cases without hemoglobinuria (from 24.2% to 38.5%). (2) No positive family hereditary history. (3) Bone marrow dysplasia, abnormal karyotype and negative sister chromatid differentiation were found in 19.2%, 12.2% and 8.9% of the PNH patients, respectively. 12.3% of the patients had bone marrow hypoplasia, and most of them had no hemoglobinuria. Ham's tests were negative in about 34.2% of the cases. CD55 and CD59 on peripheral blood cells were deficient in 100.0% of the cases, suggesting that CD55 and CD59 tests can improve the diagnosis of PNH. (4) Adrenocortical hormone was effective in 83.8% of the patients, 54.2% of whom relapsed within one year. Eight refractory and relapsed patients were treated with low dose chemotherapy (MP therapy: Melphalan 2 - 6 mg x d(-1); Prednisone 0.5 mg x kg(-1) x d(-1)). Five (62.5%) of them showed positive responses. Bone marrow failure and other side effects were not serious in this group of patients. CONCLUSIONS: PNH, an acquired blood disease seen more often among adult males, can be diagnosed more sensitively by hemocyte member CD55 and CD59 tests and treated more effectively with adrenocortical hormone or low dose chemotherapy.

Inhibiting effects of low-molecular weight heparin and adrenocortical hormone on hemolysis of red cells in patients with paroxysmal nocturnal hemoglobinuria in vitro

OBJECTIVE: To study the effects of low-molecular weight heparin (LMWH) and adrenocortical hormone (dexamethasone) on the hemolysis of red cells of patients with paroxysmal nocturnal hemoglobinuria (PNH) in vitro. METHODS: Using Ham's test and micro-complement lysis sensitive test (mCLST), the changes in hemolysis of red cells from 6 typical PNH cases were examined after adding LMWH and dexamethasone in different concentrations into the test solution in vitro. The effects of LMWH and dexamethasone on the coagulation of the tested blood samples were also studied using the activated partial thromboplastin time (APTT) test. RESULTS: Both LMWH and dexamethasone inhibited the hemolysis of PNH red cells, and they also showed a synergistic effect. The inhibiting effects were dose-dependent. Moreover, a tolerable dose of LMWH induced a limited prolongation of APTT. Dexamethasone showed two possible mechanisms in the inhibition of PNH red cells hemolysis through Ham's test and mCLST, respectively: (1) inhibiting both antibodies binding to red cells and (2) the initiation of the activation of complement 3 (C3). LMWH could inhibit hemolysis as determined by both Ham's test and mCLST, which indicated that LMWH could block the activation of complement cascade. CONCLUSIONS: Both LMWH and dexamethasone could inhibit hemolysis in PNH, and they showed a synergistic effect. Their mechanisms of inhibiting hemolysis differed from each other. Furthermore, a tolerable dose of LMWH induced a limited prolongation of APTT. LMWH might be useful for controlling acute hemolysis in patients with PNH and reducing the dose of adrenocortical hormone.

Efficacy and safety of saxagliptin in patients with type 2 diabetes mellitus:a meta-analysis of randomized controlled trials

As a new oral hypoglycemic agent, saxagliptin belongs to the class of dipeptidyl peptidase-4 （DPP-4） inhibitors. However, it remains inconclusive whether saxagliptin is associated with increased risk of adverse events （AE） and efficacy as add-on treatment. Therefore, we performed an up-to-date meta-analysis to compare the efficacy and safety of saxagliptin with placebo and other oral hypoglycemic agents in adult patients with type 2 diabetes mellitus （T2DM）. Randomized clinical trials （RCTs） comparing saxagliptin with comparators were retrieved by selecting articles from Pubmed, Embase, Cochrane Library and Clinical Trials Registry Platform up to Oct. 2013. Weighted mean difference （WMD） was used to analyze the effect of hypoglycemic agents on HbAlc, weight and fasting plasma glucose （FPG）. While the patients who achieved HbAlc〈7.0% and had AE were analyzed as relative risks （RR）. A total of 18 articles from 16 RCTs and one clinic trial from the WHO International Clinical Trials Registry Platform met the included criterion. Clinically significant decrease from baseline HbAlc compared with placebo was certified for 2.5 mg/day saxagliptin （WMD = -0.45%, 95% CI, -0.48% to -0.42%） and 5 mg/d saxagliptin （WMD = -0.52%, 95% CI, -0.60% to -0.44%）. Saxagliptin as add-on therapy was superior to thiazolidinediones, up-titrated glyburide, up-titrated metformin or metformin monotherapy in achieving HbA1c〈7.0%. Treatment with saxagliptin had negligible effect on weight, and it was considered weight neutral. Saxagliptin treatment did not increase the risk of hypoglycemia （RR = 1.28, 95% CI 0.72 to 2.27, P = 0.40） and serious adverse experiences （RR = 1.25, 95% CI 0.94 to 1.66, P = 0.13）. No statistically significant differences were observed between saxagliptin and comparators in terms of the risk of infections. The present study showed that saxagliptin was effective in improving glycaemic control in T2DM with a low risk of hypoglycaemia and incidence of infections in either monotherapy or add-on treatment. This founding should be further certified by large-sample size and good-designed RCT.

Phenotypic analysis of affected peripheral erythroid for CD59 in paroxysmal nocturnal hemoglobinuria

OBJECTIVE: To determine whether affected reticulocytes could be a reliable marker for the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH), we analyzed CD59-antigen expression on the membranes of reticulocytes and erythrocytes. METHODS: We studied 10 PNH patients and 5 healthy volunteers by two-color flow cytometry with a membrane permeable fluorescent dye, thiazole orange (TO), and anti-CD59 monoclonal antibodies (MoAb). TO was introduced to gate reticulocytes and anti-CD59 MoAb were used to identify glycosylphosphatidylinositol (GPI)-deficient cells. RESULTS: Cells from healthy individuals were only CD59 positive. However, in all PNH patients, CD59-antigen expression could be divided into 3 types: type I cells (CD59 normally positive), type II cells (CD59 partly positive) and type III cells (CD59 negative). The majority of reticulocytes belonged to type III cells, GPI-deficient cells (61.0%). In addition, the percentage of affected reticulocytes was higher than that of erythrocytes. CONCLUSIONS: Analyzing PNH reticulocytes was important, because most patients had elevated numbers of reticulocytes, which represent more closely the recent erythroid output of BM. However, circulating mature erythrocytes were subject to complement-mediated intravascular lysis. Therefore, the percentage of abnormal erythrocytes may not accurately reflect the proliferation rate of normal and abnormal erythroid progenitor cells. Thus, affected reticulocytes could be a more reliable indicator for the diagnosis of PNH than mature erythrocytes.

Retrospective study of Traditional Chinese Medicine treatment of type 2 diabetes mellitus

OBJECTIVE: To provide clinical evidence in support of Dahuang Huanglian Xiexin decoction(DHXD) to treat type 2 diabetes mellitus(T2DM) and to introduce a new treatment option for clinicians.METHODS: Retrospective analysis was used to evaluate DHXD for the treatment of T2DM by analyzing clinical records of 183 cases. Patients with T2DM who met the inclusion criteria between January 1,2013 and January 1, 2014 were enrolled. The effects of the treatment were evaluated by the changes in fasting blood-glucose(FBG), postprandial blood sugar(PBG), hemoglobin A1c(Hb Alc), blood lipid profiles and body mass index(BMI) at 1, 2, 3 and 6 months. The changes in main symptoms were alsoevaluated. The dosage of Huanglian(Rhizoma Coptidis) and related factors were analyzed.RESULTS: There was a significant improvement in mean Hb A1C at 3 and 6 months after DHXD treatment compared with the baseline level(P < 0.01).There were also significant improvements in FBG,PBG, blood lipid series and BMI. DHXD also improved the main symptoms of stomach and intestine excessive heat syndrome in patients with obese T2DM. Huanglian(Rhizoma Coptidis) was the most frequently used in 678 clinical visits, the dosage of Huanglian(Rhizoma Coptidis) was related to age, BMI, DM duration, the level of blood glucose,and use of Western hypoglycemic drugs.CONCLUSION: This study suggests that DHXD could decrease blood glucose and improve T2DM symptoms and reduce body weight. The use of DHXD may indicate a new optional treatment for T2 DM.