IgA肾病患者随机尿中ACR与24hUTP定量检测的相关性及其对临床诊断的一致性分析

目的探讨IgA肾病(immunoglobulin A nephropathy,IgAN)患者随机尿清蛋白/肌酐比值(albumin-to-creatinine ratio,ACR)与24 h尿蛋白定量(24 hour urine total protein quantification,24hUTP)检测之间的相关性及其对临床诊断的一致性分析。方法选取北京大学深圳医院2019年1月~2020年12月收治的230例原发性IgAN患者作为研究对象。采用相关性分析和组内相关系数(intraclass correlation coefficient,ICC)分析ACR与24hUTP间的相关性及其对临床诊断的一致性。应用不同慢性肾脏病(chronic kidney disease,CKD)分期和尿蛋白水平进行亚组分析。以24hUTP=0.5 g(24h),1.0 g(24h)和3.5 g(24h)为界点绘制受试者工作特征(receiver operating characteristic,ROC)曲线,确定ACR的cut-off值。结果IgAN患者ACR[0.79(0.41~1.45)g/g]与24 hUTP[1.02(0.58~1.80)g/24h]呈正相关(r=0.85,P<0.01),二者在临床诊断上的一致性程度中等(ICC=0.63,P<0.01)。亚组分析结果显示,二者的相关性和一致性不受CKD分期影响,不同CKD分期的二者相关系数(r)在0.76~0.86之间(均P<0.01),组内相关系数(interclass correlation coefficient,ICC)在0.53~0.72之间;受尿蛋白水平的影响,当24 hUTP≤0.5 g/24h时,二者无相关性(r=0.08,P>0.05),且在24 hUTP≤0.5 g/24h,0.5 g/24h<24hUTP≤1 g/24h和24 hUTP>3.5 g/24h三组中,二者的一致性可忽略(ICC均<0.20)。ROC曲线分析结果显示,当24 hUTP=0.5 g/24h,1.0 g/24h和3.5 g/24h时,ACR分别为0.30 g/g,0.57 g/g和1.28 g/g时为其cut-off值。结论IgAN患者中,ACR不能简单地替代24 hUTP进行尿蛋白水平评估。特别是在24hUTP≤1 g/24h和24 hUTP>3.5 g/24h的时候,ACR不能准确地反映真实的尿蛋白水平。

MRSA感染SP患者T细胞亚群及TLR4、TLR2、TP、ALB诊断价值

目的 探讨耐甲氧西林金黄色葡萄球菌(MRSA)感染重症肺炎(SP)患者外周血T细胞亚群变化,并分析外周血Toll样受体4(TLR4)、Toll样受体2(TLR2)及血清总蛋白(TP)、白蛋白(ALB)联合检测对其的诊断价值。方法 于2020年1月至2022年12月从河西学院附属张掖人民医院选取MRSA感染SP患者179例为感染组,另选MRSA未感染SP患者181例为对照组。分析MRSA耐药情况,比较两组外周血T细胞亚群、TLR4、TLR2及血清TP、ALB水平,并分析外周血TLR4、TLR2、血清TP、ALB诊断MRSA感染SP的价值。结果 MRSA耐药率较高的抗菌药物包括青霉素、苯唑西林、红霉素、克林霉素、四环素、环丙沙星;完全敏感的抗菌药物包括替加环素、呋喃妥因、利奈唑胺、奎努普汀。较对照组,感染组外周血CD19^(+)、TLR4、TLR2水平更高(t=15.378、13.408、12.113,P<0.05);外周血CD4^(+)、CD3^(+)、CD4^(+)/CD8^(+)及血清TP、ALB水平更低(t=23.295、26.320、17.810,P<0.05)。以感染组为阳性,对照组为阴性绘制ROC曲线进行分析,结果显示血清TLR4、TLR2、TP、ALB联合检测诊断MRSA感染SP的曲线下面积(AUC)值高于四者单一检测(P<0.05)。结论 MRSA感染SP患者外周血T细胞亚群异常变化,且外周血TLR4、TLR2呈高表达,血清TP、ALB呈低表达,四者联合检测的诊断价值更高。

Effects of Cold Acclimation and CaCl_2 on Total Soluble Protein, CaM and Freezing Resistance of Populus tomentosa Seedlings

Populus tomentosa seedlings used for cold acclimation at -3℃ were pretreated with or without 10?mmol·L -1 CaCl 2, 3?mmol·L -1 of Ca 2+ chelator EGTA, 0 1?mmol·L -1 of Ca 2+ channel inhibitor LaCl 3,and 0 05?mmol·L -1 of CaM antagonist CPZ. The changes in the contents of total soluble protein and CaM, and freezing resistance in all pretreated seedlings in various periods ( viz: following cold acclimation, chilling stress and recovery) were investigated. Results showed that cold acclimation increased the contents of total soluble protein and CaM, and freezing resistance of seedlings, which could be strongly reduced by the pretreatments of EGTA CPZ and LaCl 3 Cold acclimation combined with CaCl 2 pretreatment enhanced the effect of cold acclimation on freezing resistance, and obviously increased the contents of total soluble protein and CaM, reduced the declining degree of the contents of total soluble protein and CaM caused by chilling stress as compared with cold acclimation, augmented the increase in the level of total soluble protein and CaM during the recovery periods. Further analysis found that an increase in total soluble protein content during cold acclimation with or without CaCl 2 pretreatment mainly resulted from the increase in content of heat stable protein in total soluble protein. It is suggested that Ca 2+ calmodulin may be involved in the synthesis of total soluble protein, and the induction of freezing resistance of seedlings.

Effect of Wheat Based Diet Supplemented with Xylanase on Blood Sugar and Total Protein in Serum of Geese

[Objective] The effects of wheat based diet supplemented with xylanase on blood sugar and total protein in serum of geese were studied. [ Method ] By using the randomized design of single factor, the 1-day-old healthy goslings were divided into 6 groups and fed with corn based diet, wheat based diet and wheat based diet supplemented with xylanase at different concentrations respectively, the contents of blood sugar and total protein in serum were determined. [ Result] The wheat based diet supplemented with xylanase could increase the blood sugar and total protein in serum of geese and wheat based diet supplemented with 0.2% xylanase generated the best effect, which was higher than those of corn based diet group. As for the concentration of protein in serum, wheat based diet supplemented with 0.2% xylanase was significantly different from corn based diet and wheat based diet. [ Conclusion] The wheat based diet supplemented with xylanase could enhance geese production.

Cold Acclimation-Induced Changes in Total Soluble Protein, RNA, DNA, RNase and Freezing Resistance in Populus tomentosa Cuttings

The changes in the contents of total soluble protein and RNA, the activity of RNase in leaves and branches of Populus tomentosa cuttings at various periods (viz: cold acclimation, deacclimation, chilling stress and the recovery after chilling stress), and the survival rate and the freezing resistance of cuttings during cold acclimation at -3℃ were investigated. Results showed that cold acclimation not only increased the contents of total soluble protein and RNA, the survival rates and the freezing resistance of cuttings, decreased the activity of RNase, but also reduced the declining degree of total soluble protein and RNA contents, and the increasing level of RNase caused by chilling stress as compared with the controls. In addition, cold acclimation augmented the increase in the level of total soluble protein and RNA, and facilitated the decrease of RNase during the recovery periods. Further analysis found that the DNA content of all treatments kept relative stability at various periods. The changes in total soluble protein, RNA and RNase were closely related to the freezing resistance of cuttings. It appears that the increase of RNA content caused by cold acclimation induced decrease of RNase activity may be involved in the accumulation of total soluble protein and the induction of freezing resistance of cuttings.

Elementary study of differential expression of total soluble proteins in different life phases of Porphyra yezoensis

Total soluble proteins of different life stages, filamentous sporophytes cultivated in high temperatures, and blade gametophytes harvested in different seasons, were identified by SDS-PAGE. The types and amounts of expressed proteins also varied amongst the samples. The fewest soluble proteins were present in filamentous sporophytes. There were more types and amounts of soluble protein in conchospores than in filamentous sporophytes, but fewer than in bulgy sporophytes. More types of protein were detected in filamentous sporophytes cultivated in high temperatures than in those growing in normal situations. The most types and amounts of protein were found in blade gametophytes in all samples. Blade gametophytes harvested last year and stored at -20 ℃ showed only minor differences in expression of proteins when compared with those harvested in different seasons.

THE PROTECTIVE EFFECTS OF THE TOTAL SAPONIN OF DIPSACUS ASPEROIDES ON THE APOPTOSIS OF HIPPOCAMPAL NEURONS INDUCED BY β-AMYLOID PROTEIN

Objective To investigate the effects of the total saponin of Dipsacus asperoides (tSDA) and ginsenoside Rb1 (GRb1) on the apoptosis of primary cultured hippocampal neurons induced by β-amyloid protein (Aβ). Methods Primary cultured hippocampal neurons, the cultures were pretreated with tSDA and GRb1 on 10d for 24 hours respectively. Then the cultures were treated with 35 μmol·L -1 Aβ25-35 for 24 hours, observed the changing of survival rate of neurons and the apoptosis of neurons with biochemical analysis combining immunofluorescent cytochemical double-staining technique. Results Hippocampal neurons were treated with 35 μmol·L -1 Aβ for 24 hours, and survival rate of neurons downed to 52.6%. When neurons were pretreated by tSDA and GRb1, survival rate of neurons increased 11% to 15%. The findings of immunofluorescent cytochemical double-staining indicated that apoptotic neurons were obviously more than that of the blank group, reaching 43.9%.When neurons were pretreated by tSDA and GRb1, apoptotic neurons were downed to 16.6%, 10.8% respectively. Conclusion tSDA had the same effects as GRb1, protecting the neurons, antagonizing neurotoxicity of Aβ, increasing survival rate of neurons, and reducing apoptotic neurons induced by Aβ.

Expression and purification of the recombinant outermembrane protein Tp0453 of Treponema pallidum and its characterization of immuno-competence

To clone and express the recombinant outer membrane protein Tp0453 of Treponema pallidum and to analyze the immuno-reactivity and immunogenicity of the expressed protein, the immuno-dominant epitope of the Tp0453 was amplified from the complete genome of T.pallidum by PCR, subcloned into expression vector pQE32 to generate the recombinant plasmid pQE32/Tp0453, then expressed in E.coli M15 and analyzed by SDS/PAGE and Western blotting. The fusion protein expressed was purified with Ni-NTA affinity chromatography. Its immuno-reactivity was assayed by indirect ELISA, and the immunogenicity was determined by immunization with this fusion protein in New Zealand rabbits. In the present study, a fusion protein of molecular weight about 32 kDa was obtained. As demonstrated by Western blotting, the recombinant protein could react specifically with positive IgG sera of patients with syphilis, and the antibodies against T.pallidum in human sera were successfully detected by indirect ELISA. Both the sensitivity and specificity of ELISA based on the Tp0453 fusion protein as were 100% (30/30) when detected with control sera. In comparison with the results of IgG ELISA with those of TPPA. It was found that the sensitivity of ELISA was 96.8% and the specificity was 100%. The difference of ELISA and TPPA was not significant, and the concordance of results between ELISA and TPPA was 98.2%. In addition, specific humoral responses could be elicited by immunization with the recombinant fusion protein in New Zealand rabbits with a specific antibody titer of 1∶1280 after 3 successive doses of immunization. These results demonstrate that the expressed recombinant fusion protein shows excellent immuno-competence and provide foundation to develop a quick diagnostic kid applied to detect the presence of T.pallidum infections.

Better performance of PIVKA-II for detecting hepatocellular carcinoma in patients with chronic liver disease with normal total bilirubin

BACKGROUND Serum protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) is a promising biomarker for hepatocellular carcinoma(HCC) surveillance.AIM To identify the contributing factors related to the abnormal elevation of PIVKA-Ⅱ level and assess their potential influence on the performance of PIVKA-Ⅱ in detecting HCC.METHODS This study retrospectively enrolled in 784 chronic liver disease(CLD) patients and 267 HCC patients in Mengchao Hepatobiliary Hospital of Fujian Medical University from April 2016 to December 2019. Logistic regression and the area under the receiver operating characteristic curve(AUC) were used to evaluate the influencing factors and diagnostic performance of PIVKA-Ⅱ for HCC, respectively.RESULTS Elevated PIVKA-Ⅱ levels were independently positively associated with alcohol-related liver disease, serum alkaline phosphatase(ALP), and total bilirubin(TBIL) for CLD patients and aspartate aminotransferase(AST) and tumor size for HCC patients(all P < 0.05). Serum PIVKA-Ⅱ were significantly lower in patients with viral etiology, ALP ≤ 1 × upper limit of normal(ULN), TBIL ≤ 1 × ULN, and AST ≤ 1 × ULN than in those with nonviral disease and abnormal ALP, TBIL, or AST(all P < 0.05), but the differences disappeared in patients with early-stage HCC. For patients with TBIL ≤ 1 × ULN, the AUC of PIVKA-Ⅱ was significantly higher compared to that in patients with TBIL > 1 × ULN(0.817 vs 0.669, P = 0.015), while the difference between ALP ≤ 1 × ULN and ALP > 1 × ULN was not statistically significant(0.783 vs 0.729, P = 0.398). These trends were then more prominently perceived in subgroups of patients with viral etiology and HBV alone.CONCLUSION Serum PIVKA-Ⅱ has better performance in detecting HCC at an early stage for CLD patients with normal serum TBIL.

Determination of Proteins by Measuring Total Internal-reflected Resonance Light Scattering Signals on Water/Tetrachloromethane Interface with Evans Blue and Cetyltrimethylammonium Bromide

A sensitive and selective assay of proteins is proposed based on measuring the total internal-reflected resonance light scattering(TIR-RLS) signals produced on the water/tetrachloromethane(H_2O/CCl_4) interface. In an aqueous medium with pH value in the range of 3.29—3.78, electrostatic attraction occurs between the negatively charged Evans Blue(EB) and positively charged proteins, forming hydrophobic ion associates and resulting in EB-protein adsorption on H_2O/CCl_4 interface. The presence of cetyltrimethylammonium bromide prompts this adsorption, resulting in strongly enhanced TIR-RLS signals. The intensity of the enhanced TIR-RLS at 360—370 nm was found to be proportional to the concentration of proteins. For bovine serum albumin and human serum albumin, the linear range of detection is 0.07—1.2 μg/mL and the limits of detection are 6.68 and 6.30 ng/mL(3σ), respectively, while for lysozyme, the linear range of detection is 0.06—1.0 μg/mL and the limit of detection is 6.0 ng/mL(3σ). The content of the total albumin in a human urine sample could be directly determined by using the standard addition method with a percent recovery of 97.6%—104.1%, and the RSD ranging from 1.9% to 4.2%.

Z-Scan technique: To measure the total protein and albumin in blood

Z-scan technique is an effective tool for measuring the optical nonlinearity of the materials. By using this technique the measurement was made for total protein and albumin. The nonlinear refractive index of the total protein and albumin were found to vary linearly with concentration. Hence by calculating the nonlinear refractive index it is possible to measure their concentration in the sample. The values measured thus are found in equivalence with conventional colorimetric method.

Comparative analysis of bed density, total phenol content and protein expression pattern in <i>Posidonia oceanica</i>(L.) Delile

Posidonia oceanicameadows are experiencing a progressive decline, and monitoring their status is crucial for the maintenance of theseecosystems. We performed a comparativeanalysis of bed density, total phenol content and protein expression pattern to assess the conservation status ofPosidoniaplants from the S. Marinella (Rome, Italy) meadow. The total phenol content was inversely related to maximum beddensity, confirming the relationship betweenhigh phenol content and stressful conditions. In addition, protein expression pattern profilesshowed that the number of differentially expressed proteins was dramatically reduced in the latest years compared to previous analyses. Our results support the usefulness of integrating solid descriptors, such as phenol content, with novel biochemical/molecular approaches in the monitoring of meadows.

血清HGB、SA、STP水平与老年重症肺炎患者病情及预后的相关性分析

目的分析血清血红蛋白(HGB)、白蛋白(SA)、总蛋白(STP)水平与老年重症肺炎患者病情及预后的相关性。方法选取2020年1月至2022年12月郑州大学第一附属医院收治的90例老年重症肺炎患者,按照是否存在多器官功能障碍综合征(MODS)分为合并MODS组与无MODS组,同时根据其28 d内预后情况将患者分为死亡组与存活组,评估其临床肺部感染(CPIS)评分、急性生理学与慢性健康状况评分系统Ⅱ评分(APACHEⅡ),检测血清HGB、SA、STP水平,进行相关性分析。结果合并MODS组与无MODS组STP水平比较差异无统计学意义(P>0.05);合并MODS组HGB、SA水平低于无MODS组(P<0.05)。老年重症肺炎患者血清HGB、SA水平与CPIS评分、APACHEⅡ评分呈负相关(P<0.05);死亡组与存活组STP水平比较差异无统计学意义(P>0.05);死亡组血清HGB、SA水平低于存活组(P<0.05);血清HGB、SA水平与患者预后呈正相关(P<0.05)。结论血清HGB、SA水平与老年重症肺炎患者病情程度及预后密切相关。

The Role of C-Reactive Protein, Granulocyte Colony Stimulating Factor and Total Antioxidant Capacity in Diagnosis of Acute Appendicitis

Background and Aim: Despite the fact that acute appendicitis is the most common surgical emergency all around the world, its diagnosis is still based on clinical evaluation and accuracy of the diagnosis depending on experience. The aim of this study is to evaluate the role of inflammatory markers in diagnosis of acute appendicitis. Material and Method: The study includes 77 cases with histopathologically proven acute appendicitis and 17 control cases. Blood samples were obtained from all cases and C-reactive protein (CRP), Granulocyte Colony Stimulating Factor (G-CSF) and Total Antioxidant Capacity (TAC) were measured. Findings: In cases with acute appendicitis, CRP and G-CSF levels were found to be related to acute appendicitis;however, TAC was not affected by the disease process. Moreover, CRP and G-CSF levels were correlated with the disease severity. Conclusion: Both CRP and G-CSF can be used in diagnosis of acute appendicitis. Furthermore, increased CRP level can be a marker to show advanced cases. However, G-CSF is not an effective marker to show disease severity.

扩散加权成像表观扩散系数值与乳腺癌患者半乳糖凝集素-3、p53蛋白关系及预测TP化疗效果

目的探讨扩散加权成像(DWI)表观扩散系数(ADC)值与乳腺癌患者半乳糖凝集素-3(Gal-3)、p53蛋白关系及预测TP化疗(多西他赛+卡铂)效果。方法选取2019年10月—2021年10月承德医学院附属医院收治的143例乳腺癌(研究组)、72例乳腺良性肿瘤(良性组)及75例健康体检者(健康组)DWI参数[计算表观弥散系数最小值(ADCmin)、表观扩散系数平均值(ADCmean)]及其与组织Gal-3、p53蛋白相关性,绘制受试者工作曲线(ROC),分析DWI参数预测TP化疗效果。结果研究组ADCmin、ADCmean低于良性组、健康组,且良性组低于健康组(P<0.05)。不同肿瘤直径、病理分级、分化程度、Gal-3、p53蛋白患者ADCmin、ADCmean比较,差异有统计学意义(P<0.05)。ADCmin、ADCmean与肿瘤直径、病理分级、分化程度、Gal-3、p53蛋白呈负相关(P<0.05)。化疗后有效患者ADCmin、ADCmean及差值大于无效患者(P<0.05)。绘制ROC曲线显示,ADCmin、ADCmean差值预测乳腺癌患者TP化疗效果的AUC分别为0.769(95%CI:0.692~0.836)、0.726(95%CI:0.645~0.797)。结论DWI参数与乳腺癌患者Gal-3、p53蛋白呈负相关,且对TP化疗效果具有一定预测价值。

AFTP、CRP、SAA在腹腔积液鉴别诊断中的价值

目的探讨腹腔积液总蛋白(ascitic fluid total protein,AFTP)、C反应蛋白(C-reactive protein,CRP)、血清淀粉样蛋白A(serum amyloid A,SAA)在良恶性腹腔积液鉴别诊断中的临床意义。方法回顾性分析2018年1月~2021年12月以腹腔积液原因待查收入武汉大学人民医院消化科及感染科的210例(良性腹腔积液133例,恶性腹腔积液77例)患者的病例资料。并采用受试者操作特征(receiver operating characteristic,ROC)曲线评价AFTP、CRP、SAA对良恶性腹腔积液的诊断价值。结果恶性腹腔积液组患者的AFTP、CRP、SAA均高于良性腹腔积液组,差异均有统计学意义(P均<0.05)。AFTP、CRP、SAA的ROC曲线下面积分别为0.764、0.742、0.750。AFTP、CRP、SAA诊断恶性腹腔积液的敏感度分别为67.5%、88.3%、83.1%,特异性分别为78.9%、54.1%、69.2%。良性腹腔积液组中非门脉高压性腹腔积液组AFTP、CRP、SAA均高于门脉高压组,差异均有统计学意义(P<0.05),3项联合检测敏感度为90.9%,特异性为95.5%。其他原因恶性腹腔积液组中AFTP、SAA均高于肝癌恶性腹腔积液组,差异均有统计学意义(P<0.05)。结论AFTP、CRP、SAA是鉴别良恶性腹腔积液有价值的生物学指标,在鉴别门脉高压性腹腔积液和非门脉高压性腹腔积液中具有较高的诊断价值。

急性心肌梗死患者Tp-Te/QT比值、血清SCUBE1水平与并发恶性室性心律失常的关系

目的探讨急性心肌梗死(AMI)患者Tp-Te/QT比值、血清信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE1)水平与并发恶性室性心律失常(MVA)的关系。方法选取2021年2月—2023年2月收治的135例AMI作为病例组,另选取同期体检健康者102例作为对照组。应用心电散点图技术分析记录心电图资料,将病例组根据是否发生MVA又分为MVA组和非MVA组。分析各组Tp-Te/QT比值、血清SCUBE1水平,采用受试者工作特征(ROC)曲线评估Tp-Te/QT比值、血清SCUBE1对AMI患者并发MVA的预测效能,采用多因素Logistic回归分析探讨AMI患者并发MVA的影响因素。结果病例组Tp-Te/QT比值与血清SCUBE1水平均高于对照组(P<0.01)。MVA组Tp-Te/QT比值与血清SCUBE1水平均高于非MVA组(P<0.01)。Tp-Te/QT比值联合血清SCUBE1预测AMI患者合并MVA的曲线下面积(0.918)高于各指标单独预测的曲线下面积。多因素Logistic回归分析显示,Tp-Te/QT比值≥0.22、SCUBE1≥50.20μg/L是AMI患者并发MVA的危险因素(P<0.01)。结论Tp-Te/QT比值、血清SCUBE1是影响AMI患者合并MVA的危险因素,Tp-Te/QT比值联合血清SCUBE1对预测AMI患者合并MVA的发生风险具有一定临床价值。

Targeting the“undruggable”cancer driver genes:Ras,myc,and tp53

The term“undruggable”is to describe molecules that are not targetable or at least hard to target pharmacologically.Unfortunately,some targets with potent oncogenic activity fall into this category,and currently little is known about how to solve this problem,which largely hampered drug research on human cancers.Ras,as one of the most common oncogenes,was previously considered“undruggable”,but in recent years,a few small molecules like Sotorasib(AMG-510)have emerged and proved their targeted anti-cancer effects.Further,myc,as one of the most studied oncogenes,and tp53,being the most common tumor suppressor genes,are both considered“undruggable”.Many attempts have been made to target these“undruggable”targets,but little progress has been made yet.This article summarizes the current progress of direct and indirect targeting approaches for ras,myc,two oncogenes,and tp53,a tumor suppressor gene.These are potential therapeutic targets but are considered“undruggable”.We conclude with some emerging research approaches like proteolysis targeting chimeras(PROTACs),cancer vaccines,and artificial intelligence(AI)-based drug discovery,which might provide new cues for cancer intervention.Therefore,this review sets out to clarify the current status of targeted anti-cancer drug research,and the insights gained from this review may be of assistance to learn from experience and find new ideas in developing new chemicals that directly target such“undruggable”molecules.

脑脊液NSE和CSF-TP对颅脑外伤意识障碍患者预后判断的研究

目的探讨颅脑外伤意识障碍患者脑脊液神经元特异性烯醇化酶(NSE)和脑脊液总蛋白(CSF-TP)对意识障碍患者的意识恢复及预后判断的影响。方法选取2020年1月至2022年12月在武警浙江总队医院住院治疗的颅脑外伤意识障碍患者200例,依据患者入院时改良昏迷恢复量表(CRS-R)评估,分为植物状态和微意识状态,采集不同意识状态患者脑脊液NSE、CSF-TP的数据,统计并分析。依据患者第105天时的转归评分(GOS),分为预后良好组和预后不良组,采集不同预后患者各时间点脑脊液NSE、CSF-TP数值,统计并分析;全程用CRS-R行为量表做对应点的临床意识评估。结果植物状态患者脑脊液NSE和CSF-TP数值在不同时间点均高于微意识状态患者,相应临床CRS-R评分均低于微意识状态患者,两者呈负相关(均P<0.05);预后良好组患者脑脊液NSE和CSF-TP水平低于预后不良组,相应临床CRS-R评分均高于预后不良组,两者呈负相关(均P<0.05);以预后不良组为阳性样本,预后良好组为阴性样本,绘制ROC曲线,结果显示脑脊液NSE敏感度82.35%,CSF-TP敏感度70.59%。结论颅脑外伤患者脑脊液NSE及CSF-TP数值测定,在意识障碍患者预后判断中,可作为敏感指标。脑脊液NSE对预后判断的敏感度高于CSF-TP。

肝素结合蛋白、总胆红素和白细胞计数联合预测严重创伤合并脓毒症的效能评价

目的:评价肝素结合蛋白(HBP)联合脏器功能指标对严重创伤合并脓毒症患者预警诊断和预后预测效能评价研究。方法:回顾性分析2019年1月~2020年9月期间入住浙江大学医学院附属第二医院急诊医学科的多发伤并完成HBP检测患者184例,根据SEPSIS 3.0诊断标准将患者分为脓毒症组(n=89)和非脓毒症组(n=95),追踪患者临床结局分为死亡组(n=43)和非死亡组(n=141)。连续测定患者HBP水平,比较两组HBP峰值差异,评估其诊断脓毒症的效力,以HBP峰值的中位数为界值进一步分析其与临床预后相关性,评估HBP单独及联合总胆红素(TBil)及白细胞(WBC)评估预后的效力。结果:(1)脓毒症组(n=89)与非脓毒症组(n=95)HBP的峰值(71.7±68.6 vs 52.5±56.1)无显著差异(P=0.051)。(2)184例患者中HBP峰值与WBC计数呈正相关(r=0.244,P<0.01),与TBil水平呈正相关(r=0.241,P<0.01)。(3)TBil水平、WBC计数及PCT水平独立诊断脓毒症曲线下面积(AUC)分别是:0.618、0.631和0.718,三者联合AUC为0.684,诊断敏感度为60.7%,特异度为71.6%(P<0.05)。(4)死亡预后相关分析显示:高HBP水平组患者死亡率要显著高于低水平组(30.4%vs 16.3%,P<0.05);WBC计数值也是死亡组显著高于非死亡组(17.5±6.9 vs 12.8±4.7,P<0.01),尤其合并脓毒症者,该值有显著差异(P<0.01)。HBP峰值、TBil水平、WBC计数、SOFA评分及APACHE-II评分对预测脓毒症死亡预后的AUC分别是:0.618、0.603、0.719、0.823及0.811,HBP联合TBil及WBC评估脓毒症预后的AUC为0.750,评估的敏感度为74.4%,特异度为74.5%(P<0.05)。(5)三者联合评估在预测脓毒症预后效力上与人工评分差异无统计学意义(P>0.05)。结论:HBP、TBil及WBC三者联合用于评估多发伤患者发生脓毒症风险的预测效力较高,对于合并脓毒症的外伤患者死亡风险预测具有较高的临床指导价值。