5.Clinical value of serum endocan and procalcitonin in early diagnosis and prognosis evaluation of sepsis
Chinese Critical Care Medicine 2017;29(4):321-326
Objective To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis.Methods The patients with systemic inflammatory response syndrome (SIRS,n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHE Ⅱ, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis.Results ① Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHE Ⅱ:18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, allP < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHE Ⅱ, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. ② With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHE Ⅱ: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; allP < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHE Ⅱ, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. ③ Serum endocan, PCT, APACHE Ⅱ and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L):18.40 (16.99) vs. 3.10 (6.67), APACHE Ⅱ: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, allP < 0.01]. The AUC of endocan, PCT, APACHE Ⅱ, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%.Conclusions Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.
6.Analysis of 36 cases of diabetic ketoacidosis with increased trypsin
Chinese Journal of Primary Medicine and Pharmacy 2012;(23):3539-3540
Objective To explore the rising degree of hemodiastase,lipase and the relationship with acute pancreatitis with diabetic ketoacidosis(DKA).Methods 36 diabetic ketoacidosis patients with increased trypsin were divided into non pancreatitis group(20 cases)and pancreatitis group(16 cases)based on the results of abdominal CT.And the blood amylase,urine amylase,blood fat enzyme levels of the two groups were measured and compard.Results The blood amylase of the pancreatitis group was(275.0±10.5)U/L,and that of pancreatitis group was(615.4±17.8)U/L,the difference between two groups was obvious(P<0.01);The blood lipase of pancreatitis group was(2125.0±50.4)U/L,and that of pancreatitis group was(2021.0±19.8)U/L,there was no significant difference between the two groups(P>0.05).The blood amylase and abdominal CT results compliance high.Conclusion Pure DKA can cause diabetes pancreatic enzyme increases,and in the diagnosis of acute pancreatitis,the specificity of blood amylase is high.
7.Research progress in the diagnosis and treatment of adenoid cystic carcinoma of the salivary gland
Journal of Medical Postgraduates 2003;0(11):-
Adenoid cystic carcinoma(ACC) of the salivary gland constitutes approximately 21.9%-24.0% of all salivary gland malignant tumors,and is described as a tumor with indolent,but persistent and recurrent,growth and late onset of metastases,leading eventually to death.This review focuses on the advances in the studies of the diagnosis,treatment,and prognosis of ACC in the recent years.
8.Hypoxia-Inducible Factor-1 and Cerebral Ischemic Tolerance
International Journal of Cerebrovascular Diseases 2006;0(05):-
Hypoxia inducible factor 1 (HIF-1), a nuclear protein with transcription activity, can make the body produce adaptive response to hypoxia/ischemia by binding to target gene, transcription and post-transcriptional control. Ischemic tolerance refers to the adaptive response to transient ischemia and reperfusion, which can improve tissue tolerance during the following damage caused by more severe ischemic events. The recent studies have found that the expression of HIF-1 has an important significance in ischemic tolerance. HIF-1 may be a key factor of the oxygen signal transduction pathway in the development of cerebral ischemic tolerance.
9.Liver regeneration and bile acids metabolism
International Journal of Surgery 2010;37(8):537-540
The liver regeneration is closely related to the bile acids. To avoid the toxic effects of bile acids on hepatocyte, the state of bile secretion, the rate-limiting enzyme of the bile acid synthesis, bile acids composition as well as the transporter changes at the process of liver regeneration. In vivo and in vitro experiments show that bile acids can promote liver cell proliferation, liver regeneration may be related to the signal which is released under the bile acid imbalance. The relationship between the liver regeneration and bile acid metabolism has an important practical significance in liver regeneration.
10.Changes of serum cytokines in children with viral myocarditis induced by coxsackie virus type B and its clinical significance
Chinese Journal of Postgraduates of Medicine 2012;35(3):14-16
ObjectiveTo explore the changes of serum macrophage migration inhibitory factor (MIF),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF- α ) levels,and the relationship with creatine kinase-MB (CK-MB) in children with viral myocarditis induced by coxsackie virus type B,and its clinical significance.MethodsSerum MIF,IL-6 and TNF- α levels were detected by enzyme-linked immunosorbent assay (ELISA) in 58 cases with viral myocarditis induced by coxsackie virus type B in acute phase (viral myocarditis group) and 40 cases hospitalized children (control group).CK-MB was measured by Hitachi 7180 fully automated clinical chemistry analyzer.ResultsSerum MIF,IL-6 and TNF-o levels of viral myocarditis group [ (59.15 ± 25.35 ),(68.52 ± 12.78 ),(85.31 ± 34.18) ng/L] were significantly higher than those of control group [ ( 36.78 ± 12.06 ),( 28.75 ± 16.03 ),( 52.91 ± 14.39 ) ng/L ] (P < 0.01 ),and CK-MB of viral myocarditis group [(46.74 ± 23.89) U/L] was also significantly higher than that of control group [ ( 19.23 ± 11.56 ) U/L ] (P < 0.01 ).There was positive correlation in children with viral myocarditis between MIF,IL-6,TNF- α and CK-MB (r =0.74,0.63,0.69,P < 0.05).ConclusionsIt suggests that immune dysfunction exist in children with viral myocarditis induced by coxsackie virus type B.MIF,IL-6 and TNF- αmight take part in development of myocarditis,and the detection of them can evaluate severity of myocarditis.