目的 探讨碱性磷酸酶(ALP)浓度对皮质下缺血性血管病(SIVD)患者认知功能障碍影响,研究ALP与早期认知障碍的相关性.方法 选取2017年至2019年哈尔滨市第二医院神经内科收治的SIVD患者77例,根据头颅磁共振结果 将其分成多发腔隙性脑梗死(LI)组, 32例;脑白质稀疏(LA)组,45例.选取32例与实验组年龄区间相同的MRI无异常的老年人为对照组.LA组根据Abaron-peretz标准分4组.所有入组患者均采集空腹>8小时的静脉血,测定血清ALP水平,应用P300和简易智力状态检查量表(MMSE)进行认知功能评估.分析不同程度认知障碍组的ALP水平、P300潜伏期延长情况、MMSE评分之间的差异.结果 ALP水平随影像学分组严重性或级别增高呈递增趋势,且P<0.05,差异存在统计学意义,但LI组ALP水平无显著差异,P>0.05.MMSE评分随影像学分组严重性或级别增高呈递减趋势,且P<0.05,差异存在统计学意义.LA组四级之间两两对比可见LA1级与LA2级、LA2级与LA3级之间MMSE评分无显著差异,P>0.05,其余各级间两两比较,差异存在统计学意义,P<0.05.P300潜伏期延长时间随影像学分组严重性或级别增高呈递增趋势,且P<0.05,差异存在统计学意义.应用 SPSS Pearson 相关性分析软件对ALP水平和MMSE及P300潜伏期延长进行相关性分析,结果 显示:在对照组和LI组, ALP水平与P300和MMSE无明显相关性,P>0.05;在LA组ALP水平与P300潜伏期延长程度呈正相关,P<0.05;ALP水平与MMSE评分呈负相关,P<0.05.结论 ALP水平与P300潜伏期延长程度及MMSE评分具有相关性,故ALP水平与认知障碍相关.但ALP水平在轻度白质病变时期与无白质病变患者无显著差异,故ALP无法在早期评价患者是否出现认知障碍,但在中-重度白质病变患者中ALP水平有明显改变,且与白质病变程度呈正相关,故对于中-重度白质病变患者,ALP水平的高低可作为评估认知障碍程度的指标.

钾是细胞内液的主要阳离子,正常成人体内含钾约为50 mmol/kg,约98％的钾存在于细胞内,组织细胞内平均浓度为 l65 mmol/L,红细胞内钾浓度约为105 mmo1/L,而血清中仅有3．5~5．5 mmoL/L,钾在参与蛋白质和糖的代谢、维持心肌和神经肌肉正常的应激性、维持酸碱平衡等方面起重要作用.钠是细胞外液的主要阳离子,正常成人体内含钠2．6~3．5 mol/L,约44％分布在细胞外液中,约20％存在于血细胞及组织细胞中,其余分布在骨骼中.细胞内液中,钠的含量只有10 mmol/L,而在细胞外液中钠的浓度约为1410 mmol/L,主要功能为维持体液的正常渗透压及体内的酸碱平衡.体内钠的平衡主要依靠肾脏调节,通过醛固酮的作用,调节肾小管对钠的重吸收.本文对血清钾、钠检验的方法及临床意义做进一步介绍.

Objective Analysis of the clinical examination unqualified blood specimen and countermeasures were discussed, pro-vide a reliable reference basis for future clinical work. Methods In January 2012 - December 2014 unqualified acceptance of the college laboratory blood samples of 276, the statistical analysis of the clinical testing results and summarize the causes and thera-peutic countermeasures of unqualified specimen appeared. Results Unqualified of 276 samples from 5359 blood samples, the un-qualified rate is 5.15%, unqualified 276 specimens contained less sample size 75, 56 samples of anticoagulation, hemolysis 32 samples, clotting 27 samples, were not in time lead to 26 samples is unqualified, improper container 13 samples client ill-prepared cause unqualified specimens of 16 cases, unreasonable label sample 16, 15 specimens of pollution. Conclusion The cause of clini-cal test blood samples is unqualified, relevant countermeasures medical workers should take preventive measures, reduce the oc-currence of unqualified specimen rate, improve the quality of clinical inspection work, provide a more reliable reference basis for clinical diagnosis and treatment work.

Objective: To discuss the clinical value of applying the β-Crosslaps, P1 NP and CRP in estimating the occurrence of osteoporosis and bone eroding in rheumatoid arthritis(RA). Methods: The levels of β-Crosslaps, P1 NP, CA15-3 were examined by the electrochemi-luminescence method, and the concentration of CRP was detected by latex nephelometry. 65 RA patients and 30 healthy volunteers were enrolled in this study. RA patients were divided into early stage group and non-early group, bone erosion group and non-bone erosion group, bone erode group and non-bone erode group according to the bone destruction, the bone imaging and the results of bone imageology respectively. Results: The levels of these three markers were significantly different among these groups according to the three classification methods(P0.01). Conclusions: The concentrations of β-Crosslaps,P1 NP and CRP might be potential biomarkers for evaluating bone metabolism and bone eroding in RA. And they could be used as a therapeutic monitor with an excellence clinical application value.

目的 通过观察急性脑梗患者的血液流变、超敏C-反应蛋白及血脂的结果,探讨这几项检测指标与急性脑梗的相关性.方法 对53例急性脑梗患者和56例对照者血液流变、超敏C-反应蛋白及血脂进行检测比较.结果 急性脑梗组中全血粘度、红细胞比容、血沉、超敏C-反应蛋白及血脂均高于对照组,二者之间有显著性差异(P＜0.01).结论 与正常组健康者相比急性脑梗发作时血液流变、超敏C-反应蛋白及血脂水平升高,其超敏C-反应蛋白可作为判断脑梗预后的一个灵敏指标.