目的 探讨急性自发性脑出血患者(ICH)血清基质金属蛋白酶9(MMP-9)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肌糖蛋白-C(TNC)、肿瘤坏死因子α(TNF-α)水平,分析血清指标与脑水肿体积及预后的关系.方法 选取自2017年1月至2018年12月收治的112例ICH患者为观察组,选取同期体检的112例健康者为健康组.采用酶联免疫吸附实验(ELISA)检测血清MMP-9、NGAL、TNC、TNF-α及血生化指标水平.治疗后第7、14天行头颅CT测量脑水肿体积变化.根据治疗后3个月的改良Rankin量表评分(mRS)对观察组患者进行神经功能预后评定,并将患者分为预后良好组(mRS≤2分)与预后不良组(mRS≥3分).采用单因素及多因素Logistic回归分析MMP-9、NGAL、TNC、TNF-α水平与脑水肿发生及预后的关系.结果 观察组患者血清MMP-9、NGAL、TNC、TNF-α水平均高于健康组,差异有统计学意义(P<0.05).血清MMP-9、NGAL、TNC、TNF-α截断值分别为155.9 ng/ml[受试者工作特征曲线下面积(AUC)=0.912,95％可信区间0.874～0.949)]、307 ng/ml(AUC=0.875,95％可信区间0.826～0.925)、43.7 pg/ml(AUC=0.854,95％可信区间0.799～0.910)、105.4 pg/ml(AUC=0.848,95％可信区间0.798～0.897).治疗前、治疗后7 d及治疗后14 d,TMMP-9、NGAL、TNC、TNF-α高水平组患者脑水肿体积均大于低水平组,差异均有统计学意义(P<0.05).患者血清MMP-9、NGAL、TNC、TNF-α水平增高,NIHSS评分以及CPR水平是ICH患者预后不良的独立危险因素(P<0.05).结论 ICH患者MMP-9、NGAL、TNC、TNF-α表达明显升高,与脑水肿扩大及预后不良相关.

目的：探讨左西孟旦治疗重症监护病房（ICU）心力衰竭患者临床效果，以及对心功能和B型脑钠肽（BNP）、超敏C反应蛋白（hs‐CRP）等的影响。方法选择2013年2月至2016年2月于该院治疗的144例ICU心力衰竭患者作为研究对象，按照随机数字表法分为观察组（72例）和对照组（72例），两组患者均给予适当休息、吸氧、低盐饮食，并给予常规药物治疗。对照组在常规治疗基础上联合应用多巴酚丁胺静脉滴注，初始剂量2μg／（kg · min），1 h后增至4μg／（kg · min），持续用药24 h。观察组在常规治疗基础上联合应用左西孟旦，初始负荷量12．0μg／kg静脉注射10 min ，然后以0．1μg／（kg · min）持续静脉泵入50 min ，如耐受性好剂量增至0．2μg／（kg · min），持续静脉泵入24 h。两组患者分别于治疗前、后检测左心室射血分数（LVEF）、左室舒张末期内径、BNP、hs‐CRP 水平，观察临床疗效、用药3个月和6个月后病死率与再次入院率及不良反应发生情况。结果治疗后观察组总有效率（81．9％）显著高于对照组（66．7％），差异有统计学意义（P＜0．05）；观察组LVEF明显增高，BNP、hs‐CRP水平明显降低，差异均有统计学意义（P＜0．05）；观察组在用药3、6个月后病死率与再次入院率优于对照组，但差异无统计学意义（P＞0．05）；两组患者均发生恶心、呕吐、胸痛、心悸、低血压、头痛、低血钾等不良反应，两组各种不良反应发生情况比较差异无统计学意义（P＞0．05）。结论左西孟旦能有效提高ICU心力衰竭患者临床效果，改善心功能及BNP和hs‐CRP水平，安全性好，值得临床推广应用。

OBJECTIVE:To analyze the association of blood glucose variability and short-term outcome in critically ill.METHODS:The retrospective study including 552 patients admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2013 to March 2015. The initial blood glucose (GluAdm), the first 24 hours average blood glucose(GluMV1d) and glycemic lability index(GLI1d), 72-hour average blood glucose (GluMV3d) and glycemic lability index(GLI3d) were recorded. The receiver operating characteristic curve (ROC curve) was applied to evaluate the association between GluAdm, GLI1d, GLI3d and APACHE Ⅱ score and prognosis.RESULTS:The levels of APACHE Ⅱ, GluAdm, GLI 1d, GLI 3d of nonsurvivors were higher than those of survivors[(23.2±5.2) vs (16.7±4.4), (12.3±5.2)mmol/L vs(9.2±2.2)mmol/L, (23.3±12.2)vs(12.3±11.1), (21.6±19.3)vs(13.2±9.9), P<0.05]; there was no statistically significant difference between GluMV1d and GluMV3d; when ROC was applied, and the area under the curve (AUC) of APACHEⅡ, GLI1d and GLI3d were 0.826±0.035, 0.726±0.052 and 0.786±0.046, which were significantly higher than the GluMV1d and GluMV3d (0.412±0.031, 0.425±0.026, P<0.05) .It is correlated between GluAdm, GLI1d, GLI3d and the 28-day mortality, ICU days and total time of hospitalization.CONCLUSION:Blood glucose variability is closely related with the mortality in critical ill patients, GLI1d, GLI3d and APACHEⅡ score of critically ill patients have a similar predictive value in the short-term prognosis.

[目的]为规范从高血压患者中筛查原发性醛固酮增多症(PA)的流程,提高临床对PA的认识和诊断率.[方法]回顾性分析2011年12月至2012年12月在本院内分泌科就诊的高血压患者204例临床资料.①比较原发性高血压(PHT)患者和PA患者血浆醛固酮水平(PAC)和血浆肾素活性(PRA)与PAC/PRA比值(ARR)的差异;②统计PA患者中高血压不同级别所占的比例及其各自的ARR特点;③计算不同ARR值诊断PA的敏感性和特异性;④比较PHT与PA患者靶器官损害程度;⑤分析PA病程与靶器官损害的关系;⑥比较PA患者手术治疗后血钾、血压恢复情况及其与术前患者病程长短的关系.[结果]①通过ARR初筛以及进一步的立卧位试验结合CT及临床表现共诊断PA 46例,占同期筛选高血压患者的22.5％.其中高血压1级3例(6.5％)、高血压2级12例(28.3％)、高血压3级30例(65.2％),1例血压正常,以低钾CT异常并ARR异常支持诊断.平均收缩压(178±26.4)mmHg,平均舒张压(111±19.6)mmHg.②若以20为截点并联合PAC＞ 15ng/dL时诊断敏感性为85.7％,特异性为84.4％.③PA组并发症明显高于PHT组,其差异有统计学差异(P＜0.05).④PA组服用降压药物种类明显多于PHT组,且降压有效率明显低于PHT组.[结论]①PA在高血压2级及以上的患病率更高,在本组高达20％.②ARR对筛查PA有一定意义,以ARR为20截点并联合血PAC＞15 ng/dL,有较高的敏感性及特异性.③PA患者高血压对ii靶器官的损害远较PHT患者严重,并与其病程有关.④PA患者手术为较好的治疗方法,术后血压较术前较易控制,低钾一般可得到纠正,但术前病史长,血压偏高的患者手术后效果明显下降,故提倡早发现、早诊断、早治疗.

Objective To investigate the clinical features of primary aldosteronism (PA).Methods Clinical fea-tures, treatment and prognosis of 46 patients with PA were analyzed.Results (1) In patients aged 30 to 70 years, high blood pressure classification: grade 1 of 3 patients (6.5%), grade two of 12 cases (26.1%), grade 3 of 30 cases (65.2%), blood pressure normal of one case (2.2%).(2) Adenoma of 36 cases (78.3%), hyperplasia of five cases (10.8%), ade-nocarcinoma of 1 case (2.2%), the other of four cases (8.7%); confirmed by surgery in 20 cases, 18 cases were unilateral adenoma, one case of cancer, one case was the right of nodular hyperplasia .(3)Hypokalemia in 26 cases (56.5%), normal in 20 patients (43.5%), mean serum potassium (3.2 ±0.9) mmol /L.Surgical treatment of 20 cases, 26 cases of conser-vative treatment, blood pressure returned to normal after surgery in 10 cases, one case of no change in blood pressure , antihy-pertensive drugs to reduce the blood pressure in nine cases .Hypokalemia in 11 patients underwent surgical treatment , 10 ca-ses of postoperative serum potassium returned to normal , one patients were compared with preoperative serum potassium rising but still low.Conclusion The majority PA patients with high blood pressure are level 2 and 3, the main complications are cardiovascular diseases, the effect of surgery is good for the PA patients with adenoma .

<正>原发性醛固酮增多症(primary aldosteronism,PA)是1955年由Cohn首先发现并命名的一种肾上腺疾病,由于肾上腺皮质分泌过多的醛固酮,引起潴钠排钾,血容量增多,抑制了肾素活性而导致该病症,以高血压、伴或不伴有低血钾、醛固酮水平过高和血浆肾素活性降低为主要特征[1-2]。过去由