探讨甲状腺乳头状癌(PTC)患者手术前后肾功能指标的变化.收集2018年4月至12月59例PTC患者临床资料,按肿瘤直径分为A组(直径≤1cm,36例)和B组(＞1 cm,23例).52例健康体检者为对照组.检测健康体检者、PTC患者术前和术后1周的血清尿素氮(BUN)、肌肝(Cr)、肾小球滤过率(eGFR)、胱抑素C(CysC)、视黄醇结合蛋白(RBP)、β 2-微球蛋白(BMG)水平.通过绘制受试者工作特性曲线(ROC)分析肾功指标对PTC的诊断效能.术后患者BUN、RBP、BMG水平较术前降低(P＜0.05),Cr、eGFR、CysC水平未见明显变化(P＞0.05);A组术后BUN、RBP、BMG水平较术前降低(P＜0.05),Cr、eGFR、CysC 水平未见明显变化(P＞0.05);B 组术后 BUN、RBP 水平降低(P＜0.05),Cr、eGFR、CysC、BMG水平未见明显变化(P＞0.05).绘制ROC曲线,RBP对PTC和直径≤1cm的PTC诊断灵敏度分别为 40.68％、66.67％,特异性分别为 80.77％、65.38％,临界值为＞40.45 mg/L、＞37.75 mg/L.BMG对PTC和直径≤1cm的PTC的诊断灵敏度分别为42.37％、44.44％;特异性分别为84.62％、84.62％;临界值均为＞1.595 mg/L.PTC患者手术前后肾功能指标出现波动,提示临床需关注PTC肾功能指标变化.

Objective:To observe whether intraoperative application of Dexmedetomidine combined with Ulinastatin has protective effect on postoperative pulmonary function in elderly patients with acute abdomen.Methods:80 cases of elderly patients with acute abdomen were divided into 4 groups randomly:Control group (group C);Dexmedetomidine group (group D);Ulinastatin group (group U) and Dexmedetomidine combined with Ulinastatin group (group D+U),20 cases in each group.In group D,before induction of anesthesia,a loading dose of Dexmedetomidine 1.0 μ g/kg was infused over 10 min,followed by continuous infusion of Dexmedetomidine at a rate of 0.5 μ g/ (kg·h) until the last 0.5 h before the end of surgery.Group U received Ulinastatin 10000 U/kg after induction of anesthesia.The patients in group D+U group were treated with the above two methods;and the patients in group C were given normal saline as control.General anesthesia was used in each group.Arterial blood gas analysis,oxygenation index,serum TNF-α and IL-8 levels were observed in all patients in preoperative 1 d and postoperative 1,3 and 5 d.All patients were back to ICU with intubation after operation.The duration of intubation,ICU treatment days,total hospitalization period and postoperative pulmonary complications were recorded.Results:For the oxygenation index,there was no significant difference between each group at TO (P＞0.05).But at T1,T2 or T3,the oxygenation index in group D+U is better than group D,group U or group C (P＜0.05).The comparison of serum TNF-α and IL-8 concentration in each group was almost the same as the oxygenation index.As for Duration of intubation,ICU treatment days,total hospitalization period,those in Group D+U are shorter than in other three groups (P＜0.05).In the incidence of postoperative pulmonary complications (atelectasis,pulmonary infection,etc),group D+U (18％) was significantly lower than C group(26％),group D(32％) and U group(38％,P＜0.05).Conclusion:The combination of dexmedetomidine and ulinastatin in elderly patients with acute abdomen can reduce the perioperative inflammatory response and improve the postoperative lung function.

Objective:To evaluate the activity of superoxide dismutase (SOD) in patients with hepatitis B and Hepatocellular carcinoma.Methods:63 cases of patients with hepatitis B,101 cases of patients with Hepatocellular carcinoma (HCC) and 58 cases of normal control were collected,serum enzyme activity of SOD was detected by enzyme method.Variance analysis were applied to analyze the difference of SOD activity in different groups.Receiver operating characteristic (ROC) were applied to analyze the diagnosis performance of SOD in hepatitis B and HCC patients.Results:SOD activity from high to low in turn was hepatitis B group191.500 U/mL,healthy contol group(179.766 ± 13.546 U/mL) and HCC group 150.000 U/mL,there were significant difference when compareing any two grougs (P＜0.05).SOD=187.20 U/mL could be used as diagnosis threshold in hepatitis B patients,the sensitivity was 65.08％ and the specificity was 75.86％.SOD=166.00 U/mL can be used as diagnosis threshold in HCC patients,the sensitivity was 82.18％ and the specificity was 84.48％.SOD=170.40 U/mL could be used as diagnosis threshold in HCC patients with AFP＜20 ng/mL,the sensitivity was 82.76％ and the specificity was 79.31％.Conclusions SOD activity varies in healthy person,hepatitis B and HCC patients.The changes of SOD activity could help us to understand whether there was transformation from hepatitis B to HCC.

Objective:To study the activity of superoxide dismutase (dismutase superoxide,SOD) in peripheral blood of patients with thyroid associated diseases.Methods:84 cases of patients with thyroid cancer,21 cases of patients with nodular goiter,75 cases of patients with hyperthyroidism,56 cases of patients with hypothyroidism and 63 cases of normal control were collected,serum enzyme activity of SOD was detected by enzyme method,FT3,FT4 and TSH levels were detected by electrochemiluminescence assay.Student-t,Mann-whitney-U or Kruskal-Wallis was applied to analyse the different of SOD activity in different groups.Pearson correlation analysis were applied to analyze the correlation of SOD activity with thyroid hormone levels.Results:SOD activity in thyroid cancer group (164.536 ± 18.095) U/ml was significantly lower than that in hyperthyroidism group (173.376 ± 15.942) U/ml,hypothyroidism group (174.827 ± 19.895) U/ml and normal control group(179.529 ±11.625) U/ml(P＜0.05),SOD activity in nodular goiter group(157.667 ± 15.189) U/ml was significantly lower than that in hyperthyroidism group (173.376 ± 15.942) U/ml,hypothyroidism group (174.827 ± 19.895) U/ml and normal controls (179.529 ± 11.625) U/ml (P＜0.05).There were positive correlation of FT3,FT4 levels respectively with SOD activity in thyroid cancer group(r=0.346 P＜0.05,r=0.3278,P＜0.05),and there was positive correlation of FT3 level with SOD activity in normal control group (r=-0.5522.P＜0.05).Conclusions:SOD activity decreased in nodular goiter and thyroid cancer,so it could be used to observe the damage of thyroid tissue.Furtherly,it might be used as an auxiliary index in the diagnosis of thyroid tumors.