目的 通过对急性心肌梗死(AMI)患者体内的血清淀粉样蛋白A(Serum amyloid A protein,SAA)、α1酸性糖蛋白(α1 acid glycoprotein,AGP)水平进行分析,探讨其在诊断及预后评估中的临床价值.方法 选取2019年6月在中国医学科学院阜外医院心内科接受治疗的78例急性心肌梗死患者作为AMI组,所有患者均采用PCI术进行治疗,同时选取心脏健康者78例,作为对照组.采用全自动胶乳免疫比浊法对患者血清中SAA、AGP进行测定,分析其含量水平与急性心肌梗死病情之间的联系,并与肌钙蛋白、心电图、造影等检测结果进行对比.结果 急性心肌梗死术后患者血清中SAA含量为(175.4±31.2)mg/ml,AGP含量为(150.2±23.8)mg/ml;SAA、AGP含量变化与肌钙蛋白、心电图、造影结果一致;在预后方面,AGP升高组患者平均住院时间为(12.45±3.14)d,AGP正常组,平均住院时间为(5.12±1.98),SAA升高组中,平均住院时间为(8.19±2.0)d,SAA正常组中,平均住院时间为(9.17±3.2)d;恶性心血管事件发生率在AGP、SAA升高组中所占比例明显高于AGP、SAA正常组.结论 心梗手术后患者血清中SAA及AGP均明显升高,SAA及AGP可作为急性心肌梗死炎症、预后的重要指标.

(1) Background: Apolipoprotein E(ApoE) plays a critical role in lipid transport. The specific allele of APOE being expressed is associated with the development of coronary heart disease (CHD), however the specific mechanisms by which ApoE drives disease are unclear. In this study, we investigated the relationship between APOE allele, lipoprotein metabolome, and CHD severity to provide evidence for the efficacy of clinical cholesterol-lowering therapy; (2) Methods: Blood samples were collected from 360 patients with CHD that were actively being treated with statins. The lipoprotein profile, including particle numbers, particle size, and lipoprotein composition concentrates, was measured by nuclear magnetic resonance (NMR) spectroscopy. The severity of CHD was determined by quantifying coronary angiography results using the Gensini scoring system; (3) Results: We found there was no significant difference in low-density lipoprotein cholesterol (LDL-C) levels among ε2+ (ε2 allele carriers, consisting of ε2/ε2 and ε2/ε3 genotypes), ε3 (consisting of ε3/ε3 and ε2/ε4 genotypes), and ε4+ (ε4 allele carriers, consisting of ε3/ε4 and ε4/ε4 genotypes) participants receiving statin treatment. Compared with the ε3 group, patients with the ε2+ genotype showed lower concentrations of total low-density lipoprotein (LDL), small-LDL, and middle-LDL particles, as well as a larger LDL size, higher very low-density lipoprotein (VLDL) composition concentrates, and higher intermediate density lipoprotein (IDL) composition concentrates. The ε4+ group showed higher concentrations of total LDL, small LDL particles, and LDL compositions with smaller LDL size. The higher level of small LDL concentration was associated with a high Gensini score (B = 0.058, p = 0.024). Compared with the ε3 group, the risk of increased branch lesions in the ε2+ group was lower (OR = 0.416, p = 0.027); (4) Conclusions: The specific allele of APOE being expressed can affect the severity of CHD by altering components of the lipoprotein profile, such as the concentration of small LDL and LDL size.

目的:观察自拟活血化痰泻浊方治疗对高血压患者内皮细胞功能、炎症细胞因子及血流动力学的影响.方法:选取83例高血压患者,按照随机数字表法分为观察组42例、对照组41例,对照组采用常规药物治疗,观察组在对照组基础上用 自拟活血化痰泄浊方辅助治疗,比较两组患者治疗前后的内皮细胞功能、炎症细胞因子、血流动力学及不良反应.结果:与治疗前比较,治疗后两组内皮素(ET-1)、一氧化氮(NO)、肱动脉血流介导性舒张(FMD)、C反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)、大脑中动脉与基底动脉的平均血流速度(VM),阻力指数(RI)均明显改善.观察组治疗有效率(92.86％)明显高于对照组(75.61％).治疗后与对照组比较,观察组的ET-1、NO、FMD含量均明显升高(P＜0.05);CRP、IL-6、TNF-α含量均明显降低(P＜0.05);观察组患者的大脑VM明显升高,RI明显降低(P＜0.05);两组不良反应发生率无明显差异(P＞0.05).结论:自拟活血化痰泻浊方辅助治疗高血压可改善内皮细胞功能,减少炎症细胞因子水平,改善血流动力学,不增加其他不良反应.

We describe a dispersive solid-phase ion exchange extraction method combined with capillary electrophoresis-laser induced fluorescence detection for the determination of asymmetric dimethylarginine,symmetric dimethylarginine,and monomethylarginine in serum samples.The methylated arginine-extracted resin beads were added into a mixed solution of 4-chloro-7-nitrobenzofuran acetonitrile solution and alkaline sodium borate solution (pH =10.5) for the derivatization in a 60 ℃ water bath.The three derivatives were subjected to baseline separation in a fused silica capillary under the conditions of a separation electrolyte of 80 mmol/L phosphate (pH =2.0) and a separation voltage of 20 kV.On the basis of the FDA bioanalytical method validation guidance,the method validation was conducted and the results were satisfactory.This method was used to determine the three methylated arginines in the serum samples from local hospital.

Background: High-sensitivity cardiac troponin (hs-cTn) assays provide high sensitivity detection of myocardial injury. Although an assay using whole blood can reduce turn-around-time and labour, hs-cTn assays using whole blood samples are novel requiring characterization of their analytical performance. Methods: The imprecision of Pylon hs-cTnI assay was evaluated with whole blood, plasma and commercial quality control samples. The limit of quantitation (LOQ) of whole blood samples and plasma were determined for the Pylon hs-cTnI assay. The correlation between the Pylon hs-cTnI assay and the Abbott Architect hs-cTnI assay was evaluated using whole blood samples and plasma. Results: The average concentrations of pooled patient plasma were 8.3, 15.0 and 396.9 ng/l, while the corresponding CVs of repeatability and within-laboratory CVs were calculated respectively as 7.6% and 9.9%, 4.3% and 4.5%, and 3.3% and 4.5%. LOQ (20% CV) was 1.2 ng/l in plasma and 2.0 ng/l in whole blood. The lowest concentrations to reach 10% CV were 4.8 ng/l with plasma and 9.4 ng/l with whole blood. Quantification of whole blood and corresponding plasma samples correlated with no effect by hematocrits ranging from 25 to 44%. Conclusion: The analytical performance of the Pylon hs-cTnI assay with whole blood is comparable to that of a clinical lab instrument.

目的 研究免疫比浊法CKMBmass,通过检测临床随机样本以及检测临床中活性法CKMB倒置的样本,验证CKMBmass与化学发光平台肌酸激酶同工酶MB(CK-MB)测值一致性;再使用受试者工作特征(ROC)曲线以金标准高敏肌钙蛋白I临床判断为参照,验证CKMBmass准确性.方法 CKMBmass使用贝克曼AU5811生化分析仪、CK-MB与高敏肌钙蛋白I(cTnI)使用Abbott i2000化学发光仪进行检测.收集24例CKMBmass与CK-MB同时检测的倒置样本,验证测值一致性;随机抽取45例CKMBmass与CK-MB同时检测的血清样本,验证相关性;CKMBmass与cTnI同时测定AMI组样本与非AMI组样本,使用ROC曲线进行分析,验证CKMBmass准确性.结果 24例倒置样本,CKMBmass测值与Abbott CK-MB测值相同,阴阳性一致;45例随机样本,CKMBmass与Abbott CK-MB测值的回归方程为Y=1.002X-0.080;AMI组与非AMI组比较差异有统计学意义(P<0.05),CKMBmass AUC为0.963.结论 CMBMmass抗干扰能力及相关性与化学发光法CK-MB一致,针对AMI诊断与高敏cTnI符合度高,满足临床需求.

目的:脂蛋白颗粒直径、各血脂亚组分是独立于低密度脂蛋白胆固醇(LDL-C)的动脉粥样硬化性心血管疾病(ASCVD)的危险因素.本研究采用磁共振波谱技术(nuclear magnetic resonance spectroscopy,NMRS)分析中国人群的血脂亚组分谱,建立NMRS检测中51个检测指标中国表观健康人群的正常参考范围.方法:本研究首先评估NMRS的稳定性,并在1 091例中国人群中比较了NMRS与当前临床常规血脂检测共同指标的一致性.随后以其中691例健康人群数据,建立NMRS各项血脂指标正常参考区间,并进行性别亚组的差异分析.结果:NMRS血脂检测平台稳定性评估中,6项临床常规血脂指标(总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B)批间变异系数为1.39％～2.62％,并与临床常规生化方法学检测结果之间具有高度相关性(6项指标相关系数介于0.927～0.978).691例健康成人的低密度脂蛋白颗粒平均粒径为19.93～21.20 nm,极低密度脂蛋白、中密度脂蛋白、低密度脂蛋白的总颗粒数参考区间分别为32.6～347.3 nmol/L、8.5～105.8 nmol/L、626.0～1 829.6 nmol/L.建立5个极低密度脂蛋白亚组分、6个低密度脂蛋白亚组分、4个高密度脂蛋白亚组分的总胆固醇和甘油三酯浓度的中国表观健康成人参考区间.性别亚组分析显示,不同血脂组分在男性与女性间差异具有统计学意义.结论:NMRS检测可获得更丰富的血脂亚类谱,并建立中国健康成人的血脂各亚组分参考区间,为NMRS在临床的广泛应用打下坚实基础.

[目的]探讨sdLDL-C与LDL-C水平与冠状动脉粥样硬化病变程度的相关性.[方法]冠状动脉粥样硬化性心脏病(coronary atherosclerosis disease,CAD)患者185例(CAD组)与68例与健康对照组,采用全自动生化仪进行血清生化指标检测:小而密低密度脂蛋白胆固醇(small dense low-density lipoprotein cholesterol,sdLDL-C)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、血糖(glucose,GLU)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C).采用冠状动脉造影检查来分析冠状动脉病变情况,Gensini积分体系对冠状动脉粥样硬化病变程度进行评价分析.[结果]CAD组患者sdLDL-C、sdLDL-C/LDL-C和GLU水平高于对照组,HDL-C明显低于对照组(P＜0.05).Gensini中高分组患者血清sdLDL-C和sdLDL-C/LDL-C均高于轻度病变者和对照组,差异有统计学意义(P＜0.05),随着积分越高越明显(P＜0.05).经Spearman相关性分析,sdLDL与Gensini积分呈正相关(r=0.596,P＜0.01),sdLDL=C/LDL-C与Gensini积分呈正相关(r=0.486,P＜0.01).经ROC曲线分析,sdLDL-C值为0.103 mmol/L时,作为界值点预测冠状动脉粥样硬化病变程度最佳(ROC曲线下面积=0.682,P=0.004),其敏感度为68.8％,特异度为80.3％.[结论]sdLDL-C和sdLDL-C/LDL-C可以作为评估冠状动脉粥样硬化病变程度的有效指标,在临床上有一定的评价意义.

目的 评价3种糖化白蛋白酶法试剂的性能.方法 选取2016年5月我院收治的糖尿病患者及同期健康体检人群剩余血清制备混合血清.使用LABOSPECT 008全自动生化分析仪,依据上海市临检中心对GA的管理要求、美国临床和实验室标准协会(CLSI'88)关于ALB的要求,对日本旭化成、宁波瑞源及复星长征(A、B、C)的糖化白蛋白酶法试剂进行评价.结果 3厂家试剂测定高低值混合样本批内精密度均<1/4上海临检中心允许偏差(3.75％).3种试剂测定上海临检中心GA室间质评样本,A、B试剂测定值与认证值的平均偏倚<1/2允许总误差(±7.5％),C试剂超出可接受范围,正确度不佳.A试剂抗干扰能力最佳;Vc对B、C最终GA％结果有较大影响.0.2 mmol/L的糖化氨基酸对A试剂影响在可接受范围;0.1 mmol/L糖化氨基酸对B和C试剂均有显著影响.结论 3种糖化白蛋白酶法试剂中A试剂性能最优,尤其是在抗干扰、糖化氨基酸的消除反应方面最为突出.

目的 分析溴甲酚紫法(BCP)和溴甲酚绿法(BCG)检测清蛋白结果之间的偏差,并进行矫正.方法 分别用两种方法检测患者样本222例和质控品25例中的清蛋白含量,统计偏差及两法检测结果的低值率,建立两法检测结果的关系式.结果 ①BCG法检测结果高于BCP法,其低值率则低于BCP法;②两种方法检测质控品中值的结果无显著性差异,而低值差异有统计学显著性意义(t=-7.186,P＜0.01);③两种方法检测的血清结果均略高于血浆,两者差异有统计学显著性意义(BCG:t=-2.280,P＜0.05;BCP:t=-3.524,P＜0.01);④建立BCG检测值的校正公式:BCG校正值=1.149×BCG检测值-9.514 9.用50份标本验证此公式,r2=0.951 6,组间比较t=0.745,P=0.459 9.结论 BCG与BCP两种检测方法的不同是造成清蛋白检测结果偏差的主要原因,通过建立BCG法检测结果的矫正公式,可减少两种检测方法的结果偏差.

Objective To evaluate the effects of metabolic factors on the quality of 18F-fluorode oxyglucose (18F-FDG) myocardial metabolic imaging in coronary artery disease (CAD) patients with type 2 diabetes mellitus (T2DM). Methods Seventy CAD patients aged 60 years or over with T2DM were studied with myocardial 18 F-FDG dual isotope simultaneous acquisition (DISA) single photon emission computed tomography (SPECT). Fasting plasma glucose, total triglyceride (TG),total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-eholesterol(LDL-C), insulin, C peptide and glyeosylated hemoglobia (HbAlc) were detected. Insulin resistance and islet β cell function were calculated by using the Homeostasis Model Assessment (HOMA) equation. Results Compared with the bad image quality group (36 cases), patients in the excellent image quality group (34 cases) were younger [with average age of (62.2±8.5) years vs. (67.6±8.3) years, P<0.01] and slimmer [with BMI of (24.7±2.6)kg/m2 vs. (26.1±2.5)kg/m2, P<0.05]. The levels of fasting insulin and C peptide were lower in the excellent image quality group than those in the bad image quality group [with fasting insulin level of 8.3 (5.1～12.4) mIu/L vs. 12.7,(6.1～17.9)mIu/L and C-peptide level of 0.6(0.5～0.9)nmol/L vs. 0.9(0.6～1.2)nmol/L, respectively,both P<0.05]. The HOMA insulin resistant index was reduced in the excellent image group [2.7(1.6～4.0) vs. 4.1(1.7～6.5), P<0.05]. Logistic regression analysis showed that obesity and age≥65 years were independent risk factors for image quality, with OR value of 3.73 (95% CI: 1.12～12.45,P=0.022)and 3.75 (95%CI:0.96～14.6,P=0.058)after adjustment of other metabolic factors. Conclusions Insulin resistance is the main factor that influences the quality of 18F-FDG myocardial metabolic imaging in patients with T2DM. In addition, age≥65 years and obesity are also risk factors for image quality.