目的 探讨盐酸氨基葡萄糖联合降钙素对绝经后膝骨关节炎基质金属蛋白酶3（MMP-3）和骨桥蛋白（OPN）表达的影响。 方法 2012年1月－6月将120例绝经后膝骨关节炎妇女随机分为盐酸氨基葡萄糖组（A组）、盐酸氨基葡萄糖+依降钙素组（B组）、依降钙素组（C组），每组40例，采用酶联免疫吸附试验测定各组血清MMP-3、OPN、雌二醇、Ⅰ型胶原C端肽（CTX）和Ⅰ型胶原N端前肽（PINP）水平。 结果 A组和B组在治疗后2周和6周其膝关节评分和视觉模拟评分明显优于C组（P＜0.05），A组在治疗后2周MMP-3的表达改善明显（P＜0.05），优于其他两组。治疗后6周，B组OPN表达水平改善明显（P＜0.05），优于其他两组。C组和B组CTX和PINP水平明显改善（P＜0.05），优于A组。 结论 盐酸氨基葡萄糖联合降钙素能有效改善绝经后膝骨关节炎的症状，可能通过调节MMP-3和OPN的复合体表达，实现改善关节软骨功能的目的。
ObjectiveTo probe plasma calcitonin gene related peptide (CGRP) levels during thrombolytic therapy in patients with iliofemoral venous thrombosis in order to investigate its regularity of the alteration and its clinical significance.MethodsFifty patients with acute iliofemoral venous thrombosis and 30 patients with chronic iliofemoral venous thrombosis were given urokinase and prostaglandin E1 from veins for 15 days. The CGRP levels were determined by radioimmunoassay before treatment and on the 6th hour, 1st day, 3rd day, 7th day, 14th day, 30th day after treatment.ResultsThe plasma CGRP levels were increased in patients with acute iliofemoral venous thrombosis compared with the contrast ones. The CGRP levels in serious group was lower than those in mild group. However, the CGRP levels of 30 chronic patients and 12 patients who received the second course of thrombolysis as on effective were not different from those of contrast ones. The plasma CGRP levels were increased at the 6th hour,reached the peak at the 3th day and returned to normal at the 14th day after thrombolytic therapy in acute group which just consistent with the therapeutic effectiveness.ConclusionIt is helpful to judge whether the thrombolytic therapy is effective and the illness has come to chronic stage according to the levels of plasma CGRP in patients with iliofemoral venous thrombosis.
Objective To explore the clinical significances of serum procalcitonin ( PCT) and Creactive protein( CRP) in diagnosis and severity assessment of sepsis. Methods A total of 72 patients with different severities of sepsis admitted to Wenzhou Second People’s Hospital from June 2005 to September 2007, including 22 cases of sepsis, 26 cases of severe sepsis, and 24 cases of sepsis shock. Meanwhile, twenty non-sepsis patients were enrolled as control group. The differences of serum PCT and CRP levels, acute physiology and chronic health evaluation Ⅱ ( APACHEⅡ) scores and sepsis related organ failure assessment ( SOFA) scores were compared in controls and the septic patients with different severities and different prognosis. Results The PCT levels of patients with sepsis, severe sepsis and sepsis shock were significantly higher than that in the non-sepsis group [ ( 1. 51 ±1. 57) , ( 5. 62 ±3. 78) and ( 13. 56 ±8. 16) vs ( 0. 12 ± 0. 33) μg/L, P lt;0. 05 or P lt; 0. 01, respectively] . The CRP level, APACHEⅡ and SOFA were also increased in septic patients compared to control and progressively elavated by the severities of sepsis patients ( P lt; 0. 05 or P lt; 0. 01) , however, CRP levels were not significant different ( P gt; 0. 05) . The PCT levels, APACHEⅡ and SOFA of the patients with good prognosis were lower than those with poor prognosis( all P lt; 0. 01) , but the CRP levels was not significant different( P gt;0. 05) . Conclusion The serumlevel of PCT is superior to serumlevel of CRP in severity classification and prognosis assessment.
Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.
Objective To investigate the expression and clinical significance of soluble triggering receptor expression on myeloid cells-1（sTREM-1） in sepsis patients.Methods Serum concentrations of sTREM-1，procalcitonin（PCT），tumor necrosis factor alpha（TNF-α） and interleukin-10（IL-10） were measured by enzyme-linked immunosorbent assay，while high sensitivity C-reactive protein （hsCRP） level was detected by immunoturbidimetry in 68 patients with sepsis，40 patients with no-infective SIRS，and 20 normal individuals. The diagnostic and prognostic value of sTREM-1 and its comparison with PCT and hsCRP were analyzed. The sequential organ failure assessment （SOFA） score system was used to evaluate the severity of sepsis. The relationship between sTREM-1, PCT , hsCRP , SOFA score，TNF-α ,and IL-10 of the sepsis patients was analyzed，respectively. Results The differences in the serum concentrations of sTREM-1，PCT，hsCRP，IL-10 and IL-10/TNF-α ratio had statistical significance among three groups（Plt;0.05）. The differences in the serum concentration of TNF-α had no statistical significance among three groups （Pgt;0.05）. However，the serum levels of sTREM-1，PCT and hsCRP in the sepsis group were significantly higher than those in the SIRS group （Plt;0.05）. The receiver operating characteristic curve （ROC） analysis showed the area under the curve （AUC） for sTREM-1，PCT and hsCRP were 0.772 （95%CI 0.674-0.871），0.718 （95%CI 0.601-0.835） and 0.664 （95%CI 0.532-0.797），respectively. The serum levels of sTREM-1 and PCT in the non-survivors were significantly higher than the survivors in the sepsis group （Plt;0.01），but the differences in the serum concentration of hsCRP had no statistical significance between the non-survivors and the survivors in the sepsis group （Pgt;0.05）. There were significantly positive correlations between sTREM-1 and SOFA score，IL-10 or IL-10/TNF-α ratio（r value of 0.453，0.301，0.417，Plt;0.05），but no correlation between sTREM-1 and TNF-α（Pgt;0.05）. There was significantly positive correlation between PCT and SOFA score （r=0.436，Plt;0.05），while no relationship between hsCRP and SOFA score（Pgt;0.05）. Conclusions The serum level of sTREM-1 not only be valuable in the diagnosis of sepsis，but also may be used as a prognostic marker in sepsis，as it can reflect the severity of sepsis in certain degree. Furthermore，sTREM-1 or PCT may be superior to hsCRP in diagnosis，prognostic judgment and severity assessment of sepsis.
Objective To investigate the value of procalcitonin-guided treatment on antibiotic use in severe acute exacerbations of asthma. Methods From April 2008 to December 2010, a total of 77 patients with severe acute exacerbations of asthma were randomly assigned into a PCT group ( n =38) and a control group ( n=39) . The serum concentration of procalcitonin ( PCT) were measured in all patients. On the base of similar routine treatment, the control group received antibiotics based on the physician’s decision.Meanwhile the PCT group were treated with antibiotics according to serum PCT levels: antibiotic treatment was applied with PCT level ≥0. 25ng/mL and was discontinoued with PCT level lt; 0. 25ng/mL. Length of hospitalization, duration of antibiotics, cost of antibiotics, clinical efficacy were observed. Results The duration of antibiotics use in the PCT group [ 7 ( 5 ～11) d] was shorter than that in the control group [ 11( 7 ～16) d] ( Z = - 2. 26, P = 0. 025) , and the cost of antibiotics in the PCT group [ 2125( 1560 ～4347) yuan] was lower than that in the control group [ 3588 ( 2677 ～5280) yuan] ( Z = - 2. 01, P =0. 033) . The clinical efficacy and length of hospitalization were similar in two groups ( P gt; 0. 05) .Conclusion PCT guidance can reduce antibiotic duration and antibiotic cost in treatment of acute severe exacerbations of asthma.
Objective To investigate the effect of curcumin on calcitionin gene related peptide (CGRP) expression after spinal cord injury (SCI) in rats. Methods A total of 200 rats, weighing 250-300 g, were randomly divided into 4 groups (n=50): sham-operation group, normal saline (NS) group, low-dose curcumin group (30 mg/kg), and high-dose curcumin group (100 mg/kg). In sham-operation group, only vertebral lamina excision was performed without SCI; the SCI model was established in the other 3 groups. At immediate after modeling, 30 mg/kg and 100 mg/kg curcumin were injected intraperitoneally in 2 curcumin groups, equivalent NS was given in NS group (30 mg/kg), but no treatment in sham-operation group. At 1, 3, 7, 14, and 21 days after operation, the motor neural function was evaluated by the inclined plane test and Basso-Beattie-Bresnahan (BBB) scores; immunohistochemical staining and Western blot assay were used to observe CGRP expression. Results BBB score and inclined plane test score of NS group, low-dose curcumin group, and high-dose curcumin group were significantly lower than those of sham-operation group at each time point (P lt; 0.05). BBB score of low-dose curcumin group and high-dose curcumin group was significantly higher than that of NS group at 3, 7, 14, and 21 days after SCI (P lt; 0.05), and the score of high-dose group was significantly higher than that of low-dose curcumin group at 7, 14, and 21 days after SCI (P lt; 0.05). Inclined plane test score of low-dose curcumin group and high-dose curcumin group was significantly higher than that of NS group at 7, 14, and 21 days after SCI (P lt; 0.05), and the score of high-dose curcumin group was significantly higher than that of low-dose curcumin group at 7, 14, and 21 days after SCI (P lt; 0.05). Immunohistochemical staining results showed that the CGRP positive cells of sham-operation group was significantly more than those of the other 3 groups, and the CGRP positive cells of high-dose curcumin group were significantly more than those of low-dose curcumin group at each time point (P lt; 0.05); the CGRP positive cells of low- and high-dose curcumin groups were significantly more than those of NS group at 3, 7, 14, and 21 days after SCI (P lt; 0.05). Western blot assay results showed that the CGRP protein expressed at each time point after SCI in sham-operation group; the CGRP protein expression gradually decrease with time passing in NS group; but the CGRP protein expression gradually increased with time passing in low- and high-dose curcumin groups, and reached the peak at 14 days, then maintained a high level. Conclusion After SCI in rats, 30 mg/kg curcumin can improve rats’ motor function, and 100 mg/kg curcumin effect is more obvious, especially in promoting the expression of CGRP. That may be the mechanism of protection of the nervous system.