Microrheology of human synovial fluid of arthritis patients studied by diffusing wave spectroscopy

The viscoelastic properties of synovial fluid (SF) are critical to its functions of lubrication and shock‐absorption of joints in human body; a change in the viscoelastic properties, even of only a few percents, is often concomitant with arthritis. In this work, the elastic modulus G ′(f) and the viscous modulus G ′′(f) of SF from patients suffering from three kinds of joint diseases, namely, osteoarthritis (OA), rheumatoid arthritis (RA), and gouty arthritis (GA), were determined as a function of frequency “f ” (in the low frequency range from f ～ 0.1 to 10 Hz) by Diffusing Wave Spectroscopy (DWS) and correlated with the white blood cell (WBC) count. A strong correlation was observed, showing a higher WBC count corresponding to lower elastic and viscous moduli, G ′ and G ′′; further details depend on inflammatory vs. non‐inflammatory, and on the severity of inflammation. Different types of arthritis lead to different degrees of decreasing viscoelasticity. Identical measurements were carried out with a commercial visco‐supplementation (or artificial SF) to serve as reference. In general, the reduction in both G ′ and G ′′ was most severe in the case of GA and least severe in the case of OA. Besides, in all cases, the reduction in G ′ was more prominent than the reduction in G ′′, indicating that in general, the deterioration in the elasticity of SF by inflammation is more severe than that in the viscosity. This simple method for quantitative physical characterization of synovial fluid may serve as a useful complementary metric to the conventional biochemical analysis in clinical diagnosis of arthritis. (© 2012 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Can ultrasonography make identification of asymptomatic hyperuricemic individuals at risk for developing gouty arthritis more crystal clear?

Hyperuricemia is the most important risk factor for gouty arthritis. The quandary is how to predict which patient with asymptomatic hyperuricemia will develop gouty arthritis. Can ultrasonography help identify hyperuricemic individuals at risk for developing gouty arthritis? In the previous issue of Arthritis Research & Therapy, Pineda and colleagues found ultrasonography changes suggestive of gouty arthritis in 25% of hyperuricemic individuals. These were found exclusively in hyperuricemic individuals but not in normouricemic patients. Ultrasonography may serve as a noninvasive means to diagnose gouty arthritis in hyperuricemic individuals who have yet to develop symptomatic gouty arthritis.In the previous issue of Arthritis Research & Therapy, Pineda and colleagues present an interesting study evaluating the use of ultrasonography (US) to help identify hyperuricemic individuals at risk for gouty arthritis [1]. Hyperuricemia is the most important risk factor for gouty arthritis. The number of adults with hyperuricemia and gouty arthritis is increasing.The National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2008 showed a hyperuricemia (serum urate ≥7 mg/dl) prevalence of 21.1% in men and 4.7% in women [2]. Most individuals with hyperuricemia, however, do not develop gouty arthritis [3]. The reported gouty arthritis prevalence in the 2007 to 2008 NHANES data was 5.9% in men and 2% in women, with an overall prevalence of 3.9% (8.3 million adults) [4]. The risk of developing gouty arthritis is dependent on the severity of hyperuricemia. In the Normative Aging Study, healthy patients with serum urate levels ≥9 mg/dl upon entry into the study had a cumulative incidence of acute flares that reached 22% after 5 years, whereas those with serum urate levels ≤7 mg/dl had an annual incidence of only 0.5% [5]. In yet another study, the 5-year prevalence of gouty arthritis was 30% in individuals with serum urate levels >10 g/dl [6]. These numbers correlate with the recently reported NHANES data.The quandary is how to predict which patient with asymptomatic hyperuricemia will develop gouty arthritis, and thus who will benefit from-long term anti-inflammatory and urate-lowering therapy. Serum urate levels and gouty arthritis prevalence are related to genetic variations in the SLC2A9, ABCG2 and SLC17A3 genes. Dehghan and colleagues developed a risk score based on variations of these three genetic loci. They suggested that their genetic risk score is associated with up to a 40-fold increased risk of developing gouty arthritis, suggesting that knowledge of the genotype may help identify hyperuricemic individuals at risk for developing gouty arthritis [7]. Can US serve as another potential method to help identify hyperuricemic individuals at risk for developing gouty arthritis?Over the past several years, there has been a growing interest in musculoskeletal US in rheumatology. US visualizes tissues as acoustic reflections. Crystalline material reflects US waves more strongly than the surrounding tissues, such as unmineralized hyaline cartilage or synovial fluid. This enables distinction of monosodium urate (MSU) crystal deposition from the less echogenic surrounding soft tissues. MSU crystals are found in cartilage, tendon sheaths, synovial fluid and subcutaneous tissue. US detects deposition of MSU crystals on cartilaginous surfaces, as well as tophaceous material and typical erosions. A hyperechoic, irregular band over the superficial margin of the articular cartilage - described as a double contour sign or icing - is found exclusively in gouty arthritis [8] and represents crystalline precipitates of MSU. In addition, the presence of hypoechoic to hyperechoic inhomogeneous material surrounded by a small anechoic rim, representing tophaceous material and erosions adjacent to tophaceous material on US, are suggestive of the diagnosis of gouty arthritis. US is superior in detecting changes of gouty arthritis compared with other imaging modalities (magnetic resonance imaging, plain X-ray scans, computed tomography and three-dimensional rendering imaging) [9].Pineda and colleagues support previous evidence that US may be useful in detecting gouty arthritis in hyperuricemic patients [1]. Puig and colleagues reported that 34% (n = 12) of their asymptomatic hyperuricemic individuals had findings suggestive of tophaceous deposits [10]. Pineda and colleagues also studied a larger cohort in a controlled fashion [1]. US images of the most commonly affected joints - knees, ankles and first metatarsophalangeals - were obtained. The double contour sign and tophi were seen ultrasonographically in the knee hyaline cartilage and the first metatarsophalangeals. Tendinous infiltrations of tophaceous material were also observed. Interestingly, tendinous tophi and enthesopathies were not a rare finding in these patients. US changes suggestive of gouty arthritis were found in 25% of hyperuricemic individuals. These changes were found exclusively in the hyperuricemic individuals but not in their control group of normouricemic individuals. The main limitation of both Puig and colleagues'' study [10] and Pineda and colleagues'' study [1] is that the US findings suggestive of gouty arthritis, tophi and the double contour sign were not proven MSU crystals. In both studies, therefore, a definite diagnosis of gouty arthritis was not established.Whether finding sonographic evidence suggestive of gouty arthritis prior to development of acute flares will influence our decision of when to initiate and commit to a long-term urate-lowering therapy and chronic anti-inflammatory treatment is still to be determined. US may serve as a noninvasive means to diagnose gouty arthritis in hyperuricemic individuals who have yet to develop symptomatic gouty arthritis. How long hyperuricemia must be present before MSU crystal deposition can be seen sonographically is currently not known. Future large, prospective, randomized controlled trials of patients with proven MSU crystal gouty arthritis are needed to further evaluate the use of US to predict the presence of asymptomatic gouty arthritis in an individual hyperuricemic patient.     

痛风的相关研究

痛风是一种由高尿酸血症引起的关节炎类型。研究其流行病学,使临床对高尿酸血症及痛风性关节炎的病理生理学有了新的见解。研究表明,遗传倾向的作用越来越明显。痛风的临床表现分为无症状高尿酸血症,急性痛风性关节炎,发作间期和慢性痛风性关节炎。痛风的诊断基于实验室和放射学特征,其中偏振光显微镜发现滑液中针状或杆状的单钠尿酸盐晶体是诊断的金标准。其成像方法主要有常规放射成像、超声检查、双能CT。其中超声和双能CT应用的进步使该领域的诊断、分期、随访和临床研究有了显著的提高。深入了解痛风的发病机制,不断优化诊断方式,有助于提高痛风的临床诊疗水平。痛风的管理一直是医学史上对医学技能的挑战,当前需要不断深入了解痛风的发病机制,不断优化诊断方式,以寻求不同寻常的治疗方案。在秋水仙碱、泼尼松、别嘌醇、非布司他、雷西纳德等药物的临床应用取得不错效果的同时,存在的一些不良反应值得重视。随着精准医疗时代的到来,相信痛风的个体化诊疗有着更加乐观的未来。     

Effect of drugs on urate binding to plasma proteins

The effect of various drugs on urate binding to plasma proteins was investigated in normal subjects. Whereas allopurinol, aspirin, phenylbutazone, probenecid, and sulphinpyrazone all significantly reduced plasma urate concentrations, only aspirin, phenylbutazone, and probenecid significantly impaired urate binding. Colchicine and indomethacin in the doses administered had no significant effect on plasma urate concentrations or binding. In the case of aspirin, urate binding was reduced to 25% of normal, and this effect was quickly abolished after cessation of therapy. Phenylbutazone reduced urate binding to 56% and probenecid to 46% of normal; this impairment was still detected four days after cessation of therapy. Drugs may impair urate binding by competition for plasma protein binding sites, with displacement of bound urate. Impairment of urate binding in vivo by administration of certain drugs may be relevant to the precipitation of acute gouty arthritis, to the formation of gouty tophi, and to the augmentation of uricosuria. Furthermore, the role of drugs must be seriously considered during all studies on urate binding in patients with gout.     

Retroperitoneal lymphangiomyomatosis diagnosed by fine needle aspiration: a case report

BACKGROUND: Lymphangiomyomatosis is a rare condition affecting women of childbearing age. It is characterized by an abnormal proliferation of smooth muscle cells around lymphatics, giving rise to blockage of the large lymphatics, including the thoracic duct, and resulting in chylothorax and/or chyloascitis. The lung is the most common site of involvement. Retroperitoneum and lymph nodes can be also involved. CASE: A 40-year-old woman presented with lower urinary tract symptoms after a history of trauma and was found to have a retroperitoneal mass. Fine needle aspiration cytologic examination of the milky fluid aspirated from the mass revealed a few cohesive, 3-dimensional clusters of medium-sized cells with scanty cytoplasm, and ovoid and hyperchromatic nuclei. The background contained numerous mature lymphocytes. Laparoscopy revealed a multicystic mass filled with milky fluid. Histologic examination confirmed the cytologic diagnosis of lymphangiomyomatosis. CONCLUSION: Fine needle aspiration of lymphangiomyomatosis can be performed if cohesive clusters and a lymphoid background are present in chylous-type fluid and provided that adequate clinical information is available.     

痛风性关节炎与骨关节炎的相关性研究

目的:通过检测痛风性关节炎与骨关节炎患者膝关节液中Ⅱ型胶原羧基端端肽(C-telopeptide of type II collagen,CTX-Ⅱ)的含量,探讨痛风性关节炎与骨关节炎的相关性。方法:收集膝关节发作的痛风性关节炎患者膝关节液标本46例及骨关节炎患者膝关节液标本42例,用酶联免疫吸附试验(ELISA)法检测两组关节液中CTX-Ⅱ的含量,并研究分析痛风性关节炎膝关节液中CTX-Ⅱ的含量与影像学X线特征、单钠尿酸盐(MSU)晶体的相关性。结果:1痛风性关节炎与骨关节炎的膝关节液中CTX-Ⅱ的含量相比较无统计学差异(P=0.40);245.7%(21/46)的痛风性关节炎患者膝关节X线显示骨关节炎,与膝关节X线未显示骨关节炎的痛风性关节炎(25/46)相比较,两组CTX-Ⅱ的含量无统计学差异(P=0.84);3MSU晶体阳性的痛风性关节炎(19/46,41.3%)与MSU晶体阴性的痛风性关节炎(37/46,68.7%)患者的膝关节液CTX-Ⅱ的含量比较,前者显著高于后者,差异有统计学意义(P0.05)。结论:痛风性关节炎的受累关节存在关节软骨的退变,单钠尿酸盐(MSU)晶体在局部沉积与否与关节软骨退变的程度相关。     

Animal model of acute gout reproduces the inflammatory and ultrasonographic joint changes of human gout

IntroductionGout is an inflammatory condition induced by the deposition of monosodium urate (MSU) crystals in the joints and soft tissues that can produce acute or chronic arthritis. Several animal models of crystal-induced inflammation have been proposed that involve direct injection of MSU-crystals into different anatomical structures; however, only a few of these models reflect a true diarthrodial joint microenvironment in which an acute gouty attack takes place. The aim of this study was to assess the inflammatory and structural joint changes in a rabbit model of acute gout attack by ultrasound (US), synovial fluid (SF) and histopathological analyses.MethodsUnder US guidance, 42 rabbit knees were randomly injected with a suspension of 50 mg/ml of either MSU or allopurinol synthetic crystals. The control group received intra-articular vehicle of phosphate-buffered saline (PBS). US evaluation, SF and histopathological analyses were performed at days 1, 3, and 7.ResultsA total of 21 rabbit knees were assigned to the control group, 12 to the MSU-crystals group, and 9 to the allopurinol crystals group. By US, the MSU crystals group displayed the double contour sign and bright stippled aggregates in 67% and 75% of joints, respectively. Neither control knees nor allopurinol crystals group displayed these US signs. Power Doppler (PD) signal was moderate to intense in the MSU-crystals group and greater than both the allopurinol crystal and control groups at day 1 (P <0.001) and 3 (P <0.05), with its practical disappearance by day 7. SF leukocyte count was 40,312 ± 6,369 cells/mm³ in the MSU-crystals group, higher than in controls (P = 0.004) and allopurinol crystal group (P = 0.006). At day 7, SF leukocyte count decreased in both MSU and allopurinol crystal groups reaching the non-inflammatory range. Histologically, at day 3 intense synovial polymorphonuclear cells infiltration and MSU aggregates were identified.ConclusionThe rabbit model of MSU crystal-induced acute arthritis efficiently reproduces the inflammatory, US, SF and histopathological changes of the human acute gouty attack.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0550-4) contains supplementary material, which is available to authorized users.     

Development of novel NLRP3-XOD dual inhibitors for the treatment of gout

Gout is a crystalline-related arthropathy caused by the deposition of monosodium urate (MSU). Acute gouty arthritis is the most common first symptom of gout. Studies have shown that NOD-like receptor protein 3 (NLRP3) inflammasome as pattern recognition receptors can be activated by uric acid crystallization, triggering immune inflammation and causing acute gouty arthritis symptoms. Currently, the treatment of gout mainly includes two basic methods: reducing uric acid and alleviating inflammation. In this paper, 22 novel benzoxazole and benzimidazole derivatives were synthesized from deoxybenzoin oxime derivatives. These compounds have good inhibitory effects on NLRP3 and XOD screened by our research group in the early stage. The inhibitory activities of XOD and NLRP3 and their derivatives were also screened. Notably, compound 9b is a multi-targeting inhibitor of NLRP3 and XOD with excellent potency in treating hyperuricemia and acute gouty arthritis.     

Inflammatory gout: observations over a half-century

This is a discussion of acute gouty arthritis, seen for over 50 years of engagement. It addresses the evolution of our current understanding of the interaction between urate crystals and key cellular components of the gouty inflammatory paroxysm, with new material on pathogenesis.     

白藜芦醇对急性痛风性关节炎大鼠的影响(英文)

目的:观察白藜芦醇对急性痛风性关节炎大鼠的影响。方法:选取Wista大鼠36只,随机分为正常对照组、模型组、秋水仙碱组、白藜芦醇低剂量组、白藜芦醇中剂量组、白藜芦醇高剂量组,各组相应采用生理盐水、秋水仙碱、白藜芦醇低、中、高剂量灌胃7天(1次/日),模型组及各实验组于灌胃第四天把25g/mL(0.05mL)浓度的尿酸盐溶液注射到大鼠踝关节腔内,制备急性痛风性关节炎模型,正常对照组大鼠关节腔内注射生理盐水0.05 ml,72 h后留取踝关节关节液及关节滑膜,应用ELISA法观察关节液中IL-1β、CXCL10的变化。关节滑膜用10%福尔马林固定待做病理。结果:与模型组比较,白藜芦醇能显著降低关节液中IL-1β、CXCL10水平(P0.05),病理结果显示,白藜芦醇可减轻急性痛风性关节炎大鼠踝关节组织的水肿和炎性细胞浸润。结论:急性痛风性关节炎发病过程中IL-1β,CXCL10明显增高,白藜芦醇可有效抑制急性痛风性关节炎发作,且该作用呈一定的剂量依赖性。关键词:痛风性关节炎;白藜芦醇;白介素1-β     

痛风性关节炎动物模型的改良

目的通过改良痛风性关节炎动物模型,制备出更符合人类痛风性关节炎机制的动物模型。方法通过Coderre法与次黄嘌呤相结合（模型B）、Coderre法与氧嗪酸相结合（模型A）的方法建立痛风性关节炎动物模型,采用全自动生化分析仪测定血尿酸水平,观察关节滑膜组织形态学改变及大鼠不同时相步态变化,并将两种方法加以比较。结果模型B组大鼠血尿酸水平显著降低,关节滑膜组织形态学及不同时相大鼠步态改变明显,与模型A组比较有统计学意义。结论Coderre法与次黄嘌呤相结合方法建立大鼠痛风性关节炎动物模型更符合人类痛风性关节炎机制的动物模型。     

类风湿关节炎与痛风关节炎患者身心健康、炎症状态及免疫功能的比较

目的:比较类风湿关节炎与痛风关节炎患者身心健康、炎症及免疫状态的差异。方法:选择我院2016年5月至2018年8月收治的66例类风湿关节炎患者及63例痛风关节炎患者作为研究对象,并将之分为类风湿关节炎(Rheumatoid arthritis,RA)组及痛风关节炎(Gouty arthritis,GA)组。同时选取60例体检健康人群作为健康组。观察比较三组研究对象身心健康评分、炎症及免疫相关指标水平。结果:RA组及GA组身心健康评分显著低于健康组(P0.05),炎症及免疫相关指标水平显著高于健康组(P0.05)。RA组患者总体健康评分、社会功能评分、红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫球蛋白G(Ig G)、免疫球蛋白A(Ig A)、免疫球蛋白M(Ig M)及补体3(C3)水平显著高于GA组(P0.05),白细胞(WBC)总数明显少于GA组(P0.05),两组患者生理功能、生理职能、身体疼痛、活力、情感职能、心理健康评分及补体4(C4)水平比较差异不显著(P0.05)。结论:相较于健康人群,类风湿关节炎患者及痛风关节炎患者身心健康状况差,易出现炎症、免疫功能紊乱现象,且类风湿关节炎患者炎症程度较深,免疫功能影响更大。     

Expression of matrix metalloproteinase-9 (gelatinase B) in gouty arthritis and stimulation of MMP-9 by urate crystals in macrophages

To investigate the relevance of gelatinase-B (matrix metalloproteinase 9, MMP-9) in gouty arthritis (GA), we tested the occurrence of MMP-9 in GA patients and cell culture system. Gelatinolytic activity in the synovial fluid (SF) of patients with different kinds of arthritis was assessed by gelatin zymography. A predominant 92-kDa MMP-9 gelatinolytic activity was evident in rheumatoid arthritis (RA) and GA samples, but no activity was observed in osteoarthritis (OA) samples. Among the 53 SF samples (9 RA, 24 GA, and 20 OA) analyzed for MMP-9 and tissue inhibitor of metalloproteinase (TIMP-1) antigen levels by ELISA, MMP-9 antigen levels were elevated tenfold in GA SF compared with OA SF. In addition, GA synovial tissue extracts revealed elevated levels of MMP-9 expression as compared to OA tissue extracts by Western blot and RT-PCR analysis. Immunohistochemical studies demonstrated that MMP-9 immunoreactivity was more intense in GA than in OA synovial tissues. Furthermore, macrophages activation by gouty crystals in vitro was examined. Crystals stimulated MMP-9 gene expression in macrophage cell line and such stimulation was suppressed by PD98059. These findings suggest that the abnormal production of MMP-9 by macrophages is a reflection of the pathological conditions in joints of patients with GA, and that the activation of MMP-9 in the joint is known to play an important role in joint disease.     

痛风性关节炎的中医治疗进展

痛风是嘌呤代谢紊乱造成尿酸盐结晶沉淀在皮下组织、关节周围、骨骼及尿路而引发的病变。发作时以足拇趾及踝关节红、肿、热、痛多见,呈间歇性反复发作。由于社会发展和人们生活方式的改变,痛风性关节炎患病率有明显上升和年轻化趋势,南方和沿海经济发达地区发病率尤高。痛风性关节炎作为一个常见病多发病,严重影响着患病者的生活质量,目前西医对痛风性关节炎的治疗并不能改变其病理性质,且毒副作用较大、效果不持续,临床多以排尿酸药、糖皮质激素及秋水仙碱等一些口服药物为主。近年来随着中医药对该病的研究,中医药治疗痛风性关节炎有了较大的进展,临床上取得令人乐观的成果。本文着重从中药内治及中医外治两个方面,综述了近年来痛风性关节炎中医药治疗的研究进展。     

T cells as key players for bone destruction in gouty arthritis?

The deposition of monosodium urate (MSU) crystals in synovial fluid and tissue leads to gouty arthritis frequently associated with synovial inflammation and bone erosions. The cellular mechanism that links MSU crystals to an increased number of osteoclasts has not yet been fully understood. In a recent issue of Arthritis Research & Therapy Lee and colleagues proposed that bone destruction in chronic gouty arthritis is at least in part dependent on expression by T cells of receptor activator of NF-κB ligand (RANKL). The authors showed that pro-resorptive cytokines such as IL-1β, IL-6, and TNFα are expressed within tophi and stromal infiltrates. In vitro stimulation with MSU crystals revealed monocytes as a source for these cytokines, whereas T cells produce RANKL, the major trigger of osteoclastogenesis.     

尿酸钠结晶诱导痛风性关节炎动物模型研究进展

痛风性关节炎是由于机体嘌呤代谢紊乱,导致血内尿酸增高而引起尿酸盐在组织沉积的疾病,本文简要介绍大鼠尿酸钠结晶急性足跖肿胀模型、大鼠尿酸钠结晶急性痛风性踝关节炎模型、小鼠与大鼠尿酸钠结晶皮下气囊法急性痛风性滑膜炎模型和家兔尿酸钠结晶急性膝关节炎模型的制作方法进展。将有益于抗痛风性关节炎药物研究时的更多选择应用。     

Human gouty arthritis is associated with a distinct serum trace elemental profile

Homeostatic imbalance of essential trace elements is deeply involved in many pathophysiological states, especially in joint disorders such as gout. A total of 64 elements were measured in the serum samples in three regionally independent groups of patients with gouty arthritis (n = 100) and an age-matched healthy control group (n = 40) by inductively coupled plasma-mass spectrometry (ICP-MS). A distinct elemental profile of gouty arthritis encompassing significantly altered Li, Al, Ti, Fe, Cu, Se, Sr, Ta, Hg, Bi, Th, and U was obtained with a sensitivity of 0.97 (95% confidence interval (CI): 0.92-0.99) and a specificity of 0.95 (95% CI: 0.83-0.99) for gout diagnosis. An independent group of 52 subjects (39 gout patients and 13 healthy controls) was further used to validate the elemental signature, yielding a sensitivity of 1.00 (95% CI: 0.91-1.00) and a specificity of 1.00 (95% CI: 0.75-1.00) for gout prediction. It is also noteworthy that we were able to achieve ≥95.7% correct classification rate in both discovery and validation groups using only three elemental markers, Li, Al, and U. We also observed a good correlation between Li, Zn, and Cu and the other two risk factors, age and serum urate concentration, in gout patients. Our findings underscore that gouty arthritis possesses a unique elemental expression profile regardless of many other nutritional and environmental factors.     

血清Hepcidin 水平在老年缺铁性贫血和慢性病贫血诊断中的临床应用

目的:探讨血清铁调素(Hepcidin)在老年人群缺铁性贫血(IDA)和慢性病贫血(ACD)中的应用价值。方法:选择老年IDA患者32例,老年ACD患者34例,健康对照组28例。检测对比三组血清Hepcidin、血清铁(SI)、血清铁蛋白(SF)、C-反应蛋白(CRP)、红细胞数(RBC)、血红蛋白(Hb)、红细胞比容(HCT)、红细胞平均体积(MCV)、白细胞数(WBC)水平。结果:ACD组中WBC明显高于IDA组(P0.05)。血清Hepcidin在IDA组、ACD组及对照组之间具有显著性差异(P0.05),IDA组中Hepcidin含量比对照组低,而ACD组中Hepcidin含量比对照组高(P0.05)。IDA组、ACD组中SI明显低于对照组(P0.05),而两组间无显著性差异(P0.05)。ACD组中SF、CRP均明显高于IDA组与对照组(P0.05)。Hepcidin诊断IDA组的ROC曲线下面积(AUC)值大于诊断ACD组,IDA组的诊断指数高于ACD组。结论:血清Hepcidin含量的检测对于鉴别IDA和ACD具有重要的意义。     

血清降钙素原在脓毒症患儿中的应用价值分析

目的:探讨脓毒症患儿血清降钙素原(PCT)水平变化及临床应用价值。方法:对脓毒症组38例患儿(严重脓毒症组16例、非严重脓毒症组22例)血清PCT、C反应蛋白(CRP)水平和白细胞(WBC)计数等指标进行检测,并与非脓毒症组的40例患儿进行比较分析。结果:脓毒症组患儿血清PCT、CRP水平及WBC计数均显著高于非脓毒症组,差异具有统计学意义(P<0.05);血清PCT、CRP水平对诊断脓毒症的敏感性差异无显著性(P>0.05),均显著高于WBC计数,差异具有统计学意义(P<0.05);血清PCT水平特异性、阳性预测值、阴性预测值及约登指数均显著高于CRP和WBC计数,差异具有统计学意义(P<0.05);严重脓毒症组患儿血清PCT水平显著高于非严重脓毒症组,差异具有统计学意义(P<0.05),而两组间血清CRP水平及WBC计数差异不显著(P>0.05)。结论:PCT可作为敏感性的鉴别诊断患儿脓毒症的血清学指标,其效果优于CRP和WBC计数。     

Determination of urate crystal formation using flow cytometry and microarea X-ray diffractometry

Gout is known to be induced by monosodium urate (MSU) crystals. The formation of MSU crystals is the first step of gouty inflammation. Detecting the early stage of crystallization accurately is considered to be important in understanding the mechanism of gouty arthritis. In this study, we employed flow cytometry (FCM) to detect small amounts of crystals produced in a supersaturated solution of uric acid. FCM was sensitive and crystals were determined at 2 h after the beginning of reaction. Gamma-globulin accelerated the formation rate time-dependently and dose-dependently. Low levels of lactic acid (less than 1.0 mg/ml) did not affect the formation rate but lactic acid of 2.0 mg/ml enhanced the formation of urate crystals. The crystals obtained with 2.0 mg/ml of lactic acid were analyzed with a microarea X-ray diffractometer and were shown to be a mixture of MSU and uric acid. FCM is a very useful method to determine the formation of crystals. Furthermore, analysis with a microarea X-ray diffractometer can provide detailed information about crystal composition.