浆膜腔积液微粒体理化特性及其性质鉴别
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摘要
浆膜腔积液是一种常见的体征,病因复杂,特别是胸腔积液和腹腔积液在临床上更是常见,根据积液产生的原因和性质,浆膜腔积液可以分为漏出液和渗出液,在临床上,凡是积液都应该积极寻找病因,而诊断积液病因首先要鉴别是漏出液抑或渗出液,以缩小诊断范围,减少不必要的盲目检查,这对临床疾病的诊断和治疗有重要意义。为了解决目前区分漏出液和渗出液常用Light标准等的特异性不够理想的情况,本文拟通过研究分析浆膜腔积液微粒体的理化特性,在此基础上建立起一种具有高敏感性和特异性的检测技术,以便早期诊断浆膜腔积液的性质,促进临床疾病的诊断治疗。
本文采用准弹性激光散射技术、相分析激光电泳光散射、区带电泳等技术对浆膜腔积液中微粒体大小及其分布状态、Zeat电位和微粒体的分子构成等理化参数进行分析测定,揭示其相互关联变化的规律及其机制,发展和研究一种快速、准确和简便的鉴别漏出液和渗出液的技术手段,并提出鉴别漏出液和渗出液的参考指标。本研究得出如下结论
1浆膜腔积液存在大小不一的微粒体,积液性质与微粒体的平均粒度以及微粒体颗粒分布范围紧密相关。在漏出液中,微粒体的颗粒粒度较小,并且分布较窄。在渗出液中,微粒体的颗粒粒度较大,分布范围宽,两者有显著性差异,因此测定积液中微粒体的平均粒度可以准确鉴别浆膜腔积液的性质。
2浆膜腔积液中存在的微粒体是蛋白质,在漏出液中蛋白质分子量较小,种类也少,而渗出液中的蛋白质分子量较大,种类较多,与血清蛋白成分相似。
3漏出液和渗出液的Zeta电位有显著差异,渗出液Zeta电位较低,漏出液Zeta电位较高,可以作为鉴别漏出液和渗出液的辅助指标。
4在渗出液中,结核性积液和肿瘤性积液的微粒体粒度大小比较接近,分布范围小,而炎症性积液微粒体颗粒粒度较大,颗粒测定范围分布也广。故从粒度大小与分布状态还可判别一般炎症与结核或肿瘤。
本研究的创新点:
1首先采用准弹性激光技术系统地测量了浆膜腔积液的微粒体的粒度大小与粒度分布,揭示浆膜腔积液的性质与其微粒体的粒度与粒度分布高度相关,且漏出液和渗出液两者的粒度与粒度分布有非常显著性差异,利用粒度大小的不同能够建立起一种可靠的高灵敏度高特异性的鉴别漏出液与渗出液的方法。
2首次测定了浆膜腔积液中微粒体的表面带电状态,提示微粒体的表面带电情况与积液的性质密切相关,为进一步鉴别浆膜腔积液是漏出液还是渗出液提供了另一种简便、快速、准确、无扰的实验依据。
3采用区带电泳技术、紫外光谱技术、准弹性激光散射技术等对浆膜腔积液进行了比较全面系统的分析,测定了浆膜腔积液中的微粒体的性质、粒度、酸碱度、表面电荷状态各种参数,进一步证实了漏出液和渗出液发生发展的机制。
本文根据Light's标准和临床诊断,将浆膜腔积液分成漏出液和渗出液两组,同时根据病因对渗出液分为炎症组、肿瘤组和结核组、对各个组的浆膜腔积液的微粒体的粒度大小、粒度分布情况、微粒体表面电荷情况进行分析和研究,探讨其中的客观规律,建立了一种准确、简便、快速、无扰的鉴别浆膜腔性质的可靠手段,具有重要的临床价值,也为进一步研究浆膜腔积液的性质提供了有益的启示。
Serous effusion is a familiar clinical symptom led by complex diseases; pleural effusion and peritoneal effusion are the most familiar ones. according to its etiology and character, serous effusion is divided into transudates and exudates. It is important that etiology of serous effusion should be diagnosticated. Transudates and exudates should be distinguished in order to reduce inappropriate determination, and diagnostic range. This is significance in clinical diagnostics and treatment. In order to improve the specificity of differentiating transudates and exudstes by the common Light' s criteria, we developed a method with high sensitivity and high specificity in differentiating characteristics of serous effusion. In the method, we analyze the size and size distribution as well as the Zeta potential of the nano-particle in the effusion, using the techniques of quasi-elastic laser light scattering and phase analysis electrophoresis laser-scattering. The other physical and chemical characteristics of the effusion are also determined by zone electrophoresis and photo-spectroscopy. We obtain the following conclusions based on our reaserch:
1. The size and size distribution of the nano-particle in serous effusions are significantly different. The size of the nano-particle in transudates is small and distributes in a narrow range; while the size of the exudates nano-particles is much greater and distributes in a wide range.
2. The nano-particles in serous effusions are protein. Those in transudates are low-molecular weight molecules, while those in exudates are high-molecular weight molecules.
3. The Zeta potentials of the nano-particles are different in transudates and exudates, the Zeta potential of the particles in transudates is lower than that of exudates.
4. There is no difference between the size of the nano-particles in tubercular effusion and malignant effusion, however, the size of the nano-particles in bacterial effusion is large and range of size distribution is wide.
The innovation of this paper lies in:
(1)This is the first time to perform systematical measurements on size and size distribution of the nano-particles inserous effusion, and reveal the relation between the parameters and the characteristics of serous effusion. Based on our research, we can set up a reliable methods to distinguish transudates and exudates .
(2)It is also the first time to perform measurement on the Zeat potential of the nano-particles and reveal the relation of it with the characteristics of serous effusion. It is proved that based on this result, a fast, simple and accurate method can be developed to differentiate transudates and exudates .
(3) By the aid of analyzing other physical and biochemical parameters of the nano-particles, we suggest the mechanism for the different size and Zeta potential of the nano-particles in transudates and exudates .
Based on Light' s criteria and clinical diagnosis, serous effusion is divided into two transudates group and exudates group, at the same time exudates is divided into bacterial group , malignant group and tubercular group too. The size and size distribution, the Zeta potential of the nano-particles in each of the groups are analyzed in order to establish an easy, undisturbed method for differentiating transudates and exudates.
本文采用准弹性激光散射技术、相分析激光电泳光散射、区带电泳等技术对浆膜腔积液中微粒体大小及其分布状态、Zeat电位和微粒体的分子构成等理化参数进行分析测定,揭示其相互关联变化的规律及其机制,发展和研究一种快速、准确和简便的鉴别漏出液和渗出液的技术手段,并提出鉴别漏出液和渗出液的参考指标。本研究得出如下结论
1浆膜腔积液存在大小不一的微粒体,积液性质与微粒体的平均粒度以及微粒体颗粒分布范围紧密相关。在漏出液中,微粒体的颗粒粒度较小,并且分布较窄。在渗出液中,微粒体的颗粒粒度较大,分布范围宽,两者有显著性差异,因此测定积液中微粒体的平均粒度可以准确鉴别浆膜腔积液的性质。
2浆膜腔积液中存在的微粒体是蛋白质,在漏出液中蛋白质分子量较小,种类也少,而渗出液中的蛋白质分子量较大,种类较多,与血清蛋白成分相似。
3漏出液和渗出液的Zeta电位有显著差异,渗出液Zeta电位较低,漏出液Zeta电位较高,可以作为鉴别漏出液和渗出液的辅助指标。
4在渗出液中,结核性积液和肿瘤性积液的微粒体粒度大小比较接近,分布范围小,而炎症性积液微粒体颗粒粒度较大,颗粒测定范围分布也广。故从粒度大小与分布状态还可判别一般炎症与结核或肿瘤。
本研究的创新点:
1首先采用准弹性激光技术系统地测量了浆膜腔积液的微粒体的粒度大小与粒度分布,揭示浆膜腔积液的性质与其微粒体的粒度与粒度分布高度相关,且漏出液和渗出液两者的粒度与粒度分布有非常显著性差异,利用粒度大小的不同能够建立起一种可靠的高灵敏度高特异性的鉴别漏出液与渗出液的方法。
2首次测定了浆膜腔积液中微粒体的表面带电状态,提示微粒体的表面带电情况与积液的性质密切相关,为进一步鉴别浆膜腔积液是漏出液还是渗出液提供了另一种简便、快速、准确、无扰的实验依据。
3采用区带电泳技术、紫外光谱技术、准弹性激光散射技术等对浆膜腔积液进行了比较全面系统的分析,测定了浆膜腔积液中的微粒体的性质、粒度、酸碱度、表面电荷状态各种参数,进一步证实了漏出液和渗出液发生发展的机制。
本文根据Light's标准和临床诊断,将浆膜腔积液分成漏出液和渗出液两组,同时根据病因对渗出液分为炎症组、肿瘤组和结核组、对各个组的浆膜腔积液的微粒体的粒度大小、粒度分布情况、微粒体表面电荷情况进行分析和研究,探讨其中的客观规律,建立了一种准确、简便、快速、无扰的鉴别浆膜腔性质的可靠手段,具有重要的临床价值,也为进一步研究浆膜腔积液的性质提供了有益的启示。
Serous effusion is a familiar clinical symptom led by complex diseases; pleural effusion and peritoneal effusion are the most familiar ones. according to its etiology and character, serous effusion is divided into transudates and exudates. It is important that etiology of serous effusion should be diagnosticated. Transudates and exudates should be distinguished in order to reduce inappropriate determination, and diagnostic range. This is significance in clinical diagnostics and treatment. In order to improve the specificity of differentiating transudates and exudstes by the common Light' s criteria, we developed a method with high sensitivity and high specificity in differentiating characteristics of serous effusion. In the method, we analyze the size and size distribution as well as the Zeta potential of the nano-particle in the effusion, using the techniques of quasi-elastic laser light scattering and phase analysis electrophoresis laser-scattering. The other physical and chemical characteristics of the effusion are also determined by zone electrophoresis and photo-spectroscopy. We obtain the following conclusions based on our reaserch:
1. The size and size distribution of the nano-particle in serous effusions are significantly different. The size of the nano-particle in transudates is small and distributes in a narrow range; while the size of the exudates nano-particles is much greater and distributes in a wide range.
2. The nano-particles in serous effusions are protein. Those in transudates are low-molecular weight molecules, while those in exudates are high-molecular weight molecules.
3. The Zeta potentials of the nano-particles are different in transudates and exudates, the Zeta potential of the particles in transudates is lower than that of exudates.
4. There is no difference between the size of the nano-particles in tubercular effusion and malignant effusion, however, the size of the nano-particles in bacterial effusion is large and range of size distribution is wide.
The innovation of this paper lies in:
(1)This is the first time to perform systematical measurements on size and size distribution of the nano-particles inserous effusion, and reveal the relation between the parameters and the characteristics of serous effusion. Based on our research, we can set up a reliable methods to distinguish transudates and exudates .
(2)It is also the first time to perform measurement on the Zeat potential of the nano-particles and reveal the relation of it with the characteristics of serous effusion. It is proved that based on this result, a fast, simple and accurate method can be developed to differentiate transudates and exudates .
(3) By the aid of analyzing other physical and biochemical parameters of the nano-particles, we suggest the mechanism for the different size and Zeta potential of the nano-particles in transudates and exudates .
Based on Light' s criteria and clinical diagnosis, serous effusion is divided into two transudates group and exudates group, at the same time exudates is divided into bacterial group , malignant group and tubercular group too. The size and size distribution, the Zeta potential of the nano-particles in each of the groups are analyzed in order to establish an easy, undisturbed method for differentiating transudates and exudates.
引文
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[76] Mak TWL, Ho SS, Ho CS, et al. Pleural fluid pseudouridine in malignant and benign pleural effusions. Ann Clin Biochem 1998;35:94 - 8.
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[83] Garcia Jr N, Sanyal AJ. Minimizing ascites. Postgrad Med 2001;109:91 -103.
[84] Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology 1988;8:1104- 9.
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[87] Akriviadis EA, Kapnias D, Hadjigavriel M, et al. Serum/ascites albumin gradient: its value as a rational approach to the differential diagnosis of ascites. Scand J Gastroenterol 1996;31:814-7.
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[92] Kajani MA, Yoo YK, Alexander JA, et al. Serum-ascites albumin gradients in non-alcoholic lever disease. Dig Dis 1990;35:33 - 7.
[93] Runyon BA. Cardiac ascites: a characterization. J Clin Gastroenterol 1988;10:410- 2.
[94] Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990;98:127-33.
[95] Shakil AO, Korula J, Kanel GC, et al. Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease: a case control study. Am J Med 1996;100:179-85.
[96] Corlette MB, Dratch M, Sorger K. Amylase elevation attributable to an ovarian neoplasm. Gastroenterology 1978;74:907-9.
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[99]Burgess LJ,Swanepoel CG,Taljaard JJF.The use of adenosine deaminase as a diagnostic tool for peritoneal tuberculosis.Tuberculosis 2001;81:243-8.
[100]宋鉴清,王丽,赵敏,张丽霞.乳酸脱氢酶及其同功酶分析对胸腔积液鉴别的诊断价值.中国现代医学杂志2004:14:1-5.
[101]陈文彬,潘祥林主编.诊断学.北京:人民卫生出版社,2007年第六版,585-586.
[102]府伟灵主编.临床检验学实用技术与新进展.北京:人民军医出版社.41-53.
[103]翟佐发主编.系统解剖学.北京:人民卫生出版社.2006年第一版,134-169.
[104]冯萍,单卫民,俞秋兴.浆膜腔积液脱落细胞DNA倍体分析在肿瘤良恶性判断中的应用.苏州医学院学报,2001:21:42-45.
[105]Seriff NS,Cohen ML,Samuel P,Schulster PL.Chylothorax:diagnosis by lipoprotein electrophoresis of serum and pleural fluid.Thorax 1977;32:98-100.
[106]Staats BA,Ellefson RD,Budahn LL,et al.The lipoprotein profile of chylous and nonchylous pleural effusions.Mayo Clin Proc 1980;55:700-4.
[107]Muzaffer Metintas,Ozkan Alatas,Fusun Alatas,Omer C,olak,Necla Ozdemir,Sinan Erginel Comparative analysis of biochemical parameters fordifferentiation of pleural exudates from transudates Light's criteria,cholesterol,bilirubin,albumin gradient,alkaline phosphatase,creatine kinase,and uric acid Clinica Chimica Acta 1997:264:149-162