目的 探讨超低频经颅磁刺激(ILF-TMS)联合艾司唑仑对失眠症患者睡眠脑电图参数及血清神经营养因子表达的影响。方法 选取2018年8月—2020年4月我院失眠症患者114例,随机数字表法分为研究组(n=57)、对照组(n=57)。对照组予以艾司唑仑联合ILF-TMS假性刺激,研究组予以艾司唑仑联合ILF-TMS真性刺激,均治疗1个月。对比2组疗效与治疗前、治疗1个月后睡眠进程参数(总睡眠时间、入睡时间、睡眠效率、觉醒时间)、睡眠结构(非快速眼动睡眠期、快速动眼睡眠期)、匹兹堡睡眠质量量表(PSQI)评分、失眠严重程度指数量表(ISI)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、血清神经营养因子[胶质细胞源性神经营养因子(GDNF)、脑源性神经营养因子(BDNF)]水平。结果 (1)疗效:研究组治疗1个月后总有效率高于对照组(P＜0.05);(2)睡眠进程参数:治疗1个月后研究组总睡眠时间、睡眠效率高于对照组,入睡时间、觉醒时间短于对照组(P＜0.05);(3)睡眠结构:治疗1个月后研究组Ⅲ期、Ⅱ期、非快速眼动睡眠期高于对照组,Ⅰ期睡眠期低于对照组(P＜0.05);(4)PSQI、ISI评分:治疗1个月后研究组PSQI、ISI评分低于对照组(P＜0.05);(5)SAS、SDS评分:治疗1个月后研究组SAS、SDS评分低于对照组(P＜0.05);(6)血清神经营养因子:治疗1个月后研究组血清GDNF、BDNF水平高于对照组(P＜0.05)。结论 ILF-TMS联合艾司唑仑治疗失眠症效果确切,可上调血清神经营养因子表达,改善睡眠脑电图参数,提高睡眠质量,控制焦虑、抑郁症状。

Objective To investigate the effects of infra-low frequency transcranial magnetic stimulation (ILF-TMS) combined with estazolam on sleep EEG parameters and serum neurotrophic factors expression in patients with insomnia. Methods One hundred and fourteen patients with insomnia in our hospital from August 2018 to April 2020 were divided into study group (n=57) and control group (n=57) by random number table method. The control group was treated with estazolam combined with pseudo ILF-TMS stimulation, and the study group was treated with estazolam combined with real ILF-TMS stimulation, all of which were treated for 1 month. Comparing curative effect of two groups before and 1 month after treatment, and sleep process parameters (total sleep time, falling asleep time, sleep efficiency, waking time), the structure of the sleep stages (stage Ⅲ, Ⅱ, Ⅰ, rapid eye movement sleep), Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, serum neurotrophic factors (GDNF, BDNF) levels. Results (1) Efficacy: the total effective rate of the study group was higher than that of the control group after 1 month of treatment (P＜0.05). (2) Sleep process parameters: after 1 month of treatment, the total sleep time and sleep efficiency in the study group were higher than those in the control group, and the falling asleep time and waking time were shorter than those in the control group (P＜0.05). (3) Sleep structure: after 1 month of treatment, compared to the control group, the study group had more in stageⅢ, Ⅱ, rapid eye movement sleep, and less in stage Ⅰsleep(P＜0.05). (4) PSQI and ISI scores: after 1 month of treatment, PSQI and ISI scores of the study group were lower than those of the control group (P＜0.05). (5) SAS and SDS scores: after 1 month of treatment, SAS and SDS scores in the study group were lower than those in the control group (P＜0.05). (6) Serum neurotrophic factors: after 1 month of treatment, serum GDNF and BDNF levels in the study group were higher than those in the control group (P＜0.05). Conclusions ILF-TMS combined with estazolam is an effective treatment of insomnia. It can up-regulate the expression of serum neurotrophic factors, improve the parameters of sleep EEG, improve sleep quality, and control the symptoms of anxiety and depression.

目的 本项目主要探究关于妊娠期妇女肛肠疾病的患病现状和危险因素分析,为减少妇女在妊娠阶段肛肠疾病的发病几率,有效预防疾病发生提供参考建议。方法 本研究主要采用现况研究,以2020年5月1日—2021年5月在本院就诊的妊娠妇女患者633例作为研究对象。采用现况调查,对研究对象进行临床检查和问卷调查。临床检查为肛肠科检查,包括肛门视诊、肛门直肠指诊检查、肛门镜检查等。问卷调查主要包括五个部分,第一部分为基础资料,包括年龄,居住地(农村/城市),学历、怀孕次数,怀孕时间,流产次数;第二部分为饮食习惯;第三部分为生活习惯和方式;第四部分为肛肠疾病患病信息;第五部分为孕产妇心理焦虑调查量表。使用SPSS、SAS统计学软件对患者数据进行分析,使用t检验和单因素方差分析检测数据之间的差异性,使用多元Logistic回归对危险因素进行分析。结果 通过对妊娠妇女进行肛肠检查,根据临床肛肠疾病诊断标准得知,633名妊娠妇女中,共有437名,患病率为69.03%;根据疾病种类进行分类得知,单纯性疾病:便秘患者156例、痔疮患者105例、肛裂患者35例、肛周脓肿患者29例、直肠脱垂24例、直肠息肉15例、直肠阴道瘘10例;合并疾病:肛裂合并痔疮43例;肛肠类癌症疾病:无;根据数据分析结果得知:633名妊娠妇女中,共有437名,患病率为69.03%;根据差异性分析,肛肠疾病患病率在不同年龄、居住地、生产次数、流产次数、饮食习惯、运动量、饮酒史、焦虑状况等因素之间有统计学差异(P<0.05),在不同学历、吸烟史、睡眠时间之间无统计学差异(P>0.05);经过采用多元Logistic回归分析,结果显示,年龄、生产次数、流产次数、食物喜好、使用水果蔬菜的频率、每日运动量、饮酒史、焦虑状况等是造成妊娠期妇女肛肠疾病发病的独立危险因素。结论 造成妊娠期妇女肛肠疾病的发病的主要影响因素为年龄、居住地、怀孕次数、孕期、流产次数、饮食习惯、运动量、焦虑状况,应该针对以上因素进行防范,有效减少发病率。

目的 比较广东云浮市进行药品专区执行国家药品集中采购(GPO)前后呼吸系统疾病患儿住院医疗费用,分析其住院医疗费用的影响因素。方法 选择云城区2019—2020年0~14岁城乡儿童呼吸系统疾病住院患儿,采用单因素和多元回归统计方法分析住院医疗费用的影响因素。结果 呼吸系统疾病儿童平均住院医疗费用国家集采前(4 872.38元)高于国家药品集采后(4 620.25元,P<0.05),药费分别占参保及参合患儿住院医疗费用的35.35%和27.39%,统筹支付费用参保与参合儿童分别占46.85%和57.59%。年龄、住院天数、转归、有无合并症、疾病分类、应用GPO药物、入院分类为呼吸系统疾病患儿住院医疗费用的共同影响因素,其中住院医疗费用随着患儿年龄增加、转归良好及应用GPO药物费用而减少,为负性联系;余住院天数、有无合并症、疾病分类、入院分类则与住院总费用有着正性联系。结论 提高患儿的转归,缩短平均住院日,做好药品专区及集中采购工作可降低儿童呼吸系统疾病的住院费用。

Objective To compare the inpatient medical expenses of children with respiratory diseases before and after the implementation of national group purchasing organization(GPO) in Yunfu City, Guangdong Province, and analyze the influencing factors of inpatient medical expenses. Methods The hospitalized children aged 0~14 with respiratory diseases from 2019 to 2020 in Yuncheng district implemented the GPO were selected. The influencing factors of hospitalization expense were analyzed by single factor and multiple regression statistical methods. Results The average hospitalization expense of children with respiratory diseases before the GPO implemented (4 872.38 yuan) was higher than after (4 620.25 yuan, P<0.05); the drug expense accounted for 35.35% and 27.39% of the hospitalization expense of the insured urban and rural children, and integrated payment accounted for 46.85% and 57.59%. Age, hospitalization days, outcome, comorbidities, disease classification, application of GPO drugs and admission classification were the common influencing factors of hospitalization expense of children with respiratory diseases. Hospitalization expense decreased with the increase of age, good outcome and application of GPO drugs, which was a negative correlation. And there was a positive relationship between the rest factors and the total cost of hospitalization. Conclusions To improve the outcome of children, shorten the average length of stay, doing a good job in drug zone and group procurement can reduce the hospitalization cost of children with respiratory diseases.

目的 探讨影响先天性甲状腺功能减低症患儿不同转归的早期因素。 方法 选取2013年12月—2017年3月期间在本中心筛查并确诊的先天性甲状腺功能减低症患儿共80例,经左旋甲状腺激素钠治疗2~3年后停药评估再随访1年以上者,根据疾病转归将患儿分为持续性甲低组(29例)与暂时性甲低组(51例)。对2组患儿的临床情况进行回顾性分析,寻求影响结局的早期因素。结果 持续性甲低与暂时性甲低患儿初筛促甲状腺激素值[ 63.89 (43.89, 114.25) vs 38.54 (27.27, 60.00) mIU/L]、促甲状腺激素恢复正常所需剂量[(4.29±1.46) vs (3.38±1.34) μg/(kg·d)]、早期甲状腺超声正常比例[58.6%(17/29)vs 90.2%(46/51)]差异有统计学意义(P<0.05)。其中初筛促甲状腺激素值(最佳临界值:37.825 mIU/L,AUC=0.745,灵敏度0.897,特异度0.490)和出生后第8个月左旋甲状腺激素钠给药剂量[最佳临界值3.38 μg/(kg·d),AUC=0.759,灵敏度 0.586,特异度 0.843]可早期区别持续性甲低与暂时性甲低患儿。结论 初筛促甲状腺激素值和出生后左旋甲状腺激素钠给药剂量对先天性甲状腺功能减低症患儿临床转归有早期预测作用。

Objective To investigate the early factors affecting different outcomes of children with congenital hypothyroidism (CH). Methods A total of 80 children with CH screened and diagnosed at Meizhou Maternal and Child Health Care and Family Planning Service Center between December 2013 and March 2017, who were treated with levothyroxine sodium for 2~3 years and then discontinued for assessment and followed up for over 1 year, were selected and divided into the permanent CH group (29 cases) and transient CH group (51 cases) according to disease outcomes. The clinical conditions of the children were retrospectively analysed to seek early factors affecting outcome. Results The initial screening thyroid hormone values [ 63.89 (43.89, 114.25) vs 38.54 (27.27, 60.00) mIU/L ], the required dose to restore normal thyroid hormone in permanent and transient CH group [(4.29±1.46) vs (3.38±1.34) μg/(kg·d)], and the proportion of early normal thyroid ultrasound [58.6% (17/29) vs 90.2% (46/51)] had significant differences(P<0.05). The initial screening thyroid hormone value (optimal threshold: 37.825 mIU/L, AUC=0.745, sensitivity 0.897 and specificity 0.490) and the levothyroxine sodium dosage at eighth month of age [optimal threshold 3.38 μg/(kg·d), AUC=0.759, sensitivity 0.586 and specificity 0.843] could early distinguish permanent and transient CH children. Conclusions Initial screening thyroid hormone values and postnatal levothyroxine sodium dosage had an early predictive effect on clinical outcome in children with CH.

目的 分析76例工业区来源的结核性胸膜炎患者的患病相关因素及临床特征。方法 回顾性收集2018年1月—2020年12月于深圳市中西医结合医院住院的76例工业区来源的结核性胸膜炎患者(观察组)的病历资料和57例同期同区域来源的健康体检者(对照组)的病历资料。运用统计学分析工业区结核性胸膜炎的患病相关因素及临床特征。结果 2组的比较当中,年龄、白蛋白水平、身高、体质量、体质量指数之间的差异具有统计学意义(P<0.05);而多因素Logistic回归分析结果显示,年龄及白蛋白水平则是工业区结核性胸膜炎的独立保护因素(P<0.001,OR=0.728,95% CI:0.634～0.836以及P<0.001,OR=0.908,95% CI:0.874～0.944);工业区结核性胸膜炎的临床症状为咳嗽(71.05%)、发热(48.68%)、胸痛(47.37%),发病季节以春秋季节(27.63%和32.90%)为主。结论 工业区结核性胸膜炎的独立影响因素是年龄及白蛋白水平,临床症状主要为咳嗽、发热、胸痛,好发于春秋季节。

Objective To analyze the relative factors and clinical characteristics of 76 patients with tuberculous pleurisy from industrial area. Methods The medical records of 76 patients with tuberculous pleurisy from industrial areas (observation group) and 57 healthy subjects from the same period and region (control group) who were hospitalized in Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2020 were retrospectively collected. The correlative factors and clinical characteristics of tuberculous pleurisy in industrial area were analyzed by statistics. Results There were statistically significant differences in age, albumin level, height, weight and body mass index between the two groups (P<0.05). Multivariate logistic regression analysis showed that age and albumin level were independent protective factors for tuberculous pleurisy in industrial areas (P<0.001, OR=0.728, 95% CI: 0.634~0.836 and P<0.001, OR=0.908, 95% CI: 0.874~0.944). The clinical symptoms of tuberculous pleuritis in industrial areas were cough (71.05%), fever (48.68%) and chest pain (47.37%), and the onset season was mainly in spring and autumn (27.63% and 32.90%). Conclusions The independent influencing factors of tuberculous pleuritis in industrial area are age and albumin level. The main clinical symptoms are cough, fever and chest pain, which usually occur in spring and autumn.

目的 分析中山市博爱医院妊娠合并哮喘急性发作患者相关危险因素。方法 选取2019年7月—2021年2月中山市博爱医院收治100例的妊娠合并哮喘患者作为研究对象,将100例妊娠合并患者分为哮喘急性发作组(n=46)与未发作组(n=54),采用多因素Logistic回归分析进行调查分析。结果 100例患者中发作人数为46例,占46.0%。Logistic回归分析显示孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的危险因素(P<0.05)。发作组剖宫产率发生率、住院时间以及并发症发生率均高于未发作组,差异有统计学意义(P<0.05)。结论 孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的独立危险因素,应对此类患者给予高度重视。

Objective To analyze the risk factors of pregnancy complicated with acute attack of asthma in Zhongshan Bo'ai Hospital.Methods A total of 100 patients with pregnancy complicated with asthma treated in Zhongshan Bo'ai Hospital from July 2019 to February 2021 were selected as the research objects.Patients were divided into acute attack group (n=46) and no attack group (n=54).Multivariate logistic regression analysis was used for investigation and analysis.Results The patient number of attack was 46,accounting for 46.0%. The incidence of cesarean section,length of hospital stay and complications in the attack group were higher than those in the no attack group,and the difference was statistically significant (P<0.05).Conclusions Gestational age,use of asthma drugs,anxiety and IL-17 level were independent risk factors for pregnancy complicated with acute attack of asthma.Great attention should be paid to these patients.

目的 评估产后女性的认知功能,并分析其认知功能受损的特点,以及分析可能的影响因素。方法 病例组选取健康单胎足月顺产初产妇、二胎产妇,对照组选取一般资料匹配的未生育女性,选用蒙特利尔认知评估(Montreal Cognitive Assessment Test,MoCA)北京版、伯明翰认知评估量表(Birmingham Cognitive Screen test,BCoS)普通话版评估认知功能。结果 实际入组病例组80例产妇,均完成MoCA量表,共42例产妇完成BCoS量表,对照组30例均完成MoCA、 BCoS评估。产妇组(80例)MCA得分为(26.26±2.28)分,低于未生育女性对照组MoCA分数(27.47±1.28)分(P<0.05),产妇组认知障碍发生率为30%高于对照组6.7%(P<0.05)。初产妇组MoCA分数(26.52±2.13)分,认知障碍发生率为26%,二胎产妇组MoCA分数(25.83±2.49)分,认知障碍发生率为36.7%,两者对比无明显差别(P>0.05)。产妇组(80例)在MoCA量表视空间与执行功能分项得分低于对照组(P<0.01);产妇组BCoS评分在故事瞬时回想、苹果删除总数、听觉注意、规则转换、手势模仿5个分项低于对照组(P<0.05)。产妇的受教育年限、分娩镇痛麻醉、总产程时间是产后认知功能下降的影响因素(P<0.05)。结论 ①产后妇女可能发生认知功能障碍,但初产妇与二胎产妇的认知障碍发生率无明显差别。②MoCA量表可以用于产妇产后认知功能筛查,BCoS量表可做为全面评估产妇产后认知功能的工具,产妇产后认知受损主要在视空间、注意力、执行功能(实践与行动能力)、记忆力领域。③产妇的受教育年限、分娩镇痛麻醉、总产程时间是产后认知功能下降的影响因素。

Objective To evaluate the cognitive function of postpartum women, and analyze the characteristics of cognitive dysfunction and the possible affecting factors. Methods The case group selected healthy single-born full-term primiparae (50 cases) and second birth parturient (30 cases), and the control group (30 cases) selected non-fertile women with general data matching. The Montreal Cognitive Assessment Test (MoCA) Beijing version and Birmingham Cognitive Screen test(BCoS) were used to evaluate cognitive function. Results Of the 80 cases in the case group, all completed the MoCA test, only 42 cases completed the BCoS test. The 30 cases in the control group all completed the MoCA and BcoS.The MoCA score of the case group (80 cases) was (26.26±2.28), which was lower than that of the control group (27.47±1.28) (P<0.05). The incidence of cognitive impairment in the case group was 30%, higher than the control group 6.7% (P<0.05). The MoCA score of the primiparae group was (26.52±2.13); the incidence of cognitive impairment was 26%; the MoCA score of the second birth parturient group was (25.83±2.49); the incidence of cognitive impairment was 36.7%.There was no significant difference in the MoCA score and the incidence of cognitive impairment between primiparae and second birth parturient (P> 0.05).The case group had lower scores on visual space and executive function of MoCA test than the control group (P<0.01).The score of BCoS test in the case group was lower than that in the control group in the five items of the instantaneous recall item of the story, apple deletion, auditory attention, Birmingham rule conversion and gesture imitation (P<0.05).The years of education, labor analgesia, and the total duration of labor were the factors that affected the cognitive function of postpartum women (P<0.05). Conclusion ①Postpartum women may have cognitive dysfunction, but there was no significant difference in the incidence of cognitive impairment between primiparae and second birth parturient group. ②The MoCA test can be used for the screening of cognitive impairment of postpartum women, and the BCoS test can be used as a tool to comprehensively evaluate the cognitive function of postpartum women. The cognitive impairment of postpartum women was mainly in the fields of visual space, attention, executive function (practice and action ability), and memory. ③The years of education, labor analgesia, and the total duration of labor were the factors that affect the cognitive function of postpartum women.

目的 分析晚期三阴性乳腺癌(TNBC)的危险因素并建立有效的预后列线图。方法 通过检索美国SEER(surveillance, epidemiology, and end results)数据库筛选晚期TNBC患者,采用单因素和多因素分析来确定晚期TNBC的独立预后因素,并以此构建了列线图,通过校准曲线检验和C指数(C-index)评估已建立的列线图。结果 共纳入4 687例晚期TNBC患者,与同期其他分子分型的乳腺癌相比较,TNBC的预后最差。单因素分析发现,年龄、性别、分期、手术、化疗、放疗、转移与更好的预后相关(P<0.05)。多因素分析发现年龄、性别、种族、分期、手术、化疗、放疗、各器官转移是患者预后的独立影响因素(P<0.05),并以此构建了列线图,其C-index为0.75(95％CI,0.71～0.79),校准图显示了预测的总生存期(OS)与观察到的OS之间的最佳一致性。结论 我们分析了晚期TNBC的临床特征,为TNBC患者的OS提供了一些预后因素,并根据这些预后因素制定了列线图,帮助临床医生进行风险管理并选择TNBC患者的长期生存策略。

Objective To analyze the risk factors of advanced triple-negative breast cancer (TNBC) and establish an effective prognostic nomogram. Methods Screening patients with advanced TNBC by searching the SEER (surveillance, epidemiology, and end results) database, using univariate and multivariate analysis to determine the independent prognostic factors of advanced TNBC, and constructing a nomogram based on it. Results A total of 4 687 patients with advanced TNBC were included. Compared with other types of breast cancer over the same period, TNBC had the worst prognosis. Univariate analysis found that age, gender, stage, surgery, chemotherapy, radiotherapy, and metastasis were associated with a better prognosis (P<0.05). Multivariate analysis found that age, gender, race, stage, surgery, chemotherapy, radiotherapy, and metastasis of the organs were independent factors affecting the prognosis of patients (P<0.05), and constructed a nomogram with a C-index of 0.75 ( 95% CI, 0.71～0.79). The calibration chart showed the best agreement between the predicted overall survival (OS) and the observed OS. Conclusion We analyzed the clinical features of advanced TNBC, provided some prognostic factors for the OS of TNBC patients, and developed a nomogram based on these prognostic factors to help clinicians manage risk and choose long-term survival strategies for TNBC patients.

目的 通过回顾分析广州地区Rh阴性血的采供情况,了解Rh阴性红细胞的供应特点,更好地实施Rh阴性血液库存管理,保障输血安全。方法 统计2011—2017年广州血液中心Rh阴性血液采集量与供应量,血型及医院供血量的分布情况。结果 2011—2017年广州血液中心Rh阴性全血采集量为11 283 U,占总采血量的0.39%(11 283/2 902 485),供应总量为11 693 U,占红细胞类成分血总供应量的0.43%(11 693/2 762 229),其中悬浮红细胞供应比例逐年增加,冰冻解冻去甘油红细胞供应比例逐年下降,并从2014年起Rh阴性悬浮红细胞供应增长率明显高于血液采集增长率;4种血型供应量总体比较,差异有统计学意义(F=22.217,P＜0.05),A、B型Rh阴性悬浮红细胞供应增长最快,增长率分别为137.3%和134.1%,医院分布以三级以上及综合医院为主。结论 应根据广州地区Rh阴性红细胞采供特点,来持续改进Rh阴性血源招募和采供策略。通过建立一支Rh阴性定期献血者队伍,加强Rh阴性血液统筹管理和临床科室-输血科-采供血机构的沟通,促进Rh阴性血液的供需平衡,保障Rh阴性患者输血安全。

Objective To understand the characteristics of Rh-negative red blood cells (RBC) supply, improve the management of storage and guarantee the safety of blood transfusion. The collection and supply of Rh-negative RBC in Guangzhou city was retrospectively analyzed. Methods The amount of Rh-negative RBC collection and supply, the distribution of ABO blood type and the consumption of blood by different hospitals in Guangzhou Blood Center from 2011 to 2017 were statistically analyzed. Results During 2011-2017, 11 283 U Rh-negative RBC was collected in Guangzhou Blood Center, accounting for 0.39% of total RBC collection (11 283/2 902 485); 1 693 U Rh-negative RBC was supplied, accounting for 0.43% of the total blood supply (11 693/2 762 229). The proportion of suspended RBC supply increased year by year, in contrast with the decease of proportion of frozen defrosteddeglyceal RBC supply. In addition, the growth rate of Rh-negative suspended RBC supply was higher than that of RBC collection since 2014 (F=217, P<0.05). A-and B-Rh negative suspended RBC supply increased, with growth rates of 137.3% and 134.1%, respectively. The Rh negative RBC was predominantly supplied to Grade III and general hospitals. Conclusion By establishing a team of Rh-negative regular blood donors, the strategies for recruitment, collection and supply of Rh-negative RBC should be continuously improved according to the characteristics of Rh-negative RBC collection and supply in Guangzhou. The coordinating management of Rh-negative, as well as the communication of clinical departments, departments of transfusion and blood banks should be improved. In addition, the balance between supply and demand of Rh-negative blood should be promoted, and the safety of blood transfusion for Rh-negative patients can be improved.

目的 研究氯吡格雷联合低分子肝素对老年急性心肌梗死(acute myocardial infarction, AMI)患者血清中血脂及炎性因子的影响,为临床AMI的治疗提供参考依据。方法 选取新乡医学院第一附属医院于2016年10月—2019年11月期间收治的老年AMI患者112例,按照随机分配的原则分成两组,即对照组和观察组,每组病例各56例,治疗方式为对照组单给予口服氯吡格雷进行治疗,观察组给予口服氯吡格雷与皮下注射低分子肝素联合治疗,比较治疗前后两组患者血清中甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDH-C),炎性因子的水平变化及心功能的改变情况。结果 与治疗前相比较,治疗后对照组和观察组患者血清TG、TC及LDH-C水平均降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平均降低,患者的左心室后壁厚度、左心室舒张末期内径均有降低,射血分数升高;而与对照组治疗后相比较,治疗后观察组患者血清TG、TC及LDH-C水平进一步降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平进一步降低,患者的左心室后壁厚度、左心室舒张末期内径均降低,而射血分数升高,差异有统计学意义。结论 氯吡格雷联合低分子量肝素可通过降低血清中血脂的水平,抑制AMI过程中的炎症反应,减少炎性因子的释放,提高患者的心功能,改善患者的病情。

Objective To explore the effects of clopidogrel combined with low molecular weight heparin on serum lipids and inflammatory factors in elderly patients with acute myocardial infarction, and provide reference for clinical treatment of AMI. Methods 112 elderly patients with AMI admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2016 to November 2019 were randomly divided into control group and observation group,56 cases in each group.The control group was treated with clopidogrel alone, and the observation group was treated with clopidogrel combined with low molecular weight heparin. The levels of serum TG, TC and LDH-C, inflammatory factors and cardiac function were compared between the two groups before and after treatment. Results Compared with before treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased in the observation group and the control group after treatment. The left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased in the observation group and control group after treatment. Compared with control group after treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased, the left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased further in observation group after treatment. Conclusion Clopidogrel combined with low molecular weight heparin may improve the patient's cardiac function, then improve the patient's condition through reducing the level of serum lipids, inhibit the inflammatory reaction in AMI, reduce the release of inflammatory factors.