【摘要】目的：探究淀粉样蛋白A（serum amyloid?A，SAA）、超敏C反应蛋白（high sensitivity C-reactive protein，hsCRP）、白细胞计数（white blood cell count，WBC）、SAA/hsCRP比值对儿童感染性疾病早期鉴别的临床价值。方法：选取2025年1月--2025年6月我院就诊的感染性疾病患儿296例进行研究，其中细菌感染组86例、病毒感染组180例，另选取同期30例健康体检儿童作为对照组。检测三组SAA、hsCRP、WBC水平，计算SAA/hsCRP比值情况，通过受试者工作特征（receiver operating characteristic curve，ROC）分析各指标单独及联合检测对细菌感染和病毒感染的诊断效能。结果：与对照组比较，细菌感染组和病毒感染组SAA、hsCRP、WBC、SAA/hsCRP比值更高（P<0.05）；与病毒感染组比较，细菌感染组SAA、hsCRP、WBC更高，SAA/hsCRP比值更低（P<0.05）。相关性分析显示，SAA 与 hsCRP、WBC 及 SAA/hsCRP 比值均呈正相关（r=0.417、0.473、0.324，均 P＜0.001）；hsCRP 与 WBC 呈正相关（r=0.408，P＜0.001），与 SAA/hsCRP 比值呈负相关（r=-0.402，P＜0.001）；SAA/hsCRP 比值与 WBC 呈负相关（r=-0.523，P＜0.001）。ROC 曲线分析结果显示，SAA、hsCRP、WBC 及 SAA/hsCRP 比值均可用于儿童细菌感染与病毒感染的鉴别诊断，其 AUC 分别为 0.810、0.879、0.893 和 0.893，联合检测的 AUC 为 0.997，灵敏度为98.80%，特异度为93.89%，诊断效能优于单项指标。结论：SAA、hsCRP、WBC、SAA/hsCRP比值在儿童细菌感染性疾病及病毒感染性疾病鉴别诊断中有一定价值，临床可联合检测上述指标水平以鉴别具体感染类型，为患儿诊断及预后评估提供依据。

摘要：目的：探讨在被确诊的甲状腺乳头状微小癌（PTMC）患者中清扫颈部VI区淋巴结时，术中使用纳米炭混悬注射液示踪技术在其治疗过程中的应用价值及临床获益情况。方法：选取肇庆市第一人民医院普外科各亚专科中在2025年1月至2026年1月间收治的90例甲状腺乳头状微小癌（PTMC）患者，采用随机数字表法进行分组，分为观察组、对照组，各45例。90例患者中术前常规行FNA，并确诊为甲状腺乳头状癌，对术前确诊的单侧甲状腺乳头状癌患者，手术方式选择行单侧甲状腺全切加峡部切除和单侧颈部VI区淋巴结清扫，对术前确诊的双侧甲状腺乳头状癌患者，手术方式选择行甲状腺双侧叶全切加峡部切除及双侧颈部VI区淋巴结清扫。对观察组患者，在手术中解剖后看到甲状腺腺体后即在甲状腺腺体背侧面注射纳米炭混悬注射液混悬注射液，约0.3ml，等待显影20min后再行淋巴结清扫，对照组患者则术中不注射纳米炭混悬注射液混悬注射液。对比观察组和对照组患者所用手术时间及术中出血量，术后第1天及术后满1个月血钙（Ca）水平及甲状旁腺激素(PTH)测定情况两组的对比情况，术手术并发症中喉返神经损伤，术后声嘶，术后血肿及低钙血症甲状旁腺暂时功能低下观察组和对照组情况对比，观察组及对照组淋巴结平均检出数，淋巴阳性检出数的对比情况。结果：观察组中手术的时间长度为98.75±7.52和对照组101.52±6.54(P>0.05），统计学无差异；观察组中术中出血量为32.57±2.78和对照组的29.55±4.21(P>0.05），统计学无差异；观察组术后第1天血钙(CA)水平为2.27±0.12和甲状旁腺激素(PTH)水平为40.21±0.06均较对照组术后第1天血钙(Ca)水平为2.20±0.05和甲状旁腺激素(PTH)水平为35.42±0.03高，术后第1天观察组显著高于对照组，差异有统计学意义(P<0.05)；观察组术后第满1月血钙(Ca)水平为2.26±0.05和甲状旁腺激素(PTH)水平为43.1±4.29与对照组术后满1月血钙(Ca)水平为2.25±0.09和甲状旁腺激素(PTH)水平为42.8±3.87对比(P>0.05），统计学无差异；术后合并症观察组术后喉返神经损伤，声音嘶哑和颈部血肿分别为0，1和1与对照组的0，1和0(P>0.05），统计学无差异；术后合并症观察组术后低钙血症及甲状旁腺暂时功能低下分别为1和0与对照组术后低钙血症及甲状旁腺暂时功能低下4和3比较(P<0.05)，统计学有意义；术中观察组淋巴结显影明显好于对照组淋巴结显影；观察组淋巴结平均检出数，淋巴阳性检出数为7.654±1.65、2.71±0.65均多余对照组的6.77±1.85、2.34±0.73(p<0.05)，差异比较，有统计学意义。结论：对于甲状腺乳头状微小癌（PTMC）的患者，在手术中使用纳米炭混悬注射液进行标记示踪，有助于提高医生在行甲状腺乳头状癌清扫颈部VI区时的淋巴结显影效果及患者颈部VI区的淋巴结清扫效率；有助于提高患者淋巴结清扫彻底性，有助于降低术后复发风险，提高手术安全性；对术后并发低钙血症及永久性的甲状旁腺功能减退等有显著效果，增加患者术中甲状旁腺保护效率，可有助于提高患者远期的生存质量等，具有显著的临床应用价值。

目的 基于最佳矫正视力（BCVA）、角膜水肿程度对比改良与常规小梁切除术治疗急性闭角型青光眼（AACG）的疗效。方法 回顾性收集2021年12月—2023年6月期间信阳爱尔眼科医院收治的112例AACG患者作为研究对象,依据1∶1匹配原则,将接受常规小梁切除术的56例患者作为对照组,接受改良小梁切除术的56例患者作为观察组,统计两组围术期BCVA、眼压、术后浅前房形成状况、角膜水肿程度以及并发症状况。结果 术后3个月,观察组视力为（0.63±0.04）logMAR,高于对照组（0.50±0.03）logMAR,眼压为（16.22±2.28）mmHg,低于对照组（19.95±2.31）mmHg（t=19.457、8.600,均P<0.05）;观察组浅前房发生率为8.93%,低于对照组的26.79%（χ²=6.087,P=0.014）;观察组角膜水肿状况优于对照组（Z=2.737,P=0.006）;观察组脉络膜脱离率、滤道阻塞率、前房积血率、虹膜炎症率依次为1.79%、5.36%、16.07%、10.71%,均低于对照组17.86%、23.21%、32.14%、35.71%（χ²=8.166、7.292、3.953、9.818,均P<0.05）。结论 较常规小梁切除术,改良小梁切除术治疗AACG患者,有助于改善视力、降低眼压、减轻角膜水肿、减少浅前房发生,且安全性较高。

Objective To compare the efficacy of modified and conventional trabeculectomy in the treatment of acute angle-closure glaucoma（AACG）based on best-corrected visual acuity（BCVA）and degree of corneal edema．Methods A total of 112 patients with AACG admitted to the hospital during December 2021 to June 2023 were retrospectively selected as study objects． According to the 1∶1 matching principle,56 patients receiving conventional trabeculectomy were selected as control group,and 56 patients receiving modified trabeculectomy were selected as observation group．Perioperative BCVA,intraocular pressure,postoperative shallow anterior chamber formation,degree of corneal edema and complications were analyzed．Results At three months postoperatively,visual acuity in the observation group was（0.63±0.04）logMAR,which was higher than that in the control group（0.50±0.03）logMAR,and intraocular pressure was（16.22±2.28）mmHg,which was lower than that in the control group（19.95±2.31）mmHg（t=19.457,8.600,P<0.05）;the incidence of shallow anterior chamber in the observation group was 8.93%,which was lower than that of the control group（26.79%）（χ²=6.087,P=0.014）;the corneal edema status in the observation group was better than that of the control group（Z=2.737,P=0.006）;the rates of choroidal detachment,filtering channel obstruction,hyphema,and iris inflammation in the observation group were 1.79%,5.36%,16.07%,and 10.71%,respectively,which were lower than those of the control group（17.86%,23.21%,32.14%,and 35.71%）（χ²=8.166,7.292,3.953,and 9.818,P<0.05）．Conclusions Compared with conventional trabeculectomy,modified trabeculectomy can improve visual acuity,reduce intraocular pressure,relieve corneal edema,and reduce the occurrence of shallow anterior chamber in patients with AACG,with higher safety．

目的 探讨唐氏综合征血清学筛查风险值异常孕妇选择接受无创产前基因检测（NIPT）的影响因素,为临床制定对应策略提供参考依据。方法 选取2022年1月—2022年12月唐氏综合征血清学筛查风险值异常孕妇229例,根据是否接受NIPT分为接受组（195例）与不接受组（34例）。收集两组临床资料,采用Lasso-Logistic回归分析唐氏综合征血清学筛查风险值异常孕妇接受NIPT的影响因素。结果 单因素分析显示,年龄、文化水平、居住地、家庭平均月收入、孕前优生优育检查、孕前合并生殖相关疾病、受孕方式、不良孕产史、家族史、补充叶酸、配偶意愿、NIPT认知水平、血清学风险等级是血清学筛查异常孕妇接受NIPT的影响因素（P<0.05）;Lasso回归分析筛选出7个变量,分别为年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级;Logistic回归分析,年龄（OR=6.269,95%CI：2.413~16.285）、文化水平（OR=4.119,95%CI：1.627~10.430）、家庭平均月收入（OR=5.102,95%CI：2.067~12.594）、不良孕产史（OR=5.247,95%CI：1.833~15.021）、家族史（OR=7.416,95%CI：2.952~18.629）、NIPT认知水平（OR=5.751,95%CI：2.338~14.146）、血清学风险等级（OR=7.866,95%CI：3.057~20.238）是血清学筛查异常孕妇接受NIPT的影响因素（P<0.05）。结论 唐氏综合征血清学筛查风险值异常孕妇选择接受NIPT的影响因素较多,包括年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级,能为临床提高NIPT接受度提供指导信息。

Objective To explore the influencing factors of noninvasive prenatal testing（NIPT）for pregnant women with abnormal risk value of serological screening for Down syndrome,and to provide reference for clinical development of corresponding strategies．Methods A total of 229 pregnant women with abnormal serological screening risk values for Down syndrome from January 2022 to December 2022 were selected and divided into acceptance group（195 cases）and non-acceptance group（34 cases）according to whether they received NIPT．The clinical data of the two groups were collected and Lasso-Logistic regression was used to analyze the factors influencing the acceptance of NIPT in pregnant women with abnormal serological screening risk value for Down syndrome．Results In single factor analysis,age,education level,place of residence,average monthly family income,pre-pregnancy and childbearing examination,pre-pregnancy combined with reproductive diseases,conception method,adverse pregnancy history,family history,folic acid supplementation,spouse intention,NIPT cognition level and serological risk grade were the influencing factors for the acceptance of NIPT in pregnant women with abnormal serological screening（P<0.05）．Seven variables were selected by Lasso regression analysis,which were age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level and serological risk level．Logistic regression analysis showed that age（OR=6.269,95%CI：2.413-16.285）,education level（OR=4.119,95%CI：1.627-10.430）,average monthly family income（OR=5.102,95%CI：2.067-12.594）,adverse pregnancy history（OR=5.247,95%CI：1.833-15.021）,family history（OR=7.416,95%CI：2.952-18.629）,NIPT cognitive level（OR=5.751,95%CI：2.338-14.146）and serological risk level（OR=7.866,95%CI：3.057-20.238）were independent influencing factors for NIPT acceptance in pregnant women with abnormal serological screening（P<0.05）．Conclusions There are many influencing factors for pregnant women with abnormal serological screening risk value to accept NIPT,including age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level,serological risk grade,etc．,which can provide guidance information for clinical improvement of NIPT acceptance．

目的 探讨高频超声对小儿梅克尔憩室所致肠梗阻的诊断价值。方法 选取广州市妇女儿童医疗中心2018年1月—2023年12月经手术证实的由梅克尔憩室引起的肠梗阻患儿41例作为研究对象,回顾性分析患儿临床资料及超声表现,并与术中所见和病理结果进行对照。结果 41例患儿,发病平均年龄为（3.97±3.69）岁,其中男32例、女9例。术前超声诊断肠梗阻38例,诊断符合率为92.7%;诊断梅克尔憩室所致肠梗阻9例,诊断符合率为21.9%。术中诊断梅克尔憩室索带卡压肠管24例,腹内疝8例,肠扭转1例;肠套叠10例;梅克尔憩室炎症、粘连6例,粘连穿孔1例;憩室内异物并穿孔1例。结论 高频超声对小儿肠梗阻有重要的诊断价值,仔细探查可以明显提高梅克尔憩室所致肠梗阻的临床诊断率,为临床尽早手术提供重要依据。

Objective To investigate the diagnostic value of high frequency ultrasound for intestinal obstruction caused by Meckel's diverticulum in children．Methods From January 2018 to December 2023,41 children with intestinal obstruction caused by Meckel's diverticulum were selected as the study objects．The clinical data and ultrasound images of the children were analyzed retrospectively,and compared with the intraoperative and pathological results．Results In 41 patients,the average age of onset was（3.97±3.69）years ,including 32 males and 9 females．Preoperative ultrasonic diagnosis of intestinal obstruction in 38 cases,diagnosis coincidence rate was 92.7%．Intestinal obstruction caused by Meckel's diverticulum was diagnosed in 9 cases,the diagnosis coincidence rate was 21.9%．During the operation,24 cases of Meckel's diverticulum intestinal compression were diagnosed,8 cases of abdominal hernia,1 case of intestinal torsion,and intussusception of 10 cases．Meckel's diverticulum had inflammation and adhesion in 6 cases and adhesion perforation in 1 case．A case of foreign body in diverticulum with perforation．Conclusions High-frequency ultrasound has an important diagnostic value for intestinal obstruction in children．Careful exploration can significantly improve the clinical diagnosis rate of intestinal obstruction caused by Meckel's diverticulum,and provide an important basis for early clinical operation．

目的 探究对神经根型颈椎病(CSR)患者开展悬吊运动疗法+推拿的临床价值。方法 选择2020年1月—2021年7月100例神经根型颈椎病患者,参考“数字双盲法”,分为对照组和观察组(均n=50);对照组患者为推拿治疗,观察组基于对照组基础+悬吊运动疗法;对比治疗结果。结果 观察组临床总有效率94.00%较对照组80.00%高(P＜0.05)。2组治疗后VAS疼痛评分较治疗前均下降,且观察组较对照组更低(P＜0.05)。治疗前120°/s的等速度运动状态下2组峰力距(PT)、平均功率(AP)、屈肌峰力距/伸肌峰力距(F/E)比较(P＞0.05),经治疗后2组均显著改善,且观察组PT、AP、F/E指标较对照组均更优(P＜0.05)。2组治疗后颈椎功能障碍指数(NDI)评分、颈椎病临床评价量表(CASCS)评分较同组治疗前均改善,且观察组较对照组NDI评分更低,CASCS评分更高。结论 针对CSR患者开展悬吊运动疗法+推拿治疗,有利于调节患者颈部肌群协调能力,减轻疼痛感,改善临床症状,促进颈椎功能恢复,实现理想的治疗效果。

Objective To explore the clinical value of sling exercise therapy (SET) and massage in patients with cervical spondylotic radiculopathy (CSR). Methods From January 2020 to July 2021, 100 patients with CSR were selected and divided into control group and observation group (both n=50). The patients in the control group were treated with massage, and the observation group was treated with massage+SET, the treatment results were compared. Results The total clinical effective rate of 94.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05). The VAS pain scores of the two groups after treatment were lower than those before treatment, and the VAS pain score of the observation group was lower than that of the control group (P<0.05). The peak torque (PT), average power (AP) and flexor peak force distance/extensor peak force distance (F/E) of the two groups were significantly improved after treatment, and the PT, AP and F/E indexes of the observation group were better than those of the control group (P<0.05). After treatment, the neck disability index (NDI) score and clinical assessment scale of cervical spondylosis (CASCS) score of the two groups were significantly improved compared with those before treatment, and the NDI score of the observation group was lower and the CASCS score was higher in the observation group. Conclusions SET+massage therapy for patients with CSR is helpful to adjust the coordination ability of cervical muscle group, reduce pain, improve clinical symptoms, promote the recovery of cervical function and achieve ideal therapeutic effect.

目的 分析在临床治疗腰椎间盘突出症过程中采取脊柱微创手术的价值。方法 回顾研究2019年2月-2021年2月本院的102例腰椎间盘突出症患者,按照电脑排序将患者分为参照组51例与研究组51例。其中,接受传统手术治疗的为参照组,接受脊柱微创手术治疗的为研究组,将不同方案下的效果进行对比。结果 研究组切口长度指标更低于参照组,术中出血量指标比较差异有统计学意义少于对照组,手术时间更短于参照组,比较差异有统计学意义（P<0.05）。研究组术后引流量指标均更低于参照组,术后活动时间及住院时间指标均更低于参照组,比较差异有统计学意义（P<0.05）。两组患者接受治疗前疼痛程度评分对比,无比较差异有统计学意义差异性（P>0.05）,治疗后研究组患者疼痛评分均更低于参照组,比较差异有统计学意义（P<0.05）。研究组治疗后并发症发生概率5.88%更低于参照组的21.57%,比较统计差异比较差异有统计学意义（P<0.05）。结论 在临床治疗腰椎间盘突出症过程中采取脊柱微创手术效果良好,比较差异有统计学意义地降低患者手术损伤,缓解了患者手术疼痛感,促进患者尽快术后康复,防止并发症的发生,适合于临床中应用。

目的 分析在胃癌诊断中应用人表皮生长因子受体2（HER-2）结合肿瘤标志物检测的意义。方法 回顾性选取2019年6月—2021年6月我院收治的100例胃癌患者作为胃癌组,另选同期收治的60例胃良性肿瘤患者作为胃良性肿瘤组。比较HER-2与多项肿瘤标志物检测的诊断效能等。结果 胃癌组HER-2、糖类抗原（CA）125、CA72-4及CA19-9浓度与阳性表达率高于胃良性肿瘤组（P<0.05）。对于胃癌诊断,免疫组化指标HER-2检测的敏感度为72.00%,正确率为77.00%;多项肿瘤标志物检测的敏感度为77.00%,正确率为80.00%;二者联合检测的敏感度为89.00%,正确率为90.00%;相较于多项肿瘤标志物与HER-2单一检测,二者联合检验的正确率、敏感度更高（P<0.05）。结论 HER-2结合血清肿瘤标志物检验对胃癌的诊断价值较高。

Objective To analyze the significance of human epidermal growth factor receptor 2（HER-2）combined with tumor marker in the diagnosis of gastric cancer．Methods A total of 100 patients with gastric cancer admitted to our hospital from June 2019 to June 2021 were retrospectively selected as the gastric cancer group, and 60 cases of gastric benign tumor admitted to our hospital during the same period were also selected．The diagnostic efficacy of HER-2 was compared with those of multiple tumor markers．Results The concentration and positive expression rate of HER-2, carbohydrate antigen（CA）125, CA72-4 and CA19-9 in gastric cancer group were higher than those in gastric benign tumor group（P<0.05）．For the diagnosis of gastric cancer, the sensitivity of the immunohistochemical indicator HER-2 detection was 72.00%, and the accuracy rate was 77.00%．The sensitivity and accuracy of detecting multiple tumor markers were 77.00% and 80.00%, respectively．The sensitivity of the combined detection of the two was 89.00%, and the accuracy was 90.00%．Compared to multiple tumor markers and HER-2 single detection, the combined test of the two had a higher accuracy and sensitivity（P<0.05）．Conclusions The detection of HER-2 combined with serum tumor markers has high diagnostic value for gastric cancer．

目的 探讨CT混合征和岛征及其联合征象对脑出血早期血肿扩大的临床预测价值。方法 将2018年12月—2020年12月河南宏力医院收治的脑出血患者86例作为研究对象,按照有无血肿扩大分为早期血肿扩大组(38例)和血肿未扩大组(48例)。分析CT平扫的岛征、混合征及联合征象对早期血肿扩大的影响,使用ROC曲线及曲线下面积(area under the curve,AUC)比较混合征、岛征及联合征对脑出血后血肿扩大的诊断效能。结果 混合征、岛征、联合征象诊断血肿扩大的灵敏度分别为65.79%、50.00%、84.21%,特异度分别为72.92%、83.33%、93.75%,阳性预测值分别为65.79%、70.37%、91.43%,阴性预测值分别为72.92%、67.80%、88.24%。不同影像学征象诊断血肿扩大的灵敏度、特异度、阳性预测值和阴性预测值差异均具有统计学意义(P<0.05)。ROC曲线分析中,混合征、岛征、联合征象诊断血肿扩大的AUC分别为0.690、0.656和0.811,P均小于0.05,其中联合征象的AUC最大。结论 CT征象中的混合征和岛征分别对脑出血早期血肿扩大的患者进行有效的预测,但相较于单独征象而言,二者的联合征象的诊断效能更高,对患者早期是否出现血肿扩大的现象诊断效能更具有科学性、高效性,为临床后期的治疗提供指导意义,同时也对患者疾病的恢复及预后起到积极作用。

目的 分析补阳还五汤加减治疗肾病综合征(NS)的临床疗效。方法 选择本院2019年1月—2021年1月住院治疗的120例NS患者,通过随机数字表法分组,参照组60例患者采纳常规西医治疗,试验组60例患者在参照组基础上予以补阳还五汤治疗,对比2组临床疗效、中医症候积分、肾功能指标、不良反应总发生率。结果 试验组临床总有效率(96.67%)高于参照组(80.00%),试验组治疗后浮肿少尿、腰膝酸软、腹部胀满、头晕乏力积分均低于参照组,差异均有统计学意义(P＜0.05)。治疗后试验组24 h尿蛋白、尿素氮均比参照组低,差异有统计学意义P＜0.05,血肌酐治疗前后差异无统计学意义P>0.05。试验组不良反应总发生率(5.00%)与参照组(6.67%)比较,差异无统计学意义(P>0.05)。结论 补阳还五汤可有效改善NS患者临床症状、肾功能,降低蛋白尿,且不良反应较少,安全性较高,疗效确切。

Objective To analyze the clinical effect of addition or reduction of Buyang Huanwu decoction in the treatment of nephrotic syndrome (NS). Methods A total of 120 NS patients in our hospital from January 2019 to January 2021 were divided into two groups by random digital table method. Sixty patients in the control group were treated by conventional western medicine, 60 patients in the experimental group were treated with Buyang Huanwu decoction on the basis of control group.The clinical efficacy, traditional Chinese medicine syndrome score, renal function index and total incidence of adverse reactions were compared. Results The total clinical effective rate of the experimental group (96.67%) was higher than that of the control group (80.00%). The scores of edema and oliguria, lumbar and knee pain and limpness, abdominal distention and dizziness after treatment in the experimental group were all lower than those in the control group, with statistical significance (P<0.05). After treatment, 24 h urinary protein volume and blood urea nitrogen level in the experimental group were lower than those in the control group, the differences were statistically significant (P<0.05), while there was no statistically significant difference in serum creatinine before and after treatment (P>0.05). There was no significant difference in the total incidence of adverse reactions between the experimental group (5.00%) and the control group (6.67%,P>0.05). Conclusion Buyang Huanwu decoction could effectively improve the clinical symptoms and renal function, reduce proteinuria, and had less adverse reactions, high safety level and accurate curative effect.