目的 探讨p16/Ki-67染色、HPV E6/E7mRNA和联合检测对HSIL+病变诊断的临床价值。方法 募集2017年3月—2020年8月期间,于中山市博爱医院妇产科就诊,组织学证实为宫颈炎患者209例、LSIL患者169例、HSIL患者131例和宫颈癌患者86例作为研究对象,回顾分析研究对象术前细胞学样本p16/Ki-67染色、HPV E6/E7mRNA检测结果,纵向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在不同级别宫颈病变的阳性率的差异,横向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在相同宫颈病变的阳性率的差异,综合评估p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+病变效能的差异。结果 ①纵向比较:p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率随宫颈病变程度的加重呈趋势性升高(p16/Ki-67染色:χ²=374.34,P<0.001;HPV E6/E7mRNA检测:χ²=289.21,P<0.001;联合检测:χ²=343.90,P<0.001)。②横向比较:在宫颈炎、LSIL、宫颈癌组,p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率之间差异均不具有统计学意义(均P>0.05)。在HSIL组,p16/Ki-67染色和联合检测之间阳性率差异有统计学意义(χ²=8.09,P=0.004); HPV E6/E7mRNA和联合检测之间阳性率差异有统计学意义(χ²=11.30,P=0.001)。③p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的灵敏度,总体差异有统计学意义(χ²=7.69,P=0.021)。p16/Ki-67染色与联合检测法之间的灵敏度差异有统计学意义(χ²=7.29,P=0.007);HPV E6/E7mRNA检测与联合检测法之间的灵敏度差异有统计学意义(χ²=4.84,P=0.028)。p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的特异度及符合率的总体差异不具有统计学意义(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628)。结论 p16/Ki-67染色、HPV E6/E7mRNA 和联合检测均可有效筛出HSIL+病变,但是联合检测能显著提高HSIL+病变诊断的灵敏度,降低漏诊率,同时保持了较好的特异度和符合率,建议将p16/Ki-67染色和HPV E6/E7mRNA联合检测作为早期诊断HSIL+病变的策略。

Objective To investigate the clinical value of p16/Ki-67 staining E6/E7 mRNA and combined detection in the diagnosis of HSIL+ lesions. Methods From March 2017 to August 2020,209 cases of cervicitis,169 cases of LSIL,131 cases of HSIL and 86 cases of cervical cancer confirmed by histology were selected as the research objects. The results of p16/Ki-67 staining and HPV E6/E7 RNA detection of the preoperative cytological samples were retrospectively analyzed and the p16/Ki-67 staining and HPV E6/E7 mRNA detection results were compared longitudinally. The positive rates of E6/E7mRNA and combined detection in different grades of cervical lesions were compared.The positive rates of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the same cervical lesions were compared horizontally.The differences in the diagnostic efficacy of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+lesions were comprehensively evaluated. Results ①Longitudinal comparison:the positive rates of p16/ Ki-67 staining, HPV E6/E7mRNA and combined detection increased with the severity of cervical lesions(p16/Ki-67 staining:χ²=374.34,P<0.001;HPV E6/E7 mRNA detection:χ²=289.21,P<0.001;joint detection:χ²=343.90,P<0.001). ②Transverse comparison: in cervicitis, LSIL and cervical cancer groups,there were no significant differences in the positive rates of p16/Ki-67 staining, HPV E6/E7 mRNA and combined detection (all P>0.05). In the HSIL group,there was significant difference in the positive rate between p16/Ki-67 staining and combined detection (χ²=8.09,P=0.004)and the difference between HPV E6/ E7 mRNA and combined detection was statistically significant(χ²=11.30,P=0.001). ③The sensitivity of p16/Ki-67staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+ was statistically significant(χ²=7.69,P=0.021). The sensitivity difference between p16/Ki-67 staining and combined detection was statistically significant(χ²=7.29,P=0.007);the sensitivity difference between HPV E6/E7 mRNA detection and combined detection method was statistically significant (χ²=4.84,P=0.028). There was no significant difference in the specificity and coincidence rate of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628). Conclusion P16/Ki-67 staining,HPV E6/E7 mRNA and combined detection may effectively screen out HSIL+ lesions,reduce the missed diagnosis rate, but the combined detection may significantly improve the sensitivity of diagnosis of HSIL+ lesions, while maintaining good specificity and coincidence rate.It is suggested that p16/Ki-67 staining and HPV E6/E7 mRNA detection should be used as a strategy for early diagnosis of HSIL+ lesions.

目的 探讨肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值。方法 选取2018年1月—2020年1月我院收治的64例肝硬化患者(肝硬化组),并纳入同期来我院接受健康体检者64例(对照组),应用全自动血凝仪对肝硬化患者临床凝血指标检测。再将肝硬化组患者分为出血组与无出血组,比较对照组与肝硬化组、出血与无出血组、不同肝功能分级患者血小板参数与PT检测结果。结果 与对照组比较,肝硬化组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与肝硬化无出血组比较,肝硬化出血组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与Child-Pugh A级患者比较,肝硬化Child-Pugh B级与C级患者PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05)。结论 在肝硬化患者病情评价中凝血功能检验发挥重要作用,可为患者临床治疗提供有效理论依据,诊断准确率较高,有利于临床治疗措施制定。因此,凝血功能检验应在肝硬化疾病诊断中广泛应用。

Objective To explore the application and clinical value of automatic blood coagulation apparatus in clinical coagulation function test of patients with cirrhosis. Methods A total of 64 patients with cirrhosis admitted to our hospital from January 2018 to January 2020 (cirrhosis group) were selected, and 64 healthy subjects admitted to our hospital during the same period (control group) were included. The clinical coagulation indexes of patients with cirrhosis were detected by automatic blood coagulation apparatus. Patients in cirrhosis group were divided into bleeding group and non-bleeding group; platelet parameters and PT test results were compared between control group and cirrhosis group, bleeding group and non-bleeding group, and patients with different liver function grades. Results Compared with the control group, the levels of PDW, PT, MPV and INR in cirrhosis group were higher, and the levels of PCT and PLT were lower (P＜0.05). Compared with liver cirrhosis non-bleeding group, the levels of PDW, PT, MPV and INR were higher in liver cirrhosis with bleeding group, and the levels of PCT and PLT were lower (P＜0.05). Compared with Child-Pugh A patients, the levels of PDW, PT, MPV and INR in Child-Pugh B and C patients with cirrhosis were higher, and the levels of PCT and PLT were lower (P＜0.05). Conclusion The test of coagulation function plays an important role in the evaluation of patients with cirrhosis, and can provide effective theoretical basis for the clinical treatment of patients with high diagnostic accuracy, which is conducive to the formulation of clinical treatment measures. Therefore, the test of coagulation function should be widely used in the diagnosis of cirrhosis.

目的 分析睾丸非肿瘤性病变的超声与CT诊断价值。方法 回顾性分析58例经临床病史、超声、CT或病理证实的睾丸非肿瘤性病例,结合临床病史,分析其超声与CT表现,包括炎性(或感染性)病变、外伤性病变、先天性病变及扭转急症。结果 所有病例均行CT检查,睾丸炎症性病变共39例(包括一般性炎症,脓肿和结核),其中19例行超声检查;睾丸外伤8例,隐睾9例,睾丸扭转2例,均行超声检查。睾丸炎症性病变临床表现为患侧或双侧阴囊不同程度的红、肿、痛,或白细胞升高、其他脏器伴发结核,超声表现为睾丸体积不同程度增大,根据炎症坏死程度不同,回声表现为回声均质、回声减低、回声不均质,坏死灶内无血流信号;CT表现为睾丸体积增大,根据炎症性病变的不同可表现为睾丸轻度强化、环形强化,可伴有睾丸鞘膜积液、点状钙化或积气;睾丸外伤均有阴囊外伤史,根据受伤程度表现为白膜下血肿、实质出血、睾丸破裂;隐睾表现为睾丸位置异常或缺如;睾丸扭转表现为睾丸短时间内剧烈疼痛,并进行性加重,超声表现为“镯环征”,CT表现为精索扭转、水肿,睾丸实质水肿。结论 睾丸非肿瘤性病变超声与CT征象均具有特征性,结合患者病史可作出准确诊断。超声检查较为便捷,CT检查可免除受检者接触性疼痛、可对盆腔及腹腔进行更为全面的观察。

Objective: Discussion on diagnosis of testicular non-tumorous lesions by ultrasound and CT.Methods: Rretrospective analysis of 58 testicular non-tumor cases proved by clinical history, Ultrasound, CT or pathologically,combined with the clinical history, and analysis of the Ultrasound and CT features,including inflammatory or infectious disease, traumatic disease, congenital disease and acute torsion.Results: All cases were examined by CT,the testicular inflammatory lesions were 39 cases, 19 of them were examined by ultrasound; testicular trauma 8 cases,cryptorchidism 9 cases, testicular torsion in 2 cases, all of them were examined by ultrasound. The clinical symptom of the inflammatory lesions of the ipsilateral or bilateral scrotum with different degrees of red, swollen, painful, or leukocytosis, other organs associated with TB, Ultrasound showed the testicular volume increased to varying degrees,according to the degree of inflammation and necrosis, the echo showed homogeneous echo, echo reduction, echo heterogeneity, and no blood flow signal in the necrotic area.CT showed an increase in testicular volume, according to the different inflammatory lesions showed mild enhancement of testis, ring enhancement, with a hydrocele, calcification or gas; testicular trauma had scrotal trauma history, according to the severity of injury showed subcapsular hematoma, hemorrhage and rupture of testis; testicular cryptorchidism showed abnormal position or absent; testicular torsion showed testicular short time severe pain, and progressive, Ultrasound showed “bracelet ring sign”, CT showed testicular torsion, edema, testicular parenchyma edema.Conclusion: Ultrasound and CT features of testicular non-tumorous lesions are characteristic, and the accurate diagnosis can be made with the combination of the patient's clinical history. Ultrasound examination is more convenient, CT examination can relieve the patient's contact pain, can be more comprehensive observation of the pelvic and abdominal.

目的 分析血清过敏原检测在小儿过敏性紫癜中的临床价值。方法 本次研究对象选惠州市第一人民医院儿科以及惠州市中心人民医院儿科2015年2月—2017年3月收治的80例过敏性紫癜患儿（观察组）和同期80例健康体检儿童（对照组）。分别检测血清特异性IgE（包括食物组及吸入组）,然后进行对比分析。结果 观察组儿童食物组血清过敏原特异性IgE抗体检测阳性率为96.25%、吸入组血清过敏原特异性IgE抗体检测阳性率为85%,均高于对照组,（P<0.05）,差异有统计学意义。结论 对于过敏性紫癜患儿或其他过敏性疾病患儿可进行血清过敏原检测,从而快速、准确的找到过敏原,并在临床治疗及日常生活中加以避免,有利于疾病的治疗和预防疾病复发。

目的 分析针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的临床效果。方法 选择我院收治的乳腺肿物患者200例进行观察（2012年1月—2017年12月）,针对200例乳腺肿物患者存在的305个乳腺不可触及肿物进行活检检查,采用随机分组的方式将其分成两组后针对常规组100例乳腺肿物患者实施传统手术治疗,针对治疗组100例乳腺肿物患者实施超声引导下微创旋切活检术治疗,对比两组的治疗效果。结果 两组乳腺肿物患者之间对比的术中出血量、术后愈合时间、术后并发症发生率、治疗显效率存在差异（P<0.05）,统计学有意义;且超声引导下微创旋切活检术对于乳腺癌的诊断检出率较高。结论 针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的疗效显著,促进患者预后。

Objective To analysis of the clinical effect of ultrasound guided minimally invasive rotary biopsy for untouchable breast masses. Methods A total of 200 patients with breast masses were selected for observation （January 2012 to December 2017）, and 305 untouchable breast masses in 200 patients were examined by biopsy. It was divided into two groups randomly and then treated with traditional surgical treatment for 100 patients with breast masses in the routine group and 100 patients with breast masses in the treatment group with minimally invasive biopsy under the guidance of ultrasound. The therapeutic effects of the two groups were compared. Results There were differences between the two groups in the amount of intraoperative bleeding, postoperative healing time, the incidence of postoperative complications and the effective rate of treatment （P < 0.05）, and the differences were statistically significant （P < 0.05）. The diagnostic rate of breast cancer was higher with minimally invasive rotary biopsy guided by ultrasound. Conclusion The effect of ultrasound-guided minimally invasive rotary biopsy on untouchable breast masses is significant and promotes the prognosis of the patients.

目的 探讨妇科门诊宫颈癌高危人群采取阴道镜检查后配合宫颈细胞学检查对宫颈癌筛查价值。方法 选取2016年2月—2017年4月我院妇科门诊就诊合并宫颈癌高危患者387例为研究对象,所有患者均行阴道镜检查和宫颈细胞学检查,以最终病理检查为诊断“金标准”,探究阴道镜、宫颈细胞学检查在宫颈癌中筛查灵敏度、特异度及阳性符合率。结果 387例纳入研究宫颈癌高危患者,经病理诊断后明确诊断为宫颈癌51例,占13.18%。细胞学检查在宫颈癌中筛查灵敏度为72.55%,特异度为90.48%,阳性符合率为88.11%。阴道镜检查在宫颈癌中筛查灵敏度为50.98%,特异度为94.64%,阳性符合率为88.89%。宫颈癌筛查中,细胞学检查灵敏度高于阴道镜检查,特异度低于阴道镜检查(P＜0.05),两者检查阳性符合率比较差异无统计学意义(P＞0.05)。结论 妇科门诊宫颈癌高危患者宫颈筛查中,阴道镜筛查具有较高特异度,细胞学检查具有较高灵敏度,联合检查能提高筛查价值。

目的 探讨血清胱抑素C、尿酸及降钙素原对诊断急性心肌梗死的临床价值。方法 回顾性分析我院134例心肌梗死患者及89名健康人血清胱抑素C、尿酸及降钙素原水平。结果 与健康对照组相比,实验组患者血清Cys-C、UA和PCT均有不同程度的升高,且差异有统计学意义。此外,血清Cys-C和PCT升高的水平与心肌梗死程度有关。结论 血清Cys-C、UA和PCT水平均可以作为AMI的临床指标,并且血清Cys-C和PCT在一定程度反映心肌梗死的严重程度。

       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%（χ ² =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%（χ ² =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%）（χ ² =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%）（χ ² =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．