目的 探讨华南地区自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)临床特点,提高对该病的认识。方法 回顾性总结2010年1月—2020年1月期间收治的居住在华南地区AIH-PBC OS患者37 例,对患者的临床表现、血清学、影像学和病理学特点,伴发肝外自身免疫性疾病等情况进行分析。结果 37例AIH-PBC OS以女性(94.6%)为主,平均发病年龄(48.3±10.3)岁,确诊年龄(50.4±9.2)岁,病程(2.7±2.5)年。83.8%患者存在临床症状,以乏力纳差,身目黄染、尿黄及瘙痒最为常见。在所有患者中,诊断为慢性肝炎为45.9%,代偿性肝硬化为18.9%,失代偿性肝硬化为35.1%,合并肝外自身免疫性疾病占35.1%,以自身免疫性甲状腺疾病和干燥综合征最常见。血清谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、碱性磷酸酶、总胆红素、总胆固醇、低密度脂蛋白胆固醇水平均升高,失代偿肝硬化期患者血红蛋白和白蛋白下降(P<0.05)。近一半患者血清免疫球蛋白G、免疫球蛋白M和免疫球蛋白A水平升高,失代偿肝硬化期患者免疫球蛋白G升高最为明显(P<0.05)。自身抗体包括抗核抗体阳性率、抗线粒体抗体和(或)抗线粒体抗体M2型抗体阳性率、抗平滑肌抗体阳性率、抗核点蛋白抗体阳性率、抗核包膜蛋白抗体阳性率分别为92%、67.6%、10.8%、11.1%、13.8%。病理学提示AIH-PBC OS患者可见汇管区淋巴细胞和浆细胞浸润,肝小叶界面炎,并伴有不同程度小胆管病变,70.2%同时伴有AIH-PBC特征。肝脏影像学显示在所有患者中,29.7%存在肝硬化,18.9%存在门静脉高压,62.2%存在脾大,18.9%存在腹腔积液。结论 AIH-PBC OS同时具有AIH及PBC疾病的临床特点,病情较复杂、发病较隐蔽;同时伴有血脂代谢障碍,且容易并发肝外自身免疫性疾病。

目的 探究铁死亡相关的lncRNA在肺鳞状上皮细胞癌(简称肺鳞癌)患者中的预后意义。方法 从美国癌症和肿瘤基因图谱数据库(the Cancer Genome Atlas,TCGA)中下载肺鳞癌数据551例,包括49例正常对照样本和502例肺鳞癌患者样本。筛选出与铁死亡相关基因的共表达的lncRNA,使用单变量Cox回归进一步筛选lncRNA,然后,使用Lasso回归和多元Cox回归分构建铁死亡相关的lncRNA模型。建立基于模型的风险评分,并使用Cox回归测试其是否为独立的预后因素。铁死亡相关lncRNAs的功能富集使用基因本体(Gene Ontology)和京都基因和基因组百科全书(Kyoto Encyclopedia of Genes and Genomes)可视化。结果 4个预后铁死亡相关的lncRNA(AC253536.6,FLJ46906LUCAT,AC022150.2)显著不同,这构建了铁死亡相关的lncRNA模型。此模型将肺鳞癌患者分为低风险组和高风险组。基于模型的风险评分是肺鳞癌患者的显著独立因素(HR =2.116,95％CI=1.513~2.961;P<0.001)。此外,4个lncRNA在铁死亡过程,代谢和肿瘤经典途径中均显著富集。结论 4个铁死亡相关的lncRNAs可能是肺鳞癌患者的分子生物标志物和治疗靶标。

Objective To explore the prognostic significance of ferroptosis related lncRNAs in patients with lung squamous cell carcinoma. Methods Data of 551 lung squamous cell carcinoma cases was downloaded from the Cancer Genome Atlas (TCGA) of the United States, including 49 normal control samples and 502 lung squamous cell carcinoma samples. The lncRNAs co-expressed with genes related to ferroptosis was screened out. Univariate Cox regression was used to further screen out the lncRNAs. Then, Lasso regression and multiple Cox regression were used to construct lncRNA models related to ferroptosis. A model-based risk score system was established and Cox regression was used to test whether it was an independent prognostic factor. The functional enrichment of ferroptosis related lncRNAs were visualized using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Results The four prognostic ferroptosis related lncRNAs (AC253536.6, FLJ46906 LUCAT, AC022150.2) were significantly different, and the ferroptosis lncRNAs model was constrncted with them. This model divided lung squamous cell carcinoma patients into low-risk group and high-risk group. The model-based risk score was a significant independent factor for patients with lung squamous cell carcinoma (HR=2.116, 95% CI=1.513-2.961; P<0.001). In addition, the four lncRNAs were significantly enriched in metabolism and tumor classical pathways during the ferroptosis process. Conclusions The four ferroptosis lncRNAs could be molecular biomarkers and therapeutic targets for patients with lung squamous cell carcinoma.

目的 比较来曲唑和氯米芬治疗极严重少精子症的治疗效果。方法 选取2020—2021年在本生殖中心门诊50例极严重少精子症病例,分为2组,A组(来曲唑,研究组n=26)、B组(氯米芬,对照组n=24)。结果 来曲唑和氯米芬治疗后1月、3月,A组精子浓度明显提高,优于B组[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]。通过卵胞浆内单精子注射/体外受精胚胎移植治疗,A组妊娠16例(61.5%),B组妊娠11例(45%)。2组治疗后的血清卵泡刺激素、黄体生成素、睾酮升高[(5.9±3.8) vs (20.3±2.6);(3.6±2.8) vs (9.5±5.7);(13.6±10.5) vs (25.3±10.8),P<0.05],A组雌二醇水平降低[(36.8±20.6) vs (7.6±2.5),P<0.05]。结论 来曲唑治疗极严重少精子症有较理想的临床治疗效果,明显优于氯米芬。

Objective To explore and compare the therapeutic effects of letrozole and clomiphene in the treatment of extremely severe oligospermia. Methods A tatal of 50 cases of extremely severe oligosperospermia in the reproductive center from 2020 to 2021 were selected and divided into two groups, group A (letrozole, study group n=26) and B (clomiphene, control group n=24). Results After letrizole and clomiphene treated for 1 and 3 months, sperm concentration in group A was significantly better than group B[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]. With ICSI/IVF, 16 cases (61.5%) succeed in encyesis in group A, 11 cases (45%) in group B. Serum follicle stimulating hormone, luteinizing hormone and testosterone levels were significantly increased after treatment [(5.9±3.8) vs (20.3±2.6), (3.6±2.8) vs (9.5±5.7), (13.6±10.5) vs (25.3±10.8), P<0.05]. The level of estradiol in group A decreased [(36.8±20.6) vs (7.6±2.5), P<0.05]. Conclusions Letrozole has ideal clinical treatment effect, which is obviously superior to clommiphene.

目的 研究自适应调强放疗(ART)同步铂类化疗治疗局部晚期宫颈癌患者的可行性。方法 选取我院诊治的92例局部晚期宫颈癌患者,随机分为研究组与对照组各46例,其中对照组行调强放疗(IMRT)同步铂类化疗,研究组行ART同步铂类化疗。治疗8周后,比较2组患者临床疗效;于治疗前后比较2组患者肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平;以急性放射损伤分级标准(RTOG)和常见不良反应事件评价标准(CTCAE)比较2组患者不良反应发生情况。结果 治疗8周后,研究组客观缓解率高于对照组(P＜0.05);2组患者CEA、SCC-Ag水平均较治疗前降低,且研究组低于对照组 (P＜0.05);研究组基于RTOG的消化道反应等级与泌尿系统反应等级均低于对照组(P＜0.05);2组患者基于CTCAE的肝功能损害与皮疹评级相比,差异无统计学意义(P＞0.05)。结论 ART同步铂类化疗治疗局部晚期宫颈癌患者疗效较好,使患者病情好转,同时安全性突出,切实可行。

Objective To study the feasibility of adaptive radiotherapy (ART) combined with platinum chemotherapy in the treatment of locally advanced cervical cancer. Methods A total of 92 patients with locally advanced cervical cancer treated in our hospital were randomly divided into study group and control group, with 46 cases in each group. The control group received intensity-modulated radiation therapy (IMRT) combined with platinum chemotherapy and the study group received ART combined with platinum chemotherapy. After 8 weeks of treatment, the clinical effects of the two groups were compared. The levels of tumor markers [carcinoembryonic antigen (CEA) and squamous cell carcinoma associated antigen (SCC-Ag)] were compared between the two groups before and after treatment. The incidence of adverse reactions in the two groups was compared with the grading standard of Acute Radiation Injury Group (RTOG) and Common Terminology Criteria for Adverse Events (CTCAE). Results After 8 weeks of treatment, the Objective remission rate in the study group was higher than that in the control group (P<0.05). The levels of CEA and SCC-Ag in the study group were significantly lower than those in the control group (P<0.05). The reaction grades of digestive tract and urinary system based on RTOG in the study group were significantly lower than those in the control group (P<0.05). There was no significant difference in CTCAE based liver function impairment and rash rating between the two groups (P> 0.05). Conclusions ART combined with platinum chemotherapy is effective and safe in the treatment of locally advanced cervical cancer.

目的 探讨在慢性肾炎中采用厄贝沙坦＋肾炎康复片对肾功能的影响。方法 在我院肾内科2018年3月—2020年8月收治的慢性肾炎患者中随机选取80例,按照抽签法分为2组,对照组(40例)采用厄贝沙坦,研究组在其基础上加用肾炎康复片,对比2组肾功能指标、临床疗效及不良反应。结果 治疗后2组肾功能指标均好转,且研究组血肌酐、尿素氮、24 h尿蛋白量均低于对照组,肾小球滤过率高于对照组(P＜0.05)。2组治疗总有效率对比差异显著(P＜0.05),不良反应对比无差异。结论 在对慢性肾炎的治疗中联用厄贝沙坦及肾炎康复片可有效提高肾功能,疗效显著。

Objective To investigate the effect of irbesartan and Shenyan Kangfu Tablet on renal function in chronic nephritis. Methods A total of 80 patients of chronic nephritis admitted in our hospital from March 2018 to August 2020 were randomly selected and divided into two groups by drawing lots. The control group (40 cases) received irberartan, while the research group added Shenyan Kangfu Tablet on the basis of irberartan. The renal function indexes, clinical efficacy and adverse reactions of the two groups were compared. Results After treatment, renal function indexes in both groups were improved, and serum creatinine, urea nitrogen and 24 h urinary protein levels in the research group were lower than those in the control group, and glomerular filtration rate was higher than that in the control group (P<0.05). The total effective rate was significantly different between the two groups (P<0.05), but there was no difference in adverse reaction rate. Conclusions In the treatment of chronic nephritis, irbesartan combined with Shenyan Kangfu Tablets could effectively improve renal function, and the effect is significant.

目的 对比不同血管通路运用于血液透析中的透析充分性及并发症发生率分析。方法 选取我院2018年5月—2020年10月收治的其中60例血液透析患者作为研究对象,根据患者不同血管通路分为3组,甲组30例,采取自体动静脉内瘘为通路方式,乙组15例,采取聚四氟乙烯移植血管内瘘为通路方式;丙组15例,采取带隧道和涤纶套的透析导管为通路方式。观察并记录3组患者透析后的血红蛋白、高密度脂蛋白、总胆固醇、C反应蛋白、血浆清蛋白、低密度脂蛋白、尿素清除指数、甘油三酯、尿素降低率水平,并对患者随访10个月,观察3组患者血管通路并发症(感染及血栓栓塞)的发生情况。结果 透析后3组患者血红蛋白、总胆固醇、高密度脂蛋白、甘油三酯、血浆清蛋白、C反应蛋白、低密度脂蛋白、尿素清除指数、尿素清除率比较,差异无统计学意义(P>0.05)。甲组的感染和血栓栓塞发生率低于乙组和丙组,而乙组的感染率又低于丙组,差异有统计学意义(P<0.05)。结论 自体动静脉内瘘可以做为血液透析治疗中血管通路的首选方式,若患者自体血管条件有限,可考虑建立移植血管内瘘来保证透析的充分性,降低并发症发生率,提高患者透析安全性及生活质量。

Objective To compare the dialysis adequacy and complication incidence of different vascular access in hemodialysis. Methods A total of 60 hemodialysis patients treated in our hospital from May 2018 to October 2020 were selected as the research objects. They were divided into three groups according to different vascular access. Thirty patients in group A took autologous arteriovenous fistula (AVF) as the access, and 15 patients in group B took polytetrafluoroethylene graft (arteriovenous grafts,AVG) as the access, 15 cases in group C were treated with dialysis catheter with tunnel and polyester sleeve (tunnel-cuffed catheter,TCC). The levels of hemoglobin, high density lipoprotein, total cholesterol, C-reactive protein, plasma albumin, low density lipoprotein, urea clearance index, triglyceride and urea reduction ratio (URR) were observed and recorded. The patients were followed up for 10 months to observe the incidence of vascular access complications (infection and thromboembolism) in the three groups. Results There was no significant difference in hemoglobin, total cholesterol, high density lipoprotein, triglyceride, plasma albumin, C-reactive protein, low density lipoprotein, urea clearance index and URR among the three groups after dialysis (P>0.05). The incidence of infection and thromboembolism in group A was lower than that in group B and group C, while the infection rate in group B was lower than that in group C, the differences were statistically significant (P<0.05). Conclusions AVF can be used as the preferred way of vascular access in hemodialysis treatment. If the patient's autologous vascular conditions are limited, it can be considered to establish transplanted vascular fistula (AVG) to ensure the adequacy of dialysis, reduce the incidence of complications and improve the dialysis safety and quality of life of patients.

目的 分析妊娠期肝内胆汁淤积症(ICP)孕妇与正常孕妇围产结局及ICP孕妇不同总胆汁酸水平对围产结局及新生儿的影响,为做好ICP孕妇的妊娠期管理及其新生儿预后评估提供参考依据。方法 以2010年3月—2020年3月在我院分娩的ICP孕妇 249例为观察组,同期分娩的249例正常孕妇为对照组,比较2组围产结局相关指标。结果 观察组羊水污染、新生儿黄疸、新生儿呼吸窘迫综合征发生率均高于对照组,根据总胆汁酸水平分组,重度组早产、羊水污染发生率高于轻度组,以上差异均有统计学意义(P＜0.05)。总胆汁酸水平是ICP孕妇发生早产的危险因素(P＜0.05)。结论 ICP孕妇总胆汁酸水平可用于发生早产的预测,及时干预有利于提高其围产期质量。

Objective To analyze the perinatal outcome of women with intrahepatic cholestasis of pregnancy (ICP) and normal pregnant women and the effects of different levels of total bile acid in ICP women on perinatal outcome and newborn. To provide a reference for the management of pregnancy and prognosis of ICP women. Methods From March 2010 to March 2020, 249 women with ICP delivered in our hospital were included as the observation group, 249 normal pregnant women delivered in the same period as the control group, the perinatal outcomes of the two groups were analyzed and compared. Results The incidences of amniotic fluid contamination, neonatal jaundice and neonatal respiratory distress syndrome in the observation group were higher than that in the control group. Grouping by the total bile acid level, the incidences of premature delivery and amniotic fluid contamination in the severe group were higher than that in the mild group, with statistical significance (P<0.05). Total bile acid level was a risk factor for premature delivery in women with ICP (P<0.05). Conclusions The level of total bile acid in women with ICP can be used to predict the occurrence of premature delivery, and timely intervention is beneficial to improve the perinatal quality of ICP women.

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 探讨肠道病毒相关性脑炎患儿的临床特点;以期能为临床医师对该病的认识提供一定的帮助。方法 回顾性分析2018年1月—2019年12月广州市妇女儿童医疗中心感染科收治的37例肠道病毒相关性脑炎患儿的临床相关资料。结果 37例患儿男28例,女9例,男女比例3.11:1。主要临床症状体征发热(97.30%)、口腔疱疹和(或)皮疹(54.05%);常见神经系统症状呕吐(56.76%)、头痛(56.76%)、惊厥(29.72%),其中惊厥及呕吐头痛症状≤1岁组与其他年龄组差异有统计学意义;脑脊液检查白细胞升高为主;所有患儿均康复出院且无神经系统后遗症。结论 儿童肠道病毒相关性脑炎近一半患儿临床无咽部疱疹或皮疹表现,1岁以内患儿主要以发热及惊厥为主要表现,大于1岁尤其学龄前期及学龄期患者以发热呕吐伴头疼为主要表现;早期诊治预后良好。

Objective To explore the clinical characteristics of children with enterovirus associated encephalitis, in order to provide some help for clinicians to understand the disease. Methods The clinical data of 37 children with enterovirus related encephalitis treated in the infection department of Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were analyzed retrospectively. Results There were 28 males and 9 females, with a male to female ratio of 3.11:1. The main clinical symptoms and signs were fever (97.30%), oral herpes and/or rash (54.05%); the common nervous system symptoms were vomiting (56.76%), headache (56.76%) and convulsion (29.72%). There were significant differences in convulsion, vomiting and headache symptoms between ≤ 1 year old group and other age groups. The leukocytes level in cerebrospinal fluid was elevated. All children recovered and discharged without neurological sequelae. Conclusions Nearly half of children with enterovirus associated encephalitis had no clinical manifestations of pharyngeal herpes or rash. The main manifestations of children under 1 year old were fever and convulsion. The main manifestations of children over 1 year old, especially preschool and school-age patients, were fever and vomiting with headache. Early diagnosis and treatment had good prognosis.

目的 分析探讨健康驿站新冠病毒肺炎病例感染来源,评估驿站站内感染风险,规范驿站管理,降低感染风险。方法 对驿站2022年2月21日—3月9日全部14例新冠肺炎病例自入境到报告进行全链条风险分析。结果 14例病例为7批次不同时间入住,其中病例1、2、3、4、5、6、7、8、9、10、12、13共12例病例入境后即确诊,病例11入住5天(其共同入境、同住人员病例10,入境后即确诊)确诊、病例14入住10天发病确诊,其余病例均未呈现感染发病时间特异性,未呈现入境后交叉感染时间特异性,未见入住后空间、通风系统、排污系统交集,未见交叉感染情况。结论 该驿站目前报告新冠肺炎病例均有相关旅居史,主要在香港本土感染。13名病例大概率均在香港感染,入境隔离时发病确诊,其中病例1、2、3、4,病例6、7、8,病例10、11是3起呈现家庭聚集性感染发病,病例5、9是独立个案,病例14需要进一步排除,驿站未规范管理会导致误报及进一步扩大站内感染风险。

Objective To investigate and analyze the source of infection of COVID-19 cases in health station, assess the risk of infection, standardize the management and reduce the risk of infection. Methods From February 21 to March 9, 2022, the whole chain risk analysis of all 14 COVID-19 cases from entry to reporting was carried out. Results Fourteen cases were admitted in 7 batches at different times. Except for case 11 who diagnosed at the 5th day (the case of co-entry and co-resident case 10 was diagnosed after entry), and case 14 who diagnosed at the 10th day, the rest of the cases were diagnosed after entry, which did not show infection-onset time specificity, no time specificity of cross-infection after entry, no intersection of space, ventilation system and sewage system after entry, and no cross-infection. Conclusions The COVID-19 cases reported by the station were mainly infected in Hong Kong. Those 13 cases were highly likely infected in Hong Kong, all were diagnosed at the time of entry quarantine, while cases 1~4, cases 6~8, and cases 10~11 were 3 cases of family cluster infection, case 5 and 9 were an independent case, and case 14 needed to be further investigation. Failure to standardize the management of the station will lead to false alarms and further increase the risk of infection in the station.