目的 探讨分析胃肠道套细胞淋巴瘤的临床病理学特点分析及预后情况。方法 选取2019年1月—2021年2月间赣州市人民医院收治的50例胃肠道套细胞淋巴瘤患者为观察组,选取本院同期就诊的50例非胃肠道套细胞淋巴瘤患者为对照组。结果 50例胃肠道套细胞淋巴瘤患者的主要临床表现以腹痛为主占比50.00%;好发于回盲部、回肠、升结肠、直肠、乙状结肠,占比依次为54.00%、42.00%、36.00%、36.00%、28.00%;以多发性黏膜息肉样病变40.00%多见,死亡16例(32.00%)。年龄＞60岁、伴有脾脏肿大的胃肠道套细胞淋巴瘤死亡率更高(P<0.05)。观察组患者浅表淋巴结侵犯的比例明显高于对照组(P<0.05)。结论 胃肠道套细胞淋巴瘤主要表现为腹痛等,多发于结直肠,浅表淋巴结侵犯相对更多,以多发性黏膜息肉样病变多见,年龄＞60岁、伴有脾脏肿大的患者预后相对较差。

目的 分析基于微信平台步行运动训练对慢性充血性心力衰竭(CHF)患者心脏康复水平的影响。方法 本次研究对象来源于梅州市中医医院一内科2020年11月—2021年12月住院的90例CHF患者,根据随机数字表法分组(每组n=45),对比组给予常规药物治疗,观察组在对比组基础上给予基于微信平台步行运动训练治疗,对比两组临床疗效、心脏功能指标、血清NT-proBNP、D-D、6分钟步行距离、日常生活能力评分、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果 观察组临床总有效率(95.56%)高于对比组(66.67%),观察组治疗后左心室舒张末期内径、左心室收缩末期内径均低于对比组,观察组治疗后左室射血分数高于对比组,观察组治疗后血清NT-proBNP、D-D均低于对比组,观察组治疗后6分钟步行距离、日常生活能力评分均高于对比组,观察组治疗后MLHFQ评分低于对比组,P＜0.05(差异均具有统计学意义)。结论 基于微信平台步行运动训练可有效改善CHF患者心功能,抑制NT-proBNP、D-D高表达,提高日常生活能力、生存质量。

Objective To analyze the effect of walking training through Wechat on cardiac rehabilitation of chronic congestive heart failure (CHF) patients. Methods A total of 90 patients with CHF hospitalized in the First Internal Medicine Department of Meizhou Traditional Chinese Medicine Hospital from November 2020 to December 2021 were enrolled in this study. They were divided into two groups according to the random number table method (45 patients in each group).The control group was given routine drug treatment,and the observation group was given walking training through Wechat on the basis of control group. The clinical efficacy,cardiac function indexes,serum NT-proBNP,D-D levels,6-minute walking distance,ability of daily life (ADL) score and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score were compared between two groups. Results The total clinical effective rate of the observation group (95.56%) was higher than that of the control group (66.67%),the LVEDd and LVESd of the observation group were lower than those of the control group after treatment,the LVEF of the observation group was higher than that of the control group after treatment,the serum NT-proBNP and D-D levels of the observation group were lower than those of the control group after treatment,the 6-minute walking distance and ADL score of the observation group were higher than those of the control group after treatment,and the MLHFQ score of the observation group was lower than that of the control group after treatment,P<0.05 (the difference was statistically significant).Conclusions Walking training by Wechat could effectively improve the cardiac function of CHF patients,inhibit the high expression of NT proBNP and D-D,and improve the ability of daily living and quality of life.

目的 分析中枢神经系统孤立性纤维瘤(SFT)11例患者的临床特点、影像学及病理学表现、手术结果。方法 回顾性分析2013年—2021年于广州医科大学附属第二医院神经外科接受手术并经病理检查证实为中枢神经系统SFT的11例患者的临床资料。结果 11例患者主要症状为头晕、头痛或肢体乏力。MRI:病灶主要表现为T1WI等-低信号,T2WI混杂信号或等-稍高信号。病理组织学:镜下表现为疏密不一的梭形肿瘤细胞呈交替排列。免疫组化:肿瘤细胞主要表现为STAT6阳性、CD34阳性等特点。病灶全切除患者预后较好,病灶次全切除或既往有SFT复发病史患者容易再次复发。结论 中枢神经系统SFT患者MRI T2WI信号有助于诊断,但是最终诊断依靠病理学检查。手术切除是首选的治疗方式。

Objective To analyze the clinical features,radiological and pathological manifestations and surgical results of 11 patients with solitary fibrous tumors (SFT) of the central nervous system (CNS). Methods The clinical data of 11 patients with SFT of CNS confirmed by pathological examination in the Neurosurgery Department of the Second Affiliated Hospital of Guangzhou Medical University from 2013 to 2021 were retrospectively analyzed. Results The main symptoms of 11 patients were dizziness,headache or extremity weakness. MRI: the lesions mainly showed iso-low signal on T1WI,mixed signal or iso-slightly high signal on T2WI. Histopathological features: microscopically,there were alternating rows of spindle tumor cells with irregular density. Immunohistochemistry showed that the tumor cells were STAT6 positive,CD34 positive,etc. Patients with total resection of the lesion had a better prognosis. Patients with subtotal resection of the lesion or previous history of SFT relapse were prone to relapse. Conclusions MRI T2WI signals in patients with CNS SFT were helpful for diagnosis,but the final diagnosis depended on pathology. Surgical excision is the preferred treatment.

目的 探究合并下胫腓联合韧带损伤的踝关节骨折患者实施手术固定治疗的临床价值。方法 遴选2018年1月—2020年12月70例合并下胫腓作者联合韧带损伤的踝关节骨折患者,根据随机数字表法分2组,开展石膏外固定治疗35例(记对照组),开展手术内固定治疗35例(记观察组),评估2组治疗优良率、治疗康复情况、踝关节功能(Kofoed评分)以及日常生活能力(ADL评分)、术后并发症率。结果 观察组治疗优良率94.29%相较对照组77.14%更高(P＜0.05);观察组康复速率更快,二次手术率更低(P＜0.05);术前2组Kofoed评分、ADL评分比较,均无统计学差异(P＞0.05),术后观察组Kofoed评分、ADL评分较对照组更高(P＜0.05);观察组术后并发症率低于对照组(P＜0.05)。结论 对合并下胫腓联合韧带损伤的踝关节骨折患者开展实施手术内固定治疗,对骨折早期愈合及修复韧带损伤具有显著价值,降低二次手术率及控制术后并发风险,促进关节功能早日恢复,实现理想的临床疗效。

Objective To explore the clinical value of surgical fixation in patients with ankle fracture with lower tibiofibular syndesmosis injury.Methods A total of 70 patients with ankle fracture and lower tibiofibular syndesmosis injury from January 2018 to December 2020 were selected and divided into two groups according to the random number table method.Thirty-five cases were treated with external plaster fixation (control group) and 35 cases were treated with internal surgical fixation (observation group).The treatment and rehabilitation outcomes,ankle function (Kofoed score) and ability of daily living (ADL score),postoperative complication incidence rate of the two groups were evaluated.Results The effective rates of treatment were 94.29% and 77.14% in observation group and control group (P＜0.05).The observation group has a faster recovery rate and a lower rate of secondary operations (P＜0.05).There were no significant difference in Kofoed score and ADL score between the two groups before operation (P>0.05).After operation,the Kofoed score and ADL score in the observation group were significantly higher than those in the control group (P<0.05). The postoperative complication incidence in the observation group was significantly lower than that in the control group (P<0.05).Conclusions The implementation of internal surgical fixation in patients with ankle fracture and lower tibiofibular syndesmosis injury had significant value for early fracture healing and ligament injury repair,reduced the secondary operation rate and controlling the postoperative complication risk,promoted the early recovery of joint function and achieved ideal clinical effect.

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 观察聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)与重组人粒细胞刺激因子(rhG-CSF)在造血干细胞移植后促进造血恢复的疗效对比。方法 回顾分析2016年1月—2020年12月以来在深圳市第二人民医院血液科进行造血干细胞移植的恶性血液疾病患者共 100例,随机分为2组,分别在造血干细胞回输后给与聚乙二醇化重组人粒细胞刺激因子与重组人粒细胞刺激因子。结果 PEG-rhG-CSF组与rhG-CSF组中性粒细胞植入时间分别为(18.7±3.4)天、(18.0±3.1)天,P=0.281,无统计学差异。粒细胞缺乏伴发热在PEG-rhG-CSF组与rhG-CSF组分别发生26例、29例,发生率分别为53.06%、56.86%,P=0.89,无差异。用药次数分别为2.6次(2~5次)、18.1次(11~31次),P<0.05,差异有统计学意义。不良反应主要为骨痛、肌肉疼痛。结论 PEG-rhG-CSF组与rhG-CSF组结果相似,PEG-rhG-CSF具有用药次数少的优势。

Objective The efficacy of pegylated recombinant human granulocyte stimulating factor (PEG-rhG-CSF) and recombinant human granulocyte stimulating factor(rhG-CSF) in promoting hematopoiesis recovery after hematopoietic stem cell transplantation.Methods The data of 100 patients with malignant blood diseases who underwent hematopoietic stem cell transplantation in the Hematology Department of Shenzhen Second People's Hospital from January 2016 to December 2020 were retrospectively analyzed.They were randomly assigned to two groups,which accepted PEG-rhG-CSF and rhG-CSF respectively after hematopoietic stem cell transfusion.Results The time of neutrophil implantation in PEG-rhG-CSF group and rhG-CSF group were (18.7±3.4) days and (18.0±3.1) days respectively,P=0.281,showing no statistical difference.There were 26 cases of neutropenia with fever in PEG-rhG-CSF group and 29 cases in rhG-CSF group,with incidence of 53.06% and 56.86% (P=0.89),showing no statistical difference.The times of medication were 2.6 times (2-5 times) and 18.1 times (11-31 times),P<0.05,with significant statistical difference.The main adverse reactions were bone pain and muscle pain.Conclusions The outcomes of PEG-rhG-CSF group and rhG-CSF group were similar,PEG-rhG-CSF had the advantage of fewer times of medication.

目的 了解广东肇庆怀集县农村妇女两年来“两癌”检测的阳性情况及高危型人乳头瘤病毒(HPV)的感染特点。 方法 对2018年1月—2019年12月24 146名参与“两癌”免费检测的35~64 岁、农村妇女的宫颈癌筛查结果进行分析。以高危型HPV检测作为初筛方法,结果为HPV16、18型阳性的转诊阴道镜检查,其它高危型HPV阳性则进行薄层宫颈液基细胞学检查(TCT),TCT结果严重于或等于未明确意义的非典型鳞状上皮(ASC-US)者转诊阴道镜,阴道镜结果可疑或异常者进行组织病理学检查。 结果 高危型HPV总检出率为9.35%,单独HPV16、18和其它高危型HPV的阳性检出率分别为0.70%、0.32%、7.72%,混合感染检出率为0.61%,高危型 HPV 总检出率最高的年龄段是 60~64岁,检出率为11.22%。细胞学转诊率为65.63%,阴道镜转诊率为61.23%。宫颈癌前病变检出率为323.03/10 万,宫颈癌的检出率为45.56/10 万,早期诊断率为87.64%。宫颈癌前病变和宫颈癌的HPV16、18及混合感染占70.79%。 结论 该地区高危型HPV阳性率、宫颈癌前病变及宫颈癌检出率均较高,宫颈癌筛查异常者细胞学及阴道镜转诊率较低,提示该地区存在更高的宫颈癌发病风险。

Objective To understand the positive screening results and the infection characteristics of high-risk human papillomavirus (HPV) in Huaiji County,Guangdong Province,in the two years of the free standardization testing for rural women's “two cancers”. Methods The cervical cancer screening results of 35~64 year-old women with rural household registration who volunteered to participate in the “two cancers” free testing for rural women in the region were analyzed. High-risk HPV testing was used as the primary screening method for cervical cancer. The results of HPV16 and 18 positive patients were directly referred to colposcopy. If other high-risk HPV was positive,thin-layer cervical fluid-based cytology(TCT) was perform on those patients,whose TCT result severer than atypical squamous cells of undetermined significance (ASC-US) were referred to colposcopy,and those with suspicious or abnormal colposcopy results were referred to histopathological examination. Results The total positive detection rate of high-risk HPV was 9.35%. The positive rates of HPV16,18 and other high-risk HPV were 0.70%,0.32% and 7.72% respectively,mixed infection rate was 0.61%. The age group with the highest overall positive rate of high-risk HPV is 60-64 years old,and the rate is 11.22%. The referral rate for cytology was 65.63%,and the referral rate for colposcopy was 61.23%. The positive rate of cervical precancerous lesions was 323.03/100 000,the positive rate of cervical cancer was 45.5/100 000,and the early diagnosis rate was 87.64%.HPV16,18 and HPV mixed infections of cervical precancerous lesions and cervical cancer accounted for 70.79%.Conclusions The positive rate of high-risk HPV,cervical precancerous lesions and cervical cancer positive rate were high in this area. The being referred rate of cytology and colposcopy in cervical cancer screening was low,suggesting that there was a higher incidence of cervical cancer in this area risk.

目的 分析传染性单核细胞增多症患者临床症状和异型淋巴细胞百分比(ALY%)、肝功能等实验室检查特点,为临床提高对该病的诊断、病情评估和治疗提供参考。方法 2017年1月— 2019 年6月在深圳市中医院儿科住院治疗的73例传染性单核细胞增多症患儿,采取回顾分析法,归纳总结患者的临床症状,根据患者的异型淋巴细胞数量进行分组,A组异型淋巴细胞数量占比为4.5%～10.0%(8例);B组异型淋巴细胞数量占比为10.01%~15.0%(15例); C组异型淋巴细胞数量占比为15.01%～20%(20例); D组异型淋巴细胞数量占比为20.01%～25.0%(13例); E组异型淋巴细胞数量占比超过25.01%～30%(17例)。总结本病的临床特点,分析异型淋巴细胞百分比和肝功能损伤的相关性。结果 1.传染性单核细胞增多症的主要临床表现为发热、咽痛、伪膜和颈部淋巴结肿大。2.随着异型淋巴细胞百分比的增加,AST异常患儿越多,当异型淋巴细胞数量占比超过25.01%,AST明显升高,提示肝功能损伤越严重。结论 传染性单核细胞增多症患者的异型淋巴细胞数量与肝功能损伤存在一定的联系,可以作为患者病症诊断的重要参考,随着异性淋巴细胞百分比增加,患儿肝功能异常出现比率越高,可以指导临床判断预后和治疗。

目的 分析肺炎支原体RNA实时荧光恒温扩增技术(MP-SAT)作为肺炎支原体肺炎(MPP)患儿疗效监测指标的可行性。方法 选择2017年10月—2018年10月我院儿科收治的因CAP住院的患儿178例为研究对象,其中MPP组80例,非MPP组98例,分别检测血清MP抗体(MP-Ab)和咽拭子MP-RNA,对两种方法检测结果进行统计学分析,以MP-Ab检测为诊断MPP的参照试验,分析MP-SAT诊断MPP的准确性,对MP-SAT和MP-Ab均阳性的MPP病例行动态观察,比较MP-SAT和MP-Ab在患儿不同治疗时间点的检出率,分析MP-SAT转阴时间与临床痊愈时间的相关性,分析MP-SAT转阴时间与MPP患儿临床症状、实验室指标及X线胸片的相关性。结果 MP-SAT和MP-Ab结果不一致的比例在MPP组和非MPP组分别为60.00% (48/80)和19.39%(19/98);MP-SAT、MP-Ab在特异性和阳性预测值方面,差异有统计学意义(P＜0.05);MP-SAT、MP-Ab在敏感度和阴性预测值方面,差异无统计学意义(P＞0.05);MP-SAT、MP-Ab均为阳性28例(35.00%),MP-SAT阳性检出率随治疗时间的延长降低(P＜0.05),MP-Ab阳性检出率随治疗时间的延长升高(P＜0.05);28例临床痊愈时间为(3.11±0.88)周,MP-SAT转阴时间为(3.25±0.74)周,差异无统计学意义(P＞0.05);MP-SAT转阴时间越长的病例表现为发热持续时间越长,X线胸片肺大片实变比例越高,CRP水平越高,LDH水平越高,中性粒细胞百分比越高,淋巴细胞百分比越低(P＜0.05)。结论 MP-SAT作为新一代RNA活菌检测技术在支原体肺炎患儿疗效监测中有较高的价值,值得推广。

Objective To investigate the feasibility of Mycoplasma pneumoniae-simultaneous amplification and testing (MP-SAT)as a monitoring index for children with Mycoplasma pneumoniae pneumonia (MPP). Methods 178 hospitalized children with community-acquired pneumonia (CAP)in our hospital from October 2017 to October 2018 were selected and divided into two groups, namely MPP group (n=80)and non-MPP group (n=98). Serum MP antibody (MP-Ab)and throat swab MP-RNA were detected separately. The MP-Ab test was used as a reference for the analysis of accuracy of MP-SAT for MPP diagnosis. The MPP patients with positive MP-SAT and positive MP-Ab were observed dynamically. The detection rates of MP-SAT and MP-Ab in different treatment time points were compared. The correlation of MP-SAT negative time with clinical recovery time, clinical symptoms, laboratory parameters and chest X-ray was analyzed. Results The ratio of inconsistent MP-SAT and MP-Ab results was 60.00% (48/80)and 19.39% (19/98)in the MPP group and the non-MPP group, respectively. The MP-SAT and MP-Ab were statistically different in terms of specificity and positive predictive value (P<0.05), while no difference was found in the sensitivity and negative predictive value (P>0.05). Both MP-SAT and MP-Ab were positive in 28 cases (35.00%). The positive rate of MP-SAT was decreased with the prolongation of treatment time (P<0.05), meanwhile the positive rate of MP-Ab was increased with the treatment time (P<0.05); the clinical recovery time of 28 cases was (3.11±0.88)weeks, and the MP-SAT negative time was (3.25±0.74)weeks, with no statistical difference (P>0.05). The long-term duration of MP-SAT was characterized by long duration of fever, high consolidation rate of X-ray chest radiograph, high CRP level, high LDH level, high percentage of neutrophils, and low percentage of lymphocytes (P<0.05). Conclusion MP-SAT, as a new generation of RNA live bacteria detection technology, has high value in monitoring the efficacy of Mycoplasma pneumonia in children, and it is worth promoting.

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.