目的 探讨内镜活检Crohn病（CD）的临床病理特征,为临床提供更可靠的诊断。方法 回顾性分析内镜活检12例CD的临床表现、内窥镜特征,采用HE染色及免疫组化EnVision二步法。结果 显微镜下CD的组织学形态主要特征是非干酪样坏死性肉芽肿、裂隙状溃疡、黏膜及黏膜下层不均匀分布的重度炎症,淋巴管扩张和纤维组织增生,免疫组化染色CD68、D2-40、S-100均表达。结论 CD是一肿少见的炎症性肠病,回盲部及末段回肠是最好发部位,主要表现反复腹泻、血便等症状,内镜下见多灶溃疡,不连续性病变等特征,组织学见裂隙性溃疡,黏膜及黏膜下层的重度炎症且不均匀分布,位于生发中心的非干酪结节病样肉芽肿、淋巴管扩张和纤维组织增生等非特异性特征,可靠的病理诊断要结合临床、内镜、影像等检查及多部位多次活检。

Objective To investigate the clinical and pathological features of endoscopic biopsy tissue of Crohn disease （CD） and further to provide more reliable evidence for clinic. Methods A retrospective analysis of 12 cases of endoscopic biopsy tissue about CD’s clinical manifestations and endoscopic features,by HE staining and immunohistochemistry EnVision two-step method. Results The morphology of CD specimen is characterized by non-caseous necrotizing granuloma,ulceration,mucosal and submucosal uneven distribution of severe inflammation,dilated lymph vessels and fibrous hyperplasia. Immunohistochemical staining , all of cases express CD68,D2-40 and S-100. Conclusion CD is a rare inflammatory bowel disease. The majority of CD arises in ileocecal and terminal ileum. The main symptoms show repeated diarrhea,bloody stool and others. Endoscopic examination revealed multifocal ulcers,discontinuous lesions and other characteristics. Histological examination showed that there were nonspecific features such as fissure ulcer,severe inflammation in mucosa and submucosa with uneven distribution,non-caseous sarcoid-like granuloma in the germinal center,lymphangiectasis and fibrous tissue hyperplasia. An reliable pathological diagnosis is made that depends on many examinations including clinical,endoscope,radiology and multiple biopsy.

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 分析葡萄糖酸钙口服液在预防单采献血不良反应特别是心血管不良反应的价值。方法 随机选取3 504例在我中心单采血小板献血者作此次研究对象,将抽取对象分为比对组(n=1 728)和探析组(n=1 776),对探析组献血者进行血小板采集前为其提供葡萄糖酸钙口服液,比对组献血者不接受任何预防措施,献血过程中对献血者进行动态血压检测及动态心电图检测。结果 对比组共发生不良反应为278例(16.08%):其中全身性不良反应无晕厥78例(4.51%);全身不良反应晕厥18例(1.04%);单采相关性的不良反应中的枸橼酸盐反应为182例(10.53%);未见溶血反应和过敏反应。探析组共发生不良反应为155例(8.72%):其中全身性不良反应无晕厥54例(3.04%);全身不良反应晕厥20例(1.12%);单采相关性的不良反应中的枸橼酸盐反应为85例(4.78%);未见溶血反应和过敏反应。探析组单采相关性的不良反应中的枸橼酸盐反应显著减少。2组差异均有统计学意义(P<0.05)。比对组与探析组中,出现血压异常48例(2.78%)和12例(0.68%);心电图异常的89例(5.15%)和32例(1.80%);心率异常112例(6.48%)和38(2.14%)。为探析组的心血管不良反应的发生率低于比对组献血者,2组差异均有统计学意义(P<0.05)。结论 在献血者单采血小板为其提供葡萄糖酸钙口服液能够有效减少心血管不良反应,降低单采血小板不良反应发生率。

目的 通过皮肤点刺筛查慢性荨麻疹的变应原,为临床治疗提供依据。方法 采用“阿罗格”点刺液对2 974例临床确诊慢性荨麻疹患者行皮肤点刺试验进行29种变应原的检测,并设阳性(0.1%组胺)及阴性(生理盐水)对照,记录阳性反应的变应原和反应强度。结果 2 974名受试者中,呈阳性反应人数有1 052人,阳性率为35.37%;阳性反应结果中,受试者对蟑螂、粉尘螨、屋尘螨最为敏感,阳性率分别为78.80%、78.04%和73.76%;不同性别、月份、年龄组的阳性反应种数与反应强度无统计学上的差异:不同变应原的反应强度秩和检验(χ²=9 741.284,P<0.001)差异有统计学意义,受试者对蟑螂、粉尘螨、屋尘螨、杂草、虾和霉菌Ⅰ等的过敏强度较大。结论 皮肤点刺作为慢性荨麻疹筛查变应原的方法之一,能筛选出阳性反应强度最大的前几个变应原,临床能为患者进行行为干预规避过敏原或进一步脱敏治疗提供参考依据。

目的 探讨吗替麦考酚酯联合泼尼松治疗儿童紫癜性肾炎的临床疗效。方法 将2016年2月—2018年2月在广州开发区医院儿科和广州市第一人民医院儿科收治的36例紫癜性肾炎肾病综合征型患者根据治疗分为联合组和对照组,每组18例。联合组采用吗替麦考酚酯和泼尼松治疗,对照组采用泼尼松治疗。比较两组患儿治疗前后血肌酐(Scr)、总胆固醇(Chol)、24 h 尿蛋白定量、血白蛋白(ALB) 。结果 联合组治疗效果优于对照组,差异有统计学意义(Z=-2.461,P ＜ 0.05) ; 联合组治疗后24 h尿蛋白定量下降,血肌酐(Scr)降低,总胆固醇(Chol)下降和血白蛋白(ALB)升高,两组实验室指标差异有统计学意义(P＜ 0.05) 。结论 吗替麦考酚酯联合泼尼松治疗紫癜性肾炎治疗效果明确,可以降低血肌酐和胆固醇,改善尿蛋白水平,提升血白蛋白浓度,治疗效果明显,能有效控制病情,在临床上值得推广应用。

目的 探讨新生儿高促甲状腺素血症转归与先天性甲状腺功能减低的相关性。方法 选择2014年4月—2015年4月在本院新生儿疾病筛查中心筛查并诊断为高促甲状腺激素血症的患儿120例,期间密切监测甲状腺功能指标变化。结果 将非治疗组所有患儿按照入组该实验后首次抽取静脉血TSH检测水平分为3组:5.5~10.0 mU/L(20例)、10.1~15.0 mU/L(10例)、＞15.0 mU/L (8例)。非治疗组患儿第2次随访结果显示5.5~10.0 mU/L组所有患儿TSH水平<10.0 mU/L;10.1~15.0 mU/L组有1例患儿TSH水平＞10.0 mU/L,FT4水平在正常值上限;＞15.0 mU/L组有3例患儿 TSH水平＞10.0 mU/L,差异有统计学意义(P< 0.05),FT4水平在正常均值左右,差异没有统计学意义(P＞ 0.05),＞15.0 mU/L组3例患儿给予左旋甲状素钠治疗。治疗组有2例患儿分别在治疗15天和23天后出现医源性甲状腺功能亢进,停药和酌减药量后TSH、FT4水平均恢复正常。两组患者随访结束后TSH、TF4均恢复至正常水平。结论 大多数新生儿高促甲状腺素血症会随着年龄的增长恢复正常,而仅仅有少部分患儿会持续出现甲状腺功能异常,应积极随访;新生儿只有当TSH 基础值＞15.00 mU/L时才需要采用左旋甲状素钠替代治疗,并且严格随访甲状腺功能,避免过度治疗。

目的 了解老年冠脉支架植入患者的临床特征及治疗疗效。方法 按照纳入、排除标准入选2015年10月—2017年10月于我院住院并接受冠状动脉支架治疗的患者372例,分为女性组和男性组,收集临床资料并随访预后。结果 女性组157例,男性组215例,2组冠脉病变支数、发生心血管不良事件比例无统计学意义(P>0.05),女性组不稳定性心绞痛、合并糖尿病、高血压比例及胆固醇、甘油三酯、低密度脂蛋白、脂蛋白a、TSH水平均高于男性组(P<0.05),急性心肌梗死、吸烟比例及年龄、血肌酐均低于男性组(P<0.05)。结论 老年患者合并可控制的危险因素较多,女性要强调血糖、血脂的控制,男性要强调戒烟。冠脉病变支数、术后1年发生不良心血管事件比例无性别差异。

目的 了解我区慢性阻塞性肺疾病(COPD)稳定期患者药物使用现状,为临床规范治疗COPD指明方向。方法 对在我院治疗的COPD患者采取问卷调查的方式对其稳定期自我用药情况进行调查分析,调查内容包括吸烟史、病程、稳定期用药的种类、用药方式等。结果 我区COPD患者稳定期治疗药物种类繁多,应用LABA/ICS、吸入LAMA比例较低,存在滥用口服抗生素及无指征使用口服激素等不规范用药情况。结论 我区COPD患者稳定期药物部分符合COPD指南推荐,但存在不规范用药。

目的 探讨原发于前列腺的产黏液尿路上皮型腺癌的临床病理特征、诊断及鉴别诊断。方法 对1例极其罕见的原发于前列腺的产黏液尿路上皮型腺癌病例的临床诊治经过、病理组织学及免疫组织化学特征进行观察和总结,并复习国内外相关文献。结果 患者77岁,因排尿困难入院, B超提示前列腺增大,前列腺异常回声性质待查;CT及肠镜检查均未发现膀胱及结直肠恶性肿瘤;血清PSA未见升高。在当地医院行前列腺穿刺检查,病理诊断为前列腺黏液腺癌。遂于我院行腹腔镜下前列腺根治手术,镜下表现为黏液腺癌伴多量黏液湖形成,并见尿路上皮的腺性化生及原位腺癌与黏液腺癌的移行过渡;免疫组化示CK7及34βE12弥漫表达,CDX-2及CEA局灶表达,其余CK20、β-catenin、GATA3、PSA、PSAP、AR及P504S均阴性。结论 原发于前列腺的产黏液尿路上皮型腺癌十分罕见,其预后差,对内分泌治疗不敏感,准确诊断将有利于指导临床医生选择正确的治疗方法及评估其预后。

Objective To investigate clinicopathological characteristics, diagnosis and differential diagnosis of primary mucin-producing urothelial-type adenocarcinoma of prostate. Methods We reported a rare case of mucin-producing urothelial-type adenocarcinoma of prostate and reviewed relevant literatures to discuss the clinicopathological features, diagnosis and differential diagnosis. Results In this case, the patient was a 77-year-old male with the history of dysuria. B-ultrasound indicated benign prostatic enlargement and abnormal echogenicity remained to be determined. CT scan and gastrointestinal endoscopy didn't show any evidence of bladder and colorectal tumor. No serum prostate-specific antigen (PSA) increased. The patient underwent laparoscopic radical resection of prostate cancer. Microscopically, the tumor presented as mucinous carcinoma, similar to colorectal mucinous carcinoma, but the migration from the normal prostatic urethra was observed and the urethral epithelium at the transitional site was characterized by adenoepithelial metaplasia and adenocarcinoma in situ. Immunohistochemical staining showed neoplastic cells were diffuse and strongly positive for CK7 and 34βE12, focally positive for CDX-2 and CEA and negative for CK20, β-catenin, GATA3, PSA, PSAP, AR and P504S. Conclusion Mucin-producing urothelial-type adenocarcinoma of prostate is an extremely rare tumor. It has a poor prognosis and it is not sensitive to endocrine therapy.

目的 分析献血者献血后血肿(瘀斑)应用不同治疗方法的效果。方法 随机选取147例在广州血液中心献血后出现血肿(瘀斑)的献血者,根据其采用处理方式的差异分为甲组(n=66)、乙组(n=48)、丙组(n=33),为甲组献血者实施冷热敷法,为乙组献血者实施马铃薯片贴敷法,为丙组献血者实施喜辽妥(多磺酸粘多糖)软膏外敷法。结果 乙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=4.63,P＜0.05),丙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=13.99,P＜0.05),丙组献血者临床总有效率高于乙组献血者,2组差异有统计学意义(χ²=3.99,P＜0.05)。结论 献血者献血后血肿应用喜疗妥软膏外敷法疗效确切,可使其身心健康得到改善。

Objective To analyze the effects of different treatment methods on blood donors with haematoma(or bruise) after blood donation. Methods 147 blood donors with haematoma(or bruise) after blood donation in our blood station were randomly selected. According to the difference of treatment methods, they were divided into group A (n=66), group B (n=48) and group C (n=33), for the group A of blood donors to carry out cold and hot compress method, for the group B blood donors to implement the potato slice application method, for the group C blood donors to implement the hi-treatment ointment external application method. Results The total effective rate of group B blood donors was higher than that of group A blood donors. The difference was statistically significant (χ²=4.63,P＜0.05). The total clinical effective rate of group C blood donors was higher than that of group A blood donors. There is statistical significance (χ²=13.99,P＜0.05). The total effective rate of donors in group C was higher than that in group B. The difference between the two groups was statistically significant (χ²=3.99,P＜0.05). Conclusion The effect of external application of Hirudoid(Mucopolysaccharide Polysulfate Cream) on blood donors after blood donation is effective, which may improve their physical and mental health.