目的 探讨继发性肺结核合并肺部真菌感染的临床特点及相关高危因素。方法 收集广州市胸科医院2017年7月—2019年10月收治的继发性肺结核患者资料,病程均大于3个月,分为真菌感染组106例和非真菌感染组100例进行回顾性分析。结果 单因素分析结果显示,合并肺部其他疾病、非初治、咯血、空洞、应用广谱抗生素>l周、侵袭性操作存在统计学差异(P<0.05)。Logistic多因素分析结果显示,广谱抗生素使用>l周、侵袭性操作为真菌感染的独立危险因素(P<0.05)。结论 对于应用广谱抗生素、进行侵袭性操作的肺结核患者应警惕真菌感染风险,及早预防及诊治。

Objective To investigate the clinical characteristics and related high risk factors of secondary pulmonary tuberculosis complicated with pulmonary fungal infection. Methods Data of patients with secondary tuberculosis admitted to Guangzhou Chest Hospital from July 2017 to October 2019 were collected. All patients with a course of disease longer than 3 months were divided into the fungal infection group (n =106) and the non-fungal infection group (n =100) for retrospective analysis. Results Univariate analysis results showed that there were statistical differences in combined other pulmonary diseases, non-initial treatment, hemoptysis, cavity, application of broad-spectrum antibiotic > for 1 week, and invasive operation (P<0.05). Logistic multivariate analysis showed that >1 week of broad-spectrum antibiotics and invasive procedures were independent risk factors for fungal infection (P<0.05). Conclusion Patients with tuberculosis who are treated with broad-spectrum antibiotics and invasive procedures should be alert to the risk of fungal infection, early prevention and treatment should be undertaken.

目的 分析医院登革热阳性病例特别是重症患者的临床和实验室和流行病学特征可为登革热的早期诊断和预防控制提供依据。方法 收集2010年—2017年期间944例就诊于广州市第一人民医院并经实验室确诊的登革热患者。根据疾病的严重程度将入选患者分为3组,比较各组之间的临床和生物学变量,并使用多元回归分析了严重登革热的危险因素的影响。结果 本研究通过对7年间944例登革热患者进行回顾性分析发现登革热病例以轻症为主,77.5%的患者有基础疾病,主要为糖尿病(15.4%)和高血压患者(34%)。大部分患者就诊时表现为高热(39.05±0.67)℃,登革病毒IgM和(或)IgG阳性,白细胞及血小板减少明显及肝、肾功能异常。重症患者AST和LDH值相比轻症者升高。冠心病和肿瘤疾病的患者发生重症的比例更高。流行趋势分析显示7年间登革热出现1次爆发(2014年)。每年9～10月为登革热高发季节。登革热发病率在男女间无统计学差异。男性和女性的高发年龄分别71～80岁和51～60岁。10岁以下发病率最小,50～80岁年龄段发病率最高。结论 广州市第一人民医院登革热患者以老年人为主,基础性疾病患者是登革热高危人群。登革热患者具有高热、登革病原检测阳性、血象和肝肾功能异常的特征;临床医生在9～10月高发季节加强对高热患者的登革病原检查有利于登革热早期诊断和防治。

Objective The Guangzhou area is a high-risk area for dengue fever. This study aim to provide a basis for the early diagnosis and prevention of dengue fever by analyzing the clinical and laboratory characteristics and epidemiological analysis of dengue patients in Guangzhou,especially in critically ill patients. Methods A total of 944 patients with dengue fever diagnosed at the First People's Hospital of Guangzhou from 2010 to 2017 were collected. The enrolled patients were divided into 3 groups according to the severity of the disease,the clinical and biological variables between the groups were compared,and multiple regression analysis was used to analyze the effects of risk factors for severe dengue. Results This study retrospectively analyzed the clinical manifestations and laboratory tests of 944 patients with dengue fever in the past 7 years,showing that dengue fever cases in Guangzhou are mainly mild. 77.5% of them have underlying diseases,mainly diabetes (15.4%) and hypertension (34%). Most patients developed high fever (39.05±0.67)℃ at the time of seeing doctors,positive for dengue virus IgM and/or IgG,decreased white blood cells and thrombocytopenia,and abnormal liver and kidney function. AST and LDH values were significantly elevated in critically ill patients compared with mild cases. Patients with coronary heart disease and neoplastic disease have a higher proportion of severe cases. Epidemiological analysis of dengue virus showed an outbreak of dengue fever in 7 years (2014). September-October is the season of high incidence of dengue fever. The incidence of dengue fever was not statistically different between men and women. The high-incidence ages of men and women are 71～80 years old and 51～60 years old,respectively. The incidence rate is the lowest under the age of 10,and the highest in the 50～80 age group. Conclusion Dengue fever patients in Guangzhou are dominated by the elderly,and patients with underlying diseases are at high risk of dengue fever. Dengue fever patients have high fever,positive dengue pathogen detection,blood and liver and kidney dysfunction characteristics. Strengthening the dengue pathogen examination for hyperthermia patients during the high season of September-October is conducive to the early diagnosis and prevention of dengue fever.

目的 探讨特发性肺纤维化(IPF)患者和结缔组织病相关性纤维化间质性肺疾病(CTD-fILD)患者急性加重(AE)的短期内死亡的危险因素。方法 回顾性分析2017年10月—2019年9月在深圳大学和广州医科大学附属第一医院住院的25例 AE-CTD-fILD和26例AE-IPF患者临床信息,Kaplan-Merier法对两组患者进行生存分析,Cox回顾分析年龄、性别、吸烟、白细胞总数、C反应蛋白、红细胞沉降率及肿瘤指标在急性加重患者死亡中的作用。结果 与AE-CTD-fILD比较,AE-IPF患者组男性比例、年龄、吸烟比例较高,红细胞沉降率较低(24/26 vs 10/25,P<0.001;63.77±9.97 vs 58.00±10.32,P=0.048;16/26 vs 9/25,P=0.02;28.07±29.45 vs 64.35±40.34,P=0.002 );90天内,26例AE-IPF患者11例死亡,25例AE-CTD-fILD患者5例死亡,死亡率无明显差异(42.3% vs 20%,P=0.073);Cox回归分析显示,白细胞计数是AE-IPF和AE-CTD-fILD患者的死亡危险因素(HR=1.305,P=0.001;HR=1.529,P=0.009);CA15-3是AE-IPF患者死亡危险因素(HR=1.015,P=0.005)。结论 急性加重IPF和CTD-fILD患者短期内死亡风险相似,白细胞计数及外周CA15-3水平可能是肺纤维化急性加重患者短期内死亡的危险因素。

Objective To explore the risk factors for acute exacerbation (AE) in patients with idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated with fibrotic interstitial lung disease (CTD-fILD). Methods We retrospectively reviewed 25 patients with AE-CTD-fILD and 26 patients with AE-IPF, and Kaplan-Merier was used to analyze the survival of the two groups of patients. The impact of age,gender, smoking,WBC,CRP,ESR and tumor markers on acute exacerbation death were performed by Cox regression analysis. Results The AE-IPF patients had a higher proportion of men,age and smoking,and a lower ESR compared with AE-CTD-fILD patients(24/26 vs 10/25,P<0.001;63.77±9.97 vs 58.00±10.32,P=0.048;16/26 vs 9/25,P=0.02;28.07±29.45 vs 64.35±40.34,P=0.002 ). 11 cases of 26 patients with AE-IPF and 5 cases of 25 patients with AE-CTD-fILD died within 90 days, Log-rank tests showed patients with CTD-fILD had similar mortality rate compared with IPF patients after AE(42.3% vs 20%,P=0.073). The WBC count was negatively correlated with survival and the independent predictors for patients with AE-IPF and AE-CTD-fILD after adjusting for other clinical variates in Cox regression models(HR=1.305,P=0.001;HR=1.529,P=0.009). CA15-3 may be a risk factor for death of AE-IPF patients(HR=1.015,P=0.005). Conclusion AE-CTD-fILD and AE-IPF were associated with similar poor short-term survival, WBC count and plasma CA15-3 may be the independent survival predictors respectively for patients with acute exacerbation of pulmonary fibrosis in short term.

目的 探讨脑动静脉畸形(AVM)破裂出血发生的危险因素。方法 回顾性研究2014年—2018年我院收治的AVM病例42例,根据有无破裂出血,分为出血组和非出血组,对AVM破裂出血发生的相关因素进行统计学分析。结果 通过相关性及逐步回归分析,表明AVM破裂出血的独立危险因素为: 深部静脉引流和低龄患者。结论 对于引流静脉为深部静脉引流类型和低龄的AVM患者,应积极尽早治疗。

Objective To analyze the risk factors related to cerebral arteriovenous malformation(AVM)with hemorrhage. Methods The clinical data of 42 patients with AVM between 2014 and 2018 were respectively studied. According to the presence of rupture, the cases were divided into bleeding group and non-bleeding group. The factors associated with the occurence of AVM rupture were statistically analyzed. Results The correlation and logistic regression analysis suggested that the deep venous drainage and young patients were the independent risk factors for AVM rupture. Conclusion The young patients and the patients with deep venous drainage should be operated as soon as possible to avoid hemorrhage.

目的 了解新疆疏附县人民医院心脑血管疾病发病趋势和分析高血压发病相关危险因素,为高血压及其相关的心脑血管疾病的综合防治提供依据。方法 回顾性分析2007—2011年疏附县人民医院住院患者资料,按年份统计慢性非传染性疾病(以下简称慢性病)住院人数情况,并采用Logistic回归分析法分析维吾尔族人群高血压发病的相关危险因素。结果 新疆疏附县人民医院心脑血管疾病住院人数逐年增长,5年增长了约2.7倍,其中因高血压住院人数增长了3.5倍。BMI、血钠水平升高、血脂异常、年龄是维吾尔族人群高血压的危险因素。结论 新疆疏附县人民医院住院患者中以高血压为主的心脑血管疾病逐年增长。当地高血压及其相关的心脑血管疾病的防治采取生活方式干预基础上给予降压、降脂治疗的综合策略是优选。

Objective To investigate the incidence trend of cardio-cerebrovascular disease and the related risk factors about hypertension in Shufu people's hospital of Xinjiang. Moreover, to provide evidence of making prevention and controlling strategies for hypertension and the related cardio-cerebrovascular diseases.Methods A retrospective review was did on case data of the inpatients in Shufu people's hospital during 2007-2011.We counted the number of inpatients of chronic non-communicable diseases(NCDs)by year and collected the information of hypertensive inpatients and non-hypertensive inpatients to analyze the risk factors of hypertension in Uygurs using Logistic regression.Results The number of inpatients with cardio-cerebrovascular disease in Shufu people's hospital was increased by 2.7 times in 5 years, while the number of hypertensive inpatients was increased by 3.5 times. BMI, elevated blood sodium, and dyslipidemia, age are risk factors for hypertension in Uygur population.Conclusion The inpatients with cardio-cerebrovascular disease especially those with hypertension in Shufu people's hospital were increasing in recent 5 years. The strategy of lifestyle intervention combined with antihypertensive as well as lipid-lowering therapy is better to the prevention and treatment of hypertension and the related cardio-cerebrovascular diseases.

目的 分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺动脉高压(pulmonary hypertention,PH)的危险因素。方法 回顾2014年1月—2015年1月广州医科大学附属第一医院住院患者55例,经心脏彩色多普勒超声测量肺动脉收缩压(PASP),分为:轻度组(36≤PASP＜50 mmHg),中度组(51≤PASP＜70 mmHg)和重度组(PASP≥70 mmHg),分析比较三组临床特征,危险因素采用单因素及多因素Logistic回归分析。结果 年龄(75.3±11.6)岁,PASP为(52.6±15.1)mmHg。单因素分析中-重度PH与年龄、HCT、PaCO₂、PaO₂、D-二聚体有关;多因素Logistic回归分析确定3项危险因素:HCT[比值比(OR)=51.82,95% CI: 2.34～1149.02],RV(OR=4.53,95% CI: 2.83～7.27),及PaCO₂(OR=1.02,95% CI: 1.00～1.03)。结论 呼吸病相关PH多为轻-中度,高水平的HCT、RV直径及PaCO₂提示PH病情较重。

Objective To analyze the clinical risk factors of pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease(COPD). Methods A total of 55 hospitalized patients from 2014 to 2015 were enrolled in the study and were classified into three groups according to pulmonary artery systolic pressure (PASP) with echocardiography as follows: the mild group (36≤PASP＜50 mmHg), the moderate group (51≤PASP＜70 mmHg) and the severe group (PASP≥70 mmHg). Clinical data were recorded and retrospectively analyzed. Results The average age of all patients was (75.3±11.6)years. Echocardiography showed a mean PASP was 52.6±15.1 mmHg. Age, hematocrit (HCT), partial pressure of carbon dioxide (PaCO₂), the oxygen partial pressure (PaO₂), D-dimer and right ventricular (RV) diameter (>20 mm) were associated with moderate-to-severe PH on an univariate regression analysis, while RV (diameter >20 mm)[odds ratio (OR)=4.53, 95% CI: 2.83～7.27], HCT(OR=51.82, 95% CI: 2.34~1149.02) and PaCO₂ (OR=1.02, 95% CI: 1.00-1.03), to these patients, were independent risk factors using the multiple logistic regression analysis. Conclusion PH related to respiratory diseases is mostly mild-to-moderate. Haemoptysis,high levels of RV diameter, HCT and PaCO₂ suggest a serious condition of patients with PH related to chronic respiratory disease.

目的 探讨断指再植术后血管危象发生情况及危险因素。方法 收集2015年8月—2016年12月我院行断指再植术患者66例临床资料行回顾性分析,根据患者术后是否发生血管危象分为A组(发生血管危象)和B组(未发生血管危象),收集两组患者一般临床资料,采用单因素和多因素Logistic 回归分析影响断指再植术患者术后血管危象发生的危险因素。结果 单因素分析得出,性别、年龄、吸烟史、指别、外伤原因、末端断离及缺血时间在A、B两组间比较有统计学意义(P＜0.05)。多因素分析得出,性别、年龄、吸烟史、指别、外伤类型、末端断离、缺血时间均为影响断指再植术术后血管危象发生危险因素。结论 血管危象为断指再植术常见并发症,影响发生血管危象危险因素较多,临床中应针对性进行预防和干预,以降低断指再植术患者术后血管危象发生率,提高断指存活率。

目的 探讨规范二级预防下老老年人轻型卒中复发的危险因素。方法 收集我院80岁及以上、既往有轻型卒中病史、并进行规范二级预防半年以上的老老年患者的临床资料:一般资料、既往病史及用药情况、入院时血压及基础生化指标、影像学资料、缺血性卒中复发情况。根据有无复发缺血性卒中将患者分为复发组和无复发组两组,分析以上因素在两组间的差异。结果 80例患者中复发缺血性脑卒中共26例,复发率32.5%。统计结果显示,轻型卒中复发组与合并高血压病、入院时收缩压、D二聚体水平呈正相关,其相关系数分别为0.265(P=0.018)、0.232(P=0.038)和0.222(P=0.048)。复发组收缩压升高比例高于无复发组(χ²=6.919,P=0.031)。非条件Logistic多因素分析显示:合并高血压病[OR 95%CI=(1.162,10.230)]、收缩压升高[OR 95%CI=(0.997,68.840)]与轻型缺血性卒中复发相关。结论 合并高血压病、收缩压升高是老老年人轻型卒中规范二级预防下复发独立危险因素。

Objective To analyze the recurrence risk factors of aged patients with minor ischemic stroke under standardized secondary prevention. Methods Patients over 80 years old and with minor ischemic stroke history were enrolled, and the following data were collected: demographic characteristics, medical history, current medicine, blood test, imaging findings and recurrence of ischemic strokes. Patients were divided into two groups: the recurrence group and the non-recurrence group. Chi-square test,logistic regression models were performed to assess correlations between baseline variables and recurrence of minor stroke events. Results In our study, 26 patients had recurrent minor ischemic stroke(32.5%). The prevalence of recurrence of minor stroke was positively correlated with hypertension(CI 0.265, P 0.018), SBP(CI 0.232,P 0.038), d-2-dimer(CI 0.232,P 0.048). Patients in recurrence group are more likely to presented with SBP elevation compared to non-recurrence group(χ²=6.919, P=0.031). Unconditional logistic regression analysis showed that hypertension, especially high SBP significantly related to minor ischemic stroke recurrence. Conclusion Hypertension,especially elevated SBP, were considered as an independent risk factors for aged old patients with minor ischemic stroke who received standardized secondary prevention.

目的 分析影响广州青少年自杀行为的因素。方法 选取100例自杀行为青少年为观察组,选100例健康青少年为对照组,对比两组青少年家庭结构、家庭教育方式、自身人格特征等指标。多因素Logistic回归分析其自杀行为危险因素。结果 观察组青少年抑郁量表、焦虑量表、攻击性人格及冲动性人格量表分值均高于对照组高;单亲家庭或父母常年在外、家庭教育方式不当、学校无健康心理教育课、抑郁或焦虑、冲动或攻击性人格、负面事件、消极应对是青少年自杀行为独立危险因素,P均＜0.05。结论 家长及学校应正确引导青少年处事方式,积极面对生活,打消自杀意念。

Objective To analyze the factors influencing the suicide behavior of adolescents in Guangzhou. Methods The 100 cases of adolescent suicide behavior were selected as the observation group, 100 healthy adolescents were selected as control group, compared with two groups of adolescent family structure, family education, personality traits and other indicators. Multivariate logistic regression analysis of risk factors was taken for suicidal behavior. Results In the observation group adolescent depression scale, anxiety scale, attack impulse personality and personality amount scores were higher than those in the control group, single parent family or parents staying outside, improper family education, school health psychological education, depression or anxiety, impulsivity, or aggressive personality, negative events, negative coping were independent risk factors for adolescent suicide, P<0.05. Conclusion Parents and schools should have guide to adolescents, toface life positively, and give up thought of suicide.

目的 探讨2型糖尿病患者发生医院感染危险因素。方法 收集2010年1月—2015年1月我院收治890例2型糖尿病患者临床资料行回顾性分析,根据是否发生医院感染分为感染组(75例)和非感染组(815例),对两组患者相关因素进行分析。结果 2型糖尿病医院感染发生率为8.43%,好发于呼吸系统感染。年龄、病程、住院时间、血糖控制差、侵袭性操作、合并并发症、合并基础疾病为2型糖尿病患者发生感染的危险因素。结论 2型糖尿病患者发生医院感染危险因素较多,临床针对高危患者应重点进行预防,降低感染率,提高患者治疗效果。