目的 研究温肾利水汤联合贝前列素钠对老年原发性肾病综合征（PNS）患者T淋巴细胞亚群及肾功能的影响。方法 回顾性收集我院106例老年PNS患者临床资料（2024年4月-2026年1月），按照不同治疗方法分为研究组（n=55，温肾利水汤联合贝前列素钠）、对照组（n=51，贝前列素钠治疗）。比较两组治疗效果、中医证候积分、治疗前后肾功能[血尿素氮（BUN）、白蛋白（ABL）、血肌酐（SCR）]、T淋巴细胞亚群[CD4+、辅助性T细胞17（Th17）、CD3+]、不良反应。结果 治疗3个月后，研究组总有效率（92.73%）高于对照组（P<0.05）；治疗3个月后，研究组主证积分、次证积分均低于对照组（P<0.05）；治疗3个月后，研究组血清BUN、SCR水平低于对照组，ABL水平高于对照组（P<0.05）；治疗3个月后，研究组CD4+、CD3+高于对照组，Th17低于对照组（P<0.05）；两组不良反应发生率（5.45% VS 9.80%）相比，差异无统计学意义（P>0.05）。结论 温肾利水汤联合贝前列素钠治疗老年PNS患者能提高治疗效果，改善T淋巴细胞亚群水平，促进肾功能恢复。

目的 分析沙参麦冬汤联合硫酸羟氯喹对阴虚津亏型原发性干燥综合征（pSS）患者的治疗效果。方法 本研究采用回顾性病例对照研究，选取2023-11—2025-06期间我院确诊的114例pSS阴虚津亏型患者，依据治疗方案不同分成研究组（57例）、对照组（57例）。对照组接受硫酸羟氯喹治疗，研究组接受沙参麦冬汤、硫酸羟氯喹联合治疗，两组持续治疗2个月。观察并对比两组疗效、中医证候积分、外分泌腺功能（泪流量、唾液流率）、临床症状[欧洲抗风湿病联盟干燥综合征患者疾病活动指数（ESSDAI）、欧洲抗风湿病联盟干燥综合征患者报告指数（ESSPRI）]、免疫球蛋白[免疫球蛋白G（IgG）、IgA、IgM]水平。结果 与对照组70.18%相比，研究组治疗有效率91.23%明显较高（P＜0.05）；治疗2个月，与对照组相比，研究组中医证候积分较低，泪流量、唾液流率较高（P＜0.05）；治疗2个月后与对照组相比，研究组ESSDAI分值、ESSPRI分值明显较低（P＜0.05）；治疗2个月后与对照组相比，研究组血清IgG、IgA以及IgM水平明显较低（P＜0.05）；两组安全性对比，无明显差异（P＞0.05）。结论 沙参麦冬汤、硫酸羟氯喹联合治疗阴虚津亏型pSS效果确切，可减轻临床症状，改善免疫功能、外分泌功能，且无明显不良反应。

目的 探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法 选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者,均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查;以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能;分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性;比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果 DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P<0.05）;CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较,差异均无统计学意义（P>0.05）。在HCC MVI诊断效能中,CT、MRI影像学表现与术后病理确诊结果之间为中度一致性;DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P<0.05）。在不同b值（400、800、1 000、1 500 s/mm²）下,HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P<0.05）。结论 CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能,而MRI诊断结果与病理诊断一致性更佳,尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯,有助于指导临床医生建立“个体化”精准诊疗策略。

Objective To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024,all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen;postoperative pathology Results was used as the diagnostic gold standard．The diagnostic efficacy of CT,MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT,MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity,specificity,accuracy,positive predictive value,negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P<0.05）;none of the differences were statistically significant（P>0.05）in the comparison of diagnostic effectiveness of CT,MRI,and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness,moderate concordance was found among CT,MRI imaging phenotypes and postoperative pathology Results;high concordance was found between DWI and postoperative pathology Results．In HCC MVI patients,the proportion of non-marginal arterial reinforcement,enhanced envelope,halo reinforcement,nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P<0.05）．At different b-values（400,800,1 000,1 500 s/mm²）,ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P<0.05）．Conclusions CT,MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI,while MRI diagnostic Results are in better concordance with pathologic diagnosis．In particular,ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC,which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

目的 基于影像组学方法,探讨多层螺旋CT（MSCT）四期增强扫描单一/不同期相及不同容积感兴趣区（VOI）的选择,在术前预测原发性肝细胞癌（HCC）微血管侵犯（MVI）中的价值。方法 回顾性收集88例经手术病理证实为HCC并行术前MSCT四期增强扫描的患者,其中包括47例MVI阳性患者和41例MVI阴性患者。在MSCT增强扫描的动脉早期、动脉晚期、门静脉期及延迟期图像中手动逐层勾画肿瘤ROI,获得瘤体容积感兴趣区VOI（Vt）,然后基于计算机自动膨胀算法将Vt外扩10 mm获得瘤体及瘤周VOI（Vt+Vp）。使用Pyradiomics软件分别从Vt和Vt+Vp中提取影像组学特征,随后采用15种特征选择方法和10种分类器构建150个预测模型,并通过十折交叉检验以验证模型的效能。使用准确度、敏感度、特异度、受试者工作特性曲线下面积（AUC）评估模型的效能,并比较性能最优的前三个预测模型。结果 MSCT四期增强扫描图像中预测HCC MVI状态的影像组学模型在门静脉期的表现优于其它期相及各期相的不同组合,其中最大的AUC值在Vt和Vt+Vp两种ROI中分别为0.768和0.782。此外,基于Vt+Vp的影像组学模型对MVI的预测效能优于基于Vt的影像组学模型,基于Vt+Vp性能最优的预测模型的AUC值、准确度、敏感度和特异度分别0.782、0.728、0.745和0.705。结论 采用影像组学方法术前无创性预测HCC MVI状态首选增强扫描的门静脉期,ROI首选瘤体联合瘤周10 mm区域。

Objective To investigate the value of single or different phases of contrast-enhanced multi-slice spiral CT（MSCT）in different volumetric regions of interest（ROI）to preoperatively predict the state of microvascular invasion in primary hepatocellular carcinoma（HCC）based on radiomics methods．Methods A total of 88 patients with HCC confirmed by surgical pathology who underwent preoperative MSCT quadruple-enhanced scan were retrospectively recruited,including 47 MVI-positive patients and 41 MVI-negative patients．The ROI was manually delineated slice-by-slice in the early arterial phase,late arterial phase,portal venous phase,and equilibrium phase of enhanced MSCT images to obtain the volume of tumor VOI（Vt）,and then Vt was expanded by 10 mm through the computer expansion algorithm automatically to obtain the volume of tumor and peritumor（Vt+Vp）．Pyradiomics software was used to extract radiomic features from Vt and Vt+Vp,followed by 150 discriminant models constructed with 150 feature selection methods and 10 classifiers,and then 10-fold cross-validation was used to evaluate the performance of these models．Using accuracy,sensitivity,specificity,area under the receiver operating characteristic curve（AUC）to assess model performance．The top three predictive models with the best performance were also compared．Results The radiomics model for predicting HCC MVI status in portal venous phase among quadruple-enhanced MSCT images outperformed other phases and different combinations of phases,achieving the highest AUC values of 0.768 and 0.782 in Vt and Vt+Vp respectively．In addition,the prediction performance of the radiomics model based on Vt+Vp was superior to models based on Vt．AUC value,accuracy,sensitivity,and specificity of the model with the best performance based on Vt+Vp were 0.782,0.728,0.745 and 0.705 respectively．Conclusions Radiomics models based on the portal venous phase of contrast-enhanced MSCT and tumor combined with the 10mm peritumoral area were more recommended to be employed to preoperative non-invasively predict the state of HCC MVI．

目的 探讨多参数磁共振成像对T₁高信号间隔与非T₁高信号间隔的原发性鼻腔鼻窦黑色素瘤（PSM）的鉴别价值。方法 回顾性分析经病理证实的 PSM 44例,术前均接受常规,DWI 和DCE-MRI检查。通过单因素和多因素Logistic分析评估T₁高信号间隔与非T₁高信号间隔PSM各MRI参数的差异。结果 44例PSMs 中,T₁高信号间隔PSMs 25例,非T₁高信号间隔PSMs 19例。两者在多参数MRI中,仅T₂低信号间隔,ADC值、达峰时间（Tp）及最大相对增强率（MRER）在单变量分析中差异存在统计学意义（均P<0.05）,在多因素Logistic分析中差异均无统计学意义（P均>0.05）。结论 多参数MRI对区分T₁高信号间隔与非T₁高信号间隔的PSM具有一定的指导价值,但并不能作为区分两者的独立预测指标。

Objective To evaluate the diagnostic value of multi-parameter MRI in differential diagnosis of primary sinonasal melanoma（PSM）with high- and non-high-T₁ signal septa．Methods Forty-four patients pathologically confirmed with PSMs underwent conventional,DWI and DCE-MRI examinations before operation．Univariate and multivariate Logistic analyses were used to evaluate the differences of MRI parameters between high- and non-high-T₁ signal septa in PSMs．Results Among 44 PSMs,25 cases had high T₁ signal septa and 19 cases had non-T₁ high signal septa．In multi-parameter MRI,only T₂ low signal septa,the value of ADC,peak time（TP）and maximum relative enhancement rate（MRER）were significantly different in univariate analysis（P<0.05）,but not in multivariate Logistic analysis（P>0.05）．Conclusions Multi-parameter MRI has some value in differentiating PSM with high-T₁ and non-high-T₁ signal septa,but it can not be used as an independent predictor to distinguish them．

目的 分析CT+MRI在原发性肝癌诊断与介入治疗预后评估中的临床意义。方法 选定本院2019年1月—2021年1月住院治疗的150例原发性肝癌患者,入院后均接受介入治疗,分别予以CT、MRI检查,将手术病理检查结果作为本次研究的金标准,比较CT、MRI、CT+MRI诊断效能,Kappa检验CT、MRI、CT+MRI与金标准的一致性,比较CT、MRI、CT+MRI介入术后病灶检出率。结果 CT+MRI诊断准确率(98.67%)、特异度(75.00%)、灵敏度(99.32%)均高于CT(86.00%、25.00%、87.67%)、MRI(90.67%、91.78%、50.00%),P＜0.05(差异均有统计学意义),CT+MRI与金标准的一致性较好(Kappa值为0.779),CT、MRI与金标准的一致性一般(Kappa值为0.527、0.596)。CT+MRI介入术后病灶总检出率(12.00%)高于CT(2.00%)、MRI(4.00%),P＜0.05(差异有统计学意义)。结论 CT+MRI可提高原发性肝癌患者介入术后病灶检出率,弥补了单一CT、MRI检查的不足。

Objective To evaluate the clinical significance of CT + MRI scans in diagnosis of primary liver cancer and prognosis evaluation after interventional therapy. Methods A total of 150 cases of patients with primary liver cancer admitted to our hospital from January 2019 to January 2021 were selected. They all received interventional treatment, and were examined by CT and MRI. The results of pathological examination were taken as the gold standard in this study to compare the diagnostic efficacy of CT, MRI and CT+MRI.Kappa value was used to compare the consistency of CT, MRI, CT+MRI scans with gold standard, and compared the detection rate of lesions after CT, MRI and CT+MRI interventional surgery. Results The diagnostic accuracy (98.67%), specificity (75.00%) and sensitivity (99.32%) of CT + MRI scans were higher than those of CT (86.00%, 25.00%, 87.67%) and MRI scans (90.67%, 91.78%, 50.00%),P<0.05 (which differences were statistically significant). The consistency of CT + MRI scans with gold standard was good (kappa value was 0.779), but the consistency of CT/MRI scans with gold standard were not satisfying (kappa value were 0.527, 0.596). The total detection rate of lesions after CT + MRI interventional surgery (12.00%) was higher than that of CT (2.00%) and MRI (4.00%, which P<0.05). Conclusion CT + MRI scans can improve the detection rate of lesions in patients with primary liver cancer after interventional therapy, and make up for the deficiency of only CT or MRI scans.

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 研究探讨复合式小梁切除术治疗原发性闭角型青光眼(primary angel closure glaucoma,PACG)的疗效。方法 选取2017年6月—2019年5月我院眼科收治的PACG患者86例(98眼),所有患者入院前均确诊,按照随机数字表法分为对照组和研究组各43例。对照组以传统小梁切除术、研究组以复合式小梁切除术治疗,对比滤过泡情况、中央前房深度(CACD)、眼压(IOP)及并发症发生率。结果 研究组术后1个月、6个月Ⅰ~Ⅱ型滤过泡形成率均高于对照组,(P＜0.05)。术前,两组CACD、IOP对比差异无统计学意义(P＞0.05);术后1 d、1个月,研究组CACD均高于对照组,研究组IOP均低于对照组,(P＜0.05);术后6个月,两组IOP比较无统计学意义(P＞0.05);两组并发症比较,对照组并发症发生率38.00%,研究组6.25%,研究组低于对照组(P＜0.05)。结论 以复合式小梁切除术治疗PACG,能够促进功能性滤过泡形成、前房及IOP恢复,并能够减少并发症,临床效果优于传统小梁切除术。

目的 检测外周血循环肿瘤细胞(circulating tumor cell, CTC)在原发性肝癌患者中的表达情况,并探讨CTC动态变化及其相对于甲胎蛋白(Alpha fetoprotein AFP)对原发性癌患者术后复发转移的预测作用。方法 收集原发性肝癌患者134例,肝脏良性病变患者72例,检测外周血 CTC 数目,同时检测AFP的表达水平,分析 CTC 与 AFP 的相关性。然后在134名原发性肝癌患者中筛选出成功行肝癌根治术的患者,共86例,检测这86名患者术前、术后外周血CTC和AFP,分析CTC和AFP对原发性肝癌术后复发转移的评估价值。结果 原发性肝癌患者外周血CTC阳性率高于肝脏良性病变患者,差异有统计学意义(P＜0.05);原发性肝癌患者CTC水平与AFP水平、淋巴结转移、肿瘤结节多少有关,与年龄、性别、肿瘤直径、分化程度、肝硬化有无、TNM分期无关;原发性肝癌患者CTC和AFP生存分析显示,原发性肝癌根治术后早期复发转移与CTC和AFP密切相关;CTC较阳性对术后复发转移具有更好的诊断价值,二者联合对复发转移预测价值最高。结论 CTC可以做为一个比传统肿瘤标志物更好的对原发性肝癌术后复发转移进行监测的指标,与肿瘤标志物联合检测预测价值更高。

Objective To detect the expression of peripheral blood circulating tumor cells CTC in patients with primary liver cancer and to explore the dynamic changes of CTC and its predictive effect on postoperative recurrence and metastasis of primary cancer. Methods The number of CTC in peripheral blood was measured in 134 patients with primary liver cancer and 72 patients with benign liver disease, the expression of AFP was detected, and the correlation between CTC and AFP was analyzed. Then 86 patients with primary liver cancer were selected from 134 patients with primary liver cancer who underwent radical hepatectomy. The values of CTC and AFP in evaluating recurrence and metastasis of primary liver cancer before and after operation were analyzed by CTC and AFP, in peripheral blood of these 86 patients. Results The positive rates of CTC in peripheral blood of patients with primary liver cancer were higher than that of patients with benign liver disease(P< 0.05). The levels of CTC in patients with primary liver cancer were related to AFP level, lymph node metastasis and the number of tumor nodules, but not to age, sex, tumor diameter, differentiation degree, liver cirrhosis and TNM stage. The survival analysis of CTC and AFP in patients with primary liver cancer showed that the early recurrence and metastasis of primary liver cancer after radical resection were closely related to the positive rate of CTC and AFP, and the positive rate of CTC was more effective than that of AFP positive in the diagnosis of recurrence and metastasis after operation, and the combination of the two had the highest predictive value for recurrence and metastasis. Conclusion CTC may be used as a better index to monitor postoperative recurrence and metastasis of primary liver cancer than traditional tumor markers. The combined detection prediction value of tumor markers is higher.

目的 评价贝伐单抗联合肝动脉化疗栓塞治疗原发性肝癌的疗效及不良反应。方法 2名评价员通过独立地检索中英文数据库,纳入随机对照研究,其中治疗组为肝动脉灌注贝伐单抗联合肝动脉化疗栓塞组、对照组为单独肝动脉化疗栓塞组,并通过Jadad量表对纳入文献质量进行评分,最后采用Review Manager 5.2软件进行Meta分析。结果 纳入6篇文献,466例病例。结果显示:在疗效方面,治疗组的3、6个月疾病有效率及疾病控制率,12个月的生存率均高于对照组且差异有统计学意义(P<0.05);在安全性方面,两组间关于发热、转氨酶升高、恶心、黑便的发生率之间的比较无统计学意义(P＞0.05)。结论 肝动脉灌注贝伐单抗联合肝动脉化疗栓塞治疗原发性肝癌与单独肝动脉化疗栓塞比较,能有效提高肝癌患者近期及远期疗效,且并不增加不良反应发生率。

Objective To evaluate the efficacy and side effects of bevacizumab combined with thanscatheter artierial chemoembolzation in the treatment of primary liver cancer. Methods Two reviewers collected data about clinical trials that the combination of bevacizumab and thanscatheter artierial chemoembolzation for treatment of primary liver cancer from data bases. Jadad Score and Review Manager 5.2 software were respectively used to assess the quality of included studies and analyze the obtained data. Results Six randomized controlled trials involving 466 patients were included in this paper. The results of the meta-analysis showed that compared with thanscatheter artierial chemoembolzation group alone, bevacizumab combined with thanscatheter artierial chemoembolzation improved the response rate and disease control rate, prolonged 12 month survival rate (P<0.05). As for side effects, there were no statistically different of those about fever, level of transaminase, nausea and melena between two groups(P>0.05). Conclusion Compared with simple thanscatheter artierial chemoembolzation group, and Bevacizumab combined with thanscatheter artierial chemoembolzation group, the later may improve short-term and long-term effects, and side effects were under control.