目的 探讨经阴道超声多参数联合血清孕酮在先兆流产妊娠结局中的临床意义,以期为临床制定相应干预方案提供参考。 方法 回顾性选取我院2022年8月~2024年8月就诊的152例早期先兆流产(孕5~8周)患者作为研究对象,均随访至孕12周,根据妊娠结局分为继续妊娠组(n=64)、难免流产组(n=88),比较两组临床资料及入院时经阴道超声多参数[收缩期峰值流速(S)/舒张末期流速(D)、阻力指数(RI)、搏动指数(PI)、孕囊大小]、血清孕酮水平,Logistic回归方程分析入院时经阴道超声多参数及血清孕酮水平对先兆流产患者妊娠结局的影响,受试者工作特征(ROC)曲线分析其对先兆流产患者难免流产的预测价值。 结果 两组年龄、流产史、S/D、RI、PI、孕囊大小、血清孕酮水平比较,差异具有统计学意义(P<0.05);经Logistic回归方程分析结果显示,在校正年龄、流产史潜在混杂因素后,S/D、RI、PI、孕囊大小、血清孕酮水平仍与先兆流产患者妊娠结局显著相关,均为其独立影响因素(P<0.05);绘制ROC曲线结果显示,S/D、RI、PI、孕囊大小、血清孕酮对于先兆流产患者难免流产的预测AUC分别为0.749、0.764、0.743、0.774、0.793,具有一定预测价值;基于S/D、RI、PI、孕囊大小、血清孕酮水平建立Logistic回归方程模型,经Hosmer-Lemeshow拟合优度检验显示,构建的模型χ2=2.249,P=0.117,说明该模型构建的预测结果与实际结果一致;绘制ROC分析该模型对先兆流产患者难免流产的预测价值,结果显示AUC为0.894(95%CI:0.834~0.938),敏感度为81.82%,特异度为87.50%。结论 经阴道超声多参数联合血清孕酮对于先兆流产患者妊娠结局具有较高预测价值,临床可通过早期联合检测评估患者难免流产发生风险,以针对性制定相应干预方案。
【摘要】 目的 探讨多模态影像定量参数联合血小板与淋巴细胞比值(PLR)对上皮性卵巢癌(EOC)的诊断价值及其对良恶性卵巢病变的鉴别意义。方法 选取2023年6月至2024年12月本院收治的84例卵巢占位性病变患者作为研究对象,其中EOC患者46例纳入EOC组,良性卵巢病变患者38例纳入非EOC组。比较两组CT动脉期碘浓度、CT能谱曲线斜率及ADC值多模态影像定量参数,同时检测外周血指标并计算PLR,分析各指标在EOC诊断中的应用价值。采用受试者工作特征(ROC)曲线评价各指标单独及联合诊断效能。结果 两组年龄、体重指数及绝经情况比较差异均无统计学意义(P>0.05)。EOC组形态不规则、边界模糊、实性成分为主、壁结节形成、明显不均匀强化、中大量腹腔积液及腹膜、淋巴结转移发生率均高于非EOC组(P<0.05)。EOC组PLR、CT动脉期碘浓度及CT能谱曲线斜率均高于非EOC组,而ADC值低于非EOC组(P<0.05)。ROC曲线分析显示,CT动脉期碘浓度、CT能谱曲线斜率、ADC值及PLR诊断EOC的AUC分别为0.801、0.819、0.828及0.867;联合预测模型AUC为0.975,敏感度为94.7%,特异度为91.3%,诊断效能优于各单项指标。结论 EOC患者多模态影像定量参数及PLR均存在明显异常改变,多模态影像参数联合PLR可进一步提高EOC的诊断效能,对良恶性卵巢病变的鉴别具有一定临床应用价值。
【摘要】 目的 探讨多模态影像定量参数联合血小板与淋巴细胞比值(PLR)对上皮性卵巢癌(EOC)的诊断价值及其对良恶性卵巢病变的鉴别意义。方法 选取2023年6月至2024年12月本院收治的84例卵巢占位性病变患者作为研究对象,其中EOC患者46例纳入EOC组,良性卵巢病变患者38例纳入非EOC组。比较两组CT动脉期碘浓度、CT能谱曲线斜率及ADC值多模态影像定量参数,同时检测外周血指标并计算PLR,分析各指标在EOC诊断中的应用价值。采用受试者工作特征(ROC)曲线评价各指标单独及联合诊断效能。结果 两组年龄、体重指数及绝经情况比较差异均无统计学意义(P>0.05)。EOC组形态不规则、边界模糊、实性成分为主、壁结节形成、明显不均匀强化、中大量腹腔积液及腹膜、淋巴结转移发生率均高于非EOC组(P<0.05)。EOC组PLR、CT动脉期碘浓度及CT能谱曲线斜率均高于非EOC组,而ADC值低于非EOC组(P<0.05)。ROC曲线分析显示,CT动脉期碘浓度、CT能谱曲线斜率、ADC值及PLR诊断EOC的AUC分别为0.801、0.819、0.828及0.867;联合预测模型AUC为0.975,敏感度为94.7%,特异度为91.3%,诊断效能优于各单项指标。结论 EOC患者多模态影像定量参数及PLR均存在明显异常改变,多模态影像参数联合PLR可进一步提高EOC的诊断效能,对良恶性卵巢病变的鉴别具有一定临床应用价值。
【摘要】 目的 探讨多模态影像定量参数联合血小板与淋巴细胞比值(PLR)对上皮性卵巢癌(EOC)的诊断价值及其对良恶性卵巢病变的鉴别意义。方法 选取2023年6月至2024年12月本院收治的84例卵巢占位性病变患者作为研究对象,其中EOC患者46例纳入EOC组,良性卵巢病变患者38例纳入非EOC组。比较两组CT动脉期碘浓度、CT能谱曲线斜率及ADC值多模态影像定量参数,同时检测外周血指标并计算PLR,分析各指标在EOC诊断中的应用价值。采用受试者工作特征(ROC)曲线评价各指标单独及联合诊断效能。结果 两组年龄、体重指数及绝经情况比较差异均无统计学意义(P>0.05)。EOC组形态不规则、边界模糊、实性成分为主、壁结节形成、明显不均匀强化、中大量腹腔积液及腹膜、淋巴结转移发生率均高于非EOC组(P<0.05)。EOC组PLR、CT动脉期碘浓度及CT能谱曲线斜率均高于非EOC组,而ADC值低于非EOC组(P<0.05)。ROC曲线分析显示,CT动脉期碘浓度、CT能谱曲线斜率、ADC值及PLR诊断EOC的AUC分别为0.801、0.819、0.828及0.867;联合预测模型AUC为0.975,敏感度为94.7%,特异度为91.3%,诊断效能优于各单项指标。结论 EOC患者多模态影像定量参数及PLR均存在明显异常改变,多模态影像参数联合PLR可进一步提高EOC的诊断效能,对良恶性卵巢病变的鉴别具有一定临床应用价值。
目的 探讨经颅多普勒超声(TCD)参数联合屏气指数在颈内动脉(ICA)狭窄或闭塞所致急性脑梗死的评估价值。方法 选择2022年1月—2024年12月,在广州市花都区人民医院连续入组发病72 h内ICA狭窄或闭塞所致的急性脑梗死患者。记录患者人口统计学资料、临床资料及TCD相关参数,包括搏动指数(PI)、阻力指数( RI)、大脑中动脉平均血流速度(Vm)及屏气指数等。依据患者数字减影血管造影(DSA)结果分为侧支循环良好组及侧支循环不良组。比较两组人口统计学、临床资料及TCD相关参数,采用单因素分析、多因素Logistic回归分析及ROC曲线。结果 共纳入ICA狭窄或闭塞所致急性脑梗死共136例,其中侧支循环良好组46例,侧支循环不良组90例。单因素分析提示:侧支循环良好组与侧支循环不良组在PI[0.95(0.80,1.03)vs 1.01(0.88,1.13)]、RI[0.58(0.51,0.62)vs 0.60(0.54,0.65)]、Vm[57(44,65)vs 50.5(41,63)]及屏气指数[0.78(0.75,0.85)vs 0.72(0.59,0.79)]方面,差异具有统计学意义(P<0.05)。多因素Logistic回归分析提示Vm(OR=1.029,95%CI:1.006~1.053,P=0.014)、屏气指数(OR=723.401,95%CI:14.524~3 6031.859,P<0.001)是侧支循环不良的独立危险因素。屏气指数和Vm评估侧支循环情况的ROC曲线下面积(AUC)分别为0.713(95%CI:0.627~0.799)和0.605(0.505~0.705),两者的AUC值比较差异无统计学意义(P>0.05)。结论 屏气指数和Vm可以评估ICA狭窄或闭塞所致急性脑梗死的侧支循环,屏气指数和Vm的评估效能相当。
Objective To explore the evaluation value of transcranial Doppler ultrasound(TCD)in acute cerebral infarction caused by internal carotid artery(ICA)stenosis or occlusion.Methods From January 2022 to December 2024,patients with acute cerebral infarction caused by ICA stenosis or occlusion within 72 hours of onset were enrolled in our hospital.Patient’s demographic data,clinical data,and TCD related parameters,including pulsatility index(PI),resistance index(RI),average blood flow velocity(Vm)of the middle cerebral artery,and breath holding index(BHI)were recorded.According to the results of digital silhouette angiography(DSA),patients were divided into good collateral group and poor collateral group.Demographic,clinical data,and TCD related parameters were compared between two groups using univariate analysis,multivariate Logistic regression analysis and ROC curve.Results A total of 136 cases of acute cerebral infarction caused by ICA stenosis or occlusion were included,including 46 cases in the collateral good group and 90 cases in the collateral poor group.Univariate analysis showed that the good collateral group and the poor collateral group were different in PI(0.95[0.80,1.03]vs 1.01[0.88,1.13]),RI(0.58[0.51,0.62]vs 0.60[0.54,0.65]),Vm(57[44,65]vs 50.5[41,63]),BHI(0.78[0.75,0.85] vs 0.72[0.59,0.79])(P<0.05).Multivariate Logistic regression analysis showed that Vm(OR=1.029,95%CI:1.006-1.053,P=0.014)and BHI(OR=723.401,95%CI:14.524-36 031.859,P<0.001)were independent risk factors for collateral circulation disorders.The area under the ROC curve(AUC)for predicting collateral circulation using BHI and Vm were 0.713(95%CI:0.627~0.799)and 0.605(0.505~0.705),respectively.There was no statistically significant difference in AUC values between the BHI and Vm.Conclusions The BHI and Vm can predict the collateral circulation of acute cerebral infarction caused by ICA stenosis or occlusion,and their predictive power is comparable.
目的 探讨多参数MRI在鉴别乳腺影像报告和数据系统(BI-RADS)4类乳腺病变良恶性中的应用。方法 回顾性分析2022年1月—2024年12月于同济大学附属东方医院庐江分院行乳腺MRI检查为BI-RADS 4类且病理结果明确肿瘤的病例268例,其中良性组166例(包括乳腺纤维腺瘤93例,导管内乳头状瘤39例,乳腺囊性增生24例,乳腺分叶状肿瘤2例,浆细胞性乳腺炎8例),恶性组102例(包括浸润性导管癌89例,浸润性小叶癌6例,黏液癌2例,炎性乳腺癌5例)。对比分析单一序列和多序列联合诊断BI-RADS 4类乳腺病变良、恶性的效能;绘制基于多参数MRI受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)、特异度和灵敏度,量化多序列对于BI-RADS 4类乳腺病变良恶性的诊断效能。结果 基于多参数MRI联合诊断效能最高(AUC:0.912,95%CI:0.871~0.953),特异度为0.922,灵敏度为0.902;基于ADC值评估BI-RADS 4类乳腺病变最佳截断值为0.84×10-3 mm2 /s,且均具有统计学意义(P<0.05)。结论 基于多参数MRI能够有效诊断BI-RADS 4类乳腺病变的良、恶性,为乳腺外科疾病进一步诊疗提供影像学诊断依据。
Objective To explore the application of multiparametric MRI in differentiating benign and malignant lesions classified as BI-RADS category 4 in breast imaging.Methods A total of 268 cases of breast MRI classified as BI-RADS category 4 with confirmed tumor pathology were retrospectively analyzed from January 2022 to December 2024 at the Tongji University Oriental Hospital Lujiang Branch. Among them,166 cases were categorized as benign lesions(including 93 cases of breast fibroadenoma,39 cases of intraductal papilloma,24 cases of cystic hyperplasia,2 cases of lobular tumor,and 8 cases of plasma cell mastitis),while 102 cases were categorized as malignant lesions(including 89 cases of invasive ductal carcinoma,6 cases of invasive lobular carcinoma,2 cases of mucinous carcinoma,and 5 cases of inflammatory breast cancer).The efficacy of single-sequence versus combined multiple-sequence imaging in diagnosing benign and malignant BI-RADS category 4 breast lesions was compared and analyzed.The diagnostic efficacy of the multiparametric MRI sequences was quantified by plotting a receiver operating characteristic curve and calculating the area under the curve(AUC),as well as the specificity and sensitivity.Results The combined diagnostic efficacy of multiparametric MRI yielded the highest performance,with an AUC of 0.912(95%CI:0.871-0.953),demonstrating a specificity of 0.922 and a sensitivity of 0.902.The optimal cutoff value for differentiating BI-RADS category 4 breast lesions based on apparent diffusion coefficient values was determined to be 0.84×10-3 mm2 /s,with all results being statistically significant(P<0.05).Conclusions Multiparametric MRI can effectively diagnose benign and malignant lesions classified as BI-RADS category 4,providing a reliable imaging basis for further diagnosis and treatment in breast surgery.
目的 分析高原地区3~6年级学生屈光状态及屈光参数之间的关系。方法 2023年9月,采用随机抽样方法选取林芝市波密县某两所小学3~6年级535名学生进行校园筛查。计算并记录裸眼远视力(UCVA),非睫状肌麻痹电脑验光下散光及其轴位、等效球镜(SE)、眼轴(AL)、角膜曲率半径(CR)和眼轴/角膜曲率半径轴率比(AL/CR)。采用SPSS 22.00统计软件分析数据。结果 3~6年级学生AL和AL/CR大体趋势为随年级升高而增长,SE随年级升高而降低。3~6年级学生总体筛查性近视患病率为29.91%,且3~6年级筛查性近视患病率分别为20.35%、25.53%、30.53%和51.38%。总体散光患病率为51.59%,其中顺规散光、逆规散光及斜轴散光分别占90.22%、7.61%及2.17%。视力不良者约40.37%。以非睫状肌麻痹验光SE≤-0.50 D同时UCVA<5.0作为筛查性近视的诊断,AL/CR诊断筛查性近视的灵敏度为0.656、特异度为0.887和Youden指数为0.534,曲线下面积(AUC)为0.802,优于AL评估(AUC=0.764)。结论 高原地区3~6年级学生的筛查性近视患病率随年级升高而快速增长,且散光患病率较高,视力不良者较多。AL/CR值对筛查性近视监测具有一定的临床意义。
Objective To analyze the relationship between refractive status and refractive parameters of students in grades three-six in plateau area.Methods In September,2023,a random sampling method was used to select 535 students from grades three-six of two primary schools in Bomi County,Nyingchi City,for school screening.Distance uncorrected visual acuity(UCVA),astigmatism and its axis position,equivalent spherical(SE),axial length(AL),corneal radius(CR),and axial length/corneal radius ratio(AL/CR)were calculated and recorded.The data was analyzed using the statistical software SPSS 22.00. Results The general trend of AL and AL/CR for grade three-six students was increased with grade increasing,while SE decreased with grade increasing.The overall prevalence of screening myopia was 29.91%,and the prevalence of screening myopia in grades three to six was 20.35%,25.53%,30.53% and 51.38%,respectively.The overall prevalence rate of astigmatism was 51.59%,including 90.22%,7.61% and 2.17% for astigmatism with the rule,astigmatism against the rule and oblique astigmatism,respectively.About 40.37% of the students had poor vision.Screening myopia was diagnosed using non-cycloplegic optometry with SE ≤-0.50 D combined with UCVA<5.0.The sensitivity and specificity of AL/CR for screening myopia were 0.656 and 0.887,respectively,with a Youden index of 0.534 and an area under the curve(AUC)of 0.802.This was superior to the AL evaluation,which had an AUC of 0.764.Conclusions The prevalence of screening myopia increased rapidly with the increase of grade in grade 3 to 6 in plateau area.And there were high prevalence of astigmatism and more poor vision.AL/CR value has a certain clinical significance in the monitoring of screening myopia.
目的 探讨脊柱微调手法治疗产后腰椎-骨盆复合体疼痛的临床疗效及对腰椎前凸曲度(LL)和骨盆入射角度(PI)的调整作用,为产后腰椎-骨盆复合体疼痛的治疗提供理论依据。方法 选取2022年7月—2023年7月在上海市杨浦区中医医院推拿科和上海中医药大学附属岳阳中西医结合医院推拿科门诊治疗的产后腰椎-骨盆复合体疼痛患者共82例,随机分为对照组和治疗组,每组41例。对照组采用传统理筋推拿手法,治疗组采用脊柱微调手法治疗,两组疗程均为8周,观察临床疗效,比较两组患者的疼痛数字评分法(NRS)、Oswestry功能障碍指数(ODI)、LL和PI在治疗前后组间与组内的变化。结果 治疗组总有效率为95.12%,对照组总有效率为75.60%,治疗组优于对照组(P<0.05)。治疗后,两组NRS评分、ODI评分较治疗前均有下降,且治疗组优于对照组(P<0.05)。治疗后,两组LL和PI测量较治疗前均无明显变化,治疗组与对照组比较差异无统计学意义(P>0.05)。结论 脊柱微调手法能有效减轻患者疼痛、提升日常活动功能,但对腰椎曲度、骨盆入射角未产生移位影响,安全性高。
Objective To explore the clinical efficacy of spinal fine adjustment manipulation in the treatment of postpartum lumbopelvic pain(PLPP) and its role in adjusting lumbar lordosis and pelvic incidence,and to provide theoretical basis for the treatment of PLPP. Methods A total of 82 patients with PLPP who were treated in the outpatient clinics of the Tuina Department of Yangpu District Hospital of Traditional Chinese Medicine and the Tuina Department of Yueyang Hospital of Integrative Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine from July 2022 to July 2023 were selected and randomly divided into the control group and the treatment group,with 41 cases in each group.The control group was treated with the traditional tendon manipulation and the treatment group was treated with spinal fine adjustment manipulation,and the course of treatment for both groups was 8 weeks.Clinical efficacy was observed,and the changes of pain Numerical Rating Scale(NRS),Oswestry disability index(ODI),lumbar lordosis(LL),and pelvic incidence(PI)of the two groups were compared between the two groups and within the two groups before and after the treatment. Results The total effective rate was 95.12% in the treatment group and 75.60% in the control group,and the treatment group was superior to the control group(P<0.05).After treatment,the NRS and ODI of both groups were lower than before treatment,and the treatment group was better than the control group(P<0.05). After treatment,there was no significant change in LL and PI in both groups compared to pre-treatment.There was no significant difference between the treatment group and the control group(P>0.05). Conclusions Spinal fine adjustment manipulation can effectively reduce the pain of patients and improve the function of daily activities,but it has no displacement effect on LL and PI,which is safe and suitable for clinical promotion and application.
目的 通过分析奥氮平的群体药代动力学研究,探讨影响奥氮平药动学参数的因素,为临床制定个体化给药方案提供依据。方法 在中国知网、万方、维普、迈特思创、PubMed和Embase等中英文数据库,以“奥氮平”“群体药代动力学”“模型”“非线性混合效应模型”及“olanzapine pamoate”“olanzapine”“population pharmacokinetic”“pharmacokinetic model”“nonlinear mixed effect”“NONMEM”为检索策略,检索建库至2023年5月所有关于奥氮平群体药代动力学的研究。结果 共纳入14篇奥氮平的群体药代动力学研究,大多数研究将奥氮平的药代动力学描述为一个单室模型。成人群体药代动力学模型群体典型值吸收速率常数:(0.3~2.85)/h;表观分布清除率:(10.4~25.4)L/h;表观分布容积:(223~2 390)L。儿童青少年模型群体典型值吸收速率常数:(0.142~0.758)/h;表观分布清除率:(13.6~16.8)L/h;表观分布容积:(322~899)L。年龄、体质量、性别、种族、吸烟状况、合并用药是影响奥氮平药动学参数的显著协变量。结论 奥氮平药动学参数估计值存在差异且有不同程度的个体间变异,未来应侧重于对特殊人群的研究。有必要对先前发表的模型进行外部验证,以便更准地的描述模型的适用性。
Objective By analyzing the population pharmacokinetics of olanzapine,the factors affecting the pharmacokinetic parameters of olanzapine were discussed,so as to provide a basis for the clinical formulation of individualized dosing regimens.Methods In Chinese and English databases such as CNKI,Wanfang,Wipro database,FMRS,PubMed and Embase,all studies on population pharmacokinetics of olanzapine from the establishment of the database to May 2023 were searched with “olanzapine pamoate”“olanzapine”,“population pharmacokinetics”,“pharmacokinetic model”,“nonlinear mixed-effect” and “NONMEM” as key words.Results A total of 14 population pharmacokinetic studies of olanzapine were included.Most studies described the pharmacokinetics of olanzapine as a single-chamber model.Adult pharmacokinetic model population typical values absorption rate constant was(0.3-2.85)/h;apparent distribution clearance was(10.4-25.4)L/h;apparent volume of distribution was(223-2390)L.absorption rate constants of the population of children and adolescents was(0.142-0.758)/h,apparent distribution clearance was(13.6-16.8)L/h,apparent volume of distribution was(322-899)L.Age,weight,gender,ethnicity,smoking status and concomitant medication were significant covariates affecting the pharmacokinetic parameters of olanzapine.Conclusions Estimates of pharmacokinetic parameters of olanzapine vary and have varying degrees of inter-individual variation.In the future,research should focus on special populations.Externally validation of previously published models should also be performed to more accurately describe the applicability of the models.
目的 分析血流感染(BSI)患者血小板参数的动态变化及其在患者预后中的价值。方法 回顾性分析南通市中西医结合医院检验科明确BSI的66例患者,分为生存组(55例)和死亡组(11例)。比较不同组间病原菌分布及1周内血小板参数动态变化情况,并通过Logistic回归分析评估血小板参数动态变化的在治疗预后评估中的价值。结果 (1)BSI患者病原菌分为革兰氏阳性菌(G+)25株、革兰氏阴性菌(G-)39株、真菌2株;G+病原菌中前三位为金黄色葡萄球菌(10.61%)、表皮葡萄球菌(7.58%)、头状葡萄球菌(4.55%);G-病原菌中前三位为大肠埃希菌(24.24%)、肺炎克雷伯菌肺炎亚种(15.15%)、肠炎沙门菌血清型(3.03%);真菌为新生隐球酵母(1.52%)、光滑假丝酵母(1.52%)。(2)生存组序贯性器官功能衰竭评分(SOFA)评分为(3.24±0.53)分,低于死亡组的(6.02±1.17)分(t=12.535,P<0.001);生存组BSI病程为(20.50±2.17)d,低于死亡组的(25.71±4.81)d(t=3.352,P<0.001);生存组肺部原发感染灶30.91%,高于死亡组的63.64%(χ2=4.243,P=0.039);生存组最大平均血小板体积(MPV)为(10.96±1.58)fL,低于死亡组的(11.99±1.42)fL(t=2.004,P=0.049);生存组入院血小板计数(PLT)为(144.33±23.18)109/L,低于死亡组的(166.91±20.29)109/L(t=3.005,P=0.004);生存组最低PLT为(113.48±30.76)109/L,高于死亡组的(80.16±38.24)109/L(t=3.148,P=0.002)。(3)两组入院及BSI时、BSI后4 d内的指标比较差异均无统计学意义(P>0.05),在BSI后的5~7 d,生存组PLT为(210.83±102.37)109/L,高于死亡组的(112.75±116.84)109/L(t=2.835,P=0.006);生存组MPV为(10.12±1.58)fL,低于死亡组的(11.27±1.85)fL(t=2.142,P=0.036);生存组MPV/PLT 比值(MPR)为(5.69±2.89),低于死亡组的(11.64±8.23)(t=4.290,P<0.001)。(4)多因素Logistic回归分析发现,入院SOFA(OR=5.461,95%CI:1.544~19.319,P=0.008)、BSI病程(OR=0.773,95%CI:0.622~0.960,P=0.020)、5~7 d MPR(OR=18.976,95%CI:1.776~202.709,P=0.015)是BSI的预测因素。结论 BSI患者血小板参数动态变化较为明显,而入院SOFA、BSI病程、5~7 d MPR对于预测患者死亡风险有重要意义。