目的 调查住院老年患者因经外周静脉置入中心静脉导管（PICC）而引发的血栓情况，并分析其影响因素，为老年患者置入PICC产生的相关性血栓（PICC-CRT）和症状性血栓的评估与干预提供借鉴。方法 在2023年1月—2023年12月期间，选取广州市第一人民医院接受PICC置管的317例住院老年患者。采用包括患者一般情况调查表、运动功能评定、肌力检测、 Barthel指数评定、Padua评分等多种工具进行综合评估。采用多因素 Logistic 回归构建 PICC-CRT 及症状性血栓的预测模型，并应用逐步回归法优化变量筛选过程。模型性能通过 ROC 曲线进行评估。结果 去除临床资料不完整的患者40例，最终纳入277例患者的完整资料，其中123例患者出现了PICC-CRT，发生率为44.40%（123/277）。血栓分级中，I级78例，Ⅱ级37例，Ⅲ级8例。无症状血栓83例，占67.48%，发生率29.96%（83/277）；症状性血栓40例，占32.52 %，发生率14.44%（40/277）。单因素分析联合多因素Logistic回归显示，卒中史、凝血酶原时间（PT）、导管留置时间是住院老年患者PICC-CRT的关键因素（P＜0.05），预测模型ROC曲线下面积为0.719；置管史、恶性肿瘤史、导管留置时间、置管后并发症数量是住院老年患者PICC症状性血栓的独立影响因素（P＜0.05），预测模型ROC曲线下面积为0.812。结论 文章总结了PICC-CRT和症状性血栓独特的影响因素，基于关键因素构建了预测模型预测其发生，为护理人员预防PICC-CRT和症状性血栓的发生提供了参考。

   Objective To explore the incidence of thrombosis associated with peripherally inserted central catheter（PICC）placement in hospitalized elderly patients and to analyze its influencing factors，in order to provide a reference for the assessment and prevention of PICC-catheter related thrombosis（PICC-CRT）and symptomatic thrombosis in this population．Methods A total of 317 elderly inpatients who underwent PICC placement at a tertiary hospital in Guangzhou between January and December 2023 were enrolled．Comprehensive assessments were conducted using general patient information forms，motor function evaluation，muscle strength testing，Barthel Index，and Padua score．Multivariate Logistic regression analysis was used to construct predictive models for PICC-CRT and symptomatic thrombosis，with variable selection optimized via stepwise regression．Model performance was evaluated using receiver operating characteristic（ROC）curve analysis．Results After excluding 40 patients with incomplete clinical data，277 cases were included in the final analysis．Among them，123 patients developed PICC-CRT，with an incidence rate of 44.40%（123/277）．Thrombosis was graded as Grade I in 78 cases，Grade II in 37 cases，and Grade III in 8 cases．Asymptomatic thrombosis occurred in 83 cases（29.96%），accounting for 67.48% of PICC-CRT；symptomatic thrombosis occurred in 40 cases（14.44%），accounting for 32.52%．Univariate and multivariate Logistic regression analyses identified history of stroke，prothrombin time（PT），and catheter dwell time as key risk factors for PICC-CRT（P＜0.05），with the area under the curve（AUC）of 0.719．History of catheterization，malignancy，catheter dwell time，and number of post-catheterization complications were independent predictors of symptomatic thrombosis（P＜0.05），with an AUC of 0.812．Conclusions This study identified distinct risk factors for PICC-CRT and symptomatic thrombosis in elderly inpatients．Predictive models based on key variables may provide useful references for clinical staff in preventing the occurrence of PICC-related and symptomatic thrombosis．

       目的 调查重型β地中海贫血患儿照顾者的负担现状，并分析其影响因素，为医护人员制定干预方案提供依据。方法 采用便利抽样法，于2024年1月—12月选取华南地区5家医院就诊的重型β地中海贫血患儿的主要照顾者作为调查对象，采用一般资料调查表、Zarit照顾者负担量表、中文简化版家庭弹性量表和社会支持评定量表进行调查，并采用单因素分析、相关性分析及多重线性回归探究其影响因素。结果 共发放问卷242份，回收232份，回收率为95.87%。重型β地中海贫血患儿主要照顾者照顾负担的总体平均得分为（36.67±18.63）分。多重线性回归分析结果显示，患儿输血频率、输血相关性皮肤过敏和社会支持是患儿照顾负担的影响因素（P＜0.001），可解释总变异的23.9%。结论 重型β地中海贫血患儿照顾者负担程度以中重度为主。患儿曾出现输血不良反应、输血频率更高，其照顾者负担更重；而主要照顾者具有良好的社会支持水平有助于降低其照顾者负担。医护人员应针对以上因素制定干预方案，以减轻重型β地中海贫血患儿照顾者负担水平。

      Objective To investigate the current burden in caregivers of children with β thalassemia major and analyze its influencing factors，so as to provide a basis for medical staff to formulate intervention plans．Methods By using the convenience sampling method，primary caregivers of children with β thalassemia major from five hospitals in South China from January to December 2024 were selected as the survey subjects．The general information questionnaire，Zarit Caregiver Burden Scale，Simplified Chinese Family Resilience Scale and Social Support Rating Scale were used for the survey．And univariate analysis，correlation analysis and multiple linear regression were adopted to explore its influencing factors．Results A total of 242 questionnaires were distributed and 232 were retrieved，with a recovery rate of 95.87%．The overall average score of care burden for primary caregivers of children with β thalassemia major was（36.67±18.63）．The results of multiple linear regression analysis showed that the frequency of blood transfusion in children，transfusion-related skin allergy and social support were the influencing factors of the care burden（P＜0.001），which could explain 23.9% of the total variation．Conclusions The burden level in caregivers of children with β thalassemia major is mainly moderate to severe．The children with adverse reactions to blood transfusion and higher frequency of blood transfusion impose a heavier burden on its caregivers．The primary caregivers who have good social support can help reduce the burden．Medical staff should formulate intervention plans based on the above factors to reduce the burden level of caregivers of children with β thalassemia major．

      目的 探讨广州市公职人员中眼睑黄色瘤（XP）患病情况与生化检验指标异常的相关性。方法 从2018年来广州市干部和人才健康管理中心体检的公职人员中选取1 090例，其中筛选患XP人员545例，作为病例组，依性别、年龄分层随机抽取的未患XP的人员作为对照组，测定空腹血糖、血脂、甲状腺功能等生化指标，采用回顾性病例对照研究的方式，比较两组相关指标水平。P＜0.05为差异有统计学意义。结果 XP的患病率为0.94%（男性为0.89%，女性为1.01%）。男性和女性的XP患病率比较差异无统计学意义（χ²=2.142，P=0.143）。两组间体质量、舒张压、血脂等多项指标上的差异具有统计学意义（P＜0.05）。高体质量（OR=1.021，95%CI：1.004~1.038，P=0.017）、高舒张压（OR=1.019，95%CI：1.004~1.035，P=0.011）、低高密度脂蛋白（OR=6.127，95%CI：2.568~14.619，P＜0.001）、高低密度脂蛋白（OR=2.084，95%CI：1.456~2.981，P＜0.001）是患病的危险因素。结论 广州市公职人员中XP的患病率男性和女性接近；高体质量、高舒张压、高密度脂蛋白水平降低、低密度脂蛋白水平升高是患XP的危险因素。

   Objective To investigate the correlation between xanthelasma palpebrarum（XP）and abnormal biochemical indices in healthy individuals in Guangzhou，China．Methods A retrospective case-control study was conducted，selecting 1 090 individuals from a total of 58 053 who underwent health examinations at the Guangzhou Cadre and Talent Health Management Centre in 2018．The case group consisted of 545 individuals diagnosed with XP，while the control group included age- and sex-matched individuals without XP，randomly selected from the same database．Biochemical indices analyzed included fasting blood glucose，blood lipids，liver and kidney function，thyroid indicators，body weight，and blood pressure．Statistical significance was set at P＜0.05．Results The prevalence of XP was 0.94%（0.89% in men and 1.01% in women）．No significant difference was observed in the prevalence of XP between men and women（χ²=2.142，P=0.143）．Similarly，no significant differences were observed in thyroid-stimulating hormone（P=0.937），free triiodothyronine（P=0.216），free thyroxin（P=0.206），or fasting blood glucose levels（P=0.668）between the case and control groups．However，significant differences were noted in body weight，diastolic blood pressure，blood lipid levels，and liver and renal biochemical indicators between the two groups（P＜0.05）．Specifically，higher body weight（OR=1.021，95%CI：1.004–1.038，P=0.017），higher diastolic blood pressure（OR=1.019，95%CI：1.004–1.035，P=0.011），lower high-density lipoprotein（OR=6.127，95%CI：2.568–14.619，P＜0.001），and higher low-density lipoprotein（OR=2.084，95%CI：1.456–2.981，P＜0.001）were identified as risk factors for XP．Conclusions The prevalence of XP did not differ between males and females．However，high body weight，high diastolic blood pressure，low high-density lipoprotein，and high low-density lipoprotein are risk factors for XP．

      目的 合并肺纤维化的慢性阻塞性肺疾病（COPD）是COPD的特殊亚型，患者兼具气流受限与肺组织纤维化病理特征，临床症状更严重、肺功能下降更快，且现有单一治疗方案难以同时改善气流受限与纤维化进展，预后较差。基于此，本研究旨在分析尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD患者的效果及对肺功能的影响，为优化临床治疗方案提供依据。方法 选取2022年3月—2024年12月收治的96例合并肺纤维化的COPD患者，采用前瞻性随机对照研究设计，应用随机数字表法分为试验组与对照组。所有患者均采取常规治疗，对照组48例采取尼达尼布治疗，试验组采取尼达尼布联合格隆溴铵治疗。两组均治疗24周后，比较治疗前后症状评分、肺功能、纤维化指标、炎症指标，并分析两组治疗安全性。结果 治疗后，两组CAT评分、mMRC评分及VAS降低（P＜0.05）；且与对照组比较，试验组CAT评分、mMRC评分及咳嗽VAS评分较低（P＜0.05）。治疗后，两组FVC、FEV₁、DLCO及FEV₁/FVC比值均较治疗前改善（P＜0.05）；且与对照组比较，试验组FVC、FEV₁、DLCO及FEV₁/FVC比值较优（P＜0.05）。治疗后，两组血清KL-6、SP-D水平及CT纤维化评分均降低（P＜0.05）；且与对照组比较，试验组血清KL-6、SP-D水平及CT纤维化评分较低（P＜0.05）。治疗后，两组血清IL-6、TNF-α及TGF-β1水平降低（P＜0.05）；且与对照组比较，试验组血清IL-6、TNF-α及TGF-β1水平较低（P＜0.05）。试验组总不良反应发生率为8.33%（4/48），对照组为10.42%（5/48），两组比较差异无统计学意义（P＞0.05）。结论 尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD效果良好，可减轻患者临床症状，改善肺功能与肺纤维化，降低机体炎症反应，安全性较高。

   Objective To analyze the effects of the combination of nintedanib and glycopyrrolate in treating chronic obstructive pulmonary disease（COPD）patients with associated pulmonary fibrosis and its impact on lung function，providing a basis for optimizing clinical treatment strategies．Methods Ninety-six COPD patients with pulmonary fibrosis admitted from March 2022 to December 2024 were selected，and divided into experimental group and control group using a random number table method．Using a prospective randomized controlled study design，all patients received conventional treatment，with 48 cases in the control group receiving treatment with nintedanib and the experimental group receiving treatment with nintedanib combined with glycopyrrolate bromide．After 24 weeks of treatment in both groups，the symptom scores，lung function，fibrosis indicators，and inflammation indicators were compared before and post-treatment，and the drug safety of the two groups was analyzed．Results Post-treatment，CAT score，mMRC score and VAS decreased in both groups（P＜0.05）．Compared with the control group，CAT score，mMRC score and cough VAS score were lower in the experimental group（P＜0.05）．Post-treatment，FVC，FEV₁，DLCO and FEV₁/FVC ratio of both groups improved compared with that before treatment（P＜0.05）．Compared with the control group，FVC，FEV₁，DLCO and FEV₁/FVC ratio of the experimental group were better（P＜0.05）．Post-treatment，serum KL-6，SP-D levels and CT fibrosis scores of both groups decreased（P＜0.05）．Compared with the control group，serum KL-6，SP-D levels and CT fibrosis scores of the experimental group were lower（P＜0.05）．Post-treatment，serum IL-6，TNF-α and TGF-β1 levels in both groups decreased（P＜0.05）．Compared with the control group，serum IL-6，TNF-α and TGF-β1 levels in the experimental group were lower（P＜0.05）．The incidence of total adverse reactions in the experimental group was 8.33%（4/48），and that in the control group was 10.42%（5/48）．There was no difference between the two groups（P＞0.05）．Conclusions The combination of nintedanib and glycopyrrolate has a significant effect on the treatment of COPD complicated with pulmonary fibrosis，which can alleviate its clinical symptoms，improve lung function and pulmonary fibrosis，reduce the body’s inflammatory response，which is relatively safe．

目的 采用2023版Beers标准和2017版中国潜在不适当用药（PIM）标准，评估居家养老老年慢性病患者PIM现状并分析其影响因素。 方法 回顾性收集某医院慢性病门诊就诊的居家养老老年慢性病患者（≥65岁）的基本信息及用药数据，依据两标准进行PIM评价，采用二元Logistic回归分析PIM的影响因素。 结果 共纳入1549例居家老年慢性病患者。Beers标准检出PIM，共1092例次，其中与药物相关609例次，与疾病或症状相关5例次，应谨慎使用的药物467例次，应避免的药物-药物相互作用11例次；PIM发生例次居前五位的药物分别为阿司匹林、胰岛素、质子泵抑制剂、利伐沙班和多沙唑嗪。2017版中国PIM标准检出PIM，共996例次，其中与药物相关的546例次，与疾病状态相关的450例次；PIM发生例次居前五位的药物分别为胰岛素、氯吡格雷、螺内酯、多沙唑嗪、阿普唑仑。二元Logistic回归分析显示，慢性病种类数与用药数量是PIM发生的显著影响因素（P＜0.05）。 结论 居家养老老年慢性病患者PIM发生率较高，中国PIM标准更适用本国实践，建议纳入药师干预促进合理用药。

目的 采用2023版Beers标准和2017版中国潜在不适当用药（PIM）标准，评估居家养老老年慢性病患者PIM现状并分析其影响因素。 方法 回顾性收集某医院慢性病门诊就诊的居家养老老年慢性病患者（≥65岁）的基本信息及用药数据，依据两标准进行PIM评价，采用二元Logistic回归分析PIM的影响因素。 结果 共纳入1549例居家老年慢性病患者。Beers标准检出PIM，共1092例次，其中与药物相关609例次，与疾病或症状相关5例次，应谨慎使用的药物467例次，应避免的药物-药物相互作用11例次；PIM发生例次居前五位的药物分别为阿司匹林、胰岛素、质子泵抑制剂、利伐沙班和多沙唑嗪。2017版中国PIM标准检出PIM，共996例次，其中与药物相关的546例次，与疾病状态相关的450例次；PIM发生例次居前五位的药物分别为胰岛素、氯吡格雷、螺内酯、多沙唑嗪、阿普唑仑。二元Logistic回归分析显示，慢性病种类数与用药数量是PIM发生的显著影响因素（P＜0.05）。 结论 居家养老老年慢性病患者PIM发生率较高，中国PIM标准更适用本国实践，建议纳入药师干预促进合理用药。

目的 分析中药穴位贴敷、沙库巴曲缬沙坦联合治疗在慢性心力衰竭（CHF）中的应用效果。方法 选取我院CHF患者90例（2024-08—2026-01），依据随机数字表分成两组，每组45例。对照组接受沙库巴曲缬沙坦治疗，研究组接受中药穴位贴敷联合沙库巴曲缬沙坦治疗。观察两组疗效、6min步行距离、中医证候积分、心功能[心脏指数（CI）、每搏输出量（SV）、左室射血分数（LVEF）]、心肌指标[脑钠肽（BNP）、肌钙蛋白Ⅰ（cTnⅠ）]、安全性。结果 研究组治疗效果优于对照组（P＜0.05）；治疗后，研究组中医证候积分、BNP、cTnⅠ低于对照组，6min步行距离、LVEF、CI、SV高于对照组（P＜0.05）；两组治疗期间不良反应无显著差异（P＞0.05）。结论 中药穴位贴敷联合沙库巴曲缬沙坦治疗CHF效果显著，可减轻临床症状，改善心功能，减少心肌损伤。

Objective To analyze the clinical efficacy of combined therapy with traditional Chinese medicine acupoint application and sacubitril/valsartan in patients with chronic heart failure (CHF). Methods A total of 90 patients with CHF admitted to our Hospital from August 2024 to January 2026 were selected, and divided into two groups by random number table, with 45 cases in each group. The control group was treated with sacubitril/valsartan, while the study group received combined therapy of traditional Chinese medicine acupoint application and sacubitril/valsartan. The therapeutic efficacy, 6-minute walking distance, TCM syndrome score, cardiac function indexes [cardiac index (CI), stroke volume (SV), left ventricular ejection fraction (LVEF)], myocardial indicators [brain natriuretic peptide (BNP), cardiac troponin Ⅰ (cTnⅠ)] and safety were observed in both groups. Results The therapeutic efficacy of the study group was better than that of the control group (P<0.05). After treatment, the TCM syndrome scores, BNP and cTnⅠ levels in the observation group were lower, while the 6-minute walking distance, LVEF, CI and SV were higher compared with the control group (P<0.05). No significant between-group difference was found in adverse reactions during treatment (P>0.05). Conclusion Traditional Chinese medicine acupoint application combined with sacubitril/valsartan achieves remarkable efficacy in the treatment of CHF. It can relieve clinical symptoms, improve cardiac function and alleviate myocardial injury.

目的 探讨老年慢性阻塞性肺疾病急性加重期（AECOPD）患者应用十味龙胆花颗粒联合硫酸特布他林治疗的临床效果。方法 回顾性选取我院收治的116例老年AECOPD患者（选例时间：2024年1月~2026年2月）为研究对象，根据治疗方案将其分为参照组（58例，接受硫酸特布他林治疗）、联合组（58例，接受十味龙胆花颗粒联合硫酸特布他林治疗）。对比两组临床疗效、不良反应及治疗前后中医证候积分、慢性阻塞性肺疾病评估测试（CAT）评分、血气指标［动脉血二氧化碳分压（PaCO2）、血氧饱和度（SpO2）、动脉血氧分压（PaO2）］、免疫功能、炎症相关细胞因子［白细胞介素-8（IL-8）、分泌卷曲相关蛋白1（SFRP1）、肿瘤坏死因子-α（TNF-α）、趋化因子配体9（CXCL9）］水平。结果 联合组总有效率（94.83%）高于参照组（79.31%）（P＜0.05）；联合组治疗后各中医证候积分均较参照组低（P＜0.05）；与参照组相比，治疗后联合组CAT评分较低（P＜0.05）；联合组治疗后PaCO2水平较参照组低，SpO2、PaO2水平较参照组高（P＜0.05）；联合组治疗后CD3+、CD4+、CD4+/CD8+水平较参照组高，CD8+水平较参照组低（P＜0.05）；治疗后联合组血清IL-8、SFRP1、TNF-α、CXCL9水平均较参照组低（P＜0.05）；不良反应发生情况组间比较，无明显差异（P＞0.05）。结论 十味龙胆花颗粒联合硫酸特布他林可提高老年AECOPD患者治疗效果，减轻临床症状，改善肺功能、免疫功能及血气指标，降低机体炎症反应程度。

目的 基于Logistic多因素回归分析探讨糖尿病肾病（DKD）患者发生贫血的独立影响因素，并构建诊断模型。方法 回顾性选取2020年1月—2025年8月我院收治的200例DKD患者，依据贫血发生情况，将患者分为贫血组（80例）与非贫血组（120例）。比较2组临床资料，采用Logistic多因素回归分析DKD患者发生贫血的影响因素，并构建DKD患者发生贫血的联合诊断模型。结果 贫血组糖尿病病程、肾病分期G3~G4患者占比、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）、甘油三酯（TG）水平高于非贫血组，免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、白蛋白（ALB）、低密度脂蛋白胆固醇（LDL-C）水平低于非贫血组，差异有统计学意义（P＜0.05）；糖尿病病程（OR=1.723，95%CI：1.317~2.254）、肾病分期（OR=5.202，95%CI：2.338~11.573）、TNF-α（OR=2.861，95%CI：1.636~5.001）、hs-CRP（OR=2.073，95%CI：1.440~2.985）、IgM（OR=0.470，95%CI：0.331~0.667）、ALB（OR=0.533，95%CI：0.378~0.753）、TG（OR=3.016，95%CI：1.833~4.962）均为DKD患者发生贫血的影响因素，差异有统计学意义（P＜0.05）；基于Logistic回归分析构建联合诊断模型：Logit（P）=-0.218+0.544×糖尿病病程+1.649×肾病分期+1.051×TNF-α+0.729×hs-CRP+（-0.756）×IgM+（-0.629）×ALB+1.104×TG，经校准曲线和决策曲线检验显示，该模型诊断结果与实际预测结果具有较高一致性，且具有较高净获益。结论 糖尿病病程、肾病分期、TNF-α、hs-CRP、IgM、ALB、TG水平是DKD患者发生贫血的影响因素，临床应关注上述影响因素，以早期预防患者贫血的发生。

目的 探讨寒湿痹颗粒联合柳氮磺吡啶对强直性脊柱炎（AS）患者临床疗效、症状程度、脊柱功能、炎性因子、趋化因子的影响。方法 选取我院2023年7月-2025年6月收治的114例AS患者作为研究对象，依据随机数字表分成两组，每组57例。西药组行柳氮磺吡啶治疗，中药联合组行寒湿痹颗粒联合柳氮磺吡啶治疗。治疗3个月后，比较两组疗效、症状程度[Bath强直性脊柱炎疾病活动指数（BASDAI）]、脊柱功能[Bath强直性脊柱炎功能指数（BASFI）、Bath强直性脊柱炎计量学指数（BASMI）]、炎症因子[白介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）]、趋化因子[胸腺活化调节趋化因子（TARC）、干扰素γ诱导蛋白10（IP-10）]及不良反应。结果 治疗3个月后，中药联合组治疗有效率为94.74%，高于西药组的78.95%（P＜0.05）；中药联合组BASDAI评分、BASFI评分、BASMI评分、血清IL-1β、TNF-α、TARC、IP-10水平均低于西药组（P＜0.05）；治疗期间，中药联合组不良反应发生率为7.02%，与西药组的3.51%比较，无显著差异（P＞0.05）。结论 寒湿痹颗粒联合柳氮磺吡啶治疗AS患者效果显著，能有效改善临床症状，抑制炎性反应，改善趋化因子水平，促进脊柱功能恢复，且具有较高的用药安全性。