目的 观察程序性死亡受体1（PD-1）联合细胞毒性T淋巴细胞相关蛋白4（CTLA-4）双免疫疗法对改善晚期乳腺癌近期疗效及远期预后的影响。方法 选择2020年5月—2022年5月商丘市第一人民医院收治的124例晚期乳腺癌患者为研究对象,经随机数字表法将其分为对照组（60例）和观察组（64例）,对照组予以常规PD-1单抗免疫疗法治疗,观察组采用PD-1联合CTLA-4双免疫疗法治疗,比较2组患者治疗前后肿瘤标志物水平、治疗后病灶缓解情况,对所有患者开展为期1年随访,统计并对比2组的不良反应发生情况及远期生存情况。结果 治疗前,2组患者的肿瘤标志物水平比较差异均无统计学意义（均P>0.05）;治疗后,观察组的癌胚抗原为（3.36±0.17）ng/mL,糖类抗原15-3为（25.33±5.28）U/mL,糖类抗原19-9为（38.77±5.62）U/mL,均低于对照组[（5.27±1.36）ng/mL、（28.44±5.18）U/mL、（41.25±5.46）U/mL,均P<0.05]。治疗后,观察组的完全缓解率为21.88%（14/64）,部分缓解率为31.25%（20/64）,病情稳定率为37.50%（24/64）,均高于对照组[8.33%（5/60）、13.33%（8/60）、23.33%（14/60）],肿瘤生长率为（30.27±5.18）%,肿瘤超进展率为6.25%（4/64）,均低于对照组[（33.49±5.32）%、18.33%（11/60）,均P<0.05]。治疗后,观察组的不良反应发生率为34.38%（22/64）,略高于对照组33.33%（20/60）,组间比较差异无统计学意义（P>0.05）;观察组的中位无进展生存期为（9.33±2.25）月,中位总生存期为（10.76±3.32）月,均高于对照组[（7.25±2.31）月、（7.41±1.62）月,均P<0.05]。结论 PD-1联合CTLA-4双免疫疗法能有效改善晚期乳腺癌的近期疗效及远期预后,此疗法未明显增加不良反应发生风险,安全性高。

Objective To observe the effect of programmed cell death protein-1（PD-1）combined with cytotoxic T lymphocyte-associated antigen-4（CTLA-4）dual immunotherapy on the short-term efficacy and long-term prognosis of advanced breast cancer．Methods A total of 124 patients with advanced breast cancer who were admitted to the First People's Hospital of Shangqiu City from May 2020 to May 2022 were selected as the research objects．They were randomly divided into the control group（60 cases）and the observation group（64 cases）by the method of random number table．The control group was treated with conventional PD-1 monoclonal antibody immunotherapy,and the observation group was treated with PD-1 combined with CTLA-4 double immunotherapy．The levels of tumor markers before and after treatment and the focal remission after treatment were compared between the two groups．All patients were followed up for one year,the incidence of adverse reactions and long-term survival between the two groups were compared．Results Before treatment,there was no statistically significant difference in the levels of tumor markers between two groups（all P>0.05）．After treatment,the carcino-embryonic antigen content of the observation group was（3.36±0.17）ng/mL,CA153 was（25.33±5.28）U/mL,and CA199 was（38.77±5.62）U/mL,which were lower than those of the control group [（5.27±1.36）ng/mL,（28.44±5.18）U/mL,（41.25±5.46）U/mL,all P<0.05]．After treatment,the complete remission rate of the observation group was 21.88%（14/64）,partial remission rate was 31.25%（20/64）,and stable disease rate was 37.50%（24/64）,all higher than those of the control group [8.33%（5/60）,13.33%（8/60）,23.33%（14/60）];tumor growth rate of the observation group was（30.27±5.18）%,hyper progressive disease rate was 6.25%（4/64）,both lower than those of the control group [（33.49±5.32）%,18.33%（11/60）,both P<0.05]．After treatment,the incidence of adverse reactions in the observation group was 34.38%（22/64）,slightly higher than that in the control group 33.33%（20/60）（P>0.05）．The median progression free survival of the observation group was（9.33±2.25）months,and the median overall survival was（10.76±3.32）months,both higher than those of the control group [（7.25±2.31）months and（7.41±1.62）months]（P<0.05）．Conclusions PD-1 combined with CTLA-4 dual immunotherapy can effectively improve the short-term efficacy and long-term prognosis of advanced breast cancer．This therapy does not significantly increase the risk of side effects,which is safe．

目的 对比颈动脉内膜剥脱术（CEA）不同时间预处理对患者术后应激反应及神经功能的影响。方法 回顾性收集2019年12月—2022年12月在我院择期行CEA术治疗的74例颈动脉狭窄（CS）患者临床资料,按远隔缺血预处理（RIPC）时间不同分成2组,其中A组37例（术前1 h进行预处理）、B组37例（术前24 h进行预处理）。对比2组术前1 d、麻醉诱导后、切皮时交感神经反应指标[收缩压（SBP）、心率（HR）、舒张压（DBP）]变化及手术前后简易精神状态评价量表（MMSE）评分、应激指标[去甲肾上腺素（NE）、白细胞介素-6（IL-6）、皮质醇（Cor）]、神经功能指标[脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S-100β）]水平。结果 与A组相比,麻醉诱导后B组SBP、HR、DBP水平更高,切皮时SBP、HR、DBP水平更低（P<0.05）;与A组相比,B组术后7 d、30 d MMSE评分更高（P<0.05）;术后12 h、24 h 2组血清NE、Cor、IL-6水平均较术前1 d升高（P<0.05）,但2组比较差异无统计学意义（P>0.05）;与A组相比,B组术后12 h、24 h血清S-100β、NSE水平更低,血清BDNF水平更高（P<0.05）。结论 CEA术前实施RIPC可减轻脑损伤,发挥脑保护作用,但与术前1 h实施RIPC相比,于术前24 h实施RIPC更有助于维持机体血流动力学稳定,促进认知功能及预后恢复。

Objective To compare the effects of different time preconditioning of carotid endarterectomy（CEA）on postoperative stress response and neurological function．Methods From December 2019 to December 2022,74 patients with carotid stenosis（CS）who were selected for CEA treatment in our hospital were retrospectively collected and divided into two groups according to the time of remote ischemic preconditioning（RIPC）,including 37 cases in group A（preconditioning at 1 hour before surgery）and 37 cases in group B（preconditioning at 24 hours before surgery）．The changes of sympathetic response indexes [systolic blood pressure（SBP）,heart rate（HR）,diastolic blood pressure（DBP）] in the 2 groups at 1 d before surgery,after the anesthesia induction,and at the time of skin incision before and after surgery,and the scores of the Mini-Mental State Examination（MMSE）,stress indexes [norepinephrine（NE）,interleukin-6（IL-6）,cortisol（Cor）],and neurological function indexes [brain-derived neurotrophic factor（BDNF）,neuron specific enolase（NSE）,central nervous specific protein（S-100β）]．Results Compared with group A,the levels of SBP,HR and DBP in group B after anesthesia induction were higher,and the levels of SBP,HR and DBP were lower during skin resection（P<0.05）．Compared with group A,group B had higher MMSE scores at 7 and 30 days after surgery（P<0.05）．The serum levels of NE,Cor and IL-6 in the 2 groups were increased 12 h and 24 h after surgery compared with 1 day before surgery（P<0.05）,but there was no significant difference between the 2 groups（P>0.05）．Compared with group A,serum S-100β and NSE levels in group B were lower at 12 h and 24 h after surgery,and serum BDNF level was higher in group B（P<0.05）．Conclusions The administration of RIPC before CEA can reduce brain injury and play a protective role in brain．However,compared with the administration of RIPC 1 h before surgery,the administration of RIPC 24 h before surgery is more conducive to maintaining hemodynamic stability,promoting cognitive function and prognostic recovery．

目的 探讨药物服务干预对老年高血压患者的治疗及用药安全性的影响。方法 选取2020年6月—2021年12月潮州市中医药研究所门诊部和潮州市中医医院高血压患者90例为研究对象,采用随机数字表法分为观察组45例（给予药物服务干预）,对照组45例（给予常规用药指导）。比较干预后血压控制水平、健康知识认知、治疗依从性、自我管理行为、生活质量及药物不良反应等情况。结果 干预后,观察组舒张压、收缩压、不良反应发生率均低于对照组（P<0.05）。干预后,观察组健康知识认知水平、治疗依从率、自我管理行为评分、生活质量评分均高于对照组（P<0.05）。结论 采用药物服务干预的方式能够较好控制老年高血压患者血压水平,提升其健康知识认知水平与治疗依从性,改善自我管理行为状况,提高生活质量。

Objective To investigate the effect of drug service intervention on the treatment and drug safety of elderly patients with hypertension．Methods From June 2020 to December 2021,a total of 90 patients with hypertension from Chaozhou Institute of traditional Chinese Medicine and Chaozhou Hospital of Traditional Chinese Medicine were selected as the study objects,and were divided into observation group（45 cases,given drug service intervention）and control group（45 cases,given routine drug guidance）by random number table method．The blood pressure control level,health knowledge cognition level,treatment compliance,self-management behavior,quality of life and adverse drug reactions of elderly patients with hypertension were compared after intervention．Results After intervention,the incidence of diastolic blood pressure,systolic blood pressure and adverse drug reactions in the observation group were lower（P<0.05）．After intervention,the health knowledge cognition level,treatment compliance rate,self-management behavior score and quality of life score of the observation group were higher（P<0.05）．Conclusions The use of drug service intervention can better control the blood pressure level of elderly patients with hypertension,improve their health knowledge cognition and treatment compliance,improve self-management behavior and improve quality of life．

目的 探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

目的 分析经腹部浅表超声检查对急性阑尾炎患者检出率的影响。方法 选取濮阳市人民医院2018年12月—2020年6月疑似急性阑尾炎患者146例,均行腹部超声、浅表超声检查,以术后诊断为金标准,比较腹部、浅表超声单独及联合诊断效能、对不同类型急性阑尾炎检出率,分析不同类型急性阑尾炎影像学结果。结果 以术后诊断为金标准,146例疑似急性阑尾炎患者中阳性87例,阴性59例;腹部超声检出阳性80例,阴性66例;浅表超声检出阳性91例,阴性55例;腹部浅表超声检出阳性86例,阴性60例;腹部浅表超声诊断急性阑尾炎准确度99.32%(145/146)、灵敏度98.85%(86/87)、特异度100.00%(59/59)高于腹部超声[70.55%(103/146)、71.26%(62/87)、69.49%(41/59)]及浅表超声[69.86%(102/146)、77.01%(67/87)、59.32%(35/59)]单独诊断,漏诊率1.15%(1/87)、误诊率0.00%(0/59)低于腹部超声[28.74%(25/87)、30.51%(18/59)]及浅表超声[22.99%(20/87)、40.68%(24/59)]单独诊断(P＜0.05);腹部浅表超声对不同类型急性阑尾炎总检出率高于单独检查(P＜0.05)。结论 腹部浅表超声应用于急性阑尾炎诊断,可提高诊断准确度、灵敏度、特异度,降低漏诊率及误诊率,对不同类型急性阑尾炎检出率提高有积极作用,可收集患者详细声像信息,为临床治疗方案制定提供方向。

目的 研究益生菌结合肠内营养(enteral nutrition,EN)干预纠正缺血急性脑梗死(acute cerebral infarction,ACI)患者肠道菌落紊乱的作用及对患者预后的影响。方法 将97例无法自主进食的ACI患者根据治疗方法不同分为观察组(采用益生菌结合EN进行营养支持)和对照组(单纯EN为营养支持)进行治疗,疗程30 d,比较2组肠道菌落生长情况、患者营养水平、临床疗效及预后。结果 治疗后,2组双歧杆菌、肠球菌、大肠杆菌数量先降低后升高,2相邻时间点之间差异显著(P<0.05),2组乳酸杆菌数量持续升高,观察组各时间点之间差异显著(P<0.05),对照组治疗第7 d开始有明显差异(P<0.05),且治疗第7 d后观察组双歧杆菌、肠球菌、大肠杆菌数量高于对照组,差异有统计学意义(P<0.05),治疗第14 d后,观察组乳酸杆菌数量高于对照组,差异有统计学意义(P<0.05);治疗后,观察组体质量指数(body mass index,BMI)、肱三头肌皮皱厚度(triceps skinfold thinkness,TSF)、上臂肌围(arm muscle circumference,AMC)及血红蛋白(hemoglobin,HB)明显降低(P<0.05),对照组BMI、TSF、AMC、HB、白蛋白(albumin,ALB)及三酰甘油(triglyceride,TG)均明显降低(P<0.05),且观察组BMI、TSF、AMC、HB、ALB及TG高于对照组,差异有统计学意义(P<0.05);观察组治疗过程中腹胀、腹泻发生率低于对照组,差异有统计学意义(P<0.05);治疗后2组APACHEⅡ评明显降低(P<0.05),且观察组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);治疗后观察组日常生活活动能力(activities of daily life,ADL)评分高于对照组,ADL分级优于对照组,差异有统计学意义(P<0.05)。结论 益生菌结合EN治疗可有效纠正患者肠道菌落平衡,保护胃肠道功能,从而改善机体营养水平,提高ACI治疗效果,改善患者预后。

目的 探讨肠道菌群多样性及丰度在抗结核治疗强化期的变化。方法 收集广州市胸科医院20例初治菌阳肺结核患者使用强化方案治疗1周及强化期结束的粪便标本,所有标本进行16S rDNA测序,进行生物信息学分析。结果 强化期结束治疗组的Alpha多样性指标Chao1和observed_otus指数分别为(97.8±28.3)和(97.6±28.2),高于治疗1周组的(81±34.7)和(81±34.7),差异有统计学意义(P=0.04;P=0.038)。基于加权和未加权Unifrac距离的PCoA分析显示两组整体菌群结构无明显差异。在相对丰度较高的菌科中,强化期结束治疗组的拟杆菌科、肠球菌科、肠杆菌科、丹毒菌科、卟啉单胞菌科、双歧杆菌科等相对丰度下降,毛螺菌科、梭杆菌科、普氏菌科、瘤胃球菌科、韦氏菌科等相对丰度增加。通过线性判别分析效应量LEfse分析两组数据,发现在属水平上,厚壁菌门的瘤胃球菌、乳杆菌及放线菌门的柯林氏菌为组间显著差异菌种。结论 强化期治疗结束与治疗1周相比,肠道菌群多样性增加,但肠道菌群结构无明显差异。肠道拟杆菌科丰度减少,毛螺菌科丰度增加。

Objective To investigate the changes in the diversity and abundance of intestinal flora during the intensive period of anti-tuberculosis treatment. Methods Stool specimens from 20 patients with newly treated bacteria-positive pulmonary tuberculosis in Guangzhou Chest Hospital, which were treated with the intensive treatment for 1 week and whole intensive treatment, were collected. All the specimens were subjected to 16S rDNA sequencing and bioinformatics analysis. Results The Alpha diversity index Chao1 and observed_otus index of the treatment group with whole process were (97.8±28.3) and (97.6±28.2) respectively, which were higher than (81±34.7) and (81±34.7) of the 1-week treatment group, which had statistical differences (P=0.04;P=0.038). PCoA analysis based on weighted and unweighted Unifrac distance showed that there was no significant difference in the overall flora community structure between the two groups. Among the bacteria families with higher relative abundance, the relative abundance of Bacteroidaceae,Enterococcaceae,Enterobacteriaceae,Erysipelotrichaceae,Porphyromonadaceae and Bifidobacteriaceae in the treatment group with whole process decreased, the relative abundance content of Lachnodoiraceae,Fusobacteriaceae,Prevotellaceae, Rumincoccaceae, and Veillonellaceae increased. By using linear discriminant analysis effect size (LEfse) to analyze the two sets of data, it was found that at the genus level,Rumincoccaceae of Firmicutes and Lactobacillus;Collinsella of Actinobacteria were significantly different species between the groups. Conclusion Compared with 1 week of treatment, the diversity of intestinal flora increased at the end of intensive treatment, but there was no significant difference in the community structure of intestinal flora. The abundance of intestinal Bacteroidaceae decreased, and the abundance of Lachnodoiraceae increased.

目的 研究磁共振成像(magnetic resonace imaging, MRI)检查颈椎病患者椎间盘及颈髓病变的检出率。方法 选取2017年3月—2019年3月我院颈椎病患者216例,均行MRI检查、CT检查。比较MRI检查、CT检查颈椎病的检出率、颈椎病影像征象的检出率及神经根型、脊髓型颈椎病的检出率。结果 MRI检查颈椎病患者椎间盘膨出及突出、椎间盘变性、椎间盘纤维环病变、颈髓缺血性损伤、后纵韧带病变、颈椎病椎间隙狭窄、钩突增生、椎体后缘骨赘、小关节突增生、骨性椎管狭窄、颈椎曲度异常检出率均高于CT检查(P＜0.05);MRI检查、CT检查颈椎病患者椎间孔狭窄、椎管狭窄检出率比较,差异无统计学意义(P＞0.05);MRI检查椎间盘钙化、椎小关节骨质增生、椎间盘积气检出率低于CT检查,椎间盘突出、黄韧带增厚、脊髓变性、硬膜囊受压、神经根受压检出率高于CT检查(P＜0.05);MRI检查神经根型颈椎病检出率94.44%、脊髓型颈椎病检出率88.89%高于CT检查检出率75.00%、25.25%(P＜0.05)。结论 MRI检查颈椎病患者能提高椎间盘及颈髓病变的检出率,对多种颈椎病变征象显著,有助于颈椎病分型的鉴别诊断,从而为临床治疗方案的制定提供科学依据。

Objective To study the detection rate of cervical disc and spinal cord lesions in patients with cervical spondylosis by magnetic resonance imaging (MRI). Methods A total of 216 patients with cervical spondylosis in our hospital from March 2017 to March 2019 were selected, all of them underwent MRI and computed tomography (CT) examination. The detection rate of cervical spondylosis, imaging signs of cervical spondylosis, and cervical spondylosis of nerve root type and spinal cord type by MRI and CT were compared. Results The detection rates of cervical spondylosis patients with disc herniation and protrusion, disc degeneration, disc annulus fibrosus disease, cervical spinal cord ischemic injury, posterior longitudinal ligament disease, cervical intervertebral space stenosis, uncinate process hyperplasia, vertebral posterior margin osteophyte, facet hyperplasia, bony spinal stenosis, abnormal cervical curvature by MRI examination were higher than that by CT examination (P<0.05). There were no significant differences in the detection rates of foramen stenosis and spinal canal stenosis between MRI and CT examination (P>0.05); the detection rates of intervertebral disc calcification, vertebral facet joint hyperosteogeny and intervertebral disc pneumatosis by MRI examination were lower than that by CT examination; the detections rates of intervertebral disc herniation, ligamentum flavum thickening, spinal degeneration, dural sac compression and nerve root compression by MRI examination were higher than that by CT examination (P<0.05); the detection rates of cervical spondylotic radiculopathy and cervical spondylotic myelopathy by MRI examination were 94.44% and 88.89%, which were higher than 75.00% and 25.25% of the detection rates by CT examination (P<0.05). Conclusion MRI examination of patients with cervical spondylosis can improve the detection rates of intervertebral disc and cervical spinal cord lesions, and has significant signs for a variety of cervical lesions, which is helpful for the differential diagnosis of cervical spondylosis classification, so as to provide scientific basis for the formulation of clinical treatment plan.

目的 分析厄贝沙坦+美托洛尔治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床效果及对患者心功能影响。方法 选取本院2018年12月—2020年12月住院治疗的200例慢性CHF患者,根据不同的治疗方法分组,参照组100例患者采用厄贝沙坦治疗,治疗组100例患者采用厄贝沙坦+美托洛尔治疗,比较2组临床疗效、心功能指标、血清炎性因子、血清N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)水平、不良反应发生率。结果 治疗组临床总有效率(97.00%)高于参照组(87.00%),治疗组治疗后左室射血分数(left ventricular ejection fraction,LVEF)高于参照组,治疗组治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室收缩末期内径(left ventricular end systolic diameter,LVESd)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、NT-proBNP、Hcy水平均低于参照组,差异均具有统计学意义(P＜0.05)。治疗组不良反应发生率(4.00%)与参照组(5.00%)比较,P>0.05。结论 厄贝沙坦+美托洛尔可有效改善慢性CHF患者心功能,减轻炎症反应,抑制NT-proBNP、Hcy释放,且不良反应较少。

Objective To analyze the clinical effect of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure (CHF) and its influence on cardiac function. Methods A total of 200 patients with chronic CHF in our hospital from December 2018 to December 2020 were selected and divided into two groups according to different treatment methods. One handred patients in the control group were treated with irbesartan, and 100 patients in the treatment group were treated with irbesartan + metoprolol. The clinical efficacy, cardiac function indexes, serum inflammatory factors, serum NT-proBNP, Hcy levels and adverse reactions of the two groups were compared. Results The total effective rate of the treatment group (97.00%) was higher than that of the control group (87.00%), LVEF of the treatment group was higher than that of the control group, LVEDd, LVESd, serum TNF-α, hs-CRP, IL-6, NT-proBNP, Hcy levels of the treatment group were lower than those of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the treatment group (4.00%) was higher than that in the control group (5.00%),P>0.05. Conclusion Irbesartan + metoprolol could effectively improve cardiac function, reduce inflammatory reaction, inhibit the release of NT-proBNP and Hcy in patients with chronic CHF, with less adverse reactions.

目的 本文旨在研究穿心莲内酯对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者血清学中的炎症反应因子及肺部功能改变的影响。方法 从我院已出院的患者中挑选2017年6月—2018年6月期间收治的AECOPD患者共80例,其中给予哌拉西林舒巴坦抗感染和雾化吸入布地奈德及复方异丙托溴铵治疗的患者为对照组,对照组的治疗方法基础上给予喜炎平注射液的患者为观察组,各40例。对2组患者接受治疗前后血清学中的基质金属蛋白酶-9 (matrix metalloproteinase-9, MMP-9)、降钙素原 (procalcitonin, PCT)、白介素-6 (interleukin-6, IL-6) 水平和肺功能指标等方面进行比较。结果 2组治疗前血清学MMP-9、PCT、IL-6和肺功能指标第1秒用力呼气容积(forced expiratory volume in one second, FEV1)、用力肺活量(forced vital capacity, FVC)、一秒率(FEV1/FVC)无差异(P＞0.05)。观察组经过治疗后MMP-9为(1995.13±347.281)pg/mL、IL-6为(7.98±3.23)pg/mL,低于对照组的(2159.30±367.477)pg/mL、(10.03±5.45)pg/mL(P＜0.05);观察组治疗后的PCT、FEV1、FVC和FEV1/FVC与对照组相比差异无统计学意义 (P＞0.05)。结论 穿心莲内酯在AECOPD患者中可以减少血清学中炎症因子,值得在临床中推广。

Objective To investigate the effect of andrographolide on levels of serum inflammatory factors and pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Eighty patients with AECOPD who were treated in our hospital from June 2017 to June 2018 were selected. Forty patients in the control group were given anti-infection treatment with piperacillin and sulbactam and aerosol inhalation with compound ipratropium bromide and budesonide, while other 40 patients in study group were given andrographolide additionally. The levels of serum matrix metalloproteinase-9 (MMP-9), procalcitonin (PCT), interleukin-6 (IL-6) and the pulmonary function indexes of patients in the two groups were observed and compared before and after treatment. Results There were no statistically significant differences in the serum levels of MMP-9, PCT and IL-6 and the pulmonary function indexes forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC of the two groups before treatment (P>0.05). After treatment, in the study group, the MMP-9 and IL-6 levels in serum were (1995.13±347.281)pg/mL and (7.98±3.23)pg/mL respectively, which were significantly lower than that in the control group [(2159.30±367.477) pg/mL and (10.03±5.45) pg/mL (P＜0.05)].Compared with the control group, differences in the PCT, FEV1, FVC and FEV1/FVC in the study group were not statistically significant (P>0.05). Conclusion Andrographolide had significant clinical effect on the treatment of AECOPD, which could reduce the levels of serum inflammatory factors and it is worthy of clinical application.