目的 编制适用于老年人群的衰弱综合征中医评估量表并检验其信度与效度。方法 通过文献研究及《中华医典》检索构建条目池，采用4轮德尔菲专家咨询及预调查筛选条目形成初量表；便利抽取300例老年患者行横断面调查，以Fried表型衰弱量表为校标，进行项目分析、Cronbach’s α系数、探索性因子分析及ROC曲线分析。 结果 经条目筛选最终形成含5个核心症状条目（表A）及38个证候条目（表B）的量表。表A校标关联效度r=0.929（P＜0.05），AUC=0.957，灵敏度0.949，特异度0.859；表A+B校标关联效度r=0.648（P＜0.05），AUC=0.827，灵敏度0.606，特异度0.911；总量表Cronbach's α=0.872。结论 所研制的衰弱综合征中医量表信效度良好，可用于老年人衰弱状态筛查及中医证型判别。

Objective: To develop a Traditional Chinese Medicine (TCM) assessment scale for frailty syndrome in the elderly and to evaluate its reliability and validity. Methods: An item pool was constructed through literature review and searches of the *Chinese Medical Canon*. A preliminary scale was developed through four rounds of Delphi expert consultation and a pilot survey. A cross-sectional survey was conducted using a convenience sample of 300 elderly patients. Using the Fried Phenotypic Frailty Scale as the gold standard, item analysis, Cronbach’s α coefficient, exploratory factor analysis, and ROC curve analysis were performed. Results: After item screening, the final scale comprised 5 core symptom items (Table A) and 38 syndrome items (Table B). For Table A, the criterion-related validity was r = 0.929 (P < 0.05), AUC = 0.957, sensitivity = 0.949, and specificity = 0.859; Table A+B showed a test-retest reliability of r = 0.648 (P < 0.05), an AUC of 0.827, a sensitivity of 0.606, and a specificity of 0.911; the total scale had a Cronbach’s α of 0.872. Conclusion: The developed Traditional Chinese Medicine (TCM) frailty syndrome scale demonstrates good reliability and validity and can be used for screening frailty in the elderly and for distinguishing TCM syndrome patterns.

临床研究中,我们会经常遇到多重检验的问题。当同时检验多个假设时,如何控制犯Ⅰ类错误的概率,保证结果的准确性,是研究者面对的首要问题。然而未对多重检验进行校正的文章比例仍较大。本文从简单的单个检验假设出发,回答为什么需要进行多重校正,何时进行多重校正,同时介绍总体错误率(FWER)和错误发现率(FDR)两种重要的错误率以及在此基础上的Bonferroni和Benjamini-Hochberg校正方法,从而避免因多重检验问题带来的混乱。

In clinical research, we often encounter the problem of multiple testing. When testing many hypotheses at the same time, how to control the type I error to ensure the accuracy of the results is the primary problem faced by researchers. However, the proportion of articles that didn't correct the multiple testing remains substantial. Starting with the simple hypothesis of a single test, this article provides an introduction to multiple testing issues, answers why and when multiple corrections are needed, introduces two important error rates which are family-wise error rate (FWER) and false discovery rate (FDR), and the Bonferroni and Benjamini-Hochberg correction methods based on them, thereby avoiding confusion caused by multiple testing.

目的 探究冠心病患者实施血清胆红素与尿酸检验的临床诊断价值。方法 遴选时段2020年6月—2021年6月内100例冠心病患者记观察组,另择取同时段健康体检对象100例记对照组,检测血清胆红素、尿酸水平并2组相对比,同时观察组患者根据冠脉狭窄程度(Gensini法)分组为A、B、C、D组,比较冠脉不同狭窄程度分级下上述指标的变化;评估对比血清胆红素、尿酸单项指标检验与联合检验对冠心病患者的诊断效能。结果 观察组较对照组血清胆红素(总胆红素、直接胆红素、间接胆红素)水平更低,尿酸水平更高,对比有统计学差异(P＜0.05);随着冠脉狭窄程度越严重患者血清胆红素水平呈下降趋势,尿酸水平呈升高趋势,且4组组间比较均差异有统计学意义(P＜0.05);冠心病患者血清胆红素联合尿酸检验的诊断敏感度96.00%、特异度95.00%均高于单项检验敏感度及特异度(P＜0.05)。结论 血清胆红素与尿酸水平可作为冠心病患者诊断的敏感性指标,其与冠心病的发生及发展密切相关,可反映患者病情严重程度,且联合检验诊断价值更高。

Objective To explore the clinical diagnostic value of serum bilirubin and uric acid detection in patients with coronary heart disease. Methods A total of 100 patients with coronary heart disease from June 2020 to June 2021 were selected as the observation group, and another 100 healthy subjects in the same period were selected as control group. Serum bilirubin and uric acid levels were detected and compared between the two groups. Meanwhile, the patients in the observation group were divided into groups A, B, C and D according to the degree of coronary artery stenosis (Gensini method). The changes of the above indexes were compared among different grades of coronary stenosis. And the diagnostic efficacy of each single detection and combined detection of serum bilirubin and uric acid in patients with coronary heart disease were evaluated and compared. Results Compared with the control group, the serum bilirubin (total bilirubin, direct bilirubin, indirect bilirubin) level of the observation group was lower, and the uric acid level was higher, with statistical differences (P<0.05). With the increased severity of coronary artery stenosis, the serum bilirubin level of patients showed a downward trend, while the uric acid level showed an upward trend, and there were significant differences among the four groups (P<0.05). The sensitivity and specificity of serum bilirubin combined with uric acid detection in patients with coronary heart disease were 96.00% and 95.00% respectively, which were higher than those of single detection (P<0.05). Conclusions Serum bilirubin and uric acid levels can be used as sensitive indicators in the diagnosis of patients with coronary heart disease, and are closely related to the occurrence and development of coronary heart disease, which can reflect the severity of the disease, also the diagnostic value of combined detection is higher.

目的 探讨肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值。方法 选取2018年1月—2020年1月我院收治的64例肝硬化患者(肝硬化组),并纳入同期来我院接受健康体检者64例(对照组),应用全自动血凝仪对肝硬化患者临床凝血指标检测。再将肝硬化组患者分为出血组与无出血组,比较对照组与肝硬化组、出血与无出血组、不同肝功能分级患者血小板参数与PT检测结果。结果 与对照组比较,肝硬化组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与肝硬化无出血组比较,肝硬化出血组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与Child-Pugh A级患者比较,肝硬化Child-Pugh B级与C级患者PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05)。结论 在肝硬化患者病情评价中凝血功能检验发挥重要作用,可为患者临床治疗提供有效理论依据,诊断准确率较高,有利于临床治疗措施制定。因此,凝血功能检验应在肝硬化疾病诊断中广泛应用。

Objective To explore the application and clinical value of automatic blood coagulation apparatus in clinical coagulation function test of patients with cirrhosis. Methods A total of 64 patients with cirrhosis admitted to our hospital from January 2018 to January 2020 (cirrhosis group) were selected, and 64 healthy subjects admitted to our hospital during the same period (control group) were included. The clinical coagulation indexes of patients with cirrhosis were detected by automatic blood coagulation apparatus. Patients in cirrhosis group were divided into bleeding group and non-bleeding group; platelet parameters and PT test results were compared between control group and cirrhosis group, bleeding group and non-bleeding group, and patients with different liver function grades. Results Compared with the control group, the levels of PDW, PT, MPV and INR in cirrhosis group were higher, and the levels of PCT and PLT were lower (P＜0.05). Compared with liver cirrhosis non-bleeding group, the levels of PDW, PT, MPV and INR were higher in liver cirrhosis with bleeding group, and the levels of PCT and PLT were lower (P＜0.05). Compared with Child-Pugh A patients, the levels of PDW, PT, MPV and INR in Child-Pugh B and C patients with cirrhosis were higher, and the levels of PCT and PLT were lower (P＜0.05). Conclusion The test of coagulation function plays an important role in the evaluation of patients with cirrhosis, and can provide effective theoretical basis for the clinical treatment of patients with high diagnostic accuracy, which is conducive to the formulation of clinical treatment measures. Therefore, the test of coagulation function should be widely used in the diagnosis of cirrhosis.

目的 分析高龄呼吸道感染患者病原菌检测结果及耐药性情况,总结高龄呼吸道感染患者抗菌药物的合理用药经验。方法 对我院2018年1月—2020年12月收治的784例高龄呼吸道感染患者痰液标本进行病原菌培养及药敏试验,统计分析检测结果。结果 701株病原菌中,革兰阴性(G-)菌、革兰阳性(G+)菌和真菌分别检出497株、136株和68株,分别占70.90%、19.40%和9.70%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和奇异变形杆菌为主,分别占21.97%(154株)、18.97%(133株)、14.98%(105株)和7.13%(50株),G+菌以金黄色葡萄球菌为主,占11.27%(79株)。G-菌耐药性前五位依次为氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶,耐药率依次为95.96%、85.11%、79.88%、77.06%和52.92%。G+菌耐药性前五位依次为青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑,耐药率依次为95.59%、89.71%、84.56%、80.15%和75.00%。结论 高龄呼吸道感染患者病原菌构成以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、奇异变形杆菌和金黄色葡萄球菌为主,G-菌对氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶耐药最强,G+菌对青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑最强,且呈多重耐药特征,加强临床耐药性监测有助于指导合理用药。

Objective To analyze the test results and drug resistance of pathogenic bacteria in elderly patients with respiratory tract infections, and summarize the rational use of antibiotics in elderly patients with respiratory tract infections. Methods The sputum samples of 784 elderly patients with respiratory tract infections admitted to our hospital from January 2018 to December 2020 were collected for pathogen culture and drug sensitivity test, and the test results were statistically analyzed. Results Among 701 strains of pathogenic bacteria, 497 strains were Gram-negative (G-) bacteria (70.90%), 136 strains were Gram-positive (G+) bacteria (19.40%) and 68 strains were fungi (9.70%). G-bacteria were mainly Klebsiellapneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis, accounting for 21.97% (154 strains), 18.97% (133 strains), 14.98% (105 strains) and 7.13% (50 strains). G+bacteria were mainly Staphylococcus aureus, accounting for 11.27% (79 strains). The top five antibiotics which G-bacteria resisted were ampicillin, piperacillin, compound sulfamethoxazole, cefazolin and ceftazidime.The resistance rates were 95.96%, 85.11%, 79.88%, 77.06% and 52.92%,respectively. The top five antibiotics which G+bacteria resisted were penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and the drug resistance rates were 95.59%, 89.71%, 84.56%, 80.15% and 75.00%, respectively. Conclusions The pathogenic bacteria in elderly patients with respiratory tract infections were mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Staphylococcus aureus. G-bacteria resisted ampicillin, piperacillin,compound sulfamethoxazole, cefazolin and ceftazidime the most. G+bacteria were most resistant to penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and were characterized by multi-drug resistance.Enhancing bacterial resistance monitoring helps guiding the rational use of drugs.

      目的   探讨分析超声引导下胸膜活检（USPB）联合胸腔积液检验对于临床确诊结核性胸膜炎的应用价值。方法   选取2021年6月—2023年6月广州市胸科医院收治的96例临床诊断为结核性胸膜炎（渗出性胸膜炎）的患者为研究对象，分别使用胸腔积液检验（包含胸腔积液腺苷脱氨酶及细菌培养）、USPB、两者联合三种方法诊断，计算其准确率、特异度及灵敏度并进行分析。结果   胸腔积液诊断准确率73.96%、灵敏度72.84%，USPB诊断准确率为85.42%、灵敏度82.71%，两者联合诊断准确率为88.54%，灵敏度90.12%，较胸腔积液检验单独诊断准确率及灵敏度明显升高（P＜0.05），胸腔积液、USPB、两者联合诊断特异度差异（P＞0.05）无统计学意义。结论  USPB联合胸腔积液检验对结核性胸膜炎的确诊具有较高临床价值。

       Objective  To investigate the value of ultrasound-guided pleural biopsy（USPB）combined with  pleural effusion test in the diagnosis of tuberculous pleurisy．Methods  A total of 96 patients with tuberculous pleurisy（exudative pleurisy）admitted to the Guangzhou Chest Hospital from June 2021 to June 2023 were selected．The accuracy，specificity，and sensitivity of pleural effusion test（including adenosine deaminase and bacterial culture），USPB，and their combination were calculated and analyzed．Results  The diagnostic accuracy of pleural effusion was 73.96% and the sensitivity was 72.84%．The diagnostic accuracy of USPB was 85.42% and the sensitivity was 82.71%．The diagnostic accuracy 88.54% and sensitivity 90.12% of USPB combined with pleural effusion test were significantly higher than that of pleural effusion alone（P＜0.05），but there was no significant difference in the diagnostic specificity of pleural effusion，USPB and combination of them（P＞0.05）．Conclusions  USPB combined with pleural effusion test has high clinical value in the diagnosis of tuberculous pleurisy．