目的 了解广州市海珠区肺结核患者登记情况及流行特征,为进一步做好海珠区肺结核防治提供依据。方法 收集2008—2017年海珠区结核病信息管理系统中按现住址登记的肺结核患者资料,采用描述性流行病学方法和相关统计方法对肺结核患者登记资料进行分析。结果 2008—2017年海珠区共报告登记肺结核患者 14 384 例,年报告发病率由2008年的105.3/10万下降到2017年的73.1/10万,呈下降趋势(χ²=164.973,P<0.001);男女发病相对比为2:1;各个年龄组均有发病,其中25～34岁年龄组发病人数最多,占总发病数的21.61%;职业分布方面,家务及待业人群最多,占总发病率34.48%,其次分别是其他(不固定职业),占17.29%,退休人群,占15.12%,学校学生占比5.52%。地区分布方面,各街道年平均发病率相差较大,最高为131.23/10万,最低的为66.40/10万,差异有统计学意义(χ² =164.973,P<0.001)。结论 广州市海珠区肺结核疫情呈逐年下降趋势,但部分街道肺结核发病率仍达100/10万以上。男性人群、25~34岁年龄组和低收入人群(家务及待业、不固定职业、退休人群)是防控的主要人群,学生肺结核发病人数多,要加强学校结核病防控和筛查工作。

Objective To understand the registration situation and epidemic characteristics of tuberculosis patients in Haizhu district of guangzhou, and to provide a basis for further prevention and treatment of tuberculosis in Haizhu district. Methods The data of tuberculosis patients registered at present address in the TB information management system of Haizhu district from 2008 to 2017 were collected, and the registration data of tuberculosis patients were analyzed using descriptive epidemiological methods and relevant statistical methods. Results From 2008 to 2017, 14 384 cases of tuberculosis patients were reported in Haizhu district. The annual reported incidence rate decreased from 105.3/100,000 in 2008 to 73.1/100,000 in 2017, showing a down ward trend (χ² = 164.973, P<0.001). The relative incidence of male and female was 2:1; all age groups had morbidity, of which 25~34 years old group had the largest number of cases, accounting for 21.61% of the total number of cases; in occupational distribution, household chores and unemployed were the most, accounting for 34.48 %, followed by other (non-fixed occupations), accounting for 17.29%, retired people, accounting for 15.12%, and school students accounting for 5.52%. In terms of regional distribution, the average annual incidence rate of each street varied greatly, with the highest being 131.23/100,000 and the lowest being 66.40/100,000. The difference is statistically significant(χ²=164.973,P<0.001). Conclusion The incidence of tuberculosis in Haizhu district of Guangzhou has been decreasing year by year, but the incidence of tuberculosis in some streets is still more than 100/100,000. Male population, 25~34 years old group and low-income population (domestic and underemployed, irregular occupation, retired population) are the main population for prevention and control. Students have a large number of cases of tuberculosis, so we need to strengthen prevention, control and screening of tuberculosis in schools.

目的 探讨市区院前急救流行病学特征,为制定院前急救策略和合理调配急救资源提供参考依据。方法 采用回顾性资料收集方法选取我院2013—2014年院前急救患者14000例(对照组),2017年院前急救患者9 630例(观察组)作为研究对象,对两组的性别、年龄、死亡原因等建立数据库,采用描述性研究和圆形分布方法进行统计分析,并对比两组数据,分析院前急救患者变化趋势。结果 对照组急救患者性别男性所占比例高于女性,年龄45~55岁所占比例最高,死亡原因创伤所占比例最高,心脑血管疾病其次;观察组急救患者性别男性所占比例高于女性,但低于对照组男性所占比例,年龄45~55岁所占比例最高,但比例低于对照组,死亡原因创伤所占比例最高,心脑血管疾病其次。结论 根据院前急救时间分布规律合理调配急救资源,充分发挥院前急救功能,提高院前急救水平。

目的 分析肺肝样腺癌(HAL)的临床病理特征、诊断、免疫表型、基因检测及治疗预后等。方法 对1例HAL临床及影像学、组织学形态、免疫组化及基因检测结果等进行观察,并结合相关文献综合分析。结果 患者为48岁吸烟男性,镜下肿瘤具有肝细胞样和腺样分化特征,血清AFP升高。免疫组化: Hepatocyte,AFP, Arginase-1均阳性,ARMS-PCR法均未检测到EGFR,ALK/ROS1,KRAS及BRAF突变。结合相关文献分析: HAL常见于有吸烟史的男性,血清AFP值升高也是该肿瘤的一个特点。肿物多见于肺上叶,体积较大,易发生淋巴结和远处转移,预后相对较差。结论 HAL非常少见,易误诊,其诊断需结合形态学特点、临床病理特征及免疫组化结果等。

Objective To explore the clinicopathologic characteristics, diagnosis, immunophenotype, gene detection and prognosis of primary hepatoid adenocarcinoma of the lung (HAL). Methods A case of hepatoid adenocarcinoma of the lung was analyzed with clinical manifestations, histology, immunohistochemical staining and gene detection, and relevant literatures were reviewed. Results The patient was a 48-years-old man with smoking history. Microscopically, the tumor has the characteristics of hepatocellular carcinoma and adenoid differentiation, also serum AFP was elevated. The immunohistochemical results showed that Hepatocyte, AFP and Arginase-1were positive. No mutations were detected for EGFR, ALK/ROS1, KRAS and BRAF by ARMS-PCR. Combining with literature analysis, HAL is common in males and most patients with this tumor are smokers. Serum AFP in very high levels has been a distinguishing feature of this tumor. HAL usually presents as a large bulky solitary mass in the upper lobe. Lymph nodes and distant metastases are prone to occur. Therefore, the prognosis is very poor. Conclusion HAL is a rare malignant tumor and easy to be misdiagnosed. The diagnosis of primary hepatoid adenocarcinoma of the lung should be combined with morphological features, clinicopathological features and immunohistochemical findings.

目的 探讨不同分化程度前列腺癌患者的直肠超声图像特征,为前列腺癌分化程度的诊断提供依据。方法 纳入我院收治的前列腺癌患者120例,均接受直肠超声检查,根据Gleason评分评估分化程度分成低分化组(n=41)、中分化组(n=39)与高分化组(n=40)。分析不同分化程度患者的结节大小、血流分级、回声、边界是否清晰以及包膜完整性,并对血流频谱进行观察。结果 低分化组的结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、边界欠清晰、包膜欠完整、高回声占比高于高分化组,且低分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于中分化组,中分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于低分化组,差异有统计学意义(P<0.05)。结论 不同分化程度前列腺癌患者的直肠超声表现存在差异,随着分化程度越低,肿瘤边界清晰度、包膜完整性越差,血流越丰富。

目的 对我院43例经临床诊断及随访证实的足底筋膜炎患者MRI诊断资料进行回顾性研究,总结其MRI特征。方法 选取2016年8月—2017年8月因足底疼痛就诊的43例患者为本次研究对象,对患者进行彩超及MRI诊断,对比诊断患侧及健侧足底筋膜厚度及评测者间相关系数。结果 经临床及随访证实足底筋膜炎患者43例。MRI诊断结果:43例患者中最常见表现为足底筋膜周围软组织水肿,32例患者表现为跟骨骨髓水肿,17例患者观察到足底筋膜内肌腱信号改变。彩超及MRI诊断患侧、健侧足底筋膜厚度均有差异,MRI诊断优于对照组,组间差异有统计学意义(P＜0.05);彩超及MRI评测者间相关系数有差异,MRI诊断优于对照组,组间差异有统计学意义(P＜0.05)。结论 足底筋膜炎采用MRI诊断可观察到足底筋膜厚度及信号改变,对跟骨骨髓水肿、筋膜周围软组织肿胀改变程度有良好诊断表现,临床可作为足底筋膜炎诊断的首选方法。

Objective The MRI diagnostic data of 43 patients with plantar fasciitis confirmed by clinical diagnosis and follow-up were retrospectively studied. Methods Selection in August 2016 to August 2017 because of a foot pain clinic of 43 patients as the research object, to colour to exceed and MRI in the diagnosis of patients with diagnosed with lateral contrast and health parapodum bottom thickness of the membrane and the correlation coefficient between the reviewers. Results 43 cases of plantar fasciitis were confirmed by clinical and follow-up. Of MRI diagnosis results: 43 cases of plantar fascia around the most common soft tissue edema, 32 patients were characterized by calcaneal bone marrow edema, 17 patients were observed in the plantar fascia tendon signal change. There were significant differences in the diagnosis and treatment of the lateral and healthy side of the MRI diagnosis, and the MRI diagnosis was significantly better than the control group, and the difference between the groups was statistically significant (P< 0.05). There was significant difference in correlation coefficient between color ultrasound and MRI. MRI diagnosis was significantly better than the control group, and the difference between groups was statistically significant (P< 0.05). Conclusion Plantar fasciitis plantar fascia was observed by MRI in the diagnosis of thickness and signal change, soft tissue around the heel bone marrow edema, fascia swelling degree of change has a good diagnosis performance, clinical can be used as the preferred methods for the diagnosis of plantar fasciitis.

目的 探讨我院17年间前列腺癌患者的临床特征如发病年龄、前列腺特异性抗原(PSA)、Gleason评分、分期及穿刺阳性率等的变化。方法 采用回顾性分析,对广州市第一人民医院2000—2016年泌尿外科1 231例穿刺活检的患者及564例前列腺癌患者资料进行分析,按患者的诊断时间分为A组(2000—2005年)、B组(2006—2009年)、C组(2010—2012年)、D组(2013—2014年)、E组(2015—2016年),对各组的年龄、PSA、Gleason评分、分期及穿刺活检阳性率进行统计学分析,看各组间的各项指标差异是否有统计学意义。结果 5组年龄均值(73.36,73.74,72.05,73.40,72.96岁)、PSA均值(208.95,190.25,173.19,283.54,148.69 μg/L)及穿刺活检阳性率均值(48%,43%,37%,44%,39%)差异均无统计学意义(P均>0.05)。5组Gleason均值为6.80,6.73,7.12,6.93,7.32,A、B组和E组Gleason评分差异有统计学意义(P均<0.05),其余各组Gleason评分差异均无统计学意义(P均>0.05)。TNM分期转化得分5组均值为5.96,6.80,7.05,7.31,6.83, A和C组、D组、E组差异均有统计学意义(P均<0.05),其余各组TNM分期转化得分差异均无统计学意义(P均>0.05)。结论 17年间前列腺癌患者诊断时的年龄、PSA水平及穿刺活检阳性率没有显著变化。

Objective To investigate changes of inpatients with prostate cancer in the last 17 years such as age of onset, prostate specific antigen (PSA), Gleason score, prostate cancer staging and positive rate of prostate biopsy. Methods A retrospective analysis was conducted in 1 231 cases of biopsy patients of urology and 564 patients with prostate cancer who were hospitalized in the First People's Hospital of Guangzhou from 2000 to 2016. According to the time of diagnose. All the patients were divided into five groups: group A(2000-2005),group B(2006-2009),group C(2010-2012), group D(2013-2014)and group E(2015-2016). The age, PSA, Gleason score, staging and positive rate of prostate biopsy were compared to realize whether the indicators of the differences between groups was statistically significant. Results In five groups, means of age, PSA, Gleason score and prostate biopsy positive rate are respectively 73.36,73.74,72.05,73.40,72.96 years; 208.95,190.25,173.19,283.54,148.69 μg/L;6.80,6.73,7.12,6.93,7.32; 5.96,6.80,7.05,7.31,6.83 and 48%,43%,37%,44%,39%. There was no significant difference in age, PSA and positive rate of prostate biopsy (P>0.05). The Gleason scores of group A and group E, group B and group E were statistically significant (P<0.05), while the other groups had no significant differences in Gleason score (P>0.05). There werestatistical significancein TNM staging score between group A and group C,group D, group E(P <0.05),while the other groups had nostatistical significance (P>0.05). Conclusion There are no change of prostate cancer patients in diagnosis of age, PSA levels and positive rate of prostate biopsy in the past 17 years.

目的 分析小婴儿化脓性脑膜炎的临床特点,探讨其预测因子。方法 回顾性分析我科2015—2017年53例小月龄化脓性脑膜炎患儿的临床资料。以同时期、同年龄层的细菌感染患儿81例为观察组。通过单因素和多因素分析进行两组比较。结果 单因素分析提示早产儿、激惹、嗜睡、前囟紧张、颈强直及循环不良方面有差异。脑脊液白细胞数量、蛋白浓度、糖浓度,糖与同期血糖比值以及乳酸脱氢酶浓度均有明显差异。多因素分析提示仅脑脊液蛋白及乳酸脱氢酶有统计学意义。受试者工作曲线显示脑脊液蛋白、乳酸脱氢酶及两项指标合并的诊断效能均较高。结论 小婴儿化脓性脑膜炎患儿缺乏典型表现,密切关注早产儿基础疾病,激惹、嗜睡、前囟紧、颈强直及循环不良的临床表现,脑脊液蛋白及乳酸脱氢酶等实验室指标,有利于早期识别,及时干预,减少不良事件的发生。

Objective We aimed to analyze the clinical characteristics of community acquired purulent meningitis(PM) in infants and explore the predictors of early diagnosis. Methods Retrospective study was done with patients in our NICU from Jan 2015 to Dec 2017 aged during 29 days to 90 days. We divided them into two groups, 53 of which diagnosed PM were included as a case group, while 81 of which admitted inpatients with fever at the same periods and in the same age ranges were included as a control group. Factors including adverse basic events, clinical manifestations, laboratory examinations and so on were compared between two groups. Results Univariate analysis showed that premature, manifestations such as irritability, lethargy, bulging fontanelle,a stiff neck and the poor circulation, and cerebrospinal fluid(CSF) data like the mount of white blood cell, concentration of CSF protein, concentration of CSF glucose, CSF/blood glucose ratio, concentration of CSF lactate dehydrogenase were different between two groups. In the multivariate analysis, concentration of CSF Protein(＞0.450 g/L, OR=5.819, P=0.002) and concentration of CSF lactate dehydrogenase(＞28.300 U/L,OR=7.892, P＜0.001) were proven to be independent risk factors for the diagnosis of PM. Receiver operating characteristic (ROC) analysis revealed that the CSF protein, the CSF lactate dehydrogenase and the combination of the two factors had an increased area under the curve (AUC), the mounts of each which were 0.839,0.867 and 0.890. Conclusion Patients with PM in early infantile period are often lack of atypical clinical characteristics. We need pay highly attention to the adverse basic events, irritability, lethargy, bulging fontanelle,a stiff neck, poor circulation and CSF results. The independent predictors for early diagnosis were concentration of CSF protein and lactate dehydrogenase. It indicates that if the predictors could be identified early, diagnosis could be made timely and interventions could be operated immediately. It will be beneficial for progression-free and overall survival.

目的 探讨鼻咽癌(NPC)放疗致鼻窦炎发生的临床特征、影响因素。方法 回顾性分析2014年1月—2017年6月期间,我院收治的228例NPC患者临床资料,根据患者是否进行放疗,将患者分为非放疗组(106例)和放疗组(122例)。对比分析两组鼻咽癌致鼻窦炎的临床特点,以单因素和多因素Logistic分析鼻咽癌患者放疗后发生鼻窦炎的影响因素。结果 放疗组患者鼻窦炎发生率为81.97%,高于非放疗组患者鼻窦炎发生率54.72%,差异有统计学意义(P＜0.05)。放疗组鼻窦炎累及部位发生率从高到低,依次为后组筛窦、蝶窦、前组筛窦、窦口鼻道复合体、额窦以及上颌窦。放疗组患者鼻窦炎后组筛窦、蝶窦累及率高于非放疗组患者,差异具有统计学意义(P＜0.05)。单因素分析结果显示,放疗后鼻窦炎的发生,与患者年龄是否＞50岁,病程是否＞2年,是否存在鼻腔侵犯,肿瘤分期,是否使用滴鼻剂及是否进行鼻咽冲洗有关,差异有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示,患者病程＞2年,存在鼻腔侵犯以及T3+T4期肿瘤是NPC放疗后鼻窦炎发生的独立危险因素;使用滴鼻剂和鼻咽冲洗是NPC放疗后鼻窦炎发生的保护因素。结论 NPC放疗后具有较高的鼻窦炎发生率,并且主要累及后组筛窦和蝶窦,对于病程＞2年、存在鼻腔侵犯以及T3+T4期肿瘤的患者,应积极采取措施预防鼻窦炎的发生,使用滴鼻剂和鼻咽冲洗是预防NPC放疗后鼻窦炎发生的有效措施。

Objective To investigate the clinical features and influencing factors of nasosinusitis caused by nasopharyngeal carcinoma (NPC) radiotherapy. Methods The clinical data of 228 NPC patients admitted to our hospital from January 2014 to June 2017 were retrospectively analyzed. According to whether the patients were treated with radiotherapy, the patients were divided into non-radiotherapy group (106 cases) and radiotherapy group (122 cases). The clinical characteristics of nasosinusitis were analyzed and compared. Univariate and multivariate logistic analysis was used to analyze the influencing factors of nasosinusitis after radiotherapy in patients with nasopharyngeal carcinoma. Results The incidence of sinusitis was 81.97% in the radiotherapy group, which was higher than that in the non-radiotherapy group (54.72%). The difference was statistical significance (P<0.05). The incidence of sinusitis involvement in the radiotherapy group was in the order of ethmoid sinus, sphenoid sinus, anterior ethmoid sinus, sinus ostium and nasal tract sinus complex, frontal sinus, and maxillary sinus. The incidences of ethmoid sinus and sphenoid sinus in the post-nasal sinusitis group were higher than that in the non-radiotherapy group (P<0.05). Univariate analysis showed that the occurrence of sinusitis after radiotherapy was related to whether the patient's age was > 50 years, whether the disease duration was >2 years, whether there was nasal invasion, tumor staging, whether nasal drops were used, and whether nasopharyngeal irrigation was performed. Multivariate logistic regression analysis showed that patients with a disease course of >2 years had nasal invasion and T3+T4 tumors were independent risk factors for sinusitis after NPC radiotherapy; use of nasal drops and nasopharyngeal washing were protective factors. Conclusion There is a higher incidence of sinusitis after radiotherapy of NPC, and mainly affects the ethmoid sinus and sphenoid sinus in the posterior group. Patients with a disease course of >2 years, with nasal invasion, and T3+T4 tumors should actively take measures to prevent the occurrence of sinusitis. The use of nose drops and nasopharyngeal washing is an effective measure to prevent the occurrence of sinusitis after NPC radiotherapy.

目的 分析15例腹腔妊娠患者的临床病例特点,为临床工作提供参考依据,进一步减少漏诊及误诊的情况。方法 收集我院2002年1月—2018年6月期间住院治疗的腹腔妊娠患者的临床病例资料。回顾性分析并总结患者的临床诊治特点。通过t检验,进一步比较腹腔镜与腹式手术患者围手术期情况是否存在统计学差异。结果 1例B超检查提示大网膜妊娠可能;另1例入院前外院B超提示腹腔妊娠,孕8⁺周单活胎;其余13例患者术前B超提示宫内未见孕囊,子宫旁有包块,提示异位妊娠可能,术前未能明确腹腔妊娠。14例患者行手术治疗,另1例行介入穿刺保守治疗。术中探查发现腹腔妊娠病灶种植部位：位于大网膜5例,位于盆腔9例（膀胱区右下方盆壁1例,子宫直肠窝右侧直肠表面1例,右侧宫骶韧带2例,子宫下段前壁瘢痕处右缘1例,偏左侧肠管与子宫粘连之间1例、右侧盆壁1例、子宫直肠窝1例、子宫左侧圆韧带起始端1例）,位于腹腔1例（腰3椎体前方、腹主动脉与下腔静脉之间）。结论 腹腔妊娠的异位妊娠病灶种植部位非常广泛,超声检查需进一步扩大检查范围。必要时可选择MRI或CT检查准确定位,减少漏诊及误诊的情况。

Objective To analysis and summary clinical characteristics of 15 patients who were diagnosed with abdominal pregnancy,which supply reference for clinical work. Methods 15 cases who were diagnosed with abdominal pregnancy and admitted to Guangdong Women and Children hospital between January 2002 and June 2018 were identified. Retrospective analysis was used to summarize the clinical characteristics of diagnosis and treatment in 15 patients. Test statistics used Student's t test to find if there was statistical difference between laparoscopic and abdominal surgery patients in perioperative period. Results One case was likely diagnosed with greater omentum pregnancy by type B ultrasound. Another one patient was diagnosed with abdominal pregnancy which has 8+ weeks pregnant single live fetus by type B ultrasound in other hospital prior to hospitalization.The B ultrasound tests of the other 13 patients showed there were no sac in uterus and enclosed mass beside uterus which were diagnosed with ectopic pregnancy, but not positive diagnosis with abdominal pregnancy.Surgery was performed for 14 patients.We found more different sites where gestational sacs plant in abdominal pregnancy patients in operation, 5 cases sacs planted in greater omentum, 9 cases sacs planted in pelvic cavity including 1 case sac planted in pelvic wall bottom-right bladder,1 case sac planted in rectum outside right-hand of Douglas pouch,2 cases sacs planted in right utero-sacral ligament,1 case sac planted in right-side of scar in lower uterus segment,1 case sac planted in adhesive tissue between the lift intestinal canal and uterus,1 case sac planted in right pelvic cavity,1 case sac planted in Douglas pouch,1 case sac planted in initiating terminal of the lift round ligament of uterus. The inteventional puncture with medical treatment was supply for only 1 patient,CT test showed the sac planted in abdominal: ahead of third lumbar vertebra between abdominal aorta and inferior vena cava. Conclusion There are more sites where gestational sacs can plant in abdominal pregnancy patients. Ultrasound is first choice for patient who was considered ectopic pregnancy and better to expansion the inspection range. MRI or CT may find sacs plant site who was considered abdominal pregnancy which may reduce missed diagnosis and misdiagnosis. Surgery is first performed who was diagnosed with abdominal pregnancy. Medical treatment for patients who vital signs are stable.

目的 探讨直肠神经内分泌肿瘤的临床病理特征。方法 回顾性分析46例直肠神经内分泌肿瘤患者的临床病理资料,对不同病理分级的患者在性别、年龄、肿瘤直径、浸润深度、肝及淋巴结转移等方面进行比较。结果 直肠神经内分泌肿瘤男性多见,肿瘤多位于直肠中下段。免疫组化检测显示CgA、Syn、CD56阳性率分别为40.0%、97.8%、100%。36例Ki-67阳性指数≤2％,6例Ki-67阳性指数在3％～20％,4例Ki-67阳性指数＞20％。不同病理分级的肿瘤与患者年龄、肿瘤直径、浸润深度、淋巴结及肝转移相关,与性别不相关。结论 直肠神经内分泌肿瘤缺乏临床特异性症状,联合CgA、Syn和CD56染色可提高直肠神经内分泌肿瘤的诊断率。病理分级对预测肿瘤浸润深度、肝或淋巴结转移有重要参考价值。

Objective To investigate the pathological and clinical significance of 46 cases of rectal neuroendocrine tumors(NET). Methods Retrospectively analyzed the clinical and pathological feature of 46 patients with rectal NET, and assessed possible interactions between different pathological grades and gender, age, tumor diameter, depth of invasion, lymph node and liver metastasis. Results Rectal NET appeared more frequently in males than in females. Most tumors located in middle and distal third of rectum. The positivity rates of immunohistochemical marker CgA, Syn, CD56 were 40.0%, 97.8%, 100.0%, respectively. The cases of Ki-67 positivity rate under 2%, ranged between 3%-20%, above 20% were 36, 6, 4, respectively. Different pathological grades were significantly correlated with age, tumor diameter, depth of invasion, lymph node and liver metastasis, but not with gender. Conclusion Rectal NET had nonspecific symptoms. Combined immunohistochemical staining, such as CgA, Syn and CD56, was important in the evaluation of rectal NET. Pathological grading might be very useful for prediction of invasion depth, lymph node and liver metastasis.