目的 探究改良Miccoli手术治疗单侧甲状腺癌（TC）患者的效果及其对机体创伤应激反应的影响。方法 选取新密市中医院200例单侧TC患者（2021年3月—2023年3月）,按随机数字表法分两组。A组100例接受改良Miccoli手术治疗,B组100例接受开放根治术（OT）治疗。对比两组围术期指标、喉返神经损伤发生情况、美学效果、手术前后肿瘤指标[细胞角蛋白19片段抗原（Cyfra21.1）、半乳糖凝集素3（Gal-3）、可溶性白细胞介素-2受体（sIL-2R）]、创伤应激反应指标[去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cor）]水平。结果 A组切口长度为（2.05±0.13）cm,短于B组的（7.11±0.49）cm,住院及手术用时分别为（3.12±0.44）d、（53.48±7.52）min,均短于B组的（5.22±0.81）d、（76.81±11.39）min,术中失血量、引流量分别为（19.24±2.66）mL、（21.47±3.41）mL,均少于B组的（45.08±5.75）mL、（64.82±7.24）mL,组间比较差异有统计学意义（P<0.05）;A组喉返神经损伤总发生率为2.00%（2/100）,低于B组的12.00%（12/100）,组间比较差异有统计学意义（P<0.05）;A组美容总满意度为97.00%（97/100）,高于B组的73.00%（73/100）,差异有统计学意义（P<0.05）;A组术后3个月血清Cyfra21.1、Gal-3水平分别为（1.78±0.26）ng/mL、（6.14±1.64）ng/mL,均高于B组的（1.55±0.21）ng/mL、（5.39±1.28）ng/mL,血清sIL-2R水平为（375.36±20.12）μg/mL,低于B组的（427.13±23.18）μg/mL,组间比较差异有统计学意义（P<0.05）;A组术后1 d血清NE、E、Cor水平分别为（0.73±0.17）mmol/L、（0.49±0.10）mmol/L、（185.46±22.95）μg/L,均低于B组的（0.96±0.19）mmol/L、（0.81±0.22）mmol/L、（272.53±32.41）μg/L,组间比较差异有统计学意义（P<0.05）。结论 相较于OT治疗单侧TC患者,经改良Miccoli手术治疗更有助于提升美学效果,减少喉返神经损伤,优化围术期指标,抑制肿瘤进展,且机体产生的创伤应激反应更轻微。

Objective To investigate the effect of modified Miccoli surgery on patients with unilateral thyroid cancer（TC）and its impact on the body’s traumatic stress response．Methods The data of 200 patients with unilateral TC in Xinmi City Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were retrospectively collected and divided into two groups according to different surgical protocols．A hundred patients treated with modified Miccoli surgery were classified as group A and 100 patients treated with open radical surgery（OT）were classified as group B．The perioperative indicators,incidence of recurrent laryngeal nerve injury,aesthetic effect,as well as tumor indicators [cytokeratin 19 fragment antigen（Cyfra21.1）,galectin-3（Gal-3）,soluble interleukin -2 receptor（sIL-2R）] and trauma stress response indicators [norepinephrine（NE）,epinephrine（E）,and cortisol（Cor）] before and after surgery were compared between the two groups．Results The incision length of group A was（2.05±0.13）cm,which was shorter than that of group B [（7.11±0.49）cm]．The duration of hospitalization and operation of group A were（3.12±0.44）d and（53.48±7.52）min,respectively,which were shorter than those of group B [（5.22±0.81）d and（76.81±11.39）min]．The intraoperative blood loss and drainage volume were（19.24±2.66）mL and（21.47±3.41）mL,respectively,which were lower than those in group B [（45.08±5.75）mL and（64.82±7.24）mL],and the difference was statistically significant（P<0.05）．The total incidence of recurrent laryngeal nerve injury in group A was 2.00%（2/100）,lower than that in group B [12.00%（12/100）],and the difference was statistically significant（P<0.05）．The total satisfaction of group A was 97.00%（97/100）,higher than that of group B [73.00%（73/100）],and the difference was statistically significant（P<0.05）．Serum Cyfra21.1 and Gal-3 levels in group A were（1.78±0.26）ng/mL and（6.14±1.64）ng/mL,respectively,higher than those in group B [（1.55±0.21）ng/mL and（5.39±1.28）ng/mL]．Serum sIL-2R level was（375.36±20.12）μg/mL,lower than that of group B [（427.13±23.18）μg/mL],and the difference was statistically significant（P<0.05）．The serum levels of NE,E and Cor in group A were（0.73±0.17）mmol/L,（0.49±0.10）mmol/L and（185.46±22.95）μg/L,respectively．They were lower than（0.96±0.19）mmol/L,（0.81±0.22）mmol/L and（272.53±32.41）μg/L in group B,and the differences were statistically significant（P<0.05）．Conclusions Compared to OT treatment for unilateral TC patients,the modified Miccoli surgery is more helpful in improving aesthetic effects,reducing damage to the recurrent laryngeal nerve,optimizing perioperative indicators,inhibiting tumor progression,and producing less traumatic stress response to the body．

目的 应用iTRAQ联合质谱技术筛选COPD大鼠肺组织差异表达蛋白。方法 20只雄性SD大鼠(200~220 g),随机分为对照组和模型组,每组10只,采用熏烟法建立COPD大鼠模型。观察大鼠肺组织病理学改变,测定肺功能,BALF白细胞数,肺组织总蛋白iTRAQ标记后质谱鉴定,用生物信息学方法分析蛋白表达变化。结果 与对照组相比,模型组大鼠支气管黏膜下肌层增厚,肺内可见大量炎性细胞浸润,肺功能降低,BALF白细胞数升高(均P<0.05)。质谱鉴定出4 916种蛋白,筛选出468个差异表达蛋白,其中285个表达上调,183个表达下调。筛选了上皮细胞粘着连接蛋白、fMLP、整合素等与COPD相关蛋白。结论 基于iTRAQ技术的蛋白质组学方法筛选出COPD大鼠差异表达蛋白,为进一步研究COPD的发生机制奠定了基础。

Objective iTRAQ and mass spectrometry were used to screen the differentially expressed proteins in the lung of COPD rats. Methods 20 male SD rats (200-220g)were randomly divided into control group and treatment group, with 10 rats in each group. COPD rat model was established by smoking. The lung function, the number of BALF leukocytes, the total protein iTRAQ in lung tissue were measured and identified by mass spectrometry. The differentially expressed proteins were identified by bioinformatic analysis. Results Compared with the control group, the submucous layer of bronchus in the model group was thickened, a large number of inflammatory cells were seen in the lung, the lung function was reduced, and the number of BALF leukocytes was increased. 4 916 proteins were identified by mass spectrometry, 468 differentially expressed proteins were screened, 285 of which were up-regulated and 183 down regulated. Among them, the important COPD related proteins were epithelial adhesion connexin, fMLP and integrins. Conclusion iTRAQ technology screened out the differentially expressed proteins of COPD rats, which laid the foundation for the further study of COPD mechanism