目的 探讨功能性消化不良（FD）患者应用乳果糖联合莫沙必利治疗的临床疗效及药物对肠道菌群的影响。方法 选取2019年1月—2021年12月来院诊治的180例FD患者作为研究对象,随机分为2组,每组90例,对照组口服莫沙必利片,观察组服用莫沙必利片+乳果糖口服液,4周后观察2组患者治疗后临床症状改善率及肠道菌群数量的情况。结果 治疗4周后,观察组的总有效率（86.67%）高于对照组（72.22%）,P<0.05;观察组的乳杆菌菌群数多于对照组,肠球菌、肠杆菌菌群数少于对照组,P<0.05。结论 乳果糖联合莫沙必利用于FD患者临床治疗,总有效率高于单用莫沙必利,患者症状获得有效改善,明显改善FD患者肠道菌群水平。

Objective To explore the clinical efficacy and effect on intestinal flora of lactulose combined with mosapride in patients with functional dyspepsia（FD）．Methods A total of 180 FD patients admitted to the hospital in January 2019 and December 2021 were selected as the study subjects and randomly divided into two groups,90 cases in each group．The control group took oxapride orally and the observation group took lactulose oral solution additionally．After 4 weeks,the improvement rate of clinical symptoms and the number of intestinal flora of patients were observed．Results After 4 weeks of treatment,the total effective rate of the observation group（86.67%）was obviously higher than that of the control group（76.67%）,P<0.05;the number of Lactobacillus in the observation group was higher than that of the control group,and the numbers of Enterococcus and Enterobacteria were less than that of the control group,P<0.05．Conclusions The total effective rate of lactulose combined with mosalabin for FD patients is higher than that of mossalapride alone．The symptoms are effectively improved,and the intestinal flora level of FD patients is significantly improved．

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 评估内镜下切开联合丝裂霉素C注射治疗复发性食管良性狭窄的疗效和安全性。方法 对2021年6月—2022年5月在厦门大学附属中山医院消化内科接受内镜下切开联合或不联合丝裂霉素C注射的43例复发性食管良性狭窄患者进行回顾性分析,分为切开组与切开联合丝裂霉素C注射组,对比2组间狭窄缓解率、并发症及预防狭窄复发的效果。结果 2组患者均顺利完成治疗,无严重并发症发生。2组患者治疗后狭窄缓解率无显著差异（P>0.05）。随访12个月,切开联合丝裂霉素C注射组在狭窄缓解时长、狭窄复发再次扩张次数及扩张间隔均优于切开组（P<0.05）。结论 内镜下切开联合丝裂霉素C注射治疗安全、有效,虽然治疗后狭窄缓解率与单纯切开无显著差异,但可延长狭窄缓解期,改善狭窄复发后重复扩张的频率及间隔时间。

Objective To evaluate the efficacy and safety of endoscopic incision combined with mitomycin C injection in the treatment of recurrent benign esophageal stenosis．Methods A retrospective analysis was conducted on 43 patients with recurrent benign esophageal stenosis who received endoscopic incision combined with or without mitomycin C injection in the Department of Gastroenterology,Zhongshan Hospital of Xiamen University from June 2021 to May 2022．Patients were divided into incision group and incision combined with mitomycin C injection group．The stenosis remission rate,complications and preventive effect of stenosis recurrence were compared between the two groups．Results All patients in the two groups successfully completed the treatment without serious complications．There was no significant difference in the stenosis remission rate between the two groups after treatment（P>0.05）．In the follow-up 12 months after treatment,incision combined with mitomycin C injection group was better than incision group in the duration of stenosis remission,the number of stenosis recurrence and dilation interval（P<0.05）．Conclusions Endoscopic incision combined with mitomycin C injection is safe and effective．Although the remission rate of stenosis after treatment is not significantly different from that of incision alone,it can prolong the remission period of stenosis and improve the frequency and interval of repeated dilation after stenosis recurrence．

目的 对比分析电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效。方法 将我院2018年11月—2020年11月间收治的92例胸腺瘤患者作为本次实验案例,根据随机双盲原则进行分组,其中对照组46例患者采用传统开胸手术治疗,观察组46例患者采用电视胸腔镜手术治疗,对于2组患者治疗中的临床疗效进行对比分析。结果 观察组术后的肺功能指标下降幅度小于对照组,且观察组的手术时间、胸管引流时间、下床活动时间、住院时间均短于对照组,出血量、引流量低于对照组,切口长度小于对照组,组间指标数据存在统计学差异(P＜0.05)。结论 电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效相比,前者创伤小、恢复快、对于患者肺功能的影响更小,具有明显的优势。

目的 对本院老年重症肺炎患者的临床资料进行回顾性分析,为老年重症肺炎多药耐药菌感染的临床诊疗提供参考。方法 回顾性分析本院医院76例老年重症肺炎患者的病例信息,将患者随机分为研究组和对照组,每组38例,研究组患者在对照组基础上(头孢哌酮／舒巴坦)联合胸腺肽α1治疗。研究2组患者的痰液致病菌分布及其临床特点,通过对比2组患者治疗前后免疫功能指标T淋巴细胞CD4⁺及炎症因子超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)水平变化,对头孢哌酮/舒巴坦联合胸腺肽α1治疗老年重症肺炎的临床效果进行分析。结果 76例老年重症肺炎患者中,共检出143株病原菌,以不动杆菌属为主的革兰氏阴性菌(89株)为主要致病菌株,占比64.3%,革兰氏阳性菌(54株)以葡萄球菌属为主,占比35.7%;排名前3位的主要致病菌为:铜绿假单胞菌(33.6%)、金黄色葡萄球菌(22.4%)和大肠埃希菌(14.7%)。痰液分离出的致病菌出现了普遍的严重耐药性,主要以多药耐药铜绿假单胞菌为主。2组治疗前 T 淋巴细胞CD4⁺、hs-CRP、IL-6、TNF-α水平对比无差异(P＞0.05),治疗后观察组CD4⁺水平更高,而 CRP、TNF-α、IL-6水平更低,与对照组有差异(P＜0.05)。结论 老年重症肺炎多药耐药菌重症肺炎检出病原菌主要以铜绿假单胞菌为主,治疗上联合使用胸腺肽α1,能够有效改善患者的免疫抑制状态、减轻老年患者机体炎症反应,对于提高老年患者临床治疗效果及改善患者预后有着重要的临床意义,值得广泛推广。

目的 探讨富血小板血浆(platelet-rich plasma, PRP)联合髓芯减压治疗早期膝关节自发性骨坏死(spontaneous osteonecrosis of the knee, SONK)的临床疗效。方法 回顾性分析我院2015年6月—2020年6月收治Koshino分期为Ⅰ、Ⅱ期的SONK患者,按治疗方法不同分为单纯髓芯减压组(对照组 21例)和PRP注射+髓芯减压组(PRP组 22例),比较2组患者治疗前、后1月、3月、6月、12月的VAS评分、WOMAC评分,评估术前和随访时膝关节功能,并观察记录有无并发症。结果 43例患者术后随访12～62个月,2组患者治疗后均无切口感染、关节感染、深静脉血栓等并发症。2组患者术前VAS评分、WOMAC评分比较无统计学意义(P>0.05);VAS评分、WOMAC评分在术后1、3、6 、12月较术前比较差异均有统计学意义(P<0.05);与对照组相比,PRP组术后3、6、12月的VAS评分降低(P＜0.05),PRP组在术后6、12月的WOMAC评分改善(P＜0.05)。PRP组、对照组的总体有效率分别为90.48%(19/21)、77.27%(17/22),差异有统计学意义(P＜0.05)。在完成治疗12个月后至今的随访中,对照组共有6例患者、PRP组仅2例患者行单髁置换。结论 富血小板血浆联合髓芯减压治疗早期SONK,安全有效,临床疗效优于单纯髓芯减压术。

Objective To investigate the clinical effect of platelet-rich plasma(PRP) combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee(SONK). Methods A retrospective analysis of SONK patients with Koshino stage I and Ⅱ admitted to our hospital from June 2015 to June 2020 was carried out. According to the different treatment methods, patients were divided into core decompression group (control group, 21 patients), and knee joint cavity PRP injection combined with core decompression group (PRP group, 22 patients). The VAS scores and WOMAC scores before treatment, 1, 3, 6 and 12 months after surgery were compared between the two groups to assess the knee joint function, and observed whether there were complications. Results Forty-three patients were followed up for 12 to 62 months after the operation. After treatment, the two groups had no complications such as wound infection, joint infection, or deep vein thrombosis. The preoperative VAS score and WOMAC score of the two groups were not significantly different (P>0.05);compared with those before the operation, VAS score and WOMAC score were significantly different at 1, 3, 6, and 12 months after the operation (P<0.05); compared with the control group, the VAS score of the PRP group was significantly reduced at 3, 6, and 12 months after surgery (P<0.05), and the WOMAC score of the PRP group was significantly improved at 6 and 12 months after surgery (P<0.05). The overall effective rates of the PRP group and the control group were 90.48% (19/21) and 77.27% (17/22) respectively, and the difference between the two groups was statistically significant (P<0.05). In the follow-up 12 months after the completion of the treatment, 6 patients in the control group and 2 patients in the PRP group underwent unicondylar replacement. Conclusion The combination of platelet-rich plasma and core decompression in the treatment of early SONK was safe and effective, and the clinical effect was better than that of core decompression only.

目的 探讨慢性扁桃体炎扁桃体切除术后患者咽部疼痛采用紫银荷冰汤治疗的临床疗效。方法 选取本院2018年2月—2021年2月收治的320例慢性扁桃体炎扁桃体切除术的患者,将其根据数字随机法分为对照组与研究组各160例。其中对照组采用生理盐水漱口,研究组采用紫银荷冰汤漱口。观察2组患者用药后的疼痛程度,采用视觉模拟量表(VAS)评分进行评估。结果 2组患者咽痛术后第1～3天VAS评分比较,经统计学分析无差异(P＞0.05);咽痛术后第4～7天VAS评分比较,研究组评分优于对照组,经统计学分析有差异(P＜0.05)。研究组术后第1~3天其疗效优于对照组(P＜0.05);术后第4、6天研究组显效例数也高于对照组,但经统计学表现无差异。 经统计学分析,2组患者术后12 h、术后1天平均服用止痛药物数量无差异(P＞0.05);但术后3天、术后5天平均服用止痛药物数量经统计学分析,研究组优于对照组,有差异(P＜0.05)。结论 紫银荷冰汤具有缓解术后伤口疼痛,减轻组织炎性反应之功效,对治疗慢性扁桃体炎扁桃体切除术后患者咽部疼痛疗效显著,能有效减少止痛药物的使用数量,值得推广应用。

目的 探讨雾化吸入干扰素-α治疗对儿童疱疹性咽峡炎的治疗效果的影响。方法 本研究纳入2019年1月—2021年1月在清远市妇幼保健院住院治疗的126例疱疹性咽峡炎儿童。所有参与该研究的患儿被随机平均分为2组:对照组(63人)和干预组(63人)。对照组进行常规治疗方案,干预组在对照组基础上雾化吸入干扰素-α治疗。比较2组治疗效果的差异性。结果 干预组患儿平均发热天数(1.86±0.97天)较对照组(2.44±0.89天)低;干预组心肌酶升高比例较对照组低,组间差异有统计学意义(P<0.01)。干预组中显效(50.8%)占主要比例,而对照组中有效(74.6%)占主要比例,并且干预组总有效率(98.4%)高于对照组(96.8%)(P<0.05)。干预组住院天数(5.02±1.85天)较对照组(5.68±1.68天)降低,组间差异有统计学意义(P<0.05)。结论 在常规治疗的基础上加用雾化吸入干扰素-α治疗对提高儿童疱疹性咽峡炎的疗效有促进作用,值得临床推广。

Objective To investigate the effect of nebulized inhalation of interferon-α on the therapeutic effect of herpes angina in children. Methods This study included 126 children with herpetic angina who were hospitalized in Maternal and Child Health Hospital of Qingyuan City from January 2019 to January 2021.All children participating in the study were randomly divided into 2 groups: control group (63 children) and intervention group (63 children). The control group received conventional treatment, and the intervention group was treated with aerosol inhalation of interferon-α on the basis of the control group.The difference of the treatment effect between the two groups were compared. Results The average number of fever days of children in the intervention group (1.86±0.97 days) was lower than that of the control group (2.44±0.89 days); the increase of myocardial enzymes in the intervention group was lower than that of the control group, and the difference was statistically significant (P<0.01). The “obviously effective” (50.8%) in the intervention group accounted for the main proportion, while the “effective” (74.6%) in the control group accounted for the main proportion, and the total effective rate of the intervention group (98.4%) was higher than that of the control group (96.8%,P< 0.05). The length of hospitalization in the intervention group (5.02±1.85 days) was smaller than that of the control group (5.68±1.68 days), and the difference was statistically significant (P<0.05). Conclusion The addition of nebulized interferon-α on the basis of conventional treatment could improve the curative effect of herpetic angina in children, and it is worthy of clinical promotion.

目的 探究在胸腰段椎体成形术椎再骨折患者中采用后路椎体次全切治疗的临床疗效,并对其进行探讨与分析。方法 随机选取2019年1月—2021年1月于我院骨科治疗的胸腰段椎体成形术椎再骨折患者58例作为研究对象。给予患者后路椎体次全切治疗,记录患者的手术时间及术中出血量,对比手术前以及手术后6个月患者的VAS疼痛评分、后凸Cobb角、椎体高度、椎管容积率以及美国脊柱损伤协会(ASIA)损伤分级。结果 患者的手术时间为1.4～3.8 h,手术平均时间为(2.45±0.61)h,患者术中出血量为580～1 470 mL,术中平均出血量为(835.48±134.75)mL。手术后6个月患者的VAS疼痛评分低于手术前(P＜0.05);手术后6个月患者的后凸Cobb角小于手术前(P＜0.05);手术后6个月患者的椎体高度和椎管容积率均大于手术前(P＜0.05);患者手术前ASIA损伤分级: A级12例、B级14例、C级16例、D级12例、E级4例;患者手术后6个月ASIA损伤分级:A级5例、B级8例、C级13例、D级15例、E级17例。结论 在胸腰段椎体成形术椎再骨折患者中采用后路椎体次全切治疗可缓解患者的疼痛感,减小后凸Cobb角,增大椎体高度和椎管容积率以及改善患者的ASIA损伤分级。

Objective To investigate the clinical efficacy of posterior subtotal vertebral dissection in patients with vertebral re-fractures of thoracolumbar segmental vertebroplasty. Methods Fifty-eight patients with thoracolumbar segmental vertebroplasty vertebral re-fractures treated in the orthopedic department of our hospital from January 2019 to January 2021 were randomly selected as study subjects.The patients were treated with posterior subtotal vertebral dissection, and the operating time and intraoperative bleeding of the patients were recorded, and the VAS pain score, posterior convex Cobb angle, vertebral body height, spinal canal volume ratio, and American Spinal Injury Association (ASIA) injury classification were compared in patients before and 6 months after surgery. Results The operating time was 1.4-3.8 hours, with a mean of (2.45±0.61) hours, and the intraoperative bleeding was 580-1470 mL, with a mean of (835.48±134.75) mL.The VAS pain scores at 6 months after surgery were lower than those before surgery (P<0.05); the posterior convex Cobb angle at 6 months after surgery was smaller than that before surgery (P<0.05); the vertebral body height and spinal canal volume ratio at 6 months after surgery were greater than those before surgery (P<0.05). Preoperative ASIA injury grading: 12 cases with grade A, 14 cases with grade B, 16 cases with grade C, 12 cases with grade D and 4 cases with grade E; six months after surgery, 5 cases with grade A, 8 cases with grade B, 13 cases with grade C, 15 cases with grade D, and 17 cases with grade E. Conclusion Posterior subtotal vertebral body resection could relieve pain of thoracolumbar vertebroplasty fractures, reduce the posterior convex Cobb angle, increase vertebral body height and spinal canal volume, and improve ASIA injury classification.

目的 分析补阳还五汤加减治疗肾病综合征(NS)的临床疗效。方法 选择本院2019年1月—2021年1月住院治疗的120例NS患者,通过随机数字表法分组,参照组60例患者采纳常规西医治疗,试验组60例患者在参照组基础上予以补阳还五汤治疗,对比2组临床疗效、中医症候积分、肾功能指标、不良反应总发生率。结果 试验组临床总有效率(96.67%)高于参照组(80.00%),试验组治疗后浮肿少尿、腰膝酸软、腹部胀满、头晕乏力积分均低于参照组,差异均有统计学意义(P＜0.05)。治疗后试验组24 h尿蛋白、尿素氮均比参照组低,差异有统计学意义P＜0.05,血肌酐治疗前后差异无统计学意义P>0.05。试验组不良反应总发生率(5.00%)与参照组(6.67%)比较,差异无统计学意义(P>0.05)。结论 补阳还五汤可有效改善NS患者临床症状、肾功能,降低蛋白尿,且不良反应较少,安全性较高,疗效确切。

Objective To analyze the clinical effect of addition or reduction of Buyang Huanwu decoction in the treatment of nephrotic syndrome (NS). Methods A total of 120 NS patients in our hospital from January 2019 to January 2021 were divided into two groups by random digital table method. Sixty patients in the control group were treated by conventional western medicine, 60 patients in the experimental group were treated with Buyang Huanwu decoction on the basis of control group.The clinical efficacy, traditional Chinese medicine syndrome score, renal function index and total incidence of adverse reactions were compared. Results The total clinical effective rate of the experimental group (96.67%) was higher than that of the control group (80.00%). The scores of edema and oliguria, lumbar and knee pain and limpness, abdominal distention and dizziness after treatment in the experimental group were all lower than those in the control group, with statistical significance (P<0.05). After treatment, 24 h urinary protein volume and blood urea nitrogen level in the experimental group were lower than those in the control group, the differences were statistically significant (P<0.05), while there was no statistically significant difference in serum creatinine before and after treatment (P>0.05). There was no significant difference in the total incidence of adverse reactions between the experimental group (5.00%) and the control group (6.67%,P>0.05). Conclusion Buyang Huanwu decoction could effectively improve the clinical symptoms and renal function, reduce proteinuria, and had less adverse reactions, high safety level and accurate curative effect.