目的 通过对广东地区流行季节的发热新生儿肠道病毒感染临床特点及高危因素探讨,对高危患儿采取有效防治措施。方法 以2019年5月—10月广东省妇幼保健院门诊因发热收治入院的诊断为肠道病毒感染28例新生儿为研究对象,回顾性分析这些患儿的临床资料,分析新生儿肠道病毒感染的高危因素。结果 因发热收治入院的新生儿检测后肠道病毒感染发病率达38.3%,热峰高于38.5℃,发热持续时间大于3 d、细菌培养阴性是新生儿肠道病毒感染的高危因素。结论 在肠道病毒流行季节,对发热新生儿均应常规进行肠道病毒检测,肠道病毒感染患儿,经过有效的治疗后,能够取得较好的治疗效果,但需及时控制病毒的传播途径,针对相关危险因素进行有效的控制,从而降低发病率。

介绍我院应对新型冠状病毒感染防控工作的护理管理措施,包括发热病区的组建,护理应急队伍的建设,工作流程指引的修订和完善,院感防护措施的严格落实,后勤保障的严密管理等,并进行护理质量控制与持续改进,为其他医院的防控工作提供借鉴。

It introduces nursing management measures of novel coronavirus infection prevention and control in our hospital, including the establishment of fever ward, the construction of nursing emergency team, the revision and improvement of working process guidelines, the strict implementation of hospital sensory protection measures, tight management of logistical support, and quality control and continuous improvement of nursing. It offers experiences for other hospitals.

目的 了解从化地区儿童人冠状病毒((human coronavirus,HCoV)流行情况和临床特点,观察人冠状病毒分型OC43(HCoV-OC43)基因分布特点,探讨从化地区小儿呼吸道感染HCoV-OC43分离株与国内的HCoV-OC43分离株的同源性与基因分型,探讨HCoV-OC43与小儿呼吸道感染疾病的关系,为预防和控制呼吸道疾病提供依据。方法 本研究从化地区2017年1月—2019年6月门诊就诊的6个月~14岁的儿童610例,采集鼻咽拭子标本,病毒检测阳性的患者,这些标本取自患有急性上呼吸道感染或下呼吸道感染疾病的患者,表现出呼吸道感染的症状,例如发热(体温> 37.5℃)、咽痛、流涕、鼻塞、咳嗽和咳痰等。采用荧光定量PCR方法,对HCoV-OC43病毒核酸进行分析和测序。采用直接免疫荧光法检测其他7种常见呼吸道病毒;包括:流感病毒 A、B型(influenza virus,IVA、B)、副流感病毒Ⅰ、Ⅱ、Ⅲ 型 (parainfluenza virus, PIVⅠ、Ⅱ和Ⅲ)、呼吸道合胞病毒(respiratory syncytial virus, RSV)、腺病毒(ad enovirus, ADV)共七种常见呼吸道病毒进行检测,通过HCoV-OC43和常见呼吸道病毒的病毒监测,找出从化地区呼吸道感染患儿HCoV-OC43的N蛋白编码基因的特征。结果 从化地区6月~14岁的呼吸道感染儿童610例,采集鼻咽拭子标本,病毒检测阳性的患者,分析了8种呼吸道病毒,重点分析HCoV-OC43的临床特点。从发病时间月份分布可以看出,人HCoV-OC43主要是在春季流行, HCoV-OC43全年均可检出,春季4月份和5月份检出率较高,冬季较低,但不同月份的检出率无差异。各种常见病毒的发病率,流感病毒A(IVA)111例(18.20%)、流感病毒B(IVB)61例(10.00%)、副流感病毒Ⅰ(PIVⅠ)42例(6.89%)、副流感病毒Ⅱ(PIVⅡ)34例(5.57%)、副流感病毒Ⅲ(PIVⅢ)77例(12.62%)、呼吸道合胞病毒(RSV)135例(22.14%)、腺病毒(ADV) 82例(13.45%),冠状病毒(HCoV-OC43)68例(11.14%)。呼吸道感染多为流感病毒(A+B)和副流感病毒(Ⅰ,Ⅱ,Ⅲ)共325例(53.28%),其次是合胞病毒感染135例(22.14%),腺病毒(ADV) 82例(13.45%),冠状病毒感染最低68例(11.14%)。建立荧光定量PCR方法检测HCoV-OC43 病毒分离及基因分型测序,阳性PCR 产物测序,与HCoV-OC43中N 蛋白基因序列进行比较分析,该地区冠状病毒具有临床多样性,与国内已发表的菌株HCoV-OC43相比具有很高的同源性。结论 人冠状病毒OC43的检出率与以前的报道相符,未发现新的传染性冠状病毒,冠状病毒HCoV-OC43的流行趋势稳定,所有呼吸道感染者均表现出正常的呼吸道感染症状。常见呼吸道病毒检测, 对临床早期诊断和合理用药具有重要意义。

目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

目的 分析毕节地区新型冠状病毒(2019-nCoV)肺炎(novel coronavirus pneumonia,NCP)胸部CT影像学表现,探讨对NCP的临床诊断的价值。方法 回顾性分析毕节市第三人民医院2020年1月14日至2月18日收治的13例NCP患者的流行病学特征及胸部CT影像学特征。结果 13例患者中2例为长期居住在武汉来毕;1例由从上海到湖北宜昌逗留3天返毕;1例直接与武汉当地人接触;3例为与确诊病人的密切接触者;5例是聚集性发病,均与从浙江省台州市返毕确诊病人密切接触;1例无流行病学史。胸部CT影像学以双肺或一侧肺散在斑片状、磨玻璃状高密度影,密度不均,边界不清,肺野外带显著为特征。重型患者短期内肺部CT影像学变化明显。结论 确诊NCP普通型患者胸部CT影像学大多以典型表现为特征;重型NCP患者短时间内可出现实变及肺纤维化。

Objective To analyze the novel coronavirus (2019-nCoV) novel coronavirus pneumonia (NCP) chest CT imaging findings in Bijie area, and to explore the clinical diagnostic value of NCP. Methods The epidemiological characteristics and chest CT features of 13 NCP patients admitted to The Third People's Hospital of Bijie from January 14 to February 18, 2020 were analyzed retrospectively. Results Among the 13 patients, 2 lived in Wuhan for a long time, 1 stayed for 3 days from Shanghai to Yichang, Hubei, and returned home; 1 directly contacted with the local people in Wuhan; 3 closely contacted with the confirmed patients; 5 were clustered diseases, all closely contacted with the confirmed patients returning from Taizhou, Zhejiang province; 1 had no epidemiological history. CT imaging of the chest is characterized by patchy, ground glass high-density shadows scattered in two or one side of the lung, with uneven density, unclear boundary and significant lung field zone. Conclusion Most of the chest CT images of the patients with NCP were characterized by typical manifestations, while consolidation and pulmonary fibrosis were found in the patients with severe NCP in a short period of time.

目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。

目的 探讨揭阳地区急性下呼吸道感染住院患儿病毒病原学特点。方法 对2 125例急性下呼吸道感染患儿应用直接免疫荧光法(DIF)进行A型流感病毒(甲型流感病毒IFA)、B型流感病毒(乙型流感病毒IFB)、呼吸道合胞病毒(RSV)、腺病毒(AdV)、副流感病毒1(PIVⅠ)、2(PIVⅡ)和3型(PIVⅢ)进行病毒学检测。结果 2 125例患儿鼻咽部分泌物标本中有538例检测出至少1种病毒,总阳性率25.3％,其中RSV 阳性率(19.7%)明显高于其他病毒,具有统计学意义。春、夏、冬季的RSV阳性率大致相当,明显高于秋季。婴儿期组RSV阳性率(27.2%)最高,幼儿期组(18.7%)次之,均显著高于学龄前期、学龄期,后2组阳性率无统计学差异,青春期组未检出RSV。结论 病毒是急性下呼吸道感染的重要病原体,而其中又以RSV为著,RSV感染具有显著的季节性和年龄特征性。

Objective To investigate the viral etiology feature in hospitalized children with acute lower respiratory infection in Jieyang area. Methods A total of 2 125 children with acute lower respiratory tract infection were screened by direct immune fluorescence assay (DIF) for influenza virus A (IFA), influenza virus B (IFB), respiratory syncytial virus (RSV), adenovirus (AdV), parainfluenza virus I (PIV Ⅰ), PIV Ⅱ and PIV Ⅲ. Results In 2 125 cases of nasopharyngeal secretory specimens, 538 cases were detected at least one kinds of viruses. The total positive rate was 25.3%, of which the positive rate of RSV (19.7%) was higher than that of other viruses. The positive rate of RSV was similar in spring, summer and winter, much higher than that in autumn.The positive rate of RSV in infancy group (27.2%) was the highest,then the second was the toddler's age(18.7%), both of which were higher than that in preschool age group and school age group. There was no significant difference in the positive rate between preschool age group and school age group. In addition, RSV was not detected in the adolescence group. Conclusion Virus is an important pathogen of acute lower respiratory tract infection. The most common virus is RSV, infection of which has seasonal and age characteristics.

目的 利用大肠杆菌原核表达系统优化表达纯化肠道病毒71型(EV71)VP3结构蛋白,为后续单克隆抗体制备及检测试剂盒研发提供前期基础。方法 采用PCR方法扩增EV71病毒VP3基因,将其插入表达载体pET28a(+),构建pET28a-VP3重组质粒,转化大肠杆菌BL21(DE3)菌株,分别在25 ℃、37 ℃下经IPTG诱导表达,重组表达的蛋白产物经凝胶电泳初步分析,比较不同温度诱导表达的蛋白产物。结果 成功构建pET28a-VP3重组质粒,不同温度下诱导表达的蛋白产物在30.5 kDa左右位置均出现目的条带;37 ℃下诱导表达的蛋白超声破碎并离心后,目的蛋白基本位于沉淀中,而25 ℃诱导表达的蛋白产物有少量目的蛋白溶解于上清液中。结论 在25 ℃或37 ℃下均能利用大肠杆菌原核表达系统有效表达EV71病毒VP3蛋白;37 ℃诱导时蛋白可融性表达低,目的蛋白获取效率较高。

Objective To express VP3 capsid protein of enterovirus 71 by using Escherichia coli prokaryotic expression system. Methods VP3 gene was amplified by PCR before inserted into pET28a(+) plasmid. Then the plasmid pET28a-VP3 was transformed and expressed in the Escherichia coli BL21 strain at 25 ℃ or 37 ℃. Finally the protein was analyzed by SDS-PAGE gel electrophoresis. Results The pET28a-VP3 plasmid was successfully constructed, and the EV71 VP3 protein was expressed. Supernatant of the production after ultrasonication and centrifugation got a little VP3 protein. Conclusion The EV71 VP3 protein was expressed. Expression at 25 ℃ may lead to the dissolution of the recombinant protein.

目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 了解佛山市南海区性传播疾病(STD)门诊病人单纯疱疹病毒感染的流行情况。方法 对2013年1月—2014年6月间前往佛山市南海区3个规范化性病门诊就诊的患者进行问卷调查、生殖器疱疹临床诊断和单纯疱疹病毒分类抗体检测、分泌物实时荧光定量聚合酶链反应(FQ-PCR)检测。结果 350例疑似生殖器疱疹患者中,HSV-I的IgM 和IgG的检出率分别是5.4%(19/350)和87.7%　(307/350),HSV-II的IgM 和IgG检出率分别是2.9%(10/350)和42%(147/350),两种血清型中以HSV-I感染为主,且IgG 阳性率高于IgM(HSV-I的χ²=238.1,P＜0.005;HSV-II的χ²=259.08,P＜0.005);HSV-ⅡIgG感染者147例(男115例,女32例),感染率分别为41.2% 和42.7%。男性HSV-ⅡDNA感染率高于女性,二者差异有统计学意义(χ²=3.94,P＜0.05)。结论 本地区性病门诊中HSV抗体检出率高,以HSV-I感染为主;对于疑似生殖器疱疹患者,同时进行HSV抗原及血清HSV-I、HSV-II的 IgM和 IgG抗体联合检测更有助于临床GH诊断;男性患者易于临床诊断。

Objective To investigate the epidemiological characteristics of herpes simplex virus infection in patients attending a sexually transmitted diseases(STD)clinic in Nanhai District of Foshan. Methods The 350 patients attending the three standardized STD clinic in Nanhai District of Foshan from January,2013 to June,2014 were interviewed with an anonymous questionnaire,blood-tested for HSV(IgM、IgG) antibody.And secretion was detected by FQ-PCR for HSV antigen. Results In 350 patients with suspected GH,the positive rate of HSV-I IgM and IgG were 5.4%(19/350)and 87.7%(307/350).The positive rate of HSV-II IgM and IgG were 2.9%(10/350)and 42%(147/350),respectively.HSV-I infection was principal in two serologic types,and the positive rate of IgG was higher than that of IgM (P<0.05).There were 147 patients infected HSV-II IgG(male 115,female 32).The infection rate is 41.2% and 42.7%.The infection rate of HSV-ⅡDNA in men was higher than that in women.There was a significant difference between them(P<0.05). Conclusion There was a high positive detection rate of HSV from sexually transmitted disease clinic in this region.And HSV-1 was principal.For patients with suspected genital herpes,detection of HSV antigen tests combined with HSV-I、HSV-II IgM and IgG serum antibody tests is more helpful in the clinical diagnosis of genital herpe.HSV infected men patients were likely to clinically diagnose.