目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.

目的 探究妊娠期糖尿病(GDM)对母婴分娩结局的影响及导致不良分娩结局的相关影响因素。方法 采用现况调查的方法,通过现场问卷调查的形式,收集2017年9月—2017年11月在广州市妇女儿童医疗中心分娩并且在本院孕检的产妇的临床资料。根据是否患有妊娠期糖尿病,把调查对象分为妊娠期糖尿病组与非妊娠期糖尿病组。定量资料采用t检验或秩和检验,定性资料采用卡方检验或非参数检验,采用logistic回归模型分析不良分娩结局的相关影响因素。结果 在882例调查对象中,GDM孕妇共173例(19.6%)。研究结果表明,GDM孕妇与正常孕妇剖宫产率和住院天数差异有统计学意义(P<0.05),GDM组剖宫产率和住院天数增加,GDM产妇胎儿心脏畸形的风险增加(P<0.05)。Logistic回归分析结果提示孕妇孕次≥3次(OR值为0.399,95%CI为0.189~0.840,P=0.016)、产2次(OR值为0.283,95%CI为0.158~0.507,P<0.001)、产3次或以上(OR值为0.241,95%CI为0.112~0.520,P<0.001)、分娩孕周<37周(OR值为0.380,95%CI为0.180~0.804,P=0.011)是孕妇剖宫产的影响因素;分娩孕周<37周(OR值为16.028,95%CI为7.013~36.629,P<0.001)是孕妇住院天数>5天的影响因素。结论 妊娠期糖尿病可增加孕妇剖宫产率、住院天数以及胎儿心脏畸形的发生率;怀孕3次或以上的孕妇采用剖宫产的可能性与怀孕1次的孕妇相比风险降低;分娩2次或以上的孕妇采用剖宫产的可能性与分娩1次的孕妇相比风险降低;分娩孕周<37周的孕妇采用剖宫产的可能性较分娩孕周≥37周孕妇降低;分娩孕周<37周使孕妇住院天数>5天的风险增加升高。

目的 观察蒜氨酸对血管性痴呆(VD)脑损伤的作用,并探讨其可能的作用机制。方法 采用随机数字表法将40只大鼠分为假手术组、模型组、蒜氨酸低、中、高剂量组,每组大鼠为8只。模型组和蒜氨酸组采用双侧颈总动脉结扎建立VD大鼠模型。造模7 d后蒜氨酸组分别给予蒜氨酸10、20、30 mg/kg灌胃治疗,假手术组和模型组给予等量生理盐水灌胃治疗,每组均为1次/d,共4周。采用Morris水迷宫实验检测大鼠学习记忆能力,ELISA法检测大鼠海马超氧化物歧化酶(SOD)活性,蛋白免疫印迹法(Western blotting)检测大鼠海马iNOS、IL-1β及TNF-α蛋白的表达。结果 与假手术组相比,模型组大鼠逃避潜伏期延长,找到平台次数减少,SOD活性降低,iNOS、IL-1β及TNF-α蛋白表达量增加,差异均有统计学意义(P＜0.05);与模型组相比,蒜氨酸各剂量组大鼠潜伏期缩短,找到平台次数增多,SOD活性增高,iNOS、IL-1β及TNF-α蛋白表达量减少,差异均有统计学意义(P＜0.05)。结论 蒜氨酸能改善血管性痴呆大鼠的学习记忆能力,其机制可能与其抗氧化应激,抑制相关炎症因子的释放有关。

目的 应用斑点追踪显像定量评价阻塞性睡眠呼吸暂停综合征患者的左心房功能,并进行对比研究。方法 OSAS患者60例,根据睡眠呼吸暂停低通气指数(AHI)分为3组,轻度组,中度组,重度组,每组20人;另选择20名健康正常人作为正常对照组。采用二维斑点追踪成像技术测量各组左心房相关应变参数:收缩期应变(Ss),舒张早期应变(Se),舒张晚期应变(Sa),左心房收缩期应变率(SRs),左心房舒张早期应变率(SRe),左心房舒张晚期应变率(SRa),分析并比较各组间参数的差异性。结果 随着疾病严重程度的增加Ss、SRs、Se、SRe呈逐渐减低的趋势,而Sa、SRa先升高后减低,差异有统计学意义(P<0.05)。结论 应用斑点追踪成像技术可在OSAS患者发生左心房重构前检测出心房功能的变化。

Objective The left atrial function of patients with obstructive sleep apnea syndrome was quantitatively evaluated by speckle tracing imaging and compared. Methods Sixty patients with OSAS were divided into three groups according to the sleep apnea hypopnea index(AHI),including the mild group, the moderate group and the severe group, with 20 patients in each group. Another 20 healthy people were selected as the normal control group. Left atrial correlation strain parameters:systolic strain(Ss), early diastolic strain(Se), late diastolic strain(Sa), left atrial systolic strain rate(SRs), early diastolic strain rate(SRe), left atrium left atrium late diastolic strain rate(SRa) were measured by two dimensional speckle tracking imaging technology, and the differences of parameters between groups were compared. Results With the increase of disease severity, Ss, SRs, Se and SRe showed a trend of gradual decrease, while Sa and SRa increased first and then decreased, and the difference was statistically significant(P<0.05). Conclusion Changes in atrial function may be detected in OSAS patients prior to left atrial remodeling using speckle tracking imaging.

目的 探讨广州地区老年住院患者营养状态与日常生活能力(ADL)的相关性。方法 选取2018年7月—2019年6月在广州市第一人民医院住院年龄≥60岁的老年人共275例,收集其一般资料信息,各项临床营养指标(BMI、血清白蛋白、血红蛋白、总胆固醇、甘油三酯)、并运用营养风险筛查2002(NRS2002)评估营养风险、采用Barthel指数评定量表评估日常生活能力;分析老年住院患者营养状态与ADL之间的相关性。结果 在本组研究中,根据NRS2002评分(营养风险:NRS2002≥3;无营养风险NRS2002＜3),营养风险发生率58.9%(162/275);无营养风险发生率41.1%(113/275)。老年住院患者的NRS2002评分与ADL评分呈负相关关系(r=-0.393,P＜0.05);ADL评分与BMI、血清白蛋白、总胆固醇、血红蛋白水平呈正相关关系(P＜0.05)。结论 广州地区老年住院患者NRS2002为日常生活能力的影响因素,通过降低NRS2002评分来减少营养风险可改善老年人的日常生活能力;老年人的营养风险发生率高,应当尽早进行营养干预。

Objective To investigate relationship between nutritional status and activities of daily living(ADL) in elderly inpatients in Guangzhou. Methods Total of 275 people older than 60 were included in this study from Guangzhou First People's Hospital from July 2018 to June 2019. Their nutritional markers(including BMI, plasma albumin, hemoglobin, total cholesterol, triglyceride),the activities of daily living(ADL) were evaluated with Barthel index and the nutrition risk screening 2002(NRS2002)used to assess the nutritional risk status were collected to analyze the relationship between nutrition and ADL. Results In these subjects, based on the NRS2002 scores(nutritional risk that the NRS2002 scores were equal or greater than 3, and the non-nutritional risk that the NRS2002 scores were less than 3),58.9%(162/275) patients were having nutritional risk and 41.1%(113/275) were having non-nutritional risk. In elderly inpatients,NSR2002 were negatively associated with ADL(r=-0.393,P＜0.05). ADL was positively associated with BMI, plasma albumin and hemoglobin level(P<0.05). Conclusion In the old, the NRS2002 is an influencing marker of activities of daily living in Guangzhou. Reducing the nutritional risk by lowering the NRS2002 scores can improve ADL in the elderly. The incidence of nutritional risk is highly prevalent in elderly and early nutritional treatment will be needed.

目的 研究纤维支气管镜下给药治疗耐多药空洞型肺结核的临床治疗效果。方法 抽取我院2017年1月—2019年12月期间收治的空洞型肺结核耐多药(同时耐INH、RFP,其他药敏试验抗痨药物均敏感)患者74例作为研究对象,其中38例设作治疗组,在应用传统抗痨药物帕司烟肼、EMB、PZA、TH1321治疗基础上,应用纤维支气管镜下给药治疗,药物选择AMK和左氧氟沙星;36例设作对照组,单纯应用传统抗结核药物帕司烟肼、EMB、PZA、TH1321治疗,比较两组临床治疗效果。结果 治疗组临床治疗总有效率94.7%,高于对照组66.7%,两组比较差异有统计学意义(P＜0.05);治疗后,两组QOL评分均高于治疗前,治疗组评分高于对照组,比较差异有统计学意义(P＜0.05);治疗组患者痰菌转阴时间、病灶减少时间、空洞缩小时间等指标均优于对照组,比较差异有统计学意义(P＜0.05);两组不良反应比较无差异(P＞0.05)。结论 纤维支气管镜下给药应用AMK和左氧氟沙星,可以有效治疗耐多药空洞型肺结核,取得理想的临床治疗效果,能有效改善患者临床症状,缩短痰菌转阴、病灶减少和空洞缩小的时间,有效改善患者的生活质量,而且治疗安全性较高,可以应用于临床推广。

Objective To study the clinical effect of drug administration under fiberoptic bronchoscope in the treatment of multi drug resistant (mdr) cavitary pulmonary tuberculosis. Methods 74 patients with cavitary pulmonary tuberculosis(who were resistant to INH and RFP at the same time and sensitive to other drugs in other drug sensitivity tests) were selected as the study subjects. 38 of them were set up as the treatment group. On the basis of the treatment with traditional antituberculosis drugs such as pasiazide, EMB, PZA and TH1321, they were treated with fiberoptic bronchoscopy and drug selection AMK and levofloxacin, 36 cases as control group, were treated with traditional antituberculotic drugs, such as pasiazide, EMB, PZA and TH1321. Results The total effective rate of clinical treatment in the treatment group was 94.7%, higher than 66.7% in the control group, and the difference between the two groups was statistically significant(P<0.05);there was no difference in adverse reactions between the two groups(P>0.05). Conclusion Administration of AMK and levofloxacin under fiberbronchoscope may effectively treat mdr-cavitary tuberculosis, achieve ideal clinical treatment effect, effectively improve the clinical symptoms of patients, shorten the time of sputum bacteria turning negative, focus reduction and cavitary reduction, effectively improve the quality of life of patients. The treatment safety is high, which may be applied in clinical promotion.

目的 观察灵芝孢子粉对中重度慢性阻塞性肺疾病(COPD)稳定期患者肺功能、6分钟步行距离及T淋巴细胞亚群的影响。方法 选取稳定期中重度COPD门诊患者19例,服用灵芝孢子粉6个月后观察患者服药前后肺功能的变化及循环血液中CD4⁺、CD8⁺T淋巴细胞的比例变化,症状评分(CAT评分)以及对6 MWT的影响。结果 服用灵芝孢子粉6个月后,中重度COPD患者的六分钟步行距离延长,平均增加19 m(P＜0.01),患者的CAT评分也有改善(P＜0.01),患者肺功能与服药前相比有改善趋势,其中FEV₁较服用前平均增加60 mL(P>0.05),FVC平均增加为130 mL(P<0.01),FEV₁/FVC比例降低0.47(P>0.05);外周血CD4⁺T淋巴细胞比例增加(P<0.01),CD8⁺和CD4⁺/CD8⁺T淋巴细胞亚群比例未见明显变化(P＞0.05)。结论 服用灵芝孢子粉6个月后对肺功能无明显作用,但能改善中重度COPD患者的CAT症状评分,可能与升高CD4⁺T淋巴细胞比例有关。

Objective To observe the effects of Ganoderma lucidum spore powder on lung function, 6-minute walking distance and T lymphocyte subsets in patients with moderate to severe chronic obstructive pulmonary disease(COPD). Methods Nineteen patients with moderate-to-severe COPD outpatients in stable phase were enrolled. After taking Ganoderma lucidum spore powder for 6 months, the changes of lung function and the proportion of CD4⁺ and CD8⁺ T lymphocytes in circulating blood, the symptom score(CAT score) and impact on the 6 MWT were observed. Results After taking Ganoderma lucidum spore powder for 6 months, the six-minute walking distance of patients with moderate to severe COPD was prolonged, with an average increase of 19 meters(P<0.01). The patient's CAT score was also improved(P<0.01). There was an improvement trend in increasing average FEV1 by 60 mL(P>0.05), FVC increased to 130 mL(P<0.01) and the FEV1/FVC ratio decreased by 0.47(P>0.05). The proportion of CD4⁺ T lymphocytes in peripheral blood increased(P<0.01), and the proportion of CD8⁺ and CD4⁺/CD8⁺ T lymphocyte subsets did not reach the significance(P>0.05). Conclusion After taking Ganoderma lucidum spore powder for 6 months, it has no significant effect on lung function, but it may improve the CAT symptom score of patients with moderate to severe COPD, which may be related to the increase of CD4⁺ T lymphocyte ratio.

目的 分析广州血液中心以“生日献血纪念章”(下称生日纪念章)个性化专属纪念品对献血者的招募保留效果进行分析和研究。方法 2017年—2019年期间,广州血液中心生日当天献血者共11 790名,每半年生日当天献血的献血者人数,绘制折线图,分析2018年7月起“生日纪念章”活动前后,生日当天献血的献血者人数变化;卡方检验对比2组献血人群特征差异,分析该活动敏感人群。结果 2017年—2019年每半年生日当天献血人数总体持续增长,其中2018年7—12月较2018年1—6月,生日当天献血人数增长了406%,增长比例最大。活动前后2组人群性别、年龄、职业及既往献血次数分布差异均有统计学意义(P<0.05)。活动后男性、35岁及以上献血者、工人/职员及其他职业,固定献血者比例增加。结论 广州血液中心的“生日纪念章”活动对生日当天献血有明显的促进效果,其中,男性,年龄35岁及以上,工人/职业/其他职业及固定献血者对该活动更敏感,更可能选择生日当天献血。今后针对女性、25岁以下、学生及初次献血者,注意增加其他招募保留措施。

Objective To analyze the effect of the “Birthday Blood Donation Medal” (hereinafter referred to as the Birthday Medal) personalized souvenir to the blood donor recruitment and retention effect of blood donors in Guangzhou Blood Center. Methods From 2017 to 2019, there were a total of 11 790 blood donors donated blood on their birthday in Guangzhou Blood Center. Aline chart was drawn of the number of blood donors who donated blood on birthday to observe the trends every half a year from 2017 to 2019; Chi-square test was used to compare the characteristics of blood donors in two groups (before and after the “Birthday Blood Donation Medal” activity) and we analyzed the sensitive population of the activity. Results The number of blood donors on the birthday every half year from 2017 to 2019 continued to increase. Among them, the number of blood donors donated on birthday on July-December 2018 increased by 406% compared to the first six months of 2018, which was the largest increase. The differences in gender, age, occupation, and previous blood donation times between the two groups were statistically significant (P<0.05). After the activity, the percentage of male, 35-year-old and above blood donors, workers/clerks and other occupations, and regular blood donors increased. Conclusion The “Birthday Blood Donation Medal” activity in Guangzhou Blood Center has a significant promotion effect on blood donation on birthday. Among them, males, aged 35 and above, workers/occupations/other occupations and regular blood donors are more sensitive to this activity and are more likely to donate blood on birthday. In the future, other recruitment and retention measures should be taken to pay attention to women, under 25 years old, students and first-time blood donors.

目的 探讨C反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞计数(NC)及中性粒细胞/淋巴细胞比值(NLR)在肺癌患者化疗后合并细菌感染早期诊断中的意义。方法 收集本院肿瘤科2019年1月—2019年12月肺癌化疗后合并细菌感染患者78例,肺癌化疗后未感染患者64 例,同期健康体检人群39例,采用固相免疫色谱法和速率散射比浊法测定血清中的PCT及CRP 的含量,采用mindray cal8000血细胞分析仪进行血细胞分类计数检查,计算N及NLR。结果 化疗后感染组CRP、PCT、NC及NLR均高于化疗未感染组及健康对照组,差异均有统计学意义(P＜0.01);化疗未感染组与健康对照组CRP、PCT、NC及NLR差异有统计学意义(P＜0.01)。CRP、PCT、NC及NLR联合使用时,其灵敏度为97.507%,而特异度升高为97.15%。细菌感染患者治疗前的PCT、CRP、NC及NLR 与治疗后相比较差异有统计学意义(P<0.05),治疗后低于治疗前。结论 PCT、CRP、NC及NLR联合检测能够提高对肺癌患者化疗后合并细菌感染早期诊断的敏感度和特异度。

Objective To explore the significance of C-reactive protein (CRP), procalcitonin (PCT), neutrophil count (NC) and neutrophil / lymphocyte ratio (NLR) in the early diagnosis of bacterial infection in lung cancer patients after chemotherapy. Methods From January 2019 to December 2019, 78 cases of lung cancer patients with bacterial infection after chemotherapy, 64 cases of uninfected patients after chemotherapy and 39 cases of healthy people in the same period were collected. the contents of PCT and CRP in serum were detected by solid phase immunosorbent assay and rate nephelometry.The NC and NLR were classified and counted by mindray cal8000 hematology analyzer. Results After chemotherapy, CRP, PCT, NC and NLR in the infected group were higher than those in the uninfected group and the healthy control group (P<0.01), while CRP, PCT, NC and NLR in the uninfected group were higher than those in the healthy control group (P<0.01). When CRP, PCT, NC and NLR were used together, the sensitivity was 97.507%, while the specificity increased by 97.15%. The PCT, CRP, NC and NLR of patients with bacterial infection before treatment were lower than those after treatment (P<0.05). Conclusion PCT, CRP, NC and NLR may improve the sensitivity and specificity of early diagnosis of bacterial infection in patients with lung cancer after chemotherapy.

目的 总结一个以心脏损害为首发症状的假肥大肌营养不良症家系的遗传学及临床特征。方法 对先证者和家系成员进行临床观察、并收集其血清酶、胸片、心电图、 心脏彩色超声、肌肉组织活检及抗肌萎缩蛋白基因突变检测等结果。结果 先证者及家系成员患者符合假肥大肌营养不良症诊断,但以心脏扩大为首发症状,表现为心肌酶谱异常,心电图异常,心彩超提示扩张型心肌病,同时骨骼肌受累不明显,基因检测提示先证者及家系成员患者携带抗肌萎缩蛋白基因外显子40的无义突变[c.5632C>T, p(Gln1878^*)]。结论 该家系成员患者符合X连锁扩张型心肌病诊断,患者存在新发的抗肌萎缩蛋白基因无义突变。

Objective To summarize the genetic and clinical characteristics of a family with Duchenne muscular dystrophy (DMD) with cardiac damage as the first symptom. Methods The results of clinical observations, laboratory tests, chest radiographs, electromyography, echocardiography, muscle tissue biopsies, and DMD gene mutations were collected. Results Patients with probands and family members met the diagnosis of DMD. However, cardiac enlargement was the first symptom, presenting as abnormal myocardial enzyme spectrum, abnormal electrocardiogram, and dilated cardiomyopathy in echocardiography, while skeletal muscle involvement was not obvious. One nonsense pathogenic mutation c.5632C>T, p(Gln1878^*) of exon 40 in the DMD gene was identified in the patients with probands and family members. Conclusion The patients of this family met the diagnosis of x-linked dilated cardiomyopathy, and a new nonsense pathogenic mutation of DMD gene was identified in this family.