目的 探讨黄连素联合左氧氟沙星对肺炎克雷伯菌(KPn)抑菌作用。方法 KPn分为敏感株组和耐药株组,采用琼脂二倍稀释法测定黄连素联合左氧氟沙星对KPn的最低抑菌浓度(MIC)、抑制99％接种细菌生长的最低抑菌浓度(MIC99)、防突变浓度(MPC);比浊法测定黄连素联合左氧氟沙星对KPn生长曲线的影响。结果 与单用左氧氟沙星相比,联合黄连素后,敏感株组和耐药株组对左氧氟沙星MIC的下降率分别为33.3%和20%,2组之间无统计学差异(P>0.05)。左氧氟沙星与50 μg/mL黄连素或500 μg/mL黄连素联用后的抗菌能力均较单用左氧氟沙星好,且高浓度黄连素的联合抑菌效果较低浓度更加明显,差异有统计学意义(P<0.05)。与50 μg/mL黄连素联用后,左氧氟沙星SI下降了1/5 ;而与500 μg/mL黄连素联用则下降3/5 。结论 本实验证明了黄连素与左氧氟沙星联用能增加左氧氟沙星对KPn的抗菌作用,可以明显缩小耐药突变选择窗(MSW),且高浓度黄连素联合抗菌作用较低浓度好。

Objective To explore antibacterial effect of berberine(Ber) on K. Pneunmoniae(KPn) combing with levofloxacin(LVX). Methods KPn was divided into sensitive and resistant strains groups.The MIC, MIC99 and MPC of Ber combing with LVX on KPn was determined by the agar dilution method.The growth curve of Ber combing with LVX on KPn was measured by turbidimetry. Results Ber combined with LVX compare with LVX alone, MIC descent rate of sensitive strains group was 33.3%, resistant strains group was 20%, and there were no statistical differences along two groups(P>0.05). Ber combined with LVX could increase antibacterial effect and high concentration was more obvious than the low one, there were statistical differences(P<0.05). Compared with LVX alone,the SI value of 50 μg/mL Ber combined with LVX was decreased 1/5, and the SI value of 500 μg/mL Ber combined with LVX was decreased 3/5. Conclusion Ber combing with LVX could increase bacteriostatic effect on KPn,and reduce MSW significantly; high concentration of berberine was better than low one.

目的 探索长链非编码RNA LINC00672在肺癌组织中的表达及其与患者预后的关系。方法 采用实时荧光定量PCR技术检测LINC00672在75对肺癌组织和癌旁正常组织中的表达,分析其在癌组织中的表达水平与肺癌患者临床分期和预后的关联。结果 LINC00672在肺癌组织中的表达显著低于癌旁正常组织(P=0.026),LINC00672高表达与低表达相比能显著降低肺癌患者的死亡率(死亡风险比=0.46;95%置信区间=0.23~0.95;P=0.036),延长患者中位生存期(34个月 vs 18个月,P=0.027)。并且,LINC00672与肺癌预后的关联在低年龄组(<60 a)、吸烟者和非饮酒者中更为显著。进一步相乘交互作用分析显示LINCOO672与饮酒在肺癌死亡风险上具有显著的交互效应(P=0.049)。然而,LINC00672的表达水平在不同分期、T、N、M患者来源的肺癌组织中的表达无显著性差异。结论 LINC00672与肺癌发生发展存在关联,可用于预测肺癌患者的预后。

Objective To explore the expression status of long non-coding RNA LINC00672 in lung cancer tissues and its correlation with survival of lung cancer. Methods We applied the real-time PCR method to measure the expression level of LINC00672 in 53 pairs of lung cancer tissues and adjacent lung normal tissues, and analyzed the correlation between its expression and survival of lung cancer. Results LINC00672 was significantly down-regulated in lung cancer tissues than their adjacent lung normal tissues (P=0.026). Compared to those with low expression level of LINC00672, patients with high expression level of LINC00672 exerted a significant long median survival time than those with low expression level (34 vs 18 months, P=0.027). High LINC00672 expression also contributed to low mortality rate than low LINC00672 expression (hazard ratio=0.46, 95% confidence interval =0.23-0.95, P=0.036). Meanwhile, the correlation was more evident in those low age groups (< 60 years), smokers and non-drinkers. There was also a significant interaction between LINC00672 and drinking on affecting death risk of lung cancer. However, no significant association was observed between LINC00672 expression and clinical stages as well as T, N, M status. Conclusion LINC00672 is correlated with development of lung cancer, which may be a valuable biomarker to predict lung cancer prognosis.

目的 探讨影响本区肺结核发病的危险因素,为肺结核的防控提供参考依据。方法 采用频数匹配病例对照的研究方法,选自2012—2015年间,在本区居住的肺结核患者为病例组,按1∶1病例对照,在本区选择与病例组同性别、年龄相差<2 a的健康居民为对照组,用单因素Logistic分析及对多因素非条件Logistic 回归分析进行统计学分析。结果 肺结核发病的保护因素有文化程度的高低(OR=0.237,P<0.037),居住环境采光(OR=0.393,P<0.013),蔬菜水果类摄入(OR=0.748,P<0.021),蛋奶类摄入(OR=0.704,P<0.027)。肺结核的危险因素有工作环境是否接触粉尘(OR=2.984,P<0.001)是否吸烟(OR=1.537,P<0.020),是否饮酒(OR=1.110,P<0.041),结核病人接触史(OR=11.052,P<0.001),居住环境潮湿(OR=1.117,P<0.001)。最终被选入回归方程的因素为,文化程度、工作环境是否接触粉尘、结核病人接触史、居住环境潮湿、蔬菜水果类摄入,其OR值分别为0.471、8.945、17.652、14.268、0.234。结论 文化程度及蔬菜水果类的摄入为肺结核保护因素,工作环境接触粉尘、接触过结核病人及居住环境潮湿是肺结核的危险因素。

目的 探讨肺淋巴管肌瘤病(PLAM)的临床特征,诊断和治疗,提高对PLAM的认识,合并顽固性低氧血症时需警惕并发肺动脉栓塞,预防漏诊及误诊。方法 回顾分析1例确诊的PLAM合并肺栓塞患者病例资料,并结合相关文献进行复习。结果 PLAM是以弥漫性肺囊性病变为特征的一种罕见的缓慢进展的肿瘤性疾病,好发于育龄期女性,临床表现为呼吸困难、反复自发性气胸和乳糜胸。肺功能多表现为阻塞性或混合性通气功能障碍和弥散功能障碍,动脉血气显示低氧血症。高分辨CT(HRCT)示双肺弥漫性薄壁囊性改变。病理学检查示肺组织淋巴管增生和扩张,管外平滑肌细胞明显增生。诊断主要依靠高分辨CT、肺功能以及病理组织活检。血管内皮生长因子D是无创且可靠的血清学诊断标准。雷帕霉素抑制剂如西罗莫司科可有效治疗本病。结论 育龄期妇女,如反复出现自发性气胸、活动后呼吸困难,胸部HRCT示双肺弥漫分布囊状改变,临床上应想到PLAM可能。随疾病的进展出现顽固性的呼吸困难、低氧血症不能纠正时,需考虑是否合并存在肺动脉栓塞的可能,CT肺动脉造影可确诊。

目的 探讨ERCC1、RRM1、TS蛋白表达对晚期非小细胞肺癌(NSCLC)个体化治疗的指导意义。方法 收集经病理确诊的晚期NSCLC患者87例,其中67例愿意接受药敏免疫组化检测的患者作为研究组,采用SP法检测肿瘤组织ERCC1、RRM1、TS蛋白表达,并根据蛋白表达情况选择化疗方案;另外20例患者不进行药敏免疫组化检测,以常规吉西他滨联合顺铂方案化疗,以此作为对照组。比较两组患者化疗的有效率,疾病控制率(DCR),并以无进展生存期(PFS)为指标比较患者预后。结果 研究组67例患者中,PR 33例(49.25%),SD 13例(19.4%),PD 21例(31.35%);对照组20例患者中,PR 4例(20%),SD 4例(20%),PD 12例(60%),两组疗效之间有差异( χ²=6.437,P=0.04),研究组DCR为68.6%,高于对照组DCR 40%,差异有统计学意义(χ²=5.372,P=0.034)。研究组患者的中位PFS高于对照组,研究组的PFS为5月,对照组为3月,差异有统计学意义(P＜0.05)。结论 对晚期NSCLC患者进行ERCC1、RRM1、TS药敏蛋白免疫组化检测,指导个体化治疗方案,能提高患者化疗的疾病控制率及延长患者的疾病进展时间。

目的 对比观察单孔、单操作孔及三孔胸腔镜治疗早期非小细胞肺癌(NSCLC)的临床疗效。方法 选择125 例早期NSCLC患者,分为单孔组(38例)单操作孔组(42例)和三孔胸腔镜组(45例),观察3组手术结果和并发症发生率。结果 3组患者均顺利完成手术,无中转开胸。单孔组手术时间长于单操作孔及三孔组,差异有统计学意义(P＜0. 05)。对比所有3组手术患者的术中出血量及淋巴结清扫数目、术后总引流量及引流管留置时间、术后并发症发生率,差异无统计学意义(P＞0. 05)。单孔组及单操作孔组术后疼痛程度评分优于三孔组,差异有统计学意义(P＜0. 05)。结论 单孔及操作孔胸腔镜治疗早期NSCLC已可取代三孔胸腔镜技术,其术后恢复快,疗效确切,其中单孔手术对设备及胸腔镜医师操作技术熟练程度等要求更高,故在设备仍未有突破性的进展时,单操作孔胸腔镜手术可作为治疗早期NSCLC的优先选择。

Objective To compare the clinical effects of uniportal video-assisted thoracic surgery (VATS), single utility port VATS and 3-portal VATS lobectomy for patients with early stage non-small cell lung cancer. Methods Patients were divided into uniportal VATS lobectomy group(n=38), single utility port VATS lobectomy group(n=42) and 3-portal VATS lobectomy group (n=45). The surgical results and complication rates were observed. Results All patients completed the operation successfully, no one was changed to open operation. Operation time in uniportal VATS lobectomy group were longer than single utility port VATS lobectomy group and 3-portal VATS lobectomy group(P＜0. 05). There were no significant differences in intraoperative blood loss, number of lymph node dissection, the amount and time of postoperative extubation, and the incidence of postoperative complications(P＞0. 05). Post-operative pain score were higher in 3-portal VATS lobectomy group than in uniportal VATS lobectomy group and single utility port VATS lobectomy group (P＜0. 05). Conclusion Uniportal VATS lobectomy and single utility port VATS lobectomy can replace the 3-portal VATS lobectomy in treatment of early NSCLC, because of the faster postoperative recovery and curative effect. Uniportal VATS lobectomy requires special equipment and more operation skills, as there is no breakthrough in the equipment, single utility port VATS lobectomy may still be used as the first choice for treatment of early NSCLC.

目的 探讨手动杠杆式胸外按压心肺复苏(CPR)装置对院内心肺复苏按压质量和复苏疲劳的影响。方法 将12名医学生志愿者分为手动杠杆式胸外按压CPR装置组(LDCPR)(n=6)和徒手标准CPR组(STCPR)(n=6)模拟院内心肺复苏场景进行CPR试验。LDCPR组采用手动杠杆式胸外按压CPR装置对模拟人进行连续6min连续胸外按压,STCPR组徒手对模拟人进行6min连续胸外按压。监测复苏期间按压的深度、频率以及按压者的心率和疲劳程度等变化。结果 随着连续胸外按压的进行,按压者的心率和疲劳程度都在不断增加,有效按压深度超过5 cm次数逐渐减少,但是在连续胸外按压的第4～6min,LDCPR组按压者的心率较STCPR组慢(P<0.05),疲劳程度较轻(P<0.05),有效按压的比例更高(P<0.05)。按压频率两组比较无明显差异。结论 在本模拟人试验中,手动杠杆式胸外按压CPR装置可减轻按压者疲劳,有助于提高院内CPR时长时间胸外按压的质量。

Objective We aimed to investigate simulated in-hospital cardiopulmonary resuscitation (CPR) quality and rescuer fatigue of external chest compression-only CPR by a manual leverage device(LDCPR). Methods All 12 volunteers (medical staffs: male 6 and female 6) were randomized to standard CPR by hand(STCPR)group (n=6)or LDCPR group(n=6). At STCPR group, continuous external chest compression-only was performed for 6 minutes to simulate in hospital cardiopulmonary resuscitation on a manikin; at LDCPR group, compression-only was performed for 6 minutes by a leverage device on a manikin. We measured blood pressure of the volunteers before and after performing each CPR technique, volunteers self-report fatigue scale and continuously monitored heart rate (HR) of the volunteers during each CPR technique by smart ring. CPR quality measures included chest compression rate and depth. Results During continuous external chest compression-only CPR, compressor's heart rate and fatigue scale were rising continuously, and percent of compress depth >5 cm were declining, too.Compressor's heart rate and fatigue scale were higher in the STCPR group than in the LDCPR group (P<0.05) during the fourth to sixth minutes CPR (P<0.05). Percent of compress depth > 5 cm was higher in the LDCPR group than in the STCPR group (P<0.05) during the fourth to sixth minutes of CPR (P<0.05).Compress rate had not differed between the 2 groups during CPR. Conclusion In the manikin study, manual leverage external chest compress device may reduce fatigue scale and improve long term compression quality during in-hospital cardiopulmonary resuscitation.

目的 了解龙川地区肺炎支原体耐药情况,以便临床合理运用抗生素。方法 收集2014年—2015年间疑似肺炎支原体感染住院小儿患者的咽分泌物标本2 666例,同时作Mp培养及IgM检查,同为阳性者共149例进行耐药性统计分析。结果 在2 666例疑似感染患者中,培养肺炎支原体阳性149例,阳性率为5.59%,学龄前儿童(≤3岁)患者阳性率2.06%,学龄儿童(4～15岁)阳性率9.79% ,学龄儿童感染肺炎支原体与学龄前儿童比较有显著差异(P<0.05)。其中红霉素、阿奇霉素、罗红霉素、克林霉素、依托红霉素、克拉霉素、乙酰螺旋霉、交沙霉素、加替沙星、莫西沙星、环丙沙星、左氧氟沙星、多西环素、米诺环素耐药率分别为2%、12.4%、4%、22% 、2%、1%、80%、44%、2%、15%、10%、1%、61%、44%。冬季感染与在其他季节比较有差异(P<0.05)。结论 阿奇霉素,红霉素为代表大环内脂类抗生素仍可以作为临床一线经验用药,乙酰螺旋霉、交沙霉素耐药率大于40%,不建议作为经验药物使用。喹诺酮类抗生素耐药率一般小于15%,可作为肺炎支原体治疗的第二选择。四环素类抗生素在本地区耐药性高,不建议作为经验药物使用。要加强预防冬季肺炎支原体感染。

目的 研究多排螺旋CT低剂量扫描在浸润型肺结核化疗期间复查的应用价值。方法 选取100例浸润型肺结核化疗期病人为研究对象,对选取100例患者行常规剂量胸部CT扫描后再行低剂量扫描。比较常规剂量组和低剂量组CT扫描的图像质量及疗效评估。结果 两组扫描肺窗图像质量比较无统计学差异(P＞0.05);两组肺窗薄层多平面重建图像质量比较无统计学差异(P＞0.05); 两组软组织窗图像质量有统计学意义(P< 0.05)。观察组ED、DLP和CTDIvol等指标低于对照组(P＜0. 01),即观察组受检者CT扫描辐射剂量低于对照组(P＜0.01)。结论 多排螺旋CT低剂量胸部扫描用于浸润型肺结核的复查,可以获得与常规剂量接近的肺窗图像质量,满足肺结核病灶的分析评估,并可有效减少胸部CT扫描中的辐射剂量;既能满足肺结核复查的疗效评估,又提高了肺结核CT复查的安全性,还有效节约检查成本。

Objective To study the application of low-dose scan of multidetector row CT(MDCT)in the chemotherapy of infiltrative tuberculosis. Methods 100 patients with infiltrative pulmonary tuberculosis who were under treatment were selected. All patients accepted conventional-dose and low-dose scan of MDCT. The image quality and treatment effect of two groups were compared. Results The image quality on lung window of two groups did not differ significantly(P＞0.05). The image quality on lung window with multiplanar reconstruction of two groups also did not differ significantly(P＞0.05). The image quality on soft-tissue window differed significantly (P<0.05). The ED, DLP and CTDIvol of the low-dose group were significantly lower than those of the conventional-dose group. Conclusion For MDCT follow-up examination of patients with infiltrative tuberculosis, the image quality on lung window with low dose is similar to the image quality with conventional dose. It may effectively reduce the exposure dose of CT examination. This cost-effective modality not may can meet the curative effect evaluation of TB, but also can improve the security of the follow-up examination of patients.

目的 探讨八段锦联合呼吸训练对社区慢性阻塞性肺疾病(COPD)患者的疗效研究。方法 选取本社区2016年6月—2017年4月期间收治的重度及极重度稳定期COPD患者70例。随机分为A组(25例)、B组(23例)和C组(22例)。A组患者采用八段锦联合呼吸训练治疗,B组患者仅采用呼吸锻炼,C组患者不采用锻炼方式。记录对比三组患者治疗前后的肺功能、六分钟步行距离和圣乔治呼吸评分。结果 A组和B组患者肺功能均比治疗前及比C组改善(P＜0.05),且A组改善更明显(P＜0.05);A组和B组步行距离均比治疗前及C组增加(P＜0.05),且A组比B组增加程度更大(P＜0.05);A组和B组圣乔治呼吸评分均比治疗前及C组降低(P＜0.05),且A组比B组降低更多(P＜0.05)。结论 对COPD患者,八段锦联合呼吸训练可改善患者肺功能和运动能力,缓解呼吸困难,对患者活动及生活各方面的影响。具有较好的临床效果,值得临床推广应用。

Objective To study the effect of Baduanjin exercise combined with breathing training on patients with chronic obstructive pulmonary disease (COPD) in community. Methods We selected 70 patients with severe and extremely severe COPD at stable period in the community from June 2016 to April 2017. The patients were randomly divided into group A (25 cases), group B (23 cases) and group C (22 cases). Patients in group A were treated with Baduanjin exercise combined breathing training, while group B patients only used breathing exercise, and group C patients did not have exercise. We recorded and compared the lung function, six-minute walking distance and St Georges breathing score before and after treatment in the three groups. Results The pulmonary function of patients in group A and group B had been improved more than that before the treatment and of group C (P<0.05), and group A had been improved (P<0.05); the walking distance in group A and group B increased more than that before the treatment and of group C (P<0.05), and group A increased a greater degree than that of group B (P<0.05); The St Georges breathing score in group A and group B decreased than before the treatment and of group C (P<0.05); and group A decreased more than that of group B (P<0.05). Conclusion The Baduanjin exercise combined with breathing training may improve the pulmonary function and athletic ability of the patients with COPD, relieve dyspnea, reduce the influence of the illness on the activities activities of daily living of the patients. It has good clinical effect and is worthy of clinical application.