目的 通过对不同受孕能力精子外显子的分析,寻找并验证特异性外显子作为精子受孕能力的生物标记物。 方法 基于二代测序数据进行生物信息学分析,寻找特异性外显子并设计引物。各取8份高、低受孕能力精液标本,提取精子RNA反转录后进行real time q-PCR验证外显子的表达效率,筛选表达差异恒定的精子外显子作为生物标记物。各取10份高、低受孕能力精子标本,用筛选后的外显子引物进行real time q-PCR验证。 结果 生物信息学分析得到31个候选精子外显子,从31个候选外显子中筛选出9个表达差异恒定的精子外显子GAPDHS、HSF2BP、HSPA1L、ADAM21、SPEM1、WBP2NL、DDX20、TSGA10、PGK2;real time q-PCR验证结果显示,在高、低受孕能力精液标本中这9种精子外显子表达差异明显。 结论 初步确定,差异表达恒定的九种外显子可作为评估精子质量的生物标记物。

Objective To find and verify specific exons as biomarkers of sperm fertility by analyzing sperm exons with different fertility ability.Methods Based on the second generation sequencing data, bioinformatics analysis was conducted to find specific exons and design primers. We obtained 16 semen samples, 8 of high and the other 8 of low fertilizing ability, after the sperm RNAs were extracted and reverse-transcribed, real time q-PCR was performed to verify the expression efficiency of exons, and the sperm exons with constant expression difference were selected as biomarkers. 10 high and 10 lowfertility ability sperm samples were taken for real time q-PCR verification with screened exon primers. Results Thirty-one sperm exons were obtained by bioinformatics analysis, and 9 sperm exons with constant expression differences were selected from the 31 candidate exons, including GAPDHS, HSF2BP, HSPA1L, ADAM21, SPEM1, WBP2NL, DDX20, TSGA10 and PGK2. The results of real time q-PCR verification showed that the exons of these 9 sperm were significantly different in the semen samples with high and low fertility ability. Conclusion Nine exons with constant differential expression can be used as biomarkers to evaluate sperm quality.

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 评价SAMe-TT₂R₂评分对非瓣膜性房颤使用华法林的患者中的抗凝疗效的评估作用,探讨SAMe-TT₂R₂评分与缺血性卒中事件、出血事件的相关性。方法 以石河子大学医学院第一附属医院2018年1月—2019年1月住院治疗,确诊为非瓣膜性房颤并口服华法林抗凝的患者作为观察对象,进行为期10月的随访。通过患者的国际标准化比值(INR),计算患者的抗凝治疗范围内时间百分比(Time in Therapeutic Range, TTR),并对所有患者进行SAMe-TT₂R₂评分。运用χ²检验、Spearman秩相关、ROC曲线分析评估SAMe-TT₂R₂评分对患者抗凝疗效的预测能力。随访期内收集缺血性卒中和出血事件的发生情况,分析上述事件与SAMe-TT₂R₂评分的相关性。结果 190例患者平均TTR为(46.76±21.99)％,SAMe-TT₂R₂分数与患者的TTR呈负相关(P=0.001),ROC曲线下面积为0.661,P=0.001,约登指数0.203对应的临界值取整数为4分,敏感度和特异度分别为72.6％和47.7％,提示SAMe-TT₂R₂对预测TTR<65％有一定的价值。随访期间共有5例患者发生缺血性卒中事件,25例患者发生不同程度出血事件,11例患者发生全因死亡事件,上述事件在各个SAMe-TT₂R₂分值的发生分布差异无统计学意义(P＞0.05)。结论 在非瓣膜性房颤并使用华法林抗凝治疗的患者中,SAMe-TT₂R₂评分对使用华法林抗凝治疗患者的抗凝有效性具有一定的预测能力,可将SAMe-TT₂R₂评分作为预测华法林抗凝疗效的预测的指标。

Objective To evaluate the anticoagulant effect of SAMe-TT₂R₂ in patients with non-valvular atrial fibrillation treated with warfarin, and to explore the correlation between SAMe-TT₂R₂ and ischemic stroke events and bleeding events. Methods Patients who were diagnosed as non-valvular atrial fibrillation and with oral warfarin were enrolled in the First Affiliated Hospital of Shihezi University School of Medical College in January 2018-January 2019, and for 10 months of follow-up. Collecting patients' International normalization ratio(INR), calculating the Time in therapeutic range(TTR), and the SAMe-TT2 R2 score. And χ² test, Spearman rank correlation and ROC curve analysis were used to evaluate the predictive ability of SAMe-TT2 R2 score on anticoagulant efficacy in patients. Follow-up was conducted to investigate the incidence of ischemic stroke or hemorrhagic events and explore the relationship with the SAMe-TT2 R2 score. Results The mean TTR of 190 patients was 46.76%±21.99%, and the score of SAMe-TT_{2 R2} was negatively correlated with the TTR of the patients(P=0.001), the area under the ROC curve was 0.661, P=0.001, The critical value corresponding was 4 points, and the sensitivity and specificity were 72.6% and 47.7%, respectively suggesting that SAMe-TT₂R₂ had certain value in predicting TTR< 65%. During follow-up, a total of 5 patients had ischemic stroke, 25 patients had different degrees of bleeding, and 11 patients had all-cause death, different SAMe-TT₂R₂ scores showed no statistical significance(P>0.05). Conclusion In patients with non-valvular atrial fibrillation treated with warfarin anticoagulant, the SAMe-TT₂R₂ score has a certain predictive ability for the anticoagulant efficacy of patients treated with warfarin anticoagulant, and the SAMe-TT₂R₂ score could be used as an indicator for predicting the anticoagulant efficacy of warfarin.

目的 应用三维斑点追踪成像(3D-STI)技术评价睡眠呼吸暂停综合征患者左、右心室整体收缩功能。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。用三维斑点追踪成像技术测量各组左心室整体纵向应变(LVGLS)、圆周应变(LVGCS)、径向应变(LVGRS)、面积应变(LVGAS)以及右心室整体纵向应变(RVGLS)、圆周应变(RVGCS)、径向应变(RVGRS),并比较各组间参数的差异。结果 与轻度OSAS组比较,中、重度OSAS组LVGLS、LVGAS降低,差异有统计学意义(P<0.05);与中度OSAS组相比较,重度组LVGLS、LVGCS、LVGRS以及LVGAS均降低,差异有统计学意义(P<0.05);右心室部分应变参数变化早于左心室。结论 应用3D-STI技术能够在患者左心室射血分数(LVEF)发生改变之前发现早期左、右心室功能收缩障碍,为临床早期诊断及干预提供可靠的依据。

Objective To evaluate left and right ventricular systolic function of patients with obstructive sleep apnea syndrome (OSAS) by using three-dimensional speckle tracking imaging(3D-STI). Methods Sixty patients with OSAS were divided into three groups according to the sleep apnea hypopnea index (AHI), 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. The left ventricle global longitudinal strain (LVGLS), left ventricle global circumferential strain (LVGCS), left ventricle global radial strain (LVGRS), left ventricle global area strain (LVGAS) and right ventricle global longitudinal strain (RVGLS), right ventricle global circumferential strain (RVGCS) and right ventricle global radial strain (RVGRS) were measured by three-dimensional speckle tracking imaging technology, and the differences of parameters between groups were compared. Results Compared with mild OSAS group, LVGLS and LVGAS were decreased in moderate and severe OSAS groups, and the difference was statistically significant (P<0.05). Compared with the moderate OSAS group, LVGLS, LVGCS, LVGRS and LVGAS in the severe group all decreased, and the difference was statistically significant (P<0.05). Some of right ventricle strain parameters were earlier than that of left ventricle. Conclusion The application of 3D-STI technology can detect early left and right ventricular dysfunction before left ventricular ejection fraction(LVEF)changes, provide a reliable basis for early clinical diagnosis and intervention.

目的 本研究以ICSI后未成熟卵母细胞为研究对象,分析比较卵母细胞不同发育阶段冷冻对其后续效果的影响,评估ICSI后未成熟卵母细胞的利用价值。方法 未成熟卵母细胞直接成熟培养(新鲜组)与玻璃化冷冻后成熟培养(冷冻组)的成熟率,并利用孤雌激活的方法比较卵母细胞的发育潜力。结果 发现新鲜组与冷冻组体外培养卵母细胞成熟率、受精率、卵裂率、优质胚胎率和囊胚率均无差异(P>0.05)。但两组的GV期卵母细胞成熟率低于MI期(P<0.05),且冷冻组的GV期卵母细胞受精率低于MI期(P<0.05)。不过裸卵体外成熟培养效果欠佳,特别是对GV期卵母细胞,体外成熟培养后的卵母细胞发育潜力低下,无囊胚形成。结论 ICSI后未成熟卵母细胞的冷冻对卵母细胞的发育潜力没有明显影响,但体外成熟培养的卵母细胞发育潜力低下,有待进一步提高体外成熟培养技术。

Objective In this study, the immature oocytes after ICSI were used to analyze the effects of freezing on the subsequent development of oocytes at different developmental stages, and to evaluate the utilization value of immature oocytes after ICSI(intracytoplasmic sperm injection). Methods The immature oocytes was directly cultured (fresh group) and matured after vitrification (frozen group), and the development potential of the oocytes was compared by parthenogenetic activation. Results There was no significant difference in the oocyte maturation rate, fertilization rate, embryo cleavage rate, high quality embryo rate and blastocyst rate between the fresh and frozen groups (P>0.05). However, the maturation rate of GV oocytes in the two groups was lower than MI oocytes (P<0.05), and the fertilization rate of GV oocytes in the frozen group was lower than MI oocytes (P<0.05). However, the in vitro maturation of naked oocytes was not effective, especially for GV oocytes, the oocyte development potential after in vitro maturation was low, there was no blastocyst formation. Conclusion The freezing of immature oocytes after ICSI has no significant effect on the development potential, but the development potential of naked oocytes matured in vitro was low, and the in vitro maturation culture technology of naked oocyte needs to be further improved.

目的 应用FRAX^®工具评估广州社区中老年人发生骨质疏松性骨折的风险。方法 回顾性研究1 140例广州社区中老年人的临床资料,应用FRAX^®工具计算未来10年发生主要骨质疏松性骨折及髋部骨折的风险,分析不同危险因素与骨折风险的关系。结果 广州社区中老年人群10年内发生主要骨质疏松性骨折概率为(4.2±3.6)%,髋部骨折概率为(1.3±2.4)%。主要骨质疏松性骨折风险及髋部骨折风险、OSTA值均随着年龄增长而增加。多因素回归分析结果显示: 年龄、性别、既往骨折、继发性骨质疏松、股骨颈T值、跌倒对主要部位骨折及髋部骨折风险具有独立性预测意义。结论 FRAX^®工具可用于评估广州社区中老年人骨质疏松性骨折风险,建议在社区中老年人健康体检时应用FRAX^®工具进行骨折风险评估。

Objective To predict the osteoporotic fracture risk in senile people in Guangzhou communities by FRAX,the fracture risk assessment tool published by WHO. Methods Clinical data of 1140 cases were collected for the retrospective analysis. The FRAX tool was uesed to calculate the 10-year probability of a major osteoporotic and hip fracture.The relationship between different risk factors and the fracture risk predicted by FRAX was analyzed. Results The 10-year probability of major osteoporotic fractures was (4.2±3.6)%, and the 10-year probability of hip fractures was (1.3±2.4)%.The 10-year probability of the major osteoporotic and hip fracture increased with age.Multivariate regression analysis showed that age,gender,previous fracture,secondary osteoporosis,T-score of femoral neck BMD and fall were independent predictors of the 10-year probability of major osteoporotic fracture and hip fracture. Conclusion The FRAX tool may be effectively applied to assess the fracture risk of senile population in Guangzhou communities.We recommedated that FRAX-tool should be included in routine health check-up.

目的 了解社区医护人员的心理健康状况,评估心理干预措施效果,找到提高社区医护人员心理健康状况的有效措施。方法 采用《症状自评量表 SCL-90》对社区医护人员的心理健康状况进行基线调查,在干预3、6、9个月时分别进行SCL-90复测,以评估心理干预措施效果;根据《医护人员工作压力测试量表》的调查结果制定有针对性的心理干预措施并适时调整。结果 社区医护人员SCL-90测评总分和躯体化、强迫、人际敏感、焦虑、敌对、恐怖、偏执7个因子得分均高于全国常模水平(P<0.05);经过综合干预,随访期间SCL-90测评总分呈逐步下降趋势,干预6个月时,除人际敏感因子外,SCL-90测评总分及各因子分已趋于正常水平,与全国常模比较差异没有统计学意义(P<0.05)。至9个月时,人际敏感因子得分也恢复至正常水平。结论 社区医护人员心理健康状况低于全国常模水平,进行针对性的综合干预可提高其心理健康水平,实验显示干预时长应不低于6个月。

Objective To understand the mental health status of community health care workers, assess the effect of psychological intervention measures, and find effective measures to improve the mental health status of community health care workers.Methods With the help of Symptom Checklist SCL-90, we firstly carried out baseline survey on community medical staff mental health; then retested that at 3, 6 and 9 months later. Thus, we could assess the effect of psychological intervention. According to the results of the medical staff working pressure test questionnaire, we could develop targeted psychological intervention measures and adopt prompt adjustment.Results Community health care personnel SCL-90 evaluation score and 7 factors scores(physical,forced,interpersonal sensitivity,anxiety,hostility,terror,and paranoia) were higher than the national norm(P<0.05);after comprehensive intervention in the 9 months follow-up,the SCL-90 evaluation score was decreasing gradually.After intervention for 6 months,except for the interpersonal sensitivity factor,SCL-90 total scores and the other factor scores tend to normal levels, to compare the national norm, there was no statistical significance in differences (P<0.05). 9 months later, the scores of interpersonal sensitivity also return to normal levels.Conclusion The mental health status of community health care workers was lower than the national norm,the comprehensive intervention may improve their mental health level, and the experiment showed that the intervention should be no less than 6 months.

目的 评估AMA-M2、SP100和GP210三种自身抗体在诊断原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)中的应用价值。方法 收集我院近3年就诊患者的AMA-M2、SP100、GP210、ALP和GGT检测数据,其中PBC患者50例,非PBC肝胆疾病或自身免疫病患者226例,正常对照290例。分析这些检测指标对PBC诊断的敏感度和特异度。结果 AMA-M2、SP100和GP210诊断原发性胆汁性肝硬化的敏感度分别为96.00%、36.00%、8.00%,特异度分别为98.26%、97.87%、99.03%。PBC组病人的ALP和GGT检测结果高于非PBC病人组。结论 AMA-M2、SP100和GP210对PBC的临床诊断特异度较高;AMA-M2的敏感度高,但SP100和GP210敏感度低。

Objective To evaluate the diagnostic accuracy of AMA-M2, SP100 and GP210 for the primary biliary cirrhosis (PBC).Methods A total of 50 patients with PBC and 226 patients with other liver diseases or autoimmune diseases were enrolled in this study and 290 healthy individuals were included as normal controls. The data of AMA-M2, SP100, GP210, ALP and GGT were collected and analyzed for sensitivity and specificity in the diagnosis of PBC.Results The sensitivity and specificity of AMA-M2, SP100 and GP210 in the diagnosis of PBC were 96.00%, 36.00%, 8.00% and 98.26%, 97.87%, 99.03%, respectively. Compared to PBC group, the concentrations of ALP and GGT in non-PBC patients and controls were low.Conclusion AMA-M2 is quite accurate with high specificity and sensitivity in the diagnosis of PBC. However, SP100 and GP210 have high sensitivity but low sensitivity.

目的 探讨Cockcroft-Gault公式(CG公式)以及中国人MDRD公式(c-MDRD)在狼疮(SLE)患者肾小球滤过率(GFR)评估中的作用。方法 本研究纳入193名SLE患者。测量肾小球滤过率(mGFR)、血清肌酐(SCr),根据cMDRD公式,以及C-G公式分别得出估算肾小球滤过率(eGFR)。从不同方面对eGFR进行评估。结果 193名患者中, mGFR中位值为75.01 mL/(min·1.73 m²),eGFR-CG中位值70.22 mL/(min·1.73 m²),eGFR-cMDRD中位值70.67 mL/(min·1.73 m²)。患者分为mGFR≥60/(n=108)和mGFR<60 mL/(min·1.73 m²)(n=85)。对于总体病人而言, CG和 c-MDRD偏差值分别为0.64和3.91 mL/(min·1.73 m²)。在精确度以及准确度上,CG均优于c-MDRD。除了mGFR<60 mL/(min·1.73 m²)组中CG偏差值稍高于c-MDRD外,CG在分组后的表现仍然优于c-MDRD。结论 和中国人MDRD公式相比,CG公式更加适合用在SLE的GFR评估。

Objective Few studies has been conducted concerned Glomerular Filtration Rate(GFR) estimationequations about Cockcroft-Gault equation(CG equation)and Chinese Modification of Diet in Renal Disease equation(c-MDRD equation)in systemic lupus erythematosus(SLE). Our study aims to assess performance of two equations for renal function evaluation in patients with SLE.Methods 193 participants were enrolled in this study. Measured GFR was obtained by renal dynamic imaging method and Serum Creatinine (SCr)was determined for each participant. eGFR was gained by CG equation and c-MDRD equation respectively. Performance of equations were compared from different aspects.Results mGFR(median), eGFR-CG(median), eGFR-cMDRD(median)of the 193 participants were 75.01,70.22,70.67 mL/(min·1.73 m²)respectively. The participants were divided into two groups including mGFR≥60 (n=108)as well as mGFR<60 mL/(min·1.73 m²)(n=85). For overall participants, bias for CG equation and c-MDRD equation were 0.64, 3.91 mL/(min·1.73 m²) respectively. In terms of precision and accuracy, CG equation was better than c-MDRD equation. In subgroup, CG equation was still superior to c-MDRD equation except for bias in CG equation which is higher than c-MDRD equation in mGFR<60 ml(min·1.73 m²).Conclusion Compared with c-MDRD equation, CG performed better in GFR estimation in patients with SLE.

目的 探讨血碱性磷酸酶水平对维持性透析患者血管钙化与骨质疏松的评估价值。方法 纳入我院186例维持性透析患者,记录相关临床资料并完善实验室检查,以X线片评价血管钙化情况,双能X线吸收法检查骨密度。对上述资料进行双变量相关分析、ROC曲线分析等统计学处理。结果 血碱性磷酸酶水平与股骨颈骨密度负相关,与腹主动脉钙化评分正相关。腹主动脉钙化评分与骨密度负相关。ALP对骨质疏松及严重腹主动脉钙化诊断的ROC曲线下面积分别为0.777及0.701。结论 碱性磷酸酶是评估透析患者血管钙化骨质疏松的良好指标。

Objective To explore evaluation value of alkaline phosphatase in vascular calcification and osteoporosis in maintenance dialysis patients. Methods 186 patients in maintenance dialysis were enrolled in this study. The related clinical data was recorded. The examination of X-ray (lateral abdomens) was done to estimate vascular calcification in patients. Bone mineral density was measured by dual energy X-ray absorptiometry. The results above were analyzed by bivariate correlation analysis and receiver operator characteristic curve. Results By bivariate correlation analysis,serum alkaline phosphatase level was negatively associated with femoral neck bone mineral density, and was positively associated with abdominal aortas calcification scores. Abdominal aortas calcification scores were negatively associated with femoral neck bone mineral density. ROC curve revealed AUCs were respectively 0.777 and 0.701 for serum alkaline phosphatase level in diagnosis of osteoporosis and severe abdominal aortas calcification. Conclusion Alkaline phosphatase may be a good index to evaluate calcification and osteoporosis in maintenance dialysis patients.