目的 探讨与分析核磁弥散成像（DWI）及表观弥散系数（ADC）值在肝内非肿瘤性病变诊断与鉴别诊断中的价值。方法 选择2020年8月—2023年5月厦门大学附属第一医院收治的120例肝脏占位性病变患者为研究对象,所有患者均给予常规MRI与DWI,记录图像质量、信号特征,计算ADC值,评价诊断效能。结果 120例患者中,病理诊断为肝内非肿瘤性病变70例（非肿瘤组：肝脓肿32例、肝囊肿28例、肝炎性假瘤10例）,肝内肿瘤性病变50例（肿瘤组：肝血管瘤38例,肝癌12例）。非肿瘤组与肿瘤组的图像质量优良率分别为94.29%（66/70）与88.00%（44/50）,组间比较差异无统计学意义（χ²=1.509,P>0.05）。非肿瘤组的磁共振信号特征多为高信号（62.86%）,肿瘤组多为低信号（60.00%）,两组比较差异有统计学意义（χ²=45.691,P<0.05）。在b值为400 s/mm²和800 s/mm²条件下,非肿瘤组的ADC值（0.84±0.17、0.77±0.14）均低于肿瘤组（1.29±0.24、1.19±0.34）,差异有统计学意义（t=12.029、9.302,P<0.05）。DWI判断为肝内非肿瘤性病变68例,DWI在肝内非肿瘤性病变的鉴别诊断灵敏度与特异度分别为95.71%（67/70）和98.00%（49/50）,ROC曲线显示DWI在肝内非肿瘤性病变的诊断曲线下面积为0.895。结论 DWI在肝内非肿瘤性病变中的图像显示质量高,可通过信号特征与ADC判断病灶状况,对鉴别肝内非肿瘤性病变具有较高的诊断效能。

Objective To investigate and analyze the value of diffusion weighted imaging（DWI）and apparent diffusion coefficient（ADC）in the diagnosis and differential diagnosis of non neoplastic liver lesions．Methods A total of 120 patients with liver focal lesions admitted to the First Affiliated Hospital of Xiamen University from August 2020 to may 2023 were selected．All patients were given conventional MRI and DWI,the image quality and signal characteristics were recorded,the ADC value was calculated,and the diagnostic efficiency was evaluated．Results Among the 120 patients,70 cases were pathologically diagnosed as non neoplastic lesions（non tumor group,32 cases of liver abscess,28 cases of liver cyst,10 cases of hepatitis pseudotumor）,and 50 cases were neoplastic lesions（tumor group,38 cases of hepatic hemangioma,12 cases of liver cancer）．The excellent and good image quality rates of non tumor group and tumor group were 94.29%（66/70）and 88.00%（44/50）,respectively,and there was no significant difference between the two groups（χ²=1.509,P>0.05）．The MRI signal characteristics of non tumor group were mostly high signal（62.86%）,while the tumor group were mostly low signal（60.00%）,and the difference between the two groups was statistically significant（χ²=45.691,P<0.05）．When the b value was 400 s/mm² and 800 s/mm²,the ADC value of non tumor group（0.84±0.17,0.77±0.14）was significantly lower than that of tumor group．The difference was statistically significant（t=12.029,9.302,P<0.05）．Sixty-eight patients were diagnosed as non neoplastic lesions by DWI．The sensitivity and specificity of DWI in the differential diagnosis of non neoplastic lesions were 95.71%（67/70）and 98.00%（49/50）,respectively．The ROC curve shows that the area under the diagnostic curve of DWI for non tumor lesions in the liver was 0.895．Conclusion sDWI has high image quality in the diagnosis of non neoplastic lesions in the liver．Doctors can judge the status of lesions by signal characteristics and ADC,which has high diagnostic efficiency in the identification of non neoplastic lesions in the liver．

目的 探讨血清胱抑素C（Cys-C）联合β₂-微球蛋白（β₂-MG）早期诊断糖尿病肾病的应用价值。方法 选择2021年4月—2023年4月医院接收的100例糖尿病患者为对象,根据其有无合并肾脏疾病,将其分为糖尿病组及糖尿病肾病组,各50例,同比例选取同期到我院体检的健康人群50名进行对照研究,检测比较其Cys-C及β₂-MG水平,对比其Cys-C阳性率、β2-MG阳性率及联合检测阳性率,并对比不同疾病分期糖尿病肾病患者的Cys-C、β₂-MG水平。结果 糖尿病肾病患者Cys-C、β₂-MG水平高于糖尿病患者与健康者（P<0.05）。糖尿病患者Cys-C、β₂-MG水平高于健康者（P<0.05）。糖尿病肾病患者Cys-C阳性率64.00%、β₂-MG阳性率72.00%、Cys-C+β₂-MG联合检测阳性率96.00%高于糖尿病6.00%、10.00%、12.00%及健康者0.00%、0.00%、0.00%（P<0.05）;糖尿病Cys-C+β₂-MG联合检测阳性率12.00%高于健康者0.00%（P<0.05）;糖尿病肾病中Cys-C+β₂-MG联合检测阳性率96.00%高于CysC 64.00%、β₂-MG 72.00%（P<0.05）。糖尿病肾病不同分期患者Cys-C、β₂-MG水平比较,Ⅳ期>Ⅲ期>Ⅰ~Ⅱ期（P<0.05）。结论 糖尿病肾病患者Cys-C、β₂-MG水平明显升高,Cys-C、β₂-MG联合诊断更具有优势,而且肾损害越严重,Cys-C、β₂-MG异常程度越高,作为临床诊治的参考依据的价值较高。

Objective To investigate the application value of serum cystatin C（Cys-C）combined with β₂-microglobulin（β₂-MG）in the early diagnosis of diabetic nephropathy．Methods A total of 100 diabetic patients admitted to our hospital from April 2021 to April 2023 were selected as subjects,and divided into diabetes group and diabetic nephropathy group according to whether they have renal diseases or not,with 50 cases in each group．Then,50 healthy people who came to our hospital for physical examination in the same period were selected for comparative study,and their Cys-C and β₂-MG levels were detected and compared,and their Cys-C positive rate,β₂-MG positive rate and combined detection positive rate were compared．Results The levels of Cys-C and β₂-MG in patients with diabetic nephropathy were higher than those in patients with diabetes and healthy controls（P<0.05）．The levels of Cys-C and β₂-MG in diabetic patients were higher than those in healthy controls（P<0.05）．The positive rates of Cys-C（64.00%）,β₂-MG（72.00%）and Cys-C+β₂-MG（96.00%）in patients with diabetic nephropathy were higher than those in patients with diabetes（6.00%,10.00%,12.00%）and healthy subjects（0.00%,0.00%,0.00%）（P<0.05）．The positive rate of combined detection of Cys-C and β₂-MG in diabetic patients（12.00%）was higher than that in healthy subjects（0.00%）（P<0.05）．The positive rate of Cys-C combined with β₂-MG in diabetic nephropathy was 96.00%,which was higher than that of Cys-C 64.00% and β₂-MG 72.00%（P<0.05）．The levels of Cys-C and β₂-MG in patients with stage Ⅳ diabetic nephropathy were higher than those in patients with stage Ⅲ and Ⅰ-Ⅱ diabetic nephropathy（P<0.05）．The levels of Cys-C and β₂-MG in stage Ⅲ patients were higher than those in stage Ⅰ-Ⅱ patients（P<0.05）．Conclusions The levels of Cys-C and β₂-MG are significantly increased in patients with diabetic nephropathy,and the combination of Cys-C and β₂-MG has more advantages．The greater serious renal damage,the greater abnormal degree of Cys-C and β₂-MG,which has a higher value as a reference for clinical diagnosis and treatment．

目的 探讨高频超声对小儿梅克尔憩室所致肠梗阻的诊断价值。方法 选取广州市妇女儿童医疗中心2018年1月—2023年12月经手术证实的由梅克尔憩室引起的肠梗阻患儿41例作为研究对象,回顾性分析患儿临床资料及超声表现,并与术中所见和病理结果进行对照。结果 41例患儿,发病平均年龄为（3.97±3.69）岁,其中男32例、女9例。术前超声诊断肠梗阻38例,诊断符合率为92.7%;诊断梅克尔憩室所致肠梗阻9例,诊断符合率为21.9%。术中诊断梅克尔憩室索带卡压肠管24例,腹内疝8例,肠扭转1例;肠套叠10例;梅克尔憩室炎症、粘连6例,粘连穿孔1例;憩室内异物并穿孔1例。结论 高频超声对小儿肠梗阻有重要的诊断价值,仔细探查可以明显提高梅克尔憩室所致肠梗阻的临床诊断率,为临床尽早手术提供重要依据。

Objective To investigate the diagnostic value of high frequency ultrasound for intestinal obstruction caused by Meckel's diverticulum in children．Methods From January 2018 to December 2023,41 children with intestinal obstruction caused by Meckel's diverticulum were selected as the study objects．The clinical data and ultrasound images of the children were analyzed retrospectively,and compared with the intraoperative and pathological results．Results In 41 patients,the average age of onset was（3.97±3.69）years ,including 32 males and 9 females．Preoperative ultrasonic diagnosis of intestinal obstruction in 38 cases,diagnosis coincidence rate was 92.7%．Intestinal obstruction caused by Meckel's diverticulum was diagnosed in 9 cases,the diagnosis coincidence rate was 21.9%．During the operation,24 cases of Meckel's diverticulum intestinal compression were diagnosed,8 cases of abdominal hernia,1 case of intestinal torsion,and intussusception of 10 cases．Meckel's diverticulum had inflammation and adhesion in 6 cases and adhesion perforation in 1 case．A case of foreign body in diverticulum with perforation．Conclusions High-frequency ultrasound has an important diagnostic value for intestinal obstruction in children．Careful exploration can significantly improve the clinical diagnosis rate of intestinal obstruction caused by Meckel's diverticulum,and provide an important basis for early clinical operation．

目的 探讨胎儿颈部软组织(NT)超声检查联合血清甲胎蛋白(AFP)水平检测对产前胎儿神经管畸形诊断中的应用价值。方法 选取684例我院2018年4月—2021年4月接受产前检查的孕妇,所有孕妇分别采用NT超声检查、血清AFP水平检查,以引产结果为“金标准”,比较NT超声、血清AFP水平及联合检查诊断结果、诊断效能及对不同类型神经管畸形诊断符合率的影响。结果 经引产结果显示共48例神经管畸形胎儿;经NT超声检查共36例神经管畸形胎儿;经血清AFP水平检查共34例神经管畸形胎儿;经联合检查共47例神经管畸形胎儿;与NT超声、血清AFP水平单独检查相比,联合检查灵敏度89.58%、准确率98.68%、阴性预测值99.22%较高,漏诊率10.42%较低(P＜0.05);与NT超声、血清AFP水平单独检查相比,联合检查对于脑膨出、隐形脊柱裂胎儿检出率较高(P＜0.05)。结论 NT超声检查、血清AFP联合诊断准确率显著高于单独检查,可有效提高诊断效能,为临床筛查胎儿神经管畸形提供有效手段。

目的 探究数字乳腺三维断层融合摄影技术(DBT)联合MR波谱在乳腺高危病灶诊断中的应用。方法 选取2020年6月—2021年6月来我院进行乳腺钼靶X线摄影并诊断为BI-RADS 4级及以上的100例乳腺高危病灶患者为研究对象,对入选患者行MR波谱及DBT检查,分析MR波谱征象及DBT乳腺病变摄影特征,以病理结果为标准,评价MR波谱与DBT及两者联用对乳腺高危病灶的诊断疗效。结果 DBT敏感度、特异度、阳性预测值、阴性预测值均高于MR波谱;DBT漏诊率、误诊率均低于MR波谱漏诊率、误诊率,2组诊断方法比较(P<0.05)。MR波谱及DBT对≥2 cm恶性病变的病理诊断结果符合率比较,差异均无统计学意义(P＞0.05)。MR波谱及DBT对乳腺良性病变、恶性病变＜2 cm诊断结果符合率比较,DBT对乳腺高危患者的病理诊断结果符合率高于MR波谱(P＜0.05)。结论 乳腺高危病灶诊断中选择DBT可对乳腺高危病灶诊断中做出准确的分析和判断,对乳腺高危病灶诊断更具有应用价值,值得临床采纳。

Objective To explore the application of digital breast tomosynthesis (DBT) combined with MR wave in the diagnosis of high-risk breast lesions. Methods A total of 100 patients with breast high-risk lesions diagnosed as BI-RADS 4 or above by mammography in our hospital from June 2020 to June 2021 were selected as the research objects. The selected patients were examined by MR spectrum and DBT. The signs of MR spectrum and the photographic characteristics of DBT breast lesions were analyzed. Based on the pathological results, the diagnostic efficacy of MR spectrum, DBT and their combination in the diagnosis of breast high-risk lesions was evaluated. Results The sensitivity, specificity, positive predictive value and negative predictive value of DBT were higher than those of MR spectrum; the missed diagnosis rate and misdiagnosis rate of DBT were lower than those of MR spectrum (P<0.05). There was no significant difference in the coincidence rate of MR spectrum and DBT in the pathological diagnosis of malignant lesions ≥ 2 cm (P>0.05). The coincidence rate of MR spectrum and DBT in the diagnosis of benign and malignant breast lesions<2 cm was higher than that of MR spectrum (P<0.05). Conclusions Selecting DBT in the diagnosis of breast high-risk lesions can make accurate analysis and judgment in the diagnosis of breast high-risk lesions. It has higher application value in the diagnosis of breast high-risk lesions and is worthy of clinical adoption.

目的 观察超声心动图(UCG)+心肌损伤标志物水平检测在急性心肌梗死(AMI)患者诊断中的应用价值。方法 选取2020年6月—2021年9月我院收治的74例AMI患者为观察组,另选取同期65例疑似AMI患者为对照组,2组均进行UCG检测,并对比入院后0~2 h、2~12 h、12~24 h心肌损伤标志物[肌酸激酶同工酶(CK-MB)、氨基末端脑钠肽前体(NT-proBNP)、肌钙蛋白(cTnI)、心脏型脂肪酸结合蛋白(H-FABP)]水平,分析心肌损伤标志物与AMI病情程度的关联性及UCG+心肌损伤标志物水平检测对AMI诊断的应用价值。结果 UCG检查结果显示观察组阳性率86.79%高于对照组9.23%(P＜0.001);对照组入院后各时间段CK-MB、NT-proBNP、cTnI、H-FABP水平差异无统计学意义(P＞0.05)观察组入院后各时间段CK-MB、NT-proBNP、cTnI、H-FABP水平均高于对照组(P＜0.05);Spearman相关分析可知,血清CK-MB、NT-proBNP、cTnI、H-FABP水平与AMI患者病情程度呈正相关(r₁=0.648,r₂=0.692,r₃=0.704,r₄=0.683,P＜0.05);受试者工作特征曲线(ROC)曲线分析显示,UCG+血清CK-MB、NT-proBNP、cTnI、H-FABP联合检测对AMI患者的诊断敏感度(85.14%)、特异度(100.00%)较高(P＜0.05)。结论 UCG+心肌损伤标志物水平检测应用于AMI患者有利于提高诊断敏感度、特异度,诊断价值较高。

目的 探索胸部CT值在胸腔积液鉴别诊断的价值。方法 81例胸腔积液患者纳入本研究,胸腔积液分为渗出液、漏出液、恶性胸腔积液及良性胸腔积液。建立平均CT值的ROC曲线,计算曲线下面积。结果 81例胸腔积液患者中59例为渗出液,22例为漏出液;恶性胸腔积液33例,良性胸腔积液48例。渗出液组平均CT值(16.68±6.76)Hu高于漏出液组(5.50±3.42)Hu(P<0.000 1)。ROC曲线分析结果显示,胸腔积液平均CT值对区分渗出液和漏出液具有较高的准确性(曲线下面积为0.944 5)。当最佳界值为≥9.99 Hu时,其敏感度为88.14%,特异度为90.91%;恶性胸腔积液组平均CT值(15.38±7.29)Hu与良性胸腔积液组平均CT值(12.45±8.03)Hu没有差异(P=0.098 1)。结论 在胸腔积液的鉴别诊断过程中,胸部CT的CT值在鉴别漏出液及渗出液中有一定的价值,但尚不能用于鉴别良性及恶性胸腔积液。

Objective To explore the value of chest CT value in the differential diagnosis of pleural effusion. Methods A total of 81 patients with pleural effusion were included in this study, including exudate, transudate, malignant pleural effusion and benign pleural effusion.The ROC curve of average CT value was established and the area under the curve was calculated. Results Among 81 patients with pleural effusion, 59 cases were exudative, 22 cases were transudative, 33 cases were malignant pleural effusion and 48 cases were benign pleural effusion.The mean CT value of the exudate group, (16.68±6.76) Hu, was significantly higher than (5.50±3.42) Hu of the transudate group (P<0.000 1).ROC curve analysis showed that the mean CT value of pleural effusion had high accuracy in distinguishing exudate from transudate (area under the curve was 0.9445).When the cut-off value for exudative effusion was over 9.99 Hu, the sensitivity and specificity were 88.14% and 90.91%, respectively.The mean CT value of malignant pleural effusion group, (15.38±7.29) Hu, was not significantly different from (12.45±8.03) Hu of benign pleural effusion group (P=0.098 1). Conclusions In the differential diagnosis of pleural effusion, the chest CT value can be used to identify transudate and exudate, but not benign and malignant pleural effusion.

目的 探讨气道径向超声(RP-EBUS)引导多维度联合检查对周围型肺癌的诊断价值。方法 选取2019年9月—2021年12月于佛山市第二人民医院确诊的74例周围型肺癌患者,分析RP-EBUS引导肺活检、支气管黏膜刷检、支气管肺泡灌洗细胞学及DNA甲基化检测等多维度联合检查对周围型肺癌的诊断阳性率及影响因素。结果 RP-EBUS引导肺活检、支气管黏膜刷检、支气管肺泡灌洗液细胞学、DNA甲基化检测对周围型肺癌的诊断阳性率分别为52.7%、47.3%、45.9%和51.4%,RP-EBUS引导多维度联合检查阳性率为71.6%,高于单一方法检查(P<0.05);RP-EBUS引导多维度联合检查病灶直径≥30 mm诊断阳性率高于病灶直径＜30 mm (82.9% vs 57.6%),差异有统计学意义(P<0.05);RP-EBUS引导多维度联合检查在肺上叶、中叶/舌叶、下叶病灶的阳性率分别为69.7%、66.7%和76.9%,差异无统计学意义(P>0.05);联合检查中超声探及病灶的诊断阳性率高于超声未探及病灶(76.9% vs 33.3%),差异有统计学意义(P<0.05);病灶超声图像表现为中心均实型的联合检查诊断阳性率高于非中心均实型(86.0% vs 59.1%),差异有统计学意义(P<0.05)。结论 RP-EBUS引导多维度联合检查对周围型肺癌有更高的诊断阳性率,诊断阳性率与病灶大小、超声是否探及病灶及病灶超声图像特征有关,与病灶部位无关。

Objective To investigate the value of radial probe endobronchial ultrasound (RP-EBUS)guided multi-dimensional combined examination in the diagnosis of peripheral lung cancer. Methods A retrospective analysis of 74 patients with peripheral lung cancer which were diagnosed in Foshan Second People's Hospital from September 2019 to December 2021 was carried out. RP-EBUS guided biopsy, brushing biopsy, bronchus alveolar lavage cytology and DNA methylation detection results were analyzed to obtain the positive diagnosis rate and influencing factors. Results The positive rates of RP-EBUS guided biopsy, brushing biopsy, bronchus alveolar lavage cytology and methylation for peripheral lung cancer were 52.7%, 47.3%, 45.9% and 51.4%, respectively. The positive rate of RP-EBUS guided multi-dimensional combined detection was 71.6%, which was significantly higher than single detection (P<0.05). The positive rate of RP-EBUS multi-dimensional combined examination in lesions diameter ≥30 mm was higher than that of lesion diameter ＜30 mm (82.9% vs 57.6%, P<0.05). The positive rate of RP-EBUS guided multi-dimensional combined group in the upper lobe, middle lobe/lingual lobe, and lower lobe of the lung were 69.7%, 66.7% and 76.9%, respectively, with no significant difference (P>0.05). The positive rate of ultrasound detected lesion in combined group was higher than that of undetected lesions (76.9% vs 33.3%, P<0.05). The ultrasound images of solid center lesions had higher positive rates than that of non solid center lesions (86.0% vs 59.1%, P<0.05). Conclusions RP-EBUS guided multi-dimensional combined examination has a higher positive rate for diagnosis of peripheral lung cancer. The positive rate of diagnosis are related to the size of the lesion, whether the lesion is detected by ultrasound and the characteristics of the ultrasound image of the lesion, but not related to the location of the lesion.

现代人面临更大的工作与生活压力,每天的生活节奏较快,因此经常出现饮食不规律、饮食结构不合理等现象,这样就增加了肠胃疾病的发生率。胃肠道间质瘤（GIST）以人体胃肠道最为常见的肿瘤疾病,该病患者占全部胃肠道间叶性肿瘤患者人数的80%以上。GIST根据疾病进展、间质瘤体积等不同因素又能够分为不同的疾病类型,需采取对应的诊断措施与治疗措施。本文将针对胃小间质瘤的流行病学、临床症状、临床诊断以及治疗措施等进行研究与分析,以供参考。

Modern people are facing greater pressure in work and life,and the pace of daily life is fast．Therefore,irregular diet and unreasonable diet structure often occur,which increases the incidence of gastrointestinal diseases．Gastrointestinal stromal tumor（GIST）is the most common tumor disease in human gastrointestinal tract,accounting for over 80% of all patients with gastrointestinal mesenchymal tumors．GIST can be divided into different types according to different factors such as disease progression and stromal tumor volume,thus corresponding diagnostic and therapeutic measures should be taken．This paper studied and analyzed the epidemiology,clinical symptoms,clinical diagnosis and treatment of gastric small stromal tumors for reference．

先天性巨结肠是遗传背景复杂的先天性肠神经系统发育异常性疾病,也是小儿外科临床工作中的常见疾病,以消化道末端肠神经节缺如为典型病理特点,肠梗阻、肠穿孔、严重的巨结肠相关性小肠结肠炎是疾病的主要并发症,尤其在低龄婴幼儿起病的病例中,仍是围术期死亡的主要原因。近些年来,越来越多的学者在解析其发病机制、遗传特征、治疗手段等方面不断探索创新,但在低龄婴幼儿,尤其是新生儿期寻找创伤小、特异性高、普适性强的早诊方法仍面临巨大挑战,早发现、早干预可以有效改善患儿的生活质量及疾病预后。本文对先天性巨结肠相关的早期诊断方法进行了系统综述,以期在传统经典的诊断方法上,不断创新求索,综合不同方法的利弊,提高临床应用中的诊断效能,为疾病早期诊断方面的研究提供理论基础。