目的 探讨恙虫病患者血清乳酸脱氢酶（LDH）水平在检查中的临床价值及LDH与血小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。方法 选取2016年3月—2018年2月在我院就诊的60例恙虫病患者,其中男25例,女35例。记录患者的基本情况,血常规、肝肾功能等实验室检测指标;并检测患者血清中乳酸脱氢酶水平。并分析患者乳酸脱氢酶与小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。结果 多数患者出现发烧、头痛、腹痛、咳嗽咳痰等症状,少数患者出现腰痛、意识障碍、皮肤黏膜出血等症状;60例恙虫病患者中,52名患者血清乳酸脱氢酶含量高于正常值,15例患者血小板数量低于正常值;55名患者丙氨酸氨基转移酶高于正常值,53名患者天冬氨酸氨基转移酶高于正常值;患者血清LDH与血小板数目（r=-0.929,P<0.01）呈负相关,与丙氨酸氨基转移酶（r=0.957,P<0.01）,天冬氨酸氨基转移酶（r=0.947,P<0.01）呈正相关。结论 乳酸脱氢酶水平可以作为患者恙虫病的早期诊断标志。

Objective To investigate the clinical value of serum LDH levels in tsutsugamushi patients. Methods We selected 60 patients with tsutsugamushi disease who were enrolled in our hospital from September 2016 to February 2018,including 25 males and 35 females. We recorded the patients' basic conditions,blood tests,liver and kidney function and other laboratory testing indicators;and we detected serum lactate dehydrogenase levels in patients. The correlations in lactate dehydrogenase and platelet number,alanine aminotransferase,and aspartate aminotransferase were analyzed. Results Most patients developed fever,headache,abdominal pain,cough,sputum,and other symptoms. A small number of patients suffered low back pain,disturbance of consciousness,skin mucosal bleeding,and other symptoms;among the 60 patients with tsutsugamushi disease,the contents of serum amblytic dehydrogenase were higher than normal in 52 patients,and the numbers of platelets in 15 patients were lower than normal. The value of alanine aminotransferase was higher than normal in 55 patients,and the value of aspartate aminotransferase was higher than normal in 53 patients;serum LDH and platelet counts （r=-0.929,P<0.01）,alanine aminotransferase （r=0.957,P<0.01） and aspartate aminotransferase （r=0.947,P<0.01） showed positive correlation. Conclusion Lactate dehydrogenase level may be used as an early diagnostic marker for patients with tsutsugamushi disease.

目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

目的 探讨多指标联合监测在冠心病(CHD)早期诊断中的应用。方法 选择2018年6月—2018年12月在我院就诊的患者180例,其中动脉硬化中低危人群60例(低危组),动脉硬化中高危人群60例(高危组),确诊的冠心病患者(CHD组),另选取健康体检者60例为对照组。分析血浆游离脂肪酸、高敏C反应蛋白、尿β-2微球蛋白、血清25羟维生素D及血脂水平与冠心病之间的关系。结果 低危组、高危组和CHD组患者FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平均高于对照组,血清25羟维生素D₃、HDL-C水平均低于对照组,差异均有统计学意义(P＜0.05);低危组、高危组和CHD组患者的血清FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平逐渐升高,血清25羟维生素D₃、HDL-C逐渐降低,以CHD组最为显著。冠心病患者血清HDL-C的敏感度高于其他各指标(P＜0.05);血清FFA、hs-CRP的特异度高于其他各指标(P＜0.05)。结论 多指标联合检测对于早期诊断冠心病患者有一定意义。

Objective To explore the application of multi-index combined monitoring in early diagnosis of coronary heart disease (CHD). Methods 180 patients were selected from June 2018 to December 2018 in our hospital. Among them, 60 patients with middle and low risk of atherosclerosis (low risk group), 60 patients with middle and high risk of atherosclerosis (high risk group), 60 patients with confirmed coronary heart disease (CHD group), and 60 healthy people were selected as control group. The relationship between plasma free fatty acid, high sensitivity C-reactive protein, urinary β-2 microglobulin, serum 25-hydroxyvitamin D and blood lipid levels and coronary heart disease was analyzed. Results The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group were higher than those in control group, and serum levels of 25-hydroxyvitamin D3 and HDL-C were lower than those in control group (P<0.05). The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group increased gradually, while serum levels of 25-hydroxyvitamin D3, H-MG, TC, TG and LDL-C increased gradually. DL-C decreased gradually, especially in CHD group. The sensitivity of serum HDL-C in patients with coronary heart disease was higher than that of other indicators (P<0.05), and the specificity of serum FFA and hs-CR P was higher than that of other indicators (P<0.05). Conclusion The combined detection of multiple indicators has certain significance for the early diagnosis of coronary heart disease.

目的 探讨胸苷激酶1活性检测在胸腔积液鉴别诊断中的敏感度及特异度。方法 回顾性分析诊断明确的肺炎旁胸腔积液、结核性胸腔积液、癌性胸腔积液患者的临床资料,收集并检测三组患者胸腔积液标本中胸苷激酶1活性并进行比较。结果 三组胸腔积液胸苷激酶1含量分别为: 肺炎旁胸腔积液组: (1.18±0.73)pmol/L、结核组活性(1.31±0.64)pmol/L、癌性组(2.07±1.47)pmol/L。统计分析显示癌性组胸苷激酶1含量高于肺炎旁胸腔积液组及结核组,差异有统计学意义,而肺炎旁组与结核组胸苷激酶1含量无统计学差异。在诊断价值分析方面,当胸苷激酶1≥1.28 pmol/L时支持癌性胸腔积液诊断,但是当胸苷激酶1＜1.28 pmol/L时,无法鉴别肺炎旁和结核性胸腔积液。因此,胸苷激酶1对于癌性胸腔积液的诊断价值较好,对肺炎旁胸腔积液和结核性胸腔积液鉴别诊断效能差。临床可考虑与其他指标,如降钙素原、腺苷脱氨酶等指标联合诊断。结论 胸腔积液胸苷激酶1含量在癌性胸腔积液与非癌性胸腔积液的鉴别诊断中有较好诊断价值。

Objective To investigate the of thymidine kinase 1in differential diagnosis of pleural effusion. Methods A retrospective analysis of thymidine kinase1 activity in the parapneumonic pleural effusion and tuberculous pleural effusion and malignant pleural effusion were conducted. Results The thymidine kinase 1 of this three groups are respectively: parapneumonic group (1.18±0.73pmol/L), tuberculosis group (1.31±0.64pmol/L), and cancer group (2.07±1.47pmol/L). It was shown that the activity of thymidine kinase 1 in cancer group was higher than that of inflammation group and tuberculosis group, the difference was statistical significance, but there was no significant difference between parapneumonic group and tuberculosis group. It supported the diagnosis of malignant pleural effusion when thymidine kinase 1 was greater than or equal to 1.28pmol/L, but when the thymidine kinase 1 was less than 1.28pmol/L, it was impossible to distinguish parapneumonic pleural effusion and tuberculous pleural effusion. Therefore, the diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion is well, but the diagnosis efficiency of thymidine kinase 1 in parapneumonic pleural effusion and tuberculous pleural effusion is not well. Conclusion The diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion and non-malignant pleural effusion is well.

目的 探讨磁共振磁敏感加权成像(SWI)对脑膜、脑转移瘤的诊断价值。方法 随机选取2016年3月—2018年3月我院收治的经临床、病理确诊的50例脑膜、脑转移瘤患者为研究对象,所有患者除常规行T1WI、T2WI扫描及T1WI增强扫描检查外,额外进行SWI检查。观察不同来源脑转移瘤转移部位、肿瘤实质信号在不同成像序列上的特征及对瘤内血管情况和出血状况的判断。结果 脑转移瘤的发生部位多为顶叶(29.75%)和枕叶(20.66%),就血供区域而言,多发生于中动脉(45.45%)和颈内动脉供血区域(38.02%)。不同MRI成像序列中肿瘤信号特征比较,显示均有差异(P<0.001)。其中,肺癌脑转移瘤T1WI呈低信号(62.96%),胃癌T2WI呈现高信号(68.75%),SWI成像序列上多显示为混杂信号。SWI序列成像显示瘤内出血55例(45.45%),显示引流血管16条,瘤内出血及肿瘤血管检出率均明显高于T1WI平扫检查,差异有统计学意义(P<0.05)。结论 不同来源的脑转移瘤MR的表现不同,为逆向推测脑转移瘤来源提供依据,同时SWI是对常规序列的重要补充,尤其是在脑瘤出血和血管检出上有重要作用,值得临床推广使用。

Objective To investigate the diagnostic value of susceptibility-weighted imaging(SWI) in meningiomas and brain metastases. Methods 50 cases of clinically and pathologically confirmed patients with meningioma and brain metastasis admitted to our hospital from March 2016 to March 2018 were randomly selected as the study subjects. All patients received routine T1WI, T2WI scan and T1WI enhanced scan, and additional SWI examination was performed. We observed the characteristics of metastatic sites and tumor parenchymal signals in different imaging sequences of brain metastatic tumors from different sources and to judge the status of intramedullary blood vessels and bleeding. Results The majority of brain metastatic tumors occurred in the parietal lobe (29.75%) and occipital lobe (20.66%). In terms of the blood supply region, the majority occurred in the middle artery (45.45%) and the blood supply region of the lower artery (38.02%). Comparison of tumor signal characteristics in different MRI imaging sequences showed differences, P<0.001. Among them, T1WI of brain metastatic tumor of lung cancer presented significantly low signal (62.96%), T2WI of gastric cancer presented high signal (68.75%), and SWI imaging sequence mostly showed mixed signal.SWI sequence imaging were showed in 55 cases (45.45%) of intracranial hemorrhage and 16 drainage vessels. The detection rate of intracranial hemorrhage and tumor blood vessels was higher than that of T1WI plain scan, with statistically difference (P<0.05). Conclusion MR manifestations of brain metastatic tumors from different sources are different, providing a basis for reverse speculation of the source of brain metastatic tumors. At the same time, SWI is an important supplement to routine sequences, especially in the hemorrhage of brain tumors and the detection of blood vessels, which is worthy of clinical promotion and use.

目的 分析乳腺恶性肿瘤患者的诊断和治疗方法的动态变化,了解该疾病的患者诊治相关行为方式的变化。方法 抽取我院1999年—2014年收治的所有乳腺恶性肿瘤患者,比较不同初诊时间和初诊年龄分组间,患病部位、肿瘤大小、手术方式、治疗方式的差异。结果 比较1999年—2004年组、2005—2009年组,近年诊断的肿瘤最大直径有所下降,经过卡方比较,构成比有差异(χ²=14.2,P=0.007)。近年诊断的患者更愿意选择积极的改良根治术作为手术治疗方式(χ²=38.8,P<0.001)。就不同年龄而言,年轻的患者选择改良根治术和化疗的比例也较年老的患者高,而年龄大的患者则选择姑息治疗的比例较高(χ²=154.9,P<0.001)和(χ²=129.8,P<0.001)。结论 乳腺恶性肿瘤的认知的加强,诊治技术的提高,乳腺恶性肿瘤能够更早的被发现诊断,治疗方式的选择也更加积极。

Objective To analyze the dynamic changes of breast cancer diagnosis and treatment. and to understand the changes of related behaviors of the patients. Methods From 1999 to 2014, breast cancer patients were chosen, the differences of tumor size, operation and treatment were not compared. Results The results were compared within different groups of diagnosis years, such as 1999-2004,2005-2009, and 2010-2015. The maximum diameter of the tumor diagnosed in recent years was decreased, χ²=14.2,P= 0.007. At the same time, patients that were diagnosed in recent years were more likely to choose radical surgery as surgical treatment, χ²=38.8,P<0.001. Comparing within groups of different ages, more patients chose radical surgery and chemotherapy in younger patients than older ones, we found that the older patients chose a higher proportion of palliative care, χ²=154.9,P<0.001 and χ²=129.8,P<0.001. Conclusion Understan-ding of breast cancer malignancies was enhanced. Breast cancer may be diagnosed earlier and the choice of treatment is more positive with the development of technology.

目的 分析睾丸非肿瘤性病变的超声与CT诊断价值。方法 回顾性分析58例经临床病史、超声、CT或病理证实的睾丸非肿瘤性病例,结合临床病史,分析其超声与CT表现,包括炎性(或感染性)病变、外伤性病变、先天性病变及扭转急症。结果 所有病例均行CT检查,睾丸炎症性病变共39例(包括一般性炎症,脓肿和结核),其中19例行超声检查;睾丸外伤8例,隐睾9例,睾丸扭转2例,均行超声检查。睾丸炎症性病变临床表现为患侧或双侧阴囊不同程度的红、肿、痛,或白细胞升高、其他脏器伴发结核,超声表现为睾丸体积不同程度增大,根据炎症坏死程度不同,回声表现为回声均质、回声减低、回声不均质,坏死灶内无血流信号;CT表现为睾丸体积增大,根据炎症性病变的不同可表现为睾丸轻度强化、环形强化,可伴有睾丸鞘膜积液、点状钙化或积气;睾丸外伤均有阴囊外伤史,根据受伤程度表现为白膜下血肿、实质出血、睾丸破裂;隐睾表现为睾丸位置异常或缺如;睾丸扭转表现为睾丸短时间内剧烈疼痛,并进行性加重,超声表现为“镯环征”,CT表现为精索扭转、水肿,睾丸实质水肿。结论 睾丸非肿瘤性病变超声与CT征象均具有特征性,结合患者病史可作出准确诊断。超声检查较为便捷,CT检查可免除受检者接触性疼痛、可对盆腔及腹腔进行更为全面的观察。

Objective: Discussion on diagnosis of testicular non-tumorous lesions by ultrasound and CT.Methods: Rretrospective analysis of 58 testicular non-tumor cases proved by clinical history, Ultrasound, CT or pathologically,combined with the clinical history, and analysis of the Ultrasound and CT features,including inflammatory or infectious disease, traumatic disease, congenital disease and acute torsion.Results: All cases were examined by CT,the testicular inflammatory lesions were 39 cases, 19 of them were examined by ultrasound; testicular trauma 8 cases,cryptorchidism 9 cases, testicular torsion in 2 cases, all of them were examined by ultrasound. The clinical symptom of the inflammatory lesions of the ipsilateral or bilateral scrotum with different degrees of red, swollen, painful, or leukocytosis, other organs associated with TB, Ultrasound showed the testicular volume increased to varying degrees,according to the degree of inflammation and necrosis, the echo showed homogeneous echo, echo reduction, echo heterogeneity, and no blood flow signal in the necrotic area.CT showed an increase in testicular volume, according to the different inflammatory lesions showed mild enhancement of testis, ring enhancement, with a hydrocele, calcification or gas; testicular trauma had scrotal trauma history, according to the severity of injury showed subcapsular hematoma, hemorrhage and rupture of testis; testicular cryptorchidism showed abnormal position or absent; testicular torsion showed testicular short time severe pain, and progressive, Ultrasound showed “bracelet ring sign”, CT showed testicular torsion, edema, testicular parenchyma edema.Conclusion: Ultrasound and CT features of testicular non-tumorous lesions are characteristic, and the accurate diagnosis can be made with the combination of the patient's clinical history. Ultrasound examination is more convenient, CT examination can relieve the patient's contact pain, can be more comprehensive observation of the pelvic and abdominal.

目的 探究聚乙二醇筛查法在高泌乳血症诊断中的临床意义。方法 选取260例HP患者作为观察组以及80例健康体检者作为对照组。应用雅培I2000全自动化学发光检测仪对两组标本进行PRL浓度测定,并将标本进行PEG筛查法沉淀后再次进行PRL浓度测定,将所得数据进行对比。结果 观察组检出MP67例,检出率25.77%,对照组检出MP3例,检出率3.75%,二者差异有统计学意义(P＜0.05);HP组、MP组和对照组之间PEG沉淀前PRL浓度差异有统计学意义(P＜0.05),沉淀后HP组和MP组以及对照组差异有统计学意义(P＜0.05),MP组和对照组差异无统计学意义(P＞0.05);MP在HP引起的各种临床疾病中检出情况差异无统计学意义(P＞0.05)。结论 应用聚乙二醇筛查法对于排除MPRL对HP诊断的干扰具有可行性,对降低HP的误诊率有着重要的意义。

Objective To explore the clinical signification of polyethylene glycol screening method on the diagnosis of hyperprolactinemiat.Methods We selected 260 patients with hyperprolactinemia as observation group and 80 healthy individuals as control group. The two groups were measured with Abbott laboratories I2000 automatic chemiluminescence detector about the concentration of PRL. Then the groups were measured again after they were precipitated by the polyethylene glycol and the result data were analyzed.Results 78 cases of MP were checked out from the observation group and 3 cases were checked out from the control group. The proportion was 25.77% and 3.75% respectively, and the differences were statistically significant (P＜0.05). The difference of the concentration of PRL before precipitated by PEG among the HP group, the MP group and the control group were statistically significant (P＜0.05). After precipitating, the difference of the concentration of PRL between the HP group and the MP group were statistically significant (P＜0.05), as well as the HP group and the control group. However, there was no difference between the MP group and the control group (P＞0.05). The checking conditions of MP in some diseases caused by HP had no difference(P＞0.05).Conclusion The use of polyethylene glycol screening method is a practicable method to eliminate the interference of MPRL on the diagnosis in HP. It has significance reducing misdiagnosis rate of HP.

目的 探讨声触诊组织定量(virtual touch tissue quantification,VTQ)技术在肾上腺肿瘤诊断中的应用价值。方法 对50例患者共50个肾上腺肿瘤及同侧肾皮质进行VTQ检查,获取肾上腺肿瘤及同侧肾皮质剪切波速度(shear wave velocity,SWV)值,比较肾上腺肿瘤与同侧肾皮质及肾上腺肿瘤各类型之间SWV值,全部病例均经手术后病理证实。结果 病理证实恶性肿瘤5个,良性肿瘤45个。良、恶性肿瘤之间SWV值的差异无统计学意义。肿瘤与同侧肾皮质之间SWV值的差异有统计学意义。髓样脂肪瘤、神经鞘瘤、皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间,除皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间SWV值的差异无统计学意义外,其余任两组之间SWV值的差异有统计学意义。结论 VTQ技术可以提供肾上腺肿瘤的硬度及弹性信息,在肾上腺肿瘤的诊断中具有一定应用价值。

Objective To evaluate the application value of virtual touch tissue quantification (VTQ) technique in the diagnosis of adrenal tumors.Methods VTQ was performed in 50 patients with 50 adrenal tumors and ipsilateral renal cortex, to obtain the shear wave velocity(SWV) of adrenal tumors and ipsilateral renal cortex, the comparison between adrenal tumor and ipsilateral renal cortex and adrenal tumors of various types of SWV. All cases were pathologically confirmed after operation.Results 5 malignant tumors and 45 benign tumors were confirmed by pathology. The difference of SWV between benign and malignant tumors was not statistically significant. The difference of SWV between tumor and ipsilateral renal cortex was statistically significant. Among myelolipoma, schwannoma, adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma in addition to differences in adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma, SWV value was not statistically significant; it was statistically significant difference between the two groups in any other SWV.Conclusion VTQ technology may provide hardness and elasticity of the adrenal tumors; it has certain application value in the diagnosis of adrenal tumors.

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.