目的 观察程序性死亡受体1（PD-1）联合细胞毒性T淋巴细胞相关蛋白4（CTLA-4）双免疫疗法对改善晚期乳腺癌近期疗效及远期预后的影响。方法 选择2020年5月—2022年5月商丘市第一人民医院收治的124例晚期乳腺癌患者为研究对象,经随机数字表法将其分为对照组（60例）和观察组（64例）,对照组予以常规PD-1单抗免疫疗法治疗,观察组采用PD-1联合CTLA-4双免疫疗法治疗,比较2组患者治疗前后肿瘤标志物水平、治疗后病灶缓解情况,对所有患者开展为期1年随访,统计并对比2组的不良反应发生情况及远期生存情况。结果 治疗前,2组患者的肿瘤标志物水平比较差异均无统计学意义（均P>0.05）;治疗后,观察组的癌胚抗原为（3.36±0.17）ng/mL,糖类抗原15-3为（25.33±5.28）U/mL,糖类抗原19-9为（38.77±5.62）U/mL,均低于对照组[（5.27±1.36）ng/mL、（28.44±5.18）U/mL、（41.25±5.46）U/mL,均P<0.05]。治疗后,观察组的完全缓解率为21.88%（14/64）,部分缓解率为31.25%（20/64）,病情稳定率为37.50%（24/64）,均高于对照组[8.33%（5/60）、13.33%（8/60）、23.33%（14/60）],肿瘤生长率为（30.27±5.18）%,肿瘤超进展率为6.25%（4/64）,均低于对照组[（33.49±5.32）%、18.33%（11/60）,均P<0.05]。治疗后,观察组的不良反应发生率为34.38%（22/64）,略高于对照组33.33%（20/60）,组间比较差异无统计学意义（P>0.05）;观察组的中位无进展生存期为（9.33±2.25）月,中位总生存期为（10.76±3.32）月,均高于对照组[（7.25±2.31）月、（7.41±1.62）月,均P<0.05]。结论 PD-1联合CTLA-4双免疫疗法能有效改善晚期乳腺癌的近期疗效及远期预后,此疗法未明显增加不良反应发生风险,安全性高。

Objective To observe the effect of programmed cell death protein-1（PD-1）combined with cytotoxic T lymphocyte-associated antigen-4（CTLA-4）dual immunotherapy on the short-term efficacy and long-term prognosis of advanced breast cancer．Methods A total of 124 patients with advanced breast cancer who were admitted to the First People's Hospital of Shangqiu City from May 2020 to May 2022 were selected as the research objects．They were randomly divided into the control group（60 cases）and the observation group（64 cases）by the method of random number table．The control group was treated with conventional PD-1 monoclonal antibody immunotherapy,and the observation group was treated with PD-1 combined with CTLA-4 double immunotherapy．The levels of tumor markers before and after treatment and the focal remission after treatment were compared between the two groups．All patients were followed up for one year,the incidence of adverse reactions and long-term survival between the two groups were compared．Results Before treatment,there was no statistically significant difference in the levels of tumor markers between two groups（all P>0.05）．After treatment,the carcino-embryonic antigen content of the observation group was（3.36±0.17）ng/mL,CA153 was（25.33±5.28）U/mL,and CA199 was（38.77±5.62）U/mL,which were lower than those of the control group [（5.27±1.36）ng/mL,（28.44±5.18）U/mL,（41.25±5.46）U/mL,all P<0.05]．After treatment,the complete remission rate of the observation group was 21.88%（14/64）,partial remission rate was 31.25%（20/64）,and stable disease rate was 37.50%（24/64）,all higher than those of the control group [8.33%（5/60）,13.33%（8/60）,23.33%（14/60）];tumor growth rate of the observation group was（30.27±5.18）%,hyper progressive disease rate was 6.25%（4/64）,both lower than those of the control group [（33.49±5.32）%,18.33%（11/60）,both P<0.05]．After treatment,the incidence of adverse reactions in the observation group was 34.38%（22/64）,slightly higher than that in the control group 33.33%（20/60）（P>0.05）．The median progression free survival of the observation group was（9.33±2.25）months,and the median overall survival was（10.76±3.32）months,both higher than those of the control group [（7.25±2.31）months and（7.41±1.62）months]（P<0.05）．Conclusions PD-1 combined with CTLA-4 dual immunotherapy can effectively improve the short-term efficacy and long-term prognosis of advanced breast cancer．This therapy does not significantly increase the risk of side effects,which is safe．

目的 评价经椎间孔镜术和显微镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及优缺点,并探讨该术式的有效性、安全性,以期找到更优的手术治疗腰椎间盘突出症方法及临床应用价值。方法 通过回顾性分析我院2019年1月—2019年12月经椎间孔镜下髓核摘除术及显微镜下椎板开窗减压髓核摘除术患者,总随访251例,其中椎间孔组229例,显微镜组22例。采集数据包括病例数、性别、年龄、手术时间、出血量及切口感染情况,术前、术后的JOA评分、VAS评分、ODI功能指数、改良MacNab标准,并对数据进行统计学分析。结果 椎间孔组手术采用局麻下进行,显微镜组采用全麻下进行,其中椎间孔镜组有2例患者因术中腰部剧痛不能配合完成,余患者手术完成顺利。椎间孔镜组平均病程5个月,手术时间(96±10)min,术中出血量(25.8±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为14.23±3.08、6.08±1.64、30.18±7.92,术后JOA评分、VAS评分、ODI功能指数分别是22.65±1.58、1.77±0.5、19.67±3.89,改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%。显微镜组平均病程8个月,手术时间(45±10)min,术中出血量(62±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为15.13±2.06、6.85±1.27、29.42±7.47,术后JOA评分、VAS评分、ODI功能指数分别是23.25±1.31、1.98±0.53、20.12±4.03。椎间孔镜组改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%;显微镜组改良MacNab标准为优17例,良2例,可3例,差0例,总优良率86.4%;两组患者性别、年龄与术前JOA评分、VAS评分、ODI功能指数相关性无统计学意义;9例椎间孔镜术后患者因效果差择期行显微镜下开窗手术治疗。结论 经皮椎间孔镜手术及显微镜下开窗减压髓核摘除手术治疗腰椎间盘突出症疗效均可靠,能有效改善患者下肢放射痛等临床症状,提高患者的生活质量及减轻功能障碍,但椎间孔镜组更具有微创、出血量少、术后恢复快等优势。

目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。