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 本研究对广州地区5家教学医院的鲍曼不动杆菌进行分子流行病学分析。方法 5家教学医院共采集138株鲍曼不动杆菌,利用多位点序列分型(multilocus sequence typing,MLST)及eBURST算法评价菌株之间的遗传关系。结果 MLST将138株鲍曼不动杆菌分为8个已有序列类型(STs),分别为ST195、ST208、ST457、ST136、ST254、ST548、ST445和ST53,还发现17个新STs。其中ST195的数量最多,占所有分离株的35.5%(49/138),其次为ST208,占所有分离株的21.0%(29/138)。eBURST算法分析显示以ST195为预测祖先型的克隆复合体(clonal complex, CC) 195在医院环境中广泛传播。结论 鲍曼不动杆菌CC195是广州地区的流行克隆,各家医疗机构应根据其自身实际制定感染防控策略。

Objective We analyzed the molecular epidemiology of A.baumannii isolated from 5 teaching hospitals in Guangzhou to identify the epidemic clone in this area. Methods A total of 138 strains of A.baumannii were collected from 5 teaching hospitals, and the genetic relationship was evaluated by multilocus sequence typing (MLST) and eBURST algorithm. Results MLST divided 138 strains of A.baumannii into 8 existing sequence types (STs), namely ST195, ST208, ST457, ST136, ST254, ST548, ST445 and ST53, and 17 new STs. Among them, ST195 had the largest number, accounting for 35.5% (49/138) of all isolates, followed by ST208, accounting for 21.0% (29/138) of all isolates. eBURST algorithm showed that the clonal complex (CC) 195, the predicted founder ST195, was widely spread in the hospital environment. Conclusion A.baumannii CC195 was an epidemic clone in Guangzhou area. Medical institution should develop infection prevention and control strategies according to its own actual conditions.

目的 分析医院登革热阳性病例特别是重症患者的临床和实验室和流行病学特征可为登革热的早期诊断和预防控制提供依据。方法 收集2010年—2017年期间944例就诊于广州市第一人民医院并经实验室确诊的登革热患者。根据疾病的严重程度将入选患者分为3组,比较各组之间的临床和生物学变量,并使用多元回归分析了严重登革热的危险因素的影响。结果 本研究通过对7年间944例登革热患者进行回顾性分析发现登革热病例以轻症为主,77.5%的患者有基础疾病,主要为糖尿病(15.4%)和高血压患者(34%)。大部分患者就诊时表现为高热(39.05±0.67)℃,登革病毒IgM和(或)IgG阳性,白细胞及血小板减少明显及肝、肾功能异常。重症患者AST和LDH值相比轻症者升高。冠心病和肿瘤疾病的患者发生重症的比例更高。流行趋势分析显示7年间登革热出现1次爆发(2014年)。每年9～10月为登革热高发季节。登革热发病率在男女间无统计学差异。男性和女性的高发年龄分别71～80岁和51～60岁。10岁以下发病率最小,50～80岁年龄段发病率最高。结论 广州市第一人民医院登革热患者以老年人为主,基础性疾病患者是登革热高危人群。登革热患者具有高热、登革病原检测阳性、血象和肝肾功能异常的特征;临床医生在9～10月高发季节加强对高热患者的登革病原检查有利于登革热早期诊断和防治。

Objective The Guangzhou area is a high-risk area for dengue fever. This study aim to provide a basis for the early diagnosis and prevention of dengue fever by analyzing the clinical and laboratory characteristics and epidemiological analysis of dengue patients in Guangzhou,especially in critically ill patients. Methods A total of 944 patients with dengue fever diagnosed at the First People's Hospital of Guangzhou from 2010 to 2017 were collected. The enrolled patients were divided into 3 groups according to the severity of the disease,the clinical and biological variables between the groups were compared,and multiple regression analysis was used to analyze the effects of risk factors for severe dengue. Results This study retrospectively analyzed the clinical manifestations and laboratory tests of 944 patients with dengue fever in the past 7 years,showing that dengue fever cases in Guangzhou are mainly mild. 77.5% of them have underlying diseases,mainly diabetes (15.4%) and hypertension (34%). Most patients developed high fever (39.05±0.67)℃ at the time of seeing doctors,positive for dengue virus IgM and/or IgG,decreased white blood cells and thrombocytopenia,and abnormal liver and kidney function. AST and LDH values were significantly elevated in critically ill patients compared with mild cases. Patients with coronary heart disease and neoplastic disease have a higher proportion of severe cases. Epidemiological analysis of dengue virus showed an outbreak of dengue fever in 7 years (2014). September-October is the season of high incidence of dengue fever. The incidence of dengue fever was not statistically different between men and women. The high-incidence ages of men and women are 71～80 years old and 51～60 years old,respectively. The incidence rate is the lowest under the age of 10,and the highest in the 50～80 age group. Conclusion Dengue fever patients in Guangzhou are dominated by the elderly,and patients with underlying diseases are at high risk of dengue fever. Dengue fever patients have high fever,positive dengue pathogen detection,blood and liver and kidney dysfunction characteristics. Strengthening the dengue pathogen examination for hyperthermia patients during the high season of September-October is conducive to the early diagnosis and prevention of dengue fever.