目的 观察芳香烃受体(AhR)及Th17相关细胞因子在类风湿关节炎中的表达水平及其对疾病的预测价值。方法 选择2014年1月—2015年12月于我院就诊的RA患者60例作为观察组,选取同期于我院进行健康体检的正常人60例作为对照组,采用酶联免疫吸附法检测血清中 IL-17、IL-23及AhR的表达水平,并分析其与疾病活动度的关系。结果 RA患者血清IL-17、IL-23及AhR水平高于对照组(P＜0.05)。而根据病情严重程度,RA 非早期组IL-17、IL-23及AhR水平较早期组增高(P＜0.05)。血清 IL-17 水平与除CRP以外的病情活动度指标均呈正相关关系(P＜0.05)。IL-23 水平与SJC、TJC、HAQ 、DAS28 评分呈正相关关系(P＜0.05),但其他指标无明显相关性(P>0.05)。RA患者PBMC中AhR的表达水平与各项临床指标无相关性(P>0.05)。IL-17和IL-23水平与Sharp评分呈正相关关系(r=0.895,P＜0.01;r=0.708,P＜0.01)。AhR的表达与血清IL-17和IL-23水平呈正相关(r=0.415,P＜0.01)。经荧光定量PCR检测结果显示,RA患者AhR及其下游因子CYP1A1、IL-17、FOXP3 mRNA的表达水平高于对照组(P＜0.05)。且RA 非早期组AhR及其下游因子CYP1A1、IL-17、FOXP3 mRNA的表达水平较早期组增高(P＜0.05)。经相关关系检测,RA患者AhR及其下游因子CYP1A1、IL-17、FOXP3 mRNA的表达水平与Sharp评分呈正相关关系(r=0.715,P＜0.01;r=0.734,P＜0.01;r=0.812,P＜0.01;r=0.755,P＜0.01)。结论 Th17相关细胞因子IL-17和IL-23在RA病理生理过程中发挥重要作用,其表达增高,提示关节炎症处于活跃状态,骨质破坏较重,可作为评估RA病情的重要指标。RA患者体内AhR蛋白及其相关下游信号通路均呈高表达状态,AhR通路在RA患者的发病过程中可能发挥关键作用。

Objective To observe the expression level of aroma receptor (AhR) and Th17 related cytokines in rheumatoid arthritis and its predictive value to disease. Methods Sixty patients with RA who were treated in our hospital from January 2014 to December 2015 were selected as the observation group. Sixty healthy subjects were randomly selected as the control group. IL-17, IL-23 and AhR levels in serum were detected by enzyme-linked immunosorbent and the relationship between IL-17, IL-23 and disease activity were analyzed. Results IL-17, IL-23 and AhR levels in serum of RA patients were significantly higher than those in controls (P<0.05). However, the levels of IL-17, IL-23 and AhR levels were significantly higher in the non- early RA group than in the early group (P<0.05), depending on the severity of the disease. There was a positive correlation between serum IL-17 level and disease activity index except CRP (P<0.05). IL-23 level was positively correlated with SJC, TJC, HAQ and DAS28 scores (P<0.05), but no significant correlation was found between other indexes (P>0.05). The expression level of AhR in PBMC of RA patients was not correlated with clinical indexes (P>0.05). IL-17 and IL-23 levels were positively correlated with Sharp score (r=0.895, P<0.01; r=0.708, P<0.01). The expression of AhR was positively correlated with serum IL-17 and IL-23 levels (r=0.415, P<0.01). The expression of AhR and its downstream factors CYP1A1, IL-17 and FOXP3 mRNA in RA patients were significantly higher than those in the control group (P<0.05) by fluorescence quantitative PCR. The expression of AhR and its downstream factors CYP1A1, IL-17 and FOXP3 mRNA in RA group were significantly higher than those in early group (P<0.05). The expression level of AhR and its downstream factors CYP1A1, IL-17 and FOXP3 mRNA in RA patients were positively correlated with Sharp scores (r=0.715, P<0.01; r=0.734, P<0.01; r=0.812, P<0.01; r=0.755, P<0.01). Conclusion The Th17-related cytokines IL-17 and IL-23 play an important role in the pathophysiology of RA, and the expression of Th17-associated cytokines is increased, suggesting that arthritis is active and bone destruction is serious. The AhR protein and its associated downstream signaling pathways are highly expressed in RA patients, and the AhR pathway may play a key role in the pathogenesis of RA patients.

目的 探讨血清降钙素原(PCT)与中性粒细胞淋巴细胞比率(NLR)对预测急性胰腺炎(AP)继发急性肺损伤(ALI)的临床适用性。方法 回顾性分析60个AP病例,对合并ALI的实验组和没有合并ALI的对照组治疗前后血清PCT和NLR进行均数比较、相关性分析、ROC分析等统计分析。结果 两组间治疗前NLR(P=0.019)与治疗期间血清PCT平均值(P<0.001)有统计学差异,ROC分析:治疗前NLR、治疗期间血清PCT平均值对于预测ALI的灵敏度、特异度、约登指数分别为0.778、0.889;0.690、0.881;0.468、0.77,两者的差异有统计学意义(P=0.0134)。结论 急性胰腺炎早期治疗前,NLR对于预测ALI有一定的参考价值,而在急性胰腺炎后期,治疗期间的血清PCT平均值对于预测ALI有着良好的灵敏度和特异度,具有一定的临床适用性。

Objective To investigate the clinical applicability of serum procalcitonin levels and neutrophil-to-lymphocyte ratio (NLR) in predicting acute lung injury(ALI) secondary to acute pancreatitis(AP). Methods Sixty cases of AP were recruited to explore their serum-PCT and NLR before/after treatment. Means comparison, correlation analysis, ROC analysis were carried out. Results The NLR before treatment (P=0.019)and serum-PCT after treatment(P<0.001)were statistical significance of two groups(ALI、NON-ALI). In ROC analysis, the sensitivity, specificity, Jorden index of above two index were 0.778、0.889;0.690、0.881;0.468、0.77 respectively. There were statistically significant differences between them(P=0.0134). Conclusion In the early phase before treatment in AP, NLR has certain reference value in predicting ALI. On the other hand, in the later phase after treatment in AP, serum-PCT has great sensitivity, specificity and clinical applicability.

       目的   探讨肝脏衰弱程度联合肝功能分级预测肝硬化患者肝病复合不良事件的价值，作为识别和干预不良结局的依据。方法   选择2022年12月—2023年12月医院接收的肝硬化患者80例进行研究，随访6个月观察患者不良事件发生情况，将出现2个及以上肝病并发症的肝病复合不良事件患者25例作为观察组，将出现1个肝病并发症或未出现并发症的患者55例作为对照组，比较两组患者的基本资料、实验室指标、营养指标、体力活动水平、肝脏衰弱指数（LFI）、肝功能Child-Turcotte-Pugh（CTP）评分，采用单因素和多因素Cox回归分析评估肝硬化患者肝病复合不良事件的危险因素，使用受试者工作特征（ROC）曲线下面积评估LFI联合CTP评分预测肝硬化患者肝病复合不良事件的价值。结果   观察组年龄、丙氨酸氨基转移酶（ALT）高于对照组，红细胞计数（RBC）、血红蛋白（Hb）、血肌酐（Scr）、总胆红素（TBIL）、步速、小腿围低于对照组（t分别为4.235、6.500、3.826、3.989、4.289、8.878、2.474，均P＜0.05）。观察组营养风险48.00%、LFI≥4.5分52.00%、CTP分级B/C级76.00%高于对照组18.18%、14.55%、27.27%（χ ² 分别为7.664、12.454、16.699，均P＜0.05）。单因素Cox回归分析显示年龄、ALT、营养风险、LFI≥4.5分、CTP分级B/C级、RBC、Scr、TBIL、Hb、步速、小腿围为肝硬化患者发生肝病复合不良事件的危险因素（HR分别为2.251、1.578、1.626、1.981、1.715、1.428、1.443、1.419、1.336、1.332、1.254，均P＜0.05）。多因素Cox回归分析显示年龄、ALT、营养风险、LFI≥4.5分、CTP分级B/C级为肝硬化患者发生肝病复合不良事件的独立危险因素（HR分别为2.275、1.746、2.025、1.895，P均＜0.05）。ROC曲线结果显示LFI、CTP、LFI联合CTP预测肝硬化患者肝病复合不良事件的AUC分别为0.82、0.79、0.88（P＜0.05）。结论  年龄、肝脏衰弱、CTP分级B/C级、营养风险为肝硬化患者肝病复合不良事件的危险因素，肝脏衰弱程度联合肝功能分级预测肝硬化患者肝病复合不良事件具有更高的效能。

       Objective  To explore the value of predicting liver disease complex adverse events in patients with liver cirrhosis by combining the degree of liver frailty with liver function grading，as a basis for identifying and intervening in adverse outcomes．Methods  A study was conducted on 80 patients with liver cirrhosis admitted to the hospital from December 2022 to December 2023．Patients were followed up for six months to observe the occurrence of adverse events．Twenty-five patients with liver disease complex adverse events with two or more liver disease complications were selected as the observation group，and 55 patients with one or no liver disease complication were selected as the control group．The basic information，laboratory indicators，nutritional indicators，physical activity levels，liver frailty index（LFI），Child Turcotte Pugh（CTP）scores，univariate and multivariate Cox regression analysis were used to evaluate the risk factors for liver disease complex adverse events in liver cirrhosis patients．The value of combining LFI and CTP score in predicting liver disease complex adverse events in patients with liver cirrhosis was assessed by Receiver Operating Characteristic （ROC）curve area．Results  The age，alanine aminotransferase（ALT），red blood cell count（RBC），hemoglobin（Hb），serum creatinine（Scr），total bilirubin（TBIL），walking speed，and calf circumference of the observation group were higher than those of the control group（t=4.235，6.500，3.826，3.989，4.289，8.878，2.474，all P＜0.05）．The nutritional risk of the observation group was 48.00%，LFI score≥4.5 was 52.00%，CTP grade B/C was 76.00%，which was higher than that of the control group at 18.18%，14.55%，and 27.27%（χ ² =7.664，12.454，16.699，all P＜0.05）．Univariate Cox regression analysis showed age，nutritional risk，LFI ≥  4.5，CTP grade B/C，RBC，Scr，TBIL，Hb，step speed and calf circumference were  risk factors for the occurrence of liver disease complex adverse events in patients with liver cirrhosis（HR values=2.251，1.578，1.626，1.981，1.715，1.428，1.443，1.419，1.336，1.332，1.254，all P＜0.05）．Multivariate Cox regression analysis showed that age，ALT，nutritional risk，LFI ≥ 4.5，and CTP grade B/C were independent risk factors for liver disease complex adverse events in patients with liver cirrhosis（HR values=2.275，1.746，2.025，1.895，all P＜0.05）．The ROC curve results showed that the AUC of LFI，CTP，and LFI combined with CTP in predicting liver disease composite adverse events in patients with liver cirrhosis were 0.82，0.79，and 0.88，respectively（P＜0.05）．Conclusions  Age，liver frailty，CTP grade B/C，and nutritional  risk are  risk factors for liver disease complex adverse events in patients with liver cirrhosis．The combination of LFI and liver function grade has higher efficacy in predicting liver disease complex adverse events in patients with liver cirrhosis．

       目的  探讨转录因子E盒结合锌指蛋白1（ZEB1）、溶酶体相关膜蛋白5（LAMP5）在结直肠癌组织中的表达水平分析及预后预测价值。方法  选取驻马店市中心医院2018年1月—2020年1月收治的120例结直肠癌患者，分别采取所有患者的结直肠癌组织及癌旁组织进行免疫组化染色，对比ZEB1、LAMP5阳性率。对比不同病理特征结直肠癌患者ZEB1、LAMP5表达水平差异。对所有患者进行4年随访，依照随访结果将患者分为2个亚组，即预后不良组（n=35）和预后良好组（n=85），对比两组患者一般临床特征及ZEB1、LAMP5表达水平，应用Logistic回归分析ZEB1、LAMP5对结直肠癌预后的预测价值。结果 结直肠癌组织ZEB1、LAMP5相对表达量（38.26±5.49、26.77±3.85）与ZEB1、LAMP5阳性率（86.67%、72.22%）高于癌旁组织（15.46±2.54、8.04±1.59、23.33%、15.56%］，对比差异有统计学意义（t=41.280，χ²=25.437；t=49.255，χ ² =16.071；P＜0.05）。不同TNM分期［Ⅰ~Ⅱ期（35.55±4.13）、Ⅲ~Ⅳ期（42.32±4.75）］、淋巴结转移患者［是（44.37±4.28）、否（35.84±3.77）］、肿瘤分化程度［低分化（35.27±4.57）、中高分化（41.34±4.60）］ZEB1相对表达量对比差异有统计学意义（t=-8.281，P＜0.001；t=10.746，P＜0.001；t=-7.253，P＜0.001）；不同TNM分期［Ⅱ期（24.88±3.37）、Ⅲ~Ⅳ期（29.61±2.57）］、淋巴结转移［是（30.72±2.19）、否（25.21±3.19）］、肿瘤分化程度［低分化（24.57±3.62）、中高分化（29.04±2.55）］患者LAMP5相对表达量对比差异有统计学意义（t=-8.254，P＜0.001；t=9.227，P＜0.001；t=-7.797，P＜0.001）；预后良好组与预后不良组患者性别、年龄、大体类型、肿瘤大小对比差异无统计学意义（P＞0.05），预后良好组与预后不良组患者TNM分期、淋巴结转移、肿瘤分化程度、ZEB1、LAMP5阳性比例对比差异有统计学意义（P＜0.05）；Logistic回归分析显示：淋巴结转移、ZEB1阳性、LAMP5阳性为结直肠癌预后不良独立预测因素（P＜0.05）。结论  ZEB1、LAMP5在结直肠癌组织中呈现高表达状态，且与结直肠癌的发生有关，同时ZEB1、LAMP5是结直肠癌预后的独立预测因素，两者有希望成为结直肠癌的治疗靶点。

       Objective  To investigate the expression levels and prognostic value of transcription factor E-box binding to zinc finger protein 1（ZEB1）and lysosomal associated membrane protein 5（LAMP5）in colorectal cancer tissues．Methods  A total of 120 colorectal cancer patients admitted to a hospital from January 2018 to January 2020 were selected．Immunohistochemical staining was performed on the colorectal cancer tissues and adjacent tissues of all patients，and the positivity rates of ZEB1 and LAMP5 were compared．The expression levels of ZEB1 and LAMP5 in colorectal cancer patients with different pathological characteristics were compared．All patients were followed up for 4 years and divided into two subgroups based on the follow-up results，namely the poor prognosis group（n=35）and the good prognosis group（n=85）．The general clinical characteristics and expression levels of ZEB1 and LAMP5 were compared between the two groups．Logistic  regression analysis was used to evaluate the predictive value of ZEB1 and LAMP5 for the prognosis of colorectal cancer．Results The relative expression level of ZEB 1 and LAMP 5 in colorectal cancer tissues ［（38.26±5.49），（26.77±3.85）］ and the positive rate of ZEB 1 and LAMP 5（86.67%，72.22%）were significantly higher than that of adjacent tissues ［（15.46±2.54），（8.04±1.59），23.33%，15.56%］，the contrast  difference was statistically significant（t=41.280，χ²=25.437；t=49.255，χ ² =16.071；P＜0.05）．Relative ZEBI expression levels in different TNM stages ［I-Ⅱstage（35.55±4.13），Ⅲ-Ⅳstage（42.32±4.75）］，lymph node metastasis［Yes（44.37±4.28），No（35.84±3.77）］，degree of tumor differentiation ［hypodifferentiated（35.27±4.57），and middle or high differentiated （29.04±2.55）］，those differences were statistically significant（t=-8.254，P＜0.001；t=9.227，P＜0.001；t=-7.797，P＜0.001）．The relative expression of LAMP 5 between different TNM stages ［I-Ⅱstage（24.88±3.37），Ⅲ-Ⅳstage（29.61±2.57）］，lymph node metastasis ［yes（30.72±2.19），no（25.21±3.19）］，degree of tumor  differentiation ［hypodifferentiated（24.57±3.62），and middle or high differentiated（29.04±2.55）］，the contrast was statistically significant（t=-8.254，P＜0.001；t=9.227，P＜0.001；t=-7.797，P＜0.001）．There were no differences in gender，age，gross type，and tumor size between the good prognosis group and the poor prognosis group（P＞0.05），while there were differences in TNM stages，lymph node metastasis，tumor differentiation degrees，ratio of ZEB 1 and LAMP 5（P＜0.05）．Logistic regression analysis showed that TNM stage，lymph node metastasis，ZEB 1 positive，and LAMP 5 positive were independent predictive factors of poor prognosis in colorectal cancer（P＜0.05）．Conclusions  ZEB1 and LAMP5 are highly expressed in colorectal cancer tissues and closely related to the occurrence and development of colorectal cancer．ZEB1 and LAMP5 are independent prognostic factors for colorectal cancer，and they have the potential to become therapeutic targets for colorectal cancer．