目的 探讨亚实性肺腺癌结节CT征象在预测侵袭风险中的价值。方法 选取经胸部CT检查发现并经病理证实为肺腺癌的亚实性结节共76个病灶,病灶分为侵袭前组与侵袭组2组,分析结节CT征象,行统计学分析,明确亚实性肺腺癌结节侵袭性的预测因素。结果 侵袭前组（包括原位腺癌、微浸润性腺癌）共31例;侵袭组[浸润性腺癌（IAC）]共45例。2组在最大平均直径、结节平均CT值、结节形状、分叶、毛刺、胸膜牵拉征、有无实性成分、肿瘤微血管CT成像征间比较差异有统计学意义（P<0.05）,而在空泡征、空气支气管征方面比较差异无统计学意义（P>0.05）。结节最大直径预测浸润性腺癌侵袭性界值为13.63 mm,敏感度、特异度分别为68.9%、96.8%,AUC为0.885;平均CT值预测IAC侵袭性界值为-528 HU,敏感度、特异度分别为84.4%、83.9%,AUC为0.867。回归分析显示病灶最大平均直径（OR=2.015、P=0.01）可以作为浸润性肺腺癌结节的独立预测因子。结论 亚实性肺腺癌结节侵袭前组和侵袭组在最大直径、平均CT值、形状、分叶、毛刺、微血管征存在差异;结节的最大平均直径是IAC的独立预测因子。

Objective To investigate the value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules．Methods A total of 76 subsolid pulmonary adenocarcinoma nodules detected by chest CT and pathologically confirmed were selected,and the lesions were divided into pre-invasion group and invasion group．CT signs of nodules were analyzed and statistical analysis was performed to determine the predictive factors of invasion of subsolid pulmonary adenocarcinoma nodules．Results There were 31 cases in the pre-invasion group（including adenocarcinoma in situ and minimally invasive adenocarcinoma）and 45 cases ininvasion group[invasive adenocarcinoma（IAC）]．There were significant differences in maximum mean diameter,mean CT value of nodule,nodule shape,lobule,burr,pleural stretch sign,solid component and microvascular CT imaging signs between the two groups（P<0.05）,but there were no significant differences in vacuole sign and air bronchial sign between the two groups（P>0.05）．The maximum diameter of nodules predicted the invasion boundary of invasive adenocarcinoma was 13.63 mm,the sensitivity and specificity were 68.9% and 96.8%,respectively,and the AUC was 0.885．The mean CT value predicted the invasive boundary of IAC was -528 HU,the sensitivity and specificity were 84.4% and 83.9%,respectively,and the AUC was 0.867．Regression analysis showed that the maximum mean lesion diameter（OR=2.015,P=0.01）was an independent predictor of infiltrating lung adenocarcinoma nodules．Conclusions There were differences in the maximum diameter,mean CT value,shape,lobed,burr and microvascular signs between the pre-invasion group and the invasion group．The maximum mean diameter of nodules was an independent predictor of IAC．

目的 探讨子宫瘢痕的超声弹性成像结合厚度分析对剖宫产后再妊娠产妇子宫破裂的预测应用。方法 选择2020年1月—2021年12月在中山市中医院分娩的剖宫产术后再次妊娠经阴道分娩（VBAC）产妇作为研究对象。根据纳入和排除标准,共纳入子宫破裂的VBAC产妇32例、非子宫破裂的VBAC产妇90例。通过住院病历信息系统查询研究对象的基本信息及其在妊娠晚期（≥37周）用B超对研究对象行子宫瘢痕厚度和弹性的测量结果,采用受试者工作特征曲线（ROC）曲线分析子宫瘢痕厚度和弹性SI值对子宫破裂的预测作用。结果 子宫破裂组中年龄>35岁、妊娠>2次、与上次剖宫产间隔<2年、新生儿体质量≥3 kg、单层缝合者的比例高于非子宫破裂组（P<0.05）。122例产妇子宫瘢痕厚度的均值为（3.42±0.49）mm,SI的均值为（2.57±0.45）。ROC曲线分析结果显示：子宫瘢痕厚度单独预测子宫破裂的曲线下面积（AUC）为0.805（95%CI：0.730~0.880,P<0.05）,cut off值为3.05 mm,灵敏度为0.726,特异度为0.910,约登指数为0.636;子宫瘢痕SI单独预测子宫破裂的AUC为0.730（95%CI：0.635~0.824,P<0.05）,cut off值为2.11,灵敏度为0.767,特异度为0.781,约登指数为0.548;子宫瘢痕厚度联合预测子宫破裂的AUC为0.874（95%CI：0.812~0.937,P<0.01）,灵敏度为0.875,特异度为0.811,约登指数为0.686。子宫瘢痕厚度结合子宫瘢痕SI值预测子宫破裂的AUC高于单独使用子宫瘢痕厚度（Z=7.611,P=0.041）和子宫瘢痕SI值（Z=25.864,P=0.025）。结论 子宫瘢痕的超声弹性成像SI值联合子宫厚度可有效提高超声对于VBAC产妇子宫破裂的预测效能,具有一定的应用意义。

Objective To study the application of ultrasound elasticity imaging combined thickness analysis of uterine scar in predicting uterine rupture in women pregnant after cesarean section．Methods Pregnant women with vaginal birth after cesarean（VBAC）from January 2020 to December 2021 in Zhongshan Hospital of Traditional Chinese Medicine were selected as the research subjects．A total of 32 VBAC parturients with uterine rupture and 90 VBAC parturients without uterine rupture were included according to the inclusion and exclusion criteria．The basic information of the subjects was queried through the medical record information system of the hospital．In the third trimester（≥37 weeks）,the thickness and elasticity of uterine scar were measured by ultrasound,and the predictive effect of uterine scar thickness and elastic SI value on uterine rupture was analyzed by ROC curve．Results Chi-square test showed that the incidence of uterine rupture was higher in patients with age>35 years,pregnancy>2 times,interval from last cesarean section<2 years,newborn weight≥3kg,and the proportion of uterine rupture in single suture was higher than that in double suture（P<0.05）．The mean uterine scar thickness of 122 subjects was（3.42±0.49）mm,and the mean SI was（2.57±0.45）．The area under curve（AUC）of uterine scar thickness alone for predicting uterine rupture was 0.805（95%CI：0.730-0.880,P<0.05）,the cut off value was 3.05 mm,the sensitivity was 0.726,the specificity was 0.910,and the Youden coefficient was 0.636 by ROC curve analysis．The AUC of uterine scar SI alone for predicting uterine rupture was 0.730（95%CI：0.635-0.824,P<0.05）,the cut off value was 2.11,the sensitivity was 0.767,the specificity was 0.781,and the Youden coefficient was 0.548 by ROC curve analysis．The AUC of uterine scar thickness combination for predicting uterine rupture was 0.874（95%CI：0.812-0.937,P<0.01）,the sensitivity was 0.875,the specificity was 0.811,and the Youden coefficient was 0.686 by ROC curve analysis．The AUC predicted by uterine scar thickness combined with uterine scar SI value was higher than that predicted by uterine scar thickness alone（Z=7.611,P=0.041）and uterine scar SI value（Z=25.864,P=0.025）．Conclusions Elastic SI value of ultrasound imaging of uterine scar combined with uterine thickness can effectively improve the prediction efficiency of ultrasound for VBAC maternal uterine rupture,which has certain application significance,but further demonstration is still needed．

目的 分析早、中期肝细胞癌（HCC）切除术后早期（≤2年）复发的危险因素并探讨术前系统免疫炎症指数（SII）对早、中期HCC术后早期复发的预测价值。方法 回顾性研究2017年10月—2020年10月于我院接受肝癌根治性切除术的238例早中期HCC患者,收集基线资料,通过1∶1倾向性评分匹配（PSM）均衡组间协变量获取早期复发组及未复发组各69例;单因素和多因素Logistic回归分析影响术后早期HCC复发的相关因素,构建列线图模型,临床决策曲线（DCA）评估列线图预测模型在临床的应用效果;受试者操作特征（ROC）曲线评价预测效能,根据最高约登指数确定截断点。结果 单因素及多因素Logistic回归分析结果均提示微血管侵犯（MVI）及术前系统免疫炎症指数（SII）高水平是术后早期复发的独立危险因素;列线图模型有较好的预测效能;ROC曲线计算出SII最佳临界值为696.85×10⁹／L。结论 术前高水平SII可能对预测HCC患者术后早期复发具有潜在价值。

目的 探究血清神经元特异性烯醇化酶（NSE）、振幅整合脑电图（aEEG）动态变化对早期预测窒息新生儿脑损伤的临床意义。方法 选择2022年3月–2023年3月在我院新生儿重症监护室接受治疗的窒息新生儿作为研究对象。按窒息程度分组：轻度窒息30例为A组,重度窒息30例为B组,无窒息的30例足月儿为C组。记录A、B、C组患儿出生后的血清NSE及aEEG,包括出生后24 h、3 d、7 d的血清NSE,出生后6 h、3 d、7 d的aEEG,了解血清NSE及aEEG变化。结果 B组在出生后24 h、3 d、7 d的血清NSE高于A组、C组,组间比较差异有统计学意义（P<0.05）。出生后6 h、3 d、7 d,aEEG背景活动、睡眠觉醒周期、痫性活动和窒息程度紧密相关。结论 血清NSE、aEEG可作为窒息新生儿脑损伤的监测,对于早期预测脑损伤极具临床应用价值。

目的 分析单核细胞-淋巴细胞比率（MLR）联合游离三碘甲腺原氨酸（FT₃）对乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者生存状况的预测效果。方法 纳入我院在2019年1月—2022年1月期间收治的HBV-ACLF患者共187例进行研究,随访患者90 d的生存状况,其中69例死亡患者设为死亡组,其余118存活患者设为存活组。对2组患者的各项资料进行单因素分析,对差异有统计学意义的因素行Logistic多因素分析,分析HBV-ACLF患者死亡的危险因素,并分析MLR联合FT3对HBV-ACLF死亡的预测效果。结果 死亡组患者的年龄、肝硬化发生率、原发性腹膜炎发生率、肝肾综合征发生率、电解质紊乱发生率、终末期肝病模型、MLR、中性粒细胞与淋巴细胞计数比值、国际标准化比值、肌酐、白细胞计数、总胆红素水平均高于B组,血钠、FT₃、总血清胆固醇水平均低于存活组,差异有统计学意义（P<0.05）。MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）。MLR、FT₃、MLR+FT₃对HBV-ACLF患者死亡均有一定的预测价值,但MLR+FT3的预测价值高于其他单项预测。结论 MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）,且二者联合应用对HBV-ACLF患者死亡有较佳的预测价值。

Objective To analyze the predictive effect of mononuclear-lymphocyte ratio（MLR）combined with free triiodothyronine（FT₃）on the survival of patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）．Methods In the study,187 patients with HBV-ACLF from January 2019 to January 2022 in our hospital were included,and the survival status of the patients was followed up for 90 days．Among them,69 patients were included in the death group and the rest 118 patients were included in the survival group．The data of the two groups of patients were analyzed by univariate analysis,and the statistically significant factors were analyzed by Logistic multifactor analysis．The risk factors of death in patients with HBV-ACLF were analyzed,and the predictive effect of MLR combined with FT₃ on the death of HBV-ACLF was analyzed．Results The age,incidence of cirrhosis,primary peritonitis,hepatorenal syndrome,electrolyte disturbance,ratio of neutrophil to lymphocyte count,international standardized ratio,model for end stage liver disease,MLR,creatinine,white blood cell count and total bilirubin of the patients in the death group were higher than those in survival group,and the levels of serum sodium,FT₃ and total cholesterol were lower than those in survival group,the differences were significant（P<0.05）．The results showed that MLR≥0.60,FT₃≤2.50 pmol/L were risk factors for death of HBV-ACLF patients（P<0.05）．MLR,FT₃,MLR+FT₃ had certain predictive value for the death of HBV-ACLF patients,but the predictive value of MLR+FT₃ was higher than other single prediction．Conclusions MLR≥0.60 and FT₃≤2.50 pmol/L are risk factors for death of patients with HBV-ACLF（P<0.05）,and the combination of the two has a better predictive value for death of patients with HBV-ACLF．

目的 探讨外周血CD34阳性（CD34⁺）细胞计数对普乐沙福自体干细胞动员效果的预测价值。方法 回顾性分析2021年5月—2023年7月中山大学附属第七医院使用人粒细胞集落刺激因子（G-CSF）联合普乐沙福进行自体干细胞动员的13例患者临床资料,分析普乐沙福动员前后外周血CD34⁺细胞计数的变化及干细胞采集情况。结果 共有13例患者纳入研究,包括淋巴瘤10例和多发性骨髓瘤3例。多发性骨髓瘤患者中1例为新诊断,另2例为复发患者;淋巴瘤患者中3例为套细胞淋巴瘤,6例为弥漫大B细胞淋巴瘤（包括1例复发）,1例为B细胞淋巴瘤（不能明确类型）。本研究纳入的患者均使用G-CSF动员,在使用普乐沙福后CD34⁺细胞计数均升高,使用普乐沙福前中位CD34⁺细胞计数为13.3（2.5~76.1）/μL,使用普乐沙福后中位CD34⁺细胞计数为73.6（10.4~208.70）/μL,升高4.18（1.99~13.60）倍。13例患者中有2例患者在使用普乐沙福前外周血CD34⁺细胞计数<5 /μL,均动员失败。Spearman相关分析结果显示,使用普乐沙福后CD34⁺细胞计数与使用普乐沙福前CD34⁺细胞数呈正相关（r_s=0.769,P=0.003）。多元线性回归分析显示,使用普乐沙福后CD34⁺细胞计数能较好地预测采集结果（P=0.004）。结论 监测外周血CD34⁺细胞计数可预测普乐沙福自体干细胞动员效果,使用普乐沙福后CD34⁺细胞计数越多,CD34⁺细胞采集量越大。

Objective To explore the predictive value of peripheral blood CD34⁺ cell count for the stem cell mobilization effect of plerixafor．Methods The clinical data of 13 patients who used granulocyte colony-stimulating factor + plerixafor for stem cell mobilization in the Seventh Affiliated Hospital of Sun Yat-sen University from May 2021 to July 2023 were retrospectively analyzed．The changes of peripheral blood CD34⁺ cell count in all patients before and after the mobilization of plerixafor were analyzed．Results In 13 enrolled patients,there were 10 lymphoma patients and 3 multiple myeloma（MM）patients．One patient was newly diagnosed with MM,and the other two were recurrent patients．The lymphoma cases included 3 mantle cell lymphoma,6 diffuse large B cell lymphoma and 1 B cell non-Hodgkin's lymphoma（type cannot be specified）．The CD34⁺ cell counts were increased in all patients when mobilized with granulocyte colony-stimulating factor before plerixafor．The CD34⁺ cell count was 13.3（2.5~76.1）/μL and 73.6（10.4~208.70）/μL before and after the use of plerixafor,between which the difference was statistically significant（Z=0.578,P<0.05）,and the median increased of 4.18（1.99~13.6）times．There were 2 patients failed in mobilizing whose CD34⁺ cell count was less than 5 /μL before using plerixafor．Spearman analysis showed that there was a positive correlation in peripheral blood CD34⁺ cell count before and after the use of plerixafor（r_s=0.80,P=0.032）．The CD34⁺ cell count after using plerixafor was a good predictor of the collection results（P=0.002）．Conclusions Monitoring the CD34⁺ cell count in peripheral blood has a certain predictive value for the stem cell mobilization effect of plerixafor．The higher of CD34⁺ cell count after the use of plerixafor,the higher of CD34⁺ collection．

目的 探讨CT混合征和岛征及其联合征象对脑出血早期血肿扩大的临床预测价值。方法 将2018年12月—2020年12月河南宏力医院收治的脑出血患者86例作为研究对象,按照有无血肿扩大分为早期血肿扩大组(38例)和血肿未扩大组(48例)。分析CT平扫的岛征、混合征及联合征象对早期血肿扩大的影响,使用ROC曲线及曲线下面积(area under the curve,AUC)比较混合征、岛征及联合征对脑出血后血肿扩大的诊断效能。结果 混合征、岛征、联合征象诊断血肿扩大的灵敏度分别为65.79%、50.00%、84.21%,特异度分别为72.92%、83.33%、93.75%,阳性预测值分别为65.79%、70.37%、91.43%,阴性预测值分别为72.92%、67.80%、88.24%。不同影像学征象诊断血肿扩大的灵敏度、特异度、阳性预测值和阴性预测值差异均具有统计学意义(P<0.05)。ROC曲线分析中,混合征、岛征、联合征象诊断血肿扩大的AUC分别为0.690、0.656和0.811,P均小于0.05,其中联合征象的AUC最大。结论 CT征象中的混合征和岛征分别对脑出血早期血肿扩大的患者进行有效的预测,但相较于单独征象而言,二者的联合征象的诊断效能更高,对患者早期是否出现血肿扩大的现象诊断效能更具有科学性、高效性,为临床后期的治疗提供指导意义,同时也对患者疾病的恢复及预后起到积极作用。

目的 探讨老年吸入性肺炎的危险因素,建立风险预测模型,以期降低老年吸入性肺炎的发病率。方法 选取2017年8月28日—2020年 10月30日广州市第一人民医院老年病科住院治疗的老年肺炎患者205例,按照是否发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,对比2组患者的各项指标,分析老年吸入性肺炎的危险因素,建立风险预测模型,采用ROC曲线对模型进行预测效果检验。结果 多因素Logistic回归分析结果显示,脑梗塞、帕金森、留置胃管、长期卧床为老年吸入性肺炎的危险因素(P<0.05)。模型公式为Logit(P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀。该模型ROC曲线下面积为0.894。结论 本研究中的模型预测效果良好,可为医护人员预测老年患者发生吸入性肺炎的概率,及时采取相应的预见性护理及干预性治疗。

Objective To explore the risk factors of aspiration pneumonia in the elderly and establish the risk prediction model, in order to reduce the incidence of aspiration pneumonia in the elderly. Methods A total of 205 elderly patients with pneumonia who were hospitalized in the department of geriatrics, Guangzhou First People's Hospital from August 28, 2017 to October 30, 2020, were divided into aspiration pneumonia group and non-aspiration pneumonia group according to whether aspiration pneumonia occurred. The indicators of the two groups of patients were compared, the risk factors of aspiration pneumonia in the elderly were analyzed, the risk prediction model was established, and the prediction effect of the model was tested by receiver operating characteristic curve. Results Multivariate Logistic regression analysis showed that cerebral infarction, Parkinson's disease, indwelling nasogastric tube, and being bedridden were risk factors for aspiration pneumonia in elderly patients (P<0.05). The model formula was Logit (P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀. The area under receiver operating characteristic curve of this model was 0.894. Conclusion The prediction effect of the model in this study was good, which could predict the probability of aspiration pneumonia in elderly patients for medical staff, and to timely take the corresponding predictive care and interventional treatment.

目的 探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ²检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果 单因素分析,术前超声指标:胆囊大小>50 cm²、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论 手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。

Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ² test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm², gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.

目的 探究血清降钙素原(PCT)联合阴离子隙(AG)检测在脓毒症患者预后中预测价值。方法 选取2019年1月—2021年1月于我院治疗117例毒症患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(78例)和死亡组(39例),对比2组患者一般资料,采用多因素分析其高危因素,应用ROC曲线确定曲线下面积,评估血清PCT联合AG检测对该类患者预后的预测价值。结果 2组患者一般资料对比,年龄、中性粒细胞计数、血清C反应蛋白(CRP)、PCT、AG、APACHEⅡ评分差异有统计学意义(P<0.05);年龄、CRP、PCT、AG水平是该类死亡的危险因素;ROC曲线分析结果显示,血清PCT曲线下面积为0.737,最佳截断值为9.595;AG曲线下面积为0.791,最佳截断值为21.695;血清PCT联合AG检测曲线下面积为0.933,最佳截断值为1.3442。结论 血清PCT联合AG检测对脓毒症患者预后具有较高的预测价值。

Objective To investigate the predictive value of serum procalcitonin (PCT) combined with anion gap (AG) detection on the prognosis of patients with sepsis. Methods One hundred and seventeen patients with sepsis treated in our hospital from January 2019 to January 2021 were selected as study subjects and divided into survival group (78 patients) and death group (39 patients) according to their prognosis at 28 d of admission. The general data of the two groups was compared, multi-factor Logistic analysis of high-risk factors of sepsis patients was performed, area under the ROC curve was applied to assess the predictive value of serum PCT combined AG detection on the prognosis of sepsis patients. Results After comparing the general data of the two groups, the differences in age, neutrophil count, C-reactive protein (CRP), PCT, AG and APACHE II scores were statistically significant (P<0.05); multi-factor Logistic regression analysis showed that age, CRP, PCT and AG levels were risk factors for death in sepsis patients; the results of ROC curve analysis showed that the area under the curve of serum PCT was 0.737, with an optimal cut-off value of 9.595; the area under the AG curve was 0.791, with an optimal cut-off value of 21.695;the area under the curve of serum PCT combined with AG was 0.933, and the optimal cut-off value was 1.3442. Conclusions Serum PCT combined with AG assay had a high predictive value for the prognosis of patients with sepsis.