脓毒症当前仍然是全球范围内重要的医疗卫生问题,其对世界公共卫生及患者安全带来重大威胁。脓毒症是指宿主对感染反应失调引起的危及生命的器官功能障碍, 其发病率和病死率均极高,是临床重症医学中的重大挑战。在脓毒症病情的进展过程中, 可出现组织灌注不足、血流动力学不稳定等变化, 从而导致多器官功能受损,而心脏是常见的被累及的重要靶器官之一, 这种由脓毒症所导致的不同程度的心肌损伤, 被称为“脓毒性心肌病”, 其发生和发展机制复杂多样, 涉及循环心肌抑制因素、心肌自身因素及自主神经失调等多个方面。文章综述了脓毒症患者发生心肌损伤的高危因素, 以期为临床治疗和预防提供参考。

Sepsis currently remains an important global healthcare issue, and a major threat to world public health and patient safety．Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection, with extremely high morbidity and mortality,which is a major challenge in clinical critical care medicine．During the progression of sepsis, changes such as inadequate tissue perfusion and haemodynamic instability may occur, leading to impairment of multiple organ functions, while the heart is one of the commonly involved vital target organs, and the varying degree of myocardial damage caused by sepsis is known as “septic cardiomyopathy”．The mechanisms of its occurrence and development are complex and diverse, involving circulating myocardial inhibitory factors, myocardial auto-factors, and autonomic dysregulation．In this paper, we review the high-risk factors for myocardial injury in septic patients, providing a reference for clinical treatment and prevention.

目的 探究数字乳腺三维断层融合摄影技术(DBT)联合MR波谱在乳腺高危病灶诊断中的应用。方法 选取2020年6月—2021年6月来我院进行乳腺钼靶X线摄影并诊断为BI-RADS 4级及以上的100例乳腺高危病灶患者为研究对象,对入选患者行MR波谱及DBT检查,分析MR波谱征象及DBT乳腺病变摄影特征,以病理结果为标准,评价MR波谱与DBT及两者联用对乳腺高危病灶的诊断疗效。结果 DBT敏感度、特异度、阳性预测值、阴性预测值均高于MR波谱;DBT漏诊率、误诊率均低于MR波谱漏诊率、误诊率,2组诊断方法比较(P<0.05)。MR波谱及DBT对≥2 cm恶性病变的病理诊断结果符合率比较,差异均无统计学意义(P＞0.05)。MR波谱及DBT对乳腺良性病变、恶性病变＜2 cm诊断结果符合率比较,DBT对乳腺高危患者的病理诊断结果符合率高于MR波谱(P＜0.05)。结论 乳腺高危病灶诊断中选择DBT可对乳腺高危病灶诊断中做出准确的分析和判断,对乳腺高危病灶诊断更具有应用价值,值得临床采纳。

Objective To explore the application of digital breast tomosynthesis (DBT) combined with MR wave in the diagnosis of high-risk breast lesions. Methods A total of 100 patients with breast high-risk lesions diagnosed as BI-RADS 4 or above by mammography in our hospital from June 2020 to June 2021 were selected as the research objects. The selected patients were examined by MR spectrum and DBT. The signs of MR spectrum and the photographic characteristics of DBT breast lesions were analyzed. Based on the pathological results, the diagnostic efficacy of MR spectrum, DBT and their combination in the diagnosis of breast high-risk lesions was evaluated. Results The sensitivity, specificity, positive predictive value and negative predictive value of DBT were higher than those of MR spectrum; the missed diagnosis rate and misdiagnosis rate of DBT were lower than those of MR spectrum (P<0.05). There was no significant difference in the coincidence rate of MR spectrum and DBT in the pathological diagnosis of malignant lesions ≥ 2 cm (P>0.05). The coincidence rate of MR spectrum and DBT in the diagnosis of benign and malignant breast lesions<2 cm was higher than that of MR spectrum (P<0.05). Conclusions Selecting DBT in the diagnosis of breast high-risk lesions can make accurate analysis and judgment in the diagnosis of breast high-risk lesions. It has higher application value in the diagnosis of breast high-risk lesions and is worthy of clinical adoption.

目的 观察达雷妥尤单抗联合来那度胺及地塞米松(DRd)方案巩固治疗序贯达雷妥尤单抗和来那度胺两药维持治疗1例高龄高危初治多发性骨髓瘤患者的疗效、生存时间和不良反应。方法 回顾分析广州市第一人民医院老年病科血液肿瘤科2019年3月收治的1例高龄高危初治多发性骨髓瘤患者的临床资料,并复习相关最新文献。结果 患者应用伊沙佐米、来那度胺和地塞米松方案诱导治疗13疗程后只达到部分缓解的疗效,未能进一步缓解,且不良反应多且严重,后改为DRd方案巩固治疗2疗程后,达到完全缓解,继续使用达雷妥尤单抗联合来那度胺两药维持治疗,不良反应少,至随访结束总生存期和无进展生存期均为35个月。结论 含达雷妥尤单抗方案巩固和维持治疗可能会改善高龄高危初治多发性骨髓瘤患者的预后,延长生存时间,耐受性好。

Objective To observe the efficacy, survival time and adverse reactions of daratumumab combined with lenalidomide and dexamethasone (DRd) in the consolidation treatment of sequential daratumumab and lenalidomide maintenance treatment of an elderly patient with high-risk newly diagnosed multiple myeloma. Methods The clinical data of the elderly patient with newly diagnosed multiple myeloma treated in the Department of Geriatrics, Hematology & Oncology Ward, Guangzhou First People's Hospital in March 2019 were retrospectively analyzed, and the relevant latest literatures were reviewed. Results After 13 courses of induction treatment with isazomib, lenalidomide and dexamethasone, it only achieved partial remission, but failed to further remission, and there were many serious adverse reactions.Later, it was changed to DRd therapy to consolidate treatment.After 2 courses of treatment, it achieved complete remission.After that, we continued to use daratumumab combined with lenalidomide for maintenance treatment, with few adverse reactions.At the time of submission, the overall survival and progression free survival were 35 months. Conclusions Consolidation and maintenance therapy with daratumumab may improve the prognosis, prolong survival time and with good tolerance in elderly patients with high-risk newly diagnosed multiple myeloma.

目的 统计分析Ⅲ型食管闭锁与食管气管瘘(esophageal atresia and tracheoesophageal fistula,EA-TEF)术后气管食管瘘复发(recurrent tracheoesophageal fistula,RTEF)的高危因素,并计算高危因素预测RTEF的能力。方法 回顾分析2015年9月—2021年1 月我院EA-TEF患儿的临床资料,并根据术后是否气管食管瘘复发分成复发组(recurrent组,R组)及无复发组(not recurrent组,NR组),比较两组患儿的基本情况、开放手术或胸腔镜手术、手术时间、气管食管瘘结扎方式等术中情况,统计分析RTEF的高危因素,分析其预测RTEF的能力。结果 研究期间共纳入Ⅲ型食管闭锁患儿154例,男98例,女56 例,R组11例,NR组143例,单因素对比分析R组与NR组患儿除吻合口瘘外其余均无统计学差异,其中R组吻合口瘘6人,占该组54.55%;NR组13人,占该组9.10%,P<0.001;Logistic回归模型调整后可见有吻合口瘘相对于无吻合口瘘发生RTEF的风险增加12倍(OR=12.000,95%CI:3.216~44.771)。结论 RTEF与患儿基本情况、术中情况无关,与吻合口瘘显著相关,且有吻合口瘘的患儿出现RTEF风险是无吻合口瘘患儿的12倍。

Objective To statistical analyze the high-risk factors of recurrent tracheoesophageal fistula (RTEF) after the repair of type Ⅲ esophageal atresia and tracheoesophageal fistula (EA-TEF),and evaluate the ability of these high-risk factors predicting RTEF. Methods Retrospectively analyzed the clinical data of children with type Ⅲ EA-TEF in our hospital from September 2015 to January 2021. Patients were divided into two groups (recurrent and non-recurrent group,R and NR group) according to whether there was RTEF. The general situation of those patients, situation during surgery like open or thoracoscopic surgery,operation time,method of tracheoesophageal fistula ligation were compared. Those factors of two groups were analyzed, the high-risk factors of RTEF were summarized, and Logistic regression analysis on the high-risk factors was performed to analyze the ability of predicting RTEF. Results A total of 154 infants with type Ⅲ EA-TEF were included in the study, 98 males, 56 females. There were 11 cases in R group, 143 cases in NR group. Univariate comparative analysis was carried out on R group and NR group, and no statistical differences were found except in anastomotic fistula. There were 6 patients in R group with anastomotic fistula, accounting for 54.55%, and 13 patients in NR group, accounting for 9.10%,P< 0.001. After adjusting the Logistic regression model with the high-risk factors, there was 12-fold increase in the risk of RTEF with anastomotic fistula (OR=12.000, 95%CI: 3.216~44.771) compared with no anastomotic fistula. Conclusion RTEF was not related to patients' general situation or surgery situation, but significantly related to anastomotic fistula. Patients who with anastomotic fistula had a 12-fold increase in the risk of RTEF compared with no anastomotic fistula.

目的 分析阴道灌洗液中炎性因子表达水平与高危型人乳头瘤病毒(HPV)持续感染的相关性。方法 选择本院2019年3月—2021年3月接诊的80例高危型HPV持续感染患者作为试验组,以病理组织检查结果分组,将19例宫颈癌患者作为试验组1、将30例宫颈上皮不典型增生(CIN)I级患者作为试验组2,将31例CIN II、III级患者作为试验组3,选取同期门诊体检的30例健康女性作为对照组,均进行TGF-β、IFN-γ、IL-17、IL-6表达水平检测,比较4组TGF-β、IFN-γ、IL-17、IL-6水平、高危型HPV负荷量,Pearson分析TGF-β、IFN-γ、IL-17、IL-6水平与高危型HPV负荷量的相关性。结果 阴道灌洗液炎症因子水平、高危型HPV负荷量4组相比较,差异均有统计学意义(P<0.05)。TGF-β、IL-17、IL-6水平与高危型HPV负荷量呈正相关性,与IFN-γ水平呈负相关性,P＜0.05。结论 高危型HPV持续感染患者机体阴道灌洗液中炎性因子水平与高危型HPV负荷量存在一定的相关性,高危型HPV负荷量与IFN-γ水平呈负相关性,与TGF-β、IL-17、IL-6水平呈正相关性,通过检测阴道灌洗液中炎性因子水平,可评估HPV感染程度。

Objective To analyze the correlation between the expressions of inflammatory factors in vaginal lavage fluid and persistent infection of high-risk human papillomavirus(HR-HPV). Methods A total of 80 patients with HR-HPV persistent infection in our hospital from March 2019 to March 2021 were selected as the experimental group. According to the pathological examination results, 19 patients with cervical cancer were selected as the experimental group 1, 30 patients with CIN grade I were selected as the experimental group 2, and 31 patients with CIN grade II and III were selected as the experimental group 3. Thirty healthy women in the same period were selected as the control group. HR-HPV load, TGF- β, IFN-γ, IL-17 and IL-6 levels were detected and were compared among the four groups. Pearson analysis of correlation between TGF- β, IFN-γ, IL-17, IL-6 levels and HR-HPV load was carried out. Results There were significant differences in the levels of inflammatory factors in vaginal lavage fluid and HR-HPV load among the four groups (P<0.05). TGF- β、IL-17 and IL-6 levels were positively correlated with HR-HPV load and negatively correlated with IFN-γ (P<0.05). Conclusions There is a certain correlation between inflammatory factors in vaginal lavage fluid and HR-HPV load in patients with HR-HPV persistent infection. HR-HPV load is negatively correlated with IFN-γ, and positively correlated with TGF-β, IL-17 and IL-6. The degree of HPV infection could be evaluated by detecting the inflammatory factors in vaginal lavage fluid.

目的 了解广东肇庆怀集县农村妇女两年来“两癌”检测的阳性情况及高危型人乳头瘤病毒(HPV)的感染特点。 方法 对2018年1月—2019年12月24 146名参与“两癌”免费检测的35~64 岁、农村妇女的宫颈癌筛查结果进行分析。以高危型HPV检测作为初筛方法,结果为HPV16、18型阳性的转诊阴道镜检查,其它高危型HPV阳性则进行薄层宫颈液基细胞学检查(TCT),TCT结果严重于或等于未明确意义的非典型鳞状上皮(ASC-US)者转诊阴道镜,阴道镜结果可疑或异常者进行组织病理学检查。 结果 高危型HPV总检出率为9.35%,单独HPV16、18和其它高危型HPV的阳性检出率分别为0.70%、0.32%、7.72%,混合感染检出率为0.61%,高危型 HPV 总检出率最高的年龄段是 60~64岁,检出率为11.22%。细胞学转诊率为65.63%,阴道镜转诊率为61.23%。宫颈癌前病变检出率为323.03/10 万,宫颈癌的检出率为45.56/10 万,早期诊断率为87.64%。宫颈癌前病变和宫颈癌的HPV16、18及混合感染占70.79%。 结论 该地区高危型HPV阳性率、宫颈癌前病变及宫颈癌检出率均较高,宫颈癌筛查异常者细胞学及阴道镜转诊率较低,提示该地区存在更高的宫颈癌发病风险。

Objective To understand the positive screening results and the infection characteristics of high-risk human papillomavirus (HPV) in Huaiji County,Guangdong Province,in the two years of the free standardization testing for rural women's “two cancers”. Methods The cervical cancer screening results of 35~64 year-old women with rural household registration who volunteered to participate in the “two cancers” free testing for rural women in the region were analyzed. High-risk HPV testing was used as the primary screening method for cervical cancer. The results of HPV16 and 18 positive patients were directly referred to colposcopy. If other high-risk HPV was positive,thin-layer cervical fluid-based cytology(TCT) was perform on those patients,whose TCT result severer than atypical squamous cells of undetermined significance (ASC-US) were referred to colposcopy,and those with suspicious or abnormal colposcopy results were referred to histopathological examination. Results The total positive detection rate of high-risk HPV was 9.35%. The positive rates of HPV16,18 and other high-risk HPV were 0.70%,0.32% and 7.72% respectively,mixed infection rate was 0.61%. The age group with the highest overall positive rate of high-risk HPV is 60-64 years old,and the rate is 11.22%. The referral rate for cytology was 65.63%,and the referral rate for colposcopy was 61.23%. The positive rate of cervical precancerous lesions was 323.03/100 000,the positive rate of cervical cancer was 45.5/100 000,and the early diagnosis rate was 87.64%.HPV16,18 and HPV mixed infections of cervical precancerous lesions and cervical cancer accounted for 70.79%.Conclusions The positive rate of high-risk HPV,cervical precancerous lesions and cervical cancer positive rate were high in this area. The being referred rate of cytology and colposcopy in cervical cancer screening was low,suggesting that there was a higher incidence of cervical cancer in this area risk.

目的 探讨I¹³¹联合促甲状腺激素(TSH)抑制治疗对术后中高危组甲状腺乳头状癌(PTC)患者心肌纤维化及心房颤动(AF)的影响。方法 选取2016年8月—2017年8月南华大学附属第一医院收治的因PTC行甲状腺双侧腺叶全切术或近全切除术患者69例,根据复发危险度分层分为中危组(49例)和高危组(20例), 两组患者均行I¹³¹ 联合TSH抑制治疗,治疗后嘱患者3个月进行1次复诊或自觉不适及时复诊,观察患者心血管系统症状、心房颤动及心肌纤维化发生情况,患者治疗前后可溶性基质溶素-2(sST2)、生长分化因子-15(GDF-15)、半乳糖凝集素-3 (GAL-3)及血清乳酸脱氢酶(LDHA)含量变化。结果 I¹³¹联合TSH抑制治疗后患者心房颤动发生率和心肌纤维化相关指标水平明显高于治疗前,且高危组患者治疗后心房颤动发生率和心肌纤维化相关指标水平高于中危组,差异均有统计学意义(P<0.05)。结论 I¹³¹联合TSH抑制治疗会增加PTC患者心肌纤维化和心房颤动的发生概率,且高危组PTC患者心肌纤维化和房颤的发生率高于中危组。

Objective To investigate the impact of I¹³¹ combined with thyroid-stimulating hormone(TSH) for suppressive treatment on myocardial fibrosis(MF) and atrial fibrillation(AF) in patients with papillary thyroid (PTC). Methods 69 patients with PTC undergoing total or subtotal thyroidectomy admitted into First Affiliated Hospital of University of South China from Aug. 2016 to Aug. 2017 were selected and divided into middle-risk group (49 cases) and high-risk group (20 cases) according to the recurrence risk stratification. Two groups of patients were given I¹³¹ combined with thyroid-stimulating hormone for suppressive treatment. The patients were instructed to undergo a follow-up visit every 3 months after treatment or whenever felt unwell. The incidences of cardiovascular system symptoms, atrial fibrillation and myocardial fibrosis, changes of contents of serum soluble ST2 (sST2), growth differentiation factor-15 (GDF-15), galectin-3 (GAL-3) and lactate dehydrogenase A (LDHA) were observed. Results After I¹³¹ combined with thyroid-stimulating hormone suppressive treatment, the incidences of atrial fibrillation and myocardial fibrosis after treatment were higher than that before treatment, and the incidences of atrial fibrillation and myocardial fibrosis of high-risk group were higher than those of the middle-risk group, with statistically significant differences (P＜0.05). Conclusion Combined use of I¹³¹ and thyroid-stimulating hormone for suppressive treatment can increase the incidences of atrial fibrillation and ventricular remodeling of patients with PTC, and the incidences of high-risk group were higher than those of the middle-risk group.

目的 通过对广东地区流行季节的发热新生儿肠道病毒感染临床特点及高危因素探讨,对高危患儿采取有效防治措施。方法 以2019年5月—10月广东省妇幼保健院门诊因发热收治入院的诊断为肠道病毒感染28例新生儿为研究对象,回顾性分析这些患儿的临床资料,分析新生儿肠道病毒感染的高危因素。结果 因发热收治入院的新生儿检测后肠道病毒感染发病率达38.3%,热峰高于38.5℃,发热持续时间大于3 d、细菌培养阴性是新生儿肠道病毒感染的高危因素。结论 在肠道病毒流行季节,对发热新生儿均应常规进行肠道病毒检测,肠道病毒感染患儿,经过有效的治疗后,能够取得较好的治疗效果,但需及时控制病毒的传播途径,针对相关危险因素进行有效的控制,从而降低发病率。

目的 探讨<34周早产儿发生晚发型败血症的危险因素及其病原分布,为防控及治疗用药提供依据。方法 选择2015年1月—2017年12月本院收治的<34周早产儿,根据是否发生晚发型败血症分为感染组及对照组,回顾性分析两组临床资料,对其可能的危险因素采用多因素Logistic回归分析。分析感染组患儿所感染的病原菌及其药敏情况。结果 感染组27例,对照组73例,单因素分析显示感染组患儿出生体重低于对照组,出生窒息、机械通气、使用H₂受体阻滞剂、多种抗生素使用、经外周中心静脉置管（PICC）及PICC留置≥14天比例均高于对照组,差异有统计学意义（P<0.05）。多因素logistic回归分析显示出生体质量、PICC留置是<34周早产儿发生晚发型败血症的独立危险因素。感染组中血培养阳性20例,真菌培养阳性11例（55.0%）,G⁺菌5例（25.0%）,G^-菌4例（20.0%）。药敏结果中两性霉素B和氟康唑敏感性高。结论 早期早产儿发生晚发型败血症受多重因素影响,真菌已成为主要致病菌,应针对高危因素加强感染防控,根据血培养及药敏结果合理使用抗菌药物。

目的 观察腹横肌平面阻滞复合七氟醚诱导喉罩全身麻醉在高危产妇剖宫产手术中的应用效果。方法 在2016年12月-2017年12月间,选取我院收治的80例高危产妇作为观察对象,均择期行剖宫产手术,依照随机数字表法分为观察组、对照组,每组产妇各40例。剖宫产手术的麻醉方式为,观察组采取双侧腹横肌平面阻滞后,七氟醚吸入诱导插入喉罩,对照组采取腰硬联合麻醉。观察比较两组的生命体征、手术持续时间、麻醉并发症发生率、新生儿Apgar 评分。结果 ①观察组T1~T3时段的平均动脉压、心率均低于对照组,（P<0.05）,有统计学意义。②观察组手术持续时间、麻醉并发症发生率、新生儿Apgar 评分与对照组比较,无差异,（P>0.05）。结论 腹横肌平面阻滞复合七氟醚诱导喉罩全身麻醉在高危产妇剖宫产手术中的应用效果较好,对产妇和胎儿影响小,麻醉平稳、苏醒快,麻醉风险低,值得应用。