目的 评估AMA-M2、SP100和GP210三种自身抗体在诊断原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)中的应用价值。方法 收集我院近3年就诊患者的AMA-M2、SP100、GP210、ALP和GGT检测数据,其中PBC患者50例,非PBC肝胆疾病或自身免疫病患者226例,正常对照290例。分析这些检测指标对PBC诊断的敏感度和特异度。结果 AMA-M2、SP100和GP210诊断原发性胆汁性肝硬化的敏感度分别为96.00%、36.00%、8.00%,特异度分别为98.26%、97.87%、99.03%。PBC组病人的ALP和GGT检测结果高于非PBC病人组。结论 AMA-M2、SP100和GP210对PBC的临床诊断特异度较高;AMA-M2的敏感度高,但SP100和GP210敏感度低。

Objective To evaluate the diagnostic accuracy of AMA-M2, SP100 and GP210 for the primary biliary cirrhosis (PBC).Methods A total of 50 patients with PBC and 226 patients with other liver diseases or autoimmune diseases were enrolled in this study and 290 healthy individuals were included as normal controls. The data of AMA-M2, SP100, GP210, ALP and GGT were collected and analyzed for sensitivity and specificity in the diagnosis of PBC.Results The sensitivity and specificity of AMA-M2, SP100 and GP210 in the diagnosis of PBC were 96.00%, 36.00%, 8.00% and 98.26%, 97.87%, 99.03%, respectively. Compared to PBC group, the concentrations of ALP and GGT in non-PBC patients and controls were low.Conclusion AMA-M2 is quite accurate with high specificity and sensitivity in the diagnosis of PBC. However, SP100 and GP210 have high sensitivity but low sensitivity.

目的 探讨HHIP基因单核苷酸多态性与新疆蒙古族慢性阻塞性肺疾病易感性之间的关系。方法 以259例蒙古族吸烟慢性阻塞性肺疾病患者为病例组,245例蒙古族吸烟健康体检者为对照组,提取外周血标本 DNA,运用Taqman分型技术检测HHIP基因rs13118928、rs13141461位点多态性。结果 HHIP基因rs13118928、rs13141461位点基因型与等位基因在病例组和对照组之间的频率分布,结果显示差异有统计学意义(P<0.05)。rs13118928位点基因型AG、GG,等位基因G在病例组与对照组分布差异有统计学意义(P<0.001),且OR<1,可能降低发生COPD的风险。rs13141461位点基因型TC在病例组与对照组分布差异无统计学意义(P>0.05),rs13141461位点基因型CC, 等位基因C在病例组与对照组分布差异有统计学意义(P<0.05),且OR>1,可能增加发生慢阻肺的风险。rs13118928、rs13141461位点基因型与肺功能 FEV1%预计值比较差异有统计学意义(P<0.05)。结论 HHIP基rs13118928、rs13141461位点多态性可能与新疆蒙古族人群慢阻肺的发生有关。

Objective To explore the relationship between HHIP gene single nucleotide polymorphism and the susceptibility of Mongolian chronic obstructive pulmonary disease.Methods DNAs were extracted from the peripheral blood of 259 patients with COPD (case group) and 245 healthy controls (control group) from Xinjiang Mongolian population. Polymorphisms of HHIP rs13118928 and rs13141461 were determined by the Taqman PCR method.Results The frequency of HHIP rs13118928 and rs13141461 genotypes and alleles in the case group and the control group showed significant difference (P<0.05). HHIP rs13118928 genotype, AG, GG and allele G were significantly different between case group and control group (P<0.001), and OR<1. It could reduce the risk of COPD. There was no significant difference in HHIP rs13141461 genotype TC between the case group and the control group (P>0.05). HHIP rs13141461 genotype CC and allele C were significantly different between the case group and the control group (P<0.05), and OR>1. It may increase the risk of COPD. The difference of HHIP rs13118928, rs13141461 and FEV1% predicted value was statistically significant(P<0.05).Conclusion The polymorphism of HHIP rs13118928 and rs13141461 may be related to the occurrence of COPD in Xinjiang Mongolian population.

目的 了解住院老老年心房颤动(atrial fibrillation,AF)患者的临床特征及抗凝现况。方法 收集2015年6月—2017年9月住院老老年(≥80岁)房颤患者的抗凝用药,合并疾病,合并用药等临床信息,统计并分析,非正态分布的计量资料以中位数表示,采用秩和检验,两组计数资料采用χ²检验。结果 621例老老年患者根据性别分为男女两组,男354人,女267人,159例患者(25.6%)使用华法林,33例患者(5.31%)使用达比加群,30例患者(4.83%)使用利伐沙班,抗凝总人数为222例(35.75%)。174例患者(28.02%)使用阿司匹林,27例患者(4.35%)使用氯吡格雷,抗血小板总人数为201例(32.37%)。余198例患者(31.89%)未使用任何抗血小板或抗凝药物。结论 老老年房颤患者目前抗凝率低,抗凝药物以华法林为主。

Objective This study investigated the clinical characteristics and antithrombotic status in elderly patients with atrial fibrillation AF. Methods In this study, we collected, analyzed and characterized the data of the patients hospitalized at the First Affiliated Hospital of Shihezi Medical University from June 2015 to September 2017. Results 621 cases of elderly patients were divided into two groups according to their gender between men and women, 159 patients (25.6%) take warfarin, 33 patients (5.31%) with dabigatran, 30 patients (4.83%) uses of rivaroxaban, the total number of anticoagulation is 222 (35.75%),174 patients (28.02%) were treated with aspirin, and 27 patients (4.35%) used clopidogrel, and the total number of antiplatelet agents was 201 (32.37%). 198 patients (31.89%) did not use any antiplatelet or anticoagulant drugs. Conclusion patients with atrial fibrillation anticoagulant rate is low, and the anticoagulant is mainly warfarin.

目的 通过回顾分析某三级医院神经外科近5年发生的意外跌倒事件,以指导改进护理防范策略。方法 对2012年3月—2017年6月期间某三级医院神经外科发生的21例住院期间意外跌倒事件进行数据采集、对照研究及回顾分析。结果 61.9%事件发生于00:00~07:59时间段,71.4%无陪人在旁,85.71%年龄大于等于60岁。与非跌倒组相比,跌倒组患者有更多例数的肢体乏力(P=0.005),依从性差的比例更高(P＜0.001),特殊药物应用及跌倒史未见统计差异。结论 应重视跌倒事件多发时间段,加强对无陪人、年龄大、肢体乏力、依从性差患者的护理,优化跌倒风险评估体系及预防措施。

目的 分析广州市区2014—2016年无偿献血血液报废情况,探讨降低血液报废措施,减少血液报废。方法 收集并统计广州市区2014—2016年血液报废情况,分别统计报废血液比例。结果 2014—2016年报废血液产品共170 576 U,报废率为5.99%;非检验原因报废率(3.11%)高于检验原因报废率(2.88%),检验原因报废率呈逐年下降趋势,其中ALT及HBsAg报废率较高,非检验原因报废率呈逐年上升,其中乳糜血报废率较高。结论 进一步加强献血宣传和征询工作,以及做好团队献血的快速筛查工作,提高工作人员的操作水平,均有利于进一步降低血液报废率。

Objective To analysis blood products and disposal situation in Guangzhou from 2014-2016 to provide measures for reduce the scrap rate. Methods Collecting and statistical analysis of blood products scrap rate from 2014-2016 in Guangzhou respectively. Results A total of 170 576U blood products were scrapped in 2014-2016 and the scrap rate was 5.99%, in which non-detection scrap rate (3.11%) was higher than detection scrap rate (2.88%). Non-detection scrap rate was decreasing these years, among which ALT and HBsAg had a large proportion, while detection scrap rate was increasing, in which chylaemia scrap rate was the most highest. Conclusion We need to strengthen and publicize blood donation, as well as do well rapid screening of team blood donation and improve the operating level of staff.

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.

目的 探讨CD117在肺基底样细胞鳞状细胞癌(BSCC)与小细胞肺癌(SCLC)中的鉴别诊断作用。方法 免疫组织化学检测CD117在肺BSCC与SCLC中的表达情况,并进行统计学分析,同时文献复习CD117在这两种肿瘤中的表达情况。结果 CD117在SCLC中特异性高表达(阳性率为78%),并且具有高的敏感度、特异度、阳性预测值及阴性预测值(分别为100%、78.2%、68.7%、100%),与文献报道一致(阳性率37%～100%);而在BSCC中未见有CD117的表达,文献未见有CD117在BSCC中表达情况报道。结论 CD117有可能成为鉴别诊断BSCC与SCLC的重要指标之一。但由于本报道例数有限,还需要更大型的研究进一步证明CD117在鉴别诊断二者中的敏感度及特异度。

Objective To investigate the role of CD117 in differentiating basaloid squamous cell carcinoma (BSCC) from small cell carcinoma (SCLC) in lung. Methods Immunohistochemistry staining of CD117 and statistic data were analyzed in BSCC and SCLC, and relevant literature were reviewed. Results CD117 was specifically expressed in high level ( positive rate 78%) in SCLC with high sensitivity, specificity, positive predictive value and negative predictive value (respectively 100%、78.2%、68.7%、100%), which was highly consistent with literature reports (positive rate 37%-100%). CD117 was not detected in BSCC in our report and it was the same as in literatures. Conclusion Although our results showed that it was possible that the expression of CD117 would play an important role in differentiating BSCC from SCLC, due to limited cases in number, more studies are needed to elucidated the sensitivity and specificity.

目的 研究血清胃蛋白酶原(PG)、胃泌素17(G-17)水平和HP感染与慢性萎缩性胃炎(CAG)和肠上皮化生的相关性。方法 连续选择2016年6月—2017年6月于我院诊断慢性非萎缩性胃炎60例,CAG 40例和肠上皮化生40例,比较患者血清PGI、II和PGI/II,G-17水平以及HP阳性感染率。结果 CAG和肠上皮化生患者PGI和PGI/II低于非萎缩性胃炎患者,而PGII水平升高,G-17水平和HP阳性感染率也增加,差异均有统计学意义(P＜0.05)。结论 血清PG、G-17水平和HP感染是CAG和肠上皮化生的重要机制。

Objective To study correlation in serum pepsinogen(PG),gastrin 17(G-17) levels and helicobacter pylori(HP) infection and chronic atrophic gastritis(CAG), intestinal metaplasia. Methods A total of 60 cases as non-CAG,40 of CAG and other 40 of intestinal metaplasia from June 2016 to June 2017 were consecutives enrolled, then to compare differences of serum PGI,II,PGI/II,G-17 levels, HP infection positive rate. Results The PGI and PGI/II values in patients with CAG and intestinal metaplasia were both lower than non-CAG patients, while PGII level got more,G-17 level and HP infection positive rate were higher too(P＜0.05). Conclusion The expressions of serum PG,G-17 and HP infection may be the important mechanism to CAG and intestinal metaplasia.

目的 探讨我院17年间前列腺癌患者的临床特征如发病年龄、前列腺特异性抗原(PSA)、Gleason评分、分期及穿刺阳性率等的变化。方法 采用回顾性分析,对广州市第一人民医院2000—2016年泌尿外科1 231例穿刺活检的患者及564例前列腺癌患者资料进行分析,按患者的诊断时间分为A组(2000—2005年)、B组(2006—2009年)、C组(2010—2012年)、D组(2013—2014年)、E组(2015—2016年),对各组的年龄、PSA、Gleason评分、分期及穿刺活检阳性率进行统计学分析,看各组间的各项指标差异是否有统计学意义。结果 5组年龄均值(73.36,73.74,72.05,73.40,72.96岁)、PSA均值(208.95,190.25,173.19,283.54,148.69 μg/L)及穿刺活检阳性率均值(48%,43%,37%,44%,39%)差异均无统计学意义(P均>0.05)。5组Gleason均值为6.80,6.73,7.12,6.93,7.32,A、B组和E组Gleason评分差异有统计学意义(P均<0.05),其余各组Gleason评分差异均无统计学意义(P均>0.05)。TNM分期转化得分5组均值为5.96,6.80,7.05,7.31,6.83, A和C组、D组、E组差异均有统计学意义(P均<0.05),其余各组TNM分期转化得分差异均无统计学意义(P均>0.05)。结论 17年间前列腺癌患者诊断时的年龄、PSA水平及穿刺活检阳性率没有显著变化。

Objective To investigate changes of inpatients with prostate cancer in the last 17 years such as age of onset, prostate specific antigen (PSA), Gleason score, prostate cancer staging and positive rate of prostate biopsy. Methods A retrospective analysis was conducted in 1 231 cases of biopsy patients of urology and 564 patients with prostate cancer who were hospitalized in the First People's Hospital of Guangzhou from 2000 to 2016. According to the time of diagnose. All the patients were divided into five groups: group A(2000-2005),group B(2006-2009),group C(2010-2012), group D(2013-2014)and group E(2015-2016). The age, PSA, Gleason score, staging and positive rate of prostate biopsy were compared to realize whether the indicators of the differences between groups was statistically significant. Results In five groups, means of age, PSA, Gleason score and prostate biopsy positive rate are respectively 73.36,73.74,72.05,73.40,72.96 years; 208.95,190.25,173.19,283.54,148.69 μg/L;6.80,6.73,7.12,6.93,7.32; 5.96,6.80,7.05,7.31,6.83 and 48%,43%,37%,44%,39%. There was no significant difference in age, PSA and positive rate of prostate biopsy (P>0.05). The Gleason scores of group A and group E, group B and group E were statistically significant (P<0.05), while the other groups had no significant differences in Gleason score (P>0.05). There werestatistical significancein TNM staging score between group A and group C,group D, group E(P <0.05),while the other groups had nostatistical significance (P>0.05). Conclusion There are no change of prostate cancer patients in diagnosis of age, PSA levels and positive rate of prostate biopsy in the past 17 years.

目的 通过评估非直属附属医院临床教学质量的影响因素,探讨保障非直属附属医院同质化教学的方法。方法 将实习同学分为院校组和混合组两组,运用德尔菲法调查法对非直属附属医院临床教学过程中所遇到的困难进行分析,并提出教学改革的意见和评价。结果 得出的调查结论对教师、学生、医院教学管理人员和学校教学管理人员都提出了更高的要求,可以为达到同质化教学提供参考。结论 有针对性的开展临床教学工作,变被动教学为主动的教与学,使临床教学达到同质化,从而达到更佳的教学效果。

Objective To explore the methods of guaranteeing homogeneity teaching in Non-affiliated hospitals by assessing the factors affecting the quality of clinical teaching in Non-affiliated hospitals. Methods Divide the students into two groups:college group and mixed group,to meet the process of clinical teaching in Non-affiliated hospitals in difficulty were analyzed by using the Delphi survey method, and put forward opinions and evaluation. Results the survey findings put forward higher requirements for teachers, students, hospital teaching administrators and school teaching administrators, which can provide references for achieving homogeneity teaching. Conclusion targeted clinical teaching should be carried out to change passive teaching into active teaching and learning, so that clinical teaching can be homogenized, so as to achieve better teaching effect.