目的 研究血浆脂蛋白磷脂酶 A2(Lp-PLA2)在防治急性动脉硬化性脑梗死中的临床价值。方法 选取2014年1月—2015年12月在我院经头颅MRI+MRA及脑血管造影确诊为急性动脉硬化性脑梗死患者80例为病例组,选取同期来我院例行体检头MRI+MRA 正常的健康自愿者40名为对照组。病例组采取脑梗死规范治疗及肢体功能康复锻炼,以酶联免疫法分不同时段测定两组患者血浆Lp-PLA2的浓度,以及评价病例组神经功能缺损程度,经数据分析研究脑梗死患者血浆Lp-PLA2浓度与神经功能缺损程度相关性。结果 急性动脉硬化性脑梗死患者血浆 Lp-PLA2浓度高于健康对照组患者,经统计学分析,P<0.05,并且随着脑梗死时间的推移,Lp-PLA2浓度愈低。NIHSS评分显示,随着脑梗死时间推移,NIHSS评分越来越低,差异有统计学意义(P<0.05)。对比同时期NIHSS评分和患者 Lp-PLA2浓度,NIHSS与Lp-PLA2浓度呈正相关(r=2.376,P<0.01)。结论 血浆Lp-PLA2 浓度升高是脑梗死的危险因素之一,降低血浆 Lp-PLA2 浓度可在脑梗死的早期预防上起到积极作用。

Objective To explore clinical value of plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) in controlling acute atherosclerosis cerebral infarction. Methods 80 cases of acute atherosclerosis patients diagnosed by head MRI+MRA were selected as cases group, and 40 as normal controls. Cases treated with cerebral infarction specification therapy and lib function rehabilitation exercise. Using enzyme-linked immunoassay points at different times of measuring the concentration of plasma Lp-PLA2 in both groups, evaluating nerve function defect degree of cases, then analysis the correlation of cerebral infarction plasma concentration of Lp-PLA2 and neural function defect degree. Results Acute atherosclerotic cerebral infarction patients plasma concentration of Lp-PLA2 patients was significantly higher than healthy control group, by statistics analysis P<0.05, and with cerebral infarction time went by, the Lp-PLA2 concentration was lower. NIHSS score, with the time of cerebral infarction passed, was lower and lower, the change was statistically significant P<0.05.Compared with NIHSS score and concentration of Lp-PLA2, NIHSS and Lp- PLA2 concentration were positively correlated, r=2.376,P<0.01. Conclusion Plasma Lp-PLA2 is a risk factor for cerebral infarction. Reducing plasma concentration of Lp-PLA2 can play a positive role on the early prevention of cerebral infarction.

目的 研究细胞周期调控因子E2F-1和p16蛋白与宫颈上皮内瘤变及宫颈鳞癌的表达及其临床意义。方法 通过免疫组化SP法检测宫颈上皮内瘤变Ⅰ-Ⅱ级(CINⅠ-Ⅱ级)、宫颈上皮内瘤变Ⅲ级(CINⅢ级)、宫颈鳞癌各40例中E2F-1和p16蛋白的表达情况,并用20例慢性宫颈炎组织作对照。结果 E2F-1蛋白在CINⅠ-Ⅱ级、CINⅢ级和宫颈鳞癌组中阳性率分别为17.5%、67.5%和80.0%, 3组间有差异(χ²=37.278,P<0.001)。p16蛋白表达阳性率分别为27.5%、70.0%和82.5%,3组间差异有统计学意义(χ²=27.708, P<0.001)。CINⅠ-Ⅱ级与CINⅢ级组及宫颈鳞癌组比较均有差异,但CINⅢ级与宫颈鳞癌组间无差异。p16蛋白的表达与E2F-1蛋白表达有正相关关系;在鳞癌组中E2F-1与p16的异常表达与组织学分级、临床分期有关(P<0.05)。结论 子宫颈鳞癌的形成与E2F-1 、p16蛋白过表达是呈正相关关系,E2F-1 、p16 蛋白可能作为子宫颈鳞癌及CIN的标志物,对子宫颈癌筛查和预防有重要意义。

Objective To explore the clinicopathologic significance of the protein expression of cell cycle regulators E2F-1 and P16 in cervical intraepithelial neoplasia(CIN) and cervical squamous cell carcinoma(SCC). Methods Immunohistochemical technique S-P was used to determinate the expression of E2F-1 and P16 protein in 40 cases with CINⅠ-Ⅱ, 40 cases with CINⅢ and 40 cases with cervical squamous cell carcinoma. Results The positive rate of E2F-1 protein expression in CINⅠ-Ⅱ, CINⅢ and cervical squamous cell carcinoma was 17.5%,67.5% and 80.0%, respectively. There were significant differences among the three groups(χ²=37.278,P<0.001). The positive rate of P16 protein expression in CINⅠ-Ⅱ, CINⅢ and cervical squamous cell carcinoma was 27.5%,70.0% and 82.5%, respectively. There were significant differences among the three groups (χ²=27.708, P<0.001). The group with CINⅢ and cervical squamous cell carcinom compared with the group withCINⅠ-Ⅱ did have differences. But there were no significant differences in the group with CINⅢ and the group with cervical squamous cell carcinoma. The relative expressions between P16 and E2F-1 showed positive correlation. In the cervical squamous cell carcinoma group, the abnormal expression of E2F-1 and p16 were correlated with the histological grade and clinical stage. Conclusion It showed positive correlation between very high expression of p16 protein and E2F-1 infection in CIN and SCC. p16 protein and E2F-1 can be an indicator in SCC and CIN,which has very significance in preventing and screening of cervical cancer.

目的 探讨自噬激活剂和自噬抑制剂分别对鼻咽癌细胞CNE2放疗敏感性的影响。方法 利用RNA干扰技术使atg5基因沉默,构建自噬抑制细胞模型后,与雷帕霉素、氯喹分别处理的两组细胞一起,每天以X射线5Gy照射细胞,连续8天观察各组细胞的生长状况,并设置对照组。以MTT法及克隆集落形成法检测其细胞活力,用流式细胞仪分析其细胞周期。结果 与对照组相比,其他三组细胞存活率、克隆形成率、照射后存活率均显著降低(P<0.05);细胞周期检测除对照组外其他三组细胞集中在G0/G1期,其他两个时期比G0/G1期相对较少。结论 自噬抑制剂与激活剂和atg5沉默均能为CNE2放疗增敏,然而自噬激活剂的增敏效果好于其他,为增敏放疗提供实验依据,开辟新的放疗增敏途径。

Objective This study aimed to investigate the autophagy activators and inhibitors effects in nasopharyngeal CNE2 cells radiotherapy sensitization. Methods Atg5 gene silencing by RNA interference technology, two groups of cell autophagy inhibition were built by rapamycin and chloroquine respectively. Then 5Gy x-ray irradiation of cells was taken every day, after 8 days in a row in each group of cell growth and setting a control group. The cell viability was clonaled colony formation by MTT method assay and cell cycle by flow cytometry analysis. Results The three cell group survival rate, colony-forming rate and survival after irradiation were significantly lower (P<0.05) than the control group. Detection of cell cycle in addition to control three other groups concentrated in the G0/G1 period.That of two other periods was relatively fewer than that of the G0/G1 period. Conclusion Autophagy inhibitors, activators and atg5 silence improved the radio-sensitization to CNE2. The autophagy activator group improving the sensitivity was better than the others.This study provided evidence to sensitive radiotherapy, explored a new promising radiosensitization ways.

目的 探讨Foxp3-924(rs2232365)基因位点多态性与产后抑郁的相关性。方法 选取211例在越秀区光塔街社区卫生服务中心分娩的产妇进行回访研究,所有产妇均经PCR-SSP技术对Foxp3-924(rs2232365)基因位点分型。结果 对比产后抑郁组与对照组产妇Foxp3-924各种基因型频率,结果显示均无差异(P>0.05)。结论 产后抑郁和Foxp3-924(rs2232365)位点基因多态性无较大关联。

Objective To investigate the distribution of-924(rs2232365) genotypes and to explore the correlation between gene loci polymorphism and postpartum depression. Methods In puerpera in Yuexiu district Guangta street community health center, there were 211 cases of childbirth study visits, who were confirmed by PCR-SSP technique Foxp3-924 (rs2232365) gene locus genotyping. Results Compared postpartum depression group and control groupFoxp3-924 various genotypes, it showed no great difference (P> 0.05). Conclusion It has no greater relevance between postpartum depression and Foxp3-924 (rs2232365) polymorphism loci.

目的 通过对2011—2014年发生在本院的医疗纠纷进行统计分析,为医院持续PDCA改善服务质量,制定管理措施,减少医疗纠纷的发生提供理论依据。方法 对医务部医患关系办公室的纠纷登记数据汇总分析。结果 医疗纠纷的发生呈逐年下降趋势,但在接诊患者超过一定数量时出现反弹;外科部、内科部、产科部为纠纷多发部门;急诊科、新生儿科为纠纷高发科室;超过60%的医疗纠纷与医患沟通不足有关。结论 通过PDCA医疗质量管理,可以减少医疗纠纷的发生,医院在接诊量过大时应采取应对措施;医疗纠纷的多发部门、科室有规律性,应对纠纷重点部门加强管控;加强医患有效沟通是减少医疗纠纷发生的重要措施。

目的 观察43岁以上女性放置左炔诺孕酮宫内缓释系统(LNG-IUS)的疗效及放置后的转归,初探LNG-IUS在围绝经期使用的诊疗规范。方法 对在我院接受LNG-IUS放置术、年龄43岁以上的女性298例进行追踪回访,成功回访266例,对收集的有关LNG-IUS的效果及转归方面的数据进行总结。结果 在266例随访对象中,>91%为治疗性放环,占绝大多数,不足9%单纯用于避孕。不管放环的指征是哪一类,有93.75%～100%的女性在放置后出现月经量明显减少甚至闭经,仅6.25%子宫腺肌症、5.88%子宫内膜异常患者无月经量改变甚至经量增多。结论 LNG-IUS治疗围绝经期功能性子宫出血的效果显著,治疗失败率及因各种原因取环的比例在子宫腺肌症及子宫内膜异常患者中较高。而LNG-IUS脱落率在内分泌因素及子宫腺肌症中较高。提示这几类患者放置LNG-IUS前需充分知情告知。

目的 对ChiTaS BSS1200血液核酸检测系统(简称“ChiTaS ”)主要分析性能进行验证,确定该系统是否稳定、准确、可靠。方法 参照美国临床实验室标准化协会(CLSI)相关文件要求,对在ChiTaS上开展的HBV-DNA、HCV-RNA、HIV-RNA项目进行检出限、精密度、准确度及抗干扰等方面验证。结果 ChiTaS 分析系统HBV-DNA、HCV-RNA、HIV-RNA最低检出限分别为3.63(3.16～6.26)IU/mL、12.71(10.37～21.63)U/mL、25.49(21.43～37.48)IU/mL;HBV-DNA、HCV-RNA、HIV-RNA阳性样本总变异系数分别为2.56%、1.03%、3.36%;22个阴性样本和10个阳性样本进行8混样模式检测结果为反应性,拆分检测结果:阳性样本符合率100%、阴性样本符合率100%;溶血血浆(血红蛋白含量为5 g/L)、脂肪血浆(甘油三酯大于6.3 mmol/L)对低浓度HBV(6.3 IU/mL)、HCV(23.3 IU/mL)、HIV(47.6 IU/mL)样本检出无显著影响。结论 ChiTaS检出限、精密度、准确度等均达到生产商的检测性能的要求,实验室该系统的检测能力可以满足本血站对无偿献血者样本的常规核酸检测要求。

目的 采用二维斑点追踪技术(2D-STI)检测冠状动脉左前降支供血区心肌纵向应变,探讨其评估缺血心肌局部收缩功能的价值。方法 使用2D-STI检测不同狭窄程度(＜50%、50%~75%、＞75%)及未见明确狭窄的左前降支供血区心肌纵向应变参数:心内膜下、心外膜下及区域心肌收缩期纵向应变峰值-LS-endo、LS-epi、LS-Territorial,计算收缩期心肌跨壁纵向应变(LS-mural)。观察PCI术后供血区心肌纵向应变的变化。结果 各组内LS-endo均高于对应的LS-epi(均P<0.01)。随着左前降支狭窄程度增加,LS-endo、LS-epi、LS-Territorial、LS-mural逐渐减低(均P<0.01)。术后LS-endo、LS-epi、LS-Territorial逐渐增高,LS-mural先增高后缓慢减低再增高。结论 2D-STI可定量检测不同层次的心肌纵向应变,反映心肌局部收缩功能,为早期识别缺血心肌、评价PCI术后疗效提供参考依据。

Objective To detect myocardial longitudinal strain in the area supplied by left anterior descending coronary artery (LAD) via two dimensional speckle tracking image (2D-STI), and to investigate its estimated value of myocardial systolic function of ischemic myocardium. Methods Detection of myocardial longitudinal strain parameters in the area supplied by the LAD with different stenosis degree(＜50%、50%~75%、＞75%) and no definite stenosis via 2D-STI:subendocardial longitudianl strain (LS-endo), subepicardial longitudianl strain (LS-epi) and territorial longitudianl strain (LS-Territorial). Calculate transmural longitudinal strain (LS-mural) in the systole.Then observe the changes of myocardial longitudinal strain in the blood supply area after percutaneous coronary interventional therapy (PCI). Results LS-endo, LS-epi, LS-Territorial and LS-mural gradually decrease with the increase of LAD stenosis (all P<0.01). After operation, LS-endo, LS-epi and LS-Territorial increase progressively (all P<0.01). LS-mural increases first and then decreases and finally increases slowly. Conclusion Layer-specific quantification of myocardial longitudinal strain by 2D-STI may reveal the regional myocardial systolic function. It is useful to identify the ischemic myocardium in the early stage and evaluate the treatment effect of PCI.

目的 探讨老年2型糖尿病患者牙周病发生情况及相关因素,为开展综合预防和治疗措施提供参考。方法 选取到我院住院治疗的老年2型糖尿病患者273例,检查其牙周病患病情况,同时收集年龄、性别、文化程度、体重指数、病程、吸烟、空腹血糖、糖化血红蛋白、刷牙习惯等资料,比较牙周病患病组与未患病组之间上述资料的差异,探讨导致牙周病发生的影响因素。结果 273例研究对象中患有牙周病154例(56.41%),其中,牙龈炎60例,牙周炎94例。牙周病组平均存留牙数(18.54±6.31)颗,未患牙周病组平均存留牙数(21.62±7.48)颗(t=3.679,P<0.001)。年龄较大(P<0.001)、病程较长(P<0.001)、吸烟(P<0.001)、空腹血糖(P<0.001)和糖化血红蛋白(P<0.001)水平较高是老年2型糖尿病患者发生牙周病的危险因素,而文化程度高(P=0.017),刷牙>1次/d(P<0.001),竖刷(P=0.004),使用牙线(P=0.004)是其保护因素。结论 老年2型糖尿病患者中牙周病患病率较高,临床上应做好三级预防措施,降低牙周病发生风险因素的暴露。

Objective To explore the periodontal disease occurrence and its factors for elderly type 2 diabetes patients, providing reference for comprehensive prevention and treatment measures. Methods 273 cases of elderly in-patients with type 2 diabetes in our hospital were enrolled. We checked their periodontal disease conditions, collected information including age, sex, educational level, body mass index, disease duration, smoking, fasting blood glucose, glycosylated hemoglobin, brushing habits. These values were compared between periodontal disease group and no periodontal disease group. Results People with periodontal disease in 273 cases of the object of study included 154 patients (56.41%), among them, gingivitis 60 cases, 94 cases of periodontitis. The teeth number was (18.54±6.31) for periodontal disease group on average, with (21.62 ±7.48) for no periodontal disease group (t=3.679, P<0.001). Older (P<0.001), longer course of disease (P<0.001), smoking (P<0.001), higher fasting blood glucose (P<0.001) and higher glycosylated hemoglobin (P<0.001) were risk factors of periodontal disease for elderly patients with type 2 diabetes. And well-educated (P=0.017), brushing teeth frequency > 1 / d (P<0.001), vertical brush mode (P=0.004), the use of dental floss (P=0.004) were the protective factors. Conclusion Periodontal disease prevalence is high in elderly patients with type 2 diabetes. The three level preventive measures should be strengthened to reduce the exposure of the periodontal disease risk factors.

目的 探讨2型糖尿病肾病(DN)患者肾组织中STOML2的表达及作用。方法 免疫组化检测临床2型糖尿病肾病患者肾组织STOML2的表达及定位,采用慢病毒转染方法建立稳定过表达STOML2的HK-2细胞系,并应用Western blot检测肾小管上皮细胞钙粘蛋白(E-cadherin)、Fibronectin和STOML2的表达。结果 STOML2在DN患者肾组织的肾小管上皮细胞胞浆中表达明显升高。在高糖刺激HK-2细胞建立的EMT模型中,STOML2呈时间依赖表达上调。STOML2稳定高表达时,E-cadherin表达下调,而Fibronectin明显上调,即能促进肾小管上皮细胞发生EMT。结论 STOML2可能通过促进肾小管上皮细胞向间充质细胞分化,进而参与糖尿病肾病肾脏纤维化的发生发展。

Objective To investigate the expression and role of STOML2 in renal tissue of patients with type 2 diabetic nephropathy. Methods To detect he expression and localization of STOML2 in clinical renal tissue in patients with type 2 diabetic nephropathy by immunohistochemistry, and use lentiviral transfection method to establish a stable cell line of over-expressing STOML2, lastly apply western blot to detect the expression of E-cadherin, Fibronectin and STOML2 in renal tubular epithelial cells. Results STOML2 was significantly increased in renal tubular epithelial cytoplasm of patients with DN. In the EMT model of HK-2 cells stimulated by high glucose, STOML2 was increased in a time dependent. Overexpression of STOML2 led to E-cadherin down-regulated, while Fibronectin up-regulated, which promoted the occurrence of EMT in renal tubular epithelial cells. Conclusion STOML2 may be involved in the development and progression of renal fibrosis in diabetic nephropathy by mediating epithelial- mesenchymal transition of renal tubular epithelial cells.