目的 探讨绝经期后女性血清铁蛋白水平与代谢综合征之间的关系。方法 收集218例确诊为MS的绝经期后女性患者为试验组,对照组为经我院检查健康绝经期后的女性300例,分别测FBG、TC、TG、LDL-C、HDL-C、HbA1C、INS、SF;计算体重指数(BMI)以及测量腰围;测血压;用HOMA稳态模型来评价胰岛素抵抗指数(HOMA-IR)。结果 MS组较非MS组的铁蛋白(SF)值高(P<0.01),SF四分位各组之间比较,FBG、TG、HDL-C,BMI,腰围,收缩压、舒张压有差异(P<0.05或P<0.01),四组间年龄、TC、LDL-C无差异。与SF呈正相关的参数有腰围(P<0.01),舒张压(P<0.01),空腹血糖(P<0.01),胰岛素抵抗指数(P<0.01),负相关的参数为HDL-C(P<0.01)。结论 绝经期后女性的SF水平与MS呈显著相关,其中腰围、舒张压、空腹血糖、HDL-C、胰岛素抵抗指数与血清铁蛋白之间存在较大关联性。

Objective To study the relationship of serum ferritin level with metabolic syndrome in postmenopausal women. Methods 218 postmenopausal women with metabolic syndrome and 300 healthy postmenopausal women were included in this investigation, to detect FBG, TC, TG, LDL- C, HDL-C, HbA1C, INS, SF, calculated body mass index (BMI) and to measure waist circumference, blood pressure; Using HOMA steady-state model to evaluate indexes of insulin resistance (HOMA IR). Results Serum ferritin level was significantly higher in MS group than in the non-MS group(P<0.01). Serum ferritin quarterback was compared between each group, there were differences in FBG, TG, HDL-C,BMI, waist circumference,SBP, DBP(P<0.05 or P<0.01). There were no differences in age, TC, LDL-C. Serum ferritin level was significantly positive correlated with waist circumference (P<0.01), DBP(P<0.01), FBG(P<0.01), insulin resistance index (P<0.01), and negative correlation with HDL-C(P<0.01). Conclusion Serum ferritin level is significantly associated with metabolic syndrome in postmenopausal women. Waist circumference, DBP, FBG, HDL -C, insulin resistance index are closely associated with the serum ferritin.

目的 探讨糖尿病自我管理支持对社区2型糖尿病患者生化指标控制的影响。方法 2015年1月1日前已确诊为2型糖尿病患者,随机分为对照组和干预组,对照组303例按照广州市基本公共卫生服务包要求进行定期随访、体检及健康教育,干预组130例进行自我管理支持干预,观察两组生化指标的变化。结果 与对照组比较,自我管理支持组的空腹血糖、总胆固醇、甘油三酯、谷丙转氨酶、尿酸控制效果较好,差异有统计学意义(P<0.05)。结论 自我管理支持对社区2型糖尿病患者生化指标控制的效果良好,值得推广。

Objective To evaluate the control effect of biochemical criterion in patients with type 2 diabetes under diabetes self-management support in community. Methods 130 patients with type 2 diabetes in community from January 2015 to December 2015 accepting the diabetes self-management support were chosen as research group, another 303 diabetic patients without the diabetes self-management support were set as control group, the effect of management was analyzed. Results There was statistically significant difference (P<0.05) in biochemical criterion including blood sugar (BS), total cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT) and uric acid (UA). Conclusion Control effect of biochemical criterion was good in the diabetes self- management support for people with type 2 diabetes, which was worth to be popularized.

目的 探讨白癜风初诊患者外周血细胞因子水平与临床分型、皮损面积的相关性。方法 收集我院2009年7月—2013年7月4年间收治的初诊白癜风患者78例及健康志愿者37例,用ELISA检测外周血血清IL-6、IL-2, IFN-γ、TNF-α浓度并判断其与白癜风分型、皮损程度的相关性。结果 与对照组相比,白癜风各分型组的IL-6、IL-2水平均升高,其中,散在性的升高幅度最为明显。IL-6及IL-2与皮损面积呈正相关,其相关系数分别为0.664及0.483,P值分别为0.021及0.014。结论 IL-2及IL-6在白癜风的发病过程中起重要作用,且在不同的分型中的表达存在差异,并与皮损面积呈正相关。

Objective To evaluate the correlation of cytokine level of peripheral blood cells, clinical classification and skin lesion in preliminary diagnosis of vitiligo. Methods A total of 78 patients with vitiligo of preliminary diagnosis and 37 health volunteers were collected from July 2009 to July 2013. The peripheral blood were collected for ELISA measurement of IL-6, IL-2, IFN-γand TNF-α, and evaluated whether the cytokines concentration was correlated to clinical classification and skin lesion. Results Compared to control group, IL-6 and IL-2 in all of classification of vitiligo was higher, and the most increase was observed in scattered group. Both IL-6 and IL-2 showed the positive correlation with skin lesion (CI: 0.664 and 0.483, P=0.021 and 0.014). Conclusion IL-2 and IL-6 maybe play a key role in vitiligo etiology, and showed different level in different classification of vitiligo. Besides, they showed a positive correlation with skin lesion.

目的 探讨单倍体亲缘异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的可行性。方法 对1例诊断SAA 4年余,先后经CsA治疗、脐血移植治疗均无效并反复输注红细胞、血小板的12岁男性患者进行单倍体亲缘异基因造血干细胞移植,供者为其胞兄,高分辨HLA基因型5/10相合,预处理方案为BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d。干细胞来源为G-CSF动员的骨髓+外周造血干细胞,共计输注单个核细胞(MNC)4.055×10⁸/kg(受者体重),CD 34 2.331×10⁶/kg。GVHD预防:-1 d采用与受者HLA部分相合的第三方脐带血细胞,术后联合应用环孢素A、短程氨甲碟呤、霉酚酸酯。结果 造血缓慢重建,术后22天(+22 d)ANC>0.5×10⁹/L,术后3月血小板脱离输注。+26天DNA指纹图全部表现为供者基因型。+40天血型转为供者型“O”型。+29 d出现急性移植物抗宿主病aGVHD(胃肠型,Ⅲ度),+31 d、+34 d及+42 d予巴利昔单抗20 mg静滴,+40 d、+44 d、+63 d输注间充质干细胞,患者急性GVHD逐渐控制。期间曾出现肺部感染、口腔黏膜炎及巨细胞病毒血症,经抗感染后可控制。现随访3年,血象正常稳定,Kamofsky评分100分。结论 单倍体亲缘异基因造血干细胞移植治疗SAA,对无相合供者(包括亲缘或非亲缘)且强效免疫抑制治疗失败的患者,可考虑进行,GVHD和感染为主要并发症,需根据患者病情采用相应措施。

Objective To investigate the feasibility of haploid genetic allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia(SAA) in our hospital. Methods A 12-year-old patient with acquired SAA for 4 years showed no response to CsA and cord blood transplant treatment and was transfusion-dependent. Lacking an HLA-identical sibling donor, the patient was treated with HSCT from his brother 5/10 matched at the generic level. Theconditioning regimen was BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d. Stem cells were the source of G-CSF mobilization of bone marrow and peripheral blood stem cells, dose of stem cells infused: mononuclear cells (MNC) 4.055×10⁸/kg (body weight of subject), CD34 2.331×10⁶/kg. Prevention of GVHD: -1 d Third-party umbilical cord blood cells which were HLA partially matched were used. Postoperative joint use included cyclosporine A, short-course methotrexate, mycophenolate mofetil. Results Hematopoiesis was slowly rebuilding, 22 d after surgery (+22 d) ANC> 0.5×10⁹/L, after three months departing from transfusion of platelets. +26 d suggesting that the DNA fingerprints showed donor genotypes. +40 d into donor blood type “O” type. + 29 d occurred acute GVHD (GI type, Ⅲ degrees), + 31 d, + 34 d + 42 d infusion of basiliximab 20mg, + 40 d, + 44 d, + 63 d infusion of mesenchymal stem cells. Gradually acute GVHD was controlled in the patient, who had lung infections, oral mucositis and cytomegalovirus viremia, could be controlled with anti-infective. Now followed up for 3 years, hemogram change has been normal and stable. Kamofsky score was 100 points. Conclusion It may be considered to have haploid genetic allogeneic hematopoietic stem cell transplantation for treatment of SAA, for those patients who have non-matched donor (including relatives and non-relatives) and potent immunosuppressive therapy failure. GVHD and infection are major complications. Need to adopt appropriate measures in accordance with the patient's condition.

目的 探讨同步放化疗治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法 选取我院2014年收治的晚期NSCLC患者102例,随机分为观察组和对照组,对照组以紫杉醇联合顺铂化疗方案(TP)化疗治疗,观察组加用三维适形放疗同步放化疗治疗,观察两组的临床疗效和不良反应。结果 观察组和对照组患者的总有效率分别为43.14%和21.57% (P<0.05),两组患者的总控制率分别为84.31%和66.67% (P<0.05)。两组患者Ⅲ～Ⅳ级胃肠道反应、白细胞减少、骨髓抑制的发生率差异无统计学意义(P>0.05),观察组比对照组增加了放射性肺炎和放射性食管炎的发生 (P<0.05)。两组患者生活质量比较,差异具有统计学意义(P＜0.05)。结论 同步放化疗治疗晚期NSCLC可以显著提高治疗的总有效率、肿瘤的控制率及生活质量,但也使不良反应增加,选择治疗方案时应根据个体情况综合考虑。

Objective To study the clinical efficacy of concurrent chemoradiotherapy in the treatment of advanced non small cell lung cancer (NSCLC). Methods 102 cases of advanced NSCLC treated in our hospital in 2014 were selected and randomly divided into the observation group and the control group. Patients in control group were treated by chemotherapy with Paclitaxel combined Cisplatin (TP), while those in observation group were treated by concurrent chemoradiotherapy with three- dimensional conformal radiotherapy and TP. The clinical efficacy and adverse reactions of the two groups were observed. Results The total effective rate of the observation group and the control group were 43.14% and 21.57% (P<0.05), respectively. The total control rate of the two groups were 84.31% and 66.67%(P<0.05). In two groups III ~ IV gastrointestinal tract reaction, leukopenia, bone marrow suppression occurrence had no statistical significance(P>0.05). Incidence of radiation pneumonitis and radiation esophagitis increased in observation group(P<0.05). The difference of quality of life between the two groups was statistically significant(P<0.05). Conclusion Concurrent radiotherapy and chemotherapy in the treatment ofadvanced non-small cell lung cancer(NSCLC)can not only significantly improve the treatment, tumor control rate and quality of life, but also make adverse reaction increased. Treatment options should be chosen based on individual circumstances into account

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 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 观察以“五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效及其社区应用价值。方法 90例符合纳入、诊断标准的患儿随机分观察组与对照组,观察组以“五物甘草生摩膏”为介质膏摩法干预;对照组服用玉屏风颗粒;疗程均为2个月,观察服药后1个月(治疗)以及停药后1年内(预防)的疗效。结果 不论是从近期疗效还是远期疗效观察,观察组的疗效更显著;观察组儿童外感咳嗽症状的发生率也明显低于对照组。结论 “五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效影响显著,值得在家庭和基层医疗机构中推广应用。

目的 探讨医护一体化伤口管理模式在腰椎疾患术后伤口换药中的应用效果。方法 2014年3月—2014年8月对90例行脊柱内固定术后的腰椎疾患患者采用随机数字法将其分为管理组和对照组,管理组的患者术后换药实施医护一体化伤口管理模式,对照组采用传统方法进行伤口换药,对患者的伤口感染率、住院时间、等待换药时间、再次换药率、耗损费用及患者对医护人员满意的及自身舒适度进行统计学分析。结果 两组患者在伤口感染率无统计学差异,但医护一体化伤口管理模式应用的管理组在住院时间、等待换药时间、再次换药率、耗损费用及患者对医护人员满意的及自身舒适度效果优于传统伤口管理,差异有统计学意义(P<0.05)。结论 医护一体化伤口管理是通过医护的合作完成,在等待换药的时间、再次换药耗损费用、患者自身舒适度对及医护人员满意度优于传统换药组,创新了护理服务范畴,值得进行推广。

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。