目的 探索实体肿瘤内部不同区域的间质液压（IFP）分布的异质性。方法 通过建立新西兰大白兔的皮下浅肌层VX2移植瘤模型,通过超声造影观察肿瘤的大小、形状、血流灌注等成瘤情况,并在超声引导下通过针芯法（WIN法）测量41只荷瘤兔VX2移植瘤内部不同区域的IFP。结果 41只荷瘤兔的VX2移植瘤的中央IFP为（23.79±8.07） mmHg、肿瘤外周1/2IFP为（15.58±5.22）mmHg、肿瘤外周1/4IFP为（8.29±5.47）mmHg,IFP从中央到外周逐步降低（F=70.85,P<0.001）。结论 VX2移植瘤内不同区域的IFP存在异质性,即从中央到外周IFP呈梯度显著降低。

Objective To explore the heterogeneity of interstitial fluid pressure（IFP）distribution in different regions of solid tumors．Methods The model of VX2 tumor was established in New Zealand white rabbits．The size,shape and blood perfusion of the tumor were observed by contrast-enhanced ultrasound,the IFP of VX2 tumor in 41 rabbits was measured by the wick-in-needle method（WIN method）under the guidance of ultrasound．Results The mean values of central IFP,peripheral 1/2 IFP and peripheral 1/4 IFP were（23.79±8.07） mmHg,（15.58±5.22 ）mmHg and （8.29±5.47） mmHg,respectively by statistical analysis,the IFP values changed significantly with different regions（F=70.85,P<0.001）．Conclusions There is heterogeneity of IFP in different regions of VX2 xenografts,that is,from the center to the periphery,the IFP decreased significantly．

目的 探讨性别、年龄、日剂量、合并用药、药物厂家等因素对使用阿立哌唑患者稳态血药浓度的影响,为临床合理用药提供依据。方法 收集深圳市康宁医院2019年1月—2021年2月使用阿立哌唑住院患者血药浓度监测数据样本229份,包括患者性别、年龄、日剂量、合并用药、药物厂家等基本信息,使用SPSS 25.0统计学软件对数据进行回顾性分析。结果 经多元线性回归分析,本研究仅性别、日剂量能解释阿立哌唑血药浓度的变化。使用阿立哌唑患者血药浓度剂量比值(C/D)女性组高于男性组(P＜0.01),阿立哌唑合用丙戊酸盐组高于无合用组(P＜0.05),年龄、其他合并、药物厂家用药对阿立哌唑(C/D)值的影响无统计学差异。结论 阿立哌唑C/D值与性别有关,合并用药对其有一定影响,不同药物厂家的阿立哌唑C/D值无统计学差异,临床应加强治疗药物监测,根据血药浓度及临床诊疗效果,结合药物经济学因素优化给药方案。

Objective To provide the reference for clinical rational use of aripiprazole,to investigate the effects of gender, age, daily dose, concurrent medication, drug manufacturer and other factors on the steady-state serum concentration in aripiprazole patients. Methods Serum concentration monitoring data of 229 inpatients using aripiprazole in Shenzhen Kangning Hospital from January 2019 to February 2021 was collected, including patients' gender, age, daily dose, concurrent medication, drug manufacturer and other basic information, which were retrospectively analyzed by SPSS 25.0 statistical software. Results In this study, only gender and daily dose could explain the significant changes of aripiprazole serum concentration after multiple linear regression analysis. The serum concentration/dose ratio (C/D) was significantly higher in female patients than in male patients (P＜0.01), and the group of aripiprazole combined with valproate was markedly higher than the non-combined group (P＜0.05). Nevertheless, there were no statistically significant differences in the effects of age, concurrent medication and drug manufacturer on aripiprazole C/D values. Conclusions The C/D value of aripiprazole was closely related to gender, and concurrent medication had a certain effect on it. There was no statistical difference in the aripiprazole C/D value among different drug manufacturers. This study suggested that clinical monitoring of therapeutic drugs should be strengthened, and the prescription should be optimized based on serum concentration and therapeutic efficacy, combined with pharmacoeconomic factors.

目的 探究应用烤瓷+活动义齿修复在牙列重度磨耗伴缺失患者治疗中对咀嚼效能的影响。方法 选定本院2019年2月—2021年2月口腔科接诊的71例牙列重度磨耗伴缺失患者,按随机数字表法分为2组,对比组和病例组各35例,对比组接受常规义齿修复治疗,病例组接受采纳烤瓷+活动义齿修复,对比2组临床疗效、咀嚼功能、Fricton指数、并发症总发生率。结果 临床总有效率病例组(94.44%)高于对比组(74.29%),病例组治疗后咀嚼效率、咬合力均比对比组高,P均＜0.05。病例组治疗后Fricton指数低于对比组,病例组并发症总发生率(2.78%)低于对比组(20.00%),P均＜0.05。结论 烤瓷+活动义齿修复可有效提高牙列重度磨耗伴缺失患者咬合力、咀嚼功能,改善颞下颌关节功能,且并发症较少,效果确切。

目的 探讨胰岛素联合乌司他丁在高脂血症性重症胰腺炎中的临床疗效。方法 研究资料来自广州市花都区人民医院肝胆胰外科自2018年—2020年收治的72例高脂血症性重症胰腺炎患者资料,所有患者按照不同治疗方案随机分为3组,每组各24例。对照组采用急性胰腺炎常规治疗(即生长抑素+液体疗法);乌司他丁组则于常规组上联用乌司他丁;而研究组在常规及联合乌司他丁治疗基础上加用胰岛素强化治疗,比较3组患者腹痛及胃肠功能恢复的时间、甘油三酯下降的水平,治疗前、治疗后第3天、7天的APACHE Ⅱ评分的变化情况。结果 研究组患者腹痛症状缓解及胃肠功能恢复时间均较对照组明显缩短、腹痛症状缓解时间较乌司他丁组缩短,且研究组甘油三酯下降水平较对照组和乌司他丁组快,而研究组第3天和第7天的APACHE-Ⅱ评分较常规组及乌司他丁组低,以上差别均有统计学意义(P<0.05)。结论 胰岛素联合乌司他丁可明显改善高脂血症合并重症急性胰腺炎腹部症状、缩短胃肠功能恢复时间、迅速降低血清甘油三酯水平,对患者近期疗效确切。

Objective To explore curative effect of insulin combined with ulinastatin in therapy of severe hyperlipidemic pancreatitis. Methods A total of 72 patients with hyperlipidemia complicated with severe acute pancreatitis were randomly divided into three groups according to different treatment plans, 24 cases in each group. The regular treatment of acute pancreatitis (somatostatin+liquid therapy) was carried out in control group. Base on the regular treatment of acute pancreatitis, ulinastatin was added in ulinastatin group. Base on the treatment of ulinastatin group, insulin was added in study group, and the time of abdominal pain and gastrointestinal function recovery, glycerin level and the APACHE Ⅱ score before and after treatment among three groups were compared. Results Compared with the control group and ulinastatin group, the time of abdominal pain relief and gastrointestinal function recovery in the study group were significantly shorter, the time of triglycerides level back to normal in the study group was shorter than the other two groups, while at the third and seventh day, the APACHE Ⅱ score of the study group was lower than that of other two groups, with statistical significance (P<0.05). Conclusions Insulin combined with ulinastatin could significantly improve abdominal symptoms of hyperlipidemia complicated with severe acute pancreatitis, promote the recovery of gastrointestinal function, and rapidly reduce the level of serum triglyceride.

目的 探讨p16免疫细胞化学、人乳头瘤病毒(HPV)DNA基因分型单独和联合检测在宫颈细胞学不能明确诊断意义的非典型鳞状上皮细胞(ASC-US)分流中的价值。方法 收集2017年3月—2022年1月,585例液基薄层细胞学(TCT)诊断为ASC-US患者的宫颈细胞学标本,使用免疫细胞化学法行p16蛋白检测,生物芯片法行HPV DNA基因分型检测,患者于8周内行阴道镜下病理活检术。以组织学诊断结果为金标准,探讨p16免疫细胞化学和HPV DNA基因分型单独和联合检测方法在同一级别宫颈病变中阳性率的差异,对比同一检测方法在不同级别宫颈病变中阳性率的差异,比较p16免疫细胞化学、HPV DNA基因分型单独和联合检测对高级别鳞状上皮内病变(HSIL)以上病变诊断效能的差异,综合评定一种最优的ASC-US分流方法。结果 ①(p16+HPV DNA)联合检测在同一级别宫颈病变中阳性率高于p16免疫细胞化学、HPV DNA基因分型检测。②p16免疫细胞化学、HPV DNA基因分型、(p16+HPV DNA)联合检测的阳性率均随着宫颈病变程度的加重而递增。③(p16+HPV DNA)联合检测的综合诊断效能最佳,其灵敏度、特异度、符合率和约登指数分别为99.07%、62.55%、69.23%、0.62。结论 p16免疫细胞化学检测法与HPV DNA基因分型单独和联合检测均有助于ASC-US分流,但是,(p16+HPV DNA)联合检测具有更优的灵敏度和约登指数,同时保持了较高的特异度和符合率,可有效进行ASC-US分流。

Objective To investigate the value of p16 immunocytochemistry and human papillomavirus (HPV) DNA genotyping alone and combined in atypical squamous cells of undetermined significance (ASC-US) shunt which cervical cytology can not clearly diagnose. Methods From March 2017 to January 2022, cervical cytological specimens of 585 patients with ASC-US diagnosed by liquid based thinprep cytology test (TCT) were collected. p16 protein was detected by immunocytochemistry, HPV DNA genotype was detected by biochip and the patients underwent colposcopy pathological biopsy within 8 weeks. Taking the histological diagnosis results as the gold standard, the differences of the positive rate of p16 immunocytochemistry and HPV DNA genotyping in the same level of cervical lesions, differences of the positive rate of the same detection method in different levels of cervical lesions and differenes of p16 immunocytochemistry HPV DNA genotyping alone and combined detection of the diagnostic efficacy of lesions severer than high-grade squamous intraepithelial lesion (HSIL) were compared to comprehensively evaluate an optimal ASC-US shunt method. Results ①The positive rate of combined detection of (p16+HPV DNA) in the same level of cervical lesions was higher than that of differences of p16 immunocytochemistry and HPV DNA genotyping. ②The positive rate of combined detection of (p16+HPV DNA), p16 immunocytochemistry and HPV DNA genotyping increased with the aggravation of cervical lesions. ③The combined detection of (p16+HPV DNA) had the best comprehensive diagnostic efficiency and its sensitivity, specificity, coincidence rate and Yoden index were 99.07%, 62.55%, 69.23% and 0.62 respectively. Conclusions p16 immunocytochemical assay and HPV DNA genotyping, both alone and in combination, contributed to ASC-US shunt. However, the combined detection of (p16+HPV DNA) had better sensitivity and Yoden index, with high specificity and coincidence rate, which can effectively carry out ASC-US shunt.

目的 探讨甲状腺乳头状癌患者在严重短期甲减的状态下甲状腺功能及相关因素对血脂水平的影响。方法 纳入61例通过病理确诊为甲状腺乳头状癌的患者,采集所有患者在手术前与碘治疗前的甲状腺功能水平与血脂水平等资料,比较患者不同性别、年龄、术式、淋巴结转移情况等相关因素对血脂的影响。结果 碘治疗前的全部血脂指标均高于手术前的基线水平;在促甲状腺激素 (TSH)>60 mIU/L组中的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(APO-A1)、载脂蛋白B(APO-B)、脂蛋白(LP)水平明显高于TSH≤60 mIU/L组;女性患者的甘油三酯(TG)、动脉硬化指数(AI)水平明显低于男性患者,男性组的HDL-C、APO-A1水平低于女性组,年龄>45岁的患者TC水平高于年龄≤45岁的患者,差异均有统计学意义(P均＜0.05);不同术式及淋巴结转移分组间的血脂水平未见明显差异(P＞0.05);TC水平与游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺素(T4)水平呈负相关(r分别为-0.342、-0.370、-0.340),HDL-C、LDL-C及APO-B水平与T4水平呈负相关(r分别为-0.294、-0.354、-0.324),APO-A1水平与FT4、三碘甲状腺原氨酸(T3)、T4水平呈负相关(r分别为-0.306、-0.262、-0.263),LPa水平与T3、T4水平呈负相关(r分别为-0.268、-0.313)。结论 甲状腺乳头状癌碘治疗前短期甲减可以导致全套血脂指标升高,在此甲减状态下程度越严重的甲减可产生越高的血脂水平,同时男性患者与中老年患者也可伴随更高的血脂水平。

Objectives To investigate the influence of thyroid function and related factors on blood lipid levels in patients with papillary thyroid cancer under short-term severe hypothyroidism. Methods Sixty-one patients with papillary thyroid carcinoma diagnosed by pathology were included. The data of thyroid function and blood lipid levels of all patients before operation and iodine treatment were collected. The effects of gender, age, operation mode, lymph node metastasis and other related factors on blood lipid were compared. Results Before iodine treatment, all blood lipid indexes were higher than the baseline level before operation. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (APO-A1), apolipoprotein B (APO-B), lipoproteins (LP) in the thyroid stimulating hormone (TSH)>60 mIU/L group were significantly higher than those in the TSH≤60 mIU/L group.Triglyceride (TG) and arteriosclerosis index (AI) levels were significantly lower in female patients compared with male patients, HDL-C and APO-A1 levels were lower in male patients compared with female patients, and TC levels were higher in patients aged>45 compared with those aged≤45, with significant differences (all P<0.05). No significant differences were observed in lipid levels among the different surgical procedures and lymph node metastasis subgroups (P>0.05). TC levels were negatively correlated with free triiodothyronines (FT3), free thyroxine (FT4), thyroxine (T4) levels (r=-0.342,-0.370,-0.340,respectively). HDL-C, LDL-C, and APO-B levels were negatively correlated with T4 levels (r=-0.294, -0.354, -0.324,respectively), APO-A1 levels were negatively correlated with FT4, triiodothyronine (T3), T4 levels (r=-0.306,-0.262,-0.263,respectively), and LP levels were negatively correlated with T3 and T4 levels (r=-0.268,-0.313, respectively). Conclusions Short term hypothyroidism before iodine treatment for papillary thyroid cancer could lead to the increase of full set of blood lipid indexes, male patients and middle-aged and elderly patients could also be accompanied by higher blood lipid levels.

目的 观察新疆石河子地区绝经后女性2型糖尿病(T2DM)患者糖、脂、骨代谢特征及骨密度(BMD)情况,探讨该人群中低密度脂蛋白受体相关蛋白5(LRP5)基因rs3736228、rs3781586位点的基因多态性及突变与糖、脂、骨代谢指标的关系。方法 将新疆石河子地区2016年10月—2017年10月社区、医院门诊及住院绝经后女性按照纳入标准和排除标准选取136例为研究对象,根据患者病史、糖耐量实验及骨密度仪测定骨密度分4组,糖耐量正常与骨量正常组(A组),糖耐量正常与骨量异常组(B组),T2DM与骨量正常组(C组),T2DM与骨量异常组(D组)。测定并记录患者年龄、绝经年限等基线资料,计算体质指数(BMI)等,并检测糖代谢指标(空腹血糖等)、骨代谢指标(血Ca等)、脂代谢指标(甘油三酯等)。采用MALDI-TOF-MS法测定LRP5基因该两个位点基因多态性并进行统计分析。结果 ①糖代谢指标:与A组比较,C组、D组FPG、HbA1c均高于A组(P<0.01)。脂代谢指标:与A组比较,B组、D组TG低于A组(P<0.05)。骨代谢指标:与A组比较,B组、D组BMD(L1-4)、BMD(股骨颈)低于A组(P<0.01)。②LRP5基因该两个位点SNP基因分型分布符合Hardy-Weinberg遗传平衡定律(P>0.05);同时,该两个位点不同基因型的分布频率和等位基因频率在组间的比较经Pearson Chi-Square检验后发现暂无显著差异(P>0.05)。③LRP5基因rs3736228位点:A组,与CC型(野生型)相比,CT/TT型(突变型)甘油三酯(TG)降低(P<0.05),BMD(L1-4)降低(P<0.05);C组,与CC型(野生型)相比,CT/TT型(突变型)高密度脂蛋白(HDL-C)升高(P<0.01),磷(P)升高(P<0.05);LRP5基因rs3781586位点:B组,与GG型(野生型)相比,GT/TT(突变型)高密度脂蛋白(HDL-C)升高(P<0.05)。结论 在新疆石河子地区绝经后女性2型糖尿病人群中,LRP5基因rs3736228、rs3781586位点的基因多态性可能与糖代谢无关,但LRP5基因rs3736228位点的突变可能与脂代谢(TG、HDL-C)、骨代谢(P、BMD)有关,rs3781586位点的突变可能与脂代谢(HDL)有关。

Objective To observe the characteristics of glucose, lipid and bone metabolism and bone mineral density (BMD)in postmenopausal women with type 2 diabetes mellitus (T2DM)in Shihezi district of Xinjiang province, and to investigate the relationship in the polymorphism and mutation of rs3736228 and rs3781586 of LRP5 gene and glucose,lipid and bone metabolism indexes in this population. Method A total of 136 postmenopausal Han women, who were related in the outpatient department, community, and hospital after hospitalization in Shihezi district of Xinjiang province from October 2016 to October 2017, were selected as the study subjects by the inclusion criteria and exclusion criteria.According to the patient's medicalhistory, glucosetolerance test results and bone mineral density (BMD), they were divided into 4 groups: normal glucose tolerance and normal bone mass (group A), normal glucose tolerance and abnormal bone mass (group B), type 2 diabetes and normal bone mass (group C), and type 2 diabetes mellitus and abnormal bone mass (group D). Baseline data such as patient's age, menopause years were measured and recorded, and body mass index (BMI)was calculated. Simultaneously, glucose metabolism indicators including fasting blood glucose (FBG, etc), bone metabolism indicators (blood Ca, etc), lipid metabolism indicators(triglycerides, etc)were detected. The polymorphisms of rs3736228 and rs3781586 of LRP5 gene were determined by Maldi-Tof-Ms and those data were analyzed statistically. Results ①Glucose metabolism index: compared with group A: FPG and HbAlc in group C, group D were all higher than group A (P<0.01). Lipid metabolism index: compared with group A, TG in group B and group D was lower than that in group A (P<0.05). Bone metabolism index: compared with group A, BMD (L1- 4)and BMD (femoral neck)in group B and group D were lower than those in group A (P<0.01). ②The distribution of SNP genotypes at rs3736228, rs3781586 of LRP5 conformsed to the Hardy-Weinberg genetic equilibrium law (P>0.05). The distribution frequency and allele frequency of LRP5 genotypes rs3736228, rs3781586 were compared among the groups. Pearson chi-square test showed no significant difference (P>0.05). ③Rs 3736228 locus of LRP5 gene:in group A, compared with CC (wild type), CT/TT (mutated type)triglyceride (TG)decreased (P<0.05), BMD (L1- 4)decreased (P<0.05). In group C, compared with CC (wild type), CT/TT (mutated type)high-density lipoprotein (HDL-C)increased (P<0.05), phosphorus increased (P<0.05). Rs 3781586 locus of LRP5 gene: in group B, compared with GG (wild type), GT/TT (mutated type)high-density lipoprotein (HDL-C)increased (P<0.05).Conclusion In the Xinjiang Shihezi district among postmenopausal women with type 2 diabetes, rs3736228, rs3781586 loci of LRP5 gene polymorphism may be irrelevant to glucose metabolism, but the mutation of rs3736228 of LRP5 gene locus may be related to lipid metabolism and bone metabolism (TG, HDL-C, BMD, P), and the mutation of rs3781586 may be related to lipid metabolism (HDL-C).

目的 探讨双靶点微创联合尼莫地平治疗丘脑出血破入脑室患者的安全性及对NIHSS评分的影响。方法 选择2017年1月—2020年1月期间本院收治的54例丘脑出血破入脑室患者作为研究资料,随机分组各27例,对照组行单纯侧脑室体外引流术治疗,观察组行立体定向下侧脑室联合丘脑血肿双靶点微创穿刺引流术治疗,均实施尼莫地平治疗,观察两组手术并发症,测定治疗不同阶段患者NIHSS评分、ADL评分、神经损伤指标、创伤应激指标变化。结果 并发症率比较,观察组7.41%低于对照组29.63%,P＜0.05;治疗后,观察组NSE、NGF、β-EP、Cor均降低,且低于对照组,P＜0.05;治疗后,观察组NIHSSL评分降低且低于对照组,ADL评分升高且高于对照组,P＜0.05。结论 针对丘脑出血破入脑室患者采取立体定向下侧脑室联合丘脑血肿双靶点微创穿刺引流术及尼莫地平治疗可进一步改善神经功能及生活质量,且手术安全性高,创伤应激恢复改善,神经损伤恢复快,并发症少,值得推广。

Objective To investigate the safety of double target minimally invasive surgery combined with nimodipine in the treatment of patients with thalamic hemorrhage breaking into ventricle and its influence on NIHSS score. Methods From January 2017 to January 2020, 54 patients with thalamic hemorrhage ruptured into ventricles in our hospital were selected as the research data, and they were randomly divided into 27 cases in each group. The control group was treated with external drainage of lateral ventricle alone, and the observation group was treated with stereotactic double target minimally invasive puncture and drainage of hypothalamic hematoma. The changes of NIHSS score, ADL score, nerve injury index and trauma stress index in different stages of treatment were determined. Results The complication rate of the observation group was 7.41%, lower than that of the control group 29.63%, P<0.05; after treatment, NSE, NGF, β-EP, Cor in the observation group were decreased, and lower than those in the control group, P<0.05; after treatment, NIHSSL score of the observation group was decreased, lower than that of the control group, ADL score was increased and higher than that of the control group, P<0.05. Conclusion For patients with thalamic hemorrhage breaking into ventricles, stereotactic double target minimally invasive puncture drainage combined with thalamic hematoma and nimodipine treatment may further improve the neurological function and patients’ quality of life, and the operation safety is high, the recovery of traumatic stress is improved, the recovery of nerve injury is quick, and the complications are less, which is worthy of promotion.

目的 研究氯吡格雷联合低分子肝素对老年急性心肌梗死(acute myocardial infarction, AMI)患者血清中血脂及炎性因子的影响,为临床AMI的治疗提供参考依据。方法 选取新乡医学院第一附属医院于2016年10月—2019年11月期间收治的老年AMI患者112例,按照随机分配的原则分成两组,即对照组和观察组,每组病例各56例,治疗方式为对照组单给予口服氯吡格雷进行治疗,观察组给予口服氯吡格雷与皮下注射低分子肝素联合治疗,比较治疗前后两组患者血清中甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDH-C),炎性因子的水平变化及心功能的改变情况。结果 与治疗前相比较,治疗后对照组和观察组患者血清TG、TC及LDH-C水平均降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平均降低,患者的左心室后壁厚度、左心室舒张末期内径均有降低,射血分数升高;而与对照组治疗后相比较,治疗后观察组患者血清TG、TC及LDH-C水平进一步降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平进一步降低,患者的左心室后壁厚度、左心室舒张末期内径均降低,而射血分数升高,差异有统计学意义。结论 氯吡格雷联合低分子量肝素可通过降低血清中血脂的水平,抑制AMI过程中的炎症反应,减少炎性因子的释放,提高患者的心功能,改善患者的病情。

Objective To explore the effects of clopidogrel combined with low molecular weight heparin on serum lipids and inflammatory factors in elderly patients with acute myocardial infarction, and provide reference for clinical treatment of AMI. Methods 112 elderly patients with AMI admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2016 to November 2019 were randomly divided into control group and observation group,56 cases in each group.The control group was treated with clopidogrel alone, and the observation group was treated with clopidogrel combined with low molecular weight heparin. The levels of serum TG, TC and LDH-C, inflammatory factors and cardiac function were compared between the two groups before and after treatment. Results Compared with before treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased in the observation group and the control group after treatment. The left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased in the observation group and control group after treatment. Compared with control group after treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased, the left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased further in observation group after treatment. Conclusion Clopidogrel combined with low molecular weight heparin may improve the patient's cardiac function, then improve the patient's condition through reducing the level of serum lipids, inhibit the inflammatory reaction in AMI, reduce the release of inflammatory factors.

目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.