目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 探讨治疗青年原发性高血压,联合使用硝苯地平控释片(CCB)与厄贝沙坦(ARB)对降压效果、肾功能及不良反应的影响。方法 2012年1月—2015年1月到我院就诊的青年原发性高血压患者共计180例。将患者按照首次就诊顺序编号,分为A、B两组各90例。A组患者CCB治疗,B组患者CCB联合ARB治疗。两周后比较两组患者降压效果、肾功能及不良反应发生率。结果 两组患者治疗前的收缩压、舒张压无差异(P>0.05); 治疗两周后,收缩压、舒张压均有下降,与治疗前相比,差异有统计学意义(P<0.05)。 B组患者血压下降幅度更大。两组患者间治疗后收缩压、舒张压的比较,差异具有统计学意义(P<0.05)。 两组患者治疗前24 h尿蛋白、24h尿白蛋白无显著性差异(P>0.05), 经两周治疗后,两项指标均有下降,与治疗前相比,差异有统计学意义(P<0.05)。 B组患者下降幅度更大。两组患者治疗后24 h尿蛋白、24 h尿白蛋白比较,差异有统计学意义(P<0.05)。 两组患者各项不良反应发生率均相当(P>0.05)。结论 在青年原发性高血压治疗中,联合使用CCB与ARB,能提高降压效果,改善肾功能,不增加不良反应,值得临床推广。

目的 探讨急性卒中合并医院获得性肺炎患者的病原学特点及药物敏感性情况。方法 回顾性分析116例急性卒中合并医院获得性肺炎患者临床资料,记录其病原菌分布特点;分析检出率最高的三种病原菌耐药情况。结果 ①此次入组的116例受试患者呼吸道分泌物样本中共分离出160株病原菌,其中革兰阳性菌50株(31.3%),革兰阴性菌88株(55.0%),真菌22株(13.8%);肺炎克雷伯菌、绿铜假单胞菌及金黄色葡萄球菌为分布构成比最大的前三位病原菌,构成比分别为17.5%、15.6%和12.5%;②三种常见病原菌均对万古霉素及利奈唑胺药物敏感性较高,可达100.0%;左氧氟沙星对金黄色葡萄球菌敏感性较高,但肺炎克雷伯菌及绿铜假单胞菌等革兰阴性菌对其耐药性较强;头孢唑林对肺炎克雷伯菌及绿铜假单胞菌敏感性较高。结论 急性卒中合并医院获得性肺炎患者多以革兰阴性菌为常见病原菌,肺炎克雷伯杆菌、铜绿假单胞菌及金黄色葡萄球菌最多见;病原菌对常见抗菌药物存在不同程度耐药性,需引起临床重视,根据病原学分析结果科学合理使用抗菌药物以提升治疗效果。

目的 探讨逍遥散治疗首发抑郁症的疗效与5-HT2A受体基因多态性的关联。方法 采用病例对照研究方法,以120例首发抑郁症患者(研究组)和120例正常人(对照组)为研究对象,研究组予逍遥散治疗,疗程8周。于治疗前后采用汉密顿抑郁量表评定。采用高温连接酶检测反应法(LDR)检测5-HT2A受体基因,分析其与抗抑郁药物疗效的关系。结果 5-HT2A受体基因(T102C)T／C基因型、C／C基因型频率及等位基因频率与对照组相比差异无统计学意义(P﹥0.05)。不同基因型的疗效无差异(P﹥0.05)。结论 5-HT2A受体基因(T102C)多态性与逍遥散治疗抑郁症的疗效无关联。

目的 探讨红细胞分布宽度(RDW)与老年重症社区获得性肺炎(CAP)患者病情严重程度及预后的相关性。方法 将103例老年重症CAP患者按照近期预后分为存活组(n=83例)及死亡组(n=20例),按照RDW的水平分为RDW≥14.5%组(n=83例)和RDW＜14.5%组(n=20例);记录患者的一般临床资料及相关实验室检查指标,比较各组之间的差异,并利用Logistic回归模型分析老年重症CAP患者近期死亡的危险因素。结果 死亡组中的患者入院APACHEⅡ评分、CRP、PCT、RDW水平均高于存活组,差异有统计学意义(P＜0.05)。RDW 异常率随着PSI 级别的增高而增高,RDW 异常率分别为PSIⅠ-Ⅱ级7.32%(3/41、 PSI Ⅲ级16.67%(6/36)、PSI Ⅳ级39.13%(9/23)、PSIⅤ级 66.67%(2/3),差异有统计学意义(P＜0.05)。Spearsman相关性分析显示:RDW与APACHEⅡ评分、CRP、PCT、PSI评分呈正相关(r_s分别为=0.353,0.363,0.432,0.362,P均＜0.05)。多因素Logistic回归分析显示: RDW(OR=2.024,P＜0.05)是老年重症CAP患者近期死亡的独立危险因素。结论 RDW水平随着老年重症CAP患者病情严重程度的增加而增加,RDW增高亦是患者近期死亡的高危因素。

目的 提高对精索静脉曲张合并同侧腹股沟隐匿性斜疝的认识。方法 2009年1月—2013年9月,3例左侧精索静脉曲张合并同侧腹股沟隐匿性斜疝患者经我科诊治,合并的隐匿性腹股沟斜疝术前均未能发现,其中2例患者在行经腹股沟精索静脉高位结扎时发现合并的隐匿性疝,同时行疝修补手术;另1例术后第2天发现再次行疝修补术,疝修补手术采用Bassini术式。结果 术后6个月电话随访,3例患者腹股沟疝无复发、无睾丸萎缩、鞘膜积液并发症。结论 精索静脉曲张合并腹股沟隐匿性疝少见,但临床工作中还是会遇到,需要提高对该疾病的认识,治疗方式存在一定争议。

Objective To improve the realization of the varicocele combined with ipsilateral concealed indirect hernia. Methods Three cases of the varicocele combined with ipsilateral concealed indirect hernia were treated in our department from January 2009 to September 2013. Combined ipsilateral concealed indirect hernia were not diagnosed before operation, 2 were found during the operation of spermatic vein ligation through the groin and received Bassini's hernia repair simultaneous, another found 2 days after operation and then received Bassini's hernia repair. Results No recurrence of hernia, testicular atrophy and hydrocele observed in the follow-up by phone 6 after months. Conclusion Varicocele combined with ipsilateral concealed indirect hernia is rare, we need to improve the understanding of this disease and the therapy is controversial.

目的 探讨年轻恶性肿瘤化疗女性的发病情况及保留生育功能和卵巢功能的意义。方法 回顾性分析和总结在我院行化疗的17～40岁年轻恶性肿瘤女性患者的年龄、肿瘤类别、构成等临床资料。结果 5年间在我院化疗的1261例女性恶性肿瘤患者中,年龄15～40岁者共786例(占62.3％),其中乳腺癌355例、大肠癌89例、白血病80例、宫颈癌67例、卵巢癌46例、恶性淋巴瘤39例,胃癌38例,肺癌30例,肝癌18例。15～25岁年龄段的女性恶性肿瘤化疗以白血病和卵巢癌为主。随年龄增长,大部分女性恶性肿瘤化疗的发生率增高。结论 15～40岁年轻恶性肿瘤化疗女性中乳腺癌占首位,其次为大肠癌、白血病和宫颈癌。保留年轻患者卵巢功能和生育功能的保守治疗具有重要意义。

Objective To analyze the clinical characteristics of malignant tumor in young women receiving chemotherapy aged from 15 to 40 and investigate the role of conservative treatment. Methods The clinical data of female aged from15 to 40 years old who were received chemotherapy in our hospital between 2010 and 2014 were retrospectively analyzed. Results 786 cases were identified from 1261 cases of malignant tumor receiving chemotherapy. Including 355 cases of breast cancer,89 cases of colorectal cancer,80 cases of leukemia,67 cases of cervical carcinoma,46 cases of ovarian cancer,39 cases of lymphoma,38 cases of gastric cancer,30 cases of lung cancer and 18 cases of liver cancer. Leukemia and ovarian cancer is the most common malignant tumor in young female between 15 to 25 years old. The cases of malignant tumor receiving chemotherapy increased with increasing age. Conclusion Breast cancer is the most common malignant tumor in young female receiving chemotherapy, followed by colorectal cancer, leukemia, and cervical carcinoma. It is very important to conserve young women's ovary function and fertility function.

目的 分析我院2011—2015年我院儿科住院患者下呼吸道病原菌分布及其耐药性。方法 采用全自动生化鉴定仪对痰标本分离株进行鉴定,用全自动微生物药敏系统和纸片扩散法对病原菌的耐药性进行检测,并用头孢硝噻吩纸片法对β-内酰胺酶进行检测。结果 2011—2015年共分离得到下呼吸道病原菌518株,包括肺炎链球菌(21.62%)、金黄色葡萄球菌(16.99%)、流感嗜血杆菌(14.48%)、肺炎克雷伯菌(11.97%)、大肠埃希菌(8.11%)、卡他莫拉菌(5.41%)、鲍曼不动杆菌(3.86%)和铜绿假单胞菌(3.86%)等。药敏结果显示,肺炎链球菌对克林霉素(90.18%)、红霉素(92.86%)和复方新诺明(87.50%)的耐药率较高,金黄色葡萄球菌则对青霉素G(90.91%)和红霉素(68.18%)有较强耐药性,未发现对万古霉素或利奈唑胺耐药的革兰阳性球菌。流感嗜血杆菌对氨苄西林耐药率为32%,与其β-内酰胺酶阳性率较一致,肺炎克雷伯菌和大肠埃希菌对头孢类药物(17.33%~45.33%)和喹诺酮类药物(34.67%~50.67%)耐药性较高,并发现1株碳青霉烯耐药的肺炎克雷伯菌。结论 本院下呼吸道感染病原菌谱较广,主要包括多种革兰阳性球菌和革兰阴性杆菌,并对多种抗菌药物表现出较强耐药性,临床应注重合理应用相关抗生素,严格防控病原菌的医院感染及传播。

Objective To analyze the antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric in patients. Methods Sputum bacterial isolates were identified by an automated biochemical identification system. Antimicrobial resistance was detected by an automated drug susceptibility detection system and the disc diffusion method. The β-lactamases was tested by the nitrocefin disc detection method. Results Five hundred and eighteen bacterial pathogens were isolated from sputum samples during 2011-2015, including streptococcus pneumoniae(21.62%), staphylococcus aureus(16.99%), haemophillus influenzae(14.48%), klebsiella pneumoniae(11.97%), escherichia coli(8.11%), moraxelle catarrhalis(3.8%), acinetobacter baumanii(3.86%) and pseudomonas aeruginosa(3.86%). High resistant rates were detected for S. pneumoniae to clindamycin(90.18%), erythromycin(92.86%) and sulfamethoxazole (85.50%), while S. aureus was highly resistant to penicillin G(90.91%) and erythromycin(68.18%). Resistance to vancomycin and linezolid was not detected for gram positive cocci. The resistant rate to ampicillin was 32% for H. influenzae, which was in concordance with the production of β-lactamases. Relatively high resistance was detected for K. pneumoniae and E. coli to cephalosporins and quinolones. A carbapenem-resistant K. pneumoniae isolate was also detected. Conclusion Multiple bacterial species were isolated from lower respiratory tract infections in our hospital, including different species of gram positive cocci and gram negative bacilli, and these isolates exhibited high resistance to antibiotics tested. The clinical use of antibiotics and hospital infection and transmission of these pathogens should be controlled.

目的 探讨脑钠肽(BNP)在协助判断肺结核合并呼吸衰竭疗效及预后的价值。方法 2013年1月—2014年12月我院收治初治菌阳肺结核合并呼衰共81例,分别在抗结核、呼衰治疗前及2 周末行BNP、动脉血气分析及胸部X线检查;按住院号对应随机数字表随机抽取我院同期初治菌阳肺结核无合并呼衰104例作为对照组,采集两组数据进行回顾性病例对照研究。结果 肺结核合并呼衰BNP高于单纯肺结核11.4倍(1115.11 pg/mL比97.60 pg/mL),全肺结核高于非全肺结核3.4倍(1549.82 pg/mL比449.47 pg/mL)。治疗前BNP与PaO₂、SaO₂和pH值呈负相关,与PaCO₂呈正相关,治疗后两者无相关性。2周末 BNP是治疗前0.57倍(632.41 pg/mL比1115.11 pg/mL),死亡组高于存活组8.7倍(3119.63 pg/mL比359.84 pg/mL)。结论 肺结核合并呼衰BNP升高,治疗后随病情好转持续下降,有可能成为协助判断疗效及估测预后的指标之一。

Objective Discussion about value of brain natriuretic peptide (BNP) in helping to determine the efficacy and prognostic of pulmonary tuberculosis combine with respiratory failure. Methods 81 cases were admitted from January 2013 to December 2014 in our hospital of early treatment sputum positive pulmonary tuberculosis with respiratory failure. And the cases were carried out BNP, arterial blood gas analysis and chest X-ray before treatment and after two weeks respectively.104 cases of earlier sputum positive pulmonary tuberculosis accompanied with respiratory failure were randomly drawn according to the corresponding random number of hospitalization as a control group. Two sets of data were collected to conduct retrospective case-control study. Results BNP of pulmonary tuberculosis combine with respiratory failure is 11.4 times higher than that of tuberculosis alone (1115.11 pg/mL compare 97.60 pg/mL), the whole TB is 3.4 times higher than non-full-tuberculosis (1549.82 pg/mL t compare 449.47 pg/mL). Before treatment, BNP was negatively correlated to PaO₂, SaO₂ and pH BNP was positively correlated with PaCO₂. There was no correlation after treatment between BNP and PaCO₂.After two weeks BNP is 0.57 times of the pre-treatment (632.41 pg/mL compared 1115.11 pg/mL). The group of death is 8.7 times higher than the survival group (3119.63 pg/mL compared 359.84 pg/mL). Conclusion BNP was significantly increased in patient accompanied tuberculosis with respiratory failure .The condition is continued to decline after treatment. There is likely to be one of the indicators of helping to determine the efficacy and estimate prognosis.

目的 探索内源性神经干细胞在大鼠海马可溶性因子中的体外发育归宿及分化鉴定。方法 显微镜下分离Wistar大鼠海马组织放置于低温DMEM/12培养基,低温振荡2小时后高速离心(15000 g),获取实验所用海马组织可溶性因子。取材出生1天的Wistar乳鼠海马中的内源性神经干细胞(endogenous neural stem cells, ENSCs),将ENSCs分别于含海马可溶性因子终浓度为0(对照组)、50、100、200、400 μl/mL的无血清DMEM/F12培养基中培养6天并每日观察,使用免疫细胞化学、Western Blot印记技术比较各组ENSCs中Nestin、CD133的表达量;同时计量并比较各组ENSCs成球个数,以探索在模拟颅内微环境情况下,ENSCs发育、归宿及分化。进一步于最适宜的海马可溶性因子终浓度中分化神经球,对分化的细胞行神经元特异性蛋白入(如:β-tubullin III、MAP2)及胶质细胞特异性蛋白(如:GFAP、S100及p75 NGFR)免疫细胞化学检测。结果 大鼠ENSCs在培养基中呈单细胞漂浮生长,球形; ENSCs于海马可溶性因子各实验分组中培养第2天呈细胞球状态,对照组中无细胞球形成(与100 μl/mL组比较,P₁=0.00),100 μl/mL组与对照组比较有统计学意义(P₁=0.00<0.05);至第6天,在100 μl/mL组中的细胞球数量明显多于其余各组(P₁'=P₂'=P₃'=P₄'=0.00)。在免疫细胞化学检测中,100 μl/mL组中细胞球表达干细胞高亲和蛋白Nestin、CD133阳性,Western Blot免疫印迹检测其中Nestin、CD133蛋白高于对照组。进一步分化试验中,细胞球呈贴壁生长的单细胞状态、有突起伸出、长梭形,免疫细胞化学检测分化的细胞表达胶质细胞特异性蛋白GFAP、S100、p75NGFR阳性,但不表达神经元特异性蛋白β-tubullin III与MAP2。结论 大鼠ENSCs在终浓度为100 μl/mL的HSF作用下,可促进 ENSCs的增殖分裂;ENSCs在同样浓度下的HSF中可进一步分化为表达GFAP、S100、p75NGFR阳性的胶质样细胞;100 μl/mL的HSFS是ENSCs的一种生理性诱导剂或参与促进ENSCs增殖、分化及通过细胞替代或因子分泌等机制修复神经损伤。

Objective The aim of this study was to explore induction and differentiation of endogenous neural stem cells(ENSCs) in the hippocampus soluble factors(HSF) from the hippocampus of adult Wistar rats by mimicking an intracranial microenvironment. Methods After Wistar rats sacrificed, the hippocampus tissue was obtained in cold DMEM/F12. After centrigued and filtered, the HSF was stored at -20℃. The ENSCs was obtained from the hippocampus tissue of a neonate Wistar rat. Collected the tissue, digested and obtained the ENSCs. After we observed the morphology, the ENSCs were cultured in different concentration (0、50、100、200、400 μl/mL) of HSF for 6 days, and compared the expression of Nestin and CD133 by immunocytochemistry. Meanwhile,we compared the Nestin and CD133 protein by western blot. And then we explored the optimal concentration of HSF by the numbers of all groups on the second and sixth day. Furthermore, we did the differentiated experiment using the same concentration of HSF. Results The number of neurospheres in the 100 μg/mL group was significantly higher than those in the other groups on the 6th day. Immunofluorescence revealed that the neurospheres from ENSCs in the 100 μg/mL group more highly expressed nestin and CD133 than control. This result was confirmed by western blot analysis. The neurospheres can differentiate into glia-like cells in 100 μg/mL HSF and 1% FBS expressing GFAP, S100 and P75 NGFR by immunofluorescence. Conclusion These data indicated that HSF alone, mimicking a destination of ENSCs in vitro, could induce and differentiate neurospheres from ENSCs, as a new method to get NSCs and glia-like cells differentiated from ENCs to repair the diseases of center nervous system.