目的   采用两样本孟德尔随机化以及Meta分析研究趋化因子C-X3-C基序配体1（CX3CL1）表达水平与系统性红斑狼疮（SLE）发病风险的因果关系。方法   获取CX3CL1表达水平与SLE的全基因组关联研究（GWAS）数据，将单核苷酸多态性（SNP）作为工具变量并选择敏感的SNPs进行分析。通过逆方差加权法（IVW）、加权中位数法（WM）、MR-Egger回归法进行两样本MR分析，以OR值评估CX3CL1表达水平与SLE之间的因果关系，并对结果进行异质性和多效性检验。最后利用R软件Meta包进行Meta分析。利用coloc包进行共定位分析。结果   纳入9个SLE作为结局变量，其中4个变量ebi-a-GCST90018917（OR=2.14，95%CI：1.50~3.06），ebi-a-GCST003156（OR=2.25，95%CI：1.00~5.06），ebi-a-GCST90014238（OR=3.02，95%CI：1.54~5.94），finn-b-SLE_NOS（OR=1.81，95%CI：1.01~3.22）表明CX3CL1表达水平与SLE之间存在因果关系。关于 OR 95% CI 的森林图显示 SLE 患者的CX3CL1表达水平显著高于健康人群（OR=1.87，95%CI：1.53~2.29，P＜0.001）。共定位分析结果提示CX3CL1表达水平和SLE表型之间有共享的遗传变异位点（rs170364）。结论  CX3CL1表达水平与SLE存在正向因果关系，CX3CL1表达水平的升高使得SLE的发病风险升高。

       Objective  To investigate the causal  relationship  between CX3CL1 levels and the  risk of  systemic lupus erythematosus（SLE）using two-sample Mendelian randomization and Meta-analysis methods．Methods  Genome-Wide Association Study（GWAS）data for CX3CL1 levels and SLE were obtained．Single nucleotide polymorphisms（SNPs）were used as instrumental variables，and sensitive SNPs were selected for analysis．Two-sample Mendelian  randomization was performed using the inverse variance weighted（IVW）method，weighted median（WM）method，and MR-Egger  regression to evaluate the causal relationship between CX3CL1 levels and SLE，with OR values assessing this relationship．Heterogeneity and pleiotropy tests were conducted on the results．Meta-analysis was performed using the Meta package in R software，and colocalization analysis was conducted using the coloc package．Results  Nine SLE outcomes were included as outcome variables，with four variables（ebi-a-GCST90018917［OR=2.14，95%CI：1.50-3.06］，ebi-a-GCST003156［OR=2.25，95%CI：1.00-5.06］，ebi-a-GCST90014238［OR=3.02，95%CI：1.54-5.94］，finn-b-SLE_NOS［OR=1.81，95%CI：1.01-3.22］）indicating a causal relationship between CX3CL1 expression levels and SLE．The forest plot for OR 95%CI showed that CX3CL1 expression levels in SLE patients were significantly higher than in healthy individuals（OR=1.87［95%CI：1.53-2.29］，P＜0.001）．Colocalization analysis suggested that there was shared genetic variation sites（rs170364）between CX3CL1 expression levels and SLE phenotype．Conclusions  There is a positive causal relationship between CX3CL1 expression levels and SLE，with increased CX3CL1 levels elevating the risk of developing SLE．

目的 探究本体感觉神经肌肉促进疗法（PNF）技术与居家远程康复治疗对缺血性脑卒中患者凝血功能、平衡状态的影响。方法 选择2023年1月—2024年1月在宁乡市中医医院择期治疗的60例缺血性脑卒中患者为研究对象。按照患者选择的治疗方案进行分组, 观察组接受PNF技术联合居家远程康复指导治疗, 对照组接受常规居家远程康复指导治疗。记录疗效、凝血功能、神经功能缺损症状。结果 凝血功能方面,观察组治疗后活化部分凝血酶时间（APTT）、凝血酶原时间（PT）高于治疗前, 二聚体（D-D）、纤维蛋白原（FIB）低于治疗前,组间比较差异有统计学意义（P<0.05）。与对照组相比, 观察组的APTT、PT、D-D、FIB指标相近,组间比较差异无统计意义（P>0.05）。治疗后, 观察组平衡功能（BBS）评分比治疗前高, 组间比较差异有统计学意义（P<0.05）。观察组BBS评分、FMA评分、肌力等级更高, 组间比较差异有统计学意义（P<0.05）。结论 PNF技术+居家远程康复指导治疗可作为缺血性脑卒中患者治疗的有效手段。联合治疗后凝血功能、平衡状态、肢体功能状况、肌力明显改善, 可见联合治疗对于减轻患者病情尤为明显。

Objective To explore the effects of proprioceptive neuromuscular facilitation（PNF）and home-based remote rehabilitation on coagulation function and balance function in patients with ischemic stroke．Methods From January 2023 to January 2024, 60 patients with ischemic stroke were selected from our hospital．The patients were divided into two groups according to the treatment plan chosen by themselves．The patients in the observation group received PNF technology combined with home-based remote rehabilitation guidance, while the patients in the control group received routine home-based remote rehabilitation guidance．The curative effect, coagulation function and neurological deficit were recorded．Results After treatment, activated partial thrombin time（APTT）and prothrombin time（PT）were significantly higher, D-dimer（D-D）and fibrinogen（FIB）were significantly lower in the observation group than those before treatment（P<0.05）．Compared with the control group, the APTT, PT, D-D and FIB of the observation group were similar, and there was no significant difference between the two groups（P>0.05）．After treatment, the Berg Balance Scale score of the observation group was higher than that before treatment, and there was significant difference between the two groups（P<0.05）．The Berg Balance Scale score, Fugl-Meyer Assessment score and muscle strength grade of observation group were higher than those of control group（P<0.05）．Conclusions PNF combined with home-based remote rehabilitation can be used as an effective method for the treatment of patients with ischemic stroke．The coagulation function, balance, extremity function and muscle strength were significantly improved after combined treatment, which indicated that the combined treatment was especially effective in relieving the patients’ symptoms．

心肌梗死是由冠状动脉阻塞所引起的心肌缺氧坏死,其发病率和病死率居高不下。近年研究发现,利用组织工程手段仿生构建心肌微环境能有效改善心肌梗死区微环境,对心肌的再生能力有着重要的调控作用,能在一定程度上促进心肌再生,有望成为将来治疗心肌梗死的新方向。然而,由于对仿生心肌微环境和机体微环境交互作用、引发的生物学效应及作用机制不清楚,直接影响心肌损伤修复的过程和质量。因此,阐明仿生心肌微环境在心肌损伤修复过程中的交互作用过程及其介导的生物学效应迫在眉睫。该文系统性综述了仿生心肌微环境的构建策略及植入体内后介导的生物学效应,包括免疫调控效应、促血管再生效应以及再生协同效应等,为新型心肌补片的仿生设计和临床应用提供理论支持。

Myocardial infarction（MI）,arising from coronary artery obstruction resulting in hypoxic necrosis of myocardium,remains high morbidity and mortality．Recent studies have revealed that constructing myocardial microenvironment bionically through tissue engineering methods can effectively ameliorate the microenvironment in the infarcted area and exert a crucial regulatory role in myocardial regeneration,which promotes myocardial regeneration to a certain extent and holds promise for the treatment of MI．However,the interaction between biomimetic myocardial microenvironment and host microenvironment,as well as the triggered biological effects and mechanisms are not clear,which directly affects the process and quality of myocardial repair．Therefore,it is urgent to clarify the interaction process and biological effects mediated by the biomimetic myocardial microenvironment during myocardial repair．This review systematically summarizes the construction strategies of biomimetic myocardial microenvironment and their mediated biological effects after implantation,including immunomodulatory effects,pro-vascular regenerative effects,and regenerative synergistic effects,which provides theoretical support for the biomimetic design and clinical application of novel cardiac patches．

目的 探究改良Miccoli手术治疗单侧甲状腺癌（TC）患者的效果及其对机体创伤应激反应的影响。方法 选取新密市中医院200例单侧TC患者（2021年3月—2023年3月）,按随机数字表法分两组。A组100例接受改良Miccoli手术治疗,B组100例接受开放根治术（OT）治疗。对比两组围术期指标、喉返神经损伤发生情况、美学效果、手术前后肿瘤指标[细胞角蛋白19片段抗原（Cyfra21.1）、半乳糖凝集素3（Gal-3）、可溶性白细胞介素-2受体（sIL-2R）]、创伤应激反应指标[去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cor）]水平。结果 A组切口长度为（2.05±0.13）cm,短于B组的（7.11±0.49）cm,住院及手术用时分别为（3.12±0.44）d、（53.48±7.52）min,均短于B组的（5.22±0.81）d、（76.81±11.39）min,术中失血量、引流量分别为（19.24±2.66）mL、（21.47±3.41）mL,均少于B组的（45.08±5.75）mL、（64.82±7.24）mL,组间比较差异有统计学意义（P<0.05）;A组喉返神经损伤总发生率为2.00%（2/100）,低于B组的12.00%（12/100）,组间比较差异有统计学意义（P<0.05）;A组美容总满意度为97.00%（97/100）,高于B组的73.00%（73/100）,差异有统计学意义（P<0.05）;A组术后3个月血清Cyfra21.1、Gal-3水平分别为（1.78±0.26）ng/mL、（6.14±1.64）ng/mL,均高于B组的（1.55±0.21）ng/mL、（5.39±1.28）ng/mL,血清sIL-2R水平为（375.36±20.12）μg/mL,低于B组的（427.13±23.18）μg/mL,组间比较差异有统计学意义（P<0.05）;A组术后1 d血清NE、E、Cor水平分别为（0.73±0.17）mmol/L、（0.49±0.10）mmol/L、（185.46±22.95）μg/L,均低于B组的（0.96±0.19）mmol/L、（0.81±0.22）mmol/L、（272.53±32.41）μg/L,组间比较差异有统计学意义（P<0.05）。结论 相较于OT治疗单侧TC患者,经改良Miccoli手术治疗更有助于提升美学效果,减少喉返神经损伤,优化围术期指标,抑制肿瘤进展,且机体产生的创伤应激反应更轻微。

Objective To investigate the effect of modified Miccoli surgery on patients with unilateral thyroid cancer（TC）and its impact on the body’s traumatic stress response．Methods The data of 200 patients with unilateral TC in Xinmi City Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were retrospectively collected and divided into two groups according to different surgical protocols．A hundred patients treated with modified Miccoli surgery were classified as group A and 100 patients treated with open radical surgery（OT）were classified as group B．The perioperative indicators,incidence of recurrent laryngeal nerve injury,aesthetic effect,as well as tumor indicators [cytokeratin 19 fragment antigen（Cyfra21.1）,galectin-3（Gal-3）,soluble interleukin -2 receptor（sIL-2R）] and trauma stress response indicators [norepinephrine（NE）,epinephrine（E）,and cortisol（Cor）] before and after surgery were compared between the two groups．Results The incision length of group A was（2.05±0.13）cm,which was shorter than that of group B [（7.11±0.49）cm]．The duration of hospitalization and operation of group A were（3.12±0.44）d and（53.48±7.52）min,respectively,which were shorter than those of group B [（5.22±0.81）d and（76.81±11.39）min]．The intraoperative blood loss and drainage volume were（19.24±2.66）mL and（21.47±3.41）mL,respectively,which were lower than those in group B [（45.08±5.75）mL and（64.82±7.24）mL],and the difference was statistically significant（P<0.05）．The total incidence of recurrent laryngeal nerve injury in group A was 2.00%（2/100）,lower than that in group B [12.00%（12/100）],and the difference was statistically significant（P<0.05）．The total satisfaction of group A was 97.00%（97/100）,higher than that of group B [73.00%（73/100）],and the difference was statistically significant（P<0.05）．Serum Cyfra21.1 and Gal-3 levels in group A were（1.78±0.26）ng/mL and（6.14±1.64）ng/mL,respectively,higher than those in group B [（1.55±0.21）ng/mL and（5.39±1.28）ng/mL]．Serum sIL-2R level was（375.36±20.12）μg/mL,lower than that of group B [（427.13±23.18）μg/mL],and the difference was statistically significant（P<0.05）．The serum levels of NE,E and Cor in group A were（0.73±0.17）mmol/L,（0.49±0.10）mmol/L and（185.46±22.95）μg/L,respectively．They were lower than（0.96±0.19）mmol/L,（0.81±0.22）mmol/L and（272.53±32.41）μg/L in group B,and the differences were statistically significant（P<0.05）．Conclusions Compared to OT treatment for unilateral TC patients,the modified Miccoli surgery is more helpful in improving aesthetic effects,reducing damage to the recurrent laryngeal nerve,optimizing perioperative indicators,inhibiting tumor progression,and producing less traumatic stress response to the body．

目的 探讨血清胱抑素C（SCys-C）、同型半胱氨酸（Hcy）及尿微量白蛋白（UmAlb）在高血压患者肾损害早期评估中的应用价值。方法 选择2022年9月—2023年9月期间福建中医药大学附属第三人民医院接收的150例高血压患者作为观察组,另选择健康体检者150例为对照组,测定肾小球滤过率（GFR）、SCys-C、Hcy、UmAlb,比较不同血压程度及对照组的各指标水平,比较观察组各指标检测阳性率及诊断符合率,依据GFR值评估肾损害程度,比较不同肾损害程度患者的SCys-C、Hcy、UmAlb水平。结果 高血压2级、高血压3级患者SCys-C、Hcy、UmAlb水平高于高血压1级患者（t=5.255、10.976、21.578,P<0.05;t=7.378、18.012、23.708,P<0.05）及对照组患者（t=8.308、19.675、31.891,P<0.05;t=10.661、31.511、21.578,P<0.05）,高血压3级患者高于高血压2级患者（t=2.776、12.725、7.779,P<0.05）。观察组肾损害患者SCys-C、Hcy、UmAlb的阳性率79.41%、73.53%、83.82%高于无肾损害患者的阳性率6.10%、4.88%、6.10%（χ²=83.733、76.040、92.613,P<0.05）。观察组中重度肾损害、轻度肾损害患者的SCys-C、Hcy、UmAlb水平高于无损害患者（t=7.567、24.214、30.836,P<0.05;t=5.783、16.054、25.164,P<0.05）,中重度肾损害高于轻度肾损害患者（t=2.685、7.179、9.561,P<0.05）。结论 高血压分级越高患者的SCys-C、Hcy、UmAlb水平越高,各指标联合检测的阳性率高,而且SCys-C、Hcy、UmAlb水平越高,肾损害程度越严重。

Objective To explore the application value of serum cystatin C（SCys-C）,homocysteine（Hcy） and urinary microalbumin（UmAlb）in early assessment of renal damage in hypertensive patients．Methods A total of 150 hypertensive patients admitted to the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from September 2022 to September 2023 were selected as the observation group,and 150 healthy individuals were selected as the control group．Glomerular filtration rate（GFR）,serum cystatin C（SCys-C）,homocysteine（Hcy）,and UmAlb were measured,and the levels of various indicators in different blood pressure levels and the control group were compared．The positive rate and diagnostic accuracy of each indicator in the observation group were compared,and the degree of renal damage was evaluated based on GFR values．The levels of SCys-C,Hcy and UmAlb in patients with different degrees of renal damage were compared．Results The levels of SCys-C,Hcy and UmAlb in patients with grade 2 and grade 3 hypertension were significantly higher than those in patients with grade 1 hypertension（t=5.255,10.976,21.578,P<0.05;t=7.378,18.012,23.708,P<0.05）,as well as in the control group（t=8.308,19.675,31.891,P<0.05;t=10.661,31.511,21.578,P<0.05）,patients with grade 3 hypertension were significantly higher than those with grade 2 hypertension（t=2.776,12.725,7.779,P<0.05）．The positive rates of SCys-C,Hcy and UmAlb in patients with renal injury in the observation group were 79.41%,73.53% and 83.82%,which were significantly higher than the positive rates of 6.10%,4.88% and 6.10% in patients without renal injury（χ²=83.733,76.040,92.613,P<0.05）．The levels of SCys-C,Hcy and UmAlb in patients with severe and mild kidney damage in the observation group were significantly higher than those in patients without damage（t=7.567,24.214,30.836,P<0.05;t=5.783,16.054,25.164,P<0.05）,patients with moderate to severe kidney damage were significantly higher than those with mild kidney damage（t=2.685,7.179,9.561,P<0.05）．Conclusions The higher the grading of hypertension,the higher the levels of SCys-C,Hcy and UmAlb in patients,and the higher the positive rate of combined detection of various indicators．Moreover,the higher the levels of SCys-C,Hcy and UmAlb,the more severe the renal damage．

目的 研究同轴微导管聚乙烯醇颗粒（PVA）栓塞治疗动脉性下消化道出血患者的应用效果。方法 本研究为前瞻性研究,选择河南科技大学第一附属医院2022年1月—2023年6月收治的118例动脉性下消化道出血患者为研究对象,以计算机随机分组法将其分为常规组和试验组,各59例。两组均行数字减影血管造影检查明确出血情况,常规组予以内镜下注射止血治疗,试验组经同轴微导管PVA栓塞进行止血治疗,比较两组患者的治疗效果及预后情况。结果 在不同治疗方案下,试验组的技术成功率、临床成功率分别为89.83%（53/59）、84.75%（50/59）,均高于常规组[71.19%（42/59）、64.41%（38/59）]（χ²=11.071、10.911,P<0.05）;试验组的止血时间、凝血酶原时间（PT）、凝血酶时间（TT）分别为（50.25±10.37）min、（10.25±2.31）s、（16.33±4.47）s,均低于常规组[（55.36±10.72）min、（12.44±3.61）s、（19.35±4.23）s]（t=2.632、3.925、3.769,P<0.05）;试验组治疗后的动脉搏动指数（PI）、阻力指数（RI）分别为（1.12±0.33）（0.51±0.21）,均低于常规组[（1.65±0.41）（0.73±0.22）]（t=7.735、5.556,P<0.05）;试验组治疗7、14、30 d后的再出血率分别为5.08%（3/59）、8.47%（5/59）、10.17%（6/59）,均低于常规组[20.34%（12/59）、25.42%（15/59）、28.81%（17/59）]（χ²=10.495、10.207、11.071,P<0.05）;试验组的并发症发生率8.47%（5/59）低于常规组22.03%（13/59）,差异均具有统计学意义（χ²=7.113,P<0.05）。结论 与常规内镜下止血相比,同轴微导管PVA栓塞可显著提升动脉性下消化道出血患者的止血成功率,对缩短患者止血时间、促进凝血系统恢复、降低再出血风险及相关并发症发生风险均有积极意义。

Objective To study the effect of coaxial microcatheter PVA embolization in the treatment of patients with arterial lower gastrointestinal bleeding．Methods This study is a prospective study,118 patients with arterial lower gastrointestinal bleeding admitted between January 2022 and June 2023 were selected as the study subjects．They were randomly divided into a conventional group（59 cases）and an experimental group（59 cases）using computer randomization．Both groups underwent digital subtraction angiography examination to determine the bleeding situation．The conventional group received conventional endoscopic hemostasis treatment,while the experimental group received coaxial microcatheter PVA embolization for hemostasis treatment．The treatment efficacy and prognosis were compared between two groups．Results Under different treatment plans,the technical success rate and clinical success rate of the experimental group were 89.83%（53/59）and 84.75%（50/59）,respectively,which were higher than those of the conventional group [71.19%（42/59）and 64.41%（38/59）]（χ²=11.071、10.911,P<0.05）．The hemostatic time,PT,and TT of the experimental group were（50.25±10.37）min,（10.25±2.31）seconds,and（16.33±4.47）seconds,respectively,which were shorter than those of the conventional group [（55.36±10.72）min,（12.44±3.61）seconds,and（19.35±4.23）seconds]（t=2.632、3.925、3.769,P<0.05）．The arterial PI and RI of the experimental group after treatment were（1.12±0.33） and（0.51±0.21）,lower than those of the conventional group [（1.65±0.41）and（0.73±0.22）]（t=7.735、5.556,P<0.05）．The rebleeding rates of the experimental group after 7 days,14 days and 30 days of treatment were 5.08%（3/59）,8.47%（5/59） and 10.17%（6/59）,respectively,which were lower than those of the conventional group [20.34%（12/59）,25.42%（15/59） and 28.81%（17/59）]（χ²=10.495,10.207,11.071,P<0.05）．The incidence of complications in the experimental group was 8.47%（5/59）,which was lower than that in the conventional group 22.03%（13/59）（χ²=7.113,P<0.05）．Conclusions Compared with conventional endoscopic hemostasis,coaxial microcatheter PVA embolization can significantly improve the success rate of hemostasis in patients with arterial lower gastrointestinal bleeding,shorten the hemostasis time,promote coagulation system recovery,reduce the risk of rebleeding and related complications,with a positive significance．

目的 探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法 选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者,均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查;以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能;分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性;比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果 DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P<0.05）;CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较,差异均无统计学意义（P>0.05）。在HCC MVI诊断效能中,CT、MRI影像学表现与术后病理确诊结果之间为中度一致性;DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P<0.05）。在不同b值（400、800、1 000、1 500 s/mm²）下,HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P<0.05）。结论 CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能,而MRI诊断结果与病理诊断一致性更佳,尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯,有助于指导临床医生建立“个体化”精准诊疗策略。

Objective To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024,all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen;postoperative pathology Results was used as the diagnostic gold standard．The diagnostic efficacy of CT,MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT,MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity,specificity,accuracy,positive predictive value,negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P<0.05）;none of the differences were statistically significant（P>0.05）in the comparison of diagnostic effectiveness of CT,MRI,and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness,moderate concordance was found among CT,MRI imaging phenotypes and postoperative pathology Results;high concordance was found between DWI and postoperative pathology Results．In HCC MVI patients,the proportion of non-marginal arterial reinforcement,enhanced envelope,halo reinforcement,nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P<0.05）．At different b-values（400,800,1 000,1 500 s/mm²）,ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P<0.05）．Conclusions CT,MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI,while MRI diagnostic Results are in better concordance with pathologic diagnosis．In particular,ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC,which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

目的 对入住重症监护病房（ICU）重症孕产妇患者的病种特征和住院费用进行分析。方法 从医院信息管理系统中搜索2009—2019年广州市某省级重症孕产妇救治中心ICU的重症孕产妇住院病例,对病例资料进行描述性流行病学分析。结果 2009—2019年该救治中心ICU共收治重症孕产妇1 616例,病种排名前五位依次为心血管疾病430例（26.61%）、血液及造血器官疾病310例（19.18%）、妊娠期特定并发疾病287例（17.76%）、消化系统疾病218例（13.49%）、呼吸系统疾病110例（6.81%）。患者经济负担中位数排名前五位依次为肌肉骨骼系统和结缔组织疾病（62 252.60元）、消化系统疾病（61 684.41元）、感染性疾病（42 945.70元）、血液及造血器官疾病（40 403.52元）、神经系统疾病（40 055.93元）。结论 入住ICU内的重症孕产妇以心血管疾病、血液及造血器官疾病为主,经济学分析表明肌肉骨骼系统和结缔组织疾病造成的经济损失较大。

Objective To analyze the disease characteristics and hospitalization expenses of critically ill maternal patients in intensive care unit（ICU）．Methods Hospitalized cases of severe maternal disease in ICU of a provincial critical care center in Guangzhou from 2009 to 2019 were searched from the hospital information management system,and case data was analyzed by descriptive epidemiology．Results From 2009 to 2019,a total of 1616 critically ill maternal patients received intensive care treatment at this center．The predominant diseases observed were cardiovascular disorders（26.61%）,blood and hematopoietic organ diseases（19.18%）,specific pregnancy-related complications（17.76%）,gastrointestinal ailments（13.49%）,and respiratory disorders（6.81%）．Among the top five patient groups,the median economic burden was the highest in musculoskeletal system and connective tissue diseases（62 252.600 yuan）,followed by digestive system diseases（61 684.410 yuan）,infectious diseases（42 945.700 yuan）,blood and hematopoietic organ diseases（40 403.515 yuan）,and nervous system disorders（40 055.930 yuan）．Furthermore,a discernible correlation between hospitalization cost and length of stay was identified．Conclusions Cardiovascular diseases and disorders of blood and hematopoietic organs are the primary causes for maternal admissions to ICU．Economic analysis shows that musculoskeletal system and connective tissues diseases cause bigger economic loss ．

目的 构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型,帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险,并制定更合适的治疗策略。方法 回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料,结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量,再采用多因素分析确定独立预后因素,并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果 APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860）,Hosmer-Lemeshow 检验P=0.604,校准曲线和标准曲线高度重合,表明该模型具有良好的区分度和校准度。同时,DCA曲线显示,预测模型在大部分的阈值概率范围内提供了显著的净收益。结论 本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险,有助于临床医生制定更合适的个体化治疗策略。

Objective To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD）,enabling clinicians to more precisely evaluate mortality risk in TBAD patients during the acute stage and to devise better treatment plans．Methods This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2,focusing on mortality within 14 days of the acute phase in TBAD patients． Initially,the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection,and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model's effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve,calibration curve,and Decision Curve Analysis（DCA）．Results Acute Physidogy Score Ⅲ score,total carbon dioxide,and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860）,with a Hosmer-Lemeshow test P-value of 0.604． The close alignment of the calibration and standard curves suggested the model's strong discriminative power and calibration． Furthermore,the DCA curve revealed that the predictive model offered substantial net benefits within a wide range of threshold probabilities．Conclusions This study's nomogram,developed using APS Ⅲ score,total carbon dioxide,and red blood cell distribution width,accurately predicts the 14-day mortality risk in TBAD patients,assisting clinicians in creating better personalized treatment plans．

目的 探讨宣清导浊汤加减方联合血液透析治疗对老年慢性肾衰竭（CRF）患者肾功能、微炎症状态和毒素清除率的影响。方法 回顾性选取2019年10月—2022年10月我院收治的82例老年CRF患者,将其根据治疗方法分为联合组与单一组,每组41例。单一组仅采取血液透析治疗,联合组联合宣清导浊汤加减方治疗,对比两组患者治疗前后中医证候积分、毒素清除率、炎症因子变化。结果 治疗后,两组患者口淡不渴、肢体麻木、腰膝酸软、倦怠乏力、食少纳呆以及面色晦暗相关中医证候积分均降低,且联合组低于单一组（P<0.05）;治疗后两组患者血肌酐、尿素氮、血β₂-微球蛋白均降低,联合组低于单一组（P<0.05）;治疗后两组患者白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α炎性因子水平明显降低,且联合组更低（P<0.05）。两组在治疗期间均无不良反应。结论 宣清导浊汤加减方联合血液透析治疗老年CRF患者效果较佳,可通过降低机体炎症因子表达水平、提高毒素清除率来改善患者临床症状,且不会增加不良反应。

Objective To explore the effect of Xuanqing Daozhuo Decoction modified formula combined with hemodialysis treatment on renal function,micro inflammatory status,and toxin clearance rate in elderly patients with chronic renal failure（CRF）．Methods Retrospectively,82 elderly CRF patients admitted to our hospital from October 2019 to October 2022 were selected and divided into a combination group and a single group according to the treatment methods,with 41 cases in each group． The single group was treated with hemodialysis only,and the combined group was treated with Xuanqing Daozhuo Decoction modified formula additionally．The changes of TCM syndrome scores,toxin clearance rate and inflammatory factors before and after treatment were compared between the two groups．Results After treatment,the scores of TCM syndroms including tasteless mouth and no thirst,numbness of limbs,soreness and weakness of waist and knee,fatigue,poor appetite and sluggish stomach were all decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,serum creatinine,blood urea nitrogen and β₂-microglobulin were decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,the levels of interleukin-6,C-reactive protein and tumor necrosis factor-α inflammatory factors were significantly decreased in 2 groups,which were lower in combination group（P<0.05）．The two groups had no adverse effects during the treatment period．Conclusions Xuanqing Daozhuo Decoction modified formula and hemodialysis can improve the clinical symptoms of elderly patients with CRF,reduce the expression level of inflammatory factors in patients,and increase the clearance rate of toxins in patients,and does not increase the adverse effects．