目的 应用iTRAQ联合质谱技术筛选COPD大鼠肺组织差异表达蛋白。方法 20只雄性SD大鼠(200~220 g),随机分为对照组和模型组,每组10只,采用熏烟法建立COPD大鼠模型。观察大鼠肺组织病理学改变,测定肺功能,BALF白细胞数,肺组织总蛋白iTRAQ标记后质谱鉴定,用生物信息学方法分析蛋白表达变化。结果 与对照组相比,模型组大鼠支气管黏膜下肌层增厚,肺内可见大量炎性细胞浸润,肺功能降低,BALF白细胞数升高(均P<0.05)。质谱鉴定出4 916种蛋白,筛选出468个差异表达蛋白,其中285个表达上调,183个表达下调。筛选了上皮细胞粘着连接蛋白、fMLP、整合素等与COPD相关蛋白。结论 基于iTRAQ技术的蛋白质组学方法筛选出COPD大鼠差异表达蛋白,为进一步研究COPD的发生机制奠定了基础。

Objective iTRAQ and mass spectrometry were used to screen the differentially expressed proteins in the lung of COPD rats. Methods 20 male SD rats (200-220g)were randomly divided into control group and treatment group, with 10 rats in each group. COPD rat model was established by smoking. The lung function, the number of BALF leukocytes, the total protein iTRAQ in lung tissue were measured and identified by mass spectrometry. The differentially expressed proteins were identified by bioinformatic analysis. Results Compared with the control group, the submucous layer of bronchus in the model group was thickened, a large number of inflammatory cells were seen in the lung, the lung function was reduced, and the number of BALF leukocytes was increased. 4 916 proteins were identified by mass spectrometry, 468 differentially expressed proteins were screened, 285 of which were up-regulated and 183 down regulated. Among them, the important COPD related proteins were epithelial adhesion connexin, fMLP and integrins. Conclusion iTRAQ technology screened out the differentially expressed proteins of COPD rats, which laid the foundation for the further study of COPD mechanism

目的 探讨高脂血症大鼠模型前后血液中氨基酸代谢谱的变化,寻找高脂血症大鼠血液中氨基酸代谢标志物。方法 将SD大鼠随机分为正常对照组、模型组,连续灌胃给药4周后收集大鼠血液,测定各组大鼠血清中TG、TC、HDL-C、LDL-C含量,并运用超高效液相色谱-四极杆-飞行时间质谱(UPLC-Q-TOF-MS/MS)法测定血清中氨基酸代谢谱,利用统计学分析研究不同组动物间的氨基酸代谢的差异。结果 与正常对照组比较,模型组TG、TC、LDL-C含量升高,HDL-C含量降低,高脂血症大鼠模型建模成功;与正常对照组比较,模型组蛋氨酸、苯丙氨酸、脯氨酸、苏氨酸、缬氨酸、甘氨酸等6种氨基酸发生明显改变(P<0.05)。结论 高脂血症大鼠存在氨基酸代谢的紊乱,其中蛋氨酸、苯丙氨酸、脯氨酸、苏氨酸、缬氨酸、甘氨酸等6种氨基酸为其潜在的生物标志物。

Objective To investigate the amino acid metabolism profiles changes in the serum of SD rats, and identify the potential biomarkers. Methods SD rats were divided into normal group and model group. The contents of TG, TC, HDL-C, and LDL-C in the serum of each group were measured, after 4 weeks of continuous intragastric administration. Ultra performance liquid chromatography coupled with electrospray time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS)was used to determine amino acid metabolism profile in serum, and statistical analysis was applied to determine metabolic differences among different groups of rats. Results As compared with normal group, TG, TC, LDL-C were increased and HDL-C was decreased in model group, hyperlipidemia rat model successfully modeled. As compared with normal group, methionine, phenylalanine, proline, threonine, valine, glycine in the amino acid metabolic profiling were decreased in model group (P＜0.05). Conclusion Hyperlipidemia rats have disorders of amino acid metabolism, of which methionine, phenylalanine, proline, threonine, valine, and glycine are potential biomarkers.

目的 观察重组人血管内皮抑素注射液（恩度） 联合化疗治非小细胞肺癌（NSCLC）的近期疗效和安全性。方法 对2015年3月—2017年10月经病理组织学或细胞学检查确诊的Ⅲ-Ⅳ期NSCLC74例患者,采用随机数字法把受试者随机分为联合治疗组（n=35）和对照组（n=39）,联合治疗组接受恩度联合化疗的方案治疗;对照组单纯行常规化疗治疗。近期疗效评价采用RECIST标准,生活质量（QOL）采用Karnofsky评分（KPS）,抗癌药物急性与亚急性毒性反应分度标准分0~Ⅳ度。比较两组患者的近期疗效指标（疾病完全缓解（CR）、疾病稳定（ SD）、疾病进展（ PD）、客观有效率（RR）、疾病控制率（DCR ）;QOL评分及毒副反应情况。结果 联合治疗组近期疗效指标RR及DCR高于对照组（P < 0.05）;联合治疗组KPS评分高于对照组（P < 0.05）;两组间的毒副作用包括恶心/呕吐、腹泻、疲乏、脱发、血小板下降及白细胞下降等,两组间毒副反应出现数量比较,差异无统计学意义（P > 0.05）。结论 恩度与化疗药物联合使用可以提高NSCLC疗效和改善患者生活质量,未增加患者不良反应发生率。

Objective To observe the curative effect and the side effects of recombinant human vascular endostatin （Endostar） combined with the chemotherapy on nonsmall cell lung cancer（NSCLC）. Methods Seventy-four NSCLC patients confirmed by histopathology or cytopathology were randomly distributed to combined therapy group （n=35, with Endostar combined with chemotherapy） and control group （n=39, with conventional chemotherapy）. The recent efficacy of drug was evaluated according to the RECIST criteria. The quality of life （QOL） was assessed by usingto the Karnofsky scores, and the safety of drug was evaluated according to WHO side effects criteria. Results The therapeutic effectiveness was better in the combined therapy group than that in the control group（P<0.01）. The KPS was better in co-therapy group than that in the control group（P<0.05）. The common adverse reactions in both groups included neutropenia, thrombocytopenia, nausea/vomiting, diarrhea, lassitude, alopecia, thrombocytopenia and leukocytopenia. However, the incidence rates of adverse reactions between the two group was not significant （P>0.05）. Conclusion Endostar combined with the related chemotherapy may improve the curative effect and QOL of NSCLC.

目的 观察康柏西普玻璃体腔注射治疗湿性老年性黄斑变性病变对于视网膜神经纤维厚度的影响。方法 对2016年10月—2017年10月在汕头大学附属韶关市粤北人民医院采用康柏西普玻璃体腔注射治疗湿性老年性黄斑变性35例38眼中符合标准的患者18例（18眼）的临床资料进行回顾性分析,患者行最佳矫正视力、眼压（NCT）检查、OCT、荧光眼底血管造影（FFA）检查后,均接受0.05 mL康柏西普玻璃体腔注射,分别注射后1和2月观察患者最佳矫正视力 （BCVA）、视网膜神经纤维厚度（RNFL）变化。结果 18眼共接受康柏西普玻璃体腔注射54次,所有患眼均注射3次。注射3个月后,OCT检查结果显示有18眼视力有提高,CRT厚度有下降。第1次注射时和注射后1个月、2个月的BCVA分别为0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）,总体比较差异有统计学意义（χ²=13.880,P<0.001）;第1次注射时和注射后1个月、2个月的CRT（μm） 319.50（269.50,390.50）, 271.00（219.00,296.25） 和234.50（182.75,273.25）总体比较差异有统计学意义（χ²=11.978,P<0.05）,第1次注射时和注射后1个月、2个月后的 ARNFL（μm）86.00（76.25,98.00） 83.00（76.00,95.50）和 83.00（76.25,94.75） 总体比较差异无统计学意义（χ²=11.978,P>0.05）,第1次注射时和注射后1个月、2个月眼压（kPa）2.27（1.97,2.44）,16.0（13.7,17.0）,和 2.00（1.84,2.31） 总体比较差异无统计学意义（χ²=1.604,P>0.05）。结论 玻璃体腔注射康柏西普治疗湿性老年性黄斑变性对视网膜神经纤维厚度无明显的损害,安全且有效,但仍需要大样本量及长期随访观察。

Objective To observe the effect on the thickness of retinal nerve fibers in the patients with wet age-related macular degeneration by adopted intravitreal injection with Conbercept. Methods We analyzed 18 cases （18 eyes） that conform to the standard from 35 cases（38 eyes） retrospectively,who were treated with wet age-related macular degeneration by adopted intravitreal injection with Conbercept in Shaoguan Yuebei People's Hospital Affiliated to Shantou University from October in 2016 to October in 2017.After undergoing best corrected visual acuity （BCVA）,intraocular pressure （IOP） and fluorescein angiography （FFA）,all of them were adopted intravitreal injection with 0.05mL Conbercept. We observed the changes of best corrected visual acuity （BCVA） and retinal nerve fiber thickness （RNFL） after 1 and 2 months of adopted intravitreal injection with 0.05 mL Conbercept. Results 18 eyes were adopted intravitreal injection Conbercept 54 times totally. All the eyes were injected three times. After 3 months of injection,OCT showed that the visual acuity of 18 eyes improved and the thickness of CRT decreased. The BCVA values at the first injection,after the first injection and after the second injection were 0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）respectively. The overall difference was statistically significant （χ²=13.880,P< 0.001）. CRT（μm）values at the first injection,after the first injection and after the second injection were 319.50（269.50,390.50）,271.00（219.00,296.25） and 234.50（182.75,273.25）respectively. The overall difference was statistically significant （χ²=11.978,P< 0.05）. ARNFL（μm）values at the first injection,after the first injection and after the second injection were 86.00（76.25,98.00）,83.00（76.00,95.50） and 83.00（76.25,94.75）respectively. There was no significant difference （χ²=11.978,P> 0.05）. The IOP（mmHg）values at the first injection,after the first injection and after the second injection were 17.0（14.8,18.3）,16.0（13.7,17.0）,和 15.0（13.8,17.3）respectively. There was no significant difference（χ²=1.604,P>0.05）. Conclusion There was no obvious damage to the retinal nerve fiber by adopted intravitreal injection with Conbercept to treat the patients with wet age-related macular degeneration. That’s safe and effective,but need a large sample to follow-up for a longtime.

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.

目的 探讨血清ApoA-1浓度与食管鳞状上皮细胞癌的相关性及其预后价值。方法 对我院2010年1月—2012年10月收治的食管鳞状上皮细胞癌患者的血清ApoA-1浓度进行回顾性调查分析,与我院体检中心2009年1月—2009年4月219例正常人群的血清ApoA-1浓度作为对照组进行统计学处理分析。结果 210例食管鳞状上皮细胞癌患者组和219例健康对照组在性别和年龄比较均无统计学差异(P>0.05)。血清ApoA-1 浓度在ESCC组的pTNM和临床分期均有统计学差异(P<0.05)。与ApoA-1水平高的患者相比,ApoA-1水平低的患者的总体生存率更低(P=0.002)。结论 血清ApoA-1 水平是食管鳞状上皮细胞癌食管癌的一个重要的预后因素。

目的 探究肺表面活性物质联合高频振荡通气治疗新生儿呼吸窘迫综合征的有效性及安全性。方法 选取我院新生儿科2016年2月—2018年7月收治的120例呼吸窘迫综合征新生患儿作为研究对象,随机将其分为常规组和试验组,每组各60例。常规组实施肺表面活性物质联合常频振荡通气治疗,试验组采取肺表面活性物质联合高频振荡通气治疗,比较两组治疗前后的肺氧合功能和并发症发生情况。结果 PaO₂、OI、a/A PO₂等指标在治疗前两组差异无统计学意义(P＞0.05),治疗后试验组均要优于常规组,差异有统计学意义(P＜0.05);常规组的并发症发生率为35.0%(21/60),试验组的并发症发生率为18.3%(11/60),试验组低于常规组,差异有统计学意义(P＜0.05)。结论 新生儿呼吸窘迫综合征采用肺表面活性物质联合高频振荡通气治疗效果显著,并发症少,安全性高。

目的 探讨吗替麦考酚酯联合泼尼松治疗儿童紫癜性肾炎的临床疗效。方法 将2016年2月—2018年2月在广州开发区医院儿科和广州市第一人民医院儿科收治的36例紫癜性肾炎肾病综合征型患者根据治疗分为联合组和对照组,每组18例。联合组采用吗替麦考酚酯和泼尼松治疗,对照组采用泼尼松治疗。比较两组患儿治疗前后血肌酐(Scr)、总胆固醇(Chol)、24 h 尿蛋白定量、血白蛋白(ALB) 。结果 联合组治疗效果优于对照组,差异有统计学意义(Z=-2.461,P ＜ 0.05) ; 联合组治疗后24 h尿蛋白定量下降,血肌酐(Scr)降低,总胆固醇(Chol)下降和血白蛋白(ALB)升高,两组实验室指标差异有统计学意义(P＜ 0.05) 。结论 吗替麦考酚酯联合泼尼松治疗紫癜性肾炎治疗效果明确,可以降低血肌酐和胆固醇,改善尿蛋白水平,提升血白蛋白浓度,治疗效果明显,能有效控制病情,在临床上值得推广应用。

目的 探究肛裂切除带状皮瓣推移术对陈旧性肛裂患者肛门功能的影响。方法 收集我院2017年5月—2018年9月间收治的120例陈旧性肛裂患者资料,按随机数字法将其分为对照组(58例)和研究组(62例),对照组患者接受侧方内括约肌切开术治疗,研究组患者接受肛裂切除带状皮瓣推移术治疗。比较两组临床指标、肛门功能及并发症情况。结果 研究组创面愈合时间、住院时间低于对照组,而手术时间高于对照组(P<0.05);与术前相比,术后1周、术后1月、术后半年,两组Wexner评分均出现下降,且研究组低于对照组(P<0.05);研究组便血、尿潴留、肛门疼痛、肛缘水肿、创口感染、肛门失禁等并发症发生率低于对照组(P<0.05)。结论 肛裂切除带状皮瓣推移术治疗陈旧性肛裂效果显著,可提高肛门功能,降低并发症,值得临床推广。

Objective To investigate the effect of anal fissure excision bandage flap operation on anal function in patients with old anal fissure. Methods The data of 120 patients with old anal fissure who were admitted to our hospital from May 2017 to September 2018 were collected for retrospective analysis. They were divided into control group (58 cases) and research group (62 cases) according to the random number method. The control group received lateral sphincter incision. The patients in the study group underwent treatment of anal fissure excision bandage flap operation. The clinical indicators, anal function and complications were compared between the two groups. Results The healing time and hospitalization time of the study group were lower than that of the control group, and the operation time was higher than that of the control group (P<0.05). Compared with the preoperative period, 1 week after surgery, 1 month after surgery, and half a year after surgery, the Wexner scores of the two groups showed a significant decrease, and the study group was lower than the control group (P<0.05). The incidence of complications such as blood in the stool, urinary retention, anal pain, anal edema, wound infection and anal incontinence were lower in the study group than in the control group (P<0.05). Conclusion Anal fissure excision bandage flap operation for the treatment of old anal fissure is effective, which may improve anal function and reduce complications. It is worthy of clinical promotion.