目的 探讨通络熄风汤联合西医基础治疗对缺血性脑卒中急性期的临床疗效观察及其安全性。方法 选择2013年4月—2015年4月之间于我院收治的缺血性脑卒中急性期患者112例随机分为联合组(n=56)与对照组(n=56)。两组缺血性脑卒中急性期患者均采用常规治疗,联合组在此基础上服用通络熄风汤。比较两组治疗总有效率,神经功能缺损积分,ADL评分,血清NSE水平及用药安全性。结果 联合组总有效率(91.07%)高于对照组(75.00%)(P<0.05);神经功能缺损评分治疗后联合组与对照组低于治疗前(P<0.05);神经功能缺损评分治疗后联合组低于对照组(P<0.05);ADL评分治疗后联合组与对照组高于治疗前(P<0.05);ADL评分治疗后联合组高于对照组(P<0.05);血清NSE水平治疗后联合组与对照组低于治疗前(P<0.05);血清NSE水平治疗后联合组低于对照组(P<0.05);联合组与对照组在用药期间均无发现有严重药物不良反应。结论 通络熄风汤联合西医基础治疗对缺血性脑卒中急性期的临床疗效明显,并且用药安全性良好。

目的 探讨良性前列腺增生(BPH)并急性尿潴留(AUR)后血清肌酐、前列腺特异抗原(PSA)及其膀胱尿道功能的相关性及其临床意义。方法 对随机选择的36例已留置尿管48h以上的BPH并AUR患者进行尿流动力学检查,且同日行血清肌酐、PSA检测并分为两组:DI(逼尿肌不稳定)组(22例)和无DI组(14例),分析血清肌酐、PSA与膀胱功能各因素的相关性。结果 36例患者中逼尿肌收缩力很弱(VW)占10例,其游离PSA(fPSA)均<1.0 ng/mL,DI组中血清肌酐与膀胱顺应性、总PSA(tPSA)有相关性(r分别为0.406、-0.340,P值分别<0.01、0.05);DI幅度与膀胱顺应性、逼尿肌收缩力、tPSA有相关性(r分别为-0.309、0.677、0.304,P值分别<0.05、0.01、0.05);DI组与无DI组的fPSA与逼尿肌收缩力均有相关性(r分别为0.375、0.464,P值均<0.05)。DI组血清肌酐与fPSA、DI幅度、逼尿肌收缩力无相关性(r分别为-0.282、-0.301、-0.184,P值均>0.05);无DI组tPSA与血清肌酐、膀胱顺应性、逼尿肌收缩力无相关性(r分别为0.278、0.348、0.365,P值均>0.05)。结论 BPH并AUR患者的血清fPSA越低(<1.0 ng/mL),间接反映逼尿肌收缩力受损越严重,DI影响tPSA及肌酐水平。

目的 研究益精汤对改善男性不育症患者精子质量和提高生育率的临床疗效。方法 将符合纳入标准的100例男性不育症患者随机分为益精汤组和五子衍宗片组进行治疗,治疗后采用ZKPACS-E彩色精子质量分析系统检测精子各项参数标指和调查孕育人数,进行分析对比。结果 通过治疗前后对比,益精汤组的治愈率及临床治愈率较五子衍宗片组高,益精汤组、五子衍宗片组总有效率依次是82%、64%,差异有统计学意义(P<0.05)。益精汤组对患者的精液液化时间、精子活力等指标方面的恢复和改善优于对照组。结论 益精汤能显著提高精子的质量,在治疗男性不育症方面效果显著,值得进一步临床研究和推广。

目的 了解DFU患者的TXA2表达水平的变化及其影响因素,并讨论其与糖尿病血管病变的严重程度的相关性。方法 选择我院内分泌科2009年6月—2012年12月收治的2型糖尿病足部溃疡并坏疽形成的患者共30例、DFU非坏疽组38例、无DFU的2型糖尿病组患者40例,收集其一般资料及检查结果。分析TXA2的表达水平与其他资料的关系。并采用相关分析TXA2的稳定代谢产物TXB2水平升高的危险因素。结果 年龄、糖尿病病程、吸烟、BMI、血浆白蛋白与TXB2水平相关。结论 2型糖尿病足部溃疡患者的血浆血栓素A2水平显著增高,并且表达水平与病情严重程度相关,且与糖尿病病程、血脂、血糖 、血胰岛素、胰岛素抵抗指数水平、血压控制水平等呈明显相关关系。提示其可作为 2 型糖尿病患者血管内皮功能及动脉硬化的早期反映。

目的 构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型。方法 采用低浓度加量持续诱导法,诱导吉西他滨耐药乳腺癌细胞4T1耐药株,命名为4T1/Gem;CCK-8法测定4T1与4T1/Gem细胞的增殖抑制率,计算耐药指数; Western blot法检测细胞P-gp蛋白表达;B超引导下注射4T1/Gem细胞悬液诱导裸鼠肝脏成瘤;HE染色观察肿瘤组织病理情况,免疫组化法检测瘤组织ER、PR、HER2、Ki-67和P-gp蛋白的表达。结果 经过14个月的诱导成功建立4T1/Gem细胞株,可在含40 μg/mL的Gem培养液中稳定生长。4T1/Gem细胞耐药指数为4T1细胞的788.547倍。与亲代相比,4T1/Gem处于G1期和G2期的细胞增加,S期细胞减少;上调P-gp蛋白的表达。4T1/Gem细胞成功建立裸鼠乳腺癌肝转移模型,瘤组织中ER、PR、HER2蛋白阴性表达,Ki-67阳性10％和P-gp蛋白阳性表达。结论 成功构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型,为开发治疗乳腺癌肝转移化疗耐药的药物提供实验基础。

Objective To construct a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem) and establish a nude mouse model of breast cancer with hepatic metastatic. Methods A gemcitabine-resistant variant of the breast cancer 4T1 cell line was induced by gradually increasing the concentration of gemcitabine; this variant is referred to in this study as 4T1/Gem. The proliferation suppression rates of 4T1 and 4T1/Gem cells were determined by using the CCK-8 essay to evaluate the drug resistance indices of the cell lines. Western blot analysis was used to detect P-gp protein expression. Under ultrasonography, a 4T1/Gem cell suspension was injected into nude mice to induce liver tumors. H&E staining was used to observe tumor pathology, and immunohistochemistry was used to detect the expression of ER, PR, HER-2, Ki-67, and P-gp. Results After 14 months of induction, a 4T1/Gem cell line is established successfully. The cell line can grow stably in culture liquid containing 40 μg/ml gemcitabine. The drug resistance index of 4T1/Gem is 788.547. Compared with the 4T1 cell line, the 4T1/Gem cell line can upregulate P-gp protein expression and successfully establish a nude mouse model of breast cancer with hepatic metastatic. ER, PR, and HER-2 proteins exhibit negative expression in the tumor tissue. The positive expression of P-gp and 10% of Ki-67 proteins is also observed. Conclusion This study successfully constructs a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem)and establishes a nude mouse model of breast cancer with hepatic metastatic, thereby providing an experimental basis for developing and treating a drug-resistant variant of breast cancer.

目的 探讨原发性脾脏肿瘤的诊断与治疗。方法 选取2006年1月—2014年12月期间收治的58例原发脾脏肿瘤患者进行临床观察。结果 脾脏良性肿瘤45例,其中脾血管瘤21例,脾囊肿11例,脾淋巴管瘤8例,脾脏窦岸细胞血管瘤3例,脾错构瘤1例,脾脏硬化性血管瘤样结节性转化1例;脾脏恶性肿瘤13例,其中脾脏B细胞淋巴瘤11例,脾脏霍奇金淋巴瘤及脾脏血管肉瘤各1例。B超和CT是主要的检查方法。全组行脾切除术51例,其中开腹脾切除术23例,腹腔镜脾切除术28例;部分脾切除术5例;脾切除+胰腺体尾部切除术2例。所有病例无手术并发症。术后随访9个月~9年,平均随访时间(43.8±21.3)个月,41例脾脏良性肿瘤患者预后良好,无复发和转移;11例脾脏恶性肿瘤患者的1、3、5年生存率分别为81.8%、63.6%和27.2%。结论 原发性脾脏肿瘤的诊断主要依靠临床表现和影像学检查。手术切除不仅是脾脏肿瘤一种有效的治疗手段,也是重要的确诊方法。脾脏局限性良性肿瘤可选择部分脾切除术以保留脾脏功能。早期手术及术后联合放化疗可改善脾脏恶性肿瘤的预后。

Objective To investigate the diagnosis and treatment of primary splenic tumor. Methods The clinical data of 58 patients with primary splenic tumor from January 2006 to December 2014 were retrospectively analyzed. Results 45 cases were benign splenic tumor, including 21 hemangioma, 11 splenic cyst, 8 lymphangioma, 3 littoral cell angioma, 1 hamartoma and 1 sclerosing angiomatoid nodular transformation of spleen. 13 cases were malignant splenic tumor, including 12 lymphoma and 1 angiosarcoma. Ultrasound and CT were the main diagnostic methods. 51 cases underwent splenectomy, including 23 open splenectomy and 28 laparoscopic splenectomy. 5 cases underwent partial splenectomy and 2 splenectomy combined distal pancreatectomy. There had no postoperative complications. The follow-up period was 9 months to 9 years. 41 cases with benign splenic tumor had no recurrence or metastasis. The 1-, 3-, 5-years survival rate were 81.8%, 63.6% and 27.2% respectively of 11 patients with malignant splenic tumor. Conclusion The diagnostic of primary splenic tumor mostly rely on clinical features and imagic examination. Surgical resection is not only an effective treatment, but also a confirmed diagnosis method for primary splenic tumor. Partial splenectomy is a reasonable procedure for local benign splenic tumor. Early surgery, combined adjuvant chemotherapy and radiotherapy are important for improving the prognosis of malignant splenic tumor.

目的 比较胆总管切开探查术后留置T管和胆总管切开探查并一期缝合术后胆管内支架引流这两种模式治疗胆管疾病的手术疗效。方法 对2012年—2014年期间收治的90例需择期行胆总管探查的患者进行前瞻性随机对照研究。按照实验方式分为T管组40例和单管内支架组50例。对比分析两组胆总管置管缝合手术时间、住院时间、治疗总费用、生活质量指数值以及并发症发生率,包括引流失败率(T管滑脱、内支架管滑脱、移位)、胆漏、胆道感染、胰腺炎和残石率。结果 开腹胆总管探查术术后内支架引流患者的出院前生存质量评价高于T管引流患者,住院时间少于T管引流患者,置管及胆管缝合时间长于T管引流患者(均为P＜0.05);术后两组患者间的治疗总费用和非计划脱管、胆漏、胆道感染、胰腺炎、残石率和不能拔/脱管等术后并发症发生率的差异无统计学意义(P＞0.05)。结论 内镜下胆道支架内引流术(Endoscopic retrograde biliary drainage,ERBD)移植于胆总管切开探查并一期缝合术具有可行性、安全性及治疗效果确切,显著缩短患者住院时间、加快患者康复提高患者出院前的生存质量,并放宽胆总管一期缝合指征。

Objective To compare the clinic research between biliary stent insertion drainage and T-tube drainage after choledochotomy. Methods The clinical data of 90 cases from 2012 to 2014 were analyzed in a prospectively randomized trial, and they were divided into two groups by T-tube drainage and biliary stent insertion drainage. Cathetering and suture time, length of stay, hospital costs, life quality and incidence of complications were compared, respectively. Results After open common bile duct exploration (OCBDE), the life quality of stent group was significantly higher than that of T-tube group, the length of stay in stent group was shorter, and cathetering and suture time of bile duct in stent group was longer than that of T-tube group (P＜0.05); There were no significant differences between the two groups in the hospital costs and incidences of postoperative complications including bile leakage, early stent dislodgement, biliary infection, pancreatitis and residual stone (P＞0.05). Conclusion Endoscopic retrograde biliary drainage (ERBD) with primary closure after choledochotomy is a safe, effective and feasible procedure for the management of choledocholithiasis, it can significantly reduce the postoperative hospital stay and improve the life quality of patients and expand the indications for primary closure of CBD incision.

目的 探讨纤维支气管镜吸痰联合镜下注药治疗慢性阻塞性肺疾病(COPD)的应用价值。方法 选择50例确诊慢性阻塞性肺疾病患者,随机分为A、B两组(每组25例),两组患者均予常规治疗,B组在常规治疗的基础上加予每周二次经纤维支气管镜吸痰和镜下注药治疗。通过观察比较2组治疗前后的症状、肺通气功能、动脉血气分析的变化及不良反应来评价疗效。结果 治疗两周后,B组患者的症状、肺通气功能、血气分析以及氧合指数较A组有明显改善,无明显不良反应。结论 纤维支气管镜吸痰联合镜下注药治疗慢性阻塞性肺疾病安全、有效,值得临床推广。

Objective To investigatethe utility of applying bronchoscopy combined with endoscopic injection in patients with chronic obstructive pulmonary disease. Methods 50 patients diagnosed with chronic obstructive pulmonary disease, were randomly divided into A, B groups (n=25,respectively). All the patients received internal routine treatment. Patients in group B received bronchoscopy and endoscopic injection therapy twice a week additionally. The efficacy was evaluated by comparing improvement of symptoms, pulmonary ventilation function and arterial blood gas analysis before and after treatment. The assessment of adverse reactions was also included. Results After two weeks of treatment, the patients in group B had been improved more significantly than the patients in group A, no significant adverse reactions were found. Conclusion It's safe and effective using bronchoscopy combined with endoscopic injection therapy for chronic obstructive pulmonary disease.

目的 了解广东省某区级三甲综合医院住院老年人慢性非传染性疾病(慢非病)疾病谱及性别差异随年度推移的变化。方法 回顾性分析南方医科大学附属南海医院2006—2014年老年人出院资料。结果 住院老年人疾病谱中名列前位的疾病除了肺炎、急性胃肠道疾病,余为慢非病。慢非病比例逐年下降(65.8%~57.8%, P<0.01),疾病谱明显变化:脑血管疾病由第一位占21.3%降至17.0%居第二,恶性肿瘤从10.4%升至18.8%居第一。性别有差异:男性慢阻肺和恶性肿瘤的构成比多于女性;慢非病比非慢非病、男性比女性慢非病的人均住院总费用高(P<0.05)。结论 总结9年来南海区三甲综合医院住院诊治的慢非病居高及攀升病种、性别差异,制定措施优化医疗资源配置、减轻社会经济负担。

Objective To analyze the alteration of disease distribution and gender-differences of chronic non-communicable diseases (NCD) in hospitalized elderly from a large Comprehensive Hospital of Guangdong province. Methods Retrospective observational study including profile of discharged elderly in Nanhai hospital attached to Southern medical university from the year 2006 to 2014. Results In the top rank of diseases in hospitalized elderly, all were NCDs other than pneumonia and acute gastrointestinal diseases. The proportion of NCD accounted for all hospitalized elderly was reduced year by year, changed from 65.8% to 57.8%, P<0.01. Disease distribution of NCD altered obviously, showing that cerebrovascular disease (CVD) decreased from the first 21.3% to the second 17.0%, malignancy increased from 10.4% to 18.8% ranking as the first. Gender-differences did exist. Greater constituent ratio of chronic obstructive pulmonary disease (COPD) and malignancy were found in men than women yearly. NCD showed higher hospitalized expenses than non-NCD per capita, that of men were higher than women (P<0.05). Conclusion Summarizing the top and increasing rank of NCD and gender-differences in hospitalized elderly in a large comprehensive hospital, Nanhai district, Foshan city of 9 years, policy and program could be guided to optimize the distribution of medical resources and try to reduce the output of social economic burden.

目的 探讨血清胃蛋白酶原在胃癌筛查中的价值。方法 用ELISA方法对1102名患者血清PG水平进行检测,并行内镜病理组织学检查,采用ROC曲线确定PG筛查胃癌的最佳界定值。结果 与对照组、萎缩性胃炎组、胃良性溃疡组相比,早期胃癌组、进展期胃癌组PGI、PGR下降(P＜0.05),进展期胃癌组PGI、PGR较早期胃癌组下降(P＜0.05)。与对照组相比,早期胃癌组、进展期胃癌组、胃良性溃疡组PGII升高(P＜0.05)。PGI及PGR在ROC曲线下面积为0.920和0.831,对胃癌的诊断价值较高。PGI≤71.50 μg/L或PGR≤4.50作为筛查标准时,对胃癌高危人群筛查的灵敏度为83.33%,特异度为82.25%。结论 血清PGI、PGR在不同胃部病变中的表达水平不一致,对胃癌的早期筛查和早期诊断具有重要价值。PGI≤71.50 μg/L或PGR≤4.50是东莞地区筛查胃癌较合适的界定值。

Objective To investigate the value of serum pepsinogen PG detection for screening of gastric cancer. Methods PG was detected by ELISA of 1102 people, gastrointestinal endoscopy and biopsy pathology were also carried on. Using ROC curve to establish the PG screening standard, and verified its' value at high risk population of gastric cancer. Results Compared with control group, atrophic gastritis group and benign gastric ulcer group, serum PGI and PGR in early gastric cancer group and advanced gastric cancer group decreased significantly(P＜0.05). Serum PGI and PGR in advanced gastric cancer group were lower than early gastric cancer group(P＜0.05). Serum PGII in early gastric cancer group, advanced gastric cancer group and benign gastric ulcer group were higher than control group(P＜0.05). The area under ROC curve of PGI and PGII was 0.920 and 0.831 respectively, both of them showed high value for the diagnosis of gastric cancer. Took PGI≤71.50μg/L or PGR≤4.50 as the diagnosis criteria, the sensitivity was 83.33% and specificity was 82.25% at high risk population of gastric cancer. Conclusion Serum PGI and PGR were inconsistent in different gastric disease, which showed high sensitivity and specificity in the screening of gastric cancer,and have important value in early screening and early diagnosis of gastric cancer. PGI≤71.50μg/L or PGR≤4.50 were established as the appropriate standard for PG screening.