目的 探讨孕期生殖道菌群变化特征及其与不良妊娠结局的相关性。方法 选取2015年1月—2015年9月期间在我院妇产科门诊进行常规产科检查的90例孕妇为研究对象,根据孕期分为孕早期组28例(孕周＜14周),孕中期组29例(孕周14～28周),孕晚期组33例(29～42周)。采集阴道分泌物或宫颈分泌物,对生殖道菌群进行检测。比较三组生殖道菌群分布情况。根据细菌检测结果分为阳性组与阴性组,分别为44例、46例。观察两组不良妊娠结局发生情况,分析生殖道菌群变化特征及其与不良妊娠结局的相关性。结果 90例孕妇中,细菌检测阳性44例,占48.89%,依次为解脲脲原体20例(45.45%)、假丝酵母菌属9例(20.45%)、肠杆菌属8例(18.18%)、葡萄球菌属3例(6.82%)、阴道加德纳菌属2例(4.55%)与衣原体2例(4.55%);孕早期、孕中期、孕晚期孕妇生殖道菌群分布情况相比,差异无统计学意义(P＞0.05);细菌检测阳性者胎膜早破、产褥感染、新生儿感染、早产发生率高于细菌检测阴性者,差异有统计学意义(P＜0.05);不同菌属类型者不良妊娠结局相比,差异无统计学意义(P＞0.05)。结论 孕期生殖道菌群以解脲脲原体、假丝酵母菌属、肠杆菌属为主,细菌检测阳性者不良妊娠结局发生率高,而不同菌属类型与不良妊娠结局无关。

Objective To investigate the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes. Methods 90 pregnant women received routine obstetric examination in our obstetrics and gynecology of hospital from January 2015 to September 2015 were selected as research object. According to duration of pregnancy, they were divided into 28 cases of early pregnancy group (gestational weeks<14 weeks), 29 cases of middle pregnancy group (14~28 weeks) and 33 cases of late pregnancy group (29~42 weeks). The vaginal or cervical secretions were collected, and genital tract flora was detected. The genital tract flora distribution of three groups were compared. According to bacteria detection results, patients were divided into 44 cases of positive group and 46 cases of negative group. The adverse pregnancy outcomes of two groups were observed, and the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes was analyzed. Results Among 90 pregnant women, there were 44 cases of positive bacteria (48.89%), which included 20 cases of ureaplasma urealyticum(45.45%), 9 cases of Candida (20.45%), 8 cases of enterobacter (18.18%), 3 cases of staphylococcus (6.82%), 2 cases of vaginal gardnerella (4.55%) and 2 cases of chlamydia (4.55%); There was no statistical difference in the genital tract flora distribution among early, middle, late pregnancy group (P>0.05); The incidence of premature rupture of membrane, puerperal infection, neonatal infection and premature birth in patients with positive bacteria was higher than that in patients with negative bacteria (P<0.05); There was no statistical difference in the adverse pregnancy outcomes in patients with different types of bacterial genus (P>0.05). Conclusion Pregnant genital tract flora are mainly ureaplasma urealyticum, candida and enterobacter, and the incidence of adverse pregnancy outcomes in patients with positive bacteria is higher, but different types of bacterial genus has no correlation with adverse pregnancy outcomes.

目的 本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法 选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果 本研究患者的平均年龄(84.23±4.92)a,按eGFR<60 mL·min^-1·1.73 m^-2定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 ①肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。②年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people's hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of (84.23±4.92),had being divided into two groups according to eGFR< 60 ml·min^-1·1.73 m^-2:renal insufficiency group (n=52) and normal renal function group (n=51).There were statistical significance in the number of lacunar lesions,score of white-matter hyperintensity,mixed lesions between groups(P<0.05). Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is positively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI,and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.

目的 初步研究2型糖尿病并视网膜病变患者的血浆趋化素(chemerin)水平及其与骨密度的关系。方法 选择150名糖尿病患者,按视网膜病变分为视网膜病变组(DR组)和眼底正常对照组(NDR组),采用全自动生化检测仪测定糖化血红蛋、甘油三脂、总胆固醇、低密度脂蛋白、高敏C反应蛋白;使用ELISA法检测血浆chemerin水平。骨密度采用双能X线骨密度仪分别测定腰椎正位(L2、L3、L4)、左侧股骨颈、大粗隆区、Ward's三角区的骨密度。结果 ①与NDR组相比,DR组的糖尿病病程较NDR组显著延长(P<0.05)。②DR组的TC、LDL-C、HbA1c、hs-CRP、chemerin水平较NDR组均显著升高(P<0.05)。③DR组的股骨颈、大粗隆区、Ward's三角区的骨密度较NDR组显著降低(P<0.05)。④血清chemerin水平与病程、BMI、HbA1C呈正相关,与股骨颈、大粗隆区、Ward's三角区的骨密度呈负相关。结论 DR患者的chemerin显著升高,chemerin可能参与DR的发生发展,并可能促使DR患者的骨密度降低。

Objective To explore the relationship between the circulation level of chemerin level and bone mineral density(BMD)in type 2 diabetes retinopathy patients. Methods A total of 150 patients with type 2 diabetes were selected. They were divided into two groups: retinopathy group(DR group), non- retinopathy group(NDR group). HbAlc, triglycerides(TC), total cholesterol(TG), low density lipoprotein cholesterol(LDL-C)and high-sensitivity C-reactive protein(hs-CRP)was measured by automatic biochemical detector. Bone mineral density was measured by the dual-energy X-ray absorptiometry. The BMD of lumbar vertebrae 2-4 and the left side of the femoral neck, the greater trochanter and Ward's triangle were assessed. Results ①Compared with the NDR group, the duration of diabetes in group DR was significantly longer(P<0.05); ②The levels of TC, LDL-C, HbA1c, hs-CRP and chemerin in DR group were significantly higher,③The BMD of the femoral neck, trochanter regionandward's triangle were significant reduction;④The level of chemerin was positively correlated with the duration of diabetes, BMI, HbA1C, and negatively correlated with the bone mineral density of the femoral neck, the greater trochanter, and the s' Ward triangle. Conclusion The level of chemerinin DR patients were significantly increased, and chemerin may play a role in the occurrence and development of DR, may promote the bone density decreased.

目的 探讨维持性腹膜透析患者高尿酸血症的临床特点及相关影响因素。方法 收集152名腹膜透析患者,根据血尿酸情况将患者分为高尿酸血症组和正常血尿酸组,分析其临床资料。结果 高尿酸血症112例(73.7%)。高尿酸血症组的血钾、高血压史、血尿素氮、血清肌酐、血磷、iPTH、甘油三脂水平均较正常尿酸组升高(P均＜0.05);而年龄、血钠、血红蛋白、血白蛋白、前白蛋白、血钙、血清铁、总蛋白、hsCRP、空腹血糖、血总胆固醇、血高密度脂蛋白胆固醇、血低密度脂蛋白胆固醇、KT/V、PET无统计学差异(P均＞0.05)。血尿酸水平与血钾、血尿素氮、血磷呈正相关(P＜0.05)。结论 腹膜透析患者高尿酸血症发生率高,血尿酸与血钾、血尿素氮、血磷密切相关,及时纠正高尿酸血症可以改善预后。

Objective To investigate the clinical characteristics and its related influence factors of hyperuricemia in peritoneal dialysis patients. Methods A total of 152 peritoneal dialysis patients were enrolled. Patients were classified into hyperuricemia and normal serum uric acid (SUA)groups. Factors associated with hyperuricemia were analyzed. Results Hyperuricemia occurred in 112 cases(73.7%). There were significant differences in serum potassium, the incidence of hypertension, blood urea nitrogen, serum creatinine, serum phosphorus, parathyroid hormone, triglyceride between hyperuricemia and normal SUA groups(P<0.05). There was no significant difference in age, serum sodium, hemoglobin, serum albumin, prealbumin, serum calcium, serum iron, total protein, high sensitive C-reactive protein, serum glucose, total cholesterol, high density lipoproteins, low density lipoproteins, KT/V and PET(P>0.05). SUA levels was positively correlated with serum potassium, blood urea nitrogen and serum phosphorus(P<0.05). Conclusion Hyperuricemia was common in peritoneal dialysis patients, serum potassium levels is correlated with serum potassium, blood urea nitrogen and serum phosphorus. The timely treatment of hyperuricemia may improve the prognosis of peritoneal dialysis patients.

目的 探究S100B蛋白、神经元特异性烯醇化酶与新生儿低血糖脑损伤的诊治相关性。方法 收集2014年1月—2016年12月来我院就诊出现低血糖脑损伤的新生儿116例,设为患病组,首先根据临床表现,分为两组,有低血糖症状组(n=54)和无低血糖症状组(n=62)。两组患儿均给予常规药物治疗,有效患者82例,为有效组,无效患者34例,为无效组。同期收集健康足月的新生儿53例,为健康对照组。患儿均于治疗前、后检测血清S100B蛋白、神经元特异性烯醇化酶水平,健康对照组新生儿也于同一时间点进行相同检测。观察各组新生儿血清S100B蛋白、神经元特异性烯醇化酶水平变化,并探究其水平变化与诊断及治疗效果的相关性。结果 低血糖症状组和无低血糖症状组患儿的血糖水平均低于和健康对照组(P<0.05);低血糖症状组患儿的低血糖扶持续时间高于无低血糖症状组(P<0.05)治疗后,各组的NSE和S100B的蛋白水平差异无统计学意义(P>0.05)。患儿血清NSE和S100B与血糖水平呈负相关(r=-0.131、-0.124、P<0.05),与低血糖持续时间呈正相关(r=0.135、0.129,P<0.05)。结论 血清NSE及S100B与患儿血糖水平相关,可作为新生儿低血糖脑损伤的早期诊断指标。血清NSE及S100B水平与治疗效果存在相关性并为负相关,血清水平越低,患者治疗效果越好。

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 探讨苯作业非酒精性脂肪肝工人丙氨酸氨基转移酶(ALT)水平与颈动脉粥样硬化的关系。方法 190名的苯作业非酒精性脂肪肝工人分为ALT异常组(ALT≥40 U/L)及ALT正常组(ALT＜40 U/L)。ALT异常组再根据ALT水平分为依据ALT水平分为G1组(60例,40 U/L≤ALT＜60 U/L),G2组(40例,60 U/L≤ALT＜80 U/L),G3组(35例, ALT＞80 U/L)。观察各组颈部动脉有否内膜增厚或斑块形成。结果 与ALT异常组颈动脉内膜增厚检出率和颈动脉斑块检出率明高于ALT正常组(P<0.05)。颈动脉内膜增厚检出率和颈动脉斑块检出率与ALT正常组相比较,G1组差异无统计学意义(P＞0.05), G2组有统计学意义(P<0.05),G3组有差异(P<0.01)。颈动脉内膜增厚检出率在G1组、G2组和G3组中逐渐增加,并有统计学意义(P<0.05)。G3组颈动脉斑块检出率与G1组比较,有差异(P<0.01)。结论 苯作业非酒精性脂肪肝工人中,血清ALT水平升高与颈动脉粥样硬化密切相关。ALT≥60 U/L的苯作业非酒精性脂肪肝人群更容易患颈动脉粥样硬化,应进行必要的预防和治疗。

Objective To explore the relationship between serum alanine aminotransferase levels(ALT) and carotid atherosclerosis in benzene exposed workers with nonalcoholic fatty liver disease. Methods 190 Benzene exposed workers with nonalcoholic fatty liver disease were enrolled divided into abnormal ALT group(n=135) and normal ALT group(n=55), the abnormal ALT group was further divided into three groups according to the levels of serum alanine minotransferase (ALT): group1(G1,60 subjects, 40 U/L≤ALT＜60 U/L),group2(G2,40 subjects, 60 U/L≤ALT＜80 U/L),and group3(G3,35 subjects, ALT＞80 U/L),observed if carotid has only thick endomembrane or with plaques. Results The rate of thick endomembrane of carotid and the detection rate of plaque in the abnormal ALT group are higher than those in the normal ALT control group (P<0.05). Compared with the normal ALT control group, no significant different was found in the rate of thick endomembrane of carotid and the detection rate of plaque in G1,but G2 was significantly different(P<0.05),G3 was extremely significantly different(P<0.01). The rate of thick endomembrane of carotid in G1,G2 and G3 increased, among the three groups. There were statistically significant differences in the rate of thick endomembrane of carotid(P<0.05). benzene exposed workers with nonalcoholic fatty liver disease in G3 showed extremely statistical differences on the detection rate of plaque compared to those in G1(P <0.01). Conclusion The increased level of ALT in benzene exposed workers with nonalcoholic fatty liver disease is closely related to carotid atherosclerosis. The benzene exposed workers with nonalcoholic fatty liver disease whose ALT≥60 U/L are apt to carotid atherosclerosis, should accept the necessary precaution and treatment.

目的 探讨S100B蛋白水平与进展性脑梗塞病情的相关性,分析不同 S100B 蛋白含量的患者预后情况。方法 选取2011年10月—2012年9月在我院接受治疗的急性进展性脑梗死患者80例为研究对象。比较不同脑损害程度,进展性脑梗塞患者S100B蛋白含量及NIHSS评分动态变化。结果 急性进展性脑梗死患者血清S100B蛋白含量在治疗后第1、3、7天均升高(P＜0.05),且第3天达最高,最高值随着脑梗死面积的增大而增加,第14天下降至最低,与对照组相比,差异有统计学意义(P<0.05)。急性进展性脑梗死患者NIHSS评分与治疗前相比,在治疗后第1、3、7天均升高(P＜0.05),且第3天达最高,最高值随着脑梗死面积的增大而增加,第14天下降至最低,与对照组相比,差异有统计学意义(P<0.05)。采用Pearson对患者血清S100B蛋白含量和NIHSS评分进行相关性分析,得出相关系数为0.583,P<0.05,即血清SI00B蛋白水平与NIHSS评分呈正相关。结论 急性进展性脑梗塞患者血清S100B蛋白水平与脑梗死损坏程度及神经功能正相关,可用来判定该类患者病情及预后情况。

目的 探讨儿童肾病综合征(NS)的红细胞分布宽度(RDW)与肾功能损害的关系。方法 收集168例NS患者作为观察组,根据eGFR分期分为三组,按照起病时长4月为界限分为两组;选健康儿童100例为对照组。检测各组血常规、肝肾功能等,采用SPSS 21.0软件进行统计分析。结果 ①与对照组相比,NS患儿的RBC[(4.86±0.69)vs(4.32±0.48)],RDW[(13.39±1.69)vs(12.99±1.04)]升高,差异有统计学意义(P<0.05);②RDW在肾功能3期(14.60±1.36)较2期(12.84±0.79)升高,在起病时长≤4月患儿(13.66±1.78)较健康儿童(12.99±1.04)上升,差异有统计学意义(P<0.05);红细胞平均容积(MCV)在起病时长≤4月较对照组下降,起病时间>4月组较起病时长≤4月上升,差异有统计学意义(P<0.05)。结论 儿童NS患者的RBC、RDW较健康儿童升高,RDW在肾功能3期较2期升高。

Objective To investigate the relationship between red cell distribution width(RDW) and renal function damage in children with nephrotic syndrome(NS). Methods 168 NS patients were chosen as the observation group, divided into three groups by eGFR level, while also divided into two groups by onset duration of 4 months. 100 healthy children were included as the control group. The blood routine, biomedical function of liver and kidney were detected. Data were analyzed by SPSS 21.0. Results ① Compared to control group, NS patients have higher levels of RBC[(4.86±0.69) vs (4.32±0.48)] and RDW[(13.39±1.69) vs (12.99±1.04)], P<0.05; ② RDW is higher in the third phase of renal function than the second [(14.60±1.36) vs(12.84±0.79)], and also higher in the onset duration of less than 4 months group than the control group [(13.66±1.78) vs (12.99±1.04)], P<0.05; Mean corpuscular volume is lower in the onset duration group of less than 4 months than the control group, and higher in the onset duration group more than 4 months than the onset duration group of less than 4 months, P<0.05. Conclusion The RBC, RDW are higher in children NS patients than in the healthy children; RDW is higher in the third renal function than the second renal function.