目的 分析平板运动试验阳性患者行冠脉造影检查后结果阳性者与冠心病的高危因素的关联性,从而预警冠心病。方法 选取浙江大学医学院附属第二医院2016年3月—2019年3月行平板运动试验的阳性患者经冠脉造影结果为阳性,且资料完整者280例患者为研究对象,筛选出影响冠心病的独立危险因素。结果 性别、体质量指数(BMI)、高甘油三酯、平板恢复1、2 min心率是影响冠心病的独立危险因素。结论 对于男性、BMI>24、高甘油三酯、平板恢复1、2 min心率异常的患者,当其平板运动试验为阳性时,应建议其进一步行冠脉造影检查。

Objective To analyze the correlation between coronary angiography and the risk factors of coronary heart disease in patients with positive treadmill exercise test, so as to give early warning of coronary heart disease. Methods A total of 280 patients who underwent treadmill exercise tests from March 2016 to March 2019 in the Second Affiliated Hospital of Medical College of Zhejiang University were selected as the study subjects with positive coronary angiography results and complete data to screen out independent risk factors for coronary heart disease. Results Gender, body mass index, high triglycerides, high cholesterol, heart rate after 1 or 2 minutes of tablet recovery were the risk factors for positive coronary angiography. Conclusion For men, patients with BMI>24, high triglycerides, and abnormal heart rate after 1 or 2 minutes of tablet recovery, when the treadmill exercise test is positive, further coronary angiography should be recommended.

目的 探讨替诺福韦酯单药治疗在慢性乙型肝炎(CHB)后肝硬化失代偿期(DCC)治疗中的长期应用价值。方法 随机将84例CHB后DCC患者分为对照组及观察组,每组42例。对照组接受拉米夫定联合阿德福韦酯治疗,观察组接受替诺福韦酯治疗。对比两组12个月内治疗时间内的死亡率及肝癌发生率,并分析两组肝功能、肝硬化指标及Child-Pugh评分变化趋势,同时对比两组治疗过程中HBeAg转阴率、HBV-DNA转阴率及失代偿好转率。此外,对比两组治疗不良反应的发生率。结果 在12个月的治疗时间内,两组死亡率及肝癌发生率比较,差异无统计学意义(P>0.05)。而两组治疗过程中ALT、AST、HA、LN、PCⅢ及Child-Pugh评分呈降低趋势,ALB呈升高趋势(P<0.05);治疗6个月及12个月时,治疗组ALT、AST、HA、LN、PCⅢ及Child-Pugh评分低于对照组,ALB高于对照组(P<0.05)。而两组12个月治疗完成后,HBeAg转阴率比较差异无统计学意义,但观察组HBV-DNA转阴率高于对照组(P<0.05)。此外,两组治疗不良反应发生率比较差异无统计学意义(P>0.05)。结论 在CHB后DCC的治疗中,替诺福韦酯单药治疗方案具有良好的长期治疗效果。

Objective To evaluate the long-term value of tenofovir disoproxil monotherapy in the decompensated cirrhosis(DCC) after chronic hepatitis B(CHB). Methods Eighty-four patients with DCC after CHB were randomly divided into control group and observation group, 42 cases in each group. The control group received lamivudine combined with adefovir dipivoxil, and the observation group received tenofovir disoproxil. Mortality and incidence of liver cancer within 12 months of treatment between the two groups were compared, and the change trend of liver function, liver fibrosis index and child-pugh score in the two groups were analyzed. At the same time,we compared the conversion rate of HBeAg, HBV-DNA and decompensated positive rate between the two groups. In addition, the incidence of adverse reactions were compared between the two groups. Results Within 12 months of treatment, there were no statistically significant differences in mortality and liver cancer incidence between the two groups(P>0.05). And during the treatment, the ALT, AST, HA, LN, PC Ⅲ and Child-Pugh score showed a decrease trend, ALB showed a increase trend(P<0.05). After 6-month and 12-month treatment, ALT, AST, HA, LN, PC Ⅲ Child-Pugh score of treatment group were lower than that of control group, ALB was higher than that of control group(P<0.05). After 12 months of treatment, the negative conversion rate of HBV-DNA in the observation group was higher than that of control group(P<0.05). In addition, there was no statistically difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Tenofovir disoproxil monotherapy has a good long-term therapeutic effect in the treatment of DCC after CHB.

目的 探讨食管胃静脉曲张精准断流术与改良“三明治”法治疗食管胃静脉曲张的临床疗效。方法 选取共50例食管胃底静脉曲张患者,按随机数字法分为精准治疗组和对照组,精准治疗组(n=25)行内镜下食管胃静脉曲张精准断流术,对照组(n=25)接受改良“三明治”法内镜治疗。分析对比两组的止血成功率、再出血率、治疗显效率、并发症发生率、聚桂醇和组织胶用量、治疗时间及住院天数等指标。结果 治疗后随访3个月,术后3天内止血率两组均为100％。再出血率精准治疗组为4%,对照组为32%,差异有统计学意义(P=0.010)。静脉曲张治疗显效率精准治疗组为84%,对照组出血率为52%,差异有统计学意义(P=0.015)。并发症发生率在两组间差异无统计学意义(P>0.05)。聚桂醇和组织胶平均用量在两组间差异无统计学意义(P>0.05)。精准治疗组平均治疗时间为(32.60±6.44)min,对照组为(40.60±7.26)min,差异有统计学意义(P<0.0001);精准治疗组平均住院天数为(8.12±1.24)d,对照组为(9.12±1.39)d,差异有统计学意义(P=0.010)。结论 内镜下精准断流术治疗食管胃静脉曲张再出血率低、效果好、安全性高。

Objective To investigate the clinical efficacy of endoscopic selective varices devascularization and the modified Sandwich method on the treatment of esophagogastric varices. Methods 50 patients with esophagogastric varices were divided into therapy (endoscopic selective varices devascularization)group (n=25) and control group (n=25) by random number table method. The therapy group (n=25) received the treatment of endoscopic selective varices devascularization. The control group (n=25) was treated with modified Sandwich method injection. The success rate of hemostasis, rate of recurrent bleeding, rate of varices disappearance, complication rate, dosage of lauromacrogol and tissue adhesive, time of therapy and hospitalization days were compared and analyzed between the two groups. Results During the 3-month followup, the success rates of hemostasis were 100% in both groups 3 days after the treatments. The rates of recurrent bleeding in therapy group and control group were 4% and 32% respectively, with statistically significant difference (P=0.010). The rates of varices disappearance in therapy group and control group were 84%and 52% respectively, the difference (P=0.015) was statistically significant. There was no statistically significant difference in complication rates between the two groups(P>0.05). There was also no statistically significant difference in the average dosage of lauromacrogol and tissue adhesive between the two groups(P>0.05). The average time of therapy in therapy group and control group were(32.60±6.44)minutes and(40.60±7.26)minutes respectively, with statistically significant difference between the two groups(P=0.000). The average hospitalization days in therapy group and control group were(8.12±1.24)days and(9.12±1.39)days respectively, which is statistically significant difference between the two groups(P=0.010). Conclusion Endoscopic selective varices devascularization has the obvious advantage of a significant efficacy, low recurrence rate and high safety.

目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.

目的 利用分析各种浓度环氧化酶-2(COX-2)特异度抑制剂塞来昔布对食管癌EC109细胞系的作用,进而对COX-2蛋白表达的影响及对细胞凋亡能力的作用,进一步探讨塞来昔布对食管癌细胞凋亡的作用及机制。方法 使用0 μmol/L、20 μmol/L、60 μmol/L、100 μmol/L四个浓度的塞来昔布处理EC109细胞24 h,酶联免疫吸附剂测定(ELISA)法测定COX-2蛋白表达;流式细胞仪测定EC109细胞凋亡情况。结果 与0 μmol/L塞来昔布组比较,20 μmol/L、60 μmol/L、100 μmol/L塞来昔布组EC109细胞内COX-2蛋白表达不断降低(1.581±0.116;1.226±0.089,0.846±0.076,0.521±0.082)(P<0.05);而细胞凋亡率逐步上升(1.700±0.557,13.400±1.735,18.766±1.301,28.100±1.997)(P<0.05)药物浓度依赖于梯度。结论 塞来昔布是一种COX-2抑制剂,可能以浓度梯度的形式抑制COX-2蛋白的表达,从而促进EC109细胞的凋亡。

Objective The effects of celecoxib, a specific COX-2 inhibitor at various concentrations, on EC109 cell line of esophageal cancer were analyzed, and the effect and mechanism of celecoxib on apoptosis of esophageal carcinoma cells were further studied. Methods EC109 cells were treated with celecoxib at concentrations of 0 μmol/L, 20 μmol/L, 60 μmol/L and 100 μmol/L for 24 h. The protein of COX-2 in EC109 cells was determined by enzyme-linked immunosorbent assay (ELISA). Assay of EC109 cell apoptosis were determined by flow cytometry. Results Compared with the 0μmol/L celecoxib group, the expression of COX-2 protein in EC109 cells of 20μmol/L, 60μmol/L, 100μmol/L celecoxib group gradually decreased(1.581±0.116; 1.226±0.089, 0.846± 0.076, 0.521±0.082) (P<0.05); and the apoptotic rate gradually increased (1.700±0.557; 13.400±1.735, 18.766±1.301, 28.100±1.997) (P<0.05) in a drug concentration gradient-dependent manner. Conclusion The COX-2 inhibitor celecoxib may inhibit the expression of COX-2 protein in a concentration gradient and promote the apoptosis of esophageal cancer EC109 cells.

目的 探讨先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,IHPS)中神经元型一氧化氮合酶(neuronal nitric oxide synthase,nNOS)的表达情况,以进一步研究IHPS的发病机制。方法 选取4只Beagle孕犬按3:1分为模型组和对照组,自孕期第1天至分娩前1天,模型组孕犬每天腹腔注射一次L-NAME 6 mg/(kg.d),对照组给予同样方式注射等量的生理盐水。所有新生犬均在生后第31天、38天、45天及52天分别称重,生后52天,选取模型组中体质量增长缓慢的新生犬和对照组新生犬各5只作为实验对象,取幽门组织HE染色后显微镜下测量幽门环肌厚度,免疫组化后运用图像分析技术测定nNOS表达量。结果 与对照组新生犬比较,模型组中新生犬体质量增长慢,幽门环肌增厚,nNOS表达量减少,两组间有差异(P<0.01,P<0.01,P<0.05)。结论 幽门区nNOS表达减少与CHPS相关。

Objective To further study the pathogenesis of infantile hypertrophic pyloric stenosis(IHPS) by analyzing the expression of neuronal nitric oxide synthase(nNOS) in pylorus of CHPS. Methods According to 3:1,four Beagle pregnant dogs were selected and divided into model group and control group,from the first day of pregnancy to the first day before delivery, L-NAME was intraperitoneally injected into pregnant dogs in the model group, dose for 6mg/(kg.d),while normal saline was intraperitoneally injected into pregnant dogs in the control group.The two groups newborn dogs were weighed at 31, 38, 45 and 52 days after birth,At 52 days after birth, 5 newborn dogs were selected respectively between model group and control group as experimental subjects, obtained pyloric tissue for HE staining and measured the muscular thickness of pyloric,The expression of nNOS was determined by image analysis after immunohistochemistry. Results Compared with newborn dogs in the control group, newborn dogs in the model group had slow weight growth, increased pyloric annulus muscle thickness, and decreased expression of nNOS(P<0.01,P<0.01,P<0.05). Conclusion The decreased expression of nNOS in the pyloric region associated with IHPS.

目的 探讨睫毛蠕形螨感染与睑板腺功能障碍(meibomian gland dysfunction,MGD)发生的相关性,并分析睫毛蠕形螨感染对MGD患者眼表症状跟体征的影响。方法 前瞻性队列研究。选取2018年7月—2019年3月在广州市第一人民医院眼科门诊诊断为MGD患者47例,按照年龄将MGD患者分别纳入MGD＜40岁组(A₁组,28例)和MGD＞60岁组(B₁组,19例)。根据蠕形螨检测结果将MGD患者分别纳入蠕形螨检出阳性组(Ⅰ组,22例)与蠕形螨检出阴性组(Ⅱ组,25例)。同时,选取无MGD正常人或仅患屈光不正、玻璃体混浊的患者共49例,按照年龄将其分别纳入NMGD＜40岁组(A₂组,30例)和NMGD＞60岁组(B₂组,19例)。主要统计受试者眼部症状(眼痒、眼痛、眼干、异物感、视物模糊)发生率、睫毛蠕形螨检出数量及检出率、睑板腺排出能力评分、睑板腺分泌物性状评分及眼表疾病指数(Ocular Surface Disease Index,OSDI)。结果 MGD＜40岁组(A₁组)与NMGD＜40岁组(A₂组)睫毛蠕形螨检出数量分别为(1.14±1.938)、(0.17±0.531)只,差异有统计学意义(P=0.003,＜0.05),睫毛蠕形螨检出阳性率分别为43%、10%,差异有统计学意义(P=0.006,＜0.05);MGD＞60岁组(B₁组)与NMGD＞60岁组(B₂组)睫毛蠕形螨检出数量分别为(1.89±2.331)、(0.68±1.529)只,差异没有统计学意义(P＞0.05),睫毛蠕形螨检出阳性率分别为53%、21%,差异没有统计学意义(P＞0.05); MGD患者睫毛蠕形螨检出阳性组(Ⅰ组)与MGD患者睫毛蠕形螨检出阴性组(Ⅱ组)睑板腺分泌物性状评分分别为(3.00±1.11)、(2.28±1.28),差异有统计学意义(P＝0.047,＜0.05);Ⅰ组OSDI、睑板腺排出能力评分、眼干、眼痛、眼痒、异物感以及视物模糊发生率与Ⅱ组相比,差异均不具有统计学意义(P＞0.05);MGD组文化水平与NMGD组相比,差异没有统计学意义(P=0.382,＞0.05)。结论 首先,在40岁以下人群中,睫毛蠕形螨与MGD形成有一定相关性;而在60岁以上人群中,相较于其他影响因素,睫毛蠕形螨对MGD形成的作用并不显著,表明睫毛蠕形螨对MGD形成的影响主要体现在中青年时期,且随着年龄增长,二者之间的关联性进一步降低。另外,睫毛蠕形螨感染与MGD患者发生眼痛、眼干、眼痒、异物感以及视物模糊这些眼部症状和睑板腺分泌功能受损没有相关性。

Objective To investigate the correlation between eyelash Demodex infection and meibomian gland dysfunction (MGD) and to analyze the effect of eyelash Demodex infection on ocular surface symptoms and signs in patients with MGD. Methods Prospective cohort study. 47 patients with MGD diagnosed in the ophthalmology clinic of Guangzhou First People's Hospital from July 2018 to March 2019 were selected. The MGD patients were assigned to the MGD＜40 years old group (A₁ group, n=28) and MGD＞60 years old Group (B₁ group, n=19) according to the age. According to the Demodex test results, MGD patients were assigned to the Demodex-positive group (I group, n=22) and the Demodex-negative group (II group, n=25). At the same time, 49 patients without MGD or only with ametropia and vitreous opacity were selected and assigned to the NMGD＜40 years old group (A₂ group, n=30) and NMGD＞60 years old group (B₂ group, n=19) according to their age. The incidence of ocular symptoms (itchiness, pain, dryness, foreign body perception, and blurred vision), the number and rate of detection of eyelash Demodex, meibomian gland ejection score, meibomian gland secretion score, and Ocular Surface Disease Index (OSDI) were analyzed. Results The number of eyelash Demodex was (1.14±1.938) in MGD＜40 years old group (A₁ group) and (0.17±0.531) in NMGD＜40 years old group (A₂ group). The difference in the number of eyelash Demodex between these two groups was found to be statistically significant (P=0.003,＜0.05). The positive rate of eyelash Demodex was 43 % in MGD＜40 years old group (A1 group) and 10% in NMGD＜40 years old group (A₂ group). The difference in the positive rate of eyelash Demodex between these two groups was found to be statistically significant (P=0.006,＜0.05). The number of eyelash Demodex in MGD＞60 years old group (B₁ group) was (1.89±2.331) and in NMGD＞60 years old group (B₂ group) was (0.68±1.529). The difference in the number of eyelash Demodex between these two groups was not statistically significant(P>0.05). The positive rate of eyelash Demodex was 53 % in MGD＞60 years old group (A₁ group) and 21% in NMGD＞60 years old group (A₂ group). The difference in the positive rate of eyelash Demodex between these two groups was not statistically significant (P>0.05). The score of the meibomian gland secretion in the MGD with eyelash Demodex group (I Group) was (3.00±1.11) and in the MGD without eyelash Demodex group (II group) was (2.28±1.28). The difference in the score of the meibomian gland secretion between these two groups was found to be statistically significant (P=0.047<0.05). The differences of the OSDI score, the meibomian gland discharge ability score, the incidence rate of dry eye, eye pain, eye itching, foreign body sensation and blurred vision between these two groups were not statistically significant (P>0.05). The difference in the culture level between the MGD group and the NMGD group was not statistically significant (P=0.382, >0.05). Conclusion First, in the population under 40 years old, eyelash Demodex is correlated with MGD. Then in the population over 60 years old, the effect of eyelash Demodex on the formation of MGD compared with other influencing factors is not significant. The results indicated that the effect of eyelash Demodex was mainly reflected in the middle and young age, and the correlation between them was further reduced with the increase of age. In addition, in MGD patients, eyelash Demodex infection was not significantly correlated with the incidence of eye pain, eye dryness, eye itching, foreign body sensation, and blurred vision, as well as the degree of impairment of meibomian gland secretion function.

目的 探讨骨科手术患者住院费用的影响因素,为疾病负担分析提供线索,为合理有效控制骨科手术患者住院费用增长提供参考依据。方法 提取某院2013年、2018年两年全部骨科手术患者住院病案首页信息,对其进行统计分析,利用单因素分析、多元线性回归分析住院总费用的影响因素。结果 住院年份、性别、年龄、住院天数、出院科室、是否患有慢性内科疾病、切口愈合类型、麻醉方式、是否转科、病例分型、入院途径、手术是否择期和手术级别等是影响住院总费用的因素。合并慢性病患者,住院费用多于未合并者(P<0.000 1),病例分型为疑难危重患者住院费用大于一般患者(P<0.000 1),入院途径为急诊患者住院费用大于门诊患者(P<0.000 1),需转科患者住院费用大于未转科患者(P<0.000 1),三、四级手术患者住院费用高于一、二级手术患者(P<0.000 1)。结论 加强慢性病的防治,提高对疑难、急危重症患者的诊治水平,是缩短平均住院日、降低骨科手术患者住院费的一个重要途径。

目的 本研究的目的在于通过非孕期与孕期妇女行胎儿纤维连接蛋白的检测对比,再次认识胎儿纤维连接蛋白在早产预测中的价值,是否能有效的预测早产。方法 通过对180例非孕妇女行fFN检测,同时进行白带感染方面的检测,从而判断两者是否具有相关性,同时通过对150例中晚孕妇女于20～34周行fFN检测,判断其在预测早产发生方面的临床应用价值。结果 在180例非孕妇女,发生生殖道感染的患者fFN阳性率增高,与fFN阴性者有差异;在150例中晚孕妇女当中,患者于7天内分娩的敏感度,特异度,阳性预测价值,阴性预测价值为85.7%,69.33%,13.33%,99%。14天内分娩的敏感度,特异度,阳性预测价值,阴性预测价值为80％,68.67%,17.78%,99%。结论 由于 fFN检测易受生殖道感染及其他多种因素干扰,故其在早产预测中的准确性有限。

目的 分析加速康复外科措施在行腹腔镜辅助结直肠癌根治术治疗患者中的应用价值。方法 2017年6月—2018年8月,选取74例行腹腔镜辅助结直肠癌根治术患者进行研究,按照随机数字表法分为观察组、对照组,对照组实施常规康复外科措施,观察组实施加速康复外科措施,对比两组术后恢复情况、住院情况、应激反应及营养状态。结果 观察组术后首次排气时间、下床活动时间、早期进食时间及导管拔出时间短于对照组(P＜0.05);观察组住院时间、总住院费用少于对照组(P＜0.05);术前两组患者Hs-CRP(超敏C-反应蛋白)、ALB(白蛋白)、PA(前白蛋白)及Hb(血红蛋白)指标比较,差异无统计学意义(P＞0.05)。术后第3 d,观察组Hs-CRP、ALB、PA及Hb指标均优于对照组(P＜0.05)。结论 加速康复外科措施在腹腔镜辅助结直肠癌根治术患者中的开展价值显著。

Objective To analyze the value of accelerated rehabilitation surgery in the treatment of patients undergoing laparoscopic assisted radical resection of colorectal cancer. Methods From June 2017 to August 2018, 74 patients who underwent laparoscopic assisted radical resection of colorectal cancer were enrolled in the study. The patients were divided into observation group and control group according to the random number table method. The group implemented accelerated rehabilitation surgery measures to compare postoperative recovery, hospitalization, and immune function. Results The first exhaust time, the time of getting out of bed, the time of early feeding and the time of catheter extraction were shorter in the observation group than that in the control group(P<0.05). The hospitalization time and total hospitalization cost in the observation group were less than those in the control group(P<0.05). There were no significant differences in Hs-CRP(high-sensitivity C-reactive protein), ALB(albumin), PA(pre-albumin) and Hb(hemoglobin) between the two groups before surgery(P>0.05). On the 3rd day after operation, the indexes of Hs-CRP, ALB, PA and Hb in the observation group were better than those in the control group(P<0.05). Conclusion Accelerated rehabilitation surgery is of great value in the development of laparoscopic assisted colorectal cancer radical surgery.