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.

目的 探讨绝经期后女性血清铁蛋白水平与代谢综合征之间的关系。方法 收集218例确诊为MS的绝经期后女性患者为试验组,对照组为经我院检查健康绝经期后的女性300例,分别测FBG、TC、TG、LDL-C、HDL-C、HbA1C、INS、SF;计算体重指数(BMI)以及测量腰围;测血压;用HOMA稳态模型来评价胰岛素抵抗指数(HOMA-IR)。结果 MS组较非MS组的铁蛋白(SF)值高(P<0.01),SF四分位各组之间比较,FBG、TG、HDL-C,BMI,腰围,收缩压、舒张压有差异(P<0.05或P<0.01),四组间年龄、TC、LDL-C无差异。与SF呈正相关的参数有腰围(P<0.01),舒张压(P<0.01),空腹血糖(P<0.01),胰岛素抵抗指数(P<0.01),负相关的参数为HDL-C(P<0.01)。结论 绝经期后女性的SF水平与MS呈显著相关,其中腰围、舒张压、空腹血糖、HDL-C、胰岛素抵抗指数与血清铁蛋白之间存在较大关联性。

Objective To study the relationship of serum ferritin level with metabolic syndrome in postmenopausal women. Methods 218 postmenopausal women with metabolic syndrome and 300 healthy postmenopausal women were included in this investigation, to detect FBG, TC, TG, LDL- C, HDL-C, HbA1C, INS, SF, calculated body mass index (BMI) and to measure waist circumference, blood pressure; Using HOMA steady-state model to evaluate indexes of insulin resistance (HOMA IR). Results Serum ferritin level was significantly higher in MS group than in the non-MS group(P<0.01). Serum ferritin quarterback was compared between each group, there were differences in FBG, TG, HDL-C,BMI, waist circumference,SBP, DBP(P<0.05 or P<0.01). There were no differences in age, TC, LDL-C. Serum ferritin level was significantly positive correlated with waist circumference (P<0.01), DBP(P<0.01), FBG(P<0.01), insulin resistance index (P<0.01), and negative correlation with HDL-C(P<0.01). Conclusion Serum ferritin level is significantly associated with metabolic syndrome in postmenopausal women. Waist circumference, DBP, FBG, HDL -C, insulin resistance index are closely associated with the serum ferritin.

目的 探讨功能训练在Haglund病伴轻度认知障碍患者中的应用效果。方法 成立功能训练培训小组对46例关节镜Haglund病伴轻度认知障碍术患者实施功能训练,干预时间6个月。训练前后对患者Baird-Jackson踝关节评分、自我效能和临床疗效评估进行测评。结果 训练后,患者Baird-Jackson踝关节评分、自我效能优于训练前,临床疗效优良率升高,训练前后比较,差异均有统计学意义(P＜0.01)。结论 功能训练能促进关节镜Haglund病伴轻度认知障碍术患者踝关节功能康复和提高自我效能。

Objective To investigate the effects of application of functional training to Haglund disease patients with mild cognitive impairment. Methods The functional training group was built and gave functional training to 46 patients of Haglund disease with mild cognitive impairment. The period of intervention lasted 6 months. Before and after the training, We assessed patients in terms of scores of Baird-Jackson ankle joint, self-efficacy and clinical efficacy. Results After the training, scores of Baird-Jackson ankle joint and self-efficacy became higher and the excellent rate of clinical efficacy has risen. Compared with those before the training, the difference had statistic significance (P<0.01). Conclusion Functional training has a positive impact on the recovery of ankle joint function of Haglund disease patients with mild cognitive impairment and improve their self-efficacy.

目的 探讨糖尿病自我管理支持对社区2型糖尿病患者生化指标控制的影响。方法 2015年1月1日前已确诊为2型糖尿病患者,随机分为对照组和干预组,对照组303例按照广州市基本公共卫生服务包要求进行定期随访、体检及健康教育,干预组130例进行自我管理支持干预,观察两组生化指标的变化。结果 与对照组比较,自我管理支持组的空腹血糖、总胆固醇、甘油三酯、谷丙转氨酶、尿酸控制效果较好,差异有统计学意义(P<0.05)。结论 自我管理支持对社区2型糖尿病患者生化指标控制的效果良好,值得推广。

Objective To evaluate the control effect of biochemical criterion in patients with type 2 diabetes under diabetes self-management support in community. Methods 130 patients with type 2 diabetes in community from January 2015 to December 2015 accepting the diabetes self-management support were chosen as research group, another 303 diabetic patients without the diabetes self-management support were set as control group, the effect of management was analyzed. Results There was statistically significant difference (P<0.05) in biochemical criterion including blood sugar (BS), total cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT) and uric acid (UA). Conclusion Control effect of biochemical criterion was good in the diabetes self- management support for people with type 2 diabetes, which was worth to be popularized.

目的 探索利伯曼康复治疗对慢性精神分裂症患者社会功能的影响。方法 选取长期住院的慢性精神分裂症患者130例,随机分为研究组65例和对照组65例,研究组实施利伯曼康复治疗,在康复训练前与训练后的第1、3月末分别采用护士用住院病人观察量表(NOSIE)和住院精神病人康复疗效评定量表(IPROS)对患者进行评价。结果 患者通过利伯曼康复治疗后,NOSIE量表总积极分、社会能力、社会兴趣、个人整洁等得分有明显提高;IPROS量表的工疗情况生活能力社交能力讲究卫生能力都有较明显的提高(T、P<0.01)。结论 利伯曼康复治疗对患者的社会功能的改善有积极的意义。

Objective To explore the impacts of Lieberman rehabilitation technique on chronic schizophrenic patient's quality of life. Methods 130 patients diagnosed with chronic schizophrenia with over 5-year long hospitalization were divided into two groups randomly, with 65 samples at either study group or control group. Team to implement a lieberman rehabilitation. NOSIE and IPROS were used by nurse to assess the performance of all samples in one month after the beginning of the study and three months after the beginning study. Results After intervention, the performance of samples in study group indicated that patients had significantly higher score in NOSIE total score, social ability, social interest, individual tidiness. Patient's total negative points including irritability, mental performance, retardation and depression were decreased. IPROS living ability and social ability has improved significantly(P≤0.01). Conclusion Lieberman rehabilitation technique can improve patients'social function.

目的 探讨白癜风初诊患者外周血细胞因子水平与临床分型、皮损面积的相关性。方法 收集我院2009年7月—2013年7月4年间收治的初诊白癜风患者78例及健康志愿者37例,用ELISA检测外周血血清IL-6、IL-2, IFN-γ、TNF-α浓度并判断其与白癜风分型、皮损程度的相关性。结果 与对照组相比,白癜风各分型组的IL-6、IL-2水平均升高,其中,散在性的升高幅度最为明显。IL-6及IL-2与皮损面积呈正相关,其相关系数分别为0.664及0.483,P值分别为0.021及0.014。结论 IL-2及IL-6在白癜风的发病过程中起重要作用,且在不同的分型中的表达存在差异,并与皮损面积呈正相关。

Objective To evaluate the correlation of cytokine level of peripheral blood cells, clinical classification and skin lesion in preliminary diagnosis of vitiligo. Methods A total of 78 patients with vitiligo of preliminary diagnosis and 37 health volunteers were collected from July 2009 to July 2013. The peripheral blood were collected for ELISA measurement of IL-6, IL-2, IFN-γand TNF-α, and evaluated whether the cytokines concentration was correlated to clinical classification and skin lesion. Results Compared to control group, IL-6 and IL-2 in all of classification of vitiligo was higher, and the most increase was observed in scattered group. Both IL-6 and IL-2 showed the positive correlation with skin lesion (CI: 0.664 and 0.483, P=0.021 and 0.014). Conclusion IL-2 and IL-6 maybe play a key role in vitiligo etiology, and showed different level in different classification of vitiligo. Besides, they showed a positive correlation with skin lesion.

目的 研究PF诱导化疗联合调强放疗及二维放疗对鼻咽癌近远期疗效影响的回顾性分析。方法 回顾性分析2008年1月—2008年12月中山大学附属肿瘤医院收治的101例鼻咽癌患者治疗情况,按照治疗方案技术分为调强组(n=42)和二维组(n=59)。比较两组患者临床疗效,近期毒副反应及生存情况。结果 放疗结束时调强组患者总缓解率92.86%与二维组77.97%比较差异有统计学意义(P<0.05)。调强组Ⅲ-Ⅳ级胃肠道反应26.19%及黏膜炎14.29%发生率与二维组比较显著较少,差异有统计学意义(P<0.05)。两组患者远期毒副反应及生存率比较无显著差异(P>0.05)。结论 PF诱导化疗联合调强放疗治疗鼻咽癌患者,近远期临床疗效好,毒副反应少。

Objective To study the effects of PF induced chemotherapy combined with intensity modulated radiation therapy and two-dimensional radiotherapy on the short and long term curative effects in nasopharyngeal carcinoma. Methods The treatment condition of 101 cases of patients with nasopharyngeal carcinoma who were treated in the Tumor Hospital Affiliated to San Yat-sen University between January and December 2008 were retrospectively analyzed. According to different treatments, the cases were divided into the intensity modulated group and the two-dimensional group. The clinical curative effects, short-term toxic and side effects and survival status were compared between the two groups. Results At the end of radiotherapy, the total remission rate in the intensity modulated group was 92.86% while in the two-dimensional group was 77.97% (P<0.05). In the intensity modulated group, the incidence rates of grade Ⅲ-Ⅳgastrointestinal tract reactions (26.19%) and mucositis (14.29%) were significantly lower than those in the two-dimensional group (P<0.05). There was no significant difference in long-term side effects and survival rate between the two groups (P>0.05). Conclusion PF induced chemotherapy combined with intensity modulated radiation therapy in the treatment of patients with nasopharyngeal carcinoma has good short and long-term curative effects and few toxic and side effects.

目的 探讨单倍体亲缘异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的可行性。方法 对1例诊断SAA 4年余,先后经CsA治疗、脐血移植治疗均无效并反复输注红细胞、血小板的12岁男性患者进行单倍体亲缘异基因造血干细胞移植,供者为其胞兄,高分辨HLA基因型5/10相合,预处理方案为BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d。干细胞来源为G-CSF动员的骨髓+外周造血干细胞,共计输注单个核细胞(MNC)4.055×10⁸/kg(受者体重),CD 34 2.331×10⁶/kg。GVHD预防:-1 d采用与受者HLA部分相合的第三方脐带血细胞,术后联合应用环孢素A、短程氨甲碟呤、霉酚酸酯。结果 造血缓慢重建,术后22天(+22 d)ANC>0.5×10⁹/L,术后3月血小板脱离输注。+26天DNA指纹图全部表现为供者基因型。+40天血型转为供者型“O”型。+29 d出现急性移植物抗宿主病aGVHD(胃肠型,Ⅲ度),+31 d、+34 d及+42 d予巴利昔单抗20 mg静滴,+40 d、+44 d、+63 d输注间充质干细胞,患者急性GVHD逐渐控制。期间曾出现肺部感染、口腔黏膜炎及巨细胞病毒血症,经抗感染后可控制。现随访3年,血象正常稳定,Kamofsky评分100分。结论 单倍体亲缘异基因造血干细胞移植治疗SAA,对无相合供者(包括亲缘或非亲缘)且强效免疫抑制治疗失败的患者,可考虑进行,GVHD和感染为主要并发症,需根据患者病情采用相应措施。

Objective To investigate the feasibility of haploid genetic allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia(SAA) in our hospital. Methods A 12-year-old patient with acquired SAA for 4 years showed no response to CsA and cord blood transplant treatment and was transfusion-dependent. Lacking an HLA-identical sibling donor, the patient was treated with HSCT from his brother 5/10 matched at the generic level. Theconditioning regimen was BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d. Stem cells were the source of G-CSF mobilization of bone marrow and peripheral blood stem cells, dose of stem cells infused: mononuclear cells (MNC) 4.055×10⁸/kg (body weight of subject), CD34 2.331×10⁶/kg. Prevention of GVHD: -1 d Third-party umbilical cord blood cells which were HLA partially matched were used. Postoperative joint use included cyclosporine A, short-course methotrexate, mycophenolate mofetil. Results Hematopoiesis was slowly rebuilding, 22 d after surgery (+22 d) ANC> 0.5×10⁹/L, after three months departing from transfusion of platelets. +26 d suggesting that the DNA fingerprints showed donor genotypes. +40 d into donor blood type “O” type. + 29 d occurred acute GVHD (GI type, Ⅲ degrees), + 31 d, + 34 d + 42 d infusion of basiliximab 20mg, + 40 d, + 44 d, + 63 d infusion of mesenchymal stem cells. Gradually acute GVHD was controlled in the patient, who had lung infections, oral mucositis and cytomegalovirus viremia, could be controlled with anti-infective. Now followed up for 3 years, hemogram change has been normal and stable. Kamofsky score was 100 points. Conclusion It may be considered to have haploid genetic allogeneic hematopoietic stem cell transplantation for treatment of SAA, for those patients who have non-matched donor (including relatives and non-relatives) and potent immunosuppressive therapy failure. GVHD and infection are major complications. Need to adopt appropriate measures in accordance with the patient's condition.

目的 探讨同步放化疗治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法 选取我院2014年收治的晚期NSCLC患者102例,随机分为观察组和对照组,对照组以紫杉醇联合顺铂化疗方案(TP)化疗治疗,观察组加用三维适形放疗同步放化疗治疗,观察两组的临床疗效和不良反应。结果 观察组和对照组患者的总有效率分别为43.14%和21.57% (P<0.05),两组患者的总控制率分别为84.31%和66.67% (P<0.05)。两组患者Ⅲ～Ⅳ级胃肠道反应、白细胞减少、骨髓抑制的发生率差异无统计学意义(P>0.05),观察组比对照组增加了放射性肺炎和放射性食管炎的发生 (P<0.05)。两组患者生活质量比较,差异具有统计学意义(P＜0.05)。结论 同步放化疗治疗晚期NSCLC可以显著提高治疗的总有效率、肿瘤的控制率及生活质量,但也使不良反应增加,选择治疗方案时应根据个体情况综合考虑。

Objective To study the clinical efficacy of concurrent chemoradiotherapy in the treatment of advanced non small cell lung cancer (NSCLC). Methods 102 cases of advanced NSCLC treated in our hospital in 2014 were selected and randomly divided into the observation group and the control group. Patients in control group were treated by chemotherapy with Paclitaxel combined Cisplatin (TP), while those in observation group were treated by concurrent chemoradiotherapy with three- dimensional conformal radiotherapy and TP. The clinical efficacy and adverse reactions of the two groups were observed. Results The total effective rate of the observation group and the control group were 43.14% and 21.57% (P<0.05), respectively. The total control rate of the two groups were 84.31% and 66.67%(P<0.05). In two groups III ~ IV gastrointestinal tract reaction, leukopenia, bone marrow suppression occurrence had no statistical significance(P>0.05). Incidence of radiation pneumonitis and radiation esophagitis increased in observation group(P<0.05). The difference of quality of life between the two groups was statistically significant(P<0.05). Conclusion Concurrent radiotherapy and chemotherapy in the treatment ofadvanced non-small cell lung cancer(NSCLC)can not only significantly improve the treatment, tumor control rate and quality of life, but also make adverse reaction increased. Treatment options should be chosen based on individual circumstances into account

目的 探讨传统支气管针吸活检 (cTBNA )与超声支气管镜引导下针吸活检(EBUS-TBNA)对于肺部疾病伴有肺门及纵膈淋巴结肿大患者的诊断价值。方法 2012 年8月—2014年6月对在我院行CT检查提示肺部伴有肺门和/或纵膈淋巴结病变的患者38例, 分别利用cTBNA或EBUS-TBNA检查对肿大的淋巴结行TBNA,对所获得的标本进行相应的细胞学检查。结果 38例病例均经组织病理学诊断后确诊,并经过6个月的随访,其中cTBNA组(n=19)经组织病理明确诊断的包括:1例结核,5例小细胞肺癌,6例腺癌,3例鳞癌,1例大细胞癌,3例慢性炎症,cTBNA细胞学诊断阳性诊断率为63.16%(12/19),cTBNA组细胞学诊断肺癌的敏感度为66.67％(10/15),特异度为100％。EBUS-TBNA组(n=19)组织病理学诊断明确的1例为肺结核,1例为纵隔恶性肿瘤,1例为结节病,1例大细胞癌,1例小细胞癌,7例腺癌,5例鳞癌,2例为慢性炎症,EBUS-TBNA细胞学阳性诊断率为78.94%(15/19)。两种方法在诊断肺门及纵膈淋巴结肿大的疾病中有差异(P<0.05)。EBUS-TBNA组细胞学诊断肺癌的敏感度为86.67％(13/15),特异度为100％。结论 EBUS-TBNA细胞学检查对肺部疾病伴有肺门及纵膈淋巴结肿大的诊断率较cTBNA高,可明显提高检查阳性率,具有重要临床意义。

Objective To evaluate the value of clinical application between cTBNA and EBUS-TBNA in diagnosis of mediastinal and hilar lymph nodes. Methods Between August 2012 and June 2014, 38 in-patients with mediastinal and hilar lymph nodes took conventional transbronchial needle aspiration( cTBNA,n=19) or endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA, n=19), and we were comparing the diagnostic results of two methods. Results 19 patients in the cTBNA group were diagnosed by forceps biopsy,including 1 case of lung cancer and 162 cases of tuberculosis, 5 cases of small cell lung cancer, 6 cases of adenocarcinoma, 3 cases of squamous cell carcinoma, 1 case of large cell carcinoma, 3 cases of chronic inflammation, a cytological diagnosis of TBNA positive in 12 cases (63.16%). In the EBUS-TBNA group (n=19), the patients were diagnosed by accepting forceps biopsy, 1 case of tuberculosis, 1 case of mediastinal malignant tumor, 1 cases of sarcoidosis, 1 cases of large cell carcinoma, 1 case of small cell carcinoma, 7 cases of adenocarcinoma, 5 cases of squamous cell carcinoma, 2 cases of chronic inflammation, EBUS-TBNA cytology positive rate of diagnosis was 14 (73.68%). Two techniques in the diagnosis of mediastinal and hilar lymph nodes have statistically significant(P<0.05). The sensitinty of cytology in the diagnosis of lung caner was 86.67%(13/15),and the specificity was 100%(EBUS-TBNA). Conclusion EBUS-TBNA is an effective tool in the diagnosis of mediastinal and hilar lymph nodes and superior to cTBNA.