目的 研究甲泼尼龙琥珀酸钠对重症支原体肺炎（SMPP）患儿的治疗效果及安全性。方法 采用随机数表法将南华大学附属长沙中心医院2021年1月—2022年12月收治的108例SMPP患儿分为两组,对照组（54例）采用常规治疗,研究组（54例）采用常规治疗联合甲泼尼龙琥珀酸钠治疗,比较2组临床疗效。结果 治疗后研究组炎症因子水平低于对照组,肺功能指标、健康状况评分均高于对照组,发热、咳嗽、肺啰音及肺阴影消失时间均短于对照组（P<0.05）;两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 应用甲泼尼龙琥珀酸钠治疗可加快患儿症状缓解,改善机体炎症反应及肺功能,且安全性较高。

Objective To study the therapeutic effect and safety of methylprednisolone sodium succinate on children with severe Mycoplasma pneumoniae pneumonia（SMPP）．Methods A total of 108 children with SMPP admitted to Changsha Central Hospital from January 2021 to December 2022 were divided into two groups by random number table method．The control group（54 cases）was treated with conventional therapy,and the study group（54 cases）was treated with conventional therapy combined with methylprednisolone sodium succinate．The clinical effects of the two groups were compared．Results After treatment,the levels of inflammatory factors in the study group were lower than those in the control group,and lung function indicators and health status scores were higher than those in the control group．The disappearance time of fever,cough,lung rales and lung shadows was shorter than that in the control group（P<0.05）．There was no statistically significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions The application of methylprednisolone sodium succinate treatment can accelerate the relief of symptoms in children,improve the body's inflammatory response and lung function,and has high safety．

目的 探讨宣清导浊汤加减方联合血液透析治疗对老年慢性肾衰竭（CRF）患者肾功能、微炎症状态和毒素清除率的影响。方法 回顾性选取2019年10月—2022年10月我院收治的82例老年CRF患者,将其根据治疗方法分为联合组与单一组,每组41例。单一组仅采取血液透析治疗,联合组联合宣清导浊汤加减方治疗,对比两组患者治疗前后中医证候积分、毒素清除率、炎症因子变化。结果 治疗后,两组患者口淡不渴、肢体麻木、腰膝酸软、倦怠乏力、食少纳呆以及面色晦暗相关中医证候积分均降低,且联合组低于单一组（P<0.05）;治疗后两组患者血肌酐、尿素氮、血β₂-微球蛋白均降低,联合组低于单一组（P<0.05）;治疗后两组患者白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α炎性因子水平明显降低,且联合组更低（P<0.05）。两组在治疗期间均无不良反应。结论 宣清导浊汤加减方联合血液透析治疗老年CRF患者效果较佳,可通过降低机体炎症因子表达水平、提高毒素清除率来改善患者临床症状,且不会增加不良反应。

Objective To explore the effect of Xuanqing Daozhuo Decoction modified formula combined with hemodialysis treatment on renal function,micro inflammatory status,and toxin clearance rate in elderly patients with chronic renal failure（CRF）．Methods Retrospectively,82 elderly CRF patients admitted to our hospital from October 2019 to October 2022 were selected and divided into a combination group and a single group according to the treatment methods,with 41 cases in each group． The single group was treated with hemodialysis only,and the combined group was treated with Xuanqing Daozhuo Decoction modified formula additionally．The changes of TCM syndrome scores,toxin clearance rate and inflammatory factors before and after treatment were compared between the two groups．Results After treatment,the scores of TCM syndroms including tasteless mouth and no thirst,numbness of limbs,soreness and weakness of waist and knee,fatigue,poor appetite and sluggish stomach were all decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,serum creatinine,blood urea nitrogen and β₂-microglobulin were decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,the levels of interleukin-6,C-reactive protein and tumor necrosis factor-α inflammatory factors were significantly decreased in 2 groups,which were lower in combination group（P<0.05）．The two groups had no adverse effects during the treatment period．Conclusions Xuanqing Daozhuo Decoction modified formula and hemodialysis can improve the clinical symptoms of elderly patients with CRF,reduce the expression level of inflammatory factors in patients,and increase the clearance rate of toxins in patients,and does not increase the adverse effects．

目的 通过对原位换管与首次置管比较,验证采用原位换管方式的可行性。方法 选取儿童肾内科先后采用了首次置管与原位换管的病例20例。将原位换管作为原位换管组,首次置管作为首次置管组,比较两组操作成功有效率、导管留置天数、最大血流速/体质量[mL/（min·kg）]、操作并发症的差异。结果 两组均一次性穿刺成功,两组在管道留置天数和血流速/体质量[mL/（min·kg）]及并发症比较差异均无统计学意义（P>0.05）。结论 原位换管与首次置管的效果相同,原位换管操作简单、对患者的损伤更小。

目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表（VAS）评分低于常规组（P<0.05）,二者住院时间以及引流管拔除时间比较差异无统计学意义（P>0.05）;经过护理干预后,两组的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）均延长,血浆纤维蛋白原（FIB）降低,联合组优于常规组（P<0.05）,且联合组下肢静脉血栓发生率低于常规组（0% vs 17.14%,P<0.05）;联合组患者护理满意度更高（P<0.05）;术后1个月两组患者日常生活活动能力（ADL）评分、Fugl-Meyer评分均升高,联合组高于常规组（P<0.05）。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。

Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis．Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group．Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room．The nursing effect of the two groups was compared．Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group（P<0.05）,and the length of hospital stay and drainage tube removal time were not significantly different between the two groups（P>0.05）．After nursing intervention,the prothrombin time（PT）and activated partial thromboplastin time（APTT）of the two groups were prolonged,and the plasma fibrinogen（FIB）decreased,and the change range of the combined group was greater（P<0.05）．The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group（0.00% vs 17.14%,P<0.05）．The nursing satisfaction of patients in combination group was higher（P<0.05）．The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group（P<0.05）．Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients．

目的 分析阿莫西林克拉维酸钾与第三代头孢类抗菌药联合应用于新生儿肺炎患儿的应用效果及其对患儿肠道菌群的影响。方法 选择在2021年2月—2022年11月期间于我院新生儿科接受相关治疗的100例新生儿肺炎患儿,依照简单随机化法将患儿分为研究组（n=50）及参照组（n=50）。给予参照组常规新生儿肺炎治疗,在此基础上给予研究组患者阿莫西林克拉维酸钾与第三代头孢类抗菌药的联合治疗。治疗结束后对比两组患儿的血清因子水平、肠道菌落情况、临床疗效以及不良反应发生情况。结果 治疗前,两组患儿的血清因子水平、肠道内菌群数量比较差异无统计学意义（P>0.05）,治疗后两组患儿的降钙素原（procalcitonin,PCT）、C-反应蛋白（C-reactive protein,CRP）、白细胞计数（white blood cell count,WBC）、肠球菌、肠杆菌、双歧杆菌以及乳酸杆菌水平均有改善（P<0.05）,其中研究组的PCT、CRP、WBC、肠球菌、双歧杆菌以及乳酸杆菌数量低于参照组,而研究组的肠杆菌数量高于参照组;同时研究组的临床有效率（94.00%）与参照组的临床有效率（86.00%）比较差异无统计学意义（P>0.05）;两组患儿的不良反应发生率比较差异无统计学意义（P>0.05）,但其中研究组腹泻的发生率高于参照组（P<0.05）。结论 在对新生儿肺炎患儿进行治疗时采取阿莫西林克拉维酸钾单纯治疗与阿莫西林克拉维酸钾+第三代头孢类抗菌药（头孢他啶）的临床疗效相当,联合用药虽能更为显著地减少患儿机体的细菌数量,改善血清因子水平,但更易发生腹泻的并发症,且为了减少耐药性,应适当采用单独用药。

Objective To analyze the application effect of amoxicillin clavulanate potassium combined with third-generation cephalosporin antibiotics in children with neonatal pneumonia and its impact on the intestinal microbiota．Methods From February 2021 to November 2022,100 newborns with pneumonia who received relevant treatment in the Department of Neonatology at the First People’s Hospital of Shangqiu City were randomly divided into a study group（n=50）and a reference group（n=50）using a simple randomization method．Routine treatment was provided for neonatal pneumonia in the reference group,and on this basis,a combination treatment of amoxicillin,clavulanate potassium,and third-generation cephalosporin antibiotics was applied on the study group patients．After treatment,the serum factor levels,intestinal colony status,clinical efficacy,and incidence of adverse reactions were compared between the two groups of children．Results Before treatment,there were no statistically significant differences in serum factor levels and intestinal microbiota between the two groups of children（P>0.05）．After treatment,the levels of procalcitonin（PCT）,C-reactive protein（CRP）,white blood cell count（WBC）,Enterococcus,Enterobacter,Bifidobacterium,and Lactobacillus in the two groups of children improved（P<0.05）,with the levels of PCT,CRP,WBC,the number of Enterococcus,Bifidobacterium,and Lactobacillus in the study group was lower than that in the reference group,while the number of Enterobacter in the study group was higher．There was no statistically significant difference（P>0.05）in the clinical response rate between the study group（94.00%）and the reference group（86.00%）．There was no statistically significant difference in the incidence of adverse reactions between the two groups of children（P>0.05）,but the incidence of diarrhea in the study group was higher than that in the reference group（P<0.05）．Conclusions The clinical efficacy of amoxicillin clavulanate potassium alone and amoxicillin clavulanate potassium+third-generation cephalosporin antibiotics（ceftazidime）in the treatment of newborns with pneumonia is comparable．Although the combination therapy can significantly reduce the number of bacteria in the body of children and improve serum factor levels,it is more prone to complications of diarrhea．In order to reduce drug resistance,separate medication should be appropriately used．

目的 探讨积极综合护理措施对早期宫颈癌术后患者性功能、抑郁和主观幸福感的影响。方法 对我院收治的84例50岁以下宫颈癌患者的临床资料进行回顾性分析,将行常规护理的43例患者作为对照组、行综合护理的41例患者作为治疗组,治疗组除了常规护理内容,还采用幸福理论框架模型下（PERMA模型）的性健康管理多学科团队干预方案。分别在干预前、干预后3个月、干预后6个月采用女性性功能指数、抑郁自评量表评分和幸福感指数,对性功能指数、抑郁评分和幸福指数进行评估。结果 与对照组相比,治疗组干预3个月及6个月患者的性功能改善（F=91.08,P<0.001）。干预3个月及6个月后,治疗组抑郁评分低于对照组（F=1 092.59,P<0.001）,幸福感改善指数高于对照组（F=107.90,P<0.001）。Spearman相关分析结果显示,女性性功能指数同抑郁自评量表得分呈负相关（r_s=-0.918,P<0.001）,同幸福感指数得分呈正相关（r_s=0.844,P<0.001）。结论 综合护理在性功能、抑郁和主观幸福感方面均有明显改善。通过PERMA模式下性健康管理的多学科团队干预方案,可以提高患者的性生活质量,降低患者的抑郁程度,及改善患者的主观幸福感。

Objective To explore the effects of active and comprehensive care measures on sexual function,depression and subjective well-being of patients after early cervical cancer surgery．Methods The clinical data of 84 cervical cancer patients（under 50 years old）admitted to our hospital were retrospectively analyzed．There were 43 cases with conventional care in control group and 41 cases with comprehensive care group in treatment group．Besides the conventional care components,the comprehensive care group also adopted a multidisciplinary team intervention program for sexual health management under the framework model of well-being theory（PERMA model）．We used the female sexual function index,depression self-rating scale score and happiness index to assess the sexual function index,depression score and happiness index before,3 months and 6 months after the intervention,respectively．Results In comparison with the control group,the patients in the treatment group had a significant improvement in sexual function at 3 and 6 months of intervention（F=91.08,P<0.001）．After 3 and 6 months of intervention,the depression score was significantly lower in the comprehensive care group than in the control group（F=1 092.59,P<0.001）,and the happiness improvement index was significantly higher than in the control group（F=107.90,P<0.001）．Spearman’s correlation analysis showed that the female sexual function index was negatively correlated with the depression self-rating scale score（r_s=-0.918,P<0.001）and positively correlated with the well-being index（r_s=0.844,P<0.001）．Conclusions The comprehensive care group showed significant improvements in sexual function,depression,and subjective well-being．A multidisciplinary team intervention program for sexual health management under the PERMA model can improve the quality of patients’ sexual life,reduce their depression,and improve their subjective well-being．

目的 观察布托啡诺联合舒芬太尼镇痛方案在重症监护病房（ICU）机械通气患者中的效果及对血流动力学的影响。方法 采用前瞻性、随机对照研究,选取2021年3月—2023年3月商丘市第三人民医院ICU收治的118例机械通气患者,按1∶1随机分为观察组、对照组各59例。观察组采取布托啡诺联合舒芬太尼镇痛方案,对照组采取舒芬太尼镇痛方案。比较两组镇静、镇痛情况（镇静起效时间、停药后苏醒时间、机械通气时间、ICU住院时间、丙泊酚总用量）。以用药前（T0）、用药后6 h（T1）、12 h（T2）、24 h（T3）为时间节点,比较两组血流动力学指标[心率（HR）、平均动脉压（MAP）]。以用药后6 h（t1）、12 h（t2）、18 h（t3）、24 h（t4）为时间节点,比较两组Ricker镇静-躁动评分（SAS）、重症监护疼痛观察工具（CPOT）评分。比较两组不良反应发生情况。结果 用药后观察组镇静起效、停药后苏醒、机械通气、ICU住院时间均短于对照组,丙泊酚总用量少于对照组（P<0.05）;t1~t4时观察组CPOT评分均低于对照组,SAS评分均高于对照组（P<0.05）;T1、T2、T3时观察组HR、MAP波动幅度小于对照组（P<0.05）;观察组不良反应总发生率为10.17%,与对照组15.25%相比,差异无统计学意义（P>0.05）。结论 布托啡诺、舒芬太尼联合治疗ICU机械通气患者,可有效增强镇静、镇痛效果,维持血流动力学稳定,且安全性较高,有利于促进患者病情转归。

Objective To observe the effect of butorphanol and sufentanil combined analgesia regimen in patients with mechanical ventilation in intensive care unit（ICU）and its influence on hemodynamics．Methods A prospective,randomized controlled study was carried out on 118 patients with mechanical ventilation in ICU from March 2021 to March 2023,and the enrolled patients were randomly divided into observation group and control group with 59 cases in each group．The observation group received butorphanol combined with sufentanil analgesia regimen,and the control group received sufentanil analgesia regimen．The conditions of sedation and analgesia（sedation onset time,recovery time after drug withdrawal,mechanical ventilation time,ICU stay length,total dosage of propofol）were compared between the two groups．The hemodynamic indexes [heart rate（HR）and mean arterial pressure（MAP）] of the two groups were compared before medication（T0）,6 h（T1）,12 h（T2）and 24 h（T3）after medication as time nodes．At 6 h（t1）,12 h（t2）,18 h（t3）,24 h（t4）after medication,Ricker Sedation-Agitation Scale（SAS）and Critical Care Pain Observation Tool（CPOT）score were compared between the two groups．The occurrence of adverse reactions was compared between the two groups．Results The onset of sedation,recovery after drug withdrawal,mechanical ventilation and ICU stay in the observation group were shorter than those in the control group,and the total dosage of propofol was lower than that in the control group（P<0.05）．At t1 to t4,CPOT score of observation group was lower than that of control group,and SAS score was higher than that of control group（P<0.05）．The fluctuation amplitude of HR and MAP in the observation group was smaller than that in the control group at T1,T2 and T3（P<0.05）．The total incidence of adverse reactions in the observation group was 10.17%,compared with 15.25% in the control group,the difference was not statistically significant（P>0.05）．Conclusions The combination of butorphanol and sufentanil in the treatment of patients with mechanical ventilation in ICU can effectively enhance sedation and analgesia,maintain hemodynamic stability,and have high safety,which is conducive to promote the outcome of the disease．

目的 观察利伐沙班对心力衰竭（HF）合并心房颤动（AF）患者凝血因子及预后情况的影响。方法 采用前瞻性研究,纳入平顶山市第二人民医院2021年1月—2022年4月期间收治的123例HF合并AF患者,以数字随机表法将入组患者分为常规组（61例）和试验组（62）例,两组均行起搏器植入术（CRTD）治疗,常规组予以常规抗凝治疗辅助CRTD,试验组予以利伐沙班辅助CRTD,所有患者术后均开展一年随访,比较两组患者治疗前后的抗Xa凝血因子、心肌损伤标志物、心功能指标变化情况,以及术后血栓栓塞、心血管死亡事件发生情况。结果 治疗前,两组患者的Xa凝血因子,心肌损伤标志物,心功能指标比较差异无统计学意义（P>0.05）;在不同抗凝方案下,观察组治疗1 d后的抗Xa凝血因子为（130.44±20.18）IU/mg,治疗3 d后的抗Xa凝血因子为（115.36±20.77）IU/mg,治疗7 d的抗Xa凝血因子为（90.25±20.44）IU/mg,均低于常规组[（145.33±20.19）IU/mg、（128.45±20.16）IU/mg、（103.34±20.17）IU/mg],差异有统计学意义（P<0.05）。治疗后,试验组的肌酸激酶同工酶为（7.52±2.16）U/L,心肌肌钙蛋白Ⅰ为（0.52±0.12）ng/mL,乳酸脱氢酶为（126.41±20.45）U/L,均低于常规组[（8.44±2.28）U/L、（0.94±0.31）ng/mL、（140.33±20.25）U/L],差异有统计学意义（P<0.05）。治疗后,观察组的左室射血分数为（56.12±10.41）%,高于常规组（50.24±10.33）%,左室舒张末期内径为（47.11±10.25）mm,左室舒张末期容积为（36.72±10.43）mL,均低于常规组（53.28±10.14）mm、（42.77±10.36）mL,差异有统计学意义（P<0.05）。随访期间,试验组的血栓栓塞事件发生率为4.84%（3/62）,心血管死亡事件发生率为3.23%（2/62）,均低于常规组[19.67%（12/61）、14.75%（9/61）],差异有统计学意义（P<0.05）。结论 利伐沙班辅助CRTD能有效增强HF合并AF患者的抗Xa凝血因子活性,对减轻心肌损伤、改善心功能并降低血栓栓塞或心血管死亡风险均有积极意义。

Objective To observe the effect of rivaroxaban on coagulation factors and prognosis in patients of heart failure（HF）with atrial fibrillation（AF）．Methods This is a prospective study．The patients were included from January 2021 to April 2022 in Pingdingshan Second People’s Hospital．The study subjects were 123 patients with HF and AF．The enrolled patients were divided into the conventional group（61 cases）and the experimental group（62 cases）by the method of digital random table．Both groups were treated with cardiac resynchronization therapy with defibrillator（CRTD）．The conventional group was treated with conventional anticoagulation therapy to assist CRTD,and the experimental group was treated with rivaroxaban to assist CRTD．All patients were followed up for one year after surgery,the changes in anti-Xa coagulation factors,myocardial injury markers,cardiac function indicators,as well as the incidence of postoperative thromboembolism and cardiovascular death events between the two groups of patients before and after treatment were compared．Results Before treatment,there were no statistically significant differences in Xa coagulation factor,myocardial injury markers and cardiac function indicators between the two groups of patients（P>0.05）．Under different anticoagulation regimens,the anti-Xa coagulation factor levels in the observation group were（130.44±20.18）IU/mg after 1 day of treatment,（115.36±20.77）IU/mg after 3 days of treatment,and（90.25±20.44）IU/mg after 7 days of treatment,which were lower than that in the conventional group [（145.33±20.19）IU/mg,（128.45±20.16）IU/mg,（103.34±20.17）IU/mg]（P<0.05）．After treatment,the CK-MB level of the experimental group was（7.52±2.16）U/L,cTnI was（0.52±0.12）ng/mL,and LDH was（126.41±20.45）U/L,which were lower than that of the conventional group [（8.44±2.28）U/L,（0.94±0.31）ng/mL,（140.33±20.25）U/L]（P<0.05）．After treatment,the left ventricular ejection fraction of the observation group was（56.12±10.41）%,which was higher than the conventional group（50.24±10.33）%,left ventricular diameter was（47.11±10.25）mm,left ventricular end disastolic volume was（36.72±10.43）mL,which were lower than the conventional group（53.28±10.14）mm,（42.77±10.36）mL（P<0.05）．During the follow-up period,the incidence of thromboembolism events in the experimental group was 4.84%（3/62）,and the incidence of cardiovascular death events was 3.23%（2/62）,which was lower than the conventional group [19.67%（12/61）,14.75%（9/61）]（P<0.05）．Conclusions Rivaroxaban assisted CRTD can effectively enhance the activity of anti-Xa coagulation factors in patients with HF and AF,which has positive significance in reducing myocardial injury,improving cardiac function and reducing the risk of thromboembolism or cardiovascular death．

目的 探讨近端和远端结直肠无蒂锯齿状病变在临床和内镜特征上的区别。方法 回顾性分析103例结直肠无蒂锯齿状病变患者的临床内镜资料,对近端和远端结直肠无蒂锯齿状病变患者在性别、年龄、内镜特征（息肉大小、山田分型、内镜NICE分型、蛇形微血管、黏液帽）等方面进行比较。结果 与远端结直肠无蒂锯齿状病变相比,近端结肠无蒂锯齿状病变发病年龄更早（P=0.014）,内镜下山田1型息肉更为常见（P=0.050）,黏液帽也是近端结肠无蒂锯齿状病变的重要内镜特征（P<0.001）。结论 近端无蒂锯齿状病变内镜下扁平隐匿,容易漏诊,掌握其内镜特征有助于提高该病的检出率。

Objective To explore the differences in clinical and endoscopic characteristics of sessile serrated lesions in the proximal and distal colorectum．Methods The clinical endoscopic data of 103 patients with sessile serrated lesions of the colorectum were retrospectively analyzed．The gender,age and endoscopic features（polyp size,Yamada classification,NICE classification,dilate vessels and the mucus cap）of patients with proximal and distal colorectal sessile serrated lesions were compared retrospectively．Results Compared with distal colorectal sessile serrated lesions,the age of onset of proximal colon sessile serrated lesions was earlier（P=0.014）,endoscopic Yamada type 1 polyps were more common（P=0.050）,and mucus cap was also an important endoscopic feature of proximal colon sessile serrated lesions（P<0.001）．Conclusions The proximal sessile serrated lesions are flat and hidden under endoscopic examination which are easily missed．Understanding their endoscopic characteristics can help improve the detection rate of the disease．

目的 通过学习1例少见的组织学特征与IgG4相关性淋巴结病类似的浆细胞型特发性多中心型Castleman病（PC-iMCD）,总结两种易误诊疾病的鉴别要点,提高病理诊断水平。方法 回顾性分析1例PC-iMCD患者临床资料,常规苏木素-伊红（HE）染色分析淋巴结组织结构及细胞形态,免疫组织化学染色及原位杂交分析免疫表型及EB病毒（EBV）感染状态,并结合文献分析讨论其与IgG4相关淋巴结病的鉴别诊断。结果 48岁女性患者,临床表现为口干、多饮、皮肤瘙痒伴全身多处淋巴结肿大。实验室检查血清IgG、IgA、IgM及IgE水平均升高,血清IgG4显著升高（14.7 g/L）,白介素- 6（IL-6）异常升高（150.84 pg/mL）。病理检查显示淋巴结生发中心萎缩,套区淋巴细胞呈“洋葱皮”样围绕生发中心排列,滤泡间区扩张,其内见大量成熟的浆细胞呈片状浸润,灶区见含铁血黄素沉积及血管增生;免疫组化染色显示IgG4阳性浆细胞数大于100/高倍视野,IgG4阳性细胞/IgG阳性细胞比值>40%,Kappa及Lambda轻链呈非限制性表达;EB病毒编码RNA原位杂交（EBER）阴性。结论 部分PC-iMCD与IgG4相关淋巴结病具有相似的组织病理学特征,单纯根据组织学及免疫表型难以将两者鉴别,正确诊断需结合IgG4相关病变诊断标准、排除性诊断标准、临床表现及实验室检查综合判断。

Objective By studying a rare case of the plasma cell type idiopathic multicentric Castleman disease（PC-iMCD）with histological characteristics similar to IgG4-related lymphadenopathy,the differential points of the two easily misdiagnosed diseases were summarized to improve the level of pathological diagnosis．Methods The clinical data of one patient with PC-iMCD were collected,the structure alteration and cell morphology were observed by hematoxylin-eosin（HE）stains．The immunophenotype of cells was marked by immunohistochemical staining and the infections status of EB virus was detected by in situ hybridization．Besides,the differential diagnosis between IgG4-RD and PC-iMCD were analyzed and discussed based on literature analysis．Results This article reported a 48-year-old female who was admitted to the hospital with dry mouth,polydipsia,skin itching and multiple lymphadenopathy．The levels of various classes of serum immunoglobulin were all increased,such as IgG,IgA,IgM and IgE．Specially,the serum IgG4 was also significantly increased（14.7 g/L）and interleukin 6（IL-6）was abnormally raised（150.84 pg/mL）．The pathological examination indicated that the lymph node germinal center was atrophied and mantle zones were expanded which were composed of concentric rings of lymphocytes in an “onion skinning” appearance．Besides,the interfollicular area was expanded in which mature plasma cells were infiltrated in sheet-like,hemosiderin was deposited as well as the vessels were proliferated．Immunohistochemistry showed that the number of IgG4-positive plasma cells was >100/HPF,IgG4/IgG-positive cells ratio was >40%,and Kappa and Lambda light chains were expressed unrestrictedly．In situ hybridization revealed that the expression of EBER was negative．Conclusions PC-iMCD and IgG4-related lymphadenopathy shares similar histopathological characteristics and it’s challenging to distinguish these two diseases by their histology and immunophenotype．In conclusion,the correct diagnosis should be combined with the diagnostic criteria,exclusion diagnostic criteria,clinical manifestations and related laboratory examinations．