目的 探讨心理因素对儿童功能性腹泻的影响。方法 选取贵州省人民医院儿科2018年1月—2023年1月收治的200例功能性腹泻患儿,依照患儿年龄进行分组,将3~9岁患儿纳入儿童期观察组（n=116）、将10~14岁纳入青少年期观察组（n=84）,另选取同期体检的200名健康儿童志愿者作为对照组,将3~9岁儿童纳入儿童期对照组（n=110）、10~14岁纳入青少年期对照组（n=90）。对所有3~9岁儿童采用幼儿心理健康评定量表（CMHA-80）评价心理健康水平。对所有10~14岁儿童采用青少年版中国心理健康量表（MSSMHS）评价心理健康水平。心理因素与儿童功能性腹泻的相关性采用Spearman相关性分析,采用Logistic回归分析分析儿童功能性腹泻的影响因素。结果 儿童期观察组与对照组儿童人际关系、意志力、认知、注意力相关CMHA-80评分对比差异无统计学意义（P>0.05）,观察组儿童适应性、社会行为、性格、自我意识、情绪情感、其他相关CMHA-80评分明显低于对照组儿童（P<0.05）;青少年期观察组与对照组儿童环境适应、人际交往相关MSSMHS评分对比差异无统计学意义（P>0.05）,青少年期观察组儿童自我认识、情绪体验、认知效能相关MSSMHS评分低于对照组儿童（P<0.05）。儿童期儿童适应性、社会行为、性格、自我意识、情绪情感与功能性腹泻呈负相关（P<0.05）,青少年期自我认识、情绪体验、认知效能与功能性腹泻负正相关（P<0.05）。Logistic回归分析结果表明,性格、情绪情感、其他为儿童期功能性腹泻的影响因素（P<0.05）,情绪体验、认知效能为青少年期功能性腹泻的影响因素（P<0.05）。结论 心理因素对于儿童功能性腹泻具有较大影响。对于儿童期儿童来说,性格、情绪情感、其他不良习惯、抽动、睡眠、饮食等均是引发功能性腹泻的影响因素,对于青少年期来说,情绪体验、认知效能为引功能性腹泻的影响因素。

Objective To explore the influence of psychological factors on functional diarrhea in children．Methods A total of 200 children with functional diarrhea admitted to Pediatric Department of Guizhou Provincial People's Hospital from January 2018 to January 2023 were selected．They were grouped according to their age．Children aged 3-9 were included in the preschool observation group（n=116）,while those aged 10-14 were included in the adolescent observation group（n=84）．Additionally,200 healthy children volunteers who underwent physical examinations during the same period were selected as the control group．Children aged 3-9 were included in the preschool control group（n=110）,and those aged 10-14 were included in the adolescent control group（n=90）．Use the CMHA-80 Preschool Mental Health Assessment Scale to evaluate the level of mental health for all children aged 3-9．Evaluate the mental health level of all children aged 10-14 using the MSSMHS．The correlation between psychological factors and functional diarrhea in children was analyzed using Spearman correlation analysis,and the influencing factors of functional diarrhea in children were analyzed using logistic regression analysis．Results The results showed that there was no statistically significant difference in the CMHA-80 scores of interpersonal relationships,willpower,cognition and attention between the preschool observation group and control group（P>0.05）．The CMHA-80 scores of adaptability,social behavior,personality,self-awareness,emotions and other factors in the observation group in childhood were significantly lower than those in the control group（P<0.05）．There was no statistically significant difference in the MSSMHS scores of environmental adaptation and interpersonal communication between the adolescent observation group and control group（P>0.05）．The MSSMHS scores of self-awareness,emotional experience and cognitive efficacy in the adolescent observation group were lower than those in the adolescent control group（P<0.05）．There was a negative correlation（P<0.05）between adaptability,social behavior,personality,self-awareness,emotions and functional diarrhea in preschool children．Adolescent self-awareness,emotional experience,cognitive efficacy,and functional diarrhea were negatively and positively correlated（P<0.05）．The results of Logistic regression analysis showed that personality,emotions and other factors were the influencing factors of functional diarrhea in preschool childhood（P<0.05）．Emotional experience and cognitive efficacy were influencing factors for adolescent functional diarrhea（P<0.05）．Conclusions Psychological factors have a significant impact on functional diarrhea in children．For preschool children,personality,emotions,other bad habits,tics,sleep,diet are all factors that can cause functional diarrhea．For adolescents,emotional experience and cognitive efficacy are factors that can cause functional diarrhea．

目的 探究肺炎支原体（MP）感染大叶性肺炎患儿常规通气、脉冲振荡肺功能特点。方法 将2022年5月—2023年5月广州市妇女儿童医疗中心收治的90例MP感染大叶性肺炎患儿为观察组,通气体检健康儿童50例为对照组,依据病变将累及多肺叶作为观察A组（10例）,累及单肺叶作为观察B组（80例）。均接受常规通气与脉冲振荡肺功能测定,观察测定结果,以此为基础,分析肺功能特点。结果 观察组各常规通气肺功能指标测定结果均低于对照组健康儿童,差异有统计学意义（P<0.05）。观察组R5、R20的实测值/预计值高于对照组,X5实测值低于对照组,差异有统计学意义（P<0.05）。气道阻力指标与肺功能呈负相关关系（P<0.05）。观察组两组最大肺活量（VCMAX）、呼气流量峰值（PEF）、用力肺活量（FVC）75%、FVC50%、FVC25%的实测值/预计值差异无统计学意义,观察A组患儿FVC、FEV₁的实测值/预计值低于观察B组患儿,差异有统计学意义（P<0.05）。两组患儿脉冲振荡肺功能对比差异无统计学意义（P>0.05）。90例患儿中,常规通气异常患儿12例,患儿治疗前后VCMAX、FVC75%、FVC50%的实测值/预计值差异无统计学意义,患儿治疗前FVC、FEV₁、PEF、FVC25%的实测值/预计值均低于治疗后,差异有统计学意义（P<0.05）。结论 常规通气与脉冲振荡相关性良好,气道阻力对VCMAX及FVC具有反向作用,MP感染大叶性肺炎主要表现为小气道通气功能受损,气道阻力升高。

Objective To explore the lung function characteristics of routine ventilation and pulse oscillation in children with lobar pneumonia infected with Mycoplasma pneumoniae（MP）．Methods Ninety children with MP infected lobar pneumonia admitted to Guangzhou Women and Children's Medical Center from May 2022 to May 2023 were selected as the observation group,and 50 healthy children undergoing ventilation examination were selected as the control group．Based on the lesion,cases with multi lobar involvement were selected as the observation group A（10 cases）,cases with single lobar involvement were selected as the observation group B（80 cases）．All patients underwent routine ventilation and pulse oscillation received pulmonary function measurement,and the measurement results were observed．Based on this,the characteristics of lung function were analyzed．Results The results of routine ventilation lung function indicators in the observation group were lower than those in the control group,and the difference was statistically significant（P<0.05）．The measured/expected values of R5 and R20 in the observation group were higher than those in the control group,while the measured values of X5 were lower than those in the control group,with statistical significance（P<0.05）．There is a negative correlation between airway resistance indicators and lung function（P<0.05）．The measured/predicted values of vital capacity max（VCMAX）,peak expiratory flow（PEF）,forced vital capacity（FVC）75%,FVC50%,and FVC25% in the observation group were not with statistically significant difference．The measured/predicted values of FVC and FEV₁ in the observation group A were lower than those in the observation group B,and the difference was statistically significant（P<0.05）．There was no statistically significant difference in pulmonary function between the two groups of pediatric patients with pulse oscillation（P>0.05）．Among the 90 patients,12 had abnormal conventional ventilation．The measured/predicted values of VCMAX,FVC75%,and FVC50% before and after treatment were not significantly different．The measured/predicted values of FVC,FEV₁,PEF,and FVC25% before treatment were lower than those after treatment,and the difference was statistically significant（P<0.05）．Conclusions There is good correlation between conventional ventilation and pulse oscillation．Airway resistance has a reverse effect on VCMAX and FVC．MP infected lobar pneumonia is mainly characterized by impaired small airway ventilation function and increased airway resistance．

目的 针对精神分裂症患者接受喹硫平与帕利哌酮联合治疗对其代谢功能及血清因子的影响。方法 纳入2022年1月—2023年3月驻马店市第二人民医院收治的120例精神分裂症患者,根据住院号进行编号,并通过通过随机抽签方法分为两组,对照组60例应用单一喹硫平治疗,观察组60例应用喹硫平与帕利哌酮联合治疗,对比两组的治疗效果。结果 经治疗,观察组临床总疗效高于对照组（P<0.05）;该组各项代谢功能指标均与对照组比较差异无统计学意义（P>0.05）;该组各项血清因子测定该结果均高于对照组（P<0.05）;该组各项精神症状评分均低于对照组（P<0.05）;该组不良反应发生率与对照组比较差异无统计学意义（P>0.05）。结论 采用喹硫平与帕利哌酮联合的方式治疗精神分裂症患者,可以提升临床疗效,对患者各种精神症状及血清因子改善效果更好,虽然药物会对患者代谢功能产生一定的影响,但是联合用药与单独用药的影响情况无差异,未增加不良反应发生率,安全性良好。

Objective To evaluate the combination of quetiapine and paliperidone on metabolic function and serum factors in schizophrenia．Methods A total of 120 patients with schizophrenia admitted to Zhumadian Second People's Hospital from January 2022 to March 2023 were included,numbered according to the hospitalization number,and divided into two groups by random drawing method．Sixty patients in the control group were treated with quetiapine alone,and 60 patients in the observation group were treated with quetiapine combined with paliperidone,and the therapeutic effects of the two groups were compared．Results After treatment,the total clinical efficacy of the observation group was higher than that of the control group,P<0.05;the metabolic function indexes comparison were P> 0.05;the serum factor of observation group was higher,P<0.05;the scores of psychiatric symptoms in the group were all lower than the control group,P<0.05;the incidence of adverse reactions in the observation improve group was not different from the control group,P>0.05．Conclusions Using quetiapine and schizophrenia,can improve clinical curative effect,various mental symptoms and serum factors,although certain effect on patient metabolic function may occur,but did not significantly increase the incidence of adverse reactions,with high safety．

目的 探讨福莫特罗联合格隆溴铵对慢性阻塞性肺疾病急性加重期（AECOPD）患者的疗效。方法 选择2021年1月—2023年6月廉江市人民医院收治的97例AECOPD患者进行研究,在双方知情基础上,通过单双号抽签方式分组,抽取单号纳入对照组（n=48,予以福莫特罗治疗）,抽取双号纳入观察组（n=48,予以福莫特罗联合格隆溴铵治疗）,对比两组肺功能指标、血气指标、症状改善情况及出现的不良反应。结果 治疗后两组的肺功能指标均高于治疗前,而观察组各指标高于对照组（P<0.05）;治疗后两组PaO₂高于治疗前,PaCO₂低于治疗前,且观察组上述血气指标与对照组比较差异有统计学意义（P<0.05）;治疗后两组的CAT及SGRQ评分均低于治疗前,其中观察组评分低于对照组（P<0.05）;观察组（8.33%）与对照组（12.24%）不良反应率比较,差异不显著（P>0.05）。结论 采用福莫特罗联合格隆溴铵治疗AECOPD患者,有助于改善患者肺功能,使其血气指标得到改善,还可有效缓解其呼吸道症状,且安全性得到保障。

Objective To explore the curative effect of formoterol combined with glycopyrronium bromide on patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods The research cut-off period was from January 2021 to June 2023．A total of 97 patients with AECOPD were selected from Lianjiang People's Hospital for research．On the basis of mutual knowledge,they were divided into groups by odd and even numbers．The odd numbers were drawn into the control group（n=48,treated with formoterol）and the odd numbers were drawn into the observation group（n=48,treated with formoterol+glycopyrronium bromide）,the pulmonary function index,blood gas index,symptom improvement and adverse reactions were compared between the two groups. Results After treatment,the lung function indexes of the two groups were higher than those before treatment,while the indexes of the observation group were higher than those of the control group（P<0.05）．PaO₂ was higher and PaCO₂ was lower in the two groups after treatment,and the blood gas indexes in the observation group were different from those in the control group（P<0.05）．The scores of COPD assessment test and St. George's Respiratory Questionaire in the two groups after treatment were lower than those before treatment,while the scores in the observation group were lower than those in the control group（P<0.05）;There was no significant difference between the observation group（8.33%）and the control group（12.24%）（P>0.05）. Conclusions The choice of formoterol and qualified ammonium bromide for AECOPD is helpful to improve the lung function,blood gas index and respiratory symptoms,And the security is guaranteed．

目的 探究高原地区世居居民与常住居民的心脏结构和功能的差异性。方法 选择2022年6月—2023年8月在西藏林芝市人民医院体检的200例世居居民与常住居民作为研究对象,将世居居民和常住居民按照性别分为男女亚组,按照年龄段分为18~31岁、31~40、41~50岁亚组。比较各亚组心脏结构参数、左心功能参数、多普勒超声检测参数差异。结果 与高原常住居民男性和女性比较,世居居民男性和女性的左房内径、右房内径、右室内径、肺动脉内径、升主动脉内径、主动脉根径、室间隔厚度、左室后壁厚度、左室舒张末内径、左室收缩末内径、左室射血分数、二尖瓣 A 峰流速指标比较差异均无统计学意义（P>0.05）;而主动脉瓣口流速、肺动脉瓣口流速、二尖瓣 E 峰流速增加,两组间比较差异具有统计学意义（P<0.05）。18~31岁、31~40、41~50岁组世居居民和常住居民左房内径、右房内径、右室内径、肺动脉内径、升主动脉内径、主动脉根径、室间隔厚度、左室后壁厚度、左室舒张末内径、左室收缩末内径、左室射血分数、二尖瓣 A 峰流速指标等指标比较差异均无统计学意义（P>0.05）,但世居居民主动脉瓣口流速、肺动脉瓣口流速、二尖瓣 E 峰流速均高于常住居民,差异具有统计学意义（P<0.05）。结论 高原地区世居居民和常住居民心脏结构参数和左心功能参数无明显差异。但世居居民主动脉瓣口流速、肺动脉瓣口流速、二尖瓣 E 峰流速均高于常住居民。

Objective To explore the ethnic differences in heart structure and function between aborigines and long term residents in the plateau area. Methods A total of 200 aborigines and long term residents who underwent physical examination in our hospital from June 2022 to August 2023 were selected as the study subjects,and the aborigines and long term residents were divided into male and female subgroups,and subgroups aged 18-30 years,31-40 years and 41-50 years．The differences of cardiac structure parameters,left ventricular function parameters and Doppler parameters were compared among subgroups. Results The left atrial diameter,right atrial diameter,right ventricular diameter,pulmonary artery diameter,ascending aorta diameter,aortic root diameter,interventricular septal thickness,left ventricular posterior wall thickness,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction mitral valve A peak velocity were compared between Aborigines and plateau Long Term Residents,which were no significant difference（P>0.05）．However,the velocity of aortic valve orifice,pulmonary valve orifice and mitral valve E peak velocity increased,and the differences were statistically significant（P<0.05）．There were no significant differences in left atrial diameter,right atrial diameter,right ventricular diameter,pulmonary artery diameter,ascending aorta diameter,aortic root diameter,interventricular septal thickness,posterior left ventricular wall thickness,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction,left ventricular diameter,left ventricular diameter,and left ventricular ejection fraction mitral valve A peak velocity indexes in aborigines and long term residents between among aged 18-30 years,31-40 years,41-50 years（P>0.05）,but the differences of aortic valve orifice velocity,pulmonary valve orifice velocity and mitral valve E peak velocity were statistically significant（P<0.05）. Conclusions There were no significant difference in cardiac structure parameters and left heart function parameters between aborigines and long term residents in plateau area．However,the aortic orifice velocity,pulmonary orifice velocity and mitral E-peak velocity of aborigines were higher than those of long term residents．

目的 探讨本体感觉训练联合等速肌力训练对早期膝骨关节炎（KOA）患者的应用效果。方法 选择郑州市骨科医院2022年5月—2023年5月收治的120例早期膝骨关节炎患者为研究对象,将所有对象进行编号,采用简单随机方法分成研究组和对照组,每组各60例,两组均接受常规治疗,对照组在此基础上接受等速肌力训练,研究组在对照组基础上联合应用本体感觉训练,比较两组治疗前和治疗6周后疼痛视觉模拟量表（VAS）评分、膝关节伸屈肌群峰力矩（PT）、关节功能以及本体感觉。结果 治疗后研究组VAS评分为（1.33±0.31）分,对照组为（2.05±0.34）分,研究组低于对照组（t=12.121,P<0.05）;治疗后两组膝关节伸、屈肌群PT均较治疗前明显增加（P<0.05）,研究组大于对照组（t₁=2.696,t₂=3.360,P<0.05）;治疗后研究组WOMAC评分为（24.58±5.14）分,对照组为（26.85±5.11）分,研究组低于对照组（t=2.426,P<0.001）,研究组Lequesne指数为（6.55±1.21）分,对照组为（7.02±1.25）分,研究组低于对照组（t=2.093,P<0.001）;治疗后研究组平均轨迹误差为（21.35±5.96）%,对照组为（24.06±5.88）%,研究组改善程度优于对照组（t=2.507,P<0.001）,研究组平均负重力量差为（0.77±0.22）kg,对照组为（1.01±0.24）kg,研究组改善程度明显优于对照组（t=5.710,P<0.001）。结论 本体感觉训练联合等速肌力训练可以显著提升早期膝骨关节炎患者肌力,改善关节功能和本体感觉作用明显,适合推广。

Objective To explore the application effect of proprioceptive training combined with isokinetic muscle strength training on early knee osteoarthritis（KOA）patients．Methods A total of 120 patients with early knee osteoarthritis admitted to a hospital from May 2022 to May 2023 were selected as the study subjects．All subjects were numbered and randomly divided into an experimental group and a control group,with 60 cases in each group．Both groups received routine treatment,while the control group received isokinetic muscle strength training additionally．The experimental group received proprioceptive training in addition to the control group treatment．After 6 weeks of treatment,compare the pain situation,peak torque（PT）of knee extensor and flexor muscles,joint function,and proprioception before and after treatment between two groups were compared．Results After treatment,the VAS scores of both groups were lower than those before treatment（P<0.05）,and the experimental group was lower than the control group（t=12.121,P<0.05）．After treatment,the PT of the knee joint extensor and flexor muscle groups in both groups significantly increased compared to before treatment（P<0.05）,and the experimental group was significantly larger than the control group（P<0.05）．After treatment,the WOMAC score and Lequesne index of the two groups significantly decreased compared to those before treatment（P<0.05）,and the experimental group was smaller than the control group（P<0.05）．After treatment,the average trajectory error and average weight difference between the two groups were significantly smaller than those before treatment（P<0.05）,while the experimental group was smaller than the control group（P<0.05）．Conclusion sThe combination of proprioceptive training and isokinetic muscle strength training can significantly improve muscle strength,joint function,and proprioceptive sensation in patients with early knee osteoarthritis,making it suitable for promotion．

目的 探讨常规超声心动图联合二维斑点追踪技术评估急性白血病患儿在接受蒽环类药物治疗后产生的心脏毒性,早期检测左心功能障碍。方法 采用前瞻性非随机观察研究,选取新诊断急性淋巴细胞白血病患儿20例,分别于确诊白血病后接受蒽环类药物治疗前、接受所有蒽环类药物剂量后以及确诊白血病1年后,进行常规超声心动图和二维斑点技术监测评估心脏毒性。结果 左室流出道速度积分TVI和E、E/E’在治疗期间下降,并在诊断后1年恢复至治疗前数值。在二维斑点追踪纵向应变中,GLPS-LAX、GLPS-A2C、LV-GLPS在完成所有蒽环类药物剂量后与诊断后比较差异有统计学意义,以及诊断后1年与蒽环类药物治疗后比较差异有统计学意义。但GLPS-A4C各时间点比较差异无统计学意义。结论 常规超声心动图联合二维斑点追踪技术的纵向整体应变可早期发现白血病患儿化疗所致的左室功能障碍。

Objective To evaluate cardiotoxicity in children with acute lymphoblastic leukemia treated with anthracyclines by echocardiography combined with 2D speckle tracking imaging,and to detect left heart dysfunction early．Methods In this prospective nonrandomized study,20 children with newly diagnosed acute lymphoblastic leukemia were assessed for cardiotoxicity by echocardiography and 2D speckle tracking imaging in three periods during the treatment．Results The left ventricular outflow tract velocity integral TVI and E,E/E’ decreased during treatment,and went back to the pre-treatment value one year after diagnosis．In the longitudinal strain of 2D speckle tracking imaging,in GLPS-LAX,GLPS-A2C,LV-GLPS,there were statistical differences between treatment completed and after diagnosis,and between 1 year after diagnosis and treatment completed．However,GLPS-A4C has no statistical significance．Conclusion sThe conventional echocardiography combined with longitudinal overall strain of 2D speckle tracking imaging can comprehensively evaluate the early changes of left ventricular dysfunction caused by chemotherapy in children with leukemia．

目的 探讨术前血清肌酐（sCr）、估测肾小球滤过率（eGFR）对急性A型夹层术后急性肾损伤3级（AKI 3级）及连续性肾脏替代治疗（CRRT）的影响。方法 回顾性分析广州市第一人民医院2017年1月—2022年12月6年间收治的143例行Bentall或升主动脉置换+Sun’s手术的急性Stanford A型夹层患者术前sCr及eGFR、术后24 h及48 h sCr、尿量、术后AKI及CRRT情况。应用ROC曲线（受试者特征曲线）分析术前sCr、eGFR对术后AKI 3级及CRRT的影响。结果 术后AKI 3级27例（18.9%）,CRRT 14例（9.8%）。发生AKI 3级及CRRT的患者术前sCr水平升高（AKI3级与AKI0-2级组间比较t’=-2.722,P=0.011,CRRT与非CRRT组间比较t’=-2.184,P=0.048）、eGFR降低（AKI3级与AKI0-2级组间比较t=4.585,P<0.001,CRRT与非CRRT组间比较t=4.932,P<0.001）。ROC曲线分析提示术前sCr可有效预测术后AKI 3级（AUC 0.768,临界点123 μmol/L,灵敏度67%,特异度85%）及CRRT（AUC 0.848,临界点137.5 μmol/L,灵敏度71%,特异度88%）。eGFR可预测AKI 3级[AUC 0.761,临界点56.25 mL/（min·1.73 m²）,灵敏度67%,特异度83%]及CRRT[AUC 0.855,临界点47.6 mL/（min·1.73 m²）,灵敏度71%,特异度87%]。手术合并低心排血量等肾灌注不良时,eGFR低于75.9 mL/（min·1.73 m²）,术后CRRT发生率增加。结论 急性A型夹层术前sCr及eGFR影响术后AKI 3级及CRRT的发生。sCr>123 μmol/L、eGFR低于58.25 mL/（min·1.73 m²）的患者术后AKI 3级发生率增加。sCr>137.5 μmol/L、eGFR低于47.6 mL/（min·1.73 m²）,或合并肾灌注不良的患者术后CRRT发生率增加。

Objective To explore the influences of preoperative serum creatinine（sCr）and estimated glomerular filtration rate（eGFR）on postoperative stage 3 acute kidney injury（AKI）or continuous renal replacement treatment（CRRT）in patients with acute Stanford type A aortic dissection（ATAAD）．Methods From July 2017 to December 2022,143 ATAAD patients who underwent Bentall or ascending aortic replacement and total arch replacement and stented elephant trunk were retrospective analyzed．Data included preoperative sCr and eGFR,postoperative sCr,eGFR,urine volume,AKI and CRRT at 24 h and 48 h．Receiver operating characteristic（ROC）curve were used to analyze the influences of preoperative sCr and eGFR on stage 3 AKI and CRRT．Results Stage 3 AKI occurred in 27（18.9%）patients,including 14 patients who required CRRT．sCr was significantly higher in stage 3 AKI or CRRT group（AKI 3 vs AKI 0-2 group：t’=-2.722,P=0.011,CRRT vs non-CRRT group：t’=-2.184,P=0.048）,and eGFR was significantly lower（AKI 3 vs AKI 0-2 group：t=4.585,P<0.001,CRRT vs non-CRRT group：t=4.932,P<0.001）．Preoperative sCr could effectively predict postoperative stage 3 AKI（AUC 0.768,the best cut-off value was 123 μmol/L,sensitivity 67%,specificity 85%）and CRRT（AUC 0.848,the best cut-off value was 137.5 μmol/L,sensitivity 71%,specificity 88%）．Preoperative eGFR could predict postoperative stage 3 AKI（AUC 0.761,the best cut-off value was 56.25mL/（min·1.73 m²）,sensitivity 67%,specificity 83%）and CRRT（AUC 0.855,the best cut-off value was 47.6 mL/（min·1.73 m²）,sensitivity 71%,specificity 87%）．CRRT requirement significantly increased in patients with eGFR lower than 75.9 mL/（min·1.73 m²） who complicated with peripheral malperfusion．Conclusion sPreoperative sCr and eGFR have significant influences on incidence of postoperative stage 3 AKI and CRRT．Postoperative stage 3 AKI significantly increase in patients with sCr more than 123 μmol/L or eGFR lower than 56.25mL/（min·1.73 m²）．Postoperative CRRT significantly increase in patients with sCr more than 137.5 μmol/L,eGFR lower than 47.6mL/（min·1.73 m²）,or peripheral malperfusion．

目的 探讨真武汤联合八段锦在老年冠状动脉粥样硬化性心脏病（冠心病）患者中的应用效果。方法 将96例75岁以上冠心病患者按照随机数字表法分为对照组与干预组,每组各48例。在12周的临床研究期间,对照组用规范的冠心病二级预防药物治疗;干预组在规范的冠心病二级预防药物治疗基础上,增加真武汤以及八段锦运动处方。结果 治疗后干预组中医临床疗效（P=0.023）和中医证候积分（P<0.001）均优于对照组。两组患者的心肺运动试验指标均有改善,且干预组在升高峰值摄氧量（Peak VO₂,P=0.005）、最大摄氧量（VO₂max,P=0.001）、氧脉搏（VO₂/HR,P=0.002）和无氧阈值时最大代谢当量（MET,P=0.001）,以及降低无氧阈值（AT,P<0.001）和二氧化碳通气当量（VE/VCO₂,P=0.020）方面比对照组更明显。两组患者在36项简明健康状态调查表（SF-36）评分的8个维度中评分均有所升高,其中在生理机能（P=0.001）、生理职能（P<0.001）、一般健康状况（P=0.018）、精力（P=0.007）、社会职能（P=0.010）、精神健康（P=0.004）方面,干预组效果优于对照组;而在躯体疼痛、情感职能维度改善方面,两组间结果相近,差异无统计学意义（P>0.05）。两组患者的匹兹堡睡眠质量指数（PSQI）均有所改善,且干预组效果优于对照组（P<0.001）。结论 真武汤联合八段锦能够进一步增强老年冠心病患者中医证候疗效,改善心肺运动试验Peak VO₂、VO₂max、VO₂/HR、MET、AT、VE/VCO₂等指标,并提高SF-36评分多个维度的生活质量及睡眠质量。

Objective To explore the therapeutic effects of Zhenwu Decoction combined with Baduanjin Qigong in older adults with coronary heart disease（CHD）．Methods Ninety-six patients with CHD aged ≥75 years were randomly divided into a treatment group and a control group,with 48 patients in each group．Within the 12-week period,the control group received standard secondary prevention therapy for CHD,while the treatment group received Zhenwu Decoction and Baduanjin Qigong prescription,in addition to the standard treatment．Results After treatment,both groups showed improvement in the traditional Chinese medicine（TCM）clinical efficacy,TCM syndrome,SF-36 scores and Pittsburgh Sleep Quality Index（PSQI）scores;increase in Peak VO₂,VO₂max,VO₂/HR,and metabolic equivalent（MET）;and decrease in AT and VE/VCO₂．However,the treatment group had a more pronounced improvement in the TCM clinical efficacy（P=0.023）,TCM syndrome（P<0.001）,PSQI scores（P<0.001）,and cardiopulmonary exercise testing（CPET）indicators including Peak VO₂（P=0.005）,VO₂max（P=0.001）,VO₂/HR（P=0.002）,MET（P=0.001）,AT（P<0.001）and VE/VCO₂（P=0.020）,compared to their control counterparts． For the SF-36 scores,in comparison to the control group,the treatment group presented better outcomes in enhancing physical functioning（P=0.001）,role limitations due to physical health（P<0.001）,general health（P=0.018）,vitality（P=0.007）,social functioning（P=0.010）and mental health（P=0.004）,but not in pain or role limitations due to emotional problems．Conclusions The Zhenwu Decoction combined with Baduanjin Qigong can enhance the TCM syndrome,improve various CPET indicators such as Peak VO₂、VO₂max、VO₂/HR、MET、AT and VE/VCO₂,and elevate both quality of life and sleep quality among older adults with CHD．

目的 观察低氧对p53RFP基因表达及启动子活性的影响,探索低氧反应元件(HRE)是否参与了低氧对p53RFP基因启动子活性的调控。方法 将HEK293细胞置于低氧条件下培养,实时定量PCR及Western blot 检测p53RFP mRNA及蛋白表达水平;通过定点突变技术构建HRE突变型p53RFP启动子双荧光素酶报告基因载体并转染HEK293细胞,分别置于常氧和低氧条件下培养,双荧光素酶报告基因检测系统检测启动子活性。结果 低氧处理不同时间点p53RFP mRNA 表达水平均显著增加,差异有统计学意义(F=96.493,P<0.001);低氧组p53RFP 及HIF-1α蛋白表达量均呈时间依赖性递增。成功构建了HRE 突变型p53RFP 启动子双荧光素酶报告基因载体,双荧光素酶报告基因检测显示,与常氧组相比,低氧条件下野生型p53RFP基因启动子活性增加(t=-19.504,P<0.001),HRE单突变或双突变后启动子活性均较野生型降低(F=160.891,P<0.001)。结论 低氧可诱导p53RFP基因表达上调;成功构建了HRE 突变型p53RFP 双荧光素酶报告基因载体,HRE 位点可能在低氧调控p53RFP基因启动子活性中发挥关键作用。

Objective To investigate the effect of hypoxia on p53RFP gene expression and p53RFP promoter activity, and explore whether hypoxia responsive element (HRE) is involved in the regulation of p53RFP gene promoter activity by hypoxia. Methods HEK293 cells were cultured under normoxia and hypoxia conditions, p53RFP expressions at mRNA and protein levels were detected by real-time PCR and Western blot respectively. The HRE mutant p53RFP promoter dual luciferase reporter gene vector was constructed by site-directed mutagenesis technology and transfected into HEK293 cells under normoxia and hypoxia conditions. The promoter activities were detected by dual luciferase reporter system. Results Compared with the normoxia group, the expression of p53RFP mRNA in the hypoxia group increased significantly at different time points, and the difference was statistically significant(F=96.493,P<0.001); the expression of p53RFP and HIF-1α protein in the hypoxia group increased in a time-dependent manner. The luciferase reporter vectors containing p53RFP with mutant HRE were successfully constructed. The dual luciferase reporter gene assay showed that the activity of the wild-type p53RFP gene promoter was significantly increased under hypoxic conditions compared to normoxic condition(t=-19.504,P<0.001),and the promoter activity of p53RFP with HRE single mutation or double mutation were both significantly lower than that of wild type under hypoxic condition (F=160.891,P<0.001). Conclusions p53RFP gene expression was induced by hypoxia; the p53RFP promoter with mutant HRE dual luciferase reporter gene vectors were successfully constructed, and the HRE locus may play a key role in the hypoxia regulation of p53RFP gene promoter activity.