目的 探讨大脑中动脉(MCA)粥样硬化斑块与脑梗死类型的相关性。方法 收集2018年1月—2020年12月的大脑中动脉粥样硬化患者178例,根据患者的临床表现、病史及诊断将患者分为脑梗死组(77例,按梗死部位分为深穿支梗死组、皮质梗死组和分水岭梗死组)和非脑梗死组(101例)。2组患者使用高分辨率核磁共振成像法(HRMRI)检查患者的双侧MCA粥样硬化斑块的特征,包括形态、信号强度及分布位置,从而统计分析粥样斑块特征与脑梗死类型之间的关系。结果 178例患者中77例为脑梗死患者。脑梗死组患者的强化率为55/77(71.4%),无脑梗死组患者的强化率为53/101(52.5%),相比差异有统计学意义(χ²=2.575,P=0.027)。其中脑梗死组中深穿支梗死组强化率为17/23(73.9%,χ²=8.707,P=0.021),皮质梗死组的强化率为13/19(68.4%,χ²=6.244,P=0.017),分水岭梗死组的强化率为25/35(71.4%,χ²=4.963,P=0.028),较非强化相比差异均有统计学意义。结论 大脑中动脉粥样硬化斑块的特征与脑梗死类型关系密切,斑块特征可反映斑块的稳定性,HRMRI对斑块稳定性的判断可预测脑梗死的发生及梗死位置。

Objective To explore the correlation between middle cerebral artery (MCA) atherosclerotic plaque and cerebral infarction patterns. Methods From January 2018 to December 2020, 178 patients with MCA atherosclerosis were divided into cerebral infarction group (77 cases, divided into deep perforating branch infarction group, cortical infarction group and watershed infarction group according to the infarct location) and non-cerebral infarction group (101 cases) according to their clinical manifestations, medical history and diagnosis.Two groups of patients underwent high-resolution magnetic resonance imaging (HRMRI) to examine the characteristics of bilateral MCA atherosclerotic plaques, including morphology, signal intensity and distribution location, to statistically analyze the relationship between the characteristics of atherosclerotic plaque and the patterns of cerebral infarction. Results Of 178 patients, 77 patients with cerebral infarction.The enhancement rate of the cerebral infarction group was 55/77 (71.4%), and that of the non-cerebral infarction group was 53/101 (52.5%), and difference between the two group had statistical significance(χ²=2.575, P=0.027). In the cerebral infarction group, the enhancement rate of the deep perforating branch infarction group was 17/23 (73.9%,χ²=8.707, P=0.021), that of the cortical infarction group was 13/19 (68.4%,χ²=6.244, P=0.017), and that of the watershed infarction group was 25/35 (71.4%,χ²=4.963, P=0.028), and the difference was statistically significant compared with the non-enhanced group. Conclusion The characteristics of MCA atherosclerotic plaque were closely related to the patterns of cerebral infarction,and the characteristics of plaque can reflect the stability of plaque.The judgment of plaque stability by HRMRI may predict the occurrence and paterrn of cerebral infarction.

目的 探究老年食管鳞癌患者单纯放疗、同步放化疗临床治疗效果。方法 选我院2018年1月—2020年12月期间90例老年食管鳞癌患者为研究对象,依据不同治疗方式将其分为对照组、观察组,各45例,分别接受单纯放疗、同步放化疗治疗,比较2组治疗效果及治疗安全性。结果 观察组治疗总有效率为75.56%,与对照组60.00%相近(P＞0.05);观察组疾病控制率为97.78%,较对照组84.44%高(P＜0.05);观察组放射性肺炎、骨髓抑制发生率为24.44%、77.78%,较对照组6.67%、48.89%高;且观察组放射性肺炎、骨髓抑制、放射性食管炎2级占比分别为17.78%、35.56%、57.78%,均较对照组2.22%、8.89%、24.44%高(P＜0.05)。结论 在老年食管鳞癌患者治疗中,与单纯放疗相比,同步放化疗可提升疾病控制能力,但会增加治疗不良反应,增加不良反应严重程度,因此在临床治疗中,需慎重选择。

Objective To explore the clinical effect of radiotherapy only and concurrent chemoradiotherapy in elderly patients with esophageal squamous cell carcinoma. Methods Ninety cases of elderly patients with esophageal squamous cell carcinoma in our hospital from January 2018 to December 2020 were selected as research objects.According to different treatment methods, they were divided into control group and observation group, 45 cases in each group.They were treated with radiotherapy and concurrent chemoradiotherapy respectively.The treatment effect and safety of the two groups were compared. Results The total effective rate of the observation group was 75.56%, which was close to the control group (60.00%, P>0.05). The disease control rate of the observation group was 97.78%, which was higher than control group (84.44%, P<0.05). The incidence of radiation pneumonia and bone marrow suppression of the observation group were 24.44% and 77.78%, which were higher than that of the control group (6.67%, 48.89%). The proportion of radiation pneumonia, bone marrow suppression, radiation esophagitis grade 2 of the observation group were 17.78%, 35.78% and 57.78% respectively, higher than that of the control group (2.22%, 8.89%, 24.44% respectively, P<0.05). Conclusion Compared with radiotherapy only, concurrent chemoradiotherapy improved the ability of disease control in elderly patients with esophageal squamous cell carcinoma, but it increased the adverse reactions and aggravated the severity of adverse reactions.Therefore, it is necessary to make a careful choice in clinical treatment.

目的 探讨地西他滨(DAC)联合沙利度胺对骨髓增生异常综合征(MDS)患者的病态造血及疗效的影响。方法 以本院自2014年6月—2020年5月收治的MDS患者为研究总体,行便利抽样法选择60例于收治期间行输血、抗感染及诸如促红生成素 (EPO)+集落刺激因子(CSF)等细胞因子治疗效果不佳的MDS开展研究,按完全区化原则设立对照组及观察组,予以对照组沙利度胺治疗,观察组则于对照组基础上施予地西他滨(DAC)行联合治疗,比较2组疗效、血象相关指标、病态造血改善情况及预后转归。结果 观察组ORR为51.61%,与对照组的26.67%相比更高,差异有统计学意义(P<0.05);经治疗,2组血小板计数(PLT)、血红蛋白(HGB)、中性粒细胞计数(ANC)水平均见一定程度上升,骨髓原始细胞(bls)水平则见下降,观察组PLT、HGB、ANC相较于对照组更高,bls水平则更低(P<0.05);于2020年5月截止随访,随访时间8~96个月,中位随访时间68个月。于治疗及随访中行骨髓形态检查及染色体核型鉴别均表现正常。关于病态造血改善情况,2组T1率比较,差异无统计学意义(P>0.05);观察组国际预后积分系统评分整体优于对照组(P<0.05);2组Ⅰ~Ⅳ级不良反应比较,差异无统计学意义(P>0.05);观察组5年总生存时间率为63.33%,相较于对照组的36.67%更高(P<0.05)。结论 相较于单一沙利度胺治疗,应用地西他滨联合沙利度胺治疗MDS,疗效更为确切,且可改善血象指标,拥有一定T1率,且预后转归表现较好。

Objective To investigate the impact of decitabine (DAC) combined with thalidomide on dyshaematopoiesis and efficacy in patients with myelodysplastic syndrome (MDS). Methods Patients with MDS admitted to our hospital from June 2014 to May 2020 were selected as the research population.Among them, 60 MDS cases were selected by convenience sampling method, which had poor therapeutic effect with treatment of blood transfusion, anti-infection and cytokines treatments such as erythropoietin (EPO)+ colony stimulating factor (CSF). The control group and the observation group were set up according to the principle of complete block, and the control group was treated with thalidomide while the observation group was treated with decitabine (DAC) on the basis of the control group.The efficacy, hemogram-related indicators, improvement of dyshaematopoiesis and prognosis outcomes were compared between the two groups. Results The overall response rate (ORR) of the observation group was higher than that of the control group (51.61%vs 26.67%, P<0.05). After treatment, the levels of platelet (PLT), hemoglobin (HGB) and absolute neutrophil count (ANC) in the two groups were increased to a certain extent while the level of bone marrow blasts(bls) was decreased, and the levels of PLT, HGB and ANC of the observation group were higher than those of the control group while the level of bls was lower (P<0.05). The follow-up deadline was May 2020, and the follow-up time was 8-96 months and the median follow-up time was 68 months.During treatment and follow-up, bone marrow morphology examination and chromosome karyotype identification results were normal.Regarding the improvement of dyshaematopoiesis, the difference in T1 rate between the two groups was not statistically significant (P>0.05). The revised International Prognostic Scoring System prognosis score of the observation group was better than that of the control group (P<0.05). There were no statistically significant differences between the two groups in terms of grade I~IV adverse reactions (P>0.05). The 5-year overall survival rate of the observation group was 63.33%, which was higher than 36.67%of the control group (P<0.05). Conclusion Compared with thalidomide only treatment, the application of decitabine combined with thalidomide in the treatment of MDS had a more accurate efficacy, improved hemogram indicators, and had a certain T1 rate and good prognosis outcomes.

目的 对比分析电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效。方法 将我院2018年11月—2020年11月间收治的92例胸腺瘤患者作为本次实验案例,根据随机双盲原则进行分组,其中对照组46例患者采用传统开胸手术治疗,观察组46例患者采用电视胸腔镜手术治疗,对于2组患者治疗中的临床疗效进行对比分析。结果 观察组术后的肺功能指标下降幅度小于对照组,且观察组的手术时间、胸管引流时间、下床活动时间、住院时间均短于对照组,出血量、引流量低于对照组,切口长度小于对照组,P＜0.05,组间指标数据存在统计学差异。结论 电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效相比,前者具有明显的优势,创伤小、恢复快、对于患者肺功能的影响更小。

目的 使用TCGA数据库,探索DNA甲基化位点对肺腺癌的预后影响。方法 使用TCGA数据库,获取肺腺癌病人癌和癌旁组织甲基化表达数据、基因表达数据及临床数据;将人群分为探索组和验证组,使用LASSO在探索人群中筛选对肺腺癌预后有影响的甲基化位点;受试者工作特征曲线用于评估甲基化位点预测效果,并进一步在验证人群中验证。结果 在TCGA数据库中筛选出158个癌和癌旁组织差异表达且与所在基因mRNA表达显著相关的甲基化位点,经LASSO回归分析,cg19378330与肺腺癌预后相关。甲基化位点水平高于中位数的患者,归入高风险组,甲基化位点水平低于中位数的为低风险组。结果发现与低风险组相比,高风险组的死亡风险比低风险组增加了38%(OR=1.38,95% CI=1.16～2.69)。在探索阶段人群中其曲线下面积为0.80(95% CI=0.73～0.88),灵敏度为86.2%。验证人群中也表现出类似结果。结论 甲基化位点cg19378330与肺腺癌具有较显著的关联性,且可以对肺腺癌的风险进行有效的预测。

Objective Using the TCGA database to explore the prognostic effects of DNA methylation sites on lung adenocarcinoma. Methods TCGA database was used to collecting DNA methylation data, gene expression data and clinical data of lung adenocarcinoma patients. The population were divided into the exploratory group and the validation group. The LASSO regression analysis was used to screen the methylation sites associated with the prognosis of lung adenocarcinoma in the exploratory group. Receiver operating characteristic curve was used to evaluate the prediction effect of the model, and further verified in the validation population. Results A total of 158 methylation sites with differential expression and significant correlation with the mRNA expression of the corresponding gene were screened from the TCGA database. With LASSO regression analysis, the DNA methylation sites associated with prognosis of lung adenocarcinoma were cg19378330. Those patients with levels above the median methylation site were assigned to the high-risk group, while those with levels below the median methylation site were assigned to the low-risk group. Patients' death risk in the high-risk group were 38% higher than those in the low-risk group (OR=1.38, 95%CI=1.16-2.69). The area under the curve was 0.80 (95%CI=0.73-0.88) and the sensitivity was 86.2% in the exploratory stage population.Similar results were seen in the validation population. Conclusions The DNA methylation site cg19378330 was significantly associated withthe prognosisof lung adenocarcinoma, and could effectively predict the risk of lung adenocarcinoma.

目的 观察中等强度有氧运动联合力量训练对老年高尿酸血症(HUA)尿酸、身体机能及生活质量影响分析。方法 2019年1月—2019年12月在我社区收治的老年HUA患者60例纳入研究,随机数字表法进行分组,选取其中的30例患者实施常规饮食、运动指导为对照组,另30例患者配合中等强度有氧运动联合力量训练为研究组。比较2组患者对干预的依从性,干预前、后的血尿酸水平,身体机能及生活质量评分(WHOQOL-100评分)。结果 2组患者均在干预期内完成训练,依从性优良率比较,差异无统计学意义(P＞0.05)。干预前2组患者的血尿酸水平、身体机能比较,差异无统计学意义(P＞0.05)。干预后2组患者的血尿酸水平、安静心率较干预前降低,研究组低于对照组,而肺活量则较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。干预前2组患者的WHOQOL-100评分比较,差异无统计学意义(P＞0.05),干预后2组WHOQOL-100各项评分较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。结论 在老年HUA患者的相关指导中,运用中等强度有氧运动联合力量训练的运动干预,可较为明显的降低血清血尿酸水平,降低并平稳安静心率,提升肺活量,提升生活质量,效果理想。

Objective To observe the effect of moderate intensity aerobic exercise combined with strength training on uric acid level, physical function and quality of life in elderly patients with hyperuricemia (HUA). Methods Sixty elderly patients with HUA were treated in our center from January 2019 to December 2019. They were randomly divided into two groups, 30 cases in each group. Among them, 30 cases given routine diet and exercise guidance were included in control group, and the other 30 cases given moderate intensity aerobic exercise combined with strength training on the basis of the control group were included in study group. The compliance, blood uric acid level, physical function and quality of life (WHOQOL-100 scores) before and after the intervention were compared between the two groups. Results Two groups of patients completed the training within the expected time, and there was no significant difference in compliance (P＞0.05). Before the intervention, there were no significant differences in blood uric acid level and physical function between the two groups (P＞0.05). After the intervention, the serum uric acid level and resting heart rate of the two groups were lower than those before the intervention, and those of the research group were even lower than the control group, while the vital capacity was higher than that before the intervention, and the research group was higher than the control group, those differences were significant (P＜0.05). Before the intervention, there was no significant difference in WHOQOL-100 score between the two groups (P＞0.05). After the intervention, the scores of WHOQOL-100 in the two groups were higher than those before the intervention, and that in the study group was higher than the control group (P＜0.05). Conclusions In the relevant guidance of elderly patients with hyperuricemia (HUA), the application of moderate intensity aerobic exercise combined with strength training can significantly lower the serum uric acid level, reduce and stabilize the resting heart rate, improve the vital capacity and quality of life, with ideal effect.

目的 探讨青春期多囊卵巢综合征(PCOS)患者血清抗苗勒管激素(AMH)与25(OH)D₃水平的相关性。方法 本研究选择在2019年1月—2020年12月在我院妇科门诊就诊的PCOS青春期女性79名,另选择同期体检的非PCOS健康对照85名。对所有受试者测量身高、体质量,计算体质量指数(BMI)。由诊治医生检查研究对象是否有痤疮、多毛以及月经情况。抽取静脉血检测黄体生成素、卵泡刺激素、总睾酮、硫酸脱氢表雄酮、抗苗勒管激素和 25(OH)D₃,将 25(OH)D₃分为不足[25(OH)D₃<30 ng/mL]和缺乏[25(OH)D₃<20 ng/mL]2组,对数据进行比较分析。结果 与健康对照组比较,PCOS组更容易发生月经稀发/闭经,其痤疮发生率较高(P值均<0.05)。体质量指数、AMH值、总睾酮和硫酸脱氢表雄酮的体内检出水平在PCOS组较高,而25(OH)D₃在PCOS组较低(P值均<0.05)。PCOS组的AMH与BMI和总睾酮呈正相关关系,与25(OH)D₃呈负相关关系(P值均<0.05)。25(OH)D₃缺乏组的AMH水平高于25(OH)D₃不足组,对照组和PCOS组的25(OH)D₃缺乏组的AMH水平均高于25(OH)D₃不足组,两两比较其差异有统计学意义(P值均<0.05)。健康对照组的25(OH)D₃缺乏率为67.1%(57/85),而PCOS组的25(OH)D₃缺乏率为96.2%(76/79),2组比较其差异有统计学意义(χ²=22.68,P<0.001)。结论 青春期多囊卵巢综合征患者体内 25(OH)D₃水平与AMH 水平显著相关。AMH 和25(OH)D₃可用于评估青春期PCOS发病风险的替代指标。

Objective To explore the correlation between serum anti-Müllerian hormone (AMH) and 25(OH)D₃ levels in adolescent patients with polycystic ovary syndrome (PCOS). Methods Seventy-nine adolescent girls with PCOS and 85 non-PCOS healthy controls who walked in the gynecological clinic of our hospital from January 2019 to December 2020 were selected. Height, weight were measured and body mass index (BMI) was calculated.Hirsutism, acne and menstruation were evaluated by doctors on all subjects. Venous blood was drawn to detect levels of luteinizing hormone, follicle stimulating hormone, total testosterone, dehydroepiandrosterone sulfate, AMH and 25(OH)D₃, 25(OH)D₃ was further divided into insufficient [25(OH)D₃<30 ng/mL] and deficient [25(OH)D₃<20 ng/mL]level, then all data were compared and analyzed between two groups. Results Compared with the healthy control group, the PCOS group was more prone to have oligomenorrhea or amenorrhea, the incidence of acne was higher in PCOS group than in control group (all P values<0.05). BMI, the levels of AMH, total testosterone and dehydroepiandrosterone sulfate were significantly higher in the PCOS group compared to the control group, while 25(OH)D₃ was the opposite (all P values <0.05). AMH in the PCOS group was positively correlated with BMI and level of total testosterone, and negatively correlated with 25(OH)D₃ (all P values<0.05). The AMH level in the 25(OH)D₃ deficiency group was higher than that in the 25(OH)D₃ insufficient group, the AMH levels of the 25(OH)D₃ deficient group and control group were higher than that in the 25(OH)D₃ insufficient group,the differences were statistically significant (P<0.05). The 25(OH)D₃ deficiency rate in the healthy control group was 67.1% (57/85), while the 25(OH)D₃ deficiency rate in the PCOS group was 96.2% (76/79). The difference between the two groups was statistically significant (χ²=22.68, P<0.001). Conclusions Serum 25(OH)D₃ level was an independent factor significantly associated with AMH level in adolescents with PCOS. AMH and 25(OH)D₃ levels may be used as surrogate markers of PCOS risk in adolescents.

目的 考察灯盏花素辅助阿替普酶治疗溶栓时间窗外急性脑梗死的疗效。方法 选取82例溶栓时间窗外急性脑梗死患者,随机分成实验组(40例)和对照组(42例)。对照组给予阿替普酶治疗,实验组在对照组基础上给予灯盏花素治疗。比较治疗前及治疗2周后,2组患者的神经功能缺损程度[国立卫生研究院卒中量表(NIHSS)]、脑梗死区域组织灌注情况[相对脑血容量(rCBV)、脑血流量水平(CBF)]、血流变学指标[高切全血黏度(HSBV)、低切全血黏度(LSBV)、血浆黏度(PV)、红细胞比容(HCT)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]。结果 治疗2周后,2组NIHSS评分及HSBV、LSBV、PV、HCT、MDA水平皆低于治疗前,且实验组低于同一时间对照组(P＜0.05);2组rCBV、CBF、SOD水平皆高于治疗前,且实验组高于同一时间对照组(P＜0.05)。结论 灯盏花素辅助阿替普酶治疗溶栓时间窗外急性脑梗死的治疗效果较好,有利于逆转患者神经功能缺损程度,增加梗死区域灌注量,改善患者血流情况,对其预后康复有利。

Objective To investigate the efficacy of breviscapine combined with alteplase in the treatment of acute cerebral infarction beyond thrombolytic time window. Methods A total of 82 patients with acute cerebral infarction beyond thrombolytic time window were randomly divided into experimental group (40 cases) and control group (42 cases). The control group was treated with alteplase, and the experimental group was treated with breviscapine on the basis of the control group. Before and 2 weeks after treatment, the degree of neurological deficit [National Institutes of Health Stroke Scale (NIHSS)], regional tissue perfusion of cerebral infarction [relative cerebral blood volume (rCBV), cerebral blood flow (CBF)], hemorheological indexes [high shear whole blood viscosity (HSBV), low shear whole blood viscosity (LSBV), plasma viscosity (PV), hematocrit (HCT)], the indexes of oxidative stress [malondialdehyde (MDA) and superoxide dismutase (SOD)] were compared between the two groups. Results After 2 weeks of treatment, NIHSS score, HBSV, LSBV, PV, HCT and MDA levels of the two groups were significantly lower than those before treatment, and those of the experimental group were significantly lower than the control group at the same time (P＜0.05). The rCBV, CBF and SOD levels of the two groups were significantly higher than those before treatment, while those of the experimental group was significantly higher than the control group (P＜0.05). Conclusions Breviscapine combined with alteplase in the treatment of acute cerebral infarction beyond thrombolytic time window had good therapeutic effect, which was beneficial to improve the degree of neurological deficit, increase the perfusion volume of infarcted area, improve the cerebral blood flow of patients, and was beneficial to the prognosis and rehabilitation.

目的 对儿童重症肺炎支气管肺泡灌洗液(BALF)进行病原学分析及疾病预后的分析。方法 本研究选取2019年3月—2020年12月在我院儿科住院并进行肺泡灌洗治疗的40例重症肺炎患儿作为研究对象。通过对这些患儿在感染急性期肺泡灌洗液中的细菌、真菌、肺炎支原体等进行病原学检查以及T 淋巴细胞亚群的检测,了解台山地区儿童重症肺炎病原体情况及耐药性、T淋巴细胞亚群与疾病严重程度、预后评估的关系。结果 BALF病原学检测结果分析中,肺炎支原体27例,肺炎支原体+肺炎链球菌5例,肺炎支原体+中间葡萄球菌2例,肺炎支原体+铅黄肠球菌1例,肺炎支原体+嗜麦芽假单胞菌2例,病原菌阴性3例;本组病例血清T细胞亚群检测结果显示:大部分病例CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺水平有不同程度的下降。其中CD3⁺水平下降的有6例,CD4⁺水平下降的有16例,CD8+水平下降的有17例,CD4⁺、CD8⁺水平同时下降的有14例,CD3⁺、CD4⁺、CD8⁺水平同时下降的有4例;BALF细胞总数(3673.1±377.9)×10⁶ /L,巨噬细胞比例(23.6±17.6)%,淋巴细胞(22.1±16.2)%,中性粒细胞(46.5±24.8)%。结论 病原学分析儿童重症肺炎BALF的主要病原菌为肺炎支原体,血清T细胞亚群检测大多表现为CD4⁺、CD8⁺水平下降。

Objective To analyze the etiology of bronchoalveolar lavage fluid and prognosis of children with severe pneumonia. Methods In this study, 40 children with severe pneumonia who were hospitalized in the pediatrics department of our hospital and underwent alveolar lavage treatment from March 2019 to December 2020 were selected as the research objects. Through the detection of pathogens such as bacteria, fungi, Mycoplasma pneumoniae and T lymphocyte subsets of these children in the acute phase of infection, we can understand the pathogens and drug resistance of children with severe pneumonia in Taishan area and the relationship among drug resistance, T lymphocyte subsets and disease severity and prognosis assessment. Results In the analysis of the BALF pathogenic test results, there were 27 cases with Mycoplasma pneumoniae, 5 cases with Mycoplasma pneumoniae+Streptococcus pneumoniae, 2 cases with Mycoplasma pneumoniae+Staphylococcus intermedius, 1 case with Mycoplasma pneumoniae+Enterococcus casseliflavus, 2 cases with Mycoplasma pneumoniae+Pseudomonas maltophilia and 3 cases were pathogenic bacteria negative. The test results of serum T cell subsets of these cases showed that most of the cases had different degrees of decline in the levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺. Among them, CD3⁺ levels decreased in 6 cases, CD4⁺ levels decreased in 16 cases, CD8⁺ levels decreased in 17 cases, CD4⁺ and CD8⁺ levels decreased in 14 cases, and CD3⁺, CD4⁺, and CD8⁺ levels decreased in 4 cases; total cell number of BALF was (3 673.1±377.9)×10⁶/L, the proportion of macrophages was (23.6±17.6)%, lymphocytes had (22.1±16.2)%, and neutrophils had (46.5±24.8)%. Conclusions Pathogenic analysis showed that the main pathogen of BALF in children with severe pneumonia is Mycoplasma pneumoniae, and the detection of serum T cell subsets mostly showed a decrease in CD4⁺ and CD8⁺ levels.

目的 探讨超低频经颅磁刺激(ILF-TMS)联合艾司唑仑对失眠症患者睡眠脑电图参数及血清神经营养因子表达的影响。方法 选取2018年8月—2020年4月我院失眠症患者114例,随机数字表法分为研究组(n=57)、对照组(n=57)。对照组予以艾司唑仑联合ILF-TMS假性刺激,研究组予以艾司唑仑联合ILF-TMS真性刺激,均治疗1个月。对比2组疗效与治疗前、治疗1个月后睡眠进程参数(总睡眠时间、入睡时间、睡眠效率、觉醒时间)、睡眠结构(非快速眼动睡眠期、快速动眼睡眠期)、匹兹堡睡眠质量量表(PSQI)评分、失眠严重程度指数量表(ISI)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、血清神经营养因子[胶质细胞源性神经营养因子(GDNF)、脑源性神经营养因子(BDNF)]水平。结果 (1)疗效:研究组治疗1个月后总有效率高于对照组(P＜0.05);(2)睡眠进程参数:治疗1个月后研究组总睡眠时间、睡眠效率高于对照组,入睡时间、觉醒时间短于对照组(P＜0.05);(3)睡眠结构:治疗1个月后研究组Ⅲ期、Ⅱ期、非快速眼动睡眠期高于对照组,Ⅰ期睡眠期低于对照组(P＜0.05);(4)PSQI、ISI评分:治疗1个月后研究组PSQI、ISI评分低于对照组(P＜0.05);(5)SAS、SDS评分:治疗1个月后研究组SAS、SDS评分低于对照组(P＜0.05);(6)血清神经营养因子:治疗1个月后研究组血清GDNF、BDNF水平高于对照组(P＜0.05)。结论 ILF-TMS联合艾司唑仑治疗失眠症效果确切,可上调血清神经营养因子表达,改善睡眠脑电图参数,提高睡眠质量,控制焦虑、抑郁症状。

Objective To investigate the effects of infra-low frequency transcranial magnetic stimulation (ILF-TMS) combined with estazolam on sleep EEG parameters and serum neurotrophic factors expression in patients with insomnia. Methods One hundred and fourteen patients with insomnia in our hospital from August 2018 to April 2020 were divided into study group (n=57) and control group (n=57) by random number table method. The control group was treated with estazolam combined with pseudo ILF-TMS stimulation, and the study group was treated with estazolam combined with real ILF-TMS stimulation, all of which were treated for 1 month. Comparing curative effect of two groups before and 1 month after treatment, and sleep process parameters (total sleep time, falling asleep time, sleep efficiency, waking time), the structure of the sleep stages (stage Ⅲ, Ⅱ, Ⅰ, rapid eye movement sleep), Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, serum neurotrophic factors (GDNF, BDNF) levels. Results (1) Efficacy: the total effective rate of the study group was higher than that of the control group after 1 month of treatment (P＜0.05). (2) Sleep process parameters: after 1 month of treatment, the total sleep time and sleep efficiency in the study group were higher than those in the control group, and the falling asleep time and waking time were shorter than those in the control group (P＜0.05). (3) Sleep structure: after 1 month of treatment, compared to the control group, the study group had more in stageⅢ, Ⅱ, rapid eye movement sleep, and less in stage Ⅰsleep(P＜0.05). (4) PSQI and ISI scores: after 1 month of treatment, PSQI and ISI scores of the study group were lower than those of the control group (P＜0.05). (5) SAS and SDS scores: after 1 month of treatment, SAS and SDS scores in the study group were lower than those in the control group (P＜0.05). (6) Serum neurotrophic factors: after 1 month of treatment, serum GDNF and BDNF levels in the study group were higher than those in the control group (P＜0.05). Conclusions ILF-TMS combined with estazolam is an effective treatment of insomnia. It can up-regulate the expression of serum neurotrophic factors, improve the parameters of sleep EEG, improve sleep quality, and control the symptoms of anxiety and depression.