目的 分析广州北部区域某胸痛中心不同性别的急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的结果。方法 纳入广州市花都区人民医院2016年12月—2020年1月期间接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者。按照不同的性别,评估患者的危险因素、治疗时限性和主要心血管不良事件情况。结果 入选389名患者,73名(18.8%)为女性。和男性患者对比,女性患者年龄更大(69.3±10.8岁vs 55.8±13.1 岁,P＜0.05),具有更高比例的2型糖尿病(26.0% vs 17.7%,P＜0.05)、高血压病(58.9.0% vs 43.0%,P＜0.05)病史。女性患者的症状-首次医疗接触时间和总缺血时间均长于男性患者(分别为229.2 min vs 174.5 min,P＜0.05;424.9 min vs 317.4 min,P＜0.05),PCI术中出现慢血流/无复流的比例更高(26.0% vs 16.5%,P＜0.05)。女性患者主要住院心血管事件风险更高(11.0% vs 4.4%, P＜0.05),其中院内死亡率(4.1% vs 1.6%, P＜0.05)。女性患者在院期间发生心衰及心源性休克的比例更高(分别为34.2% vs 21.2%,P＜0.05; 30.1% vs 18.7%,P＜0.05)。结论 在行急诊介入治疗的急性ST段抬高型心肌梗死患者中,女性患者预后差于男性,具有更高的心血管事件风险,死亡率更高。

Objective We investigated sex-based outcomes after primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) in a chest pain center of northern Guangzhou. Methods From December 2016 to January 2020, consecutive STEMI patients who underwent PPCI in Guangzhou Huadu District People's Hospital were recruited. Risk factors, time variables, and major cardiovascular adverse events (MACE) were assessed according to gender. Results A total of 389 patients were enrolled,with 73(18.8%)women. Compared to men, women patients presented higher risk profiles with old age(69.3±10.8 years vs 55.8±13.1 years,P＜0.05),diabetes (26.0% vs 17.7%,P＜0.05), hypertension (58.9.0% vs 43.0%,P＜0.05).Women had longer symptom onset to first medical contact time and total ischemic time than men had(229.2min vs 174.5min,P＜0.05;424.9min vs 317.4min,P＜0.05).During PCI procedure,women presented higher ratio of slow flow/no reflow(26.0% vs 16.5%,P＜0.05).Women had increased major adverse events(11.0% vs 4.4%, P＜0.05), and higher in-hospital mortality(4.1% vs 1.6%, P＜0.05).Women presented more heart failure incidence (34.2% vs 21.2%,P＜0.05),and cardiac shock incidence(30.1% vs 18.7%,P＜0.05). Conclusion Women with acute STEMI who underwent PPCI had worse outcomes compared to men.They had higher MACE and in-hospital mortality.

目的 探讨在关节镜下膝关节前交叉韧带损伤重建术治疗的临床效果。方法 选取2018年3月—2020年3月之间我院接受住院治疗的80名膝关节前交叉韧带损伤患者作为研究对象。根据手术方式的不同,常规手术进行交叉韧带损伤的重建术治疗为常规组,关节镜下膝关节前交叉韧带损伤重建术治疗为研究组,每组各40名患者,比对两组的治疗效果。结果 通过数据得出常规组的膝功能评分(71.8±12.6)及膝功能不稳评分(13.2±1.6)要低于研究组膝功能评分(83.9±12.9)及膝功能不稳评分(19.3±2.3),差异有统计学意义(P＜0.05)。在术后疼痛评分上研究组(3.35±0.23)各项数据均优于常规组(4.35±1.69),差异有统计学意义(P＜0.05)。研究组并发症发生率仅为5%,常规组并发症发生率有17.5%,研究组数据远要低于常规组,差异有统计学意义(χ^<sup>2=5.178,P=0.023)。结论 在膝关节镜下前交叉韧带损伤重建术治疗可有效改善膝关节活动性、稳定性、有效减轻患者的疼痛感,减少并发症的发生,促进膝关节功能的康复。关节镜下进行膝关节前交叉韧带损伤重建术治疗具有临床推广和采纳的价值。

Objective To investigate the clinical effect of arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods 80 patients with ACL injury in our hospital from March 2018 to March 2020 were selected as the research objects. According to the different surgical methods, patients underwent the traditional open surgery for cruciate ligament injury reconstruction treatment were selected as the control group,patients underwent arthroscopic anterior cruciate ligament injury reconstruction treatment were as the study group, 40 patients in each group, the treatment effect of the two groups were compared. Results The Lysholm score (71.8±12.6) and and Lysholm instability score (13.2±1.6) of the control group were lower than those of the study group (83.9±12.9 and 19.3±2.3), the differences were statistically significant (P <0.05). In the postoperative pain score, the study group (3.35±0.23) data was better than the control group (4.35±1.69), the difference was statistically significant (P <0.05). The incidence of complications in the study group was only 2.5%, and that in the control group was 17.5%, which was significantly lower than the control group, and the difference was statistically significant (χ²= 5.178, P= 0.023). Conclusion Arthroscopic anterior cruciate ligament reconstruction can effectively improve the activity and stability of knee joint, effectively reduce the pain of patients, reduce the occurrence of complications, and promote the rehabilitation of knee joint function. Arthroscopic anterior cruciate ligament reconstruction has the value of clinical promotion and adoption.

目的 分析肝脓肿的临床基线及病原学特征,旨在提高临床对该病早期识别、病原体预判、并发症警惕及抗感染治疗能力。方法 收集广州番禺区中心医院2019年1月—2020年11月收治的肝脓肿病例相关临床及实验室资料。按病原体培养结果分成阳性组、阴性组。阳性组中,按不同致病菌分成肺炎克雷伯及非肺炎克雷伯亚组。比较不同组别间基线特征及实验室数据。结果 共收集肝脓肿71例,病原学培养阳性率83.1%(59例),其中肺炎克雷伯菌46例(80%)。最常见合并症包括糖尿病(54.9%)、胆道疾病(56.3%)、肺部感染(67.6%)等。病原体阳性组PCT和AST水平高于阴性组(P<0.05),但是两组之间基线特征无差异(P>0.05)。肺炎克雷伯亚组与其他病原体组相比,合并糖尿病的风险更高(P=0.007),PLT、PCT、ALT、AST和白蛋白的水平具有显著差异(P <0.05)。经过积极治疗,大多预后良好,未见死亡病例,其中7例患者发生严重侵袭性脓肿,遗留后遗症。结论 病原体阴性肝脓肿致病力方面与阳性组并无差别。肺炎克雷伯杆菌已成为肝脓肿中最常见菌群,其多见于合并糖尿病患者。其PLT、PCT、ALT、AST指标明显高于其他菌群组,伴白蛋白消耗明显。少数可伴有全身严重侵袭性脓肿。

Objective To investigate the clinical and etiological characteristics of pyogenic liver abscess (PLA) as a reference for its early identification,early prediction of pathogens, alertness to complications and rational antibacterial treatment. Methods A single center retrospective study was carried out in patients with PLA in Guangzhou Panyu Center Hospital from January 2019 to November 2020.The clinical and laboratory data of all liver abscess cases were concluded. Baseline characteristic and laboratory outcomes were grouped into Klebsiella pneumoniae group and non-Klebsiella pneumoniae subgroup according to different pathogenic bacteria. Results Among a total of 71 patients with liver abscess, 83.1%(n=59)had positive cultures. Klebsiella pneumoniae accounted for the most in 46 cases (80.0%). The most common complications included diabetes(50.7%), biliary tract disease(56.3%), pulmonary infection(67.6%) etc. The levels of PCT and AST in pathogen culture-positive group were higher than those in culture-negative group, with statistical significance (P<0.05),on the contrary there were no differences in baseline characteristic among the groups according to the results of pathogens. Compared with other pathogens, the group of Klebsiella pneumoniae liver abscess presented higher risk of diabetes.The levels of PLT, PCT, ALT, AST,and albumin in the two groups were different (P<0.05). Most patients had good outcomes, while 7 patients had residual problems represented with severe invasive abscess. Conclusion There were similar consequences between negative and positive liver abscesses. Klebsiella pneumoniae has become the most common bacteria in liver abscess. Among which, PLT、PCT、ALT、AST indexes are higher than that of other bacteria with obvious albumin depletion, even some of which may be accompanied by systemic severe invasive abscess.

目的 探究椎间孔镜下治疗腰椎间盘突出症切除黄韧带对腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度的影响。方法 选择120例腰椎间盘突出症患者,随机分为观察组与对照组各60例。观察组患者椎间孔镜术中切除部分黄韧带;对照组患者保留黄韧带。比较两组患者术后半年、1年及2年的腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度。结果 观察组术后半年、1年腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度与对照组比较(P＞0.05)。观察组术后2年与对照组比较(P＜0.05)。结论 椎间孔镜下治疗腰椎间盘突出症保留黄韧带术后腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度远期效果优于切除黄韧带。

Objective To explore the effects of ligamentum flavum resection on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space. Methods 120 patients with lumbar disc herniation were randomly divided into observation group and control group. In the observation group, part of the ligamentum flavum was excised by endoscope and in the control group, the ligamentum flavum was preserved. The lumbar lordosis angle, sacral inclination angle, lumbar curve index and intervertebral space height of the two groups were compared at 6 months, 1 year and 2 year after operation. Results At 6 months, 1 year after operation, the lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space in the observation group were compared with those in the control group(P＞0.05). 2 years after operation, the observation group was compared with the control group(P<0.05). Conclusion The long-term effect of ligamentum flavum preserving on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space is better than that of ligamentum flavum resection.

目的 观察紧密连接蛋白在高尿酸血症致大鼠肾损害模型中的表达变化以及非布司他的干预疗效。方法 将SD大鼠分为正常组,高尿酸血症组(模型组),非布司他组(干预组);氧嗪酸联合尿酸诱导制作高尿酸血症大鼠模型,给予非布司他进行干预,分别于6周后检测各组大鼠血中尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)水平,免疫组化及RT-PCR方法检测紧密连接蛋白包括膜周蛋白-1(ZO-1)、跨膜蛋白(occludin) 的表达变化,采用Masson染色检测大鼠肾间质病理改变。结果 6周时,模型组、干预组ZO-1、occludin表达较正常组降低(均P<0.05);干预组ZO-1、occludin表达较模型组增加,差异有统计学意义(均P<0.05),与正常组相比,模型组、干预组RIF指数均增高(均P<0.05),干预组RIF指数低于模型组,高于正常组(均P<0.05)。结论 紧密连接蛋白表达的降低在高尿酸血症肾间质纤维化发展过程中起着举足轻重的作用,并与血尿酸水平及肾功能损害密切相关。非布司他通过降低血尿酸水平,能改善紧密连接蛋白的表达,延缓肾功能损害,起到肾保护作用。

Objective To observe the expression of tight junction protein in hyperuricemia induced renal damage model in rats and the intervention effect of febuxostat. Methods SD rats were randomly divided into three groups: normal control group, model control group, febuxostat treatment group. Hyperuricemia was induced in rats with oxonic acid per time for three times per day, by gavage and combined with uric acid added in drinking water, while febuxostat were administered by gavage in febuxostat treatment group.The blood of rats were collected to analyse the differences of control, model and treatment group on changes of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA). Immunohistochemistry was used to assay ZO-1 and occludin protein expression and quantitive real time PCR to detect the expression of ZO-1 and occludin in renal tissue of renal interstitial fibrosis model rats induced by hyperuricemia. Paraffin section of kidney was maked and then performed Masson staining to make sure the model is successful. Results At 6 weeks, the expressions of ZO-1 and occludin in the model group and treatment group were lower than those in the normal group (all P<0.05). The expressions of ZO-1 and occludin in the treatment group were higher than those in the model group (all P<0.05). Compared with the normal group, the RIF index in the model group and treatment group were higher (all P<0.05), and the RIF index in the treatment group was lower than that in the model group and higher than that in the normal group (all P<0.05). Conclusion The downregulated expression of ZO-1 and occludin plays a crucial role during the development of hyperuricemia in renal interstitial fibrosis, and are closely related to UA level and renal function impairment. Febuxostat may improve the expression of tight junction by downregurating UA, reduce renal fuction impairment and play a role in renal protection.

目的 研究鼻内镜下应用低温等离子高选择性翼管神经分支切断治疗变应性鼻炎患者的临床疗效。方法 选取我院2019年1月—2020年12月收治的60例变应性鼻炎患者,随机数字表法分为对照组(30例)和观察组(30例)。对照组行保守治疗,观察组行鼻内镜下低温等离子高选择性翼管神经分支切断术治疗。比较两组治疗前后Lund—Kennedy内镜黏膜形态评分、视觉模拟量表(VAS)评分,分析两组治疗前后炎症细胞因子[血清肿瘤坏死因子-α(TNF-α)、白介素-4(IL-4)、白介素-6(IL-6)]及鼻黏膜功能指标[血管活性常态肠肽(VIP)、鼻腔阻力(NR)、鼻黏膜纤毛传输时间(MTT)、鼻黏膜纤毛输送率(MTR)]变化情况。结果 两组治疗后VAS评分、Lund—Kennedy评分较治疗前降低(P＜0.05);观察组治疗后VAS评分、Lund—Kennedy评分低于对照组(P＜0.05)。两组治疗后TNF-α、IL-4、IL-6水平较治疗前降低(P＜0.05);观察组治疗后TNF-α、IL-4、IL-6水平低于对照组(P＜0.05)。两组治疗后VIP、NR、MTT水平较治疗前降低(P＜0.05),MTR水平较治疗前升高(P＜0.05);观察组治疗后VIP、NR、MTT水平低于对照组(P＜0.05),MTR水平高于对照组(P＜0.05)。结论 鼻内镜下应用低温等离子高选择性翼管神经分支切断术治疗变应性鼻炎疗效显著,可改善鼻腔黏膜功能,减轻炎症反应,值得推广。

目的 利用高精确的外照射治疗技术,即图像引导放射治疗/容积旋转调强放疗(IGRT/VMAT) 时,使用千伏锥形束CT (kV-CBCT)定位来获得最佳的宫颈癌治疗获益。方法 205例接受IGRT/VMAT治疗的宫颈癌患者纳入实验组。每周做一次kV-CBCT定位后,将这些图像与计划CT扫描图像匹配后记录摆位误差。总共研究了1 025个kV-CBCT图像。采取同时期常规X片定位的90例宫颈癌患者作为对照组。根据定位中的摆位误差计算计划靶区(PTV)的边界。结果 实验组前后、上下和左右方向的摆位误差分别为(1.8±1.1)mm、(2.8±2.2)mm和(1.7±1.4)mm,对照组分别为(2.8±2.1)mm、(3.9±2.2)mm和(2.7±2.4)mm,两组差异具有统计学意义(P<0.05)。实验组前后、上下和左右方向的CTV-PTV边界分别为5.27 mm、8.54 mm和5.23 mm,对照组分别为8.47 mm、11.29 mm和8.43 mm。结论 在采用高精度技术治疗宫颈癌时,每周kV-CBCT是一种令人满意的精确定位方法,有助于减少CTV-PTV边界。

Objective To obtain the best cervical cancer treatment benefit through kilovoltage cone-beam CT (kV-CBCT) positioning, by using high-precision external beam therapy technology, that is, image-guided radiation therapy/volumetric modulated arc therapy (IGRT/VMAT). Methods Two hundred and five patients with cervical cancer treated with IGRT/VMAT were included in the experimental group. After kV-CBCT positioning once a week, these images were matched with the planned CT scan images and the setup errors were recorded. A total of 1 025 kV-CBCT images were studied. Ninety patients with cervical cancer positioned by conventional X-ray during the same period were selected as the control group. The boundary of the planned target volume (PTV) was calculated based on the setup errors. Results In the experimental group, the setup errors in the anteroposterior, superoinferior and mediolateral direction were (1.8±1.1) mm, (2.8±2.2) mm, and (1.7±1.4) mm, respectively. And in the control group, the setup errors were (2.8±2.1) mm, (3.9±2.2) mm, and (2.7±2.4) mm, respectively. The differences between the two groups were statistically significant (P<0.05). In the experimental group, the CTV-PTV boundaries in the anteroposterior, superoinferior and mediolateral direction were 5.27 mm, 8.54 mm, and 5.23 mm, respectively. And in the control group, the CTV-PTV boundaries were 8.47 mm, 11.29 mm, and 8.43 mm, respectively. Conclusion When using high-precision technology to treat cervical cancer, weekly kV-CBCT is a satisfactory and accurate positioning method, which helps to reduce the CTV-PTV boundary.

目的 分析慢性肾衰竭患者接受肾衰康方治疗对其血清微炎症状态的影响及肾功能的保护作用。方法 将2020年1月—2020年12月作为研究时间段,选取期间广东祈福医院接诊的50例慢性肾衰竭患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入25例)、观察组(加用肾衰康方治疗,纳入25例),对组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标展开分析。结果 组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗前无明显差异,P>0.05;观察组中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗后优于对照组,P<0.05。结论 肾衰康方对改善慢性肾衰竭患者血清微炎症状态、氧化应激水平、临床症状均有较好效果,且能保护肾功能,值得推广。

Objective To analyze the effect of Shenshuaikang decoction on serum microinflammation and renal function in patients with chronic renal failure. Methods From January 2020 to December 2020, 50 patients with chronic renal failure treated by Clifford Hospital were selected, and the random number table method was used for grouping. All cases were divided into control group (n=25) and observation group (n=25). The TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index were analyzed. Results There were no significant differences in TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index between the two groups before treatment, P>0.05; the TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index of the observation group were better than those of the control group after treatment, P<0.05. Conclusion Shenshuaikang decoction has good effect on improving serum microinflammation, oxidative stress level and clinical symptoms of patients with chronic renal failure, and also can protect renal function, which is worthy of promotion.

目的 探讨广州市区小学生的性格发展状况,为了解和促进广州市儿童的性格和身心健康发展提供科学依据和建议。方法 采取横断面调查研究,通过整群随机抽样的方法抽取广州市区两所小学三年级学生共405名,采用儿童艾森克个性问卷(Junior Eysenck Personality Questionnaire, JEPQ)量表进行问卷调查,采用两独立样本t检验比较性别、年龄组、不同地区间的JEPQ各维度得分,采用卡方检验比较不同地区间JEPQ各维度的高分比例。 结果 广州市区小学生JEPQ的内外向(extroversion and introversion, E)、神经质(neuroticism, N)、精神质(psychoticism, P)、掩饰性(lie, L)维度标准分T分分别为50±11、50±16、42±18、50±10。其中,20.6%的儿童情绪不稳定(N维度T分>61.5);22.3%和32.7%的儿童分别为内向(E维度T分<43.3)和外向(E维度T分>56.7)倾向;6.3%的儿童性格孤僻或有攻击性(P维度T分>61.5)。与重庆、滁州、和西安地区相比,广州地区男女生的E维度得分较高(除西安女生,P<0.05)。结论 广州市区的两成小学生有焦虑、紧张的倾向,与其他城市相比更为外向。建议打造学校-社区-家庭“三位一体”的支持网络,为儿童的身心健康发育保驾护航。

Objective To explore the personality status of urban primary school students in Guangzhou, to provide evidence and suggestions for personality traits, as well as physical and psychological health improvement of children in Guangzhou city.Methods This is a cross-sectional study. Cluster sampling was applied to the survey of personality traits in 405 grade-3 pupils from two primary schools of Guangzhou, using Junior Eysenck Personality Questionnaire (JEPQ). Independent t test was used to compare scores of all the dimensions in JEPQ between genders, age groups, and districts. Chi-square was used to compare proportion of high score in each dimension between districts. Results The standard T points of JEPQ in the dimensions of extroversion & introversion (E), neuroticism (N), psychoticism (P), lie (L) of Guangzhou city pupils were 50±11, 50±16, 42±18 and 50±10, respectively. Among them, 20.6% of subjects were emotionally unstable (T score＞61.5 in N dimension). 22.3% and 32.7% of children were introverted (T score＜43.3 in E dimension) and extroverted (T score＞56.7 in E dimension) respectively, and 6.3% of children were unsocial or aggressive (T score＞61.5 in P dimension). Compared with Chongqing, Chuzhou and Xi-an cities, the scores of E dimension were higher in both boys and girls of Guangzhou city (except for Xi-an girls, P<0.05). Conclusion Around twenty percent of Guangzhou city primary students tend to be anxious and nervous. Compared with the other cities, pupils in Guangzhou city are more extroverted. We suggested a three-in-one support network of school-community-family should be built to facilitate the children's physical and mental health development.

目的 探讨肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值。方法 选取2018年1月—2020年1月我院收治的64例肝硬化患者(肝硬化组),并纳入同期来我院接受健康体检者64例(对照组),应用全自动血凝仪对肝硬化患者临床凝血指标检测。再将肝硬化组患者分为出血组与无出血组,比较对照组与肝硬化组、出血与无出血组、不同肝功能分级患者血小板参数与PT检测结果。结果 与对照组比较,肝硬化组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与肝硬化无出血组比较,肝硬化出血组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与Child-Pugh A级患者比较,肝硬化Child-Pugh B级与C级患者PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05)。结论 在肝硬化患者病情评价中凝血功能检验发挥重要作用,可为患者临床治疗提供有效理论依据,诊断准确率较高,有利于临床治疗措施制定。因此,凝血功能检验应在肝硬化疾病诊断中广泛应用。

Objective To explore the application and clinical value of automatic blood coagulation apparatus in clinical coagulation function test of patients with cirrhosis. Methods A total of 64 patients with cirrhosis admitted to our hospital from January 2018 to January 2020 (cirrhosis group) were selected, and 64 healthy subjects admitted to our hospital during the same period (control group) were included. The clinical coagulation indexes of patients with cirrhosis were detected by automatic blood coagulation apparatus. Patients in cirrhosis group were divided into bleeding group and non-bleeding group; platelet parameters and PT test results were compared between control group and cirrhosis group, bleeding group and non-bleeding group, and patients with different liver function grades. Results Compared with the control group, the levels of PDW, PT, MPV and INR in cirrhosis group were higher, and the levels of PCT and PLT were lower (P＜0.05). Compared with liver cirrhosis non-bleeding group, the levels of PDW, PT, MPV and INR were higher in liver cirrhosis with bleeding group, and the levels of PCT and PLT were lower (P＜0.05). Compared with Child-Pugh A patients, the levels of PDW, PT, MPV and INR in Child-Pugh B and C patients with cirrhosis were higher, and the levels of PCT and PLT were lower (P＜0.05). Conclusion The test of coagulation function plays an important role in the evaluation of patients with cirrhosis, and can provide effective theoretical basis for the clinical treatment of patients with high diagnostic accuracy, which is conducive to the formulation of clinical treatment measures. Therefore, the test of coagulation function should be widely used in the diagnosis of cirrhosis.