目的 本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法 检索2000年1月—2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果 9项临床病例对照研究共1 179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P＜0.000 1)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07, P＜0.000 1),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P＜0.000 1),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.000 1),白细胞(WBC) >11×109/L的患者发生肺栓塞的风险是WBC≤11×109/L患者的6.62倍(P＜0.000 1)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02 (P＜0.000 1)和2.30 (P＜0.000 1)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论 肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞＞11×10⁹/L。

Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients. Methods The following databases such as Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Weipu Database, Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020. Statistical analysis was performed using RevMan 5.3 software. Results 9 controlled trials incorporating 1 179 patients were included in this study. The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism (HR=2.82, 95%CI[2.06,3.87], P<0.000 1). The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio (OR)=3.07 (P<0.000 1). Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II (OR=3.07,P<0.000 1). Furthermore, the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients (P<0.000 1), and 6.62 times higher than those with WBC ≤11×10⁹/L (P<0.000 1). Additionally, the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism, with OR of 3.02 (P<0.000 1) and 2.30 (P<0.000 1), respectively. However, smoking, alcohol consumption, gender, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease, hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients. Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer, and the related risk factors were pathological type, stage, chemotherapy, central venous catheterization, increased D-dimer level, and WBC>11×10⁹/L.

目的 探讨艾滋病继发真菌感染患者病情的临床特点与治疗措施。方法 选取2019年4月—2020年4月我院收治的艾滋病继发真菌感染患者90例,对所有患者的病情特点进行分析,并及时采取有效地治疗措施。分析患者真菌感染部位、病情临床特点、治疗效果。结果 患者真菌感染部位中,排在前三位的为口腔、肺、食道,占比为44.4%(40/90)、30.0%(27/90)、23.3%(21/90);90例患者中,感染真菌排在前三位的为白色念珠菌、马尔尼菲青霉菌、新型隐球菌,占比为36.7%(33/90)、24.4%(22/90)、16.7%(15/90);90例患者中,显效32例(35.5%)、有效46例(51.1%)、无效12例(13.4%),有效率为86.6%(78/90)。结论 艾滋病继发真菌感染患者中,感染的主要部位主要为口腔、肺、食道,其中感染的真菌主要有白色念珠菌、马尔尼菲青霉菌、新型隐球菌。对患者及时进行有效地抗逆转录病毒治疗可以降低患者死亡率,提高治疗效果。

Objective To explore the clinical characteristics and treatments of AIDS secondary fungal infection. Methods A total of 90 patients with secondary fungal infection of AIDS admitted to our hospital from April 2019 to April 2020 were selected, and the characteristics of all patients were analyzed, and effective treatment measures were taken in time. The sites of fungal infection, clinical characteristics and therapeutic effects were analyzed. Results The top three fungal infection sites were oral cavity, lung and esophagus, accounting for 44.4% (40/90), 30.0% (27/90) and 23.3% (21/90). Among the 90 patients, candida albicans, penicillium marneffei and cryptococcusneoforme ranked the top three, accounting for 36.7% (33/90), 24.4% (22/90) and 16.7% (15/90). Of the 90 patients, 32 had obvious effects (35.5%), 46 had effective effects (51.1%) and 12 had no effects (13.4%), and the effective rate was 86.6% (78/90). Conclusion In the patients with secondary fungal infection of AIDS, the main sites of infection were oral cavity, lung and esophagus, in which the main infected fungi were candida albicans, penicillium marneffei and cryptococcus neofordii. Timely and effective antiretroviral therapy can reduce the mortality and improve the treatment effect.

目的 探讨低机械指数诊断超声及低声压治疗超声对造影剂微泡的作用效果。方法 低机械指数的诊断超声及不同声压下低能量治疗超声体外辐照造影剂微泡,通过获得的超声造影图像间接分析微泡总浓度的变化,探讨不同机械指数诊断超声及不同声压治疗超声下微泡发生稳定空化及惯性空化情况。结果 低机械指数(<0.2)诊断超声及低声压(<0.15 MPa)治疗超声下微泡以稳定空化为主,随着机械指数增高或声压增高,微泡以稳定空化和惯性空化两种方式并存,当机械指数>0.3或声压>0.2 Mpa时,微泡以惯性空化为主。结论 微泡在低机械指数及低声压作用下发生不同空化效应,随着机械指数或声压增加,微泡破坏增加,以惯性空化效应为主。

Objective To investigate the effect of low mechanical index diagnostic ultrasound and low acoustic pressure therapy on contrast agent microbubbles. Methods Microbubbles were irradiated by diagnostic ultrasound with low mechanical index(MI) and low energy therapy under different acoustic pressure. To obtain the images, and analyze the change of microbubble concentration,the movement trend of microbubbles under different MI and different acoustic pressure were analyzed, to estimated stable cavitation or inertial cavitation of microbubbles. Results Stable cavitation was the main form of microbubbles under low mechanical index (< 0.2) diagnostic ultrasound and low acoustic pressure (< 0.15Mpa). With the increase of mechanical index or acoustic pressure, stable cavitation and inertial cavitation coexisted. When mechanical index > 0.3 or sound pressure > 0.2MPa, microbubbles were mainly inertial cavitation. Conclusion The cavitation effects of microbubbles under low mechanical index and low acoustic pressure are different. With the increase of mechanical index or acoustic pressure, the damage of microbubbles increases, and main effect is the inertial cavitation.

目的 观察结直肠癌患者使用联合药物FOLFOX化疗前后左心室应变参数的变化。方法 选取健康人30例作为正常组,收集病理确诊为结直肠癌并采用FOLFOX(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗的患者30例,以自身对照做研究,分别在化疗前、化疗1个周期后、化疗6个周期后、化疗12个周期后48 h内完成心脏超声检查,采集左心室的动态图像,获取常规参数:LVEDd、LVEDs、IVSd、LVPWd、LVEDV、LVESV、LVEF、LVFS;三维参数:SPI、SV、CO、LVEDMass、LVESMass、GAS、GRS、GLS、GCS,并比较化疗前后这些数值的变化。结果 正常组与各化疗组相比对,LVEDd、LVEDs、IVSd、LVPWd、LVPW、LVESV、SPI的变化均无统计学意义(P>0.05);LVEF、LVFS、SV、CO在化疗中、后期出现了降低,差异有统计学意义(P<0.05),HR、LVEDMass、LVESMass略升高,差异有统计学意义(P<0.05);化疗后GLS及GAS较化疗前明显减低(P<0.05),其中GAS的ROC曲线下面积为0.883,P<0.001,选30%为诊断界点,灵敏度为86.7%,特异度为80%;GLS的ROC曲线下面积为0.888,P<0.001,选19%为诊断界点,灵敏度为73.3%,特异度为90.0%。结论 三维斑点追踪技术能够早期发现FOLFOX致结直肠癌患者左心室功能的变化,其中LVGLS、LVGAS是有力的观测指标。

Objective To observe the changes of left ventricular strain parameters in patients with colorectal cancer before and after combined chemotherapy with FOLFOX. Methods 30 healthy people were selected as normal group, and 30 patients with pathologically diagnosed colorectal cancer and FOLFOX (5-fluorouracil +oxaliplatin+calcium leucovorin) chemotherapy were collected. Before, after 1 cycle of chemotherapy, after 6 cycles of chemotherapy, and within 48 hours after 12 cycles of chemotherapy, cardiac ultrasound examination was performed, and dynamic images of the left ventricle were collected to obtain conventional parameters: LVEDd, LVEDs, IVSd, LVPWd, LVEDV, LVESV, LVEF, LVFS; three-dimensional parameters: SPI, SV, CO, LVEDMass, LVESMass, GAS, GRS, GLS, GCS, and the changes of these values before and after chemotherapy were compared. Results Compared with the chemotherapy group, the normal group had no statistically significant changes in LVEDd, LVEDs, IVSd, LVPWd, LVPW, LVESV, and SPI (P>0.05); LVEF, LVFS, SV, CO were in the middle and late stages of chemotherapy. There was a decrease, the difference was statistically significant (P<0.05), HR, LVEDMass, LVEESMass were slightly increased, the difference was statistically significant (P<0.05); LGS and GAS after chemotherapy were significantly lower than before chemotherapy (P<0.05), the area under the ROC curve of GAS is 0.883, P=0.000, 30% is selected as the diagnostic boundary, the sensitivity is 86.7%, and the specificity is 80%; the area under the ROC curve of GLS is 0.888, P=0.000, 19% as a diagnostic boundary, the sensitivity is 73.3% and the specificity is 90.0%. Conclusion Three-dimensional speckle tracking technology can detect the changes of left ventricular function in patients with colorectal cancer caused by FOLFOX in early stage, of which LVLGS and LVGAS are powerful observation indicators.

目的 分析血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与脑梗死的关系。方法 择取2018年9月—2019年8月本院收治的脑梗死患者135例设为观察组,同期本院参与体检的健康志愿者135例为对照组,两组受试者均开展血液检测,收集并分析临床资料。结果 观察组性别、平均年龄、吸烟、fib水平与对照组差异无统计学意义(P＞0.05);观察组高血压患病率、糖尿病患病率、TG、LDL-C、sdLDL-C、Lp-PLA2、FBG、Hcy、D-D水平均高于对照组(P＜0.05);观察组TC、HDL-C、PT、APTT、TT水平均低于对照组(P＜0.05);按照NIHSS＜4分、4～15分、≥16分分成轻度组(甲组,n=53)、中度组(乙组,n=49)、重度组(丙组,n=33);甲组、乙组及丙组,两两亚组比较LDL-C、HDL-C、Hcy、sdLDL-C、Lp-PLA2、D-D、PT、APTT、TT及FBG,差异有统计学意义(P＜0.05);甲组、丙组饮酒率差异有统计学意义(P＜0.05);甲组与丙组、乙组与丙组冠心病患病率、Fib水平差异有统计学意义(P＜0.05)。结论 血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与脑梗死有一定关联。

Objective To analyze the relationship of serum small and dense low density lipoprotein cholesterol and homocysteine in cerebral infarction. Methods 135 patients with cerebral infarction admitted to our hospital from September 2018 to August 2019 were selected as the observation group, and 135 healthy volunteers who participated in physical examination in our hospital during the same period were selected as the control group. Results There were no significant differences in sex, average age, smoking, fib level between the observation group and the control group (P>0.05). The prevalence of hypertension, diabetes mellitus, TG, LDL-C, SDLDL-C, LP-PLA2, FBG, Hcy and D-D in the observation group were all higher than those in the control group (P<0.05). The TC, HDL-C, PT, APTT and TT levels in the observation group were all lower than those in the control group (P<0.05). According to NIHSS<4 points, 4~15 points and ≥16 points, the patients were divided into mild group (group A, n=53), moderate group (group B, n=49) and severe group (group C, n=33). Ldl-c, HDL-C, Hcy, SDLDL-C, LP-PLA2, D-D, PT, APTT, TT and FBG were compared in group A, group B and group C, and the differences were statistically significant (P<0.05). The difference of drinking rate between group A and group C was statistically significant (P<0.05). The difference of coronary heart disease prevalence and Fib level between group A and group C, group B and group C was statistically significant (P<0.05). Conclusion Small and dense low density lipoprotein cholesterol and homocysteine are associated with cerebral infarction.

目的 探讨p16/Ki-67染色、HPV E6/E7mRNA和联合检测对HSIL+病变诊断的临床价值。方法 募集2017年3月—2020年8月期间,于中山市博爱医院妇产科就诊,组织学证实为宫颈炎患者209例、LSIL患者169例、HSIL患者131例和宫颈癌患者86例作为研究对象,回顾分析研究对象术前细胞学样本p16/Ki-67染色、HPV E6/E7mRNA检测结果,纵向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在不同级别宫颈病变的阳性率的差异,横向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在相同宫颈病变的阳性率的差异,综合评估p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+病变效能的差异。结果 ①纵向比较:p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率随宫颈病变程度的加重呈趋势性升高(p16/Ki-67染色:χ²=374.34,P<0.001;HPV E6/E7mRNA检测:χ²=289.21,P<0.001;联合检测:χ²=343.90,P<0.001)。②横向比较:在宫颈炎、LSIL、宫颈癌组,p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率之间差异均不具有统计学意义(均P>0.05)。在HSIL组,p16/Ki-67染色和联合检测之间阳性率差异有统计学意义(χ²=8.09,P=0.004); HPV E6/E7mRNA和联合检测之间阳性率差异有统计学意义(χ²=11.30,P=0.001)。③p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的灵敏度,总体差异有统计学意义(χ²=7.69,P=0.021)。p16/Ki-67染色与联合检测法之间的灵敏度差异有统计学意义(χ²=7.29,P=0.007);HPV E6/E7mRNA检测与联合检测法之间的灵敏度差异有统计学意义(χ²=4.84,P=0.028)。p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的特异度及符合率的总体差异不具有统计学意义(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628)。结论 p16/Ki-67染色、HPV E6/E7mRNA 和联合检测均可有效筛出HSIL+病变,但是联合检测能显著提高HSIL+病变诊断的灵敏度,降低漏诊率,同时保持了较好的特异度和符合率,建议将p16/Ki-67染色和HPV E6/E7mRNA联合检测作为早期诊断HSIL+病变的策略。

Objective To investigate the clinical value of p16/Ki-67 staining E6/E7 mRNA and combined detection in the diagnosis of HSIL+ lesions. Methods From March 2017 to August 2020,209 cases of cervicitis,169 cases of LSIL,131 cases of HSIL and 86 cases of cervical cancer confirmed by histology were selected as the research objects. The results of p16/Ki-67 staining and HPV E6/E7 RNA detection of the preoperative cytological samples were retrospectively analyzed and the p16/Ki-67 staining and HPV E6/E7 mRNA detection results were compared longitudinally. The positive rates of E6/E7mRNA and combined detection in different grades of cervical lesions were compared.The positive rates of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the same cervical lesions were compared horizontally.The differences in the diagnostic efficacy of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+lesions were comprehensively evaluated. Results ①Longitudinal comparison:the positive rates of p16/ Ki-67 staining, HPV E6/E7mRNA and combined detection increased with the severity of cervical lesions(p16/Ki-67 staining:χ²=374.34,P<0.001;HPV E6/E7 mRNA detection:χ²=289.21,P<0.001;joint detection:χ²=343.90,P<0.001). ②Transverse comparison: in cervicitis, LSIL and cervical cancer groups,there were no significant differences in the positive rates of p16/Ki-67 staining, HPV E6/E7 mRNA and combined detection (all P>0.05). In the HSIL group,there was significant difference in the positive rate between p16/Ki-67 staining and combined detection (χ²=8.09,P=0.004)and the difference between HPV E6/ E7 mRNA and combined detection was statistically significant(χ²=11.30,P=0.001). ③The sensitivity of p16/Ki-67staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+ was statistically significant(χ²=7.69,P=0.021). The sensitivity difference between p16/Ki-67 staining and combined detection was statistically significant(χ²=7.29,P=0.007);the sensitivity difference between HPV E6/E7 mRNA detection and combined detection method was statistically significant (χ²=4.84,P=0.028). There was no significant difference in the specificity and coincidence rate of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628). Conclusion P16/Ki-67 staining,HPV E6/E7 mRNA and combined detection may effectively screen out HSIL+ lesions,reduce the missed diagnosis rate, but the combined detection may significantly improve the sensitivity of diagnosis of HSIL+ lesions, while maintaining good specificity and coincidence rate.It is suggested that p16/Ki-67 staining and HPV E6/E7 mRNA detection should be used as a strategy for early diagnosis of HSIL+ lesions.

目的 评价口服核苷类似物富马酸丙酚替诺福韦治疗宫颈持续性高危型人乳头瘤感染患者的疗效。方法 本回顾性研究中,将同一亚型高危型人乳头瘤病毒感染超过1年患者随机分为两组,治疗组给予口服富马酸丙酚替诺福韦,25 mg,每天一次,连续3个月;对照组给予宣教说明,无特殊处理。于入组后第3个及第6个月随诊。检测患者宫颈人乳头瘤病毒感染的变化,同时观察宫颈细胞学、阴道镜Reid评分及宫颈组织病理学变化。结果 宫颈持续性高危型人乳头瘤病毒感染者共82例,分为两组:治疗组42例,对照组40例。均完成随访。在治疗结束时、治疗结束后3个月,治疗组清除人乳头瘤病毒的有效率分别为 52.38% 和 61.90%,优于对照组20.00%(P＜0.05)和30.00% (P＜0.05);治疗结束时、治疗结束后3个月,治疗组细胞学异常的缓解率分别为66.67%和77.78%,优于对照组22.22%(P＜0.05)和33.33%(P＜0.05);治疗组中Reid评分3分及其以上者例数较对照组少(2 vs 10,P＜0.05),且Reid评分较基线明显下降(P＜0.05),对照组Reid评分无显著变化(P＞0.05)。6个月时治疗组中宫颈上皮内瘤变I级者组织学缓解率优于对照组(72.72% vs 35.00%,P＜0.05)。随访期间无严重不良反应。结论 口服富马酸丙酚替诺福韦可有效清除宫颈持续性高危型人乳头瘤病毒感染,且安全、临床可行。

Objective To investigate the clinical efficacy of nucleoside analogues Tenofovir Alafenamide (TAF) therapy for cervical high-risk HPV (HR-HPV) infection. Methods In this prospective study, a total of 82 patients with persistent cervical HR-HPV infection were randomly divided into two groups. The treatment group (42 patients) administered orally TAF (25mg, once daily, 3 months). The control group (40 patients) received no treatment. All patients were followed up for 6 months. HPV testing, ThinPrep cytology test (TCT), and Reid colposcopic index (RCI) grading were performed for both groups. Results HR-HPV remission rates were 52.38% and 61.9% in the treatment group at the 3-and 6-month follow-up, respectively, whereas 20% and 30% in the control group at the 3-and 6-month follow-up visits. Conversion rates of abnormal TCT results were 66.67% and 77.78% in the treatment group at two follow-up visits. In contrast, the control group showed remission rates at 22.2% and 33.3%, respectively. There were 2 and 10 patients with grade of 3-4 or higher at the treatment group and the control group at the 6-month visit, respectively. RCI scoring was declining obviously at 6 months in the treatment group (P<0.05), whereas the control group showed no significantly difference. 16 of 22 (72.72%) patients with CINⅠin the treatment group were alleviated at 6-month visit compared to 35% in the control group(P<0.05). No serious adverse events happened during the treatment and follow up. Conclusion Tenofovir alafenamide is an effective, safe and accessible treatment for cervical HR-HPV infection.

目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.

目的 观察低频电刺激治疗对脑卒中偏瘫疗效,并分析其对患者周围神经电生理学与形态学的影响。方法 选取本院94例脑卒中偏瘫患者,以数字表法随机分为两组,各47例,对照组接受基础康复治疗,实验组予以早期综合康复治疗(于对照组基础上进行低频电刺激治疗),比较两组治疗前后Berg平衡量表(BBS)评分、Fugl-Meyer运动功能(FMA)评分、关节(腕与踝)主动活动范围(AROM)、周围神经电生理学[感觉神经传导速度(SCV)、运动神经传导速度(MCV)、动态肌电图]与形态学[腕横纹正中神经(MN)横截面积(CSA)、宽度(W)以及厚度(T)]。结果 实验组治疗后BBS评分、上肢与下肢FMA评分高于对照组(P＜0.05),腕与踝AROM大于对照组(P＜0.05);实验组治疗后腓总神经与胫神经SCV、MCV高于对照组(P＜0.05),肱二头肌与腓肠肌协同收缩率均低于对照组(P＜0.05);两组治疗前后MN的CSA、T比较无差异(P＞0.05),实验组治疗后MN的W大于对照组(P＜0.05)。结论 低频电刺激联合早期综合康复治疗可有效提高脑卒中偏瘫患者平衡能力、关节活动度及上下肢功能,改善周围神经电生理学与形态学,减轻周围神经损伤。

Objective To observe the curative effect of low frequency electrical stimulation treatment on stroke hemiplegia, and analyze its influences on peripheral nerve electrophysiology and morphology of patients. Methods A total of 94 patients with stroke hemiplegia in the hospital were randomly divided into two groups by number table method, 47 cases in each group. The control group was given basic rehabilitation treatment, while experimental group was given early comprehensive rehabilitation treatment (low frequency electrical stimulation on basis of control group). The scores of Berg Balance Scale (BBS) and Fugl-Meyer assessment (FMA), joint (wrist, ankle) active range of motion (AROM), peripheral nerve electrophysiology [sensory conduction velocity (SCV), motor conduction velocity (MCV), dynamic electromyogram (EMG) ] and morphology [cross-sectional area (CSA) of carpal transverse median nerve (MN), width (W), thickness (T)] before and after treatment were compared between the two groups. Results After treatment, scores of BBS, upper and lower limbs FMA in experimental group were higher than those in control group (P<0.05), AROM of wrist and ankle was larger than that in control group (P<0.05). After treatment, SCV and MCV of common peroneal nerve and tibial nerve in experimental group were higher than those in control group (P<0.05), while co-contraction rates of biceps and gastrocnemius muscles were lower than those in control group (P<0.05). Before and after treatment, there were no differences in CSA and T of MN between the two groups (P>0.05). After treatment, W of MN in experimental group was greater than that in control group (P<0.05). Conclusion Low-frequency electrical stimulation combined with early comprehensive rehabilitation therapy may effectively increase the balance ability, joint range of motion and upper and lower limb function of stroke patients with hemiplegia, improve peripheral nerve electrophysiology and morphology, and reduce peripheral nerve injury.

目的 探讨无偿献血者ABO血型正反定型初筛结果不一致的原因分析。方法 选取2019年6月1日—2020年11月30日本血站的无偿献血者样本,采用Metis150全自动血型分析仪进行ABO正反定型初筛。初筛结果正反定型不一致先进行试管法复核,结果仍不一致时送血型参比实验室做进一步确认,并对造成ABO血型正反定型不一致的原因进行分析。结果 44 808例无偿献血者样本中初筛结果ABO血型正反定型不一致134例,发生率为0.30%。导致ABO正反定型不一致原因为:因方法学不同可经盐水介质试管法复检确认65例(48.51%);吸取红细胞或血浆异常加样量不准确25例(18.66%);仪器判读错误4例(2.98%);血型参比实验室通过延长反应时间或改变反应温度确定因抗体缺失或减少22例(16.42%)、冷凝集素2例(1.49%);增加抗A1、抗AB、抗H血清和吸收放散试验确定亚型6例(4.48%)、抗原减少2例(1.49%);洗涤自身红细胞吸收放散后定型、吸收后血清反定型确定不规则抗体8例(5.97%)。40例血型参比实验ABO血型血清学检测结果为:O型21例(52.50%)、A型8例(20%)、B型7例(17.5%)、AB型4例(10.00%)。结论 ABO血型正反定型不一致的原因很复杂。严格规范操作,减少不规则抗体对结果的影响,防止弱亚型的漏检等有效措施确保临床输血的安全。