目的 探究支气管镜下肺泡灌洗并局部使用阿米卡星治疗老年支气管扩张合并感染患者的疗效及对血清炎性因子水平的影响。方法 选取我院2018年3月—2019年5月确诊支气管扩张症、合并感染的符合纳入标准的患者共64例,按照1:1比例抽签分为2组,32例纳入观察组,应用支气管镜下肺泡灌洗阿米卡星治疗;32例纳入对照组,以单纯的支气管镜下肺泡灌洗治疗。观察并比较2组患者的治疗效果、血清炎性因子水平、肺功能情况等。结果 疗效比较显示观察组的96.9%总有效率高于对照组的75.0%(P＜0.05);血清炎性因子水平在患者用药前检测无差异(P＞0.05),经过治疗后,观察组水平均优于对照组P＜0.05;经治疗后,观察组静态肺活量、补呼气量、补吸气量、用力肺活量均优于对照组,差异具有统计学意义(P＜0.05)。结论 对老年支气管扩张合并感染患者应用支气管镜下肺泡灌洗阿米卡星治疗,促进临床效果改善,患者的症状、炎症及肺功能等指标均得到明显改善,值得推广。

Objective To investigate the efficacy of bronchoscopic alveolar lavage and local application of amikacin in the treatment of elderly patients with bronchiectasis complicated with infection and its effect on the level of serum inflammatory factors.Methods A total of 64 patients with bronchiectasis complicated with infection diagnosed in our hospital from March 2018 to May 2019 were selected.They were divided into two groups evenly by proportional drawing. Thirty-two cases were included in the observation group that were treated with bronchoscopic alveolar lavage with amikacin.The other 32 cases were included in the control group that were treated with the bronchoscopic alveolar lavage only.The therapeutic effect,serum inflammatory factor level and pulmonary function of the two groups were observed and compared.Results The total effective rate of 96.9% in observation group was higher than 75.0% in control group (P<0.05).There was no difference in the levels of serum inflammatory factors before treatment (P>0.05).After treatment,the levels of the observation group were better than those of the control group (P<0.05).After treatment,the slow vital capacity,expiratory reserve volume,inspiratory reserve volume and forced vital capacity of the patients in the observation group were better than those in the control group (P<0.05).Conclusions Bronchoscopic alveolar lavage of amikacin in elderly patients with bronchiectasis complicated with infection could improve the clinical effect.The symptoms of the patients,the serum inflammatory factors and lung function of the patients were significantly improved.The treatment is worthy of promotion.

目的 分析术前血清鳞状细胞癌相关抗原(SCCA)对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值。方法 选取2018年1月—2021年1月于我院肿瘤科治疗的128例宫颈鳞癌患者作为研究对象,根据其是否发生盆腔淋巴结转移将其分为转移组(42例)和非转移组(86例)。对比2组宫颈鳞癌患者一般资料,采用多因素Logistic分析宫颈鳞癌患者发生盆腔淋巴结转移的高危因素,采用ROC曲线评估术前血清SCCA对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值,通过约登指数确定最佳截断值。结果 2组患者一般资料对比,宫颈鳞癌细胞分化程度、宫颈鳞癌临床分期、宫颈鳞癌肿瘤直径大小、是否出现宫旁转移现象、是否出现脉管浸润现象、浸润深度、SCCA水平的差异有统计学意义,P<0.05;多因素Logistic分析显示宫颈鳞癌细胞分化程度、脉管浸润阳性、浸润深度、SCCA水平是宫颈鳞癌患者发生盆腔淋巴结转移的危险因素;ROC曲线分析结果显示,SCCA水平曲线下面积为0.909,最佳截断值为0.597 5 μg/L。结论 术前血清SCCA水平对宫颈鳞癌患者发生盆腔淋巴结转移具有预测价值。

Objective To analyze the predictive value of preoperative serum squamous cell carcinoma antigen (SCCA) on pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.Methods A total of 128 patients with cervical squamous cell carcinoma treated in the oncology department of our hospital from January 2018 to January 2021 were selected as the research objects,and divided into metastatic group (42 cases) and non-metastatic group (86 cases) according to whether pelvic lymph node metastasis occurred.The general data of the two groups of patients with cervical squamous cell carcinoma were compared.Multivariate logistic analysis was used to analyze the risk factors for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.ROC curve was used to evaluate the predictive value of preoperative serum SCCA for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma,and the optimal cut-off value was determined by Yoden index.Results When comparing the general data of the two groups of patients,the differences in the degree of cervical squamous carcinoma cell differentiation,clinical stage of cervical squamous carcinoma,tumor diameter of cervical squamous carcinoma,whether the phenomenon of parametastasis was present,whether the phenomenon of choroidal infiltration was present,depth of infiltration,and SCCA level were statistically significant,P<0.05; multi-factor logistic analysis showed that the degree of cervical squamous carcinoma cell differentiation,positive vascular invasion,depth of invasion and SCCA level were risk factors for pelvic lymph node metastasis in cervical squamous cell carcinoma patients.The results of ROC curve analysis showed that the area under the curve of SCCA level was 0.909 and the optimal cut-off value was 0.597 5 μg/L.Conclusions Preoperative serum SCCA level had good predictive value for the occurrence of pelvic lymph node metastasis in patients with cervical squamous carcinoma.

目的 了解广东肇庆怀集县农村妇女两年来“两癌”检测的阳性情况及高危型人乳头瘤病毒(HPV)的感染特点。 方法 对2018年1月—2019年12月24 146名参与“两癌”免费检测的35~64 岁、农村妇女的宫颈癌筛查结果进行分析。以高危型HPV检测作为初筛方法,结果为HPV16、18型阳性的转诊阴道镜检查,其它高危型HPV阳性则进行薄层宫颈液基细胞学检查(TCT),TCT结果严重于或等于未明确意义的非典型鳞状上皮(ASC-US)者转诊阴道镜,阴道镜结果可疑或异常者进行组织病理学检查。 结果 高危型HPV总检出率为9.35%,单独HPV16、18和其它高危型HPV的阳性检出率分别为0.70%、0.32%、7.72%,混合感染检出率为0.61%,高危型 HPV 总检出率最高的年龄段是 60~64岁,检出率为11.22%。细胞学转诊率为65.63%,阴道镜转诊率为61.23%。宫颈癌前病变检出率为323.03/10 万,宫颈癌的检出率为45.56/10 万,早期诊断率为87.64%。宫颈癌前病变和宫颈癌的HPV16、18及混合感染占70.79%。 结论 该地区高危型HPV阳性率、宫颈癌前病变及宫颈癌检出率均较高,宫颈癌筛查异常者细胞学及阴道镜转诊率较低,提示该地区存在更高的宫颈癌发病风险。

Objective To understand the positive screening results and the infection characteristics of high-risk human papillomavirus (HPV) in Huaiji County,Guangdong Province,in the two years of the free standardization testing for rural women's “two cancers”. Methods The cervical cancer screening results of 35~64 year-old women with rural household registration who volunteered to participate in the “two cancers” free testing for rural women in the region were analyzed. High-risk HPV testing was used as the primary screening method for cervical cancer. The results of HPV16 and 18 positive patients were directly referred to colposcopy. If other high-risk HPV was positive,thin-layer cervical fluid-based cytology(TCT) was perform on those patients,whose TCT result severer than atypical squamous cells of undetermined significance (ASC-US) were referred to colposcopy,and those with suspicious or abnormal colposcopy results were referred to histopathological examination. Results The total positive detection rate of high-risk HPV was 9.35%. The positive rates of HPV16,18 and other high-risk HPV were 0.70%,0.32% and 7.72% respectively,mixed infection rate was 0.61%. The age group with the highest overall positive rate of high-risk HPV is 60-64 years old,and the rate is 11.22%. The referral rate for cytology was 65.63%,and the referral rate for colposcopy was 61.23%. The positive rate of cervical precancerous lesions was 323.03/100 000,the positive rate of cervical cancer was 45.5/100 000,and the early diagnosis rate was 87.64%.HPV16,18 and HPV mixed infections of cervical precancerous lesions and cervical cancer accounted for 70.79%.Conclusions The positive rate of high-risk HPV,cervical precancerous lesions and cervical cancer positive rate were high in this area. The being referred rate of cytology and colposcopy in cervical cancer screening was low,suggesting that there was a higher incidence of cervical cancer in this area risk.

目的 通过测定川崎病(KD)患儿血清1,25(OH)₂D₃水平,探讨其与冠脉损伤(CAL)之间的关系。方法 选取在我院儿科住院的KD患儿200例,依据是否发生CAL分成CAL组(172例)和非冠脉损伤组(NCAL,28 例),并分别检测静脉内丙种球蛋白(IVIG)注射前后血清1,25(OH)₂D₃水平。选取35例健康儿童作为对照组,检测其血清1,25(OH)₂D₃水平,并进行比较。结果 IVIG输注前:CAL组和NCAL组血清1,25(OH)₂D₃水平较对照组低下(P＜0.05),CAL组最低(P＜0.05);IVIG输注后:NCAL组血清1,25(OH)₂D₃水平与对照组相比,差异无统计学意义(P＞0.05),CAL组血清1,25(OH)₂D₃水平较NCAL组和对照组低(P＜0.05);IVIG输注前后比较:CAL组和NCAL组血清1,25(OH)₂D₃水平在IVIG输注后均较输注前升高(P<0.001)。结论 KD患儿血清1,25(OH)₂D₃水平低下,而且血清1.25(OH)₂D₃水平越低,出现CAL的几率越大。

Objective The serum level of 1,25(OH)₂D₃ was detected to investigate the its relationship with coronary artery lesion (CAL) in children with Kawasaki disease (KD).Methods A total of 200 children with KD in our hospital were divided into CAL group (172 cases) and no CAL group (NCAL,28 cases) according to the CAL situation.Serum 1,25(OH)₂D₃ level before and after intravenous immunoglobulin (IVIG) injection was detected respectively.While 35 healthy children were enrolled as control group, comparing with KD children.Results Before IVIG injection,the levels of 1,25(OH)₂D₃ in the CAL and NCAL groups were lower than that in the control group (P＜0.05),and which in the CAL group was the lowest (P＜0.05).After IVIG injection,the level of 1,25(OH)₂D₃ showed no significant difference between the NCAL group and the control group (P＞0.05),and the level of 1,25(OH)₂D₃ in CAL group was lower than that in the NCAL group and control group (P＜0.05).Serum 1,25(OH)₂D₃ level in both CAL and NCAL groups increased after IVIG injection compared with that before injection (P<0.001).Conclusions The serum 1,25(OH)₂D₃ level was low in children with KD,and the lower serum 1,25(OH)₂D₃ level,the higher the incidence of CAL.

目的 比较2012版和2007版美国睡眠医学会判读标准(AASM₂₀₁₂和AASM₂₀₀₇)对慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)的诊断及其睡眠和临床特点的影响。方法 分别采用AASM₂₀₀₇与AASM₂₀₁₂分析41名稳定期COPD患者的睡眠呼吸事件,比较两种判读标准对COPD患者的呼吸暂停低通气指数(AHI),合并OSA的比例的影响;再对符合AASM₂₀₁₂但不符合AASM₂₀₀₇诊断的重叠综合征患者(OS_2012-2007)与仅符合AASM₂₀₀₇诊断的COPD患者(COPD_AASM2007)的睡眠参数和临床指标进行比较。结果 对比AASM₂₀₀₇,AASM₂₀₁₂显著增加COPD的睡眠呼吸暂停低通气指数(AHI)[1.0 (1.0, 7.5) h^-1 vs 11.5 (4.1, 25.1) h^-1, P<0.001],及合并OSA的比例(36.6% vs 70.7%, P<0.05)。OS_2012-2007与COPD_AASM20072组之间的微觉醒指数与3期睡眠比例有统计学差异,但其他睡眠参数、血压及高血压患病人数均无明显差异。结论 AASM₂₀₁₂显著增加COPD患者AHI,及合并OSA的比例,但初步的结果提示 AASM₂₀₁₂下新增的OS_2012-2007患者的病理损害相对少且轻。

Objective To compare the effects of the 2012 and 2007 American Academy of Sleep Medicine (AASM₂₀₁₂ and AASM₂₀₀₇) scoring criteria on the diagnosis, sleep and clinical characteristics of chronic obstructive pulmonary disease (COPD) with obstructive sleep apnea (OSA). Methods AASM₂₀₀₇ and AASM₂₀₁₂ were used to analyze the sleep respiratory events of 41 patients with stable COPD. Differences in apnea-hypopnea index (AHI) and diagnosis of OSA in COPD patients between AASM₂₀₀₇ and AASM₂₀₁₂ criteria were compared. Differences in sleep parameters and clinical indexes were compared between patients with overlap syndrome who met the AASM₂₀₁₂ not AASM₂₀₀₇ criteria (OS_2012-2007) and COPD patients who only met the AASM₂₀₀₇ criteria (COPD_AASM2007). Results Using the AASM₂₀₁₂ criteria, the number of AHI [1.0 (1.0, 7.5) h^-1 vs 11.5 (4.1, 25.1) h^-1, P<0.001] and the proportion complicated with OSA (36.6% vs 70.7%, P<0.05) significantly increased compared to the AASM₂₀₀₇ criteria. There was a significant difference between OS_2012-2007 and COPD_AASM2007 in arousal index and third stage of sleep, but no significant difference in other sleep parameters, blood pressure and the number of patients with hypertension. Conclusions Using AASM₂₀₁₂ significantly increased AHI and the proportion complicated with OSA in COPD patients, but the preliminary results demonstrated that pathological damages of OS_2012-2007 were relatively mild.

大便失禁是肛肠外科常见疾病,可导致患者生活质量下降,并引起一系列社会心理问题,其发病率随着年龄增加明显上升。肛门括约肌复合体损伤是大便失禁的最常见原因。目前的治疗方式包括保守治疗和手术治疗,但治疗效果仍不理想,尤其是长期治疗效果较差。最近,许多临床前和临床研究对大便失禁的干细胞疗法进行了探索,作为一种新的治疗方式,干细胞疗法有望彻底治愈大便失禁。本文就干细胞疗法治疗大便失禁的动物模型、损伤和修复机制、疗效等方面进行综述。

Fecal incontinence is a common anorectal surgical condition that can lead to decreased quality of life and a range of psychosocial problems in patients, and its incidence increases significantly with age. Damage to the anal sphincter complex is the most common cause of fecal incontinence. Current treatment modalities include conservative and surgical treatment, but treatment outcomes remain suboptimal, especially in the long term. Recently, many preclinical and clinical studies have explored stem cell therapy for fecal incontinence as a new treatment modality that holds promise for a complete cure of fecal incontinence. This paper presents a review of animal models, mechanisms of injury and repair, and efficacy of stem cell therapy for fecal incontinence.

目的 运用品管圈管理方法,提高临床全肠外营养合理应用率,规范TPN的合理应用,保证临床营养支持的安全性与合理性。方法 按照品管圈问题解决型的方法,对影响临床全肠外营养合理应用率的原因进行分析、寻找对策、实践检验,提高临床全肠外营养合理应用率。结果 通过品管圈活动,找出造成TPN不合理应用的关键环节,制定相关制度并优化流程。结论 运用品管圈模式提高临床全肠外营养合理应用率(由65.22%上升为85.32%),改善全肠外营养液成品质量,为患者提供了安全有效经济合理的营养支持治疗。

目的 观察清化血浊中药对大动脉粥样硬化型(LAA)缺血性脑卒中患者的临床疗效。方法 将105例发病24 h内符合标准的大动脉粥样硬化型缺血性脑卒中患者,随机分为观察组52例和对照组53例,对照组予以西医综合治疗,观察组在西医综合治疗的基础上加用清化血浊中药(化浊和血颗粒),疗程为14 d。两组患者分别于治疗前及治疗后7 d、14 d评定NIHSS评分;治疗前及发病1个月后分别测定mRS评分,以判定临床转归;治疗前及治疗后14 d分别采集空腹血测定低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋浓度。结果 清化血浊中药可降低大动脉粥样硬化型缺血性脑卒中患者治疗后7 d及14 d的NIHSS评分(P<0.05)、增加好转率且不增加患者复发、死亡及出血性转化,并能降低患者血低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋白。结论 清化血浊中药可减低大动脉粥样硬化型缺血性脑卒中患者的神经功能缺损,促进神经功能恢复,提高临床良好转归, 且不增加出血性转化。

目的 分析传染性单核细胞增多症患者临床症状和异型淋巴细胞百分比(ALY%)、肝功能等实验室检查特点,为临床提高对该病的诊断、病情评估和治疗提供参考。方法 2017年1月— 2019 年6月在深圳市中医院儿科住院治疗的73例传染性单核细胞增多症患儿,采取回顾分析法,归纳总结患者的临床症状,根据患者的异型淋巴细胞数量进行分组,A组异型淋巴细胞数量占比为4.5%～10.0%(8例);B组异型淋巴细胞数量占比为10.01%~15.0%(15例); C组异型淋巴细胞数量占比为15.01%～20%(20例); D组异型淋巴细胞数量占比为20.01%～25.0%(13例); E组异型淋巴细胞数量占比超过25.01%～30%(17例)。总结本病的临床特点,分析异型淋巴细胞百分比和肝功能损伤的相关性。结果 1.传染性单核细胞增多症的主要临床表现为发热、咽痛、伪膜和颈部淋巴结肿大。2.随着异型淋巴细胞百分比的增加,AST异常患儿越多,当异型淋巴细胞数量占比超过25.01%,AST明显升高,提示肝功能损伤越严重。结论 传染性单核细胞增多症患者的异型淋巴细胞数量与肝功能损伤存在一定的联系,可以作为患者病症诊断的重要参考,随着异性淋巴细胞百分比增加,患儿肝功能异常出现比率越高,可以指导临床判断预后和治疗。

目的 研究结核感染T细胞斑点试验(T-SPOT.TB)技术联合胸水腺苷脱氨酶(ADA)在结核性胸膜炎中的诊断价值。方法 在研究中选取2016年1月—2018年12月在梅州市人民医院呼吸内科和全科医学科住院的60例结核性胸膜炎患者作为研究对象,对所有患者均进行血T-SPOT.TB、胸水ADA检查,比较血T-SPOT.TB、胸水ADA及胸水ADA联合血T-SPOT.TB检查三种检测方式的诊断符合率、误诊率、漏诊率、阳性预测值、阴性预测值、准确性、特异度、敏感度。结果 胸水ADA、血T-SPOT.TB以及血T-SPOT.TB联合胸水ADA检测方式的诊断符合率分别为75%、80.00%、93.33%,联合检测方式的诊断符合率高于单一检测方式的诊断符合率(P＜0.05)。血T-SPOT.TB联合胸水ADA检测方式的误诊率、漏诊率分别为0.00%、1.72%,低于胸水ADA、T-SPOT.TB检测方式(P＜0.05);血T-SPOT.TB联合胸水ADA检测方式的阳性预测值、阴性预测值分别为100.00%,67.78%,联合检测方式的阴性预测值高于其单一检测方式(P＜0.05)。T-SPOT.TB联合胸水ADA检测方式的特异度及敏感度分别为98.79%、97.87%,联合检测方式的敏感度高于其单一检测方式(P＜0.05)。血T-SPOT.TB检测方式与胸水ADA检测方式仅在特异度方面不存在统计学差异(P＞0.05)。结论 在对结核性胸膜炎患者进行诊断时,血T-SPOT.TB联合胸水ADA具有较高的诊断价值,值得应用。

Objective To investigate the diagnostic value of t-spot test (T-SPOT.TB) combined with adenosine deaminase (ADA) in tuberculous pleuritis. Methods 60 patients with tuberculous pleurisy hospitalized in the departments of respiratory medicine and general practice of Meizhou People's Hospital between January 2016 and December 2018 were enrolled in the study. All the patients were examined by blood T-SPOT.TB and ADA. The diagnostic coincidence rate, false positive rate,false negative rate, positive predictive value, negative predictive value, accuracy, specificity and sensitivity of the three detection methods of T-SPOT.TB, ADA, and T-SPOT.TB combined with ADA were also analyzed. Results The diagnostic coincidence rate of ADA, T-SPOT.TB and T-SPOT.TB combined with ADA was 75%, 80.00% and 93.33%, respectively. The diagnostic coincidence rate of the combined test was higher than that of the detection method (P<0.05). The misdiagnosis rate and missed diagnosis rate of blood T-SPOT.TB combined with ADA were 33.3% and 1.75%, respectively. The positive predictive value and negative predictive value of blood T-SPOT.TB combined with ADA test were 98.2% and 66.6%, respectively. The negative predictive value of combined T-SPOT.TB combined with ADA test was higher than that of the single test (P<0.05). The specificity and sensitivity of the T-SPOT.TB combined with ADA were 98.79% and 97.87%, respectively, and the sensitivity of the combined test was higher than that of the single test (P<0.05). Conclusion Blood T-SPOT.TB combined with pleural effusion ADA has higher diagnostic value in patients with tuberculous pleurisy and is worthy of clinical application.