目的 回顾性分析支气管肺泡细胞癌(bronchioloalveolar carcinoma,BAC)临床特点,提高早期BAC的确诊率,减少误诊。方法 对2013年—2014年间在我院确诊的BAC病例5例的临床资料进行回顾性分析。结果 5例患者中男4例,女1例,年龄在50～73岁之间,在社区医院均曾误诊为肺炎,所有患者均在我院经支气管镜肺活检后确诊为BAC。结论 BAC是一种较为特殊的肺癌,临床上症状无特异性,极易误诊为普通肺炎。由于BAC预后差,误诊后果严重,对初诊为普通肺炎的患者经常规抗感染治疗后临床症状及影像学表现改善不明显时,应及时进行各项检查、明确诊断,以便有效改善患者预后。

Objective To elevate the clinical diagnosis of BAC (bronchioloalveolar carcinoma) so as to reduce misdiagnosis by using retrospective analyses. Methods Retrospective analyses were used to study the five BAC patients, who were diagnosed in our hospital from 2013 to 2014. Results 4 of 5 male, and 1 female, age between 50 and 73, were diagnosed as pneumonia. All of them were made a definite diagnosis as BAC after performing transbronchial lung biopsy. Conclusion BAC is an exceptional lung adenocarcinoma and there is no specific clinic symptom. BAC was easily misdiagnosed as common lung pneumonia. There will be serious consequences after misdiagnosis of BAC due to its poor prognosis. Those patients who were misdiagnosed as common lung disease, but there was no obvious improvement after accepting long anti-infective therapy and there was negatively detection of pathogenic bacteria in them, are needed to perform all other clinical examination to clarify a diagnosis, and to further improve the prognosis of the patients.

目的 研究乳管镜在乳头溢液的诊断中的应用价值。方法 回顾性分析2010年2月－2014年3月采用乳管镜检查的123例乳头溢液患者的临床资料。结果 乳管镜检查发现乳腺导管癌8例,导管内乳头状瘤33例,乳头状瘤病32例,导管扩张及炎症35例。术后病理检查证实乳腺导管癌5例,导管内乳头状瘤35例,乳头状瘤病30例,导管扩张及炎症33例。结论 乳管镜可作为诊治乳头溢液的首选措施,其所起到的作用是超声、钼靶及乳管造影所不及的。

Objective To study the clinical application value of the fiberoptic ductoscopy(FDS) on the diagnosis of nipple discharge. Methods A retrospective analysis of 123 patients with nipple discharge undergoing FDS from February 2010 to March 2014. Results After fiberoptic ductoscopy examination,it was found there were 8 cases of breast cancer,33 cases of intra-duct papilloma,35 cases of papillomatosis,35 cases of dilatation and inflammation. However there were 5 cases of breast cancer,35 cases of intra-duct papilloma,30 cases of papillomatosis, and 33 cases of dilatation and inflammation were comfirmed through postoperative pathological examination. Conclusion Fiberoptic ductoscopy is more effective than B-ultrasonography and Mo-traget mammography, so it can be the preferred method of diagnosis and treatment for nipple discharge.

目的 探讨儿童登革热(DF)合并肝功能损害的临床特征。方法 对2014年8—12月我院感染科收治住院的78例儿童DF的临床资料进行回顾性分析。结果 并发肝功能损害36例(46.15%),其中血清丙氨酸转氨酶(ALT)升高24例(30.77%),血清天冬氨酸转氨酶(AST)升高33例(42.31%);27例(75%)ALT/AST病程2周内恢复正常,9例于1月复查恢复正常。仅有1例总胆红素(TBIL)升高80.8 μmol/L,直接胆红素升高为主,1周后恢复正常。肝功能损害组较无肝功能损害组在外周血白细胞水平、血小板水平差异有统计学意义(P<0.05)。结论 儿童DF并肝功能损害较普遍,以轻度损害为主。与年龄、性别、皮疹、外周血白细胞、血小板有相关性。

Objective To approach the clinical characteristics of children dengue fever combined liver function damage. Methods Clinical data of 78 cases of children dengue fever in our hospital were retrospectively analyzed from August to December in 2014. Results 36 cases (46.15%) complicated with liver function damage. Among them 24 cases (30.77%) of serum alanine aminotransferase (ALT) increased, 33 cases (42.31%) of serum aspartate aminotransferase (AST) increased; 27 cases (75%)ALT/AST returned to normal within 2 weeks, 9 cases were recovered to normal in 1 month. Only 1 cases of total bilirubin (TBIL) increased to 80.8 mol/L, recovered after 1 week. Liver injury group and non liver injury group of peripheral blood leukocytes, platelets level comparison was statistically significant (P<0.05). Conclusion Children dengue fever combined liver function damage was common, mainly mild. There was correlation with age, gender, skin rash, peripheral blood leukocytes and platelets.

目的 研究比较低流量异氟烷与七氟烷麻醉在小儿腹腔镜手术中的麻醉效果。方法 选取在我院进行腹腔镜手术治疗的小儿患者120例作为研究对象,随机分为异氟烷和七氟烷两组,每组各60例,分别采用低流量异氟烷和七氟烷进行麻醉,比较两组患儿的相关麻醉参数,以及入睡、苏醒、拔管时间和不良反应情况。结果 两组患儿的不同时期脉搏氧饱和度、心率、呼气末二氧化碳浓度比较无差异(P＞0.05);七氟烷组患儿的不同时期的平均动脉压具有较强的稳定性,而异氟烷组患儿在诱导期间、手术过程中平均动脉压降低,差异有统计学意义(P＜0.05)。结论 在小儿腹腔镜手术过程,采用低流量七氟烷进行麻醉,可以使手术过程中血流动力学更加稳定,缩短术后拔管时间,减少术后不良反应发生,更易满足小儿腹腔镜手术的麻醉要求。

Objective To investigate efficacy between low flow isoflurane and sevoflurane in pediatric laparoscopic surgery. Methods 120 cases of children underwent laparoscopic surgery in our hospital were randomly divided into two groups. 60 patients in isoflurane group were given low-flow isoflurane anesthesia; 60 patients in sevoflurane group were given low-flow isoflurane anesthesia. Heart rate (HR), mean arterial blood pressure (MAP), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) at different period, sleep and awakening time, extubation time, and adverse reactions of two groups were observed. Results Heart rate (HR), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) of two groups at different period had no significantly difference (P>0.05). Mean arterial blood pressure (MAP) of two groups at different period had significantly difference (P<0.05). The sleep time and recovery time of two groups had no significant difference (P>0.05). The extubation time of sevoflurane was significantly lower than isoflurane group (P<0.05). The adverse reaction rate of sevoflurane was significantly lower than isoflurane group (P<0.05). Conclusion Low flow isoflurane and sevoflurane can be used in pediatric laparoscopic surgery, and the efficacy of sevoflurane is better.

目的 回顾分析我院胆石症患者个体化治疗方案的效果。方法 2006年8月—2015年1月,我院治疗不同类型胆石症患者3176例,其中胆囊结石2987例,其他类型胆管结石患者189例,定期复查B超等影像检查并最长随访9年,从并发症和术后主观症状、残石率和结石复发率等情况,了解治疗效果。结果 全组患者均手术成功, 大部分自觉症状明显好转,胆囊结石患者平均手术时间(35.7±14.5)分钟, 平均住院时间(3.5±2.5)天;胆管结石平均手术时间(70.3±31.5)分钟,平均住院时间(9.5±4.7)天。胆囊结石残留率0.1%,保胆术式结石复发率8.1%;胆管结石残留率3.7%和复发率5.5%。结论 胆石症患者病情繁杂多样,尤其是肝内胆管结石,治疗需要个体化。

Objective To retrospective analyze the effect of individualization treatment of calculus of cholelithiasis patients. Methods 3176 patients with different kind of cholelithiasis were treated in our hospital during Aug 2006 to Jan, 2015, including 2987 gallstone patients and 189 calculus of bile duct patients. Periodic review of B ultrasound and follow-up was taken after the surgery for 9 years, recording and analyzing intraoperative and postoperative complications, symptoms, residual stones and stone recurrence rate and other, and to evaluate the therapeutic effect. Results Surgeries of all the patients were performed successfully. Postoperative follow-up indicated that symptoms were relieved. The operative duration of gallstone patients was (35.7 ± 14.5) min, and the average hospitalization time was (3.5±2.5) days. The operative duration of calculus of bile duct patients was (70.3± 31.5) min, and the average hospitalization time was (9.5±4.7) days. And the calculus residual rate and recurrence rate of gallstone patients was 0.1% and 8.1% individually. The calculus residual rate and recurrence rate of calculus of bile duct patients was 3.7% and 5.5%. Conclusion Conditions of calculus of cholelithiasis patients are complicated, especially calculus of intrahepatic duct patient. It is necessary to take individual treatment schedule for them.

目的 探讨OAB与CP/CPPS的症状及诊断的重叠情况,为临床诊疗提供参考。方法 151例中青年男性患者入选为研究对象,按OAB及CP/CPPS的定义及诊断标准将其分为OAB组、CP/CPPS组及OAB+CP/CPPS组,并对OAB+CP/CPPS组进行诊断性治疗对研究对象进行明确诊断;根据年龄分为:18~25岁组、26~35岁组和36~49岁组,比较各年龄组患者OAB及CP/CPPS的重叠情况;对各组患者的临床症状进行分析比较,了解其重叠情况。结果 在151例研究对象中,可诊断为OAB、CP/CPPS、OAB+CP/CPPS的分别有62例(41.06%)、32例(21.19%)、57例(37.75%),因此OAB与CP/CPPS的诊断重叠率为37.75%,明显大于CP/CPPS患者的诊断率;各年龄组间诊断重叠率无差异(P>0.05);症状的重叠方面,OAB+CP/CPPS组有尿急、尿频、夜尿症、急迫性尿失禁、尿不尽感、排尿困难、泌尿生殖系疼痛和或不适症状的分别为57例(100.00%)、50例(87.72%)、21例(36.84%)、2例(3.51%)、12例(21.05%)、2例(3.51%)、57例(100.00%),其中,尿急、尿频及泌尿生殖系疼痛或不适症状的重叠率最高;OAB+CP/CPPS组经诊断性治疗后诊断为OAB患者约61.40%,而CP/CPPS患者为38.60%。结论 OAB与CP/CPPS两者间有相当高的重叠率且远高于CP/CPPS的诊断率,在OAB与CP/CPPS两者诊断重叠的患者中为OAB的可能性更大。

Objective To explore symptoms and diagnosis of overlap between OAB and CP/CPPS, providing reference for clinical treatment. Methods 151 cases of young men were enrolled in the study. According to the definition and diagnostic criteria of OAB and CP/CPPS, we divided the study subjects into OAB group, CP/CPPS group and OAB+CP/CPPS group. And OAB+CP/CPPS group would get a two-week diagnostic treatment to study a clear diagnosis. We also divided the subjects into 18-25 age group, 26-35 year-old age group and 36-49 group according to the age, comparing the overlap of OAB and CP/CPPS in different age groups. The symptoms of the subjects in each group were analyzed to compare and study the overlap. Results Among these 151 cases, 62 cases (41.06%) can be diagnosed as OAB, 32 cases (21.19%) as CP/CPPS, 57 cases (37.75%) as OAB+CP/CPPS. Therefore, OAB and CP/CPPS diagnostic overlap was 37.75%, significantly higher than the diagnosis of CP/CPPS patients; no significant difference (P>0.05) among all age groups diagnostic overlap rate; overlapping terms of symptoms, OAB + CP/CPPS group urgency, urinary frequency, nocturia, urgency incontinence, urine not the flu, difficulty urinating, or genitourinary pain and discomfort were 57 cases (100.00%), 50 cases (87.72%), 21 cases (36.84%), 2 cases (3.51%), 12 cases (21.05%), 2 cases (3.51%), 57 patients (100.00%), which overlap ratio urgency, frequency, and genitourinary pain or discomfort was high; OAB+CP/CPPS group after diagnosis diagnostic treatment of OAB patients was about 61.40%, while CP/CPPS patients was 38.60%. Conclusion There is high overlap rate between OAB and CP/CPPS, which is much higher than the diagnostic rate of CP/CPPS. It is likely to have an OAB when a patient is diagnosed as OAB or CP/CPPS at the same time.

目的 探讨肝脏脂肪变性对肝脏切除手术安全性及预后的影响。方法 选取2012年1月—2014年12月在我院接受肝切除术治疗的肝癌患者172例,根据HE染色结果,172例患者中无脂肪变性106例(对照组),轻度脂肪变性42例(轻度组),中重度脂肪 24例(中重度组),比较各组患者基本资料(性别、年龄等)、手术情况、生化指标、术后并发症、住院时间等。结果 三组患者体重指数(BMI)差异有统计学意义(P＜0.05),中重度组BMI最高,为(26.94±3.14)kg/m²;中重度组患者手术时间、术中出血量、输注红细胞和肝门阻断时间分别为(182.39±42.17)min、(553.07±50.22)mL、(1.18±0.34)U和(20.15±6.07)min,均高于其他两组(P＜0.05);中重度组患者重度并发症发生率为45.83%,高于对照组和轻度组的9.43%和9.52%(P＜0.05);中重度组住院时间和ICU时间分别为(23.06±7.30)d和(3.71±1.03)d,高于其他两组(P＜0.05)。结论 轻度肝脏脂肪变性对手术基本无影响,而中重度脂肪变性会增加手术时间和出血、重度并发症发生较多,不利于手术的安全性以及预后。

Objective To explore the effect of liver steatosis on liver resection safety and the prognosis. Methods Selected from January 2012 to December 2014 in our hospital liver resection of 172 cases of liver cancer patients, according to the results of HE staining, 172 patients without fatty degeneration in 106 cases (control group), 42 cases of mild steatosis (mild steatosis group), 24 cases of severe fatty (moderate and severe steatosis group),observed each group patients the clinical characteristics, surgery situation, biochemical index, postoperative complications, hospitalization time, etc. Results Body mass index(BMI)of patients in the three groups difference was statistically significant (P<0.05), moderate and severe steatosis group had the highest BMI (26.94±3.14)kg/m²; in moderate and severe steatosis group, surgery time, intraoperative bleeding volume, infusion of red blood cells and hepatic portal occlusion time were (182.39±42.17) min, (553.07±50.22) ml, (1.18±0.34) U and (20.15±6.07) min. They were significantly higher than that of the control group and mild steatosis group (P<0.05); moderate and severe steatosis patients with severe complication rate was 45.83%,significantly higher than that in the control group and the mild steatosis 9.43% and 9.52%. The difference was statistically significant (P<0.05); In moderate and severe steatosis group, hospitalization time and ICU were (23.06±7.30) d and(3.71±1.03) d, significantly higher than that in the control group and the mild steatosis group(P<0.05). Conclusion Mild liver steatosis have no effect on the surgery, severe liver steatosis may increase the surgery time and bleeding, severe complications occurred more, is not conducive to the safety of the surgery and prognosis.

目的 探讨老年人血尿酸(serum uric acid,SUA)水平与阿尔茨海默病(Alzheimer's disease,AD)的相关性。方法 选择227例我院老年病科住院患者为研究对象,其中阿尔茨海默病67例,其余160例为非AD组。收集病史、吸烟史、服药史,并检测血尿酸、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBS)、血肌酐(Cr)水平。比较各SUA四分位数水平AD的发生率,并进行相关性分析。结果 AD组血尿酸水平低于非AD组,差异有统计学意义(P＜0.01);多因素分析筛选出年龄、性别、缺血性脑卒中是危险因素(P＜0.05),而服用他汀、SUA、HDL-C是保护因素(P＜0.05)。对AD和SUA的四个分组做Spearman等级相关分析(rs=-0.285,P<0.001),结果呈等级负相关。结论 血尿酸水平与老年人AD相关,血尿酸可能是AD发病的保护性因素。

Objective To explore the correlation between serum uric acid(SUA) level and Alzheimer's disease(AD) in elderly patients. Methods 67 cases of the elders with Alzheimer's disease and 160 elders matching with age and gender were enrolled from Jan 2013 to Dec 2014 in the study,the blood levels of biochemical factors such as SUA,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood sugar(FBS) and creatinine(Cr) were measured by automatic biochemistry analyzer in the two groups. The related factors such as history of disease,smoking and medication history were collected. The correlation between the level of SUA and AD was analyzed. Results The serum uric acid levels in AD group were significantly lower than those in control group(P＜0.01). Multivariate logistic regression analysis showed that age, gender, ischemic stroke were risk factors, and taking statin, SUA, and HDL-C were protective factors(P＜0.05). Spearman correlation tests indicated that there was an inverse correlation between SUA levels and AD(rs=-0.285,P<0.001). Conclusion Serum uric acid level is significantly related to AD in the elderly.SUA may be a protective factor of the occurrence of AD.

目的 了解青海省北京/W系结核分枝杆菌分布特征。方法 收集青海地区结核分支杆菌临床分离株,采用RD105缺失基因检测鉴定北京/W系结核分枝杆菌。结果 共收集237株结核分枝杆菌临床分离株,采用RD105缺失基因检测鉴定北京/W系结核分枝杆菌220株,占92.8%,非北京/W结核分枝杆菌,共17株,占7.2%。北京/W系结核分枝杆菌在青海地区性别与民族分布差异没有统计学意义(P＞0.05)。结论 北京/W结核分枝杆菌为青海地区流行菌株,在人群易于发生感染和传播。

Objective To ascertain the epidemiological characteristics of Beijing/W lineage Mycobacterium tuberculosis in Qinghai Province. Methods M. tuberculosis clinical isolates were collected and identified with an RD105 deletion test.Statistical analysis was performed by using the test. Results Totally, 237 clinical isolates of M. tuberculosis were collected in which 220 strains (92.8%) belonged to the Beijing/W lineage of M. tuberculosis while 17strains (7.2%) belonged to the non-Beijing/W lineage of M. tuberculosis according to the RD105 deletion test. There were no significant differences in the distribution of Beijing/W lineage of M. tuberculosis in the gender and nationality (P＞0.05). Conclusion Beijing/W lineage of M. tuberculosis were prevalent in Qinghai province and prone to having infection and transmission in the crowd.

目的 确定CD4⁺CD25⁺Treg调节性T细胞在重症肺炎克雷伯菌肺炎中的表达以及意义,探讨CD4⁺CD25⁺Treg在重症肺炎克雷伯菌肺炎的免疫抑制中的调控作用。方法 通过气管内滴注肺炎克雷伯菌菌液建立重症肺炎模型。采用流式细胞仪检测CD4⁺CD25⁺Treg细胞及酶联免疫吸附法(ELISA)等方法检测各种细胞因子。结果 重症肺炎克雷伯菌肺炎大鼠的脾脏和肺中CD4⁺CD25⁺Treg的数量增加。使用了CD25抗体(PC61)去除机体内源性的CD4⁺CD25⁺Treg,分别去除脾脏和肺的94%和90%的CD4⁺CD25⁺Treg。CD25抗体组在建模4 h,12 h及24 h后,肺部MPO及血清IL-1,IL-6,MIP-2较对照组高(P<0.05),肺和BLA比对照组高(P<0.05),CD25抗体组大鼠生存率比对照组低(P<0.05)。结论 内源的CD4⁺CD25⁺Treg对大鼠抑制重症肺炎克雷伯菌肺炎的过度免疫损害反应起到保护作用。

Objective To confirm the expression and meaning of the T regular cell in the severe Klebsiella pneumonia, and to evaluate the regular and control affect in the immunologic suppression of the severe Klebsiella pneumonia. Methods To build the severe pneumonia model by intratracheally inoculated with Klebsiella pneumoniae bacteria. To check sorts of inflammation factors by the methods of ELISA and flow cytometry. Results The quantity of the CD4⁺CD25⁺Treg in the splenic and lungs of the mice with severe Klebsiella pneumonia were increased. Anti-CD25Ab(PC61) was used to remove endogenousCD4⁺CD25⁺Treg. Anti-CD25 treatment remove 90% of CD4⁺CD25⁺Treg cells. The cytokine production(IL-1β,IL-6,MIP-2)in the anti-CD25-treated group were significantly increased. And it also increased significantly in the airway neutrophil infiltration, while the survival rate had been decreased. Conclusion Endogenous CD4⁺CD25⁺Treg can provide obvious protection effect to the restraining the over immunity damage of the severe Klebsiella pneumonia for the mice.