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.

目的 探讨超声引导下宫颈癌根治术的应用效果及对患者远期生存率的影响。方法 选取本院2015年1月—2017年12月共收治的70例宫颈癌患者作为研究对象,将2016年7月—2017年12月纳入的患者作为观察组,2015年1月—2016年6月纳入的患者作为对照组,各35例,给予对照组患者常规腹腔镜根治术,给予观察组患者超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗。对比两组患者的治疗效果、远期生存率与复发率以及术后6个月、1年、2年、3年的FACT-G评分情况。结果 两组疾病控制率对比无差异(97.14% vs 85.71%,P＞0.05);观察组的治疗总有效率为高于对照组的(85.71% vs 60.00%,P＜0.05);观察组和对照组患者1年生存率对比无差异(P＞0.05),观察组2年、3年生存率高于对照组(P＜0.05),观察组和对照组1年局部复发率对比无差异(P＞0.05),观察组的2年、3年局部复发率低于对照组(P＜0.05);观察组术后6个月、1年、2年、3年的FACT-G评分高于对照组(P＜0.05)。结论 应用超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗宫颈癌能够提升患者的治疗效果,减少疾病复发和提高远期生存率,提升患者的生存质量,值得临床应用推广。

Objective To investigate the application effect of ultrasound-guided radical hysterectomy for cervical cancer and its influence on the long-term survival rate of patients. Methods A total of 70 patients with cervical cancer admitted from January 2015 to December 2017 were selected as the research subjects, and the patients enrolled from July 2016 to December 2017 were selected as the observation group, patients from January 2015 to June 2016 as the control group, each with 35 cases. The control group was given conventional laparoscopic radical hysterectomy, and the observation group was given ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation technology. The treatment effect, long-term survival rate, recurrence rate and FACT-G scores 6 months, 1 year, 2 years and 3 years after operation were compared between the two groups. Results There were no significant differences in disease control rates between the two groups (97.14% vs 85.71%, P>0.05); the total effective rate of treatment in the observation group was higher than that in the control group (85.71% vs 60.00%, P<0.05). There was no significant difference in the 1-year survival rate between the observation and the control group (P>0.05). The 2-year and 3-year survival rate of the observation group were higher than that of the control group (P<0.05). There was no significant difference in comparison of 1-year local recurrence rate between the observation group and the control group (P>0.05). The 2-year and 3-year local recurrence rate of the observation group were lower than that of the control group (P<0.05). FACT-G scores in the observation group after surgery at 6 months, 1 year, 2 years, and 3 years were significantly higher than the control group (P<0.05). Conclusion The application of ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation in the treatment of cervical cancer can improve the treatment effect, reduce disease recurrence rate, increase long-term survival rate, and improve the quality of life of patients, which is worthy of clinical application and promotion.

目的 探讨维持性血液透析患者症状负担的现状,并分析影响因素。方法 采用一般状况调查表、血液透析患者症状评估量表、慢性病自我效能量表对96名维持性血液透析患者进行调查。结果 维持性血液透析患者症状负担总得分为63.76±46.70,平均每位患者经历14.10±7.91个症状;其中自我效能、原发病、是否进行日常运动、碱性磷酸酶、血清钠是独立影响因素(P＜0.05)。结论 根据影响因素采取针对性的干预措施,有望缓解患者的症状负担。

Objective To explore the symptom burden and evaluate the risk factors in maintenance hemodialysis patients.Methods A total of 96 patients were retrospectively investigated by Karnofsky Performance Status, dialysis symptom index and chronic disease self-efficacy scale.Results The total score of symptom burden in patients was 63.76±46.70. The average experienced symptoms were 14.10±7.91 per patient. The result by multiple regression analysis indicated that self-efficacy, the primary disease, daily exercises, the level of alkaline phosphatase and sodium in serum were independent risk factors for symptom burden in patients.Conclusion Tailored treatments based on risk factors for hemodialysis patients may relieve their symptom burden.

目的 通过对不同受孕能力精子外显子的分析,寻找并验证特异性外显子作为精子受孕能力的生物标记物。 方法 基于二代测序数据进行生物信息学分析,寻找特异性外显子并设计引物。各取8份高、低受孕能力精液标本,提取精子RNA反转录后进行real time q-PCR验证外显子的表达效率,筛选表达差异恒定的精子外显子作为生物标记物。各取10份高、低受孕能力精子标本,用筛选后的外显子引物进行real time q-PCR验证。 结果 生物信息学分析得到31个候选精子外显子,从31个候选外显子中筛选出9个表达差异恒定的精子外显子GAPDHS、HSF2BP、HSPA1L、ADAM21、SPEM1、WBP2NL、DDX20、TSGA10、PGK2;real time q-PCR验证结果显示,在高、低受孕能力精液标本中这9种精子外显子表达差异明显。 结论 初步确定,差异表达恒定的九种外显子可作为评估精子质量的生物标记物。

Objective To find and verify specific exons as biomarkers of sperm fertility by analyzing sperm exons with different fertility ability.Methods Based on the second generation sequencing data, bioinformatics analysis was conducted to find specific exons and design primers. We obtained 16 semen samples, 8 of high and the other 8 of low fertilizing ability, after the sperm RNAs were extracted and reverse-transcribed, real time q-PCR was performed to verify the expression efficiency of exons, and the sperm exons with constant expression difference were selected as biomarkers. 10 high and 10 lowfertility ability sperm samples were taken for real time q-PCR verification with screened exon primers. Results Thirty-one sperm exons were obtained by bioinformatics analysis, and 9 sperm exons with constant expression differences were selected from the 31 candidate exons, including GAPDHS, HSF2BP, HSPA1L, ADAM21, SPEM1, WBP2NL, DDX20, TSGA10 and PGK2. The results of real time q-PCR verification showed that the exons of these 9 sperm were significantly different in the semen samples with high and low fertility ability. Conclusion Nine exons with constant differential expression can be used as biomarkers to evaluate sperm quality.

目的 探讨35周岁以下患者行D5单囊胚移植的可行性。方法 回顾性分析2016年1月—2019年7月期间,女方年龄≤35岁,在本中心行新鲜周期全胚冻后第一冻融移植的663个周期,根据胚胎发育天数及囊胚移植数目分为三组:D3双优胚移植组(D3双优组:n=508)、D5单囊胚移植组(D5单囊组:n=47)、D5双囊胚移植组(D5双囊组:n=108),对三组的临床结局进行比较分析。结果 D5双囊组临床妊娠率高于D3双优组及D5单囊组,且差异有统计学意义(P＜0.05),但D5单囊组与D3双优组相比,无统计学差异(P＞0.05);D5单囊胚的多胎率低于D5双囊组及D3双优组,差异均有统计学意义(P＜0.001),D3双优组的多胎率也低于D5双囊组,差异亦有统计学意义(P＜0.05);D5单囊组和D5双囊组的种植率都高于D3双优组,差异都有统计学意义(分别是P＜0.05,P＜0.001),而D5单囊组合D5双囊组之间无统计学差异(P＞0.05);但三组之间的早期流产率及宫外孕率均无统计学差异(P＞0.05)。结论 年龄≤35周岁的患者全胚冷冻后第一冻融移植周期选择D5单囊胚进行移植,既能获得良好的临床妊娠率和种植率,又极大降低多胎妊娠率。

Objective To investigate the clinical outcomes of the single blastocyst transfer of day 5 in the women under 35 years old. Methods A retrospective study was conducted to analyze clinical outcomes of women less than 35 years old and experienced embryo transfer in the first frozen-thawed cycles from January 2016 to July 2019 in the Center of Reproductive Medicine of Guangzhou Women and Children's Medical Center. According to the embryo developmental days and transfer blastocyst numbers, all patients were divided into three groups: double high-quality cleavage embryo transfer of day 3 (n=508), single blastocyst transfer of day 5(n=47), double blastocyst transfer of day 5(n=108). The clinical outcomes were compared. Results The clinical pregnancy rate of the double blastocyst transfer of day 5 was higher than the other two groups,and the differences were statistically significant(P＜0.05). However, there was no statistical difference between the single blastocyst transfer of day 5 and the double high-quality cleavage embryo transfer of day 3(P＞0.05). The multiple pregnancy rate of the single blastocyst transfer of day 5 was lower than the other two groups, and the differences were statistically significant (P＜0.001),and that of the double high-quality cleavage embryo transfer of day 3 was even lower than that of the double blastocyst transfer of day 5,and the difference was statistically significant(P＜0.05). The implanting rate of the double high-quality cleavage embryo transfer of day 3 was lower than the other two groups, and the differences were statistically significant (P＜0.05;P＜0.001),but there was no statistical difference between the single blastocyst transfer of day 5 and the double blastocyst transfer of day 5 (P＞0.05). However, the early miscarriage rate and the ectopic pregnancy rate did not exhibit statistical differences (P＞0.05). Conclusion Single blastocyst transfer of day 5 can ensure clinical pregnancy rate and implantation rate while effectively reducing multiple pregnancy in the women undergoing the first frozen-thawed cycles of under 35 years old.

目的 分析基底节区脑出血患者接受神经内镜手术治疗的疗效。方法 将2019年6月—2020年8月接诊且行开颅血肿清除术的33例基底节区脑出血患者作为对照组,将同期接诊且行神经内镜手术的33例基底节区脑出血患者作为观察组,对组间美国国立卫生研究院卒中量表(NIHSS)、独立功能量表(FIM)、日常生活能力(ADL)评分、手术情况、血清水通道蛋白4(AQP4)水平、脑水肿体积、并发症情况展开分析。结果 (1)组间NIHSS、FIM、ADL评分在术前无明显差异,P>0.05;术后,观察组NIHSS评分更低,且FIM、ADL评分更高,P<0.05;(2)观察组骨窗大小(2.53±0.66)cm、切口长度(4.22±0.67)cm、术中失血量(47.58±11.25)mL、手术用时(1.58±0.42)h均少于对照组(10.88±1.13)cm、(11.84±2.31)cm、(149.83±33.76)mL、(2.99±0.63)h,且血肿清除率(88.84±9.62)%大于对照组(75.31±7.24)%,P<0.05;(3)观察组术后1周、术后2周、术后1个月时的AQP4水平、脑水肿体积均小于对照组,P<0.05;(4)观察组发生1例并发症(3.03%),对照组发生7例并发症(21.21%),P<0.05。结论 对基底节区脑出血患者进行神经内镜手术治疗,手术创伤小,可以降低AQP4水平,减少脑水肿体积及并发症,提高生活能力,值得推广。

Objective To analyze the curative effect of neuroendoscopic surgery in patients with basal ganglia intracerebral hemorrhage. Methods From June 2019 to August 2020, 33 patients with basal ganglia intracerebral hemorrhage who received craniotomy and hematoma clearance were selected as the control group, and 33 patients with basal ganglia intracerebral hemorrhage who received neuroendoscopic surgery at the same period were selected as the observation group. NIHSS,FIM and ADL scores,details of the surgery, levels of AQP4, brain edema volume and complications were analyzed. Results (1) There were no significant differences in NIHSS, FIM and ADL scores between the two groups before operation, P＞0.05; after operation, NIHSS score of the observation group was lower, and FIM and ADL scores were higher, P＜0.05. (2) Bone window size of the observation group was (2.53±0.66) cm, incision length was (4.22±0.67) cm, intraoperative blood loss was (47.58±11.25) mL, and operation time was (1.58±0.42) h, which were less than those of the control group [(10.88±1.13) cm and (11.84±2.31) cm, (149.83±33.76) mL, (2.99±0.63) h], and the hematoma clearance rate (88.84±9.62)% was higher than that of the control group (75.31±7.24)%, P＜0.05. (3) The AQP4 level and brain edema volume of the observation group 1 week, 2 weeks and 1 month after operation were lower than those of the control group, P＜0.05. (4) There was one complication (3.03%) in the observation group and seven complications (21.21%) in the control group,P<0.05. Conclusion Neuroendoscopic surgery for patients with basal ganglia cerebral hemorrhage can reduce the level of AQP4, the volume of brain edema and complications, and improve the ability of life, which is worthy of promotion.

目的 探讨糖尿病肾病患者肾功能恶化的危险因素。 方法 采用回顾性队列研究分析山东省立第三医院2017年1月—2020年5月108例患者的临床数据。将病人分为糖尿病肾病肌酐翻倍组和不翻倍组,比较两组间临床数据的变化。结果 糖尿病肾病肌酐翻倍组的BUN、胱抑素C和ACR水平均高于肌酐不翻倍组;eGFR、CO₂、ALB、HGB均低于肌酐不翻倍组,差异有统计学意义(P<0.05)。而UA、GLU、血脂、糖化血红蛋白,糖尿病和高血压病史差异无统计学意义(P>0.05)。相关分析表明血肌酐与BUN、eGFR、胱抑素C、ACR呈正相关;与ALB,HGB和CO₂呈负相关。多元线性回归分析结果显示,eGFR,胱抑素C,ACR, ALB和HGB是糖尿病肾病肾功能恶化的影响因素(P<0.05)。结论 糖尿病肾病除检测肾功能的常规指标外,还可观察ACR、ALB和HGB水平的变化,对判断患者肾功能是否恶化有一定价值。

Objective To investigate the risk factors of renal function deterioration in patients with diabetic nephropathy. Methods Retrospective cohort study was used to analyze the clinical data of 108 patients from January 2017 to May 2020 in the Third Hospital of Shandong Province. Patients were divided into diabetic nephropathy creatinine doubling group and non-doubling group. The changes of clinical data in two groups were compared and the risk factors of renal function deterioration were analyzed. Results The levels of BUN、cystatin C and ACR in the creatinine doubling group were higher than those in the creatinine non-doubling group, and the levels of eGFR、CO₂、ALB、 HGB were lower than those in the creatinine non-doubling group, the differences were statistically significant (P<0.05). However, there were no significant differences in the levels of UA, blood glucose, blood lipid, glycosylated hemoglobin, the history of diabetes and hypertension (P>0.05). The correlation analysis showed that serum creatinine was positively correlated with BUN、 eGFR、cystatin C and ACR and negatively correlated with CO₂、ALB and HGB. The results of multiple regression analysis showed that eGFR、cystatin C、ACR、ALB and HGB were independent influencing factors of renal function deterioration(all P<0.05). Conclusion Diabetic nephropathy can not only notice the routine indexes of renal function, but also observe the changes of ACR、ALB and HGB levels, which has certain value for awareing the renal function deterioration in patients.

目的 探讨高通量透析模式对改善维持性血液透析(MHD)患者β2微球蛋白清除率及高血压的影响。方法 选择2018年9月1日—2018年10月31日期间在广州市增城区新塘医院血液净化中心接受MHD患者40例为实验对象(除外因自身耐受因素长期使用低通量透析患者)。采用随机数表法分两组,每组20例。对照组接受低通量血液透析,观察组接受高通量血液透析。比较两组治疗效果,并记录0个月、3个月、6个月、12个月、18个月治疗前后β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、心率、血压变化,并对两组心血管疾病情况进行统计。结果 观察组总有效率为95.00%,高于对照组的20.00%(P<0.05);治疗后,观察组β2-MG、iPTH均降低,而3个月后对照组略有升高,观察组[(12.48±2.10)mg/L、(210.13±18.12)ng/L]低于对照组[(30.21±2.37)mg/L、(289.41±17.02)ng/L],观察组治疗3个月、6个月、12个月、18个月的β2-MG清除率高于对照组(P<0.05);与治疗前比较,两组的平均动脉压、收缩压均降低,且观察组低于对照组(P<0.05);对照组各时间点24小时舒张压及收缩压差异无统计学意义(P>0.05);与治疗前比较,观察组24小时舒张压、收缩压治疗后1个月、3个月、6个月、12个月、18个月均降低,且低于对照组(P<0.05);两组患者心血管疾病发生率比较:观察组有1例因急性心肌梗死住院行PCI术;对照组有2例因心力衰竭住院治疗,1例因急性冠脉综合症住院治疗。两组并发症发生率比较P>0.05。结论 高通流量透析模式可有效提高MHD患者的治疗效果,有效清除血液毒素,降低患者的高血压,减少并发症,可在临床推广使用。

Objective To investigate the effect of high flux dialysis mode on the improvement of β2-microglobulin clearance and hypertension in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD at the Blood Purification Center of Xintang Hospital, Zengcheng District, Guangzhou from September 1, 2018 to October 31, 2018 (except for long-term low-flux dialysis patients due to self-tolerance factors)were selected. Random number table method was used to divide the patients into two groups,20 patients in each group. The control group received low flux hemodialysis, and the observation group received high flux hemodialysis. The treatment effects of the two groups were compared, levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), changes in heart rate and blood pressure, and statistics on cardiovascular disease in the two groups before and after treatment at 3, 6, 12, and 18 months were recorded. Results The total effective rate in the observation group was 95.00%, which was higher than the 20.00% in the control group (P<0.05). After treatment, the levels of β2-MG and iPTH of the two groups decreased, and the observation group [(13.02±2.10) mg/L, (210.13±18.12) ng/L] was lower than the control group [(19.78±2.37) mg/L, (289.41±17.02)ng/L]; the β2-MG clearance rate of the observation group was higher than that of the control group at 3 months, 6 months, 12 months, and 18 months (P<0.05).Compared with that before treatment, the average arterial pressure and systolic blood pressure of the two groups were reduced, and the observation group was lower than that of the control group (P<0.05); the differences between diastolic blood pressure and systolic blood pressure at each time point in the control group were not significant (P>0.05); the 24-hour diastolic blood pressure and systolic blood pressure of the observation group decreased after 1, 3, 6, 12 and 18 months, compared with those before treatment (P<0.05), and were lower than those in the control group (P＜0.05).Comparison of the incidence of cardiovascular disease between the two groups: 1 case in the observation group was hospitalized for acute myocardial infarction; 2 cases in the control group were hospitalized for heart failure and 1 case was hospitalized for acute coronary syndrome; complications incidence in the two groups were compared (P>0.05). Conclusion The high flux dialysis mode can effectively improve the treatment outcomes of MHD patients, effectively remove blood toxins, lower blood pressure, and reduce the incidence of complications. It can be used in clinical practise.

目的 总结一种新的技术在心脏术后纵隔感染的应用经验。方法 回顾性分析2017年2月—2019年6月15日心脏术后发生纵膈感染成人患者,共有5例(1.2%),其中男性4例,女性1例,平均年龄(49±19)岁,平均体质量(70±15)kg,2例为急性A型主动脉夹层,2例为冠心病,1例为感染性心内膜炎合并白塞氏病,患者确诊后出现创面感染重、分泌物多,行VSD(负压封闭引流)进行过渡治疗,待创面清洁、肉芽新鲜后入手术室行清创术,术中4例采用SternaLock胸骨固定系统进行固定,1例因未累及至胸骨后,仅在胸骨前方行清创缝合。结果 4例完全治愈并顺利出院,1例因出现多器官功能衰竭死亡,但伤口愈合良好。结论 通过VSD引流增加了胸骨血流,加速肉芽组织形成,防止感染进一步加重,稳定胸骨,为进一步清创创造了良好的基础,同时运用SternaLock^®胸骨固定系统(8孔型钛板及2.4 mm自钻锁螺钉)进行固定,明显增加了胸骨的稳定性,进一步改善患者预后。

Objective To summarize the application experience of a new technique in mediastinal infection after cardiac operation. Methods A retrospective analysis of adult patients with mediastinal infection after cardiac surgery from February 2017 to June 15, 2019 were taken including a total of 5 cases (1.2%), of which 4 were male and 1 was female, with an average age (49±19) years old, average weight (70±15) kg;2 cases had acute type A aortic dissection, 2 cases had coronary heart disease, 1 case had infective endocarditis with Behcet's disease. After diagnosed, the patients developed severe wound infection and excessive secretion. VSD (vacuum sealing drainage) was performed for transitional treatment. After the wounds were cleaned and the granulation were still fresh, the wounds were for debridement in the operating room. During the operation, 4 cases were fixed with the SternaLock^® plating system, and 1 case was only treated with debridement and suture in front of the sternum because it did not involve the sternum. Results Four cases were cured and discharged smoothly, and 1 case died due to multiple organ failure, but the wound healed well. Conclusion The VSD increased sternum blood flow, which accelerated the granulation tissue formation, further to prevent infection and stable sternum, create a good foundation for further debridement, meanwhile the SternaLock ^® plating system(consists of eight pass since the titanium plate and 2.4 mm drill lock screw) was used for fixation, which significantly increased the stability of the sternum, further improved the prognosis of patients.

目的 儿童流感相关坏死性脑病(influenza-associated necrotizing encephalopathy,IANE)是一种严重的流感并发症,目前缺乏早期诊断预警指标,本文探讨血生化和脑脊液检测在儿童IANE早期预警中的作用,为IANE早期诊断提供预测参考。 方法 回顾分析2016年1月—2020年12月在我院接受诊治的确诊流感并发神经系统并发症的患儿。40例流感相关性脑病(influenza-associated encephalopathy,IAE)和32例IANE患儿纳入研究。采用受试者工作特征曲线(ROC)分析来确定所选变量的预警价值。 结果 与IAE组相比,IANE组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐激酶(CK)、乳酸脱氢酶(LDH)、脑脊液乳酸脱氢酶(CSF LDH)、脑脊液蛋白(CSF PRO)均升高,两组差别有统计学意义(P<0.05)。用于区分IAE和IANE的LDH、CSF LDH和CSF PRO的曲线下面积(AUC)分别为0.876、0.853和0.831。LDH>535 U/L预测IANE的敏感度为89.7%,特异度为86.5%。CSF LDH>67 U/L预测IANE的敏感度为82.8%,特异度为73.3%。CSF PRO>0.49 g/L预测IANE的敏感度为73.7%,特异度为76.6%。IANE患儿死亡10例(43.3%),IAE患儿死亡0例(P<0.05)。 结论 IANE组LDH、CSF LDH和CSF PRO明显升高,可作为IANE的早期预警指标。对此类患儿要密切评估,早期预测及干预,减少后遗症及病死率,改善预后。

Objective Influenza-associated necrotizing encephalopathy (IANE) in children is a serious complication of influenza. At present, there is a lack of indicators for early diagnosis and early warning. In this paper, the role of blood biochemical and cerebrospinal fluid detection in early warning of IANE in children is discussed, so as to provide a predictive reference for early diagnosis of IANE. Methods A retrospective analysis was conducted on children diagnosed with influenza and with neurological complications who were treated in our hospital from January 2016 to December 2020. Forty children with influenza-associated encephalopathy (IAE) and 32 children with IANE were included. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive value of the selected variables. Results Compared with IAE group, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine kinase (CK), lactate dehydrogenase (LDH), cerebrospinal fluid lactate dehydrogenase (CSF LDH) and cerebrospinal fluid protein (CSF PRO) were all increased in IANE group, and the differences between the two groups were statistically significant (P<0.05). The area under curve (AUC) of LDH, CSF LDH and CSF PRO used to distinguish IAE from IANE were 0.876, 0.853 and 0.831, respectively. The sensitivity and specificity of LDH>535 U/L for predicting IANE were 89.7% and 86.5% respectively. The sensitivity and specificity of CSF LDH>67 U/L for predicting IANE were 82.8% and 73.3% respectively. The sensitivity and specificity of CSF PRO＞0.49 g/L in predicting IANE were 73.7% and 76.6%. There were 10 deaths of IANE (43.3%) and 0 death of IAE (P<0.05). Conclusion The levels of LDH, CSF LDH and CSF PRO were significantly increased in IANE group, which could be used as early warning indicators for IANE. For such children, close evaluation, early prediction and intervention should be made to reduce sequelae and fatality rate and to improve prognosis.