目的 探讨非酒精性脂肪肝患者昼夜节律特点并分析昼夜节律与非酒精性脂肪肝的相关性。方法 选取2017年12月—2018年12月我院门诊部及住院部非酒精性脂肪肝患者60例作为观察组,对照组抽取门诊体检正常人群60例。通过使用本院自制个人一般资料调查表、睡眠节律清晨型与夜晚型量表(MEQ)以及智能手环检测两组纳入对象的昼夜节律(饮食方式、饮食时间、活动节律、体重指数、睡眠节律等)。对比分析两组患者昼夜节律特点并分析其与非酒精性脂肪肝的相关性。结果 非酒精性脂肪肝患者在BMI、睡眠绝对夜晚型、睡眠中度夜晚型、日均运动量小于30 min、睡眠时间紊乱、睡眠时长以及深度睡眠时间等方面与对照组患者比较差异有统计学意义(P＜0.05);以非酒精性脂肪肝为应变量,以昼夜节律为自变量进行回归分析发现性别、年龄、工作性质、BMI、睡眠节律、身体锻炼、睡眠时长、深度睡眠时长与非酒精性脂肪肝呈现正相关且差异有统计学意义(OR＞1,P＜0.01)。结论 非酒精性脂肪肝患者昼夜节律一般存在失眠熬夜、睡眠时间不规律、少运动、身形丰满等特点,引发非酒精性脂肪肝相关因素包括BMI、睡眠节律、运动节律、职业性质、年龄、性别、睡眠质量等,临床上可尝试对非酒精性脂肪肝患者进行昼夜节律干预治疗,改善预后。

Objective To explore the characteristics of circadian rhythm in patients with nonalcoholic fatty liver disease(NAFLD) and to analyze the correlation between circadian rhythm and NAFLD. Methods From December 2017 to December 2018,60 patients with NAFLD in outpatient department and inpatient department of our hospital were selected as observation group,while 60 normal people were selected as control group.The circadian rhythm (dietary pattern,dietary time,activity rhythm,body mass index,sleep rhythm) of the subjects in the two groups were measured by self-made personal data questionnaire,MEQ and smart bracelet.The circadian rhythm characteristics of two groups were compared and the correlation between circadian rhythm and NAFLD was analyzed. Results There were significant differences in BMI,absolute night sleep,moderate night sleep,daily average exercise less than 30 minutes,sleep disturbance,sleep duration and deep sleep time between the patients with NAFLD and the control group (P<0.05). NAFLD was used as dependent variable and circadian rhythm as independent variable. Logistic regression analysis showed that gender,age,nature of work,BMI,sleep rhythm,physical exercise,sleep duration and deep sleep time were positively correlated with fatty liver (OR>1,P<0.01). Conclusion The circadian rhythm of NAFLD patients generally has the characteristics of insomnia,staying up late,irregular sleep time,less exercise and plump figure.The related factors causing NAFLD include BMI,sleep rhythm,motor rhythm,occupational nature,age,gender and sleep quality.In clinic,circadian rhythm intervention therapy may improve the prognosis of patients with NAFLD.

目的 分析医院登革热阳性病例特别是重症患者的临床和实验室和流行病学特征可为登革热的早期诊断和预防控制提供依据。方法 收集2010年—2017年期间944例就诊于广州市第一人民医院并经实验室确诊的登革热患者。根据疾病的严重程度将入选患者分为3组,比较各组之间的临床和生物学变量,并使用多元回归分析了严重登革热的危险因素的影响。结果 本研究通过对7年间944例登革热患者进行回顾性分析发现登革热病例以轻症为主,77.5%的患者有基础疾病,主要为糖尿病(15.4%)和高血压患者(34%)。大部分患者就诊时表现为高热(39.05±0.67)℃,登革病毒IgM和(或)IgG阳性,白细胞及血小板减少明显及肝、肾功能异常。重症患者AST和LDH值相比轻症者升高。冠心病和肿瘤疾病的患者发生重症的比例更高。流行趋势分析显示7年间登革热出现1次爆发(2014年)。每年9～10月为登革热高发季节。登革热发病率在男女间无统计学差异。男性和女性的高发年龄分别71～80岁和51～60岁。10岁以下发病率最小,50～80岁年龄段发病率最高。结论 广州市第一人民医院登革热患者以老年人为主,基础性疾病患者是登革热高危人群。登革热患者具有高热、登革病原检测阳性、血象和肝肾功能异常的特征;临床医生在9～10月高发季节加强对高热患者的登革病原检查有利于登革热早期诊断和防治。

Objective The Guangzhou area is a high-risk area for dengue fever. This study aim to provide a basis for the early diagnosis and prevention of dengue fever by analyzing the clinical and laboratory characteristics and epidemiological analysis of dengue patients in Guangzhou,especially in critically ill patients. Methods A total of 944 patients with dengue fever diagnosed at the First People's Hospital of Guangzhou from 2010 to 2017 were collected. The enrolled patients were divided into 3 groups according to the severity of the disease,the clinical and biological variables between the groups were compared,and multiple regression analysis was used to analyze the effects of risk factors for severe dengue. Results This study retrospectively analyzed the clinical manifestations and laboratory tests of 944 patients with dengue fever in the past 7 years,showing that dengue fever cases in Guangzhou are mainly mild. 77.5% of them have underlying diseases,mainly diabetes (15.4%) and hypertension (34%). Most patients developed high fever (39.05±0.67)℃ at the time of seeing doctors,positive for dengue virus IgM and/or IgG,decreased white blood cells and thrombocytopenia,and abnormal liver and kidney function. AST and LDH values were significantly elevated in critically ill patients compared with mild cases. Patients with coronary heart disease and neoplastic disease have a higher proportion of severe cases. Epidemiological analysis of dengue virus showed an outbreak of dengue fever in 7 years (2014). September-October is the season of high incidence of dengue fever. The incidence of dengue fever was not statistically different between men and women. The high-incidence ages of men and women are 71～80 years old and 51～60 years old,respectively. The incidence rate is the lowest under the age of 10,and the highest in the 50～80 age group. Conclusion Dengue fever patients in Guangzhou are dominated by the elderly,and patients with underlying diseases are at high risk of dengue fever. Dengue fever patients have high fever,positive dengue pathogen detection,blood and liver and kidney dysfunction characteristics. Strengthening the dengue pathogen examination for hyperthermia patients during the high season of September-October is conducive to the early diagnosis and prevention of dengue fever.

目的 分析毕节地区新型冠状病毒(2019-nCoV)肺炎(novel coronavirus pneumonia,NCP)胸部CT影像学表现,探讨对NCP的临床诊断的价值。方法 回顾性分析毕节市第三人民医院2020年1月14日至2月18日收治的13例NCP患者的流行病学特征及胸部CT影像学特征。结果 13例患者中2例为长期居住在武汉来毕;1例由从上海到湖北宜昌逗留3天返毕;1例直接与武汉当地人接触;3例为与确诊病人的密切接触者;5例是聚集性发病,均与从浙江省台州市返毕确诊病人密切接触;1例无流行病学史。胸部CT影像学以双肺或一侧肺散在斑片状、磨玻璃状高密度影,密度不均,边界不清,肺野外带显著为特征。重型患者短期内肺部CT影像学变化明显。结论 确诊NCP普通型患者胸部CT影像学大多以典型表现为特征;重型NCP患者短时间内可出现实变及肺纤维化。

Objective To analyze the novel coronavirus (2019-nCoV) novel coronavirus pneumonia (NCP) chest CT imaging findings in Bijie area, and to explore the clinical diagnostic value of NCP. Methods The epidemiological characteristics and chest CT features of 13 NCP patients admitted to The Third People's Hospital of Bijie from January 14 to February 18, 2020 were analyzed retrospectively. Results Among the 13 patients, 2 lived in Wuhan for a long time, 1 stayed for 3 days from Shanghai to Yichang, Hubei, and returned home; 1 directly contacted with the local people in Wuhan; 3 closely contacted with the confirmed patients; 5 were clustered diseases, all closely contacted with the confirmed patients returning from Taizhou, Zhejiang province; 1 had no epidemiological history. CT imaging of the chest is characterized by patchy, ground glass high-density shadows scattered in two or one side of the lung, with uneven density, unclear boundary and significant lung field zone. Conclusion Most of the chest CT images of the patients with NCP were characterized by typical manifestations, while consolidation and pulmonary fibrosis were found in the patients with severe NCP in a short period of time.

目的 探究高龄患者植入静脉输液港并发感染相关影响因素分析。方法 随机抽取我院2015年5月—2018年8月期间收入高龄患者总计72例,对并发感染患者数量进行统计,采取Logistic回归方程进行计算,分析高龄患者植入静脉输液港并发感染相关因素。结果 共计纳入植入静脉输液港并发感染患者总计72例,其中并发感染患者为23例,占比31.94%,对比两组一般资料,发现两组患者在穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量上存在差异,数据对比差异有统计学意义(P＜0.05),将上述有差异资料带入Logistic回归方程计算,发现穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量均为导致高龄患者植入静脉输液港并发感染影响因素。结论 对高龄患者而言,植入静脉输液港并发感染各项因素中,包括穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量,患者需加强关注,可控制输液港相关感染。

Objective To explore the influencing factors of infection in elderly patients with intravenous infusion port. Methods 72 elderly patients from May 2015 to August 2018 were randomly selected in our hospital. After counting the number of patients with complicated infection,the relative factors of infection in elderly patients were analyzed by using the Logistic regression equation. Results A total of 72 patients were included in the intravenous infusion port with concurrent infection,of which 23 were accompanied with infection,accounting for 31.94%.By comparing the general data,two groups in puncture sites,types of diseases,application times and frequencies,histories of diabetes and body masses had statistically difference(P<0.05). It was found all the above factors were the concomitant factors leading to the implantation of intravenous infusion port in elderly patients by putting the difference data into the Logistic regression equation. Conclusion To control infusion port related infection,the elderly patients should focus more on the infection factors of the implantation in intravenous infusion port which included puncture sites,types of diseases,application times and frequencies,histories of diabetes and body masses.

目的 探讨B超与MRI、宫腔镜联合诊断对宫腔占位性病变的临床意义。方法 选择2017年1月1日— 12月31日我院收治的108例疑似宫腔占位性病变患者为研究对象。所有患者均于宫腔操作前行阴道彩色多普勒超声(以下简称B超)检查、MRI检查及宫腔镜检查。与病理检查结果对比,分别分析其灵敏度、特异度。结果 108例患者中宫腔无病理变化者27例,子宫内膜息肉39例,子宫内膜增生27例,子宫黏膜下肌瘤10例,子宫内膜癌5例。B超、MRI、宫腔镜诊断灵敏度分别为72.84%、71.60%、75.31%,特异度分别为62.96%、85.19%、66.67%。B超+MRI诊断子宫黏膜下肌瘤和子宫内膜癌灵敏度100%,特异度分别为87.76%和99.03%。B超+MRI+宫腔镜诊断子宫内膜增生、子宫黏膜下肌瘤、子宫内膜癌灵敏度均为100%。结论 宫腔占位病变以良性病变居多,B超联合宫腔镜和MRI检查可提高诊断率。对子宫内膜癌高危人群应进行B超与MRI联合检查,宫腔镜定位活检仅在必要时实施。

Objective To explore the clinical significance of B-ultrasound, MRI and hysteroscopy in the diagnosis of uterine space occupying lesions. Methods 108 patients with suspected uterine space occupying lesions admitted to our hospital from January 1 to December 31 2017 were selected as the study objects. All patients were examined by vaginal color Doppler ultrasound, MRI and hysteroscopy before uterine operation. Compared with the results of pathological examination, the sensitivity and specificity were analyzed. Results Among the 108 patients, 27 had no pathological changes in uterine cavity, 39 had endometrial polyps, 27 had endometrial hyperplasia, 10 had submucous myoma, and 5 had endometrial cancer. The sensitivity of B-ultrasound, MRI and hysteroscopy were 72.84%, 71.60% and 75.31% respectively, and the specificity were 62.96%, 85.19% and 66.67% respectively. The sensitivity of B-ultrasound+MRI in the diagnosis of submucous myoma and endometrial carcinoma was 100% and the specificity was 87.76% and 99.03%, respectively. The sensitivity of B-ultrasound+MRI+hysteroscopy in the diagnosis of endometrial hyperplasia, submucous myoma and endometrial carcinoma was 100%. Conclusion Most of the uterine space occupying lesions are benign. B-ultrasound combined with hysteroscopy and MRI may improve the diagnosis rate. The high-risk group of endometrial cancer should be examined by B-ultrasound and MRI, and hysteroscopic biopsy would be performed only when necessary.

目的 探讨河源地区机采血小板固定献血者血小板抗原系统的基因多态性特征,为建立本地区机采血小板供血者库奠定基础。方法 采用PCR-SSP方法对100例机采血小板固定献血者进行血小板抗原HPA1～17系统基因分型。结果 HPA1～17基因中成多态性分布的等位基因是HPA2a、HPA3a、HPA5a、HPA15a,其频率分别为0.96、0.49、0.99、0.515。HPA-2、HPA-3、HPA-5、HPA-15系统存在aa、ab、bb 三种表型。HPA1a、HPA4a、HPA6a-14a、HPA16a-17a基因频率为1,呈单线性分布,未发现b基因。结论 河源地区血小板HPA-3系统不配合率最高(0.420),HPA-15系统次之。建立本地区机采血小板供血者库,为患者提供HPA相合的血小板,对减少临床血小板输注无效的发生具有重要意义。

Objective To study the polymorphism of human platelet antigens in fixed apheresis platelet donors in Heyuan area and to lay a foundation for the establishment of platelets donor bank. Methods PCR-SSP method was used to analyze HPA 1～17 genotype in 100 fixed platelet donors. Results The highest numbers of heterozygotes were HPA2a,HPA3a,HPA5a and HPA15a,with frequencies of 0.96,0.49,0.99 and 0.515,respectively. The frequencies of HPA1a,HPA4a,HPA6a-14a and HPA16a-17a genes were 1,which showed a single linear distribution. Conclusion HPA-3 system were the highest mismatch rate (0.420),followed by HPA-15 system. It is great significance to establish a local platelet donor bank and provide HPA compatible platelets for patients.

目的 探讨以肺间质改变为主的不典型肺结核的CT特征。方法 收集2018 年1月—2018 年12月期间44例经我院临床及实验室确诊的以肺间质改变为主的不典型肺结核的CT影像学资料,进行归纳总结,分析其影像特点。结果 44例以肺间质改变为主的不典型肺结核其中14例患者在肺叶的分布呈局限性分布,其中主要分布于右肺上叶占13例;30例呈弥漫性分布;以间质改变为主的局限性分布及弥漫性分布的不典型肺结核均以细网织影、微结节、细支气管壁增厚、小叶间隔增厚为主要表现,树芽征、磨玻璃影在弥漫性分布中相对常见,其合并空洞、支气管扩张、纵膈淋巴结肿大钙化、胸膜炎、肺大疱的比例高于局限性分布患者;以肺间质改变为主的不典型肺结核呈局限性分布(14例)的患者预后良好,13例呈显著吸收,1例吸收良好;弥漫性分布(30例)的患者中,18例显著吸收,其中6例未吸收或吸收欠佳。结论 以肺间质为改变为主的非典型肺结核具有其特征性,了解其CT特点有助于提高临床诊断及更好的评价治疗预后。

Objective To discuss value of the CT features of atypical pulmonary tuberculosis with pulmonary interstitial changes and improve the early diagnosis of pulmonary tubeculosis. Methods The CT imaging data of 44 patients with atypical pulmonary tuberculosis with interstitial changes was collected from January 2018 to December 2018,and the imaging characteristics were analyzed. Results In 44 cases of atypical pulmonary tuberculosis,14 cases of atypical pulmonary tubeculosis were the localized distribution,13 cases were mainly in the right upper lobe,and 30 cases were diffuse distribution. The atypical pulmonary tuberculosis of the localized and diffuse distribution mainly with interstitial changes was characterized by tine reticular shadow,micnodule,thickening of bronchiole wall and thickening of interlobular Septa. Tree-bud sign and ground-glass shadow were common in diffuse distribution,and the proportions of cavity,bronchiectasis,mediastinal lymphadenopathy calcification,pleurisy and bullae were higher than that in localized distribution. The atypical pulmonary tuberculosis patients with localized pulmonary interstitial changes (14 cases) have a favourable prognosis,13 cases with significant absorption,1 case with favourable absorption,and 18 cases with the atypical pulmonary tuberculosis patients with diffuse pulmonary interstitial changes (30 cases) with significant absorption,6 cases with no absorption or poor absorption. Conclusion The atypical pulmonary tuberculosis with interstitial changes has its characteristics,and the CT features is helpful to improve the clinical diagnosis and better evaluation of treatment prognosis.

目的 通过分析孤立性蝶窦病变的临床特点,进一步提高早期诊断率及治疗疗效。方法 回顾性分析2019年1月—2019年8月在我科手术的孤立性蝶窦病变的9例患者临床资料,总结分析蝶窦病变的临床症状、鼻窦影像学表现及鼻内镜手术疗效。结果 蝶窦病变平均发病年龄约59.1岁,1例为双侧真菌性蝶窦炎,只有1例首诊于耳鼻喉科,8例患者就诊于神经内科,都以头痛为首发症状,1例鼻流清亮液体,鼻腔异味2例,鼻塞、脓涕1例,嗅觉功能减退1例。不同类型的蝶窦病变影像学表现不同,临床症状不同,绝大多数患者以头痛为首发症状。所有患者均在全身麻醉下行鼻内镜手术。术后随访至少3月以上,术后症状完全消失,无复发病例。结论 头痛是孤立性蝶窦病变最常见的临床特点,鼻窦影像学检查是重要的诊断手段,鼻内镜下经嗅裂蝶筛隐窝进路开放蝶窦是最有效的治疗手段。

Objective By analyzing the clinical characteristics of solitary sphenoid sinus disease,the early diagnosis rate and therapeutic effect can be further improved. Methods The clinical data of 9 patients with isolated sphenoid sinus lesions operated on in our department from January 2019 to August 2019 were retrospectively analyzed,and the clinical symptoms,imaging features of the sinuses and the efficacy of nasal endoscopic surgery were summarized and analyzed. Results The average age of onset of sphenoid sinus lesions was 59.1 years old,1 case was bilateral fungal sphenoid sinusitis,only 1 case was first diagnosed in the department of otolaryngology,8 cases were treated in the department of neurology,all with headache as the first symptom,1 case had clear rhinorrhea,2 cases had nasal odor,1 case had nasal obstruction,1 case had purulent nose,and 1 case had anosmia. The imaging manifestations and clinical symptoms of different types of sphenoid sinus lesions were different,and headache was the first symptom of most patients. All patients underwent nasal endoscopic surgery under general anesthesia. The patients were followed up for at least 3 months after the operation,and the symptoms completely disappeared without recurrence. Conclusion Headache is the most common clinical feature of isolated sphenoid sinus lesions. Imaging examination of the sinus is an important diagnostic method,and endoscopic opening of the sphenoid sinus through the sphenoidal cleft via sphenoidal recess is the most effective treatment method.

目的 探究Harris-Benedict(HB)公式用于估算机械通气的危重症患者能量代谢的准确性,以及不同BMI分组对其影响。方法 使用间接能量测定法测量患者的静息能量(ICREE),通过HB公式计算其静息能量代谢估算值(HBREE)。将80例患者按BMI分为4组,并通过配对样本t检验对ICREE与HBREE进行比较,Pearson分析用于分析ICREE与HBREE的相关性。结果 共纳入80例机械通气的危重症患者。除肥胖组外的其余各组病人,ICREE均高于HBREE(均P＜0.01),HB公式的准确率为23.75%。ICREE与HBREE相关性差(r=0.331,P＜0.01)。当各组使用校正系数对HB公式进行调整后,ICREE与HBREE差异无统计学意义,准确率提高至38.8%。结论 使用HB公式不能很好地反应危重症患者的实际能量代谢。BMI可能是影响HB公式准确性的重要因素。依据不同BMI分组,使用相应校正系数可提高HB公式的准确性。

Objective To explore the accuracy of the Harris-Benedict (HB) formula used to estimate the energy metabolism in critically ill patients undergoing mechanical ventilation and the effects of different BMI groups on it. Methods Indirect calorimetry was used to measure the resting energy of the patient,and the estimated resting energy metabolism was calculated by the HB formula. 80 patients were divided into four groups according to BMI. ICREE and HBREE were compared by paired sample t test. Pearson analysis was used to analyze the correlation between ICREE and HBREE. Results This study included 80 critically ill patients undergoing mechanical ventilation.Except for the obese group,ICREEE was higher than HBREE in all patients and the remaining groups of patients. The accuracy rate of the HB formula was 23.75%. The correlation between ICREE and HBREE is poor(r=0.331,P＜0.01). There was no statistical difference between ICREEE and HBREE and the accuracy rate increased to 38.8% after the Harris-Benedict equation was adjusted by using the correction factor. Conclusion Using the HB formula can not reflect the actual energy metabolism of critically ill patients well. BMI may be an important factor affecting the accuracy of HB formula. The accuracy of the HB equation can be improved by using different correction factors according to different BMI groupings.

目的 本研究旨在探讨压迫止血法在减少实时超声引导经皮肾穿刺术后并发症中的价值。方法 选取2011年9月1日—2016年12月31日于我院行超声引导下经皮肾穿刺术患者405例。按肾穿刺后是否行立即行压迫止血法分2组,非压迫止血法为对照组(A组),压迫止血法为研究组(B组)。记录患者术前血压、凝血四项、血红蛋白、血小板等指标。记录穿刺次数及每次穿刺所取标本长度。术后24 h复查穿刺点出血情况及肾周血肿情况。穿刺术后24 h内监测血尿情况。结果 与非采用压迫止血法超声定位经皮肾穿刺术后(A组)相比,压迫止血法术后(B组)并发症发生率较低, A组肉眼血尿发生率为8.8 %,B组为4 %,差异有统计学意义(P=0.048);A组24 h肾周血肿发生率为 62.1%,B组为49.8%,差异有统计学意义(P=0.042)。结论 实时超声引导下经皮肾穿刺后立即行压迫止血法,可有效减少术后肾周血肿和血尿。

Objective To discuss how to reduce the post-biopsy complications of real-time ultrasound-guided percutaneous renal biopsy by manual compression. Methods A total of 405 ultrasound-guided biopsies were performed in 404 patients in our hospital, between September 2011 and January 2017, were recruited to this study. They were divided into 2 groups, group A biopsy without manual compression, and group B biopsy with manual compression. All patients' records were retrospectively reviewed and both pre and post biopsy information, as well as complications were collected. Results The gross hematuria rate is 8.8 % (16 patients) in group A, but in group B, the rate is 4 %. The perirenal hematoma rate at 24 h after biopsy in group A detected by ultrasound is 62.1% (113 patients), and 49.8% (116 patients, P vs group A=0.042) in group B. Conclusion Manual compression to the puncture site reduced complications like perirenal hematoma and gross hematuria after real-time ultrasound-guided renal biopsy.