目的 探讨血浆脑利钠肽前体(proBNP)和心肌损伤标志物(CK-MB和cTnI)联合检测对老年脓毒症患者心肌损伤及预后评估的临床意义。方法 选择60例老年脓毒症患者按病情严重程度分为一般脓毒症组和严重脓毒症组,另选取同期在我院行健康体检的同龄人30例作为对照组。比较三组和不同预后患者血浆proBNP、cTNI、CK-MB水平及急性生理和慢性健康状态评分Ⅱ(APACHE Ⅱ) ,并对各指标进行相关性分析。结果 脓毒症患者血浆proBNP、cTnI水平高于对照组,且严重脓毒症组APACHEⅡ评分高于一般脓毒症组(均P＜0. 05);死亡组患者其血浆中的proBNP,cTNI和CK-MB水平及APACHE Ⅱ评分均高于存活组患者(均P＜0.05),差异有统计学意义;严重脓毒症组患者血浆proBNP 水平与cTnI及CK-MB水平呈正相关性(P＜0.05); 血浆proBNP水平、cTnI水平、CK-MB水平分别与APACHEⅡ评分呈正相关性(P＜0.05)。结论 血浆proBNP 及cTnⅠ水平可有效反映老年脓毒症患者心肌受损程度,早期血浆proBNP、cTnI、CK-MB水平联合检测对老年脓毒症患者预后判断可能有重要临床意义。

Objective To study the clinical significance of cardiac injury biomarkers(CK-MB and cTnI) and pro-brain natriuretic peptide(proBNP) joint detection for prognosis value in Elderly sepsis. Methods Sixty elderly patients with sepsis were selected. According to the severity of disease divided into general and severe sepsis group.Meanwhile, 30 healthy volunteers as a control group. Comparative study of plasma proBNP, cTnI, CK-MB levels and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) in three groups;and the correlation analysis of the indicators. Results Compared with control group, the plasma levels of proBNP and cTnI were significantly higher in patients with sepsis; And the APACHEⅡ score in the severe sepsis group was significantly higher than the general sepsis group (P<0. 05). The plasma proBNP, cTnI, CK-MB level and APACHE Ⅱ scores in death group were significantly higher than the survival group (P<0. 05). The proBNP plasma levels, cTnⅠ and CK-MB levels in severe sepsis patients were positively correlated (P<0. 05); They were positively correlated between ProBNP level, cTnⅠ level and the APACHEⅡ score(P<0. 05). Conclusions ProBNP plasma levels and cTnⅠ can effectively reflect the extent of the cardiac damage in elderly sepsis; Early plasma proBNP level, cTnI and CK-MB combined detection of elderly sepsis may have important clinical significance.

目的 探究孕妇血清PAPP-A、IR与妊娠期糖尿病的临床相关性。方法 以我院2013年4月—2014年4月期间收治的160例妊娠期糖尿病孕妇作为观察组,以同期收治的妊娠期正常孕妇作为对照组。对比分析两组孕妇血清PAPP-A含量与IR计算值差异。结果 观察组孕妇血清PAPP-A水平低于对照组,而IR计算值明显高于对照组,差异有统计学意义(P<0.05)。结论 孕妇血清PAPP-A与IR水平与妊娠期糖尿病相关性显著,妊娠期糖尿病患者血清PAPP-A明显降低,而IR则明显增加,可为临床诊断提供参考依据。

Objective To explore the clinical relevance of the pregnant women serum PAPP -a, IR and gestational diabetes. Methods The 160 cases of gestational diabetes mellitus were treated in our hospital from April 2013 to April 2014 as the observation group, and the normal pregnant women were treated as the control group. The differences of serum PAPP-A levels and IR values in the two groups were compared and analyzed. Results The serum PAPP-A level of the observation group was significantly lower than that of the control group, while the IR value was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion The level of serum PAPP-A and IR in pregnant women is significantly related to the gestational diabetes mellitus. The serum PAPP-A of the patients with gestational diabetes is significantly decreased, while the IR is significantly increased, which can provide reference for clinical diagnosis.

目的 探讨双歧三联活菌联合补中益气丸治疗腹腔镜胆囊切除术后腹泻患者的临床疗效及安全性。方法 将2014年3月—2015年3月我院收治的68例腹腔镜胆囊切除术后腹泻患者随机分成观察组和对照组(每组34例),观察组患者给予双歧三联活菌联合补中益气丸治疗,对照组患者给予双歧三联活菌治疗,比较两组患者治疗前后的临床症状积分,总体临床疗效以及不良反应。结果 治疗4周后,观察组和对照组患者大便次数、大便性状积分和腹痛/腹部不适积分均明显低于治疗前(P＜0.05),同时观察组患者大便次数、大便性状积分和腹痛/腹部不适积分低于对照组患者(P＜0.05);观察组和对照组患者临床症状总积分均低于治疗前(P＜0.05),且观察组患者临床症状总积分低于对照组患者(P＜0.05);观察组患者临床疗效总有效率(91.2%)高于对照组患者临床疗效总有效率为(70.6%)(P=0.03);观察组和对照组患者治疗期间均未出现明显药物不良反应。结论 双歧三联活菌联合补中益气丸治疗腹腔镜胆囊切除术后腹泻能明显改善患者的临床症状,总体疗效较好,不良反应率较低,值得在临床上推广应用。

Objective To investigate the clinical efficacy and safety of bifid triple viable combined with buzhongyiqi pills in treatment of patients with diarrhea after Laparoscopic cholecystectomy. Methods 68 patients with diarrhea after Laparoscopic cholecystectomy in our hospital between March 2014 and March 2015 were randomly divided into observation group and control group with each 34 cases. The patients in observation group were given bifid triple viable and Buzhongyiqi pills therapy and the patients in control group were given bifid triple viable therapy. The clinical symptoms, clinical efficacy and adverse reactions were observed before and after treatment and were compared between two groups. Results After 4 weeks of treatment, the frequency of excrement, scores of excrement consistency and scores of abdominal pain and abdominal unwell in the observation group and the control group were significantly lower than those in relevant groups before treatment (P<0.05) and the frequency of excrement, scores of excrement consistency and scores of abdominal pain and abdominal unwell in observation group were significantly lower than that in the control group (P<0.05). The aggregate score of clinical symptoms in observation group and control group were both significantly lower than that in each group before treatment (P<0.05), and the aggregate score of clinical symptoms in observation group patients was significantly lower than that in the control group patients (P<0.05). The total clinical effective rate in observation group(91.2%)was significantly higher than that in control group(70.6%)(P=0.03). There were no adverse drug reactions in the observation group and the control group during treatment period. Conclusion Bifid triple viable combined with Buzhongyiqi pills in treatment of patients with diarrhea after laparoscopic cholecystectomy could significantly improve clinical symptoms and get good overall effect, which is worthy of clinical application.

目的 探讨无脊髓神经损伤伴有大骨块突入椎管的胸腰椎爆裂骨折后路间接减压与椎弓根固定技术的应用价值。方法 对42例无脊髓神经损伤伴有大骨块突入椎管的胸腰椎爆裂骨折患者行椎弓根螺钉内固定及后路间接减压术,未进行椎板切除,伤椎上下椎体与伤椎同时植钉进行撑开间接减压,术后随访观察伤椎椎体高度的恢复,节段后凸角的纠正,椎管内骨块复位情况以及有无神经损伤症状。结果 42例患者均获随访,术后平均随访30个月。间接减压患者伤椎前后缘高度分别是:术前53.8%、82.3%,术后91.7%、95.3%;节段后凸角分别是:术前27.1°,术后5.3°;椎管截面积术前平均51.2%,术后83.7％;术后各项指标与术前相比有差异(P＜0.01)。患者术后随访均无迟发性神经损伤发生。结论 对于椎管内骨块占位但无脊髓及神经损伤的胸腰椎爆裂骨折行后路间接减压椎弓根钉内固定可以达到良好的治疗效果。

Objective To investigate the effectiveness of posterior indirect decompression and internal fixation with pedicle screws in treating thoraclumbar burst fracture without spinal cord or nerve damage accompanied with Large bone protruding into the spinal canal. Methods 42 cases were treated with pedicle screw fixation and kept the lamina. Pedicle screws were inserted into injury vertebra and adjacent centrums, and braced them for indirect decompression at the same time. To observe the recovery of injured vertebral height, the correction of segmental kyphosis angle, the restoration of protruding bone fragment and presence of nerve injury symptoms. Results After the operation, the patients were followed up for average 30 months, by comparing indexes between preoperation and postoperation, indirect decompression patient's anterior and posterior flange height of vertebral body was 53.8% and 82.3% vs 91.7% and 95.3%, and the segmental kyphosis angle was 27.1° vs 5.3°, and the cross-sectional area of spinal canal was 51.2% vs 83.7% on average. There was a significant difference between the indexes of before and after the operation. In postoperation follow-up, no patient had delayed neurological damage. Conclusion Pedicle screw internal fixation with indirection decompression is an effective method to treat thoraclumbar burst fracture,with bone fragments in spinal canal and without nervous dysfunction.

目的 探讨内科治疗的高血压基底节区出血的疗效及预后相关的因素。方法 回顾性分析2005年4月—2014年12月贵阳市第二人民医院神经外科收治的174例高血压脑出血患者的临床资料,所有患者均采用内科保守治疗,对疗效及影响患者预后的因素进行分析。结果 174例患者中,死亡50例,持续植物生存状态4例,对124例存活患者进行随访,随访时间2~117个月,随访ADL分级Ⅰ级43例,Ⅱ级53例,Ⅲ级21例,Ⅳ级3例,Ⅴ级4例,预后较好者(ADL分级Ⅰ~Ⅱ级)96例,预后不良者(ADL分级Ⅲ~Ⅴ级)28例。χ²检验显示入院 GCS评分和出血量是影响患者预后的因素。结论 影响高血压基底节区脑出血患者的预后因素较多,GCS评分较高、出血量少的患者可采用内科治疗,多数患者预后较好。

Objective To investigate treatment efficacy and the factors influencing prognosis of conservative treatment of hypertensive intracerebral hemorrhage in basal ganglia. Methods A retrospective analysis was conducted on the clinical data of 174 patients with hypertensive intracerebral hemorrhage in basal ganglia who were admitted to our hospital during the period from April 2005 to December 2014. All the patients were given internal medicine conservative treatment and followed up to observe the clinical curative effect to analyze the prognosis. Results Of the 174 patients, 50 patients died and 4 patients were persistent vegetative state. 124 patients were followed up for 2-117 months and they were classified according to ability of daily life(ADL) prognosis scale: 43 cases were in I grade, 53 cases in II grade, 21 cases in III grade, 3 cases in IV grade, 4 cases in V grade. 96 cases achieved favourable outcomes and 28 cases got poor outcomes.The results of Chi square test revealed that GCS scale and intracerebral hemorrhage volume were the factors influencing prognostic of hypertensive intracerebral hemorrhage in basal ganglia. Conclusion There were many prognosis factors related with hypertensive intracerebral hemorrhage. The curative effect and prognosis in patients with conservative treatment is obvious in these patients with high GCS scale and less intracerebral hemorrhage volume.

目的 探讨CYP2C19不同基因分型对急性冠状动脉综合征(ACS)患者服用氯吡格雷后血小板聚集率的影响。方法 选取2015年1月—2016年3月入住心内科的ACS患者258例为研究对象。入院时及服用氯吡格雷三日后分别抽取静脉血检测血小板聚集率及CYP2C19基因型。结果 快代谢型组(extensive metabolisers, EM)和中代谢型组(intermediate metabolisers, IM)服药前后血小板最大聚集率分别为(58.76±15.45)% vs(35.17±10.26)%和(59.35±11.58)% vs(47.66±12.59)%(P<0.05), 而慢代谢型组(poor metabolisers, PM)的血小板最大聚集率无明显降低。快代谢型组的最大血小板聚集率的降低幅度比慢代谢型组大(23.58±12.39% vs 11.65±13.56%,P<0.05)。 共有33例(12.79%)患者为氯吡格雷抵抗, 其中快代谢型组中氯吡格雷抵抗者2例(1.67%), 中代谢型组中氯吡格雷抵抗者3例(2.80%), 慢代谢型组中氯吡格雷抵抗者28例(90.32%) (三组比较P=0.038)。结论 ACS患者CYP2C19基因分型与服用氯吡格雷后血小板最大聚集率有关,与氯吡格雷抵抗有关。

Objective To explore the relationship between platelet aggregation rate and CYP2C19 gene polymorphisms. Methods A total of 258 cases diagnosed as acute coronary syndrome (ACS) from January 2015 to March 2016. The platelet aggregation rate was tested before and 3 days after taking clopidogrel. CYP2C19 gene polymorphisms was tested by Gene chip hybridization technique. Results The platelet aggregation rate before and after taking clopidogrel was(58.76±15.45)% vs(35.17±10.26)% and(59.35±11.58)% vs(47.66±12.59)%(P<0.05)in EM group and IM group. But there was no change in PM group. The PM group were associated with a significant increase risk of clopidogrel resistance compared with EM group and IM group. Conclusion CYP2C19 gene polymorphisms influence the rate of platelet aggregation rate after taking clopidogrel and are associated with clopidogrel resistance in ACS patients.

目的 研究中药熏洗、中药离子导入加CPM综合疗法对膝关节功能障碍患者的作用效果。方法 从2014年4月—2016年4月,于我院共有78例膝关节功能障碍病患就诊。以数字法随机分成观察组(39例)和对照组(39例)。观察组给予中药熏洗以及中药离子导入再加以CPM综合疗法进行护理,对照组仅给予CPM综合疗法护理。观察两组患者护理后膝关节疼痛程度以及活动范围。结果 观察组患者膝关节功能优者占比51.28%,总有良率为84.62%,均高于对照组的25.64%,51.28%;观察组患者膝关节活动范围优者占比51.28%,总优良率为89.74%,均高于对照组的28.21%,66.67%;观察组患者WOMAC评分中膝关节疼痛以及膝关节僵硬和膝关节功能得分均低于对照组,WOMAC总分也低于对照组,差异均有统计学意义(P均＜0.05)。结论 中药熏洗、中药离子导入加CPM综合疗法能显著改善患者膝关节功能,增加活动度数,减轻疼痛等级,值得临床推广使用。

Objective To study the effect of traditional Chinese medicine fumigation, traditional Chinese medicine iontophoresis combined with CPM combined therapy on patients with knee joint dysfunction. Methods From April 2014 to April 2016, in our hospital there were a total of 78 cases of knee joint dysfunction disease patient treatment. With digital method they were randomly divided into observation group (39 cases) and control group (39 cases). The observation group was treated with Chinese herbal fumigation and washing and Chinese medicine iontophoresis and CPM combined therapy nursing, control group only received CPM combined therapy nursing. Observation of nursing care of the patients in the two groups were knee pain and range of motion. Results The observation group of patients with knee joint function was accounted for than 51.28%. The total yield was 84.62%. They were significantly higher than those in the control group of 25.64%, 51.28%; Observation group of patients with knee joint range of motion was accounted for than 51.28%. The total excellent and good rate was 89.74%, were significantly higher than those in the control group of 28.21%, 66.67%; Observation group, WOMAC score of knee pain and knee stiffness and knee joint function score were significantly lower than those of the control group. WOMAC score was significantly lower than that of the control group. The differences were statistically significant (P<0.05). Conclusion Traditional Chinese medicine fumigation, traditional Chinese medicine iontophoresis combined with CPM therapy could significantly improve the patient's knee function, increase the degree of activity, reduce the pain level. It is worth to have clinical application.

目的 探讨初诊的弥漫大B细胞淋巴瘤(DLBCL)患者外周血Th17细胞的表达与国际预后指标(IPI)之间关系。方法 初诊DLBCL组(n=45)按照国际预后指数(IPI)积分分为4组,采用ELISA和流式细胞术检测各个DLBCL组与正常对照组(n=43)的外周血中IL-17的浓度以及Th17阳性细胞比例,比较各组数值间的差异,并分析IPI的5个指标与IL-17的浓度以及Th17阳性细胞比例的相关性。结果 DLBCL中高危组与高危组的IL-17的浓度以及Th17阳性细胞比例较正常对照组及其他IPI组降低,有显著性差异;DLBCL四组的IL-17的浓度以及Th17阳性细胞比例均低于正常对照组;且可见随着IPI分组的增高,IL-17的浓度以及Th17阳性细胞比例呈降低的趋势;IPI指标中年龄、临床分期、全身状态与Th17细胞的表达有相关性。结论 初诊DLBCL患者外周血Th17细胞的表达与国际预后指标有关系;随着IPI积分的增加,DLBCL患者Th17细胞表达下降;临床上对于年龄60岁以上、临床分期Ⅲ期以上、长期卧床及需别人照顾的患者更要注意监测其外周血Th17细胞的表达情况。

Objective To explore the relationship between the international prognosis indexes(IPI) and the Th17 cells expression in DLBCL patients. Methods DLBCL patients (n=45) were divided into 4 groups according to IPI score, peripheral blood were taken from each person in DLBCL groups and normal group. We used ELISA to test IL-17 and flow cytometry (FCM) to examine the Th17 positive cells. We compared the value of each group, and analyzed the relativity of IPI and Th17 cells' expression. Results Th17 cells' expression level in middle-high risk group and high risk group were higher than that in normal group and other IPI groups; Th17 cells' expression level in DLBCL groups were all lower than that in normal group; Th17 cells decreased while IPI score increased; Age, clinical stage and general body state have the relativity with DLBCL patients' Th17 cells expression level. Conclusion Th17 cells in DLBCL patients has the relativity with prognosis index. In our clinical diagnosis and treatment, we need to pay more attention to those patients who are over 60 years old, or whose clinical stage is above Ⅲ phase, or who need to stay on bed for a long time and need other peoples' help .

目的 了解新疆生产建设兵团第三师图木舒克市不同民族Rh血型分布情况及人群Rh血型知识知晓率。方法 2015年6月—2016年2月通过自行设计调查问卷,在全师随机对1325人进行匿名式问卷调查,了解受访者的血型知识知晓率及民族间的差异等信息。结果 有效问卷1259份,调查对象年龄范围18~95岁,平均年龄(56.57±38.34)岁。维吾尔族人Rh阴性血型比例为3.5%(24/677),高于汉族人Rh阴性血型比例0.7%(2/275,P<0.05)。人群整体Rh血型知晓率为53.5%。汉族人Rh血型知识知晓率高于维吾尔族人(P<0.05)。40~49岁年龄组的人群Rh血型知识知晓率较高于其他年龄组(P<0.05)。结论 维吾尔族人群的具有Rh阴性血型的比例高于汉族人,第三师图木舒克市人群的Rh血型知识知晓率偏低,需要进一步在人群中宣传Rh血型知识。

Objective To explore the distribution and awareness rate of Rh blood types for the different nations in Tumushuke City, the location of the third division of Xinjiang Production and Construction Corps. Methods Questionnaire was performed to get the information of distribution and awareness rate of Rh blood types for the different nations during from June of 2015 to February of 2016 in Tumushuke City, and 1325 respondents in total were interviewed. Results There were 1259 respondents with valid questionnaire who aged from 18 to 95 years old, with the average age of (56.57±38.34) years old. The Rh negative rate in Uyghur nationality was 3.5% (24/677), which was significantly higher than that of the Han's 0.7% (2/275, P<0.05). The total awareness rate of all the respondents was 53.5%, and the awareness rate of Han nationality was significantly higher than that of Uyghur ones (P<0.05). The awareness rate of the group who aged from 40 to 49 years old was apparently higher than that of the other age groups (P<0. 05). Conclusion The rate of Rh negative was higher in Uyghur nationality when compared to Han nationality. The awareness rate of Rh blood types is still low in Tumushuke City, where the health education is required.

目的 构建重组pEGFP-C3-HCVc真核表达载体,并建立稳定表达HCVc基因的肝内胆管癌细胞株RBE-core。方法 采用PCR钓取目的基因HCVc,并克隆入pEGFP-C3的多克隆位点,构建pEGFP-C3-HCVc重组质粒。经过双酶切及测序验证后,采用脂质体将pEGFP-C3-HCVc质粒转染到RBE细胞中,经2周G418 (200 μg/mL) 筛选后进行单克隆挑选及扩大培养,建立稳定表达HCVc的胆管癌细胞株RBE-core。采用RT-PCR和Western blot验证HCVc在RBE-core中的表达情况。结果 PCR成功钓取HCVc基因,大小约573 bp,并插入pEGFP-C3载体HindⅢ和BamHⅠ多克隆位点;双酶切及测序证实目的基因HCVc正确连接到pEGFP-C3的多克隆位点。RT-PCR和Western blot分别在573 bp处和34 KD左右检测到相应的阳性条带。结论 成功构建重组质粒pEGFP-C3-HCVc,并在胆管癌细胞RBE中获得稳定表达。

Objective To construct a recombinant plasmid of pEGFP-C3-HCVc containing hepatitis C virus core protein, and establish the HCVc-expressing cell line RBE-core. Methods The HCVc gene was amplified by PCR and cloned into HindⅢ and BamHⅠsite of pEGFP-C3 plasmid. The recombinant plasmid of pEGFP-C3-HCVc was confirmed by sequencing. RBE cells were transfected with the recombinant plasmid by using Lipofectamine 2000, and then performed G418 (200 μg/mL) selection after 2 weeks. The expressing of HCVc gene in RBE cells was confirmed by RT-RCR and western blot. Results The recombinant plasmid of pEGFP-C3-HCVc was successfully constructed. RT-PCR and western blot detected a 573bp and 34KD bland, indicating the stably expressing of HCVc in RBE cells. Conclusion The recombinant plasmid of pEGFP-C3-HCVc is stabled expressing in RBE cells,which provides support for the further study.