目的 分析应用蓝激光成像技术(BLI)联合内镜智能分光比色技术(FICE)诊断早期食管癌的临床意义。方法 收集本院及下级医院2016年1月—2018年6月在普通内镜下发现的108例食管可疑病变患者,分别给予白光、FICE和BLI不同模式进行观察诊断,再结合放大模式对病变部位的上皮乳头内毛细血管袢(IPCL)进行观察、分型、判断性质。最后取活检送病理学检查。内镜数据和病理数据采用Kappa一致性检验方法、Spearman相关性分析,统计每种内镜检查模式诊断的准确性,分析各方法下IPCL分型与病理诊断之间的相关性。结果 Kappa一致性检验显示,白光内镜、FICE、BLI以及FICE+BLI等模式诊断早期食管癌的准确度、敏感度、特异度、阳性预测、阴性预测及Kappa值呈逐步升高;Spearman相关性分析显示,FICE、BLI以及BLI与FICE联合诊断时,IPCL分型与早期食管癌的诊断均呈正相关,且BLI联合FICE的相关性强于BLI或FICE单独诊断。结论 BLI联合FICE可显著提高早期食管癌的诊断率,结合放大内镜下IPCL分型可判断早期食管癌病理分型。

Objective To analyze the clinical significance of blue laser imaging (BLI)technology combined with Fuji intelligent chromo endoscopy (FICE)in the diagnosis of early esophageal cancer. Methods 108 cases of patients with esophageal suspicious lesions admitted to our hospital from January 2016 to June 2018 were enrolled in the study. They were given different modes of white light, FICE and BLI for observation and diagnosis, and the magnifying endoscopy model was combined to observe the intraepithelial papillary capillary loop (IPCL)at lesions sites for IPCL typing. After complete endoscopic examinations, the lesions were taken for pathological examination. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of each method were tested by Kappa consistency test. Spearman correlation analysis was used to analyze the correlation between IPCL classification and pathological diagnosis under each method. Results Kappa consistency test showed that the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of white light endoscopy, FICE, BLI and FICE+BLI were increased in the diagnosis of early esophageal cancer. IPCL classification under combined magnifying endoscopy showed that type IV was mainly early esophageal cancer, and types I-III were mainly precancerous lesions. Spearman correlation analysis showed that through FICE, BLI and BLI combined with FICE for diagnosis, IPCL classification was positively correlated with early esophageal cancer, and the correlation of BLI combined with FICE was stronger than that of BLI or FICE. Conclusions BLI combined with FICE can greatly improve the diagnosis rate of early esophageal cancer. Combined with magnifying endoscopy, IPCL classification can judge the pathological types of early esophageal cancer.

目的 分析小儿葫芦散应用于儿童喘息性支气管炎中的治疗效果。方法 在我院2015年8月—2018年12月诊治的喘息性支气管炎患儿中选取68例,并严格按照系统随机分配原则分为对照组和观察组,各34例。其中对照组采用常规治疗,观察组采用小儿葫芦散治疗,观察对比两组患儿治疗效果和临床症状消失时间。结果 对照组总有效率为76.47%,观察组总有效率为94.12%,对照组总有效率低于观察组,且对照组临床症状消失时间均长于观察组,差异有统计学意义(P<0.05)。结论 小儿葫芦散应用于喘息性支气管炎患儿中具有显著疗效,进一步改善肺功能情况,促进患儿康复,值得推广。

目的 探讨非霍奇金淋巴瘤(NHL)合并HBV感染患者化疗过程中肝功能监测的临床意义。方法 以2014年3月—2016年6月我院21例NHL合并HBV感染患者为研究对象,所有患者采用CHOP方案进行化疗,治疗2~6周期。 分别于化疗前后对患者肝功能进行检查,采用荧光定量PCR法进行乙肝病毒DNA复制情况检测;肝功能出现中重度异常患者进一步测定凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fb)等,同时对NHL辅助性标志物进行监测,主要包括β₂微球蛋白(β₂-MG)及乳酸脱氢酶(LDH)。结果 随着化疗进行,患者ALT、GLB、胆红素水平逐渐增高(P<0.05),ALB、PA水平逐渐降低(P<0.05);相比于化疗进行2个周期,进行4～6周化疗者肝功能损害率和重症肝炎发生率均升高,差异有统计学意义(P<0.05)。结论 NHL合并HBV感染患者化疗过程中对肝功能监测,有助于防止重症肝炎发生,并降低病死率,具有重要临床意义。

目的 探究聚乙二醇筛查法在高泌乳血症诊断中的临床意义。方法 选取260例HP患者作为观察组以及80例健康体检者作为对照组。应用雅培I2000全自动化学发光检测仪对两组标本进行PRL浓度测定,并将标本进行PEG筛查法沉淀后再次进行PRL浓度测定,将所得数据进行对比。结果 观察组检出MP67例,检出率25.77%,对照组检出MP3例,检出率3.75%,二者差异有统计学意义(P＜0.05);HP组、MP组和对照组之间PEG沉淀前PRL浓度差异有统计学意义(P＜0.05),沉淀后HP组和MP组以及对照组差异有统计学意义(P＜0.05),MP组和对照组差异无统计学意义(P＞0.05);MP在HP引起的各种临床疾病中检出情况差异无统计学意义(P＞0.05)。结论 应用聚乙二醇筛查法对于排除MPRL对HP诊断的干扰具有可行性,对降低HP的误诊率有着重要的意义。

Objective To explore the clinical signification of polyethylene glycol screening method on the diagnosis of hyperprolactinemiat.Methods We selected 260 patients with hyperprolactinemia as observation group and 80 healthy individuals as control group. The two groups were measured with Abbott laboratories I2000 automatic chemiluminescence detector about the concentration of PRL. Then the groups were measured again after they were precipitated by the polyethylene glycol and the result data were analyzed.Results 78 cases of MP were checked out from the observation group and 3 cases were checked out from the control group. The proportion was 25.77% and 3.75% respectively, and the differences were statistically significant (P＜0.05). The difference of the concentration of PRL before precipitated by PEG among the HP group, the MP group and the control group were statistically significant (P＜0.05). After precipitating, the difference of the concentration of PRL between the HP group and the MP group were statistically significant (P＜0.05), as well as the HP group and the control group. However, there was no difference between the MP group and the control group (P＞0.05). The checking conditions of MP in some diseases caused by HP had no difference(P＞0.05).Conclusion The use of polyethylene glycol screening method is a practicable method to eliminate the interference of MPRL on the diagnosis in HP. It has significance reducing misdiagnosis rate of HP.

目的 探讨急性心衰(AHF)患者NTpro-BNP,cTnI,hs-CRP的变化及其临床意义。方法 分别选取342例AHF患者和30例同期健康查体者作为观察组和对照组。统计2组NTpro-BNP,cTnI,hs-CRP及LVEF水平及随访期间死亡率。分析患者NTpro-BNP,cTnI,hs-CRP与其LVEF的关系及其联合预测患者死亡率的价值。结果 观察组NTpro-BNP,cTnI,hs-CRP均较对照组升高,LVEF则较对照组降低;与T₀比较,患者T₂、T₃、T₄的NTpro-BNP,cTnI,hs-CRP均降低,LVEF则升高;心衰较严重患者其NTpro-BNP,cTnI,hs-CRP较高,LVEF则较低(P<0.05)。观察组存活患者NTpro-BNP,cTnI,hs-CRP较低,LVEF则较高(P<0.05)。AHF患者NTpro-BNP,cTnI,hs-CRP与其LVEF均呈负相关且预测预后的价值良好。结论 AHF患者NTpro-BNP,cTnI,hs-CRP与其心功能相关且其联合预测预后的价值较高,可能作为AHF患者心功能及患者预后评估的参考指标。

Objective To study the NTpro-BNP, cTnI and hs-CRP changes of patients with acute heart failure(AHF)and its clinical significance. Methods 342 patients with AHF and 30 healthy persons were selected as observation group and control group. NTpro-BNP, cTnI, hs-CRP and LVEF level of two groups and mortality during the follow-up period were analyzed. Relationship between NTpro-BNP, cTnI, hs-CRP and LVEF, and value of them unitedly predicting mortality of patients were analyzed. Results NTpro-BNP, cTnI, hs-CRP of observation group were higher than that of the control group while LVEF was lower than that of the control group; Compared with T₀, NTpro-BNP, cTnI, hs-CRP of observation group in T₂, T₃, T₄ were reduced while LVEF increased; Patients with more serious heart failure had higher NTpro-BNP, cTnI, hs-CRP and lower LVEF (P<0.05). NTpro-BNP, cTnI, hs- CRP of survived patients in observation group were lower while LVEF was higher(P<0.05). NTpro-BNP,cTnI and hs-CRP of AHF patients were negative correlated with LVEF and value of them predicting good prognosis. Conclusion NTpro-BNP, cTnI, hs-CRP of AHF patients are related to its heart function and the value of them unitedly predicting prognosis is good, thus they may used cardiac function and prognosis evaluation reference index of AHF patient.

目的 探讨系统性红斑狼疮(SLE)患者外周血中25-羟基维生素D(25-OH-D)和白介素-17(IL-17)水平的变化及其临床意义。方法 选取40例SLE患者作为研究对象, 20例健康体检人员为健康对照组。运用电化学发光法检测25-OH-D水平,酶联免疫吸附法检测IL-17水平。结果 SLE患者25-OH-D水平明显低于健康对照组(P<0.01),活动期SLE患者25-OH-D水平明显低于缓解期患者(P<0.01)。SLE患者IL-17水平明显升高(P<0.01)。低25-OH-D水平与肾损害(P<0.01)相关,与疾病活动度评分(SLEDAI评分)(r=-0.844,P<0.01)及IL-17水平(r=-0.596,P<0.01)负相关。结论 SLE患者25-OH-D水平降低,低25-OH-D水平与肾损害、病情活动及高IL-17水平相关,25-OH-D可能参与了SLE的炎症进程。

Objective To assess the 25-hydroxyvitamin D (25-OH-D) and interleukin-17(IL-17) status in patients with systemic lupus erythematosus(SLE) and its clinical significance. Methods 40 SLE patients along with 20 matched controls were collected. Chemilumineseent immunoassay (CLIA) was used to detect the levers of serum 25-OH-D. The levels of serum IL-17 were evaluated using enzyme-linked immunosorbent assay (ELISA). Results Serum 25-OH-D level in SLE patients was significantly lower than in healthy controls (P<0.01). Serum 25-OH-D level in active SLE patients was significantly lower than in inactive SLE patients (P<0.01). Lever of IL-17 was significantly higher in SLE patients than in healthy controls (P<0.01). Insufficiency of 25-OH-D was related to renal disorders. Serum 25-OH-D level was negatively correlated with systemic lupus erythematosus disease activity index (SLEDAI) scores(r=-0.844, P<0.01)and serum levels of IL-17(r=-0.596, P<0.01). Conclusion Insufficiency of 25-OH-D is prevalent in SLE patients. It is associated with nephritis, disease activity and high serum levels of IL-17, thus it may play an important part in the inflammatory process in SLE.

目的 探讨血清铁蛋白及超敏C反应蛋白联合检测对急性脑出血患者的临床意义。方法 2012年1月—2015年12月,自发性脑出血的患者77例,男42例,女35例;年龄45～82 a,平均年龄(67.19±10.17)a。根据Rankin 评分将患者分成两组,A组,MRS≤2分,预后良好; B组,MRS＞2分,预后差;另选取同期健康体检者35例作为健康对照组,即C组。分别于入院时、发病后第3天、7天、14天时,采静脉血化验血常规、Hs-CRP及SF;于入院时和发病后第3天时,进行头颅CT检查。采用美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS) 分别于入院及随访12个月时,对两组患者神经功能损伤及恢复情况进行评估。结果 77例脑出血患者在发病12个月随访时, 53例患者MRS≤2分,预后良好;24例患者MRS＞2分,预后较差。于入院时、发病后第3天、7天、14天,脑出血患者的Hs-CRP及SF水平均显著高于健康体检人员,差异具有统计学意义(P<0.05);在各时间点脑出血患者中的预后较差组Hs-CRP及SF水平均不同程度高于预后良好组;但在入院发病后第3天则显著高于预后良好组,差异具有统计学意义(P<0.05),同时,脑出血患者中的预后较差组脑水肿量及水肿系数均显著高于预后良好组,差异具有统计学意义(P<0.05)。影响脑出血预后的独立危险因素包括NIHSS评分(P=0.012),Hs-CRP(P=0.027)和SF水平(P=0.041)。结论 Hs-CRP及SF水平在一定程度上可作为脑出血预后的重要评估指标。

Objective To investigate the clinical significance of combined detection of serum ferritin and high sensitive C reactive protein in patients with acute cerebral hemorrhage. Methods From January 2012 to December 2013, 77 cases with cerebral hemorrhage male 42, female 35; aged 45 to 82 year old, average age (67.19±10.17)years old. According to MRS(Modified Rankin Scale) score criteria, patients were divided into good prognosis group(group A) with MRS ≤2, and poor prognosis group (group B)with MRS ＞2. Another 35 cases of healthy physical examination were selected as the healthy control group(group C). RT(Routine blood test), Serum Ferritin(SF)and Hs-CRP were tested at the time of admission, the third, the seventh and the fourteenth day from onset of the disease respectively. Head CT were done at the time of admission, the third day from onset of the disease respectively. Neurological assessment were scored according to the NIHSS criteria(National Institutes of Health Stroke Scale) for the patients in the two groups at the time of admission and 12 months of follow up. Results 77 cases of cerebral hemorrhage were followed up for 12 months, 53 cases with MRS ≤2, the prognosis was good; And 24 cases with MRS >2, the prognosis was poor. The levels of Hs-CRP and SF were all higher in patients with cerebral hemorrhage than that in healthy control group (P<0.05) at the time of admission, the third day,seventh and fourteen day from onset of the disease respectively. The levels of Hs-CRP and SF were higher in group B than that in control group at the time of admission, the third day, the seventh day and the fourteenth day from onset of the disease respectively, but only at the time of admission, three days from onset of the disease, the difference was statistically significant (P<0.05). At the same time, the brain edema and edema index in the group B were higher than those in group A. The independent risk factors influencing the prognosis of cerebral hemorrhage were NIHSS score (P=0.012), Hs-CRP(P=0.027) and SF(P=0.041). Conclusion Hs-CRP and SF may be important indicators of the prognosis for cerebral hemorrhage in a certain degree.

目的 分析PBK在前列腺癌中的表达及临床意义。方法 利用前列腺癌的组织芯片,包含98例前列腺癌及81例对照癌旁组织作为研究对象,免疫组化方法检测PBK的表达情况,并运用统计学方法分析免疫组化芯片及Taylor数据库中PBK表达与前列腺癌临床病理特征之间的关系。结果 PBK在前列腺癌中表达明显升高(P=0.001);且在Gleason高评分组的表达比低评分组表达升高(P=0.001)。Taylor数据库得到相似结果,且运用Kaplan-Meier分析发现PBK与无生化复发生存率显著相关(P=0.007),最后采用Cox回归模型进行多因素综合分析发现在影响前列腺癌预后的队列中,PBK高表达(P=0.041)与Gleason评分、病理分期都是前列腺癌生化复发的独立预测指标。结论 PBK的表达与前列腺癌密切相关,可作为临床诊断及治疗的分子标志物。

Objective To investigate the expression and clinical significance of PBK in prostate cancer. Methods Using tissue microarrays of prostate cancer, which including 98 cases of prostate cancer and 81 cases of normal tissue adjacent to cancer as the research object, the expression of PBK was detected by immunohistochemistry, and statistical analysis was used to analyze the relationship between the expression of PBK and the clinicopathological features of prostate cancer in the microarray and Taylor database. Results The expression of PBK in prostate cancer was significantly higher (P=0.001), and the expression increased in the group of high Gleason score (P=0.001). The Taylor database obtained similar results, and Kaplan-Meier analysis showed that PBK was significantly correlated with the biochemical recurrence free survival (P=0.007). Finally, Cox regression model was used to analyze the prognostic factors of prostate cancer. Result shows that, the high expression of PBK (P=0.041), Gleason score and pathological stage were independent predictors of biochemical recurrence of prostate cancer. Conclusion The expression of PBK is closely related to prostate cancer, and can be used as a molecular marker for clinical diagnosis and treatment.

目的 探讨不稳定型心绞痛伴左心收缩功能不全患者血清脑钠肽前体(Pro-BNP)、同型半胱氨酸(Hcy) 和血沉(ESR)的表达与临床意义。方法 选取2015年1月—2016年10月于广州市第一人民医院心血管内科就诊的130例不稳定型心绞痛(A组) 、130例不稳定型心绞痛伴左心收缩功能不全(B组)患者作为研究对象,同时选取同期130例健康体检者(C组)作为对照。分别检测3组受试者的血清Pro-BNP、Hcy、ESR水平,并用方差分析对3组血清水平进行比较;通过Pearson相关分析比较B组患者的血清Pro-BNP、Hcy和ESR水平与左心室射血分数(LVEF)的相关性。结果 不稳定型心绞痛患者和不稳定型心绞痛伴左心收缩功能不全患者的Pro-BNP、Hcy、ESR水平均明显高于对照组,不稳定型心绞痛伴左心收缩功能不全患者的Pro-BNP、Hcy、ESR水平明显高于不稳定型心绞痛患者血清水平。随着心功能分级的升高,患者的血清Pro-BNP、Hcy和ESR水平呈明显上升趋势。血清Pro-BNP、Hcy、ESR水平与 LVEF 呈负相关,血清 Hcy、ESR水平与Pro-BNP水平呈正相关。结论 不稳定型心绞痛伴左心收缩功能不全患者血清Pro-BNP、Hcy、ESR水平与心功能分级明显相关,可作为不稳定型心绞痛伴左心收缩功能不全病情评估及预后判断的重要指标。

Objective To investigate the expressions and clinical significances of atrial brain natriuretic peptide precursor (PRO-BNP), homocysteine (Hcy) and erythrocyte sedimentation rate (ESR) in patients with unstable angina pectoris associated by Left ventricular systolic insufficiency. Methods A total of 130 patients with simple unstable angina pectoris and another 130 patients with unstable angina pectoris associated by left ventricular systolic insufficiency treated during January 2015 and October 2016 were selected as group A and group B respectively,and at the same period,130 healthy persons taking medical examination were selected as the control froup (group C). Serum levels of PRO-BNP,Hcy and ESR were detected in three groups,and the correlation between serums PRO-BNP,Hcy and ESR and left ventricular ejection fraction (LVEF) in group B were analyzed. Results Serum levels of in group A and B were significantly higher than those in group C,and the levels in group B were significantly higher than those in group A. In group B,serum levels of PRO-BNP,Hcy and ESR were significantly increased with rising cardiac function classification. Serum levels of PRO-BNP,Hcy and ESR in group B were negatively correlated with LVEF,but serum levels of Hcy and ESR were positively correlated with PRO-BNP level. Conclusion Serum levels of PRO-BNP,Hcy and ESR in group A and B are significantly correlated with cardiac function in patients with unstable angina pectoris associated by left ventricular systolic insufficiency,so the levels may be used as important indexes for evaluating the severity and prognosis of with unstable angina pectoris associated by left ventricular systolic insufficiency.

目的 探讨脑钠肽(BNP)在协助判断肺结核合并呼吸衰竭疗效及预后的价值。方法 2013年1月—2014年12月我院收治初治菌阳肺结核合并呼衰共81例,分别在抗结核、呼衰治疗前及2 周末行BNP、动脉血气分析及胸部X线检查;按住院号对应随机数字表随机抽取我院同期初治菌阳肺结核无合并呼衰104例作为对照组,采集两组数据进行回顾性病例对照研究。结果 肺结核合并呼衰BNP高于单纯肺结核11.4倍(1115.11 pg/mL比97.60 pg/mL),全肺结核高于非全肺结核3.4倍(1549.82 pg/mL比449.47 pg/mL)。治疗前BNP与PaO₂、SaO₂和pH值呈负相关,与PaCO₂呈正相关,治疗后两者无相关性。2周末 BNP是治疗前0.57倍(632.41 pg/mL比1115.11 pg/mL),死亡组高于存活组8.7倍(3119.63 pg/mL比359.84 pg/mL)。结论 肺结核合并呼衰BNP升高,治疗后随病情好转持续下降,有可能成为协助判断疗效及估测预后的指标之一。

Objective Discussion about value of brain natriuretic peptide (BNP) in helping to determine the efficacy and prognostic of pulmonary tuberculosis combine with respiratory failure. Methods 81 cases were admitted from January 2013 to December 2014 in our hospital of early treatment sputum positive pulmonary tuberculosis with respiratory failure. And the cases were carried out BNP, arterial blood gas analysis and chest X-ray before treatment and after two weeks respectively.104 cases of earlier sputum positive pulmonary tuberculosis accompanied with respiratory failure were randomly drawn according to the corresponding random number of hospitalization as a control group. Two sets of data were collected to conduct retrospective case-control study. Results BNP of pulmonary tuberculosis combine with respiratory failure is 11.4 times higher than that of tuberculosis alone (1115.11 pg/mL compare 97.60 pg/mL), the whole TB is 3.4 times higher than non-full-tuberculosis (1549.82 pg/mL t compare 449.47 pg/mL). Before treatment, BNP was negatively correlated to PaO₂, SaO₂ and pH BNP was positively correlated with PaCO₂. There was no correlation after treatment between BNP and PaCO₂.After two weeks BNP is 0.57 times of the pre-treatment (632.41 pg/mL compared 1115.11 pg/mL). The group of death is 8.7 times higher than the survival group (3119.63 pg/mL compared 359.84 pg/mL). Conclusion BNP was significantly increased in patient accompanied tuberculosis with respiratory failure .The condition is continued to decline after treatment. There is likely to be one of the indicators of helping to determine the efficacy and estimate prognosis.