目的 探讨中性粒细胞及淋巴细胞比值与急性冠状动脉综合征、冠状动脉狭窄程度的相关性。方法 选取2019年2月—2020年2月我院收治的急性冠状动脉综合征患者90例作为研究对象,根据检查结果将患者分为两组,分别为不稳定心绞痛组(51例)、急性心肌梗死组(39例),同时选取同期在我院检查且没有明显狭窄的患者52例作为对照组。对三组人群的中性粒细胞-淋巴细胞比值进行测定。比较三组人群中性粒细胞-淋巴细胞比值(NLR)、冠状动脉病变(Gensini)评分、不同冠状动脉病变狭窄患者NLR、Gensini评分、分析中性粒细胞-淋巴细胞比值与急性冠状动脉综合征、冠状动脉狭窄程度的相关性。结果 急性心肌梗死组NLR值大于不稳定心绞痛组、对照组(P＜0.05),急性心肌梗死组Gensini评分高于不稳定心绞痛组、对照组(P＜0.05);重度冠状动脉病变狭窄组NLR值大于中度狭窄组、轻度狭窄组(P＜0.05),重度冠状动脉病变狭窄患者Gensini评分高于中度狭窄组、轻度狭窄组(P＜0.05);NLR与急性冠状动脉综合征、冠状动脉狭窄程度呈正相关(r=0.236,P＜0.05;r=0.214,P＜0.05)。结论 中性粒细胞-淋巴细胞比值与急性冠状动脉综合征有明显的关系,且可以对患者的冠状动脉狭窄程度进行判断。

目的 分析重症流感相关性脑病患儿的临床特点及诊治要点。方法 回顾性分析2017年5月—2020年4月收入我院PICU的17例重症流感相关性脑病患儿的临床资料进行回顾性分析。结果 17例患儿中男性10例、女性7例,起病年龄3(2～5)岁。所有患儿均出现发热,1(0～3.5)天后出现神经系统症状,包括惊厥发作(88%)和昏迷(88%)。头颅影像学检查病变主要分布在丘脑、脑干、髓质脑室周围白质,呈对称性和多灶性改变。经颅多普勒检查出现脑血流速度减慢呈震荡波、钉子波的5例患儿均死亡。16例患儿予机械通气,2例予连续性肾替代治疗,死亡8例,存活者出院前均遗留不同程度神经系统损害。结论 儿童重症流感相关性脑病以发热、惊厥和昏迷为主要表现,头颅影像学及脑电图、经颅多普勒等检查有助于早期诊断和预后判断,早期联合应用甲强龙冲击及IVIG的有效性仍需进一步研究。

Objective To analyze the characteristics, diagnosis and treatment of severe influenza-associated encephalopathy in children. Methods The clinical data of 17 children with severe influenza-associated encephalopathy admitted to PICU from May 2017 to April 2020 were retrospectively analyzed. Results Among the 17 cases, 10 were male and 7 were female, and the onset age was 3 (2-5) years old. All children developed fever, and neurological symptoms 1 (0-3.5) days later, including seizures (88%) and coma (88%). The lesions were mainly distributed in the thalamus, brainstem and medullary ventricular white matter, showing symmetry and multifocal changes. All the 5 cases with slowed cerebral blood flow velocity and presented shock wave or nail wave died. 16 children were on mechanical ventilation, 2 with continuous renal replacement therapy, and 8 died. All the survivors had varying degrees of neurological damage before discharge. Conclusion Severe influenza-associated encephalopathy of childhood is mainly characterized by fever, convulsions and coma. Cranial imaging, EEG, TCD and other examinations are helpful for early diagnosis and prognosis judgment. The effectiveness of early combined application of methylprednisolone and IVIG still needs further study.

目的 研究探讨体质指数和体脂百分比与老年类风湿关节炎患者发生肌少症的相关性。方法 纳入2018 年1月— 2020 年 6 月我院治疗的230例RA患者以及110例正常体检人员,分别设为研究组与对照组。采用双能X线骨密度仪测定骨骼肌肉量,四肢骨骼肌总量,体脂百分比(PBF),计算骨骼肌质量指数(SMI),体质指数(BMI);根据SMI水平将RA患者分为有、无肌少症组,比较两间组指标差异,采用Logistics回归分析探讨RA患者合并肌少症的独立影响因素。结果 ①RA组患者肌少症发生率高于对照组(49.1％ vs 18.2％,χ²=29.927,P＜0.001)。RA组患者消瘦百分比高于对照组(20.9％ vs 8％,χ²=5.375,P=0.020), RA组与正常对照组间BMI分组构成比比较差异有统计学意义(χ²=8.157,P=0.043)。②RA组BMI、骨骼肌量及四肢骨骼肌量均低于对照组,差异有统计学意义(P＜0.05),体脂百分比高于对照组,差异有统计学意义(P＜0.05)。③RA消瘦组肌少症发生率高于正常组(χ²=10.716,P＜0.001)、超重组(χ²=28.073,P＜0.001)和肥胖组(χ²=11.601,P＜0.001);RA消瘦组、正常组、超重组、肥胖组间肌少症发生率差异有统计学意义(χ²=32.522,P＜0.001)。PBF分组肌少症发生率正常组高于超重组,差异无统计学意义(χ²=2.609,P=0.016)。④RA肌少症组BMI消瘦百分比高于无肌少症组(22.1％ vs 3.4％,χ²=40.593,P＜0.001),BMI正常百分比高于无肌少症组(60.1％vs 51.3％,χ²=1.843,P=0.175);BMI超重百分比低于无肌少症组(15.0％ vs 39.3％,χ²=33.895,P＜0.001), BMI肥胖百分比低于无肌少症组(2.6％ vs 6.0％,χ²=1.531,P=0.216)。两组间PBF构成比比较差异无统计学意义(χ²=2.609,P=0.106)。⑤RA消瘦组患者肌少症的发生风险高于正常组(OR=7.197,95％CI:3.103～23.614,P＜0.001),超重RA患者肌少症的发生风险低于正常组(OR=0.095,95％CI:0.036～0.268,P=0.026),年龄为RA患者发生肌少症的危险因素(OR=1.096,95％CI:1.015～1.390,P＜0.001)。结论 肌少症在老年RA患者中发病率高,与体质指数具有一定相关性。

目的 探讨儿童贫血与血红蛋白等因素的相关性。方法 选取2017年7月——2019年5月于天津市河东区6月龄至5岁以下的儿童作为研究对象参与血红蛋白的检测,剔除重复值及缺失值后,共纳入453例儿童,根据儿童血红蛋白水平将儿童分为贫血组及健康组,对儿童家属进行相关问卷调查,通过Logistic回归分析探讨儿童贫血的影响因素。结果 该社区453例儿童中贫血儿童116例,贫血检出率为25.61%,Hb含量为(125.34±13.75)g/L。贫血组及健康组儿童月龄、主要照顾者、照顾者对喂养知识的知晓率、出生6个月后的喂养方式及添加辅食年龄比较差异具有统计学意义(P＜0.05)。多因素分析结果显示:6~＜12个月、照顾者对喂养知识的知晓＜60%、出生6个月后混合喂养、4~6个月添加辅食均为影响儿童发生贫血的危险因素(OR=2.78、3.82、3.90、3.50)。结论 天津市河东区儿童的贫血情况较为严重,政府相关机构应制定相关的营养改善政策,加大有关儿童正确喂养知识的宣传,同时,医疗机构应对贫血儿童做好相应的健康检查,完善父母的公共卫生教育工作。

目的 探讨精神分裂症患者亚甲基四氢叶酸还原酶 (MTHFR)基因多态性、血浆HCY水平与心血管疾病发生风险的相关性。方法 收集住院精神分裂症患者164例,记录一般资料和测定患者MTHFR C677T基因多态性、血浆同型半胱氨酸(HCY)水平、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、Framingham心血管疾病发生风险评分(FRS)等指标。其中10年心血管疾病发生风险用 Framingham心血管疾病风险评分表来计算。结果 1.CC、CT、TT基因型血浆HCY水平呈增高趋势,差异有统计学意义(P<0.001);CC基因型和CT基因型血浆HCY水平与FRS评分呈正相关关系(r_s=0.27,P=0.016;r_s=0.42,P=0.002);TT基因型血浆HCY水平与FRS评分之间无相关性(r_s=0.05,P=0.784)。2.低、中、高风险组的血浆HCY水平差异无统计学意义;低风险组和中风险组血浆HCY水平与FRS评分呈正相关关系(r_s=0.29,P=0.000;r_s=0.55,P=0.006);高风险组血浆HCY水平与FRS评分无相关性(r_s=-0.16,P=0.66)。结论 精神分裂症病人血浆HCY水平与FRS评分具有相关性,MTHFR C677T基因多态性、血浆HCY水平是对精神分裂症病人心血管疾病风险评估的合理补充之一。

目的 探究妊娠期糖尿病(GDM)对母婴分娩结局的影响及导致不良分娩结局的相关影响因素。方法 采用现况调查的方法,通过现场问卷调查的形式,收集2017年9月—2017年11月在广州市妇女儿童医疗中心分娩并且在本院孕检的产妇的临床资料。根据是否患有妊娠期糖尿病,把调查对象分为妊娠期糖尿病组与非妊娠期糖尿病组。定量资料采用t检验或秩和检验,定性资料采用卡方检验或非参数检验,采用logistic回归模型分析不良分娩结局的相关影响因素。结果 在882例调查对象中,GDM孕妇共173例(19.6%)。研究结果表明,GDM孕妇与正常孕妇剖宫产率和住院天数差异有统计学意义(P<0.05),GDM组剖宫产率和住院天数增加,GDM产妇胎儿心脏畸形的风险增加(P<0.05)。Logistic回归分析结果提示孕妇孕次≥3次(OR值为0.399,95%CI为0.189~0.840,P=0.016)、产2次(OR值为0.283,95%CI为0.158~0.507,P<0.001)、产3次或以上(OR值为0.241,95%CI为0.112~0.520,P<0.001)、分娩孕周<37周(OR值为0.380,95%CI为0.180~0.804,P=0.011)是孕妇剖宫产的影响因素;分娩孕周<37周(OR值为16.028,95%CI为7.013~36.629,P<0.001)是孕妇住院天数>5天的影响因素。结论 妊娠期糖尿病可增加孕妇剖宫产率、住院天数以及胎儿心脏畸形的发生率;怀孕3次或以上的孕妇采用剖宫产的可能性与怀孕1次的孕妇相比风险降低;分娩2次或以上的孕妇采用剖宫产的可能性与分娩1次的孕妇相比风险降低;分娩孕周<37周的孕妇采用剖宫产的可能性较分娩孕周≥37周孕妇降低;分娩孕周<37周使孕妇住院天数>5天的风险增加升高。

目的 探讨广州地区老年住院患者营养状态与日常生活能力(ADL)的相关性。方法 选取2018年7月—2019年6月在广州市第一人民医院住院年龄≥60岁的老年人共275例,收集其一般资料信息,各项临床营养指标(BMI、血清白蛋白、血红蛋白、总胆固醇、甘油三酯)、并运用营养风险筛查2002(NRS2002)评估营养风险、采用Barthel指数评定量表评估日常生活能力;分析老年住院患者营养状态与ADL之间的相关性。结果 在本组研究中,根据NRS2002评分(营养风险:NRS2002≥3;无营养风险NRS2002＜3),营养风险发生率58.9%(162/275);无营养风险发生率41.1%(113/275)。老年住院患者的NRS2002评分与ADL评分呈负相关关系(r=-0.393,P＜0.05);ADL评分与BMI、血清白蛋白、总胆固醇、血红蛋白水平呈正相关关系(P＜0.05)。结论 广州地区老年住院患者NRS2002为日常生活能力的影响因素,通过降低NRS2002评分来减少营养风险可改善老年人的日常生活能力;老年人的营养风险发生率高,应当尽早进行营养干预。

Objective To investigate relationship between nutritional status and activities of daily living(ADL) in elderly inpatients in Guangzhou. Methods Total of 275 people older than 60 were included in this study from Guangzhou First People's Hospital from July 2018 to June 2019. Their nutritional markers(including BMI, plasma albumin, hemoglobin, total cholesterol, triglyceride),the activities of daily living(ADL) were evaluated with Barthel index and the nutrition risk screening 2002(NRS2002)used to assess the nutritional risk status were collected to analyze the relationship between nutrition and ADL. Results In these subjects, based on the NRS2002 scores(nutritional risk that the NRS2002 scores were equal or greater than 3, and the non-nutritional risk that the NRS2002 scores were less than 3),58.9%(162/275) patients were having nutritional risk and 41.1%(113/275) were having non-nutritional risk. In elderly inpatients,NSR2002 were negatively associated with ADL(r=-0.393,P＜0.05). ADL was positively associated with BMI, plasma albumin and hemoglobin level(P<0.05). Conclusion In the old, the NRS2002 is an influencing marker of activities of daily living in Guangzhou. Reducing the nutritional risk by lowering the NRS2002 scores can improve ADL in the elderly. The incidence of nutritional risk is highly prevalent in elderly and early nutritional treatment will be needed.

目的 探讨具有不同载脂蛋白E4等位基因(Apolipoprotein E4 alleles,APOE4)阿尔茨海默病患者的神经心理学量表差异。方法 纳入2014年1月—2017年12月广州市第一人民医院收治阿尔茨海默病患者28人,分别予简易精神状态检查量表、阿尔茨海默病评定量表-认知部分、临床医师通过面谈对变化的印象、日常生活活动能力量表、神经精神问卷,并检测量表间相关关系。之后随访18个月,观察量表评测的各功能变化及互相间相关性。检测不同载脂蛋白E4等位基因等阿尔茨海默病相关基因分布及与量表间相关关系。结果 认知评定量表间、认知评定量表与整体评价量表间、以及认知评定量表与日常活动能力评定量表间具有相关性。精神与行为症状量表分数与其他评定量表无明显相关性。随访中各量表分数变化间均无相关性。各基因组间功能变化无显著性差异,载脂蛋白E4等位基因变异主要影响患者的认知功能。等位基因分布与患病年龄,日常活动能力及精神与行为症状无相关性。结论 阿尔茨海默病量表评测的各认知领域间相关性不同,功能变化间无相关关系。载脂蛋白E4等位基因变异主要影响患者的认知功能。

Objective The present study aimed to elucidate the performance of multiple psychological tests among different Apolipoprotein E4 alleles (APOE4) in people with Alzheimer's disease (AD). Methods 28 patients were enrolled from January 2014 to December 2017 in Guangzhou First People'S Hospital. All patients were tested by using Mini-mental State Examination (MMSE), Alzheimer's disease Assessment Scale (ADAS-cog), Clinician's Interview-Based Impression of Change (CIBIC-Plus), Activities of Daily Living (ADL) and the NeuroPsychiatric Inventory (NPI). After 18 months follow-up visit, the change of the tests points were recorded. AD pathogenic genes, including Apolipoprotein E4 allele's variations, were detected in all patients. Then the correlations of APOE4 alleles and multiple psychological tests were analyzed. Results The correlations were confirmed between MMSE and ADAS-cog, MMSE and CIBIC-plus, MMSE and ADL, ADAS-cog and CIBIC-plus, ADAS-cog and ADL. NPI showed no correlation with the others. No correlation was found between changes of multiple psychological tests after 18 months follow-up. APOE4 alleles' variation affected cognitive function mainly. The effects of APOE4 on ADL and NPI showed no statistical significance in AD patients. No correlation was found among patients groups with different APOE4 alleles in all psychological tests and age of onset. Conclusion The correlations were existed among multiple cognitive domains while levels were different. The changes between psychological tests showed no correlations. APOE4 alleles' variation affected cognitive function mainly.

目的 研究NR3C1(核受体亚科3,C组,成员1)又称糖皮质激素受体(GR)表达量对前列腺癌恶性程度的影响及其与前列腺癌生化复发的相关性。方法 通过组织芯片免疫组化染色检测的方法检验NR3C1在不同恶性程度前列腺癌组织的表达情况,结合Taylor数据库分析NR3C1表达水平与前列腺癌临床病理特征关系,再采用Kaplan-Meier法分析NR3C1对前列腺癌生化复发生存率的影响,最后用Cox回归分析临床病理特征与生化复发的相关性。结果 组织芯片免疫组化结果显示NR3C1在Gleason评分低的前列腺癌组织中表达高于Gleason评分高的前列腺癌组织(P=0.028)。结合Taylor公用数据库分析,NR3C1在前列腺癌组织中的表达低于癌旁组织(P＜0.001),NR3C1在Gleason评分低的前列腺癌组织中表达高于Gleason评分高的前列腺癌组织(P=0.005),NR3C1低表达与PSA复发(P=0.028)和转移(P=0.003)相关。Kaplan-Meier结果提示:NR3C1高表达组患者术后的生化复发生存率更高(P=0.043),总体生存率没有明显区别(P=0.872)。单因素分析结果显示:NR3C1(P=0.002),病理分期(P＜0.001),Gleason评分(P＜0.001),是否转移(P=0.012)是前列腺癌生化复发的影响因素。多因素分析结果显示:高Gleason 评分(P=0.017)和转移(P<0.001)均为生化复发危险因素。结论 NR3C1影响前列腺癌的发病进程,检验NR3C1的表达情况,能预测前列腺癌患者生化复发的概率,可协助判断前列腺癌预后。

Objective We study the role of NR3C1 (nuclear receptor subfamily 3,group C,member 1) in PCa progression,and the correlation between its expression level and the biochemical recurrence of PCa. Methods Immunohistochemistry was used to detect the expression of NR3C1 in PCa tissues of different degrees of malignancy. The associations of NR3C1 expression and clinical pathological features were analyzed using the Taylor dataset. Kaplan-Meier was used to detect the relationship between NR3C1 expression and biochemical recurrence survival rate in PCa. Cox-regressive analysis was used to detect the relationship between clinical pathological features and biochemical recurrence. Results Immunohistochemistry analysis showed the expression of NR3C1 was higher in which its Gleason Score was lower(P=0.028). Base on the Taylor dataset,the expression of NR3C1 was higher in the adjacent benign tissues than that in PCa(P＜0.001). The expression of NR3C1 was higher in which its Gleason Score was lower(P=0.005). Furthermore,low NR3C1 expression was associated with PSA failure(P=0.028) and Metastasis(P=0.003). Kaplan-Meier showed the biochemical recurrence-free time of PCa patients in low NR3C1 expression groups reduced(P=0.043). The overall survival time of PCa patients was not correlated to NR3C1 expression levels(P=0.872). Single factor analysis showed the biochemical recurrence is associated with NR3C1 expression(P=0.002),pathological stage(P＜0.001),Gleason score(P＜0.001), Metastasis status(P=0.012). Multivariate analysis by Cox regression further identified the high Gleason Score(P=0.017) and Metastasis status (P<0.001)were hazards of the biochemical recurrence. Conclusion Our study showed that the expression of NR3C1 critically connected with the process of PCa,which indicated that we can predict the probability of the biochemical recurrence and determine the prognosis of prostate cancer by detecting the expression of NR3C1 in PCa patients.

目的 探讨精神分裂症患者载脂蛋白E基因多态性与血清ApoE浓度、血脂、心血管疾病发生风险的相关性。方法 收集住院精神分裂症患者116例,记录一般资料和测定患者载脂蛋白E基因(APOE)、载脂蛋白E(ApoE)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、心血管疾病发生风险评分(Framingham risk score,FRS)等指标。结果 ①APOEε2、ε3、ε4不同等位基因组精神分裂症患者TC、载脂蛋白E、FRS评分差异有统计学意义(P=0.01,P=0.005,P=0.012)。②载脂蛋白E与TC、FRS评分存在负相关关系(r_s=-0.48,P=0.02;r_s=-0.52,P=0.04),APOE ε4等位基因组载脂蛋白E与TC、FRS评分存在更高的相关关系(r_s=-0.55,P<0.001;r_s=-0.63,P=0.04)。结论 精神分裂症患者ApoE基因多态性与载脂蛋白E、胆固醇、FRS评分存在关联,ApoE基因-载脂蛋白E-胆固醇代谢通路可能是精神分裂症患者心血管疾病的致病机制之一。