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《广州医药》编辑部
目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料,按照7︰3比例随机化分为训练列(293例)和验证队列(126例)。统计基于开发队列数据,采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素,并构建风险预测模型。基于开发队列和验证队列数据,采用校准曲线、受试者操作特征(ROC)曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎,发生率为26.97%。美国国立卫生研究院卒中量表(NIHSS)评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值(NPAR)、中性粒细胞计数与淋巴细胞计数比值(NLR)、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素(P<0.05)。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型,校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近;ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906(95%CI:0.867~0.937)、0.884(95%CI:0.815~0.934);决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。
Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage(ICH)and validate the predictive performance of the model.Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022.They were randomly divided into a development cohort(293 cases)and a validation cohort(126 cases)according to a 7∶3 ratio.The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data,and a risk prediction model was constructed.Based on the development cohort data and validation cohort data,the predictive performance of the model was analyzed using calibration curves,receiver operating characteristic(ROC)curve,and decision curve analysis.Results Among 419 patients,113 developed stroke associated pneumonia,with a rate of 26.97%.The National Institutes of Health Stroke Scale(NIHSS)score,swallowing difficulties,initial hematoma volume,neutrophil percentage to albumin ratio(NPAR),neutrophil count to lymphocyte count ratio(NLR),surgical treatment,endotracheal intubation,and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH(P<0.05).Based on the above influencing factors,a risk prediction model for stroke associated pneumonia in patients with ICH was constructed.The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence.The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906(95%CI:0.867-0.937)and 0.884(95%CI:0.815-0.934),respectively.The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%,and the threshold probability of the validation cohort was between 2%-76%,the intervention using this model was more clinically valuable than all/no intervention.Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score,swallowing difficulties,initial hematoma volume,NPAR,NLR,surgical treatment,tracheal intubation,and indwelling gastric tube has good predictive performance and clinical application value.
目的 探讨营养风险管理结合分期饮食指导对溃疡性结肠炎(UC)患者营养状况的影响。方法 选择郑州市大肠肛门病医院收治的90例UC患者,纳入时间为2024年1月—2025年1月,按照计算机分组法分为对照组(45例),给予分期饮食指导,观察组(45例),在对照组的基础上增加营养风险管理,观察两组患者症状改善情况、营养状况、生活质量。结果 干预后,观察组Mayo评分(4.30±1.14)分、主观整体营养状况评价表(PG-SGA)评分(1.74±0.38)分低于对照组(5.48±1.33、2.28±0.43)分(P<0.05);观察组血红蛋白(HB)、前白蛋白(PA)、白蛋白(ALB)水平高于对照组(P<0.05),IBDQ各维度评分及总分更高(P<0.05)。结论 对UC患者应用营养风险管理结合分期饮食指导,能够减轻临床症状,改善营养状况,促进生活质量的提升。
Objective To explore the influence of nutritional risk management combined with staged dietary guidance on the nutritional status of ulcerative colitis(UC)patients.Methods A total of 90 UC patients admitted to our hospital were selected and included from January 2024 to January 2025.According to the computer grouping method,45 cases were divided into control group with staged dietary guidance,and 45 cases were divided into observation group with nutritional risk management.The symptoms improvement,nutritional status,and quality of life of the two groups were observed.Results After intervention,the observation group had lower Mayo score(4.30±1.14)and Patient?Generated Subjective Global Assessment(PG-SGA)score(1.74±0.38)than the control group(5.48±1.33 and 2.28±0.43,respectively)(P<0.05);the observation group had higher levels of hemoglobin(HB),prealbumin(PA),and albumin(ALB)than the control group(P<0.05),and also had higher scores in all dimensions and total score of the Inflammatory Bowel Disease Questionnaire(IBDQ)(P<0.05).Conclusions The application of nutrition risk management combined with staged dietary guidance in UC patients can reduce clinical symptoms,improve nutritional status,promote the improvement of life quality.
目的 调查重型β地中海贫血患儿照顾者的负担现状,并分析其影响因素,为医护人员制定干预方案提供依据。方法 采用便利抽样法,于2024年1月—12月选取华南地区5家医院就诊的重型β地中海贫血患儿的主要照顾者作为调查对象,采用一般资料调查表、Zarit照顾者负担量表、中文简化版家庭弹性量表和社会支持评定量表进行调查,并采用单因素分析、相关性分析及多重线性回归探究其影响因素。结果 共发放问卷242份,回收232份,回收率为95.87%。重型β地中海贫血患儿主要照顾者照顾负担的总体平均得分为(36.67±18.63)分。多重线性回归分析结果显示,患儿输血频率、输血相关性皮肤过敏和社会支持是患儿照顾负担的影响因素(P<0.001),可解释总变异的23.9%。结论 重型β地中海贫血患儿照顾者负担程度以中重度为主。患儿曾出现输血不良反应、输血频率更高,其照顾者负担更重;而主要照顾者具有良好的社会支持水平有助于降低其照顾者负担。医护人员应针对以上因素制定干预方案,以减轻重型β地中海贫血患儿照顾者负担水平。
Objective To investigate the current burden in caregivers of children with β thalassemia major and analyze its influencing factors,so as to provide a basis for medical staff to formulate intervention plans.Methods By using the convenience sampling method,primary caregivers of children with β thalassemia major from five hospitals in South China from January to December 2024 were selected as the survey subjects.The general information questionnaire,Zarit Caregiver Burden Scale,Simplified Chinese Family Resilience Scale and Social Support Rating Scale were used for the survey.And univariate analysis,correlation analysis and multiple linear regression were adopted to explore its influencing factors.Results A total of 242 questionnaires were distributed and 232 were retrieved,with a recovery rate of 95.87%.The overall average score of care burden for primary caregivers of children with β thalassemia major was(36.67±18.63).The results of multiple linear regression analysis showed that the frequency of blood transfusion in children,transfusion-related skin allergy and social support were the influencing factors of the care burden(P<0.001),which could explain 23.9% of the total variation.Conclusions The burden level in caregivers of children with β thalassemia major is mainly moderate to severe.The children with adverse reactions to blood transfusion and higher frequency of blood transfusion impose a heavier burden on its caregivers.The primary caregivers who have good social support can help reduce the burden.Medical staff should formulate intervention plans based on the above factors to reduce the burden level of caregivers of children with β thalassemia major.
目的 构建与验证回肠造口术后造口周围皮炎发生的列线图预测模型。方法 回顾性分析广州市中山大学附属第六医院2022年7月—2023年7月收治的441例回肠造口术患者资料。通过单因素Logistic回归确定影响因素,基于训练队列建立列线图模型,并采用受试者操作特征(ROC)曲线和校准曲线分别评估模型的区分度与校准能力,同时通过决策曲线分析(DCA)评估临床实用性。在内部验证队列进行模型性能验证。结果 单因素Logistic回归确定6个危险因素,最终选取其中5个(是否糖尿病、造口定位、是否接受造口护理宣教、造口皮肤凹陷、性别)构建预测模型。训练队列中,模型校准曲线显示良好拟合优度(Hosmer and Lemeshow检验P = 0.976),ROC曲线下面积为0.672;决策曲线证实模型具有临床应用价值,预测模型在验证集上有类似结果。结论 本研究建立的5参数列线图模型具有良好的区分度、校准能力和临床实用价值,可为造口周围皮炎的预测提供量化工具。
Objective To establish a predictive nomogram for peristomal dermatitis after ileostomy.Methods This study analyzed 441 patients who underwent ileostomy at a third-class premium hospital.The risk factors of peristomal dermatitis were determined by univariate binary Logistics regression.Then a predictive nomogram was established with the risk factors in the training cohort.The discrimination and calibration ability of the nomogram was demonstrated by receiver operating characteristic curves and calibration curves,respectively.Besides,a testing cohort was utilized to validate the nomogram model.To reflect the clinical utility of the model,we also performed decision curve analysis.Results A total of six parameters was determined as the risk factors of peristomal dermatitis.Finally,five of them(whether diabetes,stoma location,whether to receive stoma care education,stoma skin depression,gender)were chosen to establish the nomogram.The calibration curve showed favorable calibration ability in the training cohort with a Hosmer and Lemeshow goodness of fit test P-value of 0.976 and the area under the curve of the nomogram is 0.672.The decision curve showed nomogram had potential clinical utility.These results were consistent with the testing cohort.Conclusions The nomogram established by five parameters was capable of predicting the occurrence of peristomal dermatitis with favorable discrimination and calibration ability and shows potential clinical utility.
目的 探讨广州市公职人员中眼睑黄色瘤(XP)患病情况与生化检验指标异常的相关性。方法 从2018年来广州市干部和人才健康管理中心体检的公职人员中选取1 090例,其中筛选患XP人员545例,作为病例组,依性别、年龄分层随机抽取的未患XP的人员作为对照组,测定空腹血糖、血脂、甲状腺功能等生化指标,采用回顾性病例对照研究的方式,比较两组相关指标水平。P<0.05为差异有统计学意义。结果 XP的患病率为0.94%(男性为0.89%,女性为1.01%)。男性和女性的XP患病率比较差异无统计学意义(χ2=2.142,P=0.143)。两组间体质量、舒张压、血脂等多项指标上的差异具有统计学意义(P<0.05)。高体质量(OR=1.021,95%CI:1.004~1.038,P=0.017)、高舒张压(OR=1.019,95%CI:1.004~1.035,P=0.011)、低高密度脂蛋白(OR=6.127,95%CI:2.568~14.619,P<0.001)、高低密度脂蛋白(OR=2.084,95%CI:1.456~2.981,P<0.001)是患病的危险因素。结论 广州市公职人员中XP的患病率男性和女性接近;高体质量、高舒张压、高密度脂蛋白水平降低、低密度脂蛋白水平升高是患XP的危险因素。
Objective To investigate the correlation between xanthelasma palpebrarum(XP)and abnormal biochemical indices in healthy individuals in Guangzhou,China.Methods A retrospective case-control study was conducted,selecting 1 090 individuals from a total of 58 053 who underwent health examinations at the Guangzhou Cadre and Talent Health Management Centre in 2018.The case group consisted of 545 individuals diagnosed with XP,while the control group included age- and sex-matched individuals without XP,randomly selected from the same database.Biochemical indices analyzed included fasting blood glucose,blood lipids,liver and kidney function,thyroid indicators,body weight,and blood pressure.Statistical significance was set at P<0.05.Results The prevalence of XP was 0.94%(0.89% in men and 1.01% in women).No significant difference was observed in the prevalence of XP between men and women(χ2=2.142,P=0.143).Similarly,no significant differences were observed in thyroid-stimulating hormone(P=0.937),free triiodothyronine(P=0.216),free thyroxin(P=0.206),or fasting blood glucose levels(P=0.668)between the case and control groups.However,significant differences were noted in body weight,diastolic blood pressure,blood lipid levels,and liver and renal biochemical indicators between the two groups(P<0.05).Specifically,higher body weight(OR=1.021,95%CI:1.004–1.038,P=0.017),higher diastolic blood pressure(OR=1.019,95%CI:1.004–1.035,P=0.011),lower high-density lipoprotein(OR=6.127,95%CI:2.568–14.619,P<0.001),and higher low-density lipoprotein(OR=2.084,95%CI:1.456–2.981,P<0.001)were identified as risk factors for XP.Conclusions The prevalence of XP did not differ between males and females.However,high body weight,high diastolic blood pressure,low high-density lipoprotein,and high low-density lipoprotein are risk factors for XP.
目的 观察慢性阻塞性肺疾病急性加重期(AECOPD)患者应用基于Caprini量表评估的干预模式联合充气加压泵(IPC)预防静脉血栓(VTE)的效果。方法 选取河南省人民医院在2023年11月—2024年11月收入的82例AECOPD患者作为研究对象,经随机数表法分为对照组41例予以VTE常规干预,观察组41例在对照组的基础上接受基于Caprini量表评估的干预模式联合IPC预防。比较两组AECOPD患者肢体情况及深静脉血栓(VTE)发生情况、凝血指标及股静脉血流速度。结果 观察组肢体肿胀率、肢体疼痛率及VTE发生率均低于对照组(P<0.05)。干预前,两组AECOPD患者凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体水平比较差异无统计学意义(P>0.05);干预后,两组患者TT、PT、APTT、D-二聚体水平均降低,观察组较低(P<0.05)。干预前,两组AECOPD患者平均流速、血流峰速及阻力指数比较差异无统计学意义(P>0.05);干预后,两组患者平均流速、血流峰速均升高,观察组高于对照组(P<0.05);阻力指数均降低,观察组低于对照组(P<0.05)。结论 AECOPD患者应用基于Caprini量表评估的干预模式联合IPC能有效降低肢体肿胀率、肢体疼痛率及VTE发生率,改善凝血指标与股静脉血流速。
Objective To observe the effect of a Caprini score?based intervention model combined with intermittent pneumatic compression(IPC)in preventing venous thromboembolism(VTE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 82 AECOPD patients admitted to Henan Provincial People’s Hospital from November 2023 to November 2024 were selected as subjects and randomly divided into a control group(41 cases)and an observation group(41 cases)using a random number table.The control group received routine VTE prevention,while the observation group received the Caprini score?based intervention combined with IPC in addition to the routine care.The extremity conditions,occurrence of VTE,coagulation parameters,and femoral venous blood flow velocity were compared between the two groups.Results The rates of extremity swelling,extremity pain,and VTE incidence in the observation group were lower than those in the control group(P<0.05).Before the intervention,there were no statistically significant differences in thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),or D?dimer levels between the two groups(P>0.05).After the intervention,TT,PT,APTT,and D?dimer levels decreased in both groups,with lower values in the observation group(P<0.05).Before the intervention,there were no statistically significant differences in mean flow velocity,peak flow velocity,or resistance index between the two groups(P>0.05).After the intervention,mean flow velocity and peak flow velocity increased in both groups,with higher values in the observation group(P<0.05),while the resistance index decreased,with a lower value in the observation group(P<0.05).Conclusions The application of a Caprini score?based intervention model combined with IPC in AECOPD patients can effectively reduce the rates of extremity swelling,extremity pain,and VTE incidence,and improve coagulation parameters and femoral venous blood flow velocity.
目的 评估使用炎症、免疫及营养指标对于胃癌根治术后发生腹膜转移的预测作用,并建立适用于术前风险评估的预测模型。方法 回顾性收集2022—2024年苏州市立医院85例晚期胃癌患者的临床资料,按术后是否发生腹膜转移分为转移组44例与非转移组41例。通过分析比较两组间的营养参数[血清白蛋白、纤维蛋白原及预后营养指数(PNI)]、炎症指标[中性粒细胞计数、C反应蛋白、中性粒细胞与淋巴细胞比值(NLR)及全身免疫炎症指数(SII)]、肿瘤标志物以及免疫功能指标(淋巴细胞计数、IL-2、IL-6、TNF-α和IFN-γ)等。使用单因素及多因素Logistic回归分析确定独立预测因子,并构建预测模型,采用Bootstrap法内部验证,计算校正后的曲线下面积及收缩因子,以优化模型性能。结果 多因素分析结果显示,IL-6(OR=1.116,95%CI:1.020~1.224)与CA125(OR=1.016,95%CI:1.006~1.026)为术后腹膜转移的独立预测因素,构建的预测模型区分能力良好,初始AUC为0.801(95%CI:0.702~0.900),经Bootstrap校正后AUC为0.797,模型校准度理想,具有良好的临床稳健性。结论 基于术前IL-6和CA125水平的预测模型,可用于评估胃癌患者根治术后发生腹膜转移的风险。该模型可在术前阶段有效识别高风险病例,为临床制定个体化辅助治疗方案及随访策略提供关键参考,并具有改善患者预后的潜在价值。
Objective To evaluate the predictive value of inflammatory,immune,and nutritional indicators for peritoneal metastasis after radical gastrectomy in gastric cancer and to establish a predictive model applicable for preoperative risk assessment.Methods Clinical data from 85 patients with advanced gastric cancer treated at Suzhou Municipal Hospital between 2022 and 2024 were retrospectively collected.Patients were divided into two groups based on postoperative peritoneal metastasis occurrence:a metastasis group(n=44)and a non-metastasis group(n=41).Indicators analyzed and compared between groups included nutritional parameters(serum albumin,fibrinogen,PNI),inflammatory markers(neutrophil count,CRP,NLR,SII),tumor markers and immune indicators(lymphocyte count,IL-2,IL-6,TNF-α,IFN-γ).Univariate and multivariate logistic regression analyses identified independent predictors for constructing the prediction model.Internal validation was performed using 1 000 bootstrap resamples to calculate the adjusted area under the curve(AUC)and shrinkage factor for model optimization.Results Multivariate analysis identified IL-6(OR=1.116,95%CI:1.020-1.224)and CA125(OR=1.016,95%CI:1.006-1.026) as independent predictors of postoperative peritoneal metastasis.The constructed predictive model demonstrated good discriminatory ability,with an initial AUC of 0.801(95%CI:0.702–0.900)and a bootstrap-corrected AUC of 0.797.The model exhibited ideal calibration and good clinical robustness.Conclusions This study established a predictive model based on preoperative IL-6 and CA125 levels to assess the risk of peritoneal metastasis after radical surgery in gastric cancer patients.The model effectively identifies high-risk cases preoperatively,providing critical guidance for developing individualized adjuvant treatment and follow-up strategies,with potential to improve patient prognosis.
目的 合并肺纤维化的慢性阻塞性肺疾病(COPD)是COPD的特殊亚型,患者兼具气流受限与肺组织纤维化病理特征,临床症状更严重、肺功能下降更快,且现有单一治疗方案难以同时改善气流受限与纤维化进展,预后较差。基于此,本研究旨在分析尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD患者的效果及对肺功能的影响,为优化临床治疗方案提供依据。方法 选取2022年3月—2024年12月收治的96例合并肺纤维化的COPD患者,采用前瞻性随机对照研究设计,应用随机数字表法分为试验组与对照组。所有患者均采取常规治疗,对照组48例采取尼达尼布治疗,试验组采取尼达尼布联合格隆溴铵治疗。两组均治疗24周后,比较治疗前后症状评分、肺功能、纤维化指标、炎症指标,并分析两组治疗安全性。结果 治疗后,两组CAT评分、mMRC评分及VAS降低(P<0.05);且与对照组比较,试验组CAT评分、mMRC评分及咳嗽VAS评分较低(P<0.05)。治疗后,两组FVC、FEV1、DLCO及FEV1/FVC比值均较治疗前改善(P<0.05);且与对照组比较,试验组FVC、FEV1、DLCO及FEV1/FVC比值较优(P<0.05)。治疗后,两组血清KL-6、SP-D水平及CT纤维化评分均降低(P<0.05);且与对照组比较,试验组血清KL-6、SP-D水平及CT纤维化评分较低(P<0.05)。治疗后,两组血清IL-6、TNF-α及TGF-β1水平降低(P<0.05);且与对照组比较,试验组血清IL-6、TNF-α及TGF-β1水平较低(P<0.05)。试验组总不良反应发生率为8.33%(4/48),对照组为10.42%(5/48),两组比较差异无统计学意义(P>0.05)。结论 尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD效果良好,可减轻患者临床症状,改善肺功能与肺纤维化,降低机体炎症反应,安全性较高。
Objective To analyze the effects of the combination of nintedanib and glycopyrrolate in treating chronic obstructive pulmonary disease(COPD)patients with associated pulmonary fibrosis and its impact on lung function,providing a basis for optimizing clinical treatment strategies.Methods Ninety-six COPD patients with pulmonary fibrosis admitted from March 2022 to December 2024 were selected,and divided into experimental group and control group using a random number table method.Using a prospective randomized controlled study design,all patients received conventional treatment,with 48 cases in the control group receiving treatment with nintedanib and the experimental group receiving treatment with nintedanib combined with glycopyrrolate bromide.After 24 weeks of treatment in both groups,the symptom scores,lung function,fibrosis indicators,and inflammation indicators were compared before and post-treatment,and the drug safety of the two groups was analyzed.Results Post-treatment,CAT score,mMRC score and VAS decreased in both groups(P<0.05).Compared with the control group,CAT score,mMRC score and cough VAS score were lower in the experimental group(P<0.05).Post-treatment,FVC,FEV1,DLCO and FEV1/FVC ratio of both groups improved compared with that before treatment(P<0.05).Compared with the control group,FVC,FEV1,DLCO and FEV1/FVC ratio of the experimental group were better(P<0.05).Post-treatment,serum KL-6,SP-D levels and CT fibrosis scores of both groups decreased(P<0.05).Compared with the control group,serum KL-6,SP-D levels and CT fibrosis scores of the experimental group were lower(P<0.05).Post-treatment,serum IL-6,TNF-α and TGF-β1 levels in both groups decreased(P<0.05).Compared with the control group,serum IL-6,TNF-α and TGF-β1 levels in the experimental group were lower(P<0.05).The incidence of total adverse reactions in the experimental group was 8.33%(4/48),and that in the control group was 10.42%(5/48).There was no difference between the two groups(P>0.05).Conclusions The combination of nintedanib and glycopyrrolate has a significant effect on the treatment of COPD complicated with pulmonary fibrosis,which can alleviate its clinical symptoms,improve lung function and pulmonary fibrosis,reduce the body’s inflammatory response,which is relatively safe.
常染色体显性多囊肾病(ADPKD)是导致遗传性肾衰竭的主要病因之一,目前仍缺乏有效的手段来逆转其疾病进展。干细胞疗法因其在组织修复和免疫调节方面的潜力,成为研究的热点领域。本研究系统阐述了造血干细胞(HSCs)通过旁分泌作用、代谢重塑及免疫调控干预ADPKD病理进程的机制,并总结了其在急性肾损伤和慢性肾病中的临床转化证据。此外,文章比较分析了间充质干细胞(MSCs)和诱导多能干细胞(iPSCs)在ADPKD治疗中的独特优势与面临的挑战,为多模态干细胞疗法的开发提供理论支持。
Autosomal dominant polycystic kidney disease(ADPKD)stands as a leading cause of inherited renal failure,with current therapeutic strategies lacking effective means to reverse disease progression.Stem cell therapy,owing to its potential in tissue repair and immunomodulation,has emerged as a focal point of research.This review systematically elucidates the mechanisms by which hematopoietic stem cells(HSCs)intervene in ADPKD pathology through paracrine effects,metabolic reprogramming,and immune regulation.Furthermore,it summarizes clinical translational evidence of HSCs in both acute kidney injury and chronic kidney disease.This article also comparatively analyzes the unique advantages and challenges of mesenchymal stem cells(MSCs)and induced pluripotent stem cells(iPSCs)in the context of ADPKD treatment,thereby providing theoretical support for the development of multimodal stem cell therapies.
目的 通过年龄、性别等多方面研究各亚型注意缺陷多动障碍(ADHD)儿童的智力结构分布特征的临床研究,为ADHD的个体化干预提供科学依据。方法 实验组纳入ADHD儿童754例,其中注意缺陷型(ADHD-I)280例(37.13%)、多动-冲动型(ADHD-HI)212例(28.12%)、混合型(ADHD-C)262例(34.75%),按年龄分为三组:低龄组(6~8岁)、中龄组(9~11岁)及高龄组(12~14岁);对照组为正常儿童412例,为同期选择的性别、年龄相匹配的儿童。选择采用韦氏智力评估等方法分别对两组儿童进行评估等,对评估结果进行比较和综合分析。结果 ADHD儿童的智力评估结果低于对照组(P<0.01),且在言语智商方面表现更为明显,在各分测验中以A因子(言语理解)和C因子(记忆/注意集中)为主,而B因子(知觉组织能力)方面则无差异。ADHD-HI型及ADHD-C型的总智商及操作智商均高于ADHD-I型,ADHD-C型言语智商和A因子均高于ADHD-I型(P<0.01),ADHD-HI型的智力水平最高,而ADHD-I型与ADHD-C型的智力水平差异无统计学意义(P>0.05)。各年龄段ADHD儿童的智力发育均受到不同程度的影响,尤其是中龄组儿童及高龄组女童所受影响更明显;低、中龄组儿童的智力发育水平均高于高龄组儿童,提示ADHD儿童的智力损害随年龄增长而加重;同一年龄段ADHD女童的智力损害较男童更为严重。结论 本地区6~14岁ADHD儿童的智力水平较低,以言语智商低下更为明显,ADHD-HI型在3个亚型中智力损害最小,ADHD儿童的智力损害随年龄增长而加重,同一年龄段ADHD女童的智力损害较男童更为严重。
Objective To investigate the distribution characteristics of intellectual structure in children with different subtypes of attention deficit hyperactivity disorder(ADHD)by age and gender,providing scientific basis for individualized treatment and intervention of ADHD.Methods The experimental group consisted of 754 children with ADHD,including 280 cases(37.13%)of inattentive type(ADHD-I),212 cases(28.12%)of hyperactivity impulsive type(ADHD-HI),and 262 cases(34.75%)of combined type(ADHD-C).They were divided into three groups by age:young group(6-8 years old),middle group(9-11 years old),and older group(12-14 years old).The control group consisted of 412 normal children with matched sex and age recruited during the same period and had similar sex ratio.The specific methods of Wechsler Intelligence Scale were mainly applied to evaluate normal children and children with ADHD,and the evaluation results were subjected to multidimensional analysis and comparison.Results The intelligence assessment results of ADHD children were significantly lower than those of the control group(P<0.01),with a more pronounced performance in verbal intelligence.In various sub tests,factors A(verbal comprehension)and C(memory and attention concentration)were the main factors,while there was no difference in factor B(perceptual organization ability).The ADHD-HI and ADHD-C types had higher total intelligence and operational intelligence than the ADHD-I type,and the ADHD-C type had higher verbal intelligence and factor A than the ADHD-I type(P<0.01).The intelligence level of the ADHD-HI type is the highest,while there is no statistically significant difference in intelligence level between the ADHD-I type and the ADHD-C type.The intellectual development of children in different age groups was affected to varying degrees,especially in the middle and older groups of girls.This study found that the intellectual development of children in the young and middle group was higher than that of children in the older group,indicating that the intellectual development of ADHD children will be increasingly damaged with age.At the same time,it was also found that ADHD girls in the same age group had more severe intellectual development impairment than boys.Conclusions The intelligence level of children with ADHD aged 6-14 in this region is relatively low,with verbal intelligence quotient being more pronounced.ADHD-HI has the smallest intellectual impairment among the three subtypes,and the intellectual development of ADHD children becomes more severe with age.ADHD girls in the same age group have more severe intellectual development impairment than boys.