目的 研究添加与不加甲苯对24 h尿微量总蛋白(MPr)和尿微量白蛋白(UMA)定量测定的影响。方法 收集各个浓度段门诊及住院病人的新鲜随机尿共82份,检测即刻与在低、中、高温度条件下,加和不加甲苯保存24 h后尿液MPr和UMA的浓度,通过配对t检验方法检验差异有无统计学意义。结果 即刻尿MPr的值与低中温条件下、有无甲苯的24 h尿MPr的检测值比较,差异均无统计学意义(P＞0.05),但与在高温条件有无甲苯检测值比较,差异均有统计学意义(P＜0.05);即刻尿UMA的值与低中温条件下、有无甲苯的24 h尿UMA检测值比较,差异均无统计学意义(P＞0.05),与高温条件下有无甲苯检测值相比,差异均有统计学意义(P＜0.05);同一温度保存24 h,得到尿MPr、尿UMA的检测值,有无甲苯的检测结果比较,差异均无统计学意义(P＞0.05)。结论 实验证明甲苯在24h尿MPr与尿UMA的定量检测中无使用的必要性。

Objective To investigate the effect of toluene in the quantitative detection of 24 hour(24 h) urine micro protein(MPr) and urine micro albumin(UMA). Methods Eighty-two random urine of the patients with different concentrations were collected.The group without toluene and the other group with toluene were stored at the low, medium and high tempreture for 24 h respectively. Then MPr and UMA were measured in 0 h and 24 h. Paired t-test was used to test whether the difference was statisticallysignificant. Results When stored at the low and medium temperature,the results of immediate detection of MPr and UMA were compared with those of the addition of toluene or without for 24 h. The difference was not statistically significant (P>0.05). However, there was significant difference in MPr and UMA value of urine at high temperature under the same comparison(P<0.05). Stored at the same temperature for 24 hours, the results of MPr and UMA were compared between the adding groups and the non-adding groups. The results showed that there was no significant difference between them. Conclusion The specimens for the quantitative detection of the 24 h MPr and UMA are not need to be added with toluene, and toluene in the urine is not preservatively effective.

目的 探讨维持性腹膜透析患者高尿酸血症的临床特点及相关影响因素。方法 收集152名腹膜透析患者,根据血尿酸情况将患者分为高尿酸血症组和正常血尿酸组,分析其临床资料。结果 高尿酸血症112例(73.7%)。高尿酸血症组的血钾、高血压史、血尿素氮、血清肌酐、血磷、iPTH、甘油三脂水平均较正常尿酸组升高(P均＜0.05);而年龄、血钠、血红蛋白、血白蛋白、前白蛋白、血钙、血清铁、总蛋白、hsCRP、空腹血糖、血总胆固醇、血高密度脂蛋白胆固醇、血低密度脂蛋白胆固醇、KT/V、PET无统计学差异(P均＞0.05)。血尿酸水平与血钾、血尿素氮、血磷呈正相关(P＜0.05)。结论 腹膜透析患者高尿酸血症发生率高,血尿酸与血钾、血尿素氮、血磷密切相关,及时纠正高尿酸血症可以改善预后。

Objective To investigate the clinical characteristics and its related influence factors of hyperuricemia in peritoneal dialysis patients. Methods A total of 152 peritoneal dialysis patients were enrolled. Patients were classified into hyperuricemia and normal serum uric acid (SUA)groups. Factors associated with hyperuricemia were analyzed. Results Hyperuricemia occurred in 112 cases(73.7%). There were significant differences in serum potassium, the incidence of hypertension, blood urea nitrogen, serum creatinine, serum phosphorus, parathyroid hormone, triglyceride between hyperuricemia and normal SUA groups(P<0.05). There was no significant difference in age, serum sodium, hemoglobin, serum albumin, prealbumin, serum calcium, serum iron, total protein, high sensitive C-reactive protein, serum glucose, total cholesterol, high density lipoproteins, low density lipoproteins, KT/V and PET(P>0.05). SUA levels was positively correlated with serum potassium, blood urea nitrogen and serum phosphorus(P<0.05). Conclusion Hyperuricemia was common in peritoneal dialysis patients, serum potassium levels is correlated with serum potassium, blood urea nitrogen and serum phosphorus. The timely treatment of hyperuricemia may improve the prognosis of peritoneal dialysis patients.

目的 了解异鼠李素对LPS刺激下THP-1细胞炎症因子IL-6、MCP-1、TNF-α释放的影响及其抗炎特征。方法 用PI单染色法检测其细胞存活率;用ELISA法检测THP-1细胞炎症因子IL-6、MCP-1、TNF-α释放。结果 不同浓度的LPS均能使炎症因子IL-6释放增高,且24 h及48 h间水平无差异,但随着LPS刺激浓度的增高,细胞的坏死数量也会随之升高;不同浓度的异鼠李素能在不同时间点不同程度地抑制炎症因子MCP-1、TNF-α、IL-6的释放。结论 异鼠李素能抑制LPS刺激下THP-1细胞炎症因子IL-6、TNF-α、MCP-1的释放,并呈浓度依赖性。

Objectives Our study is aim to investigate the influence of the isorhamnetin on the releasing of inflammatory factor cytokines of the THP-1 cells. Methods PI single staining method was used to detect the cell survival rate. ELISA was used to detecte the concentrations of inflammatory cytokines(MCP-1、IL-6、TNF-α). Results The concentration of IL-6 in THP-1 cells were increased after stimulated with LPS and there no difference between the 24 h group and 48 h group. The survival rate of THP-1 cells decreased as the concentration of LPS increased.The isorhamnetin in different concentration could inhibit the secretion of inflammatory cytokines in different time. Conclusion It is found in our study that isorhamnetin may inhibit the secretion of MCP-1, IL-6, TNF-α in THP-1 cells stimulated by LPS in a concentration dependent way.

目的 观察比较术中及术前化疗干预对进展期胃恶性肿瘤手术患者p53、ki-67表达及预后的影响,为临床化疗时间的选择提供理论依据。方法 自2014年8月—2015年5月,我院共收入胃恶性肿瘤患者40例,将40例患者随机分为两组,每组各20例,保证两组患者在性别、年龄、胃癌分期等方面可比,无统计学差异(P＞0.05),标记为Ⅰ组和Ⅱ组。Ⅰ组20例患者于术前进行化疗干预,Ⅱ组在术中给予化疗干预。观察比较两组患者p53、ki-67表达状况及预后。结果 Ⅰ组及Ⅱ组治疗后p53及ki-67均比治疗前升高,差异有统计学意义(P<0.05)。但是治疗后,Ⅰ组和Ⅱ组的p53表达状况组间差异不明显,无统计学意义(P>0.05)。治疗前后,AI差异有统计学意义(P<0.05)。Ⅰ组效果明显好于Ⅱ组,两者差异有统计学意义(P <0.05)。术后六个月、一年随访时发现两组复发率、死亡率差别不大,无统计学意义(P>0.05),术后两年随访发现Ⅱ组复发率、死亡率明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论 术中化疗的疗效优于术前化疗,患者预后较术前化疗好。

Objective To observe the effect of intraoperative and preoperative chemotherapy on the expression of p53, Ki-67 and prognosis in patients with advanced gastric cancer. Methods 40 cases of advanced gastric cancer in our hospital from Aug 2014 to May 2015 were enrolled in the study, and were divide into 2 groups randomly. In group I, 20 patients received chemotherapy intervention befoerer operation, and the other group received chemotherapy intervention during operation. The expressions and prognosis of p53 and Ki-67 were observed and compared between the two groups. Results Group Ⅰ and group Ⅱ after treatment, p53 and Ki-67 were higher than that before treatment, with statistical significance(P<0.05). However, there was no significant difference in the expression of p53 between group Ⅰ and group Ⅱ after treatment, and there was no significant difference(P>0.05). Before and after treatment, the difference of AI was significant, with statistical significance (P<0.05). The effect of group Ⅰ was obviously better than that of group Ⅱ, the difference was statistically significant(P<0.05). Six monthse after the operation and one year follow-up found two groups of recurrence rate and mortality rate had no significant difference(P>0.05). After two years follow-up found the group Ⅱ recurrence rate, mortality was lower than in group Ⅰ (P<0.05). Conclusion The effect of intraoperative chemotherapy is better than that of preoperative chemotherapy, and the prognosis is better than that of preoperative chemotherapy.

目的 探讨影响老年患者用药依从性的原因及对策。方法 随机抽取我院区门诊就诊的老年患者进行问卷调查,了解其用药依从性及影响依从性原因,根据调查结果结合临床分析,实施相应的干预措施,评价实施对策前后患者用药依从性及影响依从性的原因。结果 实施干预措施后老年患者用药依从率从60.06%上升至84.39%,P＜0.05,差异有统计学意义。结论 通过对老年患者加强医药知识教育及医患沟通;简化用药方案;医院、社区、家庭给予支持等措施可提高老年患者用药依从性。

目的 观察不同血液净化方式对维持性血液透析(MHD)患者透析中低血压(IDH)的干预作用。方法 选择透析中低血压患者30例,随机分为血液透析(HD)组,血液透析滤过(HDF)组,血液灌流联合血液透析(HP+HD)组,各组均为10例。比较三组患者透析中低血压的发生率。分别于首次治疗前、后,治疗24周后测定血清血β₂-微球蛋白(β₂-MG)、N末端B型利钠肽原(NT-proBNP)、血浆白蛋白(ALB)。结果 ①HDF+HD、HP+HD组透析中低血压发生率降低(P<0.05)。②与治疗前相比,首次治疗后HDF能降低血β₂-MG水平(P<0.05);治疗24周后,HP+HD、HDF组均可降低血β₂-MG浓度(P<0.05),且HP+HD组下降更明显(P<0.05)。首次治疗及治疗24周后,HD组均不能降低NT-proBNP水平,而HDF、HP+HD组均能有效降低血NT-proBNP浓度(P<0.05)。首次治疗和治疗24周后3组患者ALB水平的差异均无统计学意义,同期3组患者ALB水平的差异亦不显著(P>0.05)。结论 HDF或HP+HD能有效降低MHD患者IDH的发生率,值得推广。

Objective To explore the efficacy of different blood purification methods on intradialytic hypotension(IDH) in maintenance hemodialysis (MHD) patients. Methods Thirty MHD patients with IDH were randomly divided into three groups: hemodialysis(HD) group(n=10),hemodiafiltration(HDF) group(n=10),hemoperfusion combined with hemodialysis (HP+HD) group(n=10). The changes of blood pressure in therapy and the frequency of intradialytic hypotension were compared.Before and after the first treatment,after 24 weeks of treatment serum blood beta 2-microglobulin(β₂-MG),serum NT-proBNP,albumin(ALB)weremeasured. Results ①Compared with HD group,the frequency of intradialytic hypotension was significantly reduced in HDF and HP+HD group(P<0.05). ② In HFD group serumβ₂-MG decreased after the first dialysis session(P<0.05). After the treatment for 24 weeks, serumβ₂-MG levels decreased in HP+HD and HFD group (P<0.05),especially in HP+HD group(P<0.05). Serum NT-proBNP cannot decreased after first dialysis session and after the treatment for 24 weeks in HD group, however, can decreased in HFD and HP+HD group (P<0.05). There were no changes of ALB levels between three groups after first dialysis session and after the treatment for 24 weeks (P>0.05). Conclusion Hemodiafiltration or hemoperfusion associated with hemodilysis can improve the hemodynamic stability in IDH patients, it can be used as a long term therapy.

目的 探讨开展药学服务干预对中老年COPD患者用药时间以及剂量的准确性的影响。方法 选取100名中医科门诊中老年COPD患者,随机分为干预组与对照组,干预组开展参与中医药治疗方案的确立、用药的衡量以及对患者进行用药指导、疾病健康宣教、定期随访等药学服务。对照组不作相关的药学服务干预。结果 干预组服药时间依从性(97.89±1.11)%,剂量准确率(99.95±0.05)%,干预组患者用药依从性比对照组有提高;平均疗程(11.12±2.1)天,比对照组缩短,差异有统计学意义(P<0.05)。结论 药师通过药学服务提高了中老年COPD患者的用药依从性及准确性,从而缩短疗程,值得推广。

Objective To investigate the time of drug use and dose accuracy in middle aged and elderly patients with COPD to develop pharmaceutical care intervention. Methods 100 middle aged and elderly patients with COPD were selected from the department of traditional Chinese medicine, randomly divided into intervention group and control group, the intervention group was developed pharmaceutical care including taking part in setting of therapeutic schedule, pharmaceutical measurement and guide of drug use in patients, health education, regular visit etc. The control group did not have pharmaceutical care intervention. Results The time of taking medicine compliance was (97.89±1.11)% and dose accuracy was(99.95±0.05)% in the intervention group. The intervention group had significantly improved compared with the control group. The course of treatment was(11.12±2.1)days. The average course of treatment was shorter than the control group. The difference was statistically significant (P<0.05). Conclusion Medication compliance of middle aged and elderly patients with COPD is higher by pharmaceutical care from the pharmacists. The course of treatment is shortened. It is worth using widely.

目的 对晚期非小细胞肺癌(NSCLC)患者进行回顾性分析,探讨参一胶囊维持治疗对患者炎症因子的影响。方法 经参一胶囊联合化疗一线治疗后取得缓解或稳定的37名晚期NSCLC患者意向性分为治疗组(A组,21人)和对照组(B组,16人)。A组继续服用参一胶囊每天2次,每次20 mg,服药至疾病进展或无法耐受;B组未予特殊治疗。分别于第1 d、90 d采血,检测白细胞计数、中性粒细胞计数、C反应蛋白、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素1α(IL-1α)、白细胞介素6(IL-6)和白细胞介素10(IL-10)。结果 治疗前后比较,治疗组各项炎症指标均未发生明显变化(P>0.05);而对照组的TNF-α、IL-1β、IL-6上升(P值分别为<0.001、0.032、0.001),IL-10下降(P=0.035);治疗后两组间比较,对照组TNF-α、IL-1β、IL-6上升(P值分别为<0.001、0.001、0.004),IL-10则下降(P=0.002)。两组间IL-1α及白细胞计数、中性粒细胞计数、C反应蛋白无变化(P>0.05)。结论 参一胶囊维持治疗可使晚期NSCLC患者TNF-α、IL-1β及IL-6的低表达,提示调节炎症反应可能是参一胶囊维持治疗抑制NSCLC进展的机制之一。

Objective To retrospectively investigate the influence of Shenyi Capsule maintenance therapy on inflammatory factors in patients with advanced NSCLC. Methods Thirty seven patients with advanced NSCLC, who had become palliative or stable after first-line treatment with combined Shenyi capsule chemotherapy, were intentionally assigned to treatment group (group A, 21 patients) and control group (group B, 16 patients). Shenyi capsule was given to group A (20mg p.o., bid) until appearance of deterioration or intolerance, while no special treatment was given to group B. Leukocytes, neutrophils, C-reactive protein, tumor necrosis factor α (TNF-α), interleukin-1β(IL-1β), interleukin-1α (IL-1α),interleukin-6(IL-6) and interleukin-10(IL-10) were tested by blood specimens taken respectively on 1st day and 90th day. Results There were no statistical differences (P>0.05) between the level of inflammatory factors on 1th day and 90th day in treatment group. In control group, however, TNF-α、IL-1β and IL-6 increased (P<0.001, P=0.032、P=0.001 respectively) and IL-10 decreased significantly (P=0.035). Furthermore, the level of TNF-α、IL-1β and IL-6 in treatment group were also higher (P<0.001, P=0.001, P=0.004 respectively), while IL-10 was lower (P=0.002)than control group on 90th day. There were no statistical differences(P>0.05)between the two groups in the level of IL-1α, leukocyte, neutrophils or C reactive protein on 1th day and 90th day. Conclusion Shenyicapsule maintenance therapy could lower the expression of TNF-α、IL-1β and IL-6 in patients with advanced NSCLC, which indicates that the regulation of inflammatory reaction may be one of the mechanisms of inhibition from NSCLC progression in Shenyi capsule maintenance therapy.

目的 探讨健康信念对心脏直视手术患者围术期心脏康复的影响。方法 选取我院2015年1月—2015年12月在全麻体外循环下行心脏直视手术患者 312例,按便利抽样法分为观察组159例和对照组153例。对照组按传统的心脏术后护理常规进行护理,观察组在对照组的基础上引入健康信念模式。比较两组患者心理健康状况、术后康复情况、护理满意度情况等。结果 观察组出院前一日SCL评分138.05±19.04,低于对照组155.84±21.27(t=7.1561,P<0.01);观察组拔除气管插管后24h、48h、72h疼痛评分分别为(2.25±1.22,1.98±0.67,1.24±0.57),低于对照组(3.28±1.01,2.71±0.98,1.87±0.86)(t值分别为6.003,7.652,7.597,P<0.01);观察组术后肺部并发症发生率2.52%低于对照组5.88%(χ²=4.550,P<0.05);观察组术后住院时间(10.93±5.58)d,短于对照组(15.79±5.24)d(t =7.933,P<0.01);观察组护理满意度97.48%,高于对照组90.84%(χ²=6.310,P<0.05)。结论 将健康信念模式用于心脏直视手术后患者,能够减轻患者术后不适症状,促进患者早日下床活动,降低肺部并发症的发生率,缩短术后住院时间,提高患者护理满意度。

目的 探讨系统性红斑狼疮(SLE)患者并发感染的影响因素并提出相应对策。方法 统计2012年1月—2015年12月在风湿免疫科住院的SLE患者,依据是否存在感染分为两组:感染组和非感染组。查电子病历记录感染组患者感染部位、所感染病原体的种类、免疫抑制治疗方案、病程、住院次数、血液生化指标、红细胞沉降率、肝肾功能以及补体C3、C4 水平,分析SLE患者发生感染的危险因素。结果 近三年风湿免疫内科共收治SLE患者302例,合并感染44例,发生感染63例次,感染发生率7.32%,高于全院感染发生率2.82%,差异有统计学意义(P<0.05)。呼吸系统感染有43例次,占68.25%,是患者最常见的感染部位。单因素分析显示,激素的冲击治疗、血红蛋白降低、白蛋白降低和血清肌酐水平异常(P<0.01)及ESR异常(P<0.05)是医院感染的危险因素。结论 SLE患者感染发生率高,免疫抑制剂冲击治疗、有合并症患者更易发生感染。应合理使用免疫抑制剂,密切留意患者感染症状,并定期检测血红蛋白、白蛋白及ESR等各项实验室指标,及时发现感染并进行病原学培养,做到尽早、合理治疗。