目的 分析区级医院甲型流行性感冒患者的临床特征,为基层医院甲型流感的早期诊断及防控工作提供科学依据。方法 对2019年12月广州市番禺区中心医院发热门诊就诊的具有流感样症状的发热患者共628例,进行咽拭子甲型流感病毒核酸检测,收集患者临床资料,包括性别、年龄、体温、症状、血常规,根据核酸检测结果分为阴性组及阳性组,2组结果进行比较。结果 甲型流感病毒核酸检测阳性患者共116例,阳性率为18.5%。阳性组发病年龄以14～19岁所占比例最大,共91例(78.4%)。阳性组平均年龄小于阴性组(P＜0.05)。阳性组发病体温以38.1～39 ℃所占比例最大,共47例(46.5%)。阳性者平均体温高于阴性组(P＜0.01)。症状方面,阳性组仅鼻塞流涕比例较阴性组高(P＜0.05)。阳性组白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值、淋巴细胞百分比均低于阴性组(P＜0.01)。结论 2019年冬季甲型流感患者以青少年为主,单纯症状较难区分甲型流感及普通感冒,需结合血常规特别是白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值的降低进行分析。

Objective The clinical characteristics of patients with influenza A in district hospital were analyzed to provide scientific basis for early diagnosis, prevention and control of influenza A in primary hospital. Methods A total of 628 patients with influenza-like symptoms from Guangzhou Panyu Central Hospital in December 2019 were enrolled, and the clinical data was collected, including gender, age, body temperature, symptoms, and blood test results. According to the result of influenza A nucleic acid detection, patients were divided into negative group and positive group, and the clinical data of these two groups were compared. Results A total of 116 patients were positive in influenza A virus nucleic acid detection, which positive rate was 18.5%. In the positive group, patients aged 14-19 accounted for the largest proportion, with 91 patients (78.4%). The mean age of the positive group was significantly lower than that of the negative group (P＜0.05). Body temperature ranged from 38.1 to 39 ℃ accounted for the largest proportion in the positive group, with 47 patients (46.5%). The mean body temperature of the positive group was significantly higher than that of the negative group (P＜0.01). In terms of symptoms, only the proportion of nasal congestion in positive group was higher than that in negative group (P＜0.05). In terms of blood test results, WBC count, neutrophil absolute value, lymphocyte absolute value and lymphocyte percentage in the positive group were significantly lower than those in the negative group (P＜0.01). Conclusions The majority of patients with influenza A in the winter of 2019 were teenagers, and it was difficult to distinguish influenza A from the common cold only by symptoms. The differential diagnosis should be carried out in combination with the blood routine analysis, especially the decrease in the white blood cell count, the absolute value of neutrophil and the absolute value of lymphocytes.

目的 探讨甲状腺Bethesda Ⅲ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法 收集356例Bethesda Ⅲ结节患者,对其诊断原因, ROM及亚分类进行总结分析。结果 在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),Bethesda Ⅲ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。Bethesda Ⅲ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P＜0.05)。结论 Bethesda Ⅲ类的诊断具有一定的主观性和经验性,而对Bethesda Ⅲ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。

Objective To investigate the diagnostic causes of Bethesda Ⅲ (AUS/FLUS) thyroid nodules and the value of subcategories in predicting risk of malignancy (ROM) of thyroid nodules. Methods The data of 356 cases of Bethesda Ⅲ nodules were collected, and the causes, ROM and subcategories were summarized. Results In 97 resected specimens, 72 were diagnosed as papillary thyroid carcinoma (PTC), and the ROM of Bethesda Ⅲ was 74.2%. The main factors affecting the diagnosis of PTC were small lesions, few puncture cells, atypical nuclear features and lack of papillary structure. Secondary factors included significant interstitial fibrosis or calcification, unqualified smear, improper fixation, poor staining and lack of cytological diagnosis experience. According to the subcategories of Bethesda Ⅲ, 132 cases were included in low-risk group, nodules of 12 cases in the group were resected, which ROM was 8.3%; 122 cases were included in high-risk group, nodules of 70 cases were resected, which ROM was 92.9%; 102 cases were included in middle-risk group, nodules of 15 cases were resected, which ROM was 40.0%. The differences between high-risk group and low/medium-risk group were statistically significant (P＜0.05). Conclusion The diagnosis of Bethesda Ⅲ is subjective and empirical in some degree, and the risk related subcategories of Bethesda Ⅲ nodules is helpful to achieve better ROM stratification and improve the clinical management of the disease.