目的 探讨双柏散与喜疗妥软膏治疗经外周静脉穿刺置入中心静脉导管(PICC)相关性静脉炎的临床疗效对比。方法 选取PICC相关性静脉炎患者80例,随机分为观察组和对照组各40例,观察组采用双柏散水蜜制剂外敷,对照组采用喜疗妥软膏外涂,观察2组临床疗效。结果 观察组显效率87.5％,总有效率97.5％;对照组显效率65％,总有效率80％。观察组显效率和总有效率均高于对照组(P<0.05)。两组在治疗后各时点疼痛评分均低于治疗前(P<0.01);对照组在治疗24h后各治疗时点疼痛评分均低于治疗前,差异有显著性意义(P<0.01),但在12 h治疗时点疼痛评分虽亦低于治疗前,但差异无显著性意义(P>0.05)。观察组患者在治疗后12 h、24 h、36 h和48 h时点的静脉炎疼痛评分均低于对照组,差异有显著性意义(P<0.01或P<0.05),而在72 h时点两组疼痛评分差异无显著性意义(P>0.05)。结论 本研究结果表明双柏散外敷治疗PICC相关性静脉炎效果优于喜疗妥组,且疼痛症状改善时间更早。

Objective To compare clinical efficacy in the treatment of phlebitis correlation with peripherally inserted central catheter (PICC) between Shuangbai Powder and Hirudoid cream. Methods 80 patients with PICC correlation phlebitis were randomly divided into observation group and control group. There were 40 cases in the observation group treated with Shuangbai Powder and 40 cases in the control group treated with Hirudoid cream. We observed clinical curative effect of two groups. Results The efficiency rate was 87.5% and total effective rate was 97.5% in the observation group. The efficiency rate was 65% and total effective rate was 80% in the control group. The difference of the efficiency rate and total effective rate between observation group and control group was significance (P<0.05). The pain scores were lower in observation group after treatment than it was before(P<0.01);The pain scores were lower in control group after 24 hours treatment than it was before(P<0.01);The pain scores after 12 hours of treatment lower than before, but there was no significant difference(P>0.05). The pain scores after 12 hours,24 hours,36 hours and 48 hours of treatment in observation group were lower than control group(P<0.01 or P<0.05),but there was no significant difference in the pain score of both groups after 72 hours of treatment(P>0.05). Conclusion The clinical efficacy in the treatment of phlebitis correlation with peripherally inserted central catheter (PICC) by Shuangbai Powder is better than Hirudoid cream, and the time of pain relief in the group treated by Shuangbai Power is earlier than it treated by Hirudoid cream.

目的 研究BAG-1基因与乳腺癌他莫昔芬(TAM)治疗敏感性的相关性。方法 以58例乳腺癌患者为观察组,50例乳腺良性肿瘤患者为对照组。予以观察组患者TAM治疗,检测并统计2组患者肿瘤组织BAG-1基因的阳性率;并根据检测结果将观察组患者分为BAG-1阳性组与阴性组,对比分析观察组BAG-1阳性者与阴性者的临床预后及血清肿瘤标志物水平,包括癌胚抗原(CEA)、糖类抗原153(CA153)。结果 观察组BAG-1基因阳性率为74.14%,对照组为12%,2组比较, P＜0.05。观察组BAG-1阳性组患者临床缓解率为46.51%,阴性组为66.67%,2组比较,P＜0.05;BAG-1阳性组患者临床控制率为67.44%,阴性组为86.67%,2组比较,P＜0.05。观察组BAG-1阳性组患者平均OS为(1.55±0.86)a,PFS为(1.02±0.31)a,阴性组依次为(2.76±0.95)a、(2.06±0.82)a,2组比较,差异均有统计学意义(P＜0.05)。治疗后,观察组BAG-1阴性组患者血清CEA、CA153指标值均低于对照组(P＜0.05)。结论 BAG-1基因与乳腺癌TAM治疗敏感性密切相关,BAG-1阳性者行TAM治疗的临床效果及预后均较阴性者差。

Objective To study the correlation between BAG-1 gene and the sensitivity of tamoxifen (TAM) in breast cancer. Methods 58 cases of breast cancer patients as the observation group, 50 cases of benign breast cancer patients as the control group.The positive rate of BAG-1 gene in two groups of patients was detected and statistically analyzed by TAM. The patients in the observation group were divided into BAG-1 positive group and negative group according to the test results, and the positive rate of BAG- (CEA), carbohydrate antigens 153 (CA153) and carcinoembryonic antigen (CEA). Results The positive rate of BAG-1 gene was 74.14% in the observation group and 12% in the control group, P<0.05. The clinical response rate of BAG-1 positive group was 46.51% and negative group was 66.67%, P<0.05; The clinical control rate of BAG-1 positive group was 67.44%, negative group was 86.67%. Compared 2 groups , it was P<0.05. The mean OS was (1.55±0.86) years, PFS was(1.02±0.31) years in the BAG-1 positive group and (2.76±0.95) years in the negative group and (2.06±0.82) years in the negative group, (P<0.05). After treatment, the serum CEA and CA153 values in the negative group of BAG-1 were lower than those in the control group (P<0.05). Conclusion BAG-1 gene and breast cancer TAM treatment sensitivity is closely related to BAG-1 positive TAM treatment of clinical efficacy and prognosis were worse than negative.

目的 分析研究不同类型脑梗死患者睡眠结构及其与抑郁的相关性,为脑梗死患者睡眠障碍及抑郁的治疗提供新的思路及理论支持。方法 抽取我院2012年4月—2015年5月接收的124例脑梗死患者进行分组研究,根据脑梗死不同发生部位将患者分为四组,分别为小脑梗死组30例、皮层梗死组33例、脑干梗死组29例及皮层下梗死组32例,对比观察四组患者睡眠结构及睡眠参数和睡眠障碍、HAMD评分的相关性。结果 四组患者睡眠结构相比存在明显差异,脑干梗死组和皮层下梗死组觉醒时间远多于小脑梗死组和皮层梗死组,小脑梗死组NREM 1+2期、NREM期明显短于皮层梗死组、脑干梗死组及皮层下梗死组,小脑梗死组REM期、NREM 3+4期明显大于皮层梗死组、脑干梗死组及皮层下梗死组,各项数据对比差异均有统计学意义(P＜0.05);HAMD评分、PSQI评分和NREM1+2期、觉醒指数呈正相关关系(P＜0.05,r＞0);与REM期和NREM 3+4期呈负相关关系(P＜0.05,r＜0)。结论 皮层下梗死睡眠结构紊乱发生率更高,并且睡眠结构的变化和脑梗死后抑郁评分、睡眠障碍评分具有一定关系。

Objective To study the correlation between sleep structure and depression in patients with different types of cerebral infarction,to provide new ideas and theoretical support for the treatment of sleep disorders and depression in patients with cerebral infarction. Methods 124 patients with cerebral infarction in our hospital from April 2012 to May 2015 were selected. They were divided into four groups according to the different parts of the cerebral infarction, respectively, 30 cases of cerebellar infarction group, 33 cases of cortical infarction group, 29 cases of brainstem infarction group and 32 cases of subcortical infarction group. The correlation of sleep structure and sleep parameters, sleep disorder and HAMD score of the four groups were observed and compared. Results There was a significant difference in sleep structure between the four groups. Brainstem infarction group and subcortical infarction group awakening time was far more than that of cerebellar infarction group and cortex infarction group.Cerebellar infarction group NREM 1+2, NREM period was significantly shorter in cortical infarction, brain stem infarction group and subcortical infarction group. Cerebellar infarction group of REM and NREM stage 3+4 were significantly greater than that of cortical infarction death group, brain stem infarction group and cerebral cortex infarction group. The differences were statistically significant(P<0.05);HAMD score, PSQI score and NREM1+2 period, arousal index was positively correlated (P<0.05, r> 0); And REM phase and 3+4 NREM phase was negatively correlated (P<0.05, r< 0). Conclusion Subcortical infarction sleep structure disorder incidence is higher, and the sleep structure changes and infarction depression score, sleep disorder score has a certain relationship.

目的 探讨孕期生殖道菌群变化特征及其与不良妊娠结局的相关性。方法 选取2015年1月—2015年9月期间在我院妇产科门诊进行常规产科检查的90例孕妇为研究对象,根据孕期分为孕早期组28例(孕周＜14周),孕中期组29例(孕周14～28周),孕晚期组33例(29～42周)。采集阴道分泌物或宫颈分泌物,对生殖道菌群进行检测。比较三组生殖道菌群分布情况。根据细菌检测结果分为阳性组与阴性组,分别为44例、46例。观察两组不良妊娠结局发生情况,分析生殖道菌群变化特征及其与不良妊娠结局的相关性。结果 90例孕妇中,细菌检测阳性44例,占48.89%,依次为解脲脲原体20例(45.45%)、假丝酵母菌属9例(20.45%)、肠杆菌属8例(18.18%)、葡萄球菌属3例(6.82%)、阴道加德纳菌属2例(4.55%)与衣原体2例(4.55%);孕早期、孕中期、孕晚期孕妇生殖道菌群分布情况相比,差异无统计学意义(P＞0.05);细菌检测阳性者胎膜早破、产褥感染、新生儿感染、早产发生率高于细菌检测阴性者,差异有统计学意义(P＜0.05);不同菌属类型者不良妊娠结局相比,差异无统计学意义(P＞0.05)。结论 孕期生殖道菌群以解脲脲原体、假丝酵母菌属、肠杆菌属为主,细菌检测阳性者不良妊娠结局发生率高,而不同菌属类型与不良妊娠结局无关。

Objective To investigate the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes. Methods 90 pregnant women received routine obstetric examination in our obstetrics and gynecology of hospital from January 2015 to September 2015 were selected as research object. According to duration of pregnancy, they were divided into 28 cases of early pregnancy group (gestational weeks<14 weeks), 29 cases of middle pregnancy group (14~28 weeks) and 33 cases of late pregnancy group (29~42 weeks). The vaginal or cervical secretions were collected, and genital tract flora was detected. The genital tract flora distribution of three groups were compared. According to bacteria detection results, patients were divided into 44 cases of positive group and 46 cases of negative group. The adverse pregnancy outcomes of two groups were observed, and the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes was analyzed. Results Among 90 pregnant women, there were 44 cases of positive bacteria (48.89%), which included 20 cases of ureaplasma urealyticum(45.45%), 9 cases of Candida (20.45%), 8 cases of enterobacter (18.18%), 3 cases of staphylococcus (6.82%), 2 cases of vaginal gardnerella (4.55%) and 2 cases of chlamydia (4.55%); There was no statistical difference in the genital tract flora distribution among early, middle, late pregnancy group (P>0.05); The incidence of premature rupture of membrane, puerperal infection, neonatal infection and premature birth in patients with positive bacteria was higher than that in patients with negative bacteria (P<0.05); There was no statistical difference in the adverse pregnancy outcomes in patients with different types of bacterial genus (P>0.05). Conclusion Pregnant genital tract flora are mainly ureaplasma urealyticum, candida and enterobacter, and the incidence of adverse pregnancy outcomes in patients with positive bacteria is higher, but different types of bacterial genus has no correlation with adverse pregnancy outcomes.

目的 本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法 选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果 本研究患者的平均年龄(84.23±4.92)a,按eGFR<60 mL·min^-1·1.73 m^-2定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 ①肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。②年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people's hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of (84.23±4.92),had being divided into two groups according to eGFR< 60 ml·min^-1·1.73 m^-2:renal insufficiency group (n=52) and normal renal function group (n=51).There were statistical significance in the number of lacunar lesions,score of white-matter hyperintensity,mixed lesions between groups(P<0.05). Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is positively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI,and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.

目的 初步研究2型糖尿病并视网膜病变患者的血浆趋化素(chemerin)水平及其与骨密度的关系。方法 选择150名糖尿病患者,按视网膜病变分为视网膜病变组(DR组)和眼底正常对照组(NDR组),采用全自动生化检测仪测定糖化血红蛋、甘油三脂、总胆固醇、低密度脂蛋白、高敏C反应蛋白;使用ELISA法检测血浆chemerin水平。骨密度采用双能X线骨密度仪分别测定腰椎正位(L2、L3、L4)、左侧股骨颈、大粗隆区、Ward's三角区的骨密度。结果 ①与NDR组相比,DR组的糖尿病病程较NDR组显著延长(P<0.05)。②DR组的TC、LDL-C、HbA1c、hs-CRP、chemerin水平较NDR组均显著升高(P<0.05)。③DR组的股骨颈、大粗隆区、Ward's三角区的骨密度较NDR组显著降低(P<0.05)。④血清chemerin水平与病程、BMI、HbA1C呈正相关,与股骨颈、大粗隆区、Ward's三角区的骨密度呈负相关。结论 DR患者的chemerin显著升高,chemerin可能参与DR的发生发展,并可能促使DR患者的骨密度降低。

Objective To explore the relationship between the circulation level of chemerin level and bone mineral density(BMD)in type 2 diabetes retinopathy patients. Methods A total of 150 patients with type 2 diabetes were selected. They were divided into two groups: retinopathy group(DR group), non- retinopathy group(NDR group). HbAlc, triglycerides(TC), total cholesterol(TG), low density lipoprotein cholesterol(LDL-C)and high-sensitivity C-reactive protein(hs-CRP)was measured by automatic biochemical detector. Bone mineral density was measured by the dual-energy X-ray absorptiometry. The BMD of lumbar vertebrae 2-4 and the left side of the femoral neck, the greater trochanter and Ward's triangle were assessed. Results ①Compared with the NDR group, the duration of diabetes in group DR was significantly longer(P<0.05); ②The levels of TC, LDL-C, HbA1c, hs-CRP and chemerin in DR group were significantly higher,③The BMD of the femoral neck, trochanter regionandward's triangle were significant reduction;④The level of chemerin was positively correlated with the duration of diabetes, BMI, HbA1C, and negatively correlated with the bone mineral density of the femoral neck, the greater trochanter, and the s' Ward triangle. Conclusion The level of chemerinin DR patients were significantly increased, and chemerin may play a role in the occurrence and development of DR, may promote the bone density decreased.

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 探究S100B蛋白、神经元特异性烯醇化酶与新生儿低血糖脑损伤的诊治相关性。方法 收集2014年1月—2016年12月来我院就诊出现低血糖脑损伤的新生儿116例,设为患病组,首先根据临床表现,分为两组,有低血糖症状组(n=54)和无低血糖症状组(n=62)。两组患儿均给予常规药物治疗,有效患者82例,为有效组,无效患者34例,为无效组。同期收集健康足月的新生儿53例,为健康对照组。患儿均于治疗前、后检测血清S100B蛋白、神经元特异性烯醇化酶水平,健康对照组新生儿也于同一时间点进行相同检测。观察各组新生儿血清S100B蛋白、神经元特异性烯醇化酶水平变化,并探究其水平变化与诊断及治疗效果的相关性。结果 低血糖症状组和无低血糖症状组患儿的血糖水平均低于和健康对照组(P<0.05);低血糖症状组患儿的低血糖扶持续时间高于无低血糖症状组(P<0.05)治疗后,各组的NSE和S100B的蛋白水平差异无统计学意义(P>0.05)。患儿血清NSE和S100B与血糖水平呈负相关(r=-0.131、-0.124、P<0.05),与低血糖持续时间呈正相关(r=0.135、0.129,P<0.05)。结论 血清NSE及S100B与患儿血糖水平相关,可作为新生儿低血糖脑损伤的早期诊断指标。血清NSE及S100B水平与治疗效果存在相关性并为负相关,血清水平越低,患者治疗效果越好。

目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 探讨红细胞分布宽度(RDW)与老年重症社区获得性肺炎(CAP)患者病情严重程度及预后的相关性。方法 将103例老年重症CAP患者按照近期预后分为存活组(n=83例)及死亡组(n=20例),按照RDW的水平分为RDW≥14.5%组(n=83例)和RDW＜14.5%组(n=20例);记录患者的一般临床资料及相关实验室检查指标,比较各组之间的差异,并利用Logistic回归模型分析老年重症CAP患者近期死亡的危险因素。结果 死亡组中的患者入院APACHEⅡ评分、CRP、PCT、RDW水平均高于存活组,差异有统计学意义(P＜0.05)。RDW 异常率随着PSI 级别的增高而增高,RDW 异常率分别为PSIⅠ-Ⅱ级7.32%(3/41、 PSI Ⅲ级16.67%(6/36)、PSI Ⅳ级39.13%(9/23)、PSIⅤ级 66.67%(2/3),差异有统计学意义(P＜0.05)。Spearsman相关性分析显示:RDW与APACHEⅡ评分、CRP、PCT、PSI评分呈正相关(r_s分别为=0.353,0.363,0.432,0.362,P均＜0.05)。多因素Logistic回归分析显示: RDW(OR=2.024,P＜0.05)是老年重症CAP患者近期死亡的独立危险因素。结论 RDW水平随着老年重症CAP患者病情严重程度的增加而增加,RDW增高亦是患者近期死亡的高危因素。