目的 探讨脑梗塞与雌激素及高同型半胱氨酸血症之间的相关性。方法 纳入我院2013年1月—2014年11月确诊为脑梗塞的患者100例,正常对照的健康体检者100例,比较两组患者的血浆高同型半胱氨酸和雌激素水平。结果 脑梗死患者的血浆同型半胱氨酸水平高于正常组,两组比较差异有统计学意义(P＜0.05);高同型半胱氨酸血症脑梗塞组为72例,正常组为18例,两组比较差异有统计学意义(P＜0.05);同型半胱氨酸的阳性率男性为92%,女性为44%,男性患者高于女性,(P＜0.05);脑梗塞组雌激素水平降低,脑梗塞和雌激素水平呈负相关(P＜0.05),有糖尿病和酗酒的患者E2水平低于无糖尿病和酗酒的E2水平,差异有统计学意义(P＜0.05)。结论 急性脑梗塞患者同型半胱氨酸水平高于正常组,雌激素水平低于正常组,高同型半胱氨酸血症是脑梗死的重要危险因素,雌激素为脑梗塞患者的保护性因素。

目的 探讨心肌细胞RyR2和L型钙通道的基因变异与室性心律失常和心源性猝死的相关性。方法 回顾分析2010年1月—2012年12月在我院就诊的慢性心力衰竭患者622例的临床资料,并选取同一时期体检中心体检的健康人群516例作为对照组,门诊或者电话随访记录慢性心力衰竭患者的死亡为终点,通过候选基因分析可能具有相关功能的4个基因变异,rs41315858(G1885E)、rs3766871(G1886S)、rs790896(G>A)和rs723672(T>C),采用Logestic、Cox回归分析对4个候选基因变异进行相关性研究。结果 入选622例慢性心力衰竭患者和516例对照组,基因分析结果显示RyR2上的基因变异rs376687lA等位基因携带可以增加慢性心力衰竭患者发生室性心律失常的风险性;校正可能与该疾病相关的危险因素后,rs376687lA等位基因携带会增加心源性死亡和心源性猝死的风险,RyR2上的基因变异rs790896A等位基因携带可以降低心源性猝死风险。结论 RyR2上的基因变异rs376687lA是室性心律失常和心源性猝死的遗传学预测因子,而rs790896A等位基因是慢性心力衰竭患者的保护因子,可降低室性心律失常和心源性猝死的风险。

Objective To investigate the myocardial cells RyR2 and L-type calcium channel gene variants with ventricular arrhythmias and sudden cardiac death correlation. Methods Retrospective analysis of patients with chronic heart failure from January 2010 to December 2012 in our hospital including 622 cases of clinical data, and to select 516 cases of healthy people in medical examination center during the same period as a control group.Clinic or telephone follow-up recorded chronic patients with heart failure and sudden death acting as end. We analyzed possible candidate genes, according to four gene variants related functions, rs41315858 (G1885E), rs3766871 (G1886S), rs790896 (G> A) and rs723672 (T> C), by using Logestic, Cox regression analysis of four candidate gene variants for related research. Results 622 cases of chronic heart failure patients were enrolled and 516 patients in the control group. Genetic analysis showed that the gene variant alleles carried rs376687lA RyR2 may increase in patients with chronic heart failure ventricular arrhythmia risk; correction may be associated with the disease after risk factors, rs376687lA allele carries an increased risk of cardiogenic death and sudden cardiac death, and gene mutation alleles carried on rs790896A RyR2 can reduce the risk of sudden cardiac death. Conclusion Gene mutation rs376687lA RyR2 on genetics is predictor of ventricular arrhythmias and sudden cardiac death, and rs790896A allele is protective factor in patients with chronic heart failure which can be reduced ventricular arrhythmias and sudden cardiac death in risk.

目的 通过对银行从业人员动脉硬化发生率及相关分析,了解该群体的血管状况,并分析引起动脉硬化发生的相关危险因素,为银行从业人员提供切实可行的健康指导方案。方法 以2013年1月—2014年12月在我单位进行体检的银行从业人员实验组1534例,非银行从业人员对照组1479例为研究对象,利用OMRON BP-203RPE III型动脉硬化检测仪测量出bapwv的数据,并对所有人员的体检数据进行分析整理。结果 实验组(银行从业人员)1534例,年龄(35.32±7.14)岁,动脉硬化发生率28.6%;对照组(非银行从业人员)1479例,年龄(37.45±6.33)岁,动脉硬化发生率13.5%;吸烟、体重指数、高血压、糖尿病、睡眠障碍五个方面,P<0.05,差异有统计学意义;银行内部工作性质不同,动脉硬化发生率也不同,P<0.05,差异有统计学意义。讨论 通过健康体检,及时发现银行从业人员动脉硬化发生率高于非银行从业人员,对于控制和延缓银行从业人员心血管事件的发生有重要意义。

目的 对经皮冠状动脉介入(PCI)治疗术前高敏C反应蛋白(hs-CRP)水平进行测定,探究其与患者术后发生造影剂肾病相关性。方法 选取2011年4月—2013年5月在我院进行PCI手术疗的患者120例为实验对象。根据术前hs-CRP值分为3组:A组(hs-CRP<1 mg/L,n=56),B组(hs-CRP 1～3 mg/L,n=40)和C组(hs-CRP>3 mg/L,n=24)。观察各组术后造影剂肾病的发生情况以及探究其两者之间的相关性。结果 A、B、C组患者术后CIN的发生率分别为8.93%、22.5%和50.0%,经过统计学比较,差异有统计学意义(P<0.05)。患者术前hs-CRP水平年龄在75岁以上、男性、糖尿病、贫血、水化治疗均与CIN显著独立相关。C组MACE发生率均高于A组、B组(P<0.05)。结论 接受PCI手术治疗的患者,其术前hs-CRP水平与其术后CIN的发生具有一定的相关性,患者术前hs-CRP水平越高,术后更可能发生CIN,hs-CRP的水平可作为辅助CIN诊断的指标。

目的 探讨老年人血尿酸(serum uric acid,SUA)水平与阿尔茨海默病(Alzheimer's disease,AD)的相关性。方法 选择227例我院老年病科住院患者为研究对象,其中阿尔茨海默病67例,其余160例为非AD组。收集病史、吸烟史、服药史,并检测血尿酸、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBS)、血肌酐(Cr)水平。比较各SUA四分位数水平AD的发生率,并进行相关性分析。结果 AD组血尿酸水平低于非AD组,差异有统计学意义(P＜0.01);多因素分析筛选出年龄、性别、缺血性脑卒中是危险因素(P＜0.05),而服用他汀、SUA、HDL-C是保护因素(P＜0.05)。对AD和SUA的四个分组做Spearman等级相关分析(rs=-0.285,P<0.001),结果呈等级负相关。结论 血尿酸水平与老年人AD相关,血尿酸可能是AD发病的保护性因素。

Objective To explore the correlation between serum uric acid(SUA) level and Alzheimer's disease(AD) in elderly patients. Methods 67 cases of the elders with Alzheimer's disease and 160 elders matching with age and gender were enrolled from Jan 2013 to Dec 2014 in the study,the blood levels of biochemical factors such as SUA,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood sugar(FBS) and creatinine(Cr) were measured by automatic biochemistry analyzer in the two groups. The related factors such as history of disease,smoking and medication history were collected. The correlation between the level of SUA and AD was analyzed. Results The serum uric acid levels in AD group were significantly lower than those in control group(P＜0.01). Multivariate logistic regression analysis showed that age, gender, ischemic stroke were risk factors, and taking statin, SUA, and HDL-C were protective factors(P＜0.05). Spearman correlation tests indicated that there was an inverse correlation between SUA levels and AD(rs=-0.285,P<0.001). Conclusion Serum uric acid level is significantly related to AD in the elderly.SUA may be a protective factor of the occurrence of AD.

       目的   探讨长病程2型糖尿病（T2DM）患者体质指数（BMI）与胰岛β细胞功能间的相关关系。方法    选取2023年12月—2024年3月于承德市中心医院内分泌风湿免疫科住院的260例长病程（病程≥10年）T2DM患者作为研究对象，依据BMI将其分成正常组、超重组和肥胖组，比较三组间一般资料、检验学指标及检查的差异，分析胰岛β细胞功能与各指标间的相关性。结果   三组研究对象在空腹静脉血糖（FPG）、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-IR）、尿酸（UA）、甘油三酯（TG）等上差异有统计学意义（P＜0.05），在胰岛β细胞功能指数（HOMA-β）比较差异无统计学意义（P＞0.05）；肥胖组的FPG、FCP、HOMA-IR、UA、TG均高于正常组（P＜0.05），超重组的UA、TG均高于正常组（P＜0.05），肥胖组的FPG、HOMA-IR、UA高于超重组（P＜0.05），Spearman相关分析结果显示HOMA-β与体质量指数（BMI）无相关性（r=0.046，P=0.461），HOMA-β与UA（r=0.226，P＜0.001）、TG（r=0.148，P=0.017）呈正相关，HOMA-IR与BMI（r=0.279，P＜0.001）与、UA相关（r=0.284，P＜0.001）及TG（r=0.349，P＜0.001）呈正相关，多元线性回归分析显示UA是HOMA-β的影响因素（P＜0.05），BMI、UA、TG是HOMA-IR的影响因素（P＜0.05）。结论    长病程的T2DM患者，其胰岛素抵抗水平随着BMI的增加逐渐升高，而胰岛β细胞功能指数与BMI的相关性不显著。同时，UA和TG也是长病程T2DM患者胰岛β细胞功能的影响因素。

       Objective  To explore the correlation between body mass index（BMI）and islet β cell function in patients with long course type 2 diabetes mellitus（T2DM）．Methods  A total of 260 patients with T2DM with a long course of disease（course≥10 years）admitted to the Department of Endocrinology and Rheumatology of Chengde Central Hospital from December 2023 to March 2024 were selected as the study objects，and were divided into normal group，overweight group and obese group according to BMI．Comparison among the three groups in general data，inspection index and and the difference of the islet β cell function were performed，and the correlation among the indexes was analyzed．Results  There were statistically significant differences in fasting plasma glucose（FPG），fasting C peptide（FCP），homeostasis model assessment-insulin resistance（HOMA-IR），uric acid（UA）and triglycerides（TG）among the three groups（P＜0.05），but no statistically significant differences in homeostatic model assessment of β-cell function（HOMA-β）（P＞0.05）．The levels of FPG，FCP，HOMA-IR，UA and TG in the obese group were higher than those in the normal group（P＜0.05）；the levels of UA and TG in the overweight group were higher than those inthe normal group（P＜0.05）；the levels of FPG，HOMA-IR and UA in the obese group were higher than those in the overweight group（P＜0.05）．Spearman correlation analysis showed that HOMA-β was not correlated with BMI（r=0.046，P=0.461），but was positively correlated with UA and TG（r=0.226，P＜0.001；r=0.148，P=0.017），HOMA-IR was positively correlated with BMI，UA and TG（r=0.279，P＜0.001；r=0.284，P＜0.001；r=0.349，P＜0.001）．Multiple linear regression analysis showed that UA was the influencing factor of HOMA-β（P＜0.05），BMI，UA and TG were the influencing factors of HOMA-IR（P＜0.05）．Conclusions  In T2DM patients with long disease course，the level of insulin  resistance increased gradually with the increase of BMI，but the correlation between β-cell function index and BMI was not significant．At the same time，UA and TG are also factors affecting the function of islet β cells in patients with long-course T2DM．

       目的  探讨TRIB2在结肠癌中的表达水平及与预后及免疫浸润之间的关系。方法  TIMER数据库分析TRIB2在泛癌种中的表达；TCGA、GSE17538下载结肠癌患者RNA-seq数据和临床信息，评估其与临床病理特征的相关性；生存曲线、单因素和多因素Cox分析探讨TRIB2与预后的相关性，并构建列线图；对TRIB2进行差异基因的富集分析；分析TRIB2表达水平与免疫细胞浸润、免疫检查点、肿瘤突变负荷（TMB）以及免疫治疗敏感性之间的相关性。结果  TRIB2在结肠癌组织中高表达（P＜0.05）；CMS1结肠癌患者TRIB2 mRNA表达水平最高；TRIB2是结肠癌患者的独立预后因素（单因素Cox回归分析：HR=1.397，95%CI：1.100~1.774，P=0.006；多因素Cox回归分析：HR=1.502，95%CI：1.158~1.947，P=0.002）；TRIB2与免疫细胞的浸润密切相关，并且与免疫检查点分子表达水平以及TMB正相关（r=0.39，P＜0.001）；TRIB2的表达水平与免疫检查点抑制剂的疗效相关。结论  TRIB2在结肠癌中高表达且与结肠癌患者预后差和免疫微环境密切相关。

       Objective  To explore the expression of TRIB2 in colon cancer and its relationship with prognosis and immune cell infiltration．Methods  TIMER database was used to analyse the expression of TRIB2 in pan-cancer．RNA-seq  data and clinical information of colon cancer patients were downloaded from TCGA and GSE17538 to assess the correlation between TRIB2 with clinicopathological features．Survival curves，univariate and multivariate COX regression analysis were performed to explore the correlation between TRIB2 and prognosis，and a nomogram was constructed．Gene enrichment analyses were performed for TRIB2．Correlations between TRIB2 expression and immune cell infiltration，immune checkpoints，tumor mutation burden（TMB），and immunotherapy sensitivity were analyzed．Results  TRIB2 was highly expressed in colon cancer tissues（P＜0.05）．The highest level of TRIB2 mRNA expression was found in CMS1．TRIB2 was an independent prognostic factor for colon cancer patients（univariate Cox regression analysis：HR=1.397，95%CI：1.100-1.774，P=0.006；multivariate Cox regression analysis：HR=1.502，95%CI：1.158-1.947，P=0.002）．TRIB2 was closely associated with immune cell infiltration and positively correlated with the expression level of immune checkpoint molecules as well as TMB（r=0.39，P＜0.001）．The expression of TRIB2 was correlated with the efficacy of immune checkpoint inhibitors．Conclusions  TRIB2 is highly expressed in colon cancer and is closely associated with poor prognosis and the immune microenvironment of colon cancer patients．

       目的   探讨女性医务人员月经改变的影响因素及与心理状态的相关性。方法   对深圳市3家医院女性医护人员进行随机抽样得到869份问卷调查样本，均为知情自愿参与本项调查研究。统计女性医务人员出现女性月经改变的比率和月经改变的基本特征，并采用单因素和多因素分析的方法分析影响月经改变因素。并以抑郁症筛查量表（PHQ-9）评估女性医护人员的心理状态，分析女性医务人员月经改变与心理状态评分间相关性。结果  869名女性医护人员中有293例发生月经改变，改变率为33.72%，其中月经周期改变94例、经期时间改变86例、月经量改变68例、痛经改变45例。将869例女性医护人员分为月经正常组和月经改变组，经单因素分析，两组间的年龄、职业、值夜班频率、既往病史、新冠感染等比较差异无统计学意义（P＞0.05）。月经改变组的护士占58.36%高于月经正常的24.48%，月经改变组的新冠一线抗疫人员占64.51%高于月经正常的27.08%，月经改变组合并妇科疾病史的占比20.82%（61例）高于月经正常组的占比11.98%（69例）。而月经改变组的护士、新冠一线抗疫人员、合并妇科疾病史、新冠感染的比较差异有统计学意义（P＜0.05）。多因素分析显示，职业为护士、合并妇科疾病史、新冠一线抗疫人员的P值分别为0.001、0.004、＜0.001，故而职业为护士、合并妇科疾病史、新冠一线抗疫人员是女性医务人员月经改变的危险因素。月经改变组PHQ-9评分为9.10±2.57，月经正常组PHQ-9评分为5.98±1.06，月经改变组PHQ-9评分高于月经正常组（P＜0.001）。两组受试者PHQ-9评分比较差异具有统计学意义，月经改变组PHQ-9评分中0～4分受试者为26.3%，月经正常组为47.2%，月经改变组PHQ-9评分中0～4分者比例小于月经正常组，差异具有统计学意义（P＜0.05）。结论   女性医务人员中职业为护士、合并妇科疾病史、新冠一线抗疫人员是月经改变的主要危险因素，且月经改变与心理状态有密切的相关性，需引起医疗机构的关注。

      Objective  To analyze the influencing factors of menstruation changes of female medical staff and the correlation with their psychological status．Methods  The female medical staff in three hospitals of Shenzhen were  randomly sampled to get 869 questionnaires，with informed and willing to participate in this research．The rate of female menstruation changes and the basic characteristics of menstruation changes in female medical staff were calculated，and the influencing factors of menstruation changes were analyzed by single factor and multi factor analysis．And the psychological status of female medical staff was using the Depression Screening Scale （PHQ-9），and the correlation between menstrual changes and psychological status scores of female medical staff were analyzed．Results  Among 869 female medical staff，293 had hemorrhagic menstrual disease，with a change rate of 33.72%．Among them，94 had changes in menstrual cycle，86 had changes in menstrual period days，68 had changes in menstrual volume，and 45 had changes in dysmenorrhea．These 869 female medical staff were divided into normal menstruation group and menstrual change group．Through single factor analysis，there was no statistical difference between the two groups in terms of age，careers，night shift frequency，previous medical history，COVID-19 infection （P＞0.05）．The percentage of nurses in the menstrual change group was 58.36%，higher than that of 24.48% in the normal menstruation group．The percentage of frontline medical staff combating COVID-19 in the menstrual change group was 64.51%，higher than that of 27.08% in the normal menstruation group．And the percentage of menstrual change group with a history of combined gynecological diseases was 20.82% （61 cases），higher than that of the normal menstruation group was 11.98% （69 cases）．And the difference was statistically significant when comparing the ratio of nurses，the frontline medical staff combating COVID-19，the history of gynecological diseases，and COVID-19 infection in the menstrual change group （P＜0.05）．Multivariate analysis showed that the occupation of nurses，frontline medical staffs combating COVID-19，and history of gynecological diseases were the risk factors for menstrual changes．The PHQ-9  score of the menstrual change group was higher than that of the normal menstrual group，and the difference was statistically significant．Conclusions  The main risk factors for menstrual changes are nurses，frontline anti-epidemic staff，and women with gynecological disease history．Menstrual changes are closely related to mental status，attention from healthcare organizations．

      目的   探讨载脂蛋白E（ApoE）基因多态性与卒中后认知障碍的相关性，即大动脉粥样硬化型脑梗塞的严重程度。方法   采用病例——对照研究的方法，收集九江学院附属医院神经内科的100例急性缺血性脑卒中且病因分型为大动脉粥样硬化型患者（脑梗死组）和50例性别、年龄匹配的非缺血性脑卒中患者（对照组）。检测患者的 ApoE 基因型、血脂、美国国立卫生院卒中量表（NIHSS）、卒中后6个月简易智力状态检查量表（MMSE）等，采用多因素方差分析等统计学方法分析他们之间的关联性。结果  ApoE 3/4基因型频率与Ɛ3、Ɛ4等位基因频率，在脑梗死组别中高于对照组（P＜0.05）。同时，携带Ɛ3等位基因患者的低密度脂蛋白水平高于携带Ɛ2、Ɛ4等位基因的患者；进一步分析发现含Ɛ3等位基因的脑梗死患者NIHSS评分更高、卒中后认知障碍更严重（P＜0.05）。结论  ApoE基因型为Ɛ3/4、等位基因Ɛ3、Ɛ4更易罹患大动脉粥样硬化型脑梗死，提示该基因型是脑梗死的易感基因，脑梗死后认知障碍患者Ɛ3等位基因的频率较高，可能是卒中后认知障碍的易感因素。

       Objective  To  explore the  relationship  between ApoE  gene  polymorphisms  and  post-stroke  cognitive  impairment，the severity of large artery atherosclerotic cerebral infarction．Methods  A  case-control research  study was conducted，gathering  data from  100 individuals  diagnosed with large artery atherosclerotic cerebral infarction according to the TOAST classification，who admitted to the Neurology Department of the Affiliated Hospital of Jiujiang University．Additionally，50 non-ischemic stroke patients，matched for gender and age，were included as the control group．The patients were assessed for ApoE genotype，blood lipid，NIHSS，and MMSE scale at 6 months post-stroke，and statistical methods were used to analyze their associations.  Results  Significant differences were observed in the ApoE 3/4 genotype frequency and Ɛ3、Ɛ4 allele frequency between patients with cerebral infarction and the control group，with a notably higher incidence of cerebral infarction in the former．Furthermore，patients carrying the Ɛ3 allele exhibited significantly higher LDL levels than those carrying Ɛ2 or Ɛ4．The analysis also revealed that patients with the Ɛ4 allele experienced higher NIHSS and severer post-stroke cognitive impairment．Conclusions  The findings suggest that the ApoE genotype Ɛ3/4 and allele Ɛ3、Ɛ4 may predispose individuals to develop large atherosclerotic cerebral infarction，indicating a susceptibility gene for cerebral infarction．Additionally，the Ɛ3 allele was associated with a higher frequency of cognitive deficits after cerebral infarction，implying that it may be a predisposing factor for post-stroke cognitive impairment．

       根据美国国家胆固醇教育计划成人组第三次报告NECP-ATPⅢ会议定义，当男性年龄＜55岁，女性年龄＜65岁诊断为冠状动脉粥样硬化性心脏病（冠心病）时即为早发冠心病（pCAD）。作为冠心病的特殊类型之一，pCAD发生多伴明显家族史。近年来随着早发冠心病患者人数呈明显上升趋势，且单核苷酸多态性（SNP）研究和全基因组关联研究的迅速发展，与早发冠心病相关的基因多态性研究成为热点。笔者利用多个文献数据库检索国内外相关文献，对近年早发冠心病的基因多态性研究进展予以综述，并尝试归纳总结出新的重点研究方向。

   According to the third meeting of the Adult Education Group of the Cholesterol Education Program of the United States（NECP-ATPⅢ），premature coronary artery disease（pCAD）is a disease diagnosed in men ＜55 years old and women ＜65 years old，which is a special form of CAD with multiple obvious family history．In recent years，with the increasing number of patients with pCAD，and the rapid development of single nucleotide polymorphism（SNP）and genome-wide association studies，the study of gene polymorphism related to premature coronary artery disease has become a hot topic．Several database were searched to collect relevant literature at home and abroad，and the research progress of gene polymorphism of premature coronary artery disease in recent years was summarized，and tried to provide new key research directions．