高原驻训官兵处于高原低压、低氧环境,同时驻地周边因环境恶劣、训练演习任务繁重、饮食不规律、营养不均衡、水源紧缺等不利因素,导致官兵机能降低.加之医疗卫生条件有限,针对性的口腔保健工作不到位,导致高原官兵的口腔发病率较高.本文针对喀喇昆仑山高原驻地官兵口腔健康调查资料现状,对高原人群口腔疾病的特点及高原环境对口腔疾病的影响做一综述,并对今后高原官兵口腔研究的方向进行分析讨论,以指导临床和科研工作.
目的:探讨青海地区内镜下冷、热圈套器切除结直肠小息肉的安全性及有效性.方法:分析我院2018年1月-2021年3月诊断结直肠小息肉(直径5 mm～10 mm)患者361例,其中内镜下冷圈套器切除术(cold snare polypectomy,CSP)187例(CSP组)、内镜下热圈套器切除术(hot snare polypectomy,HSP)174 例(HSP 组).比较两组患者手术及住院情况、术后并发症发生情况、息肉特点.结果:两组患者性别、年龄、回肠末端插管成功率、波士顿评分、息肉部位、巴黎分型、病理类型、息肉完整切除率比较,差异均无统计学意义(P＞0.05);CSP组平均切除时间为(3.76±2.10)min短于HSP组的(5.29±2.04)min(P＜0.05);CSP 组平均住院天数为(4.71±1.62)d 短于 HSP 组的(6.10±1.88)d(P＜0.05);CSP组术后并发症总发生率为1.61％小于HSP组的9.19％(P＜0.05).结论:CSP与HSP均可有效的治疗结直肠小息肉,但CSP更简便、更快捷、更经济、更安全,值得临床推广应用.
目的:通过比较单独药物治疗与药物联合重复经颅磁刺激(rTMS)治疗帕金森病(PD)运动症状及非运动症状疗效,探讨rTMS对高海拔地区PD症状的改善情况.方法:收集2019年11月-2021年11月青海省人民医院神经内科住院的PD患者52例,随机数字表法分为常规组24例,磁刺激组28例.常规组给予美多芭结合假性磁刺激治疗,磁刺激组给予美多芭结合rTMS治疗.比较两组患者治疗前后运动功能、生活质量、抑郁评分及不良反应发生情况.结果:①治疗后,两组患者运动功能评分、生活质量评分及抑郁评分均较治疗前明显下降(P＜0.05),且磁刺激组患者各项评分均显著低于常规组患者(P＜0.05);②两组患者基本无不良反应.结论:高频rTMS可以改善PD患者运动症状,且药物(美多芭)联合rTMS治疗比单药物治疗对运动症状改善更明显.高频rTMS刺激可以改善PD患者非运动症状(抑郁),改善PD患者日常生活能力,提高其生活质量,值得临床推广应用.
目的:探讨青海地区持续性心房颤动(房颤)患者的临床特征及危险因素.方法:回顾性分析2018年11月-2020年11月我院房颤中心数据库内1 062例房颤患者的临床资料,以房颤持续时间分为阵发性房颤组(401例)和持续性房颤组(661例),比较分析两组患者的一般资料及持续性房颤的危险因素.结果:将两组患者年龄、体重、平均收缩压、平均心率、左心房前后径、右心房左右径、左心室舒张末期内径、右心室舒张末期内径、左心室射血分数、B型钠尿肽(BNP)、CHA2DS2-VASc评分、心肌病史、慢性心衰病史(心功能Ⅱ～Ⅳ级)比较,差异均有统计学意义(P＜0.05).Logistic回归分析提示左心房前后径大、右心房左右径大、CHA2DS2-VASc评分高、合并慢性心衰Ⅱ～Ⅳ级为发生持续性房颤的危险因素(OR＞1),而平均收缩压高、左心室舒张末期内径大、左心室射血分数低(OR＜1)为发生持续性房颤的保护因素.结论:与阵发性房颤患者比较,青海地区持续性房颤患者具有平均收缩压高、左心扩大、右心房扩大、左心室射血分数低、栓塞风险高、心衰程度重等临床特点,需引起临床诊疗重视.
高原缺氧性脑损伤的保护机制研究,是高原脑科学研究的重要课题.青藏高原海拔高,急进、移居和世居人群较多,是世界上最理想的高原医学实验现场,得益于得天独厚的地理环境,开展高原缺氧预处理脑保护机制研究意义重大.近年来本领域研究进展迅速,成果显著.本文从分子细胞、动物实验、人体现场等不同层面,通过抑制氧化应激、神经炎症、胶质增殖,调节神经发生、突触可塑性变化、抗神经凋亡,机体生理性组织氧合代偿、线粒体空间可塑性、低氧调节自适应、内吞及自噬等方面,对缺氧预处理脑保护机制进行了研究探讨和阐述,并对应用前景进行展望,意在推动基础研究、临床实践和转化应用相结合,为阐明高原神经系统低氧适应的调控机制,保护高原人群脑功能,防治高原脑病发挥积极的作用,促进高原医学的发展和高原人群的健康.
Objective:The purpose of this study is to provide a simple and feasible diagnostic method for the diagnosis of CMS by exploring the diagnostic value of exosome miRNAs from the altered expression profiles of serum exosomemiRNAs in mice under chronic hypoxia exposure.Methods:By establishing an animal model of hypoxia,the researchers extracted serum exosomes,isolated them by precipitation method,identified them by electron microscopy,and analyzed the expression profiles of serum exosome miRNAs in mice by high-throughput sequencing.Then differential miRNAs were analyzed by GO and KEGG enrichment pathways.Thirty patients with CMS and 30 healthy controls were selected for validation of the above sequencing results,and ROC curve analysis was performed to identify exosome miRNAs with diagnostic potential for CMS.Results:There were 7 miRNAs up-regulated and 19 miRNAs down-regulated in the high-altitude group.GO and KEGG enrichment analysis of differential miRNAs showed that the differences mainly focused on the Ras signaling pathway,GnRH signaling pathway,MAPK signaling pathway,and VEGF signaling pathway,.The top 3 miRNAs with elevated and decreased sequencing results were selected for validation analysis in CMS and control groups,whose results were similar to those of mouse exosome sequencing.Compared with the control group,the expression of mir-5100,mir-7653-5p,mir-3084-5p increased,and mir-704,mir-184-3p, and mir-378a-5p decreased in the CMS group（P＜ 0.001）.The AUC values of these six differential exosome miRNAs were all greater than 0.70,suggesting their diagnostic value.The AUC value of mir-5100 was 0.81（95% CI 0.75-0.87,P＜0.001）,with the highest sensitivity and specificity of 68.89% and 80%,respectively.When a threshold of＞ 1.84（Fold change） was used,it indicated better diagnostic efficacy.Conclusion:The expression profiles of serum exosome miRNAs in CMS patients have obvious differences compared with the control group,and the molecular mechanisms are compatible with the symptoms and signs of CMS patients.Among them,mir-5100 has a relatively good sensitivity and specificity as a biomarker for CMS,which is expected to become a new reference indicator for the diagnosis of CMS.
"春种一粒粟,秋收万颗子."当这一期《高原医学杂志》与读者们见面的时候,已是"万类霜天竞自由"的时节了.在这个充满收获的季节,我不禁回想起在盛夏落幕的中华医学会第十次高原医学学术大会,让我们每个高原医务工作者深刻感受到高原医学发展的勃勃生机,感受到时代召唤的责任感,在勇攀科学高峰的过程中,我们担负新的使命,踏上了新的征程.
目的:探讨应用地塞米松、沙丁胺醇气雾剂与红景天联合治疗急性高原反应(AMS)的临床疗效.方法:收集2020年7月-2021年6月我院收治的AMS患者90例为观察对象,随机分为对照组与观察组各45例.对照组单纯采用红景天口服液进行治疗,观察组在对照组的治疗基础上给予地塞米松及沙丁胺醇气雾剂联合治疗,比较两组患者临床治疗效果、基础生理指标及治疗前后AMS症状评分.结果:观察组患者总有效率为97.8％,优于对照组患者的80.0％(P＜0.05).观察组患者的脉率(P)、呼吸频率(R)、红细胞计数(RBC)及血红蛋白水平(HB)均低于对照组患者(P＜0.05);治疗前两组患者AMS症状评分比较,差异无统计学意义(P＞0.05);治疗后3、7天,观察组患者AMS症状评分均低于对照组患者(P＜0.05).结论:将地塞米松、沙丁胺醇气雾剂与红景天药物联合应用于AMS患者治疗过程中,可有效改善AMS患者临床症状,促使患者身体机能恢复正常,为患者生命安全提供重要保障,值得临床推广应用.
Objective:The purpose of this paper is to explore the changes of estrogen level,blood lipid indexes,blood pressure and blood glucose of perimenopausal women aged 40 and above living in areas with an altitude above 4 500 meters,and analyze their correlations.Methods:From January 2018 to January 2020,perimenopausal women,who had a normal physical examination at the Zhiduo People’s Hospital of Yushu Prefecture,Qinghai Province,were collected as observation objects.The subjects who met the criteria were divided into three age groups:forties and above,fifties and above,sixties and above,while their general information was recorded.The study team used automatic biochemical analyzer enzymatic method to measure blood lipid indexes,including total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein（HDL） andlow-density lipoprotein（LDL）.The team used automatic chemiluminescence analyzer and supporting reagents to detect the levels of serum progesterone（P）,estradiol（E 2 ）,follicle stimulating hormone（FSH） and prolactin（LH）,analyzing the correlation between E 2 or FSH level and various indexes of blood lipid,respectively.Results:With the increase of age,blood pressure increased,and the detection rates of hypertension in the 40～、50～and 60～age groups were 3.85%,9.41%,and 46.88%respectively.And there was a significant difference in the detection rate of abnormalities among different age groups（P＜0.05）.GLU abnormalities,with a significant difference,in different age groups were 6.41%;23.53%and 21.88%（P ＜0.05）.The increase rate of fasting blood glucose in the 40～age group was significantly lower than that of the 50～age group（P＜0.05） and the 60～（P＜0.05）.With the increase of age,HDL decreased and LDL increased,and there were significant differences among different age groups respectively（P＜0.05）.The level of E 2 decreased and FSH increased with the increase of age,and there were significant differences among different age groups respectively（P ＜0.05）.E2 was positively correlated with LDH while FSH was positively correlated with LDL.Conclusion:The decrease of estrogen level in perimenopausal women at high altitude is the main factor which increases the abnormal rate of blood lipids,blood glucose and blood pressure.Postmenopausal women at the age of 60 have a higher risk of cardiovascular disease,and corresponding measures should be taken as soon as possible.
目的:探讨高海拔地区慢性肺源性心脏病患者集束化肺康复护理模式的应用效果.方法:收集2020年3月-2021年3月我院收治的高原地区慢性肺源性心脏病患者88例,随机分为对照组和研究组各44例.对照组应用常规护理干预,研究组应用集束化肺康复护理干预.观察并比较两组患者的满意度、一秒用力呼气容积(FEV1)、左室射血分数(LVEF)、6 min步行距离及生活质量情况.结果:研究组患者满意度高于对照组患者(P＜0.05);研究组患者并发症发生率低于对照组患者(P＜0.05);研究组患者FEV1及LVEF指标均高于对照组患者(P＜0.05);研究组患者6 min步行距离长于对照组患者(P＜0.05),研究组患者生活质量评分高于对照组患者(P＜0.05).结论:与常规护理干预相比,高原地区慢性肺源性心脏病患者实施集束化肺康复护理效果显著,可有效改善患者的肺功能,提高其满意度和生活质量,减少并发症的发生,值得临床推广应用.
目的:探讨产前超声筛查技术诊断高海拔地区多民族早孕期(11周～13+6周)胎儿异常的价值.方法:收集2020年7月-2021年7月来我院行颈部透明层(NT)厚度检查的1 969例胎儿超声表现,评估早孕期超声诊断胎儿异常的价值.结果:产前超声诊断胎儿异常87例,畸形发生率4.42％,其中结构畸形44例;NT增厚43例(其中颈部淋巴水囊瘤11例).其中,汉族畸形发生66例,少数民族(包括藏族、回族、土族、撒拉族、蒙古族、满族)畸形发生21例.结论:在早孕期进行超声检查能较早地检出胎儿异常:严重结构畸形、为染色体畸形胎儿提供线索,临床早期处理,最大程度减轻对孕妇的损伤,具有重要的临床意义.
长链非编码RNA(LncRNA)是一类由于缺乏开放阅读框而丧失蛋白编码能力的RNA序列,临床上与多种疾病的发生相关,大量研究表明LncRNA在肿瘤耐药过程中起着关键调控的作用,已经证实相关LncRNA如H19的异常表达与肿瘤的耐药有关,因此,LncRNA与肿瘤耐药的相关性研究意义重大.本文就LncRNA介导肿瘤耐药过程的发生机制及LncRNA H19与肿瘤耐药中的相关研究进展进行综述.
目的:了解西宁地区青少年近视患病现状及影响因素,为近视防控工作提供依据.方法:采用横断面研究,于2021年8月-2021年12月对西宁市第一人民医院(10～19)岁就诊者随机发放调查问卷,对西宁地区青少年近视患病情况及影响近视的相关因素进行分析.结果:①西宁地区青少年总体近视率为64.63％.女生近视率为69.58％,高于男生的近视率60.07％(P＜0.01);②多因素Logistic回归分析结果显示,不同性别、父亲近视、读书写字距离＜33 cm、平均每天使用电子设备时间在(1～3)小时、躺着看书以及没有做眼保健操休息眼睛的习惯都是青少年近视的危险因素.结论:西宁地区青少年近视率为64.63％,患病率较高,提醒政府、学校、家长应该引起重视,加强对青少年近视不良影响因素的控制,改善西宁地区青少年视力状况.
Objective:This study is aimed to investigate the incidence,risk factors,treatment and sequelae of anti-tuberculosis drug-induced liver injury（ATDILI） in patients with hepatitis B virus infection and tuberculosis（HBV-TB）.Methods:A total of 125 patients with HBV-TB treated in the Fourth People’s Hospital of Qinghai Province from July 2017 to July 2020 were included and divided them into ATDILI group and non-antituberculosis drug-induced liver injury（NATDILI） group according to the different conditions.We will retrospectively analyze their clinical data.Results:The incidence rate of ATDILI was 28%.The site of tuberculosis in ATDILI group was more than that in NATDILI group（P ＜0.05）.The damage degree of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,albumin（ALB） and prothrombin time activity（PTA） in ATDILI group was higher than that in NATDILI group（P ＜0.05）.The proportion of patients with cirrhosis＞ 8 kPa in ATDILI group was higher than that in NATDILI group（P＜0.05）.The incidence of ATDILI in hepatitis B virus E antigen（HBeAg） positive group was higher than that in HBeAg negative group（P＜0.05）.Conclusion:HBeAg positive,cirrhosis＞ 8 kPa,tuberculosis multiple site infection are risk factors for ATDILI in HBV-TB patients.
目的:总结青海地区新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者临床特点及应用新型冠状病毒中和抗体(中和抗体)治疗前后特异性抗体滴度IgM、IgG水平,为COVID-19患者的治疗提供参考依据.方法:收集青海省第四人民医院2021年10月21日-2021年11月4日收治的11例接受中和抗体治疗的COVID-19患者的临床资料,记录患者的性别、年龄、基础疾病、发病至应用中和抗体时间、发病至新型冠状病毒核酸转阴时间、住院时间、实验室检查结果以及2019新型冠状病毒(2019-nCoV)抗体免疫球蛋白(IgM、IgG)水平.结果:11例患者中,男性2例(18.2％),女性9例(81.8％),年龄(28～80)岁,平均年龄(40.7±17.1)岁,2例合并糖尿病,1例合并高血压,1例合并乙型病毒性肝炎,发病至应用中和抗体平均时间为(3.8±2.2)d,2019-nCoV核酸转阴平均时间为(23.1±4.4)d,平均住院时间为(24.1±4.5)d.应用中和抗体前,11例患者白细胞(WBC)均数(5.23±2.2)×109/L,淋巴细胞(LYM)均数(1.04±0.41)×109/L;应用中和抗体1 d、2 d、3 d、4 d后WBC无明显变化(P＞0.05),LYM在不同时间段均呈上升趋势(P＜0.05).应用中和抗体前,C-反应蛋白(CRP)均数中位数35.80 mg/L,白细胞介素6(IL-6)中位数 7.85 ng/L;应用中和抗体后,CRP在1d、2 d、3 d无明显变化(P＞0.05),4 d后明显降低(P＜0.05),IL-6在不同时间段均无明显变化(P＞0.05).应用中和抗体前,11例患者IgM滴度中位数0.023、IgG滴度中位数2.154.应用中和抗体后11例患者IgM在1 d时无明显变化(P＞0.05),在3d、6d、12d明显升高(P＜0.05);IgG在1d时明显增高(P＜0.05),3 d、6 d、12 d均维持在较高水平,与治疗前比较差异有统计学意义(P＜0.05).结论:11例患者应用中和抗体后,IgG抗体水平在l d内呈明显上升趋势,且可维持较长时间,起到持续抗病毒作用;淋巴细胞(LYM)计数在不同时间段均呈上升趋势,免疫力恢复,取得较好的临床治疗效果.
Objective:This study is to evaluate the effect of intensive statins on the treatment of asymptomatic middle cerebral artery stenosis and cerebral hemodynamics by transcranial color Dopplerultrasound（TCCD） at high altitude.Methods:60 asymptomatic patients with middle cerebral artery stenosis screened by TCCD in Xining area were collected and further diagnosed by CTA.The patients were divided into drug taking group and control group according to whether they regularly took intensive statins.The cerebral hemodynamic parameters of asymptomatic patients with middle cerebral artery stenosis were examined by TCCD before treatment,and TCCD was performed again 6 months after treatment.Results:The incidence of middle cerebral artery stenosis in the drug group was higher than that in the control group（P ＜0.05）.The reversion of severe stenosis in the medication group was better than that in the control group（P＜0.05）.After treatment,the levels of LDL-C,TC and TG in the treatment group were significantly lower than before treatmentand thosein the control group（P ＜0.05）.After treatment,the average blood flow velocity（Vm）,systolic blood flow velocity（Vs） and diastolic blood flow velocity（Vd）of the two groups were lower than before treatment（P ＜0.05）,and the pulsatility index（PI） was higher than before treatment（P＜0.05）,and the drug taking group was better than the control group（P＜0.05）.Conclusion:Intensifying statins at high altitude can not only reduce the blood lipid level of asymptomatic ICAS patients,but also promote the outcome of middle cerebral artery stenosis and improve cerebral hemodynamic parameters.
目的:观察加速康复外科在高海拔地区经尿道前列腺电切术(TURP)围手术期的应用效果.方法:收集2018年8月-2020年8月在我院泌尿外科行TURP治疗的90例前列腺增生患者,随机将其分为观察组和对照组,每组各45例.对照组患者采用泌尿外科常规围手术期准备及护理措施,观察组在对照组的基础上进行ERAS,比较两组患者的临床应用效果.结果:观察组患者尿管拔除时间、下床活动时间、术后肛门首次排气时间、住院天数均短于对照组患者,(P＜0.05).观察组患者术后疼痛评分以及术后6 h、24 h、48 h发生膀胱痉挛症状的评分均低于对照组,差异有统计学意义(P＜0.05).对照组术后出血、漏尿、膀胱痉挛发生率分别为44.44％、37.78％、46.67％均高于观察组的 2.22％、0、13.33％,差异有统计学意义(P＜0.05).结论:加速康复外科在高海拔地区经尿道前列腺电切术围手术期的应用效果较为显著,能有效缩短患者恢复时间、减轻患者疼痛以及术后发生膀胱痉挛症状的风险,值得临床推广应用.
目的:探讨高海拔地区腹腔镜联合胆道镜胆总管探查后一期缝合术中应用"挤冲探三步法"取石的治疗效果.方法:收集2016年4月-2022年3月我院通过"挤冲探三步法"取石的76例胆囊结石合并胆总管结石患者的临床资料,观察其临床治疗效果和并发症发生情况.结果:76例患者中结石取尽74例(97.37％),残余结石发生2例(2.63％),胆漏发生1例(1.32％),门诊随访期间发现术后胆道狭窄1例(1.32％).手术时间(131.00±32.50)分,住院时间(8.72±3.82)天,术后VAS疼痛评分(2.01±0.84)分.血清总胆红素在术后第4天可见明显下降(P＜0.05).发生胆漏和残余结石的患者经保守治疗后均痊愈.结论:在高海拔地区胆囊结石合并胆总管结石患者中,采用"挤冲探三步法"取石是安全可行的,并且取得了较好的治疗效果,可为腹腔镜胆总管探查术后一期缝合胆总管提供前提保障,值得在高海拔地区胆囊结石合并胆总管结石患者中推广使用.
Objective:This paper is aimed to study the changes of peripheral blood erythrocyte related parameters of officers and soldiers stationed at different altitudes and to analyze the effects of time and altitude on red blood cell related parameters.Methods:Erythrocyte related parameters of officers and soldiers stationed at altitudes of 3 700 m、4 200 m、4 900 m and 5 200 m were collected at the time point of 1 month、3 months、6months、9 months and 11 months.Red blood cell count（RBC）、hemoglobin（HGB）、hematocrit（HCT）、mean red blood cell volume（MCV）、mean red blood cell hemoglobin content（MCH）、mean red blood cell hemoglobin concentration（MCHC） and coefficient of variation of red blood cell distribution width（RDV-CV） were analyzed,which were compared with the same indexes of officers and soldiers stationed in plain.Results:RBC、HGB、HCT and RDW-CV showed an increasing trend with the increase of the altitude and the extension of the garrison time,and the difference was statistically significant compared with plain（P＜0.05）.RBC、HGB and HCT showed an increasing trend compared with plain at altitude of 3 700 m（P ＜0.05）.The difference of MCV、MCH and MCHC was not significant compared with plain.The RBC、HGB and HCT of 9 months at 4 200 m,6 and 9 months at 4 900 m were significantly increased（P ＜0.05）,then remaining at a relatively stable level.The RBC、HGB and HCT at 5 200 m was significantly higher than that at 1 month（P＜0.05）,which then remained at a relatively stable level.MCV、MCH and MCHC changed with the increase of altitude and stationing time,but within the normal range.RDW-CV increases with altitude and time accumulated.Conclusion:The erythrocyte level is stable at 3 700m,and it will not affect the body with the extension of time,so it is suitable to stay for a long time.At 4 200 m at9 months,at 4 900 m at 6 months,9 months,and at 5 200 m at about 6 months,erythrocyte related values showed a large increase,which can be used as the adjustment period of each altitude garrison,to prevent and reduce the incidence of altitude diseases to the maximum extent.
目的:观察酒肝胶囊联合硫普罗宁治疗青海地区酒精性肝病的临床疗效.方法:收集我院2019年1月—2020年12月肝病、消化科门诊ALD130例酒精性肝病患者随机分为对照组63例和观察组67例.对照组予口服硫普罗宁肠溶片0.2 g,每日3次;观察组在对照组的基础上予口服酒肝胶囊4粒,每日3次.两组均治疗12周.比较两组患者治疗前后中医症状量化积分、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)、碱性磷酸酶(ALP)、总胆红素(TBIL)、总胆固醇(TC)、三酰甘油(TG)以及血清Ⅲ型胶原(PC-Ⅲ)、透明质酸(HA)和层粘连蛋白(Ln)等指标水平,Fibroscan(肝脏硬度、脂肪衰减)指标变化,同时记录不良反应发生情况.结果:治疗后观察组总有效率为100％,对照组总有效率为88.89％,观察组优于对照组、差异有统计学意义(P＜0.05).观察组治疗后各中医症状量化积分低于治疗前(P＜0.01).两组治疗后ALT、AST、γ-GT、TBIL、TG以及PC-Ⅲ、HA、Ln等指标均较治疗前下降,且观察组上述指标变化较对照组更为显著(P＜0.05).观察组治疗后Fibroscan(肝脏硬度、脂肪衰减)指标较治疗前显著降低(P＜0.01).两组治疗前后均无药物毒副作用及不良反应发生.结论:酒肝胶囊联合硫普罗宁治疗酒精性肝病患者有较好的临床疗效,且安全性高.
