目的 探讨乌司他丁联合序贯透析、持续血滤治疗重症急性胰腺炎(SAP)所致脓毒症休克的疗效,并分析其对血清炎症因子、高迁移率族蛋白1(HMGB1)、肥胖抑制素(Obestatin)及肝肾功能的影响.方法 选取自2019年1月至2021年8月收治的70例SAP所致脓毒症休克患者为研究对象,按照随机数字表法分为A组(n=35)与B组(n=35).A组给予乌司他丁治疗,B组在A组基础上创建体外循环,进行序贯透析、持续血滤治疗.两组患者均治疗7 d,评估并比较两组患者临床疗效.记录并比较两组患者治疗前、治疗后急性生理与慢性健康评分(APACHEⅡ),序贯器官衰竭(SOFA)评分,血清炎症因子[白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)]、HMGB1、Obestatin水平,及肝肾功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌酐(SCr)、血尿素氮(BUN)].记录并比较两组患者28 d病死率.结果 治疗后,B组总有效率为91.4％(32/35),高于A组的71.4％(25/35),差异有统计学意义(P<0.05).治疗后,两组APACHEⅡ评分、SOFA评分及血清IL-6、IL-8、TNF-α、HMGB1、Obestatin、ALT、AST、BUN、SCr水平均较治疗前降低,且B组低于A组,差异有统计学意义(P<0.05).B组28 d病死率为8.6％(3/35),低于A组的28.6％(10/35),差异有统计学意义(P<0.05).结论 乌司他丁联合序贯透析、持续血滤可有效缓解SAP所致脓毒症休克患者炎症反应,促进病情恢复,改善患者预后.

目的探讨慢性心力衰竭患者外周血miR-133a的表达水平及其临床意义.方法选取2015年3月至2018年12月在该院诊断为慢性心力衰竭的患者54例为心力衰竭组,选取同期该院的体检健康者50例为对照组.采用荧光定量PCR检测外周血miR-133a表达水平,并检测血清凋亡分子B淋巴细胞瘤-2(Bcl-2)、Bcl-2相关x蛋白(Bax)、含半胱氨酸的天冬氨酸蛋白水解酶-3(Caspase-3)的水平及心功能指标左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、脑钠肽(BNP)的水平;采用Pearson相关分析各指标的相关性.结果心力衰竭组外周血中miR-133a的表达水平,血清中Bcl-2的水平、LVEF低于对照组,血清中Bax、Caspase-3、BNP的水平及LVEDD、LVESD高于对照组,差异均有统计学意义(P＜0.05).心力衰竭组患者的美国纽约心脏病学会(NYHA)心功能分级越高,外周血miR-133a表达水平及血清中Bcl-2的水平越低,血清中Bax、Caspase-3的水平越高,差异均有统计学意义(P＜0.05).心力衰竭组miR-133a、Bcl-2与LVEF呈正相关,与LVEDD、LVESD、BNP呈负相关,差异均有统计学意义(P＜0.05);Bax、Caspase-3与LVEF呈负相关,与LVEDD、LVESD、BNP呈正相关,差异均有统计学意义(P＜0.05);miR-133a与Bcl-2呈正相关,与Bax、Caspase-3呈负相关,差异均有统计学意义(P＜0.05).结论慢性心力衰竭患者外周血miR-133a表达水平降低,且与NYHA分级、心功能变化有关,其可能通过靶向调控凋亡分子参与慢性心力衰竭的发生、发展.

目的 探讨慢性心力衰竭(CHF)患者血清微小RNA-21(miR-21)表达水平与炎症因子、心功能分级和心肌重构的关系.方法 选取2017年1月至2019年7月该院门诊收治的CHF患者90例作为CHF组,同期在该院进行体检的健康人群100例作为健康对照组.采用实时荧光定量PCR法检测两组研究对象血清中miR-21的表达水平,根据CHF组血清miR-21表达量中位数将其分为高miR-21组、低miR-21组各45例.进一步检测各组研究对象的血清炎症因子[超敏-C反应蛋白(hs-CRP)、肿瘤坏死因子 α(TNF-α)、白细胞介素(IL)-6、IL-17]、超声心功能参数[左室射血分数(LVEF)、右室射血分数(RVEF)、每搏输出量(SV)、心脏指数(CI)]及心功能分级、超声心肌重构参数[左心室后壁厚度(LVPW)、左心室质量指数(LVMI)、左室重构指数(LVRI)].分析CHF患者血清miR-21表达水平与炎症因子、心功能分级和心肌重构的相关性.结果 CHF组血清中miR-21的表达量及LVEF、RVEF、SV、CI低于健康对照组,且血清脑钠肽(BNP)、脑钠肽前体(NT-proBNP)、hs-CRP、TNF-α、IL-6、IL-17水平及LVPW、LVMI、LVRI明显高于健康对照组(P<0.05).低miR-21组患者血清中hs-CRP、TNF-α、IL-6、IL-17水平及LVPW、LVMI、LVRI、心功能Ⅲ～Ⅳ级所占比例高于高miR-21组,低miR-21组LVEF、RVEF、SV、CI低于高miR-21组(P<0.05).相关性分析显示,CHF患者血清中miR-21表达量与血清hs-CRP、TNF-α、IL-6、IL-17、心功能分级以及心肌重构参数LVPW、LVMI、LVRI均呈负相关,而与心功能参数LVEF、RVEF、SV、CI呈正相关(P<0.05).结论 CHF患者血清中miR-21表达水平异常降低,与机体炎性反应程度及心脏损伤程度直接相关,miR-21可能参与CHF发生、发展并在辅助评估病情方面具有一定意义.

Objective To investigate the expression of human epididymis secretory protein 4 (HE4) and osteopontin(OPN) in normal endometrium group,precancerous lesion group and endometrial cancer group,and to analyze the correlation between the two proteins as well as the effect on the prognosis of EC operation.Methods Immunohistochemical SP method was used to detect the expression of HE4 and OPN in normal group,precancerous lesion group and cancer group of Handan Central Hospital from January 2009 to June 2015,and the correlation of factors and overall survival time was evaluated by Kaplan-Meier method and Log-rank test.COX model was used for multivariate analysis.Results In normal group,precancerous lesion group and cancer group,the positive expression of HE4 protein gradually increased respectively 13.33％,32.00％,70.76％,and the positive expression of OPN protein also gradually increased respectively 10.00％,24.00％,63.74％,with statistically significant difference between the three groups (P ＜ 0.05).The positive expression rate of HE4 and OPN protein in surgery pathological stage,histological grade,myometrial invasion and lymph node metastasis group,and the differences were statistically significant (P ＜ 0.05).Spearman correlation analysis showed that the expression of HE4 protein was positively correlated with the expression of OPN protein in endometrial carcinoma (r =0.397,P ＜ 0.05).Kaplan-Meier analysis showed that the five factors of surgical pathologic staging,myometrial invasion,lymph node metastasis,HE4 positive status and OPN positive status were associated with prognosis (P ＜ 0.05),while the age,histological grade,histological type were not associated with prognosis (P ＞ 0.05).COX multivariate stepwise analysis showed that the significant factors influencing the prognosis were surgery pathological stage,histological grade,myometrial invasion,HE4 positive status and OPN positive status,but the histological grade was the least (P =0.049).Conclusion HE4 and OPN protein is highly expressed in the EC and both were positively correlated.The endometrial carcinoma patients with late surgery pathological stage,high histological grade,deep myometrial invasion,HE4 expression positive,OPN expression positive have poor prognosis.HE4 and OPN are expected to be an important marker for evaluating the prognosis of EC.

目的 检测uPA蛋白在不同子宫内膜癌中的表达情况,及其与雌激素受体(ER)表达的相关性,进而探讨uPA在子宫内膜癌发生发展中的作用.方法 选取子宫内膜癌50例(癌组)、子宫内膜不典型增生50例(癌前病变组)及正常增殖期子宫内膜30例(正常组),应用免疫组化SP法,检测uPA蛋白和ER的表达水平,分析其表达与子宫内膜癌临床病理参数的关系及二者的相关性.结果 在不同子宫内膜组织中,uPA蛋白的阳性表达率分别为13.33％、40.00％、54.00％,而ER的阳性表达率呈逐渐下降趋势,分别为100％、72.00％、56.00％,且组间比较差异均有统计学意义(P＜0.05).uPA蛋白及ER的表达率在手术病理分期、肌层浸润深度及有无淋巴结转移,差异均有统计学意义(P＜0.05).子宫内膜癌中uPA的表达与ER的表达呈负相关(r=-0.293,P＜0.05).结论 uPA的表达可能受雌激素的调控,参与了子宫内膜癌的发生、发展、浸润等过程.

Objective To study the efficacy of Glutamine and Loperamide for chemotherapy-induced diarrhea in the patient with digestive tract carcinoma.Methods One hundred and twenty eight persons with chemotherapy-induced diarrhea were divided into treatment group and control group randomly.treatment group take glutamine 3 g once daily and loperamide 4 mg at the first time and then 2 mg each four hours orally and treat a distances for five days.Control group take smecta 3 g thrice daily orally.Each patient was observed the change after 72 h.Results Treatment group has better efficacy in the treatment of chemotherapy-induced diarrhea than that of control group.Conclusion It was significantly efficacy that Glutamine and Loperamide for chemotherapy-induced diarrhea in the patient with digestive tract carcinoma.