Background and purposeSudden sensorineural hearing loss (SSNHL) can be a prodromal symptom of ischemic stroke, especially posterior circulation strokes in the anterior inferior cerebellar artery (AICA) area. Early diagnosis and optimal treatment for vascular SSNHL provide an opportunity to prevent more extensive area infarction. The objective of our research was to find clues that suggest stroke at the stage of isolated sudden hearing loss.MethodsWe retrospectively investigated the medical records of patients who received an initial diagnosis of sudden sensorineural hearing loss upon admission from January 2017 to December 2022 at Capital Medical University Affiliated Beijing Tiantan Hospital. Among these patients, 30 individuals who developed acute ischemic stroke during their hospital stay were enrolled as the case group. To create a control group, we matched individuals from the nonstroke idiopathic SSNHL patients to the case group in terms of age (±3 years old) at a ratio of 1:4. We collected the clinical characteristics, pure tone hearing threshold test results, and imaging information for all patients included in the study.ResultsThree models were constructed to simulate different clinical situations and to identify vascular sudden sensorineural hearing loss (SSNHL). The results revealed that patients with SSNHL who had three or more stroke risk factors, bilateral hearing loss, moderately severe to total hearing loss, and any intracranial large artery stenosis and occlusion (≥50%) were at a higher risk of developing ischemic stroke during hospitalization. Consistent with previous studies, the presence of vertigo at onset also played a significant role in the early detection of upcoming stroke.ConclusionClinicians should be alert to SSNHL patients with bilateral hearing loss, moderately severe to total hearing loss and other aforementioned features. Early pure tone audiometric hearing assessment and vascular assessment are necessary for high-risk patients with SSNHL.

Objective:To investigate the correlations of urinary Alzheimer-associated neuronal thread protein (AD7c-NTP) with apolipoprotein E (ApoE) allele and cognitive function in patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI) and Alzheimer's disease (AD).Methods:Two hundred and fifty-nine AD patients or patients at prodromal AD stage, including SCD ( n=148), MCI ( n=65), and AD ( n=46), admitted to Department of Neurology, Xuanwu Hospital, Capital Medical University from January 2019 to January 2021, were chosen. Results of neuropsychological assessment, ApoE alleles and urinary AD7c-NTP level were collected in all subjects. Correlations of AD7c-NTP with grading of ApoE alleles and neuropsychological assessment results were analyzed by Spearman's rank correlation. Results:Urinary AD7c-NTP level in AD group was significantly higher than that in MCI group and SCD group ( P<0.05). ApoE genotype test showed that, in these 259 subjects, 24 had ApoE genotype grading 1, 150 had APOE genotype grading 2, 10 had APOE genotype grading 3, and 75 had APOE genotype grading 4; compared with patients with ApoE genotype grading 1 and 2, patients with ApoE genotype grading 4 had significantly increased urinary AD7c-NTP level ( P<0.05). Correlation analysis showed that urine AD7c-NTP level was positively correlated with ApoE genotype grading ( r s=0.264, P<0.001). Urinary AD7c-NTP level was negatively correlated with scores of Montreal cognitive assessment, auditory verbal learning test-N5, animal verbal fluency test and Boston naming test ( P<0.05), and positively correlated with shape trails tests-A and shape trails tests-B scores ( P<0.05). Conclusion:In AD patients or patients at prodromal AD stage, the higher the urinary AD7c-NTP level, the higher the ApoE genotype grading and the greater the decline in cognitive function.

肝性脊髓病为临床少见病,多发生于伴有门-体分流的终末期肝病患者,致残率高,治疗难度大.钱英教授在肝性脊髓病治疗方面有丰富的临床经验,对本病的病因病机提出了新的认识,即"瘀、毒、虚、损"共同作用导致"肝-肾-髓-脑"轴受损,并提出了滋补肝肾、酸甘柔筋、活血通络、清热通腑、通补奇经的综合治法.同时,对本病的针灸治疗也形成了独特的经验.

Objective:To study the correlation between regular follow-up and complications in peritoneal dialysis patients, and to provide basis for clinical diagnosis and treatment and patient management.Methods:A single-center retrospective analysis method was used. The data of 212 peritoneal dialysis patients who were followed up in Huadu District People's Hospital of Guangzhou from January to October 2020 were collected. Among them, 156 patients themselves were followed up once a month, as a regular follow-up group, and other 56 patients with poor regular follow-up as an irregular follow-up group. The basic and clinical data of the two groups were analyzed. χ2 test was used for the count data, independent sample t test or Wilcoxon rank sum test was used for the measurement data, and Spearman rank correlation analysis was used for correlation analysis. Results:In the irregular follow-up group, the time of dialysis was 44.50 (22.00, 77.50) months, the education level above middle school accounted for 53.57% (30/56), the systolic blood pressure was (147.84±19.79) mmHg (1 mmHg=0.133 kPa), the incidence of cardiovascular events was 28.57% (16/56), and the incidence of respiratory diseases was 10.71% (6/56), which were higher than those in the regular follow-up group (all P<0.05). In the irregular follow-up group, the complete self-care accounted for 73.21% (41/56), the fluid change by patients themselves accounted for 71.43% (40/56), the residual urine volume was 100.00 (0.00, 300.00) ml, and the serum albumin level was (33.65±5.14) g/L, which were lower than those in the regular follow-up group (all P<0.05). The 56 patients in the irregular follow-up group had 53 cases of complications, accounting for 94.64% (53/56); among the causes of complications, cardiovascular events accounted for 26.32% (35/133). Correlation analysis showed that regular follow-up was negatively correlated with self-care ability, fluid change operators, time of dialysis, systolic blood pressure, cardiovascular events, respiratory disease, and other diseases ( r=-0.176, -0.272, -0.167, -0.196, -0.195, -0.218, -0.159; P=0.011, 0.001, 0.015, 0.004, 0.004, 0.001, 0.021); regular follow-up was positively correlated with education level, residual urine volume, and serum albumin level ( r=0.141, 0.204, 0.165; P=0.041, 0.003, 0.016). Conclusion:During the long-term maintenance peritoneal dialysis treatment, it is of great significance to strengthen the regular follow-up for patients to reduce complications, especially the occurrence of cardiovascular and cerebrovascular events.

Objective:To explore the prevalence of helicobacter pylori(HP) infection and risk factors in patients who were receiving hemodialysis(HD).Methods:During August 2018, 190 HD patients and control group of 18375 health check-up people of the physical examination center of the hospital at the same intervals as the control group were selected by the cross-sectional survey method. The prevalence of HP between HD patients and healthy people was analyzed. Secondly, HD patients were divided into HP-positive(27 patients) and HP-negative(163 patients). Finally, Multivariate regression analysis was used to analyze the risk factors of HP infection in hemodialysis patients by comparing the basic conditions and the clinical indicators.Results:The prevalence of HP infection in hemodialysis patients and healthy people was 14.20% and 22.20%, and the difference was statistically significant( P<0.05). The basic condition and clinical indicators of HP positive group and HP negative group were analyzed, and the cause of renal failure may play an important role in HP infection.The platelet count, platelet hematocrit, globulin, total bile acid, ALT/AST ratio in HP positive group were significantly higher than those in HP negative group( P<0.05), while the hemoglobin and hematocrit were significantly lower than those in HP negative group( P<0.05). Binary logistic regression analysis showed that total bile acid( OR=1.057, 95% CI: 1.001-1.115, P=0.045), ALT/AST ratio( OR=3.950, 95% CI: 1.149-13.581, P=0.029) were independent risk factors for HP infection in hemodialysis patients. Conclusions:The incidence of HP infection in hemodialysis patients is 14.20%, which is lower than that of healthy people.Total bile acid and ALT/AST ratios are independent risk factors for HP infection in hemodialysis patients.

目的 探讨新型冠状病毒肺炎(COVID-19)恢复期患者临床特征.方法 采用病例观察的方法,记录COVID-19患者出院后每次随访的临床症状、舌象、肺部CT和血生化指标情况.结果 出院14 d随访(实际随访时间为出院后6～20d)58例,中医证型中余邪未尽证34例(58.62％),气阴两虚证24例(41.38％);咽拭子SARS-CoV-2核酸检测复阳2例(3.4％);57例行肺部CT检查,肺部炎症完全吸收4例(7.0％),肺部炎症较前好转53例(93.0％).出院28 d随访(实际随访时间为出院后21～34 d)31例,余邪未尽证6例(19.4％),气阴两虚证25例(80.6％);咽拭子SARS-CoV-2核酸检测复阳1例(3.4％);30例行肺部CT检查,肺部炎症完全吸收9例(30.0％),肺部炎症较前好转21例(70.0％).结论 随着恢复时间的延长,患者临床表现和肺部影像学持续好转,中医证型由余邪未尽向气阴两虚转化.

目的 分析认识46例首都医科大学附属北京佑安医院收治的新型冠状病毒肺炎确诊病例的中医临床特征.方法 采集患者的病史、中医证候及诊疗过程资料,分析不同分型患者证候演变及转归.结果 46例患者中疫毒袭肺证(普通型)27例,湿毒郁肺证(普通型)13例,疫毒闭肺证(重型)6例,所有患者均接受中药治疗,中成药26例,中药汤剂20例.早期(0~3 d)症状相对较少,但已表现出特征性舌质红或暗红、苔黄腻或白腻的特点,进展期(4~14 d)半数以上患者出现发热(89.13% )、咳嗽咳痰(71.40% )、口干口渴(68.60% )、乏力(60% )、咽干或咽痛(57.10% )、纳呆(54.30% ),重症患者舌腻而干或少苔.恢复期( ＞15 d)多数患者症状明显缓解,咳嗽咳痰(72.20% )、口干口渴(66.70% )、汗出(50% )仍较突出,舌苔由厚转薄,苔腻的程度有所改善、苔色由黄逐渐转白,舌象改变较为缓慢.普通型与重型的中位病程分别为16.5 d(14~26 d)和25 d(21~27 d),平均住院天数分别为(13.24 ± 4.36) d、(19.73 ± 2.33) d.病毒核酸中位转阴时间分别为11.41 d(4~22 d)、14.5 d(9~24 d),肺部电子计算机断层扫描(computed tomography,CT)检查病灶开始吸收的中位时间分别为10 d(5~19 d)、15.5 d(8~21 d).结论本病湿热证候突出,病程长,对中医不同证型特征的认识有助于指导中医辨证施治.

目的 初步探索俯卧位通气(PPV)在人感染H7N9禽流感致重度急性呼吸窘迫综合征(ARDS)的疗效和安全性.方法 收集福州肺科医院RICU 2017年2月至4月确诊人感染H7N9禽流感2例患者的PPV前2 h (Pre-PPV),PPV后2h、4h、6h、8h、10h、12 h (PPV-2 h、PPV-4 h、PPV-6 h、PPV-8 h、PPV-10h、PPV-12h),改为仰卧位通气(SPV)后2h、4 h(SPV-2 h、SPV-4 h)相关呼吸力学和血流动力学数据,利用SPSS 19.0软件进行分析.结果 2例均行有创机械通气;1例PPV前纵隔气肿;症状出现至首次PPV分别为5d、8d.共行12次PPV,PPV 13(12～15)h/次,PPV过程中(PPVmean)氧合指数(OI)较Pre-PPV改善[(186.20±71.34) mm Hg比(131.36±45.43) mm Hg,P=0.020J;PPV过程中(PPVmean)平均动脉压(MAP)较Pre-PPV有所下降[(86.84±10.17) mm Hg比(97.58±20.51) mm Hg,P=0.009].SPV后(SPVmean)每小时尿量较PPV增多[(100.19±96.73) mL/h比(52.96±21.64) mL/h,P=0.002].与Pre-PPV对比,OI以PPV 10h和12h改善为著(P值分别为0.009、0.040).2例均存活.PPV过程中未发生深静脉置管滑脱、气管插管意外脱管、气管插管滑入一侧气管、气管插管阻塞.结论 PPV可改善人感染H7N9禽流感所致的重度ARDS患者的氧合功能,并发症少.

Objective:To Analyze the clinical features and influencing factors of elderly patients with new coronavirus pneumonia (COVID-19) and provide reference for clinical diagnosis and treatment.Methods:A retrospective analysis was performed for 109 inpatients diagnosed with COVID-19, including 39 in the elderly group and 70 in the non-elderly group, and the clinical data and prognosis of the two groups were compared.Results:The incidence of severe and critical cases in the elderly group was higher than that in the non-elderly group [48.7% (19/39)] vs.[15.7%(11/70)], P=0.032. The proportion of patients with chronic underlying diseases in the elderly group was significantly higher than that in the non-elderly group [84.6% (33/39)] vs. [30% (21/70)], P=0.003. There were 15 cases with chest tightness in the elderly group (38.5%), 12 cases of wheezing (30.8%) which were significantly higher than those in the non-elderly group. The laboratory examination tests of elderly groups showed a significantly lower absolute count of peripheral blood lymphocytes than non-elderly groups, and there was a significant difference ( P=0.029), and C-reactive protein and Neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the elderly group than that of non-elderly groups ( P<0.001). The abnormal value of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Albumin (ALB), creatinine (CREA), creatine kinase (CK), myoglobin (MYO) in the elderly group were higher than those in the non-elderly group ( P<0.05). Age, underlying disease, NLR are independent risk factors affecting prognosis. Conclusions:Elderly patients with the COVID-19 often have multiple underlying diseases, if the rates of laboratory lymphocyte count, C-reactive protein, liver and kidney function and myocardial enzyme spectrum abnormalities increased more obviously, the patients are more likely to develop into severe and critical status. Factors affecting the prognosis include age greater than 60 years, presence of underlying disease and serum NLR levels.

探索新型冠状病毒肺炎(即2019冠状病毒病,COVID-19)普通型、重型的中医药疗效,采用病例系列观察的方法,详细记录COVID-19患者治疗前后临床症状、舌象、肺部CT和血生化指标情况.2例普通型COVID-19患者住院予单用中药和对症治疗,1例重型COVID-19患者采用中西医结合治疗,3例患者治疗后临床症状均改善,肺部CT示炎症消失或好转,新型冠状病毒核酸检测阴性,治愈出院.运用中医扶正祛邪治疗COVID-19取得了较好临床疗效.

Background: Subjective cognitive decline (SCD) is considered the earliest symptomatic manifestation of preclinical Alzheimer's disease (AD). Currently, given the lack of effective and curable pharmacological treatments for AD, non pharmacological interventions (NPIs) for individuals with SCD may provide a valuable opportunity for the secondary prevention of AD. Objective: This systematic review and meta-analysis, conducted in accordance with the PRISMA guidelines, aimed to investigate the benefits of current NPIs in the population with SCD. Methods: The online electronic databases, including MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, PsycInfo, and CINAHL, were searched to identify randomized controlled trials of NPIs for SCD. Intervention strategies were psychological and health-related education interventions, mind-body therapy, lifestyle modification, cognitive training, and multidomain interventions. Outcomes included subjective memory, objective memory, global cognitive function, psychological well-being, and mood. Study quality was determined using the criteria of the Cochrane collaboration's tool. The Hedges' g of change was analyzed. Results: Eighteen studies were included in this review and meta-analysis. Overall, psychological and health-related education interventions exhibited a medium effect on objective memory function (Hedges' g =0.53, p = 0.01). Cognitive training led to a small effect on objective memory, which was marginal statistically (Hedges' g =0.19, p = 0.05). In addition, cognitive training also significantly improved subjective memory performance (Hedges' g = 0.49, p = 0.0003) and psychological well-being (Hedges' g = 0.27, p = 0.03). Conclusion: Overall, the psychological intervention and cognitive training may be beneficial to cognitive function and psychological well-being. NPIs may be effectively implemented in older adults with SCD.

目的 观察中药“喷灌疗法”(儿童型开喉剑喷雾剂口腔喷雾联合清热解毒中药灌肠)治疗普通型手足口病的临床疗效.方法 选择2017年7-10月诊断为普通型手足口病的患儿70例,其中来自北京佑安医院36例,来自河北省邯郸市妇幼保健院34例.采用随机数字表法将息儿分为对照组和治疗组各35例.对照组给予西医对症处理.治疗组采用开喉剑喷雾剂(儿童型)口腔喷雾治疗,每日6～8次,每次6喷;用清热解毒方灌肠,每日1次.2组均治疗3～7天,随访3天.对比2组退热时间、口腔黏膜病变消失时间、皮疹/疱疹消失时间,记录继发肺部或其他部位感染情况、重症转化情况、不良事件发生情况.结果 发热但体温≤38.5℃、未应用退热西药治疗的患儿21例,治疗组13例、对照组8例,2组退热时间分别为(1.77±0.60)、(2.66±0.52)天,治疗组退热时间短于对照组,2组比较差异无统计学意义(P=0.31);体温≥38.5℃患儿8例,治疗组3例,对照组5例,均接受了药物(百服宁)治疗,由于例数较少,未做分层比较.出现咽部明显充血、口腔黏膜疱疹或溃疡等病变的患儿66例,治疗组、对照组分别31例、35例,2组口腔黏膜病变消失时间分别为(3.84±1.46)、(4.80±1.21)天,差异有统计学意义(P =0.005).2组皮疹/疱疹消失时间分别为(5.21±1.34)、(6.11±1.18)天,治疗组皮疹/疱疹消失时间短于对照组(P=0.004).2组治疗期间均未发生其他部位继发感染、重症转化及不良事件.结论 中药“喷灌疗法”可有效缩短普通型手足口病的患儿的口腔黏膜病变消失时间、皮疹/疱疹消失时间,明显改善症状,且安全性高.

肺孢菌肺炎(PCP,Pneumocy stis carinii pneumonia)是由耶氏(早前称为卡氏)肺孢子菌引起的一种机会性感染性真菌性肺病.复方磺胺甲噁唑/甲氧嘧啶(SMZ/TMP)由于价格低廉、疗效确切是PCP 治疗的一线用药,但其胃肠道副作用大,肝肾功能损害和骨髓毒性等原因,有时导致治疗失败.近年来有棘白菌素类单药或联合用于PCP 的初始治疗或挽救治疗成功的报道[1-2],不良反应少,耐受性好.米卡芬净治疗PCP 的文献未见报道.本文回顾性分析了7 例确诊肺孢菌肺炎患者单药或联合使用米卡芬净治疗的疗效及安全性.

Objective To investigate the difference in the indicators and the complications of end stage renal disease of patients before and after changing peritoneal dialysis into hemodialysis,in order to guide the patients to adapt new dialysis methods.Methods Retrospectively analysis of 26 patients who changed dialysis mode with? complete clinical date during January 2009 to January 2017 in the hospital was performed,the last results before change mode and 3 months after changing to hemodialysis were selected.SPSS 19.0 software was used to analyze the data.Results There were 16 males and 10 females patients,mean age was (53.46 ± 16.49)years.After changing to hemodialysis dialysis,the total protein level was higher[(69.06 ±8.86)g/L vs.(61.91 ±9.60) g/L,P ＜0.05],albumin level was higher[(37.25 ±4.60) g/L vs.(32.31 ±6.87) g/L,P ＜0.05],phosphorus level was higher[(2.38 ±0.95) mmol/L vs.(1.82 ±0.72) mmol/L,P ＜0.05],potassium level increased significantly [(5.28 ± 0.9) mmol/L vs.(4.08 ± 1.08) mmol/L,P ＜ 0.05],urea nitrogen,serum creatinine and total cholesterol decreased significantly[(19.12 ±9.72) mmol/L vs.(27.12 ±9.10) mmol/L,P ＜ 0.05],[(888.45 ± 25.23) μmol/L vs.(1022.64 ± 37.85) μmol/L,P ＜ 0.05],[(3.78 ± 0.83) mmol/L vs.(4.52 ± 0.98) mmol/L,P ＜ 0.05].The changes in leukocyte,hemoglobin,serum calcium,triglyceride,serum sodium,high-sensitivity C-reactive protein,estimated glomerular filtration rate,serum iron,total iron binding capacity,transferin saturation were not statistically significant (P ＜ 0.05).Conclusions Both peritoneal dialysis and hemodialysis can be used as a replacement for end stage renal disease patients.In the transitional phase,we should strengthen education carefully for the patients to avoid the occurrence of hyperkalemia.

Objective To explore the effect of continuous quality improvement (CQI) in reducing catheter-related blood stream infection (CRBSI) in patients taking hemodialysis.Methods The incidence of CRBSI in the patients taking maintenance hemodialysis at our hospital from 2015 to 2017 was investigated;PDCA circulation method management was carried out.By monitoring the number of cases of catheter infection in the patients taking hemodialysis at our department,the related factors of infection were analyzed,the problems were found in time,and measures for continuous improvement were taken.The incidences of CRBSI before and after PDCA were compared.Results After 2 years' application of PDCA circulation,the infection rate decreased from 13.19％ to 3.45％,and was decreasing.Conclusion CQI can reduce the incidence of CRBSI and is worth for clinical application.

目的 探讨中药组方清肠利肝方(QCLG)对D-氨基半乳糖/脂多糖(D-GalN/LPS)所致急性肝衰竭(ALF)小鼠肝细胞自噬的影响.方法 将野生型健康C57BL/6雄性小鼠分为正常对照组、ALF模型组、QCLG干预组和QCLG+自噬抑制剂3-MA干预组.ALF模型组:腹腔注射D-GalN/LPS建立ALF模型;QCLG干预组:D-GalN/LPS给药前3天给予QCLG灌胃,1次/日;QCLG+ 3-MA干预组:D-GalN/LPS给药前3天给予QCLG灌胃,1次/日,D-GalN/LPS给药前24 h尾静脉给予3-MA干预.各组于D-GalN/LPS给药6h后收集小鼠肝脏组织和血清,检测小鼠血清ALT、AST,免疫印迹、实时荧光定量PCR检测小鼠肝组织自噬水平;抑制自噬后观察各组小鼠死亡率和肝脏损伤.结果 与正常对照组比较,ALF模型组ALT、AST水平升高,自噬水平下降;QCLG干预组ALT、AST水平较ALF模型组显著降低,自噬水平升高,差异有统计学意义(P＜0.05);抑制自噬后,QCLG的保护性作用被逆转,小鼠死亡率升高,肝脏损伤加重.结论 QCLG可促进D-GalN/LPS所致ALF小鼠肝细胞自噬水平,减轻肝细胞损伤.

Objective To investigate the death related information and causes of death of the hemodialysis patients in our hospital, improve the prognosis and survival rate of hemodialysis patients, and provide a basis for the clinical diagnosis and treatment of hemodialysis patients in the future. Methods All the informations of the hemodialysis death patients in our dialysis center from January 2012 to December 2017 were collected, and the numbers of death, death age, dialysis age, primary kidney disease type and cause of death were analyzed. Results A total of 113 death patients were in-cluded. The median dialysis age was 11. 7 months. The causes of death were cardiovascular and cere-brovascular diseases (46 cases), infection(13 cases),advanced carcinoma (4 cases), and other cau-ses (7 cases). Among the death patients of different dialysis age, those with shorter dialysis age had more serious anemia and lower albumin. Conclusions The life time of the hemodialysis death pa-tients in our hospital is short, among the dead patients,the proportion of hemodialysis patients less than 1 year is the highest. The main causes of death are cardiovascular and cerebrovascular diseases and in-fection. The treatment of anemia timely and improvement of nutritional status may help improve early survival rate.

本研究回顾性收集2012年1月1日至2017年12月1日在广州市花都区人民医院透析中心登记的436例血液透析（HD）患者的信息，男265例（60.8%），共113例（25.9%）死亡，根据患者透析龄分为短期（小于1年）、中期（1~3年）、长期（大于3年）组，Cox回归分析提示，在短期透析患者中急性左心衰（HR=2.5，95%CI 1.3~4.7，P=0.005）和使用临时导管进行透析（HR=53.5，95%CI 7.2~399.5，P<0.001）是死亡的独立危险因素；在中期透析患者中，年龄大于80岁（HR=34.8，95%CI 5.8~209.0，P<0.001）和肿瘤（HR=31.7，95%CI 4.4~226.7，P=0.001）是死亡的独立危险因素；而在长期透析患者中急性左心衰（HR=9.0，95%CI 3.1~26.2，P<0.001）和年龄60~79岁（HR=5.7，95%CI 1.8~18.3，P=0.004）是死亡的独立危险因素。本研究提示，不同透析龄患者的死亡危险因素不同，关注年长透析患者、防治心血管疾病、提前造瘘可能会改善血透患者的预后。

目的 探讨并比较血清酶联免疫分析法(ELISA)和侧流免疫层析法(LFA)检测血清隐球菌荚膜多糖抗原(CrAg)在肺隐球菌病(PC)中的应用价值.方法 采集2016年1月～2018年6月福建省福州肺科医院109例疑似PC患者的血液,采用ELISA和LFA两种方法对血清CrAg进行检测,对比分析两种方法对PC的诊断效率,同时监测治疗过程中血清CrAg的浓度变化.结果 109例患者中,经肺活检或肺穿刺液隐球菌检测确诊为PC53例,非PC56例,检验结果如下:(1)应用ELISA方法,PC组血清CrAg浓度为[11.43(5.92,47.96)]μg/L,其中CrAg≤3.2μg/L的例数明显低于非PC组,而CrAg≥5.0μg/L的例数则明显高于非PC组,两者比较差异均有统计学意义(均P<0.05).应用LFA方法,PC组血清CrAg检测阳性率明显高于非PC组,两者比较差异有统计学意义(P<0.05).(2)应用ROC曲线分析显示,ELISA检测血清CrAg的曲线下面积为0.939(95％可信区间为0.892～0.985).其中截断值取3.54μg/L时约登指数最高,视为最佳截断值,对应的敏感度、特异度、阳性预测值及阴性预测值分别为94.3％、80.4％、82.0％和93.8％.(3)当血清CrAg取4.0μg/L为截断值时,ELISA和LFA的诊断敏感度(88.7％和83.0％)两者比较差异无统计学差异(P>0.05),但ELISA特异度(82.1％)明显低于LFA(98.2％),两者比较差异有统计学意义(P<0.05).当截断值分别取5.0μg/L、6.0μg/L和7.0μg/L时,ELISA和LFA的诊断敏感度及特异度相当(均P>0.05).当取8.0μg/L为截断值时,ELISA的诊断敏感度(62.3％)明显低于LFA(83.0％),两者比较差异有统计学意义(P<0.05),但特异度(100％和98.2％)两者大致相仿(P>0.05).(4)14例患者在抗真菌治疗过程中监测血清CrAg的浓度变化,治疗前荚膜抗原浓度为[19.33(7.11,43.46)]μg/L,治疗后6个月荚膜抗原浓度为[8.09(5.39,11.90)]μg/L,较前明显下降,两者比较差异有统计学意义(P<0.05).结论 血清CrAg浓度为3.54μg/L时视为ELISA的最佳截断值,但当取5.0μg/L为截断值时,ELISA同时有较好的诊断敏感度和特异度,且和LFA的诊断效率相当,两种方法均有助于对PC的快速诊断,值得临床推广.与LFA定性检测相比,ELISA可动态监测血清CrAg的浓度变化,有助于PC的疗效判断和预后评估.

Objective To investigate the effect of PDCA cycle method for reducing the utilization rate of antimicrobial drugs in hospitalized patients.Methods The inpatients treated at our department were selected as research objects.PDCA cycles were used to manage the utilization rate of antibiotics.And then,the antibiotics use rates before and after management were analyzed.Results After the implementation of PDCA management mode,the antibiotics use rate decreased from 70.38％ to 58.64％.Conclusion The application of PDCA cycles can effectively reduce the antibiotics use rate in inpatients,solve the weak points found in the management work,promote the management staffs ability to discover and solve problems,and improve the management quality,so it is worth being widely generalized in various departments.