目的:观察双环醇联合熊去氧胆酸(UDCA)治疗Ⅰ型自身免疫性肝炎(AIH)合并原发性胆汁性肝硬化(PBC)患者的应答率及免疫指标变化.方法:纳入2017年1月至2019年6月郑州大学附属郑州中心医院收治的(AIH-PBC)患者90例,采用随机数字表分为对照组(45例)和观察组(45例).对照组患者采用UDCA治疗,观察组患者采用双环醇联合UDCA治疗.比较两组患者治疗前及治疗1年后天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)水平变化情况及治疗后指标的应答率,免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)水平变化,比较两组患者的不良反应发生情况.结果:与治疗前比较,治疗1年后两组患者AST、GGT、ALT、ALP水平均降低(P<0.05),且观察组患者各指标均低于对照组(P<0.05).治疗后观察组患者肝功能生化指标应答率均高于对照组(P<0.05).与治疗前比较,治疗后两组患者IgG、IgA、IgM水平均降低(P<0.05),且观察组患者上述指标均低于对照组(P<0.05).两组患者均无严重不良反应,差异无统计学意义(P>0.05).结论:双环醇联合UDCA治疗Ⅰ型AIH-PBC可改善患者肝功能生化指标,提高生化指标应答率,同时促进患者免疫功能的恢复,安全性较高.

目的 探讨注射半剂量18F-氟代脱氧葡糖(18F-flurodeoxyglucose,18F-FDG)对恶性肿瘤患者全身正电子发射计算机断层显像(positron emission tomography/computed tomography,PET/CT)图像质量的影响,以确定注射半剂量18F-FDG对恶性肿瘤进行有效诊断的可行性.方法 回顾性分析2021年2月至2021年9月在河南省人民医院PET/CT中心18F-FDG全身显像40例确诊恶性肿瘤患者的PET/CT图像.患者分为全剂量组(3.70 MBq/kg,20例)和半剂量组(1.85 MBq/kg,20例).两组患者均采用联影全景动态PET/CT扫描仪采集图像,全剂量组患者PET采集时间3 min,半剂量组患者PET采集时间10 min.由2名从业核医学5年以上的医生采用5分制(5分-优;1分-差)对两组图像打分,并对比两组肿瘤部位最大标准摄取值(maximum of the stand-ard uptake value,SUVmax)值、肿瘤与肌肉摄取比值等指标,以评定图像质量,数据分析采用x2检验.结果 全剂量组和半剂量组图像在性别、年龄、体质量指数、注射和成像间隔时间、肿瘤病变性质和病理类型等方面两组之间差异无统计学意义(P＞0.05).全剂量组和半剂量组图像质量平均评分接近,分别为(4.6±0.3)分和(4.5±0.2)分.两组肿瘤SUVmax和肿瘤与肌肉摄取比值等指标之间没有显著差异(P＞0.05).结论 与全剂量组相比,半剂量组呈现了较好的信噪比.半剂量组获得的图像质量评分与全剂量组相比没有统计学意义上的差异.因此,患者在接受联影全景动态PET/CT检查时,如果18F-FDG的总剂量有限,患者可通过注射半剂量的18F-FDG并适当延长PET采集时间来满足临床诊断对图像的要求.

目的 前瞻性分析大脑静息葡萄糖代谢改变在初诊肺癌患者情绪障碍发病中的临床意义.方法 实验组来自临床拟诊肺癌并拟行全身(脑+躯干)18F-氟脱氧葡萄糖(18F-FDG)正电子发射断层显像/计算机体层摄影(PET/CT)检查的患者,对照组来自健康体格检查者.所有被试者在18F-FDG PET/CT检查前接受哈密尔顿抑郁量表(HAMD)及焦虑量表(MAS)评定,对比分析大脑静息葡萄糖代谢改变、情绪障碍评分以及两者之间的相关性.结果 最终纳入155例肺癌患者(实验组)及152例健康体检者(对照组),实验组HAMD评分及MAS评分均高于对照组(t=1.020.P=0.04;t=0.09,P=0.03);实验组脑PET显像存在以双侧额、颞叶为主的多个脑区葡萄糖代谢减低,且受累脑区平均标准化摄取值(SUV)在双侧额叶及左侧颞叶分别与HAMD评分呈负相关(r=-0.68、-0.60、-0.55),在左侧额叶及左侧颞叶分别与MAS评分呈负相关(r=-0.59、-0.58).结论 大脑静息葡萄糖代谢改变与情绪障碍在肺癌患者中具有显著相关性,且以额叶为著.脑葡萄糖代谢改变可能是肺癌患者情绪障碍发病的神经病理基础,有望作为神经生物学标记用于临床评估.

Objective:To prepare 68Ga-2-(4, 7-bis(carboxymethyl)-1, 4, 7-triazonan-1-yl)pentanedioic acid (NODAGA)-YHWYGYTPQNVI (GE11) and evaluate its feasibility of PET imaging for pancreatic cancer. Methods:GE11 peptide was conjugated with NODAGA and then labeled with 68Ga. The labeling yield, radiochemical purity, hydrophilicity, stability and specificity in vitro were determined. Human pancreatic cancer BxPC3 nude mice models ( n=9) were established. MicroPET imaging was then obtained after 30 and 90 min, and mice were sacrificed at 90 min to acquire the radioactivity distribution of main organs and tumors. Pair t test was used to analyze the data. Results:The labeling yield was (73.5±5.4)% and radiochemical purity was more than 98%. After incubation 120 min in mouse serum at 37 ℃, radiochemical purity was more than 92%. The uptake was specific in BxPC3 cell lines. MicroPET images showed that 68Ga-NODAGA-GE11 could accumulate quickly in tumor. Value of tumor uptake was significantly higher than that of normal pancreas at 90 min ((1.38±0.25) vs (0.49±0.07) %ID/g; t=12.67, P<0.05), and the radio-uptake of blood, muscle and bone was lower than that of tumor. Conclusions:68Ga-NODAGA-GE11 is easy to be prepared with high radiochemical purity and good stability, and can specifically target BxPC3 xenograft tumor. However, due to the high uptake in the kidneys and liver, the value of 68Ga-NODAGA-GE11 in PET imaging for pancreatic tumor needs further study.

目的 探讨"知信行"模式护理干预对痛风患者治疗依从性与生活质量的影响.方法 选取2019年1 ～12月在郑州大学附属郑州中心医院风湿免疫科住院治疗的痛风患者120例,采用随机数字法分为对照组与观察组,每组60例.对照组患者给予痛风常规护理,观察组患者在对照组的基础上采用"知信行"护理模式进行护理干预.比较两组患者护理干预前后的治疗依从性、血尿酸水平、西医症状体征积分以及生活质量.结果 干预前,两组患者的治疗依从性、血尿酸水平、西医症状体征积分以及生活质量比较,差异均无统计学意义(P＞0.05);干预90 d后,观察组患者治疗依从性高的比例(93.3％)显著高于对照组(80.0％),血尿酸水平、西医症状体征积分显著低于对照组,生活质量评分显著高于对照组,差异有统计学意义(P＜0.05).结论 将"知信行"模式应用于痛风患者的护理管理中,能显著提高患者的治疗依从性,有效降低患者的血尿酸水平及西医症状体征积分,提高患者的生活质量.

目的:探讨艾拉莫德与雷公藤多苷片治疗类风湿关节炎的临床效果.方法:选取2018年1月～2020年1月收治的类风湿关节炎患者100例为研究对象,按照随机数字表法分为对照组和观察组,各50例.对照组予以雷公藤多苷片联合甲氨蝶呤治疗,观察组给予艾拉莫德联合甲氨蝶呤治疗.比较两组治疗前后关节疼痛敷、压痛数、肿胀数,红细胞沉降率及超敏C反应蛋白水平.结果:治疗前两组关节疼痛数、压痛数、肿胀数比较无显著性差异(P＞0.05),治疗后两组关节疼痛数、压痛数、肿胀数均低于治疗前,且观察组低于对照组(P＜0.05);治疗前两组红细胞沉降率、超敏C反应蛋白水平比较无显著性差异(P＞0.05),治疗后两组红细胞沉降率、超敏C反应蛋白水平均较治疗前降低,且观察组低于对照组(P＜0.05).结论:采用艾拉莫德治疗类风湿性关节炎患者,可有效控制病情进展,改善临床症状,临床疗效显著.

目的 探讨沙利度胺联合柳氮磺吡啶对强直性脊柱炎患者炎性反应的影响.方法 选取2016年5月至2018年5月我院收治的强直性脊柱炎患者76例,随机分为对照组和观察组各38例.对照组给予柳氮磺吡啶治疗,观察组采用沙利度胺联合柳氮磺吡啶治疗,比较两组的治疗效果、 炎性因子水平、 脊柱活动度、 骨密度.结果 观察组的总有效率为94.74％,高于对照组的78.95％(P<0.05).观察组治疗后的IL-6、IL-23、TNF-α水平均低于对照组,脊柱活动度、 骨密度T值均高于对照组,差异均有统计学意义(P<0.05).结论 沙利度胺联合柳氮磺吡啶治疗强直性脊柱炎患者,可有效提高治疗效果,降低炎性因子水平,改善脊柱活动度及骨密度,可行性高.

目的:观察霉酚酸酯联合环磷酰胺治疗狼疮性肾炎疗效及对患者免疫功能的影响.方法:选取我院收治的狼疮性肾炎患者84例,按治疗方案的不同分为对照组和观察组,各42例.对照组予以环磷酰胺(静脉冲击,1 g/次,1次/月)治疗,观察组在对照组的基础上给予霉酚酸酯(0.5 g,bid)治疗.比较两组实验室检查指标、系统性红斑狼疮疾病活动指数(SLEDAI)评分、T淋巴细胞亚群CD3+、CD4+、CD8+等免疫功能指标水平、临床疗效以及不良反应.结果:治疗后两组SLEDAI评分、24 h尿蛋白定量均低于治疗前,血清白蛋白(ALB)高于治疗前,差异有统计学意义(P＜0.05);治疗后观察组SLEDAI评分、24 h尿蛋白定量显著低于对照组,ALB显著高于对照组,差异有统计学意义(P＜0.05);治疗后,两组CD3+、CD8+均低于治疗前,CD4+高于治疗前,差异有统计学意义(P＜0.05);治疗后观察组CD3+、CD8+显著低于对照组,CD4+显著高于对照组,差异有统计学意义(P＜0.05);观察组总缓解率为95.24％,显著高于对照组的73.81％,差异有统计学意义(P＜0.05);两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论:霉酚酸酯联合环磷酰胺治疗狼疮性肾炎疗效显著,可有效改善患者病情及免疫状态,且安全性较高.

目的 探究miR-146a和miR-155在老年原发性干燥综合征(PSS)患者血清中的表达及临床意义.方法 老年PSS患者80例(疾病组)和同期健康体检者80例(对照组)为研究对象,采用实时荧光定量PCR法检测血清miR-146a、miR-155表达水平,采用阻抗法检测血清白细胞(WBC)含量,采用免疫比浊法测定血清免疫球蛋白(Ig)G抗体水平,采用间接免疫荧光法检测血清抗核抗体(ANA),采用免疫组化法检测血清抗SSA、抗SSB抗体,采用Pearson法分析miR-146a、miR-155及二者分别与WBC、IgG的相关性;采用受试者工作特征(ROC)曲线分析检测miR-146a、miR-155表达水平对PSS诊断价值.结果 与对照组比较,疾病组血清中miR-146a表达水平明显升高(P<0.001),miR-155表达水平明显降低(P<0.001),血清中WBC数量显著减少(P<0.001),IgG水平显著增加(P<0.001);与抗ANA阴性组、抗SSA阴性组、抗SSB阴性组比较,抗ANA阳性、抗SSA阳性组、抗SSB阳性组miR-146a表达水平显著升高,miR-155表达水平显著降低(P<0.001);PSS患者血清中miR-146a与miR-155表达呈显著负相关(r=-0.718,P<0.05),与WBC呈显著负相关(r=-0.694,P<0.05),与IgG呈显著正相关(r=0.690,P<0.05);PSS患者血清中miR-155与WBC呈显著正相关(r=0.566,P<0.05),与IgG呈显著负相关(r=-0.693,P<0.05);血清miR-146a、miR-155表达水平诊断PSS疾病的曲线下面积(AUC)为0.831、0.834,截断值为0.625、0.651,特异度为0.825、0.838,灵敏度为0.800、0.813;二者联合诊断PSS疾病的AUC为0.884,特异度为0.925,灵敏度为0.763.结论 miR-146a在PSS患者血清中高表达,miR-155低表达,二者呈负相关,可能参与PSS发生发展过程,对PSS早期诊断有一定参考价值.

目的:探讨观察对痔疮术后创缘水肿患者中给予地奥司明片治疗的临床效果.方法:选取95例痔疮术后创缘水肿病人,按照随机综合序贯法分为对照组(n=47)和观察组(n=48),将不同时刻水肿积分、创面愈合时间、临床疗效作为观察指标.结果:水肿积分在组间、时间和相互作用方面比较均有显著差异(P<0.05),本组内每两个时刻水肿积分和不同时刻组间数据比较均有显著差异(P<0.05);观察组创面愈合时间较对照组明显缩短(P<0.05),且临床疗效分布及总有效率组间差异也均有显著性(P<0.05).结论:对痔疮创缘水肿实施常规疗法的同时另给予地奥司明片不仅可以减轻水肿症状,还可促进创面愈合,效果更为显著.

Objective To compare the application value of three palliative regimens in the treatment of hilar cholangiocarcinoma.Methods From June 2014 to May 2016,225 patients with hilar cholangiocarcinoma who were admitted to the department of hepatobiliary surgery and department of gastroenterology in our hospital were selected as study subjects.According to different regimens,they were divided into palliative surgical resection group (80 cases,group A),endoscopic biliary drainage group (70 cases,group B) and percutaneous transhepatic biliary drainage group (75 cases,group C).The success rate of treatment and total success rate were compared between different regimens.The survival time and length of stay were analyzed,and liver function indexes [alanine aminotransferase (ALT),total bilirubin (TBIL),alkaline phosphatase (ALP)] were compared.The complications were recorded.Results The total success rate of treatment in group A (53.75％) was significantly lower than that in group B (70.00％) and group C (73.3％) (P ＜ 0.05).The success rates of type Ⅳ in group A and group B (7.50％,10.00％) were respectively lower than that in group C (26.67％) (P ＜ 0.05).The length of stay showed no significant difference between groups (P ＞ 0.05).The median survival time of group A was longer than that of group B and group C [(13.51 ± 1.17) months vs (8.97 ± 1.56) months,(8.74 ± 1.65) months] (P ＜ 0.05).After treatment,the levels of ALT,TBIL and ALP decreased,and the decreasing range in group B was the most obvious (P ＜ 0.05).The incidence of postoperative long-term complications in group A (31.25％) was respectively higher than that in group B and group C (15.71％,16.00％) while there was no significant difference between group B and group C (P ＞ 0.05).Conclusion The effect of percutaneous / endoscopic biliary drainage is obviously better than that of palliative surgery in the treatment of hilar cholangiocarcinoma.For patients with type Ⅰ ～Ⅲ hilar cholangiocarcinoma,endoscopic approach is preferred,while patients with type Ⅳ hilar cholangiocarcinoma,transhepatic biliary stent implantation is suggested.

ObjectiveTo study the efect of laparoscopic repair in the treatment of gastric perforation.Methods Selected 90 cases of patients with gastric perforation as the research object from January 2013 to February 2014,the random number expression,was divided into control group and observation group,each group 45 cases,control group treated with open operation,observation group treated with laparoscopic repair,to compare the clinical efect of two groups of patients after treatment.ResultsThe observation group of operation time,intraoperative blood loss,postoperative exhaust time,length of hospital stay were better than that of control group,diference had statistical significance(P< 0.05),observation group the incidence of postoperative complications(4.44%)was lower than the control group(13.33%),the diference was statisticaly significant(χ2=4.8812,P< 0.05).Conclusion Laparoscopic repair the clinical curative efect of treatment of gastric perforation was superior to that of the traditional open surgery,has smal trauma,quick recovery,less complications.

目的：探讨普外科急腹症的临床治疗效果。方法2011年9月－2013年9月收治的68例急腹症患者随机分为观察组与对照组，每组34例，观察组行腹腔镜手术治疗，对照组行传统治疗，对比2组患者治疗效果及临床数据。结果观察组总有效率显著高于对照组，手术时间、出血量及住院时间明显低于对照组，差异具有统计学意义（P＜0．05）。结论在普外科急腹症的临床治疗中，使用腹腔镜手术方法，可以有效提高治疗效果，同时减少患者治疗痛苦，缩短住院时间，促进患者恢复，值得在临床中应用和推广。

Objective To explore the method and effect on treatment of abdominal open trauma department of general surgery. Methods Selected 80 cases with abdominal open trauma department in general surgery from 2012 January to 2015 January in our hospital, divided into combined group and control group randomly, each group has 140 cases. The comprehensive group had comprehensive treatment, contrast group was treated with routine treatment, compared with the two groups treatment rate. Results The effective rate of comprehensive treatment group was 96.42%, the treatment group was 85.71%, the comprehensive group of adverse reactions was 10%, the treatment group was 17.85%, P<0.05, had difference statistically significance. Conclusion The comprehensive treatment of abdominal open trauma department of general surgery patients, can improve the treatment efifciency, reduce adverse reactions.

Objective:To observe the clinical effect of octreotide in the treatment of.Methods:80 cases with abdominal adhesions intestinal obstruction after operation were selected from August 2012 to August 2013.The were randomly divided into the observation group and the control group with 40 cases in each.The control group were given the treatment measures of conventional conservative routine abdominal adhesive ileus after operation,including anti infection treatment,maintain normal acid-base balance and water electrolyte balance,keep the parenteral nutrition the body needs,maintain gastrointestinal pressure reduction,and no cases to drink water.The observation group were given octreotide 0.1mg subcutaneous injection based on the treatment of the control group,every 8 hours given,in order to promote the patient's feces and gas emissions.We compared the effect of two groups after the treatment,and we compared their hospitalization time,surgical operation rate,anal exhaust time, gastrointestinal decompression amount,abdominal distension and pain relief time and so on.Results:The hospitalization time,anal exhaust time,gastrointestinal decompression amount,abdominal pain relief time and other indicators of the observation group after the postoperative treatment were better than those of the control group,and the difference was statistically significant(P<0.05). Conclusion:The curative effect of octreotide in the treatment of intestinal obstruction even sticky after abdominal operation is obvious,so it is worthy of popularizing.

Objective:To explore the effect of the improved clinical pathway in the operation treatment of thyroid nodules.Methods:60 cases with thyroid nodules who had the operation treatment were selected from April 2012 to April 2013.They were randomly divided into the control group and the observation group with 30 cases in each.The control group were given the clinical routine treatment.The observation group adopted the improved clinical pathway to treat.We compared the hospitalization time,waiting for the operation time,hospitalization expenses and the postoperative complication of the two groups.Results:After the operation,there was no significant difference in the complications of the two groups(P>0.05).The total hospitalization time,waiting for the operation time and the hospitalization cost index of the observation group were better than those of the control group.The two groups had significant difference(P<0.05).Conclusion:The improved clinical pathway in the treatment of thyroid nodule operation is more effective than the traditional clinical pathway,so it is worthy of promotion and innovation in practice.

针对炼焦行业亟待解决的节能减排、降低成本和提高焦炭质量的问题,分析了影响焦炭质量的主要因素,选择了六项指标来预测焦炭的质量,建立了通过遗传算法(GA)优化神经网络的焦炭质量预测模型。实践表明,GA优化的BP神经网络焦炭质量预测模型有较好的适应性和预测精度,具有一定的实际应用价值。