目的:研究孕中期胎儿DNA无创产前筛查(NIPT)联合血清绒毛膜促性腺激素β亚单位(fβ-hCG)、同型半胱氨酸(Hcy)进行高龄孕妇产前筛查的价值,评估妊娠结局.方法:按标准选取高龄产妇126例,以羊水穿刺胎儿染色体核型分析结果为金标准,比较分析NIPT联合fβ-hCG、Hcy和单一筛查的价值.结果:126例高龄孕妇经羊水穿刺胎儿染色体核型分析检出阳性6例,确诊三体综合征4例,性染色体异常2例;NIPT检出阳性4例,阴性122例,其中三体综合征4例,无假阳性患者;血清fβ-hCG检出阳性7例,阴性119例,其中三体综合征2例、性染色体异常1例、假阳性4例;血清Hcy筛查阳性9例,阴性117例,其中三体综合征2例、性染色体异常2例、假阳性5例;联合筛查检出阳性15例,阴性111例,其中三体综合征4例、性染色体异常2例、假阳性9例.单一筛查中NIPT的曲线下面积值(AUC)为0.833,显著高于fβ-hCG(0.733)、Hcy(0.812)(P＜0.05);敏感度为100.00％高于 fβ-hCG(50.00％)、Hcy(66.67％)(P＜0.05);而特异度为66.67％,低于 fβ-hCG(96.67％)、Hcy(95.83％)(P＜0.05).联合筛查的AUC值为0.963,显著高于单一筛查各项(P＜0.05),敏感度为100.00％,特异度为92.50％.结论:NIPT联合fβ-hCG与Hcy进行高龄孕妇产前筛查可以有效地评估其妊娠结局,相比于单一筛查方式准确性更好.

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) on the spatially-delayed responses of working memory using cynomolgus macaques.Methods:The working memory of six male cynomolgus macaques (8-9 years old) was trained using a spatially-delayed response task. They were then randomly divided into an iTBS group and a control group, each of 3. The iTBS group was given iTBS at an intensity of 35% of the maximum output, with 2 seconds of stimulation followed by 8 seconds of rest with trains of 50Hz bursts repeated at a frequency of 5Hz over a period of 192 seconds once daily for 5 days, while the control group was given sham iTBS. Before and after the 5 days, the body weight and working memory of each animal were evaluated. The total number of effective feeding episodes, and of effective feeding episodes with short and long delay periods were recorded.Results:There was no significant change in the average body weight of either group before and after the modeling and iTBS intervention. After the intervention the number of total effective feeding cases and those with a short delay period were both significantly higher in the iTBS group than in the control group. However, no significant inter-group differences in the effective feeding cases with a long delay period were observed.Conclusions:iTBS is effective in improving the spatially-delayed responses of working memory, at least in cynomolgus macaques.

肺部感染是各种疾病导致长期卧床患者常见的、严重的并发症,长期反复使用抗生素治疗,不仅耗费财力,且易导致耐药菌产生,对于长期卧床患者若病情稳定应尽早采取有效措施降低肺部感染发生率.笔者收治1例长期卧床合并肺部感染病例,经电动站立床训练1周后两肺炎症改善明显,本文总结治疗过程并分享经验.

目的 探究慢性阻塞性肺疾病(COPD)患者不规则趋化因子(FKN)、白三烯B4(LTB4)及呼出气一氧化氮(FeNO)水平变化及其临床意义.方法 选择2019年4月至2020年4月在我院就诊的120例COPD患者,另选取同期健康体检者60例作为对照组,按病情严重程度将120例患者分为COPD急性加重期患者(n= 64)与稳定期患者(n= 56).比较三组第1秒用力呼气容积在预计值的百分比(FEV1％pred)、一秒率(FEV1/FVC)、FKN、LTB4及FeNO;采用Pearson法分析FKN、LTB4及FeNO指标水平与FEV1％pred、FEV1/FVC的相关性.结果 COPD组患者FEV1％pred、FEV1/FVC水平明显低于对照组,FKN、LTB4、FeNO水平明显高于对照组(P＜0.05);COPD急性加重期组患者FEV1％pred、FEV1/FVC水平明显低于稳定组,FKN、LTB4、FeNO水平明显高于稳定组(P＜0.05);COPD患者FKN、LTB4水平与FEV1％pred及FEV1/FVC均呈负相关(P＜0.05),FeNO水平与FEV1％pred及FEV1/FVC无相关性(P＞0.05).结论 FKN、LTB4、FeNO水平与COPD病情严重程度密切相关,随着患者病情的加重呈升高趋势,可为临床准确评估COPD患者病情程度、制定治疗方案提供可靠信息.

目的 调查分析可能导致老年髋部骨折患者术后发生医院获得性肺部感染的危险因素.方法 抽取首都医科大学附属北京世纪坛医院2013年1月-2018年2月收治的髋部骨折老年患者224例,回顾性分析患者一般资料,根据是否发生医院获得性肺部感染分为感染组与未感染组,分析患者痰液病原菌培养结果,单因素及多因素Logistic回归分析老年髋部骨折患者术后医院获得性肺部感染的高危因素.结果 224例老年髋部骨折患者术后发生医院获得性肺部感染20例,发生率为8.93％.20例肺部感染患者经痰液培养分离出病原菌20株,其中13株为革兰阴性菌,占65.00％,革兰阳性菌5株,占25.00％,真菌2株,占10.00％;多因素Logistic回归分析发现,高龄、骨折至入院就诊时间长、合并呼吸系统疾病、合并神经系统疾病、手术时间长、全麻、有吸烟史、有慢性阻塞性肺疾病史、贫血均可能是导致老年髋部骨折术后肺部感染的危险因素(P＜0.05).结论 老年髋部骨折患者术后发生医院获得性肺部感染危险因素较多,术前积极纠正患者贫血、治疗合并症、改善肺功能,术后给予患者针对性的干预,可能会降低术后医院获得性肺部感染风险,对改善患者预后有一定临床价值.

目的:探讨血小板-淋巴细胞比率(PLR)、中性粒细胞-淋巴细胞比率(NLR)及红细胞分布宽度(RDW)在冠心病(CHD)患者疾病严重程度中的诊断价值.方法:选取2018-05-2019-10在我院进行冠状动脉造影(CAG)检查的患者170例,根据检查结果分为CHD组(130例)与对照组(非CHD组,40例);并按冠状动脉狭窄程度(Gensini)积分,将130例CHD患者分为CHD低危组(45例)、CHD中危组(50例)及CHD高危组(35例).比较4组研究对象PLR、NLR、RDW水平及Gensini积分,采用Pearson法分析PLR、NLR、RDW水平与Gensini积分相关性,采用受试者工作特征(ROC)曲线检测PLR、NLR、RDW指标单独及联合诊断对CHD患者病情严重程度的诊断价值.结果:3组CHD患者PLR、NLR及RDW水平均明显高于对照组(P＜0.05),CHD患者Gensini积分、PLR、NLR及RDW水平均随病情严重程度的增加而上升(P＜0.05);CHD患者PLR、NLR及RDW水平与Gensini积分呈正相关(r=0.439、0.431、0.573,P＜0.05);PLR、NLR、RDW单独及联合诊断CHD患者病情严重程度的AUC值分别为0.782、0.776、0.767及0.875.结论:机体内PLR、NILR、RDW水平可作为评估冠状动脉病变程度的指标,与CHD患者病情严重程度密切相关.

Objective To explore the clinical significance of serum levels of hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) in diagnosis of acute leukemia. Methods A total of 40patients with acute leukemia (AL) in this hospital during May2015to May 2017 were randomly selected for this study, they were enrolled as AL group, and 40healthy persons selected in this hospital for health physical examination were listed as control group. Serum levels of HGF and VEGF in these two groups were detected by using ELISA. The efficacy of chemotherapy in AL group was divided into complete remission (CR) and incomplete remission (NR). Then, the serum levels of HGF and VEGF in these two groups were statistically compared and analyzed. The serum levels of HGF and VEGF of these patients with different chemotherapy in AL group were statistically analyzed. Results The serum levels of HGF and VEGF in AL group were 1224.5±283.2pg/ml and 727.2±228.9 pg/ml respectively. They were significantly higher than those of control group (P＜0.01). Serum levels of HGF and VEGF in patients with ALL and ANLL were significantly higher than those of control group (P＜0.01). The difference in serum levels of HGF and VEGF between ALL and ANLL patients was not signⅢcant (P＞0.05). The clinical efficacy of chemotherapy with CR in patients of group AL, ALL and ANLL with serum HGF, VEGF levels were significantly lower in patients with NR (P＜0.05). Conclusion Serum levels of hepatocyte growth factor(HGF) and vascular endothelial growth factor (VEGF) in patients with acute leukemia have auxiliary clinical significance in diagnosis and prognosis with good effect, hence it is worthy to be applied for clinical promotion.

目的 分析乙二胺四乙酸二钾(EDTA-K2)诱导血小板假性减少症(EDTA-PTCP)患者的血小板的不同检测方式及结果.方法 回顾性选取2016年5月至2017年5月首都医科大学附属北京友谊医院收治的EDTA-K2诱导的血小板假性减少患者35例,采用Sysmex-XE 5000全自动血球分析仪分别对EDTA-K2抗凝电阻抗法、核酸荧光染色法、枸橼酸钠抗凝电阻抗法进行血小板计数和血小板手工计数,并比较标本静置0～5 min、30 min、60 min、120 min不同时间段血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)的变化差异.结果 35例患者采集后0～5 min,EDTA-K2抗凝电阻抗法、枸橼酸钠抗凝电阻抗法仪器检测和血小板手工计数结果分别为(237.5±89.2)×109/L、(268.5±87.8)×109/L、(257.2±91.4)×109/L,差异无统计学意义(P>0.05);EDTA-K2抗凝电阻抗法静置30 min、60 min、120 min后血小板计数均值分别为(55.2±23.4)×109/L、(39.5±25.0)×109/L、(37.5±22.0)×109/L,结果均显著低于0～5 min内血小板计数结果(P<0.01),亦显著低于同时段枸橼酸钠抗凝电阻抗法和血小板手工计数结果(P<0.01).电阻抗法和核酸荧光染色法显示,EDTA-K2抗凝标本静置30 min、60 min、120 min后MPV、PDW均显著高于0～5 min的检测结果(P<0.01),PCT则显著低于0～5 min的检测结果(P<0.01);两种方法同一时间段MPV、PDW、PCT差异均无统计学意义(P>0.05).结论 EDTA-PTCP患者EDTA-K2抗凝在一定程度上引发血小板聚集,MPV、PDW、PCT的数值变化可以提示血小板聚集的发生.应采用末梢血血小板手工计数,从而将可靠数据提供给临床.

Objective To explore the auxiliary diagnostic value of interferon-γ release assays ( IGRAs) for human immunodeficiency virus infection and pulmonary tuberculosis with negative culture. Methods The clinical data of 128 cases of negative HIV pulmonary tuberculosis, HIV/AIDS and pulmonary tuberculosis by IGRAs were ret-rospectively analyzed. Rate within the group and between groups were compared by chi-square test. T test was used for measurement data. Taking positive or negative results of IGRAs as the dependent variable factor, it used logistic regression (parameter estimation based on the condition of backward method) to analyze the results. Results (1) The level of blood interferon-γ and the positive detection rate were higher in HIV and pulmonary tuberculosis with negative culture patients than in patients with HIV/AIDS (U=7. 813, P=0. 005;chi-square=8. 486, P=0. 004), but it was close to pulmonary tuberculosis with negative culture patients ( U =1. 109, P =0. 292; chi-square =2. 459, P=0. 117). (2) Compared with negative HIV/ pulmonary tuberculosis patients, the level of of CD4+,&nbsp;lymphocyte count and CD4+ /CD8+ increased obviously in IGRAs positive HIV/ pulmonary tuberculosis patients ( t=5. 349, P=0. 002;t=2. 834, P =0. 009; t =5. 576, P <0. 001), and blood sedimentation decreased (t = -2. 317, P=0. 029). (3) Logistic regression analysis showed that CD4+ was independent factor for HIV/ pulmonary tuberculosis with negative culture (Waldχ2 =4. 434, P=0. 035, OR=13. 5, 95% CI=1. 197 -152. 211). (4) The sensitivity of IGRAs detection was 35. 7%, and the diagnosis accuracy was 72. 7%, which were higher than tu-berculosis antibody (21. 4%, 63. 6%) and PPD (14. 2%, 67. 0%) in HIV/ pulmonary tuberculosis with negative culture. Its specific degree was 90. 0%, which was similar with PPD (91. 7%) and slightly higher than tuberculosis antibody (83. 3%). The detection sensitivity of IGRAs joint PPD and tuberculosis antibody was up to 60. 7%. Con-clusion IGRAS can help to sieve out early from HIV patients or find HIV/TB patients. CD4+ <200/μl will influ-ence IGRAs. IGRAs is better than PPD and tuberculosis antibody for diagnosing HIV/pulmonary tuberculosis with negative culture. The three joint detection also helps to early diagnose HIV and pulmonary tuberculosis with negative culture.

Objective To analyze clinical value of blood indicators in the diagnosis of leukemia. Methods From March 2014 to March 2015,the blood test results of the 133 cases of leukemia patients were retrospectively analyzed. The change of white blood cells,hemoglobin and platelet levels were compared. Results The number of WBC and RBC in leukemia patients were higher than those of healthy patients,but PLT was lower. The blood cells examination revealed,101 cases with WBC increased,29 cases decersed,abnormal degree 97. 74%(130 / 133),ele-vated red blood cell in 25 cases,decreased 10 cases,abnormal rate 26. 32%(35 / 133 ),one case with elevated platelet,reduced in 92 patients, abnormal rate of 69. 92%(93 / 133);blood cell morphology examination showed abnormal white blood cells 129 cases(96. 99% ),abnormal red blood cells 23 cases(17. 29% ),platelet abnormalities 27 cases( 20. 30% ),blood cell morphology abnormal 131 cases(98. 50% ). Conclu-sion The number and shape of blood detection in the diagnosis of leukemia can be considered as a basis for screening,disease monitoring and symptomatic treatment method of leukemia.

Objective To study the clinical diagnosis value of high-sensitivity C-reactive protein( hs-CRP)and blood routine test in children infected with Mycoplasma pneumoniae( M. pneumoniae). Methods Children infected with M. pneumoniae in our hospital from August 2011 to September 2013 were enrolled in observation group and healthy children received physical examination in the same period were enrolled in control group. The results of hs-CRP and blood routine examinations and clinical manifestations of children infected with M. pneumoniae were observed. Results Compared with control group,hs-CRP level(15. 8 ± 2. 1 ml/L),white blood cell count(14. 8 ± 1. 9 × 109/L),neutro-phil granulocyte ratio(71. 4 ± 10. 4%),and monocyte ratio(5. 5 ± 0. 9%)were significantly higher;while lymphocyte ratio(23. 7 ± 3. 2%) was significantly lower in observation group. The positive rate(95%)of hs-CRP was significantly higher than that of blood routine test. The lev-el of hs-CRP was positively correlated with the remission time of cough,expectoration,asthma and pulmonary rales. Conclusion The detection of hs-CRP may better indicate M. pneumoniae infection than blood routine test and hs-CRP level is positively correlated with the remission of clinical symptoms and signs.

皮肤性病学是一门具有专科特色、病种繁杂且以形态学为主要临床表现的学科，强调学生对皮损的认识和辨别能力。传统的以教师讲授为主的灌输式教学方法，不利于学生对皮肤性病这门学科的自主学习及临床实践能力的培养。为了克服传统教学法中的一些缺点，我们将案例教学法( CBL)和以问题为基础的教学法( PBL)相结合应用于皮肤性病科的临床教学中，可以培养学生的临床思维和临床实践能力，进一步提高皮肤性病科的教学质量及解决临床实际问题的能力。

尿液常规检测一般以干化学试带和尿液自动化仪器相结合,具有快速、准确等优点,对许多疾病的诊断起着重要作用[1-2].但尿液检测涉及诸多环节,包括分析前、分析中、分析后的质控因素,临床反馈不满意的结果中,有80%最终可溯源到标本质量不符合要求[3],只有规避影响尿液检测的因素,才能保证检验结果的真实、客观,本研究基于urisys2400尿自动分析仪进行尿常规检测,将其质控因素分析如下.

Objective:To observe the effects of selective α2-adrenergic receptor agonist alpha-Methylnorepinephrine (α-MNE) on BNP and myocardium in rabbits with cardiopulmonary resuscitation (CPR). Methods:Rabbit models of CPR were established. Eighteen rabbits were randomly divided into three groups:operation control group (group A) underwent anesthesia,surgery and endotracheal intubation without induced ventricular fibrillation; epinephrine group (group B) administered the standard dose of epinephrine (30 μg/kg) during CPR; α-MNE group (group C) administered α-MNE (100 μg/kg) during CPR. Serum BNP was detected 15 minutes before inducing ventricular fibrillation and 30,60,120,180 and 240 minutes after CPR. Myocardium was taken for microscopic detection 240 minutes after successful resuscitation. Results:Level of serum BNP was significantly higher in group B and group C than that in group A after CPR (P<0.01),and it reached the peak at 30th minutes. The increment of BNP in group C were less than that in group B (P<0.01). Myocardial injury was seen in group B and group C under the microscope,but the myocardial damage was less in group C than that in group B. Conclusions:α-methylnorepinephrine may reduce the BNP secretion and myocardial pathological damage at the early stage of cardiopulmonary resuscitation,and it has protective effect on the heart after CPR.

目的 探讨全血B型钠尿肽(BNP)水平在诊断及鉴别诊断心源性呼吸困难及非心源性呼吸困难的临床意义.方法 选取以呼吸困难为主诉的患者187例,分为A组(心源性呼吸困难组)134例,B组(非心源性呼吸困难组)53例.其中心源性呼吸困难组按照超声心动图检查结果分为A1组(单纯舒张功能不全)、A2组(单纯收缩功能不全)、A3组(收缩并舒张功能不全)三个亚组;按照NYHA心功能分级标准对心功能进行分级(Ⅱ～Ⅳ),测定各组患者全血中的BNP浓度.结果 A组患者BNP浓度为741.3±462.8pg/ml,B组为89.3±47.2pg/ml,两组间差异有显著性(P<0.001).A组各亚组间BNP浓度:A1组为273.8±34.5pg/ml,A2组为430.2±97.8pg/ml,A3组为789.3±132.4pg/ml,各亚组间BNP水平差异有显著性(P<0.05).心功能Ⅱ、Ⅲ、Ⅳ级患者BNP浓度分别为438.1±289.3pg/ml、703.4±367.9pg/ml和998.7±538.2pg/ml,三组间有显著差异(P<0.05).心源性呼吸困难组患者BNP水平与心脏舒张末期内径呈显著正相关,与左心室射血分数(LVEF)呈负相关(P<0.05).结论 BNP水平对于急性呼吸困难,尤其是心源性呼吸困难与非心源性呼吸困难的诊断及鉴别诊断有重要价值.

目的报告因抗凝剂乙二胺四乙酸二钾(EDTA-K2)引起血小板假性减少病例,以引起同行注意。方法选择不同检验方法进行血小板的检测。结果血细胞计数中抗凝剂EDTA-K2引起血小板检验结果假性减少,导致对检验结果的错误理解、极易误诊,而且使病人承受不必要的进一步检查,增加了病人的医疗费用及痛苦。结论目前临床用EDTA-K2作为血细胞计数的抗凝剂,但引起血小板不正常的粘附、聚集,导致抗凝静脉血血小板结果假性减少。所以应引起同行们的注意。

目的通过分析不同职业的4272人的体检结果,探讨北京市成人脂肪肝的流行病学特征及与其他疾病的关系。方法4272例体检人员被调查,包括病史,血压、血糖、血脂的检测,并采用B超诊断脂肪肝。通过性别、年龄分层后比较脂肪肝的患病率及与其他疾病的相关性。结果脂肪肝的总患病率为31.04%,男、女患病率随年龄增长明显升高,20～60岁年龄段男性患病率明显高于女性;脂肪肝组合并高血压、糖尿病、血脂异常者明显高于非脂肪肝组;TG3升高男性明显高于女性。结论北京市成人脂肪肝的患病率高,与性别、年龄、血脂升高的类型有关,且与高血压、糖尿病、高血脂有较高的并存率。

Objective To determine the abnormal result for activated partial thromboplastin time(APTT)by instrument detection with two commercial reagents. Methods The APTT values of plasm from healthy subjects and patients receiving oral anticoagulant,standard plasm of coagulation factor Ⅷ and plasm with cacucium heparin were detected respectively by two kinds of APTT reagents.The results were analyzed by SPSS10.0. Results There was notable difference in APTT value between the two kinds of APTT results if the result was expressed in second.While there was no notable differences was found if reported in APTT ratio. Conclusion Each clinical lab should establish its own reference range of APTT.The results detected by different laboratory can be compared when they are reported in APTT ratio.The result should be considered abnormal when it prolongs over seven seconds more than that of normal in the present method.