目的:通过比较经行腹全子宫切除术、阴式全子宫切除术与腹腔镜下全子宫切除术这三种途径的临床效果,探讨3种术式的优劣差异.方法:收集我院妇科在2017年5月-2020年5月实施全子宫切除的237例患者为观察对象,其中经腹全子宫切除术(TAH组78例)、阴式全子宫切除术(TVH组80例)、腹腔镜下全子宫切除术(LH组79例),进行同期观察比较.对三组的手术时间、术中出血量、肛门排气时间、住院天数、住院费用、术后感染、术后并发症等数据进行统计学分析,比较三种术式的优劣差异.结果:TVH组的手术时间均明显少于TAH组和LH组,差异有统计学意义(P＜0.05),TVH组的术中出血量均明显少于TAH组和LH组,差异有统计学意义(P＜0.05),TAH组的肛门排气时间晚于LH组和TVH组,差异有统计学意义(P＜0.05),TAH组的住院天数晚于LH组和TVH组,差异有统计学意义(P＜0.05),TVH组术后感染发生率低于TAH组和LH组,差异有统计学意义(P＜0.05),TAH组患者住院费用相对较低,TVH组次之,其中尤以LH组住院费用最高,三组住院费用比较,差异有统计学意义(P＜0.001).结论:三种全子宫切除术的手术途径各有利弊,选择时应在保证患者手术安全、治疗有效的前提下,同时根据患者的个人意愿、医生的手术经验和医疗设备等情况综合判定.在无阴式手术禁忌证的情况下,阴式手术是子宫切除术的最佳途径,手术时间短、恢复快、并发症少,且适应证更广,值得临床推广,可视为子宫切除术的首选方法.

Objective To explore the expression of the Merlin protein in normal cervix and cervical can-cer of the Han,Tibetan and Hui nationalities in Qinghai. Methods Immunohisto-chemical staining was per-formed to detect the expression of Merlin in 108 cases of cervical carcinoma(40 cases of Han,38 cases of Tibetan and 30 cases of Hui nationality)and 107 cases of normal cervix(40 cases of Han,37 cases of Tibetan and 30 cas-es of Hui nationality). Results The positive expression rates of Merlin in normal cervix were 90.0%,91.9%and 86.7%respectively and those in cervical carcinoma were 17.5%,18.4%and 16.7%respectively. There was signifi-cantly statistical difference(P<0.05). However,there was no significant difference in the positive rates of Merlin between cervical carcinoma among different ethnic groups(P>0.05). The expression of Merlin was not correlated with age,FIGO stage,lymph metastasis and cell differentiation(P > 0.05)in cervical carcinoma of three ethnic groups. Conclusion The decrease or even deletion of Merlin may be involved in the development of cervical can-cer,and it plays an important role in cervical cancer. The expression of Merlin exerts no effect on the occurrence of cervical cancer and it is not associated with the clinical characteristics of the patients ,suggesting that it may not be involved in the invasion and metastasis of cervical cancer.

多发性骨髓瘤(MM)是临床上浆细胞病中最常见的一种恶性肿瘤.其发病机制不明确,可能与细胞因子异常表达有关.研究表明:B细胞活化因子(BAFF)/增殖诱导配体(APRIL)在正常和恶性B淋巴细胞表面都表达,但在MM患者中高表达;BAFF/APRIL的表达可能在MM发病中起一定作用;血清BAFF、APRIL水平可能与MM的严重程度有关;BAFF/APRIL可以联合或单独作为MM的肿瘤负荷指标,评估MM的预后.BAFF及APRIL有可能成为治疗MM的分子靶点.

Irregular antibodies include all antibodies other than anti-A,-B,-AB in serum.Currently,numbers of studies have shown that the irregular antibodies are one of the main reasons that cause immune hemolytic transfusion reaction (HTR),hemolytic disease of the newborn (HDN),alloimmune thrombocytopenia (AIT),the difficult cross identification of clinical blood type,difficult crossmatching of blood and so on.Therefore,we review the types and characters of irregular antibodies,relationship between clinical diseases and irregular antibodies,the transfusion strategy of patients with irregular antibodies,and the recommendations for irregular antibodies management,in order to provide a theoretical basis for clinical blood transfusion and crossmatching.

Objective:To explore the prevalence of human papillomavirus(HPV)and genotypes distribution in Tibetan women living in plateau area.Methods:Genotypes of HPV from 7051 Tibetan women's cervix swabs were detected using flow-through hybridization and gene chip technology.15 kinds of high-risk types were HPV16,18,31,33,35,39,45,51,52,53,56,58,59,66,68),and 6 kinds of low-risk types were HPV6,11,42,43,44,CP8304.Results:The total positive rate of HPV among 7051 Tibetan women was 19.50%,and 21 subtypes of HPV were detected,of which HPV16(32.29%)was the most common one,followed by HPV58(19.64%),HPV52(10.25%),HPV53(7.42%)and HPV18(5.96%).The infection rate of high-risk genotype,single low-risk one were 93.60%(1287/1375)and 6.40%(188/1375).The single and multiple infection rates were 88.58%(1218/1375)and 11.49%(158/1375).There were two peaks of infection among different age groups:the first one in women less than 25 years old(24.23%),and the second one in women not less than 55 years old(30.54%).Conclusion:The common infection genotypes are HPV16,HPV58,HPV52,HPV53 and HPV18in Tibetan women living in plateau area,and the high-risk genotype as well as the single infection are primary.There is a low infection rate in simple low-risk genotype and multiple infection,and the age at infection tends to be younger and older.

Objective:To explore the distribution of the genotypes of human papillomavirus(HPV)in Tibetan,Han and Hui women living in Qinghai area,and to analyze its relationship with cervical lesions.Methods:Genotypes of HPV from 745 Tibetan women,2594 Han women,426 Hui women in Yushu,Xining,Hainan were examined by flow?through hybridization and gene chip technology,as well as liquid based cytology(TCT)between Jan.2012 and Dec2013.Afterwards,those who were both positive in the two tests mentioned above went through the histological biopsy.Results:The total positive rate of HPV among 3765 women was 12.96%(488/3765).The infection rates of the high-risk genotype,the low-risk genotype,the single infection and the mixed infection were 94.67%,5.33%,92.01%and 7.99%.The infection rate was 15.84%in Tibetan women,12.10%in Han women,and 13.15%in Hui women.The infection of HPV 16 and HPV58accounted for the highest proportion.The statistically significant differences in the rates of the single infection or the mixed infection among Tibetan,Han and Hui were found,however,There were no significant differences in the prevalence of the high-risk genotype or the low-risk genotype among Tibetan.The most common genotypes of HPV were HPV16,HPV58,HPV52,HPV53,HPV18,HPV39,HPV31,HPV45 in Tibetan,Han and Hui women with cervical cancer and cervical intraepithelial neoplasia.Conclusion:Tibetan women shows a little higher in positive rate of HPV.The prevalence of the high-risk genotype and the single infection is common in Tibetan,Han and hui women.The genotypes of HPV and cervical cancer and cervical intraepithelial neoplasia are mainly HPV16 and HPV58.The single infection could be more likely to lead to cervical cancer.

目的：研究青海高原地区不同民族患者红细胞血型不规则抗体的发生频率及其特异性抗体的分布特点。方法：采用微柱凝胶试验对选取2010年10月—2014年3月我院各临床科室符合红细胞输注指征的34 401例患者进行红细胞不规则抗体筛选,对于抗体阳性的血液标本鉴定其抗体种类和类型。结果：青海高原地区汉族人群红细胞血型不规则抗体的检出率为0.197%（51/25 931）、藏族人群红细胞血型不规则抗体的检出率为0.254%（14/5 503）、回族人群红细胞血型不规则抗体的检出率为0.474%（14/2 952）。结论：本研究检出了青海高原地区汉族、藏族、回族人群红细胞血型不规则抗体频率和分布特点,检出较多的特异性抗体除外冷抗体及自身抗体,依次为抗Rh、抗M、抗Lew、抗P等;青海高原地区不同民族人群不规则抗体存在民族特异性及地域性,建议青海高原地区各基层医疗机构应将不规则抗体筛查纳入临床常规检验指标。

Objective:To explore the status of human papillomavirus( HPV) infection and distribution of HPV subtypes in women living in Qinghai. Methods:Twenty- one subtypes of HPV from cervix swabs of 26 622 women were detected with the flow- through hybridization and gene chip technology. Results:The positive rate of HPV among the 26 622 women was 16. 72%. All 21 genotypes were detected. HPV16,58,52,53 and 18 were the most prevalent high- risk types. The positive rate of high- risk types was 14. 78%. The infection rate of single high- risk genotype was 13. 56%,that of the single low- risk genotype was 1. 22%,and that of the multiple infection was 1. 94%. There were significant differences in HPV infection among different age groups( P < 0. 05),the highest rates were in women with less than 25 years of age and not less than 55 years of age. Conclusion; Among women in Qinghai,the primary infection type is high- risk genotype,in which the top five are subtypes of HPV 16,58,52,53 and 18. There is a low infection rate in the single low- risk genotype and the multiple infection. HPVcp8304 is the common subtype.

Objective:To observe changes of blood oxygen saturation(SaO2) in crows acute exposed to high altitude from plain and Xining region.Methods:1 200 volunteer from plain(over sea level 7m) and Xining area(2 260m)were exposed to Yushu(3 750m) quickly,and were assigned at the first group(plain crowd,n=500) and the 2nd group(Xining crowd,n=700).Level of SaO2 was measured after 12h,24h,72h and 7days exposed Yushu by a portable oxygen saturation detector.Acute mountain sickness(AMS)was examined in the both groups in Yushu on the basis of the diagnostic criteria of AMS in Sep.1995.Results:Incidence of AMS began at(83.7±2.1)% of SaO2(a 25% incidence) In the first group,and began at(83.7±2.1)% of SaO2 for the 2nd group(a 21% incidence).Level of SaO2 in plain crowd from plain to Yushu decreased 11%;13% decrease for Xining crowd.Conclusions:Detection of SaO2 and change of SaO2 level could be a biological marker in diagnosis of AMS at high altitude.

To determine the risk factors leading to acute high altitude disease(AHAD).Methods:A total of 1 200 volunteers,who worked in Yushu area for relief and reconstruction after earthquake,were collected from April 2010 to October 2012,and were divided into the AHAD(n=276) group and non-AHAD group(n=924),aged 20 through 50 years.The symptoms score of AHAD,ordinary circumstances,family genetic history,family situation and Eysenck questionnaire were studied in the both groups.And SaO2 level,lung function,ECG,heart rate,blood pressure were measured after 12,24 hours and 3,7 days exposed Yushu area.In the evening on the 6th and 7th day,the respiratory sleep testing was conducted consecutively for 12 hours when objects were complete rest only.Results:The results found that the occurrence of AHAD relates to the patient's BMI,smoking,family history of AHAD,bad mood,lung function,SaO2 level,ST segment,heart rate,blood pressure,breathing sleep testing so on.Conclusions:The occurrence of AHAD is a result of many factors.

目的:比较高原不同海拔地区围绝经期藏族女性及其与平原地区围绝经期汉族女性性激素水平。方法:选择西宁地区组(海拔2 260m、平均大气压580mmHg(1mmHg=0.133kPa)、平均氧分压为121.8 mmHg)及玉树地区组(海拔4 200m、平均大气压约430mmHg、平均氧分压约90mmHg),两组各180例女性,年龄45岁～55岁,平均年龄(47.0±2.7)岁,BM I(23.1±2.5)kg/m2;性激素检测均于排卵期的滤泡早期空腹抽取静脉血,分离血清,均采用放射免疫分析方法测定雌二醇(E2)、卵泡生长激素(FSH)、催乳素(PRL)、孕酮(P)、睾酮(T)、促黄体生成素(LH)的含量。结果:西宁地区组与玉树地区组围绝经期藏族女性性激素比较无显著性差异(P>0.05),同时不同海拔组围绝经期藏族女性性激素与平原地区组围绝经期汉族女性性激素性激素各项指标比较无显著性差异(P>0.05)。结论:高原不同海拔地区围绝经期藏族女性性激素与平原地区围绝经期汉族女性性激素无区别。

目的:比较高海拔地区与平原地区围绝经期妇女的骨密度(BMD)。方法:经DEXA确诊为骨质琉松的人群分为三组:高原地区(海拔4200m)围绝经期妇女180例为A组,年龄45岁～50岁,均为汉族,移居高原20余年。中度海拔地区(海拔2260m)围绝经期妇女180例为B组,年龄45岁～50岁,均为汉族,移居西宁地区20余年。平原地区(海拔40m)围绝经期妇女180例为C组,年龄同前,均为汉族,世居南京。采用法国DMS公司生产的CHRONOS型双能X线骨密度仪测定A组、B组和C组腰椎、大转子及股骨颈BMD。结果:A、B、C三组腰椎2～4、大转子、股骨颈BMD相比,无显著性差异(P>0.05)。结论:高海拔地区围绝经期妇女骨密度与平原地区无区别。

目的:评价自体富血小板凝胶(autologous platelet-rich gel,APG)治疗西宁地区糖尿病足的有效性和安全性。方法:共纳入11例患者,取患者自身外周静脉血,经离心、分离、浓缩制得富含血小板血浆(plate-let-rich plasma,PRP),将其与凝血酶-钙剂按一定比例(101)(V/V)混合凝固形成APG,然后用双通注射器将APG均匀喷洒至溃疡表面或注射至深部窦道内。结果:11例患者治疗12周后,溃疡愈合率为63.6%(7/11),总有效率为84.6%(9/11);APG治疗后前3周溃疡面积愈合速度最快(P<0.05);APG对窦道治愈率为90.0%(10/11);治疗过程中无不良反应发生。结论:APG用于治疗西宁地区糖尿病足是安全有效的。

目的:明确在西宁地区(2260m)医院获得性下呼吸道感染的致病菌及其抗菌药物敏感性,为西宁地区临床第一线治疗使用抗菌药物提供科学依据。方法:对1598例我院住院患者在院内获得肺部感染行细菌学培养和药物敏感性试验进行分析。结果:培养出细菌891株,其中革兰氏阴性杆菌占80.81%,革兰氏阳性菌分离率占18.86%。结论:西宁地区医院内感染的病原菌以革兰氏阴性杆菌为主,对亚胺硫霉素有较高的敏感性。

目的:探讨西宁地区(海拔2600m)脂肪肝的病因。方法:比较分析西宁地区脂肪肝与非平原地区(广东佛山地区海拔0m)脂肪肝的主要病因。结果:在高海拔地区脂肪肝患者中酒精过量、高脂饮食、肥胖所占比例要比平原地区脂肪肝患者多。结论:西宁地区脂肪肝与非平原地区脂肪肝患者中,致病因素所占比例不同,因此预防保健侧重点有所不同。

目的探讨血液滤过(HF)在危重病救治中的疗效.方法对32例住院患者随机均等分为2组,一组行HF治疗,另一组在常规治疗的基础上用肝素对照.观察比较二组疗效及血液促炎细胞因子含量.结果治疗后HF组促炎细胞因子含量较NHF组显著降低(P＜0.05).结论HF组危重病患者疗效高于NHF组.早期HF有利于纠正促炎细胞因子过度释放,可缓解病情,提高疗效.

目的:加深对急性间质性肺炎临床表现及影像学特征认识,提高诊断及治疗好转率.方法:通过X线胸片、胸部CT、血气分析及尸检等,对5例住院急性间质性肺炎病例进行回顾分析.结果:急性间质性肺炎特征:病因不明确,无肺部疾病史,起病急,进行性呼吸困难,双肺可闻及Velcro罗音,胸部X线片、CT呈弥漫性间质病变、斑片浸润阴影,短期内迅速进展.结论:熟悉掌握急性间质性肺炎临床及影像特征,可提高诊断、治愈好转率.

本文对1998年3月至2003年3月我院入住的(西宁地区:海拔2 260m)慢性肺心病急性加重期患者536例进行分析,结果有198例为合并高血糖,比较高血糖组与非高血糖组对肺心病预后的影响及干预治疗后对肺心病预后的改进,现报告如下.

双氯灭痛片又名双氯芬酸钠片,主要成分是双氯芬酸钠,是一种衍生于苯乙酸类的非甾体消炎镇痛药,是该类药物中作用最强的一种.其特点是抗炎、镇痛作用强,并具有抗过敏作用,不良反应少,用量小,口服吸收好,个体差异少.副作用有头晕,头痛,皮疹,以及胃不适、纳差等胃肠道反应.致血小板减少偶见报道,高原地区更为少见,我院遇见一例,现报道如下.