目的 了解近3年新乡地区血流感染病原菌分布及其对常用抗菌药物耐药性,为临床合理使用抗菌药物提供参考依据.方法 回顾分析2014年10月-2017年9月新乡医学院第一附属医院和第二附属医院血流感染病原菌临床分布和耐药状况,分离培养和鉴定按照《全国临床检验操作规程》进行,药敏试验采用纸片扩散法(K-B法)和MIC法,数据采用WHONET5.6软件统计分析.结果 38 016份血培养标本,检出病原菌3 428株,阳性检出率9.0％,其中革兰阴性菌1 689株,占49.3％,革兰阳性菌1 411株,占41.2％,分离率居前5位的细菌依次是凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和鲍曼不动杆菌.大肠埃希菌、肺炎克雷伯菌对多数抗菌药物耐药率高达50.0％以上,对碳青霉烯类抗生素保持较好的敏感性;鲍曼不动杆菌对常用抗菌药物耐药率菌均高于30.0％;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为43.3％和65.7％.结论 血流感染病原菌种类多样,耐药情况严重,临床应重视耐药性监测,根据药敏结果合理选用抗菌药物,以减缓耐药菌株的产生和流行,有效控制血流感染.

目的 了解2013-2015年铜绿假单胞菌的临床分布特征及耐药性变迁,为临床医生合理用药提供科学依据.方法 分析2013年1月-2015年12月临床分离的692株铜绿假单胞菌的临床分布和耐药性,分离培养鉴定按照《全国临床检验操作规程》进行,药敏试验采用MIC法,数据采用WHONET5.4统计处理.结果 2013-2015年共检出铜绿假单胞菌692株,其中从痰中检出573株,占82.80％;感染科室主要分布在呼吸内科、ICU.2013-2014年,铜绿假单胞菌对各类抗菌药物耐药率较高,而多粘菌素B、头孢哌酮/舒巴坦仍具有较好的抗菌活性.2015年,耐药率呈下降趋势.3年间,多重耐药铜绿假单胞菌检出率为36.3％,泛耐药铜绿假单胞菌检出率为0.7％.结论 铜绿假单胞菌耐药情况较为严重,应加强耐药性监测,合理使用抗菌药物,以减少耐药菌株的产生和流行,控制医院感染.

目的:了解住院精神病患者乙肝(HBV)、丙肝(HCV)、爱滋病(HIv)和梅毒(TP)感染情况.方法:对7 137例住院精神病患者采用酶联免疫吸附试验(ELISA)进行血清HBsAg、抗-HCV、抗-HIV和抗-TP检测、抗-HIV初筛.结果:7 137例住院精神病患者血清HB-sAg、抗-HCV、抗-HIV和抗-TP阳性率分别为4.74％(338/7137)、1.03％ (70/6767)、0.03％(2/6775)、0.64％ (9/1398).不同性别患者的HBsAg、抗-HCV的阳性率比较,男性高于女性,差异有统计学意义(P＜0.01).不同年龄段患者的HBsAg、抗-HCV的阳性率比较,差异有统计学意义(P＜0.01),其中20～ 40岁住院患者HBsAg阳性率显著高于其他年龄段(P＜0.01).结论:住院精神病患者不同程度存在HBV、HCV、HIV、TP感染,病区应采取监测、隔离、消毒、治疗等综合性措施,以防交叉感染.

目的 探讨乙肝HBeAg、前S1-抗原和HBV-DNA的相关性,为临床诊疗提供实验室依据.方法 乙肝HBeAg和前S1-抗原检测采用ELISA法,HBVDNA载量采用PCR-荧光探针法.结果 (1)前S1-抗原阳性率HBeAg(+)组91.25％ (73/80)显著高于HBeAg(-)组25.48％ (40/157) (x2=37.552,P＜0.005);HBVDNA阳性率HBeAg(+)组88.75％ (71/80)亦显著高于HBeAg(-)组29.30％ (46/157)(x2=30.508,P＜0.05).(2) HBeAg阳性率HBV-DNA高水平复制组(即＞107拷贝/ml) 82.22％ (37/42)显著高于低水平复制组(即103～ 105拷贝/ml)45.0％ (9/20)(x2=10.78,P＜0.05);前S1-抗原阳性率HBV-DNA高水平复制(即＞107拷贝/ml)组96.15％ (42/45)亦显著高于低水平复制(即103～105拷贝/ml)组45.0％ (9/45) (x2=30.508,P＜0.005).结论 乙肝HBeAg、前S1-抗原与HBV-DNA检测,一致性较好,两者均可作为乙肝病毒复制和传染的实验室指标.

Objective To explore the effects of modified electroconvulsive therapy (MECT) on myocardial enzyme of female schizophrenics .Methods Sixty female schizophrenics were randomly divided into two groups of 30 ones each ,both groups took orally risperidone or olanzapine ,on this basis research group was plus MECT .Pre-and post-MECT myocardial enzyme changes of two groups were monitored .Results All indexes of myocardial enzyme heightened more significantly at the end of MECT compared with pre-MECT in research group (P<0 .05 or 0 .01) ,those were significant higher than in control group (P<0 .05 or 0 .01);pre-and post-treatment (P>0 .05) and group differences (P>0 .05) in all indexes of serum myo-cardial enzyme had no notable statistical significances at the end of the second week after MECT .Conclu-sion MECT could cause transient increased phenomenon of schizophrenics’ myocardial enzyme .

目的 探讨粪便隐血试验化学法(匹拉米洞法)、免疫法(转铁蛋白胶体金法)以及两种方法联合检测在消化道出血性疾病诊断中的临床应用价值.方法 对2012年1月至2012年12月2 910例住院患者粪便隐血试验中查出阳性的590例的临床资料进行回顾性分析,计算两种方法单独应用和联合应用时诊断的灵敏度、特异性、阳性似然比、阴性似然比、阳性预测值和阴性预测值,比较两种方法单独应用和联合应用对消化道出血的诊断价值.结果 590例粪便隐血阳性患者中,消化道出血性疾病448例,非消化道出血疾病142例.化学法隐血试验对消化道出血性疾病诊断的灵敏度、特异性、阳性似然比、阴性似然比、阳性预测值和阴性预测值分别为96.0％、94.6％、17.9、0.04、0.82和0.99.免疫法分别为93.8％、99.2％、115.4、0.06、0.97和0.98.两种方法联合应用时分别为91.3％、99.7％、321.1、0.09、0.99、0.98.结论 匹拉米洞化学法敏感性高,但特异性差.阳性似然比和阳性预测值免疫法高于化学法,两种方法的阴性似然比和阴性预测值接近.总体评价,免疫法优于化学法.两种方法联合应用均为阳性时,对诊断消化道出血的特异性和确证价值最高.两种方法联合检测,能提高对消化道出血的诊断效率,减少误诊.且两种方法都简便易行,成本低廉.

目的 了解河南省金黄色葡萄球菌临床分布及耐药性,为临床合理使用抗菌药物提供依据.方法 采用纸片扩散法(K-B法)或自动化仪器法对2012年河南省8所医院临床分离菌株进行药敏试验,以CLSI 2010年标准判断结果,WHONET 5.6软件分析数据.结果 8所医院2012年共分离金黄色葡萄球菌962株,检出MR-SA470株检出率为48.9％,检出MSSA492株检出率为51.1％,以老年病科、呼吸科检出率最高,分别为57.1％、54.8％,门诊检出率最低为34.8％;MSSA对青霉素耐药率为81.3％,对红霉素、克林霉素、克拉霉素耐药率分别为77.4％、70.1％、70.7％,对头孢类、氨基糖苷类、喹诺酮类、利福平均高度敏感,敏感率均＞80.0％;MRSA对抗菌药物的耐药率明显高于MSSA,未发现万古霉素、替考拉宁和利奈唑胺耐药株.结论 MRSA对抗菌药物耐药性高,应重视MRSA万古霉素MIC监测,合理使用抗菌药物.

OBJECTIVE To investigate the distribution and drug resistance of clinical isolates in central Henan province in 2010 for the guidance of rational application of antibacterials.METHODS The drug susceptibility testing and the detection of extended-spectrum β-lactamase(ESBLs) of clinical isolates from 7 hospitals in central part of Henan were performed using K-B method or automated system.The results were analyzed by WHONET5.4 according to CLSI 2008.RESULTS Of 5014 clinical isolates,3402 strains(67.9%) were gram-negative bacilli and 1612 strains(32.1%)were gram-positive cocci.E.coli,coagulase-negative Staphylococcus(CNS),P.aeruginosa,S.aureus(SAU) and Klebsiella spp were the most common clinical isolates,accounting for 20.6%,16.2%,11.4%,9.2% and 9.2%,respectively.The detection rates of ESBLs were 48.7% in E.coli,36.2% in Klebsiella spp and 18.1% in P.mirabilis isolates;The detection rates of MRSA and MRSCN in Staphylococcus were 67.4% and 81.4%,respectively.SAU and CNS were highly resistant to penicillin,macrolides and sulfamethoxazole/trimethoprim,but lowly resistant to nitrofurantoin and rifampicin,with no vancomycin-resistant Staphylococcus strains.Resistant rates of Enterococcus spp to vancomycin,nitrofurantoin,ampicillin and pennicillin were 0.9%,27.0%,36.0% and 41.4%,respectively.And the resistant rate of isolates to gentamicin reached 67.6%.CONCLUSION The bacterial resistance in central Henan province is still increasing.Therefore,regular surveillance of bacterial resistance is of great importance for the rational use of antibiotics and the reduction of production and spread of drug-resistant isolates.

[Objective] To study the drug resistance of Staphylococcus in urinary tract infection,and offer scientific basis for reasonable usage of antibiotics.[Methods]A total of 580 strains of pathogens were cultured and identified by routine method and K-B method was applied for the drug susceptibility test and detecting special resistant strains MAS.[Results]Among 580 strains of pathogens from infected urinary tract,Staphylococcus accounted for 11.2%(65 strains).The drug resistance testing showed 100.0% of Staphylococcus were sensitive to vancomycin and resistant to the other antibiotics in different degree.The MRS detection rate was 55.4%.[Conclusion]The infections caused by Coagulase-negative Staphylococcus(CNS) is rising annually.Resistance of Staphylococcus is quite serious..Clinician should base on drug susceptibility test to choose antibiotics reasonably and decrease the generation of resistant strains and improve efficacy.

OBJECTIVE To investigate the drug resistance of enterococci in urinary tract infection,to provide the bases for clinical anti-infective therapy.METHODS The pathogenic bacteria in urine specimens of 1 329 outpatients and inpatients between in January,2009 and in December,2011 were cultured and identified,and antimicrobial susceptibility test that KB disk diffusion method was used.RESULTS Enterococcus in urinary tract infection accounted for 10.2%,of which were main enterococcus faecium and enterococcus faecalis.The proportion of enterococcus faecium(35.3%) was higher than those of enterococcus faecalis(27.2%).Two kinds of enterococcus were with low resistance to vancomycin,teicoplanin,ampicillin,chloramphenicol,one of which enterococcus faecalis was with low resistance to penicillin G(21.6%),nitrofurantoin(27.0%).CONCLUSION Enterococcus is with multiple antibiotic resistance,and drug resistance of different species of enterococci are quite different.The clinical medication should have a rational choice in antimicrobial agents based on susceptibility testing.

我国是乙型肝炎病毒(HBV)感染率较高的国家,大部分感染者为无临床症状的HBV携带者,而HBV与肝硬化、原发型肝癌有密切关系.加之精神病医院的特殊管理模式,精神病患者由于受精神症状支配,因意外发生皮肤破损的情况较常见,因而患者易发生HBV感染,严重威胁患者的健康.为了解住院精神病患者HBV感染状况,作者对在我院住院精神病患者HBV五项指标进行了检测分析,现将结果报告如下.

[Objective]To understand the epidemic of Escherichia Coli in the urinary tract infection and it's sensitivity to 14 antibiotics,and to provide references for the clinical application of drugs.[Methods]128 strains Escherichia Coli infected urinary samples which were collected from 2008 to 2009 were carried out K-B method susceptibility test and ESBLs test.[Results]A total of 355 strains of the clinical isolates were isolated from 1 029 cases of urine samples.128 strains of them were the E.coli,and 65 producing ESBL bacteria was detected in 128 E.coli.It's positive rate was 50.8%.The best effect of killing bacteria was Imipenem.It's susceptibility was 100%,the secondly was Amikcacin(81.5%).[Conclusion]Escherichia coli is the most common clinical isolates of urine specimen,and the multidrug resistance was serious in the producing ESBL bacterias.Imipenem should be applied firstly in the treatment to the infection of the producing ESBL bacteria.

OBJECTIVE To investigate the drug resistance of clinical isolated bacteria to commonly used antibiotics in Xinxiang,2009,so as to guide the proper use of antibacterial drugs in clinics.METHODS The results of susceptibility test on the clinical isolated bacteria were collected from 5 different hospitals in Xinxiang.The collected data were analyzed by using WHONET 5.4 statistical software.RESULTS Among 6281 isolated bacteria,methicillin resistant Staphylococcus aureus(MRSA) and MRCNS accounted for 69.7% and 81.7% respectively.On average,70.5% of E.faecalis and 77.9% of E.Faecium were found with highly drug resistant to concentrated gentamicin.About 46.2% of Escherichia coli and 31.0% of Klebsiella pneumonia were found producing ESBLs.The drug resistant rates of Enterobacteriaceae against imipenem and meropenem accounted for an average of 5.4% and 8.3%,respectively.The drug resistant rates of the isolated Pseudomonas aeruginosa against imipenem and meropenem accounted for of 33.1% and 18.6%,respectively.The resistant rates of Acinetobacter baumannii to imipenem and meropenem were increased to 49.1% and 38.0%,respectively.The detection rates of pan-drug resistant strains fell in the order of 1.2% and 1.8%.Polymyxin showed good antibacterial activity to the pan-drug resistant P.aeruginosa and A.baumannii.CONCLUSION The drug resistance of bacteria has characteristics in certain area.It is important to strengthen the surveillance to the drug resistance of the isolated bacteria in routine work,which is useful for the proper use of antimicrobial agents and the control of the spread and outbreak of multi-drug resistant and pan-drug resistant bacteria.

[Objective]To investigate the bacteriological feature and drug-fast of bacteria in hydrothorax-peritoneum.[Methods]Bacteria culture and drug-sensitive test in hydrothorax-peritoneum preparation collected from 2007.1 to 2009.10,and retrospective analysis was conducted for them.[Results](1)The hydrothorax-peritoneum preparation was conducted for 1531 cases,the bacteria culture positive were 251 cases with the positive rate of 16.4%.301 strains pathogenic bacteria were found,including P.aesuginosa,S.aurus,S.epidermidis and E.coli.(2)The composition of G+ coccus and G-bacillus were almost equivalent in hydrothorax.G-bacilluss' percentage was high(64.1%)in hydroperitoneum.(3)Four pathogenic bacteria showed drug-fast to Streptomycin,Gentamycin,Ampicillin,Carbenicillin and Clindamycin,but was sensitive to Imipenem,Sulperazon and Mezlac-illin.The others were drug fast against clinical isolates at different degree.[Conclusion]The bacteriological examination of hydrothorax-peritoneum must be done.Selecting bacteria-sensitive drug has an important value to diagnosing and treating infection of thoracic and abdominal cavity.

目的:探讨急性脑梗死患者血液流变学及血细胞参数的变化及临床意义.方法:对137例脑梗死患者和120例健康人进行血液流变学及血细胞参数检测,并进行比较分析.结果:患者组除红细胞变形指数外的血液流变学指标、白细胞计数、红细胞计数、血红蛋白含量、平均血小板体积、血小板分布宽度显著高于对照组(P<0.05~0.01);平均红细胞体积、平均红细胞血红蛋白含量、血小板计数和红细胞变形指数显著低于对照组(P0.05).结论:血液流变学及血细胞参数异常可能与脑梗死的发生有关.

[Objective] To investigate the HBV infection in psychotic inpatients.[Methods] HBV markers of serum were tested by enzyme linked immunoassay(ELISA) in 3755 psychotic inpatients.[Results] Positive rates of HBsAg,HBsAb,HBeAg,HBeAb and HBcAb in serum were 8.81%、 30.81%、 3.12%、 21.54% and 15.29% respectively.The total infection rate of HBV was 43.65%.15 infection models were detected from 1639 HBV positive samples.HBsAg(+),HBsAb(-),HBeAg(-) HBeAb(+),HbcAb(+) accounted for 12.20%,and HBsAg(+),HBsAb(-),HBeAg(+),HBeAb(-),HBcAb(+) accounted for 5.86%.[Conclusion] There are HBV infection sources in psychotic inpatients.Comprehensive measures such as monitor,isolation and disinfection must be taken to prevent the infection of HBV in hospital for psychotic inpatients.

Objective To explore the clinical signifinance of CDS5 and CD59 expression in diagnosis aplastic anemia-paroxysmal nocturnal hemoglobinuria (AA-PNH) syndrome. Methods The expression of CU55 and CD59 were measured by flow cytometry in 19 cases with AA-PNH syndrome, at the same time the Ham test was done, and the positive detection rates were compared between two methods. Results The expressions of CUSS in red blood cell and white blood cell were found abnormal in 17 cases (89.4%) and 19 cases (100%), while the expressions of CD59 in red blood cell and white blood cell were found abnormal in 18 cases (94.7%) and 19 cases (100%). The abnormal rate of Hams test was 26.3%. The abmormal rates of CU55 and CD59 were higher than those of Hams test (P＜0.05). Conclusion The expression of CD55 and CD59 can improve the diagnosis of AA-PNH syndrome.

泌尿系感染是临床常见感染性疾病之一[1].为探讨泌尿系感染的病原学特点,指导临床合理使用抗菌药物,对2007年1月至2008年12月本院门诊和住院患者235例尿培养阳性标本的细菌学和体外耐药检测资料进行回顾分析.

[Objective] To discuss the distribution and changes of antibiotic resistance of Pseudomonas aeruginosa, so as to provide references for clinic reasonable drug application. [Methods] All the Pseudomonas aeruginosa were retrospectively analyzed in from 2002 to 2007, and its antimicrobial resistance was determined by Kirby-Bauer method. [Results] A total of 864 strains of Pseudomonas aeruginosa were separated in recent six years, and the sputum samples with pseudomonas aeruginosa accounted for 516 strains ( 59.7% ). The cefoperazone / sulbactem, imipenem, cefepime, ceftazidime, piperacillin / tazobactam and amikacin were sensitive to Pseudomonas aeruginosa, and the antibiotic resistance rates were 17.7% , 18.1%, 24.0%, 33.3%, 36.3% and 41.2%, respectively. Moreover, the ampicillin, cefazolin and cefuroxine showed highly resistance, and other drugs also showed different drug resistance effect. [Conclusion] PA is a common conditional pathogen of the hospital infection, and its drug resistance and multiple drug resistance is serious. Therefore, rational use of medicines is very important.

为探讨血尿酸(Serum uric acid,SUA)与高血压病的关系,本文对127例高血压病患者血尿酸水平进行检测,并与108例健康体检者进行对照分析,报道如下. 对象与方法 1 对象高血压病组:2007年10月至2008年10月新乡医学院第二附属医院内科门诊及住院患者,共127例,男68例,女59例,平均年龄50.9±11.4岁;其中1级高血压39例,2级高血压41例,3级高血压47例.