目的 探讨外周血炎症指标中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、血小板平均体积/淋巴细胞比值(MPVLR)、血栓弹力图(TEG)参数MA、α角在急性脑梗死患者中的临床意义.方法 选取2019年7月—2020年12月在平湖市第一人民医院心血管内科确诊为急性脑梗死(ACI)患者作为脑梗死组(共111例),选取同时期健康体检者作为对照组(共50例),分别根据白细胞计数、淋巴细胞计数、血小板计数、血小板平均体积计算NLR、PLR、MPVLR和TEG参数MA、α角等,比较2组的一般临床资料及NLR、PLR、MPVLR、MA等水平.结果 脑梗死组的NLR、PLR、MPVLR、MA、α角水平明显高于对照组(P＜0.01).NLR、MPVLR在NIHSS评分轻度组、中度组、重度组组间比较差异有统计学意义(P＜0.05).脑梗死NIHSS评分与NLR、PLR、MPVLR指标呈正相关(P＜0.05).ROC曲线分析,脑梗死组NLR、PLR、MPVLR的曲线下面积分别为0.807、0.678、0.744,MA和α角的曲线下面积分别为0.772、0.760,NLR、PLR、MPVLR联合MA、α角指标AUC为0.875,优于单一指标检测.结论 NLR、PLR、MPVLR可与MA、α角联合检测对急性脑梗死患者具有较好的诊断价值.

目的 :比较危急重症病人动脉血和静脉血中钾离子结果有无差异.方法 :随机抽取2019年2月 —6月我院重症监护室收治的病人61例,分别采集动脉血和静脉血,采用血气分析仪测定动脉全血钾离子浓度和某公司生产的7600生化分析仪测定静脉血血清中钾离子的浓度,比较两者结果是否有统计学差异及其相关性.结果 :动脉血钾浓度明显低于静脉血钾浓度,差异有统计学意义(t=-5.406,P=0.000).动脉血钾与静脉血钾存在线性相关关系,静脉血钾浓度=1.024+0.783动脉血钾浓度,相关系数r=0.712,P<0.005.结论 :动脉血钾与静脉血钾存在线性相关性,动脉血钾值可代入线性回归方程换算成静脉血钾浓度,作为临床诊治的依据.

目的 探讨阴道微生态改变与宫颈高危型人乳头状瘤病毒(HR-HPV)感染的相关性.方法 选择2017年1月-2018年12月在本院妇科就诊妇女1 543例进行阴道微生态检测、常规行薄层液基细胞学(TCT)检查、PCR-反向点杂交法检测HPV 23种亚型;TCT阴性且HR-HPV感染人群设为HR-HPV组,TCT和HPV检测结果均阴性人群设为HPV阴性组,比较2组阴道微生态检查结果.结果 1 543例受检者TCT阳性152例,1 391例TCT阴性受检者141例感染HR-HPV.细菌性阴道病(BV)、外阴阴道假丝病(VVC)、需氧菌性阴道炎(AV)、pH值＞4.5、阴道清洁度异常及乳酸杆菌减少组HR-HPV感染率均明显高于对应阴性组(P＜0.01);HR-HPV组BV、VVC、AV、pH值＞4.5、阴道清洁度异常及乳杆菌减少检出率均明显高于HPV阴性组(P＜0.01).结论 BV、VVC、AV、pH值＞4.5、阴道清洁度异常及乳酸杆菌减少等阴道微生态变化与HR-HPV感染之间存在相关性.

Objective To investigate the value of serum amyloid A (SAA) level in evaluating the disease activity of juvenile idiopathic arthritis (JIA). Methods One hundred children with JIA in First People's Hospital of Pinghu from January 2017 to March 2018 were included in this study. The serum levels of C-reactive protein (CRP) , erythrocyte sedimentation rate (ESR) and SAA as well as bone mineral density were measured. The juvenile arthritis disease activity score with 27-joint reduced count (JADAS-27) was used to evaluate the activity of JIA. Fifty healthy children were selected as control group. The correlation of SAA change in JIA cases with CRP and ESR was analyzed. Results SAA in active JIA children was 88.32±21.01 mg/L, which was significantly higher than that in healthy children (16.54±6.87 mg/L) , and the difference was statistically significant (t=25.809, P<0.05). In 100 cases of JIA, SAA was positively correlated with CRP and ESR (r=0.801, P=0.031; r=0.710, P=0.022). In 50 cases of systemic JIA, SAA was also positively correlated with CRP and ESR (r=0.881, P=0.002;r=0.770, P=0.008). SAA was not related to the number of active arthritis and the severity of joint symptoms (both P>0.05). The levels of SAA (t=21.344) , CRP (t=7.643) , ESR (t=15.622) , white blood cells (t=14.682) and platelets (t=7.910) in children at active stage were higher than those at stable period, but the bone mineral density was lower with significant differences (all P<0.05). The levels of SAA (t=18.911) , CRP (t=7.048) , ESR (t=7.841) and white blood cells (t=22.689) in children with systemic JIA were significantly higher than those in cases of non systemic JIA (all P<0.05) , but there were no statistical differences in level of platelet (t=0.075) and bone mineral density (t=0.937) (both P<0.05). In predicting JIA activity with a single indicator, the diagnostic value of SAA was only inferior to ESR. The area under the curve of SAA combined with platelets and CRP was 0.868 and 0.954, which were greater than 0.7. The scores of JADAS-27 in children with active JIA were all higher than those in children at stable stage, and the differences were statistically significant (all P<0.05). The correlation analysis showed that the total score of JADAS-27 was related to SAA, CRP, ESR, white blood cells, platelets, and bone mineral density (r value was 0.451, 0.501, 0.608, 0.401, 0.311 and-0.387, respectively, all P<0.05). Conclusion SAA significantly increases in the serum of children with systemic and active JIA, which has a good correlation with two traditional JIA activity indexes of CRP and ESR and is positively correlated with the JADAS-27 score. SAA combined with platelets may become an indicator of JIA disease activity.

Objective To investigate the relationships of serum 25-hydroxyvitamin D levels with bone metabolism markers in the second and third trimester of pregnancy women.Methods A total of 1090 pregnant women(13-40 weeks gestational age) and 120 healthy nulliparous were enrolled.The levels of serum 25 (OH)D,N-MID,β-CTX were determined by electrochemical luminescence.Results The average serum 25 (OH)D level was (11.23 ± 5.82)ng/ml in the second and third trimester of pregnancy.There 917 cases (84.13％) with 25(OH)D deficiency,152 cases (13.94％) with insufficiency and 21 cases (1.93％) with sufficiency.The serum 25(OH)D level in winter and spring was lower than that in summer and autumn (9.97 ± 5.28 ng/ml vs.12.24 ± 5.77 ng/ml,P＜0.05).There were significant differences in serum 25 (OH)D,N-MID and β-CTX levels among pregnant women in different age groups (P＜0.05).The level of Vitamin D was not correlated with N-MID(r=-0.017,P ＞0.05),negatively correlated with β-CTX (r=-0.090,P＜0.05);and N-MID was positively correlated with β-CTX (r=0.586,P＜0.05).Conclusion Vitamin D deficiency is common during the second and third trimester of pregnant women,particularly in winter and spring seasons.The serum 25(OH)D and N-MID,β-CTX levels are different in pregnant women of different ages.The level of serum 25 (OH)D shows no significant correlation with N-MID but negative correlation with β-CTX.

结核病是由结核分枝杆菌（ MTB）感染引起的慢性传染病，对疑似结核病人进行痰抗酸杆菌涂片染色镜检及分枝杆菌培养，直接找到病原菌，对诊断结核病具有重要意义。但上述两种方法也有其局限性：涂片镜检法总的敏感性为22％～80％［1］，并且无法在镜下区分与MTB形态、染色相同的非结核分枝杆菌（ NTM ），而NTM 与MTB一样严重威胁人类健康［2-3］。分枝杆菌培养法是临床诊断结核病的“金标准”，但该方法灵敏度也不够高，阳性率约为40％～60％［4］，并且该法检测周期长，从培养至菌种鉴定一般需要8周甚至更长，且对早期结核菌感染者、药物治疗后细胞壁缺损L型细菌难以检出。为此，找到一种适合基层医疗单位应用，并能快速、灵敏诊断结核病，有效区分MTB与NTM的实验室诊断方法，在临床上有重要应用价值。荧光定量聚合酶链反应（ FQ-PCR）是一种在聚合酶链反应（ PCR ）体系中引入荧光基团，利用荧光信号实时监测整个PCR扩增进程的方法，可对标本中起始 DNA 模板进行定量，提高检测灵敏度，同时省去了电泳步骤，减少污染机会，特异性更好。 FQ-PCR结果以循环阈值（ Ct值）表示， Ct值越小，说明起始模板核酸浓度越高。本研究试图应用FQ-PCR法检测痰标本中MTB，以为临床提供一种快速、灵敏、特异的结核病辅助诊断方法。

目的：了解2010年至2013年铜绿假单胞菌的标本分布及耐药性变迁，为临床用药提供依据。方法采用ATB G-5全自动微生物分析仪对菌株进行鉴定及药敏检测，药敏结果采用WHONET软件进行分析。结果2010年至2013年我院分别检出88株、95株、122株、138株铜绿假单胞菌，检出率分别为11.5%、14.2%、15.1%、17.3%。443株铜绿假单胞菌在痰液中检出率最高，占61.4%，其次是伤口分泌物，占19.0%；耐药率最高的抗菌药物是氨苄西林/舒巴坦、复方新诺明，均＞90.0％；对哌拉西林/他唑巴坦、阿米卡星和妥布霉素较敏感，耐药率＜16.0%；耐药率增长幅度较大的是亚胺培南和美罗培南；铜绿假单胞菌泛耐药菌株检出率为9.0％。结论应重视铜绿假单胞菌耐药性的监测工作，预防和减少耐药菌株的产生。

Objective]Procalcitonin(PCT) was evaluated as a parameter for predicting bacteremia diagnosed by blood cultures . [Methed]Blood cultures and PCT levels from 3343 specimens collected in 2013were analyzed [Result]The PCT concentrations of bacteremia cases(n=331) were significantly higher than those of non-bacteremia(n=2856)(median:3 .2ng/ml vs 0 .4ng/ml ,P<0 .05 ) .The area under the receiver operating characteristic curve (ROC-AUC ) of PCT for discriminating bacteremia from non-bacteremia was 0 .86 ,and sensivityorspecialitywas 0 .76 or 0 .86 .[Conclusion]PCT could be helpful in the accurate diagnosis of bacteremia .

目的：探讨本院阴道炎患者细菌性阴道病（BV）、支原体、衣原体（CT）、真菌、滴虫感染分布情况，为临床提供诊治依据。方法：对本院2013年1-12月采集的门诊就诊的阴道炎患者的阴道分泌物标本，用生理盐水法进行滴虫和假丝酵母菌的检测，BV快速法检测细菌性阴道病，用培养法检测支原体，采用胶体金法检测沙眼衣原体。结果：在2588例阴道分泌物标本中，共检出阳性标本2027例，阳性率为78．3％，其中细菌性阴道病1213例，检出率为46．9％，支原体789例，检出率为30．5％，假丝酵母菌279例，检出率为10．8％，滴虫86例，检出率为3.3％，衣原体81例，检出率为3．1％。阳性标本中，单纯性感染1693例，占83．5％，两种或两种以上混合感染334例，占16．5％。结论：BV和支原体是本地区阴道炎患者感染的主要病原体，应加强对阴道炎患者病原学联合检测，以便更全面地反映阴道炎患者的病原学感染状况，协助临床医生做出正确诊断和治疗。

Objective To understand the serotypes and drug susceptibility of Salmonella as well as the clinical manifestation of Salmonella infection in Pinghu from 2009 to 2013.Methods The biochemical identification and serotyping of 91 Salmonella strains isolated were conducted and the drug susceptibility test was performed by using Merieux Alliance VITEK-2 Compact from French.Results Eleven serotypes were detected in the 91 Salmonella isolates,Paratyphi A and Salmonella typhi were the major serotypes of blood stream infection;Salmonella typhimurium and Salmonella enteritidis were the major serotypes of intestinal infection.Fever,pains,yellow watery stools were the main clinical symptoms of Salmonella infection.The drug sensitive rate of the Salmonella strains was 34.07% to Ampicillin,36.26% to Piperacillin and 45.05% to Tetracycline.The Salmonella strains were sensitive to the third and forth-generation cephalosporins,quinolones and carbapenems(70%-100%).The drug resistant rates of 5 common serotypes of Salmonella to Ampicillin /sulbactam were obvious different.The resistant rates of Salmonella typhimurium and Salmonella enteritidis were 75.00% and 47.62%.The resistant rates of Paratyphi A,Salmonella typhi and Paratyphoid C were less than 20%.Conclusion Salmonella is one of the pathogens causing diarrhea in children under 7years old,The serotypes of Salmonella varies by sources from which they are detected,and the drug resistances of Salmonella varies by their serotypes.It is necessary to strengthen the surveillance among the risk population.Salmonella is sensitive to most antibiotics,and cephalosporins or quinolones may be the first choice in clinical treatment.

Objective To study the distribution and drug-resistance of the pathogens in pediatric patients. Methods The pathogens analysis and the drug sensitivity test were done for the qualified samples from pediatric patients from January 2011 to December2012. Results 305 Pathogens were isolated,including Gram-positive cocci 166( 54. 5%),Gram-negative bacteria 134( 43. 9%),fungi 5( 1. 6%). The top four Gram-positive cocci were Staphylococcus aureus( 82 isolates 49. 4%),Staphylococcus( 27 isolates 16. 3%),Staphylococcus epidermidis( 27 isolates 16. 3%),Staphylococcus haemolyticus( 17 isolates 10. 2%); the top four Gram-negative bacilli were Klebsiella pneumoniae( 42 isolates 30. 2%),Escherichia coli( 28 isolates 20. 1%),Acinetobacter baumanii( 21 1isolates 15. 1%),Enterobacter cloacae( 15 isolates 10. 8%),different drug resistance was displayed in different pathogenic bacteria,ESBLs-producing E.coli and Klebsiella pneumoniae accounted for 28. 6% and 11. 9%. Conclusion Gram-positive cocci are the main pathogenic bacteria of pediatric patients. Staphylococcus aureus is the most common. Different pathogenic bacteria has different drug resistance to antibiotics. It should strengthen the pathogen detection and drug resistance surveillance,disinfection and sterilization of the provisions of the operation should be strictly implemented,as soon as possible to progress bacterial identification and susceptibility test and it should depeng on drug sensitivityto choice medicant,rational use antibacterial drugs.

<正>阴道炎是妇科的常见病、多发病,长期以来一直困扰着全球数以百计的妇女,影响着妇女的身心健康,近年来由于感染因素的逐渐增多,其发病率也逐渐升高,其中真菌性和滴虫性阴道炎也占有相当大的比例[1],由于引起阴道炎致病原的多样性变化,为了解我院阴道炎患者阴道炎的感染情况,对1461例阴道炎患者的分泌物标本进行滴虫、假丝酵母菌、细菌性阴道病、支原体、衣原体进行检查,检查结果报告如下。

Objective:To compare the detection levels of acid-fast bacilli in sputum smear specimen,so as to discuss and study how to improve the concrete practice and positive rate of sputum smear in laboratory of basic hospital.Methods:From January to December in 2011,the sputum smear specimens in the hospital were collected to detect acid-fast bacillus by direct smear examination and Ziehl-Neelsen anti-acid staining method,then the smear positive rates of different sputum specimens were statistically analyzed.Results:In 2839 sputum smear specimens,specimens were positive in 669 cases(23.6%).Purulent sputum positive rate was 50.7%,bloody sputum positive rate was 28.9%,mucus sputum positive rate was 24.3%,and watery sputum positive rate was 6.9%.Conclusion:The detection rate of acid-fast bacillus was greatly influenced by the character of sputum specimens.Qualified sputum smear is the key to improve positive rate.Moreover,the improvement of the quality and responsibility of sputum examination and strict laboratory quality control can both increase the positive rate of microscopic examination on sputum smear.

OBJECTIVE To study the distribution and drug resistance of the pathogens causing respiratory tract infections in tuberculosis patients.METHODS The bacterial culture and the drug susceptibility testing were performed for the qualified specimens submitted from hospitalized tuberculosis patients from Jan 2009 to Dec 2010,the statistical analysis was performed.RESULTS Of totally 161 strains of pathogens isolated,there were 108(67.1%) strains of gram-negative bacilli,34(211%) strains of gram-positive cocci,and 19(11.8%) strains of fungi;the top 3 gram-negative bacilli were Klebsiella pneumoniae(37.9%),Enterobacter cloacae(16.1%),and Escherichia coli(8.1%),respectively;the top 3 gram-positive cocci were Staphylococcus aureus(6.8%),S.haemolyticus(3.7%),and S.epidermidis(4.4%);the pathogens varied in the drug resistance to common antibiotics.CONCLUSION Gram-negative bacilli are predominant pathogens causing respiratory tract infections in tuberculosis patients,among which K.pneumoniae is most common and highly drug-resistant,so it is necessary to strengthen the detection of pathogens and the surveillance of drug resistance and reasonably use of antibiotics.

Objective To investigate the roles of serum oxidized low density lipoprotein(ox-LDL)/beta2-glycoprotein Ⅰ(β2-GPI) complex in type 2 diabetes mellitus(T2DM)patients complicated with coronary heart disease(CHD)and its clinical significance.Methods Serum samples were collected from 68 T2DM patients complicated with CHD,69 patients with T2DM,65 patients with CHD and 60 healthy controls.Serum ox-LDL/β2-GPI complex were measured by enzyme-linked immunosorbent assay(ELISA),and the fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),glycosylated hemoglobin(HbA1C),fasting serum insulin(FINS),body mass index(BMI)and waist to hip ratio(WHR)were determined and analyzed.Results The T2DM patients complicated with CHD had significantly higher levels of ox-LDL/β2-GPI complex than T2DM group,CHD group and control group(P<0.05).The ox-LDL/β2-GPI complex level was positively correlated with TG and homeostasis model assessment insulin resistance(HOMA-IR) index in the T2DM patients complicated with CHD(r =0.219 and 0.228,P<0.01).TG and ox-LDL/β2-GPI complex were the risk factors of T2DM.The ox-LDL/β2-GPI complex and HbA1Cwere the risk factors of T2DM complicated with CHD.Conclusions Serum ox-LDL/β2-GPI complex may play an important role in the development of T2DM complicated with CHD.

目的:了解及分析儿科重症监护室患儿微生物的分布情况,用以提供临床合理用药的科学依据。方法:收集儿科重症监护病房患儿的体液标本行微生物培养并对结果进行统计学分析。结果:患儿的体液标本中共分离出微生物93株,其中革兰阴性菌72株占77.4%,分离率由高到低依次为克雷伯氏菌属、非发酵菌、艾希氏菌属和肠杆菌属;革兰阳性菌检出21株占22.6%,其分离率由高到低依次为葡萄球菌属、酵母样真菌、链球菌属和肠球菌属。结论:儿科重症监护室患儿的最常见致病微生物为革兰阴性杆菌,临床医生应经验性选择合适抗生素进行治疗。

目的:探讨平湖地区妇女阴道炎感染情况及其病原菌分布状况.方法:采集受检女性阴道分泌物,采用直接涂片和培养等方法检测细菌、支原体和念珠菌,沙眼衣原体采用胶体金法.结果:1366例阴道炎患者中念珠菌、支原体、细菌的感染率较高,分别为47.0％、46.0％和31.4％,混合感染率为29.2％.各年龄组间细菌(除淋球菌)的感染率差异无统计学意义(P＞0.05),各年龄组间念珠菌、支原体、衣原体、淋病奈瑟菌和滴虫的感染率差异有统计学意义(P＜0.05).21 ～45岁年龄段妇女支原体和衣原体感染率显著高于其他年龄段,45岁以上组滴虫和淋球菌的感染率明显高于＜45岁年龄组.结论:平湖地区妇女阴道炎混合感染率较高,临床对阴道炎患者应进行病原菌的联合检测,对合理对症用药有重要意义.

[Objective] To analyze the distribution of pathogens and drug resistance of the patients in our hospital's intensive care unit(ICU),in order to providing the clinical basis for the rational use ofantibiotics.[Methods] Analyzed 863 samples of bacteria distribution and drug resistance delivered.[Results] 552 samples of bacteria were detected intotal 863,including 437 Gram-negative bacilli,62 fungi,51 Gram-positive cocci.In the respect of drug resistance,Gram-negative bacilli has higher rates of drug resistance to benzyl-an,cephalosporin and has lower rates of drug resistance to ciprofloxacin,amikacin,tobramycin.Gram-positive cocci has higher drug resistance to penicillin,quinolone except that has no drug resistance to vancomycin.Fungi has lower rates of drug resistance.[Conclusion] ICU patients are seriously infected and mainly of pathogens is Gram-negative bacilli,followed by Gram-positive cocci and fungi.Identification and drug sensitivity test of ICU bacteria infection should be strengthened,rationally using antibiotics,preventing the spread of resistant bacteria in hospitals.

OBJECTIVE To investigate the resistance and distribution of the Gram-negative pathogens isolated from children with respiratory tract infection in our distric.METHODS A total of 420 strains from sputum specimens of the sick children were isolated and cultured from Jan 2009 to Jun 2009,and the strains were identified and the antibiotic resistance tested.RESULTS There were 220 strains(50.5%) including 148(69.8%) of Gram-negative bacteria.The major Gram-negative bacteria were Escherichia coli(33.1%),Klebsiella pneumoniae(26.4%),Haemophilus influenzae(13.5%) and Pseudomonas aeruginosa(8.1%).From them E.coliand K.pneumoniaewere sensitive to imipenem,cefepime and gentamicin,H.influenzaewas sensitive to cefotaxime,cefuroxime,amoxicillin/clavulanic acid,chloramphenicol,ciprofloxacin and imipenem,but highly resistant to Cotrimoxazole and ampicillin and P.aeruginosahad a wide range of antibiotic resistance,but sensitive to imipenem.CONCLUSIONS The bacteria of respiratory tract infections in children in our district are mainly Gram-negatives.The major Gram-negative bacteria are E.coli,K.pneumoniae,H.influenzaeand P.aeruginosa.Clinical treatment should be chosen according to antimicrobial susceptibility test.