[目的]通过开展品管圈活动,有效地降低造口粪水性皮炎的发生率及提高病人的生活质量。[方法]以2014年12月—2015年12月来山西省肿瘤医院就诊的100例肠造口病人为对照组,采用常规护理方法护理;2016年1月—2016年12月来医院就诊的100例肠造口病人为观察组,在常规护理的基础上开展品管圈活动。比较两组造口粪水性皮炎的发生率及病人舒适度、疼痛度、满意度情况,同时记录更换造口袋时间。[结果]观察组病人造口粪水性皮炎发生率明显低于对照组（P＜0.01）;两组病人舒适度、满意度、疼痛程度及更换造口袋时间差异也具有统计学意义（P＜0.05）。[结论]通过品管圈活动,有效地降低了造口粪水性皮炎的发生率,提高了病人护理质量。

Objective To assess the early diagnostic value of white blood cell count (WBC), neutrophil percentage (NEU%), C-reactive protein (CRP) and procalcitonin (PCT) in blood bacterial infection.Methods Clinical data of 114 patients with bacterial blood stream infections(BSI group) and 247 patients without bloodstream infections (control group) admitted to Taiyuan Third People''s Hospitalin 2015 were retrospectively analyzed.The WBC, NEU%, CRP and PCT were measured in all patients.Receiver opearating characteristic curve (Roc) was used to evalute the accuracy of WBC, NEU%, CRP and PCT in the diagnosis of blood stream bacterial infectious.Results There were no significant differences in gender and age between two groups (χ2=0.7731, t=0.9900, both P>0.05).The WBC, NEU%, CRP and PCT levels in BSI group were significantly higher than those in control group (all P<0.05).There were no significant differences in WBC, NEU% and CRP levels between G+ bacterial and G-bacterial infections in bacteremia group (P>0.05), while there was significant difference in PCT level (P<0.05).In diagnosis of bacteremia, the area under the ROC curve of PCT(0.827) was the largest, followed by CRP (0.721), NEU% (0.677) and WBC (0.593), the differences were statistically significant(Z=2.332, 3.355 and 3.786, P<0.05 or <0.01).Conclusion WBC, NEU%, CRP and PCT levels are of certain diagnostic value for bacterial bloodstream infections, particularly the PCT.In addition, PCT can predict G+ bacterial and G-bacterial infections.

目的 通过检测HBsAg阳性母亲分娩的新生儿外周血中T/B淋巴细胞亚群水平,分析HBV宫内传播对新生儿免疫功能的影响.方法 选择2011年1月至2014年12月太原市第三人民医院妇产科HBsAg阳性母亲分娩新生儿220例作为研究对象.采用酶联免疫吸附试验(ELISA)方法检测HBsAg阳性母亲及新生儿外周血HBV血清学标志物,实时荧光定量PCR检测HBsAg阳性母亲及新生儿外周血HBVDNA含量,流式细胞术(FCM)检测新生儿外周血T/B淋巴细胞亚群水平.新生儿出生24 h内静脉血HBsAg阳性或/和HBVDNA值＞103 copies/ml者判定为发生HBV宫内传播.结果 HBsAg阳性母亲分娩新生儿HBV宫内传播发生率为11.36％.宫内传播新生儿组(n=25)与非宫内传播新生儿组(n=195)外周血T淋巴细胞亚群(CD3+、CD4+、CD8+)相对计数[(60.71±13.64)％ vs (60.04±15.06)％,(43.37±12.69)％vs(43.77±13.39)％,(15.03±6.32)％vs(15.14±6.14)％],CD4+/CD8+[(3.42±1.66)％ vs(3.33±1.71)％]及B淋巴细胞中CD19+相对计数[(6.64±3.63)％vs(6.39 ±3.99)％]差异均无统计学意义(P均＞0.05).依据HBsAg阳性母亲分娩新生儿外周血HBVDNA不同载量,分为高载量组(HBVDNA≥107copies/ml)、低载量组(HBVDNA＜ 107 copies/ml)、阴性组(HBVDNA＜ 103 copies/ml).随着HBsAg阳性母亲分娩新生儿外周血HBVDNA载量增加,新生儿外周血CD3+、CD4+、CD8+相对计数及CD4 +/CD8+值逐渐增高,CD19+相对计数比例逐渐减低.高载量组新生儿CD3+、CD4+相对计数高于低载量组和阴性组,差异有统计学意义(P均＜0.05);3组新生儿CD8+、CD19+相对计数及CD4+/CD8+比较差异均无统计学意义(P均＞0.05).结论 随着HBVDNA载量的增加,HBsAg阳性母亲分娩的新生儿外周血中T淋巴细胞亚群(CD3+、CD4+)比例上升,新生儿细胞免疫功能处于活跃状态,易出现自身免疫反应,应采取相应措施防止自身免疫性疾病的发生.

This study determined the effect of hepatitis B virus (HBV) replication in peripheral blood mononuclear cell (PBMC) from HBsAg-positive mothers on HBV intrauterine transmission. A total of 150 HBsAg-positive mothers and their neonates were recruited in this study. Within 24 h after birth, HBV serological markers, serum HBV DNA, PBMC HBV relaxed circular DNA (rcDNA), and covalently closed circular DNA (cccDNA) were measured in the HBsAg-positive mothers and their neonates before passive-active immune prophylaxis. The relationship between HBV replication in PBMC and HBV intrauterine transmission was examined through Chi-square test and logistic regression. The rate of HBV intrauterine transmission was 8.00% (12/150) in the 150 neonates born to HBsAg-positive mothers. The positivities of PBMC HBV rcDNA and cccDNA in the HBsAg-positive mothers were 36.67% (55/150) and 10% (15/150), respectively. Maternal PBMC HBV cccDNA was a risk factor of HBV intrauterine transmission (OR= 6.003, 95% CI: 1.249–28.855). Maternal serum HBeAg was a risk factor of PBMC HBV rcDNA (OR= 3.896, 95% CI: 1.929–7.876) and PBMC HBV cccDNA (OR= 3.74, 95% CI: 1.186–11.793) in the HBsAg-positive mothers. Administration of hepatitis B immune globulin was a protective factor of PBMC HBV cccDNA (OR= 0.312, 95% CI: 0.102–0.954) during pregnancy. The positivity of PBMC HBV rcDNA was related to that of cccDNA in the HBsAg-positive mothers (c2=5.087, P= 0.024). This study suggests that PBMC is a reservoir of HBV and an extrahepatic site for virus replication and plays a critical role in HBV intrauterine transmission.

1992年，Takahashi 等［1］成功分离出 HCV 核心抗原，其在各亚型 HCV 中高度保守，血清中的 HCV 核心抗原非常稳定。抗-HCV 检测的窗口期为7～8周，HCV RNA 为1～3周，HCV 核心抗原检测的窗口期与 HCV RNA 仅相差1～2 d［2］。因此，检测 HCV 核心抗原可提高 HCV 感染窗口期的阳性检出率，比检测抗-HCV 更能避免因窗口期产生的漏诊，而且 HCV 核心抗原与 HCV RNA 有一定相关性，可作为治疗效果的监测指标。