目的 探讨三磷酸腺苷结合盒转运体A1(ABCA1)基因多态性与阿尔茨海默病相关神经丝蛋白(AD7c-NTP)的关系.方法 选择2019年1月至2022年1月于延安大学咸阳医院就诊的阿尔茨海默病(AD)患者214例(AD组),选择同期该院健康体检者214例(对照组),收集两组一般资料,比较两组认知功能[简易精神状态量表(MMSE)评分]、血脂、尿AD7c-NTP水平,测定两组ABCA1基因多态性.结果 AD组MMSE评分、高密度脂蛋白胆固醇(HDL-C)水平均低于对照组,尿AD7c-NTP、总胆固醇(TC)水平以及高脂血症史患者比例均高于对照组,差异均有统计学意义(P<0.05);两组RR、RK、KK基因型频率比较,差异均有统计学意义(P<0.05);AD组中RR基因型患者MMSE评分低于RK+KK型,尿AD7 c-NTP水平高于RK+KK型,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,高脂血症史、TC、HDL-C、尿AD7c-NTP、MMSE评分、RK+KK基因型是AD的影响因素(P<0.05).结论 AD的发生与血脂、尿AD7c-NTP水平及ABCA1基因多态性有关,同时ABCA1基因多态性与患者AD7c-NTP水平存在一定关系,通过检测ABCA1基因型及尿AD7 c-NTP水平可能为AD患者个体化治疗提供新的思路.

Objective To explore the clinical application value of the levels of serum miRNA-146,miRNA-195 in diabetic retinopa-thy. Methods The plasma and clinical data from 91 cases of the patients with DR were collected,38 cases of volunteer blood plasma from a ran-dom sample of the general population were extracted. The Expression levels of miRNA-146,miRNA-195 were quantitatively detected by RT-PCR method. The patients with diabetic retinopathy were divided into the non-proliferating diabetic retinopathy group (NPDR)and proliferating diabetic retinopathy group (PDR). The relationship between the changes of the expression of the levels of the serum miRNA-146,miRNA-195 and DR were observed. Results In the case group,the levels of serum miRNA-146,miRNA-195 raised and lowered respectively,compared with that in control group with significant difference (P < 0. 01). The expression levels of miRNA-146 in NPDR group were lower than that in PDR group (P < 0. 01). The expression of the miRNA-195 were higher than that in PDR group (P < 0. 01). The levels of miRNA-146, miRNA-195 were negatively correlated in both NPDR and PDR group (r = 0. 687,-0. 692,P < 0. 01). The expression level of miRNA-146 and miRNA-195 respectively had correlation with the levels of glycosylated hemoglobin (HbAlc),urine white silkworm/ creatinine and fasting plasma glucose (FPG)in NPDR and PDR group (r = 0. 532,0. 610,0. 587,P < 0. 01;r =-0. 538,-0. 62,-0. 56,P < 0. 01). Conclu-tion Detection of the expression of serum miRNA-146,miRNA-195 can predict the occurrence of DR and help to determine its dangerous de-gree and estimate the development of the disease.

目的：依据病原菌及其药敏结果，合理应用抗菌药物，提高治疗效果。方法对陕西省咸阳市第一人民医院眼科中心1896份结膜囊分泌物进行细菌培养，分离病原菌，鉴定并做药敏试验。结果1896份结膜囊分泌物标本，检出病原菌384株，阳性率20．25％。其中革兰阳性菌286株，占74．48％；革兰氏阴性菌89株，占23．18％；真菌9株，占2．34％。分离前5位病原菌分别是表皮葡萄球菌（35．95％）、金黄色葡萄球菌（11．08％）、肺炎链球菌（8．65％）、溶血葡萄球菌（4．86％）和铜绿假单胞菌（4．05％）。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林表皮葡萄球菌检出率分别为25．00％和76．07％，金黄色葡萄球菌对眼科常用药物喹诺酮类（环丙沙星、左氧氟沙星）和氨基糖苷类耐药率不到20．00％和35．00％，表皮葡萄球菌和溶血葡萄球菌稍高。氯霉素、氧氟沙星、左氧氟沙星对肺炎链球菌有较高的抗菌活性，耐药率为25．00％、25．00％和16．67％。肺炎链球菌对青霉素耐药率达66．67％。结论细菌性结膜炎病原菌分布存在地区及国家间的差异，表皮葡萄球菌为该院眼科中心细菌性结膜炎首要病原菌，应重视结膜囊病原菌培养，依据药敏试验结果合理使用抗菌药物，提高治疗效果。

目的 探讨中老年人群血清脂联素(APN)等脂类代谢指标在甲状腺功能紊乱疾病中的变化及其相关性.方法 采用电化学发光法检测159例甲状腺功能亢进症(简称甲亢)、120例甲状腺功能减退症(简称甲减)患者及140名体检正常者(正常对照组)甲状腺激素[三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)]水平,采用酶联免疫吸附试验(ELISA)测定各组血清APN水平,对比各组血清APN、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1 (apo A1)、载脂蛋白B(apo B)、载脂蛋白E(apo E)的差异,并分析其相关性.结果 甲亢组、甲减组、正常对照组之间血清APN、TC、TG、LDL-C、apo E水平差异有统计学意义(P＜0.05),血清HDL-C、apo A l、apo B差异无统计学意义(P＞0.05);相关分析显示甲亢组和甲减组FT4与TC的相关性最高(r值分别为-0.498、-0.461,P=0.000).结论 中老年甲状腺功能紊乱患者血清APN等脂类指 标有明显变化.TC与FT4的关系最为密切.

Objective To analyze the pathogenic bacteria distribution,structure and characteristics of drug resistance in patients with acute stroke complicated with pulmonary infection,in order to provide reference for the prevention of hospital infection and rational use of antimicrobial agents.Methods A total of 864 clinical specimens of acute stroke complicated with pulmonary infection were chosen for study between January 2012 and December 2014.Separation and cultivation were done in accordance with the operation procedures regulated by the Ministry of Health.Drug sensitivity examination was done by Kirby-Bauer (k-b).Super-extensive spectrum β lactamase (ESBL) and methicillin resistant staphylococcus aureus (MRSA) were detected to analyze the bacterial species and resistance transition.Results A total of 864 samples were cultivated,in which G-bacteria accounted for 61.2％.The main pathogenic bacteria was Klebsiella pneumoniae bacteria,Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumanmii and Staphylococcus aureus.Imipenem had high antimicrobial activity to G-bacilli,especially to Escherichia coli and Klebsiella pneumoniae bacteria.Linezolid,vancomycin and teicoplanin had high antibacterial activity to staphylococcus aureus.Vancomycin resistant Staphylococcus aureus was not found.Ciprofloxacin had high antibacterial activity to Pseudomonas aeruginosa,while imipenem had low antibacterial activity to Pseudomonas aeruginosa.Amikacin had high antibacterial activity to acinetobacter.Conclusions G-bacilli are predominant in acute stroke complicated with pulmonary infection.ESBLs and MRSA detection rate is high,and we should pay attention to the rational use of antibiotics to reduce drug resistance.

目的 探讨白细胞介素-12(IL-12)、单核细胞、淋巴细胞在e抗体(HBeAb)阳性乙型肝炎病毒(HBV)携带者中的变化及其相关性.方法 检测HBeAb阳性的121例慢性HBV携带者 ,HBeAb阳性的129例非活动性乙型肝炎表面抗原(HBsAg)携带者及130例健康志愿者(健康对照组)血液IL-12、单核细胞、淋巴细胞水平并进行比较分析.结果 慢性HBV携带者血液IL-12水平低于健康对照组 ,两者之间差异有统计学意义(t= -2 .319 , P<0 .05 ) ,淋巴细胞、单核细胞水平略高于健康对照组 ,两者之间差异无统计学意义( t=0 .367、0 .481 ,P>0 .05 ).非活动性HBsAg携带者血液 IL-12、淋巴细胞、单核细胞水平低于健康对照组 ,两者之间差异有统计学意义(t= -5 .259、-2 .454、-2 .956 ,P<0 .05).慢性 HBV携带者血液IL-12、淋巴细胞、单核细胞水平高于非活动性HBsAg携带者 ,其中IL-12、单核细胞水平差异有统计学意义(t=2 .399、2 .477 ,P<0 .05) ,而淋巴细胞水平差异无统计学意义(t=1 .633 ,P>0 .05).结论 IL-12与HBeAb阳性HBV携带者人群机体免疫力有关 ,IL-12水平高低与机体免疫能力启动强弱呈正比 ,非活动性HBsAg携带者的免疫能力低于慢性HBV携带者.

目的：探讨复发性、首发性脑梗死患者血淸抗心磷脂（ACA ）抗体（ACA‐IgG、IgM ）、β2糖蛋白Ⅰ（β2GPⅠ）的关系，为脑梗死患者的预防和治疗提供依据。方法 ELISA法定量检测230例首发性脑梗死、264例复发性脑梗死、145例健康对照者血清ACA‐IgG、ACA‐IgM、β2GPⅠ，对比分析各组别之间的差异。结果经方差分析，首发性脑梗死组、复发性脑梗死组、健康对照组血清抗心磷脂抗体ACA‐IgG、ACA‐IgM、β2GPⅠ水平差异有统计学意义（P＜0．05），首发性脑梗死组、复发性脑梗死组均高于健康对照组，差异有统计学意义（P＜0．05），复发性脑梗死组高于首发脑梗死组，差异有统计学意义（P＜0．05）。结论检测脑梗死患者的血清ACA、β2GPⅠ对于脑梗死的复发预测和临床早期干预有重要的意义。

目的：分析2011年1月至2013年12月延安大学咸阳医院神经外科临床标本培养分离病原菌的分布、构成及耐药特点，为医院感染的预防控制及抗菌药物合理使用提供依据。方法收集2011年1月至2013年12月神经外科送检的所有标本进行分离培养，采用细菌鉴定板条进行细菌分离鉴定，采用纸片扩散法进行药敏试验；耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林凝固酶阴性葡萄球菌（MRSCN）、超广谱β‐内酰胺酶（ESBLs）均按照原卫生部检验操作规程的确认方法进行操作。采用WHONET5．6软件进行耐药性分析。结果共培养非重复标本1464株，分离阳性标本630株，阳性检出率为43．03％，以痰标本为主，占74．46％；主要致病菌为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌、不动杆菌属；检出ESBLs阳性菌株158株，MRSA阳性菌株81株，M RSCN阳性菌株12株。2011～2013年大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感率均大于95．00％；金黄色葡萄球菌对利奈唑胺的敏感率也大于90．00％，未发现对万古霉素和替考拉宁耐药的金黄色葡萄球菌；铜绿假单胞菌对多黏菌素B和环丙沙星的敏感率均大于90．00％，但对亚胺培南的敏感率不高，3年均低于40．00％；不动杆菌属对庆大霉素和左氧氟沙星有较高的敏感性，均大于80．00％。结论神经外科的细菌感染已不容忽视，应注意抗菌药物的合理使用，加强细菌的耐药性监测。