Objective:To investigate the value of serum progranulin (PGRN)in the clinical diagnosis of adult sepsis patients.Methods:One hundred and eighty-seveninfection patients admitted to the intensive care unit(ICU) of Affiliated Dongfeng Hospital, Hubei University of Medicinewere divided into non-sepsis group(94 patients) and sepsis group (93 patients)according to the third international consensus definitions for sepsis and septic shock. Patients in the sepsis group were divided into two subgroups according to the degrees of infection: septic shock group (46 patients) and non-septic shock group (47 patients). The levels of serum PGRN, procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and lactic acid (Lac) were compared between the two groups and subgroups within 1 h into the ICU, as well as the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores within 24 h into the ICU. Logistic regression model was used to analyze the relationship between PGRN and sepsis. The receiver operating characteristic (ROC) curve of the subject was drawn. The diagnostic value of PGRN in sepsis was evaluated and compared with PCT, CRP, IL-6, TNF-α and Lac.Results:The levels of PGRN, PCT, CRP, IL-6, TNF-α, Lac and APACHEⅡ, SOFA scores in the sepsis group were higher than those in the non-sepsis group: (129.25 ± 17.81) μg/L vs. (43.17 ± 7.68) μg/L, (5.92 ± 0.82) μg/L vs. (1.34 ± 0.17) μg/L, (64.07 ± 10.51) mg/L vs. (37.18 ± 5.44) mg/L, (111.68 ± 13.17) ng/L vs. (32.41 ± 5.61) ng/L, (86.06 ± 12.19) ng/L vs. (46.44 ± 7.63) ng/L, (2.96 ± 0.45) mmol/L vs. (1.47 ± 0.22) mmol/L, (23.62 ± 4.24) scores vs. (11.74 ± 2.07) scores, (14.84 ± 2.42) scores vs. (1.36 ± 0.23) scores, and the differences were statistically significant ( P<0.05). The levels of PGRN, PCT, CRP, IL-6, TNF-α, Lac in the septic shock group were higher than those in non-septic shock group:(143.29 ± 13.54) μg/L vs. (116.59 ± 10.73) μg/L, (7.64 ± 1.17) μg/L vs. (4.24 ± 0.59) μg/L, (74.49 ± 10.46) mg/L vs. (53.89 ± 8.41) mg/L, (124.48 ± 14.37) ng/L vs.(99.16 ± 13.61) ng/L, (95.91 ± 14.75) ng/L vs. (76.42 ± 11.24) ng/L, (3.52 ± 0.46) mmol/L vs. (2.45 ± 0.39) mmol/L, and the differences were statistically significant ( P<0.05). Logistic regression analysis showed that SODA scores and serum PGRN, PCT, CRP, IL-6, Lac levels were independent risk factors for sepsis ( P<0.05). The ROC curve analysis showed that the area under the curve (AUC) of PGRN was higher than that of CRP, IL-6, TNF-α and Lac for predicting the occurrence of sepsis in infection patients ( P<0.05). The AUC of PGRN was higher than that of CRP, IL-6, TNF-α and Lac for predicting the occurrence of septic shock in infection patients ( P<0.05). Conclusions:The levels of serum PGRN is a good biomarker for the diagnosis of sepsis and could reflect the severity. It has certain clinical value.

Objective:To investigate the diagnostic and prognostic assessment value of serum interlukin(IL)-35 combined with Klotho protein in acute kidney injury(AKI) with sepsis.Methods:One hundred and seventy-five patients with sepsis admitted to Affliated Dongfeng Hospital, Hubei University of Medicine from January 2017 to May 2019 were enrolled and divide into AKI group(86 cases) and non-AKI group (89 cases) according to the standard of Kidney Disease Improving Global Outcomes (KIDGO) and groups were divided based on the prognosis of AKI clinical outcome. The levels of serum creatine (Scr), serum IL-35 and Klotho protein of different groups were compared. The receiver operating characteristic curve (ROC curve) of serum IL-35, Klotho protein and IL-35 combined with Klotho protein were drawn, and the value of serum IL-35, Klotho protein and IL-35 combined with Klotho protein in the diagnosis and prognosis prediction of sepsis AKI were evaluated.Results:The level of Scr in the AKI group was higher than that in the non-AKI group [(264.43 ± 67.86) μmol/L vs. (64.76 ± 22.41) μmol/L], while the levels of IL-35 and Klotho protein were lower than those in the non-AKI group [(69.37 ± 28.15)ng/L vs. (94.74 ± 35.32) ng/L, (142.31 ± 32.55) ng/L vs. (256.23 ± 36.25) ng/L], and the differences were statistically significant ( P<0.05). In the patients that had AKI, those who were in AKI phase one, without continuous renal dialysis or whose renal functions recovered at the end point had relatively lower Scr level and higher IL-35 and Klotho protein levels, and the differences were statistically significant ( P<0.05). The area under the curve (AUC) of AKI and staged AKI predicted by IL-35 combined with Klotho protein levels were 0.918 and 0.899 respectively, and the area under the curve (AUC) of continuous renal replacement therapy needed in the AKI patients and their renal function recovery predicted by IL-35 combined with Klotho protein levels were 0.954 and 0.950 respectively, all higher than the single indicator, and the differences were statistically significant ( P<0.05). Conclusions:IL-35 and Klotho protein levels are good biomarkers in diagnosing the patients′ sepsis complicated by AKI as well as the prognosis. The combination of the two index will further improve the prediction effect.

目的探讨连续性血液净化（CBP）治疗合并急性肾损伤（AKI）的多器官功能障碍综合征（MODS）患者的临床价值及预后影响因素。方法选择2014年1月—2017年12月就诊治疗的68例合并AKI的MODS,记录患者一般资料,检测CBP治疗前后炎性因子、肝肾功能、血流动力学、急性生理学及慢性健康状况评分（APACHEⅡ评分）等指标和预后情况,并分析影响预后的危险因素。结果治疗后68例合并AKI的MODS患者C反应蛋白、白介素-6、肿瘤坏死因子-α、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、直接胆红素、肌酐、尿素、心率、中心静脉压水平、APACHEⅡ评分及序贯性器官衰竭评分（SOFA）均较治疗前降低,而平均动脉压、心脏指数和氧和指数水平均升高（P ＜0. 01）。本组病死率为44. 12%。年龄≥60岁、AKIⅢ期、器官衰竭个数＞ 3个、采用机械通气及APACHEⅡ评分和SOFA评分过高均为影响合并AKI的MODS经CBP治疗后预后的独立危险因素（P ＜0. 05,P ＜0. 01）。结论 CBP治疗可显著降低合并AKI的MODS患者炎性因子水平,改善其肝肾功能和血流动力学,临床应及时评估预后情况,给予有效干预措施改善预后。

目的 探讨基质金属蛋白酶组织抑制剂-3(TIMP-3)提高喉癌Hep-2细胞顺铂化疗敏感性的作用机制.方法 试验分为空白对照组(A组)、顺铂组(B组)和顺铂+TIMP-3组(C组),A组和B组均为10 mL Hep-2细胞液溶于10％胎牛血清中,分别加入0和5μmol/L顺铂5 mL,C组为10 mL转染TIMP-3的Hep-2细胞液加入顺铂(5μmol/L)5 mL,置CO2培养箱中,于37℃、5％CO2、20％O2条件下培养72 h.以噻唑蓝(MTT)比色法检测Hep-2细胞活力及细胞单克隆形成数目,以流式细胞仪检测Hep-2细胞凋亡情况,以荧光共聚焦显微镜检测线粒体膜电位(MMP)水平,以实时荧光定量聚合酶链反应(PCR)法检测TIMP-3 mRNA表达水平,以酶联免疫吸附法检测细胞色素酶C、胱天蛋白酶-3(Caspase-3)、胱天蛋白酶-9(Caspase-9)蛋白表达水平.结果 与A组比较,B组和C组细胞活力、存活率水平、细胞单克隆形成数目、MMP均显著降低,细胞凋亡率、TIMP-3 mRNA和细胞色素酶C、Cas-pase-3、Caspase-9蛋白表达水平均显著升高(P<0.01);C组上述指标均优于B组(P<0.01);TIMP-3与细胞色素酶C、Caspase-3、Caspase-9呈显著正相关(P<0.01).结论 TIMP-3能提高喉癌Hep-2细胞顺铂化疗敏感性,其机制与上调TIMP-3,促进MMP去极化和线粒体细胞色素C释放,进而诱导Caspase-3和Caspase-9过表达引起细胞凋亡有关.

目的 观察参附注射液联合糖皮质激素对脓毒血症患者降钙素原(PCT)、N末端B型利钠肽原(NT-proBNP)及炎症因子的影响.方法 患者90例按随机数字表法分为两组,在常规治疗基础上,对照组接受糖皮质激素治疗,观察组联合应用参附注射液治疗.比较两组炎症因子、NT-proBNP及PCT水平变化,并进行疗效评价及不良反应发生情况分析.结果 治疗后两组肿瘤坏死因子-α(TNF-α)、白细胞介素-18(IL-18)、白细胞介素-10(IL-10)水平均明显降低(P＜0.05),且以观察组降低更为显著(P＜0.05).治疗后两组PCT和NT-proBNP均低于治疗前(P＜0.05);且观察组低于对照组(P＜0.05).治疗后,两组单核细胞表面人类白细胞抗原DR位点(HLA-DR)水平比治疗前提升(P＜0.05),且观察组高于对照组(P＜0.05).对照组总有效率为82.22％,明显低于观察组的95.56％(P＜ 0.05).对照组出现疑似药物不良反应3例(6.67％),观察组出现疑似药物不良反应2例(4.44％),两组差异无统计学意义(P＞0.05).结论 参附注射液联合糖皮质激素辅助治疗脓毒血症疗效显著,其作用机制可能与减轻炎症反应,提升免疫力,同时降低NT-proBNP及PCT水平,提升HLA-DR水平有关.

mRNA基因芯片表达谱为头颈肿瘤(head and neck cancer,HNC)的分子生物学诊断及研究HNC的生物过程提供了诸多重要生物学信息.通过生物信息学技术研究HNC基因表达谱,从而发掘头颈癌新的分子标志物.对4个GSE数据集和癌症基因组图谱(cancer genome atlas,TCGA)头颈癌数据库进行了综合分析,鉴定出HNC和相邻正常组织(adjacent normal tissue,ANT)样本中3 639个差异表达基因(differentially expressed genes,DEGs),然后应用加权基因共表达网络分析相关差异表达基因DEGs和HNC临床特征之间的关系.鉴定出15个共表达基因模块.其中蓝绿色基因模块所对应HNC患者的风险比(hazard ratio,HR)最高.通过对该模块的进一步研究,发现氧化低密度脂蛋白1(oxidized low density lipoprotein receptor 1,OLR1)的表达量与HNC患者的总体生存率呈显著负相关性.OLR1在mRNA水平的表达水平可作为判断HNC患者生存预后的潜在分子标志物.

目的 探讨埃索美拉唑联合枸橼酸莫沙必利治疗反流性咽喉炎临床疗效及对反流症状与体征指数、胃蛋白酶的影响.方法 选取医院2014年1月至2016年10月收治的反流性咽喉炎患者116例,回顾性分析患者的临床及随访资料,按治疗方法的不同分为对照组和观察组,各58例.对照组患者予以埃索美拉唑治疗,观察组患者在对照组治疗基础上加用枸橼酸莫沙必利,两组均治疗8周.结果 观察组临床总有效率为96.55％,明显优于对照组的75.86％(P<0.05);治疗后,两组患者反流症状指数、反流体征指数及胃蛋白酶水平均较治疗前明显降低,且观察组降低幅度明显大于对照组(P<0.05).结论 埃索美拉唑联合枸橼酸莫沙必利治疗反流性咽喉炎临床疗效显著,可有效降低反流症状指数与体征指数,抑制胃蛋白酶分泌.

目的：对比观察特异性免疫治疗对变应性鼻炎（ AR）患者免疫功能的影响及临床应用效果。方法选取2010年4与—2012年3月收治的AR患者166例，随机分为观察组与对照组，观察组使用粉尘螨滴剂进行特异性免疫治疗，对照组使用氯雷他定治疗，对比观察2组临床疗效及其对免疫功能的影响。结果2组治疗后IL－2、IL－4、IL－5以及IFN－γ等免疫功能相关指标水平均明显改善（P均＜0．05），且观察组改善程度明显优于对照组（P均＜0．05）；同时观察组患者总有效率明显高于对照组（P＜0．05）。结论对变应性鼻炎患者实施特异性免疫治疗，能够降低血清中细胞因子水平，恢复患者的免疫调节功能，减轻其变态反应与临床症状，具有更为理想的临床治疗效果。

目的：探讨内镜下鼻内结构重建术与常规开放手术治疗鼻源性头痛的临床效果。方法选取鼻源性头痛患者110例，随机平均分为观察组和对照组各55例，分别行内镜下鼻内结构重建术与常规开放手术，对比2组临床疗效与复发率。结果与对照组比较，观察组患者手术时间、术后卧床时间显著缩短（P 均＜0．05），术中出血量与术后引流量显著减少（P 均＜0．05），治疗显效率与总有效率显著提高（P 均＜0．05），术后复发率显著降低（P ＜0．05）。结论相比传统开放手术，鼻内镜下鼻内结构重建术具有更为显著的临床疗效，术中创伤小、恢复快，术后疗效维持较好，具有较高的临床价值。

目的：探讨中鳖甲软坚胶囊治疗慢性乙型肝炎合并肝硬化早期的临床疗效。方法慢性乙肝早期肝硬化患者80例随机分为对照组和观察组2组，分别行常规西医治疗与联合鳖甲软坚胶囊治疗，对比2组患者的临床效果。结果观察组临床总有效率显著高于对照组；2组患者血清肝功能指标治疗后均明显改善，观察组AST与TBil改善情况明显优于对照组；B超显示2组患者治疗后肝右叶最大斜径与脾脏厚度明显降低，观察组降低更显著；穿刺活检显示2组患者治疗后肝纤维化均明显改善，观察组更为显著。结论鳖甲软坚胶囊在慢性乙肝早期肝硬化治疗中，能够有效促进西医治疗的临床效果，同时改善肝功能，降低肝纤维化的程度，缓解肝脾肿大情况，具有确切的临床效果。

目的:观察茵陈蒿汤加味治疗非酒精性脂肪肝(Nonalcoholic Fatty Liver Disease,NAFLD)的临床疗效.方法:将96例NAFLD患者随机分为对照组和观察组各48例,所有患者均戒酒烟、控制饮食、适当运动,对照组口服水飞蓟素胶囊治疗,观察组在对照组基础上采用茵陈蒿汤加味治疗,比较两组患者的临床效果以及治疗前后生化指标变化.结果:观察组的有效率高于对照组(P＜0.05);两组患者治疗后的ALT、AST、TBiL、CHO、TG均较治疗前显著改善(P＜0.05),且观察组改善幅度优于对照组(P＜0.05).结论:茵陈蒿汤加味治疗非酒精性脂肪肝临床疗效显著,可以有效降低脂肪肝定量值,改善肝功能.

目的：观察二甲双胍与盐酸小檗碱联合治疗非酒精性脂肪肝（NAFLD）的临床效果。方法将 NAFLD患者114例随机分为观察组与对照组，2组均实施生活方式干预、饮食管理等，观察组在此基础上加用二甲双胍与盐酸小檗碱进行联合治疗，对比观察 2组临床疗效。结果2组治疗后血糖、血脂水平明显改善，且观察组改善效果优于对照组（P ＜0．05）；2组肝功能、瘦素及胰岛素抵抗水平均显著好转，且观察组相比对照组效果更佳（P ＜0．05）；2组肾功能均未见明显变化（P ＞0．05）；观察组治疗临床总有效率显著高于对照组（P ＜0．05）。结论在行为干预基础上使用二甲双胍与盐酸小檗碱联合治疗 NAFLD 患者，能够有效改善患者血糖、血脂水平以及肝功能状态，具有更为理想的临床效果，可以进一步研究推广。

目的:观察小青龙汤联合布地奈德鼻喷剂治疗变应性鼻炎的临床疗效.方法:选取本院收治的变应性鼻炎患者80例作为研究对象,按照随机平行分组法分为治疗组与对照组各40例,对照组给予布地奈德鼻喷剂治疗,治疗组在对照组治疗的基础上加用小青龙汤治疗,两组均以4周为1个疗程,比较两组患者临床疗效及机体血清炎性因子变化情况.结果:两组患者治疗后症状体征评分均较治疗前明显降低(P＜0.05),但同期组间比较治疗组较对照组明显降低(P＜0.05);治疗组有效率明显高于对照组(P＜0.05);治疗后两组患者血清IL-6、IL-8水平均较治疗前明显降低(P＜0.05),IL-10水平较治疗前明显升高(P＜0.05),但同期组间比较治疗组较对照组改善更加明显(P＜0.05),具有统计学意义.结论:小青龙汤联合布地奈德鼻喷剂治疗变应性鼻炎疗效显著,其可能通过改善血清炎性因子发挥作用.

目的 观察糖皮质激素(糠酸莫米松)喷鼻与白三烯受体拮抗剂(孟鲁司特钠)口服治疗小儿腺样体肥大(AH)的临床疗效.方法 将120例AH患儿按随机数字表法随机分为A组(糠酸莫米松组)、B组(孟鲁司特钠组)、C组(联合用药组)各40例,治疗3个月为1个疗程,比较3组患儿临床疗效及各项指标变化.结果 治疗1个疗程后,A组与B组总有效率比较无显著性差异(P＞0.05),C组总有效率显著高于A组和B组(P均＜0.01);3组患儿治疗前症状评分及A/N比值比较均无显著性差异(P均＞0.05),治疗后均较治疗前明显改善(P均＜0.05),A、B组与同期C组比较均有显著性差异(P均＜0.05).结论 糠酸莫米松喷鼻与孟鲁司特钠口服联合治疗儿童AH较单一用药效果理想,值得推广应用.

目的：探讨提高慢性乙型肝炎患者抗病毒治疗依从性的护理方法。方法随机抽取慢性乙型肝炎患者98例为实验研究对象，根据单双号的方法随机分为2组。对照组采用临床常规护理，实验组采用强化健康教育联合家属健康教育方法，对比观察2组患者的抗病毒治疗依从性。结果实验组患者49例中，出现用药停止1例，随意更改治疗药物1例，漏服2例；对照组49例出现用药停止3例，随意更改药物7例，漏服13例，2组患者治疗依从性比较差异有统计学意义（P＜0.05）。实验组治疗依从性得分为（45.14±1.25）分，明显高于对照组，组间比较差异有统计学意义（P＜0.05）。结论对慢性乙型肝炎患者给予强化健康教育联合家属健康教育的护理方法，可以有效地提高患者的抗病毒治疗依从性，提高其遵医行为，是一种较好的护理措施。

目的 研究大黄鼻饲联合扩肛对危重患者肠道功能的影响.方法 将180例ICU患者随机分为三组:常规治疗组、大黄治疗组和大黄联合扩肛治疗组,每组60例.观察每组患者腹胀发生率、48 h排便率、肠内营养中断率、MODS发生率及转出率(5 d和10 d)等指标.结果 与常规治疗组相比,大黄组及大黄联合扩肛组腹胀发生率、肠内营养中断率、MODS发生率显著下降;48 h排便率及转出率(5 d和10 d)显著上升,差异有统计学意义(P＜0.05).与大黄组比较,大黄联合扩肛组腹胀发生率、肠内营养中断率、MODS发生率显著下降;48 h排便率及转出率(5 d和10 d)显著上升,差异有统计学意义(P＜0.05).结论 大黄鼻饲联合扩肛能改善危重患者肠道功能;扩肛治疗及大黄鼻饲可增加危重患者对肠道营养的耐受性,从而使危重患者易于接受肠内营养,改善危重患者的预后,两种方法联合使用效果更理想.

Objective To evaluate and analyze the application value of continuous Acute Physiology and Chronic Health EvaluationⅢ(APACHEⅢ)apply on critically ill patients in the intense care unit.MethodsBy collecting and sorting out the data of 320 cases of serious patients,the prognosis of patients were evaluated by APACHEⅢfor 3 days in continuation and tracking the results in the end.ResultsThere was a significant correlation between the score of APACHEⅢ and the actual mortality.The mortality increased remarkably when the score was>90.It is helpful that judging the result of serious patients by using continuous APACHEⅢ.ConclusionsAPACHEⅢ score system can be used to evaluate state of an illness and prognosis.It is the basis of medical quality and reasonable application of ICU source.

[Objective] To apply Acute Physiology Chronic Health Evaluation Ⅲ(APACHEⅢ)in evaluation of the ICU patient's condition and prognosis,and simultaneously compare the prognosis predicted by dynamic APACHEⅢ scoring and MODS scoring with the actual prognosis.[Methods]The clinical data of 286 critically ill patients were collected and divided into survival group (252 cases) and death group (34 cases).APACHEⅢ was adopted to evaluate patients of the 2 groups for the 1st,3rd,5th,7th day,the results were compared.MODS scoring and prognosis prediction were simultaneously carried out.[Results]The APACHEⅢ scores of the 1st,3rd,5th,7th day and fatality rate of death group were all higher than those of the survival group(P<0.05 or P<0.01).Dynamic scoring could help to determine prognosis.There was consistency between APACHE Ⅲ scoring and MODS scoring.MODS scoring was correlated with mortality.[Conclusion]Dynamic APACHEⅢ and MODS scoring systems can be used for evaluation of the ICU patient's condition and prognosis,and it is the evidence of medical quality and rational use of ICU resource.

采用功能性鼻内镜手术治疗非侵袭性真菌性上颌窦炎,疗效满意.现已在临床广泛开展.手术成功是保证疗效的根本,合理的术后处理对保证疗效很重要.作者自2004年9月至2009年9月采用功能性鼻内镜手术治疗非侵袭性真菌性上颌窦炎患者43例,对其术后处理及疗效进行回顾性总结,现报道如下.

目的:提高临床医师时隐匿性中耳炎的认识,减少误诊.方法:对11例隐匿性中耳炎误诊为分泌性中耳炎病案资料进行回顾性分析.结果:11例误诊病例经手术证实均为隐匿性中耳炎,术后听力均有提高,无复发.结论:隐匿性中耳炎因为没有鼓膜穿孔及耳漏病史,临床症状与分泌性中耳炎相似,极易误诊为分泌性中耳炎,分泌性中耳交久治不愈,或疗效欠佳者要警惕中耳乳突内存在隐蔽性病变,赢骨薄层三堆CT扫描是减少误诊最重要的诊断方法.