本文报道1例既往因慢性间质性肾炎长期口服甲泼尼龙导致细胞免疫功能下降的非HIV感染的重症肺炎患者,在支气管肺泡灌洗液标本中经宏基因组二代测序检测到耶氏肺孢子菌及结核杆菌.由于患者对磺胺类药物过敏,且其他二线治疗药物短期内无法获得,故选择单用卡泊芬净50 mg静脉滴注治疗耶氏肺孢子菌肺炎(PJP).4 d后,患者的感染症状、实验室检查结果、胸部CT及X线片检查均显示病情得到改善,提示单用卡泊芬净抗感染治疗PJP有效.

选择重症有机磷农药急性中毒患者100例为研究对象,根据治疗方式分为观察组和对照组.对照组49例,给予血液灌流治疗,观察组51例,采用血液灌流加液体复苏治疗.比较两组患者的临床疗效、血清肿瘤坏死因子(TNF-α)、乳酸水平、胆碱酯酶(CHE)活力、肌钙蛋白(cTnI)水平、临床症状改善及不良反应发生情况.结果显示,治疗前,两组TNF-α、乳酸水平比较,差异无统计学意义(P＞0.05).治疗后,观察组总有效率为94.12％,明显高于对照组的73.47％,CHE活力高于对照组;观察组TNF-α、乳酸水平、cTnI水平低于对照组;昏迷时间、CHE活力恢复时间、住院时间和不良反应率均明显低于对照组,差异均有统计学意义(P＜0.05).提示,液体复苏治疗重症有机磷农药中毒效果好,值得推广.

目的 探讨慢性乙型肝炎(chronic hepatitis B,CHB)患者发生肝硬化的影响因素并构建预测模型.方法 选取2016年6月至2019年4月在陕西省人民医院感染性疾病科就诊的CHB肝硬化患者55例和CHB患者54例,收集两组患者临床资料并比较,分别采用两独立样本t检验及 χ2检验进行单因素分析,然后将差异有统计学意义的因素进行二元Logistic回归分析,最终得出CHB发生肝硬化的相关影响因素,并建立预测模型.结果 单因素分析显示,年龄、蜘蛛痣、血小板(platelet,PLT)与CHB发生肝硬化有相关性(P<0.05).多因素分析显示,年龄、蜘蛛痣、PLT是CHB发生肝硬化的独立影响因素(P<0.05),预测模型建立为:Logit P=-3.989+1.934×年龄+3.05×蜘蛛痣+1.203×PLT,其AUC为0.849,标准误为0.037,95％CI:0.776～0.921,根据约登指数计算公式,确定P值的截断值为0.29,其诊断的敏感度为69.10％,特异度为88.90％.结论 年龄、蜘蛛痣、PLT是CHB患者发生肝硬化的独立影响因素,利用上述因素构建的模型可为临床判断是否发生肝硬化提供重要依据.

目的 探讨脉管浸润在胃癌患者预后预测中的作用.方法 回顾性分析2012年1月至2017年1月在陕西省人民医院普外科接受根治性胃癌手术患者的临床资料,采用HE染色和免疫组化两种方法对患者进行脉管浸润的评估.采用χ2检验分析脉管浸润与患者临床病理特征之间的关系,采用单因素和多因素分析法来确定影响患者无病生存期和总生存期的预后因素.结果 在273例胃癌手术患者中,26.0％(71/273)被诊断为脉管浸润,22例为单纯的血管浸润,25例为单纯的淋巴管浸润,剩余24例患者同时存在淋巴管与血管浸润.进一步分析发现,随着肿瘤TNM分期的升高,脉管浸润的发生率呈递增趋势,从Ⅰ期胃癌的7.7％上升到Ⅲ期胃癌的36.8％(P<0.05);脉管浸润还与胃癌的肿瘤部位、病理T分期和病理N分期有关(P<0.05).脉管浸润是胃癌患者无病生存期(相对风险比为1.5,95％置信区间为1.1～2.2,P=0.018)和总生存期(相对风险比为1.8,95％置信区间为1.3～2.6,P=0.001)的独立预测因子.结论 脉管浸润是可手术胃癌患者复发和转移的高危因素,同时也是胃癌预后不佳的独立预测因子,在完善胃癌的TNM分期和监测术后复发转移中发挥重要作用.

目的 分析MYBL2在胃癌组织中的表达水平及其与患者预后、免疫细胞浸润的关系.方法 采用肿瘤免疫评估资源(TIMER)数据库分析MYBL2在泛癌中的差异性表达;采用Kaplan-Meier plotter数据库分析MYBL2表达水平与患者预后的关系;采用TIMER数据库分析MYBL2表达水平与免疫细胞浸润的关系.结果 在胃腺癌(STAD)患者中,肿瘤组织的MYBL2表达水平明显高于正常组织(P<0.001).Kaplan-Meier生存曲线显示,MYBL2高表达患者第一次进展时间为12.1个月,短于低表达患者的24.8个月(P=8.5e-05);MYBL2高表达患者的中位生存期为20.5个月,短于低表达患者的33.2个月(P=0.0011).MYBL2高表达与B细胞(r=-0.165,P=1.48e-03)、CD8+T细胞(r=-0.169,P=1.12e-03)、CD4+T细胞(r=-0.146,P=5.07e-03)、巨噬细胞(r=-0.364,P=4.74e-13)、中性粒细胞(r=-0.158,P=2.28e-03)、树突状细胞(r=-0.233,P=5.86e-06)浸润程度呈负相关,与纯度无相关性(r=0.115,P=2.53e-02).结论 MYBL2在胃癌患者中高表达,可作为预后不佳的预测指标.MYBL2高表达可抑制免疫细胞浸润,实现肿瘤细胞的免疫逃逸,促进肿瘤进展.

目的 探讨术前血清纤维蛋白原是否可作为胃癌预后预测的分子标志物.方法 回顾性分析术前纤维蛋白原水平与胃癌患者临床病理特征之间的相关性,并对胃癌患者的无病生存期和总生存期进行单因素和多因素生存分析,筛选影响胃癌患者预后的独立的影响因素.结果 327例患者最终纳入本研究,33.9％(111/327)的胃癌患者术前诊断为纤维蛋白原升高;进一步分析显示,纤维蛋白原水平升高与胃癌患者的病理T分期(P<0.001)、病理N分期(P=0.004)以及病理TNM分期(P<0.001)相关,随着肿瘤分期的升高,患者纤维蛋白原水平随之升高;单因素生存分析显示,相较于纤维蛋白原正常的患者,术前高纤维蛋白原水平的胃癌患者显示了较差的无病生存期(21.6月对比43.0月,P<0.001),同样,纤维蛋白原高的患者总生存期只有23.6月,远低于纤维蛋白原正常患者的56.4月,P<0.001.多因素分析证实纤维蛋白原升高是患者拥有较差的无病生存期和总生存期的独立的影响因素.结论 胃癌患者术前易发生高纤维蛋白原血症,且其高水平与胃癌患者的肿瘤浸润深度及淋巴结转移密切相关,高纤维蛋白原水平是胃癌患者预后不佳的独立的影响因素,提示纤维蛋白原可作为胃癌预后预测的潜在的血清标志物.

探讨乙酰谷酰胺注射液联合纳洛酮对急性重症酒精中毒复苏疗效及抗氧化功能的机制,选择2017年5月至2019年5月该院接诊的95例急性重症酒精中毒患者,通过随机数表法分为研究组50例和对照组45例,两组均接受常规处理,对照组在此基础上,给予盐酸纳洛酮注射液治疗,研究组在对照组基础上给予乙酰谷酰胺注射液治疗.比较两组治疗起效时间、显效时间和痊愈时间,并观察治疗前、治疗12 h后抗氧化功能指标、神经递质指标、肝功能指标的变化及安全性.研究组的治疗起效时间、显效时间、痊愈时间分别为(70.86±14.14) min、(165.64±33.69) min、(245.36±33.13) min,对照组分别为(96.24±17.95) min、(231.84±38.18) min、(313.89±34.79)min,差异均有统计学意义(P＜0.05);治疗后12 h,抗氧化功能指标中,研究组总抗氧化能力(TAC)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、丙二醛(MDA)分别为(12.34±1.66) kU/L、(138.37±16.64) U/L、(94.36± 11.65)U/mL、(5.57±0.62) μmol/L,对照组分别为(10.16±1.45) kU/L、(124.32±13.73) U/L、(78.54±8.08) U/mL、(8.12±0.97) μmol/L,神经递质指标中,研究组多巴胺(DA)、5-羟色胺(5-HT)分别为(145.69±13.31) ng/L、(141.03±14.97) ng/mL,对照组分别为(164.57±14.54) ng/L、(171.32±13.73) ng/mL,肝功能指标中,研究组谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(γ-GT)分别为(32.32±1.56) U/L、(29.74±1.84) U/L、(24.19±1.82)U/L,对照组分别为(34.21±1.63) U/L、(34.23±2.31)U/L、(27.56±1.78)U/L,差异均有统计学意义(P＜0.05);两组治疗后均未出现严重酒后并发症及药物不良反应,无死亡病例.乙酰谷酰胺注射液联合纳洛酮治疗急性重症酒精中毒患者的复苏效果显著,和单独使用纳洛酮相比,联合治疗可进一步改善机体抗氧化能力,促进神经递质、肝功能的恢复.

目的采用生物信息学分析,探讨神经纤毛蛋白-1（NRP1）在胃癌中的表达与肿瘤免疫微环境中免疫细胞浸润的相关性及其对患者预后的影响。方法应用TIMER数据库分析NRP1在胃癌中的差异性表达,分析NRP1表达与免疫细胞浸润之间的相关性,进一步分析NRP1基因的不同体细胞拷贝数变化与免疫细胞浸润之间的关系,多因素生存分析NRP1表达与肿瘤免疫细胞浸润对胃癌患者预后的影响,最后应用Kaplan-Meier plotter数据库计算不同NRP1表达水平胃癌患者的至第一次进展时间（FP）和总生存期（OS）。结果 TIMER数据库基因差异表达分析显示,NRP1在胃癌肿瘤组织中较正常组织中特异性高表达（P＜0.001）。其次,Kaplan-Meier plotter生存分析显示高表达NRP1的胃癌患者显示较短的至第一次无进展时间（24.3月对比49.5月,P=0.0059）和总生存期（34.7月对比70.4月,P=0.0036）。进一步分析显示NRP1表达与胃癌肿瘤微环境中的肿瘤纯度呈负相关（r=-0.173,P=7.21e-04）,其表达与胃癌微环境中CD8+T细胞、巨噬细胞、树突状细胞、中性粒细胞呈正相关,且差异具有统计学意义。再次,在胃癌中NRP1的体细胞拷贝数变化中的臂及获得与6种免疫细胞的浸润均相关。最后,多因素生存分析显示,在胃癌患者中,NRP1表达（HR:1.43,95%置信区间:1.13-1.82,P=0.003）和巨噬细胞浸润（HR:76.53,95%置信区间:3.43-1705.40,P=0.004）是影响其预后的独立的影响因素。结论 NRP1在胃癌中特异性高表达,其高表达是胃癌预后不佳的影响因素,NRP1表达与肿瘤免疫微环境中免疫细胞浸润相关,巨噬细胞浸润和NRP1表达是影响胃癌预后的因素。

目的 分析腹膜透析相关性腹膜炎(PDAP)致病菌的类型、药物敏感性及临床转归,以期为临床合理用药提供参考.方法 回顾性分析2011年3月至2019年10月陕西省人民医院收治的PDAP患者293例,留取入院当日第1袋浑浊腹膜透出液进行致病菌培养,观察药敏试验结果、患者疗效及转归.结果 293例患者腹膜透出液致病菌培养阳性率为75.09％,其中革兰阳性菌为70.00％,革兰阴性菌为24.09％,真菌为3.64％,混合感染为2.27％.革兰阳性菌感染比例男性高于女性,以凝固酶阴性葡萄球菌最多,占64.28％;革兰阴性菌感染比例女性高于男性,以大肠埃希菌最多,占47.17％.药敏试验结果显示葡萄球菌中耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分离率分别为45.00％和45.45％.293例PDAP患者的治愈率为85.67％,拔管改血液透析率为8.53％,病死率为3.75％,放弃治疗率为2.05％.结论 陕西省人民医院PDAP致病菌以革兰阳性菌为主,但存在性别差异,近8年PDAP治愈率较高.

Objective: To observe the expressional changes in Notch signaling pathway and toll-like receptor 4 (TLR4) and their interactions on the functions of CD14(+) monocytes in chronic hepatitis C patients. Methods: A total of 24 treatment-naïve chronic hepatitis C cases and 10 healthy individuals, who visited Shaanxi Provincial People's Hospital from August to October 2017, were enrolled. Selected CD14(+) monocytes were stimulated by the Notch signaling pathway inhibitor DAPT or transfected with TLR4 siRNA, and the levels of Notch1, Notch2, Hes1 and Hes5 mRNA were detected by real-time quantitative PCR. TLR4 protein levels and phosphorylation of NF-κB was detected by Western blot. ELISA was used to detect the level of cytokines secreted from CD14(+) monocytes. A t-test or paired t-test was used for comparison between groups. Results: The relative expression of Notch1 mRNA (3.97 ± 2.03 vs. 0.91 ± 0.76, P < 0.01) and downstream of Notch signaling pathway (5.96 ± 2.31 vs. 0.99 ± 0.45, P < 0.01), Hes1 mRNA and Hes5 mRNA (4.31 ± 1.05 vs. 0.84 ± 0.20, P < 0.01) in CD14+ monocytes of chronic hepatitis C patients was significantly higher than that of healthy individuals. The relative expression of TLR4 mRNA (5.14 ± 1.09 vs. 1.27 ± 0.39) and protein level in CD14(+) monocytes of chronic hepatitis C patients were significantly higher than those of healthy individuals (P < 0.01). An inhibition of Notch signaling pathway with DAPT had reduced the relative expression level of TLR4 mRNA (2.58 ± 1.36 vs. 4.34 ± 1.88, P < 0.05), protein expression and phosphorylation of NF-B in CD14(+) monocytes of chronic hepatitis C patients. Furthermore, the secretion level of MCP-1 [(94.32 ± 23.59) pg/ml vs. (64.07 ± 9.39) pg/ml, P < 0.01] and IL-8 [(12.54 ± 4.89) pg/ml vs. (7.92 ± 3.01) pg/ml, P < 0.05] was significantly reduced. TLR4 siRNA transfection reduced the expressions of Notch1 mRNA (2.09 ± 1.72 vs. 3.73 ± 1.75, P < 0.05), Hes1 (2.87 ± 0.84 vs. 5.54 ± 0.97, P < 0.01), and Hes5 (2.89 ± 0.93 vs. 4.51 ± 1.54, P < 0.01) in CD14(+) monocytes of chronic hepatitis C patients. Conclusion: Interaction of Notch signaling pathway with TLR4 can promote the function of CD14(+) monocytes in chronic hepatitis C patients.

目的 探讨运用自体外周血干细胞移植疗下肢动脉缺血性疾病,并对其疗效进行临床观察.方法 本研究共入组58例下肢动脉缺血性疾病患者,均进行自体外周血进行干细胞移植治疗.对患者的疼痛感、冷感、间歇跛行、踝肱指数(ABI)、侧支血管生成数量等指标进行治疗前后比较,从而评估自体外周血干细胞移植疗下肢动脉缺血性疾病治疗效果.结果 患者治疗后在疼痛感、冷感、间歇跛行3个方面较治疗前明显降低,差异具有显著性(P＜0.05),ABI评分与侧支血管生成数评分方面,差异具有显著性(P＜0.05).自体外周血进行干细胞移植的有效率是84.4%.结论 自体外周血干细胞移植是治疗下肢动脉缺血性疾病的安全而有效方法.

目的 分析布鲁杆菌性骨关节损害的流行病学及临床特征.方法 回顾性分析66例布鲁杆菌病患者的临床资料,其中并发骨关节损害16例(A组),未并发骨关节损害50例(B组),比较两组患者在流行病学、临床症状及体征、实验室检查、治疗效果等方面的差异.结果 A组患者发病例数以4月份为多(5例),B组以5月份为多(6例);B组患者农民的比例明显高于A组(P＜0.05);两组患者性别、年龄、动物接触史比较,差异均无统计学意义(均P ＞0.05).A组患者收住骨科、骨关节疼痛的比例均高于B组(均P＜0.05);两组患者发病到确诊时间及急性期获得诊断、发热、多汗、淋巴结肿大、肝脏肿大、脾脏肿大的比例比较,差异均无统计学意义(均P＞0.05).两组患者试管凝集试验阳性率、血培养阳性率以及WBC、C反应蛋白、ESR水平比较,差异均无统计学意义(均P ＞0.05).两组患者规范治疗率、复发率比较,差异均无统计学意义(均P＞0.05);A组治疗后退热时间明显长于B组(P＜0.05).结论 布鲁杆菌病并发骨关节损害较为常见,患者职业为农民的比例较低,收住骨科、骨关节疼痛的比例较高,治疗后退热时间较长.

目的 观察联合经皮腔内血管成形术(PTA)及自体外周血干细胞移植(ABSCT)治疗下肢动脉缺血性疾病可行性和近期效果.方法 研究共入组48例下肢动脉缺血性疾病患者,依自愿原则分组,仅采用PTA治疗的19例患者为PTA组,单纯ABSCT组10例,PTA与ABSCT联合治疗的19例患者为联合治疗组.常规治疗方案3组相同,对3组患者的疼痛感、冷感、间歇跛行、踝肱指数(ABI)、侧支血管生成数量等方面的指标进行比较,从而判断3组患者的疗效差异.结果 在疼痛感、冷感、间歇跛行3方面3组患者均明显降低,差异有统计学意义(P＜0.05),ABI评分与侧支血管生成数评分方面,3组均升高,差异有统计学意义(P＜0.05).与PTA及ABSCT组比较,联合治疗组在疼痛感、冷感、间歇跛行方面、ABI评分与侧支血管生成数评分改善更为明显(P＜0.05).联合治疗组的有效率是89.5％,PTA组的有效率是78.9％,ABSCT组的有效率是60.0％,联合治疗组效果显著优于PTA组和ABSCT组(P＜0.05).结论 PTA联合ABSCT治疗下肢动脉缺血性疾病安全、有效,疗效优于单纯PTA术及单纯ABSCT移植治疗.

Objective To investigate the influence of the Notch signaling pathway on CD8 + T lymphocyte function in patients with chronic hepatitis C (CHC) and the role of the Notch signaling pathway in the pathogenesis of CHC.Methods A total of 38 treatment-na(i)ve CHC patients who visited Shaanxi Provincial People's Hospital from January to August,2016 and 17 healthy volunteers were enrolled in this study.CD8 + T lymphocytes were isolated,and quantitative real-time PCR was used to measure the mRNA expression of Notch1 and Notch2 in CD8 + T lymphocytes.CD8 + T lymphocytes,which were isolated from HLA-A2-restricted CHC patients,were co-cultured with hepatitis C virus (HCV)-infected Huh7.5 cells in both direct and indirect contact culture systems.DAPT,a Notch signaling pathway inhibitor,was added,and the changes in cytotoxic and non-cytotoxic functions of CD8 + T lymphocytes were analyzed by measuring the levels of lactate dehydrogenase level and cytokines.The t-test was used for comparison of continuous data between groups.Results The mRNA expression of Notch1 and Notch2 in CD8 + T lymphocytes in CHC patients was 10 and 4 times,respectively,that in healthy volunteers (t =6.63,P =0.003;t =18.88,P ＜ 0.001).Inhibition of the Notch signaling pathway significantly increased the percentage of dead cells in the direct contact culture system (26.41-± 4.76％ vs 13.65 ± 4.65％,t =3.32,P =0.029),while it did not influence the cytotoxity of CD8 + T lymphocytes in the indirect contact culture system.After inhibition of the Notch signaling pathway,there was a significant increase in the expression of interferon-γin the direct (52.19 ± 12.38 pg/ml vs 18.62 ±5.66 pg/ml,t =4.27,P =0.013) and indirect contact culture systems (18.86 ± 3.09 pg/ml vs 5.52 ± 2.52 pg/ml,t =5.79,P =0.004).After inhibition of the Notch signaling pathway,there was a significant increase in the expression of tumor necrosis factor-α in the direct contact culture system (1296.0 ± 293.3 pg/ml vs 585.3 ± 32.62 pg/ml,t =4.17,P =0.014),while there was no significant change in the indirect contact culture system (297.3 ± 175.4 pg/ml vs 273.7 ± 105.9 pg/ml,t =0.20,P =0.851).Conclusion Inhibition of the Notch signaling pathway can enhance the cytotoxic and non-cytotoxic functions of CD8 + T lymphocytes in CHC patients.The Notch signaling pathway may induce immune tolerance in chronic HCV infection by inhibiting the function of CD8 + T lymphocytes.

Objective:To investigate the autologous peripheral blood stem cell transplantation ( ABSCT) combined with inter-ventional therapy in treatment of chronic lower limb ischemia. Methods:38 patients with chronic lower limb ischemia were divided into 2 groups. 19 patients treated with ABSCT combined with interventional therapy were used as combined treatment group,and the other 19 patients treated with autologous peripheral blood stem cell transplantation and interventional as single interventional therapy group. The patients in two groups receieved conventional therapy. The limb pain, cold feeling, intermittent claudication, ankle brachial index (ABI) and the number of collateral vessel formation of the patients in two groups were observed before and after treatment,and the cur-ative effects in two groups were compared. Results:Compared with before treatment,the limb pain scores,cold feeling scores and inter-mittent claudication scores of the patients in two groups after treatment were significantly decreased,the differences were statistically sig-nificant (P＜0. 05),and the ABI and the number of collateral vessel formation were increased,and the difference was statistically sig-nificant (P＜0. 05). Compared with the intervention group,the limb pain,cold feeling,intermittent claudication,ABI and the number of collateral vessel formation of the patients in the combined treatment group were more significant (P＜0. 05). The total effective rate of the two groups were 89. 5% and 78. 9% ,respectively,the total effective rate in combinaed treatment group was higher than that in sin-gle interventional therapy group (P＜0. 05). Conclusion:ABSCT combined with interventional therapy is a safe and effective method for the treatment of chronic lower limb ischemia.

Objective To investigate the effect of thymosin α1 therapy on the function of CD4 + CD25 + CD127dim/-regulatory T (Treg)cells in chronic hepatitis B (CHB) patients.Methods A total of 67 CHB patients who were admitted to Department of Infectious Diseases in Shaanxi Provincial People's Hospital from December 2016 to July 2017 were enrolled,among whom 38 patients received entecavir antiviral therapy (control group) and 29 received entecavir combined with thymosin c1 for injection (treatment group).Peripheral blood mononucleated cells were isolated before and after treatment,and flow cytometry was used to measure the percentage of CD4 + CD25 + CD127dim/-Treg cells.CD4 + CD25 + CD127dim/-Treg cells were purified and co-cultured with autologous CD4 + CD25-T cells.CCK-8 assay was used to measure cell proliferation,and ELISA was used to measure the levels of cytokines.The t-test was used for comparison of related indices between the two groups,the chi-square test was used for comparison of categorical data.Results In the control group,the percentage of CD4 + CD25 + CD127dim/-Treg cells was significantly reduced from 12.32％ ± 1.22％ at baseline to 8.85％ ±2.18％ after 12 weeks of treatment (t =4.579,P =0.0005),while in the treatment group,this value was significantly reduced from 13.71％ ± 2.32％ at baseline to 9.26％ ± 2.30％ after 12 weeks of treatment (t =4.803,P =0.0003).The measurement of cytokines was performed for 17 patients in the control group and 21 in the treatment group.After 12 weeks of treatment,the control group showed no significant changes in cell proliferation and levels of cytokines in the co-culture system of Treg and CD4 + CD25-T cells;the treatment group had a significant increase in cell count in the co-culture system [(3.66 ± 0.95) × 106 vs (2.07 ± 0.51) × 106,t =5.709,P ＜ 0.0001],as well as significant reductions in the levels of inhibitory cytokines interleukin-10 (41.40 ± 11.89 pg/ml vs 56.53 ± 27.85 pg/ml,t =2.639,P =0.019) and interleukin35 (122.9 ± 9.98 pg/ml vs 130.0 ± 15.98 pg/ml,t =2.459,P =0.028) and significant increases in the levels of antiviral cytokines interferon-α (297.5 ± 83.56 pg/ml vs 235.6 ± 67.72 pg/ml,t =2.603,P =0.017) and interferon-γ(5.83 ± 0.85 pg/ml vs 4.39 ± 0.95 pg/ml,t =4.659,P =0.0004).Conclusion Thymosin α1 can inhibit the level and immunosuppressive function of CD4 + CD25 + CD127dim/-Treg cells in CHB patients and improve their immune function.

目的 探讨本地区急性细菌性痢疾的流行病学特征.方法 回顾性分析陕西省人民医院2011年1月至2016年12月共1027例急性细菌性痢疾患者的流行病学资料,包括发病时间、发病地点、病例的人口学特点等.结果 5~10月份的发病率显著超过其它6个月;病例主要集中在碑林区、雁塔区和莲湖区;患者平均年龄为(26.4±6.5)岁.病例数据显示,0~4岁组发病率最高,其次为21~40岁组(P>0.05);0~4岁组2014、2015年及6年总发病率显著高于其它年龄组,差异具有统计学意义(P<0.05);散居儿童组发病率最高,其次为个体组(P>0.05);散居儿童组2011、2015年及6年总发率显著高于其它组,差异具有统计学意义(P<0.05).1027例患者男女比例为1.15:1,差异具有统计学意义(P<0.05).结论 本地区急性细菌性痢疾发病高峰在5~10月,0~4岁散居儿童、21~40岁人群、个体工作者发病率较高,男性患者多于女性患者,提示此类人群是本地区急性细菌性痢疾的高发人群,应加强对这些人群的急性细菌性痢疾的监测和预防.

目的 探讨慢性乙型肝炎/乙肝肝硬化长期治疗过程中阿德福韦酯(ADV)的肾毒性,为临床安全用药提供依据.方法 监测2012年12月-2013年12月在陕西省人民医院传染科门诊服用ADV治疗的93例慢性乙型肝炎/乙肝肝硬化患者的血磷、肌酐水平.结果 低血磷发生率为17.2％,服药时间长、年龄大、肝硬化者易发生低血磷.1例患者在ADV治疗期间出现低血磷并伴血清肌酐升高,病理检查示慢性肾间质炎、肾小球增生硬化.结论 服用ADV期间需定期监测血磷、血清肌酐水平,尤其是肝硬化、年龄大、服用时间长者,必要时行肾穿刺病理检查.

目的：了解非疫区综合性医院布鲁氏菌病的流行病学及临床特征。方法：回顾性分析陕西省人民医院收治的35例布鲁氏菌病患者的流行病学及临床资料。结果：22例（62．9％）患者有羊接触史；发热及骨关节疼痛是突出症状；35例患者降钙素原水平均不高；布鲁氏菌血清试管凝集试验阳性率为93．8％、血培养阳性率为56．0％；误诊率34．3％；6例（17．1％）患者治疗方案不规范。结论：羊等牲畜接触史可提示布鲁氏菌病的诊断；临床表现多样化、误诊率较高；血清降钙素原水平不高，试管凝集试验阳性率高于血培养阳性率；治疗仍存在不规范之处，应早期、足疗程、联合用药治疗。

目的:分析HIV感染者的流行病学及临床特征,为艾滋病的诊断提供依据。方法:对16例HIV感染者的流行病学、临床特征及血常规变化进行分析。结果:16例患者,首次就诊以反复发热最多,其次是发热同时伴有重症肺部感染、体重减少,外周血WBC总数降低以淋巴细胞为主,传播途径以性传播和输血途径为主。结论:对于有冶游史的反复发生发热、特别是同时患重症肺部感染、体重减少的患者要重视艾滋病的筛查工作。