[目的]探讨淫羊藿苷对椎间盘退变大鼠的治疗作用及机制.[方法]将50只大鼠采用纤维环穿刺法建立椎间盘退变模型.将存活的48只大鼠随机分为模型组、淫羊藿苷组、激动剂组、激动剂+淫羊藿苷组,每组12只,另取10只作为假手术组.激动剂+淫羊藿苷组给予淫羊藿苷6.0 g/kg灌胃、尾静脉注射脂多糖5 mg/kg,淫羊藿苷组给予淫羊藿苷6.0 g/kg灌胃,激动剂组给予尾静脉注射脂多糖5 mg/kg,每日1次,连续2周.给药过程中,激动剂组和激动剂+淫羊藿苷组各死亡1只大鼠.给药结束后,酶联免疫吸附分析(ELISA)检测血清白细胞介素(IL)-6、IL-1β、肿瘤坏死因子α(TNF-α)含量,苏木素-伊红(HE)染色法观察椎间盘组织病理学改变,末端脱氧核苷酸转移酶介导的dUTP缺口末端标记(TUNEL)法检测髓核细胞凋亡率,蛋白免疫印迹(Western Blot)法检测椎间盘组织核转录因子kappaB(NF-κB)p65、p-p65、B淋巴细胞瘤2基因(Bcl-2)、Bcl-2相关X蛋白(Bax)的蛋白表达水平,免疫组织化学法检测椎间盘组织p-p65蛋白阳性表达.[结果]模型组大鼠椎间盘髓核与纤维环之间界限模糊、纤维环排列紊乱且存在缝隙,髓核细胞聚集、皱缩,基质减少;与模型组比较,淫羊藿苷组椎间盘纤维环结构和髓核形态及排列趋于正常;激动剂组大鼠椎间盘病变程度较模型组严重;激动剂+淫羊藿苷组大鼠椎间盘病变较激动剂组减轻.与假手术组比较,模型组血清IL-6、IL-1β、TNF-α含量,髓核细胞凋亡率,p-p65、Bax蛋白表达水平升高,Bcl-2蛋白表达水平降低(均P<0.05);与模型组比较,淫羊藿苷组IL-6、IL-1β、TNF-α含量,髓核细胞凋亡率,p-p65、Bax蛋白表达水平降低,Bcl-2蛋白表达水平升高(均P<0.05),而激动剂组IL-6、IL-1β、TNF-α含量,髓核细胞凋亡率,p-p65、Bax蛋白表达水平升高,Bcl-2蛋白表达水平降低(均P<0.05);与淫羊藿苷组比较,激动剂+淫羊藿苷组IL-6、IL-1β、TNF-α含量,髓核细胞凋亡率,p-p65、Bax蛋白表达水平升高,Bcl-2蛋白表达水平降低(均P<0.05);与激动剂组比较,激动剂+淫羊藿苷组IL-6、IL-1β、TNF-α含量,髓核细胞凋亡率,p-p65、Bax蛋白表达水平降低,Bcl-2蛋白表达水平升高(均P<0.05).[结论]淫羊藿苷可改善椎间盘退变大鼠椎间盘病理损伤,减轻炎症反应,减少髓核细胞凋亡,其机制可能与抑制NF-κB信号通路有关.

Objective:To explore the correlation between tumor markers and prognosis of patients with idiopathic inflammatory myopathy (IIM) associated interstitial lung disease (ILD).Methods:A total of 149 patients who were no less than 18 years old and diagnosed with IIM-ILD from July 2017 to September 2019 in the First Affiliated Hospital of Zhengzhou University were consecutively enrolled in the study. Ten patients were lost to follow-up. The remaining 139 cases were regarded as research objects. Patients were divided into survival group or death group according to their one-year survival status. Then their baseline characteristics were compared. Univariate Cox regression analyses of age, gender, cancer, inflammatory indexes, muscle zymogram, tumor markers, ferritin, melanoma differentiation-associated gene 5 (MDA5) antibody and treatment regimens were conducted to identify prognostic risk factors of one-year mortality. Corrected multivariable cox regression was applied to screen the independent risk factors associated with one-year mortality of IIM-ILD. According to the cut-off value of carcinoembryonic antigen (CEA) and neuron specific enolase (NSE) (6 μg/L and 28 μg/L, respectively), patients were divided into high-level groups and low-level groups. Kaplan Meier survival curve were generated to compare one-year survival rate of high-level groups and low-level groups. On the basis of qualitative results of MDA5 antibody, patients were split into two groups with positive MDA5 antibody or negative MDA5 antibody. The differences of CEA, NSE levels between the two groups and the correlation between CEA, NSE levels and ferritin were analyzed.Results:Age, lactate dehydrogenase (LDH), CEA, carbohydrate antigen (CA) 199, NSE and ferritin in the death group were higher than those in the survival group, while the rate of immunosuppressant administration was lower than that in survival group ( P<0.05). Univariate regression analyses showed that CEA, cytokeratin 19 fragment (CYFRA211) and NSE were risk factors for one-year mortality of IIM-ILD. Adjusted by age, treatment regimens and tumor, multivariate regression analysis showed that CEA [ HR=1.112, 95% CI (1.017-1.214), P=0.019] and NSE [ HR=1.033, 95% CI (1.002-1.064), P=0.034] were independent risk factors for one-year mortality. One-year survival rate of the group with CEA≥6 μg/L was lower than that in the group with CEA<6 μg/L (Logrank test, P<0.001). Similarly, one-year survival rate of the group with NSE≥28 μg/L was lower than that in the group with NSE<28 μg/L (Logrank test, P<0.001). In addition, the CEA level in patients with positive MDA5 antibody was higher than that in patients with negative MDA5 antibody ( P<0.001). However, there was no correlation between NSE and MDA5 antibody. Moreover, serum levels of CEA ( r=0.299, P=0.002) and NSE ( r=0.349, P<0.001) were positively correlated with ferritin. Conclusions:Tumor markers have predictive value for the prognosis of IIM-ILD. Higher CEA and NSE are independent risk factors for poor prognosis in patients with IIM-ILD.

回顾性观察郑州大学第一附属医院2018年1月至2019年1月收治的慢阻肺急性加重患者302例，其中65例并发肺动脉高压，比较其临床特点，发现多项血液生物标志物在慢阻肺急性加重合并发肺动脉高压的患者中差异有统计学意义。进一步采用受试者工作特征曲线分析氨基末端脑钠肽前体（NT-proBNP）预测慢阻肺急性加重并发肺动脉高压的曲线下面积最大。相关血清生物标志物特别是NT-proBNP可能提示临床慢阻肺急性加重患者并发肺动脉高压，有一定的筛查价值。

目的 探讨穿龙骨刺胶囊联合艾瑞昔布治疗膝骨关节炎的临床效果.方法 选取2020年1月—2021年1月在郑州大学第一附属医院治疗的102例膝骨关节炎患者,根据用药差别分为对照组和治疗组,每组各51例.对照组口服艾瑞昔布片,0.1 g/次,2次/d;治疗组在对照组基础上口服穿龙骨刺片,4 g/次,3次/d.两组均经8周治疗.观察两组的临床疗效,比较两组临床症状改善时间、相关评分和血清氧化应激指标.结果 经治疗,治疗组总有效率是98.04％,显著高于对照组的82.35％(P<0.05).经治疗,治疗组膝关节疼痛、肿胀、活动受限改善时间明显短于对照组(P<0.05).经治疗,两组VAS评分、WOMAC评分、ISOA评分均较治疗前显著降低,但Lysholm评分显著升高(P<0.05);且治疗后治疗组相关评分改善优于对照组(P<0.05).经治疗,两组患者血清超氧化物歧化酶(SOD)显著升高,但丙二醛(MDA)水平显著降低(P<0.05);治疗后,治疗组血清氧化应激水平改善优于对照组(P<0.05).结论 穿龙骨刺胶囊联合艾瑞昔布治疗膝骨关节炎具有较好的临床疗效,可有效改善患者临床症状,改善关节功能,抑制氧化应激反应,有着良好的临床应用价值.

目的 研究带锁髓内钉固定结合术后骨康胶囊治疗四肢创伤性骨折后骨不连患者的效果及对血清ALP、OPG水平的影响.方法 本次研究对象均来自于2017年2月—2019年6月在郑州大学第一附属医院治疗的四肢创伤骨折骨不连患者60例,将以上患者随机分为两组,每组患者30例.观察组患者采取带锁髓内钉固定结合术后骨康颗粒治疗,对照组患者采取带锁髓内钉固定治疗.观察两组患者的治疗效果、术后Lane-Sandhu评分、血清ALP、OPG水平以及骨代谢水平之间的差异.结果 观察组患者治疗总有效率(86.67％)显著高于对照组(63.33％),差异有统计学意义(P<0.05);观察组患者的术后Lane-Sandhu评分明显优于对照组,经过治疗后,两组患者的血清ALP、OPG水平均显著升高,且观察组患者的血清ALP、OPG水平显著高于对照组,两组患者的血清ⅠCTP、PⅠCP、BGP均显著提高,且观察组患者的血清ⅠCTP、PⅠCP、BGP显著高于对照组.结论 带锁髓内钉固定结合术后骨康胶囊治疗四肢创伤性骨折后骨不连患者血清ALP、OPG水平显著提升,效果显著,建议临床推广.

Objective: To study the characteristics and clinical significance of pulmonary function test and kerbs von den lungen 6 (KL-6) in anti-synthetase syndrome related interstitial lung disease (ASSD-ILD) and idiopathic pulmonary fibrosis (IPF). Methods: The clinical data of 43 patients with ASSD-ILD (ASSD-ILD group) from May 2015 to May 2017 were collected retrospectively, including 12 males and 31 females, and 34 patients with IPF (IPF group) treated in the First Affiliated Hospital of Zhengzhou University during the same period, including 28 males and 6 females, were also included. The basic information, and the value of pulmonary function test [pulmonary function parameters included the forced vital capacity expressed as percent predicted (FVC%pred), the forced expiratory volume in 1 second expressed as percent predicted (FEV(1)%pred), the ratio of FVC to FEV(1) (FVC/FEV(1)), the peak expiratory flow expressed as percent predicted (PEF%pred), the forced expiratory flow at 25%, 50%, 75% of FVC as percent predicted (FEF(25)%pred, FEF(50)%pred, and FEF(75)%pred), the maximum mid-expiratory flow as percent predicted (MMEF% pred), and the diffusing capacity for carbon monoxide as percent predicted (DLCO% pred)], and serum KL-6 level in ASSD-ILD and IPF were compared. Results: The FEV(1)%pred, FEF(50)%pred, FEF(75)%pred, and MMEF%pred values in ASSD-ILD group were significantly lower than those in IPF group (all P<0.05), while the FVC% pred, FVC/FEV(1), PEF% pred, FEF(25)%pred, and DLCO% pred values in ASSD-ILD group had no significant difference compared with IPF group (all P>0.05). There was no significant difference in serum KL-6 level between ASSD-ILD group and IPF group [(1 169±911) vs (1 210±908) U/ml, t=0.62, P=0.463]. Follow-up analysis showed that the serum KL-6 level of ASSD-ILD patients who died within two years was significantly higher than that of survivors [(2 060±1 168) vs (1 042±858) U/ml, t=2.93, P=0.041]. The serum KL-6 level of patients who died within two years of IPF patients was also significantly higher than that of patients who survived [(1 767±865) vs (1 089±894) U/ml, t=2.53, P=0.026]. The serum KL-6 level in ASSD-ILD group was negatively correlated with FVC%pred (r=-0.43, P=0.004), FEV(1)%pred (r=-0.39, P=0.010) and DLCO% pred (r=-0.41, P=0.006). There was no correlation between serum KL-6 level and pulmonary function test indexes in IPF group (all P>0.05). Conclusions: There is difference in pulmonary function test between ASSD-ILD patients and IPF patients. High serum KL-6 level will be predictive of poor prognosis.

目的 探讨3D打印技术辅助PVP治疗老年骨质疏松性椎体压缩骨折的临床疗效.方法 回顾性分析自2017-01-2019-05诊治的94例老年骨质疏松性椎体压缩骨折,47例采用3D打印技术辅助PVP治疗(观察组),47例单纯采用PVP治疗(对照组).比较2组手术时间、术中出血量、术中透视次数、骨水泥渗漏数、术后1d与术后3d血清皮质醇(Cor)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平以及术后6个月与术后12个月椎体前缘压缩比值、伤椎Cobb角、O-DI指数.结果 94例均顺利完成手术,随访时间16～27个月,平均21.5个月.观察组手术时间、术中出血量、术中透视次数、骨水泥渗漏数较对照组少,术后1d与术后3d的Cor、SOD、MDA水平较对照组低,术后6个月、术后12个月椎体前缘压缩比值、伤椎Cobb角、ODI指数较对照组小,差异有统计学意义(P＜0.05).结论 3D打印技术能简化PVP术中操作,减少术中透视次数,疗效确切,减轻患者氧化应激反应,降低骨水泥渗漏率.

目的 分析支气管哮喘合并过敏性鼻炎患者的肺功能和气道炎症标志物特征.方法 回顾性分析2017年4月至2019年3月郑州大学第一附属医院呼吸科收治的140例非重症成年支气管哮喘患者的临床资料.根据是否合并过敏性鼻炎分为合并组(支气管哮喘合并过敏性鼻炎患者35例)和哮喘组(单纯支气管哮喘患者105例).将哮喘组中32例无过敏原检测结果的患者去除后,根据过敏史及过敏原检测结果将哮喘组患者分为过敏性哮喘组(38例)和非过敏性哮喘组(35例).比较合并组、哮喘组、过敏性哮喘组及非过敏性哮喘组患者的呼出气一氧化氮(FeNO)、肺功能[第1秒用力呼气容积占预计值的百分比(FEV1％pred)、第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)]、外周血嗜酸性粒细胞百分比(EOS％).对合并组和哮喘组的FeNO、EOS％进行相关性分析.分析FeNO、EOS％对支气管哮喘合并过敏性鼻炎的诊断价值.结果 合并组FeNO和EOS％水平均高于哮喘组,差异有统计学意义(均P<0.05).合并组FEV1％pred、FEV1/FVC分别与哮喘组比较,差异无统计学意义(均P>0.05).合并组FeNO和EOS％水平均高于过敏性哮喘组和非过敏性哮喘组,差异有统计学意义(均P<0.05).过敏性哮喘组FeNO和EOS％水平均高于非过敏性哮喘组,差异有统计学意义(均P<0.05).合并组FeNO与EOS％水平呈正相关(r=0.551,P<0.05).哮喘组FeNO与EOS％水平呈正相关(r=0.240,P<0.05).FeNO诊断支气管哮喘合并过敏性鼻炎的最佳临界值为71.65μg·m-3,敏感度和特异度分别为71.40％、80.00％.EOS％诊断支气管哮喘合并过敏性鼻炎的最佳临界值为3.25％,敏感度和特异度分别为82.90％、71.40％.结论 支气管哮喘合并过敏性鼻炎患者FeNO和外周血EOS％明显升高,两者水平呈正相关.检测FeNO、EOS％有助于支气管哮喘合并过敏性鼻炎的诊治.

目的 探讨老年股骨转子间骨折采取股骨近端防旋髓内钉(PFNA)与解剖锁定钢板治疗的临床效果.方法 选取本院2016年11月～2017年10月收治的70例老年股骨转子间骨折患者作为研究对象,按照随机数表法分为观察组与对照组,各35例,对照组接受解剖锁定钢板治疗,观察组接受PFNA治疗.记录两组患者手术时间、切口长度、手术出血量、骨折愈合时间,评价术后髋关节功能情况,实施组间对比分析.结果 两组患者在骨折愈合时间与术后髋关节功能优良率上对比差异无统计学意义(P＞ 0.05),但观察组患者手术时间更短、切口长度更短、手术出血量更少与对照组比较差异有统计学意义(P ＜0.05).结论 老年股骨转子间骨折患者采取股骨近端防旋髓内钉治疗,取得的效果与解剖锁定钢板相当,但前者手术时间更短,切口更小,手术出血量更少,值得借鉴.

膝关节骨关节炎是一种累及骨、滑膜及关节周围支持结构的疾病,本病的发生率呈逐年上升趋势,其疾病最终多以手术治疗为主,笔者研究了临床腓骨近端截骨术在治疗膝骨关节炎方面的应用,发现其要明显优于胫骨高位截骨术、股骨远端截骨术、关节成形及融合术等手术模式,值得临床推广.

The aim of this study was to investigate the association between four single nucleotide polymorphisms in NR3C1 (Tth111I, BclI, ER22/23EK, and N363S), which encode the glucocorticoid receptor, and asthma susceptibility in patients from the Henan Province of China. Three hundred and twenty-eight patients with asthma and 60 healthy volunteers were recruited to this study. The target SNPs were genotyped by polymerase chain reaction (PCR)-high resolution melting and PCR-restriction fragment length polymorphism. The frequencies of the AA (8.84%) and GG (30.79%) genotypes of Tth111I were higher, and that of the AG genotype was lower (60.37%), in the asthma patients compared to that seen in healthy controls (5.00, 26.67, and 68.33%, respectively). On the other hand, asthma patients showed higher frequencies of the AA genotype (78.05%) of N363S, and lower frequencies of the AG and GG genotypes (15.55 and 6.40%), compared to healthy volunteers (71.67, 18.33, and 10.00%, respectively). Neither of these differences were found to be statistically significant. Moreover, we observed no significant differences in the genotype or allele frequencies of the BclI and ER22/23EK SNPs between the patient and control groups. In conclusion, SNPs in NR3C1 were not significantly associated with asthma in patients from the Henan Province. Patients showed higher frequencies of the AA and GG genotypes of Tth111I and the AA genotype of the N363S SNP compared to healthy volunteers, although these differences were not significant.

目的：探讨不同手术方案治疗股骨转子间骨折并发同侧股骨颈骨折的临床效果。方法选取2013年5月～2015年5月收治的股骨转子间骨折并发同侧股骨颈骨折患者92例，随机分为对照组和观察组，各46例。对照组给予髋螺钉治疗，观察组给予髓内钉治疗，对比两组临床治疗效果。结果观察组术中出血量、术后负重时间显著少于对照组，差异有统计学意义（P＜0.05）；观察组手术时间、术后住院时间、骨折愈合时间与对照组相比，差异无统计学意义（P＞0.05）；观察组髋关节创伤后评分与对照组相比，差异无统计学意义（P＞0.05）；观察组并发症发生率显著低于对照组，差异有统计学意义（P＜0.05）。结论髓内钉治疗股骨转子间骨折并发同侧股骨颈骨折效果显著，能够有效减少术中出血量，降低并发症发生率，促进患者早日康复。

Objective To explore the clinical effect of multiple-level spinal fracture treated by internal ifxation of the injured vertebra.Methods106 cases of patients with multiple-level spinal fracture were selected in our hospital from the February 2013 to October 2015, to divided into the treatment group and control group, each 53 cases. The control group was given the cross wound cone internal fixation for treatment, the treatment group was treated by internal ifxation of the injured vertebra. To compared the recover condition of fracture site and rehabilitation efficacy after operation of them.Results After treatment, the observation group after treatment and after 6 months Cobb angle, vertebral height compared to the leading edge of the leading edge of the normal vertebral height ratio of the control group, the difference was signiifcant (P<0.01).Conclusion That able to effective improving the clinical effect of multiple-level spinal fracture treated by internal ifxation of the injured vertebra, and the restoration effect is satisfaction after operation.

Objective: To investigate the levels of neuropeptide S in the brain of asthmatic mice with anxiety and the effects of inflammatory mediatores on changes of neuropeptide S in in vitro experiments. Methods: According to the random number table method, 40 BALB/C mice were randomly divided into 4 groups: the control group, the asthma group, the anxiety group and the asthma and anxiety group. The relative expressions of neuropeptide S mRNA in the brain tissue of each group were detected by quantitative real-time polymerase chain reaction(QRT-PCR). Rat cortex neurons obtained by primary culture were divided into 4 groups: the PBS control group, the interleukin-1 beta group, the interleukin-6 group and the tumor necrosis factor-alpha group. After stimulation with inflammatory cytokines the mRNA expressions of neuropeptide S were measured by QRT-PCR and neuropeptide S levels in the cell culture supernatants were measured by emzyme linked immunosorbent assay(ELISA). Results: The relative expressions of neuropeptide S mRNA were decreased in the anxiety group(0.87±0.05) and the asthma and anxiety group(0.79±0.03)compared with the control group(1.00±0.05)and the asthma group(0.96±0.06), most notably in the asthma and anxiety group (all P<0.05). Compared to the PBS control group[(1.00±0.06), (50.6±1. 8)ng/L] and the interleukin-1 beta group[(0.94±0.08), (49.5±1.0)ng/L], the levels of neuropeptide S mRNA and neuropeptide S were decreased in the interleukin-6 group[(0.88±0.07), (45.4±1.2)ng/L] and the tumor necrosis factor-alpha group[(0.86±0.07), (46.0±1.0)ng/L](all P<0.05). There were no significant differences between the interleukin-1 beta group and the PBS control group(all P>0.05). Conclusions: Up-regulated interleukin-6 and tumor necrosis factor-alpha in asthma can inhibit the secretion of neuropeptide S in neuronal cells. The decline of brain neuropeptide S, which has anti-anxiety effect, may lead to the occurrence of anxiety, which may be a potential mechanism of comorbidity of asthma and anxiety.

<正>临床上因挤压、碾挫、撕脱等原因造成的足踝部皮肤、软组织缺损并不少见,足踝部骨折后局部软组织肿胀,切开复位时若掌握不好时机,加上术中对局部的皮肤软组织