目的 评价99m锝甲氧基异丁基异腈(99 Tcm-MIBI)静息心肌灌注显像对冠状动脉性心脏病(CAD)的诊断价值.方法 选择2020-01-01-2021-06-01郑州大学第二附属医院就诊的76例疑诊和诊断为CAD的患者作为研究对象,均行99 Tcm-MIBI静息心肌灌注显像(MPI)和冠状动脉造影(CAG),以CAG作为CAD诊断的"金标准",99 Tcm-MIBI静息MPI与之比较.结果 通过分析MPI图中各节段心肌对显像剂的摄取量,可明确病变血管的位置.67例CAG阳性者(单支血管病变者13例,双支血管病变者17例,三支血管病变者37例)中,99 Tcm-MIBI静息MPI异常者64例,正常3例;9例CAG阴性者中,99 Tcm-MIBI静息MPI异常者4例,正常者5例;99 Tcm-MIBI静息MPI对CAD诊断的灵敏度为95.5％,特异度为55.6％,阳性预测值为94.1％,阴性预测值为62.5％;99 Tcm-MIBI静息MPI的准确性为90.8％,Kappa值为0.54.结论 99 Tcm-MIBI静息MPI作为一种简便、安全、无创、经济的检查方法,可反映心肌血流灌注的情况,其对CAD诊断的灵敏度、准确性高,可作为可疑CAD患者CAG检查前的初筛.

目的 探讨多巴酚丁胺负荷99 Tcm-甲氧基异丁基异腈(MIBI)门控心肌灌注显像(G-MPI)诊断经皮冠脉介入术(PCI)后冠状动脉支架内再狭窄(ISR)的价值.方法 选取2019年6月至2020年12月在郑州大学第二附属医院就诊的PCI术后3个月以上、伴有典型心绞痛症状、临床怀疑冠状动脉ISR的73例患者,进行回顾性分析.所有患者均于1个月内行多巴酚丁胺负荷99 Tcm-MIBI G-MPI和冠状动脉造影(CAG)检查,以CAG作为金标准评价多巴酚丁胺负荷99 Tcm-MIBI G-MPI诊断PCI术后冠状动脉ISR的价值.结果 73例患者中共计94支冠状动脉植入支架,其中22例患者的25枚(26.6％)支架经CAG检查出现了ISR.22例中单支冠状动脉局部病变10例(45.5％),单支弥漫病变及多支病变12例(54.5％).多巴酚丁胺负荷99 Tcm-MIBI G-MPI诊断94支冠状动脉PCI术后发生ISR的准确性、灵敏度、特异性、阳性预测值、阴性预测值分别为91.5％(86/94)、88.0％(22/25)、92.8％(64/69)、81.5％(22/27)和95.5％(64/67).诊断单支局部病变组与单支弥漫病变及多支病变组PCI术后ISR的灵敏度、特异性、阳性预测值和阴性预测值差异无统计学意义(P>0.05).诊断植入直径≥3.50、3.00、≤2.75 mm支架组PCI术后ISR的灵敏度、特异性、阳性预测值和阴性预测值差异无统计学意义(P>0.05).诊断糖化血红蛋白≥6.5％组与<6.5％组PCI术后ISR的灵敏度、特异性、阳性预测值差异无统计学意义(P>0.05),但阴性预测值差异有统计学意义(P<0.05).结论 多巴酚丁胺负荷99 Tcm-MIBI G-MPI在冠心病患者PCI术后发生ISR中具有重要的诊断价值,尤其对高血糖或血糖控制不佳的患者是否发生ISR有较高的阴性预测值,可作为CAG检查前的初筛,是一种经济、有效、无创的诊断方法.

Objective:To explore the value of combined detection of carcinoembryonic antigen (CEA) and tumor-associated macrophage (TAM) in prognosis assessment of rectal cancer.Methods:The clinical data of 128 patients with stage Ⅱ-Ⅲ rectal cancer who underwent radical resection of rectal cancer in our hospital from January 2014 to June 2015 were analyzed and the prognosis of the patients was followed up. According to preoperative CEA and TAM indexes, the patients were randomly divided into four groups, namely CEA(+ )/TAM(+ ) group, CEA(+ )/TAM(-) group, CEA(-)/TAM(-) group, and CEA(-)/TAM(-) group. The clinical and pathological data of the four groups were compared by C2 test, the survival of the patients was analyzed by Kaplan-Meier method, and the factors that might affect the prognosis of the patients were analyzed by COX risk regression model.Results:There were no statistically significant differences in age or gender between the four groups (age χ2=1.855, P>0.05; Gender χ2=1.419, P>0.05, all P<0.05); The tumor differentiation degree and TNM stage of the 4 groups were compared, and the difference was statistically significant (tumor differentiation degree χ2=20.919, P<0.01; TNM stage χ2=15.844, P<0.01, all P>0.05); The differences in tumor differentiation degree, TNM stage and overall survival (OS) were statistically significant ( P<0.05). The comparison of OS stage among the four groups showed that THE CEA(+ )/TAM(+ ) group had the shortest OS {45.9 months [95% confidence interval ( CI) 41.5-50.3]}, and the CEA(-)/TAM(-) group had the longest OS [58.9 months (95% CI 55.2-62.6)], with statistically significant differences ( χ2=21.307, P<0.01). Univariate analysis results suggested that the prognosis of rectal cancer patients was related to CEA, TAM, tumor differentiation degree and TNM stage. Multivariate analysis suggested that CEA, TAM, degree of tumor differentiation and TNM stage were independent risk factors for the prognosis of rectal cancer patients. Conclusion:The prognosis of rectal cancer is related to CEA, TAM, tumor differentiation degree and TNM stage. Preoperative serum CEA, TAM and TNM stage may be independent risk factors for rectal cancer, and combined detection of preoperative CEA and TAM levels may be of prognostic value in patients with rectal cancer.

目的 探讨PET-CT在难治性癫痫手术致痫灶定位应用中的准确性.方法 回顾性分析80例2016-03—2018-05在郑州大学第二附属医院治疗的难治性癫痫患者,所有患者均已明确口服抗癫痫药物效果较差,经磁共振检查均为阴性,经24 h视频脑电监测结果 回示有明显异常,根据是否行PET-CT检查分组,其中40例行PET-CT检查的患者设定为观察组,使用神经外科导航融合PET-CT影像学数据行术前定位癫痫灶;未行PET-CT检查的40例患者设定为对照组.2组患者术中均使用皮层脑电图监测定位致痫灶,并通过手术切除癫痫灶,观察术后癫痫症状的缓解情况.结果 观察组治疗效果明显优于对照组(P<0.05);且观察组术后癫痫缓解情况、术中损伤明显优于对照组(P<0.05).结论 PET-CT联合神经外科导航可优化难治性癫痫手术的过程,在整个治疗过程起到关键作用.

Objective:To investigate whether the severity of white matter hyperintensities is related to bilirubin level.Methods:A total of 484 healthy subjects were included, and those with acute cardio-cerebral vascular disease, liver disease, bilirubin abnormality and other diseases causing high white matter hyperintensities were excluded. A cross-sectional study analyzing the correlation between the severity of white matter hyperintensities and bilirubin was conducted. The severity of white matter hyperintensities was measured by the Fazekas visual score.Results:The average age of patients in the mild group and severe group was 63.66±12.21 and 78.37±10.36 years old respectively. Comparison between the two groups [ t=1.748, P<0.01, odds ratio ( OR)=1.100 95% confidence interval ( CI): 1.076-1.125]. There were 183 patients (56.83%) with hypertension in the mild group and 130 patients (80.25%) with hypertension in the severe group ( P<0.05, OR=1.907, 95% CI: 1.119-3.249). Hypertension was an independent risk factor for white matter hyperintensities in the brain. Low bilirubin level was a risk factor for high signal in the white matter. After adjusting for the influence of other related factors, the lowest quartile bilirubin level Q1 was used as a reference, there were 88 cases (56.45%) in the mild group and 34 cases (43.55%) in the severe group; 86 cases (70.97%) in the Q2 mild group and 34 cases (29.03%) in the Q2 severe group ( P<0.01, OR=0.418, 95% CI: 0.220-0.792); 81 cases (71.77%) in the Q3 mild group and 40 cases (28.23%) in the Q3 severe group ( P<0.05, OR=0.504, 95% CI: 0.265-0.957). There was statistically significant. Conclusion:Low bilirubin levels may be risk factors of white matter hyperintensities.

目的:探讨血清肿瘤相关物质(TAM)联合TPSA、FPSA/TPSA对前列腺癌的诊断价值.方法:研究对象分为3组,前列腺癌组50例、良性前列腺增生组(BPH组)58例、正常对照组67例.采集空腹静脉血,测定血清中TAM、TPSA、FPSA的含量并计算FPSA/TPSA的比值.结果:前列腺癌组TPSA、FPSA、TAM均高于BPH组及正常对照组,FPSA/TPSA则低于BPH组及正常对照组;BPH组TPSA、FPSA均高于正常对照组(P<0.05).以血清TPSA>4.0μg/L,FPSA/TPSA<0.16,TAM>95 U/mL为临界值时,TPSA、FPSA/TPSA、TAM、TAM+TPSA、TAM+FPSA/TPSA诊断前列腺癌的灵敏度和特异度分别为(92.0％、69.6％),(80.0％、80.8％),(84.0％、82.4％),(96.0％、88.0％),(94.0％、86.4％),且血清TAM联合TPSA诊断前列腺癌的灵敏度和特异度更高.结论:血清TAM联合TPSA可提高对前列腺癌的诊断效能.

Aim:To investigate the association between MTHFR gene polymorphism and plasma homocysteine( Hcy) levels in patients with vascular dementia( VaD) .Methods: A total of 73 patients with VaD and 75 patients with nonde-mented cerebral infarction were recruited in the study.PCR-RFLP was used to analyze the polymorphism of MTHFR gene. The folic acid and vitamin B12 levels were measured using immunoassay method.And circulating enzymatic method was empolyed to test the Hcy concentration in plasma.The degree of dementia was classified according to the MMSE for patients with VaD.Results:The genotype TT and T allele frequency of MTHFR gene in VaD group were significantly higher than that in nondementia cerebral infarction group(P<0.05).The concentration of plasma Hcy was higher in patients with TT and CT type than those with CC genotype(P<0.001).Mean total plasma Hcy concentration was significantly higher in VaD patients than that in the patients with nondemented cerebral infarction(P<0.001), but the levels of folate and vita-min B12 were significantly lower in VaD patients than in the patients with nondemented cerebral infarction(P<0.05).The degree of dementia was positively related with plasma Hcy level(r=0.227,P=0.018).Conclusion:Genetic mutations of MTHFR C677T and the hyperhomocysteinemia may closely related to the occurrence of VaD.

目的 为了观察盐酸美金刚对治疗血管性痴呆(VaD)的疗效及其安全性.方法 选取来自干部病房或门诊的轻中度VaD患者共62例,随机分成治疗组和对照组,治疗组32例,对照组30例,两组患者在年龄、性别、文化程度、病程、痴呆程度等方面比较差异无统计学意义(P＞0.05),具有可比性.治疗组给予盐酸美金刚,起始剂量是5 mg/d,前3周以每周5 mg递增,从第4周起,使用剂量维持在20 mg/d,口服,共24周;对照组给予吡拉西坦0.8g,3次/d口服,共24周.治疗前和治疗24后周均给予简易智能痴呆量MMSE、ADL行为量表进行评分,比较得分的情况.结果 两组治疗前后MMSE、ADL评分分别进行比较,均有明显的改善;两组治疗24周后MMSE、ADL评分比较差异有统计学意义.治疗组有2例(占6.25％)、对照组有2例(占6.67％)出现轻度的不良反应,均为一过性反应.结论 盐酸美金刚对老年轻中度VaD患者的认知功能、日常行为能力有明显改善作用,安全性好且其疗效优于吡拉西坦.

目的：研究血浆同型半胱氨酸（Hcy）浓度及其代谢酶N5，N10-亚甲基四氢叶酸还原酶（MTHFR）基因多态性与缺血性脑卒中（IS）的关联。方法分别测定85例IS患者和82例对照者血浆Hcy浓度、叶酸、维生素B12水平及MTHFR基因多态性。结果IS组血浆Hcy浓度显著高于对照组高Hcy血症所占比例高于对照组，差异有统计学意义（P＜0.05）；IS组叶酸、维生素B12水平显著低于对照组；2组Hcy浓度与叶酸、维生素B12水平均呈负相关；MTHFR基因TT纯合子组血浆Hcy水平显著高于CT杂合子组及CC纯合子组；CT杂合子组和CC纯合子组间血浆Hcy浓度亦有显著性差异；MTHFR基因TT纯合子在IS的分布频率显著高于对照组；IS组MTHFR基因T、C等位基因频率分别为57.65％、42.35％，对照组为38.41％、61.59％，2组比较有显著性差异。结论血浆Hcy浓度增高是IS的危险因素之一；Hcy浓度与叶酸、维生素B12水平呈负相关，叶酸、维生素B12缺乏可能是导致血浆Hcy增高的重要原因；MTHFR基因突变很可能是血浆Hcy升高的主要影响因素；MTHFR基因C677T突变可能与IS的易感性密切相关。