EB病毒(EBV)隶属于γ-亚科疱疹病毒,是引起儿童传染性单核细胞增多症(IM)的主要病原体.IM是一种自限性疾病,发热、咽炎、淋巴结肿大是其典型临床三联征,治疗主要为控制并发症.EBV感染几乎可影响全身系统和器官,可伴有多种不同的疾病表现,常见有肺炎、肝炎、关节炎等,出现急性肾功能异常较少见.

Objective:To investigate the distribution and drug resistance of pathogenic bacteria on wound infections in burn patients, and provide reference for clinical application of antibiotics.Methods:The distribution and drug resistance of the bacteria isolated from the primary wound culture of patients in the Burn Department of Shaoxing Second Hospital from 2015 to 2020 were statistically analyzed.Results:A total of 2 437 strains of bacteria were detected, including 1 570 (64.42%) strains of gram-positive bacteria, mainly including 709 S. aureus, 434 S. epidermis, 174 S. haemolyticus and 112 Enterococcus. A total of 867(35.58%) strains of gram-negative bacteria were detected, mainly including 131 K. pneumoniae, 111 E. coli, 153 E. cloacae, 156 P. aeruginosa and 101 A.baumannii. The proportion of gram-negative bacteria increased significantly during 6 years ( χ2trend=78.74, P<0.001). The main gram-positive bacteria( S. aureus, S. epidermidis and S. haemolyticus) were all sensitive to tigecycline, teicoranin and vancomycin, and were highly resistant to methicillin(30.75%, 77.19% and 90.23%) and penicillin(96.90%, 97.93% and 95.98%). The resistance rates of five major gram-negative bacteria( K. pneumoniae, E. coli, E. cloacae, P. aeruginosa and A. baumannii) to meropenem, imipenem, amikacin, cefepime, ceftazidime, tobramycin, ciprofloxacin and levofloxacin were lower than 30%. The drug resistance rates of S. aureus to azithromycin, compound minophen, erythromycin, ciprofloxacin, clindamycin, moxifloxacin, gentamicin and levofloxacin showed significant downward trend during 2015 and 2020 ( χ2trend=4.75, 15.97, 5.70, 12.77, 7.16, 8.60, 11.27 and 10.71, P=0.029, <0.001, 0.016, <0.001, 0.007, 0.003, 0.001 and 0.001). Conclusions:S. aureus is the common pathogenic bacteria isolated from the wound surface of the burn patients in this hospital. The drug resistance of gram-negative bacteria is relatively low.

1 病历摘要 患儿男,17月龄,因"腹泻、呕吐4天"于2020年4月来院就诊.4天前患者无明显诱因下出现腹泻、呕吐,后大便2～3次/d,稀便,呈墨绿色,伴阵发性腹痛,以脐周为著,伴呕吐,4～5次/d,为胃内容物,无发热、抽搐、咳嗽、气促.门诊超声:小肠套叠肠间少量积液,胆囊偏大,胆囊、胆总管沉积物,胆道轻度扩张.门诊医生以急性胰腺炎、胆总管扩张症、肝功能不全收入院.入院查体:T 37.4℃,P 124次/min,R 28次/min.神志清,精神可,无发绀,皮肤无皮疹、破溃.腹软,脐周有轻压痛,肝脾肋下未及,未触及包块和肠型,肠鸣音无亢进.实验室检查:WBC14.7×109/L↑,ALT 461U/L↑, AST 262U/L↑,淀粉酶(AMY)594U/L↑.入院后予头孢哌酮钠舒巴坦钠抗感染、复方甘草酸苷注射液护肝.治疗数日后再次查血生化:ALT 304U/L↑,AST 258U/L↑, AMY 144U/L↑,总胆红素(TBIL)45μmol/L↑.腹部超声:考虑环状胰腺致局部梗阻,胆囊沉积物,胆道轻度扩张,胆总管下段沉积物.治疗12天患者未见明显好转,转上级医院继续治疗.

目的 探讨miR-1233在结直肠癌(colorectal cancer,CRC)诊断中的临床应用价值.方法 收集经手术后病理诊断为结直肠癌患者85例,同时选择53例结直肠腺瘤(colorectal adenoma,CA)患者为对照组,采用实时荧光定量PCR技术,检测结直肠癌患者、对照组miR-1233水平,采用电化学发光技术检测2组肿瘤标志物水平.结果 miR-1233在结直肠癌患者中表达升高,差异有统计学意义(P＜0.05);血清miR-1233诊断结直肠癌患者的曲线下面积(AUC)及95％CI为0.836(0.75～0.91),且诊断结直肠癌具有较高的阳性预测值(82.1％);血清miR-1233与CA724水平呈正相关(r=0.300,P=0.004),与CA19-9水平呈正相关(r=0.315,P = 0.003),与CEA 水平呈正相关(r =0.434,P =0.001),进行单因素及多元Logistic回归分析,发现miR-1233是结直肠癌发生的独立危险因素,其OR及95％CI为1.923(1.21～2.93).结论 miR-1233升高与结直肠癌关系密切,在诊断和预测结直肠癌发生及疗效观察中具有潜在的临床意义.