目的 通过生物信息学方法筛选多发性骨髓瘤(multiple myeloma,MM)潜在的关键基因,并分析其免疫浸润模式.方法 从基因表达综合数据库(gene expression omnibus,GEO)获取与多发性骨髓瘤相关的基因表达谱GSE118985,(GSE133346和GSE146649),采用生物信息学方法筛选与多发性骨髓瘤相关的差异表达基因(DEGs)并进行基因本体(GO)功能注释和京都基因与基因组百科全书(KEGG)富集分析、免疫细胞浸润分析.通过蛋白质-蛋白质相互作用网络筛选出多发性骨髓瘤潜在的关键基因,利用数据GSE7116 验证关键基因在多发性骨髓瘤中的诊断价值并绘制受试者工作特征(receiver operator characteristic,ROC)曲线.结果 共筛选出101个DEGs.GO功能注释和KEGG富集分析显示,DEGs主要富集在免疫反应过程中,细胞因子受体相互作用、细胞外基质受体相互作用、粘着斑和Hedgehog信号通路等,单核细胞是多发性骨髓瘤最主要的免疫浸润细胞.最终筛选出5 个关键基因,分别为SDC1,IRF4,CD38,TNFRSF17和CCND1,核心基因对验证模型联合诊断的AUC为 0.933.结论 SDC1,IRF4,CD38,TNFRSF17 和CCND1 在多发性骨髓瘤中均上调,联合诊断的效能较高,可能是多发性骨髓瘤潜在的生物标志物,可为以后治疗提供新的思路.

目的 探讨乌鲁木齐地区居民二胎生育意愿及二胎生育人群的孕前危险因素.方法 2016年1月-2017年6月,对乌鲁木齐新市区、水磨沟区、天山区、沙依巴克区1 547名女性进行问卷调查,使用单因素x2检验和Logistic多因素回归分析.结果 75.7％的女性有意愿生育二胎,年龄、抚养模式、婚后幸福程度、国家政策是二胎生育意愿的影响因素(P＜0.05).在1 547名女性中,418名生育二胎并对其妊娠结局进行随访.单因素x2检验显示,年龄、患病史、妇科疾病、孕期服药、吸烟补充叶酸、一胎生育方式可能是二胎人群的危险因素(P＜0.05);Logistic回归分析表明,患病史、妇科疾病、是否服药、是否吸烟、一胎生育方式是不良妊娠结局的危险因素.结论 乌鲁木齐地区居民二胎生育意愿强烈,应加强二胎生育人群的孕前保健工作,降低不良妊娠结局发生率.

目的 本文采用基于问题的学习(PBL)方法在留学生临床实验诊断教学的应用效果.方法 以新疆医科大学国际教育学院2015级四年制临床专业82名留学生为研究对象,将其分成实验组和对照组各41人,实验组采用PBL教学模式,对照组采用传统教学模式,课程结束后通过试卷考核和问卷调查评价教学效果.结果 实验组留学生的学习兴趣、团队协作能力、实验操作技能、对教学模式的喜爱度5个方面均高于对照组,差异具有统计学意义(P＜0.05);实验组测试成绩明显高于对照组,差异具有统计学意义(P＜0.05).结论 PBL教学模式能激发留学生学习兴趣、启发实验思维、增强自主学习能力,学生更容易接受,这种教学模式更值得推荐,为留学生教学添彩.

目的 用非创伤性指标建立慢性乙型肝炎(CHB)患者肝纤维化诊断模型,并评价建立的模型的诊断价值.方法 检测270例行肝脏组织病理学检查的CHB患者的肝纤维化血清学标志物[血小板(PLT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TB)、白蛋白(Alb)、白蛋白/球蛋白(A/G)比值、红细胞分布宽度(RDW)、凝血酶原活动度(PTA)、纤维蛋白原(Fib)、乙型肝炎病毒e抗原(HBeAg)]水平.分析这些检测指标与CHB患者肝纤维化的相关性.采用Logistic回归分析建立诊断模型,采用受试者工作特征(ROC)曲线分析其诊断价值,并与已建立的诊断模型(APRI、FIB-4、AAR、GPR、RPR)进行比较.结果 通过Logistic回归分析逐一分析各项指标,得出回归方程建立新的诊断模型AFPPR:AFPPR=1/[1+EXP(-2.584-A/G比值×1.426-PLT×0.013-PTA×0.016-Fib×0.605+RDW×0.364)].ROC曲线分析显示,AFPPR诊断显著肝纤维化的曲线下面积(AUC)为0.80,明显大于其他5个诊断模型的AUC(P<0.01),AAR对于显著肝纤维化及严重肝纤维化基本无诊断价值(P>0.05);AFPPR诊断严重肝纤维化的AUC为0.76,与其他5个模型的AUC比较,除AAR模型(P=0.000)外,差异均无统计学意义(P>0.05).结论 建立的AFPPR诊断模型可用于诊断CHB患者的显著肝纤维化,可作为临床动态监测肝纤维化的补充性证据.

Objective To explore the effect of apatinib on the level of Th1/Th2 in patients with advanced lung cancer and its therapeutic effect. Methods 70 patients with advanced lung cancer treated in our hospital were divided into two groups, the control group and the study group, the control group (n=35) were treated with teggio, and the patients in the study group (n=35) were treated with apatinib. The changes in the level of Th1/ Th2 cytokine and the serum tumor markers in the two groups of patients. Chronicles, therapeutic effects and progres-sion free survival were compared. Results The level of IFN- gamma, TNF- alpha, IL-4 and IL-10 after treatment in the study group was significantly improved (P<0.05). The level of IFN- gamma and TNF- alpha in the control group was not significantly changed after treat-ment (P>0.05) and the level of IL-4 and IL-10 was significantly improved (P<0.05), and the serum tumor marker C in the study group after treatment (P<0.05). The level of EA, CAl99, CAl25 and SCC was significantly lower than that of the control group (P<0.05). The effective rate was 68.6% in the control group. The effective rate was 94.3% in the study group, and the clinical effect of the study group was obvi-ously superior. In the control group (P<0.05), the progression free survival in the control group was 3.5 months, while the study group was 5.1 months. The study group was significantly longer than the control group (P<0.05). Conclusion Atapatinib can reduce the level of serum tumor markers and Th1/Th2 cytokines in patients with advanced lung cancer, and prolong the life free period of the patients, which is worthy of further clinical use.

目的 探讨血清肝纤维化标志物透明质酸(HA)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)对慢性乙型肝炎(CHB)肝纤维化的诊断价值.方法 选择119例行肝组织病理学检查的CHB患者,检测其肝纤维化血清学标志物,比较不同肝组织炎症活动度分级和纤维化程度分期患者的4项血清肝纤维化标志物水平,根据受试者工作特征曲线(ROC)探讨联合检测对CHB肝纤维化的诊断价值.结果 随着肝脏炎症和纤维化程度不断加重,HA、CⅣ、PⅢP均不断升高(均P<0.05),而LN在不同分期肝脏炎症和纤维化患者中无显著差异(均P>0.05).Spearman相关性分析显示,HA、CⅣ、PⅢP与肝脏炎症活动度和肝纤维化程度呈正相关(炎症r值为0.568、0.461、0.490,纤维化r值为0.609、0.475、0.403,均P<0.01).多因素非条件Logistic回归分析显示,随着HA、CⅣ、PⅢP的升高,肝脏炎症、纤维化的风险也升高〔炎症优势比(OR)的95%可信区间(95%CI)为1.038(1.012~1.065)、1.038(1.010~1.066)、1.025(1.004~1.047),纤维化OR(95%CI)为1.065(1.030~1.100)、1.035(1.006~1.065)、1.022(1.000~1.045)〕.ROC曲线下面积(AUC)分析显示,HA+CⅣ+PⅢP联合检测的AUC大于各单项检测的AUC(0.877比0.820、0.734、0.744,均P<0.01),联合检测的敏感度为70.2%,特异度为90.3%.结论 联合检测HA、CⅣ、PⅢP对诊断CHB纤维化的敏感度、特异度均较单项指标高,有助于诊断CHB患者肝纤维化,且联合检测的特异度好于灵敏度,可适当用于肝纤维化的筛查,但用于临床诊断还存在局限性.

Objective:To investigatethe early diagnostic value of interleukin-6 (IL-6) for sepsis in neonates. Methods:A comprehensive electronic search was performed to retrieve relevant studies on IL-6 in diagnosis of sepsis in Neonates. The data bases included Cochrane Library, PubMed, EMBASE, VIP database, Medline, Web of knowledge, Chinese BioMedicine Database, CNKI and Wanfang Database. The time range was from the initiation of the database to August 2016, and QUADAS items were used to evaluate the quality of the included studies. The pooled specificity, pooled sensitivity, negative likelihood ratio, positive likelihood ratio and summary receiver operating characteristic curve (SROC) were analyzed by the Meta-Disk 1.4 software. Finally, the sensitivity analysis and analysis for heterogeneity cause were performed.Results: Fourteen studies screened from 542 related articles were included in the review. The meta-analysis of DerSimonia-Laird showed that the pooled sensitivity was 0.72 [95% CI (0.69,0.74) ] and the pooled specificity was 0.85 [95% CI (0.83,0.87) ]. The positive likelihood ratio and negative likelihood ratio were 5.98 [95% CI (3.79,9.43) ] and 0.23 [95% CI (0.15,0.37) ], respectively. The diagnostic odds ratio was 29.23 [95% CI (14.79,57.77) ], overall area under the curve (AUC) of SROC curve was 0.9199 (Q*=0.8532). Conclusions: In the early sepsis, IL-6 has higher sensitivity and specificity for diagnosis of sepsis in neonates. IL-6 increases the probability for diagnosis of sepsis, but it needs to combine with clinical manifestations and other related laboratory tests for the diagnosis.

Objective To conduct a systematic review to identify the diagnostic value of procalcitonin( pCT)for detecting serious bacterial infections in children having different thermal process with fever without source ( FWS ). Methods A comprehensive electronic search was performed to retrieve relevant studies on pCT in diagnosis of serious bacterial infections in children with FWS. From the initiation of the database from establishment to July 2014,QUADAS items were used to evaluate the quality of included studies. pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,summary receiver operating characteristic curve( SROC),and the heterogeneity of included studies with different thermal process were analyzed by using Meta-Disk software. Finally,the sensitivity and analysis for heterogeneity cause were performed and Stata 12. 0 software was used to assess the publication bias with funnel plot. Results Eleven studies were included for the review,including 10 English studies and 1 Chinese study. The pooled sensitivity and specificity of pCT test for thermal process under 24 h were 0. 75(95%CI:0. 69-0. 80)and 0. 80(95%CI:0. 77-0. 83),SROC area under the curve(AUC)was 0. 870(95%CI:0. 817-0. 923);the pooled sensitivity and specificity of WBC were 0. 48(95%CI:0. 41-0. 55)and 0. 54(95%CI:0. 51-0. 58),AUC was 0. 484 (95%CI:0. 440 -0. 663);sensitivity and specificity of ANC were 0. 30(95%CI:0. 21 -0. 40)and 0. 78(95%CI:0. 73 -0. 83),respectively. The pooled sensitivity and specificity of pCT test for thermal process between 24 and 48 h were 0. 86 (95%CI:0. 79-0. 91)and 0. 63(95%CI:0. 60-0. 67),AUC was 0. 857(95%CI:0. 761-0. 953);the pooled sensitivity and specificity of WBC were 0. 54(95%CI:0. 44-0. 65)and 0. 46(95%CI:0. 41-0. 51),AUC 0. 558(95%CI:0. 479-0. 636);sensitivity and specificity of ANC were 0. 47(95%CI:0. 28-0. 66)and 0. 12(95%CI:0. 08-0. 17),respectively. The pooled sensitivity and specificity of pCT test for thermal process over 48 h were 0. 83(95%CI:0. 75-0. 90)and 0. 55(95%CI:0. 50-0. 59),AUC was 0. 816(95%CI:0. 596-0. 996). The sensitivity of WBC in 2 studies were 0. 69(95%CI:0. 41-0. 89)and 0. 34( 95%CI:0. 28 -0. 41 ),respectively;the specificity of WBC in 2 studies was 0. 81( 95%CI:0. 69 -0. 91 ) and 0. 29 (95%CI:0. 24 -0. 35),respectively;sensitivity and specificity of ANC were 0. 87(95%CI:0. 75 -0. 95),0. 40(95%CI:0. 34-0. 46). Conclusion When children having different thermal process with FWS,pCT provides a good specificity in the thermal process under 24 h,and provides a good sensitivity in the thermal process between 24 and 48 h. Since the heterogeneity among studies,it should be applied in combination with clinical features and other tests.