目的 探讨阴道微生态改变与宫颈高危型人乳头状瘤病毒(HR-HPV)感染的相关性.方法 选择2017年1月-2018年12月在本院妇科就诊妇女1 543例进行阴道微生态检测、常规行薄层液基细胞学(TCT)检查、PCR-反向点杂交法检测HPV 23种亚型;TCT阴性且HR-HPV感染人群设为HR-HPV组,TCT和HPV检测结果均阴性人群设为HPV阴性组,比较2组阴道微生态检查结果.结果 1 543例受检者TCT阳性152例,1 391例TCT阴性受检者141例感染HR-HPV.细菌性阴道病(BV)、外阴阴道假丝病(VVC)、需氧菌性阴道炎(AV)、pH值＞4.5、阴道清洁度异常及乳酸杆菌减少组HR-HPV感染率均明显高于对应阴性组(P＜0.01);HR-HPV组BV、VVC、AV、pH值＞4.5、阴道清洁度异常及乳杆菌减少检出率均明显高于HPV阴性组(P＜0.01).结论 BV、VVC、AV、pH值＞4.5、阴道清洁度异常及乳酸杆菌减少等阴道微生态变化与HR-HPV感染之间存在相关性.

Objective To investigate the relationships of serum 25-hydroxyvitamin D levels with bone metabolism markers in the second and third trimester of pregnancy women.Methods A total of 1090 pregnant women(13-40 weeks gestational age) and 120 healthy nulliparous were enrolled.The levels of serum 25 (OH)D,N-MID,β-CTX were determined by electrochemical luminescence.Results The average serum 25 (OH)D level was (11.23 ± 5.82)ng/ml in the second and third trimester of pregnancy.There 917 cases (84.13％) with 25(OH)D deficiency,152 cases (13.94％) with insufficiency and 21 cases (1.93％) with sufficiency.The serum 25(OH)D level in winter and spring was lower than that in summer and autumn (9.97 ± 5.28 ng/ml vs.12.24 ± 5.77 ng/ml,P＜0.05).There were significant differences in serum 25 (OH)D,N-MID and β-CTX levels among pregnant women in different age groups (P＜0.05).The level of Vitamin D was not correlated with N-MID(r=-0.017,P ＞0.05),negatively correlated with β-CTX (r=-0.090,P＜0.05);and N-MID was positively correlated with β-CTX (r=0.586,P＜0.05).Conclusion Vitamin D deficiency is common during the second and third trimester of pregnant women,particularly in winter and spring seasons.The serum 25(OH)D and N-MID,β-CTX levels are different in pregnant women of different ages.The level of serum 25 (OH)D shows no significant correlation with N-MID but negative correlation with β-CTX.

Objective To study the application of BNP,NT-proBNP and ST2 in diagnosis of heart failure (HF).Methods Ninety-seven HF patients admitted to our hospital served as a HF group and 61 HF-free patients served as a control group.The patients in HF group were further divided in to class Ⅱ group (n=32),class Ⅲ group (n=36) and class Ⅳ group (n=29) according to their cardiac function in NYHA classification.The serum ST2,BNP and NT-proBNP levels were measured and their value in diagnosis of HF was analyzed.Results The serum BNP,NT-proBNP and ST2 levels were significantly higher in HF group than in control group (396.0 ng/L vs 39.4 ng/L,P＜0.01;1825.0 ng/L vs 215.0 ng/L,P＜0.01;56.8 μg/L vs 25.4 μg/L,P＜0.01),which increased with the increasing cardiac function in NYHA classification (P＜0.01).The area under the ROC curve for BNP,NT-proBNP,ST2,combined NT-proBNP and ST2 was 0.874,0.891,0.842,0.905 respectively for the diagnosis of HF.Conclusion BNP,NT-proBNP and ST2,3 new biomarkers,can improve the diagnosis of HF.

Objective To investigate the relationship between atherogenic index of the plasma (AIP) and gestational diabetes mellitus (GDM).Methods Clinical data of 764 women with 24-28 week gestation receiving prenatal cares in Jiaxing Maternal and Child Health Hospital from July to October of 2014 were retrospectively analyzed.Among 764 cases there were 133 cases of gestational diabetes(GDM group) and 631 healthy pregnant women(control group).Receiver operating curve (ROC) was used to evaluate the CHO,TG,HDL-C,LDL-C,CHO/HDL ratio,TG/HDL-C ratio,LDL/HDL ratio and AIP in distinguishing the two groups.The correlation between TG and HDL-C was analyzed by Spearman correlation analysis.Results The area under the curve (AUC) of AIP in diagnosis of GDM was 0.79 (P＜0.0001).Taking AIP 0.0985 as cut-off value,the sensitivity,specificity and negative predictive value of AIP in diagnosis of GDM were 78.9％,64.2％ and 94.1％,respectively.TG was negatively correlated with HDL-C in study group (r=-0.175,P=0.042),but there no correlation in control group (r=0.008,P=0.851).Conclusion AIP may be used to predict low risk of GDM and as an indicator to reflect atherogenic changes of serum lipid profile in GDM patients.

目的 检测胰腺癌患者血清肝素酶(HPA)水平,探讨血清肝素酶检测在胰腺癌实验室诊断中的价值.方法 检测67例胰腺癌患者和100例健康体检者外周血清中HPA、CA19-9和CEA的水平,比较胰腺癌组术前和术后7d的变化及与对照组之间的差异.结果 胰腺癌组各肿瘤标志物测定值及阳性率明显高于正常对照组,术前测定值明显高于术后,差异均有统计学意义(P＜0.05).血清学指标HPA敏感度、特异度、准确性、阳性预测值和阴性预测值均高于已有指标CA19-9和CEA,标志物联合检测的敏感度和诊断准确性均比单项检测高.结论 血清HPA检测对胰腺癌诊断有重要意义,血清肿瘤标志物联合检测可以提高诊断价值.

目的 重组并原核表达人乙酰肝素酶(HPA),并对重组产物rHPA进行免疫原性鉴定,获得足够的乙酰肝素酶为其功能研究奠定基础.方法 利用包含HPA全长序列质粒为模板,扩增肝素酶eDNA片段,将其插入表达载体pET42a,转化到大肠杆菌BL21 DE3中,0.5 mmol/L的IPTG诱导表达.SDS-PAGE检测目的重组蛋白表达情况,Ni-NTA亲和层析法提纯rHPA,Western Blot和ELISA检测rHPA的免疫原性.结果 成功构建了人乙酰肝素酶原核表达系统,rHPA表达量为细菌总蛋白的23.4％,SDS-PAGE显示提纯后的rHPA为单一的蛋白条带.鼠抗人HPA能有效识别rHPA.结论 所构建的人乙酰肝素酶原核表达系统能高效表达rHPA,表达的产物有良好的免疫原性.

目的:分析新生儿脐带血与静脉血对其溶血病(HDN)检测结果有无差异.方法:对O型孕妇(丈夫菲0型)进行产前IgG溶血性抗体效价的测定,对效价≥1∶128的孕妇,在分娩时留取新生儿脐带血,同时采集出生后1～2天和3～4天、5～7天静脉血,进行新生儿溶血三项(直接抗人球蛋白试验、游离抗体试验和放散试验)检测并比较.结果:同一患儿脐带血与出生后1～2天采集静脉血检测结果无差异,与出生后3～4天、5～7天采集的静脉血检测结果差异有统计学意义.结论:脐带血和静脉血虽均可作为新生儿溶血病的检测,但脐带血阳性率高,而且取材方便,便于早诊断早治疗,可作为诊断HDN的首选标本.

Objective To investigate the relationship between the titer of IgG anti- A(B) in pregnant women with blood O and hemolytic disease of the newborn. Methods A total of 504 pregnant women with the O blood group whose husbands were the other blood groups were selected to determine the IgG anti- A( B) titers by microcolumn gel test. Red blood cells were taken from umbilical vein of the newborns to examine ABO blood groups and RhD blood group. The direct antiglobin test,free antibody test and antibody release test were also carried out on the umbilical vein blood samples from the newborns. Results In the serum of 504 pregnant women with O blood group,IgG anti- A(B) titers≤1∶ 64 was found in 265 cases,IgG anti- A(B) titer was 1∶ 128 in 116 cases,IgG anti- A(B) titer was 1∶ 256 in 53 cases,IgG anti- A(B) titer was 1∶ 512 in 41 cases and IgG anti- A(B) titer was 1∶ 1024 in 29 cases. Seventy- four cases were diagnosed as HDN positive among them. The ROC curve analysis showed the most appropriate cut- off value of IgG anti- A(B) titer was 1∶ 128,with the sensitivity of 93. 2% and specificity of 66. 1%,and the area under curve was 0. 872. Conclusion It is recommended that the cut- off value of IgG anti-A(B) titers for HDN was 1∶ 128 in microcolumn gel test,with higher predictive value in hemolytic diseases of the newborn.

目的探讨糖类抗原(CA)15-3、CA125和癌胚抗原(CEA)联合检测对乳腺癌的临床价值。方法采用化学发光免疫分析法检测93例乳腺癌患者、85例乳腺良性肿瘤患者及80名正常对照者血清CA15-3、CA125和CEA水平;将93例乳腺癌患者按临床分期标准分为Ⅰ～Ⅱ期50例、Ⅲ期26例、Ⅳ期17例。比较各组3项指标的检测结果并计算阳性率及联合检测的阳性率。结果正常对照组、乳腺良性肿瘤组及乳腺癌组CA15-3、CA125和CEA水平依次增高,差异均有统计学意义(P<0.05)。乳腺癌组CA15-3、CA125、CEA水平随着临床分期的增高而相应增高,差异均有统计学意义(P<0.05)。乳腺癌组CA15-3、CA125、CEA阳性率分别为46.2%、31.2%、17.0%,三者联合检测阳性率为76.3%,均高于乳腺良性肿瘤组和正常对照组(P<0.05)。结论CA15-3、CA125和CEA联合检测对乳腺癌具有良好的辅助诊断价值。

Objective To investigate the carbapenems resistant genotypes of pandrug-resistance of ICU wards isolates of Acinetobacter baumannii in order to provide a scientific basis for the rational use of antibiotics.Methods Totally 20 strains of pandrug-resistant Acinetobacter baumannii were collected and the minimum inhibition concentration was tested with E-test method.The carbapenems resistant genotypes of blaOXA-23,blaOXA-24,blaOXA-51,blaOXA-58,blaVIM,blaNDM-1 and blaIMP were performed by PCR method.Results The resistance rates of 20 strains of Acinetobacter baumannii to piperacillin,piperacillin-tazobactam,cefotaxime,ceftazidime,ceftriaxone,cefepime,cefoperazone-sulbactam,imipenam,meropenem,gentamycin and ciprofloxacin were all 100%,but to amikacin 55%,to minocycline 70%,to trimethoprim-sulfame thoxazole 80% and to polymyxin B 0.0%.PCR experiment showed that 14 strains with blaOXA-23 and 2 strains with blaVIM and one strain with blaIMP were positive.Conclusion The pandrug-resistant Acinetobacter baumannii was seized of higher drug-resistance rates.The main cause of carbapenems resistance of pandrug resistant Acinetobacter baumannii was producing β-lactams such as carbapenemase.The main genotypes were blaOXA-23 and blaVIM.More steps should be taken to control the spread of these resistance isolates.

<正>妊娠高血压综合征(PIH)是妇女一种以高血压、蛋白尿、水肿为特征的多脏器受损的妊娠期常见的高危妊娠并发症,其发生率约为10%,且是孕产妇和围生儿死亡的主要原因之一。PIH妇女常被认为处于一种慢性弥漫性血管内凝血(DIC)状态或血栓前状态,PIH时动态观察血小板参数和凝血指标,以期达到和减少DIC或血栓并发症的目的。本研究联合检测PIH患者孕晚期血小板(PLT)、血小

目的:初步探讨微量法红细胞沉降率应用于婴幼儿中测定的可行性。方法:以Vesmatict自动血沉仪法为参考方法,比较微量法与Vesmatic血沉仪法分别测定90名婴幼儿未梢血和静脉血红细胞沉降率(ESR)的结果。结果:两方法间的线性关系为y=0.22x+15.1,相关性具有统计学意义(r=0.78,P<0.001)。结论:微量法红细胞沉降率采用末梢血适合婴幼儿ESR的测定,测定结果与标准魏氏法具有可比性。

目的探讨急性冠脉综合征(ACS)患者血清P选择素及基质金属蛋白酶-9(MMP-9)水平及其临床意义。方法选取40例临床确诊的ACS患者,15例稳定心绞痛(SA)和15名健康对照者,采用酶联免疫吸附试验(ELISA)测定P选择素及MMP-9水平。结果ACS患者外周血清P选择素、MMP-9水平均高于SA组及对照组(P<0.01);ACS患者治疗后P选择素、MMP-9水平均低于治疗前(P<0.01)。结论血清P选择素、MMP-9浓度升高与ACS的发生存在密切的关系,血清P选择素、MMP-9浓度升高可以作为ACS发生的预测指标。

Objective:To nvestigate the relationship between development of insulin resistance and the change of adioponectin/leptin ratio in aged type 2 diabetes patients,and explore the mechanism of insulin resistance for providing a basis for clinical diagnosis and treatment.Methods:Serum adiponectin and leptin levels were measured with ELISA and RIA in 249 aged patients with type 2 diabetes and 90 controls.Besides,the levels were measured in another 216 aged type2 diabetes patients both before and after one-year treatment.Results:The serum levels of adiponectin in aged type 2 diabetes patients were significantly lower than those in controls(P<0.01).The serum levels of leptin in the aged patients with type 2 diabetes were significantly higher than those in controls(P<0.01).In the 216 aged type 2 diabetes patients undergoing one year treatment,the adiponectin and leptin levels and the adiponectin/leptin ratio showed significant difference(P<0.01).Adiponectin level was inversely correlation with leptin level.Conclusion:The mechanism of insulin resistance is closely correlated with levels of adiponectin and leptin in aged type 2 diabetes patients.The change of adiponectin/leptin ratio is important for sub-type of diabetes.

目的:探讨肝炎肝硬化并发自发性细菌性腹膜炎（SBP）患者腹水中内毒素（LPS）、白细胞介素-6（IL-6）、降钙素原（PCT）水平的变化及其临床意义。方法:183例肝炎肝硬化并发腹水患者作腹水LPS、IL-6和PCT水平检测,所有SBP患者腹水均作细菌培养。结果:97例SBP患者腹水LPS、IL-6、PCT水平明显高于86例无SBP患者（P＜0.01）,G-菌SBP腹水中的1PS水平明显高于G + 菌SBP腹水（P＜0.01）。结论:腹水LPS、IL-6、PCT水平的检测有助于SBP的诊断,并且腹水LPS水平的检测还有助于SBP病原菌的鉴别。

Objective:To evaluate the significance of the HBV-LP detection to the diagnosis and treatment of the patients with HBeAg-negative chronic hepatitis B.Methods:HBV-LP,PreS1-Ag and PreS2-Ag were detected with ELISA while HBV-DNA with RT-PCR in 247 serum samples collected from patients of HBeAg-negative chronic hepatitis B.Results:The positive rate of HBV-DNA,HBV-LP,PreS1-Ag and PreS2-Ag was 51.0%,66.4%,22.3% and 34.0%,respectively,in 247 cases.The positive rate of HBV-LP was higher than PreS1-Ag and PreS2-Ag.There is significant difference(P0.01).Conclusion:The level of serum HBV-LP could reflect the state of HBV infection and replication,which is more sensitive than PreS1-Ag and PreS2-Ag in the patients with HBeAg-negative chronic hepatitis B.The level of serum HBV-LP is much more valuable to monitor the treatment and prognosis of the patients with HBeAg-negative chronic hepatitis B.

急性冠状动脉综合征(ACS)是包括不稳定型心绞痛、急性心肌梗死和猝死等在内的一类疾病的总称,发生率近年来日趋增高.ACS的发生、发展是致炎因子与抗炎因子共同参与的病理生理过程.白细胞介素(IL)-10、白细胞介素(IL)-18和肿瘤坏死因子(TNF-α),前者是抗炎因子,后二者对加速粥样硬化(AS)起促进作用[1～3].作者对ACS患者进行血清IL-18、IL-10及TNF-α水平的测定,旨在探讨其在ACS疾病中的临床意义.

目的探讨以雷贝拉唑为基础三联疗法治疗幽门螺杆菌相关消化性溃疡的疗效。方法经胃镜检查确认为幽门螺杆菌阳性的活动性消化性溃疡患者60例,随机分为2组。治疗组31例,予以雷贝拉唑20mg、阿莫西林1000 mg及克拉霉素500 mg,每日2次,疗程7天,治疗7天后继续单独口服雷贝拉唑20mg,每日1次;十二指肠壶腹部溃疡疗程为4周,胃溃疡为6周。对照组29例,予以奥美拉唑20mg,阿莫西林1000mg及克拉霉素500mg,每日2次,疗程7天,治疗7天后单独服用奥美拉唑20mg,每日1次;十二指肠壶腹部溃疡疗程为4周,胃溃疡为6周。结果雷贝拉唑组用药1天症状缓解率为80.66%,奥美拉唑组为62.07%;雷贝拉唑组和奥美拉唑组的溃疡愈合率分别为90.32%和75.86%,两组的溃疡治疗有效率分别为96.77%与96.55%;两组幽门螺杆菌根除率分别达到95.4%和91.3%。结论雷贝拉唑是治疗幽门螺杆菌相关性消化性溃疡的理想药物。

杀伤细胞免疫球蛋白样受体(KIR)是调节NK细胞功能的重要受体,其基因家族具有高度多态性,KIR基因分型对于阐明其功能作用具有重要的意义。本文综述了近年来杀伤细胞免疫球蛋白样受体基因分型等位基因的鉴定及其应用,如单倍型组合分析等方面的研究进展。

目的:探讨血清半胱胺酸蛋白酶抑制剂C(CysC)在糖尿病早期肾脏损害中的应用价值。方法:采用透射比浊法在日立7180自动生化分析仪上检测糖尿病早期肾损害患者的血清CysC的浓度,同时测定血肌酐(Cr)、血糖(GLU)。统计分析血清CysC和血Cr、血糖的相关性,并对血清CysC和血Cr的诊断敏感予以比较分析。结果:血清CysC和血Cr之间具有很好的正相关性(r=0.814),而与GLU仅存在轻度相关,但在GLU>6.1mmol/L的患者中血清CysC异常占48.1%。结论:血清CysC对糖尿病早期肾脏损害的评估较血Cr更具优势。