目的 探讨原发性肝癌(PHC)患者血浆外泌体A1BG反义RNA 1(A1BG-AS1)表达情况及其对PHC的诊断及预后评估价值.方法 选取2016年12月至2018年6月在该院治疗的75例PHC患者作为PHC组,26例单纯肝硬化患者作为肝硬化组,另选取同期50例体检健康者作为对照组,采用实时荧光定量PCR(RT-qPCR)检测血浆外泌体A1 BG-AS1表达水平,分析A1 BG-AS1表达水平与临床病理特征关系,采用受试者工作特征(ROC)曲线分析血浆外泌体A1BG-AS1对PHC的诊断价值,Kaplan-Meier法分析PHC患者生存曲线,Cox回归模型分析影响PHC患者预后的危险因素.结果 对照组、肝硬化组、PHC组血浆外泌体A1BG-AS1表达水平比较,差异有统计学意义(P<0.01),其中肝硬化组、PHC组血浆外泌体A1BG-AS1表达水平明显低于对照组(P<0.01);PHC组血浆外泌体A1BG-AS1表达水平明显低于肝硬化组(P<0.01).A1BG-AS1、AFP联合检测诊断PHC的曲线下面积(AUC)为0.898(95％CI:0.839～0.941),约登指数为0.657,灵敏度为90.67％,特异度为75.00％.PHC患者血浆外泌体A1BG-AS1表达水平与肿瘤分期、肝功能分级和淋巴结转移有关(P<0.05).Kaplan-Meier生存分析显示,A1BG-AS1高表达PHC患者的3年生存率明显高于A1BG-AS1低表达PHC患者(χ2=6.857,P=0.009).肿瘤分期为T3～T4、有淋巴结转移、A1BG-AS1低表达是影响PHC患者预后的独立危险因素(P<0.05).结论 PHC患者血浆外泌体A1BG-AS1低表达,其与临床病理特征和预后有关,血浆外泌体A1BG-AS1、AFP联合检测对PHC有较高诊断价值,可作为PHC诊断与预后判断的标志物.

目的 比较呼吸道病毒抗原、抗体检测及二者联合检测在呼吸道感染老年患者中的临床应用价值.方法 收集2019年1-12月该院收治的呼吸道感染老年患者的血清和鼻咽拭子,利用直接和间接免疫荧光法分别检测呼吸道病毒的抗原和抗体IgM,对比分析抗原、抗体及其联合检测的阳性率,并分析患者性别、年龄、病程对其检测结果的影响.结果 725例患者中抗原检测、抗体检测、联合检测的总阳性率分别为36.0％、27.0％、42.9％,3种检测方法的总阳性率比较差异有统计学意义(P<0.05).不同病程患者抗原检测、抗体检测阳性率比较差异有统计学意义(P<0.05).发病≤2 d、发病3～4 d、发病5～6 d患者抗原检测阳性率均高于抗体检测阳性率(P<0.05),但其联合检测阳性率与抗原检测阳性率比较差异均无统计学意义(P>0.05);发病≥7 d患者联合检测阳性率明显高于抗原、抗体检测阳性率(P<0.05).结论 呼吸道感染老年患者发病早期呼吸道病毒抗原检测优于抗体检测,与抗原检测相比,抗原、抗体联合检测没有明显提高阳性率;抗原、抗体联合检测可以显著提高发病≥7d患者呼吸道病毒检出阳性率.

目的 探讨何首乌不同溶剂提取物在治疗糖尿病方面是否具有药效学优势,比较不同溶剂对糖尿病及其并发症的影响.方法 高脂饲料喂养联合腹腔內注射小剂量四氧嘧啶的方法,造成糖尿病大鼠模型,分别用二甲双胍、何首乌水提物、何首乌乙醇提取物、何首乌正丁醇提取物进行干预,观察给药前后大鼠体重、血糖、血脂值以及肝组织结构变化.结果 给药6周后发现3种何首乌提取物与模型组相比,显著性降低了糖尿病大鼠的血糖以及TG、TC、LDL-C,升高了HDL-C,减轻肝细胞脂肪样变性.结论 3种何首乌提取物对糖尿病大鼠模型血糖、血脂有明显的改善作用,提示其对糖尿病合并血脂异常有治疗作用.

Objective:To analyze the changes and clinical significance of NT-proBNP and D-dimer in neurolog-ic impairment and hemorrhagic transformation risk in elderly patients with acute cerebral infarction.Method:123 elderly patients with acute cerebral infarction were selected as cerebral infarction group,86 cases with health exami-nation as control group.The levels of serum NT-proBNP and plasma D-dimer in each group were detected.The cer-ebral infarction group was diveded into light,medium and heavy subgroup according to NIHSS scoring method,and was diveded into hemorrhagic transformation(HT)group and non hemorrhagic transformation(NHT)group accord-ing to head MRI results of 7-10 days after the onset of the disease.The levels of the two indicators between different groups and subgroups were compared.Results:In cerebral infarction group,the levels of NT-proBNP and D-dimer were both significantly higher than those in control group (P <0.01),and the medium and heavy subgroup were higher than those in light subgroup(P <0.01),and the heavy subgroup were higher than in medium subgroup(P <0.01).The level of D-dimer in HT group was significantly higher than that in NHT group(P <0.01).The differ-ence of the level of NT-proBNP between the two subgroups had no statistical significance(P >0.05 ).Conclusion:The increased NT-proBNP and D-dimer levels have an important clinical significance to analyze neurologic impair-ment and hemorrhagic transformation risk in elderly patients with acute cerebral infarction.

目的 研究何首乌不同提取物对2型糖尿病胰岛素抵抗大鼠血糖、胰岛素抵抗及InsR基因表达的影响.方法 高脂饲料喂养联合腹腔内注射小剂量四氧嘧啶制造糖尿病胰岛素抵抗大鼠模型,分别用二甲双胍、何首乌水提物、何首乌乙醇提取物、何首乌正丁醇提取物进行干预,观察给药前后大鼠空腹血糖、血清胰岛素水平,计算胰岛素抵抗指数(HOMA-IR)及胰岛素敏感指数(ISI),采用RT-PCR法测定肝细胞膜InsR mRNA基因表达情况.结果 三组何首乌提取物的血糖、FINS、HOMA-IR水平较模型组显著下降(P＜0.01),ISI水平显著上升(P＜0.01);肝细胞膜上InsR基因表达量上升.结论 何首乌提取物改善2型糖尿病大鼠的胰岛素抵抗,可能与上调InsR基因表达量有关.

目的:探讨老年内科患者的输血阈值水平,评价不同输血策略对老年患者红细胞输注效果及临床结局的影响.方法:回顾性调查2012-03-2014-03老年内科患者的临床输血资料及病历资料,统计分析老年患者的输血阈值水平;根据患者输血前血红蛋白(Hb)水平将患者分为开放性输血组(＞60 g/L)和限制性输血组(＜60 g/L),比较分析2组输注效果、病死率、输血不良反应的发生率,院内感染等指标.结果:老年内科患者输血Hb阈值达(63.8±15.1)g/L,限制性输血组输注显效率明显高于开放性输血组(P＜0.01),无效及效果不佳的比率明显低于开放组(P＜0.01);2组输血不良反应的发生率和住院期间病死率比较差异无统计学意义(P＞0.05),院内感染率,住院天数的差异有统计学意义(P＜0.01).结论:限制性输血策略对于提高老年患者的输注效率,减少院内感染率和住院时间有积极意义.

OBJECTIVE To analyze the distribution and drug resistance characteristic of the pathogenic bacteria causing nosocomial infections in elder death cases.METHODS The clinical data of elder inpatients who died in hospital from Jan.2009to Apr.2012were investigated and analyzed retrospectively.RESULTS Of the 237elder death cases,nosocomial infections occurred in 109cases with 113case-times,with the infection rate of 46.0%and case-time infection rate of 47.68%.The malignant tumor and respiratory system diseases were with the highest infection rate(54.29% and 50.0%,respectively).The respiratory tract was the main infected location, accounting for 73.45%.Gram-negative bacilli were the predominant pathogens(69.14%),followed by grampositive cocci and fungi(20.22% and 10.64%,respectively).The resistant rates of Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus to most antibiotics were higher than 50.0%.CONCLUSIONS The rate of nosocomial infection in elder death cases is high,and the pathogens possess broad antibiotic resistance spectrum and higher antibiotic resistance rate.Great emphasis on the identification and drug sensitive test of bacteria,and regular surveillance for bacterial resistance have great significance in clinical reasonable use of antibiotics and the control of nosocomial infections.

Objective The relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and different types of coronary heart disease (CHD) was studied.Methods Literatures concerning CHD and Lp-PLA2 published from January 2004 to December 2013 in "Wan fang"," CNKI",PubMed and Science Citation Index Expanded (SCIE)/Social Sciences Citation Index (SSCI)/Arts and Humanities Citation Index (A&HCI) database were retrievaled,and then relevant data were extracted.RevMan5.1 statistical software was used for processing and analysis.Results A total of 8 literatures involving 1 292 subjects were included.Meta-analysis showed that the levels of serum Lp-PLA2 in the patients with stable angina (SA),unstable angina (UA) or acute myocardial infarction (AMI) were significantly higher than those of normal controls,respectively [SMD (95 ％ CI) were 2.46 (1.20,3.71),2.68 (1.47,3.89),and 2.57 (1.50,3.65),all P =0.000].Serum Lp-PLA2 level in patients with UA or AMI was higher than that in patients with SA,respectively [SMD =0.78,95 ％ CI(0.28,1.28),P =0.002],[SMD =1.12,95 ％ CI(0.72,1.51),P =0.000] ;Serum level of Lp-PLA2 in patients with AMI was also higher than that in patients with UA [SMD =0.58,95％ CI (0.29,0.86),P =0.000].Conclusion The study demonstrated that increased serum Lp-PLA2 level is significantly associated with the severity of CHD.

OBJECTIVE To investigate the relationship between the hepatitis B serological patterns and Pre-S1Ag.METHODS The hepatitis B serological patterns of 19273 patients and healthy people were tested by enzyme linked immunosorbent assay(ELISA),the modes were divided into the negative group and the positive group according to the results of the hepatitis B surface antigen(HBsAg).RESULTS The Pre-S1Ag positive rate of the HBsAg positive group was 61.8%,the Pre-S1Ag positive rate of HBsAg negative group was 1.4%.The serological patterns of HBsAg positive group showed that there were 7 modes,the detection rates of HBsAg(+),HBeAg(+),HBcAb(+) and HBsAg(+),HBeAg(+) modes were the highest,accounting for 93.3%(513/550);the serological patterns of HBsAg negative group showed that there were 7 modes,the positive rates of Pre-S1Ag ranged from 0.09% to 6.46%,the Pre-S1Ag positive rate was very different in different HBV serological patterns.CONCLUSION The detection of Pre-S1Ag in different HBV serological patterns has important significance and it is helpful to correctly judge the HBV infection and replication level.It provides reliable rules for the selection of clinical treatment program and the observation of clinical efficacy.