首页期刊导航|中国医师进修杂志
期刊信息/Journal information
中国医师进修杂志
中国医师进修杂志

姒健敏

旬刊

1673-4904

yishi@zgysjxzz.com

0411-82482314

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国医师进修杂志/Journal Chinese Journal of Postgraduates of Medicine北大核心CSTPCD
查看更多>>1978年创刊，中华人民共和国卫生部主管，中华医学会主办。本刊是综合性临床医学期刊，其主要读者对象为临床中、高级内、外、妇、儿、五官科医务人员。从创刊至今始终坚持以继续医学教育、岗位进修培训为办刊宗旨。现开设的主要栏目：专题辅导、专家论坛、临床论著、进展概述、综述与讲座、教学查房、临床病例讨论、病例报告、探讨与评价、药物与临床、影像与临床、新技术介绍、教训纵横等。其中专题辅导、教学查房等栏目深受读者欢迎。
正式出版
收录年代

    人工智能和多组学赋能胸痛中心高质量发展

    夏经钢张莉
    193-194页
    查看更多>>摘要：胸痛中心建设是急诊急救"五大中心"建设之一，是高危胸痛早期识别、分层和及早救治的重要保障，人工智能和多组学技术的进步，赋能智慧化胸痛中心建设高质量发展，为高危胸痛，特别是急性心肌梗死的早期预警标志物的研发提供了支持，实现了对急性心肌梗死的全生命周期精准管理，进一步改善患者的预后。

    人工智能多组学胸痛中心

      原文链接:
    • 万方数据

    肾移植术后心血管事件发生的危险因素及其对移植肾功能的影响

    郭呈龙夏经钢尹春琳张莉...
    195-200页
    查看更多>>摘要：目的 分析肾移植患者发生术后心血管事件（PCE）的危险因素及其对移植肾脏功能的影响。 方法 回顾性分析首都医科大学宣武医院2020年3月至2022年3月120例行肾脏移植患者的临床资料。其中，发生PCE 23例（PCE组），未发生PCE 97例（非PCE组）。记录患者术前和术后相关资料，采用多因素Logistic回归分析影响肾移植患者发生PCE的独立危险因素。 结果 肾移植患者PCE发生率为19.17%（23/120）。两组性别构成、术前血脂异常率、术前高血压率和免疫抑制剂使用情况比较差异无统计学意义（P>0.05）；PCE组年龄、术前体质量指数>30 kg/m2率、术前透析时间>12个月率、术前糖尿病率、术前心血管疾病率、术前糖尿病肾病率、尸体供肾肾移植率、术后血脂异常率、术后血清肌酐>200 μmol/L率、术后新发糖尿病率、术后延迟性衰竭率和术后急性反应率明显高于非PCE组，差异有统计学意义（P<0.01或<0.05）。多因素Logistic回归分析结果显示，年龄、术前糖尿病、术前心血管疾病、术前糖尿病肾病、术后血清肌酐>200 μmol/L和术后急性反应是影响肾移植患者发生PCE的独立危险因素（OR = 2.40、3.42、3.85、1.98、2.62和2.11，95% CI 1.67～3.58、1.61～7.05、2.61～5.55、1.05～3.85、1.25～4.52和1.20～4.78，P<0.01或<0.05）。两组术后3个月血清肌酐比较差异无统计学意义（P>0.05）；PCE组术后6和12个月血清肌酐明显高于非PCE组[（139.58 ± 31.54）μmol/L比（105.36 ± 21.05）μmol/L和（198.32 ± 40.12）μmol/L比（107.63 ± 24.64）μmol/L]，差异有统计学意义（P<0.01）。 结论 肾移植患者PCE发生率较高，导致PCE的危险因素较多。若是采取相关措施来校正或去除危险因素，或可降低肾移植患者PCE发生率，延长生存时间。 Objective To analyze the risk factors for postoperative cardiovascular events (PCE) after renal transplantation and their impact on transplant kidney function. Methods The clinical data of 120 patients who underwent kidney transplant at Xuanwu Hospital, Capital Medical University from March 2020 to March 2022 were retrospectively analyzed. Among them, 23 cases occurred PCE (PCE group), and 97 cases did not occur PCE (non-PCE group). The relevant preoperative and postoperative data were recorded. Multivariate Logistic regression was used to analyze the independent risk factors of PCE in kidney transplant patients. Results The incidence rate of PCE in kidney transplant patients was 19.17% (23/120). There were no statistical differences in the gender composition, preoperative dyslipidemia rate, preoperative hypertension rate and immunosuppressant use between two groups (P>0.05) the age, preoperative body mass index>30 kg/m2 rate, preoperative dialysis time>12 months rate, preoperative diabetes rate, preoperative cardiovascular disease rate, preoperative diabetic nephropathy rate, cadaver kidney transplant rate, postoperative dyslipidemia rate, postoperative serum creatinine >200 μmol/L rate, postoperative new-onset diabetes rate, postoperative delayed failure rate and postoperative acute reaction rate in PCE group were significantly higher than those in non-PCE group, and there were statistical differences (P<0.01 or <0.05). Multivariate Logistic regression analysis showed that age, preoperative diabetes, preoperative cardiovascular disease, preoperative diabetic nephropathy, postoperative serum creatinine >200 μmol/L and postoperative acute reaction were independent risk factors of PCE in kidney transplant patients (OR = 2.40, 3.42, 3.85, 1.98, 2.62 and 2.11 95% CI 1.67 to 3.58, 1.61 to 7.05, 2.61 to 5.55, 1.05 to 3.85, 1.25 to 4.52 and 1.20 to 4.78 P<0.01 or <0.05). There was no statistically significant difference in serum creatinine 3 months after surgery between two groups (P>0.05) the serum creatinine 6 and 12 months after surgery in PCE group was significantly higher than that in non-PCE group: (139.58 ± 31.54) μmol/L vs. (105.36 ± 21.05) μmol/L and (198.32 ± 40.12) μmol/L vs. (107.63 ± 24.64) μmol/L, and there were statistical differences (P<0.01). Conclusions The incidence of PCE in kidney transplant patients is higher, and there are many risk factors for PCE. If relevant measures are taken to correct or remove risk factors, it may reduce the incidence of PCE and prolong survival time in kidney transplant patients.

    肾移植心血管疾病危险因素肾功能

      原文链接:
    • 万方数据

    基于两样本孟德尔随机化分析体质量指数与妊娠期高血压的关系

    胡梦巾武德崴李博宇夏经钢...
    201-204页
    查看更多>>摘要：目的 利用两样本孟德尔随机化探究体质量指数（BMI）与妊娠期高血压的关系。 方法 利用BMI与妊娠期高血压的全基因组关联研究汇总数据（数据纳入截止时间为2023年10月31日），通过逆方差加权法、MR-Egger回归法、加权中位数法、简单模型和加权模型进行两样本孟德尔随机化分析。采用Cochrane Q检验评估结果的异质性，MR-Egger回归截距和漏斗图检验结果的水平多效性。 结果 固定效应和随机效应模型下的逆方差加权结果显示，随着BMI的升高妊娠期高血压的风险也增加（OR = 1.62和1.62，95% CI 1.39～1.88和1.39～1.88，P<0.01）。敏感性分析结果显示，MR-Egger回归法、加权中位数法和加权模型提示随着BMI的增加妊娠期高血压风险增加（OR = 1.51、1.56和1.71，95% CI 1.01～2.26、1.23～1.99和1.09～2.69，P<0.05或<0.01）。尽管CochraneQ检验结果显示存在异质性（P = 0.04），但随机模型下的逆方差加权结果依然提示BMI会增加妊娠期高血压的风险，且未观察到水平多效性（P = 0.73）。 结论 肥胖会增加妊娠期高血压的风险，孕妇要注意控制体质量以降低妊娠期高血压的风险。 Objective To investigate the relationship between body mass index (BMI) and gestational hypertension using two-sample Mendelian randomization analysis. Methods The summary level data for BMI and gestational hypertension were obtained from the genome-wide association study (the deadline for data inclusion was October 31, 2023). All data were analyzed by inverse variance weighting, MR-Egger regression, weighted median, simple model and weighted model methods. Cochrane Q test was used to evaluate heterogeneity, MR-Egger regression intercept test and funnel plot were used to assess horizontal pleiotropy. Results Inverse variance weighting result under fixed effects and random effects models showed that the risk of gestational hypertension increased with the increase of BMI (OR = 1.62 and 1.62, 95% CI 1.39 to 1.88 and 1.39 to 1.88, P<0.01). Sensitivity analysis results including MR-Egger regression, weighted median and weighted model methods showed that BMI increased the risk of gestational hypertension (OR = 1.51, 1.56 and 1.71 95% CI 1.01 to 2.26, 1.23 to 1.99 and 1.09 to 2.69 P<0.05 or <0.01). Although CochraneQ test result showed evidence of heterogeneity (P = 0.04), inverse variance weighting under a random model suggested that BMI increased the risk of gestational hypertension. Horizontal pleiotropy was not observed in the above analysis (P = 0.73). Conclusions Obesity may increase the risk of gestational hypertension. Pregnant women should pay attention to weight control to decrease the risk of gestational hypertension.

    高血压,妊娠性人体质量指数孟德尔随机化分析

      原文链接:
    • 万方数据

    依托咪酯和七氟烷麻醉对老年脊柱手术患者脑氧代谢、脑血流灌注和术后谵妄的影响

    李军侯唯艺吕彤
    205-211页
    查看更多>>摘要：目的 探讨依托咪酯和七氟烷麻醉对老年脊柱手术患者脑氧代谢、脑血流灌注和术后谵妄的影响。 方法 采用前瞻性研究的方法，选择2020年3月至2021年5月于中国中医科学院广安门医院择期行脊柱手术的96例老年患者作为研究对象，按随机数字表法将所有患者分为七氟烷组和依托咪酯组各48例，七氟烷组采用七氟烷吸入镇痛，依托咪酯组采用依托咪酯静脉自控镇痛，记录两组患者自主呼吸恢复时间，唤醒时间，清醒拔管时间，术后1、3、6、12、24和48 h疼痛数字评分（NRS），术后谵妄发生率，颈内静脉血氧饱和度（SjvO2）；并计算脑动静脉血氧含量差（AVDO2）和脑氧摄取率（CERO2）脑氧代谢指标；连续记录麻醉诱导前（T0）、意识消失后（T1）、注射麻醉药物后（T2）、气管插管后（T3）、手术开始前（T4）、术中30 min（T5）、术中60 min（T6）及术毕（T7）不同时间点大脑中动脉收缩峰值流速（Vs-MCA）、舒张期末流速（Vd-MCA）、平均流速（Vm-MCA）脑血流灌注指标。 结果 两组患者术后自主呼吸恢复时间、唤醒时间、清醒拔管时间比较差异均无统计学意义（P>0.05）。七氟烷组术后1 、3 、6 、12 、24和48 h静息NRS分别为（1.27 ± 0.12）、（2.13 ± 0.22）、（3.26 ± 0.23）、（3.29 ± 0.22）、（2.52 ± 0.11）、（2.02 ± 0.11）分；依托咪酯组分别为（1.27 ± 0.13）、（2.02 ± 0.21）、（2.13 ± 0.13）、（2.11 ± 0.26）、（2.08 ± 0.17）、（1.02 ± 0.17）分；重复测量方差分析结果显示，两组患者术后静息NRS比较差异有统计学意义（P<0.05）。两组患者不同时间点术后静息NRS比较差异有统计学意义（P<0.05）。依托咪酯组术后谵妄发生率明显低于七氟烷组[4.17%　（2/48）比16.67%（8/48）]，差异有统计学意义（P<0.05）。七氟烷组和依托咪酯组患者术后SjvO2均高于术前[（69.96 ± 4.17）%比（58.26 ± 4.16）%、（61.22 ± 4.19）%比（58.25 ± 4.17）%]，且AVDO2、CERO2均低于术前[（60.23 ± 5.22）%比（64.22 ± 4.17）%、（50.23 ± 6.19）%比（64.23 ± 4.19）%，（37.22 ± 6.23）%比（40.23 ± 5.16）%、（31.26 ± 5.17）%比（40.27 ± 4.18）%]（P<0.05），依托咪酯组术后SjvO2高于七氟烷组，且AVDO2、CERO2均低于七氟烷组，差异有统计学意义（P<0.05）。重复测量方差分析结果显示，两组患者Vs-MCA、Vd-MCA、Vm-MCA脑血流灌注指标比较差异均有统计学意义（P<0.05）。不同时间点两组患者Vs-MCA、Vd-MCA、Vm-MCA比较差异均有统计学意义（P<0.05）。两组患者不同时间点Vs-MCA、Vd-MCA、Vm-MCA比较差异均有统计学意义（P<0.05）。 结论 相比七氟烷，依托咪酯具有更好的镇痛作用，可降低术后谵妄发生率，改善脑氧代谢，减少脑血流灌注。 Objective To study cerebral oxygen metabolism and cerebral blood flow in etomidate and sevoflurane anesthesia effects of perfusion and postoperative delusions. Methods A prospective study was used. The 96 elderly patients who underwent elective spinal surgery in Guang′anmen Hospital, China Academy of Chinese Medical Sciences from March 2020 to May 2021 were selected as the study subjects. All patients were divided into sevoflurane group and etomidide group by random numbers table, each with 48 cases. The sevoflurane group was treated with sevoflurane inhalation for analgesia, with etomidate intravenous-controlled analgesia in the etomidate group. The recovery time of spontaneous respiratory, wake time, awake extubation time, numerical rating score (NRS 1, 3, 6, 12, 24 and 48 h), incidence of postoperative delusion, internal jugular vein oxygen saturation (SjvO2) were recorded. Arteriovenous oxygen content (AVDO2) and cerebral oxygen intake rate (CERO2) were calculated. The peak cerebral artery constriction rate (Vs-MCA), diastolic velocity (Vd-MCA) and mean flow rate (Vm-MCA) pre-induction of anesthesia (T0), loss of consciousness (T1), after fentanyl injection (T3), endotracheal intubation (T4), 30 min (T5), 60 min (T6) and postoperative (T7) were recorded. Results There were no significant differences in the recovery time of spontaneous breathing, wake time and awake extubation time between the two groups (P>0.05). The resting NRS in sevoflurane group at 1, 3, 6, 12, 24 and 48 h after operation were (1.27 ± 0.12), (2.13 ± 0.22), (3.26 ± 0.23), (3.29 ± 0.22), (2.52 ± 0.11) and (2.02 ± 0.11) points, respectively. Etomidate group was (1.27 ± 0.13), (2.02 ± 0.21), (2.13 ± 0.13), (2.11 ± 0.26), (2.08 ± 0.17) and (1.02 ± 0.17) points, respectively. The results of repeated measurement ANOVA showed that there was significant difference in NRS between the two groups (P<0.05). There were significant differences in postoperative resting NRS between the two groups at different time points (P<0.05). The incidence of postoperative delusion in etomidate group was lower than that in sevoflurane group: 4.17% (2/48) vs. 16.67% (8/48), and the difference was statistically significant (P<0.05). Postoperative SjvO2 in sevoflurane group and etomidate group was higher than that before surgery: (69.96 ± 4.17)% vs. (58.26 ± 4.16)%, (61.22 ± 4.19)% vs. (58.25 ± 4.17)%. In addition, both AVDO2 and CERO2 were lower than those before operation: (60.23 ± 5.22)% vs. (64.22 ± 4.17)%, (50.23 ± 6.19)% vs. (64.23 ± 4.19)%, (37.22 ± 6.23)% vs. (40.23 ± 5.16)%, (31.26 ± 5.17)% vs. (40.27 ± 4.18)% (P<0.05), postoperative SjvO2 in etomidate group was higher than that in sevoflurane group, and AVDO2 and CERO2 were lower than that in sevoflurane group. The difference was statistically significant (P<0.05). The results of repeated measurement ANOVA showed that there were statistically significant differences in cerebral blood perfusion indexes of Vs-MCA, Vd-MCA and Vm-MCA between the two groups (P<0.05). There were statistically significant differences in Vs-MCA, Vd-MCA and Vm-MCA between two groups at different time points (P<0.05). There were significant differences in Vs-MCA, Vd-MCA and Vm-MCA between the two groups at different time points (P<0.05). Conclusions Compared with sevoflurane, etomidate can reduce the postoperative delusion rate, improve cerebral oxygen metabolism and reduce cerebral blood flow perfusion.

    麻醉依托咪酯七氟烷老年脊柱手术脑血流灌注术后谵妄

      原文链接:
    • 万方数据

    微小RNA-211-5p靶向抑制促红细胞生成素肝细胞激酶受体及配体B2信号通路对脊髓神经损伤和功能影响研究

    李名武钱李慧孙法瑞段军...
    212-221页
    查看更多>>摘要：目的 检测微小RNA（miR）-211-5p、促红细胞生成素肝细胞激酶受体B2（EphB2）及促红细胞生成素肝细胞激酶配体B2（ephrin B2）在脊髓损伤（SCI）后脊髓组织以及神经细胞中的表达，探讨其对SCI大鼠神经功能恢复的机制和效果。 方法 2020年5月至2021年6月采用斯普拉格-道利（SD）大鼠和未受伤的PC12细胞进行前瞻性研究。SD大鼠分为假手术组和SCI组，每组各30只，在术后不同时间点（1、3、7、14、21和28 d）进行Basso-Beattie-Bresnahan（BBB）评分，实时荧光定量聚合酶链反应（qPCR）检测miR-211-5p和Eph/ephrin B2 mRNA的相对表达含量；另将SCI大鼠分为重组慢病毒载体LV-miR-211-5p组（A组）、空慢病毒载体LV-eGFP（B组）、0.9%氯化钠组（C组），每组15只，分别重组慢病毒载体、空慢病毒载体和0.9%氯化钠注射于脊髓损伤处头、尾侧，于术后1、7和14 d收集BBB评分，检测脊髓组织中的miR-211-5p和Eph/ephrin B2 mRNA的相对表达含量，另用免疫荧光染色法检测各组GAP-43和突触素的表达。另外用150 μmol/L过氧化氢（H2O2）建立PC12损伤细胞系模型，分别用流式细胞术、Western blot检测不同细胞系的凋亡率和凋亡相关蛋白和含量，双荧光素酶报告基因验证miR-211-5p是否靶向调控EphB2。 结果 动物实验结果显示，术后不同时间点，SCI组的miR-211-5p在损伤后1、3、7、14、21和28 d水平低于假手术组（0.70 ± 0.03比1.00 ± 0.10、0.60 ± 0.04比1.00 ± 0.05、0.45 ± 0.10比1.00 ± 0.12、0.30 ± 0.06比1.00 ± 0.15、0.20 ± 0.05比1.00 ± 0.13、0.10 ± 0.02比1.00 ± 0.07），EphB2和ephrinB2水平高于假手术组（1.10 ± 0.05比1.00 ± 0.01、1.80 ± 0.01比1.00 ± 0.08、2.30 ± 0.01比1.00 ± 0.10、2.60 ± 0.01比1.00 ± 0.05、2.80 ± 0.01比1.00 ± 0.06、3.00 ± 0.01比1.00 ± 0.07，1.20 ± 0.05比1.00 ± 0.02、1.60 ± 0.01比1.00 ± 0.03、2.10 ± 0.10比1.00 ± 0.01、2.40 ± 0.11比1.00 ± 0.09、2.70 ± 0.13比1.00 ± 0.05、2.90 ± 0.12比1.00 ± 0.03），差异均有统计学意义（P<0.05）；术后14 d，A组BBB评分高于B组和C组[（14.0 ± 1.1）分比（8.0 ± 1.1）和（8.2 ± 1.2）分]，miR-211-5p水平高于B组和C组（1.90 ± 0.10比0.40 ± 0.01和0.50 ± 0.02），Eph/ephrin B2水平低于B组和C组（0.70 ± 0.10比1.80 ± 0.04和1.90 ± 0.06，0.60 ± 0.03比2.00 ± 0.04和2.10 ± 0.05），差异均有统计学意义（P<0.05）；免疫荧光染色示，术后14 d A组GAP-43和突触素含量均高于B组和C组（P<0.05）。细胞实验结果显示，过表达miR-211-5p能够抑制H2O2诱导的PC12细胞凋亡率和细胞凋亡相关基因Cleaved-caspase3的表达（P<0.05）。敲低miR-211-5p能够提高H2O2诱导的PC12细胞凋亡率和细胞凋亡相关基因Cleaved-caspase3的表达（P<0.05）。双荧光素酶报告基因实验证实EphB2是miR-211-5p的靶基因，过表达EphB2可拮抗miR-211-5p对H2O2诱导的PC12后细胞凋亡抑制作用。 结论 miR-211-5p可通过抑制Eph/ephrin B2信号通路的表达而促进SCI的神经功能修复，提示把Eph/ephrin B2作为靶点，采用miR-211-5p抑制Eph/ephrin B2信号通路可能对SCI有保护作用。 Objective To detect the expression of microRNA (miR)-211-5p, erythropoietin hepatocyte kinase receptor B2 (EphB2) and erythropoietin hepatocyte kinase ligand B2 (ephrin B2) in spinal cord tissues as well as nerve cells after spinal cord injury (SCI), and to explore their mechanisms and effects on neurological recovery in SCI rats. Methods The study was conducted from May 2020 to June 2021 using Sprague Dawley (SD) rats and PC12 cells. SD rats were divided into sham-operated group and SCI group of 30 rats each, and Basso-Beattie-Bresnahan (BBB) score were performed at different postoperative time points (1, 3, 7, 14, 21 and 28 d), and the relative expression of miR-211-5p and Eph/ephrin B2 mRNA was measured by quantitative real-time polymerase chain reaction (qPCR) the SCI rats were divided into recombinant lentiviral vector LV-miR-211-5p group (group A), empty lentiviral vector LV-eGFP (group B) and saline group (group C), with 15 rats in each group, respectively. The recombinant lentiviral vector, empty lentiviral vector and saline were injected on the cephalic and caudal sides of the spinal cord injury, and the relative expression of miR-211-5p and Eph/ephrin B2 mRNA in the spinal cord tissue was measured at 1, 7 and 14 d after surgery. In addition, a PC12 injury cell line model was established with 150 μmol/L hydrogen peroxide (H 2O2), and the apoptosis rate and apoptosis-related proteins and contents of different cell lines were detected by flow cytometry and Western blot, respectively. MiR-211-5p was verified to target EphB2 by dual luciferase reporter gene. Results The results of the animal experiments showed that at different postoperative time points, the miR-211-5p levels in the SCI group were lower than those in the SHAM group: 0.70 ± 0.03 vs. 1.00 ± 0.10, 0.60 ± 0.04 vs. 1.00 ± 0.05, 0.45 ± 0.10 vs. 1.00 ± 0.12, 0.30 ± 0.06 vs. 1.00 ± 0.15, 0.20 ± 0.05 vs. 1.00 ± 0.13, 0.10 ± 0.02 vs. 1.00 ± 0.07. In contrast, levels of Eph/ephrin B2 were higher in the SCI group compared to the SHAM group: 1.10 ± 0.05 vs. 1.00 ± 0.01, 1.80 ± 0.01 vs. 1.00 ± 0.08, 2.30 ± 0.01 vs. 1.00 ± 0.10, 2.60 ± 0.01 vs. 1.00 ± 0.05, 2.80 ± 0.01 vs. 1.00 ± 0.06, 3.00 ± 0.01 vs. 1.00 ± 0.07 and 1.20 ± 0.05 vs. 1.00 ± 0.02, 1.60 ± 0.01 vs. 1.00 ± 0.03, 2.10 ± 0.10 vs. 1.00 ± 0.01, 2.40 ± 0.11 vs. 1.00 ± 0.09, 2.70 ± 0.13 vs. 1.00 ± 0.05, 2.90 ± 0.12 vs. 1.00 ± 0.03 (P<0.05). At 14 d after surgery, Group A exhibited higher BBB scores than Groups B and C: (14.0 ± 1.1) points vs. (8.0 ± 1.1) and (8.2 ± 1.2) points, while miR-211-5p levels were higher than those in Groups B and C: 1.90 ± 0.10 vs. 0.40 ± 0.01 and 0.50 ± 0.02, and Eph/ephrin B2 levels were lower than those in Groups B and C: 0.70 ± 0.10 vs. 1.80 ± 0.04 and 1.90 ± 0.06, 0.60 ± 0.03 vs. 2.00 ± 0.04 and 2.10 ± 0.05 (P<0.05). Immunofluorescence staining showed that the levels of GAP-43 and synaptophysin in group A were higher than those in groups B and C at 14 d after surgery (P<0.05). Cellular assays showed that overexpression of miR-211-5p inhibited the apoptosis rate of H2O2-induced PC12 cells and the expression of the apoptosis-related gene Cleaved-caspase3 (P<0.05). Knockdown of miR-211-5p increased the apoptosis rate of H2O2-induced PC12 cells and the expression of the apoptosis-related gene Cleaved-caspase3 (P<0.05). Dual luciferase reporter gene assay confirmed that EphB2 was a target gene of miR-211-5p and overexpression of EphB2 antagonized the inhibitory apoptosis effect of miR-211-5p on H2O2-induced PC12 cells. Conclusions This study showed that miR-211-5p could promote neurological repair in SCI by inhibiting the expression of Eph/ephrin B2 signaling pathway, suggesting that using miR-211-5p as a target to inhibit Eph/ephrin B2 signaling pathway may have a protective effect on SCI.

    脊髓损伤微RNAs促红细胞生成素肝细胞激酶功能

      原文链接:
    • 万方数据

    胃早癌超级微创非全层切除术中组织夹-牙线可变角度牵引法的应用

    邵群王向东韩珂李金平...
    221-225页
    查看更多>>摘要：目的 牵引方法可加快胃早期肿瘤超级微创非全层切除的速度，缩短术者的学习曲线，探讨采用组织夹-牙线可变角度牵引法作为胃肠早期肿瘤经内镜非全层切除过程中的牵引方法。 方法 采用回顾性研究的方法，纳入2022年1月至2023年6月于解放军总医院第一医学中心开展的早期胃癌行超级微创病灶非全层切除术的18例患者，采用同级别专家进行操作，分为牵引组和非牵引组各9例，分别记录其黏膜下剥离时间（SDT）、黏膜下剥离速度（SDS）、术中固有肌层暴露、固有肌层缺损度分级（MPD）、术中出血量、整块切除、治愈性切除、手术费用及手术器械使用情况。 结果 9例采用可变角度牵引法，9例未采用牵引法。两组整块切除率和治愈性切除率均为100%。牵引组SDT为28.00（21.00，34.00） min，非牵引组为56.00（40.00，85.00） min，差异有统计学意义（P<0.05）；牵引组SDS为（0.58 ± 0.21） cm2/min，非牵引组为（0.23 ± 0.10） cm2/min，差异有统计学意义（P<0.05）。牵引组固有肌层暴露8例，非牵引组6例；牵引组术中固有肌层损伤MPD-0级8例，MPD-Ft级1例；非牵引组MPD-0级4例，MPD-Pt级1例，MPD-Ft级4例。两组术中出血量、住院费用、手术费用和住院时间比较差异均无统计学意义（P>0.05）。两组无严重不良事件发生。 结论 可变角度牵拉法加快了胃早癌非全层切除的SDT和SDS，固有肌层与黏膜层充分分离，剥离深度更深，固有肌层损伤率低，术中出血量少，未增加医疗费用，该方法可以成为超级微创手术的辅助治疗技术。 Objective Assisted traction technology is effective in increasing the rate of super minimally invasive surgery (SMIS) in patients with early gastric cancer (EGC), and shortening the operator′s learning curve. We adopt the variable angle traction technique of tissue clamp dental floss as a traction technique in this research. Methods Patients with early gastric cancer who were treated with SMIS - non full layer resection of EGC were enrolled in the First Medical Center of Chinese PLA General Hospital from January 2022 to June 2023. This research was carried out by experts at the same level. It was divided into two groups: traction and non-traction. Submucosal detachment time (SDT), submucosal detachment rate (SDS), lamina propria exposure, muscularis propria defect (MPD), bleeding during operation, block resection, surgical resection, hand operation expenses, and surgical instruments were recorded. Results Nine patients adopted variable angle traction, and 9 patients did not. The overall resection rate and curative resection rate of both groups were 100%. The mean SDT time was 28.00 (21.00, 34.00) min in traction group and 56.00 (40.00, 85.00) min in non traction group. And it had statistical significance (P = 0.005). The SDS was (0.58 ± 0.21) cm2/min in traction group and (0.23 ± 0.10) cm2/min in non-traction group. And it had statistical significance (P<0.05). Exposure of intrinsic muscle layer (IML): 8 cases in the traction group and 6 cases in the non-traction group. Intraoperative IML injury: in the traction group, 8 cases were MPD-0 and 1 case was MPD-Ft in the non-traction group, 4 cases were MPD-0, 1 case was MPD-Pt, and 4 cases were MPD-Ft. There was no statistical difference between the two groups in terms of intraoperative bleeding, hospitalization expenses, surgical expenses, and the total hospitalization time. There were no serious adverse reactions or outcomes. Conclusions The variable angle traction method accelerates SDT and SDS for SMIS-non full layer resection of EGC. It has the advantages of the sufficient separation of IML and mucosal layer, the deeper dissection depth, the low injury of IML, low intraoperative bleeding, and no additional medical costs. Therefore, this method can become an auxiliary treatment technology for SMIS.

    胃肿瘤超级微创手术非全层切除术辅助牵引技术黏膜下剥离术

      原文链接:
    • 万方数据

    动态心电图联合血清脑钠肽、肌酸激酶同工酶评估呼吸道感染并发病毒性心肌炎病情的临床价值

    刘童铭韩冰洁房阳亮吕彤...
    226-230页
    查看更多>>摘要：目的 分析动态心电图联合血清脑钠肽（BNP）、肌酸激酶同工酶（CK-MB）水平在评估呼吸道感染并发病毒性心肌炎患者病情严重程度中的临床价值。 方法 回顾性选取2018年1月至2022年12月浙江大学医学院附属邵逸夫医院收治的125例呼吸道感染患者，依据是否并发病毒性心肌炎分为并发组（71例）、未并发组（54例），对比动态与常规心电图的特征，分析并发组与未并发组入院时血清BNP、CK-MB水平，对比不同心肌炎病情患者的动态心电图、血清BNP及CK-MB，分析其联合诊断价值。 结果 动态心电图中房性早搏及窦性心动过速等检出率高于常规心电图[38.03%（27/71）比22.54%（16/71）、28.17%（20/71）比14.08%（10/71）]（P<0.05）；并发组入院时血清BNP、CK-MB水平均高于未并发组[（104.26 ± 10.75） ng/L比（54.11 ± 5.69） ng/L、（17.89 ± 1.86） U/L比（13.46 ± 1.42） U/L]，差异有统计学意义（P<0.05）；呼吸道感染并发重症病毒性心肌炎患者（37例）动态心电图中房性早搏、窦性心动过速、短阵室性心动过速、一度房室传导阻滞、ST段改变、QRS低电压检出率及入院时血清BNP、CK-MB水平均高于并发轻症病毒性心肌炎患者（34例）[51.35%（19/37）比23.53%（8/34）、43.24%（16/37）比11.76%（4/34）、32.43%（12/37）比11.76%（4/34）、29.73%（11/37）比8.82%（3/34）、43.24%（16/37）比14.71%（5/34）、24.32%（9/37）比5.88%（2/34）、（107.19 ± 10.56） ng/L比（101.08 ± 10.18）ng/L、（18.33 ± 1.85） U/L比（17.41 ± 1.76） U/L]，差异有统计学意义（P<0.05）；以临床病理诊断为准，动态心电图、入院时BNP、入院时CK-MB、三者联合诊断急性上呼吸道感染并发病毒性心肌炎的Kappa值分别是0.784、0.765、0.733、0.879，且联合检测灵敏度、准确度更高。 结论 动态心电图联合血清BNP、CK-MB能较好评估呼吸道感染并发心肌炎患者病情严重程度，可加以监测。 Objective To analyze the clinical value of dynamic electrocardiogram combined with serum brain natriuretic peptide (BNP) and creatine kinase isoenzyme (CK-MB) levels in evaluating the severity of respiratory tract infection complicated with viral myocarditis. Methods A total of 125 patients with respiratory tract infection who were admitted to the Affiliated Run Run Shaw Hospital of Medical School, Zhejiang University from January 2018 to December 2022 were selected retrospectively. They were divided into the complication group (71 cases) and the non-complication group (54 cases) according to whether they were complicated with viral myocarditis. Dynamic and conventional electrocardiogram characteristics were compared. Serum BNP and CK-MB levels in the complication group and the non-complication group at admission were analyzed. Dynamic electrocardiograms and serum BNP and CK-MB levels of patients with different severity of myocarditis were comparatively analyzed. The value of combined diagnosis was analyzed. Results The detection rates of atrial premature beats and sinus tachycardia by dynamic electrocardiogram were higher than those by conventional electrocardiogram: 38.03% (27/71) vs. 22.54% (16/71), 28.17% (20/71) vs. 14.08% (10/71) (P<0.05). Serum BNP and CK-MB levels in the complication group were higher than those in the non-complication group: (104.26 ± 10.75) ng/L vs. (54.11 ± 5.69) ng/L, (17.89 ± 1.86) U/L vs. (13.46 ± 1.42) U/L (P<0.05). The detection rates of atrial premature beats, sinus tachycardia, burst ventricular tachycardia, first-degree atrioventricular block, ST segment change and low QRS voltage, serum BNP and CK-MB levels in patients with respiratory tract infection complicated with severe viral myocarditis (37 cases) were higher than those in patients with mild viral myocarditis (34 cases): 51.35% (19/37) vs. 23.53% (8/34), 43.24% (16/37) vs. 11.76% (4/34), 32.43% (12/37) vs. 11.76% (4/34), 29.73% (11/37) vs. 8.82% (3/34), 43.24% (16/37) vs. 14.71% (5/34), 24.32% (9/37) vs. 5.88% (2/34), (107.19 ± 10.56) ng/L vs. (101.08 ± 10.18) ng/L, (18.33 ± 1.85) U/L vs. (17.41 ± 1.76) U/L (P<0.05). Compared with clinical pathological diagnosis,Kappa values of dynamic electrocardiogram, BNP at admission, CK-MB at admission and combination of the three for diagnosing acute upper respiratory tract infection complicated with viral myocarditis were 0.784, 0.765, 0.733 and 0.879. The sensitivity and accuracy of combined diagnosis were higher. Conclusions Dynamic electrocardiogram combined with serum BNP and CK-MB can better help to evaluate the severity of respiratory tract infection complicated with myocarditis. Therefore, they are worthy of monitoring.

    超声心动描记术,超声心动图心肌炎脑钠肽肌酸激酶同工酶呼吸道感染

      原文链接:
    • 万方数据

    血清白细胞介素-17A、趋化因子配体19水平与狼疮性肾炎患者疾病活动度的关系

    徐利徐玮玮张学会陈伟伟...
    231-236页
    查看更多>>摘要：目的 探究血清白细胞介素17A（IL-17A）、趋化因子配体19（CCL19）水平与狼疮性肾炎患者疾病活动度的关系。 方法 采用回顾性研究的方法，选取济宁医学院附属医院2020年6月至2023年2月收治的狼疮性肾炎患者100例为疾病组，依据疾病活动指数将患者分为非活动组（32例）、轻度活动组（21例）、中度活动组（29例）、重度活动组（18例）；另选取同期进行体检的健康者100例作为对照组。酶联免疫吸附法（ELISA）检测血清IL-17A、CCL19表达水平；Pearson法分析狼疮性肾炎患者血清IL-17A、CCL19与常规指标的相关性；受试者工作特征曲线分析血清IL-17A、CCL19对狼疮性肾炎疾病活动度为中/重度的诊断价值。 结果 疾病组血清IL-17A、CCL19表达水平均显著高于对照组[（252.63 ± 64.47）ng/L比（123.27 ± 25.12） ng/L、（566.98 ± 73.36） ng/L比（275.63 ± 50.48）ng/L]（t = 18.70、32.72，P<0.05）；重度活动组、中度活动组、轻度活动组血清IL-17A和CCL19水平均高于非活动组[（331.42 ± 87.46）、（278.50 ± 74.19）、（232.34 ± 59.16）ng/L比（198.18 ± 46.22）ng/L，（662.33 ± 89.57）、（606.14 ± 79.25）、（552.84 ± 68.36）ng/L比（487.13 ± 62.19）ng/L]，且随着疾病活动度的增加，血清IL-17A、CCL19水平均逐渐升高（F = 17.86、25.35，P<0.05）；活动组肾小球滤过率、白蛋白、补体C3、补体C4均显著低于非活动组[（69.17 ± 13.25）ml/（min·1.73 m2）比（86.18 ± 14.16）ml/（min·1.73 m2）、（24.18 ± 5.11）g/L比（31.25 ± 6.35）g/L、（432.35 ± 95.22）mg/L比（675.42 ± 125.16） mg/L、（76.58 ± 17.51）mg/L比（121.42 ± 27.18）mg/L]，血肌酐、尿蛋白、红细胞沉降率均显著高于非活动组[（92.34 ± 16.24）μmoI/L比（53.21 ± 9.17）μmoI/L、（3.43 ± 0.82）g/24 h比（1.26 ± 0.23）g/24 h、（66.37 ± 12.28）mm/1 h比（35.62 ± 8.67）mm/1 h]，差异均有统计学意义（t = 5.86、5.97、10.74、9.93、12.70、14.67、12.74，均P<0.05）；狼疮性肾炎患者血清IL-17A、CCL19与肾小球滤过率、白蛋白、补体C3、补体C4均呈负相关，与血肌酐、尿蛋白、ESR均呈正相关（P<0.05）；血清IL-17A、CCL19二者联合诊断狼疮性肾炎疾病活动度的曲线下面积为0.961，优于各自单独诊断（Z = 2.24和3.16，P = 0.025和0.002）。 结论 血清IL-17A、CCL19表达水平随着狼疮性肾炎患者疾病活动度的增加而逐渐升高，二者联合检测对狼疮性肾炎疾病活动度有较好的诊断价值。 Objective To investigate the relationship between serum levels of interleukin-17A (IL-17A) and chemokine ligand 19 (CCL19) and disease activity in patients with lupus nephritis. Methods A total of 100 patients with lupus nephritis admitted to Affiliated Hospital of Jining Medical College from June 2020 to February 2023 were collected as the disease group, according to the disease activity index, patients were grouped into inactive group (32 cases), mild active group (21 cases), moderate active group (29 cases), and severe active group (18 cases) another 100 healthy individuals who underwent physical examinations in our hospital during the same period were collected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect the expression levels of IL-17A and CCL19 in serum Pearson method was applied to analyze the correlation between serum IL-17A, CCL19 and routine indicators in patients with lupus nephritis receiver operating characteristic curve was applied to analyze the diagnostic value of serum IL-17A and CCL19 for moderate/severe lupus nephritis disease activity. Results The expression levels of IL-17A and CCL19 in the serum of the disease group were obviously higher than those of the control group: (252.63 ± 64.47) ng/L vs. (123.27 ± 25.12) ng/L and (566.98 ± 73.36) ng/L vs. (275.63 ± 50.48) ng/L (t = 18.70 and 32.72, P<0.05) the serum levels of IL-17A and CCL19 in the severe active, moderate active, and mild active groups were higher than those in the inactive group: (331.42 ± 87.46), (278.50 ± 74.19) and (232.34 ± 59.16) ng/L vs. (198.18 ± 46.22) ng/L (662.33 ± 89.57), (606.14 ± 79.25) and (552.84 ± 68.36) ng/L vs. (487.13 ± 62.19) ng/L, and with the increase of disease activity, the levels of serum IL-17A and CCL19 gradually increased (F = 17.86 and 25.35, P<0.05) the glomerular filtration rate, albumin, complement C3 and complement C4 in the active group were obviously lower than those in the inactive group: (69.17 ± 13.25) ml/(min·1.73 m2) vs. (86.18 ± 14.16) ml/(min·1.73 m2), (24.18 ± 5.11) g/L vs. (31.25 ± 6.35) g/L, (432.35 ± 95.22) mg/L vs. (675.42 ± 125.16) mg/L, (76.58 ± 17.51) mg/L vs. (121.42 ± 27.18) mg/L, while blood creatinine, urine protein and erythrocyte sedimentation rate were obviously higher than those in the inactive group: (92.34 ± 16.24) μmoI/L vs. (53.21 ± 9.17) μmoI/L, (3.43 ± 0.82) g/24 h vs. (1.26 ± 0.23) g/24 h, (66.37 ± 12.28) mm/1 h vs. (35.62 ± 8.67) mm/1 h ( t = 5.86, 5.97, 10.74, 9.93, 12.70, 14.67 and 12.74 P<0.05) serum IL-17A and CCL19 in patients with lupus nephritis were negatively correlated with glomerular filtration rate, albumin, complement C3, and complement C4, while positively correlated with blood creatinine, urine protein, and ESR (P<0.05) the area under the curve (AUC) of the combined diagnosis of serum IL-17A and CCL19 for lupus nephritis disease activity was 0.961, which was superior to their respective individual diagnoses (Z = 2.24 and 3.16, P = 0.025 and 0.002). Conclusions The expression levels of IL-17A and CCL19 in serum gradually increase with the increase of disease activity in patients with lupus nephritis. The combined detection of the two has good diagnostic value for disease activity in lupus nephritis.

    狼疮肾炎,狼疮性肾炎白细胞介素17A趋化因子配体19疾病活动度相关性

      原文链接:
    • 万方数据

    消化性溃疡合并幽门螺杆菌感染患者血清微小RNA-155和135b-5p表达变化及临床意义

    艾宽宽胡瑞瑞薛原王岩...
    237-241页
    查看更多>>摘要：目的 探讨消化性溃疡合并幽门螺杆菌（Hp）感染患者血清微小RNA（miR）-155和miR-135b-5p表达水平及其临床意义。 方法 采用前瞻性研究的方法，连续选取济宁医学院附属医院2021年7月至2023年2月消化性溃疡患者263例。其中，经14C呼气试验确定为Hp感染146例（Hp感染组），未合并Hp感染117例（非Hp感染组）；免疫印迹法确定Ⅰ型Hp感染110例，Ⅱ型Hp感染36例。采用实时荧光定量聚合酶链反应法检测血清miR-155和miR-135b-5p表达水平，放射免疫法检测血清胃泌素水平，酶联免疫吸附法检测血清胃蛋白酶原（PG）Ⅰ和PG Ⅱ水平；记录患者基本临床资料。采用多因素Logistic回归分析影响消化性溃疡患者发生Hp感染的独立危险因素；采用受试者工作特征（ROC）曲线分析血清miR-155和miR-135b-5p对消化性溃疡患者发生Hp感染的诊断价值。 结果 Hp感染组胃泌素、PG Ⅰ、PG Ⅱ、溃疡出血率和复发比例明显高于非Hp感染组[（108.47 ± 15.35）ng/L比（79.63 ± 10.58）ng/L、（295.41 ± 37.26）pg/L比（236.75 ± 29.17）pg/L、（44.08 ± 8.52）pg/L比（39.29 ± 6.74）pg/L、25.34%（37/146）比15.38%（18/117）和21.92%（32/146）比11.97%（14/117）]，差异有统计学意义（P<0.01或<0.05）。Hp感染组血清miR-155和miR-135b-5p明显高于非Hp感染组（1.94 ± 0.63比0.95 ± 0.29和1.86 ± 0.57比1.03 ± 0.31），差异有统计学意义（P<0.01）。Ⅰ型Hp感染患者血清miR-155和miR-135b-5p明显高于Ⅱ型Hp感染患者（2.05 ± 0.66比1.60 ± 0.54和1.97 ± 0.61比1.52 ± 0.45），差异有统计学意义（P<0.01）。多因素Logistic回归分析结果显示，血清miR-155、miR-135b-5p、胃泌素、PG Ⅰ是影响消化性溃疡患者发生Hp感染的独立危险因素（OR = 1.443、1.436、1.452和1.438，95% CI 1.165～1.787、1.146～1.799、1.187～1.777和1.150～1.798，P<0.01）。ROC曲线分析结果显示，血清miR-155和miR-135b-5p联合诊断消化性溃疡患者发生Hp感染的曲线下面积明显大于血清miR-155和miR-135b-5p单独诊断（0.907比0.839和0.836，Z = 2.57和2.81，P = 0.010和0.005）。 结论 消化性溃疡合并Hp感染患者血清miR-155和miR-135b-5p水平较高，两者联合检测对消化性溃疡患者发生Hp感染具有较高的诊断价值。 Objective To investigate the expression levels and clinical significance of serum microRNA (miR) -155 and miR-135b-5p in patients with peptic ulcer complicated with Helicobacter pylori (Hp) infection. Methods A prospective study was conducted, and 263 patients with peptic ulcer were selected consecutively from July 2021 to February 2023 at the Affiliated Hospital of Jining Medical College. Among them, 146 cases were confirmed as Hp infection (Hp infection group) and 117 cases were not complicated with Hp infection (non Hp infection group) by 14C breath test type Ⅰ Hp infection was in 110 cases, and type Ⅱ Hp infection was in 36 cases by immunoblotting method. The serum expression levels of miR-155 and miR-135b-5p were detected by real-time fluorescence quantitative polymerase chain reaction, serum gastrin level was detected by radioimmunoassay method, and the serum pepsinogen (PG) Ⅰ and PG Ⅱ were detected by enzyme linked immunosorbent assay. The clinical data were recorded. Multivariate Logistic regression analysis was used to analyze the independent risk factors of Hp infection in patients with peptic ulcer receiver operating characteristic (ROC) curve was used to analyze the efficacy of serum miR-155 and miR-135b-5p in diagnosis the Hp infection in patients with peptic ulcer. Results The gastrin, PG Ⅰ, PG Ⅱ, ulcer bleeding rate and recurrence rate in Hp infection group were significantly higher than those in non Hp infection group: (108.47 ± 15.35) ng/L vs. (79.63 ± 10.58) ng/L, (295.41 ± 37.26) pg/L vs. (236.75 ± 29.17) pg/L, (44.08 ± 8.52) pg/L vs. (39.29 ± 6.74) pg/L, 25.34% (37/146) vs. 15.38% (18/117) and 21.92% (32/146) vs. 11.97% (14/117), and there were statistical differences (P<0.01 or <0.05). The serum miR-155 and miR-135b-5p inHp infection group were significantly higher than those in non Hp infection group (1.94 ± 0.63 vs. 0.95 ± 0.29 and 1.86 ± 0.57 vs. 1.03 ± 0.31), and there were statistical differences (P<0.01). The serum miR-155 and miR-135b-5p in patients with typeⅠHp infection were significantly higher than those in patients with type Ⅱ Hp infection (2.05 ± 0.66 vs. 1.60 ± 0.54 and 1.97 ± 0.61 vs. 1.52 ± 0.45), and there were statistical differences (P<0.01). Multivariate Logistic regression analysis result showed that serum miR-155, miR-135b-5p, gastrin and PG Ⅰwere independent risk factors ofHp infection in patients with peptic ulcer (OR = 1.443, 1.436, 1.452 and 1.438 95% CI 1.165 to 1.787, 1.146 to 1.799, 1.187 to 1.777 and 1.150 to 1.798 P<0.01). ROC curve analysis result showed that the area under the curve of serum miR-155 combined with miR-135b-5p in the diagnosis ofHp infection in patients with peptic ulcer was significantly greater than that of serum miR-155 and miR-135b-5p alone (0.907 vs. 0.839 and 0.836, Z = 2.57 and 2.81, P = 0.010 and 0.005). Conclusions The serum levels of miR-155 and miR-135b-5p are high in patients with peptic ulcer complicated with Hp infection, and the combination of the two has high diagnostic value for Hp infection in patients with peptic ulcer.

    消化性溃疡幽门螺杆菌微RNAs诊断

      原文链接:
    • 万方数据

    急性胰腺炎患者血清三结构域35和肿瘤坏死因子受体相关因子3表达水平及其临床意义

    才新韩敏卓尕吉张莉...
    242-247页
    查看更多>>摘要：目的 探究急性胰腺炎（AP）患者血清三结构域35（TRIM35）和肿瘤坏死因子受体相关因子3（TRAF3）表达水平及其与病情程度和预后的相关性。 方法 采用前瞻性研究的方法，选取青海红十字医院2020年7月至2022年9月AP患者93例（观察组），其中轻症急性胰腺炎（MAP）40例，中重症急性胰腺炎（MSAP）29例，重症急性胰腺炎（SAP）24例；另选取同期健康体检者40例作为健康对照组。采用实时荧光定量聚合酶链反应（RT-qPCR）法检测血清TRIM35和TRAF3水平。随访入院28 d后的生存状况。相关性分析采用Pearson法；采用多因素Logistic回归分析血清TRIM35和TRAF3与AP患者预后的关系；采用受试者工作特征（ROC）曲线分析血清TRIM35和TRAF3对AP患者预后的评估价值。 结果 观察组血清TRIM35和TRAF3水平明显高于健康对照组（3.76 ± 1.36比1.02 ± 0.19和5.37 ± 2.18比1.04 ± 0.16），差异有统计学意义（P<0.01）。MSAP和SAP患者血清TRIM35和TRAF3水平明显高于MAP患者（4.11 ± 1.73和4.96 ± 1.47比2.79 ± 1.04、5.43 ± 2.15和7.01 ± 2.85比4.35 ± 1.79），SAP患者明显高于MSAP患者，差异有统计学意义（P<0.05）。随访结果显示，死亡11例，存活82例。死亡患者血清TRIM35和TRAF3明显高于存活患者（4.94 ± 1.01比3.60 ± 1.67和7.08 ± 1.43比5.14 ± 2.57），差异有统计学意义（P<0.05）。Pearson相关分析结果显示，AP患者血清TRIM35水平与血清TRAF3水平呈正相关（r = 0.483，P<0.01）。多因素Logistic回归分析结果显示，血清TRIM35和TRAF3水平是影响AP患者预后的独立危险因素（OR = 1.86和1.37，95% CI 1.12～3.09和1.02～1.82，P<0.05）。ROC曲线分析结果显示，血清TRIM35联合TRAF3水平评估AP患者预后的曲线下面积明显大于血清TRIM35和TRAF3单独评估（0.85比0.81和0.81，Z = 0.03和0.04，P<0.05），血清TRIM35和TRAF3水平的最佳截断值为4.90和6.11。 结论 AP患者血清TRIM35和TRAF3水平明显升高，且与病情程度有关，血清TRIM35和TRAF3水平是影响AP患者预后的独立影响因素，两者联合检测评估AP患者的预后更有价值。 Objective To explore the expression levels of serum triple domain 35 (TRIM35) and tumor necrosis factor receptor associated factor 3 (TRAF3) in patients with acute pancreatitis (AP) and their correlation with the severity and prognosis of the disease. Methods Using a prospective research method, 93 patients with AP (observation group) were selected from July 2020 to September 2022 in Qinghai Red Cross Hospital, including 40 cases of mild acute pancreatitis (MAP), 29 cases of moderate to severe acute pancreatitis (MSAP) and 24 cases of severe acute pancreatitis (SAP). During the same period, 40 healthy individuals who underwent physical examinations were selected as healthy control group. The serum TRIM35 and TRAF3 levels were detected by real time fluorescence quantitative polymerase chain reaction (RT-qPCR). The survival status after 28 d of admission was followed up. The correlation was analyzed by Pearson method. Multivariate Logistic regression analysis was used to analyze the relationship between serum TRIM35 and TRAF3 levels and the prognosis in patients with AP. The efficacy of serum TRIM35 and TRAF3 in predicting the prognosis in patients with AP was evaluated by the receiver operating characteristics (ROC) curve. Results The serum TRIM35 and TRAF3 levels in observation group were significantly higher than those in healthy control group (3.76 ± 1.36 vs. 1.02 ± 0.19 and 5.37 ± 2.18 vs. 1.04 ± 0.16), and there were statistical differences (P<0.01). The serum TRIM35 and TRAF3 levels in patients with MSAP and SAP were significantly higher than those in patients with MAP (4.11 ± 1.73 and 4.96 ± 1.47 vs. 2.79 ± 1.04, 5.43 ± 2.15 and 7.01 ± 2.85 vs. 4.35 ± 1.79), the indexes in patients with SAP were significantly higher than those in patients with MSAP, and there were statistical differences (P<0.05). The follow-up results showed that 11 cases died and 82 cases survived. The serum TRIM35 and TRAF3 levels in death patients were significantly higher than those in surviving patients (4.94 ± 1.01 vs. 3.60 ± 1.67 and 7.08 ± 1.43 vs. 5.14 ± 2.57), and there were statistical differences (P<0.05). Pearson correlation analysis result showed that serum TRIM35 level was positive correlation with serum TRAF3 level in patients with AP (r = 0.483, P<0.01). Multivariate Logistic regression analysis result showed that serum TRIM35 and TRAF3 levels were the independent risk factors of prognosis in patients with AP (OR = 1.86 and 1.37, 95% CI 1.12 to 3.09 and 1.02 to 1.82, P<0.05). ROC curve analysis result showed that the area under the curve of serum TRIM35 combined with TRAF3 levels for evaluating the prognosis in patients with AP was significantly larger than serum TRIM35 and TRAF3 alone (0.85 vs. 0.81 and 0.81,Z = 0.03 and 0.04, P<0.05). The optimal cutoff values of serum TRIM35 and TRAF3 levels were 4.90 and 6.11. Conclusions The serum TRIM35 and TRAF3 levels in patients with AP are significantly elevated, and are related to the severity of the condition. The serum TRIM35 and TRAF3 levels are independent risk of prognosis in patients with AP, and their combined detection is more valuable in evaluating the prognosis in patients with AP.

    胰腺炎预后肿瘤坏死因子受体相关肽和相关蛋白质类三结构域35

      原文链接:
    • 万方数据