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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。
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    2024年卷首语

    石祥恩
    1页
    查看更多>>摘要：我们怀着喜悦的心情迎来了2024年伊始，也是我国农历吉祥的龙年。《中国医师进修杂志》迎来了47卷刊。在过去的一年里，我们面对疫情后的形势，秉持积极稳妥、稳中求进的思路，认真履行国家卫生健康委员会、国家新闻出版署、中华医学会等上级主管部门的各项工作，按期完成了235篇文章发表计划。严格执行国家标准和行业规范，严格执行三审三校制度。参加了第八届中国科协优秀科技论文暨2023年度中华医学会科技论文TOP100遴选申报活动，2023年度中国临床案例成果数据库优秀临床案例成果征集遴选活动。经过专业投稿者、医务读者、期刊人员、审稿专家等的共同努力，我刊连续多年收录为中国科技核心期刊、中国科技论文统计源期刊及中国学术期刊影响因子年报统计源期刊，高质量办刊创佳绩，社会效益和经济效益成效显著，主要学术指标大幅度提高，其中期刊综合影响因子由0.921提高到1.027，增幅11.51%；期刊影响力指数学科排序（共215种杂志）由第79名提高到第71名；省部级以上基金论文由32篇提高到38篇，增幅18.75%，被引半衰期由3.2提高到3.3，增幅3.13%；自引频次由118次提高到158次，增幅33.90%，高影响力作者发文由65篇提高到109篇，增幅67.69%。荣获2022年度《中华医学杂志》社有限责任公司期刊进步奖，在2022年度中华医学会系列杂志审读中获英文摘要单项优秀期刊和法定计量单位单项优秀期刊。我们与时俱进地选题和约稿，2023年出版了4期重点号文章，满足读者的关切，包括心内科相关疾病的诊治新进展、骨肿瘤诊治新进展、哮喘诊疗新进展及恶性脑胶质瘤诊治诸多方面的最新成果等，面对不同学科专业的问题，进行学术进展综述，提高了期刊实用性、专业性和影响力。
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    从外科康复治疗到消化道动力外科

    王剑张莉
    2-5页
    查看更多>>摘要：短肠综合征外科康复治疗的核心是通过将扩张的肠管恢复至正常直径来纠正短肠综合征继发的肠管扩张和小肠细菌过度生长，并恢复肠管的运动功能。这一外科实践证实了这样一个结论：外科手术可以改变小肠的动力。结合之后的其他针对胃肠道功能或代谢性疾病的外科治疗手段并由此引申，将这一关系扩展到其他胃肠道动力障碍性疾病的治疗，提出了消化道动力外科的概念。以消化道测压技术研究为基础，对胃肠道动力障碍性疾病中的重症患者即发生肠功能障碍的患者进行筛选和治疗将有助于拓展新的外科治疗手段。

    短肠综合征外科康复治疗胃肠道动力障碍性疾病消化道动力外科消化道测压

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    功能性消化不良患者重叠下消化道症状的临床特征和胃电图分析

    李飞俞汀王美峰林琳...
    6-12页
    查看更多>>摘要：目的 分析功能性消化不良（FD）患者重叠下消化道症状（LGS）的表现和胃电图特征。 方法 回顾性分析2018年1月至2020年12月南京医科大学第一附属医院61例FD患者的临床资料。其中，FD重叠LGS 33例（FD重叠LGS组），单纯FD 28例（单纯FD组）。记录FD患者重叠LGS的表现；采用罗马Ⅳ标准评估消化不良症状评分；采用医院焦虑抑郁量表（HADS）评估焦虑和抑郁状态，匹兹堡睡眠质量指数（PSQI）量表评估睡眠障碍情况；进行胃电图检查，记录正常慢波百分比（N%）、胃动过缓百分比（B%）、胃动过速百分比（T%）、胃节律紊乱百分比（A%）、主频率、主功率和餐后与餐前功率比（PR）。 结果 FD患者重叠LGS的最常见症状是下腹胀[84.85%（28/33）]。FD重叠LGS组上腹胀气评分明显高于单纯FD组[7.00（6.50，7.00）分比分5.00（0.50，7.00）分]，差异有统计学意义（P<0.01）；两组其他各消化不良症状评分及总评分比较差异无统计学意义（P>0.05）。FD重叠LGS组抑郁和睡眠障碍发生率明显高于单纯FD组[42.42%（14/33）比14.29%（4/28）和69.70%（23/33）比39.29%（11/28）]，差异有统计学意义（χ2 = 5.77和5.68，P<0.05）；两组焦虑发生率比较差异无统计学意义（P>0.05）。FD重叠LGS组，胃底区餐后T%和胃体区餐后A%明显低于餐前[13.79%（6.79%，21.46%）比20.69%（12.45%，27.59%）和3.45%（0，6.90%）比6.90%（3.45%，13.79%）]，差异有统计学意义（P<0.01）；单纯FD组，胃底区餐后N%明显低于餐前[55.92%（43.71%，70.02%）比69.27%（48.07%，78.45%）]，差异有统计学意义（P<0.05）。胃底区，FD重叠LGS组餐前N%明显低于单纯FD组，餐前B%和T%明显高于单纯FD组，差异有统计学意义（P<0.01或<0.05）；胃体区，FD重叠LGS组餐前N%明显低于单纯FD组，差异有统计学意义（P<0.05）；幽门区，FD重叠LGS组PR明显低于单纯FD组，差异有统计学意义（P<0.05）；整体胃，FD重叠LGS组餐前N%明显低于单纯FD组，餐前B%和T%明显高于单纯FD组，差异有统计学意义（P<0.01或<0.05）。Spearman相关分析结果显示，FD重叠LGS患者病程与胃电参数无相关性（P>0.05）；消化不良症状总评分与整体胃餐后A%呈正相关（r = 0.345，P<0.05），与整体胃及幽门区餐后主频率呈负相关（r = - 0.357和- 0.473，P<0.05或<0.01）。 结论 FD患者可重叠多种LGS。FD重叠LGS患者消化不良症状更严重；伴抑郁和睡眠障碍的比例更高；空腹时近端胃电节律异常和排空功能受损更严重。FD重叠LGS患者消化不良症状程度与餐后胃电节律异常相关。 Objective To analyze the characteristics and electrogastrogram features of patients with functional dyspepsia (FD) overlapping lower gastrointestinal symptoms (LGS). Methods The clinical data of 61 patients with FD from January 2018 to December 2020 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Among them, FD overlapping LGS was in 33 cases (FD overlapping LGS group), and simple FD in 28 cases (simple FD group). The manifestations of patients with FD overlapping LGS were recorded. The dyspeptic symptom score was assessed using the Rome Ⅳ criteria. Anxiety and depression status were evaluated using the hospital anxiety and depression scale (HADS), and sleep disorder was assessed using the Pittsburgh sleep quality index (PSQI). The electrogastrogram was performed, and the normal slow wave percentage (N%), bradygastria percentage (B%), tachygastria percentage (T%), arrhythmia percentage (A%), dominant frequency, dominant power and postprandial-to-fasting power ratio (PR) were recorded. Results The most common symptom in FD patients overlapping LGS was lower abdomen distention, the incidence was 84.85% (28/33). The upper abdominal bloating score in FD overlapping LGS group was significantly higher than that in simple FD group: 7.00 (6.50, 7.00) scores vs. 5.00 (0.50, 7.00) scores, and there was statistical difference (P<0.01) there were no statistical differences in other dyspeptic symptoms scores and total score between the two groups (P>0.05). The incidences of depression and sleep disorder in FD overlapping LGS group were significantly higher than those in simple FD group: 42.42% (14/33) vs. 14.29% (4/28) and 69.70% (23/33) vs. 39.29% (11/28), and there were statistical differences (χ2 = 5.77 and 5.68, P<0.05) there was no statistical difference in the incidence of anxiety between the two groups (P>0.05). In FD overlapping LGS group, the postprandial T% in the gastric fundus and postprandial A% in the gastric body were significantly lower than those before meal: 13.79% (6.79%, 21.46%) vs. 20.69% (12.45%, 27.59%) and 3.45% (0, 6.90%) vs. 6.90% (3.45%, 13.79%), and there were statistical differences (P<0.01). In simple FD group, the postprandial N% in the gastric fundus was significantly lower than that before meal: 55.92% (43.71%, 70.02%) vs. 69.27% (48.07%, 78.45%), and there was statistical difference (P<0.05). In the gastric fundus, the preprandial N% in FD overlapping LGS group was significantly lower than that in simple FD group, preprandial B% and T% were significantly higher than those in simple FD group, and there were statistical differences (P<0.01 or <0.05). In the gastric body, the preprandial N% in FD overlapping LGS group was significantly lower than that in simple FD group, and there was statistical difference (P<0.05). In the pyloric region, the PR in FD overlapping LGS group was significantly lower than that in simple FD group, and there was statistical difference (P<0.05). In the overall stomach, the preprandial N% in FD overlapping LGS group was significantly lower than that in simple FD group, the preprandial B% and T% were significantly higher than those in simple FD group, and there were statistical differences (P<0.01 or <0.05). Spearman correlation analysis result showed that the disease course was not correlated with electrogastrogram parameters in patients with FD overlapping LGS (P>0.05) the total score of dyspeptic symptoms was positively correlated with postprandial A% in the overall stomach (r = 0.345, P<0.05), and negatively correlated with postprandial dominant frequency in the overall stomach and pyloric region (r = -0.357 and -0.473, P<0.05 or <0.01). Conclusions FD patients can overlap with various LGS. The patients with FD overlapping LGS have more severe dyspepsia symptoms, higher proportions of comorbid depression and sleep disorders, and more severe abnormalities in fasting proximal gastric electrical rhythm and emptying function. The severity of dyspeptic symptoms in patients with FD overlapping LGS is correlated with postprandial gastric electrical rhythm abnormalities.

    消化不良入睡和睡眠障碍重叠症状胃电图焦虑抑郁

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    小肠压力测定用于胃肠动力障碍性疾病诊疗的初步研究

    张联合卞邦健金欣郭宏杰...
    13-18页
    查看更多>>摘要：目的 研究小肠压力测定在胃肠道动力障碍性疾病患者诊疗中的应用价值。 方法 回顾性分析上海交通大学医学院附属第九人民医院2019年2月至2020年1月20例疑诊胃肠道动力障碍性疾病患者的临床资料，均行诊断性小肠压力测定，分析小肠压力测定对临床诊断和治疗决策的影响。 结果 纳入20例患者中，18例成功完成小肠压力测定。14例测压结果明显异常，9例经治疗有明显营养学改善，5例进行维持性营养支持治疗。10例患者小肠测压具有改变或明确诊断的意义，12例患者小肠测压结果影响了治疗方案。 结论 小肠压力测定结果明显影响患者的临床诊断和治疗决策，在胃肠道动力障碍性疾病的诊疗实践中具有重要价值。 Objective To investigate the significance of small intestinal manometry in clinical diagnosis and treatment of patients with gastrointestinal motility disorders. Methods The clinical data of 20 suspected patients with gastrointestinal motility disorders from February 2019 to January 2020 in Shanghai Jiaotong University Affiliated Ninth People′s Hospital were retrospectively analyzed. All patients were performed small intestinal manometry, and the influence on diagnosis and treatment as well as the clinical value of this technique were analyzed. Results Among the 20 patients, 18 patients successfully accepted small intestinal manometry. Among the 18 patients, 14 patients showed significant motility abnormalities, among which 9 patients showed significant nutritional improvement after treatment and 5 patients were treated with maintaining nutritional support. In 10 patients, small intestinal manometry served as a deciding diagnostic tool, and in 12 patients, major modifications of treatment strategy were made according to results of small intestinal manometry. Conclusions The small intestinal manometry significantly improves diagnosis and treatment decision in the patients with gastrointestinal motility disorders and shows great value on the clinical practice on this group of patients.

    小肠测压胃肠动力障碍性疾病肠功能障碍

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    肠动力障碍13例分析

    郭宏杰卞邦健金欣张联合...
    18-22页
    查看更多>>摘要：目的 分析肠动力障碍（ED）的临床特点，以提高临床诊治能力。 方法 回顾性分析上海交通大学医学院附属第九人民医院和南京医科大学第四附属医院2019年8月至2022年7月13例行小肠测压的ED患者临床资料，包括临床表现、小肠压力测定结果、治疗和预后。 结果 13例患者中，小肠压力测定结果1项异常9例，2项异常2例，3项异常2例。患者均有便秘病史，5例以便秘起病行结肠次全切除术。3例患者伴有严重腹痛，其中1例依赖阿片类药物。8例患者采用手术治疗，均获得营养学改善及症状减轻。 结论 ED是明确定义的疾病，具有清晰的诊断标准，部分患者外科治疗可以改善症状。 Objective To investigate the clinical characters of enteric dysmotility (ED), in order to improve clinical diagnosis and treatment capabilities. Methods The clinical data of 13 ED patients underwent small intestinal manometry from August 2019 to July 2022 in the Shanghai Jiaotong University Affiliated Ninth People′s Hospital and the Fourth Affiliated Hospital of Nanjing Medical University were retrospectively analyzed, including the clinical manifestation, small intestinal manometry result, treatment and prognosis. Results Among 13 patients, 1 abnormality was presented in 9 cases, 2 abnormalities presented in 2 cases and 3 abnormalities presented in 2 cases. All 13 cases presented a history of constipation, 5 cases started with constipation and underwent subtotal colectomy. Three patients showed severe chronic abdominal pain with one of them opiate dependence. Eight patients underwent surgical treatment, all of which achieved nutritional improvement and symptom relief. Conclusions ED is a concisely defined disease with clear diagnostic criteria. The surgery can increase the symptoms of some patients.

    肠动力障碍小肠测压肠功能障碍

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    腹腔镜下Nissen胃底折叠术治疗难治性胃食管反流病的短期疗效分析

    王镇张永强邵国益胡根...
    23-27页
    查看更多>>摘要：目的 探讨腹腔镜下Nissen胃底折叠术治疗难治性胃食管反流病（rGERD）的安全性和短期疗效。 方法 回顾性分析2018年3月至2022年3月江阴市人民医院61例行腹腔镜下Nissen胃底折叠术患者的临床资料。其中，术前服用质子泵抑制剂（PPI）后症状明显缓解14例（A组），服用PPI后症状部分缓解30例（B组），服用PPI后症状未缓解加用双倍剂量规律治疗8周以上症状仍未缓解17例（C组）。比较三组手术治疗和恢复情况。 结果 61例患者手术时间（117.46 ± 28.50） min，术中失血量23.00（8.00，34.00） ml，术后住院时间3.00（2.00，5.00） d。三组手术时间、术中失血量、术后住院时间、合并食管裂孔疝手术、放置补片比较差异无统计学意义（P>0.05）。三组患者术后均未发生腹腔出血、腹腔感染和消化道穿孔等短期严重并发症。三组满意度评分、术后总体症状主观缓解、反流症状、PPI使用情况、吞咽困难、腹胀、腹泻或便秘比较差异无统计学意义（P>0.05）。三组均未发生上腹痛、复发和再手术情况。 结论 腹腔镜下Nissen胃底折叠术对于rGERD疗效确切，抗反流效果明显，术后未出现严重并发症，无复发和再手术病例。 Objective To investigate the safety and short-term efficacy of laparoscopic Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD). Methods The clinical data of 61 patients underwent laparoscopic Nissen fundoplication from March 2018 to March 2022 in Jiangyin People′s Hospital were retrospectively analyzed. Among them, 14 patients had significant symptom relief after using proton pump inhibitor (PPI) before operation (group A), 30 patients had partial symptom relief after using PPI (group B), and 17 patients had persistent symptoms despite regular treatment with double-dose PPI for more than 8 weeks (group C). The surgical outcomes and recovery were compared among the three groups. Results For the 61 patients, the surgical time was (117.46 ± 28.50) min, the intraoperative blood loss was 23.00 (8.00, 34.00) ml, and the postoperative hospital stay was 3.00 (2.00, 5.00) d. There were no statistically significant differences in surgical time, intraoperative blood loss, postoperative hospital stay, concurrent hiatal hernia repair and mesh placement among the three groups (P>0.05). No short-term severe complications such as abdominal bleeding, abdominal infection and gastrointestinal perforation occurred in any group. There were no statistical differences in satisfaction score, subjective relief of overall postoperative symptoms, reflux symptoms, PPI usage, dysphagia, abdominal distention, diarrhea or constipation among the three groups (P<0.05). No upper abdominal pain, recurrence and reoperation occurred in the three groups. Conclusions Laparoscopic Nissen fundoplication has a definite therapeutic effect on rGERD, with significant anti reflux effects. There are no serious complications after surgery, and there are no recurrence or reoperation.

    胃食管反流胃底折叠术腹腔镜手术质子泵抑制剂治疗结果

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    血清前蛋白转化酶枯草溶菌素9、分泌型卷曲相关蛋白-4表达与肥胖性多囊卵巢综合征患者性激素、糖脂代谢的相关性

    刘源李煜吴侠吕彤...
    27-32页
    查看更多>>摘要：目的 探讨肥胖性多囊卵巢综合征患者血清前蛋白转化酶枯草溶菌素9（PCSK9）、分泌型卷曲相关蛋白-4（SFRP-4）表达与性激素、糖脂代谢的相关性。 方法 回顾性选取2021年4月至2022年10月徐州市妇幼保健院诊治的130例多囊卵巢综合征患者作为研究对象，根据体质量指数将患者分为肥胖组60例，非肥胖组70例。采用酶联免疫吸附法检测血清PCSK9、SFRP-4水平。对肥胖性多囊卵巢综合征患者血清PCSK9、SFRP-4水平与性激素（促黄体生成素、睾酮、卵泡刺激素）、糖代谢指标[空腹血糖（FPG）、糖化血红蛋白（HbAlc）、空腹胰岛素（FINS）、稳态模型评估法胰岛素抵抗指数（HOMA-IR）]、脂代谢指标[总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）]的相关性进行Pearson法分析。 结果 肥胖组较非肥胖组多囊卵巢综合征患者血清PCSK9、SFRP-4水平均显著升高[（679.36 ± 162.21） μg/L比（421.68 ± 103.74） μg/L、（302.87 ± 70.58） μg/L比（184.21 ± 52.45） μg/L]，差异有统计学意义（P<0.05）；与非肥胖组相比，肥胖组患者促黄体生成素、睾酮水平明显升高[（18.36 ± 5.34） U/L比　（9.47 ± 2.21） U/L、（3.61 ± 0.97） nmol/L比（3.02 ± 0.84） nmol/L]（P<0.05），卵泡刺激素水平明显降低[（7.28 ± 1.62） U/L比（8.03 ± 2.10） U/L]，差异有统计学意义（P<0.05）；肥胖组多囊卵巢综合征患者FPG、HbAlc、FINS水平及HOMA-IR均显著高于非肥胖组[（5.46 ± 0.67） mmol/L比（5.04 ± 0.49） mmol/L、（7.96 ± 0.98）%比（6.68 ± 0.77）%、（34.08 ± 3.64） U/L比（23.67 ± 2.52） U/L、8.27 ± 1.84比5.30 ± 1.52]，差异有统计学意义（P<0.05）；与非肥胖组相比，肥胖组多囊卵巢综合征患者TC、TG、LDL-C水平均显著升高[（4.86 ± 0.67） mmol/L比（4.12 ± 0.54） mmol/L、（1.64 ± 0.36） mmol/L比（1.06 ± 0.21） mmol/L、（2.81 ± 0.56） mmol/L比（2.14 ± 0.42） mmol/L]（P<0.05），HDL-C水平明显降低[（1.11 ± 0.25） mmol/L比（1.52 ± 0.40） mmol/L]，差异有统计学意义（P<0.05）；肥胖性多囊卵巢综合征患者血清PCSK9、SFRP-4水平与促黄体生成素、睾酮、FPG、HbAlc、FINS、HOMA-IR、TC、TG、LDL-C呈正相关（P<0.05），与卵泡刺激素、HDL-C呈负相关（P<0.05）。 结论 肥胖性多囊卵巢综合征患者血清PCSK9、SFRP-4水平升高，与患者性激素、糖脂代谢有关。 Objective To investigate the correlation between the expression of serum preprotein convertase subtilisin/kexin type 9 (PCSK9), secreted frizzled related protein-4 (SFRP-4) and sex hormone, glucose and lipid metabolism in obese polycystic ovary syndrome (PCOS) patients. Methods A total of 130 patients with polycystic ovary syndrome diagnosed and treated in Xuzhou Maternal and Child Health Hospital from April 2021 to October 2022 were selected as the study subjects, the patients were divided into obese group (60 cases) and non obese group (70 cases) according to body mass index. Enzyme linked immunosorbent assay was applied to detect the serum levels of PCSK9 and SFRP-4. The correlation between serum PCSK9, SFRP-4 levels and sex hormones (luteinizing hormone, testosterone, follicle stimulating hormone), glucose metabolism indicators [fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), homeostatic model assessment insulin resistance index (HOMA-IR)], lipid metabolism indexes [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)] in patients with obese polycystic ovary syndrome was analyzed by Pearson method. Results The serum levels of PCSK9 and SFRP-4 in obese group were significantly higher than those in non obese group: (679.36 ± 162.21) μg/L vs. (421.68 ± 103.74) μg/L, (302.87 ± 70.58) μg/L vs. (184.21 ± 52.45) μg/L, the difference was statistically significant ( P<0.05). Compared with the non obese group, the obese group had significantly higher levels of luteinizing hormone and testosterone: (18.36 ± 5.34) U/L vs. (9.47 ± 2.21) U/L, (3.61 ± 0.97) nmol/L vs. (3.02 ± 0.84) nmol/L (P<0.05), and significantly lower levels of follicle stimulating hormone: (7.28 ± 1.62) U/L vs. (8.03 ± 2.10) U/L, with statistically significant differences (P<0.05) the levels of FPG, HbA1c, FINS and HOMA-IR in obese group were significantly higher than those in non obese group: (5.46 ± 0.67) mmol/L vs. (5.04 ± 0.49) mmol/L, (7.96 ± 0.98)% vs. (6.68 ± 0.77)%, (34.08 ± 3.64) U/L vs. (23.67 ± 2.52) U/L, 8.27 ± 1.84 vs. 5.30 ± 1.52, and the differences were statistically significant (P<0.05) compared with the non obese group, the obese group had significantly increased levels of TC, TG and LDL-C: (4.86 ± 0.67) mmol/L vs. (4.12 ± 0.54) mmol/L, (1.64 ± 0.36) mmol/L vs. (1.06 ± 0.21) mmol/L and (2.81 ± 0.56) mmol/L vs. (2.14 ± 0.42) mmol/L (P<0.05), and HDL-C level was significantly reduced: (1.11 ± 0.25) mmol/L vs. (1.52 ± 0.40) mmol/L, with statistically significant differences (P<0.05) the levels of serum PCSK9 and SFRP-4 in obese polycystic ovary syndrome patients were positively correlated with luteinizing hormone, testosterone, FPG, HbA1c, FINS, HOMA-IR, TC, TG and LDL-C (P<0.05), and negatively correlated with follicle stimulating hormone and HDL-C (P<0.05). Conclusions The serum PCSK9 and SFRP-4 levels in obese polycystic ovary syndrome patients are elevated, which is related to sex hormones, glucose and lipid metabolism.

    多囊卵巢综合征肥胖性性激素糖脂代谢

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    孟鲁司特联合布地奈德治疗儿童间歇性哮喘的疗效研究

    陈刚曹静耿玉荣刘倩...
    33-38页
    查看更多>>摘要：目的 分析孟鲁司特联合布地奈德治疗儿童间歇性哮喘的效果及对气道重塑、T辅助细胞1（Th1）/T辅助细胞2（Th2）相关细胞因子的影响。 方法 采用前瞻性研究的方法，选取2021年12月至2023年2月黄骅市人民医院收治的120例间歇性哮喘患儿，按照随机数字表法分为对照组（雾化吸入布地奈德治疗）、观察组（在对照组基础上联合孟鲁司特治疗）各60例，比较两组临床疗效、气道重塑指标[气道总面积（Ao）、气道外径（D）、气道壁面积占气道总截面积百分比（WA%）]、肺功能[呼气峰流速值（PEF）、第1秒最大用力呼气量（FEV1）/用力肺活量（FVC）、用力呼出25%肺活量（MEF25%）]、Th1/Th2相关细胞因子、炎性反应指标[肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-4、IL-6、γ-干扰素（IFN-γ）]、复发与不良反应发生率。 结果 观察组治疗总有效率高于对照组[90.00%（54/60）比75.00%（45/60）]（P<0.05）；治疗后观察组Ao、D、WA%均小于对照组[（17.58 ± 1.89） mm2比（19.22 ± 1.94） mm2、（4.25 ± 0.48） mm比（4.48 ± 0.49） mm、（63.75 ± 6.49）%比（69.22 ± 7.14）%]，差异有统计学意义（P<0.05）；治疗后观察组PEF、FEV1/FVC、MEF25%均高于对照组[（3.13 ± 0.34）L/s比（2.86 ± 0.35）L/s、（87.45 ± 8.86）%比（83.59 ± 8.42）%、（87.63 ± 8.86）%比（82.15 ± 8.43）%]（P<0.05）；治疗后观察组Th1、Th1/Th2水平高于对照组[（14.13 ± 1.46）%比（10.27 ± 1.25）%、3.46 ± 0.39比1.88 ± 0.25]，Th2水平低于对照组[（3.96 ± 0.45）%比（5.48 ± 0.56）%]（P<0.05）；治疗后观察组TNF-α、IFN-γ较对照组更高[（76.15 ± 7.78） ng/L比（66.38 ± 6.47） ng/L、（7.15 ± 0.74） ng/L比（6.14 ± 0.66） ng/L]，IL-4、IL-6低于对照组[（77.85 ± 7.96）ng/L比（86.42 ± 8.74） ng/L、（37.25 ± 3.89） mg/L比（44.23 ± 4.57） mg/L]，差异有统计学意义（P<0.05）；观察组的复发率较对照组更低[3.33%（2/60）比15.00%（9/60）]，差异有统计学意义（P<0.05），两组间不良反应发生率比较差异无统计学意义（P>0.05）。 结论 孟鲁司特联合布地奈德可降低儿童间歇性哮喘气道重塑，改善患儿的肺功能、Th1/Th2相关细胞因子、炎性反应指标，降低复发率，安全性好，值得在临床推广实践。 Objective To analyze the effect of montelukast combined with budesonide in the treatment of children with intermittent asthma, and the impact on airway remodeling and T helper type 1 (Th1)/T helper type 2 (Th1/Th2) related cytokines. Methods A prospective study was conducted among 120 children with intermittent asthma admitted to Huanghua Municipal People′s Hospital from December 2021 to February 2023. The children were randomly divided into the control group (60 children treated with budesonide atomizationinhalation) and the observation group (60 children treated with montelukast on the basis of the treatment of control group). Clinical efficacy, airway remodeling indicators [total area of airway (Ao), outer diameter of airway (D) and wall area to total airway cross-sectional area (WA%)], pulmonary function [peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) and the maximum expiratory flow at 25% of vital capacity (MEF25%)], Th1/Th2 related cytokines, inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6) and interferon-gamma (IFN-γ)], recurrence, and the incidence of adverse reactions were compared between the two groups. Results The total effective rate in the observation group was higher than that in the control group: 90.00% (54/60) vs. 75.00% (45/60) (P<0.05). After treatment, Ao, D and WA% in the observation group were lower than those in the control group: (17.58 ± 1.89) mm2 vs. (19.22 ± 1.94) mm2, (4.25 ± 0.48) mm vs. (4.48 ± 0.49) mm, (63.75 ± 6.49)% vs. (69.22 ± 7.14)% (P<0.05). PEF, FEV1/FVC and MEF25% in the observation group were higher than those in the control group: (3.13 ± 0.34) L/s vs. (2.86 ± 0.35) L/s, (87.45 ± 8.86) % vs. (83.59 ± 8.42) %, (87.63 ± 8.86)% vs. (82.15 ± 8.43)% (P<0.05). The levels of Th1 and Th1/Th2 in the observation group were higher than those in the control group: (14.13 ± 1.46) % vs. (10.27 ± 1.25) %, 3.46 ± 0.39 vs. 1.88 ± 0.25, and the level of Th2 was lower than that in the control group: (3.96 ± 0.45)% vs. (5.48 ± 0.56)% (P<0.05). After treatment, the levels of TNF-α and IFN-γ in the observation group were higher than those in the control group: (76.15 ± 7.78) ng/L vs. (66.38 ± 6.47) ng/L, (7.15 ± 0.74) ng/L vs. (6.14 ± 0.66) ng/L. The levels of IL-4 and IL-6 were lower than those in the control group: (77.85 ± 7.96) ng/L vs. (86.42 ± 8.74) ng/L, (37.25 ± 3.89) mg/L vs. (44.23 ± 4.57) mg/L (P<0.05). The recurrence rate in the observation group was lower than that in the control group: 3.33% (2/60) vs. 15.00% (9/60) (P<0.05). The incidence rates of adverse reactions in the two groups were without statistically significant difference between the groups (P>0.05). Conclusions Montelukast combined with budesonide can reduce airway remodeling in children with intermittent asthma, improve their pulmonary function, Th1/Th2 related cytokines and inflammatory response indicators, and reduce recurrence rate, with good safety.

    布地奈德细胞因子孟鲁司特儿童间歇性哮喘气道重塑

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    外周血血小板与γ-谷氨酰转移酶对冠心病斑块稳定性的评估价值

    王李伟尤曦吕彤
    39-43页
    查看更多>>摘要：目的 探讨冠心病患者外周血血小板与γ-谷氨酰转移酶比值（PLT/GGT）对虚拟组织学-血管内超声（VH-IVUS）识别的斑块稳定性的评估价值。 方法 采用前瞻性研究的方法，纳入2020年6月至2022年12月浙江省荣军医院/嘉兴学院附属第三医院收治的冠心病患者100例，根据VH-IVUS检查的斑块稳定性分为易损斑块组42例与稳定斑块组58例；比较两组一般资料、PLT/GGT及其他实验室指标，分析冠心病患者外周血PLT/GGT与斑块稳定性的关系及PLT/GGT对患者斑块稳定性的评估价值。 结果 易损斑块组C反应蛋白（CRP）、γ-谷氨酰转移酶（GGT）水平高于稳定斑块组[（8.07 ± 1.85）mg/L比（7.23 ± 1.57） mg/L、（72.39 ± 10.85） U/L比（67.13 ± 8.57） U/L]，PLT水平、PLT/GGT低于稳定斑块组[（180.76 ± 11.75） × 109/L比（187.36 ± 12.47） × 109/L、2.55 ± 0.42比2.84 ± 0.41]，差异有统计学意义（P<0.05）；点二列相关性分析结果显示，冠心病患者VH-IVUS识别的斑块稳定性与CRP、GGT、PLT、PLT/GGT均有关，差异有统计学意义（P<0.05）；受试者工作特征曲线分析结果显示，冠心病患者外周血PLT/GGT评估斑块稳定性的曲线下面积为0.71，具有一定评估价值。 结论 冠心病患者外周血PLT/GGT与VH-IVUS识别的斑块稳定性密切相关，可作为评估患者斑块稳定性的有效指标。 Objective To investigate the value of peripheral blood platelet to gamma-glutamyl transferase ratio (PLT/GGT) in evaluating plaque stability recognized by virtual histology-intravascular ultrasound (VH-IVUS) in patients with coronary heart disease. Methods This study was a prospective study. A total of 100 patients with coronary heart disease admitted in Zhejiang Veteran Hospital/the Third Affiliated Hospital of Jiaxing University from June 2020 to December 2022 were included. They were divided into vulnerable plaque group (42 cases) and stable plaque group (58 cases) based on the stability of the plaque examined by VH-IVUS. The general data, PLT/GGT and other laboratory indexes were compared between the two groups. The relationship between PLT/GGT and plaque stability in peripheral blood of patients with coronary heart disease and the evaluation value of PLT/GGT on plaque stability were analyzed. Results The levels of C-reactive protein (CRP) and gamma-glutamyl transferase (GGT) in the vulnerable plaque group were higher than those in the stable plaque group: (8.07 ± 1.85) mg/L vs. (7.23 ± 1.57) mg/L, (72.39 ± 10.85) U/L vs. (67.13 ± 8.57) U/L, and PLT, PLT/GGT levels were lower than those in the stable plaque group: (180.76 ± 11.75) × 109/L vs. (187.36 ± 12.47) × 109/L, 2.55 ± 0.42 vs. 2.84 ± 0.41, the differences were statistically significant (P<0.05). Point two column correlation found that the plaque stability recognized by VH-IVUS in patients with coronary heart disease was related to CRP, GGT, PLT, PLT/GGT (P<0.05). Receiver operating characteristic curve analysis showed that the area under the curve (AUC) for assessing plaque stability using the peripheral blood PLT/GGT in patients with coronary heart disease was 0.71, which had certain evaluation value. Conclusions The peripheral blood PLT/GGT in patients with coronary heart disease is closely related to the plaque stability recognized by VH-IVUS, and can be used as an effective indicator for evaluating plaque stability in patients.

    冠心病动脉粥样硬化斑块稳定性虚拟组织学-血管内超声γ-谷氨酰转移酶

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    重症急性胰腺炎患者肠道菌落情况与其并发急性呼吸窘迫综合征的关系分析

    郭伟楼滟张锦丽吴杭捷...
    44-47页
    查看更多>>摘要：目的 探讨重症急性胰腺炎患者肠道菌落情况与其并发急性呼吸窘迫综合征的关系。 方法 采用前瞻性研究的方法，选取2019年3月至2021年2月浙江省医疗健康集团杭州医院收治的106例重症急性胰腺炎患者为观察组，根据是否并发急性呼吸窘迫综合征将其分为并发组52例和无并发组54例。另选取同期健康体检者100例为对照组，分析重症急性胰腺炎患者肠道菌落情况与其并发急性呼吸窘迫综合征的关系。 结果 观察组和对照组的肠道菌群数目（乳酸杆菌、双歧杆菌、大肠埃希菌）比较差异有统计学意义（t = 49.69、73.28、46.32，P<0.05）。并发组与非并发组菌群的肠道菌群数目（乳酸杆菌、双歧杆菌、大肠埃希菌）比较差异有统计学意义（t = 34.85、39.71、23.47，P<0.05）。并发组血清内毒素、二胺氧化酶以及D-乳酸水平均显著高于非并发组[（0.63 ± 0.16）EU/ml比（0.45 ± 0.08）EU/ml、（6.29 ± 1.18）U/ml比（4.89 ± 0.91）U/ml、（11.63 ± 2.84）mmol/L比（9.33 ± 2.61）mmol/L]，差异有统计学意义（t = 7.37、6.85、4.34，P<0.05）。Spearman分析结果显示重症急性胰腺炎并发急性呼吸窘迫综合征与其肠道乳酸杆菌、双歧杆菌菌群数目呈负相关（r = - 0.342和- 0.291，P = 0.011和0.021），与其肠道大肠埃希菌菌群数目呈正相关（r = 0.263，P = 0.033）。 结论 重症急性胰腺炎患者普遍存在肠道菌落失衡，且并发急性呼吸窘迫综合征患者肠道菌落失衡和肠道黏膜屏障功能受损情况更严重，重症急性胰腺炎并发急性呼吸窘迫综合征与其肠道菌落情况存在明显相关性。 Objective To investigate the relationship between intestinal flora and acute respiratory distress syndrome in patients with severe acute pancreatitis. Methods One hundred and six patients with severe acute pancreatitis admitted to a hospital from March 2019 to February 2021 were selected as the observation group for prospective analysis. They were divided into concurrent group (52 cases) and non-concurrent group (54 cases) according to whether they were complicated with acute respiratory distress syndrome. In addition, 100 healthy people in the same period were selected as the control group to analyze the relationship between intestinal flora and acute respiratory distress syndrome in patients with severe acute pancreatitis. Results There were significant differences in the number of intestinal flora (Lactobacillus, Bifidobacterium, Escherichia coli) between the observation group and the control group (t = 49.69, 73.28 and 46.32 P<0.05). There were significant differences in the number of intestinal flora (Lactobacillus, Bifidobacterium, Escherichia coli) between the concurrent group and the non-concurrent group (t = 34.85, 39.71 and 23.47 P<0.05). The levels of serum endotoxin, diamine oxidase and D-lactic acid in the concurrent group were significantly higher than those in the non-concurrent group: (0.63 ± 0.16) EU/ml vs. (0.45 ± 0.08) EU/ml, (6.29 ± 1.18) U/ml vs. (4.89 ± 0.91) U/ml, (11.63 ± 2.84) mmol/L vs. (9.33 ± 2.61) mmol/L (t = 7.37, 6.85 and 4.34, P<0.05). Spearman analysis showed that severe acute pancreatitis complicated with acute respiratory distress syndrome was negatively correlated with the number of intestinalLactobacillus and Bifidobacterium (r = - 0.342 and - 0.291, P = 0.011 and 0.021), which was positively correlated with the number of intestinal Escherichia coli flora (r = 0.263, P = 0.033). Conclusions Intestinal colony imbalance is common in patients with severe acute pancreatitis, and the imbalance of intestinal colony and the impairment of intestinal mucosal barrier function are more serious in patients with acute respiratory distress syndrome. There is a significant correlation between severe acute pancreatitis complicated with acute respiratory distress syndrome and its intestinal colony.

    胰腺炎呼吸窘迫综合征,成人重症肠道菌落

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