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中国综合临床
中国综合临床

袁聚祥

月刊

1008-6315

zgzhlc@heuu.edu.cn

0315- 3726280

063000

河北省唐山市建设南路57号

中国综合临床/Journal Clinical Medicine of China北大核心CSTPCD
查看更多>>1980年创刊，中华人民共和国卫生部主管，中华医学会、天津市环湖医院、华北煤炭医学院主办。本刊办刊宗旨：面向临床，突出综合，讲究实用；使临床医师了解医学各科进展，解决在临床中遇到的具体问题。栏目与内容：述评、论著、临床病例讨论、误诊误治、病例报告、综述等。重点刊登内、外、妇、儿等学科的临床实用性文章。
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    血钙水平与伴有高钙血症的急性肾损伤患者预后的相关性分析

    彭丹魏文倩赵东方项周霞...
    81-87页
    查看更多>>摘要：目的 分析血钙水平与伴有高钙血症的急性肾损伤（acute kidney injury，AKI）患者生存预后和肾功能恢复预后的相关性。 方法 x ¯ 回顾性分析2015年12月至2022年8月上海交通大学医学院附属第一人民医院各科收治的伴有高钙血症的AKI患者的临床资料，纳入研究对象157例。以出院时为观察终点，观察患者在这段时间内的生存情况和肾功能恢复情况。根据出院时的生存情况，将患者分为生存组（116例）和死亡组（41例）；根据出院时的肾功能恢复情况，将生存患者分为肾功能恢复组（63例）和肾未恢复组（53例）。符合正态分布的连续变量以±s表示，两组组间均数比较采用独立样本t检验；不符合正态分布的连续变量以中位数（四分位数）［M（Q1，Q3）］表示，两组间采用Mann-Whitney U检验进行比较。分类变量以频数（百分比）表示，根据不同的适用情况选择χ2检验及Fisher确切概率法进行比较。血钙水平与研究对象预后的相关性采用单因素及多因素Logistic回归分析。 结果 研究对象的年龄为（68.37±16.28）岁，男性97例（61.78%）。生存组和死亡组的年龄分别为（65.39±16.13）、（76.80±13.67）岁，男性分别为66、31例，恶性肿瘤病史（除多发性骨髓瘤外）分别为37、23例，白蛋白分别为（35.41±6.84）、（30.82±5.75）g/L，生存组和死亡组在年龄、性别、恶性肿瘤病史（除多发性骨髓瘤外）、白蛋白的差异均有统计学意义（统计量值分别为t=4.04、χ2=4.49、χ2=7.51、t=3.85；均P<0.05）。肾功能恢复组和未恢复组AKI分级1级的构成比分别为33.33%（21/63）、64.15%（34/53），2级分别为36.51%（23/63）、24.53%（13/34），3级分别为30.16%（23/63）、11.32%（6/34），出院血钙分别为（2.50±0.38）、（2.70±0.58）mmol/L，住院血钙分别为（2.60±0.29）、（2.78±0.39）mmol/L，血钙最低值分别为（2.28±0.36）、（2.50±0.51）mmol/L，B型钠尿肽分别为118（64，283）、248（69，1 383）ng/L，肾功能恢复组和未恢复组在AKI分级、出院血钙、住院血钙、血钙最低值、B型钠尿肽的差异均有统计学意义（统计量值分别为χ2=11.84、t=2.26、t=2.75、t=2.73、U=2.62；均P<0.05）。多因素Logistic回归分析结果显示，年龄（OR=1.062，95%CI 1.027~1.098，P<0.001）、恶性肿瘤病史（除多发性骨髓瘤外）（OR=3.811，95%CI 1.623~8.951，P=0.002）、白蛋白降低（OR=0.889，95%CI 0.829~0.953，P=0.001）是影响患者院内死亡的独立危险因素；AKI严重程度（AKI2级OR=2.984，95%CI 1.281~6.954，P=0.011，AKI3级OR=5.280，95%CI 1.863~14.963，P=0.002）、出院血钙升高（OR=0.813，95%CI 0.666~0.992，P=0.041）是影响患者早期肾功能恢复的独立危险因素。 结论 血钙水平与伴有高钙血症的AKI患者的院内死亡风险无关，而与早期肾功能恢复预后有关。积极控制血钙、治疗肿瘤原发病及纠正低蛋白血症有助于改善此类患者的预后。 Objective To analyze the correlation between serum calcium levels and the prognosis of survival and renal recovery in patients with acute kidney injury (AKI) accompanied by hypercalcemia. Methods x ¯ This retrospective study analyzed the clinical data of patients with AKI accompanied by hypercalcemia admitted to Shanghai General Hospital from December 2015 to August 2022. There were 157 patients included in the study. The observation endpoint was set at discharge, focusing on the patients' survival and renal recovery during this period. Based on their status at discharge, patients were divided into a survival group (116 cases) and a death group (41 cases) and among the survivors, into a renal recovery group (63 cases) and a non-recovery group (53 cases). Continuous variables conforming to normal distribution were expressed as ±s, and the mean comparison between the two groups was performed using an independent sample t-test. Continuous variables not conforming to normal distribution were represented by median (interquartile range) and compared between groups using the Mann-Whitney U test. Categorical variables were expressed as frequency (percentage), and comparisons were made using the chi-squared (χ2) test or Fisher's exact test, as applicable. The correlation between serum calcium levels and patient outcomes was analyzed using univariate and multivariate Logistic regression. Results The average age of the study subjects was (68.37±16.28) years, with 97 males (61.78%). The ages in the survival and death groups were (65.39±16.13) years and (76.80±13.67) years, respectively, with 66 males in the survival group and 31 in the death group. The history of malignancy (excluding multiple myeloma) was 37 cases and 23 cases, respectively, and serum albumin levels were (35.41±6.84) g/L and (30.82±5.75) g/L, respectively. Significant Statistical differences were observed in age, gender, history of malignancy (excluding multiple myeloma), and serum albumin were found between the survival and death groups (statistical values: t=4.04, χ2=4.49, χ2=7.51, t=3.85 all P<0.05). AIK 1 stage were 33.33%(21/63) and 64.15%(34/53), 2 stage were 36.51%(23/63) and 24.53%(13/34), 3 stage were 30.16%(23/63) and 11.32%(6/34) in the renal recovery and non-recovery groupsrespectively. Serum calcium at discharge in the renal recovery and non-recovery groups were (2.50±0.38) mmol/L and (2.70±0.58) mmol/L, respectively, with mean serum calcium levels of (2.60±0.29) mmol/L and (2.78±0.39) mmol/L, and lowest serum calcium levels of (2.28±0.36) mmol/L and (2.50±0.51) mmol/L, respectively. BNP levels were 118 (64, 283) ng/L and 248 (69, 1 383) ng/L, respectively. Significant differences in AKI stage, serum calcium at discharge, mean serum calcium, lowest serum calcium, and BNP were observed between the two groups (statistical values: χ2=11.84, t=2.26, t=2.75, t=2.73, U=2.62, all P<0.05). Multivariate logistic regression analysis showed that age (OR=1.062, 95%CI 1.027-1.098, P<0.001), history of malignancy (excluding multiple myeloma) (OR=3.811, 95%CI 1.623-8.951, P=0.002), and serum albumin (OR=0.889, 95%CI 0.829-0.953, P=0.001) were independent risk factors for in-hospital mortality of patients severity of AKI(AKI2 OR=2.984, 95%CI 1.281-6.954, P=0.011, AKI3 OR=5.280, 95%CI 1.863-14.963, P=0.002) and serum calcium level at discharge (OR=0.813, 95%CI 0.666-0.992, P=0.041) were independent risk factors affecting early renal recovery of patients. Conclusion Serum calcium level is not associated with the risk of in-hospital mortality in patients with AKI accompanied by hypercalcemia but is related to the prognosis of early renal recovery. Proactively managing serum calcium, along with treatment of the primary malignancy and correction of hypoalbuminemia can help improve the prognosis of these patients.

    急性肾损伤高钙血症预后危险因素

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    血清同型半胱氨酸和定量脑电图与脑出血预后的相关性研究

    欧亚张萍淑元小冬张丽丽...
    88-95页
    查看更多>>摘要：目的 探讨入院血清同型半胱氨酸水平与定量脑电图指标对于脑出血患者不良预后的预测价值。 方法 回顾性连续收集2017年1月至2022年12月在开滦总医院神经内科重症加强治疗病房诊治的出血性卒中患者89例临床资料。根据出院30 d后的改良Rankin评分（modified Rankin scale，mRS）将患者分为两组：预后良好组（mRS≤2分）、预后不良组（mRS 3~6分）。收集患者临床资料、定量脑电图（quantitative electroencephalogram，qEEG）监测16导联各脑区相关脑电指标。出血预后的影响因素分析采用多因素Logistic回归分析。采用受试者特征（receiver operating characteristic，ROC）曲线分析脑电相关指标及入院同型半胱氨酸预测出血性卒中患者出现不良预后的价值。 结果 （1）脑出血预后不良组年龄大于预后良好组［（66.51±13.64）岁比（60.53±11.69）岁］，t=2.15，P=0.034；入院血清同型半胱氨酸水平显著高于预后良好组［17.28（15.52，24.72）mmol/L比14.50（10.28，16.00）mmol/L，Z=4.14，P<0.001］。（2）脑出血预后不良组10-20导联中Fp1-2、F4、C4、P4、F8、T4导联δ脑波功率值高于预后良好组［87.99（41.57，196.69）比50.67（26.64，54.75），Z=2.76，P=0.006］；［79.17（40.71，200.00）比45.06（20.22，61.00），Z=2.10，P=0.036］；［72.64（34.97，219.78）比34.42（19.81，63.4），Z=2.03，P=0.043］；［65.06（33.36，177.45）比28.12（15.88，63.36），Z=2.08，P=0.038］；［52.92（25.64，187.91）比23.61（11.67，43.26），Z=2.21，P=0.027］；［66.67（32.56，180.76）比36.31（17.2，53.78），Z=2.46，P=0.014］；［57.30（25.24，127.04）比29.57（11.91，41.89），Z=2.26，P=0.024］. Fp1-2、F3、F4、C3、C4、P3-4、O1、F7-8、T3-4导联θ脑波功率值高于预后良好组［77.45（47.63，138.72）比35.88（20.92，44.81），Z=3.50，P<0.001］；［77.05（35.16，120.22）比38.74（19.86，58.09），Z=2.27，P=0.023］；［85.24（52.53，147.90）比35.42（14.7，52.59），Z=2.61，P=0.009］；［75.81（37.90，124.97）比36.85（17.92，55.43），Z=2.30，P=0.021］；［72.00（43.92，123.54）比28.37（14.02，51.9），Z=2.22，P=0.027］；［67.08（32.01，104.05）比31.32（17.98，45.28），Z=2.10，P=0.035］；［55.33（32.29，94.30）比25.64（11.87，34.01），Z=2.24，P=0.025］；［48.84（20.64，96.28）比19.85（9.83，28.58），Z=2.30，P=0.022］；［48.46（25.06，81.78）比23.95（8.80，29.16），Z=2.51，P=0.012］；［64.46（39.38，112.44）比26.85（15.74，39.58），Z=2.80，P=0.005］；［65.68（31.78，102.00）比31.09（15.98，46.96），Z=2.38，P=0.017］；［45.26（28.34，73.14）比21.45（10.57，36.59），Z=2.04，P=0.042］；［43.50（22.58，78.67）比25.45（11.91，32.26），Z=2.22，P=0.027］；Fp1-2、F3-4、C3-4、P4、F7-8、T4、全脑平均导联慢波指数功率值高于预后良好组［6.64（2.98，10.42）比3.65（2.31，4.30），Z=2.65，P=0.01］；［6.53（3.96，11.65）比3.53（2.56，4.51），Z=2.30，P=0.022］；［7.38（4.62，13.12）比3.83（1.70，4.71），Z=2.38，P=0.017］；［5.88（4.02，12.15）比3.18（2.21，4.46），Z=2.29，P=0.022］；［6.13（3.83，11.22）比2.97（1.53，4.58），Z=2.01，P=0.044］；［6.07（3.53，9.39）比2.74（2.00，3.81），Z=2.40，P=0.016］；［4.11（2.51，9.23）比2.18（1.37，2.82），Z=2.25，P=0.024］；［5.71（3.81，10.44）比3.22（1.86，4.04），Z=2.28，P=0.023］；［6.00（3.65，10.37）比3.04（2.00，4.00），Z=2.39，P=0.017］；［4.08（2.56，8.33）比2.08（1.60，3.14），Z=2.50，P=0.013］，其中全脑平均慢波指数导联差异有统计学意义［5.45（3.31，10.08）比3.17（2.02，4.88），Z=3.62，P=0.005］。（3）Logistic 回归结果显示，入院血清同型半胱氨酸（homocysteine，HCY）值（OR 1.311，95%CI 1.008~1.705，P=0.044）、入院国立卫生研究院卒中量表（national institutes of health stroke scale，NIHSS）评分（OR1.588，95%CI 1.074~2.349，P=0.020）和全脑平均慢波指数（OR 8.596，95%CI 1.088~67.889，P=0.041）是脑出血预后不良的影响因素。（4）通过绘制ROC曲线，发现入院HCY值、全脑平均慢波指数、入院NIHSS评分预测脑出血不良预后的ROC曲线下面积（area under curve，AUC）分别为0.768（95%CI 0.665~0.872）、0.743（95%CI 0.634~0.852）、0.896（95%CI 0.827~0.965），截断值分别为15.67，3.62，8.50，灵敏度分别为77.8%、71.1%、68.9%，特异度分别为59.4%、68.7%、100.0%，约登指数分别为0.372、0.398、0.689。 结论 脑出血急性期，脑电生理表现为δ、θ、慢波指数在全脑出现增多。入院HCY值越高，提示脑出血患者预后越差。入院HCY值、全脑平均慢波指数对急性脑出血不良预后有一定预测价值。 Objective To explore the predictive value of admission serum homocysteine levels and quantitative electroencephalogram (qEEG) indicators for adverse outcomes in patients with cerebral hemorrhage. Methods A retrospective study was conducted on 89 patients, who were collected as the study objects with hemorrhagic stroke treated in the neurology intensive care unit at Kailuan General Hospital from January 2017 to December 2022. Patients were categorized into two groups based on modified Rankin Scale (mRS) scores at discharge: a good prognosis group (mRS≤2) and a poor prognosis group (mRS 3-6). Clinical data and qEEG monitoring of various brain regions were collected. The impact factors of hemorrhagic prognosis were analyzed using multifactorial logistic regression. ROC curve analysis was performed to assess the predictive value of qEEG and admission homocysteine levels for adverse outcomes in hemorrhagic stroke patients. Results (1) The age of the poor prognosis group was higher than that of the good prognosis group((66.51+13.64) to (60.53+11.69), t=2.15, P=0.034) and admission serum homocysteine levels were significantly higher in the poor prognosis group than in the good prognosis group (17.28(15.52,24.72)mmol/L to 14.50(10.28,16.00)mmol/L, Z=4.14, P<0.001). (2) In the poor prognosis group, power values of δ brain waves in leads Fp1-2, F4, C4, P4, F8, and T4 were higher than those in the good prognosis group (87.99(41.57,196.69) to 50.67(26.64,54.75),Z=2.76, P=0.006) (79.17(40.71,200.00) to 45.06(20.22,61.00), Z=2.10, P=0.036) (72.64(34.97,219.78) to 34.42(19.81,63.4), Z=2.03, P=0.043) (65.06(33.36,177.45) to 28.12(15.88,63.36), Z=2.08, P=0.038) (52.92(25.64,187.91) to 23.61(11.67,43.26), Z=2.21, P=0.027) (66.67(32.56,180.76) to 36.31(17.2,53.78), Z=2.46, P=0.014) (57.30(25.24,127.04) to 29.57(11.91,41.89), Z=2.26,P=0.024). Power values of θ brain waves in leads Fp1-2, F3, F4, C3, C4, P3-4, O1, F7-8, and T3-4 were higher in the poor prognosis group(77.45(47.63,138.72)比35.88(20.92,44.81), Z=3.50, P<0.001) (77.05(35.16,120.22) to 38.74(19.86,58.09),Z=2.27, P=0.023) (85.24(52.53,147.90) to 35.42(14.7,52.59), Z=2.61, P=0.009) (75.81(37.90,124.97) to 36.85(17.92,55.43), Z=2.30, P=0.021) (72.00(43.92,123.54) to 28.37(14.02,51.9), Z=2.22, P=0.027) (67.08(32.01,104.05) to 31.32(17.98,45.28), Z=2.10, P=0.035) (55.33(32.29,94.30) to 25.64(11.87,34.01), Z=2.24, P=0.025) (48.84(20.64,96.28) to 19.85(9.83,28.58), Z=2.30, P=0.022) (48.46(25.06,81.78) to 23.95(8.80,29.16), Z=2.51,P=0.012) (64.46(39.38,112.44) to 26.85(15.74,39.58), Z=2.80, P=0.005) (65.68(31.78,102.00) to 31.09(15.98,46.96), Z=2.38,P=0.017) (45.26(28.34,73.14) to 21.45(10.57,36.59), Z=2.04, P=0.042) (43.50(22.58,78.67) to 25.45(11.91,32.26), Z=2.22,P=0.027). Power values of slow-wave index in leads Fp1-2, F3-4, C3-4, P4, F7-8, and T4, as well as the overall brain average, were higher in the poor prognosis group (6.64(2.98,10.42) to 3.65(2.31,4.30),Z=2.65, P=0.01) (6.53(3.96,11.65) to 3.53(2.56,4.51), Z=2.30, P=0.022) (7.38(4.62,13.12) to 3.83(1.70,4.71), Z=2.38, P=0.017) (5.88(4.02,12.15) to 3.18(2.21,4.46), Z=2.29, P=0.022) (6.13(3.83,11.22) to 2.97(1.53,4.58), Z=2.01,P=0.044) (6.07(3.53,9.39) to 2.74(2.00,3.81),Z=2.40,P=0.016) (4.11(2.51,9.23) to 2.18(1.37,2.82), Z=2.25, P=0.024) (5.71(3.81,10.44) to 3.22(1.86,4.04), Z=2.28, P=0.023) (6.00(3.65,10.37) to 3.04(2.00,4.00), Z=2.39, P=0.017) (4.08(2.56,8.33) to 2.08(1.60,3.14), Z=2.50, P=0.013), with significant statistical differences noted (5.45(3.31,10.08) to 3.17(2.02,4.88),Z=3.62, P=0.005). (3) Logistic regression results showed that admission homocysteine levels (OR 1.311,95% CI 1.008-1.705, P=0.044), admission NIHSS scores (OR 1.588,95%CI 1.074-2.349, P=0.020), and overall brain average slow-wave index were influencing factors for poor prognosis in cerebral hemorrhage (OR 8.596,95%CI 1.088-67.889, P=0.041). (4) ROC curve analysis revealed that the AUC for predicting adverse outcomes in cerebral hemorrhage was 0.768 (95%CI (0.665, 0.872)) for admission homocysteine levels, 0.743 (95% CI (0.634, 0.852)) for the overall brain average slow-wave index, and 0.896 (95%CI (0.827, 0.965)) for admission NIHSS. The cutoff values were 15.67, 3.62, and 8.5, respectively. Sensitivity was 77.8%, 71.1%, and 68.9%, and specificity was 59.4%, 68.7%, and 100%, respectively. The Youden indices were 0.372, 0.398, and 0.689. Conclusion In the acute phase of cerebral hemorrhage, electroencephalographic physiological changes manifest shows an increase in the δ, θ, and slow-wave index throughout the entire brain. Higher admission homocysteine levels suggest a worse prognosis in patients with cerebral hemorrhage. Admission homocysteine levels and overall brain average slow-wave index have certain predictive value for adverse outcomes in acute cerebral hemorrhage.

    脑出血卒中定量脑电图同型半胱氨酸预后评价

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    应激性高血糖比率联合C反应蛋白与降钙素原在胫腓骨开放性骨折患者术后感染中的评估价值

    孙博王静悦李冀李彬...
    96-103页
    查看更多>>摘要：目的 探究胫腓骨开放性骨折患者应激性高血糖比率（stress hyperglycemia ratio，SHR）、C反应蛋白（C reactive protein，CRP）、血清降钙素原（procalcitonin，PCT）对其术后感染的评估价值。 方法 本研究为前瞻性分析。收集2018年1月至2023年1月于唐山市第二医院、华北理工大学附属医院骨外科住院治疗的胫腓骨开放性骨折患者为研究对象，完成结局评定共839例，依据所选入组研究对象是否发生术后感染分为感染组（103例）和非感染组（736例），单因素分析两组患者临床资料，再经多因素Logistic回归分析胫腓骨开放性骨折术后感染的危险因素，绘制受试者工作特征（receiver operating characteristic，ROC）曲线，分析SHR、CRP、PCT及三者联合模型对不良结局的预测效能。 结果 单因素分析示：感染组SHR 1.82±0.31、CRP（92.28±36.07）mg/L、PCT（6.35±1.79）μg/L，非感染组三者分别为1.05±0.12、（56.35±10.21）mg/L、（2.17±0.41）μg/L，两组比较差异均有统计学意义（t值分别为46.90、21.60、54.17，均P<0.001）；感染组中白蛋白<30 g/L所占比率63.11%（65/103），高于非感染组37.64%（277/736）（χ2=24.28，P<0.001），且两组在受伤至手术时间比率［感染组≥6 h为71.84%（74/103），<6 h为28.16%（29/103）；非感染组≥6 h为43.07%（317/736），<6 h为56.93%（419/736）；χ2=35.37，P<0.001］、Gustilo-Anderson分型比率［感染组Ⅰ、Ⅱ型为44.46%（46/103），ⅢA型为33.98%（35/103），ⅢB型为12.62%（13/103），ⅢC型为8.47%（9/103）；非感染组Ⅰ、Ⅱ型为59.10%（435/736），ⅢA型为32.47%（239/736），ⅢB型为5.98%（44/736），ⅢC型为2.45%（18/736）；χ2=20.34，P<0.001］、术后引流比率［感染组为40.60%（48/103），58.02%（427/736）；χ2=4.79，P=0.029］方面，差异均有统计学意义；多因素Logistic回归分析示：SHR（OR=1.871，95%CI 1.621~2.160，P<0.001）、CRP（OR=1.060，95%CI 1.015~1.107，P=0.009）、PCT（OR=1.497，95%CI 1.420~1.577，P<0.001）是胫腓骨开放性骨折发生术后感染的独立危险因素，其中SHR的OR值最大，为发生研究结局的最强影响因子；其他的独立影响因素还有年龄（OR=1.052，95%CI 1.038~1.066，P<0.001）、Gustilo-Anderson分型ⅢC型（OR=1.875，95%CI 1.038~2.015，P<0.001）；通过绘制SHR、CRP、PCT及三者联合模型预测胫腓骨开放性骨折发生术后感染ROC曲线，结果显示三者联合模型较单独应用的诊断预测价值更高，其灵敏度和特异度分别为86.4%、70.4%，均高于单独进行评估的灵敏度（78.6%、77.7%、75.7%）和特异度（69.2%、69.3%、69.6%）。 结论 SHR、CRP、PCT三者联合模型较单独检测具有更高的预测评估价值，可为胫腓骨开放性骨折患者发生术后感染的早期诊断提供较好的临床依据。 Objective To explore the the evaluation value of stress hyperglycemia ratio (SHR), C-reactive protein (CRP), and serum procalcitonin (PCT) for postoperative infection in patients with open tibiofibular fractures. Methods This study was a prospective analysis. Patients with open tibiofibular fractures hospitalized in the Department of Orthopaedic Surgery of The Second Hospital of Tangshan and North China University of Science and Technology Affiliated Hospital from January 2018 to January 2023 were collected as the research objects, and a total of 839 cases were assessed for outcome, which were divided into infection group (103 cases) and non-infection group (736 cases) according to whether the selected subjects had postoperative infection. The clinical data of the two groups were analyzed by univariate analysis, and the risk factors of postoperative infection of open fracture of tibia and fibula were analyzed by multivariate Logistic regression, and the receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of SHR, CRP, PCT, and their combined models on adverse outcomes. Results Univariate analysis showed that the infection group had SHR (1.82±0.31), CRP (92.28±36.07) mg/L, PCT (6.35±1.79) μg/L, the non infection group had (1.05±0.12), (56.35±10.21) mg/L and (2.17±0.41) μg/L, respectively, and there were significant differences between the two groups (t values were 46.90, 21.60, and 54.17, respectively all P<0.001). The proportion of albumin (<30 g/L) in the infection group was higher than that in the non-infection group (63.11%(65/103), 37.64%(277/736) (χ2=24.28, P<0.001), and the two groups had significant differences in the rate of time from injury to operation (the infection group ≥6 h was 71.84%(74/103), <6 h was 28.16%(29/103) the non-infection group ≥6 h was 43.07%(317/736), <6 h was 56.93%(419/736) χ2=35.37, P<0.001), the rate of Gustilo-Anderson classification (the infection group Ⅰ、Ⅱ was 44.46%(46/103), ⅢA was 33.98%(35/103), ⅢB was 12.62%(13/103), ⅢC was 8.47%(9/103) the non-infection groupⅠ、Ⅱ was 59.10%(435/736), ⅢA was 32.47%(239/736), ⅢB was 5.98%(44/736), ⅢC was 2.45%(18/736) χ2=20.34, P<0.001) and the rate of postoperative drainage volume (the infection group was 40.60%(48/103),the non-infection group was 58.02%(427/736) χ2=4.79, P=0.029). Multivariate Logistic regression analysis showed that SHR (OR=1.871,95% CI 1.621-2.160, P<0.001), CRP (OR=1.060, 95% CI 1.015-1.107, P=0.009), PCT (OR=1.497, 95% CI 1.420-1.577, P<0.001) were independent risk factors for postoperative infection in open tibiofibular fractures. Among them, SHR had the highest OR value, which was the strongest factor affecting the outcome of the study. Other independent factors were age (OR=1.052, 95% CI 1.038-1.066, P<0.001) and Gustilo-Anderson type-ⅢC (OR=1.875, 95% CI 1.038-2.015, P<0.001). By drawing the ROC curve of SHR, CRP, PCT and their combined model to predict the incidence of postoperative infection in open tibiofibular fractures, the results showed that the combined model had higher diagnostic predictive value than the single application, and its sensitivity and specificity were 86.4% and 70.4%, respectively, which were higher than the sensitivity (78.6%, 77.7%, 75.7%) and specificity (69.2%, 69.3%, 69.6%) of the single assessment. Conclusion The combined model of SHR, CRP and PCT has a higher predictive value than the single detection, which can provide a better clinical basis for the early diagnosis of postoperative infection in patients with open tibiofibular fractures.

    应激性高血糖比率C反应蛋白降钙素原胫腓骨开放性骨折术后感染

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    NUDT2基因致智力障碍伴或不伴周围神经病1例并文献复习

    牟苇杭赵澎盛倩倩袁琳...
    104-108页
    查看更多>>摘要：目的 总结报道1例智力障碍伴或不伴周围神经病（intellectual developmental disorder with or without peripheral neuropathy，IDDPN）患儿的临床特点和基因核苷二磷酸连接片段X型基序2（nucleoside diphosphate linked moiety X- type motif 2，NUDT2）的致病变异。 方法 采用回顾性分析，对2023年4月就诊于天津市儿童医院康复医学科的1例IDDPN患儿临床资料进行总结，并对现有报道NUDT2变异所致IDDPN患儿的临床表型与其基因突变谱的关系进行分析。 结果 本例患儿全面发育迟缓，面容特殊，四肢肌张力减退，伴有周围神经损害，全外显子测序发现患儿携带NUDT2基因的一个纯合突变c.34C>T（p.R12X）为无义突变。Sanger法验证，父母双方均为c.34C>T杂合子突变携带者。纳入国外已报道的10例IDDPN患者，发现导致发病的均为纯合突变，临床表型均有不同程度的认知障碍、运动障碍，其中3例合并周围神经损害。 结论 本例患儿低出生体质量/身长，婴儿期吸吮无力，肌张力减退，全面发育迟缓伴周围神经损害，基因检测提示NUDT2基因的纯合无义突变，诊断为IDDPN，为临床对该病的认识提供证据支持。 Objective To summarize the clinical characteristics and pathogenic mutation of gene NUDT2 in the child with intellectual disability with or without peripheral neuropathy (IDDPN). Methods The clinical characteristics and development of one child attending the Department of Rehabilitation of Tianjin Children's Hospital were evaluated retrospectively,and the relationship between the clinical phenotype and gene mutation profile of NUDT2 was analyzed. Results The child had global developmental delay, special appearance, low muscle tone of the limbs, accompanied by peripheral nerve damage in the limbs, and whole exome sequencing found that the child carried a homozygous mutation of NUDT2 gene, c.34C>T (p.R12X), which was a nonsense mutation. Sanger verified that both parents were carriers of c.34C>T heterozygous mutations. In the inclusion of 10 registered IDDPN patients, it was found that all of them were homozygous mutations, and the clinical phenotypes all had different degrees of cognitive impairment and movement disorders, among which only 3 cases were complicated by peripheral nerve damage. Conclusions The child in this case had low birth weight/length, weak sucking ability in infancy, cognitive impairment, peripheral nerve damage, and genetic testing showed homozygous nonsense mutation of NUDT2 gene, which provided evidence support for the clinical understanding of the disease.

    智力障碍周围神经损害核苷二磷酸连接片段X型基序2纯合突变

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    甲巯咪唑治疗弥漫性毒性甲状腺肿及桥本毒症后甲状腺激素与甲状腺上动脉流速变化的对比分析

    魏剑芬吴乃君程明慧成曦爽...
    108-113页
    查看更多>>摘要：目的 探讨弥漫性毒性甲状腺肿（graves disease，Graves病）及桥本毒症患者在甲巯咪唑治疗前后甲状腺激素及甲状腺上动脉流速变化。 方法 x ¯ 采用病例对照研究，选取在2021年10月至2022年12月华北理工大学附属医院内分泌科就诊的Graves病（Graves病组）、慢性淋巴细胞性甲状腺炎甲状腺功能亢进病例（桥本毒症组）各45例为研究对象。分析Graves病组以及桥本毒症组患者甲状腺激素及甲状腺上动脉血流速度经甲巯咪唑治疗前后变化。满足正态分布的计量资料以±s表示，两组间均数比较采用t检验；不满足正态分布的计量资料以M（Q1，Q3）表示，两组间中位数比较采用Wilcoxon秩和检验。计数资料组间构成比比较采用χ2检验。 结果 治疗前两组间促甲状腺激素（thyroid stimulating hormone，TSH）差异无统计学意义，治疗后1个月及3个月与治疗前差值比较差异均无统计学意义（均P>0.05）。治疗前Graves病组与桥本毒症组游离三碘甲状腺原氨酸（free triiodothyronine，FT3）分别为（24.09±9.29）、（17.41±9.36）pmol/L，游离甲状腺素（free thyroxine，FT4）分别为（60.23±20.82）、（43.47±21.71）pmol/L，收缩峰值流速（peak stolie vloiy，PSV）分别为（69.53±5.70）、（52.65±4.64）cm/s，两组比较差异均有统计学意义（t值分别为3.39、3.74，Z=13.83，均P<0.001）；Graves病组与桥本毒症组治疗1个月与治疗前差值FT3分别为（-6.36±5.32）、（-12.64±9.08）pmol/L（t=4.02，P<0.001），治疗3个月与治疗前差值FT3分别为（-10.14±9.50）、（-17.80±11.17）pmol/L（t=3.51，P<0.001）；Graves病组与桥本毒症组治疗1个月与治疗前差值FT4分别为（-28.47±10.09）、（-20.57±14.48）pmol/L（t=7.01，P<0.001），治疗3个月与治疗前差值FT4分别（-47.06±20.57）、（-30.17±20.54）pmol/L（t=3.91，P<0.001）；Graves病组与桥本毒症组PSV治疗1个月与治疗前差值分别为［-13.10（-34.10，-2.60）］、［-10.50（-27.5，-0.20）］cm/s（Z=2.63，P=0.009），3个月与治疗前差值分别为［-31.40（-53.20，-12.70）］、［-19.90（-46.00，-4.70）cm/s（Z=4.40，P<0.001）］，差异有统计学意义。 结论 弥漫性毒性甲状腺肿及桥本毒症甲巯咪唑治疗后甲状腺激素水平均下降，但差异无统计学意义。弥漫性毒性甲状腺肿患者较桥本毒症患者甲状腺上动脉PSV水平下降明显。 Objective To investigate the changes of thyroid hormones and the flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyrotoxicosis before and after treatment with methimazole. Methods x ¯ A case-control study was conducted to select 45 cases of Graves' disease and 45 cases of Hashimoto's thyroiditis from October 2021 to December 2022 in the Department of Endocrinology, North China University of Science and Technology Affiliated Hospital. The changes of thyroid hormone and blood flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyroiditis before and after treatment with methimazole were analyzed. Measurement data satisfying normal distribution were expressed by ±s, and the mean between two groups was compared by t test. Measurement data not satisfying normal distribution were expressed by M(Q1, Q3), and the median between two groups was compared by Wilcoxon rank sum test. χ2 test was used to compare the constituent ratio of enumeration data among groups. Results There was no significant difference in thyroid stimulating hormone (TSH) between the two groups before treatment, and there was no significant difference in TSH between the two groups after 1 month and 3 months of treatment (all P>0.05). The levels of free triiodothyronine (FT3) were (24.09±9.29) pmol/L and (17.41±9.36) pmol/L in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. FT4 were (60.23±20.82) and (43.47±21.71) pmol/L, respectively, and the peak stolie vloiy (PSV) were (69.53±5.70) and (52.65±4.64) cm/s, respectively in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. There were significant differences between the two groups (t values wrere 3.39 and 3.74, Z=13.83, all P<0.001). The difference of FT3 between one month after treatment and before treatment was (-6.36±5.32) and (-12.64±9.08) pmol/L (t=4.02, P<0.001) and the difference in FT3 between 3 months of treatment and before treatment was (-10.14±9.50) and (-17.80±11.17) pmol/L, respectively (t=3.51, P<0.001) between the Graves disease group and the Hashimoto's thyroiditis group. The difference in FT4 between the Graves disease group and the Hashimoto's thyroiditis group after 1 month of treatment and before treatment was (-28.47±10.09) and (-20.57±14.48) pmol/L (t=7.01,P<0.001), and the difference of FT4 was (-47.06±20.57) and (-30.17±20.54) pmol/L (t=3.91, P<0.001) between the Graves disease group and the Hashimoto toxin group. The difference between one month after treatment and before treatment was (-13.10(-34.10,-2.60)) and (-10.50(-27.5,-0.20)) cm/s (Z=2.63, P=0.009), respectively. The difference between 3 months and before treatment was (-31.40(-53.20,-12.70)) and (-19.90(-46.00,-4.70)cm/s (Z=4.40, P<0.001)) between the Graves disease group and the Hashimoto's thyroiditis group, and the difference was statistically significant. Conclusion Thyroid hormone levels were decreased after treatment with methimazole in patients with diffuse toxic goiter and Hashimoto toxemia, but the difference was not statistically significant. The PSV level of superior thyroid artery in patients with diffuse toxic goiter was significantly lower than that in patients with Hashimoto's thyrotoxicosis.

    弥漫性毒性甲状腺肿桥本毒症甲巯咪唑甲状腺上动脉流速甲状腺激素

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    多疗程碘［ 131I］-间碘苄胍治疗多部位转移性副神经节瘤1例

    李赟高洪波李隆敏邵玉军...
    114-119页
    查看更多>>摘要：副神经节瘤（paraganglioma，PGL）是一种引起内分泌性高血压的少见神经内分泌肿瘤，所有副神经节瘤均具有转移潜能。转移性副神经节瘤患者5年存活率<50%，治疗是较大的难题。转移性PGL对碘［131I］-间碘苄胍（131I-meta-iodobenzylguanidine，131I-MIBG）具有较高的特异性摄取，因此治疗效果佳、耐受性良好、不良反应少，但目前国内暂缺少相关详细临床诊疗数据。现报道1例多部位转移性副神经节瘤多疗程131I-MIBG详细诊治经过，并探讨其治疗效果、安全及耐受性，供临床参考。 Paraganglioma (PGL) is a rare neuroendocrine tumor that causes endocrine hypertension. All paragangliomas had metastatic potential. The 5-year survival rate of patients with metastatic paraganglioma is less than 50%, and the treatment is a big problem. Metastatic PGL has a high specific uptake of iodine [131I]-meta-iodobenzylguanidine (131I-MIBG), so the treatment is effective, well tolerated, and has few adverse reactions. However, there is a lack of relevant detailed clinical diagnosis and treatment data in China. This article reports the diagnosis and treatment of a case of multi-site metastatic paraganglioma with multiple courses of 131I-MIBG, and discusses the efficacy, safety and tolerance of the treatment for clinical reference.

    副神经节瘤转移碘［131I］-间碘苄胍

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    骨髓受累且无皮损表现的母细胞性浆细胞样树突细胞肿瘤1例治疗体会

    王瑞平闫艳柳丽松
    120-122页
    查看更多>>摘要：原发性骨髓母细胞性浆细胞样树突细胞肿瘤（lastic lasmacytoid endritic ell eoplasm，BPDCN）是一种罕见的有高度侵袭性的血液系统恶性肿瘤，典型BPDCN常以皮损为首发症状，常常累及淋巴结、骨髓、中枢神经系统和其他软组织等，对化学治疗和放射治疗均不敏感，预后极差。2020年8月28日巴彦淖尔市医院收治1例以腹痛、贫血、肝脾肿大为首发表现，缺乏典型皮损症状的患者，经过骨髓形态、流式细胞免疫分型及骨髓活检检查，最终诊断BPDCN。通过对呈现无皮损表现的罕见BPDCN病例的临床资料分析，为临床医师对该病的识别及治疗提供参考。 Plasm Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) is a rare and highly invasive hematological malignancies. Typical BPDCN usually starts with skin lesions, involves lymph nodes, bone marrow, central nervous system and other soft tissues. It is not sensitive to chemotherapy and radiotherapy, and the prognosis is very poor. A patient with abdominal pain, anemia, hepatosplenomegalosis as the first manifestations, and lack of typical skin lesions was admitted in Bayannur Hospital on August 28, 2020. BPDCN was finally diagnosed by bone marrow morphology, flow cytometry and bone marrow biopsy. Provide reference for clinical doctors to indentify and treat BPDCN by analyzing the clinical data of rare BPDCN cases with no skin lesions.

    母细胞性浆细胞样树突细胞肿瘤骨髓地西他滨维奈克拉治疗

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    误诊为亚急性甲状腺炎的急性化脓性甲状腺炎合并颈深部间隙感染伴Lemierre综合征1例报道并文献复习

    王健楠别瑶阚成霞曹志斌...
    123-127页
    查看更多>>摘要：急性化脓性甲状腺炎（acute suppurative thyroiditis，AST）是一种罕见的甲状腺疾病，多由金黄色葡萄球菌等感染所致，发病初期与亚急性甲状腺炎（subacute thyroiditis，SAT）难以鉴别。现报道1例最初被误诊为SAT的青年男性患者的临床资料，但临床确切诊断为患有AST合并颈深部间隙感染（deep neck space infections，DNSIs）并伴有 Lemierre综合征，并结合相关文献分析其临床特征和治疗过程，希望能提高临床医师对这种疾病的认识。 Acute suppurative thyroiditis(AST) is a rare thyroid disease, mostly caused by infections such as Staphylococcus aureus, and it is difficult to distinguish from subacute thyroiditis(SAT) at the beginning of the disease. Here we report the clinical data of a young male patient who was initially misdiagnosed as SAT, but was clinically diagnosed as AST with DNSIs accompanied by LS. The clinical features and treatment, combined with related literature, aim to enhance clinicians' understanding of this disease.

    急性化脓性甲状腺炎颈深部间隙感染亚急性甲状腺炎Lemierre综合征

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    非酒精性脂肪性肝病的血清学标志物研究进展

    李妹王荣琦柳丽松
    128-132页
    查看更多>>摘要：非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）患病率逐年增加，已成为严重威胁人类健康的公共卫生问题。NAFLD患者如不干预，可从单纯脂肪变性进展为非酒精性脂肪性肝炎（non-alcoholic steatohepatitis，NASH）、肝纤维化甚至是肝硬化。因此，早期诊断与治疗尤为重要。肝活检是诊断NAFLD的金标准，但因其有创、出血、高成本等局限性，限制了其在临床中的广泛应用，迫切需要灵敏、便捷的无创诊断方法来实现对NAFLD的早诊早治。本文将近年来国内外NAFLD血清学诊断方法的有关进展作一综述。 The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing year by year, and it has become a serious public health problem that threatens human health.NAFLD patients can progress from simple steatosis to non-alcoholic steatohepatitis (NASH), liver fibrosis, and even cirrhosis without intervention. Therefore, early diagnosis and treatment are particularly important.Liver biopsy is the gold standard for diagnosing NAFLD, but its limitations such as invasion, bleeding, and high cost limit its widespread clinical application. There is an urgent need for sensitive and convenient non-invasive diagnostic methods to achieve early diagnosis and treatment of NAFLD.This article provides a review of the progress in serological diagnostic methods for NAFLD both domestically and internationally in recent years.

    非酒精性脂肪性肝病非酒精性脂肪性肝炎非酒精性脂肪性肝纤维化血清学标志物诊断

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    患者报告结局在淋巴瘤临床研究中的应用进展

    赵婉越钱思宇宋云飞常宇笑...
    133-138页
    查看更多>>摘要：随着生物-心理-社会医学模式备受重视，患者报告结局取得了重大进展。现通过综合分析和总结领域内的文献，探讨患者报告结局在淋巴瘤临床研究中的应用进展，旨在为未来的相关研究提供有益参考。 With the increasing emphasis on the bio-psycho-social medical model, significant progress has been made in patient-reported outcomes. Now, through a comprehensive analysis and synthesis of literature within the field, this study explores the advancements in the application of patient-reported outcomes in clinical research on lymphoma. The intention is to provide valuable references for future related studies.

    淋巴瘤患者报告结局健康相关生命质量

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