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中国实用医刊
中国实用医刊

秦省

半月刊

1674-4756

zgsyyk@163.com

0371-65920096

450003

河南省郑州市经三路七号

中国实用医刊/Journal Chinese Journal of Practical Medicine
查看更多>>1974年1月创刊，中华人民共和国卫生部主管，中华医学会主办。本刊原名《中原医刊》，中国期刊全文数据库全文收录期刊、中国学术期刊综合评价数据库统计刊源期刊、中国核心期刊（遴选）数据库收录期刊、万方数据-数字化期刊群收录期刊。重点报道内、外、妇、儿等学科进展，以及新理论、新成果等。设有论著、临床实践、经验交流、临床研究、药物与临床、综述、误诊分析等栏目。
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    超声引导下微波消融联合 125Ⅰ粒子植入、靶向免疫治疗对不可切除巨块型肝癌的疗效观察

    李艳李均彪王勇许伟...
    1-6页
    查看更多>>摘要：目的 探讨超声引导下微波消融联合125Ⅰ粒子植入、靶向免疫治疗对不可切除巨块型肝癌的疗效。 方法 回顾性抽取2019年12月至2022年5月徐州医科大学附属医院收治的不可切除巨块型肝癌患者58例，采用随机数字表法分为研究组(29例)与对照组(29例)。对照组接受超声引导下微波消融联合125Ⅰ粒子植入治疗，研究组在对照组的基础上接受靶向免疫治疗。比较两组临床疗效，比较两组治疗前后血清肿瘤标志物[甲胎蛋白(AFP)、甲胎蛋白异质体-L3(AFP-L3)、异常凝血酶原(DCP)]、血清学指标[血管内皮生长因子(VEGF)、胸腺激酶1(TK1)]和免疫功能；比较两组不良反应发生情况；随访1年，记录两组无进展生存期(PFS)情况。 结果 研究组客观缓解率、临床控制率高于对照组(P<0.05)。治疗后，两组血清AFP、AFP-L3、DCP水平均较治疗前降低(P均<0.05)，且研究组低于对照组(P<0.05)。治疗后，两组血清VEGF、TK1水平均较治疗前降低(P均<0.05)，且研究组低于对照组(P<0.05)。治疗后，两组CD4＋、CD4＋/CD8＋、免疫球蛋白M水平均较治疗前升高(P均<0.05)，且研究组高于对照组(P<0.05)；治疗后，两组CD8＋水平均较治疗前降低(P均<0.05)，且研究组低于对照组(P<0.05)。两组丙氨酸氨基转移酶(ALT)升高、天冬氨酸氨基转移酶(AST)升高、高血压、蛋白尿等Ⅰ～Ⅳ级不良反应总发生率比较差异未见统计学意义(P>0.05)。随访1年，对照组与研究组各失访1例，随访率为95.55%(28/29)，研究组中位PFS为7.02个月(95%CI：5.20～11.14)，对照组中位PFS为4.19个月(95%CI：3.98～10.87)，研究组PFS曲线优于对照组(P<0.05)。 结论 超声引导下微波消融联合125Ⅰ粒子植入、靶向免疫治疗对不可切除巨块型肝癌的疗效确切，可降低肿瘤标志物水平，改善免疫功能，抑制血清VEGF、TK1表达，安全可靠，且可延长患者中位PFS。 Objective To investigate the clinical effect of ultrasound-guided microwave ablation combined with iodine-125 (125Ⅰ) seed implantation and targeted immunotherapy in the treatment of unresectable massive hepatocellular carcinoma. Methods A total of 58 patients with unresectable massive hepatocellular carcinoma admitted to the Affiliated Hospital of Xuzhou Medical University from December 2019 to May 2022 were retrospectively selected, and they were divided into study group (29 cases) and control group (29 cases) by random number table method. The control group received ultrasound-guided microwave ablation of liever neoplasms combined with 125Ⅰ seed implantation, while the study group received targeted immunotherapy based on the treatment of the control group. The clinical efficacy of the two groups were compared. The levels of tumor markers, including α-fetoprotein (AFP), α-fetoprotein anisoplast L3 (AFP-L3) and disseminated intravascular coagulation profile (DCP), serological indicators, including vascular endothelial growth factor (VEGF) and thymokinase 1 (TK1), and immune function were compared between the two groups before and after treatment. The incidence of adverse reactions of the two groups were compared. The progression-free survival (PFS) of the two groups were recorded after 1 year of follow-up. Results The objective remission rate and clinical control rate of the study group were higher than those of the control group (P<0.05). After treatment, the levels of serum AFP, AFP-L3 and DCP in the two groups decreased compared with preoperative levels (allP<0.05) and the levels of the above indicators in study group were lower than those in the control group after treatment (P<0.05). After treatment, levels of serum VEGF and TK1 of the two groups all decreased (allP<0.05), and the levels in the study group were lower compared with the control group (P<0.05). After treatment, the levels of cluster of differentiation 4+ (CD4+ ), CD4+ /cluster of differentiation 8+ (CD8+ ), and immunoglobulin M in the two groups increased (all P<0.05), and the levels in the study group were higher compared with the control group (P<0.05). After treatment, level of CD8+ in the two groups decreased (all P<0.05), and level of CD8+ in the study group was lower compared with the control group (P<0.05). There was no significant difference in the total incidence of Ⅰ-Ⅳgrade adverse reactions between the two groups, such as alanine aminotransferase increasing, aspartate aminotransferase increasing, hypertension and proteinuria (P>0.05). After 1 year of follow-up, both the control group and the study group had 1 case lost to follow-up, and the follow-up rate of the two groups were 95.55% (28/29). The median PFS of the study group was 7.02 months (95%CI 5.20-11.14), and the median PFS of the control group was 4.19 months (95% CI 3.98-10.87). The PFS curve of the study group was better than that of the control group (P<0.05). Conclusions Ultrasound-guided microwave ablation combined with 125Ⅰ seed implantation and targeted immunotherapy, in the treatment of unresectable massive hepatocellular carcinoma, can effectively reduce the levels of tumor markers, improve immune function, inhibit the expression of serum VEGF and TK1. The treatment method is safe and reliable, and it can prolong the median PFS of patients.

    肝癌不可切除巨块型微波消融125Ⅰ粒子植入靶向免疫治疗

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    食管鳞状细胞癌预后相关铁死亡基因筛选与预后风险模型构建

    宋志雨李陶威张耀勇马天江...
    7-10页
    查看更多>>摘要：目的 探讨食管鳞状细胞癌(ESCC)患者预后相关的铁死亡基因，并构建预后风险模型。 方法 通过GEO数据库及FerrDb数据库筛选ESCC患者铁死亡相关差异表达基因，并对差异基因进行基因功能分析、构建PPI网络及模块分析，使用Logistic回归分析ESCC预后相关铁死亡基因，采用LASSO回归分析构建ESCC预后风险模型并进行验证。 结果 肿瘤组织和癌旁组织共筛查到51个铁死亡相关差异表达基因，主要富集到不饱和脂肪酸的代谢过程、响应刺激、角质细胞分化等生物过程及铁死亡、白细胞介素-18信号通路、TP53通路等信号通路，共得到三个主要模块10个基因。筛选出19个差异铁死亡基因与ESCC患者生存显著相关，构建了由FTL、SLC39A14、ALOX12、SCP2、NCF2、DUSP1、MMP13、CDKN2A、GPT2等9个铁死亡基因组成的风险模型，LASSO回归分析和受试者工作特征曲线分析结果显示，高风险组预后较差，3年生存率的受试者工作特征曲线下面积为0.835。 结论 通过生物信息学方法筛选出19个影响ESCC患者预后的铁死亡相关基因，并成功构建9个铁死亡相关基因组成的预后风险模型，该风险模型对ESCC患者预后的预测价值较高。 Objective To investigate the ferroptosis-related genes associated with the prognosis of esophageal squamous cell carcinoma (ESCC), and construct a prognostic model for the disease. Methods The GEO database and FerrDb database were used to screen differentially expressed ferroptosis-related genes of ESCC, and the gene function of differentially expressed genes were analyzed. Protein-protein interaction was construct to perform gene module analysis. The prognostic-related ferroptosis-related genes were analyzed by logistic regression analysis. And the prognostic model for ESCC was constructed by LASSO regression analysis, and was validated. Results Fifty-one differentially expressed ferroptosis-related genes were screened in tumor tissues and adjacent tissues, which were mainly enriched in signaling pathways of the metabolism of unsaturated fatty acids, response to stimulation, keratinocyte differentiation, iron death, interleukin-18, and TP53, and three main gene modules and 10 genes were obtained in total. Nineteen differentially expressed ferroptosis-related genes were screened which were significantly related to the survival of patients with ESCC, and a risk model consisting of 9 ferroptosis-related genes, including FTL, SLC39A14, ALOX12, SCP2, NCF2, DUSP1, MMP13, CDKN2A, and GPT2 was constructed. The results of LASSO regression analysis and subject operating characteristic curve analysis showed that the high-risk group had a poor prognosis. The area under the receiver operating characteristic curve of the 3-year survival rate was 0.835. Conclusions Nineteen ferroptosis-related genes associated with the prognosis of patients with ESCC are detected out by bioinformatics methods, and a prognostic risk model composed of 9 ferroptosis-related genes was successfully constructed. This prognostic model has high predictive value for the prognosis of ESCC.

    食管鳞状细胞癌铁死亡相关基因预后模型

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    经皮克氏针撬拨联合弹性髓内钉治疗儿童股骨长度不稳定骨折的效果观察

    薛超丁晨马文娟
    11-14页
    查看更多>>摘要：目的 探讨经皮克氏针撬拨联合弹性髓内钉治疗儿童股骨长度不稳定骨折的临床效果。 方法 抽取2019年3月至2023年9月汉中市中心医院收治的股骨长度不稳定骨折患儿82例，按随机数字表法分为对照组与观察组，每组41例。对照组接受弹性髓内钉治疗，观察组在对照组基础上加施经皮克氏针撬拨。比较两组骨折复位优良率、围术期相关指标，比较两组治疗前后下肢功能情况[Fug-Meyer下肢评价量表(FMA-LE)评分、功能性独立评定量表(FIM)评分、功能性步行量表(FAC)评分]及应激反应相关指标[皮质醇(Cor)、去甲肾上腺素(NE)、C反应蛋白(CRP)]。 结果 观察组骨折复位优良率(95.12%，39/41)高于对照组(80.49%，33/41)，P<0.05。观察组术中出血量、术后引流量、C臂透视次数少于对照组，且手术时间及住院时间短于对照组(P<0.05)。治疗后3个月，观察组FMA-LE、FIM、FAC评分均高于对照组(P均<0.05)。治疗后48 h，观察组Cor、NE、CRP水平均低于对照组(P均<0.05)。 结论 经皮克氏针撬拨联合弹性髓内钉治疗儿童股骨长度不稳定骨折，可减少术中出血量、C臂透视次数、术后引流量，缩短手术时间、住院时间，缓解应激反应，复位优良率高，术后下肢功能恢复快。 Objective To investigate the effect of Kirschner wire percutaneous rotation prying combined with elastic intramedullary nails on length unstable femoral fractures in children. Methods A total of 82 children with length unstable femoral fractures admitted to Hanzhong Central Hospital from March 2019 to September 2023 were selected, and they were rdivided into a control group and an observation group by random number table method, with 41 cases in each group. The control group was treated by elastic intramedullary nails, while the observation group was treated by Kirschner wire percutaneous rotation prying based on the treatment of the control group. The excellent rate of fracture reduction and perioperative related indicators were compared between two groups. The lower limb function evaluated by Fug-Meyer assessment of lower extremity (FMA-LE) score, functional, independence measure (FIM) score and functional ambulation category (FAC) score, and stress response related indicators, including cortisol (Cor), norepinephrine (NE) and C-reative protein (CRP), were compared between the two groups before and after treatment. Results The excellent and good rate of fracture reduction in the observation group (95.12%, 39/41) was higher than that in the control group (80.49%, 33/41), P<0.05. The intraoperative bleeding volume, postoperative drainage volume, and C-arm fluoroscopy frequency in the observation group were lower than those in the control group, while the surgery time and hospital stay in the observation group were shorter than those in the control group (P<0.05). After 3 months of treatment, the scores of FMA-LE, FIM and FAC in the observation group were higher than those in the control group (allP<0.05). At 48 hours after surgery, the levels of Cor, NE and CRP in the observation group were lower than those in the control group (allP<0.05). Conclusions Kirschner wire percutaneous rotation prying combined with elastic intramedullary nails in the treatment of length unstable femoral fractures in children can reduce intraoperative bleeding, C-arm fluoroscopy frequency and postoperative drainage flow. Moreover, it can shorten surgical time and hospital stay, alleviate stress response, improve excellent rate of reduction, and promote postoperative recovery of lower limb function.

    骨折股骨长度不稳定骨折儿童弹性髓内钉经皮克氏针撬拨

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    乳腺癌腋窝淋巴结转移与临床特征的相关性分析

    李静马艳丽
    15-18页
    查看更多>>摘要：目的 分析乳腺癌腋窝淋巴结转移与临床特征的相关性。 方法 观察性研究。抽取2022年7月至2023年3月郑州大学第一附属医院收治的乳腺癌患者184例，依据乳腺癌腋窝淋巴结转移情况分为腋窝淋巴结转移组(59例)和无腋窝淋巴结转移组(125例)。比较两组的临床特征，包括肿块最大直径、肿块位置、是否有脉管瘤栓及雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(HER-2)、Ki-67抗原(Ki-67)的表达，分析乳腺癌腋窝淋巴结转移与临床特征的相关性。 结果 腋窝淋巴结转移组Ki-67阳性表达率、脉管瘤栓率高于无腋窝淋巴结转移组，差异有统计学意义(P<0.05)；两组肿块最大直径、肿块位置及ER、PR、HER-2表达比较，差异未见统计学意义(P>0.05)。Logistic回归分析结果显示，Ki-67阳性表达、脉管瘤栓可能是乳腺癌腋窝淋巴结转移的影响因素(OR＝3.26、12.67，P均<0.05)。 结论 乳腺癌腋窝淋巴结转移与肿块最大直径、肿块位置及ER、PR、HER-2的表达无关，与Ki-67阳性表达、脉管瘤栓有关。 Objective To analyze the correlation between axillary lymph node metastasis and clinical features of breast cancer. Methods This stidy was an observational study. A total of 184 breast cancer patients admitted to the First Affiliated Hospital of Zhengzhou University from July 2022 to March 2023 were selected, and they were divided into axillary lymph node metastasis group (59 cases) and non-axillary lymph node metastasis group (125 cases) according to the occurrence of axillary lymph node metastasis from breast cancer. The clinical features, including the major diameter of the mass, location of the mass, vasculoma thrombosis and expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67 antigen (Ki-67), of the two groups were compared. The correlation between axillary lymph node metastasis and clinical features of breast cancer was analyzed. Results The positive expression rate of Ki-67 and incidence of vasculoma thrombosis of the axillary lymph node metastasis group were higher than those of the non-axillary lymph node metastasis group, and the differences were statistically significant (P<0.05). There was no significant difference in the the major diameter of the mass, location of the mass and expression of ER, PR or HER-2 between the two groups (P>0.05). The results of logistic regression analysis showed that positive expression of Ki-67 and vasculoma thrombosis could be the influencing factors of axillary lymph node metastasis from breast cancer (OR=3.26, 12.67 all P<0.05). Conclusions Axillary lymph node metastasis from breast cancer is not related to the major diameter of the mass, location of the mass and the expression of ER, PR or HER-2 however, it is related to the positive expression of Ki-67 and vasculoma thrombosis.

    乳腺癌腋窝淋巴结转移最大直径位置

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    单操作孔胸腔镜治疗肺大疱并自发性气胸的临床观察

    刘朋涛丁亚楠于苗子傅利霞...
    18-21页
    查看更多>>摘要：目的 探讨单操作孔胸腔镜治疗肺大疱并自发性气胸的临床价值。 方法 抽取漯河医学高等专科学校第二附属医院2017年3月至2023年3月收治的肺大疱并自发性气胸患者94例，采用随机数字表法分为对照组和研究组，每组47例。对照组采用传统三孔胸腔镜治疗，研究组采用单操作孔胸腔镜治疗。比较两组围术期指标、疼痛程度[视觉模拟评分法(VAS)评分]、肺功能指标[第1秒用力呼吸容积(FEV1)、肺残气量(RV)、肺总量(TLC)]、血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]及并发症发生率。 结果 研究组术中出血量及术后引流量少于对照组，住院时间短于对照组(P<0.05)；术后1、2 、3 d，研究组VAS评分低于对照组(P<0.05)。术前及术后3 d，两组FEV1、RV、TLC水平比较差异未见统计学意义(P>0.05)；术后3 d，两组FEV1水平高于术前，RV、TLC水平低于术前(P<0.05)。术前及术后3 d，两组PaO2、PaCO2水平比较差异未见统计学意义(P>0.05)；术后3 d，两组PaO2水平高于术前，PaCO2水平低于术前(P<0.05)。研究组并发症发生率(8.51%，4/47)与对照组(4.26%，2/47)比较差异未见统计学意义(P>0.05)。 结论 单操作孔胸腔镜治疗肺大疱并自发性气胸效果较好，能缓解机体疼痛，改善肺功能及血气指标，加快患者恢复，且安全性良好。 Objective To investigate the clinical value of single-hole thoracoscopy in the treatment of pulmonary bulla complicated by spontaneous pneumothorax. Methods A total of 94 patients with pulmonary bulla complicated by spontaneous pneumothorax treated in the Second Affiliated Hospital of Luohe Medical College from March 2017 to March 2023 were selected, and they were divided into control group and study group according to random number table method, with 47 cases in each group. The control group was treated by traditional three-hole thoracoscopic treatment, and the study group received single-hole thoracoscopic treatment. The perioperative indexes, pain degree assessed by visual analogue scale (VAS) score, lung function indexes, including forced expiratory volume in 1 second (FEV1), residual volume (RV) and total lung volume (TLC), blood gas indexes, including arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2), and incidence of complication of the two groups were compared. Results Compared with the control group, the study group had less intraoperative blood loss, less postoperative drainage volume, and shorter hospital stay (P<0.05). Compared with the control group, VAS score of the study group was lower on 1, 2 and 3 days after surgery (P<0.05). Before and 3 days after surgery, there was no statistically significant difference in levels of FEV1, RV and TLC between the two groups (P>0.05). Three days after surgery, the FEV1 level in both groups increased, and the levels of RV and TLC in both groups decreased, compared with preoperative levels (P<0.05). Before and 3 days after surgery, there was no statistically significant difference in levels of PaO2 and PaCO2 between the two groups (P>0.05). Compared with preoperative levels, level of PaO2 in both groups increased, and level of PaCO2 decreased 3 days after surgery (P<0.05). There was no significant difference in the incidence of complications between the study group (8.51%, 4/47) and the control group (4.26%, 2/47),P>0.05. Conclusions Single-hole thoracoscopy has significant effects in the treatment of pulmonary bulla complicated by spontaneous pneumothorax, which can relieve body pain, improve lung function and blood gas indexes, and accelerate recovery of patients, with good safety.

    气胸自发性肺大疱单操作孔胸腔镜

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    中原地区男性原发性肾结石发生的影响因素分析

    李中学马艳丽
    22-25页
    查看更多>>摘要：目的 分析中原地区男性原发性肾结石发生的影响因素。 方法 纳入2022年3月至2023年3月于郑州市第七人民医院进行健康体检的男性172例，检测外周血维生素D受体基因FokI多态性，依据肾结石发生情况将其分为发生组(30例)和未发生组(142例)。分析两组FokI多态性基因分布及一般资料，采用多因素Logistic回归分析中原地区男性原发性肾结石发生的影响因素。 结果 发生组ff基因型占比高于未发生组，差异有统计学意义(P<0.05)。发生组体质指数、每日饮水量、饮食习惯、肾结石家族史构成比与未发生组比较，差异有统计学意义(P<0.05)。两组年龄、文化程度、饮酒史、吸烟史、饮用水类型构成比较，差异未见统计学意义(P>0.05)。多因素Logistic回归结果显示，FokⅠ基因型、体质指数、每日饮水量、饮食习惯、有肾结石家族史是男性原发性肾结石发生的独立影响因素(OR＝2.11、1.91、0.40、5.87、8.76, P均<0.05)。 结论 FokⅠ基因型、体质量、每日饮水量、饮食习惯、有肾结石家族史是中原地区男性原发性肾结石发生的独立影响因素，该地区男性应适当增加每日饮水量、控制蛋白质摄入量，ff基因型者、有肾结石家族史者应注意调整饮食结构及生活方式。 Objective To analyze the influencing factors of occurrence of male primary renal calculus in Central Plains. Methods A total of 172 males who underwent physical examination in the Seventh People’s Hospital of Zhengzhou from March 2022 to March 2023 were enrolled in the study, and they underwent test for vitamin D receptor gene FokI polymorphism in peripheral blood. According to incidence of renal calculus, they were divided into occurrence group (30 cases) and non-occurrence group (142 cases). The distribution of FokI polymorphisms and general data in the two groups were analyzed. The univariate and multivariate logistic regression analyses were used to analyze the influencing factors of occurrence of primary renal calculu in males in the Central Plains. Results The proportion of ff genotype in the occurrence group was higher than that in the non-occurrence group, and the difference was statistically significant (P<0.05). There were significant differences in body mass index, daily water intake, dietary eating habits, and family history of renal calculu between the occurrence group and the non-occurrence group (P<0.05). There was no significant difference in the proportions of age, education level, drinking history, smoking history and drinking water type between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that FokI genotype, body mass index, daily water intake, dietary eating habits, and family history of renal calculu were independent influencing factors for the occurrence of primary kidney stones in males (OR=2.11, 1.91, 0.40, 5.87, 8.76 all P<0.05). Conclusions FokI genotype, body weight, daily water intake, dietary eating habits, and family history of renal calculu are independent influencing factors for the occurrence of male primary kidney stones in Central Plains. Men in Central Plains should appropriately increase their daily water intake and control protein intake. Men with ff genotype and family history of renal calculu should pay attention to adjusting their diet and lifestyle.

    肾结石男性影响因素

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    化脓性脑膜炎患儿血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平变化及其临床意义

    王亮亮杨培娜闫瑜傅利霞...
    26-30页
    查看更多>>摘要：目的 分析化脓性脑膜炎患儿血浆及脑脊液中白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、γ干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)水平变化及其临床意义。 方法 抽取2018年1月至2021年12月安阳市妇幼保健院收治的化脓性脑膜炎患儿82例为观察组，按照其病情严重程度分为重症组(24例)和轻症组(58例)；另抽取疑似中枢神经感染后经多种检测排除的82例患儿作为对照组。所有研究对象均进行血浆及脑脊液IL-4、IL-6、IFN-γ、TNF-α水平检测。比较各组血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平，并分析观察组患儿治疗前后血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平，随访6个月后评估观察组患儿预后状况，比较预后良好患儿和预后不良患儿血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平。 结果 观察组血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平高于对照组(P<0.05)；重症组血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平高于轻症组(P<0.05)；治疗后，观察组血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平低于治疗前(P<0.05)；观察组中预后良好者血浆及脑脊液中IL-6、TNF-α水平低于预后不良者(P<0.05)。 结论 化脓性脑膜炎患儿血浆及脑脊液中IL-4、IL-6、IFN-γ、TNF-α水平较高，且IL-4、IL-6、IFN-γ、TNF-α水平能显示病情程度，临床应结合IL-4、IL-6、IFN-γ、TNF-α水平变化情况拟定相关治疗方案，改善患儿预后。 Objective To analyze the changes and clinical significance of levels of interleukin-4 (IL-4), interleukin-6 (IL-6), interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α) in plasma and cerebrospinal fluid in children with purulent meningitis. Methods A total of 82 children with purulent meningitis treated in Anyang Maternal and Child Health Care Hospital from January 2018 to December 2021 were selected as the observation group, and they were divided into severe group (24 cases) and mild group (58 cases) according to the severity of the disease. Another 82 children who were suspected of central nervous system infection but were diagnosed without the disease by vary examinations were selected as the control group. All subjects were tested for levels of IL-4, IL-6, IFN-γ, and TNF-α in plasma and cerebrospinal fluid. The levels of IL-4, IL-6, IFN-γ and TNF-α in plasma and cerebrospinal fluid were compared between the observation group and the control group, and between the severe group and the mild group. The preoperative and postoperative levels of IL-4, IL-6, IFN-γ, and TNF-α in plasma and cerebrospinal fluid in the observation group were analyzed. After a follow-up of 6 months, the prognosis of the observation group was evaluated, and the levels of IL-4, IL-6, IFN-γ and TNF-α in plasma and cerebrospinal fluid were compared between the children with good prognosis and poor prognosis. Results The levels of IL-4, IL-6, IFN-γ, and TNF-α in plasma and cerebrospinal fluid in the observation group were higher than those in the control group (P<0.05). The levels of IL-4, IL-6, IFN-γ, and TNF-α in plasma and cerebrospinal fluid in the severe group were higher than those in the mild group (P<0.05). After treatment, the levels of IL-4, IL-6, IFN-γ, and TNF-α in plasma and cerebrospinal fluid in the observation group were lower than those before treatment (P<0.05). The levels of IL-6 and TNF-α in plasma and cerebrospinal fluid in patients with good prognosis were lower than those in patients with poor prognosis in the observation group (P<0.05). Conclusions The levels of IL-4, IL-6, IFN-γ and TNF-α in plasma and cerebrospinal fluid of children with purulent meningitis are high, and the levels of IL-4, IL-6, IFN-γ and TNF-α can indicate the severity of the disease. Clinical treatment should be developed according to the changes in the levels of IL-4, IL-6, IFN-γ and TNF-α to improve the prognosis of children.

    化脓性脑膜炎血浆脑脊液白细胞介素-4白细胞介素-6

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    胸腔镜下微创肺段切除术治疗肺部磨玻璃样结节的临床研究

    王志宏杨光辉常金明罗文卿...
    31-33页
    查看更多>>摘要：目的 分析胸腔镜下微创肺段切除术治疗肺部磨玻璃样结节的效果。 方法 抽取2020年4月至2021年4月南阳市中心医院收治的肺部磨玻璃结节患者150例，按随机数字表法分为肺段切除组与肺叶切除组，每组75例。肺叶切除组采用胸腔镜下肺叶切除术，肺段切除组采用胸腔镜下微创肺段切除术。比较两组围术期情况(手术时间、术中出血量、留置引流管时间、住院时间)、肺功能[最大每分钟通气量(MVV)、最大肺活量(FVC)]、术后疼痛度及并发症发生率。 结果 肺段切除组手术时间长于肺叶切除组，术中出血量少于肺叶切除组，留置引流管时间、住院时间短于肺叶切除组(P<0.05)。术后6个月，肺段切除组MVV、FVC高于肺叶切除组(P<0.05)。术后1、3、5 d，肺段切除组VAS评分低于肺叶切除组(P<0.05)。肺段切除组并发症发生率(2.67%，2/75)低于肺叶切除组(12.00%，9/75)，差异有统计学意义(P<0.05)。 结论 胸腔镜下微创肺段切除术治疗肺部磨玻璃样结节患者，可减轻疼痛，改善肺功能，降低并发症发生率，加快患者术后恢复。 Objective To analyze the effect of minimally invasive thoracoscopic segmentectomy in the treatment of pulmonary ground-glass nodules. Methods A total of 150 patients with pulmonary ground-glass nodules treated in Nanyang Central Hospital from April 2020 to April 2021 were selected, and they were divided into segmentectomy group and lobectomy group according to the random number table method, with 75 cases in each group. The lobectomy group underwent thoracoscopic lobectomy, and the segmentectomy group was treated by minimally invasive thoracoscopic segmentectomy. The perioperative conditions (operation time, intraoperative blood loss, indwelling time of drainage tube and hospital stay), lung function assessed by maximal minute ventilation volume (MVV) and forced vital capacity (FVC), postoperative pain, and incidence of complication were compared between the two groups. Results The segmentectomy group had longer operation time, less intraoperative blood loss, shorter indwelling time of drainage tube and shorter hospital stay, compared with the lobectomy group (P<0.05). Six month after operation, MVV and FVC in the segmentectomy group were higher than those in the lobectomy group (P<0.05). The VAS score in the segmentectomy group was lower than that in the lobectomy group 1, 3 and 5 days after operation (P<0.05). The incidence of complications in the segmentectomy group (2.67%, 2/75) was lower than that in the lobectomy group (12.00%, 9/75),P<0.05. Conclusions Minimally invasive thoracoscopic segmentectomy, in the treatment of pulmonary ground-glass nodules, can relieve pain, improve lung function, reduce incidence of complications, and accelerate postoperative recovery.

    肺结节胸腔镜下微创肺段切除术胸腔镜下肺叶切除术

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    急性胰腺炎患者血清VEGF、IL-6及血浆D-D水平变化及其与病情严重程度的相关性

    徐娇阳张林马春燕李佳佳...
    34-37页
    查看更多>>摘要：目的 探究急性胰腺炎(AP)患者血清血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)、血浆D-二聚体(D-D)水平变化，并分析其与病情严重程度的相关性。 方法 抽取2021年6月至2022年12月开封市中心医院收治的86例AP患者为研究对象(设为研究组)，其中轻中度者61例，重度者25例；另抽取同期入院排除胰腺炎的胃肠炎患者86例作为对照组。比较对照组与研究组血清VEGF、IL-6及血浆D-D水平。比较研究组不同病情程度患者血清VEGF及IL-6水平、血浆D-D水平、急性胰腺炎严重程度床边指数(BISAP)、Ranson评分。采用Pearson分析研究血浆D-D及血清VEGF、IL-6水平与BISAP评分、Ranson评分、病情程度的相关性。绘制受试者工作特征曲线评价血清VEGF、IL-6及血浆D-D水平对AP病情程度的诊断价值。 结果 研究组血浆D-D及血清VEGF、IL-6水平高于对照组(P<0.05)。研究组重度患者血浆D-D及血清VEGF、IL-6水平高于轻中度患者(P<0.05)；重度患者BISAP评分、Ranson评分高于轻中度患者(P<0.05)。Pearson相关性分析结果显示，D-D、VEGF、IL-6水平与BISAP评分、Ranson评分、病情程度呈正相关(P<0.05)。受试者工作特征曲线结果显示，D-D、VEGF、IL-6联合诊断AP病情程度的曲线下面积(AUC)大于单项指标诊断(P<0.05)，且与BISAP评分、Ranson评分诊断的AUC比较差异未见统计学意义(P>0.05)。 结论 AP患者血清VEGF、IL-6及血浆D-D水平升高，且与病情严重程度密切相关。联合检测其水平对重度AP具有一定诊断价值。 Objective To investigate the changes of levels of serum vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and plasma D-dimer (D-D) in patients with acute pancreatitis (AP), and analyze the correlation of them with the severity of the disease. Methods Eighty-six patients with AP admitted to Kaifeng Central Hospital from June 2021 to December 2022 were selected as study objects (as the study group). Among them, 61 cases were classified as mild to moderate, while 25 cases were classified as severe. Additionally, 86 patients with gastroenteritis who were admitted to the hospital during the same period were selected as control group, excluding pancreatitis cases. The levels of serum VEGF, IL-6 and plasma D-D were compared between the control group and the study group. The levels of serum VEGF, IL-6 and plasma D-D, bedside index of acute pancreatitis severity (BISAP) score, and Ranson score were compared among patients with different degrees of disease in the study group. Pearson analysis was used to analyze correlation of levels of serum VEGF, IL-6 and plasma D-D with BISAP score, Ranson score and disease severity.The diagnostic value of serum VEGF, IL-6 and plasma D-D levels for the degree of AP condition was evaluated using the receiver operating characteristic curve. Results Levels of serum VEGF, IL-6 and plasma D-D in the study group were higher than those in the control group (P<0.05). The levels of serum VEGF, IL-6 and plasma D-D in severe cases were higher than those in mild-to-moderate cases in the study group (P<0.05). Compared with mild-to-moderate cases, severe cases had higher BISAP score and higher Ranson score (P<0.05). Results of pearson analysis showed that levels of D-D, VEGF and IL-6 are positively correlated with BISAP score, Ranson score and disease severity (P<0.05). Results of receiver operating characteristic curve showed that, area under the curve (AUC) of combination of D-D, VEGF and IL-6 was greater than those of the three single indicators in diagnosing disease severity of AP, and it had no significant difference with AUC of BISAP score and Ranson score (P>0.05). Conclusions Levels of serum VEGF, IL-6 and plasma D-D are elevated in patients with AP, and are closely related to the severity of the disease. The combined detection of them has some diagnostic value for severe AP.

    急性胰腺炎血管内皮生长因子D-二聚体白细胞介素-6

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    宫腔镜子宫内膜息肉电切术后应用左炔诺孕酮宫内节育系统预防子宫内膜息肉复发的效果

    刘凤伟隗玮马艳丽
    38-41页
    查看更多>>摘要：目的 分析宫腔镜子宫内膜息肉电切术(TCRP)后应用左炔诺孕酮宫内节育系统(LNG-IUS)预防子宫内膜息肉(EP)复发的效果。 方法 回顾性抽取2019年3月至2022年3月信阳市妇幼保健院收治的EP患者78例，依据治疗方案分为对照组(39例)和观察组(39例)。两组均予以TCRP治疗，对照组术后口服地屈孕酮，观察组术后予以LNG-IUS。比较两组临床效果、月经恢复情况(月经经期、月经周期、月经量)、血红蛋白(Hb)水平、子宫内膜厚度、不良反应及EP复发情况。 结果 观察组总有效率(94.87%，37/39)高于对照组(76.92%，30/39)，P<0.05。术后12个月，两组月经经期、月经周期比较差异未见统计学意义(P>0.05)，观察组月经量少于对照组(P<0.05)。术后3、6、12个月，观察组Hb水平高于对照组(P<0.05)，观察组子宫内膜厚度小于对照组(P<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)；观察组EP复发率(2.56%，1/39)低于对照组(20.51%，8/39)，P<0.05。 结论 TCRP后应用LNG-IUS治疗可提高临床效果，减小子宫内膜厚度，改善月经情况，降低EP复发率。 Objective To analyze the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) in preventing recurrence of endometrial polyps (EP) after hysteroscopic transcervical resection of polyp (TCRP). Methods A total of 78 EP patients admitted to Xinyang Maternal and Child Care Hospital from March 2019 to March 2022 were selected retrospectively, and the patients were divided into control group (39 cases) and observation group (39 cases) according to the treatment plan. Both groups were treated by TCRP. The control group was treated with oral dydrogesterone after operation, and the observation group was treated by LNG-IUS after operation. The clinical effect, menstrual recovery evaluated by menstrual period, menstrual cycle and menstrual volume, level of hemoglobin (Hb), endometrial thickness, incidence of adverse reactions and recurrence of EP were compared between the two groups. Results The total effective rate of the observation group (94.87%, 37/39) was higher than that of the control group (76.92%, 30/39), P<0.05. There was no significant difference in menstrual period and menstrual cycle between the two groups 12 months after surgery (P>0.05). The menstrual volume in the observation group was lower than that in the control group 12 months after surgery (P<0.05). Compared with the control group, the observation group had higher level of Hb and thicker endometrial thickness 3, 6 and 12 months after surgery (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The recurrence rate of EP in the observation group (2.56%, 1/39) was lower than that in the control group (20.51%, 8/39),P<0.05. Conclusions The application of LNG-IUS treatment after TCRP can improve the clinical effect, reduce the endometrial thickness, improve the menstrual condition, and reduce the recurrence rate of EP.

    子宫内膜息肉宫腔镜子宫内膜息肉电切术左炔诺孕酮宫内节育系统

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