PTX-3对肾综合征出血热患者疾病严重程度及预后的预测价值研究

目的　分析肾综合征出血热（hemorrhagic fever with renal syndrome, HFRS）患者血浆正五聚素-3（pentraxin-3, PTX-3）的水平变化,探讨其对HFRS病情严重程度及预后的预测价值。方法　随机纳入105例2012年10月—2014年12月空军军医大学第二附属医院传染科收治的HFRS患者,依据HFRS临床分型标准,将纳入患者分为轻型、中型、重型和危重型4组。采集患者急性期静脉血标本96份,恢复期65份,同时采集27名健康志愿者静脉血标本作为对照,分离血浆,应用ELISA法检测PTX-3水平。分析PTX-3水平在不同分型患者急性期及恢复期的表达变化,以及与对照组的差异,评估其在重症HFRS早期预警中的价值;分析急性期PTX-3与常规实验室指标及预后的相关性,采用ROC曲线评估急性期PTX-3水平对HFRS患者预后（死亡）的预测价值。结果　105例患者中,轻型17例、中型27例、重型26例、危重型35例。各型患者及对照组之间性别、年龄比较,差异均无统计学意义（P均＞0.05）。各型患者急性期血浆PTX-3水平均显著高于同型恢复期和对照组（P均＜0.05）,危重型患者急性期PTX-3水平显著高于其他分型（P均＜0.05）。患者急性期PTX-3水平与WBC、AST、APTT呈正相关,与PLT、ALB、血浆纤维蛋白原水平呈负相关（|rs|＞0.500,P＜0.05）。ROC曲线分析急性期PTX-3水平对HFRS患者预后（死亡）的预测价值,AUC为0.753（95%CI：0.593～0.914,P=0.003）。结论　PTX-3可作为重症HFRS的早期预警指标,其有助于评估HFRS疾病严重程度及预测患者预后。     

妊娠期高血压患者血清MCP-1、PECAM-1、组织因子表达及临床意义

目的:检测妊娠期高血压(PIH)患者血清单核细胞趋化蛋白-1(MCP-1)、血小板内皮细胞黏附分子-1(PECAM-1)、组织因子(TF)表达水平及与凝血指标关系。方法:以2018年3月-2021年1月本院PIH孕妇200例(PIH组),正常妊娠孕妇200例为对照组,将PIH孕妇分为妊娠期高血压、轻度子痫前期、重度子痫前期。酶联免疫吸附试验检测各组血清中MCP-1、PECAM-1、TF水平;全自动血凝仪检测血浆中凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fg)和D-二聚体(D-D)。Pearson分析PIH孕妇血清MCP-1、PECAM-1、TF与血浆各凝血指标相关性。结果:与对照组比较,PIH组血清MCP-1、TF水平、血浆Fg、D-D水平升高,血清PECAM-1水平降低,血浆PT、APTT、TT缩短(P0.05);与妊娠期高血压相比,轻度子痫前期、重度子痫前期血清MCP-1、TF水平、血浆Fg水平升高,血清PECAM-1水平降低,血浆APTT、TT缩短,重度子痫前期血浆中D-D水平升高,与轻度子痫前期相比,重度子痫前期血清MCP-1、TF水平,血浆Fg水平升高,血清PECAM-1水平降低,血浆APTT、TT缩短(均P0.05)。PIH孕妇血清MCP-1、TF与血浆APTT、TT呈负相关,与Fg、D-D呈正相关,PECAM-1与血浆APTT、TT呈正相关,与Fg、D-D呈负相关(均P0.05);血清MCP-1、TF与PECAM-1呈负相关,MCP-1与TF呈正相关(均P0.05)。结论:PIH患者血清MCP-1、TF高表达,PECAM-1低表达,且随疾病加重变化增加,3者关系密切且均与凝血指标相关,可能在临床有一定诊断价值。     

妊娠期高血压患者血清VEGF、IL-18、MCP-1水平及与血液流变学指标关系

目的:探讨妊娠高血压患者血清血管内皮细胞生长因子(VEGF)、白介素-18(IL-18)、单核细胞趋化因子-1(MCP-1)水平及与血液流变学指标关系。方法:选取2017年4月—2019年5月本院收治的125例妊娠高血压综合征患者为观察组,另取同期本院产前检查的正常妊娠孕妇103例为对照组,酶联免疫吸附实验检测两组血清VEGF、IL-18、MCP-1水平,ZL9000血液流变仪检测血液流变学指标,比较两组差异,分析VEGF、IL-18、MCP-1水平与血液流变学的相关性。结果:观察组VEGF、IL-18、MCP-1水平均高于对照组,血液流变学指标中全血高低切黏度、高低切还原黏度,血浆黏度、红细胞聚集指数、纤维蛋白原、红细胞比容等高于对照组(均P<0.05)。Pearson相关性分析显示,血清VEGF、IL-18、MCP-1水平均与全血高低切黏度,高低切还原黏度、红细胞聚集指数呈正相关,VEGF水平与血浆黏度呈正相关(均P<0.05)。结论:妊娠期高血压综合征患者血清VEGF、IL-18、MCP-1水平升高,且与血液流变学指标关系密切。     

肺结核患者外周血单个核细胞MCP-1表达上升

目的 研究肺结核患者血浆单核细胞趋化蛋白（MCP-1）的浓度特点及外周血单核细胞（PBMCs）经结核分枝杆菌特异性抗原肽刺激后MCP-1和IFN-γ的表达及相关性.方法 20例活动期肺结核患者和16位PPD阳性健康对照,采集EDTA抗凝血,用结核分枝杆菌特异性抗原肽刺激PBMCs,采用FlowCytomix流式技术检测血浆和细胞培养液上清上中MCP-1和IFN-γ的表达.结果 肺结核患者血浆MCP-1浓度与对照组比较差异无统计学意义[肺结核组（263.8±25.31）pg/ml,对照组（212.1±18.04）pg/ml,P＞0.05],但肺结核患者的血浆MCP-1水平偏高,尤其是呼吸道症状明显的患者.肺结核患者的PBMCs经结核分枝杆菌特异性抗原肽刺激后,培养液上清中MCP-1的水平比血浆显著升高,肺结核患者与对照组比较差异有统计学意义[（21460±3376）pg/ml vs 10910±2141）pg/ml,P＜0.01],与IFN-γ的分泌无关（spearman r=0.1835,P＞0.05）.结论 肺结核患者血浆MCP-1浓度可能与病情发展相关;结核分枝杆菌特异性抗原肽刺激外周血单个核细胞产生的MCP-1可能成为新的诊断指标之一.     

不同临床分度HIE新生儿血清sICAM-1水平动态变化

目的探讨轻、中、重度缺氧缺血性脑病（HIE）新生儿疾病极期和恢复期初血清可溶性细胞间黏附分子-1（sICAM-1）水平的动态变化及意义。方法对照组正常足月新生儿脐血17例，轻（13例）、中（14例）、重度（9例）HIE患儿组共36例，对所有患儿疾病极期、恢复期初血清sICAM-1水平进行双抗体夹心酶联免疫（ELISA）法检测。统计学处理采用方差分析、q检验及t检验。结果轻、中、重度HIE组患儿疾病极期血清sICAM-1水平显著升高，但3组升高的水平差异显著（P〈0．001、0．01）。3组恢复期初血清sICAM-1水平均较极期显著下降（P〈0．001），但均未降至对照组水平（P〈0．01）；且3组之间仍有差异，中、重度之间的差异已无意义（P〉0．05），而中、重度与轻度间的差异显著（P〈0．01）。结论HIE疾病极期血清sICMA-1水平急剧升高的程度与脑损伤程度密切相关。临床动态监测HIE患儿血清sICAM-1有助于判断其病情轻重和预后。     

血清TNF-α、MCP-1水平与老年骨质疏松症患者骨代谢指标的相关性研究

目的 探讨血清TNF-α、 MCP-1水平与老年骨质疏松症患者骨代谢指标的相关性。方法 选取2021年1月至2022年8月我院收治的50例老年骨质疏松症患者为观察组,同期选取50例骨量正常的老年自愿者作为对照组。检测两组的TNF-α、MCP-1、 CTX-1、 PⅠNP、 OC水平,采用Pearson检验分析TNF-α、 MCP-1与CTX-1、 PⅠNP、 OC的相关性。结果 观察组的TNF-α、 MCP-1水平均高于对照组（P <0.05）。观察组的CTX-1水平高于对照组,PⅠNP、 OC水平低于对照组（P <0.05）。Pearson相关性分析显示,TNF-α、 MCP-1与CTX-1呈正相关,与PⅠNP、 OC呈负相关（P <0.05）。结论 老年骨质疏松症患者存在骨代谢失衡,外周血TNF-α、 MCP-1水平与骨代谢指标具有显著的相关性。     

进展期胃癌血浆胆固醇水平相关研究

目的 了解进展期胃癌及对照组胃溃疡病人手术前后血浆胆固醇水平，探讨其与胃癌临床分型的相关性。方法 术前及术后10d测定临床确诊的胃癌及胃溃疡病人血浆胆固醇含量，记录相应病例胃癌临床分型，进行统计学分析。结果 进展期胃癌患者术前血浆胆固醇较对照组术前显著降低，差异有高度统计学意义（P〈0．01）；胃癌术后血浆胆固醇水平升高，与术前比较。差异有统计学意义（P〈0．05），与对照组术后比较差异无统计学意义。A组Bormann（Ⅲ、Ⅳ型）手术前血浆胆固醇较B组Bormann（Ⅰ、Ⅱ型）降低，差异有统计学意义（P〈0．05）；A、B组术后血浆胆固醇均升高（P〉0．05）；各自与术前相比，A组差异无统计学意义，B组差异有高度统计学意义（P〈0．01）。结论 进展期胃癌患者，手术前血浆胆固醇水平降低，术后升高；降低、升高的程序与临床分型相关；临床分型越差，术前、术后血浆胆固醇水平越低，升高的程度越明显。     

肾综合征出血热患者血清炎性细胞因子与疾病进程及预后的相关性

目的分析肾综合征出血热患者不同临床分期及不同临床分型血清中C反应蛋白、白细胞介素-1、白细胞介素-6、肿瘤坏死因子-α水平与疾病的相关性,为HFRS临床诊治提供依据。方法以2018年6月至2020年1月在锦州医科大学附属第一医院住院的37例HFRS患者和15例健康体检者(对照组)为研究对象,用ELISA法分别检测患者血清炎性细胞因子CRP、IL-1、IL-6和TNF-α水平,并分析其与临床分期、临床分型的相关性。结果临床分期为急性期和恢复期的患者血清中CRP、IL-1、IL-6和TNF-α水平均高于正常组(P<0.01),且急性期各细胞因子显著高于恢复期(P<0.01);临床分型轻型、中型、重型、危重型患者血清CRP、IL-1、IL-6和TNF-α水平较比对照组有不同程度的增加(P<0.05)。Spearman相关分析显示,CRP、IL-1、IL-6和TNF-α水平与不同临床分期呈负相关(r=-0.48,P<0.01;r=-0.59,P<0.01;r=-0.33,P=0.03;r=-0.47,P<0.01);与不同临床分型呈正相关(r=0.42,P=0.01;r=0.56,P<0.01;r=0.52,P<0.01;r=0.34,P=0.04);与预后(存活)呈负相关(r=-0.32,P=0.02;r=-0.46,P<0.01;r=-0.40,P<0.01;r=-0.37,P=0.01)。结论HFRS患者血清炎性细胞因子水平与疾病严重程度及预后密切相关。     

子痫前期孕妇血浆IL-6水平与疾病严重程度的相关性分析

目的:探讨子痫前期孕妇血浆IL-6水平与疾病严重程度的相关性.方法:收集90例子痫前期孕妇,依据孕妇的相关检验结果分为轻度组和重度组,同时收集45例正常孕妇作为对照组,比较各组孕妇血浆IL-6水平的高低,以及血浆IL-6水平的高低与疾病严重程度的相关性.结果:与正常对照组孕妇相比,子痫前期孕妇血浆各检测指标均明显升高,IL-6水平的升高与疾病严重程度呈正相关(r=0.738,P=0.033).结论:对于子痫前期孕妇,检测血浆IL-6水平可在一定程度上预测及反映患者的严重程度,值得临床推广.     

新型冠状病毒肺炎 无症状感染者的临床与免疫学特征分析

[摘要]　目的　探讨新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）无症状感染者的临床和免疫学特征。方法　选取2020年1月22日—6月22日石家庄市第五医院收治的59例COVID-19患者作为研究对象,分析不同疾病分期患者的临床资料。利用流式细胞术检测患者外周血T淋巴细胞亚群计数,Procarta Plex多细胞因子检测系统检测外周血25种细胞因子和9种趋化因子水平。结果　59例COVID-19患者中,无症状感染组28例（47.5%）、轻型组6例（10.2%）、普通型组19例（32.2%）,重型/危重型组6例（10.2%）。无症状感染组中位年龄为23.0（19.3,34.8）岁,显著低于普通型组的35.0（24.0,52.0）岁和重型/危重型组的64.5（52.0,68.3）岁（P均＜0.05）。无症状感染组患者较少患有基础疾病,均无症状、体征和胸部CT变化,其外周血CD3+ T细胞、CD4+ T细胞、CD8+ T细胞计数均显著高于重型/危重型组（P均＜0.05）,同时CD4+ T细胞计数显著高于普通型组（P＜0.05）。14例无症状感染组患者治疗前与治疗后CD3+ T细胞、CD4+ T细胞和CD8+ T细胞计数比较,差异均无统计学意义（P均＞0.05）。14例无症状感染组患者治疗前后CD4+ T细胞计数的变化幅度均显著低于普通型组、重型/危重型组（P均＜0.05）。无症状感染组外周血可检测到11种细胞因子和趋化因子,其中IL-7水平显著高于对照组, IP-10水平均显著低于普通型组、重型/危重型组,差异均具有统计学意义（P均＜0.05）。结论　COVID-19无症状感染者以青年为主,但未发现与性别因素相关。随着COVID-19病情进展,普通型、重型/危重型患者外周血T细胞亚群计数降低,而细胞因子和趋化因子水平升高,但上述指标在无症状感染者中未见显著改变。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.