2019年甘肃省碘缺乏病监测结果分析

目的:了解甘肃省人群碘营养状况,为相关部门的政策调整提供科学依据。方法:2019年,采用横断面调查方法,在甘肃省14个市（州）86个县（区、市）的87个监测单位进行碘缺乏病调查。采集8 ~ 10岁儿童和孕妇随意1次尿样和家中食用盐盐样,测定尿碘和盐碘含量;在其中40个监测单位,采用B超法测量儿童甲状腺容积。结果:共调查...     

基于生物信息学分析转录因子HLF及KLF7在头颈部鳞癌进展过程的表达及预后意义

摘要：目的:通过生物信息学手段筛选驱动头颈部鳞癌（HNSCC）进展的潜在关键转录因子,分析其表达特征及预后意义。方法:从癌症基因组图谱数据库获取HNSCC转录组测序数据,筛选不同分期肿瘤组织与正常黏膜组织的差异转录因子。通过STEM工具分析差异转录因子在HNSCC进展过程的表达模式。在R3.5.1环境下,利用survival包和survminer包计算差异转录因子的预后意义。最后利用人类蛋白图谱数据库对候选转录因子进行免疫组化验证,并通过基因集富集分析挖掘与转录因子密切相关的通路。结果:和正常组织相比,HNSCC各分期的差异转录因子分别为172（Ⅰ期）,272（Ⅱ期）,272（Ⅲ期）,307（Ⅳ期）,各分期共有差异转录因子为7个。其中HLF及KLF7等5个差异转录因子与HNSCC患者预后显著相关。免疫组化结果显示,上述转录因子表达趋势均与转录组测序结果一致,其中HLF在HNSCC 4个分期表达均显著下调,而KLF7则呈现相反趋势。基因集富集分析显示,HLF表达下调可显著激活细胞外基质分解及对Ⅰ型干扰素的反应等生物进程; KLF7高表达时,角质形成细胞增殖、细胞-基质连接组件等生物进程显著激活。结论:HLF及KLF7等转录因子表达失调与HNSCC分期及患者预后密切相关,并潜在参与驱动HNSCC的恶性进展。     

简易快速气管切开器

为了简化气管切开手术操作,更便于基层医务工作者掌握气管切开技能,使喉头梗阻的患者及时得到抢救,我们设计了一种简易、快速气管切开器(下称气管切开器),供临床应用。现介绍如下:     

2010年甘肃省临夏回族自治州碘缺乏病知行信现状调查

目的了解甘肃省碘缺乏病重点地区碘缺乏病健康教育现状。方法采用随机抽样方法对临夏州8县(市)1225名五年级小学生和797名育龄妇女进行碘缺乏病问卷调查。结果学生对缺碘造成甲状腺肿、智力低下和生傻孩子知晓率分别为88.8%、85.6%和68.7%,差异有统计学意义(P<0.05),碘盐是最好防治方法的知晓率为90.0%,向父母宣传的行为具有率为52.9%,认为碘缺乏病一定能预防的信念具有率为87.3%。育龄妇女对缺碘造成甲状腺肿、智力低下和生傻孩子知晓率分别为86.2%、70.0%和46.3%,差异有统计学意义(P<0.05),碘盐是最好防治方法的知晓率为87.3%,以防伪标志购盐的行为具有率分别为60.2%,菜熟时放盐的行为具有率分别为69.8%;学生对缺碘造成危害的知晓率高于育龄妇女,差异有统计学意义(P<0.05)。结论在目前以学校为主要场所的宣传模式下,临夏州总体碘缺乏病知行信水平高于甘肃省水平,但不同县(市)、不同目标人群及不同知识点的知行信水平差异很大,因此必须加强健康教育工作的过程评估,结合民族特点和实际情况,探讨宗教场所的健康教育模式。在认知的水平上,要强化态度、信念和行为转变这个健康教育的最终目的,使健康教育的效果更持久。     

2009年甘肃省碘缺乏病调查结果分析

目的 掌握甘肃省碘缺乏病防治现状,为制订碘缺乏病的防治措施提供依据.方法 2009年,在甘肃省14个市(州),每个市(州)抽取1个达标县(市、区、旗),并按东、西、南、北、中5个方位各抽取1个乡(镇、街道),不足5个乡时全部抽取;在所抽取的每个乡(镇、街道),各抽取1个村,进行居民户碘盐情况及碘盐销售网络调查.同时在每个村抽取1所小学,进行儿童尿碘、甲状腺、智商检查及碘缺乏病知晓状况调查.结果 共检测1420份食用盐,加权碘盐覆盖率为99.53%,加权合格碘盐食用率为98.15%.共对1761名8～10岁儿童检测尿碘,中位数为225.87μg/L,在14个县中,有5个县儿童尿碘处于适宜水平,7个县超过了碘适宜水平.2个县处于碘过量水平.共对3051名8～10岁儿童进行甲状腺检查,加权甲状腺肿大率为1.9%,只有红古区儿童加权甲状腺肿大率大于5%,为5.3%.共对2815名8～10岁儿童进行智商检测,平均智商为105.3,除卓尼县和康乐县之外,其余各县儿童智商均在100以上.碘缺乏病知晓调查平均分为3.2分.知道缺碘不聪明的占57.08%(1229/2153),知道缺碘致甲状腺肿大的占71.76%(1544/2153),知道碘盐是最好的防治方法的占68.04%(1465/2153),向家人讲述碘盐好处的占61.82%(1331/2153).共凋查了87个乡(镇)102个村的食盐销售情况,每个乡(镇)都有一个碘盐代销点,每个村至少有1个碘盐零售店,但73.5%(75/102)的零售店无销售许可证.结论 甘肃省碘缺乏病防治取得了显著进展,合格碘盐食用率达到国家消除标准,甲状腺肿大率明显下降,大多数县儿童尿碘处于"大于适宜水平",碘盐销售网络基本健全,但各县碘缺乏病健康教育工作进展不平衡.

Abstract：

Objective To master the status in control of iodine deficiency disorders (IDD) in Gansu province and to provide the basis for development of control strategies. Methods One county which reached the national standardization of IDD elimination was selected randomly from each of 14 cities of Gansu province in 2009, then one town was selected respectively from five directions (east, south, west, north, and central) of the above selected counties. One village was chosen from every town which was selected for investigating household iodized salt and iodized salt sales network. At the same time the thyroid of children was examined, their urinary iodine (UI) was determined, the intelligence quotient(IQ) values of children were measured and health education was surveyed in one primary school which was chosen in each of the selected town. Results A total of 1420 edible salt samples were tested;the weighted iodized salt coverage rate and the weighted qualified iodized salt rate were 99.53% and 98.15 respectively. Urine samples were collected from 1761 children included in the study. The urinary iodine median was 225.87 μg/L. The urinary iodine medians were at optimal levels in five counties, over the optimal levels in seven counties and at excessive levels in two counties. A total of 3051 children aged 8 - 10 were randomly selected for thyroid examination. The weighted thyroid goiter rate(TGR) of children was 1.9%, and TGR was higher than 5% only in Hoaggu county. IQ of 2815 children was tested and the mean IQ was 105.3, except for the country of Zhuoni and Kangle, the mean IQ of other counties were over 100. The average score of health education was 3.2.Children of 57.08% (1229/2153) knew that iodine deficiency could lead to mental retardation, 71.76% (1544/2153) knew that iodine deficiency could cause thyroid goiter, 68.04%( 1465/2153 ) knew that eating iodized salt was the best method for IDD prevention and control and 61.82%(1331/2153) informed their families of the benefits of eating iodized salt. Each town had one agency selling iodized salt and each village had one more retail store with iodized salt, but 73.5%(75/102) of the stores without license for the sales. Conclusions Great progress has been made on the prevention and control of IDD in Gansu province. The qualified iodized salt consumption rate has reached the national standard for IDD elimination, TGR has decreased markedly, the urinary iodine levels in more counties are over the optimal levels and iodized salt distribution network is basically sound. But progress in health education is uneven.     

2001-2009年甘肃省碘盐监测结果及非碘盐问题地区分布特征分析

目的 分析2001-2009年甘肃省碘盐监测结果及非碘盐问题地区分布特征,为制订碘缺乏病防治对策提供依据.方法 按照国家碘盐监测方案,甘肃省对生产批发(2001-2007年)和居民户(2001-2009年)两个层次进行监测.盐碘测定采用直接滴定法(GB/T 13025.7-1999),川盐或特殊盐采用仲裁法测定.合格碘盐判定标准为(35±15)mg/kg(20～50 mg/kg),非碘盐判定标准为＜5 mg/kg.结果 2001-2007年共监测生产批发层次盐样4900批,批质量合格率为97.80%(4792/4900).2001-2009年居民户非碘盐率均＜5%,碘盐覆盖率均＞90%,合格碘盐食用率2003年以后均＞90%.2001-2009年共监测出非碘盐问题市(州)23年次,其中临夏州、武威市分别占39.1%(9/23)和21.7%(5/23);共监测出非碘盐问题县(区)123年次,其中少数民族和国家级贫困县有68年次,占55.3%(68/123).2001-2005年、2006-2009年少数民族和国家级贫困县分别占非碘盐问题县的49.4%(44/89)和70.6%(24/34).结论 甘肃省生产批发层次碘盐质量状况良好,居民户合格碘盐食用率达到国家碘缺乏病消除标准.但少数民族地区和贫困地区的非碘盐问题突出,在今后一段时期内将成为甘肃省碘缺乏病防治的重点地区.

Abstract：

Objective To analyze monitoring results of iodized salt and distribution characteristics of problem areas with non-iodized salt in Gansu province during 2001 - 2009 and to provide a basis to develop countermeasures to iodine deficiency disorders. Methods According to the criterion of "The National Scheme of Iodized Salt Surveillance", two levels of monitoring were carried out on production and wholesale-level(during 2001 -2007) and household-level(during 2001 - 2009). Salt iodine was determined by direct titration method (GB/T13025.7-1999), and Sichuan salt or special salt was determined with an arbitration method. Criteria for qualified iodized salt was (35 ± 15)mg/kg(20 - 50 mg/kg), and for non-iodized salt was ＜ 5 mg/kg. Results During 2001 - 2007, a total of 4900 salt samples at production and wholesale-levels were examined, with a qualification rate of 97.80% (4792/4900). Non-iodized salt rates were all below 5% in Gansu province, consumption rate of qualified iodized salt was higher than 90% after 2003. During 2001 - 2009, cities(states) with non-iodized salt problems appeared 23 times, with Linxia accounting for 39.1%(9/23), Wuwei accounting for 21.7%(5/23). During 2001 -2009, counties(districts) with non-iodized salt problem appeared 123 times, including 68 times of ethnic minorities and state poverty counties, accounting for 55.3%(68/123). During 2001 - 2005 and 2006 - 2009, ethnic minorities and state poverty counties were accounting for 49.4%(44/89) and 70.6%(24/34) in counties with non-iodized salt problem. Conclusions The quality of iodized-salt at production and wholesale level is satisfactory in Gansu province, household consumption rate of qualified iodized salt have reached national standard for eliminating iodine deficiency disorders. But ethnic minorities and state poverty counties are main regions with non-iodized salt problem,these areas will be the key areas of prevention of iodine deficiency disorders in Gansu province in the future.     

甘肃省临夏回族自治州农村地区碘缺乏病干预期内出生的儿童智力状况调查

目的了解甘肃省临夏回族自治州(简称临夏州)农村地区10 ～ 12岁儿童智力状况。方法 2019年9 - 11月, 采用横断面研究方法在临夏州8个县(市)开展10 ～ 12岁儿童智力状况调查。采用中国联合型瑞文测验(农村版)进行儿童智力测验并运用常模计算其智商(intelligence quotient, IQ), 用以评价儿童智力水平。结果共对临夏州1 721名儿童进行智力测验, IQ均值为103.2。其中, 智力低下(≤69)占1.0%(18/1 721), 边缘(70 ～ 79)占3.0%(52/1 721), 中下(80 ～ 89)占8.4%(144/1 721), 中等(90 ～ 109)占56.6%(974/1 721), 中上(110 ～ 119)占21.9%(377/1 721), 优秀(120 ～ 129)占7.8%(135/1 721), 极优秀(≥130)占1.2%(21/1 721)。10、11、12岁儿童各有635、598、488名, IQ均值分别为106.1、103.3和99.2;男、女童各有919、802名, IQ均值分别为102.9和103.4。结论 20...     

异搏停治疗完全性右束支传导阻滞并发心房扑动两例

<正> 例1 男性,86岁。间隙血尿伴尿急尿痛2用,咳嗽、胸闷3天,于1989年2月24日入院。患者有慢性支气管炎、肺气肿、高血压、肺心合并冠心病史,发现完全性右束支传导阻滞10余年,体检:神清,T36.8℃,P 62次/分,BP 22.7/8.53kPa,两肺呼吸音减低,心界向左下扩大,心率62次/分,律齐,A_2亢进。血WBC 8.3×10~9/L,N0.82,RBC 3.12×10~(12),尿镜检见满视野红细胞,     

甘肃省武威市城市与农村成人碘营养状况及甲状腺功能调查

目的 了解甘肃省武威市城市和农村健康成人碘营养水平及甲状腺功能状态.方法 2009年4月至2010年1月,采用横断面调查方法,在甘肃省武威市城市(城市组)及农村(农村组)常住居民(居住并生活半年以上)中各抽取18～45岁成人约100人,采集1次随机尿样及空腹血样.砷铈催化分光光度法检测尿碘;化学发光免疫法检测血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、游离三碘腺原氨酸(FT3);放射免疫法检测血清甲状腺球蛋白抗体(TGAb)、甲状腺微粒体抗体(TMAb).结果 分别检测城市组、农村组尿样99、98份,尿碘中位数分别为189.0、258.2μg/L,城市组低于农村组(Z=-4.020,P＜ 0.01).分别检测城市组、农村组血样104、95份,其中城市组FT4[(16.8±3.0)pmol/L]高于农村组[(15.4±2.4)pmol/L,t=3.539,P＜ 0.01].城市组、农村组TGAb阳性率分别为11.5％(12/104)、15.8％(15/95),TMAb阳性率分别为13.5％ (14/104)、14.7％(14/95);男、女TGAb阳性率分别为5.5％(6/109)、23.3％(21/90),TMAb阳性率分别为6.4％(7/109)、23.3％(21/90),其中TGAb、TMAb阳性率男性均低于女性(x2值分别为13.362、11.661,P均＜0.01).城市组和农村组甲状腺功能异常率分别为16.3％(17/104)、8.4％(8/95),其中亚临床型甲状腺功能减退(亚甲减)最常见,分别为14.4％(15/104)、7.4％(7/95);男、女甲状腺功能异常率分别为11.9％(13/109)、13.3％(12/90),其中亚甲减分别为11.0％(12/109)、11.1％(10/90).结论 武威市城市成人碘营养处于适宜水平,但农村存在碘营养偏高或部分过量;甲状腺功能异常发生以亚甲减为主;应关注碘营养过量对患甲状腺疾病,尤其是女性患病的风险.     

武威市妊娠妇女碘营养水平及甲状腺功能状态分析

目的了解不同妊娠期妇女碘营养水平及甲状腺功能状态。方法于2009年4月-2010年1月采用横断面调查方法随机抽取甘肃省武威市90名(城市49人,农村41人)妊娠期妇女。采集样本人群空腹晨起血样及任意一次尿样,检测血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、甲状腺球蛋白抗体(TGAb)、甲状腺微粒体抗体(TMAb)及尿碘。结果孕早、中、晚期妇女尿碘中位数分别为231.49、158.25和328.35μg/L,尿碘低于150μg/L的比率分别为39.29%、45.16%、25.81%。孕早期FT3、FT4水平高于孕晚期(P﹤0.05),TSH水平呈增高趋势,组间比较差异无显著性(P>0.05)。不同妊娠期妇女TGAb、TMAb抗体阳性率比较差异无显著性(P>0.05)。孕早、中、晚期妇女甲状腺功能紊乱发生率比较差异有显著性(P<0.05)。结论妊娠妇女碘营养状况良好,部分孕妇存在甲状腺功能减退倾向。