肝炎后肝硬化并发肝癌的危险因素分析

目的探讨肝炎后肝硬化并发肝癌可能存在的危险因素。方法随机选取我院2006年1月至2013年5月期间肝炎后肝硬化并发肝癌的患者50例为观察组,随机选取肝炎后肝硬化未并发肝癌的患者70例为对照组,回顾性分析两组患者肝炎后肝硬化并发肝癌的危险因素。结果单因素分析结果显示,年龄、饮酒史、糖尿病、HBV、HCV、抗一HBC、抗一HBe、HBs抗原为肝炎后肝硬化并发肝癌的危险因素。将单因素分析有意义的危险因素纳入Logistic多因素回归分析显示,糖尿病为并发肝癌的独立危险因素（0R1．897,P〈0．05）;HBs抗原阳性为并发肝癌的独立危险因素（DR3．346,P〈0．05）;HBVDNA阳性为并发肝癌的独立危险因素（OR3．679,P〈0．05）。结论肝炎后肝硬化的临床多种危险因素可引起肝癌并发症的发生,其中糖尿病、HBVDNA阳性与HBs抗原阳性是并发肝癌的独立危险因素。     

原发性肝癌超声检出率及临床分析

目的探讨原发性肝癌检出率及危险因素。方法应用B超、彩色多普勒血流显像（CDFI）及三维彩色血管能量成像（3D－CPA）检查10,383例肝脏。结果正常组肝癌检出率为0．14％,脂肪肝组检出率为0．84％,慢性肝炎及HBV感染组检出率为10．56％,肝硬化组检出率为36．61％。与正常组比较,肝癌发生危险度在肝硬化组最高（RR＝261．5,95CI＝140．45～47914）,依次为慢性肝炎、HBV感染组（RR＝75．43,95％CI＝40．21～137．53）及脂肪肝组（RR＝6．00,95％CI＝3．22～1836）。结论慢性肝炎、HBV感染、肝硬化中原发性肝癌发生危险度高;脂肪肝和慢性肝炎、HBV感染及肝硬化一样同属原发性肝癌的高危人群。     

肝硬化合并自发性细菌性腹膜炎的危险因素Logistic回归分析

目的：研究肝硬化腹水合并自发性细菌性腹膜炎的相关因素，为其治疗和预防提供理论依据。方法：收集156例肝硬化腹水合并自发性细菌性腹膜炎患者和未合并自发性细菌性腹膜炎肝硬化312例患者的临床资料，建立数据库，应用Logistic回归分析方法分析临床相关危险因素。结果：合并消化道出血（OR=4．453，95％CI：0．341～12．458），合并腹泻（OR=4．674，95％CI：0．467～11．462），腹水白蛋白（OR=4．345，95％CI：1．673～7．665），是肝硬化并自发性细菌性腹膜炎发生的危险因素。结论：肝硬化合并自发性细菌性腹膜炎发生与腹泻、消化道出血及腹水低蛋白密切相关，应予以及时有效的防治，以减少自发性细菌性腹膜炎的发生。     

消化道肿瘤患者化疗后感染危险因素logistic回归分析

目的：分析消化道肿瘤患者化疗后感染危险因素。方法：选取2014年7月至2015年7月该院收治的消化道肿瘤患者60例作为研究对象,分析化疗后患者感染部位、病原菌分布特点及相关危险因素。结果：消化道肿瘤患者化疗后发生感染20例,感染率33．33％,其中呼吸系统感染占13．33％、泌尿系统占8．33％、消化道占11．67％;检出病原菌40株,其中革兰阴性菌占37．50％、革兰阳性菌占30．00％、真菌占32．50％;经多因素logistic回归分析发现,住院时间长、血清白蛋白偏低、预防应用抗菌药物、肿瘤晚期是消化道肿瘤患者化疗后感染的独立危险因素（P0．05）。结论：消化道肿瘤患者化疗后感染病原菌主要为革兰阴性菌,感染相关危险因素较多,高龄、住院时间长、血清白蛋白低、预防应用抗菌药物、肿瘤晚期是消化道肿瘤患者化疗后并发感染的独立危险因素。     

慢性呼吸道疾病并发社区获得性下呼吸道感染住院患者的病原菌调查

目的研究慢性呼吸道疾病并发社区获得性下呼吸道细菌感染住院患者的病原菌分布。方法回顾性分析2001～2005年在北京大学第三医院呼吸病房住院的212例社区获得性下呼吸道细菌感染患者的临床资料、痰培养及药敏结果，患者均具有慢性呼吸道基础疾病。结果临床分离病原菌229株，革兰阴性杆菌为主。慢性阻塞性肺疾病急性加重期患者感染的病原菌中革兰阴性杆菌占73．9％，铜绿假单胞菌和肺炎克雷伯菌最常见，分别为18．2％和13．6％；革兰阳性球菌占23-8％，其中金黄色葡萄球菌10．2％，肺炎链球菌9．1％。支气管扩张症患者感染革兰阴性杆菌占86．2％，前3位分别为铜绿假单胞菌（27．5％）、副流感嗜血杆菌（13．7％）和流感嗜血杆菌（11.8％）。Logistic回归分析发现：感染铜绿假单胞菌的危险因素为患有支气管扩张症（OR=5．590，95％CI 2．792～11．192）；感染鲍曼不动杆菌的危险因素为前1个月内使用制酸剂（OR=9．652，95％CI 2．636～35．339）和低蛋白血症（OR=2．679，95％CI 1．108～6．476）；感染肠杆菌科细菌（包括肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌）的危险因素为前1个月内使用抗菌药物（OR=4．236，95％CI 1．982～9．057），患有肾脏疾病（OR=4．305，95％CI 1．090-17．008）和糖尿病（OR=2．836，95％CI 1．339—6．009）。结论患有慢性呼吸道疾病患者并发社区获得性下呼吸道感染时的病原菌以革兰阴性杆菌为主，根据基础疾病、病情严重程度和用药史的不同而变化，对病原菌的正确判断有助于制定合理的经验性抗感染方案。     

慢性阻塞性肺疾病急性加重期患者肺部感染的病原菌及危险因素分析

目的 探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者肺部感染病原菌分布、危险因素及相关因子的表达。方法 回顾性分析2016年8月—2020年5月嘉兴市第一医院收治的102例AECOPD患者的临床资料。其中，发生肺部感染者52例作为观察组，未发生肺部感染者50例作为对照组。对AECOPD患者肺部感染病原菌分布特征进行分析，通过单因素及多因素分析AECOPD患者肺部感染危险因素，并对两组患者D二聚体（DD）、纤维蛋白原（FIB）、C反应蛋白（CRP）、降钙素原（PCT）水平进行检测。结果 52例AECOPD肺部感染者中检出病原菌69株。其中革兰阴性菌44株（63.77%），以肺炎克雷伯菌（21.74%）及铜绿假单胞菌（18.84%）为主；革兰阳性菌23株（33.33%），以金黄色葡萄球菌（17.39%）及屎粪肠球菌（8.70%）为主；真菌2株（2.90%）。年龄［R=3.203（95% CI：1.072，9.570）］、糖皮质激素使用时间［R=5.27（95% CI：1.835，15.184）］、住院时间［R=2.925（95% CI：1.077，7.939）］、机械通气史［R=2.964（95% CI：1.006，8.734）］及ABCD分组［R=3.347（95% CI：1.091，10.271）］为AECOPD并发肺部感染的独立危险因素（P <0.05）。观察组DD、FIB、CRP、PCT水平均高于对照组（P <0.05）。结论 AECOPD患者发生肺部感染的致病菌以革兰阴性菌为主，而年龄、糖皮质激素使用时间、住院时间、机械通气史及ABCD分组是患者肺部感染的独立危险因素，且该类患者凝血机制及炎症反应异常。     

急性心肌梗死合并泵衰竭的影响因素分析

目的探讨急性心肌梗死（AMI）患者合并泵衰竭的影响因素。方法以98例AMI患者为研究对象，对比分析泵衰竭组（41例）与对照组（57例无泵衰竭）的病史、危险因素、临床表现、并发症、病死率等特点。结果泵衰竭组有陈旧心肌梗死（OMI）病史、前壁或多部位AMI、收缩压（SBP）低、脉压（PBP）低、左室射血分数（LVEF）〈50％、酸肌酶（CK）峰值高，心率（HR）〉80次／min、WBC〉10×10^9／L、房颤、肺部感染等与对照组差异有统计学意义（P〈0．05～0．001）。Logistic多因素回归分析表明，肺部感染（OR=7．661，95％CI：2．228—26．336）、LVEF〈50％（OR=4．902，95％CI：1．484—16．194）、前壁或多部位AMI（OR=4．417，95％CI：0．803～24．309）、HR〉80次／min（OR=4．098，95％CI：1．259-13．335）、WBC〉10×10^9／L（OR3．651，95％CI1．169-11．403）是AMI并发泵衰竭的独立危险因素。结论AMI患者发生泵衰竭与多种因素有关，AMI患者合并肺部感染、LVEF〈50％、前壁或多部位AMI、HR〉80次／min，WBC〉10×10^9／L是并发泵衰竭的独立危险因素。     

肝炎后肝硬化患者院内感染的临床分析

目的：调查肝炎后肝硬化患者院内感染的发生情况,探讨与其相关的危险因素及预防措施。方法：回顾性分析2006年1月至2009年12月本院感染内科收治的248例肝炎后肝硬化患者的临床资料,其中86例发生院内感染,分析发生院内感染的影响因素及其与预后的关系。结果：肝炎后肝硬化患者院内感染率为34．7％（86／248）,以呼吸道感染多见。患者年龄60岁以上、住院时间30d以上、侵入性操作、并发合并症等是发生院内感染的危险因素（49．6％比16．2％,57．4％比12．7％,54．9％比18．7％,51．3％比19．4％,均P〈0．05或P〈0．01）。院内感染的病原菌以革兰阴性菌为主,耐药率较高,且常见多重耐药。结论：肝炎后肝硬化患者院内感染发生率高,耐药率高,医务人员应高度重视,采取综合措施加以防治。     

肝炎后肝硬化并发肝癌的相关危险因素探讨

目的：探讨肝炎后肝硬化并发肝癌的相关危险因素。方法选择肝炎后肝硬化并发肝癌患者47例（研究组）;另外,选择肝炎后肝硬化未并发肝癌患者47例（对照组）,回顾性分析2组患者肝炎后肝硬化并发肝癌的危险因素。结果经单因素分析显示,年龄、饮酒史、糖尿病、HBV阳性、Hbs抗原阳性等是肝炎后肝硬化并发肝癌可能存在的危险因素,且差异具有统计学意义（P<0.05）。经Logistic多因素回归分析发现,HBV阳性、HBs抗原阳性、糖尿病为肝炎后肝硬化并发肝癌的独立危险因素,且差异具有统计学意义（P<0.05）。结论肝炎肝硬化并发肝癌有多种危险因素,其中糖尿病、HBV DNA阳性与HBs抗原阳性是并发肝癌的独立危险因素,对于糖尿病、HBVDNA阳性与HBs抗原阳性的乙肝肝硬化患者,在临床上应予以注意和预防,以防止原发性肝癌的发生。     

机械通气并发肺部感染危险因素的Logistic回归分析

目的探讨综合重症监护病房（ICU）机械通气并发肺部感染的独立危险因素。方法对我院2006年10月至2008年6月入住综合ICU行有创机械通气的患者80例进行前瞻性队列研究,根据是否发生肺部感染,先用单因素分析筛选有统计学意义的危险因素,再通过多元Logistic回归分析,确定机械通气并发肺部感染的独立危险因素。结果本组患者肺部感染发生率为47．50％。单因素分析提示年龄、低蛋白血症、慢性阻塞性肺疾病（COPD）史、机械通气时间、多种抗生素的应用、ICU住院天数是肺部感染的危险因素,回归分析提示机械通气时间和多种抗生素的应用的相对危险度及其95％可信区间分别为1．257（1．004～3．587）、P=0．024,6．243（4．013—39．525）、P=0．007。结论肺部感染的发生与多种临床因素相关,机械通气时间和多种抗生素的应用是肺部感染的独立危险因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.