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1.
目的:探讨血清烯醇化酶和肌钙蛋白I及β2-微球蛋白在新生儿窒息中的变化及其意义。方法:选择24例窒息新生儿(轻度窒息14例,重度窒息10例)和26例同期正常足月新生儿为研究对象。在出生后24h内和治疗后第7d分别抽血,采用ELISA法及乳腺增强免疫比浊法检测各组血清烯醇化酶、肌钙蛋白I及β2-微球蛋白含量。结果:(1)窒息新生儿出生第1d血清烯醇化酶、肌钙蛋白I及β2-微球蛋白含量均显著高于对照组(P均〈0.01),且重度窒息组较轻度窒息组差异有统计学意义(P〈0.01);(2)窒息患儿经7d治疗,重度窒息组较对照组(P〈0.01)和轻度窒息组(P〈0.05)差异有统计学意义,轻度窒息组较对照组差异无统计学意义(P〉0.05);轻、重度窒息组较出生时各参数含量显著下降(P〈0.01)。结论:(1)血清烯醇化酶、肌钙蛋白I及β2-微球蛋白水平变化与窒息程度密切相关;(2)新生儿窒息时伴有脑、心、肾等多脏器的损伤,轻度窒息几经治疗在短期内即可恢复,重度窒息儿不能快速恢复,对预后判断具有重要临床价值。  相似文献   

2.
新生儿脐血中瘦素水平的临床研究   总被引:2,自引:0,他引:2  
目的 探讨脐血瘦素水平与新生儿体重、性别的关系及其临床意义。方法 采用放射免疫法测定96例足月新生儿脐血瘦素水平,根据不同出生体重分为小于胎龄儿(SGA)组22例,适于胎龄儿(AGA)组46例及大于胎龄儿(LGA)组28例,同时测量新生儿身长,计算体重指数(BMI),对结果进行相关性分析。结果 脐血瘦素水平与胎儿出生体重、BMI呈正相关(P〈0.01);3组脐血瘦素水平LGA组明显高于AGA、SGA组(均为P〈0.05),AGA组明显高于SGA组(P〈0.05)。男女婴的脐血瘦素水平差异无显著性(P〉0.05)。结论 脐血瘦素水平与新生儿体重、BMI呈正相关,提示其与胎儿宫内发育密切相关,但如何调控需进一步研究。脐血瘦素水平与胎儿性别无关,提示男女婴瘦素水平无差异。  相似文献   

3.
目的探讨尿视黄醇结合蛋白(RBP)和尿微量白蛋白(mAlb)对新生儿窒息肾损害的早期诊断价值。方法将78例窒息新生儿分为重度和轻度2组。用集尿袋分别采集窒息新生儿出生后第2天和第5天随意新鲜尿,采用免疫透射比浊法测定尿RBP和mAlb含量。并与40名正常新生儿比较。结果窒息新生儿出生后第2天的尿RBP和mAlb含量均明显高于正常对照组(P〈0.05),且重度窒息组高于轻度窒息组(P〈0.05)。重度窒息组出生后第5天的尿RBP和mAlb含量仍高于正常对照组(P〈0.05)。结论尿RBP和mAlb可作为判断新生儿窒息缺氧后‘肾脏早期损伤程度的生化指标。  相似文献   

4.
目的:探讨窒息新生儿QT离散度(QTcd)和心肌肌钙蛋白I(CTnI)的动态变化及相关性。方法:分别采用标准12导联心电图和免疫组化法对46例窒息新生儿出生后48h内和治疗7d后的QTcd和CTnI值进行检测,同时检测20例无窒息新生儿QTcd和CTnI值,分别进行比较。结果:发病48h内与对照组比较,窒息新生儿各组QTcd和CTnI值显著上升(P〈0.05,P〈0.01)。与轻度窒息组比较,重度窒息组QTcd和CTnI值显著上升(P〈0.01)。治疗后,轻度窒息组QTcd和CTnI值均呈显著下降,与治疗前比较差异有显著性(P〈0.01)。重度窒息组治疗前后比较差异无显著性(P〉0.05)。QTcd和CTnI呈正相关(r=0.68,P〈0.01)。结论:窒息新生儿QTcd和CTnI有显著变化,二者的监测有利于心肌受累程度的全面评价,对判断患儿预后有重要意义  相似文献   

5.
目的探讨围生期窒息复苏后新生儿脑组织氧饱和度(regional cerebral oxygen saturation,rSO2)的变化及相应的护理措施。方法收集围生期轻度窒息新生儿30例,重度窒息新生儿14例,健康对照新生儿28例,分别于出生后第1、2.3、5、7天行rSO2监测,同时测定经皮脉搏氧饱和度(pulse oxygen saturation,SpO2),并对3组新生儿监测数据进行比较。结果轻度窒息组新生儿出生后各时点rSO2、SpO2监测值与健康对照组比较,差异无统计学意义(P〉0.05);重度窒息组新生儿出生后第1—3天rSO2与健康对照组、轻度窒息组比较,差异无统计学意义(P〉0.05),第5天rSO2监测值与健康对照组及轻度窒息组比较,差异有统计学意义(P〈0.05),第7天rSO2监测值与健康对照组比较,差异有统计学意义(P〈0.01),与轻度窒息组比较,差异有统计学意义(P〈0.05);重度窒息组新生儿SpO2各时点监测值与健康对照组及轻度窒息组比较差异无统计学意义(P〉0.05)。结论重度窒息新生儿出生后第5、7天的rSO2明显下降;SpO2不能反映rSO2的变化;对窒息复苏后新生儿严密监护、保持呼吸道通畅、氧疗、减少身体的耗氧量具有重要的临床意义。  相似文献   

6.
摘要目的:探讨胰岛素泵持续强化治疗妊娠期糖尿病对新生儿脐带血胰岛素样生长因子-1(IGF—1)水平与出生体重的影响。方法:选择妊娠期糖尿病患者42例,其中胰岛素泵治疗组(CSII组)20例,胰岛素多次皮下注射(MSII)治疗组(MSII组)22例,妊娠期正常孕妇(对照组)24例。测定孕妇空腹血糖、餐后2h血糖、糖化血红蛋白及其分娩的新生儿体重、脐带血胰岛素样生长因子-1水平。结果:CSII组与MSII组比较,孕妇空腹血糖、产后2h血糖、糖化血红蛋白差异有统计学意义(P〈0.001),与对照组比较差异无统计学意义(P〉0.05)。CSII组与MSII组比较,新生儿出生体重及IGF-1水平分别为(3228±343)g和(3792±381)g;(57±21)μg/L和(82±26)μg/L,差异有统计学意义(P〈0.001),与对照组比较差异无统计学意义(P〉0.05)。脐带血IGF-1水平与新生儿出生体重之间呈正相关(Pearson相关系数:0.715,P〈0.01)且有直线关系(R^2=0.511,P〈0.01)。结论:胰岛素泵持续强化治疗妊娠期糖尿病能更好地控制孕妇血糖,明显改善新生儿脐带血IGF-1水平与出生体重,临床应用效果优于传统的胰岛素多次皮下注射。  相似文献   

7.
目的:探讨新生儿窒息与肾功能损害的关系。方法:对70例窒息新生儿与30例无窒息新生儿作血尿素氮(BUN)及肌酐(Cr)检测.并进行分析观察。结果:70例窒息新生儿中血BUN、Cr显著高于无窒息对照组(P<0.001),重度窒息组血BUN、Cr显著高于轻度窒息组(P<0.05),体重<2500g组BUN、Cr显著高于体重>/2500g组(P<0.025),胎龄<37周组BUN、Cr显著高于胎龄≥37周组(P<0.05)。结论:新生儿窒息缺氧会导致肾功能损害.血BUN、Cr可作为判断肾功能受损的指标。  相似文献   

8.
目的:观察次声对大鼠作用后,血浆内血管紧张素Ⅱ(AⅡ)含量的变化。方法:用16Hz、90dB次声作用1、7、14、21、2h/次.d^-1。分别于作用后0.5、6、12、18、24h观察大鼠血浆内AⅡ含量的变化。结果:大鼠血浆内AⅡ含量在次声作用1d后,与对照组相比0.5h已开始增高(P<0.01),12h达高峰,而后下降,至24h降为最低点,但仍高于对照组(P<0.05);次声作用7d,在0.5h前与对照组相比差异无显著性意义(P>0.05);以后渐渐升高,至24h达高峰,与对照组相比差异有显著性意义(P<0.01);次声作用14d,与对照组相比0.5h达高峰(P<0.01),而后渐渐下降,至24h与对照组比较差异无显著性意义(P>0.05);次声作用21,戌对照组相比0.5h达高峰(P<0.01),而后下降,12h降为最低点,但仍高于对照组(P<0.05),18、24hT复呈显著增高(P<0.01)。结论:次声作用后,大鼠血浆内AⅡ含量随次声作用时间的不同而呈不同的规律性改变。  相似文献   

9.
目的:研究GIK液对体外循环缺血-再灌注后心肌胰岛素抵抗的防治作用。方法 选取18条雄性犬,常规建立体外循环,升主动脉阻断60min后开放,造成体外循环缺血-再灌注动物模型进行试验。分GIK治疗组和对照组,分别在体外循环前、体外循环30min、升主动脉开放后10、30、60min抽取血样,采集动脉和冠状静脉窦血样测定血浆葡萄糖、乳酸、胰岛素、C肽、生长激素和皮质醇等,进行动态对比分析。结果:两组体外循环期间血糖、乳酸、胰岛素、C肽、生长激素和皮质醇等与体外循环前比较均有不同程度增高(P〈0.05);同时,GIK组生长激素和皮质醇浓度显著低于对照组(P〈0.05),而胰岛素、C肽浓度以及血糖、乳酸的摄取利用能力显著高于对照组(P〈0.05)。结论:体外循环缺血-再灌注后,机体胰岛素抵抗同时,存在明显的心肌胰岛素抵抗;GIK液治疗可以增加胰岛素敏感性,提高心肌对葡萄糖和乳酸的利用能力,从而有效防治心肌胰岛素抵抗。  相似文献   

10.
黄献文  杨彤  马钊 《实用医学杂志》2007,23(19):3014-3015
目的:探讨新生儿缺氧缺血性脑病(HIE)中血清心肌肌钙蛋白I(cTnI)的动态变化及意义。方法:对36例HIE患儿(HIE组)及40例同期住院正常新生儿(对照组)进行外周血cTnI含量动态监测,分别于出生后24h,3、5及7d采血检测。结果:(1)HIE组患儿cTnI测定值显著高于对照组,差异有显著性(P〈0.01);(2)HIE纽患儿血清cTnI在出生后24h达高峰,轻度HIE组3d降至正常.中度HIE组5d降至正常.重度 HIE组7d降至正常。结论:窒息缺氧对脑细胞造成损害的同时对心肌亦造成损害.对新生儿HIE进行外周血cTnI含量检测能早期诊断心肌损伤.从而可以早期干预治疗.改善预后.[著者文摘]  相似文献   

11.
BACKGROUND: Insulin, growth hormone (GH), and growth factors (insulin-like growth factors [IGFs] and their binding proteins [IGFBPs]) are known to influence fetal growth and also the synthesis/secretion of the recently discovered hormones leptin and ghrelin. METHODS: In 153 delivering mothers and their offspring at birth, we prospectively investigated the association between mothers' and babies' serum concentrations of ghrelin, leptin, insulin, IGF-1, and IGFBP-3 and neonatal anthropometric characteristics and the growth of the fetus. We also tried to put babies' serum glucose and GH measurements in this context. RESULTS: Birth weight (BW), birth length, head circumference, and ponderal index (PI) were positively associated with cord IGF-1, IGFBP-3, and leptin and negatively associated with GH. BW was independently associated with maternal stature and prepartum weight, birth length with maternal stature, PI with maternal insulin and prepartum weight, and head circumference with maternal ghrelin. Compared with preterm infants whose development was appropriate for gestational age (AGA), preterm growth-restricted babies displayed alteration in GH-IGF axis (increased GH and low IGF-1 and IGFBP-3 concentrations), low leptin and glucose concentrations, and increased ghrelin concentrations. In large-for-gestational-age (LGA) babies, leptin, IGFBP-3, insulin, and glucose concentrations were significantly higher in asymmetric LGA newborns than in symmetric LGA and AGA newborns. CONCLUSIONS: We found relationships between metabolic factors, fetal growth, and anthropometry. Intrauterine growth restriction involved alteration in the fetal GH-IGF axis, with relatively low leptin and glucose concentrations and increased ghrelin concentrations. Leptin, insulin, and IGFBP-3 delineated subtypes of fetal overgrowth.  相似文献   

12.
目的探讨不同窒息程度新生儿治疗前后血清肌钙蛋白-I(cTnI)水平变化及QT离散度的变化及其临床意义。方法收集30例轻度窒息新生儿(轻度窒息组),20例重度窒息新生儿(重度窒息组)出生后24h内及治疗后第7天的cTnI与肌酸磷酸激酶同工酶(CK-MB);同时第1天及第7天对收集病例进行心电图检测计算QT离散度,并与围产期无窒息史的20例新生儿(对照组)进行比较。结果窒息组新生儿生后第1天血清cTnI与CK-MB及QT离散度均较对照组明显升高(P均<0.01),且重度窒息组较轻度窒息组cTnI与CK-MB升高更明显(P均<0.01),表明窒息程度越重血清cTnI与CK-MB升高越明显。治疗7d后窒息新生儿cTnI与CK-MB水平及QT离散度均能下降,与治疗前(第1天)比较差异有统计学意义(P均<0.01)。结论 cTnI与CK-MB均能敏感检出窒息新生儿心肌损伤,且随着病情好转cTnI与CK-MB及QT离散度均有明显下降,但由于CK-MB影响因素较多,且活性持续时间较短,目前多用cTnI作为反映心肌损害指标,其联合QT离散度检测能早期敏感检出窒息后缺氧缺血性心肌损害,有助于疗效判断及病情与预后评估。  相似文献   

13.
甲状腺激素及瘦素水平变化对胎儿生长发育的影响   总被引:1,自引:0,他引:1  
目的 探讨甲状腺激素和瘦素水平对胎儿生长发育的影响。方法 采用放射免疫法测定 2 4例 IUGR孕妇 (受试组 )、4 0例正常孕妇 (对照组 )血清及其新生儿脐血中的甲状腺激素 [游离 T3(FT3)、游离 T4 (FT4 )、促甲状腺素(TSH) ]和瘦素水平 ,分析甲状腺激素、瘦素水平与胎儿生长发育之间的关系。结果  IUGR孕妇血清及脐血中 TSH水平均高于对照组 ,而 FT4 及瘦素水平均低于对照组 (P<0 .0 5 ) ;脐血 FT3、FT4 及瘦素水平均与胎儿出生体重呈正相关(P<0 .0 5、P<0 .0 1)。孕妇血清瘦素水平与脐血瘦素水平无相关。瘦素水平与 TSH呈负相关。结论 胎儿生长发育与脐血 TSH、FT3、FT4 及瘦素水平均有密切关系 ,对评估胎儿体重和生长发育均具有重要的临床意义。  相似文献   

14.
We studied the interrelationship between the obese gene product serum leptin, insulin and counterregulatory hormone concentrations and glycogen synthesis in 26 healthy men. A 4-h euglycaemic insulin clamp with muscle biopsies was performed after a resting control day in 26 subjects, and in 14 of them also after heavy, glycogen-depleting (32%, P < 0.01) exercise. Serum leptin concentrations were at baseline 34% (0.67 ± 0.18 vs. 1.03 ± 0.13 ng L?1, P ± 0.05) lower after the exercise, and rose during hyperinsulinaemia by 56% (to 1.38 ± 0.19 ng L?1, P < 0.001) and 34% (to 1.05 ± 0.20 ng L–1, P < 0.01) after the post-exercise and control studies respectively. Basal serum leptin concentration correlated positively with body mass index (r = 0.42, P < 0.05), serum cortisol concentration (r = 0.70, P < 0.001) and the rise in muscle glycogen content during the clamp (r = 0.43, P < 0.05) and inversely with serum growth hormone concentration (r = ?0.43, P < 0.05). There was a positive correlation between serum leptin after hyperinsulinaemia and serum insulin concentration during the hyperinsulinaemia (r = 0.42, P < 0.05). After exercise, basal serum leptin level correlated with serum triglyceride concentration (r = 0.82, P < 0.001) and after hyperinsulinaemia serum leptin correlated positively with muscle glycogen content (r = 0.56, P < 0.05). It was concluded that serum leptin concentrations correlate directly with serum insulin, cortisol and triglyceride and inversely with growth hormone concentrations. They are decreased by glycogen-depleting exercise and increase during hyperinsulinaemic clamp. These data suggest that leptin is associated with factors regulating fuel homeostasis and its hormonal control in man.  相似文献   

15.
不同时间抚触对新生儿睡眠及体格发育的影响   总被引:1,自引:1,他引:0  
目的:观察沐浴后不同时间抚触对正常新生儿睡眠及体格发育的影响。方法:根据母乳在新生儿胃内排空的时间,将120例纯母乳喂养的足月正常新生儿随机分为沐浴后立即抚触组(I组),沐浴后2~3 h抚触组(Ⅱ组),沐浴后3~4 h抚触组(Ⅲ组),每组40例。三组均按新生儿常规护理,出生后24 h进行全身抚触,15 m in次/,每天1次,直至28 d。结果:三组新生儿出生后3 d体重、身长、头围及睡眠指标比较,差异无显著性意义(均P〉0.05);Ⅲ组新生儿28 d体重、身长、头围较I组、Ⅱ组增长快(均P〈0.05);Ⅲ组新生儿也较I组、Ⅱ组新生儿安静,睡眠时间长,睡眠-觉醒节律形成早(均P〈0.05)。结论:最佳时间抚触有助于提高新生儿睡眠质量,较早地建立睡眠-觉醒节律,有利于新生儿生长发育,为婴幼儿期抚触奠定了基础。  相似文献   

16.
摘要 目的: 观察抗脂益肝汤联合二甲双胍对非酒精性脂肪肝(NAFLD)胰岛素、瘦素抵抗的影响。方法: 按不同治疗方法将123例诊断为NAFLD的患者随机分成4组:抗脂益肝汤联合二甲双胍治疗组(33例)、二甲双胍治疗组(30例)、抗脂益肝汤治疗组(32例)、安慰剂组(28例),各组均同时予饮食控制和运动处方,疗程为6月。治疗前后检测肝功能、血脂水平、空腹血糖、空腹血胰岛素、血清瘦素水平,计算BMI、胰岛素抵抗指数(采用稳态模式评估法计算胰岛素抵抗指数),比较治疗前后各指标的变化。结果: 4组患者治疗后肝功能、血脂紊乱均明显改善,差异显著(P<0.05或P<0.01);联合治疗组、二甲双胍治疗组、抗脂益肝汤组胰岛素、瘦素抵抗均明显改善,差异显著,以联合治疗组改善最显著(P<0.05或P<0.01),安慰剂组无明显改善,用药期间4组患者均未出现显著的不良反应。结论: 抗脂益肝汤联合二甲双胍能明显改善NAFLD患者肝功能、促进脂质代谢、改善胰岛素及瘦素抵抗。  相似文献   

17.
背景瘦素在女性青春期发育中的作用尚有争议,且其与其他激素(生长激素、性激素、胰岛素)之间的相互关系有待进一步的探讨.目的探讨瘦素在女性青春期发育中的作用及其与生长激素、性激素、胰岛素的相互关系.设计非随机对照研究.地点和对象本研究由哈尔滨医科大学营养与食品卫生学教研室完成,受试对象为450名健康自愿者,选自哈尔滨市动力区4所学校.方法筛选7~17岁单纯性肥胖女性150例,选择正常和营养不良组各150例,以相互身高相差不超过2 cm,年龄相差不超过3个月进行111配比,进行各项指标测定.主要观察指标身高、体质量,血清瘦素、生长激素、胰岛素、睾酮和雌二醇水平.结果①女性血清瘦素水平与体质量指数和年龄均呈正相关(r=0.72,P<0.01;r=0.39,P<0.01).②女性血清瘦素水平从B1期(Tanner分期,下同)到B5期逐步上升.正常组B2期血清瘦素水平(7.72μ/L)和营养不良组B2期(7.36μg/L)相近,但显著低于肥胖组B2期血清瘦素水平(12.85μg/L),其他各期肥胖组、正常组和营养不良组差异均具有显著性意义.③瘦素与生长激素呈负相关(r=-0.10,P<0.01),与胰岛素呈强正相关(r=0.78,P<0.001),但与雌二醇和睾酮无相关性.结论瘦素在启动女性青春期发育中可能发挥了作用.B2期瘦素水平可能是瘦素启动女性青春期发育的阈剂量.Bs期瘦素水平迅速增长具有抑制生长激素增长,起到了青春期发育结束信号的作用.  相似文献   

18.
针刺对肥胖大鼠瘦素和胰岛素含量的影响   总被引:1,自引:5,他引:1  
目的探讨针刺对肥胖机体瘦素和胰岛素含量及其血脑转运的作用.方法将1月龄刚断乳SD雄性大鼠分为正常组、针刺组和对照组,观察针刺治疗前后肥胖大鼠体质量、体脂及中枢和外周瘦素和胰岛素水平的变化.结果肥胖大鼠体质量、体脂及血清瘦素和胰岛素水平均显著高于正常大鼠,而下丘脑瘦素和胰岛素水平均显著低于正常大鼠.针刺治疗取得良好减肥疗效的同时,针刺组肥胖大鼠血清瘦素和胰岛素水平[(13.43±1.85)μg/L,(66.92±24.71)mIU/L]与对照组[(17.23±3.07)μg/L,(172.40±74.99)mIU/L]比较,均明显回降(P<0.05和0.01),而下丘脑瘦素和胰岛素水平却明显升高(P<0.01和<0.05).大鼠体质量与血中瘦素呈显著正相关(r=0.677,P<0.01);血清瘦素与胰岛素含量呈明显正相关(r=0.538,P<0.05).结论针刺对肥胖机体下丘脑和血中瘦素和胰岛素水平的良性调整作用可能是改善瘦素抵抗和胰岛素抵抗以及调整异常的内分泌代谢的一个重要环节.这种作用可能是针刺减肥的关键因素之一.  相似文献   

19.
Leptin, the ob gene product, plays an important role in the regulation of body fat mass and weight. In previous studies, it was demonstrated that leptin is detectable in human fetal cord blood as early as at 18 weeks of gestation and that serum leptin concentrations are significantly reduced in small gestational age newborns. In the present study, we investigated whether umbilical and maternal serum leptin concentrations correlate with intrauterine growth retardation (IUGR). In addition, we aimed to determine the relationships between leptin concentration in the maternal and cord blood. We studied 40 newborn infants (21 female and 19 male; gestational age, 38-42 weeks) and their mothers. Of the infants studied, 10 had IUGR. Serum leptin concentrations were measured by radioimmunoassay. All newborns had detectable leptin concentrations. Leptin concentrations were significantly lower in newborns with IUGR and in their mothers (n = 10; 3.53 +/- 1.42 ng/ml, 6.75 +/- 1.47 ng/ml, respectively) than in infants experiencing normal growth and their mothers (n = 30; 5.58 +/- 2.98 ng/ml, 9.85 +/- 6.50 ng/ml, respectively) (p < 0.01 for newborns, p < 0.05 for mothers). There was no significant correlation between umbilical leptin concentration and maternal leptin concentration (r = 0.229; p = 0.155) in all study groups but, significantly, a correlation was observed in the group with IUGR (r = 0.736; p = 0.015). There were no significant correlations between both umbilical and maternal leptin concentrations and parity, delivery type and gestational age. There was a correlation between umbilical leptin concentration and birth weight of newborns (r = 0.383; p = 0.015) but no correlation with body mass index (BMI) of the newborns (r = 0.034; p = 0.834). Maternal leptin concentrations correlated with maternal weight and BMI (r=0.606; p=0.000, r=0.535; p=0.000, respectively). There was no correlation between maternal leptin concentrations and birth weight of the newborns (r=0.179; p=0.269) and with BMI of the newborns (r = 0.146; p = 0.367). There was no gender difference in leptin concentrations in the newborns (n=21; 5.50 +/- 3.37 ng/ml, for females; n = 19; 4.58 +/- 1.98 ng/ml for males) (p = 0.296). In summary, we have shown that IUGR is associated with a decreased leptin concentration in newborns and their mothers. The association between umbilical serum leptin and birth weight in this and other studies suggests a pivotal role of fetal leptin in regulating fetal growth and development.  相似文献   

20.
目的 评估Apgar评分及脐带血pH值对足月新生儿窒息的预测价值,探讨Apgar评分及脐带血pH值与足月新生儿窒息严重程度的相关性.方法 选取窒息足月新生儿46例作为窒息组,健康足月新生儿49例作为健康组,比较两组出生1、5 min Apgar评分和脐带血pH值;采用受试者工作特征(receiver oper-atin...  相似文献   

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