Cornell指数和Sokolow指数诊断左室肥大价值的研究

目的探讨Cornell指数和Sokolow指数诊断左室肥大(LVH)的价值。方法随机选择2008年1月～2009年8月我院住院患者200例,依据超声心动图测定左室心肌重量指数(LVMI)分为左室肥大组(A组)104例和正常组(B组)96例,然后根据心电图测量R_(avL)+Sv_3和Rv_5+Sv_1的值,计算Cornell指数和Sokolow指数的诊断敏感度、特异度及准确度。结果 Cornell指数的诊断敏感度为61.54%,特异度为83.33%,准确度为72.00%;Sokolow指数的诊断敏感度为37.50%,特异度为89.58%,准确度为62.50%,经过统计分析,Cornell指数和Sokolow指数敏感度(P<0.01),准确度(P<0.05),均有统计学意义,而特异度(P>0.05),无统计学差异。结论 Cornell指数标准是诊断左室肥大较好的指标。     

涂片法、L-J法、MGIT 960法及GeneXpert法检测在疑似肺结核患者临床诊断中的应用

目的研究痰涂片抗酸染色法(涂片法)、罗氏培养法(L-J法)、结核分枝杆菌MGIT 960液体培养法(MGIT 960法)及GeneXpert MTB/RIF(GeneXpert法)检测在疑似肺结核患者临床诊断中的应用价值。方法将2016年1月至2020年12月深圳市第三人民医院收治的80例疑似肺结核患者作为研究对象,对全部患者痰标本进行涂片法、L-J法、MGIT 960法及GeneXpert法检测,以临床诊断结果为金标准,比较4种方法单独检测及联合检测在疑似肺结核患者临床诊断中的敏感度、特异度、阳性预测值及阴性预测值。结果临床诊断结果显示,在80例疑似肺结核患者中,有41例肺结核患者,39例非肺结核患者;涂片法检测的敏感度为36.59%、特异度为89.74%、阳性预测值为78.95%、阴性预测值为57.38%;L-J法检测的敏感度为31.71%、特异度为94.87%、阳性预测值为86.67%、阴性预测值为56.92%;MGIT 960法检测的敏感度为43.90%、特异度为92.31%、阳性预测值为85.71%、阴性预测值为61.02%;GeneXpert法检测的敏感度为39.02%、特异度为100.00%、阳性预测值为100.00%、阴性预测值为60.94%;涂片法+L-J法+GeneXpert法+MGIT 960法联合检测的敏感度(48.78%)最高,特异度(87.18%)最低。结论涂片法、L-J法、MGIT 960法及GeneXpert法检测在疑似肺结核患者临床诊断中的应用效果较好,其中MGIT 960法检测的敏感度最高,GeneXpert法检测的特异度最高,而4种方法联合检测可以有效提高诊断的敏感度。     

分段血浆醛固酮/肾素活性比值对原发性醛固酮增多症的诊断效力

目的:探讨血浆醛固酮/肾素比值(ARR)对原发性醛固酮增多症(PA)的诊断效力.方法:收集我院经术后病理确诊的279例原发性醛固酮增多症(PA)患者及同期随机抽取的70例原发性高血压(PH)患者,计算血浆ARR,以10为组距,分为11组,计算各个组段的PA和PH例数及ARR值诊断PA的敏感度、特异度和Youden指数,并绘制ROC曲线.结果:ARR在30～、40～、50～各组段内,诊断PA的敏感度、特异度及Youdon指数分别为83.2％、82.9％、66.1％,77.8％、88.6％、66.4％和74.2％、92.9％、67.1％.结论:ARR在30～60之间时诊断PA的敏感度、特异度及Youden指数较高.     

听性脑干反应波V反应阈在外伤后听觉损害中的应用

目的:探讨听性脑干反应(ABR)波V反应阈在外伤后听觉损害程度中的价值。方法:对耳外伤者50耳及正常人30耳进行ABR及纯音测听。结果:30耳正常人波V反应阈下10~20 dBnHL,相当于其客观听阈,50耳外伤者主观听阈与客观听阈符合12耳(24%),伪聋7耳(14%),夸大性聋31耳(62%)。结论:ABR与纯音测听相结合,能准确评估出较为客观的真实听力状况。     

磁共振成像诊断髋臼唇撕裂价值的分析

目的:探究磁共振成像(MRI)在髋臼唇撕裂中的临床诊断价值。方法:从2016年3月～2018年1月期间到某院进行诊治的所有髋臼唇撕裂患者当中随机选取53例髋臼唇撕裂患者作为本次的观察研究对象,对这53例患者的髋关节MRI诊断情况和MR影像检查情况进行回顾性分析,对比敏感度、特异度和准确性。结果:在髋关节MRI的髋臼唇撕裂诊断当中,敏感度为90.57%,特异度为88.68%,准确性为92.45%;在髋关节MR的髋臼唇撕裂诊断当中,敏感度为88.68%,特异度为90.57%,准确性为90.57%,两者没有明显的差异,P0.05。结论:从敏感度、特异度和准确性来看,髋关节MRI诊断与髋关节MR诊断之间没有明显的差异,但髋关节MRI诊断的安全性比髋关节MR高,因此髋关节MR诊断具有一定的有创性和关节感染的潜在可能性。     

血清FS、CA125联合检测在卵巢型子宫内膜异位症与卵巢良性肿瘤鉴别诊断中的应用

目的 :探讨血清卵泡抑素(follistatin,FS)、糖链抗原125(carbohydrate antigen125,CA125)联合检测在卵巢型子宫内膜异位症与卵巢良性肿瘤鉴别诊断中的应用价值。方法 :选取2012年3月至2014年6月期间我院确诊治疗的卵巢型子宫内膜异位症患者38例作为异位组,同期选取卵巢良性肿瘤36例作为良性组,统计分析并采用电化学发光免疫法检测所有患者血清中FS、CA125表达水平。结果 :异位组患者血清中FS、CA125表达水平明显高于良性组(P<0.05);在FS=1.53 mg/L时,对卵巢型子宫内膜异位症与卵巢良性肿瘤的鉴别诊断敏感度为61.36%,特异度为86.54%,准确度为84.51%,在CA125=25.42 U/ml时,鉴别诊断敏感度为83.32%,特异度为85.18%,准确度为90.25%,二者联合的鉴别诊断敏感度为93.26%,特异度为94.41%,准确度为97.14%。在鉴别诊断敏感度、特异度和准确度方面,FS联合CA125检测>CA125检测>FS检测(P<0.05)。结论 :FS、CA125可作为鉴别诊断卵巢型子宫内膜异位症与卵巢良性肿瘤的重要参考指标,二者联合诊断具有更高的敏感度、特异度和准确度,值得临床作进一步推广。     

妊娠期高血压患者凝血指标及D-D水平变化的临床意义

目的 探讨妊娠期高血压征（妊高症）患者D-二聚体（D-D）水平及凝血指标变化的临床意义。方法 以95例妊高症患者为对象,以同期100例健康者为对照组。检测两组凝血指标及D-D水平,并分析其与妊高症病情及预后的关系。结果 妊高症组D-D、FIB水平高于对照组,APTT、PT水平低于对照组（P<0.05）;D-D诊断妊高征的AUC、敏感度、特异度分别为0.954(95%CI:0.913～0.979)、88.42%、89.49%;Fbg诊断妊高征的AUC、敏感度、特异度分别为0.934(95%CI:0.888～0.965)、93.68%、90.53%;APTT妊高征的AUC、敏感度、特异度分别为0.880(95%CI:0.825～0.922)、72.63%、92.63%;PT妊高征的AUC、敏感度、特异度分别为0.903(95%CI:0.852～0.941)、80.00%、90.53%。结论 D-D、FIB、APTT、PT与妊高症的发生及发展存在联系,检测四者水平可能有助于妊高征的早期诊断。     

肝脏超声造影及TK1、AFP对肝脏局灶性结节性病变良恶性分析价值

目的：分析肝脏超声造影及胸苷激酶1(Thymidine kinase 1,TK1)、甲胎蛋白(alpha fetoprotein, AFP)对肝脏局灶性结节性病变良恶性诊断价值。方法：选取2018年9月-2020年9月某院收治肝脏局灶性结节性病变患者128例(128个病灶)均行超声造影及血清TK1、AFP检查,以穿刺活检结果作为“金标准”,分析3种检查方法在肝脏局灶性结节性病变良恶性中的诊断价值。结果：超声造影、血清TK1、AFP联合检测肝脏局灶性结节性病变良恶性的准确度(95.31%)、敏感度(97.30%)、特异度(92.59%)、约登指数(0.899)、阳性预测值(94.74%)、阴性预测值(96.15%)明显高于单独检测。超声造影检测准确度91.41%、敏感度93.24%、特异度88.89%、约登指数0.821、阳性预测值92.00%、阴性预测值92.57%。血清TK1检测准确度85.94%、敏感度89.19%、特异度81.48%、约登指数0.707、阳性预测值84.62%、阴性预测值85.94%。血清AFP检测准确度86.72%、敏感度86.49%、特异度87.04%、约登指...     

窄带成像联合放大胃镜技术在早期胃癌及癌前病变筛查中的诊断价值分析

目的探讨窄带成像联合放大胃镜技术(ME-NBI)在早期胃癌及癌前病变筛查中的诊断价值。方法157例胃黏膜病变患者,均依次接受白光内镜(WLE)、ME-NBI检查进行早期胃癌及癌前病变筛查。比较两种检查方式图像质量评分,分析两种检查方式检查结果,以病理检查结果为金标准,比较两种检查方式诊断效能。结果ME-NBI检查的微血管及腺管图像质量评分均高于WLE检查,差异均有统计学意义(P<0.05)。病理检查结果显示,阳性25例,阴性132例。WLE检查结果显示:阳性57例,阴性100例。ME-NBI检查结果显示:阳性42例,阴性115例。以病理检查结果为金标准,WLE检查的敏感度为60.0%(15/25),特异度为68.2%(90/132),准确度为66.9%(105/157);ME-NBI检查的敏感度为88.0%(22/25),特异度为84.8%(112/132),准确度为85.4%(134/157)。ME-NBI检查的敏感度、特异度、准确度均显著高于WLE检查,差异均有统计学意义(P<0.05)。结论ME-NBI在早期胃癌及癌前病变诊断中检出率高,比WLE的敏感度、特异度、准确度更高,减少误诊,更适用于早期胃癌及胃癌前病变诊断。     

浅谈超声常规检查结合弹性成像在乳腺肿块的诊断中临床价值

目的:探讨超声常规检查结合弹性成像在乳腺肿块诊断中的临床意义。方法:选取某院治疗的84例乳腺病变患者(87个病灶)结合弹性成像(UE)技术进行超声常规检查,以病理诊断为金标准,评价超声检查的意义。结果:良性肿块72个(82.75%),恶性肿块12个(13.79%)。超声对恶性肿块诊断的敏感度71.42%、特异度97.26%,准确度为93.10%。弹性成像诊断乳腺良恶性病变的敏感度为78.57%,特异度为96.00%,准确度为95.40%。结论:超声弹性成像技术为超声鉴别乳腺良、恶性病变提供了一个新的诊断思路,特别是在诊断一些边界模糊的病灶方面具有极高的应用价值。     

Evaluating children's hearing by DPOAEs at 1-10 kHz

The efficacy of application of DPOAE (distortion product otoacoustic emission) in the evaluation of hearing in children was assessed. 106 children were checked by both DPOAE and ABR. The results show that DPOAE is highly effective in discriminating between hearing disorders and normal hearing. The correct classification rate of normal ears varied between 86.8-96.8% and ears with hearing loss (ABR threshold equal or above 20 dB HL) 87-100%. At the lower frequencies (1-2 kHz) the hit rate was lower. The results of this study suggest that the DPOAE can be used as a rapid hearing screening test for infants and children providing frequency specific information, mostly in the 3-10 kHz frequency range. The effectiveness of DPOAE at 1-10 kHz was evident in children with middle ear dysfunction and in detecting infants with possible high frequency hearing loss. In addition, high frequency DPOAE broadens the range typically available from click-evoked ABR measurements. This information is of increased clinical value not only in terms of speech and language development but also for detecting children who are at high-risk for possible hearing deterioration and who require early intervention.     

Otological evaluation of newborns who failed otoacoustic emission screening.

Early identification of congenital hearing loss and early rehabilitation is extremely important. Otoacoustic emissions (OAE) are an efficient tool for hearing screening. Previous studies using click evoked otoacoustic emissions (CEOAEs) for newborn hearing screening resulted in approximately 70% pass rate, reflecting intact hearing. The aim of our study was to perform a detailed otological evaluation of newborns who failed OAE screening, using otoscopy, tympanometry and ABR. CEOAEs were recorded from 257 newborns prior to their release from the hospital. Those babies who did not pass the CEOAE were examined by DPOAE, otoscopy, tympanometry and ABR, if needed. 73% of all the newborns had CEOAE in both ears. 20% had CEOAE in only one ear. When the test was administered again three days postpartum, the CEOAE pass rate increased; 98% passed in at least one ear. Most of the newborns (84%) who failed had an obstruction of the external ear canal (collapsed ear canal or debris). There was a good correlation between the otoscopy and the tympanometry. Based on the above results, a newborn hearing screening protocol was introduced.     

Audiological screening of neonatal intensive care unit graduates at high risk of sensorineural hearing loss

AIM: To audit the identification and screening of graduates from a neonatal intensive care unit with risk factors for sensorineural hearing loss. METHODS: Hospital medical records of newborn infants discharged from the neonatal intensive care unit, Christchurch Womens Hospital, between 1 July 1994 and 30 June 1995 (n=564), were examined to identify those at risk for sensorineural hearing loss according to the American Speech-Language Hearing Association risk criteria 1991. Auditory brainstem response test results were obtained from the Christchurch Hospital Audiology Department. Outcome measures were: presence of hearing loss risk factors, numbers tested with auditory brainstem response, age at test and presence and degree of hearing impairment. RESULTS: Of 5,215 live births in Christchurch, 564 infants were discharged through the neonatal intensive care unit. Of these, 86 had risk factors for sensorineural hearing loss. There were 72 (84%) infants tested at audiology, with fifteen (17%) having abnormal test results. There were fourteen with risk factors who did not get audiology screening. CONCLUSION: A high proportion (84%) of high risk newborn infants had auditory brainstem response testing. Further improvement would require strict implementation of standard procedures. Auditory brainstem response screening is part of a wider population surveillance approach to identify hearing loss as early as possible.     

葛根素注射液治疗突发性耳聋的Meta分析

目的利用Meta分析方法对葛根素注射液治疗突发性耳聋的临床试验进行分析,评价其治疗效果。方法检索1994年~2004年国内发表的葛根素注射液治疗突发性耳聋临床试验的相关文献,采用Review Manager4.2软件对符合条件的文献进行荟萃分析。结果共有4个临床试验纳入本次研究,同质性检验X2=0.80,P>0.05,故采用固定效应模型进行分析。与对照组比较,葛根素注射液治疗突发性耳聋总有效率更高,比值比为2.05,95%可信区间为1.10~3.82(P<0.05)。结论临床可选用葛根素注射液治疗突发性耳聋。     

8742例新生儿听力筛查结果分析

目的:通过对天津市塘沽区新生儿先天性听力障碍发病率的筛查,了解新生儿听力障碍及其相关因素。方法:使用德国-麦科全自动耳声发射听力筛查仪,对8742例新生儿在出生后72h进行双耳畸变产物耳声发射(DPOAE)检查,初筛未通过者在42d后再次复查DPOAE,复筛仍未通过者进行听性脑干反应(ABR)检查,ABR检查不通过者在3～4个月内接受全面的听力学诊断和评估,以确定听力损失的性质和程度。结果:初次筛查通过率为91.50%(7999/8742),复查通过率为57.47%(427/743),追访ABR经过全面的听力学诊断和评估确诊先天性听力障碍9例。结论:天津市塘沽区新生儿先天性听力障碍发病率可初步认为是0.1%;采用DPOAE能较简便地筛查新生儿的听力障碍,及早发现有听力障碍的个体,使其在语言发育的关键年龄段之前就能得到适当干预。     

Evaluation of test sensitivity and test specificity of three field methods for quantification of chloroquine in urine using liquid chromatography as reference method

We have evaluated three quantitative colorimetric methods [bromthymol blue (BTB), Haskins, and Saker-Salomons (S-S)] for measurement of concentrations of chloroquine (CQ) in urine. A graphical evaluation of test sensitivity and test specificity at different concentrations of CQ in authentic urine samples was used. Liquid chromatography (LC) was used as a reference method. The Haskins method showed the highest test specificity (89%) and test sensitivity (97%), at a discrimination value of 2 mumols/L. At the same sensitivity (97%) as the Haskins method, S-S and BTB methods had test specificities of 49 and 13%, respectively. The correlation coefficients between the LC method and the colorimetric methods were all higher than 0.94 at a urinary concentration range of 2-100 mumols/L. The intra- and interassay variations for the colorimetric methods were all uniformly less than 15% at 2 mumols/L, but the Haskins method showed less variation than the other two methods.     

高压氧联合常规药物治疗突发性耳聋38例临床效果观察

目的探讨高压氧联合常规药物治疗突发性耳聋的临床效果。方法将38例突发性耳聋患者按听力水平分为轻度耳聋组8例、中度耳聋组19例和重度耳聋组11例。3组均采用高压氧联合常规药物治疗,对3组临床疗效、不良反应及治疗前、后听力水平进行比较,并评价该治疗方案的可行性。结果轻、中、重度耳聋组治疗后总有效率分别为100.0%、94.7%、90.9%,3组总有效率两两比较差异均无统计学意义(P>0.05)。3组治疗后听力值均低于治疗前,差异有统计学意义(P>0.05)。3组治疗过程中均未出现明显不良反应。结论高压氧联合常规药物治疗突发性耳聋疗效满意,能够明显提高患者的听力水平,且治疗过程中无明显不良反应,是值得临床应用的治疗方案。     

Discrimination of auditory from nonauditory toxicity by reflex modulation audiometry: effects of triethyltin

The evaluation of toxicity in sensory systems presents particular problems because of the need to distinguish specific sensory loss from other toxic effects. It has recently been shown that modulation of reflex behavior by low-intensity test stimuli can be used to provide a rapid assessment of sensory acuity and of ototoxic hearing loss. In this report the ability of the method to distinguish the known neuromuscular consequences of triethyltin (TET) from hearing loss is demonstrated. Rats treated with TET bromide (30 mg/liter) in their drinking water for 3 weeks showed a profound decrease in acoustic startle reflex amplitudes which was apparent prior to overt neuromuscular weakness and subsequent hindlimb paralysis. Following cessation of treatment, startle levels recovered to preexposure values. Despite these large changes in startle reflex amplitudes, TET treatment did not alter the ability of pure tone stimuli to modulate reflex behavior. These results indicate that TET as administered in these studies disrupted neuromuscular function but did not affect hearing.     

长期氧疗预防慢性阻塞性肺病所致感音神经性聋的效果

目的探讨长期氧疗(LTOT)对慢性阻塞性肺病患者听功能的调治作用。方法选择48例已确诊为慢性阻塞性肺病患者随机分为治疗组28例和对照组20例。治疗组给予长期氧疗,对照组未接受长期氧疗,随访观察3年。两组试验前后均行纯音测听、听性脑干反应测听(ABR)检查。采用配对t检验分析同组试验前后阈值的差异,t检验分析组间差异。结果治疗组治疗后与对照组之间以及对照组前后对比观察存在显著差异;治疗组治疗前与对照组之间以及治疗组前后对比观察无显著差异。结论持续氧疗可有效减缓慢性阻塞性肺病引起的感音神经性聋的发生。