老年抑郁症患者血清Hcy、BDNF、NRG-1变化及与认知功能损害的关系

目的 探究老年抑郁症患者血清同型半胱氨酸（Hcy）、脑源性神经营养因子（BDNF）、神经 调节蛋白-1（NRG-1）变化及与认知功能损害的关系。方法 选择2016 年1 月至2019 年6 月来徐州市东 方人民医院就诊的老年抑郁症患者116例作为观察组,按照智力状态检查量表（MMSE）评分结果将观察组 中认知功能损害57例作为认知功能损害组,认知功能未损害59例作为认知功能未损害组。并选取同期 100名健康人群作为对照组,比较各组血清Hcy、BDNF、NRG-1变化,探究Hcy、BDNF、NRG-1变化与认知 功能损害的关系。结果 认知功能损害组Hcy为（29.49±6.36） μmol/L高于对照组的（10.47±3.31）μmol/L 及无认知功能损害组的（15.58±4.27）μmol/L,认知功能损害组BDNF 为（6.57±1.58） μg/L,低于对照 组的（18.26±4.73）μg/L 及无认知功能损害组的（13.24±3.45） μg/L,认知功能损害组NRG-1 水平为 （11.25±4.12） pg/ml,低于对照组的（32.50±7.14）pg/ml 及无认知功能损害组的（23.38±5.26） pg/ml,认 知功能损害组MMSE 评分为（21.36±1.05）分,低于对照组的（28.01±0.94）分及无认知功能损害组的 （27.93±0.71）分;且与对照组比较,无认知功能损害组Hcy 升高,BDNF、NRG-1 水平降低（P＜ 0.05）。观 察组MMSE 评分与血清Hcy 呈负相关,与BDNF、NRG-1 均呈正相关（r值分别为-0.790、0.778、0.777,P＜ 0.05）。预测老年抑郁症患者认知功能损害时,3项指标联合的曲线下面积（AUC）最大为0.884,优于单一的 Hcy、BDNF、NRG-1（P＜0.05）。单因素分析,认知功能损害患者Hcy水平及独居人数高于认知功能未损害组, BDNF、NRG-1水平低于认知功能未损害组（P＜0.05）;多因素分析显示,Hcy（OR=3.688）、BDNF（OR=2.575）、 NRG-1 水平（OR=3.019）,独居（OR=1.388）是老年抑郁症患者认知功能损害的独立危险因素（P＜ 0.05）。 结论 老年抑郁症认知损害患者的血清Hcy 高于健康人群及认知未损害患者,BDNF、NRG-1 水平低于 健康人群及认知未损害患者,临床检测老年抑郁症患者血清Hcy、BDNF、NRG-1 水平,能有效预测患者 认知功能受损的可能性,从而进行早期预防,改善患者生活质量。     

国产MALDI-TOF MS系统microTyper MS对革兰阴性菌的鉴定性能评估

目的 评估国产基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)系统microTyper MS鉴定革兰阴性菌的性能.方法 使用国产MALDI-TOF MS系统microTyper MS与进口质谱系统VITEK MS系统同步鉴定该实验室储存的标准菌株及2018年6月至2019年6月临床分离的革兰阴性菌株.鉴定结果不一致时,使用表型试验或16 s rDNA测序进行确认,以此评估microTyper MS对革兰阴性菌的鉴定能力.结果 纳入鉴定的革兰阴性菌株一共45属4509株.VITEK MS系统准确鉴定4419株,准确率为98.0％;microTyper MS准确鉴定4405株,准确率为97.7％.结论 microTyper MS在革兰阴性菌鉴定方面具有与VITEK MS系统相仿的临床细菌鉴定能力.     

The Effect of Body Weight and Alcohol Consumption on Hyperuricemia and Their Population Attributable Fractions: A National Health Survey in China

IntroductionThe prevalence of hyperuricemia (HUA) is increasing worldwide; understanding of population attributable fraction of modifiable risk factors (MRFs) is important for disease prevention. Given the sparse evidence on how MRFs influence HUA in mainland China, we aimed to explore the effect of excess body weight and alcohol consumption and their population attributable fractions of HUA based on a national survey in mainland China.MethodsUsing data from the China National Health Survey which included 31,746 Han Chinese of 20–80 years of age from 10 provinces, we estimated the prevalence and MRFs (overweight/obesity and alcohol consumption) of HUA. HUA was defined as serum uric acid >417 μmol/L in men and >340 μmol/L in women. Restricted cubic-spline models were used to demonstrate the linear and nonlinear associations between exposures and HUA. The adjusted population attributable risk (PAR) was calculated to understand the relative importance of each MRF.ResultsThe prevalence of HUA was 25.1% in men and 15.9% in women. The population fraction of HUA cases that could be avoided by weight loss was 20.6% (19.3%–22.0%) in men and 18.1% (17.1%–19.0%) in women. The PAR of alcohol consumption was 12.8% (8.5%–17.1%) in men. Participants from Southwest China (Yunnan) had the highest HUA prevalence (47.9% in men and 29.9% in women) but with lower PAR of MRFs, especially in men (16.7%). Subjects in North China had lower HUA prevalence but higher PAR of MRFs. Around 44.8% male HUA cases in Inner Mongolia (26.9% of HUA prevalence) and 37.7% cases in Heilongjiang (34.4% of HUA prevalence) were attributable to overweight/obesity and alcohol consumption.ConclusionThere are significant sex and geographic difference on PAR of HUA due to MRFs. More tailored prevention strategies are needed to prevent HUA through weight loss and reduction of alcohol consumption.     

氧驱动雾化吸入普米克令舒及博利康尼治疗支气管哮喘的疗效观察

目的探讨普米克令舒及博利康尼混悬液氧气驱动雾化吸入治疗支气管哮喘的疗效。方法将60例支气管哮喘患者随机分为两组,两组均采用常规治疗。观察组在对照组全身用药治疗基础上,采用普米克令舒及博利康尼混悬液雾化吸入治疗。对治疗后患者病情转归情况进行比较。结果观察组哮喘症状的缓解、肺功能改善情况增加均明显优于对照组。结论氧驱动雾化吸入普米克令舒及博利康尼治疗支气管哮喘疗效好,起效快,方便、安全。     

家庭无创正压通气对稳定期COPD合并Ⅱ型呼吸衰竭患者的疗效观察

目的观察家庭无创正压通气(HNPPV)治疗对稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的疗效.方法选取稳定期COPD合并Ⅱ型呼吸衰竭患者60例,根据有无长期HNPPV通气分为观察组32例及对照组28例,2组患者均给予常规治疗,观察组在常规治疗的基础上加用HNPPV.2组患者入组前及治疗1年时均测定动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%pred)、FEV1/FVC、6分钟步行距离(6MWD),采用改良英国医学研究委员会呼吸困难量表(mMRC)进行呼吸困难评估,采用COPD评估测试(CAT)问卷进行症状评估.记录1年内因COPD急性加重的住院次数.结果观察组与对照组治疗后比较,PaO2显著升高(t=3.02,P<0.01),PaCO2显著降低(t=-9.52,P<0.01),FVC显著增高(t=2.5,P<0.05),6MWD显著增高(t=12.86,P<0.01),mMRC、CAT问卷、住院次数显著降低(t=-4.76、-2.14、-10.41,P值均<0.05).结论稳定期COPD合并Ⅱ型呼吸衰竭患者在一般治疗的基础上加用HNPPV,可以纠正低氧血症和CO2潴留,改善肺功能,提高运动耐量,减轻临床症状,减少住院次数.     

经直肠三维彩色血管能量成像诊断前列腺增生与前列腺癌的研究

目的探讨经直肠三维彩色血管能量成像(TR3D-CPA)对前列腺癌(PCa)及前列腺增生(BPH)的鉴别诊断价值。方法对22例PCa和60例BPH病变区血管行TR3D-CPA重建,进行血管半定量分型及血管指数(VI)定量分析。结果TR3D-CPA显示PCa较BPH血管丰富,血管走行迂曲、紊乱,粗细不均。以TR3D-CPA型诊断PCa的敏感性为77.3%,特异性为85%;PCa的VI高于BPH,二者比较差异有统计学意义(P<0.05),以VI>0.19条/cm3诊断PCa敏感性为77.3%,特异性为63.3%。结论血管分型及VI能客观地反映PCa的血管分布特征,可作为前列腺良恶性病变的鉴别诊断依据。     

雌激素受体-α基因PvuⅡ、Xba Ⅰ多态性及山茶籽油与广西壮族绝经后骨质疏松症的关联性

目的:探讨雌激素受体-α(ER-α)基因多态性及山茶籽油与广西壮族妇女绝经后骨质疏松症(PMOP)的关联性.方法:615例广西长期食用山茶籽油壮族妇女和616例广西长期非食用山茶籽油壮族妇女,定量超声骨质密度仪测量2组右侧足跟骨宽带超声衰减值(BUA),PCR-RFLP检测2组ER-α基因多态性.结果:食用山茶籽油组绝经妇女与非食用山茶籽油组绝经妇女同一年龄组相比较,前者的不正常骨量和骨质疏松症的患病率均明显低于后者.ER-α基因PvuⅡ等位基因频率在2组中存在差异,P等位基因患PMOP的风险是p等位基因的1.566倍.食用山茶籽油组绝经后骨质疏松症携带XbaⅠ酶切位点的X等位基因分布频率明显少于非食用山茶籽油组绝经后骨质疏松症.结论:提示P等位基因可能是PMOP的遗传易感基因;食用山茶籽油对PMOP有防治作用,X等位基因可能是对山茶籽油起交互作用的敏感基因.     

Plasma vaspin concentrations are decreased in acute coronary syndrome,but unchanged in patients without coronary lesions

Objective

Previous studies suggested that decreased serum vaspin levels were associated with coronary artery disease (CAD). The present study aimed to investigate the association between plasma vaspin levels and different states of CAD.

Design and methods

A total of 162 patients with coronary angiography (CAG) proved that CAD was enrolled. Additional 103 patients complained with “chest discomfort” with negative CAG, and 60 normal subjects were enrolled in this study. The levels of plasma vaspin, adiponectin, clinical parameters, lipid profile and C reactive protein (CRP) were measured.

Results

The levels of plasma vaspin were significantly lower in the CAD group (0.47 ± 0.63 μg/L) than those in the healthy group and CAG (−) group (all p < 0.001). In CAD group, the pos hoc analysis showed that serum vaspin concentration in acute myocardial infarction group (0.21 ± 0.19 μg/L) was significantly lower than that in the unstable angina pectoris group (0.40 ± 0.37 μg/L) (p = 0.012), and serum vaspin concentration in unstable angina pectoris was significantly lower than that in stable angina pectoris group (0.92 ± 0.94 μg/L) (p = 0.013). The plasma vaspin concentration was also negatively correlated with the severity of CAD (1-vessel: 0.86 ± 0.90 μg/L; 2-vessel: 0.36 ± 0.39 μg/L; 3-vessel: 0.21 ± 0.16 μg/L). The plasma vaspin concentration in CAG (−) group with “chest discomfort” (1.93 ± 2.57 μg/L) was similar to the healthy control group (2.18 ± 3.49 μg/L).

Conclusions

The plasma vaspin concentration correlated to the severity of CAD. Furthermore, plasma vaspin has a value of avoiding patients without CAD from unnecessary CAG.     

某三级甲等医院护理不良事件发生情况分析

目的：通过对护理不良事件的发生时间、类型及原因进行分析,提出改进措施,以预防和减少不良事件的发生。方法对某三级甲等医院2013年上报的210例护理不良事件进行回顾性分析,统计护理不良事件的类型、原因、不良事件高发的时间段等资料。结果不良事件高发的主要时间段集中在7：00—8：59和10：00—10：59,占28.57%;交接班前后、上午班、下午班及晚班是不良事件发生的高峰期。结论护理管理者可调整当前护理排班模式,减少护理人员交接班次数,提高护理人员业务水平熟练程度,以期减少护理不良事件的发生。     

活血化瘀利水法联合西药治疗老年单纯收缩期高血压病48例

目的：观察活血化瘀利水法联合苯磺酸氨氯地平对老年单纯收缩期高血压患者的疗效以及生存质量。方法：本研究采用随机、对照的试验设计方法,将110例老年单纯收缩期高血压患者随机分为两组。对照组55例,予口服苯磺酸氨氯地平,其中脱落11例,有44例进入统计;治疗组55例,在对照组基础上加服活血化瘀利水中药,其中脱落7例,有48例进入统计。疗程为8周。结果：中医症状积分改善程度治疗组血瘀证明显优于本组非血瘀证及对照组（P〈0．01）。收缩压降压疗效治疗组血瘀证优于其他各组（P〈0．01）,SF-36生存质量量表评分改善作用治疗组明显优于对照组（P〈0．01或P〈0．05）。结论：活血化瘀利水中药方与常规西药联用治疗老年单纯收缩期高血压效果更好。