血清铁蛋白诊断慢性肝病显著纤维化和肝硬化的临床价值

目的探讨血清铁蛋白在慢性肝病显著纤维化和肝硬化中的诊断价值。方法收集来我院诊疗的122例慢性肝病患者资料,均进行肝组织病理学检查,检测患者的肝纤维化4项、肝功能以及血清铁蛋白的水平,以肝穿刺的病理结果作为依据,比较血清铁蛋白与肝纤维化4项、血常规等指标对显著肝纤维化和肝硬化诊断价值的优劣,并采用Logistic回归分析探讨相关影响因素。结果血清铁蛋白、肝纤维化四项指标水平均与肝纤维化程度呈正相关,均随着肝纤维化分期增加而增加,并且在肝硬化时期最高(P<0.05)。对纤维化或肝硬化的可能影响因素进行单因素分析,结果发现血小板透明质酸、层黏蛋白、Ⅳ型胶原、Ⅲ型前胶原、血清铁蛋白等因素与显著纤维化有关;而白细胞计数、血小板、白蛋白、层黏蛋白、Ⅳ型胶原、Ⅲ型前胶原、血清铁蛋白等因素与肝硬化有关。ROC曲线分析血清铁蛋白对显著纤维化的诊断效能,曲线下面积为0.816(0.803~0.910),血清铁蛋白在截点值为138.17 ng/mL时,敏感度为82.0%,特异度为91.2%。ROC曲线分析血清铁蛋白对肝硬化的诊断效能,曲线下面积(AUC)为0.827(0.817~0.846),血清铁蛋白在截点值为160.25 ng/mL时,敏感度为82.4%,特异度为91.5%。结论血清铁蛋白、肝纤维化四项与慢性肝病显著纤维化和肝硬化程度有关,且以上方式简便、创伤性小、可重复性较强,对检测肝纤维化以及肝硬化程度具有良好的提示作用。     

凋亡相关蛋白3（APR3）在宫颈鳞癌组织中的表达及临床意义

目的：探讨 APR3在不同宫颈组织的表达情况和临床病理意义。方法：免疫组化法（SP 法）对放化疗前后的宫颈鳞癌组织80例,CIN 90例以及正常宫颈组织30例的 APR3表达情况进行检测。结果：APR3在宫颈鳞癌中阳性表达率为81．25％,明显高于 CIN 组的31．11％以及对照组的10．00％（P ＜0．01）。放化疗后宫颈鳞癌组织中 APR3的表达率为51．25％,低于放化疗前81．25％（P ＜0．01）。APR3阳性表达率随临床分期的增高而增加（P ＜0．05）,病理分化程度的降低而增加（P ＜0．05）,有淋巴结转移者阳性表达率明显高于无转移者（P ＜0．05）。结论：APR3与子宫颈病变良恶性有关,与子宫颈鳞癌发生发展相关。放化疗可能影响宫颈鳞癌组织中 APR3的表达水平。     

Evaluating clinically significant changes in health-related quality of life: A sample of relatives of patients with severe traumatic brain injury

The objective of the study was to investigate change and predictors of change in health-related quality of life (HRQoL) in relatives of patients with severe traumatic brain injury (TBI) during rehabilitation, and to analyse associations between changes in HRQoL and symptoms of anxiety and depression. The Vitality (VT), Mental Health (MH), Social Function (SF) and the Role Emotional (RE) scales from the Short Form 36, and the anxiety and depression scales from the Symptom Checklist-90 – Revised were used. Of the 62 relatives, 24.6% experienced a reliable improvement on the VT scale, 53.2% on the MH scale, 27.4% on the SF scale and 16.1% on the RE scale. Of the relatives, 24.0% experienced clinically significant change (CSC) on the VT scale, 19.6% on the MH scale, 21.6% on the SF scale, and 19.2% on the RE scale. Relatives’ age and higher patient Glasgow Coma Scale score predicted the experience of CSC in RE, and change on the Functional Independence Measure in patients predicted CSC on the MH scale. Improvements in VT as well as MH were associated with improvement in symptoms of anxiety and depression, and improvement in SF was associated with improvement in symptoms of depression. About one-fifth of the sample experienced a CSC on one of the four HRQoL measures. Relatives experiencing CSC tended to be related to patients who showed more improvement during rehabilitation. Improvements in HRQoL were associated with improvements in symptoms of anxiety and depression.     

Risk and prognostic factors of transplantation‐associated thrombotic microangiopathy in allogeneic haematopoietic stem cell transplantation: a nested case control study

Transplantation‐associated thrombotic microangiopathy (TA‐TMA) is a significant complication of haematopoietic stem cell transplantation. However, it remains controversial which clinical or laboratory markers are of evident risk and prognostic value. From 2006 to 2013, a nested case control study was carried out in our centre to study the risk and prognostic factors of TA‐TMA. A total of 654 consecutive patients who underwent allogeneic haematopoietic stem cell transplantation were studied. Twenty‐six (4.0%) patients matched the established diagnostic criteria. Subjects with TA‐TMA had significantly higher 3‐year none relapse mortality compared with those without (65.4% vs 15.4%, P < 0.0001). Grades 2 to 4 aGVHD and cytomegalovirus viremia were independent risk factors, and serum LDH level >500U/L as well as hypertension were early signs of TA‐TMA occurrence. Liver dysfunction and significant gastric bleeding were independent risk factors for TA‐TMA related mortality. Subjects with either liver dysfunction or significant gastric bleeding had significantly higher 3 year TA‐TMA related mortality cumulative incidence than subjects without. These observations lead to the conclusion that allo‐HSCT recipients with grades 2 to 4 aGVHD or cytomegalovirus viremia should be monitored for TA‐TMA. Liver dysfunction and significant gastric bleeding are prognostic factors for TA‐TMA. Copyright © 2016 John Wiley & Sons, Ltd.     

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目的了解福州市12岁学生龋病患病情况,为福州市口腔卫生保健工作及龋病的防治工作提供科学依据。方法于2010年10月,福州市第一医院口腔科按第六次全国学生体质健康调研工作的要求,随机抽调福州市城乡中小学12岁的学生共555名进行龋病的流行病学调查,以患龋率、龋均和龋齿充填率、显著性龋均指数为统计指标,采用SPSS17.0统计软件对结果进行统计分析。结果福州市12岁学生的患龋率为29.7%,受检者龋均为0.53,患龋者龋均为1.78,龋齿充填率为20.1%,显著性龋均指数为2.79。城区和乡镇的学生患龋率分别为25.3%和33.8%,差异有统计学意义(χ2=4.800,P=0.028);龋均分别为0.37和0.46,差异无统计学意义(t=-1.031,P>0.05);龋齿充填率分别为23.4%和17.5%,差异无统计学意义(χ2=1.605,P=0.205)。男生和女生的患龋率分别为26.9%和32.7%,差异无统计学意义(χ2=2.284,P=0.131);龋均分别为0.34和0.49,差异有统计学意义(t=-2.322,P<0.05);龋齿充填率分别为20.5%和19.8%,差异无统计学意义(χ2=0.023,P=0.879)。结论福州市12岁学生总体患龋率不高,但充填率低,乡镇学生的患龋率高于城区。今后预防保健工作应注意提高龋齿治疗率,特别是乡镇学生的龋齿预防和保健工作仍需加强。