维持性血液透析患者自体动静脉内瘘血栓影响因素观察

目的观察维持性血液透析(maintenance hemodialysis,MHD)患者血浆同型半胱氨酸(homocysteine,Hcy)、C反应蛋白(C-reactive protein,CRP)水平及透析低血压发生率等指标是否影响自体动静脉内瘘(autogenous arteriovenous fistulas,AVF)血栓的发生。方法选择以自体AVF为血管通路的MHD患者92例,观察1年是否有过1次或1次以上的内瘘血栓栓塞事件,将其分为AVF血栓组和非AVF血栓组。比较2组患者的透析中低血压发生率、Hcy、CRP、低密度脂蛋白(low density lipoprotein,LDL)、血浆白蛋白(albumin,Alb)、血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit value,Hct)、铁蛋白等1年内两次化验的平均值指标及透析时间,并进行相关危险因素分析。结果入选92例MHD患者的透析低血压发生率为19.6%(18/92),AVF血栓组和非AVF血栓组的透析低血压发生率比较,差异有统计学意义(P0.05)。92例MHD患者Hcy异常发生率为100%,但2组患者的血浆Hcy水平差异无统计学意义,2组患者的CRP和铁蛋白水平差异也无统计学意义。危险因素分析提示Hb和透析低血压是AVF血栓形成的危险因素,Hcy、CRP不是AVF血栓形成的危险因素。AVF血栓组的透析时间及Hct低于非AVF血栓组,其差异有统计学意义(P0.05),其他白细胞、SCr、血小板、LDL、Alb等生化指标的差异无统计学意义。结论透析低血压、Hb都是MHD患者AVF血栓发生的危险因素,而Hcy、CRP等与AVF血栓的发生无相关性。     

济南市35262例健康体检者贫血情况调查

目的：了解济南市2015年健康体检人群贫血情况,探讨贫血防治对策,为健康管理提供依据。方法以2015年度在本院体检的35262例济南市健康体检人群为研究对象,按照年龄和性别分组,分析各组的贫血检出率、贫血严重程度和贫血分类情况。结果男性贫血检出率为1.40%(299/21227),女性为6.58%(924/14035),女性贫血检出率明显高于男性,差异有统计学意义(P<0.05),尤其是女性40~49岁年龄组贫血检出率最高,达33.76%(413/14035);男女贫血程度均以轻度贫血为主,共占贫血总数的86.92%(1063/1223),男女贫血类型均以小细胞低色素性贫血为主,共占贫血总数的75.13%(852/1134)。男性小细胞低色素性贫血检出率为28.31%(321/1134),女性为73.28%(813/1134),且女性的小细胞低色素性贫血检出率明显高于男性,差异有统计学意义(P<0.05)。结论济南市健康体检人群中,贫血是女性较为常见的疾病,应加强健康宣传,提高认识,定期进行检查,以便早期发现并及时进行治疗。     

广州市番禺区学龄前儿童各年龄组间RBC、HGB及MCV比较

目的：探讨广州市番禺地区学龄前儿童各年龄组间红细胞计数(RBC)、血红蛋白浓度（HGB）及平均红细胞体积(MCV)的参考值范围。方法选择2014年在番禺区中心医院就诊的6个月≤年龄≤6岁的健康儿童3290例;筛除离群数据后,按性别、年龄分组,采用SPSS19.0软件进行统计分析。结果除了女童不同年龄组间及2~3岁男女儿童间RBC水平、6个月~1岁及4~6岁男女童间HGB水平、2~3岁男女童间MCV水平比较差异均无统计学意义(P<0.05)外,其他参数在不同年龄组间比较差异均有统计学意义(P<0.05);学龄前儿童各参数与《全国临床检验操作规程》(第4版)参考范围比较,差异均有统计学意义(P<0.05)。结论番禺地区应根据本地域人群特点、不同年龄及性别建立合适RBC、HGB、MCV参考值范围,为临床诊断儿童贫血和评价儿童的营养和生长发育状况提供可靠的依据。     

血糖水平与慢性心力衰竭合并2型糖尿病患者预后的相关性

目的 研究血糖水平与慢性心力衰竭合并2型糖尿病患者预后的相关性。 方法 选取2014年4月至2016年3月重庆市开州区人民医院收治的90例慢性心力衰竭合并2型糖尿病患者为研究对象,并将患者按照随访中测定的糖化血红蛋白(HbA1c)值划分为血糖达标组(HbA1c<7.0%)与血糖未达标组(HbA1c≥7.0%),对比两组患者联合主要心血管事件的发生率,并分析无联合主要心血管事件患者的生存率。 结果 与血糖达标组相比,血糖未达标组的空腹血糖及餐后2 h血糖水平差异有统计学意义,而且心力衰竭程度越重,糖化血红蛋白水平越高(P<0.05),联合主要心血管事件的发生率较高(3.77%比18.92%,P=0.018);两组患者的N末端B型利钠肽原与左室射血分数水平差异无统计学意义(P=0.721,P=0.117)。 结论 将HbA1c控制在7.0%以下,可有效改善慢性心力衰竭合并2型糖尿病患者的预后水平。     

Evoked-cerebral blood oxygenation changes in false-negative activations in BOLD contrast functional MRI of patients with brain tumors

Blood oxygenation level dependent contrast functional MRI (BOLD-fMRI) has been used to define the functional cortices of the brain in preoperative planning for tumor removal. However, some studies have demonstrated false-negative activations in such patients. We compared the evoked-cerebral blood oxygenation (CBO) changes measured by near-infrared spectroscopy (NIRS) and activation mapping of BOLD-fMRI in 12 patients with brain tumors who had no paresis of the upper extremities. On the nonlesion side, NIRS demonstrated a decrease in deoxyhemoglobin (Deoxy-Hb) with increases in oxyhemoglobin (Oxy-Hb) and total hemoglobin (Total-Hb) during a contralateral hand grasping task in the primary sensorimotor cortex (PSMC) of all patients. On the lesion side, NIRS revealed a decrease in Deoxy-Hb in five patients (Deoxy-decrease group), and an increase in Deoxy-Hb in seven patients (Deoxy-increase group); the Oxy-Hb and Total-Hb were increased during activation in both groups, indicating the occurrence of rCBF increases in response to neuronal activation. BOLD-fMRI demonstrated clear activation areas in the PSMC on the nonlesion side of all patients and on the lesion side of the Deoxy-decrease group. However, in the Deoxy-increase group, BOLD-fMRI revealed only a small activation area or no activation on the lesion side. Intraoperative brain mapping identified the PSMC on the lesion side that was not demonstrated by BOLD-fMRI. The false-negative activations might have been caused by the atypical evoked-CBO changes (i.e. increases in Deoxy-Hb) and the software employed to calculate the activation maps, which does not regard an increase of Deoxy-Hb (i.e., a decrease in BOLD-fMRI signal) as neuronal activation.     

糖化血红蛋白联合空腹血糖检测在妊娠期糖尿病筛查中的效果

目的：观察糖化血红蛋白（HbA1c）联合空腹血糖检测在妊娠期糖尿病筛查中的效果。方法选择2013年1月～2013年12月进行产前保健或分娩的孕妇168例,所有孕妇均在行口服75 g葡萄糖耐量试验的同时检测糖化血红蛋白,共发现17例妊娠期糖尿病患者,将其纳入妊娠期糖尿病组,其他151例正常孕妇纳入正常组。对两组进行HbA1c、口服75 g葡萄糖耐量试验。结果妊娠期糖尿病组HbA1c、口服75 g葡萄糖耐量试验1 h PG、2 h PG检测结果均显著高于正常组,且差异存在统计学意义（P＜0.05）,而妊娠期糖尿病组空腹血糖与正常组空腹血糖比较,差异无统计学意义（P＞0.05）。两组孕妇HbA1c一次检测成功率均为100%,均显著高于空腹血糖、口服75 g葡萄糖耐量试验一次性检测成功率。结论 HbA1c联合空腹血糖检测在妊娠期糖尿病筛查能够显著提高妊娠期糖尿病的检出率,值得应用于临床。     

股骨颈骨折患者影响手术治疗效果因素分析

目的探讨股骨颈骨折患者术后临床结局的影响因素。方法对180例股骨颈骨折患者的临床资料进行统计分析,记录所有患者的性别、年龄、血清白蛋白水平、血清Hb水平、受伤时间和手术时间的间隔时间、术前合并症及术前的身体状况,分析其对术后1年的临床结局的影响。结果死亡患者与存活患者的合并症（89．6％与10．4％）、身体状况分级（84．9％与15．1％）、Hb水平（98．4％与1．6％）、血清白蛋白水平（98．9％与1．1％）以及总淋巴细胞数目（96．6％与3．4％）之间差异均有统计学意义（X。=7．227、13．855、16．201、6．678、4．649,均P〈0．05）。经多因素Logistic回归分析,合并症〉2种、身体状况分级处于Ⅲ级或Ⅳ级、Hb水平〈100g／L、血清白蛋白水平〈35g／L以及总淋巴细胞数目〈1．5×10 9／L均为股骨颈骨折患者术后临床结局的危险因素。结论合并症、身体状况分级、Hb水平、血清白蛋白水平及总淋巴细胞数目为股骨颈骨折患者术后增加临床病死率的危险因素。     

Current understandings and perspectives on non-cancer health effects of benzene: A global concern

Objective

Benzene, as a volatile organic compound, is known as one of the main air pollutants in the environment. The aim of this review is to summarize all available evidences on non-cancerous health effects of benzene providing an overview of possible association of exposure to benzene with human chronic diseases, specially, in those regions of the world where benzene concentration is being poorly monitored.

Methodology

A bibliographic search of scientific databases including PubMed, Google Scholar, and Scirus was conducted with key words of “benzene toxic health effects”, “environmental volatile organic compounds”, “diabetes mellitus and environmental pollutants”, “breast cancer and environmental pollution”, “prevalence of lung cancer”, and “diabetes prevalence”. More than 300 peer reviewed papers were examined. Experimental and epidemiologic studies reporting health effects of benzene and volatile organic compounds were included in the study.

Results

Epidemiologic and experimental studies suggest that benzene exposure can lead to numerous non-cancerous health effects associated with functional aberration of vital systems in the body like reproductive, immune, nervous, endocrine, cardiovascular, and respiratory.

Conclusion

Chronic diseases have become a health burden of global dimension with special emphasis in regions with poor monitoring over contents of benzene in petrochemicals. Benzene is a well known carcinogen of blood and its components, but the concern of benzene exposure is more than carcinogenicity of blood components and should be evaluated in both epidemiologic and experimental studies. Aspect of interactions and mechanism of toxicity in relation to human general health problems especially endocrine disturbances with particular reference to diabetes, breast and lung cancers should be followed up.     

吸烟饮酒对胃癌治疗前血红蛋白、PLR、NLR的影响及护理对策

目的 探讨吸烟饮酒对胃癌治疗前血红蛋白、血小板淋巴细胞比率（platelet to lymphocyte ratio,PLR）、中性粒细胞淋巴细胞比率（neutrophil to lymphocyte ratio,NLR）的影响.方法 纳入202例胃癌病例,单因素Kruskal-Wallis和多元线性回归分析吸烟、饮酒与胃癌治疗前血红蛋白、PLR、NLR的关系.结果 Kruskal-Wallis显示吸烟对胃癌治疗前血红蛋白、PLR、NLR差异有统计学意义（P=0.010,0.009,0026）,饮酒则对胃癌治疗前血红蛋白、PLR、NLR无明显影响（P=0.415,0.090,0.168）.多元线性回归显示吸烟对胃癌治疗前血红蛋白（P=0.001）、PLR（P=0.001）有显著关联,但对胃癌治疗前NLR无显著关联（P=0.246）;饮酒对治疗前血红蛋白（P=0.930）、PLR（P=0.665）、NLR （P=0.817）无显著关联;吸烟（P=0.988）、饮酒（P=0.407）不是影响胃癌分期的独立影响因素.结论 吸烟是影响胃癌治疗前血红蛋白降低、PLR升高的独立危险因素,应加强护理干预,改善患者血红蛋白及全身性炎症反应.