宁夏医科大学总医院简介(英文)
医院各科室英文翻译
medicaldepartment/departmentofinternal medicine:内科surgical deparment;department of surgery:外科pediatrics department:小儿科obstetrics and gynecology department:妇产科ophtalmology department:眼科dental department:牙科ENT(ear-nose-throat)department:耳鼻喉科urology department:泌尿科dermatologydepartment;skindepartment:皮肤科department of general surgery普通外科orthopedic surgery department:矫形外科traumatology department:创伤外科plastic surgery:整形外科anesthesiology department:麻醉科pathology department:病理科cardiology department:心脏病科psychiatry department:精神病科orthopedics department:骨科department of cardiac surgery:心脏外科department of cerebral surgery:胸外科neurology department:神经科neurosurgery department:神经外科thoracic surgery department:脑外科department of anus & intestine surgery肛肠外科department of hepatobiliary surgery肝胆外科department of traditional Chinese medicine:中医科department of infectious diseases传染病科geriatrics department:老人病专科hematology department:血液科department of rheumatism风湿科department of endocrinology内分泌科department of plastic surgery医学整形科hepatology department:肝病专科nephrology department:肾脏科department of venereology性病专科department of physiotherapy理疗科electrotherapy room电疗科heliotherapy room光疗科wax-therapy room蜡疗科hydrotherapy room水疗科central laboratory中心实验室clinical labororatory临床实验室bacteriological labororatory细菌实验室biochemical labororatory生化实验室serological labororatory血清实验室laboratory of immunology免疫室reception room, waiting room侯诊室VIP waiting room贵宾候诊室consultation room诊察室therapeutic room治疗室isolation room隔离室audiometric room测听室labour room待产室delivery room分娩室fetal monitor room胎心监护室induced abortion room人工流产室rest room for induced abortion人流休息室registration office:挂号处out-patient department:门诊部in-patient department:住院部nursing department:护理部consulting room:诊室emergency room:急诊室emergency operation room急诊手术室emergency observation room急诊观察室admitting office:住院处operation room:手术室cystoscopy room膀胱镜室department of endoscope内镜区fibrescope room纤维镜室gastroscope room胃镜室color ultrasonic room彩超室electrocardiogram room心电图室electroencephalogram room脑电图室dressing room换药室outpatient Surgical Center门诊手术中心X-raydepartment/departmentofradiology:放射科blood bank:血库hemodialysis room血透室dispensary; pharmacy:药房nutrition department营养部diet- preparation department配膳室therapeutic department治疗室supply-room供应室disinfection-room消毒室dressing room换药室mortuary太平间record room病案室doctor’s office医生办公室nurse”s office护士办公室nursing station护士站ward:病房medical Ward内科病房surgical Ward外科病房pediatric Ward儿科病房transfusion room输液室surgery therapeutic room外科治疗室coronary Care Unit (CCU)心脏重症室resuscitation room抢救室intensive Care Unit (ICU)重症室medical Intensive Care Unit (MICU)内科重症室neonatal Intensive Care Unit (NICU)新生儿重症室pediatric Intensive Care Unit (PICU)儿科重症室surgical Intensive Care Unit (SICU)外科重症室。
尿路感染3种方案治疗的成本_效果分析
35. 65 元 / 瓶) ,左氧氟沙星片( 浙江医药股份有限 B 组: 左氧氟沙星注射液 100mL,静脉滴注,2 次 /
公司 新 昌 制 药 厂,0. 2g × 6s / 盒,1. 35 元 / 片 ) , 日,疗程 7d; C 组: 左氧氟沙星注射液 0. 9% 氯化钠
0. 9% 氯化钠注射液 250mL( 山东华鲁制药有限公 注射液 250mL,静脉滴注,2 次 / 日; 疗程 4d,然后
文章编号:1674 - 6309(2012)09 - 0934 - 03
·经验交流·
儿童血友病 53 例临床分析
1003. 38
90. 9
1103. 84 10666. 67
费) ]× 2 × 7 = 1166. 90 元
C
587. 38
87
675. 15
—
B = ( 35. 65 × 2 + 7. 50) × 2 × 7 = 1103. 20 元
χ2AB = 0. 15; χ2AC = 12. 30; χ2BC = 9. 73; C 组成本与 A、B、组
为 19 例( 90. 5% ) ; B 组 22 例患者痊愈 16 例( 痊愈 率 72. 7% ) ,显效 4 例( 显效率 18. 2% ) ,总有效率 为 20 例( 90. 9% ) ; C 组 23 例患者痊愈 15 例( 痊愈 率 65. 2% ) ,显效 5 例( 显效率 21. 7% ) ,总有效率
原学检查均恢复正常; 显效: 病情明显好转,以上四 大。在计算增量成本 - 效果比时常以最低成本方
项中有一项未完全恢复较而得。三组治疗方
不够明显; 无效: 用药 72h 病情无明显进步或有加 案的成本 - 效果分析结果见表 3。
项目建设原则
医院全局事件管理解决方案第一章项目背景1.1用户现状宁夏医科大学总医院,集医疗、教学、科研、预防保健和干部保健等职能于一体,是省内规模最大、技术力量雄厚、医疗设备先进、专家人才荟萃的一所综合性三级甲等医院。
医院占地24.2万多平方米,建筑面积26.6万多平方米。
资产总额15.96亿元。
在编职工2070人,开放床位2188张,共有45个临床科室、17个医技科室、6个研究所,年门急诊量78.49万人次,住院患者5.24万人次,手术量(含门诊)2.65万人次。
临床医学院有16个系、4个自治区级重点学科,临床医学为一级学科硕士学位点。
医院拥有双源64排螺旋CT、3.0T 核磁共振、血管造影机、数字胃肠机、高档超声及各种内窥镜、各种先进检验设备、放疗设备、眼科准分子激光治疗仪等国内外大型高、精、尖医疗设备2000余台。
设置近100多平米的办公区域作为信息中心新的办公场所以及150多平米的场地作为医院新的中心机房,并按照专用机房进行装修、同时还配备了专用设备,以保障信息系统的安全运行。
目前该院拥有各类高端计算机设备,包括惠普小型机2台,IBM服务器10余台,CISCO6509核心交换机2台,其他各类应用服务器近20台,院内局域网构建全部采用美国CISCO交换机,有近100台,终端设备已经超过2000台,经过改造的三层交换网络技术,网络交换容量已经达到万兆级,为将来医院传输影像数据奠定了坚实的基础。
截止目前,信息中心牵头主持建设了以医院临床信息为核心的医院信息系统,包括门诊收费子系统、住院管理子系统、药剂管理子系统、医技管理子系统、临床检验管理子系统、病案管理子系统、财务管理子系统、物资供应管理子系统等各大功能模块,系统涵盖了门诊部、临床科室、药房库、医技科室、财务处和医院各管理机构等主要部门的大部分业务工作。
现运行的系统包括门诊收费系统、门诊排队叫号系统、门禁系统、会议签到系统、住院系统、临床检验信息系统、图文报告系统,基本能够满足现阶段医院及社会的要求。
各类医院名称
各类医院名称医学院中各部、院、系名称南方医科大学Southern Medical University第一军医大学The First Military Medical University训练部The Department of Training科研部The Department of Scientific Research校务部The Department of Administrative Affairs 政治部The Department of Politics基础医学部The Faculty of Basic Medical Sciences药学院The School of Pharmacy第一附属医院The First Affiliated Hospital医疗系The Faculty of Medicine护理系The Faculty of Nursing Science卫生勤务系The Faculty of Health Services热卫系The Faculty of Tropical Medicine卫生管理系The Faculty of Health Management检验系The Faculty of Medical Laboratory医学学士Bachelor’s Degree of Medicine (M.B.)医学硕士Master’s Degree of Medicine (M.M.)医学博士Doctoral Degree of Medicine (M.D.)各学科名称西医western medicine中医Traditional Chinese Medicine(TCM)中西结合integration of western medicine and TCM 临床医学检验clinical medical laboratory临床检验医学clinical laboratory medicine循证医学evidence-based medicine急救医学emergency medicine实验医学experimental medicine法医学legal / forensic medicine口腔医学oral medicine内科学internal medicine精神病学mental medicine基础医学preclinical medicine预防医学preventive medicine军事医学military medicine航空医学aviation medicine / aeromedicine 航海医学naval / nautical medicine航天医学aerospace medicine放射医学radiomedicine / radiation medicine 核医学nuclear medicine运动医学sports medicine兽医学veterinary medicine / theriatrics脱落细胞学exfoliative cytology血液学hematology寄生虫学parasitology微生物学microbiology免疫学immunology生物化学biochemistry分子生物学molecular biology各类医院名称总医院general hospital教学医院teaching hospital附属医院affiliated / attached hospital人民医院people’s hospital红十字医院red cross hospital职工医院staff & workers hospital中心医院central hospital地段医院community hospital中医院Traditional Chinese Medicine (TCM) hospital专科医院specialized hospital妇婴保健医院maternity & infant / child health hospital肿瘤医院tumor hospital五官科医院ear, nose, and throat (ENT) hospital传染病医院infectious disease hospital精神病医院mental health hospital / lunatic asylum医、护、药、研究、技术、实验系列专业职称医士assistant doctor住院医师resident住院总医师chief resident主治医师attending doctor / visiting doctor / docor-in-charge 副主任医师associate senior doctor主任医师full senior doctor药士assistant pharmacist药师pharmacist主管药师pharmacist-in-charge副主任药师associate senior pharmacist主任药师full senior pharmacist护工orderly护士nurse; nurse aide护师nurse practitioner主管护师nurse-in-charge副主任护师associate senior nurse主任护师full senior nurse技士technician技师technologist主管技师technologist-in-charge副主任技师associate senior technologist主任技师full senior technologist实验员laboratory technician助理实验师assistant experimentalist实验师experimentalist高级实验师senior experimentalist研究实习员research assistant助理研究员assistant research fellow / research associate副研究员associate research fellow研究员research fellow与医学有关的常用国家级机构名称、研究项目、奖项和荣誉称号中国科学院The Chinese Academy of Sciences卫生部The Ministry of Health国家药品监督管理局The State Drug Administration国家中医药管理局The State Administration of Traditional Chinese Medicine中国药品生物制品鉴定所China Institute of Drug and Bioproduct Control国家自然科学基金会The National Natural Science Foundation Council中华医学会Chinese Medicine Association中国中西医结合研究会China Association for the Integration of Traditional ChineseMedicine & Western medicine中国护理学会China Society of Nursing Science中国红十字会The Red Cross Society of China863计划项目The 863 Program Project“九五”计划项目The Ninth Five-year Plan Program Project 科技攻关项目The Program of Tackling Key Scientific and TechnologicalProblems Project国家自然科学基金项目The National Natural Sciences FundProject国家发明奖State Invention Award国家自然科学奖State Natural Science Award科技成果奖Scientific and Technological Achievement Award 科技进步奖Scientific and Technological Progress Award新长征突击手New Long March Pace Setter三八红旗手March 8th Red Banner Pace Setter十佳青年科学家T en Top Young Scientists检验医学专用术语血细胞分析仪hematology analyzer流式细胞仪flow cytometry中国临床检验标准委员会Chinese Committee for Clinical Laboratory Standards 美国国家临床实验室标准委员会National Committee for Clinical Laboratory Standards 国际血液学标准化委员会International Committee for Standardization in Hematology 质量保证quality assurance室间质量评价external quality assessment室内质量控制internal quality control批间between-batch批内within-batch尿液分析仪urine analyzer尿沉渣分析仪urine sediment analyzer计算机辅助精子分析computer aided semen analysis试带reagent/test strip直方图histogram通道channel酶联免疫吸附试验enzyme-linked immunosorbent assay, ELISA理学检验gross examination化学检验chemical examination显微镜检查microscopic examination构词法1. 与数字有关的前缀数字前缀示例一mono-/uni- monomer/monoclone/carbon monoxide/unidirectional 二bi-/di- bilateral/biphasic/carbon dioxide/dipeptide三tri- trilateral/triphasic/trigeminal nerve四tetra- tetramer/tetracycline/tetraplegia五penta- pentagon/pentachromic/pentachloride六hexa- hexachromic/benzene hexachloride/hexacycliccompound七hepta- heptachromic/heptaploid/heptavalent八octa- octahedral/octal system九nona- nonapeptide/nonagon十deca- decade/decagram/decaliter十位数的表示:个位数前缀+deca, hexadecanol (十六醇), tetradecapeptide gastrin(十四肽胃泌素), octadecanoic acid (十八烷酸)2. 与人体系统、器官有关的前(后)缀名称通用名前(后)缀示例血blood hemo-/hemato- hematology/hemoglobin/hematoma血清serum sero- serotonin/seroconvert/serolipase血管vessel vaso- vasopressor/cardiovasology/cerebrovascular静脉vein veno- venography/intravenous/venoconstriction 动脉artery arterio- arteriology/arteriole/arteriosclerosis 肌muscle myo- myology/myositis/myocarditis髓marrow myel-/myelo- myelocyte/myelitis/myeloma神经nerve neur-/neuro- neurology/neuritis/neuron细胞cell cyto-/-cyte cytology/cytoma/leukocyte组织tissue histo- histocyte/histoblast/histodiagnosis尿urine uro-/ur- urology/urosurgery/urogenital体body somato-/-some somatology/somatopsychic/chromosome 心heart cardio- cardiomyopathy/carditis/cardiology脑brain encepholo- encephalitis/encephalology/encephaloma 肺lung pulmo- pulmonitis/pulmonectomy/pulmonology 肝liver hepato- hepatitis/hepatobiliary/hepatology胃stomach gastro- gastritis/gastrointestinal/gastrology胆gallbladder chole- cholecystitis/cholinergic/cholecystectomy 肠intestine entero- enteritis/enterectomy/enterology脾spleen spleno- splenitis/splenectomy/splenology胰pancreas pancreato- pancreatitis/pancreatectomy/pancreactopathy肾kidney nephro- nephritis/nephropathy/nephrology膀胱/囊bladder cysto- cystoscopy/cystometer/cystodynia肾上腺adrenal adreno- adrenocortical/adrenogenital/adrenoreceptor支气管bronchus bronch-/ bronchia/bronchiectasis/bronchoscopybroncho-3. 与颜色有关的前缀颜色通用名前缀示例色color chrom-/chromo- chromosome/chromatin/chromatometer 白white leuko- leukocyte/leukemia/leukocytuira红red erythro- erythrocyte/erythrocyturia/erythrometer黑black melano- melena/melanoma/melanoderma黄yellow xantho- xanthopsin/xanthosis/xanthoma蓝blue cyan-/cyano- cyanosis/cyanopsia/cyanemia紫purple/violet绿green棕brown brown mixture/brown ring橙orange Victoria orange/ethyl orange/orange G 粉红pink pink frothy sputum绯红crimson青铜bronzed bronzed diabetes4. 与疾病和疾患有关的前(后)缀含义前(后)缀形容词示例病patho- pathogen/pathology/pathogenesis -pathy -pathic neuropathy/nephropathy/adenopathy 病态增多-osis -otic neurosis/tuberculosis/schistosomiasisleukocytosis/erythrocytosis/granulocytosis病态减少-penia -penic leukocytopenia/erythrocytopenia/granulocytopenia无a-/an- atypical/anuria/agranulocytopenia小/微-let roplet/platelet/lefletmicro-microscopy/microorganism/micronucleus大/巨macro- macroscopic/macronucleus/macrophage -megaly splenomegaly/acromegaly/hepatomegaly 复合/多poly- polyuria/polymer/polyopia全/泛pan- pancolectomy/panmyelosis/pandemic 相反dis- disease/disorder/disability困难/障碍dys- dysfunction/dyspepsia/dyspnea不良mal- malfunction/malnutrition/malpractice 炎症-itisappendicitis/bronchitis/arthritis瘤/块-oma lymphoma/adenoma/hematoma血症-emia leukemia/septisemia/bacteremia痛-algia/-algesia/alge-/-algo analgesia/hypoalgesia/algometer麻痹-plegia hemiplegia/pamplegia/myoplegia扩张-ectasis/-ectasia bronchiectasis/capillarectasia/lymphadenectasis流出-rrhea diarrhea/hypermenorrhea/rhinorrhea 坏死-necrosis/necro-/necr-hepatonecrosis/myonecrosis/necrospermia结石litho-/-lith lithiasis/lithogenesis/cholelithes血小板/血栓thrombo- thromboplastin/thrombomodulin/thrombocyte5. 与外科手术有关的前(后)缀含义前(后)缀示例切除-ectomy appendectomy/gastrectomy/splenectomy 切开-tomy tracheotomy/hysterotomy/craniotomy 切割(器)-tome tracheotome/thoracotome吻合-stomy duodenoenterostomy/gastroesophagostomy成形术-plasty tracheoplasty/osteoplasty/myoplasty整(矫)形ortho- orthopedics/orthopod/orthotherapy造影-graphy angiography/nephrography/phlebography经……trans- transdominal/translateral/transurethral 6. 与方位有关的前缀含义通用词前缀示例上upper/superior epi-/supra- epidemic/epithelium/supracostal下lower/inferior infra-/sub- infracostal/subclavicular/subcutaneous 前front/anterior/ fore-/ante- forehead/anteroposterior/precirrhosis prior antero-/pre- 后back/posterior post-/retro- posthepatic/postprandial/retrocardiac 内inner/internal in-/endo-/ento- inhalation/endoscopy/entocranial外outer/external ex-/exo- extract/excretion/exocardial间between inter- intermuscular/intercostals/intercourse 旁/副on the side of para- parathyroid/paraprotein/pararenal 周around peri- perioperative/pericarditis/peritoneum中心central centri-/centra- centrifugation/centralize/centronucleuscentro-反/对opposite counter-/contra- counterpart/countershock/contraindication同种/相同homogeneity iso- isoagglutinin/isologue/isoenzyme7. 与“作用”有关的前(后)缀含义前(后)缀示例杀-cide/-cidal insecticide/pesticide/bactericidal抑-stasis/-static bacteriostasis/virostatic/tuberculostatic驱逐-fuge febrifuge/centrifuge抗anti- antibiotic/antibody/antimycotic去/脱/除de- dehydroprednisone/detergent/desensitization 回/再/复re- reabsorb/reactivation/recombinant冷冻cryo- cryobiology/cryopreservation/cryoprotectant溶解-lysis hemolysis/thrombolysis/isolysis否/去/分离dis- disinfection/dissociate/dissection向后/退行retro- retrograde/retrosternal/retrocardiac8. 与化学品有关的前(后)缀含义前(后)缀示例酸盐-ate sulfate/nitrate/acetate醛-ol alcohol/propanol/taxol酮-al/keto retinal/methylal/propanal/ketosteroid/ketogenic 硫thio- thioglycolate/thioalcohol/thiocarbamide糖glyco- glycogenolysissaccharo- saccharomyces-saccharide polysaccharide-ose glucose/fucose/galactose酶-ase reductase/transminase/kinase素-in penicillin/heparin/nuclein原-gen allogen/antigen/glycogen苯基/酚phen-/pheno- phenol/phenate/phenetidin氨基amino- aminobenzene/aminopherase/aminopyrine化合物-ide oxide/chloride/sulphide粪sterco-/fec stercobilin/stercoemia/fecalarra水/氢hydro-/hydr- hydroxide/hydrocarbon/hydrochloride乙酰acet-/aceto- acetaldehyde/acetate/acetylene磺基sulf-/sulfa-/sulfo- sulfacid/sulfadiazine/sulfosalicylic acid。
乳腺癌术后化疗病人症状群范围综述
乳腺癌术后化疗病人症状群范围综述铁万琴1,张 曦2*,牛 萌2,杨玲玲2,许 洋1,陈雪丰1,潘 璐1,陈思羽11.宁夏医科大学护理学院,宁夏750004;2.宁夏医科大学总医院S y m p t o mc l u s t e r s i n p a t i e n t s r e c e i v i n g c h e m o t h e r a p y a f t e r b r e a s t c a n c e r s u r g e r y :a s c o p i n g re v i e w T I E W a n q i n ,Z H A N GX i ,N I U M e n g ,Y A N GL i n g l i n g ,X UY a n g ,C H E NX u ef e ng ,P A NL u ,C H E NS i yu S c h o o l o fN u r s i n g ,N i n g x i aM e d i c a lU n i v e r s i t y ,N i n gx i a 750004C h i n a C o r r e s p o n d i n g A u t h o r Z H A N GX i ,E -m a i l :1131642260@q q.c o m K e yw o r d s b r e a s t c a n c e r ;c h e m o t h e r a p y ;s y m p t o mc l u s t e r ;s c o p e r e v i e w 摘要 目的:对乳腺癌术后化疗病人症状群研究进行范围综述㊂方法:遵循范围综述的方法学框架,检索中国知网㊁维普数据库㊁万方数据库㊁中国生物医学文献数据库㊁P u b M e d ㊁W e bo f S c i e n c e ㊁C I N A H L ㊁E M b a s e ㊁t h eC o c h r a n eL i b r a r y ㊁M e d L i n e ㊁S c o pu s 中乳腺癌术后化疗病人症状群的相关研究㊂检索时限为建库至2023年9月26日㊂对纳入文献进行数据提取及汇总分析㊂结果:共纳入27篇文献,症状群的识别要素涵盖症状评估及分析方法等㊂乳腺癌术后化疗病人症状群的种类涉及13种,其中较常报告的症状群为消化道症状群和心理症状群㊂结论:乳腺癌术后化疗病人化疗期间存在多种症状群,并呈动态变化㊂未来需进一步探索症状群评估工具和分析方法,更好地验证不同时间点症状群的构成和特点,为优化症状管理干预方案奠定基础㊂关键词 乳腺癌;术后化疗;症状群;范围综述d o i :10.12102/j.i s s n .2095-8668.2024.09.006 国际癌症研究机构(I n t e r n a t i o n a l A g e n c y fo r R e s e a r c ho nC a n c e r ,I A R C )研究数据显示,2020年全球范围内存在约1929.3万例癌症新增病例,其中,女性乳腺癌新增病例数高达230万例,占全球女性癌症病例的24.5%,发病率位于癌症排行榜的第1位,成为全球第一大癌症[1-2]㊂随着肿瘤早期诊断㊁治疗技术的不断进步,乳腺癌病人的生存率逐年提高[3-4]㊂但是在疾病治疗过程中,由于治疗方式或其他因素引起的各种症状,对病人造成了极大的心理和生理负担,如焦虑㊁抑郁㊁疲乏㊁睡眠障碍㊁恶心等[5]㊂这些症状常以集群的形式发生㊁发展,进一步加重病人的症状负担,降低病人的生活质量[6]㊂2001年,D o d d 等[7]首次提出了症状群的概念,即2个或2个以上相互关联的症状同时发生,组成稳定的症状小组,并独立于其他症状群㊂症状群的研究对乳腺癌病人化疗期间症状的早期识别和有效管理至关重要㊂我国已有学者对乳腺癌病人症状群进行了探索,然而各研究中症状群的分析方基金项目 宁夏回族自治区重点研发计划项目,编号:2022C MG 03082;宁夏自然科学基金项目,编号:2023A A C 03582作者简介 铁万琴,护士,硕士研究生在读*通讯作者 张曦,E -m a i l :1131642260@q q.c o m 引用信息 铁万琴,张曦,牛萌,等.乳腺癌术后化疗病人症状群范围综述[J ].循证护理,2024,10(9):1560-1566.法㊁类型以及特点尚不明确,且存在较大异质性,给症状群管理带来障碍㊂本研究采用范围综述的方法[8],旨在探索国内外乳腺癌病人术后化疗期间症状群的识别方法㊁症状群类型㊁不同化疗阶段症状群变化规律,提出目前乳腺癌术后化疗病人症状群研究存在的问题,明确未来研究方向,以促进乳腺癌术后化疗病人症状群管理的发展,提升症状管理效率㊂1 资料与方法1.1 确立研究问题明确乳腺癌术后化疗病人症状群研究问题:1)乳腺癌术后化疗病人症状群的类型有哪些?2)乳腺癌术后化疗病人症状群评估工具有哪些?3)不同化疗阶段症状群是如何变化的?1.2 文献纳入与排除标准纳入标准:1)研究内容涉及乳腺癌术后化疗病人症状群;2)研究对象年龄>18岁;3)不限制研究设计类型,包括质性研究㊁量性研究㊁混合研究㊂排除标准:1)重复发表文献;2)文献类型为综述㊁会议论文;3)非中英文文献;4)无法获取全文㊂1.3 文献检索检索中国知网㊁维普数据库㊁万方数据库和中国生物医学文献数据库㊁P u b M e d ㊁W e b o f S c i e n c e㊁C I N A H L ㊁E M b a s e ㊁t h eC o c h r a n eL i b r a r y㊁M e d L i n e ㊁S c o pu s ,检索时限为建库至2023年9月26日㊂中文㊃0651㊃C H I N E S EE V I D E N C E -B A S E D N U R S I N G M a y,2024V o l .10N o .9检索词为: 乳腺肿瘤/乳腺癌/乳癌/乳房肿瘤/乳房癌 症状群/症状对/症状集/症状簇 ;英文检索词为:b r e a s t n e o p l a s m s b r e a s t n e o p l a s m b r e a s tc a n c e r b r e a s tt u m o r* b r e a s tc a r c i n o m a* m a m m a r y c a n c e r h u m a n m a m m a r y n e o pl a s m * h u m a n m a m m a r y c a r c i n o m a* b r e a s t m a l i g n a n tn e o p l a s m* b r e a s t m a l i g n a n tt u m o r* s y n d r o m e s y m pt o m c l u s t e r * s y m p t o m c o n s t e l l a t i o n * c o n c u r r e n t s y m p t o m * m u l t i p l e s y m p t o m * s y m pt o m c o m b i n a t i o n ㊂以P u b M e d 为例,检索式为:(((((((((("b r e a s t n e o p l a s m s "[M e S H T e r m s ])O R ("b r e a s t n e o p l a s m "[T i t l e /A b s t r a c t ]))O R ("b r e a s t c a n c e r "[T i t l e /A b s t r a c t ]))O R ("b r e a s t t u m o r *"[T i t l e /A b s t r a c t ]))O R ("b r e a s t c a r c i n o m a *"[T i t l e/A b s t r a c t ]))O R ("m a m m a r y ca n c e r "[T i t l e /Ab s t r ac t ]))O R ("h u m a nm a m m a r y n e o p l a s m*"[T i t l e /A b s t r a c t ]))O R ("h u m a nm a m m a r yc a r c i n o m a *"[T i t l e /A b s t r a c t ]))O R ("b r e a s tm a l i g n a n t n e o pl a s m*"[T i t l e /A b s t r a c t ]))O R ("b r e a s tm a l i gn a n t t u m o r *"[T i t l e /A b s t r a c t ]))A N D (((((("s y n d r o m e "[M e S H T e r m s ])O R ("s y m pt o m c l u s t e r *"[T i t l e /A b s t r a c t ]))O R ("s y m p t o mc o n s t e l l a t i o n*"[T i t l e /A b s t r a c t ]))O R ("c o n c u r r e n ts y m p t o m *"[T i t l e /A b s t r a c t ]))O R ("m u l t i p l e s y m p t o m *"[T i t l e /A b s t r a c t ]))O R ("s y m pt o mc o m b i n a t i o n "[T i t l e /A b s t r a c t ]))㊂1.4 文献筛选与资料提取将检索到的文献导入E n d N o t eX 9并去除重复文献㊂由2名经过循证医学培训的护理研究生根据纳入和排除标准通过阅读标题和摘要独立进行初筛,之后阅读纳入文献全文进行复筛㊂筛选过程中如有疑问或分歧,邀请本课题组中经过培训且获得证书的循证小组成员参与讨论直至达成一致意见,最终确定纳入文献㊂文献提取内容包括作者㊁国家㊁研究类型㊁研究对象特征㊁样本量㊁治疗阶段㊁评估工具㊁使用维度㊁分析方法㊁症状群类型等,并进行汇总分析㊂2 结果2.1 文献筛选结果初步检索获得文献4325篇,其中P u b M e d 750篇㊁W e b o f S c i e n c e 502篇㊁C I N H A L724篇㊁E M b a s e 358篇㊁t h eC o c h r a n eL i b r a r y 106篇㊁M e d L i n e 数据库856篇㊁S c o pu s 数据库710篇㊁中国知网93篇㊁万方数据库109篇㊁维普数据库43篇㊁中国生物医学文献库74篇㊂使用N o t e E x pr e s s 剔除重复文献后余2346篇,阅读标题和摘要排除2211篇,查阅全文排除108篇,最终纳入文献27篇[6,9-34],其中英文15篇[17-18,21-25,27-34],中文12篇[6,9-16,19-20,26]㊂2.2 文献基本特征本研究共纳入27项研究,发表于2008 2023年,来自6个国家,中国15篇[6,9-16,19-20,23,26,29-30]㊁美国6篇[22,25,27,31-33]㊁泰国3篇[17-18,24],沙特阿拉伯[21]㊁瑞典[28]㊁以色列[34]各1篇㊂其中14篇为横断面研究[9-22],13篇为纵向研究[6,23-34],纳入的研究显示了乳腺癌术后病人化疗前㊁化疗期间和/或化疗之后所经历的症状群呈现动态变化特点㊂具体见表1㊂表1 纳入文献的基本特征作者国家 研究类型样本量(例) 分期 治疗阶段评估工具/维度分析方法/纳入标准症状群祝龙玲等[6]中国纵向研究200未描述化疗前2d (T 1)㊁第1次化疗1周后(T 2)㊁第3次化疗1周后(T 3)中文版M S A S 探索性因子分析/症状发生率>20%①②③④⑤王艳等[9]中国横断面研究506Ⅰ~Ⅳ期1~4个化疗周期后中文版M D A S I 探索性因子分析①②⑤⑥刘淑英等[10]中国横断面研究65未描述至少1次化疗后中文版M D A S I 探索性因子分析①②⑤⑥蒋蕾等[11]中国横断面研究164未描述正在化疗病人中文版M D A S I 探索性因子分析①②王千心等[12]中国横断面研究169Ⅰ~Ⅲ期术后化疗自行设计的乳腺癌化疗病人症状测评量表/严重程度探索性因子分析/症状发生率>10%②④⑤⑦㊃1651㊃循证护理2024年5月第10卷第9期(总第125期)(续表) 作者国家研究类型样本量(例) 分期 治疗阶段评估工具/维度分析方法/纳入标准症状群李丽燕等[13]中国横断面研究154Ⅰ~Ⅲ期入院完成治疗1周后自行设计的乳腺癌化疗病人症状评价量表探索性因子分析/症状发生率>20%①②④⑦邓珍珍等[14]中国横断面研究240Ⅰ~Ⅲ期至少2次化疗后自行设计的乳腺癌化疗病人症状测评量表探索性因子分析/症状发生率>10%①②③④张静等[15]中国横断面研究128Ⅰ~Ⅳ期至少2次化疗后中文版M S A S探索性因子分析/症状发生率>20%①②③④张雅琳等[16]中国横断面研究144未描述至少2次化疗后中文版M S A S 探索性因子分析法/症状发生率>20%①②③④C h o n g k h a m -A n g 等[17]泰国横断面研究322Ⅰ~Ⅲ期化疗后第7天泰国版M S A S /严重程度/困扰程度主成分分析,探索性因子分析①②③⑧⑨V u t t a n o n 等[18]泰国横断面研究48未描述化疗后E S A S /严重程度探索性因子分析①②⑥⑧任东辉[19]中国横断面研究106Ⅰ~Ⅲ期老年人正在化疗的病人自行设计的一般临床调查问卷探索性因子分析/症状发生率>20%①②③④赵润平等[20]中国横断面研究456未描述至少1次化疗后自行设计乳腺癌化疗病人常见症状问卷探索性因子分析法⑤⑥⑩A l k a t h i r i等[21]沙特阿拉伯横断面研究100Ⅰ~Ⅲa 期术后化疗病人:化疗后1周S E S /频率/严重程度/困扰程度未汇报/症状发生率>20%②⑩L a n gf o r d 等[22]美国横断面研究3910~Ⅲ期至少化疗2个周期后1周内单一症状评估量表/严重程度潜在类别剖面分析①⑥⑧L u o 等[23]中国纵向研究620Ⅰ~Ⅲ期第1次化疗(T 1)㊁第2次化疗(T 2)㊁第3次化疗(T 3)~第8次化疗(T 8)中文版M S A S探索性因子分析/症状发生率>20%①②③④⑤P h l i gb u a 等[24]泰国纵向研究112Ⅰ~Ⅲa 期化疗前(T 1)㊁第2周期化疗前(T 2)㊁化疗结束后1个月(T 3)改良的M S A S/困扰程度探索性因子分析①②③④S u l l i v a n 等[25]美国纵向研究540未描述化疗前1周(T 1)㊁化疗后1周(T 2)㊁化疗后2周(T 3)M S A S /发生率/严重程度探索性因子分析①②④⑦李楠楠[26]中国纵向研究215Ⅰ~Ⅳ期化疗前(T 1)㊁第1次化疗后(T 2)㊁第3次化疗后(T 3)㊁第6次化疗后(T 4)中文版M S A S 不明确/症状发生率>20%①②③④⑤⑧G w e d e 等[27]美国纵向研究179Ⅰ~Ⅲ期化疗前㊁化疗结束时M S A S 聚类分析B r o w a l l 等[28]瑞典纵向研究124Ⅰ~Ⅲa 期基线(T 1)㊁化疗1个月(T 2)㊁化疗3个月(T 3)㊁化疗6个月(T 4)M S A S主成分分析/平均症状积分>0.5①②㊃2651㊃C H I N E S EE V I D E N C E -B A S E D N U R S I N G M a y,2024V o l .10N o .9(续表)作者国家研究类型样本量(例)分期治疗阶段评估工具/维度分析方法/纳入标准症状群W a n g等[29]中国纵向研究120Ⅰ~Ⅳ期化疗第1周(T1)㊁化疗第1个月(T2)㊁化疗第3个月(T3)㊁化疗第6个月(T4)中文版M D A S I探索性因子分析/症状发生率>20%①②③④⑤⑧H s u等[30]中国纵向研究1030~Ⅲ期化疗第3周期后连续21d 台湾版M D A S I潜在类别增长分析①②⑤⑥A l b u s o u l 等[31]美国纵向研究219Ⅰ~Ⅲa期首次化疗前2d(T1)㊁第3次化疗后第7天(T2)㊁第4次化疗后第7天(T3)㊁化疗结束后1个月(T4)HA D S㊁S E S/严重程度探索性因子分析/症状发生率>20%②⑥⑧⑩B e r g e r等[32]美国纵向研究202未描述首次辅助化疗前(T1)㊁最后1次化疗后1个月(T2)㊁基线后1年(T3)HA D S㊁S E S/严重程度探索性因子分析/症状发生率20%②⑩S a n f o r d 等[33]美国纵向研究80未描述化疗前(T1)㊁化疗第4周期前7d(T2)㊁化疗开始后6个月(T3)单一症状评估量表/症状数量/严重程度聚类分析㊁混合效应模型分析⑤⑥G o l a n-V e r e d 等[34]以色列纵向研究40Ⅰ~Ⅲ期化疗前(T1)㊁至少2个周期后(T2)单一症状评估量表/严重程度聚类分析①⑥⑧注:M S A S为记忆症状评估量表,M D A S I为安德森症状评估量表,E S A S为埃德蒙顿症状评估量表,S E S为症状体验量表, HA D S为医院焦虑抑郁量表;症状群中,①为心理症状群,②为消化道症状群,③为自我形象紊乱症状群,④为激素相关症状群,⑤为神经系统相关症状群,⑥为疲乏相关症状群,⑦为皮肤黏膜症状群,⑧为疼痛相关症状群,⑨为营养症状群, 为治疗相关症状群, 为患病行为症状群, 为术后症状群, 为高/低症状负担, 为体重改变症状群㊂2.3乳腺癌术后化疗病人症状群的评估纳入的27项研究中,症状群评估工具包括M S A S (n=10)[6,15-17,23-28]㊁M D A S I(n=5)[9-11,29-30]㊁单一症状评估量表(n=3)[22,33-34]㊁自行设计量表(n=5)[12-14,19-20]㊁E S A S(n=1)[18]㊁S E S(n=3)[21,31-32]6种评估工具㊂2.4乳腺癌术后化疗病人症状群的识别纳入27项研究中,症状群识别方法包括探索性因子分析(n=19)[6,9-20,23-25,29,31-32],其中9项研究纳入症状发生率>20%的病人,2项研究纳入症状发生率> 10%的病人,此外还有聚类分析(n=3)[27,33-34]㊁主成分分析(n=2)[17,28]㊁潜在类别剖面分析(n=1)[22]㊁潜在类别增长分析(n=1)[30]㊁混合效应模型分析(n=1)[33]等症状群识别方法㊂2.5乳腺癌术后化疗病人不同阶段症状群变化27项研究涉及13种症状群,常见的症状群类型包括消化道症状群(n=22)[6,9-19,21,23-26,28-32]㊁心理症状群(n=20)[6,9-11,13-19,22-26,28-30,34]㊁神经系统相关症状群(n=10)[6,9-10,12,20,23,26,29-30,33]㊁自我形象紊乱症状群(n= 10)[6,14-17,19,23-24,26,29]㊁激素相关症状群(n=12)[6,12-16,19,23-26,29]㊁疲乏相关症状群(n=8)[9-10,18,22,30-31,33-34]和疼痛相关症状群(n=7)[17-18,22,26,29,31,34]等㊂其中消化道症状群和心理症状群在乳腺癌病人术后化疗期间持续存在,且呈动态变化㊂2.5.1化疗前症状群乳腺癌病人化疗前存在2~6个症状群,包括心理症状群㊁自我形象紊乱症状群㊁疼痛相关症状群㊁激素相关症状群㊁消化道症状群㊁治疗相关症状群㊁疲乏相关症状群等[6,24-26,28,31-34]㊂祝龙玲等[6]调查发现,乳腺癌术后化疗病人心理症状群㊁自我形象紊乱症状群㊁激素相关症状群持续存在于化疗前及化疗中㊂S u l l i v a n 等[25]根据症状发生率及严重程度2个维度分别提取症状群,发现紧张㊁感到悲伤㊁担忧和感到易怒这一心㊃3651㊃循证护理2024年5月第10卷第9期(总第125期)理症状群在化疗前后都持续存在㊂2.5.2化疗中症状群乳腺癌病人化疗中存在2~6个症状群,包括消化道症状群㊁心理症状群㊁激素相关症状群㊁疲乏相关症状群㊁神经系统相关症状群㊁自我形象紊乱症状群㊁治疗相关症状群等[6,23,26,28-31,33]㊂A l b u s o u l等[31]运用症状严重程度维度探索术后化疗病人症状群发现,消化道症状群包括缺乏食欲和恶心㊂A l k a t h i r i等[21]以严重程度维度聚类时,消化道症状群由恶心和缺乏食欲组成;当以频率和痛苦维度聚类时,消化道症状群由恶心㊁缺乏食欲和睡眠障碍组成㊂研究表明,消化道症状群在化疗中具有普遍性和特异性,尽管在不同维度下症状群的组成有差异,但在所有化疗病人中都发现了这一聚类,消化道症状群是肿瘤化疗病人公认的症状群[35],乳腺癌病人术后㊁化疗期乃至化疗完成均存在该集群[36]㊂2.5.3化疗后期症状群乳腺癌病人化疗后期存在3~6个症状群,包括疼痛相关症状群㊁神经系统相关症状群㊁心理症状群㊁激素相关症状群㊁消化道症状群等[23,26,28-29]㊂李楠楠[26]研究发现,随着化疗的进行消化道症状群和自我形象紊乱症状群逐渐变得严重,同时神经系统相关症状群也开始显现,到化疗后期时乳腺癌病人的焦点集中在自我形象紊乱症状群㊂L u o等[23]研究也发现,随着化疗次数的增加,头晕㊁难以集中注意力等神经系统症状群的发生率明显增加,但第2次~第7次化疗自我形象紊乱症状群保持稳定,第8次化疗未发现该症状群㊂2.5.4化疗后症状群乳腺癌病人化疗后存在1~4个症状群,包括疲乏相关症状群㊁疼痛相关症状群㊁心理症状群㊁治疗相关症状群㊁自我形象紊乱症状群㊁激素相关症状群等[24,31-32]㊂A l b u s o u l等[31]在乳腺癌病人化疗结束后1个月调查发现,以恶心为核心症状的消化道症状群不再出现,由疲劳㊁疼痛和睡眠障碍组成新的症状群㊂B e r g e r等[32]在化疗1年后调查发现,20%的乳腺癌病人还存在疲劳㊁疼痛和睡眠障碍㊁注意力不集中㊁焦虑等症状,且焦虑为该症状群的核心症状㊂3讨论3.1乳腺癌术后化疗病人症状群评估工具有待进一步探索选择适宜的症状群评估工具是乳腺癌病人症状群研究的关键,能够直接影响评估的准确性㊂目前,有关症状群的评估工具主要分为单一症状评估工具和多种症状评估工具㊂本研究纳入的27项研究中,3项研究使用单一症状评估工具[22,33-34],主要用于症状群的验证性研究中,如S a n f o r d等[33]使用癌症治疗功能评价疲乏分量表(F A C T-F)㊁癌症治疗功能评价认知分量表(F A C T-C o g)㊁匹兹堡睡眠质量指数量表(P S Q I)㊁H A D S,验证了乳腺癌术后化疗病人睡眠障碍-疲乏-抑郁-焦虑-感知认知障碍症状群的存在㊂其余24项研究[6,9-21,23-32]均采用多种症状评估工具进行症状评估㊂症状群的探索性研究中,使用较多的为M S A S和M D A S I㊂蒋蕾等[11-15]对正在进行乳腺癌术后化疗的病人进行横断面研究,蒋蕾等[11]采用中文版M D A S I 提取了2个症状群,即心理症状群和消化道症状群,张静等[15]采用中文版M S A S提取了4个症状群,即心理症状群㊁消化道症状群㊁激素相关性症状群㊁自我形象紊乱症状群㊂L u o等[23]及W a n g等[29]分别采用中文版M S A S和中文版M D A S I,以相同的症状群分析方法对乳腺癌术后化疗病人进行纵向研究,L u o等[23]提取消化道症状群㊁心理症状群㊁神经系统症状群㊁更年期症状群㊁自我形象紊乱症状群㊂W a n g等[29]在此基础上提取了疾病症状群㊁疼痛相关症状群㊂C h o n g k h a m-A n g等[17]运用泰国版M S A S基于严重程度识别出情感相关症状群㊁胃肠与能量相关症状群㊁形象与营养相关症状群㊁疼痛与不适相关症状群;基于困扰程度识别出情绪㊁能量和疼痛相关症状群㊁胃肠道相关症状群㊁形象相关症状群㊁不适-营养相关症状群㊂由此可见,评估工具不同症状群的类型和数量也会发生改变㊂目前,尚无统一的症状群评估工具,多为研究者根据其研究目的自行选择,且以上评估工具均为乳腺癌普适性症状评估工具,尚无乳腺癌特异性症状评估工具㊂同时,中文版症状记忆评估量表作为多维度评估量表,症状评估包括频繁程度㊁严重程度以及困扰程度㊂若维度不一,症状群组成或数量也有所变化㊂因此,为促进乳腺癌病人化疗期间症状群的管理,有必要探索并统一评估工具㊂对于多维度测量工具,未来应尝试在不同人群㊁不同治疗阶段进行测量,并扩大样本量,进一步明确哪个维度更适合症状群的研究㊂3.2乳腺癌术后化疗病人症状群的识别方法有待进一步探讨采用科学的统计方法识别和量化症状群是开展癌症症状管理研究的关键㊂目前,癌症症状群提取和确立的研究方法多为探索性因子分析[6,9-20,23-25,29,31-32]㊁聚类分析[27,33-34]㊁主成分分析[17,28]等以 变量 为中心的方法[37]㊂S u l l i v a n等[25]采用探索性因子分析在乳腺癌病人化疗前㊁化疗后1周㊁化疗后2周分别提取6㊁5㊁5个症状群,其中心理症状群㊁激素相关症状群㊁营养㊃4651㊃C H I N E S EE V I D E N C E-B A S E D N U R S I N G M a y,2024V o l.10N o.9症状群㊁消化道症状群㊁皮肤黏膜症状群在症状维度和出现时间方面都相对稳定;B r o w a l l等[28]采用主成分分析方法在乳腺癌病人化疗前及化疗1个月㊁3个月㊁6个月分别提取2个㊁3个㊁3个㊁3个症状群㊂这些症状群分析方法主要依据症状之间的关联将症状进行分类,关注于探讨症状的数量关系与差异,却忽略了在整个疾病治疗过程中症状㊁功能等健康结局的错综复杂,存在着大量的个体差异[38],会形成异质性群体㊂因此,近年来研究者开始基于某个症状群内症状的体验识别病人亚组,首先明确一个特定的症状群(如神经心理症状群),然后采用单一症状量表对群内各症状进行评估,最后采用聚类分析或潜在类别剖面分析基于症状体验对病人进行分组,并可鉴别不同组别病人的一般资料和生活质量的差异[39],这种识别方法能更好地解释群体中主观性症状的多样性[39]㊂G o l a n-V e r e d 等[34]采用单一症状评估工具对乳腺癌术后化疗病人进行聚类发现,疼痛-疲劳-睡眠障碍-抑郁症状群存在高低症状聚类㊂L a n g f o r d等[22]采用潜在类别剖面分析得出,不同乳腺癌术后化疗病人在疼痛-疲劳-睡眠障碍-抑郁症状群内症状体验存在高㊁中㊁低症状3个亚组㊂根据病人症状群内各症状得分的差异,基于统计方法将病人分组,探索特定症状群亚组,可帮助医护人员从症状群严重程度维度识别不同的潜在症状类别,筛选出发生不同症状的风险病人,提高医疗风险决策的效力[40]㊂然而,采用单一症状量表评估疲乏㊁睡眠障碍㊁焦虑等特定的症状,是基于循证或临床经验假定症状群的数目和组成后通过统计分析验证症状间的相关性,仅关注预先确定的症状的研究可能会忽略其他重要的症状或症状群,具有较大的主观性㊂因此,未来可以考虑从探索性视角出发,不事先假定症状群数目和组成,而是把病人可能出现的症状都列入研究范畴,对症状的探索较客观㊁全面㊂同时,在乳腺癌症状群领域,症状群分析方法比较单一,未来应结合质性研究,尝试新的分析方法,如潜在类别分析㊁机器学习及网络分析,通过多种分析方法进行比较,确定最佳方法和符合临床实际的症状群㊂3.3乳腺癌术后化疗病人症状群随时间呈动态变化随着症状群研究体系的不断发展与完善,症状群研究不单只通过横断面调查的方式探讨症状群的组成㊁影响因素㊁临床干预及症状群管理等,同时考虑到随着疾病病程进展或治疗策略变化,症状群内症状的发生频率㊁严重程度和对机体的困扰程度会发生改变,症状群的种类和内部结构也会出现相应的变化㊂因此,少数学者已将症状群的研究重点从横断面调查逐渐转向纵向研究,旨在探索相对稳定的症状集群和疾病发展轨迹[41]㊂祝龙玲等[6]在化疗前2d(T1)㊁第1次化疗1周后(T2)㊁第3次化疗1周后(T3)发现在3个时间点均存在3个症状群,即心理症状群㊁自我形象紊乱症状群和激素相关症状群,但化疗后较化疗前均更严重,其中心理症状群的严重程度变化较小,这与S u l l i v a n等[25]的研究结果相似㊂L u o等[23]调查了第1个化疗周期(T1)至第8个化疗周期(T8)乳腺癌术后化疗病人的症状群,T1识别了消化道症状群㊁情绪和心理症状群㊁更年期症状群㊂T2~T7识别出消化道症状群㊁情绪心理症状群㊁神经系统症状群㊁更年期症状群㊁自我形象紊乱症状群㊂在T8时间点提取消化道症状群㊁情绪和心理症状群㊁神经系统症状群㊁更年期症状群,同时发现T1时的症状数最少,T6时的症状数最多,症状数量在T1~T4时增长最快,T5时短暂下降,T6~T8时症状数量趋于平缓㊂与以上研究不同的是,H s u等[30]采用潜类别增长模型在第3个21d 化疗周期的前14d内识别出3个症状群即神经认知群㊁情绪-恶心症状群㊁疲劳-厌食症状群,其中疲劳-厌食症状群和情绪-恶心群在化疗第3天至第5天达到中等水平,随后在第21天化疗周期的前14d内逐渐下降至轻度水平,通过识别在不同时间点上具有相似症状群的病人亚组,更客观地描述了乳腺癌化疗病人不同症状群严重程度的纵向趋势,帮助医护人员了解个体症状纵向变化的差异,利于医护人员针对高危人群的症状管理干预进行风险分层管理,改善病人的预后㊂鉴于此,未来研究方向应尝试采用客观的纵向数据分析方法,着眼于症状群随时间的纵向变化,积极探索每个治疗阶段症状的变化,有助于为不同化疗阶段的乳腺癌病人提供最佳症状管理干预措施㊂4小结乳腺癌术后化疗病人在化疗前㊁化疗中㊁化疗后期㊁化疗结束后1个月至1年期间经历多种症状群,且在不同化疗阶段呈现动态变化,提示研究人员在探索症状群变化的同时,需将乳腺癌术后化疗病人人群异质性考虑在内,有利于识别发生癌症症状群的高危人群,为后期临床医护人员根据不同化疗阶段的症状群变化特征构建精准化的症状管理方案,进行有针对性的干预打下基础㊂然而,目前我国乳腺癌病人术后化疗期间症状群的症状群评估工具不一㊁分析方法单一,导致症状群构成差异较大㊂今后需进一步完善统计分析方法和评估工具,使用纵向数据分析研究症状群的潜在机制㊂㊃5651㊃循证护理2024年5月第10卷第9期(总第125期)参考文献:[1] S U N G H,F E R L A YJ,S I E G E L R L,e ta l.G l o b a lc a n c e rs t a t i s t i c s2020:G L O B O C A Ne s t i m a t e s o f i n c i 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医院简介英文版
Liaocheng, known as China’s Water City in the North of the Yangtz River, is located at the junction of Henan, Hebei and Shandong Provinces, and also at the intersection of the Yellow River and the Beijing-Hangzhou Grand Canal. Liaocheng has a population of 5.8 million and covers an area of 8590 square kilometers. Liaocheng is famous for its water, and filled with aural because of water. There are 23 rivers each covers a drainage area of more than 30 square kilometers, and 3 rivers each covers a drainage area of more than 100 square kilometers. The Yellow River, known as the Mother River of China, serpentines more than 50 kilometers here. The world famous Beijing-Hangzhou Grand Canal runs through the city centre. So many lovely rivers and lakes formed a unique scenery of the lake in the city, the city in the lake, the city surrounded by the rivers. Liaocheng is an ancient city with a history of 2500 years. There are 9 key cultural relics under state protection in Liaocheng such as Guangyue Tower, Caozhi Tomb and Shanshan Guild Hall etc. We also have 15 key cultural relics under province protection in Liaocheng. Liaocheng is rich in mineral resources. There are 24 billion tons coal reserves, 30 million tons of oil reserves, 1 trillion cubic meters natural gas reserves and 645 billion cubic meters of rock oil.Liaocheng People’s Hospital and Liaocheng School of Clinical Medicine, Taishan Medical University, was established in July 1947. It is a comprehensive tertiary hospital which includes clinical services, undergraduate and postgraduate teaching, as well as scientific research. With the unique geographical and technological advantages, the hospital has gradually grown to become one of the biggest regional healthcare centers, serving for the people come from Henan, Hebei, Shanxi, Anhui and Inner Mongolia provinces, apart from Liaocheng Municipal City. There are 3100 employees in the Hospital, among which 550 are consultant doctors, and 600 doctors have a master or doctoral degree. There are 2600 hospital beds, 82 in patient wards. In the year of 2009, the hospital provided services to 1.53 million outpatients and 130,000 inpatients, with 25,000 surgical procedures performed.With the state-of-the-art hospital infrastructure and medical equipment, the hospital covers 2 main campuses with the total clinical space of 250,000 m2. The healthcare-center-building located in the eastern bank of JingHang Canal is the largest single building of 110,000 m2. There are about 2300 sets of large-scale advanced medical equipments in the hospital, such as Brilliance iCT, Achiva 3.0T MR and Brilliance 64. There are two provincial medical research institutes which provide supports for research and development. They are Oral Maxillofacial-Head and Neck Key Laboratory of Medical Biology, Research Center of Minimally Invasive Treatment for Cardiovascular Diseases.Several disciplines in the hospital have become leading groups in Shandong Province.The Neurology Department and Cardiology Department are the key clinical and research departments of the province. Hematology Department, Oncology Department, Cardiovascular Surgery Department, Thoracic Surgery Department, Anesthesiology Department and Operating Theatre are also the major medicine and health departments of Shandong Province. Oral Maxillofacial Surgery is appointed as the A-level department by the Ministry of Health. Restoration orthodontic discipline is appointed as the center for health vocational and technical training by the Chinese Ministry of Health. Hepatobiliary Department is identified as the unit of performing liver transplantation by the Ministry of Health, Digestive Department, Neurology Department, Cardiology Department, General Surgery Department and Orthopedic Surgery Department are designated national center for clinical medicine.The hospital pays great attention to develop collaborative relationship with international medical institutions, which now including Singapore General Hospital; Wonju College of Medicine, Yonsei University in Korea; Nationwide Children’s Hospital of Ohio State University in USA; School of Clinical Medicine, Tulane University in USA; Asan Medical Center, University of Ulsan College of Medicine in Korea; Charles Sturt University in Australia; Medical Research Center of University of Utrecht in the Netherlands. International cooperations have greatlyenhanced the growth of technological progress such as Cardiovascular Diseases Research Center of China. Liaocheng People’s Hospital and Australia. Charles Sturt University, Medical Research Center of China. Liaocheng People’s Hospital and Netherlands. University of Utrecht.In recent years, the hospital focuses on new technologies such as interventional and microsurgery technology, tissue and organ transplantation, acute and severe diseases treatment technology, and diagnose of the knotty problems. Many new procedures have been performed: demicoincide hematopoietic stem cell transplantation, repair of ventricular septal defect with thoracoscope, Fallot’s Trilogy total correction, carotid artery endarterectomy, coronary artery bypass of extracranium and intracranium, stem cells treatment, pediatric CP surgery.As the leading hospital in Shandong Province, Liaocheng People’s Hospital is the postgraduate training center and teaching hospital of Shandong Medical University; Qingdao Medical University; Xuzhou Medical University and Taishan Medical University. The School of Dentistry, Taishan Medical University is located in the hospital. The hospital has trained a large number of college students to be qualified doctors, nurses and allied health professionals.The hospital is a not-for-profit institution with a tradition of providing affordable tertiary healthcare to a vast inland population of more than 10 million people. It has played a critical role in many local and national emergent events such as Wenchuan earthquake; hand, foot and mouth disease; influenza H1N1 and other major infectious diseases. During these events Liaocheng People’s Hospital has been the designated center to provide services to the people from the regions being affected.医苑盛华水城晖——蓬勃发展的山东省聊城市人民医院卓越秀美的“江北水城运河古都”聊城,古老而又神奇。
重症患者凝血功能障碍
人格品德 至诚至信 专业技术 精益求精
抗凝机制
• 在凝血启动的同时,抗凝机制也迅速启动 ,并几乎涉及凝血过程的每一个步骤。
• 在人体,最重要的抗凝物质有抗凝血酶( AT,旧称ATⅢ)、蛋白C(PC)和组织因子 途径抑制物(TFPI)。
宁夏医科大学总医院急诊科
人格品德 至诚至信 专业技术 精益求精
宁夏医科大学总医院急诊科
人格品德 至诚至信 专业技术 精益求精
凝血功能基础—血管壁 • 血管壁
• 基本作用:血管内皮细胞分泌的 蛋白质,保持血管完整性。
• 促凝作用
– 内皮素 – 聚集和激活血小板物质,vWF因子 – 血小板活化因子 – 组织因子 – 抑制纤溶
• 抗凝作用
凝血酶原活动度(PTA)
• 凝血酶原活动度(prothrombin-activity , PTA):凝血酶原是血液凝固因子之一 ,凝血酶原是由肝脏合成的维生素K依赖因 子之一,PTA是肝病严重程度及预后判断的 最主要指标。
• 《肝衰竭诊治指南》(2012年版) 中以 PTA≤40%作为肝衰竭临床诊断及分期的主 要指标。
组织因子途径抑制物(TFPI)
• 由内皮细胞合成和释放的一种糖蛋白,在 血浆中以游离型和与脂蛋白结合型两种形 式存在,但发挥抗凝作用的是游离型。 TFPI的抗凝作用的步骤是:先与Ⅹa结合形 成Ⅹa-TFPI复合物,然后再与Ⅶa-TF复合 物结合为Xa-TFPI-Ⅶa-TF四合体,从而使 Ⅶa-TF失去活性。
宁夏医科大学总医院急诊科
人格品德 至诚至信 专业技术 精益求精
1 凝血功能基础 2 正常凝血过程 3 抗凝机制 4 纤溶机制 5 内皮细胞的作用 6 正反馈与负反馈
宁夏医科大学总医院急诊科
POMES综合征5例报道并文献复习
POMES 综合征是一组以多发性周围神经病和单克隆浆细胞增生为主要临床表现,累及神经、内分泌、血液、消化、皮肤、浆膜腔等多系统损害的综合征。
其病因及发病机制尚未完全明了,首先被Crow 和Fukase 提出,也被称为Crow -Fukase 综合征[1-2],其临床表现主要为多发性神经病(polyneuropathy )、脏器肿大(organomegaly )、M 蛋白(M protein )、内分泌病(endocrinopathy )和皮肤改变(skin changes ),Bardwish 取本病的五大临床特征的英文首字母,命名为POEMS 综合征。
POMES 是一种罕见的疾病,因其多系统累及、临床表现不一、非特异性等特点,常被漏诊或误诊。
现将宁夏医科大学总医院2010—2017年确诊的5例POMES 综合征临床特点报告如下。
1临床资料1.1一般资料收集2010—2017年就诊于宁夏医科大学总医院确诊的5例POMES 综合征患者病历资料,其中男性2例,女性3例,年龄40~57岁,发病至确诊时间2个月~7年。
1.2诊断标准所有病例均符合2003年POMES 综合征诊断标准[3],无慢病毒感染、长期放射线及化学试剂接触史,既往无内分泌及血液病病史。
均行胸部CT 、B 超、超声心动图、肌电图、血清免疫球蛋白、内分泌功能等检查,行腰椎穿刺4例,骨髓穿刺3例。
1.3临床表现(1)首发症状:4例(80%)患者主要以四肢无力、麻木为首发症状,其他症状包括四肢末端感觉减退、皮肤变黑及双下肢水肿。
另外1例(20%)以植物神经损害起病,表现为雷诺综合征。
(2)周围神经损害:所有患者表现为慢性、进行性四肢无力、四肢末端感觉减退,下肢重于上肢。
(3)皮肤改变:5例患者就诊时均有不同程度皮肤改变,表现为全身皮肤粗糙,皮肤广泛色素沉着、发黑。
4例皮肤发黑以颜面部及四肢末端为主,1例皮肤色素沉着尤以腰带区、乳晕、掌纹处明显。
医院各科英语简称√
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Medicine运动医学科Sport Medicine肺结核加护病房TBICU外伤加护病房Trauma ICU健康检查中心Health Evaluation Center脑血管中心Cerebral Vascular Clinic神经医学中心Brain Center烧伤中心Burn Center癌症中心Cancer center癌症防治中心Cancer Control and Prevention Center高压氧治中心Hyperbaric Oxygen Therapy Center肥胖防治中心Weight Reducing床科部洗肾中心Hemodialysis Center医学美容中心Medical Cosmetic Center医学影像中心Medical Image Center运动健中心Rehabilitation-Exercise Center医院常用中英文对照汇编病人保健推广中心Diabetic Center中西合作医中心Chinese-Western Cooperative Treatment Center社区护Home Care护之家Nursing Home护部Nursing Dept. / Nursing Department护长室Head Nurse医技术CT 登记处CT AdmissionX 光摄影室(借片室)X-ray Room孕症谘询室Infertility Consultation Room内分检查室Endocrine Examination Room内科诊查室Internal Medicine Clinic内视镜室Endoscopy化学治Chemo-Therapy心电图室EKG心导管室Cardiac Catheterization Room心脏血管中心Cardiovascular Center心脏血管检查室Cardiovascular Examinations心脏超音波Heart Echo水室Hydrotherapeutics生化实验室Biochemical Lab生检查科Physiological Exam皮肤病诊断中心Dermological Pathological Center 石膏室Plaster Room光子刀治中心Photon Knife Center多功能超音波室Multi-Function Echo Room肌电图室EMG血库Blood Bank血液肿瘤科Hematology血清免疫学实验室Immu-serological Lab血管功能检查室Vascular Function Test血管摄影室Cardiac Angiography动检查室Urokinetic Exam. Room技术室Technical Support Division乳房超音波Breast Echo乳房摄影室Mammography儿童治室Pediatric Therapy Room儿童物治室Pediatric Physical Therapy儿童职能治室Pediatric Occupational Therapy 呼吸治Respiratory Therapy放射免疫分析室Radioimmunoassay Unit放射科登记室Radiology Registration医技术放射线治科Radiotherapy科微波热室Genitouro Urologic超音波Urology Echo物治Physical Therapy物职能治室Occupational and Physical Therapy 医院常用中英文对照汇编肺功能PFT肺功能室Pulmonary Function Testing门诊检验Oupatient Check-UPS门诊体检Physical Check-Ups急诊X 光室ER X-Ray Room胃镜室Endoscopy Room胎儿影像中心3D Live Image Center气管镜室Bronchoscopy Room特殊检查室Special Examination胸部超音波Chest Echo闪烁摄影室Diagnostic Imaging Unit骨质密检查室Bone Density骨骼肌肉超音波室Echo for Skeletal Muscles采室Urine Collection Room产房Delivery Room细胞遗传室Cytogenetics细菌研究室Bacterial Laboratory麻醉科实验室Anesthesiology Laboratory健科治室Rehabilitation Therapy紫外线光室Ultraviolet Therapy肾功能室Renal Function肾脏超音波Renal Echo视检查室Check-up for Eye Sight周边血管室Peripheral Vascular Examination微生物实验室Microbiological Lab新生儿观察室Observation Room-New Born Babies 眩检查室Vertigo Test准份子射室Laser Treatment腹部超音波Abdominal echo腹膜透析室CAPD脑波室EEG Unit解剖病科实验室Anatomical Pathology Laboratory 运动治室Therapeutic Exercise Room射治室Laser Therapy电脑断层摄影室CT Scan Unit电室Electrotherapy Room磁振造影扫描室MRI Unit膀胱功能室Bladder Function Test膀胱镜室Cystoscopy Room语言治Speech Therapy器官移植Organization Transplantation医技术检伤分Triage检验室Laboratory检验科Laboratory Medicine检体收发室Specimen Collection检体受紧急报告取Emergency Procedure检体处室Lab Samples营养室Nutrition Dept.床病室Clinical Pathology医务室(医站)Clinic药剂科(药局)Pharmacy体外震波碎石机Lithotripsy研讨室Meeting Room,Seminar Room医师研究室Physicians‘ Office医师讨室Physicians‘ Meeting Room医院常用中英文对照汇编研究室Study Room男化妆室/男厕所Men‘s Restroom / Gentlemen‘s Restroom 洗手间/盥洗室Restroom身心障碍专用厕所Disabled Restroom储藏及仓库中央供应室Central Supply Center中央库房Central Storage供应室Supply Room清洁工具室Janitors Room急诊清洁室ER Janitor洗衣房Laundry汅物间Soiled Materials清洁班Cleaning Crew告示或者警告标示施工中Under Construction禁止吸烟No Smoking禁止饮食No Food or Drink禁食槟榔Chewing betel nut is prohibited禁止携带物No Pets严禁烟火No Open Flames请勿(禁止)进入No Entry闲人勿进Authorized Personnel Only节约用水Please Conserve Water随手关灯Turn Off Lights When Leaving高压危(wei)险,有电勿挨近Keep Clear-High Voltage电器设备,严禁擅入Do not enter!Power Equipment告示或者警告标示请取号码牌,静候叫号时迳往挂号处挂号Take a number. Go to counter when number is called.防火门火警时随手关门Fire Escape-Please Keep Closed避难出口高逃生缓机Emergency Exit & Escape Sling紧急疏散方向图Evacuation Plan禁止将投手伸出扶梯外Please do not stretch out your hand or head您的位置You are here电梯内请勿交谈,请戴口罩Do not talk in elevator,Please put on respirator医院常用中英文对照汇编严禁工作人员戴手套触摸按钮Employee, pushing buttom with your grove on is prohibited资源回收及垃圾资源回收/垃圾分Recycling塑胶Plastic垃圾桶Trash垃圾处室Disposal Area特殊空间太平间Morgue其它药物医药分业谘询专线Medical and Pharmaceutical Consultation Inquiries 身体健康检查谘询预约服务专线Physical Examination出入口及专用道请勿停车No Parking身心障碍专用坡道Disabled Ramp书表慢性病续处方笺Chronic Illness Prescription Slip慢性病续处方笺Chronic Continuous Prescription慢性病续处方笺Refill Presriptions For Chroni Disease诊断书Medical Certificate挂号费Registration Fee证明费Certification Fee费Ambulance Fee特定医费Special Medical Fee部份负担费Self-Payment Fee诊察费Diagnostic Fee病房费Ward Fee伙食费Diet Fee检查费Laboratory Fee放射线诊费X-Ray Fee治处置费Therapeutic Treatment Fee 手术费Operation Fee健治费Rehabilitation Therapy血液血浆费Blood Product Fee血液透析费Hemodialysis Fee麻醉费Anesthetic Fee特殊材费Special Medical Supply Fee 药费Medicine Fee药事服务费Medicine Service Fee精神科治费Psychiatric Treatment Fee 注射技术费Injection Fee婴儿费Infant Fee特定健保费Special N.H.I. Fee病影印Medical Records Copying出院病Dischargged Medical Records 门诊申报Outpaitent Declareation住院申报Inpatient Declareation。
医院各科室中英文对照
医院各科室中英文对照急诊室——Emergency Room医院-—Hospital内科病房——Medical Ward外科病房——Surgical Ward儿科病房——Pediatric Ward接生房—-Labor and Delivery手术室——Operation Room (OR)心脏重症室——Coronary Care Unit (CCU)重症室——Intensive Care Unit (ICU)内科重症室——Medical Intensive Care Unit (MICU)初生婴儿重症室——Neonatal Intensive Care Unit (NICU)儿科重症室——Pediatric Intensive Care Unit (PICU)外科重症室——Surgical Intensive Care Unit (SICU)末期护理—-Hospice居家健康服务、药疗、物理治疗等——Home Health Service化验所(进行化验研究)——Laboratory门诊手术中心(一般非严重性手术)——Outpatient Surgical Center 药房(药物、医疗用品)——Pharmacy医疗服务—-Health Care Provider医生—-Physician针灸——Acupuncture过敏性专科—-Allergy and Immunology麻醉科-—Anesthesiology心脏科——Cardiology心胸外科-—Cardio—Thoracic Surgery 脊椎神经科-—Chiropractic结肠直肠外科——Colorectal Surgery 牙科-—Dentistry皮肤科—-Dermatology内分泌科——Endocrinology家庭科——Family Practice肠胃科--Gastroenterology普通全科——General Practice普通外科—-General Surgery老人病专科——Geriatrics血液科—-Hematology肝病专科——Hepatology传染病科-—Infectious Disease内科——Internal Medicine肾脏科-—Nephrology神经科--Neurology神经外科-—Neurosurgery妇产科—-Obstetrics-Gynecology癌症专科-—Oncology眼科——Ophthalmology验光科——Optometry骨外科——Orthopedic Surgery整骨疗科—-Osteopathy耳鼻喉科-—Otolaryngology (ENT)病理科—-Pathology小儿科—-Pediatrics整形外科——Plastic surgery足科-—Podiatry精神治疗科——Psychiatry物理康复科—-Physiatry物理疗法及恢复正常生活护理——Physical Medicine and Rehabilitation 肺科——Pulmonary Medicine癌症放射疗科—-Radiation OncologyX光科—-Radiology泌尿科——Urology血管外科——Vascular Surgery其它医疗专业人员——Other Health Care Professionals听觉学专家-—Audiologist牙医助理——Dental Assistant饮食指导员-—Dietitian遗传病辅导员——Genetic Counselor健康技员——Health Technician化验技员——Laboratory Technician医务助理——Medical Assistant医学技师——Medical Technologist护士——Nurse家访护士—-Home Visiting Nurse接生护士-—Nurse Midwife营养专家—-Nutritionist药剂师—-Pharmacist药理学专家——Pharmacologist物理治疗员——Physical Therapist医生助手-—Physician's Assistant心理学专家—-Psychologist心理辅导员—-Psychologic Counselor呼吸治疗员—-Respiratory TherapistX光科技员——X-Ray Technician总值班室——general staff on call康复门诊——rehabilitation out-parient神经外科——department of neurosurgery 卫生间-—rest room男卫生间——toilet(male)女卫生间——toilet(female)开水间——water supply room储藏室——store静--keeping quite医生办公室——doctor office处置室—-disposal room换药室——dressing room医务人员洗手间——medical workers toilet 盥洗室——laundry room挂号收费处——registration & charge门诊——out-parient急诊——emergency请勿吸烟-—no smooking神经内科门诊——neurology consultant room抢救监护室——critical care and monitoring room 神经外科门诊—-neurosurgery out-patient clinic 急诊外科——surgery清创手术室——operation room骨科急诊—-orthopaedics emergency石膏室——plaster room急诊内科——internal medicine眼科急诊——ophthal mology emergency住院收费——inpatient charging service西药房——pharmacy化验室——laboratory输液室——transfusion roomCT、拍片、B超——X-ray、B ultrasound病理科-—department of pathology检验中心——laboratory center emergency急诊ICU病房——ICU ward检验诊断中心——Lab。
关于宁夏银川体检中心调研报告
关于宁夏银川体检中心调研报告一.兴庆区1.慈铭体检慈铭简介:慈铭体检医院属慈铭奥亚七星级体检医院连锁医院,是慈铭集团在宁夏唯一连锁机构。
慈铭集团成立于2004年,是原解放军301医院肿瘤内科医师、留德医学博士韩小红女士创立。
是目前国内规模最大。
专业化程度高、覆盖范围广、年体检量最多的专业体检机构,实现连锁化经营,拥有45家体检机构。
地址:银川市兴庆区文化西街106号国际贸易中心B座四层体检对象:企事业及个人收费标准:男性套餐价:214元—2152元女性套餐价:319元—2362元体检项目:常规体检项目,根据套餐不同,体检项目有所增减。
综合分析:1.体检机构规模化、男女区分检,VIP专用通道方便快捷。
2.设备一流、技术先进,拥有东芝TBA—120FR全自动生化分析仪,德国罗氏全自动免疫分析仪、飞利浦彩色超声诊断仪、人体代谢热层像系统、动脉硬化检测仪等先进专业检查设备。
3.体检项目多样化,提供多种个性化套餐,模块化加减。
4.专业健康教育系列课程、资深健康管理师主讲。
5.国内就诊绿色通道,权威特色专科医师定向推荐。
6.专业流动体检车,为周边企事业单位提供优质便捷的上门体检服务。
2.宁夏医科大学总医院(附属医院)医院简介:医院集医疗、教学、科研、预防保健和干部保健等职能于一体,是省内规模大、技术力量雄厚、医疗设备先进、专家队伍荟萃的一所综合性三级甲等医院。
地址:银川市兴庆区胜利南街804号体检对象:企事业单位及个人收费标准:男性套餐价:380元—2300元女性套餐价:510元—2460元体检项目:常规体检项目,根据套餐不同,体检项目有所增减。
还可自选基因检测项目(包括单项或成套项目)。
综合分析:医院拥有一批有实力的科研技术队伍,与世界先进水平的诊疗中心接轨,有力地提高了宁夏医疗和科研的整体水平。
拥有国内外大型高、精、尖医疗设备1472台。
具备一流水准手术室和现代化教学设施的临床技能培训中心,医院的硬件水平高。
宁夏医学优秀学术论文奖评选揭晓-宁夏医科大学
一等奖
序号
论文题目
第一作者
工作单位
刊物名称及论文
发表刊期
1
心衰组织中热休克蛋白60和72的表达调节
王 银
宁夏医科大学
Journal of Molecular and Cellular Cardiology48(2010)
2
“右旋糖酐-磁性LDH-氟尿嘧啶”转运模型在正常大鼠体内分布的磁靶向性
细胞与分子免疫学杂志201010
18
宁夏回族自治区职工体重与血压血糖血脂关系
宋 辉
宁夏医科大学
中国公共卫生2010.3
19
前列腺癌扩散加权成像ADC值结合PSA检测在前列腺癌术前评估中的作用
陈志强
宁夏医科大学附属医院
中华泌尿外科杂志2009.10
20
细胞外信号调节激酶在寻常性银屑病皮损中的表达
葛新红
李红
宁夏医科大学附属医院
Brain & Development 2010.1
8
海人酸致痫大鼠中神经肽Ghrelin和Nesfatin-1的表达
刘诤
宁夏医科大学附属医院
中华医学杂志
2011.7
9
病灶清除植骨内固定治疗相邻多椎体脊柱结核
施建党
宁夏医科大学附属医院
中国脊柱脊髓杂志2010.2
10
宁夏地区病毒性脑炎中新发博尔纳病病毒感染的研究
杨文君
宁夏医科大学
Annals of Surgical Oncology
5
中国汉族正常人岛叶体积的高分辨率MRI测量
郭玉林
宁夏医科大学附属医院
中华放射学
2010.6
6
医院部门及科室中英文对照
医院部门及科室中英文对照1. 医院部门•门诊部门:Outpatient Department (OPD)•急诊科:Emergency Department•住院部门:Inpatient Department•体检部门:Physical Examination Department•检验科:Pathology Department / Laboratory•放射科:Radiology Department•药房:Pharmacy Department•护理部:Nursing Department•营养科:Nutrition Department•血液科:Hematology Department•麻醉科:Anesthesiology Department•手术室:Operating Room / Surgical Department•康复医学科:Rehabilitation Department•传染病科:Infectious Diseases Department•特需门诊:Specialty Outpatient Clinic•精神科:Psychiatry Department•眼科:Ophthalmology Department•口腔科:Dentistry Department•妇产科:Obstetrics and Gynecology Department•儿科:Pediatrics Department•耳鼻喉科:Otorhinolaryngology Department•皮肤科:Dermatology Department•心血管内科:Cardiovascular Department / Cardiology Department 2. 医院科室2.1 内科•普通内科:General Internal Medicine•呼吸内科:Respiratory Medicine•消化内科:Gastroenterology•肾内科:Nephrology•内分泌科:Endocrinology•血液科:Hematology•心内科:Cardiology•风湿免疫科:Rheumatology and Immunology•感染科:Infectious Diseases•神经内科:Neurology•肝胆科:Hepatology•心血管内科:Cardiovascular Department / Cardiology Department 2.2 外科•普通外科:General Surgery•心胸外科:Cardiothoracic Surgery•神经外科:Neurosurgery•骨科:Orthopedics•泌尿外科:Urology•胸外科:Thoracic Surgery•肛肠科:Colorectal Surgery•矫形外科:Reconstructive Surgery•显微外科:Microsurgery•整形外科:Plastic Surgery2.3 妇产科•妇科:Gynecology•产科:Obstetrics•妇幼保健:Maternal and Child Health•生殖医学科:Reproductive Medicine2.4 儿科•儿科:Pediatrics•新生儿科:Neonatology•小儿外科:Pediatric Surgery•小儿心脏科:Pediatric Cardiology2.5 眼科•眼科:Ophthalmology•视光科:Optometry•眼底科:Ophthalmology Retina Department•斜视眼科:Strabismus Department•眼表科:Cornea Department2.6 口腔科•口腔科:Dentistry•正畸科:Orthodontics•口腔修复科:Oral Rehabilitation•口腔黏膜科:Oral Mucosal Department•牙周科:Periodontology2.7 皮肤科•皮肤科:Dermatology•美容皮肤科:Cosmetic Dermatology•性病科:Venereology2.8 耳鼻喉科•耳鼻喉科:Otorhinolaryngology•鼻科:Rhinology•喉科:Laryngology•耳科:Otology•颈部外科:Cervical Surgery2.9 传染病科•传染病科:Infectious Diseases•病毒学:Virology•寄生虫学:Parasitology•干预感染科学:Interventional Infection Science •病原微生物学:Pathogenic Microbiology2.10 康复医学科•康复医学科:Rehabilitation Medicine•理疗科:Physiotherapy•职业病科:Occupational Medicine•运动医学科:Sports Medicine2.11 精神科•精神科:Psychiatry•精神心理科:Psychology and Psychiatry•睡眠医学科:Sleep Medicine•药物依赖科:Drug Dependence以上为医院部门及科室中英文对照,供参考使用。
基于FIB、HB、FOBT、CEA构建的Logistic回归模型对结直肠癌的诊断价值
㊃论 著㊃D O I :10.3969/j.i s s n .1672-9455.2024.06.017基于F I B ㊁H B ㊁F O B T ㊁C E A 构建的L o g i s t i c 回归模型对结直肠癌的诊断价值*侯晓慧1,2,张玉英1,谢小亮3,王良方1,2,冯丽君1,2,杜沛静1,2,李 刚1,师志云1ә1.宁夏医科大学总医院医学实验中心,宁夏银川750000;2.宁夏医科大学第一临床医学院,宁夏银川750000;3.宁夏医科大学总医院结直肠外科,宁夏银川750000摘 要:目的 评价纤维蛋白原(F I B )㊁血红蛋白(H B )㊁癌胚抗原(C E A )和粪便隐血试验(F O B T )联合检测在结直肠癌患者中的诊断价值,为结直肠癌诊断提供参考㊂方法 选取宁夏医科大学总医院2021年1月至2022年6月结直肠外科收治的110例结直肠癌患者作为癌症组,选取同期病房收治的43例良性结直肠疾病患者为非癌症组㊂回顾性分析并比较癌症组及非癌症组常规实验室指标(血常规㊁生化常规㊁肿瘤标志物㊁细胞因子㊁F O B T )结果,采用L o g i s t i c 回归分析结直肠癌的影响因素并构建L o g i s t i c 回归模型,采用受试者工作特征(R O C )曲线分析L o gi s t i c 回归模型对结直肠癌的诊断价值;进一步构建诊断结直肠癌的列线图并绘制校准曲线图进行内部验证㊂结果 癌症组患者血F I B ㊁C E A 水平及F O B T 阳性率高于非癌症组,A /G ㊁H B 水平低于非癌症组,差异均有统计学意义(P <0.05)㊂将F I B ㊁H B ㊁F O B T ㊁C E A 进行多因素L o gi s t i c 回归分析,建立L o -gi s t i c 回归模型作为4项指标联合检测模型:P =1/[1+e -(13.792-0.144ˑX 1+1.057ˑX 2+0.560ˑX 3+3.029ˑX 4)],其中X 1为H B 水平,X 2为F I B 水平,X 3为C E A 水平,X 4为F O B T 检测结果(阳性=1,阴性=0)㊂R O C 曲线分析结果显示,当最大约登指数为0.841时,L o g i s t i c 回归模型诊断结直肠癌的灵敏度为86.4%,特异度为97.7%,曲线下面积(A U C )为0.961(95%C I :0.933~0.988)㊂建立L o gi s t i c 回归模型的列线图,并绘制校准曲线图,结果提示该模型的预测概率与实际概率具有较好的一致性㊂结论 基于F I B ㊁H B ㊁C E A 和F O B T 4项指标构建的L o g i s t i c 回归模型,对结直肠癌有着较好的诊断价值,也为临床对结直肠癌的早期筛查和诊断提供了一定的方向㊂关键词:结直肠癌; 诊断价值; 纤维蛋白原; 癌胚抗原; 粪便隐血试验中图法分类号:R 446.1;R 735.3文献标志码:A文章编号:1672-9455(2024)06-0805-05D i a g n o s t i c v a l u e o f c o n s t r u c t e d L o g i s t i c r e gr e s s i o n m o d e l i n c o l o r e c t a l c a n c e r b a s e d o n F I B ,H B ,C E A ,F O B T a n d C E A*H O U X i a o h u i 1,2,Z HA N G Y u y i n g 1,X I E X i a o l i a n g 3,WA N G L i a n g f a n g 1,2,F E N G L i ju n 1,2,D U P e i j i n g 1,2,L I G a n g 1,S H I Z h i yu n 1ә1.D e p a r t m e n t o f M e d i c a l E x p e r i m e n t a l C e n t e r ,G e n e r a l H o s p i t a l o f N i n g x i a M e d i c a l U n i v e r s i t y ,Y i n c h u a n ,N i n g x i a 750000,C h i n a ;2.F i r s t C l i n i c a l M e d i c a l C o l l e g e ,N i n g x i a M e d i c a l U n i v e r s i t y ,Y i n c h u a n ,N i n g x i a 750000,C h i n a ;3.D e p a r t m e n t o f C o l o r e c t a l S u r g e r y ,G e n e r a l H o s p i t a l o fN i n g x i a M e d i c a l U n i v e r s i t y ,Y i n c h u a n ,N i n gx i a 750000,C h i n a A b s t r a c t :O b je c t i v e T o e v a l u a t e t h e d i a g n o s t i c v a l u e of c o m b i n e d d e t e c t i o n o f f i b r i n og e n (F I B ),h e m o g l o -bi n (H B ),c a r c i n o e m b r y o n i c a n t i g e n (C E A )a n d f e c a l o c c u l t b l o o d t e s t (F O B T )i n p a t i e n t s w i t h c o l o r e c t a l c a n c e r ,i n o r d e r t o p r o v i d e r e f e r e n c e f o r t h e d i a gn o s i s o f c o l o r e c t a l c a n c e r .M e t h o d s A t o t a l o f 110p a t i e n t s w i t h c o l o r e c t a l c a n c e r a d m i t t e d a n d t r e a t e d i n t h e C o l o r e c t a l S u r g e r y D e p a r t m e n t o f t h e G e n e r a l H o s pi t a l o f N i n g x i a M e d i c a l U n i v e r s i t y f r o m J a n u a r y 2021t o J u n e 2022w e r e s e l e c t e d a s t h e c a n c e r g r o u p,a n d 43p a t i e n t s w i t h b e n i g n c o l o r e c t a l d i s e a s e d u r i n g t h e s a m e p e r i o d w e r e s e l e c t e d a s t h e n o n -c a n c e r g r o u p.T h e d i f f e r e n c e s i n t h e r o u t i n e l a b o r a t o r y i n d e x e s (b l o o d r o u t i n e ,b i o c h e m i c a l r o u t i n e ,t u m o r m a r k e r s ,c yt o k i n e s a n d F O B T )w e r e r e t r o s p e c t i v e l y a n a l y z e d a n d c o m p a r e d b e t w e e n t h e c a n c e r g r o u p a n d t h e n o n -c a n c e r g r o u p .T h e L o g i s t i c r e -g r e s s i o n w a s u s e d t o a n a l y z e t h e i n f l u e n c i n g f a c t o r s o f c o l o r e c t a l c a n c e r a n d a L o g i s t i c r e gr e s s i o n m o d e l w a s c o n s t r u c t e d .T h e r e c e i v e r o p e r a t i n g c h a r a c t e r i s t i c (R O C )c u r v e w a s u s e d t o a n a l y z e t h e d i a gn o s t i c v a l u e o f t h e ㊃508㊃检验医学与临床2024年3月第21卷第6期 L a b M e d C l i n ,M a r c h 2024,V o l .21,N o .6*基金项目:宁夏自然科学基金项目(2023A A C 03516);宁夏医科大学总医院 青年拔尖人才 专项(N Y D Z Y 026)㊂ 作者简介:侯晓慧,女,在读研究生,主要从事临床病原微生物方面的研究㊂ ә 通信作者,E -m a i l :s h i z h i y u n 123@126.c o m ㊂ 网络首发 h t t ps ://l i n k .c n k i .n e t /u r l i d /50.1167.r .20240130.1442.002(2024-02-01)L o g i s t i c r e g r e s s i o n m o d e l o n c o l o r e c t a l c a n c e r;a n o m o g r a m f o r d i a g n o s i n g t h e c o l o r e c t a l c a n c e r c o r r e l a t i o n w a s f u r t h e r c o n s t r u c t e d a n d a c a l i b r a t i o n c u r v e c h a r t w a s d r a w n f o r c o n d u c t i n g t h e i n t e r n a l v a l i d a t i o n.R e s u l t s T h e s e r u m F I B a n d C E A l e v e l s a n d F O B T p o s i t i v e r a t e i n t h e c a n c e r g r o u p w e r e h i g h e r t h a n t h o s e i n t h e n o n-c a n c e r g r o u p,t h e A/G a n d H B l e v e l s w e r e l o w e r t h a n t h o s e i n t h e n o n-c a n c e r g r o u p,a n d t h e d i f f e r e n c e s w e r e s t a t i s t i c a l l y s i g n i f i c a n t(P<0.05).T h e m u l t i v a r i a t e L o g i s t i c r e g r e s s i o n a n a l y s i s o n F I B,H B,F O B T a n d C E A w a s c o n d u c t e d a n d t h e L o g i s t i c r e g r e s s i o n m o d e l s e r v e d a s t h e4-i t e m j o i n t d e t e c t i o n m o d e l:P=1/[1+ e-(13.792-0.144ˑX1+1.057ˑX2+0.560ˑX3+3.029ˑX4)],w h e r e X1,X2a n d X3w e r e t h e H B,F I B a n d C E A l e v e l s r e s p e c t i v e-l y,a n d X4w a s t h e F O B T d e t e c t i o n r e s u l t(p o s i t i v e=1,n e g a t i v e=0).T h e R O C c u r v e a n a l y s i s s h o w e d t h a t w h e n t h e m a x i m u m J o r d a n i n d e x o f t h e L o g i s t i c r e g r e s s i o n m o d e l f o r d i a g n o s i n g c o l o r e c t a l c a n c e r w a s0.841, t h e s e n s i t i v i t y o f t h e m o d e l w a s86.4%,t h e s p e c i f i c i t y w a s97.7%,a n d t h e a r e a u n d e r t h e c u r v e(A U C)w a s0.961(95%C I:0.933-0.988).T h e n o m o g r a m o f t h e L o g i s t i c r e g r e s s i o n m o d e l a n d c a l i b r a t i o n c u r v e w e r ed r a w n,a n d t he r e s u l t s i n d i c a t e d t h a t t h e p r e d i c t i v e p r o b a b i l i t y of t h e m o d e l h a dg o o d c o n s i s t e n c e w i th t h e a c-t u a l p r o b a bi l i t y.C o n c l u s i o n T h e L o g i s t i c r e g r e s s i o n m o d e l c o n s t r u c t e d b a s e d o n f o u r i n d i c a t o r s o f F I B,H B, C E A a n d F O B T h a s g o o d d i a g n o s t i c v a l u e f o r c o l o r e c t a l c a n c e r a n d p r o v i d e s a c e r t a i n d i r e c t i o n f o r e a r l y s c r e e n i n g a n d d i a g n o s i s o f c o l o r e c t a l c a n c e r i n c l i n i c a l p r a c t i c e.K e y w o r d s:c o l o r e c t a l c a n c e r; d i a g n o s t i c v a l u e;f i b r i n o g e n;c a r c i n o e m b r y o n i c a n t i g e n;f e c a l o c c u l t b l o o d t e s t结直肠癌是最危险的恶性肿瘤之一,在癌症相关死亡中排第二位[1]㊂尽管在治疗策略方面已取得了很大进展,结直肠癌仍是威胁人类生命的主要恶性肿瘤,其特征是发病率和病死率高[2]㊂早期识别结直肠癌,可以降低结直肠癌的病死率,因此结直肠癌的早期筛查十分重要㊂结肠镜检查已被公认为具有高灵敏度和特异度的结直肠癌筛查的金标准,然而,它在金钱和人力方面成本较高,且需要经验丰富的内窥镜医生和较高的患者依从性[3]㊂因此,如何在结直肠癌病变早期找到一种简单㊁诊断效能高的诊断指标仍需研究㊂有研究表明,纤维蛋白原(F I B)可能是结直肠癌的潜在生物标志物[4]㊂癌胚抗原(C E A)作为肿瘤标志物,已广泛应用于结直肠癌的早期诊断[5]㊂粪便隐血试验(F O B T)至今仍是结直肠癌普查中使用最广泛且评估最多的一项试验[6]㊂本研究回顾性分析结直肠癌相关指标,通过多因素L o g i s t i c回归分析结直肠癌的独立影响因素并构建L o g i s t i c回归模型,旨在早期识别结直肠癌,提高患者存活率并有助于个性化医学的发展㊂1资料与方法1.1一般资料选择宁夏医科大学总医院2021年1月至2022年6月结直肠外科收治的110例结直肠癌患者作为癌症组㊂结直肠癌诊断依据相关影像检查辅助诊断,病理活检及免疫组化结果明确诊断,并且肿瘤分期符合‘美国癌症联合委员会A J C C-T NM分期指南(第7版)“㊂癌症组纳入标准:(1)经病理检查初次确诊结直肠癌;(2)未接受过手术㊁放疗㊁化疗及免疫治疗㊂另选取同期病房收治的排除癌症,有良性结直肠疾病的患者43例作为非癌症组,纳入标准:结直肠疾病经病理检查确诊非恶性㊂所有纳入患者的排除标准:(1)合并感染性疾病;(2)合并其他部位肿瘤;(3)合并血液系统疾病;(4)器官移植;(5)存在免疫功能缺陷;(6)临床及实验室数据缺失㊂因为本研究为回顾性分析,因此免除了受试者书面知情同意㊂本研究经宁夏医科大学总医院医学伦理委员会批准(K Y L L-2022-1322)㊂1.2方法收集患者一般情况㊁营养指标㊁血常规㊁生化常规㊁肿瘤标志物㊁细胞因子㊁F O B T中可能成为结直肠癌潜在生物标志物的相关指标㊂各实验室指标检测方法如下:采用X N9000血细胞分析仪测定血液常规指标;采用B e c k m a n C o u l t e r流式细胞仪测定血清白细胞介素-2(I L-2)㊁白细胞介素-4(I L-4)㊁白细胞介素-6(I L-6)㊁白细胞介素-10(I L-10)㊁γ-干扰素(I N F-γ)㊁肿瘤坏死因子-α(T N F-α)水平;采用全自动生化分析仪测定各项生化指标及肿瘤标志物水平㊂F O B T采用单克隆法(胶体金法)检测粪便中的血红蛋白(H B)㊂所有检测过程严格按照实验室工作流程㊁各指标的标准检测流程进行操作㊂比较两组患者性别㊁年龄㊁体质量指数(B M I)㊁F O B T结果㊁总蛋白(T P)㊁清蛋白(A L B)㊁球蛋白(G L B)㊁清蛋白与球蛋白比值(A/G)㊁白细胞计数(W B C)㊁中性粒细胞计数(N B C)㊁淋巴细胞计数(L YM)㊁H B㊁红细胞计数(R B C)㊁单核细胞计数(MO N O)㊁血小板计数(P L T)及F I B㊁D-二聚体(D-D)㊁C E A㊁I L-2㊁I L-4㊁I L-6㊁I L-10㊁T N F-α㊁I F N-γ水平㊂1.3统计学处理采用S P S S26.0统计软件进行数据处理㊂用P-P图检验数据是否满足正态分布,呈正态分布的计量资料以xʃs表示,两组间比较采用独立样本t检验;非正态分布的计量资料用M(P25,㊃608㊃检验医学与临床2024年3月第21卷第6期 L a b M e d C l i n,M a r c h2024,V o l.21,N o.6P 75)表示,两组间比较采用M a n n -W h i t n e y U 检验;计数资料以例数㊁百分率表示,两组间比较采用χ2检验㊂采用多因素L o g i s t i c 回归分析患结直肠癌的影响因素并构建L o g i s t i c 回归模型,将纳入L o g i s t i c 回归模型的指标通过受试者工作特征(R O C )曲线评价其独立及联合诊断结直肠癌的价值并通过约登指数校正计算截止点,转换为二分类变量㊂应用R 语言及相关软件构建L o gi s t i c 回归模型的列线图并绘制校准曲线对模型数据进行内部验证㊂以P <0.05为差异有统计学意义㊂2 结 果2.1 癌症组与非癌症组患者临床基线资料比较 癌症组与非癌症组间F O B T 结果㊁A /G 及H B ㊁F I B ㊁C E A 比较,差异均有统计学意义(P <0.05)㊂见表1㊂表1 癌症组与非癌症组基础资料及各项指标比较[x ʃs 或n (%)或M (P 25,P 75)]组别n年龄(岁)性别男女F O B T 结果阴性阳性B M I(k g/m 2)T P(g /L )癌症组11061.85ʃ11.2171(64.5)39(35.5)11(10.0)99(90.0)24.37ʃ3.5465.17ʃ5.71非癌症组4361.40ʃ13.5428(65.1)15(34.9)27(62.8)16(37.2)24.00ʃ3.1063.91ʃ9.61t 或χ2或Z0.210.0046.150.631.00P0.8340.9470.0010.5320.321组别nA LB (g/L )G L B (g/L )A /GW B C (ˑ109/L )H B (g/L )癌症组11026.92ʃ4.1026.92ʃ4.101.44ʃ0.285.85ʃ1.52124.59ʃ19.06非癌症组4338.95ʃ5.2725.66ʃ3.591.53ʃ0.225.98ʃ1.80143.88ʃ11.15t 或χ2或Z-1.261.77-2.03-0.47-6.23P0.2100.0780.0440.639<0.001组别nN B C (ˑ109/L )L YM (ˑ109/L )MO N O (ˑ109/L )R B C (ˑ1012/L )癌症组1103.18(2.51,4.17)1.67(1.36,2.14)0.47(0.36,0.60)4.58(4.17,4.88)非癌症组433.27(2.58,4.26)1.71(1.36,2.30)0.49(0.36,0.54)4.70(4.14,5.19)t 或χ2或Z-0.51-0.58-0.04-1.83P0.6120.5640.9660.068组别nP L T (ˑ109/L )F I B (g/L )D -D (μg /m L )C E A (n g/m L )I L -2(p g/m L )癌症组110238.5(187.3,293.8)3.08(2.66,3.44)0.35(0.20,0.71)4.31(2.52,7.18)0.68(0.39,1.50)非癌症组43211.0(180.0,267.0)2.70(2.43,3.15)0.31(0.19,0.62)1.90(1.33,2.37)0.56(0.23,1.15)t 或χ2或Z1.732.740.326.201.34P0.0830.0060.747<0.0010.179组别nI L -4(p g/m L )I L -6(p g/m L )I L -10(p g/m L )T N F -α(p g/m L )I F N -γ(p g/m L )癌症组1100.80(0.32,2.89)4.49(1.87,7.76)1.65(0.81,3.45)1.88(0.73,3.88)0.71(0.32,3.85)非癌症组431.22(0.45,1.84)3.57(1.44,11.15)2.02(1.07,3.51)1.48(0.73,2.30)0.87(0.42,2.14)t 或χ2或Z-0.330.38-0.780.77-0.04P0.7420.7030.4360.4430.9662.2 L o g i s t i c 回归分析 将表1中所有差异性指标通过V I F (方差膨胀因子)独立性检验,V I F 均<5可不考虑共线性问题,以P <0.05为标准去除无意义变量,筛选出4项指标即F I B (原值输入)㊁F O B T (阳性=1,阴性=0)㊁C E A (原值输入)㊁H B (原值输入)作为自变量,以是否是结直肠癌(是=1,否=0)为因变量,进行多因素L o g i s t i c 回归分析㊂H o s m e r -L e m e s h o w 检验拟合优度良好,结果显示F I B ㊁F O B T ㊁C E A ㊁H B 是患结直肠癌的独立影响因素(P <0.05)㊂建立L o gi s t i c 回归模型作为4项指标联合检测模型:P =1/[1+e-(13.792-0.144ˑX 1+1.057ˑX 2+0.560ˑX 3+3.029ˑX 4)],其中X 1为H B 水平,X 2为F I B 水平,X 3为C E A 水平,X 4为F O B T 检测结果(阳性=1,阴性=0)㊂见表2㊂2.3 R O C 曲线分析H B ㊁F I B ㊁C E A ㊁F O B T 单项诊断结直肠癌的效能 以非癌症组为对照,绘制R O C 曲线分析H B ㊁F I B ㊁C E A ㊁F O B T 单项诊断结直肠癌的价值㊂当H B 取最大约登指数为0.841时,最佳截断值为133.5g /L ,灵敏度为81.4%,特异度为61.8%,㊃708㊃检验医学与临床2024年3月第21卷第6期 L a b M e d C l i n ,M a r c h 2024,V o l .21,N o .6曲线下面积(A U C )为0.799(95%C I :0.723~0.875)㊂当F I B 取最大约登指数为0.296时,最佳截断值为2.84g /L ,灵敏度为69.1%,特异度为60.5%,A U C 为0.643(95%C I :0.546~0.739)㊂当C E A 取最大约登指数为0.598时,最佳截断值为2.81n g /m L ,灵敏度为69.1%,特异度为90.7%,A U C 为0.823(95%C I :0.758~0.888)㊂F O B T 灵敏度为90.0%,特异度为62.8%,A U C 为0.764(95%C I :0.670~0.858)㊂见图1㊂表2 实验室指标多因素L o gi s t i c 回归分析结果指标βS EPO RO R 的95%C IH B-0.1440.037<0.0010.8660.806~0.930F I B1.0570.4510.0192.8771.189~6.964C E A0.5600.2090.0071.7501.161~2.638F O B T3.0290.713<0.00120.6825.108~83.738图1 H B ㊁F I B ㊁C E A ㊁F O B T 单项诊断结直肠癌的R O C 曲线2.4 R O C 曲线分析L o gi s t i c 回归模型诊断结直肠癌的效能 绘制R O C 曲线分析L o g i s t i c 回归模型诊断结直肠癌的效能,结果显示最大约登指数为0.841时,模型灵敏度为86.4%,特异度为97.7%,A U C 为0.961(95%C I :0.933~0.988),提示模型诊断效能优于各指标单独诊断效能㊂见图2㊂图2 L o gi s t i c 回归模型诊断结直肠癌的R O C 曲线2.5 列线图 基于H B ㊁F I B ㊁C E A 的最佳截断值将其转换为二分类变量,建立L o gi s t i c 回归列线图㊂列线图所对应的评分分别为F O B T 结果阳性为100分,C E Aȡ2.81n g/m L 为100分,F I Bȡ2.84g /L 为43分,H B <133.5g /L 为68分㊂如图3㊂图3 列线图2.6 L o gi s t i c 回归模型的验证 通过对模型数据进行内部验证,绘制C a l i b r a t i o n 校准曲线,结果显示该模型的预测概率与实际概率具有较好的一致性㊂见图4㊂图4 校准曲线图3 讨 论结直肠癌是全球最常见的恶性肿瘤之一[7]㊂早期识别并接受治疗的结直肠癌患者预后较好,延迟诊断和晚期结直肠癌患者预后较差[8]㊂且早发性结直肠癌(即在50岁以下患者中诊断出的结直肠癌)的发病率在世界各地一直在增加[9-10]㊂结直肠癌的早期识别对临床医师来说仍然是一个严峻的考验㊂大多数结直肠癌起源于前体性息肉[11],初期是一种局部疾病,早期临床症状表现不明显,后来进展并成为全身性疾病,通常确诊时已错过最佳治疗时间㊂因此,结直肠癌的早期识别和诊断有着重要的意义㊂F I B 是一种糖蛋白,以前被公认为主要在凝血中起作用㊂越来越多的证据表明,F I B 可作为多种恶性肿瘤的预后判断指标[12]㊂F I B 可以由癌细胞释放,并参与许多其他生物学行为,包括肿瘤血管生成,癌细胞增殖㊁黏附和迁移[13]㊂C E A 作为传统的肿瘤标志物可用于结直肠癌的辅助诊断和预后判断[14]㊂C E A在结直肠癌诊断中具有较高灵敏度,然而,C E A 在许多类型的肿瘤中表达,缺乏特异性[15]㊂因此,大多数学者认为,单一C E A 不是结直肠癌的合适诊断标志物,需要联合检测其他指标来提高诊断效果[16]㊂F O B T 可检测出肉眼不可见的出血,结肠镜检查因价格低廉和非侵入性而在结直肠癌筛查中被广泛应㊃808㊃检验医学与临床2024年3月第21卷第6期 L a b M e d C l i n ,M a r c h 2024,V o l .21,N o .6用[17]㊂而单个生物标志物的检测存在一定程度的缺陷,因此,联合检测多种生物标志物可有效提高肿瘤的诊断准确性[18]㊂本研究结果显示,癌症组患者F I B㊁C E A水平及F O B T阳性率高于非癌症组,H B水平低于非癌症组㊂且R O C曲线显示基于F I B㊁H B㊁C E A和F O B T4项指标构建的L o g i s t i c回归模型诊断结直肠癌有着良好的效能㊂基于F I B㊁H B㊁F O B T㊁C E A构建的预测结直肠癌发生风险概率的列线图,该图可直观显示模型中各指标与结直肠癌诊断的相关性,并可应用于临床㊂在校准度方面,本研究绘制了校准曲线图,提示该模型的预测概率与实际概率有较好的一致性㊂本研究采用的实验室检测指标包含在常规检查中,方便获得,简单㊁快速,同时为患者减少了检查花费,降低了预测成本㊂但值得注意的是,首先本研究是回顾性研究且样本量较少,可能会存在诊断价值的偏差与无法避免的选择偏倚,后期需要进一步收集更多的样本及进行前瞻性设计研究以更好评估各指标在结直肠癌诊断中的价值㊂其次本研究为单中心数据,尽管本研究对列线图模型进行了内部验证,且校准度良好,但后期仍需加大样本量及在其他医疗机构对模型进行评估及验证㊂综上所述,基于F I B㊁H B㊁C E A和F O B T4项指标构建的L o g i s t i c回归模型,对结直肠癌有着较好的诊断价值,也为临床对结直肠癌的早期筛查和诊断提供了一定的方向㊂参考文献[1]I S L AM M R,A K A S H S,R A HMA N M M,e t a l.C o l o nc a n c e r a nd c o l o re c t a l c a n c e r:p r e v e n t i o n a n d t r e a t m e n t b yp o t e n t i a l n a t u r a l p r o d u c t s[J].C h e m B i o l I n t r a c t,2022, 368:110170.[2]L I J J,HU A N G L,Z HA O H Z,e t a l.T h e r o l e o f i n t e r-l e u k i n s i n c o l o r e c t a l c a n c e 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[6]K A U R K,Z U B A I R M,A D AM S K I J J.F e c a l o c c u l t b l o o dt e s t[M].T r e a s u r e I s l a n d(F L):S t a t P e a r l s P u b l i s h i n g,2023.[7]K A R P I N S K I T M,O Z A R OW S K I M,S T A S I E W I C Z M.C a r c i n o g e n i c m i c r o b i o t a a n d i t s r o l e i n c o l o r e c t a l c a n c e r d e v e l o p m e n t[J].S e m i n C a n c e r B i o l,2022,86(P t3):420-430.[8]K I M B J,HA N N A M H.C o l o r e c t a l c a n c e r i n y o u n g a-d u l t s[J].J S u r g O n c o l,2023,127(8):1247-1251.[9]P A T E L S G,K A R L I T Z J J,Y E N T,e t a l.T h e r i s i n g t i d e o f e a r l y-o n s e t c o l o r e c t a l c a n c e r:a c o m p r e h e n s i v e r e v i e w o f e p i d e m i o l o g y,c l i n i c a l f e a t u r e s,b i o l o g y,r i s k f a c t o r s,p r e-v e n t i o n,a n d e a r l y d e t e c t i o n[J].L a n c e t G a s t r o e n t e r o lH e p a t o l,2022,7(3):262-274.[10]G A N E S H K,S T A D L E R Z K,C E R C E K A,e t a l.I mm u-n o t h e r a p y i n c o l o r e c t a l c a n c e r:r a t i o n a l e,c h a l l e n g e s a n d p o t e n t i a l[J].N a t R e v G a s t r o e n t e r o l H e p a t o l,2019,16(6):361-375.[11]C H E N B,S C U R R A H C R,M C K I N L E Y E T,e t a l.D i f-f e r e n t i a l p r e-m a l ig n a n t p r o g r a m s a n d m i c r o e n v i r o n m e n t ch a r t di s t i n c t p a t h s t o m a l i g n a n c y i n h u m a n c o l o r e c t a lp o l y p s[J].C e l l,2021,184(26):6262-6280.[12]C H E N G F,Z E N G C,Z E N G L,e t a l.C l i n i c o p a t h o l o g i c a la n d p r o g n o s t i c v a l u e o f p r e o p e r a t i v e p l a s m a f ib r i n o g e n i ng a s t r i c c a n c e r p a t i e n t s:a M e t a-a n a l y s i s[J].M e d i c i n e(B a l t i m o r e),2019,98(40):e17310.[13]S A HN I A,F R A N C I S C W.V a s c u l a r e n d o t h e l i a l g r o w t hf a c t o r b i n d s t o f i b r i n og e n a n d f i b r i n a n d s t i m u l a t e s e n d o-t h e l i a l c e l l p r o l i f e r a t i o n[J].B l o o d,2000,96(12):3772-3778.[14]钱香,王宏,任真,等.N L R与F I B和C E A及C A19-9在结直肠癌中的应用价值[J].中华预防医学杂志,2021,55(4):499-505.[15]R A O H,WU H M,HU A N G Q Y,e t a l.C l i n i c a l v a l u e o f s e r u m C E A,C A24-2a n d C A19-9i n p a t i e n t s w i t h c o l o r e c-t a l c a n c e r[J/O L].C l i n L a b,(2021-04-01)[2023-08-06].h t t p s://p u b m e d.n c b i.n l m.n i h.g o v/33865243/.[16]S I R E G A R G A,S I B A R A N I H.C o m p a r i s o n o f c a r c i n o-e m b r y o n i c a n t i g e n l e v e l s a m o n g d e g r e e of d i f f e r e n t i a t i o na n d c o l o r e c t a l c a n c e r's l o c a t i o n i n m e d a n[J].O p e n A c-c e s s M a c ed J Me d S c i,2019,7(20):3447-3450.[17]Y A N G P Y,Y A N G I T,C H I A N G T H,e t a l.E f f e c t s o ff e c a l o c c u l t b l o o d i mm u n o a s s a y s c r e e n i ng f o r c o l o r e c t a l c a n c e r-e x p e r i e n c e f r o m ah o s pi t a l i n c e n t r a l T a i w a n[J].M e d i c i n a(K a u n a s),2023,59(4):680.[18]J I A N G M Z,D I N G G W,L I G Z.D i a g n o s t i c v a l u e o fc o m b i n ed de t e c t i o n of m u l t i p l e t u m o r m a r k e r s a n d b l o o dl i p i d i n d e x e s i n c o l o r e c t a l c a n c e r a n d i t s p r e d i c t i o n o n a d-v e r s e r e a c t i o n s o f c h e m o t h e r a p y[J].J B U O N,2021,26(4):1226-1230.(收稿日期:2023-08-08修回日期:2024-01-26)㊃908㊃检验医学与临床2024年3月第21卷第6期 L a b M e d C l i n,M a r c h2024,V o l.21,N o.6。
宁夏医科大学总医院阿拉善经济开发区医院
宁夏医科大学总医院阿拉善经济开发区医院
简介
宁夏医科大学总医院阿拉善经济开发区医院位于阿拉善经济开发区贺兰区,是按照二级医院规模建设的综合性医疗机构。
医院集医疗、科研、预防保健等职能于一体,是宁夏医科大学总医院垂直管理的7家分支医院之一。
医院规划占地面积3.5万平方米,建筑面积4万平方米,设计床位400张,总投资逾2亿元;现有职工145人(包括宁夏医科大学总医院派驻的优质管理团队和专家队伍),其中,卫技人员占81%,行政及后勤人员占19%;医院开设外科、内科、妇产科、儿科、皮肤科、眼科、耳鼻喉科、口腔科、中医科、急诊科、检验科、影像科、体检中心等专业科室,建有层流净化手术室及ICU病房,拥有东芝螺旋CT、中科美仑DR、丹麦BK彩超、西斯美康全自动生化分析仪、全自动血球仪等大型医疗设备;医院由宁夏医科大学总医院按照“管理输出、技术输出、人才输出、质量控制、多点执业”五大理念进行全方位管理,通过宁夏医科大学总医院的“传、帮、带”,最终实现自身医疗服务水平的全面、快速提升。
宁夏医科大学总医院简介(英文)
General Hospital of Ningxia Medical University was founded in 1935, formerly known as Ningxia provincial hospital before the liberation. The hospital is located in Yinchuan which is the capital City of Ningxia Province. It covers an area of 230,000 square metres (350.7 acres) and a building area of 266,000 square meters. In 2011, it officially changed its name to the General Hospital of Ningxia Medical University, which administered the 7 branches. It is a set of medical, teaching, scientific research, training, examination, preventive care and health functions in one of modern comprehensive three A-level hospital. As a regional medical, scientific research, education, examination and training center, General Hospital of Ningxia Medical University leads the development of medical enterprise. At present, it has been already ranked the leading level between China Northwest and Inner Mongolia, Shanxi seven provinces (area).Ⅰ.Discipline construction and developmentGeneral Hospital of Ningxia Medical University has a total of 4525in-services staff, including 64 doctors and 599 master personnel. General Hospital has 2186 open beds, outpatients volume per-year reaches 1005100 person-time. For one year, patients discharged from hospital can be achieved 70300 person-time and operation volume can be 40200 person-time. Its medical care, teaching, scientific research and examination training cover up a radiation of over 500 kilometers, serving a population of about 13 million.General hospital services a wide range of specialist and has a rapid development. It set up a total of 47 clinical departments, 13 medical technology departments, 6 research institutes, in which has 5 clinical specialty construction project of the Ministry of health national (Cardiovascular Department of internal medicine, Intensive care medicine, Department of Neurosurgery, Cardiovascular surgery, Respiratory and Critical care medicine);2 advantage discipline of the autonomous region. (Department of Cardiology, Department of Neurosurgery).Ⅱ.Teaching workGeneral hospital (including clinical medicine college) is the only affiliated hospitals of Ningxia Medical University. It has been to bear the heavy late clinical teaching work for years, to train a batch of another batch of medical personnel in Ningxia Province. It lay the foundations for the medical education and the development of medical and health cause. Therefore it’s made a great Contribution to promote economic development in Ningxia Province.Ⅲ.Scientific research workIn recent 5 years, the hospital has won 66 National Natural Science Funds and 339 provincial and ministerial level scientific research projects. It made a very important contribution to rise a level of medical scientific research development in Ningxia Province.Ⅳ.Device configurationThe hospital has many advanced 3.0T NMR, PET-CT, CT, GE gem / 64 row helical CT, full-field digital mammography, high-end four-dimensional colorDoppler ultrasound, high-end bone density instrument, SPECT-CT, DSA, multi functional digital X-ray machine, full automatic biochemical lines, automatic blood lines, full automatic chemiluminescence analyzer, 454 sequencing instrument and the more largely high-end, precise, top technology medical equipments.The department of neurosurgery in the hospital was formally established in May 1987. By several years of stormy history, it has been developed into a set of medical, teaching, researching department which has a leading position in the whole region through several generations of experts’ and professors’unremitting efforts and exploration. In 2001, it won the "Municipal key disciplines" title. In 2011, it won the "national key specialist" title of Ministry of health.The department of neurosurgery has 125 beds (including 6 beds in ICU ward). The personnel structure is 18 Deputy Chief Physician, including 1 doctoral tutor, 9 master tutor, 4Dr. and 20master. The departments treated patients for more than 2000 people per year, nearly 1300 operations per year. The patients were involved in Ningxia, Shanxi, Gansu and Inner Mongolia Province. It can carry out the operation as follows : all types of craniocerebral trauma operation; various parts of the brain tumor; spinal tumor operation; transsphenoidal pituitary tumor operation; intracranial aneurysm clipping operation; intracranial aneurysm embolization operation; after intraventricular endoscopy with intraventricular tumor operation; function department of neurosurgery operation etc. In the Northwest Region , it has a leading level, parts of operation can be reached the domestic advanced level.。
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General Hospital of Ningxia Medical University was founded in 1935, formerly known as Ningxia provincial hospital before the liberation. The hospital is located in Yinchuan which is the capital City of Ningxia Province. It covers an area of 230,000 square metres (350.7 acres) and a building area of 266,000 square meters. In 2011, it officially changed its name to the General Hospital of Ningxia Medical University, which administered the 7 branches. It is a set of medical, teaching, scientific research, training, examination, preventive care and health functions in one of modern comprehensive three A-level hospital. As a regional medical, scientific research, education, examination and training center, General Hospital of Ningxia Medical University leads the development of medical enterprise. At present, it has been already ranked the leading level between China Northwest and Inner Mongolia, Shanxi seven provinces (area).Ⅰ.Discipline construction and developmentGeneral Hospital of Ningxia Medical University has a total of 4525in-services staff, including 64 doctors and 599 master personnel. General Hospital has 2186 open beds, outpatients volume per-year reaches 1005100 person-time. For one year, patients discharged from hospital can be achieved 70300 person-time and operation volume can be 40200 person-time. Its medical care, teaching, scientific research and examination training cover up a radiation of over 500 kilometers, serving a population of about 13 million.General hospital services a wide range of specialist and has a rapid development. It set up a total of 47 clinical departments, 13 medical technology departments, 6 research institutes, in which has 5 clinical specialty construction project of the Ministry of health national (Cardiovascular Department of internal medicine, Intensive care medicine, Department of Neurosurgery, Cardiovascular surgery, Respiratory and Critical care medicine);2 advantage discipline of the autonomous region. (Department of Cardiology, Department of Neurosurgery).Ⅱ.Teaching workGeneral hospital (including clinical medicine college) is the only affiliated hospitals of Ningxia Medical University. It has been to bear the heavy late clinical teaching work for years, to train a batch of another batch of medical personnel in Ningxia Province. It lay the foundations for the medical education and the development of medical and health cause. Therefore it’s made a great Contribution to promote economic development in Ningxia Province.Ⅲ.Scientific research workIn recent 5 years, the hospital has won 66 National Natural Science Funds and 339 provincial and ministerial level scientific research projects. It made a very important contribution to rise a level of medical scientific research development in Ningxia Province.Ⅳ.Device configurationThe hospital has many advanced 3.0T NMR, PET-CT, CT, GE gem / 64 row helical CT, full-field digital mammography, high-end four-dimensional colorDoppler ultrasound, high-end bone density instrument, SPECT-CT, DSA, multi functional digital X-ray machine, full automatic biochemical lines, automatic blood lines, full automatic chemiluminescence analyzer, 454 sequencing instrument and the more largely high-end, precise, top technology medical equipments.The department of neurosurgery in the hospital was formally established in May 1987. By several years of stormy history, it has been developed into a set of medical, teaching, researching department which has a leading position in the whole region through several generations of experts’ and professors’unremitting efforts and exploration. In 2001, it won the "Municipal key disciplines" title. In 2011, it won the "national key specialist" title of Ministry of health.The department of neurosurgery has 125 beds (including 6 beds in ICU ward). The personnel structure is 18 Deputy Chief Physician, including 1 doctoral tutor, 9 master tutor, 4Dr. and 20master. The departments treated patients for more than 2000 people per year, nearly 1300 operations per year. The patients were involved in Ningxia, Shanxi, Gansu and Inner Mongolia Province. It can carry out the operation as follows : all types of craniocerebral trauma operation; various parts of the brain tumor; spinal tumor operation; transsphenoidal pituitary tumor operation; intracranial aneurysm clipping operation; intracranial aneurysm embolization operation; after intraventricular endoscopy with intraventricular tumor operation; function department of neurosurgery operation etc. In the Northwest Region , it has a leading level, parts of operation can be reached the domestic advanced level.。