全身免疫炎症指数对慢性肾脏病非透析患者左心室肥厚的评估价值

李新丽, 沈蕾, 芦源, 费梅, 李建中, 徐德宇, 周玲, 卢国元

李新丽, 沈蕾, 芦源, 费梅, 李建中, 徐德宇, 周玲, 卢国元. 全身免疫炎症指数对慢性肾脏病非透析患者左心室肥厚的评估价值[J]. 实用临床医药杂志, 2022, 26(3): 44-49. DOI: 10.7619/jcmp.20213497
引用本文: 李新丽, 沈蕾, 芦源, 费梅, 李建中, 徐德宇, 周玲, 卢国元. 全身免疫炎症指数对慢性肾脏病非透析患者左心室肥厚的评估价值[J]. 实用临床医药杂志, 2022, 26(3): 44-49. DOI: 10.7619/jcmp.20213497
LI Xinli, SHEN Lei, LU Yuan, FEI Mei, LI Jianzhong, XU Deyu, ZHOU Ling, LU Guoyuan. Evaluation value of systemic immune inflammation index for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease[J]. Journal of Clinical Medicine in Practice, 2022, 26(3): 44-49. DOI: 10.7619/jcmp.20213497
Citation: LI Xinli, SHEN Lei, LU Yuan, FEI Mei, LI Jianzhong, XU Deyu, ZHOU Ling, LU Guoyuan. Evaluation value of systemic immune inflammation index for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease[J]. Journal of Clinical Medicine in Practice, 2022, 26(3): 44-49. DOI: 10.7619/jcmp.20213497

全身免疫炎症指数对慢性肾脏病非透析患者左心室肥厚的评估价值

基金项目: 

江苏省苏州市科学技术局项目 SS2019055

详细信息
    通讯作者:

    沈蕾, E-mail: shenlei2073@163.com

  • 中图分类号: R692.5;R446

Evaluation value of systemic immune inflammation index for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease

  • 摘要:
      目的  探讨非透析的慢性肾脏病(CKD)患者左心室肥厚(LVH)的发生情况及相关危险因素, 分析全身免疫炎症指数(SII)对LVH的评估价值。
      方法  选取CKD患者196例为研究对象(CKD组),根据性别分为CKD男性组117例和CKD女性组79例,并选取同期40例健康者为对照组。收集并分析3组实验室指标及心脏超声资料。分析左心室质量指数(LVMI)与其他指标的相关性。采用Logistic回归分析LVH的危险因素,以及分析SII与LVH的关系。
      结果  男性、女性LVH患病率分别为31.62%、50.63%。收缩压(SBP)升高、血红蛋白(Hb)降低、SII升高是男性患者LVH发生的独立危险因素,而高龄、Hb降低、尿酸(UA)上升是女性患者LVH发生的独立危险因素(P<0.05)。
      结论  LVH在非透析的CKD患者中普遍存在,且女性患者较多。贫血是所有CKD患者LVH的危险因素, SII升高是男性患者LVH的危险因素。
    Abstract:
      Objective  To investigate the incidence and risk factors of left ventricular hypertrophy (LVH) in non-dialysis patients with chronic kidney disease (CKD), and to analyze the value of systemic immune inflammation index (SII) in evaluating LVH.
      Methods  A total of 196 non-dialysis patients with CKD were selected as study subjects (CKD group). According to gender, 196 cases were divided into male CKD group (n=117) and female CKD group (n=79), and 40 healthy subjects in the same period were selected as control group. The laboratory indexes and cardiac ultrasound data of three groups were collected and analyzed. The correlation between left ventricular mass index (LVMI) and other indexes was analyzed. Logistic regression was used to analyze the risk factors of LVH and the relationship between SII and LVH(P<0.05).
      Results  The prevalence of LVH in male and female was 31.62% and 50.63%, respectively. Increased systolic blood pressure (SBP), decreased hemoglobin (Hb) and increased SII were independent risk factors for LVH in male patients, while older age, decreased Hb and increased uric acid (UA) were independent risk factors for LVH in female patients.
      Conclusion  LVH is common in non-dialysis patients with CKD, and there are more female patients. Anemia is a risk factor for LVH in all CKD patients while SII is a risk factor for LVH in men.
  • 图  1   基于性别的CKD各期LVH发生情况

    表  1   CKD组与对照组临床指标比较(x±s)[M(P25, P75)]

      指标 CKD男性组(n=117) CKD女性组(n=79) 对照组(n=40)
    年龄/岁 57.50(46.00, 66.00) 55.50(43.00, 67.50) 54.00(47.25, 63.00)
    体质量指数/(kg/m2) 24.03(22.15, 27.16)# 22.68(20.79, 26.13) 22.98(21.22, 26.37)
    收缩压/mmHg 139.50(129.75, 153.00)* 138.00(124.00, 153.50)* 124.50(115.00, 135.00)
    舒张压/mmHg 81.93±10.42 78.70±11.67 79.30±12.78
    平均动脉压/mmHg 101.72±10.10* 98.23±12.14 95.41±15.12
    脉压/mmHg 57.75(47.00, 68.00)* 58.25(46.50, 68.75)* 45.50(40.00, 54.50)
    中性粒细胞与淋巴细胞比值 2.83(1.95, 4.23)* 2.95(2.02, 4.56)* 1.71(1.37, 2.04)
    淋巴细胞与单核细胞比值 2.87(2.26, 4.00)* 2.95(1.98, 4.27)* 4.77(3.85, 5.74)
    血小板与淋巴细胞比值 113.23(89.84, 147.02) 116.35(93.69, 155.52) 111.05(85.49, 136.19)
    全身免疫炎症指数/(×1012/L) 472.92(303.26, 663.45)* 430.50(309.39, 577.46)* 310.06(263.65, 404.09)
    血红蛋白/(g/L) 121.50(96.00, 138.00)*# 108.00(87.00, 122.00)* 138.50(129.25, 153.25)
    红细胞分布宽度/% 12.80(12.10, 13.40) 12.95(12.40, 13.60) 12.50(12.03, 13.20)
    血小板/(×1012/L) 195.25±61.87 206.62±70.29 199.56±63.49
    碱性磷酸酶/(U/L) 64.70(54.30, 82.30) 59.95(45.75, 85.10) 61.35(50.30, 71.68)
    白蛋白/(g/L) 38.45(34.10, 41.70)* 38.45(34.5, 42.00)* 43.75(42.75, 46.48)
    尿素氮/(mmol/L) 11.20(7.70, 22.80)* 12.30(5.90, 21.45)* 5.45(4.60, 6.18)
    血清肌酐/(μmol/L) 201.00(129.30, 393.30)* 201.05(83.05, 383.00)* 62.00(52.98, 71.40)
    尿酸/(μmol/L) 438.90(373.20, 519.50)*# 399.65(326.40, 491.15)* 337.70(275.73, 389.25)
    血糖/(mmol/L) 4.88(4.39, 5.39) 4.84(4.41, 5.74) 4.89(4.49, 5.39)
    总胆固醇/(mmol/L) 4.42(3.83, 5.15)# 4.94(4.275, 5.85) 4.80(4.29, 5.54)
    甘油三酯/(mmol/L) 1.47(1.08, 2.24)* 1.51(1.15, 2.36)* 1.20(0.82, 1.44)
    高密度脂蛋白胆固醇/(mmol/L) 0.97(0.79, 1.14)* 1.22(0.97, 1.45)* 1.26(1.06, 1.56)
    低密度脂蛋白胆固醇/(mmol/L) 2.53(1.79, 3.33) 2.66(2.00, 3.31) 3.01(2.39, 3.38)
    钙/(mmol/L) 2.21(2.11, 2.32) 2.21(2.13, 2.33) -
    磷/(mmol/L) 1.25(1.06, 1.53) 1.35(1.20, 1.54) -
    超敏C反应蛋白/(mg/L) 1.35(0.47, 2.95)* 0.98(0.35, 3.29)* 1.72(1.44, 2.84)
    eGFR/[mL/(min·1.73 m2)] 29.08(12.60, 52.05)* 23.65(11.14, 72.50)* 105.03(98.91, 118.54)
    eGFR: 估算肾小球滤过率。与对照组比较, *P<0.05; 与CKD女性组比较, #P<0.05。
    下载: 导出CSV

    表  2   CKD组与对照组心脏超声指标比较[M(P25, P75)][n(%)]

    指标 CKD男性组(n=117) CKD女性组(n=79) 对照组(n=40)
    左房内径/mm 38.00(35.00, 42.00)* 38.00(33.50, 41.50)* 34.00(32.00, 38.00)
    室间隔厚度/mm 10.00(9.00, 11.00)*# 9.00(9.00, 10.00)* 9.00(8.00, 9.00)
    左心室舒张末内径/mm 51.00(47.00, 54.00)*# 47.50(44.00, 51.00) 46.00(43.25, 49.00)
    左室舒张期后壁厚度/mm 10.00(9.00, 10.00)* 9.00(8.50, 10.00)* 9.00(8.00, 9.75)
    左心室质量/g 181.98(153.42, 213.18)*# 153.09(127.73, 175.61)* 135.79(109.44, 164.13)
    左心室质量指数/(g/m2) 104.90(83.20, 120.84)* 95.87(84.23, 114.70)* 79.61(69.89, 95.13)
    相对室壁厚度/mm 0.39(0.36, 0.42) 0.38(0.36, 0.41) 0.37(0.35, 0.40)
    EF值/% 65.00(61.00, 69.00)* 67.00(63.00, 69.00) 67.00(65.00, 69.00)
    左心室肥厚 37(31.62) 40(50.63) -
    EF: 射血分数。与对照组比较, *P<0.05; 与CKD女性组比较, #P<0.05。
    下载: 导出CSV

    表  3   LVMI与临床指标的相关性分析

      自变量 CKD男性组(n=117) CKD女性组(n=79)
    r P r P
    年龄/岁 0.109 0.242 0.482 < 0.001
    体质量指数/(kg/m2) 0.053 0.570 -0.074 0.516
    收缩压/mmHg 0.411 < 0.001 0.366 0.001
    舒张压/mmHg -0.130 0.163 -0.139 0.221
    平均动脉压/mmHg 0.131 0.158 0.101 0.377
    脉压/mmHg 0.477 < 0.001 0.509 < 0.001
    中性粒细胞与淋巴细胞比值 -0.003 0.978 -0.093 0.415
    淋巴细胞与单核细胞比值 0.086 0.357 0.129 0.258
    血小板与淋巴细胞比值 0.277 0.002 0.024 0.834
    全身免疫炎症指数/(×1012/L) 0.284 0.002 -0.050 0.659
    血红蛋白/(g/L) -0.635 < 0.001 -0.625 < 0.001
    红细胞分布宽度/% 0.373 < 0.001 0.318 0.004
    血小板/(×1012/L) -0.106 0.255 -0.394 < 0.001
    碱性磷酸酶/(U/L) 0.046 0.619 0.177 0.119
    白蛋白/(g/L) -0.204 0.027 -0.083 0.469
    尿素氮/(mmol/L) 0.537 < 0.001 0.576 < 0.001
    血清肌酐/(μmol/L) 0.615 < 0.001 0.585 < 0.001
    尿酸/(μmol/L) 0.007 0.944 0.413 < 0.001
    血糖/(mmol/L) 0.030 0.748 -0.085 0.457
    总胆固醇/(mmol/L) -0.264 0.004 -0.246 0.029
    甘油三酯/(mmol/L) -0.097 0.299 0.108 0.342
    高密度脂蛋白胆固醇/(mmol/L) -0.260 0.005 -0.336 0.002
    低密度脂蛋白胆固醇/(mmol/L) -0.226 0.014 -0.330 0.003
    钙/(mmol/L) -0.377 < 0.001 -0.257 0.022
    磷/(mmol/L) 0.415 < 0.001 0.213 0.059
    超敏C反应蛋白/(mg/L) -0.064 0.496 0.021 0.853
    eGFR/[mL/(min·1.73 m2)] -0.398 < 0.001 -0.487 < 0.001
    eGFR: 估算肾小球滤过率。
    下载: 导出CSV

    表  4   影响CKD男性组患者LVH的Logistic回归分析

      自变量 单因素Logistic回归分析 多因素Logistic回归分析
    OR(95%CI) P OR(95%CI) P
    年龄/岁 1.010(0.984~1.036) 0.461 - -
    体质量指数/(kg/m2) 1.063(0.946~1.194) 0.306 - -
    收缩压/mmHg 1.056(1.025~1.087) < 0.001 1.033(1.001~1.066) 0.043
    舒张压/mmHg 0.992(0.955~1.030) 0.662 - -
    平均动脉压/mmHg 1.037(0.996~1.080) 0.079 - -
    脉压/mmHg 1.057(1.028~1.087) < 0.001 - -
    中性粒细胞与淋巴细胞比值 1.142(0.888~1.467) 0.300 - -
    淋巴细胞与单核细胞比值 1.169(0.867~1.574) 0.305 - -
    血小板与淋巴细胞比值 1.013(1.005~1.022) 0.003 - -
    全身免疫炎症指数/(×1012/L) 1.002(1.001~1.004) 0.001 1.002(1.001~1.004) 0.009
    血红蛋白/(g/L) 0.959(0.942~0.976) < 0.001 0.962(0.943~0.981) < 0.001
    红细胞分布宽度/% 1.822(1.235~2.687) 0.003 - -
    血小板/(×1012/L) 0.999(0.993~1.005) 0.744 - -
    碱性磷酸酶/(U/L) 1.017(0.999~1.034) 0.066 - -
    白蛋白/(g/L) 0.955(0.897~1.017) 0.151 - -
    尿素氮/(mmol/L) 1.073(1.032~1.115) < 0.001 - -
    血清肌酐/(μmol/L) 1.004(1.002~1.006) < 0.001 - -
    尿酸/(μmol/L) 1.002(0.999~1.006) 0.223 - -
    血糖/(mmol/L) 1.141(0.879~1.481) 0.320 - -
    总胆固醇/(mmol/L) 0.669(0.461~0.970) 0.034 - -
    甘油三酯/(mmol/L) 0.746(0.500~1.114) 0.152 - -
    高密度脂蛋白胆固醇/(mmol/L) 0.179(0.039~0.821) 0.027 - -
    低密度脂蛋白胆固醇/(mmol/L) 0.724(0.491~1.067) 0.103 - -
    钙/(mmol/L) 0.005(0~0.100) 0.001 - -
    磷/(mmol/L) 4.238(1.609~11.166) 0.003 - -
    超敏C反应蛋白/(mg/L) 1.019(0.898~1.157) 0.769 - -
    eGFR/[mL/(min·1.73 m2)] 0.973(0.956~0.990) 0.002 - -
    eGFR: 估算肾小球滤过率。
    下载: 导出CSV

    表  5   影响CKD女性组患者LVH的Logistic回归分析

      自变量 单因素Logistic回归分析 多因素Logistic回归分析
    OR(95%CI) P OR(95%CI) P
    年龄/岁 1.068(1.031~1.107) < 0.001 1.064(1.019~1.111) 0.005
    体质量指数/(kg/m2) 1.005(0.909~1.111) 0.919 - -
    收缩压/mmHg 1.032(1.006~1.059) 0.017 - -
    舒张压/mmHg 0.970(0.932~1.009) 0.133 - -
    平均动脉压/mmHg 1.006(0.970~1.043) 0.761 - -
    脉压/mmHg 1.068(1.029~1.108) 0.001 - -
    中性粒细胞与淋巴细胞比值 0.929(0.731~1.181) 0.548 - -
    淋巴细胞与单核细胞比值 1.044(0.795~1.371) 0.756 - -
    血小板与淋巴细胞比值 0.998(0.990~1.005) 0.543 - -
    全身免疫炎症指数/(×1012/L) 1.000(0.999~1.001) 0.923 - -
    血红蛋白/(g/L) 0.942(0.916~0.969) < 0.001 0.953(0.926~0.982) 0.002
    红细胞分布宽度/% 1.593(1.041~2.439) 0.032 - -
    血小板/(×1012/L) 0.986(0.977~0.994) 0.001 - -
    碱性磷酸酶/(U/L) 1.013(0.995~1.032) 0.150 - -
    白蛋白/(g/L) 0.999(0.938~1.064) 0.974 - -
    尿素氮/(mmol/L) 1.095(1.036~1.157) 0.001 - -
    血清肌酐/(μmol/L) 1.004(1.002~1.007) 0.001 - -
    尿酸/(μmol/L) 1.006(1.002~1.011) 0.004 1.006(1.001~1.012) 0.031
    血糖/(mmol/L) 0.735(0.507~1.064) 0.102 - -
    总胆固醇/(mmol/L) 0.578(0.372~0.898) 0.015 - -
    甘油三酯/(mmol/L) 0.957(0.664~1.380) 0.814 - -
    高密度脂蛋白胆固醇/(mmol/L) 0.148(0.035~0.618) 0.009 - -
    低密度脂蛋白胆固醇/(mmol/L) 0.457(0.262~0.795) 0.006 - -
    钙/(mmol/L) 0.056(0.002~1.288) 0.072 - -
    磷/(mmol/L) 4.108(0.965~7.482) 0.056 - -
    超敏C反应蛋白/(mg/L) 1.027(0.916~1.152) 0.650 - -
    eGFR/(mL/min/1.73 m2) 0.970(0.954~0.986) < 0.001 - -
    eGFR: 估算肾小球滤过率。
    下载: 导出CSV
  • [1]

    JHA V, GARCIA-GARCIA G, ISEKI K, et al. Chronic kidney disease: global dimension and perspectives[J]. Lancet, 2013, 382(9888): 260-272. doi: 10.1016/S0140-6736(13)60687-X

    [2]

    PARK M, HSU C Y, LI Y M, et al. Associations between kidney function and subclinical cardiac abnormalities in CKD[J]. J Am Soc Nephrol, 2012, 23(10): 1725-1734. doi: 10.1681/ASN.2012020145

    [3]

    LONDON G M, PANNIER B, GUERIN A P, et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study[J]. J Am Soc Nephrol, 2001, 12(12): 2759-2767. doi: 10.1681/ASN.V12122759

    [4]

    ZOCCALI C, BENEDETTO F A, MALLAMACI F, et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression[J]. Kidney Int, 2004, 65(4): 1492-1498. doi: 10.1111/j.1523-1755.2004.00530.x

    [5]

    MASIHA S, SUNDSTRÖM J, LIND L. Inflammatory markers are associated with left ventricular hypertrophy and diastolic dysfunction in a population-based sample of elderly men and women[J]. J Hum Hypertens, 27(1): 13-17. doi: 10.1038/jhh.2011.113

    [6] 卢进, 张洪旭, 张育琴, 等. 维持性血液透析患者发生左心室肥厚的影响因素及RDW、hs-CRP的预测价值[J]. 中国医药导报, 2020, 17(12): 185-188. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202012047.htm
    [7] 权钰迪, 周巧, 冯锦红, 等. 控制营养状态评分和血小板/淋巴细胞比值与腹膜透析患者左心室肥厚的关系[J]. 临床肾脏病杂志, 2020, 20(12): 946-950. doi: 10.3969/j.issn.1671-2390.2020.12.003
    [8] 史倩雯, 胡雅玲, 范彦君, 等. 维持性血液透析患者中性粒细胞/淋巴细胞比值与左心室肥厚的临床研究[J]. 中国中西医结合肾病杂志, 2020, 21(1): 49-52. doi: 10.3969/j.issn.1009-587X.2020.01.016
    [9] 韩博, 吴舜, 何先东, 等. 基于免疫细胞计数的系统性炎症反应指数在预测肾透明细胞癌患者预后中的作用研究[J]. 免疫学杂志, 2020, 36(2): 160-164, 184. https://www.cnki.com.cn/Article/CJFDTOTAL-MYXZ202002014.htm
    [10] 罗永祥, 周涛. 全身免疫炎症指数对失代偿期肝硬化患者预后的评估价值[J]. 中国肝脏病杂志: 电子版, 2021, 13(1): 52-58. doi: 10.3969/j.issn.1674-7380.2021.01.009
    [11]

    STEVENS L A, LI S Y, WANG C C, et al. Prevalence of CKD and comorbid illness in elderly patients in the United States: results from the Kidney Early Evaluation Program (KEEP)[J]. Am J Kidney Dis, 2010, 55(3 Suppl 2): S23-S33.

    [12]

    PAOLETTI E, BELLINO D, CASSOTTANA P, et al. Left ventricular hypertrophy in nondiabetic predialysis CKD[J]. Am J Kidney Dis, 2005, 46(2): 320-327. doi: 10.1053/j.ajkd.2005.04.031

    [13] 侯凡凡, 马志刚, 梅长林, 等. 中国五省市自治区慢性肾脏病患者心血管疾病的患病率调查[J]. 中华医学杂志, 2005, 85(7): 458-463. doi: 10.3760/j:issn:0376-2491.2005.07.009
    [14] 肖玉枝. 性激素在女性心血管疾病中的作用研究[J]. 中外健康文摘, 2010, 7(11): 104-106.
    [15] 王朝霞, 吕吉元. 绝经后雌激素补充治疗与女性心血管疾病关系研究进展[J]. 中西医结合心脑血管病杂志, 2015, 13(4): 502-505. doi: 10.3969/j.issn.16721349.2015.04.029
    [16] 孙宁玲, CHEN J W, 王继光, 等. 亚洲高血压合并左心室肥厚诊治专家共识[J]. 中华高血压杂志, 2016, 24(7): 619-627, 600. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ201607008.htm
    [17] 冉兵, 晁玥, 安县朝, 等. 高血压左室肥厚伴左心衰竭的心脏彩超诊断分析[J]. 实用临床医药杂志, 2017, 21(23): 122-123. doi: 10.7619/jcmp.201723045
    [18]

    DI LULLO L, GORINI A, RUSSO D, et al. Left ventricular hypertrophy in chronic kidney disease patients: from pathophysiology to treatment[J]. Cardiorenal Med, 2015, 5(4): 254-266. doi: 10.1159/000435838

    [19]

    YOUSIF N G, HADI N R, AL-AMRAN F, et al. Cardioprotective effects of irbesartan in polymicrobial Sepsis: the role of the p38MAPK/NF-κB signaling pathway[J]. Herz, 2018, 43(2): 140-145.

    [20]

    MATSUMOTO M, IO H, FURUKAWA M, et al. Risk factors associated with increased left ventricular mass index in chronic kidney disease patients evaluated using echocardiography[J]. J Nephrol, 2012, 25(5): 794-801. doi: 10.5301/jn.5000066

    [21]

    LONDON G M. Left ventricular hypertrophy: why does it happen[J]. Nephrol Dial Transplant, 2003, 18(Suppl 8): viii2-viii6.

    [22]

    PORTOLÉS J, TORRALBO A, MARTIN P, et al. Cardiovascular effects of recombinant human erythropoietin in predialysis patients[J]. Am J Kidney Dis, 1997, 29(4): 541-548.

  • 期刊类型引用(8)

    1. 杨超,刘兵,马翔宇,韩宁,薛海鹏,王冠,张志文,韩天宇. Masquelet技术联合抗生素骨水泥涂层髓内钉治疗胫骨干感染性骨不连疗效观察. 创伤与急危重病医学. 2023(03): 162-164+169 . 百度学术
    2. 杨鈜,张陪根,张建寿,王能达. 复杂性胫骨干骨折X射线及CT检查的诊断价值及预后分析. 实用医院临床杂志. 2021(04): 220-223 . 百度学术
    3. 唐犁春. 影响胫腓骨开放骨折患者术后发生术区感染的相关因素分析. 现代医学与健康研究电子杂志. 2021(22): 107-109 . 百度学术
    4. 李婷婷,程亮,赵葵兵,王豫. 开放性胫骨骨折病人层流净化手术室术中切口感染多因素Logistic分析. 全科护理. 2020(30): 4170-4173 . 百度学术
    5. 刘凤珍,莫东霞,莫敏. 胫腓骨骨折围手术期护理研究. 智慧健康. 2019(19): 53-55 . 百度学术
    6. 魏英俊,徐克武,蒋宜伟,张文贤,贾柯. 胫骨骨折内固定术后感染的相关危险因素. 中医正骨. 2018(05): 37-39+42 . 百度学术
    7. 李筱轶,秦瑾,冯忠军,闻海丰. 开放骨折清创术后患者住院费用的多元线性回归分析. 河北医药. 2018(23): 3574-3577 . 百度学术
    8. 吴芬琳,李丽娟,唐雅璇. 基于医疗软件开发课程的社区医院信息管理智能分析系统. 电脑知识与技术. 2017(30): 13-14 . 百度学术

    其他类型引用(2)

图(1)  /  表(5)
计量
  • 文章访问数:  236
  • HTML全文浏览量:  159
  • PDF下载量:  14
  • 被引次数: 10
出版历程
  • 收稿日期:  2021-08-29
  • 网络出版日期:  2022-03-04
  • 发布日期:  2022-02-14

目录

    /

    返回文章
    返回