类风湿性关节炎与骨质疏松关系的探讨

目的 了解类风湿性关节炎（RA）患者骨密度（BMD）的变化和骨质疏松（OP）的发生情况。方法 采用双能X线骨密度仪（DEXA）对45例50-70岁的男性类风湿性关节炎患者和80例正常健康男性进行腰椎（L2～L4）、左股骨上端（股骨颈、Ward’s三角区、大转子）骨密度测定,所得数据进行统计分析。结果 类风湿性关节炎组无论腰椎或股骨上端的骨量丢失较健康对照组差异有显著性（P〈0．05）,类风湿性关节炎患者骨密度明显低于健康对照组,骨质疏松患病率91％。结论 类风湿性关节炎患者存在着明显的骨质丢失。     

中老年女性类风湿关节炎患者骨丢失临床特点分析

目的　探讨中老年女性类风湿关节炎（RA）患者骨丢失的临床特点。方法　选取2008年8月—2016年6月在四川省人民医院风湿科门诊确诊的年龄≥40岁女性RA患者543例为RA组,另于同期在本院收集年龄≥40岁女性健康体检者1 742例为对照组。比较两组不同年龄段受试者腰椎正位L1-4、左侧股骨颈（NECK）、华氏区（WARDS）、大转子（TROCH）、股骨干（SHAFT）、全髋骨（TOTAL）部位的骨密度（BMD）及腰椎、股骨部位骨质疏松（OP）情况。结果　RA组40~49、50~59岁受试者L1、L2、L3、L4及L1-4部位BMD低于对照组,差异有统计学意义（P<0.05）;两组60~69、70~79、≥80岁受试者L1、L2、L3、L4及L1-4部位BMD比较,差异无统计学意义（P>0.05）。RA组40~49、50~59、60~69岁受试者NECK、WARDS、TROCH、SHAFT、TOTAL部位BMD低于对照组,差异有统计学意义（P<0.05）;两组≥80岁受试者NECK、WARDS、TROCH、SHAFT、TOTAL部位BMD比较,差异无统计学意义（P>0.05）。RA组40~49、50~59岁受试者腰椎、股骨的OP发生率以及60~69岁受试者股骨的OP发生率高于对照组,差异有统计学意义（P<0.05）;两组60~69岁受试者腰椎的OP发生率以及70~79、≥80岁受试者腰椎、股骨的OP发生率比较,差异无统计学意义（P>0.05）。结论　RA可以增加患者的骨丢失和OP发生风险,且其对不同年龄和不同部位的影响存在差异;中老年RA患者应注意OP的防治。     

类风湿关节炎患者骨质疏松情况分析

目的：了解类风湿关节炎（rheumatoid arthritis ,RA）患者骨质疏松（osteoporosis ,OP）的发生情况,并探讨其相关影响因素。方法使用双能X线骨密度仪测量64例RA 患者的股骨颈、Ward’s三角区、大转子、腰椎骨密度（bone mineral density ,BMD）,并予60例年龄、性别、体重指数匹配的健康志愿者作为对照组。结果 RA 组在腰椎（L2～ L4）、股骨上端（股骨颈、Ward’ s 三角区、大转子）的BMD较对照组均明显降低,差异有统计学意义（P＜0.05）。结论 RA 患者普遍发生BMD下降,骨量减少和O P发病率均显著高于对照组,其发病机制可能与 RA 本身及糖皮质激素的长期应用等因素相关。     

女性Colles''''骨折患者骨密度分析

目的 探讨由轻创伤引起的伸直型桡骨远端骨折(Cones’骨折)与患者骨密度(BMD)关系，为骨质疏松的预防和治疗提供依据。方法 对76例40—70岁由轻创伤引起Colles’骨折的女性患者和92例同年龄无骨折史的女性，用双能X线骨密度仪(DEXA)测量腰椎、左股骨上端BMD，对数据进行统计分析。结果 Colles’骨折组BMD明显低于同年龄对照组，其腰椎和左股骨上端Wardg三角区骨质疏松(OP)检出率分别为31．48％和51．18％。结论 40—70岁女性由轻创伤引起的Colles’骨折与BMD有密切关系。     

陕西地区正常人骨密度测量结果分析

目的：获得正常人骨密度（BMD）参数，明确不同性别、不同部位的骨峰值及骨质疏松的诊断标准，为骨质疏松症的群体防治提供科学依据。方法：采用美国Luner公司生产的DPX－IQ型双能X线骨密度测度仪（DXA），随机对陕西地区20－89岁的受试者2524人进行腰椎（L2－4）及股骨上端（Neck,Ward's,Troch)的BMD测定。结果：骨峰值男性明显高于女性，且较女性早10a，骨峰值平均在20－39岁，无明显性别差异；在任何年龄都是女性的骨量小于男性；BMD的变化与年龄增长关系密切，女性存在着与年龄因素和绝经期因素有关的骨量丢失；松质骨（腰椎和股骨上端各部位）从30岁以后，随年龄增长骨量逐渐丢失，股骨上部各部位BMD累积丢失率明显高于腰椎。结论：不同部位松质骨骨量丢失也存在着较大的差异，以股骨Ward's三角最敏感。     

女性类风湿关节炎患者骨密度变化的影响因素

目的:探讨女性类风湿关节炎(RA)患者骨质疏松(OP)的危险因素及其与临床指标的相关性。方法:使用双能X线骨密度仪测定115例女性RA患者和101名健康女性L1～L4、股骨颈、全髋等部位骨密度(BMD),并观察患者的疾病活动指标和实验室指标。结果:女性RA患者患OP发生率高于健康女性(P0.01),其各部位BMD均低于对照组(P0.05～P0.01)。OP组RA患者各部位BMD均明显低于非OP组(P0.01)。OP组患者年龄更大、绝经年数更长、病程和晨僵时间更长、疼痛关节数更多、HAQ平均积分更高、关节功能和X线分期更差(P0.05～P0.01)。RA组OP性骨折的概率明显高于健康女性(P0.01),使用糖皮质激素的RA患者第L1～L4的BMD低于未使用患者(P0.05)。Logistic Regression分析显示绝经[OR=4.582(1.503～13.974),P0.01]和X线分期[OR=2.267(1.233～4.167),P0.01]为RA患者OP发生的主要危险因素。结论:女性RA患者发生OP和骨折风险均显著高于健康女性,其OP的发生和多因素相关,绝经年数更长、X线分期较差、使用糖皮质激素是RA患者发生OP的主要危险因素。     

定量CT测量腰椎和股骨近端骨矿含量

目的：了解椎体和股骨近端松质骨骨密度(BMD)变化的规律,为骨质疏松（OP）防治提供依据。方法：对436例20~74岁正常人的第2~4腰椎和股骨近端的松质骨做定量CT（QCT）测量,测量结果按5岁1个年龄组进行统计学相关性分析。结果：男性及女性腰椎、股骨近端BMD随年龄增加而降低,与年龄呈负相关,男性BMD与年龄的直线相关方程：腰椎BMD=218.61－1.53×年龄(r=-0.6109,P<0.001), 股骨近端 BMD=236.0－1.99×年龄(r=-0.5967, P<0.001);女性BMD与年龄的直线相关方程： 腰椎BMD=269.5－2.77×年龄(r=-.7085,P<0.001) ,股骨近端BMD=259.9－2.46×年龄 (r=-0.6289,P<0.001)。男性BMD下降较平缓,女性45岁之后腰椎BMD下降加速,统计学结果低于男性（P<0.001）;男性股骨近端累积丢失率、OP检出 率均大于腰椎,而女性腰椎骨累积丢失率、OP检出率大于股骨近端。结论：男性应注重测量髋部BMD,女性特别是绝经后妇女腰椎BMD的测量对OP的早期诊断有重要意义。     

类风湿关节炎患者血清骨形态发生蛋白6与骨质疏松的关系

目的 探讨类风湿关节炎（RA）患者骨形态发生蛋白（BMP）-6与骨质疏松（OP）的关系.方法 比较分析99例RA患者与40例健康组及RA患者中不同骨密度组间BMP-6以及其他因子水平,以及各因子之间的相关性.结果 RA患者OP发生率明显高于健康组,其腰椎和股骨颈的骨矿密度（BMD）均低于健康组,而其血清BMP-6浓度明显升高（均P＜0.05）.RA伴OP的患者BMP-6水平明显升高,抗环瓜氨酸（CCP）抗体水平也明显升高（均P＜0.05）;RA患者的腰椎BMD和股骨颈BMD正相关（r=0.817,P＜ 0.01）,而腰椎BMD与血清BMP-6及年龄负相关（r=-0.393、-0.449,均P＜0.05）;股骨颈BMD则与年龄及抗CCP抗体水平负相关（r=-0.551、-0.458,均P＜0.05）.RA患者血清BMP-6浓度与DAS28评分及IL-6、TNF-α浓度正相关（r=0.249、0.237、0.263,均P＜0.05）.结论 BMP-6水平异常可能是诱导RA患者发生OP的因素之一,其在RA中的作用机制值得进一步研究探索.     

女性骨关节炎骨质疏松危险因素分析

目的:探讨女性骨关节炎(OA)骨质疏松(OP)的危险因素。方法:使用双能X线骨密度仪测定300例女性OA患者(OA组)和101名健康女性(对照组)第1~4腰椎(L_1~4)、股骨颈、全髋等部位骨密度(BMD)。统计分析各组与OP相关的危险因素。结果:女性OA患者OP发生率显著高于健康女性(P<0.01),各部位BMD均低于对照组(P<0.01)。OA患者OP组各部位BMD均明显低于非OP组(P<0.01),OA患者绝经后组各部位BMD均低于绝经前组(P<0.01),OA患者OP组较非OP组年龄更大,绝经时间更长,孕产次数更多(P<0.01)。OA组OP女性未来10年骨折的概率明显高于对照组(P<0.01)。结论:女性OA患者发生OP和骨折风险均显著高于健康女性,其OP的发生和多因素相关,增龄、绝经年限长、孕产次数多是OA患者发生OP的主要危险因素。     

绝经前后女性身体成分与骨密度相关性分析

目的探讨绝经前后女性身体成分与骨密度（BMD）的关系。方法采用LunaProdigy双能X线BMD检测仪对健康体检的绝经前女性22例、绝经后女性62例进行腰椎正位,左髋和全身BMD检测和身体成分检测。结果①绝经前组股骨各部位、腰椎（L1—L4）和全身BMD,以及全身和躯干肌肉显著高于绝经后组（P〈0．05,或P〈0．01）;②绝经前组全身、躯干和左大腿肌肉均与全身BMD呈显著正相关,身棒成分与腰椎和股骨BMD无显著相关性（P〉0．05）;③绝经后组全身和躯干的脂肪、肌肉分别与L3、L4、股骨大粗隆、股骨干和全身BMD均呈显著正相关（P〈0．05,或P〈0．01）;全身脂肪、肌肉,躯干脂肪分别与L1、L2和股骨颈BMD均呈显著正相关（P〈0．05,或P〈0．01）;躯干肌肉与股骨大粗隆骨密度呈显著正相关（P〈0．05）;左大腿成份与上述部位骨密度均无显著相关性。结论绝经前女性全身BMD与肌肉成分密切相关。绝经后女性全身和躯干脂肪、肌肉与腰椎、股骨和全身BMD密切相关,但脂肪成分似乎更明显。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.