组织细胞坏死性淋巴结炎32例分析

组织细胞坏死性淋巴结炎（histocytice necrotizing lym phadenitis,HNL）是1972年日本学者Kikuchi和Fujimoto等首先报道的一种少见的良性自限性疾病,又称菊池病（Kikuchi disease）或Kikuchi-Fujimoto病（KFD）。以发热、颁部淋巴结肿大为主要临床表现，可累及多系统多器官，表现为皮疹、关节痛、浆膜腔积液、肝脾大等一系列炎症综合征，常就诊于风湿科。现将我院1990年1月至2005年6月收治的HNL患者进行回顾性分析，现报告如下。     

金黄色葡萄球菌骨髓炎并脓毒血症继发川崎病合并菊池病1例

<正>川崎病(Kawasaki disease,KD)又被称为皮肤黏膜淋巴结综合征,是一种好发于5岁以下儿童的、以全身血管炎为主要病理改变的急性发热、出疹性疾病,其主要临床特征为发热、不同程度口腔黏膜改变、皮疹、眼结膜充血、手足指端改变等,可累及小血管、中等肌性动脉及全身各个脏器。组织细胞坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)又称为Kikuchi病或Kikuchi-Fujimoto病(菊池病),好发于年轻女性的淋巴结炎症性     

血清中性粒细胞载脂蛋白检测对急性细菌感染性疾病的诊断价值

目的 探讨血清中性粒细胞载脂蛋白(HNL)检测对急性细菌感染性疾病诊断的价值。方法 选取急性细菌感染患者79例为细菌感染组(脓毒血症组24例、局部细菌感染组55例)、病毒感染患者39例(病毒感染组)、健康体检者45例(对照组),分别采用酶联免疫法、化学发光法、免疫比浊法检测抗生素使用前和使用后血清HNL、降钙素原(PCT)及C反应蛋白(CRP),采用受试者工作特征(ROC)曲线评价HNL、PCT、CRP水平变化对急性细菌感染性疾病的诊断效能。结果 治疗前,血清HNL、PCT、CRP水平脓毒血症组>局部细菌感染组>病毒感染组>对照组(P均<0.05);随着治疗时间增加,局部细菌感染组HNL和PCT检测值在诊断界值以上患者的比例显著降低。分析ROC曲线,血清HNL诊断急性细菌感染性疾病的效能与PCT相仿(P>0.05),优于CRP(P<0.05);其cut-off值为141.43μg/L时,灵敏度、特异度最高。结论 血清HNL(141.43μg/L)可作为急性细菌感染早期诊断的指标,且其水平变化能反映患者细菌感染控制情况。     

血清HNL、CD64和PCT检测对细菌感染性疾病的临床诊疗

目的通过观察细菌性感染患者治疗前后中性粒细胞载脂蛋白(HNL)、中性粒细胞CD64和降钙素原(PCT)的水平变化,探讨HNL、CD64和PCT检测在细菌感染性疾病中的诊断价值。方法 210例感染性疾病病例,根据就诊者的临床表现、影像学检查资料,实验室检测结果等,把这些患者归入细菌感染亚组105例和病毒感染亚组105例,分析比较患者治疗前后HNL、CD64和PCT的变化情况。结果治疗后,细菌性感染组HNL、CD64和PCT水平较治疗前明显降低(P0.05)。治疗前HNL、CD64和PCT的受试者工作特征(ROC)曲线下面积(AUC)分别为0.930、0.930、0.855,AUC(HNL+PCT)为0.969,AUC(HNL+CD64)为0.983,AUC(CD64+PCT)为0.965,AUC(HNL+CD64+PCT)为0.990。HNL、CD64和PCT联合检测的准确性高于各指标单独检测。结论血清HNL、CD64和PCT联合检测能准确判断患者是否为细菌感染,有较高的特异性和灵敏度,为感染性疾病的早期诊断和鉴别诊断提供依据,同时也为患者的治疗和预后评估提供了临床指导。     

51例菊池病患者临床资料回顾性分析

目的 :比较、分析我院近10年收治的菊池病儿童及成人患者的临床特点及其异同,以提高诊断率,减少误诊、误治。方法:回顾性分析51例最终诊断为菊池病患者的临床资料,按照患者是否成年进行分组,比较2组之间的临床特点,并分析误诊、误治的原因。结果:51例患者中儿童组26例,成人组25例,2组中均以男性患者为主,男女比例分别为1.4∶1及1.3∶1。96.1%的患者在发病时有淋巴结肿大表现,且多累及颈部淋巴结(44例,占89.8%),其中成人组右侧颈部淋巴结受累更为多见(36.0%比15.4%,P=0.040 3),没有一例单纯锁骨上淋巴结肿大。82.4%的患者存在发热,2组之间差异无统计学意义(P=0.273 5),发热平均持续(23.5±36.2) d。51例患者中32例(62.7%)乳酸脱氢酶(lactate dehydrogenase,LDH)升高,31例(60.8%)白细胞减少,20例(39.2%)中性粒细胞比例降低。儿童组患者中性粒细胞比例减少更常见(65.4%比12.0%,P0.000 1),而在LDH、白细胞计数等实验室检查结果之间差异无统计学意义。51例患者中35例(68.6%)曾被误诊,儿童误诊率(22例,84.6%)高于成人误诊率(13例,52.0%)(P=0.012 1)。最终51例经淋巴结活组织检查(活检)后确诊为菊池病,予糖皮质激素治疗后好转。结论:儿童与成人菊池病患者的临床特点相似,多有发热、淋巴结肿大、白细胞减少、LDH增高,此外儿童患者更易出现中性粒细胞比例减少,成人患者更易出现右侧颈部淋巴结肿大。另外,虽然患者几乎都存在淋巴结肿大,但若只累及锁骨上淋巴结,诊断为菊池病的可能性不大。以上可作为初步诊断菊池病的主要参考依据。对于怀疑菊池病的患者都应尽早进行淋巴结活检,避免或减少误诊、误治。     

炎症性肠病患者的营养问题

<正>炎症性肠病(inflammatory bowel disease,IBD),包括克罗恩病(Crohn disease,CD)和溃疡性结肠炎(inflammation colitis,UC)以及多种炎症性并发症性病变在内。IBD以往是北美与欧洲国家的常见肠病[1]。近30年日本IBD发病率增高。我国近10年来随着生活方式和饮食结构的改变,IBD就诊人数呈明显增高趋势,已成为我国常见的消化系疾病[1~3]。迄今,IBD的发病原因仍未明确,但胃肠道是人体进行正常消化、吸收与维持机体良好营养状态的中枢性器     

脑小血管疾病与血管性认知障碍

随着我国社会人口构成的老龄化,认知障碍对人群健康的影响日显突出。血管性认知障碍(Vascular Cognitive Im-pairment,VCI)在认知疾病中占有相当大的比例,在欧美国家中发病率仅次于阿尔茨海默病(Alzheimer’s disease,AD),而在中国和日本等东亚国家中,其发病率与AD不相上下。目     

组织细胞坏死性淋巴结炎45例临床分析

组织细胞坏死性淋巴结炎(HNL,也称Kikuchi-Fujimolo病、Kikuchi病)是一种主要累及淋巴结肿大的良性、自限性疾病[1].该病多累及青年人,至今病因未明、发病机制不清.近年发病率呈上升趋势.我院近期收治了HNL患者45例,现将其临床资料分析如下.     

组织细胞性坏死性淋巴结炎误诊17例分析

组织细胞性坏死性淋巴结炎(HNL)是一种独立的淋巴结非肿瘤性疾病，常因发热、淋巴结肿大而就诊。其临床及病理改变与恶性淋巴瘤、结核病等类似，很容易误诊。本文就我院1998年6月至2002年5月收治的17例HNL误诊原因分析如下。     

受控衰减参数在脂肪肝诊断中的应用

<正>脂肪性肝病(fatty liver disease,FLD)是以弥漫性肝细胞大泡性脂肪变为主要特征的临床病理综合征,主要包括酒精性肝病(alcoholic liver disease,ALD)和非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD),疾病谱包括单纯性脂肪肝、脂肪性肝炎及其相关肝硬化[1]。随着肥胖、糖尿病和酒精滥用成为全球化的流行趋势,无论是NAFLD还是ALD都已成为重要的公共健康问题,并且酒精性和非酒精性FLD     

炎症性肠病抗肿瘤坏死因子-α治疗新进展

<正>炎症性肠病(inflammatory bowel disease,IBD)包括克罗恩病(Crohn’s disease,CD)和溃疡性结肠炎(ulcerative disease,UC),是一类以慢性肠道非特异性炎症为主要表现的一组疾病,其病因和发病机制不十分清楚的。目前,比较公认的发病机制为:在环境、遗传、感染和免疫等多因素相互作用下和饮食及肠道微生态改变等参与下,肠道固有免疫和适应     

成年女性Ⅰ型戈谢病1例并文献复习

<正>戈谢病(Gaucher disease,GD)是最常见的溶酶体贮积病(lysosomal storage disease,LSD),属常染色体隐性遗传病,1882年由法国医生Gaucher首先报道而得名。该病由于基因突变导致机体葡萄糖脑苷脂酶(glucocerebrosidase,GBA),又称酸性β-葡萄糖苷酶,acidβ-glucosidase)活性缺乏,造成其底物葡萄     

Surgical management of colonic diverticular disease:Discrepancy between right- and left-sided diseases

AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed.The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology.Rightsided diverticula were classified as those arising from the cecum,ascending colon,and transverse colon,and those from the descending colon,sigmoid colon,and rectum were classified as left-sided diverticulosis.To assess the changing trend of occurrence of diverticulosis,data were compared with two previous studies of 51 patients.RESULTS:The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001,(27.5%vs48.1%,P<0.05).Moreover,no differences in gender,body mass index,multiplicity of the diverticula,fever,or leukocytosis were noted between patients with rightsided and left-sided disease.However,patients with right-sided disease were significantly younger(50.9year vs 64.0 year,P<0.01).Furthermore,left-sided disease was significantly associated with a higher incidence of complicated diverticulitis(89.2%vs 57.5%,P<0.01),combined resection due to extensive inflammation(21.6%vs 5.0%,P<0.05),operative complications(51.4%vs 27.5%,P<0.05),and in-hospital mortality(10.8%vs 0%,P<0.05),along with longer post-operative hospitalization duration(21.3±10.2 d vs 10.6±8.1 d,P<0.05).CONCLUSION:Compared with right-sided diverticular disease,the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.     

陈玉根教授治疗炎症性肠病临床经验

<正>炎症性肠病(Inflammatory bowel disease,IBD)是一种临床难治性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)。IBD是北美和欧洲的常见病,近30年日本IBD发病率亦呈逐步增高趋势。我国虽尚无普通人群流行病学资料,但近10多年来本病就诊人数呈逐步增加趋势,且非常明显,IBD在我国已成为消化系统常见病[1]。现代医学治疗IBD,包括5-ASA     

Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort

AIM:To investigate the evolution of disease phenotypein adult and pediatric onset Crohn’s disease(CD) populations,diagnosed between 1977 and 2008.METHODS:Data of 506 incident CD patients were analyzed(age at diagnosis:28.5 years,interquartile range:22-38 years).Both in-and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database,which included incident patients diagnosed between January 1,1977 and December 31,2008 in adult and pediatric onset CD populations.Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis.RESULTS:Among this population-based cohort,seventy-four(12.8%) pediatric-onset CD patients were identified(diagnosed ≤ 17 years of age).There was no significant difference in the distribution of disease behavior between pediatric(B1:62%,B2:15%,B3:23%) and adult-onset CD patients(B1:56%,B2:21%,B3:23%) at diagnosis,or during follow-up.Overall,the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5-and 10-years of follow-up.Similarly,time to change in disease behaviour from non stricturing,non penetrating(B1) to complicated,stricturing or penetrating(B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis.Calendar year of diagnosis(P = 0.04),ileal location(P < 0.001),perianal disease(P < 0.001),smoking(P = 0.038) and need for steroids(P < 0.001) were associated with presence of,or progression to,complicated disease behavior at diagnosis and during follow-up.A change in disease location was observed in 8.9% of patients and it was associated with smoking status(P = 0.01),but not with age at diagnosis.CONCLUSION:Long-term evolution of disease behavior was not different in pediatric-and adult-onset CD patients in this     

金葡菌骨髓炎并败血症继发川崎病合并菊池病1例

目的 探讨川崎病合并菊池病的临床特征、病理特点、诊断及治疗措施 方法: 回顾性分析 1例金葡菌骨髓炎并败血症继发川崎病合并菊池病患者的临床资料并进行讨论 结果: 1例15岁男性患者因间断发热1周入院,入院查血培养及骨髓培养为金黄色葡萄球菌感染,腰椎磁共振报告为骨髓炎,骨髓象结果提示噬血现象,行抗感染治疗效果不佳,入院8天后患者出现右侧颌下淋巴结肿大及躯干四肢红色丘疹,行淋巴结活检提示菊池病,心脏超声表现为川崎病,经丙种球蛋白、阿司匹林、激素等治疗,患者体温恢复正常。 结论 川崎病及菊池病为少见病,当抗感染效果不佳时,需要考虑是否存在少见的川崎病及菊池病。     

Assosiation of angiopoietin-like protein 2with lower extremity arterial disease in type 2 diabetes mellitus

<正>Objective To study the assosiation of angiopoietinlike protein 2(ANGPTL2)with lower extremity arterial disease in type 2 diabetes mellitus.Methods A total of360 type 2 diabetic patients were divided into three groups:without(group A),with mild to moderate(group B),and severe(group C)lower extremity arterial disease according to the ankle brachial index.And,120     

再次冠状动脉重建治疗:一个不容忽视的问题

<正>冠状动脉重建术包括经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和外科冠状动脉搭桥术(coronary artery bypass grafting,CABG),是目前治疗冠状动脉疾病(coronary artery disease,CAD)最常用和最重要的手段。     

Allergy and Immunology

<正>2015418 Expression and signifficance of 25-hydroxy vitamin D in rheumatic disease patients and the risk between it and cardiovascular disease.LI Jinchan(李金潺),et al.Dept RheumatolImmunol,2nd Hosp,Shanxi Med Univ,Taiyuan 030001.Chin J Rheumatol2015;19(9):611-613.     

Preventive effect of a pectic polysaccharide of the common cranberry Vaccinium oxycoccos L. on acetic acid-induced colitis in mice

INTRODUCTION Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis (UC), are characterized by chronic and spontaneously relapsing inflammation resulting in tissue destruction[1]. At present, there is no radical treatment for …