多平面经食管超声心动图测量房间隔缺损面积的研究

为了探讨新型多平面经食管超声心动图（ＭＴＥＥ）测量房间隔缺损（ＡＳＤ）面积的可行性和可靠性，在２３例ＡＳＤ患者中进行了ＭＴＥＥ检查。利用心电图门控于心动周期的Ｐ波顶点、Ｐ－Ｒ段、Ｒ波顶点、Ｊ点、Ｔ波起点、Ｔ波顶点、Ｔ波终点等７个时相，以ＭＴＥＥ技术每隔１０°扫查角度测量ＡＳＤ直径，由此绘出心动周期每一时相的ＡＳＤ图形，并计算其面积，然后与手术测量的ＡＳＤ面积进行比较。结果显示：（１）ＡＳＤ面积在心动周期中呈动态改变；（２）ＭＴＥＥ于Ｐ波顶点测量的ＡＳＤ面积与手术测值相关最佳（ｒ＝０．９２），余心动周期时相ＭＴＥＥ与手术测值亦相关良好（ｒ＝０．８２～０．８８），表明ＭＴＥＥ为ＡＳＤ面积的测量提供了可靠的新方法。     

造血干细胞移植后患者的重症肝静脉闭塞病

报告我院４３例各类造血于细胞移植（ＨＳＣＴ）患者的重症肝静脉闭塞病（ＳＶｔｉＤ）的发生情况，共发生６例，约１４％；自体骨髓移植（ＡＢＭＴ）中的发生率７．９％。６例皆有肝大、肝痛、肝功能异常，黄疽和腹水，最终死于多脏器功能衰竭。提示ＳＶＯＤ系ＨＳＣＴ中与预处理相关的危及生命的重要并发症，提高对ＳＶＯＤ的认识，及时采取有效防治措施是ＡＢＭＴ临床至关重要的问题。     

心肌梗塞病人心室晚电位与电程序刺激的相关性及其预后意义

对４８例心肌梗塞（ＭＩ）病人的心室晚电位（ＶＬＰ）检测与自发和心室电程序刺激（ＥＰＳ）诱发单形性持续性室性心动过速（ＳＭＶＴ）的相关性的研究表明：（１）临床无自发持续室速者ＶＬＰ和ＥＰＳ阳性率分别为１９％和２６％；（２）ＥＰＳ诱发ＳＭＶＴ者ＶＬＰ检出率（６２．５％）高于未诱发者（９。４％）；（３）ＶＬＰ阳性者ＥＰＳ－ＳＭＶＴ诱发率（７６．９％）高于ＶＬＰ阳性者（１７．１％）（Ｐ〈０．０５）。结果显     

骨髓增生异常综合征患者T细胞受体基因重排的检测价值

目的 为了解骨髓增生异常综合征（ＭＤＳ）患者Ｔ细胞受体（ＴＣＲ）基因重排情况。方法 应用聚合酶链反应检测３６例ＭＤＳ患者ＴＣＲＶγＩ－Ｊγ基因重排。结果 ８例（２２．２％）ＭＤＳ患者检测出克隆性ＴＣＲＶγＩ－Ｊγ基因重排;难治性贫血伴有原始细胞增多（ＲＡＥＢ）,慢性粒－单细胞白血病（ＣＭＭＬ）和转化中的ＲＡＥＢ（ＲＡＥＢ－Ｔ）组ＴＣＲＶγＩ－Ｊγ基因重排阳性ＭＤＳ转化为急性白血病时间显著短于重排阴     

老年甲亢患者甲状腺刺激抗体检测及临床应用

以血清ＩｇＧ刺激培养的甲状腺机能亢进症患者甲状腺细胞，通过测定ｃＡＭＰ的释放值确定甲状腺刺激抗体（ＴＳＡｂ）的活性。结果显示：①老年Ｃｒａｖｅｓ病（ＧＤ）未治组ＴＳＡｂ活性显著高于ＧＤ缓解组与缓解停药组，３组患者ＴＳＡｂ的阳性率分别为８８．９％、４７．８％和４５．５％，甲状腺腺瘤组和对照组ＴＳＡｂ均为阴性。②ＧＤ缓解停药时５例ＴＳＡｂ阳性者中４例（８０．０％）于１年内复发，而６例阴性者仅１例（１６．７％）复发。③ＴＳＡｂ活性与血清Ｔ３、Ｔ４浓度无明显相关关系。提示ＴＳＡｂ测定对老年ＧＤ的诊断、鉴别诊断、治疗和预后判断有重要的指导意义。     

扩张型心肌病猝死高危因素分析

收治１２２例扩张型心肌病（ＤＣＭ），其中１２例住院期间发生猝死（猝死组），１１０例存活（存活组）。结果发现，持续性室速（ＳＶＴ）的猝死率为５２．９％，非持续性室速（ＮＳＶＴ）为８．１％；心室晚电位（ＶＬＰ）阳性者猝死率为３０％，阴性者为１１％；猝死组生前平均ＱＴ离散度（ＱＴｄ）、右室流出道分别为９６．２２±２２．２３ｍｓ、３．５４±０．１８ｃｍ，存活组分别为５４．２０±１２．１１ｍｓ、２．８８±０．２８ｃｍ。提示ＳＶＴ、ＶＬＰ阳性、ＱＴｄ显著增加、右室流出道扩张为ＤＣＭ的猝死高危因素     

不同结核分支杆菌抗原对结核病的诊断价值

目的　研究不同结核分支杆菌单体蛋白抗原在结核病体液免疫诊断中的价值。方法以快速免疫色谱法（ＩＣＴＴＢ卡） 检测结核分支杆菌５ 种单体蛋白的抗原性，观察其在结核病诊断中的敏感性和特异性，并与ＰＰＤ 皮试及脂阿拉伯糖甘露糖（ＬＡＭ） 相比较。结果　ＩＣＴＴＢ 卡、ＬＡＭ 及ＰＰＤ皮试诊断结核病的敏感性分别为５５．９％ 、５２．６％ 、７５．０％ ，后者与前二者间差异均有显著意义（ Ｐ＜０ ．０５）；ＩＣＴＴＢ卡、ＬＡＭ、ＰＰＤ皮试诊断肺结核的特异性为８７ ．６％ 、６２．９％ 、６８．９％ ，前者与后二者间差异均有非常显著意义（ Ｐ＜ ０．０１）；ＩＣＴＴＢ卡诊断肺结核病的临床阳性预计值为８８ ．５％ ，临床阴性预计值为５３ ．８ ％ ；非结核病例中的ＩＣＴＴＢ阳性主要由抗原４、５ 阳性所致，如果去除抗原４ 、５，那么ＩＣＴＴＢ诊断结核病的特异性将提高到９８．９％ 。结论　血清结核分支杆菌单体蛋白抗原性的测定是肺结核病一项有用的辅助诊断手段。     

老年人不同体质对心脏结构、血流、功能及血压的影响

目的观察体重对老年人心血管系统的影响。方法６２３例老年人根据体质指数（ＢＭＩ）分为肥胖、超重、正常及消瘦４组，检测血压、空腹血糖（ＢＳ）、胆固醇（ＴＣ）、甘油三酯（ＴＧ）及超声心动图。结果肥胖及超重组较正常体重及消瘦组收缩压（ＳＢＰ）及舒张压（ＤＢＰ）均增高（均为Ｐ＜０．０５），主动脉径（ＡｏＤ）、左房径（ＬＡＤ）、左室舒张及收缩末径（ＥＤＤ及ＥＳＤ）及心肌质量（ＬＶＭ）增加（均为Ｐ＜０．０５）。ＳＢＰ、ＤＢＰ均与体重、ＢＭＩ、ＴＣ、ＬＶＭ及心房收缩期与舒张早期充盈峰值流速（ＡＰＦＶ与ＥＰＦＶ）之比值（Ａ／Ｅ）呈明显正相关（Ｐ＜０．０５、０．０１或０．００１），ＤＢＰ与年龄呈明显负相关（Ｐ＜０．００１）。多元逐步回归分析证实ＬＶＭ、ＡＰＦＶ及ＬＡＤ均与ＢＭＩ呈正相关（均为Ｐ＜０．０１），ＥＰＦＶ与ＢＭＩ呈负相关（Ｐ＜０．０５）；射血分数（ＥＦ）、年龄、ＢＳ与ＳＢＰ呈正相关（Ｐ＜０．０５、０．００１及０．０１），与ＤＢＰ呈负相关（Ｐ＜０．０５或０．００１）。结论体重是影响心脏结构、血流、功能及血压的重要因素；ＥＦ、年龄、ＢＳ是分别影响ＳＢＰ及ＤＢＰ的独立因素。     

系列电药理研究筛选有效抗折返性室上性心动过速药物的临床意义

对６７例折返性室上性心动过速（ＲＳＶＴ）施行以单一抗心律失常药物（ＡＡＤ）为基础、异丙肾上腺素（Ｉｓｏ）和美托洛尔（Ｍｅｔ）为辅助的系列电药理研究（ＳＥＰＳ）（简称ＡＩＭ－ＳＥＰＳ）。结果表明，Ｉｓｏ能使普罗帕酮和莫雷西嗪的抗ＲＳＶＴ总有效率分别降低６６．７％～８０．０％和２０．０％，该效应能被Ｍｅｔ所抵消。随访资料提示，对于选择预防ＲＳＶＴ临床复发有效的长期口服ＡＡＤ，ＡＩＭ－ＳＥＰＳ明显优于单一ＡＡＤ的电药理研究。     

大脑皮质及海马乙酰胆碱酯酶纤维分布及其与痴呆关系的研究

目的探讨脑内胆碱能性神经纤维与痴呆发病机理之间的关系。方法采用尸检脑组织标本，经乙酰胆碱酯酶（ＡＣｈＥ）酶组织化学染色及图像分析技术测定ＡＣｈＥ纤维密度，观察ＡＣｈＥ阳性纤维在非痴呆老年人、Ａｌｚｈｅｉｍｅｒ型老年性痴呆（ＳＤＡＴ）及多发梗塞性痴呆（ＭＩＤ）患者大脑皮质和海马内的不同分布及密度改变。结果（１）脑内ＡＣｈＥ纤维的分布以海马内最丰富，其次为额叶和颞叶，顶叶及枕叶内较稀疏；（２）ＳＤＡＴ和ＭＩＤ患者海马和额叶ＡＣｈＥ纤维密度均比非痴呆老年人明显降低，尤以海马部位明显（Ｐ＜０．００１），ＳＤＡＴ患者减少最显著；（３）额叶、颞叶和海马内ＡＣｈＥ纤维密度与生前长谷川痴呆量表（ＨＤＳ）得分有显著正相关性。结论中枢胆碱能神经功能障碍与痴呆程度密切相关，但可能不是ＳＤＡＴ的特异性发病因素。     

Frequency of magnetic resonance signal abnormalities of the brain in patients aged less than 50 years with idiopathic dilated cardiomyopathy.

Twenty patients with idiopathic dilated cardiomyopathy (IDC) aged less than 50 years (mean 41) and an age-matched group of 20 healthy volunteers were studied. All subjects were free of cerebrovascular symptoms and risk factors for stroke. Magnetic resonance imaging of the brain, extracranial Doppler ultrasonography, heart catheterization and echocardiography were performed. In patients with IDC, a higher frequency of ventricular enlargement (p less than 0.02), cortical atrophy (p less than 0.01) and white matter lesions (p less than 0.05) was observed. Cerebral infarcts were found in 4 patients (p less than 0.05) who showed clinically severe limitation of functional capacity (New York Heart Association class III or IV). The extent of cortical atrophy, and the duration of clinical evidence of IDC showed a significant correlation (p less than 0.04). The data indicate a high incidence of parenchymal abnormalities of the brain in young, neurologically asymptomatic patients with IDC.     

Evaluating human liver reserve function by measuring serum concentrations of phenacetin and its metabolites

OBJECTIVES: To evaluate human liver reserve function (LRF) by a simple and efficient method for measuring serum concentrations of phenacetin and its metabolites. METHODS: Overall 20 patients with liver cirrhosis (Child–Pugh score ≥ 7, aged 48–79 years), 30 healthy young volunteers (aged 18–40 years), and 20 healthy elderly volunteers (aged 61–80 years) were enrolled. All participants received a single oral dose of 0.5 g phenacetin. Liquid chromatography tandem mass spectrometry was used to determine the serum concentrations of phenacetin and its metabolites, including acetaminophen, acetaminophen glucuronide and acetaminophen sulfate. RESULTS: The serum concentration of phenacetin was significantly higher in cirrhotic patients than those in either of the healthy volunteer groups (P < 0.001). It was higher in healthy elderly volunteers than that in healthy young ones but there was no statistically significant difference (P > 0.05) between them. The serum concentrations of acetaminophen, acetaminophen glucuronide and acetaminophen sulfate were significantly lower in cirrhotic patients than in the healthy controls (P < 0.001). The serum concentrations of these three metabolites in healthy elderly volunteers were lower than those in healthy younger volunteers but again, there was no statistical significant difference (P > 0.05). The serum concentration of acetaminophen in healthy male volunteers was significantly higher than that in the women (P < 0.05). CONCLUSION: Monitoring cytochrome P450 1A2 (CYP450 1A2)-mediated phenacetin metabolism is a simple and efficient method for evaluating human LRF. This method would warrant further validation in a large cohort clinical study.     

Modification of disease outcome in Salmonella-infected patients by HLA-B27

OBJECTIVE: To study whether HLA-B27 modifies the outcome of Salmonella infection in vivo. METHODS: The frequency of HLA-B27 was determined in 198 Salmonella-infected patients and 100 healthy controls by immunofluorescence and polymerase chain reaction. The excretion of Salmonella was monitored at monthly intervals. The symptoms of acute infection and possible joint involvement were evaluated using questionnaires. RESULTS: Thirty-eight of 198 Salmonella-infected patients (19.2%) and 13 of 100 healthy controls (13.0%) were HLA-B27 positive. The excretion of Salmonella did not differ significantly between HLA-B27-positive and -negative patients, or for patients with versus those without joint symptoms. As many as 35 patients (17.7%) reported Salmonella-triggered joint symptoms. Three of 14 patients (21.4%) with arthralgia, 5 of 13 patients (38.5%) with probable reactive arthritis (ReA), and 6 of 8 patients (75%) with confirmed ReA were HLA-B27 positive. The duration and severity of joint symptoms directly correlated with HLA-B27 positivity. Women reported Salmonella-induced pain and swelling of joints more frequently than men (P = 0.07 and P = 0.03, respectively). Patients with Salmonella-triggered joint symptoms reported abdominal pain and headache more frequently than patients without joint symptoms (P = 0.05 and P = 0.004, respectively). CONCLUSION: HLA-B27 did not (at least, not strongly) confer susceptibility to Salmonella infection. Salmonella excretion correlated neither with HLA-B27 positivity nor with the occurrence of joint symptoms. Joint symptoms were surprisingly common during or after Salmonella infection. HLA-B27-positive patients had a significantly increased risk of developing joint and tendon symptoms. Moreover, HLA-B27 positivity correlated with the development of more severe and prolonged joint symptoms.     

Haemophilia Joint Health Score in healthy adults playing sports

To evaluate outcome of prophylactic clotting factor replacement in children with haemophilia, the Haemophilia Joint Health Score (HJHS) was developed aiming at scoring early joint changes in children aged 4–18. The HJHS has been used for adults on long‐term prophylaxis but interpretation of small changes remains difficult. Some changes in these patients may be due to sports‐related injuries. Evaluation of HJHS score in healthy adults playing sports could improve the interpretation of this score in haemophilic patients. The aim of this study was to evaluate the HJHS scores in a cohort of young, healthy men participating in sports. Concomitant with a project collecting MRI images of ankles and knees in normal young adults, HJHS scores were assessed in 30 healthy men aged 18–26, participating in sports one to three times per week. One physiotherapist assessed their clinical function using the HJHS 2.1. History of joint injuries was documented. MRI images were scored by a single radiologist, using the International Prophylaxis Study Group additive MRI score. Median age of the study group was 24.3 years (range 19.0–26.4) and median frequency of sports activities was three times per week (range 1–4). Six joints (five knees, one ankle) had a history of sports‐related injury. The median overall HJHS score was 0 out of 124 (range 0–3), with 60% of subjects showing no abnormalities on HJHS. All joints were normal on MRI. These results suggest that frequent sports participation and related injuries are not related with abnormalities in HJHS scores.     

老年吸入性肺炎的临床特点和防治对策

目的 探讨老年吸入性肺炎的临床特点以及防治对策.方法 收集2004年3月～ 2009年5月老年吸入性肺炎住院患者56例,分析临床和病原学的特点.结果 老年吸入性肺炎患者56例,死亡15例,好转41例.结论防治老年吸入性肺炎应根据病原学进行有效抗菌治疗.     

Atrial kinetics and left ventricular diastolic filling in the healthy elderly

A delay of left ventricular isovolumic relaxation and decrease in myocardial compliance may result in a decline of measured early filling rates in elderly subjects. Previous studies of diastolic function, however, have not excluded coronary artery disease or addressed the contribution of atrial contraction to diastole. The present study evaluated radionuclide-derived diastolic variables in 13 healthy elderly volunteers aged 75 +/- 6 years without symptoms or risk factors for coronary disease who had normal findings on the stress electrocardiogram, stress gated blood pool imaging and two-dimensional echocardiogram. Results were compared with those of a group of 10 healthy young volunteers aged 26 +/- 5 years. High count, 32 frame, double-buffered gated blood pool acquisitions were obtained at rest in the left anterior oblique view with an RR interval variation less than 5%. Left ventricular time-activity curves were analyzed and flow-volume loops for each group were constructed. In the healthy elderly: peak early diastolic filling rate is decreased, time of peak early filling and time to first third of diastolic filling are delayed, and peak late left ventricular filling rate and percent of atrial filling volume are augmented, suggesting an adaptive response of the atria to diminished left ventricular compliance.     

Haemophilic magnetic resonance imaging score in healthy controls playing sports

Magnetic resonance imaging (MRI) is the most sensitive imaging modality to assess joint lesions, but the clinical relevance of subtle joint changes in haemophilic patients playing sports is unknown. A haemophilia specific MRI score is available, but was never evaluated in physically active healthy controls. It is not known if unexpected MRI changes in young active haemophilic patients are due to sports participation. The aim of this study was to evaluate knees and ankles in a cohort of young active healthy men using a haemophilia specific MRI score to provide context for joint evaluation by MRI in young haemophilic patients. Three Tesla MRI of knees and ankles were performed in 30 healthy men aged 18–26 years, regularly active in sports. MR images were scored by a single independent radiologist, using the International Prophylaxis Study Group additive MRI score. One physiotherapist assessed clinical function using the Haemophilia joint health scores (HJHS). History of complaints or injuries affecting knees and/or ankles, very intensive sports and current sports activities were documented. Median age was 24.3 years (range 19.0–26.4) and median number of sports activities per week was 3 (range 1–4). Six joints (five knees, one ankle) had a history of a sports‐related injury. The median HJHS per joint was 0 out of 20 (range 0–1). All joints had a MRI score of 0. These results suggest that regular sports participation or very low HJHS scores are not associated with haemophilia specific MRI changes in knees and ankles.     

Increased pregnancy loss in young women with aortoiliac disease

BACKGROUND: During clinical evaluation of young women with peripheral arterial occlusive disease, we were surprised by the high prevalence of pregnancy loss in women with segmental stenosis confined to the aortoiliac segment. We wondered if increased occurrence of miscarriage is the result of high expression of vascular and obstetrical risk factors in these patients, or if it is related to localization of disease. In a case-control study designed to investigate risk factors for peripheral arterial occlusive disease in young women, we assessed the risk of miscarriage in these patients according to level of obstruction. METHODS: A total of 202 female patients, aged 18-49 years and 466 healthy control women from a population based case-control study, donated venous blood samples and filled out a structured questionnaire concerning classical cardiovascular risk factors and obstetrical history. In all patients, diagnosis of peripheral arterial occlusive disease was confirmed by intra-arterial angiography. Patients were classified into two groups: those with and those without stenosis of the aortoiliac segment (aortoiliac disease). RESULTS: In 77 of the 202 patients (38%) with peripheral arterial occlusive disease, the obstruction was confined to the aortoiliac segment. The occurrence of miscarriage was high (42%) in young women with aortoiliac disease. Compared to healthy controls, the risk of miscarriage increased 3-fold (OR 3.1; 95% CI 1.8-5.6) in these patients. Adjustment for obstetrical and vascular risk factors did not affect the risk estimate. CONCLUSION: This is the first study that identifies aortoiliac disease as a risk factor for pregnancy loss in young women. The risk of miscarriage is increased 3-fold in women with aortoiliac disease. The presence of vascular and obstetrical risk factors did not affect the strength of the association. Pregnancy loss could be the first sign of insufficient aortic circulation in these patients.     

Clinical manifestations of patients with chronic pancreatitis

BACKGROUND: Recent advances in molecular and genomic technologies and pancreatic imaging techniques provided some insights into genetic, environmental, immunologic, and pathobiological factors for chronic pancreatitis (CP). This study was undertaken to investigate the clinical manifestations of patients with chronic pancreatitis at our hospital. METHODS: The data of the patients with CP who had been treated at our hospital between 1997 and 2004 were analyzed. RESULTS: The major symptoms of the patients with CP were abdominal pain, dyspepsia, loss of weight, diabetes mellitus, pancreatic pseudocyst, steatorrhea, and calcification. Biliary diseases were found to be the first cause of CP in this study; but alcohol abuse was the major cause of CP in men and biliary diseases were the first etiological factors for CP in women. The etiological difference of constituent ratio between men and women was related to alcohol comsumption (P<0.01). CONCLUSIONS: During the past 8 years, biliary diseases have been the major etiological factors for CP, but their constituent ratio is decreasing, and the constituent ratio of alcohol abuse is increasing gradually. Alcohol tends to replace biliary diseases as the primary etiological factor for CP.     

以癫痫为主要表现的儿童遗传代谢性疾病

目的提高对遗传代谢性疾病所致儿童癫痫的认识。方法采用回顾性方法,对我院以癫痫发作为主诉就诊,经血氨、乳酸、血同型半胱氨酸、尿有机酸气相色谱质谱联用分析、骨髓涂片、脑脊液检查、溶酶体酶活性分析、线粒体基因检测、线粒体酶活性分析确诊的先天代谢性缺陷病26例患儿的临床表现、生化特点以及诊疗情况进行回顾和分析。结果所有患儿均有癫痫发作,以部分性发作、痉挛发作为最常见发作形式,少数患者可有肌阵挛发作。患者多有不同程度的体格或智力运动发育迟滞,年长儿发病的线粒体脑肌病患者发病前智力正常,发病后出现智力运动倒退。脑电图表现以多灶独立性棘波、高度失律、背景慢波为主要表现。患者癫痫发作多难以控制,部分患者对因治疗后癫痫发作明显好转。结论先天代谢性疾病是儿童癫痫的病因之一;临床上应根据患儿发病急缓、生长发育、智力行为等,选择适宜的检查,以早期诊断。除了抗癫痫治疗以外,应根据不同的病因给予病因治疗。