第三讲 急性胰腺炎的病理

急性胰腺炎的病因复杂，分类方法很多，有病因分类法、病理分类法、临床分类法等。这里仅介绍病理分类法，这种分类法是以疾病发展过程中的病理学变化为基础的，主要是将急性胰腺炎分为两大类：①急性水肿性胰腺炎（或称急性间质水肿性胰腺炎）；②急性坏死性胰腺炎（或称急性出血坏死性胰腺炎）。前者病理学上胰腺间质水肿，偶见部分坏死及胰周坏死，     

Lauren分类法在胃癌CT分期及术前评估中的价值

目的：通过对本组胃癌患者的螺旋CT（SCT）扫描图像应用Lauren组织临床分类法进行分期及术前评估,旨在提高胃癌CT分期和术前评估的准确性。方法：通过对48例胃癌患者SCT的轴位图像和重建的MPR及SSD图像的观察分析,以Lauren组织临床分类法为基础按TNM对各病例进行分期及术前评估。结果;所有患者的肿瘤诊断符合率为100％,I期肿瘤2例,Ⅱ期肿瘤18例,Ⅲ期肿瘤15例,Ⅳ期肿瘤13例,CT分期的准确性为85．4％,术前评估的准确性为95．0％。结论：以Lauren组织临床分类法为基础,SCT可以比较准确地对胃癌进行TNM分期及术前评估,为临床治疗提供具有价值的信息。     

第三讲急性胰腺炎的病理

急性胰腺炎的病因复杂,分类方法很多,有病因分类法、病理分类法、临床分类法等.这里仅介绍病理分类法,这种分类法是以疾病发展过程中的病理学变化为基础的,主要是将急性胰腺炎分为两大类:①急性水肿性胰腺炎(或称急性间质水肿性胰腺炎);②急性坏死性胰腺炎(或称急性出血坏死性胰腺炎).     

脂溢性角化病220例临床和病理分析

目的探讨脂溢性角化病的临床、组织病理特征和诊断情况。方法对220例组织病理学诊断为脂溢性角化病患者的临床资料进行回顾性分析。结果发病者以老年患者居多;男性多于女性;暴露部位比非暴露部位更易发病;病理分型中以棘层肥厚型及角化过度型最为常见;临床诊断易与色素痣、扁平疣、寻常疣、日光性角化病、基底细胞癌、黑素瘤等相混淆,此时诊断主要依靠组织病理学检查。结论脂溢性角化病与性别、年龄、日光照射有关,组织病理学检查在其诊断及鉴别诊断中具有重要意义。     

临床医生视角看肝脏病理

肝组织病理学在肝脏疾病分级分期和不明原因肝病病因探寻方面起着至关重要的作用。作为临床医生，要充分了解肝组织活检的适应证和禁忌证、肝脏疾病的病理特征、肝组织病理学的地位和作用、临床病理沟通重要性等内容。本文对上述内容作一概述，以帮助临床医生更好的应用肝组织病理学这一有创诊断方法。     

CD24在肝癌组织中的表达

目的探讨CD24在肝细胞癌组织中的表达情况及作为肝癌早期诊断指标及分子靶向治疗的可能性。方法应用寡核苷酸基因芯片、RT-PCR和免疫组织化学技术检测CD24在人正常肝组织、肝硬化组织及肝癌组织中的表达,分析CD24与临床病理学特征的关系及其发生的分子生物学机制。结果寡核苷酸基因芯片、RT-PCR及免疫组织化学方法证明CD24在肝癌组织中mRNA及蛋白水平均呈高表达,与病理学分级无显著相关性。结论 CD24在肝癌组织中显著增高,但与肿瘤分化程度无密切相关性。     

我国结核病病理学诊断和研究的现状与展望

本文对我国结核病病理学诊断现状及分子病理学在未来结核病诊断和基础研究中的作用进行了阐述.与其他方法相比,病理学诊断依然是结核病、尤其是菌阴肺结核及肺外器官结核病确诊的重要手段.目前,我国结核病病理诊断总体上处于组织学和细胞学水平,仍以组织学形态特征和查找病原体作为结核病诊断依据.因PCR的临床检测对实验室、仪器设备及技术人员的要求较高,所以目前国内仅部分大型医院病理科开展了此项检查.分子病理学科的发展,将病理学的研究与诊断引领到蛋白、核酸等生物大分子水平,为结核病病理学诊断及研究带来了新的发展机遇.近年来,分子生物学检测技术发展迅速,在痰标本、体液标本等应用广泛,而在组织标本中推广较慢,因此,需要加快这些新技术在结核病分子病理学诊断中的临床应用.今后,结核病病理学诊断应在病理形态的基础上,进一步在寻找病原体、菌型鉴定及相关耐药基因的检测等方面做更多努力,为结核病的正确诊断与合理化治疗提供更准确的依据.     

超声引导下经皮肝脏穿刺活检的临床价值

目的探讨超声引导下经皮肝脏穿刺活检的临床价值。方法采用PHILIPS-HD11超声仪、3.5MHz高频探头、Bard活检枪及活检针对肝脏进行穿刺,对穿刺组织进行病理学检查。结果46例患者均穿刺成功,获取肝组织108块。病理学检查诊断为慢性乙型肝炎38例,慢性丙型肝炎4例,肝细胞癌1例,原发性胆汁性肝硬化1例,自身免疫性肝炎肝硬化1例,D-J综合征并成人特发性胆管缺失综合征1例。结论超声引导下经皮肝脏穿刺活检能确定肝脏损害的病理性质,对指导临床诊断和治疗有重要的应用价值。     

移植肾组织病理学的某些进展

移植肾组织病理学的某些进展陈惠萍，陈劲松关键词肾移植；病理改变；ＢＡＮＦＦ分类法器官移植中肾移植最普遍，国际标准化的移植肾病理诊断标准也已被广泛应用，并且起着越来越重要的作用。因而正确认识移植肾病理改变，对于移植后肾功能不全的正确诊断及选择治疗方案，...     

大肠黏膜病变腺管分型和病理不符病例再探讨

目的通过对腺管分型和临床病理不符的病例进行再分析,研究大肠粘膜病变腺管开口分型与组织病理学的关系,探讨内镜在初步判断大肠粘膜病变组织学类型方面的价值。方法复习结肠镜检查的影像学资料,选出腺管分型和临床病理不符的病例,分别请有经验的内镜医师及病理学专家复核该病例的腺管分型和组织病理学资料。结果共选出腺管分型和临床病理不符的病例65例,经有经验的内镜医师及病理学专家复核,20(31%)例病例的腺管分型和临床病理与原诊断完全相同,18(28%)例病例的腺管分型和原分型不同,27(41%)例病例的组织病理学诊断与原诊断不符。有1例原诊断为绒毛状腺瘤的病例,病理学专家认为局部可疑癌变。结论大肠粘膜病变的腺管开口类型与组织病理学高度相关,通过腺管分型可以初步判断大肠粘膜病变的组织学类型及良恶性。内镜医师和病理医师应加强相互的沟通和交流,以减少工作的失误。     

晚期血吸虫病新临床分型方法探讨

目的探讨一种更实用、更科学的晚期血吸虫病新标准化临床分型方法,以便更准确地应用于晚期血吸虫病的普查、诊断、治疗和疗效评估。方法收集湖南省血吸虫病防治所附属湘岳医院1990 01-2010 01住院病人及2004 01-2010 01湖南省晚期血吸虫病医疗救助项目的晚期血吸虫病人共计11 092例,采用现行分型和新分型法2种分型方法分别统计并进行分析比较。结果 11 092例按现行分型法分型:巨脾型5 710例,腹水型2 993例,结肠增殖型834例,侏儒型54例;但有1 501例未列出类型。新分型法为8型:巨脾型、腹水型、结肠增殖型、侏儒型、普通型、出血型、脑病型、混合型。分别为2 870、1 885、425、38、1 281、1 857、553、1 759例;但有424例归于慢性血吸虫病。根据临床特征以及专业角度,提出晚期血吸虫病新的分型。结论新的分型方法能更全面准确地反映血吸虫病临床特征、严重并发症和预后,为诊断与治疗提供更大的帮助。     

Management of patients with sphincter of Oddi dysfunction based on a new classification

AIM: To propose a new classif ication system for sphincter of Oddi dysfunction (SOD) based on clinical data of patients. METHODS: The clinical data of 305 SOD patients documented over the past decade at our center were analyzed retrospectively, and typical cases were reported. RESULTS: The new classification with two more types (double-duct, biliary-pancreatic reflux) were set up on the basis of the Milwaukee criteria. There were 229 cases of biliary-type SOD, including 192 (83.8%) cases cured endoscopicall...     

Comparison of different methods of classifying patients with systemic lupus erythematosus

The sensitivity and percent agreement of 3 methods of classifying patients with systemic lupus erythematosus (SLE), the 1982 American Rheumatism Association (ARA) revised criteria and a simple and full classification tree, were compared using data from The Johns Hopkins Lupus Cohort, a prospective study of 198 patients with SLE. The 1982 revised criteria were significantly more sensitive than the simple classification tree, correctly identifying 184 (93%) cases compared to 168 (85%) (p = 0.016). Agreement between these 2 classification schema was noted in 174 (87%) cases with 164 classified correctly and 10 failing to satisfy either criteria set. The full classification tree correctly identified 186 (94%) cases. There was no difference in the sensitivity of either the 1982 revised criteria or the full classification tree by racial group; however, the simple classification tree was significantly less sensitive among black than Caucasian patients (80 vs 91.5% p = 0.038). Our data support the continued use of the 1982 revised ARA criteria for the classification of patients with SLE for clinical and epidemiologic research studies.     

基于M-ANNHEIM分类系统的307例慢性胰腺炎临床特征分析

目的 以M-ANNHEIM分类系统为指导,研究慢性胰腺炎(CP)的临床表现、病因、危险因素,探讨M-ANNHEIM分类系统对CP的有效性及临床指导意义.方法 收集2007年12月到2009年12月在长海医院住院的CP患者的临床资料,按M-ANNHEIM分类系统进行分类.结果 307例CP患者入组,其中男性214例,女性93例,男∶女=2.3∶1,成人256例,青少年(＜18岁)51例.有饮酒史129例(42.0%),吸烟110例(35.8%),血脂升高31例(10.1%),12例有胰腺分裂、胰腺创伤后胰管瘢痕形成等胰腺导管因素.胰腺钙化231例(75.2%),外分泌功能不全(脂肪泻)45例(14.7%),内分泌功能不全(糖尿病)58例(18.9%),曾行胰腺外科手术者32例(10.4%),伴有胰腺假性囊肿、胆管梗阻、胰腺癌等严重的器质性并发症者39例(12.7%).M-ANNHEIM临床分期:0期患者为0,Ⅰ期患者220例(71.7%),Ⅱ期69例(22.5%),Ⅲ期12例(3.9%),Ⅳ期6例.M-ANNHEIM临床特征及严重性评分平均为7.78分.轻度69例(22.5%),中度174例(56.7%),进展62例(20.2%).结论 M-ANNHEIM 分类系统是临床实践的一个简单的、客观的、精确的、有效的和相对非侵害性的分类系统,有助于研究各危险因素对疾病的影响及其交互作用.     

毒蕈中毒3638例临床分型的探讨

目的提高对毒蕈中毒的认识和认知,探讨毒蕈中毒的临床分型、特征和预后。方法检索国内1995年1月至2004年12月公开发表的毒蕈中毒191篇文献,共报道了毒蕈中毒3466例,我院1980年1月至2004年12月收治的毒蕈中毒患者172例,共3638例毒蕈中毒患者进行临床分型的探讨。结果胃肠炎型571例,全部治愈;急性肾衰竭型1450例,治愈1414例（97．5％）,死亡36例（2．5％）;中毒性肝炎型1010例,治愈841例（83．3％）,死亡169例（16．7％）;神经精神型214例,治愈197例（92．1％）,死亡17例（7．9％）;溶血型73例,治愈71例（97．3％）,死亡2例（2．7％）,不同类型毒草中毒疗效和预后差异有统计学意义（P〈0．001）。分型不详者320例,其中以多器官功能障碍综合征者222例,治愈98例（44．1％）,死亡124例（55．9％）,无法分型者98例,治愈90例（91．8％）,死亡8例（8．2％）。结论毒蕈中毒患者的临床表现和中毒发生机制非常复杂,毒蕈中毒的类型和分型应符合临床报道的病例资料及特征,教科书和专著报道的毒蕈中毒分为4型,这与毒蕈中毒临床实际情况和本研究结果不相符。因此,根据本研究3638例毒蕈中毒资料,临床应分为5种类型：（1）胃肠炎型;（2）急性肾衰竭型;（3）中毒性肝炎型;（4）神经精神型;（5）溶血型。是否存在混合型,有待进一步观察更多的毒蕈中毒临床病例资料。     

Gene expression profiling in follicular lymphoma to assess clinical aggressiveness and to guide the choice of treatment

Follicular lymphoma (FL) is a disease characterized by a long clinical course marked by frequent relapses that vary in clinical aggressiveness over time. Therefore, the main dilemma at each relapse is the choice for the most effective treatment for optimal disease control and failure-free survival while at the same time avoiding overtreatment and harmful side effects. The selection for more aggressive treatment is currently based on histologic grading and clinical criteria; however, in up to 30% of all cases these methods prove to be insufficient. Using supervised classification on a training set of paired samples from patients who experienced either an indolent or aggressive disease course, a gene expression profile of 81 genes was established that could, with an accuracy of 100%, distinguish low-grade from high-grade disease. This profile accurately classified 93% of the FL samples in an independent validation set. Most important, in a third series of FL cases where histologic grading was ambiguous, precluding meaningful morphologic guidance, the 81-gene profile shows a classification accuracy of 94%. The FL stratification profile is a more reliable marker of clinical behavior than the currently used histologic grading and clinical criteria and may provide an important alternative to guide the choice of therapy in patients with FL both at presentation and at relapse.     

Patterns of uveitis as a guide in making rheumatologic and immunologic diagnoses

Objective. To describe the patterns of clinical presentation in a series of 407 patients with uveitis and to establish the relationship between these patterns and the final diagnosis. Methods. Patients were referred to the Uveitis Clinic of a tertiary hospital from January 1992 to January 1996. All patients received a complete ophthalmologic examination, and a general clinical history was obtained. The current International Uveitis Study Group classification system was used for anatomic classification. To establish the final diagnosis of the most common entities causing uveitis, current diagnostic criteria were used. A discriminant analysis, with diagnostic grouping as the outcome variable and the clinical presentation features as discriminating variables, was performed. Results. With our classification system, 66.5% of the cases could be correctly classified according to the clinical pattern and morphologic findings. By diagnostic groups, discriminant analysis showed that 75% of patients with Behçet's disease, 77.1% of those with spondylarthropathy (including inflammatory bowel disease), 33.3% of those with sarcoidosis, 97.9% of those with toxoplasmosis, 85.7% of those with Vogt-Koyanagi-Harada syndrome, 100% of those with herpes, and 50.4% of those with idiopathic uveitis were correctly classified. In the miscellaneous group, which included disease entities with fewer than 5 cases, 42.9% were correctly classified. Conclusion. Rheumatologic evaluation of the patient with uveitis can be more cost-effective if the referring ophthalmologist follows the classification system described herein, allowing a tailored approach in which only specific and necessary diagnostic tests are used.     

Barrett食管的临床病理特征分析

目的探讨内镜下拟诊为Barrett食管(BE)患者的临床症状、内镜下表现类型和病理特征之间的关系。方法对184例内镜下拟诊为BE的患者进行临床症状评估,HE染色行病理组织学分析。并对临床症状、内镜下表现类型及病理特征之间的关系进行相关分析。结果内镜下拟诊184例BE患者,反酸33例次,反食7例次,烧心23例次,胸骨后疼痛13例次,上腹痛70例次,上腹胀38例次,其中10例患者有食管外症状(咳嗽、咽炎等);37例无明显症状。内镜表现类型岛型128例,环周型43例,舌型13例。活检证实有柱状上皮化生88例(占47.8%),其中有46例可见肠上皮化生,发现1例不典型增生。病理确诊的46例肠化BE和42例非肠化BE患者的反酸发生率明显高于非BE患者,其他临床症状比较无明显差异;内镜下拟诊的3种类型的BE患者临床主要症状比较无明显差异;内镜表现为环周型、岛型和舌型BE的柱状上皮化生和肠化生的检出率无明显差异。结论(1)病理确诊的BE患者反酸的发生率明显高于非BE患者。(2)BE患者内镜表现类型与症状无关。(3)内镜表现以岛状多见,柱状上皮化生和肠上皮化生在3型BE中检出率无差异。     

Application of neural networks to the classification of giant cell arteritis

Objective. Neural networks are a group of computer-based pattern recognition methods that have recently been applied to clinical diagnosis and classification. In this study, we applied one type of neural network, the backpropagation network, to the diagnostic classification of giant cell arteritis (GCA). Methods. The analysis was performed on the 807 cases in the vasculitis database of the American College of Rheumatology. Classification was based on the 8 clinical criteria previously used for classification of this data set: 1) age ≥50 years, 2) new localized headache, 3) temporal artery tenderness or decrease in temporal artery pulse, 4) polymyalgia rheumatica, 5) abnormal result on artery biopsy, 6) erythrocyte sedimentation rate ≥50 mm/hour, 7) scalp tenderness or nodules, and 8) claudication of the jaw, of the tongue, or on swallowing. To avoid overtraining, network training was terminated when the generalization error reached a minimum. True cross-validation classification rates were obtained. Results. Neural networks correctly classified 94.4% of the GCA cases (n = 214) and 91.9% of the other vasculitis cases (n = 593). In comparison, classification trees correctly classified 91.6% of the GCA cases and 93.4% of the other vasculitis cases. Neural nets and classification trees were compared by receiver operating characteristic (ROC) analysis. The ROC curves for the two methods crossed, indicating that the better classification method depended on the choice of decision threshold. At a decision threshold that gave equal costs to percentage increases in false-positive and false-negative results, the methods were not significantly different in their performance (P = 0.45). Conclusion. Neural networks are a potentially useful method for developing diagnostic classification rules from clinical data.     

不同体重指数新型冠状病毒肺炎患者的临床特点及转归

目的:探讨不同体重指数(BMI)新型冠状病毒肺炎(COVID-19)患者的临床特点及转归,为病情评估及预后提供依据。方法:收集2020年1月16日至2020年3月28日在武汉科技大学附属孝感医院确诊的541例COVID-19患者临床资料,根据BMI分为正常体重组、超重组和肥胖组,比较3组患者的临床特点及转归。采用有序 ...