维持性血液透析患者血清维生素D水平与血红蛋白、促红细胞生成素抵抗的相关性

目的 探讨维持性血液透析(MHD)患者血清维生素D水平与血红蛋白(Hb)、促红细胞生成素(EPO)抵抗的关系。方法 将113例MHD患者根据血清25(OH)D3水平(<10μg/L、10~20μg/L、21~30μg/L)分为A组36例、B组52例、C组25例,比较3组血清Hb、铁蛋白、白蛋白(ALB)、C反应蛋白(CRP)水平以及重组人促红细胞生成素(r Hu EPO)用量、EPO抵抗指数(ERI)等指标的差异,采用Pearson相关分析血清25(OH)D3水平与Hb、CRP、ERI的关系。结果 与A组比较,B、C组r Hu EPO用量、ERI、CRP水平降低,Hb、25(OH)D3水平升高(P均<0.05),且C组以上指标变化最明显(P均<0.05)。MHD患者血清25(OH)D3水平与Hb呈正相关(r=0.846,P<0.01),与ERI(r=-0.776,P<0.01)、CRP(r=-0.806,P<0.01)呈负相关。结论 MHD患者Hb水平降低、EPO抵抗的发生与维生素D缺乏有关。     

血清25-羟基维生素D与老年高血压及其危险分层的相关性研究

目的探讨血清25-羟基维生素D[25(OH)D]在老年高血压发生、发展中的作用。方法随机选取老年高血压患者230例作为高血压组,进行高血压分级和危险分层,高血压分级1、2、3级分别为22、65、143例;高血压危险分层低中危、高危、极高危分别为23、53、154例;合并症组87例和无合并症组143例。选择同期住院的非高血压患者138例作为对照组。电化学发光法测定血清25(OH)D水平,同时用全自动生化分析仪检测血脂、空腹血糖、血尿酸以及炎性因子高敏C反应蛋白(hs-CRP)和血清淀粉样蛋白A(SAA)。比较血清25(OH)D水平差异,同时进行相关性分析。结果与对照组比较,高血压组的血清25(OH)D水平显著降低[(11.73±5.30)μg/L vs(19.02±6.37)μg/L,P0.01]。随着高血压分级和危险分层的增加,血清25(OH)D水平逐级、逐层显著降低。高血压3级血清25(OH)D水平显著低于高血压2级和1级患者[(9.36±3.93)μg/L vs(12.32±3.41)μg/L和(16.62±5.04)μg/L,P0.01]。高血压极高危患者显著低于高危和低中危患者[(9.49±4.18)μg/L vs(11.66±3.46)μg/L和(18.44±5.04)μg/L,P0.01]。合并症组血清25(OH)D水平显著低于无合并症组[(8.69±2.89)U/L vs(16.96±6.02)U/L,P0.01]。Pearson相关分析显示,高血压组患者血清25(OH)D与收缩压、舒张压、TC、LDL-C、尿酸、hs-CRP、SAA均呈负相关(P0.05,P0.01)。进一步多元回归分析表明,收缩压、舒张压、hs-CRP和SAA是影响血清25(OH)D的独立危险因素(P0.05,P0.01)。结论血清25(OH)D下降可能参与老年高血压的发生、发展及心脑脏器的损害。25(OH)D水平越低,高血压越重,提示患者预后不良。     

冠心病患者血清25(OH)D水平的改变及其与冠状动脉病变严重程度的相关性

目的探讨冠心病患者血清25(OH)D水平的改变并分析其与冠状动脉病变程度的相关性。方法选择150例行冠状动脉造影患者,记录所有入选患者的一般情况,包括性别、年龄、高血压和糖尿病病史等情况。采用免疫透析比浊法测定生化指标,包括空腹血糖、低密度脂蛋白胆固醇(LDLC)、血清钙。所有患者均通过高效液相色谱-串联质谱法测定血清25(OH)D水平。根据造影结果,把患者分为正常对照组和冠状动脉病变组,冠状动脉病变组根据SYNTAX评分分为轻度、中度和重度三个亚组。结果冠心病患者血清25(OH)D水平(13.87±7.16μg/L)显著低于正常对照组(21.67±7.38μg/L,P0.05)。冠状动脉病变SYNTAX积分≥33分组(重度组)、23~32分组(中度组)和≤22分组(轻度组)血清25(OH)D水平均明显低于正常对照组(P0.05),且随冠状动脉病变SYNTAX积分增加(病变程度加重)血清25(OH)D水平逐渐降低(P0.05)。血清25(OH)D水平与冠状动脉病变严重程度呈显著负相关(r=-0.328,P=0.019)。所有患者LDLC、血糖及血清钙水平分别为2.90±0.98 mmol/L、5.85±1.46 mmol/L、2.09±0.22 mmol/L。双变量相关性分析示25(OH)D水平与患者年龄、LDLC、血糖及血清钙无明显相关性。结论血清25(OH)D水平在冠心病患者中显著降低,且其水平与冠状动脉病变严重程度密切相关。     

25羟维生素D及甲状旁腺激素与高血压的关系

目的目前血清25羟维生素D[25-(OH)D]、甲状旁腺激素(PTH)与高血压是否直接相关尚无定论,文章旨在探讨三者之间的关系。方法选取2014年3月至2015年7月就诊于盛京医院心血管内科的患者368例,其中男性202例。按照是否患高血压分为高血压组(198例)和非高血压组(170例)。收集研究对象一般资料并检测PTH以及25-(OH)D水平。分析25-(OH)D、PTH与高血压之间的关系。结果高血压组患者25-(OH)D水平低于非高血压组(37.67±18.23 nmol/L比42.45±20.41 nmol/L,P=0.018)。两组间PTH水平差异无统计学意义(50.08±28.80 ng/L比50.45±22.37 ng/L,P=0.892)。Pearson相关性分析显示,25-(OH)D与PTH呈负相关(r=-0.225,P0.05)。二元Logistic回归分析显示维生素D缺乏或不足是高血压的独立危险因素(OR=1.847,95%CI 1.138~2.996,P=0.013),PTH升高与高血压发病风险不存在相关。结论维生素D不足或缺乏与高血压相关,是高血压的危险因素。     

25-羟维生素D与糖尿病慢性肾脏疾病患者血糖控制的相关性研究

目的探讨25-羟维生素D[25(OH)D]与糖尿病慢性肾脏疾病(CKD)患者血糖控制的相关性。方法收集CKD患者130例和健康体检(NC)者45名,根据eGFR分为CKD1期、CKD2期和CKD3~5期组,测定各组血清25(OH)D和HbA1c。结果 CKD各组25(OH)D水平低于NC组(P0.05);CKD1期、CKD2期和CKD3~5期组25(OH)D水平依次降低(P0.05),HbA1c依次升高(P0.05)。25(OH)D与HbA1c呈负相关(r=-0.511,P=0.002)。多元线性回归分析结果显示,HbA1c、年龄、病程和BMI是25(OH)D的影响因素。结论 CKD患者血糖控制情况与25(OH)D水平密切相关。     

血清25羟维生素D3与成纤维细胞生长因子23在2型糖尿病合并高血压患者中变化趋势的观察

目的了解血清25羟维生素D3[25-(OH)D3]与成纤维细胞生长因子23(FGF23)水平在T2DM合并高血压患者中的变化趋势。方法选取T2DM合并高血压患者40例(DH组),单纯T2DM患者40例(T2DM组),以及同期体检的健康者40名(NC组),检测血清25-(OH)D3和FGF23水平及各项临床生化指标。结果 T2DM组血清25-(OH)D3水平[(31.96±2.13)μg/L]低于NC组[(33.53±2.53)μg/L](P<0.05),DH组25-(OH)D3水平[(30.82±2.83)μg/L]较T2DM组更低(P<0.01)。T2DM组FGF23水平[(1.80±0.09)μg/L]高于NC组[(1.14±0.09)μg/L](P<0.01),DH组FGF23水平[(1.86±0.08)μg/L]较T2DM组更高(P<0.01)。结论血清25-(OH)D3和FGF23水平与T2DM合并高血压有相关性。     

2型糖尿病患者血清25羟维生素D_3水平与高敏C反应蛋白、尿白蛋白排泄率的相关性研究

目的探讨T2DM患者血清25羟维生素D3[25(OH)D3]水平与高敏C反应蛋白(hsCRP)、UAER的相关性。方法160例T2DM患者按照25(OH)D3水平分组,比较各组间hsC-RP、UAER、甲状旁腺激素(PTH)和生化指标的结果。结果UAER水平在25(OH)D310ng/ml组、25(OH)D310~19ng/ml组和25(OH)D3≥20ng/ml组逐渐降低[(72.17±64.15)vs(55.35±30.35)vs(11.11±7.66)mg/L,P0.01];hsC-RP水平亦逐渐降低[(4.70±4.39)vs(4.60±6.45)vs(4.40±5.72)mg/L,P0.05]。相关分析显示,25(OH)D3与UAER、hsC-RP呈负相关(r=-0.472,-0.228,P0.01),与eGFR呈正相关(r=0.172,P0.05)。多元线性回归分析显示,UAER(β=-0.101,P0.01)、hsC-RP(β=-0.306,P0.01)是25(OH)D3的独立影响因素。结论 T2DM患者大多存在血清25(OH)D3的缺乏,hsC-RP、UAER可能是影响血清25(OH)D3水平的独立危险因素。     

维生素D对老年社区获得性肺炎的辅助治疗作用

目的探讨维生素D(Vitamin D,Vit D)佐治老年人社区获得性肺炎(community acquired pneumonia,CAP)的临床疗效。方法选择老年CAP患者104例,随机分为Vit D治疗组和安慰剂对照组,每组各52例,以同期体检的78例健康老年人作对照。应用酶联免疫吸附法检测血清中25-(OH)D_3水平,应用免疫透射比浊法检测血清中Ig A及CRP水平,并记录CAP患者的临床症状、体征、实验室、影像学检查的变化情况及住院天数。结果 CAP患者组治疗前,血清25-(OH)D_3、IgA和CRP水平分别为(25.22±8.68)nmol/L、(0.28±0.06)g/L和(119.50±21.76)mg/L,其中血清25-(OH)D_3和Ig A水平均明显低于正常对照组(t=25.213,P0.01;t=22.280,P0.01),而血清CRP水平显著高于正常对照组(t=-47.114,P0.01),且CAP患者血清25-(OH)D_3水平与血清IgA水平呈正相关(r=0.829,P0.05)。同安慰剂对照组相比,Vit D治疗组患者血清CRP水平降低,临床总有效率提高了34.4%,住院天数缩短了25.1%,且三项值组间比较均有统计学意义(t=5.017,P0.01;χ~2=4.248,P0.05;t=6.321,P0.05)。Vit D治疗组患者治疗后血清25-(OH)D3和Ig A水平分别为治疗前的2.84倍和1.96倍。安慰剂对照组患者治疗前后血清25-(OH)D_3和IgA水平差异无统计学意义。结论 VitD缺乏可能是老年人CAP的潜在病因,补充足量Vit D可缓解CAP患者临床症状,明显缩短病程。     

胃肠道肿瘤癌性贫血患者血清Hepcidin和IL-6、IFN-γ、TNF-α表达及意义

目的:探讨胃肠道肿瘤癌性贫血患者外周血铁调素(Hepcidin)水平变化的意义及其与白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)和肿瘤坏死因子-α(TNF-α)浓度变化的相关性。方法:采用双抗夹心生物素-亲和素-酶联免疫吸附试验(ABC-ELISA)法检测94例胃肠道恶性肿瘤患者的血清Hepcidin、IL-6、IFN-γ和TNF-α浓度,其中29例伴有癌性贫血,分析Hepcidin与贫血、IL-6、IFN-γ、TNF-α之间的相关性。结果:①胃肠道肿瘤癌性贫血患者血清Hepcidin和IL-6水平均显著高于无贫血患者[(50.89±32.78)μg/L∶(30.06±30.40)μg/L、(30.77±34.44)ng/L∶(11.61±28.13)ng/L,均P0.05],而IFN-γ和TNF-α无明显差异[(138.96±70.23)ng/L∶(135.00±59.06)ng/L、(7.20±3.81)ng/L∶(9.20±8.19)ng/L,均P0.05];②胃肠道肿瘤癌性贫血患者的Hepcidin与IL-6呈正相关(r=0.375,P0.05),而与IFN-γ和TNF-α无相关性(r=-0.167和0.01,均P0.05);③胃肠道肿瘤癌性贫血患者的Hepcidin和IL-6、IFN-γ、TNF-α均与血红蛋白无相关性(均P0.05)。结论:胃肠道肿瘤癌性贫血患者外周血清Hepcidin和IL-6显著升高,且Hepcidin浓度与IL-6水平呈正相关,Hepcidin和IL-6在胃肠道肿瘤癌性贫血的发生发展过程中起重要的作用。     

中国人群血清甲状旁腺素水平

目的分析中国不同地区人群血清甲状旁腺素(parathyroid hormone,PTH)水平,建立中国人群的PTH参考区间。方法选取中国不同地区表观健康人2 449名,检测血清PTH水平,同时检测血钙(calcium,Ca)、血磷(phosphor,P)及血清25羟维生素D(25 hydroxyvitamin D,25OHD)水平。探讨不同地区、不同性别、不同年龄人群PTH的差异,并建立适合中国人群的PTH参考区间。结果中国人群血清PTH的浓度为(37.07±14.29)ng/L,2.5~97.5百分位数为16.00~71.96 ng/L。大连地区人群血清PTH水平显著低于其他地区。血清PTH水平随年龄增加而增加,在同一年龄组性别间差异无统计学意义(P0.05)。随着血清25OHD水平增高,PTH显著降低(P=0.000)。血清25OHD不足及正常人群(≥20μg/L)的血清PTH 95%参考范围是14.10~65.22 ng/L。血清25OHD水平随年龄增加而增加(P0.01)。血清Ca水平随年龄增加而降低(P0.01)。血清Ca在血清25OHD水平10μg/L时低于血清25OHD水平≥20μg/L时(P0.05)。血P在血清25OHD水平20μg/L时明显高于血清25OHD≥20μg/L时(P=0.000)。结论本研究建立了中国人群PTH的参考区间,在建立中国人群PTH参考区间时需要考虑维生素D缺乏的影响。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.     

Communicating with patients with inflammatory bowel disease

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are chronic illnesses that affect hundreds of thousands of Americans. Patients with IBD suffer chronically from diarrhea, abdominal pain, gastrointestinal bleeding, malabsorption, and weight loss requiring continuous medical and surgical attention. Despite recent advances in therapy, IBD follows a course of exacerbations and remissions with approximately 25-50% of patients relapsing annually. Hence, these diseases are readily encountered in primary care and gastroenterology clinics. Though medical and surgical treatment options have improved significantly, little has been written about the psychosocial aspects of IBD. Currently, there is a paucity of data concerning effective communication methods enabling physicians to develop stronger rapport with patients suffering from IBD, the care of whom requires a multidisciplinary approach involving primary care physicians, gastroenterologists, and colorectal surgeons. Because IBD has a high morbidity, it is worthwhile to further investigate those social factors that will improve patients' quality of life. In this paper, we summarize some of the common problems that emerge when taking care of patients with IBD and provide initial guidelines based on the world literature regarding the management and education of patients with IBD. Both primary care physicians and specialists (gastroenterologists, colorectal surgeons) need to be aware of the questions and concerns of IBD patients and to be capable of dispensing the information in a clear and concise manner. Using the case scenario format, we review the most common aspects of communication for health care professionals taking care of IBD patients and suggest ways to establish and maintain long-term doctor-patient relationships. The two most significant interventions that dramatically improve quality of life and patient-physician relationships are proper patient education and appropriate treatment of concurrent depression and anxiety. We hope that our review will form a framework by which different members of the medical team learn their roles in the complex management decisions affecting IBD patients.