Primary Clinical Evaluation of the Joint Replacement for the Treatment of the First Metatarsophalangeal Arthritis

Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant.Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant.There were 2 males and 10 females with a mean age of 61.4 (range,56-75) years old.Of them,9 cases (11 feet) were hallux valgus with osteoarthritis;1 case (2 feet) was rheumatic arthritis;2 cases (2 feet) were traumatic arthritis.The subjective and objective results were evaluated during follow-up.Results All of the patients were followed up regularly with an average of 24.7 months,ranging from 12 to 38 months.Ten patients were completely satisfied with the operation;1 patient showed partial satisfaction,and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation.Osteolysis around the implant occurred in 2 cases without clinical symptoms,and no special treatment was given.Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.     

Influencing factors analysis of among middle aged and old aged spontaneous knee joint osteoarthritis pople in Xi＇an

Objective： To explore the prevalence rate of knee joint osteoarthritis and its pathogenetic features among the middle-aged and old aged people in the urban and rural area of Xi＇an. Methods： From May to October 2005, 1 538 Han nationality above 40 years in Xi＇an were investigated according to stratified and cluster random sampling. The same questionnaire was delivered to subjects who had been given normotopia and lateral position radiographic examination in both knees. Excluded from etiological arthritis, some subjects with clinical symptoms and a radiographic grade （beyond Kellgren ＆ Lawrence grade Ⅱ ） were finally diagnosed as spontaneous knee joint osteoarthritis. All analyses were performed with SPSS 13.0 and t test, U test. Single factor analysis and multiple logistic regression analysis were used to analyze dates. Results： The total prevalence of spontaneous knee joint osteoarthritis was 12. 1% with 2.5% and 2.1% for right and left knees, respectively. The prevalence of knee joint osteoarthritis in women was 2.5 times of that in men （17.2% vs 6.8%, P=0. 000）. the osteophyte prevalence in women was 2.3 times of that in men （26.5% vs 11. 4%, P=0. 000）. The prevalence of knee joint osteoarthritis and osteophyte increased with the growth of age. So did the symptomatic knee, except for the age group of 56- 60 years and 66-70 years. The prevalence of symptomatic knee joint for urban area was significantly higher than that for rural area （56. 3% vs 45. 3%, P=0. 003）. In women, the prevalence of knee joint osteoarthritis increased significantly with the increasing of body mass index, which had not been observed in men. Female and obesity are the risk factors for osteoarthritis, but bean and its products and meat could prevent the osteoarthritis. Conclusion： Old age, female and obesity serve as risk factors for knee joint osteoarthritis.     

Influencing factors analysis of spontaneous knee joint osteoarthritis among middle aged and old aged pople in Xi''''an

Objective:To explore the prevalence rate of knee joint osteoarthritis and its pathogenetic fea- tures among the middle-aged and old aged people in the urban and rural area of Xi'an.Methods:From May to October 2005,1538 Han nationality above 40 years in Xi'an were investigated according to strati- fied and cluster random sampling.The same questionnaire was delivered to subjects who had been given normotopia and lateral position radiographic examination in both knees.Excluded from etiological arthri- tis,some subjects with clinical symptoms and a radiographic grade (beyond Kellgren & Lawrence gradeⅡ) were finally diagnosed as spontaneous knee joint osteoarthritis.All analyses were performed with SPSS 13.0 and t test,U test.Single factor analysis and multiple logistic regression analysis were used to analyze dates.Results:The total prevalence of spontaneous knee joint osteoarthritis was 12.1% with 2.5% and 2.1% for right and left knees,respectively.The prevalence of knee joint osteoarthritis in wom- en was 2.5 times of that in men (17.2% vs 6.8%,P=0.000).the osteophyte prevalence in women was 2.3 times of that in men (26.5% vs 11.4%,P=0.000).The prevalence of knee joint osteoarthritis and osteophyte increased with the growth of age.So did the symptomatic knee,except for the age group of 56- 60 years and 66-70 years.The prevalence of symptomatic knee joint for urban area was significantly higher than that for rural area (56.3% vs 45.3%,P=0.003).In women,the prevalence of knee joint os- teoarthritis increased significantly with the increasing of body mass index,which had not been observed in men.Female and obesity are the risk factors for osteoarthritis,but bean and its products and meat could prevent the osteoarthritis.Conclusion:Old age,female and obesity serve as risk factors for knee joint os- teoarthritis.     

TWENTY-THREE YEAR''S RESEARCH ON PREVENTION OF CERVICAL CANTCER

Preventive mass screening was conducted every l-2 years in 42 textile factories from 1958- 80 in Shanghai. A total of 846,104 examinations was made, and the percentage of women ex- amined was 70-90%. In 23 years the age- standardized prevalence rate was lowered by 97.6%. 520 cases of cervical cancer were fonnd, among them 465 patients are still alive. The 10-year survival rate (life-table method) was 93.1%, and the 20-year, 86.1%. There were rio stage IV, III and II cases in recent 18, 8 and 7 years, respectively. In the past 8 years, all 45 cases except one were of subclinical type. The average incidence rate of cervical cancer ranked 5th among all malignant cases at these factories, whereas the mortality rate came down to the last. The prevalence rate of cervical cancer in the ≥40 year old group was over 3 times higher than in the <40 year old group. During the 23 years the median age of cervical cancer patients was postponed by 8.7 years. The disease has not been discovered in <40 year old women in the last 3 years. Carcinoma in-situ was not detected in the <40 year old group in the last 8 years. The prevalence rate of cervical atypical hyperplasia in the ≥40. year old group was 7.5 times higher than in the group. of <48 years. Therefore women ≥40 years, old are the high risk group in our series.     

Epidemiologic study of soft tissue rheumatism in Shantou and Taiyuan, China

Background Soft tissue rheumatism is a group of common rheumatic disorders reported in many countries.For investigating the prevalence rate of soft tissue rheumatism in different population in China, we carried out a population study in Shantou rural and Taiyuan urban area.Methods Samples of 3915 adults in an urban area of Taiyuan, Shanxi Province, and 2350 in a rural area of Shantou,Guangdong Province were surveyed.Modified International League of Association for Rheumatology （ILAR）-Asia Pacific League of Association for Rheumatology （APLAR） Community Oriented Program for Control of Rheumatic Diseases （COPCORD） core questionnaire was implemented as screening tool.The positive responders were then all examined by rheumatologists.Results Prevalence rate of soft tissue rheumatism was 2.0% in Taiyuan, and 5.3% in Shantou.Rotator cuff （shoulder）tendinitis, adhesive capsulitis （frozen shoulder）, lateral epicondylitis （tennis elbow）, and digital flexor tenosynovitis （trigger finger） were the commonly seen soft tissue rheumatism in both areas.Tatarsalgia, plantar fasciitis, and De Quervain＇s tenosynovitis were more commonly seen in Shantou than that in Taiyuan.Only 1 case of fibromyalgia was found in Taiyuan and 2 cases in Shantou.The prevalence of soft tissue rheumatism varied with age, sex and occupation.Conclusions Soft tissue rheumatism is common in Taiyuan and Shantou, China.The prevalence of soft tissue rheumatism was quite different with different geographic, environmental, and socioeconomic conditions; and varying with age, sex, and occupation.The prevalence of fibromyalgia is low in the present survey.     

Treatment and prognosis of primary mediastinal seminoma

Objective: To investigate the surgical treatment and prognosis of the primary mediastinal seminoma. Methotis: Three cases with primary mediastinal seminoma from 1985 were retrospectively studied. They were male, aged 23, 36 and 32 years respectively. The primary symptoms were chest pain and coughing. The chest X-ray examination revealed solid round mass in the anterior mediastinum, with the diameters varied from 3 cm to 18 cm and a smooth clear edge. The diagnosis was not clearly in all three cases, and then operation was performed. Results: There were no operative deaths and complications. The tumor was radically removed in 2 cases and palliatively removed in 1 case. The post-operative pathological diagnosis is seminoma in all three cases. Radiotherapy were performed in 4 weeks after operation. All cases have been followed up to now, with 1 cases of death and 2 cases survival. Conclusion: Primary seminoma of the mediastinum is very rare. Operation is the main treatment for the primary mediastinal seminoma. Seminoma shows a good prognosis.     

Primary tracheobronchial amyloidosis in China: Analysis of 64 cases and a review of literature

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.     

Current trends of the prevalence of childhood asthma in three Chinese cities: a multicenter epidemiological survey

Objective To analyze the prevalence of asthma and asthma related symptoms among children aged 0-14 years in three Chinese cities and to obtain a crude estimation of the trend of childhood asthma prevalence in China. Methods A cross-sectional, population-based survey of prevalence of asthrna was conducted in children aged from 0 to 14 years in 3 major cities of China （Beijing, Chongqing, and Guangzhou） with different geographic locations. All the subjects were randomly selected by a multi-stage sampling method. Three to five schools and kindergartens in 2 urban districts in each city were randomly selected for the survey, and a validated questionnaire that included the core questions of the International Study of Asthma and Allergies in Childhood, Phase III questionnaire and several additional questions were used. All questionnaires were completed by parents or guardians of the selected children. Children whose parents responded affirmatively to the question＂ Has your child ever been diagnosed as asthma by a doctor＂ were recognized as victims of asthma. Results The prevalence of asthma in Beijing, Chongqing, and Guangzhou was 3.15%, 7.45%, and 2.09%, respectively. These values were significantly higher than those obtained 10 years ago in the national epidemiological survey in 2000 which used the same method of investigation and the same diagnotic criteria （x^2=3.938, P=-0.047; 22=73.506, P≤0.001; x^2=11.956, P=0.001, in each city）. Of the asthmatic children 57.21%, 69.91%, and 60.00% had their first attack before the age of 3 in Beijing, Chongqing, and Guangzhou, respectively. Wheezing was the primary clinical manifestation for all asthmatic children, followed by persistent cough and repeated respiratory infections. Both the prevalence of asthma and asthma-related symptoms were statistically higher in males than in females. Conclusion The prevalence of childhood asthma is statistically higher than that 10 years ago in the three Chinese cities.     

Y-V vascular pedicle elongation technique in island flap transplantation

Objective To introduce a new technique for vascular pedicle elongation in island flap transplantation, and evaluate its clinical results. Methods From February 1994 to October 2001,16 cases were treated with island flap transplantation with Y-V vascular pedicle elongation technique. There were 10 males and 6 females with the age ranging from 19 to 45 years (average 26. 8 years). The locations of the primary injury were as follows: the fingers in 6 cases, the great toe in 2 cases, the other toes in 2 cases, the knee joint in 3 cases and the proximal tibia in 1 case. The flaps vascularized by a branch of "Y" pattern bifurcation were used. Both branches of "Y" shaped vascular pedicle arising form the same main vessel trink were dissected, then the main vessel trunk was severed at the division of the branches, the arc of "Y" bifurcations was then turned into "V" pattern, the length of pedicle was significantly elongated than the original pedicle. Results The operative procedures were smooth in the patients,     

全髋关节置换治疗继发于化脓性感染的髋关节炎

Background Suppurative arthritis of the hip occurred most often in children, and often had sequelae after infection resolusion because of delay in treatment. Due to the anatomic abnomalities of the bone and soft tissue, the relatively young age and potential risk of postoperative deep infection, the implementation of total hip arthroplasty (THA) in patients who had osteoarthritis secondary to hip pyogenic infection have more challenge. Methods We retrospectively analyzed 19 total hip arthroplasties that had been performed from April 2003 to July 2008 in adult patients who had osteoarthritis secondary to hip pyogenic infection, the average age of the patients at the time of the operation was 40.7 years (34 to 52 years). There were 7 males and 12 females, the average age of infection was 10.6 years (7 to 13 years), and the average quiescent period of infection was 29.5 years ranging from 22 to 41 years. The count of WBC, ESR and CRP were examined routinely with normal values before surgery. The duration of follow-up was 34 months ( 6 to 52 months). Results There were no evidence of infection by the means of laboratory values, intraoperative exploration, and bacterial culture of joint fluids and synovial tissue. Split fracture above the lesser trochanter occurred in two hips, and healed without adverse sequelae after fixation with wires. One patient with sciatic nerve palsy was successfully treated by positioning the hip in extension and the knee in flextion with complete resolution of motor symtoms one month later. There were no cases of dislocation, deep vein thrombosis or postoperative reinfection. The clinical symptoms and degree of hip joint activities had been significantly improved. The Harris hip scores and the range of motion improved from 47.3（27～63）and 53°±46°(0～140°) preoperatively to 89.7（75～96）and 125°±56°(70°～230°) at the latest follow-up. Conclusions It’s safe and efficient to perform THA in patients who had osteoarthritis secondary to pyogenic sepsis of the hip in childhood when the infection was in a quiescent period. The key point to the success of surgery are exclusion of active infection preoperatively, quiescent period of infection more than ten years, and adequate intraoperative soft-tissue releases.     

第2跖趾关节痛风性关节炎并发先天性短指(趾)畸形1例报告

目的: 报道1例第2跖趾关节痛风性关节炎并发先天性短指(趾)畸形病例,并对其诊疗情况进行讨论。方法: 该男性17岁患者因右足第2跖趾关节反复肿痛6个月入院,诊断为先天性短指(趾)畸形,右第2跖趾关节痛风性关节炎,手术行痛风石切除和关节成形术。结果: 患者术后恢复顺利,疼痛消失,恢复正常行走。结论: 痛风可并发足部畸形,临床上需注意鉴别诊断,手术治疗可获得良好效果。     

痛风性关节炎X线表现与临床分析

目的探讨痛风性关节炎的X线及临床特点的。方法总结分析28例痛风性关节炎的X线表现、临床表现及实验室检查的结果。结果患者全部为男性,平均发病年龄为（50±16）岁。以足第一跖趾最为好发（19/28,67.9%）。X线表现主要是软组织偏侧性肿胀;骨质侵蚀性破坏呈穿凿状,边缘锐利、硬化,关节间隙狭窄,关节面不规整,可发生纤维强直,甚至关节畸形,也可发生半脱位或脱位,可伴有骨质增生,邻近骨质疏松。结论痛风性关节炎是一种主要累及中年男性,以急性关节炎症为主要表现的疾病,以第一跖趾关节最常受累。痛风性关节炎的X线表现多样,易与其他单发或多发骨关节病相混淆,必须认真分析其X线征象并结合临床表现及实验室检查才能做出正确诊断。     

痛风患者发生关节及肌腱内晶体沉积的临床特点

目的:探讨痛风患者发生关节及肌腱内晶体沉积的临床特点,为痛风的早期诊治提供依据。方法:选择2019年6—12月在北京大学人民医院风湿免疫科连续就诊的痛风患者共105例进行回顾性分析,应用高频超声技术检测其膝、踝、足趾及其他疼痛关节和肌腱,并依据其有无尿酸钠晶体沉积以及晶体沉积部位对其进行分组,收集临床资料,并分析各组临床特点。结果:105例患者中,未检测到关节或肌腱内晶体沉积的患者共25例(无结晶组), 检测到关节内结晶的患者共43例(关节组),检测到肌腱内结晶(伴或不伴关节结晶)的患者共37例(肌腱组)。其中关节组最常累及的部位为跖趾关节(29例,67.4%),其次为膝关节(10例,23.2%)、踝关节(9例,20.9%), 此外还可见晶体沉积于腕关节(2例)、足背关节(2例)、近端指间关节(1例)。肌腱组最常累及的部位为股四头肌腱(16例,43.2%), 其次为跟腱(13例,35.1%)、髌腱(12例,32.4%)、肱三头肌腱(5例,13.5%),此外还可见晶体沉积于冈上肌腱(3例)、肩胛下肌腱(2例)、屈指肌腱(2例)、桡侧腕长伸肌腱(1例)、桡侧腕短伸肌腱(1例)、胫骨前肌腱(1例)、胫骨后肌腱(1例)、屈趾肌腱(1例)。3组间利用多样本方差分析/多样本秩和检验进行比较,患者年龄、尿酸初次升高年龄、血糖水平及C反应蛋白差异均有统计学意义;经多重比较,肌腱组年龄、尿酸初次升高年龄、C反应蛋白均显著高于无结晶组;无结晶组与关节组、肌腱组与关节组差异无统计学意义。结论:在痛风患者中,超声检测到晶体沉积于关节或肌腱是常见的,最常累及的部位包括跖趾关节、膝关节、踝关节,以及股四头肌肌腱、跟腱、髌腱、肱三头肌肌腱。3组间年龄、尿酸初次升高年龄、C反应蛋白、血糖水平差异有统计学意义,且有晶体沉积患者合并泌尿系结石的比例显著高于无结晶沉积者。     

汕头地区脂肪肝患病现状分析

目的 调查汕头地区健康体检人群脂肪肝发病率以及年龄分布特征,并探讨脂肪肝的健康管理方法.方法 对2012年5月-2013年8月的16个月中在汕头市中心医院体检中心进行健康体检的人员中随机抽取3155例人员进行调查,将脂肪肝分为轻中重度,按性别年龄分组进行统计学分析.结果 3155例检查结果中共检出脂肪肝884例,男性患病率（31.3％）高于女性（23.5％）,差异有统计学意义（P＜0.05）,男性50岁前各年龄组间的脂肪肝总患病率随年龄增长有不断增高的趋势,但在50岁以后女性患病率反而有所增加,在20～49岁各年龄组间,男性脂肪肝患病率均高于女性,差异有统计学意义（P＜0.05）.在50岁以后各年龄组间,女性脂肪肝患病率均高于男性,但差异无统计学意义（P＞0.05）.结论 汕头地区脂肪肝患病率较高,并呈逐渐年轻化趋势.提倡加强人们的健康检查意识,定期检查,早期发现,及时预防,纠正不良习惯,改善生活方式,加强锻炼,合理饮食.     

Swanson人工跖趾关节置换术治疗第2~5跖趾关节疾病的疗效评价

目的: 探讨使用Swanson双柄硅胶假体行跖趾关节置换治疗骨性关节炎、类风湿关节炎等引起的第2~5跖趾关节病变的中长期临床疗效。方法: 2010年1月至2015年10月应用Swanson双柄硅胶假体实施第2~5跖趾关节置换术21例,成功随访16例,其中,男性2例,女性14例,平均年龄(66.7±5.5)岁,类风湿关节炎9例,严重骨性关节炎5例,跖骨头骨软骨病2例。采用美国足踝外科协会Maryland足部评分系统、视觉模拟评分(visual analogue score, VAS)和影像学检查等方法对手术前后行走及跖趾关节活动度、疼痛程度等进行临床评价。结果: 随访时间17个月至5年,平均3.2年。Maryland足部评分:术前为(60.69±6.12)分,术后末次随访时为(88.13±5.84)分。术前跖趾关节活动度:背伸5.4°±3.1°,跖屈4.4°±2.7°;术后:背伸15.7°±4.5°,跖屈12.2°±4.3°,术后跖趾关节活动度较术前有明显改善,数据对比差异有统计学意义(P<0.01)。VAS评分:术前评分为(6.8±0.9)分,术后末次随访为(2.3±0.8)分,术后跖趾关节疼痛症状得到明显改善。根据美国足踝外科协会Maryland足部评分系统,术后评分较术前评分有显著性提高(P<0.01),优良率达到81.3%。结论: Swanson双柄硅胶假体跖趾关节置换术能够较好地缓解疼痛, 增加关节活动范围及稳定性,维持前足正常的行走能力,是重建第2~5跖趾关节结构、恢复关节功能的有效方法,但仍存在一些不良反应的发生概率,需要进一步改进。     

全身多发巨大痛风石的外科手术综合治疗

目的探讨和评价以手术为主的综合疗法治疗全身多发巨大痛风石的效果。方法对2009—2012年我院收治的13例全身多发巨大痛风石患者,在发作间歇期或慢性期进行手术治疗,同时行一期关节功能重建术并结合药物、康复等综合治疗。结果手术部位共42处,其中在掌指关节及指间关节17处、第1跖趾关节13处、肘关节7处、腕关节5处。术后患者均获随访,随访期为6～35个月、平均13．5月;切口I期愈合39处、延期愈合3处,术后功能及外形均获改善,疼痛消失;术后痛风年均发作次数为（0．8±0．6）次,较术前的（4．8±1．1）次明显减少。结论采用以手术治疗为主的综合疗法是全身多发巨大痛风石的最佳治疗方法,术中保护关节功能及功能重建尤为重要,能改善临床症状、减少发作次数,有利于提高患者的生活质量。     

Swanson人工跖趾关节置换术治疗第2~5跖趾关节疾病的疗效评价

目的: 探讨使用Swanson双柄硅胶假体行跖趾关节置换治疗骨性关节炎、类风湿关节炎等引起的第2~5跖趾关节病变的中长期临床疗效。方法: 2010年1月至2015年10月应用Swanson双柄硅胶假体实施第2~5跖趾关节置换术21例,成功随访16例,其中,男性2例,女性14例,平均年龄(66.7±5.5)岁,类风湿关节炎9例,严重骨性关节炎5例,跖骨头骨软骨病2例。采用美国足踝外科协会Maryland足部评分系统、视觉模拟评分(visual analogue score, VAS)和影像学检查等方法对手术前后行走及跖趾关节活动度、疼痛程度等进行临床评价。结果: 随访时间17个月至5年,平均3.2年。Maryland足部评分:术前为(60.69±6.12)分,术后末次随访时为(88.13±5.84)分。术前跖趾关节活动度:背伸5.4°±3.1°,跖屈4.4°±2.7°;术后:背伸15.7°±4.5°,跖屈12.2°±4.3°,术后跖趾关节活动度较术前有明显改善,数据对比差异有统计学意义(P<0.01)。VAS评分:术前评分为(6.8±0.9)分,术后末次随访为(2.3±0.8)分,术后跖趾关节疼痛症状得到明显改善。根据美国足踝外科协会Maryland足部评分系统,术后评分较术前评分有显著性提高(P<0.01),优良率达到81.3%。结论: Swanson双柄硅胶假体跖趾关节置换术能够较好地缓解疼痛, 增加关节活动范围及稳定性,维持前足正常的行走能力,是重建第2~5跖趾关节结构、恢复关节功能的有效方法,但仍存在一些不良反应的发生概率,需要进一步改进。     

中青年男性与老年男性痛风临床特点比较分析

目的　探讨中青年男性和老年男性痛风的临床特点。方法　对比分析62例中青年男性痛风患者和81例老年男性痛风患者的饮食习惯、发病诱因、临床表现、生化指标、伴发疾病等。结果　两组患者均嗜好高嘌呤饮食,中青年男性饮酒明显多于老年男性患者;发病诱因方面中青年男性主要有剧烈运动、大量饮酒,而老年男性主要是感冒、天气变化及使用利尿剂;中青年男性痛风首发第一跖趾关节为多,多数累及单关节,而老年男性则以膝、踝等大关节为多,累及2～3个关节; 老年男性合并高血压、冠心病、糖尿病的概率比中青年男性多,两者差异有统计学意义(P＜0.05), 但两者合并高脂血症的概率则无明显差异。结论　两组患者临床特点略有差异, 但都会出现合并高血脂的情况,老年患者则更易合并冠心病、高血压、糖尿病等。良好的生活方式、合理饮食结构、避免使用利尿药等有利于疾病的预防。     

影响双能CT尿酸盐结晶检出率的因素

目的: 探讨金标准明确诊断的痛风患者中双能CT(dual energy computed tomography, DECT)检出尿酸盐结晶的影响因素。方法: 选择2011年6月至2018年12月,在北京大学第一医院门诊或住院患者关节滑液偏振光分析尿酸晶体阳性诊断为急性或慢性痛风的病例资料进行回顾性分析,所有患者均接受关节液或痛风石分析和DECT扫描。采用卡方检验、二元Logistics回归及t检验,分析DECT结果与临床资料、实验室检查及药物治疗的关系。结果: 共29例患者入组本研究,22例DECT检出尿酸盐结晶,7例未检出,根据是否检出尿酸盐晶体分为两组,与DECT阴性组相比较,DECT阳性组年龄更高[(47±12)岁vs.(39±11)岁,P=0.15], 体重指数(body bass index,BMI)更高[(27.9±3.7) kg/m²vs.(22.8±2.1) kg/m²,P=0.002],痛风病程更长[(135±102)个月vs.(45±53)个月, P=0.035];阳性组既往血尿酸最高值亦高于DECT阴性组[(643±121) μmol/L vs.(543±103) μmol/L,P=0.043];阳性组患者DECT时血清尿酸值虽然高于DECT阴性组[(558±150) μmol/L vs.(513±88.9) μmol/L,P=0.497], 但差异无统计学意义;DECT检查阳性组与阴性组相比较,检查时处于急性期的患者分别为18例(81.8%) vs.4例(57%), P=0.311;服用降尿酸药物的患者分别为22例(100%) vs.5例(71%), P=0.052;反复典型发作的患者分别为22例(100%) vs.6例(85%), P=0.241。各关节症状与DECT发现尿酸盐结晶一致性比较,右膝关节最高(Kappa=0.627), 其后依次为左第一跖趾(metatarsophalangeal 1, MTP1, Kappa=0.58)、右MTP1(Kappa=0.551)、左膝(Kappa=0.494),均具统计学意义,踝关节症一致性较低(右踝:Kappa=0.19,左踝:Kappa=0.256),均无统计学意义。与DECT尿酸盐晶体检出率有关的变量分别为BMI[2.307(1.139~4.670) kg/m², P=0.02]、痛风病程 [ 0.306(0.906~4.881)年,P=0.186]、既往尿酸最高值 [0.023(0.981~2.764) mg/dL, P=0.137]。结论: BMI较大、既往最高尿酸值较高、痛风病程较长的痛风患者DECT检出的敏感性越高。     

252例住院儿童麻疹临床流行病学特征分析

目的:探讨2年来儿童麻疹的流行、临床及实验室检查的特点,以期更好的预防和治疗麻疹。方法:对汕头潮南民生医院自2006年2月至2008年1月收治的252例麻疹的流行病学及临床资料进行回顾性分析。结果:252例住院儿童麻疹中,男162例,女90例,男孩显著多于女孩,年龄3月-14岁,以幼儿及学龄前儿童发病率较高,1岁以内主要集中在5-9月龄;以农村人口及流动人口为主,占79.37%;有免疫接种史者仅34例,占15.08%,无免疫接种史者206例,占81.75%;有明确麻疹接触史者212例,占84.13%,反复到医院就诊而先后被确诊为麻疹者76例,占30.16%;临床以典型麻疹为主,并发症以麻疹肺炎最常见。结论:切实搞好计划免疫,消除免疫空白,保证免疫接种有效率,及时进行复种,在流行前期强化应急接种,加强隔离管理,是控制麻疹暴发流行、消除麻疹的有效措施。