晕痣治疗的研究进展

晕痣是一种中心痣周围皮肤出现色素脱失斑的皮肤疾病,发病率约为1%,无性别差异。目前对晕痣的研究较少,现将近年来晕痣的流行病学、临床表现、组织病理学、病因及发病机制,尤其对晕痣的中心痣祛除与否做详细总结。     

2型糖尿病患者发生冠心病的相关危险因素

 目的 探讨2型糖尿病患者发生冠心病的相关危险因素。方法 选择2型糖尿病216例,根据是否合并冠心病分为单纯2型糖尿病组(n=119)和2型糖尿病合并冠心病组(n=97),分别检测两组的尿微量白蛋白与肌酐比值(urinary albumin creatinine ratio, UACR),游离脂肪酸(free fatty acid, FFA),同型半胱氨酸(Homocysteine, Hcy),logistic 回归分析2型糖尿病患者发生冠心病的危险因素。结果 与单纯2型糖尿病组比较,2型糖尿病合并冠心病组的FFA、UACR、Hcy,明显升高[(0.80±0.35)mmol/L vs(0.53±0.20)mmol/L,P=0.035; (65.80±7.50)mg/g vs (40.99±6.07) mg/g,P=0.029;(19.36±6.33)μmol/L vs (12.93±7.07)μmol/L,P=0.033]。多因素logistic 回归分析显示,FFA (OR=2.335,95%CI:1.770~4.018,P=0.018)、UACR(OR=1.166,95%CI:1.082~2.330,P=0.032)、Hcy (OR=2.113,95%CI:1.810~3.770,P=0.026)为2型糖尿病患者发生冠心病的危险因素。结论 FFA、UACR、Hcy均为2型糖尿病患者发生冠心病的相关危险因素,应对这部分人群进行积极的干预和治疗。     

类人胶原蛋白敷料联合超脉冲CO2点阵激光治疗凹陷性痤疮瘢痕的疗效和安全性

  目的 评价类人胶原蛋白敷料联合超脉冲CO₂点阵激光治疗面部凹陷性痤疮瘢痕的疗效和安全性。 方法 选择2015-05至2016-12就诊的面部痤疮凹陷性瘢痕患者76例,随机分为对照组和治疗组,各38例。对照组采用超脉冲CO₂点阵激光,间隔3个月治疗1次,共4次。治疗组在点阵激光术后给予类人胶原蛋白敷料外用。采用ECCA评估法评价皮损,对比两组患者的瘢痕评分、急性炎性反应红斑和疼痛持续时间、结痂时间、痂皮完全脱落时间、误工期、不良反应等。 结果 两组患者治疗后ECCA评分均比治疗前明显下降,治疗组比对照组下降更明显(P<0.05);治疗组术后红斑持续时间(1.25±0.62)d,疼痛持续时间(1.46±0.77)d,均明显短于对照组,差异有统计学意义(t=-2.483,P=0.015;t=-3.219,P=0.002);两组术后结痂时间对比,差异无统计学意义(t=-0.439,P=0.066),但治疗组痂皮完全脱落时间、误工期均短于对照组,差异有统计学意义(t=-3.049,P=0.003;t=-2.197,P=0.031);治疗组患者主观感受和舒适程度评价优于对照组,差异有统计学意义(Z=-2.197,P=0.028),治疗组患者满意率(68.42%)高于对照组(44.74%),差异有统计学意义(χ²=4.338,P=0.037);治疗组色素沉着发生率5.26%,低于对照组的21.05%,差异有统计学意义(χ²=4.145,P=0.042),两组患者均未出现水泡、感染和增生性瘢痕等不良反应。 结论 联合外用类人胶原蛋白敷料可明显提高超脉冲CO₂点阵激光术后痤疮凹陷性瘢痕患者的治疗效果,缩短急性期红斑持续时间和疼痛持续时间,促进愈合,缩短误工期,减少不良反应,改善患者术后不良感受,提高生活质量。     

自发性颅内出血死亡的多因素回归分析

 目的 探讨自发性颅内出血(spontaneous intracerebral hemorrhage, SIH)患者30 d内死亡的危险因素。方法 回顾性分析2012-01至2016-01医院收治的SIH患者324例。30 d内死亡82例,为死亡组,其余242例存活患者为存活组,统计分析两组患者入院时主要临床特征。单因素和多因素logistic回归分析显示格拉斯哥昏迷评分降低、糖尿病、小脑出血、出血量增加和脑室出血等死亡的危险因素。结果 与存活组比较,死亡组年龄显著偏大[(54.38±12.47)岁 vs (51.73±11.94)岁, P=0.028];高血压病显著增加(68.29% vs 55.79%, P=0.047),;糖尿病显著增加(46.34% vs 27.69%, P=0.002);吸烟率显著增加(35.37% vs 21.07%, P=0.009);小脑出血率显著增高(20.73% vs 8.68%, P=0.003);脑室出血率显著增高(74.39% vs 54.96%, P=0.002);手术率显著降低(20.73% vs 37.19%, P=0.006);出血量显著增多[(110.98±36.96)ml vs (77.04±31.81)ml, t=4.922, P=0.000];格拉斯哥昏迷评分显著降低(7.52±2.70 vs 9.54±2.06,t=4.207, P=0.000)。结论 格拉斯哥昏迷评分降低、糖尿病、小脑出血、出血量增加和脑室出血是SIH患者30 d内死亡的危险因素。
     

影响颈动脉狭窄患者认知功能的因素调查

 目的 调查影响颈动脉狭窄患者认知功能的因素,为早期识别认知功能损害提供参考。方法 选择经全脑血管数字减影血管造影(DSA)技术诊断的颈动脉狭窄患者116例,通过蒙特利尔认知评估量表(MoCA)评估其认知功能,利用多重线性回归分析筛选认知功能的影响因素。结果 MoCA总分平均为19.23±2.52,检出认知功能损害患者72例,检出率为62.1%;多元线性回归分析结果显示年龄(β=-3.71,P=0.02)、吸烟(β=-2.02,P=0.02)、高血压(β=-2.40,P=0.02)、高血脂(β=-2.65,P=0.02)、糖尿病(β=-3.29,P=0.03)、狭窄程度(β=-4.41,P=0.03)等为颈动脉狭窄患者认知功能的影响因素。结论 颈动脉狭窄患者认知功能的影响因素可能包括血管性危险因素及狭窄本身的病理特征因素。     

2型糖尿病并发周围神经病理性疼痛的患病率及危险因素分析

 目的 探讨住院患者2型糖尿病(type 2 diabetes mellitus,T2DM)并发周围神经病理性疼痛(diabetic peripheral neuropathic pain, DPNP)的患病率及危险因素。方法 选取2020-10至2021-02山西医科大学附属第二医院T2DM周围神经病变的住院患者260例。根据神经病理性症状和体征评分(LANSS)问卷,≥12分诊断为DPNP,＜12分为非DPNP,将患者分为DPNP组(129例)和非DPNP组(131例)。比较两组的一般资料和实验室资料,将组间比较有意义的变量纳入二元Logistic回归分析。结果 DPNP组与非DPNP组一般资料比较,病程、合并糖尿病视网膜病变和合并糖尿病肾病差异有统计学意义(P<0.05),性别、年龄、BMI、吸烟史、饮酒史、家族史、学历、合并高血压、合并心血管疾病、用药情况、监测血糖情况、治疗方案、体重管理、饮食控制和身体活动差异无统计学意义。实验室资料比较,两组HbA₁c、HDL-C、尿微量白蛋白和UACR差异有统计学意义(P<0.05);空腹血糖及C肽、餐后2 h血糖及C肽、三酰甘油、总胆固醇、LDL-C、尿素、肌酐、尿酸和尿肌酐差异无统计学意义。二元Logistic回归分析得出,病程(OR=1.042,95%CI 1.001～1.085,P=0.045)、合并糖尿病肾病(OR=3.565,95%CI 1.497～8.487, P=0.004)、HbA₁c(OR=1.179,95%CI 1.041～1.334,P=0.009)、HDL-C(OR=0.228,95%CI 0.073～0.705,P=0.010)、UACR(OR=1.004,95%CI 1.001～1.008, P=0.027)是DPNP发生的危险因素。结论 对于病程较长,合并糖尿病肾病、HbA₁c升高、HDL-C降低、UACR升高的患者,应警惕DPNP发生的风险。     

益生菌用于重度急性胰腺炎治疗的Meta分析

 目的 用Meta分析的方法评价益生菌用于治疗重度急性胰腺炎(severe acute pancreatitis, SAP)的效果。方法 检索PubMed、The Cochrane Library、中国生物医学文献数据库(CBM)、中文科技期刊数据库(维普),中国期刊全文数据库(CNKI),万方学术期刊全文数据库,全面查找益生菌治疗SAP的文献,评价纳入文献的方法学质量,用RevMan5.0软件统计分析。结果 共纳入7篇文献,共有SAP患者654例,Meta分析结果显示实验组与对照组在病死率(RR=1.29, 95% CI:0.77~2.16,P=0.33)、多器官衰竭发生率(RR=0.81, 95%CI:0.52~1.24,P=0.33)、感染性并发症发生率(RR=0.72, 95%CI:0.37~1.39,P=0.33)及抗生素使用率(RR=0.89, 95% CI:0.71~1.10,P=0.28)方面均无统计学差异,但在胰腺脓肿发生率(RR=0.53, 95% CI:0.28~0.98,P=0.04)方面存在统计学差异。结论 益生菌不能降低SAP患者感染性并发症发生率、多器官衰竭发生率、抗生素使用率和病死率,但可能降低胰腺脓肿发生率。     

2型糖尿病并发骨质疏松的相关危险因素

 目的 探讨2型糖尿病(T₂DM)患者并发骨质疏松的危险因素。方法 将334例T₂DM患者根据骨密度(BMD)值分为骨量正常组、骨量减少组和骨质疏松组,对比各组患者年龄、DM病程、体重指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、C肽分泌指数(HOMA-β)、C肽曲线下面积(C-PAUC)、C肽抵抗指数(HOMA-CR)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿微量白蛋白(mALb)、肾小球滤过率(GFR)及慢性并发症发生的差异,并进行Logistic回归分析。结果 334例T₂DM患者中骨量正常者116例,男75例(64.66%),女41例(35.34%);骨量减少者110例,男50例(45.45%),女60例(54.55%);骨质疏松者108例,男46例(42.59%),女62例(57.41%)。与骨量正常组比较,骨质疏松组和骨量减少组年龄大,DM病程长,HbA1c高,HOMA-β、C-PAUC低、下肢动脉硬化发生率高(P<0.05)。骨质疏松组BMI、HOMA-CR低于骨量正常组(P＜0.05),mALb、中重度下肢动脉硬化、视网膜病变及周围神经病变发生率高于骨量正常组(P＜0.05)。高龄(OR=1.123,P=0.019)、长病程(OR=1.052,P=0.028)、低HOMA-β(OR=0.706,P=0.016)及高mALb(OR=1.289,P=0.006)是骨质疏松的独立危险因素。结论 高龄、长病程、胰岛功能差、糖尿病肾病是T₂DM并发骨质疏松的危险因素,糖尿病慢性并发症与骨质疏松密切相关。     

cN0期甲状腺乳头状癌中央区淋巴结转移的危险因素分析

 目的 探讨cN0期甲状腺乳头状癌患者中央区淋巴结转移相关危险因素。方法 纳入北京协和医院行双侧中央区淋巴结清扫的cN0期甲状腺乳头状癌患者570例,回顾性分析患者术前甲状腺超声图像及临床病理资料特征,分析预测cN0期甲状腺乳头状癌中央区淋巴结转移相关危险因素。结果 570例cN0期甲状腺乳头状癌患者中发生中央区淋巴结转移282例,占49.5%;其中男性(OR=1.787, 95% CI:1.066-2.997, P=0.028)、年龄小于45岁(OR=2.063, 95% CI:1.366-3.115, P=0.001)、多发病灶(OR=1.764, 95% CI:1.134-2.743, P=0.012)、肿瘤直径＞1 cm(OR=1.844, 95% CI:1.201-2.831, P=0.005)、伴有微钙化(OR=1.965, 95% CI:1.296-2.979, P=0.001)且有被膜侵犯(OR=2.868, 95% CI:1.880-4.377, P=0.000)是中央区淋巴结转移的独立危险因素。结论 对于男性、年龄小于45岁、多发病灶、肿瘤直径＞1 cm、伴有微钙化且有被膜侵犯的cN0期甲状腺乳头状癌应根据影像学及临床病理资料考虑采取积极的手术方式或更加密切的随访。     

2型糖尿病患者血浆氧化三甲胺与视网膜病变的相关性

 目的 探讨2型糖尿病(T2DM)患者血浆氧化三甲胺(TMAO)与视网膜病变(DR)的相关性。方法 选择航天中心医院内分泌科T2DM患者101例,分为DR组(n=32)和无DR组(n=69)。采用ELISA法测定血浆TMAO浓度,采用Logistic回归和ROC曲线分析血浆TMAO与DR的关系。结果 DR组患者的年龄、糖尿病病程、收缩压、血浆TMAO均大于无DR组(P＜0.05),而血白蛋白、三酰甘油低于无DR组(P＜0.05)。Logistic回归分析显示,调整相关混杂因素后,年龄(OR=1.070, 95%CI:1.011～1.133, P=0.019)、血白蛋白(OR=0.807, 95%CI:0.701～0.929, P=0.003)、TMAO(OR=1.062, 95%CI:1.006～1.121, P=0.029)是DR的危险因素。ROC曲线显示单独血浆TMAO预测DR的曲线下面积(AUC)为0.650(P=0.024),年龄、血白蛋白、TMAO联合的AUC为0.789(P＜0.001)。结论 DR患者表现出更高水平的血浆TMAO,TMAO是DR的相关危险因素,TMAO联合年龄、血白蛋白等对DR有较高的预测价值。     

Neurocutaneous melanosis in children with giant congenital melanocytic nevi

Twenty-four children with giant congenital melanocytic nevi underwent brain MRI at 1.5 T scanner. Melanin deposits in the brain were found in seven children (29.2%) located in temporal lobes, thalamus, cerebellum, and pons. One patient showed leptomeningeal involvement. Six patients were asymptomatic, and one had epilepsy. As opposed to previous reports, localization of skin nevi on anterior part of trunk was correlated to central nervous system involvement. In all patients with brain involvement skin nevi showed picture of compound nevus with neurofibromatic component.     

Blue rubber bleb nevus syndrome.

Two cases of pediatric blue rubber bleb nevus syndrome are reported. The main features of the disease are rubbery blue cutaneous nevi and hemangiomatous, frequently hemorrhagic malformations of the bowel wall. Polypoid filling defects were seen throughout the bowel on barium studies. This entity should be considered in the differential diagnosis of polyposis, and the skin should be carefully examined for nevi when multiple bowel polyps are demonstrated, especially in patients with gastrointestinal bleeding.     

Reversed halo sign in pulmonary paracoccidioidomycosis

OBJECTIVE: The purpose of this study was to evaluate the prevalence of the reversed halo sign in pulmonary paracoccidioidomycosis. MATERIALS AND METHODS: The high-resolution CT scans (1- or 2-mm collimation scans) of 148 consecutive patients with proven pulmonary paracoccidioidomycosis were reviewed to determine the prevalence of the reversed halo sign in these patients. The reversed halo sign was defined as central ground-glass opacity surrounded by a crescent or ring of consolidation. The images were reviewed by two radiologists who reached a decision by consensus. RESULTS: A reversed halo sign was found in 15 patients (10%), including 13 men and two women ranging in age from 20 to 58 years (mean, 48 years). Three patients had only one reversed halo sign, one had two lesions, and the remaining had multiple lesions. The size of the sign ranged from 10 to 50 mm (average, 20 mm). In two cases the reversed halo sign was the only finding on CT. The most common associated findings seen in the remaining 13 patients included bilateral patchy areas of ground-glass attenuation (n = 10), parenchymal bands (n = 8), and small centrilobular nodules (n = 8). Three patients underwent surgical lung biopsy. Histologically the central area of the lesions consisted of an inflammatory infiltrate in the alveolar septa, composed of macrophages, lymphocytes, plasma cells, and some giant cells, with relative preservation of the alveolar spaces. The periphery of the lesion consisted of dense and homogeneous intraalveolar cellular infiltrate. There was no evidence of organizing pneumonia. CONCLUSION: The reversed halo sign is seen in approximately 10% of patients with paracoccidioidomycosis. In these patients, this sign reflects the presence of a central area of predominantly interstitial inflammation surrounded by predominantly air-space infiltration.     

Epidermal nevus syndrome: megalencephaly with bihemispheric and cerebellar involvement: imaging and neuropathologic correlation

Epidermal nevus syndrome (ENS) is a sporadic neurocutaneous disorder characterized by the combination of epidermal nevi with significant central nervous system, eye, and skeletal abnormalities. Hemimegalencephaly and related brain abnormalities are the dominant neuropathologic abnormalities in ENS. Magnetic resonance imaging features of the case reported here revealed enlargement of both cerebral hemispheres and malformed basal ganglia, with incomplete separation of the caudate nucleus and putamen. In addition, the right cerebellar hemisphere was enlarged, with disorganized folia. None of these findings have been reported previously in this disorder.     

肝胆疾病与色素痣的关系

经B超检查发现并经其它检查确诊的肝胆疾病50例,其中46例在皮肤相应经络线上出现色素痣,占92％;另设50例无肝胆疾病者作为对照组,其中有痣者1例,占2％。结果表明,观察组有痣率明显高于对照组,说明肝胆疾患和痣的发生率成正比。认为探讨这类疾病在经穴上的表现,对肝胆疾病的早期诊断具有一定的参考价值。     

系统护理干预在体外冲击波治疗肢体疼痛中的应用效果

 目的 观察系统护理干预在骨科体外冲击波(extracorporeal shock wave, ESW)治疗肢体疼痛中的应用效果。方法 2012-01至2014-01在骨科接受ESW治疗的肢体疼痛患者328例,按随机数字表方法分成系统组(n=164)和常规组(n=164)。常规组行骨科常规护理,系统组行系统护理干预,分析两组临床疗效、疼痛指标评分及护理的满意度。结果 系统组患者临床治疗有效率(95.12%)比常规组(78.05%)高(P＜0.05),且系统组患者肢体疼痛缓解效果好,疼痛评分比常规组低(P＜0.05);系统组患者对护理的满意度(98.17%)与常规组(80.49%)相比,差异具有统计学意义(P＜0.05)。结论 对行ESW治疗骨科肢体疼痛患者行系统护理干预,疗效显著,具有一定临床意义。     

Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications

OBJECTIVE: The aim of our study was to evaluate the usefulness of the reversed halo sign on high-resolution CT in the diagnosis of cryptogenic organizing pneumonia. MATERIALS AND METHODS: Between 1996 and 2001, we saw 31 patients with biopsy-proven cryptogenic organizing pneumonia. During the same period, we also saw 30 patients with non-cryptogenic organizing pneumonia diseases, from which cryptogenic organizing pneumonia should be differentiated: Wegener's granulomatosis (n = 14), diffuse bronchioloalveolar carcinoma (n = 10), chronic eosinophilic pneumonia (n = 5), and Churg-Strauss syndrome (n = 1). Two independent observers analyzed CT findings and recorded how frequently the so-called reversed halo sign (central ground-glass opacity and surrounding air-space consolidation of crescentic and ring shape) was seen on high-resolution CT. RESULTS: The most common patterns of parenchymal abnormalities of cryptogenic organizing pneumonia were ground-glass opacity (28/31 patients, 90%) and consolidation (27/31, 87%). The ground-glass opacity pattern showed random distribution, and the consolidation pattern showed subpleural or peribronchovascular (20/27 patients, 74%) distribution with predominance in the middle or lower lung zone. The reversed CT halo sign was seen in six (19%) of 31 patients with cryptogenic organizing pneumonia and in none of the patients with the diseases that needed to be differentiated from cryptogenic organizing pneumonia on CT. CONCLUSION: The reversed halo sign, although seen only in one fifth of patients with the disease, appears relatively specific to make a diagnosis of cryptogenic organizing pneumonia on CT.     

320 nm强脉冲光与窄谱中波紫外线治疗稳定期白癜风近期疗效的比较

目的比较320 nm强脉冲光与窄谱中波紫外线治疗稳定期白癜风的近期疗效。方法稳定期白癜风患者103例,随机分为2组,治疗组50例给予320nm强脉冲光治疗,能量密度360 J/cm~2,之后递增30～80J/cm~2,光斑面积1.5 cm×4.0 cm,脉宽30～50 ms,每月治疗1次;对照组53例给予窄谱中波紫外线照射皮损,能量密度0.3～4.0J/cm~2,3 d照射1次。照射后两组患者均口服复合维生素B、叶酸,外用复方卡力孜然酊。3个月为1个疗程,根据色素恢复的程度评价临床疗效。结果痊愈率治疗组(第1疗程为18.0%,第2疗程为64%)显著高于对照组(第1疗程为5.7%,第2疗程为13.2%)(均P0.001),显效率治疗组第1疗程(38.0%)显著高于对照组第1疗程(24.5%)(P0.01);治疗组病程1年者疗效显著优于病程1年者(显效率第1疗程病程1年者48.5%,病程1年者为17.7%,P0.001)。痊愈率第2疗程治疗组为69.7%,对照组为13.2%(P0.05);对不同部位皮损统计学分析的结果显示,以头面部疗效最好,躯干、四肢次之,手足较差。结论 320 nm强脉冲光治疗稳定期白癜风疗效明显优于窄谱中波紫外线,起效快,不良反应少,是治疗稳定期白癜风患者比较理想的选择。     

复方倍他米松联合CO2点阵激光、PDL激光治疗瘢痕疙瘩疗效分析

 目的 观察分析复方倍他米松(商品名得宝松)联合CO₂点阵激光、PDL激光治疗瘢痕疙瘩的临床疗效。方法 选取2018-04至2019-12武警辽宁总队医院接受治疗的111例瘢痕疙瘩患者作为研究对象,随机分为A组、B组、C组,每组37例。A组采用CO₂点阵激光+PDL激光治疗,B组采用CO₂点阵激光+得宝松治疗,C组采用得宝松联合CO₂点阵激光+PDL激光治疗,每4周为1疗程,共3个疗程。所有患者在治疗6个月后进行观察,观察3组治疗前后瘢痕各维度评分(VSS)、转化生长因子β₁(TGF-β₁)、基质金属蛋白酶9(MMP-9)含量变化,以及临床疗效、不良反应及复发率情况。结果 治疗6个月后,三组色泽、血管分布、瘢痕柔软度、厚度、VSS总分较治疗前显著降低,其中C组显著优于A组、B组(P＜0.05),但B组和C组未见统计学差异;A组、B组、C组总有效率分别为86.49%、83.78%、94.60%,C组疗效显著优于A组和B组(P＜0.05);治疗1个月后,三组TGF-β₁、MMP-9表达含量较治疗前显著改善(P＜0.05),C组TGF-β₁、MMP-9表达显著低于A组和B组(P＜0.05),而A组和B组比较,未见统计学差异;在治疗后1个月时,A组2例瘢痕疙瘩治疗区域出现部分色素沉着,B组3例出现颜色发红、血管丰富情况,其余患者均未出现疼痛、血肿、瘙痒、皮肤感染、色素沉着及皮肤萎缩等不良反应,且未见复发;在治疗6个月时,患者色素沉着及颜色发红等不良反应基本消退,但三组均出现部分瘢痕疙瘩复发情况,复发率分别为8.11%(3例,A组)、5.41%(2例,B组)及2.70%(1例,C组)(χ²=0.24,P=0.98)。结论 得宝松联合CO₂点阵激光、PDL治疗瘢痕疙瘩疗效确切,安全性高,有效促进瘢痕组织恢复,值得临床推广。