慢性乙型肝炎患者肝胆湿热证和肝郁脾虚证的决策树诊断模型初探

目的 建立基于临床数据的慢性乙肝患者典型证候的诊断模型，探索与慢性乙肝典型证候相关的症状、体征和实验室指标组合。 方法 对1 004例慢性乙肝患者进行证候学调查和实验室检测，包括 88项症状、舌脉象、20项体征和 14项实验室指标。然后选取典型证候的临床数据，联合采用Logistic回归、决策树、贝叶斯网络方法进行数据分析，构建能够有效区分不同证候的诊断模型。 结果 1 004例慢性乙肝患者中最为典型的证候为肝胆湿热证（340例，占33.86%）与肝郁脾虚证（366例，占36.45%）。首先采用Logistic回归分析得到具有统计学意义的16项症状与体征及3项实验室指标，然后采用决策树方法构建能够区分肝胆湿热证、肝郁脾虚证的诊断模型（辨证诊断准确率=74.36%），发现苔白、淡红舌、巩膜黄染、两目干涩、丙氨酸转氨酶（ALT）和 HBeAg是鉴别两证型的有效指标组合。采用贝叶斯网络分析的结果也验证了上述指标的重要性。 结论 本文建立了一种能够有效判别慢性乙肝患者肝胆湿热证、肝郁脾虚证的决策树诊断模型，为将基于经验的中医辨证转向基于数据模型的辨证提供了方法，有助于促进证候的客观化诊断。     

A method for assessing quality of control from glucose profiles.

AIM: As the practice of multiple assessments of glucose concentration throughout the day increases for people with diabetes, there is a need for an assessment of glycaemic control weighted for the clinical risks of both hypoglycaemia and hyperglycaemia. METHODS: We have developed a methodology to report the degree of risk which a glycaemic profile represents. Fifty diabetes professionals assigned risk values to a range of 40 blood glucose concentrations. Their responses were summarised and a generic function of glycaemic risk was derived. This function was applied to patient glucose profiles to generate an integrated risk score termed the Glycaemic Risk Assessment Diabetes Equation (GRADE). The GRADE score was then reported by use of the mean value and the relative percent contribution to the weighted risk score from the hypoglycaemic, euglycaemic, hyperglycaemic range, respectively, e.g. GRADE (hypoglycaemia%, euglycaemia%, hyperglycaemia%). RESULTS: The GRADE scores of indicative glucose profiles were as follows: continuous glucose monitoring profile non-diabetic subjects GRADE = 1.1, Type 1 diabetes continuous glucose monitoring GRADE = 8.09 (20%, 8%, 72%), Type 2 diabetes home blood glucose monitoring GRADE = 9.97 (2%, 7%, 91%). CONCLUSIONS: The GRADE score of a glucose profile summarises the degree of risk associated with a glucose profile. Values < 5 correspond to euglycaemia. The GRADE score is simple to generate from any blood glucose profile and can be used as an adjunct to HbA1c to report the degree of risk associated with glycaemic variability.     

宫角妊娠36例临床分析

目的 探讨宫角妊娠的临床特点、诊断和治疗方法.方法 对1990年1月～2006年8月北京协和医院收治的36例宫角妊娠进行回顾性分析.结果 在1 717例异位妊娠中,宫角妊娠共36例,占2%,临床表现为停经(100%)、不规则阴道出血(44%)和腹痛(39%).宫角妊娠术前诊断困难,误诊率达50%,易被误诊为输卵管间质部妊娠、绒癌.36例患者中1例(3%)观察治疗,9例(25%)在B超或腹腔镜监测下行清宫术,5例(14%)行全子宫切除术,16例(44%)行开腹或腹腔镜下宫角和/不和同侧输卵管切除术,5例(14%)行开腹或腹腔镜宫角妊娠物清除术.36例患者均预后良好,随访有3例宫内妊娠.结论 宫角妊娠的诊断主要依据B超,治疗以手术为主,治疗方案应个体化.     

孕妇凝血指标的数学模型及指标异常变化警戒值探讨

目的探讨孕妇不同孕期凝血指标变化趋势的数学模型及凝血指标异常变化的警戒值估计,帮助临床医生及预防保健人员及早期发现高危人群,有效预防产科出血和凝血并发症的发生。方法对214例孕妇的孕期凝血指标进行回顾性追索,根据聚类分析的结果,建立方差分析、回归分析及ARIMA时间序列分析模型,比较各检测指标在不同孕期的变化规律。结果所建模型均能够很好的模拟不同孕期凝血指标的变化规律,结果显示:PLT指标值在孕晚期出现明显的下降(P0.05),PT与INR指标值在妊娠中期的下降明显(P0.01),APTT在整个妊娠期均下降(P0.01),FG指标值在妊娠晚期出现上升(P0.01),不同孕期凝血指标的警戒值表达式为:μ±2σ。结论所建模型能够较好的模拟不同孕期凝血指标变化规律,不同孕期凝血指标的正常参考值范围及异常警戒值具有一定的医学应用价值。     

Cartilage destruction in small joints by rheumatoid arthritis: assessment of fat-suppressed three-dimensional gradient-echo MR pulse sequences in vitro

Purpose. To assess the accuracy of different MR sequences for the detection of articular cartilage abnormalities in rheumatoid arthritis. Design and patients. Ten metacarpophalangeal joints and 10 metatarsophalangeal joints (specimens from arthritis patients undergoing ablative joint surgery) were examined with a fat-suppressed (FS) 3D FLASH, a FS 3D FISP, a FS 2D fast spin-echo T2-weighted, and a 2D FS spin-echo T1-weighted sequence. Each cartilage lesion and each cortical lesion was graded from 0 to 4 (modified Outerbridge staging system). Subsequently, the results of each sequence were compared with the macroscopic findings and statistically tested against each other. Results. The study shows that 3D gradient-echo sequences with fat suppression were best for imaging and grading of cartilage lesions in arthritis of the small joints of the hands and feet. Using 3D techniques, all grade 2, grade 3, and grade 4 lesions of cartilage or cortical bone were detected. Conclusion. FS 3D gradient-echo techniques were best for the detection and grading of hyaline cartilage and subchondral bone lesions in rheumatoid arthritis. MRI has a great potential as an objective method of evaluating cartilage damage and bone erosions in rheumatoid arthritis.     

日本血吸虫成虫31/32KD抗原的纯化及其免疫化学特性

本文采用超凝胶柱层析法分离纯化日本血吸虫成虫31/32KD抗原。分离的抗原经银染色及免疫印迹法分析证明已达免疫纯及生化纯级。该抗原PAS染色呈阴性,经过碘酸钠处理后不失去活性,在琼脂糖凝胶电泳中趋向阳极。鉴于血吸虫成虫31/32KD组分是一种主要血清学抗原,它的分离纯化为改进和标化血吸虫病的诊断提供了条件。     

壳聚糖辐射效应的研究（Ⅰ）──辐照剂量与分子量的关系及辐射裂解的G（S）值

通过粘度的测量，考察了壳聚糖在不同条件下经不同剂量γ射线辐照所引起的分子量的变化，并分别计算了真空和空气中壳聚糖辐射裂解的Ｇ（Ｓ）值。     

人造心脏瓣膜替换术18例体会

本文报告风湿性心脏瓣膜病,人造心脏瓣膜替换术18例。术后因低心排、多脏器功能衰竭死亡3例。作者认为:人造心脏瓣膜替换术是治疗风湿性心脏瓣膜病的有效方法,但在新开展心脏瓣膜替换术的单位,应严格掌握手术适应症,以单瓣替换术为首选,严重多瓣膜病变,伴重要脏器功能不全者手术应慎重。     

深圳宝安3～7岁健康幼儿血清糖、离子、非蛋白含氮类化合物表达水平观察

目的观察深圳宝安3～7岁健康幼儿血清糖、离子、非蛋白含氮类化合物表达水平。方法采用OLRPUSAU-640全自动生化仪及OLRPUS诊断试剂、东欧生物诊断试荆，检测316例体检健康幼儿血清中Ca^＋＋、Mg^＋＋、P^＋＋＋、GLU、BUN、Cr、UA的含量。结果①．1组与4组及2组与3、4组Ca^＋＋组间方差分析，差异有统计学意义，P〈0.05。②．1组与2、3、4组Cr组间方差分析，差异有统计学意义P〈0．05。而Mg^＋＋、P^＋＋＋、GLU、BUN、UA组间方差分析差异无统计学意义，P〉0．05。结论笔者证实了3～4岁健康幼儿与6～7岁健康幼儿及4～5岁健康幼儿与5～7岁健康幼儿血清Ca^＋＋表达水平有差异。也证实了3～4岁健康幼儿与4～7健康幼儿Cr含量存在差异。由此可见，3～7岁健康幼儿建立自己的参考值是必要的。