不同痛经表现的子宫腺肌症患者外周血肿瘤标记物表达水平差异性分析

目的 分析不同痛经表现的子宫腺肌症患者外周血肿瘤标记物表达水平,探讨肿瘤标记物检测的临床意义.方法 回顾分析我院2010年3月-2012年9月收治的85例子宫腺肌症患者的临床病例资料,按痛经程度及痛经持续时间分组,检测不同痛经程度及不同痛经持续时间患者的糖类抗原125（CA125）、糖类抗原199（CA199）、癌胚抗原（CEA）水平.结果 痛经程度重、痛经程度轻、无痛经的CA125、CA199、CEA水平组间比较,差异有统计学意义（P＜0.05）,CA125、CA199、CEA的高低排次为痛经程度重＞痛经程度轻＞无痛经;痛经持续时间长、痛经持续时间短、无痛经的CA125、CA199、CEA水平组间比较,差异有统计学意义（P＜0.05）,CA125、CA199、CEA的高低排次为痛经持续时间长＞痛经持续时间短＞无痛经.结论 子宫腺肌症患者有无痛经、痛经程度、痛经持续时间与外周血肿瘤标记物表达水平密切相关,连续、动态和联合检测肿瘤标记物水平具有重要的临床意义.     

Effects of thermotherapy and transcutaneous electrical nerve stimulation on patients with primary dysmenorrhea: A randomized,placebo-controlled,double-blind clinical trial

ObjectivesTo evaluate the effects of thermotherapy and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pressure pain threshold (PPT) and conditioned pain modulation (CPM) in patients with primary dysmenorrhea (PD).DesignA randomized, placebo-controlled, double-blind clinical trial.SettingPhysiotherapy Department of the Universidade Cidade de São Paulo, São Paulo (Brazil).InterventionsEighty-eight dysmenorrheic women were randomly allocated into four groups: Thermotherapy + TENS(n = 22), Thermotherapy(n = 22), TENS(n = 22) and Placebo(n = 22). Thermotherapy was applied by microwave diathermy (20 min), and TENS (200 μs, 100 Hz, 30 min), into the lower abdomen both.Main outcome measuresPain intensity was measured using the numeric rating scale (NRS) and the McGill Pain Questionnaire (Br-MPQ). PPT and CPM were recorded from women’s abdominal and lumbar. The evaluation was done in 5 times: baseline, after 20, 50, 110 min and 24 h from intervention.ResultsThere was a significant decrease in the NRS for Thermotherapy + TENS vs. TENS, for Thermotherapy vs. TENS and for Placebo, after 20 min; for Thermotherapy vs. TENS and for Placebo, after 110 min and 24 h. Abdome PPT increased in the Thermotherapy + TENS vs. TENS and Placebo, after 50 min; for Thermotherapy + TENS vs. Placebo and for Thermotherapy vs. Placebo, after 110 min. No changes in lumbar PPT and CPM were observed.ConclusionsThe use of thermotherapy reduced NRS compared to the TENS and Placebo after 20, 110 min and 24 h. Thermotherapy demonstrated an increase in the PPT in the abdomen after 50 and 110 min and decreased the Br-MPQ scores after 110 min in patients with PD.     

Personal perception and body awareness of dysmenorrhea and the effects of rhythmical massage therapy and heart rate variability biofeedback—A qualitative study in the context of a randomized controlled trail

ObjectiveThe purpose was to involve women’s personal experiences of daily life with primary dysmenorrhea (PD) and their body perceptions of the dysmenorrhea-related symptoms in relation to the treatment procedure and to explore the perception of Heart Rate Variability Biofeedback (HRV-BF) or Rhythmical Massage (RM) according to Ita Wegman as a therapeutic intervention within the framework of Anthroposophic Medicine (AM).DesignFrom 60 women who participated in our randomized controlled trial analyzing the effects of HRV-BF or RM, we examined 14 women to get an in-depth understanding of this prevalent disease, using a qualitative design. The women drew their body image before and after the 3-month-intervention on body silhouette diagrams and described their body-perceptions. Semi-structured interviews were conducted and analyzed using content analysis.ResultsWomen perceive dysmenorrhea as a disturbance of their daily lives. The body images showed the variations of experience, from misbalances of body perception to overwhelming attacks of pain hindering a normal life for several days per month. Perception of therapeutic interventions range from relaxing without effects on complaints to important changes and benefits on the physical, emotional, and/or social level. Both therapies can support stronger self-awareness through enabling a more differentiated sense of body-awareness, sometimes resulting in women experiencing fewer limitations in their daily lives. Effects may be influenced by the readiness to resonate with the therapeutic process. Qualitative interviews and body images can serve as tools to integrate individuality and help to integrate embodied more or less conscious aspects of complaints.ConclusionsThe body silhouette diagram could be used systematically to include reflections of embodiment in the therapeutic and research settings and help to diagnose in advance the ability of participants to resonate with interventions. RM and HRV-BF influence self-awareness and may enable salutogenic and self-management capacities. For more effective treatment it may be helpful to make treatment suggestions based on an integrative individual history that includes preferences, expectations and a body silhouette diagram.     

丹莪妇康煎膏治疗痛经患者的临床疗效观察

目的：对痛经患者采用丹莪妇康煎膏进行治疗的临床效果进行分析研完。方法：将我院收治的痛经患者分为两组,一组接受妈富隆治疗,一组接受丹莪妇康煎膏治疗,比较两组患者的临床治疗效果。结果：接受丹莪妇康治疗的患者组,其治疗有效率明显高于接受妈富隆治疗的患者组,p〈0．05;其月经恢复正常时间明显短于接受妈富隆治疗的患者组,p〈0．05。结论：丹莪妇康煎膏能够有效改善痛经患者的临床症状,减轻患者痛苦,使患者的月经能够尽快恢复正常。     

Prevalence and conditions associated with chronic pelvic pain in women from S?o Luís,Brazil

The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject''s home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10) were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94), premenopausal status (OR=2.95), depressive symptoms (OR=2.33), dysmenorrhea (OR=1.77), smoking (OR=1.72), irregular menstrual flow (OR=1.62), and irritative bladder symptoms (OR=1.90). The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.     

Are systemic lupus erythematosus patients carrying MEFV gene less prone to renal involvement? Report of three cases and review of the literature

Abstract

Familial Mediterranean fever (FMF) is an autosomal recessive auto inflammatory disease, characterized by acute attacks of serositis, arthritis or skin rash. Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease characterized by multisystem inflammatory lesions affecting any organ systems in the body. Coexistence of FMF and SLE is rare in literature. In this report, we present three patients with FMF associated with SLE.     

电浮针对原发性痛经镇痛作用的随机对照研究

目的:观察电浮针疗法对原发性痛经(PD)的镇痛作用及临床疗效。方法:171例PD患者,随机分为电浮针组、浮针组和药物组各57例,电浮针组采用电针刺激(疏波频率约60 Hz、串长2.5 s,密波频率约60 Hz、串长5 s,强度2~3 V,持续30 min)与浮针疗法相结合,远取三阴交穴治疗,浮针组采用浮针疗法取三阴交穴治疗,药物组采用口服布洛芬缓释胶囊(0.3 mg/次,2次/日)治疗,3组均连续治疗3个月经周期,治疗后随访3个月经周期统计疗效。结果:纳入171例患者,163例完成试验,脱落8例。电浮针组、浮针组与药物组总有效率(ITT/PP)分别为94.74%/96.43%、91.23%/96.30%和77.19%/83.02%;电浮针组:近期治愈40/40,显效9/9,好转5/5,无效3/2;浮针组:近期治愈38/38,显效10/10,好转4/4,无效5/2;药物组:近期治愈10/10,显效27/27,好转7/7,无效13/9。ITT和PP分析结果一致:电浮针和浮针组的总疗效以及痊愈率显著优于药物组(P<0.01),电浮针与浮针组的总疗效以及痊愈率差异无显著性意义;短时间内电浮针组镇痛作用优于浮针组(P<0.05)。结论:三阴交穴电浮针疗法对PD的镇痛作用具有高效快捷、安全无痛的特点,临床疗效显著优于口服布洛芬缓释胶囊。     

腹腔镜下骶前神经切除术治疗子宫内膜异位症致痛经的疗效观察

目的评价骶前神经切除术治疗盆腔子宫内膜异位症致痛经的疗效。方法2000年3月以来,深圳市罗湖区人民医院为97例盆腔子宫内膜异位症所致痛经病人行骶前神经切除术、宫骶韧带切除术和单纯病灶切除术,其中骶前神经切除术29例,宫骶韧带切除术35例,单纯病灶切除术33例,对3组的手术情况、手术效果、术后随访等进行对比研究。结果3组病人术后随访1~24个月经周期,3组病人术后痛经完全缓解率骶前神经切除术组、宫骶韧带切除术组和单纯病灶切除术组12个月分别为75.9%、37.1%和33.3%,24个月为72.5%、31.4%和21.2%。结论腹腔镜下骶前神经切除术能明显提高子宫内膜异位症致痛经的治愈率。     

以非甾体类消炎药为对照的口服中药治疗原发性痛经的系统评价

目的评价口服中药治疗痛经的疗效与安全性。方法通过电子检索和手工检索收集国内外发表的关于比较中医药口服和非甾体类消炎药治疗痛经的临床随机对照试验,纳入文献的质量评价参照Jadad评分标准,数据采用RevMan4.2.2版进行统计分析。结果最终纳入18个中医药治疗痛经的随机对照试验共1800例,口服中药治疗痛经与非甾体类消炎药比较更有效,疗效差异有统计学意义。中药多采用理气活血、散寒止痛之品,对照组采用西医非甾体类消炎药如双氯芬酸、布洛芬、吲哚美辛、去痛片等,疼痛缓解人数试验组与对照组分别为1052/1116(94.27%)、536/684(78.36%),异质性检验P<0.05,故采用随机效应模型。关于中医药治疗的不良反应未提及的有13篇文献,无不良反应的有4篇文献,仅有1篇文献表述治疗组有轻泻的不良反应。纳入文献的质量普遍较低。结论现有临床资料显示出中医药治疗痛经比非甾体类消炎药更有效的倾向,且未发现明显的副作用。但由于存在发表偏倚和普遍低质量的随机对照试验,使结论的可信度降低,有待设计严格的随机双盲安慰剂对照试验予以证实。     

Clinical Study on Treatment of Primary Dysmenorrhea with Qihuang Herbal Warm Bag

目的观察"歧黄"养生温灸包对原发性痛经患者的影响.方法以原发性痛经患者32例为观察对象,采用温灸包外敷的方法,治疗2个月经周期后观察临床疗效,并检测患者治疗前后的前列腺素F2a(PGF2a)及β内啡肽(β-EP)的变化.结果温灸包对不同程度的痛经患者均有疗效,可使血中PGF2a含量下降及β-EP升高.结论温灸包治疗原发性痛经有效.温灸包能够降低血清PGF2a含量,增加血清β-EP含量.