Q-TC间期的早期改变在乙胺碘呋酮临床监测中的意义

目的 :探讨乙胺碘呋酮对Q -TC 间期的早期影响及意义。方法 :按每公斤体重 15mg单次服用乙胺碘呋酮 ,然后对患者进行 72h血药浓度及心电图Q -TC 间期监测。结果 :血药浓度与Q -TC 间期延长及抗心律失常疗效呈正相关 ,相关系数分别是 0 .70及 0 .74。Q -TC 间期延长与抗心律失常疗效的相关性更好 ,相关系数为 0 .99。Q -TC 间期较用药前平均延长了 (13 .8± 3 .9) % ,疗效明显 ,无与此有关的心律失常发生。结论 :服用乙胺碘呋酮时Q -TC 间期的延长是一定血药浓度及发挥疗效的标志 ,Q -TC 间期延长 2 5 %可能仍属安全范围。     

低剂量阿德福韦酯致Fanconi综合征和低磷骨软化症1例及文献回顾

A young male patient with a clear diagnosis of chronic hepatitis B, had taken long-term adefovir dipivoxil and lamivudine antiviral therapy. Osteomalacia related symptoms, such as bone pain and walking difficulties appeared 10 months ago. Renal damage related symptoms, such as urine volume change and increased urinary foam appeared 7 months ago. The examination showed signs of osteomalacia after admission, such as duck step, osteoarticular tenderness, thoracic and pelvic compression sign positive. Relevant examinations showed that hypophosphatemic osteomalacia related signs, such as hypophosphatemia, normal blood calcium, elevated blood alkaline phosphatase, no significant decline in active vitamin D3 and intact parathyroid hormone (iPTH). In bone mineral density test, bone fracture line could be noted. Bone scan suggested multiple metabolic lesions. At the same time, there were Fanconi syndrome related performances, such as elevated serum creatinine, decreased blood uric acid, urine glucose positive, elevated urinary and uric acid, urinary protein positive with mainly small molecule proteins, increased renal tubular damage indicators, and the clearance test suggested a decrease in renal tubular reabsorption of phosphorus. Kidney stones could be seen in urinary ultrasound. Therefore, combined with the patient’s clinical manifestations, past history and examinations, we definitely considered his diagnosis was adefovir dipivoxil related renal injury. Adefovir has been widely used for the treatment of chronic hepatitis B. Some studies confirmed that the nephrotoxicity of adefovir, including Fanconi syndrome and hypophosphatemic osteomalacia, was dose-dependent. A daily high-dose of 60-120 mg/d adefovir was concluded in the treatment of human immunodeficiency virus (HIV) infection, inducing nearly 1/2 patients of renal injury. A daily moderate-dose of 30 mg/d adefovir was used for patients in chronic hepatitis B, with nearly 1/3 patients of renal injury. Long-term low-dose adefovir (10 mg/d) used for chronic hepatitis B patients was found to be responsible for renal injury, but the incidence was significantly reduced. We studied this patient and related literature to analyze the pathogenesis, clinical characteristics and treatment outcomes in low-dose adefovir-induced Fanconi syndrome and hypophosphatemic osteomalacia.     

607例伴或不伴胎膜早破早产的妊娠结局分析

目的探讨早产伴胎膜早破对母儿结局的影响。方法收集2003年1月至2013年12月广州医科大学附属第三医院607例伴或不伴胎膜早破的无其他明显诱因早产病例,将其分为伴或不伴胎膜早破两组,比较两组母婴结局。结果早产伴胎膜早破组(n=369)产妇剖宫产率明显大于不伴胎膜早破组(n=238)(18.43%vs11.76%,P<0.05);平均住院天数明显高于不伴胎膜早破组(6.3 d vs 5.5 d,P<0.05);新生儿的感染发生率明显高于不伴胎膜早破组(20.51%vs 11.32%,P<0.05);新生儿呼吸窘迫综合征发生率明显高于不伴胎膜早破组(9.23%vs2.83%,P<0.05),差异均有统计学意义。结论早产伴胎膜早破会增加早产产妇的剖宫产率,以及早产儿和围产儿致病率和死亡率,尽早发现并恰当处理胎膜早破对降低早产发生率和早产儿发病率、死亡率有重要意义。     

32P胶体在超声引导下治疗婴儿海绵状血管瘤的临床价值

目的：探讨32P胶体在超声引导下治疗婴儿海绵状血管瘤的临床价值。方法选取在我院住院治疗的海绵状血管瘤患儿104例,给予32P胶体注射治疗,根据有无超声引导分为超声引导下行32P胶体注射治疗组(A组)和无超声引导下行32P胶体注射治疗组(B组)。用药量及浓度根据血管瘤的部位、大小、类型及患者年龄而定,注射量每次不超过500μCi。结果104例患儿注射治疗1~3次不等,平均每个瘤体注射1.51次,平均治疗时间为6个月;随访5年。A组42例,治愈率为78.6%(33例),总有效率为92.9%(39例);B组62例,治愈率为64.5%(40例),总有效率为77.4%(48例)。结论在超声引导下可提高32P胶体注射治疗皮肤海绵状血管瘤的治愈率。     

塞来昔布预防唑来磷酸治疗老年性骨质疏松症不良反应的疗效观察

目的探讨预防应用塞来昔布是否可以减少使用唑来磷酸治疗老年性骨质疏松症不良反应的发生。方法选取2012年1月至2015年1月老年性骨质疏松症患者116例,年龄61~86岁。依据输注唑来磷酸前是否预防应用塞来昔布及布洛芬分为空白对照组、布洛芬组、塞来昔布组。观察输注唑来磷酸过程中及输液后3 d内不良反应发生的情况。结果 (1)塞来昔布组发热比例最少,塞来昔布组7例(14%)、布洛芬组8例(25%)、空白对照组13例(38.2%)。(2)中热(38.1-39℃)、高热(39℃)的塞来昔布组比例显著低于其他两组,而低热(37.3-38℃)的塞来昔布组比例略高于其他两组。各组在不同发热程度的比例分别为:塞来昔布组:低热4例(8%)、中热2例(4%)、高热1例(2%);布洛芬组:低热3例(6.3%)、中热3例(9.4%)、高热3例(9.4%);空白对照组:低热2例(5.9%)、中热5例(14.7%)、高热6例(17.6%)。三组发热程度比较有显著性差异(P0.05)。(3)肌肉痛、骨骼关节疼痛、流感样症状、消化道症状、头晕、头痛、心悸等不良反应发生率均为塞来昔布组最低。除心悸、皮疹外,其他不良反应发生率在三组间均有显著性差异(P0.05)。结论预防性应用塞来昔布可以减少唑来磷酸不良反应的发生。     

慢性肾脏病流行病合作工作组方程和肌酐全年龄段方程用于成人慢性肾脏病

目的比较慢性肾脏病流行病合作组方程(CKD-EPI)和肌酐全年龄段方程(FAS)评估慢性肾脏病(CKD)患者肾小球滤过率(GFR)的价值。方法回顾性分析393例CKD,以99 Tc m-DTPA肾动态显像法所测GFR(Tc-GFR)为金标准,采用3个CKD-EPI方程及3个FAS方程,分别为流行病学-血肌酐(EPI-SCr)、流行病学-胱抑素C(EPI-Cys-C)、流行病学-血肌酐联合胱抑素C(EPI-SCr-Cys-C)、FAS-血肌酐(FAS-SCr)、FAS-胱抑素C(FAS-Cys-C)和FAS-血肌酐联合胱抑素C(FAS-SCr-Cys-C)方程计算GFR(eGFR),比较其eGFR与Tc-GFR差异、相关性、方程偏倚,观察方程评价CKD患者GFR水平的适用性、敏感度、特异度、准确率及精确度等。结果①总样本中FAS-SCr-Cys-C偏倚最小、精确度最好,FAS-Cys-C和FAS-SCr次之,EPI-SCr偏倚最大、精确度最差;②FAS-Cys-C在P10和P30准确率最高,FAS-SCr-Cys-C次之,EPI-SCr最低;③方程曲线下面积(AUC)依次为FAS-SCr-Cys-C>EPI-SCr-Cys-C>FAS-Cys-C>EPI-Cys-C>FAS-SCr>EPI-SCr;FAS-SCr-Cys-C的AUC最大,为0.941[95%CI(0.909,0.973),P<0.001],eGFR截断值取41.71 ml/(min·1.73 m 2)时,阳性预测值为98.0%,阴性预测值为51.3%,敏感度为83.3%,特异度为92.3%,约登指数为0.756;EPI-SCr-Cys-C敏感度最高(89.0%),阳性预测值略低于FAS-SCr-Cys;EPI-SCr的AUC最小,敏感度最低。结论FAS-SCr-Cys-C方程可用于测定CKD患者各期GFR。     

肾移植术后早期肺部感染的预防性治疗

目的 评价肾移植术后早期肺部感染预防性治疗的有效性.方法 选取2003年1月至2004年6月247例患者为常规治疗组,2005年1月至2006年12月227例患者为预防治疗组,随访4年,回顾性分析不同组别的感染率、感染时相、病原体以及预后.结果 常规治疗组患者中发生肺部感染84例,感染率34.0％,其中重症肺炎30例;预防治疗组患者中发生肺部感染40例,感染率17.6％,其中重症肺炎8例.预防治疗组重症肺炎发生率较常规治疗组明显偏低（35.7％ vs20％）,且病死率低（4.05％ vs 0.88％,x2=4.81,P＜0.05）.术后30 d内,常规治疗组与预防治疗组的感染发生率差异无统计学意义,但在30 d后,预防治疗组的肺部感染发生率要低于常规治疗组,尤其是在移植后30 ～ 180 d内预防治疗组的感染率明显低于常规治疗组.结论 肾移植早期为发生肺部感染尤其是重症肺部感染的高风险时期,预防性应用更昔洛韦、增效联磺片可明显降低早期肺部感染发生,尤其是重症肺部感染的发生,降低患者的死亡率,值得在临床上广泛应用.     

微小核糖核酸miR-541在1型糖尿病中的遗传变异研究

目的 对1型糖尿病(T1DM)儿童微小RNA miR-541基因进行筛查,以了解T1DM儿童该基因变异情况.方法 选择2006年1月至2009年8月在南京医科大学附属南京儿童医院内分泌科确诊的T1DM患儿69例和46名健康对照儿,用PCR扩增结合直接测序方法,对miR-541基因-1084～+167区域的遗传变异进行筛选;用限制性片段长度多态性(RFLP)方法对筛选出的特定变异位点检测,并用RNA二级结构分析软件RNAfold分析.结果 发现1个单核苷酸多态性(SNP)数据库报道的SNP(rs12893725),以及新发现3个未报道的基因变异,其中-284杂合C→T、-569杂合G→A为SNP在健康对照和糖尿病儿童均存在,其发生率、发病年龄和发病时糖化血红蛋白在患者和对照组中无显著差异.因-404杂合G→T基因变异仅在3例糖尿病患者发现,随后采用RFLP对该位点变异在另外105名健康对照者进行筛查,发现健康对照者和T1DM儿童的-404杂合D→T基因变异发生率分别为1/(46+105)和3/69,是一种少见SNP,RNAfold分析发现-404G→T基因变异显著影响miR-541前体二级结构,可能导致其处理和表达差异.结论 发现miR-541基因在T1DM存在遗传变异,其中-404杂合G→T是可能的糖尿病相关变异.     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.