泮托拉唑钠肠溶片与泮托拉唑钠胶囊治疗消化性溃疡的临床随机对照研究

目的:比较泮托拉唑钠肠溶片与泮托拉唑钠胶囊治疗消化性溃疡的临床疗效及评价其不良反应。方法:采用随机对照和开放试验的方法治疗胃镜检查确诊的消化性溃疡病人共162例,其中泮托拉唑钠肠溶片组(试验组)62例,其中胃溃疡18例,十二指肠溃疡44例;泮托拉唑钠胶囊组(对照组)60例,其中胃溃疡16例,十二指肠溃疡44例;开放组40例,其中胃溃疡12例,十二指肠溃疡28例。结果:试验组中胃溃疡的愈合率和总有效率分别为83.3%和100.0%,十二指肠溃疡的愈合率和总有效率分别为88.6%和97.7%;对照组中胃溃疡的愈合率和总有效率分别为81.3%和100.0%,十二指肠溃疡的愈合率和总有效率分别为84.1%和97.7%;开放组中胃溃疡的愈合率和总有效率分别为91.7%和100.0%,十二指肠溃疡的愈合率和总有效率分别为85.7%和100.0%。试验组中疼痛消失率和其他消化道症状的消失率在胃溃疡为94.4%和92.3%,在十二指肠溃疡则为97.7%和98.0%。对照组中疼痛消失率和其他消化道症状的消失率在胃溃疡为93.8%和93.6%,在十二指肠溃疡则为97.7%和97.3%。两组在愈合率、总有效率、疼痛消失率和其他消化...     

缺血性结肠炎患者的血黏度及血脂分析

目的：分析缺血性结肠炎（IC）患者的血黏度及血脂状况，为防治IC提供依据。方法确诊为IC患者（观察组）与健康者（对照组）各43例，测定高切变率下的全血黏度、低切变率下的全血黏度、D-二聚体、总胆固醇（CHOL）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（Apo-A1）、载脂蛋白B（Apo-B）。结果观察组高切变率全血黏度、低切变率全血黏度、D-二聚体、CHOL、TG、LDL-C、Apo-B 水平，均高于对照组，HDL-C、Apo-A1低于对照组，差异均有统计学意义。结论缺血性结肠炎患者血黏度及血脂明显异常，血管栓塞风险高，积极改善微循环与合理的调脂治疗，可预防和减缓缺血性结肠炎的发生及进展。     

结缔组织病患者129例消化道表现

目的:观察结缔组织病患者的消化道表现.方法:对1994-2004年在我院住院的结缔组织病患者129例消化道表现、发生率进行临床分析.结果:129例结缔组织病患者中有61例出现消化道症状,占47.3%.本组病例中以消化道症状为首发症状的有10例,其中误诊漏诊6例,占60%.结论:结缔组织病消化道症状发生率高,对首发消化道症状易误诊、漏诊,应引起临床重视.     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

尿激酶联合ACEI治疗糖尿病肾病疗效观察

糖尿病肾病起病隐匿 ,发展相对较慢 ,有报道血管紧张素酶抑制剂 (ＡＣＥＩ)治疗糖尿病肾病有一定疗效[1 ,2 ] 。本文应用尿激酶联合ＡＣＥＩ治疗糖尿病肾病取得更为满意的效果 ,现将尿激酶联合ＡＣＥＩ治疗糖尿病肾病 33例同单用ＡＣＥＩ治疗糖尿病肾病 33例作对照观察 ,现报告     

宫颈上皮内瘤变的诊治和进展（二）

３　治疗宫颈上皮内瘤变（ＣＩＮ）包括宫颈不典型增生（轻、中、重）和原位癌，ＣＩＮ的治疗主要有二类：①保守治疗；②手术治疗。治疗方法的选择主要取决于ＣＩＮ的级别、病变范围、年龄、体质及对生育要求等。治疗原则对ＣＩＮⅠ、Ⅱ级宜采用保守治疗，ＣＩＮⅢ级则以手术治疗为主。近代对ＣＩＮ的治疗趋向于保守状况。３．１　ＣＩＮ保守治疗依据３．１．１　宫颈癌发生发展的研究表明从癌前病变到癌的发生需经较漫长时间（至少１０年以上），见图１。图１　宫颈癌自然史发展过程中的典型程序３．１．２　约有５０％的宫颈不典型增生发…     

72例慢性心力衰竭临床分析

目的 分析慢性心力衰竭的病因、诱因及住院和门诊治疗情况,提高临床诊治水平,改善预后.方法 查阅72份慢性心力衰竭住院病历和门诊病历,统计病因、诱因和药物治疗情况.结果 基本病因以冠心病和高血压性心脏病为主,占73.6％,合并两种以上基础心脏病占47.1％.诱因以快速房颤和血压升高为主,占78.5％.72例住院患者药物使用率：氢氯噻嗪75％,卡托普利71％,地高辛44％、参麦41％,螺内酯41％,美托洛尔和呋塞米均是13.7％,毛花苷C 8％,显效18例（25％）,其中：有效22例（30.5％）,无效32例（44.5％）,其中有3例住院1天自动出院.出院治疗后3个月门诊随访：显效44例（81.5％）,有效8例（14.8％）,死亡2例（3.7％）.结论 本组慢性心力衰竭患者多种基础心脏病并存,以冠心病和高血压性心脏病引起的心力衰竭最多见,发病以快速房颤和高血压为主要诱因.基层医院大部分患者住院时间短,治疗不彻底,门诊随访继续给予规范有效的治疗,效果理想,预后好.     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

妇科肿瘤全量放射治疗后手术82例回顾分析

[目的]分析宫颈癌及子宫内膜癌全量放射治疗后再手术的临床情况。[方法]回顾71例宫颈癌及11例子宫内膜癌行全量体外 腔内放疗,因各种指征行筋膜外子宫切除术57例、附件切除术9例,次广泛或广泛子宫切除术10例等。[结果]手术时间:筋膜外子宫切除术平均2.7h,次广泛或广泛子宫切除术3.8h,附件切除术1.8h。手术出血量:39例<200ml,30例≥200ml(平均462m1)。手术并发症包括:伤口裂开3例,伤口感染3例,泌尿道并发症4例,肠瘘1例,肠损伤1例,总并发症14.7%,术后病理显示宫颈残存癌或肿瘤复发、转移/宫体受侵39例,5年生存率44.3%;子宫内膜癌未控或新发生的子宫内膜癌16例,5年生存率64.5%。[结论]全量放射治疗后再手术并发症相对增多,但筋膜外子宫切除术仍是安全、有效的治疗方法。     

子宫颈癌化疗进展

半个世纪以来 ,化疗在子宫颈癌治疗中并不占主导地位 ,然而 ,近 1 0多年来 ,子宫颈癌化疗日益受到关注。究其原因有 :( 1 )手术和放射治疗是子宫颈癌传统经典的治疗方法 ,已有 1 0 0余年历史。尽管手术技巧、放疗设备和技术不断改进 ,40年来子宫颈癌的治疗效果并无根本提高 ,总 5年生存率在 5 0 %左右徘徊。( 2 )子宫颈癌治疗失败的主要原因是肿瘤局部未控或复发 ,约占 60 %～ 70 % ,其次是淋巴结转移和远处播散。增加放射剂量可提高盆腔控制 ,但由于晚期并发症的增加使剂量增加受到限制 ,国内外众多学者试图改变这种状况 ,但并未奏效。因此…