以肾功能不全为首发症状的原发性巨球蛋白血症1例分析

笔者收治以肾功能不全为首发症状的原发性巨球蛋白血症1例，分析如下。 1病历摘要 男，70岁。主因乏力、头痛、头晕、食欲下降3个月余，恶心、呕吐2周，尿少3d于200702—05收入院。患者曾在外院就诊，因肌酐为406μmol／L，尿蛋白（＋＋＋），诊断为慢性肾功能不全，给予尿毒清等治疗，症状无缓解而转我院。     

2016—2018年天津市第一中心医院感染性疾病病原菌的分布及耐药性分析

目的 探究2016—2018年天津市第一中心医院感染性疾病病原菌的分布及耐药性分析。方法 分析2016年1月—2018年10月天津市第一中心医院524例感染性疾病患者,进行病原菌检测、鉴定以及药敏试验,统计并记录病原菌的分布以及各病原菌的耐药性。结果 524例感染性疾病患者检出病原菌503株,革兰阴性菌311株（61.83%）,革兰阳性菌153株（30.42%）,真菌31株（6.16%）,其他8株（1.59%）;革兰阴性菌主要为鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌,分别有102株（20.28%）、65株（12.92%）、47株（9.34%）,革兰阳性菌以金黄色葡萄球菌、肺炎链球菌为主,分别有54株（10.74%）、32株（6.36%）,真菌以热带假丝酵母菌和白色假丝酵母菌为主,分别有13株（2.58%）、11株（2.19%）;大肠埃希菌对头孢西丁、头孢他啶、妥布霉素、头孢噻肟的耐药率较高,对头孢哌酮、头孢吡肟、美罗培南、氨曲南的耐药率低于10%,鲍曼不动杆菌对氨苄西林、左氧氟沙星、氨曲南、庆大霉素的耐药率高于50%,对头孢吡肟、阿米卡星、头孢哌酮的耐药率低于10%;肺炎克雷伯菌对头孢他啶、氨苄西林、妥布霉素、头孢噻肟、头孢西丁、氨曲南的耐药率高于50%,对阿米卡星、美罗培南、头孢哌酮的耐药率低于10%;金黄色葡萄球菌对苯唑西林、左氧氟沙星、四环素、青霉素G、复方新诺明的耐药率高于50%,对环丙沙星、利奈唑胺、红霉素、万古霉素、替加环素的耐药率低于10%,肺炎链球菌对环丙沙星、庆大霉素、青霉素G、四环素的耐药率高于50%,对红霉素、复方新诺明、万古霉素、替加环素的耐药率低于10%。结论 2016—2018年天津市第一中心医院感染性疾病患者病原菌主要为革兰阴性菌,且主要病原菌耐药性较高,临床医师应该对感染性疾病患者进行病原菌检测并选择种类合理的抗生素进行治疗。     

老年人贫血及营养状况分析

Objective To observe the incidence rate of anaemia and analyze the nutritional situation in the elderly population.Methods From April to August 2010,a total of 2052 elderly persons from out-department of Tianjin First Center Hospital were divided into four age groups:65-69years group (n=528),70-74 years group (n=593),75-79 years group (n=423) and 80 years and over group (n= 508).The body mass index (BMI),haemoglobin (Hb),mean corpuscular volume (MCV),triglyceride (TG),creatinine (Cr),serum albumin (ALB) and ferritin (Fer) were tested and evaluated using K-W test.Results (1) Anaemia was found in 90 subjects (4.4 %),4.0% in men and 6.l% in women,9.5% in 80 years and over group.The subjects with Hb level less than 90g/L were all 80 years and over.(2)There were significant differences among the groups in BMI,TG,Cr,ALB,Hb,MCV and Fer levels (all P＜0.01).There were significant differences among four groups in Hb and ALB levels (P＜0.01 ),and partially differences in TG, Cr and MCV levels (P＜0.05).(3)The Hb level was significantly correlated with TG, ALB, Fer and MCV levels (r=0.115,0.211, 0.114 and 0.089, all P＜0.01 ) from Pearson analysis.Conclusions Anemia incidence in elderly population is increased along with aging and is higher in women than in men, especially higher in 80 years and over group.Nutritional situation gets worse with aging.     

曲美他嗪对80岁以上老年冠心病心力衰竭患者脑钠肽及心功能的影响

【目的】观察曲美他嗪对老年冠心病慢性心力衰竭患者脑钠肽及心功能的影响。【方法】80岁以上老年冠心病患者68例，心功能在Ⅲ-Ⅳ级，随机分为曲美他嗪组（35人）和对照组（33人），对照组采用常规抗心衰治疗方法，曲美他嗪组在常规抗心衰治疗基础上加用曲美他嗪治疗，各组病人观察治疗12周，每组病人分别进行治疗前后血浆脑钠肽及心功能指标的测定。【结果】曲美他嗪组与对照组均能降低血浆脑钠肽水平，与对照组相比，曲美他嗪组下降更明显，差异有显著性（P〈0．01）；与对照组相比，曲美他嗪组能更有效的改善心功能（p〈0．05）。【结论】在常规心衰治疗的基础上，加用曲美他嗪能显著降低血浆脑钠肽的水平，从而改善患者的心功能。     

2型糖尿病患者脉压与慢性肾损害

目的为了观察2型糖尿病脉压与年龄及蛋白尿的关系;方法选择血肌酐<2.00mg/d1的住院患者,检测收缩压、舒张压、脉压以及24小时尿蛋白定量;结果SBP及PP在微量蛋白尿组和临床蛋白尿组是增加的,在老年组也是如此,而DBP在老年组是下降的趋势。多因素回归分析升高的PP与增加的PP明显相关(p<0.001)。结论在2型糖尿病患者,PP与年龄、蛋白尿程度及大动脉硬化紧密相关。     

痛风舒胶囊联合非布司他治疗痛风的临床研究

目的探讨痛风舒胶囊联合非布司他治疗痛风的临床效果。方法选取2016年6月—2018年12月天津市第一中心医院收治的86例痛风患者,随机分为对照组和治疗组,每组各43例。对照组口服非布司他片,40mg/次,1次/d。治疗组在对照组基础上口服痛风舒胶囊,3粒/次,3次/d。两组均连续治疗3个月。观察两组的临床疗效,比较两组治疗前后主要症状体征改善情况、红细胞沉降率(ESR)、血清学指标和36项健康调查简表(SF-36)评分。结果对照组和治疗组的总有效率分别是81.4%、95.3%,两组比较差异具有统计学意义(P0.05)。治疗后,两组关节疼痛评分、关节肿胀评分、关节畸形评分、受累关节数、痛风石最大直径均较治疗前显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些症状体征改善情况均优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组ESR值、尿酸、C反应蛋白(CRP)、白介素-1β(IL-1β)、丙二醛(MDA)水平均较治疗前显著降低,而超氧化物歧化酶(SOD)水平均显著升高,同组治疗前后比较差异有统计学意义(P0.05);治疗后,ESR值、尿酸、CRP、IL-1β、MDA水平显著低于对照组,而SOD水平高于对照组,两组比较差异具有统计学意义(P0.05)。结论痛风舒胶囊联合非布司他治疗痛风的整体疗效显著,有助于减轻患者症状,减少受累关节数,促进痛风石溶解,控制血尿酸水平,改善机体过度炎症状态,拮抗氧化应激,改善患者生活质量,具有一定的临床推广应用价值。     

左-卡尼汀对老年终末期肾病患者微炎症和营养状态的影响

的探讨左-卡尼汀对老年终末期肾病患者微炎症和营养状态的影响。方法选择天津医科大学第二医院血液净化中心老年终末期肾病患者68例,进行12周的左-卡尼汀治疗, 1g／次,3次／周,每次透析结束后静脉注射。治疗前后应用超敏C反应蛋白(hs-CRP)和改良主观全面营养评价法(MSGAN)对患者进行微炎症和营养状态评估,同时测定血清白蛋白、前白蛋白、血红蛋白、转铁蛋白、肌酐、尿素氮、钙、磷、全段甲状旁腺激素(iPTH)等生化指标,并观察药物的不良反应。结果治疗后hs-CRP水平为(6．45±2．53)mg／L,营养不良评分为(12．48±6．32)分,较治疗前(10．73±5．42)mg／L和(20．56±5．85)分明显降低(P<0．01),血清白蛋白、前白蛋白、转铁蛋白、血红蛋白和尿素氮升高(P<0．01,P<0．05),而肌酐、钙、磷及iPTH治疗前后差异无统计学意义(P>0．05)。患者不良反应发生率为4．4％,均可耐受。结论左-卡尼汀可改善老年终末期肾病患者的微炎症和营养状态。     

磷酸肌酸钠治疗老年肺炎合并心力衰竭45例

老年人免疫功能低下,常存在多种疾患,发生肺炎后常并发心功能不全,导致治疗时间延长、治疗费用增长、病死率增加.磷酸肌酸钠是参与细胞能量代谢的重要物质之一,能扩张冠状动脉,营养心肌,保护细胞膜,改善心脏功能.本文拟观察传统治疗方法加用磷酸肌酸钠治疗老年肺炎合并心力衰竭患者的疗效及安全性.     

老年人贫血及营养状况分析

Objective To observe the incidence rate of anaemia and analyze the nutritional situation in the elderly population.Methods From April to August 2010,a total of 2052 elderly persons from out-department of Tianjin First Center Hospital were divided into four age groups:65-69years group (n=528),70-74 years group (n=593),75-79 years group (n=423) and 80 years and over group (n= 508).The body mass index (BMI),haemoglobin (Hb),mean corpuscular volume (MCV),triglyceride (TG),creatinine (Cr),serum albumin (ALB) and ferritin (Fer) were tested and evaluated using K-W test.Results (1) Anaemia was found in 90 subjects (4.4 %),4.0% in men and 6.l% in women,9.5% in 80 years and over group.The subjects with Hb level less than 90g/L were all 80 years and over.(2)There were significant differences among the groups in BMI,TG,Cr,ALB,Hb,MCV and Fer levels (all P＜0.01).There were significant differences among four groups in Hb and ALB levels (P＜0.01 ),and partially differences in TG, Cr and MCV levels (P＜0.05).(3)The Hb level was significantly correlated with TG, ALB, Fer and MCV levels (r=0.115,0.211, 0.114 and 0.089, all P＜0.01 ) from Pearson analysis.Conclusions Anemia incidence in elderly population is increased along with aging and is higher in women than in men, especially higher in 80 years and over group.Nutritional situation gets worse with aging.     

老年人贫血及营养状况分析

目的 观察分析老年人贫血发生率及营养状况.方法 选择门诊健康查体的离退休老年人2052例,按年龄分为4组,65～69岁(528例)、70～74岁(593例)、75～79岁(423例),≥80岁(508例),检测体质指数(BMI)、血红蛋白(Hb)、红细胞平均体积(MCV)、三酰甘油(TG)、血肌酐(Cr)、血浆白蛋白(ALB)、血清铁蛋白(Fer)等指标,统计贫血发生率及对各营养指标进行分析.结果 (1)老年人贫血发生率为4.4%,其中男性4.0%,女性6.1%,＞80岁组为9.5%.Hb＜90 g/L者5例,均为80岁以上高龄患者.(2)各年龄组营养相关指标BMI、TG、Cr、ALB、Hb、MCV、Fer差异有统计学意义(均P＜0.01),且Hb、ALB在4组间差异有统计学意义(均P＜0.01),TG、Cr、MCV在多组间差异也有统计学意义(均P＜0.05).(3)经Pearson相关性分析,Hb与TG、ALB、Fer、MCV呈正相关,相关系数r值分别为0.12、0.21、0.11、0.10(均P＜0.01).结论 老年人随着年龄增长,贫血发生率逐渐增加,女性多于男性,尤以80岁以上高龄者发生率最高,且营养状况随着年龄增长而逐渐恶化.

Abstract：

Objective To observe the incidence rate of anaemia and analyze the nutritional situation in the elderly population.Methods From April to August 2010,a total of 2052 elderly persons from out-department of Tianjin First Center Hospital were divided into four age groups:65-69years group (n=528),70-74 years group (n=593),75-79 years group (n=423) and 80 years and over group (n= 508).The body mass index (BMI),haemoglobin (Hb),mean corpuscular volume (MCV),triglyceride (TG),creatinine (Cr),serum albumin (ALB) and ferritin (Fer) were tested and evaluated using K-W test.Results (1) Anaemia was found in 90 subjects (4.4 %),4.0% in men and 6.l% in women,9.5% in 80 years and over group.The subjects with Hb level less than 90g/L were all 80 years and over.(2)There were significant differences among the groups in BMI,TG,Cr,ALB,Hb,MCV and Fer levels (all P＜0.01).There were significant differences among four groups in Hb and ALB levels (P＜0.01 ),and partially differences in TG, Cr and MCV levels (P＜0.05).(3)The Hb level was significantly correlated with TG, ALB, Fer and MCV levels (r=0.115,0.211, 0.114 and 0.089, all P＜0.01 ) from Pearson analysis.Conclusions Anemia incidence in elderly population is increased along with aging and is higher in women than in men, especially higher in 80 years and over group.Nutritional situation gets worse with aging.