类风湿性关节炎患者的心脏损害-超声心动图、心机械图和心电图的研究

为研究类风湿性关节炎(RA)患者心脏功能的损害,确定心脏功能损害的指标,达到早期预防和治疗的目的,本研究采用超声心动图、心机械图以及心电图对32例RA患者(按美国风湿病协会诊断标准)进行详细检查,观察患者心脏形态及心脏功能的改变。结果显示出9例患者伴心包积液     

类风湿性关节炎的皮肤表现

类风湿性关节炎常累及皮肤,且可相当严重。类风湿性结节和类风湿性血管炎为本病常见的表现,但也可出现其它损害使诊疗发生困难。这些皮肤损害的临床病程各异,并可与关节炎的活动度无关。现分别叙述如下:一、类风湿性结节:是类风湿性关节炎的主要     

类风湿关节炎心脏损害28例超声心动图分析

类风湿关节炎心脏损害２８例超声心动图分析李春梅张梅四川省人民医院（６１００７２）四川省卫生管理干部学院（６１００４１）类风湿性关节炎（ＲＡ）是侵犯全身结缔组织的自身免疫性疾病，最常累及关节滑膜，心脏亦是其最常受累脏器之一。本文对２８例ＲＡ患者行彩色多...     

爱若华治疗类风湿关节炎合并肾脏损害20例临床研究

目的探讨爱若华治疗类风湿性关节炎合并肾脏损害的疗效和不良反应。方法选择20例类风湿性关节炎合并肾脏损害的患者,给予爱若华50mg/d连用3d后减至20mg/d,维持治疗。观察治疗前后24h尿蛋白定量,肾功能、肝功能、血常规以及不良反应。结果爱若华有效控制风湿活动,显著减少蛋白尿。完全缓解5例,部分缓解13例,无效2例。治疗过程中有3例患者出现恶心,上腹不适,2例出现一过性ALT、AST升高。结论爱若华对大部分类风湿性关节炎合并肾脏损害患者治疗有效,副作用较少,使用安全。     

类风湿关节炎心脏损害36例临床分析

目的探讨类风湿关节炎心脏损害的特点及诊断方法。方法收集2006年6月-2010年5月类风湿关节炎住院患者121例,根据检查结果分为心脏损害组和无心脏损害组。分析年龄、性别、病程及疾病活动与类风湿关节炎心脏损害的相关性。结果 121例类风湿关节炎患者中心脏损害36例（29.8%）,其中心包炎12例（33.3%）,心电图ST-T缺血性改变8例（22.2%）,心律失常7例（19.4%）,瓣膜病变5例（13.9%）,心肌损害3例（8.3%）,冠状动脉炎1例（2.8%）。14例（38.9%）出现临床症状,主要表现为活动后轻度心悸胸闷。心脏损害组类风湿因子（RF）滴度、血沉（ESR）明显高于无心脏损害组。结论类风湿关节炎心脏损害并不少见,且与疾病活动相关。超声心动图在诊断类风湿关节炎心脏损害方面具有重要价值。     

类风湿性关节炎肾脏损害(附3例报告)

类风湿性关节炎除具有典型的关节僵硬、肿痛、畸形，类风湿因子（RF）阳性外，还可伴有全身各脏器的损害。关于类风湿病本身和治疗用药对肾脏病变的影响，近几年国内报道较少，现将我院收治的50例类风湿性关节炎中伴肾脏损害的3例报告如下。例1，女，65岁。1983年6月5日入院。患类风湿性关节炎6年，一直服用拨尼松30mg／日，近8个月加服硫酸锌。因出现反酸、胃痛入院。查体：满月脸，水牛背。体温、血压，脉率均正常。两肺闻及湿罗音，心脏正常。剑突下轻压痛，双下肢轻度浮肿，观指间关节呈梭状畸形，双腕关节背屈受限。实验室检查：RF（…     

护理干预32例类风湿性关节炎患者的临床观察

目的:探讨类风湿性关节炎患者的护理措施。方法:对我院2014年4月-2015年7月之间收治的32例类风湿性关节炎患者的临床护理观察分析。结果:本组32例类风湿性关节炎患者经护理干预后,病情均得到明显好转。结论:对类风湿性关节炎患者行有效护理措施,可减轻其疼痛感,并有助于提高其生活质量。     

类风湿性关节炎肾脏损害(附3例报告)

类风湿性关节炎除具有典型病变外,还可伴有全身各脏器的损害。现将我院收治的3例伴有肾脏损害的类风湿性关节炎病例报告如下。例1,女,65岁。患类风湿性关节炎6年。一直服强的松30mg/日,近8个月加服硫酸锌,因出现反酸、胃痛而入院。查体:满月脸,水牛背,两肺闻及湿罗音,剑突下有轻度压痛,双下肢轻度水肿,双手指间关节呈梭状畸形,双腕关节背屈受限。实验室检查:RF     

类风湿性心脏病(美国)

类风湿性关节炎病人可发生数型类风湿性心脏损害,这类心脏病的发病率为类风湿病人的27～34％。心脏受损可呈下列形式的任何一种:心包炎,心肌炎,心内膜炎与瓣膜炎和冠状动脉炎。临床特点不具特征性,包括心包摩擦音、胸痛、心律失常、杂音以     

老年类风湿性关节炎并肺损害5例误诊分析

为掌握老年类风湿性关节炎并肺损害的诊断，分析5例老年类风湿性关节炎并肺损害患者的临床资料。结果，5例患者临床症状不典型，易误诊，双肺底吸气时闻及广泛、持续、高调的湿罗音。肺“CT”示双肺中下呈网状纤维化改变。提示老年类风湿性关节炎并肺损害易误诊。用抗生素治疗无效，激素治疗有效。     

类风湿性关节炎致肺功能损害的研究

目的　研究类风湿性关节炎 (RA)致肺功能损害的变化。方法　采用日本产ChestGrophHI -70 1型体积容积描记肺功能仪检测 5 8例RA组患者的肺功能情况 ,设 5 8例非吸烟健康者作为对照组。结果　RA组弥散功能明显受损(P均 <0 .0 1) ,弥散功能异常率为 62 .0 7% ,小气道阻塞为 48.2 8% ,肺气肿为 43 .10 % ,通气功能减退为 3 2 .76% ,阻塞性通气障碍为 3 2 .76% ,限制性通气障碍为 3 6.2 1%。结论　RA患者的肺功能损害以弥散功能减退为主 ,其次为小气道阻塞、肺气肿、通气功能减退 ,对早期肺损害诊断有重要意义。     

Cardiac rheumatoid nodules

Rheumatoid nodules in the heart are unusual specific manifestations of rheumatoid arthritis. This paper describes three cases in which these nodules were found at necropsy. The patients were women with long histories of rheumatoid arthritis, two of whom had significant but unexplained congestive cardiac failure. The rheumatoid nodules were present in the patients' myocardium and in one patient's pericardium. We suggest that in patients with rheumatoid arthritis with severe but unexplained cardiac failure, the possibility of rheumatoid nodules in the heart should be considered.     

金昌地区风湿病患病状况分析

论文收集分析了金昌地区1988～1992年110例风湿病患病情况,发现女性多于男性,风心病和类风湿性关节炎年龄有后移现象,SLE预后差,多死于肾衰、心衰和感染。类风湿性关节炎由于关节变形和功能障碍影响病人的工作和生活,风心病多引起房颤,加速心功能的恶化和劳动力的丧失,风湿热预后较好。故SLE、类风湿性关节炎、风湿热的早期诊断、合理治疗可延缓病情发展,及时防治房颤可保护心功能。     

血清叶酸同型半胱氨酸与类风湿关节炎心血管病变的关系

目的探讨类风湿关节炎（RA）患者体内血清叶酸（FA）、同型半胱氨酸（Hcy）与心血管病变之间的关系。方法采用ELISA法检测98例RA患者和40例正常人血清FA与Hcy水平,并根据是否存在颈动脉超声、心电图、超声心动图等异常将RA患者分为有心血管病变组（n=32）及无心血管病变组（n=66）,分析各组间FA与Hcy的差别。结果①RA患者有心血管病变组、无心血管病变组及正常对照组3组间血清FA水平差异有统计学意义[分别为（4.80±1.41）ng/ml,（6.92±2.02）ng/ml,（10.11±2.01）ng/ml,P〈0.01）],RA患者FA水平均低于健康对照组,而RA有心血管疾病组FA水平又低于RA无心血管疾病组（P〈0.01）。②RA患者有心血管病变组、无心血管病变组及健康对照组3组间血清Hcy水平差异有统计学意义[分别为（5.85±2.90）μmol/L、（3.39±1.21）μmol/L、（1.98±0.69）μmol/L,P〈0.01）],RA患者Hcy水平均高于对照组（P〈0.01）,而RA有心血管病变组Hcy水平又高于RA无心血管疾病组。③血清FA水平高的RA患者Hcy水平低,而血清FA水平低的RA患者Hcy水平高,两者呈负相关性（r=-0.43,P=0.000）。④血清高FA组发生心血管事件的风险是低FA组的0.230倍,血清高Hcy与心血管疾病发生的优势比（OR）为3.440,95%置信区间为1.322～8.948。结论 RA患者血清FA水平降低或血清Hcy水平升高会导致心血管病变发生率升高。RA患者血清FA水平与Hcy水平呈负相关。     

MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY

Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.KEY WORDS: Heart injuries, Thoracic injuries, Traumatology, Wounds, gunshot, Wounds, nonpenetrating, Wounds, penetrating     

Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis

Abstract

Study design. Case-series study.

Objective. To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis.

Background. Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports.

Methods. Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 years and mean rheumatoid arthritis duration of 15 years. The medical records and imaging studies of all patients were reviewed.

Results. The affected nerve roots were L4 in four patients and L3 in two patients. Foraminal stenosis was not demonstrated in magnetic resonance images in four of the six patients. Selective radiculography with nerve root block reproduced pain, manifested blocking effect, and demonstrated compression of the nerve root by the superior articular process of the lower vertebra in all patients. Conservative treatment was performed on one patient, and surgery was conducted for the rest of the five patients; radiculopathy was improved in all patients.

Conclusions. Lumbar foraminal stenosis is a characteristic pathology of rheumatoid arthritis, and should be kept in mind in the diagnosis of lumbar radiculopathy. Selective radiculography is useful in the diagnosis of affected nerve roots.     

Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis

Study design

Case-series study.

Objective

To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis.

Background

Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports.

Methods

Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 years and mean rheumatoid arthritis duration of 15 years. The medical records and imaging studies of all patients were reviewed.

Results

The affected nerve roots were L4 in four patients and L3 in two patients. Foraminal stenosis was not demonstrated in magnetic resonance images in four of the six patients. Selective radiculography with nerve root block reproduced pain, manifested blocking effect, and demonstrated compression of the nerve root by the superior articular process of the lower vertebra in all patients. Conservative treatment was performed on one patient, and surgery was conducted for the rest of the five patients; radiculopathy was improved in all patients.

Conclusions

Lumbar foraminal stenosis is a characteristic pathology of rheumatoid arthritis, and should be kept in mind in the diagnosis of lumbar radiculopathy. Selective radiculography is useful in the diagnosis of affected nerve roots.     

心肌酶谱在类风湿性关节炎患者血清中的变化及临床意义

目的探讨心肌酶谱检测对类风湿性关节炎（RA）患者临床价值。方法回顾分析42例活动性RA患者（活动组）、37例非活动性RA患者（非活动组）、40例健康体检者（对照组）的血清天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶MB同工酶（CK-MB）等指标的检测结果,其中AST、LDH、CK测定采用速率法,CK-MB测定采用免疫抑制法。结果①三组患者的血清AST、LDH、CK、CK-MB比较差异有统计学意义（P〈0.05）;活动组的血清AST、LDH、CK、CK-MB显著高于非活动组（P〈0.05）,非活动组的血清AST、LDH、CK、CK-MB显著高于对照组（P〈0.05）。②治疗后,活动组患者血清AST、LDH、CK、CK-MB均显著下降,治疗前后相比差异有统计学意义（P〈0.05）。结论 RA患者常伴随有心肌细胞损伤。在RA患者诊治过程中,应定期监测其心肌酶谱,以防心脏不良事件的发生。     

钝性暴力、心肺复苏、急性心梗致心脏破裂及主动脉夹层破裂致心包填塞法医病理形态学特点

目的探讨钝性暴力、急性心梗及心肺复苏致心脏破裂法医病理形态学特点,为法医病理鉴别诊断提供依据。方法本中 心自2013~2017年法医病理解剖心脏破裂案例共44例,包括心包完整的钝性暴力致心脏破裂11例、心梗致心脏破裂9例、心肺 复苏致心脏破裂4例及主动脉夹层破裂致心包填塞20例,分别对心脏破裂部位的大体和组织病理学特点及心包积液特点进行 比较分析。结果钝性暴力致心脏破裂形态多样,部位不确定,可有多处破裂,大多伴有肋骨或胸骨骨折,心包积液量可多可少, 镜下见出血、心肌收缩带坏死等病理学改变。心肺复苏所致心脏破裂部位均位于右心室前壁靠近心尖处,略呈斜行,伴有肋骨 骨折或胸骨骨折,心包积血量少且没有凝血块,镜下仅见少许出血。心梗致心脏破裂心包积血量多并伴有凝血块,与心肺复苏 相比有显著差异（P<0.05）,心脏破裂部位均位于左室壁,镜下可见心肌细胞坏死、炎细胞浸润及附壁血栓形成。主动脉夹层破 裂致心包填塞心包积血量多并伴有凝血块,显著高于钝性暴力、心梗及心肺复苏（P<0.05）。结论心脏破裂处的出血、炎细胞浸 润、附壁血栓形成等及心包积血中有凝血块是生前损伤的依据。