云南省245例AIDS患者死亡原因分析

目的　分析云南省245例AIDS患者的死亡原因及特点,为预防及干预策略提供参考。方法　收集云南省传染病医院2015年1月—2019年12月收治的245例AIDS死亡患者的病例资料,并进行回顾性分析。结果　245例AIDS死亡患者中CD4+ T淋巴细胞计数≤50个/μl 129例（52.65%）,86例行HIV RNA检测,病毒载量为（3.90±0.75）lg拷贝/ml;74例（30.20%）行高效抗反转录病毒治疗（highly active antiretroviral therapy, HAART）,平均生存时间为（1106.0±72.5）d;171例（69.80%）未行HAART,平均生存时间为（710.0±25.5）d,行HAART组生存时间长于未行HAART组,差异具有统计学意义（t=9.338,P=0.002）。245例AIDS患者中183例合并机会性感染（opportunistic infections, OIs）。死于HIV相关性原因192例（78.36%）,死于非HIV相关原因53例（21.64%）。在行HAART组与未行HAART组中死于HIV相关原因患者分别为70.27%、81.87%,两者相比,差异具有统计学意义（χ2=4.100,P=0.043）;HIV相关死亡原因中,感染性休克在行HAART组与未行HAART组中的占比分别为24.31%、41.52%,未行HAART组死于感染性休克发生率高于行HAART组,差异具有统计学意义（χ2=6.603,P=0.010）。结论　AIDS死亡患者普遍合并OIs,且确诊时间晚、HAART率低、CD4+ T淋巴细胞计数低、病毒载量高。OIs仍然是导致AIDS患者死亡的主要原因,早期有效的HAART可以延长AIDS患者的生存期,降低病死率。     

广西HIV/AIDS病人死亡影响因素的回顾性调查

目的了解广西壮族自治区（广西）艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（HIV/AIDS病人）中,与AIDS相关死亡病例和非AIDS相关死亡病例的分布情况,以及接受AIDS抗病毒治疗病例死亡的主要影响因素。方法采用AIDS综合防治数据信息系统中的HIV/AIDS死亡病例信息数据进行分析。结果对2010年1月-2011年7月死亡的5 265例有效个案进行分析,临床诊断为AIDS相关疾病死亡2 647例（50.3%）,意外伤害410例（7.8%）,其他疾病或难以确定与AIDS相关疾病的死亡1 973例（37.5%）,不详235例（4.5%）。4 382例（83.2%）未接受抗病毒治疗的主要原因是,发现较晚（46.4%）和家庭经济困难（13.7%）。2004-2011年7月底,累计治疗AIDS病人21 761例,死亡1 718例。在有完整资料的1 694例死亡病例中,825例（48.7%）在治疗后3个月内死亡;1 065例（62.9%）治疗前最近1次检测CD4T淋巴细胞≤50个/μL。结论未能及时就医或诊断时间较晚,免疫功能低下,是HIV/AIDS病人死亡的主要影响因素。要进一步建立健全监测检测和治疗体系,提高覆盖面和可及性,争取HIV/AIDS病人早发现、早诊断,及时开展抗病毒治疗,降低病死率。     

18例艾滋病合并噬血细胞综合征临床特点分析

[摘要]?目的?总结AIDS合并噬血细胞综合征（hemophagocytic lymphohistiocytosis, HLH）的临床特点。方法?回顾性分析2009年1月1日—2021年12月31日在北京地坛医院住院的AIDS患者中HLH的发病率、病因、临床特征和预后。结果?在1641例AIDS合并机会性感染或肿瘤患者中,18例患者诊断为HLH,发病率为1.1%。马尔尼菲青霉菌、巨细胞病毒、EB病毒、鸟分支杆菌和结核分支杆菌感染、非何杰金淋巴瘤、卡波西肉瘤是HLH发生的诱因。经过治疗后仍有10例患者死亡,病死率为55.6%（10/18）。结论?AIDS合并机会性感染或肿瘤的患者出现HLH的发病率低、病死率高,容易漏诊、误诊,对于AIDS患者,要警惕HLH的发生。     

63例艾滋病合并隐球菌脑膜炎患者临床特点分析

目的?分析AIDS合并隐球菌脑膜炎（cryptococcal meningitis, CM）患者的临床特点。方法?采用横断面研究，收集首都医科大学附属北京佑安医院于2019年1月—2022年1月确诊并治疗的AIDS合并CM患者的临床特点、实验室检查结果及预后资料。结果?共纳入63例AIDS合并CM的病例。患者平均年龄（37.22±10.95）岁，CD4+ T淋巴细胞计数中位数为22个/μl。总病死率为15.9%（10/63）。63例患者中，死亡（死亡组）10例，中位生存时间5 d，正常出院（正常出院组）53例。分析结果显示死亡组的低CD4+ T淋巴细胞计数、合并隐球菌菌血症、颅内高压、白细胞计数升高及血小板计数降低发生率高于正常出院组（P均＜0.05）。死亡组临床表现包括脑膜刺激征、颅神经受累、意识障碍的发生率高于正常出院组（P均＜0.05）。结论?AIDS合并CM患者病死率较高，应针对高危人群加强宣教及隐球菌筛查，保持良好依从性，及时发现耐药，避免自行停药，便于早期诊断，早期干预。     

伊立替康联合米托恩醌治疗难治／复发性非霍奇金淋巴瘤的疗效观察

目的：在国内首次报道伊立替康（开普拓）联合米托恩醌治疗难治和复发非霍奇金淋巴瘤（NHL）的疗效;为难治性NHL的治疗寻找新的方法。方法：采用开普拓联合米托恩醌为主的化疗方案治疗21例难治和复发NHL,评价其疗效及不良反应。结果：7例（33．3％）难治和复发NHL达完全缓解（CR）;8例（38．1％）达部分缓解（PR）;总有效率为71．4％。不良反应主要为骨髓抑制、迟发性腹泻以及胃肠道反应,患者均能耐受。结论：开普拓联合米蒽醌对NHL特别是部分难治和复发NHL仍有效,不良反应可以耐受。可用于治疗对其他化疗方案无效的难治和复发NHL。     

CMxOP方案联合治疗复发及难治性淋巴瘤

目的：探讨复发及难治性淋巴瘤的有效治疗方案。方法；采用米托蒽醌联合COP方案（CMxOP）治疗复发及难治性非霍奇金淋巴瘤（NHL）32例。结果：完全缓解10例（3．2％），部分缓解11例（34．4％）无效11例（34．4％），总有效率65．6％。结论：此方案对复发及难治性淋巴瘤有效。     

嵌合抗原受体T细胞治疗成人复发/难治急性B淋巴细胞白血病的长期疗效分析

目的：评价嵌合抗原受体T细胞（CAR-T）序贯治疗复发/难治成人急性B淋巴细胞白血病（B-ALL）的长期疗效。方法：收集接受CAR19/22 T细胞序贯治疗的35例复发/难治B-ALL成人患者的临床资料。统计分析其CAR-T疗效、不良反应和转归，应用Kaplan-Meier法分析患者总生存率和无进展生存率的特征。随访截至2023年2月28日。结果：所有患者的CAR-T治疗总反应率为77.1%（27/35），中位总生存期为12.2（0.3~59.5）个月，中位无进展生存期为7.5（0.3~57.3）个月。治疗无反应组患者回输前均伴高肿瘤负荷和高危遗传学/分子学异常，其总生存期和无进展生存期显著低于有反应组（P均＜0.0001）。27例（77.1%）携带高危遗传学异常患者的总生存期（P=0.0344）和无进展生存期（P=0.0244）显著低于低危组。回输后细胞因子释放综合征和免疫效应细胞相关神经毒性综合征的发生率分别为91.4%（32/35）和17.1%（6/35）。10例（28.6%）CAR-T治疗后复发患者的CD19/CD22表达仍为双阳性（2例CD19弱表达）。结论：CAR19/22 T细胞序贯治疗能有效降低抗原逃逸复发率，不良反应可控。伴高肿瘤负荷或高危遗传学异常的患者预后不佳，回输前降低肿瘤负荷、回输后予以积极抗炎治疗以及长期病情监测有助于改善其预后。此外，回输2年后处于存活状态患者的长期生存率可能更好。     

艾滋病住院患者137例死亡原因分析

目的探讨艾滋病(AIDS)住院患者的病死率及其死亡原因。方法对2010年住院期间死亡的艾滋病患者的临床资料进行回顾性分析。结果 2010年艾滋病住院患者共死亡137例,病死率为10.56%,其中男性105例,女性32例,比例为3.28:1,住院时间为(12.82±16.21)d,72.72%患者的CD4~+T细胞计数100个/μl。接受高效抗逆转录病毒治疗(HAART)的患者HIV抗体确认阳性到死亡的时间明显长于未接受HAART治疗的患者(Z=-5.042,P=0.000)。最常见的导致患者死亡的原因为肺部感染、中枢神经系统感染、青霉病等。结论晚期AIDS患者病死率高,各种机会性感染仍是导致患者死亡的主要原因,HAART能明显延长艾滋病患者的存活时间。     

老年消化道疾病患者围手术期死亡病例分析

目的分析老年消化道疾病患者围手术期死亡的主要原因，探讨降低病死率的方法。方法回顾性总结1990至2003年2891例老年消化道患者的临床资料，对其中61例围手术期死亡患者进行分析。用Logisitic回归方法分析患者的血红蛋白、白蛋白、血压、心脏病、糖尿病等与围手术期病死率的关系。结果在2891例中，并存心血管疾病者1338例（46．2％），呼吸系统疾病813例（28．1％），糖尿病449例（15．5％），肾功能不全348例（12．1％），贫血（血红蛋白低于110g／L）796例（26．2％），低蛋白血症（白蛋白低于35g／L）442例（22．2％），围手术期死亡61例（2．1％），死亡的主要原因为心血管系统并发症、呼吸系统并发症和肾功能衰竭等。Logisitic回归分析结果显示：术前心血管疾病、低蛋白血症与围手术期病死率明显相关。结论加强老年消化道患者围手术期的处理对降低病死率有重要意义。     

原发性干燥综合征死亡原因及相关因素分析

目的 子解原发性干燥综合征（ｐＳＳ）的死亡原因和高危因素。方法 分析１７２例ｐＳＳ患者中９例死亡病例的死亡原因，并通过死亡组与存活组各项资料比较，进行死亡相关单因素分析。结果 死亡９例患者平均存活时间（９．５±６．３）年，总病死率为５．２３％。与ｐＳＳ相关的最常见的死亡原因为肺间质纤维化伴感染，其他还有肝硬化腹水感染、恶性淋巴瘤、颅内出血、肺动脉高压等。９例中与感染有关的有５例。死亡组与存活组的单     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。