结缔组织病合并急性间质性肺炎6例临床分析

目的分析结缔组织病合并急性间质性肺炎的临床特点及发病原因,提高诊断和治疗水平,降低病死率。方法对我院2003年—2011年收治的6例结缔组织病合并急性间质性肺炎患者的临床资料进行回顾性分析。结果类风湿关节炎和干燥综合征在病程中都有可能出现急性间质性肺炎,治疗及时病变可吸收,恢复至急性间质性肺炎前状态。混合型结缔组织病病程中有肌炎,雷诺现象、指端硬化及肺动脉高压1例及皮肌炎患者合并急性间质性肺炎2例均治疗无效死于呼吸衰竭。结论结缔组织病合并急性间质性肺炎虽治疗方法相同但结果却不同,皮肌炎和混合型结缔组织病合并急性间质肺炎预后差。     

特发性间质性肺炎的临床表现及治疗

目的探讨特发性间质性肺炎的临床表现及治疗方法。方法对我院58例特发性间质性肺炎患者的临床表现及治疗方法进行分析。结果本组患者治疗后病情明显缓解,治疗后患者的肺活量和动脉氧分压显著高于治疗前,差异有统计学意义（P〈0.05）。治疗过程中发生不良反应22例,2例在住院期间因呼吸衰竭死亡。结论对特发性间质性肺炎的治疗要尽可能争取明确诊断,区别对待,从而改善患者的症状及预后。     

髓过氧化物酶阳性的间质性肺炎临床分析

目的总结髓过氧化物酶阳性的间质性肺炎(MPO-IP)的临床特点。方法回顾性分析2013年6月至2016年1月于我院住院的15例MPO-IP患者的临床资料,包括临床表现、实验室检查、肺功能、胸部高分辨率CT(HRCT)和治疗资料,并与同期诊断的11例特发性肺纤维化(IPF)患者比较。结果 MPO-IP患者发病年龄较高[(74.07±6.31)岁vs.(66.73±6.80)岁,P0.01]。纳入的所有患者均无血管炎相关肾脏表现。MPO-IP与IPF患者在性别、吸烟、咳嗽咳痰、喘息、气促、HRCT表现、FVC%pred、T_LCO%pred、Pa O_2和Pa CO_2的差异无统计学意义(P0.05)。15例MPO-IP患者中HRCT上表现为普通型间质性肺炎(UIP)12例,非特异性间质性肺炎(NSIP)2例,机化性肺炎(OP)1例,其中5例合并肺气肿。11例IPF患者均表现为UIP改变,4例合并肺气肿。1例MPO-IP和5例IPF患者出现杵状指。两组在杵状指和治疗选择上差异有统计学意义(P0.05)。IPF患者治疗上以对症为主9例,MPO-IP患者使用了糖皮质激素联合免疫抑制剂7例,2例MPO-IP患者予以吡非尼酮治疗。结论 MPO-IP患病年龄大于IPF患者,HRCT以UIP改变为主,杵状指更多见于IPF,药物治疗除糖皮质激素和免疫抑制剂外,使用吡非尼酮值得进一步深入研究。     

糖皮质激素治疗特发性间质性肺炎31例临床分析

目的:研究特发性间质性肺炎(idiopathic interstitial pneumonia, IIP)患者对糖皮质激素治疗的反应性.方法:回顾性分析31例糖皮质激素治疗的IIP患者,从临床表现、肺功能、影象学及病理学等方面分析IIP患者对糖皮质激素治疗的反应性.结果:(1)激素治疗有效组(A组)16例,激素治疗无效组(B组)15例,年龄分别为(55±6)岁和(63±10)岁(P<0.05),病程分别为(14.4±26.4)月和(67.2±105.1)月(P<0.05);(2)静息状态下呼吸困难分别有1例和4例,高热分别有1例和4例,肺内湿罗音A组较B组少;(3)PaO2分别为(74.2±15.5)和(58.8±20.7) mm Hg(P<0.01);(4)影象学表现为蜂窝肺者B组较多;(5)A组3例病理为非特异性间质性肺炎,2例为普通型间质性肺炎,1例为急性间质性肺炎,B组1例为急性间质性肺炎.结论:年轻、病程短、临床病情较轻、非蜂窝肺表现、病理分型NSIP者对激素反应好,在无病理诊断的情况下,应对IIP患者早期应用激素试验治疗.     

病毒引起间质性肺炎一例

目的探讨间质性肺炎临床特点及治疗方法。方法通过这例病例发病过程。治疗经过、及预后来认识间质性肺炎的临床特点、诊断与治疗。结论间质性肺炎是是肺间质的病变,引起的原因多种多样,病毒、药物等,加深对该病的病理特征、临床特点、以及诊断与治疗的了解,是今后临床应予以重视的问题。     

免疫检查点抑制剂相关性肺炎的临床特点及CT表现

目的 评价CT在免疫检查点抑制剂相关性肺炎(CIP)诊疗中的作用和意义。方法 回顾性分析本中心21例经免疫检查点抑制剂治疗过程中发生CIP患者的详细临床资料及影像学特点。结果 21例CIP患者男15例,女6例,用药至发生CIP的中位时间为3个月(0.6-13个月),CT表现:3例累及一侧肺叶,18例病变累及双侧肺叶,对称分布者15例,非对称肺分布5例。影像学分型:机化性肺炎10例,非间质性肺炎模式6例,过敏性肺炎模式4例,急性间质性肺炎模式2例;21例CIP的临床分级及影像分级存在中度相关r=0.557,P=0.009<0.05。结论 CIP临床症状及CT表现不典型,CT结合免疫检查点抑制剂治疗史有助于早期发现及诊断,为确定治疗方案提供依据。     

EGFR-TKIs治疗晚期非小细胞肺癌并发间质性肺炎4例报告并文献复习

目的总结表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors,EGFR-TKIs)在治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)中所致间质性肺炎的临床表现、诊断和治疗。方法回顾性分析我科4例晚期NSCLC患者靶向治疗药物致间质性肺炎的临床表现、诊断、治疗经过及转归。结果 4例晚期NSCLC患者均接受了化疗,并分别因化疗后病情进展或不能耐受进一步化疗而口服吉非替尼或厄洛替尼,在EGFR-TKIs治疗后30 d内出现呼吸困难、咳嗽和低氧血症,并发间质性肺炎,其中3例病情进展迅速,因呼吸衰竭死亡,提示其预后凶险。结论对接受EGFR-TKIs治疗的患者,一旦出现呼吸困难和咳嗽,应及时进行胸部CT、肺功能、血气分析等相关检查。该类间质性肺炎预后凶险,病死率很高,一旦确诊间质性肺炎,应立即停用EGFR-TKIs,并及时予以足量激素及氧疗等对症治疗,必要时进行呼吸支持,才有可能改善其预后。     

急性间质性肺炎的临床诊治分析

目的 探讨急性间质性肺炎的诊断、鉴别诊断和治疗.方法 报道了3例临床诊断为急性间质性肺炎(acute interstitial pneumonia,AIP)病例,并结合相关文献分析.结果 3例患者均在病程早期应用了激素冲击和抗病毒治疗,其中2例患者经治疗1个月余痊愈出院,1例死亡.结论 该病是一种病因未明、起病急骤、病情危重、死亡率高、以肺部弥漫性浸润并迅速发展为呼吸衰竭为特征的肺部疾病,早期激素及抗病毒治疗可有一定疗效.     

ICU特发性间质性肺炎37例临床分析

目的探讨ICU特发性间质性肺炎患者的临床诊断要点。方法选取本院ICU收治的37例特发性间质性肺炎患者为研究对象,以影像、病理及临床表现为依据进行诊断和分型;结合患者临床资料和既往病史,分析各病理类型的诊断要点。结果本组病例共计非特异性间质性肺炎16例,普通特发性间质性肺炎5例,淋巴细胞性间质性肺炎4例,急性间质性肺炎4例,隐源性机化性肺炎3例,脱屑性间质性肺炎3例,呼吸性细支气管炎合并间质性肺病2例。临床表现以咳嗽为主(37例,100%),部分患者有进展性或急性呼吸困难(19例,51.4%),少数患者出现不同类型的肺内啰音(8例,21.6%),另有6例(16.2%)患者为杵状指趾。HRCT显示多数患者为弥漫性网状影病变(19例,51.4%)或磨玻璃影样病变(21例,56.8%),亦有部分结节影(11例,29.8%)和实变影(9例,24.3%)。此外,2例(5.41%)患者支气管出现牵拉性扩张。肺部病理显示肺泡间隔以淋巴细胞和浆细胞浸润为主(33例,89.2%),纤维增生样病变为辅(16例,43.2%),另有少数泡沫样细胞(4例,10.8%)。结论特发性间质性肺炎病因复杂、诊治困难,各类型患者的临床、影像、病理特征既有个体化特征,又有交叉点,典型性不强,其诊断应在影像、病理及临床表现的基础上,根据患者临床资料和既往病史进行综合考虑。     

血清KL-6与SP-D在结缔组织病并发间质性肺炎及细菌性肺炎中的应用

目的:研究血清KL-6与表面活性蛋白(SP)-D在鉴别结缔组织疾病合并间质性肺炎及细菌性肺炎中的临床价值。方法:明确诊断的结缔组织疾病患者92例按照临床症状、高分辨率CT、病原学检查结果分为间质性肺炎(31例),细菌性肺炎(34例)和无肺病变(27例)3组,以健康人(11人)为正常对照组。ELISA法测定血清KL-6、SP-D浓度,比较各组间的差异。结果:①间质性肺炎组KL-6、SP-D浓度较无肺病变及正常健康组明显升高(P<0.01),两者具有正向相关性(P<0.05)。②血清KL-6浓度在细菌性肺炎组没有发现有统计学意义的升高;而血清SP-D浓度在细菌性肺炎组比较间质性肺炎组、无间性肺炎以及正常对照组均有明显升高(P<0.01),与KL-6血清浓度无明显相关(P>0.05)。结论:联合检测血清KL-6与SP-D可能有助于结缔组织疾病合并间质性肺炎同细菌性肺炎的鉴别。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.