幼年与成年斯蒂尔病的临床比较

目的　了解幼年与成人斯蒂尔病临床特点 ,提高诊治水平。方法　对 4 3例幼年型斯蒂尔病 (JOSD)与 5 2例成人斯蒂尔病 (AOSD)的临床资料进行回顾性分析。结果　发热、关节症状、皮疹、白细胞及血沉增高发生率高 ,是幼年型与成人型斯蒂尔病的主要临床表现 ,两组比较无显著性差异。JOSD组咽痛 37.2 %、肌痛 32 .6 %、脾肿大4 6 .5 % ;AOSD组咽痛 6 1 .5 %、肌痛 5 7.8%、脾肿大 70 .1 % ;AOSD组高于JOSD组 ,差异有显著性。结论　JOSD与AOSD临床表现各有特点 ,掌握其特点 ,有利于早期诊治     

成年人Still病40例临床分析与治疗体会

目的 探讨成年人Still病的临床特点与治疗体会,提高对本病的认识和诊断水平.方法 回顾性分析资料完整的40例成年人Still病患者的临床表现和实验室检查结果 .结果 40例患者中发热40例(100.0%),皮疹35例(87.5%),关节炎和关节痛30例(75.O%),咽痛28例(70.O%),淋巴结肿大26例(65.O%),肝脾肿大20例(50.0%);40例Still病患者白细胞均高于正常值,为(11.5～38.6)×10~9/L,血小板≥>300×10~9/L,27例;红细胞沉降率≥30mm/1h 32例;40例患者C反应蛋白均升高;38例血清铁蛋白升高;24例患者免疫球蛋白升高;40例患者抗核抗体和类风湿因子均阴性;26例肝脏转氨酶升高;30例补体C_3升高.40例患者经糖皮质激素或联合非甾体类抗炎药治疗均有效.结论 成年人Still病临床表现复杂,容易误诊,发热、皮疹和关节炎或关节痛是Still病的主要I临床特点,血清铁蛋白可作为疾病活动的指标.通常需要糖皮质激素治疗,多数预后较好.     

Still病30例临床分析

本文对３０例Ｓｔｉｌｌ病（幼年型类风湿性关节炎全身型）的临床表现及误诊情况进行了观察。结果病例误诊率高达８０．３％，误诊时间最长者达一年之久，对极易误诊的败血症、风湿热、结核病，ＳＬＥ等６类疾病误诊原因进行了分析探讨，作者根据本组病例分析，结合部分文献回顾，提出了长期发热，一过性皮疹等７项诊断要点，指出凡全身症状或关节症状持续６周以上而相关疾病诊断依据不足时，应高度注意本病，尤其是对合并有心、脑、     

幼年型类风湿性关节炎180例临床分析

本文对幼年型类风湿性关节炎（ＪＲＡ）１８０例进行临床分析,结果显示：ＪＲＡ好发于男性患儿,年龄大多在学龄儿童,以全身型多见占５５％,其次为多关节炎型占２５％和少关节炎型占２０％。临床缺乏特异性表现,同时伴有各系统受损。类风湿因子阳性率偏低为１５．５％,水平不稳定。     

成人Still病9例临床分析

成人Still病(过去曾用名变异性亚败血症)是类风湿性关节炎的一型，即全身型。本病在临床病变中并非少见，但由于对本病认识不足基层医院误诊时有发生。为提高诊疗水平，现将我院1998—2003年收治的成人Still病例9例分析如下：     

幼年型强直性脊柱炎的临床诊治分析

目的 观察幼年型强直性脊柱炎的临床诊疗效果,并探讨其发病机理及最新诊疗进展.方法 26例患者均口服柳氮磺胺吡啶(SASP)第1周0.5g,3次/d,第2周起1.0g,3次/d;甲氨喋呤(MTX)7.5mg,每周1次,进行治疗.结果 26例患者中有18例患者病情得到缓解(69.2%);7例患者病情得到部分缓解(26.9%);1例患者病情加重(3.8%).结论 幼年型强直性脊柱炎采用常规药物进行治疗能够取得一定疗效,早期的诊断对该病的控制和治疗尤为重要.     

48例全身型幼年特发性关节炎临床分析

目的：分析全身型幼年特发性关节炎（ SOJIA）的临床特征、治疗及预后。方法收集西安市儿童医院风湿免疫科自2012年9月至2015年4月收治的48例SOJIA患儿资料,分析其临床特征、治疗方案及疗效。结果48例患儿中,男女比率1．67：1;发病年龄4月至13．5岁,平均年龄为6．3岁。主要症状为发热48例（100．0％）,关节炎39例（81．3％）,皮疹36例（75％）,并发巨噬细胞活化综合征4例（8．3％）。实验室检查白细胞计数、血沉、超敏C反应蛋白及血清铁蛋白均明显升高,感染骨髓象为主（占76．7％）。采用个体化初始治疗后42例（87．5％）临床缓解;5例甲泼尼龙冲击治疗后临床缓解;1例合并巨噬细胞活化综合征（MAS）死亡。10例（20．8％）减药过程中病情反复加用生物制剂、环孢素A、来氟米特等治疗后临床缓解;6例（12．5％）停药后复发;4例（8．3％）失访。结论 SOJIA患儿男性略多于女性,发病年龄跨度较广。约有1／4患儿临床不伴有关节炎及皮疹,最常累及大关节。血常规、血沉、血清铁蛋白、C反应蛋白为判定临床缓解的敏感指标。对于难治性、激素依赖性SOJIA患儿适时加用生物制剂可改善其预后,减少激素副作用。     

性欲型与非性欲型罪犯性心理与性激素对比研究

罪犯是一个特殊的群体 ,常处于无异性接触的监狱大墙内 ,他们的性心理表现出极大的特异性。众所周知 ,性罪犯反改造恶习深 ,重新犯罪率高 ,具有与其他犯罪不同的特点和规律。试图对性犯罪与非性犯罪者从性心理和基础性激素水平进行对比研究 ,使管教工作能对症下药 ,增加针对性。现将我们在 2 0 0 0年 10月的研究结果报告如下。1　方法与资料笔者结合监狱实际 ,参考有关资料编制了一组书面问卷 ,包括家庭教育、生活环境、文化程度、兴趣爱好、成长过程、职业、性格、人际关系、改造表现、性心理状况、判刑前的夫妻感情等 30余项题 ,要求犯人…     

酷似成人Still＇s病的肺癌1例及文献复习

本文报告酷似成人Still＇s病的肺癌一例。本例患者为中年男性,以关节痛、发热、咽痛伴白细胞及血清铁蛋白明显升高为主要表现,酷似成人Still＇s病,但经肺CT及肺组织活检病理检查诊断为肺腺癌,通过文献复习提示关节痛、白细胞及血清铁蛋白升高不仅见于成人Still＇s病,也可见于实体恶性肿瘤,肿瘤标志物及肺CT检查有助于早期鉴别诊断。     

Long-Term Consumption of Oats in Adult Celiac Disease Patients

Many celiac disease patients tolerate oats, but limited data are available on its long-term consumption. This was evaluated in the present study, focusing on small-bowel mucosal histology and gastrointestinal symptoms in celiac adults maintaining a strict gluten-free diet with or without oats. Altogether 106 long-term treated celiac adults were enrolled for this cross-sectional follow-up study. Daily consumption of oats and fiber was assessed, and small-bowel mucosal morphology and densities of CD3+, αβ+ and γσ+ intraepithelial lymphocytes determined. Gastrointestinal symptoms were assessed by a validated Gastrointestinal Symptom Rating Scale questionnaire. Seventy (66%) out of the 106 treated celiac disease patients had consumed a median of 20 g of oats (range 1–100 g) per day for up to eight years; all consumed oat products bought from general stores. Daily intake and long-term consumption of oats did not result in small-bowel mucosal villous damage, inflammation, or gastrointestinal symptoms. Oat-consumers had a significantly higher daily intake of fiber than those who did not use oats. Two thirds of celiac disease patients preferred to use oats in their daily diet. Even long-term ingestion of oats had no harmful effects.     

老年期重症肌无力的临床特征

目的研究老年期重症肌无力(MG)的临床特点.方法将20年间诊治的1 924例MG,根据发病年龄分为小儿期MG(≤14岁)、成年期MG(15～59岁)及老年期MG(≥60岁).采用x^2检验比较三组的临床资料.结果老年期MG在整个MG中只占5.5%,男性发病者较多见(男:女=1.4:1),以延髓支配肌肉首发者多见,合并胸腺瘤者多而合并其他自体免疫病者少,以延髓支配肌肉首发而误诊为脑血管病者多见,病死率高,但死于肌无力者少.结论老年期MG与成年期、小儿期相比有其独特之处,及时掌握其特点将有助于指导临床的诊断和治疗.     

成人牙周病正畸治疗的临床研究

目的初步研究成人牙周病采用正畸治疗的临床效果。方法对5例成人牙周病患者,经过牙周病基础治疗后,根据患者的不同情况确定正畸治疗方案。结果 5例成人牙周病患者经12～18个月的正畸治疗,临床效果满意,牙槽骨较治疗前无明显吸收。结论对成人牙周病患者进行合理的正畸治疗,不仅能为牙周病患者创造一个健康的牙周环境和功能良好的牙列,而且能很好地控制牙周病的发展,极大地提高了牙齿的存留时间和咀嚼功能。     

Clinical Manifestation and Diagnostic Process of Celiac Disease in Poland—Comparison of Pediatric and Adult Patients in Retrospective Study

The diagnosis of celiac disease (CD) may be delayed due to non-specific clinical symptoms. The aim of the study was to evaluate the clinical manifestation and diagnostic process of CD in Polish children and adults. Methods: The members of the Polish Coeliac Society (n = 2500) were asked to complete a questionnaire on socio-demographic factors, clinical and diagnostic aspects of CD. The analysis was based on 796 responses from patients with confirmed CD diagnosis, and included 224 (28.1%) children and 572 (71.9%) adults. Results: The mean duration of symptoms prior to CD diagnosis in children was significantly shorter than in adults (p < 0.001), and amounted to 3.1 and 9 years respectively. The most frequent symptoms before CD diagnosis were abdominal pain and bloating in children (70.4%), and chronic fatigue in adults (74.5%). Although almost all CD patients claimed to strictly avoid gluten after CD diagnosis, symptoms were still present in the majority of these respondents. No comorbid diseases were reported by 29.8% of children and by 11.7% of adults (p < 0.001). Conclusions: the results indicate that CD diagnosis is delayed in Poland, especially in adults, and clinicians should be aware of the diversity in CD presentation.     

克罗恩病的临床营养支持

营养支持治疗已成为治疗克罗恩病(CD)的重要手段,尤其是肠内营养(EN)近年来在CD治疗中的地位日益提升。适时和恰当地应用EN可加速缓解肠道炎症,有效改善患者的营养状况和促进机体的康复。本文综述了EN在CD治疗中的疗效机制、疗效证据、国内外研究新进展以及在儿童、成人CD治疗中的应用。     

Vitamin D and Crohn's Disease in the Adult Patient

Crohn's disease (CD) is characterized as a chronic immune‐mediated inflammatory disorder of the gastrointestinal tract. Current consensus surrounding the cause of the disease suggests a complex interplay between genetic susceptibility, the intestinal microbiome and environmental factors, leading to the aberrant Th1 and Th17 immune cell mediated response. Vitamin D deficiency is common in CD patients, and long‐standing deficiency has been associated with reduced bone mineral density (BMD). Accumulating evidence now suggests that in addition to maintaining skeletal integrity, vitamin D also plays an integral role in regulating the general immune response, a function employed via its genomic actions on the vitamin D receptor (VDR). The VDR is expressed in all immune cells and both directly and indirectly targeted by the bioactive form of vitamin D, 1,25‐Dihydroxyvitamin D (1,25[OH]₂D). Impaired regulation or deficiency of the vitamin has been linked to the promotion of self‐reactive T cell development, loss of immune tolerance to self‐structures, and experimental colitis in animal models, whereas the subsequent administration of the vitamin in these models resulted in the improvement of immune‐mediated symptoms. In addition, low vitamin D has been associated with disease activity in CD patients, and supplementation appears to be beneficial in improving clinical scores and reducing inflammation. Therefore, the primary aims of this article were to review the molecular evidence supporting the immunoregulatory roles of vitamin D and its supplementation in the CD patient, based on existing literature. The physiological processes, accepted serum concentration values, and its well‐recognized role in bone health were also summarized.     

Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach

Osteoporosis affects many patients with celiac disease (CD), representing the consequence of calcium malabsorption and persistent activation of mucosal inflammation. A slight increase of fracture risk is evident in this condition, particularly in those with overt malabsorption and in postmenopausal state. The adoption of a correct gluten-free diet (GFD) improves bone derangement, but is not able to normalize bone mass in all the patients. Biomarkers effective in the prediction of bone response to gluten-free diet are not yet available and the indications of guidelines are still imperfect and debated. In this review, the pathophysiology of bone loss is correlated to clinical aspects, defining an alternative proposal of management for this condition.     

肾脏疾病患者医院感染病原学调查及相应对策

目的了解肾脏疾病患者医院感染的临床特点、病原菌的分布及耐药情况,为预防和治疗肾脏疾病患者的感染提供依据。方法回顾性调查2004年1月-2006年2月肾脏疾病住院患者分离出的病原菌。结果从223例患者的各种临床标本分离出240株病原菌,其中革兰阴性杆菌占55.4%,革兰阳性球菌占26.3%,真菌占10.0%,革兰阳性杆菌占8.3%;阳性率最高的为大肠埃希菌,其次为副流感嗜血菌;分离的菌株有54.2%来自于尿液标本,其次为痰标本21.3%;分离菌株对临床常用抗菌药物表现不同程度的耐药性;混合感染率不高。结论肾脏疾病患者医院感染的病原菌以肠杆菌科细菌为主,主要为多重耐药的大肠埃希菌,引起的泌尿系统感染。     

慢性肾脏病不同分期血红蛋白水平的变化及其影响因素分析

目的探讨慢性肾脏病（CKD）患者血红蛋白水平的基础状况。方法对中山大学附属第三医院。肾内科门诊就诊的CKD患者进行为期9个月的前瞻性横断面调查。结果共有655例CKD病例入选。前四位慢性肾脏病的病因分别为原发性肾小球疾病、狼疮肾炎、高血压肾病和糖尿病肾病。CKD3期以后,患者血红蛋白水平逐级降低,贫血发生率逐级上升,差异均有显著性（P〈0．01）。多元回归分析结果显示,血红蛋白水平与肾小球滤过率、体质指数、血白蛋白水平、原发性肾小球疾病呈显著性正相关（P〈0．01）,与收缩压、年龄呈显著性负相关（P〈0．05）。结论血红蛋白水平是慢性肾脏病患者CKD3期以后肾脏病情动态变化的重要指标。