老年人阻塞性睡眠呼吸暂停综合征与心律失常关系的探讨

目的：探讨老年人阻塞性睡眠呼吸暂停综合征（OSAS）与心律失常发生，发展的关系。方法：选择拟诊老年OSAS患者120例和健康对照组40例进行多导睡眠图或脉搏血氧监测和动态心电图（hoter)监测分析。结果：OSAS组中，睡眠呼吸暂停／低通气指数（AHI），动脉血氧饱和度（SaO2)降低大于0．04的总次数，SaO2低于0．9的时间明显高于健康对照组（均为P＜0．001），睡眠中SaO2最低值，平均值均低于对照组（均为P＜0．001），在轻、中、重度组间两两比较上述指标也有显著性意义（均为P＜0．001），轻，中、重度OSAS患者心律失常的发生率分别为63％，78％，94％，与对照组（34％）相比，轻度组差异无显著性（P＞0．05），中、重度组的心律失常发生率则显著升高（P＜0．05），P＜0．01），在轻、中、重度组间两两比较，心律失常发生的总次数和每小时的发生次数差异也有显著性（均为P＜0．01），结论：OSAS病情越严重，睡眠时SaO2降低的程度越显著，低氧血症也越明显，心律失常的发生与睡眠时相和SaO2降低的程度显著相关，OSAS患者心律失常的发生可能与低氧血症有关。     

脉冲强迫振荡测定值在睡眠呼吸暂停综合征中的变化及其临床意义

目的：观察脉冲强迫振荡（IOS）测定值在阻塞性睡眠呼吸暂停综合征（OSAS）患者中的变化，并探讨其临床意义。方法：用ISO技术检测36例OSAS患者、14例慢性阻塞性肺疾病（COPD）患者和12名正常人呼吸阻抗，同时进行睡眠监测。结果：OSAS患者R20明显高于COPD组和对照组，差异有非常显著性（P＜0．01），R5－R20虽低于COPD组，但仍高于对照组，差异亦有非常显著性（P＜0．01）。将OSAD患者睡眠监测指标与IOS测定指标相关性进行研究，发现呼吸暂停低通气指数（AHI）与R5和R20呈正相关，相关系数（r)分别为0．66和0．86（P＜0．01）；最低SO2与R5、R5－R20呈负相关，r分别为－0．66和－0．79（P＜0．01）；平均SO2与R5、R5－R20呈负相关，r分别为－0．81和－0．69（P＜0．01）。结论：IOS技术可作为用于检测OSAS患者上气道阻力的 方法，并且有助于其病理机制的探讨。     

老年睡眠呼吸暂停综合征患者心率变异的临床研究

目的：研究老年睡眠呼吸暂停综合征（SAS）患睡眠时心率变异性（HRV）的改变,以评价其呼吸暂停过程中自主神经功能状态。方法：对SAS 68例,对照组69例老年患进行整夜（＞7小时）多导睡眠图（PSG）监测,同时记录、比较两组心率变异的各项时域、频域指标变化。结果：与对照组比较,SAS组的血氧饱和度显下降（P＝0．001）,心率变异指数（HRVindes)降低（P＜0．05）,低频（LF）、高频（HF）显增高（P均＜0．01）。结论：老年SAS患夜间HRV有显改变,提示这时有严重的自主神经功能紊乱。     

睡眠呼吸暂停综合征对癫痫的影响

目的探讨睡眠呼吸暂停综合征对癫痫的影响。方法选择我院癫痫患者64例，其中合并睡眠呼吸暂停综合征患者40例（观察组），比较其与不合并睡眠呼吸暂停综合征24例（对照组）患者的癫痫发作次数。结果合并睡眠呼吸暂停综合征的癫痫患者癫痫发作频率高，两组患者间差异有显著性意义（P〈0．01）。结论癫痫和睡眠呼吸暂停综合征互相影响。     

正压通气治疗睡眠呼吸暂停综合征并代谢综合征的研究

目的：研究持续气道内正压通气（CPAP）对睡眠呼吸暂停综合征（SAS）并代谢综合征（MS）的疗效。方法：158例SAS并MS患者被随机分成两组，即CPAP治疗组（治疗组）和药物治疗组（对照组），治疗组在药物组治疗基础上加用CPAP治疗。两组患者于治疗前、治疗4周后分别行呼吸睡眠监测：动脉血氧饱和度（SaO2）、呼吸参数，并测空腹血糖（FPG）、空腹胰岛素（FINS）、餐后2h血糖（2hPG）、餐后2h胰岛素（2hPINS）、胰岛素敏感性指数（ISI）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）、收缩压（SBP）、舒张压（DBP）的变化。结果：与对照组比较，治疗组治疗后呼吸暂停和低通气均明显减少，打鼾消失，低氧发作次数减少，最低SaO2明显提高（P〈0．01）；同时血糖、胰岛素、TC、TG浓度，SBP、DBP均明显降低，HDL-C水平明显升高，与对照组比较有明显差异（P〈0．01）。结论：CPAP治疗SAS并MS除能改善SAS病情外，还能加强药物疗效，改善代谢参数，降低血压，降低心脑血管病危险因素的程度。     

老年阻塞性睡眠呼吸暂停低通气综合征患者精神健康状况的调查

目的探讨老年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的心理健康状况。方法对129例老年人行多导睡眠图（PSG）检查，根据呼吸暂停低通气指数（AHI）将其分为对照组（AHI〈5）25例，轻中度OSAHS组（5≤AHI≤30）68例，重度OSAHS组（AHI〉30）36例。分别对其进行症状自评量表（SCL-90）及抑郁自评量表（SDS）、焦虑自评量表（SAS）测定，比较3组各指标的差异性。结果3组SCL-90总分有显著差异，随AHI加重而呈递增趋势（P〈0．01），在各因子中，躯体化、强迫症状、人际关系敏感、焦虑、抑郁、偏执和精神病性7个因子3组得分比较有显著差异，轻中度及重度OSAHS组均高于对照组（P〈0．01）。3组SDS评分与SAS评分比较，轻中度及重度OSAHS组均高于对照组（P〈0．01）。结论老年OSAHS患者精神健康状态差，伴随着明显的焦虑、抑郁等不良心理问题。     

老年人睡眠呼吸暂停与血液流变学相关性研究

目的探讨老年睡眠呼吸暂停综合征（SAS）与血液流变学各项指标的相关性。方法依据多导睡眠图监测结果，按睡眠呼吸暂停低通气指数（AHI）分为3组：正常对照组（AHI〈5），轻度SAS组（5≤AHI〈30），中重度SAS组（AHI≥30）。对各组进行血液流变学检查、体重指数（BMI）测定。结果中重度SAS组BMI大于正常对照组及轻度SAS组（P〈0．05，P〈0．01），AHI与BMI有明显的相关性，中重度SAS组的血液黏稠度、血细胞比容（vPRc）、红细胞聚积指数（RAD、纤维蛋白原（F1B）明显高于轻度SAS组和正常对照组（P〈0．05，P〈0．01）。结论SAS与肥胖的严重程度及血液黏稠度增高有关。     

老年代谢综合征与睡眠呼吸暂停综合征的相关性

代谢综合征(MS) 是一组代谢异常症候群,为探讨睡眠呼吸暂停与MS 之间关系,本文对老年睡眠呼吸暂停综合征(SAS) 患者进行临床分析. 1 资料与方法 1.1 一般资料 选择46例MS患者,均为男性,测定结果符合SAS诊断标准,年龄60～76[平均(66±7)]岁,同时按测定结果分为2组:轻、中度SAS组25例,年龄60～78 [平均(65±7)]岁;重度SAS 组21 例,年龄61～75[平均(66±7)]岁;正常对照组为无SAS者,共35例,均为男性,年龄60～75[平均(64±8)]岁.     

夜间血氧饱和度监测对睡眠呼吸暂停综合征的诊断价值

目的探讨夜间动态血氧饱和度（SaO2）监测对睡眠呼吸暂停综合征（SAS）患者的诊断价值。方法对比174例打鼾者的动态SaO2及多导生理仪睡眠呼吸监测结果,并根据睡眠呼吸暂停低通气指数（AHI）将其中的100例受试者分为非SAS组（AHI＜5）工例、轻度SAS（AHI5～19）26例、中度SAS（AHI20～39）25例、重度SAS（AHI≥40）23例四组,测定其持续气道正压通气（CPAP）治疗前后的动态SaO2变化。结果每小时氧饱和度下降≥4％的次数（DI4即氧减饱和度指数）与AHI的相关性好（r＝0．91,P＜0．001）,能够较好地反映SAS患者睡眠呼吸紊乱的频度,对AHI≥5患者,DI4≥5的敏感性达94％以上,能够检出绝大多数的SAS患者;若以DI4≥15为标准,可以准确诊断98％以上的SAS患者,且两项指标都不会漏诊AHI≥20的患者。治疗前各组两两之间及治疗前后的DI4、氧饱和度≤90％的时间占总监测时间的百分比（SIT90）均有显著差异（P＜0．01）。结论选用适当的DI4作为标准,对初步筛选或准确判断SAS患者具有一定价值;DI4及SIT90能够较好地反映SAS患者夜间缺氧的程度,可作为综合判断SAS患者病情严重程度的指标,对SAS治疗效果的判定也有指导意义。     

老年鼾症病人中睡眠呼吸暂停综合征与糖尿病的关系

目的探讨如何在老年糖尿病病人中尽早发现中重度睡眠暂停综合征（SAS）患者。方法将75例打鼾患者分为糖尿病组和无糖尿病组,进行多导睡眠仪（PSG）监测,观察睡眠呼吸暂停低通气指数（AH1）结果,判定SAS的轻重程度,并进行比较。结果鼾症患者中糖尿病组SAS频率分布与无糖尿病组相比有显著性差异（P〈0．05）,鼾症患者中糖尿病组SAS轻重程度频率分布与无糖尿病组相比其构成有显著性差异（P〈0．05）,且糖尿病组中、重度SAS频率显著高于无糖尿病组的频率。结论鼾症病人在合并糖尿病时,易发生睡眠呼吸暂停,睡眠呼吸暂停的程度较重,因此可以为糖尿病患者存在夜间打鼾,就应警惕SAS的存在,需进行PSG监测检查,尽早诊断、治疗SAS,从而更好地控制血糖。     

Syndromic Disorders with Short Stature

Short stature is one of the major components of many dysmorphic syndromes. Growth failure may be due to a wide variety of mechanisms, either related to the growth hormone (GH)/insulin-like growth factor axis or to underlying unknown pathologies. In this review, the relatively more frequently seen syndromes with short stature (Noonan syndrome, Prader-Willi syndrome, Silver-Russell syndrome and Aarskog-Scott syndrome) were discussed. These disorders are associated with a number of endocrinopathies, as well as with developmental, systemic and behavioral issues. At present, GH therapy is used in most syndromic disorders, although long-term studies evaluating this treatment are insufficient and some controversies exist with regard to GH dose, optimal age to begin therapy and adverse effects. Before starting GH treatment, patients with syndromic disorders should be evaluated extensively.     

Patients’ experiences of a diagnosis of Hughes’ syndrome

The objectives of the study were to describe the experience of patients immediately prior to a diagnosis of Hughes syndrome (HS) or antiphospholipid syndrome and post-diagnosis. A questionnaire survey was carried out set in the Hughes Syndrome Foundation, St. Thomas’ Hospital, London, 2006. Participants were all patients who are members of the Hughes Syndrome Foundation. The main outcome measures were responses to a questionnaire relating to the experiences of people with a diagnosis of HS, such as number of hospitalisations, number of consultants seen, number of miscarriages, etc. A total of 157 patients completed the questionnaire, giving a response rate of 60.4%. Most (85%) were women and mean age was 46 years (SD 12). The median time to diagnosis was 3 years. The median number of consultants seen was 2 (max 19) with a median time in hospital pre-diagnosis of 10 days. The most common initial diagnoses were migraines, multiple sclerosis and systemic lupus erythematosus. Among women, 46% had had a miscarriage. Two thirds of respondents thought a blood test would have led to an earlier diagnosis. Comments from patients indicated a lack of awareness among specialists and general practitioners. The survey demonstrated a long time lag for diagnosis of Hughes syndrome, with increased costs to the NHS and emotional and financial cost to the patient. Greater awareness of this condition would benefit patients and the NHS.     

遗传性低钾失盐性肾小管病临床分析

目的：分析遗传性低钾失盐性肾小管病的临床特点。方法：回顾性分析上海瑞金医院肾内科住院治疗Bartter综合征和Gitelman综合征共23例，其中经典型Bartter综合征4例，Gitelman综合征19例。结果：4例Bartter综合征发病年龄4月-33岁，临床上以多饮、多尿、乏力主要表现，2例患儿表现为脱水、呕吐、生长发育障碍；19例Gitelman综合征患者发病年龄10—52岁，临床上以双下肢无力、多饮、多尿、夜尿增加为主要表现，部分Gitelman综合征患者伴手足抽搐；实验室检查均表现为低血钾代谢性碱中毒，尿钾排出增加，血肾素活性、血管紧张素Ⅱ及醛固酮明显升高。而血压正常；经典型Bartter综合征尿钙肌酐比〉0．2，Gitelman综合征表现为低血镁、低尿钙、低尿钙肌酐比〈0．2；补钾或联合消炎痛、安体舒通和门冬氨酸钾镁等药物治疗后症状缓解。结论：低钾失盐性肾小管病主要特点包括低血钾代谢性碱中毒、高尿钾、血肾素、血管紧张素Ⅱ、醛固酮水平增高而血压正常，Bartter综合征和Gitelman综合征鉴别主要在发病年龄、血镁和尿钙水平，本病治疗应补钾、补镁、前列腺素合成酶抑制剂、醛固酮拮抗剂等多种药物联合应用。     

从痰湿瘀热论治2型糖尿病代谢综合征52例

目的观察从痰、湿、瘀、热立论应用清热祛浊胶囊治疗2型糖尿病代谢综合征的疗效。方法 52例2型糖尿病代谢综合征患者,在原基础治疗基础上,加服清热祛浊胶囊5粒,每日3次。3个月后观察指标变化。结果治疗后患者的空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇、收缩压、舒张压、体重指数明显下降(P<0.05或P<0.01);高密度脂蛋白胆固醇有所升高,但无统计学意义。治疗总有效率82.7%。结论从痰、湿、瘀、热立论组方的清热祛浊胶囊可以改善2型糖尿病代谢综合征患者的高血糖、高血压、高血脂、肥胖等多种心血管危险因子。     

The postcardiac injury syndromes.

Late pericarditis following myocardial infarction, cardiac surgery, or trauma is referred to as postmyocardial infarction syndrome (PMIS) or postcardiotomy syndrome (PCS), respectively. The term postcardiac injury syndrome (PCIS) is used to encompass both these entities. PCIS is characterized by fever, pleuropericardial pain, pericarditis, and pulmonary involvement. Abnormal laboratory findings include leukocytosis, high sedimentation rate, and chest x-ray abnormalities of pleural effusion with or without pulmonary infiltrates. Evidence supports an immunopathic etiology; viruses may play a contributing role. The course is benign but rare complications include tamponade, constriction, anemia, and coronary bypass graft occlusion. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.     

预激综合征合并快慢综合征的临床分析

目的通过对12例预激综合征合并室上性心动过速患者临床及电生理资料的分析,提出室上性心动过速发作结束时伴发的晕厥可能是窦房结功能一过性受抑的结果,探讨和证实这一发生机制设想的合理性.方法12例预激综合征合并室上性心动过速患者,男8例,女4例,平均年龄32.5岁(19～49岁).均因室上性心动过速伴晕厥住院.经各种电生理检查评价窦房结功能,冠脉造影排除冠脉的异常,并进行射频消融术和(或)抗心动过速起搏器治疗.随访2～5年.结果12例患者均符合下列条件预激综合征伴发室上性心动过速结束时有晕厥发生,年龄多属青年、中年,经各种电生理检查提示窦房结功能正常.冠脉造影证实冠状动脉正常,室上性心动过速终止时心电图均证实为较长时间的窦性停搏.4例经植入抗心动过速起搏治疗,3例经射频消融术及抗心动过速起搏器治疗,5例经射频消融术治疗,经2～5年的随访,全组12例患者无一例再发生室上性心动过速及晕厥.结论预激综合征合并室上性心动过速伴发的晕厥均由功能性病态窦房结功能障碍机制引起,尽管因果关系明确,但与多数预激综合征患者的临床经过不一致的原因尚不清楚,有待进一步探讨.此外,这些符合快慢综合征患者晕厥治疗和预防的关键是根治室上性心动过速,植入人工心脏起搏器预防晕厥似乎必要性不大.     

Somatotype and idiopathic mitral valve prolapse

Records from 18 subjects with angiographic idiopathic mitral valve prolapse, 28 subjects with merely exaggerated posterior mitral leaflet systolic bulging, and 100 subjects with normal hemodynamic and angiographic findings were compared with regard to age, sex, height, weight, ponderal index (height/³ weight), auscultatory and echocardiographic abnormalities. Chest x-ray films available for subjects with mitral valve prolapse were reviewed. The ponderal index of subjects with mitral valve prolapse (13.1 ± 0.8) differed from that of subjects with merely exaggerated posterior mitral leaflet systolic bulging (12.6 ± 0.7) (P < 0.02) and from that of subjects without angiographic abnormality (12.3 ± 0.8) (P < 0.001). The three groups differed in ponderal index when equated statistically for age, height, weight, and sex (P < 0.001). Among mitral valve prolapse patients, an asthenic habitus occurred independent of the presence of thoracic skeletal abnormalities.     

Lymphoma-associated hemophagocytic syndrome: clinical features and treatment outcome

The clinical features and prognostic factor of lymphoma-associated hemophagocytic syndrome (LAHS), diagnosed according to World Health Organization classification, were investigated by reviewing the clinical records of 29 patients between September 1994 and September 2006. Compared with patients with T or natural killer (NK)/T cell LAHS, patients with B cell LAHS were older (p = 0.022), were less likely to exhibit disseminated intravascular coagulation (DIC; p = 0.011), and had less direct involvement of bone marrow (p = 0.03). Clinical response was achieved in 15 (65.2%) and complete remission (CR) was achieved in 4 (17%) of 23 patients who received chemotherapy. Four patients received high-dose chemotherapy and autologous stem cell transplantation (A-SCT), and three of these four patients showed CR. The median survival was 36 days (95%CI, 20.2–51.8). Univariate analysis showed that poor performance status (p = 0.028), T or NK/T cell lymphoma (p = 0.016), presence of jaundice (p = 0.063), the presence of DIC (p = 0.002), and poor clinical response to treatment (p < 0.001) predicted poor overall survival. These data suggest that the clinical features differ significantly between B cell LAHS and T or NK/T cell LAHS. Intensive treatment including high-dose chemotherapy and A-SCT should be investigated. A-Reum Han and Hye Ran Lee contributed equally to this study.