北京地区13 336例成人空腹血脂水平分析

目的 通过检测健康查体者空腹血脂水平来了解北京地区人群血脂水平现状及其血脂异常患病率.方法 应用日立7 170全自动生化分析仪检测北京地区13 336例成人空腹血脂,血脂指标包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),比较不同性别和年龄组间血脂水平差别及血脂异常患病率的差异.结果 总体血脂异常患病率59.9%,男性71.6%,女性47.2%.男性TC平均(4.89±0.87)mmol/L、LDL-C平均(3.33±0.84)mmol/L、HDL-C平均(1.28±0.30)mmol/L、TG中位数1.32 mmol/L;女性TC平均(4.79±0.94)mmol/L、LDL-C平均(2.99±0.89)mmol/L、HDL-C平均(1.53±0.34)mmol/L、TG中位数0.9mmol/L.男性和女性4种血脂成分异常患病率均随年龄增加而增高(P＜0.01).TC、LDL-C、TG水平随年龄增加而增高(P＜0.01),HDL-C水平随年龄的增加有降低趋势(P＜0.01).TC在25～44岁间男性高于女性(P＜0.01),在55岁以上女性显著高于男性(P＜0.05).LDL-C在18～44岁间男性高于女性(P＜0.01),在45～74岁女性显著高于男性(P＜0.01).HDL-C水平各年龄组女性明显高于男性(P＜0.01).TG在18～54岁男性显著高于女性(P＜0.01),在55～64岁组两性间无差异,64岁以上女性高于男性(P＜0.05).结论 北京地区成人中血脂异常患病率较高,并且随年龄增大而增高,男女性别间血脂异常患病率差异有统计学意义.     

高脂血症患者血清TC,TG 和HDL-C 水平与精液质量相关性研究

目的 探讨高脂血症患者血清总胆固醇( total cholesterol , TC ),三酰甘油( triglyceride , TG ) 及高密度脂蛋白胆固醇( high-density lipoprotein cholesterol, HDL-C ) 与男性精液质量之间的关系。方法 选取2019 年9 月～ 2020 年10 月来广州市番禺区中心医院男性科就诊的126 例成年男性,根据血脂水平将其分为两组,86 例高血脂患者作为高脂血症组,40 例血脂正常男性作为对照组。对比分析两组受检者精液质量参数、血清TC, TG 和HDL-C 水平,分析血清血脂水平与精液质量之间的相关性。结果 高脂血症组患者精子浓度[54.2(25.10,88.85)×106/ml]、精子总数[167.31(81.51,256.99)×106/ml]、前向运动精子百分率 (PR) ( 31.29% ±16.37%) 和精子总活力( 39.22%±16.69%) 均低于对照组[63.9(49.25, 114.20)×106/ml, 258.24(209.19, 349.99)×106/ml, 36.39%±9.43%, 44.31%±10.07%],差异有统计学意义( t/Z= -3.404,-4.271,2.206,2.115, 均P＜ 0.05)。与对照组相比,高脂血症组患者血清TC水平(5.83±1.04 mmol/L vs 4.41±0.60mmol/L), TG 水平(2.59±0.58 mmol/L vs 1.05 ± 0.18mmol/L) 和 HDL-C 水平(0.96±0.11 mmol/L vs 1.37 ±0.22 mmol/L),差异均有统计学意义(t= 9.015,7.123, 19.845, 均P ＜ 0.01)。相关性分析显示,精子浓度与血清TG 和 TC 水平呈负相关( r =-0.185, -0.192, 均P ＜ 0.05),精子总数与血清TG 和 TC 水平呈负相关 ( r =-0.235, -0.233, 均P ＜ 0.05),精子浓度、精子总数与血清HDL-C 水平呈正相关 ( r =0.267, 0.354, 均P ＜ 0.01),前向运动精子百分率及精子总活力与血清HDL-C水平呈正相关 ( r=0.183, 0.178, 均P ＜ 0.05)。结论 高脂血症会导致男性精液质量下降,育龄期男性应关注血脂水平的控制。     

妊娠妇女血脂水平及其与新生儿出生体重的关系

目的 比较妊娠期妇女与非孕妇女血脂水平及其与新生儿出生体重的关系.方法 测定202例妊娠妇女(妊娠妇女组)和174名非孕女性(对照组)的血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),并分析妊娠妇女血脂与新生儿出生体重的相关性.结果 妊娠妇女组TC[(6.43±2.08)mmol/L]、TG[(2.54±0.92)mmol/L]和LDL-C[(4.12±1.97)mmol/L]水平高于对照组[分别为(4.45±0.89、1.17±0.73、2.75±0.66)mmol/L],差异均有统计学意义(P均<0.01);HDL-C水平低于对照组[(0.85±0.15)mmol/L和(1.13±0.30)mmol/L],差异有统计学意义(P<0.01);妊娠妇女组TC、TG、LDL-C、HDL-C异常率高于对照组[分别为49.5%(100/202)、55.9%(113/202)、46.5%(94/202)、90.6%(183/202)与4.8%(5/174)、7.4%(9/174)、4.0%(7/174)、42.0%(73/174)],差异均有统计学意义(P均<0.01);新生儿出生体重与妊娠妇女的TC和LDL-C水平呈正相关[TC:r=0.395,P<0.01;LDL-C:r=0.408,P<0.01],与HDL-C水平负相关(r=-0.270,P<0.001).结论 妊娠妇女的TC、LDL-C和HDL-C水平高于非妊娠妇女,且与新生儿出生体重明显相关,因此孕期应加强定期监测血脂水平,以控制巨大儿的发生.     

维持性血液透析患者血脂变化和胰岛素抵抗的相关分析

目的 了解维持性血液透析患者的血糖、血脂和胰岛素抵抗情况.方法 选取我科维持性血液透析患者(观察组)48例,同时选取30例健康体检者(对照组),测定两组的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、血脂指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(ISI).结果 与对照组比较,观察组BUN、Cr、UA、FIns、FPG和HOMA-IR水平升高,总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)降低,BUN (24.9±5.8)mmol/Lvs (5.0±1.6)mmol/L(P＜0.05); Cr(820±222)μmol/L vs (73±17)μmol/L(P＜0.05); UA(397±96)μmol/L vs (298±79)μmol/L(P ＜0.05); FIns(16+11)mU/L vs (11±5)mU/L(P＜0.05);FPG(6.1±1.6)mmol/L vs (5.1±0.6)mmol/L(P ＜0.05);HOMA-IR 4.3±3.2 vs 2.4±1.2 (P＜0.05);TC(4.2±1.2)mmol/L vs(5.3±1.1)mmol/L(P＜0.05); HDL-C( 1.3±0.5)mmol/L vs (1.6±0.4)mmol/L(P＜0.01);LDI-C(3.0±1.0)mmol/L vs (4.1±1.1)mmol/L(P＜0.05).在观察组,TC与FPG呈负相关(r=-0.3482,P＜0.05);HDL-C与Fins呈负相关(r=-0.2603,P＜0.05);LDI-C与FPG呈负相关(r=-0.3289,P＜0.05),而对照组仅TG与FPG、HOMA-IR呈正相关(r =0.371,0.368,P＜0.05).结论 维持性血液透析患者中存在脂代谢紊乱,可能参与胰岛素抵抗.     

超声检出脂肪肝与血脂水平及肝功能关系分析

目的 探讨脂肪肝与血脂、肝功能之间关系,为其诊断及预后提供依据.方法 随机抽取在我院体检超声检出86例脂肪肝者为患者组.对其匹配正常者98例为健康对照组,测定空腹静脉血中总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)、脂蛋白(a)[Lp(a)];肝功能检测指标:丙氨酸转氨酶(ALT)、γ-谷氨酰转肽酶(GGT).结果 脂肪肝患者组TC、TG、LDL-C、Apo-B、Lp(a)、ALT、GGT浓度显著高于对照组(P＜0.01),分别为TC (4.35±1.21) mmol/L vs (2.23±0.68) mmol/L,TG(5.28±0.78) mmol/L vs (4.38±0.73) mmol/L,LDL-C(4.35±1.02) mmol/L vs (3.25±0.87)mmol/L,Apo-B(1.02±0.28) mg/L vs (0.76±0.22) mg/ L,Lp(a)(0.22±0.08) mg/L vs (0.13±0.06) mg/ L,ALT(40±17)U/L vs(25±12)U/L,GGT(56±21)U/L vs (26±14) U/L;而HDL-C、Apo-A1低于健康对照组(P＜0.01),分别为HDL-C(1.32±0.50) mmol/L vs (1.87±0.37) mmol/L,Apo-A1 (1.09±0.32) g/L vs (1.35±0.43)g/L;脂肪肝患者组TC、TG、LDL-C、Apo-A1、Apo-B、Lp(a)、ALT、GGT浓度异常比例显著高于对照纽,分别为TC41.9％ vs 14.3％,TG 74.4％ vs 32.7％,LDL-C 55.8％ vs 28.6％,Apo-A1 23.3％ vs 11.2,Apo-B 27.9％ vs 13.3％(P＜0.05或＜0.01).结论 超声检查结合血脂、肝功能的异常情况对脂肪肝诊断及预后具有指导作用.     

多普勒超声评价2型糖尿病患者主动脉顺应性

目的探讨多普勒超声评价2型糖尿病患者主动脉顺应性的应用价值,并分析血糖、血脂对其影响.方法选取2型糖尿病患者及年龄、性别相匹配的健康人各60例,测量胸腹主动脉的脉搏波传导速度(PWV)、空腹血糖(FBG)、血浆总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL -C)、载脂蛋白 AI(ApoAI)和载脂蛋白B(ApoB).结果 2型糖尿病患者PWV显著增快[(9.41±1.48) m/s vs (7.45±1.59 )m/s,P＜0.01]; PWV与 FBG、TC、TG、LDL-C、ApoB呈显著正相关(FBG: r=0.42,P＜0.01;TC:r=0.32,P=0.03;TG:r=0.27,P＜0.01;LDL-C:r=0.33,P＜0.01;APOB:r=0.24,P＜0.01), 与 HDL-C呈显著负相关(r=-0.41,P＜0.01).结论多普勒法的PWV能无创伤又简便地评价2型糖尿病患者主动脉顺应性.2型糖尿病患者主动脉顺应性下降,PWV加快,与血糖增高、血脂代谢紊乱有关.     

SLE患者血清胱抑素C与血脂的相关性分析

目的 探讨系统性红斑狼疮(SLE)患者血清胱抑素C(Cys C)与血脂的相关性及其临床意义。方法 采用全自动生化仪测定136例SLE患者和113例体检健康者的血清胱抑素C(Cys C)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和超敏C反应蛋白(hsCRP)浓度。所得数据用SPSS13.0统计软件进行统计分析。结果 SLE患者组与健康对照组比较,血清hsCRP(13.5±4.85 mg/L vs 2.03±0.88 mg/L),Cys C(2.63±1.95mg/L vs 0.85±0.37 mg/L),LDL-C(3.06±1.21 mmol/L vs 2.33±0.41 mmol/L),TC(5.32±2.63 mmol/L vs 4.02±1.67 mmol/L)和TG(1.92±0.83 mmol/L vs 1.44±0.8 mmol/L),显著高于健康对照组,两组比较差异有统计学意义(t=2.45～12.4,P值均＜0.05); 与健康对照组比较,SLE组患者HDL-C(1.12±0.31 mmol/L vs 1.52±0.85 mmol/L)水平降低(P值＜0.01)。SLE患者组血清Cys C与hsCRP水平和TG,TC,LDL-C水平呈正相关(P值＜0.01),和HDL-C水平呈负相关(P值＜0.01),而健康对照组无明显相关性(P值＞0.05)。结论 SLE患者血清Cys C水平升高与血脂水平存在明显相关性,联合检测SLE患者血清Cys C和血脂指标对SLE患者并发心血管疾病和动脉粥样硬化疾病进行预防、早期诊断和治疗有重要意义。     

类风湿关节炎患者血脂水平与炎症及免疫指标的相关性研究

目的探讨类风湿关节炎(RA)患者血脂水平与炎症及免疫指标的相关性。方法选取2015-2017年51例RA患者作为病例组,60例健康体检者为对照组,检测两组总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、抗环瓜氨酸转肽酶抗体(ACCP)、超敏C反应蛋白(hs-CRP),比较各组血脂、ACCP、hs-CRP差异。分析RA组血脂水平与ACCP及hs-CRP的相关性。结果RA组TC、HDL-C、LDL-C水平显著低于对照组(P0.05);TC/HDL-C比值、ACCP、hs-CRP水平显著高于对照组(P0.05)。两组间TG水平差异无统计学意义(P0.05)。HDL-C、LDL-C水平与ACCP、hs-CRP水平呈负相关(r=-0.784,P=0.001;r=-0.655,P=0.01;r=-0.576,P=0.034;r=-0.648,P=0.036)。TC/HDL-C比值分别与ACCP、hs-CRP水平呈正相关(r=0.679,P=0.01;r=0.648,P=0.04)。结论 RA患者血脂代谢紊乱,以HDL-C水平降低为主。炎症和免疫反应与血脂水平有密切关系。     

血液透析患者脂质紊乱相关因素的研究

目的 研究血液透析患者脂质紊乱与胰岛素抵抗、瘦素、微炎症状态的相关关系.方法 测定102例血液透析患者(血液透析组)及26例健康者(健康对照组)体质量指数(BMI)、血脂、D二聚体(D-dimer)、空腹胰岛素(FINS)、空腹血糖(FBG)、瘦素、血C反应蛋白(C reactive protein,CRP)等指标,并计算胰岛素抵抗指数(HOMA-IR),分析脂代谢指标与HOMA-IR及CRP的相关性.结果 血液透析患者BMI、血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、瘦素、D-dimer、HOMA-IR、CRP明显升高,高密度脂蛋白胆固醇(HDL-C)明显减低(P＜0.05或＜0.01),血液透析组和健康对照组分别为BMI 24.20±12.20 vs 22.52±2.77,TG(2.76±0.65) mmol/L vs (2.33±0.72) mmol/L,LDL-C(3.01±0.71) mmol/L vs (2.51±0.75) mmol/L,瘦素(3.51±1.02)μg/L vs (2.96±0.89)μg/L,D-dimer(8.97±1.39) mg/L vs (4.99±1.61) mg/L,HOMA-IR 2.49±1.15 vs 1.89±0.85,CRP(45. 10±0.61) mg/L vs (17.60±0.54) mg/L,HDL-C( 1.09±0.41) mmol/L vs (1.32±0.36) mmol/L,血液透析患者BMI、TG、LDI-C、D-dimer和CRP与HOMA-IR呈正相关(r＝0.601、0.313、0.324、0.306、0.301,P＜0.05或＜0.01),HDL-C与HOMA-IR呈负相关(r＝-0.283,P＜0.05);其BM1与TG、LDL-C、D-dimer、FINS、HOMA-IR与CRP呈正相关(0.221,0.310,0.273,0.281,0.282,0.304,P＜0.05或＜0.01),HDL-C与CRP呈负相关(r=-0.342,P＜0.01).结论 血液透析患者脂代谢紊乱发生率高,与胰岛素抵抗及炎症反应相关,纠正脂代谢紊乱有助于降低此类患者心脑血管并发症的发病率.     

高海拔地区低海拔落差对藏、汉族血压、血糖、血尿酸和血脂水平的影响

目的探讨高海拔地区低海拔落差对藏、汉族血压、血糖、血尿酸和血脂水平的影响,为高血压、高血糖、高尿酸血症和高脂血症的预防提供研究资料。方法 244例被调查者为世居或长期生活在海拔3 100m及2 940m的牧区藏族、城镇藏族、城镇汉族人群,测定被调查者收缩压、舒张压、血糖、血尿酸、血脂,对检测结果进行比较。结果 3 100m海拔中,牧区藏族血糖高于城镇藏族血糖(6.21±2.48)mmol/L vs.(4.75±0.77)mmol/L(P0.01),牧区藏族低密度脂蛋白胆固醇(LDL-C)高于城镇汉族及城镇藏族LDL-C(2.33±0.76)mmol/L vs.(2.00±0.52)mmol/L vs.(1.93±0.67)mmol/L(P0.05),但牧区藏族、城镇藏族、城镇汉族受检者之间收缩压、舒张压、血尿酸、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)差异无统计学意义(P0.05)。2 940m海拔中,城镇藏族及城镇汉族舒张压高于牧区藏族舒张压(78.49±12.07)mm Hg vs.(77.23±11.12)mmHg vs.(67.80±10.18)mm Hg(P0.01),城镇汉族血尿酸高于城镇藏族及牧区藏族血尿酸(337.56±107.76)μmol/L vs.(275.19±80.00)μmol/L vs.(260.84±78.92)μmol/L(P0.01),城镇汉族TG高于城镇藏族及牧区藏族TG(2.00±1.27)mmol/L vs.(1.24±0.85)mmol/L vs.(1.19±0.64)mmol/L(P0.01),城镇汉族TC高于牧区藏族TC(4.49±0.94)mmol/L vs.(4.13±0.91)mmol/L(P0.05),牧区藏族HDL-C高于城镇汉族HDL-C(1.70±0.40)mmol/L vs.(1.49±0.41)mmol/L(P0.01),城镇藏族LDL-C高于牧区藏族LDL-C(2.26±0.88)mmol/Lvs.(1.84±0.88)mmol/L(P0.05),但牧区藏族、城镇藏族、城镇汉族受检者之间收缩压、血糖差异无统计学意义(P0.05)。3 100m海拔中牧区藏族舒张压、血尿酸、TC、LDL-C高于2 940m海拔中牧区藏族舒张压、血尿酸、TC、LDL-C(78.74±10.38)mm Hg vs.(67.80±10.18)mm Hg(P0.01),(308.39±96.38)μmol/L vs.(260.84±78.92)μmol/L(P0.05),(4.57±0.96)mmol/L vs.(4.13±0.91)mmol/L(P0.05),(2.33±0.76)mmol/L vs.(1.84±0.88)mmol/L(P0.01)。两个海拔中,城镇藏族之间及城镇汉族之间各指标差异无统计学意义(P0.05)。结论高海拔地区低海拔落差对牧区藏族舒张压、血尿酸、TC、LDL-C有明显影响。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.