老年糖尿病197例死因分析

目的：探讨老年糖尿病的死亡原因，方法：对197年住院死亡的老年糖尿病患者的资料进行回顾性分析。结果：死因前5位依次为糖尿病肾病，恶性肿瘤，感染性疾病，脑血管病和心血管病。女性糖尿病肾病死因构成比高于男性（分别为35．59％和20．14％，P＜0．05），恶性肿瘤死因构成比男高性女性（分别为28．06％和13．56％，P＜0．05）。糖尿病肾病死因构成比随年龄增加呈下降趋势，感染性疾病则随年龄增加呈增长趋势，结论：针对老年人特点，采取有效措施，预防或延缓糖尿病并发症的发生是降低病死率的关键。     

糖尿病167例死因探讨

对我院20年中167例住院糖尿病死亡病例进行回顾性总结分析，以了解主要死因及其变化趋势。结果①随着住院糖尿病人数逐渐增加，住院糖尿病死亡人数亦逐渐增加，糖尿病死亡病例以老年人为主，占55．09％；②急性并发症所占比例逐渐下降，慢性并发症比例上升；③脑、心、肾等慢性并发症是糖尿病主要死因，占38．92％，其中脑血管病居各种死亡原因首位，占15．57％；④感染在死因中虽有下降，仍占9．72％。因此，普及糖尿病教育，严格控制血糖，防治急、慢性并发症对延长糖尿病患者寿命，降低病死率至关重要。     

1998、1999年全国城乡老年人死因顺位

用 1995年全国 1%人口抽查资料 ,对 1998、1999年全国卫生统计年报资料中≥ 6 0岁年龄组城乡居民年龄别、疾病别死亡率进行标化 ,得出 1998、1999年全国城乡老年人死因顺位。表 1　 1998年全国城乡老年人死因顺位 (1/10万 )顺位 城市　死因　　　　　　　死亡率 　 农村　死因　　　　　　　死亡率 　 合计　死因　　　　　　　死亡率 　1脑血管病　　 43 7.3 9呼吸系疾病　　 5 17.5 9呼吸系疾病　　 492 .2 32恶性肿瘤 418.86脑血管病 445 .62脑血管病 444 .783心脏病 3 3 1.43恶性肿瘤 3 85 .5 8恶性肿瘤 3 88.984呼吸系疾病 2 69.5 2心…     

离休干部172例在院死亡疾病谱分析

目的：探讨在长海医院住院去世的上海军队离休干部的死亡原因及其变化趋势。方法选取1985年3月至2013年1月上海军队干休所死亡离休干部172例及其死亡登记表,分析死因顺位及死因构成比。结果1985年1月～2013年1月,该队列人群前5位死因构成比分别为：肿瘤（41.9%）,神经系统疾病（16.9%）,循环系统疾病（15.7%）,呼吸系统疾病（10.5%）和内分泌、营养与代谢疾病（7.6%）。前5位死亡病种分类构成比分别为：肿瘤（42.4%）,冠心病（12.8%）,慢性阻塞性肺疾病（8.7%）,脑梗死（8.1%）和2型糖尿病（7.6%）。肿瘤死亡顺位及构成比前8位分别为：肺癌（35.6%）,胰腺癌（9.6%）,直肠癌和胃癌（均为8.2%）,前列腺癌和肝癌（均为5.5%）,淋巴瘤和多发性骨髓瘤（均为4.1%）。结论肿瘤是老年患者最主要的致死原因,心脑血管疾病也是老年患者住院死亡的主要原因之一,应加强肿瘤与心脑血管疾病的防治工作。     

饮水砷暴露居民死因的调查与分析

目的调查饮水砷暴露地区居民的死亡情况。方法运用横断面调查方法，对20个砷中毒病区常住居民1999—2001年的死亡情况进行调查，调查结果按照国际疾病分类（ICD-10）编码分类登记，标化死亡率采用2000年全国标准人口构成进行标化。结果20个砷中毒病区3年累计调查人口33473人，死亡人口256人．粗死亡率764．79／10万．标化死亡率812．59／10万，砷中毒病区居民死亡率明显高于一般人群（u=3．82，P〈0．01）。其中．男性死亡率高于女性（u=2．14，P〈0．05）。各年龄组中儿童、中老年死亡率明显高于一般人群，砷中毒病区居民全死因标化死亡比（SMR）为1．43（95％CI：1．26～1．61，P〈0．05），砷中毒病区居民的前5位死因是呼吸系统疾病、恶性肿瘤、脑血管病、心脏病、内分泌系统疾病。结论饮水砷暴露地区居民的死亡率明显高于一般人群．尤以儿童和中老年明显，死因主要是呼吸系统疾病、恶性肿瘤等慢性疾病为主。     

1996例老年护理医院住院患者疾病谱及死因分析

目的了解老年护理医院住院患者主要疾病谱及死因构成。方法收集2006年～2008年住院1996例老年病例计算患病率及死因的构成比并进行排序。结果前十位疾病构成比依次为高血压病（52．6％）、冠心病（49．8％）、脑梗死后遗症（38．3％）、老年性痴呆（21．3％）、肺部感染（19．3％）、2型糖尿病（18．9％）、前列腺增生症（31．14％）、尿路感染（15．4％）、恶性肿瘤（6．9％）、慢性肾功能不全（4．2％）。死亡率前五位疾病排列依次为冠心病（58．1％）、肺部感染（17．5％）、慢性阻塞性肺疾病（7．4％）、恶性肿瘤（5．5％）、尿毒症（1．8％）。结论老年护理医院住院患者的疾病谱及主要死因的结果,为老年专科护理医院如何提高医疗护理质量,制订有效治疗护理对策,提供参考依据。     

老年糖尿病住院患者病死率及死因分析

目的：了解老年糖尿住院患者病死率及主要死亡原因,方法：回顾和总结１９９２年至１９９９年间的住院患者中,老年糖尿病患者住院情况及２４８例死亡病例的死亡时间和原因,并与非老年糖尿病患者比较,结果：８年中,老年糖尿病病患者占糖尿病住院患者的比例呈显著增加趋势（１９９２－１９９５年为５９．９３％,１９９６－１９９９年为６７．６３％,Ｐ＜０．００１）,老年糖尿病死亡病例占有所有糖尿病死亡病例的８５．８％,老年糖尿病患者病死率（７．８％）明显高于非老年糖尿病患者（２．３％,Ｐ＜０．００１）,并随年龄增加而显著上升（６０－６９岁组４．７２％,７０－７９岁组１１．３４％,８０岁以上组２３．６０％,Ｐ＜０．００１）,男性病死率（９．６１％）显著高于女性（５．８２％,Ｐ＜０．００１）,老年糖尿中层得前５位死因顺序是：心血管疾病,脑血管疾病,胖发肿瘤,糖尿病肾病,感染,死于心,脑,肾疾病的病例中,７６．６％伴高血压,结论：老年糖尿病患者病死率随年龄增长而增高,男性显著高于女性,心,脑,肾并发症是其最重要的死亡原因,高血压是其主要危险因素,严格控制高血糖的早期控制血压,对防治糖尿病并发症和降低病死率有重要意义。     

4875例住院病人死因分析

目的 为提高住院治疗有效率、控制并降低病死率提供科学依据。方法 按照ICD-9标准对4875例住院死亡病例进行回顾性分析，归纳导致住院病人死亡的主要死因及其年龄分布、性别比例。结果肿瘤、脑血管病、损伤、心脏病是导致住院病人死亡的主要疾病。结论 针对主要死因制定切实可行的防治措施，是提高住院治疗有效率的关键。     

实验室检查在心脏病诊断中的应用

随着我国经济的发展，人民生活方式的改变，心脏疾病逐渐增多。陈灏珠等对1948～1989年上海地区心脏病病人病种构成比进行分析，结果显示心脏病病例在内科住院病人中所占比例在增高。1985年上海心血管病死亡率在增高，由1951年的71．36％／lO万(列第5顺位)上升到230．90／10万(列第1顺位)。     

综合性医院老年住院病人住院费用分析

目的通过对徐州市老年住院病人医疗费用分析，为政府制定合理的医疗费用提供决策依据。方法对收集的老年住院病人资料按国际疾病分类（ICD-10）为标准进行汇总分析。结果1999～2004年徐州市老年患者住院人数、人均费用中位数和日均费用中位数逐年增加，而住院天数中位数逐年减少。不同系统疾病医疗费用快速增长，主要表现在人均费用中位数在前3位的分别为肿瘤，泌尿生殖系统疾病，循环系统疾病，日均费用中位数在前3位的分别为肿瘤，呼吸系统疾病，循环系统疾病。不同年龄、性别、职业、预后的住院天数中位数、人均费用中位数、日均费用中位数有明显差异。结论随着人口老龄化快速发展，老年病不仅影响患者的生命和生活质量，也给社会尤其是患者的家庭带来沉重的经济负担。降低医疗费用已成为当前的热点，政府、社会应给予更多的关注。     

Concerted action of wild-type and mutant TNF receptors enhances inflammation in TNF receptor 1-associated periodic fever syndrome

TNF, acting through p55 tumor necrosis factor receptor 1 (TNFR1), contributes to the pathogenesis of many inflammatory diseases. TNFR-associated periodic syndrome (TRAPS, OMIM 142680) is an autosomal dominant autoinflammatory disorder characterized by prolonged attacks of fevers, peritonitis, and soft tissue inflammation. TRAPS is caused by missense mutations in the extracellular domain of TNFR1 that affect receptor folding and trafficking. These mutations lead to loss of normal function rather than gain of function, and thus the pathogenesis of TRAPS is an enigma. Here we show that mutant TNFR1 accumulates intracellularly in peripheral blood mononuclear cells of TRAPS patients and in multiple cell types from two independent lines of knockin mice harboring TRAPS-associated TNFR1 mutations. Mutant TNFR1 did not function as a surface receptor for TNF but rather enhanced activation of MAPKs and secretion of proinflammatory cytokines upon stimulation with LPS. Enhanced inflammation depended on autocrine TNF secretion and WT TNFR1 in mouse and human myeloid cells but not in fibroblasts. Heterozygous TNFR1-mutant mice were hypersensitive to LPS-induced septic shock, whereas homozygous TNFR1-mutant mice resembled TNFR1-deficient mice and were resistant to septic shock. Thus WT and mutant TNFR1 act in concert from distinct cellular locations to potentiate inflammation in TRAPS. These findings establish a mechanism of pathogenesis in autosomal dominant diseases where full expression of the disease phenotype depends on functional cooperation between WT and mutant proteins and also may explain partial responses of TRAPS patients to TNF blockade.     

鞍钢职工心脑血管疾病现状与发病趋势

目的分析鞍钢职工大样本人群心脑血管疾病的发病率及易患因素分布情况。方法通过对鞍钢集团95 912例职工的心脑血管疾病既往史、吸烟、血压、糖尿病、血清总胆固醇、高密度脂蛋白、体重指数、总胆固醇与高密度脂蛋白胆固醇的比值等数据的分析,前瞻性分析受检人群心脑血管疾病发病的危险分层。结果冠心病1 910例(2.00%),脑血管病607例(0.63%),吸烟19 453例(20.28%),糖尿病788例(0.82%),高血压31 698例(33.05%),高脂血症8 347例(8.70%),体重超重55 462例(57.83%),总胆固醇(TC)/高密度脂蛋白胆固醇(HDL-C)≥3.5的10 487例(10.93%);缺血性心血管病发病概率多分布于极低危(68.14%)和低危(5.75%),中危(0.865%)占很小的比例,颈动脉粥样硬化斑块发生概率多分布于高危(44.23%)、中危(23.21%)和极高危(10.51%),无低危和极低危。结论目前鞍钢职工的健康状况不容乐观,应进一步加大健康知识宣教力度。     

Graves病患者血清中TSH抗体检测及其免疫学意义

利用~(125)I标记的人TSH(~(125)I-hTSH)作为放射性示踪配体,对29例正常人和58例Graves病患者血清中抗hTSH自身抗体(TSHab)进行了检测。正常人TSHab指数(TSHabJ)为0.85±0.22;而32例初发患者和26例接受抗甲状腺药物治疗患者的TSHabJ分别为1.47±0.35(P<0.001)和1.19±0.37(P>0.05)。SPA菌体结合沉淀试验表明:这种与hTSH结合的抗体属于IgG成分。TSHab的存在提示Graves病的免疫学发病已涉及到独特型-抗独特型反应机理。     

Chronic liver inflammation: Clinical implications beyond alcoholic liver disease

Chronic alcohol exposure can lead to alcoholic liver disease, including hepatitis, cirrhosis and hepatocellular carcinoma, and chronic inflammation can simultaneously cause systemic medical illness. Recent evidence suggests that alcoholic liver disease is a predictor for liver-related diseases, cardiovascular disease, immunologic disease, and bone disease. Chronic inflammation in alcoholic liver disease is mediated by a direct inflammatory cascade from the alcohol detoxification process and an indirect inflammatory cascade in response to gut microflora-derived lipopolysaccharides (LPS). The pathophysiology of alcoholic liver disease and its related systemic illness is characterized by oxidative stress, activation of the immune cascade, and gut-liver interactions. Integrative therapeutic strategies for alcoholic liver disease include abstaining from alcohol consumption; general anti-inflammatories such as glucocorticoid, pentoxifylline, and tumour necrosis factor-α antagonist; antioxidants such as N- acetylcysteine; gut microflora and LPS modulators such as rifaximin and/or probiotics. This review focuses on the impact of chronic liver inflammation on systemic health problems and several potential therapeutic targets.     

Celiac Disease: A Disorder Emerging from Antiquity,Its Evolving Classification and Risk,and Potential New Treatment Paradigms

Celiac disease is a chronic genetically based gluten-sensitive immune-mediated enteropathic process primarily affecting the small intestinal mucosa. The disorder classically presents with diarrhea and weight loss; however, more recently, it has been characterized by subclinical occult or latent disease associated with few or no intestinal symptoms. Diagnosis depends on the detection of typical histopathological biopsy changes followed by a gluten-free diet response. A broad range of clinical disorders may mimic celiac disease, along with a wide range of drugs and other therapeutic agents. Recent and intriguing archeological data, largely from the Gobleki Tepe region of the Fertile Crescent, indicate that celiac disease probably emerged as humans transitioned from hunter-gatherer groups to societies dependent on agriculture to secure a stable food supply. Longitudinal studies performed over several decades have suggested that changes in the prevalence of the disease, even apparent epidemic disease, may be due to superimposed or novel environmental factors that may precipitate its appearance. Recent therapeutic approaches are being explored that may supplement, rather than replace, gluten-free diet therapy and permit more nutritional options for future management.     

Paediatric aspects of coeliac disease: old challenges and new ones…

The concept of coeliac disease has expanded from a gastrointestinal disease with malabsorption to a systemic immunological disease with a genetic basis. Epidemiological studies indicate that environmental factors, like the infant feeding pattern, affect the clinical presentation while population-screening studies indicate that the prevalence, at least in Caucasian populations, is similar. Secondary complications, like malignancies, osteopenia - osteoporosis, gynaecological and obstetrical problems and autoimmune diseases, are common. The risk is reduced or prevented by treatment with a gluten-free diet. The basis for such a secondary prevention is: 1. early case-finding by a) knowledge about different presentations of the disease and factors affecting that, b) generous serological testing in patients with vague symptoms, c) screening of risk groups, and, 2. support for children and adolescents with coeliac disease to comply with the gluten-free diet.     

Canadian Digestive Health Foundation Public Impact Series 4: celiac disease in Canada. Incidence, prevalence, and direct and indirect economic impact

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning celiac disease.     

Prevalence of Coronary Artery Disease in Patients with Valvular Heart Disease

ABSTRACT. To evaluate the usefulness of preoperative coronary angiography in patients undergoing preoperative investigation because of valvular heart disease, we performed coronary angiography in a consecutive series of 329 patients. The prevalence of significant coronary artery disease was 32%. Asymptomatic coronary artery disease was present in 13%. Angina pectoris proved to be a poor predictor of coronary artery disease in aortic valve disease. In mitral valve disease, however, the specificity was high. A cost-benefit calculation was carried out in order to assess what advantage routine coronary angiography might have. According to this, coronary angiography should be performed in all patients suffering from valvular heart disease with angina pectoris, whereas it can be omitted in younger patients without angina. A cut-off point of 60 years seems appropriate for aortic valve disease and 65 years for mitral valve disease.