Meta-analysis of Barrett’s esophagus in China

AIM:To investigate the epidemiology and characteristics of Barrett’s esophagus(BE)in China and compare with cases in the west.METHODS:Studies were retrieved from the China National Knowledge Infrastructure and PubMed databases using the terms"Barrett"and"Barrett AND China",respectively,as well as published studies about BE in China from 2000 to 2011.The researchers reviewed the titles and abstracts of all search results to determine whether or not the literature was relevant to the current topic of this research.The references listed in the studies were also searched.Inclusion and exclusion criteria for the literature were appropriately established,and the data reported in the selected studies were analyzed.Finally,a meta-analysis was performed.RESULTS:The current research included 3873 cases of BE from 69 studies.The endoscopic detection rate of BE in China was 1%.The ratio of male to female cases was 1.781 to 1,and the average age of BE patients was 49.07±5.09 years.Island-type and shortsegment BE were the most common endoscopic manifestations,accounting for 4.48%and 80.3%,respectively,of all cases studied.Cardiac-type BE was observed in 40.0%of the cases,representing the most common histological characteristic of the condition.Cancer incidence was 1.418 per 1000 person-years.CONCLUSION:Average age of BE patients in China is lower than in Western countries.Endoscopic detection and cancer incidence were also lower in China.     

蛋白丢失性肠病61例临床分析

目的 通过对蛋白丢失性肠病临床资料的总结分析,提高对本病的认识.方法 对北京协和医院1997至2009年诊断的61例蛋白丢失性肠病进行分析总结.结果 男26例,女35例,年龄16～77(40±15)岁.水肿为首发症状51例;腹水为主要症状41例;合并双侧胸腔积液23例;腹痛16例,腹泻33例;所有患者均有显著的低蛋白血症.37例患者经核素99Tcm标记白蛋白显像证实存在肠道蛋白丢失,24例为临床诊断.原发病主要为系统性红斑狼疮(28例),先天性淋巴管扩张(12例).治疗上以原发病治疗为主.结论 蛋白丢失性肠病临床并非罕见,以严重的低蛋白血症和多浆膜腔积液为特征,核素99Tcm标记白蛋白显像是特异性的诊断方法之一,治疗上以原发病治疗为主,预后与原发病控制与否相关.

Abstract：

Objective To increase the understanding in protein-losing enteropathy (PLE).Methods Sixty-one PLE patients were enrolled in the study and the clinical characteristics, complicated disease, diagnosis and treatment were analyzed. Results The age of the patients was 16-77 (40±15)years, and the gender ratio was 35:26 (female: male). The main clinical manifestations were bilateral lower limb edema in 51 cases, ascites in 41 cases, bilateral pleural effusion in 23 cases, pericardial effusion in 13cases, abdominal pain in 16 cases and diarrhea in 33 cases. The prominent abnormality in laboratory examinations was hypoalbuminemia. The underlying diseases include systemic lupus erythematosus (SLE) in 28 cases, intestinal lymphangiectasia in 12 cases, hepatic cirrhosis in 5 cases, heart diseases in 5 cases,Crohn's disease in 3 cases, membranous nephropathy in 2 cases, Budd-Chiari syndrome in 1 case. Four cases happened after abdominal operation and 1 case after radiation therapy of gastric cardia cancer. Thirtyseven cases were diagnosed by 99Tcm-labelled human serum albumin scintigraphy and 24 cases were diagnosed clinically. Treatment was focused on underlying diseases. The clinical manifestations in 21 cases of SLE improved after SLE was controlled. In 2 cases of intestinal lymphangiectasia and one with Crohn's disease, the clinical manifestations improved after surgery. The other patients had no improvement.Conclusions PLE was not uncommon in clinical practice. Its predominant characteristics were severe hypoalbuminemia, edema and dropsy of serous cavity. PLE can complicate other diseases such as SLE,intestinal lymphangiectasia. Treatment should be focused on primary disease.     

累及皮肤的结节病35例临床分析

目的 总结分析累及皮肤的结节病的临床特点.方法 回顾性分析北京协和医院1980-2009年35例累及皮肤的结节病患者的临床资料,按有无皮肤外其他系统受累分为单纯皮肤结节病组(简称皮肤组)与合并其他系统受累的皮肤结节病组(简称系统组).结果 (1)35例患者男女之比1:3.38,发病年龄(47.5±10.0)岁,皮肤组(41.8±12.5)岁,系统组(50.5±7.1)岁.(2)皮肤损害分布以四肢最为多见,皮肤损害类型以皮下结节最为多见,其次是斑丘疹和结节红斑.(3)皮肤外系统受累以肺、关节和淋巴结最为多见,与国外全身结节病资料相比,肺受累率偏低,而关节、淋巴结、肾脏、肌肉、神经系统受累率较高.(4)在系统组中,乏力和体重减轻的发生率明显高于皮肤组(P＜0.05);ESR、C反应蛋白、类风湿因子高于皮肤组(P＜0.05).系统组患者糖皮质激素的使用率(95.7%)高于皮肤组(66.7%,P＜0.05).结论 累及皮肤的结节病皮肤损害以皮下结节最为多见,肺受累率低,有系统受累者平均发病年龄、炎性指标水平及糖皮质激素使用率均较无系统受累者高.

Abstract：

Objective To investigate clinical features of cutaneous sarcoidosis. Methods A retrospective analysis was carried out based on the clinic data of 35 patients with cutaneous sarcoidosis who were hospitalized in Peking Union Medical College Hospital during 1980-2009. They were divided into two groups, the group without systemic involvement (skin group )and the group with systemic involvement ( systemic group). Results ( 1 ) The ratio of men and women with cutaneous sarcoidosis was 1: 3. 38, and the average incident age was (47. 5 ± 10. 0) years old. The average incident age of skin group and systemic group were (41.8 ± 12.5 ) years old and ( 50. 5 ± 7. 1 ) years old, respectively. (2) The most common skin manifestation was subcutaneous nodule, followed by maculopapule and erythema nodosa. The most common involved sites were limbs. (3) The common involved systems extra-skin included the lung, joints and lymph nodes. The involvement rate of lung in cutaneous sarcoidosis of our present data was lower than those of foreign reports. However, the involvement rates of joints, lymph nodes, kidney, muscles and nervous system showed higher in our data. (4) The incidences of fatigue and weight loss in systemic group were higher than those in skin group ( P ＜ 0. 05 ). The indexes of erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor in systemic group were higher than those in skin group ( P ＜ 0. 05 ). More patients in systemic group were treated with corticosteroid than that in skin group ( 95.7% vs 66.7%, P ＜ 0. 05 ).Conclusions Subcutaneous nodules are the most common and the involvement rate of lung is lower in cutaneous sarcoidosis of our present data. Compared to the patients without systemic involvement, the average incident age of systemic ones is older, the indexes of inflammation markers and the usage of corticosteroid are higher.     

Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases

AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy. METHODS: A PubMed search using the terms "Takotsubo cardiomyopathy (TC)" and "apical ballooning syndrome" yield 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed. RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64±14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain wasthe primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation +1.6% of ST segment depression +17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%. CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.     

抗磷脂综合征174例临床特点及与欧洲数据的比较分析

Objective To analyze the clinical characteristics of antiphospholipid syndrome (APS) in a cohort of Chinese patients. Methods From January 1996 to October 2009, 174 patients with defined APS were retrospectively studied,χ2 test was selected. Results The cohort consisted of 151(86.8%) female and 23 (13.2%) male. Mean age at study was (42±13) years (range: 14-75 years). Thirty-one (17.8%) patients had primary APS, 143 (82.2% ) patients had APS associated with other diseases, including 138 cases of systemic lupus erythematosus (SLE). One hundred and forty-one (81.0%) had thrombosis episodes, among which the most common presenting manifestations were stroke (27.6%), deep venous thrombosis (27.6%) and pulmonary embolism (6.3% ). Stroke was more prevalent in Chinese than European patients. Forty-five patients (31.9%) had thrombotic recurrences and 62 patients (44.0%) had more than two sites of thrombosis. Patients with primary APS had higher rates of rethrombosis than those with secondary APS (P<0.05). Fetal morbidity rate of 126 married women in our study was 50.0%. Seven of APS patients with APS nephropathy were characterized by thrombotic microangiopathy. The presence of anticardiolipin antibodies was detected in 112 patients (64.4% ), anti-beta-2 glycoprotein Ⅰ antibodies in 103 patients (59.1%) and lupus anticoagulant in 50 patients (28.7%). Conclusion APS is characterized by recurrent thrombosis, pregnancy morbidity and positive antiphospholipid antibodies tests. Stroke, deep venous thrombosis and pulmonary embolism are the most common manifestations both in Chinese and European patients. Rethrombosis is more prominent in primary APS. Thrombotic microangiopathy is one of the most common histological changes of APS nephropathy. Multiple tests for aPL are proposed.     

抗磷脂综合征174例临床特点及与欧洲数据的比较分析

Objective To analyze the clinical characteristics of antiphospholipid syndrome (APS) in a cohort of Chinese patients. Methods From January 1996 to October 2009, 174 patients with defined APS were retrospectively studied,χ2 test was selected. Results The cohort consisted of 151(86.8%) female and 23 (13.2%) male. Mean age at study was (42±13) years (range: 14-75 years). Thirty-one (17.8%) patients had primary APS, 143 (82.2% ) patients had APS associated with other diseases, including 138 cases of systemic lupus erythematosus (SLE). One hundred and forty-one (81.0%) had thrombosis episodes, among which the most common presenting manifestations were stroke (27.6%), deep venous thrombosis (27.6%) and pulmonary embolism (6.3% ). Stroke was more prevalent in Chinese than European patients. Forty-five patients (31.9%) had thrombotic recurrences and 62 patients (44.0%) had more than two sites of thrombosis. Patients with primary APS had higher rates of rethrombosis than those with secondary APS (P<0.05). Fetal morbidity rate of 126 married women in our study was 50.0%. Seven of APS patients with APS nephropathy were characterized by thrombotic microangiopathy. The presence of anticardiolipin antibodies was detected in 112 patients (64.4% ), anti-beta-2 glycoprotein Ⅰ antibodies in 103 patients (59.1%) and lupus anticoagulant in 50 patients (28.7%). Conclusion APS is characterized by recurrent thrombosis, pregnancy morbidity and positive antiphospholipid antibodies tests. Stroke, deep venous thrombosis and pulmonary embolism are the most common manifestations both in Chinese and European patients. Rethrombosis is more prominent in primary APS. Thrombotic microangiopathy is one of the most common histological changes of APS nephropathy. Multiple tests for aPL are proposed.     

Children with transposition of the great arteries: Should they actually be born in Nigeria?

AIMTo describe the clinical and echocardiographic features of Nigerian children with transposition of the great arteries and emphasize the need for collaboration with cardiac centres in the developed countries to be able to salvage the children.METHODS Prospective and cross sectional involving consecutive patients diagnosed with transposition of the great arteries using clinical evaluation and echocardiography at the Paediatric Department of Lagos State University Teaching Hospital,Lagos Nigeria as part of a large study between January 2007 and December 2015.RESULTS There were 51 cases of transposition of the great arteries within the study period with a male to female ratio of 2:1 and a prevalence of 1.55 per 10000among population of children who presented to centre during the study.Its proportion amongst children with congenital heart disease was 4.9%,while it was15.4%among those with cyanotic congenital heart disease.The mean age±SD of the subjects was 10.3±21.8 mo.Up to 70%of the patients were less than6 mo of age at initial presentation.The most common mode of presentation was cyanosis.The most common associated intracardiac anomaly was ventricular septal defect which occurred in 56%of the patients.CONCLUSION Transposition of the great arteries is as common in Nigeria as in the other parts of the world.The most common mode of presentation was cyanosis.There is an urgent need to establish paediatric cardiac centres in Nigeria if these children are to be salvaged.     

儿童原发性干燥综合征五例并文献复习

Objective To further understand the clinic manifestations of childhood primary Sjogren's Syndrome(pSS) and enhance early diagnosis. Methods Five cases of pSS from Renji Hospital, Shanghai, were reported and their clinical features were analysoed. And literatures from Medline database and Weipu database were reviewed and discussed. Results ①Childhood pSS had various clinic presentations that were non-specific and sicca symptoms were absent or occur late in most cases. ② The most common presentations were recurrent parotiditis and cutaneous manifestations with various locations and forms. ③ American-European Criteria for SS were not suitable for the diagnosis of childhood pSS. Conclusion Recurrent parotiditis and cutaneous manifestations in children can be used as clues for the diagnosis of childhood pSS but needs to be further confirmed by the positive results of salivary gland biopsy and autoantibodies examination, particularly SSA/SSB.     

儿童原发性干燥综合征五例并文献复习

Objective To further understand the clinic manifestations of childhood primary Sjogren's Syndrome(pSS) and enhance early diagnosis. Methods Five cases of pSS from Renji Hospital, Shanghai, were reported and their clinical features were analysoed. And literatures from Medline database and Weipu database were reviewed and discussed. Results ①Childhood pSS had various clinic presentations that were non-specific and sicca symptoms were absent or occur late in most cases. ② The most common presentations were recurrent parotiditis and cutaneous manifestations with various locations and forms. ③ American-European Criteria for SS were not suitable for the diagnosis of childhood pSS. Conclusion Recurrent parotiditis and cutaneous manifestations in children can be used as clues for the diagnosis of childhood pSS but needs to be further confirmed by the positive results of salivary gland biopsy and autoantibodies examination, particularly SSA/SSB.     

儿童原发性干燥综合征五例并文献复习

Objective To further understand the clinic manifestations of childhood primary Sjogren's Syndrome(pSS) and enhance early diagnosis. Methods Five cases of pSS from Renji Hospital, Shanghai, were reported and their clinical features were analysoed. And literatures from Medline database and Weipu database were reviewed and discussed. Results ①Childhood pSS had various clinic presentations that were non-specific and sicca symptoms were absent or occur late in most cases. ② The most common presentations were recurrent parotiditis and cutaneous manifestations with various locations and forms. ③ American-European Criteria for SS were not suitable for the diagnosis of childhood pSS. Conclusion Recurrent parotiditis and cutaneous manifestations in children can be used as clues for the diagnosis of childhood pSS but needs to be further confirmed by the positive results of salivary gland biopsy and autoantibodies examination, particularly SSA/SSB.     

系统性红斑狼疮患者发病及就医行为的现况调查

目的 回顾性分析系统性红斑狼疮(SLE)的发病形式、临床特点以及患者发病后的就诊情况.方法 采用流行病学现况调查的研究方法,随机调查了300例SLE患者,了解其自发病以来的临床表现以及发病后的就诊情况,并采用SPSS 13.0统计软件包进行统计学分析.结果 ①在300例SLE患者中,男女之比为1:13.②首发临床表现以关节痛/炎最多,其次为皮疹、发热,分别占46.3%、34.0%、32.7%.与女性患者相比,男性更容易于发病时即出现肾脏损害.60.9%的患者于发病起1年内出现肾脏损害,提示自SLE发病起1年为肾脏损害的高发期.③患者首次就诊选择风湿免疫科者较少,仅占35.3%(106/300),但风湿免疫科的确诊比例最高,为99.1%(105/106).从出现临床症状到患者就诊的中位时间为半个月,从患者出现症状到确诊SLE的中位时间为3个月,有23.7%的患者需要1年以上方能确诊.结论 关节痛/炎、皮疹、发热为SLE最常见的首发临床表现.与女性患者相比,男性患者更容易出现肾脏损害.发病后不能正确选择科室就诊、诊断延误的SLE患者仍占相当大比例.     

系统性红斑狼疮合并妊娠患者孕期病情的变化及其对母儿结局的影响

目的 探讨系统性红斑狼疮(SLE)合并妊娠孕妇孕期病情的变化及其对母儿结局的影响.方法 选择44例合并SLE患者的46次妊娠,分析孕期SLE病情的活动情况及其对母儿结局的影响,找出与母儿不良预后相关的危险因素.采用t检验、X2检验或Fisher精确概率法及多因素非条件Logistic回归分析等方法进行统计学分析.结果 ①孕期出现SLE病情活动19例次(活动组);无SLE活动27例次(稳定组).SLE的活动率在孕前病情稳定的患者中为16％(5/32),在孕前病情不稳定的患者中为100％( 8/8),2组相比差异有统计学意义(P＜0.05).②孕期SLE活动的主要临床表现为:活动性狼疮肾炎(11例)、皮疹(10例)和关节炎(7例);主要并发症为各类感染(11例).③母儿结局:早产、胎儿生长受限( FGR)和胎儿丢失的发生率在活动组分别为42％、47％和26％,在稳定组分别为7％、15％和0,活动组较稳定组明显升高,差异有统计学意义(P＜0.05);子痫前期、胎儿窘迫和新生儿窒息的发生率在活动组分别为16％、16％和5％,在稳定组分别为7％、19％和0,2组相比差异无统计学意义(P＞0.05).11例活动性狼疮肾炎患者的早产和FGR的发生率分别为55％和64％,较无活动性狼疮肾炎者的11％和17％明显升高,差异有统计学意义(P＜0.05).⑤Logistic回归分析显示肾损害、低补体水平、抗磷脂抗体(aPL)阳性和血清尿素氮水平分别是早产、FGR、胎儿丢失和胎儿窘迫的独立危险因素(P＜0.05).结论 ①孕期SLE活动可明显增加早产、FGR和胎儿丢失的发生率;活动性狼疮肾炎可明显增加早产和FGR的发生率;②肾损害、低补体水平、aPL阳性和血清尿素氮水平与不良胎儿结局密切相关.     

COPD急性加重期患者治疗前后血清4-HNE水平的变化

目的 综合评估不同分组COPD急性加重期(acute exacerbation of chronic obstructivepulmonary disease,AECOPD)患者治疗前后血清4-羟基壬烯醛(4-HNE)水平的变化,探讨4-HNE水平在COPD不同情况下的作用.方法 收集2013年1月至2015年5月山西医科大学附属山西大医院住院的40例AECOPD患者为研究对象,其中男36例,女4例,平均年龄(67±9)岁.所有患者按4种方式分组:①肺功能Ⅰ-Ⅱ级组和肺功能Ⅲ-Ⅳ级组;②B组(低风险多症状组)和D组(高风险多症状组);③合并心血管疾病组和无心血管疾病组;④嗜酸粒细胞≤2％组和嗜酸粒细胞＞2％组.另设健康对照组50例,与AECOPD组患者性别、年龄相匹配.采用酶联免疫吸附试验测定各组患者血清中4-HNE水平.结果 ①与健康对照组(9.4±3.0)mg/L比较,AECOPD患者治疗前(18.5±5.2) mg/L和治疗后(19.0±5.1) mg/L血清4-HNE水平均明显增高,差异均有统计学意义(P＜0.05).②AECOPD名组治疗前后及各亚组间治疗前比较血清4-HNE水平差异均无统计学意义(P＞0.05).③肺功能Ⅰ-Ⅱ级组和肺功能Ⅲ-Ⅳ级组及B组和D组治疗后血清4-HNE水平下降的比例分别为43.8％和50.0％及46.7％和54.5％,差异均无统计学意义(P＞0.05).④合并心血管疾病组和无心血管疾病组及嗜酸粒细胞≤2％组和嗜酸粒细胞＞2％组,治疗后血清4-HNE水平下降的比例分别为25.0％和66.7％及73.3％和32.0％,差异均有统计学意义(P＜0.05).⑤AECOPD患者治疗前后血清4-HNE水平与FEV1％pred差异无统计学意义(P＞0.05).结论 AECOPD患者系统性氧化应激反应增强,合并心血管疾病及外周血嗜酸粒细胞＞2％的AECOPD患者治疗后仍持续存在较高的系统性氧化应激反应,4-HNE水平可能成为COPD不同情况下的生物标志物,并为COPD提供新的治疗靶点.     

儿童幽门螺杆菌感染情况及其与上消化道症状的关系

[目的]探讨儿童幽门螺杆菌（Hp）感染与上消化道症状及胃黏膜病变的关系.[方法]纳入300例有上消化道症状患儿,Hp感染情况采用13C或尿素呼气试验或血清Hp抗体检查,204例患儿接受胃镜检查.[结果]①Hp阳性率为34.67％（103/300）,男女患者Hp阳性率差异无统计学意义（P＞0.05）,3～6岁、7～10岁及11～14岁年龄组Hp阳性率依次升高,组间差异有统计学意义（P＜0.05）;②胃镜检查显示39.21％患儿（80/204）有胃黏膜病变,Hp阳性者胃黏膜病变比例高于Hp阴性者（P＜0.05）;③Hp阴性者胃黏膜病变以轻-中度为主,而Hp阳性者胃黏膜病变以中-重度为主,两者病变严重程度的差异有统计学意义（P＜0.05）.[结论]有上消化道症状儿童Hp阳性率较高,且随年龄增长而增高,Hp感染与胃黏膜病变发生及严重程度相关.     

Systemic lupus erythematosus in Chinese: The singapore experience

Summary A clinical survey of idiopathic systemic lupus erythematosus (SLE) was conducted in 183 Chinese patients from 1970–1980. The major initial manifestations were skin and mucous membrane involvement (52%), fever and malaise (48%), arthritis and arthralgia (44%). Renal and neuropsychiatric involvements are described in some detail. Five-year survival was 70% and 10-year survival was 60%. The three major causes of death were renal, neurologic and infective. Factors contributing to this relatively high mortality compared with Western series are discussed.     

EB病毒潜伏期膜蛋白1诱发系统性红斑狼疮可能机制的探讨

目的 探讨EB病毒潜伏期膜蛋白1(LMP1)诱发系统性红斑狼疮(SLE)的可能机制.方法 应用实时荧光定量聚合酶链反应(PCR)检测SLE患者及健康对照外周血单个核细胞(PBMCs)的LMP1、凋亡相关基因bcl-2、bax mRNA表达水平,酶联免疫吸附试验(ELISA)法检测B细胞活化因子(BAFF)水平.采用x2检验进行阳性率比较,采用2-△△Ct法比较各基因表达水平,采用Student-Newman-Kqeuls法进行均数间两两比较.结果 ①SLE患者组LMP1阳性率为25％,显著高于健康对照组的11％(P=0.03).②SLE组bcl-2 mRNA表达水平2-△△Ct值为0.0257,对照组为0.0183,差异有统计学意义.③SLE组LMP1阳性患者bcl-2 mRNA表达水平2-△Ct值为0.0427,而LMP1阴性患者为0.0217,差异有统计学意义.④SLE组LMP1阳性患者、LMP1阴性患者,健康对照组LMP1阳性者、LMP1阴性者血清BAFF水平分别为(106±15)、(82±19)、(68±19)、(64±17) μg/L,SLE组LMP1阳性患者与其余3组比较差异均有统计学意义(P均＜0.01),SLE组LMP1阴性患者与健康对照2组比较差异有统计学意义(P＜0.01).结论 EB病毒可能通过LMP1影响凋亡相关基因bcl-2表达、诱导B细胞产生BAFF,导致被感染的自身反应性B细胞存活延长而促发SLE发生发展.     

系统性红斑狼疮男性患者临床及免疫学特征

目的 分析142例男性系统性红斑狼疮(SLE)患者起病时首发及发病过程中临床表现特征、自身抗体分布以及其他实验室指标改变特征,探讨SLE男性患者的临床及免疫学特征.方法 收集1994年4月至2010年4月于本院风湿免疫科住院的男性SLE患者142例,年龄12 ～ 68岁,平均年龄31.9岁;同期住院女性SLE患者320...     

儿童原发性干燥综合征五例并文献复习

目的 探讨儿童原发性干燥综合征(pSS)的常见临床表现以便于早期诊断.方法 列表分析了5例上海仁济医院收治的儿童pSS的临床特点,并搜索Medline和维普数据库进行文献复习.结果 ①儿童干燥综合征(SS)临床非特异性症状多见,口眼干燥症状往往缺乏或较晚出现;②反复发作的腮腺炎和皮肤病变发生率高,皮肤病变以皮肤十燥、鱼鳞样变和可触及的紫癜样皮疹为最常见表现,发生部位多变;③成人诊断标准不适用于儿童pSS的诊断.结论 儿童pSS的常见临床表现为有用的诊断线索,确诊依赖于抗SSMSSB抗体和唇腺活检检查.     

甲氨蝶呤在国人类风湿关节炎治疗中不良反应的调查及分析

目的 调查类风湿关节炎(RA)患者治疗中服用甲氨蝶呤(MTX)及其不良反应发生情况.方法 以现场问卷调查的形式记录325例RA患者服用MTX及其相关不良反应.采用SPSS 11.5软件进行统计分析.率的比较采用x2检验.结果 ①服用MTX患者总不良反应发生11例,占34.2%,其中胃肠道反应发生率最高(64例,占19.7%).总停药43例,占13.2%,其中肝功能损害停药率最高(17例,占5.2%).胃肠道反应及口腔溃疡发生时间在1周之内,肝功能受损、白细胞减少一般1～2个月.②MTX不良反应的发生率随服用剂量的增加而升高.③服用叶酸组不良反应发生率均低于未服叶酸组.结论 MTX治疗RA不良反应较常见,程度较轻,但应定期随访,避免严重不良反应的发生.补充叶酸可明显增加患者的耐受性.     

血D-二聚体检测在类风湿关节炎中的临床意义

目的 检测类风湿关节炎(RA)患者血中D-二聚体水平,探讨其在RA中的临床意义.方法 本研究纳入RA患者58例,疾病对照组患者64例(包括系统性红斑狼疮18例、血清阴性脊柱关节病15例、骨关节炎11例、其他结缔组织病20例).所有患者均排除血栓性疾病,近6个月无手术、外伤和肿瘤病史.记录患者的临床和实验室指标,采用免疫比浊法检测血中D-二聚体水平.并研究其与RA患者疾病活动度(DAS28评分)、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)等指标的关系.采用Mann-Whitney U检验、t检验及Spearman相关分析.结果 ①RA患者血D-二聚体增高的比例明显高于疾病对照组(分别为82.6%和21.9%,P＜0.01).血D-二聚体水平在RA患者中明显高于对照组[分别为(1.76±1.57)和(0.32±0.25)mg/L,P＜0.01].②在RA患者中,D-二聚体增高组DAS28水平高于D-二聚体正常组(5.4±1.0和4.4:±0.8,P＜0.01).D-二聚体增高组RA患者的ESR、CRP和RF水平均高于D-二聚体水平正常组RA患者[分别为(58±29)和(28±13)mm/1 h;(39±36)和(11±9)mg/L;(409±718)和(46±40)U/ml,P均＜0.05].③相关性分析显示,D-二聚体水平与DAS28评分(r=0.406,P＜0.01)、ESR(r=0.355,P＜0.01)和RF(r=0.319,P＜0.05)具有相关性.结论 RA患者血D-二聚体水平较其他风湿病患者明显升高,且与病情活动度密切相关.提示凝血-纤溶系统激活可能在RA的病情发展和病理过程中发挥作用.

Abstract：

Objective To detect D-Dimer in the blood of rheumatoid arthritis (RA) patients and to investigate its clinical significance in RA. Methods Blood samples were obtained from 58 patients with RA,18 patients with systemic lupus erythematosus (SLE), 15 patients with ankylosing spondylitis, 11 patients with osteoarthritis, and 20 patients with other connective tissue diseases. The presence of thrombotic diseases was excluded in all patients. The presence of D-Dimer in the blood was examined by immunoturbidimetry. The following clinical and laboratory data were collected: disease activity index DAS28, rheumatoid factor (RF),erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Mann-Whitney U test, t-test ,Spearman correlation were used for statistical analysis. Results ① The prevalence of high level D-Dimer in RA patients was higher than that of the control group (82.6％ vs 21.9％, P＜0.01). The titer of D-Dimer in RA was significantly higher than that of the control group [(1.76±1.57) vs (0.32±0.25) mg/L, P＜0.01]. ②DAS28 was higher in RA patients with positive D-Dimer than those with negative D-Dimer (5.4±1.0 vs 4.4±0.8,P＜0.01). The values of ESR, CRP and RF in RA patients with positive D-Dimer were significantly higher than those in patients with negative D-Dimer (P＜0.05). ③ There was positive correlation between D-Dimer and DAS28 (r=0.406, P＜0.05), ESR (r=0.355, P＜0.01), and RF (r=0.319, P＜0.05). Conclusion The level of D-Dimer in the blood of RA patients is significantly higher than other rheumatic diseases, and is positively correlated with disease activities. The results indicated that the activation of coagulation-fibrinolytic systems may play a role in the pathogenesis of rheumatoid arthritis.