风湿热的几个非特异性表现(附53例临床分析)

<正> 近四十年来,急性风湿热的严重程度有所减轻,患者临床表现往往也不典型。用Jones标准来诊断急性风湿热是众所公认的,但随着抗生素和抗风湿制剂的广泛应用,风湿热的特异性表现(即Jones主征)已较少见,而一些非特异性表现逐渐为人们重视。为此,特收集我院1978～1982年5年间住院风湿热患者53例,其中男31例,女22例,年龄6～18岁,全部病例均符合1965年修订的Jones诊断标准。本文旨在分析和讨论风湿热患者非特异性表现的出现率、机理及临床特点。     

急性风湿热诊断标准探讨(附62例临床分析)

本文采用修订的Jones标准对62例首发急性风湿热患者进行诊断分析。结果,符合该诊断标准的仅33例(53.23％),29例(46.77％)不能用该标准作出诊断。通过临床结合分析,有效的抗风湿治疗,并结合文献,对Jones诊断标准提出四种情况的诊断意见,以提高诊断的可靠性,避免漏诊与误诊。     

风湿热

风湿热是一种炎性疾患,系A族链球菌感染的后果。1/3～1/2的病例可发生心脏损害。风湿热可发生于任何年龄,但婴儿罕见,最多见于5～15岁。在流行性链球菌咽峡炎患者中,风湿热的发病率平均2～3％,而在散发和轻症病人中,发病率可能更低。影响发病率的两个重要因素是:(1)链球菌感染恢复过程中咽部带菌的时间;(2)对链球菌感染免疫反应的强弱。以往患过风湿热者,链球菌感染后发病率明显增高(10～50％)。     

关于风湿热的诊断与防治的一些问题(综述)

风湿热是由于 A 族溶血性链球菌感染所致,反复发作的全身胶原组织的一种炎症性疾病。临床表现以心脏炎与关节炎为主,伴有发热、毒血症、皮疹、皮下小结、舞蹈病等症状。关节受累是风湿热的常见症状,其重要性主要在于心脏受累,约占风湿热病例的1/3～1/2。心脏受累以后,重者可在急性期死亡,更多的是引起心脏瓣膜等结构发生慢性疤痕组织和变形。故有“风湿热象条疯狗,舔了一下关节,却咬了一口心脏”的比喻。而在链球菌性咽炎流行的病例中,约有3％病例发生风湿热。风湿热是对劳动人民     

儿童急性风湿热73例远期随访

为了解儿童急性风湿热之预后,探讨影响预后之有关因素,将我院1964～1978年间儿科收治之急性风湿热初发病例,按1965年Joaes修订标准复核诊断,随访73例的结果报告如下。材料与方法 73例中男38例,女35例。年龄5～12岁,其中≥7岁者62例。分组①无心脏炎组(20例),其中包括单纯     

小儿风湿热87例临床分析

<正> 风湿热(Rheumatic fever)是由A组β溶血性链球菌感染后所引起的全身结缔组织非化脓性炎症,病变主要是累及心脏、滑膜、皮肤、脑等器官,从80年代以来,世界各地风湿热的发病率又开始回升,其临床表现也发生了变异,现将我院儿科1992年2月～2000年2月8年间87例小儿风湿热病例     

补阳还五汤对亚砷酸治疗急性早幼粒细胞白血病患者的心脏保护作用

[目的]评价补阳还五汤对亚砷酸治疗的急性早幼粒细胞白血病(APL)患者心脏的保护作用.[方法]将62例使用亚砷酸化疗而引起心脏毒性患者随机分为治疗组和对照组,每组各31例.对照组给予西医常规治疗(包括将维生素C 3.0 g加入5％葡萄糖注射液100 mL中静脉滴注,1次/d,同时口服辅酶Q1010 mg,3次/d),治...     

小儿风湿热28例临床分析

报告我院近１０件来收治的２８例小儿风湿热临床分析。其发病年龄、临不表现均符合修订的Ｊｏｎｅｓ诊断标准。其中心肌炎２０例（７１．４％）。关节炎１９例（６７．９％）。经抗炎、抗风湿及激素治疗，１５例治愈，１３例好转。本病发生多与上呼吸道感染有关，累及心脏的比例高，故使用激素的指征可适当放宽，本病易复发，应于初发后５－１０年长期肌注育霉素，发病后应及时刊物为、抗风湿治疗。     

儿童首次发作的急性风湿热73例远期随访

为了解儿童急性风湿热预后,探讨影响预后之有关因素,收集我院1964～1978年间我科收治之风湿热初发病例,按1965年Jones修订标准复核诊断,随访73例结果报告如下; 73例中男38例,女35例,年龄5～12岁,其中≥7岁者62例。按入院时表现分组①无心脏炎组(20例)其中包括单纯性风湿性关节炎19例,舞蹈症1例;②心脏炎组(53例)其中心肌炎38例,心内膜炎12例,全心炎3例。 随访最短1年,最长15年,5年以上者47例,10年以上者18例,复查内容包括详细病史查体,心电图,     

急性风湿热564例临床分析

本文报道恩施自治州16年采收治的急性风湿热564例,并对不同住院时期和不同年龄阶段风湿热发病及临床表现特点进行分析。发现恩施自治州急性风湿热住院比例有所下降,但住院病例明显增多,不同年龄阶段风湿热发病中临床表现差异大,风湿热发病年龄有增大趋势,30岁以后初发者占22.5％。认为中老年风湿热也应受到重视。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.