1958例系统性红斑狼疮住院患者临床特征分析

目的回顾性分析系统性红斑狼疮(SLE)住院患者的临床特征,分析其发病形式及患者就诊时的情况。方法采用流行病学调查的方法,随机抽取江苏省10年来1 958例SLE住院患者的病历,分析其临床特征,采用SPSS 13.0软件包进行统计学分析。结果①在1 958份病例中,临床特征以关节痛(炎)最多(53.8%),其次为面部红斑(48.3%)、发热(36.1%)、肾损害症状(24.5%)。②男女发病比例为1.0︰15.0,男性以皮疹最多见,占59.0%,高于女性47.6%,其次为发热(47.5%),高于女性(35.3%),关节痛(炎)(45.9%低于女性(54.3%),男性肾损害(36.9%),高于女性(23.7%)。③不同年龄患病率:≤20岁(19.2%),>40岁(18.8%),20～40岁(62.0%)。④从出现症状到住院:发热13.8个月,肾损害症状19.5个月,关节痛(炎)36.9个月,面部红斑37.2个月。结论关节痛(炎)、面部红斑、发热是SLE最常见的临床表现,是就诊的主因。中青年女性发病率高,男性皮疹、发热、肾损害发生率高,而女性关节痛(炎)发生率高于男性。     

复方丹参注射液联合甲强龙治疗过敏性紫癜50例临床护理

目的探讨应用复方丹参注射液联合甲强龙(甲泼尼龙)治疗儿童急性期过敏性紫癜(HSP)的临床护理价值。方法选择儿科住院的HSP患儿50例,急性期均给予复方丹参注射液+甲泼尼龙静脉滴注,治疗过程中进行积极的中西医结合护理,观察情志、皮肤、关节疼痛、腹痛以及肾损伤等临床护理。结果全部患儿在急性期症状均得到有效控制。45例消化道出血于1周内停止(90%)。合并关节疼痛28例(56%),一周内恢复。合并肾脏受累23例(46%),3个月内全部患儿肾功能恢复。治疗及随访期间全部患儿未出现明显药物毒副作用。结论急性期应用复方丹参注射液联合甲泼尼龙可迅速控制HSP的消化道出血、关节疼痛、合并肾损伤等。耐心细致的护理是保证治疗效果的关键因素。     

Helicobacter pylori: prevalence,clinical and endoscopic findings in children who underwnet upper endoscopy for abdominal ailments

A total of 97 children aged 1 month to 16 years (mean 6.6 years) had upper endoscopies performed in Paediatric Institute, Kuala Lumpur Hospital between January 1997 and December 1999 for various gastrointestinal symptoms. Of these 70 children were tested for Helicobacter pylori. The four most common indications for upper endoscopy were recurrent abdominal pain, upper gastrointestinal bleeding, epigastric pain and vomiting. The overall prevalence of this infection in this heterogenous group of symptomatic children was 10% (7/70). This study shows that H.pylori positivity in a routine endoscopy population is low and does not appear to be associated with specific symptoms.     

胰胆管合流异常10例的临床分析

目的探讨胰胆管合流异常(pancreaticobiliary maljunction,PBM)的临床特点、诊断及治疗。方法对西京医院2009～2011年确诊的10例PBM患者临床资料进行回顾性分析。结果患者主要临床表现为腹痛(100%),伴有发热(20%)、黄疸(30%)、恶心(40%)和消化不良(10%)等。50%的患者存在上腹部压痛,Murphy征均为阴性。70%患者肝功能检查异常。青少年患者(13～18岁,3例)多合并先天性胆管囊肿。中年患者(45～62岁,7例)多合并复发性胰腺炎、慢性胰腺炎、慢性胆囊炎和胆总管结石。有3例行腹部B超检查,7例行腹部CT检查,但均未确诊。MRCP明确诊断者3例,其中1例为P-B型,2例开口类型不明确。ERCP明确诊断者7例。均为B-P型。结论内镜下胰胆管逆行造影(ERCP)是诊断PBM的金标准,不仅可以清晰显示胆管、胰管和共同段,还可以进行内镜下治疗以缓解患者症状。择期外科手术是治疗PBM的主要方法,防止可能出现的并发症。     

Primary malignant lymphoma of the gastro-intestinal tract: a clinicopathological study of 24 cases.

Twenty-four cases of primary lymphoma of the gastro-intestinal tract were diagnosed during the period 1970 to 1991. There was a preponderance of males and the male to female ratio being 1.4:1. Age ranged from 9-70 years, mean 32.2 years. Small intestine was involved in 50% cases, large bowel in 9 cases (37.5%) and stomach in 3 cases (12.5%). There were 5 cases (20.8%) of Hodgkin's disease and 19 cases (79.2%) were of non-Hodgkin's lymphoma. All cases of gastric lymphoma complained of epigastric pain, weight loss and vomiting. In lymphoma of small intestine, 8 patients complained of pain associated with vomiting and 6 patients complained of distension of abdomen. In large bowel lymphoma, pain in right iliac fossa was complained by 4 patients and bleeding per rectum by 3 patients. Out of all the 24 cases, changes in bowel habit were noted in 15 patients and occult blood was positive in 13 cases. Palpable abdominal mass was noted in 14 patients. Histomorphologically, all the 3 cases in the stomach were of lymphocytic lymphoma diffuse type. Out of 19 non-Hodgkin's lymphoma, 15 were of lymphocytic lymphoma and 4 were of histiocytic lymphoma.     

Familial Mediterranean fever in six Australian children

Six Australian children fulfilled the diagnostic criteria for familial Mediterranean fever. None had a family history of the disease, but five children came from ethnic groups that typically were associated with the disease. The symptoms commenced before five years of age in all the children, and three children underwent unnecessary operations because of the symptoms of recurrent fever and abdominal pain. All six children benefited from colchicine prophylaxis by mouth. More cases can be expected to be recognized in Australia because of the large number of Australian children with a Mediterranean heritage.     

过敏性紫癜93例临床分析

对93例过敏性紫癜进行分析,发现:发病季节以春、冬为高,占73.1%;无性别差异;年龄以学龄期儿童最多,占74.2%。53.8%患儿发病与细菌或病毒感染有关。本文着重讨论了消化道和肾脏损害的临床表现及机理。预后大多良好,近期治愈率82.8%,好转率15%,均为伴有肾脏损害的患者。     

儿童再发性腹痛与上消化道疾病及幽门螺杆菌感染的关系

目的：探讨儿童再发性腹痛与上消化道疾病、幽门螺杆菌感染的关系。方法：对198例再发性腹痛(RAP)息儿进行胃镜检查及幽门螺杆菌检测。结果：组织病理学证实169例(85．4％)粘膜有炎症改变。慢性胃炎140例(82．8％)，食道炎15例(8．87％)，十二指肠球炎8例(4．73％)，消化性溃疡6例(3．55％)。组织学染色及快速尿素酶实验证实HP感染为97例(49．0％)。HP阳性者粘膜均有炎症改变。胃炎HP感染率为64．3％。而HP阴性胃炎者仅35．7％，相反，食道炎和十二指肠球炎者HP感染率低。消化性溃疡者其中5例(83．3％)HP阳性。1例(16．7％)HP阴性。结论：小儿LRAP中上消化道疾病占较高比率。HP感染可能是引起RAP的主要原因之一。     

先天性胆管扩张症56例临床分析

目的探讨先天性胆扩张症（CBD）的诊断和治疗。方法对56例14岁以下CBD患儿一般资料、诊断依据、扩张胆管类型和术式进行回顾性分析。结果本组患儿发病年龄在3岁以下者占46.4%;男女比为1∶2.5;具有＂三联症＂者约占21.4%,具有＂四大症状＂者约占12.5%;经B超、磁共振胰胆管成像（MRCP）、CT等检查,诊断符合率分别为92.9%、96.4%和81.8%,全部患儿行手术治疗,除1例因术后并发胆汁性腹膜炎死亡,其余55例痊愈。结论 B超、MRCP是诊断CBD的常规检查手段,小儿重症胆总管囊肿先行B超引导下囊肿穿刺置管外引流术是一种较好的临时措施,扩张胆管切除＋肝总管空肠Roux-en-Y吻合术是治疗CBD的标准术式。     

王耀光教授治疗痹证经验撷萃

痹证是临床常见肢体经络病之一,临床表现多样、病情复杂,患者常疼痛难忍,严重影响日常工作与生活。王耀光教授认为痹证的病因病机为邪阻经络、脏腑气血精液亏虚,治疗上常选用经方加减,善用虫类药、藤类药且注意肝肾的调护。本文主要介绍王耀光教授治疗痹证的临床经验。     

温脾健胃颗粒治疗小儿功能性腹痛临床观察

目的:观察温脾健胃颗粒治疗小儿功能性腹痛的临床疗效。方法:将80例小儿功能性腹痛患儿随机分为治疗组与对照组各40例,治疗组以温脾健胃颗粒,对照组以颠茄片及思连康口服;比较两组治疗后腹痛、食欲不振等临床症状积分变化情况。结果:两组腹痛发作情况均有不同程度的改善,而治疗组显效率及总有效率均高于对照组。结论:温脾健胃颗粒治疗小儿功能性腹痛临床疗效确切。     

133例遗传性血管性水肿患者的临床分析

目的分析遗传性血管性水肿（HAE）患者临床特点,总结HAE发病规律及临床表现模式。方法通过临床问诊、病历查阅、电话随访、家系调查等方法回顾性分析40个HAE家系133例患者临床及实验室资料。结果（1）临床表现：所有患者均有肢体和／或颜面、生殖器水肿史。89例（66．9％）患者病程中出现过喉水肿,有4例患者曾经因喉水肿引起的窒息行气管切开术。102例（76．7％）患者有腹部症状包括轻微腹部不适,甚至难以耐受的腹部绞痛。对就诊时正处于腹痛发作期的6例患者行腹部B超检查,均发现有腹水。（2）发病频率：未经诊治时,100例（75．2％）患者发病频率≤每月1次,31例（23．3％）患者每月发病1～3次,仅2例患者发病频率≥每月4次,即每周发病1-2次。（3）家族史：8例无明确家族史。（4）类型：133例患者中130例为Ⅰ型HAE（HAE-Ⅰ）,仅1个家系中的3例患者C1-INH含量略高于正常,C1-INH功能为正常值的2％,诊断为Ⅱ型HAE（HAE-Ⅱ）。（5）长期预防性治疗：本研究中58例（43．6％）采用口服达那唑行长期预防性治疗,对所有患者都能起到预防发作的作用,大多数患者对达那唑耐受良好。结论（1）遗传性血管水肿是一种罕见的常染色体显性遗传病。（2）我国HAE-Ⅱ罕S见,跟国外报道似有不同。（3）长期应用达那唑治疗可有效预防遗传性血管水肿发作,患者耐受性好。     

Upper gastrointestinal endoscopy in children - an experience at a paediatric gastroenterology unit

Upper gastrointestinal endoscopy has changed the management of upper gastrointestinal problems in children. The aim of this communication is to share our experience with 153 cases on whom upper gastrointestinal endoscopy was done over a period of 24 months at a paediatric gastroenterology unit of a tertiary care hospital of Dhaka, Bangladesh. Children who attended the department with various gastrointestinal problems are the subjects of this paper. Intravenous midazolam and 10% pharyngeal xylocain were used in majority of cases for sedating the children. The ages of the children were between 15 months to 15 years (9.41+/- 3.22 years). The positive diagnostic yield was 92 out of 153 cases (60.1%). The major indication for doing endoscopy in the present series was recurrent abdominal pain (51.6%), followed by upper gastrointestinal bleeding (28.8%). Combining histopathological findings and CLO/rapid urease tests the overall positive yield of recurrent abdominal pain was 45 out of 79 (57%). The sources of upper gastrointestinal bleeding could be identified in 79.5% cases. Esophageal varices indicating portal hypertension were found in 62.5% children who were endoscoped for unexplained splenomegaly with or without ascitis. Endoscopy has become a safe and valuable procedure in the management of upper gastrointestinal problems in children and gastric antral biopsy has increased the positive diagnostic yield of recurrent abdominal pain in the studied children.     

Intussusception in children 2 years of age or older.

The hospital records of 111 children aged 2 to 15 years who were treated for intussusception between mid-1974 and mid-1984 were reviewed. Severe intermittent abdominal pain was the most consistent, and frequently the only, clinical feature. Hydrostatic reduction was almost as successful as in children under 2 years of age, and its success was independent of the duration of symptoms. Most cases were idiopathic, but lead points were common in children 6 years of age or older. There was an unexpectedly high recurrence rate, 20%. In all three children with lymphoma the signs and symptoms were clearly atypical and were suggestive of pre-existing disease. In the absence of suspicious clinical or radiologic findings, laparotomy to rule out lymphoma is not warranted.     

148例溃疡性结肠炎临床分析

目的：探讨溃疡性结肠炎（ＵＣ）临床特征，提高对本病的认识及诊治水平。方法：回顾性分析我院１９９５年￣１９９７年收治的经纤维结肠镜确诊的１４８例ＵＣ患者的临床特征。结果：发现ＵＣ的住院病例较前有增高趋势，男女发病率无明显差异，发病平均年龄为４０．３７岁，３０￣４９岁多发。临床特征有腹泻（８０．４１％），脓血便（６３．５１％），腹痛（６８．９２％）及发热，这些表现的发生率随病变范围加大而增高，病变范围     

小儿急性胰腺炎27例临床分析

目的:探讨小儿急性胰腺炎的临床特征,以提高该病的诊断和治疗水平.方法:回顾分析近5年收治的27例小儿急性胰腺炎的临床资料.结果:呕吐、腹痛、发热是小儿急性胰腺炎症状;血、尿淀粉酶均显著升高;腹部超声显像率为33.3%,而同期腹部CT显像率为83.3%;病毒感染(40.7%)和胆源性疾病是小儿急性胰腺炎的主要病因.结论:小儿急性胰腺炎与成人相比临床特征和病因有差异,早期保守治疗能达到满意的效果.     

睡眠问题、焦虑及压力是颞下颌关节紊乱病肌筋膜疼痛发病的风险指标

目的：调查睡眠及心理问题在颞下颌关节紊乱病（temporomandibular disorders, TMD）患者中的患病情况,并探讨其是否可能与TMD发病有关。方法：采用抑郁焦虑压力量表-21（depression, anxiety and stress scales-21, DASS-21）评估患者抑郁、焦虑、压力情况;采用匹兹堡睡眠质量指数量表（Pittsburgh sleep quality index,PSQI）评估患者睡眠质量;纳入连续就诊的755名TMD初诊患者（男性：172名,女性：583名）,年龄11~82岁,平均年龄（29.99±13.60）岁。收集患者TMD临床检查各项数据及临床统计信息,根据颞下颌关节紊乱病研究诊断标准（Research Diagnostic Criteria for Temporomandibular Disorders, RDC/TMD）,755名TMD患者共分为7组,包括肌筋膜疼组、关节盘移位组、关节痛/骨关节炎（病）组、肌筋膜疼痛+关节盘移位组、肌筋膜疼痛+关节痛/骨关节炎（病）组、关节盘移位+关节痛/骨关节炎（病）组以及肌筋膜疼痛+关节盘移位+关节痛/骨关节炎（病）组,为进一步统计分析,将TMD患者又分为伴有（n=181）和不伴有肌筋膜疼痛（n=574）两组,采用SPSS 20.0对结果进行统计学分析。 结果：伴有肌筋膜疼痛患者,其中度以上睡眠问题、抑郁、焦虑以及压力的患病率（27.1%、28.7%、60.8%及32.0%）显著高于不伴有肌筋膜疼痛（关节盘移位及关节痛/骨关节炎（病）的患者（11.1%、10.1%、27.4%及11.0%）, P<0.05。Logistic逐步回归分析表明,睡眠问题［（OR=1.74）,具体包括主观睡眠质量（OR=1.69）和睡眠障碍（OR=1.63）两项睡眠因子］、焦虑（OR=3.14）及压力（OR=2.15）与TMD肌筋膜疼痛的发病有关,且差异具有统计学意义（P<0.05）。结论：TMD患者常常主诉有睡眠及心理问题,与关节盘移位或关节痛/骨关节炎（病）相比,肌筋膜疼痛患者更为严重;主观睡眠质量、睡眠障碍、焦虑及压力与TMD肌筋膜疼痛的发生有关。     

上海市长宁区学龄儿童消化不良症状发生情况及其与膳食模式的关联研究

为调查上海市长宁区学龄儿童消化不良症状的发生情况,研究膳食模式对其影响,于2019年9月采用整群抽样方法从长宁区5所小学选择304名7～11岁健康儿童,使用问卷调查基本信息、生活习惯、食物消费情况和消化不良症状的发生情况.采用因子分析提取膳食模式,通过Logistic回归分析膳食模式与学龄儿童消化不良症状的关系.半年内...     

西宁地区儿童过敏性紫癜128例临床分析

目的探讨西宁地区儿童过敏性紫癜(Henoch一Schonlein purpura,HSP)的临床特征。方法对128例过敏性紫癜患儿的发病特点、临床表现、肾损害相关因素等方面进行回顾性分析。结果发病季节:第1、2、3、4季度的发病率依次为32.03%、9.37%、7.04%、51.56%。诱因:感染占72.65%,药物过敏占10.94%,食物过敏占7.3%。肾脏症状发生率为26.56%。结论西宁地区HSP发病率以第1、4季度发病人数为多;发病诱因以感染为首要因素,结果有别于内地。HSP早期出现较多肾外症状,易发生肾损害。以腹痛为首发症状的HSP易误诊为急腹症。     

小儿生殖细胞肿瘤的诊断和治疗(附20例报告)

目的:探讨小儿生殖细胞肿瘤(GCT)的临床特征、病理类型、诊断、治疗方法。方法:对20例GCT患儿的临床资料进行回顾性分析。患儿年龄5月至9岁,其中卵巢肿瘤14例,睾丸肿瘤6例。结果:20例均行手术治疗,术后恢复良好,随访1~5年,全部存活。其中1例术后脾脏及肝脏先后出现转移灶,已再次手术。10例恶性卵巢肿瘤术后行PEB方案化疗。所有病例均经术后病理学检查确诊。结论:小儿GCT其临床表现无特异性,多以腹痛、腹胀、下腹部、盆腔及睾丸包块为首发症状。其预后与肿瘤的分期,组织级别有关。分期越早、级别越低,患者预后越好。早期手术切除是主要治疗方法,恶性肿瘤需要化疗或放疗,定期随访十分重要。