糖皮质激素联合羟氯喹治疗系统性红斑狼疮皮疹的疗效观察

目的:观察糖皮质激素(泼尼松)联合羟氯喹治疗系统性红斑狼疮皮疹的疗效。方法:选择73例系统性红斑狼疮患者,随机分成A、B两组,A组38例,在采用糖皮质激素[泼尼松:第1周40 mg/(次.d),第2周30 mg/(次.d),其后逐渐减量]治疗的基础上,加羟氯喹0.2 g/次,2次/d口服;B组35例,仅使用糖皮质激素[泼尼松第1周50 mg/(次.d),第2周40 mg/(次.d),其后逐渐减量]治疗,疗程均为4周。结果:A组有效率92.1%,B组82.8%,两组疗效差异无统计学意义(P>0.05)。但在皮质激素用量上,二者差异有统计学意义(P<0.05)。结论:羟氯喹联合糖皮质激素治疗系统性红斑狼疮皮疹,与单纯使用糖皮质激素治疗相比,糖皮质激素用量低,不良反应小,患者耐受性好,值得推广。     

肺奴卡菌病一例

临床资料 患者女性，68岁。因“多关节肿痛4年，发热、咳嗽20d”于2006年10月9日入院。患者于2002年开始相继出现多关节疼痛及皮肤散在红斑，外院确诊为系统性红斑狼疮（SLE），并予泼尼松片50mg／d口服，1年后减量为5mg/d维持，症状缓解。2004年自行停服。2006年7月复发，给予泼尼松片60mg/d口服，1月后减为30mg／d维持。     

系统性红斑狼疮合并贲门失弛缓症1例

患者，女。15岁。因反复发热、面部红斑1年余，意识丧失、抽搐2h于2005年4月113收住院。2003年12月，患者无诱因出现发热、面部红斑，伴恶心、呕吐，外院诊断为系统性红斑狼疮（SLE），给予泼尼松45mg／d治疗，症状缓解，激素渐减量至20mg／d维持。2004年4月，病情复发，并出现癫痫样发作、血小板减少、尿蛋白（3＋），[第一段]     

抗磷脂综合征合并门静脉下腔静脉栓塞一例

患者女 ,2 8岁。因反复血小板减少 4年余 ,发热、咳嗽、腹痛、便血 1周 ,呕血 3d于 2 0 0 3年 1月 2 3日入院。患者于1998年 9月因少量鼻衄、齿衄多次在院外就诊 ,发现血小板减少 ,约 10× 10 9/L左右 ,诊断原发性血小板减少性紫癜。口服泼尼松片 6 0mg每日 1次治疗 (疗程时间不详 ) ,血小板升至 10 0× 10 9/L以上后减量停药。但血小板反复减低 ,最低时 8× 10 9/L。于 2 0 0 1年 10月在院外诊断为 :系统性红斑狼疮 (SLE)。持续口服泼尼松 6 0mg/d ,约 8个月之后减量至 10mg/日维持。 2 0 0 2年 1月患者发生自然流产一次。 2 0 0 2年 4…     

疑难病例析评第246例紫癜样皮疹-气短-心悸-活动耐力下降

病历摘要 患者男,50岁,因"反复双下肢紫癜样皮疹6年,气短、心悸1个月余"于2005年11月住北京协和医院.患者自1999年于大腿内侧、腰部、踝部、上臂内侧出现成片紫癜样皮疹.2001年6月诊断为过敏性紫癜? 予泼尼松30 mg 1次/d及雷公藤多甙10 mg 3次/d治疗,皮疹有缓解,当泼尼松减量到15 mg 1次/d时,皮疹再次出现.多次查尿蛋白阳性.2005年7月患者觉头晕,查尿常规:尿蛋白1.0～>3.0 g/L、潜血大量;24 h尿蛋白定量0.4～1.6 g;心脏超声(UCG)示少量心包积液.     

妊娠合并系统性红斑狼疮伴脑病性癫()一例报告

1 临床资料患者27岁,因发现面部蝶行红斑8年,反复意识丧失、抽搐2年,停经38周入院.1990年仁济医院诊断为系统性红斑狼疮(SLE),予口服泼尼松治疗,近年维持量为5mg/d.1996年始因反复意识丧失、抽搐,诊断为SLE脑病.     

肾病综合征并发肺孢子菌肺炎一例

1 病例简介 患者,女,67岁,因反复眼睑及双下肢水肿半年,咳嗽发热5 d于2009-03-28入院.患者半年前出现眼睑及双下肢水肿,尿中泡沫增多,尿常规检查示:尿潜血(+ + +),尿蛋白(+ +),在外院诊断为肾小球肾炎,给予雷公藤多苷,贝那普利等药物治疗,眼睑及双下肢水肿时轻时重.3个月前受凉后上述症状加重,伴恶心、呕吐,24 h尿蛋白定量为4.44 g,血清蛋白29.1 g/L,在外院诊断为肾病综合征,给予泼尼松50 mg,1次/d,雷公藤多苷20 mg,3次/d,来氟米特20 mg,1次/d及抗凝、降脂等治疗.     

不同剂量糖皮质激素治疗系统性红斑狼疮的临床疗效及对骨骼的影响

目的探讨不同剂量糖皮质激素治疗系统性红斑狼疮的临床疗效及对骨密度和骨损伤的影响。方法选择2013年1月至2015年8月淮安市第二人民医院收治的90例系统性红斑狼疮患者为研究对象,根据随机数字法分为高剂量组、中剂量组和低剂量组,每组30例。高剂量给予泼尼松100 mg/d口服治疗,连续治疗4周后每周递减5 mg直至维持剂量;中剂量组患者给予泼尼松80 mg/d口服治疗,连续治疗4~8周后每周递减5 mg直至维持剂量;低剂量组患者第1周给予泼尼松40 mg/d口服治疗,第2周给予30 mg/d口服治疗,第3周起逐渐减量直至维持剂量。治疗6个月后,比较3组患者的临床疗效,观察三组患者治疗前后血清甲状旁腺素(PTH)、血钙及Wards三角区骨密度变化,以及骨损伤发生率。结果高剂量组、中剂量组、低剂量组总有效率分别为90.00%(27/30)、83.33%(25/30)、66.67%(20/30),高剂量组、中剂量组临床疗效优于低剂量组(P<0.05)。治疗后,高剂量组、中剂量组血清PTH显著高于低剂量组[(22.7±5.3)ng/L、(19.8±4.7)ng/L比(16.9±4.8)ng/L],血钙显著低于低剂量组[(2.02±0.14)mmol/L、(2.10±0.16)mmol/L比(2.19±0.14)mmol/L](P<0.05);高剂量组Wards三角区骨密度均低于中剂量组、低剂量组[(0.71±0.19)g/cm2比(0.81±0.17)g/cm2、(0.84±0.19)g/cm2](P<0.05)。高剂量组骨损伤发生率为33.33%(10/30),显著高于中剂量组、低剂量组的10.00%(3/30)和6.67%(2/30)(P<0.05)。结论高剂量与中剂量泼尼松治疗系统性红斑狼疮的临床疗效相当,但高剂量治疗的骨损伤发生率较高,可将中剂量糖皮质激素作为治疗系统性红斑狼疮的指导用量。     

医源性股骨头无菌性坏死2例

临床资料例1,女,24岁。5年前确诊系统性红斑狼疮(SLE),使用强的松60mg/日、雷公藤60mg/日,住院治疗4个月,出院时强的松40mg/日,以后渐减量,一年后以强的松7.5mg/日,雷公藤20mg/日维持治疗。本次入院前1月起出现双侧髋部酸痛、行走明显障碍。诊断:SLE缓解期,股骨头无菌性坏死。例2,女,31岁,因发热,关节肿痛,免疫学异常于13年前确诊SLE,使用强的松60mg/日治疗2个月病情缓解后出院,以后渐减量至15mg/日,维持至5年因两     

系统性红斑狼疮合并偏瘫一例报告

1 病例摘要患者女性,65岁。因左踝部皮肤破溃半月余,1989年10月24日入院。患者于1986年1月起出现发热,关节痛及两手指尖瘀斑抗核抗体阳性,曾在本院确诊为系统性红斑狼疮(SLE)。经倍他米松,硫唑嘌呤等治疗,症状缓解。出院后倍他米松维持应用2年余,剂量1mg/日,后自行停药。不久患者双下肢反复出现红斑、结节、破溃等症状。检查:BP18/12kPa,双     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.