SARS的X线表现

目的 总结严重急性呼吸综合征(SARS)早期X线和CT的特征表现及诊断意义。方法 对82例临床确诊的1周内SARS病例的数字式正侧位x线胸片对比CT所见进行回顾性分析总结。结果 X线胸片分为7种类型：正常或局限性肺纹理粗重型4例(4．9％)；棉絮样渗出型48例(58．5％)；假性空洞型5例(6．1％)；叶段实变型12例(4．6％)；多灶肉芽肿型3例(3．7％)；弥漫渗出型3例(3．7％)；混合型7例(8．5％)。累及一侧肺57例(70％)，两侧同时受累25例(30％)。单发病变52例(63．4％)，单肺、双肺双发或多发30例(36．6％)。有局灶性病变的患者中，位于肺门周围或呈中央分布者22例；位于外围或胸膜下者32例。病变在3cm者以上者62例。累及肺上叶者32例(右侧19个、左侧13个)、右肺中叶12例和肺下叶38例(右侧20个、左侧18个)，其中30例呈多肺叶的双发或多发病变。14例患者行HRCT检查，均有阳性表现，其中4例在X线胸片上未见异常。结论 肺部浸润病灶是SARS的重要影像表现，具有复杂多样性，其中多灶肉芽肿及假性空洞征象可能是较特异的X线征象。HRCT能够显著提高SARS早期病变的检出率。追踪观察胸部X线的变化是观察疗效的重要指标。     

FasL和Bcl-2在肾癌组织中的表达及意义

目的：探讨FasL和Bcl-2在肾癌发生中的作用及与转移、预后的关系。方法：应用免疫组化法检测50例肾癌组织和50例正常肾组织FasL和Bcl-2的表达，与肾癌病理分级、临床分期、淋巴结转移和随访相比较。结果：FasL和Bcl-2在肾癌组织中的阳性表达分别为4l例(82．0％)和39例(78．0％)，而在正常肾组织中分别为6例(12．0％)和5例(10．0％)；G／G2中均为16例(76．2％)，G3 G4中为25例(89．2％)和23例(82．1％)；在Ⅰ Ⅱ期中分别为23例(74．2％)和20例(64．5％)，Ⅲ Ⅳ期为18例(94．7％)和19例(100％)；有淋巴结转移者为17例(100％)．无淋巴结转移者为24例(72．7％)及22例(66．7％)；生存率大于5年组为29例(74．3％)和27例(69．2%)．小于5年组则均为12例(100．0％)。均有显著性差异(P＜0．05)。结论：FasL和Bcl-2的异常表达与肾癌的发生、发展、病理分级、临床分期等有一定关系，可作为判断恶性程度和预后的指标。     

非典型肺炎的临床影像学探讨

目的探讨影像学对非典型肺炎的诊断价值。方法通过对一组发热、影像学诊断为肺炎病人资料的回顾分析，归纳出非典型肺炎多见的影像学征象。结果(1)非典型肺炎发病占肺炎总数的21．9％(185／872)；(2)节段肺炎约占非典型肺炎的61％(113／185)；多发肺炎约占18％(33／185)，最为多见；(3)非典型肺炎的渗出吸收较慢，统计平均为19.8d；(4)非典型肺炎检验结果为白血球总数升高少见，为13．6％；白细胞分类为淋巴升高最多见，为91．9％。结论影像学对非典型肺炎的诊断有重要的价值，其与典型肺炎的鉴别尚应结合临床和检验资料。     

重症急性胰腺炎43例外科治疗探讨

目的 探讨提高重症急性胰腺炎治愈率、降低病死率的外科治疗策略。方法 对我科收治的43例重症急性胰腺炎临床资料进行回顾性分析总结。结果 非手术治疗29例；治愈率89．7％(26／29)；病死率6．9％(2／29)，手术治疗14例；治愈率85．7％(12／14)；病死率14．3％(2／14)，重症Ⅰ级手术率24％(6／25)；治愈率92％(23／25)；病死率4％(1／25)，重症Ⅱ级手术率44．4％(8／18)；治愈率83．3％(15／18)；病死率16．6％(3／18)，总手术率32．6％(14／43)；总治愈率88．4％(38／43)；总病死率9．3％(4／43)。结论 严格把握手术指征和时机，以非手术综合治疗为主，手术治疗为辅的外科治疗策略。     

碳酸锂治疗酒依赖疗效分析

目的 评估碳酸锂治疗酒依赖的临床疗效。方法 对符合DSM-3诊断标准的36例酒依赖患使用碳酸锂治疗，并配合认知疗法，随访3a。结果 36例患住院17-60d，平均30d，均痊愈出院。经3a随访，36例中发现有12例(33．3％)完全戒断饮酒，均坚持服用碳酸锂；有15例(41．7％)能控制饮酒，间断服用碳酸锂；有9例(25％)重新喝酒，均未坚持服用碳酸锂。结论 碳酸锂能减轻酒依赖患的酒醉，减少持续饮酒的欲望。碳酸锂治疗酒依赖安全度高，疗效肯定。     

间质性膀胱炎的诊治

目的 探讨间质性膀胱炎的诊断及治疗。方法 对16例根据NIADDK诊断标准确诊的间质性膀胱炎的临床资料进行分析，总结该病特点及治疗效果。结果 16例间质性膀胱炎中仅2例膀胱镜检查发现典型Hunner溃疡。无溃疡型14例(87．5％)，膀胱平均容量285ml；组织病理学报告4例(25％)无炎性表现；12例膀胱呈非特异性炎性表现，其中有3例(25％)是粘膜下层组织肥大细胞明显增多。治疗用膀胱药物灌注，膀胱水压扩张及口服药物。12例(75％)有明显效果。结论 间质性膀胱炎诊断及治疗困难，易误诊而延误治疗，诊断主要依靠典型临床症状，膀胱镜检及病理学改变。大多数病人采取综合治疗可获得明显疗效。     

骨质疏松性骨折的临床特点及康复对策

目的：分析研究骨质疏松性骨折患者的临床特点，并提出相应的防治措施及康复对策。方法：对1997年2月～2003年2月人住我院康复医学科的骨质疏松骨折患者202例在性别、年龄、骨质疏松类型及程度、骨折原因、部位、次数、病程、治疗方法、并发症及预后等临床方面进行综合分析。结果：研究对象中原发性骨质疏松169例(83．66％)，继发性33例(16．34％)；骨质疏松程度：2．0S～3．0S 72例(35．64％)，3．0S～4．0S75例(37．13％)，大于4．0S55例(27．23％，)；自发性骨质疏松18例(8．9l％)，跌倒致骨折184例(91．09％)；单次骨折158例(78．22％)，多次骨折44例(21．78％)；骨折后手术治疗171例(84．65％)，保守治疗3l例(15．35％)；并发感染或压疮172例(85．15％)：平均住院天数50．30天；ADL评分(B1)≥75分182例(90．10％)(轻度功能缺陷)；50-70分13例(6．44％)(中度功能缺陷)；25-45分5例(2．47％)(重度功能缺陷)；≤20分2例(0．99％)(极重度功能缺陷)。结论：骨质疏松性骨折发生率与年龄，骨质疏松程度呈正相关性分布，跌倒是骨折最危险因素。     

免疫双扩散和免疫印迹法检测抗J0-1抗体对肌炎诊断价值的比较

目的 比较免疫双扩散(ID)及免疫印迹(IBT)法检测抗J0-1抗体对多发性肌炎／皮肌炎(PwDM)的诊断价值。方法 抗J0-1抗体阳性的33份病例分为三组：①ID法阳性组；②IBT法阳性组；③两种方法均阳性组。分别计算和比较它们与PM／DM临床诊断的符合率，并对抗J0-1抗体阳性PM/DM的临床特点作简要描述。结果 ①ID法检测阳性20例，17例(85％)为PM／DM，其中12例(60％，)为PM，5例(25％)为DM；3例(15％)为其他结缔组织病(CTDS)。②IBT法检测阳性20例，7例(35％)为PM／DM，其中4例(20％)为PM，3例(15％)为DM；7例(35％)为其他结缔组织病(CTDS)；6例(30%)为非结缔组织病。③ID和IBq、检测结果均阳性7例，诊断全部是PM／DM，其中4例(57．1％)为PM，3例(42．9％)为DM。④ID法检测抗J0-1抗体阳性组与IBT法出现55KD蛋白条带组，两组间比较，PM／DM所占百分比有非常显著性差异(P=0．0012)。结论 ID法较IBT法检测抗J0-1抗体更具特异性，两法结合检测抗J0-1抗体较为可靠。     

系统性红斑狼疮血液学异常与临床特点

为了探讨系统性红斑狼疮(SLE)血液学异常改变及其临床特点，对58例SLE患者血液学资料及应用皮质激素和免疫抑制剂治疗的效果进行了回顾性分析。结果表明：58例中血像异常者50例(86．2％)，以各系细胞减少为主，贫血41例(70．7％)，血小板减少34例(58．7％)，白细胞减少37例(63．8％)，二系以上异常41例(70．7％)，以血液学异常为首发症状就诊者12例(20．7％)，其中误诊为血液系统疾病7例(12．1％)。在58例中30例行骨髓细胞学检查，发现骨髓增生活跃或明显活跃23例(76．7％)，增生低下者7例(23，3％)，患者表现为增生性贫血或特发性血小板减少性紫癜(1TP)骨髓像。38例行肝、脾B超检查，查明脾肿大25例(65．8％)；25例行抗人球蛋白试验，3例阳性(12.0％)；22例血小板减少者行血小板抗体测定，16例抗体增高(72．7％)；给予26例二系以上血细胞减少患者皮质激素和免疫抑制剂治疗，血像均有不同程度上升，其中包括6例骨髓增生低下者。结论：血液系统是SLE易并发损害的器官，相关血液学异常较常见，其特点是血液学改变多样性，缺乏特异性，以二系以上血细胞减少常见，在骨髓像方面主要表现为增生活跃。对SLE患者用皮质激素和免疫抑制剂治疗不会导致骨髓抑制，反而会使大部分患者外周血像明显改善。     

布地奈德雾化混悬液吸入治疗小儿急性喉炎27例疗效观察

目的：观察吸入布地奈德雾化混悬液治疗小儿急性喉炎的疗效。方法：59例急性喉炎患者，分为两组，治疗组27例，男19例，女8例，年龄≤1岁10例，—3岁10例，—14岁7例。对照组32例，男22例，女10例，年龄≤1岁12例，—3岁15例，—14岁5例。就诊时均有声嘶、咳嗽、咽痛等表现，重者出现三凹征(或四凹征)等喉梗阻症状。两组间病例数、性别、年龄、病程、临床表现差异均元显著意义(P＞0．05)。两组病人均采用相同的综合性治疗及一般对症处理。治疗组给予布地奈德雾化混悬液每次1mL加生理盐水至2mL，经空气压缩泵雾化吸入，连用2—3次，对照组给予静脉滴注地塞米松每次0．25—0．5mg／kg，4—6h1次，观察4—6h。结果：治疗组显效14例(占51．9％)，有效7例(占25．9％)，无效6例(占22．2％)；对照组显效5例(占15．6％)，有效8例(占25．0％)，无效19例(占59．4％)。X^2＝8．27，P＜0．01，差异有非常显著意义。结论：布地奈德雾化混悬液空气压缩泵雾化吸入对小儿急性喉炎疗效优于静脉滴注地塞米松，副作用小，适合在门诊使用。     

Retrospective study of 30 cases of Legionella pneumonia in the Kansai region

Thirty Legionella pneumonia cases were clinically investigated retrospectively from 1999 to 2005 at the Respiratory Medicine Department of Kyoto University and affiliated hospitals. Twenty-eight cases were sporadic and two cases were part of an outbreak. The patients consisted of 28 men and 2 women, with a mean age of 58.8 years (range 25–87). Nineteen cases were smokers and 19 had some underlying disease. The mean period from the disease occurrence to presenting at a hospital was 4.8 days (range 1–15). The mean period from presenting at hospital to Legionella pneumonia diagnosis was 4.6 days (range 0–22). Urinary antigen detection tests for Legionella pneumophilla were performed for 25 cases, and resulted in the diagnosis of 22 cases. Other diagnostic tests with positive findings were culture (buffered charcoal–yeast extract agar, BCYE), the polymerase chain reaction (PCR) test, and serological diagnosis (enzyme immunoassay and microagglutination test). Legionella species diagnosis was obtained by culture and serology for 13 cases: 10 cases had Legionella pneumophila serogroup 1, 2 cases had Legionella pneumophila serogroup 6, and 1 case had Legionella longbeachea. Fluoloquinolones (Fq) are most often used for therapy, especially in recent cases, and were predominantly the chosen treatment (70%). Death due to Legionella pneumonia occurred in 4 cases: 3 cases had severe underlying diseases, and 1 case took 18 days to diagnose (doctors' delay). To detect the majority of Legionella pneumonia cases, a combination of diagnostic examinations is still needed. Regarding the management of community-acquired pneumonia, both the cost and the indication of diagnostic examinations for Legionella infection should be considered simultaneously.     

老年人社区获得性肺炎临床分析

目的：分析老年人社区获得性肺炎的临床特点及流行病学特征。方法：对上海市宝山区25家医院3502例老年人社区获得性肺炎患者的临床资料进行回顾性分析。结果：年龄60～105（75.03±8.42）岁,男性1831例（52.3%）,女性1671例（47.7%）。冬春季节发病2406例（68.7%）,夏秋季发病1096例（31.3%）。发热1578例（45.1%）,咳嗽或咳痰1986例（56.7%）,乏力伴纳差2001例（57.1%）。血白细胞数升高（≥10×109/L）708例（20.2%）,白细胞数正常而中性粒细胞升高1209例（34.5%）,白细胞数减少（≤4×109/L）88例（2.5%）,两者均正常1497例（42.7%）。双肺肺炎996例（28.4%）,左肺肺炎913例（26.1%）,右肺肺炎1593例（45.5%）。合并基础疾病1935例（55.3%）,出现并发症518例（14.8%）。患者住院天数8～47（18.3±2.4）d。住院费用为人民币1865～9892（4823.36±251.24）元。死亡291例（9.3%）。结论：老年人社区获得性肺炎临床表现不典型,双肺病变多见,合并基础疾病及并发症多,住院时间长,医疗费用较高。     

Usefulness of linezolid in the treatment of hospital-acquired pneumonia caused by MRSA: a prospective observational study

Clinical results for linezolid (LZD) treatment of hospital-acquired pneumonia (HAP) caused by methicillin-resistant Staphylococcus aureus (MRSA), particularly microbiologically evaluable or severe cases, are limited in Japan. A prospective observational study was conducted in order to assess the usefulness of LZD in Japanese patients with MRSA pneumonia. The study tracked fifteen participants treated with LZD for pneumonia who met the criteria of the HAP guidelines and were confirmed to have pneumonia caused by MRSA. Of these, six were severe and 13 had received antibiotic treatment before treatment with LZD. Of the 13 participants assessed for their clinical responses, seven were rated as cures, three were rated as failures, and three were indeterminate. The overall cure rate (cure/cure + failure) was 70.0% (7/10), and the cure rate by severity was 33.3% (1/3) for severe cases and 85.5% (6/7) for moderate cases. The one severe case with a clinical response rating of cure had failed to respond to vancomycin. Among the seven participants with a clinical response rating of cure, the microbiological response was eradication in three, presumed eradication in three, and indeterminate in one. Three serious adverse events occurred in two of the 15 participants, but none were considered to be causally related to LZD. The results suggest that LZD has high potential for severe and multidrug-resistant cases. A higher cure rate was achieved in moderate cases. In cases of pneumonia that are most likely MRSA infections with poor prognosis, it was suggested to be important for patient outcome to implement the most effective therapy before the patient’s condition becomes serious.     

2013—2018年江西省南昌市重症肺炎病例流行病学特征分析

目的分析江西省南昌市重症肺炎病例的流行病学特征，为重症肺炎病例的临床防治提供依据。方法收集2013年4月至2018年3月南昌市重症肺炎病例的呼吸道样本和病例资料，进行病原学和流行病学分析。结果来自17家南昌市医疗机构的261例重症肺炎病例，检出流感病毒核酸阳性81例，阳性检出率为31.03%。 其中包括新甲H1（43例）、季H3（13例）、人感染H7N9禽流感（18例）、人感染H10N8禽流感（3例）和乙型流感（4例）。 重症肺炎病例主要集中在冬春季（12月至次年5月），男女性别比为1.69∶1。 病例年龄最小为1月龄，最大为95岁。 21例人感染H7N9/H10N8禽流感病例，病死率33.33%。 90.48%（19/21）的病例通过不明原因肺炎监测发现，年龄中位数为69岁，大部分病例有基础性疾病和明确禽类接触史。结论南昌地区重症肺炎病例流感病毒以新甲H1流感病毒流行为主，应及时发现新型流感病毒，坚持监测工作常态化，做好传染病防控工作。     

Evaluation of lamoxactam in the treatment of severe bacterial infections

We investigated the clinical efficiency and safety of lamoxactam for treatment of 28 episodes of infection in 26 adult patients (15 males and 11 females) whose ages ranged from 17 to 83 years (mean 48.7). 4 patients had 'ultimately fatal diseases' and the remaining 22 had 'nonfatal diseases'. The clinical condition at the beginning of treatment was 'critical' or 'poor' in 15 cases. Episodes of infection treated were: 14 intraabdominal, 9 bacteremia, 5 nephro-urinary, 3 osteomyelitis, and a miscellaneous group including pneumonia, soft tissue, parameningeal focus and infected V-P shunt. A total of 34 microorganisms were responsible for 25 episodes of infection. 15 and 10 episodes were mono- and polymicrobial, respectively. Isolated microorganisms included 13 aerobic facultative gram-negative bacillus, 5 facultative gram-positive cocci, and 16 anaerobes. Total dosage of lamoxactam administered by patient ranged from 24 to 234 g (mean 57.6 g), and mean duration of therapy was 15.2 days (range 8-42 days). The overall rate of clinical response to lamoxactam was excellent, amounting to 84% of episodes and 91% of patients. Local and general tolerance was good, and lamoxactam had to be discontinued only once during therapy due to an episode of neutropenia. Enterococcal colonization (5 of 26 patients, 19%) and superinfections (3 of 26 cases, 11.5%) were undesirably frequent in our patients. Lamoxactam seems to be an effective and safe single-agent therapy for many bacterial infections. The possibility of enterococcal colonization and superinfections should be monitored, specially in patients with urinary or intraabdominal infections.     

2例重症社区获得性肺炎的抗感染方案的药学监护

目的:探讨临床药师在重症社区获得性肺炎中对抗感染方案的药学监护。方法:通过对2例重症社区获得性肺炎的抗感染方案的初始经验治疗方案进行分析并提出建议、对万古霉素治疗疗程分析和建议、对药鲍曼不动杆菌进行药学监护。结果:对1例患者的重症社区获得性肺炎的初始经验治疗方案成功干预,患者感染得到有效控制,病情好转。结论:重症社区获得性肺炎初期治疗重视对非典型病原体的覆盖,并要保证充足疗程治疗;临床药师参与临床,可以协助医师为患者制定有效的、合理的、经济的抗感染方案。     

A retrospective study of health care-associated pneumonia patients at Aichi Medical University hospital

Health care-associated pneumonia (HCAP) was defined in the American Thoracic Society/Infectious Disease Society of America guidelines on hospital-acquired pneumonia in 2005. However, little is known about the occurrence of HCAP in Japan. A retrospective review of background characteristics, pathological conditions, causative organisms, initial treatments, and risk factors for HCAP was conducted to determine the relationship of HCAP to community-acquired pneumonia and hospital-acquired pneumonia. Thirty-five patients who were admitted to our hospital for pneumonia acquired outside our hospital were included and were stratified by disease severity according to the Japanese Respiratory Society risk stratification guidelines (A-DROP [age, dehydration, respiratory failure, orientation disturbance, and shock blood pressure] criteria). All patients had an underlying disease. A total of 70 microbial strains (25 gram-positive, 37 gram-negative, 6 anaerobic, and 2 causative of atypical pneumonia) were isolated from sputum cultures, showing high isolation frequencies of Pseudomonas aeruginosa and Staphylococcus aureus and extremely low isolation frequencies of Streptococcus pneumoniae and Haemophilus influenzae. “History of hospitalization within 90 days before the onset of pneumonia” was the most common risk factor, and most of the patients had two or three risk factors. Initially, monotherapy [mainly tazobactam/piperacillin (TAZ/PIPC), sulbactam/ampicillin (SBT/ABPC), ceftriaxone (CTRX), cefepime (CPFM), carbapenems, or fluoroquinolones] or combination therapy (beta-lactam and fluoroquinolone) were administered and gave clinical effects in 63% (22/35) of cases. Bacteriological effects were seen in most strains (57%; 40/70). Since the causative organisms of HCAP were closely related to those of hospital-acquired pneumonia and not to community-acquired pneumonia, we believe that aggressive chemotherapy using broad-spectrum antimicrobials is needed in the initial treatment.     

Place des micro-organismes atypiques et des virus dans les pneumonies aiguës communautaires sévères

Usually, intensivists do not focus on atypical bacteria and viruses in severe community-acquired pneumonia (CAP). Only Legionella pneumophila and influenza virus, following the recent H1N1 influenza pandemic, are routinely suggested as responsible agents. However, CAP due to atypical bacteria may represent up to 44% of all CAP. Viral CAP is considered less severe than the usual bacterial ones, although 25% of them warrant hospitalization and 15% result in severe sepsis. Even though L. pneumophila is the most frequently atypical pathogen involved in severe cases, Mycoplasma pneumoniae may be responsible for multiorgan failure. To date, tools including detection of Legionella antigen in urine and Mycoplasma using polymerase chain reaction (PCR) allow rapid and accurate diagnosis. The treatment is based on macrolides and fluoroquinolones that can be associated in severe Legionnaire diseases. The presence of virus in CAP, either alone or in association with bacteria, has been demonstrated using molecular biology tests. These techniques also allowed the identification of several new viruses in CAP. However, the exact role of these detected viruses in CAP as well as the efficiency of antiviral therapy still represent major unsolved concerns.     

Acquired tracheobronchomalacia. A bronchological follow-up study

Ninety-four patients with acquired tracheobronchomalacia were followed up between 1967-1977, for an average of 5.2 years. Fifty-six were still alive at the end of the period, and 47 of these were reexamined. Twenty-one patients had retired on pensions for lung disease. Of the 36 patients who underwent rebronchoscopy, tracheomalacia alone was seen in 3 and tracheobrochomalacia in 33. Six out of the 9 cases of tracheomalacia and all the 5 cases of bronchomalacia had developed into tracheobronchomalacia. The malacia was mild in 6 (17%), moderate in 8 (22%) and severe in 22 (61%), against the figures of the preceding bronchoscopy: 13 (36%), 17 (47%) and 6 (17%), respectively. Mild bronchitic changes were seen in 9 (25%) and severe in 22 (61%) bacterial cultures grew Haemophilus, Proteus mirabilis and Klebsiella, and the culture was positive on 8 occasions (22%). A fungal culture of the bronchial aspirate was positive in 9 cases (25%). No pronounced eosinophilia on the bronchial mucosa was observed.     

传染性非典型肺炎--附首例报告

目的：报道广州呼吸疾病研究所处理首例传染性非典型肺炎的临床诊断和治疗经验。方法：回顾性分析该例的临床资料及治疗经过。结果：该病人有2个多月呼吸道疾病失，病情突然加剧，表现为间质性肺炎及急性呼吸窘迫综合征，白细胞计数基本正常，但淋巴细胞比例偏低，经多种抗生素治疗无明显疗效。使用肾上腺皮质激素及机械通气等对症治疗78日痊愈出院。8位医护人员被感染。结论：该例为传染性非典型肺炎，起病突然及病情发展凶险，可能为一种新病原体感染，值得引起重视。