佳木斯市艾滋病抗病毒治疗患者生存率及影响因素分析

目的 了解佳木斯市艾滋病病毒感染和艾滋病患者(HIV/AIDS)抗病毒治疗(HAART)生存率,并分析影响因素。方法 采用回顾性队列研究,通过《中国疾病预防控制信息系统》采集佳木斯市疾病预防控制中心2009年6月至2019年7月收治的HIV/AIDS HAART患者的一般资料,采用寿命表法计算生存率,采用多因素Cox比例风险模型分析生存时间的影响因素。结果 共纳入1986例HIV/AIDS HAART患者,其中死于HIV/AIDS相关疾病48例(占2.42%),HIV/AIDS HAART的1、3、5、10年累积生存率分别为98.44%、97.84%、97.47%、96.29%;多因素Cox比例风险模型分析结果显示,经血感染HIV(HR=3.125)、开始治疗时年龄30～(HR=4.518)、开始治疗时年龄50～(HR=15.897)、有漏服药(HR=5.647)的HIV/AIDS HAART患者死亡的危险较大,高中及以上文化程度(HR=0.264)、基线CD4+T淋巴细胞计数350个/μL(HR=0.183)的HIV/AIDS HAART患者死亡的危险较小。结论2009年6月至2019年7月佳木斯市HIV/AIDS HAART患者生存率较高,经血感染、HAART时年龄较大、有漏服药是HIV/AIDS HAART患者生存的危险因素,高中及以上文化程度、基线CD4+T淋巴细胞计数350个/μL是HIV/AIDS HAART患者生存的保护因素。     

不同性别老年HIV/AIDS患者抗病毒治疗预后影响因素及CD4+T淋巴细胞恢复情况

目的 通过分析老年HIV/AIDS患者基本资料及临床随访资料，了解老年HIV/AIDS患者抗病毒治疗后的预后影响因素及CD4恢复情况。方法 收集2005—2015年在柳州市的艾滋病抗病毒治疗点接受抗病毒治疗(antiretroviral therapy, ART)且年龄≥50岁的HIV/AIDS患者3 618例，对患者的资料包括基本信息、CD4⁺T细胞计数、WHO临床分期、感染途径及随访情况等进行回顾性分析。采用Kaplan-Meier法比较患者生存差异，多因素Cox回归分析影响患者死亡风险的独立影响因素，比较不同性别患者随访期间CD4⁺T细胞计数的恢复情况。结果 随访期间，截止观察终点5年女性累计生存率为0.82，男性累计生存率为0.66。多因素Cox回归分析显示，影响抗病毒治疗效果的独立影响因素为年龄(OR=1.909,95%CI:1.479～2.464,P<0.001)、BMI(OR=0.744,95%CI:0.574～0.965,P=0.026)、性别(OR=0.692,95%CI:0.503～0.952,P=0.023)、除结...     

兴化市2004—2018年HIV/AIDS患者生存时间及其影响因素分析

目的：分析兴化市HIV/AIDS患者生存时间及其影响因素，为HIV/AIDS的治疗与管理提供科学依据。方法：采用回顾性队列研究方法搜集HIV/AIDS的相关信息，运用 Kaplan-Meier绘制累积生存率曲线及其生存概率，用Cox回归模型分析HIV/AIDS患者生存时间的影响因素。结果：对2004—2018年244例HIV/AIDS患者进行观察，截止至2019年7月31日累计观察1 009.8人年，中位数为4.2（0～13.6）人年。HIV/AIDS患者第0、1、2、3、5、6、7年累积生存概率分别为91.0%、88.9%、88.0%、86.4%、85.6%、83.3%、81.5%。接受抗病毒治疗组累积生存概率为90.5%，高于未接受抗病毒治疗组的41.4%，差异有统计学意义（P＜0.01）。首次检测CD4计数≥350/mm3组死亡风险是CD4计数＜200/mm3组的0.21倍（95%CI=0.06～0.67），接受过抗病毒治疗组的死亡风险是未治疗组的0.09倍（95%CI=0.04～0.24）倍。随报告发现时年龄增长，死亡风险相应增加。结论：确诊时年龄、初诊时CD4计数、是否接受抗病毒治疗是影响HIV/AIDS生存时间的主要因素，应强化健康教育，提高HIV感染者的早诊、早治率，以提升患者的生存概率。     

基于贝叶斯Cox风险比例回归的兰州市HIV感染者/AIDS患者死亡影响因素分析

【目的】了解兰州市HIV/AIDS报告病例相关特征的构成情况,分析艾滋病相关死亡的影响因素。【方法】通过收集兰州市2011-2019年HIV/AIDS报告病例信息,采用生存分析方法,构建贝叶斯Cox风险比例回归模型分析影响死亡的相关因素。【结果】本研究共选取2 312例HIV/AIDS患者,其中艾滋病相关死亡45例。多因素回归结果显示,患者年龄越大,死亡风险越高;确诊时为AIDS患者的死亡风险是HIV感染者的13.91倍;与未接受CD4检测的患者相比,接受CD4检测的患者的死亡风险降低;进行抗病毒治疗者的死亡风险是未进行抗病毒治疗者的0.22倍。【结论】确诊时年龄、病程阶段、是否接受抗病毒治疗是兰州市HIV/AIDS患者艾滋病相关死亡的影响因素,因此要加强艾滋病相关人群健康教育,提倡早发现、早诊断、早治疗,扩大艾滋病检测与治疗的覆盖面,延长艾滋病患者的生存时间。     

中医药治疗艾滋病生存分析

目的探讨中医药治疗HIV/AIDS的生存时间及其影响因素。方法对进行中医药治疗的469例HIV/AIDS患者的临床资料进行分析,采用寿命表法分析患者生存时间;运用Cox等比例风险回归法分析影响患者生存时间的因素。结果患者的中位生存时间为:72.25个月。单因素分析显示,对生存时间有显著影响的因素有:血红蛋白、血肌酐(Cr)、谷草转氨酶(AST)、CD4、卡洛夫斯基积分、乏力、裂纹舌、细脉、中医辨证分型;多因素分析结果显示:血肌酐、AST、细脉和中医辨证分型更具有决定性意义。结论血红蛋白、CD4、卡洛夫斯基积分是艾滋病患者生存时间的保护因素,而血肌酐、AST、乏力、裂纹舌、细脉、中医辨证分型是危险因素,临床上应采取相应措施进行干预,以提高患者生存时间和生活质量,降低病死率。     

1997—2016年舟山市艾滋病患者生存时间及影响因素分析

目的了解舟山市艾滋病患者生存时间及影响因素,为舟山市能够更有效地开展艾滋病防治提供科学依据。方法采用回顾性队列研究方法,收集舟山市报告并确诊的384例艾滋病患者的发病、死亡等信息及影响因素,用寿命表分析累积生存率,用Cox回归模型进行AIDS患者生存时间的多因素分析。结果 384例研究对象,男性占75%,男女比例31,平均年龄(42.3±15.4)岁,本市户籍占76.1%,已婚有配偶占56.3%,经性传播感染占95.6%。研究对象的平均观察时间为(42.4±42.0)个月,平均生存时间为187.97个月(95%CI 175.11~200.82),中位生存时间为216.00个月,参加AIDS抗病毒治疗(HAART)的患者平均生存时间为210.66个月(95%CI196.57~224.74),未参加HAART患者的平均生存时间111.72个月(95%CI 94.70~128.73)。研究对象总死亡率为4.24/1000人月,患者的相关死亡率为2.64/1000人月,1、3、5、10年生存率分别为92.35%、87.92%、86.13%、83.68%。多因素COX回归模型表明,CD4+细胞计数越小越容易死亡(HR=18.252,95%CI 5.492~60.658);参加HAART能有效降低AIDS患者的死亡风险(HR=0.120,95%CI 0.049~0.294)。结论不同地区、职业的AIDS患者生存时间不同,HAART可以有效延长AIDS患者的生存时间,舟山市应继续扩大HAART的覆盖面,并对AIDS患者的CD4+细胞计数进行定期检测,提高AIDS患者的生存率。     

云南省大理州50岁及以上HIV/AIDS患者生存状况分析

背景 云南省大理州1997年首次报告50岁及以上人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immunodeficiency syndrome,AIDS)患者(简称HIV/AIDS患者),2010年以后50岁及以上HIV/AIDS患者报告数呈现明显上升趋势。2017年公布的《中国遏制与防治艾滋病“十三五”行动计划》中,已正式将老年人作为艾滋病防治的重点人群之一。目的 分析大理州50岁及以上HIV/AIDS患者的生存状况。方法 对1997-2018年报告的50岁及以上HIV/AIDS患者,运用寿命表法计算生存率,运用Cox回归分析生存的影响因素。结果 大理州2 019例50岁及以上HIV/AIDS患者的中位生存时间为8.33年(95%CI:7.75～9.33)。寿命表法分析结果显示确诊后1年、5年、10年的生存率分别为74.76%、56.26%、40.29%。Cox回归分析结果显示50岁及以上HIV/AIDS患者男性死亡风险是女性的1.74倍(95%CI:1.43～2.12);未抗病毒治疗患者的死亡风险是抗病毒治疗...     

HIV/AIDS患者治疗前后CD4~+、CD8~+细胞水平检测结果分析

目的了解HIV/AIDS患者高效逆转录抗病毒(HAART)治疗前后CD4+、CD8+细胞计数水平变化情况。方法利用流式细胞分析技术对随机选取在本院住院治疗的177例HIV/AIDS患者进行治疗前后CD4+、CD8+检测,观察其治疗前后CD4+、CD8+细胞计数水平的变化。结果经过6个月的HAART治疗后,在选取的177例HIV/AIDS患者中,CD4+、CD8+细胞计数均较抗病毒治疗前有上升的趋势,治疗前后细胞计数比较差异具有非常显著统计学意义(P<均0.01)。结论 HIV/AIDS患者在持续HAART治疗后,CD4+、CD8+细胞计数将会提升到一定的水平,其可更好地提高HIV/AIDS患者的免疫力,在延长患者生命中具有重要的现实意义。     

HIV/AIDS患者高效抗反转录病毒治疗后免疫重建炎性综合征的发生率及其影响因素

目的分析HIV/AIDS患者高效抗反转录病毒治疗(HAART)后免疫重建炎性综合征(IRIS)的发生率及其影响因素。方法回顾性分析11 045例接受HAART治疗的HIV/AIDS患者的临床资料,包括一般资料、基线CD4⁺T细胞计数、CD4/CD8比值、IRIS及合并症发生情况。采用Logistic回归模型分析HIV/AIDS患者HAART后发生IRIS的影响因素。结果 11 045例患者中,共326例(2.95%)发生IRIS。已婚、合并结核感染以及合并梅毒是HIV/AIDS患者HAART后发生IRIS的危险因素,而年龄≥51岁是其保护因素(均P<0.05)。结论已婚、合并结核感染以及梅毒的HIV/AIDS患者经HAART后更易发生IRIS,而老年人发生IRIS的概率或更低。     

HAART患者失访相关影响因素Logistic回归分析

目的 探讨艾滋病抗病毒治疗患者失访发生的相关影响因素,为HIV/AIDS患者管理提供依据。方法 收集2005年6月-2018年12月在南宁市第四人民医院进行抗病毒治疗的艾滋病抗病毒治疗患者为研究对象,使用Excel的RAND随机函数生成的随机数字由小到大进行排序,选取排序前200例的HAART失访的患者为观察组,对照组为在治疗的艾滋病患者中随机选取的200例。采用Logistic回归分析方法分析患者性别、年龄、基线CD4⁺T淋巴细胞计数、传播途径、基线疾病分期、目前疾病分期、最近1次CD4⁺T淋巴细胞计数、领药、婚姻状况、子女人数、地区、药物不良反应等12项因素与失访的关系。结果 观察组接受HAART 12个月内失访85例,占总失访人数的42.5%,24个月内失访123例,占总失访人数的61.5%。将12个因素进行多因素logistic回归分析,最终进入回归模型的因素为传播途径、最近1次CD4⁺T淋巴细胞、药物不良反应,其调整的OR值及OR95%CI分别为6.26(2.99~13.10)、8.68(4.32~17.45)、10.52(2.77~40.00)。结论 HIV/AIDS患者HAART 失访大部分发生在开始治疗的2年内,对出现HAART有不良反应的患者进行及时处理或更换治疗方案,强化对注射吸毒、治疗后CD4⁺T淋巴细胞提升不理想HIV/AIDS感染者的个体指导和警示教育,增强患者治疗信心,减少失访的发生。     

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.