硫酸软骨素和硫酸氨基葡萄糖对成人大骨节病的疗效分析

目的 观察硫酸软骨素和硫酸氨基葡萄糖对大骨节病的疗效.方法 2007年7月,在黑龙江省尚志市光辉村按<大骨节病诊断标准>检出患者80例.按病情等级、年龄、性别将80例患者分成治疗组、对照组.每组40人.治疗组给予硫酸软骨素和硫酸氨基葡萄糖治疗,对照组给予安慰剂(等量淀粉).在治疗前及治疗后(第8个月)对患者进行直立体位的膝关节X线拍片,利用刻度放大镜测量X线膝关节腔宽度.结果 对照组治疗前、后的X线膝关节腔宽度分别为(4.30±2.14)、(4.10±2.07)mm,治疗组分别为(4.17±2.15)、(4.16±2.11)mm.药物对X线关节腔宽度没有影响(F=0.50,P>0.05),时间、药物与时间的交互作用对X线关节腔宽度有影响(F值分别为67.66、46.74,P均<0.05).治疗组X线关节腔宽度治疗前低于对照组(P<0.05),治疗后高于对照组(P<0.05);对照组治疗前X线关节腔宽度高于治疗后(P<0.05).结论 硫酸软骨素和硫酸氨基葡萄糖减缓了成人大骨节病患者膝关节间隙继续变窄的进程,对关节软骨起到了保护作用,为成人大骨节病治疗在药物选择和疗效判定上提供了依据.     

“硫酸软骨素”和“塞来昔布”治疗成人大骨节病患者的成本效果分析

目的对"硫酸软骨素"和"塞来昔布"治疗成人大骨节病患者进行成本效果分析,为筛选价格低廉、效果好和副作用小的治疗药物提供依据。方法采用流行病学实验研究的方法,选择阿坝州大骨节病流行区中的成人大骨节病患者200例,随机分为2组,分别服用"硫酸软骨素"和"塞来昔布",长期随访记录WOMAC指数评分和服药情况,计算并比较两组的成本效果。结果当以WOMAC指数改变幅度作为效果指标时,硫酸软骨素组和塞来昔布组的成本效果比C/E1分别为87.07元vs 154.67元,以硫酸软骨素组为基准,塞来昔布组的增量成本效果比△C/△E1为200.11元;当以有效率作为效果指标时,两组的C/E2分别为3 085元vs 3 078元,△C/△E2为3 077元。结论总体上可以认为服用硫酸软骨素较服用塞来昔布方案为优。但这也不是绝对的,如果资源充分,也可考虑选择服用塞来昔布。     

中医药二联疗法治疗成人大骨节病临床疗效观察

目的观察中医药二联疗法对成人大骨节病的临床疗效,选出质优、价廉、疗效好和副作用小的治疗方法。方法选择确诊的成人大骨节病患者69例,随机分成中医药二联疗法治疗组34例和西医组35例,中医药二联疗法治疗组给予自拟内服汤药制剂和离子导入治疗,西医组给予口服硫酸软骨素和维生素E。结果治疗前后西医组(t=9.418)和中医组(t=7.662)的临床疗效差异有统计学意义(均P0.05);总有效率中医组79.41%、西医组51.43%,中医组高于西医组,差异有统计学意义(χ2=5.953,P0.05);治疗后中医组和西医组比较,中医组关节休息痛得分(t=1.787)和四肢活动能力得分(t=2.793)高于西医组,差异有统计学意义(均P0.05)。结论中医药二联疗法可以提高成人大骨节病的显效率和总有效率,对改善患者四肢运动能力和关节休息痛的治疗效果明显,具有推广价值。     

肾炎康复片治疗老年糖尿病肾病的临床观察

目的 探讨肾炎康复片治疗老年糖尿病肾病的临床疗效.方法 收集在河北联合大学附属医院肾内科和内分泌科诊治的糖尿病肾病患者100例,分为观察组(n=50)和对照组(n=50),观察组患者给予肾炎康复片联合贝那普利治疗,对照组患者只给予贝那普利治疗,比较两组患者临床疗效.结果 观察组患者显效率、总有效率分别为52.0％、92.0％,高于对照组(44.0％、78.0％),差异均有统计学意义(P＜0.05);而无效率(8.0％)低于对照组(22.0％),差异有统计学意义(P＜0.05).两组患者生化指标与治疗前相比均显著改善,差异有统计学意义(P＜0.05);观察组患者改善更显著(P＜0.05).两组患者治疗后肾小球滤过率(GFR)、肾有效血流量(ERPF)、滤过分数(EF)与治疗前相比均显著改善(P＜0.05);观察组患者改善更显著(P＜0.05).结论 在贝那普利治疗老年糖尿病肾病基础上增加肾炎康复片能显著提高患者的临床疗效.     

四川省阿坝州控制大骨节病相关因素的病例对照调查

目的 调查影响四川省阿坝州大骨节病病情的相关因素,寻找有效防控措施.方法 采用病例对照研究的方法,选取2009、2010年金川、马尔康县大骨节病监测点8～ 15岁儿童右手X线正位片阳性者作为病例组,同时以X线正位片阴性且与病例组人员同性别、同年龄、同村庄、同学校1∶1配对儿童作为对照组,通过问卷方式调查相关防控措施落实情况.采集调查对象发样,用氢化物原子荧光光谱法检测发硒,统计分析影响大骨节病病情的相关因素.结果 共调查64人,病例组和对照组各32人.所在学校主食结构(每周食用米饭次数)比较,差异无统计学意义(Z=-0.695,P＞0.05),副食结构比较,差异无统计学意义(肉类:Z=-1.270,P＞0.05;奶品:Z=-0.300,P＞0.05);发硒水平比较,差异无统计学意义[(0.27±0.09)、(0.26±0.10)mg/kg,x2=0.094,P＞0.05];所在家庭人均年收入比较,差异无统计学意义(Z=-1.079,P＞ 0.05);所在家庭主食结构(大米:x2=1.024;面食x2=1.636)、副食结构(肉类:Z=-1.231;奶品:Z=-0.603)比较,差异无统计学意义(P均＞ 0.05).病例组中骨端阳性者主食面食的家庭比例(84.6％,11/13)高于对照组(59.4％,19/32,x2=8.477,P＜ 0.05),而主食大米的家庭比例(61.5％,8/13)明显低于对照组(81.3％,26/32,x2=5.529,P＜0.05).结论 补硒未能显示防病作用,彻底换粮可能是消除大骨节病危害的有效途径.     

司帕沙星及卷曲霉素方案治疗耐多药肺结核近期疗效观察

目的 观察和评价含司帕沙星和卷曲霉素联合化疗方案在耐多药肺结核(MDR-TB)治疗中的疗效.方法 将高州市慢性病防治站2005-2010年104例MDR-TB患者采用数字表法随机分为治疗组[3(Cm+ Sfx+L2 +D+TH)或15(Sfx+L2+D+TH)]52例、对照组3(L2ZED+Am)或15L2ED]52例.观察痰菌阴转率、X线胸片病灶吸收率、空洞闭合率.采用x2检验,P＜0.05为差异有统计学意义.结果 治疗组3个月末、6个月末、12个月末、疗程结束时痰菌阴转率分别为53.8％(28/52)、73.1％(38/52)、80.8％(42/52)、88.5％(46/52)；对照组分别为15.4％(8/52)、42.3％(22/52)、57.7％(30/52)、65.4％(34/52),两组比较差异均有统计学意义(x21=17.0,P＜0.01；x22=10.1,P＜0.01；x23=6.5,P＜0.05;x24 =7.8,P＜0.01).治疗组疗程结束时X线胸片病灶吸收率为90.4％(47/52)、空洞闭合率为81.6％(31/38)；对照组分别为67.3％(35/52)、57.1％(20/35).两组比较差异均有统计学意义(x21=8.3,P＜0.01；x22=4.7,P＜0.05).结论 含司帕沙星及卷曲霉素的方案治疗MDR-TB,有助于痰菌阴转和病变吸收好转.     

2009年黑龙江省大骨节病历史病区成人颈动脉粥样硬化调查

目的 调察黑龙江省大骨节病历史病区成人大骨节病病例颈动脉粥样硬化的流行强度,探讨成人大骨节病与动脉粥样硬化发生的关系.方法 2009年,在黑龙江省大骨节病病区山河农场、尚志市和非病区双城县兰棱镇(简称双城对照区),各调查5个村,以40岁以上病区大骨节病患者和双城对照区居民为观察对象,用便携式彩超进行了颈动脉粥样硬化检查,保留超声图片并按病变程度诊断记分.结果山河病区5个村大骨节病病例颈动脉粥样硬化检出率分别为50.0%(26/52)、37.3%(19/51)、42.5%(30/71)、58.2%(39/67)、44.0%(22/50);尚志病区5个村分别为63.0%(34/54)、45.3%(24/53)、47.2%(25/53)、60.0%(30/50)、51.9%(28/54);双城对照区5个村分别为63.9%(46/72)、43.1%(31/72)、57.1%(40/70)、46.9%(30/64)、53.0%(35/66).以村为单位,山河、尚志病区与双城对照区颈动脉粥样硬化标准化检出率比较,差异均无统计学意义(T值分别为25.0、24.5,P均＞0.05);3个地区间颈动脉粥样硬化标准化检出率比较,差异无统计学意义(x2=0.36,P＞0.05);3个地区间颈动脉粥样硬化标准化严重程度比较,差异有统计学意义(x2=15.28,P＜0.05),其中尚志病区与双城对照区比较,差异有统计学意义(x2=8.92,P＜0.05).大骨节病患者病情严重程度与颈动脉粥样硬化的标准化检出率和严重程度间均未见明显关联(x2值分别为1.88、5.07,P均＞0.05).结论黑龙江省大骨节病历史病区成人颈动脉粥样硬化检出率不高于非病区.     

针刀松解肾俞穴治疗膝骨性关节炎肾虚络痹证的疗效

目的探讨针刀松解肾俞穴对膝骨性关节炎(KOA)肾虚络痹证的疗效及血清基质细胞衍生因子(SDF)-1、基质金属蛋白酶(MMP)-3、MMP-9、MMP-13水平的影响。方法将116例KOA患者按随机数字表分为对照组和治疗组各58例。对照组口服硫酸氨基葡萄糖胶囊,0.5 g/次,3次/d。治疗组在对照组基础上采取针刀松解肾俞穴,1次/w。治疗8 w后,比较两组西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、Lysholm量表(LKSS)、Lequesne指数评分、临床疗效、血清SDF-1、MMP-3、MMP-9、MMP-13水平。结果治疗后,治疗组WOMAC量表指标(关节疼痛、关节僵硬、日常活动受限)评分、WOMAC量表总分、Lequesne指数评分明显少于对照组(P<0.01),LKSS评分明显多于对照组(P<0.01);治疗组总有效率显著高于对照组(P<0.05);治疗组血清SDF-1、MMP-3、MMP-9、MMP-13水平明显低于对照组(P<0.01)。结论针刀松解肾俞穴治疗KOA肾虚络痹证可明显改善症状和膝关节功能,提高疗效,下调血清SDF-1、MMP-3、MMP-9、MMP-13水平可能与其疗效有关。     

瓜蒌薤白半夏汤对兔动脉粥样硬化模型主动脉蛋白聚糖的作用

目的从调整动脉壁蛋白聚糖代谢角度观察化痰治法代表方剂——瓜蒌薤白半夏汤抗动脉粥样硬化的药理机制。方法3月龄新西兰兔30只,随机分为正常组、模型组、治疗组。模型组和治疗组均给予高脂饮食造成动脉粥样硬化模型,治疗组同时给予瓜蒌薤白半夏汤灌胃。6周后取材,检测血脂,观察主动脉粥样硬化病变程度,提取主动脉蛋白聚糖,酶解为糖胺多糖,再进行醋酸纤维素薄膜电泳分析,测定各种糖胺多糖组份含量。结果正常组血胆固醇和低密度脂蛋白含量分别为13.43±3.12mmol/L、8.53±1.37mmol/L,动脉壁蛋白聚糖组份硫酸软骨素、硫酸皮肤素含量分别为21.93±1.82mg/g、15.56±1.61mg/g;与正常组比较,模型组表现为典型的动脉粥样硬化病理变化,血总胆固醇和低密度脂蛋白含量明显升高,分别为23.63±4.31mmol/L、15.63±1.27mmol/L(P<0.01),动脉壁蛋白聚糖组份硫酸软骨素、硫酸皮肤素含量明显升高,分别为31.23±1.41mg/g、19.36±1.64mg/g(P<0.01或P<0.05);与模型组比较,治疗组动脉粥样硬化灶病变程度明显减轻,动脉壁蛋白聚糖组份硫酸软骨素、硫酸皮肤素含量明显降低,分别为22.33±1.58mg/g、14.36±1.71mg/g(P<0.01或P<0.05),但血胆固醇和低密度脂蛋白无明显的降低,分别为20.54±3.59mmol/L、14.53±1.32mmol/L。结论瓜蒌薤白半夏汤可降低粥样硬化病变动脉壁硫酸软骨素蛋白聚糖、硫酸皮肤素蛋白聚糖含量,从而减轻动脉粥样硬化病变,但降低血脂作用不明显。     

物理治疗方法配合康复训练治疗腰椎间盘突出症的疗效

目的 探讨物理方法配合康复训练治疗腰椎间盘突出症的临床效果.方法 入选近期在该院住院治疗的腰椎间盘突出症患者143例,根据患者在住院期间治疗方式的不同将所有患者分为观察组(n=72)和对照组(n=71),观察组患者给予物理治疗配合康复训练,对照组患者只给予物理治疗,比较两组患者近期和远期疗效.结果 观察组患者痊愈率、显效率、总有效率分别为51.4％、26.4％、95.9％均高于对照组患者36.6％、18.3％、84.5％(P＜0.05);而观察组无效率低于对照组(P＜0.05);观察组在治疗后、治疗后6个月、治疗后12个月VAS评分均低于对照组;JOA评分高于对照组(P＜0.05).结论 物理治疗方法配合康复训练可以显著提高腰椎间盘突出症患者的临床疗效,优于单纯的物理治疗.     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.