吸入表面激素治疗肺结节病10例疗效分析

目的　探讨对肺结节病治疗副作用小、且有一定疗效的新方法。方法　对 10例Ⅱ期肺结节病患者进行了吸入表面激素治疗的观察。治疗方法为二丙酸倍氯米松 (必可酮或必酮碟 ) 60 0～ 12 0 0 μg d、分 2～ 3次吸入 ,疗程 8～ 12个月。其中 6例为单纯吸入表面激素治疗 ;另外 4例 ,2例为开始用强的松口服 ,2～ 3个月后改为吸入表面激素序贯治疗 ,2例为开始用表面激素治疗 ,后改为强的松口服 3～ 4个月 ,又改为吸入激素序贯治疗。以临床症状、胸部X线、血气或肺功能等检查观察疗效。结果　 10例病人临床症状均有改善 ,血氧分压均有提高 ,X线 9例改善 ,其中 1例停药 1年后复发。 3例肺功能异常者 ,2例改善 ,1例无变化。结论　吸入表面激素疗法治疗肺结节病 ,对临床症状、血氧分压及胸部X线有改善作用 ,作为口服激素的序贯治疗 ,有进一步研究的价值     

风湿病合并慢性乙型肝炎病毒感染患者用药安全性的临床研究

目的 研究合并慢性乙型肝炎病毒(HBV)感染的风湿病患者的治疗方案对肝功能和HBV复制的影响.方法 分析并随访21例HBV表面抗原(HBsAg)阳性的风湿病患者临床特点和治疗情况.结果 乙型肝炎小三阳患者19例,大三阳2例.Ⅰ组为12例使用免疫抑制剂组;治疗采用甲氨蝶呤(MTX)和来氟米特(LEF)中的一种或两种联合柳氮磺吡啶(SASP)或羟氯喹(HCQ);其中3例患者因HBV-DNA＞105拷贝/ml加用了抗HBV治疗;随访7～47个月,4例出现丙氨酸转氨酶(ALT)升高,无HBV复制加重者.Ⅱ组为9例使用激素和(或)免疫抑制剂组.激素使用量为泼尼松0.8～1.2 mg·kg-1·d-1.2例单用激素,3例合用环磷酰胺(CTX),2例合用MTX,1例合用HCQ.所有患者均加用抗病毒治疗.随访3～50个月,有2例出现ALT升高,无HBV复制加重者.结论 合并HBV感染的风湿性疾病患者若HBV-DNA＜105拷贝/ml使用小剂量免疫抑制剂较为安全;在需要使用大剂量激素和(或)免疫抑制剂时,建议加用抗病毒治疗并密切监测肝功能和病毒复制指标,其使用是相对安全的.     

外源性皮质类固醇引起骨质丢失的可逆性

外源性皮质类固醇引起骨质疏松可逆性问题迄今未解决,因长期用类固醇后不易停止的而停止类固醇治疗对骨质疏松过程的影响未被研究。作者描写6例慢性长期结节病,停止皮质类固醇治疗后显示椎骨网状矿质计数(VCMC)的改善,为首报病例。 前瞻性研究近6年结节病患者。入组标准:①组织学证明结节病;②长期泼尼松(强的松)治疗,仅治疗结节的活性加功能损害患者;③在泼尼松治疗末骨矿质丢失;④由于临床上不需要而停止泼尼松;⑤停止泼尼     

结节病复发22例临床特点及原因分析

目的探讨结节病复发的主要临床特点及影响复发的因素。方法对2008—2014年中国医科大学附属第一医院门诊及住院经病理确诊为结节病的103例患者进行随访12~82个月,平均随访(43.1±19.7)个月,筛选出符合复发诊断标准的患者,将其临床特点与未复发的患者进行回顾性对比分析。结果 (1)103例患者中自行缓解16例,87例行糖皮质激素治疗,其中复发22例(男1例,女21例),年龄平均(50±8)岁;Ⅰ期2例,Ⅱ期18例,Ⅲ期2例。(2)复发组与未复发组初治时病情分期、肺功能、支气管肺泡灌洗液(BALF)中细胞计数及T淋巴细胞亚群、肺外受累等情况差异无统计学意义。(3)复发组初始治疗疗程4~36个月,未复发组疗程6~15个月,两组比较差异有统计学意义(P0.05),复发患者中有3例疗程仅4个月,4例减药过程不规律,自行停药,减量或增加剂量。(4)患者复发时间多为停用激素后,其中停药6个月内复发12例,7~12个月复发9例,3年后复发1例。结论结节病复发主要出现在停药1年内,复发组临床无特异表现,激素服用不规律和疗程不足是影响结节病复发的主要因素。     

环磷酰胺、大剂量N-乙酰半胱氨酸治疗特发性肺间质纤维化疗效分析

目的探讨特发性肺间质纤维化的临床有效治疗方法。方法将65例特发性肺间质纤维化患者分为治疗组1、治疗组2和对照组三组。对照组给予常规强的松治疗;治疗组1给予强的松加环磷酰胺治疗;治疗组2给予强的松加大剂量N-乙酰半胱氨酸治疗。观察并比较患者治疗前后临床症状体征、胸部影像学及肺功能的变化。结果治疗前各组间具有可比性。治疗后,治疗组1与对照组的疗效无明显差异;而治疗组2的疗效则明显好于治疗组1及对照组。结论强的松联合大剂量N-乙酰半胱氨酸是临床治疗特发性肺间质纤维化的有效手段。     

肺结节病合并胸腔积液14例诊治分析

目的对肺结节病合并胸腔积液的诊治进行分析。方法对我院1991~2009年间,肺结节病合并胸腔积液的14例患者进行分析。结果 8例为Ⅱ期,6例为Ⅰ期。13例口服醋酸泼尼松片（0.5 mg/kg）逐渐减量治疗。3例曾联合抗结核治疗。口服激素1个月后,4例胸腔积液消失,4例明显减少,3个月后14例患者胸腔积液均消失,1例留有胸膜肥厚。结论肺结节病出现胸腔积液的机制不明,激素治疗剂量与无胸腔积液患者用量相同,逐渐减量。     

异基因造血干细胞移植治疗有侵袭性真菌感染史的急性白血病3例并文献复习

目的：探讨有侵袭性真菌感染史的急性白血病患者进行异基因造血干细胞移植（allo—HSCT）的可行性。方法：3例急性白血病患者移植前均有真菌感染病史,2例肺部真菌感染,1例肺部及肝脾真菌感染,经抗真菌治疗病情好转后行异基因HSCT。所选供者均为HLAA、B、DR位点全相合的同胞兄弟姐妹,使用改良BU／CY预处理方案,用MTX加CsA预防急性移植物抗宿主病,移植0d开始使用抗真菌药预防真菌感染。结果：随访1年半,3例患者无白血病复发,1例出现肺部真菌感染,抗真菌治疗后好转。余2例真菌感染病灶均稳定。结论：通过控制真菌感染的易感因素及再次预防,有真菌感染史的急性白血病进行HSCT是可行的。     

罗格列酮(文迪雅)治疗2型糖尿病临床观察

确诊的2型糖尿病,初始口服降糖药有效,而后效果变差,无酮症,未用胰岛素治疗的患者18例,饮食控制和最大剂量药物治疗二个月以上,平均空腹血糖(FBG)≥10.0mmol/L或餐后2小时血糖(PBG)≥14.0mmol/L,糖化血红蛋白(HbA1c)≥8.5%,加用罗格列酮(文迪雅)4毫克,一日一次口服共一年,其间每月复查一次血糖(空腹及餐后),3个月复查一次糖化血红蛋白(HbA1c),并做肝、肾功、血脂的检测.结果加用罗格列酮(文迪雅),3个月后患者的空腹血糖及餐后2小时血糖,糖化血红蛋白均明显改善(P《0.01),一年后患者的空腹血糖及餐后2小时血糖,糖化血红蛋白仍持续改善(P《0.01),甘油三脂亦有所改善(P《0.05),血压、体重、总胆固醇有所下降,但无统计学意义.治疗过程中未出现肝功、肾功、心功能的损害及严重低血糖的发生.结论罗格列酮(文迪雅)对改善2型糖尿病的血糖、血脂有显著疗效.是治疗2型糖尿病的一种安全有效的药物.     

中剂量氨甲蝶呤、阿糖胞苷治疗成人复发性急性白血病10例报告

成人复发性急性白血病治疗相当困难 ,且缓解时间短。为此 ,我们近年设计用中剂量氨甲蝶呤 (MTX)、阿糖胞苷 (Ara-C)治疗成人复发性急性白血病 10例 ,取得了一定疗效。现报告如下。一般资料 :本组 10例均为在我院使用 HOAP或 COAP方案初治取得完全缓解 (CR)且定期用原方案巩固治疗的患者。男 8例 ,女 2例 ,年龄 18～ 5 2岁。其中急淋 (AL L) 3例 ,急非淋 (ANL L) 7例。 3例 AL L 患者中 ,缓解 1～ 2年后复发 2例 ,缓解 6～ 12个月后复发 4例 ,缓解 3～ 6个月后复发1例。 10例患者的骨髓像均呈急性白血病表现。用药方法 :1MTX2 0 …     

加巴喷丁不同加量方法治疗老年带状疱疹急性期神经痛对比观察

目的 探讨加巴喷丁不同加量方法治疗老年带状疱疹急性期神经痛的临床疗效与耐受性.方法 老年带状疱疹急性期神经痛患者32例,随机分为A组和B组,各16例.A组第1天晚上服用加巴喷丁300 mg,第2天早300 mg、晚300 mg,第3天早、中、晚各300 mg,此后以此剂量维持.B组第1天早、中、晚各100 mg,第2天早、中、晚各200 ng,第3天早、中、晚各300 mg,此后以此剂量维持.若加量过程中患者感疼痛明显好转,可以不用继续加量.分别于治疗前及治疗后第4、8、14天,采用视觉模拟评分（VAS）进行疼痛评估,同时观察患者的不良反应.结果 A组首次剂量后有2例出现嗜睡、共济失调、头昏,1例退出,1例转为B组加量方法,A、B组治疗后第4、8、14天VAS较治疗前均有下降（P均＜0.01）,但治疗后两组第4、8、14天VAS比较,P均＞0.05.结论 加巴喷丁不同加量方法治疗老年带状疱疹急性期神经痛均有效,但是3次/d服用、每次剂量从100 mg起渐加量的方法患者耐受性更好.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。