糖皮质激素治疗结缔组织病致低血糖症临床分析

目的 观察结缔组织病(connective tissue disease,ClTD)予糖皮质激素治疗后致血糖降低的临床特征.方法 对我院应用糖皮质激素后出现低血糖的28例CTD的临床资料进行回顾性分析.结果 28例CTD中系统性红斑狼疮19例,占67.86％;女性多于男性(男∶女=1∶8.3);发病年龄较轻,15 ～30岁19例,占67.86％;病程及累积应用糖皮质激素时间以24～60个月例数最多,分别占42.86％、32.14％;糖皮质激素累积剂量以5000 ～ 10 000 mg例数最多,占46.43％.28例出现低血糖时均无低血糖症状,血糖平均3.2 mmol/L,予糖皮质激素规律减量后,26例血糖恢复正常,余2例未恢复,继续糖皮质激素原方案治疗、规律减量,仍随访中.结论 患CTD的低龄女性患者长期、大剂量应用糖皮质激素后易诱发低血糖,治疗中需及时调整糖皮质激素用量以控制低血糖的发生.     

结缔组织病患者结膜印迹细胞凋亡研究

目的探讨结膜印迹细胞的流式细胞术凋亡检测在干眼发病机制研究与结缔组织病患者干眼诊断中的应用价值。方法对结缔组织病患者60例（120眼）进行眼科病史询问、泪液分泌实验Ⅰ（S-I-T）、泪膜破裂时间（BUT）及荧光素染色计分（FL）检查,根据检查结果和有无Sjogren综合征分为非干燥综合征无干眼（NSS1）组、非干燥综合征干眼（NSS2）组、干燥综合征无干眼（SS1）组和干燥综合征干眼（SS2）组。并对其行结膜印迹细胞流式细胞术凋亡检测。结果结膜上皮细胞凋亡百分比除NSS1组与SS1组间差异无统计学意义（P=0.998）外,其余各组差异均有统计学意义（P〈0.001）。且细胞凋亡百分比与FL成正相关（r=0.926,P〈0.001）,与S-I-T、BUT结果成负相关（r=–0.712,r=–0.818,P〈0.001）。有无干眼和有无干燥均影响结膜上皮细胞凋亡量,且干眼与干燥有交互作用。结论细胞凋亡可能是造成干眼眼表损害的重要因素,凋亡检测有助于结缔组织病患者干眼的诊断。干眼和干燥均可使结膜上皮细胞凋亡增加。印迹细胞流式细胞凋亡检测是一项微创、有效的眼表凋亡检测方法。     

肺超声与HRCT诊断结缔组织病相关间质性肺病的对比分析

目的探讨肺超声在诊断结缔组织病相关间质性肺病时与HRCT的一致性。方法选取在我院风湿免疫科病区收治患有结缔组织病的60例患者。所有患者均进行HRCT检查和LUS检查,以HRCT为金标准,对比两种检查结果,并对检查结果进行一致性分析。结果肺超声诊断CTD-ILD的灵敏度、特异度、阳性预测值和阴性预测值分别为97.9%、83.3%、95.9%和90.9%。McNemar检验结果显示两种检查方法诊断结果无统计学差异(P=1.000),一致性检验结果显示两种检查方法诊断结果一致性Kappa值为0.839。结论 LUS诊断CTD-ILD有很高的准确度和诊断效能,且与HRCT有较好的一致性。     

结缔组织病合并肺动脉高压患者的右室功能:多普勒组织成像技术研究

目的采用多普勒组织成像技术分析结缔组织病（CTD）合并肺动脉高压（PAH）患者右室功能和各项指标之间的关系。方法34例CTD合并PAH患者以及32例无PAH的对照者进行超声心动图检查,评价右室大小和功能。同时采用多普勒组织成像（DTI）评价右室侧壁、室间隔和左室侧壁的应变曲线及三尖瓣环的运动速度。结果DTI结果显示与对照组相比,CTD合并PAH患者的右室应变峰值、三尖瓣环收缩速度和舒张早期速度显著降低,同时存在右室不同步。结论DTI技术可以反映CTD合并PAH患者的右室功能状况。     

糖尿病患者血清硫酸脱氢表雄酮含量与大血管病变的关系

目的　探讨男性 2型糖尿病患者血清硫酸脱氢表雄酮 (DHEA- S)含量变化与大血管病变的关系。方法　用化学发光法测定 6 8例男性 2型糖尿病患者血清 DHEA- S含量 ,并与 30例年龄匹配的男性健康人对照。结果　糖尿病组 DHEA- S含量明显低于对照组 (P<0 .0 1) ,且这种下降在糖尿病并发大血管病变时更为显著 (P<0 .0 1)。 DHEA- S含量与甘油三酯 (TG)及低密度脂蛋白 (L DL)呈负相关 ,(P<0 .0 5 )。结论　男性 2型糖尿病患者血清硫酸脱氢表雄酮含量的降低可能与大血管病变的发生有关 ,其确切的发病机理有待研究     

Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases

Lung involvement in connective tissue diseases is associated with substantial morbidity and mortality, most commonly in the form of interstitial lung disease, and can occur in any of these disorders. Patterns of interstitial lung disease in patients with connective tissue disease are similar to those seen in idiopathic interstitial pneumonias, such as idiopathic pulmonary fibrosis. It may be difficult to distinguish between the 2 ailments, particularly when interstitial lung disease presents before extrapulmonary manifestations of the underlying connective tissue disease. There are important clinical implications in achieving this distinction. Given the complexities inherent in the management of these patients, a multidisciplinary evaluation is needed to optimize the diagnostic process and management strategies. The aim of this article was to summarize an approach to diagnosis and management based on the opinion of experts on this topic.     

土三七致肝小静脉闭塞病一例的病情观察与护理

肝小静脉闭塞病（hepatic veno-occlusive disease,HVOD）是肝小叶中央静脉和小叶下静脉内无血小板性质块阻塞所引起的疾病,其临床特征与门脉高压相似,即无法解释的体重增加、腹水、肝大、黄疸,在临床工作中较少见,临床诊断、治疗和护理都比较棘手。我科于2009年4月收治了1例服用土三七引起肝小静脉闭塞病的患者,现将病情观察和护理体会介绍如下。     

Epidemiological Evidence for the Association of Hyperglycaemia and Atherosclerotic Vascular Disease in Non-insulin-dependent Diabetes Mellitus

Non-insulin-dependent diabetes mellitus (NIDDM) increases substantially the risk for all manifestations of atherosclerotic vascular disease, coronary heart disease (CHD), cerebrovascular disease and peripheral vascular disease. Only a small proportion of this excess risk can be explained by the effects of conventional cardiovascular risk factors, which implies that the diabetic state or factors related to it have to play a significant role in the pathogenesis of macrovascular disease in NIDDM. Six recent prospective population-based studies including a large number of NIDDM patients have indicated that poor glycaemic control evaluated by fasting hyperglycaemia or glycosylated haemoglobin levels increases the risk for CHD, stroke and amputation independently of other risk factors. A dose-response relationship between markers of glycaemic control and the incidence of cardiovascular mortality and morbidity has been demonstrated in all these studies. However, there is so far no direct proof that strict glycaemic control would delay or prevent atherosclerotic complications.     

Insulin Glargine U100 Improved Glycemic Control and Reduced Nocturnal Hypoglycemia in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease Stages 3 and 4

PurposeGlycemic control in patients with chronic kidney disease (CKD) is particularly hard to achieve because of a slower insulin degradation by the kidney. It might modify the long-acting insulin analogue pharmacokinetics, increasing its time–action and the risk of hypoglycemia. However, because this insulin has no peak action, it might be a more tolerable approach to patients with CKD. This hypothesis remains to be tested, because no study has thus far examined the efficacy and safety profile of long-acting basal analogues in patients with significant loss of renal function. The purpose of this study was to compare the glycemic response to treatment with glargine U100 or neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes mellitus (T2DM) and CKD stages 3 and 4.MethodsThirty-four patients were randomly assigned to glargine U100 or NPH insulin after a 2-way crossover open-label design. The primary end point was the difference in glycosylated hemoglobin (HbA_1c) and in the number of hypoglycemic events between weeks 1 and 24, whereas secondary end points included changes in glycemic patterns, weight and body mass index, and total daily dose of insulin. HbA_1c was determined by ion-exchange HPLC, and hypoglycemia was defined as glucose concentration of 54 mg/dL (3.0 mmol/L) detected by self-monitoring of plasma glucose or continuous glucose monitoring.FindingsAfter 24 weeks, mean HbA_1c decreased on glargine U100 treatment (−0.91%; P < 0.001), but this benefit was not observed for NPH (0.23%; P = 0.93). Moreover, incidence of nocturnal hypoglycemia was 3 times lower with glargine than with NPH insulin (P = 0.047).ImplicationsOur results found that insulin glargine U100 could be effective, once it improved glycemic control, reducing HbA_1c with fewer nocturnal hypoglycemia episodes compared with NPH insulin in this population. These clinical benefits justify the use of basal insulin analogues, despite their high cost to treat patients with T2DM and CKD stages 3 and 4. Clinical Trials identifier: NCT02451917.     

社区2型糖尿病患者疾病知识掌握现状的调查分析

目的 了解社区2型糖尿病(DM)患疾病知识掌握现状，为社区糖尿病教育提供依据。方法 对社区2型DM患200例进行问卷调查，并对结果进行分析。结果 社区DM患疾病知识掌握情况总体较好，但疾病基础知识比较欠缺，是否接受过DM健康教育及化程度是影响掌握情况的因素。结论 应对社区DM患加强疾病基础知识和护理的宣传与教育，提高他们自我护理和病情监测的能力，以提高生活质量。     

组织多普勒显像评价冠心病对右室舒张功能的影响

目的：应用组织多普勒显像（DTI）评价冠心病患者右心室舒张功能。方法：应用脉冲多普勒（PW）测量42例临床确诊冠心病患者在右室舒张期三尖瓣口充盈早期血流峰值速度（E）和心房收缩峰值（A）,并计算E/A;应用组织多普勒测量三尖瓣环舒张早期运动速度（e）,舒张晚期运动速度（a）及e/a值,并与健康组50例进行比较。结果：冠心病组E/A〈1,而健康组E/A〉1;冠心病组e、e/a均较健康组显著降低（P〈0.05）。结论：冠心病可引起右室舒张功能减低,因此组织多普勒显像能够评价冠心病患者对右心室舒张功能的影响。     

多普勒组织显像技术对冠心病患者二尖瓣环运动特点分析

目的 探讨多普勒组织显像技术对二尖瓣环运动速度定量分析，评价冠心病患者左室收缩，舒张功能的价值。方法 52例冠心病患者，20例排除心脏疾患的就诊者(对照组)均行二维超声心动图(2DE)及脉冲多普勒组织显像(DTI)检查，冠心病患者均行选择性冠状动脉造影(SCA)，对正常人及冠心病患者二尖瓣环6个位点进行S波峰值速度VS，E波峰值速度VE，A波峰值速度VA及VE／VA值测定。结果 冠心病患者与正常人比较，病变冠脉支配的室壁二尖瓣环处Vs，VE及VE／VA降低，二尖瓣环其他各位点运动速度发生变化。结论 DTI可早期定量反映冠心病患者收缩及舒张功能的变化，为心脏病治疗效果评估提供了较敏感的参数。     

多巴酚丁胺负荷试验中多普勒组织成像技术的应用价值

目的　静息状态与大剂量多巴酚丁胺 (Dob)负荷状态下 ,采用多普勒组织成像 (DTI)技术观察冠心病患者室壁运动 ,探讨大剂量 Dob负荷试验中 DTI检测冠心病的应用价值。方法　采用 DTI测量大剂量 Dob负荷试验中 32例冠心病患者 (至少 1支冠状动脉主支狭窄≥ 5 0 % )静息状态、峰值负荷下侧壁、后室间隔、前壁、下壁心肌基底段、中段心内膜下心肌运动频谱 ,对照组 2 5例相应节段作对照。 DTI分析指标 :收缩期峰值运动速度 (Vs)。结果　选择性冠状动脉造影结果将冠心病组患者心肌节段区分为正常节段与缺血节段。静息状态下 ,冠心病缺血节段(abnormal,A组 )与对照组相应正常节段 (normal,N组 )间 Vs无显著性差异 ;与 N组比较 ,峰值负荷下 A组各节段 Vs明显降低 (P<0 .0 5 ) ;以选择性冠状动脉造影为诊断冠心病的金标准 ,将峰值负荷下基底段心肌 Vs≤ 11.5 cm/ s,中段心肌 Vs≤ 9.5 cm/s为诊断冠状动脉狭窄的截断值 ,DTI结合大剂量多巴酚丁胺负荷试验诊断冠状动脉狭窄的敏感性、特异性、准确率分别为 85 .7%、84 .0 %、 84 .8% ;与常规多巴酚丁胺负荷超声心动图中室壁运动评分 (WMS)比较 ,DTI结合大剂量多巴酚丁胺负荷试验诊断冠状动脉狭窄的特异性与其并无显著差异 ;而敏感性、准确率显著增高 (P<0 .0 1)。结     

Accelerated Infliximab Induction for Severe Lower Gastrointestinal Bleeding in a Young Patient with Crohn’s Disease: A Case Report

BACKGROUNDSevere lower gastrointestinal bleeding (SLGIB) is a rare complication of Crohn''s disease (CD). The treatment of these patients is a clinical challenge. Monoclonal anti-TNFα antibody (IFX) can induce relatively fast mucosal healing. It has been reported for the treatment of SLGIB, but there are few reports on accelerated IFX induction in CD patients with SLGIB.CASE SUMMARYA 16-year-old boy with a history of recurrent oral ulcers for nearly 1 year presented to the Gastroenterology Department of our hospital complaining of recurrent periumbilical pain for more than 1 mo and having bloody stool 4 times within 2 wk. Colonoscopy showed multiple areas of inflammation of the colon and a sigmoid colon ulcer with active bleeding. Hemostasis was immediately performed under endoscopy. The physical examination of the patient showed scattered small ulcers in the lower lip of the mouth and small cracks in the perianal area. Combined with his medical history, physical examination, laboratory examinations with high C-reactive protein (CRP), platelet count (PLT), erythrocyte sedimentation rate (ESR) and fecal calprotectin levels, imaging examinations and pathology, a diagnosis of CD was taken into consideration. According to the pediatric CD activity index 47.5, methylprednisolone (40 mg QD) was given intravenously. The abdominal pain disappeared, and CRP, PLT, and ESR levels decreased significantly after the treatment. Unfortunately, he had a large amount of bloody stool again after 1 wk of methylprednisolone treatment, and his hemoglobin level decreased quickly. Although infliximab (IFX) (5 mg/kg) was given as a combination therapy regimen, he still had bloody stool with his hemoglobin level decreasing from 112 g/L to 80 g/L in a short time, so-called SLGIB. With informed consent, accelerated IFX (5 mg/kg) induction was given 7 days after initial presentation. The bleeding then stopped. Eight weeks after the treatment, repeat colonoscopy showed mucosal healing; thus far, no recurrent bleeding has occurred, and the patient is symptom-free.CONCLUSIONThis case highlights the importance of accelerated IFX induction in SLGIB secondary to CD, especially after steroid hormone treatment.     

脉冲组织多普勒定量分析冠心病患者左室局部收缩功能

目的应用脉冲组织多普勒成像(DTI)定量分析冠心病患者左室局部收缩功能,比较心肌梗死(心梗)与非心梗患者室壁运动变化的异同,评价收缩速度和时间指标检测室壁运动异常的价值。方法冠心病非心梗组16例、前壁心梗组21例,对照组16例。记录左室侧壁、间隔、前壁和下壁基底段及中段心肌运动频谱。DTI检测指标心肌收缩峰值速度(s)、局部射血前时间(PEP)、心肌收缩峰值时间(Ts)、局部射血时间(ET)、PEP/ET。结果前壁心梗组所有节段、非心梗组侧壁和前壁节段s均显著降低;前壁心梗组较非心梗组、梗死节段较非梗死节段s也显著降低。冠心病两组PEP、Ts显著延长。结论DTI所测s、PEP和Ts可敏感反映冠心病患者左室局部收缩功能异常;s还可反映心肌缺血损害的严重程度,有助于确定心梗部位。     

脉冲多普勒组织成像对冠心病左室局部收缩功能的研究

目的　探讨脉冲多普勒组织成像 (PW DTI)技术几个量化指标评价冠心病患者左室局部收缩功能的临床价值。方法　应用该技术对 32例正常人和 34例冠心病患者左室局部收缩功能进行测量 ,测量指标 :s波峰值速度 (s)、持续时间(s D)及时间速度积分 (s TVI)。结果　正常组s、s TVI从基底段到心尖段逐渐降低 (P <0 .0 5 ) ;冠心病组病变节段s、s TVI低于正常组的相应节段 (P <0 .0 5 ) ,而s D差异不显著。结论　s ,s TVI是反映冠心病患者局部收缩功能的较好指标 ,s D不能作为其评价指标     

Double Ventricular Response by a Single Ventricular Extrastimulus to the Inner Loop of Reentry in a Patient Without Apparent Heart Disease

SHIMIZU, A., et al. : Double Ventricular Response by a Single Ventricular Extrastimulus to the Inner Loop of Reentry in a Patient Without Apparent Heart Disease. In a patient without apparent heart disease, a ventricular extrastimulus delivered from the left ventricular apex where the electrogram was recorded 30 ms after the onset of the QRS complex during VT advanced the second QRS complex, but not the first QRS complex. The morphology of the second QRS complex was the same as that of VT. The postpacing interval was the same as the cycle length of the VT. These findings indicated that the site of stimulation was at the inner loop of the reentry circuit of the VT. A ventricular extrastimulus with a shorter coupling interval advanced the first and second QRS complexes, indicating that the ventricle was activated by antidromic and orthodromic activation from the extrastimulus. Radiofrequency ablation at that site of stimulation terminated the VT and no further VT could be induced.