阻塞性睡眠呼吸暂停低通气综合征患者呼吸阻抗值变化的意义

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸阻抗值的变化及临床意义。方法用脉冲振荡技术检测38例OSAHS患者、28例COPD患者和20例健康人的呼吸阻抗值,同时进行多导睡眠图监测。结果 OSAHS患者上气道阻力(R35)、中心气道阻力(R20)明显高于COPD组和对照组,差异有统计学意义(P均<0.05);且共振频率、呼吸总阻抗(Zrs)、中心阻力、R20、R35随OSAHS病情加重呈升高趋势,各组之间差别有统计学意义(P均<0.05);OSAHS患者R35、R20与呼吸暂停低通气指数(AHI)呈正相关(r分别为0.623、0.617,P均<0.05);R35、R20、Zrs与最低指端血氧饱和度呈负相关(r分别为-0.607、-0.591和-0.462,P均<0.05)。结论 OSAHS患者上气道阻力及中心气道阻力升高,且此改变与OSAHS病情严重程度相关。     

睡眠呼吸暂停的诊断

睡眠呼吸暂停包括阻塞性与中枢性两大类型.由于呼吸中枢驱动消失引起的呼吸暂停事件为中枢性,如果呼吸暂停是因为上气道阻塞所致则称为阻塞性睡眠呼吸暂停.如果呼吸事件发生时气流只是显著减少而不是停止则称为低通气.由于低通气与呼吸暂停所致的病理生理变化相似,都可引起间歇缺氧和微觉醒,且二者的治疗方法相似,人们常常把呼吸暂停和低通气统称为呼吸暂停低通气综合征.如果呼吸暂停及低通气是由于上气道阻塞或不完全阻塞所致,则称为阻塞性睡眠呼吸暂停低通气综合征.通常人为地把每小时发生呼吸暂停低通气次数(AHI) ＜5认为正常,当AHI≥5次即为异常.阻塞性睡眠呼吸暂停低通气综合征的诊断与其他许多疾病一样主要根据病史、体格检查,特别是睡眠多导图进行诊断.     

OSAHS病人气道呼吸阻力测定的临床分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征病人呼吸阻抗力的临床意义。方法选取70例OSAHS和肺通气功能检测正常的病人为研究对象,按照呼吸暂停低通气指数(AHI)分成轻、中、重度,探讨两组病人呼吸阻抗力的差异。结果两组病人采用4 Hz和16 Hz两个振荡频率进行比较,发现中重度组病人阻力增加较为显著,但差异无显著性(P>0.05),但是采用8 Hz时显示两者差异具有显著性(P<0.05)。结论研究示OSAHS病人肺功能正常时,其小气道可有病变。脉波振荡肺功能(IOS)对于诊断OSAHS具有临床意义。     

阻塞性睡眠呼吸暂停低通气综合征患者睡眠过程中呼吸力学的变化

目的 研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者在睡眠过程中的呼吸力学变化特点.方法 60例疑似OSAHS患者及21例无OSAHS临床表现的志愿者入选本研究,其中男70例,女11例,平均年龄(44±13)岁.所有受试者均接受整夜多导睡眠图监测,并同时采用面罩旁气流技术动态描记整个睡眠过程中的呼吸力学指标和潮气量流速容量环(TBFVL).根据呼吸暂停低通气指数(AHI)将入选者分为OSAHS组(AHI≥15次/h)54例和对照组(AHI＜15次/h)27例.采用重复测量方差分析比较OSAHS组各期潮气吸气容积(VTI)/潮气呼气容积(VTE)及对照组各期呼吸力学指标变化;自身比较采用配对t检验;组间比较采用x2检验.结果 清醒状态下呼吸周期的VTI/VTE为0.99±0.04,说明吸气和呼气潮气量大致相等.OSAHS组发生睡眠呼吸暂停后第1个呼吸周期VTI/VTE(1.37±0.18)明显升高,在睡眠呼吸暂停前5次内和最后一次呼吸周期VTI/VTE均值(0.86±0.08和0.72±0.19)明显降低,说明呼吸暂停前一段时间内呼气量明显多于吸气量,而呼吸暂停后吸气量多于呼气量.OSAHS组无呼吸事件浅睡眠期VTI[(463±122)ml]、VTE[(466±127)ml]和分钟通气量[(6.4±1.6)L/min]比睡前[(554±134)ml、(565±147)ml和(8.3±1.9)L/min]明显减少.TBFVL结果显示,OSAHS组吸气阻力升高者占100%(54/54),呼气阻力升高者和两种阻力同时升高者均占96.3%(52/54).结论 在发生睡眠呼吸暂停前OSAHS患者呼气量明显多于吸气量,直至呼吸停止,这使患者发生睡眠呼吸暂停前的功能残气量明显减少,从而上气道更加狭窄,此病理生理过程在OSAHS整个发病过程中占有重要地位.OSAHS患者浅睡眠期的潮气量和通气量较睡前降低,睡眠过程中以上气道吸气相阻力升高为主的同时普遍存在呼气相阻力升高.     

我国阻塞性睡眠呼吸暂停低通气综合征的诊断和治疗中的几个问题

阻塞性睡眠呼吸暂停综合征(OSAS)或阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种慢性睡眠呼吸疾病,是近年来呼吸疾病临床和研究的新领域.其特征是睡眠状态中反复发生上气道完全或不完全阻塞,伴有间断的低氧血症或合并高碳酸血症、睡眠结构紊乱等,主要临床症状是睡眠过程中打鼾、呼吸暂停或憋醒,晨起头痛,日间嗜睡,疲劳,记忆力下降等.     

不同严重程度的阻塞性睡眠呼吸暂停低通气综合征患者呼吸道阻力的变化及临床意义

目的研究不同严重程度的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸道阻力的变化及临床意义。方法选取96例2015年3月~2017年5月我院收治的OSAHS患者为研究对象,根据OSAHS病情严重程度分为轻度组37例(轻度:AHI:5~15次/h)和中、重度组59例(中度及重度:AHI>15次/h),观察比较两组个人体格特征指数(体重指数、颈围、腹围及呼吸暂停低通气指数(AHI))、气道阻抗指标[总呼吸阻抗(Z5)、总气道阻力(R5)、中心气道阻力(R20)、外周(肺及周围小器官)弹性阻力(X5)、50%用力呼气流速(FEF50%)、中段用力呼气流速(MMEF)]及睡眠参数[最低血氧饱和度(LSaO 2)、微觉醒指数(ArI)、呼吸暂停指数(Apnea index,AI)、低通气指数(HI)],并作呼吸阻抗指标与AHI的相关性分析及嗜睡量表(ESS)和ArI与睡眠参数及AHI的相关性分析。结果中、重度组患者体重指数、颈围、腹围及AHI明显高于轻度组,差异具有统计学意义(P<0.05);观察组Z5、R5、R20、FEF50%及MMEF值明显高于轻度组(P<0.05);两组X5值比较差异无统计学意义(P>0.05);轻度组ArI、AI、HI值明显低于中、重度组(P<0.05);轻度组LSaO 2值明显高于中、重度组(P<0.05);AHI与Z5、R5、R20、FEF50%呈正相关,与X5、MMEF无相关性(P>0.05);ESS与ArI、AI、AHI呈正相关,与LSaO 2呈负相关(P<0.05);ArI与AI、AHI呈正相关,与LSaO 2呈负相关(P<0.05);ESS与HI及ArI与HI无相关性(P>0.05)。结论不同严重程度OSAHS患者个人体格特征指数、气道阻抗指标及睡眠参数存在较大差异,OSAHS患者病程进展与气道阻抗指标相关,且ESS与ArI和相关睡眠指数具有相关性。     

阻塞性睡眠呼吸暂停综合征的研究进展——阻塞性睡眠呼吸暂停综合征的研究概述

睡眠呼吸障碍是与睡眠相关的呼吸道疾患,以睡眠中发生异常呼吸事件为特征,包括上气道阻力综合征、鼾症、阻塞性睡眠呼吸暂停综合征（OSAHS）、中枢性睡眠呼吸暂停低通气综合征、睡眠低通气综合征及陈一施呼吸等,临床上以OSAHS最常见。OSAHS是以睡眠时反复呼吸暂停、间歇性低氧、睡眠结构紊乱和反复微觉醒为特征,伴或不伴低通气的临床综合征。近年来,随着对人群患病率的流行病学调查,该病患病率之高、并发症之严重越来越引起人们的关注。     

青海地区阻塞性睡眠呼吸暂停低通气综合征与外周气道阻力的相关性

目的通过分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的肺功能，探讨OSAHS与气道外周阻力的相关性。 方法收集2017年8月至2019年8月我院住院并确诊为OSAHS的青海地区成年患者184例。根据睡眠呼吸暂停/低通气指数(AHI)将OSAHS患者分为三组，即轻度组(5≤AHI≤15)、中度组(1530)。通过Spearman相关性分析探索AHI与R5-R20之间的相关性。多因素线性回归模型用于分析OSAHS不同严重程度与R5-R20之间的关系；根据慢性阻塞性肺疾病(COPD)及性别进行亚组分析，进一步探索OSAHS不同严重程度与R5-R20之间的关系。 结果共纳入184例确诊为的青海地区成年患者。Spearman相关性分析结果显示，随着AHI的增加，OSAHS患者的R5-R20随之增加(r＝0.402，P<0.001)。多因素线性回归分析得出，OSAHS严重程度每增加一个度，R5-R20增加(β，0.340；95%CI，0.199～0.481；P<0.001)。亚组分析结果显示，无论女性还是男性(女性：β，0.517；95%CI，0.207～0.827；P＝0.002；男性：β，0.309；95%CI，0.144～0.474；P<0.001)，COPD或非COPD的亚组内(非COPD：β，0.262；95%CI，0.113～0.410；P＝0.001；COPD组：β，0.497；95%CI，0.154～0.840；P＝0.005)，OSAHS严重程度与R5-R20的上述关系仍然存在。 结论OSAHS不同严重程度与外周气道阻力相关，即OSAHS越严重，外周气道阻力越大。     

阻塞性睡眠呼吸暂停低通气综合征的诊断与治疗

关于阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnoea hypopnea syndrome，OSAHS)的WSCS(wisconsin sleep cohort study)人群调查显示，30～60岁人群中呼吸暂停和低通气指数(apnea hypopnea index，AHI)大于和等于5的男性占24％、女性占9％。尽管AHI大于和等于5     

脉冲震荡测定在阻塞性睡眠呼吸暂停低通气综合征患者不同体位中的变化及临床意义

目的 探讨脉冲振荡(impulse oscillometry system,IOS)检测在明确阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)诊断、判断其病情程度,评估体位对OSAHS的影响,鉴别体位性OSAHS的价值.方法 IOS检测92例临床高度怀疑睡眠呼吸紊乱患者不同体位(坐位、侧卧位、仰卧位)的呼吸阻抗,同时进行睡眠监测.结果 OSAHS组较对照组坐位、侧卧位、仰卧位的ZRS、R5、R20、R35数值显著升高(P＜0.05);重度OSAHS组侧卧位、仰卧位的ZRS、R5、R20、R35值较轻、中度OSAHS组显著升高(P＜0.05);非体位性OSAHS侧卧位ZRS、R5、R20、R35值较体位性OSAHS组显著升高(P＜0.05);非体位性OSAHS侧卧位△ZRS、△R5、△R20、△R35较体位性OSAHS组显明显偏小(P＜0.05);而R5-R20、X5、△R5-R20、△X5在OSAHS组和对照组间以及非体位性OSAHS组和体位性组间比较,差异无统计学意义(P＞0.05).结论 IOS可用于OSAHS的初步检查,评估其严重程度;体位变化对上气道阻力有显著影响,IOS可能可以鉴别出体位性OSAHS.     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.