强直性脊柱炎的外周关节病

148例强直性脊柱炎AS患外周关节病者130例,发病率为88％,幼年发病组明显高于成年发病组(P<0.01),外周关节炎者47例,其中下肢非对称性关节炎占83％。85％的患者于外周关节病5年内出现腰骶病/或僵硬感。幼年发病组其关节炎、肌腱端病表现及髋关节致残率均高于成年组。有外周关节病组其关节外表现多于无外周关节病组。ESR、CRP和IgA在伴有关节炎的病例中明显升高,故可作为AS活动的参考指标。常规摄骶髂关节X片和行HLA-B27检查有助疾病的早期诊断。     

强直性脊椎炎误诊漏诊的原因分析

目的 通过对强直性脊椎炎（AS）病例的临床资料进行分析，以加强对AS的认识，尽量减少误诊和漏诊。方法 回顾分析近几年同济医院中医科88例AS患者的临床资料，包括病程中腰痛及外周关节疼痛情况，影像学检查结果及有关实验检查。结果 88例患者中有50例误诊，误诊率为56.8%，误诊疾病主要是类风湿性关节炎，骨关节结核，化脓性关节炎、股骨头无菌性坏死，腰椎间盘突出症等疾病。结论 AS起病隐匿，临床误诊率高，且误诊疾病多、及时行骨盆及脊椎X线检查有利于AS的诊断，骶髂关节CT检查有利于早期病例的发现，此外，HLA-B27抗原也可以为诊断提供线索。     

强直性脊柱炎早期临床、骶髂关节多层螺旋CT表现及HLA-B27表达的相关性研究

目的对66例强直性脊柱炎早期临床表现、骶髂关节的CT表现和实验室特点进行分析。方法66例患者,男60例、女6例,年龄17-57岁,平均25．7岁。全部病例行骶髂关节的多层螺旋凹轴位平扫,并记录其HLA-B27及血沉（ESR）检查结果。结果髋部疼痛者占63％,腰痛者占40％。多层螺旋CT征象,以骶髂关节变毛糙、模糊、受侵蚀出现率最高,68．1％;其他如关节硬化50％,关节间隙变窄36．3％,关节融合91％。实验室检查结果HLA-B27阳性、ESR变快分别为100％、92％。结论强直性脊柱炎患者早期腰痛、外周关节炎、“4”字试验阳性、骶髂关节压痛和腰椎压痛为常见症状和体征。骶髂关节的多层螺旋CT检查,常见骶髂关节变毛糙、模糊、受侵蚀征象,实验室检查HLA-B27呈阳性是早期重要的诊断依据。     

强直性脊柱炎56例临床分析

目的:总结强直性脊柱炎(AS)的临床特点,提高诊治水平.方法:回顾性分析56例强直性脊柱炎患者的临床资料.结果:56例强直性脊柱炎中,男50例,女6例,平均发病年龄28岁;首发症状为慢性腰痛者43例占76.78%;关节外表现仅见虹膜炎10例占17.85%;骨盆正位片全部有骶髂关节炎占100%;HLA-B27阳性52例占92.85%;25例误诊占44.64%;治疗药物主要有非甾体类抗炎药(NSAIDs)、柳氮磺胺吡呤(SSZ)、甲氨蝶呤(MTX)、糖皮质激素等.结论:强直性脊柱炎多见于青年男性,其首发症状多为慢性腰痛,临床易误诊,骨盆正位片、骶髂关节炎及HLA-B27阳性有助于早期诊断和治疗.     

强直性脊柱炎伴发葡萄膜炎患者的临床特征分析

目的 探讨强直性脊柱炎(ankylosingspondylitis, AS)伴发葡萄膜炎患者的临床特征,减少临床误诊或漏诊率。方法 回顾分析2023年3月～6月在哈尔滨医科大学附属第一医院就诊的68例AS患者的临床资料,其中葡萄膜炎组31例、非萄萄膜炎组37例。行人类白细胞抗原B-27(human leukocyte antigen B-27,HLA-B27)、血沉(erythrocyte sedimentation rate, ESR)、C反应蛋白(C-reactive protein, CRP)和骶髂关节CT、裂隙灯检查,记录AS疾病活动性评分(Bath Ankylosing Spondylitis Disease Activity Index, BASDAI评分)、疾病功能性评分(Bath AS Function Index, BASFI)。结果 AS伴发葡萄膜炎患者HLA-B27阳性率为80.65%,与非葡萄膜组(78.38%)比较差异无统计学意义(P>0.05),AS伴发葡萄膜炎患者ESR、CRP升高,与非葡萄膜炎组比较差异有统计学意义(P<0.05);葡萄膜炎组...     

强直性脊柱炎并发干燥综合征患者的临床特点及其实验室检查结果分析

目的：阐明强直性脊柱炎（AS）并发干燥综合征(SS)患者的特点,为该病的治疗及并发症的防治提供依据。方法：选择确诊的AS并发SS患者11例,总结临床特点和实验室检查结果,分别比较AS并发SS与单纯AS和单纯SS患者外周关节受累率、人类白细胞抗原-B27(HLA-B27)阳性率、抗核抗体(ANA)阳性率和C反应蛋白(CRP)、血沉(ESR)及免疫球蛋白水平。结果：11例患者均符合AS和SS的诊断标准,均有腰背痛与口干和(或)眼干症状;外周关节受累9例,葡萄膜炎1例;影像学示骶髂关节炎双侧≥2级9例,单侧3级1例,单侧4级1例;HLA-B27阳性7例,HLA-B27阳性率(63.6%)明显低于单纯AS患者(92.9%)(P<0.05);唾液腺放射性核素检查阳性9例;泪液分泌试验阳性11例;ANA阳性9例,ANA阳性率(81.8%)与单纯SS患者(84.8%)比较差异无统计学意义;抗SSA抗体阳性8例;抗SSB抗体阳性6例;唇腺病理检查阳性11例。AS并发SS患者CRP、ESR和免疫球蛋白水平高于单纯AS和SS患者,但差异无统计学意义(P>0.05);与AS患者比较,AS并发SS患者高球蛋白血症发生率升高(P<0.05)。结论：AS和SS可以同时发生,两病同时并发患者更易出现外周关节受累。     

放射学阴性脊柱关节炎和强直性脊柱炎患者的临床特征比较和磁共振早期诊断价值

[目的]分析在2013年1月至2014年8月期间,于中山大学附属第三医院初次确诊为放射学阴性脊柱关节炎患者和强直性脊柱炎患者共119例的临床特点和影像学改变.[方法]选取确诊为放射学阴性脊柱关节炎(nr-axSpA)患者59例和强直性脊柱炎(AS)患者60例,对临床表现、实验室检查、骶髂关节X线及MRI检查等进行分析,比较nr-axSpA患者和AS患者在临床表现、疾病活动度和影像学改变的差异.[结果]59例nr-axSpA患者和60例AS患者经确诊后纳入研究,nr-axSpA组男性患者比率(66.1％)显著低于于AS组(86.7％)(P=0.008).与AS组相比,nr-axSpA组的病程较短(P=0.001).Nr-axSpA组的Bath强直性脊柱炎疾病活动度指数(BASDI)和强直性脊柱炎疾病活动度评分(ASDAS-CRP)均高于AS组(分别为P＜0.001,P=0.002),Bath强直性脊柱炎测量指数(BASMI)优于AS组(P＜ 0.001).MRI检查结果显示nr-axSpA的骶髂关节骨髓水肿发生率显著高于AS组(P=0.004),而侵蚀、脂肪沉积、强直的发生率均显著低于AS组(分别为P=0.002,P=0.049,P＜0.001).[结论]Nr-axSpA患者疾病活动度及骶髂关节炎症表现显著高于AS患者,骨髓水肿合并骨侵蚀可作为中轴型脊柱关节炎(SPA)早期诊断的MRI特异性表现.     

以急性前葡萄膜炎为首发症状的强直性脊柱炎43例临床分析

目的:探讨以急性前葡萄膜炎(AAU)为首发症状的强直性脊柱炎(AS)患者的临床特点,以提高对关节外以AAU表现为主的AS的认识水平,减少误诊或漏诊率。方法:对43例临床确诊为AS并以AAU为首发症状的住院患者行HLA-B27、C反应蛋白、血沉和骶髂关节CT、眼压、视力、裂隙灯等检查及AS疾病活动性评分(BASDAI评分)、疾病功能性评分(BASFI)、葡萄膜炎严重程度(EIU)评价。结果:1AS并发AAU患者平均发病年龄为(27.0±11.3)岁,病程为(6.34±5.17)年,所有患者均有骶髂关节炎改变。2AS并发AAU患者CRP、ESR升高,与未并发AAU组比较差异有统计学意义(P<0.05);AS并发AAU患者HLA-B27阳性率为84.6%,与未并发AAU组相比差异无统计学意义(P>0.05)。3AS并发AAU患者葡萄膜炎等级评分为(6.24±2.43)分,与BASDAI评分呈正相关(r=0.68,P<0.05)。结论:以AAU为首发表现的AS起病隐匿,多累及青年男性,病情易反复,AAU严重程度与AS的病情活动有一定相关性。     

温肾蠲痹汤治疗活动期强直性脊柱炎

目的 观察温肾蠲痹汤治疗活动期强直性脊柱炎的临床疗效及机制.方法 将50例患者,随机分为中药治疗组和西药对照组,各25例,2组疗程均为24周,观察2组治疗前后腰背痛(分)、中医证候评分、巴氏AS疾病活动性指数(BASDAI)、巴氏AS功能指数(BASFI)、枕墙距、扩胸距、指距地、Schober及TNF-α、ESR、CRP等指标的改善情况.结果 2组BASDAI、BASFI、腰痛、中医证候评分、枕墙距、扩胸距、指距地、Schober及TNF-α、ESR、CRP等指标较治疗前均有改善(P＜0.05),且治疗组优于对照组(P＜0.05).结论 温肾蠲痹汤治疗活动期强直性脊柱炎能改善腰痛等症状及增加关节活动功能,其作用机制可能与改善炎性细胞因子TNF-α的水平有关.     

人类白细胞抗原B27阳性与阴性强直性脊柱炎患者骶髂关节CT图像的对比分析

目的探讨人类白细胞抗原B27(HLA-B27)阳性和阴性强直性脊柱炎(AS)患者的骶髂关节CT影像学差异。方法选取2013年1月至2018年6月在马鞍山市中医院及市人民医院确诊的182例AS患者,根据HLA-B27检测结果分为阳性组和阴性组,其中阳性组145例,阴性组37例,比较两组患者骶髂关节CT影像学表现的差异。结果①骶髂关节CT诊断分级:阳性组Ⅱ级40例、Ⅲ级72例、Ⅳ级33例;阴性组Ⅱ级24例、Ⅲ级11例、Ⅳ级2例。②骶髂关节CT征象检出率:两组患者在关节面硬化检出率上的差异无统计学意义(P> 0. 05);阳性组在关节面侵蚀、关节间隙改变及骨性强直等方面检出率高于阴性组,差异有统计学意义(P均<0. 05)。结论 HLA-B27阳性和阴性AS患者骶髂关节在CT影像学表现上存在差异。     

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.