肝动脉化疗栓塞术联合阿德福韦酯治疗原发性肝癌的疗效观察

目的 探讨经皮肝动脉栓塞化疗术(TACE)联合阿德福韦酯治疗原发性肝癌的临床疗效.方法 将106例原发性肝癌患者随机分为观察组和对照组各53例,两组均采用Seldinger技术行TACE治疗,予以肝动脉化疗和碘油栓塞;在此基础上,观察组同时口服阿德福韦酯10 mg、1次/d.治疗前后两组均行甲胎蛋白(AFP)检测及影像学检查,观察肿瘤变化、碘油沉积情况及其充填面积占肿瘤总面积的百分率;并观察记录两组临床疗效.结果 与治疗前及对照组比较,观察组的AFP降低(P＜0.05);总有效率(75.48％)显著高于对照组(60.38％)(P＜0.05).观察组1、2、5年生存率分别为90.57％、75.47％和54.72％;对照组分别为83.02％、54.72％和37.74％,两组比较P均＜0.05.结论 TACE联合阿德福韦酯治疗原发性肝癌的临床疗效明显优于单纯行TACE治疗者.     

氩氦刀联合肝动脉栓塞化疗与单纯氩氦刀治疗原发性肝癌比较研究

目的比较氩氦刀冷冻消融治疗联合肝动脉灌注化疗栓塞（TACE）与单纯氩氦刀治疗原发性肝癌的优劣。方法 86例原发性肝癌患者随机分为2组,A组43例行单纯氩氦刀冷冻消融治疗,B组43例行氩氦刀冷冻消融治疗联合TACE。分别在治疗前、治疗后8、15、30和50 d监测并记录各组甲胎蛋白（AFP）的动态变化。结果与A组比较,B组的AFP下降明显（P〈0.05）。结论氩氦刀冷冻消融联合TACE治疗原发性肝癌是一种微创、安全、有效的新方法,对于不适宜手术切除治疗的肝癌患者是一种有效的治疗方法。     

肝动脉、门静脉联合介入治疗原发性肝癌(附15例报告)

原发性肝癌患者35例，对其中15例行肝动脉栓塞化疗术后再行经门静脉栓塞化疗（双重化疗组），20例行单纯肝动脉栓塞化疗术（单一化疗组）。术后定期随访患者的超声、CT表现和血清甲胎蛋白（AFP）。结果：双重化疗组在延长患者生存期、缩小肿瘤大小等方面均优于单一化疗组。认为肝动脉、门静脉联合介入治疗法是治疗肝癌的有效方法。     

肝动脉化疗栓塞联合微波消融治疗原发性肝癌临床疗效分析

目的评价肝动脉化疗栓塞（TACE）联合微波凝固消融治疗中晚期肝癌的疗效。方法 48例患者接受TACE治疗,另48例患者给予TACE联合微波消融治疗。结果治疗3个月后,TACE组CR为33.3%,联合组为75.0%（P〈0.05）;TACE联合微波消融治疗患者AFP下降程度明显高于TACE治疗组（P〈0.05）;治疗后6个月随访,TACE联合微波消融治疗患者的生存率为100%,TACE治疗患者为91%,治疗后12个月时,两组分别为83%和47%（P〈0.05）。结论微波凝固消融联合TACE治疗原发性肝癌是安全、有效的方法,效果明显优于单纯的TACE治疗。     

奥沙利铂联合表柔比星经肝动脉化疗栓塞治疗原发性肝癌的研究

目的:观察奥沙利铂联合表柔比星经肝动脉化疗栓塞(TACE)治疗原发性肝癌的效果及安全性。方法:80例原发性肝癌患者按随机数字表法分为对照组(单纯碘油TACE)和观察组(奥沙利铂联合表柔比星经TACE),对比两组患者治疗总有效率、1年生存率;比较两组患者术前、治疗3周、治疗6周血清甲胎蛋白(AFP)、癌胚抗原(CEA)水平;并对比两组患者不良反应发生率。结果:观察组患者总有效率(92.50%)较对照组(72.50%)高,1年生存率(75.00%)较对照组患者(60.00%)高;治疗3周时观察组患者CEA水平降低且低于对照组患者,治疗6周时观察组AFP、CEA均降低且低于对照组患者;观察组患者血小板减少率(10.00%)、白细胞减少率(22.50%)、中性粒细胞减少率(22.50%)均低于对照组。上述比较均有统计学差异,P均0.05。结论:奥沙利铂联合表柔比星-TACE能提高原发性肝癌患者治疗效果,降低肿瘤标志物水平,减少不良反应,提高1年生存率,值得临床应用。     

肝动脉化疗栓塞术联合微波消融治疗原发性大肝癌疗效观察

目的观察肝动脉化疗栓塞术(TACE)联合微波消融治疗原发性大肝癌的疗效。方法将60例大肝癌(肿瘤直径>5 cm)患者按照治疗方法分为观察组28例和对照组32例,观察组采用TACE联合微波消融治疗,对照组仅行TACE。观察两组疗效,ELISA法检测治疗前后血清甲胎蛋白(AFP),记录中位生存时间及6、12、18、24个月累计生存率。结果观察组治疗总有效率为96.4%,对照组为81.3%,两组比较,P<0.05。观察组治疗前后血清AFP水平分别为(399.13±430.214)、(235.31±308.047)U/L,对照组分别为(491.90±439.203)、(609.81±420.135)U/L,两组治疗前与治疗后比较,两组治疗后比较,P均<0.05。观察组中位生存时间为10个月,对照组为7个月。观察组、对照组6个月生存率分别为89%、50%,12个月生存率分别为18%、0,18个月生存率分别为4%、0,24个月生存率分别为0、0,两组6个月、12个月生存率比较,P均<0.05。结论与单行TACE比较,TACE联合微波消融治疗原发性大肝癌疗效较好,且术后患者生存率高。     

射频消融联合同步TACE治疗老年肝癌的疗效

目的探讨射频消融同步经动脉化疗栓塞(TACE)治疗老年肝癌的可行性。方法选取老年原发性肝癌患者152例,按照病案号的单双号分为观察组和对照组各76例。观察组给予射频消融同步TACE治疗;对照组先行TACE治疗,1~2 w后再行射频消融治疗。比较两组患者生存情况、甲胎蛋白(AFP)水平、治疗前后肿瘤体积、肿瘤完全坏死率、并发症发生情况。结果观察组患者1年和2年生存率均明显高于对照组(P0.05)。两组AFP阳性患者中治疗前AFP水平之间无明显差异;治疗后12个月时观察组AFP水平明显低于对照组(P0.05)。治疗前两组患者肿瘤体积之间无明显差异;治疗后3、6、12个月观察组患者肿瘤体积均明显低于对照组(P0.05)。对照组患者肿瘤完全坏死率明显高于对照组(P0.05)。两组患者并发症发生率之间无统计学差异(P0.05)。结论射频消融联合同步TACE治疗老年原发性肝癌与先行TACE治疗相比疗效更佳,且具有较好的安全性,在临床老年肝癌患者的治疗中具有较好的可行性。     

三维适形放疗联合肝动脉化疗栓塞术对原发性肝癌患者临床疗效、生存率及γ-GT、AFP的影响

目的探讨三维适形放疗(3-DCRT)联合肝动脉化疗栓塞术(TACE)对原发性肝癌患者临床疗效、生存率及γ-GT、AFP的影响。方法按照随机数字表法将80例原发性肝癌患者均分为试验组和对照组,对照组患者给予TACE治疗,试验组患者在此基础上给予3-DCRT治疗,比较2组患者临床疗效和预后情况。结果试验组患者疗程结束后客观缓解率(ORR)明显高于对照组,差异具有统计学意义(P0.05);2组患者疗程结束后γ-GT、AFP水平变化情况比较,差异无统计学意义(P0.05);试验组患者1、2、3年生存率及中位生存时间均明显高于对照组,差异具有统计学意义(P0.05);肝内肿瘤进展是导致患者死亡的主要原因,转移是导致患者死亡的次要原因。结论在TACE基础上联用3-DCRT能够有效提高原发性肝癌近期疗效和远期生存率,但与单纯TACE比较,在γ-GT、AFP的影响上差异并无明显统计学意义。     

高温碘油热栓塞治疗原发性肝癌患者

目的 探讨高温碘油血管栓塞及热杀伤作用对原发性肝癌的疗效。方法 将131例原发性癌患者随机分为两组：热碘油栓塞组63例，化疗栓塞组68例。采用Seldinger方法，将导管超选择插入肿瘤供血动脉：（1）用110℃稀释热碘油脉冲式热栓塞；（2）用碘油化疗药物乳剂栓塞。结果 热栓塞组肿瘤小率和甲胎蛋白（AFP）复常率高于化疗栓塞组，而且术后临床不良反应轻，肝功能损害不明显，生存期较长。结论 高温稀释碘油流动性增加，对肿瘤滋养血管栓塞更为彻底，比热提高，对肿瘤细胞热杀伤作用增强。治疗原发性肝癌疗效好，不良反应轻，适应证广。     

高强度聚焦超声联合肝动脉化疗栓塞术治疗中晚期原发性肝癌的临床研究

目的通过应用高强度聚焦超声（HIFU）联合肝动脉化疗栓塞术（TACE）治疗原发性肝癌（HCC）的临床疗效。探讨其治疗原发性肝癌的价值。方法对2001年4月至2002年12月79例原发性肝癌患者,其中46例接受单独HIFU治疗,20例HIFU治疗前曾行经皮肝动脉栓塞化疗（TACE）治疗,13例行TACE单独治疗。对这些患者的资料进行临床分析。结果治疗后HCC患者临床症状减轻、血清AFP水平呈不同程度的下降（P〈0.05）。病灶缩小、血供减少或消失。局部无并发症出现,心肾功能正常,但肝脏酶谱有一过性升高。HIFU治疗后肿物回声有不同程度增强。HIFU治疗后CT或MRI呈典型的凝固性坏死表现。HIFU联合TACE治疗有效率为70%（14/20）,优于单纯HIFU组的41%（19/46）,优于单纯TACE组的31%（4/13）,组间比较有显著性差异（P〈0.05）。HIFU治疗组与TACE治疗组3、6个月及1年、2年生存率比较,无明显差异。结论 HIFU治疗原发性肝癌具有一定疗效。HIFU联合TACE治疗原发性肝癌是有效和可行的,两者具有协同作用。将为临床非侵入性治疗肝脏肿瘤提供一个可考虑的新的局部治疗手段。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

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.     

以肥厚性硬脑膜炎为主要表现的肉芽肿性多血管炎临床病例分析

目的探讨肉芽肿性多血管炎(GPA)继发肥厚性硬脑膜炎(HCP)的临床特点。方法回顾性分析北京协和医院2004—2018年收治的GPA继发HCP病例资料的特点。结果①GPA患者315例,19例继发HCP,占6.0%;②男性12例,女性7例;年龄19~64岁,中位年龄57岁。③神经系统表现:19例均有头痛,16例颅神经受累。受累部位:额部8例,颞部8例,颅底8例(鞍旁4例,其中海绵窦3例,眶尖2例),小脑幕6例,大脑镰2例,顶部1例,枕部1例,1例合并硬脊膜炎。④系统表现:发热10例,体质量下降8例,肺部受累4例,肾脏受累3例,16例鼻窦炎,10例中耳炎,16例局限型GPA。⑤15例ANCA抗体阳性,8例蛋白酶3(PR3)-ANCA阳性,6例髓过氧化物酶(MPO)-ANCA阳性。⑥16例行腰椎穿刺检查:脑脊液压力9例升高、5例正常、2例降低;脑脊液蛋白升高10例。⑦15例(78.9%)伯明翰系统性血管炎评分(BVAS)>15分。⑧19例均使用糖皮质激素、免疫抑制剂治疗,其中12例行甲泼尼龙冲击治疗,12例鞘内注射地塞米松(或+甲氨蝶呤),19例病情均缓解。结论HCP是GPA少见且严重的表现,主要表现为颅高压和颅神经受累,多见于局限型GPA患者,常伴有全身疾病的活动,需积极治疗。