常见自身免疫性疾病患者血清25-羟维生素D水平的差异分析

目的 分析常见自身免疫性疾病患者血清25-羟维生素D[25(OH)D]水平差异及25(OH)D水平与其他实验室指标的相关性。方法 选取2022年9月至2023年4月于福建省立医院风湿免疫科就诊的自身免疫性疾病患者229例作为试验组,其中系统性红斑狼疮(SLE)58例、类风湿关节炎(RA)45例、干燥综合征(SS)37例、强直性脊柱炎(AS)60例、皮肌炎(DM)14例和系统性硬化症(SSc)15例;选择同期体检健康人群29例作为对照组。收集血清标本,采用高效液相色谱-串联质谱法对血清标本中的25(OH)D进行检测,分析25-羟维生素D₂[25(OH)D₂]、25-羟维生素D₃[25(OH)D₃]和总25(OH)D水平在常见自身免疫性疾病患者中的差异;分析总25(OH)D水平与其他实验室指标之间的相关性。结果 试验组的血清总25(OH)D水平表现为缺乏或不足的比例总体上高于对照组。试验组的25(OH)D₃和总25(OH)D水平低于对照组,差异有统计学意义(P<0.05),试...     

类风湿性关节炎患者血清25-羟-维生素D水平与疾病活动度的相关性

目的 探讨类风湿性关节炎（RA）患者的血清25-羟-维生素D[25-(OH)-D]水平及其与疾病活动度的相关性。方法 选取2016年6月至2017年10月本院风湿免疫科收治的RA患者80例作为RA组,另选取同期进行体检的健康者80例作为对照组,检测比较两组的血清25-(OH)-D水平。计算RA患者的疾病活动性评分28(DAS 28),分析疾病的严重程度与维生素D水平的相关性。结果 RA组的血清25-(OH)-D水平为（21.05±10.02）μg/L,84%存在维生素D缺乏。对照组的血清25-(OH)-D水平为（32.87±14.16）μg/L,34%存在维生素D缺乏。RA组的血清25-(OH)-D水平明显低于对照组,差异有统计学意义（P<0.01）。RA疾病完全缓解组、低活动性组、中度疾病组和高疾病活动组的血清25-(OH)-D水平分别为（34.32±8.70）μg/L、（31.80±2.30）μg/L、（24.47±7.28）μg/L和（15.36±5.84）μg/L。血清25-(OH)-D水平与RA疾病活动性呈显著负相关（P<0.01）。结论 维生素D缺乏在RA患者中...     

支气管扩张症患者维生素D缺乏与慢性鼻窦炎的相关性研究

目的 探讨支气管扩张症（支扩）患者维生素D缺乏与慢性鼻窦炎的关系。方法 选择119例支扩患者,检测其入院时血清25-羟维生素D[25（OH）D]、血清总IgE、嗜酸性粒细胞比例,并对其进行鼻窦CT Lund-Mackay评分。根据患者入院时血清25（OH）D是否<20 ng/mL分为维生素D缺乏组和正常组,比较支扩患者中维生素D缺乏组与正常组间的慢性鼻窦炎发生率,以及支扩合并鼻窦炎患者中维生素D缺乏组与正常组的Lund-Mackay评分,分析支扩合并鼻窦炎患者血清25（OH）D水平及与Lund-Mackay评分的相关性。结果 119例支扩患者中,69例存在维生素D缺乏,50例维生素D正常;其中有鼻窦炎的患者71例,占59.7%,48例患者鼻窦无异常;与维生素D正常组相比,维生素D缺乏组的慢性鼻窦炎发生率更高（P < 0.05）。71例支扩合并慢性鼻窦炎的患者中,维生素D缺乏组的Lund-Mackay评分高于维生素D正常组（P < 0.05）。支扩合并慢性鼻窦炎患者的血清25（OH）D水平与Lund-Mackay评分呈负相关（P < 0.05）。 结论 支扩患者的维生素D缺乏与其慢性鼻窦炎发生、发展有关。     

女性系统性红斑狼疮患者骨密度与疾病活动性关系研究

目的 探讨系统性红斑狼疮（SLE）患者骨密度与疾病活动性关系.方法 选择92例SLE患者和92例健康对照,均为女性.检测所有纳入对象血清25（OH）D水平.采用SLE疾病活动指数（SLEDAI）评价SLE患者病情活动性,并根据SLEADI评分分为非活动组（n=26）、轻度活动组（n=35）、中度活动组（n=26）、重度活动组（n=5）,采用骨密度仪测量SLE患者双侧股骨颈、股骨大转子、全髋、腰椎L1-L4的骨密度,并进行统计分析.结果 SLE患者血清25（OH）D水平为23.82±5.92 ng/ml,健康对照者为44.82±7.92 ng/ml,存在显著差异（P〈0.001）;重度活动组血清25（OH）D水平显著低于轻度活动组和非活动组（P均〈0.05）.重度活动组患者左右侧股骨颈、左右侧大转子显著低于非活动组和轻度活动组.重度活动组左右侧全髋关节骨密度显著低于非活动组（P均〈0.05）.相关分析发现左右侧股骨颈、左右侧大转子、全髋关节骨密度与SLEDAI评分具有较好的相关性.结论 女性SLE患者维生素D水平降低及骨密度降低与SLE疾病活动性存在关联.应积极防治SLE患者骨密度降低及骨质疏松的发生.     

2型糖尿病患者血25-羟维生素D水平的改变及其对血糖与骨量的影响

目的：研究2型糖尿病患者血25-羟维生素D[25（OH）D]水平的改变对血糖与骨量的影响。方法本研究收集621例复旦大学附属中山医院内分泌科2009年10月至2011年3月住院2型糖尿病患者的临床资料,将测得的血25（OH）D进行季节校正后纳入分析。以血25（OH）D等于50 nmol/L为界将患者分为25（OH）D缺乏组[25（OH）D＜50 nmol/L]及25（OH）D非缺乏组[25（OH）D≥50 nmol/L]两组,观察两组之间糖代谢指标[包括空腹血糖（FBS）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、糖化白蛋白、空腹胰岛素（FINS）]及骨代谢指标[包括甲状旁腺激素（PTH）、碱性磷酸酶（ALP）、骨密度]的差异。结果（1）2型糖尿病患者25（OH）D的平均水平低于50 nmol/L,而且女性较男性更低（P＜0.001）;（2）维生素D缺乏组血空腹胰岛素水平高于维生素D非缺乏组（P＜0.05）,胰岛素抵抗指数（HOMA-IR）也高于维生素D非缺乏组（P＜0.001）。FPG、HbA1c及胰岛素分泌指数（HOMA-B）两组间无明显统计学差异;（3）维生素D缺乏组PTH高于维生素D非缺乏组（P＜0.05）;维生素D缺乏组腰椎、股骨颈和全髋骨密度均低于维生素D非缺乏组（P＜0.05）;钙磷乘积及ALP两组间无统计学意义差异。结论2型糖尿病患者普遍存在维生素D缺乏,在2型糖尿病人群中,胰岛素抵抗、骨量流失可能与血25（OH）D水平降低有关。     

维生素D在类风湿关节炎患者中的水平变化及其与疾病发展的相关性研究

目的探讨维生素D在类风湿关节炎(RA)患者中的水平变化及其与疾病发展的相关性。方法选择门诊收治的RA患者共57例和健康对照40例,检测并收集所有研究对象血清25(OH)D水平,RA患者的类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体、疾病活动评分(DAS28)、红细胞沉降率(ESR)、C反应蛋白(CRP)、血清免疫球蛋白Ig G、Ig M、Ig A等,并比较分析。结果 RA患者血清25(OH)D水平(14.91±3.76 ng/ml)显著低于健康对照组(25.87±5.87 ng/ml),差异有统计学意义(P0.001)。57例RA患者中出现25(OH)D缺乏者39例(68.42%),不足15例(26.32%),正常3例(5.26%),与对照组相比有统计学差异。RA患者25(OH)D的水平分别与关节压痛指数(TJC)、关节肿胀指数(SJC)、ESR、DAS28的相关性明显(P均0.05),与年龄、CRP、RF、抗CCP抗体滴度等无明显相关性。根据DAS28评分,病情为稳定或轻度活动者(9例)[(22.43±4.34)ng/m1]的RA患者血清25(OH)D水平高于中度活动者(19例)[(16.54±4.54)ng/ml]和重度活动者(29例)[(12.15±6.21)ng/ml],差异具有统计学意义(F=13.746,P0.001)。结论 RA患者存在明显的维生素D不足与缺乏,并贯穿疾病始终,是RA病情活动的影响因素。     

Vitamin D及疾病活动性指标在强直性脊柱炎继发骨质疏松中的作用研究

目的 研究 AS 患者中25（OH）VitaminD3水平以及疾病活动性指标（ESR、CRP）与 BMD 的关系及维生素D 的营养状况。方法 46例确诊的 AS 患者,按照 BMD 的检测结果分成三组：骨量正常组、骨量减少组、骨质疏松组,分别检测三组人群中25（OH）VitaminD3、CRP、ESR 的水平。同时对所有受试对象进行 BMD 的测量,检测部位包括腰椎后前位（L1-L4）、股骨颈（neck）、大转子（troch）。结果 三组人群的25（OH）VitaminD3水平无显著性差异（P＞0．05）。CRP 与大转子处的骨密度呈负相关（r＝-0．330,P ＜0．05）。骨质疏松组的 ESR、CRP 的水平与骨量正常、骨量减少组比较差异有统计学意义（P ＜0．05）,骨质疏松组的 AS 患者 ESR、CRP 水平显著增加。结论 AS 继发骨质疏松的发生可能与疾病的活动性相关。绝大多数的 AS 患者存在 VD 的缺乏和不足,并且随着骨量丢失的增加, VD 缺乏率有逐渐增加的趋势,但是维生素 D 是否参与其发病还有待进一步研究。     

未用药抑郁障碍患者血清25(OH)D水平分布特征

目的 探讨不同性别、年龄的未用药抑郁障碍患者血清25-羟维生素D[25(OH)D]水平分布情况，并与其他精神疾病患者进行比较以指导临床工作。方法 纳入1583例未用药的精神疾病患者，记录其性别、年龄、诊断和血清25(OH)D水平，比较抑郁障碍与其他精神障碍疾病、抑郁障碍中不同性别和年龄段患者的血清25(OH)D水平。结果 抑郁障碍患者血清25(OH)D水平低于精神分裂症、焦虑障碍和睡眠障碍患者（P均<0.05）。抑郁障碍患者中血清25(OH)D水平缺乏者占55.7%、不足者占37.0%、充足者占7.4%。女性患者的血清25(OH)D水平低于男性患者（P <0.001）。未成年患者的血清25(OH)D水平低于老年患者（P <0.001）。结论 抑郁障碍患者的血清25(OH)D水平与其他精神疾病患者之间存在差异，提示可进一步探讨血清25(OH)D在抑郁障碍患者起病、转归过程中的作用。抑郁障碍患者中血清25(OH)D缺乏和不足普遍，尤其是女性及未成年患者，提示需要对这部分重点人群进行血清25(OH)D水平的检测，及时补充维生素D。     

类风湿关节炎患者外周血25羟基维生素D、白介素-6的表达

目的 分析类风湿关节炎(RA)患者血清25羟基维生素D[25(OH)D]、血浆白介素(IL)-6水平及临床意义.方法 选取2019年9月至2021年2月蚌埠医学院第一附属医院治疗的RA患者99例为研究组,按照28个关节疾病活动度(DAS28)评分分为:高度疾病活动期组36例,中度疾病活动期组25例,低度疾病活动期组21...     

支气管哮喘患者血清25-羟维生素 D水平与肺功能的相关性

目的：探讨支气管哮喘患者血清25-羟维生素 D[25（OH）D3]水平与肺功能的相关性。方法选取我院呼吸内科2013年1-10月重度、中度、轻度哮喘患者各13例,另选择我院同期健康体检者15名为对照组,分别进行血清25（OH）D3和肺功能指标的检测,计算第1秒用力呼气容积占预计值百分比（FEV1％ pred）。结果轻度组、中度组和重度组患者 FEV1％ pred 分别为（86.62±10.80）％、（67.23±11.30）％和（31.26±12.80）％,两两比较差异均有统计学意义（P 均＜0.01）;对照组与轻度、中度和重度支气管哮喘组25（OH）D3分别为（17.28±7.12）、（14.33±6.82）、（10.28±5.51）、（5.68±3.26）μg/ L,两两比较差异均有统计学意义（P ＜0.01或0.05）。支气管哮喘患者血清25（OH）D3水平（y）与肺功能（x）呈直线正相关,直线回归方程：y =-0.0115＋0.167x。结论维生素 D 缺乏与支气管哮喘的发病及病情程度相关,补充维生素 D 也应作为支气管哮喘患者的一种治疗手段。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.