SARS患者康复期股骨头缺血性坏死病例对照研究

目的 探讨严重急性呼吸综合征(SARS)患者康复期股骨头缺血性坏死的影响因素,为临床进一步研究SARS患者股骨头缺血性坏死的致病机制提供线索.方法 调查92例SARS康复患者治疗期间激素用法,随访康复患者1年以上,以MRI检测双侧髋关节,测定股骨头缺血性坏死,统计学分析采用Logistic回归多因素分析.结果 92例SARS康复患者激素总量平均为(1479.9±188.3)mg,应用天数平均为(11.4±1.0)d,激素单日最大用量平均为(123.1±13.7)mg/d;有冲击疗法的患者6例,无冲击疗法的患者86例,其中有6例股骨头缺血性坏死;经统计学分析发现激素总量与股骨头缺血性坏死有统计学意义;年龄、性别、激素应用天数、有无冲击疗法、激素单日最大用量等因素与股骨头缺血性坏死无统计学意义.结论 SARS患者康复期股骨头缺血性坏死主要与治疗期间激素总量有关;与患者年龄、性别、激素应用天数、有无冲击疗法、激素单日最大剂量无关.     

SARS患者康复期股骨头缺血性坏死病例对照研究

目的探讨严重急性呼吸综合征（SAPS）患者康复期股骨头缺血性坏死的影响因素，为临床进一步研究SARS患者股骨头缺血性坏死的致病机制提供线索。方法调查92例SAPS康复患者治疗期间激素用法，随访康复患者1年以上，以MRI检测双侧髋关节，测定股骨头缺血性坏死。统计学分析采用Logistic回归多因素分析。结果92例SARS康复患者激素总量平均为（1479．9±188．3）mg，应用天数平均为（11．4±1．0）d，激素单日最大用量平均为（123．1±13．7）mg／d；有冲击疗法的患者6例，无冲击疗法的患者86例，其中有6例股骨头缺血性坏死；经统计学分析发现激素总量与股骨头缺血性坏死有统计学意义；年龄、性别、激素应用天数、有无冲击疗法、激素单日最大用量等因素与股骨头缺血性坏死无统计学意义。结论SAPS患者康复期股骨头缺血性坏死主要与治疗期间激素总量有关；与患者年龄、性别、激素应用天数、有无冲击疗法、激素单日最大剂量无关。     

早期股骨头缺血性坏死核素扫描、SPECT与MRI诊断对比研究

目的探讨核素扫描、SPECT与MRI诊断对股骨头缺血性坏死的诊断价值。方法回顾分析45例早期股骨头缺血性坏死患者的69个股骨头,所有患者均行核素扫描、SPECT、与MRI检查,分析诊断的敏感性和影像学特征。结果全组患者核素扫描、SPECT以及MRI对早期股骨头缺血性坏死病人诊断敏感度分别为91%、100%和100%。SPECT及MRI与核素扫描相比,前两种方法诊断符合率高于核素扫描,差异有统计学意义（P〈0.05）。结论 SPECT及MRI是诊断股骨头缺血性坏死的可靠方法,有助于股骨头缺血性坏死的早期诊断。     

MRI检查在诊断0-Ⅱ期股骨头缺血性坏死中的影像价值

目的探讨0-Ⅱ期股骨头缺血性坏死(ANFH)的MRI影像表现。方法回顾性分析我院MRI检查诊断并临床随访的45例早期(0-Ⅱ期)ANFH患者的影像表现。结果 MRI检查发现早期(0-Ⅱ期)ANFH表现为股骨头软骨板及软骨下骨质信号异常,骨髓水肿、关节囊积液并见特征性的双线征。结论 MRI检查对早期(0-Ⅱ期)ANFH有很高的特异性和敏感性,能为临床早期诊断及治疗提供重要的依据。     

MRI与多排螺旋CT诊断早期股骨头缺血性坏死的临床价值对比

目的探讨MRI与多排螺旋CT诊断早期股骨头缺血性坏死的临床价值。方法选取我院2015年3月至2016年10月期间收治的67例股骨头缺血性坏死患者,术前分别行MRI与多排螺旋CT检查,比较其诊断准确性和早期阳性征象检出率。结果 MRI的总诊断准确率为97.01%,显著高于多排螺旋CT的86.57%,差异有统计学意义(P<0.05);MRI对早期患者的诊断准确率为92.31%,显著高于多排螺旋CT的69.23%,差异有统计学意义(P<0.05)。MRI的股骨头坏死早期阳性征象检出率显著高于多排螺旋CT,差异有统计学意义(P<0.05)。结论与多排螺旋CT比较,MRI在早期股骨头缺血性坏死诊断中具更高的准确性,可为临床治疗提供可靠的参考。     

股骨头坏死的核磁共振诊断价值探讨

目的:研究股骨头无菌性缺血性坏死的核磁共振成像(MRI)特点。方法:分析57例共89张病变股骨头的MRI图像。结果:表现为股骨头信号异常者100%,股骨头破坏变形者42张(占47.20%),股骨颈受累者6张(占6.74%),关节间隙改变者31张(占34.83%),股骨头髋关节积液者56张(占69.66%),髋关节半脱位者5张(占5.62%)。结论:股骨头无菌性缺血性坏死有较特征性的MRI表现,因此,磁共振在发现股骨头缺血性坏死的早期病变以及确定坏死的部位及程度等方面明显优于普通X线、CT及棱索扫描。核磁共振在早期诊断股骨头缺血性坏死具有重要价值。     

体外冲击波治疗成年人早期股骨头缺血性坏死的临床分析

目的 探讨体外冲击波治疗成年人早期股骨头缺血性坏死的疗效.方法 40例成年人早期股骨头缺血性坏死均为Ficat分期Ⅰ～Ⅲ期,采用单次足量冲击波治疗,能量密度为0.5～0.6mJ/mm2,以股骨头缺血坏死部位及其边缘为靶位,共选取4～6点,每点冲击1000次,共冲击4000～6000次,术后3个月内不负重,4～6个月内部分负重.所有病例分别在治疗前和治疗后3、6及12个月进行MRI检查(同时测量坏死区域所占股骨头体积的百分比),髋关节Harris评分(满分100分)和双侧髋关节X线片.结果 40例患者体外冲击波治疗后3、6及12个月,坏死区域所占股骨头体积的百分比,髋关节Harris评分与治疗前比较,差异均有统计学意义(P均《0.01).结论 体外冲击波治疗成年人早期股骨头缺血性坏死疗效显著,应成为临床治疗该类疾病的主要方法之一. 4～6点,每点冲击1000次,共冲击4000～6000次,术后3个月内不负重,4～6个月内部分负重.所有病例分别在治疗前和治疗后3、6及12个月进行MRI检查(同时测量坏死区域所占股骨头体积的百分比),髋关节Harris评分(满分100分)和双侧髋关节X线片.结果 40例患者体外冲击 治疗后3、6及12个月,坏死区域所占股骨头体积的百分比,髋关节Harris评分与治疗前比较,差异均有统计学意义(P均<0.01).结论 体外冲击波治疗成年人早期股骨头缺血性坏死疗效显著,应成为临床治疗该类疾病的主要方法之一. 4～6点,每点冲击1000次     

糖尿病合并代谢综合征患者冠状动脉钙化相关危险因素分析

目的探讨体外冲击波治疗成年人早期股骨头缺血性坏死的疗效。方法40例成年人早期股骨头缺血性坏死均为Ficat分期Ⅰ-Ⅲ期，采用单次足量冲击波治疗，能量密度为0．5-0．6mJ／mm^2，以股骨头缺血坏死部位及其边缘为靶位，共选取4-6点，每点冲击1000次，共冲击4000。6000次，术后3个月内不负重，4-6个月内部分负重。所有病例分别在治疗前和治疗后3、6及12个月进行MRI检查（同时测量坏死区域所占股骨头体积的百分比），髋关节Harris评分（满分100分）和双侧髋关节X线片。结果40例患者体外冲击波治疗后3、6及12个月，坏死区域所占股骨头体积的百分比，髋关节Harris评分与治疗前比较，差异均有统计学意义（P均〈0．01）。结论体外冲击波治疗成年人早期股骨头缺血性坏死疗效显著，应成为临床治疗该类疾病的主要方法之一。     

股骨头缺血性坏死病例的现况调查

目的 了解股骨头缺血性坏死患者的一般人口特征、疾病学特征、病因学特征及相互间关系.方法 随机抽取1 062例股骨头缺血坏死住院患者病案资料,所有患者经X线、CT、MRI或骨核素扫描检查确诊.采用SPSS17.0软件进行统计分析.结果 汉族和少数民族构比值为26.23:1,汉族和少数民族分组的地区构成,差异有统计学意义(P＜0.01).ARCO分期和年龄分布显示,34～43岁年龄段Ⅲ期、Ⅳ期构成比高,44～53岁年龄段I期、Ⅱ期构成比高.各地区病例在各年龄段的构成,差异有统计学意义(P＜0.01).西北地区20～29岁年龄段病例构成比最高,其他地区均40～50岁年龄段病例构成比最高.男性、汉族的各病因发病年龄,差异有统计学意义(P＜0.01);双侧、汉族的各病因发病时间,差异有统计学意义(P＜0.05).结论 股骨头缺血性坏死患者民族、性别、年龄、地域、职业、病因、单双侧发病、分期等因素之间相互联系.     

髓芯减压术加自体骨髓细胞结合自体髂骨移植治疗早期股骨头缺血性坏死

近年来,股骨头缺血性坏死患者明显增加,但其疗效仍不甚理想,如何早期诊断一直是国内外学者努力的方向.其预后关键在于预防、早期诊断和早期有效的治疗.我院骨科通过MRI检查早期发现和诊断股骨头缺血性坏死(ARCO分期I、II期),通过髓芯减压术加自体骨髓细胞结合自体髂骨移植治疗早期股骨头缺血性坏死12例,取得较好效果.     

严重急性呼吸综合征出院患者生存质量的测量与评价

目的　测量与评价SARS患者出院一个月后的生存质量。方法　对本院 80例出院一个月后的SARS患者运用生存质量量表 (SF -3 6)进行问卷调查 ,构建数据库 ,进行统计分析。结果　八个维度中只有躯体功能得分 >80分 ,总体健康、活力以及心理健康这三个维度得分都 <60分。是否重症SARS患者在八个维度方面的比较差异均无显著性 (P >0 0 5 )。结论　SARS出院患者生存质量不高 ,需进一步康复治疗。康复治疗应包括功能恢复和心理治疗二方面。     

Preparations and limitations for prevention of severe acute respiratory syndrome in a tertiary care centre of India

This short-term observational study of infection control practice was performed in the medical emergency outpatient department (EMOPD) of a tertiary-care hospital in India when threatened by an outbreak of severe acute respiratory syndrome (SARS). An investigator attended the lobby daily to screen patients with symptoms for SARS. Patient/attendant load, patient flow, medical staff working practices and position in the EMOPD were observed. Infection control measures such as fumigation and cleaning were noted, as was the EMOPD laboratory function, use of personnel protection and display of information on infectious diseases. A total of 162 (7.4%) of the 2165 patients surveyed had respiratory symptoms but no cases of SARS were found. The flow of patients and their attendants was not systematic. No laboratory tests for SARS were available, and no educational material on SARS was displayed. The EMOPDs in key hospitals need be able to screen for infectious diseases, especially in view of the threats from SARS and Avian influenza.     

重型SARS合并MODS的临床救治初探

目的 探讨重型严重急性呼吸综合征(SARS)合并多器官功能障碍综合征(MODS)病例的发病特点、机制和治疗方法。方法 回顾性分析某院收治的54例重型SARS病例临床资料。结果 54例重型SARS患者均出现全身炎症反应综合征(SIRS)；29例(53．70％)并发MODS，死亡12例(41．38％)；器官损害以肺脏和心脏损害最常见，其次是脑、血液系统、肾、肝脏。结论 重型SARS患者出现MODS的主要原因是机体严重缺氧，故对其的救治应强调及时纠正缺氧状态；并需重视对多器官功能障碍的早期检查、诊断和治疗。     

Anti-SARS-CoV immunoglobulin G in healthcare workers, Guangzhou, China

To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics.     

Impact of severe acute respiratory syndrome care on the general health status of healthcare workers in taiwan.

BACKGROUND: The impact of the outbreak of severe acute respiratory syndrome (SARS) was enormous, but few studies have focused on the infectious and general health status of healthcare workers (HCWs) who treated patients with SARS. DESIGN: We prospectively evaluated the general health status of HCWs during the SARS epidemic.The Medical Outcome Study Short-Form 36 Survey was given to all HCWs immediately after caring for patients with SARS and 4 weeks after self-quarantine and off-duty shifts. Tests for detection of SARS coronavirus antibody were performed for HCWs at these 2 time points and for control subjects during the SARS epidemic. SETTING: Tertiary care referral center in Taipei, Taiwan. SUBJECTS: Ninety SARS-care task force members (SARS HCWs) and 82 control subjects. RESULTS: All serum specimens tested negative for SARS antibody. Survey scores for SARS HCWs immediately after care were significantly lower than those for the control group (P<.05 by the t test) in 6 categories. Vitality, social functioning, and mental health immediately after care and vitality and mental health after self-quarantine and off-duty shifts were among the worst subscales. The social functioning, role emotional, and role physical subscales significantly improved after self-quarantine and off-duty shifts (P<.05, by paired t test). The length of contact time (mean number of contact-hours per day) with patients with SARS was associated with some subscales (role emotional, role physical, and mental health) to a mild extent. The total number of contact-hours with symptomatic patients with SARS was a borderline predictor (adjusted R2=0.069; P=.038) of mental health score. CONCLUSIONS: The impact of the SARS outbreak on SARS HCWs was significant in many dimensions of general health. The vitality and mental health status of SARS HCWs 1 month after self-quarantine and off-duty shifts remained inferior to those of the control group.     

SARS患者粪便、痰标本病毒RNA阳性检出率与病程变化的关系

目的 探讨严重急性呼吸综合征(SARS)患者粪便、痰标本中病毒RNA阳性检出率与病程变化的关系。方法 采取一步法逆转录聚合酶链反应(RT-PCR)对不同病程的临床标本进行SARS冠状病毒(SARS-associated coronavirus,SARS-CoV)RNA的扩增和序列测定,并采用趋势X~2检验探讨标本阳性检出率与不同发病时间的关系。结果 被检样品中扩增出的特异性片段,经测序验证为SARS-CoV序列(同源性100％)。在检测的临床标本中,粪便标本阳性检出率最高(21.55％)。趋势X~2检验显示SARS患者粪便和痰标本中病毒阳性检出率均随着发病时间的增长而下降,X~2=12 55和16.408,P=0.0004和P=0.000 05。结论 一步法RT-PCR可以有效检测SARS患者临床标本存在的SARS-CoV;SARS患者粪便、痰标本RT-PCR阳性率随着发病时间的增长而下降。     

Investigation of alcohol metabolizing enzyme genes in Chinese alcoholics with avascular necrosis of hip joint,pancreatitis and cirrhosis of the liver

AIMS AND METHODS: Alcoholism may cause a range of diseases including avascular necrosis of the hip joint (AVN), cirrhosis of the liver, pancreatitis and oesophageal carcinoma. Chinese alcoholic patients diagnosed with AVN have a higher incidence of cirrhosis than of acute pancreatitis or oesophageal cancer. Thus, the aim of this study was to investigate genetic differences in polymorphisms of the alcohol-metabolizing enzymes ADH2, ADH3, ALDH2 and P4502E1 for subgroups of Chinese alcoholic patients, defined by diagnoses of AVN (n = 51), acute pancreatitis (n = 92) and liver cirrhosis (n = 159), and for 280 non-alcoholic patients. RESULTS: Analysis revealed that ADH2*1 allele frequency was significantly lower for the alcoholic AVN than for the cirrhosis subgroup. However, no significant difference was found between the alcoholic AVN and pancreatitis subgroups. Furthermore, ALDH2*2 prevalence was not found to differ significantly between the alcoholic subgroups. When compared with our previously published data for alcoholic patients with oesophageal carcinoma, ADH2*1 carriage was significantly less frequent for the alcoholic AVN patients in the current study. Further, ALDH2*2 carriage was significantly less frequent for the alcoholic AVN subgroup than for the oesophageal carcinoma patients. CONCLUSIONS: The allele frequencies for ADH2*1 and ALDH2*2 are different when comparing subpopulations of alcoholics defined by presence of specific alcohol-induced diseases, suggesting that genetic variation in alcohol-metabolizing enzyme genes accounts for, at least in part, the specific types of organ damage observed. We also found the combination of AVN and cirrhosis to be more prevalent than that of AVN and acute pancreatitis. In contrast, the ADH2 and ALDH2 allele frequencies for the AVN subgroup were more similar to those of the acute-pancreatitis than to the cirrhosis subgroup. These data indicate the possibility that other genetic variations may also influence the type of organ-specific complications in Chinese alcoholics.     

SARS transmission among hospital workers in Hong Kong

Despite infection control measures, breakthrough transmission of severe acute respiratory syndrome (SARS) occurred for many hospital workers in Hong Kong. We conducted a case-control study of 72 hospital workers with SARS and 144 matched controls. Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk for SARS infection (unadjusted odds ratio 2.42 to 20.54, p < 0.05). The likelihood of SARS infection was strongly associated with the amount of personal protection equipment perceived to be inadequate, having <2 hours of infection control training, and not understanding infection control procedures. No significant differences existed between the case and control groups in the proportion of workers who performed high-risk procedures, reported minor protection equipment problems, or had social contact with SARS-infected persons. Perceived inadequacy of personal protection equipment supply, infection control training <2 hours, and inconsistent use of personal protection equipment when in contact with SARS patients were significant independent risk factors for SARS infection.     

广州市儿童非典型肺炎41例临床特点分析

【目的】探讨非典型肺炎(severe acute respiratory syndrome，SARS)的临床特征，为临床防治SARS提供依据。【方法】对广州市某SARS定点收治医院41例SARS住院患儿与同期住院44例普通肺炎患儿的性别、年龄、人口学特征及父母亲职业分布、SARS接触史、症状、体征、实验室检查、影像学特征等进行分析。【结果】41例感染SARS患儿病例组，男性22例，女性19例，男女发病没有明确性别差异。发病前有明确SARS接触史、以家庭聚集发病5例。本组年龄分布，发病年龄最小3个月，最大12岁，平均年龄7岁。以11岁年龄组发病较多(7例占17％)。本组儿童发病以散发为主，未见学校、托幼机构内流行。41例SARS患儿治疗痊愈出院后，追综调查1年暂未发现传染他人感染致病的证据。【结论】儿童SARS发病率较低，临床症状较轻．预后好。     

北京市SARS隔离医学观察效果评价

目的 了解北京市严重急性呼吸综合征(SARS)流行期间被隔离医学观察人群的构成及发病情况，为科学合理地隔离SARS病例的接触者提供依据。方法 把海淀区按地理方位分为东、西、南、北、中5个区域，每个区域从有隔离观察人群的街道(乡镇)中抽取1个街道(乡镇)，通过街道(乡镇)“非典”防治办公室，布置有被隔离医学观察对象的居委会把统一的调查表发给被隔离观察者，让其自己填写调查表。若无法自己填写，则请他人代为填写。结果 共调查被隔离者1028名，发现24例SARS病例，罹患率2．3％；61％(630／1028)的人是因为接触SARS病例而被隔离的，其中61％(383／630)的人在SARS病例的症状期与其接触；24例病例均在SARS病例的症状期与其接触；未在SARS病例症状期与其接触的人均未发病，这部分人占被隔离人数的63％(645／1028)；167名在SARS病例潜伏期与其接触的人均未发病。结论 只有在SARS病例发病后与其接触的人员才需要隔离，如果以此标准对SARS的直接接触者进行隔离，则可以节省63％的费用。未发现SARS病例在潜伏期有传染性。