中西医结合治疗狼疮性肾炎临床观察

系统性红斑狼疮是一种病因不明的自身免疫性疾病，常常出现多系统损害。肾脏是系统性红斑狼疮中最易侵犯且受累较重的器官，目前临床上主要以糖皮质激素、免疫抑制剂治疗狼疮性肾炎，但存在较明显的副作用。我们采用中西医结合疗法治疗狼疮性肾炎23例，并与单纯应用西医疗法治疗12例进行对照观察，现报告如下。     

梅尼埃病的内淋巴积水显像

目的 采用无创性技术经咽鼓管鼓室内导入造影剂钆,进行内耳三维快速液体衰减反转恢复磁共振扫描(three dimensional fluid attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MBI),探讨梅尼埃病内淋巴间隙的显像.方法 7例梅尼埃病患者患侧经咽鼓管鼓室内导入钆喷酸葡胺稀释液,24 h后进行内耳3D-FLAIR MRI.全部患者于造影剂导入前、导人后24 h及3个月时分别进行纯音测听和鼓室声导抗检查.结果 5例患者内耳3D-FLAIR MRI显示造影剂钆广泛分布于患侧耳蜗、前庭和(或)半规管的外淋巴,可以区分内、外淋巴间隙的边界,清晰显像内淋巴情况;2例患者患侧包围内淋巴的外淋巴间隙缩小或消失(即不显影),提示内淋巴积水的存在.5例患侧中耳鼓室腔内未见造影剂钆增强;2例患侧部分中耳乳突腔内可见造影剂钆增强,而内耳未见明显增强.所有患者造影剂给药前和给药后24 h纯音测听平均听阈无明显变化;给药前、给药后24 h及3个月时鼓室声导抗结果无明显变化.结论 经咽鼓管鼓室内导入造影剂钆进行内耳3D-FLAIR MRI扫描,可以了解梅尼埃病患者内淋巴间隙情况.     

活血通络汤治疗偏头痛36例

偏头痛以剧烈头痛 ,或左或右 ,或全头痛反复发作为其特点。我们采用活血通络汤治疗偏头痛 36例 ,并与尼莫地平进行对照。现报告如下 :1　一般资料5 2例患者均为门诊患者 ,治疗组 36例 ,其中男性 14例 ,女性 2 2例 ;年龄 18～ 5 2岁 ,平均 35 .2岁 ;病程 2～ 15个月 ,平均 8.5个     

梦游症治验二则

梦游症 ,又名梦行症、神游症、冶游症 ,是现代医学精神病学中精神障碍的一种疾病 ,包括癫痫性梦行症和癔病性梦行症。因本病发病率不高 ,中医学中尚无专著论述。本人临床 2 0多年 ,曾见数例梦行症 ,应用中医药疗法 ,效果较佳 ,兹介绍验案二则如下 :1　心肾不交案邹某某 ,男 ,1 2岁 ,学生 ,1 995年 1 0月 2 6日初诊。主诉 :夜卧惊叫游走 1个月余。病史 :近 1个多月来 ,无明显诱因 ,深夜入睡后 ,突然惊呼坐起 ,然后起床到客厅走动 ,数分钟后又回床安然入睡 ,每晚必发 1次 ,第二日清晨苏醒后 ,对头晚情况全然不知 ,余尚可。曾到某医院门诊求治 …     

梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较

目的通过无创性经咽鼓管中耳腔导入造影剂钆行内耳3D-FLAIR MRI扫描的方法,对梅尼埃病患者组受试者进行研究,得到该年龄组耳蜗及前庭内耳内淋巴间隙的比值,并与20~55岁组正常值进行比较。方法在鼻内窥镜引导下,将稀释的钆喷酸葡胺注射液通过咽鼓管注入患耳中耳腔,给药1 d后行3D-FLAIR MRI扫描,得到内耳内淋巴间隙的显影,并对内耳内淋巴间隙、总淋巴间隙进行测量和计算,得到内耳内淋巴间隙与总淋巴间隙的比值,并与正常受试者组数据进行比较。结果在患者3D-FLAIR MRI扫描图像中可见耳蜗及前庭部内耳内淋巴间隙显影。对患者组3D-FLAIR MRI图像进行总淋巴间隙面积和内淋巴间隙面积的测量和计算,内淋巴间隙与总淋巴间隙面积之比为内耳内淋巴间隙的比值(前庭为RV,耳蜗为RC)。前庭内耳内淋巴间隙的比值为0.39±0.07,耳蜗内耳内淋巴间隙的比值为0.16±0.05。与20~55岁正常受试者组比较,两组RV差异有统计学意义(t=-6.07,P0.05);两组的RC无统计学差异(t=0.783,P0.05)。依据刘芳等提出的内耳内淋巴积水的诊断标准(RV39%,RC27%),梅尼埃病患者组前庭内淋巴间隙积水阳性率为42.9%,耳蜗内淋巴积水阳性率为9.52%。处于梅尼埃病发作期的两位患者RV值测量均为阳性。结论梅尼埃病患者组与正常受试者组相较,两组RV值有显著差异,患者组RV值明显大于正常受试者组;两组RC值无明显差异。前庭内淋巴积水诊断阳性率为42.9%,2例发作期患者均存在前庭内淋巴积水阳性;耳蜗内淋巴积水诊断阳性率为9.52%。     

血管壁磁共振成像在老年颈动脉粥样硬化患者术前评估中的应用

目的 探讨磁共振成像(MRI)对老年颈动脉粥样硬化患者术前评估的应用价值及序列优化.方法 70例老年缺血性脑血管疾病的患者,超声检查发现颈动脉分叉处有斑块,分别进行颈动脉MRI和数字减影血管造影(DSA)检查.颈动脉MRI检查序列包括平扫及增强T1加权(T1W1)、T2加权、质子加权(PDWI)和3D时间飞跃法MR血管成像(3D-TOF MRA).扫描完成后将图像分为两种序列组合,即5序列组合(上述5个序列)和2序列组合(T1WI和3D TOF)MRI图像.DSA检查摄取颅外段颈动脉常规正位及侧位图像.分析MRI与DSA之间、MRI不同序列组合之间对管腔狭窄和纤维帽破溃的检出差异.结果 70例患者中1例图像质量较差,余69例中除3支血管为支架置入术后,共135支血管.5序列及2序列MRI组合检测的平均管腔狭窄程度分别为(38.3±31.0)%和(38.5±30.9)%,差异无统计学意义(t=2.447,P＞0.05).DSA检测的平均血管狭窄程度为(35.1±31.8)%,以其作为金标准,MRI两种序列组合与金标准间具有很好的一致性(Kappa值0.773).两种序列组合分别检出36支血管具有溃疡斑块,差异无统计学意义;DSA检出16支血管具有溃疡斑块,MRI与DSA检出溃疡斑块的差异有统计学意义(χ2=12.0,P＜0.01).结论 MRI可以准确判断颈动脉的管腔狭窄程度并检出溃疡斑块的存在,通过对扫描序列的优化可以有效减少检查时间,是老年颈动脉粥样硬化患者术前评估的较好的检查手段.

Abstract：

Objective To study the value of carotid plaque magnetic resonance imaging (MRI) in pre-operation assessment in the elderly patients with carotid atherosclerosis and explore the possibility of minimizing the contrast weightings to gain sweeptime. Methods Totally 70 elderly patients with cerebral ischemia (average age of 68.8 years) underwent carotid MRI and digital subtraction angiography (DSA) due to the appearance of carotid plaque detected by ultrasound. Carotid plaque MRI was acquired with 3.0T MR scanner and 8 channel surface coil. The standard carotid plague MRI program included pre-and post-contrast T1 weighted imaging (T1WI), T2 weighted imaging, proton density weighted imaging and 3D time of flight MR angiography (3D TOF MRA). All these program were divided into two combinations: the 5-sequence MRI (all the sequences) and 2-sequence MRI (T1WI and TOF MRA). Digital subtraction angiography (DSA) in coronal and lateral views of carotid artery was performed with GE Advantx LCN+. The software SPSS 13.0 was used to statistically analyze the difference between MRI and DSA, and that of two sequence combinations was used in the detection of luminal stenosis and fibrous cap (FC) rupture. Results Totally 135 arteries were analyzed while 3 arteries in one patient were excluded due to the poor quality image and stent placement. The degree of luminal stenosis were (38.3±31.0)% and (38.5±30.9)%, respectively, detected by the two MRI sequence-combination with no significant difference (t=2.447, P＞0.05) and was (35.1±31.8)% by DSA. There was a good concordance between MRI and DSA in luminal stenosis detection (Kappa value: 0.773). No statistical difference was found between two MR sequence combinations in detecting FC rupture (both in 36 vessels). DSA detected FC rupture of 16 vessels, showing remarkably difference contrast to MRI(χ2=12.0, P＜0.01). Conclusions MRI can accurately detect the luminal stenosis and FC rupture. The short time scanning resulting from sequence optimization could make MRI much more suitable than DSA to do the pre-operation assessment for senile carotid atherosclerotic patients.