血尿酸水平与冠状动脉病变及代谢综合征的关系

目的 探讨血尿酸水平变化与冠状动脉病变程度、代谢综合征及其相关组分的关系.方法 343例(男性223例,女性120例)接受冠状动脉造影检查的患者,应用冠脉狭窄指数(CSI)评价冠状动脉病变严重程度.结果 (1)女性血尿酸水平显著低于男性[(306.3±76.9对358.9±85.2)μmol/L,P＜0.01],而男女性代谢综合征及各组分的患病率未见明显差异.(2)女性≥3项代谢异常亚组血清尿酸水平显著高于1项代谢异常亚组(P＜0.01)及2项代谢异常亚组(P＜0.05),而男性尿酸水平与代谢异常数目无明显关系.(3)将男、女人群的尿酸值分为4分位数,女性位于上1/4位点者的CSI评分高于下1/4位点者[7.0(2.5～12.0)对2.0(0.0～6.0),P=0.025].女性多支病变组血尿酸水平明显高于无病变组[(327.0±81.9对284.9±78.6)μmol/L,P=0.033].(4)Logistic回归显示年龄(β=0.042,P=0.007)和血脂异常(β=0.836,P=0.037)为男性冠脉病变的独立危险因素,而女性人群中血压异常(β=1.127,P=0.039)及血脂异常(β=0.901,P=0.009)为影响冠脉病变的主要因素.结论 血尿酸水平较高的女性,代谢异常组分聚集较多,其冠状动脉病变程度较重,故尿酸水平可作为女性动脉粥样硬化的标志.

Abstract：

Objective To analyze the association of blood uric acid level with the severity of coronary artery stenotic changes, metabolic syndrome (MS), and its components. Methods A total of 343 individuals ( male 223,female 120) who underwent coronary angiography and had complete data on MS and serum uric acid were collected. The severity of coronary artery disease (CAD) was assessed by the coronary stenesis index (CSI). MS was diagnosed according to the Guideline on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. Results (1)The mean uric acid level was significantly lower in women than in men [ ( 306.3±76.9 vs 358.9±85.2 ) μmol/L, P＜0.01 ]. The prevalence of MS and its components showed no difference between men and women. (2) The uric acid level in women with 3 components was higher than those with1( P＜0. 01 ) or 2 ( P＜0.05 ) components of metabolic disorders, but not in men. (3) Quartiles of concentration of uric acid were computed. Compared with those in the lowest quartile of uric acid, women in the highest quartile had higher CSI score [ 7.0 (2.5-12.0) vs 2. 0( 0.0-6.0), P= 0. 025 ]. Moreover, the uric acid level was higher in women with multivessel lesions than nonCAD patients [ (327.0±81.9 vs 284.9±78.6) μmol/L, P = 0.033 ]. However, no correlation was found between uric acid level and the severity of coronary artery lesion in men. (4) Logistic regression showed that age (β=0.042, P=0. 007) and dyslipidemia(β=0.836, P=0. 037 ) were the independent risk factors of CAD in men, and hypertension(β=1. 127, P=0.039) and dyslipidemia(β=0.901, P=0.009)in women. Conclusions In women with higher uric acid level, the clustering of metabolic abnormalities was increased, and the coronary artery lesion was more severe. High uric acid level might be a marker of CAD for women.     

病毒性肝炎新进展(续)

乙型肝炎病毒感染能引起肝外其它器官系统异常,如血清病综合征、结节性多动脉炎、肾小球肾炎及混合性冷球蛋白血症等.各种HBV抗原(HBsAg、HBcAg、HBeAg)都可以IC的形式沉积于肝外组织中而引起肝外表现.在HBV感染时,致病的抗原可能是病毒本身的结构抗原,如HBsAg,也可能是在病毒基因物质作用下产生的新抗原.血清病综合征急性HBV感染的前驱症状有时表现为血清病样综合征,如发热、关节痛、荨麻疹.相当多的患者伴有对称性关节痛和关节炎,常伴有关节晨间僵硬,易被误诊为急性类风湿性关节     

彩色多普勒超声对乳腺肿块的诊断分析

乳腺肿块是女性的多发病，超声诊断简便、直观、无创伤性且重复性好，已广泛用于乳腺体检和几乎所有的乳腺疾病。本文对87例患者99个乳腺肿块的超声图像特征同手术病理结果作了对照分析，旨在进一步提高诊断准确率。     

稳心颗粒对老年心律失常患者24小时心电图检测结果的影响

目的：探讨稳心颗粒对老年人心律失常(包括无器质性心脏病的房性和室性早搏及器质性心脏病合并的房性和室性早搏)的治疗效应。方法：90例合并或无心血管疾病的老年快速性心律失常患者,按照治疗组与对照组2：1的比例随机给予稳心颗粒或心律平治疗。治疗开始前和结束后分别进行三大常规、肝肾功能等指标检查,并做普通心电图及24小时心电图(Hoher)检测。结果：稳心颗粒对无或合并心血管疾病的老年患者24小时心电图监测中房性和室性早搏的总有效率与心律平组比较无显著性差异。结论：稳心颗粒对老年房性、室性心律失常的治疗安全有效。     

胰腺浆液性微囊性腺瘤1例

患者女性,40岁。自述2年前无明显诱因出现上腹部胀痛、进食后加重,口干、口苦、食欲不振等症状。后因劳累及饮食不慎,上述症状反复发作。CT示胰体尾部占位性疾病,考虑胰腺黏液腺瘤。血生化检查:血清CA19-914U/ml,AFP7ng/ml,CEA4ng/ml,CA-12513·6U/ml,淀粉酶255·9U/L;尿淀粉酶3112·6U/L。术中见胰体有一6cm×5cm大小包块,质稍硬,与周围组织粘连不紧密,但与胰腺粘连紧密。病理检查巨检:部分胰腺及不整形组织,其中见一直径7cm包膜完整的肿物,与周围组织界限清楚,肿物切面为蜂窝状多微小囊改变,囊内为无色清亮液体,其间见灰白色纤维…     

女性,踏过"离婚"沼泽地

经过一场残酷的“离婚战”，无论男方还妇方往往身心疲惫，精神不振，特别对于女性来说，更容易进入一些心理误区，严重影响身心健康。     

盆腔脓肿误诊12例分析

盆腔脓性包块是生殖器常见炎症之一,近年来发病率有上升趋势.随着性生活的活跃,本病在临床上越来越多见.盆腔脓肿以附件包块、腹痛、B超下包块为主要特征,而B超下包块内容物没有特异性,易与卵巢肿瘤、子宫内膜异位囊肿相混淆.对我院2001-01～2002-08误诊12例分析如下.     

穴位注射氟哌啶防治恶性肿瘤患者化疗呕吐的疗效观察

目的观察穴位注射氟哌啶在预防和治疗肿瘤患者化疗时引起恶心呕吐中的临床疗效。方法对21例肿瘤患者采取自身对照的方法进行疗效观察。21例患者首次化疗疗程采用传统静脉注射方法预防和治疗化疗药物,第2次化疗疗程则另加用穴位注射来预防和治疗,观察患者在化疗期间有无恶心呕吐等主观感受。结果穴位注射总有效率达85.7%明显高于传统静脉注射方法的61.9%,差异有统计学意义（P〈0.05）。结论穴位注射防治恶性肿瘤患者化疗导致恶心呕吐疗效明显。