招飞体检乙型肝炎病毒筛查方法及其意义

目的 调查招飞学生HBV血清标志物模式及分布特点,探讨聚合酶链反应(polymerase chain reaction,PCR)荧光探针法与酶联免疫吸咐测定(enzyme linked immunosorbent assay,ELISA)在招飞体检HBV筛查中的应用价值. 方法 对象为参加本区招飞体检的学生(包括应届高中生、大学生)3843名.按出生年分为1992年前和1992年后(包括1992年)两个年龄组;根据户籍种类分为农村和城市学生.乙肝血清标志物采用ELISA法进行HBsAg、HBsAb、HBeAg、HBeAb及HBcAb共5项定性检测,按随机数字法随机抽取不同模式(除单项HBsAb阳性外)标本365例,采用PCR荧光探针法进行HBV-DNA定量检测. 结果 ①共检出13种HBV血清标志物模式,主要为HBsAb(+)模式;其次为5项全阴模式,HBsAb(+)、HBcAb(+)模式,HBsAb(+)、HBeAb(+)、HBcAb(+)模式,HBcAb(+)模式;HBsAg阳性以HBsAg(+)、HBeAg(+)、HBcAb(+)及HBsAg(+)、HBeAb(+)、HBcAb(+)模式为主,分别占HBsAg阳性总数的38.75％和46.25％.②两个年龄组HBsAb(+)模式,HBsAb(+)、HBeAb(+)模式和HBcAb(+)模式检出率差异有统计学意义(x2 =9.350、8.563,P＜0.01);其他模式检出率差异无统计学意义(P＞0.05).③农村与城市学生相比,除HBsAb(+)、HBeAb(+)、HBcAb(+)模式和HBcAb(+)模式外,其他5种常见模式检出率差异有统计学意义(x2=4.592～34.838,P＜0.01或P＜0.05).④HBV-DNA定量检测病毒载量＞1000 copies/ml者62例,其中HBsAg阳性者占77.42％,其他模式占22.58％.HBsAg(+)、HBeAg(+)、HBcAb(+)者HBV-DNA检出率为95.45％(21/22),病毒载量为9.16×106～9.81×107copies/ml.HBsAg(+)、HBeAb(+)、HBcAb(+)者HBV-DNA检出率为45.71％(16/35),病毒载量为1.24×104～7.95×105 copies/ml.HBsAg(+)、HBeAg(+)者均检出HBV-DNA,病毒载量为(2.39～5.34)×107 copies/ml. 结论 ELISA法检测HBV血清标志物与PCR定量检测HBV-DNA相结合,有助于解决招飞体检HBV携带者误诊和漏检问题.     

应用RU486流产后出血的防治

目的 :探讨应用米非司酮 (RU486)与米索前列醇终止早孕 (孕期≤ 49天 )后出血的防治方法。方法 :我们试用缩宫药物催产素并口服益母草膏 ,以期减少流血量 ,缩短流血时间。结果 :通过与未用缩宫药物者对照 ,发现用药后有一定疗效     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

围产期脑血管病5例分析

本文综合报道围产期脑血管病5例,分析了发病原因及治疗措施。 例1,25岁,初孕,双胎,重度妊高征。妊娠期间血压波动于21.3～23.2/14.7～16kPa,孕36周时突然头痛、呕吐、抽搐并摔倒在地,继之意识障碍,血压22/16kPa,尿蛋白,水肿Ⅲ度,右侧偏瘫,CT扫描示左侧内囊出血。给予脱水、降颅压、止血等综合治疗,病情一度稳定,24小时后病情恶化,出现深昏迷,并发脑疝死亡。 例2,29岁,经产妇,既往无高血压病史,妊娠41周,于顺产后23小时突然出现头痛、呕吐,继之嗜睡,浅昏迷,出现脑膜刺激征,CT扫描示蛛网膜下腔出     

利用多平台遗传学技术产前诊断一罕见的含der(6)t(6;22)(q27;q11.2)的非罗氏易位及其随访

目的对一对平衡易位携带者夫妇,利用多平台遗传学技术进行产前诊断,并随访。方法对夫妇双方行染色体核型分析,对羊水细胞行核型分析、染色体微阵列分析(CMA)、荧光原位杂交(FISH),并以新生儿脐血对各检测进行复核;对新生儿随访至1周岁。结果父亲核型为46,XY,t(6;22)(q27;q11.2),母亲为46,XX;胎儿核型为45,XY,der(6)t(6;22)(q27;q11.2)pat,-22,CMA结果显示未测到有临床意义的拷贝数变异,FISH结果显示6号端粒区、22号端粒区和22q11.21区信号无增加或缺失;脐血复查结果与先前相同;对新生儿随访显示生命里程碑节点均正常。结论合理应用多平台遗传学技术,对产前诊断罕见病例十分重要。     

军队干部心血管病预防策略与干预模式探讨

根据某部对1995～2004年干部体检资料和同期疾病死亡情况分析,高血压病、高脂血症、糖尿病、冠心病、脑血管病的发病率分别由1995年的21.2%、17.1%、9.5%、12.3%、7.8%上升为2004年的30.4%、31.6%、13.7%、19.1%和12.9%,心血管病日益成为威胁干部健康的头号杀手.     

超声在女性附件扭转诊断中的临床价值

目的探讨彩色多普勒超声在女性附件扭转诊断中的临床价值。方法对41例经手术病理证实的卵巢、输卵管或卵巢肿物蒂扭转患者的声像图表现进行回顾性分析。结果 41例卵巢、输卵管或卵巢肿物蒂扭转中31例声像图均可显示扭转蒂部(血管蒂);超声表现为位于卵巢或肿物一侧的团状不均质中等回声结构;10例未能显示蒂部。结论彩色多普勒超声能及时诊断附件扭转。扭转时血管蒂形成的团状不均质中等回声是其特异性表现,是诊断扭转的有力依据。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

目的 探讨甲状腺功能减退症(简称甲减)及亚临床甲减对孕产妇妊娠结局及围产儿的影响.方法 回顾性分析2005年1月至2008年3月在北京协和医院妊娠合并甲减(57例)或亚临床甲减(20例)分娩孕妇77例,随机选取同期分娩的正常孕妇79例作为对照,分析三组孕妇的一般临床资料、产时产后并发症及嗣产儿结局.结果 3年间我院妊娠合并甲减的患病率为0.74%,合并亚临床甲减的患病率为0.26%,凡呈逐年升高趋势.妊娠合并甲减组新生儿平均出生体重低于对照组[(3191.8±659.4)g和(3301.9±423.1)g,P<0.05],妊娠期糖代谢异常发生率(24.6%)及小于胎龄儿的发生率(12.3%)均高于对照组(分别为11.4 %和2.5%)(P<0.05).妊娠合并亚临床甲减组各项妊娠期并发症的发生率与对照组比较,均无统计学意义.结论 妊娠合并甲减及亚临床甲减的患病率逐年上升,即使经过治疗,甲减或亚临床甲减孕妇小于胎龄儿等并发症的发生几率仍增加.对高危人群早期筛查、充分治疗是改善妊娠结局的最好方法.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.