2009年河北省饮水型地方性氟中毒病情调查

目的 了解饮水型地方性氟中毒的病情动态和评价防治措施的落实效果,为及时调整防治策略提供科学依据.方法 2009年,采用单纯随机抽样的方法,在河北省饮水型氟中毒病区县中抽取38个县(市、区),采用系统抽样方法,将各病区县所有病区村分成轻、中、重3类,从每类病区村中各抽取1个病区村,对全部病区村进行水氟监测;调查病区村全部8～12岁儿童氟斑牙患病情况,从每个年龄段选择6人,检测尿氟;对各病区村全部16岁以上常住人口开展临床氟骨症检查,并检测20人份(男、女各半)尿氟.结果 共调查112个病区村,其中改水村66个,未改水村46个.采集改水工程水样236份,水氟范围为0.1～4.3 mg/L,有20个工程水氟＞1.2 mg/L,占总数的33.3%(20/60);采集未改水村水样230份,水氟范围为0.2～4.6 mg/L,水氟＞1.2 mg/L的水源数占总数的76.1%(35/46).共对5169名8～12岁儿童进行了氟斑牙患病情况调查,氟斑牙检出率为36.43%(1883/5169),氟斑牙指数为0.81.调查16岁以上成人71 497人,临床氟骨症检出率为4.81%(3438/71 497),中度以上临床氟骨症检出率为1.56%(1114/71 497).分别测定了2876和2021份儿童和成人尿氟,几何均数分别为2.30、3.32 mg/L.结论 水氟＜1.2 mg/L的已改水村儿童氟斑牙检出率均在30%以下,儿童氟斑牙检出率和成人临床氟骨症检出率随着改水时间的延长呈现逐渐下降的趋势.未改水病区,儿童氟斑牙检出率和成人临床氟骨症病情随水氟升高而上升.河北省饮水型氟中毒流行仍然较为严重,应该加快改水降氟进度并提高改水工程合格率.

Abstract：

Objective To understand the status of drinking-water-borne endemic fluorosis and the effect of preventive measure in Hebei province, so as to provide a basis to prevent and cure the disease. Methods Thirtyeight affected counties(cities, districts) with drinking-water-borne endemic fluorosis were sampled by random sampling in Hebei in 2009. All affected villages in every county were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. Dental fluorosis of children aged 8 - 12 were examined and 6 copies of urine samples were randomly collected in each age group in the above-mentioned villages. Clinical skeletal fluorosis was diagnosed among adults aged 16 and over and 20 copies of urine samples were tested for fluorosis in every village.Results A total of 112 affected villages were investigated, among which the drinking water quality of 66 villages were improved and 46 villages were not improved. A total of 236 copies of water samples from the 66 villages were measured and the fluoride content ranged from 0.1 to 4.3 mg/L, among which 20 copies of water samples exceeded the fluorine standard of 1.2 mg/L, accounting for 33.3%. A total of 230 copies of water samples were collected in the 46 villages and the fluoride content ranged from 0.2 to 4.6 mg/L, among which 76.1% (35/46) of the water samples exceeded the fluorine standard of 1.2 mg/L. A total of 5169 children aged 8 - 12 were examined of dental fluorosis, the dental fluorosis rate was 36.43%(1883/5169) and the dental fluorosis index was 0.81. A sum of 71 497 adults aged over 16 years were examined, and the rate of skeletal fluorosis was 4.81%(3438/71 497), moderate or severe clinical detection rate of skeletal fluorosis was 1.56%( 1114/71 497). A total of 2876 copies of children urine samples and 2021 copies of adult urine samples were tested and the geometric mean of fluoride content was 2.30,3.32 mg/L, respectively. Conclusions The prevalence of dental fluorosis of children in the areas with improved water is less than 30% and the rate of dental fluorosis and skeletal fluorosis decline gradually with time.The rate of dental fluorosis and skeletal fluorosis increases with the increase of water fluoride in the water quality not improved areas. The endemic fluorosis is still comparatively serious in Hebei. The progress of improving water quality in the areas with endemic fluorosis should be accelerated and the acceptability of improved water should be enhanced.     

甲状腺功能亢进性心脏病危险因素分析

目的 探讨甲状腺功能亢进(简称甲亢)性心脏病发生的危险因素,为控制甲亢性心脏病的发生提供科学依据.方法 2010年3月选择自2000年以来在山东省甲状腺疾病防治中心住院的982例甲亢患者,依据是否并发心脏病分为单纯甲亢组和甲亢性心脏病组,就病因、性别、年龄、病程及游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、促甲状腺激素受体抗体(TRAb)等因素进行比较,并采用Logistic回归方法对甲亢性心脏病发病相关因素进行分析.结果 甲亢患者并发甲亢性心脏病的患病率为7.7%(76/982),甲亢性心脏病组在年龄、病程、FT3和TRAb水平上分别为[(51.4±11.5)岁、(6.3±2.1)年、21.6pmol/L、71.6 U/L],单纯甲亢组为[(37.9±9.8)岁、(2.6±1.3)年、14.9 pmol/L、49.6 U/L],组间比较,差异有统计学意义(u=9.93、15.23,T=44954、48792.5,P均＜0.05).年龄大、FT3,和TRAb水平高、病程长、毒性弥漫性甲状腺肿(相对危险度值分别为1.751、1.470、1.483、1.445、1.234)并发甲亢性心脏病的危险性大.结论 毒性弥漫性甲状腺肿、高龄、病程长、FT3和TRAb水平高是甲亢性心脏病的危险因素,及时预防和控制甲亢性心脏病的危险因素,减少甲亢性心脏病的发生与死亡.

Abstract：

Objective To study the risk factors of hyperthyroid heart diseases(HHD) by analyzing clinical features of patients in order to provide a scientific basis for prevention and treatment of HHD. Methods Nine hundred and eighty two cases were selected as objective from in-patient data of Thyroid Disease Treatment Centre of Shandong Province. The cases were divided into hyperthyroidism group and HHD group. The variables of etiology,sex, age, duration of disease, TSH, FT3, FT4 and TRAb were analyzed by comparative analysis. The risk factors were analyzed by logistic regression. Results The prevalence of hyperthyroidism complicated hyperthyroid heart disease was 7.7%(76/982), age, duration of diseases, FT3, TRAb in the HHD group were [(51.4 ± 11.5), (6.3 ±2.1) years, 21.6 pmol/L, 71.6 U/L], in hyperthyroidism group were [(37.9 ± 9.8), (2.6 ± 1.3) years, 14.9pmol/L, 49.6 U/L]. The differences were statistically significant(u = 9.93,15.23, T = 44954,48792.5, P ＜ 0.05)between the two groups. The factors of the older, higher FT3 and TRAb, longer duration, Graves disease (OR =1.751,1.470,1.483,1.445,1.234) increased the risk of HHD. Conclusions Graves disease, longer duration, old age, higher FT3 and TRAb are the risk factors of HHD. Timely prevention and control of risk factors is necessary to reduce the incidence of HHD.     

鬼臼毒素纳米脂质载体诱导永生化人宫颈上皮细胞凋亡的作用及机制

目的 研究鬼臼毒素纳米脂质载体(POD-NLC)对永生化人宫颈上皮细胞(H8 细胞)的凋亡诱导作用及机制.方法 采用超声乳化法制备POD-NLC,分别以不同质量浓度(0.000 1、0.001、0.01、0.1、μg/ml)的POD-NLC和鬼臼毒素(POD)处理H8细胞,采用MTT法检测细胞增殖抑制率,流式细胞术(FCM)检测细胞凋亡率,荧光显微镜和透射电镜观察细胞形态变化.结果 POD-NLC和POD干预后均能抑制HB细胞增殖,且呈时间和剂量依赖性,在同一时间相同浓度条件下,POD-NLC干预后细胞增殖抑制率明显高于POD干预后;0.01μg/ml的POD-NLC干预H8细胞24、48 h后细胞凋亡率均明显高于POD.POD-NLC和POD干预H8细胞48 h后,荧光显微镜和透射电镜下观察均出现核固缩、染色质高度凝聚、凋亡小体等典型的凋亡形态改变.结论 与POD相比,POD-NLC对H8细胞具有更强的增殖抑制和凋亡诱导效果,其机制可能为POD经NIC包裹后对组织的黏附性增大,更易黏附于细胞表面,细胞内的药物浓度提高.     

不同碘摄入量对甲状腺肿和甲状腺结节影响的前瞻性研究

目的 研究不同碘摄入量人群非毒性甲状腺肿(甲肿)和非毒性甲状腺结节的流行病学特点及影响其发生、发展和转归的因素.方法 2004年对盘山(长期轻度碘缺乏)、彰武(碘缺乏基础上补碘至碘超足量)和黄骅(长期碘过量)社区于1999年参加本课题组流行病学研究并进行甲状腺B超检查的人群(3 385人)进行甲状腺疾病的随访调查.结果 (1)盘山、彰武和黄骅社区弥漫型甲肿的累积发病率分别为7.1%、4.4%和6.9%,盘山和黄骅均显著高于彰武(均P<0.01);结节型甲肿的累积发病率分别为5,0%、2.4%和0.8%,盘山的发病率最高(P<0.01).(2)三社区甲状腺单发结节的累积发病率分别为4.0%、5.7%和5.6%,多发结节的累积发病率分别为0.4%、1.2%和1.0%.(3)基础碘缺乏、碘过量、甲状腺自身抗体(thyroid autoantibody,TAA)阳性是甲肿发生的独立危险因素.(4)彰武初访时TAA阳性人群非毒性甲肿的发生率显著高于TAA阴性人群(P<0.01),盘山和黄骅无显著差异.(5)三社区非毒性弥漫型甲肿维持人群和黄骅非毒性结节型甲肿维持人群随访前后TAA阳性率均高于同社区正常人群(P<0.05).结论 碘缺乏和碘过量均有可能使甲肿的发病率增加.碘缺乏社区结节型甲肿高发,弥漫型甲肿是碘过量社区甲肿发牛的主要形式.甲状腺自身免疫与甲肿的发生和维持相关,这种相关性在历史上为碘缺乏而后过度补碘的社区更明显.     

180例高危病例的冠状动脉搭桥术——停跳与不停跳手术的比较

目的:比较体外循环冠状动脉搭桥手术(on-pump coronary artery bypass grafting,(CABG)与不停跳冠状动脉搭桥手术(off-pump coronary artery bypass grafting,OPCAB)对高危手术病人术后死亡率、并发症发生率等的影响. 方法:从2002年1月至2003年11月,新加坡国立心脏中心共为180例高危冠状动脉粥样硬化性心脏病病人(欧洲心脏手术危险性评估系统Euroscore≥6分)行冠状动脉搭桥术,包括121例CABG(占67.2%)和59例OPCAB(占32.8%).将两组病人术前、术中情况以及术后住院期间的死亡率、并发症发生率等分别进行比较. 结果:术后在血制品的应用、呼吸机辅助时间、呼吸功能不全的发生率、ICU滞留天数以及住院天数等方面,OPCAB均明显优于CABG. 结论:OPCAB对高危冠心病病例具有良好的可行性,与CABG相比,具有明显的优越性.     

河北省2009年低碘盐覆盖地区碘缺乏病监测报告

目的了解河北省2008年度低碘盐覆盖地区碘缺乏病防治状况。方法在每个监测县抽取3个乡,在每个乡随机抽取2个村小学,在每所小学抽取40名8～10岁学生,用B超检测其甲状腺容积,采集尿样并测定尿碘含量,在每个乡抽取2个行政村,在每个村对20户18～40岁育龄妇女家中的食盐供应状况进行调查,随机抽检其中10名育龄妇女的尿碘浓度。结果 9个县的8～10岁儿童尿碘中位数在130.1μg/L～277.6μg/L之间,尿碘含量<50μg/L的尿样比例在0～8.9%之间;2个县的8～10岁儿童尿碘中位数>300μg/L。11个县的8～10岁儿童的甲状腺肿大率在0～5.0%之间。育龄妇女家中食盐均为购买,以食用精制盐为主,占总数的91.7%;碘盐和非碘盐分别占76.5%和23.5%。9个县的18～40岁育龄妇女尿碘中位数在131.0μg/L～273.2μg/L之间,尿碘含量<50μg/L的尿样比例在0～14.0%之间。2个县的18～40岁育龄妇女尿碘中位数>300μg/L。结论河北省2008年度大部分低碘盐覆盖地区8～10岁儿童的碘营养处于较适宜的水平,其甲状腺肿大率<5%,18～40岁育龄妇女的碘营养状况良好;个别地区受水源性高碘的影响,8～10岁儿童和18～40岁育龄妇女的碘营养过剩。     

iPSCs在心律失常疾病体外模型方面的研究进展

心律失常严重威胁人类健康,许多遗传性心律失常由基因突变引起。以患者的诱导型多能干细胞（iPSCs）源性的心肌细胞作为体外模型,可为研究心律失常的发病机制提供新的思路。本文主要对iPSCs源性诱导型心肌细胞的产生过程以及心律失常患者诱导iPSCs 心肌细胞在长QT综合征、儿茶酚胺依赖性室性心动过速、致心律失常性右室心肌病等疾病模型的研究进展进行了综述。     

Follow up after successful eradication of Helicobacter pylori: Symptoms and reinfection

The important long-term outcomes after Helicobacter pylori eradication are the proportion of patients with continuing symptoms, and the rate of recrudescence of the infection. Patients with proven H. pylori infection prior to treatment and a negative urea breath test at least 4 weeks after completing treatment were invited to return for a further urea breath test and a questionnaire. There were 167 patients and the mean interval since the post-treatment urea breath test was 16 months. The endoscopic diagnoses were duodenal ulcer 72, duodenitis 17, gastric ulcer 26, normal or oesophagitis 52. The ethnic groups were European 86, Maori 25, Pacific Island 28 and other ethnic groups 28. Ten patients (6%) had a positive urea breath test at follow up. The proportion of patients showing recrudescence of H. pylori was related to the delta value (δ) of the post-treatment urea breath test: δ 0–2. five of 146 (3.4%); δ 2–3, two of 18 (11%); and δ 3–4, three of five (60%). A symptom questionnaire was given to 147/157 patients with a persistently negative breath test; 60 had no symptoms, 31 had heartburn, 30 had epigastric pain, 15 had both heartburn and epigastric pain, and 11 had nausea or other symptoms. There were fewer symptoms in patients with gastric ulcer (GU) compared with patients with duodenal ulcer (DU) and non-ulcer patients. Twenty-four patients (16%) were taking H₂-antagonists (including seven DU and five GU), 15 were taking antacids and four were taking omeprazole. There was no difference in medication use between diagnostic groups. Eighteen of the 46 patients (39%) with heartburn stated that this was a new symptom. Heartburn was a common symptom for duodenal ulcer patients after eradication (24/74, 32%). A second urea breath test 6–12 months after eradication is required to definitely prove eradication. Patients with a breath test † value of 2–4 should have a repeat urea breath test.     

急性心肌梗死抗凝治疗后并发弥漫性肺泡出血一例

1 病例资料患者男性,82岁.因发作性胸痛6个月,发热2d,突发咯血、呼吸困难1 d于2012年6月4日入院.患者6个月前因急性ST段抬高型心肌梗死(下壁)行冠状动脉造影,结果为三支病变,并置入支架(Medtronic Resolute)两枚,术后规律服用阿司匹林100 mg/d及氯吡格雷75 mg/d.2d前患者中午进餐后(较油腻)突发寒战、发热、恶心、呕吐(有胆管结石病史),来急诊时血压140/100 mm Hg,心率135次/min,血红蛋白141 g/L,白细胞15.46×109/L,中性粒细胞87.3％,心电图检查见V2～ V6导联T波高尖,查心肌肌钙蛋白Ⅰ(TnI) 21.17 μg/L,诊断急性心肌梗死、胆道感染.     

肝动脉栓塞化疗联合体部立体定向放射治疗原发性肝癌的近期疗效分析

目的探讨肝动脉介入化疗（TACE）联合体部立体定向放射治疗（SBRT）原发性肝癌的近期疗效和毒副作用。方法对收治的Ps评分≥2分的原发性肝癌患者58例予以TACE联合陀螺旋转式钴^60SBRT治疗,随访观察患者疗效及毒副反应。结果58例患者中完全缓解10例（17．24％）,部分缓解21例（36．21％）,稳定20例（34．48％）,进展7例（12．07％）。总有效率为53．45％。1年局部控制率为36．21％,1年总生存率为62．07％。结论TACE联合SBRT治疗原发性肝癌的近期疗效好,毒副作用低,远期疗效需进一步观察。