光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

目的 应用光学相干断层成像(OCT)技术比较不稳定性心绞痛(UAP)和稳定性心绞痛(SAP)患者冠状动脉粥样硬化斑块特征.方法 对临床诊断的23例UAP和24例SAP患者,在完成冠状动脉造影并确诊冠心病后进行OCT检查.根据OCT结果 回顾性比较分析UAP和SAP患者冠状动脉粥样硬化斑块特征,包括富含脂质斑块(≥2个象限的脂质斑块)、斑块纤维帽厚度、薄纤维帽粥样斑块(TCFA)、斑块破裂、钙化和血栓等.结果 47例患者中有44例成功进行OCT检查,包括22例UAP和22例SAP患者.UAP患者冠状动脉富含脂质斑块为91%(20/22),多于SAP患者的73%(16/22),但差异无统计学意义(P=0.741).UAP患者冠状动脉脂质斑块表面纤维帽厚度明显小于SAP患者[(69.5±34.7)μm比(141.1±68.5)μm,P=0.000],纤维帽侵蚀比例为59%(13/22),明显多于SAP患者的9%(2/22,P=0.000);TCFA[73%(16/22)比14%(3/22),P=0.000]和斑块破裂[50%(11/22)比9%(2/22),P=0.003]多于SAP患者.UAP患者冠状动脉斑块表而可见血栓形成多于SAP患者,但差异无统计学意义[27%(6/22)比9%(2/22),P=0.761].在斑块钙化方面,UAP与SAP患者之间差异无统计学意义.结论 OCT技术可清晰显示冠状动脉粥样斑块特征.与SAP患者比较,UAP患者冠状动脉粥样硬化斑块表现为纤维帽更薄、更多的纤维帽侵蚀、更多的破裂斑块和TCFA.     

经皮冠状动脉介入术前阿托伐他汀强化治疗对预后的影响

目的评价经皮冠状动脉介入术前患者行阿托伐他汀强化治疗对预后的影响。方法60例入选患者术前被随机分为两组,强化治疗组29例患者,术前12小时内服用阿托伐他汀80mg;对照组31例患者,术前12小时内服用阿托伐他汀20mg,所有患者术后均以阿托伐他汀每日20mg,每日1次长期维持。观察两组患者术前及术后24小时的肌酸激酶同工酶、肌钙蛋白I、C反应蛋白等指标的变化,比较两组在出院3个月时主要不良心血管事件发生率。结果强化治疗组主要不良心血管事件发生率为3．4％,对照组为22．6％（P〈0．05）;与对照组相比,强化治疗组患者术后肌酸激酶同工酶、肌钙蛋白I升高幅度显著减低（P〈0．05）;C反应蛋白升高的幅度低于对照组,但两组比较差异无统计学意义（P〉0．05）。结论PCI术前使用80mg阿托伐他汀同常规使用20mg的剂量相比,强化治疗的患者在短期预后方面获益大。     

恙虫病45例临床特征分析

目的：分析恙虫病患者的临床特征。方法：回顾性分析2012年8月至2016年3月在我们皮肤科就诊的45例恙虫病患者的临床资料。结果：潜伏期1-3周。主要表现发热（100.00%,45/45）、头痛（28.89%,13/45）、肌痛（55.56%, 25/45）、皮损（100.00%,45/45）、疲倦（71.11%,32/45）、胃肠道症状（35.55%,16/45）。37例（82.22%）患者躯干四肢出现红斑和斑丘疹。特征性皮损是所有患者出现焦痂,好发于胸部（28.89%,13/45）、腹部（24.44%,11/45）、腋下（11.11%,5/45）和外阴（8.89%,4/45）。结论：恙虫病临床表现多样,皮肤焦痂溃疡性损害是本病的特征性皮肤表现。     

耳内镜下外伤性鼓膜穿孔的诊治

耳部外伤往往引起鼓膜穿孔,鼓膜小穿孔可自行愈合,而大穿孔常需修复处理。2008年6月~2012年6月我科门急诊收治30例外伤性鼓膜穿孔患者耳内镜下进行修复,取得良好疗效,现报道如下。     

紫杉烷类药物2周对比3周化疗方案治疗进展期非小细胞肺癌的系统评价

目的：系统评价紫杉烷类药物2周与3周化疗方案治疗进展期非小细胞肺癌（Non-small cell lung cancer,NSCLC）的疗效和安全性。方法：检索数据库PubMed、Embase、Cochrane Library、Web of Science,维普、万方、CNKI,检索时间从各数据库建库至2011年7月25日,搜集紫杉烷类药物2周对比3周化疗方案治疗NSCLC的随机对照试验（Randomized controlled trials,RCTs）。选择符合纳入标准的文献,提取资料、按照Cochrane协作网推荐的质量评价标准进行文献质量评价。使用RevMan 5.0 软件进行统计学分析。结果：共纳入8个RCTs,包括624例患者。Meta分析结果显示：与3周组相比,2周组可以降低白细胞减少（RR=0.49,95％CI：0.38-0.62,P＜0.01）、恶心/呕吐（RR=0.60,95％CI：0.44-0.81,P＜0.01）、脱发（RR=0.35,95％CI：0.16-0.77,P＜0.05）等毒副反应的发生率;但在有效率（RR=1.09,95％CI：0.88-1.35,P=0.44）、1年生存率（RR=1.16,95％CI：0.91-1.47,P=0.22）和肝毒性（RR=0.26,95％CI：0.04-1.56,P=0.14）方面的差异无统计学意义。结论：紫杉烷类药物2周与3周化疗方案治疗进展期NSCLC的有效性和1年生存率相似,但2周化疗方案毒副反应的发生率较低。     

胆总管囊肿的影像学诊断26例报告

目的：本文回顾性分析了胆总管囊肿的影像学表现,旨在对其影像学检查方法进行探讨。方法：对26例用B超(BUS)、CT、磁共振胆胰管成像(MRCP)及内镜逆行胆胰管造影(ERCP)检查的胆总管囊肿病例进行了分析。结果：胆总管囊肿的影像学表现因检查方法的不同而表现也不同。结论：在胆总管囊肿的影像学检查方法中,BUS可作为首选,而MRCP优于其他检查,因为后者是一种既安全而又可靠,诊断正确率也高的影像学检查方法。     

血管生成相关长链非编码RNA在冠状动脉慢性完全闭塞病变中的治疗作用

长链非编码 RNA 参与生物的生理过程和疾病的病理过程,是重要的生物标志物或公认的治疗 的疾病靶点。长链非编码RNA通过调控两种效应细胞(血管内皮细胞和平滑肌细胞)动脉生成和血管新生 过程参 与冠状动脉侧支循环的形成,从而影响冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)的预后。“治疗性血管生成”作为促进冠脉侧支循环的一种替代疗法,已被证明能显着改善 CTO 患者的预后 和生活质 量。因此,通过调节血管生成过程,长链非编码RNA有望成为CTO治疗的新靶点。本文综述了血 管生成相关 长链非编码RNA的分类和功能,以及它们调节血管生成在冠脉侧支循环的作用。     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.