IgA肾病不是一个均一的疾病：知难行亦难

20世纪60年代免疫荧光技术在组织病理学中的应用,让我们认识到一组以肾小球IgA沉积为其免疫病理特点的肾小球疾病,并将他们命名为"IgA肾病".40年后的今天,长期临床观察的积累,大量基础研究的汇总,又让我们开始重新审视这一疾病的性质.IgA肾病不是一个均一的疾病这一概念正在为大家所接受,然而,如何将目前对IgA肾病发病机制研究中的发现与不同的临床表型联系起来进行整合深化,再据此提出针对性治疗措施,并在临床上加以验证,是目前IgA肾病研究中的一个突出问题.     

Testing for familial aggregation of functional traits

In a genetic epidemiology study of a trait, prior to collecting genotype data the foremost task is to test for familial aggregation and examine heritability. Recently, functional traits have drawn attentions from investigators. Here, to test for familial aggregation of a functional trait in the family studies, a test constructed based on the leading functional principal component of heritability, which is a summary measure of temporal genetic variation in a functional trait, is proposed. The p‐value of the test can be approximated by a permutation procedure given the family structure. The asymptotic distribution of the test statistic is derived. Simulations are carried out to examine the size and the power of the test. The proposed methods are applied to the total cholesterol data in the Framingham Heart Study. Copyright © 2009 John Wiley & Sons, Ltd.     

静息心率与老年慢性心力衰竭预后的相关性分析

目的探讨老年慢性心力衰竭（CHF）患者入院时静息心率与其心功能及预后的相关性。方法选择213例老年CHF患者，按入院时静息心率（治疗前心率）分为3组：CHF 1组（静息心率48～79次／min），CHF 2组（静息心率80～99次／min），CHF3组（静息心率100～140次／min）。并在循证医学标准治疗的基础上，对其入院、出院时及随访的心功能及预后进行分析。结果老年CHF患者入院时的静息心率与出院时的疗效（相关系数-0．163；P=0．017）、随访疗效（相关系数-0．161；P=0．019）显著负相关；与总死亡率（相关系数0．162；P=0．018）显著正相关。亚组分析显示：CHF1组、2组、3组间总有效率分别为92．7％、77．5％、73．2％；1组与2、3组间比较差异有统计学意义（P=0．011；P=0．007）。总死亡率分别为7．3％、22．5％、26.8％；1组与2、3组间比较差异有统计学意义（P=0．017；P=0．009），2、3组间比较差异无统计学意义。结论静息心率可作为判断老年CHF治疗效果和预后的预测指标之一。     

腮腺良性和恶性多形性腺瘤的超声研究

目的研究腮腺良性和恶性多形性腺瘤的超声特点,为临床医师诊治提供有效依据。方法选取腮腺良性多形性腺瘤患者79例和恶性多形性腺瘤患者15例,对其肿块的大小、硬度、内部回声、彩色多普勒血流显像(CDFI)特点结合病理学诊断进行对照研究。结果恶性多形性腺瘤的声像图特点与良性多形性腺瘤相似,但其肿瘤相对较大,质地更硬,内部回声分布更紊乱。不同性质的肿瘤的大小和质地有显著性差异,(P<0.01)。结论多形性腺瘤的超声诊断主要依据二维图像之特点。当多形性腺瘤大于3.0 cm,硬度较硬,内部回声分布不均多提示恶性。     

广东省梅县重点人群碘营养状况调查分析

Objective To estimate the present salt iodine content and iodine nutrition need of high risk population of iodine deficiency disorder in Meixian County. Methods Each primary school was selected from urban and rural areas(Xiyang Town, 20 kilometers away from Meixian County), the goiter rate of 8 to 10 year-old students was examined and urinary iodine and household salt iodine was sampled. Twenty to 40 year-old women of childbearing age nearby schools around the urban and villages around Xiyang Town were selected to collect their urine and salt samples. At urban hospitals and rural health centers, 0 to 2 year-old infant urine samples were collected, Thyroid gland was palpated and urinary iodine was determined by iodine in urine by As3+-Ce4+catalytic spectrophotometry, salt iodine was determined by direct titration. Results The goiter rates of 8 to 10 year-old students were 1.5 % (3/200), 1.0% (1/100) for the urban area and 2.0% (2/100) for rural area. Median of urinary iodine in 8 to 10 year-old students, infants, women of childbearing age averaged at 237.1 μg/L and 280.1, 234.7,187.6 μg/L respectively, with each being 287.4,245.0,205.5 μg/L in urban area and 278.9,228.5,176.4 μg/L in rural area. Women of childbearing age had a higher percentage of urinary iodine < 50.0 μg/L than students,students had a higher percentage than infants, each being 7.5%(15/200), 4.5%(9/200), 4.0%(4/100). The ration of urinary iodine > 300.0 μg/L was more in infants than in students, that in students was more than that in women of childbearing age, each being 33.0% (33/100), 30.0% (60/200),22.5% (45/200). The median of salt iodine was 27.2 mg/kg. The coverage of iodized salt was 100.0%(400/400). Ninty-seven percent(194/200) and 96.0% (192/200) of qualified iodized salt were consumed in urban area and in rural area. Conclusions The amount of iodine added to salt meets the requirement in the 3 kinds population risk of iodine deficiency disorder. But a higher iodine status has been found out in students and infants. It is reasonable to decrease the present salt iodine content.     

NeuroformⅡ支架联合MatrixⅡ弹簧圈治疗颅内宽颈动脉瘤的初步经验

目的探讨NeuroformⅡ支架植入联合MatrixⅡ弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效、技术要点、安全性及并发症防治。方法诊断为颅内宽颈动脉瘤的病人11例,其中大脑前动脉瘤2例,后交通动脉瘤4例,眼动脉瘤1例,大脑中动脉瘤2例,椎基底动脉瘤2例。7例先行NeuroformⅡ支架瘤颈成形,将微导管通过支架网眼置入动脉瘤内,填塞弹簧圈;4例先置入微导管于动脉瘤内,再释放支架后栓塞,术后3~6个月随访。结果所有病例栓塞操作均顺利完成,无手术并发症;其中致密填塞8例,部分致密填塞3例,术后病人均恢复良好,4例短期随访无再出血及血栓栓塞症状发生。结论NeuroformⅡ支架联合MatrixⅡ弹簧圈治疗颅内宽颈动脉瘤安全、有效。     

有限内固定结合外固定支架治疗胫骨远端骨折

目的探讨有限内固定结合Hybrid外固定支架治疗胫骨远端骨折的疗效。方法从2003年1月～2005年7月,使用Hybird外固定支架治疗胫骨远端骨折21例,按AO分类:A1型4例;A2型5例;A3型4例;C1型2例;C2型3例;C3型3例,其中开放性骨折8例,手术采用有限切开,骨片钉固定,Hybrid外固定支架不跨踝关节固定。结果术后21例均获随访,平均随访时间12.3个月,骨折平均愈合时间7.6个月。功能评定采用Bone的踝关节活动度进行评价,优良率达76%。结论Hybrid外固定支架设计合理并能维持骨干的轴线,骨片钉能很好的固定骨折块,同时避免了软组织的并发症,可使踝关节早期活动,防止踝关节僵硬,因而是治疗胫骨远端骨折有效的方法之一。     

病理技术质量控制的探讨

病理技术是病理学诊断不可分割的一部分,正确的染色结果是病理诊断的重要依据之一.病理技术的规范与否,制片质量的好坏很大程度上影响病理医生作出正确的病理诊断.     

小切口股骨近端解剖钢板治疗股骨转子间骨折

目的 探讨股骨转子间骨折的治疗方法和疗效。方法小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折17例。结果 随访时间8个月～3年，平均1.6年，优良16例，占94%（16/17）。结论 小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折具有切口小、出血少等优点，是一种微创手术。     

组织工程化表皮膜片构建及其在供皮区的应用研究

目的构建组织工程化表皮细胞膜片并应用于供皮区创面治疗。方法利用患者少量自体或同种异体正常皮肤分离、培养、扩增的表皮细胞,接种于壳聚糖明胶膜构建成表皮细胞膜片;将膜片移植于治疗组供皮区创面、适度加压,同时设立对照组:空白材料对照以及传统油纱布对照覆盖创面。于术后5～10d、30d、90d行大体观察、组织学检查、广谱角蛋白、外皮蛋白、层粘连蛋白、免疫组织化学检测以及Ⅰ、Ⅲ型胶原比值测定(偏光显微镜、RTPCR)。结果利用自体及异体表皮细胞和壳聚糖明胶膜能够构建出人表皮细胞膜片,应用于临床供皮区创面治疗15例,经过3个月随访,疗效肯定。移植膜片创面愈合时间(8.1±1.3)d,空白材料对照区为(16.2±3.8)d,空白油纱布对照区为(23.0±5.8)d。移植膜片存活良好,结构较完整、术后30d及90d观察:12例无明显增生,3例有轻度增生(20.0%),而空白油纱布对照区11例遗留增生性瘢痕(74.4%,χ2=8.127,P<0.01)。结论表皮细胞-壳聚糖明胶膜片能促进供皮区创面早期愈合并减少后期瘢痕增生,具有良好治疗效果。