人微小病毒B19与自然流产的相关性研究

目的 探讨人微小病毒B19(HPV B19)与自然流产的相关性.方法 选取30例自然流产患者作为病例组.随机抽取30例同期正常妊娠的孕妇作为对照组.所有受试者均记录自然流产的潜在危险因素.抽取所有受试者肘静脉血,采用巢式聚合酶链反应法检测HPV B19 DNA,采用ELISA法检测HPV B19 IgM抗体.采用Logistic多元回归分析法进行多因素分析.结果 两组孕次≥2次,合并高血压、糖尿病,HPV B19 DNA阳性率比较差异有统计学意义[43.3％( 13/30)比13.3％(4/30)、33.3％( 10/30)比6.7％(2/30)、30.0％ (9/30)比6.7％(2/30)、36.7％(11/30)比3.3％(1/30)](P＜0.05);而HPV B19 IgM抗体阳性率比较差异无统计学意义(P＞0.05).多因素分析显示,孕次≥2次、合并高血压、HPV B19 DNA阳性是孕妇发生自然流产的独立危险因素(OR=1.85、1.95、4.85,P＜0.05).HPV B19 DNA阳性患者早期自然流产发生的风险明显高于晚期自然流产,差异有统计学意义(P＜0.05).结论 HPV B19感染是自然流产患者的独立危险因素,需要早期检测并对妊娠孕妇进行必要的干预,以降低自然流产的发生.     

Abdominal apoplexy: A rare case of spontaneous rupture of the superior mesenteric artery in a hypertensive patient

INTRODUCTIONSpontaneous rupture of an intra-abdominal visceral artery is an exceptionally rare and potentially fatal cause of abdominal apoplexy.PRESENTATION OF CASEWe present a case of a 54-year-old hypertensive male who developed hypovolemic shock in our Emergency Department after presenting with abrupt onset of abdominal pain and diarrhea. Intra-operative findings revealed rupture of the superior mesenteric artery with massive hemoperitoneum. The bleeding vessel was ligated and the patient made a full recovery after 3 weeks in the Intensive Care Unit.DISCUSSIONHigh index of suspicion is necessary for early preoperative diagnosis and must be considered in any patient with a history of hypertension presenting with abrupt abdominal pain, signs of peritoneal irritation and unexplained hypovolemic shock. Immediate resuscitation and prompt surgical control of bleeding is paramount in patient prognosis.CONCLUSIONThe seemingly unpredictable nature of abdominal apoplexy must be noted, a precipitating cause in most cases is untraceable and early diagnosis relies solely on awareness of the condition.     

Spontaneous Coronary Artery Dissection in a Young Man with a Factor V Leiden Gene Mutation: A Case Report and Review of the Literature

Spontaneous coronary artery dissection is a rare but increasingly recognized cause of acute myocardial ischemia in young adults, especially in women. We report a case of spontaneous coronary dissection in a young healthy man who was also a carrier of the factor V Leiden gene mutation.     

宫腔镜检查在复发性流产患者诊治中的作用

目的探讨宫腔镜检查在复发性流产(recurrent spontaneous abortion,RSA)患者中的诊治作用。方法 2009年1月至2013年5月对苏州大学附属第二医院就诊的95例RSA患者进行宫腔镜检查,对其检查结果进行分析。结果 95例RSA患者中,子宫腔粘连70例(73.68%),子宫内膜息肉12例(12.63%),子宫腔畸形7例(7.37%),子宫内膜炎3例(3.16%),子宫黏膜下肌瘤1例(1.05%)。研究发现末次流产距就诊时限与宫腔粘连程度有明显相关性(P<0.05),时间间隔越长,宫腔粘连的程度越严重;自然流产次数与宫腔粘连程度没有明显相关性(P>0.05)。结论宫腔镜检查具有直观、操作简单、安全高效、并发症少等优点,在RSA的诊治中具有重要意义。     

内镜下抗反流黏膜切除术和贲门缩窄术治疗胃食管反流病的临床疗效对比

目的 对比内镜下抗反流黏膜切除术（anti-reflux mucosectomy,ARMS）和贲门缩窄术（endoscopic cardial constriction ligation,ECCL）治疗胃食管反流病的临床疗效。方法 回顾性分析2015年12月—2018年8月在郑州大学第一附属医院行ARMS或ECCL治疗,并定期随访的48例胃食管反流病患者病例资料,其中20例行ARMS（ARMS组）,28例行ECCL（ECCL组）,比较两种术式短期及长期临床疗效。结果 两种术式的操作成功率均为100.0%,ECCL组手术时间明显短于ARMS组[（8.43±1.59）min比（34.05±12.35）min,t=－9.227,P＜0.001]。术后2个月随访,ECCL组和ARMS组症状改善有效率分别为89.3%（25/28）和60.0%（12/20）,差异有统计学意义（χ2=4.128,P=0.042）,ECCL组GERD Q评分低于ARMS组[（6.24±1.22）分比（7.35±1.79）分,t=-2.400,P＝0.023]。术后1年随访,两组症状改善有效率、GERD Q评分,以及DeMeester评分和pH＜4时间百分比差异均无统计学意义（P＞0.05）。结论 ARMS和ECCL治疗胃食管反流病的长期临床疗效相当,但ECCL短期疗效更具优势。     

抗精子抗体、抗子宫内膜抗体、抗心磷脂抗体和抗核抗体检测在复发性流产诊断中的价值

目的探讨抗精子抗体(antisperm antibody,AsAb)、抗子宫内膜抗体(anti-endometrial antibody,EmAb)、抗心磷脂抗体(anticardiolipin antibody,ACA)及抗核抗体(antinuclear antibody,ANA)的检测在复发性流产(recurrent spontaneous abortion,RSA)诊断中的价值。方法选取2016年8月至2019年4月在成都市妇女儿童中心医院就诊并诊断为RSA的患者473例为研究组,选取同期无任何不良孕产史的已生育健康女性152例为对照组。对两组对象用酶联免疫吸附法测定AsAb、EmAb、ACA,用免疫印迹法测定ANA。结果研究组和对照组AsAb、EmAb、ACA和ANA检出阳性率分别为20.08%、15.22%、23.04%、20.71%和3.95%、1.97%、5.26%、4.61%,两组比较差异有统计学意义(P<0.05);研究组和对照组ANA谱中抗双链DNA抗体(double stranded DNA antibody,dsDNA)、抗Ro-52抗体阳性率分别为5.50%、4.23%和1.32%、0,两组比较差异有统计学意义(P<0.05);不同流产次数患者AsAb、EmAb、ACA及ANA阳性率比较,差异无统计学意义(P>0.05);研究组和对照组AsAb、EmAb、ACA及ANA联合检测阳性率分别为71.46%和15.79%,两组比较差异有统计学意义(P<0.05);研究组单一AsAb、EmAb、ACA及ANA检测阳性率与4种抗体联合检测阳性率比较,差异有统计学意义(P<0.05)。结论AsAb、EmAb、ACA及ANA与RSA具有相关性;AsAb、EmAb、ACA与ANA联合检测诊断RSA的价值优于单独检测。     

Spontaneous coronary artery dissection with pseudoaneurysm formation diagnosed by intravascular ultrasound: a case report

Spontaneous coronary artery dissection is a rare cause of myocardial ischemia. Coronary artery pseudoaneurysm may occur after percutaneous coronary interventions and rarely spontaneously. We present a patient who had spontaneous coronary artery dissection with formation of a pseudoaneurysm diagnosed by intravascular ultrasound.