我院发热门诊运转过程中存在的问题及对策

笔分析了发热门诊在运转过程中存在布局欠合理、医务人员身心压力大、防SARS的各类用品供应跟不上、发热门诊的维持费用较大、欠费病人急剧增多等问题。针对存在问题。通过每周举行“SARS”专题协调会、向礼会招聘有经验的各类医务人员、适当调节医务人员心理状态、加强对抗SARS物质的后勤保障、减免经济困难的发热病人的费用等措施使存在问题得到妥善解决。笔认为抗击SARS这样的烈性传染病，需要全社会的积极参与。     

DHF／DSS患者凝血和纤溶系统变化的临床意义

目的检测 DHF/DSS 患者急性期凝血和纤溶系统的变化,探索患者血浆渗漏和出血的发病机制。方法收集正常健康者、DF 和 DHF/DSS 急性期患者的血浆各30份,应用 ELISA 法检测 t-PA、PAI-1、PC、TM、TF、TFPI 和 D-二聚体,发色底物法测 AT 等分子。结果血管内皮细胞的特异性表达产物 vWF 和TM 升高;TF升高,TFPI 没有变化;t-PA 显著增加,PAI-1下降,t-PA/PAI-1比值显著升高,PC、AT 和D-二聚体变化无统计学意义。结论 DHF/DSS 患者急性期血管内皮细胞活化或损伤的同时,凝血和纤溶系统均已活化;内皮细胞通过表达 TM、t-PA 和 PAI-1等相关分子在引起凝血和纤溶系统失调,造成血浆渗漏和出血等方面起重要作用。TM、t-PA 和 PAI-1等变化在 DHF/DSS 的发病机制中起重要作用,对 DHF/DSS 急性期有诊断价值,可作为辅助诊断指标。     

2004～2005年滇西地区肾综合征出血热调查

目的 为掌握滇西地区肾综合征出血热流行病学特点,提供防治参考,对人间和鼠间疫情进行了调查.方法 收集滇西本病疫情资料,并在该地区采集人血清以及鼠肺脏和血清作汉坦病毒抗原和抗体检查.结果 滇西地区2004和2005年共报告病例41例,占全省同期发病数的40.59%.主要发病地区为祥云、兰坪、古城、永胜、宁蒗、宾川、巍山、弥渡、大理市(县、区),人群隐性感染率为1.81%.2004和2005年在玉龙、古城、永胜、宾川、祥云、大理、澜沧、景东、龙陵、盈江、腾冲、昌宁、宁蒗县和兰坪县(市、区)采集到16种1 825份鼠肺标本,鼠间汉坦病带毒率为2.47%.居民区以褐家鼠和黄胸鼠为优势鼠种,野外以高山姬鼠和大绒鼠为优势种,带毒鼠种为褐家鼠、黄胸鼠、大绒鼠、大足鼠、高山姬鼠和臭鼩鼱.结论 该地区广泛存在以褐家鼠和黄胸鼠为主要宿主动物的家鼠型疫源地,也存在着以高山姬鼠和大绒鼠为主的野鼠型疫源地.滇西疫区正在扩大,应采取以灭家鼠和健康人群接种家鼠型或两型混合疫苗为主的防治措施.     

Fever of unknown origin in the elderly

Fever of unknown origin (FUO) means fever that does not resolve itself in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. The differential diagnosis is often different in older patients, and presentation of disease is frequently nonspecific and symptoms are difficult to interpret. Multisystem disease has emerged as the most frequent cause of FUO in the elderly, and temporal arteritis is the most frequent specific diagnosis. Infections, particular tuberculosis, remain an important group. FUO is often associated with treatable conditions in this age group. Early recognition and prompt initiation of appropriate empirical therapy are cornerstones of the strategy.     

2种检测人肾综合征出血热IgG抗体ELISA试剂盒的比较

目的 探讨国产与进口人肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)IgG抗体ELISA检测试剂盒的性能差异. 方法 采用国产和进口ELISA试剂盒分别检测50例HFRS疫苗接种者血清样本中抗人HFRS IgG抗体含量,分析比较2种ELISA试剂盒的一致性、灵敏性、精密度以及方法学等的差异. 结果 2种ELISA试剂盒的精密度良好,批内变异系数均<5%;2种试剂阳性一致率为100%,阴性一致率为20%,相似率为60%;灵敏性检测结果显示,2种ELISA试剂盒的灵敏性差异较大(P<0.05),国产ELISA试剂盒的灵敏度约是进口ELISA试剂盒的5倍. 结论 国产人HFRS IgG抗体ELISA检测试剂盒灵敏性好,进口ELISA试剂盒特异性好,国产和进口ELISA试剂盒的精密度均良好,在实际应用中应根据具体情况合理选用.     

发热伴血小板减少综合征危重度评分对患者预后的评价

目的：探讨发热伴血小板减少综合征（SFTS）死亡相关因素,设立 SFTS 危重度评分并检验其对 SFTS 患者预后的评价作用。方法对2011年6月至2014年10月山东大学附属济南市传染病医院住院治疗并确诊为 SFTS 的123例患者行死亡相关危险因素的 Logistic 回归分析,进而设定 SFTS危重度评分,并通过受试者工作特征曲线（ROC）与快速急诊内科评分（REMS 评分）、急性生理和慢性健康评分系统Ⅱ（APACHEⅡ）进行预后预测能力的比较。结果123例患者中死亡31例（死亡组）,男17例,女14例;生存92例（生存组）,男45例,女47例。单因素 Logistic 回归分析结果显示,格拉斯哥昏迷（GCS）评分、乳酸脱氢酶、部分活化凝血活酶时间、脉搏血氧饱和度与 SFTS 死亡相关,差异均有统计学意义（均 P ＜0．05）。且4项指标的单项评分,死亡组均高于存活组（均 P ＜0．05）。SFTS 死亡组的REMS、APACHEⅡ评分和 SFTS 危重度评分均高于存活组（均 P ＜0．01）。REMS、APACHEⅡ评分和SFTS 危重度评分的曲线下面积（AUC）分别为0．734、0．746、0．788。Youden 指数以 SFTS 危重度评分为最高,当取阈值为15．0时,其预测 SFTS 患者住院期间死亡风险的敏感度为74．2％,特异度为76．1％。结论 REMS、APACHEⅡ评分和 SFTS 危重度评分对 SFTS 预后均具有良好的评价作用,其中以 SFTS 危重度评分更为简捷且预测能力最佳。     

Risk factors for AA amyloidosis in Germany

Objective: To identify risk factors for serum amyloid-A (AA) amyloidosis in patients living in Germany.

Methods: Clinical and genetic data were obtained from 71 patients with AA amyloidosis. SAA1 genotypes were analyzed in 231 individuals. Control groups comprised 45 patients with long-standing inflammatory diseases without AA amyloidosis and 56 age-matched patients without any inflammatory disease.

Results: The most frequent underlying diseases of AA amyloidosis were familial Mediterranean fever (FMF) (n?=?24, 34%) and inflammatory rheumatic diseases (n?=?30, 42%). Patients without any known underlying disease (n?=?11, 16%) were considered as having idiopathic AA amyloidosis. Patients with FMF were significantly younger at disease onset and younger at diagnosis of AA amyloidosis compared with patients with rheumatic diseases. Patients with idiopathic AA amyloidosis were older than patients with definite rheumatic diseases. Patients with FMF and high penetrance MEFV gene mutations had a relative risk of 1.73 for AA amyloidosis. Patients with FMF or a rheumatic disease and the SAA1 α/α genotype had a relative risk of 4.86 and 2.53, respectively, for developing an AA amyloidosis. The prevalence of this risk genotype was 36% in German patients without an inflammatory disease, 92% in German patients with AA amyloidosis and 100% in German patients with idiopathic AA amyloidosis.

Conclusions: Risk factors for AA amyloidosis are the presence of a hereditary autoinflammatory or chronic rheumatic disease, elevated C-reactive protein and SAA serum levels, a long delay of a sufficient therapy, an advanced age and the SAA1α/α genotype.     

Dengue Hemorrhagic Fever in a Japanese Traveler with Pre-existing Japanese Encephalitis Virus Antibody

An adult Japanese man who had just returned from Thailand developed dengue hemorrhagic fever (DHF). A primary infection of dengue virus (DENV) was confirmed, specifically DENV serotype 2 (DENV-2), on the basis of the detection of the virus genome, a significant increase in the neutralizing antibody and the isolation of DENV-2. DHF is often observed following a secondary infection from another serotype of dengue virus, particularly in children, but this case was a primary infection of DENV. Japan is a non-endemic country for dengue disease. In fact, only Japanese encephalitis (JE) is known to be a member of the endemic flavivirus family. In this study, IgG antibody against Japanese encephalitis virus (JEV) was detected. JEV belongs to the family of dengue virus and prevails in Japan, particularly Kyushu. Among many risk factors for the occurrence of DHF, a plausible candidate could be a cross-reactive antibody-dependent enhancement (ADE) mechanism caused by JEV antibody. This indicates that most Japanese travelers who living in dengue non-endemic areas, particularly Kyushu, should be aware of the occurrence of DHF.