90岁及以上老年原发性高血压患者共病情况及与常见老年事件的相关性

目的调查90岁及以上老年原发性高血压患者共病情况,并对其与常见老年事件的相关性进行分析。方法采用横断面调查方法,入选2017年1~12月于辽宁省金秋医院(辽宁省老年病医院)住院治疗的年龄≥90岁的老年共病患者419例。根据是否患有高血压分为高血压组和对照组,比较两组一般资料差异。收集患者的共病种类,统计数量并采用Charlson共存病指数(CCI)对共病严重程度进行评价。采用Spearman相关分析计算入院时血压水平与CCI的相关性,应用多元线性回归分析CCI与心房颤动、脆性骨折、肺炎、尿路感染、植入起搏器状态、管饲、导尿、催眠药物使用及通便药物使用等老年事件的相关性。结果入选患者总体CCI评分为(4.0±2.2)分,校正年龄后评分为(8.0±2.2)分,总体共病数为(7.7±2.6)种。高血压组患者289例,占全部患者69.0%,其中男性202例,女性87例。高血压组与对照组比较:CCI评分为(4.6±2.1)分比(2.8±1.9)分,t=8.261,P=0.000;共病数量(8.3±2.5)种比(6.3±2.4)种,t=7.568,P=0.000;收缩压(133.81±13.31)mmHg比(124.91±11.61)mmHg,t=6.922,P=0.000;舒张压(72.24±7.56)mmHg比(69.68±7.25)mmHg,t=3.304,P=0.001。采用Spearman相关分析提示,CCI与血压水平存在相关性(r=0.101,P=0.039)。多元线性回归分析提示,CCI与脆性骨折、肺炎、尿路感染、管饲、催眠药使用及通便药使用独立相关(均为P<0.05)。结论90岁及以上老年原发性高血压患者在共病数量及程度上较无高血压者更明显,CCI与血压水平存在相关性,老年共病伴有更多的脆性骨折、肺炎、尿路感染、管饲、催眠药使用及通便药使用。     

Motility index measured by magnetic resonance enterography is associated with sex and mural thickness

BACKGROUND Recently, a technique has been developed to use magnetic resonance enterography(MRE) for the evaluation of small bowel motility. The hypothesis was that assessment of the motility index(MI) should reflect differences in motility between clinical conditions.AIM To aim of the present observational, cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate. Healthy volunteers were included as controls. MRE was prepared and conducted in accordance with clinical routines. On the day of examination, all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS) and IBS-symptom severity scale. Maps of MI were calculated from dynamic MR images. ANOVA was used to evaluate differences in MI between groups, classified as healthy, Crohn's disease, ulcerative colitis, IBS, other assorted disorders and dysmotility. Logistic and linear regression were applied to the MI values. All medical records were scrutinized for medical history.RESULTS In all, 224 examinations were included(inclusion prevalence 76.3%), with 22 controls and 202 patients. There was a significant difference in the MI of the jejunum(P = 0.021) and terminal ileum(P = 0.007) between the different groups. The MI was inversely associated with the mural thickness of the terminal ileum in men(P 0.001) and women(P = 0.063) after adjustments, and tended to be lower in men than in women(P = 0.056). Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P 0.001) and women(P = 0.030). In women, diarrhea was inversely associated with the MI of the jejunum(P = 0.029), and constipation was positively associated with the MI of the terminal ileum(P = 0.039).CONCLUSION Although MIs differ across diseases, a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness. Symptoms are weakly associated with the MI.     

Role of cystatin C and renal resistive index in assessment of renal function in patients with liver cirrhosis

AIM:To evaluate the clinical significance of cystatin C and renal resistive index for the determination of renal function in patients with liver cirrhosis.METHODS:We conducted a study of 63 patients with liver cirrhosis.A control group comprised of 30 age and gender-matched healthy persons.Serum cystatin C was determined in all study subjects and renal Doppler ultrasonography was made.Estimated glomerular filtration rate from serum creatinine(GFRCr)and cystatin C(GFRCys)was calculated.RESULTS:We confirmed significant differences in val-ues of cystatin C between patients with different stages of liver cirrhosis according to Child-Pugh(P=0.01),and a significant correlation with model of end stage liver disease(MELD)score(rs=0.527,P<0.001).More patients with decreased glomerular filtration rate were identified based on GFRCys than on GFRCr(P<0.001).Significantly higher renal resistive index was noted in Child-Pugh C than in A(P<0.001)and B stage(P=0.001).Also,a significant correlation between renal resistive index and MELD score was observed(rs=0.607,P<0.001).Renal resistive index correlated significantly with cystatin C(rs=0.283,P=0.028)and showed a negative correlation with GFRCys(rs=-0.31,P=0.016).CONCLUSION:Cystatin C may be a more reliable marker for assessment of liver insufficiency.Additionally,cystatin C and renal resistive index represent sensitive indicators of renal dysfunction in patients with liver cirrhosis.     

单侧颈动脉狭窄患者的脑血流自动调节功能

目的 采用近红外光谱分析技术,研究单侧颈动脉重度狭窄患者脑血流自动调节功能(CA)。方法 以2015年1月至2017年2月在北京电力医院行全身麻醉手术的30例患者为研究对象,其中,15例单侧颈动脉重度狭窄患者为狭窄组,15例无颈动脉狭窄患者为对照组,两组患者性别和年龄相匹配。在稳定的全身麻醉状态下,同时记录脑组织氧饱和指数(TOI)和平均动脉压,计算相关系数r,根据r值判断CA状态。结果 狭窄组患者狭窄侧与非狭窄侧的TOI差异无统计学意义(66.52±6.50比65.23±4.50;t=0.93, P=0.368),狭窄组狭窄侧与对照组同一侧的TOI差异也无统计学意义(66.52±6.50比64.22±3.87;t=1.18, P=0.248)。狭窄组狭窄侧和非狭窄侧的r值分别为0.36±0.12和0.17±0.11,狭窄组狭窄侧和对照组同一侧的r值分别为0.36±0.12和0.13±0.08。术前3个月内,狭窄组15例患者中,5例有短暂性脑缺血发作,2例有脑梗病史。将r值为0.342作为评估CA异常的判断点时,其敏感性为0.625,特异性为0.909。结论 在正常血压波动范围内,单侧颈动脉重度狭窄患者狭窄侧的脑血流和血压有一定的相关性。     

不育症男性风疹病毒感染与精子DNA碎片率的相关分析

目的：探讨不育症男性风疹病毒(Rubella virus)感染情况及其与精子DNA碎片率的关系。 方法：检测553例不育男性患者血清中的风疹病毒IgM抗体,将患者分为风疹病毒IgM(RV-IgM)阳性组和风疹病毒IgM(RV-IgM)阴性组,分别检测精子DNA碎片率。 结果：RV-IgM阳性组的精子DNA碎片率显著高于RV-IgM阴性组(P<0.05)。结论：风疹病毒急性感染对精子DNA完整性有影响,可能导致男性不育。     

应用PAR指数评价骨性安氏Ⅱ类错（牙合）畸形矫治效果的临床研究

目的：测量骨性安氏Ⅱ类错畸形患者经拔牙或非拔牙矫治后的牙特征,以评价其临床治疗效果。方法应用PAR指数分别对采用拔牙或非拔牙矫治的两组青少年骨性安氏Ⅱ类错畸形患者（均21例）矫治后的牙模型进行定量测量,分析比较两组治疗后牙特征的差异。结果矫治后,拔牙组权重PAR总分为（0.62±0.74）,非拔牙组为（0.90±1.37）,差异无统计学意义（P＞0.05）。其他PAR各分值两组均较低,差异亦无统计学意义（ P＞0.05）。结论青少年骨性安氏Ⅱ类错畸形经拔牙与非拔牙矫治后,从牙特征方面评价均取得了满意的疗效。     

基于FGF21 水平分析绝经女性高尿酸血症 与胰岛素抵抗的相关性

目的 通过测定绝经高尿酸血症患者血清成纤维细胞生长因子21（FGF21）和胰岛素抵抗指数 （HOMA-IR）的变化,探讨FGF21、胰岛素抵抗（IR）与血清尿酸（SUA）的相关性。方法 选取2017 年 12 月—2019 年8 月于锦州医科大学附属第一医院就诊的无症状高尿酸血症绝经患者76 例作为高尿酸血症组, 并根据BMI 水平分为高BMI 组和正常BMI 组。另选取同期在该院体检的健康绝经女性80 例作为对照组。 分别检测高尿酸血症组和对照组的FGF21、血清肌酐（Scr）、SUA、HOMA-IR、FPG、空腹胰岛素（FIns）、 血脂、血压等指标。结果 高尿酸血症组BMI、Scr、SUA、TG、FGF21、FIns 及HOMA-IR 较对照组高（P <0.05）。 高BMI 组SUA、FGF21、FIns 及HOMA-IR 较正常BMI 组高（P <0.05）。经Pearson 相关性分析,FGF21 与 BMI、TG、FPG 及lnFIns 呈正相关（r =0.803、0.472、0.184 和0.747,P <0.05）。ln（HOMA-IR）与BMI、 TG、FPG 及lnFIns 呈正相关（r =0.616、0.452、0.529 和0.644,P <0.05）。FGF21 与ln（HOMA-IR）呈正 相关（r =0.752,P <0.05）,SUA 与ln（HOMA-IR）呈正相关（r =0.537,P <0.05）,SUA 与FGF21 呈正相关 （r =0.573,P <0.05）。FGF21 和ln（HOMA-IR）预测高尿酸血症的ROC 曲线下面积分别为0.850（95% CI ： 0.793,0.907）和0.914（95% CI ：0.868,0.960）。结论 在绝经高尿酸血症患者中HOMA-IR 水平明显上升 且伴随FGF21 水平升高。提示FGF21 水平升高与IR、高尿酸血症有密切关系,其可能参与IR 导致高尿酸血 症的病理过程,并对高尿酸血症的发生有预测作用。     

肥胖对加速康复流程下全膝关节置换术围术期失血量的影响

目的 评价加速康复流程下肥胖对全膝关节置换术（TKA）围术期失血量的影响。方法 回顾性分析2017年8月—2018年8月四川大学华西医院关节外科中心行初次单侧TKA的患者的临床资料,按照体重指数（BMI）分为正常组（18～<24?kg/m2）、超重组（24～<28?kg/m2）和肥胖组（≥28?kg/m2）,比较各组患者的基线资料、总失血量、术中输血量、隐性失血量、总失血量和血容量（PBV）的比值、异体输血率、血红蛋白和血细胞比容变化量、术后住院时间和并发症发生率等。结果 肥胖组患者的PBV最高（P?<0.05）,肥胖组患者的总失血量和隐性失血量与超重组和正常组比较,差异有统计学意义（P?<0.05）,但3组间术中出血量、总失血量和PBV的比值、血红蛋白和血细胞比容变化量比较,差异均无统计学意义（P?>0.05）。3组患者均没有异体输血、肺栓塞和切口深层感染,3组深静脉血栓、切口红肿渗出和恶心呕吐的发生率比较,差异无统计学意义（P?>0.05）。结论 在加速康复流程下,肥胖患者行TKA围术期失血风险更高,其中隐性失血是主要原因,但肥胖患者失血量和血容量的比值、异体输血率、血红蛋白和血细胞比容变化量并没有升高。     

针刺加红外线照射五脏调神穴联合药物治疗不寐40例

目的:观察针刺加红外线照射五脏调神穴联合药物治疗不寐的临床疗效。方法:纳入80例不寐患者,按照随机数字表法分为观察组与对照组各40例,对照组采取地西泮和谷维素口服治疗,观察组在对照组基础上加用针刺合红外线照射五脏调神穴治疗,10 d为1个疗程。3个疗程后,对比两组患者匹兹堡睡眠质量指数(PSQI)得分、临床疗效及脑电图主要睡眠参数变化。结果:两组治疗后PSQI得分得到优化,观察组得分优于对照组(P<0.05);两组治疗后睡眠参数得到优化,观察组优于对照组(P<0.05);观察组痊愈率高于对照组(P<0.05);两组皆无明显不良反应。结论:针刺加红外线照射五脏调神穴联合药物疗法治疗不寐具有较好效果,能够改善患者睡眠质量、脑电图参数,且不良反应较少。