2008年北京市石景山区艾滋病自愿咨询检测状况

目的调查北京市石景山区艾滋病自愿咨询检测（VCT）门诊现状,及时了解VCT门诊存在的问题,便于针对性地制定艾滋病健康教育和高危行为干预计划,使VCT门诊更多更及时地发现HIV感染者。方法对2008年1～12月到北京市石景山区疾病预防控制中心（CDC）艾滋病VCT门诊求询的580名求询者进行匿名问卷调查,收集社会人口学特征、求询原因、危险行为等信息,由求询者决定是否接受HIV抗体检测。结果580名求询者以20～40岁青壮年为主,占80.5%;男女比例为1.4∶1;41.6%未婚,52.9%已婚;初中及以下文化占51.0%;求询原因以非婚异性性行为为主,占54.3%;92.4%接受HIV抗体检测,其中阳性3例,HIV抗体检出率为0.6%;3例阳性者均为通过男男性接触感染,男男性接触人群HIV抗体检出率为8.3%。结论求询者以20～40岁青壮年为主,求询原因多样,以非婚异性性行为为主,HIV抗体感染者以男男性接触人群为主。VCT能有效发现HIV抗体阳性者,应广泛开展VCT工作,加强对男男性接触者的行为干预。     

Changes in the spectrum of kidney diseases: a survey of 2803 patients from 2010 to 2018 at a single center in southeastern China

Primary glomerular disease was the leading cause of chronic kidney disease (CKD) in China; however, changes in the economy and environment introduce variations in the spectrum of kidney diseases. This study aimed to analyze renal biopsy data to inform disease prevention and public health interventions. In this retrospective cohort study, data from 2,803 consecutive renal biopsies conducted at our center between January 2010 and December 2018 were analyzed. The sample was disaggregated by age and the date of biopsy to facilitate analysis. Primary glomerulonephritis (PGN) is the most frequent (81.84%) finding, followed by secondary glomerulonephritis (SGN; 15.38%), tubulointerstitial nephritis (15.38%), and others (1.57%). IgA nephropathy (IgAN), idiopathic membranous nephropathy (iMN), and minimal change disease were the primary causes of PGN. Among PGN cases, the incidence of iMN arose, especially among those aged ≥ 60 years old, during the observation period. Contrary to the case of iMN, the proportion of IgAN in PGN trended downward, continuously, and at length. Moreover, IgAN mainly affected those aged 25–44 years old and less so those aged ≥ 60 years old. Lupus nephritis, Henoch–Schönlein purpura nephritis, and diabetic nephropathy (DN) were key causes of SGN. A ratio reversal between infectious disease and chronic disease dramatically changed SGN patterns. In the past year, the incidence of hepatitis B–related nephritis has constantly declined; however, the proportion of DN among SGN had steadily increased. The incidence of iMN significantly increased during these years. Among SGN cases, the proportion of DN has increased.     

Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: A Review

Primary sclerosing cholangitis is a disease affecting around 0.006–0.016% of the population. Of these, around 75% have concomitant inflammatory bowel disease (IBD) according to the most recent epidemiological studies. Several theories have been proposed regarding the pathogenesis of primary sclerosing cholangitis (PSC). These include changes in the function of cholangiocytes, effects of the gut microbiome, association with specific human leukocyte antigen haplotypes and dysregulation of the immune system. However, these do not explain the observed association with IBD. Moreover, there are considerable differences in the frequency and outcomes between patients with PSC and ulcerative colitis compared with PSC and Crohn’s disease. The aim of this review is to appraise the most recent studies that have contributed to the epidemiology, advances in the pathophysiology, and characterization of important clinical aspects of the association of PSC and IBD.     

中西医结合治疗卵巢储备功能减退患者成功妊娠二例并文献复习

卵巢储备功能减退（diminished ovarian reserve,DOR）是卵巢因素所致不孕症的主要原因之一,西医临床治疗方法主要依赖于口服提高卵巢储备功能的药物、人工激素周期替代疗法和辅助生殖技术助孕,中医运用补肾健脾法治疗DOR具有不良反应少、疗效持久、治疗手段多样化等优势。报告2例在常规西医治疗基础上应用中医补肾健脾法综合治疗DOR患者成功妊娠的情况,强调个体化中西医结合治疗方案对于解决疑难病证的重要性,为临床应用中医药治疗DOR患者提供证据。     

人类免疫缺陷病毒新近感染及其检测技术的研究进展

人类免疫缺陷病毒（HIV）感染使全球面临严重问题,而对HIV新近感染的检测是估算HIV新发感染趋势研究的新方向。HIV核心蛋白p24抗原可早期检出因而用于HIV新近感染的检测,但因其敏感性低,对群体发病率的估计存在局限性;HIV核酸检测用于新近感染的判断敏感性和特异性都较高．尤其是集合核酸技术的应用降低了核酸检测技术本身的高成本;BED（指HIV-1特异的B、E和D亚型）捕获酶联免疫法的数据结果则更能反映出新近感染高危因素以及其他方面的变化规律,对评估HIV新发感染动态趋势起到积极作用。     

艾滋病相关淋巴结病理改变及其与淋巴结中CD4+CD25+调节性T细胞的相关性

目的探讨艾滋病患者淋巴结组织中CD4 CD25 调节性T细胞的表达、分布及其与病理改变的相关性。方法对22例活检及13例尸体解剖的HIV/AIDS患者的淋巴结进行组织学观察和病理分期,采用免疫组织化学法对淋巴结组织中的CD4 CD25 调节性T细胞特异性标记物FoxP3进行检测。结果35例艾滋病患者的淋巴结中,1～4期分别有5、4、14和12例。所有淋巴结组织中均检测出FoxP3的阳性表达;在1、2期病变淋巴结内,FoxP3阳性细胞数量较多,分布于滤泡间区和副皮质区;3、4期随着淋巴细胞的数量衰竭,阳性细胞数量的减少更加明显。结论艾滋病患者淋巴结中存在有CD4 CD25 调节性T细胞,随着淋巴结病变的进展其数量减少或耗竭。     

临床路径在基层医院RVD患儿中的应用及临床评价

目的：探讨在基层医院对轮状病毒肠炎(RVD)患儿实施临床路径管理的可行性及临床意义。方法：采用回顾性调查分析的方法,传统治疗组RVD患儿采用传统的治疗、护理方式,临床路径组实施临床路径管理。观察记录两组患儿家长的满意度、抗菌素使用率、平均住院时间和住院费用。结果：与传统治疗组比较,临床路径管理可明显提高患儿家长的满意度,降低抗菌素使用率,缩短住院时间和降低住院费用,组间比较差异具有统计学意义(P＜0.01)。结论：基层医院对RVD实施临床路径管理切实可行,既节约了医疗资源,又带来了社会效益,值得推广。     

湿阻热郁型原发性干燥综合征患者唾液β2-微球蛋白的变化及意义

目的:探讨湿阻热郁型原发性干燥综合征(pSS)患者唾液β2-微球蛋白(MG)的变化及其对干燥综合征中医辨证的意义。方法:62例pSS女性患者被纳入研究,其中湿阻热郁型患者31例,非湿阻热郁型患者31例,另以10名健康女性体检者为正常对照,检测所有受试者的唾液β2-MG水平,并对其结果进行统计分析。同时,对所有患者的唾液β2-MG水平与其病程及年龄的相关性进行分析。结果:湿阻热郁型患者的病程较非湿阻热郁型患者明显延长(P<0.05)。与健康者相比,所有患者的唾液β2-MG含量均明显上升(P<0.001);与非湿阻热郁型患者相比,湿阻热郁型患者的唾液β2-MG含量亦明显增加(P<0.001)。随着患者病程的延长及年龄的增加,唾液β2-MG含量有逐渐增加的趋势,但其差异不具有统计学意义(P>0.05)。结论:唾液β2-MG含量可能成为临床pSS湿阻热郁型中医辨证的客观参考指标之一。     

GP strategies to avoid imaging overuse. A qualitative study in Norwegian general practice

ObjectivesThe aim of the study was to identify general practitioners’ (GPs) strategies to avoid unnecessary diagnostic imaging when encountering patients with such expectations and to explore how patients experience these strategies.Design, setting and subjectsWe conducted a qualitative study that combined observations of consultations and interviews with GPs and patients. A total of 24 patients visiting nine different GPs in two Norwegian urban areas were included in the study. Of these, 12 consultations were considered suitable for studying GP strategies and were therefore selected for a more thorough analysis.Main outcome measuresGPs’ communication strategies to avoid unnecessary medical imaging and patients’ experiences with such strategies.ResultsFive categories of strategies were identified: (1) wait and see – or suggest an alternative; (2) the art of rejection; (3) seek support from a professional authority; (4) partnership and shared decision-making and (5) reassurance, normalisation and recognition. The GPs often used multiple strategies. Factors related to a long-term doctor–patient relationship seemed to influence both communication and how both parties experienced the decision. Three important factors were evident: the patient trusted the doctor, the doctor knew the patient’s medical history and the doctor knew the patient as a person. The patients seemed to be generally satisfied with the outcomes of the consultations.ConclusionGPs largely combine different strategies when meeting patients’ expectations of diagnostic imaging that are not strictly medically indicated. Continuity of the doctor–patient relationship with good personal knowledge and trust between doctor and patient appeared crucial for patients to accept the doctors'' decisions.

Key points

• GPs usually combine a broad range of strategies to avoid unnecessary medical imaging
• The patients appeared generally satisfied regardless of the strategy the strategy used by the GPs and even where their referral request were rejected
• Factors related to a long-term doctor–patient relationship appeared decisive