血清HE4、ROMA水平在赣州表面健康女性人群中的分布研究

目的探讨赣州表面健康女性人群血清人附睾蛋白(HE4)、ROMA水平在不同年龄及不同绝经状态时的分布情况。方法采用罗氏电化学发光法对414例未绝经期及244例绝经期表面健康女性血清HE4水平进行检测。结果血清HE4水平随年龄的增长而升高,差异有统计学意义(P0.05);40岁以上各年龄组及40岁以下各年龄组组间血清HE4、ROMA水平比较差异无统计学意义(P0.05),40岁以上各年龄组与40岁以下各年龄组血清HE4、ROMA水平比较差异有统计学意义(P0.05);未绝经女性血清HE4平均水平为48.29±9.30pmol/L、ROMA平均水平7.16±3.08,绝经女性血清HE4平均水平为56.96±10.00pmol/L、ROMA平均水平11.17±3.94,两者比较差异有统计学意义(P0.05)。结论年龄和绝经与否影响赣州表面健康女性人群的血清HE4、ROMA水平分布。     

赣南地区幽门螺旋杆菌与2型糖尿病和代谢综合征相关性研究

目的:探讨赣南地区幽门螺旋杆菌(Hp)与2型糖尿病(T2DM)和代谢综合征(MS)的相关性。方法:采用多阶段随机抽样的横断面研究方法,抽取2020年11月—2021年4月赣南地区常住人口3200例为研究对象,比较Hp阳性组与Hp阴性组的T2DM和MS发病率,T2DM和MS患者Hp阳性组与Hp阴性组的临床相关指标。结果:Hp阳性组T2DM和MS发病率明显高于Hp阴性组,T2DM患者Hp阳性组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)明显高于Hp阴性组,MS患者Hp阳性组体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、FPG、HbA1c、HOMA-IR、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)明显高于Hp阴性组,高密度脂蛋白(HDL-C)明显低于Hp阴性组,差异均有统计学意义(P<0.05)。结论:赣南地区Hp感染与T2DM和MS的发生密切相关,加强Hp的筛查及根治对这两种疾病具有重要意义。     

获得性依赖维生素K凝血因子缺乏症62例临床特征及误诊分析

目的 探讨非婴幼儿获得性依赖维生素K凝血因子缺乏症的临床特征及误诊原因.方法 回顾性分析我院诊治的62例获得性依赖维生素K凝血因子缺乏症患者的病因、临床表现、治疗、随访结果及误诊原因.结果 62例患者中51例患者病因不明,11例为杀鼠药中毒.所有患者均同时或先后出现皮肤、黏膜、皮下及关节、肌肉、内脏出血,首发最常见出血症状为血尿;35例(56.5%)失血患者血红蛋白(Hb)＜100g/L,最低仅为32g/L;治疗后患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、国际标准化比值(INR)与治疗前比较差异均有统计学意义[(145.46±43.22)s、(36.62±7.85)s,(107.33±47.38)s、(13.64±4.86)s,(7.63±1.87)、(2.14±0.68),t值分别为19.51、15.49、13.62,P均＜0.01],血小板计数、凝血酶时间(TT)、纤维蛋白原(Fg)均正常,患者自出血症状至明确诊断的中位时间为8(2～192)d,其中16例患者出血1～6个月才确诊,首诊误诊率高达61.3%(38/62),误诊为泌尿系统疾病占60.5%(23/38),其次为血友病占21.1%(8/38).所有患者接受维生素K治疗,总疗程为1～22个月,少数严重出血患者同时使用凝血酶原复合物和(或)血浆输注.中位随访时间为8(1～56)个月,无一例患者复发.结论 非婴幼儿获得性依赖维生素K凝血因子缺乏症多数原因不明.首发出血最常见的症状为血尿,本病易误诊,最常见误诊为泌尿系统疾病,早期的凝血功能检测可减少误诊.维生素K序贯治疗可有效防止复发,患者预后良好.

Abstract：

Objective To explore the clinical features and causes of misdiagnosis of the patients with acquired deficiency of vitamin K-dependent coagulation factors (ADVKDCF). Methods Retrospective analysis was performed with the data from 62 patients with ADVKDCF for etiological factors, clinical manifestations,laboratory examinations, diagnosis and treatments. Results Among the 62 patients, 51 patients were with unknown causes( subgroup A) and 11 were with clear histories of anticoagulant rodenticide poisoning( subgroup B). The presentations of hemorrhage of the patients varied with hematuria as the most common first symptom,followed by skin, mucosa, muscle, internal organs bleeding (28/62). The most common hemorrhage symptom is hematuria. 35 of the 62 patients had hemoglobin(Hb) levels less than 100 g/L due to blood loss( the lowest level was 32 g/L). Thirty-eight patients were misdiagnosed at the first visit and the median time from hemorrhage manifestation to definite diagnosis was 8 days (range,2 to 192 days). ADVKDCF was mostly misdiagnosed as the urinary system diseases (23/38), followed by hemophilia (8/38). Laboratory examinations showed normal platelet count , throm bin time (TT) and normal fibrinogen(Fg) concentration, but prolonged plasma prothrombin time (PT), activated partial prothrombin time (APTT) and international normalized ration (INR). All of patients received high dose vitamin K ( intravenous vitamin K1 with a initial dose of 20 to 240 mg/d and then oral vitamin K4 maintenance) . The bleeding symptoms disappeared 1 day after treatment and the Hb levels increased dramatically. There were significant differences in PT, APTT and INR of the patients before and after treatment( P ＜0. 01 ). Followed by a median follow - up of 8 months , no patient had severe adverse effects or recurrence. Conclusion The hemorrhage presentations of the patients with ADVKDCF are various. The most common hemorrhage symptom is hematuria. The misdiagnosis rate of ADVKDCF is high with urinary systems disorders as the most common misdiagnosis. Sequential treatment with vitamin K is an effective and safe method to prevent recurrence. Early detection of coagulation function is helpful to reduce misdiagnosis possibility.     

赣南地区幽门螺旋杆菌与2型糖尿病和代谢综合征相关性研究

目的:探讨赣南地区幽门螺旋杆菌(Hp)与2型糖尿病(T2DM)和代谢综合征(MS)的相关性。方法:采用多阶段随机抽样的横断面研究方法,抽取2020年11月—2021年4月赣南地区常住人口3200例为研究对象,比较Hp阳性组与Hp阴性组的T2DM和MS发病率,T2DM和MS患者Hp阳性组与Hp阴性组的临床相关指标。结果:Hp阳性组T2DM和MS发病率明显高于Hp阴性组,T2DM患者Hp阳性组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)明显高于Hp阴性组,MS患者Hp阳性组体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、FPG、HbA1c、HOMA-IR、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)明显高于Hp阴性组,高密度脂蛋白(HDL-C)明显低于Hp阴性组,差异均有统计学意义(P<0.05)。结论:赣南地区Hp感染与T2DM和MS的发生密切相关,加强Hp的筛查及根治对这两种疾病具有重要意义。