系统性血管炎的诊治进展

系统性血管炎是以血管壁炎症和纤维素样坏死为病理特征,具有多种临床表现的一组疾病。可分为原发性和继发性,常见原发性血管炎有巨细胞动脉炎、大动脉炎、结节性多动脉炎、川崎病、变应性肉芽肿性血管炎、韦格纳肿、显微镜下多血管炎等。近几年,有关原发性系统性血管炎的诊断标准和治疗方面已取得不少的进展,本文综述了诊断与治疗该病的最新进展,有一定临床参考价值。     

四妙散加减治疗系统性红斑狼疮30例

目的:探讨中医治疗系统性红斑狼疮的方法。方法:用四妙散加减综合治疗系统性红斑狼疮30例并从临床症状、实验室指标与单用西药的对照组进行比较。结果:两组治疗系统性红斑狼疮均有效(p〉0.05),而改善实验室指标四妙散配合西药综合治疗更有效(p〈0.05)。结论:四妙散加减配合西药综合治疗对活动性系统性红斑狼疮有更好的疗效,而且能有效控制实验室指标;对活动性系统性红斑狼疮的辨证治疗,应当注重除湿。     

透明质酸检测对肝病及非肝病患者的诊断价值

血清透明质酸是近年来在临床上应用较广泛的肝病及非肝病的检测指标.本文用放射免疫学方法对82例正常献血员,134例肝病患者血清及慢性阻塞性肺病、肺心病、冠心病、肾病、类风湿性关节炎和系统性红斑狼疮等非肝病患者透明质酸进行了检测.结果表明肝病患者血清透明质酸明显高于对照组,非肝病各组明显高于正常对照组（p<0.01）,具有一定的临床诊断意义.因此,血清透明质酸对肝病的诊断、分型、病情进展以及非肝病诊断有一定价值.     

55例卵巢囊性畸胎瘤的超声诊断分析

目的探讨超声对卵巢囊性畸胎瘤的诊断价值。方法对55例经手术及病理证实的囊性畸胎瘤的超声图像进行回顾性分析。结果55例囊性畸胎瘤中超声诊断51例,诊断符合率92．7％,2例误诊为巧克力囊肿,1例误诊为浆液性乳头状囊腺瘤,1例误诊为卵巢囊肿。结论超声对卵巢囊性畸胎瘤的诊断具有重要的价值,可作为首选检查方法。     

Sjgren综合征

<正> Sjogren综合征(SS)是一种以干燥性角结膜炎、慢性唾液腺炎为主征的自身免疫病,常合并类风湿性关节炎(RA)、系统性红斑狼疮(SLE)、硬皮病、皮肌炎,结节性多动脉炎、多发性肌炎、慢性活动性肝炎、慢性淋巴细胞性甲状腺炎(又称桥本氏病)、纤维素性肺泡炎,间质性肾炎、Waldenstrom巨球蛋白血症、冷球蛋白血症等疾病。1993年瑞典眼科医生Henrick Sjgren首先描述了本病。近年来,随着诊断技术的发展,进一步提高了对疾病的诊断和探索病因及发病机理的能力。本文就近年国外有关文献作一综述。     

中国雷公藤制剂治疗系统性红斑狼疮疗效的Meta分析

应用Cochrne协作网和保存系统评价的专用分析软件RevMan4.2进行Meta分析,对1982年至今我国公开发表的运用雷公藤制剂辅助或联合其他药物治疗系统性红斑狼疮的文献进行临床疗效的综合评价分析.结果表明,符合并纳入该次Meta分析的文献共有九篇,经卡方检验OR=0.26（95%CI为0.16～0.40）,OR值大于零,且＂漏斗图＂图形基本对称并偏向对照组,表明雷公藤制剂治疗系统性红斑狼疮有较为明显的效果.     

四妙散加减治疗系统性红斑狼疮30例

目的：探讨中医治疗系统性红斑狼疮的方法。方法：用四妙散加减综合治疗系统性红斑狼疮30例并从临床症状。实验室指标与单用西药的对照组进行比较。结果：两组治疗系统性红班狼疮均有效（P＞0．05），而改善实验室指标四妙散配合西药综合治疗更有效（P＜0．05）。结论：四妙散加减配合西药综合治疗对活动性系统性红斑狼疮有更好的疗效，而且能有效控制实验室指标；对活动性系统性红班狼疮的辨证治疗，应当注重除湿。     

自身免疫病的表观遗传内容的渗透

研究发现,系统性红斑狼疮和类风湿性关节炎这两种自身免疫病与表观遗传密不可分。通过文献梳理法对系统性红斑狼疮和类风湿性关节炎的表观遗传内容作出介绍,并对自身免疫病部分的教学中渗透表观遗传内容作出相应建议。     

系统性红斑狼疮的口腔病损特点及治疗

目的：探讨系统性红斑狼疮（SLE）的口腔病损特点及治疗方法。方法：对我院肾内科自2000～2006年同收治的系统性红斑狼疮（SLE）患者39人进行临床分析。发现其中口腔受累的有8人，分析其口腔病损特点，并给予全身和口腔局部的综合治疗。结果：8例患者通过局部治疗，口腔病变均有明显好转，同时配合全身用药，均好转出院。结论：对系统性红斑狼疮（SLE）患者的口腔病变治疗采用以上方法是值得推广使用的。     

50例乳腺癌的超声诊断与分析

目的：探讨高频超声在乳腺癌诊断中的价值.方法：利用高频超声对50例乳腺癌图像特征进行分析,并与病理结果进行比较.结果：在高频超声检测的50例乳腺癌患者中,术前超声诊断乳腺癌46例,诊断符合率为92%.诊断乳腺实性占位3例,占6%.误诊为乳腺纤维瘤1例,占2%.结论：高频超声是诊断乳腺癌的一种有效方法.     

Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

Objective: To review the efficacy and safety of rituximab therapy for systemic lupus erythematosus (SLE).Methods: We searched for randomized controlled trails and observational studies that evaluated the effect of rituximab based on the systemic lupus erythematosus disease activity index (SLEDAI), British Isles lupus assessment group index (BILAG), urine protein levels, and the prednisolone dose, and had adequate data to calculate the mean, standard deviation (SD), and 95% confidence intervals, and to systematically review and meta-analyze observational studies with fixed effects model or random effects model. Results: We included 2 randomized controlled studies and 19 observational clinical studies. We summarized the data from the 19 observational studies, analyzed the heterogeneity of the literature, and then used fixed effect model or random effect model for statistical analysis. The SLEDAI, BILAG, and urine protein levels and the prednisolone dosage were decreased after rituximab treatment, and the decreases in the BILAG, urine protein levels, and the prednisolone dose were found to be significant (P<0.05), when compared with baseline level. Rituximab’s adverse effects generally could be controlled with an effective dosing regimen. Conclusions: Although there are still controversies about rituximab’s treatment on SLE, but our study had showed that rituximab had favorable effects on refractory lupus. The long-term efficacy and safety of rituximab require further study.     

老年肺炎96例临床分析

目的:探讨老年肺炎的临床特点,减少临床误诊率,提高老年肺炎的诊疗水平.方法:对2008年1月～2010年1月住德州市人民医院资料完整的96例65岁以上肺炎病例进行回顾性分析.结果:既往有慢性心,肺疾病,脑血管病,糖尿病等基础病及高龄者发病多,发病以冬春季节为多.临床症状:约2/3患者有发热、咳嗽、咳痰等呼吸道症状,1/3的患者以非呼吸道症状为首发症状.47%有心力衰竭、呼吸衰竭、电解质紊乱等并发症.痰培养显示革兰氏阴性杆菌多,双肺CT及X线检查以双肺小片状渗出影多见.结论:正确认识老年肺炎的临床特点,做出早期诊断和治疗,提高治愈率,降低死亡率.     

女性系统性红斑狼疮患者血清中催乳素水平的研究

用放免法检测了２４名系统性红斑狼疮（ＳＬＥ）妇女及２０名健康对照组血清中催乳素（ＰＲＬ）水平， ＳＬＥ者同时检测ＩｇＧ和ＩｇＭ，结果发现ＳＬＥ伴有高催乳素血症，并且高水平 ＰＲＬ与 ＩｇＧ和 ＩｇＭ呈正相关．提示 ＰＲＬ通过刺激免疫球蛋白的产生诱导 ＳＬＥ发病．     

Proteins induced by telomere dysfunction are associated with human IgA nephropathy

Aging is one of the contributing risk factors for kidney diseases. Accumulating evidence prompts the view that telomere length in kidney tissue cells is an indicator for organismal aging. Previously identified aging markers (cathelin-related antimicrobial peptide (CRAMP), stathmin, elongation factor-1α (EF-1α), and chitinase) were associated not only with telomere driven aging in mice but also with human aging and chronic diseases. This study focuses on the relationship between these biomarkers and IgA nephropathy (IgAN) progression in the Chinese population. For 260 individuals, the four markers are determined in blind datasets using direct enzyme-linked immunosorbent assay (ELISA) and immunofluorescence staining. The expression levels of CRAMP and chitinase increased in blood plasma, urine, and kidney tissues during human IgAN progression. And for the other nephropathy, such as systemic lupus erythematosus (SLE), diabetic nephropathy (DN), and focal segmental glomerulosclerosis (FSGS), there is no protein upregulation with telomere shortening. Moreover, a combination of CRAMP and chitinase can distinguish patients with IgAN from healthy individuals with 88.2%/92.5% (plasma) and 74.3%/84.2% (urine) sensitivity/specificity. These data provide the experimental evidence that telomere shortening and related inflammatory proteins are associated with human IgAN, and it could be a new direction for the disease progression study.     

股部外伤致肠系膜下动脉栓塞1例

目的:分析股部刺伤与肠系膜动脉栓塞的关系,为防止临床上今后发生类似误诊提供参考;方法:结合临床误诊病例,联系基础医学理论进行分析并行开腹探查;结果:开腹探查证实该例股部刺伤患者急性腹痛乃因肠系膜下动脉的分支———乙状结肠动脉栓塞、乙状结肠坏死所致;结论:股部外伤,尤其是严重刺伤导致大血管破裂并脂肪组织严重损伤时可能引起其他器官脂肪栓塞。     

非典型麻疹误诊2例分析

目的:分析非典型麻疹的临床特点及产生误诊的原因,以便及时准确地诊断非典型麻疹。方法:临床病例分析法。结果:分析流行病学资料、详细询问病史、严密观察病情相结合对减少误诊有重要意义。结论:医师经验不足,麻疹早期临床表现不典型是造成非典型麻疹误诊的主要原因。     

在超声专业住院医师规范化培训中使用案例教学法的作用和意义

自我国制定住院医师规范化培训制度以来,各培训基地都在不断改进教学方法,目的在于引导规培学员成长为合格的临床医师。案例教学法是一种科学的教学方法,可以帮助学习者在遇到困难时能够积极正确地处理问题,在住院医师规范化培训中,使用这种方法可以使学员独立思考,将不同学科紧密联系,避免误诊、漏诊,更好地为患者服务。文章旨在探讨超声专业住院医师规范化培训中采用案例教学法的作用和意义。     

Authority,Status, and the Dynamics of Insider–Outsider Partnerships at the District Level

As school districts move toward systemic approaches to instructional reform, they are increasingly collaborating with outside organizations in this complex work. While emerging research touts the benefits of insider–outsider collaboration, we know little about the underlying processes by which partnerships are negotiated and maintained at the district level. Drawing on data from a longitudinal case study of a collaborative effort between an urban school district and a university-based research center, we investigate the role of authority and status in an insider–outsider partnership at the district level. We use conceptual tools from frame analysis and sociological theories of authority to describe the process by which authority and status relations develop. We then show that both authority and status shape how negotiation between insiders and outsiders unfolds. We argue that those with authority have a greater range of tools for negotiation and thus have greater influence. Status relations are important but are often mediated by authority relations. In addition, we argue that the organizational structure of the district shapes how the process unfolds in consequential ways. We conclude with implications for scholarship on and the practice of insider–outsider collaborations at the district level.