尿微量清蛋白与尿肌酐比值对妊娠期糖尿病早期肾损伤的诊断价值

目的 探讨随机尿微量清蛋白/尿肌酐比值(UmAlb/UCr)在妊娠期糖尿病(GDM)肾损伤早期诊断的应用价值.方法 收集59例正常妊娠妇女和66例GDM患者,并选取50例非妊娠健康育龄妇女作为健康对照组,检测各组随机尿UmAlb/UCr值、血清肌酐(Scr)和尿素(Urea).结果 对各组检测结果进行统计分析,比较各组差异,统计工具采用SPSS17.0统计软件.结果 GDM组、正常妊娠组和健康对照组的尿UmAlb/UCr检测结果分别为(12.02±16.70)、(1.83±0.50)、(1.86±0.45)mg/mmol,Scr检测结果分别为(81.43±37.58)、(58.34±12.01)、(55.79±10.04)μmol/L,Urea检测结果分别为(7.71±4.38)、(4.78±1.23)、(4.93±1.34)mmol/L.GDM组的UmAlb/UCr、Scr和Urea结果与正常妊娠组和健康对照组比较差异有统计学意义(P<0.01),正常妊娠组和健康对照组比较差异无统计学意义(P>0.05).GDM组的UmAlb/UCr、Scr和Urea检测阳性率分别为39.4%、25.8%和22.7%,GDM组的UmAlb/UCr检测阳性率高于Scr和Urea,差异有显著性意义(P<0.05).结论 随机UmAlb/UCr比值可作为GDM肾损伤早期诊断的敏感指标.     

关节镜下双线双骨道技术治疗前交叉韧带胫骨止点撕脱骨折的疗效观察

目的 观察关节镜下双线双骨道技术治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。方法 回顾性分析自2020-02—2022-06采用关节镜下双线双骨道技术治疗的42例前交叉韧带胫骨止点撕脱骨折,根据患者术后膝关节X线片检查结果评估骨折复位及愈合情况,并应用Lysholm评分及IKDC评分评估术后膝关节功能恢复情况。结果 42例均获得随访,随访时间12～26个月,平均15.6个月。术后X线片均显示骨折复位良好,骨折均愈合,骨折愈合时间为2～4个月,平均2.9个月。末次随访时Lysholm评分为（93.6±3.1）分,高于术前（50.6±3.4）分,差异有统计学意义（t=9.840,P<0.001）。末次随访时IKDC评分为（94.2±2.7）分,高于术前（54.0±4.2）分,差异有统计学意义（t=8.560,P<0.001）。结论关节镜下双线双骨道技术治疗前交叉韧带胫骨止点撕脱骨折的疗效可靠,不仅简化了手术流程,而且固定牢固、手术创伤小、膝关节功能恢复快,值得临床推广应用。     

肾移植术后并发自体尿路上皮多器官癌六例的临床分析

Objective To analyze the etiology, clinical diagnosis and outcomes of 6 cases of multifocal urothelial carcinomas following transplantation. Methods A retrospective analysis was performed on 6 cases of multifocal urothelial carcinomas following renal transplantation in our center. Results Six patients were diagnosed as having multifocal urothelial carcinomas, including 1 case of related renal transplantation. Five cases were diagnosed by painless gross hematuria 2～48 months after renal transplantation, and I patient was diagnosed as having bladder tumors by B-uhrasound. All lesions happened un-simultaneously, from 1.5～16 months, and each case accepted operation 2～5 times. One case accepted radical cystectomy and cutaneous ureterostomy of the graft, and one accepted radical cystectomy, cutaneous ureterostomy of the graft and urethrectomy. All of 6 cases received OKT3 or Daclizumab as the induced-immunosuppressive therapy and tacrolimus or cyclosporine A + mycofenolate mofetil + steroid as the maintenance therapy. Intravesical chemotherapy started in all patients immediately after the surgery. All operations were successful and most patients got satisfactory results. Conclusions Kidney recipients have a higher rate of transitional cell carcinomas which are characterized by easy metastasis, and mostly have unsatisfactory prognosis. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy. A routine examination at regular intervals after transplantation is very important.     

突入膀胱不同形态的前列腺增生的有限元分析

目的 通过有限元分析方法，探索不同形态的膀胱内前列腺突出（intravesical prostatic protrusion,IPP）对排尿过程的影响。方法 基于1例前列腺中叶和双侧叶突入膀胱的良性前列腺增生患者MRI图像，重建其下尿路有限元模型（模型3）。通过图像修改突出部分，构建双侧叶突出模型（模型1）和中叶突出模型（模型2）。结合有限元分析软件进行双向流固耦合仿真分析，比较3种模型的前列腺尿道形变和流体动力学参数。结果 排尿过程中，模型3前列腺尿道角减小的程度最大，其次是模型2。模型3中的液体压强损失最严重。在每种膀胱内压下，模型1的流体速度大于其他模型，模型3的最大流率低于其他模型。在相同的膀胱出口截面积，模型3的最大流率低于其他模型，且增加膀胱出口截面积会进一步扩大这一差距。结论 与具有相同IPP长度但只有中叶突出或只有双侧叶突出的患者相比，中叶和双侧叶均突出的患者具有更大的尿道阻力和更小的最大尿流率。评估IPP不仅要测量其长度，还要注意IPP形态。