无症状脑梗死认知功能障碍与脑血流灌注的关系

目的 探讨无症状脑梗死（SCI）患者认知障碍与脑血流灌注的关系.方法 32例SCI患者和21例健康对照组分别完成简易精神状态检查量表（MMSE）、临床痴呆评定量表（CDR）的评定及SPECT脑血流灌注检测,比较两组中轻度认知障碍（MCI）的发生率,并分析各组脑血流灌注的特点.结果 SCI组中MCI的发生率为34.37%,明显高于对照组的14.28%（P＜0.01）.SCI患者的脑血流灌注在双侧颞叶、顶叶、额叶及基底节区明显减低（P＜0.05,P＜0.01）,其中MCI组双侧颞叶、顶叶的脑血流灌注明显低于非MCI组.相关分析显示MCI组MMSE分值与双侧顶叶及左侧颞叶脑灌注呈正相关.结论 SCI可以明显提高MCI的发生,脑血流灌注减低在MCI的发病机制中可能起重要作用.     

CT引导下骶髂关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的研究

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.     

82例围产儿死亡原因分析

本文对第一汽车制造厂职工医院,1990～1992年住院分娩的4 811例围产儿进行了调查分析;围产儿死亡率为17.04‰,其中死产死亡率明显低于死胎及活产新生儿死亡率。围产儿死亡原因前6位依次为畸形、早产、脐带因素、过期妊娠、妊高征、肺部疾患。文章对如何降低围产儿死亡率进行了分析和讨论。     

我国疟症流行现状

我国疟症流行现状中国医科大学医学信息学系（１１０００１）王淑侠疟疾是世界性的对人类健康危害较严重的寄生虫病，《１９９６年世界卫生报告》中将其列为“十大常见传染病”之一。此资料报道，全球１９９５年疟疾患者达５亿人，仅次于腹泻病、结核及肠寄生虫病，同年死...     

18F-氟代脱氧葡萄糖正电子成像术/计算机断层扫描对甲状腺结节鉴别诊断的价值

目的探讨¹⁸F-氟代脱氧葡萄糖正电子成像术/计算机断层扫描(¹⁸F-FDG PET/CT)对甲状腺结节鉴别诊断的价值及使用标准化摄取值(SUVmax)评价甲状腺结节性质的可行性。 方法回顾性分析101例术前行¹⁸F-FDG PET/CT显像检查,术后病理明确诊断的甲状腺结节患者,其中男性30例,女性71例;年龄17～78岁,平均(48.2±12.9)岁。计算PET/CT对甲状腺结节良恶性鉴别效能(敏感度、特异度、准确度、阳性预测值及阴性预测值),并对病灶组织、健侧甲状腺组织或周围组织分别勾画出感兴趣区,测量SUVmax值进行相互比较。所获得患者的SUVmax值用均数±标准差的形式表述,均数差异使用t检验。 结果PET/CT对甲状腺结节良恶性鉴别的敏感度为89.1%,特异度为60.0%,准确度为62.3%,阴性预测值为35.2%,阳性预测值为90.1%;甲状腺恶性结节组SUVmax为：6.70±4.57(1.3～21.7),高于良性结节组的3.87±2.41(1.3～12),差异有统计学意义(t＝3.14,P<0.05)。 结论PET/CT对于甲状腺结节的良恶性鉴别具有一定的意义,且通过SUVmax值来判断良恶性肿瘤也具有可行性。     

CT引导下骶髂关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的研究

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.     

FHIT和HIF-1α在子宫内膜异位症中的表达及意义

目的:探讨脆性组氨酸三联体(FHIT)和缺氧诱导因子(HIF-1α)在子宫内膜异位症中的表达。方法:应用免疫组化SP法检测30例子宫内膜异位症异位内膜和在位内膜及30例同期单纯子宫肌瘤患者子宫内膜(对照组)中FHIT和HIF-1α的蛋白的表达。结果:FHIT在正常子宫内膜、在位子宫内膜、异位子宫内膜中的阳性表达率逐渐降低(χ2=28.865,P<0.000 1),在内异症r-AFS分期中比较,在位子宫内膜FHIT的表达差异无统计学意义(χ2=2.337,P=0.341);而异位内膜中的FHIT表达差异有统计学意义,Ⅰ~Ⅱ期高于Ⅲ~Ⅳ期(χ2=6.816,P=0.019)。HIF-1α在正常子宫内膜、在位子宫内膜、异位子宫内膜中的阳性表达率逐渐升高(χ2=55.798,P=0.000),在内异症r-AFS分期中比较,HIF-1α在在位内膜和异位内膜的表达差异均无统计学意义(χ2=0.867,P=1.000;χ2=2.049,P=0.583);FHIT与HIF-1α在内异症中表达有相关性,FHIT与HIF-1α的表达水平在在位内膜中呈显著负相关(r=-0.443,P=0.014);FHIT与HIF-1α的表达水平在异位内膜中呈显著负相关(r=-0.462,P=0.010)。结论:FHIT与HIF-1α可能共同促进了内异症的发生、发展。     

低代谢肺肿瘤209例正电子发射体层摄影术回顾

目的：分析肺肿瘤脱氧葡萄糖正电子发射体层摄影术（FDGPET）低摄取特征。方法：病理确诊肺肿瘤，回顾性分析PET代谢表现，以SUVmax〈2．5为低代谢标准，综合分析病例分布特点。结果：21例肺肿瘤低FDG摄取，17例为腺癌。高分化腺癌呈低摄取最多，占高分化腺癌病例的40％。结论：低代谢由肿瘤的组织特性决定，多见于腺癌。PET肺内低代谢病灶解析，要注意排除分化较好的腺癌可能，结合CT病灶特征，可提高诊断准确率。     

64层螺旋CT在法洛四联症诊断中的价值

目的：探讨64层螺旋CT在法洛四联症及其伴发畸形诊断中的临床应用价值。方法：对21例法洛四联症患者CT资料进行回顾性分析，与手术或心血管造影结果对照。所有病例均行64层螺旋CT检查，并进行多平面重建和容积再现等三维重建。21例患者均行超声心动图检查。14例有手术结果，7例经心血管造影证实。结果：64层螺旋CT对21例患者均显示了肺动脉狭窄、室间隔缺损、主动脉骑跨及右室壁肥厚。合并畸形包括动脉导管未闭6例，右位主动脉弓4例，双主动脉弓2例，永存左上腔静脉7例，迷走左头臂静脉3例，单支冠状动脉1例和大的主肺侧支动脉3例。结论：64层螺旋CT及三维重建不仅显示了心脏的解剖畸形，还清晰显示了冠状动脉及肺动脉的发育情况。64层螺旋CT是一种诊断法洛四联症的重要检查方法。