妊娠梅毒患者的驱梅治疗及对围产结局的影响

目的:探讨妊娠期驱梅治疗的方法及对围产结局的影响。方法:选取89例妊娠期合并梅毒孕妇,依据确诊梅毒及首次注射首剂青霉素治疗时间分为3组,其中在妊娠早期(孕周≤12周)24例为早孕组,妊娠中期(12周<孕周<29周)31例为中孕组,妊娠晚期(孕周≥29周)34例为晚孕组,给予规范苄星青霉素或红霉素治疗,观察围产儿预后。结果:早孕组及中孕组产妇不良妊娠结局发生率分别为8.33%、19.35%,明显低于晚孕组(52.94%),差异具有统计学意义(P<0.05);89例孕妇根据初次检测RPR滴度不同分组,其中滴度≤1∶4者53例,滴度≥1∶8者36例,滴度≤1∶4者新生儿不良预后发生率为7.55%,明显低于滴度≥1∶8孕妇分娩的新生儿不良预后发生率(27.18%),差异具有统计学意义(P<0.05),先天性梅毒患病率分别为3.22%、22.77%,差异具有统计学意义(P<0.05);早孕组孕妇分娩新生儿RPR阳性率为20.83%,先天性梅毒患病率为0,中孕组分别为19.35%、3.23%,晚孕组分别为70.59%、26.47%,早孕组及中孕组RPR阳性率、先天性梅毒患病率明显低于晚孕组,差异具有统计学意义(P<0.05)。结论:妊娠合并梅毒孕妇采取驱梅治疗时机与围产儿的预后及先天性梅毒患病率密切相关,早期正规进行驱梅治疗能明显改善围产儿预后,降低先天性梅毒发生率。     

新生儿先天性梅毒39例预后与孕母诊治情况的关系

目的:研究新生儿先天性梅毒发病及预后与其母妊娠期间治疗情况的关系。方法:分析先天性梅毒39例新生儿临床资料,根据孕妇正规治疗者与未治疗或治疗不彻底者病情观察组与对照组,常规给予青霉素治疗疗程2周,神经梅毒疗程3周。孕母青霉素过敏者给予红霉素治疗。结果:对照组因多器官功能衰竭死亡1例,余38例出院时情况良好。随访患儿RPR抗体1年内转阴35例,治疗1年后尚未转阴2例。观察组出院RPR转阴5例,治疗后4个月转阴6例,对照组出院RPR转阴11例,治疗后9个月RPR转阴13例。观察组与对照组患儿胎龄、体质量、重要脏器损害比较差异均有统计学意义(P<0.05)。结论:积极开展婚前及孕期梅毒筛查,早期诊断、早期正规治疗是减少梅毒对患儿损害的关键。     

梅毒孕妇所产新生儿血清学检测及转归情况分析

目的:分析梅毒孕妇所产新生儿血清学检测及转归情况。方法:选择2016年2月-2017年2月来本院治疗的单胎妊娠合并梅毒的孕妇160例及活产新生儿160例为研究对象。于新生儿出生前进行快速血清反应素试验(RPR)和梅毒螺旋体颗粒凝集(TPPA)试验,新生儿出生后3 d定期进行梅毒血清学检测。对妊娠合并梅毒的孕妇和新生儿梅毒血清学进行分析,比较不同时间段血清学转阴情况。结果:160例孕妇中,TPPA单阳性46例,RPR、TPPA双阳性114例,新生儿TPPA单阳性49例,111例为RPR和TPPA双阳性。孕妇单TPPA阳性与孕妇双阳性的新生儿梅毒血清测试结果比较,差异有统计学意义(P0.05)。根据持续检测后,新生儿双阳性中,出生6个月后,RPR阳性已全部转阴;出生18个月后,TPPA阳性已全部转阴。新生儿单TPPA阳性中,出生18个月后,TPPA阳性已全部转阴。TPPA单阳性新生儿阴峰出现在出生后第5～6个月。孕妇RPR的滴度越高,新生儿RPR的阴性时间越长(P0.05)。新生儿出生时RPR滴度在1︰1～1︰4时,新生儿的血清RPR阴性时间逐渐增加,但滴度为1︰8时的血清RPR阴性时间明显缩短;新生儿出生时RPR滴度阴性～1︰2,新生儿的血清TPPA阴性时间明显增加,RPR滴度1︰4～1︰8时,新生儿的血清TPPA阴性时间逐渐缩短。结论:经过治疗的妊娠合并梅毒孕妇所产新生儿梅毒血清学检查结果中RPR和TPPA双阳性占比仍然很高,孕妇产前RPR滴度高的新生儿阳性持续时间可能较长,但出生后一段时间内可转成阴性。建议对梅毒阳性新生儿进行长期随访,对先天性梅毒的诊断应慎重。     

新生儿梅毒螺旋体乳胶凝集试验阳性60例临床分析

目的探讨梅毒螺旋体乳胶凝集试验（TPPA）阳性新生儿母亲治疗情况对新生儿发病的影响及新生儿梅毒的主要表现。方法对我院2002年至2007年查出的60例TPPA阳性新生儿进行临床分型、x线检查、免疫测定和定期随访。结果新生儿期共确诊先天性梅毒35例,疑诊10例,正常15例。确诊35例中,母亲均未治疗。新生儿快速梅毒血清试验（RPR）滴剂≥母4倍28例,先天性梅毒以早产、肝脾肿大、皮疹为主;6例并发神经梅毒,脑脊液RPR阳性。确诊组治疗后RPR滴度不同程度下降;疑诊组RPR滴度均在6个月内转阴,正常组持续阴性。结论母亲产前定期产检,常规筛查,有效治疗可降低先天性梅毒的发病率;早期诊断、早期治疗、定期随访可明显降低先天性梅毒的病死率。     

妊娠合并梅毒的产前治疗对妊娠结局及母婴预后的影响

目的 研究妊娠合并梅毒患者在产前进行治疗对妊娠结局以及母婴预后效果的影响.方法 回顾相关资料选取妊娠梅毒患者60例,由于在产前的不同时间进行治疗,分为孕早期组(<20周)34例和孕中晚期组(≥20周)26例,两组均对已经确诊的梅毒患者进行治疗,观察并对比两组患者的不同时间治疗后的妊娠结局、新生儿的Apgar评分及母婴RPR滴度.结果 进行不同时间的干预治疗后,效果不同,其中孕早期组患者的正常分娩率高于孕中晚期组,且妊娠不良结局的发生率低于孕中晚期组,且新生儿的预后Apgar评分及母婴RPR滴度均优于孕中晚期组,各小组患者间的数据结果进行比较后,发现差异较显著,差异具有统计学意义(P<0.05).结论 针对梅毒妊娠患者进行产前不同时间的治疗后,发现妊娠前期的治疗效果较好,增加了正常分娩的的发生率,减少了妊娠不良结局情况的发生,提高了母婴的生存质量,值得患者信赖和在临床中推广应用.     

孕妇梅毒筛查的临床意义

目的探讨梅毒筛查的临床意义。方法2009年所有产科门诊孕妇孕中期常规行梅毒快速血浆反应素环状卡片试验（RPR）筛查,对RPR阳性者再行梅毒螺旋体明胶颗粒凝集试验（TPPA）确诊,并行甲苯胺红不加热血清试验（TRUST）滴度检测,对确诊梅毒者实行长效青霉素标准治疗3周,并追踪梅毒孕妇产后新生儿TPPA及TRUST滴度检测情况,记录结果并分析。结果3660例孕妇RPR阳性7例,发生率0．19％,检测TPPA阳性4例,占RPR阳性者57．14％（4n）,梅毒检出率0．11％（4/3660）,1例梅毒孕妇TRUST滴度1：64,胎儿宫内死亡引产,余3例梅毒孕妇TRUST滴度1：1～1：4,产前滴度均为1：2,3名梅毒孕妇分娩的新生儿TPPA检测均阳性,TRUST滴度均0,未提示发生胎传梅毒。结论孕妇梅毒筛查检出率低,但梅毒孕妇早检查、早确诊、早治疗对改善胎儿预后、预防胎传梅毒有重要意义。     

30例先天性梅毒的临床分析

目的:探讨新生儿先天性梅毒的临床表现,诊断及治疗。方法:对30例先天性梅毒患者进行回顾性总结分析。结果:患者先天性梅毒临床表现复杂、多样化,缺乏典型症状,主要表现为皮肤损害、早产、鼻塞、病理性黄疸、发热、消化道症状、肝脏肿大、贫血、骨损害、神经梅毒等,梅毒快速血浆反应素试验(RPR)及甲苯胺红不加热血清试验(TRUST)均为阳性可以诊断。应用青霉素治疗疗效好,剂量10万U/(kg·d),分2次静脉滴注,q12h,疗程2周。确诊神经梅毒的新生儿疗程3周。结论:先天性梅毒临床表现多样,有多脏器损害,易误诊、漏诊,如果早发现、早诊断、早治疗,可以减少先天性梅毒对新生儿身心的损害、取得良好的预后。     

新生儿先天性梅毒诊治体会

目的:探讨新生儿先天性梅毒的诊疗方法.方法:对7例确诊为先天性梅毒病例的诊疗过程采用回顾性分析.结果:7例快速血浆反应素试验(RPR)、梅毒螺旋体血凝试验(TPHA)均为阳性,母亲血TPHA均为阳性,经青霉素1个疗程驱梅治疗,治愈好转出院.结论:先天性梅毒早期诊断,经青霉素充分治疗者,预后良好.     

妊娠合并梅毒170例临床分析

目的探讨妊娠梅毒患者临床特点、治疗方法和妊娠结局,以降低先天性梅毒发生率。方法170例经血清学检查确诊为梅毒的孕妇,根据妊娠期是否行全疗程抗梅毒治疗,分为治疗组(92例)和未治疗组(78例),选择同期正常孕妇为对照组(100例)。比较三组孕妇的妊娠结局,治疗组和未治疗组围产儿预后及新生儿先天梅毒的发生情况。结果①妊娠结局:治疗组足月分娩率为93.47%(86/92),未治疗组仅为30.76%(24/78),对照组为96.00%(96/100)。未治疗组与治疗组、对照组比较,差异有显著性(P<0.05)。治疗组早产及死胎发生率分别为6.52%(6/92)和2.17%(2/92),接近对照组的6.00%(6/100)、0,明显低于未治疗组的30.77%(24/78)、28.21%(22/78),差异有显著性(P<0.05)。治疗组窒息儿、低体重儿、先天梅毒患儿发生率及新生儿死亡率明显低于未治疗组,两组比较,差异有显著性(P<0.05)。治疗组分娩正常新生儿者占60.86%(56/92),未治疗组仅占25.64%(20/78)。②治疗孕周越早,先天梅毒患儿发生率越低(P<0.05)。先天梅毒患儿的发生率,应用苄星青霉素孕妇为23.07%(18/78),应用红霉素孕妇为100%(14/14)。③新生儿血清RPR阳性率治疗组为79.50%,未治疗组为100%,差异无显著意义。结论妊娠梅毒患者临床分期以潜伏期梅毒为主,体征及症状不典型,容易误诊。因此,妊娠早期常规梅毒筛查特别重要。治疗开始时的孕周及用药,是影响妊娠梅毒结局的重要因素。     

早期先天性梅毒32例临床分析

目的探讨早期先天性梅毒的诊断、治疗及预防措施。方法回顾分析32例经临床、梅毒血清学检查确诊的早期先天性梅毒患儿的临床资料。结果早期先天性梅毒临床表现多种多样,以皮疹为主,易产生合并症,患儿及其母亲快速血浆反应素试验(RPR)及梅毒螺旋体血凝试验(TPHA)均为阳性,且患儿RPR滴度均高于其母亲RPR滴度的4倍以上。确诊后给予青霉素10~15万u/(kg.d)治疗,疗程2周,25例(78.1%)临床痊愈,5例(15.6%)临床好转。结论对于无严重合并症的早期先天性梅毒患儿临床治愈率高。预防先天性梅毒的关键是围生期早期诊断及治疗。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.