胃食管反流病诊断问卷在成人难治性哮喘诊治中的应用

目的探讨胃食管反流病诊断问卷（RDQ）对分析难治性哮喘（DA）中胃食管反流因素及评价治疗的价值。方法对门诊的469例DA患者进行RDQ问卷调查,得分≥12分者诊断为胃食管反流病（GERD）;愿意接受GERD治疗的患者列为治疗组;将对埃索美拉唑或莫沙必利有过敏反应或不愿意接受GERD治疗的DA患者列为对照组,治疗4 w,观察治疗前后RDQ和哮喘症状、呼吸功能的变化。结果 469例DA患者中,135例有GERD,发生率为28.78%;男女性别比1.14∶1;年龄（38.5±10.6）岁。反酸是最常见的症状,其次为反流和烧心。治疗组治疗后RDQ评分、哮喘自评得分和呼吸功能均优于对照组（P〈0.05）。结论胃食管反流是DA的重要发病因素,但多数DA患者缺乏典型的胃食管反流症状。RDQ问卷可以较好地鉴别GERD是否为DA的原因,并可以指导GERD诱导的DA的治疗。     

对"慢性咳嗽"的再认识

慢性咳嗽占呼吸科门诊 1 /3以上 ,很长时间以来对胸透正常 ,咳嗽症状迁延不愈者多诊断为“支气管炎”。近年来人们逐渐认识到这部分人中有半数并非支气管炎。“慢性咳嗽”是指连续咳嗽三周以上者。之所以定为三周 ,因为大部分呼吸道感染 (多为病毒引起 ) ,多在三周内已治愈 ,其咳嗽症状一般随之消失。当然临床上应经过胸透等检查初步排除肺炎、支气管扩张、肺癌等疾病。今就近年来国内外对“慢性咳嗽”的研究作一简单文献复习。该症实际上是多种疾病的特殊类型 ,表现为以咳嗽症状为主。1　咳嗽变异性哮喘 ( cough variantasthma,CVA)这类…     

多腔道阻抗联合pH监测对危重症患者胃食管反流的诊断价值研究

目的 比较多腔道阻抗联合pH监测(MⅡ-pH监测)和单独pH监测两种方法对危重症患者胃食管反流(GER)的诊断价值.方法 采用前瞻观察性研究方法,分析2013年7月-2014年12月间连续收入北京市海淀医院重症医学科(ICU)的住院患者.所有研究对象均行24h MⅡ-pH监测,记录并分析GER的相关参数,包括总反流次数、液体反流次数、酸性反流次数、反流暴露时间、反流清除时间等.比较MⅡ-pH监测结果中MⅡ-pH监测和单独pH监测对诊断GER的异同.结果 116例ICU住院患者中,MⅡ-pH监测识别出115例(99.1％)患者共发生5024次反流(43.28±3.96次/例,中位数34次/例,范围0～196次/例),而单独pH监测识别出54例(46.6％)患者共发生1868次酸性反流(7.66±1.65次/例,中位数0次/例,范围0～81次/例).MⅡ-pH监测的总反流次数中位数以及液体反流次数中位数(分别为34.0和30.5次)明显多于单独pH监测的反流次数中位数(0次),差异有统计学意义(P=0.000);MⅡ-pH监测到的总反流暴露时间中位数、平均反流清除时间中位数和最大反流清除时间中位数(分别为522、10、108s)均明显长于单独pH监测(分别为5.06、2.53、3.46s),差异有统计学意义(P=0.000).相关分析显示,单独pH监测的酸性反流次数与MⅡ-pH监测的总反流次数(r=0.119)以及液体反流次数(r=0.231)呈弱相关,而与MⅡ-pH监测的酸性反流次数无明显相关性(r=0.656).结论 在危重症患者GER的监测方法中,MⅡ-pH监测较单独pH监测更为敏感.     

功能性烧心与难治性胃食管反流病的临床特征比较

 目的 比较功能性烧心(functional heartburn,FH)和难治性胃食管反流病(refractory gastroesophageal reflux disease,rGERD)的临床特征。方法 对24小时Ph-阻抗监测确定的8例FH和38例rGERD患者的临床资料进行分析。问卷包括一般情况、胃食管反流病、反流症状积分表(RSS),以及焦虑(SAS)、抑郁(SDS)评价量表等。结果 FH和rGERD患者的性别、年龄、体质指数(BMI)、典型症状、吸烟饮酒史、RSS、SAS、SDS评分间的差异无统计学意义;但rGERD患者胃食管反流病问卷(GerdQ)得分(中位数8)显著高于FH组(中位数6),差异有统计学意义(P＜0.01)。结论 FH患者的GerdQ 评分明显低于rGERD患者。
     

反流性咽喉炎43例临床分析

目的探讨喉咽反流(LPR)与胃食管反流病(GERD)的关系及诊治方法。方法对43例反流性咽喉炎患者,收集患者症状、喉镜检查及部分患者胃食管镜检查、24 h食管pH监测结果,依据Belafsky等设立的反流症状指数(RSI)及反流征象分数(RSF)评估,均拟诊断LPR,给予质子泵抑制剂及必要口服胃动力药物治疗12周,比较患者治疗前后症状、喉镜及RSI和RSF评分判断治疗效果。结果治疗4周后总有效率为37.2%(16例),治疗6周后总有效率48.8%(21例),治疗8周后总有效率86.1%(37例),治疗12周后总有效率90.7%(39例)。结论针对可疑LPR患者行诊断性PPI治疗不失为一种简便易行且疗效确切的方法。     

Barrett食管的临床特征

Barrett食管(Barrett’s esophagus,BE)的主要病因是胃食管反流(gastroesophageal refluxdisease,GERD),Barrett食管与食管腺癌密切相关〔1〕。近年来,Barrett食管及其相关食管腺癌的发生率增长很快,在西方国家尤其明显,在有反流症状的患者中Barrett食管的发生率可达15%〔2〕。每年大约有1%的Barrett食管患者发展为食管腺癌〔3〕,因此,早期诊断和治疗Barrett食管以及治疗早期食管腺癌显得非常必要。本文主要介绍Barrett食管的定义、分类、流行病学、临床表现、内镜下表现、组织学特点、Barrett食管与食管腺癌的监测及其Barrett食管临…     

部队合理用药系列讲座（2） 胃食管反流临床用药

胃食管反流（GER）是指胃内容物反流到食管引起不适症状和（或）并发症。在GER治疗中,合理选择药物非常重要。现就有关情况介绍如下。     

埃索美拉唑治疗胃食管反流性咳嗽的临床疗效分析

目的：评价埃索美拉唑治疗胃食管反流性咳嗽的临床疗效。方法：将64例反流性食管炎患者,随机分成两组,其中一组给予埃索美拉唑治疗,另一组给予奥美拉唑治疗,治疗2个月后,评价其临床疗效。结果：治疗2个月后,治疗组临床症状改善总有效率、胃镜检查结果与对照组比较均有统计学差异（P〈0.05）,且优于对照组。结论：埃索美拉唑能有效地改善RE患者的症状,有助于提高患者健康相关生活质量,值得临床推广应用。     

不同反流物对食管上皮屏障的损伤研究

制作单纯胃食管反流（Ｇ组）、单纯十二指肠食管反流（Ｄ组）及十二指肠胃内容物混合食管反流（ＤＧ组）动物模型,对食管标本进行扫描电镜（ＳＥＭ）、透射电镜（ＴＥＭ）及镧示踪法电镜检查,以研究不同反流物对食管粘膜上皮屏障的损伤情况。结果显示：Ｇ组见表层细胞脱落,细胞间桥粒明显减少,镧颗粒进入上皮细胞间隙,但未见进入细胞内;Ｄ组损害较严重,细胞表面微褶明显减少、不规则,细胞膜不连续,细胞器变性,镧颗粒可进入     

反流物对食管组织内细胞增殖相关基因表达的影响

用不同手术方式制作单纯胃食管反流（Ｇ组）、单纯十二指肠食管反流（Ｄ组）、十二指肠胃混合食管反流（ＤＧ组）及无反流对照组（Ｃ组）动物模型,于术后不同时期取出食管,用免疫组化法检测ｐ１６、ＰＣＮＡ、Ｃｙｃｌｉｎ Ｄ１、ＣＤＫ４等基因的表达。结果显示：Ｄ组、ＤＧ组大鼠食管组织中ＰＣＮＡ、Ｃｙｃｌｉｎ Ｄ１、ＣＤＫ４基因表达显著高于Ｇ组,并随反流时间延长而明显增强,反流组与Ｃ组相比均有显著差异;各组不同时     

42例慢性咳嗽诊治分析

目的:提高对慢性咳嗽诊断水平。方法:收集我院2005年1月至2006年12月慢性咳嗽42例(门诊30例,住院12例),对其病因、诊断和治疗结果进行分析。结果:这些病例的病因变化很大,其中咳嗽变异型哮喘12例(28.6%)、鼻后滴流综合征9例(21.4%)、胃食管反流性咳嗽7例(16.7%)、嗜酸粒细胞性支气管炎5例(11.9%)、感冒后咳嗽4例(9.5%)、药物性咳嗽3例(7.1%)、气管肿瘤2例(4.8%)。结论:慢性咳嗽的病因复杂多变,必须首先明确病因,才能够采取针对性的治疗措施。     

慢性咳嗽Irwin诊断程序的临床应用

目的探讨慢性咳嗽Irwin诊断程序临床运用中的优缺点,加深对慢性咳嗽的病因、诊断、鉴别诊断及治疗的认识。方法回顾性分析2009年在解放军总医院第一附属医院门诊按照Irwin小组提出的慢性咳嗽诊断程序确诊的118例慢性咳嗽患者的临床资料。结果按照Irwin小组提出的慢性咳嗽诊断程序,118例慢性咳嗽患者均得到确诊,确诊率100%;确诊时间1~30d;临床治愈113例,治愈率达96%。慢性咳嗽的病因分布为:哮喘及哮喘相关疾病(过敏性鼻炎、过敏性咽喉炎、咳嗽变异型哮喘等)和嗜酸性粒细胞性支气管炎共32例,占27.1%;上气道咳嗽综合征(慢性鼻炎、鼻窦炎、咽囊炎、鼻后滴漏综合征、慢性咽喉炎、声带息肉等)28例,占23.7%;胃食管反流病23例,占19.5%;下呼吸道疾病(支气管内膜结核、肺结核、气管内黏膜腺癌、肺癌、支气管扩张症、肺间质纤维化等)14例,占11.9%;心功能不全致咳10例,占8.5%;因服用血管紧张素转换酶抑制剂(ACEI)类降压药致咳6例,占5.1%;心因性咳嗽3例,占2.5%;其他2例,占1.7%。结论慢性咳嗽Irwin诊断程序全面详尽,临床应用中要结合患者实际情况,加以灵活运用。慢性咳嗽的病因复杂,主要有哮喘及相关疾病、鼻窦炎及上气道咳嗽综合征、胃食管反流病三大类。     

慢性前列腺炎中医药诊治经验探讨

目的 探讨中医药诊治慢性前列腺炎的经验。方法 收集医案,建立数据库,通过SAS9.4软件进行研究,分析证型与用药的规律。结果 共搜集医案259例,证型有湿热型、肾虚型、瘀滞型。以湿热型为主,兼夹瘀。治法以升清降浊、清利湿热、活血化瘀为主,少用补肾法。使用经验方剂,共使用中药27味。常用的前14位中药分别为柴胡、桔梗、升麻、泽泻、茯苓、白花蛇舌草、蚕沙、丹参、甘草、菊花、王不留行、车前子、木通、猪苓。结论 慢性前列腺炎中医病因病机多为湿热蕴结下焦,清气不升、浊阴不降,治则为升清降浊、清利湿热、兼以活血化瘀。     

肾上腺节细胞神经瘤的多层螺旋CT诊断与临床分析

目的对肾上腺节细胞神经瘤的多层螺旋CT(MSCT)诊断与临床特征进行分析。方法对我院2010—2012年收治的60例肾上腺无功能性肿瘤患者进行回顾性分析。其中肾上腺节细胞神经瘤患者18例,肾上腺无功能腺瘤患者24例,转移瘤8例,无功能嗜铬细胞瘤患者10例,共64个病灶。采用Lightspeed VCT 64层螺旋CT扫描仪对其病灶行平扫及随后30 s、70 s、3 min动态增强扫描,并将其影像学表现进行比较分析。结果①肾上腺节细胞瘤形态上大多表现为卵圆形,边界模糊,密度均匀,有明显的桃尖征,病变部位多以右侧为主,可又钙化的情况出现;②肾上腺节细胞神经瘤在同一扫描或时间点的CT平均值与其他各病变类型差异均有统计学意义(P<0.05),其中平扫时表现出密度高于无功能腺瘤,而低于嗜铬细胞瘤和转移瘤,而在增强扫描各时间点其密度则表现出明显低于其他各病变类型,差异均具有统计学意义(P<0.05)。结论临床上肾上腺节细胞神经瘤与其他各类型肾上腺无功能肿瘤相比,其MSCT表现在其病变形态、边界清晰度、肿瘤内钙化、发病部位与平扫CT平均值及增强扫描各时间点CT平均值均有明显的差异性,临床可根据其特点进行鉴别诊断,并对其手术治疗提供影像学依据。     

南疆地区慢性咳嗽60例病因分析

慢性咳嗽是十分常见的呼吸系症状,引起慢性咳嗽的病因较为复杂,对病因进行正确的判断是取得疗效的关键,但临床中常易发生对慢性咳嗽的误诊、误治。笔者总结了新疆南疆地区60例慢性咳嗽患者的临床资料,以探讨该地区慢性咳嗽病的分布规律,为临床治疗提供帮助。     

Cerebrospinal fluid volume analysis for hydrocephalus diagnosis and clinical research

In this paper we analyze volumes of the cerebrospinal fluid spaces for the diagnosis of hydrocephalus, which are served as reference values for future studies. We first present an automatic method to estimate those volumes from a new three-dimensional whole body magnetic resonance imaging sequence. This enables us to statistically analyze the fluid volumes, and to show that the ratio of subarachnoid volume to ventricular one is a proportionality constant for healthy adults (= 10.73), while in range [0.63, 4.61] for hydrocephalus patients. This indicates that a robust distinction between pathological and healthy cases can be achieved by using this ratio as an index.     

肺炎支原体感染诱发儿童咳嗽变异性哮喘临床分析

目的分析由肺炎支原体感染诱发的咳嗽变异性哮喘的临床特点。方法对44例咳嗽变异性哮喘且肺炎支原体抗体阳性患儿回顾性分析，观察组23例，对照组21例，两组均给予了大环内酯类抗感染、止咳等治疗，观察组同时雾化吸入支气管扩张剂。结果肺炎支原体感染诱发的咳嗽变异性哮喘以咳嗽为主要症状，肺部未闻及哮鸣音，大环内酯类抗感染、止咳治疗无效，加以雾化吸入支气管扩张剂效果明显。结论肺炎支原体是诱发咳嗽变异性哮喘的重要因素之一，雾化吸入支气管扩张剂治疗效果显。     

产科急性弥漫性血管内凝血10例诊治分析

目的探讨产科急性弥漫性血管内凝血（DIC）早期预防及诊治方法。方法分析我院10例产科引起DIC可能的原因、实验室检查及诊治方法。结果9例为剖宫产结束分娩,其中2例子宫次全切除术,1例自然分娩,上述10例均治愈。结论对产科可易发生DIC的高危患者．必须熟练掌握DIC的早期诊断和处理原则,尤其是及时有效地处理诱发DIC的疾病以预防或减少DIC的发生,从而降低DIC的病死率：     

Multi-centre analysis of incidental findings on low-resolution CT attenuation correction images

Objective:

To review new incidental findings detected on low-resolution CT attenuation correction (CTAC) images acquired during single-photon emission CT (SPECT-CT) myocardial perfusion imaging (MPI) and to determine whether the CTAC images had diagnostic value and warrant reporting.

Methods:

A multicentre study was performed in four UK nuclear medicine departments. CTAC images acquired as part of MPI performed using SPECT were evaluated to identify incidental findings. New findings considered to be clinically significant were evaluated further. Positive predictive value (PPV) was determined at the time of definitive diagnosis.

Results:

Of 1819 patients studied, 497 (27.3%) had a positive CTAC finding. 51 (2.8%) patients had findings that were clinically significant at the time of the CTAC report and had not been previously diagnosed. Only four (0.2%) of these were potentially detrimental to patient outcome.

Conclusion:

One centre had a PPV of 0%, and the study suggests that these CTAC images should not be reported. Two centres with more modern equipment had low PPVs of 0% and 6%, respectively, and further research is suggested prior to drawing a conclusion. The centre with best quality CT had a PPV of 67%, and the study suggests that CTAC images from this equipment should be reported.

Advances in knowledge:

This study is unique compared with previous studies that have reported only the potential to identify incidental findings on low-resolution CT images. This study both identifies and evaluates new clinically significant incidental findings, and it demonstrates that the benefit of reporting the CTAC images depends on the type of equipment used.Myocardial perfusion imaging (MPI) performed using single-photon emission CT (SPECT) is often subject to artefacts owing to the scatter and absorption of photons prior to detection. These artefacts can mimic myocardial perfusion defects leading to false-positive findings. It has been demonstrated that CT attenuation correction (CTAC) can compensate for these errors in SPECT MPI, resulting in image quality improvement and more accurate diagnosis.^1,2 The low-resolution/low-dose CT scan is performed through the area of the chest, which is aligned with the SPECT scan of the heart, so only a limited CT scan of the thorax is acquired. CT images are essentially a by-product of the attenuation correction (AC) process, the CT acquisition being primarily for AC purposes.Acquisition using a low tube current (mA) and large slice thickness results in images that have low signal-to-noise ratio, poor spatial resolution and an increased potential for partial volume artefacts compared with those of diagnostic CT studies. Motion artefacts may also be evident, as patients are not required to hold their breath during the CT acquisition. The resulting images are adequate for the purpose for which they have been acquired but are often not considered to be of diagnostic quality. The latest guidelines from the British Nuclear Cardiology Society suggest that if the CTAC images are of diagnostic quality, then it is good practice to review them according to a local policy,³ but the guidelines do not specify what constitutes “diagnostic quality”. However, the CTAC images often reveal incidental findings.^4,5 This would suggest that whilst the images are of lower quality than a diagnostic CT scan, they could potentially have some diagnostic value.In the UK, the ionizing radiation (medical exposure) regulations 2000⁶ stipulate that each medical radiation exposure should be evaluated and a record kept of any findings. Although this implies that CTAC images should be reported, this is ambiguous because of the non-diagnostic nature of the images and lack of professional body guidance.^3,7The objectives of this study were:

1. (1) to review the new incidental findings that were detected on low-resolution CTAC images acquired during SPECT-CT MPI that were thought to be clinically significant at the time of reporting.
2. (2) to determine whether the CTAC images had diagnostic value and warranted reporting.

In this study, we considered “clinically significant” to mean that there was a high suspicion that the pathology, if any, underlying the incidental radiological finding could impact negatively on patient well being and that further investigation was required.     

老年人社区获得性肺炎的临床特点及诊治分析

目的探讨老年社区获得性肺炎(CAP)的临床特点。方法分析110例老年CAP住院患者的临床资料,根据年龄分为高龄组与非高龄组,分析两组患者的临床表现、辅助检查及治疗转归。结果与非高龄组患者比较,高龄组CAP患者临床表现不典型,肺部体征明显,病变范围较广。白细胞总数增高不明显,而血清白蛋白及PO2降低明显,痰病原菌的阳性率也明显高于非高龄组。结论重视高龄CAP的不典型临床症状及特点,对高龄CAP患者做到早诊断、早治疗,合理使用抗生素及营养支持等综合治疗是提高治愈率的关键。