Miller-Fisher综合征7例临床分析

目的分析Miller—Fisher综合征的临床特点。方法回顾性分析7例Miller-Fisher综合征患者的临床资料。结果临床分析发现7例Miller—Fisher综合征患者均具有眼外肌麻痹、共济失调、腱反射减弱或消失三联征，脑脊液蛋白细胞分离是该病的特征性表现；肌电图呈神经源性损害，传导速度减慢，F波潜伏期延长；CT和MRI检查均未见明显异常。5例同时使用免疫球蛋白和甲基强的松龙治疗，1例使用免疫球蛋白治疗，1例接受甲基强的松龙治疗。出院后随访3～6个月，6例痊愈。结论Miller-Fisher综合征主要累及周围神经系统，免疫球蛋白和激素治疗有效，且预后良好。     

副肿瘤性小脑变性二例

副肿瘤性小脑变性(paraneoplastic cerebellar degeneration,PCD)是一种与肿瘤相关,但原因并不十分明确的非转移性小脑病变,临床病例少见.我院收治2例,现报告如下.     

Genetical Study of Mutation in Maternal-fetal ABO Incompatibility

This study looked into a family involving a rare mother-child ABO blood type inconsistency and explored its genetic and molecular basis. In the family, the mother had type AB blood and the father was blood type B and they gave birth to a baby of blood type O. Their blood types were phenotypically identified by using different techniques, including micro-column gel test, immune inhibition test, absorption and elution tests. The sequences of all 7 exons of ABO allele from the core family members were determined by using PCR and clone-based sequencing. The loci of mutated gene were compared against normal human genes. The result showed that the mother’s erythrocytes were agglutinable with monoclonal anti-A antibody(2+) and had agglutination reaction with anti-B antibody(4+). The mother’s serum registered agglutination action with standard blood type A cells. The findings showed an ABO inconsistency. When domestic antibodies were used, the mother’s erythrocytes yielded agglutination reaction with humanized anti-B serum(4+) and anti-B monoclonal antibody but were non-agglutinable with humanized anti-A serum and anti-A monoclonal antibody. Upon absorption and elution, the titer of anit-A antibody was 128 both before and after the absorption test, with no significant difference found between pre- and post-absorption values. Our results confirmed that the mother’s allelic gene was type B and contained type A. The father’s blood type was type B, and son’s blood type was type O. Clone-based sequencing revealed that the mother carried a heterozygous gene of B101.01(nt A640→G)/O01, which contained an M214→V mutation that could express a weak expression of antigen A, resulting in blood type AB. However, their son did not have the M214→V mutation, which yielded a false ABO-inconsistency between him and his mother. We were led to conclude that type B gene with a M214→V mutation can encode both antigen B and weak antigen B that can lead to false ABO-inconsistencies.     

动脉瘤性蛛网膜下腔出血早期认知功能减退的临床研究

目的观察动脉瘤性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者早期认知功能减退的发生率并探讨其发生的危险因素。方法回顾性分析2016年1月至2020年8月在福建省立医院就诊的195例动脉瘤性SAH并急诊行血管内介入栓塞治疗患者的临床资料,按照术后2周简易精神状态检查(Mini-Mental State Examination,MMSE)评定结果,分为认知功能减退组(n=40)与认知功能正常组(n=155),比较两组患者性别、年龄、高血压、糖尿病、吸烟、血脂、尿酸、肌酐、抽搐表现、心肌损伤、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、格拉斯哥昏迷量表(Glasgow coma scale,GCS)、Hunt-Hess分级、术前出血巴罗神经学研究所(Barrow Neurological Institute,BNI)评分、蛛网膜下腔出血早期脑水肿评分(Subarachnoid hemorrhage early brain edema scale,SEBES)、术前脑积水、术前改良Rankin评分(modified Rankin scale,mRS)、动脉瘤位置、动脉瘤大小、介入栓塞手术方式、是否脑脊液引流、合并甲状腺机能低下、脑血管痉挛、迟发性脑梗死等指标并进行比较,应用单因素、多因素Logistic 回归分析蛛网膜下腔出血出现早期认知功能下降的危险性因素。结果单因素分析显示:认知功能减退组患者年龄、尿酸、肌酐水平高于认知功能正常组,差异有统计学意义(P<0.05)。与认知功能正常组相比,认知功能减退组在合并hs-CRP升高、抽搐、肌钙蛋白升高等临床表现、脑功能损伤评分高(Hunt-Hess分级≥3级、GCS评分≥8分、术前出血BNI评分≥3分、早期脑水肿SEBES评分≥3分)、出现围手术期并发症(术前脑积水、术前mRS评分>3分、脑血管痉挛、合并迟发性脑梗死)方面可能性更高,差异有统计学意义(P<0.05)。多因素分析示高龄(OR=7.990,95%CI:1.021~1.121,P=0.005)、高尿酸(OR=4.059,95%CI:1.000~1.011,P=0.044)、早期脑水肿SEBES评分高(OR=7.072,95%CI:2.344~277.908,P=0.008)、术后超声经颅多普勒超声(transcranial Doppler,TCD)提示脑血管痉挛(OR=8.064,95%CI:2.100~57.244,P=0.005)、合并迟发性脑梗死(OR=5.118,95%CI:1.173~9.238,P=0.024)是动脉瘤性SAH行介入栓塞术后发生早期认知功能下降的独立危险因素。结论建议对aSAH合并高龄、高尿酸、脑水肿严重、继发脑血管痉挛及迟发性脑梗死的患者进行动态的神经心理学评估,早期识别认知功能减退并积极干预。     

微柱凝胶法检测孕妇IgG抗体效价的意义

新生儿溶血病（HDN）是由母体内存在的与其胎儿红细胞不合的IgG血型抗体而引起的同种被动免疫疾病。最常见的是ABO血型系统溶血。孕妇IgG抗体的效价能够对HDN的发生、发展提供早期辅助诊断的依据而具有重要的临床意义。微柱凝胶技术是一种新的血型血清技术，因此本文应用微柱凝胶法检测孕妇IgG抗A（B）抗体效价，现报告如下。     

68例肺癌合并肺结核回顾性临床分析

目的探讨肺癌合并肺结核的临床特点,提高肺癌合并肺结核的临床早期诊断率。方法回顾性总结和分析68例肺癌合并肺结核患者的临床资料。结果 68例肺癌合并肺结核患者,男性多于女性,大于60岁49例,占72.1%。癌灶与结核灶同侧同叶41例,占60.3%;同侧不同叶18例,占26.5%;不同侧9例,占13.2%。肺癌合并肺结核以腺癌最多31例(45.6%),其次为鳞癌20例(29.4%),未分化癌8例(11.8%),支气管肺泡癌6例(8.8%),腺鳞癌3例(4.4%)。结论肺癌与肺结核间存在密切关系,二者合并时易漏诊、误诊。掌握肺癌的早期症状及其相关影像学特征,必要时做纤支镜、肺部CT或CRI等检查,可显著提高早期诊断率,延长患者生存期。     

体检人群高尿酸血症患病情况及影响因素分析

目的:了解深圳市南山医院体检人群血尿酸水平及高尿酸血症患病率,并对高尿酸血症的相关因素进行分析。方法:选择2014年体检者2 900人作为研究对象,计算高尿酸血症患病情况,并应用logistic回归模型分析其相关影响因素。结果:男性血尿酸水平（354.6±83.8）μmol/L,明显高于女性的（267.3±61.1）μmol/L（P<0.01）;男性中高尿酸血症患病率为19.3%,显著高于女性的11.4%（P<0.01）。经logistic回归分析,年龄、男性、肥胖、高血压和高三酰甘油均为高尿酸血症的危险因素（P<0.05）。结论:深圳市南山医院体检人群血清尿酸水平偏高,年龄、男性、肥胖、高血压和高三酰甘油是高尿酸血症的危险因素。     

氟哌噻吨美利曲辛治疗非小细胞肺癌患者合并抑郁状态的临床研究

目的观察氟哌噻吨美利曲辛治疗非小细胞肺癌（NSCLC）患者合并抑郁状态的临床效果。方法选择NSCLC合并抑郁状态患者76例,随机分为对照组和氟哌噻吨美利曲辛组,各38例,两组均给予NP方案化疗。化疗当日,对照组于早餐后半小时口服维生素C0.2g（2片）;氟哌噻吨美利曲辛组于早餐后半小时口服氟哌噻吨美利曲辛（每片含氟哌噻吨0.5mg,美利曲辛10mg）2片。分别于治疗前及治疗第21、42天应用Zung抑郁自评量表（SDS）、中国癌症患者化学生物治疗生活质量量表（QLQ-CCC）、卡氏功能状态量表（KPS）评定患者抑郁状态及生活质量。结果治疗前两组SDS、QLQ-CCC、KPS评分差异无统计学意义,具有可比性（P〉0.05）。治疗第21、42天,氟哌噻吨美利曲辛组与对照组相比,SDS评分均明显降低（P〈0.01）;治疗第42天,QLQ-CCC各项评分及KPS评分明显升高（P〈0.05）。结论氟哌噻吨美利曲辛可显著改善NSCLC患者的抑郁状态,提高患者的生活质量。