目的：探討無肌病性皮肌炎的臨床特點。方法：回顧性分析符合Euwer提出的ADM診斷標準的5例患者的臨床資料，包括臨床癥狀體征、肌酶譜、肌電圖、肌肉病理檢查、胸部影像學檢查、治療方案。結果：所有患者均先后出現皮肌炎典型皮損，無肌痛或肌無力等主訴，肌酶譜、肌電圖均正常。2例抗核抗體陽性，3例有肌活檢非特異性改變，1例合并間質性肺炎，無患者合并惡性腫瘤。結論：皮肌炎是一種復雜的綜合征，需要行全身系統檢查，結合肌電圖和肌肉病理檢查進行綜合診斷。
目的 探討不同診斷或分類標準在脊柱關節病患者之間診斷效能、臨床特點。 方法 收集2000年2月－2012年8月141例脊柱關節病患者及197例類風濕關節炎、未分化關節炎患者資料。采用3種診斷標準下對141例患者分為紐約標準（NY）組、歐洲脊柱關節病研究（ESSG）組及脊柱關節病國際評估（ASAS）組，統計患者的臨床表現、骶髂關節CT、MRI、實驗室指標，并加入197例類風濕關節炎未分化關節炎患者，計算和比較3種診斷的敏感性、特異性。 結果 在141例脊柱關節病中，62例符合NY標準，34例符合ESSG標準，45例只符合ASAS標準。3組患者在性別、胸廓受限、附著點炎及跖（指）炎、非甾體抗炎藥及慢作用藥使用、炎癥因子水平方面差異無統計學意義（P＞0.05）；ASAS組則較19 NY組及ESSG組患者更年輕、病程較短，且表現有外周關節炎明顯高于其余兩組（P＜0.05）；NY組炎性腰背痛、脊柱活動受限、HLA-B27陽性率明顯高于其余兩組，且使用生物制劑比例最高，達48.38；在骨盆X線、骶髂關節CT表現關節侵蝕上，NY組較其他兩組更嚴重。NY、ESSG、ASAS分類標準敏感性依次為43.97%、47.51%、73.76%，特異性依次為100.00%、90.86%、84.26%。 結論 ASAS分類標準敏感性高，患者更年輕、病程更短，炎性腰背痛、外周關節炎是ASAS診斷中非常重要的指標；NY組脊柱活動受限及關節侵蝕最顯著，HLA-B27陽性可能是預測AS很好的指標。NY標準特異性最高，敏感性最低，而ASAS標準敏感性最高，特異性最低。
【摘要】 目的 提高對系統性紅斑狼瘡(SLE)并發急腹癥(AA)臨床復雜性的認識,總結診治經驗。方法 對2008年以來收治20例系統性紅斑狼瘡并發急腹癥的患者進行回顧性分析,并復習近9年相關文獻。結果 系統性紅斑狼瘡住院患者中并發急腹癥發生率2.56％；急腹癥多數(80%)與系統性紅斑狼瘡病情活動相關,也可能由獨立于系統性紅斑狼瘡的其他疾病引起(20%),病情復雜,容易誤診。腹部CT尤其是增強CT檢查對確定系統性紅斑狼瘡相關急腹癥病因有重要作用。結論 系統性紅斑狼瘡活動是系統性紅斑狼瘡并發急腹癥最主要的原因,SLEDAI評分在系統性紅斑狼瘡并發急腹癥鑒別診斷中有一定作用。及時診斷、正確治療后,系統性紅斑狼瘡活動相關急腹癥患者的預后較好。
Objective To verify the predictive value of Sino System for Coronary Operative Risk Evaluation（SinoSCORE） on quality of life in patients undergoing coronary artery bypass graft （CABG） surgery. Method A total of 234 patients in Peking University People’s Hospital undergoing CABG between November 2008 and September 2010 hadcompleted the preoperative and 6-month postoperative Short Form-36 （SF-36）. There were 172 （73.5%） male patients and63 （26.5%） female patients. The average age was 63.0±10.1 years. According to the SinoSCORE， 234 patients were dividedinto three groups：low risk （SinoSCORE score less than 1 point，n=67）， medium risk （SinoSCORE score 2-5 points，n=77） and high risk （SinoSCORE score more than 6 points，n=90） group. Clinical information of the 234 patients was collected， andthe score values of all patients were calculated according to the SinoSCORE model. Statistic methods were performed toevaluate the relationship between quality of life and SinoSCORE. Results The postoperative quality of life have improvedsignificantly， but the improvement of quality of life have no significantly different between groups. There was statisticallysignificant correlation between quality of life and SinoSCORE （P＜0.05， r value at-0.150 to 0.255）.Linear regression analysis showed that SinoSCORE was significantly collected with quality of life in multiple subgroups （P＜0.05， r 2＜0.1） .Conclusion SinoSCORE have statistically correlated with quality of life， and have certain but limited predictive value on quality of life in CABG patients.
Objective To research the transfer of adenovirus human bone morphogenetic protein 4 (Ad-hBMP-4) to human degenerative lumbar intervertebral disc cells in vitro and analyze its effect on the proteoglycan, collagen type II, and Sox9 of intervertebral disc cells. Methods Identified Ad-hBMP-4 was amplified and detected. Degenerative lumbar intervertebral disc cells were aspirated from the degenerative lumbar intervertebral disc of patients with Modic III level disc protrusion (aged, 27-50 years). The expressing position of collagen type II was identified in the intervertebral disc cells through the laser confocal microscope. The intervertebral disc cells at passage 1 were transfected with Ad-hBMP-4 as experimental group. After 3 and 6 days of transfection, RT-PCR was used to detect the mRNA expressions of proteoglycan, collagen type II, and Sox9, and Western blot to detect the expressions of proteoglycan and collagen type II proteins. Non-transfected cells at passage 1 served as control group. Results The virus titer of Ad-hBMP-4 was 5 × 106 PFU/mL. No morphological changes in the cells after transfection by Ad-hBMP-4. Collagen type II mainly expressed in the cell cytoplasm. The mRNA expressions of the proteoglycan, collagen type II, and Sox9 in experimental group at 3 and 6 days after transfection were significantly higher than those in control group by RT-PCR (P lt; 0.05), and the expressions of proteoglycan and collagen type II proteins were significantly higher than those in contorl group by Western blot (P lt; 0.05). There were significant differences between 3 days and 6 days in experimental group (P lt; 0.05). Conclusion Ad-hBMP-4 could transfect human degenerative lumbar intervertebral cells with high efficiency and promote collagen type II, proteoglycan, and Sox9 expressions. hBMP-4 may play an important role in the repair process during early disc degeneration.
Objective To evaluate the results of open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. Methods From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 caseswere extremely serious (less than 30° extension-flexion arc) and 18 cases were serious (30-60° extension-flexion arc). The range of motion of the elbow stiffness was (32.5 ± 28.9)° and the Mayo score was 51.9±13.1 before operation. All initial fractures were healed according to cl inical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Results Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instabil ity and debil itating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 ± 14.4 and the range of motion of elbow stiffness was (108.8 ± 36.0)°; showing significant differences when compared with preoperation (P lt; 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrol ysis. Conclusion Open elbow arthrolysis and postoperative rehabil itation for patients with elbow stiffness can improve joint function and ensure the stabil ity of elbows.