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吸入激素在支气管扩张症中的应用

支气管扩张症(简称支扩)是以进行性和不可逆性气道破坏和扩张为特征的慢性气道炎症性疾病[1]，大多表现为长期咳嗽、咳脓性痰，反复急性发作，肺功能受损，后者主要表现为阻塞性通气功能障碍，气道反应性增高，晚期患者常常出现劳力性呼吸困难，严重影响患者生活质量[2,3] 。大部分支扩患者第1秒用力呼气容积(FEV )每年下降大约50mL [4] 。在我国支扩的发病率为0.3‰～0.5‰。2005年美国成人支扩发病率约为52．3／100 000。发病率随年龄而增加，在所有年龄阶段女性发病率均较男性高，预计在美国有18岁以上的支扩患者110 000例，每年医疗费用约6．3亿美元[5]。

阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血浆同型半胱氨酸的变化

目的 探讨同型半胱氨酸( HCY) 在OSAHS 合并高血压发病中的作用。方法 检测22例OSAHS 合并高血压患者、20 例OSAHS不伴高血压患者血浆HCY 水平, 并与对照组比较, 将检测结果与睡眠呼吸监测( PSG) 指标进行相关性分析。PSG 监测指标包括呼吸暂停低通气指数( AHI) 、血氧饱和度小于90% 占总睡眠时间百分比( SLT90% ) 、最低血氧饱和度( LSaO2 ) 、平均血氧饱和度( MSaO2 ) 、觉醒指数( AI) 、睡眠呼吸暂停最长时间( LAT) 。结果 OSAHS 不伴高血压患者血浆HCY明显高于对照组[ ( 18. 28 ±6. 80) μmol /L 比( 6. 32 ±3. 95) μmol /L, P lt;0. 01] , OSAHS 合并高血压组与OSAHS 不伴高血压组比较血浆HCY 进一步升高[ ( 23. 83 ±5. 90) μmol /L 比( 18. 28 ±6. 80) μmol /L, P lt;0. 01] 。血浆HCY 水平与OSAHS 不伴高血压组及OSAHS 合并高血压组的AHI、SLT90% 均呈正相关( P 均lt;0.01) , 与LSaO2、MSaO2 均呈负相关( P 均lt;0. 01) 。结论 HCY 参与了OSAHS 的病理生理过程, 在OSAHS 合并高血压患者发病中起一定作用。

Changes and Implications of Plasma Neuropeptide Y Level in Patientswith Obstructive Sleep Apnea-Hypopnea Syndrome

Objective To investigate the role of plasma neuropeptide Y ( NPY) level in obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods The patients underwent polysomnography ( PSG)monitoring in the sleep disorder center of Zhongda Hospital from January 2008 to December 2009 were analyzed. Plasma NPY levels were compared between different groups allocated according to apnea-hypopnea index ( AHI) and body mass index ( BMI) . Plasma NPY levels were measured by enzyme-linked immunoassay. Results The plasmaNPY levels in the severe and moderate OSAHS groups were significantly higher than the groups withoutOSAHS of the same weight degree ( P lt;0. 05) . The plasmaNPY levels in the severe OSAHS groups were significantly higher than the groups with mild and moderate OSAHS of the sameweight degree. In the severe OSAHS patients, the plasma NPY level of the obese group was significantly higher than the overweight group and the normal weight group( P lt;0. 05) . In the non-OSAHS and mild to moderate OSAHS patients, there was no significant difference among different groups of weight ( P gt;0. 05) .Plasma NPY level in the OSAHS patients was correlated positively with AHI ( r =0. 667, P lt;0. 05) and BMI( r =0. 265, P lt;0. 05) , but negatively with LSaO2 ( r = - 0. 523, P lt; 0. 05) and MSaO2 ( r = - 0. 422, P lt;0. 05) . Conclusion Plasma NPY level is correlated with OSAHS, and increases with the severity of OSAHS. Plasma NPY level has no correlation with obesity.

Clinical Significance of Serum A-FABP in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Objective To investigate the relationship between adipocyte fatty acid binding protein ( A-FABP) and obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 120 patients were recruited and underwent polysomnography. The groups were allocated according severity of OSAHS and obesity. Plasma A-FABP ( ng/mL) levels were measured by ELISA. The associations between A-FABP and AHI, BMI, LSaO2 , MSaO2 , neck collar, waist /hip ratio, insulin resistance index were analyzed. Results Plasma A-FAPB levels were significantly higher in the OSAHS group than in the non-OSAHS group of same weight, independent of age and gender. In the non-OSAHS group and the severe OSAHS group, plasma A-FABP levels of obesity persons were significantly higher than those without obesity, independent of age and gender. Plasma A-FAPB level was positively correlated with AHI, BMI, insulin resistance index, neck collar, SLT90% , and waist/hip ratio, but negatevely correlated with LSaO2 and MSaO2 in the OSAHS group. In the non-OSAHS group, plasma A-FAPB level was positively correlated with BMI and insulin resistance index. Conclusions Plasma A-FABP level is higher in patients with severe OSAHS. Plasma A-FABP level is positively correlated with BMI and insulin resistance index both in OSAHS and non-OSAHS patients.

卵黄管瘘并脐尿管瘘致粘连性肠梗阻1例报道

患者,男,4岁,因“反复脐部红肿痛,流脓5个月,再发3 d并腹胀，哭闹、呕吐”入院……

急性重症胰腺炎的早期诊断及手术时机选择（附93例报告）

虫类药物在临床中的应用

虫类药物是动物类中药的重要部分，包括一些昆虫、软体动物、环节动物、节肢动物及小型爬行动物等。这些药物应用于临床据记载已有两千多年历史，早在《神农本草经》中就对虫类药物的各种临床功用作了详细记载。明代《本草纲目》中收载的虫类药物达107种，占动物药（444种）的24%，使虫类药得到很大发展。现就虫类药物在临床中的应用做一综述。

Effects of Cardioselective Beta-Blockers on Respiratory Function in COPD Patients:A Meta-Analysis

Objective To evaluate the effects of cardioselective beta-blockers on respiratory function in patients with chronic obstructive pulmonary disease ( COPD) . Methods We used computer to search the Cochrane Controlled Trials Register database, Medline, Netherlands EMBASE/Excerpta Medica,EBSCO database, China Academic Journal and the Chinese Biomedical Literature Database, as well as respiratory magazines and conference abstracts, without language restrictions. The information was retrieved until December 2011. We collected all the randomized, blinded, controlled clinical trails ( RCTs ) of cardioselective beta-blockers on respiratory function in patients with COPD. Then two evaluators evaluated the quality of RCTs according to the Cochrane Review Manual 4. 2 independently. Meta-analysis was performed using statistical software Stata 11. 0. X2 test was used to analyze their heterogeneity. Standardizedmean difference ( SMD) was used to describe continuous variables. Relative risk degree ( RR) was used to describe categorical variables, and 95% CI was used to describe treatment effect. Results 22 trails met the selection criteria. Meta-analysis showed no change of FEV1 in COPD patients after taking single dose of cardioselective beta-blockers [ SMD - 0. 367, 95% CI( - 0. 786, 0. 052) ] and no respiratory symptoms aggravation [ RR1. 000, 95% CI( 0. 848, 1. 179) ] . Meta-analysis also showed no change of FEV1 in COPD patients who received long-term cardioselective beta-blockers treatment [ SMD - 0. 236, 95% CI( - 0. 523,0.051) ] , and no respiratory symptoms aggravation [ RR 1. 000, 95% CI ( 0. 830, 1. 205) ] . Inhaled beta-2 agonists showed no effect on FEV1 in COPD patients after either long-term administration [ SMD - 0. 200,95% CI( - 0. 586, 0. 187) ] or single dose administration of cardioselective beta-blockers [ SMD - 0. 078,95% CI( - 0. 654, 0. 497) ] . Conclusion Cardioselective beta-blockers, given to patients with COPD in conditions such as heart failure, coronary artery disease and hypertension in the identified studies did not produce adverse respiratory effects.

Clinical Analysis of Patients with Sever Influenza H1N1 in Xinjiang Region

Objective To investigate the clinical characteristics of patients with sever H1N1 influenza in Xinjiang region, and analyze risk factors related to patients’prognosis. Methods 63 patients with severe H1N1 influenza from September 2009 to December 2009, who came from five general hospitals and contagious disease hospitals were retrospectively studied. Data of baseline characteristics, treatment, and outcomes were collected. Results Among the 63 cases of severe H1N1 influenza patients, 46 patients survived, in which 30 cases were complicated with pneumonia( 63. 8% ) , 10 cases with MODS ( 43. 48% ) ;26 were male,20 were female; the median age was ( 28. 48 ±19. 59) years old.17 patients died, in which 11 were male, 6 were female; the median age was ( 39. 47 ±21. 23) years old. There were no significantdifferences in white blood cells, neutrophils, granulocytes, lymphocytes, Hb, platelets, CK-MB, HB, DH, UN,APTT, INR, K+ , Na+ , Cl - , PaO2 , SaO2 between the survival patients and the died patients ( P gt; 0. 05) .However there were significant differences in AST, ALT, CK, LDH, AL, CR, and pH ( P lt; 0. 05) .Conclusions Most of the patients with sever H1N1 influenza are young. The typical clinical manifestations are fever, cough, and expectoration. The patients usually are complicated with pneumonia. The patients complicated with MODS have a higher risk of death. Early administration of effective antiviral agents, low dose corticosteroids, and reasonable mechanical ventilation may improve the prognosis.