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1.
目的:探讨普外科患者术后切口感染的病原菌分布情况及影响因素。方法:回顾性分析2017年9月-2019年1月河北省秦皇岛市第一医院普通外科一病区接受手术治疗的150例患者的临床资料,术后发生切口感染的75例患者作为感染组,术后未发生切口感染的75例患者作为对照组,分析术后切口感染的病原菌分布情况,并比较两组患者的临床资料,对普外科患者术后切口感染的影响因素进行多因素Logistic回归分析。结果:感染组分离出病原菌75株,包括43株革兰阴性菌(57.33%)、28株革兰阳性菌(27.33%)、4株真菌(5.33%),经单因素分析显示,年龄、手术时间、有无合并糖尿病、有无植入性器械、住院时间与普外科患者术后切口感染有关(P0.05);经多因素Logistic分析显示,年龄≥60岁、合并糖尿病、手术时间≥2 h、有植入性器械、住院时间≥1月为普外科患者术后切口感染的独立危险因素(P0.05)。结论:普外科患者术后切口感染病原菌株以革兰阴性菌和革兰阳性菌为主,针对术后切口感染的危险因素实施干预措施,可以降低术后切口感染率,保证患者手术效果和改善预后。  相似文献   

2.
目的:探究消化性溃疡患者胃大部切除术后发生残胃癌的危险因素,并提出相应干预措施。方法:选取我院收治的行胃大部切除术治疗后的消化性溃疡患者180例作为研究对象,将其随机分为两组,每组90例。对照组给予常规干预,观察组给予综合干预,观察两组的干预效果,同时将发生残胃癌患者与未发生残胃癌患者各项资料进行对比,分析影响残胃癌发生的危险因素。结果:观察组中没有患者发生残胃癌,对照组中有10例患者发生残胃癌,发生率为11.11%,显著高于观察组(P0.05);两组患者在首次手术年龄、性别、HP感染上进行对比差异无统计学意义(P0.05);两组患者在首次手术吻合方式、首次手术溃疡位置上对比具有统计学意义(P0.05),残胃癌组组采用毕Ⅰ式2例,毕Ⅱ式7例,Roux-Y式1例;未发生残胃癌组采用毕Ⅰ式82例,毕Ⅱ式74例,Roux-Y式14例,残胃癌组首次手术溃疡位置以十二指肠球部为主,未发生残胃癌组以十二指肠球部、胃体部为主;Logistics回归分析结果证实首次手术吻合方式、首次手术溃疡位置属于残胃癌发生的主要危险因素。结论:术后残胃癌发生危险因素包括首次手术吻合方式、首次手术溃疡位置,同时相关并发症的发生同样会增加术后残胃癌发生风险,应加强引流管干预、并发症干预,并将此作为基础制定综合干预方案。  相似文献   

3.
目的:分析肝硬化合并肺部感染的病原菌分布及危险因素。方法:选取2013年2月到2018年7月期间我院接受治疗的肝硬化患者518例,统计所有患者中并发肺部感染的例数,收集患者的临床资料,包括性别、年龄、病因、住院时间、是否有侵入性操作、是否有腹水、Child-Pugh分级、是否有上消化道出血、是否有合并基础疾病等临床资料,分析肺部感染与患者的各项临床资料的关系,并检测肝硬化合并肺部感染的病原菌分布情况,采用多因素Logistic回归分析肝硬化患者发生肺部感染的危险因素。结果:518例肝硬化患者中有80例发生肺部感染,发生率为15.44%。单因素分析显示,性别与肝硬化患者发生肺部感染无关(P0.05),年龄、病因、住院时间、侵入性操作、腹水、Child-Pugh分级、上消化道出血、合并基础疾病均是肝硬化患者发生肺部感染的影响因素(P0.05)。多因素Logistic回归分析显示,年龄芏60岁、住院时间芏2周、有侵入性操作、有腹水、Child-Pugh分级为C级、有上消化道出血、合并基础疾病均是肝硬化患者发生肺部感染的危险因素(P0.05)。80例肝硬化患者合并肺部感染患者的痰液标本中共检出病原菌93株,其中革兰阴性菌51株,占比54.84%,革兰阳性菌37株,占比39.78%,真菌5株,占比5.38%。结论:肝硬化合并肺部感染的主要病原菌为革兰阳性菌和革兰阴性菌,且肺部感染的危险因素较多,临床上应根据其危险因素做好相对应的防治措施,以减少肺部感染的发生。  相似文献   

4.
目的:分析肝部分切除术治疗肝内胆管结石患者术后并发症及影响因素。方法:选取我院收治的肝内胆管结石患者117例,均采取肝部分切除术治疗,对其临床资料进行回顾性分析,研究术后并发症的发生情况,并对影响因素进行分析。结果:本组117例患者,并发症发生率35.04%,其中肝功能衰竭1例,胆道出血2例,消化道出血6例,腹腔感染6例,胆瘘6例,胸腔积液8例,切口感染12例。并发症组患者术前白蛋白、手术时间、既往胆道手术史水平与非并发症组比较,差异均有统计学意义(P0.05)。肝部分切除术后的并发症多因素Logistic回归分析结果显示,手术时间、既往胆道手术史均是术后并发症独立风险因素。结论:肝部分切除术治疗肝内胆管结石患者术后并发症发生率较高,以切口感染和胸腔积液为最,患者的既往手术史以及手术时间均是影响并发症发生的重要危险因素,做好针对性预防可预防并发症的发生。  相似文献   

5.
目的调查妇科肿瘤患者术后盆腔感染的情况以及病原菌分布,并探讨术后发生盆腔感染的危险因素。方法回顾性分析自2013年1月到2017年1月在东南大学附属中大医院接受妇科肿瘤手术治疗的384例患者的临床资料。统计妇科肿瘤术后盆腔感染的发生率及病原菌的分布情况。将发生盆腔感染的患者分为感染组,未发生盆腔感染的患者分为未感染组,对比两组的临床资料,并通过多因素Logistic回归分析,归纳妇科肿瘤患者术后发生盆腔感染的危险因素。结果术后发生盆腔感染41例,感染率为10.68%,培养出病原菌54株,其中革兰阳性菌14株,占25.93%,革兰阴性菌35株,占64.81%,真菌5株,占9.26%。感染组患者年龄60岁的比例、手术持续时间2h的比例、合并慢性基础疾病的比例、开放手术的比例、术前化疗的比例、术后留置引流管的比例和术后卧床时间7d的比例均显著高于未感染组(均P0.05);多因素Logistic回归分析结果显示,年龄大、手术持续时间长、合并慢性基础疾病、开放手术、术前化疗、术后留置引流管、术后卧床时间长均是妇科肿瘤患者术后盆腔感染的危险因素(均P0.05)。结论妇科肿瘤患者术后较容易并发盆腔感染,病原菌主要为革兰阴性菌。多种因素可增加术后盆腔感染的风险,临床应加强防控措施,降低妇科肿瘤患者术后盆腔感染的发生率。  相似文献   

6.
目的:对比分析完全腹腔镜与开腹脾切除加贲门周围血管离断术治疗肝硬化门脉高压症的手术治疗效果。方法:120例研究对象均来自于2012年1月-2013年12月第四军医大学唐都医院普外科收治的肝硬化门静脉高压患者,将所有患者分为观察组与对照组,每组60例。两组患者均给予脾切除加贲门周围血管离断术,观察组在腹腔镜下操作完成,对照组传统开腹完成手术。比较两组患者术中出血量、手术及住院时间、胃肠道功能恢复时间及并发症发生情况。结果:120例患者均按分组要求顺利完成手术,手术时间比较无统计学差异(P0.05);观察组术中出血量、术后住院时间及胃肠道恢复排气时间均优于对照组(P0.05);术后发热、切口感染、腹腔出血积液及门静脉系统血栓等为术后常见并发症,观察组术后并发症发生率低于对照组(P0.05)。结论:腹腔镜下脾切除+贲门周期血管离断术治疗门静脉高压症临床效果显著,安全性高,患者术后恢复快。  相似文献   

7.
目的: 对在手术室中进行手术治疗患者采用全期护理干预的效果进行分析。方法: 选取2010年11月—2013年6月在我院进行手术治疗的患者201例,随机分为两组患者,常规组患者100例,采用常规护理干预措施,全期护理组患者101例,在常规手术基础上进行手术全期护理干预措施,对比两组患者的护理效果。结果: 全期护理组患者的平均手术时间、住院治疗时间、术后患者护理满意度、合并症发生率显著优越于常规护理组患者,差异性显著,具有统计学意义(P<0.05)。两组患者均未发生因护理干预措施导致严重不良后果发生。结论: 针对手术患者在常规护理干预措施基础上应用手术全期干预措施,可显著缩短平均手术时间、住院治疗时间;显著提高患者术后满意度,降低术中并发症发生,安全性较高,适宜针对手术患者广泛应用和开展。  相似文献   

8.
李彩连 《蛇志》2017,(2):202-203
目的分析腹腔镜下小儿疝气手术的护理干预方法及效果。方法选取2015年6月~2016年5月我院收治的98例腹腔镜下小儿疝气手术患者为研究对象,随机分为观察组和对照组各49例。对照组给予常规护理干预,观察组给予针对性护理干预,观察比较两组治疗效果及并发症发生情况。结果观察组患儿的下床活动时间、住院时间与术后疼痛水平均优于对照组,组间差异具有统计学意义(P0.05);观察组患儿术后牵拉疼痛、尿潴留与切口感染等并发症发生率低于对照组,差异具有统计学意义(P0.05)。结论腹腔镜下小儿疝气手术配合针对性护理干预有助于促进病情恢复、预防并发症的发生,具有较高的临床应用价值。  相似文献   

9.
目的:分析流产术后并发宫腔粘连的危险因素,并探讨宫腔镜联合雌孕激素对宫腔粘连的干预效果,以期为宫腔粘连的防治提供依据。方法:选取2016年1月至2017年2月于我院接受流产术后并发宫腔粘连的患者100例作为粘连组,另选取同期于我院接受流产术后未发生宫腔粘连的患者100例作为未粘连组。比较粘连组和未粘连组患者基本资料、既往史情况、手术指标,并采用多因素Logistic回归分析流产术后并发宫腔粘连的危险因素。进一步将粘连组按照随机数字表法分成对照组(n=50)和观察组(n=50),对照组患者进行雌孕激素治疗,观察组患者进行宫腔镜联合雌孕激素治疗。比较观察组与对照组患者治疗3个周期后首次月经情况以及临床疗效。结果:粘连组孕次、产次、吸宫时负压、吸宫时间以及合并盆腔炎时间均高于未粘连组,差异均有统计学意义(P0.05)。经多因素Logistic回归分析可得,吸宫时负压≧500 mm Hg、吸宫时间≧15 min为流产术后并发宫腔粘连的危险因素(P0.05)。观察组治疗3个周期后首次月经量减少发生率、首次月经中期子宫内膜厚度≤8 mm发生率低于对照组,治疗有效率高于对照组(P0.05)。结论:吸宫时负压≧500 mm Hg、吸宫时间≧15 min均属于流产术后并发宫腔粘连的独立危险因素,临床应根据以上危险因素采取相应预防措施,以减少宫腔粘连的发生。而对于已发生宫腔粘连的患者,采用宫腔镜联合雌孕激素治疗具有较好的干预效果,值得在临床上推广应用。  相似文献   

10.
目的:探讨老年冠心病(CHD)患者冠状动脉旁路移植术(CABG)后早期肺部并发症危险因素。方法:收集296例在我院接受CABG的老年冠心病患者(≥60岁)的临床资料,按照术后早期是否出现肺部并发症将患者分为肺部并发症组和非肺并发症组,比较两组一般临床资料及相关围术期指标的差异,利用Logistic回归分析探讨影响早期术后肺部并发症的危险因素。结果:296例CABG手术患者中有52例出现肺部并发症(发生率17.6%);两组在年龄、吸烟、体质量指数(BMI)、术前心功能分级、术前左室射血分数(LEVF)、三支病变、左主干病变、体外循环、体外循环时间、主动脉阻断时间、手术时间、术后24 h输红细胞(RBC)量、术后24 h胸腔引流量、术后24 h平均血糖存在统计学差异(P0.05);年龄(OR=1.137)、BMI(OR=1.636)、术前LEVF(OR=1.733)、左主干病变(OR=1.532)、体外循环(OR=2.134)、术后24 h输RBC量(OR=1.243)、术后24 h平均血糖水平(OR=1.335)是影响术后肺部并发症发生的危险因素(P0.05)。结论:老年冠心病患者CABG术后早期肺部并发症受到多种因素影响,临床中应当重视此类高危因素,以制定相关干预措施降低肺部并发症的发生率。  相似文献   

11.
熊愫兵  李中艳  付静  柴进  张婷  房殿春 《生物磁学》2013,(36):7104-7107
目的:分析失代偿期肝硬化患者感染的相关危险因素和临床特点。方法:回顾性分析我院2012年4月--2013年4月住院的197例肝硬化失代偿期患者,比较感染患者与非感染患者的年龄、性别、肝功能分级、白细胞水平、门静脉内径、肝硬化并发症、侵入性操作措施、应用抗菌药物、住院时间等差异。结果:197例患者中发生感染的56例,其中以呼吸道和腹部感染为主。统计发现肝功能分级、白细胞水平、侵入性操作、住院时间及抗菌药的运用等与感染因素有关(P〈0.05)。结论:引起失代偿期肝硬化感染的危险因素是多方面的,临床特点也较突出,需要我们采取防措施去避免。  相似文献   

12.
摘要 目的:探讨不同病因肝硬化患者临床特征及其预后影响因素。方法:回顾性选择2017年1月至2020年12月来我院诊治的具有完整资料,同时明确诊断为肝硬化,病因为乙肝后肝硬化(78例)、酒精性肝硬化(42例)。分析两组患者的一般资料、并发症发生情况、合并疾病情况,分析乙肝后肝硬化、酒精性肝硬化患者的预后影响因素。结果:两组患者在性别、职业、临床表现(黄疸、黑便、呕血、蜘蛛痣、脾脏增大)、肝脏体积缩小、并发症(上消化道出血、肝性脑病)、合并疾病(脂肪肝、糖尿病、胰腺炎、胆结石)方面有统计学意义(P<0.05)。乙肝后肝硬化组的疾病进展发生率明显较酒精性肝硬化组高(P<0.05)。单因素分析结果表明,临床表现(乏力、食欲减退、皮肤瘙痒、腹痛、腹胀、呕血、黑便、腹水)、Child-Pugh分级、并发症(上消化道出血、肝性脑病)是影响乙肝后肝硬化患者预后的因素(P<0.05);Logistic回归分析结果表明,Child-Pugh分级在B、C级、存在上消化道出血与肝性脑病是影响乙肝后肝硬化患者预后的危险因素(P<0.05)。单因素分析结果表明,临床表现(黄疸)、Child-Pugh分级、并发症(上消化道出血、肝性脑病、感染)是影响酒精性肝硬化患者预后的因素(P<0.05);Logistic回归分析结果表明,Child-Pugh分级为C级、存在上消化道出血肝性脑病、感染是影响酒精性肝硬化患者预后的危险因素(P<0.05)。结论:乙肝后肝硬化与酒精性肝硬化的差异主要体现在性别、职业、临床表现、并发症与合并疾病中,影响乙肝后肝硬化预后的危险因素为Child-Pugh分级在B、C级、存在上消化道出血与肝性脑病,影响酒精性肝硬化预后的危险因素为Child-Pugh分级为C级、存在上消化道出血、肝性脑病、感染,需防治并发症,以改善患者预后。  相似文献   

13.
Hepatic cirrhosis is the end-stage of chronic liver diseases. The majority of patients with hepatic cirrhosis die from life-threatening complications occurring at their earlier ages. Liver transplantation has been the most effective treatment for these patients. Since liver transplantation is critically limited by the shortage of available donor livers, searching for an effective alternative therapy has attracted great interest in preclinical studies. The transplantation of autologous bone marrow-derived mesenchymal stem cells holds great potential for treating hepatic cirrhosis. Mesenchymal stem cells can differentiate to hepatocytes, stimulate the regeneration of endogenous parenchymal cells, and enhance fibrous matrix degradation. Experimental and clinical studies have shown promising beneficial effects. This review is intended to translate the bench study results to the patients' bedside. The potential interventions of mesenchymal stem cells on cirrhosis are illustrated in terms of the cellular and molecular mechanisms of hepatic fibrogenesis.  相似文献   

14.
Primary biliary cirrhosis (PBC) is a cholestatic liver disease characterised by the autoimmune destruction of the small intrahepatic bile ducts. The disease has an unpredictable clinical course, but may progress to fibrosis and cirrhosis. Although medical treatment with urseodeoxycholic acid is largely successful, some patients may progress to liver failure requiring liver transplantation. PBC is characterised by the presence of disease specific anti-mitochondrial (AMA) antibodies, which are pathognomonic for PBC development. The disease demonstrates an overwhelming female preponderance and virtually all women with PBC present in middle age. The reasons for this are unknown; however several environmental and immunological factors may be involved. As the immune systems ages, it become less self tolerant, and mounts a weaker response to pathogens, possibly leading to cross reactivity or molecular mimicry. Some individuals display immunological changes which encourage the development of autoimmune disease. Risk factors implicated in PBC include recurrent urinary tract infection in females, as well as an increased prevalence of reproductive complications. These risk factors may work in concert with and possibly even accelerate, immune system ageing, contributing to PBC development. This review will examine the changes that occur in the immune system with ageing, paying particular attention to those changes which contribute to the development of autoimmune disease with increasing age. The review also discusses risk factors which may account for the increased female predominance of PBC, such as recurrent UTI and oestrogens.  相似文献   

15.
目的:探讨综合性优质护理对肝硬化患者肝功能及生存质量的影响。方法:选择2014年5月-2015年5月在我院接受治疗的100例肝硬化患者为研究对象,根据干预方法不同分为对照组和实验组,每组50例。对照组患者给予常规护理干预,实验组患者在对照组基础上给予综合性优质护理干预。观察并比较两组患者干预前后的肝功能、Child-Pugh评分及生活质量评分的变化情况。结果:干预后,两组患者AST、ALT及Child-Pugh评分均明显低于干预前,且实验组低于对照组,差异均具有统计学意义(P0.05);干预后,两组患者生活质量评分均优于干预前,且实验组优于对照组,差异均具有统计学意义(P0.05)。干预后,两组患者S-AI及SDS评分均显著低于干预前,且实验组显著低于对照组,差异具有统计学意义(P0.05)。结论:综合性优质护理干预能够改善肝硬化患者肝功能,提高生活质量,值得临床推广应用。  相似文献   

16.

Background

Cerebrovascular complications are severe events following orthotopic liver transplantation (OLT). This study aimed to observe the clinical and neuroimaging features and possible risk factors of in-hospital cerebrovascular complications in the patients who underwent OLT.

Patients and methods

We retrospectively reviewed 337 consecutive patients who underwent 358 OLTs. Cerebrovascular complications were determined by clinical and neuroimaging manifestations, and the possible risk factors were analyzed in the patients with intracranial hemorrhage.

Results

Ten of 337 (3.0%) patients developed in-hospital cerebrovascular complications (8 cases experienced intracranial hemorrhage and 2 cases had cerebral infarction), and 6 of them died. The clinical presentations were similar to common stroke, but with rapid deterioration at early stage. The hematomas on brain CT scan were massive, irregular, multifocal and diffuse, and most of them were located at brain lobes and might enlarge or rebleed. Infarcts presented lacunar and multifocal lesions in basal gangliar but with possible hemorrhagic transformation. The patients with intracranial hemorrhage had older age and a more frequency of systemic infection than non-intracranial hemorrhage patients. (P = 0.011 and 0.029, respectively).

Conclusion

Posttransplant cerebrovascular complications have severe impact on outcome of the patients who received OLT. Older age and systemic infection may be the possible risk factors of in-hospital intracranial hemorrhage following OLT.  相似文献   

17.
The study was aimed at analysing the epidemiological structure of patients with liver cirrhosis without HBsAg treated in 1980-1988. There were 231 of such cases in this period of time. The most frequent cause of liver cirrhosis in patients under 60 years of life was chronic alcoholism whereas 40% of the diagnosed liver cirrhosis in older persons was of unclear etiology. Patients complaints, clinical examinations, and results of the laboratory tests were analysed. The course of the disease was more severe in alcohol-produced liver cirrhosis leading to the haemorrhage from esophageal varices in 36%, and coma in 8% of cases. Alcohol-produced liver cirrhosis promoted other complications such as: cancer of the liver, hepato-renal syndrome or encephalopathy. Liver cirrhosis of unclear etiology in the elderly may be a consequence of the prolonged exposition to environmental pollutants. More severe course of alcohol-produced liver cirrhosis may depend on simultaneous action of two harmful factors: alcohol and environmental pollutants.  相似文献   

18.
ABSTRACT: BACKGROUND: Cirrhosis produces variety of symptoms which eventually lead to a negative impact on Health Related Quality of Life (HRQOL). The general aim of this study was to evaluate the magnitude of poor HRQOL and to assess factors related with HRQOL in patients with CLD in Pakistan. FINDINGS: This was a cross sectional study conducted in gastroenterology outpatient clinics of Aga Khan University Hospital, Karachi on adult patients with cirrhosis. In this study chronic liver disease questionnaire (CLDQ) was used to assess HRQOL of these patients and CLDQ score was used as an outcome measure to determine factors related with HRQOL. 273 participants were recruited in the study; 155 (57%) were males. Mean age of participants was 49 [PLUS-MINUS SIGN] 11 years. The most common cause for cirrhosis was viral infection 247(91.5%). Mean Model for End Stage Liver Disease (MELD) score was 12.6 [PLUS-MINUS SIGN] 6.8 and 2/3 of patients 209 (76.6%) had advanced cirrhosis in Child Turcot Pugh (CTP) B or C stage. Poor HRQOL was seen in 187(69%; 95% C.I.: 63%, 74%) of the participants. Mean CLDQ score was 4.36 [PLUS-MINUS SIGN]1.1. Amongst all of the domains, fatigue domain had lower CLDQ score. Hemoglobin (beta = 0.09 [SE = 0.04]), Albumin (beta = 0.32[SE = 0.09]), Diastolic Blood Pressure (DBP) (beta = 0.01[0.005) prior history of decompensation (beta = 0.98[SE = 0.39] were significant factors associated with HRQOL in patients with liver cirrhosis. CONCLUSION: Frequency of poor health related quality of life determined by CLDQ score is high in patients with liver cirrhosis. Hemoglobin, serum albumen, prior history of decompensation (like encephalopathy and upper gastro intestinal bleed), are associated with health related quality of life.  相似文献   

19.
OBJECTIVE--To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN--Nine year retrospective study. SETTING--Cambridge and King''s College Hospital liver transplant programme. SUBJECTS--24 Patients (three women, 21 men) with alcoholic cirrhosis. MAIN OUTCOME MEASURES--Survival, rehabilitation, and clinical and laboratory evidence of a return to harmful drinking after transplantation. RESULTS--15 Patients were selected for transplantation because of repeated admission to hospital for the complications of advanced portal hypertension despite abstinence, and six because they had a hepatocellular carcinoma superimposed on alcoholic cirrhosis. Three patients who were not abstinent received transplants. The one year survival rate was 66%, and of the 18 patients surviving at least three months, 17 had been rehabilitated. In three patients laboratory variables and histological examination of the liver suggested a return to drinking, though they did not admit to taking alcohol. These patients represented the only cases in the series that were not abstinent before transplantation. CONCLUSIONS--The survival and rehabilitation of patients who received transplants for alcoholic cirrhosis compared favourably with those of patients who received transplants for cirrhosis of other aetiology. The criteria for selection for liver transplantation in patients with alcoholic cirrhosis should include recurrent complications related to severe portal hypertension despite maximum medical treatment in addition to a minimum period of six months of abstinence before transplantation.  相似文献   

20.
非酒精性脂肪性肝病(NAFLD)在西方国家较为常见,近年来在我国的发病呈上升趋势,且发展逐渐低龄化。非酒精性脂肪性肝病患者可能因持续性肝损伤而导致纤维化进展,可与慢性病毒性肝炎和酒精性肝病一样发展到终末期肝硬化,并出现肝硬化严重并发症,也有可能发展成肝癌,最终需要肝移植治疗。它严重危害人类的健康,影响人类的生活及生存质量。多因素的发病机制使其愈来愈被人们所重视,研究和了解非酒精性脂肪性肝病的流行病学、发病机制、诊断及治疗方法,对人类非常重要,如果在疾病的早期,也就是单纯性脂肪肝阶段就对疾病进行干预,这样可以取得很好的治疗效果,NAFLD是人类在本世纪需要面对的疾病之一,因此研究它的发病机制及治疗方法是非常必要的。  相似文献   

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