首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 24 毫秒
1.
摘要 目的:探究维持性腹膜透析患者认知功能障碍与营养状况的关系。方法:前瞻性纳入2019年1月至2020年6月在济宁医学院附属医院就诊的172例维持性腹膜透析患者,收集患者一般资料。采用蒙特利尔认知评估量表(MoCA)评估患者的认知功能,根据MoCA评分分为认知功能正常组及认知功能障碍组。采用微型营养评估量表(MNA)评估患者营养状态,以MNA评分分为营养正常组、潜在营养不良组、营养不良组,比较认知功能正常组及认知功能障碍组营养状况占比情况,分析维持性腹膜透析患者认知功能与营养状况的相关性及影响认知功能的相关因素。结果:与认知功能正常组比较,认知功能障碍组患者透析时间明显延长,MNA总分、MoCA总分明显降低(P<0.05)。与认知功能正常组比较,认知功能障碍组患者营养正常者比例明显降低,营养不良者比例明显升高(P<0.05),潜在营养不良者比例有所升高但差异无统计学意义(P>0.05)。经Pearson相关性检验分析显示,维持性腹膜透析患者MoCA总分与MNA总分呈明显正相关(P<0.05)。经Logistic回归分析显示,透析时间(延长)、营养不良均为维持性腹膜透析患者认知功能障碍的危险因素(P<0.05)。结论:维持性腹膜透析认知功能障碍患者营养不良发生率明显升高,且患者认知功能障碍与营养状况具有明显相关性,加强患者的营养状况有助于降低认知功能障碍的发生风险。  相似文献   

2.
Background and objectivePoor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission.Materials and methodsA previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy.ResultsA total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group.ConclusionsThe data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients.  相似文献   

3.
doi: 10.1111/j.1741‐2358.2011.00529.x Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland Introduction: This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. Material and Methods: Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60–69, 70–79, 80–89 and 90–99 years. Results: Seventy‐four per cent of patients were aged over 80 years. The prevalence of ASA‐P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. Conclusions: The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.  相似文献   

4.
目的:分析膳食营养干预联合抗阻力训练治疗老年男性肌少症患者的临床效果。方法:选取200例老年男性肌少症患者作为研究对象,应用随机数字表法将其分为研究组和对照组,每组各100例。对照组患者给予常规营养和运动知识宣教干预,研究组给予膳食营养干预联合抗阻力训练,两组患者均连续干预6个月。检测和比较两组患者干预前后的握力、简短肌肉功能测试(SPPB)评分、日常生活能力(ADL)评分、左心室射血分数(LVEF)、蒙特利尔认知评估量表(MoCA)评分、简易智能状态检查量表(MMSE)评分的变化和认知功能损害的发生率。结果:干预后,研究组患者的握力、SPPB评分、ADL评分、LVEF、MoCA评分、MMSE评分均较干预前明显改善,且均明显优于对照组,差异均有统计学意义(P0.05)。结论:膳食营养干预联合抗阻力训练可以改善老年男性肌少症患者的肌力,提高日常生活能力,增强心肌射血功能,并改善患者的认知功能。  相似文献   

5.
BackgroundThe use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium.MethodsAn ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital. All patients over 80 years-old were included, except re-admissions or those subjected to palliative care. The data collected included sex, age, chronic medication and any recent changes, recent drugs prescribed prior to an episode of delirium, chronic kidney disease, diabetes mellitus, dementia, visual and auditory impairment, and their combination as sensory impairment, previous falls, stroke, brain tumour, and incident and prevalent delirium.ResultsA total of 72 patients were included. Incident delirium was detected in 8.1% of the patients, and prevalent delirium in 40.9%. A statistically significant association was established between anticholinergic drugs and the incident delirium measured by the ARS scale (P=.017). None of the scales was able to establish a significant association with prevalent delirium.ConclusionThe ARS scale was related to new episodes of delirium. All scales were insufficient when it came to establishing an association with prevalent delirium.  相似文献   

6.
BackgroundPrehypertension is a precursor to hypertension status. Psychological distress has been identified earlier among hypertensives; however, there is little evidence for the presumptive relationship between prehypertension and psychological distress.ObjectiveThe study aimed to assess the psychological wellbeing of the Al-Kharj, Saudi Arabia population, using the General Health Questionnaire (GHQ-12) and correlating it with prehypertensive patients in the same population.MethodsA cross-sectional analysis of the population of Al-Kharj, Saudi Arabia, was carried out between January and June of 2016. With an 85 percent response rate, a total of 1016 participants participated in the study. A multiple linear regression analysis was performed to assess the relationship between prehypertension and psychological distress.ResultsThe findings of the adjusted analysis demonstrated that, on average prehypertensive patients were more distressed psychologically than non-hypertensive patients (unstandardized Beta regression coefficient = 3.600; P-value 0.025). Similarly, on average women were found to be more psychologically distressed than men (unstandardized Beta = 1.511, P-value 0.002). Civil workers and unemployed individuals were more psychologically distressed than employed individuals (unstandardized Beta = 1.326, P-value 0.041) while adjusting for the sociodemographic and other variables such as BMI, diabetes status, cholesterol, and smoking status.ConclusionThe current study shows that as compared to normotensive patients, self-rated mental wellbeing and psychological wellbeing are all considerably poorer among prehypertensive patients. To prevent individuals from having negative psychological outcomes and their long-term complications, the Government of Saudi Arabia needs to concentrate on prehypertensive, female, and unemployed individuals. Well-designed longitudinal studies, primarily in Saudi Arabia, are needed in the future to research the cause and impact of poor mental health and prehypertension.  相似文献   

7.
目的:探讨肥厚型心肌病(HCM)患者认知功能障碍的发生及影响因素。方法:收集2018年4月至2019年7月期间空军军医大学第一附属医院超声医学科HCM患者198例。综合北京版蒙特利尔认知评估(MoCA)量表结果及教育程度,判断患者认知功能:文盲且MoCA得分14分、1年≤教育年限≤6年且MoCA得分20分、或教育年限6年且MoCA得分25分为认知功能障碍组(n=37),其余为认知功能正常组(n=161)。比较两组患者一般资料、超声心动图检查结果及认知功能评估结果。采用多因素logistic回归分析筛选HCM患者认知功能障碍的可能危险因素。结果:HCM患者认知功能障碍的发生率为18.7%(37/198)。与认知功能正常组相比,认知功能障碍组HCM患者年龄较大(P0.05),受教育年限较短(P0.05),心功能分级及左心室舒张功能较差(P0.05),激发左心室流出道压差较高(P0.05)。认知功能障碍组HCM患者MoCA得分较低(P0.05),尤其在视空间与执行功能和延迟回忆(P0.05)两项上得分较差。多因素logistic回归分析结果表明,调整年龄(OR=14.435, 95%CI:4.476-46.550; P0.001)和教育年限(OR=5.274, 95%CI:2.024-13.744; P=0.001)后,激发左心室流出道压差(OR=3.844, 95%CI:1.551-9.524; P=0.004)是HCM患者认知功能障碍的独立危险因素。结论:激发左心室流出道压差可以增加HCM患者认知功能障碍的发生风险。  相似文献   

8.
摘要 目的:探讨老年帕金森病(PD)患者睡眠障碍的危险因素,并观察睡眠障碍对认知功能、心理状态和衰弱的影响。方法:选取2018年3月~2021年9月期间中国人民解放军海军青岛特勤疗养中心收治的91例老年PD患者作为研究对象,根据是否存在睡眠障碍将入选的91例患者分为睡眠障碍组(n=56)及非睡眠障碍组(n=35)。采用蒙特利尔认知评估量表(MoCA)评估所有患者的认知功能状况。采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评价患者焦虑、抑郁情况。采用Tilburg衰弱评估量表评估所有患者的衰弱情况。采用多因素Logistic回归分析探讨老年PD患者睡眠障碍的危险因素,并观察睡眠障碍对认知功能、心理状态和衰弱的影响。结果:睡眠障碍组的视空间与执行功能、语言、命名、延迟回忆、注意、抽象、定向评分及总分均低于非睡眠障碍组(P<0.05)。睡眠障碍组的HAMA、HAMD评分均高于非睡眠障碍组(P<0.05)。睡眠障碍组的心理衰弱、躯体衰弱、社会衰弱评分及总分均高于非睡眠障碍组(P<0.05)。多因素Losgistic回归分析结果显示:HAMA评分偏高、多巴丝肼片等效剂量偏高、HAMD评分偏高、Hcy偏高是老年PD患者睡眠障碍的危险因素(P<0.05)。结论:HAMA评分偏高、Hcy偏高、多巴丝肼片等效剂量偏高、HAMD评分偏高是老年PD患者睡眠障碍的危险因素。同时,睡眠障碍可加重老年PD患者的认知功能障碍和衰弱程度,增加抑郁焦虑情绪。  相似文献   

9.
摘要 目的:探究瑞芬太尼联合丙泊酚对躁狂症患者电休克治疗后的再定向时间和认知功能的影响。方法:招募2018年2月至2019年9月在本院就诊的150例躁狂症患者,将患者分为对照组和观察组,各75例。通过简易精神状态检查(MMSE)评分系统比较电休克疗法(ECT)后的认知障碍。通过杨氏躁狂量表(YMRS)评分系统比较躁狂症患者的狂躁严重程度。通过MMSE评分系统比较躁狂症患者ECT后的时间定向能力。通过无创血压和心电图监测患者ECT前后的平均动脉压和心率。结果:两组患者一般资料统计无差异(P>0.05)。观察组术后5小时无障碍率较对照组升高(P<0.05),观察组术后5小时出现严重认知障碍率较对照组降低(P<0.05),中度认知障碍率两组比较无差异(P>0.05)。ECT后5小时和24小时观察组与对照组的YMRS评分比较无差异(P>0.05)。ECT前,观察组时间定向评分与对照组比较无差异(P>0.05),ECT后,观察组时间定向评分较对照组升高(P<0.05)。ECT前和ECT后,观察组的平均动脉压和心率比较无差异(P>0.05)。结论:在接受ECT的躁狂患者中,瑞芬太尼补充丙泊酚诱导麻醉不影响ECT的疗效,并且能减少ECT后认知障碍的发生,缩短重定向时间。  相似文献   

10.
ABSTRACT

Few studies consider the health benefits of pet ownership from a biopsychosocial perspective, and a paucity of studies investigate cat ownership. The current study was designed to determine if psychosocial factors (stress, loneliness, and depression), biological levels of stress and inflammation (salivary cortisol, interleukin-1β, and C-reactive protein [CRP]), and cognitive function were associated with companion cat ownership/attachment in community-dwelling older adults. Community-dwelling older adults (n = 96, mean age = 76.6 years) who either owned a cat and no dog (n = 41) or owned neither a cat nor a dog (n = 55) completed questionnaires (Perceived Stress Scale, Revised–UCLA Loneliness Scale, Geriatric Depression Scale-Short Form, Montreal Cognitive Assessment, and Lexington Attachment to Pets Scale) and provided saliva specimens which were assayed for stress and inflammatory biomarkers. The majority of participants screened positive for mild cognitive impairment, reported low levels of stress, loneliness, and depression, and the biomarkers reflected fairly low levels of stress and inflammation. Binary logistic regression analysis revealed that psychosocial factors, salivary biomarkers, and cognitive function were not significantly associated with cat ownership. Age was the only significant predictor of cat ownership (OR = 0.92, p < 0.01) with the odds of cat ownership decreasing by 8.3% per year of advancing age. On average, cat owners were “somewhat attached” to their cats; however, 26% were “strongly attached” to their cats. Correlation analyses revealed the level of attachment to cats was not associated with study outcomes. These results show that cat ownership declined with each advancing year, which lessens the opportunity for older adults to form attachment bonds. The level of pet attachment supports the consideration of cats as a source of an attachment relationship for older adults, including those with cognitive impairment.  相似文献   

11.
12.
摘要 目的:探讨记忆训练联合电针疗法对全脑放疗患者认知功能、健康相关生命质量和颅脑磁共振灌注成像参数的影响。方法:选择江南大学附属医院2020年3月~2022年1月期间收治的全脑放疗患者94例,根据随机数字表法分为研究组(常规干预、记忆训练联合电针疗法)和对照组(常规干预),各为47例。对比两组认知功能、健康相关生命质量和颅脑磁共振灌注成像参数的变化。结果:治疗1周、2周、3周、4周后,两组蒙特利尔认知功能检查量表(MoCA)和简易精神状态量表(MMSE)评分均较治疗前逐渐下降,但研究组各时间点MoCA、MMSE评分高于对照组(P<0.05)。治疗4周后,两组健康相关生命质量量表(HRQoL)各维度评分及总分均较治疗前升高,且研究组上述评分均高于对照组(P<0.05)。治疗4周后,两组颅脑平均脑血容量(CBV)值和平均脑血流量(CBF)值均较治疗前下降,但研究组上述值高于对照组(P<0.05)。结论:记忆训练联合电针疗法可减缓全脑放疗后导致的认知功能损害,并提升患者的健康相关生命质量,可能与调节脑血容量、脑血流量有关。  相似文献   

13.
14.
PurposeTo characterize cerebral glucose metabolism associated with different cognitive states in Parkinson’s disease (PD) using 18F-fluorodeoxyglucose (FDG) and Positron Emission Tomography (PET).MethodsThree groups of patients were recruited in this study including PD patients with dementia (PDD; n = 10), with mild cognitive impairment (PD-MCI; n = 20), and with no cognitive impairment (PD-NC; n = 30). The groups were matched for age, sex, education, disease duration, motor disability, levodopa equivalent dose and Geriatric Depression Rating Scale (GDS) score. All subjects underwent a FDG-PET study. Maps of regional metabolism in the three groups were compared using statistical parametric mapping (SPM5).ResultsPD-MCI patients exhibited limited areas of hypometabolism in the frontal, temporal and parahippocampal gyrus compared with the PD-NC patients (p < 0.01). PDD patients had bilateral areas of hypometabolism in the frontal and posterior parietal-occipital lobes compared with PD-MCI patients (p < 0.01), and exhibited greater metabolic reductions in comparison with PD-NC patients (p < 0.01).ConclusionsCompared with PD-NC patients, hypometabolism was much higher in the PDD patients than in PD-MCI patients, mainly in the posterior cortical areas. The result might suggest an association between posterior cortical hypometabolism and more severe cognitive impairment. PD-MCI might be important for early targeted therapeutic intervention and disease modification.  相似文献   

15.

Background

Cognitive impairment is commonly observed in patients with Hashimoto thyroiditis (HT). Low levels of vitamin D have been correlated with cognitive impairment in non-HT population. We examined the association of vitamin D levels with cognitive impairment in patients with HT.

Methods

We recruited 194 patients with HT and 200 healthy volunteers. Levels of serum 25-hydroxyvitamin D (25(OH)D) were measured using a competitive protein-binding assay. Cognitive funtion was assessed using Montreal Cognitive Assessment score (MoCA). Subjects with a MoCA scores <?26 are considered as having mild cognitive impairment (MCI). Multivariate analysis was performed using logistic regression models.

Results

Fifty-five HT patients (28.4%) were diagnosed as having MCI. Patients with MCI had significantly lower 25(OH)D levels when compared with patients without MCI (33.9?±?6.2 vs. 44.3?±?9.6?nmol/L, P?<?0.001). Significant differences in 25(OH)D quartiles of HT patients were observed between the patients with MCI and the patients without MCI (P?<?0.001). In multivariate analyses, serum 25(OH)D levels (≤ 34.0 and?≥?47.1?nmol/L) were significantly associated with cognitive impairment in patients with HT (OR 6.279, 95% CI 2.673–14.834, P?<?0.001; OR 0.061, 95% CI 0.008–0.491, P?=?0.009, respectively).

Conclusion

Our results demonstrate an important association between serum vitamin D levels and cognitive impairment in patients with HT.
  相似文献   

16.
IntroductionThere are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients’ characteristics, outcomes, and prescribed treatments.MethodsA retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made.ResultsFrom 1887 patients admitted to the orthogeriatric unit, 469 (24.85%) were referred to the FLS. Of those, 328 were women (75.6%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (96.8% of the patients with independent gait versus 64.8%) than non-FLS patients (p < 0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%).ConclusionsPatients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological).  相似文献   

17.
摘要 目的:观察脑卒中后认知障碍(PSCI)患者在认知康复训练基础上辅助高频重复经颅磁刺激(rTMS)治疗后,其认知功能和血清脑源性神经营养因子(BDNF)、血管内皮生长因子(VEGF)水平变化。方法:选择我院2020年1月~2020年12月期间接收的300例PSCI患者,以随机数字表法将患者分为实验组(150例)、对照组(150例)。对照组在常规治疗基础上联合认知康复训练,实验组则在对照组的基础上联合高频rTMS。对比两组认知功能、日常生活能力、听觉事件相关电位、血清BDNF和VEGF水平及不良反应。结果:两组治疗4周后蒙特利尔认知评估量表(MoCA)各条目评分及总分均较治疗前升高,且实验组高于对照组(P<0.05)。两组治疗4周后改良Barthel指数(MBI)评分较治疗前升高,且实验组高于对照组(P<0.05)。实验组治疗4周后P300潜伏期短于对照组,P300波幅高于对照组(P<0.05)。两组治疗4周后血清BDNF、VEGF水平升高,且实验组高于对照组(P<0.05)。两组不良反应发生率组间对比无统计学差异(P>0.05)。结论:认知康复训练联合高频rTMS可有效改善PSCI患者认知功能,上调其血清BDNF、VEGF水平,改善听觉事件相关电位,从而提高患者日常生活能力。  相似文献   

18.

Background/Aims

Large-scale population studies measuring rates and dynamics of cognitive decline in multiple sclerosis (MS) are lacking. In the current cross-sectional study we evaluated the patterns of cognitive impairment in MS patients with disease duration of up to 30 years.

Methods

1,500 patients with MS were assessed by a computerized cognitive battery measuring verbal and non-verbal memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Cognitive impairment was defined as below one standard deviation (SD) and severe cognitive impairment as below 2SD for age and education matched healthy population norms.

Results

Cognitive performance in our cohort was poorer than healthy population norms. The most frequently impaired domains were information processing speed and executive function. MS patients with secondary-progressive disease course performed poorly compared with clinically isolated syndrome, relapsing-remitting and primary progressive MS patients. By the fifth year from disease onset, 20.9% of patients performed below the 1SD cutoff for impairment, p = 0.005, and 6.0% performed below the 2SD cutoff for severe cognitive impairment, p = 0.002. By 10 years from onset 29.3% and 9.0% of patients performed below the 1SD and 2SD cutoffs, respectively, p = 0.0001. Regression modeling suggested that cognitive impairment may precede MS onset by 1.2 years.

Conclusions

The rates of cognitive impairment in this large sample of MS patients were lower than previously reported and severe cognitive impairment was evident only in a relatively small group of patients. Cognitive impairment differed significantly from expected normal distribution only at five years from onset, suggesting the existence of a therapeutic window during which patients may benefit from interventions to maintain cognitive health.  相似文献   

19.
IntroductionCognitive impairment is a transition stage between normal aging and dementia, the prevalence of last one increases with age; the damage of the functions and physical integrity, places the older adult in a greater susceptibility to get sick. Telomere length is a hallmark of aging to characterize this phenotype, as well as a biomarker that reflects the underlying state of the cell. In this work, the relative length of telomeres in older adults with cognitive impairment was correlated.Material and methodsObservational-analytical study, in samples of adult patients older than 65 years with and without cognitive impairment, in whom the relative length of telomeres was measured.ResultsNinety samples of older adults were included in the study and in the association analysis according to multivariate logistic models, cognitive impairment showed almost five times more risk for telomere shortening in relation to the presence of the diagnosis of cognitive impairment (Odds ratio 4.88, p = 0.027).ConclusionsWhen correlating the relative length of telomeres in older adults diagnosed with cognitive impairment, this association was confirmed for shorter.  相似文献   

20.

Background

Cognitive impairment may be seen in as many as 43–70% of patients with multiple sclerosis (MS) and may be observed in all MS subtypes. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) battery may be used to evaluate cognition status. The purpose of the current study is to validate the BICAMS battery in Turkish.

Methods

Patients with MS attending our clinic between September 2014 and April 2015 were invited to participate. Healthy control participants were matched in terms of age, gender and years of education.

Results

One hundred seventy-three MS patients and 153 healthy control participants were enrolled in the study. MS patients performed significantly worse in all trials than the members of the healthy control group. In addition, cognitive dysfunction was identified in 78 of the 173 (45.1%) patients. In the MS with cognitive impairment group, 64 out of 151 (42.4%) subjects were RRMS patients, 12 out of 18 (66.7%) were secondary progressive MS patients, and 2 out of 4 (50%) were primer progressive MS patients.

Conclusions

The BICAMS has been proposed for assessing cognitive impairment in MS patients. This study shows that the battery is suitable for use in Turkey.
  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号