高血压流行病学病因分析和总结

近年来,由于社会变革和人们生活方式的变化,我国心血管病发病率及相关危险因素均有增加趋势。据2002年卫生部组织的全国居民27万人营养与健康状况调查资料显示,我国居民膳食质量明显提高,但城市居民膳食结构不尽合理。畜肉类及油脂类消费过多,慢性非传染性疾病患病率上升迅速(2)。我国18岁及以上居民高血压患病率为18.8%,估计全国患病人数1.6亿多。与1991年比较,患病率上升31%。我国人群高血压知晓率为30.2%,治疗率为24.7%,控制率为6.1%,与1991年比有所提高,但仍处于较差水平。高盐饮食与高血压患病密切相关,饮酒与高血压和血脂异常的患病密切相关,脂肪摄入多且体力活动少的人,患高血压病的机会多。     

消化道出血病因的临床分析

目的:回顾性分析消化道出血的病因构成、相关因素及治疗情况。方法:收集2008年7月至2013年9月因消化道出血在沈阳军区总医院消化内科住院的患者资料,包括患者的一般资料、入院日期、病因、出血部位、生命体征、疾病史。依据消化道出血程度分为轻度组(86例)、中度组(90例)、重度组(132例),分析消化道出血的病因特征。结果:与轻度组比较,重度组上消化道出血患者比例较高,中、重度组Blatchford评分、心率、尿素、血肌酐、凝血酶原时间、INR、血糖明显升高(P0.05);收缩压、舒张压、红细胞、血红蛋白、总蛋白、白蛋白、总胆固醇明显减低(P0.05)。重度组患有食管胃底静脉曲张的比例较高,行内镜下治疗的比例高(P0.05)。结论:根据患者出血程度可初步判断患者消化道出血的部位及病因,为临床诊治提供有价值的参考依据。     

683 例胸腔积液病因分析

目的：目前医学证实有很多疾病的分布与民族及种族有关,而维吾尔族是新疆特有的少数民族,本文探讨了2010~2012 年入 住我院的诊断明确的所有683 例胸腔积液（PE）患者与其中276 例维吾尔族PE 患者的病因分布的差异,从而指导临床工作。方法：回顾性分析2010~2012 年入住我院的683 例PE 患者及其中276 例维吾尔族PE 患者的临床资料,分析维吾尔族PE 患者与入我院总的PE 患者二者之间病因分别的差异。结果：入我院总的PE 患者与其中维吾尔族PE 患者最常见的病因相同,均为结核性PE、恶性PE、心功能不全性PE、肺炎旁PE,但二者之间这四种病因的分布有差异,前者病因分布顺序为恶性PE、结核性PE、心功能不全性PE、肺炎旁PE,而后者病因的分布顺序为结核性PE、心功能不全性PE、恶性PE、肺炎旁PE;二者在不同年龄段的病因分布也具有差异,后者在≤40 岁组与41~59 岁组比较、≤40 岁组与≥60 岁组比较有统计学差异,但41~59 岁组与≥ 60 岁组比较无统计学差异,但前者在上述三个年龄段比较均有统计学差异。结论：入我院总的PE 患者与维吾尔族PE患者的最主要的病因相同,但二者这四个病因分布的顺序不同,且二者在不同年龄段的病因分布也存在差异,前者在三个年龄段的病因分布均存在差异,而后者仅在二个年龄段的病因分布存在差异。     

683例胸腔积液病因分析

目的：目前医学证实有很多疾病的分布与民族及种族有关,而维吾尔族是新疆特有的少数民族,本文探讨了2010～2012年入住我院的诊断明确的所有683例胸腔积液（PZ）患者与其中276例维吾尔族PE患者的病因分布的差异,从而指导临床工作。方法：回顾性分析2010-2012年入住我院的683例PE患者及其中276例维吾尔族PE患者的临床资料,分析维吾尔族PE患者与入我院总的PE患者二者之间病因分别的差异。结果：入我院总的PE患者与其中维吾尔族PE患者最常见的病因相同,均为结核性PE、恶性PE、心功能不全性PE、肺炎旁PE,但二者之间这四种病因的分布有差异,前者病因分布顺序为恶性PE、结核性PE、心功能不全性PE、肺炎旁PE,而后者病因的分布顺序为结核性PE、心功能不全性PE、恶性PE、肺炎旁PE;二者在不同年龄段的病因分布也具有差异,后者在≤40岁组与41-59岁组比较、≤40岁组与≥60岁组比较有统计学差异,但41～59岁组与≥60岁组比较无统计学差异,但前者在上述三个年龄段比较均有统计学差异。结论：入我院总的PE患者与维吾尔族PE患者的最主要的病因相同,但二者这四个病因分布的顺序不同,且二者在不同年龄段的病因分布也存在差异,前者在三个年龄段的病因分布均存在差异,而后者仅在二个年龄段的病因分布存在差异。     

磷酸肌酸钠注射液治疗高龄多病因心力衰竭患者疗效分析

目的：观察磷酸肌酸钠注射液治疗≧80 岁高龄多病因心力衰竭患者的疗效。方法：≧80 岁高龄多病因心力衰竭患者115 例,随机分为治疗组58 例,对照组57 例。对照组给予常规抗心衰治疗,治疗组在此基础上加用磷酸肌酸钠注射液,观察两组治疗 前后NYHA心功能分级、血浆NT-proBNP 水平,磷酸肌酸钠注射液相关不良反应发生率并监测治疗前后的肝肾功能等指标。结 果：治疗5 天后治疗组总有效率显著高于对照组（P<0.05）,血浆NT-proBNP 含量显著低于对照组（P<0.05）,需加用洋地黄类强心 药物的患者人数显著低于对照组（P<0.05）;治疗14天后两组各指标均有显著改善,总有效率、血浆NT-proBNP 下降幅度无明显 区别。结论：常规抗心衰治疗基础上加用磷酸肌酸钠注射液能够更快改善≧80 岁高龄多病因心力衰竭患者症状,安全有效。     

163例小儿腹痛的病因分析

目的探讨小儿腹痛的常见病因。方法对163例腹痛患儿详细询问病史．细致体检及必要的实验室检查。结果以腹痛为主诉就诊的患儿病因复杂,其中最常见的是急性胃肠炎37例（占17．13％）,肠道寄生虫病35例（占16．20％）,消化性溃疡21例（占9．72％）,过敏性紫癜19例（占8．79％）等。结论小儿腹痛病因复杂,临床医生必须对获得的各种临床资料（包括病史、体征及辅助检查结果）进行认真分析和鉴别诊断,对常见的腹痛病因逐一进行排除．才能获得正确诊断。     

冠状动脉造影正常的胸痛患者病因分析

目的:探讨冠状动脉造影正常的胸痛患者的病因及其临床特征.方法:对49例临床拟诊冠心病而冠状动脉造影正常的胸痛患者的临床特征进行回顾性分析,为胸痛的临床诊断提供思路.结果:最后诊断:急性心梗死1例(2.04%);冠心病心绞痛10例(20.45%);高血压病12例(24.49%);心律失常8例(16.33%);糖尿病6例(12.24%);X综合症7例(14.29%);急性胆囊炎2例(4.08%);急性胰腺炎2例(4.08%);反流性食管炎1例(2.04%);颈椎病2例(4.08%).结论:冠状动脉造影正常的胸痛患者并不能完全排除冠心痛,要考虑心外病变、非冠心病性器质性心脏病和X综合症等众多的影响因素.     

2009例藏族白内障患者的病因构成及相关因素分析

目的:分析2009例藏族白内障手术患者的病因构成及相关因素。方法:收集2013年10月至2014年10月西藏自治区藏医院眼科2009例藏族白内障手术患者病例资料,按病因、年龄、性别、白内障类型、人工晶状体屈光度、文化程度、经济水平进行分类,运用统计学方法分析西藏地区藏族白内障患者发病特点。结果:2009例藏族白内障手术患者中,年龄相关性白内障1885眼(93.83%),核性白内障1197例(59.58%)。年龄2-89岁,平均年龄62.53岁,男1012眼(50.37%),女997眼(49.63%)。50-59岁年龄组的核性白内障患者比例明显高于40-49岁年龄组(P0.01;80-89岁年龄组的核性白内障患者比例高于70-79岁年龄组(P0.05)。根究Emery分级,50-59岁年龄组Ⅳ级白内障患者比例明显高于40-49岁年龄组(P0.01);80-89岁年龄组Ⅳ级白内障患者比例明显高于70-79岁年龄组(P0.05)。术前裸眼视力为0.02及0.02以下1688例(84.02%)。高度近视患者13例(0.65%),远视患者406例(20.21%)。农牧区患者1310例(65.21%),明显多于其他行业患者。结论:年龄相关性白内障仍是西藏地区藏族白内障患者的主要病因,以核性白内障为主要发病类型。随年龄增长,核性白内障患者越来越多,核硬度分级越来越高。患者主要来源于农牧区,多数术前视力差。高度近视发病率较其他地区发病率低,而远视发病率较高。     

苏州市玻璃体积血的临床病因分析

目的:探讨苏州市不同年龄组玻璃体积血的常见病因,为疾病预防提供依据。方法:对在2009年~2011年住我院的287例295眼玻璃体积血患者的临床资料进行回顾性分析。结果:在所有玻璃体积血患者中,糖尿病性视网膜病变(diabetic retinopathy,DRP)111例(38.7%),眼外伤60例(20.9%),视网膜静脉阻塞(retinal vein occlusion,RVO)59例(20.6%),孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)32例(11.1%)。年龄<45岁的青年组中,眼外伤导致的玻璃体积血最多,为36例(48.6%),其次为DRP 26例(35.1%),视网膜血管炎(retinal vasculitis,RV)10例(13.5%)。45~59岁中年组中,DRP导致玻璃体积血最多,为61例(50.8%),其次为RVO 20例(16.7%)、眼外伤17例(14.2%)、RRD 16例(13.3%)。≥60岁老年组中,RVO导致玻璃体积血最多,为38例(40.9%),其次为DRP 24例(25.8%),RRD 15例(16.1%)。结论:DRP、眼外伤、RVO、RRD是引起玻璃体积血最常见的病因。青年患者的主要病因是眼外伤、DRP和RV,而中老年患者的主要病因是DRP及RVO。     

慢性前列腺炎病因分析及护理对策

前列腺炎是男性泌尿生殖系统常见病,约50％的男性在其一生中曾有前列腺炎的症状。其中,慢性前列腺炎（CP）更为多见,在全世界男性中的患病率为9％～14％．本病的临床表现变化多端．病因及发病机制尚未完全阐明,因此许多患者没有得到有效的治疗,严重影响息者生活质量。现对我院2003-2009年收治住院的96例慢性前列腺炎患者的资料进行总结分析如下。     

Bacterial Communities in Semen from Men of Infertile Couples: Metagenomic Sequencing Reveals Relationships of Seminal Microbiota to Semen Quality

Some previous studies have identified bacteria in semen as being a potential factor in male infertility. However, only few types of bacteria were taken into consideration while using PCR-based or culturing methods. Here we present an analysis approach using next-generation sequencing technology and bioinformatics analysis to investigate the associations between bacterial communities and semen quality. Ninety-six semen samples collected were examined for bacterial communities, measuring seven clinical criteria for semen quality (semen volume, sperm concentration, motility, Kruger''s strict morphology, antisperm antibody (IgA), Atypical, and leukocytes). Computer-assisted semen analysis (CASA) was also performed. Results showed that the most abundant genera among all samples were Lactobacillus (19.9%), Pseudomonas (9.85%), Prevotella (8.51%) and Gardnerella (4.21%). The proportion of Lactobacillus and Gardnerella was significantly higher in the normal samples, while that of Prevotella was significantly higher in the low quality samples. Unsupervised clustering analysis demonstrated that the seminal bacterial communities were clustered into three main groups: Lactobacillus, Pseudomonas, and Prevotella predominant group. Remarkably, most normal samples (80.6%) were clustered in Lactobacillus predominant group. The analysis results showed seminal bacteria community types were highly associated with semen health. Lactobacillus might not only be a potential probiotic for semen quality maintenance, but also might be helpful in countering the negative influence of Prevotella and Pseudomonas. In this study, we investigated whole seminal bacterial communities and provided the most comprehensive analysis of the association between bacterial community and semen quality. The study significantly contributes to the current understanding of the etiology of male fertility.     

ICU呼吸机相关性肺炎患者炎性因子水平与病原学特征及危险因素分析

摘要 目的：研究重症监护室（ICU）呼吸机相关性肺炎（VAP）患者炎性因子水平与病原学特征及危险因素。方法：将从2017年1月～2019年12月,于我院ICU接受治疗的120例患者纳入研究。将其按照是否发生VAP分成VAP组48例与无VAP组72例。比较两组炎性因子水平,分析VAP患者的病原菌分布情况,分析ICU患者发生VAP的危险因素。结果：VAP组肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）及C反应蛋白（CRP）水平均高于无VAP组（均P＜0.05）。48例VAP患者共分离得到病原菌76株,按照占比从高到低的顺序依次为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、凝血酶阴性葡萄球菌、真菌,占比分别为22.37%、18.42%、17.11%、14.47%、13.16%、7.89%、6.58%。经单因素分析发现：ICU患者发生VAP与机械通气时间、抗菌药物联用以及留置胃管有关（均P＜0.05）,与年龄、性别无关（均P＞0.05）。经多因素Logistic回归分析发现：机械通气时间≥7 d、抗菌药物联用、留置胃管均是ICU患者发生VAP的危险因素（P＜0.05）。结论：VAP患者的炎性因子水平存在显著升高的情况,且其病原菌以铜绿假单胞菌、鲍氏不动杆菌以及金黄色葡萄球菌等为主。此外,机械通气时间、抗菌药物联用以及留置胃管均与VAP的发生关系密切,值得临床重点关注。     

Molecular Detection of Chlamydia trachomatis and Other Sexually Transmitted Bacteria in Semen of Male Partners of Infertile Couples in Tunisia: The Effect on Semen Parameters and Spermatozoa Apoptosis Markers

This study was undertaken to determine the prevalence of Chlamydia trachomatis, Mycoplasmas, and Ureaplasmas in semen samples of the male partners of infertile couples and to investigate whether Chlamydia trachomatis could initiate apoptosis in human spermatozoa. A total of 85 males partners of infertile couples undergoing routine semen analysis according to World Health Organization guidelines were included. Specimens were examined for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum and Ureaplasma parvum by Real time PCR (qPCR). Semen specimens were analysed for the appearance of apoptotic markers (sperm DNA fragmentation, activated caspase 3 levels, mitochondrial membrane potential (ΔΨm)) using flow cytometry. C. trachomatis, N. gonorrhoeae, U. urealyticum, M genitalium were detected in semen samples of 13 (15.2%), 5 (5.8%), 5 (5.8%) and 3 (3.5%) male partners of infertile couples, respectively. M. hominis and U. parvum were detected in semen sample of only one patient (1.1%). The semen of infertile men positive for C. trachomatis showed lower mean of semen count and lower rapid progressive motility (category [a]) of spermatozoa compared to uninfected men with statistically significances (p = 0.02 and p = 0.04, respectively). Flow cytometry analyses demonstrated a significant increase of the mean rate of semen with low ΔΨm and caspase 3 activation of infertile men positive for C. trachomatis compared to uninfected men (p = 0.006 and p = 0.001, respectively). DNA fragmentation was also increased in sperm of infertile men positive for C. trachomatis compared to uninfected men but without statistical significances (p = 0.62). Chlamydial infection was associated to loss of ΔΨm and caspase 3activation. Thus, C. trachomatis infection could be incriminated in apoptosis induction of spermatozoa. These effects may explain the negative direct impact of C. trachomatis infection on sperm fertilizing ability.     

Individual Traits and Environmental Factors Influencing Sleep Timing: A Study of 225 Japanese Couples

Behavioral and physiological processes, such as sleep-wakefulness, thermoregulation, and hormone secretion, exhibit 24-h rhythms in most organisms. These biological rhythms are driven by the circadian clock system and are entrained by the external environment, which in the case of humans includes social time schedules. Couples might be ideal experimental subjects to discriminate between individual traits and environmental factors, as they share lifestyle habits but not genetic backgrounds. In this study, sleep timing was compared between married Japanese couples (n?=?225) who had lived together for 1 yr or more (mean 17 yrs). Additionally, the authors evaluated the influence of individual traits and environmental factors on an individual's sleep timing per each couple. The results reveal that the sleep timings of a couple are mainly associated with the chronotypes of the husband and wife, whereas the sleep timings are significantly influenced by certain environmental factors. The findings suggest that chronotype remains one of the major determinants of an individual's sleep onset and wake times. Understanding an individual's chronotype may help improve the quality of life issues surrounding sleep. (Author correspondence: mishima@ncnp.go.jp)