【摘要】 目的 分析合并免疫指标异常的视神经脊髓炎临床特点。 方法 回顾性分析2009年5月-2010年11月收治的62例视神经脊髓炎患者中24例合并免疫指标异常患者的临床资料。24例均为女性，发病年龄14~53岁。对其临床表现、视觉诱发电位、影像学检查结果、免疫检查结果进行分析。 结果 所有患者均有脊髓和视神经同时或先后受累的表现。24例视觉诱发电位检查23例异常。脊髓MRI显示病变集中于颈段、上胸段脊髓。颈段和胸段脊髓同时受累17例，单纯颈段脊髓受损6例，单纯胸段脊髓受损1例。所有患者抗核抗体滴度均≥1∶100，合并抗SSA抗体阳性14例（55.5％），同时合并抗SSB抗体阳性11例（45.8％），合并抗Rib抗体阳性1例，合并抗SCL-70抗体阳性1例，合并抗dsDNA抗体1例。 结论 视神经脊髓炎合并免疫指标异常的患者以女性较为多见，易复发，青壮年患者发病率最高。脊髓MRI示病变集中于颈段、上胸段脊髓，表现为长节段脊髓损害。视神经脊髓炎患者合并结缔组织病的病例较多。【Abstract】 Objective To analyze the clinical features of neuromyelitis optica (NMO) combined with abnormal immune parameters. Methods We retrospectively reviewed the clinical data of 24 patients with NMO and abnormal immune parameters among the 62 NMO patients who were admitted into our department between May 2009 and November 2010. All patients were female, aged from 14 to 53 years. We analyzed their clinical manifestations, visual evoked potentials, imaging results, and immunological examinations. Results All patients had simultaneous or successive spinal cord and optic nerve involvement. Twenty-three patients had abnormal visual evoked potential. MRI showed that the lesions focused on the cervical and upper thoracic spinal cord. Both cervical and thoracic spinal cord were involved in 17 cases; there were 6 cases of simple cervical spinal cord injury and 1 case of simple thoracic spinal cord damage. Antinuclear antibody titer of all the patients was ≥1∶100. Combined positive anti-SSA antibody occurred in 14 patients (55.5%); Concomitant positive anti-SSB antibodies occurred in 11 patients (45.8%); Combined positive anti-Rib antibodies occurred in 1 patient; Combined positive anti-SCL-70 antibody occurred in 1 patient; and combined positive anti-dsDNA antibodies occurred in 1 patient. Conclusions NMO combined with abnormal immune parameters mainly occurs in female patients, especially in young people. Recurrence rate is high. MRI shows that the lesions focus mainly on the cervical and upper thoracic spinal cord, manifesting the characteristic of long segment damage. And NMO is frequently combined with connective tissue disease.
ObjectiveTo explore the therapeutic effect of glucosamine hydrochloride combined with calcium and vitamin D on knee osteoarthritis. MethodsA total of 120 female outpatients with knee osteoarthritis from January 2014 to January 2015 were selected. The patients were randomly divided into study group and control group (60 patients in each group) according to their treatment sequence. The patients in the study group were given oral calcium citrate, alfacalcidol and glucosamine hydrochloride while those in the control group were given glucosamine hydrochloride only. Both groups were investigated and scored by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire before and three and six months after treatment. ResultsThree and six months after the treatment, WOMAC scores of both groups were lower than those before the treatment with significant differences (P<0.05). Three months after the treatment, WOMAC scores between the two groups didn't differ much (P>0.05), while the difference between the two groups was significant 6 months after the treatment (P<0.05). Three months after the treatment, the difference of total effective rate in the study group (43.3%) and control group (41.7%) was not significant (P>0.05), while the rate in the study group (65.0%) was obviously higher than that in the control group (46.7%) 6 months after the treatment (P<0.05). ConclusionGlucosamine hydrochloride has exact effect on knee osteoarthritis. There are differences in the therapeutic effect on knee osteoarthritis between glucosamine hydrochloride combined with calcium and vitamin D and glucosamine hydrochloride alone after six-month treatment.
Objective To explore the clinical features and prognosis related factors of severe drug eruption. Methods The clinical data of 48 patients with drug eruption treated between January 2010 and August 2015 were retrospectively analyzed. Results The major type of drug eruption was Stevens-Johnson syndrome (58.3%), followed by toxic epidermal necrolysis (TEN) (27.1%) and hypersensitivity syndrome (14.6%). The major allergenic drug which might cuase drug eruption was antimicrobial agent (25.0%), followed by antipyretic analgesic drug (22.9%) and antigout drug (18.8%). Carbamazepine and allopurino were the common drugs caused TEN. Conclusion It is important to give sufficient corticosteroid earlier combined with intravenous immunoglobulin for reducing mortalities of severe drug eruption.
Objective To construct and verify the diagnostic model of preoperative malignant risk of ovarian tumors, so as to improve the diagnostic efficiency of existing test indexes. Methods The related serological indicators and clinical data of patients with ovarian tumors confirmed by pathology who were treated in the Affiliated Hospital of Southwest Medical University between January 2019 and September 2023 were retrospectively collected, and the patients were randomly divided into a training set and a verification set at a 7∶3 ratio. Logistic regression was used to construct a diagnostic model in the training set, and the diagnostic efficacy of the model was verified through discrimination, calibration, clinical benefit, and clinical applicability evaluation. Results A total of 929 patients with ovarian tumors were included, including 318 cases of malignant ovarian tumors and 611 cases of benign ovarian tumors. The patients were randomly divided into a training set of 658 cases and a validation set of 271 cases. A diagnostic model was constructed using logistic regression in the training set, containing 5 factors namely age, percentage of neutrophil (NEU%), fibrinogen to albumin ratio (FAR), carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4): modelUAM=−3.211+0.667×age+2.966×CA125+0.792×FAR+1.637×HE4+0.533×NEU%, with a Hosmer-Lemeshow test P-value of 0.21. The area under the receiver operating characteristic (ROC) curve measured in the training set was 0.927 [95% confidence interval (0.903, 0.951)], the sensitivity was 0.947, and the specificity was 0.780. The area under the ROC curve of the validation set was 0.888 [95% confidence interval (0.840, 0.930)], the sensitivity was 0.744, and the specificity was 0.901. Conclusion A new quantitative tool based on age, NEU%, FAR, CA125 and HE4 can be used for the clinical diagnosis of ovarian malignant tumors, and it is helpful to improve the diagnostic efficiency and is worth popularizing.
ObjectiveTo investigate the effect of icaritin on the small cell lung cancer cell lines NCI-H446 and its mechanism. MethodsThe NCI-H446 cells at logarithmic growth phase were divided into control and icaritin groups. The cells in the control group were normally treated and cells in the icaritin group were incubated with icaritin (8 μmol/L). Thiazole blue and flow cytometry were used to examine the proliferation and apoptotic changes in the two groups 48 hours after incubation respectively. Gene expression of Janus kinase 2 (JAK2) and signal transducers and activators of transcription 3 (STAT3) were detected by real-time quantitative polymerase chain reaction. The changes of JAK2, STAT3, phospho-JAK2 (p-JAK2), phospho-STAT3 (p-STAT3), Bax and BCL-2 protein were detected by Western blotting. ResultsCompared with the control group, the proliferation rate of NCI-H446 cells in the icaritin group was significantly lower (P<0.05), but the apoptotic rate of NCI-H446 cells in the icaritin group was significantly higher (P<0.05). After the treatment with icaritin, the expression of JAK2 and STAT3 mRNA had no obvious differences. The Western blotting results showed that there was no significant changes in total JAK2, STAT3 protein (P>0.05), but an increasing trend in p-JAK2, p-STAT3 and Bax was observed with the decreasing of BCL-2 (P<0.05). ConclusionIcaritin can inhibit the proliferation and promote the apoptosis of NCI-H446 cells and the effect may be achieved through JAK2/STAT3 signal transduction pathway.
ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.