目的 总结甲状腺功能亢进性肝功能损害 （ HLI ） 的临床特点和治疗方案。 方法 对2008年1月－2010年12月诊治的49例HLI患者临床资料进行回顾性总结分析，据其治疗方案的不同分抗甲状腺治疗组和单纯保肝治疗组，比较二组患者治疗后肝功能恢复情况。 结果 所有患者入院时均存在不明原因肝功能不全，而后明确为HLI。其中女29例（59.2%），男20例（40.8%），年龄10～70岁，平均45岁。 症状主要表现为体重下降（65.3%），心悸（51.1%），怕热多汗（49.0%）， 厌油纳差、食欲减退 （44.9%）。主要体征包括甲状腺肿大（36.7%），双下肢水肿（24.5%），心界扩大（16.3%），皮肤巩膜黄染（14.3%），肝脾肿大（12.2%）等。肝功能检验异常主要表现为谷丙转氨酶升高（68.9％），谷草转氨酶升高（57.8％）为主，其次是谷氨酰转移酶（69.4%）、直接胆红素（59.2%）、总胆红素（44.9%）、碱性磷酸酶（42.9%）、乳酸脱氢酶（26.5%）升高，以及白蛋白（32.7%）下降。死亡3例，病死率6.1%。采用Wilcoxon秩和检验结果提示抗甲状腺治疗组的总胆红素和直接胆红素低于单纯保肝治疗组，组间差异有统计学意义（P＜0.05）。 结论 此类患者可同时具备甲状腺功能亢进和肝功能不全的临床表现，肝功能常表现为淤胆型肝炎。HLI总体预后较好，抗甲状腺治疗是该病的关键。
Objective To explore the value of pulmonary ultrasound in the evaluation of pulmonary edema and the guidance of pulmonary therapy in patients with acute respiratory distress syndrome (ARDS). Methods Sixty patients with ARDS admitted to the Department of Critical Medicine of Shanghai Seventh People’s Hospital were randomly divided into a lung ultrasound group and a control group, with 30 patients in each group. The gender, age and etiology of patients were collected, and the relevant data were recorded at the time of admission and on the 7th day, including Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment score (SOFA), white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), extravascular pulmonary water index, oxygenation index, and mechanical ventilation treatment time. Pulmonary ultrasound score was collected in the pulmonary ultrasound group. The 7-day improvement rate, intensive care unit (ICU) hospitalization time and 28 day mortality rate of the two groups were also collected. The value of pulmonary ultrasound in evaluating the severity, treatment process and prognosis of patients, and the correlation between pulmonary ultrasound score and extravascular pulmonary water index were studied. Results There was no significant difference in APACHEⅡ score, SOFA score, oxygenation index, extravascular pulmonary water index, WBC, CRP or PCT between the two groups before and after treatment (all P>0.05). After 7 days of treatment, the two groups improved, and the pulmonary ultrasound group improved more significantly with more shorter mechanical ventilation time, higher 7-day improvement rate, shorter ICU hospitalization time, and lower 28-day mortality rate (all P<0.05). The extravascular pulmonary water index was positively correlated with APACHEⅡ score and SOFA score, and negatively correlated with oxygenation index. The pulmonary ultrasound score was positively correlated with APACHEⅡ, and SOFA score and extravascular pulmonary water index, and negatively correlated with oxygenation index. Conclusions Pulmonary ultrasound can effectively evaluate the severity of ARDS patients, guide the individualized treatment, and predict the prognosis. It can be used as a routine monitoring method for patients with ARDS.
Objective To evaluate the short-term cl inical outcomes of metal-on-metal total hi p resurfacing arthroplasty in treating osteonecrosis of the femoral head (ONFH) in young and middle-aged patients and to compare with patients of hip osteoarthritis at the same period. Methods From July 2006 to October 2008, 33 patients (45 hips) with ONFH (ONFH group) and 39 patients (45 hips) with osteoarthritis (osteoarthritis group) were treated with metal-on-metal total hipresurfacing arthroplasty. In ONFH group, there were 18 males (27 hips) and 15 females (18 hips) with an average age of 42.7 years (range 19-58 years), including 22 left hips and 23 right hips. The causes were trauma (4 cases), glucocorticoid (25 cases), drugs (2 cases), alcohol (1 case), and psoriasis (1 case). According to Steinberg classification, there were 10 hips at stage III, 18 hips at stage IV a, 13 hips at stage IV b, and 4 hips at stage IV c. The Harris score was 52.0 ± 4.6. The disease course was 1-12 years. In osteoarthritis group, there were 26 males (30 hips) and 13 females (15 hips) with an average age of 47.1 years (range 42-65 years), including 17 left hips and 28 right hips. The causes were degenerative arthritis (23 cases), trauma (11 cases), and ankylosing spondyl itis (5 cases). The Harris score was 57.0 ± 3.8. The disease course was 3-17 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention without compl ications of infection and thrombosis of deep vein of lower extremities. The patients were followed up for 26 months in ONFH group and 28 months in osteoarthritis group. Femoral neck fracture occurred in 1 case of osteoarthritis group after 4 months, who received total hip arthroplasty; no compl ication of prosthesis loosening, dislocation, incision infection, osteonecrosis, and bone absorption occurred in other patients. At last follow-up, the Harris scores were 93.0 ± 5.5 in ONFH group and 94.0 ± 2.4 in osteoarthritis group, showing no significant difference between two groups (P gt; 0.05); but there were significant differences between pre- and post-operation (P lt; 0.01). Conclusion The cl inical short-term outcomes ofmetal-on-metal total hip resurfacing arthroplasty to treat ONFH are satisfactory. It can achieve similar outcomes to that ofosteoarthritis group. More cases and long-term follow-up are needed to investigate long-term cl inical outcomes.