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中国医师进修杂志
中国医师进修杂志

姒健敏

旬刊

1673-4904

yishi@zgysjxzz.com

0411-82482314

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国医师进修杂志/Journal Chinese Journal of Postgraduates of Medicine北大核心CSTPCD
查看更多>>1978年创刊，中华人民共和国卫生部主管，中华医学会主办。本刊是综合性临床医学期刊，其主要读者对象为临床中、高级内、外、妇、儿、五官科医务人员。从创刊至今始终坚持以继续医学教育、岗位进修培训为办刊宗旨。现开设的主要栏目：专题辅导、专家论坛、临床论著、进展概述、综述与讲座、教学查房、临床病例讨论、病例报告、探讨与评价、药物与临床、影像与临床、新技术介绍、教训纵横等。其中专题辅导、教学查房等栏目深受读者欢迎。
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    阿托伐他汀联合吲哚布芬治疗老年糖尿病肾脏病合并大动脉粥样硬化型缺血性卒中恢复期的临床研究

    李美杰马艳时伟张立娜...
    247-253页
    查看更多>>摘要：目的 探讨阿托伐他汀联合吲哚布芬治疗老年糖尿病肾脏病（DKD）合并大动脉粥样硬化型缺血性卒中（LAA-IS）恢复期的有效性和安全性。 方法 回顾性分析2018年9月至2022年4月保定市第二中心医院102例老年DKD合并LAA-IS恢复期患者的临床资料。其中，采用阿托伐他汀联合吲哚布芬治疗51例（观察组），阿托伐他汀联合阿司匹林治疗51例（对照组），均连续治疗6个月。比较两组治疗前后血栓前状态指标，包括花生四烯酸（AA）和二磷酸腺苷（ADP）诱导血小板聚集率、纤维蛋白原（FIB）、蛋白C；神经功能和日常生命质量，采用美国国立卫生研究院卒中量表（NIHSS）评估神经功能缺损情况，采用改良Barthel指数（MBI）评估日常生命质量；颈动脉超声指标，包括颈动脉内膜-中层厚度（IMT）和最大斑块面积；肾纤维化指标，包括转化生长因子-β1（TGF-β1）、基质金属蛋白酶-9（MMP-9）、透明质酸和血小板衍生生长因子-BB（PDGF-BB）。记录药物不良反应发生情况。 结果 两组治疗前各观察指标比较差异无统计学意义（P>0.05）。两组治疗后AA诱导血小板聚集率、ADP诱导血小板聚集率、FIB、NIHSS评分、IMT和最大斑块面积明显低于治疗前，蛋白C和MBI评分明显高于治疗前，差异有统计学意义（P<0.01）；两组治疗后比较差异无统计学意义（P>0.05）。两组治疗后TGF-β1、MMP-9、透明质酸和PDGF-BB明显低于治疗前，且观察组明显低于对照组[（39.46 ± 6.89） μg/L比（45.04 ± 8.20） μg/L、（278.46 ± 49.39） μg/L比（327.30 ± 57.28） μg/L、（102.37 ± 20.62） μg/L比（116.84 ± 24.97） μg/L和（25.26 ± 4.45） μg/L比（28.13 ± 5.08） μg/L]，差异有统计学意义（P<0.01）。观察组不良反应发生率明显低于对照组[7.84%（4/51）比23.53%（12/51）]，差异有统计学意义（P<0.05）。 结论 与阿托伐他汀联合阿司匹林相比，老年DKD合并LAA-IS恢复期患者给予阿托伐他汀联合吲哚布芬在改善血栓前状态相关指标、减少神经功能缺损、提高日常生命质量、逆转颈动脉粥样硬化方面的效果相当，但阿托伐他汀联合吲哚布芬能进一步保护患者肾功能，安全性更高。 Objective To investigate the efficacy and safety of atorvastatin combined with indobufen in the treatment of elderly patients with diabetic kidney disease (DKD) complicated with large atheromatous ischemic stroke (LAA-IS) during convalescence. Methods The clinical data of 102 elderly patients with DKD complicated with LAA-IS during convalescence from September 2018 to April 2022 in Baoding Second Central Hospital were retrospectively analyzed. Among them, 51 patients were treated with atorvastatin combined with indobufen (observation group), 51 patients were treated with atorvastatin combined with aspirin (control group), and both groups were treated continuously for 6 months. The prethrombotic state indexes, neurological function and quality of daily life, carotid artery ultrasound indexes, renal fibrosis indexes before treatment and after treatment were compared between two group. The prethrombotic state indexes included arachidonic acid (AA) and adenosine diphosphate (ADP) induction platelet aggregation rate, fibrinogen (FIB), protein C the National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function, and the modified Barthel index (MBI) was used to evaluate the quality of daily life carotid artery ultrasound indexes included carotid artery intima-media thickness (IMT) and maximum plaque area the renal fibrosis indexes included transforming growth factor-β1 (TGF-β1), matrix metalloproteinase-9 (MMP-9), hyaluronic acid and platelet derived growth factor-BB (PDGF-BB). The adverse reactions were recorded. Results There were no statistical differences in the all indexes before treatment between two groups (P>0.05). In two groups, compared before treatment, the AA induction platelet aggregation rate, ADP induction platelet aggregation rate, FIB, NIHSS score, IMT and maximum plaque area after treatment were significantly lower, the protein C and MBI score were significantly higher, and there were statistical differences (P<0.01) but there were no statistical differences after treatment between two groups (P>0.05). The TGF-β1, MMP-9, hyaluronic acid and PDGF-BB after treatment in two groups were significantly lower than before treatment, and the indexes in observation group were significantly lower than those in control group: (39.46 ± 6.89) μg/L vs. (45.04 ± 8.20) μg/L, (278.46 ± 49.39) μg/L vs. (327.30 ± 57.28) μg/L, (102.37 ± 20.62) μg/L vs. (116.84 ± 24.97) μg/L vs. (25.26 ± 4.45) μg/L vs. (28.13 ± 5.08) μg/L, with statistically significant differences( P<0.01). The incidence of adverse reactions in observation group was significantly lower than that in control group: 7.84% (4/51) vs. 23.53% (12/51), and there was statistical difference (P<0.05). Conclusions Compared with atorvastatin combined with aspirin, atorvastatin combined with indobufen in elderly patients with DKD complicated with LAA-IS during convalescence has the same effect in improving the related indicators of prethrombotic state, reducing neurological function deficit, improving the ability of daily living, and reversing carotid atherosclerosis. However, atorvastatin combined with indobufen can further protect renal function with higher safety.

    糖尿病肾病糖尿病,2型老年人脑梗死阿托伐他汀吲哚布芬

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    基于微血管并发症探究罗沙司他联合左卡尼汀治疗糖尿病肾脏病血液透析患者肾性贫血的疗效

    薛宇韦丽王婷婷李亚伟...
    254-259页
    查看更多>>摘要：目的 探究罗沙司他联合左卡尼汀治疗糖尿病肾脏病（DKD）血液透析患者肾性贫血的效果及对铁代谢、微炎性状态和微血管并发症的影响。 方法 回顾性分析2020年1月至2021年10月北京老年医院89例DKD血液透析肾性贫血患者的临床资料。其中，采用重组人促红素和左卡尼汀治疗肾性贫血44例（对照组），采用重组人促红素、左卡尼汀和罗沙司他治疗肾性贫血45例（研究组），治疗3个月。比较两组疗效。于治疗前和治疗1、3个月后检测实验室指标，其中贫血相关指标包括血红蛋白、红细胞计数和红细胞平均体积（MCV），铁代谢指标包括血清铁、铁蛋白和转铁蛋白饱和度（TSAT），炎性指标包括白细胞介素-8（IL-8）、C反应蛋白（CRP）和肿瘤坏死因子-α（TNF-α）。记录不良反应；治疗后随访1年，记录糖尿病微血管并发症发生情况，包括糖尿病周围神经病变（DPN）和糖尿病视网膜病变（DR）。 结果 研究组总有效率明显高于对照组[93.33%（42/45）比77.27%（34/44）]，差异有统计学意义（χ2 = 4.60，P<0.05）。两组治疗前各实验室指标比较差异无统计学意义（P>0.05）；研究组治疗1和3个月后血红蛋白、红细胞计数、MCV、血清铁、铁蛋白和TSAT明显高于对照组，IL-8、CRP和TNF-α明显低于对照组，差异有统计学意义（P<0.01或<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。治疗结束后随访1年，研究组失访2例，对照组失访3例。研究组DR和DPN发生率明显低于对照组[0比14.63%（6/41）和2.33%（1/43）比19.51%（8/41）]，差异有统计学意义（χ2 = 4.75和4.81，P<0.05）。 结论 罗沙司他联合左卡尼汀治疗DKD血液透析患者肾性贫血效果可靠且安全，可有效缓解贫血症状，提高铁代谢水平，减轻炎性反应，降低糖尿病微血管并发症发生风险。 Objective To investigate the effect of roxadustat combined with levocarnitine in the treatment of renal anemia in hemodialysis patients with diabetic kidney disease (DKD), and its effects on iron metabolism, microinflammation status and microvascular complications. Methods The clinical data of 89 hemodialysis renal anemia patients with DKD from January 2020 to October 2021 in Beijing Geriatric Hospital were retrospectively analyzed. Among them, 44 patients (control group)were treated with recombinant human erythropoietin and levocarnitine for renal anemia, and 45 patients (study group) were treated with recombinant human erythropoietin, levocarnitine and roxadustat for renal anemia. Both groups were treated for 3 months. The efficacy was compared between two groups. The laboratory indexes were measured before treatment and after 1, 3 months of treatment, including anemia related indexes such as hemoglobin, red blood cell count and mean corpuscular volume (MCV) iron metabolism indexes such as serum iron, ferritin and transferrin saturation (TSAT) inflammatory indexes such as interleukin-8 (IL-8), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α). The adverse reactions were recorded. The patients were followed up for 1 year after treatment, the incidence of diabetic microvascular complications, including diabetic peripheral neuropathy (DPN) and diabetic retinopathy (DR), was recorded. Results The total effective rate in study group was significantly higher than that in control group: 93.33% (42/45) vs. 77.27% (34/44), and there was statistical difference (χ2 = 4.60, P<0.05). There were no statistical differences in the laboratory indexes before treatment between two groups (P<0.05) the hemoglobin, red blood cell count, MCV, serum iron, ferritin and TSAT after 1 and 3 months of treatment in study group were significantly higher than those in control group, the IL-8, CRP and TNF-α were significantly lower than those in control group, and there were statistical differences (P<0.01 or <0.05). There was no significant difference in the incidence of adverse reactions between two groups (P>0.05). After 1 year follow-up, 2 cases were lost in study group and 3 cases in the control group. The incidence of DR and DPN in study group were significantly lower than those in control group: 0 vs. 14.63% (6/41) and 2.33% (1/43) vs. 19.51% (8/41), and there were statistical differences (χ2 = 4.75 and 4.81, P<0.05). Conclusions Roxadustat combined with levocarnitine in the treatment of renal anemia in hemodialysis patients with DKD is reliable and safe, and can effectively relieve anemia symptoms, improve iron metabolism, reduce inflammatory response, and reduce the risk of diabetic microvascular complications.

    糖尿病肾病肾透析贫血左卡尼汀罗沙司他

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    导管导向溶栓与导管导向取栓术治疗高危肺栓塞的疗效比较

    王冲崔飞飞陈永山宇轲...
    259-263页
    查看更多>>摘要：目的 比较导管导向溶栓与导管导向取栓术治疗高危肺栓塞的疗效。 方法 回顾性分析2020年4月至2023年1月河北中石油中心医院105例高危肺栓塞患者的临床资料。其中，采用导管导向溶栓治疗52例（溶栓组），导管导向取栓术治疗53例（取栓组）。比较两组疗效、症状缓解时间、血氧饱和度恢复时间、病死率、Qanadli栓塞指数、肺动脉压力和并发症。 结果 两组总有效率、症状缓解时间、血氧饱和度恢复时间、病死率和总并发症发生率比较差异无统计学意义（P>0.05）。溶栓组和取栓组治疗后Qanadli栓塞指数和肺动脉压力明显低于治疗前[溶栓组：22.08 ± 8.57比45.18 ± 13.27和（24.18 ± 5.19） mmHg（1 mmHg = 0.133 kPa）比（34.15 ± 6.22） mmHg，取栓组：23.11 ± 8.62比44.82 ± 13.14和（23.66 ± 5.02） mmHg比（34.89 ± 6.27） mmHg]，差异有统计学意义（P<0.01）；两组治疗前后Qanadli栓塞指数和肺动脉压力比较差异无统计学意义（P>0.05）。 结论 在高危肺栓塞患者中，导管导向溶栓和导管导向取栓术均具有良好的疗效，能促进临床症状缓解和血氧饱和度恢复，改善预后。 Objective To compare the efficacy of catheter-directed thrombolysis versus catheter-directed thrombectomy for high-risk pulmonary embolism. Methods The clinical data of 105 patients with high-risk pulmonary embolism from April 2020 to January 2023 in Hebei China Petroleum Central Hospital were retrospectively analyzed. Among them, 52 patients were treated with catheter-directed thrombolysis (thrombolysis group), and 53 patients were treated with catheter-directed thrombectomy (thrombectomy group). The efficacy, symptom relief time, oxygen saturation recovery time, mortality rate, Qanadli embolic index, pulmonary artery pressure and complications were compared between two groups. Results There were no statistical differences in total effective rate, symptom relief time, oxygen saturation recovery time, mortality rate and total incidence of complications between two groups (P>0.05). Compared with before treatment, the Qanadli embolic index and pulmonary artery pressure after treatment in thrombolysis group and thrombectomy group were significantly lower, thrombolysis group: 22.08 ± 8.57 vs. 45.18 ± 13.27 and (24.18 ± 5.19) mmHg (1 mmHg = 0.133 kPa) vs. (34.15 ± 6.22) mmHg, thrombectomy group: 23.11 ± 8.62 vs. 44.82 ± 13.14 and (23.66 ± 5.02) mmHg vs. (34.89 ± 6.27) mmHg, and there were statistical differences (P<0.01) but there was no statistical difference the Qanadli embolic index and pulmonary artery pressure before and after treatment between two groups (P>0.05). Conclusions In patients with high-risk pulmonary embolism, both catheter-directed thrombolysis and catheter-directed thrombectomy have good efficacy and can promote the relief of clinical symptoms and the recovery of oxygen saturation, improving the prognosis.

    肺栓塞血栓溶解疗法血栓切除术疗效比较研究

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    晕厥患者发作症状及同步脑电监测特征2例报告

    陈佳任连坤张莉
    264-267页
    查看更多>>摘要：晕厥和癫痫的发作症状存在一定的重叠，这可能导致晕厥患者被误诊为癫痫。为了提高诊断的准确性，详细询问病史和视频脑电监测是至关重要的。晕厥患者脑电图改变主要为"慢波"和"慢-平-慢波"模式，不同的脑电图模式与不同的症状表现相关联。在发作期间观察抽动次数、是否伴随失张力发作、是否有口舌咬伤迹象以及患者主观感觉有助于两者的鉴别诊断。在无法进行视频脑电图监测的情况下，使用智能手机录制患者的发作视频也是一个有效的替代手段。

    晕厥癫痫脑电波体征和症状病例报告

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    膀胱继发性肾源性腺瘤1例报告

    徐立静孙光曦曾浩张莉...
    267-270页
    查看更多>>摘要：总结1例膀胱继发性肾源性腺瘤的临床特点与诊断过程，以提供对该罕见疾病的认识和了解。

    腺瘤膀胱尿道上皮病例报告

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    急性心肌梗死合并糖代谢异常的诊疗现状

    韩雪雪夏经钢张莉
    271-274页
    查看更多>>摘要：急性心肌梗死有较高的发生率和病死率，对全球健康有着巨大的影响。糖代谢异常是心血管疾病发病和死亡的独立危险因素。了解急性心肌梗死后糖代谢异常的分类、流行病学特点及与预后的相关性等内容极其重要。通过对急性心肌梗死后糖代谢异常的诊疗现状进行总结，旨在阐明不同类型糖代谢异常对急性心肌梗死患者预后的影响，为临床早期干预提供帮助，进一步促进急性心肌梗死患者慢性病管理水平的提高。

    急性心肌梗死糖代谢异常治疗综述

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    急性中高危肺栓塞远期预后现况及影响因素

    冯淑惠尹春琳张莉
    275-279页
    查看更多>>摘要：急性中高危肺栓塞因其较高的发病率和病死率，在临床上一直受到广泛关注。关于治疗方式选择的衡量，目前研究多着眼于近期预后，对远期预后的关注较少。了解患者的远期预后现况及其影响因素，特别是右心功能和生命质量情况，可为治疗策略的制定提供更多维度的科学依据。

    肺栓塞预后危险因素综述

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    急性心肌梗死合并糖尿病治疗新进展

    张天行夏经钢张莉
    280-284页
    查看更多>>摘要：目前，急性心肌梗死合并糖尿病发病率较高，患者预后差、经济负担大，严重危害人类健康。了解急性心肌梗死合并糖尿病流行病学、疾病特点、治疗现况、预后现状及相关影响因素等内容，可为深入探究共病综合管理策略提供理论依据，以提升患者生命质量、改善预后。

    心肌梗死糖尿病预后综述

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    维生素D与帕金森病

    刘月赵红尹文超王翠...
    285-288页
    查看更多>>摘要：维生素D（VitD）是一种脂溶性维生素，为糖皮质激素类衍生物，VitD可以调节钙磷代谢，增强细胞的增殖与分化。VitD在中枢神经系统代谢中扮演着重要角色，然而VitD与帕金森病（PD）患病风险、PD运动症状和非运动症状严重程度等的关系尚不明确。探讨VitD与PD患病风险、PD症状相关性以及VitD可能影响PD的机制，以期为临床研究提供依据。

    帕金森病维生素D运动症状非运动症状

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