目的 探讨炔雌醇环丙孕酮联合二甲双胍对多囊卵巢综合征(PCOS)患者促排卵结局及性激素水平的影响。方法 选择2015年3月—2016年12月我院收治的多囊卵巢综合征(PCOS)患者90例,将其参照随机数字表法分为2组,各45例。对照组给予炔雌醇环丙孕酮治疗,在此基础上给予观察组二甲双胍治疗,1个疗程后评估两组临床疗效、性激素水平、药物不良反应,并观察治疗6个月后2组促排卵结局。结果 观察组治疗总有效率、排卵率、妊娠率均较对照组高,T、E₂、LH水平较对照组低,差异具有统计学意义(P＜0.05);观察组不良反应率与对照组相比,差异无统计学意义(P＞0.05)。结论 炔雌醇环丙孕酮联合二甲双胍可显著提高PCOS临床疗效,改善性激素水平及促排卵结局,且不增加不良反应率,安全性较高。

雄激素性脱发是一种人群中常见的损容性疾病,其发病与多种因素有关,而遗传因素在发病率中具较大的影响。低能量激光疗法(Low-Level Laser Therapy)是近年来用于治疗雄激素性脱发的光疗技术。低能量激光是一种低能量,短波长的激光,因早期研究发现其具有促进毛发生长的作用而被用于研究治疗雄激素性脱发(AGA)。在低功率激光疗法中,通过使用低能量激光照射毛囊,使毛囊炎性反应得以减轻,同时促进细胞新陈代谢,从而使休止期毛囊复苏,达到促进毛发生长的作用。本文通过对低能量激光疗法治疗雄激素性脱发的机制及效果进行论述,并讨论局部治疗、系统治疗等其他方法联合低功率激光在AGA治疗中的研究进展。

Androgenetic alopecia is a common and ashamed disease in the human population. Its incidence is related to a variety of factors, and the gene have a greater impact on the incidence. Low-level laser therapy LLLT is a phototherapy technique for the treatment of androgenetic alopecia in recent years. Low-level laser means low-energy, short-wave length that have been used for research and treatment of androgenetic alopecia because of the early discovery which is promoting hair growth. In LLLT, the laser irradiates hair follicles, so that reduces the folliculitis, while promoting cell metabolism.From this, the dormant hair follicles resume growth. This article discusses the mechanism and effect of low-level laser therapy for the treatment of androgenetic alopecia, and further discusses the advancement of topical treatment, systemic treatment, and other methods which combined with low-level laser in the treatment of AGA.

目的 探讨广州地区老年人维生素D水平及其与骨密度、甲状旁腺激素的相关性。方法 收集2016年6月—12月在广州市第一人民医院老年病科就诊的患者。检测25-羟维生素D、甲状旁腺激素、Ⅰ型前胶原氨基端前肽、β-Ⅰ型胶原C端肽、腰椎和髋部骨密度。将患者分为维生素D缺乏组(≤20 ng/mL)、维生素D不足组(20～30 ng/mL)、维生素D充足组(≥30 ng/mL)。结果 ①426例研究对象的平均年龄是(79.77±7.69)岁,25羟维生素D平均值是(20.38±8.20)ng/mL。维生素D缺乏、不足、充足者比例分别是53%(226/426)、34.3%(146/426)、12.7%(54/426)。②25羟维生素D水平随年龄增加而降低。25羟维生素D与股骨颈和全髋骨密度呈正相关(r=0.18,P＜0.001),与甲状旁腺激素呈负相关(r=-2.05,P＜0.001)。结论 广州地区老年人维生素D不足及缺乏十分普遍。维生素D与股骨颈、髋部骨密度呈正相关,与甲状旁腺激素呈负相关。

Objective To investigate the vitamin D level of elder people in Guangzhou and the relationship in vitamin D, bone mineral density and parathyroid hormone. Methods To screening elderly patients in the geriatric department of Guangzhou First peoples Hospital from June to December 2016.Serum 25-hydroxy vitamin D,parathyroid hormone,procollagen typeⅠN-terminal propeptide,β-crosslaps of C-telopeptide of typeⅠcollagen,bone mineral density were measured.Three groups were divided according to the serum 25(OH)D level,including deficiency group(≤20 ng/mL),insufficiency group(20-30 ng/mL) and sufficiency group(≥30 ng/mL). Results The mean age of the 426 subjects was 79.77±7.69 years old. The average level of 25(OH)D was 20.38±8.20 ng/mL. The proportion of vitamin D deficiency, insufficient and sufficient persons were 53% (226/426), 34.3% (146/426), and 12.7% (54/426). The level of 25 hydroxy vitamin D was decreased with age.Correlation analysis showed that 25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density(r=0.18,P＜0.001),was negatively correlated with parathyroid hormone(r=-2.05,P＜0.001). Conclusion Vitamin D deficiency or insufficiency is highly prevalent in elderly men in Guangzhou.25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density, negatively correlated with parathyroid hormone.

目的 比较阿那曲唑与他莫昔芬治疗激素受体阳性绝经后转移性乳腺癌[HR（+）MBC]的疗效和安全性。方法 本次研究对象为在我院诊治的80例HR（+）MBC患者,选取时间段为2016年1月—2018年1月,随机分为各40例的阿那曲唑组与他莫昔芬组,比较两组临床疗效及安全性差异。结果 治疗3个月后,阿那曲唑组的临床缓解率（92.50%）优于他莫昔芬组（72.50%）,性激素E2、LH、P水平低于他莫昔芬组,T水平高于他莫昔芬组（P<0.05）;治疗期间,两组患者的不良反应发生率（30.00%、25.00%）比较无统计学意义（P>0.05）。结论 阿那曲唑治疗HR（+）MBC效果确切,有利于调节机体性激素水平,减慢癌症进展,对于提高患者的生存质量有重要意义。

目的 观察尝试采用激素替代疗法(hormonereplace menttherapy,HRT)治疗更年期疾病的干眼症的临床疗效。方法 将80例(160眼)干眼症患者随机分成2组,治疗组40例(80眼)在滴人工泪液的基础上采用激素替代疗法(HRT)口服治疗。对照组40例(80眼)单纯采用人工泪液滴眼液滴双眼。两组同时给予综合护理。3个月后观察疗效。结果 治疗组总有效率82.5%,对照组总有效率60%,两组总有效率比较差异有统计学意义(P<0.05),治疗组疗效优于对照组。结论 在人工泪液滴眼液滴双眼的基础上尝试采用激素替代疗法(HRT)治疗更年期疾病的干眼症患者,效果优于单纯应用人工泪液点眼。

Objective To investigate the role of hormone replace menttherapy (HRT) in treating xerophthalmia among patients with climacteric disease. Methods Eighty xerophthalmia patients (160 eyes) were randomly divided into two groups. Forty patients in the treatment group (80 eyes) were treated using combined HRT and artificial drops. Forty patients in the control group (80 eyes) were treated using artificial drops alone. All patients were provided comprehensive nursing. The evaluation of clinical effects was performed after 3 months of treatment. Results The total effective rate of both groups was 82.5% in the treatment group and 60% in the control group, respectively (P<0.05). Conclusion Combined HRT and artificial drops is more effective in treating climacteric disease-related xerophthalmia than using artificial drops only.

目的 观察不同疗程吗替麦考酚酯(MMF)治疗激素依赖或激素抵抗成人微小病变肾病(MCD)的疗效和复发率。方法 2011年2月—2013年8月我院收治的25例激素依赖或抵抗成人MCD,随机分为短疗程组12例和长疗程组13例。短疗程组给予MMF联合口服泼尼松治疗6个月,观察12月,长疗程组治疗18个月,前6个月治疗同短疗程组,此后单用小剂量MMF维持,观察两组的疗效及复发率。结果 长疗程组有1例因严重感染在第2月退出研究,其余24例均完成18月的随诊;两组在治疗第6月时尿蛋白定量降低、血浆白蛋白升高,均与治疗前有差异(均P<0.05);与第6月比较,疗程结束时短疗程组尿24小时蛋白定量升高(P<0.05),长疗程组尿24小时定量无明显改变(P>0.05);治疗第6月两组均有9例完全缓解(75%),两组无差异(χ²=0.372,P>0.05);治疗第18月时与第6月比较,短疗程组6例复发(54.54%),长疗程组有2例复发(18.18%),两组复发率比较无差异(χ²=0.076,P>0.05)。结论 MMF能有效诱导缓解成人MCD,小剂量维持治疗可以有效降低复发率。

Objective To observe the efficacy and recurrence rates of mycophenolate mofetil (MMF) on hormone-dependent or steroid-resistant adult minimal change disease (MCD). Methods We retrospectively reviewed the records of adult patients at Shunde district hospital of traditonal Chinese medicine of Foshan for minimal change from February 2011 to August 2013. All patients who were hormone-dependent or steroid-resistant were collected. Twenty-five patients were randomly divided into short or long course group. The patient at short course group was given MMF combined with oral prednisone for 6 months, and the long course group was given for 18 months. Patient demographics, efficacy of medicines and recurrence rates were observed. Results Except one case of the long course group quitting at the second month because of severe infection, the other cases all finished the 18 months of follow up. At the 6 month after therapy with MMF, in both group, the 24h urine protein had lowered significantly (P<0.05) and the serum albumin level had risen remarkably (P<0.05). At the end of the follow up, compared with the 6 month after therapy, the 24 h urine protein of the short course group had increased (P<0.05), while those of the long course group had no obvious difference (P>0.05). At the 6 month after therapy, there were 9 cases achieved complete remission.There was no significant difference between the two groups (χ²=0.372, P>0.05). At the end of the follow up, compared with the 6 month after therapy, there were 6 cases experienced relapse (54.54%) in the short course group and 2 cases of those in the long course group (18.18%), but with no significant difference between them (χ²=0.076, P>0.05). Conclusion MMF can induce the remission of adult MCD efficiently, and its low dose maintenance treatment can decrease recurrence rates.

目的 评估SCORTEN评分与我国SJS/TEN患者疾病严重程度的一致性,比较单用糖皮质激素(TCS)和糖皮质激素—丙种球蛋白冲击(TCS-IVIG)联合治疗SJS/TEN的临床效果。方法 收集我院2005年6月—2015年5月住院的SJS/TEN患者,计算每例患者的SCORTEN评分,采用Hosmer-Lemeshow检验评估SCORTEN模型的预期死亡率和实际死亡率的拟合度;比较单用TCS和TCS-IVIG联合治疗的患者在疾病严重程度、住院天数、疾病控制时间和死亡率方面的差异。结果 SCORTEN模型的预期死亡率和实际死亡率之间的拟合度良好(各组P值均大于0.5);二组患者在住院天数、疾病控制时间和死亡率方面的差异没有统计学意义(P分别为0.105,0.910,0.701),但TCS-IVIG组患者的疾病严重程度显著高于TCS组(P=0.017)。结论 SCORTEN评分可以用于评估国内SJS/TEN患者的病情严重程度,并预测患者预后;与单用TCS相比,联合IVIG有助于提高重症SJS/TEN患者的救治效果。

Objectivs To evaluate the performance of SCORTEN in severity of SJS/TEN in China, and to compare the efficacy of corticosteroid therapy (TCS) and intravenous immunoglobulin combined therapy (TCS-IVIG). Methods Collected retrospectively the data of the SJS/TEN patients from June 2005 to May 2015 in our hospital. Hosmer-Lemeshow statistic were used to assess SCORTEN model calibration. And the differences between TCS group and TCS-IVIG group were compared in severity-of-illness, length of hospitalization, disease control time and mortality. Results A good calibration were found in all groups (all P＞0.5). Although the severity-of-illness in the TCS-IVIG group was significantly higher than that in the TCS group (P=0.017), there was no statistical significance between the two groups in length of hospitalization, disease control time and mortality (P=0.105, 0.910, 0.701, respectively). Conclusion SCORTEN can be used to assess the severity-of-illness in Chinese patients with SJS/TEN and to predict the prognosis. Compared with single TCS, It could improve the clinical outcomes of patients with severe SJS/TEN combined with IVIG.

目的 探讨联合运用透明质酸钠及雌激素预防人工流产术后子宫内膜炎的临床疗效。方法 选择2015年1月—2015年6月在我院接受人工流产术者97例,随机分为观察组48例及对照组49例。对照组术后服用雌激素,观察组同时服用雌激素及透明质酸钠。于术后1周、3周时检测两组患者子宫内膜炎症状评分及宫颈分泌物炎症指标。结果 经过21天的干预之后,两组患者子宫内膜炎症状相比较,观察组患者下腹疼痛、白带增多及发热得分都低于观察组(P<0.05)。宫颈分泌物的CRP、IL-6、IL-9水平检测,术前两组患者之间差异不显著;治疗1周时,两组炎症因子水平均升高,但对照组变化更为明显;干预3周后,两组炎症因子水平较之1周时有所下降,但观察组基本降至正常水平,与对照组相比,差异有统计学意义(P<0.05)。结论 透明质酸钠联合雌激素预防人工流产术后子宫内膜炎效果明显,值得临床推广。

目的 观察十一酸睾酮联合左卡尼汀治疗特发性弱精症的疗效。方法 回顾性分析2012年11月—2014年6月在我科诊断为弱精子症的386例患者的临床资料,按标准分成轻(A组)、中(B组)、重(C组)3组。分别给予左卡尼汀、十一酸睾酮联合左卡尼汀治疗,观察两种治疗方法对特发性弱精子症的疗效。结果 A组、B组患者两种治疗方法治疗后精子PR均有升高,差异有统计学意义(P＜0.05),C组患者给予左卡尼汀治疗患者治疗后PR无改善,差异无统计学意义(P＞0.05);十一酸睾酮联合左卡尼汀治疗患者治疗后PR升高,差异有统计学意义(P＜0.05)。A、B、C组患者给予左卡尼汀治疗的有效率分别是47.6%,41.7%,18.9%,总有效率为37.9%;A、B、C组患者给予十一酸睾酮联合左卡尼汀治疗的有效率分别是52.6%,45.5%,34.7%,总有效率为45.5%。A组、B组患者两种治疗方法疗效无差异(P＞0.05);C组患者给予十一酸睾酮联合左卡尼汀组有效率高于给予左卡尼汀组,差异有统计学意义(P＜0.05)。结论 十一酸睾酮联合左卡尼汀治疗特发性弱精子症的疗效优于左卡尼汀单一用药。

Objective To observe the effects of eleven acid testosterone combined with L-carnitine on curing idiopathic asthenospermia. Methods Retrospective analysed the clinical data of 386 patients with asthenospermia patients from November 2012 to June 2014 in our department.According to the standard,the patients were divided into mild A,moderate B,severe C in 3 groups,given L-carnitine treatment and given eleven acid testosterone combined with L-carnitine treatment.We observed effect of the two therapeutic methods for the treatment of idiopathic asthenospermia. Results The sperm PR were increased,In group A and group B patients after treated.The difference was statistically significant(P<0.05).In group C,the patients received the treatment of L-carnitine,the sperm PR has no obvious improvement,There was no significant difference(P>0.05).The patients received the treatment of eleven acid testosterone combined with L-carnitine the sperm PR significantly increased,the difference was statistically significant(P<0.05).The treatment efficiency of A,B,C group received L-carnitine were 47.6%,41.7%,18.9%,the total effective rate was 37.9%.The treatment efficiency of A,B,C group received eleven acid testosterone combined with L-carnitine were 52.6%,45.5%,34.7%,the total effective rate was 45.5%;There was no significant difference in group A and group B(P>0.05).The treatment efficiency in group C received eleven acid testosterone combined with L-carnitine group is obviously higher than that given L-carnitine group,the difference was statistically significant(P<0.05). Conclusion The curative effect of eleven acid testosterone combined with L-carnitine in the treatment of idiopathic asthenospermia is better than that of L-carnitine single drug treatment.

目的 探讨脑梗塞与雌激素及高同型半胱氨酸血症之间的相关性。方法 纳入我院2013年1月—2014年11月确诊为脑梗塞的患者100例,正常对照的健康体检者100例,比较两组患者的血浆高同型半胱氨酸和雌激素水平。结果 脑梗死患者的血浆同型半胱氨酸水平高于正常组,两组比较差异有统计学意义(P＜0.05);高同型半胱氨酸血症脑梗塞组为72例,正常组为18例,两组比较差异有统计学意义(P＜0.05);同型半胱氨酸的阳性率男性为92%,女性为44%,男性患者高于女性,(P＜0.05);脑梗塞组雌激素水平降低,脑梗塞和雌激素水平呈负相关(P＜0.05),有糖尿病和酗酒的患者E2水平低于无糖尿病和酗酒的E2水平,差异有统计学意义(P＜0.05)。结论 急性脑梗塞患者同型半胱氨酸水平高于正常组,雌激素水平低于正常组,高同型半胱氨酸血症是脑梗死的重要危险因素,雌激素为脑梗塞患者的保护性因素。