临床诊疗

中西医结合治疗绝经后骨量减少及骨质疏松患者骨代谢指标影响的临床观察

Clinical Observation of Bone Metabolic Index in Post menopause Osteopenia and Osteoporosis Patients Treated by Combination of TCM and WM

:64-65
 
目的 通过比较治疗组服药前、后骨密度及骨代谢指标的变化情况,并将治疗组、对照组分别作对比,观察壮骨颗粒治疗绝经后女性骨量减少及骨质疏松、改善其骨代谢的临床疗效。方法 将研究对象随机分为两组,治疗组服用壮骨颗粒+迪巧,对照组只服用迪巧。结果 壮骨颗粒组治疗后血清中的PINP、β-Crosslaps及N-MID下降(P<0.05);与治疗前相比,腰椎(L2-L4)BMD提高(P<0.05);壮骨颗粒能改善绝经后女性骨代谢及提高骨密度的效果优于迪巧组。结论 壮骨颗粒是治疗绝经后女性骨量减少及骨质疏松、提高骨量、改善骨代谢情况的安全有效药物。
学术前沿

先天性血管瘤的研究进展

Research progress of congenital hemangioma

:1021-1027
 
        先天性血管瘤(CH)是一种较为罕见的良性血管肿瘤,出生前瘤体已经存在,按照出生后瘤体的生长特征可分为4类:不消退型CH、部分消退型CH、快速消退型CH以及迟发性扩张型CH。不同类型的CH其临床特征及治疗方式不同。结合近年CH的研究进展报道,文章对CH的发病机制、临床特征、诊断及治疗着重进行综述,以期更好地为临床诊治提供指导。
        Congenital hemangioma(CH)is a relatively rare benign vascular tumor that is present before birth.Based on the growth characteristics of CH after birth,CH can be classified into four types:non-involuting congenital hemangioma,partially involuting congenital hemangioma,rapidly involuting congenital hemangioma,and delayed expanding congenital hemangioma.Different types of CH exhibit distinct clinical features and require different treatment approaches.This  review focuses on  recent research advances in CH,including its pathogenesis,clinical characteristics,diagnosis,and treatment,aiming to provide better guidance for clinical practice.
医院管理

广州中医优势病种分值付费政策实施效果探析

Analysis on the effect of dominant diseases of traditional Chinese medicine under the DIP payment mode in Guangzhou

:849-854
 
       目的   分析广州市中医优势病种按病种分值付费政策实施效果,以期为完善广州市中医病种付费方式改革提供参考思路。方法   以广州市某三甲中医医院住院患者在政策实施前(n=6 057)及实施后(n=7 208)住院病历为研究样本,对医院次均住院医疗费用、中医综合治疗费占比、平均住院日进行两独立样本非参数检验等描述性统计分析。  政策实施后,住院人次增长19%,患者次均住院医疗费用下降7.02%(P<0.001),中医综合治疗费用占比提升0.8%P>0.05),医疗机构平均住院日缩短0.63 d(P<0.001),入组中医优势病种患者自费率较非入组的低,医疗机构总体病例组合指数下降,中医优势病种结算有盈余。结论  中医优势病种按病种分值付费政策有利于医保-患者-医院三方共赢;但中医优势病种入组率有待提高,建议加大对中医医疗机构的支持与助力;中医综合治疗费用占比提升不显著,建议完善中医治疗项目医疗服务价格动态调整机制;中医优势病种仅局限在住院,建议实现诊疗单元全覆盖。
       Objective  To discuss the correlation analysis of the hospitalization expenses of TCM dominant diseases under the DIP payment mode,and provide a reference for further promoting the reform of the payment mode of TCM dominant diseases in Guangzhou.Methods  The nonparametric test was used to analyze the number of inpatients,the average hospitalization cost,and the proportion of TCM comprehensive treatment on the data of inpatient records before and after the implementation of the TCM dominant diseases policy,the sample sizes were 6 057 and 7 028 respectively.Results  After the implementation of the TCM dominant diseases policy,there was a slight fluctuation in the number of inpatients from 6 057 to 7 208,the average hospitalization cost was decreased by 7.02%(P<0.001),the proportion of TCM comprehensive treatment costs had an increase of 0.8%(P0.05),the average length of hospital stay was shorten by 0.63 days(P<0.001),the self-expense  rate of the patients with the TCM dominant diseases of in the group was lower than that of the patients without the group,the total case mix index value of the hospital decreased,but there was a surplus on the group of TCM dominant diseases settlement.Conclusios  The policy is conducive to the tripartite win-win of medical insurance,patients and hospitals.However,the enrollment rate of TCM dominant diseases need to be improved,which is suggested to increase the support for TCM hospitals.The proportion of TCM comprehensive treatment has not increased significantly,so it is suggested to improve the dynamic adjustment mechanism of medical service price of TCM treatment items.The TCM dominant diseases are only limited to hospitalization,and it is recommended to achieve full coverage of diagnosis and treatment units.
论著

类风湿因子、T 淋巴细胞亚群与类风湿关节炎病情程度的关系研究

Relationship between rheumatoid factor,T lymphocyte subsets and the degree of rheumatoid arthritis

:361-365
 
       目的   分析类风湿因子(RF)、T淋巴细胞亚群(CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ )与类风湿关节炎病情程度的关系。方法   选取2023年1月—2024年4月收治的90例类风湿关节炎患者作为观察组,同期到院的90例健康体检者为对照组,均接受RF、CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ 检测,并按照类风湿关节炎患者病情评价(DAS28)判定观察组患者病情的严重程度,应用Pearson相关性分析RF、CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ 与患者病情严重程度的关系。结果   与对照组比较,观察组RF及CD8+ 水平较高,CD3+ 、CD4+ 及CD4+ /CD8+ 水平较低(P<0.05);不同病情的RF及CD8+ 水平比较,重度患者最高,其次为中度、轻度,而CD3+ 、CD4+ 及CD4+ /CD8+ 水平比较,轻度患者最高,其次为中度、重度,两两比较均有差异统计学意义(P<0.05);经Pearson相关性分析,RF及CD8+ 水平与病情程度呈正相关,CD3+ 、CD4+ 及CD4+ /CD8+ 水平与病情程度呈负相关(P<0.05)。结论  RF、T淋巴细胞亚群指标与类风湿关节炎发生、发展有密切关系,可为医师准确评估患者病情严重程度提供可靠参考。
       Objective  To analyze the relationship between rheumatoid factor(RF),T lymphocyte subsets(CD3+CD4+ ,CD8+ ,CD4+ /CD8+ )and the severity of rheumatoid arthritis.Methods  A total of 90 patients with rheumatoid arthritis from January 2023 to April 2024 were selected as the observation group,and 90 healthy checkup individuals who came to the hospital during the same period were selected as the control group.All patients underwent RF,CD3+ ,CD4+ ,CD8+ ,and CD4+ /CD8+  tests,and the severity of their condition was determined based on the evaluation of rheumatoid arthritis patient condition(DAS28).Pearson Correlation analysis was used to analyze the relationship between RF,CD3+ ,CD4+ ,CD8+ ,CD4+ /CD8+  and the disease severity of the patients.Results  Compared with the control group,RF and CD8+  levels in the observation group were higher,while the levels of CD3+ ,CD4+  and CD4+ /CD8+  were low(P<0.05).Comparison of RF and CD8+  levels for different conditions,the RF and CD8+  levels of the severe patients was highest,followed by moderate and mild.However,the CD3+ ,CD4+  and CD4+ /CD8+levels were highest in mild patients,followed by the moderate and sereve patients.Statistical significance was found in both pairwise comparisons(P<0.05).After the Pearson correlation analysis,RF and CD8+  levels were positively correlated with the degree of disease,while CD3+ ,CD4+ ,and CD4+ /CD8+  levels were inversely associated with the degree of disease condition(P<0.05).Conclusions  RF and T lymphocyte subsets are closely related to the occurrence and development of rheumatoid arthritis,and can provide reliable references for physicians to accurately evaluate the severity of patients’ conditions.
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