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。

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 研究分析急性呼吸窘迫综合征(ARDS)患者血清甲状腺素变化与疾病的严重程度的相关性。方法 选取2016年1月—2018年1月在我院重症医学科收治的123例急性呼吸窘迫综合征及41例非急性呼吸窘迫综合征患者,根据2012柏林定义,ARDS又再划分为轻度组(26.67 kPa2/FiO₂≤40.00 kPa,PEEP或CPAP≥0.49 kPa)、中度组(13.33 kPa2/FiO₂≤26.67 kPa,PEEP≥0.49 kPa) 及重度缺氧组(PaO₂/FiO₂≤13.33 kPa,PEEP≥0.49 kPa),同时再选取同一时段内在我院进行常规体检的41例健康成人作为对照,对他们血清的甲状腺激素水平测定。结果 健康成人对照组与非ARDS组比较, 血清TSH、FT4、TT4、FTS、TT3水平测定差异没有统计学意义(P＞0.05),ARDS组较另外两组以上指标均有降低(P＜0.05),轻、中、重三组间比较,血清甲状腺素的差异存在统计学意义。结论 急性呼吸窘迫综合征患者血清甲状腺素水平与缺氧程度呈正相关,随着疾病严重程度加大,其水平差异的变化更加明显,动态监测甲状腺素水平对疾病严重程度的判断和对预后的评估具有重大意义。

Objective To analyze serum thyroid hormone level change of acute respiratory distress syndrome and the correlation between the severity of disease. Methods 123 cases (including mild 26.67 kPa2/FiO₂≤40.00 kPa,PEEP or CPAP≥0.49 kPa,moderate 13.33 kPa 2/FiO₂≤26.67 kPa,PEEP≥0.49 kPa and severe PaO₂/FiO₂≤13.33 kPa,PEEP≥0.49 kPa)of patients with acute respiratory distress syndrome and 41 cases of non-ARDS were involved. from January 2016 to January 2018 in our hospital and 41 cases of healthy people by routine check-up in our hospital during the same period were selected,then the serum thyroid hormone levels were determined. Results Compared with healthy control group,TSH、FT4、TT4、FTS、TT3 level in non-ARDS group has no statistical difference(P＞0.05),while compared with the rest of the two groups,all indexes in ARDS group were lower (P＜0.05). And TSH、FT4、TT4、FT3、TT3 levels in moderate ARDS group decreased compared with those in relatively mild ARDS (P＜0.05). The level of each index in severe ARDS group decreased compared with the moderate ARDS group (P＜0.05). There was statistical difference in detection index level in three groups. Conclusion The serum thyroid hormone level of ARDS patients is positively correlated with hypoxemia. As the pathological severity changes ,the level of hypoxemia changes are more apparent. Dynamic monitoring of serum thyroid hormone is of great significance in severity judgement and prognosis evaluation.

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 观察隔药壮灸神阙穴治疗女性黄褐斑的临床疗效及对血清性激素水平的影响。方法 将72例患者随机分为2组,治疗组38例和对照组34例,治疗组予隔药壮灸神阙穴治疗,对照组予口服维生素C、维生素E治疗,10次为1个疗程,第2、4、6疗程末观察疗效,治疗前后测定月经第2～3天血清雌二醇(E2)、孕酮(P)、泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)水平。结果 第6疗程末治疗组总有效率为83.33％,对照组总有效率30.30%,治疗组疗效优于对照组(P＜0.05),治疗组治疗前后E2、LH下降水平有统计学意义(P＜0.05)。对照组治疗前后E2、P、PRL、FSH、LH、T水平变化不明显(P＞0.05)。治疗后2组E2、LH比较,差异有统计学意义(P＜0.05)。结论 隔药壮灸神阙穴治疗女性黄褐斑临床疗效较好,可能通过调节性激素而起到治疗作用。

Objective To observe the clinical efficacy on female chloasma treated with acupuncture of Zhuang minority medicine at Shengque xue and its influence on sex hormone levels. Methods 72 cases were divided randomly into a treatment group(38 cases) and a control group(34 cases). In treatment group, acupuncture of Zhuang minority medicine at Shengque xue was applied. In control group, oral administration of vitamin C and vitamin E were given. The cases of treatment group were treated ten times as one session. At the end of 2,4,6 treatment session efficacy were analyzed respectively. The levels of serum estradiol(E2), progesterone(P), prolactin(PRL), follicule stimulating hormone(FSH), luteinizing hormone(LH) and testosterone(T) were detected on day 2-3 of menstruation. Results At the end of 6 treatment session the total effective rate was 83.33％ in treatment group and was 30.30% in control group, the efficacy in treatment group were superior to that in control group, with significant difference(P＜0.05). In treatment group, the levels of LH and E2 after treatment were lower as compared with those before treatment(P＜0.05). In control group, there were no obvious changes in E2,P, PRL, FSH, LH and T before and after treatment(P＞0.05). The levels of LH and E2 after treatment were significantly different in comparison of two groups(P＜0.05). Conclusion Acupuncture of Zhuang minority medicine at Shengque xue achieves a definite efficacy on female chloasma in clinic and its pharmacological mechanism may be relevant with its regulation on sex hormone levels for the patients.