系统性红斑狼疮误诊的反思

系统性红斑狼疮是一种极为复杂的自身免疫性疾病,临床表现变化多端,早期误诊率高.对1328例系统性红斑狼疮误诊病例进行分析,剖析了该病的本质及特征,并探讨导致误诊的原因,提出了预防误诊的对策,以期提高对本病的早期诊断.     

从临床诊治系统性红斑狼疮谈中西医结合的思路

1　既辨证、又辨病 ,诊断学上的中西医结合中医重宏观 ,西医重微观 ;中医重整体 ,西医重局部 ;中医重辨证 ,西医重辨病 ,这是中、西医学的优势和特点。分而言之 ,中医是辨证论治 ,通过望、闻、问、切四诊获得“证候”之后 ,再根据中医的藏象、经络、气血、病因病机理论 ,在证候与自然、社会、心理等诸多因素的关系分析中 ,确定病因病机以辨证求因 ;而西医是“辨病施治” ,根据来自病人、作为认识疾病重要线索的症状 ,进行具有针对性的仪器或实验室检查 ,以明确局部的病灶 (器官、组织、细胞 )的病理改变 ,或产生这种病理改变的致病因子 ,做…     

系统性红斑狼疮的临床决策

系统性红斑狼疮是临床上表现最复杂多变的疾病之一,其诊断、评价、患者教育、治疗及随访工作中既要遵循临床决策的共同法则,又有其特殊之处。减少误诊漏诊、正确看待和应用各种临床指南和病情评价方法以及提高诊疗水平的关键,是应用临床决策学的方法进行综合分析、评价、再分析和再评价,并且要贯穿患者的终生。     

系统性红斑狼疮的临床决策

系统性红斑狼疮是临床上表现最复杂多变的疾病之一,其诊断、评价、患者教育、治疗及随访工作中既要遵循临床决策的共同法则,又有其特殊之处.减少误诊漏诊、正确看待和应用各种临床指南和病情评价方法以及提高诊疗水平的关键,是应用临床决策学的方法进行综合分析、评价、再分析和再评价,并且要贯穿患者的终生.     

系统性红斑狼疮的感染现状及治疗决策

系统性红斑狼疮是一种侵及全身结缔组织的自身免疫性疾病,疾病本身就可以导致免疫力下降从而导致感染的发生,然而与此同时,治疗狼疮的药物(糖皮质激素和免疫抑制剂)及新型治疗方法更加大了感染的风险,其间的矛盾不言而喻,因此治疗上药物的取舍与剂量大小的选择显得尤为重要.     

系统性红斑狼疮的感染现状及治疗决策

系统性红斑狼疮是一种侵及全身结缔组织的自身免疫性疾病,疾病本身就可以导致免疫力下降从而导致感染的发生,然而与此同时,治疗狼疮的药物(糖皮质激素和免疫抑制剂)及新型治疗方法更加大了感染的风险,其间的矛盾不言而喻,因此治疗上药物的取舍与剂量大小的选择显得尤为重要。     

糖皮质激素治疗系统性红斑狼疮中“度”的把握

系统性红斑狼疮是一种与遗传、免疫、种族、环境等因素有关的侵犯多系统结缔组织的全身性自身免疫性疾病。该病多器官受累,症状重且复杂,病情反复缓解和发作,故本病的治疗是一个长期的过程,需要终身治疗。糖皮质激素在系统性红斑狼疮的治疗中为最关键的药物,糖皮质激素的剂量、合理运用及“度”的掌握是治疗疾病成败的关键。     

糖皮质激素治疗系统性红斑狼疮中"度"的把握

系统性红斑狼疮是一种与遗传、免疫、种族、环境等因素有关的侵犯多系统结缔组织的全身性自身免疫性疾病.该病多器官受累,症状重且复杂,病情反复缓解和发作,故本病的治疗是一个长期的过程,需要终身治疗.糖皮质激素在系统性红斑狼疮的治疗中为最关键的药物,糖皮质激素的荆量、合理运用及"度"的掌握是治疗疾病成败的关键.     

从系统论的角度看系统性红斑狼疮分类标准的变迁

系统性红斑狼疮是一种复杂的自身免疫性疾病,本文试从系统论中的整体性、层次性、动态性、目的性原理来阐述SLE分类标准的变迁,揭示系统性思维对于正确把握SLE分类标准的重要性,临床诊疗决策中系统论的运用具有重要意义.     

系统性红斑狼疮病因病理与防治的思考

系统性红斑狼疮(SLE)是一种临床表现有多系统损害症状的慢性系统性自身免疫病。虽然对SLE的病因、病理的研究有了较大的进展,但SLE的治疗并不理想,目前仍然有约10%的患者在发病5年内死亡。从哲学角度对SLE的病因、病理与防治中存在的问题进行了综合分析,并为SLE的临床实践和进一步研究提供了思路。     

Systemic lupus erythematosus is associated with negatively variable impacts on domains of sleep disturbances: a systematic review and meta-analysis

Sleep disturbances are common in systemic lupus erythematosus (SLE), but the features of sleep disturbances are not well understood. The aim of this study was to identify the impact of SLE on specific sleep quality domains and to determine its prevalence and associations. We performed a systematic review and meta-analysis to compare the sleep outcomes of individuals with SLE and healthy controls. PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science CNKI, VIP, CNKI and Wanfang database were searched to find the published literatures (from these databases established to May 2017). Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using Revman5.3 software. Score of the Pittsburgh Sleep Quality Index (PSQI) scoring system was used as the outcome measurement, and mean differences (MD) with 95% confidence intervals (CI) were calculated. Five studies were included, including 350 SLE and 1396 healthy controls. A total of 5 studies including 827 patients were eligible for inclusion in the systematic review and meta-analysis. In this meta-analysis, each domain of the PSQI score: subjective sleep quality (MD, .58; 95% CI, .26, .89), sleep latency(MD, .47; 95% CI, .21, .73), sleep duration (MD, .36; 95% CI, .13, .58), habitual sleep efficiency (MD, .58; 95% CI, .32, .84),sleep disorders (MD, .56; 95% CI, .34, .77), use of sleep medication (MD, .56; 95% CI, .33, .80), daytime dysfunction (MD, .57; 95% CI, .11, 1.04) and the global score (MD, 3.59; 95% CI, 1.37, 5.80) were higher in SLE women than healthy controls. Furthermore, subjective sleep quality and habitual sleep efficiency were most severely affected especially. It demonstrated that targeted interventions should be done to improve their sleep quality. Early recognition and appropriate intervention are essential to reduce the negative impact of sleep disturbances on the patient’s sleep quality and outcome of their disease.     

Psychological Factors that Link Socioeconomic Status to Depression/Anxiety in Patients with Systemic Lupus Erythematosus

Our analyses examined whether reserve capacity factors would explain the relationship between socioeconomic status (SES) and symptoms of depression/anxiety in patients with systemic lupus erythematosus (SLE). We assessed disease activity, depression/anxiety symptoms, and intrapersonal and interpersonal reserve capacity measures in 128 patients with SLE. Multiple meditational analyses revealed that intrapersonal and interpersonal psychosocial aspects of reserve capacity fully mediated the relationship between SES and depression/anxiety. Lower SES was indirectly associated with higher symptoms of depression and anxiety through the effects of psychosocial resilience. Interventions aimed at improving modifiable reserve capacity variables, such as self-esteem and optimism, may improve anxious/depressive symptomatology in patients with SLE.     

Lupus Symptoms Inventory (LSI): Development and Validation of a Self-evaluation Inventory of the Subjective Symptoms of Systemic Lupus Erythematosus

The goal of this study was to develop a simple, easy, and quick self-report measure, the Lupus Symptom Inventory (LSI), designed to evaluate subjective symptoms of Systemic Lupus Erythematosus (SLE). The internal consistency of the LSI was tested, as well as its concordance with physician reports and serological indicators of disease activity by evaluating the self-reports of 46 patients with SLE who completed the LSI daily for a one-month period. Throughout this one-month period, parameters of serological activity and routine medical check-up were obtained. The results showed a high internal consistency of the LSI, with a Cronbach alpha of .86. Additionally, a contingency analysis showed agreement between medical report and patient self-report on the same day for six of seven lupus symptoms (difficulty breathing (p < .004), joint pain (p < .001), loss of appetite (p < .003), general malaise (p < .005), fatigue (p < .005), and skin rash (p < .018)) but not for abdominal symptoms. Finally, differences were found between LSI scores of patients with high versus low serological activity (χ²(1) = 5.302; p < .021), with the former presenting higher LSI scores than the latter. These results show that the LSI may be a reliable and valid instrument for evaluating the subjective symptoms of the disease as well as its fluctuations.     

卵巢肿瘤蒂扭转误诊、漏诊分析

回顾性分析了我院10年间17例卵巢肿瘤蒂扭转病例,并从患者年龄、临床表现、辅助检查、治疗情况等方面对误诊、漏诊的原因进行了分析。发生在青少年、儿童的卵巢肿瘤蒂扭转误诊率为52．9％,发生在绝经后妇女者误诊率为29．4％,最易误诊为急性阑尾炎,临床医生应予以高度重视。