目的 探讨跟骨定量超声测量(QUS)对筛查社区绝经期妇女骨质疏松症的临床价值.方法 选取在上海市社区健康体检的500名绝经期妇女作为研究对象,根据年龄将500例妇女分为三组,年龄≤59岁组,年龄60~69岁组,年龄≥70岁组,对所有入选对象同时进行双能X线吸收仪(DXA)和QUS骨密度检测,以DXA诊断结果为金标准,分析QUS对绝经期妇女骨质疏松症的诊断价值.结果 经DXA测量结果显示,500名绝经期妇女中,诊断为骨质疏松症89例,不同年龄组之间骨密度存在明显差异,随着年龄的增长,骨质疏松症所占比例明显升高,差异有统计学中意义(P<0.05);经QUS测量结果显示,500位绝经期妇女中,诊断为骨质疏松症71例,且不同年龄组绝经期妇女之间骨密度存在明显差异,随着年龄的增长,骨质疏松症所占比例明显升高,差异有统计学意义(P<0.05);以DXA诊断结果为金标准,DXA共确诊89例骨质疏松,QUS正确诊断骨质疏松69例,诊断特异度为99.51%,灵敏度为77.53%,阳性预测值为97.18%,阴性预测值为95.34%,误诊率为0.47%,漏诊率为22.47%,诊断符合率为95.60%.结论 QUS筛查社区绝经期妇女骨质疏松症具有较好的特异度及灵敏度,并具有较高的诊断符合率,可以作为社区绝经期妇女骨质疏松筛查工具.

目的 探讨定量超声检测在社区骨质疏松筛查中的临床应用价值.方法 对357例研究对象分别行右侧跟骨定量超声检测(QUS)和双能X线吸收法(DXA)测量腰椎及髋部骨密度、t值,应用Spearman相关性分析,了解QUS的诊断价值.以DXA法为诊断骨质疏松症金标准,分析QUS诊断ROC曲线,确定最佳阈值,判定灵敏度、特异度,评估诊断效能.结果 入组对象骨量减少227例(63.6％),骨质疏松112例(31.4％);QUS-T和DXA-T呈正相关.QUS-T与DXA-T腰椎、髋部的相关性系数男性分别为0.092、0.234,女性为0.308、0.218.QUS检测骨量减少的ROC曲线面积为0.716,最佳界值为-2.325,敏感度为0.90,特异性为0.50,尤登指数为0.400.骨质疏松的ROC曲线线下面积为0.687,最佳界值为-2.48,敏感度为0.870,特异性为0.420,尤登指数为0.290.结论 QUS检测虽不能用于骨质疏松的诊断,但可作为社区筛查骨质疏松的有效工具,根据筛查结果适时用DXA确诊,有益于家庭医生早期开展干预和防治工作.

目的 了解近5年上海市徐汇区徐家汇社区卫生服务中心全科门诊疾病谱变化,为有针对性地提升全科服务能力,开展社区全科医疗提供参考.方法 对2010-2014年全科门诊数据进行回顾性分析,按国际疾病分类ICD-10统计疾病谱顺位.结果 2010-2014年全科门诊平均门诊量50.36万人次/年,门诊量逐年上升,男女比例稳定.疾病系统顺位前三位为循环系统、呼吸系统和内分泌代谢系统.就诊的主要病种为高血压、糖尿病、冠心病、上呼吸道感染和支气管炎,其中高血压5年均居第一,占前五位主要疾病的19.31％.结论 社区卫生服务机构需根据本社区全科门诊疾病谱的特点及其变化,就诊人群特点,开展有针对性的全科医生临床能力培养,及时调整服务功能,提高社区卫生服务质量.

Objective: To investigate the distribution characteristics of the bone mass of the elderly people in the community and their prevalence of osteoporosis and to analyze their related factors. Methods: The data of age, weight, height and the determination result of the quantitative ultrasonic bone density were collected from the elderly people over 60 years old in a community and statistically analyzed after grouping them according to the gender, age and BMI. Results: The bone mass distribution of the men and women in all age groups had the statistically significant differences (P<0.01). The incidence of osteoporosis in the women was higher. The age and bone mass distribution had the negative correlation. The greater the age, the less bone mass and the higher the incidence of osteoporosis. The comparison of the index of the bone mass distribution (BMI) between groups had an obviously statistical difference (P<0.01). The index of the female BMI and osteoporosis occurrence had a weak positive correlation (r=0.315, P<0.01). Conclusion: The community elderly women are the high incidence population of osteoporosis. The determination of the quantitative ultrasonic bone density is the first choice for the osteoporosis screening in the community.

目的 分析徐家汇街道社区老年人骨质疏松症的相关因素,为制定社区老年人骨质疏松症防治对策提供依据.方法 社区卫生服务中心与上海市第六人民医院骨质疏松症科合作,应用双能X线骨密度仪对参加本中心65岁以上老年人健康体检的342名老年人进行骨密度测定,按骨密度测定值分为正常对照组和骨量减少及骨质疏松症组,采用Logistic回归分析影响骨密度的相关因素.结果 在调查的342名老年人中,骨密度正常者占26.3％,骨量减少及骨质疏松症者占73.7％,女性骨质疏松症患病率显著高于男性,差异有统计学意义(P＜0.01).多因素Logistic回归分析显示,年龄、性别、曾因轻微碰撞或跌倒伤到骨骼、身高较年轻时降低＞3 cm、经常腹泻和45岁前绝经者为骨质疏松症的主要影响因素.结论 女性、高龄、曾因轻微碰撞或跌倒伤到骨骼、身高较年轻时降低＞3cm、经常腹泻和45岁前绝经者是该社区老年人骨质疏松症患病的高危因素,提示应加强有该方面因素老年人骨质疏松症的防治工作.

Objective To evaluate the clinical efficacy of ginger partition moxibustion on special points for the treatment of chronic gastritis.Methods Ninety cases were randomized into two groups: treatment group in which 45 cases were treated by ginger partition moxibustion on Zhongwan(RN12),Tianshu(ST25) and Zusanli(ST36) points,and control group in which 45 cases were treated by Rabeprazole and Weifuchun Tablet,with the course of 3 months.The clinical efficacy,clinical symptom scores,working time and recurrence were observed in the following 6 months.Results The overall effective rate was 95.6%in the treatment group and 84.4% in the control group,with a difference between the two groups(P0.05).The stomachache,abdominal destention and fullness,anorexia,acid regurgitation and loose stool were alleviated remarkably in treatment group,with significant differences between before and after treatment(P0.05,P0.01),there were significant differences in scores of stomachache,abdominal destention and fullness in control group(P0.05);after treatment,the anorexia,acid regurgitation and loose stool in treatment group were statistically different from controls(P0.05).There were significant differences in average working time and recurrence between the two groups(P0.05).Conclusion Ginger partition moxibustion on special points has positive effect on chronic gastritis,with rapid action and low recurrence rate.

Objective: To demonstrate the phenomena and reasons of the improper usage of antibiotics at the general practitioner out-patient clinics of the community health service centre and explore the measures to improve the proper usage of antibiotics. Method: Randomly 3 120 antibiotics prescriptions at the general practitioner out-patient clinics were chosen from Jul. 2011 to Jan. 2012 in our community health service center and the amount of the improper prescriptions and items were summarized so as to analyze and find out the improvement measures. Result: 136 improper prescriptions from the overall antibiotics prescriptions were found, which accounted for 4.36%. From the improper ones, the dominant reasons were "inconsistency of diagnosis and medication " and "improper usage and dosage" , which took 39.71% and 36.03% respectively. Conclusion: Based on the analysis of the reasons of improper antibiotic usage, we found it was caused by both doctors and patients. We need to explore the improvement measures to prevent the abuse of antibiotics based on the characteristics of the community general practitioner.