Background Gait speed and grip strength are simple markers of physical capability, which are associated with adverse outcomes in the elderly. However, there are few studies on the prediction of adverse outcomes in this population by the combination of the two markers. Objective To investigate the associations of gait speed and grip strength with adverse outcomes in geriatric inpatients. Methods A cohort design was used in this study. From August 2015 to December 2018, eligible geriatric inpatients aged≥65 years were recruited from Department of Geriatrics, Fuxing Hospital, Capital Medical University. We measured the gait speed and grip strength with 6-meter walking test and dynamometer, respectively. By the gait speed, the patients were divided into tertiles (T1 group: ≤ 0.6 m/s, T2 group: >0.6-0.8 m/s, T3 group: >0.8 m/s). By the grip strength, they were divided into L1, L2 and L3 tertiles (L1 group: ≤ 21.6 kg for males, ≤ 14.6 kg for females; L2 group: > 21.6 kg but ≤ 28.2 kg for males, >14.6 kg but ≤ 19.4 kg for females; L3 group: >28.2 kg for males, >19.4 kg for females). Follow-up was conducted by telephone once every three months within one year after discharge and once half a year after this until December 31, 2019. All-cause mortality and falls were recorded. Survival curves were constructed by the Kaplan-Meier method. Cox regression analysis was used to investigate the association of gait speed, grip strength, or their combination with all-cause mortality and falls. ROC curves for comparing the ability of the two makers or their combination on predicting all-cause mortality and falls. Results Among the 685 patients, 29 (4.2%) were lost to follow-up, and the other 656 cases who finished the follow-up with complete data were included for analysis. During the follow-up period, 130 patients (19.8%) died from all causes and 147 patients (22.4%) experienced falls. There were 222, 225 and 209 patients in the low, moderate and high tertiles of gait speed (T1, T2 and T3 groups), and 215, 229 and 212 patients in the low, moderate and high tertiles of grip strength (L1, L2 and L3 groups), respectively. Log-rank test showed that the cumulative survival curves of all-cause mortality and falls differed significantly among T1, T2 and T3 groups (P<0.01). The same results were obtained in L1, L2 and L3 groups (P≤0.01). Cox regression analysis with adjustment for potential confounders showed that compared to patients in high tertiles of both gait speed and grip strength, the risk of all-cause mortality significantly increased in those both in low gait speed and low or moderate tertiles grip strength〔HR=3.29, 95%CI (1.13, 9.55) ; HR=3.09, 95%CI (1.08, 8.85) ; P<0.05〕, and the risk of fall significantly increased in those in low tertiles of both gait speed and grip strength 〔HR=1.92, 95%CI (1.13, 4.27), P<0.05〕. The prediction probability of the joint diagnostic model of gait speed and grip strength was estimated by Logistic regression analysis, and the AUC of the combination of them for predicting all-cause mortality and falls was 0.756 〔95%CI (0.710, 0.801) 〕, and 0.700〔95%CI (0.659, 0.741) 〕, respectively. Conclusion In geriatric inpatients, the combination of gait speed and grip strength had higher predictive value for all-cause mortality and falls, which is helpful to optimize the health management.

目的 探讨老年原发性骨质疏松症患者衰弱状态与再入院、死亡的关系.方法 采取前瞻性队列研究,纳入2017年1月至2019年12月首都医科大学附属复兴医院综合科住院的骨质疏松症患者227例(≥65岁).入院后根据临床衰弱量表(CFS-09)确定是否衰弱,将老年性骨质疏松症患者分为2组:衰弱组121例(CFS≥5)和非衰弱组106例(CFS<5).收集患者性别、年龄、病史及口服药种类等一般资料,进行认知功能、营养风险等老年综合评估.出院后随访1～3(1.8±0.7)年,记录患者再入院及死亡信息.采用SPSS 23.0软件进行数据分析.根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ2检验.采用Cox回归分析衰弱状态与再入院、死亡的关系.结果 患者年龄为67～100(85.1±5.0)岁,衰弱患者121例(53.3％).衰弱组中年龄(P<0.001)、查尔森共病指数(P<0.001)、口服药种类(P=0.004)、服用潜在不适当用药(PIM)的人数(P=0.004)和种类(P=0.001)、存在营养风险人数(P<0.001)、认知功能障碍(P<0.001)、日常生活能力受损(P<0.001)均高于非衰弱组.Cox回归分析结果显示,在校正年龄、共病及潜在不适当用药(PIM)因素后,衰弱状态(CFS≥5)对死亡、再入院无明显影响.将衰弱分组进一步限制为中度以上,其中衰弱组64例(CFS≥6)和轻度衰弱及非衰弱组163例(CFS<6),校正年龄、共病及PIM因素后,中度以上衰弱(CFS≥6)明显增加全因死亡(HR=3.260,95％CI 1.626～6.538,P=0.001)和再入院(HR=1.727,95％CI 1.213～2.458,P=0.002)的风险.结论 以CFS-09确定的中度以上衰弱(CFS≥6)增加老年原发性骨质疏松患者死亡、再入院风险.临床医师应重视骨质疏松患者衰弱评估,尽早采取干预措施,减少患者死亡和再入院的风险.

目的 探讨非急性冠状动脉综合征(ACS)、无急慢性心力衰竭的老年住院患者高敏肌钙蛋白T(hs-cTnT)和N末端B型钠尿肽前体(NT-proBNP)与衰弱的关系.方法 入选住院患者772例,根据Fried表型衰弱量表评估为无衰弱组309例、衰弱前期组199例,衰弱组264例.检测各组hs-cTnT及NT-proBNP水平.结果 与无衰弱组比较,衰弱前期组和衰弱组血红蛋白、白蛋白水平明显降低,hs-cTnT及NT-proBNP水平明显升高,衰弱组左心室舒张末期内径(LVEDD)和LVEF明显降低(P＜0.05,P＜0.01).衰弱组血红蛋白、白蛋白、LVEDD及LVEF明显低于衰弱前期组,hs-cTnT、NT-proBNP水平明显高于衰弱前期组(P＜0.01).校正合并慢性疾病后logistic回归分析显示,hs-cTnT、NT-proBNP对数转换(lgNT-proBNP)为衰弱前期和衰弱的独立危险因素(P＜0.05,P＜0.01),校正实验室及超声心动图检查指标等混杂因素后,hs-cTnT仍为衰弱前期和衰弱的独立危险因素(P＜0.01),而lgNT-proBNP与衰弱及衰弱前期无相关性(P＞0.05).hs-cTnT预测衰弱的ROC曲线下面积(AUC)为0.676 (95 ％CI:0.636～0.717),NT-proBNP预测衰弱的AUC为0.669(95％CI:0.629～0.708),hs-cTnT预测衰弱的AUC稍高于NT-proBNP(P＞0.05).结论 无ACS及无急慢性心力衰竭的老年住院衰弱患者hs-cTnT和NT-proBNP水平高,hs-cTnT与衰弱、衰弱前期独立相关,hs-cTnT预测衰弱的AUC稍高于NT-proBNP.

目的 探讨握力与住院老年高血压病人全因死亡的关系. 方法 采用前瞻性队列研究方法,入选≥65岁住院高血压病人,记录病人基本资料、生化指标、血压、共病及多重用药情况,分别采用Katz日常生活能力量表(Katz-ADL)、MMSE、微营养评定法简表(MNA-SF)评估病人的日常生活活动能力、认知状况及营养状态,采用电子读表式握力计测量握力(kg),出院随访1年以上并记录病人全因死亡的发生情况.采用Spearman相关系数分析握力与不同性别病人各变量之间的相关性,Kaplan-Meier曲线和Cox回归模型分析握力与全因死亡风险的相关性. 结果 共入选病人572例,平均年龄(84.02±5.98)岁,其中男性336例(58.7％);中位随访时间为3.17(2.50,3.75)年,随访期间共111例(19.4％)发生全因死亡.Spearman相关分析显示,在不同性别病人中,握力与年龄、Charlson共病指数呈负相关,与Hb水平及Katz-ADL、MMSE、MNA-SF评分呈正相关(P<0.05).将握力进行四分位数分组,Kaplan-Meier曲线显示,随着握力下降,死亡风险逐渐升高(log-rank:P<0.001);Cox回归模型显示,调整混杂因素后,在男性病人中,最低握力组比最高握力组全因死亡风险显著增高(HR=2.484,95％CI:1.200～5.140,P=0.014),而在女性病人中未见明显相关性. 结论 在住院老年男性高血压病人中,低握力与出院后全因死亡风险相关,握力可作为一项简便易行的健康结局预测指标.

Since China has entered into an aging society, the health of the elderly is becoming a pivotal issue.Aging is associated with a loss of muscle mass and strength, resulting functional decline.As simple and useful tools for evaluating muscle strength and physical performance, gait speed and grip strength have been increasingly valued by clinicians.Some studies have shown that they are important predictors of adverse outcomes in the elderly, such as disability, falls, all-cause death and cardiovascular disease.However, there is no general agreement on their cut-off values.Exploring the relationship between parameters and adverse health outcomes will help achieve optimal management of elderly health.

目的 探讨步速与住院老年高血压患者全因死亡的相关性.方法 选择2015年6月至2017年12月在首都医科大学附属复兴医院综合科住院的年龄≥65岁的高血压患者515例,记录患者基本资料、共病及多重用药情况,采用6m步行试验计算步速,并评估患者日常生活能力、认知状况及营养状态,出院随访2年以上并记录患者全因死亡的发生情况,分析步速与全因死亡的相关性.结果 共入选患者515例,平均年龄(84.1±5.9)岁,其中男299例(58.1％),中位随访3.3(2.7,3.9)年,随访期间共106例(20.6％)发生全因死亡.Spearman相关分析显示,步速与年龄、Charlson共病指数、多重用药呈负相关,与24 h舒张压水平、微营养评定法简表、简易智能评估量表及Katz日常生活能力量表评分呈正相关(P<0.05).将步速进行三分位数分组,Kaplan-Meier曲线显示随着步速下降,全因死亡风险逐渐升高(log-rank:P<0.001),Cox回归模型结果 显示,在调整混杂因素后,与最高步速组相比,最低步速组全因死亡风险更高(HR=2.325,95％CI:1.113～4.855,P=0.025).结论 在住院老年高血压患者中,低步速与出院后全因死亡风险相关,步速可作为一项简便易行的死亡预测指标.

诊断学是连接基础与临床医学的桥梁课程,是学习掌握临床医学各学科的基础,对医学生临床思维、实践技能的培养起至关重要的作用.文章结合近年来的国内文献在诊断学中开展混合式教学的情况进行总结和分析,以期为医学教学改革提供参考.

目的 探讨步速与住院高龄老年患者全因死亡的相关性.方法 选择2015年6月至2017年12月在首都医科大学附属复兴医院综合科住院且年龄≥80岁的患者510例,记录患者基本资料、共病及多重用药情况,采用Katz日常生活能力量表(Katz-ADL)、简易智能评估量表(MMSE)、微型营养评定法简表(MNA-SF)、抑郁自评量表(SDS)评估日常生活活动能力、认知状况、营养状态及抑郁状况,采用6米步行试验计算步速,出院随访2年以上并记录患者全因死亡的发生情况.采用SPSS 21.0统计软件进行分析.Spearman相关系数分析步速与各变量之间的相关性,Kaplan-Meier曲线和Cox回归模型分析步速与全因死亡风险的相关性.结果 共入选患者499例,年龄(86.3±4.1)岁,其中男性298例(59.7％),中位随访3.3(2.7,3.9)年,随访期间共118例(23.6％)发生全因死亡.Spearman相关分析显示,步速与年龄、Charlson共病指数呈负相关(r=-0.352、-0.196、-0.124,P<0.05),与Katz-ADL、MMSE及MNA-SF评分呈正相关(r=0.430、0.291、0.273,P<0.05).将步速三分位数分组,Kaplan-Meier曲线显示随着步速下降,全因死亡风险逐渐升高(P<0.001);Cox回归模型结果显示,在调整混杂因素后,与最高步速组相比,其他2组全因死亡风险更高(中等步速组:HR=2.365,95％CI 1.231～4.541,P=0.010;最低步速组:HR=2.363,95％CI 1.215～4.591,P=0.011).结论 住院高龄老年患者中,低步速与出院后全因死亡风险相关,步速可作为一项简便易行的死亡预测指标.

目的:探讨磁共振灌注成像(PWI)在颞叶癫痫的定位诊断中的意义.方法:选取颞叶癫痫患者16例,在惯常癫痫发作后12 h内及发作24 h后间歇期分别进行PWI检查,测定对应脑区部位脑组织的相对脑血流量(rCBF).结果:发作后12 h内致痫侧颞前叶rCBF高于对侧13例(81.25％),低于对侧3例(18.75％),差异有统计学意义(P<0.05).进行发作间歇期PWI扫描9例,发作间歇两侧rCBF比较,差异无统计学意义(P>0.05).结论:本研究结果提示PWI技术中rCBF对颞叶癫痫的定位诊断有一定临床指导意义.

中毒性表皮坏死松解症( toxic epidermal necrolysis, TEN)是一种少见的严重皮肤黏膜反应,最常由药物引发,其临床特征为水疱、表皮剥脱和多部位黏膜炎,可伴系统功能紊乱.TEN起病急、进展迅速,死亡率高达30％[1].现将首都医科大学附属复兴医院综合科收治的1例高龄TEN患者的临床资料报道如下,并进行文献复习.

Objective To explore the relationship between benign prostatic hyperplasia(BPH) and carotid artery disease,hypertension and cerebral infarction.Methods 141 elderly BPH patients with 103 prostatic volume(PV) ≤50 ml and 38 PV > 50 ml were selected.All patients' PV and extracranial carotid artery were calculated by colour Doppler ultrasound examination.Results The maximum of intimal medial thickness of carotid artery in PV > 50 ml group was significantly higher than PV≤50 ml group(P < 0.05).Multivariable analysis showed that therosclerosis,hypertension and cerebral infarction were independent factors associated with BPH respectively(P < 0.05).Conclusion Carotid therosclerosis,hypertension and cerebral infarction were associated with BPH.

Objective To investigate the relationship between peripheral arterial disease and urinary albumin to creatinine ratio(UACR) in elderly type 2 diabetes inpatients.Methods A total of 230 diabetes inpatients were included in this study.The ABI,UACR,serum creatinine,lipids profile,hemoglobin A1c(HbA1c) and other indexes were measured.Results In 230 elderly inpatients,the prevalence of urinary albumin was 48.7%(112 /230)and the prevalence of abnormal ABI was 29.6%(68 /230).Prevalence of abnormal ABI was 50.0%,37.8%,19.5% in the clinical,micro- and normal albuminuria.Prevalence of urinary protein was 48.5%,21.6% in patients with ABI≤0.95,0.95 < ABI ≤1.4.ABI showed a negative correlation with UACR(r =- 0.263,P < 0.001).Logistic regression analysis showed that OR(95% CI) for PAD was 3.082(1.783-6.172) with UACR.In models adjusted for age,sex,duration of diabetes,HbA1c and other traditional cardiovascular risk factors,OR(95% CI) for PAD was 2.135(0.962-4.758) with UACR.Conclusion The elderly type 2 diabetes inpatients with peripheral arterial disease usually have a high prevalence of diabetic kidney disease.PAD was associated with UACR.

Objective: To investigate the effect of the therapy of promoting blood circulation on elderly cancer patients with lower limb vein thrombosis.Methods: Forty-two patients were divided into two groups.Twenty patients in the control group were treated with routine treatment and twenty-two patients in the treatment group were treated with both routine treatment and therapy of promoting blood circulation(Yinxingdamo injection 20ml added into 250ml 0.9% saline for intravenous infusion,once daily).Results: The overall response rate of the treatment group is 81.82%,while the control group 70.00%.The changes of calf perimeter and D-Di contents of the treatment group are significantly better than control group.The prothrombin time and platelets contents have no significant change.Conclusions:The therapy of promoting blood circulation has positive effect on elderly cancer patients with lower limb vein thrombosis and is worthy of further study.

随着糖尿病患病人数的增加,作为糖尿病的严重并发症--糖尿病肾病(diabetic kidney disease,DKD)已成为世界范围内终末期肾病(end-stage renal disease,ESRD)的最主要原因.肥胖尤其是中心性肥胖所导致的一系列代谢异常包括胰岛素抵抗(insulin resistance,IR)、高胰岛素血症、脂代谢异常及血流动力学改变等均可引起肾脏功能及形态学的改变,促发和加速蛋白尿及肾小球硬化的发生[1].

欧州心脏调查和中国心脏调查等大型流行病调查发现2/3的冠心病(CHD)患者合并糖代谢异常,表明糖尿病与冠心病关系密切[1-2].本文对合并糖尿病的冠心病患者的冠脉病变特点及其血脂水平的改变和高血压、吸烟、肥胖等危险因素进行了讨论,现将结果报道如下.

冠心病是一种多危险因素所致的慢性疾病,目前公认的冠心病危险因素有高血压、脂质代谢紊乱、吸烟、年龄、糖代谢紊乱等,而各危险因素与冠脉狭窄程度的关系研究,国内外的报道不一.

Objective To evaluate the effects of two different short-term intensive therapies on β-cell function in newly diagnosed type 2 diabetic patients.Methods Twenty newly diagnosed type 2 diabetic patients were divided into two groups of 10 patients each and randomly treated with glargine or glimepiride plus metformin for 4 weeks.The improvement of β-cell function,FPG,PPG,HbA1c were measured before and after intensive therapy in each group.The difference in the improvement of β-cell function,blood glucose and the frequency of hypoglycemia were compared between groups.Results After the treatment,FPG(12.25 vs.6.05 and 11.83 vs.6.35mmol/L),2hPG(18.67 vs.8.11 and 16.95 vs.8.73mmol/L),HbA1c(8.98% vs.7.38% and 9.17% vs.7.71%) were significantly decreased(all P<0.001) in each group.The mean insulin concentrations at each point during IVGTT were increased(P<0.05),while the fasting insulin concentration remained unchanged.The area under the curve of insulin(59.66 vs.122.63 P<0.01 and 59.25 vs.104.11μU/(ml·min) P<0.01) and c-peptide(21.70 vs.29.90 P<0.01 and 21.04 vs.30.94ng/(ml·min) P<0.05),first-phase insulin secretion(-1.46 vs.49.07 and-0.65 vs.35.10μU/(ml·min),all P<0.05) and Homeostasis model assessment of beta-cell function(14.34 vs.58.82 and 14.69 vs.60.58,P<0.01) were increased in each group.The time of achieved optimal glycemic control was shorter in glargine group[(15.50±4.09)vs.(21.42±4.68)day P<0.01].Conclusions Short-term intensive therapy with glargine or glimepiride plus metformin could effectively improve glycemic control and β-cell function,especially the first-phase insulin secretion in newly diagnosed type 2 diabetic patients with hyperglycemia,and the time of achieved optimal glycemic control was shorter in glargine group.Both were simple and convenient approaches easy to carry out at the beginning of treatment.